PART III

CONTRIBUTIONS FROM THE JOURNAL: PROPRIETARY PRODUCTS

NOSTRUMS IN RETROSPECT

A Series of Nine Articles Reviewing Worthless or Unscientific Proprietary Mixtures Previously Criticized

S. Q. Lapius, M.D.

[FOREWORD.--It is more than twelve years since the Council on Pharmacy and Chemistry of the American Medical Association was created. Since then there have been but few issues of The Journal that have not called the attention of the medical profession to the debasing influence on scientific medicine of unscientific or worthless proprietary mixtures advertised to physicians for their use in prescribing. The Council on Pharmacy and Chemistry has investigated and shown many of these preparations to be fraudulent in one way or another, and these reports have been published in The Journal. In spite of this, these preparations have been advertised continuously to physicians, through medical journals and otherwise, and prescribed by a large number of physicians. One reason for this is that there are many physicians who have never seen these reports--who were not in active practice at the time, or who were not reading The Journal. We probably have among our readers at the present time 35,000 or 40,000 physicians who were not among the readers of The Journal twelve years ago. It is desirable, then, that we should take up, in more or less detail, several of the more widely advertised products that have been the subjects of previous reports. It has been repeatedly stated in The Journal that many of the proprietary mixtures--the so-called ethical proprietaries advertised to physicians--were no better and no worse than “patent medicines” advertised to the public.

Every physician who has the welfare of medicine at heart should put these questions squarely to himself if he has not already taken a firm stand on this whole problem: What is my attitude toward the work of the Council? Are its reports worthy of acceptance? Am I upholding the Council in its efforts to place therapeutics on a rational basis, not by blind faith alone, but by an honestly critical attitude toward it? Am I following the path of indolence by taking the advice of nostrum makers without any serious effort to determine whether they are true or false? In a word, am I really practicing medicine, or am I an unpaid agent and a dupe of nostrum makers? There are other revolutions than political. The public can be wronged just as certainly by the abuse of its confidence in clinicians as by the usurpers of political power, and when the public is thoroughly aroused the heavy hand of retribution is not likely to be too discriminating. That the sins of clinicians are standing out plain for any one who wishes to read is becoming more and more evident. There is but one short and ugly word that properly characterizes the physician who accepts a fee for prescribing that about which he has no more knowledge than has the one for whom he prescribes it. Are you with the nostrum makers or with decent medicine?

The article below is the first of a series written for The Journal by one who is thoroughly conversant with the work of the Council on Pharmacy and Chemistry and can speak authoritatively on questions dealing with the action of drugs and the treatment of diseases. We believe that these articles will prove of interest and profit and that they will help physicians to answer the questions just propounded.]

[ARTICLE I]

Bell-Ans (Pa-Pay-Ans Bell)[H]

[H] See also ????.{sic}

Bell-ans, for years advertised only in medical journals under the name “Pa-pay-ans (Bell),” is now advertised in newspapers as a remedy that “Absolutely Removes Indigestion.” As it is still being advertised to physicians, we propose to analyze the claims made for it with as much care as would be exercised in the discussion of the newest discovery in medicine, because we believe that it is desirable to show the trend of exploitation of a certain type of preparation in the medical press.

In the _New York Medical Journal_ the following advertisement recently appeared on the front cover:

A recently purchased package of Bell-ans contained a circular in which it was stated that Bell-ans removes flatulence, vertigo, weakness and other symptoms of indigestion quickly and pleasantly; that it aids the digestion of food and tends to restore the digestive tract to a normal condition; that it relieves vomiting in pregnancy, alcoholism, seasickness and cholera morbus, besides being pleasant, harmless and effective for colic, sour stomach, feverishness, and wakefulness of infants and children. The circular contained paragraphs purporting to be taken from various medical journals, including the _New York Medical Journal_, _Wisconsin Medical Recorder_, the _Lancet Clinic_, _International Journal of Surgery_, and _Massachusetts Medical Journal_. No exact references were given to permit verification or to determine whether or not the quotations were from “reading notices” (advertisements) or from the scientific part of the journals in question. To quote one of the statements given:

“The results from the use of Bell-ans (Pa-Pay-ans Bell) in the treatment of indigestion are so prompt and so generally good--and the evidence of this fact is accumulating so rapidly and from such reliable sources--that we venture to suggest to our readers who have not tried this remedy that they prescribe one original sealed package of Bell-ans (Pa-pay-ans Bell) and that they carefully note the results from its use.

“We suggest an original sealed package because the preparation is widely and badly imitated, and unless such a package is specified an imitation of little value may be substituted and the experiment be thus rendered useless.”

It is possible that Bell-ans has been imitated, but it is not true that it is widely imitated, for no such imitation has ever been called to our attention, and we strongly suspect that the main reason for desiring that an original package be dispensed is that the patient may see for himself the name BELL-ANS plainly blown in the glass.

The circular in question states that there is no derangement of the digestive organs on which the proper dose of Bell-ans will not act quickly and pleasantly! These are samples of the claims made for Bell-ans. Let us inquire into the nature of the conditions for which the preparation is recommended and the treatment advised by well known clinicians.

The subject of indigestion is discussed by Robert Hutchison and Robert Saundby under the general title of dyspepsia in the “Index of Treatment by Various Writers,” Edition 6, 1912, pp. 260-265. Hutchison says: “In the first place it must be remembered that in many patients who complain of ‘indigestion’ the seat of the trouble is not in the stomach at all.”

The general principles to be observed in the treatment of functional dyspepsia, as given by Hutchison, are: (1) to remove the cause; (2) to adapt the diet to the impaired functional power of the stomach; (3) to administer such drugs as are calculated to stimulate or correct the particular function or functions which happen to be impaired, or disordered. Proper diet, proper mastication of food, hygiene of the mouth, and constipation are enumerated as deserving attention. Careful attention to securing a proper diet is essential. The choice of drugs depends, of course, on the conditions that give rise to indigestion, and he calls attention to the necessity of avoiding all routine treatment and compiling one’s prescription with an eye to the special disorder or disorders of function, whether secretory, motor or sensory, believed to be present. Hutchison gives the following typical prescriptions to illustrate the use of drugs in the different disorders of function:

FOR HYPERSECRETION (HYPERCHLORHYDRIA, ACID DYSPEPSIA, ETC.)

Sodium bromid 10 grains Bismuth subcarbonate 15 grains Chloroform water 1/2 ounce

This mixture to be taken before meals. Sodium bicarbonate. Bismuth subcarbonate. Heavy magnesium carbonate, of each equal parts. A small teaspoonful of the powder to be taken mixed with a little water or milk about two hours after meals.

FOR DEFICIENT SECRETION (HYPOCHYLIA, ACHYLIA, GASTRITIS, ETC.)

Sodium bicarbonate 10 grains Tincture of nux vomica 10 minims Spirit of chloroform 8 minims Compound infusion of gentian 1/2 ounce

This mixture to be taken before meals.

Dilute hydrochloric acid and glycerin, of each 15 minims with enough water to make half an ounce, to be taken about twenty minutes after meals.

FOR DEFECTIVE MOTILITY (ATONIC DYSPEPSIA, GASTROPTOSIS, ETC.)

Hutchison recommends the use of 10 minims of tincture of nux vomica in an aromatic vehicle, such as infusion of quassia and compound tincture of cardamom; but another aromatic bitter, such as the compound tincture of gentian, will serve quite as well, of course. This is to be taken before each meal, and for the flatulence that often accompanies this trouble he gives menthol, aromatic spirit of ammonia and spirit of chloroform, as may be needed.

FOR ACID DYSPEPSIA

Robert Saundby recommends the following to be used before each meal for the relief of acid dyspepsia: sodium bicarbonate, bismuth subcarbonate, magnesium carbonate, of each 10 grains; mucilage of tragacanth 15 minims, and enough peppermint water to make an ounce.

These are only a few of the conditions that are discussed by Hutchison and Saundby, but they serve to show that the treatment of indigestion by a single prescription or combination is wholly irrational.

Bell-ans, both under its present name and under its older name, “Pa-pay-ans (Bell),” has always been alleged by its manufacturers to contain papain or to be a preparation of the digestive juice from the fruit of _Carica papaya_ (papaw) with other substances. Various chemists have attempted to find papain present and to determine the digestive power of the tablets, but without success. For this reason The Journal suggested that the change of name from “Pa-pay-ans (Bell)” to “Bell-ans” was probably not made entirely for euphonious reasons, as alleged, especially when one considers that the name of a nostrum is its most valuable asset. It is much more likely that as analyses indicated there was not and probably never had been any papain present in the product, the name was changed for fear that some day the misleading term “Pa-pay-ans” might bring the preparation in conflict with the federal Food and Drugs Act.

Pa-pay-ans (Bell) was examined for the Council on Pharmacy and Chemistry in 1909 and the tablets were found to consist of charcoal, sodium bicarbonate, ginger, saccharin and oil of gaultheria. No digestive ferment could be detected in the tablets. Sodium bicarbonate is antacid and serves to dissolve mucus; ginger, if in sufficient amount, causes the expulsion of flatus, and charcoal, while an absorbent in the dry state, is probably useless for any therapeutic purpose whatever after it becomes saturated with gastric juice. Bell-ans, then, has all of the virtues, which are few, and all of the limitations, which are many, of a tablet of sodium bicarbonate and ginger. Its value in the treatment of acute indigestion would be limited to the value of a tablet of such a composition. It is absurd to suppose that it could have the slightest value in the far more serious conditions attended with intestinal indigestion, with the toxemia and autointoxication to which they give rise.

Bell-ans is now advertised directly to the public--but it is no less valuable on that account. True, it is a “patent medicine” in the commonly accepted sense of the term, but it is no more a “patent medicine” today than it was fifteen years ago when it reached the public, not through the direct medium of the newspapers but the more indirect route of the medical journals and undiscriminating physicians. It is true that, in view of the serious nature of many conditions which are loosely spoken of by the public as “indigestion,” its present method of exploitation is likely to make it just that much more dangerous because of the larger publicity that will be given. The point to be borne in mind is that Bell-ans is now in fact what it has always been in essence, a “patent medicine.”

Again we ask the question: How do you wish to be classified, Doctor--among those who follow blindly the lead of a firm of nostrum makers, or among the intelligent members of the profession who study their cases carefully and prescribe intelligently? The manufacturers of Bell-ans claim that 100,000 American physicians now prescribe Bell-ans, and that 600,000,000 of the tablets are sold annually. If this is even approximately true it is a serious reflection on the medical profession, for the Council examined Bell-ans and reported its findings nearly eight years ago (_J. A. M. A._ =53=:569 [Aug. 14] 1909), and the statements made in that report are as incontrovertible today as they were then.--(_From The Journal A. M. A., Nov. 24, 1917._)

[ARTICLE II]

Anasarcin and Anedemin

“Anasarcin” and “Anedemin” are the twin nostrums of cardiac pseudotherapy. They are dubbed “twin nostrums” not so much because of any similarity in their formulas, that being a minor consideration in the average nostrum, but because of the close similarity in their methods of exploitation, the therapeutic claims made for them, and the time and place of their birth.

It may be remembered that they both claim Winchester, Tenn., as their birthplace, and they appeared on the market at about the same time; furthermore, a comparison of the claims formerly made for both of them indicated that one mind conceived the main idea that lies back of their exploitation. While Anasarcin is especially dealt with in this article, much of the discussion applies with equal force to Anedemin.

A LUSH FIELD FOR NOSTRUMS

Cardiac disease, with its resultant renal involvement, is frequently encountered; and running, as it does, a chronic course, it offers an almost ideal field of exploitation for the typical nostrum vender. By a typical nostrum vender we mean one whose knowledge of his product is far below that of his appreciation of a certain element of human character. On this element rests the whole secret of the nostrum vender’s success. It is variously termed credulity, gullibility and childlike simplicity, but it is that which often causes even the most conscientious clinician to turn aside from the use of the best known and most dependable drugs at his command, in the face of disappointment and failure, and employ some vaunted mixture which, in his saner moments, he scorns to use.

Anedemin is said to consist of a “Scientific Combination of three of the more recently investigated members of the Digitalis Series, with Sambucus”; that is, of apocynum, strophanthus and squill with elder. It is difficult to know just what idea the statement that it is a “scientific combination” of these drugs is intended to convey, for it is unscientific to mix three drugs of this group for use in fixed proportion in a wide range of conditions, if indeed, there is ever any indication for their use.

The great disadvantages of strophanthus and apocynum pertain to the extreme uncertainty of their absorption from the gastro-intestinal tract. Strophanthus is occasionally absorbed promptly, sometimes so slowly that the therapeutic effects are not induced until an amount equal to several times that which would prove fatal if all of it were absorbed into the circulation has been administered, and, unfortunately, one cannot control the absorption which may continue until a fatal effect is induced. This is true to an even greater degree of apocynum, and it was due to the recognition of this fact that apocynum was not admitted to the U. S. Pharmacopeia IX, the committee on dosage having agreed that no safe and effective dose could be given.

THE COUNCIL’S PREVIOUS FINDINGS

In 1907 the Council on Pharmacy and Chemistry examined the literature used in the exploitation of Anasarcin and Anedemin and published its report. Anasarcin tablets, it was pointed out, were said to contain the active principles of _Oxydendron arboreum_ (sour wood), _Sambucus canadensis_ (elder) and _Urginea scilla_ (squill), and the following claims were made for the nostrum:

“Does what dropsy medicaments have hitherto failed to accomplish.”

“Superior to digitalis, strophanthus, scoparius, squills, acetate of potash and the hydragogue cathartics all put together.”

“The only known relief and permanent cure of dropsies.”

“Unrivaled heart tonic.”

“The most powerful agent known.”

“Safe in administration.”

“Non-toxic as ordinarily administered.”

“Will nauseate some persons,” but “the reaction from the temporary depression is prompt.”

“In Bright’s disease, both the interstitial and parenchymatous forms of nephritis, acute or chronic, no remedy ... to equal it in efficacy.”

“Without increasing the debility of the patient or interfering with nutrition by producing loss of appetite ...”

“This treatment is to be continued without cessation until all symptoms of dropsy have disappeared.”

A comparison of the earlier claims with those now being made (see advertisement reproduced from the _New York Medical Journal_) illustrates one of the results of the work of the Council. Today the nostrum exploiter avoids the cruder forms of obvious misstatement, but continues to make, by inference, claims that are equally misleading. It will be observed in this case that a more cautious pen worded the later advertisement, but there is still evident the intent to convince the reader that Anasarcin is superior to the official drugs in the treatment of cardiovascular diseases. The facts are that Anasarcin is at best a dangerous remedy in the hands of the average clinician in the treatment of such conditions, and its use is at all times to be condemned.

No competent investigator has ever investigated the pharmacology of sour wood (_Oxydendron arboreum_), and it appears to have no therapeutic value other than that due to a slight acidulousness. Elder (_Sambucus canadensis_) contains a trace of a volatile oil as its most important constituent, according to the British Pharmaceutical Codex of 1911 (p. 908), but it is difficult to explain why a trace of volatile oil should be considered important. Elder may be dismissed without further consideration in connection with Anasarcin tablets.

THE PHARMACOLOGY OF SQUILL

This leaves only squill among the constituents of Anasarcin for consideration. Sollmann (Manual of Pharmacology, 1917, p. 409) in discussing the advantages claimed for squill over other drugs of the digitalis group, says: “Dixon, 1906, points out that any superiority is outweighed by its disadvantages: uncertain absorption; strong gastro-intestinal irritation.” Squill was formerly used as an expectorant and diuretic, the activity having been attributed to two amorphous glucosids, scillipicrin and scillitoxin, but Ewins, 1911, found these to be impure mixtures. A later investigator claimed to have isolated two glucosidal agents from squill, but similar claims have often been made only to be disproved later, and we know of no confirmation of the claims regarding the isolation of any pure principles from squill having any true typical digitalis action.

The statement quoted from Sollmann is accepted by practically all pharmacologists, and we may say with certainty that squill is decidedly inferior to digitalis in the treatment of cardiovascular, and cardiorenal diseases, and certainly no active principles of squill were known to the scientific world at a time that the remarkable claims were first made for Anasarcin by an obscure pharmacist of Winchester, Tenn. Indeed, if Anasarcin were all that it was claimed to be, its discovery would have made Winchester as famous as a certain Wisconsin city was said to have been made by a popular beverage.

It has been abundantly demonstrated, and it is now almost universally accepted among well informed pharmacologists and clinicians, that all digitalis principles exert the same kind of action on the heart after they enter the circulation in effective doses, though they differ to an extraordinary degree in the intensity of their action and in their undesired sideactions, such as nausea and vomiting. When the use of Anasarcin (squill) is followed by immediate improvement after digitalis has failed, it merely shows that the dosage of digitalis was insufficient or that it was discontinued and the squill mixture was substituted before the full therapeutic effects of the digitalis developed.

WHEN THE DIGITALIS GROUP IS CONTRAINDICATED

If the administration of a sufficient dose of digitalis is not followed by improvement in the circulation, it shows that the heart is incapable of responding to such treatment and the further use of any of the drugs of this group is distinctly contraindicated. This is confirmed by the experience of nearly every competent observer of digitalis therapy, and numerous fatalities have resulted from the failure to appreciate this fact and further administer some other member of the group, such as strophanthus or squill.

It is now well known that the cardiac effects of toxic doses of squill, and other members of the group, resemble closely those of cardiac disease, and it is often impossible to determine whether the behavior of the heart in a given case is attributable to insufficient dosage, to excessive dosage, or to the progress of the cardiac disease itself. If this occurs when one uses the best known members of the group, it is certain that it occurs even more frequently when others that are less understood are employed. In the light of this knowledge of the dangers attending the incautious use of any member of the digitalis group, and more especially the use of impure principles, such as are commonly obtained from squill, it is impossible to condemn sufficiently the recommendation that the use of Anasarcin should be continued without cessation until all symptoms of dropsy have disappeared.

Digitalis bodies are not suited for the treatment of all cardiac disturbances, and it is, of course, self-evident that a time must come in the treatment of chronic cardiac disease when the heart is incapable of responding to any form of treatment with improvement. But, unfortunately, it never loses its response to toxic doses, and to push the administration of any drug or mixture containing any drug of the entire digitalis group--and especially those, like squill, in which the side actions are most prominent--beyond the point of tolerance is to court certain disaster.

THE TREATMENT OF CARDIAC DROPSY

While it is quite certain that many lives have been sacrificed to the failure to understand this phase of cardiac therapy, it is equally certain that many lives have been sacrificed because of insufficient dosage, and one can steer a safe course between these dangers only by using the best known preparation available; and in the present state of our knowledge it is indisputable that digitalis and the tincture of digitalis are best suited for the treatment of cardiac disease except in those few cases in which intramuscular or intravenous administration must be employed temporarily for immediate effect.

The secret of prescribing successfully for the relief of dropsy in cardiac disease consists in understanding the effects of digitalis on the heart, in administering it until these effects indicate that the desired object has been obtained, and stopping, or interrupting, the administration at that point until the effects begin to wear off. Cumulation, so called, is a positive advantage in such cases. It merely means that the desired therapeutic effects once induced persist for a time, and that further medication is unnecessary during such persistence of action. Eggleston has recently shown (_Arch. Int. Med._ =16=:1 [July] 1915; abstr., _J. A. M. A._ =44=:459 [July 31] 1915) that the full therapeutic effects of digitalis can be induced in suitable cases within a few hours even with oral administration.

We are not aware of a single publication in which a careful, detailed clinical study of Anasarcin has been reported. The claims made for Anasarcin, past and present, indicate either a deliberate purpose to mislead or crass ignorance of the rudiments of pharmacology and therapeutics. The exploiters of the nostrum claim that thousands of physicians have found Anasarcin tablets of unsurpassed remedial value in the treatment of disorders of the circulatory system and of ascitic conditions.[244] It must be admitted that too many physicians have prescribed Anasarcin, otherwise the manufacturers would not have continued to spend thousands of dollars in advertising it in medical journals during a period of more than ten years.

[244] Former estimates of the number of physicians who prescribed Anasarcin appear to have been too high, possibly based on the ratio obtaining in Winchester, Tenn. Inquiry at five fairly busy drug stores in a large eastern city showed that in no instance was the pharmacist even acquainted with the name. One pretended to be, and manifested pity for the inquirer’s ignorance in supposing that it could be imported during the war! He was obviously merely less honest than the others, who frankly admitted they had never heard of it.

Doctor, this article is meant to be a candid discussion with you, whether you use Anasarcin or not, because every clinician is vitally interested in the customs that obtain in the practice of medicine, and we wish to put a hypothetic question to you. Answer it, at least to yourself, in exactly the spirit in which it is put. Suppose that you prescribe Anasarcin for a patient who is critically ill with cardiac disease. He dies. Are you willing to tell the relatives frankly just what you used and the nature of the evidence on which you based your choice of this nostrum? Let the supposition be carried further and say that the case was hopeless, and agree that digitalis and all other drugs would have been equally ineffective. Granting all this, would your explanation satisfy? Would you in all candor dare to offer such an explanation? Try it as a hypothetic case before you are forced to apply it.--(_From The Journal A. M. A., Dec. 8, 1917._)

[ARTICLE III]

Pepto-Mangan

It would be interesting, and even instructive, to know how many educated physicians, if any, are now prescribing Pepto-Mangan (Gude): interesting as indicating the number who have neglected to avail themselves of the work of the Council on Pharmacy and Chemistry, especially the earlier work; instructive in that it would show how many are still prescribing by the rule of thumb, and who are taking their therapeutic instructions from purely commercial sources instead of striving to learn how to choose those drugs that are most effective in the treatment of disease.

It has been pointed out many times in the pages of The Journal that many nostrums are advertised first to physicians, and that after physicians have served as the unpaid agents of the manufacturers in introducing the preparations, their exploitation is then commonly continued by means of advertisements in the public press. This plan has been followed successfully in so many cases that we have now come to look on it as the regular course. It is in keeping with this rule that we find Pepto-Mangan now advertised in the public press, the physicians having served the manufacturer’s purpose.

DISCARDED THEORIES OF IRON MEDICATION

It will be recalled that many years ago the theory was held that hydrogen sulphid (sulphureted hydrogen) interfered with the absorption of the iron of the food, and that the administration of medicinal iron prevented this interference by neutralizing the hydrogen sulphid (sulphureted hydrogen). It was only a short step to argue that manganese might replace the medicinal iron in combining with the hydrogen sulphid, permitting the food iron to be absorbed, and it was held that only food iron could be utilized in the formation of hemoglobin.

It is hardly necessary to remind the reader that this theory rests on numerous fallacies. There is no hydrogen sulphid worth mentioning in the small intestine where iron is absorbed; food iron cannot be utilized directly in the formation of hemoglobin but must be broken into simple forms for absorption; and, further, inorganic iron, such as ferrous carbonate, serves the purpose admirably when iron is indicated. With the acceptance of these well established facts, all possible excuse for the therapeutic employment of Pepto-Mangan in place of iron vanished; but as plain and simple as this fact is, the unnecessary and expensive Pepto-Mangan continues to be prescribed by physicians who will not take the slight trouble to investigate the claims for this nostrum.

FALSE AND MISLEADING CLAIMS

There is not merely a difference of opinion between the exploiters and the Council, but there has been also actual misrepresentation in the exploitation of this nostrum to physicians. This has been shown on more than one occasion. About twelve years ago, the M. J. Breitenbach Company, the proprietors of Pepto-Mangan, claimed that the report of the commission that had been appointed for the investigation of anemia in Porto Rico “would alone suffice to establish Pepto-Mangan at once as the foremost hematinic known.” Examination of the report showed that the commission made no such claims; on the contrary the commission protested against this misrepresentation (_J. A. M. A._ =45=:1099 [Oct. 7] 1905).

Undaunted by this exposure of their methods, the Breitenbach Company later sent out a statement of results purporting to have been obtained by one Mateo M. Gillen, in the treatment of infantile anemia on Randall’s Island in New York City. At the instance of The Journal the hospital records in these cases were examined, and it was found that the pretended report was little more than a tissue of falsehood (_J. A. M. A._ =48=:1197 [April 6] 1907).

About two years ago the Council reported that while the statements just referred to were no longer made, they had never been definitely admitted by the Breitenbach Company to be erroneous, and that Pepto-Mangan was then being exploited to the public indirectly. (Council Reports, 1914, p. 121.)

We reproduce an advertisement that has been appearing weekly in the _New York Medical Journal_ for several months. One can only suppose that this advertisement was intended to mislead physicians, and it would be an insult to the intelligence of the average reader to attempt any detailed discussion of it, but enough has been said to show how misleading the statements are. One should note particularly the advice--old as the nostrum business itself--contained in the advertisement, to prescribe an original bottle. The reason for such advice is simple. Experience has shown that when original bottles are dispensed patients soon learn to buy the nostrum without consulting the physician, for they shrewdly suspect that he knows no more about the preparation than they, and that he gets his information from precisely the same sources that are available to them. They are obviously right. In truth, the physician who prescribes Pepto-Mangan as a hematinic shows ignorance of the most rudimentary facts of iron therapy, and the intelligent patient soon perceives his limitations.

THE PROBLEM OF IRON THERAPY

The investigation of the problems of iron therapy and its utilization in the formation of hemoglobin forms one of the most brilliant chapters in pharmacologic research, and there is no better established fact in therapeutics than that any organic or inorganic preparation of iron that does not irritate the stomach may be employed effectively when the administration of iron is indicated. “Useful Drugs” contains a list of iron preparations that are suitable for all conditions which call for iron, and the clinician may rest assured that he will never have occasion to go outside that list to prescribe any substitute.

As a matter of fact, it seems probable that the very number of available iron preparations has served to cause confusion, thus affording an opportunity for the nostrum maker to introduce his superfluous compounds. It may be difficult at times to select the preparation of iron best suited to the individual patient; and it is this difficulty that has led the clinician to listen to the seductive claims made for the various pretended substitutes for iron. One should approach the question of choosing the proper form of iron for therapeutic use with the recognition of the fact that there is no such thing as a substitute for iron in the formation of hemoglobin, that there are no ideal forms of iron other than those found in the foodstuffs. Further, the clinician cannot avoid the disadvantages inherent in all forms of iron that he can prescribe, and he must therefore seek that which seems best suited for the individual patient.

Bunge estimated the amounts of iron present in various foods; and a table based on this, and other data, is given in “Pharmacology of Useful Drugs” (published by the American Medical Association). Ordinary foods in an ample diet contain enough iron to supply the normal daily loss, which amounts to only a few milligrams, but many persons who have poor appetites take an insufficient amount of iron in their food and become anemic. In such cases the additional iron required can be supplied best by adding spinach, eggs, apples, or other iron-rich food to the dietary.

SOME IRON COMBINATIONS

William Hunter discusses the subject of anemia and its treatment at considerable length in the “Index of Treatment,” Ed. 6, pp. 17-37, and gives many prescriptions containing iron for use under different conditions; and while it is unnecessary to reproduce all of these here, a few may be given in order to suggest suitable methods of prescribing iron when it cannot be given in sufficient amounts in the food.

In chlorosis Hunter advises that that form of iron which experience has shown to be least disturbing to the patient’s stomach should be used, and he suggests separate stomachic mixtures to be used simultaneously, not mixed with the iron itself. When constipation exists--and this is a very common accompaniment of chlorosis--he gives the following aperient iron combination:

Gm. or c.c.

℞ Ferrous sulphate |25 gr. iv Magnesium sulphate 4| Ʒ i Aromatic sulphuric acid |5 ♏ vii Tincture of ginger |7 ♏ x Compound infusion of gentian (B. P.) q. s., ad 30| ℥ i

This, constituting a single dose, is to be taken twice daily--at 11 a. m. and 6 p. m. A little compound tincture of gentian and water may be used in place of the compound infusion of the British Pharmacopeia. He modifies this somewhat as occasion demands by using sodium sulphate and adding sodium bicarbonate (which converts the sulphate of iron into ferrous carbonate) and adds 10 minims of spirit of chloroform to act as a stomachic.

Hunter also suggests the use of pills of aloes and iron in place of the mixture described above, and when constipation has been corrected, the aloes may be omitted and the pill of ferrous carbonate alone may be used for the iron. Hunter’s comment regarding this pill is, “very satisfactory.”

The same form of iron is available in the compound iron mixture, formerly official, which Hunter says is exceedingly good. In this country the compound solution of iron and ammonium acetate, Basham’s mixture, so called, has long enjoyed a wide reputation as causing very little disturbance of the stomach, and the homely tincture of ferric chlorid is probably useful in a large majority of cases in which the stomach is not especially irritable.

We may say with assurance that one of the forms suggested here will suffice for practically every case in which it is necessary to reinforce the amount of iron available in the food by some pharmaceutical preparation. If these do not satisfy your requirements, consult a really competent pharmacist and enlist his aid in devising a mixture especially suited to your individual patient.--(_From the Journal A. M. A., Dec. 29, 1917._)

[ARTICLE IV]

Cactina Pillets

This preparation may be considered briefly in view of the recent discussion in this series of articles of the pharmacology of the digitalis group and the principles of treatment in cardiovascular disease. The manufacturers maintain that cactina is wholly unlike digitalis, and that is the truth, as we shall show; but since they claim that it is useful in certain conditions of the heart in which digitalis is commonly employed by well informed clinicians, it is necessary to consider its cardiac actions--or its lack of them! It is difficult to determine just what action cactina is supposed to exert on the heart. For example, one advertisement contains the following:

“Cactina Pillets. A gentle cardiac tonic that supports and sustains the heart through its capacity to improve cardiac nutrition.”

Just how the cardiac nutrition is to be improved without an improved coronary circulation is not explained. It would be interesting to know in what other way this is to be accomplished, and how an improved coronary circulation can be induced without acting on the heart or vessels. But that is what digitalis does, and you should remember that cactina is so very different from digitalis! Then again:

“Cactina Pillets. A remedy that steadies and strengthens the heart by imparting tone to the heart muscle.”

That is a pretty direct statement, but digitalis imparts tone; and we must not forget that “cactina” is wholly unlike digitalis, and we are told that “cactina” is:

“Invaluable in all functional cardiac disorders such as tachycardia, palpitation, arrhythmia, and whenever the heart’s action needs regulating or support.”

If these are merely functional disorders of the heart, it is highly desirable to know what are the symptoms of really serious cardiac disease! Since the manufacturers give us no information concerning the mode of action of “cactina” we will turn to the literature of disinterested observers. If one attempts to discover the origin of “cactina,” he will probably meet with disappointment, for various bibliographies fail to mention the name of Sultan, who is said to have isolated “cactina” from _Cactus grandiflorus_. It seems that Sultan worked with _Cactus_, or some other plant, when a student of pharmacy, and it is to be remembered that Cactina Pillets are manufactured by the Sultan Drug Company.

It is doubtful whether Sultan actually worked with genuine _Cactus grandiflorus_; and, in fact, there is good reason for thinking that he did not, for all subsequent workers who have taken pains to secure genuine _Cactus grandiflorus_ have failed to detect the presence of any active principle, except possible traces that are of no therapeutic importance whatever.

WHAT THE COUNCIL FOUND

The Council on Pharmacy and Chemistry examined the literature relating to cactus and certain proprietary preparations, including Cactina Pillets, alleged to be made from cactus, and has reported the results of its investigation (_J. A. M. A._ =54=:888 [March 12] 1910) and we will quote from that report.

“The therapeutic value of this plant has been variously estimated by different observers. Experimental evidence as to its action is scanty and no complete chemical examination has ever been made.

“Reputable men have testified that some of the plants of the cactus family contain very active principles, but so far experiments seem to prove that _Cactus grandiflorus_ has neither the action of digitalis nor that of strychnin. The principal contributions, clinical and experimental, for and against the drug are set out below.”

The report then proceeds to analyze the work of O. H. Myers, R. A. Hatcher, Boinet and Boy-Teissier, Sayre, Gordon Sharp, S. A. Matthews, P. W. Williams, Aulde and Ellingwood, and comes to conclusions that are set forth as follows, in brief:

1. It is uncertain what part of the plant contains the active principle, if any such principle exists.

2. Part of the experimental and clinical work has been published under proprietary auspices.

3. The value of clinical evidence when unsupported by animal experimentation is much diminished by the tendency of enthusiastic and untrained observers to attribute to the drug given the effect really due to general remedial measures, psychic suggestion and so forth.

In other words, the literature does not afford a report of a single piece of careful painstaking work the results of which lend support to the claims made for Cactina Pillets as stated above, for it is obvious that if _Cactus grandiflorus_ contains no active principle, no active principle can be extracted from it. Some time after the report of the Council was published, Hatcher and Bailey secured genuine _Cactus grandiflorus_ directly from a competent botanist, Dr. C. A. Purpus, of Vera Cruz, Mexico, and studied it experimentally. They reported (_J. A. M. A._ =56=:26 [Jan. 7] 1911) in part as follows:

“We have been unable to obtain any evidence that the true Mexican _Cactus grandiflorus_ possesses any pharmacologic action whatever; but, on the contrary, it appears to be a singularly inert substance when administered either by the mouth or by the vein.”

When colossal doses of _Cactus grandiflorus_ are given by the vein, they sometimes--but not always--appear to exert an extremely feeble action on the heart; but this action is so slight that its nature could not be determined. Even the most colossal doses of _Cactus grandiflorus_ administered by the mouth to cats, dogs and frogs exert no perceptible effect.

Sollmann thus satirizes the absurd claims made by the exploiters of proprietary forms of cactus: “Should the heart be too slow, cactus quickens it; if the heart is too fast, cactus slows it; should the heart be too weak, cactus strengthens it; if the heart is too strong, cactus weakens it; does the heart wobble, cactus steadies it; if the heart is normal, cactus does not meddle with it” (_J. A. M. A._ =51=:52 [July 4] 1908).

Will physicians continue to accept the statements of an interested nostrum vender--who submits not a shred of evidence to support his claims, but who has a financial interest in convincing them--even when his statements are diametrically opposed to all the evidence that the Council on Pharmacy and Chemistry has been able to secure?--(_From The Journal A. M. A., Jan. 19, 1918._)

[ARTICLE V]

Ammonol and Phenalgin

At the time that synthetic chemical drugs were coming into fame and when every manufacturer who launched a new headache mixture claimed to have achieved another triumph in synthetic chemistry, Ammonol and Phenalgin were born. Of course, these twins of analgesic pseudotherapy were claimed to be synthetics and were duly christened with “formulas.” They were among the first of the nostrums examined for the Council on Pharmacy and Chemistry, and the false claims made for them were exposed.

The analyses made for the Council showed that Ammonol and Phenalgin were simple mixtures, having the following composition:

ACETANILID SODIUM BICARBONATE AMMONIUM CARBONATE AMMONOL 50 25 20 PHENALGIN 57 20 10

The reports of the Council on, and numerous references to, these two nostrums may be found in The Journal of various dates.[245] The reports will prove interesting to those who are not familiar with, or have forgotten, the methods of nostrum exploiters at the time the Council was formed. Following the Council’s exposure of the false claims made by the manufacturers of Phenalgin, the _Medical Record_ published an advertisement of that nostrum in which an attempt was made to discredit the Council’s report. The editor of the _Medical Record_ was requested by the Council to publish the facts in the case but he refused to do so.

[245] J. A. M. A. 44: 1791 (June 3) 1905; ibid. 44: 1997 (June 24) 1905; ibid. 45: 935 (Sept. 23) 1905; ibid. 46: 134 (Jan. 13) 1906; ibid. 46: 290 (Jan. 27) 1906; ibid. 58: 280 (Jan. 27) 1912.

Long after the death of Dr. Cyrus Edson, the claim was made that Phenalgin was made under his direction and that it was his “discovery.” As a matter of fact, Dr. Edson had favored the use of Ammonol at one time, and when the Council exposed the false claims then being made for Phenalgin, The Journal charged that a fraud was being perpetrated on the medical profession. Despite the exposure of the methods used in exploiting Ammonol and Phenalgin, one finds just as glaringly false statements made in the advertisements of Phenalgin today as were made in its unsavory past. This would seem to indicate either that physicians have short memories or that they are strangely indifferent to the welfare of their patients, to their own reputations and to the good name of medicine.

The _New York Medical Journal_ of Dec. 22, 1917, contained an advertisement of Phenalgin--it has been running for months--from which the following is quoted:

“For the relief of PAIN the ‘logical supplanter of opium and other habit-forming drugs’ is PHENALGIN. No matter how severe or where located pain is promptly and satisfactorily controlled by this effective anodyne--and without disturbing the digestion, suppressing the secretions, causing constipation or inducing a drug habit.

“This is why Phenalgin has superseded opium and its derivatives for relieving HEADACHES, RHEUMATISM, GOUT, LA GRIPPE, LUMBAGO, NEURALGIA, DISORDERS OF THE FEMALE, DYSMENORRHEA, AND PAINFUL CONDITIONS GENERALLY. To thousands of physicians Phenalgin ‘is the one dependable analgesic--the logical supplanter of opium.’”

If we are to suppose that the composition of Phenalgin is today essentially the same as when it was examined, the claims just quoted are obviously false for, of course, such a mixture must have the properties of acetanilid with all of its drawbacks and limitations. We may contrast the statements made in the advertisement just quoted with those made in Bulletin 126 of the Bureau of Chemistry of the U. S. Department of Agriculture. This bulletin on “The Harmful Effects of Acetanilid, Antipyrin and Phenacetin” summarizes the replies received from 400 physicians to whom a questionnaire had been sent. The information thus gained was tabulated and the figures that follow are from these tables. There were reported no fewer than 614 cases of poisoning by acetanilid with 16 deaths and 112 cases of its habitual use. The larger number of cases of poisoning followed the administration of the drug, by physicians, in doses larger than those now regarded as fairly safe. This large number reported by only 400 physicians indicated an excessively large number in the whole country. Since the questionnaire was sent to nearly a thousand physicians, of whom about 500 failed to reply, it may be assumed that had it been sent to the entire 130,000 physicians in the country, at least 75,000 cases of poisoning would have been reported.

Prior to the passage of the federal Food and Drugs Act (the “Pure Food Law”) many nostrum makers had declared that their preparations contained no acetanilid. When that law went into effect, some of these manufacturers triumphantly pointed to the fact that they were still able to make the same claim without conflicting with the requirements of the law. This was accomplished in fact by changing the formula and substituting acetphenetidin (phenacetin) for the acetanilid. While acetphenetidin is somewhat less toxic than acetanilid, bulk for bulk, the toxicity and therapeutic activity of the two drugs are nearly proportional.

The claim made by many proprietary medicine manufacturers that they are “strictly ethical” because they advertise only to physicians is mere verbal camouflage. There may be no more certain way of insuring the continued use of a nostrum by the public than to have it prescribed by physicians; and none know this better than the makers of nostrums. A proprietary individuality is obtained by giving some special form to the tablets and package or a special coloring to the capsules (“Specify ‘Phenalgin Pink Top Capsules’”) so as to indicate the identity of the products in such a way that the patient may in the future procure them without the advice or warning of the physician. When a proprietary preparation with the name or initials stamped on it or attached to it is prescribed, the patient immediately is aware of the fact, and his respect for the physician’s intelligence and wisdom is naturally lessened.

The physician should never place such dangerous drugs as acetanilid and acetphenetidin, or ready made mixtures of them, in the hands of the patient in such a way that they can be employed without his supervision or control. He should never prescribe more than is needed at the time and should not form the habit of using fixed doses or combinations of drugs without a special reference to the particular needs of the individual.

Certain forms of headache yield more readily to a mixture of caffein and acetanilid or caffein and acetphenetidin than to either acetanilid or acetphenetidin alone. When the physician wishes to prescribe such a mixture he may combine 1 grain of caffein or 2 grains of citrated caffein with 3 grains of acetanilid or 4 grains of acetphenetidin in a powder or capsule. Under supervision such a dose may be repeated at intervals of from two to four hours if necessary to control pain. It is necessary to remember, however, that when small doses fail to give relief, increase in the dose is useless. This fact is especially important, and disregard or ignorance of it has been responsible for many cases of poisoning. Further, it should be remembered that while it was taught for many years that the admixture of caffein with acetanilid lessened the effect of the latter drug on the heart, Hale has shown that this is not the case and such mixtures must be used with special caution.--(_From The Journal A. M. A., Feb. 2, 1918._)

[ARTICLE VI]

Fellows’ Syrup, and Other Preparations of the Hypophosphites

We hope that it is clear to those who have read the several articles of this series that their purpose is to present evidence that will enable the reader to form a correct estimate of the literature employed in the exploitation of various nostrums. The distinction between mere assertion--however plausible, and from however eminent an authority--and evidence should again be emphasized. Satisfactory evidence rests on careful observation by those who are capable of accurately determining to what extent any changes that may be observed are due to the therapeutic agent employed and not mere accompaniments of such treatment.

When the Council on Pharmacy and Chemistry was organized in 1905, the greater part of the literature of the nostrums was so palpably misleading, the statements often so ludicrously false, that it was only necessary to call attention to this fact to have those claims collapse. As a result of the Council’s work, the exploiters of worthless nostrums have developed a greater degree of shrewdness in avoiding the easily exploded falsehoods. This has made it increasingly difficult to point out the exact statements on which many of the false claims now rest, even though the exploitation as a whole is as inherently dishonest as before. If a nostrum is worthless, any exploitation must be false and misleading in effect, even though not one single false direct statement is made.

A platitude may be given an appearance of importance if uttered in an impressive manner, and it may be employed to suggest far more than it categorically affirms. These two facts are appreciated by many nostrum exploiters and we find that they have adopted the impressive manner to secure attention, and the platitude to suggest far more than they could defend in direct statement. Thus we have the “lie with circumstance.”

FELLOWS’ SYRUP

A full page advertisement, which has been appearing regularly for about a year and which must represent a good deal of money, is used to give an appearance of importance to a few words which, if printed in ordinary type, would either pass wholly unnoticed or would lead one to assume that something essential to the full meaning had been omitted. The statement, in full reads:

“Fellows’ Syrup differs from other preparations of the hypophosphites. Leading clinicians in all parts of the world have long recognized this important fact. Have you? To insure results, prescribe the genuine ℞ Syr. Hypophos. Comp. Fellows’. Reject cheap and inefficient substitutes. Reject preparations ‘just as good.’”

The only direct statement contained in the advertisement is to the effect that many clinicians have observed that Fellows’ syrup and other preparations of the hypophosphites are not alike. In truth, Fellows’ is not like the better preparations of this type, since after standing it contains a muddy looking deposit that any pharmaceutical tyro would be ashamed of. Technically, then, the statement is true, but it is hardly credible that the manufacturer is paying for an entire page in a medical journal to make this statement without any attempt to suggest something else.

The advertising pages of six medical journals were examined in the order in which they chanced to come to hand. In five of these, the entire advertisement of Fellows’ syrup was in the words just quoted; not a single word more. In one there was the further statement:

“Not a new-born prodigy or an untried experiment, but a remedy whose usefulness has been fully demonstrated during half a century of clinical application.”

These advertisements show that the exploiters of Fellows’ Syrup are spending a great deal of money to induce physicians to prescribe the preparation, and it is equally evident that they wish to convey the impression that the preparation has some therapeutic value. Since we find nothing directly false, in the first mentioned advertisement at least, we must take the evident intent for consideration and determine what therapeutic value, if any, this preparation has, and whether it is advisable for physicians to employ it in any case.

The preparation, according to the statement just cited, has been in use for fifty years. As the exploiter of any preparation cites the most convincing evidence in his possession in support of his views, this claim may be assumed to be the strongest available, and if this evidence fails we must reject the contention as not proved. Here we face a dilemma, for examination of the literature used in the exploitation of Fellows’ Syrup fails to disclose any evidence of the kind that we have described as satisfactory; and we are, therefore, forced to conclude that none has ever been found. By this it is not to be implied that no reputable physician has ever reported favorably concerning the therapeutic effects of this preparation. It is quite possible that an extensive literature of that sort might be found if one examined the older medical journals. But the day has passed when every improvement that follows the administration of a preparation is blindly attributed to the drug in question. Clinical research today is far more exacting.

We will assume that the reader who has investigated the question with an open mind will have come to the decision that the contention that Fellows’ syrup is of especial therapeutic value is not proved. We might rest with that assumption and ask the clinician whether he is prepared to use a nostrum that has been before the medical profession for half a century without any satisfactory evidence having been gained that it possesses therapeutic value. We might ask him whether he would be willing to tell his patients that he was prescribing such a nostrum for them in the face of the absence of any such evidence of its value.

THE INERTNESS OF THE HYPOPHOSPHITES

But we prefer to go even further and show him that not only is there an entire absence of any evidence of its therapeutic value so far as we have been able to learn, but in addition there is an abundance of evidence that the hypophosphites are devoid of any such therapeutic effect as they were formerly reputed to have, and that, in fact, they are, so far as any effect based on their phosphorus content is concerned, singularly inert.

While we have thus far taken the Fellows’ preparation as the subject of the discussion, we may take a broader view and examine the subject of the hypophosphites in general, and the substitutes containing phosphorus that have been introduced from time to time. It hardly needs to be said that if the hypophosphites are without therapeutic value, it is impossible to give them value by combining them in a muddy-looking, ill-made preparation such as Fellows’ Syrup. Such evidence was submitted to the medical profession in a report of the Council on Pharmacy and Chemistry (_J. A. M. A._ =67=:760 [Sept. 2] 1916); and we would strongly advise any one who is disposed to act on the suggestion contained in the advertisements of Fellows’, and other hypophosphite preparations, to read that report in full and to think the matter over before prescribing one of these nostrums. Quoting briefly from the report in question:

“Although the overwhelming weight of evidence was against the probability that the hypophosphite preparations are of value as therapeutic agents, the Council thought it well to investigate the subject. Dr. W. McKim Marriott of Baltimore was therefore requested to review the evidence for and against the therapeutic usefulness of the hypophosphites and to conduct such experiments as seemed necessary.”

The Council was not content to rest on the mere absence of evidence for the value of these preparations or any one of them, but sought to obtain evidence that would fulfil the conditions mentioned above, and in pursuance of this plan it secured the cooperation of a trained investigator, one who would work under the best of conditions for learning the truth. The results of Dr. Marriott’s investigation were published in The Journal, Feb. 12, 1916, p. 486, and should be read by everyone who has any interest in the problem. Lest some of our readers may fail to refer to the original of Marriott’s paper, we will quote briefly from it:

“None of the subjects of the experiment experienced any effect whatsoever from the administration of the drug ... Almost all of the ingested hypophosphite is eliminated unchanged....

“These experiments (Forbes) demonstrate conclusively that the hypophosphites possess no specific value as a source of phosphorus for the body.... It is doubtful if there are any conditions in which the body suffers from lack of phosphorus. Even should such conditions exist, phosphorus, in the form that it occurs in the ordinary foods, or as phosphates, is more efficient in supplying the deficit than hypophosphites that must be oxidized before utilization and which are only about 15 per cent. oxidized if at all. For example, half a glass of milk contains more available phosphorus than three large doses of hypophosphites of 15 grains each, as great a dosage as is usually given.

“What then, is the therapeutic value of hypophosphites? There is no reliable evidence that they exert a physiologic effect; it has not been demonstrated that they influence any pathologic process; they are not ‘foods.’ If they are of any use, that use has never been discovered.”

The case seems to stand about like this: A nostrum maker spends thousands of dollars to tell physicians that his cloudy preparation is not like other preparations, and physicians are expected to accept that as convincing evidence that they should prescribe and their patients, perforce, take it. This too, in spite of the evidence gained by careful scientific investigators that the hypophosphites in fairly large doses contain less available phosphorus than half a glass of milk, and that there is no evidence available that they exert any therapeutic effects at all.

Should we take the meaningless statement of a nostrum maker, who does not submit evidence of any therapeutic value of his preparation--unless one can call certain careless habits of prescribing evidence--and assume the responsibility of prescribing a nostrum that according to all scientific evidence available is useless, and of no more effect than a few teaspoonfuls of milk, so far as its hypophosphite content is concerned? It may be argued that it possesses some value because of its bitter nature. We will not deny that it is bitter; so is strychnin, so is quinin, so are scores of simple drugs, but what physician would care to admit to his patients that he did not know how to prescribe a simple bitter, such as nearly every layman can select for himself, without recourse to a preparation such as Fellows’ Syrup?

We have felt that it is not wholly satisfactory to discourage the use of a given nostrum without making an effort to assist the physician in choosing wisely in the treatment of the condition for which the nostrum is claimed to be useful. In the present instance, however, we fear that would prove a task beyond our powers, for the hypophosphites have been used in such a variety of conditions that the discussion would have to include nearly the whole materia medica if we were to follow our usual procedure.--(_From the Journal A. M. A. Feb. 16, 1918._)

[ARTICLE VII]

Shotgun Nostrums

Formerly it was customary to prescribe mixtures of many drugs on the assumption that if one of the ingredients missed the mark another might be expected to hit it, just as a poor marksman is more likely to hit a target at short range with a blunderbuss than with a high powered rifle. Increased precision in every branch of science has become the outstanding feature of civilization. The soldier today must shoot straight with a rifle that sends a single ball. There is none of the disposition to rely on chance as when the blunderbuss was used. A capable physician directs his drug straight at the seat of the trouble, and we now have many drugs that can be depended on to exert definite actions. The complex mixture is just as preposterous in modern therapeutics as the blunderbuss would be on a modern battlefield.

Every drug exerts undesired side actions, and it is the aim of the modern physician to try to select the one which will have a maximum of therapeutic with a minimum of undesired actions. When a complex mixture is employed, it is obvious that only the best is utilized, whereas all the undesired side actions come into play. We do not pretend that even the best studied drug has not much to be learned about it; but the nostrum maker who exploits a complex mixture either knows practically nothing of the side actions that it will exert, or, if he knows, he conceals that knowledge. He knows that massive doses of hydrated chloral combined with various narcotics can be relied on to cause unconsciousness in nearly all cases, but he prefers to speak of this as a hypnotic action. This is plain gambling with human life. When the patient dies, it is difficult to prove that death was caused by the mixture alone.

The Council on Pharmacy and Chemistry has expended a great deal of time and energy in combating the “shotgun” nostrum evil. It is easy to understand the disadvantages of such mixtures but it is not so easy to demonstrate the misleading character of the claims made, with an entire disregard of the truth, for these mixtures. No one believes that a pot of gold lies at the end of the rainbow, but no one has actually gone there to see for himself.

BROMIDIA

There are many types of “shotgun” nostrum. Some are dangerous, as in the case of “Bromidia”; some are preposterous, therapeutic monstrosities which excite the contempt of educated physicians, as in the case of “Tongaline”; some are merely useless mixtures of well known drugs, sold under grotesquely exaggerated claims, as in the case of “Peacock’s Bromides.”

Various formulas have been given for Bromidia. The manufacturers appear to be more cautious under those circumstances in which falsehood might lead them into collision with the federal authorities, than when giving reign to fancy and considering only the best means of winning the favor of the physician. It is said to consist of hydrated chloral, potassium bromid, Indian cannabis, and hyoscyamus. It is impossible to determine from the published formulas just how much hydrated chloral and potassium bromid it contains, but is probable that there are about 15 grains of each of these two drugs to the fluidram, and variable amounts of Indian cannabis and a small amount of either extract or tincture of hyoscyamus.

This much is certain: Bromidia is a distinctly dangerous mixture for indiscriminate use. The claim of the manufacturers, implied, rather than directly stated, that it is superior to an extemporaneously prepared mixture of those drugs is especially reprehensible because it tends to create the impression that the nostrum is safer in effective doses, conducing to a false sense of security on the part of those who are deluded into prescribing it in larger doses than they would a mixture of the same drugs prepared extemporaneously.

A report of the Council on Pharmacy and Chemistry published in The Journal, May 16, 1914, p. 1573, mentions three instances in which death is reported to have followed the use of Bromidia. The manufacturers of Bromidia have no magic power to render hydrated chloral harmless, while it retains its hypnotic action. It depresses the central nervous system, and it is nothing less than monstrous for any one to pretend to rob this drug of its dangerous properties while it retains its hypnotic effects. If the patient requires a hypnotic, the physician should choose that one which his judgment and experience dictate as the best for that particular patient. If he needs hydrated chloral, the physician should prescribe exactly as much as he believes the patient needs. If the effect is slightly greater or slightly less than anticipated, no harm is done and the physician has gained experience that will be valuable in future prescribing. If Bromidia is prescribed and unexpected effects are induced, it is impossible to know whether these were due to the hydrated chloral or to one of the other narcotics or to a synergistic action; and there is nothing to guide in the further use of the nostrum, for mixtures of narcotics commonly have much less uniformity of action than a single drug.

The irritant action of hydrated chloral on the stomach can be avoided by the use of bland fluids or dilute solutions. The following serves as an example of the way in which it may be prescribed conveniently:

Gm. or c.c. Hydrated chloral 2|6 gr. xl Syrup of orange peel | Water of each 30| fl ℥ i

A tablespoonful (15.0 c.c.) of this mixture, containing 10 grains (0.65 gm.) of hydrated chloral, will often induce sleep in the absence of severe pain or serious disturbance, and seldom does this dose have to be repeated more than once in such simple cases. Hydrated chloral is often used in somewhat smaller doses in combination with potassium bromid, which may be prescribed in a mixture such as the following:

Gm. or c.c. Hydrated chloral 1|3 gr. xx Potassium bromid 3|9 gr. lx Syrup of orange peel | Water of each 30| fl ℥ i

In producing sleep when severe pain is absent this is as effective as the preceding, in similar doses. The use of repeated doses of hydrated chloral in such a mixture as this, or in the form of Bromidia or other nostrum when sleeplessness is due to severe pain is highly dangerous. It should be remembered that while hydrated chloral is an effective hypnotic in case of simple sleeplessness, it is not actively analgesic except in distinctly dangerous doses. Bromidia in repeated doses will induce sleep even in the presence of pain, of course; but any active narcotic does that, and it is correspondingly dangerous. Small doses of morphin given alone are preferable when sleeplessness is due to severe pain.

TONGALINE

“Tongaline” is an example of the type of “shotgun” nostrum that would be merely ludicrous if we could look on anything that degrades therapeutics so lightly. A report was made to the Council on Pharmacy and Chemistry, and published in The Journal, July 17, 1915, p. 269, and in this report it is stated that Tongaline is said to consist of tonga, cimicifuga racemosa, sodium salicylate, colchicum, and pilocarpin. Whether the formula was cut short just there because the office boy ran out of breath at that point, or because the discoverers of this wonderful combination had not heard of the eminently potent substances that the witches added to their cauldron, we can leave to the reader’s imagination, for it is manifestly impossible to present an orderly discussion of the pharmacology and therapeutics of such a preposterous jumble of drugs.

PEACOCK’S BROMIDES

“Peacock’s Bromides” belongs to a slightly different class. It is said to consist of the bromids of sodium, potassium, ammonium, calcium and lithium. In the absence of a logical explanation of the pretended superiority of this mixture over one that is made extemporaneously, the exploiters seem to have been driven to the necessity of pretending that its freedom from contaminating chlorids explains its claimed advantages over mixtures of the official or commercial bromids. The truth is that the chlorids are used as antidotes in bromid poisoning.

Disregard the claims made for Peacock’s Bromides, and ask yourself the question whether you have ever actually seen any ill results following the use of the official bromids that you could reasonably attribute to contaminating chlorids. Furthermore, carefully consider the relative advantage of a single bromid (say the bromid of potassium, or bromid of sodium, if you prefer it), with the opportunity of observing its effects and adjusting the dose in accordance with the results of your experience, and a mixture such as Peacock’s Bromides, the composition of which you do not know, and which the manufacturer can alter to suit his own convenience.

While it is true that the therapeutic art will not degenerate in its entirety merely because some physicians continue to use the most fraudulent and worthless nostrums, yet, on the other hand, to the extent that a physician continues to be guided by the false teachings of nostrum venders who have no therapeutic training, he is plunged into therapeutic chaos.--(_From The Journal A. M. A., March 2, 1918._)

[ARTICLE VIII]

Tyree’s Antiseptic and Aseptinol

It may seem paradoxic to say that recent progress in the medical sciences has made therapeutic chaos possible, but it is true nevertheless. Revolutions are sometimes slow and orderly, sometimes sudden and attended with confusion. The revolutionary changes in the medical sciences have been so numerous and so rapid that the general practitioner has been unable to keep pace with them, and in the resulting confusion the nostrum maker has seen his opportunity for exploiting his useless, dangerous or unscientific preparations. The greater the confusion, the greater his opportunity; and it is no exaggeration to say that he has been the most potent factor in maintaining the chaos of therapeutics.

The majority of our readers would probably say that the existing scientific medical literature insures the permanence of established beliefs, but every one who has delved into the literature has found instances of truths that had been established and forgotten--buried under the ever-increasing avalanche of contributions to that literature.

Rapid advances are still being made in the medical sciences and unless constant vigilance is exercised therapeutics will return to the chaotic condition from which it has so recently emerged. It was in recognition of these facts--the danger of this return to chaos, and the difficulty, in fact, impossibility, of any individual’s keeping pace with all of the medical sciences--that the American Medical Association secured the cooperation of men in various branches of medicine in the Council on Pharmacy and Chemistry, in order that it may place the results of therapeutic progress before the readers of The Journal in an impartial manner.

Are you profiting by this work, or are you still depending on your unaided efforts to distinguish the false teachings of the nostrum venders from that of scientific medicine? Are you prescribing “Antikamnia” and “Ammonol” or a simple member of the group, such as acetanilid or phenacetin? Are you depending on “Tyree’s Antiseptic,” so called, or are you using an antiseptic about which there is no mystery, for which no false claims are made, and one which is really effective? In short, are you using drugs of unquestioned value, such as are described in “Useful Drugs,” or are you taking your therapeutic instructions from nostrum makers’ circulars?

Perhaps you have been led to believe that the Council on Pharmacy and Chemistry is composed of “theorists” and that the nostrums represent the work of “practical men.” Every one should strive to be practical, of course, and it is worth while to inquire whether scientific experimenters, who so largely mold medical literature, should be termed theorists, or practical men. A practical man practices that which is useful in the treatment of the sick, and he must determine who is capable of furnishing him with a better materia medica. A perusal of medical literature will convince any unbiased mind that medical science progresses only by means of experiment, hence experimenters must be considered the really practical men while those who cling to outworn theories are really the “theorists.”

When Lister introduced antiseptic methods into surgery he inaugurated a veritable revolution, which afforded the nostrum makers opportunities for reaping rich harvests through the exploitation--under extraordinary claims--of cheap mixtures of little, or no, value. There is no lack of antiseptics of extraordinary activity in the test tube that are practically harmless to man, and it would seem natural to suppose that such antiseptics could be used to control the development of bacteria in such diseases as typhoid fever, but, unfortunately, such hopes have not been fulfilled. Ehrlich experimented with many phenol derivatives that showed decided antiseptic activity in the test tube, in the hope that he might find some that could be used to combat such common diseases as diphtheria and typhoid fever, but while many of these are of low toxicity for man, he was unable to find even one that could be used effectively in the treatment of any of these diseases. His discovery of arsphenamin (“salvarsan”) resulted from quite another type of investigation.

Many practitioners lose sight of the essential difference between antiseptics and disinfectants and employ antiseptics in cases in which only a disinfectant action would be of value. An antiseptic does not destroy bacteria, it merely inhibits their growth; and when it is diluted too much, it loses its effects and the bacteria may begin to multiply as though no antiseptic had been used. This is especially true after the use of weak antiseptics in the mouth. These are soon diluted or removed by the saliva, and the bacteria continue to multiply with only a momentary interruption at best; hence to advise the use of an oral antiseptic as an effective means of treating diphtheria is little short of criminal.

“Tyree’s Antiseptic Powder” was submitted to the Council nearly twelve years ago. The label on the package stated:

“This preparation is a scientific combination of borate of sodium, alumen, carbolic acid, glycerin and the crystallized principles of thyme, eucalyptus, gaultheria and mentha in the form of a powder.”

A leaflet issued several years ago by the Aseptinol Manufacturing Company states that “Pulv. Aseptinol Comp.” combines in an elegant form boric acid, the salts of aluminum, crystallized phenol, and the active crystalline principles of thymus, mentha and gaultheria.

A comparison of these formulas would justify the designation of the two preparations as twins, but even one twin may have a wart where the other lacks it. The formula of Pulv. Aseptinol Comp. given in the leaflet also includes _Hydrastis canadensis_, but we believe that a wart should be quite as much of an addition to the anatomy of man as the hydrastis is to this already preposterous formula. Similar as the formulas of these two nostrums were said to be, the general methods of exploiting them were even more similar. A partial list of the diseases for which each has been recommended by its exploiters shows the similarity of methods pursued:

TYREE’S WAS SAID TO BE USEFUL PULV. ASEPTINOL COMP. WAS SAID TO IN THE TREATMENT OF: BE USEFUL IN THE TREATMENT OF:

Leucorrhea Leucorrhea Gonorrhea Gonorrhea Vaginitis Vaginal inflammation Pruritus Pruritus Ulcerated conditions of Ulceration of vagina or the mucous membrane cervix Scrofulous ulcers Chronic ulcers Syphilitic ulcers Prophylactic against specific disease Disinfecting offensive Cleansing pus cavities cavities Deodorant Deodorant Profuse and offensive Checks abnormal secretion perspiration

We stated that the formula furnished by Tyree was that given above, but the Council was never able to learn when Tyree actually employed the formula except for advertising purposes; and analysis of the powder showed that Tyree’s Antiseptic Powder was essentially a mixture of boric acid and zinc sulphate, with insignificant amounts of odorous principles.

A remarkable fact brought out in the course of the consideration of the preparation by the Council was that Tyree admitted that he had changed the formula without having published the new one. The Council then showed that a specimen of the “antiseptic” that had been kept in a retail drug store for several years was essentially similar to that sold at the later date. Thus it would seem that Mr. Tyree had been making his powder by one formula and publishing an entirely different one for years before the Council published the facts in the case.

If Tyree found it necessary to change the formula of his powder--if indeed, he ever used the published formula--why did the Aseptinol Manufacturing Company adopt it, or one so closely resembling it?

It is obvious that both of these twin nostrums are utterly unfit for treating the various conditions for which they are or have been recommended; and in view of the misrepresentation in one case, it is difficult to understand why it should be taken as the model for the other. Do physicians believe that a simple mixture of boric acid and zinc sulphate, or a mixture such as that given in the formula of “Aseptinol” powder, is in any way superior to a prescription such as any physician could write?

There is a far more important question to consider than the relative merits of such nostrums and a prescription of the physician’s own devising. That question is whether the medical profession is going to help perpetuate the chaotic conditions that the use of such nostrums fosters or to assist in therapeutic progress by maintaining its independence of such false teachers, and seeking to aid in the establishment of a rational use of drugs and remedial measures.--(_From The Journal A. M. A., March 30, 1918._)

[ARTICLE IX]

Neurosine and the Original Package Evil

We called attention recently to the skill which the nostrum vender displays in avoiding the particular thorn that pricks him, and his development of the art of impressively saying, “Nothing in General,” as exemplified in the advertisements of Fellows’ Syrup. Nostrum sellers are more canny than original; and when once an idea finds lodgment with one of them, it is made to serve many masters. Formerly exploiters of either vicious or worthless nostrums were wont to boast that their preparations were exploited in a “strictly ethical manner.” Recent perusal of as choice a lot of advertisements as can be found in the most degraded of medical journals failed to disclose this claim in a single instance, although the claim that a preparation is “advertised only to physicians” is still common.

The advertisement of “Neurosine,” which we reproduce, was the first one which came to our attention when we searched through some medical journals for one that would illustrate a discussion of the “original package” evil. This is the only reason for selecting Neurosine rather than another. Such half page advertisements and others of similar size in various medical journals cost a good deal of money and they presuppose that the Dios Chemical Company is interested in having original bottles of Neurosine dispensed every time that nostrum is prescribed.

Why should the firm have any such deep interest in seeing that an original _bottle_ gets to the patient? Why should it be necessary to do anything more than see that the genuine _mixture_ reaches the patient? Does it seem within the bounds of reason that substitution is so commonly practiced by pharmacists that this firm must go to large expense to prevent the substitution of spurious mixtures for its product? Is dishonesty the rule among pharmacists? Common sense rejects the plea as placing too great a strain on one’s credulity. Obviously, then, the advertisement does not tell the whole truth, though it does indeed tell exactly what the nostrum maker wishes to have done, that is, to have only _original bottles_ dispensed when physicians prescribe that nostrum. The fact we have; the reason is not far to seek.

When the pharmacist puts up an ordinary, nonproprietary prescription, the patient gets no clue from the package as to the nature of the prescription employed. But when an original bottle of Neurosine is dispensed, even though the pharmacist puts his own prescription label on it, the patient sees the difference at once and knows just why the usual prescription bottle was not employed. He also knows that he can get the medicine with its original wrapper or label by merely showing the bottle to the druggist, for the words “Neurosine” and “Dios Chemical Co.” are blown in the glass. Here, then, may be a plausible reason for desiring that only original bottles be dispensed.

You may ask, “What difference does it make if the patient does learn the name of the nostrum, he must go to his physician for advice concerning its use?” Having learned the name of the remedy that has been prescribed for sleeplessness, let us say, he proceeds to use it whenever he imagines that he needs it; and that need, real or imaginary, has a way of increasing in frequency. As a result, the patient takes far more Neurosine than the physician would think of permitting if the matter had not passed entirely beyond his control.

Not only has the patient acquired a dangerous habit of self-prescribing, but he takes especial delight in recommending his favorite remedy to friends whose symptoms, real and imaginary, seem to resemble his own. This offers him an opportunity to prescribe with an air of authority. It was prescribed for him by Dr. Blank, and it gave relief, _ergo_ it may be depended on to give relief to others! Thus is the basis laid for its general use by the laity, when this process is multiplied sufficiently. The statement is susceptible of easy proof by any one who cares to investigate the matter for himself. There is probably no physician worthy of the name who will attempt to deny that the promiscuous use of hypnotics and narcotics is dangerous, and certainly no careful physician will deliberately place a narcotic in the hands of patients to be used freely and without control.

Since we have selected Neurosine at random, so far as this particular discussion is concerned, it is worth while to inquire into its composition, the claims that have been made for it and the evidence, if any exists, for or against its therapeutic value. Even the most active of hypnotics are worse than useless if they are inferior to other readily available hypnotics, or if they have undesired side-actions that outweigh any advantages that they might otherwise have.

The Council on Pharmacy and Chemistry investigated the literature relating to Neurosine and published its report in The Journal, Jan. 9, 1915, p. 165. According to this report the manufacturers of Neurosine claimed that each fluidounce contained:

Bromid of potassium, C. P. 40 grains Bromid of sodium, C. P. 40 grains Bromid of ammonium, C. P. 40 grains Bromid of zinc 1 grain Extract lupulin 32 grains Cascara sagrada, fl. ex. 40 minims Extract henbane 0.075 grain Extract belladonna 0.075 grain Extract cannabis indica 0.60 grain Oil bitter almonds 0.60 grain Aromatic elixir

This chemical blunderbuss was recommended for use in insomnia, hysteria, neurasthenia, migraine, neuralgia, delirium tremens, epilepsy and many other conditions. Also it was called an ideal calmative for children suffering from chorea, the exploiters claiming that “All authorities recommend the bromids, hyoscyamus and cannabis indica in this disease.” Oliver T. Osborne, professor of therapeutics in Yale Medical School, does not mention one of these three drugs in his discussion of the Medicinal Treatment of Chorea, in the Handbook of Therapy, though he quotes several authorities in this article. Indeed, he does not mention one of the ten drugs included in the above formula of Neurosine in connection with the treatment of this disease. It is a curious fact that Osborne gives the greatest prominence to the use of that drug which is claimed to be wanting in the formula of Neurosine, namely, hydrated chloral.

Perhaps you may have seen temporary relief follow the administration of Neurosine in chorea, and may argue that theorizing is of little value in the face of personal experience. We shall not deny that some may have had that experience, for Osborne calls attention to the fact that the success of any medicinal treatment must be judged in the light of the fact that chorea is self-limited, and the intensity of the symptoms will abate in from two to four weeks. In view of this, we would hardly dispute the claim that one may administer narcotics, such as those contained in Neurosine, and the symptoms of chorea may abate in spite of such mistreatment. In all the years that Neurosine has been exploited to physicians with such remarkable claims, we have never seen a report of a careful clinical study in which the product has been used under the conditions which scientific investigation demands. Would you prescribe any nonproprietary preparations which had never been studied clinically, if a horse-shoer or grocer’s boy told you it would cure epilepsy or malaria?

According to an editorial note appended to the report of the Council on Neurosine, the Dios Chemical Company consisted at that time (1915) of J. H. Chambers, his wife and two sons. It appeared that Chambers never claimed to have any special knowledge of chemistry, pharmacy or medicine, yet we find that he arrogated to himself or to his employees the right to offer therapeutic advice to the medical profession, and even to direct them as to how they should prescribe a given mixture.

We sometimes fail to see the forest because of the trees. It may help us to obtain a better perspective, in a problem that concerns us intimately, by resorting to a hypothetic case, if a close analogy is maintained. In order that we may see ourselves as others see us in such a situation, let us consider the following imaginary case: You become involved in a lawsuit in which an effort is made to deprive you of your property and your liberty. You seek what you had reason to believe was competent legal advice; but, nevertheless, you lose your case and find yourself deprived of your property and your liberty. Now let us suppose further that you discover, when too late to permit you to correct your mistake, that your legal adviser (we can hardly call such a man a lawyer) had been acting all along under the guidance of a plumber who made no pretense of knowing anything about law. How would you feel regarding that pretended lawyer? Would you feel that you had been treated fairly? Would you feel disposed to speak with all charity of him, to recommend him to those in need of legal advice?

You would probably feel toward such a lawyer as patients must feel toward physicians who prescribe proprietary nostrums based on information and advice offered by those who, though without any special knowledge of chemistry, pharmacy or medicine, will be benefited financially if their information and advice are accepted and acted on.--(_From The Journal A. M. A., April 27, 1918._)

ANASARCIN ADVERTISING[I]

[I] See index for other articles on Anasarcin.

_To the Editor_:--As an old Fellow of the A. M. A. I beg to present the following facts to you, and to ask if anything can be done by you to expose the methods of these people: A concern calling itself “The Anasarcin Chem. Co.” of Winchester, Tenn., has caused to be sent to physicians a chart on the subject of “Diagnostics of Renal Diseases.” This chart contains eighteen plates, which were all taken without knowledge or permission of either myself or my publishers, William Wood & Co., from the third edition of my book on “Urinary Analysis and Diagnosis.” The plates are partly composite plates, but mostly portions of plates, exactly reproduced from my book. I at once caused my publishers to write to the Anasarcin Company; and a few days ago I received a letter from a Dr. H. Elliott Bates of 118 East Twenty-Eighth Street, New York, whose letterhead says, “Medical Advertising.” In this letter the writer says that it was he who suggested the sending of such a chart, and admits that all the plates were taken from my book. In this letter he offers to have a letter sent to every physician of the country “in which it is explicitly stated that the cuts on the chart were taken from your book, and that complete information regarding the matters treated on the chart can be found in your book.” In other words he offers to advertise my book free of cost to me, so that I should take no further steps in the matter. I consider this entire matter an outrage, and thought it best to write to you for advice, since my publishers seem to think that in spite of the violation of the copyright nothing can be done.

Besides the cuts, some of the text on the chart is bodily taken from my book, while some of the other text, not taken from my book, but apparently compiled from different articles, is in part entirely wrong, so much so that I must be ashamed of its being associated with any of my own work.

By giving this letter your early consideration, and advising me what you think it best for me to do, you would greatly oblige

Louis Heitzman, M.D., New York.

[Comment.--Readers of The Journal are, of course, familiar with the articles[246] that have been published on “Anasarcin,” the “dropsy cure”! Knowing the standard of ethics that the Anasarcin concern adopts in the exploitation of its ridiculous squill mixture, our readers will not be surprised at the standard of commercial ethics which would justify the appropriation of copyrighted scientific material for nostrum advertising purposes. The statement of Dr. Heitzmann’s publishers that “in spite of a violation of copyright nothing can be done” is, of course, incorrect. Something _can_ be done by those who hold the copyright.--Ed.]--(_From The Journal A. M. A., Oct. 18, 1919._)

[246] J. A. M. A. =46=:288 (Jan. 27) 1906; ibid. =48=:1535 (May 4) 1907; ibid. =48=:1614 (May 11) 1907, and ibid. =49=:1992 (Dec. 8) 1917.

ANTIMERISTEM-SCHMIDT

Some, possibly many, of our readers have received a letter from Cologne, Germany, from the “Bakteriologisch-Chemisches Laboratorium Wolfgang Schmidt.” The letter contains a circular directing the attention of American physicians to “Antimeristem-Schmidt.” It also contains some advertising leaflets. One physician in sending this material to The Journal writes:

“A copy of the enclosed circulars has been sent to many of the physicians in this city, and probably elsewhere. Perhaps it has already been called to your attention. Let us be as liberal as possible with our recent enemies. The sooner the old channels of scientific communication are re-opened, the better. But let us not allow such blatant commercialism from a foreign country to go unprotested, any more than we should if it were from our own.”

It should be noted in passing that the envelop in which the Wolfgang Schmidt letter came has on its face a rubber-stamped impress to the effect: “Concerns Cancer Treatment.” The circular letter declares that by means of Antimeristem-Schmidt “either a cure or improvement has been effected in numerous inoperable cases” of malignant tumors. American physicians are asked “to employ the preparation when occasion arises” and are assured that “every medical man in city or country will be able to carry out treatment without preliminary knowledge.” With the letter are two leaflets discussing the use and administration of the product; one contained what was called a “Synopsis of some of the more recent publications regarding the employment of Antimeristem-Schmidt in inoperable malignant tumors.” The “recent” publications comprised three articles published in 1910 and one published in 1912!

Antimeristem-Schmidt was rather widely exploited some six or seven years ago. As was explained in The Journal, March 8, 1913, p. 766, it is a preparation claimed to be useful in the treatment of inoperable cancer and as a supplementary treatment after operations for cancer. The treatment is founded on a theory advanced by one O. Schmidt that the cause of cancer is found in a fungus, _Mucor racemosus_, which, Schmidt at first asserted, carried a protozoon which he regarded as the real cause of the disease. The vaccine is said to be prepared from cultures from this fungus. While Schmidt claims that he has been able to produce cancer by means of the organism, scientific research has not verified his claims. Extensive clinical trials have shown the treatment to be without effect. The Journal also advised its readers on April 19, 1913, that no license for the sale of Antimeristem-Schmidt had been granted by the Treasury Department and, therefore, its importation into this country was prohibited. Neither the therapeutic nor the legal status of the product has been changed since then.--(_From The Journal A.M.A., Dec. 6, 1919._)

ANTIPHLOGISTINE

_To the Editor_:--Last September, my chief, Dr. J. S. Millard, received a letter from the Denver Chemical Mfg. Co., manufacturers of “Antiphlogistine.” This letter purported to quote many large commercial concerns as testifying to the value of Antiphlogistine. Recently, I doubted the veracity of these claims and wrote to some of those quoted. I quote from the original letter of the Antiphlogistine company:

“The surgeon to the electric light and electric railroad company in New Orleans says that Antiphlogistine is the finest thing he has ever used in burns, especially flash and brush burns.

“The physician to the New York Edison Co. makes a similar statement. He says that the application gives speedy relief and the burns heal quickly without scars.”

I wrote to Dr. John Woodman, the physician to the New York Edison Co., who replied in part as follows:

“The Denver Chemical Manufacturing Company have no authority to quote me.... I gave Antiphlogistine a thorough trial, and found it had a very limited use, and I cannot recommend it for burns....”

Again, the Antiphlogistine letter said:

“It may be of interest to you to know that at the emergency hospital of the Ford Automobile Co. in Detroit, Antiphlogistine is carried in stock and is used extensively by the three physicians in burns, bruises, infected wounds, sprains and other traumatic conditions which are constantly arising in such a plant....”

I wrote to Dr. Mead who replied as follows:

“In answer to your letter of January 25th, will state that no Antiphlogistine has been purchased or used in this hospital for years past, and I cannot imagine why the representative of the Denver Chemical Company should make such a statement as attributed to him....”

He adds that “Antiphlogistine has never been used” in his department “on an open wound, abrasion or burn.” Is there not some way that such exploitation of our large companies can be prevented?

A. G. Gould, M.D., Akron, Ohio.

Plant Physician, the Goodyear Tire & Rubber Co.-(_From the Journal A.M.A., Feb. 23, 1918._)

“AUTO-HEMIC SERUM”

A Cure for Laziness, Ugliness, Frigidity and Many Other Things

The following letters are typical of many that have been received asking for information regarding Dr. L. D. Rogers and his “Auto-Hemic Serum.” This from a physician in New York state:

“Can you give me any information in reference to Dr. Rogers of Chicago, Ill., who has an Auto-Hemic Institute?”

And this from Kansas:

“Just received a letter from a Dr. L. D. Rogers, 2812 North Clark St., who is anxious to sell me a course in ‘Auto-Hemic Therapy.’ Would you kindly inform me what he has to sell? He did not tell me what it consisted of; am inclined to believe it is a rank fake. Kindly let me know what _The Journal_ thinks about it. Just what is it? In the letter they claim that it is practically a panacea for every blood disease.”

This from Maine:

“What is Auto-Hemic Therapy? I have a handsome red and yellow circular from the Ideal Life Extension Press, 2812 North Clark St., Chicago, soliciting subscriptions to their publication, offering as a bonus this book, ‘Auto-Hemic Therapy’ by L. D. Rogers, A.M., M.D., LL.D., Chicago, and membership in the American Medical Union.”

THE NATIONAL MEDICAL UNIVERSITY

In order better to appreciate the probable scientific status of “Auto-Hemic Serum,” it is well briefly to sketch some of the previous activities of its discoverer, Dr. L. D. Rogers. For many years Rogers was the head and chief owner of the National Medical University of Chicago, a low-grade school of the “sun-down” variety. The “university” is now out of existence and for some time before it went out of existence was not recognized either by the board of health of the state in which it operated or by the boards of the majority of the other states in the Union. The report of the Carnegie Foundation on medical education had this to say about the laboratory facilities of Rogers’ school:

“The school occupies a badly lighted building, containing nothing that can be dignified by the name of equipment. There has been no dissecting thus far (October to the middle of April, 1909), anatomy being didactically taught. Persistent inquiry for the ‘dissecting-room’ was, however, finally rewarded by the sight of a dirty, unused, and almost inaccessible room containing a putrid corpse, several of the members of which had been hacked off. There is a large room called the chemical laboratory, its equipment ‘locked up,’ the tables spotless. ‘About ten’ oil-immersion microscopes are claimed--also ‘locked up in the storeroom.’ There is not even a pretense of anything else. Classes in session were all taking dictation.”

Dr. Rogers is, or was, if he is not still, “Permanent Secretary” of the “National Association of Panpathic Physicians”--whatever that is. In fact, one of Dr. Rogers’ specialties seems to be the founding of quasimedical organizations--organizations, apparently, which may prove useful in the promulgation of such projects as he may, at the time, be interested in. A few years ago, Rogers was exploiting a “cancer serum” and, _presto_, the “American Cancer Research Society” came into being, L. D. Rogers, president. Soon thereafter certain members of the profession were circularized urging them to purchase shares in the “Cancer Research Laboratory and Hospital,” par value $10. Apparently, the profession did not invest.

A few years ago, also, L. D. Rogers’ name appeared on the “Faculty” list of the “American Post-Graduate School,” a concern which granted--on the mail-order plan--a long line of sonorous degrees and an equally complete line of ornate diplomas.

THE JAPANESE CONSUMPTION CURE

Then, in 1915, there appeared in the classified columns of certain newspapers the following advertisement:

TUBERCULOSIS--New Japanese treatment; to prove merits and give discovery quick publicity will send 10 days’ treatment free. DR. ROGERS, 546 Surf St., Chicago.

So far as we have been able to learn, Rogers, for some unexplained reason, did not call into existence out of the vastly deep a “Japanese-American Tuberculosis Research Society.” This consumption cure apparently died of inanition.

Then came the “Auto-Hemic Serum” with its inevitable sequel, the “National Society of Auto-Hemic Practitioners.” Another adjunct to the serum exploitation is the _North American Journal of Homeopathy_, the official organ of the “Auto-Hemic Practitioners” and of the “American Medical Union” and possibly of some other “societies”--but not representative of homeopathy!

WHAT IS AUTO-HEMIC THERAPY

What is this new therapy? According to a very lurid poster, it is described as “The Missing Link in Medicine”--possibly referring to the ease with which one may make monkeys of certain physicians. More specifically, although still vaguely, we learn:

“It consists in giving the patient a solution made by attenuating, hemolizing, incubating and potenizing a few drops of his or her own blood, and administering it according to a refined technic developed by the author.”

Elsewhere it is said to consist:

“... in taking five drops (or some multiple of five) of blood from a vein and putting it into nineteen times as much sterilized, distilled water, and incubating it at fever temperature for twenty-four hours, and then making further dilutions according to the needs of the case, as can be determined only by a physician skilled in its use.”

Neither of these statements, of course, describes the “refined technic” of those “skilled in its use,” but those who are interested can, by sending Dr. L. D. Rogers, “One Hundred Dollars cash-in-advance” get a mail-order course in this new marvel.

But if it is rather expensive to learn just how to use “Auto-Hemic Serum,” it does not cost so much to learn what the “serum” will do. Rogers has written a book on the subject, “Auto-Hemic Therapy,” which is used as a premium for subscriptions to the _North American Journal of Homeopathy_, price $5.00 per year, payable in advance. In the book Dr. Rogers modestly assures his readers that he considers his discovery more important than that of Alexis Carrel, winner of a Nobel Prize.

A CURE FOR LAZINESS

One of the chief virtues claimed for this serum is that of developing in the patient who takes it an unbounded energy that, apparently, makes him want to work himself to death. In some sensational articles that have appeared in Sunday editions of newspapers on Rogers’ serum, the stuff has been described as “Lazy Serum.” One of the first cases described in the Rogers book is that of a young waiter, “a good-for-nothing lazy fellow who would not work and would not pay for medical services” and who was turned over to Dr. Rogers’ free clinic. He was given the serum on Thursday and was told to report Saturday. He did not return until Monday, his excuse being that “he worked all day Saturday until midnight and all day Sunday and felt as if he could work all day and all night without rest.” The “case report” ends:

“... finally remarking, ‘I feel like a bird’ he flew out of the classroom and we never saw him again.”

HOUSEWIVES TAKE NOTICE

The next case described is that of a servant girl who had not worked for a year; within a week after taking the “Auto-Hemic Serum,” “she voluntarily beat carpets till she blistered her hands.” Then there was the rooming house keeper who had spent more than half of each day in bed. After an “Auto-Hemic” injection she “discharged her maid and janitor ... and did all the work of her twelve room house herself, beating rugs, firing furnace and carrying out ashes besides doing some of the laundry.” “Case No. 7176” is interesting: A man, generally considered the laziest person in his community and with a habit of “drinking thirty whiskies a day,” took “Auto-Hemic Serum.” He stopped drinking, shaved himself and changed from “a “bum” to that of a sober, clean, wholesome, bright and honest workman.” Then there was the case of the “lady physician” who “took the serum one evening and the next morning reported that she had the ‘giggles’ all day”; also she became “more magnetic.” More remarkable still was the case of the young woman clerk in a retail store who, after taking the serum, “astonished her employer by volunteering to work overtime.” In the chapter dealing with “Ills Peculiar to Women” Dr. Rogers details the moving story of a _man_ to whom the “serum” was given and who reported that “about the third twenty-four hours after taking it his bowels moved forty times”--nevertheless, “he felt no exhaustion.”

In all phases of human activity the serum seems to work wonders. “The cases are numerous in which the frigidity of both sexes have [_sic_] melted after Auto-Hemic treatment.” A young married woman with a morbid dislike for her husband took the serum and within a week “became normal.” The discoverer suggests that in some cases there is no doubt that this serum “would prevent divorce.” A 40 year old woman who could not endure to wear any waists but white or black was able, it seems, after taking the serum to tolerate a veritable Jacob’s coat.

Is, then, “Auto-Hemic Serum” good for everything? Let Dr. Rogers answer:

“Briefly stated, without any great exaggeration, this new modified serum treatment is good for anything that is the matter with you, provided the cause is not organic, mechanical or bacterial.”

One infers that in the inorganic, mental, spiritual and nonbacterial spheres the stuff is supreme. But it has its limitations. For instance, Dr. Rogers states that he once had “a very troublesome cough which lasted several weeks, but did not yield to this serum.” Reaching the conclusion that some other treatment was necessary “he had the bones of his neck ‘adjusted’ and got immediate relief.”

AS A COMPLEXION BEAUTIFIER

The serum “cannot be made up by the barrel and sold at wholesale or retail”:

“If it could be bottled and stored and sold at retail like a patent medicine, the demand for it as a complexion beautifier alone would net the proprietor millions. More than one person a few days after taking the treatment has been wrongly accused of painting.”

Should any of The Journal readers decide to take the $100 mail-order course in “Auto-Hemic Therapy” he should realize that even after he has done so there are certain restrictions in the practice of this “therapy.” In no case must he administer “a course of Auto-Hemic Treatment” for “less than $100, paid in advance.” The only exceptions to this rule are “cases of absolute charity, expectant mothers and to persons positively unable to pay that amount.” Furthermore, Dr. Rogers says that for the reputation of his method, as well as for the good of all concerned, “I insist that the entire fee be paid in advance and that the course extend over a period of one year whether the patient needs few or many treatments.”

DOLLARS AND CENTS

For those who do not wish to take the mail-order course, Rogers offers to prepare individual specimens of the “serum” from blood that is sent to him by the physician. The cost of this “serum” is $5.00, “in advance,” of course.

Still emphasizing the commercial side, “Auto-Hemic Therapy” is especially recommended to “the general practitioner growing old and the physician who is ambitious to build up a creditable and lucrative practice” because “the health of four people out of five (old or young, whether they consider themselves sick or well) taken at random can be improved by this method of treatment”! An Ohio physician was said to have doubled his $3,000 practice in two years after starting the “Auto-Hemic” method. A Virginia physician is alleged to have “increased his income $10,000 a year.” A Pennsylvania physician urged by Rogers to send $150.00 for the mail-order course, was assured that this “is merely a nominal amount, as most of the doctors have been able to get this amount back the first month.”

But enough. The story, were it not for the tragic element that forms the background, would be amusing. But it _is_ tragic!--(_From The Journal A.M.A., Feb. 14, 1920._)

“AUTOLYSIN” ADVERTISING

_To the Editor_:--Enclosed is a little booklet I received today from the Goodhue Publishing Co., of New York, exploiting the Horowitz-Beebe cure-all for cancer, which, were it not for certain obvious serious features, would make humorous reading.

What psychologic explanation can be made of the fact that there are always sufficient numbers of suckers to make such pseudoscientific adventures profitable?

H. C. Dodge, M.D., steamboat Springs, Colo.

_To the Editor_:--In my professional life I have been flooded with the usual number of insults to intelligence both by mail and by the softspoken detail man. As a result, I have no doubt, of the active propaganda for reform carried on by The Journal, these insults have lost a certain quality of “rawness” and become much more cleverly done.

One of these has just been perpetrated on the profession which will probably hold the championship pennant for 1916, although I admit that it is early in the year to begin prophecy. A very modestly bound, well printed volume comes to my desk with the compliments of the publishers. At the end of the volume is a group of highly ethical advertisements of other books of the author. So far, so good. The last four pages, however, contain the advertisement of a forthcoming book on the “autolysin” treatment of inoperable cancer. Perhaps we might forgive this were it not for the following paragraph: “This book tells how the general practitioner ... may take an active hand in fighting the malady. The weapons he requires are an ordinary hypodermic syringe and some ampules of Autolysin. The syringe he already possesses. Autolysin he may secure, if he is a legally qualified practitioner, by writing,” etc. Incidentally, the book is advertised to the Intelligent Layman.

Isn’t it beautiful? Too bad the lamented F. F. F. with his mock turtles or those prominent eugenists of scopolamin-morphin fame could not take a lesson in advertising. It was not very long ago that we were invited to come East and learn how to use “autolysin,” or else pay the rather heavy fee for an imported tutor. Now all we need is a “gun” and some of the “dope.” All this is interesting in view of the recent article on the failure of “autolysin” in mouse tumor. It is a foregone conclusion that a lot of “autolysin” will be used, so cancer patients, who have been told that they have cancer, will get better through suggestion, and a lot of enthusiastic reports will pour in from medical brethren who have never studied psychology. Then the thing will slump and we shall all be ready for the next fad.

Nevertheless, each one of these things furnishes us with a text for another sermon on ethics of medical advertising, so I suppose they do not live in vain.

J. W. Force, M.D., Berkeley, Calif.

Assistant Professor of Epidemiology, University of California.

[Comment.--With each of the foregoing communications is a circular letter from the Goodhue Company, advertising Dr. Henry Smith Williams’ book on “The Autolysin Treatment of Cancer.” With this circular is a booklet entitled “Notes on the Treatment of Inoperable Cancer with the New Remedy AUTOLYSIN (Horowitz-Beebe) Issued by the Autolysin Laboratory.” Similar circular letters and pamphlets have been sent to The Journal from various parts of the country. The Goodhue Company, publishers, therefore are apparently killing two birds with one stone--advertising the book as well as “Autolysin.”

The Journal has been informed that Henry Smith Williams in some of his magazine articles uses the pen name “Stoddard Goodhue,” and that Henry Smith Williams is a part owner of the Goodhue Publishing Company.

Articles on “Autolysin” will be found in The Journal, Nov. 6, 1915, pp. 1641, 1647 and 1662. The article on “Action of ‘Autolysin’ on Mouse Tumors,” by Dr. Francis Carter Wood, appeared in The Journal, Jan. 8, 1916, p. 94.-- Ed.]--(_Correspondence in The Journal A.M.A., Jan. 29, 1916._)

“BASIC CANCER RESEARCH” AND “COSMOPOLITAN CANCER RESEARCH SOCIETY”

Medical journals, and some other technical publications, have received recently what purport to be items of news value sent out by the “Medical News Bureau,” 77 Seventh Ave., Brooklyn, New York. The “manager” of this alleged bureau is given as D. E. Woolley. These “news items” are undated but are marked: “(For immediate release)” One of these starts with the statement, attributed to Mme. Curie, that cancer can be cured by radium and then continues:

“Cancer can be cured by the use of selenium and tellurium, more plentiful and less costly elements,” says F. W. Humphreys of Brooklyn, an American born student of chemistry and science who has devoted years to the study of the cause of cancer and the discovery of methods for relief....

“For the purpose of further developing methods of control and treatment of disease by the use of selenium and tellurium discovered by a number of local scientists, chemists and physicians, the Basic Cancer Research has been organized and an efficient laboratory established at 847 Union Street, Brooklyn....”

“Through the education of the people and special instruction to physicians it is hoped it may soon be possible to gain control of and eradicate the disease which now appears so great a menace. Mr. F. W. Humphrey, one of the organizers of the new institution, estimates that within ten years, or perhaps less time, cancer will no longer be considered a fatal disease.”

Evidently the joker here is the “Basic Cancer Research” of 847 Union Street, Brooklyn!

Newspapers are approached from a different angle. They receive free publicity matter on stationery reading “Cosmopolitan Cancer Research Society” (D. E. Woolley, secretary), 847 Union St., Brooklyn, N. Y. With this matter is a letter from Woolley addressed to the editor of the paper to which the stuff is sent and asking:

“In the interest of suffering humanity will you please give space to the enclosed?

“No object of greater importance has ever been presented for your helpful consideration. Thousands are dying whom you can help save.”

According to the “news item” that accompanies this letter the “Cosmopolitan Cancer Research Society” has been founded for the purpose of “investigating and developing methods” by which cancer “may be successfully combated and eventually eradicated.” It states further that the “society” will “disseminate information concerning symptoms, diagnosis, treatment and methods of prevention” of cancer. Furthermore, the membership of the society “includes physicians, scientists and chemists of prominence, laymen of means, and the sympathetically inclined from all walks of life.” Nor is this all!

“Doctor Frederick Klein the eminent authority on urinology and the chemistry of cancer, has evolved a new colorimetric test which is a most wonderful and valuable discovery in the diagnosis of cancer and various other diseases. This test will be particularly valuable in all life extension work because it determines, even in children the possibility of predisposition toward any particular disease, whether tuberculosis, cancer, diabetes or any of the diseases which in later life may become fatal. It determines also the vitality of the subject enabling the physician to accurately determine the condition of any of the vital organs.”

We learn in closing that memberships in the “society” are “graduated from $1.00 upwards according to the ability and disposition of those who may be interested.”

Located at 77 Seventh Avenue, from which the press agent material of the “Medical News Bureau” is sent, is the “Basic Chemical Corporation of America.” According to such information as we have been able to get, the president of this concern is F. W. Humphreys, the “student of chemistry and science who has devoted years to the study of the cause of cancer and the discovery of methods of relief.” We are informed that Mr. Humphreys was for a while in the employ of a “chemical company” of Philadelphia, and has been in the photographic line down in Virginia and later was connected with a real estate concern in Brooklyn. Another officer of the Basic Chemical Corporation is said to have been in the grocery line in a small village in Missouri, selling out and later coming to Brooklyn and entering the insurance business. Still another officer, it seems, was in the fish business. In addition to these three officers, there are two directors, one of whom is in the fancy grocery line, and the other is a local practicing physician whose name we find in the Propaganda department’s testimonial file under Sanmetto and Arsenauro.

The Dr. Frederick Klein, who is described as the “eminent authority on urinology and the chemistry of cancer,” is not a physician but claims a Ph.D. from Munich, Bavaria. Klein claims to have developed certain urinary tests. One of these, according to him, “indicates the body _Vitality_ with great accuracy,” another proves the presence of cancer, a third is the “syphilis test” and a fourth is the “pregnancy test.” And these are not all!

Those who read the reports of the Council on Pharmacy and Chemistry may remember that Frederick Klein is the gentleman who made “Sulfo-Selene,” which the Council, in refusing it recognition, described as a “mixture containing a selenium compound of undetermined composition produced by reduction of nitro-selenous acid with sulphurous acid, mixed with bile salts and diluents.” Sulfo-Selene was widely exploited in the newspapers in 1916 as a remedy for cancer, and Klein got a good deal of publicity at that time.

Just what product the Basic Chemical Corporation of America is putting, or is about to put, on the market we do not know. From the rather vague talk about selenium and Frederick Klein’s marvelous diagnostic discoveries, it might be inferred that “Sulfo-Selene” was to be resurrected. Be that as it may, it seems fairly obvious that the material being sent out by D. E. Woolley--whether as “Manager” of the “Medical News Bureau” or as “Secretary” of the “Cosmopolitan Cancer Research Society”--is advertising matter in the guise of news.

In this connection it is worth noting that the American Newspaper Publishers’ Association, in a special bulletin issued in 1909, published a very complete list of press agents and the interests these agents represented. This list contains the name D. E. Woolley, who then was sending out press notices for the National Association of Piano Dealers of America. Is this the gentleman who is now acting as press agent for the Basic Chemical Corporation of America? If it is, it may be that the slump in the piano trade has caused Mr. Woolley to turn from musical instruments to cancer cures.--(_From The Journal A. M. A., Sept. 3, 1921._)

Seleni-Bascca

In the issue of September 3 The Journal called attention to a campaign of free publicity that was being instituted by a Brooklyn concern that, apparently, had for sale an alleged remedy for cancer. The press agent material was of two kinds--for medical journals and for newspapers. That which went to the medical journals was sent out on the stationery of the “Medical News Bureau,” 77 Seventh Ave., Brooklyn. The “manager” of the bureau was given as D. E. Woolley. The items sent out to medical journals stated that the “Basic Cancer Research” had been organized to develop a treatment of cancer by the use of selenium and tellurium.

The material received by newspapers was sent out by the “Cosmopolitan Cancer Research Society,” 847 Union St., Brooklyn (the same address as the “Basic Cancer Research”). The “Secretary” of the “Cosmopolitan Cancer Research” was D. E. Woolley!

The name of one “Dr. Frederick Klein” loomed large in the matter sent out by the “Cosmopolitan Cancer Research Society.” Klein, we were told, is “the eminent authority on urinology and the chemistry of cancer.” The Journal called attention to the fact that Frederick Klein’s name was not unknown in the Propaganda files, as he was the gentleman who manufactured “Sulfo-Selene,” a product that was widely heralded in the newspapers in 1916 as a remedy for cancer. It was also brought out that Klein, who is not a physician, claims to have evolved certain remarkable urinary diagnostic tests whereby the presence of cancer, syphilis, etc., may be determined.

More than a month after the publication of The Journal’s article, a letter was received (October 8) from Frederick Klein. To quote literally from part of the letter:

“In the above _Journal_ dated Sept. 3th, Vol. 77, on page 805, regarding the ‘Cosmopolitan Cancer Research Society’ you have amongst others, mentioned my name Dr. Frederick Klein.

“I wish to inform you that I have given my legal adviser the order to write a note to the above Cosmopolitan Cancer Research Society, 847 Union St., Brooklyn, forbidden them to the effect that my name _should not_ be used by above society in any form or writing in any of their transactions, this has been done some time ago to prevent unethical conceptions concerning myself.”

Shortly after the article of September 3 another item appeared in the newspapers throughout the country to the effect that the Cancer Research Society was offering a “$100,000 Cancer Prize” for a “medicinal cure for cancer.” Many of the newspapers of the country seemed to bite on this piece of free publicity. This was in the first week of October. In the third week of the same month a Brooklyn paper announced that 3,000 people had submitted formulas for curing cancer to the Cosmopolitan Cancer Research Society. The article containing this announcement gave interesting descriptions of some of the “cures” submitted and closed with the statement that the Cosmopolitan Cancer Research Society was establishing “clinics” in various cities. It ended with the statement:

“All treatments are confidential. In this respect the society had the cooperation of the Brooklyn Bureau of Charities. It also has the cooperation of the American Medical Association.”

The closing sentence is, of course, unequivocally false.

At the time of The Journal’s article the name of the particular preparation which the Basic Chemical Corporation of America was putting out was unknown. Shortly after the article appeared it was learned that the product was on the market as “Seleni-Bascca.” A physician, himself a sufferer from carcinoma, after reading the article of September 3, sent The Journal some correspondence he had received from the Cosmopolitan Cancer Research Society regarding the alleged cure. One piece was a letter signed “F. W. Humphrey, Acting Director; Dictated by Dr. George D. Barney,” which read in part:

“Our claim is a very simple one indeed, namely that the use of a proper preparation of Selenium (Seleni-Bascca) restores the Sulphur metabolism to normal; we claim that cancer cannot exist in any form, when the Sulphur metabolism is normal, the results from the proper use of Seleni-Bascca in cases of Carcinoma are quick and lasting, the Medical Profession can hardly realize that in this modest treatment a remedy for the Dreaded Carcinoma has been discovered.

“Seleni-Bascca in its colloidal form is quickly taken up by the blood stream, reaches the finest tissues and almost immediately resists the further growth of the disease. The research work has been going on since 1901, under the direction of Dr. Frederick Klein, in connection with Medical Men who have proved to their own satisfaction that Seleni-Bascca should be used as a treatment in every case of malignancy.”

Seleni-Bascca comes in small vials containing fifty tablets. Each vial bears a label reading:

“_SELENIBASCCA._ A mixture of Colloidal Selenium in tablet form. Recommended in the internal treatment of Carcinoma and some other cases of faulty metabolism.”

Some of the preparation was turned over to the A. M. A. Chemical Laboratory with the request that the tablets be examined to determine whether or not they contained, as claimed, selenium in colloidal form. The laboratory report follows:

CHEMICAL REPORT

“An original vial of ‘Seleni-Bascca’ (Basic Chemical Corporation of America) was examined in the A. M. A. Chemical Laboratory to determine whether or not the substance contained colloidal selenium. The bottle contained 50 tablets weighing approximately 0.1 gm. (about 1-1/2 gr.) each. The major portion of the tablet was soluble in hot water. Qualitative tests indicated the presence of chlorid, sulphate, small amount of nitrate, potassium, sodium, starch, talc and selenium. Tellurium was not found to be present. The ash was equivalent to 5.5 per cent.; over one-half of the ash consisted of a talc-like substance. The amount of selenium present in the specimen examined was only about 1.3 per cent.

“In the literature sent out by The Basic Chemical Corporation, ‘Dr. Frederick Klein’ is mentioned as chemist. Several years ago, the Council on Pharmacy and Chemistry investigated ‘Sulfo-Selene,’ a cancer remedy, with which the same ‘Dr. Klein’ was connected. The alleged composition of ‘Sulfo-Selene,’ as given to the Council, was:

“Selenium .25 “Sulphur (partially in colloidal .10 and partially in crystalloid state) “Potassium carbonate .10 “Nitrogen .05 “Bile Salts .50 “To which is added an inert base or vehicle; as sugar of milk or amylum.”

“It was claimed that ‘Sulfo-Selene’ was prepared by reducing nitro-selenious acid with sulphurous acid, neutralizing with potassium bicarbonate and then adding bile salts. Assuming that the composition claimed for ‘Sulfo-Selene’ was correct the analysis of ‘Seleni-Bascca’ shows that the two products resemble each other. The tests, however, failed to reveal in ‘Seleni-Bascca’ the presence of the bile salts claimed to have been present in ‘Sulfo-Selene.’”

“The product is not colloidal as claimed as the selenium can be removed by ordinary filtration.”--(_From The Journal A. M. A., Nov. 19, 1921._)

Repudiated by the Brooklyn Bureau of Charities

_To the Editor_:--My attention has been called to the fact that there appears in a recent issue of The Journal of the American Medical Association a statement that the Cosmopolitan Cancer Research Society, located at 847 Union Street, Brooklyn, has the cooperation of the Brooklyn Bureau of Charities. In reply may I say that the Bureau of Charities has no connection, understanding, or relationship whatever, with the Cosmopolitan Cancer Research Society, and has never sent a patient to them.

T. J. Riley, Brooklyn.

Secretary, Brooklyn Bureau of Charities.--_Correspondence from The Journal A. M. A., Dec. 24, 1921._

BELL-ANS (PAPAYANS, BELL)[J]

As the New York Tribune’s “Ad-Visor” Sees It

[J] See index for additional article on Bell-Ans.

“Why avoid draughts? Sit by an open window if you want to! Just take a few drops of Sneeze-o before you go into the draught and after you come out of it, and you’ll never catch cold.

“Don’t be afraid of contagion. Kiss your Uncle Ebenezer, even if he’s dying of tuberculosis! Just fortify yourself with a sip of Lungicide before you go to his bedside, and another when you come away, and you’ll be taking no risk.

“Are you going to sit there and let the other folks eat up all the good things just because you are afraid to pitch in, when 2 or 3 Bell-Ans taken before and after the meal would enable you to enjoy your share of all that’s coming without a bit of discomfort or distress? Bell-Ans has restored the pleasures of the table to thousands who say: ‘I can now eat anything and plenty of it, too.’”

“The first two blurbs are The Ad-Visor’s. The third is a bona fide advertisement of Bell-Ans, aimed to catch the holiday trade. They are all patterned after the same style and the first two are no more lacking in logic than the last. Overeat--deliberately court indigestion--invite gout--don’t be a gourmet, be a gourmand--be an anti-Hoover and eat a lot of food, whether you need it or not; than take Bell-Ans. If it doesn’t ‘absolutely remove indigestion,’ your druggist will give you back your money! Could anything be fairer than that?

“Such copy as this is not limited in its evil effects to the misguided individual who eats lobster and ice cream at midnight and trusts to Bell-Ans to atone for his indiscretion. The most serious effect of such reckless advice is the example which the advertising sets to other advertisers.”

The comments just quoted are from the Ad-Visor department of the New York _Tribune_ of Feb. 7, 1918. They are respectfully referred to the _New York Medical Journal_, the _International Journal of Surgery_ and the _Woman’s Medical Journal_--three presumably scientific publications that through their advertising pages urge physicians to prescribe Bell-ans.--(_From The Journal A.M.A., Feb. 23, 1918._)

CAMPHO-PHENIQUE

Appealing to the New Fledged Graduate.

The secretary of the Harvard University Medical School received from the Campho-Phenique Company of St. Louis a letter that, presumably, has been sent to most of the medical colleges of the country. It read:

“We wish to supply the senior class of all Medical Colleges with physicians’ samples of CAMPHO-PHENIQUE Liquid and CAMPHO-PHENIQUE Powder, and Ointment for 1918.

“We will thank you very kindly if you will send us a communication stating the number of students in your graduating class, and if possible, we would like the name of each and every student, that we may send him personally a sample of CAMPHO-PHENIQUE. In this way, we are sure the party receives the sample.”

Presumably, the Campho-Phenique concern believes in following the old advice: Catch ’em young! In this connection, it may be well briefly to call to the attention of fourth-year medical students the results of the investigation of the Council on Pharmacy and Chemistry of Campho-Phenique. The Council’s findings on Campho-Phenique Liquid were to the effect that the preparation, which was exploited under a false “formula,” was, essentially, a solution of camphor and phenol in liquid petrolatum, substances well known in medicine and none of which under its own name has been credited with possessing any superlative virtues. The Council’s verdict on Campho-Phenique Powder was that “for all practical purposes it is essentially a camphorated talcum powder” containing, apparently, sufficient camphor and phenol to give the talcum powder an odor. It was further brought out in the Council’s report that the Campho-Phenique Company was in effect one of the numerous trade names adopted by one James F. Ballard of St. Louis. Mr. Ballard seems to market a number of “patent medicines,” most of them sold direct to the public, but some, as in the case of Campho-Phenique, exploited to the public via the medical profession. “Herbine,” a “marvelous preparation” that “puts the liver in healthy condition”; “Ballard’s Snow Liniment” that when applied to wounds performs “a perfect cure that leaves no scar”; “Dr. T. L. Stephens’ Chemical Eye Salve” which “acts quickly in all cases” and cures “failing vision,” are some of the numerous “patent medicines” made and sold by Ballard. “Collins Ague Remedy,” “Swaim’s Panacea,” “Swayne’s Panacea” and “Renne’s Pain Killing Oil” are four more of Mr. Ballard’s products, for each of which he has pleaded guilty in the federal courts to making false and fraudulent claims knowingly and wantonly.

If medical colleges of the better class were turning out graduates today who could be caught by free samples of such nostrums as Campho-Phenique, then, indeed, would the outlook for the future of scientific medicine be a gloomy one. But they are not. The young man or woman who goes out today from a reputable medical college is imbued with the scientific spirit, has developed habits of straight thinking and will not, we believe, be so uncritical as to accept at their face value claims made for nostrums of the Campho-Phenique type.--(_From The Journal A. M. A., Feb. 9, 1918._)

“CINCHOPHEN”: FORMERLY “ATOPHAN”

It will be remembered that the Federal Trade Commission adopted the names arsphenamin and neoarsphenamin for the drugs first introduced as “salvarsan” and “neosalvarsan,” respectively; the terms barbital and barbital sodium for the substances first introduced as “veronal” and “veronal sodium,” and the word procain as the name for the compound first marketed as “novocain.” In issuing licenses for the use of the patents on these drugs, the commission stipulated that the drugs should be sold under the new American title unless the firm desired to use a new trade designation, in which case the titles chosen by the commission should be given equal prominence. The Council on Pharmacy and Chemistry has cooperated with the Federal Trade Commission and has adopted the new names as the descriptive names which appear in New and Nonofficial Remedies. The Chemical Foundation, Inc., which has purchased some 4,500 German-owned patents, many of them for synthetic drugs, proposes to continue the wise policy of the Federal Trade Commission by requiring that those who receive licenses for the use of patents for synthetic drugs must use a common designation for each drug selected by the foundation. “Cinchophen” has been selected as the designation for the substance introduced as “atophan” (also described in the U. S. Pharmacopeia under “phenylcinchoninic acid”). In consideration of this action on the part of the Chemical Foundation, and also because physicians found it difficult to use the pharmacopeia name “phenylcinchoninic acid,” the Council on Pharmacy and Chemistry has recognized the contracted term “cinchophen” as a name for the drug introduced as “atophan.” It is hoped that physicians will support this simplified and nonproprietary nomenclature in the same spirit with which they adopted the terms “arsphenamin,” “barbital” and “procain.”--(_Editorial from The Journal A.M.A., Aug. 9, 1919._)

“COLLOSOLS”: AN UNCRITICAL ENGLISH ENDORSEMENT

Under the auspices of the British Association for the Advancement of Science, there has just appeared a report on the present status of colloid chemistry.[247] The work has been recognized as sufficiently important to receive the endorsement of the government Department of Scientific and Industrial Research. Of particular interest to physicians is the chapter on “Administration of Colloids in Disease” written by Alfred B. Searle, “consulting chemist, Sheffield.” After a somewhat academic generalization of colloidal drugs, the “thesis” is devoted largely to the “Collosols”--proprietary preparations made by the Crookes Laboratories. The “scientific” evidence presented by Searle for colloids in medicine reads as if the advertising literature of the Crookes concern had been considered ample source of information. Thus: “Colloidal Manganese,” besides having been “used with remarkable and surprising results in the treatment of coccogenic skin diseases,... gives excellent results [in impetigo, chronic seborrheic eczema and acute folliculitis] when employed in conjunction with intramine”! The grave danger of the intramine therapy has been known for more than two years, both here and abroad,[248] in fact, one author stated that in cases of intramine injections, “the pain is undiluted torture.” In a style as bombastic and verbose as the usual house-organ write-up, the report recklessly details all sorts of conditions in which so-called colloids--and particularly the “Collosol” brand--have been recommended, but derogatory findings are conspicuous by their omission. Even Sir Malcolm Morris is quoted as lending his name (and title) to the endorsement of “Collosols.”

[247] British Association for the Advancement of Science. Second Report on Colloid Chemistry. Published for the Department of Scientific and Industrial Research by His Majesty’s Stationery Office.

[248] Ferrivine, Intramine and Collosol Iodine, J.A.M.A. =69=:841 (Sept. 8) 1917.

In the United States the medical profession has created a means whereby physicians need not be misled by such “high” authorities as evidently has been the case with our English confrères. Once more the value of the Council on Pharmacy and Chemistry is strikingly manifested. What are the facts about “Collosols”? The Council has reported that a number of the “Collosol” preparations were not colloids at all, and “if ... injected intravenously as directed, death might result, making the physician morally if not legally liable”;[249] that in the cases in which the therapeutic claims were examined, the claims were found to be either exceedingly improbable or exaggerated; furthermore, that the A. M. A. Chemical Laboratory found “Collosol Cocaine,” on analysis, to contain only 40 per cent. of the claimed amount of cocain.[250]

[249] Collosol Preparations, J.A.M.A. =72=:1694 (June 7) 1919.

[250] Collosol Cocaine Not Admitted to N. N. R., J. A. M. A. 72: 1094 (April 12) 1919.

Such are the findings which have been presented to the American physician. But the British physician is now being made the object of an intensive advertising campaign for “Collosols,” based in part on an uncritical, pseudogovernmental endorsement. Just so long as the English profession will not protect itself by creating a competent board to examine and judge proprietary medicines and to control methods of exploitation, just so long will such extravagant and even cruelly misleading claims continue to impede scientific progress in therapeutics.--(_Editorial from The Journal A. M. A., Oct. 18, 1919._)

Collosol Manganese

_To the Editor_:--Has anything been published on the efficacy of “Collosol Manganese” in malaria? I recently read the Council’s report which indicated the fakishness of the “Crooke’s Collosols,” but I also was told that the War Office of England had requested a study to be made of colloidal manganese in malaria.

J. B., Columbus, Ohio.

ANSWER.--Stephens, Yorke, Blacklock, Macfie, Cooper and Carter report in the _Annals of Tropical Medicine and Parasitology_ (Feb. 28, 1919, p. 345) the results of their investigation for the English government and conclude: “Collosol Manganese in the doses used is of no value in the treatment of simple tertian malaria.”--(_Query in The Journal A. M. A., May 3, 1919._)

COTTON PROCESS ETHER

_To the Editor_:--Please let me know what information you have about the enclosed clipping?

E. W. Carpenter, M.D., Greenville, S. C.

_To the Editor_:--“Cotton Process Ether,” manufactured by the Du Pont Co., has been given considerable notoriety in the lay press. A letter of inquiry addressed to the firm elicits the information that “Cotton Process Ether is a very highly refined Di-ethyl Ether charged with Ethylene Gas.” ... What is your opinion of the “Cotton Process Ether”? Has the Council on Pharmacy and Chemistry investigated this product?

John L. Atlee, M.D., Lancaster, Pa.

_To the Editor_:--I have been waiting for some reference to the new anesthetic referred to in the enclosed clipping, but if any has been made in the medical press I have failed to notice it. If there is anything of interest in connection with this item, and it is not too much trouble, I will thank you to put me in touch with the situation.

Holman Taylor, M.D., Fort Worth, Tex.

ANSWER.--About January 20, the “News Service” of the “E. I. Du Pont De Nemours and Co., Inc.,” circularized the press of the country with what it was pleased to term a “good ‘filler’”; this particular piece of press agent work dealt with “The New Du Pont Ether.” To quote one paragraph from the “News Item”:

The new anesthetic, which is a highly refined di-ethyl ether, modified by the addition of gases, has the following characteristics: (1) the property of inducing and maintaining anesthesia with practical freedom from postoperative nausea, and (2) the property of inducing and maintaining analgesia (conscious insensibility to pain) as distinguished from anesthesia (insensibility to pain plus narcosis).

The Du Pont Ether and the claims made for it are seemingly based on the work of one man, “James H. Cotton, M.A., M.D., Toronto, Canada,” who published an article on “Cotton Process Ether and Ether Analgesia,” in the _American Journal of Surgery_ for April, 1919. However, Cotton did not give the composition of the “new” ether nor, so far as we are aware, has his work been corroborated. In view of the inquiries received, the Secretary of the Council on Pharmacy and Chemistry asked the Du Pont Chemical Works for the composition of the new ether. From the firm’s reply we quote one paragraph:

“... The procedures of manufacture, and the exact composition of our ether, we regard as confidential information which we are entitled to retain unless a condition were to arise in which we were unable alone to satisfy the demand for this type of ether.”

It has been recognized--and incorporated in the “Principles of Medical Ethics”--that the use of a therapeutic agent of unknown composition is unscientific and contrary to the best interests of the medical profession and the public; but it is many times more serious for a physician to employ a secret or semisecret substance as an anesthetic. A physician using such a semisecret substance would have little defense if the patient should die.--(_Query in The Journal A. M. A., Feb. 21, 1920._)

A Note from the Manufacturers

In the Query and Minor Notes department of The Journal of February 21, some inquiries from physicians relative to “Cotton Process Ether” were answered. In referring to the composition of this product it was stated that the secretary of the Council on Pharmacy and Chemistry had asked the manufacturers, the Du Pont Chemical Works, for information on this point and one paragraph from the firm’s reply was quoted. Another paragraph from the same letter was omitted; and to this omission the manufacturers took exception, expressing the opinion that by it The Journal led its readers to infer that the concern had “refused to furnish any information whatever” regarding the composition of the ether. The following paragraph, italicized as in the original letter, is the one in question:

“_Cotton Process Ether contains no components which do not occur in other anesthesia ethers._ Its peculiar properties result from the thorough methods taken to exclude harmful impurities, such as aldehydes, peroxides, traces of acids, carbon monoxide, sulphur compounds, etc., and to include carefully regulated quantities of only such of the usual components as we have found to give distinctly beneficial properties to the ether. We are willing to state that in this class we consider properly prepared ethylene of greatest importance, but we have not announced which of the beneficial components of anesthesia ether we include in our ether, or the amount of such components.”

As the quotation shows, the paragraph is informative in a negative rather than in a positive way in that it states what Cotton Process Ether _is not_ rather than what it _is_. Since that time, however, the manufacturers have notified The Journal that they have definitely decided to present Cotton Process Ether to the Council on Pharmacy and Chemistry for consideration and that in preparing the data required by the Council will define Cotton Process Ether as follows:

“An improved anesthesia ether consisting of highly refined diethyl oxid (C₂H₅)₂O, plus approximately two volumes of ethylene (C₂H₄), 1/2 volume of carbon dioxide (CO₂) and 1 per cent. by weight of ethyl alcohol.”--(_From The Journal A. M. A., May 22, 1920._)

DIONOL

“Dionol” is advertised to physicians by the Dionol Company of Detroit. If one takes the word of the manufacturers, the therapeutic possibilities of Dionol are apparently limited only by the blue sky. Even the company admits that “the unprecedented range of action” of this marvel “may come as a surprise.” A glance over the published “case reports” confirms the inference. From “Bed Sores,” “Bubo,” “Catarrh” and “Circumcision” through “Croup,” “Deafness,” “Dysmenorrhea” and “Eczema,” including “Endometritis,” “Erysipelas,” “Gastritis” and “Hemorrhoids,” not omitting “Osteomyelitis,” “Otitis Media,” “Pneumonia” and “Ptomaine Poisoning,” down through the pathologic alphabet to “Quinsy,” “Sciatica,” “Spinal Curvature,” “Varicose Veins,” and “Whooping Cough” one concludes that here at last is a catholicon indeed.

What is Dionol? First it should be said that the preparation comes in two forms: as an ointment and as an emulsion. The ointment, so declare the manufacturers, “is _always_ required”; the emulsion may be used “as an auxiliary treatment.” The Dionol “literature” when stripped of the verbal camouflage with which it abounds may be said to propound the following theories and propositions: First, that the nerves of the body are electric conductors insulated from the surrounding tissues by the nerve sheaths; second, that inflammation breaks down the insulation with the resultant escape of the current and an interference with the normal metabolic action of the cells; third, that Dionol, when applied to the body, penetrates the tissues, “coating the cells and with them the nerve sheaths with a nonconducting layer which is sufficient to insulate the nerve sheaths and stop the leak.”

So much for the theory on which the alleged action of Dionol is based. Dionol itself is a sort of glorified petrolatum. Not, of course, that the manufacturers describe it in any such crude and understandable language. According to the company, Dionol is “composed of pure hydrocarbons, especially selected with regard to specific gravity, viscosity and other necessary physical properties” which has been “perfectly _deionized_ by our special scientific process under the Baines Method.” It appears, from further reading, that ordinary petrolatum will not “turn the trick”; presumably because it does not overcome the human short circuits which the Dionol Company declare are always present in inflammation. When, however, the petrolatum has been subjected to the “Baines Method” it achieves, it seems, an esoteric value that puts to shame its plebeian origin.

The whole thing is very simple. To those physicians that like this sort of thing this preparation should make a strong appeal.--(_From The Journal A. M. A., Jan. 26, 1918._)

Glorified Petrolatum

An Indiana physician sends us in a batch of leaflets detailing the marvels of “Dionol” and thus comments:

“I received the enclosed in the mail today and I am puzzled, perplexed and astounded. I had formed the opinion that the profession was getting better; that it was more scholarly than formerly when the two course school was still in existence and any one could matriculate; that it was no longer possible for a ‘patent medicine’ manufacturer to palm off his wares on us. After reading this stuff and realizing that such methods must be remunerative, I am deeply humiliated. Is it possible that educated physicians respond to this kind of advertising? Or has some one perpetrated a joke on me? If the profession can be thus successfully exploited one can no longer wonder at the following which every new ‘ic’ and ‘ism’ acquires.”

It is a pity that the medical profession generally does not react to the Dionol and similar advertising as does our correspondent. As the concern continues to do business, the presumption is that at least some physicians are using Dionol. As was pointed out in The Journal of Jan. 26, 1918, Dionol seems to be a glorified and esoteric form of petrolatum. The exploitation of Dionol is based on the following theory: (1) The brain is a generator of neuro-electricity; (2) the nerves are the conductors of this electricity; (3) the nerve sheaths are the insulator; (4) wherever there is local inflammation the nerves are short circuited, due to a breaking down of the insulation resistance of the nerve sheath; (5) this results in “an escape of neuro-electricity;” (6) Dionol coats the nerve sheaths with a nonconducting layer and this restores the insulation and “stops the leak.”

Whether this ingenious theory was invented to lend an air of verisimilitude to an otherwise bald and unconvincing tale and give a “reason for being” for Dionol or whether Dionol was first invented and it became necessary to evolve a theory that would give some plausibility to the claims made for this etheralized petrolatum, we are unable to say. In any case the theory and the product are exploited together.

Among the material sent in by a correspondent are some “Dionol Case Reports.” Neither the names nor the addresses of the physicians making these reports are given, but the company states that they may be had “on request.” One special “report” is featured under the heading “Infected Wound. Striking Results After United States and French Government Army Surgeons Failed” is signed “Dr. W.” It is dated July 19, 1919. A few months ago the Dionol Company was sending out this same testimonial with the full name and address of the “doctor” giving it. Investigation showed that the “doctor” in question was an osteopath whose specialties, according to his advertisement in his local newspaper, are “Catarrhal Deafness and Hay Fever, Acute and Chronic Diseases”! In this connection it is worth noting that investigation of some of the earlier testimonials sent out by the Dionol concern and alleged to have been given by “doctors” showed that the gentlemen in question were “drugless healers.”

As a “true indication of the value which the medical profession is placing on Dionol” the Dionol Company has published the names of some physicians who, it is alleged, have used the preparation.--(_From The Journal A. M. A., Feb. 7, 1920._)

THE ELI PRODUCTS OF ELI H. DUNN

Physicians are receiving some miscellaneous advertising matter from a concern that seems to operate under various names such as “E. H. Dunn & Co.,” “Eli H. Dunn,” “Eli Laboratory,” etc. The concern is located at 3820 Main St., Kansas City, Mo. One Journal reader, who is evidently not greatly impressed by this material, forwards the stuff to us with the laconic request: “Will you please give me your opinion on this junk?”

The “junk” referred to comprised, in part, an advertising leaflet on “Eli 606 Capsules,” another leaflet on “Eli Vaginal Capsules,” still another on “Eli ‘Vim’ Restorative;” then there was reference to the inevitable nostrum for intravenous use: “Ampoules Eli Venhydrarsen.” A four-page leaflet, headed in large and very black letters “Confidential Guide to Live Wire Physicians Only,” expressed its key-note in the opening paragraph:

“How to make MONEY as well as REPUTATION in the treatment of all CHRONIC AILMENTS and all types, forms and sequella of VENEREAL diseases.”

The “Eli ‘Vim’ Restorative” is said to be a “tonic aphrodisiac.” The “action” of the product is to “Arouse Sexual Ardor and Desire. Influx blood supply to the genital organs.” A postscript to the “Guide” urges physicians:

“If you do not already use Intravenous Serums, by all means get an outfit, if for no other reason than to meet the popular DEMAND.”

A “Special Note” in the “Confidential Guide” advises physicians who “have to deal with Hysteria” to “write the Author of this Guide, who will explain by personal letter a method of cooperation by which such Convulsions may be At Once and forever stopped.... There will be $100 for You from every case treated.” One physician wrote to the “Author of this Guide”--Eli H. Dunn, M.D.--asking for further information on this treatment for hysteria. He received in reply two letters both signed Eli H. Dunn; one was to be shown to the patient, the other was for the doctor’s own information. The letter for the patient to see described the marvelous effects of “Dunn’s Intravenous and Restorative Treatment” in hysteria and recommended it “with the utmost confidence in every case able to pay you the fee commensurate with the service you render.” Then followed these two paragraphs:

“The cost of the treatment when administered by yourself is $300 CASH WITH ORDERS which includes one complete outfit and technique for administering.

“Should you call me personally in consultation an additional fee of $150 per diem covering the time I am away from my Kansas City office; fees to be collected and held until I arrive.”

The letter that was intended only for the doctor’s eye declared:

“You are to have $100 of the fee and $50 of the per diem.”

It explained that the “complete outfit” referred to in the “patient’s letter” would “consist in part of a tube of intravenous medication” and doses of “Restorative Capsules” and “Eli 606 Capsules.”

Eli H. Dunn seems to have had a somewhat varied and spectacular career. After being graduated in 1885 he apparently started practice in Orion, Ill. During the nineties he was practicing at Elma, Iowa, and about 1900 he seems to have moved to Kansas City, Mo. During 1906 and 1908, he also had an additional office at Denver, Col. About this time he was exploiting “Dunn’s Uterine Evacuant” which was “a strictly legitimate” product which could “be injected within the uterus with perfect safety and immediate effect.” This stuff was advertised both from the Kansas City and the Denver offices. The “Personal Column” of a Kansas City paper in 1910 carried the message to “Ladies” that “Dr. Dunn” was a “Regular physician for women only,” Dunn’s violation of the postal laws in 1911 and of the federal Food and Drugs Act in 1912 need not be gone into at this time.

The Journal would feel like apologizing for devoting space to such a preposterous scheme were it not for the fact that physicians, being human, sometimes “fall for” preposterous schemes. Some, we know, have nibbled at Dunn’s bait; others may do so. The gross commercialism that permeates the advertising matter sent out by Dunn again emphasizes the fact that the fad for intravenous medication offers an attractive field for those who would exploit our profession.--(_From The Journal A. M. A., Nov. 22, 1919._)

GLOVER’S CANCER SERUM

Scores of letters have reached--and are reaching--The Journal office similar in effect to the following:

“I am enclosing ‘literature’ received from the ‘T. J. Glover Research Laboratory.’ Though purporting to come from Toronto, where the $25.00 are to be sent, if you please, the envelope bears the 448 New York postmark.”

The above is from New Jersey while the two following are from Michigan and Illinois, respectively:

“Have you any information in regard to this party and his treatment for cancer? This is the first I have heard of any such work having been done. One wonders if it is presented in good faith or if the money god has overcome the gentleman’s scientific spirit.”

“Is this just one more of them? Why a roan horse? Some people might want serum from a nice bay or calico cow pony.”

The literature referred to comes in an envelop bearing the name of “T. J. Glover, Research Laboratory, Toronto, Canada,” but mailed, apparently, from New York City. The enclosures are a single sheet circular signed Thomas Joseph Glover and entitled “Etiology of Cancer,” a “Directions” slip and a card quoting prices. In the circular Dr. Glover states that he has prepared a serum from immunized horses, “between ages of seven and nine years, of the roan type,” and has injected this intramuscularly “into patients in the advanced stages of cancer and noticed that it has a specific action on every known type of cancer.” Further:

“Up to the present time I have apparently cured cancer of the face, eye, nose, lip, mouth, tongue, stomach, bowel, bladder, breast and uterus.”

In addition to the circular, was a small leaflet giving directions for the injection of the serum and also a card bearing Dr. Glover’s name and Toronto address and reading:

+------------------------------------------------------------+ | This is to advise you that DR. T. J. GLOVER’S Serum | | for the treatment of cancer can now be had by | | application to office at above address. | | | | PRICE FIVE DOLLARS PER TREATMENT. FIVE TREATMENTS | | MINIMUM NUMBER SENT AT ONE TIME. | | | | Send money by Post-Office Money Order or Certified Cheque. | | | | DIRECTIONS FOR TREATMENT WITH EACH ORDER. | +------------------------------------------------------------+

This advertising material, which is evidently being widely circulated in the United States, would indicate that the Glover Research Laboratory had received a permit from the United States Public Health Service licensing the interstate sale of this serum in the United States. No such license has been issued.

The Journal briefly reported in the department of Medical News, Oct. 30, 1920, that the Academy of Medicine of Toronto had appointed a committee to investigate the claims made for the Glover “cancer serum.” In the meantime, the most charitable thing that can be said is that the “treatment” is in the experimental stage and the reported results have not been corroborated by independent investigators.--(_From The Journal A.M.A., Jan. 1, 1921._)

The Toronto Academy of Medicine Reports Unfavorably on Glover’s Cancer Serum

The method of exploitation of the alleged cancer serum being put out by Dr. T. J. Glover of Toronto, Canada, was briefly discussed in this department of The Journal for January 1. At that time it was pointed out that the medical profession of the United States was being widely circularized by Dr. Glover and that, while the letters purported to come from Toronto, they were, in fact, mailed from New York City. Since this article appeared the circularization seems to have continued undiminished and physicians in various parts of the United States have sent in the Glover advertising material. Oddly enough, the matter now sent out, while identical in every respect with that dealt with in the previous article, bears a different return address on the back of the envelop. The envelops are the same; but the legend “T. J. Glover Research Laboratory, 538 Jarvis St., Toronto, Canada,” has been crudely crossed out and there has been substituted by means of a rubber stamp the legend “MRS. STEWART, 309 W. 54th St., New York.” Still later letters have been modified to the extent that the letters “RS” of “MRS.” have been cut out of the stamp and it now reads “M . STEWART.”

There has now come to hand a report just published by a special committee appointed by the council of the Academy of Medicine, Toronto, to investigate the Glover Serum. The report of this committee may be summed up by one of its closing paragraphs, which reads:

“The data which your committee has been able to obtain have not convinced it that the results of treatment obtained by the use of Dr. Glover’s serum are better than those obtained by similar methods introduced by others, and which have ultimately disappointed the hopes entertained of them.”

The committee’s report deals with the claims that Dr. Glover has made for his serum, both experimental and clinical. It seems that Dr. Glover has claimed that, experimentally, he had (1) cultured cancer cells and from these cells had isolated and cultured an organism which he declared was confined to, and present in, every type of cancer; (2) produced cancer in a number of animals by inoculation with these cells and organisms; (3) obtained a serum--from a horse that had been injected with cultures of these cells and organisms--which, when injected into experimental animals rendered them immune to inoculation, and (4) produced improvement or cure in cases of human cancer by the injection of his serum. The committee reported that it was unable to obtain any evidence to substantiate Dr. Glover’s claims on the experimental aspect of the question as Dr. Glover had refused to permit representatives of the committee to visit his laboratory; had refused the request of the committee to be allowed to examine his cultures and experimental material; had not acceded to the request of the committee that he demonstrate his ability to culture cancer cells and organisms and to produce cancer by inoculation or to immunize animals against it.

The committee attempted also to collect information which would enable it to pass on the clinical claims made by Dr. Glover, first, as to whether he has succeeded in producing cures, either regularly or occasionally, in cases definitely established as cancer and, second, to enable the committee to decide whether his serum in cases definitely established as cancer produces improvement beyond that which occasionally occurs spontaneously or under palliative measures. On both of these points, the committee reported that it found no evidence to warrant the hope that a specific cure for cancer has been discovered by Dr. Glover or that the serum had produced a cure in any case definitely established as cancer.

It should be understood, that the committee’s investigations and findings were completed before the present advertising campaign of the Glover serum was initiated.--(_From The Journal A.M.A, Feb. 5, 1921._)

GLYCO-THYMOLINE AND POLIOMYELITIS

One characteristic of the “patent medicine” business is that it trades on fear. Should an epidemic occur the market is flooded with new nostrums purporting to cure or prevent the disease in question, while the manufacturers of older “patent medicines” revamp their advertising so as to make it appear that their preparations are all that stand between the scourge and the public. One has but to remember “Peruna’s” exploitation of the yellow fever epidemic in New Orleans some years ago and the way in which the exploiters of “Pond’s Extract” played on the fears of the public at the time of the former meningitis epidemic in New York City.

At present the public is much exercised over the epidemic of infantile paralysis. Anticipating that the nostrum fraternity would attempt to reap a golden harvest from the public distress, the federal officials issued a bulletin of warning on the subject. Naturally, the bulletin was addressed to the lay public, the government assuming that physicians knew enough to avoid being misled by any such advertising campaigns. Apparently, the assumption is too broad. At any rate, the manufacturers of “Glyco-Thymoline” are circularizing physicians, one of whom writes as follows:

_To the Editor_:--I am enclosing circular letter that I received this morning which seems to me almost a crime. I do not suppose that there is any way to prevent anything of this sort, but it is certainly a shame to attempt to deceive people in this way. As I recollect, Glyco-Thymoline is almost inert, practically no more efficient than Dobell’s Solution.

E. Fletcher Ingals, M.D., Chicago.

The circular letter referred to was on the stationery of Kress & Owen Company, manufacturers of Glyco-Thymoline. It read:

_Dear Doctor_:--Regarding Infantile Paralysis, it is conceded that the source of infection is through the Nose, Mouth and Throat.

Taking this measure to be correct, we believe that there is no safer prophylactic measure than the use of Glyco-Thymoline, with three parts of water, as a mouth, tooth and nasal wash, by means of the K. & O. Nasal Douche and the toothbrush.

Glyco-Thymoline tends to promote exosmosis, and prevents the absorption of the germ or toxic matter.

We would be glad to send you samples of both Glyco-Thymoline and the Douche should you so desire.

With best wishes, we beg to remain,

Yours very truly,

Kress & Owen Company.

Glyco-Thymoline has been discussed in these pages. A report of the Council on Pharmacy and Chemistry pointed out that this “patent medicine” is simply a weak antiseptic, so feeble that even in full strength it does not kill _Staphylococcus aureus_ in four hours and is of little, if any, greater therapeutic value than sterile salt solution. Yet, Glyco-Thymoline has been recommended by its manufacturers, either directly or inferentially, for such diseases as diphtheria, ophthalmia neonatorum and consumption. Today its manufacturers put it forward as one of the safest prophylactic measures against infantile paralysis and have the effrontery to make this suggestion, not to the uninstructed public but to the medical profession. Presumably, as a business organization, the concern believes it will convince a sufficient number of physicians of the therapeutic efficacy of its product to pay for the cost of this advertising campaign. If it appraises the situation correctly there need no longer be any wonder expressed that in the recent suit against The Journal, “patent medicine” makers were able to enlist the help of medical men.--(_From The Journal A. M. A., Sept. 16, 1916._)

GLYKERON: COLD STORAGE TESTIMONIALS[K]

[K] Glyco-Heroin

The law which limits the length of time that food products may be kept in cold storage could with advantage have its scope extended to include “patent medicine” testimonials. Physicians recently received through the mails--at a time when the mails were frightfully congested with Christmas business--a sixteen page pamphlet sent out in a plain envelop as first class matter. The caption of the pamphlet reads: “Cough and Its Treatment in Pulmonary and Laryngeal Tuberculosis: By Henry Levien, M.D., While Medical Director and Physician-in-Charge of the Liberty Sanitarium, Liberty, N. Y. From the _Buffalo Medical Journal_.” The pamphlet is devoted to the alleged virtues of that dangerous and widely advertised nostrum, “Glyco-Heroin (Smith),” whose more recent and less descriptive name is now “Glykeron.” Physicians might assume, and doubtless will assume, from the pamphlet that this reprint represents a recent pronouncement on the subject with which it deals. The facts are that the “Liberty Sanitarium” has, apparently, been out of existence for at least fifteen years, while the article itself originally appeared more than eighteen years ago--September, 1901. One of many physicians who sent in the copies received called attention to the fact that he had left the address to which the pamphlet was directed, more than six years ago. Even at that, the mailing lists of the concern that sells this heroin-containing nostrum are more than twelve years ahead of its “clinical reports.”--(_Editorial from The Journal A. M. A., Jan. 17, 1920._)

GRAY’S GLYCERINE TONIC: “WHOSE BREAD I EAT HIS SONG I SING”

Last September the United States Department of Agriculture issued a press bulletin describing the work of the Bureau of Chemistry in prosecuting the venders or manufacturers of fraudulently exploited “patent medicines.” At the end of the bulletin was a tabulated list of “other preparations against which the government’s charge that they were falsely or fraudulently labeled was sustained by the federal courts.” Tucked away in the list was a product often euphemistically described as an “ethical proprietary” but none the less essentially a “patent medicine”--“Gray’s Glycerine Tonic.” The editor of the _Atlanta Journal of Medicine_, apparently not having read the bulletin with any great degree of care, published it verbatim. Thus it was that the _Atlanta Journal-Record of Medicine_ for September, 1915, presented the interesting sight of a half-page advertisement of “Gray’s Glycerine Tonic” in the same issue that contained the government’s article classifying “Gray’s Glycerine Tonic” among the false and fraudulent products! What happened? In the very next issue the _Atlanta Journal-Record of Medicine_ apologized thus editorially:

“In our September issue, Gray’s Glycerine Tonic Comp. was inadvertently included in a list that seemed to be under the ban of the Government and very likely an injustice has been done the Purdue Frederick Company which we desire to undo as far as possible.”

Did the editor mean by “inadvertently included,” that he would have omitted “Gray’s Glycerine Tonic” from the government’s list had he noticed it in time? If so, on what grounds? It is a fact that “Gray’s Glycerine Tonic” was one of the “Fifty Falsely Labeled Medicines”; it is also a fact that it is one of the products that government officials and the federal courts have declared to be sold under claims that are “false, fraudulent and misleading.” If “Gray’s Glycerine Tonic” was fraudulently exploited--and the government and the courts have so declared it--why is it necessary for the editor of a medical journal to apologize to his subscribers for having told them so?--(_Editorial from The Journal A. M. A., Jan. 1, 1916._)

HAGEE’S CORDIAL OF COD LIVER OIL

“Under the deceptive heading ‘Making Cod Liver Oil Palatable,’ the _Charlotte Medical Journal_ in its December issue prints a boost for ‘Cord. Ext. Ol. Morrhuae Comp. (Hagee),’ or, as it is generally known to the drug trade, ‘Hagee’s Cordial of Cod Liver Oil.’

“The boost intimates that this is a preparation in which cod liver oil has in some way been rendered palatable, and then goes on to say that this is a cod liver oil product which has not suffered the least loss of those essential elements which make the crude oil such a high-class reconstructive.

“At first sight one might question whether a cod liver oil product which contains absolutely no cod liver oil had not suffered the loss of essential elements. But a closer reading discloses a significant qualification, namely, the phrase, ‘those elements which make the crude oil such a high-class reconstructive.’

“The boost is misleading from beginning to end. The manufacturers have not succeeded in this preparation in ‘making cod liver oil palatable,’ nor does their preparation in any way possess the virtues of cod liver oil. These claims have again and again been refuted, but they continue to be published--at a price but rarely in reputable medical journals.”

The above is quoted from the _Weekly Bulletin_ of the Department of Health of the City of New York. The Bulletin is issued for the enlightenment of the public.--(_From The Journal A. M. A., Jan. 8, 1916._)

HYPNO-BROMIC COMPOUND

A physician in Vermont writes:

“This is simply a word of inquiry--and of possible warning to other practitioners--regarding a preparation known as Hypno-Bromic Compound manufactured by H. K. Wampole & Co. This compound is dispensed by druggists without prescription and contains in each ounce:

“Cannabis indica 1 gr. “Morphin 1/4 gr. “Potassium bromid 48 gr. “Hyoscyamus 1 gr. “Chloral hydrate 96 gr.

“I have at the present time three young women who are addicts to this preparation as the result of thoughtless prescriptions from physicians. This mixture evades the working of the Harrison Act and may be dispensed freely at the discretion of the druggist and, as a result, these three cases of mine have been able, by visiting at the various drug stores in town, to keep an ample supply on hand at all times.”

“Hypno-Bromic Compound” is more than an unscientific mixture; it is a dangerous product and should not be sold indiscriminately over the drug counter. Before the Harrison Narcotic Law went into effect, “Hypno-Bromic Compound” contained half a grain of morphin sulphate to the ounce instead of its present one-fourth grain. Physicians remember that Section 6 of the Harrison law contains a joker--put over by the “patent medicine” interests--that exempts proprietary remedies containing one-fourth grain of morphin or less to the ounce from the restrictions of that act. While it is illegal for a physician to write a prescription which contains morphin, no matter how small the amount, unless he conforms in all ways to the requirements of the Harrison Narcotic Law, “patent medicine” concerns can sell indiscriminately nostrums containing morphin up to this amount and the public can buy them without let or hindrance. No reputable druggist would sell a layman over 700 grains of chloral hydrate or 2 grains of morphin or 8 grains of extract of cannabis indica, without a prescription, yet, the druggist may hand over 8 ounce bottles of Hypno-Bromic Compound which contain 768 grains of choral hydrate, 2 grains of morphin sulphate, 8 grains of extract of cannabis indica, 8 grains of hyoscyamus and 384 grains of potassium bromid! Physicians who prescribe such products as Hypno-Bromic Compound and druggists who indiscriminately sell such stuff are disgracing two honorable professions.--(_From The Journal A. M. A., Feb. 7, 1920._)

INTRAVENOUS COMPOUND (LOFFLER)

Its Composition and the Peculiar Methods by Which It Is Exploited

For some time past inquiries have been received regarding Charles Lyman Loffler, his Post-graduate Course in Intravenous Therapy and especially relative to “Intravenous Compound (Loffler).” For instance, a physician writes:

“Can you tell me anything about the Physicians Drug Syndicate.... They are pushing the sale of Thymozene and offering One Hundred Dollars’ worth of stock fully paid and non-assessable, free to those sending in their order, and also a copy of Dr. Loffler’s Lectures on the Blood.”

And from another physician:

“What do you know of Charles Loffler, M.D., and his Intravenous Compound? A few evenings ago a man who appeared to be about 40 years old came to my office and tried to interest me in the above-mentioned article; he claimed to be Dr. Charles Loffler of Chicago. With him was a young lady whom he introduced as Miss B----. Miss B---- said that she had been with Dr. X---- [a physician of high standing in Los Angeles] for two months and that he was using the Intravenous Compound; also quoted other physicians.... His whole layout looks quackish, and were it not for the fact that he showed me a letter that appeared to be from Dr. X----, I should not have given him a second thought.”

And this also:

“Charles Loffler, M.D., or his agent was traveling around inducing one M.D. in each town to take up his methods of blood examination and treatment and with a little advertising of blood examinations free the doctor selected gets quite a run of patronage.”

Another physician writes:

“My attention has been called by another physician to Loffler’s Intra-Venous Compound. May I trouble you to give me any information that you may have with regard to its composition and its value as a therapeutic agent?”

C. L. Loffler does business from Rooms 1101-1102, Venetian Bldg., Chicago, the location of the “Intravenous Chemical Co.,” the “Physicians Drug Syndicate” and the “Ma-Oze Chemical Co.” Of these, more later. The Journal has in its files a large amount of material regarding Loffler. A brief résumé of that part of the material dealing with Loffler’s professional activities will be given for the purpose of allowing physicians to evaluate the scientific status of Loffler’s “Lectures,” “Post-Graduate Courses,” his therapeutic “discoveries” and his products.

It seems that Loffler was reared in Yankton, S. D. In 1898-1899, Loffler was a senior student at John Creighton Medical College, but, for reasons that need not be gone into here, he was never graduated. He received a diploma from Barnes Medical College in 1900, and in the same year was licensed to practice in South Dakota. In 1902 he was at Le Mars, Iowa; in 1904 his name appears in the medical directory, under Sioux Falls, S. D., as “Specialist in Chronic Troubles.”

THE INTRAVENOUS COMPANY IN COLORADO

Charles L. Loffler’s “specialty” is “Intravenous Medication.” In 1912 and 1913, as the Intravenous Company of Colorado Springs, he was sending out a booklet entitled “Consumption.” This described the alleged marvelous results to be obtained in the treatment of tuberculosis by the use of “Intravenous Compound”; there was also a side line, “The Loffler Internal Bath Plate.” At that time the administration of “Intravenous Compound” was recommended intravenously, hypodermically, by rectum, by mouth and even by insufflation. When the stuff was to be given by rectum, the recommendation was made: “First wash out the bowels with a preliminary injection of two or three quarts of warm water, using for this purpose the Loffler Internal Bath.”

In 1913 Loffler sought a larger field for his peculiar talents and left Colorado Springs. After a short stay in Denver he is next found in Minneapolis, where he was also “engaged in the practice of intravenous therapy” and, incidentally, seems to have been an organizer and manager of a common law concern known as the Automatic Thrasher Co.

THE PHYSICIANS’ DRUG SYNDICATE

In 1919 we find Loffler in Chicago as president of the “Physicians Drug Syndicate.” This concern--another common law organization--had for its vice president one A. E. Erling, M.D., and for its secretary and treasurer, Arthur C. Hanson. Erling was discussed[251] in an article that appeared in The Journal, July 5, 1919, on the egregious “Allied Medical Association of America” of which organization C. L. Loffler was “President” in 1918.

[251] Here is what _The Journal_ published on Erling:

A. E. Erling according to the stationery, is “Chairman” of “Censors.” Our records fail to show that Erling ever graduated in medicine. The Health Department of Milwaukee, however, says that Erling, when interviewed, claimed to have “a diploma from the German Medical College of Chicago, but refused to show or present the same.” The American Medical Directory has this item:

_German Medical College, Chicago. Chartered Dec. 28, 1891, by Johann Malok. Fraudulent. Extinct._

A few years ago Erling was in La Crosse, Wis., and in 1908 a circular letter bearing his name and picture was sent out, from which the following extracts are taken. Capitalization as in the original:

“Dear Friend:--Permit me to call your attention to the fact that Dr. A. E. Erling, the eminent specialist, after many years of travel, practice and medical research, has given up his extensive road practice and severed his connection with the several medical institutes which have heretofore occupied considerable of his attention.... Dr. Erling’s success in the treatment of all CHRONIC DISEASES IS TRULY REMARKABLE. NERVOUSNESS, ALL BLOOD DISEASES, RHEUMATISM, DISEASES PECULIAR TO WOMEN; CATARRH, DEAFNESS, CHRONIC CONSTIPATION ... APPENDICITIS ... PILES, STOMACH TROUBLES, PARTIAL PARALYSIS, etc., give way as if by magic under his skilful method of treatment.... Understand, please, that Dr. Erling DOES NOT ACCEPT A CASE FOR TREATMENT unless he can PROMISE A SPEEDY AND POSITIVELY PERMANENT CURE.”

_The Journal_ also has in its files advertisements (vintage of 1915), from some Wisconsin country newspapers; which notify the afflicted that “Drs. Erling and Karass, the expert German Specialists,” could be seen in their offices in the “Schlegel Hotel,” the “Schlitz Hotel,” etc., as the case might be. Whether one of these “German Specialists” was Dr. Arnold E. Erling, _The Journal_ does not know. Official medical records fail to show, at least, that there is any other Erling in the state of Wisconsin.

Hanson, the secretary and treasurer of the Physicians Drug Syndicate, is said to have hailed originally from Minot, N. D., where he was in the drug business. His name appears in the Propaganda files as the manager of the Ma-Oze Chemical Co. of Minneapolis, which, in October, 1919, was advertising in a daily paper of that city:

“Protect yourself against influenza. Don’t let the germs get a foothold in your system. Kill them with Ma-Oze Antiseptic Powder. Use it as a gargle. It is ... sure death to all kinds of disease germs.”

In a preliminary statement sent out by Hanson in the early part of 1919 it seems that the Physicians Drug Syndicate was conceived “primarily to supply physicians with a product to be used in Leucorrhea and personal cleanliness of women.” This product, apparently, was the Ma-Oze of influenza fame in Minneapolis. It was to be put out, however, under the name of “Thymozene,” which, “packed in 4 ounce unlabeled carton for dispensing,” would “show nearly 100 per cent. profit to the organization over the profit which you make if you dispense your own drug.”

THYMOZENE, FREE STOCK--AND EVERYTHING

In October, 1919, the Physicians Drug Syndicate was circularizing physicians in Iowa trying to get them to send in $6 for “1 Dozen Thymozene 4 oz.” For this $6 the doctors were to get, in addition to the marvelous Thymozene, the following rights, privileges and emoluments:

1. A free Post-Graduate Course in Intravenous Therapy by Dr. Charles Loffler.

2. A gift of $100 worth of stock in the Physicians Drug Syndicate.

3. A copy of Dr. Loffler’s Lectures on Blood.

4. The privilege of purchasing future supplies of Thymozene “at wholesale prices less discount of 33-1/3 per cent.”

The letter making these offers mentioned incidentally:

“Besides our product Thymozene we have been forced to add a Uterine Wafer to be used in connection with hot Thymozene douches in Leucorrhea. These wafers are simply miracle workers.”

In addition to this circular letter there was a membership blank leaflet detailing the marvels of “Thymozene.” There was another leaflet headed in very large, black type “Influenza” and recommending “Ma-Oze Antiseptic Powder” or “Thymozene” for this condition. Still another leaflet accompanying it lauded “Intravenous Compound (Loffler)” and reprinted laudatory puffs of this preparation that were credited to H. H. Witherstine, M.D., Rochester, Minn., Joseph B. Klinehans, M.D., Chicago, and the “Loring Park Sanatorium” of Minneapolis.

In addition to the Intravenous Compound (Loffler) there is, of course, certain “apparatus for the giving of the treatment” which the Intravenous Chemical Co. supplies. The “compound” must be given just so, and the Intravenous Chemical Co. “reserves the right to refuse to supply any physician with Intravenous Compound (Loffler) who, either through lack of proper apparatus or proper care in preparation of solution, or for any reason, uses it in such a manner that will cast discredit upon it.”

The complete apparatus, including 2 ounces of Intravenous Compound (Loffler), sells for $24. What is Intravenous Compound? Apparently, nobody knows except Charles L. Loffler, who asks physicians to inject--and we regret to say some are injecting--this nostrum of unknown composition into the veins of their patients. To a physician who had raised the point of secrecy Loffler wrote in part:

“I am sure that you will agree with me that it is far better to place this treatment in the hands of competent physicians, such as Dr. Witherstine, and many more whose names I will gladly send you, and to protect the honest and competent doctor who investigates and takes up the work, than to publish the formula and give to the unscrupulous a chance to try to make the product and no doubt to claim to cure disease that is beyond hope. The formula is not kept secret for profit ... but is so kept upon the advice of a number of good men who have the interest of the doctor at heart.... I am willing and anxious to place the product and the results in thousands of cases before the A. M. A. on the one condition that the formula shall be kept secret for the benefit of the reputable physician.”

In another letter written more recently to a physician who called attention to the secrecy of the nostrum, Loffler wrote:

“The Intravenous Compound contains approximately 58 per cent. oxygen, 12 per cent. chlorine, 16 per cent. potassium, 9 per cent. sodium and 5 per cent. boron. I have no hesitancy in giving it, and it was due to an incompetent man in this office that this was not given fully in the booklet. He made the changes without my consent and has caused me to answer many inquiries by physicians.”

A seeming frankness is a trick as old as nostrum exploitation itself. Loffler’s “formula” is meaningless. A quack who was putting out a mixture of 1 part baking soda and 2 parts common salt might with equal frankness say that his marvelous combination contained approximately 35.4 per cent. sodium, 4.8 per cent. carbon, 19 per cent. oxygen, 40.4 per cent. chlorin, and 0.4 per cent. hydrogen.

In order that the profession might know more about this product a specimen was turned over to the A. M. A. Chemical Laboratory for analysis. Here is what the chemists report:

CHEMISTS’ REPORT

“One original 2 ounce bottle of ‘Intravenous Compound (Loffler) for Intravenous Use’ was submitted to the Association’s Chemical Laboratory for examination. According to the label, the product is sold by the ‘Intravenous Chemical Co., Chicago.’ The bottle contained a white granular substance, which appeared as if the ingredients had been fused together. The product responded to tests for sodium, potassium, chlorate, borate and nitrate. As this same set of chemical radicals was found by Puckner and Hilpert (J. A. M. A., May 22, 1908, p. 1706) to be present in ‘Oxychlorin’ and ‘Zyme-oid,’ a quantitative comparison of ‘Intravenous Compound (Loffler)’ was made.

“The analysis indicated that all three products are essentially the same:

INTRAVENOUS OXYCHLORIN, ZYME-OID, COMPOUND, Per Cent. Per Cent. Per Cent. Potassium (K+) 12.26 13.50 13.79 Sodium (Na+) 8.20 9.84 9.82 Boric acid anhydride (B₂O₃) 18.63 13.42 15.20 Chlorate (ClO₃-) 25.52 27.53 26.44 Nitrate (NO₃-) 21.70 24.22 23.75 Water calculated 13.29 10.42 11.72

“Assuming that the chlorate in ‘Intravenous Compound (Loffler)’ is present as potassium chlorate and the nitrate is present as sodium nitrate, the figures obtained by the analysis correspond to a mixture approximately as follows:

Potassium chlorate (KClO₃) 38.6 per cent. Sodium nitrate (NaNO₃) 32.6 per cent. Potassium borate (K₂B₄O₇) 4.9 per cent. Sodium borate (Na₂B₄O₇) 4.0 per cent. Boric acid 21.1 per cent.

“From the results of the examination it is concluded that this preparation is a mixture of alkali chlorate and nitrate and boric acid, probably produced by fusing together the constituents. It is practically the same mixture as Oxychlorine and Zyme-oid as analyzed nearly fourteen years ago in the A. M. A. Chemical Laboratory.”

Throughout the advertising of “Intravenous Compound (Loffler)” the physician is reminded of the financial returns that the product offers.

“... The financial return will prove as interesting to yourself as results are to the patients.”

“And lastly but not less interesting, the financial returns are commensurate with results.”

“... the instruction given me in the use of your Intravenous Compound and the opportunity presented adds four to five hundred dollars per month to my bank account.”

“... will not only give you more positive results than have ever obtained in chronic and progressive diseases but a very remunerative business.”

“Intravenous Compound (Loffler) is supplied in granular form, 2 ounces to a bottle, at $2 per bottle. An ounce will average fifteen treatments and treatments are at from $3 to $5 each, according to the ability of the patient to pay.”

A physician whose name the Intravenous Chemical Company had given as a user of Intravenous Compound (Loffler) was written to by another physician who was interested in the matter and he was asked frankly for his opinion. He replied in part:

“The treatment makes a profound impression on the recipient and is usually followed by a marked improvement mentally, and I have not been keen enough to draw the line of just how far the physical or material improvement went and when the psychical began.

“For the office ‘specialist’ of the advertising type this would be a boon, but I am not entirely satisfied that its use completely justifies its claims.”

SUMMARY

Intravenous Compound (Loffler) stands revealed as a nostrum of secret composition which physicians are asked to inject into the veins of their patients. It must be purchased in connection with some supplementary material, “a complete set of apparatus,” sold by the same concern. Its successful administration is said to depend on following a technic detailed either in a booklet sent out by Loffler or given by Loffler in a “Post-graduate Course” which costs physicians $50 unless they have purchased six dollars’ worth of another nostrum, “Thymozene.”

The intravenous administration of drugs is impressive. To the patient the technic is mysterious and its psychic effect striking. Its dangers--infection, air embolism, intravascular clotting, sudden death--are matters of record. Every conservative physician will admit that there is no excuse for the intravenous administration of even those drugs that are well known and whose effects have been carefully studied, except when distinct advantages are to be secured. As The Journal has stated before, “Little is known of the results to be expected from intravenous therapy even with simple substances.”

What, then, can be said of the physician who subjects his patients to the intravenous injection--“at from $3 to $5 each, according to the ability of the patient to pay”--of a preparation of whose composition he is as ignorant as he must be of its effects? Intravenous Compound (Loffler) has been on the market ten years; it is unmentioned in the literature of scientific medicine. The name of its exploiter, while not unknown in the twilight zone of professionalism as the exploiter of a nostrum, as a “Specialist” in “Chronic Troubles” and “Intravenous Therapy,” as well as in other capacities even less savory, is equally unknown to scientific medicine.--(_From The Journal A. M. A., Nov. 12, 1921._)

INTRAVENOUS SPECIALTIES

_To the Editor_:--There is a salesman here in Salt Lake City making extravagant claims about the medicines advertised in the enclosed pamphlet. Would you kindly advise me as to your opinion of it?

W. C. Schulte, M.D., Salt Lake City.

_To the Editor_:--I am interested in knowing the attitude of the Council on Pharmacy and Chemistry regarding the products of the Intravenous Products Company of America, 121 Madison Avenue, New York City. If the Council has already reported, please refer me to the appropriate number of _The Journal_. If it has not, please give me any information available.

H. B. Gessner, M.D., New Orleans.

ANSWER.--The Intravenous Products Company of America has not requested the Council on Pharmacy and Chemistry to examine any of its intravenous specialties, nor have they been discussed in The Journal or examined in the American Medical Association Chemical Laboratory. The firm’s list of specialties bears a striking resemblance to those of other “intravenous specialty” firms. Endoarsan, like Venarsen of the Intravenous Products Company of Denver, is stated to contain a cacodylate (dimethylarsenate) along with mercury and iodid. Venarsen was reported on unfavorably by the Council (The Journal, May 22, 1915, p. 1780), the inferior efficacy of sodium cacodylate was discussed (The Journal, March 25, 1916, p. 978) and the worthlessness of sodium cacodylate as a spirocheticide confirmed by H. N. Cole (The Journal, Dec. 30, 1916, p. 2012), William G. Ward (The Journal, Feb. 3, 1917, p. 390), and R. L. Sutton (The Journal, Feb. 17, 1917, p. 566). Endosal, like Venosal of the Intravenous Products Company of Denver, is said to contain salicylate and a colchicum preparation (the latter is also said to contain iodids). Venosal was found unacceptable for New and Nonofficial Remedies by the Council on Pharmacy and Chemistry. Like other “intravenous” firms, this company advertises the intravenous administration of drugs such as sodium iodid and hexamethylenamin. The objections to and the dangers of indiscriminate administration of drugs intravenously was recently emphasized in a report of the Council on Pharmacy and Chemistry “Some of Loeser’s Intravenous Solutions” (The Journal, April 16, 1921, p. 1120).--(_Query from The Journal A. M. A., Dec. 10, 1921._)

IODEX

At fairly frequent intervals physicians receive through the mail free samples of “Iodex,” a black ointment sent out in small, circular aluminum boxes. Iodex is sold by Menley and James, Ltd., New York City, under the claim that it is a preparation of free iodin,[252] minus the objectionable features that go with free iodin. The preparation was examined in the A. M. A. Chemical Laboratory in 1915, and found practically devoid of free iodin. The laboratory also reported that when 1 or 2 grams of Iodex was rubbed on the skin of the forearm on several subjects and the urine collected and tested for iodin, the results were negative. This disproved the claim that “thirty minutes after inunction [with Iodex] iodine can be found in the urine.”

[252] “Free” or elementary iodin (such as the tincture of iodin) is used externally for its local irritant and antiseptic effects. “Combined iodin” (_e. g._, iodid of potassium), does not produce these effects; and when preparations containing iodin in combined form are used, it is with the expectation of obtaining the systemic (“alterative”) effects such as are produced by iodids.

The findings of the laboratory, which were summed up in a report (The Journal, June 19, 1915) of the Council on Pharmacy and Chemistry on Iodex, were essentially as follows:

1. The composition is incorrectly stated; the actual iodin content is only about half of that claimed.

2. The action of Iodex is _not_ essentially that of free iodin, although that is the impression conveyed by the advertising.

3. The assertion that iodin may be found in the urine shortly after Iodex has been rubbed on the skin has been experimentally disproved.

At the time the laboratory reported its findings, it pointed out the obvious contradiction in the claim that Iodex is not only an “effective free iodine application without drawbacks” but also a means of “really efficient external iodine therapy without stain or irritation.” It is impossible to have free iodin present in sufficient quantities to be therapeutically efficient and not get skin stains and irritation.

In a recent issue of the house organ, _Pharmacal Advance_, there was a large display advertisement of Iodex under the heading: “For prophylaxis and to ‘Double Cross’ Disease,” with the claims:

“Free Iodine.”

“Rub Through Skin.”

“Does Not Irritate nor Stain.”

On other pages of the same issue these claims appeared:

“There is no therapeutic virtue in Iodex which is not inherent--though often latent--in Free Iodine; and there is no virtue in Free Iodine which is not available in Iodex.”

“In Iodex all the beneficent properties of Iodine are emphasized and all its disadvantages are eliminated--in a word, Iodex is Pure Free Iodine presented therapeutically active and efficient, ready for use in all conditions, with all the well-known powers of Free Iodine, but without the sequelæ of unpleasant effects, as irritation, corrosion, desquamation, staining, etc., which defeat the ends of treatment when ordinary preparations of Iodine are used. The fact that Free Iodine in the form of Iodex can now be used in rectal and vaginal treatment, without irritation, speaks volumes for its penetrability and bland action.”

These quotations are sufficient to show that the manufacturers of Iodex still persist in their claim that the product contains free iodin. In view of this, the A. M. A. Chemical Laboratory has again examined Iodex, having recently purchased specimens on the open market. It reports that Iodex gives no test for free iodin, or at most, but minute traces.

An interesting side-light on the methods of Menley and James is also brought out in the issue of _Pharmacal Advance_ just quoted. Under a “department” misnamed “Book Reviews” the following appears:

“THE ACTIONS OF DRUGS.--Torald Sollmann, M.D. Published by W. B. Saunders Co., Philadelphia. This is a book of lectures designed for students in pharmacy and deals with the subject in plain and simple language. The author in his introduction has brought out the fact that over-counter prescribing is baneful both to the public and to the pharmacist himself. Among some of the interesting points brought out that _Pharmacol Advance_ has always maintained, namely, that ‘Potassium iodid is not absorbed efficiently by the skin; hence the ointment of potassium iodid is unscientific.’

“We would especially call attention to Ungt. Iodi U. S. P., containing Potassium Iodid, used as a solvent for its iodin content. Accepting Sollmann’s statement, it is to be assumed that Ungt. Iodi U. S. P. has not 100 per cent. efficiency.”

Garbling statements from scientific works for the purpose of puffing proprietaries is not unusual in nostrum exploitation. The facts are that the statement in Sollmann’s book, introduced in the Menley and James house organ under the guise of a book review, appeared in a discussion of iodin compounds. In this the author points out that to obtain systemic iodid effects, it is irrational to apply iodin preparations externally. So far as the free iodin content of the official ointment of iodin is concerned, L. E. Warren (Reports of the A. M. A. Chemical Laboratory, 1917) has shown that even after more than six months this ointment still contains about 75 per cent. of the free iodin originally added. The official ointment (Unguentum Iodi, U. S. P.), therefore, so far as its free iodin content is concerned, is far superior to Iodex, which contains no iodin in its free state.--(_From The Journal A. M. A., May 3, 1919._)

THE WILLIAM F. KOCH CANCER REMEDY

A number of inquiries have been received of which those that follow are typical. This from a Philadelphia physician:

“Would you give me any information you have about one so-called ‘Dr. W. S. Koch,’ Detroit, Michigan? This man is said to claim to have in his possession a cure for cancer, the nature of which I do not know. I know, however, that he obtained a very large fee not very long ago in treating a case, but without success ...”

While a Chicago physician writes:

“I have at hand a pamphlet from Wm. F. Koch, M.D., Ph.D., of Detroit, Mich., which is supposed to be a reprint from the _Medical Record_ of Oct. 30, 1920, entitled ‘A New and Successful Diagnosis and Treatment of Cancer.’ Will you kindly advise me what you know about this man’s work on this subject and how much stock I can put in the claims he makes in this article?”

And this from a physician in Seattle, received a few days ago:

“Has your office any knowledge of the cancer cure devised by Dr. William F. Koch, Ph.D., M.D., of Detroit? He published an article on it in the _Medical Record_, Oct. 30, 1920.... I enclose copy of letter received by one of our patients from his ‘western representative’ which reads like pure quackery. I do not find Dr. Koch’s name in either the A. M. A. or Polk’s medical directories.”

The letter referred to in the last inquiry as coming from Dr. Koch’s “western representative” was addressed to a woman who had written to Dr. Koch with reference to his alleged cancer cure. The letter, dated Jan. 19, 1921, was signed “Chas. L. Tisdale, 1898 Geary Street, San Francisco.” It read:

“_Dear Madam_:--Your letter of January 10th written to Dr. Koch of Detroit in reference to his cancer cure has been sent to me by Dr. Koch. I am the western representative of Dr. Koch and am giving the treatments with his remedy. I am now treating 14 cases here with some most wonderful results. The amount of the remedy that Dr. Koch can supply me with is limited and it is a very expensive substance. None of it can be sent to Seattle or any other place for I have only enough to treat the cases that are constantly presenting themselves here. If you could come to San Francisco and have the money to pay a reasonable fee, say enough to pay for the remedy, I would be very glad to do everything I can for you.

“The results that have already shown in many of these cases warrant me in believing that almost any case of cancer can be cured if the treatment is persisted in.”

According to our records, Dr. William F. Koch of Detroit was born in 1885. Some years ago he graduated in chemistry and for some time held the position of professor of physiology and physiologic chemistry at the Detroit College of Medicine and Surgery. In 1918, Dr. Koch received his degree in medicine from this same college. Less than a year after his graduation, Dr. Koch declared that he had “developed a real specific cure for cancer.” In the _Detroit Medical Journal_ for July, 1919, there appeared a brief article by William F. Koch, entitled “A New and Successful Treatment and Diagnosis of Cancer.” A more extensive article bearing the same title was published in the _New York Medical Journal_ of Oct. 30, 1920.

As a result of the publicity that was given the Koch treatment, the Wayne County (Detroit) Medical Society appointed a committee to investigate the treatment. Its first report appeared in the Bulletin of the society for Dec. 22, 1919. Briefly, this report said that the Board of Health of Detroit had placed at the disposal of the committee twelve beds in a local hospital with the necessary special nurses and everything else required free of charge. The committee sent certain patients to the hospital; and there were also some other patients recommended by different physicians as proper cases for treatment. There were nine altogether. After going over the cases carefully, the committee found some in which the diagnosis was doubtful. There were five cases, however, of undoubted cancer, a positive diagnosis having been made from specimens and microscopic examination. The management and treatment of these patients were turned over to Dr. Koch.

Dr. Koch seems to have raised certain objections and to have made certain criticisms. He also insisted that he ought to have some representative on the committee. The committee offered to put on any and all he would name. He failed to name any. The committee reported further that Dr. Koch was very negligent in his treatment of the patients and finally, on November 26, the committee met with Koch and went over all the cases with him. At that time he gave the patients injections and promised to attend to the treatment regularly in the future. According to the report, he saw the patients only once more (three days later) and then did not come near them again. As the patients became disgusted with the neglect, some of them left and the committee sent the rest home and closed its connections with the investigation of the subject.

In the same issue of the Bulletin of the county society in which this committee’s report was published, the editor of the Bulletin stated that from all sections of the country inquiries were coming relative to the treatment and “from long distances patients are coming to Detroit to be ‘cured’ of cancer.” The editor further stated: “It is reported that Dr. Koch is treating many patients, promising much and charging well.” To this Dr. Koch retorted that only about 30 per cent. of his patients had “contributed.” The rest were treated free.

The Wayne County Medical Society Bulletin for Jan. 5, 1920, was devoted almost exclusively to another discussion of Dr. Koch’s “cancer cure.” It was there stated that a second committee had been appointed to gather what information could be obtained from outside sources relative to cases treated by Dr. Koch. This committee reported that of fifty-six cases of which it was able to obtain data, only three of the patients showed clinical improvement; twenty-one of the patients were dead. Three more patients treated both by the Koch injections and by operation were reported as clinically improved. The condition of eighteen of the patients was reported as stationary, or unimproved. In eleven of the cases, the results were unknown but the surgeons reported unfavorably.

The committee reported further that Dr. Koch’s records were incomplete and that he had submitted no proof that his injections have any particular merit and the committee concluded that the study “is entirely experimental and improperly supervised.”

Evidently, the most that can be said of Dr. Koch’s alleged “cure” for cancer is that the claims made for it have not been supported by independent investigators.--(_From The Journal A. M. A., Feb. 12, 1921._)

Further Comment

Last week some space was given to the alleged cure for cancer put out by Dr. William F. Koch of Detroit. Incidentally, it should be mentioned that Dr. Koch’s article of Oct. 30, 1920, to which reference was made, appeared not in the _New York Medical Journal_, as stated, but in the New York _Medical Record_.

The following correspondence throws additional light on the subject:

_To the Editor_:--To the number of inquiries which you have received regarding the alleged cure of cancer by Dr. Koch, permit me to add the following personal experience. On July 1, 1920, I was asked to examine an ex-patient of mine whom I had not seen professionally for many years. Her husband frankly told me that for several months his wife had been treated by Dr. W. F. Koch for inoperable carcinoma of the pelvic organs, that he wished Dr. Koch to retain charge of the treatment but hoped I would give my opinion regarding certain nervous manifestations in the patient which were causing him (her husband) much concern.

At the same time, he showed me a letter written by Dr. Koch purporting to explain the symptoms and offering suggestions regarding treatment. I called on the patient and found her in the last stages of generalized carcinomatosis. Simple palpation of the abdomen revealed multiple nodules involving both lower and upper abdominal quadrants. I did not feel justified in making a pelvic examination but noted a profuse foul-smelling discharge on the vulvar pad. My prognosis did not meet with the deluded husband’s approval. The patient died within a week and a necropsy confirmed the clinical picture of carcinomatosis. Enclosed is Dr. Koch’s letter; the patient’s name should, of course, be omitted if you see fit to publish this note.

George de Tarnowsky, M.D., Chicago.

The letter from Dr. Koch which Dr. de Tarnowsky enclosed with his own, follows. We have, of course, deleted the name of the patient.

_Dear Doctor_: Mrs. ---- has absorbed and is still absorbing some killed tumor tissue. She has absorbed some three pounds, I judge. The results of the absorption are intoxication quite general (nervous, muscular, perhaps nephritic). The myocardium at present shows no signs of poisoning but the skeletal muscles and nerve do. The important toxin liberated by the killed tissue is methyl cyanimide which combines ammonia (NH₂) from the amino acids, and thus becomes methyl guanidine. This latter has produced in my patients an intoxication varying in similarity to: idiopathic tetany in children, chorea in children, eclampsia in women, and has even been so severe as tetanus in some of the muscle spasms; a toxic albuminuria has resulted in some of my cases.

All of my cases have cleaned up so far. Of course, I cannot predict in any individual case, except that when the absorption has been completed and the toxin all eliminated, everything should return to normal, unless the toxin has destroyed tissue beyond physiological repair. My suggestions as to treatment would be elimination, saving the kidneys as much as possible, by whatever methods you find best and necessary.

At present I am treating symptomatically thus--atropin as a guanidine antidote, arsenic as a chorea coupled antidote as a prevention to the production of guanidine from the cyanimide, the use of dilute hydrochloric acid has proven successful to me. Even a urine boiling solid--albumen has cleared up in one case in three days just by taking large quantities of 1/2 per cent HCl. I am explaining the factors I have contended with in these cases, but do not want to influence your plan of treatment when your judgment finds me insufficient.

Sincerely,

Wm. F. Koch.

I shall have a publication out very soon on the treatment of these tetanics and eclampsia with HCl.

It is worth noting that this letter of Dr. Koch’s was written June 28, just three days before Dr. de Tarnowsky saw Mrs. ---- and less than a week before she died of generalized carcinoma.

Not the least important element in the story which these two letters tell is the optimism engendered in the husband of the poor cancer patient by the widely vaunted treatment of Koch. And herein lies one of the most pernicious features connected with the exploitation of alleged cures for cancer, tuberculosis, etc. All such remedies, whether fraudulent both in their inception and exploitation or those which while equally worthless are at least honestly put forward and are based on a certain amount of scientific investigation, produce a profound and marked temporary change in the patient’s condition. It is this that tends to warp the judgment not only of the unscientific layman, but also of the physician. The psychic element in cancer has been well described by Weil:

“It is, indeed, very remarkable that a patient who has been consigned to death as a victim of a hopeless malady, should regain his spirits and his appetite, when he is again confronted with the hope of a cure, and of the eradication of his disease? It is a phenomenon well known to every student of the disease that a large proportion of cases responds in just this manner to any treatment which is offered them. Osler has described a case of cancer of the stomach in which the mere visit to a consultant of sanguine temperament, though poor judgment, whose assurance of the patient that there was no possibility of cancer, resulted in the disappearance of all the symptoms and a gain of 18 pounds in weight. It is this psychic influence, which has occasionally deluded the honest student of cancer cure, and which has also so generously played into the hands of the dishonest.”--(_From The Journal A. M. A., Feb. 19, 1921._)

THE LUCAS LABORATORIES’ PRODUCTS

The Journal has received several inquiries about the products put out by the Lucas Laboratories, Incorporated, of New York City. A typical inquiry is that received from Dr. F. A. Jewett of Brooklyn, who writes:

“The enclosed circular is sent out to the medical profession by Dr. William Lucas, 287 W. 70th St., New York. What do you know of this man and his methods?”

William H. Lucas was graduated by the Medical College of Ohio in 1895 and was licensed in 1897. He is not a member of his local medical society. The products put out by the Lucas Laboratories are for intravenous use, and their method of exploitation indicates that the concern is less interested in the science of therapeutics than it is in taking commercial advantage of the present fad for intravenous medication. The Journal has protested editorially against the unnecessary use of the intravenous administration of drugs, and the abuse of this method of drug giving prompted the Council on Pharmacy and Chemistry recently to emphasize the danger of indiscriminate intravenous medication.

The products of the Lucas Laboratories, Inc., have not been examined either by the A. M. A. Chemical Laboratory or by the Council on Pharmacy and Chemistry. The composition of these products is essentially secret, which in itself should be sufficient to deter physicians from using them. Of course, in accordance with all the tenents of orthodox nostrum exploitation, “formulas” are furnished. Even the crude hieroglyphics that used to be palmed off on the medical profession by nostrum exploiters under the guise of “graphic formulas” are outdone by the Lucas Laboratories in publishing the alleged formulas of its preparations. If we, as physicians, knew more chemistry, the Lucas Laboratories would not find it profitable to publish such ineffable nonsense as that which characterizes their “literature.” For instance:

“‘Luvein’ Arsans (Plain)” is said to be: “Di hypo sodio calcio phosphite hydroxy arseno mercuric iodid.” The first part of this “formula” might stand for sodium and calcium hypophosphite. The remainder is meaningless except that it suggests (but does not insure) the presence of arsenic and mercury iodide.

“‘Luvein’ Arsans, Nos. 1, 2 and 3.”--“Meta hydroxy iodide sodio arsano mercuric dimethyl benzo sodio arsenate, ai oxy sodio tartaria sulpho disheuyl hydrazin.” Who can venture even a conjecture as to the possible significance of this?

“‘Luvein’ Creosophite.”--“Ammonio hydroxy calcio sodio hypo-phosphite arsenous pentoxy iodide.” While the name suggests creosote, the “formula” gives no hint of this. It might refer to hypophosphites of ammonium, calcium and sodium with iodide of arsenic. Whether arsenous (trivalent arsenic) or arsenic (pentavalent arsenic) iodide or both are intended, is a question.

“‘Luvein’ Hexacol.”--“Hexa methylenepyro catechin mono methyl amino ether glycerite.” By moving these syllables around like the old “fifteen puzzle” they can be arranged to represent hexamethylenamin and monomethyl-ether of pyrocatechin, or guaiacol, having the “glycerite” left over.

It is futile to discuss the therapeutic claims made for the various preparations put out by the Lucas Laboratories. One might as profitably discuss the therapeutic claims made for “Peruna” or “Paine’s Celery Compound” for the exploitation of the latter products is on just as high a scientific plane as the exploitation of the “Luvein” nostrums. The proposition offered to physicians by the Lucas Laboratories, Inc., is an insult to the intelligence of the medical profession. Not that the products themselves are necessarily any worse or any better than many offered for intravenous use; the selling methods are more crude, that is all.

The facts are, we have entered a new cycle of nostrum development. The unscientific mixtures for oral administration that characterized so large and disreputable a part of the proprietary medicine business of the past two or three decades are giving way to equally unscientific mixtures for intravenous use. The dangers of the older nostrums are accentuated in the newer by the added element of risk that is inseparable from intravenous therapy. Add to this the temptation to the physician in the way of more substantial fees which, legitimately enough, may be charged when intravenous administration is called for, and the menace of the new style nostrum becomes evident. The Journal can only reiterate the warning that intravenous therapy should be employed only when most positively indicated. Further, because of the danger that is inseparable from this method of drug administration, physicians should be doubly careful to see that products employed for intravenous use come from firms of unquestioned scientific standing.--(_From The Journal A. M. A., Sept. 20, 1919._)

“PHYLACOGENS”[L]

[L] This matter was largely reprinted in the Propaganda for Reform, eighth and ninth editions.

A physician in Florida writes:

“I am enclosing a copy of a circular letter just received from Parke, Davis & Company, and will call your attention to a marked paragraph in this letter on which I would like to have an expression of your opinion.”

The circular letter which the doctor forwards is devoted to singing the praises of “Pneumonia Phylacogen.” It opens with the statement: “Influenza, we learn, has appeared in your section.” The paragraph marked by our correspondent reads:

“Pneumonia Phylacogen has been found to be a dependable means of preventing and treating pneumonic complications of Influenza. In one large city it became a routine measure to give all persons affected with Influenza an injection of Pneumonia Phylacogen as a prophylactic of pneumonia. The results were remarkable. Not only did the cases improve rapidly, but in a great majority of them the pneumonia did not occur.”

The “Phylacogens” were repeatedly discussed in The Journal during 1913 and 1914 when these products were being pushed with much vigor by the manufacturers. We know of no evidence that calls for a revision of the statements then made regarding them. The injection of phylacogens is simply the administration of a mixture of the filtered products of several bacterial species. The results which follow represent the reaction of the bacterial protein--a reaction for good or evil. There is no scientific evidence to show that they possess any specific prophylactic virtue. To recommend their use in cases of influenza, as a prophylactic against pneumonia, is unwarranted, and the physician who acts on the advice of the manufacturer must assume the responsibility for the results. In case of mishap he cannot fall back on the manufacturer; he will find no scientific evidence to support him.--(_From The Journal A. M. A., Nov. 15, 1919._)

PINEOLEUM ADVERTISING METHODS

Capitalizing the Name and Position of the President of the American Medical Association

_To the Editor_:--Enclosed is a postal card which a physician in Oklahoma has sent me together with thirty-six cents in stamps. The envelop was addressed to me at the address of the Pineoleum Company. The postoffice corrected the address and sent it to me. It is evident, therefore, that the physician in Oklahoma thought I was sending these postals as an employee of the Pineoleum Company, or, at least, was endorsing their products.

Kindly do me the favor to publish this letter in The Journal as a protest against the dishonesty of this method of advertising. What is quoted from an article that I wrote appeared originally in the _New York State Journal of Medicine_ and was abstracted in The Journal of the American Medical Association of August 2, 1919. The obvious inference to be drawn from this postal is that I referred to the products of the Pineoleum Company in that article. I did not have the products of the Pineoleum Company in my mind. I never have used their products and never prescribed them.

This form of advertising is done with intent to deceive and did deceive the doctor in Oklahoma. It was therefore a successful falsehood, its success depending on the false use of the name of the President of the American Medical Association to bolster up the sale of the product.

I resent the use of my name in connection with the quack advertising of nostrum venders. The low, vulpine cunning of the method used is on the same level as the deceit and dishonesty which use this form of advertising to the injury of my name and reputation. As President of the American Medical Association I must insist that you protect me by publishing this letter in The Journal, giving it as widespread publicity as possible.

Alexander Lambert.

[Comment.--“Pineoleum” is a “patent medicine” advertised in the cheapest and most effective way--by the aid of the easy going and complacent physician. In 1906 Pineoleum was being marketed by the Winslow Laboratory of New York City, which also put out three or four other nostrums--“Morumalt,” “Egeriol,” “Digestylin,” and “Ford’s Nucleo-Peptone.” Pineoleum was advertised to the public then as it is advertised now, via the medical profession. Physicians are circularized and are offered a petty graft in the form of a cheap nebulizer and a sample bottle of Pineoleum. Some time ago the company seems to have developed a scheme whereby physicians could make money “dispensing Pineoleum nebulizer outfits at more than 140 per cent. profit.” The Pineoleum concern for years has also polluted the stream at its source by attempting to get the secretary of the senior class of every medical school to distribute its free nebulizer outfits to members of the class and receive therefor 5 cents for each outfit distributed! The life history of Pineoleum is that of the typical nostrum. Epidemics, of course, are utilized as opportunities for pushing the product. In 1911 a card was sent out featuring “A Special LaGrippe Offer”; in 1916 the profession was circularized recommending Pineoleum as “The Ideal Prophylactic” in infantile paralysis; during the past year influenza has again been the selling point.

The case described by Dr. Lambert is not the first example of the misuse of names and statements of physicians. Last December the Pineoleum concern was sending out an advertising card in which Dr. McCoy of the United States Public Health Service was quoted as recommending Pineoleum as the “bulwark of prevention” and “battery of relief” in influenza. Of course, Dr. McCoy never said anything of the sort. A protest against this particular falsehood resulted in another card being sent out several months later by the Pineoleum people purporting to explain and apologize for the misquotations and putting the blame on the printer. The “apology” ended with a postscript (in larger and bolder face type than the body of the card) that urged physicians to “secure our liberal introductory advertising proposition on improved oil nebulizer outfits.” From the standpoint of publicity for Pineoleum, the “explanation and apology” was doubtless as good an advertisement as the original card of misrepresentation.--Ed.]--(_From The Journal A. M. A., Nov. 1, 1919._)

“PROTEAL THERAPY” AND HENRY SMITH WILLIAMS

_To the Editor_:--Will you please advise as to the success and safeness in using the Proteal treatment for tuberculosis by Henry Smith Williams, M.D., LL.D., 104 East 40th Street, New York?

C. P. Burchard, Alamogordo, N. M.

_To the Editor_:--Kindly send me any available information on “The Proteal Treatment for Cancer.” An article by Dr. Henry Smith Williams, 120 West 32 Street, New York City, in April _Hearst’s_ has caused relatives to request its use in a case of carcinoma of the liver under my care.

M. M. Reppard, Middlebourne, W. Va.

_To the Editor_:--I am enclosing a leaflet, mailed to me on request, by Dr. Henry Smith Williams of New York City, who published a series of articles during the last year in _Hearst’s Magazine_ on “Proteal Therapy.” If you have investigated this man and his proteal treatment, I should like to know the result of your findings. I am a consumptive and am, therefore, particularly interested in its alleged benefactions for the treatment of tuberculosis.

Michael A. Long, Glen Lake Sanitarium, Hopkins, Minn.

_To the Editor_:--What information can you give me regarding Henry Smith Williams, M.D., LL.D., 104 East Fortieth Street, New York, and the therapeutic value of the “Proteal Therapy” that he has originated?

M. D. Baker, M.D., San Jose, Calif.

The above letters are selected from many received on the subject. Henry Smith Williams is better known in the journalistic world than in the field of scientific medicine. He was graduated by the Chicago Medical College in 1884. In the thirteen issues of medical directories of the United States that have been published during the past thirty years Dr. Williams’ name does not appear--except for the issues of 1890 and 1893--until the 1914 edition. So far as we have been able to find, Dr. Williams had not until 1915 contributed any articles to medical journals. The catalog of the Surgeon General’s Library contains no reference to any articles of Dr. Williams except those that have appeared in popular magazines. The volumes of the Index Medicus from 1907 until 1914, inclusive, also contain no references to any articles by him in medical journals. The Journal‘s author index to current medical literature from 1900 to 1914, inclusive, fails to record any articles by Dr. Williams in medical journals. Dr. Williams’ articles, however, in popular magazines have been voluminous and numerous. Sometimes his articles have been under his own name and sometimes under the nom de plume, “Stoddard Goodhue, M.D.” Under the latter name the _Cosmopolitan_ published articles on “Adding Years to Your Life,” “Battle of the Microbes,” “Do You Choose Your Children?” and “What is the Matter With Your Brain?” Under his own name articles have appeared in popular magazines on such subjects as “Burbank’s Way with Flowers,” “Every Woman Her Own Burbank,” “Why Not Live Forever?” “Science of Breeding Kings,” “New Cancer Treatment” and “New Hope for Rheumatism Sufferers.” In addition, Dr. Williams has published books on such subjects as “History of the Art of Writing,” “Historians’ History of the World,” “Story of Nineteenth Century Science,” “Luther Burbank,” “Twilight Sleep” and others. The Goodhue Company of New York City, which publishes some of Dr. Williams’ books has, we understand, for its president, Dr. Henry Smith Williams, for its vice president, Dr. Williams’ wife, and for its secretary-treasurer, Dr. Williams’ daughter.

Readers of The Journal will remember the publicity given in 1915 and 1916 to an alleged treatment for cancer, sometimes called the “Horowitz-Beebe Autolysin Treatment.” The method was heralded widely both in a certain portion of the medical press and in popular magazines and newspapers. A popular article by Henry Smith Williams on “The New Cancer Treatment” appeared in the _Illustrated World_ for October, 1915, with pictures of Dr. Horowitz, Dr. Beebe, etc. A month or two later, physicians received, gratis, from the Goodhue Company a neatly bound little book on “Alcohol Hygiene and Legislation,” by E. H. Williams, M.D. (brother of Henry Smith Williams). Enclosed with it was a letter from the Goodhue Company asking physicians to accept the book. The body of the letter was devoted to calling the attention of physicians to an “important work” by Dr. Henry Smith Williams on “The Autolysin Treatment of Cancer” that the Goodhue Company was publishing. With the letter, there was a small advertising pamphlet “Issued by the Autolysin Laboratory” and advertising that product. In addition, the last thirteen pages of the book on “Alcohol Hygiene” contained advertisements of the Goodhue Company’s publications with particular emphasis (four pages of it) on the “Autolysin Treatment of Cancer,” by Henry Smith Williams.

In May, 1917, physicians in the West received a letter from the “Ellison-White Chautauqua System” informing them that Dr. Henry Smith Williams was to lecture at “your Chautauqua” and reminding them that “he has recently issued two volumes, ‘The Autolysin Treatment of Cancer’ which he believes will be his greatest contribution to medical science.” The present “Proteal” treatment appears to be a modification of the “Autolysin” treatment. Dr. Williams, in attempting to justify the use of his “Proteal” in tuberculosis, cancer, rheumatism, etc., takes advantage of certain investigations bearing on the nonspecific reactions resulting from the parental injection of foreign proteins. So far as we can discover, there is no scientific evidence to indicate that the “Proteal” treatment expounded by Williams is of value in the treatment of cancer, tuberculosis or the other numerous diseases for which the “Proteals” are recommended.

It is a question whether such articles as those on “The Proteal Treatment of Cancer,” “New Hope for Rheumatism Sufferers,” etc., published in popular magazines or newspapers serve any useful public purpose. May they not, on the contrary, by raising false hopes, cause much mental suffering and do scientific medicine great harm?--(_From The Journal A. M. A., July 6, 1918._)

PROTEOGENS

Commercial Therapeutics[M]

[M] See index for additional articles on proteogens.

A report of the Council on Pharmacy and Chemistry that appears elsewhere[253] in this book deals with another attempt to foist on our profession a series of essentially secret preparations whose therapeutic value has not been scientifically demonstrated. Grotesquely extravagant claims are advanced as to the therapeutic potency and range of action of substances of whose nature and effects we have no trustworthy information. Physicians are advised to use--and many undoubtedly are using--these alleged remedies in the treatment of diseases in which delay in the proper kind of treatment may be of the greatest danger to the patient. As stated, there is available no reliable information regarding the effects of these substances when they are introduced in the human body. They may have no effect whatever, or they may produce more or less direct injury; in either case, there is the chance that damage, even irreparable to the patient, may result because rational treatment is withheld.

[253] Page 227.

If we accept the statement that the preparations are largely vegetable proteins, it is a fair inference that, under certain conditions, they may cause a febrile reaction of the same general nature as that caused by other foreign proteins when injected into the body. We know that such reactions are not without danger and that the treatment of certain infections by induced reactions to foreign proteins is strictly an experimental procedure to be undertaken only under very special conditions. There is, therefore, no known valid reason why a physician should assume the responsibility for using these alleged remedies in the treatment of his patients; there is a very obvious reason why he should not--the therapeutic instructions of “the House of Merrell, always interested in the progress of plant therapy” to the contrary notwithstanding. It is the old story of exploiting physicians through commercial pseudoscience; of trading on the credulity of the profession to the detriment of the public. As Osler[254] recently protested so vigorously:

[254] Advance pages, the Oxford Medicine, 1919, Vol. 1, Part. 3, p. 245.

Some time ago a pamphlet came from X and Company, characterized by brazen therapeutic impudence, and indicating a supreme indifference to anything that could be called intelligence on the part of the recipients. That these firms [manufacturing pharmacists] have the audacity to issue such trash indicates the state of thraldom in which they regard us. And I would protest against the usurpation on the part of these men of our function as teachers. Why, for example, should Y and Company write as if they were directors of large genito-urinary clinics instead of manufacturing pharmacists? It is none of their business what is the best treatment for gonorrhea--by what possibility could they ever know it, and why should their literature pretend to the combined wisdom of Neisser and Guyon? What right have Z and Company to send on a card directions for the treatment of anemia and dyspepsia, about which subjects they know as much as an unborn babe, and, if they stick to their legitimate business, about the same opportunity of getting information? For years the profession has been exploited in this way, until the evil has become unbearable, and we need as active a crusade against the pseudoscience in the profession as has been waged of late against the use of quack medicines by the public. We have been altogether too submissive, and have gradually allowed those who should be our willing helpers to dictate terms and to play the rôle of masters. FAR TOO LARGE A SECTION OF THE TREATMENT OF DISEASE IS TODAY CONTROLLED BY THE BIG MANUFACTURING PHARMACISTS, WHO HAVE ENSLAVED US IN A PLAUSIBLE PSEUDOSCIENCE.

What shall the profession do to protect itself against this humiliation--to throw off the credulity that extols pseudoscience and makes commercialized empiricism financially profitable? Osler says the remedy is obvious: “Give our students a firsthand acquaintance with disease, and give them a thorough practical knowledge of the great drugs, and we will send out independent, clear-headed, cautious practitioners who will do their own thinking and be no longer at the mercy of the meretricious literature, which has sapped our independence.” Excellent! But must humanity wait a generation? Why not stop this evil at once? The American Medical Association has provided the means whereby this can be done, if physicians will only make use of it--the Council on Pharmacy and Chemistry.--(_Editorial from The Journal A. M. A., July 12, 1919._)

An Alleged Endorsement of Proteogens Repudiated

_To the Editor_:--I note in the issue of The Journal for July 12, a statement regarding the so-called “Proteogens” manufactured by the Wm. S. Merrell Company of Cincinnati.

My attention has been called to the fact that salesmen of this company have been exhibiting a letter purporting to show that this department has endorsed their products in the treatment of venereal diseases. The letter in question was written by a physician employed in one of the clinics conducted jointly by this department and the U. S. Public Health Service, and the stationery of the department was used without authority. The physician in question has made numerous efforts to recall the letter, but the Merrell people profess an inability to control its use.

I need not add that this department has not endorsed and will not endorse these products, and has no evidence that they are of any value whatsoever.

Allen W. Freeman, M.D., Commissioner of Health, State of Ohio, State Department of Health.

--(_Correspondence in The Journal A. M. A., July 26, 1919._)

The Manufacturer’s Protest and a Reply

_To the Editor_:--Allow us to direct your attention to several misstatements which appear in the letter signed, “Allen W. Freeman, M.D., Commissioner of Health, State of Ohio,” published in The Journal of the American Medical Association for July 26.

1. Salesmen of this company have _not_ been exhibiting a “letter purporting to show that this department has endorsed their products in the treatment of venereal diseases,” as stated by Dr. Freeman.

2. The author of the letter has _not_ “made numerous efforts to recall the letter, but the Merrell people profess an inability to control its use,” as stated by Dr. Freeman.

A physician employed in one of the clinics used our Proteogens Nos. 10 and 11 extensively and is still using them to a large extent in his private practice. He is a man of standing in the community in which he practices and is also a professor in one of the leading medical colleges in the state.

The letter in question cites the case of a man who had been under treatment for three years with 606, 914 and most of the other treatments in general use, and on August 31, a year ago, still gave a Wassermann test plus 4. He was given Proteogen No. 10, and by the middle of December the Wassermann was negative and the man was discharged as cured.

While this letter was written on the stationery of the Bureau of Venereal Diseases of the Department of Health, State of Ohio, it was written in the first person, and made no pretension in any way to being official nor was any such pretense made or authorized by the Merrell Company.

The author of the letter has _not_ made “numerous efforts to recall the letter,” nor has the Merrell Company “professed an inability to control its use.”

The physician did ask that the letter be returned to him, and his request was complied with promptly.

[Then follows the full text of the letter in question. As its contents have no bearing on the question under discussion, it is omitted.--Ed.]

In over ninety-one years of honorable service as manufacturers of medicinal preparations, the Wm. S. Merrell Company has never endeavored to advance its interests through misrepresentation.

The Wm. S. Merrell Company, Chas. G. Merrell, Pres.

[The letter above was submitted to Dr. Allen W. Freeman, Commissioner of Health of the State of Ohio. Dr. Freeman’s comments appear below.--Ed.]

_To the Editor_:--The plain issue of veracity raised in the communication of the Merrell Company must be settled on the evidence, which is unfortunately too voluminous to be published in full in The Journal. Copies of the correspondence in the case have been furnished the editor, and the originals are on file in the office of the state department of health in Columbus.

1. Whether or not the photographic reproduction of a letter written on the letter head of this department, and the distribution of copies to salesmen for display to physicians, was a conscious effort on the part of the firm in question to create the impression that the letter was an official one is perhaps a matter of inference. That it did create such an impression is evidenced by the letters of inquiry received from physicians who saw it.

2. The statement that the Merrell Company refused to return the _letter_ is perhaps erroneous. They did apparently return the original letter but not the _photographic copies_ which had been distributed to their salesmen. On May 22 the firm wrote as follows:

“A number of physicians who are in cooperation with both state and national bureaus of venereal diseases have been using our Proteogens with marked success and there are doubtless many letters carried by our salesmen--reports from some of these physicians.”

This was interpreted to mean that the firm had no method of knowing what letters were carried by their salesmen and was not responsible for them. Whether or not this interpretation is correct is again, perhaps, a matter of opinion.

The purpose of the original communication was to make plain to those of the profession who have already seen or might subsequently see the letter referred to that the communication was the expression of an individual and not of the Department.

A. W. Freeman, Commissioner.

--(_Correspondence in The Journal A. M. A., Sept. 6, 1919._)

Details of the Alleged Endorsement of Proteogens

Our readers will remember the recent correspondence published in The Journal of July 26 and September 6, by Dr. A. W. Freeman, Commissioner of Health of the State of Ohio and the Wm. S. Merrell Co. The letters dealt with the use that had been made by the Wm. S. Merrell Co. of a letter, written on the official stationery of the Bureau of Venereal Diseases of the State Department of Health of Ohio, puffing one of the company’s proprietary remedies--Proteogen No. 10.

Dr. Freeman wrote to The Journal calling the attention of the profession to the use of this letter and explaining that the letter was merely the expression of opinion of an individual, and not an expression from the State Department of Health. The Wm. S. Merrell Co. took exception to certain inferences made in Dr. Freeman’s letter and in the course of a letter to The Journal regarding this, incorporated the contents of the testimonial letter. The Journal, in publishing the Merrell letter, omitted this testimonial on the ground that the _contents_ of the letter had no bearing on the question under discussion.

We have now received a letter from the company protesting against this omission. The Journal, therefore, takes this opportunity of briefly restating such facts as it has been able to get regarding the entire matter and publishing the letter. The facts are as follows:

1. In February of this year a Cincinnati physician, Dr. C. J. Broeman, wrote to Dr. A. S. Horovitz relative to alleged results with Proteogen No. 10. The letter was written--without authority--on the official stationery of the Bureau of Venereal Diseases of the State Department of Health of Ohio.

2. The Wm. S. Merrell Co. had linen mounted photographs made of Dr. Broeman’s letter and distributed them to their Proteogen detail men. Accompanying these photographic copies was a communication to these detail men describing the photographed letter as one written by:

“... a Cincinnati physician who is now Acting Assistant Surgeon, U. S. Public Health Service, cooperating with the Bureau of Venereal Diseases of the Department of Health of the State of Ohio.”

3. The right hand top corner of the official stationery, as can be seen by the reproduction, bore the name of “James D. Bauman, Deputy Commissioner.” Dr. Broeman’s signature was rather illegible and could easily be mistaken, by those not knowing the handwriting of either man, for the signature of Deputy Commissioner Bauman. In at least one instance it was so mistaken, and the physician who was misled wrote to the Director of the Bureau asking whether the testimonial for Proteogen No. 10 which had been shown him by the Merrell detail man was really an official communication.

4. On May 15, 1919, Commissioner of Health Freeman wrote to the Merrell Co. stating that he had been informed that one of the Merrell representatives was using as an advertisement a letter bearing the letterhead of the Bureau of Venereal Diseases of the State Department of Health and what purported to be a report signed by “Mr. Bauman, Deputy Commissioner.”

5. On May 19, the Wm. S. Merrell Co. wrote Dr. Freeman that he was certainly mistaken in regard to the use of any “report signed by Mr. Bauman.” Dr. Freeman then sent to the company the letter he had received from the physician who had mistaken Broeman’s letter for an official letter by Bauman. Although it would seem that this letter and Commissioner Freeman’s protest should have made plain to the Wm. S. Merrell Co., the fact that the letter, incorrectly referred to as Mr. Bauman’s, was in reality Dr. Broeman’s, the company remained silent regarding its use of the Broeman letter and, on May 22, merely reiterated that there had been “no letter circulated by this company containing a testimonial of your Mr. Bauman.” On May 28 (six days later) the Merrell company sent to its Proteogen detail men another general letter, “for personal use of agents,” in which it again called their attention to the “photographic copy mounted on linen” of Dr. Broeman’s letter. This communication to the detail men also declared that it “has been suggested that the further use of Dr. Broeman’s letter might antagonize the State Department of Health” and, therefore the detail men were told to “discontinue using the photographic copy in question” and to return the photographs to the head office.

Here, briefly are the bald facts in the case. The essential point at issue is whether these photographic copies of Dr. Broeman’s letter would or would not be likely--whether or not they were so intended--to mislead physicians into believing that the endorsement was an official one by the State Board of Health rather than an individual one. One can but wonder why, if, as the Merrell company so vehemently asserts, there was no intention of misleading physicians on this point, the company should have gone to the trouble and expense of _photographing_ the entire letter, including the letterhead, rather than making typewritten or mimeographed copies of the _contents_ of the letter.--(_From The Journal A. M. A., Sept. 27, 1919._)

Dr. Broeman’s Final Report on Proteogens

_To the Editor_:--In the September 27 issue of The Journal my name was mentioned in connection with the Merrell Chemical Company’s “Proteogens” in the treatment of syphilis. The Merrell Chemical Company promised not to use my name at any time in connection with their “Proteogens” injection and they know that the use of my name has been distinctly against my wishes. I feel that in justice to myself, as well as the public, I should report the result of my experiments with their “Proteogens” in private practice.

In explanation I might say that I began the use of their “Proteogens” in April, 1918, and I feel that I now have enough data to give a complete report. I might say that all my results have been practically nil; particularly is this true in my cases of syphilis, which all had a four plus Wassermann reaction when I discontinued using this form of treatment.

Very truly yours,

C. J. Broeman, M.D., Cincinnati.

--(_Correspondence in The Journal A. M. A., Oct. 11, 1919._)

PULVANE

In a twelve-page pamphlet, sent out by the Pulvane Laboratories, Inc., of Des Moines, Iowa, and purporting to deal with “The Therapy of Pulvane, an advanced method for the treatment of Respiratory Diseases,” we are told that Pulvane “was developed in a United States Army General Hospital by officers of the Medical Department.”

Pulvane “originally was intended only for its germicidal action upon tubercle bacilli in the lung,” but it is now also recommended for asthma, hay fever, bronchitis, rhinitis, laryngitis and “other affections of the air passages.” Of the alleged action of Pulvane on tuberculosis we read:

“It destroys the spores of the bacilli as well as the germs themselves. It prevents infection of new areas by aspiration, gravity or surface contact.

“In cases where sputum is positive it is a very noteworthy fact that shortly after treatment is begun, the bacilli begin to disappear, gradually diminish in number, and finally the sputum becomes negative.”

Pulvane is administered, by inhalation, at the offices of the Pulvane Laboratories, Inc. Its “discoverer” chanced on a method of “introducing into solution and volatizing a certain germicide, extremely rare in its usage because of its resistance heretofore to attempts to bend it to scientific will.” This “rare” medicament is alpha naphthol! But since the discovery of this volatizing method “three other ingredients of high therapeutic value have been added.” What are these other ingredients?

“They would be named were it not that Pulvane requires special technique in its preparation and administration. Our medical directors do not consider it advisable to identify them here because of the possibility of incompetent hands attempting their use. The medical directors, however, will be glad to name every ingredient of Pulvane for any reputable member of the profession. Pulvane Laboratories reserve only the method of compounding.”

Presumably, therefore, if physicians desire to know what Pulvane is, the Pulvane Laboratories, Inc., “will be glad to name every ingredient of Pulvane.” It is worth noting that nothing is said about quantities. It is also worth remembering that “Peruna” and some other “patient medicines” have for years printed on the label the _names_ of the alleged ingredients. How much longer is the medical profession going to be fooled with the trick of nostrum exploiters pretending a frankness that means nothing?

From a recent issue of a Des Moines newspaper we learn that the Pulvane Laboratories are about to establish a sanatorium where the Pulvane treatment can be given. This announcement is said to be made by John P. Mosher, the alleged discoverer of Pulvane. Mosher is not a physician. The newspaper article states, further, that Mosher’s experiments were tried out “under the observation of Major Sharpe,” commander at Fort Des Moines. It appears also that an ex-newspaper reporter is connected with the Pulvane Laboratories. The value of having a good publicity man is obviously recognized. There also seems to be connected with the concern a Dr. Harry P. Hall. We find in the records reference to one Harry P. Hall who was graduated by the Medical Department of Drake University of Des Moines, Iowa, in 1894, and was licensed in Iowa in 1896. Our records indicate that he has not been in practice for some years. We also find in our files some newspaper clippings regarding a Dr. Harry P. Hall who, in 1914, pleaded guilty to a charge of using the mails to defraud and was fined in the federal courts. Whether there is any connection between these two names, we do not know.

Reverting to the claims made by the Pulvane Laboratories that Pulvane was “developed in a United States Army General Hospital by officers of the Medical Department” the following statement has recently been received by The Journal from Surgeon-General Ireland of the United States Army:

“It has been brought to my attention that a concern in Des Moines, Iowa, known as the Pulvane Laboratories, has issued a pamphlet in which statements are made which would naturally lead medical men to believe that the experiments, etc., referred to therein were made with the approval of and more or less under the direction of the Medical Department of the Army. I wish to say that this is not so; that the Medical Department had nothing whatever to do with the matter and that it thoroughly disapproves of the methods used by the promoters of this concern.--(_From The Journal A. M. A., March 11, 1922._)

SAL HEPATICA

Sal Hepatica is a saline laxative sold by the Bristol-Myers Company of New York. Little information is given, or, apparently, ever has been given, concerning the composition of this product. Many years ago the stock medical journal advertisement contained this statement:

“_Composition._--Sal Hepatica contains all of the Tonic, Alterative and Laxative Salts of the celebrated ‘Bitter Waters’ of Europe, especially those of Bohemia, as determined by actual chemical analysis of these waters, and fortified by the addition of Lithium and Sodium Phosphates.”[255]

[255] Some of the Sal Hepatica advertising has claimed that it “is a saline combination with the addition of Sodium Phosphate and _Lithia Citrate_!”

Sal Hepatica no longer “contains all the tonic, alterative and laxative salts ...,” etc., for the label on a package recently purchased reads:

“SAL HEPATICA is an effervescent saline combination possessing medicinal properties similar to the natural ‘Bitter Waters’ of Europe, and fortified by the addition of Sodium Phosphate.”

In 1909, the _Druggists Circular_ published an analysis of Sal Hepatica which showed that the preparation contained only 0.04 per cent. of lithium phosphate. By referring to the two quotations just given it will be noticed that today the manufacturers make no claim that their preparation is fortified with any salt of lithium. A circular accompanying recent trade packages states:

“Sal Hepatica is composed solely of harmless salts, being absolutely free from Acetanilid, Phenacetin, Caffein, Calomel, opium or coal tar derivatives.”

Since neither the names nor the amounts of the “harmless salts” are mentioned, the composition of Sal Hepatica is secret. It is a trick of the nostrum exploiter, old but ever popular, to mention numerous drugs which his preparation does _not_ contain; it helps to distract attention from the fact that he does not tell what the preparation _does_ contain!

In the old-time medical journal advertisements, one reads, “Sal Hepatica is the most powerful solvent of Uric Acid known.” (The same advertisement as it appeared in those days in The Journal shows that claim toned down to, “Sal Hepatica is a powerful solvent of Uric Acid.”) In those easy going days, the Bristol-Myers Company declared that “diabetes is treated with decided advantage by means of Sal Hepatica ... it ... possesses the property of arresting the secretion of sugar in the liver.” In the old days, too, Sal Hepatica was recommended in the treatment of cirrhosis of the liver, Bright’s disease, gravel, phthisis, etc.

The present advertising circular recommends Sal Hepatica as an eliminant, laxative or cathartic in gout, autointoxication, “Bilious Attacks,” rheumatism, acute indigestion, catarrhal conditions of the stomach, pyorrhea, headache, dizziness, heart burn, “Summer Complaints,” “Derangements of the Stomach and Liver,” skin diseases, colic, alcoholic excesses, and as a “preventive of Seasickness.”

In 1914 the Council on Pharmacy and Chemistry published[256] a report on Sal Hepatica declaring it secret in composition and sold under exaggerated and unwarranted claims.

[256] J. A. M. A., Feb. 7, 1914, p. 472.

In view of the inquiries which The Journal continues to receive it seemed worth while to make a chemical examination of the present-day product. Accordingly specimens were purchased and analyzed in the A. M. A. Chemical Laboratory. The report that follows was submitted by the chemists:

“Sal Hepatica is a white, granular, odorless powder. It effervesces on the addition of water in which it eventually dissolves. The aqueous solution, after boiling to remove carbon dioxid, has an acid reaction to litmus.

“Since a great many medicinal substances are sold in effervescent form, and since practically no information is given by the manufacturer concerning the composition of Sal Hepatica, it became necessary to test for a considerable number of therapeutic agents. The absence of acetanilid, acetphenetidin, alkaloids, ammonium salts, benzoates, caffein, citrates, heavy metals, hexamethylenamin, magnesium, potassium, salicylates and sugars was demonstrated by appropriate tests. The presence of a carbonate (probably in the form of a bicarbonate), a phosphate, a sulphate, a chlorid, tartaric acid, sodium and traces of lithium was shown by qualitative tests.

“Quantitative analysis indicated that the composition of the specimens examined was essentially as follows:

Sodium phosphate, anhydrous 4.4 per cent. Sodium sulphate, anhydrous 26.5 per cent. Sodium tartrate, anhydrous 12.7 per cent. Sodium bicarbonate 19.5 per cent. Tartaric Acid, free 20.8 per cent. Sodium chlorid 8.9 per cent. Lithium phosphate trace Water of hydration (by difference) 7.2 per cent.

“From the results of the analysis, it appears probable that the composition of the mixture before ‘granulation’ was approximately as follows:

Sodium phosphate 4 per cent. Sodium sulphate 25 per cent. Sodium bicarbonate 30 per cent. Tartaric Acid 30 per cent. Sodium chlorid 8 per cent. Lithium phosphate trace Water of hydration (by difference) 3 per cent.

“Sal Hepatica, therefore, is essentially an effervescing mixture of dried sodium sulphate (Glauber’s salt) and sodium tartrate with a little dried sodium phosphate and table salt added. It is similar to the effervescent artificial Carlsbad Salt described in the National Formulary.

“In 1909 the _Druggists Circular_ published the following analysis of Sal Hepatica:

Sodium phosphate 29.80 parts Sodium sulphate (Glauber’s salt) 26.27 parts Sodium bicarbonate (baking soda) 18.00 parts Sodium chlorid (salt) 13.05 parts Lithium phosphate 0.04 parts Citric and tartaric acids (to make 100) 12.84 parts

“A comparison of the recent analysis with the earlier one would seem to indicate that considerable changes have been made in the formula since the first examination. The proportions of sodium phosphate have been greatly reduced, while the sodium bicarbonate and tartaric acid have been increased and the citric acid entirely eliminated.”

Sal Hepatica, then, is a simple effervescent saline laxative, essentially secret in composition and sold under claims that would be laughed at were the full formula of the product a matter of public knowledge.--(_From The Journal A. M. A., Oct. 29, 1921._)

SALICON

“Salicon” is marketed by the K. A. Hughes Company, Boston, as “an improved aspirin.” In a circular sent out to the public a little over a year ago the following claims were made for it:

“We rendered aspirin absolutely harmless and yet retained all its virtues as a medicine.”

“It positively will not depress the heart nor upset the stomach no matter how large amounts of it are taken.”

“... the Massachusetts state medical authorities ... adopted its use at all the state camps for fighting the Spanish influenza....”

The first two statements quoted above are obviously false. The third statement might have been true although it seemed unlikely. A letter was, therefore, written to the Department of Public Health of the Commonwealth of Massachusetts and the claim of the K. A. Hughes Company relative to the adoption of Salicon in all the state camps by the “state medical authorities” was brought to their attention. The reply of the department on this point was emphatic:

“The State Department of Health of Massachusetts did not endorse the use of Salicon for any purpose.”

Some Salicon was purchased on the open market and submitted to the A. M. A. Chemical Laboratory for analysis. Here is the chemists’ report.

“One original bottle of ‘Salicon’ (K. A. Hughes Company, Boston) was submitted by the Propaganda department of The Journal to the Association’s Chemical Laboratory for examination. The bottle contained 100 white tablets having an average weight of 0.407 gram (6.3 grains), each. The amount of ash was 20.9 per cent. Qualitative tests indicated the presence of magnesium, carbonate, starch, acetylsalicylic acid and a trace of calcium; a very small amount of a petrolatum-like substance was present. Alkaloids and drugs used for a laxative effect were not found. The amount of acetylsalicylic acid extracted by chloroform was 50.7 per cent. The amount of magnesium present as magnesium oxid was 14.3 per cent. The amount of magnesium oxid derived from magnesium carbonate U. S. P. is variable; but calculating on the lowest limit, 14.3 per cent. of magnesium oxid is equivalent to at least 35.5 per cent. of magnesium carbonate. This figure agreed closely with that obtained from the U. S. P., method of assay. The acetylsalicylic acid was not combined with the magnesium. From the above, it may be stated that each tablet consisted essentially of a mixture of 3.2 grains of acetylsalicylic acid (aspirin), 2.2 grains of magnesium carbonate and some starch. Although labeled 5 grains, each tablet did not contain 5 grains of the most active ingredient, acetylsalicylic acid.”

The same old story. An ordinary mixture of well known drugs put on the market as a new discovery and foisted on the public under false and misleading claims.--(_Correspondence in The Journal A. M. A., Feb. 5, 1921._)

SO-CALLED SECRETIN PREPARATIONS

In China the administration of powdered tiger-bone is--or was--a favorite form of treatment in cases of supposed cardiac weakness. The theory is, presumably, that the cardiac strength of the tiger would be a good thing for the patient to acquire. Since many patients have recovered after taking tiger-bone, and no one has proved that they might not have died had they failed to take it, “clinical experience” stands back of the treatment; and where is the skeptic so rash as to challenge that? The Chinese physician believes in his tiger-bone therapy, and, with the best interests of his patient at heart, insists on obtaining absolutely true and authentic tiger-bone. Not satisfied with the assertions of the dealers, the conscientious Chinese physician subjects his tiger-bone to a kind of physiologic standardization. He offers the bone in question to a dog! If it is an ox-bone--a frequent form of substitution--the dog will seize and eagerly gnaw it, whereas, according to all the teachings of Chinese pharmacognosy, if it is a tiger-bone the dog will depart hurriedly with his tail between his legs. Very foolish? Yes! But before we smile superciliously at the Chinese medical man, let us turn to the report of the Council on Pharmacy and Chemistry on “So-Called Secretin Preparations.”[257] After reading this report let us put to ourselves, squarely and honestly, the question: Has the attitude toward secretin therapy, of a certain portion of those who represent Western modern medicine, really been much more scientific than that of the Chinese medical profession toward tiger-bone therapy? On the basis of a hypothesis scarcely less crude and unsubstantiated than that which assumes that tiger-bone is of value in heart disease, it has been assumed that secretin is of value in gastro-intestinal diseases. On the ground of “clinical evidence” scarcely more critical than that exhibited by our confrères in the antipodes, it has been asserted that alleged secretin preparations actually are efficious. Indeed, in one respect the methods of the Chinese physician appear more scientific than those of his Western brethren. To the best of his ability, the Oriental at least makes sure that he is administering genuine tiger-bone; he does not rely on the unverified word of his dealer alone. The American physician has not been making the least effort to ascertain whether his supposed secretin preparations are truly such; and, as a matter of fact, scientific investigation seems to indicate that some of these products contained no secretin at all! Whatever one may think of the validity of his test, the Chinese physician does his best according to his lights. As to “clinical experience,” Dr. Jacobi has well said that some people make the same mistake a hundred times and call it “experience.”--(_Editorial from The Journal A. M. A., Jan. 15, 1916._)

[257] Page 64.

SUCCUS CINERARIA MARITIMA

Another Illustration of One of the Weaknesses of the Federal Food and Drugs Act

The Walker Pharmacal Company of St. Louis was, we understand, if it is not still, one of the subsidiary concerns of the Luyties Homeopathic Pharmacy Company. It has for years sold a nostrum, “Succus Cineraria Maritima,” under the claim that by simply dropping this stuff into the eye, twice daily, cataract and other opacities of the eye will be cured. For instance:

“... the only remedy for the relief of cataract and other opacities of vision, which stands before the medical fraternity on a firm foundation of accomplished results....”

“... possesses a specific power in removing the obstruction to vision.”

“In this class of cases [cataract] physicians can place reliance on Succus Cineraria Maritima (Walker) which does not require the services of a specialist but is simply dropped into the eye with an ordinary medicine dropper twice daily....”

“... has been used with success in cataract, both lenticular and capsular, pterygium and opacities of the cornea, softening the opaque deposits, causing dissolution, and by its stimulating properties, hastening absorption.”

Succus Cineraria Maritima is advertised to the medical profession in true “patent medicine” style by means of testimonials from doctors, obscure and deceased. The preparation is valueless for the purposes for which it is sold and “has about as much effect on the dissolution or dispersal of opacities due to organic changes in the lens as pouring the same down the back of the patient’s neck!” More than five years ago the Council on Pharmacy and Chemistry reported on the worthlessness of the drug, Cineraria maritima, and, at the same time, The Journal pointed out that the drug would have been forgotten long ago had it not been for the prodigal use of printers’ ink by the Walker Pharmacal Company in advertising its Succus Cineraria Maritima.

These facts are given for the purpose of refreshing the memory of our readers and are but incidental to the object of this article. In due time the federal authorities proceeded against the Walker Pharmacal Company charging that Succus Cineraria Maritima was misbranded under the federal Food and Drugs Act. The government chemists reported that analysis “showed that the product was essentially an aqueous solution of glycerin, boric acid and vegetable drug extractives carrying tannin-like bodies.” The direct and inferential claims made in the advertising matter accompanying the trade package were quoted by the federal authorities, who pointed out that the Walker Pharmacal Company was selling the nostrum under claims that would create in the minds of the purchasers the belief that Succus Cineraria Maritima was a remedy for cataract and other opacities of the eye causing impaired vision and that it was a cure for senile cataract, trachoma, secondary opacities, etc. These claims the government charged were “false and fraudulent in that the same were applied to the article knowingly, and in reckless and wanton disregard of their truth or falsity,” because “in truth and in fact it was not, in whole or in part, composed of, and did not contain, such ingredients and medicinal agents” as would produce the therapeutic effects claimed.

These charges put the matter flatly up to the Walker Pharmacal Company. This company has for years been telling physicians that their stuff _could_ and _would_ do just what the federal authorities insisted it can _not_ and will _not_ do. Did the Walker Pharmacal Company attempt to defend its claims? Did it demonstrate that Succus Cineraria Maritima would cure cataract? Did it produce evidence of the numerous cases of recovery from blindness or partial blindness which must have been available if the preparation had the powers claimed for it? No! The Walker Pharmacal Company in February, 1916, pleaded guilty--and was fined a paltry $10 and costs.

This, however, is not the end of the story. The company was prosecuted because it had published the false and fraudulent claims in the trade package, thus bringing the claims within the purview of the federal Food and Drugs Act. Had the Walker Pharmacal Company confined its false statements to medical journal advertisements, to the circular letters sent to physicians or to any other advertising matter not part of the trade package, it could have snapped its fingers at the Food and Drugs Act.

It was in February, 1916, that the Walker Pharmacal Company pleaded guilty to the charge of making false and fraudulent claims for Succus Cineraria Maritima. In October, 1916, they were still sending out circular letters to physicians urging the use of Succus Cineraria Maritima in the treatment of cataract and enclosing the usual booklet of testimonials claiming cures for cataract and other opacities of the lens and cornea!

Can one conceive a better illustration of the inadequacy of the Food and Drugs Act? The dishonest exploiter of proprietary medicines cares little that the law requires him to keep within certain bounds of truthfulness in the advertising that accompanies the trade package. It isn’t the claims in the trade packages that sell the product; it’s the advertising in medical journals, in circular letters, etc. Yet, the Food and Drugs Act offers no check or curb on false statements or fraudulent claims made for proprietary or “patent medicines” in any other place than the trade packages.

A few weeks ago The Journal called attention to a flagrant case of fraud; and at that time it said, “It is justifiable to assume that when any man, whatever his business, admits in court that he has made fraudulent claims and then continues to make the same claims through channels that are not controlled by penal enactment, that man’s standard of business ethics is such that the public needs protection against it. There are many such men in the ‘patent medicine’ world. The only way in which the public may properly be protected against being defrauded in such cases is for the federal Food and Drugs Act to have its scope extended to cover _all_ advertising of the products coming under the purview of the act.”--(_From The Journal A. M. A., March 17, 1917._)

TEKARKIN

Edward Percy Robinson’s “Cure” for Cancer

From various parts of the country The Journal has received a sixteen page pamphlet, _Therapeutic Leaves_. The publication, which has a saffron colored cover, is said to be published by the National Bio-Chemical Laboratory, Mount Vernon, N. Y. The National Bio-Chemical Laboratory seems to be a style used by Dr. Edward Percy Robinson. The “editorial offices” of _Therapeutic Leaves_ are given as “501 Knox Bldg., 5th Ave. at 40th St., New York,” which is a roundabout way of describing 452 Fifth Ave., the office address of Edward Percy Robinson. The first number (February, 1921) of _Therapeutic Leaves_ gives the names of the “editors” as “E. P. Robinson, M.D., and W. A. Jenner, B.A.” In addition, there is “Assistant Editor, F. J. Geiger,” and “Gen’l Manager, Beverly K. Robinson.” The first and second numbers of _Therapeutic Leaves_ (February and March, 1921) are practically identical, being evidently printed from the same plates. _Therapeutic Leaves_ purports to be a periodical published as “a medium for the dissemination of knowledge, pertaining to therapeusis.” Actually, it is an advertising medium dealing with the products of the National Bio-Chemical Laboratory: “Osmo-Calcic Solution,” “Tekarkin” and “Osmotic Mangano-Potassic Solution.”

These preparations are said to be the “formulas” of Dr. Edward Percy Robinson who lives in Mt. Vernon, N. Y., and has an office at 452 Fifth Ave., New York City. They are used by Dr. Robinson in the treatment of cancer. At an earlier stage they seem to have been known under different names: “Tekarkin” was first “Hypotonic Sal-Cella” and then “Neoanabolin-X;” “Osmo-Calcic Solution” was “Osmotonic Calcic” while “Osmotic Mangano-Potassic Solution” was “Osmotonic Drops.” The three solutions are put up in one package containing 4 c.c. (about 65 minims) of “Tekarkin” and 1 ounce each of the other preparations. The package sells for $10.00. “Remittance with order ... We have no agents.”

Most of the material in _Therapeutic Leaves_ is a rehash of four papers published by Edward Percy Robinson in the New York _Medical Record_ of various dates between September, 1917, and July, 1920. In these Robinson advances the theory that cancer is caused by an excess of sodium chlorid (table salt) in the blood and tissues and that it can be cured by administering a solution of potassium nitrate. Such a treatment sounds ideally simple. One might assume that all that was necessary was to make up a solution of potassium nitrate and inject it. One might further wonder how it would be possible to commercialize such a “treatment.” “Homemade solutions,” says Dr. Robinson, “are apt to be disappointing.” Their use is likely to cause “considerable swelling at the site of an injection, accompanied with tenderness and some heat.” Moreover, “a wide hyperemic area with red blotches has been observed in a number of instances.” In order to avoid “accidents of this sort” which would “bring discredit upon an excellent agent,” Dr. Robinson, “after considerable experimental work” has obtained “a solution of this chemical which would meet the ideal requirements.” This is available under the name “Tekarkin.” Dilute potassium nitrate solution sold under the name “Tekarkin” sells for $67 an ounce. The physician can make his own solution, of the purest and highest grade potassium nitrate on the market, at an expense, for the chemical, not exceeding 5 cents an ounce.

_Therapeutic Leaves_ also contains the usual number of those “clinical reports” which bulk so large in the literature of “cures” for cancer. Then there is a full page advertisement of a side-line of the National Bio-Chemical Laboratory: “Vitamines (Compressed) Tekarkin Brand;” “They have a meaty taste.”

The medical profession, naturally, is interested in knowing more about the physician who admits that he has discovered the cause and cure of cancer. According to our records, Edward Percy Robinson was born in 1871 and was graduated in 1897 by Bellevue Hospital Medical College. He was licensed in New York State the same year and has practiced in New York City continuously since that time. He is not, and apparently never has been, a member of his local medical society.

In 1914 Robinson was specializing in “facial contouring.” One piece of advertising purports to be the reprint of an interview with “Dr. E. P. Robinson, Specialist, as he sat in his office at 116 West 39th Street, having questions fired at him by the reporter.” Thus Dr. Robinson:

“There are physicians everywhere who abandon the general, or family, practice of medicine, to devote their life to some specialty. My specialty is the improvement of the facial features and the beautifying of the shoulders, neck and arms. I round out hollow cheeks, build up the neck, eradicate wrinkles, make irregular noses perfect and remove defects by a process which is my own secret. I claim no superhuman power or ability; I have simply bent my whole professional study and energy to the one line of remodeling--so to speak--the human features, and I employ only scientific methods and aids in my operations.”

In another piece of advertising, a little booklet bearing Edward Percy Robinson’s name, we find the following:

“This is what I accomplish....

“Remove all wrinkles and traces of age from the forehead, or about the eyes and mouth. Lift sag from cheeks and chin.

“Round out hollow cheeks.

“Remove depressions and defects from the chin.

“Build up the neck and shoulders.

“Build up and enlarge the bust.

“Round out and give symmetry to unshapely arms and remove the lines of age from the hands.

“Correct many of the defects not mentioned here, but which may be possessed by exceptional cases.”

Still another advertising leaflet purports to be a reprint of an “editorial” from the _Mercantile and Financial Times_ of March 11, 1914. It is a pretentious puff of Robinson, telling about his “scientific attainments” and his marvelous secret preparations used in “Youthifying the Face.” The _Mercantile and Financial Times_ is an utterly discredited sheet run for the purpose of selling what appear to be editorial comments. Such “editorial” puffs are paid for through the purchase of a certain number of copies of the paper by the party who desires the publicity. The Associated Advertising Clubs of the World exposed this publication in a special bulletin issued in June, 1919, and described it as an “example of publications that serve as convenient tools of fake promoters.” In 1911 the _Mercantile and Financial Times_ published an “editorial” endorsement of the consumption cure “Nature’s Creation.” It has done the same for a fakish device known as the “Ideal Sight Restorer.” It published a puff on the “Oxypathor,” a swindle so preposterous that the exploitation of this “gaspipe” fake was debarred from the U. S. mails and its exploiter was sent to the federal penitentiary.

We also find in our files a testimonial signed E. P. Robinson, M.D., 1402 Broadway (Edward Percy Robinson’s address in 1912), extolling the virtues of a foolish piece of quackery, the obesity cure “Get Slim.” This nostrum was exposed in The Journal some years ago and was also exposed by Dr. Wiley in _Good Housekeeping_. The “Get Slim” concern sued _Good Housekeeping_ for libel but a jury decided that _Good Housekeeping_ had told the truth. In the “Get Slim” testimonial Robinson is quoted as saying that he is “acquainted with the ingredients entering into its manufacture” and he describes it, as did the “Get Slim” concern, as “a purely vegetable combination.” The fact is the Association’s chemists found this “purely vegetable combination” to consist of sugar and tartaric acid, each colored pink, and baking soda.

And this is the gentleman who claims to have discovered the cause of, and offers for sale a cure for, one of the most baffling scourges known to modern medicine--cancer. Except for the articles that have been published during the past three years in the _Medical Record_, we are unable to find anywhere in representative medical literature anything to indicate that Edward Percy Robinson can lay any claim to special knowledge of, or skill in the treatment of, cancer. What we do find are advertisements describing Edward Percy Robinson’s alleged abilities as a “face beautifier,” puffs from utterly uncritical or discredited sources and a testimonial to the value of a preposterous “fat cure” fake.

With the best brains of the world at work on the problem of cancer, it is reasonable to assume that any man who has found out even a little more than has previously been discovered or is able to accomplish even a little better results than the average in the treatment of this dreaded disease, would be well known to scientific medicine.

* * * * *

After this article was in type physicians began sending in No. 3 (April, 1921) of _Therapeutic Leaves_. This is still another reprint of Nos. 1 and 2, with minor changes. In the first two, Tekarkin is described as “a solution of potassium nitrate of special strength;” in No. 3 it becomes “a special solution containing potassium nitrate.” In Nos. 1 and 2, Robinson described an alleged case of “Cancer of the Rectum _Treated_ with Tekarkin.” In No. 3 this becomes “Medicinal Treatment _Cures_ Cancer of the Rectum.” In No. 3 the names of the editors, assistant editor and general manager are eliminated.

The inside back cover of No. 3 contains an advertisement of Tekarkin, in which physicians are warned that “Cancer of the Lung May Present Diagnostic Signs of Tuberculosis.” It contains the further startling information that the particular micro-organism responsible for pulmonary tuberculosis is the Klebs-Loeffler bacillus! Thus:

“The Klebs-Loeffler bacillus may find a suitable habitat in a malignant area of lung tissue and thrive therein. The presence of the bacillus does not necessarily exclude the presence of cancer. A chronic cough with blood-streaked sputum may be the result of tuberculosis and cancer.”--(_From The Journal A. M. A., May 28, 1921._)

TYREE’S ANTISEPTIC POWDER AGAIN

The “Ethical and Commercial Requirements” of the Drug Business

“I am fond of the retail drug business and follow it every day of my life. I know and observe to the fullest extent its ethical and commercial requirements.” This from a circular letter recently received by physicians, and signed J. S. Tyree, who asks that he be forgiven for writing you personally, but there are several reasons why he thinks the circumstances warrant it. All of which is preliminary to calling attention to an enclosure, which accompanies the circular letter, and is described as a “short memorandum” submitted for “your consideration.”

The “memorandum” is a four-page leaflet of which three pages are devoted to “Tyree’s Antiseptic Powder.” One of these three pages is a reproduction of a letter on the stationery of the Surgeon General’s Office of the War Department, and signed “W. M. Gray, M.D., Microscopist, Army Medical Museum; Pathologist to Providence Hospital.” The letter describes a series of “bacteriological and comparative tests” made by Dr. Gray with Tyree’s Antiseptic Powder. The entire second page of the circular is given over to the results of these bacteriologic tests which compare various strengths of Tyree’s Antiseptic Powder with “mercuric bichlorid,” phenol and formaldehyde.

The physicians who received this advertising material in April, 1919, might easily overlook the fact that Dr. Gray has been dead several years, that the letter which is reproduced is dated Jan. 3, 1890, and that the bacteriologic tests were made in 1889--thirty years ago!

The Council on Pharmacy and Chemistry in 1906[258] published the results of an analysis of Tyree’s Antiseptic Powder which showed that although the stuff was advertised as a mixture of borax and alum, it was in fact essentially a mixture of zinc sulphate and boric acid. The publication of the Council’s report in 1906, showing the falsity of the formula, brought out the admission that the composition had recently been changed. Certain it is, however, that for at least a decade past, the Tyree product has been a zinc sulphate-boric acid preparation. Yet, according to the manufacturer’s own statement, Tyree’s Antiseptic Powder in 1889, when Dr. Gray made his bacteriologic tests, was an entirely different substance from the present mixture.

[258] At this time Tyree’s Antiseptic Powder was an “ethical proprietary”--heaven save the mark!--and advertised only to physicians. Later, as _The Journal_ has shown, it entered the “patent medicine” field as “ideal for douche” and the “best preventative known.” The articles on this nostrum are reprinted in the ninth edition of “The Propaganda for Reform.”

Here then we have a manufacturer publishing in 1919, in behalf of a certain product, tests that were made in 1889 with a product of different composition, although of the same name! Is this observing “to the fullest extent” the “ethical and commercial requirements” of the “retail drug business”?

There is no scientific excuse for such a mixture as Tyree’s Antiseptic Powder. If, however, physicians feel that they must use an irrational conglomeration such as this, why not prescribe Pulvis Antisepticus, N. F.? Like the Tyree product, this, too, is essentially a mixture of zinc sulphate and boric acid, with minute amounts of phenol, eucalyptol, menthol and thymol, to say nothing of a dash of salicylic acid. This official article has at least the virtue of constancy of strength, composition and purity assured under the federal Food and Drugs Act.--(_From The Journal A. M. A., May 17, 1919._)

WHEELER’S TISSUE PHOSPHATES

“The Commissioner of Health directs me to call to your attention the enclosed advertisement issued by T. B. Wheeler, M.D., Company, Montreal, Canada, in which the name of the Association’s _Journal_ is being used.”

Accompanying this brief note to The Journal from the secretary of Dr. Haven Emerson, Commissioner of the Department of Health of the City of New York, was a four page leaflet devoted to the exploitation of “Wheeler’s Tissue Phosphates.” The trend of the circular is to lead the average reader to infer that The Journal of the American Medical Association has endorsed Wheeler’s Tissue Phosphates. For example, in describing the preparation one reads:

“It embodies ... the best recent scientific opinion concerning the treatment of the disease (tuberculosis) as stated ... by the official Journal A. M. A.”

Elsewhere in the circular The Journal’s criticisms of the hypophosphites and the glycerophosphates (proprietary preparations which are competitors of the Wheeler product) are quoted and twisted into a tribute to the ingredients of Wheeler’s Tissue Phosphates. Garbling quotations, distorting statements, separating phrases from their contexts and omitting qualifying clauses, all for the purpose of making out a case for some proprietary remedy is a trick as old as quackery itself. That it should be used in advertising Wheeler’s Tissue Phosphates is entirely fitting. Obviously, the T. B. Wheeler, M.D., Company esteems the opinion of The Journal on pharmacologic matters. This being the case, it should, in the interest of truth and scientific accuracy, publish in its advertising circulars just what The Journal has said about Wheeler’s Tissue Phosphates. It could not do this better than by quoting from a recent editorial note which commented on a report of the Chemical Laboratory on this preparation. Here is part of the The Journal’s comment:

“‘Wheeler’s Tissue Phosphates’ is an unscientific shotgun mixture whose most active and powerful drug is the alcohol it contains. That it was not years ago relegated to the realms of obsolete and discarded preparations is a commentary alike on the lack of scientific discrimination and on the power of advertising.”

Here we have “Wheeler’s Tissue Phosphates” stripped of the verbal camouflage with which its exploiters have invested it.--(_Editorial from The Journal A. M. A., Sept. 22, 1917._)

BRIEFER PARAGRAPHS

Alcresta Lotion

_To the Editor_:--What is the composition of Alcresta Lotion?

L. T. A. Hotten, M.D., Paris, Idaho.

According to a circular in our files, “Alcresta Dental Lotion-Libby” contains “Emetin, the active amebicidal principle of Ipecac, together with Benzoic Acid, Thymol, Eucalyptol and Aromatics.” The theory that emetin is an active amebicide against pyorrhea alveolaris has been exploded. In this connection, it is interesting to note that the firm does not list the product in the latest catalogue in our files.--(_Query from The Journal A. M. A., Oct. 29, 1921._)

Calcidin Tablets (Abbott)

_To the Editor_:--What is the composition of calcidin tablets (Abbott) and what is their value?

J. S.

ANSWER.--Calcidin is claimed to be a mixture of iodin, lime and starch. In contact with water, the iodin and lime react to form calcium iodid and calcium iodate. By the acid of the gastric juice, the calcium iodid and calcium iodate are decomposed with liberation of free iodin. The administration of calcidin tablets amounts to giving free (elementary) iodin. In the past, the advertising for calcidin has contained the unwarranted claim more or less directly that it was the most effective and only noninjurious preparation of iodin for internal use, and that it possesses all of the valuable properties of the iodin with all of the objectionable effects left out. So far as we know, the effects produced by the administration of free iodin do not differ from those produced by the administration of iodids and, therefore, calcidin has no advantage over the iodids, such as sodium iodid.--(_Query in The Journal A. M. A., Sept. 25, 1920._)

Di-Crotalin Treatment of Epilepsy

_To the Editor_:--Do you have any literature or information relative to the Di-Crotalin treatment for epilepsy? I will be very grateful if you can furnish information as to method of preparation, rationale of the treatment, etc.

R. C. Decker, Captain, M. R. C., U. S. Soldiers’ Home, Washington, D. C.

ANSWER.--Di-Crotalin is a rattlesnake venom preparation sold by the Swan-Myers Company of Indianapolis as a “Treatment for Epilepsy, Chorea, Bronchial Asthma, Chronic or Hereditary Nervous Headache, Nervous Prostration Incident to Change of Life, Hysteria-Mania, Insomnia, Neurasthenia, etc.” Dr. Thomas J. Mays of Philadelphia advocated the use of rattlesnake venom for tuberculosis. Later his former assistant, Dr. R. H. Spangler, used the same material in the treatment of epilepsy. That any measure of success sufficient to justify the adoption of the rattlesnake venom or crotalin treatment for epilepsy has resulted is not to be concluded from the available reports. Still less evidence is there for the use of rattlesnake venom in the list of conditions for which the Swan-Myers Company has recommended its preparation. There are a number of good reasons why a cautious physician will shun the administration of this treatment and advise against it. J. F. Anderson, working in the hygienic laboratory of the United States Public Health Service, reported a death from the crotalin treatment in consequence of infection, and reports that the market supply of crotalin solution and crotalin tablets is highly contaminated. He also found both crotalin and crotalin solution to vary in activity. The use of rattlesnake venom was discussed in The Journal, March 15, 1913, p. 850.--(_Query in The Journal A. M. A., Aug. 17, 1918._)

Estivin

_To the Editor_:--What is “Estevin,” or something like that? It is said to be good in hay-fever.

Constant Reader.

ANSWER.--The product called “Estivin” is sold by Schieffelin and Company, New York. A request for a statement of the composition of this preparation sent to Schieffelin and Company by the Council on Pharmacy and Chemistry brought the indefinite and, therefore, meaningless statement that “‘Estivin’ is an extract of Rosa Gallica containing no alcoholic or foreign ingredients.”--(_Query from The Journal A. M. A., Nov. 12, 1921._)

Iron Arsenite

_To the Editor_:--Can you inform me how iron arsenite can be prepared for subcutaneous injection? A commercial firm furnishes physicians with ampules of arsenite of iron. Is this really arsenite of iron?

S. H. Kempner, M.D., New York.

ANSWER.--Ferric arsenite (iron arsenite) is in itself relatively insoluble in water, but may be treated with ammonium citrate, the resulting product thus being soluble; the latter substance was at one time described in New and Nonofficial Remedies as “Ferric Arsenite, Soluble” and is sometimes sold as a solution in ampule form. In 1912, the Council on Pharmacy and Chemistry deleted “Ferric Arsenite, Soluble” from New and Nonofficial Remedies because “one cannot, in administering Ferric Arsenite, Soluble, give a useful dose of iron without giving too much arsenic; and, vice versa, one cannot give a safe dose of arsenic without giving too little iron.” The Council, therefore, held the preparation to be irrational and unscientific.--(_Query in The Journal A. M. A., Feb. 19, 1921._)

K-Y Lubricating Jelly

_To the Editor_:--1. What is the composition of “K-Y Lubricating Jelly”? 2. Can you furnish a formula for a simple nongreasy lubricating jelly?

S. T.

ANSWER.--1. The composition of “K-Y Lubricating Jelly” has not been divulged. Examination of the advertising matter reveals only meaningless statements, such as: “This is a judicious combination of vegetable products ... Combined in well balanced proportions with non-irritating antiseptics ...,” “It incorporates a sufficient quantity of mild antiseptics (of the Thymol class) ...” and “... contains _NO_ formaldehyde.”

2. Probably a simple tragacanth jelly, which can be made cheaply, will produce the same effects as those of the proprietary preparation. The following formula was published by Mr. J. K. Thum, apothecary at the German Hospital, Philadelphia (_Druggists Circular_, September, 1915, p. 586):

LUBRICATING JELLY

Tragacanth, whole 3 gm. Glycerin 25 c.c. Phenol 1.5 gm.

Distilled water, a sufficient quantity to make 300 c.c. The tragacanth is broken in small pieces, and put into a wide-mouthed bottle; the other ingredients are added and the bottle frequently shaken.

In regard to this formula, Mr. Thum writes:

It has been used in our gynecologic department for years.... For the last six years we have been dispensing it in collapsible tubes throughout the hospital for general work.--(_Correspondence in The Journal A. M. A., May 12, 1917._)

“Nikalgin”

_To the Editor_:--_Collier’s_ has a special article this week on “Nikalgin.” Have you any information on this subject? It sounds like nostrum stuff.

P. R. Minahan, M.D., Fond du Lac, Wis.

ANSWER.--“Nikalgin” is said to be the “invention” of Gordon Edwards, an engineer. Large claims for its anesthetic and antiseptic virtues have been made. While no very definite information seems to be forthcoming regarding the preparation, it has been said to be “composed of quinin, hydrochloric acid and urea.” This would indicate that “Nikalgin” may be nothing more wonderful than the well known local anesthetic, quinin and urea hydrochlorid, the _Quininae et Ureae Hydrochloridum_ of the U. S. Pharmacopeia, or a modification of it.--(_Query in The Journal A. M. A., Sept. 22, 1917._)

Pertussin and Syrup of Thyme

_To the Editor_:--A short time ago I received a sample of “Pertussin” and used some in an obstinate case of bronchitis with excellent results. I have since received a catalog from a pharmaceutical firm, which advertises syrup of thyme. I have searched for a formula to make my own syrup of thyme, but have not been able to find one. Will you publish one?

E. F. Benner, M.D., Salfordville, Pa.

ANSWER.--The subjoined formula yields a product very similar to “Pertussin” in taste, flavor, composition, and probably in activity as well:

Fluidextract of thyme 15 c.c. Glycerin 15 c.c. Syrup to make 100 c.c.

The original German preparation contained 1.5 gm. of sodium bromid in each hundred cubic centimeters, and this might be added to the foregoing formula with advantage, so far as action is concerned. However, a sample of “Pertussin” purchased in the open market in the United States failed to respond to tests for bromids.

As fluidextract of thyme is not official, this formula is presented as furnishing an acceptable preparation:

Thyme, in No. 60 powder 100 gm.

Moisten with a mixture of:

Water 25 c.c. Alcohol 15 c.c. Glycerin 10 c.c.

After standing five hours, pack in a percolator. Exhaust with a menstruum of alcohol, 1 volume, and water, 3 volumes. Reserve the first 85 c.c. of percolate. Concentrate the weak percolate to a soft extract and dissolve in the reserved portion. Make up to 100 c.c. by addition of a mixture of alcohol, 1 volume, and water, 3 volumes.

Other aromatic expectorants, such as terebene, terpin hydrate or creosote, might be expected to have similar but greater effect in chronic bronchitis. (_Query in The Journal, A. M. A., March 27, 1920._)

Quinin and Urea Hydrochlorid

_To the Editor_:--Could you tell me why quinin and urea hydrochlorid has not become more popular for local anesthesia? Is it less efficacious or more toxic than other preparations? If it is useful, can you name some trustworthy firm or brand? Please omit my name in answering.

L. F. C., M.D., Mexico.

ANSWER.--Quinin and urea hydrochlorid “has the actions of quinin. When injected hypodermically it exerts an anesthetic action much more prolonged than that of cocain” (Useful Drugs, Ed. 4, 1920, p. 127). It has been pointed out editorially in The Journal (Feb. 14, 1920, p. 462) that quinin has been regarded for more than half a century by toxicologists as a protoplasmic poison capable of destroying various forms of animal and vegetable cells, and hence it need not be surprising that tissue necrosis may be produced by strong solutions of the quinin salts. That this deleterious reaction actually does occur and has militated against the general use of quinin and urea hydrochlorid is confirmed by the report of the Committee on the Advantages and Disadvantages of Local Anesthesia in Nose and Throat Work (The Journal, July 31, 1920, p. 315). To quote:

The only local anesthetic that produces edema and sloughing is quinin and urea hydrochlorid. So many statements were found in the literature that this anesthetic has been abandoned in other fields of medicine because of edema and sloughing, that writers who had presented favorable reports in nose and throat operations were communicated with by your committee. One writer who had recorded 390 cases of tonsillectomies extolling this anesthetic, which he had used for four years and is still so recorded, now states that he has not used it in two years, although no publication has been made retracting his former endorsement. Still another writer, who stated that quinin-urea came nearest the ideal local anesthetic, now states that he has ceased using it. Your committee finds that as far as nose and throat operations are concerned, this drug has practically gone into “innocuous desuetude.”

The anesthesia produced by this drug at the time of operation is good and the recovery of the patient might often be enhanced by its use if it did not have the serious drawback. The product is official in the U. S. Pharmacopeia, and may be obtained from any reputable pharmaceutical house.--(_Query in The Journal A. M. A., Aug. 21, 1920._)

Ricord Pills and House Organ Therapeutics

_To the Editor_:--My mail is frequently cluttered with pseudo-scientific data from various manufacturers of proprietary remedies which contain as much real scientific information as the _Police Gazette_. I am enclosing a sample page of such a periodical. The article has been so cleverly worded in the first paragraph, as to impress the unthinking with the idea that sodium cacodylate is superior to arsphenamin, when we know in reality that sodium cacodylate has been proved practically worthless in syphilis (_vide_ “Venarsen”). One case is reported, in which twenty injections of sodium cacodylate were administered intravenously, from October 23 to December 14. On December 18, a Wassermann test proved negative, it had been strongly positive on October 20, but during the same interval from October 23 to December 14, the patient had been taking by mouth “Ricord pills” each containing half a grain of yellow iodid of mercury; granted that he had taken these pills regularly, during all that time, it might well be that the Wassermann would be sharply influenced by them. Again, a negative Wassermann in the midst of treatment proves little; it might be positive again in a few days. The article stimulates the further use of a product of known worthlessness in the treatment of syphilis. How any one can use sodium cacodylate in preference to arsphenamin in syphilis is beyond me. If I mistake not, the Propaganda Department has not taken up the matter of these various pamphlets of the drug companies, such as the _Doctor’s Factotum_, _Therapeutic Notes_, etc., lauding to the skies such articles as “Seng,” “Cactina Pillets,” etc., _ad nauseam_. The saddest part of the whole thing is that it must bring returns from the unthinking, otherwise they would soon disappear, which would be a great relief for the scrubwomen who empty our waste baskets.

Paul E. Bechet, M.D., New York.

[Comment.--The “sample page” sent by Dr. Bechet is from the March-April, 1918, number of Parke, Davis & Company’s _Therapeutic Notes_. It contains an “Original Communication” on “The Treatment of Syphilis with Sodium Cacodylate, by Adolph Lappner, M.D., Detroit, Mich.” The “article,” while nominally devoted to the praise of sodium cacodylate, is virtually a puff for “Ricord Pills.” a Parke, Davis & Co. product.]--(_Correspondence in The Journal A. M. A., July 13, 1918._)

Stannoxyl

_To the Editor_:--I am very anxious to know whether tin or stannous oxid (SnO) has or has had any place among useful drugs. I have seen such a prescription given in the treatment of mucous colitis, and would be very glad to learn what its use may be.

Carlos Manuel Garcia, M.D., Havana, Cuba.

ANSWER.--Recently, on the assumption that tin workers are less troubled with boils than the average person, two French investigators proposed the use of tin compounds in the treatment of staphylococcic infections. Based on their work, a proprietary preparation--Stannoxyl--has been placed on the market which is claimed to be “composed of stannous oxide and specially purified metallic tin.” Absurd claims are made for the product: for instance, “... We have no hesitation in offering STANNOXYL--in Tablets or Cachets--as the only true specific for diseases of Staphylococcus origin.” The available evidence is unconvincing and in no way warrants such exaggerated statements.--(_Query in The Journal A. M. A., March 6, 1920._)

_To the Editor_:--I was much interested in your answer to a query about Stannoxyl (The Journal, March 6, p. 629). I submit the following experience as a confirmatory note:

While serving with the Royal Army Medical Corps in Egypt, I for some time had charge of the medical division of a hospital in which most of the skin diseases occurring among soldiers in the district were treated. The most common conditions were boils and septic sores, chiefly due to staphylococcal infection, though several of the latter cases were diphtheritic. The treatment adopted was that in ordinary use, namely, incision and evacuation of pus, application of antiseptic dressings, and in most cases employment of the specific vaccine. It was possible to judge of the efficacy of any variations of treatment, as there were always plenty of cases undergoing the usual treatment with which the results could be controlled.

An available supply of Stannoxyl, a proprietary remedy consisting of a mixture of metallic tin and tin oxid, enabled me to give it a fair trial in full doses in eight cases of boils of average severity, in which culture revealed the infecting organism to be _Staphylococcus aureus_. The boils were treated locally as usual, but no vaccine was given. No improvement could be demonstrated in these cases that could not be shown in other cases similarly treated with the omission of Stannoxyl; in fact, three of the treated cases were much longer in clearing up than the untreated controls. Eight cases do not constitute a very large series from which to draw conclusions; but if the preparation were as good as the descriptive literature would lead one to believe, one should have expected an evident result in at least one of these cases.

It has been stated that Stannoxyl does not inhibit the growth of staphylococci, but only renders the growth less virulent. It is known that a certain amount of tin may be absorbed from the intestine, and Salant, Rieger and Treuhardt have shown that in certain cases tin may be retained for some time in the skin; but it is questionable whether, when preparations of tin are given by mouth, any reaches the staphylococci in the boils, or at any rate enough materially to influence their growth or virulence.

In the cases treated by me, the results did not at all suggest that Stannoxyl was a “specific for diseases of staphylococcal origin.”

J. W. C. Gunn, M.A., M.B., Ch.B., Cape Town. Professor of Pharmacology, University of Cape Town.

--(_Correspondence in The Journal A. M. A., Nov. 20, 1920._)

Syphilodol

_To the Council on Pharmacy and Chemistry_:--If you have not already done so, will you kindly examine and report on “Syphilodol” advertised in the enclosed pamphlet?

B. C. Pedersen, M.D., New York.

_To the Editor_:--Have you any information concerning the enclosed half page advertisement [of Syphilodol] from the _Urologic and Cutaneous Review_?

Edward S. Newell, M.D., Pelham, N. Y.

_To the Editor_:--I am enclosing an advertisement for a substance called “Syphilodol” manufactured in New York. Am not familiar with this article nor have I seen it advertised in the higher class journals. Can you tell me whether The Journal’s department of New and Nonofficial Remedies has passed on this article or whether you have any data concerning it? It looks a trifle fishy to me.

Louis Leroy, M.D., Memphis, Tenn.

_To the Editor_:--I am sending the enclosed correspondence [Syphilodol letters] to you as it looks as if it might have some interesting features from the point of view of your nostrum department.

Isadore Dyer, New Orleans, La.

ANSWER.--These are but some of the inquiries that have been received on this subject and it is encouraging to note the scientifically critical attitude of physicians toward new therapeutic agents. According to the French Medicinal Company, Inc., which markets this product, “Syphilodol is a synthetic chemical product of silver, arsenic and antimony....” Nowhere in the advertising matter is there any more definite statement as to the composition of this new “synthetic” than that just quoted. The product is now under examination in the Association’s laboratory and when this is completed a more detailed report will doubtless be forthcoming. At present the work has progressed sufficiently to show that Syphilodol tablets contain considerable quantities of mercury! Although the advertising leaflets claim that the preparation is “the formula of the late Dr. Alfred Fournier of Paris” and had been exhaustively tested by Metchnikoff, who is alleged to have found it superior to salvarsan and neosalvarsan, yet, strange to say, a careful search of French medical journals fails to show any reports on Syphilodol. _Verb. sap._--(_Query in The Journal A. M. A., Feb. 23, 1918._)

Thialion

_To the Editor_:--Kindly inform me regarding thialion, manufactured by the Vass Chemical Company, Danbury, Conn. Please omit my name and address in answering in The Journal.

H. C. W.

ANSWER.--Thialion is an heirloom of the days when lithium salts were supported to be nature’s antidote for all kinds of ailments, supposedly due to excess of uric acid. It was advertised as a uric acid eliminant and therefore good for all kinds of diseases. The Council on Pharmacy and Chemistry published a report on thialion in The Journal, Nov. 3, 1906. At that time thialion was advertised by the Vass Chemical Company as a “laxative salt of lithia” with the chemical formula “3Li₂O.NaO.SO₃.7HO,” and an elaborate structural formula was also furnished. The Council reported that the product was not a definite chemical compound, but a mixture consisting chiefly of sodium sulphate, sodium citrate and small amounts of lithia. In recent advertisements, thialion is referred to as “A Non-Effervescing Lithiated Laxative Salt,” “a non-hygroscopic, non-deliquescent, granular salt of lithia,” etc., but the chemical formula does not appear, nor is any definite statement of composition furnished. According to this advertisement, the “indications” for thialion are: “gout, rheumatism, uric acid diathesis, constipation, acute and chronic, sluggish liver, Bright’s disease, albuminuria of pregnancy, asthma, incontinence of urine, gravel, cystitis, chronic lead poisoning, headache, neuralgia, neurasthenia and lumbago, Hay fever, etc.”--(_Query in The Journal A. M. A., Dec. 6, 1919._)

Venarsen

_To the Editor_:--The following is a copy of a letter sent to the Intravenous Products Company, which needs no explanation:

June 8, 1917.

_The Intravenous Products Co., Denver, Colo._

Gentlemen:--In reply to your circular letter under date of June 3, may I say that after using a great quantity of Venarsen both in clinical and private cases, I can see no more effect upon these cases than if so much water had been administered.

This is also the report of Don R. Black, pathologist for Bell Memorial Hospital, University of Kansas. In our experiments all bloods were tested before and after each administration of this product.

William A. Wilson, M.D., Kansas City, Mo.

(_Correspondence in The Journal A. M. A., July 7, 1917._)