letter I have never received a reply.

While a physician from Illinois writes:

“I am enclosing a clipping from a Chicago paper relative to Dr. Thomas Webster Edgar of New York and his operation for transplanting the glands of ring-tailed monkey. I note that he is a member of the New York County Medical Society! What is there to this? I have seen no mention of these wonders in _The Journal_.”

Thomas Webster Edgar was born in 1889. The records show that he was graduated in medicine by the University and Bellevue Hospital Medical College in 1913, and was licensed to practice medicine in the State of New York the same year. In March, 1919, an article by T. Webster Edgar appeared in the _New York Medical Journal_ on “Diabetes Mellitus.” In this Edgar gave a theory of the cause of diabetes mellitus and stated that he had “treated successfully, twenty cases of definite diabetes.” In the article he spoke positively of the successful results he had obtained by the “intramuscular injections of my diabetic serum.” No information was given regarding this serum except that he mentioned vaguely that it was “prepared from normal blood after the animal is exercised to the point of fatigue.”

A few days after the appearance of this article in the _New York Medical Journal_, newspaper articles appeared regarding a cure for diabetes perfected by “Dr. Thomas Webster Edgar, 766 West End Avenue, New York City.” According to these reports, Edgar said:

“I tried the blood of rabbits and found what I wanted. In obtaining the blood I first put the rabbit upon a treadmill and keep it there until it reaches a stage of fatigue. Then I draw the blood, and after heating it to 60 degrees centigrade separate the corpuscles from the serum. When the serum has been treated after the method I have discovered, I inject it immediately subcutaneously.

“I have attained success in 65 per cent. of my cases and I have had 100 cases. I do not say that the cure is infallible, but I am now certain that it will work in most cases, particularly when the patient observes the rules laid down and undergoes faithful treatment.”

In April, 1919, a physician in Kansas wrote to Edgar at the request of a diabetic patient asking for information about the “serum.” Edgar replied that it would be impossible to send the physician any of the serum for administration unless the “patient is willing to pay me for the cost of same, which will be approximately the sum of $25.” He stated further that, in a few months’ time, he hoped to be able to manufacture the serum in larger quantities which would “more than cut the expense in half.”

In the same month a layman in Chicago who read the newspaper story wrote to Edgar and asked for details regarding terms and the arrangements that would have to be made to take the “treatment.” Edgar replied that he expected to be in Chicago in a few weeks’ time and would see the man in consultation with his regular physician, that he would administer the first injection and give instructions to the physician as to subsequent injections. Edgar added:

“My custom is to have all fees paid in advance and my charge is $200.00 by certified cheque or money-order.”

A layman in one of the smaller cities of New York wrote to Edgar in May, 1919, and received a reply from Edgar’s secretary stating that the treatment extends “over a period of three months, cost $150.” He was also told that the serum could be sent to his physician for administration “for the sum of $25 prepaid by money-order.” The letter closed with the statement that Edgar “has been very successful with the serum.”

A layman in South Carolina who wrote to Edgar in June, 1919, was told that the treatment as administered by Edgar “extends over a period of two months; fee $300” and that if he wanted the serum administered by his own physician the cost would be “$50 prepaid.”

In May, 1920, Edgar had another article on diabetes, also in the _New York Medical Journal_. In this, too, he refers to his serum in the following words:

“In conclusion I may state that I have been able to produce some rather startling results by the use of my serum, which is prepared from the blood of rabbits after they have undergone a series of maneuvres capable of activating the various internal secretory glands to increased action. The serum contains the internal secretions in hormone form.”

Gradually the newspaper publicity on Edgar’s diabetic “serum” died down. Then, in November, 1920, there appeared--again in the _New York Medical Journal_--an article by Edgar on “Sterility, Sex Stimulation and Endocrines.” Edgar there stated that he wished to place himself “on record as being interested in sex stimulation” and that he wanted to notify the profession that he had another serum which he was using “with success in the treatment of this condition.” Thus:

“... I feel entitled to state that I have a distinctly beneficial serum for the alleviation of presenile and senile deficiency; and that my product is capable of producing a new lease of life in those whose functions have been reduced to a minimum.”

How long Edgar has been featuring his “serum” for “sex stimulation” it is difficult to determine, but during the last year the newspapers have carried sporadic reports of alleged remarkable results produced by “Dr. Thomas Webster Edgar of 766 West End Ave., New York,” through the transplantation of the “interstitial gland” taken from “a special species of orangoutang.” A layman who wrote Edgar some months ago regarding this “gland implantation” received a letter from Edgar’s secretary stating that the treatment “has been most successful in all cases” and assuring him that “the experimental stage had been passed, and the operation is advised in all cases presenting symptoms of presenility or age.” A week later the same man received a letter written by Edgar himself in which he reiterated the claim that all of the operations had been successful. Edgar added that he was now treating all cases “by operation instead of the serum,” and that “the fee for operation is $500, inclusive of the sanitarium,” the patients remaining in the “sanitarium” “for from two to three days.” A month or two later the prospective patient received another letter signed, “Thomas Webster Edgar, M.D.,” assuring him that “the effect is permanent, and does not wear off. No ill effects can possibly result.”

Commencing, Oct. 1, 1921, a series of sensational articles appeared regarding one of Edgar’s alleged monkey gland implantations performed on an individual described as “one time lawyer and then a writer.” These articles purport to be written partly by one of the newspaper staff, partly by the man undergoing the “operation” and at least one by Thomas Webster Edgar. The material is played up in the style typical of yellow journalism. In addition to repeated pictures of the individual who is being operated on, there also are given pictures of Thomas Webster Edgar and one of his “ring-tailed monkeys.” Doubtless the “story” has sold many newspapers. Its sensational character, the element of mystery and above all its sex slant will appeal to that large class of newspaper readers that hunger for stuff of this sort. Doubtless, too, it has proved a large advertising asset for Thomas Webster Edgar.

The statement that appears in the series to the effect that Edgar “is a member of the County Medical Society of New York” is incorrect. Edgar is not a member.

The further newspaper claim that Edgar is “an authority on glandular transplantation” should also be accepted with reservations. “Authorities” are created with ease in the pages of newspapers. Edgar may possibly be termed an authority in a newspaper or, shall we say, Pickwickian sense.--(_From The Journal A. M. A., Oct. 15, 1921._)

The Journal Receives a Letter Denouncing “Medical Clerks” and “Biased Sceptres”

The Journal recently published in this department some inquiries regarding Thomas Webster Edgar, M.D., of New York City, relative to some alleged serums that Dr. Edgar had developed for diabetes and sex stimulation, respectively, and relative also to the newspaper publicity given Dr. Edgar in connection with the alleged transplantation of glands from “ring-tailed monkeys.”

We are in receipt of a letter signed, “Thomas Webster Edgar, M.D.,” and reading as follows. It is given _verbatim et literatim_:

“_Gentlemen_:--I have read with great interest your editorial regarding the publicity given my work in metabolism, and gland implantation.

“Your pseudo, expose, and distinctly libelous insinuations are unjust, and they lead me to believe that you are going to be called to account at a very early date.

“My profession is the practice of medicine, and the policy of my practice is not controlled by the editorial department of the journal. I am progressive, and a firm believer that legitiment medicine and surgery can not be practiced if the physician be governed by a set of medical clerks, who disdainfully boast that they control, and govern the healing art through out the breadth of the land, with a sceptre that is biased and steeped in the unadulterated commercialism of a certain medical clique.

“Aside from the fact that I am an associate editor on a medical publication, it is disgraceful, as well as unjust that you have written such an editorial with out first investigating the therapeutic value of my serum, and implantation operation.

“The psychology of your editorial, only reflects on your editorial department, and will tend to belittle some of the greatest surgeons in the country.

“It may be to your advantage to know, that this very afternoon, I was on the program with the following men.

“Dr. Lewis Gregory Cole--New York “Dr. Charles H. Mayo--Rochester, Minn. “Dr. John B. Deaver--Philadelphia “Dr. Charles Peck--New York.

“My paper was entitled--Senility, its etiology and treatment by gland implantation. I am sure the above mentioned gentlemen are thoroughly ashamed of your actions in the matter, as well as thoroughly disgusted with the baby like attitude you have displayed. You have no sense of fair play, and if it is with in my power to undue the wrong which you have wrought me, I shall endeavor to vindicate myself in the eyes of the clear thinking members of the profession.

“I sincerely trust you will publish this communication, in order that my brethren shall understand and appreciate that your thrust has not gone unnoticed.

“It is my hope that the various medical societies through out the country, will call upon me to read a paper on my work, so that I may be able to offer substantial evidence to the fact that you have done me an injustice.

“Very truly yours,

TWE/AEL [Signed] “Thomas Webster Edgar, M.D.”

Dr. Edgar’s statement that he had been on the program with Drs. Cole, Mayo, Deaver and Peck was sufficiently startling to prompt further investigation. It was found that the program in question was that of the annual meeting of the New York and New England Association of Railway Surgeons. It was further found that Edgar’s name did appear on some of the printed programs but not on others. It was rather naturally assumed that the name had been put on the program before the officers of this organization had seen the crude publicity to which The Journal recently called attention. It was found, however, that after several hundred programs had been printed about 150 more were needed and “in the meantime, Dr. Edgar had come into the limelight” in his ring-tailed monkey gland transplantation rôle and “was invited to read a paper on the subject.” While he accepted this invitation the secretary of the organization tells us that Edgar did not read his paper but, when the paper was called, declined, saying it was time for him to be in his office!

As for the rest of Dr. Edgar’s communication, The Journal appreciates that courtesy is due “an associate editor on a medical publication”--referring doubtless to the _Western Medical Times_. Dr. Edgar’s pronouncement that “legitimate medicine and surgery can not be practiced if the physician be governed by a set of medical clerks” seems reasonable--if cryptic. But it is when he charges that these “clerks” govern the healing art “with a sceptre that is biased and steeped in the unadulterated commercialism of a certain medical clique,” that he really shines. Whatever opinion one may hold of Dr. Edgar’s ability to compound serums, surely no one can question his skill as a mixer of metaphors. His reference to “sceptres” deserves to be embalmed in every textbook on rhetoric with the classic of the Hibernian statesman who passionately declared: “I smell a rat! I see it floating in the air! But, mark you, Sir, I shall nip it in the bud!”--(_From The Journal A. M. A., Dec. 3, 1921._)

GLYCEROPHOSPHATES

Physicians who prescribe on definite principles must often be puzzled by the number and variety of glycerophosphates on the market. All available evidence indicates that, as sources of phosphorus to the animal organism, the glycerophosphates possess no advantages over the ordinary inorganic phosphates.[290] The glycerophosphates are split up in the intestine, and liberate inorganic phosphates. In this form they are absorbed and utilized, if they are utilized at all. There is no evidence that glycerophosphates have any pharmacologic action to warrant the belief that they are of use as therapeutic agents. The theory that organic phosphorus compounds are more readily assimilable than inorganic compounds and hence a better means of introducing phosphorus into the system is still kept alive in the promotion of certain proprietary mixtures, in spite of the scientific evidence that the organism can assimilate phosphorus quite as readily from inorganic as from organic phosphorus compounds.[291] The glycerophosphates will continue to be manufactured until physicians refuse to prescribe them. A chemist in the “research laboratory” of a well known manufacturing firm has recently given a rather interesting reason for the use of glycerophosphates--from the manufacturers’ point of view. He is quoted as saying: “On account of the instability of phosphorus in elixir of phosphorus, nux vomica and damiana we have quite recently replaced the phosphorus by glycerophosphates. Such a preparation is apparently equally as effective, for we continue to have a great demand for it.” This is doubtless a sufficient reason for the substitution from the manufacturers’ point of view; but how about the patient, who, after all, is the one to be considered? Is it not a matter of considerable importance to the patient whether he receives phosphorus, one of the most powerful drugs known, or the inert glycerophosphates? The chemist’s statement seems to imply that it is not. It may be of interest to recall that a member of the firm whose chemist gives this “reason” for the use of glycerophosphates, in a recent address, was rather severe in his condemnation of institutions of learning, hospitals, etc., for their lack of cooperation with manufacturers: he said that “they should welcome an opportunity to let any manufacturer try out or test his products in their clinics, laboratories, etc.” A test as to whether there is a difference between the action of glycerophosphates and ordinary poisonous yellow phosphorus, especially when the former are mixed with extracts of nux vomica and damiana, would not be likely to appeal to many hospitals and laboratories as a very promising field of research at this day since, as has been stated, the scientific evidence at present available does not furnish any warrant for the therapeutic use of glycerophosphates.--(_Editorial from The Journal A. M. A., April 15, 1916._) [290] Organic Phosphorus Compounds, Editorial, J. A. M. A. 40: 1958 (June 21) 1913. Marshall, E. K.: The Therapeutic Value of Organic Phosphorus Compounds, J. A. M. A. 44: 573 (Feb. 13) 1915.

[291] Marshall, E. K.: The Therapeutic Value of Organic Phosphorus Compounds, J. A. M. A. 44: 573 (Feb. 13) 1915.

INFLUENZA VACCINES

With the appearance of the epidemic of influenza, reports began to appear, chiefly in newspapers, as to new serums, vaccines, drugs and other methods for checking and even for curing the disease. A few samples of such as have come to The Journal appear in our Tonics and Sedatives Department this week. In Massachusetts, Commissioner E. R. Kelly appointed two committees to investigate the value of influenza vaccines as a preventive agent and as a treatment of the disease. The first committee, a special board for scientific investigation, consisting of Dr. M. J. Rosenau, chairman, and Frederick P. Gay and George W. McCoy, was appointed to consider the evidence available on the prophylactic and therapeutic use of vaccines against influenza. This committee presented the following conclusions:

1. The evidence at hand affords no trustworthy basis for regarding prophylactic vaccination against influenza as of value in preventing the spread of the disease, or of reducing its severity. The evidence from the present epidemic, though meager, suggests that the incidence of the disease among the vaccinated is smaller than among the nonvaccinated. The board, therefore, concludes that further experimental evidence should be collected.

2. The evidence at hand convinces the board that the vaccines we have considered have no specific value in the treatment of influenza.

3. There is evidence that no unfavorable results have followed the use of the vaccines.

The second committee, known as the Special Board of Statistical Investigation, consisted of Dr. George C. Whipple, chairman, William H. Davis and F. C. Crum. This committee reported:

1. The weight of such statistical evidence as we have been able to accumulate indicates that the use of the influenza vaccine which we have investigated is without therapeutic benefit. Exceptional cases where apparent benefit has resulted from the use of the vaccine can be matched by other cases where similar recoveries have been made without vaccination.

2. The statistical evidence, as far as it goes, indicates a probability that the use of this influenza vaccine has some prophylactic value.

3. There is also some evidence to the effect that other methods of protection, such as open-air treatment and the use of proper masks, are effective in protecting exposed attendants, and the use of vaccine should not be taken as an excuse for omitting such safeguards.

As a result, the following recommendations were made:

That the state encourage the distribution of influenza vaccine intended for prophylactic use, but in such manner as will secure scientific evidence of the possible value of the agent. The use of such vaccine is to be regarded as experimental.

That the state shall neither furnish nor endorse any vaccine at present in use for the treatment of influenza.

These reports are conservative, and offer to other health commissioners and their communities a reliable guide as to procedures that should be adopted before subjecting or trying out on the public any method of prevention or treatment that may be offered. These matters are the domain of medical science, and medical scientists of recognized ability should be called on to make the decision.--(_Editorial from The Journal A. M. A., Oct. 19, 1918._)

Serums and Vaccines

With respect to serums and vaccines in influenza, there are certain simple facts and considerations that physicians will do well to keep in mind at this times. The main point to keep always in sight is that unfortunately we as yet have no specific serum or other specific means for the cure of influenza, and no specific vaccine or vaccines for its prevention. Such is the fact, all claims and propagandist statements in the newspapers and elsewhere to the contrary notwithstanding. This being the case, efforts at treatment and prevention by serums and vaccines, now hurriedly undertaken, are simply experiments in a new field, and the true value of the results cannot be predicted by any one. Indeed, the exact results can be determined if at all only after a time, in most cases probably not until the epidemic is past and all the returns fully canvassed. Consequently, the physician must keep his head level and not allow himself to be led into making more promises than the facts warrant. This warning applies especially to health officers in their public relations.

As to serum treatment, the only noteworthy new method so far is the injection in severe cases of influenzal pneumonia of the serum of patients who have recovered from such pneumonia.[292] The principle of this method is rational; analogous procedures have given seemingly good results in scarlet fever and other diseases; and the results reported in influenzal pneumonia appear promising. Further trial of this treatment under proper conditions consequently seems to be warranted. It should be borne in mind, however, that McGuire and Redden[292] made their observations in the declining phase of the epidemic when the organism or organisms concerned appeared to be losing virulence. For this and other reasons, the expectations as to what may be accomplished by this method must be kept within reasonable bounds. Influenza is a self-limited disease with variable complications and of variable severity in different places, thus offering great difficulties in the way of evaluation of different methods of treatment.

[292] McGuire, L. W., and Redden, W. R.: Treatment of Influenza Pneumonia by the Use of Convalescent Human Serum: Preliminary Report, J. A. M. A. =71=:1311 (Oct. 19) 1918.

At least two kinds of vaccine are in use in the hope that they may have preventive effects. One consists solely of killed influenza bacilli; it being extensively used in the East. We have as yet no decisive figures as to its effects, but there is an impression that it may have some value. The other vaccine is a mixed vaccine of the more important bacteria in the respiratory tract in influenza, principally pneumonococci, streptococci and influenza bacilli. It appears that vaccines of this nature are in extensive use, but we have no evidence that any benefit will be derived from them. To say that thousands have been vaccinated with apparently good results means nothing at all, simply because we are still in the midst of the outbreak, in many places even in the earlier stages. How slender the basis of this anti-influenzal vaccination when it is considered that the real nature of influenza is still unknown! In any event, it will require many carefully elaborated and controlled observations before anything definite may be learned in regard to the effect of these vaccines, and it is probably safe to say that nothing on which to rely in the future can be learned from the indiscriminate vaccination now going on. There is, therefore, no basis on which promise of protection from vaccines may be made. They may be harmless, and they may or may not be of preventive value.--(_Editorial from The Journal A. M. A., Oct. 26, 1918._)

INTRAVENOUS THERAPY

The intravenous administration of drugs is a new departure in therapy, but one which is rapidly increasing in use. Among its reputed advantages are that it is the quickest means of obtaining the effects of a drug, the effects are obtained with a certainty not obtained by other methods, and they are so marked that they cannot fail to impress the observer. These advantages in many cases are apparent rather than real; but even were they real advantages, they should not blind us to the various and serious dangers which this method involves. The technic, although not difficult, must be thoroughly mastered, or undue pain, infection, air embolism, or even death may result. Such accidents, however, are ordinarily easily avoided, and should be considered quite inexcusable. More serious is the fact that the drugs given intravenously reach the system, and especially the heart, in a different manner and concentration from that to which physicians are accustomed with ordinary methods of administration. Pharmacologists have long practiced intravenous administration, when studying acute effects of drugs, and they have observed that frequently the immediate result of such injections is a prompt fall of blood pressure, not obtained when the same drugs are given by mouth or even hypodermically. This fall in blood pressure is commonly attributed to irritation of the endocardium. It is usually of short duration, but is certainly undesirable and sometimes may have serious results.

It has also been observed that several drugs, for instance, quinin and potassium, depress the cardiac muscle when given intravenously much more than when given in other ways. Furthermore, any substance which tends to precipitate proteins must be injected slowly and with extreme caution, or it will produce intravascular clotting and sudden death. Deaths have resulted not only from a lack of knowledge of the technic of intravenous therapy, but also from a lack of knowledge of drugs which may be so administered. Sudden death has been reported following the injection of an iron preparation containing peptone, and also following intravenous injection of ether. Intravenous injections, while sometimes superior to the slower methods, are distinctly inferior when a continuous, rather than a sudden, action is desired. Drugs leave the blood system with great rapidity, and therefore their action on the circulation will cease promptly unless they are continuously supplied. It would be undesirable to inject intravenously such drugs as iodids, nitrites, iron or salicylates.

With these dangers and disadvantages in mind, it seems unwise to resort to promiscuous intravenous medication until the effects of this method have been studied in detail for the drugs employed, and unless there are distinct advantages to be secured. This is the case when an immediate action is necessary in emergencies, as in the use of strophanthin for cardiac collapse, quinin in pernicious malaria, etc., or if the drug would be destroyed in the stomach or tissues as in the case of salvarsan, or when the drug is not adequately absorbed by any other channel, as in the case of epinephrin.

Intravenous therapy will be most securely advanced if its employment is restricted to such well defined fields. These fields can be satisfactorily determined only by a scientific pharmacologic study of the action of these drugs when so administered in animals, as well as in man, under conditions in which the results are carefully controlled. The intravenous method is an impressive one, approaching in preparation almost to that which goes with a surgical operation. The patient is usually interested and impressed by this new, and to him, mysterious method. There is a psychic element in his reaction to the injection which is not a factor in his reaction to the same drug when given by mouth. The intravenous injection of a complex mixture would appear to be particularly reprehensible. Little is known, as has been stated, of the results to be expected from intravenous therapy, even with simple substances. The use of complex mixtures will without doubt react against the proper use of the method.--(_Editorial from The Journal A. M. A., Nov. 11, 1916._)

IODIN FUMES

One of the important factors connected with therapeutics as a science is the method of administration of medicinal substances. Drugs may be given by mouth, by hypodermic or intravenous injection, by inhalation, by inunction or, less frequently, by the use of other entrances into the body. In choosing a method, the physical characters of the substance to be administered and the immediate effects of the substance on the body tissues with which it may come in contact must be especially taken into consideration.

These factors apply particularly in the case of substances like iodin, arsenic, mercury or the biologic products in which the mode of administration radically modifies the action. For some time, manufacturers have urged substitutes for tincture of iodin, claiming that their substitutes were free from the undesirable properties of the tincture, and, at the same time, possessed special virtues which the tincture could not possess. More recently, attention has been directed to the administration of iodin in the form of vapor. The diffusing and penetrating powers of gases have particularly attracted the attention of therapeutists, since by this method drugs may be applied to rather inaccessible portions of the body, such as the lining of the lungs, the throat and the mucous membranes of the genito-urinary tract. Furthermore, it has been asserted that iodin in the form of fumes has increased combining powers, and is thus far more potent in effect than iodin administered by any other route. There do not seem to have been any adequate scientific investigations of the subject, however, until the recently published results of Luckhardt and his collaborators[293] at the University of Chicago. In their experiments, both on man and on animals, accurately determined quantities of iodin were vaporized in a special device, and the fumes applied to the skin. At the same time, the tincture was applied to the skin of other persons as a control. Iodin was also applied to the skin of dogs with hyperplastic thyroid glands; and the effects on the gland, before and after administration, studied. Dogs were also used to determine whether iodin fumes were absorbed from the lungs. As a result of these investigations, which are reported in great detail, it was found that iodin, when deposited on the skin in the form of fumes, is absorbed. More iodin was recovered from the urine, following the application of the tincture, than was recovered following the use of the fumes. This result is explained by the authors on the ground that probably more iodin was actually applied, and that the iodin so deposited was held in combination with the protein during the process of coagulation of the latter by the alcohol of the tincture, leading to a state of continuous absorption. It is probable, furthermore, that the iodin deposited on the skin in the form of fumes is revaporized to some extent by the heat of the body.

[293] Luckhardt, A. B.; Koch, F. C.; Schroeder, W. F.; and Weiland, A. H.: The Physiological Action of Fumes of Iodin, J. Pharmacol & Exper. Therap. 15: 1 (March) 1920.

Most important were the effects of iodin administered intratracheally in the forms of fumes. Iodin given in this way seems to be rapidly and completely absorbed; but it was found that the administration of the fumes of iodin by inhalation through the respiratory passages, even in small quantities, is fraught with great danger. Such administration induces dyspnea; and when it is given in large quantities, acute and fatal pulmonary edema ensues within twenty-four hours. When respiratory disorders are present at the time of administration, the fatal edema supervenes very quickly. Thus far, no device designed to deliver fumes controls the dosage.

It is interesting to consider, as do the authors, the fact that the fumes of iodin have the same effect as those of two other halogens, bromin and chlorin. The results of these experiments with iodin fumes on the dog, as shown by necropsy findings, are practically identical with those reported by military surgeons as found in soldiers gassed with chlorin during the war.

The results of these researches are additional evidence as to how scientific research may confirm or deny conclusions based on empiric therapeutic observations. The work may well serve as a model for similar experiments, now being made, on the therapeutic use, intravenously, of such substances as nonspecific proteins or organic preparations of toxic drugs. The patient should at least have the chance that is afford him by preliminary experiments, scientifically performed on animals in the research laboratory.--(_Editorial from The Journal A.M.A., May 29, 1920._)

ITALIAN PHYSICO-CHEMICAL COMPANY

Many and various are the letters received by The Journal asking for information about an alleged scientific organization in Italy styled _l’Académie Physico-Chimique Italienne_. This Italian Physico-Chemical Academy is operated from Palermo, Italy. Here is the scheme: Dr. John Doe, an American physician receives an imposing-looking letter bearing the Palermo, Sicily, postmark and addressed to “_Monsieur le Docteur John Doe, Médecin_.” On opening the letter “_Monsieur le Docteur_” finds that the “Council” of _l’Académie Physico-Chimique Italienne_ has nominated him “Honorary Member of this Academy” and furthermore has bestowed on him “a First Class Medal for technical work and scientific merit.” All this, “in consideration of your many dignities and great learning.” Dr. Doe is told that as soon as he will write an acceptance of this honor “in conformity with Section 19 and 22 of the Constitution” he will be sent “the Medal, Diploma and all the other documents relating to the title accorded.” The joker in the scheme lies in the necessity for Dr. John Doe “conforming” with “Section 19 and 22 of the Constitution.” Here are the sections:

“_Sec. 19._--The entrance fee to cover office and postal expenses, including postage of diploma is 5 Dollars, and is payable once at the admission to the Academy by special bulletin filled up, stamped and signed.”

“_Sec. 22._--Those to whom medals are awarded and who wish to possess them must pay for their coinage 10 Dollars as the Academy does not, at present, possess the necessary funds for this purpose....”

In short the whole thing means that if Dr. Doe is willing to send $15 in good American money he will receive in due time from the academy a “diploma” and a gilt (not gold) medal.

About four years ago when the “Academy” seemed to be making a particularly heavy bid for American dollars the member of The Journal staff in charge of the Propaganda Department wrote to the “Academy,” on his personal stationery, asking about the cost of membership in the “Academy” and asking also for a copy of the “prospectus.” And that was all. In reply he received a letter stating that “in consideration of” his “many dignities and great learning” he had been nominated “an officer of this academy” and had been awarded “_la médaille de première classe_” for humanitarian work and scientific merit. In order to obtain these tokens of the “Academy’s” regard it would be necessary to inform the “Academy” of acceptance “in conformity with Section 19 and 22 ...” As the Propaganda Department did not consider the diploma and gilt medal worth $15 even as exhibit for its museum of fakes, the “Form of Acceptance” was not filled in and returned “in accordance with Section 19 and 22.”

The leading spirits in the operation of this diploma and medal mill are D. and G. Bandiera, who, so far as we can learn, are neither physicians nor pharmacists nor have any scientific standing. The “Academy” has been referred to at various times[294] by The Journal.--(_From The Journal A. M. A., Feb. 26, 1916._)

[294] J. A. M. A. 48: 2196 (June 29) 1907; Editorial 57: 1373, Berlin letter, p. 1380 (Oct. 21) 1911; 58: 1455 (May 11) 1912; 60: 770 (March 8) 1913; 60: 1480 (May 10) 1913; 61: 1737 (Nov. 8) 1913.

WHAT IS LIQUID PETROLATUM?

The use of liquid petrolatum in chronic constipation, which has recently become the vogue, has naturally been commercialized; as a result, also naturally, claims of superiority of one brand over another have been made. Some of these claims may have been well founded; others certainly are not. Some have claimed superiority for those products made from Russian oil over those made from American oils. As naphthene hydrocarbons predominate in Russian crude petroleums, and paraffin hydrocarbons in many or most American crude petroleums, it was assumed that the petrolatums derived from these sources differed from one another in like manner. Both the naphthenes and the paraffins are chemically inert; but some unexplained therapeutic superiority has been assumed to reside in the naphthenes. Consequently, it has been urged that the American liquid petrolatums should not be used internally. So far these claims and counterclaims have been based on much theory and little fact. The Journal publishes this week a contribution by Benjamin T. Brooks, Senior Fellow in charge of petroleum investigations at Mellon Institute, Pittsburgh. Brooks calls attention to the fact that Marcusson, in 1913, pointed out that most of the so-called “mineral oils” used for therapeutic purposes contain no paraffin hydrocarbons whatever; that they consist solely of naphthenes and polynaphthenes. Brooks confirms this statement so far as American liquid petrolatums are concerned. He states that many American petroleums, such as most of those from the Gulf region, are like the Russian in containing no paraffin; and that, in the case of those petroleums that do contain it, the customary refinery method of removing paraffin is sufficient to produce true naphthene and polynaphthene petrolatums. “The claim that only Russian oils belong in this class,” he says, “has no basis in fact and has been advanced presumably for business reasons.” The name “paraffin oil” applied to these liquid petrolatums, then, is a misnomer. The new name, “white naphthene oils,” suggested by Brooks, seems superfluous, however, since the pharmacopeial title, “liquid petrolatum,” is subject to no such objection.--(_Editorial from The Journal A. M. A., Jan. 1, 1916._)

THE LOWENTHAL POSTGRADUATE COURSE

Which Tells How to Make Diagnoses Accurately, Scientifically Check the Christian Scientists and Increase Your Earning Power

During the past year The Journal has received letters from physicians in various cities asking for information regarding the “Post Graduate Course of Lectures and Clinics on Nervous and Mental Diseases” which was going to be given in their respective cities by Dr. Albert A. Lowenthal of Chicago. The following inquiries are typical:

“_To the Editor._--Please note the enclosed letter from the American Organotherapy Company which appears to be conducted by Lowenthal. The proposition of conducting these clinics impresses me as a piece of colossal gall which is amazing even in these days. Do you know anything about this matter?”

“_To the Editor._--Who the dickens is Albert A. Lowenthal, M.D.? Note the circular enclosed. I have blue circled the remarks he evidently thinks will attract.”

In May, 1919, Chicago physicians received a form letter, signed, and on the stationery of, Albert A. Lowenthal, notifying them that Dr. Lowenthal was about to “give a Post Graduate Course of Lectures and Clinics on nervous and mental diseases” in the “Banquet Hall, Morrison Hotel.” Enclosed was a “Programme and Reservation Card” and a self-addressed envelop for physicians to notify Dr. Lowenthal that they would be present. In addition to showing physicians “how to make diagnoses accurately,” Dr. Lowenthal offered to “explain fully how to scientifically check the Christian Scientists and increase your earning power!” And all for nothing!

At later dates similar letters were received by physicians in other cities, on the stationery of the “American Organotherapy Company, Room 902, 31 North State St., Chicago.” Dr. Lowenthal, whose Chicago office is Room 901, 31 North State St., is, apparently, president, treasurer and practical owner of this company. Enclosed with each of these letters--which offered the same inducements, free--was an envelop addressed to Albert A. Lowenthal in care of the hotel at which Dr. Lowenthal would stay while in that city. There was also a “Programme and Reservation Card” as in the case of the letters sent to Chicago physicians.

According to our records, Dr. Albert A. Lowenthal was born in Chicago in 1874 and was graduated by the College of Physicians and Surgeons, Chicago, in 1895, receiving his license the same year.

In a leaflet issued some time ago by Albert A. Lowenthal, M.D., “for the sole purpose of enlightening Prospective Patients in regard to the therapeutic value of the Organo Therapy Treatment for Nervous Diseases,” we learn that Dr. Lowenthal is, or was:

“Professor Nervous and Mental Diseases, Chicago Hospital College of Medicine.”

“Formerly Professor Nervous and Mental Diseases, Dearborn Medical College, Jenner Medical College.”

“Adjunct Professor on Neurology and Psychiatry, University of Illinois College of Medicine.”

“Formerly Physician Illinois Eastern Hospital for the Insane.”

“Formerly Supt., Riverview Hospital for Nervous Diseases, Kankakee, Ill.”

“Formerly on Advisory and Associated Attending Staff Cook County Hospital.”

In Polk’s Medical Directory for 1904, Dr. Albert A. Lowenthal’s name appeared, under Chicago, at 910-912 Chicago Opera House Building. He was described as “Superintendent of Lowenthal’s Sanitarium.” In the same issue of the directory, there was a display advertisement of the Lowenthal Sanitarium, which, while located at Kankakee, Ill., had its “main offices” at 912 Chicago Opera House Bldg., Chicago. The advertisement was headed “GOAT LYMPH TREATMENT,” and read in part:

“Goat Lymph has revolutionized medicine, and has been adopted by the scientific medical world as the only therapeutical agent that will absolutely bring about positive results in chronic conditions, such as Neurasthenia, Nervous Collapse, Paralysis, Locomotor Ataxia, Brain Fag, Oncoming Insanity, Chronic Stomach Disorders, in fact such diseases needing cell stimulation.”

It mentioned further that Dr. Albert Lowenthal “introduced Goat Lymph to the medical world as a curative agent.”

A few years ago a Chicago concern, known as the “American Animal Therapy Co.,” put out such products as “Lymphoid Compound (Lowenthal),” “Ova Mammoid (Lowenthal),” “Prostoid (Lowenthal),” etc. The American Animal Therapy Co. had for its manager James M. Rainey. Rainey also operated the “Rainey Medicine Co.,” a mail-order “patent medicine” concern that sold “Vitaline,” a “general debility cure.” The Rainey “Vitaline” quackery was exposed in The Journal, Oct. 1, 1910, and the matter appears in “Nostrums and Quackery.”

When the American Animal Therapy Company was operating from 84 Adams St., Chicago, it claimed to have a hospital and laboratory at Kankakee. At the same time letters were being sent out on the stationery of “The Lymph Hospital,” signed Albert A. Lowenthal, M.D. Although this “hospital” was at Kankakee, Ill., the address on the stationery was 84 Adams St., Chicago, and its telephone number was that of the American Animal Therapy Company. According to the stationery, the “Medical Department” of the Lymph Hospital was “under the personal direction of Dr. Albert A. Lowenthal, who introduced the Lymph Compound and Lymphoid Compound to the Scientific Medical World as a curative agent in Chronic Nervous conditions.” A layman received a letter from the “Lymph Hospital” urging him to take “Lymphoid Compound.” Later he received a “follow-up” letter, from which the following extracts are made. Capitals used as in the original:

“Do you know that the doctors of this country are using the LYMPHOID COMPOUND EXCLUSIVELY in all cases, where the nervous system is greatly involved, with the most MARVELOUS RESULTS. ISN’T THAT SUFFICIENT PROOF as to the merit of the remedy?”

“... Nobody can tell you there is something just as good, because THERE IS NOTHING JUST AS GOOD AS THE LYMPH--in fact IT IS THE ONLY THING THAT CAN BE DEPENDED UPON.”

“... Our Dr. Lowenthal gives his personal attention to all cases at the Hospital and devotes a portion of his time advising by mail those persons under treatment who are unable to come to the Hospital. He is a man of WORLD WIDE REPUTATION IN TREATING NERVOUS DISEASES--HIS ADVICE ON CASES LIKE YOURS IS WORTH EVERYTHING TO YOU.”

“Think this over and if you do, you will write an order today for the Lymphoid Compound. The home treatment costs $9.50 for thirty three days--think of that. You have our physician’s advice and care free of charge--could anybody ofter more to you?”

In 1908 Dr. Lowenthal appeared as a witness for Edward R. Hibbard, who was being prosecuted by the federal authorities. Hibbard operated a “men’s specialist” office in Chicago; it had two entrances and a different name for each entrance--the “Boston Medical Institute” and the “Bellevue Medical Institute.” Hibbard was found guilty of fraud in the operation of this concern and was fined $1,500. The transcript of the testimony in the Hibbard case records that Dr. Albert A. Lowenthal, when on the stand, claimed to “have treated as many nerve patients as any nerve specialist in Chicago.” He further declared, according to the transcript, that physicians who make a specialty of nervous diseases “mature in about ten years” and that after that time most of them become nervous wrecks or insane. This was in 1908. In this connection it is worth noting that in letters sent out by Lowenthal in May, 1919, he claimed:

“In the past twenty-five years I have limited my work to neurological and psychological cases....”

In 1908 also, Dr. Lowenthal was sending out letters to Illinois physicians in his capacity as secretary of the “Physicians’ League of Illinois.” The “league” issued a “report on candidates for governor and members of legislature,” giving the names of the various political candidates for office whom “the members of the league can safely support.” There were no “membership” fees and a physician who wrote asking “who foots the bills” received no reply.

In 1915 Albert A. Lowenthal, whose “valuable discoveries in the domains of Organo Therapy, Neurology and Pediatrics, have given him an international reputation as a Neurologist, Alienist and Climatological Expert of high standing,” was “Medical Superintendent” of the “National Sanitarium Information Bureau.” This purported to represent the “Leading Sanitariums and Health Resorts in the U. S.” The “Bureau” expected to make its “profit from the 10 per cent. honorarium received on every referred patient.” The “Business Manager” of this concern was one Hubert Miller, M.D. The following advertisement appeared in the classified department of the _St. Louis Post Dispatch_ in 1915:

A layman who wrote in answer to this advertisement received a letter from Dr. Lowenthal in which he said that it was his intention to take about thirty patients south with him for four months--cost of trip $500, which includes medical treatment, board, etc. Dr. Lowenthal stated further:

“I have treated probably more cases of Locomotor Ataxia and Paralysis than any Physician in United States and can honestly state that with Organo Therapy Treatment your walk can be improved and pains controlled.”

In March, 1919, Dr. Lowenthal paid a visit to Spokane, Wash., and Portland, Ore. A Portland paper heralded his coming and printed a picture of “Dr. A. A. Lowenthal, World famous alienist.” The paper described Dr. Lowenthal as “the alienist consulted in the Harry Thaw case” and the one “who treated John Alexander Dowie of Zion City fame and Pope Leo XIII.” The fulsome puffery that Dr. Lowenthal got while in Spokane drew criticism from one or two members of the local medical profession, who wrote to the newspapers protesting. One of the physicians who thus wrote declared that Lowenthal’s “coming was announced in a circular sent through the Owl Drug Company which is agent for the sale of products of an organo-therapy company.”

Apparently, it was after Dr. Lowenthal’s return from the Pacific Coast that he commenced to announce his “Post-Graduate Course of Lectures and Clinics” to the physicians of Chicago, Denver, St. Louis, Columbus, etc.--and, incidentally, to bring to the attention of the medical world the alleged virtues of the products of the American Organo-Therapy Company.--(_From The Journal A. M. A., July 3, 1920._)

MEDICAL SOCIETY OF THE UNITED STATES

From “Division of Fees” to “Down with Autocracy”

The “Medical Society of the United States” has for its “Honorary President” one A. H. Ohmann-Dumesnil, A.M., M.D., M.E., Sc.D., Ph.D., and for its “Secretary and Treasurer” one Emory Lanphear, M.D., C.M., Ph.D., LL.D. As originally planned, the “society” seems to have been based on the idea of organizing the “fee-splitters.” In May, 1916, the birth of the organization was announced to the medical profession through a letter signed Emory Lanphear, written on the stationery of the “Medical Society of the United States.” Even in its embryonic state the society had A. H. Ohmann-Dumesnil, A.M., M.D., M.E., for its president, and Emory Lanphear, M.D., Ph.D., LL.D., as its treasurer. The letter read in part:

“We--the majority of the medical profession--who believe in division of fees (_i. e._, that the surgeon should not ‘hog’ the whole of a patient’s money and leave nothing for the family doctor), are no longer welcome in the A. M. A. We are therefore organizing the Medical Society of the United States, which will not be conducted for the benefit of a few selfish egotists. We would like to have you with us.

“It costs only $1.00 to join. This covers dues for 1916, and includes expense for the beautiful certificate of membership (suitable for framing), which you will receive on admission. Fill enclosed blank and return to me with $1.00.”

But presumably the idea of organizing on a basis of “fee splitting” did not make a hit, so the lure was changed. Today physicians are approached with the plea that the “Medical Society of the United States” will make the medical world free for democracy; it is, we are assured, a “Society of Protest Against the Autocracy of the A. M. A.,” and a “Society of Medical Democracy.”

Membership costs “only $1.00 ... including the cost of a beautiful certificate of membership.” No penalties or punishments are involved for belonging to other societies, and:

“Joining our body need not affect your membership in any other society--even the A. M. A., if you wish to belong to it, and be ‘bossed’ by the ‘Simmons Gang’.”

The dollar for the “beautiful certificate” and membership is solicited by means of circular letters signed “Emory Lanphear,” coming from 3447 Pine St., St. Louis, Mo., the address of what has been variously called the “American Polyclinic,” the “American Hospital,” and later, the “German Hospital.” The “Surgeon-in-Charge” of the “German Hospital” is Emory Lanphear, M.D., C.M., Ph.D., LL.D. When running under the name of the “American Hospital,” Lanphear solicited operative work on a “division of fees” basis, which, the general practitioner was told, meant that “you are to have 40 per cent. of all fees received from your patients sent to our staff for operation or treatment.”

With the change in name from “American Hospital,” to “German Hospital,” Lanphear appealed for a “portion of your operative work on a basis of pure reciprocity.” This “pure reciprocity” seems to have been a still more liberal distribution of the patient’s money, for from a 40 per cent. basis it was raised to an even fifty-fifty. Said Lanphear, in a letter sent out a few months ago:

“I wish also to inform you in spite of the despicable opposition of the hypocritical gang in charge of the A. M. A., and the no less contemptible action of the St. Louis Medical Society, I am going to remain in St. Louis and continue to do surgical work upon a ‘division of fee’ basis. To be more explicit, if you bring me a case for operation I shall allow you one half of the fee for your time, trouble, responsibility and help in the management of the case.”

Before leaving the interesting professional personality of Lanphear, and carefully avoiding any details of a personal nature, we may remind our readers that as long ago as 1908 Lanphear was the “Dean” of the “Hippocratean College of Medicine,” with A. H. Ohmann-Dumesnil, A.M., M.D., M.E., Sc.D., “Vice-Dean.” At that time Lanphear sent out letters to physicians proposing the organization of a “Post Graduate Faculty” on the following basis:

“Those who hold full professorships shall purchase stock in the corporation to the amount of $1,000.00; those who become lecturers or instructors shall pay in the sum of $500.00; those who are to be merely clinical assistants will buy ten shares of stock, $100.00.”

The “Hippocratean College” was a “sundown” affair; it never graduated a student, and expired in 1910.

But to come back to the “Society of Medical Democracy”: The “Medical Society of the United States” seems to have been born in 1916. Its parents, so far as is apparent, seem to have been Lanphear and Ohmann-Dumesnil. The latter, it may be remembered, used to be the editor and proprietor of the _St. Louis Medical and Surgical Journal_, a publication so obviously venal, that its value to the nostrum makers, whose interests it espoused, must have been small. Advertising pages, “original articles” and “editorials”--all were used to puff nostrums of the crudest type. It was Ohmann-Dumesnil and his journal that came to the defense of the “patent medicine” interests when they were so hard hit by Mr. Adam’s “Great American Fraud” series. In commenting on this phase of “patent medicine” activities, _Collier’s_, in January, 1907, said:

“Headache powders came in for a considerable share of attention in the patent medicine articles. There was much talk of libels among the headache powder makers, but they decided upon the safer methods of hiring a meretricious medical publication, the _St. Louis Medical and Surgical Journal_, to print an article in which the _Collier’s_ statements were branded as lies, and the _Collier’s_ editors and writers as liars and libelers. This article the Proprietary Association of America circulated in pamphlet form. The journal which printed it died a natural death a few weeks later. Its editor, one A. H. Ohmann-Dumesnil, has just appeared in the public prints in an unsavory connection with a corrupt lobbying project in St. Louis.”

Some of the nostrums that Ohmann-Dumesnil has recommended are: “Sanmetto,” “Gonosan,” “Cactina Pillets,” “Pepto-Mangan,” “Satyria,” “Campho-Phenique,” “Tongaline,” “Germiletum,” “Narkogen,” “Nosophen,” “Mercauro,” “Arsenauro,” and “Hydrozone.” Many of these testimonials were, of course, used by the manufacturers in their advertising “literature.”

At the time that the Medical Society of the United States was being organized--in 1916--there was published what purported to be a preliminary program of its first meeting. The meeting was held in St. Louis, and the program, while containing the names of men with special fads or interests to exploit, also contained the names of some men of standing. It appeared, however, on investigation, that at least some of the latter had but a hazy conception of the use to which their names were being put, and protested vigorously on learning the facts, repudiating the organization.

Now, in 1918, another drive is on for membership; letters signed “Emory Lanphear” are being sent to various selected groups of physicians. For example, the Eclectics are being coaxed by a letter which commences:

“We want every reputable Eclectic practitioner in this country to join our society of protest against the iniquities of the A. M. A.”

An identical letter has been addressed to Homeopaths, the words “Homeopathic practitioner” being substituted for “Eclectic practitioners.” In all of the letters the “beautiful certificate of membership” is emphasized, and the trivial cost--“only $1.00 a year”--is referred to, while the plea: “surely you are willing to help to that amount to ‘down’ the ‘gang’ in charge of the A. M. A.,” is featured. Another group of letters has gone out to the graduates of the Barnes Medical College. This commences:

“Most graduates of ‘Old Barnes’ have joined our society of protest against the iniquities of the A. M. A. Why should you also not come in? It costs only $1.00 to become a member, including the cost of a beautiful certificate of membership.”

Still another group appeal is based on sex; thus Lanphear:

“We want every reputable ‘lady physician’ in this country to join our society of protest against the iniquities of the A. M. A.”

And yet another:

“You formerly belonged to the Tri-State Medical Society, of which I was Treasurer for 20 years. It is now dead. I wish you would join our new society which has superseded Tri-State in this territory.”

With these various letters is enclosed a “preliminary program” of the 1918 meeting which is to be held October 8 and 9 in Chicago. As might be expected, many of the names on the program are characteristic of the organization and an interesting “story” might be made from the material in The Journal’s files on the individuals. Such names are of men, who, professionally speaking, range from faddists, who ride grotesque and bizarre medical hobbies, to those who with special interests to exploit and unable to use reputable medical organizations for that purpose, take refuge in such hybrid conglomerations as the Medical Society of the United States. Not that the program contains the names of crude quacks, or obvious medical swindlers. It is representative, rather, of that twilight zone of professionalism, the penumbra, in whose uncertain light it is difficult to distinguish between the unbalanced visionary, with a fad, and the more sinister near-quack, with a “scheme.”--(_From The Journal A. M. A., Oct. 5, 1918._)

THE NATIONAL FORMULARY--A REVIEW OF THE FOURTH EDITION

The fourth edition of the National Formulary appears simultaneously with the U. S. Pharmacopeia IX, and is to become official at the same time (September 1). The principles which determine its scope, as frankly set forth in the preface, are apparently the same as those applied, though more faint-heartedly, in the compilation of the Pharmacopeia. A statement in the preface of the new National Formulary runs:

“The scope of the present National Formulary is the same as in previous issues, and is based on medical usage rather than on therapeutic ideals. The committee consists entirely of pharmacists, or of men with a pharmaceutical training, and it cannot presume either to judge therapeutic practice or to follow any particular school of therapeutic practice. The question of the addition or deletion of any formula was judged on the basis of its use by physicians and its pharmaceutical soundness. The considerable use by physicians of any preparation was considered sufficient warrant for the inclusion of its formula in the book, and a negligible or diminishing use as justifying its exclusion.”