The Propaganda for Reform in Proprietary Medicines, reprinted from the Journal of the American Medical Association

From time to time The Journal of the American Medical Association has published the reports of the Council on Pharmacy and Chemistry and the Chemical Laboratory, as well as other matter on proprietary medicines. Repeated requests for some of the matter have led to the compilation of “The Propaganda for Reform in Proprietary Medicines,” which, in the present volume, attains its ninth edition.

The seventh, eighth and ninth editions have been compiled on slightly different principles from their predecessors. The therapeutic reform work of The Journal and of the Association’s Chemical Laboratory was at first confined almost entirely to the criticism and analysis of the so-called ethical proprietaries. This was right; the medical profession owed it to the public to combat the nostrum evil within its own ranks.

As the more flagrant evils of the “ethical proprietary” question were mitigated, the Association has turned the light on the more widespread and dangerous “patent medicine” evil. The articles devoted to “patent medicines” or quackery being naturally of greater interest to the general public than to the medical profession, the number of inquiries from laymen regarding various quacks and nostrums has steadily increased. It has been thought best, therefore, to publish separately1 all of the matter from The Journal relative to quackery and to those nostrums exploited only or chiefly to the public, and to include in the Propaganda for Reform practically none of the matter that is of direct interest primarily to laymen. In one or two instances in which the subjects were of equal interest to the profession and to the public matter that has already appeared in “Nostrums and Quackery” is also given here; but as a general rule the contents of the ninth edition of “The Propaganda for Reform” are of strictly professional interest. Those physicians who are desirous of obtaining in convenient form the matter dealing with “patent medicines” should order the book “Nostrums and Quackery” or the various pamphlets on the same subjects that have been issued since “Nostrums and Quackery” came from the press.

The ninth edition of “Propaganda for Reform” contains a number of new articles, greatly increasing the size of the book. It also contains one novel feature which greatly enhances its value. The index includes references not only to articles in the book, but also to matter on proprietaries not accepted by the Council on Pharmacy and Chemistry which appeared in The Journal of the American Medical Association and elsewhere. This index makes of this edition of “Propaganda for Reform” a very full work of reference on proprietaries which are undeserving of recognition. It should be understood, however, that not all articles indexed are condemned; some are merely discussed and compared.

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THE PROPAGANDA FOR REFORM IN PROPRIETARY MEDICINES

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To the Council on Pharmacy and Chemistry:

In response to the request of your chairman we have investigated the below-mentioned preparations and report as follows:

Specimens of the articles were bought in different cities in the open market, and in original sealed packages, and were analyzed by some of us or under our direction. Each article was examined by at least two chemists, and some were subjected to several analyses. While certain of the preparations are represented as being chemical compounds, the specimens examined were all found to be mixtures, the principal ingredient being acetanilid. The percentage proportions of acetanilid given below are the minimum obtained by any of the analysts.

Soda and ammonia, combined with carbonic acid, are calculated and reported as sodium bicarbonate and as ammonium carbonate (U. S. P.) respectively. Salicylic acid is calculated and reported as sodium salicylate. Diluents and other constituents than those reported were not determined.

AMMONOL

According to the analyses of the contents of the original sealed packages as purchased, this was found to be a mixture, and to contain the following ingredients approximately in the proportions given:

Acetanilid.	Sodium Bicarb.	Ammonium Carb.
50.	25.	20.

ANTIKAMNIA[B]

According to the analyses of the contents of the original sealed packages as purchased, this was found to be a mixture, and to contain the following ingredients approximately in the proportions given:

Acetanilid	Caffein	Citric Acid	Sodium Bicarb.
68.	5.	5.	20.

KOEHLER’S HEADACHE POWDERS

According to the analyses of the contents of the original sealed packages as purchased, this was found to be a mixture, and to contain the following ingredients approximately in the proportions given:

Acetanilid	Caffein
76.	22.

ORANGEINE

According to the analyses of the contents of the original sealed packages as purchased, this was found to be a mixture, and to contain the following ingredients approximately in the proportions given:

Acetanilid	Sodium Bicarb.	Caffein
43.	18.	10.

Other constituents said to be present were not determined.

PHENALGIN[C]

According to the analyses of the contents of the original sealed packages as purchased, this was found to be a mixture, and to contain the following ingredients approximately in the proportions given:

Acetanilid	Sodium Bicarb.	Ammonium Carb.
57.	29.	10.

Certain packages of phenalgin were purchased which on analysis did not show ammonium carbonate.

SALACETIN[D]

According to the analyses of the contents of the original sealed packages as purchased, this was found to be a mixture, and to contain the following ingredients approximately in the proportions given:

Acetanilid	Sodium Bicarb.	Sodium Salicylate
43.	21.	20.

We recommend that this report be printed in The Journal of the American Medical Association.

Respectfully submitted,
J. H. Long, M.S., Sc.D.,		Committee on Chemistry, Council on Pharmacy and Chemistry of the A. M. A.
W. A. Puckner, Ph.G.,
S. P. Sadtler, Ph.D.,
J. Stieglitz, Ph.D.,
H. W. Wiley, M.D., Ph.D.,

(From The Journal A. M. A., June 3, 1905).

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Agar-lac, said to be the product of “Agar-lac, Inc.,” is sold by E. Fougera and Company, New York. The following “formula” for Agar-lac is published:

“Agar-Agar with Lactic Ferments	Grs.	41⁄2
Phenolphthalein	Grs.	1⁄2”

Regarding the “lactic ferment,” the identity of which is not declared by the manufacturer and for the viability of which no precautions appear to be taken, the Council’s expert on lactic acid ferments reported that Bacillus bulgaricus was present in small numbers only and that there were at least two other bacteria present, one of which is a gas-former of the Bacillus coli type.

The Council found that the amount of agar-agar in Agar-lac and the identity of the “lactic ferment” are not declared; that the name “Agar-lac” is blown in the glass and that the method of its exploitation will lead laymen to use it to their detriment; that the claims that it “facilitates assimilation of proteids” and that it is of value as an aid to “gastro-intestinal digestion” give a false value to the mixture and that the claims emphasize the action of agar-agar when from the composition it is evident that the phenolphthalein action will predominate; that the name does not indicate its predominating constituent, phenolphthalein, and that the use of a ready-made combination of cathartic drugs, such as agar-agar and phenolphthalein with lactic acid ferments, is unscientific. The Council therefore refused recognition to Agar-lac.​—(From The Journal A. M. A., Nov. 14, 1914.)

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The following reports were submitted to the Council by the subcommittee to which these articles were assigned:

ANASARCIN

To the Council on Pharmacy and Chemistry:—​Your subcommittee to whom Anasarcin (Anasarcin Chemical Co., Winchester, Tenn.) was assigned, herewith submits its report:

This remedy is offered in two forms: “Anasarcin Tablets,” a pretended combination of the active principles of oxydendron arboreum, sambucus canadensis, and urginea scilla; and “Anasarcin Elixir,” said to contain the active principles of oxydendron, sambucus, hepatica and potassium nitrate. The advertisements of these articles conflict with the rules of the Council as follows:

With Rules 1 and 2: The composition of these articles is kept secret, in that the proportion of the ingredients is not furnished. The statement that it contains the “active principles” is misleading, since these are for the most part unknown.

With Rule 6: The description of the pharmacologic action of Anasarcin agrees practically with that of squill. No material part of its effects can be attributed to the other ingredients. Nevertheless, the advertisement studiously cultivates the impression that Anasarcin has no relation whatever to the digitalis group in which scilla is commonly placed. The claims are therefore misleading. The claim of its infinite superiority to digitalis, the claims that it cures neurasthenia, eliminates uric acid in rheumatism, and is useful in obesity, cystitis, lumbago and eclampsia, dyspepsia and asthma, and that it works wonders in exophthalmic goiter, appear exaggerated or false.

The recommendation of its indiscriminate use in nephritis, for lowering the blood-pressure and the statement (contradicted in the firm’s own literature) that it is not depressing, are actually dangerous.

It is recommended that the articles be refused recognition, and that the report, with explanations, be published.

ANEDEMIN

To the Council:—Your subcommittee to whom Anedemin (Anedemin Chemical Co., Winchester, Tenn.) was assigned herewith submits its report:

Anedemin is an evident imitation of Anasarcin. It is marketed as tablets, said to contain the isolated active principles of strophanthus, apocynum, squill and sambucus, chemically combined. The quantities are not stated. The therapeutic claims are copied almost literally from the Anasarcin circulars and are equally false. Anedemin, therefore, conflicts with Rules 1, 5, 6 and 7.

It is recommended that this report be published, with comments.

The reports were adopted by the Council and are herewith published.

W. A. Puckner, Secretary.

This wonderful remedy, Anasarcin, has already been exposed in these columns (The Journal A. M. A., Jan. 27, 1906), but it deserves additional mention, as it teaches several important lessons of general application. It is a typical example of the revival, under a new name and a thin disguise, of an old, time-worn article, squill, presumably because experience has demonstrated its general inferiority to other drugs. Anasarcin further illustrates the dangers involved in the use of semi-secret nostrums. It also shows how a short experience with a widely advertised but little understood drug is apt to lead to conclusions which more extensive experience demonstrates to be entirely fallacious.

The first lesson is, that formulas are not always what they seem. A hasty glance at the formula of Anasarcin tablets, the basis of the Anasarcin dropsy cure, creates the impression that it is a non-secret remedy; for it is said to represent a combination of the active principles of oxydendron, sambucus and scilla. As a matter of fact, it is a secret nostrum of the insidious kind. A formula which omits the quantities of its potent ingredients means very little. Further than this, we do not hesitate to charge that the claimed composition is a deliberate deception. The circulars emphasize the claim that Anasarcin consists of the isolated principles, and not of the crude drugs. Now, the isolated active principles of sambucus and oxydendron are not on the market, for the good and sufficient reason that no active principles have ever been isolated. Are we to believe that the Anasarcin Company has surpassed the accredited chemists and has discovered such principles and is isolating them? We shall have more to say on this subject presently; but any one in the least familiar with the difficulties attending the isolation of organic principles knows such an idea to be preposterous. Indeed, it is absolutely incompatible with the exhibition of ignorance of the elementary facts of pharmaceutical chemistry which is given by these people when they call the active principles of digitalis and squill “alkaloids.”

It is an axiom that the effects of a mixture can only be understood if the action of its components are known. So far as we know, the physiologic effects of oxydendron and sambucus have never been scientifically investigated, for the simple reason that they are too slight and indefinite to promise results. Both are credited with some slight, obscure diuretic action. Oxydendron, the sour wood or sorrel tree, is a small tree of the heath family, the acid leaves of which are said to be chewed by hunters for their pleasant taste and for the relief of thirst. Sambucus is the common elder. It is most unlikely that these two innocuous substances should play any part in the claimed powerful effect of Anasarcin; they are evidently put in the formula, we do not say in the preparation, to obscure the fact that Anasarcin is composed principally of squill. That this is so can be gathered unmistakably from a study of the pharmacologic action of Anasarcin as described by its promoters:

To appreciate fully the meaning of this description of the actions of Anasarcin, it should be compared with the effects of the digitalis group, to which squill belongs. The following account is quoted literally from a recent text-book of pharmacology (Sollmann):

The phenomena of the therapeutic stage of digitalis action are said to be:

1. Slowing of the heart, with systole and diastole both lengthened.

2. Increased strength of beat, leading to greater efficiency of the individual contractions, and to an increase in the total efficiency.

3. A tendency to the systolic phase.

4. A rise of blood-pressure, due mainly to the increased action of the heart, but partly also to a vaso­con­stric­tion.

The therapeutic action may be explained, in part, as follows:

A larger amount of blood will be thrown into the aorta and coronary circulation. The first effect will be an improved nutrition of the heart.... The tonic action ... narrows the ring of the valves, brings them together, narrows the ori­fice.... The venous congestion will tend to be relieved. This relief ... will fall in the first place on the lungs.... The lowering of the venous pressure will tend to cause absorption of the effusions.

The nauseant action of squill, which is alluded to in connection with Anasarcin, is too well known to require more than a mention.

In brief, then, it appears from the statements of the Anasarcin Company that the action of the remedy is that of squill and that the other ingredients are a mere blind. It is, of course, well known that squill can be used as a substitute for digitalis in cardiac dropsy, although it is generally considered very inferior to the latter drug. Rose Bradford, for instance, states: “Squill is not used to any extent in the treatment of cardiac disease and cardiac dropsy, digitalis being a far more efficient and less toxic substance.” However, it has been frequently observed that digitalis occasionally fails, and it may then be replaced successfully by another member of the group. At all events, it is very likely that squill is a fairly efficient substitute for digitalis, especially when it is supplemented by a very free course of Epsom salts and by potassium nitrate (the active ingredient of Anasarcin Elixir), both of which are stated to be essential adjuvants to the Anasarcin (or squill) tablets. There can be no objection to the use of squill when it is indicated; but any one who wishes to use it should do so with his eyes open, knowing what substance he is using and how much (which he does not in Anasarcin); knowing also that it has the same indications and limitations as digitalis. He should not be misled by such statements as the following:

Any one wishing to use squill should take the trouble to acquaint himself with the results obtained by competent and independent observers, and not rely on it in eclampsia, septicemia, “vices of civilization,” all forms of neurasthenia, as “an active eliminator of uric acid in rheumatism,” in hepatic cirrhosis, dyspepsia, asthma, obesity, cystitis (!), lumbago, exophthalmic goiter, etc.

He should also learn the contra-indications to the use of squill, deducible from the fact that it causes vaso­con­stric­tion and raises the blood-pressure (prohibiting its use in Bright’s disease and arterio­scler­osis), and that it produces marked gastric irritation, consequently nausea and depression, that it is a very toxic agent, and that the dangers of cumulative action must be borne in mind. In respect to these the advertisements of the Anasarcin people are little short of criminal, for these state:

Physicians who are inclined to disregard this warning, and who follow the advice of the Anasarcin people, should remember that their patients—​or their friends—​will put the blame for the results, which are bound to follow sooner or later, on the prescribers, and not on the deceptive advertisements of the Anasarcin Chemical Company.

There is another little matter which throws an illuminating side-light on the Anasarcin Company. They take every occasion to say that Anasarcin is “not offered to the laity,” “never sold to the laity,” etc.; but witness the following, which was found in the Retail Druggist of May, 1906, p. 179. The italics are ours.

CURE FOR DROPSY.

If we are disposed to doubt the vaunted scientific ability of the Anasarcin Company, we are forced to admire their business methods, at least, if there is any truth in the saying that imitation is the seal of success. Anasarcin has had this rather undesirable compliment paid to it, for its native town of Winchester has given birth to another remedy, Anedemin, which looks like a fair-haired twin brother. The Anedemin Company has adopted Anasarcin almost bodily. The name—​“opposed to edema”—​is about as close as the copyright laws permit. The pharmacologic and therapeutic claims agree almost literally with those of Anasarcin and contain the same exaggerations and dangerous misstatements. There is the same emphasis on free purgation with Epsom salts. The dose is the same. Both are marketed at $2.00 for a box of 100—​only the Anedemin people have adopted the prize package device of throwing in 20 or 30 tablets extra, for good measure, and give a discount of 75 cents or so.

In short, the Anedemin Company has appropriated all of Anasarcin which they considered of any value. It is, therefore, rather suggestive that they drew the line at the formula. Anasarcin is said to contain squill, sambucus and oxydendron; Anedemin discards the oxydendron and reinforces the squill with strophanthus and apocynum. Notwithstanding this material change in composition, the actions are described as identical; this is again rather suggestive.

The Anedemin Company, like the Anasarcin Company, scorns crude drugs and claims to use only the isolated principles. It was saved the trouble of discovering active principles for strophanthus and apocynum, for these are known; but it managed to find some scope for its inventive genius, “both drugs being so chemically treated and disposed as to absolutely eliminate all objectionable and disagreeable properties and effects” so as to convert a vasoconstrictor action into a dilator action; so as to render them non-toxic and non-cumulative; so as to deprive apocynum of its characteristic nauseant effect. Who can say that the days of miracles are past? Even this is not the limit of Anedemin alchemy; if we are to believe their claims, they have succeeded in forcing strophanthin, apocynum, scillain, etc., to combine with each other: “It is a definite chemical compound of the active principles” of these drugs! This makes the achievements of Emil Fischer in synthesizing sugars and proteids appear as mere child’s play.

Since the formulas were completed, however, clinical reports have been numerous enough—​almost too numerous, if we are to believe them. Anedemin has been on the market for less than three years; the circulars emphasize that testimonials and endorsements are not solicited. Nevertheless, we are told that it is “endorsed by over fifty thousand clinicians throughout the United States.” Since the total number of physicians in the United States and Canada is only about 128,000, this means that nearly every second physician has endorsed Anedemin. The Anasarcin Company solicits endorsements and they seem to do the larger business. Hence the majority of physicians of the United States must have written an endorsement of either Anedemin or Anasarcin, or both. Or is this statement another “invention”? It is a little peculiar that nearly all the endorsements come from small towns in sparsely settled districts; practically none from the centers of population. Does this mean that dropsy is more common in the rural communities than in the cities?

THE INVENTORS OF ANASARCIN AND ANEDEMIN

Even the newspapers, when they tax our credulity with pretended scientific “discoveries,” feel the moral obligation of justifying themselves by telling us something of the personality and experience of the discoverers. We may ask, therefore, who are these expert pharmaceutic and synthetic chemists, these manufacturers of active principles, these skilled clinicians of wide experience, who have “intelligently built up the formula by wide application”? What are we told of these men who ask us to believe, on their mere assurance, in miracles and feats of magic; who tell us that they have converted neutral principles into alkaloids, that they have effected definite chemical compounds between these neutral principles, that they have discovered principles that do not exist, that they have changed the actions of these principles to suit their wishes, that, in short, they have reversed the laws of Nature?

These companies are located in Winchester, Tenn., a town of about 1,500 inhabitants, situated in an agricultural country. The town boasts of neither scientific schools, colleges, universities nor laboratories. The Anasarcin Company was organized in 1902, the incorporators and directors being Dr. John W. Grisard and his sons, Dr. John P. Grisard, B. A. Grisard, and A. F. Grisard, and Will E. Walker, all of Winchester. Dr. John W. Grisard seems to be the originator and promoter of Anasarcin. W. E. Walker is an insurance solicitor of Winchester and is not actively identified with the business. We are informed that he owns but a single share of stock having a face value of $100, and that he was added to the company in order to comply with the laws of Tennessee, which require five directors for any corporation. Dr. John W. Grisard, the father, has practically retired, but still has a general supervising interest in the business. There is no regularly licensed pharmacist or chemist connected with the company. The office is in the rear of a jewelry store in the business part of Winchester and on the second floor above. According to our reporter, an office force of about ten stenographers and clerks handles the correspondence and labels and sends out the preparation which is made in a crude frame building located on a side street and without laboratory equipment. According to our reporter, the work is done by the Grisards and a colored man.

The Anedemin Chemical Company was organized in 1905 with a capital of $20,000, the incorporators and directors being Dr. T. B. Anderton, Floyd Estill, J. J. Lynch, J. M. Littleton and I. G. Phillips, all residents of Winchester, and all lawyers with the exception of Dr. T. B. Anderton. A Mr. Gordon, a clerical employee of the company, is reported to have active charge of the business, to prepare the medicine and conduct the correspondence. The office headquarters, laboratory and complete outfit of the Anedemin Company comprises two rooms over the law office of Estill & Littleton. No one connected with the company is a regularly licensed pharmacist or graduate chemist.

Of the six physicians located in Winchester, three (50 per cent.) are engaged in the dropsical cure business. Poor Winchester! Aside from their connection with these two nostrums, these physicians may be estimable and worthy citizens, but where, pray, did they find the extensive clinical facilities and pharmaceutical knowledge necessary for their wonderful and epoch-making discovery? Were they aided in their scientific work by the four lawyers connected with the Anedemin Company or by the insurance solicitor who is a director of the Anasarcin Company? Did the 1,500 inhabitants of the town furnish the vast clinical material necessary for discovering and working out the formulas of these two preparations? If so, we fear that dropsical affections are much more prevalent in Winchester than in any other known spot on the globe. This matter should be investigated. Without doubt the vital statistics of Franklin County would be most interesting and we commend them to the special attention of the medical profession in Tennessee.​—(From The Journal A. M. A., May 4 and 11, 1907.)

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The report which appears below was submitted by a referee and after adoption by the Council was sent to the manufacturer for comment, in accordance with the Council’s regular procedure in such cases. The manufacturer’s comments were transmitted to a second referee, who reported that after a careful consideration of the manufacturer’s reply he saw no valid reason for a modification of the report. The referee also reported that a visit to the Maignen Institute further served to convince him of the viciousness of the treatment as given and that the records made by the persons in the employ of the institute were too inadequate to serve as clinical evidence. On the referee’s recommendation, the report as originally adopted was reendorsed by the Council and authorized for publication.

W. A. Puckner, Secretary.

Maignen Antiseptic Powder is marketed by the “Maignen Institute for the Study of Bacterial Diseases,” Philadelphia. It is claimed to be a mixture of calcium hydroxid, sodium carbonate, aluminum sulphate and boric acid, but no statement as to the amount of the several constituents is furnished. Its action depends on the sodium hydroxid which is formed when the powder is treated with water, 1 Gm. of the powder as now submitted to the Council yielding 0.32 Gm. of sodium hydroxid (NaOH) and a specimen obtained a year ago yielding 0.28 Gm. Its promiscuous use is recommended both to physicians and to the public with claims which are extravagant, preposterous and even dangerous.

A pamphlet, clearly intended for the laity, entitled “What Is Catarrh?” gives direction for the “sterilization” of the nose, throat, stomach, lungs, eyes, gums, mouth and the genito-urinary tract. The following, taken from this pamphlet, illustrates the absurdity of the claims made for Maignen Antiseptic Powder:

“STERILIZATION OF THE STOMACH

Eighty-eight disorders are listed in a pamphlet entitled “Antiseptic Therapeutics” all of which are reported as having been treated with success. The dangerous character of the Maignen “sterilization” propaganda is illustrated by a pamphlet “First Aid to Baby-Sick” and by the recommendation on the trade package:

The legend on the trade package and the advertising matter contained in it are likely to lead the public to place dependence on a weak sodium hydroxid solution as a means of preventing blood-poison, lockjaw, hydrophobia and infectious diseases. The pamphlet “First Aid to Baby-Sick” recommends its use in sore eyes, teething and sore mouth, sore throat, running ears, running nose, sore chest, summer complaint, skin troubles and infection after vaccination; if any trust is put in these claims, they are bound to lead to the sacrifice of many infants through neglect of proper treatment.

Patent No. 1,086,339 has been granted on this powder to P. J. A. Maignen of Philadelphia by the U. S. patent office on the following specification of claim made in the application:

With brazen assurance this grant has been twisted by the unscrupulous promoters into a government endorsement of the preparation. It, of course, means nothing of the sort, as, no doubt, in accordance with legal routine the patent was granted without any investigation by the patent office to determine the effectiveness of the powder for the purpose claimed.

In view of the dangerous, unwarranted and absurd claims made for Maignen Antiseptic Powder the referee recommends that it be refused recognition, and that the Council declare its agreement with views expressed in the article “Maignen Pulv.” published in The Journal, Feb. 15, 1913, p. 537, particularly the following:

Because the Maignen Institute has twisted the granting of U. S. patent No. 1,086,339 into a quasi-endorsement of the claims made for Maignen Antiseptic Powder it is recommended that a copy of this report be sent to the Commissioner of Patents as a protest against the present law, which authorizes the granting of patents on unproved and improbable medical claims.​—(From The Journal A. M. A., Nov. 14, 1914.)

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Tyree’s antiseptic powder was assigned for examination to a subcommittee of the Council, which made the following report:

To the Council on Pharmacy and Chemistry:—Your subcommittee, to whom was assigned Tyree’s Pulv. Antiseptic Comp., marketed by J. S. Tyree, Washington, D. C., reports as follows: The label on the package states: “This preparation is a scientific combination of borate of sodium, alumen, carbolic acid, glycerin and the crystallized principles of thyme, eucalyptus, gaultheria and mentha, in the form of a powder,” etc.

The statement that the powder contains the crystalline principles of thyme, eucalyptus, gaultheria and mentha is vague and misleading, since the chief medical constituents of eucalyptus and gaultheria are liquids, but it tends to convey the impression that the powder contains the essential constituents of these drugs, namely, thymol, oil of eucalyptus or eucalyptol, oil of wintergreen, or methyl salicylate, and menthol.

The literature supplied to physicians claims its composition to be: “Parts, sod. bor., 50; alumen, 50; ac. carbol., 5; glycerin, 5; the cryst. principles of thyme, 5; eucalyptus, 5; gaultheria, 5, and mentha, 5.”

The composition, therefore, might be expressed as follows:

Sodium borate (borax)	50 parts, or	38.46	per cent.
Alum	50 parts, or	38.46	per cent.
Phenol (carbolic acid)	5 parts, or	3.85	per cent.
Glycerin	5 parts, or	3.85	per cent.
Thymol	5 parts, or	3.85	per cent.
Oil of eucalyptus or eucalyptol	5 parts, or	3.85	per cent.
Oil of gaultheria (or methyl salicylate)	5 parts, or	3.85	per cent.
Menthol	5 parts, or	3.85	per cent.

Analysis of specimens purchased from different sources in the open market were made under our direction. The reports of the chemists show that Tyree’s antiseptic powder contains no borax, or mere traces only, and that it contains no alum, or mere traces only. Instead, the analyses show that boric acid and zinc sulphate are the essential constituents. The amounts of carbolic acid, thymol, menthol, etc., contained in the powder, if present, were far below the quantities indicated by the formula. The presence of glycerin could not be demonstrated, and, if present, the amount must be very small.

One chemist reports: The result of analysis shows that different samples differ slightly in composition, but that the following indicates the average composition of the product:

Per Cent.
Zinc sulphate, anhydrous	15.56
Boric acid	81.26
Volatile matter at 100° C. for four hours	0.45

The undetermined portion consists of salicylic acid, carbolic acid, menthol and eucalyptol; possibly other antiseptic agents may be present in very minute quantities.

From the above findings we conclude that Tyree’s antiseptic powder is a mixture of boric acid and dried zinc sulphate and antiseptic bodies, such as menthol, salicylic acid and carbolic acid, eucalyptol, etc. From this it can be readily seen that the label, which is supposed to set forth the composition of Tyree’s antiseptic powder, is not in accord with the facts. The powder does not contain either borate of sodium or alum, and the presence of glycerin could not be established. The antiseptic agents, exclusive of the boric acid, are present only in small amounts.

The report of another analysis concludes as follows:

It evidently contains less than the amount stated of the principles of thyme, eucalyptus, wintergreen and mint. It also contains a very small amount indeed of carbolic acid, much less than that stated. We have been unable to identify certainly the presence of glycerin, and it is doubtful if it be present.

From the result of the analysis we feel confident that the preparation is to all intents and purposes a mixture of boric acid and sulphate of zinc.

The carbolic acid, thyme, eucalyptus, wintergreen, etc., if present, are present only in sufficient amount to give the compound a satisfactory odor.

In view of the fact that J. S. Tyree has given wide publicity to a formula which the preceding report has shown to be a deliberate mis­rep­re­sen­ta­tion of facts, it is recommended that the article be refused recognition by the Council on Pharmacy and Chemistry, and that this report be published in The Journal of the American Medical Association.

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

W. A. Puckner, Secretary.

Mr. Tyree, in a letter to Dr. Simmons (which he states he writes at the request of Dr. Kebler of the Drug Laboratory of the Department of Agriculture, though he is under no moral or financial obligation to do so), says that it has been his intention to inform the medical profession of his reasons for changing the formula of Tyree’s Antiseptic Powder from an alum and borax base to a boracic acid and zinc base. He states that this change was made at the suggestion of prominent physicians connected with hospital clinics on nose and throat, venereal and other conditions and that he has had in contemplation the omission from the label of the various conditions to which the preparation is applicable.

Mr. Tyree, it will be seen, assumes the right to sell to physicians a preparation with a descriptive formula which he acknowledges is false, and he presumes to use his own pleasure as to the time when he will inform them of its true composition.

Mr. Tyree does not state when he changed the formula. We do not know whether it was a year ago, five years ago or ten years ago, but we do know that the package which was used in making the first analysis was purchased as early as last February, and the first chemist’s report was submitted to the Council March 5, 1906. On April 4 Mr. Tyree was notified by the Council that the composition of Tyree’s Antiseptic Powder did not correspond to the formula published by him.

Whether or not Mr. Tyree is justified in offering our profession a preparation as composed chiefly of borax and alum when in reality it is chiefly composed of boric acid and zinc sulphate, we leave physicians to judge.

A report from the Council on Pharmacy and Chemistry on Tyree’s Antiseptic Powder appeared in The Journal, Oct. 20, 1906. This showed that the preparation, advertised as a “scientific combination of borate of sodium, alumen, carbolic acid, glycerin and the crystallized principles of thyme, eucalyptus, gaultheria and mentha, in the form of a powder.” was essentially a mixture of boric acid and sulphate of zinc—​approximately four-fifths of the former to one-fifth of the latter. “The carbolic acid, thyme, eucalyptus, wintergreen, etc., if present, are present only in sufficient amount to give the compound a satisfactory odor.” As will be remembered, in the correspondence published at that time, Mr. Tyree attempted to explain the discrepancies between his statements and the proved facts by intimating that he had recently changed the formula, and that it was his intention “on or about the first of February to state to the medical profession his reasons for changing the formula,” and that the change had been made “a short time ago, at the suggestion of several prominent gentlemen.” Since that time, through circulars and other advertisements, Mr. Tyree has attempted to explain the matter in various ways. In his latest circular letter he seems to make a deliberate attempt to mislead our profession and to misrepresent facts to a degree that makes it almost impossible to believe that the circular came from a man who claims to be honorable.

First, however, we shall take this opportunity to publish some matter which we have had in reserve since the first exposé was made last October. When it was realized that Mr. Tyree intended to defend himself by claiming that a change had recently been made in the powder, we took occasion to try to secure some of the preparation that had been on the market for a long time. In this we succeeded very well. From a Chicago druggist one package was bought which had been in the store at least since July, 1902—​how much longer is not known. The druggist from whom the powder was obtained bought the drug store in July, 1902, and this powder was on hand at that time, none having been bought since. This particular powder was analyzed by a chemist, who found the composition practically the same as that given in the Council’s report, this chemist estimating that it contained approximately 81 per cent. boric acid and 14 per cent. anhydrous zinc sulphate. Bearing in mind that for at least four years and ten months Tyree’s Powder has been essentially the same as it is today, this letter is very interesting: (The comments in brackets are, of course, ours.)

For years Mr. Tyree has been misleading physicians by making false statements regarding the composition of his powder and regarding its value as a therapeutic agent. When exposed he tries to defend himself and his business by statements and excuses that are worthy of a schoolboy trying to get out of a bad scrape. We would respectfully suggest to him that he either take his wonderful powder off the market, or—​which would probably amount to the same thing—​tell the truth, and the whole truth, about it.​—(From The Journal A. M. A., May 18, 1907.)

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Apergols, put out by H. K. Wampole Co., Inc., is alleged to be a “Uterine Stimulant.” Apergols is apparently an inversion of the name Ergoapiol and the preparation appears to have essentially the same formula, namely:

Apiol	5	min.
Oil Savine	1⁄2	min.
Ergotin	1	gr.
Aloin	1⁄8	gr.
Aromatics		q. s.

As in Ergoapiol, the constituent referred to in the formula as “Apiol” appears to be oleoresin of parsley-seed instead of the definite substance apiol described in New and Nonofficial Remedies. In general the claims made for Apergols are the same as those made for Ergoapiol (see p. 82). The Council refused admission to Apergols because they are advertised indirectly to the public, because of unwarranted therapeutic claims, because of the non-descriptive name and because the product is unscientific.​—(From The Journal A. M. A., Dec. 12, 1914.)

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Aseptikons are vaginal suppositories sold by the Chinosol Co. of New York. Each suppository is said to contain:

Ac. Salicylici	2	gr.
Ac. Borici	10	gr.
Quin. purae (Alkal.)	1	gr.
Chinosol	2	gr.
But. Cacao	60	gr.

The following claims appear in advertisements:

The Council decided that the foregoing claims in the absence of evidence must be held exaggerated and likely to mislead, and also that the claim “Stronger than Bichloride” which appears on the box is misleading.

The position of the Council is that “In the case of pharmaceutical preparations or mixtures the trade name must be so framed as to indicate the most potent ingredients.” The name Aseptikons does not give any indication of the ingredients of the product.

The Council holds that “The combination of two or more remedies in a mixture must be considered contrary to scientific medicine unless a distinct reason exists for such combination.” No evidence has been submitted to establish the value of the combination in Aseptikons.

On the basis of the evidence submitted the Council voted that Aseptikons be refused recognition because unwarranted and misleading therapeutic claims are made, because the name does not indicate its potent constituents, and because the combination of two or more remedies in a mixture is considered contrary to scientific medicine unless a distinct reason exists for such combination.​—(From The Journal A. M. A., Nov. 14, 1914.)

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Betul-ol (E. Fougera and Co., New York) is a methyl salicylate preparation advertised to physicians (and indirectly to the public) as an external analgesic and anti-rheumatic. The statements regarding its composition are vague, misleading and, as shown by examination in the Chemical Laboratory of the American Medical Association, untrue. The therapeutic claims are based on discarded theories. Although the alleged superiority of natural over synthetic salicylates has been disproved, physicians are urged to use Betul-ol because it contains, or is alleged to contain, a natural salicylate. Another discarded theory is pressed into service in the claim that the chloral in the mixture will be absorbed and converted into chloroform in the blood. The recommendations for the use of Betul-ol in rheumatism are likely to lead the public to the self-treatment of rheumatism. In view of the serious complications and sequelae of rheumatic fever this recommendation is utterly unjustifiable and a danger to public health—​even if the external application of this mixture in uncertain doses were as effective as a proper internal use of salicylates—​a theory contrary to experience and unsupported by adequate evidence.

The Council therefore refused recognition to Betul-ol.​—(From The Journal A. M. A., Dec. 12, 1914.)

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The Council has authorized publication of the following reports on Peacock’s Bromides and Chionia, sold by the Peacock Chemical Company, St. Louis.

W. A. Puckner, Secretary.

PEACOCK’S BROMIDES

This is another nostrum of the ordinary mixture type. Of the various statements concerning composition furnished by the company, the following gives as much information as any:

The label on the trade package indicates the presence of 10 per cent. of alcohol. It will be observed that the proportions of the different bromids are not stated. Hence, the assertion of the Peacock Chemical Company that “there is nothing secret in this compound” cannot be true. A physician prescribing it cannot know how much of each ingredient he is giving; it may be 14¹⁄₂ grains of potassium bromid and ¹⁄₈ grain each of sodium, ammonium, calcium and lithium bromid, or any other of an enormous number of possible permutations of the proportions.

While the theoretical basis of bromid medication is not yet fully settled, the weight of the best pharmacologic authority and clinical experience is decidedly against the dogmatic claim of the Peacock Chemical Company that “the best result is obtained by prescribing a combination of bromides.” And if there were any advantage in prescribing such a combination, the physician ought to regulate the proportions.

The following quotations are from the advertising matter:

These claims are unfounded. The analyses published in the concern’s own advertising “literature” show a variation of 8 per cent., in the bromid content, which certainly indicates a sufficient lack of uniformity.

Again quoting:

In view of the claim of low chlorid content, it is interesting to note that the analyses above referred to show that the chlorid content is actually higher than that of some other bromid preparations on the market.

The claim of merit on the ground of freedom from chlorids is, of course, absurd, and must be regarded as an attempt to play upon the credulity of the doctor. As a matter of fact, the average individual takes with his food many times the amount of chlorid he could possibly take in contaminated bromid. The 10 per cent. of alcohol would undoubtedly have a greater disturbing influence on the bromid action than the amount of chlorid that might be present in any bromid on the market.

Then we have the statement that, owing to this freedom from chlorids:

Sodium chlorid, even as an impurity, would retard rather than favor the development of bromism; sodium chlorid is even used as an antidote in bromid poisoning.

The therapeutic claims lay stress on the value of the bromids in sleeplessness, epilepsy, sexual excitement, tetanus, infantile convulsions, chorea, delirium tremens, the climacteric, migraine, headache due to pelvic conditions, ovarian neuralgia, etc. These and other claims, while too vague to be branded as falsehoods, are misleading and not in accordance with modern teaching or practice; the latter recognize the limitations of bromid therapy as well as its scope and advantages. For instance, in epilepsy the company asserts that:

The best modern clinical teaching concerning the treatment of epilepsy is that bromids should be avoided except as a last resort. Bromids do not cure, and the amount necessary to control the convulsions may produce a degree of mental hebetude that is a greater evil than the disease itself.

It is recommended that the preparation be held ineligible for admission to N. N. R., because of its conflict with Rules 1, 4, 6 and 10 of the Council, and that this report be published.

CHIONIA

Chionia, according to the statement of the Peacock Chemical Company, which exploits the product, contains 19 per cent. alcohol and is “A Preparation of Chionanthus Virginica.”4

This preparation is advertised particularly as “a potent hepatic stimulant” and special claims are made for it in various disturbances of the liver:

In passive congestion of the liver, the manufacturers would have us believe

As a prophylactic against eclampsia, if a history of torpidity of the liver is obtained:

Chionanthus virginica has never been shown to have the slightest pharmacologic activity and no evidence is presented that its offspring, Chionia, has any therapeutic value whatever in any disturbance of the liver. The promoters themselves indicate a lack of faith in their own preparation, for they advise the use of old and efficient forms of treatment along with Chionia—​heart tonics and laxatives in passive congestion of the liver, mercurial purge or podophyllin and sodium phosphate in “biliousness,” and quinin in malaria. Finally, with delightful English and elaborate insouciance, they advise in the treatment of eclampsia:

The physician who prescribes Chionia promotes a fraud.

The Council held Chionia ineligible for admission to N. N. R.

[Editorial Comment: In Peacock’s Bromides and Chionia the Peacock Chemical Company has, for a third of a century, been foisting on the medical profession nostrums composed of drugs that are easily combined in any proportion that the physician may want to prescribe. The company has been inflicting on the unthinking physician pseudo-scientific rubbish in the form of advertising literature that should long ago have been regarded as an insult to the intelligence of the medical profession. The following medical journals are carrying advertisements of Peacock’s Bromides and Chionia:

Alienist and Neurologist	Medical Fortnightly
American Journal of Surgery	Medical Herald
American Medicine	Medical Record
Archives of Pediatrics	Medical Review of Reviews
Atlanta Journal-Record of Medicine	Medical Sentinel
Buffalo Medical Journal	Medical Standard
Charlotte Medical Journal	Medical Summary
Chicago Medical Recorder	Medical Times
Denver Medical Times and Utah Medical Journal	Medical World
	Nashville Journal of Medicine and Surgery
Eclectic Medical Journal	New Orleans Medical and Surgical Journal
Ellingwood’s Therapeutist	New York Medical Journal
Indianapolis Medical Journal	Pacific Medical Journal
International Journal of Surgery	Southern Practitioner
Lancet-Clinic	Texas Medical Journal
Louisville Monthly Journal of Medicine and Surgery	Texas Medical News
	Therapeutic Gazette
Maryland Medical Journal	Wisconsin Medical Recorder
Medical Brief	Woman’s Medical Journal]
—(From The Journal A. M. A., April 3, 1915.)

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The following report was submitted to the Council by a member of its Committee on Therapeutics, with the recommendation that publication be authorized. This recommendation was adopted.

W. A. Puckner, Secretary.

Bromidia (Battle & Co., St. Louis) at once suggests bromids; yet Bromidia is essentially a chloral rather than a bromid preparation. This nostrum illustrates the need of the provision in the Council’s Rule 8 under which recognition is refused pharmaceutical mixtures whose names do not indicate their most potent ingredients. While the chloral content of Bromidia has been given considerable publicity, yet the preparation is used both by physicians and by the public without due consideration of its potent ingredient. This fact is attested not only by the fatal results which have followed its use but also by the many reports of habit formation. As long ago as in 1887 a fatal case of poisoning was reported5 to the medical society of the District of Columbia due to an overdose taken by a Bromidia addict. The physician who reported this case also gave his experience with another patient who had the Bromidia habit. In the discussion of the paper a number of cases were reported by others present in which Bromidia had been taken without a physician’s advice and with more or less grave symptoms of poisoning.

In the report of a death of one who had been a slave to Bromidia it was said:6 “When the body was found, there were eleven one-ounce Bromidia bottles about the room or on his person. Nine were entirely empty and the other two were about half full. None of these bottles indicated that they had been purchased on a physician’s prescription, only the druggist’s label marked ‘Bromidia’ being on them.”

Dr. Horatio C. Wood, Jr., gave7 a striking illustration of how preparations like Bromidia come to be used even by physicians without consideration of their constituents:

A circular, “The Advantages of Bromidia,” makes it plain how physicians come to use a preparation like Bromidia without consideration of its potent constituent. In this circular the presence of chloral is at first frankly admitted, then it is suggested that in the combination the evil effects of chloral are completely eliminated and in the end the impression is left that Bromidia is practically innocuous. Thus at the beginning while arguing that Bromidia is better than extemporaneous preparations the chloral content is plainly acknowledged:

Again:

Then, suggesting the indiscriminate use of Bromidia—as an entity as Dr. Wood suggests—​the claim is made that:

Finally Bromidia becomes a simple bromid preparation. Thus an advertisement reads:

In addition to the general invitation to use Bromidia in epilepsy and various nervous disorders, a circular also recommends its use in typhoid, a recommendation, which, if followed, may turn the scale in favor of a fatal result. The circular states:

Particularly vicious is the recommendation that it be given to children. Thus, in a pamphlet entitled “Effective Drugs Effectively Combined”:

Formerly advertisements asserted that each fluidram of Bromidia contained:

“Chloral hydrate	15	grains
“Potassium bromid	15	grains
“Extract of Cannabis indica	1⁄8	grain
“Extract of henbane	1⁄8	grain”

This formula also appears on the label of a sample package sent through the mails during 1914. A recent circular contains a somewhat different formula. Instead of “¹⁄₈ gr. each of gen. Imp. Ext. Cannabis Ind. and Hyoscyam.” as was formerly claimed, each fluidram of Bromidia is now said, not to “contain” but to “represent,” not the extracts but the far less potent drugs “Cannabis indica ¹⁄₈ grain, Hyoscyamus ¹⁄₈ grain,” thus:

“Chloral hydrate	15	grains
“Pot. brom.	15	grains
“Cannabis indica	1⁄8	grain
“Hyoscyamus	1⁄8	grain”

Furnishing still greater variety, the labels on a recently purchased bottle of Bromidia, where under the Food and Drugs Act the presence of narcotic drugs must be declared, read:

These various statements as to the composition of Bromidia leave one very much “in the air.” As chloral and potassium bromid are easily determined and since lying on the labels of widely exploited proprietaries has become somewhat risky recently, it is probable that the statements on the trade package are to be depended on and that each fluidram of Bromidia contains something like 12 grains each of chloral and potassium bromid and not 15 grains as the medical profession has been and is being told.

Pharmacists who have attempted to put up a nonproprietary preparation similar to or, more correctly, having the alleged composition of Bromidia have found it practically impossible to do so. The reason is that extract of cannabis indica is almost insoluble in a menstruum such as that found in Bromidia. The National Formulary, first edition, listed Mistura Chlorali et Potassii Bromidi Composita of which it was said: “Each fluidram contains 15 grains each of Chloral and of Bromid of Potassium, and ¹⁄₈ grain each of Extract of Indian Cannabis and Extract of Hyoscyamus.” In this the pharmacists attempted to incorporate the cannabis indica by using the tincture of the drug and suspending it by the addition of tincture of soap bark. In the present edition of the National Formulary, the preparation is made by triturating the extract of cannabis indica with pumice stone and then filtering the finished product. This gives an “elegant” preparation—​but one from which the cannabis indica is filtered out! A sad commentary on the National Formulary. It should not be supposed, however, that the manufacturers of Bromidia have solved the problem that has baffled the pharmacists; not at all. Bromidia probably contains no more cannabis indica than does its National Formulary prototype. The statement on the present trade packages, that the amount of cannabis indica in Bromidia is “indeterminate,” is but a tardy acknowledgment of the fact that the stuff has not, and never had, the amount of cannabis indica claimed for it for so many years.

The “indications” named on the Bromidia labels are, in common with nostrums of this type, but suggestions for self-drugging. They will appeal to the layman who has purchased, either by prescription or otherwise, an “original package” of Bromidia and who may imagine he suffers from “nervousness,” “sleeplessness,” “headache” or “neuralgia.”

But while the manufacturers in their advertising matter have on the whole not disguised the presence of chloral so much as they have attempted to make it appear that the chloral has been robbed of its dangers—​for all hypnotics if used thoughtlessly are dangerous—​after all the name has created the false impression that Bromidia is a bromid preparation. It is because of this false impression carried by its name, that Bromidia came to be used in­dis­crim­in­ate­ly by the profession and in the course of time still more in­dis­crim­in­ate­ly and recklessly by the public. Bromidia is a vicious chloral preparation masquerading under a misleading name. That physicians have been impressed by the claims of its harmlessness and by the mystery connected with the formula is not a credit to the intelligence of our profession. There is no doubt but that physicians are responsible for the use and abuse of this chloral preparation by the public.

There is no scientific or rational excuse for a ready-made preparation of this sort. When chloral or a bromid is indicated the proper dose of each of these, if they are to be combined, should be determined for each patient. Potassium bromid and chloral hydrate both are readily soluble in water, syrup or elixirs and it is a simple matter to prescribe the required dose of chloral and of bromid dissolved in some aromatic water like cinnamon-water (Aqua Cinnamomi), in some syrup like syrup of orange (Syrupus Aurantii) or in an elixir like the aromatic elixir (Elixir Aromaticum) or adjuvant elixir (Elixir Adjuvans). If this mixture is prescribed thus the physician is alive, alike to the dangers and the limitations of the drugs; if it is prescribed under a misleading proprietary name, the physician endangers his patient, stultifies his profession and tends to perpetuate the great American fraud.

[Editor’s Note.—A list of some of the medical journals that advertise Bromidia:

Texas Medical News	Southern Practitioner
Nashville Journal of Medicine & Surgery	New Orleans Medical & Surgical Journal
Medical Brief	Therapeutic Gazette
Annals of Surgery	Medical Herald
Charlotte Medical Journal	Medical Times
Medical Sentinel	Texas Medical Journal
Memphis Medical Monthly	Wisconsin Medical Recorder
Laryngoscope	International Journal of Surgery
Medical World	Vermont Medical Monthly
Medical Review of Reviews	Atlanta Journal-Record of Medicine
Louisville Monthly Journal	St. Paul Medical Journal
Indianapolis Medical Journal	Hospital Bulletin of the University of Maryland
Monthly Cyclopedia & Medical Bulletin	Denver Medical Times
Journal of Nervous & Mental Diseases	Buffalo Medical Journal
Maryland Medical Journal	Medical Review
Merck’s Archives	Ellingwood’s Therapeutist
Iowa Medical Journal	Eclectic Medical Journal
Medical Standard	Massachusetts Medical Journal]
—(From The Journal A. M. A., May 16, 1914.)

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The Council voted that cactus grandiflorus should not be accepted for New and Nonofficial Remedies, and that a statement be prepared for The Journal giving the reasons for this action. Accordingly the following report has been adopted by the Council and its publication authorized.

W. A. Puckner, Secretary.

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

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

EXPERIMENTAL EVIDENCE

O. H. Myers8 worked with a product which he calls cactina and which he regards as the active principle of the drug. (As no such substance as cactina is described in any materia medica, it is impossible to state what Myers really used.) He found that it had a strychnin-like action and raised the blood-pressure.

Hatcher comes to the conclusion: “Either Myers’ work was a pure fabrication or he was dealing not with cactin but with a substance similar to the pellotin of Heffter, the action of which resembles that of strychnin to a certain extent.”

E. Boinet and J. Boy-Teissier9 experimented with an aqueous extract, an alcoholic extract, and with an alkaloid which they call “cactine.” They concluded from three sets of experiments on frogs that extract of cactus produces, in ten minutes, a temporary increase in the heart’s action which frequently repeated doses are required to maintain; and that large doses slow the heart and produce arrhythmia.

L. E. Sayre10 experimented with a preparation of cactus, made from the stem of the plant, by injecting it into the dorsal lymph space of the frog. There was seemingly an increase in the amplitude of the heart’s action and an indication of a strengthened beat or increased force.

R. A. Hatcher11 states that it is possible that cactus grandiflorus, under certain conditions, may contain a principle with a strychnin-like action. But Hatcher made ten experiments on frogs, four on cats, six on dogs, two on rabbits, and one on a guinea-pig, with Cactina pillets of the Sultan Drug Company and the Cactin of the Abbott Alkaloidal Company. From 1 to 15 pillets in frogs and up to 25 in dogs were used at each dose. In no single instance was there any evidence of a digitalis-like or strychnin-like action, or, in fact, of any decided action of any kind whatever.

Gordon Sharp12 was unable to obtain either alkaloid or glucosid from the plant, but found a series of resins that caused contraction of the blood-vessels of a frog. This was not a digitalis-like contraction, but depended, he believed, on simple acidity. On the heart of the frog the resins have little or no effect, comparisons being made with digitalis in the same animals. There is no proof that cactus grandiflorus itself shortens diastole, or in fact, that it has any special action on the heart muscle at all. Sharp experimented on himself with large doses of an extract made with alcohol 1 to 5, but got no noticeable results. He thinks that the plant may have some slight diuretic action.

Sayre submitted the preparation which he used in his experiments for more careful testing to E. M. Houghton, who reported that it had practically no action on the heart.

In commenting on Houghton’s results, Reid Hunt said that they were confirmed by his own experiments. He did not deny, however, that the drug might have some therapeutic effect and that, in very large doses, it did affect the kidneys.

S. A. Matthews13 found one preparation of cactus (cactin—​Abbott) absolutely inert so far as any effect on the heart is concerned. He found that cactina (Sultan Drug Co.) in very large doses depressed both the circulation and respiration. In this regard it differs from strychnin, and it has no resemblance to the action of digitalis, strophanthus or any of the heart stimulants. A dose of from 10 to 12 pillets administered intravenously to a 10 to 12 kg. dog exerted little or no influence on the heart or circulation; the larger dose may cause a slight fall in blood-pressure. When 70 or more pillets were administered within two and a half hours the animal generally died.

The work of Boinet and Boy-Teissier also has been criticized by Hatcher on the ground that their most positive results were obtained with an alkaloid which no one at this day is able to prepare. The results quoted in this report, however, were obtained by the use of extracts of cactus so that it does not seem that they should be entirely rejected, whatever their value may be.

CLINICAL EVIDENCE

Clinical observations have been more abundant than exact, and a favorable action of the drug in some organic diseases of the heart has been reported; other observers would limit its use to functional arrhythmia, insisting that it is not a substitute for digitalis or aconite, but that it occupies a place distinct from either of those remedies.

P. W. Williams14 recommends cactus for functional heart disease, but, as a rule, found it useless in organic disease. He thinks it one of a class of remedies which act on the accelerator nerves and sympathetic ganglia, shortening the diastole and stimulating the spinal vasomotor nerve centers. Williams apparently relied on Myers for his knowledge of the pharmacologic action, and his paper is a fair example of the clinical studies of cactus.

Ellingwood15 claims that cactus is a cardiac tonic, acting on the accelerator nerves and heart ganglia, increasing muscular force and arterial tension. He recommends it in both organic and functional diseases.

Boinet and Boy-Teissier found that therapeutic doses of 40 drops of tincture of cactus were without effect on the normal heart. In patients with noisy asystole (asystolie bruyante) the same dose produced no appreciable effect. In the period of latent non-compensation of true cardiac patients, from 80 to 100 drops a day increased the force of the failing heart. In patients with secondary heart disease with arrhythmia of nervous origin, daily doses of 80, 100 and 120 drops of the tincture were well tolerated for weeks; they seemed to increase the fulness of the pulse and regulated its rhythm. In spite of such large doses, these observers never noticed any symptoms that could be attributed to a cumulative action. It must be remembered that the precise preparation of cactus which they used is not known.

Aulde16 recommends it as a cardiac tonic free from cumulative effects.

Gordon Sharp says: “The therapeutics of the subject, I think, are clear enough. Cactus grandiflorus cannot be included in our list of cardiac drugs. It is not even a simple stomachic tonic and at most all one can say is that it has small diuretic action.”

Hatcher says: “Clinical testimony is so conflicting that between the extreme views of Gordon Sharp and those of Ellingwood there is room for an honest difference of opinion concerning cactus grandiflorus.”

Matthews himself took 100 granules of cactin (¹⁄₆₇ gr.—1 mg. each), 25 every four hours, without experiencing the least effect.

CONCLUSIONS

Reliable conclusions regarding the therapeutic use of cactus grandiflorus are rendered difficult on account of several factors.

1. It is uncertain what part of the plant contains the active principle if one exists; and its nature is unknown. The National Standard Dispensatory states that its “activity must be confined to the flower in some special stage of its development or to a certain part of it or to some parts gathered with it.” This uncertainty may explain the negative results obtained by some observers, but it makes the drug one that cannot be generally relied on and gives an excellent opportunity for the exploitation of proprietary preparations.

2. Some of the experimental work and much of the clinical evidence has been obtained and published under proprietary auspices. For this reason many of the therapeutic claims made for the drug must be viewed as merely the reflection of the exaggerated statements made by the advertisers of proprietary preparations.

3. The value of clinical evidence when unsupported by an animal experimentation is much diminished by the tendency of enthusiastic and untrained observers to attribute to the drug given the effect really due to general remedial measures, psychic suggestion and so forth. While it must be admitted that valuable remedies may exist whose therapeutic properties cannot be revealed by animal experimentation, yet in the absence of such experimental evidence conclusions should be drawn with extreme caution.

Bearing these conditions in mind, the following statements seem to be justified: (a) The botanical, chemical and pharmaceutical properties of cactus are not sufficiently determined to make any available preparation a reliable remedy. (b) There is some evidence that cactus may be capable of affecting the animal heart and nervous system, but its action is not that ordinarily attributed to it. It does not increase the force of the heart-beat. (c) While there is some clinical testimony as to its usefulness in functional diseases of the heart, the indications for its administration are at present too uncertain to afford a safe basis for recommending it.

4. While the drug may be deserving of further experimental and clinical investigation, this should be carried on in reliable pharmacologic laboratories and in clinics provided with facilities for exact observation.​—(From The Journal A. M. A., March 12, 1910.)

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In response to inquiries and in view of the extensive advertising propaganda, the Council, on Dec. 19, 1913, took up for consideration Calcreose (Maltbie Chemical Company, Newark, N. J.). Examination showed that the preparation contained, in loose combination, approximately equal weights of creosote and lime. The claims made in the advertising “literature” were extravagant and uncritical, and the Council therefore held Calcreose ineligible for New and Nonofficial Remedies.

In June, 1914, at the request of the Maltbie Chemical Company, the Council undertook a reconsideration of the preparation. The advertising claims were now found more conservative. Before the existing claims could be judged, however, the Council deemed it necessary to require from the company satisfactory proof (1) that the large doses of Calcreose recommended and administered actually furnish large amounts of creosote to the blood, and (2) that patients taking these large doses do not suffer from digestive disturbances, loss of nutrition, albumin in the urine or phenol urine, as claimed. The Council accordingly advised the company of this requirement, at the same time stipulating that nothing in the report should be interpreted as indicating a belief on the part of the Council that enormous doses of creosote are necessary for, or will promote a cure of tuberculosis.

The Maltbie Chemical Company has not up to the present date furnished this proof, but has evinced a disposition to make the Council’s holding Calcreose under advisement appear in the guise of a quasi-approval. It is therefore recommended that Calcreose be refused recognition for conflict with Rule 6.​—(From the Journal A. M. A., June 26, 1915.)

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The following report was submitted to the Council on Pharmacy and Chemistry by the subcommittee to which Campho-Phenique had been assigned:

To the Council on Pharmacy and Chemistry:—Campho-Phenique, sold by the Campho-Phenique Co., St. Louis, Mo., is claimed to be composed of phenol 49 per cent., and camphor 51 per cent.

Examination of specimens, purchased in the open market, made under our direction, demonstrates that the statements made in regard to the composition are not true. Instead of containing 49 per cent. of phenol (carbolic acid), the analysis showed that it contains not more than 20 per cent. Instead of containing 51 per cent. of camphor, the analysis demonstrates that the amount of camphor is not more than 38 per cent. Besides phenol and camphor, a third substance was found which proved to be liquid petrolatum and to be present to the extent of 38 per cent. or more.

Since the statements made in regard to the composition of Campho-Phenique are deliberate mis­rep­re­sen­ta­tions of the facts, it is recommended that the article be not approved.

Besides Campho-Phenique, the above-mentioned firm also sells a preparation labeled Campho-Phenique Powder. While no statement in regard to the composition of this product is made on the label or in the literature, such expressions as “Campho-Phenique in a powdered form” and “Powdered Campho-Phenique” lead to the inference that it has essentially the same composition as that stated for the liquid preparation. An examination of a specimen of Campho-Phenique Powder purchased in the open market showed that 92 per cent. of it was a talcum-like inorganic substance. The remaining 8 per cent. consisted chiefly of camphor with a small amount of phenol.

In view of the fact that Campho-Phenique Powder contains very little phenol, but instead consists chiefly of an inorganic talcum-like substance, its name is misleading and deceptive. It having been shown that Campho-Phenique Powder corresponds to a camphorated talcum powder, the claims that it “has no equal as a dry dressing,” that it is “absolutely superior to iodoform,” and that it has “all the excellent properties of aristol and iodoform,” are unwarranted. It is recommended that the article be not approved, and that this report be published.

The recommendations of the subcommittee were adopted by the Council, and in accordance therewith the above report is published.

W. A. Puckner, Secretary.

The above report on a much advertised “ethical” proprietary medicine is worthy of the thoughtful consideration of the members of the medical profession, as it illustrates admirably some of the conditions connected with this proprietary medicine business.

THE FORMULA A FAKE

First, it illustrates the fact that the published formulas of the “ethical” proprietaries are not always reliable. The Campho-Phenique Company has been very willing to give out a formula, purporting their product to be 51 per cent. camphor and 49 per cent. phenol (carbolic acid). Now, these two drugs will make a liquid mixture, and any druggist can make it, and the mixture will have about the same consistency and appearance as Campho-Phenique. But its effect differs decidedly from that of Campho-Phenique. Some months ago a very intelligent physician, in discussing the proprietary medicine business, said that in some cases physicians could not get druggists to make preparations which were as satisfactory as those which could be bought ready-made. He cited Campho-Phenique as an illustration. He said that he had used this preparation for burns, etc., but as he did not like to use preparations put up by companies about which he knew nothing, he asked his druggist to make the mixture in accordance with the published formula. The druggist’s preparation was not satisfactory; it had a decidedly different effect from Campho-Phenique, and so he tried another druggist. This druggist also followed the published formula, but his results, too, differed materially from the proprietary article.

The various analyses that have been made show why the preparations put up by the druggists did not resemble that made by the company; since, according to the analyses, Campho-Phenique consists of 40 per cent. liquid petrolatum, which is an inert but soothing diluent, while instead of 49 per cent. of carbolic acid, as claimed, it really contains less than 20 per cent. This is an entirely different proposition. Now, if the physician referred to above will have his druggist make a mixture of 20 per cent. of carbolic acid, 40 per cent. of camphor and 40 per cent. of liquid petrolatum, and will then compare this resulting compound with Campho-Phenique, he will find that there is not much difference. Furthermore, he will realize that there is nothing either new or wonderful about the preparation. Camphorated oil and carbolized oil are both in common use. Campho-Phenique is apparently simply a mixture of the two.

THE POWDER STILL WORSE

So much for the liquid. The powder seems to be something entirely different, for, according to the chemist’s report, over 90 per cent. of it is inert, absorbent, talcum-like material. There is enough camphor and carbolic acid to give the powder an odor and thus mislead physicians, especially those who are in the habit of taking for granted that whatever statements nostrum manufacturers make are true. Perhaps it is a fairly good dressing for wounds—​at least it will do no harm—​but its name is misleading and deceptive. For all practical purposes it is essentially a camphorated talcum powder.

COMPANY A “PATENT-MEDICINE” CONCERN

The second interesting phase of this “ethical” proprietary is that it illustrates another point, i. e., that many of these articles are supplied to our profession by those who are not legitimate manufacturing pharmacists. The Campho-Phenique Company of St. Louis, according to all reports, is owned and controlled by a gentleman named Ballard. This “company” supplies the medical profession with the preparations under consideration and also with Chloro-Phenique and Scrofonol. We are informed that this same Mr. Ballard is the principal owner, if not the sole owner, of quite a number of “patent-medicine” companies, such as Ballard-Snow Liniment Co., Brown’s Iron Bitters Co., Mayfield Medicine Mfg. Co., Smith Bile Beans Co., Swain’s Laboratory, and several others. We learn from the wholesale drug trade lists that these various “companies” make and sell, besides the Campho-Phenique preparations, Ballard-Snow Liniment, Ballard’s Herbine, Brown’s Iron Bitters, Dr. Herrick’s Pills, Richardson’s Life-Preserving Bitters, Smith’s Bile Beans, Swain’s All Healing Ointment, and several other “patent medicines.”

It is hardly necessary to make any further comments. The whole business is nauseating to those who know the actual conditions of this nostrum business and how our profession is being deluded. The Campho-Phenique matter is not an exception; it is simply another illustration of these conditions.

The majority of “ethical” proprietaries are foisted on our profession, either without any formula accompanying them, or with a “formula” that is a fake. The majority of the “ethical” proprietaries are manufactured and supplied to physicians, with instructions regarding their use, by men who bear the same relation to legitimate pharmacy that the veriest quack that ever swindled a credulous public bears to scientific medicine.​—(From The Journal A. M. A., April 20, 1907.)

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The following reports on products of the Rio Chemical Company have been submitted by a referee. The Council recommends that they be published, as the preparations discussed are glaring instances of nostrums exploited through physicians on unscientific claims and false representations.

W. A. Puckner, Secretary.

Celerina belongs to what Samuel Hopkins Adams calls the “bracer” type of nostrum. According to the label it contains 42 per cent. alcohol (whisky contains about 50 per cent.). The other ingredients of Celerina are declared to be as follows:

Kola contains a very small percentage each of caffein and theobromin. It is impossible for the infinitesimal amounts of these alkaloids in an ordinary dose of Celerina to produce any physiologic effect.

Viburnum has been called a “uterine sedative,” whatever that may be. Its only real activity is the psychic one due to its taste and odor.

Celery at one time was credited with being both an antispasmodic and a nerve stimulant—​a remarkable combination of opposing qualities! Scientific investigation has failed to show that celery has any physiologic or therapeutic activities. If it had the slightest medicinal value, the rational course would be to prescribe it in its fresh and natural state. The small dose contained in a teaspoonful of Celerina is inappreciable and not even equivalent to that contained in a stalk of celery.

Ladyslipper, more imposing under the Latin name of “cypripedium,” is a flowering plant with a legendary reputation as an “antispasmodic and nerve stimulant.” It has been in the therapeutic scrap-heap for years. It contains a little tannic acid, gallic acid and a volatile oil. Even a tannic acid action cannot be expected from a teaspoonful of a preparation containing 20 grains of ladyslipper to the ounce.

Prickly ash (xanthoxylum) has never been shown to have any activity other than that of a local irritant, especially to mucous membranes. The slight “bite” from this drug would be entirely covered up by the alcohol in Celerina. Any stimulating effect which this drug may have on the stomach is greatly inferior to that produced by a very small glass of ordinary ginger ale.

In short, there is no ingredient in Celerina, except the alcohol, that has any recognizable activity; and the alcohol content is nearly as great as that of ordinary whisky. Some of the claims and recommendations for this nostrum are:

Think of prescribing an alcoholic nostrum four times a day to promote recovery from alcoholic excess!

The sang froid with which the exploiters of this nostrum refer to other “quacks and faddists” as reaping “juicy fruit” from neurasthenics would command admiration were it not so pitiful.

Of course, the disappearance of nervous aphonia might follow the application of any treatment whatever, be it Eddyism, Chiropractic, Peruna or Celerina.

In

Here is a good example of proprietary-house therapeutics: Such widely different conditions as digestive trouble and the climacteric are to be treated with a combination of alcohol, simple bitters and aromatics! Why not order a cocktail under its own name? It would be equally efficacious, less mysterious and its dangers might be better realized!

Any other hot toddy at bedtime (and it need not cost a dollar a bottle) might give relief; but the intelligent physician to-day recognizes the danger of prescribing alcohol in such conditions.

And the same effect follows its use:

Moreover:

The statement made by its manufacturers that this preparation is free from narcotics or habit-forming drugs is not true. Alcohol is both a narcotic and a habit-forming drug.

As in the case of other nostrums containing no potent drugs but alcohol, Celerina is recommended for various diseased conditions in combination with a familiar form of treatment by drugs of more or less value. The physician who thoughtlessly prescribes one of these combinations will without doubt unthinkingly attribute any subsequent improvement to the Celerina. Thus, for malaria, a prescription of quinin and Celerina is advised; for chorea in children, arsenic with Celerina; in “Convalescence from La Grippe,” strychnin sulphate, Fowler’s solution, and Celerina; for impotence, nux vomica, dilute phosphoric acid and Celerina. In none of these conditions would Celerina affect favorably anything except the pockets of the exploiters; in some, as in the chorea of children, the alcohol would be positively detrimental. Of course, the value of such prescriptions (so far as they have any apart from the fictitious value lent by the alcohol) resides altogether in the standard drugs prescribed with Celerina.

There is no possible excuse for writing a prescription for Celerina, either in original package or mixed with well-known or valuable drugs. The sooner it is realized that this preparation has no place in medicine, should never be prescribed by physicians and is essentially nothing but alcohol and bitters exploited under a fancy name, the better for the public health and the science of medicine. The continued sale and use of Celerina is a disgrace to the medical profession.

Aletris Cordial is a nostrum containing therapeutically worthless drugs in alcohol (28 per cent.).

The “formula” on the label reads:

At one time these drugs had some vogue, chiefly as domestic remedies. They have been discarded as valueless by modern scientific medicine.

Aletris, or unicorn root (Aletris farinosa), contains a bitter principle and starch. The remarkable uterine tonic properties formerly ascribed to it have not been confirmed by reliable observers. It is practically worthless.17

Helonias, or false unicorn (Chamaelirium luteum), is asserted to be a hemostatic and uterine tonic. No trustworthy evidence has ever been offered in support of the claims made for this drug; reliable medical literature contains no reference to it; it has no valid claim on the attention of physicians.18

Scrophularia, or figwort (Scrophularia marilandica), contains a principle which has a digitalis-like action on the heart. Its activity is so slight in comparison with that of digitalis, however, that there was nothing to be gained by studying it. The drug is consequently little known and is not mentioned in critical works on pharmacology. If the drug were therapeutically active in the quantities used, another danger would be added to that of the alcohol content of Aletris Cordial. Since the recommended dose (a teaspoonful) contains, if the formula be correct, only about 4 grains of figwort, this drug too may be regarded as practically inert in this preparation.

Not one of these drugs has been deemed worthy of mention in the Pharmacopeia. The Council has previously discussed them and declared them valueless (Reports Council Pharm. and Chem., 1909, p. 146; 1910, p. 10; 1912, p. 42).

In Aletris Cordial, then, there is no ingredient capable of producing any other effect than the alcohol stimulation and such psychic effect as may be due to the bitter taste. Yet physicians are asked to believe that

Such claims as these, when made for a mixture containing no therapeutically active constituent except alcohol, are absolutely preposterous. It should be noted that the declared alcohol content of Aletris Cordial is much higher than that of the strongest wines, and, in the light of medical experience, quite high enough to promote the formation of the alcohol habit in a steady user. The following recommendation, taken from the company’s “Budding into Womanhood” circular, therefore, is outrageous:

It is to be hoped that no medical practitioner is so heedless of consequences as to prescribe for adolescent girls a worthless nostrum capable of creating a craving for alcohol. The temperance societies might with profit take steps to inform laymen, especially women, concerning the worthlessness of this nostrum, the risk involved in taking it, and the outrageous character of the recommendations made for it by the manufacturers.

Kennedy’s Pinus Canadensis, Light (recently renamed “Abican”) and Dark (renamed “Darpin”) are also exploited by the Rio Chemical Company. Although they have been on the market some thirty or forty years they appear to have achieved no marked degree of commercial success. Yet they have been imitated by most of the pharmaceutic houses. They are of interest chiefly through the barefaced fraud involved in their exploitation.

COMPOSITION CLAIMED

Apparently the dark preparation (“Darpin”) was first put on the market; then the light one (“Abican”) was offered, to be used only “as an injection and externally.” The reason for the existence of the light preparation evidently was the objectionable property of the dark, which stained linen. The two preparations are both said to be extracts of Pinus Canadensis or hemlock bark. A circular issued some years ago contained the following statement:

The labels on the packages of the light and dark preparations sent out to-day bear, respectively, only the following references to composition, the first on the dark and the second on the light:

ACTUAL COMPOSITION

“Darpin” or Kennedy’s Pinus Canadensis, Dark, does contain tannin, but, as the simplest of chemical tests demonstrate, Pinus Canadensis, Light, does not contain tannin. It might as truthfully be called maple syrup or beef tea.

It is almost a work of supererogation to discuss the therapeutic claims made for preparations sold under false pretenses as to composition. It is enough to mention that Kennedy’s Pinus Canadensis, Dark or Light, is recommended in

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

The intelligent physician of to-day knows that his forefathers in the days of the stage-coach employed tannic acid in its crude form and treated intestinal disease in a very unsatisfactory manner; he knows, further, that advances in our knowledge of pathology have rendered the use of tannic acid in gastro-intestinal therapeutics largely unnecessary and that when it is used it should be in some form that will pass the stomach unchanged. So far as its use as local application is concerned, he knows, without need of instruction from the Rio Chemical Company, when tannin is indicated, and the Pharmacopeia furnishes a suitable preparation for the physician so that he need not resort to an unscientific nostrum like Darpin.

The physician who is competent to treat a case of gonorrhea does not need to be told that alum and zinc sulphate may be useful in such conditions, and he does not want them palmed off on him for something else under the name of Pinus Canadensis, Light, Abican or what not. Also, he prefers to use them, when they are needed, singly and in strength suited to the conditions of the individual case.

[Editorial Comment.—Celerina, Aletris Cordial and Kennedy’s Pinus Canadensis, Light and Dark, appear to be the entire output of the Rio Chemical Company, which was one of the earliest of the various companies organized by James J. Lawrence of Medical Brief fame. The business was moved from St. Louis to New York City in 1901. According to what we believe to be reliable information, the Rio Chemical Company is now composed of James P. Dawson, president; William W. Conley, vice-president and treasurer; and E. D. Pinkerton, secretary. These also constitute the directors. It appears that James P. Dawson is a member of the law firm of Dawson and Garven, St. Louis; E. D. Pinkerton is said to be Miss Effie D. Pinkerton, stenographer for Dawson and Garven. We know little concerning William W. Conley except that he appears to be in charge of the establishment in New York. We find no evidence that he is either a chemist or a pharmacist; his name does not appear in the membership list of the American Chemical Society or of the American Pharmaceutical Association, nor can we discover that he has published anything in the way of chemistry or pharmacy. As a matter of fact, the Rio Chemical Company is another of the pseudo-chemical companies created to exploit one or more proprietaries—​in this instance Celerina, Aletris Cordial and Pinus Canadensis. The following medical journals carry advertisements of the Rio products (or did late in 1914): American Journal of Surgery, American Medicine, Denver Medical Times and Utah Medical Journal, Eclectic Medical Journal, International Journal of Surgery, Interstate Medical Journal, Massachusetts Medical Journal, Medical Brief, Medical Century, Medical Council, Medical Review of Reviews, Medical Sentinel, Medical Standard, Texas Medical Journal and Woman’s Medical Journal.].​—(From The Journal A. M. A., Feb. 13, 1915.)

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Occasional inquiries in regard to the therapeutic value of Cineraria maritima caused the Council to consider the drug with reference to its fitness for inclusion in N. N. R. among non-official, non-proprietary remedies. The following report, having been submitted to the Council by a subcommittee, was adopted and its publication authorized.

W. A. Puckner, Secretary.

To the Council:—The juice of a plant referred to as Cineraria maritima was at one time supposed to be of value in the treatment of cataract and certain other affections of the eye. No scientific evidence is available to show that the drug is therapeutically active, and its value is no doubt correctly estimated by Dr. Casey Wood, who (“Ophthalmic Therapeutics,” p. 446; Cleveland Press, Chicago, 1909) says:

The plant from which Cineraria maritima juice is claimed to be prepared is commonly referred to in literature as Cineraria maritima, but is more correctly described as Senecio cineraria, D. C.

It may be considered a matter of indifference whether a remedy like this be advertised for the treatment of such diseases as cataract, providing its application could do no harm, but it must be remembered that it is recommended also for other diseases of the eye in which its use, by postponing efficient treatment, would be the means of serious damage or even loss of vision.

Since there is no evidence to show that this drug is of any therapeutic value, it is recommended that it be not admitted to the list of non-official, non-proprietary remedies in N. N. R., and that the Council formally expresses its opinion that the drug, as judged by the evidence which is available, is without value in the treatment of cataract or similar diseases of the eye.

[Editorial Comment.—Cineraria maritima would long since have been relegated to the limbo of discarded and discredited drugs had it not been given a semiproprietary character by a St. Louis nostrum house—​the Walker Pharmacal Company—​which, like the Manola Chemical Company, is, we understand, practically a subsidiary concern of the Luyties Homeopathic Pharmacy Company. The Walker concern exploits this drug under the name Succus Cineraria Maritima (Walker). Its method of exploitation consists in publishing testimonials, which it dignifies with the name “clinical reports,” from men whom it designates as “representative physicians.” As indicative of what constitutes representative physicians, we find that of the seven testimonials given in their pamphlet the names of three of the signers are not to be found in any medical directory.

The exploitation of Succus Cineraria Maritima (Walker) is the oft-repeated story of the resurrection of discarded and worthless drugs for the purpose of creating proprietorship in a nostrum. Cineraria maritima is worthless; its therapeutic value is nil. By the prodigal use of printers’ ink, the medical profession—​and through it the public—​has been humbugged into believing that it possesses curative value.]​—(From The Journal A. M. A., Nov. 11, 1911.)

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This is one of the “oilless” cod liver cordials. Like other manufacturers of such extracts, the Katharmon Chemical Company, St. Louis, which owns Hagee’s Cordial, attempts to trade on the reputation long enjoyed by cod liver oil as a promoter of growth and nutrition. The following is the statement of composition furnished by the company:

And here are some of the therapeutic claims:

Of course, these absurd claims hark back to the time of the prevalence of the now discarded theory that the valuable properties of cod liver oil reside, not in the fat, but in certain nitrogenous, alkaloid-like constituents present in infinitesimal amounts. Further “playing up” this theory:

Proprietary manufacturers usually ignore scientific investigations which establish facts adverse to proprietary claims; but the same proprietary manufacturers are quick to seize on any theory that can be twisted into support of their interests. Thus, recent investigations having shown that cod liver oil, like butter and egg yolk, possesses certain growth-promoting properties not found in some other fats, the promoters of Hagee’s Cordial claim these properties of cod liver oil for their extract. They assert:

The Council has previously expressed the opinion19 that the preponderance of evidence indicates that whatever therapeutic value cod liver oil may have depends chiefly, if not entirely, on its fat (oil). There never was any evidence or scientific authority for the theory that the therapeutic value of cod liver oil was independent of its fat content. The fact that the fat is the growth-promoting element has already been shown, and J. P. Street, chemist for the Connecticut Agricultural Experiment Station (The Journal A. M. A., Feb. 20, 1915, p. 638), in a series of experiments on a number of the so-called extracts of cod liver or cod liver oil (including Hagee’s Cordial) has conclusively demonstrated that the growth-promoting properties of the oil are not to be found in the extracts. Street placed rats on a ration not sufficient to maintain normal nutrition and growth for an extended period. After the rats had been on this ration for some time and a failure to maintain weight was indicated, an amount of dealcoholized Hagee’s Cordial was substituted for a portion of the lard contained in the ration. Later Hagee’s Cordial was replaced by cod liver oil.

Street says:

Hagee’s Cordial of the Extract of Cod Liver Oil Compound has neither the nutritive qualities nor the reconstructive efficacy of cod liver oil. This mixture is worthless for the conditions for which it is advertised, and is marketed under misleading and unwarranted claims. It is recommended that Hagee’s Cordial be held ineligible for New and Nonofficial Remedies.​—(From The Journal A. M. A., April 10, 1915.)

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Wampole’s Preparation is another of the oil-free “extracts” of cod liver. The following formula (which, be it observed, is non-quantitative and therefore practically worthless) is published by the owners, Henry K. Wampole & Co., Inc.:

An alcohol content of 17 per cent. is declared on the label. The following claims are typical of those made for the preparation:

In the Council’s opinion, as previously expressed,20 such therapeutic value as there may be in cod liver oil is chiefly, if not altogether, due to the fat (oil). Lately, the investigations of J. P. Street of the Connecticut Agricultural Experiment Station have definitely disproved the claims made for the Wampole’s and similar preparations. In Street’s experiments, rats were placed on a ration insufficient for normal nutrition and growth. After the rats had been on the ration for a time long enough for inability to maintain weight to become evident, dealcoholized Wampole preparation was substituted for a portion of the lard contained in the ration. Later the Wampole preparation was replaced by cod liver oil. From these experiments it appears that, although the Wampole preparation is said to contain malt extract and sugar, it does not show the advantage over ordinary cod liver oil as a source of nutriment which is claimed for it by the manufacturers. Street emphasizes that the Wampole preparation does not possess to any marked degree the reconstructive properties of cod liver oil, butter fat and egg yolk, on which foods rats gain weight rapidly and steadily after having been on a deficient diet. Street calls attention to the fact that the amount of alcohol consumed daily by the user of the Wampole preparation (the equivalent of 0.7 fluidounces of whiskey) explains to a considerable extent the asserted tonic virtues of the preparation.

Though offered as an efficient substitute for cod liver oil, Wampole’s “Perfected and Tasteless Preparation of an Extract of Cod Liver” lacks both the nutritive and the reconstructive properties and is marketed under an indefinite name and unwarranted and untrue claims. It is recommended that Wampole’s Preparation be held ineligible for New and Nonofficial Remedies.​—(From The Journal A. M. A., April 10, 1915.)

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The following report has been adopted by the Council and its publication directed

W. A. Puckner, Secretary.

To the Council:—Your committee on pharmacology has read with interest the contribution from the Association’s laboratory on Waterbury’s Metabolized Cod-Liver Oil Compound. The report shows that misleading and false statements are made in regard to the composition of the product and also that exaggerated and unwarranted claims are made for its therapeutic value. In view of the attempt of the Waterbury Chemical Co. to create a false impression in regard to the therapeutic value of the composition of its product, it is recommended that the following report be adopted and published:

The Council believes that there is a preponderance of evidence to indicate that whatever therapeutic value cod-liver oil has, that value depends chiefly, if not entirely, on its fat (oil). In the opinion of the Council, the word cod-liver oil should not be used in connection with any preparation unless it consists to a large extent (25 per cent. or more) of cod-liver oil. Since Waterbury’s Metabolized Cod-Liver Oil Compound contains no appreciable quantity of cod-liver oil, the name is incorrect and misleading, and as a cod-liver oil preparation it is believed to be wholly valueless. The Council has previously voted that Waterbury’s Cod-Liver Oil Compound be refused recognition because of conflict with Rules 1 and 6.​—(From The Journal A. M. A., Oct. 9, 1909.)

[Contribution from the Chemical Laboratory of the American Medical Association]

W. A. Puckner and L. E. Warren

A full page advertisement of Waterbury’s Metabolized Cod-Liver Oil Compound appeared in the Iowa Medical Journal, March 15, 1909, in the form of a letter purporting to give the results of an analysis of the product made for the firm by a Chicago chemist. In this letter-advertisement the chemist states at the outset that the results of his examination “are somewhat at variance with the statements made in The Journal.” These statements he quotes as follows:

The chemist admits in his letter to the firm that his analyses verify statements 1 and 3, but regarding statement 2 he says: “I find that your preparation is acid in reaction, but when strongly acidified gives a distinct turbidity within 10 minutes and a voluminous precipitate within 1 hour. This precipitate is shown to consist of fatty acids of cod-liver oil, which are thrown down by the splitting of the soaps, on acidifying either with sulphuric or hydrochloric acid.” From these results he states that to him it seems that the “preparation does not deserve the statement that it contains no soap, as there is no question whatever of the presence of cod-liver oil.”

While in the letter published in this advertisement the chemist claims to have demonstrated the presence in the product of “saponified cod-liver oil,” he omits to mention the quantities of the soap present. In the article that originally appeared in The Journal (Oct. 13, 1906), in addition to the three paragraphs quoted by the chemist, the following statements were made:

“By these simple tests a physician is easily able to demonstrate that the preparation does not contain cod-liver oil. It is therefore valueless for the purpose of nutrition for which we give the oil. More careful analysis confirms the results of these tests and shows that it contains no fat or fatty acids (except the merest traces)....”

At the time these statements were published in The Journal, the St. Paul Medical Journal, October, 1906, contained an advertisement for Waterbury’s Metabolized Cod-Liver Oil Compound, which contained this statement:

In the Ohio Medical Journal of Feb. 15, 1907, there appeared in the form of an advertisement what purported to be an analysis of Waterbury’s Metabolized Cod-Liver Oil Compound by Prof. C. N. Kinney of Drake University. While Professor Kinney made a quantitative analysis of the preparation, the quantities were omitted from the analysis as published. A footnote added by the Waterbury Chemical Company called attention to this fact and closed as follows:

If this weirdly constructed sentence meant anything, it meant that the complete analysis would be furnished on request. Such requests to the company, however, from various sources failed to elicit the information required nor was the “complete analysis” forthcoming. The inference to be drawn is fairly plain.

In a circular accompanying the product as sold at present, this statement occurs:

As previous examination disclosed only the merest traces of cod-liver oil in the product though claims were made that it “represents cod-liver oil in its entirety,” and in view of the fact, too, that present advertisements emphatically declare that cod-liver oil is present in the preparation as now sold, it was thought best to examine some of the preparation with especial reference to the quantities of fatty acids from cod-liver oil.

OLD LABEL		NEW LABEL
It is interesting in this connection to note that this product is no longer being sold under the name “Metabolized Cod Liver Oil Compound.” See the illustrations of the old and new labels.

The results of the examination are briefly as follows: The total quantity of acids isolated amounted to about 0.3 per cent., and of this amount about two-thirds was salicylic acid. Thus it appears from the examination of the specimens bought on the open market that the preparation contains at most but 0.1 per cent. of the fatty acids from cod-liver oil, a totally insignificant quantity.

Notwithstanding the protestations by the manufacturers, in the form of published analyses and circulars, it is seen that the statements published in The Journal, Oct. 13, 1906, p. 1207, are essentially substantiated; it is further evident that the product does not deserve to be designated as a cod-liver oil preparation. To obtain a medicinal dose of cod-liver oil the patient would be compelled to swallow the contents of a bottle of this mixture, and as the product contains 11 per cent. alcohol the patient who did so would probably experience a degree of exhilaration not referable to cod-liver oil.​—(From The Journal A. M. A., Oct. 9, 1909.)

This product of the Waterbury Chemical Company, of Des Moines, Iowa, was exposed in The Journal of the American Medical Association, October 9, 1909. In May, 1910, the United States Government issued a notice of judgment in which it was declared that Waterbury’s Metabolized Cod Liver Oil Compound was misbranded. The court rendered its decree of condemnation and forfeiture.—​[Notice of Judgment, No. 303.]

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The Waterbury Chemical Company having requested that the Council reconsider its action of four years ago (see preceding report) on the product then known as Waterbury’s Cod-Liver Oil Compound, now called Waterbury’s Compound, the matter was submitted to a referee. The referee reported that the statement now made as to the composition of this product is as follows:

He held that the Waterbury Chemical Company has not submitted satisfactory evidence to indicate that the objections of the Council’s former unfavorable report have been met; that there is no evidence that the product is a substitute for cod-liver oil in any way; and that under the present methods of exploitation it constitutes what is at least an inferential fraud; and recommended that no further consideration be given to Waterbury’s Compound. The report was adopted by the Council.​—(From The Journal A. M. A., March 20, 1915.)

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Colchi-Sal, said to be made by the Anglo-American Pharmaceutical Co., Ltd., New York, is advertised, sold and “guaranteed” (sic) by E. Fougera and Co., Inc., New York. According to the label of a recently purchased specimen:

The advertising circular around the bottle adds that the mixture also contains “appropriate aromatic adjuvants.”

It is recommended in “Gouty and Chronic Rheumatic Manifestations,” “acute cases of Gout,” “intestinal auto-intoxication or dyspepsia,” “bilious headaches,” etc. Salicylates are generally recognized as valuable in acute manifestations of acute articular rheumatism; colchicum is useless in these conditions. Both salicylates and colchicum are practically useless in chronic rheumatic and in chronic gouty affections. For dyspepsia, bilious headache, etc., salicylates are distinctly contra-indicated and the drastic purgation produced by colchicum would not be thought desirable. Though methyl salicylate administered internally is not generally considered so efficient as sodium salicylate, it is asserted that the former

Further, the highly improbable and unsubstantiated claim is made that “the active principle of Cannabis indica” (whatever that may be) “corrects any tendency of the colchicine to irritate the gastro-intestinal tract” and that the “appropriate aromatic adjuvants” “prevent intolerance of the methyl salicylate.”

Colchi-Sal is put up in a way to appeal to the public; the bottle has the name “Colchi-Sal” blown in the glass; the label gives full instruction for the use of Colchi-Sal, and also the price, suggesting that the preparation may be freely purchased. Wrapped around the bottle is a circular advising its use in various affections.

The physician who acts on the advice that it is well to “insist on the pharmacist dispensing original bottles ...” of the “little green capsules” actually suggests to his patient the use of this preparation of methyl salicylate and colchicum in conditions in which these drugs may do much harm and in which proper treatment is imperative.

Colchi-Sal is typical of unscientific ready-to-take proprietaries. It was held ineligible for New and Nonofficial Remedies because of its secret composition, viz., the unknown nature of the “active principle of Cannabis indica” (Rule 1); because the circular in the package and the name blown in the bottle constitute advertisement to the laity (Rule 4); because the claim that cannabis indica removes the gastro-intestinal irritation, and the claim of the superiority of methyl salicylate are unwarranted therapeutic claims (Rule 6); because the name does not indicate the presence of the habit-forming cannabis indica, and because of its unscientific composition (Rule 10).​—(From The Journal A. M. A., March 20, 1915.)

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Having voted that Cypridol Capsules be refused recognition, the Council directed that for the information of physicians publication of the following report be authorized.

W. A. Puckner, Secretary.

Cypridol Capsules, sold by E. Fougera & Co., New York, are stated to be “Bottled in the New York Laboratories of Vial, late Rigaud and Chapoteaut, Paris,” and to contain, in each capsule, 2 mg. (¹⁄₃₂ grain) mercuric iodid (biniodid of mercury) dissolved in a fatty oil. They are claimed to permit the administration of mercury without danger of salivation—​an obvious mis­rep­re­sen­ta­tion.21 Cypridol Capsules are marketed in a way to appeal to the public. If they are once prescribed, the directions on the bottle and the full instructions for the treatment of syphilis by means of Cypridol and by other proprietaries sold by Fougera & Co. is likely to lead the patient to attempt the treatment of this malady on his own accord, and thus probably to forfeit his chances of cure. Cypridol is a vicious example of the “ready-to-take” proprietaries.

Cypridol Capsules are in conflict with the rules of the Council as follows:

Rule 4: The dosage, price, etc., on the label, and the name “Cypridol” blown in the bottle, all tend to a direct self-prescribing by the public. In addition to the objectionable statements on the bottle itself, the preparation is put up in patent medicine style and is accompanied by a circular giving full directions for the use of this and of other proprietaries for the treatment of syphilis in all of its stages. The circular states that “a 1 per cent. solution of bin-iodide of mercury in an aseptic oil” is “An Improved Specific in the Treatment of Syphilis,” and after lauding the virtues of Cypridol, gives full directions for the treatment of syphilis in its various stages by means of Capsules of Cypridol augmented, during periodical cessation of treatment, by “small doses of iodide of strontium (Paraf-Javal’s standard solution, thirty grains to the ounce).” Further, the circular expounds the need of “a toning up of the general system” and by means of obsolete theories and obviously untrue assertions recommends “Chapoteaut’s Wine [another of their proprietary preparations], each ounce of which contains 10 grains of phospho-glycerate of lime. This is a delicious, nutritive tonic. A pint bottle costs $1.00.”

Rule 6: Whereas it is evident that Cypridol, depending for its effects on mercuric iodid, the ordinary well-known hydrargyri iodidum rubrum of the U. S. Pharmacopeia, must naturally have the properties of a mercuric compound, unwarranted claims such as the following are made:

Rule 8: The non-informing name “Cypridol” for a mercuric iodid preparation is bound to lead to its use without consideration of the fact that a potent mercury preparation is being used, requiring a careful adjustment of dosage, a consideration of the needs of the individual case, a correct diagnosis, etc. While the advertising propaganda argues that “physicians recognize the advantage of prescribing this solution of mercuric iodide in an aseptic oil under the name of ‘Cypridol,’ because it does not betray to the laity the fact that mercury is being used,” not only the physician but also the patient has a right to know, and ought to know, the potent character of the remedy which is being administered.

It is recommended that Cypridol be refused recognition and that publication of this report be authorized.​—(From The Journal A. M. A., Dec. 19, 1914.)

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Cystogen is the therapeutically suggestive name applied to hexa­methylen­amin by the Cystogen Chemical Company. While investigation has shown that hexa­methylen­amin yields formaldehyd only in the presence of an acid and consequently can produce an antiseptic effect only in the gastric juice and in the urine, it is claimed that Cystogen is an “intestinal antiseptic” and that it “bears its disinfectant and antitoxic qualities into well-nigh every important bodily cavity.”

As the sale of a simple drug even with the aid of the most extravagant claims probably did not offer sufficient opportunity for an extensive proprietary propaganda, the Cystogen Company has put out two other preparations, Cystogen Aperient and Cystogen-Lithia, and finds it an easy matter by means of extravagant claims, unwarranted assertions and pseudo-scientific arguments to recommend the use of one or another, or often all three, in a well-nigh endless number of diseases.

As the continued patronage of the medical profession cannot be relied on for proprietaries of this sort, the Cystogen Chemical Company takes good care that every Cystogen prescription is likely to spread the Cystogen gospel among the people. The Council has directed publication of its report on the Cystogen products to call attention to the way in which a simple drug of established value may be made the basis of an extensive proprietary propaganda. A conservative discussion of the action of hexa­methylen­amin appears in the Council’s publication, “Useful Drugs.” The Council therefore refused recognition to Cystogen, Cystogen Aperient and Cystogen-Lithia.​—(From The Journal A. M. A., Dec. 12, 1914.)

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Cysto-Sedative is sold by Strong, Cobb and Company, Cleveland, Ohio, with the claim:

The therapeutically active constituents of arbor vitæ, pichi, saw palmetto and couch grass have never been isolated—​indeed, it has not been proved that all of these drugs contain any therapeutically active constituents. Yet the absurd claims are made that all inert matter has been eliminated and each lot of drug used in the preparation of Cysto-Sedative is “tested in reference to its medicinal activity.” Equally preposterous is the claim:

Some other extravagant claims made for this complex unscientific mixture are:

The Council voted that Cysto-Sedative be refused recognition.​—(From The Journal A. M. A., Dec. 12, 1914.)

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Some time ago it was decided that a reexamination should be made of Taka-Diastase and Liquid Taka-Diastase, both of which had previously been rejected, to ascertain whether or not the preparations were in accord with the claims made for them by the manufacturers. Accordingly, the matter was referred to a committee of the Council, and an examination of specimens of these two preparations bought in the market was made. The referee’s report, which appears below, according to the usual procedure, and before final confirmation by the Council, was first submitted to the manufacturers of Taka-Diastase for comment. The report recommends that the rejection of Taka-Diastase and Liquid Taka-Diastase be allowed to stand, and that the report be published. Parke, Davis & Co., in their reply, which is given in full below, claim that the report is unjust concerning Liquid Taka-Diastase, because the period of activity of the preparation has been greatly prolonged by reducing the amount of alcohol from 18 per cent. to 10 per cent. and by adding glycerin. They reiterate their claims for the digestive power of Taka-Diastase, but admit that it will not reduce the stated amount of starch to the colorless end-point in ten minutes (the standard method for the valuation of diastase). They further state that they would change the word “digest” on the label to “liquefy.”

The conclusion of the report having been questioned, the entire matter was referred to a member of the Council’s staff of clinical consultants. His report, which, also, is given in full below, states that the material before him was sufficient to decide the matter, and no further tests were necessary. He concludes that the claims of the manufacturers regarding the strength and properties of the material are erroneous and exaggerated; that the literature still sent out by Parke, Davis & Co. is misleading; and that if substitution of the word “liquefy” for “digest” were endorsed by the Council confusion would result which would give an exaggerated and false value to Taka-Diastase. He therefore recommends that the report of the reinvestigation of Taka-Diastase be accepted by the Council and published.

This report of the second referee was referred to Parke, Davis & Co. with the request that they state more definitely the actual amylolytic strength of their preparations. To this they replied that they had no desire to discuss the subject further, or to make any additional statements.

In accordance with the second referee’s recommendations, the Council confirmed its provisional action and voted that the rejection of Taka-Diastase and Liquid Taka-Diastase be allowed to stand, and that the report which appears below be authorized for publication.

W. A. Puckner, Secretary.

REFEREE’S REPORT ON TAKA-DIASTASE AND LIQUID TAKA-DIASTASE

Following is the report of the committee to which was referred the reexamination of Taka-Diastase and Liquid Taka-Diastase:

Some time ago a comparison was made of the various methods proposed for the valuation of preparations claimed to have amylolytic power. This work was reported in The Journal,22 and the method proposed for the testing of diastase preparations now appears in New and Nonofficial Remedies.23 In view of the incorrect and exaggerated claims made for Taka-Diastase, the Council in 1908 was obliged to rescind its acceptance and to direct its omission from New and Nonofficial Remedies. The report contained the following reference to Taka-Diastase (Parke, Davis & Company), a product that had been accepted for inclusion with New and Nonofficial Remedies:

“The widest discrepancy between the values as claimed by the manufacturer and those found by actual tests seems to be shown in the case of Taka-Diastase. The liquid preparation has been tested a number of times in different samples and has always been found weak. Some samples, in fact, were quite inert. This ferment appears to lose strength very rapidly in solution, as the manufacturers now concede. The stability of the solid product is also far from satisfactory, and appears to be less than that of the ferment as marketed some years ago. The two samples examined recently were weak.”

More than three years have now elapsed since the publication of the Council’s findings regarding Taka-Diastase—​sufficient time, it is believed, for the manufacturers to modify either their claims or the product itself, and thus again make it eligible for inclusion with New and Nonofficial Remedies. With this idea in mind new specimens of Taka-Diastase and Liquid Taka-Diastase were purchased from a Chicago drug house and the preparations reinvestigated. The following is the report of this reinvestigation.

REPORT OF THE REEXAMINATION

In our report on the diastase preparations three years ago, it was recommended that Taka-Diastase be removed from New and Nonofficial Remedies, because the examinations showed that it did not have the digestive strength claimed for it. This was true both for Taka-Diastase itself and for Liquid Taka-Diastase. So far as the latter was concerned, the starch-converting power was practically nil in those preparations which had been in the drug stores for some months.

During the last few weeks new tests have been carried out with several samples of the Taka-Diastase preparations and the results obtained are essentially the same as those obtained in the former examinations. The liquid preparation is still extremely weak in starch-converting power, while we found that Taka-Diastase itself would convert only 16.6 parts of pure anhydrous starch to the colorless end-point in ten minutes, as explained below.

In our method of experimentation we determine the weight of the diastase in question which will convert a given weight of starch in uniform paste to the so-called colorless end-point in ten minutes, that is to the point where it will no longer give any color reaction with a standard iodin solution. The standard starch weight in 50 c.c. always is 1 gm. or 1,000 mg. and to a series of flasks containing this amount of starch, maintained at a constant temperature of 40 C., the diastase dilutions are added. These diastase dilutions are made by dissolving small, accurately weighed amounts of the sample in some small, constant volume of water, usually 5 or 10 c.c. and they are then poured into the starch flasks at the right temperature, and agitated regularly.

Tests are made by taking a few drops from each flask and mixing with the iodin solution. The end-point is reached when a dilution is found which, at ten minutes from the mixing time, gives no color with the iodin reagent. The first set of tests is taken as a general guide, and quite accurate results may be obtained in a second set of dilutions.

We first used a sample of Taka-Diastase bought in the open market. It was found that 140 mg. were required to convert the gram of starch as explained. This is equivalent to a conversion of 7.14 parts of starch by 1 part of the Taka-Diastase.

A new, and possibly fresher, sample was then obtained and the test repeated. With this new sample it was found that 60 mg. were necessary to convert the gram of starch to the colorless end-point in ten minutes, from which it follows that 1 part of the ferment will convert 16.6 parts of starch to the colorless end-point in the same time. With a new sample of Liquid Taka-Diastase obtained simultaneously it was found that 3.5 c.c. were necessary to convert 1 gram of starch to the colorless end-point in ten minutes. As a fluidounce of this liquid is said to contain 20 grains of the solid it will be seen that the results approximately agree with those of the first sample of the solid, and that they are both very low.

In the earlier tests 16 parts of starch converted by 1 part of the ferment was the value found. These results are in close agreement with values reported by Sherman (Jour. Am. Chem. Soc., xxxii, 1073) for a sample of recent purchase. He found a conversion of 51 parts of starch to the colorless end-point in thirty minutes for one sample, while for another he found 66 parts, in the same time. It will be noted that our time limit is ten minutes. It is worthy of note that for a perfectly fresh and specially prepared sample furnished by Dr. Takamine, a conversion of 278 parts in thirty minutes was found by Sherman. Taking the time into consideration, it will be seen that the results are about the same for the market samples as those found by us and much lower than claimed, as well as much lower than for other makes of similar products. The difference in the behavior of fresh specially prepared Taka-Diastase and the market sample is very clearly shown. No one questions the fact that fresh laboratory samples of Taka-Diastase may show a moderate converting power on starch. But we have to deal with the activity of market samples only, and Sherman’s work and our own show the low digesting power of the product as physicians may secure it on the market.

The marked difference in activity between perfectly fresh and ordinary market samples of Taka-Diastase is very clearly shown also in a recent paper published by Wohlgemuth.24 In the digestion of starch paste to the “dextrin” stage Wohlgemuth found in the commercial sample a strength approximately a hundred times less than that observed in a fresh sample sent him by Dr. Takamine.

Wohlgemuth’s results were obtained by a method not essentially different from ours, with this difference, however, that he digested through 24 hours in the cases reported, and carried the reaction to the “dextrin” stage only, in place of to a colorless end-point. Making the proper reductions, it is evident that the actual values found by him for the market samples bought in Germany are not greater than those reported by us.

The reference to the work of Sherman is made because, in a following paper in the same journal, he recommends the use of salt as an activator in finding the strength of certain diastase preparations. It is well known that dialyzed diastase preparations and starch of highest purity have but slight action on each other; a little salt increases the activity greatly, and also increases the activity of commercial diastase preparations. These facts Sherman utilizes in working out a method for valuation of commercial diastases. The facts were well known to us at the time of our former report, but it was not thought best to depart from the general method which had been in use by all analysts following the general scheme of Roberts. Quite recently, I. Bang has published a paper on the investigation of diastase (Biochem. Ztschr., xxxii, 417) in which he studies the behavior of sodium chlorid and other salts on the rapidity of starch conversion, and finds that a much smaller amount of salt than Sherman recommends brings the maximum increase.

The method employed in our former tests is a good comparative method, and this is all that may be claimed at present for any method. By adding salt to our starch solution the activity of Panase and other ferments is likewise greatly increased. For Panase, a preparation possessing rather high starch-converting power, we have recently found an increase of about 30 per cent. in the converting power, with salt present. Working to loss of blue color, merely, it is possible in this way to get a higher value than that claimed by the manufacturer. There is no practical gain in using the salt for our purpose as the methods are at best arbitrary, and the results only comparative.

Taking all the facts into consideration, it is recommended that the rejection of Taka-Diastase and Liquid Taka-Diastase be allowed to stand and that, in view of their extensive exploitation, this report be authorized for publication so that physicians may know the facts.

This report was referred to Parke, Davis & Co., and they made the following reply:

“The report submitted in your letter of the 23d is, we contend, erroneous and unjust: first, to our Liquid Taka-Diastase, because over three years ago we changed our formula, reducing the alcohol from 18 per cent. to 10 per cent., increasing the glycerin and thus prolonging greatly the period of activity.

“As for our regular Taka-Diastase, our claim is and has been for years simply that Taka-Diastase will digest or hydrolyze 150 times its weight of starch in ten minutes, under proper conditions. We do not claim, we do not permit our representatives to claim, that Taka-Diastase will completely transform starch, to the colorless end-point, into sugars. Taka-Diastase is used to supplement a deficiency of ptyalin and converts the starch into soluble material with great rapidity, thus giving the gastric fluid immediate access to the proteids.

“If in the enclosed labels the word ‘digest’ were replaced with the word ‘liquefy,’ the claim could not be assailed by the most carping critic. To save any possible question, we shall therefore make this change in our label, having it read: ‘Taka-Diastase will liquefy 150 times its weight of starch in ten minutes, under proper conditions.’ Is there the slightest question in your mind that this statement as just quoted is entirely correct and entirely supported by clinical experience?

“It is our conviction that Taka-Diastase has a very remarkable power to hydrolyze starch either in the test-tube or in the stomach, and that this property is of great utility in clinical work. We do not claim that its conversion of the starch into sugars is complete, to the colorless end-point of the Johnson test; and on this point we have been perfectly frank with the Council, as well as with every physician who has taken sufficient interest to inquire.”

In view of the above protest, the matter was submitted to a second referee, who reported as follows:

“Your referee on the matter of Taka-Diastase has made a careful investigation of the reports and correspondence submitted, and begs to make the following report:

“The question at issue, viz., whether Taka-Diastase should be included in New and Nonofficial Remedies, I believe, can be determined by the material before me, and further tests of the material are not necessary.

“The letter of the makers of Taka-Diastase admits that the early claims regarding the strength and properties of the material were erroneous and exaggerated. Since the product was once admitted to New and Nonofficial Remedies, it may be claimed that as the Council on Pharmacy and Chemistry must have been in error then, it may be now. Your referee does not consider this supposition worth discussing. The conclusion he draws is that the Council was too hasty in accepting the preparation, and that the incident shows how much better it would be in all cases to accept no remedy until sufficient time has been given for conclusive tests.

“The literature still sent out by Parke, Davis & Co. regarding Taka-Diastase is misleading and of a kind more appropriate for a nostrum than a standard chemical substance. What would we think if morphin, quinin or even heroin were advertised in the same way? I cite the statement, ‘Taka-Diastase digests starchy food with vigor and directness.’ It seems to the referee that the proposition to modify the label to indicate the amount of starch which is liquefied rather than the amount which is saccharified, in accordance with the Council’s standard, is bound to lead to confusion and to give an exaggerated and false value to Taka-Diastase.

“Your referee recommends that the report of the reinvestigation of Taka-Diastase which has been submitted to me, be made available to the medical profession, and that the rejection of Taka-Diastase and Liquid Taka-Diastase be allowed to stand.”

This report of the second referee was submitted to Parke, Davis & Co., with the request that they state more explicitly their claims regarding the activity of Taka-Diastase and Liquid Taka-Diastase, in order that, if they decided to revise their claims for the preparations, such revision of claims might be published along with the reports of the Council. They replied:

“Answering your note of the 15th instant: We have no desire to discuss further the subject of your letter of February 24, or to make any statement beyond that set forth in our letter to you of Dec. 27, 1911.”​—(From The Journal A. M. A., July 6, 1912.)

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Digalen is a proprietary said to contain a soluble form (digitoxinum solubile Cloetta) of digitoxin, the chief active principle of digitalis. This preparation was accepted25 by the Council in 1909 for inclusion in New and Nonofficial Remedies. The Council had not at that time determined whether Digalen contained “soluble amorphous digitoxin,” as claimed, or not. The product was accepted merely as a standardized soluble and fairly stable digitalis preparation.

After the acceptance of Digalen, the therapeutic claims made for it by the manufacturers increased in extravagance. Meanwhile, evidence was brought forward by various independent investigators which tended not only to show that these therapeutic claims were unfounded, but also to discredit the claim that Digalen contained a principle chemically identical with digitoxin. In view of the obscurity of the whole subject of the chemistry of the digitalis principles, the latter claim (that Digalen was a solution of “amorphous digitoxin”) had been an academic issue at the time of the acceptance of the product. When, however, the manufacturers of Digalen sought to mislead physicians by increased and unwarranted therapeutic claims, the Council felt that investigation of the whole matter was imperatively demanded to decide whether or not Digalen should be retained in N. N. R.

The questions at issue were: (1) the presence in Digalen of “amorphous digitoxin”; (2) the constancy of composition and reliability of action of Digalen, and (3) the claim that it causes less gastric disturbance than digitoxin. No satisfactory proof has yet been offered that Digalen contains “amorphous digitoxin.” The mass of evidence tends to show that Digalen is not constant in composition or reliable in action, and that, when given in doses corresponding in therapeutic activity, Digalen causes quite as much gastric disturbance as the official galenical preparations of digitalis.

The outcome of protracted negotiations between the Council and the Hoffmann-La Roche Chemical Works may be summed up as follows: 1. The manufacturers promise to hold in abeyance the claim regarding the presence of “amorphous digitoxin.” 2. They refuse to concede the variable composition of Digalen. 3. They reassert the claim that Digalen is superior to other digitalis products with respect to liability to cause gastric irritation and consequent vomiting.

In view of the unsatisfactory character of the reply on the second and third points, the Council voted that Digalen be omitted from N. N. R. and that publication of the report on Digalen which appears below be authorized, as well as of the two reports26 (A and B) referred to therein.

W. A. Puckner, Secretary.

Because of persistent conflict with Rule 6 (unwarranted therapeutic claims) and Rule 1 (composition) it is recommended that Digalen be omitted from New and Nonofficial Remedies; also that a copy of the report be sent to the manufacturers, and that publication of this report and the two previous reports submitted to the Council be authorized.

The nature of the problems involved necessitates a somewhat extended discussion of the subject.

Digalein (liquid) is said to contain 1 part of soluble amorphous digitoxin Cloetta in 1,000 parts of glycerin and 1,600 parts of water with 7.5 per cent. of alcohol. One c.c. is said to contain 0.0003 gm. of the amorphous digitoxin.

Digalen was accepted by the Council27 and the following footnote was appended to the description in New and Nonofficial Remedies:

Tablets of Digalen were accepted by the Council as a dosage form of Digalen. Each tablet is said to represent 0.5 c.c. (eight minims) of Digalen (liquid).

One of the principal considerations which led the Council to accept Digalen was that it was regarded as affording a fairly constant and stable preparation of digitalis suitable for intravenous administration. If Digalen is not fairly stable and of fairly constant composition it has no obvious advantage over an active soluble digitalis preparation, such as digitalein.

The evidence now at hand seems to show: 1. Digalen is not of constant composition or activity. 2. The manufacturers, or their agents, continue to make misleading statements. 3. It is merely a solution of certain digitalis principles, probably of digitalen mainly, in impure form.

COMPOSITION

Cloetta28 prepared a soluble amorphous substance which he called “Digitoxinum solubile Cloetta,” but no information concerning the method of preparation has been published.

Cloetta reported the result of an elementary analysis of his product which he compared to the analyses of digitoxin (crystalline) made by Schmiedeberg and by Kiliani, and stated that there could be no doubt concerning the chemical identity of the two substances.

Kiliani29 characterized as preposterous Cloetta’s claim that the active constituent of Digalen is chemically identical with digitoxin and stated that Digalen was merely an impure digitalein. Kiliani has recently reiterated the statement that the so-called “amorphous digitoxin” is not identical with digitoxin.30

Cloetta’s failure to publish his method of preparing Digalen places an additional burden of proof on him (or the manufacturers of Digalen), concerning the identity of the product, and in the face of Kiliani’s denial of the correctness of Cloetta’s contention we must have strong corroborative evidence of Cloetta’s claim before we can accept it as being established.

The difficulties of dealing with the chemistry of digitalis are so well known that they hardly require further mention here, but under the circumstances Cloetta cannot be considered as being wholly unprejudiced, and, while the same might perhaps be said of Kiliani, such evidence as can be deduced tends strongly to support Kiliani’s view, and to disprove the contention of Cloetta.

There is much confusion regarding the names which have been applied to the various principles obtained from digitalis, and while it is undesirable that an established name should be given to a newly discovered principle, one might overlook this if no effort were made to associate the therapeutic actions of the two substances to an extent which the truth did not justify.

While the Council at that time did not challenge the existence of “amorphous digitoxin” and made no attempt to determine the identity with digitoxin of the substance forming the basis of Digalen, the manufacturers of Digalen have sought to show that Digalen and digitoxin were identical so far as their therapeutic actions were concerned, but that Digalen lacked the disadvantages of digitoxin. What was a purely academic question when the acceptance of Digalen was under discussion by the Council becomes a matter of very great practical importance when the manufacturers of Digalen seek to mislead the physician by these claims.

The evidence which lends support to the view that Digalen and digitoxin are wholly dissimilar may be summarized as follows: Digalen differs greatly in its physical properties from digitoxin and in certain of its physiologic actions, as the manufacturers themselves state, Digalen being amorphous, and soluble in water, while digitoxin is crystalline and insoluble in water. The manufacturers state that Digalen differs from digitoxin in certain of its physiologic actions, but the two substances do indeed differ far more than they admit.

Cloetta and the manufacturers of Digalen lay especial stress on the claim that Digalen is cumulative to a far less extent than digitoxin, and that it has far less tendency to cause gastric disturbance than the latter. The first of these claims is true; the second is the very opposite of the truth, as we shall show.

We know nothing of the structure of any of the digitalis principles, and even though one were to admit (purely for the sake of argument) that Digalen and digitoxin were chemical isomers, that fact could not be taken to lend any support to the contention that the two substances were identical, in the face of the established fact that they differ physically and physiologically in nearly every particular, and agree only in that they both cause standstill of the heart in the same way—​an action possessed also by so dissimilar a substance as barium.

The manufacturers of Digalen support the claim of the identity of their product with digitoxin by stating that “Digalen is a solution of the most active glucoside of digitalis.”31 Of course, it is very generally admitted that digitoxin is the most active principle of digitalis, though there is some question concerning its glucosidal nature.

Digalen is in fact far less active than digitoxin, as has been shown by a number of independent observers[M] (Worth Hale, 1910; Hatcher and Brody, 1910; Neave, 1907; Miller, 1908; the referee; Weis, 1912).

The essential fact which appears from the investigation of Weis is that Digalen did not behave like digitoxin in any case.

Hale also found that Digalen gave atypical actions in which the effects on the central nervous system became prominent. The referee can corroborate these observations of Hale’s on frogs, but the convulsive symptoms were prominent with some specimens of Digalen on mammals, though not with others, the more recent specimens of the preparation showing the action prominently.

The results of all these biologic tests, as well as of the physical tests made by Weis, certainly lend no support to the contention of Cloetta that the potent constituent of Digalen is identical with digitoxin, but, on the contrary, they show conclusively that the two substances differ widely in many essentials, and the continued claim of the manufacturers that the “amorphous digitoxin” said to be contained in Digalen is the same as digitoxin, or that it is the most active glucosid of digitalis, can be considered only as misleading, and therefore in conflict with the rules of the Council.

CONSTANCY OF COMPOSITION AND ACIDITY

The manufacturers of Digalen continue to claim that it is of constant and uniform activity,32 and they imply this even when they do not state it in those words; for example, a substance cannot be considered reliable if it is variable in activity. “Digalen is Absolutely Reliable. It is Standardized and consequently always uniform. It does not produce gastric disturbances.”

That the foregoing is absolutely untrue can be shown abundantly. Hale33 found digalen not to be uniformly stable; Weis found very different degrees of activity for Digalen in the liquid and tablet forms, the tablets being but one-third as active as the liquid, and the referee found very great variations in the activity of different specimens of Digalen, one specimen being almost inert. The results obtained by Miller show that Digalen is sometimes very slightly active, or not at all so.

The foregoing citations show conclusively that Digalen is not of uniform activity. When reliability is claimed for Digalen in contrast to the known variability of digitalis, it must be considered as tantamount to the claim that Digalen is not subject to such variability and it must be held that the manufacturers make misleading statements when they assert that Digalen is absolutely reliable.

The manufacturers claim that Digalen does not produce gastric disturbances (see advertisement cited).

It is quite true that when small doses of Digalen are used therapeutically it fails to produce gastric disturbances because it is of such slight activity, as previously stated, but when it is used in amounts which correspond in activity to such doses of the ordinary galenical preparations of digitalis as commonly cause nausea and vomiting it does cause gastric disturbances quite as readily as the latter.

Among the clinicians who have found that Digalen causes gastric disturbances may be cited: Veiel,34 Mueller,35 Eichhorst36 and Teichmann.37

Eggleston and Hatcher38 compared the emetic and cardiac activity of Digalen and numerous other digitalis bodies and preparations and found that the emetic activity of Digalen was decidedly greater in proportion to its cardiac (or therapeutic) action than was that of digitalis or digitoxin.

In the absence of any evidence to controvert this clinical and experimental evidence, the continued claim that Digalen does not disturb the stomach must be looked on as deliberate mis­rep­re­sen­ta­tion.

MISLEADING THERAPEUTIC CLAIMS

The recommendation that Digalen be dismissed from N. N. R. is made with the full appreciation of the fact that the manufacturers of Digalen and their agents have repeatedly stated that they desired to comply with the rules of the Council, and that they have withdrawn several statements to which the Council has taken exception, but the fact remains that despite these reiterations the advertisements of Digalen continue to embody statements which the Council can only consider misleading.

The Council believes that the following advertisements constitute gross therapeutic exaggerations:

Digalen is not a sheet anchor in pneumonia, for there is no drug deserving such a title. Digalen has no action which other digitalis preparations lack, and cannot save lives otherwise hopelessly lost. The dosage of Digalen cannot be controlled any better than that of other digitalis preparations, since its activity is variable. We cannot control the myocarditis of advanced tuberculosis by this or any other means.

CLAIMED SUPERIORITY

Various digitalis principles, including digitoxin, digitalin (true) and digitalein, have been known for many years. Therapeutically they have been found wanting and there appears to be no basis for the continued claim that Digalen has any superiority over these several digitalis principles. On the contrary, the evidence is accumulating that Digalen has no advantage in any particular over a solution of digitalein, and misleading claims of the manufacturers and their agents certainly interfere with the formation of that calm and unbiased opinion on the part of the general practitioner, which, when applied to the non-proprietary digitalis principles has caused them to fall into disuse.​—(From The Journal A. M. A., Sept. 5, 1914.)

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A preparation called Dioradin was placed on the market as a cure for consumption three years ago in Europe and somewhat later in this country. It was first submitted to the Council in July, 1911. Because of the manifestly unwarranted claims made for its use in the treatment of tuberculosis, the Council voted that the product be refused recognition for conflict with Rule 8, without at that time taking under consideration the question whether or not it was in conflict with other rules of the Council.

In June, 1912, further consideration of Dioradin was requested. The American agent having promised a reform in the methods of advertising, the Council considered the available evidence regarding the identity and value of the preparation. Examination of evidence regarding the composition of Dioradin—​claimed to consist of radium chlorid, iodoform and menthol in an ether-oil solution—​showed serious discrepancies as to the amount of radium as well as to the identity and amounts of other constituents. It was further found that the experimental evidence was insufficient and biased. Then, too, in view of the difficulty of judging the effects of medicines in tuberculosis, the clinical data were unconvincing. There was nothing to prove that the reported improvements, even if they actually occurred, were to be ascribed to the mixture as a whole rather than to any one of its constituents.

As a result of these findings, the Council voted that Dioradin be refused recognition and that the publication of these facts be authorized. In accordance with its regular procedure, it also submitted the report to the agent. In reply the agent submitted evidence which showed that he was not responsible for the misstatements about Dioradin but offered no facts that affected the Council’s findings.

The entire matter having been referred to a second referee, minor modifications of the first draft of the report were authorized. Since then the Dioradin Company has submitted two reports of examinations of Dioradin made for the company in Germany showing a higher radium content than that previously found. These reports do not alter the facts brought out in the report of the Council that the composition of Dioradin has been variable, which past variability arouses a feeling of uncertainty or lack of confidence. In view of this the amended report was ordered published and appears below.

W. A. Puckner, Secretary.

FIRST SUBMISSION OF DIORADIN

Dioradin, a preparation for the treatment of consumption originated by Dr. R. de Szendeffy, Budapest, Hungary, was submitted to the Council by Louis Gero, Ltd., New York, with the following statement of composition:

A circular which accompanied the submission stated:

Later these indefinite statements of composition were supplemented by the following:

“In 100 c.c. there are:
1	gr. Iodoform.
5	" Menthol.
10	drops Radium chlorid solution (1 milligr. in 100 c.c. of water).
5	gr. ether.
90	" Oil (ol. amygd. frig. press).”

In a circular contained in the package these claims were made:

In view of the general extravagance of the claims made for its therapeutic action the preparation was rejected without considering other possible conflicts with the rules of the Council.

SECOND SUBMISSION OF DIORADIN

Having been advised of the rejection by the Council of Dioradin the American agency, which in the meantime had become the Dioradin Co., requested further consideration. The Council therefore took up the subject again. After certain typographical errors had been corrected the following was now given as the composition:

“1	gram Iodoform.
5	grams Menthol.
10	drops Radium Chlorid Solution (containing 1 milligram of radium chlorid in 100 cubic centimeters of water).
5	grams Ether.
89	grams expressed oil of almond.
This liquid is put up in ampules containing one cubic centimeter of liquid.”

In support of the therapeutic claims for Dioradin the American agent submitted literature consisting chiefly of articles by Dr. Bernheim of Paris. Before reporting on the requested reconsideration of Dioradin the referee directed the secretary of the Council to point out to the American agent that in the formula given, the amount of non-volatile matter should be about 90 per cent., whereas the report of the Lederle Laboratories which accompanied the request for reconsideration states that but 72.08 per cent. was found in the analysis. In reply the agent stated that he had called the attention of Dr. Szendeffy (the originator of Dioradin) to the discrepancies concerning non-volatile matter and that he felt sure the discrepancy was wholly accidental (sic). In a later communication the agent submitted a statement of analysis from the Lederle Laboratories of a new specimen of Dioradin according to which the amount of non-volatile matter agreed essentially with the amount claimed by the agent.

The referee, having examined the evidence, is of the opinion that the statement of composition is misleading and that the therapeutic claims are unwarranted, thus:

DISCREPANCIES IN RADIUM CONTENT

The chief claims for its therapeutic value are based on the radium content, yet the discrepancies and contradictions, regarding this are serious.

In connection with the reconsideration of this product the agent presented a certificate of chemical examination by the Lederle Laboratories in which the following statement was made as to the radio-activity:

A cursory reading of this paragraph gives the impression that Dioradin possesses fully the amount of radio-activity claimed by its originator, Dr. A. de Szendeffy. This impression is greatly strengthened by the concluding paragraph of the Lederle report, which says:

On inquiry as to the method used by the Lederle Laboratories, in determining radio-activity the agent submitted a further statement of the Lederle Laboratories which describes the gamma ray test by which the determination was made and a radium value equivalent to 0.000041 mg. of radium bromid per capsule was obtained. The report then says:

It is evident that the wording of the reports of the Lederle Laboratories is liable to give the impression that their examination confirms the claims made for Dioradin.

It is further evident from these reports that the amount of radio-active matter has not been definitely ascertained but that it is at the best very small. The unreliability of the claims for radium content of Dioradin was recently shown by Buechner,43 who found a specimen obtained from an apothecary to contain but 1-1,000 of the amount claimed.

VOLATILE AND NON-VOLATILE MATTER

The varying claims regarding the content of volatile and non-volatile matter throw doubt on the entire composition of Dioradin, for if the statement as to these is wrong the rest of the statement regarding composition cannot be given credence.

In the first submission of Dioradin about 89 per cent. of non-volatile matter was claimed but in the report of the analysis by the Lederle Laboratories, which accompanied the resubmission, only about 72 per cent. was found. Later the Lederle Laboratories reported that an examination of a new specimen of Dioradin had shown about 90 per cent. of non-volatile matter. The discrepancies between the composition claimed for Dioradin and that found for the product in the first Lederle report has shown that the agent was quite ignorant of the composition of the product which he was selling.

INDEFINITENESS OF THE IODIN CONTENT

The label on the trade package of Dioradin first submitted to the Council stated that the product contained iodoform; a similar statement was made in the submission of the product; the circular accompanying the first submission stated that “iodin salts” were contained in the product while the iodin content was referred to further on in this circular as “combinations of evasive iodin terpins.” In Bernheim’s papers, which have been used to advertise Dioradin, and which are referred to in the same circular, the iodin compound is called “iode peptonisé,” which, according to information stated by the American agent to have come from Budapest, is to be translated “iodized peptone.” What is the meaning of this confusion? One would naturally suppose that the preparation to be sold in this country contains iodoform in an ether-oil solution while the one used by Bernheim and Dieupart44 was stated to contain an ethereal solution of “iodized peptone.” This is another mystification, for an ethereal solution of any kind of peptone would be a novelty. The matter is of some importance, for Bernheim and Dieupart lay great stress on the difference between “peptonized iodin” and other iodin (loc. cit., p. 333) and of the superiority of ethereal over oily solutions (loc. cit., p. 334). The American agents, however, in the second submission, state that this is all a mistake; that the Dioradin used by Bernheim is the same Dioradin which was submitted to the Council; and that this does not contain, and never did contain, the ethereal solution of “iode peptonisé” to which Bernheim attached so great importance. Bernheim (report to Medical Congress of Lyons) himself has come to the same conclusion; for five months after his first paper he believes that the “special salt of radium” (sic) is the principal agent; so that the “peptonized iodin” must be unimportant, and in a cablegram of July 4, 1912, he now informs the Dioradin Company that the formula was incorrectly given in his first papers “owing to my ignorance of actual composition,” and that all the Dioradin used by him was of the composition stated in the submission to the Council.

While this vindicates the good faith of the American Dioradin Company, it does not clear up the mystery. The question occurs at once: What led Dr. Bernheim to make such positive statements? Was he drawing purely on his imagination? If so, why did his imagination take this peculiar special direction? Or if he did have some reason to imagine the “iode peptonisé,” who supplied this reason? And if, at that time, he was given to understand by Szendeffy, who must have supplied him with the material, that it contained the iodized peptone, how can he be positive at this time, that it did not contain it? Has he actually analyzed the old material?

There is also a further question which needs to be answered. Why has Dr. Szendeffy waited until Dioradin was rejected by the Council before correcting Bernheim’s serious misapprehension, in the meantime permitting the circulation of Bernheim’s paper?

Until these questions have been satisfactorily answered, the element of mystery about the composition of Dioradin cannot be cleared away.

EXPERIMENTAL EVIDENCE

The available experimental evidence regarding “Dioradin” is restricted to some quotations from its inventor Szendeffy, in the paper of Bernheim and Dieupart (p. 334). These, if confirmed, would show that radium alone has practically no effect on cultures of tubercle or colon bacilli; that 0.1 gm. of “iode-menthol” (concentration not stated) checks the growth of the acid-fast organisms; and that this antiseptic efficiency can be nearly doubled by the addition of a little radium. No quantitative data are given, so that it is difficult to judge the accuracy of the observation. Granting that it is correct, it would have little bearing on the therapeutic actions of Dioradin, for there is nothing to show that the effective test-tube concentration is reached in the pulmonary tissues.

It is also claimed that the injection of Dioradin prevents tubercle infection. The referee believes that the Council and the medical profession should hesitate to accept this conclusion without further details; and these would require confirmation by unprejudiced observers.

CLINICAL EVIDENCE

The Dioradin Company submits considerable clinical data in favor of Dioradin. It must be remembered that most favorable opinions have been published, from time to time, about scores of “consumption cures,” which have mysteriously lost their efficiency when their novelty wore away. There is no more reason to doubt the good faith of those who are enthusiastic about Dioradin than of those who have been enthusiastic about other “cures.” There appear to be features in the course of tuberculosis which make the judgment of therapeutic measures peculiarly difficult. It is possible that impartial clinical trials of Dioradin by tuberculosis experts appointed by the Council might facilitate judgment as to the actual efficiency of Dioradin. The referee doubts, however, whether this would advance the Council very much toward the acceptance of the substance. Such an investigation would be so lengthy that it should not be undertaken until the Dioradin Company itself has offered at least presumptive evidence in this direction, especially in view of the adverse report recently made by Cecil Wall.45 Ten tuberculous patients were treated by Wall in strict accordance with the method outlined to him by Bernheim, yet Wall concludes that none of the cases, though treated accurately in accordance with the instructions, can be quoted to justify any of the claims for the therapeutic efficiency of Dioradin. The Council cannot undertake lengthy investigations of this character until it is put in possession of data which would show to its satisfaction that such investigations would probably be fruitful.

CONCLUSIONS

From investigations made, it appears that the claims in regard to the composition of Dioradin have contained vague statements and contradictions which arouse a feeling of uncertainty and lack of confidence. Until this uncertainty is cleared away, Dioradin cannot be considered as complying with Rule 1. The experimental data are insufficient and unconvincing. Some favorable clinical reports have been submitted, but the accuracy of the observations is to be questioned and they are more than offset by the negative results observed by Cecil Wall. As might be expected, other negative results, if observed, have not been submitted and there is nothing in the manufacturer’s claim to show whether the improvement reported is really due to the peculiar mixture called Dioradin or to any one of its ingredients.

It is therefore recommended that Dioradin be not accepted for New and Nonofficial Remedies. In view of the extensive advertising of this preparation and because of the admittedly incorrect statements in the earlier papers it is recommended that publication of this report be authorized.​—(From The Journal A. M. A., Oct. 26, 1912.)

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The Council has voted to reject several non-proprietary articles and has recommended that the reasons for their rejection be given in The Journal; among these is echinacea. The following paper has been submitted by a subcommittee with the recommendation that it be published. This recommendation was adopted.

W. A. Puckner, Secretary.

When this drug was first introduced, it was a typical nostrum, with exaggerations regarding its therapeutic value that were somewhat more gross than usual. It was later adopted by the eclectic school without being freed from the stigmata of its origin. It was also pressed into use as the main ingredient of such proprietary preparations as Echafolta, Ecthol Eusoma, etc. Efforts have been made to get the regular profession to use it in these various forms.

According to J. U. Lloyd (Pharm. Review, vol. xxii, p. 9–14), the introduction of echinacea into eclectic medicine is due to the efforts of Dr. H. F. C. Meyer to increase the sale of Meyer’s Blood Purifier, a secret remedy containing it. The following is a literal copy of the label on this nostrum:

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

These absurd claims of an evidently ignorant man have passed into the more recent proprietary advertising matters and into much of the eclectic writings. Indeed, the seemingly impossible had been attained by even surpassing Meyer’s all-but-all-embracing claims. Not content with endorsing echinacea as a positive and speedy “specific” for rattlesnake bite, syphilis, typhoid fever, malaria, diphtheria and hydrophobia, later enthusiasts have credited it with equally certain curative effects in tuberculosis, tetanus and exophthalmic goiter, and with the power of retarding the development of cancer.

It is worth noticing—although it is not surprising—​that these far-reaching claims have been made on no better basis than that of clinical trials by unknown men who have not otherwise achieved any general reputation as acute, discriminating and reliable observers. No attempt seems to have been made to verify these claims by accurate scientific methods, clinical or otherwise, although this could very easily have been done.

Not one of the eulogistic reporters and exploiters seems to have considered it worth while to determine by the simplest control experiments whether the drug possesses any bactericidal or antiseptic powers whatever. It is therefore not very strange that discriminating physicians have failed to show much enthusiasm. One of the warmest endorsers of echinacea, C. S. Chamberlain (who later became the president of the Eusoma Pharmaceutical Company), complains that he has been unable to interest regular physicians in the remedy. He reviews the statements of previous authors and reports eight cases of infection, only two being acute or extensive, in which he used it with asserted success.

In view of the lack of any scientific scrutiny of the claims made for it, echinacea is deemed unworthy of further consideration until more reliable evidence is presented in its favor.

REFERENCES

Meyer, H. F. C.: Eclectic Med. Jour., 1887; Goss: Chicago Med. Times, 1888; Hages: Eclectic Med. Jour., 1888; Shelly: Medical Gleaner, 1894; Lloyd, C. G.: Eclectic Med. Jour., 1897; Lloyd, J. U.: Eclectic Med. Jour., 1897; Lloyd, J. U.: Pharm. Review, xxii, 9–14; Schnitz, Elsie M.: Wis. Med. Recorder, 1898, ii, 202; White, J. N.: Texas Med. News, 1898, viii, 110–113; Stinson, J. C.: Therap. Gazette, 1900; Hale, E.: Lancet-Clinic, March, 1901; Thielen, B. F.: Echafolta, Its Uses in Dental Surgery, Dental Reg., 1903, vii, 462–465; Gorse, C. A.: New Albany Med. Herald, 1903–4, xxii, 384; Chamberlain, C. S.: Louisville Monthly Jour. Med. & Surg., 1904–5, xi, 219–223; Lancet-Clinic, 1905, M. S., liv, 279–283; Ellingwood, F.: Therap. Gazette, 1905, 3, S., xxi, 298–300; French, J. M.: Med. Brief, 1905, xxxiii, 537; Mathews, A. B.: Georgia Pract., 1905, i, 137–140.​—(From The Journal A. M. A., Nov. 27, 1909.)

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Echtisia (Wm. S. Merrell Chemical Co.), Ecthol (Battle and Co.) and Echitone (Strong, Cobb and Co.) are proprietary preparations each of which is alleged to contain echinacea as its chief constituent. In 1909 the Council examined into the claims made for echinacea. This drug has been claimed to be a “specific” for rattlesnake bite, syphilis, typhoid fever, malaria, diphtheria and hydrophobia. Enthusiasts have credited it with equally certain curative effects in tuberculosis, tetanus, and exophthalmic goiter and with power of retarding the development of cancer. Of course there is no reliable or trustworthy evidence to substantiate these claims. Echinacea is not often prescribed under its own name, but is employed as an ingredient in proprietary preparations mixed with other little-used or obsolete substances. Thus Echtisia is said to contain echinacea, wild indigo, arbor vitae and poke root; Ecthol, to have echinacea and arbor vitae; Echitone, to consist of echinacea, pansy and blue flag. Naturally the manufacturers of such proprietaries make use of all available optimistic reports in promoting their sale, while each manufacturer ascribes special and peculiar virtues to the combination represented in his particular preparation. The Merrell Chemical Company claims that baptisia (wild indigo) is a “destroyer” of devitalizing elements in the blood “a vitalizer of the blood as well”; that thuja (arbor vitae) is a “perfect antiseptic and a generator of vital force in disorganized tissues,” and that a long list of diseases, including diphtheria, syphilitic sciatica and gonorrheal rheumatism, “are all more or less amenable to full doses” of phytolacca (poke root). Strong, Cobb and Co. maintain that Iris versicolor (blue flag) is “one of the most powerful excitants of the biliary, salivary and pancreatic secretions,” and that the “principal sphere of action of Viola tricolor [pansy] is in the gastro-intestinal canal and the skin.”

There is no satisfactory evidence that the claims for any of these substances are any more reliable than those for echinacea. Notwithstanding, Strong, Cobb and Co. claim for Echitone “not only the virtues of its constituent parts, but a wider field and a particular therapeutic value of its own”; Battle and Co., maintain that Ecthol is the “‘Ideal Corrector’ of depraved conditions of the fluids and tissues,” while the Merrell Company urges the virtues of Echtisia in a list of diseases ranging from acne to appendicitis and from gangrene to rattlesnake bite. The Council refused recognition to these three products and directed publication of reports to call attention to the exaggerated, unwarranted and often utterly absurd claims made for these and similar preparations.​—(From The Journal A. M. A., Jan. 2, 1915.)

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Ergoapiol (Martin H. Smith Co., New York) is a mixture put up in capsules, each of which is said to contain

Apiol (Special M. H. S.)	5	grains
Ergotin	1	grain
Oil Savin	1⁄2	grain
Aloin	1⁄8	grain

Examination discloses the fact that, contrary to the claim made, each capsule, instead of containing 5 grains of apiol, really contains some liquid preparation of the type of oleoresin of parsley seed. Ergoapiol is recommended (on the label) for such diseases as “Amenorrhea, Dysmenorrhea and other Menstrual Disorders,” while a circular enclosed in the package contains many suggestions that may be counted on to lead to its indiscriminate and uncritical use.

Ergoapiol is an unscientific, shot-gun mixture of drugs having widely different therapeutic effects. Where the action of parsley is desired, the effects of ergot would ordinarily, be contra-indicated; furthermore, neither aloin or savin would be called for in conditions that demanded the effects of apiol. It would be impossible to predict the action of a mixture of this kind in the varying conditions for which its use is advised by the manufacturers. To combine four drugs of dissimilar action in fixed proportions for the routine treatment of conditions which have little in common except that they involve the female generative organs, is unscientific and absurd. The Council refused admission to Ergoapiol.​—(From The Journal A. M. A., Dec. 12, 1914.)

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The original rules of the Council governing the acceptance of articles have recently been modified, particularly by adoption of Rule 10, which reads:

In view of these modifications, the Council is reconsidering the articles already accepted with the view of determining their compliance with the rules as amended. In line with this the Council reconsidered Erpiol (Dr. Schrader), manufactured by the William S. Merrell Chemical Company, and from the evidence given below concluded that one of the constituents, gossypin, is inert and its use unscientific. The Council therefore voted that Erpiol (Dr. Schrader) be omitted from New and Nonofficial Remedies and authorized publication of the following report.

W. A. Puckner, Secretary.

In consequence of the more thorough scrutiny now given by the Council to the therapeutic value of the remedies admitted to New and Nonofficial Remedies, the Council has reconsidered Erpiol (Dr. Schrader), previously accepted for New and Nonofficial Remedies. Erpiol (Dr. Schrader) is the name applied to capsules containing apiol, ergotin and gossypin, which are sold as an emmenagogue. The first two ingredients have a recognized value in the treatment of diseases of the female generative organs. The third, gossypin, is a preparation from cotton-root bark, belonging to the somewhat indefinite class of pharmaceutical preparations known as resinoids.

Cotton-root bark (Gossypii radicis cortex, U. S. P.) has been credited by some with pharmacologic and therapeutic properties, similar to ergot, especially in its action on the uterus; experiments on pregnant animals do not confirm this view. Most authorities on gynecology either make no reference whatever to the drug or ascribe little or no value to it. The preparations from the dried bark are inert.

From reports made to him, Professor J. U. Lloyd concluded (Eclectic Med. Jour., 1876, xxxvi, 545) that a prime fluidextract of fresh cotton-root bark is an active therapeutic agent and deserving the attention of the medical profession, while that of the dry bark is inert and worthless. The gossypin on the market is made from the dried bark.

Professor Lloyd, who is considered an authority on eclectic medicine, says: “Were it left to me to admit or exclude it, by reason of its therapeutical position, I should exclude it, because, in my opinion, it has never been demonstrated, in clinical practice, to be worthy of any therapeutic recognition whatever.”

As the available evidence indicates that gossypin is an inert preparation, Erpiol (Dr. Schrader) was considered in conflict with Rule 10 and the Council has therefore voted that it be deleted from New and Nonofficial Remedies.​—(From the Journal A. M. A., June 3, 1911.)

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The Council voted to refuse to recognize false unicorn as a non-proprietary article and the following statements, submitted by a subcommittee, were ordered published.

W. A. Puckner, Secretary.

Helonias dioica, or more properly Chamælirium luteum, is a plant, preparations of which enter into various proprietary mixtures for diseases of the female pelvic organs. In the advertisements of these preparations it is usually credited with hemostatic powers and is asserted to be a uterine tonic.

There is practically no reference to this drug in reliable medical literature, and as there is no evidence worthy of credence to support the claims made for it, the drug was not considered deserving of a place in the Pharmacopeia. Hence, it may be regarded as a drug not worthy of attention of physicians.​—(From The Journal A. M. A., Nov. 27, 1909.)

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Formurol, Citrocoll and Aspirophen were submitted to the Council by the Cellarius Company of San Francisco. The manufacturers having failed to substantiate the claims they make for these products, the Council has voted that the preparations be refused recognition. The Council also authorized the publication of the following report, which deals particularly with one of the preparations—​Formurol.

W. A. Puckner, Secretary.

Formurol is the product of the Chemische Fabrik Falkenberg, Falkenberg-Gruenau, near Berlin, Germany. The Cellarius Company, San Francisco, acting as selling agents for the United States, submitted Formurol (along with Aspirophen and Citrocoll, also made by the same firm) to the Council, with the statement that it is “hexa­methylen­tetramin­sodium-citrate,” and that it has the following composition: “C₆H₇O₇Na.C₆H₁₂N₄.”

Zernik,46 who examined these products, reported that Aspirophen, Citrocoll and Formurol do not have the composition that is claimed for them by the Fabrik Falkenberg. Formurol, he states, is not a definite chemical compound, but a mixture of hexa­methylen­amin and sodium citrate. The agents were advised of this fact by the Council and were asked to submit evidence to substantiate their claims. No such evidence was submitted.

Since a compound having the composition that is claimed for Formurol is theoretically possible, the Council requested that the product be examined in the Association Laboratory to determine whether it still was the simple mixture reported by Zernik, or whether, perhaps, it now possessed the formula claimed for it. The following report was made by the Association chemists:

Formurol, as submitted to the Council, was in the form of tablets weighing about 1 gm. each and appeared to be composed of a fine white substance interspersed with some transparent particles. The tablets were readily soluble in water, were odorless and possessed a slightly acid taste. The aqueous solution responded to tests for hexa­methylen­amin, citrate and sodium. To determine whether hexa­methylen­amin was present in the free or the combined state, the method of Zernik was employed. This consists in the extraction of Formurol with chloroform, which dissolves out hexa­methylen­amin, leaving insoluble sodium citrate. As the use of the solvent, chloroform, would seem to preclude decomposition of such a hypothetical compound as “hexa­methylen­amin-sodium-citrate,” the extraction of hexa­methylen­amin from Formurol may be taken to demonstrate its presence in the free state.

That Formurol is not a compound of hexa­methylen­amin, but a mixture of hexa­methylen­amin and sodium citrate, was further indicated by the appearance of the crushed tablets described above. Further, on the low-power microscope the powder was found to be composed of transparent crystals and white opaque particles which appeared to be masses of minute crystals. When treated with chloroform the transparent crystals dissolved, leaving the white masses intact, demonstrating the presence of two distinct substances, one soluble and the other insoluble in chloroform. It having been demonstrated that the residue obtained by evaporation of chloroform could not be weighed as hexa­methylen­amin, due to enclosed chloroform, the amount of this substance in the residue was determined.

The method used has been described in the Report of the Chemical Laboratory of the American Medical Association, Vol. I, p. 55, and depends on the decomposition of hexa­methylen­amin by means of sulphuric acid to form ammonium sulphate and formaldehyd. From this solution the ammonia is liberated, distilled and determined by titration and from the ammonia found the amount of hexa­methylen­amin is calculated. By this method Formurol was found to contain (a) 35.42 per cent. and (b) 35.32 per cent., or an average of 35.37 per cent. hexa­methylen­amin. The residue insoluble in chloroform was shown to consist essentially of disodium hydrogen citrate by determining the amount of sodium (Na) contained in Formurol. The percentage of sodium calculated from the amount of sodium sulphate found was (a) 11.38 per cent. and (b) 11.20 per cent., or an average of 11.29 per cent., equivalent to 62.50 per cent. disodium hydrogen citrate.

As a check on this determination, the amount of material contained in Formurol which is insoluble in chloroform was determined. It was found to be (a) 63.23 per cent. and (b) 63.49 per cent., making an average of 63.36 per cent., and thus agreeing fairly well with the results obtained when the sodium content was assumed to be disodium hydrogen citrate. From this analysis it appears that Formurol is not a definite compound of hexa­methylen­amin and sodium citrate, but instead is a mixture of these substances consisting approximately of hexa­methylen­amin 35.37 per cent. and sodium acid citrate (disodium hydrogen citrate) 63.36 per cent., practically a mixture of 1 part hexa­methylen­amin and 2 parts sodium acid citrate. These results agree with those reported by Zernik47 and show that the product now, as then, is not true to claims.

In view of the findings of the laboratory, it is recommended that Formurol be refused recognition. As the exploitation of well-known remedies under false and misleading names is detrimental to the progress of medicine, it is recommended that publication of this report be authorized.

[Editorial Note: This report illustrates once more the value of the Council on Pharmacy and Chemistry and the Chemical Laboratory to the medical profession. Before the Council was organized there was no agency to protect the physician’s interests in the matter of pharmaceuticals. Under the old régime Formurol would have been heralded as a new “synthetic” of the most approved made-in-Germany type—​and the claims would have gone unchallenged. To-day its status is made clear and the profession is informed. Only those who have closely studied the question can realize what a wonderful power for commercial probity the Council has proved. Under the laissez faire system of the past, many large pharmaceutical firms gave little attention to the accuracy of the claims made for their products. If the advertising gave good “pulling” results, that was all that was asked or expected. Within the past five years a wonderful change has taken place in this regard, and firms of the better class have so modified their advertising as to make it not only conservative in tone, but to approximate scientific accuracy.]​—(From The Journal A. M. A., Jan. 21, 1911.)

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The Bristol-Myers Co., Brooklyn, N. Y., sells Gastrogen Tablets which are described as “A Neutralizing Digestive” to be “used in connection with Sal Hepatica.” Sal Hepatica, it will be remembered, is another product of the Bristol-Myers Company and has been the subject of previous unfavorable comment. The label on a recently purchased package of Gastrogen Tablets contains the following:

While these recommendations sound as if they were addressed to the public, Gastrogen Tablets are advertised in medical publications and hence come within the scope of the Council. Gastrogen Tablets are said to be composed of pepsin, calcium carbonate, calcium phosphate and “aromatics.” As each tablet, according to the label, contains 7 grains of calcium carbonate (chalk), the recommended dosage would in most cases be sufficient to neutralize the gastric fluids in the stomach and would thus tend to prevent the pepsin from exerting its digestive effects. The means adopted to relieve one symptom of dyspepsia, in other words, defeats the action of the means for relieving the indigestion. The fact is that patients who need an antacid do not need pepsin, while those who need pepsin will be harmed by the administration of an antacid. Gastrologists hold that, except in rare cases, the evidence tends to show that wherever there is a sufficiency of hydrochloric acid there is a sufficiency of pepsin. When pepsin is lacking it should be administered along with hydrochloric acid to make it effective. The Council voted that Gastrogen Tablets be refused recognition.​—(From The Journal A. M. A., Dec. 12, 1914.)

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

W. A. Puckner, Secretary.

Glyco-Heroin, Smith (Martin H. Smith Co., New York) is marketed in a showy “patent-medicine” type of package, the label on which announces the presence of ¹⁄₂ grain of heroin to the fluidounce and admits the presence of 3.5 per cent. alcohol, an active ingredient that is not discussed in any way in the literature sent out by the manufacturer.

The composition of Glyco-Heroin, Smith, is given as follows: “Each teaspoonful represents: Heroin ¹⁄₁₆ grain, White Pine Bark 3¹⁄₂ grains, Ammonium Hypophosphite 3 grains, Balsam Tolu ¹⁄₄ grain, Hyoscyamus 1 grain, Glycerin Q. S.” The alcohol is not mentioned in the formula.

The advertising matter says of the merits of the formula:

The absurdity of this assertion will be appreciated on comparing the nature, quantities and activities of the several ingredients. Thus, while heroin, a potent habit-forming drug, is present in unusually large proportions, tolu, an innocuous or comparatively harmless product, is said to be represented by ¹⁄₄ grain, a relatively small quantity, hardly sufficient to impart even a distinctive taste or flavor. Ammonium hypophosphite, in the amount said to be present, may be considered to be practically useless, while the dose of hyoscyamus, an additional narcotic, is fairly large. The white pine bark present is probably as active as would be a corresponding amount of white pine shavings or of turpentine sufficient to give the preparation a slight odor. The vehicle, glycerin, is claimed to be “notably advantageous,” but not a word occurs in the discussion by the manufacturer in regard to the presence of alcohol, which is certainly quite as active medicinally as the balsam of tolu and contributes fully as much to the flavor or taste of the preparation as does the white pine bark.

In prominent type on the outer label of the trade package we are told that the preparation is intended for the treatment of “COUGH, ASTHMA, PHTHISIS, PNEUMONIA, BRONCHITIS, LARYNGITIS, WHOOPING-COUGH AND KINDRED INFECTIONS.” In much smaller type: “Glyco-Heroin (Smith) is distinctly a product designed expressly for the use of physicians.” The circular included with the trade package, however, bears statements which would tend to encourage self-drugging by the layman, and in view of the manner in which the preparation is exploited are undoubtedly intended to do so. For instance:

How cruelly misleading the literature put out by the manufacturer of this nostrum is, will be apparent from a comparison of the rather large dose of heroin in a teaspoonful of the nostrum and the directions on the package that:

A WICKED FALSEHOOD

Included in much of the advertising matter that has been put out is the bare-faced untruth that the preparation does not produce narcotism or habituation. Here is a quotation from an undated circular:

That this assertion is not in keeping with facts is evidenced by the recent report of a study on the sale and use of heroin made by the U. S. Department of Agriculture. From the information gathered it appears that the sales of heroin and heroin-containing preparations have increased greatly, particularly in those states which have rigid laws preventing the indiscriminate sale of morphin and cocain. Investigation of the subject establishes the fact that many drug victims who formerly used morphin and cocain, and who under the new laws find it difficult to obtain these substances, have begun using heroin, the sale of which is not as yet carefully restricted under state laws. The drug is said to be fully as dangerous as morphin, and by many is held to be much worse, for the reason that it occasionally kills the victim outright, and its habitual use is far harder to overcome than that of other drugs.

Phillips,48 in discussing the prevalence of the heroin habit, reports, among others, the case of a physician aged 60 who began to take heroin because he suffered from a chronic cough and thought there was no danger of habit from the use of this drug because he believed the statements of various manufacturing firms who claimed that there was no danger of habit.

In a pamphlet now being distributed to the medical profession, entitled, “Glyco-Heroin (Smith), an exposition of its components together with references to its value in the treatment of Bronchitis, Cough, Cough of Phthisis, Laryngitis, Pneumonia and allied disorders of the Respiratory Tract,” the several alleged uses of the nostrum in the treatment of cough, “Regardless of the nature of its underlying cause,... whether of recent origin or of long duration,” are discussed at length, and eminent practitioners with degrees extending the width of the printed page are quoted in support of the statements made. While it may be permissible for a theoretically trained medical tyro who lays claim to the right of appending the abbreviations M.A., M.D., D.C.L., L.R.C.P. to his name to laud a heterogeneous habit-forming cough-syrup like Glyco-Heroin, Smith, similar testimonials from a man entitled to append Ph.G., M.S., M.D. to his name makes one doubt the value of the training, either scientific, pharmaceutical or medical, that has been given the poor unfortunate who, according to his own statements, in­dis­crim­in­ate­ly doses a female patient of 7 and a male patient of 40 with huge doses of heroin every two, four or six hours.

The danger of contributing to the spread of the heroin habit by the use of preparations of this type is indicated by an editorial in The Journal of the American Medical Association,49 which points out that although heroin and its hydrochlorid have been in use but a few years they have already established themselves among the habit-forming drugs and have become sufficiently conspicuous in this respect to awaken the thinking public to the deplorable results for which they may become responsible. Phillips,49 in the article mentioned above, quotes Petty, who reports that in the last 150 cases of drug habit coming under his care he saw eight cases of heroin addiction. Three of these were initial cases; in one the patient had been cured of the opium habit, but following an operation heroin was prescribed, and the habit followed. The remaining four patients purposely substituted heroin for morphin, to which they had been addicted.

THE GROWTH OF HEROIN ADDICTION

The imminent danger of substituting heroin for either morphin or cocain is shown by the fact, reported by the U. S. Department of Agriculture, that during the early months of 1913 the coroner’s office in Philadelphia County, Pa., held inquests on five sudden deaths from heroin poisoning. In each case the victim was a heroin fiend and took an overdose. Drug fiends are apparently able to consume relatively large quantities of morphin or cocain, but any sudden and material increase in the amount of heroin taken is liable to prove fatal. As indicating the wide sale of this substance, it is known that one druggist in Pennsylvania whose store is located in an undesirable section of his city has been buying heroin tablets in 25,000 lots.

GLYCO-HEROIN, SMITH, A “PATENT MEDICINE”

The popularity of Glyco-Heroin, Smith, as a household nostrum is suggested by the fact that one of the larger department-store type of drug-stores in the city of Philadelphia lists this preparation in its “patent-medicine” catalogue at $1.75 per bottle and sells it freely to all who care to buy. This is due to the fact that Pennsylvania, like many other states, does not include heroin in the prohibited list of habit-forming drugs that can be supplied only on physicians’ prescriptions.

To what extent Glyco-Heroin, Smith, is responsible for developing the rapidly growing heroin habit is of course problematic. It is reasonable, however, to suppose that a preparation, each teaspoonful of which contains so large a dose of heroin as does this nostrum, when taken as repeatedly and as in­dis­crim­in­ate­ly as is directed by the manufacturer, would offer possibilities for harm sufficient in number to induce the thinking medical practitioner to avoid its use altogether and at least to suggest to even the most commercial dabbler in the healing art the desirability of carefully considering its potency for harm before endorsing its use in the treatment of “cough and kindred affections.”​—(From the Journal A. M. A., June 6, 1914.)

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The Council, having voted that Glyco-Thymoline be refused recognition, authorized publication of the following report.

W. A. Puckner, Secretary

Glyco-Thymoline (Kress and Owen Company, New York) is a typical example of a “patent medicine” advertised to the public through the doctors. Bottles of the mixture with the name blown in the glass are issued to physicians for distribution to patients, and the circular which comes around the bottle more or less directly recommends it for use in almost every form of infectious disease.

COMPOSITION AND VARYING FORMULAS

Different formulas for Glyco-Thymoline have appeared. At one time it was said to contain:

Another formula, which appeared about the same time, was:

A later formula was like the second except that it included “Menthol, 0.08.”

Analysis in the chemical laboratory of the American Medical Association showed that Glyco-Thymoline contained borax, but no boric acid; sodium salicylate, but no salicylic acid; sodium benzoate, but no benzoin; the compound benzo-salicyl. sod. could not be determined, but a mixture of sodium benzoate and sodium salicylate was demonstrable.50 Later Puckner pointed out51 that while such a combination as benzo-salicylate of sodium is known, it could not possibly be present in Glyco-Thymoline because the alkalinity of this mixture would decompose the compound. As the manufacturers evidently recognize that false formulas can no longer be made plausible, only vague statements as to the composition are now offered.

Two points should be noted in this connection:

1. Glyco-Thymoline conflicts with Rule 1 of the Council on Pharmacy and Chemistry, which declares that no article shall be accepted for inclusion with New and Nonofficial Remedies unless its composition be furnished.

2. No matter which published formula be accepted as correct, it is at best a weak antiseptic. The antiseptic ingredients present cannot act as germicides in the strength in which they are used, or in the alkaline solution on the unique virtues of which the circular lays so much stress (“the one antiseptic solution based on the alkalinity and saline strength of normal blood”). As shown by Verhoeff and Ellis,52 undiluted Glyco-Thymoline does not kill Staphylococcus aureus in four hours. It evidently, they say, “could have but little if any greater therapeutic value than sterile salt solution.”

DANGEROUS RECOMMENDATIONS

In Diphtheria: “Case-reports” in the advertising pamphlet describe the treatment of diphtheria with Glyco-Thymoline. It is surely unnecessary to point out that, whatever the possible merits of Glyco-Thymoline or its ingredients, they are utterly irrelevant here. But let a “case-report” be quoted:

Words of denunciation fall flat before the complacent self-revelation of the physician who “decided not to use antitoxin.” Surely if any other physicians have been misguided by this example, there must be many another “interesting story of Glyco-Thymoline” to tell—​not to speak of other families that have been “finished up.”

In Ophthalmia Neonatorum: We gain from the same advertising pamphlet the following information on prophylaxis:

At the very best, Glyco-Thymoline is a weak, a very weak antiseptic—​not a germicide. To assert, or even to imply, that it is superior to the well-tried and efficacious Credé method of treatment for ophthalmia in the new-born is cruelly wicked.

In Consumption: This from the same pamphlet:

It is, instead, an ill-established fiction. To talk about maintaining an “absolutely aseptic” environment under any practical conditions of daily life is to talk nonsense; the thing is impossible, even were it desirable. But, not to be distracted from the main issue by subsidiary falsehoods:

And this is the preparation, it will be remembered—​this “powerful agent for promoting asepsis”—​which, when applied in undiluted strength, was unable to kill Staphylococcus aureus in four hours!

It would be a waste of space to cite further evidence to show that the advertising of Glyco-Thymoline is in conflict with Rule 6 of the Council, which provides that no article shall be accepted “concerning which the manufacturer or his agents make unwarranted, exaggerated or misleading statements as to the therapeutic value.” It is further in conflict with Rule 4, against indirect advertising by means of the label, package or circular accompanying the package.

CLAIMS TO ORIGINALITY

Hatcher and Wilbert have pointed out that from a therapeutic point of view the composition of Glyco-Thymoline is based on the formula of the widely known “compound solution of sodium borate,” or Dobell’s solution. For the phenol in the original, a mixture of antiseptic acids and volatile oils has been substituted.

SUMMARY

Glyco-Thymoline is in conflict with Rules 1 and 4 of the Council on Pharmacy and Chemistry, because of its indefinite composition and the method of advertising it to the public. It is in conflict with Rules 10, 6 and 8, in that it is an unscientific, shot-gun mixture sold under unwarranted therapeutic claims and under a misleading name. Altogether it must be considered an unscientific heterogeneous mixture, in which a few valuable ingredients are hidden by the useless shrubbery which surrounds them.​—(From The Journal A. M. A., Oct. 10, 1914.)

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A number of specimens of Glycozone purchased in the open market were examined by a subcommittee. The product was found to be a mixture of approximately 90 per cent. glycerin, 5 per cent. glyceric acid, a small amount of water and traces of undetermined matter. The absence of hydrogen peroxid or other peroxids was demonstrated.

In its report the subcommittee held that: (1) The name of the product is objectionable and misleading; (2) the statements made in regard to its composition also are misleading; (3) the claims for its therapeutic value are exaggerated and untrue. Since the objectionable statements have been given wide publicity among physicians as well as among the laity, the subcommittee recommended that attention should be called to the matter in The Journal.

The report of the subcommittee was adopted by the Council.

W. A. Puckner, Secretary.

Comment:—While the name gives the impression that ozone or some similar substance is an essential constituent of Glycozone, or else that the preparation is a compound or derivative of ozone, and while the earlier advertisements stated that Glycozone was “glycerine combined with ozone,” the examination made by the Council shows that there is no basis of fact for such inferences.

In the advertisements the “chemical formula” C₃H₆O₄ + C₃H₈O₃ appears under the word Glycozone. From the Council’s report it is apparent that C₃H₆O₄ stands for glyceric acid and the C₃H₈O₃ for glycerin, and that these, therefore, indicate the chief constituents of Glycozone. Few, doubtless, would recognize the first formula as being that of a glyceric acid, a product practically unknown in medicine, nor would many associate glycerin with the second. The evident intent is that physicians should accept the formula as a badge of respectability.

According to the label on a trade package, Glycozone is “prepared only by Charles Marchand, chemist,” and is {“}an absolute cure for dyspepsia, catarrh of the stomach, ulcer of the stomach, heart-burn,” etc. The label further reads: “This remedy is positively harmless. By destroying the microbian element in the stomach it prevents the fermentation of food and stimulates digestion.” An examination of medical literature fails to reveal any basis for these claims. While glycerin possesses some antiseptic properties, it is evident that the glycerin which constitutes 90 per cent. of this remedy is not the agent that gives the glycozone such phenomenal virtues. General literature contains nothing that would indicate that glyceric acid in any quantity, with or without glycerin, possesses these miraculous properties. If by “microbian element” is meant microbic organisms, the statement is without foundation. There is nothing in this product which possesses these bactericidal powers.

The circular which accompanied a trade package envelops the preparation in an air of mystery. Derivation from, or close relation to, ozone and hydrogen peroxid is vaguely hinted at, without definite assertion. Thus, the chief therapeutic properties of glycozone and hydrozone are compared as follows:

There is no similarity between the action of hydrozone, which is a hydrogen peroxid preparation, and glycozone, which consists of a mixture of glycerin and glyceric acid. The representation is false and misleading. The following statement, also, is an unwarranted exaggeration of the facts:

The following is another illustration of the vague statements made: After asserting that Glycozone is hygroscopic and that it will deteriorate by absorption of water unless securely corked, it is stated that “Its healing properties increase with age.” Whatever mysterious ingredient there may be present in this mixture to justify the statement that the healing properties increase with age can only be conjectured. To humbug the patient further, the circular advises him to use only a “silver, glass or hard rubber spoon.”​—(From the Journal A. M. A., June 5, 1909.)

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The following report on Gardner’s Syrup of Hydriodic Acid was submitted to the Council by a subcommittee:

This product was first taken under consideration in February, 1906. Reference to several committees was necessary, on account of the peculiar claims for the pharmaceutical, and especially the therapeutic, superiority of this preparation. At this time, as the Council did not have the necessary facilities for investigating therapeutic claims, the product was approved by the Council.

Since this time, however, the manufacturers have laid especial stress in their advertisements on some highly improbable claims, stating, for instance, that this Syrup of Hydriodic Acid possesses “all the advantages, with none of the objectionable symptoms caused by potassium iodid, or other forms of iodin medication.” To one with even an elementary knowledge of chemistry, the absurdity of this statement should be evident. The alkaline reaction of the tissues makes it impossible that hydriodic acid should persist as such in the body. In fact, the iodin must circulate in precisely the same form, whether administered originally as potassium iodid or as hydrogen iodid. The qualitative identity of the therapeutic actions is further proof of this fact, were such needed.

Since the most important objectionable symptoms of iodid medication arise after the absorption of the drugs, and since hydrogen iodid is conceded to be readily absorbed, it is evident that these symptoms must be equally liable to occur with hydrogen iodid as with potassium iodid, provided that equivalent doses of iodin are administered. An apparent difference in clinical results would arise if one drug were habitually given in smaller doses than the other. Since, however, the iodin is present in the body in precisely the same form, whether it is administered as a hydrogen iodid or potassium iodid, it is evident that a given degree of therapeutic effect would correspond to an identical tendency to iodism, whichever drug was used. If, as appears to be the case, the use of hydriodic acid is commonly restricted to those cases in which only minimal doses of iodin are required, the relative infrequency, or even absence of symptoms with such doses would not prove that the drug itself is less apt to cause them than is the potassium salt.

These facts are in reality self-evident; but since the Council now has proper facilities for obtaining the views and experiences of clinicians, it voted to submit the statement in question to its staff of clinical consultants, and to be guided by their advice.

OPINIONS OF THE CLINICAL STAFF

The following is an epitome of the replies of the eleven members of this staff who had used the article or who expressed an opinion to the questions sent out by the Council:

1. Query: “Do you think it possible that such a preparation could be devoid of the usual effects of iodin preparations?”

Eight reply that they consider this, a priori, impossible; three stamp the statement as highly improbable, but do not care to say that it would be impossible. One of the correspondents remarks: “While distinctly taking the position that under many conditions we must accept clinical results which we find not explainable by our theoretical knowledge, where the conditions are so simple as in this case and where we know that the iodin, whether administered as hydrogen iodid or potassium iodid, must behave in the same way, after absorption, I believe that no properly educated and correct thinking physician can or will, after due consideration, fail to reject the claims of superiority made by the proprietors of this preparation.”

2. Query: “Would you consider it necessary to make clinical experiments to settle this question?”

Seven of the correspondents consider this superfluous; four of these have had some experience with the article. Four, who have not used this product, consider a clinical test advisable. Under Query 3 we discuss the results of such tests.

3. Query: “When using Gardner’s Syrup of Hydriodic Acid, have you ever noticed from it any of the objectionable effects of iodin preparations?”

Six of the correspondents have not used it, or are uncertain whether or not they used the product made by Gardner. One correspondent remarks: “Never used it. Repelled by claims of superiority which exaggerate disadvantages of potassium iodid and overlook the small amount of iodin used in the preparation advertised.” The five clinicians who have prescribed the preparation report as follows: 1. Objectionable iodin effects in two cases, both patients being intolerant of all iodin preparations. 2. Has only prescribed it once or twice, but thinks he has seen iodism in one case, some years ago; does not recall clearly. 3. No; but has used this make very little, and then always in very small but continued doses. 4. No, always used it in small doses. 5. Yes, several cases in children; typical coryza, etc., with doses of three drams three times a day.

Conclusions: It appears that typical iodism occurred in several cases, after doses corresponding to 10 grains or less of potassium iodid per day, and this is a rather limited clinical material. Objectionable iodin effects are, therefore, not uncommon. Several correspondents remark that the relative infrequency of iodism is easily explainable by the fact that syrup is rarely employed in conditions which demand an active iodin medication and that it is, therefore, always taken in small doses. In fact, the main if not the only point of superiority of the syrup appears to be in its flavor.

These clinical opinions and experiences, therefore, are in complete agreement with the judgment of the committee, namely, that the therapeutic claims made by the manufacturers for this article are exaggerated and misleading.

OTHER MISSTATEMENTS

The above is by no means the only misstatement in the printed matter issued by this manufacturer. In the publication, “The Applications of Iodin,” issued in 1907, there occur the following misleading statements which, since they refer to plainly chemical facts, did not require submission to the clinical staff:

That the administration of potassium iodid after meals greatly impairs its physiologic action “by its chemical union with the various food products” (page 19). So far as the committee knows, potassium iodid does not combine with the food products in the stomach.

“Iodid of potassium, having an alkaline reaction, neutralizes the hydrochloric acid in the gastric secretions, causing indigestion, loss of appetite and depression” (page 19). The United States Pharmacopeia states, under Potassii Iodidum: “Its aqueous solution is neutral or has a slightly alkaline reaction on litmus paper.” The slight occasional alkalinity would be physiologically insignificant, and it is absurd to claim that this alkalinity causes “indigestion, loss of appetite and depression.”

“The dose of iodid of iron is so small that the amount of iodin contained therein is of little advantage” (page 19). As a matter of fact, the pharmacopeial average dose (1 c.c.) of the Syrup of Iodid of Iron contains as much iodin (0.85 grains) as a teaspoonful of Gardner’s Syrup of Hydriodic Acid (0.83 grains).

“In hydriodic Acid the iodin is in combination with hydrogen, one of the elements of the natural secretions of the body, and is, therefore, in physiologic harmony” (page 21). No comment is needed.

It is implied elsewhere (page 29) that potassium iodid decomposes more readily, with the liberation of iodin, than does hydrogen iodid. This is contrary to the prevailing opinion, and would require definite evidence before it could be accepted. It is also stated the large doses of potassium iodid in syphilis are necessary, because the gastric decomposition prevents complete absorption. This is certainly untrue, for potassium iodid is absorbed almost quantitatively.

These, and numerous other misstatements, constitute violations of Rule 6; and it is, therefore, recommended that Gardner’s Syrup of Hydriodic Acid be removed from the list of remedies approved by the Council; it is further recommended that this report be published.

The Council postponed final action on the report, pending its submission to R. W. Gardner. This having been done, and the reply of Mr. Gardner submitted to the Council, the above report was adopted and ordered published.

W. A. Puckner, Secretary.

(From The Journal A. M. A., Nov. 14, 1908.)

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The Purdue Frederick Company, exploiters of Gray’s Glycerine Tonic, have recently been advertising to the medical profession a nostrum called Hyperol. The following report to the Council, by the referee, was adopted and its publication authorized.

W. A. Puckner, Secretary.

According to the label, Hyperol is “A Utero-Ovarian Corrective and Tonic.” The circular accompanying the trade package states that it is:

From another circular we learn that:

This “formula” is not very enlightening and a physician who wrote for further details was told that Hyperol contained:

Hydrastin	1⁄40	gr.
Aloin	1⁄12	gr.
Iron salts	3	gr.
Apiol (Special)	3	♏
Ergotin	1	gr.
And excipients.

If this is correct, then, so far as its active ingredients are concerned, Hyperol is but a mixture of well-known drugs, having contradictory properties. According to the claims in the circular quoted above, it is useful both in amenorrhea and in menorrhagia. The mixture is as unscientific as it is unnecessary. It cannot be adapted to any individual case; when ergot is indicated, apiol would naturally be contra-indicated; if aloes is appropriate, hydrastis may defeat the object sought. It is unnecessary because no intelligent physician would prescribe such a combination of drugs in any given case. The claims are exaggerated, improbable and foolish. Hyperol conflicts with the following rules of the Council:

Rule 4, in that statements on the label and in the circular enclosed with the trade package advertise it to the public in the treatment of diseases.

Rule 6, in that exaggerated and unwarranted claims are made for its therapeutic qualities.

Rule 8, in that the name of this pharmaceutical mixture fails to disclose the potent constituents.

Rule 10, in that it is unscientific.

It is recommended that publication of this report be authorized to call attention to the unscientific character of such complex mixtures.

[Editor’s Note: Hyperol is advertised in American Medicine and the St. Paul Medical Journal.]​—(From The Journal A. M. A., April 18, 1914.)

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A subcommittee of the Council reported that unwarranted claims and mis­rep­re­sen­ta­tion were made for Ingluvin by its manufacturers, William R. Warner & Co., recommended that the preparation be refused recognition and that the report be submitted to Warner & Co. for action.

The report was submitted to the firm, and after waiting one month and no acknowledgement or reply having been received, the Council directed its publication. It is as follows:

REPORT ON INGLUVIN

Ingluvin is manufactured by W. R. Warner & Co., chemists, Philadelphia, Pa. The printed matter contains numerous claims and representations of which the following are specimens:

Two samples were purchased at different times in the open market and on examination found to consist essentially of powdered meat fiber mixed with what appeared to {be} a membranous tissue resembling the lining of a gizzard. Both samples on being tested by the method prescribed by the U. S. Pharmacopeia for estimating the strength of pepsin were found to possess little, if any, proteolytic activity. In order to determine whether or not the lining of a fowl’s gizzard possesses proteolytic action, a fresh gizzard was secured, the lining washed slightly with water, then removed and on using one-half of same in place of pepsin as prescribed by the Pharmacopeial method, it was found to digest 10 grams of albumin within the time limit. Pepsin, when properly kept, does not lose its strength to any material extent.

A careful examination was made for the presence of glycocholic acid, claimed to be the active principle of Ingluvin, but its presence could not be established. Furthermore, the anatomic relations of the fowl are such as to preclude its presence.

The above shows that Ingluvin does not possess nearly as much proteolytic activity as ordinary saccharated pepsin recognized by the 1880 Pharmacopeia, which was prepared on the basis of digesting 300 times its weight of egg albumin. Inasmuch as no glycocholic acid is present in Ingluvin, it would seem that saccharated pepsin would be far more efficacious in treating the abnormal conditions for which Ingluvin is recommended in the advertising circulars. Furthermore, the claims made for the preparation are grossly extravagant.

A communication from Warner & Co. has been received since the above report was adopted, in which it is stated: “The reason that previous letter was not replied to was because we were desirous of securing all the information possible on the subject. Since that time we have made considerable research and also made laboratory investigation, and are enclosing the accumulated data with diagram of a part of the alimentary canal showing the esophagus, crop and gizzard.”

Much of the other matter submitted is immaterial. The following, so far as it means anything, seems to confirm the correctness of the report of the Council’s referee that Ingluvin is practically devoid of proteolytic activity: “... the therapeutic activity must be due to the bitter property, rather than any proteolytic activity, and it probably increases, thereby, the functional activity of the stomach, by which the normal digestive process is increased. Ingluvin in a 0.4 per cent. hydrochloric acid solution at 37 to 40 C. or if mixed with an aqueous solution of pepsin under the same conditions possesses an acrid, bitter taste and increases the secretion of the saliva and this is practically the same condition as when in the stomach, it no doubt stimulates the depressed mucosa peptic glands and increases gastric solution.”

W. A. Puckner, Secretary.

COMMENTS

The fallacies attending the use of digestive ferments in most stomach diseases have been previously noted in The Journal.53 In most digestive disorders a deficiency of the digestive ferment has not been proved. In cases in which pepsin is lacking, its administration is valueless unless it is combined with large doses of hydrochloric acid, and it is doubtful whether this combination is either necessary or conspicuously useful. There is, however, something so alluring about medication by digestive ferments which are assumed to supply a physiologic need, that since their discovery they have formed a fertile field for the activity of the manufacturer of proprietaries. As by scientific laboratory tests, it is possible to determine whether a given preparation has digestive power, the manufacturers of Ingluvin avoid this point by claiming that the remedy acts, not on the food, but on the stomach itself. That remedies may exist which act as stimulants to the digestive secretions can not be denied, although at the present time this power has not been satisfactorily demonstrated. The proprietors of Ingluvin, finding that proteolytic activity is not to be attributed to this preparation of chickens’ gizzards, announce a new therapeutic fact in the claim that “the natural glycocholic acid in Ingluvin is the active principle and the most efficient agent in the treatment of all stomachic and enteric disorders. According to the report made to the Council there is no glycocholic acid in this preparation, nor is it possible, from the anatomic arrangements of the fowl’s digestive apparatus, for it to get there. By all the tests which can be applied to determine its value this preparation is of much less value in digestive disorders than saccharated pepsin, which was discontinued in the Pharmacopeia because of its inferiority to the other forms of the ferment.

The repudiation, by the manufacturers, of the more absurd claims made for Ingluvin, shows the need of maintaining an attitude of healthy skepticism toward the advertised therapeutic virtues of proprietary preparations. If a physician is disposed to use digestive ferments, he should give preference to the official preparations, and ferments from other sources should be required to stand the exact tests which demonstrate the worthlessness of so many preparations on the market.​—(From The Journal A. M. A., July 11, 1908.)

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The Council voted that Intestinal Antiseptic W-A be refused recognition, and that the publication of the following report be authorized.

W. A. Puckner, Secretary.

The Abbott Alkaloidal Company advertises “Intestinal Antiseptic W-A” as

This formula is in conflict with Rule 1 in that it does not state in what proportion the sul­pho­car­bo­lates are present.

The name “Intestinal Antiseptic W-A” is in conflict with Rules 4 and 8, since it is therapeutically suggestive.

The preparation is in conflict with Rules 6 and 10, in that exaggerated claims are made for it, no evidence being submitted to prove the superior value of the mixture.

The most serious of these conflicts consists in the exaggerated and misleading therapeutic claims. The advertisements say:

These extreme claims exceed the limits of permissible optimism, unless they are supported by strong dependable evidence. They contrast sharply with the low esteem in which the phe­nol­sul­pho­nates (sul­pho­car­bo­lates) are generally held. To accept these claims, and to justify encouraging physicians to rely on them, it would be necessary to establish:

First, that feasible concentrations have a distinct antiseptic action on cultures of intestinal bacteria. This experiment could be easily made, but the claims do not seem to be based on evidence of this kind.

Second, that the preparation actually checks putrefaction in the intestines. There are several methods by which this proof may be attempted; but the claims do not appear to be based on evidence of this kind.

Third, that the preparation actually has a favorable influence on the progress of diseases. This sort of evidence is exposed to so many fallacies that it would have to be gathered very carefully and critically, duly discounting the effect of other treatment; for instance, by comparison with similar cases which do not receive this preparation. This is especially important; and yet we find directions to use this preparation in conjunction with active cathartic treatment, which in itself has considerable influence on the conditions for which this preparation is recommended. No evidence of this kind is presented.

The testimonials contained in the advertisements cannot be considered as serious evidence. None present any indication of accurate record or proper control of conditions, or of the performance of control observations. They are superficial impressions, to which little or no weight can be attached.

It is recommended that Intestinal Antiseptic W-A be considered ineligible for New and Nonofficial Remedies.​—(From The Journal A. M. A., Dec. 19, 1914.)

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Bannerman’s Intravenous Solution (Wm. Bannerman and Co., Chicago) was refused recognition because vague, indefinite and misleading statements were made regarding its composition, because it was recommended for anemia, tuberculosis and syphilis under grossly exaggerated and unwarranted claims and because the intravenous injection of complex and indefinite mixtures is unscientific and dangerous. Notice of the action of the Council having been sent to the Bannerman Company, the firm submitted a revised statement of composition and also a revised advertising circular.

The claim is made that Bannerman’s Intravenous Solution “is a compound of only the purest and proven efficient U. S. P. drugs.” According to the latest statement:

Each 10 c.c. of Bannerman’s Solution contains:
Hydrargyri Albuminas Mercury Content	1	1-9	Gr.   or	0.075 Gm.
Ferri Albuminas Iron Content	4	1-4	Grs. or	0.286 Gm.
Sodii Chloridum	6	1-5	Grs. or	0.412 Gm.
Calcii Salicylicum	4		Grs. or	0.26   Gm.
Guaiacol	4		Grs. or	0.26   Gm.
Creosote (Beechwood)	5		Grs. or	0.32   Gm.

The solvent is said to be distilled water.

The formula is unsatisfactory in several particulars. The stated amounts of some of the ingredients are in excess of their solubility in water; the nature and amount of albumin contained in the “Hydrargyri Albuminas” and “Ferri Albuminas” are not given; the claim that the solution contains only U. S. P. drugs is not true. But the main objection to the preparation is its unscientific character and the unwarranted therapeutic claims made for it.

Even though a patient had all three diseases, syphilis, tuberculosis and anemia, it would be most irrational to use a shotgun prescription, containing, in fixed unvarying proportions, mercury for the syphilis, iron for the anemia and germicides for the tuberculosis. In syphilis the mercury-content of Bannerman’s Solution is inadequate; in anemia the intravenous administration of iron is unwarranted, and in tuberculosis there is no evidence that the injection of bactericides is efficient.

Exception must be taken, moreover, to the statement that “its use is absolutely safe.” The danger of anaphylaxis from repeated injections of albuminates cannot be disregarded, and as J. F. Anderson, director of the Hygienic Laboratory, has pointed out54 we know little of the secondary or remote effects of the intravenous injection of toxic substances; some of them probably do permanent harm.

Such claims as the following require no comment:

In view of the facts given, the Council again refused recognition to Bannerman’s Intravenous Solution.​—(From The Journal A. M. A., Jan. 2, 1915.)

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Iodalia is sold by Geo. J. Wallau, Inc., with the claim that because of the peculiar combination in which it contains iodin it is a valuable and efficient substitute for iodids. The preparation was examined in the Chemical Laboratory of the American Medical Association, which reported to the Council that, contrary to claim, iodin in the form present in Iodalia would, when administered, act like an ordinary iodid. Further the proportion of iodin present was so small that to administer the equivalent of 20 grains of potassium iodid it would be necessary to give the contents of a one-dollar bottle of Iodalia. In view of this report it is evident that the claim that Iodalia is “always well tolerated” and that it cannot produce “symptoms of iodism” is true only because of the small percentage of iodin it contains. The claims made in the advertising matter, that Iodalia is an efficient iodin medication in the treatment of syphilis, that it is a suitable substitute for cod-liver oil and that it may be used in anemia, dysmenorrhea, dyspepsia, malaria and diseases of the heart, are entirely unwarranted.

Iodalia is exploited in a way to suggest its use to the public for a host of diseases. Particularly reprehensible are the recommendations contained in a circular which accompanies the trade package that Iodalia:

The Council voted that Iodalia be refused recognition.​—(From The Journal A. M. A., Dec. 12, 1914.)

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Iodex is manufactured by Menley and James, Ltd., New York. It is advertised as

The advertising conveys the impression that the effects of free iodin are to be obtained from the preparation; it is said to contain “5 per cent. Therapeutically Free Iodine,” and to do

The statements are also made that the preparation “neither stains, irritates, blisters or cracks the skin,” and that “thirty minutes after inunction iodin can be found in the urine.”

The following report of an examination made by the Chemical Laboratory of the American Medical Association has been submitted to the Council:

“Iodex is dark green, practically black. The green color is apparent when the ointment is rubbed on the skin, but disappears on continued rubbing. This nonstaining property is explained by the results of a test for free iodin, made on five specimens, four of which yielded only minute traces of free iodin, while the fifth yielded none. Of course, the statements that Iodex is an ‘Effective Free Iodin Application Without Drawbacks’ and also a means of ‘Really Efficient External Iodine Therapy Without Stain or Irritation’ contradict each other. Free iodin cannot be present in a sufficient quantity to be therapeutically efficient in any application which does not stain or irritate the skin.

“The total iodin content of the five specimens was found to be 2.63 per cent.—​a little over one-half of the content claimed.

“Absorption and excretion experiments were performed to test the claim that ‘thirty minutes after inunction iodin can be found in the urine.’ In several subjects, from 1 to 2 gm. of Iodex was rubbed on the skin of the forearms, and the urine, for periods varying from seven to seventy-two hours, was collected and tested for iodin. In all of the tests the results were negative.”

Iodex is advertised as beneficial in muscular soreness, sprains, sciatica, neuritis, chronic rheumatism, enlarged glands, orchitis, epididymitis, gout, burns and dermatomycoses. It is also said to be “Indicated in Glandular Enlargements, Inflammatory Conditions, Various Joint Diseases, Rheumatism, Skin Diseases, Chilblains, etc., etc.”

To sum up:

1. As shown in the foregoing laboratory report, the composition is incorrectly stated, for the actual iodin content is only about half of that claimed.

2. It is not true that the action of Iodex is essentially that of free iodin, which is the impression conveyed by the advertising.

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

In view of these findings, the Council voted that Iodex be refused recognition for conflict with Rules 1, 4 and 6.​—(From The Journal A. M. A., June 19, 1915.)

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

W. A. Puckner, Secretary.

Iodia is put on the market by Battle and Company, under the claim that it contains potassium iodid in combination with iron phosphate and vegetable “principles.” It is extravagantly recommended for use in many and varied conditions. For instance, it is “an unexcelled altero-reconstructive,” “almost a specific” in eczema and rheumatism and “a highly efficient form of iodin,” which will not produce iodism!

The therapeutic effects of iodids result from a chemical transformation by which molecular iodin is set free in the tissues, thus producing a mild degree of iodism. It follows, then, that a preparation which cannot give rise to the symptoms of iodism cannot be expected to produce the therapeutic effects of the iodids. The claim that Iodia is therapeutically efficient without producing iodism therefore justifies suspicion, to put it mildly.

In view of the exaggerated tone of the advertising, together with the fact that a report from the Chemical Laboratory of the American Medical Association showed marked discrepancies between the formula and the composition of Iodia, it seemed desirable to investigate this product. The report of the laboratory, which is given below, shows conflict with Rule 1 (secrecy of composition) and with Rule 2 (false claims of standardization). A discussion of the claims made for Iodia follows the report.

LABORATORY REPORT

The composition of Iodia is given thus:

We are told that:

This “formula” is an absurdity: First, the amounts of the “active principles” of the plants named are not given; second, these “principles,” with the possible exception of menispermum alkaloids, have not been isolated; and, third, ferric phosphate and potassium iodid are incompatible! Incidentally, there are no methods whereby it is possible to secure “absolute uniformity” of a mixture such as Iodia is claimed to be.

Qualitative tests demonstrated the absence of iron and the absence of all but traces of phosphorus compounds (0.015 gm. phosphorus per 100 c.c.). Minute traces of alkaloids, possibly from menispermum, were found (that amount being about 0.004 gm. per hundred c.c. of the preparation). Therapeutically this quantity is entirely negligible. Determinations of iodid demonstrated the presence of only about 60 per cent. of the amount of potassium iodid claimed. The “formula” for Iodia is false and misleading.55

DANGEROUS RECOMMENDATIONS

One of the Iodia labels reads:

Such recommendations are likely to lead to self-drugging in conditions that are not only dangerous to the individual but also a menace to the community. The preparation thus conflicts with Rule 4 of the Council. After admitting the need of efficient iodid medication in certain stages of syphilis and after exaggerating the frequence and severity of symptoms of iodism, an advertising circular entitled “Practical Therapeutics” asserts:

It is generally accepted that in certain stages of syphilis the only hope of success lies in efficient iodin medication. The exploiters of Iodia state that a dose of the nostrum contains 2¹⁄₂ grains of potassium iodid; actually it contains only 1¹⁄₂ grains. To urge physicians and the public to depend on this product for efficient iodid medication constitutes an unwarranted therapeutic exaggeration (Rule 6) which approaches criminality. The reason Iodia does not produce iodism is that, in the doses recommended, the iodin action is extremely feeble.

Likening the human body to a factory and discussing the “break downs” which are likely to occur, a circular entitled “Always Trustworthy” says:

These recommendations show that in addition to the objections already given, this nostrum is an unscientific shot-gun mixture. This brings it in conflict with Rule 10 (unscientific articles inimical to the medical profession and the public).

It is recommended that Iodia be refused recognition.​—(From The Journal A. M. A., Nov. 21, 1914.)

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The Council has authorized publication of the following report on Burnham’s Soluble Iodine.

W. A. Puckner, Secretary.

Burnham’s Soluble Iodine is offered to the medical profession by the Burnham Soluble Iodine Company, Auburndale, Mass., under the claim that by

Beyond this no statement as to the qualitative or quantitative chemical identity of Burnham’s Soluble Iodine is furnished; this secrecy, of course, has given the preparation a certain mysterious prestige among unthinking physicians.

Burnham’s Soluble Iodine was examined in the Chemical Laboratory of the American Medical Association some six years ago and was found to be an alcoholic solution of free iodin (approximately 3 gm. per hundred c.c.) and combined iodin in the form of iodid (equivalent to about 2 gm. of potassium iodid per hundred c.c.). Thus the total iodin content was somewhat less than half of that of the official Tincture of Iodin (Tr. Iodi), which contains 7 gm. of free iodin and 5 gm. of potassium iodid to each 100 c.c. The official tincture, diluted one-half, therefore, would be essentially equivalent to the Burnham preparation, both being miscible with water. The Burnham Soluble Iodine Company objected to the conclusions drawn, from this analysis, but admitted the correctness of the analysis itself.

Any one who gathered his first knowledge of the subject from the Burnham advertising might readily infer that no soluble iodin had been known prior to Burnham’s Soluble Iodine. This, of course, is not the case; the method of producing a solution of iodin by the use of an iodid has long been known.

The following statement is not only obviously untrue but also nonsensical:

The company lays stress on the assumed superiority over the iodids of a preparation containing free iodin. This assumption is based on a fallacy. Those who regard free iodin as superior to combined iodin forget that free iodin taken by the mouth is converted in the intestines, by the action of the alkaline intestinal secretions, into an iodid with a small amount of iodate, while administered intravenously (a procedure that, while advocated by the Burnham concern, is therapeutically indefensible), it enters into combination with the alkaline salts and proteins of the blood. The free iodin in Burnham’s Soluble Iodine must act in the system as an iodid, and the whole iodin content, to furnish a correct estimate of the value of the preparation, should be reckoned as an iodid.

Bearing this in mind, then, it is evident that the doses of Burnham’s Soluble Iodine recommended by the manufacturers are extremely small. They range from 20 minims (equivalent to 1 grain of potassium iodid) to ¹⁄₂ minim (equivalent to ¹⁄₄₀ grain of potassium iodid). From 5 to 20 minims (equivalent to about ¹⁄₄ to 1 grain of potassium iodid) is the dosage recommended for syphilis; from “1 to 3 minims [equivalent to from ¹⁄₂₀ to ³⁄₂₀ grain of potassium iodid] three to six times daily” for typhoid and other intestinal diseases. No wonder the exploiters can say that this nostrum does not irritate the intestines, that it is “non-irritating to the weakest stomach” and that there is an “entire absence of toxic action from maximum doses”! Its alleged freedom from the irritating and untoward effects of ordinary iodids is due, not to any inherent superiority of the preparation, but to the insignificant amount of iodid present.

The preparation is advertised for use in an extremely wide range of diseases, in some of which iodid therapy is recognized as of value, while in others it is generally regarded as either worthless or harmful. Given orally or intravenously (the recklessness of the latter method should again be emphasized) Burnham’s Soluble Iodine is claimed to be of:

Since, as previously explained, free iodin, when introduced into the body, enters into chemical combination before it has a chance to permeate the tissues, and since the alkali iodids possess very slight (in fact, for this purpose, negligible) antiseptic powers, it is evident that this claim is unfounded. So, for the same reason, is the claim that “as an intestinal antiseptic,” Burnham’s Soluble Iodine is:

It is recommended in exophthalmic goiter, notwithstanding that this condition is generally recognized as contra­indi­cat­ing the administration of iodids, which excite the action of the thyroid gland, and which therefore must be used with great circumspection. An especially indefensible recommendation is that ¹⁄₂ minim of Burnham’s Soluble Iodine (equivalent to ¹⁄₄₀ grain of potassium iodid) be administered every five minutes in “membranous croup”—​diphtheria—​until relief from dyspnea is obtained. But, of all the extravagant claims made for this preparation, perhaps the following is the most reprehensible:

Remove the mystery and tell physicians that a dose of ¹⁄₁₀ or ¹⁄₄ of a grain of potassium iodid is “the most potent method of treatment available” in tuberculosis and the absurdity becomes self-evident. Nor is this the worst feature of the advice here offered. Iodin, by combining with the fatty acids of tuberculous tissues, promotes their autolysis and consequently their softening and breaking down. The products of this autolysis are carried by the lymphatics to healthy tissues and thus may spread the infection. Therefore the use of iodids in tuberculosis, even in small dosage, should not be undertaken lightly.

It is recommended that Burnham’s Soluble Iodine, a semi-secret preparation, exploited by means of extravagant and dangerous therapeutic claims, be held ineligible for admission to New and Nonofficial Remedies, and that this report be published.​—(From The Journal A. M. A., May 15, 1915.)

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Eimer and Amend, New York, who market Iodotone, state that it is a solution of hydrogen iodid (hydriodic acid) in glycerin, containing 1 grain of iodin to each fluid dram. The unwarranted assertion is made that Iodotone

This cannot be true, for it is certain that, because of the alkaline reactions of the tissues, iodids, whether administered as hydrogen iodid or as alkali iodids, must circulate in precisely the same form and therefore exert the same therapeutic effects in precisely the same way.

Eimer and Amend further assert that the ordinary iodids may to advantage be replaced by Iodotone. The absurdity of this claim is apparent when it is considered that it will be necessary to administer nearly one fluidounce of glycerin to obtain an amount of Iodotone equivalent to a 10-grain dose of potassium iodid. The additional claim that Iodotone will not disturb the stomach or produce the usual disagreeable symptoms of iodism is evidently unwarranted, for it is generally conceded that symptoms of iodism can be avoided only at the risk of insufficient iodin medication. Because of these unwarranted and misleading claims and because the name Iodotone would tend toward the uncritical use of the preparation as a general tonic, the Council voted that Iodotone be refused recognition.​—(From The Journal A. M. A., Dec. 12, 1914.)

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Iosaline is a rheumatism remedy for external application. In view of the misleading and unwarranted claims which are made for it, the Council voted that Iosaline be refused recognition and recommended publication of the Committee’s report which appears below.

W. A. Puckner, Secretary.

COMMITTEE’S REPORT

The following sweeping but rather indefinite claims are made for Iosaline.

As there are few, if any, known iodin compounds which are “readily absorbed” through the skin and which will not at the same time produce discoloration or discomfort, it was thought worth while to take up the examination of Iosaline. The results of this examination are reported by the Chemical Laboratory of the Association as follows:

Laboratory Report:—Iosaline is advertised by the Iosaline Company of New York, as a remedy for the treatment by external application, of rheumatism, gout, neuralgia, pneumonia and numerous other diseases. Concerning its composition the following statements are made:

The placing of a cipher before the percentage figure for alcohol, though perhaps accidental and not meant to mislead, might cause a hasty or careless reader to understand 7 per cent. or .07 per cent., instead of 70 per cent., as the proportion of alcohol present.

The preparation examined was a very pale yellowish, translucent solid having a strong odor of methyl salicylate and a fainter odor of menthol. A package sold for 2 ounces contained 51.7 gm. Qualitative tests indicated the presence of alcohol, an iodid, menthol, methyl salicylate, potassium, sodium, combined fatty acids and a trace of glycerin. Thyroid extract was not found. Quantitative examination indicated the following approximate composition for Iosaline:

Alcohol (by weight)	48.05	per cent.
Menthol	2.07	per cent.
Methyl salicylate	10.25	per cent.
Potassium iodid (4.25 per cent. iodin)	5.55	per cent.
Soap	12.68	per cent.
Glycerin	a trace
Water and undetermined matter to make 100 per cent.

Iosaline, therefore, appears to be a solidified, watery-alcoholic solution of soap containing potassium iodid, menthol and methyl salicylate. Physiologic tests carried out by rubbing the preparation on the skin and afterward testing the saliva and the urine for an iodid indicated that none of the potassium iodid is absorbed. Since Iosaline is claimed to contain 70 per cent. of alcohol and 5 per cent. of iodin, the alcohol content is but 68.7 per cent. and the iodin content but 85 per cent. of the amounts claimed. The phrase “combined iodin” is evidently meant to mislead, and adds the element of mystery on which preparations of this class rely so largely.​—(From The Journal A. M. A., March 15, 1913.)

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Nourry Wine (E. Fougera and Co., New York) is a proprietary iodin preparation said to contain 12 per cent. of alcohol and 1¹⁄₂ grains of iodin in combination with tannin to the fluidounce. Experiments made in the A. M. A. Chemical Laboratory demonstrate that the iodin contained in Nourry Wine is present either in the form of iodid ions or in a form very readily yielding iodid ions and that therefore its action will be that of ordinary iodid. Yet a circular asserts:

While Nourry Wine contains but an insignificant proportion of iodin, the circular claims that “Nourry Wine presents a high dose of iodin.” Further, the label on Nourry Wine and the circular which is wrapped with it suggests its use in a number of diseases in which iodin medication is considered of minor importance. These recommendations, bolstered up by testimonials from twelve to twenty-five years old, are likely to lead the public if not the medical profession to use this weak iodid wine where efficient treatment is called for. The attempt is made to give a further false value to Nourry Wine in the minds of those who prize everything that is foreign by the suggestion that it comes from France when in reality it is made in New York. In conclusion the Council held that, though the alcohol of the wine is the most potent constituent, the constant use in the advertising matter of the term “Nourry Wine,” unqualified by the adjective “Iodinated,” was mischievous as likely to lead to the thoughtless use of the preparation in cases unsuitable for iodin medication. The Council refused recognition to Nourry Wine.​—(From The Journal A. M. A., Dec. 12, 1914.)

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The following report was submitted to the Council on Pharmacy and Chemistry by the subcommittee which examined Labordine:

To the Council on Pharmacy and Chemistry:—Your subcommittee presents the following report on Labordine, sold by the Labordine Pharmacal Co., St. Louis.

Labordine is advertised to physicians as having the following composition:

Apium Graveolens (true active principle) “Process-Laborde”	353⁄8
Gaultheria Fragrantissima (true active principle) “Process-Laborde”	251⁄8
Acete Amide-Phenyle	151⁄8
Quinina	11⁄8
Benzoyl-Sulphyonic-Imide	231⁄4

It is stated to be a “vegetable antipyretic”; that {“}it reduces temperature without heart depression,” and physicians are warned to “avoid acetanilid poisoning and danger from other coal-tar antipyretics.”

While the “formula” and the statement just quoted are sufficient evidence of the fraudulent character of the product, yet an abstract of the reports of the chemists who analyzed it is given further to demonstrate its character.

Taking the average of the reports of analyses, labordine contains:

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

This report of analysis only makes apparent that Labordine is not what it is claimed to be. While it is claimed to contain 23¹⁄₄ per cent. saccharin, this substance was not present, or mere traces only. While, in a disguised way, it is stated to contain 15¹⁄₈ per cent. acetanilid, it contained nearly 40 per cent.

It is recommended that Labordine be not approved and that this report be published.

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

W. A. Puckner, Secretary.

COMMENTS

A concrete illustration of some general principles previously laid down is furnished by a nostrum too unimportant to be of any value, save to “point a moral and adorn a tale.”

About thirteen years ago Labordine was advertised under the name of Analgine-Labordine, “A purely vegetable product,” “a combination of the active principles of Camellia Thea, Apium Graveolens, saccharin and carbohydrates,” “Superior to Antipyrine, Phenacetine, Antifebrine, Acetanilid”—​note the use of two names for the same thing—​“or any of their imitations,” and “unexcelled by any coal-tar product or their compounds.” In 1894 the name was changed to Labordine, in order, as its owner stated, to prevent its being mistaken for a coal-tar product of similar name.

What its composition was at this time we do not know, since there is no guarantee of the permanence nor stability of nostrum formulas except “the honor and reputation of the manufacturers,” which, as investigation has shown, is not always unimpeachable. There has been nothing to prevent alteration of the formula, if the proprietors desired, with every change in the moon. But the name and the general tone of the advertising has been the same. The claim of superiority over coal-tar products has been constantly made.

As to the present conditions, a circular enclosed with a sample of Labordine, recently sent from the St. Louis office, contains the formula given above in the report of the Council. In the same circular are also found these illuminating statements: “The medical profession has long appreciated the dangers involved in the administration of various mineral remedies now so commonly employed, and the value of a safe, effective and reliable vegetable antipyretic is universally recognized. Such a remedy is Labordine. It is purely vegetable in its composition and produces none of the evil after-effects of the coal-tar derivatives.... Labordine ... is a purely vegetable cardiac stimulant.... There is nothing mysterious about Labordine or its constituents.... The ‘Process-Laborde’ gives the true active principles of the Celery and Indian Wintergreen, something heretofore difficult to obtain. To this is added the fact that absolutely chemically pure Acet-Amide-Phenyle is used. The latter is the most valuable and, in fact, the only vegetable antipyretic known.”

The above report of the Council shows the following facts:

1. Apium Graveolens (true active principle), “Process-Laborde” is probably powdered celery seed. One chemist says: “The powder has the characteristic odor of celery, while a microscopic examination shows the presence of a substance having the characteristic structure of seeds in general.” If celery seed has any “active principle” it has never been isolated. As to its therapeutic value, nothing whatever is known. It is, we understand, highly beneficial in the case of singing canaries, but authorities in scientific therapeutics have never discovered that it possessed any remarkable medicinal qualities.

2. Gaultheria Fragrantissima (true active principle), “Process-Laborde,” is probably ordinary everyday salicylic acid. One analysis showed salicylic acid to be present to the amount of about 7 per cent. The question of whether or not salicylic acid could in any way be considered the “true active principle” of Gaultheria Fragrantissima, was submitted to Prof. John Uri Lloyd of Cincinnati, the eminent authority on the chemistry of the proximate principles of plants, who replies:

“The advertisement is evidently so worded that, although the name of the Indian plant Gaultheria Fragrantissima is employed, its true and active principle being wintergreen oil, the concoctor can mystify his patrons and at the same time use the well-known wintergreen oil, made in America, which in my opinion, so far as any chemical test might be concerned, could not be distinguished from the methyl salicylic acid (wintergreen oil) derived from the Indian plant. Concerning whether salicylic acid is a proximate constituent of Gaultheria Fragrantissima, in my opinion, it would be a misnomer to make such an announcement. Salicylic acid, per se, does not exist, in my opinion, in the plants mentioned, being made by chemistry.”

3. The third and most important ingredient in this “purely vegetable antipyretic” is brazenly announced as “Acet-Amide-Phenyle,” but it is only necessary to say that this imposing designation is an attempt to “Frenchify” a scientific name for acetanilid.

Analysis shows that this coal-tar product is present to the amount of 37.9 per cent., or 1.89 grains in a 5-grain tablet.56 In other words, this imposing Labordine, made by a mysterious and elsewhere unheard of “Process-Laborde,” is simply one more of the many acetanilid powders that have been foisted on our profession and that have filled our journals for years past. The only thing in it that is of practical therapeutic value is 2 grains of acetanilid to a 5-grain tablet. The statement that Labordine is a purely vegetable preparation is probably intended by the proprietors as a good joke on the medical profession. Acetanilid is not usually regarded as a vegetable product, at least it is not ordinarily found in market gardens. The only vegetable source from which acetanilid can be obtained is the beautiful flowering coal-tar bush, from which so many other nostrum vendors obtain their “perfectly harmless, purely vegetable antipyretics,” all composed of acetanilid and something to hide it. If the statements made by one of the company’s employees and quoted below are true, Labordine is not “manufactured and made chemically pure in the laboratories of the Labordine Pharmacal Company,” for this company has no laboratory, and its product is manufactured for it.

4. Our readers will be interested to know that the important ingredient entered under the imposing name of Benzoyl-Sulphyonic-Imide is simply a highly scientific name for saccharin. Even on this point, however, the formula is misleading, since it claims 23¹⁄₄ per cent. of this substance, whereas the analysis shows that the presence of saccharin could not be proved. If it is present at all it is in quantities much less than stated, and so small as to be difficult of recognition. Instead it appears that the product contains common starch and about 35 per cent. of milk sugar.

THE COMPANY ITSELF

One of the humiliating phases of the proprietary medicine business is that, in many instances, these preparations are foisted on our profession by men who know nothing of medicine, pharmacy or chemistry, yet who not only presume to concoct our medicines for us, but also assume to instruct us how to use them.

Gould’s Commercial Register for 1907 gives the officers of the Labordine Pharmacal Company as H. M. Coudrey, president; M. Crawley, vice-president, and D. E. Gamble, Jr., secretary and treasurer. The place of business is given as 420 Market street, St. Louis. We are informed that Harry M. Coudrey is an insurance agent and the present member of Congress from the Twelfth Missouri District; that Mark Crawley is a clerk in the insurance office of H. M. Coudrey; and that Mr. Gamble is cashier in the same office. A recent visit of a representative of The Journal to 420 Market street, St. Louis, showed that the office of the Labordine Pharmacal Company is in Room 12 on the third floor of an old dilapidated building. There was no sign on the door of the office, but on the wall next to an old elevator was a very small sign which read “Labordine Chemical Company, Room 12.” The office at the time of the visit was apparently in charge of a young woman about 20 years old. Careful scrutiny of the furniture and fixtures showed that the room contained an old oak roll-top desk in one corner and a kitchen table, on which were piled about half a dozen packages of Labordine. The floor of the room was bare and very dirty. In an adjoining room, the door of which was open, was piled a lot of broken furniture. No laboratories nor chemical apparatus were visible. The young woman in charge stated that Labordine was made by the Mallinckrodt Chemical Works, at No. 3600 North Second Street, St. Louis.

This is a fair sample of nostrums and of the methods of exploiting them. The bitterly humiliating fact about the whole business is that a preparation, advertised under such palpably misleading claims, could actually be advertised in medical journals, even in journals of a supposedly high scientific standard, and could be bought and prescribed for years by supposedly intelligent and conscientious physicians. It is not supposed that every physician should be enough of a chemist to detect the ridiculous discrepancies between the published formula and the therapeutic claims made for such a mixture. But that members of a supposedly learned profession should fail to have enough interest in the preparations they prescribe for their confiding patients to find out that acetanilid is being masked under an obsolete and little used name, that under an imposing polysyllabic designation is hidden saccharin, that the so-called “active principle Process-Laborde” (whatever that may be), is equivalent only to one-third grain of salicylic acid in a 5-grain tablet, and that the advertising matter sent out for years by this company contained absolute falsehoods regarding the composition and therapeutic benefits of its preparation, is certainly just cause for shame and humiliation. If a physician, knowing the composition of Labordine, wishes to prescribe it and prescribes it intelligently, he has a perfect right to do so. If he wishes his patient to have 2 grains of acetanilid, ¹⁄₂₀ of a grain of quinin, and ¹⁄₃ of a grain of salicylic acid, and considers a mixture of ground celery seed, starch and milk sugar as a proper vehicle for this medication, no one will question his right to administer it. No physician, however, has any right, either moral or professional, to prescribe a preparation, concerning the ingredients of which he knows absolutely nothing.

Is it possible that such carelessness may be one of the causes of waning public confidence in our profession? We leave it to our readers to determine whether such a moral can be drawn from this typical nostrum story.​—(From The Journal A. M. A., March 30, 1907.)

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The Franco-American Ferment Company has advised the Council on Pharmacy and Chemistry that, in advertising its products, it will no longer conform to the rules of the Council. This is evident. The Franco-American Ferment Company has distributed circulars in which the public is informed that auto-intoxication is the cause of innumerable ills ranging all the way from arterio­scler­osis, rheumatism and gout to chronic headache, odorous perspiration, nervous disorders and melancholia; that the Bulgarian bacillus “is a wonderful corrective or remedy” for all these conditions, and that the Lactobacilline products are the only preparations of Bulgarian bacillus “to be had in America which bear his [Professor Metchnikoff’s] personal endorsement”—​by inference, the only reliable products. In view of the action of the Franco-American Ferment Company, and of the tendency of their advertising to cause the public to exaggerate slight ailments into alarming conditions, the Council has voted that the several Lactobacilline products of this concern be deleted from New and Nonofficial Remedies.​—(From The Journal A. M. A., April 17, 1915.)

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In 1907 the Council on Pharmacy and Chemistry published a report on Lactopeptine. At that time it was shown that Lactopeptine did not have the composition claimed for it. The same claims as to composition are still being made for the product. In view of this fact, a second examination of Lactopeptine has been made and the result reported to the committee on chemistry. The report confirms the Council’s findings of six years ago. After adoption by the committee, it was adopted by the Council and its publication authorized.

W. A. Puckner, Secretary.

SECOND EXAMINATION OF LACTOPEPTINE

Two specimens of Lactopeptine in original unbroken packages were recently examined. One of these was an American preparation said to be produced by the New York Pharmaceutical Association at Yonkers and the other an English preparation from John Morgan Richards and Sons, London.

When Lactopeptine was first examined by the Council about six years ago, it was found to be little more than weak saccharated pepsin, and did not contain the other ferments which were claimed by the manufacturers to be present. A statement concerning this was published in the Council Reports for 1905–1908, p. 43. Because of claims recently made by the exploiters that this preparation contains not only pepsin but also pancreatin, diastase, lactic acid and hydrochloric acid, and that the failure to recognize these must be due to the lack of ability of the chemists making the examination, it seemed worth while to undertake a new series of tests on samples from two sources mentioned, the products on the British and American markets. The label on the British sample gives the following as the composition:

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

The label on the American sample gives no quantities but states that it “represents a combination of the principal digestive and enzymogenic agents, Pepsin, Pancreatin, Diastase, Lactic and Hydrochloric Acids, in the proper proportion to insure best results.”

We have examined both preparations for starch-digesting power according to the methods employed in our previous examinations of such ferments and already reported. Diastase and the amylopsin of pancreatin seem to be completely absent, or, if present at all, in such minute traces that digestion of starch is not shown after one hour when quantities running from 60 mg. up to 150 mg. were allowed to act on 500 mg. of starch made up into paste. These tests were repeated, always with the same results, and were controlled by digestions of the same starch with other diastase preparations of known value.

Tryptic activity appears likewise to be absent, as in weak alkaline solution after fifteen hours’ digestion no effect on coagulated egg albumin or fibrin was observed when 100 mg. of each preparation was used with 1 gm. of the protein material.

As was found in the previous investigation the two products have some peptic activity, but this activity is comparatively weak, as about 200 mg. of each preparation are required to digest 10 gm. of coagulated egg albumin with 0.2 per cent. hydrochloric acid in three hours at 40 C. (104 F.), and 100 mg. portions were unable to completely digest 10 gm. portions of egg albumin with acid of the same strength in four hours at 50 C. (122 F.).

Hydrochloric acid is absent, as might be expected from the character of the preparation, and the amount of combined chlorid is small; but qualitative tests were obtained for organic acid resembling in behavior lactic acid, which is probably present in combined form.

It must be reaffirmed then that in digestive activity both the Lactopeptine purchased in the United States and that bought in England are essentially weak saccharated pepsins.

[Editorial Note.—The report of 1907 demonstrated that Lactopeptine was at that time a weak saccharated pepsin. The present report shows that Lactopeptine, as it is sold both in the United States and Great Britain, is still the same weak pepsin preparation. By the false statements which appear on the Lactopeptine labels the exploiters lay themselves liable to prosecution under the Food and Drugs Act—​just as they have laid themselves liable for the past six years. The continued exploitation of this preparation warrants a restatement of facts that have been given many times before:

1. A preparation having the composition claimed for Lactopeptine—​a powder containing pepsin, pancreatin, diastase, lactic acid and hydrochloric acid—​cannot be produced commercially.

2. Even if such a combination were available, the acidity of the mixture itself and of the gastric juice would in all probability destroy the pancreatin before it could reach the intestinal tract.

3. Even if every constituent could exert its proper function at the right time, the administration of such a shotgun mixture would be unscientific and uncalled for.]​—(From The Journal A. M. A., Aug. 2, 1913.)

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The following was submitted to the Council by a subcommittee:

To the Council:—While meat extracts contain only traces of coagulable proteids and have little food value, meat juices are prepared by a process which ensures the presence in the finished product of considerable quantities of coagulable proteids and they therefore have considerable value as foods. Many preparations which are sold as beef juices or meat juices have no right to these designations. Since the public and physicians are likely to be misled by the names given to these products and by the false claims which are made for them as foods and depend on them in the nourishment of the sick, it is important that their composition and their value as foods should be known.

In the following report is presented the results of an examination of some of the commercial products found on the American market. The report shows that Wyeth’s Beef Juice (John Wyeth & Bro., Philadelphia), Bovinine (The Bovinine Co., New York), Carnine (Carnine Co., Fougera & Co., New York), and Valentine’s Meat Juice (M. J. Valentine, Richmond, Va.) are sold under names which are incorrect, that their composition is not correctly stated by the manufacturers and that false and misleading statements are made in regard to their value as food.

It is recommended that the products named be refused recognition for conflict with Rules 1, 6 and 8. Since these preparations are typical of many others on the market, and as their use is a menace to the public health it is recommended that the report be published.

This report was adopted by the Council.

W. A. Puckner, Secretary.

Beef or meat juices are clearly to be distinguished from beef or meat extracts. The word “juice” applies solely to the fluid portion remaining in fresh meat after proper cooling and storing and may be obtained by pressure or diffusion with or without a low degree of heat. Under heavy pressure freshly chopped meat will yield from 25 per cent. to 40 per cent. of a thick reddish juice and if the meat is previously frozen or heated to 60 C., as much as 50 per cent. may be obtained. This gives some idea as to the probable cost of preparing beef juice at home. The chief characteristics of meat juice are the presence of a considerable proportion of coagulable protein and a low content of meat bases. That above represents the nature of these commodities as usually understood by the medical profession, is clearly shown by this quotation:57

“One or two teaspoonfuls of this (meat juice) are added to a teacupful of cold or warm water, which, however, must not be boiling, or otherwise the albumin would be coagulated, but it may, however, be sufficiently warm to drink comfortably.”

Beef juice is considered by some physicians of much dietetic service and believed to represent liquid food in concentrated form. W. O. Atwater,58 relative to this product says:

“Beef juice obtained from the best steak which has been merely warmed through over the coals and then entirely deprived of soluble substance by a screw press, is undoubtedly the most concentrated of the liquid foods.”

The latter authority gives a number of analyses of beef juices prepared under known conditions.

DEFINITION OF MEAT JUICE

Meat juice is defined by the standards committee of the Association of Official Agricultural Chemists as the fluid portion of muscle fiber obtained by pressure or otherwise, and may be concentrated by evaporation at a temperature below the coagulating point of the soluble protein. The solids contain not more than 15 per cent. of ash, not more than 2.5 per cent. of sodium chlorid (calculated from the total chlorin present), not more than 4 nor less than 2 per cent. of phosphoric acid (P₂O₅), and not less than 12 per cent. of nitrogen. The nitrogenous bodies contain not less than 35 per cent. of coagulable proteins and not more than 40 per cent. of meat bases.

Meat juices of commerce are supposed to be made by subjecting properly prepared meat to heavy pressure with subsequent concentration of the juice in vacuo at a low temperature. The latter is necessary because if the temperature is raised to any material extent the valuable coagulable, soluble proteins referred to above are precipitated and lost. In order to establish a basis of comparison relative to the composition of natural raw beef juice a number of samples were prepared under known conditions and submitted to analysis. The results contained in the subjoined table clearly show that meat juices made under known conditions vary according to the mode of preparation, but it is evident that practically one-half of the nitrogen is present as coagulable protein.

FOOD VALUES

In order to arrive at the food value of any commodity it is necessary to consider its chemical composition, available potential energy, absorbability, etc. On referring to the analytical table it will be found that the amount of inorganic material in meat juices Nos. 7 and 10 is unduly high. It appears that sodium chlorid, per se, has been added to both Bovinine and Wyeth’s Beef Juice probably as a preservative in the latter and for condimental purposes in the former. The relative and absolute proportions of phosphatic material in both products is excessive. The other constituents present in the ash are those usually found in meat products.

The amount of sugar and glycerin in Carnine is interesting. These agents may be added for preserving purposes, but the resulting product, on account of its syrupy appearance, leads to the belief and is so represented, that it is a concentrated food. Glycerin is also present in Bovinine and Valentine’s meat juice. Bovinine in addition contains about 8 per cent. alcohol.

The total nitrogen content of the trade products excepting Carnine, is greater than the amount of nitrogen present in meat juices proper, but the relative amount of nitrogen present as coagulable protein—​the valuable part of meat juice—​is much greater in the latter. In fact, the amount of coagulable protein present in Valentine’s Meat Juice may be considered nil, which indicates that an unduly high temperature is used in its preparation. In this connection it should also be noted that even a moderate elevation of temperature influences the chemical composition of meat juices. For example, the coagulable matter present in Nos. 3, 4 and 5, is approximately one-half that present in Nos. 1 and 2, which appears to indicate that the best product can be made without the use of any heat whatever. Several of the trade products, namely Nos. 7, 8 and 9, contain about as much coagulable material as meat juice made by heating beef to 60 C. According to the formula appearing in a circular of the Bovinine Company, a part of the coagulable matter is present in the form of egg albumin, but the company claims egg albumin is not used at present. In the case of Carnine, the coagulable matter appears to be introduced by the use of blood itself. The exact nature of the coagulable protein matter in Wyeth’s Beef Juice has not been ascertained. It is well known to manufacturers and physiologic chemists that it is practically impossible to manufacture a genuine meat juice possessing a reasonable amount of coagulable proteins, which is stable without a preservative.

Meat juices, in addition to the coagulable protein material, contain other protein bodies such as albumoses and peptones. These bodies are largely formed from the original protein bodies present in the meat juice during the process of manufacture. They are highly nutritious and largely and readily absorbed from the alimentary canal, but the amount of these bodies present in the trade products is relatively small excepting in Bovinine, which is not a meat juice, particularly when the high prices are considered.

A considerable proportion of the nitrogenous matter contained in Valentine’s and Wyeth’s products is present in the form of amino bodies frequently included in the general term, “extractives.” These bodies may be oxidized in the body and thus supply heat in a manner similar to alcohol, but it should be remembered that there still appears to be a wide difference of opinion among various observers on this point. Some appear to be of the opinion that the amino bodies are devoid of food value in that these bodies appear in the urine practically unchanged. It would, therefore, appear that the value of the amino bodies is largely of a stimulant character.

The food value of meat juices, therefore, resides largely, if not solely, in the coagulable and other protein material present. Comparing the calorific value or potential energy available in meat juices proper on this basis with that present in the commercial products, excluding Bovinine, it will be seen that on the average the genuine meat juices—​that is, those made by pressure, direct from the meat itself as wanted—​are much superior to the commercial products, notwithstanding the marked concentration in some cases. The calories given in the accompanying table do not include sugar, alcohol or any other added material of this character.

WYETH’S BEEF JUICE

“Wyeth’s Beef Juice” is not a true beef juice, but resembles rather a diluted meat extract. It contains much added inorganic matter, is low in coagulable proteins, and considering the degree of concentration, relatively deficient in nutritive value. Some of the claims contained in the circular accompanying this preparation, in view of its composition set forth above, may be of interest:

COMPOSITION OF MEAT JUICES

Column Headings:
 2 = Per cent. volatile matter 100 C.
 3 = Per cent. inorganic matter
 4 = Per cent. sodium chlorid
 5 = Per cent. phosphoric pentoxid (P₂O₅)
 6 = Per cent. ether extract, glycerol and undetermined matter
 7 = Per cent. total nitrogen
 8 = Per cent. coagulable proteins (N × 6.25)
 9 = Per cent. other proteins (N × 6.25)
10 = Amino bodies (N × 3.12)
11 = Calories per 500 gm. obtained from protein factor 4.8
12 = Calories per 500 gm. obtained from amino bodies factor 0.56

Name of Preparation	2		3		4		5		6		7		8		9		10		11		12
Trade Products:
Chuck beef, cold pressed	86	.85	1	.86		.20		.31	1	.32	1	.74	6	.13	2	.94		.90	217	.68	2	.52
Round beef, cold pressed	85	.76	1	.53		.12		.37		.75	2	.08	8	.56	2	.37	1	.03	262	.32	2	.88
Chuck beef pressed at 60 C.	91	.90	1	.29		.19		.29		.81	1	.09	2	.56	2	.50		.84	121	.44	2	.35
Chuck beef pressed at 60 C.	89	.56	1	.27		.16		.37	2	.98	1	.09	3	.00	2	.63		.56	135	.12	1	.57
Round beef pressed at 60 C.	90	.65	1	.36		.16		.36	2	.09	1	.16	4	.25		.31	1	.34	109	.44	3	.75
Chuck beef heated six hours before pressing 60–100 C.	98	.11		.39		.05		.12		.25		.24	....		1	.00		.25	24	.00		.70
Made in Laboratory:
Beef Juice, John Wyeth & Bro., Philadelphia, Pa.	58	.84	16	.21	6	.71	3	.27	12	.51	3	.15*	2	.88	3	.56	6	.00	154	.56	16	.80
Bovinine, The Bovinine Co., 75 W. Houston St., New York City	80	.40‡	1	.55	1	.05		.09	3	.64‖	2	.36	3	.38	10	.75		.28	339	.12		.78
Carmine Co., Lefranco, Paris, France; Imported by Fougera & Co., Agents, New York City	24	.80§		.86		.09		.33	68	.94¶		.96	2	.25	2	.56		.59	115	.44	1	.65
Meat Juice, M. J. Valentine, Richmond, Va.	57	.64	10	.26	1	.77	3	.41	20	.41#	3	.06†		.19	5	.44	6	.06	135	.12	16	.97

*: Including 0.20 per cent. as NH₃;  ‡: 8.17 per cent. alcohol found;  ‖: 3.1 per cent. glycerol found;  §: vacuum 70 C.;  ¶: 47.50 per cent. cane sugar—14.2 per cent. glycerol found;  #: 8 per cent. of glycerol found.  †: including 0.22 per cent. NH₃;

The several samples of beef juice were prepared from practically fat free, finely comminuted, chuck and round beef, first by pressure at the ordinary temperature; second, by heating the prepared meat for several hours at 60 C., then submitting to pressure. Sample No. 6 was made from chuck beef, prepared as above, by heating six hours at from 60 to 100 C., and expressing after cooling. It is not a beef juice proper but was prepared, analyzed and added to the list for information. Its composition resembles several commercial articles closely. A number of products represented and sold as meat juice in the United States were analyzed and the results recorded in the accompanying table.

BOVININE

Bovinine, advertised as a “condensed beef juice prepared by a cold process” is a mixture of alcohol, glycerin, added sodium chlorid, and apparently some form of defibrinated blood. According to the manufacturer’s literature egg albumin was used formerly but this ingredient is said to be no longer employed. It is not a meat juice in any sense of the word. Numerous mis­rep­re­sen­ta­tions will be found on the label and in the literature of Bovinine, of which the following are typical:

A series of experiments carried out with dogs under anesthesia, by injecting Bovinine into the stomach, the pyloric end of which was ligated, shows that Bovinine is not readily absorbed and assimilated by the stomach as claimed. The amount of protein material found in the stomach at the end of one-half hour to one hour and a quarter was practically equal to the amount introduced by the Bovinine.

It is also represented that Bovinine is of great service in case of an irritable stomach. This is not borne out by experiment. Bovinine fed to dogs by the mouth, either alone or mixed with food, induced vomiting, which was less marked when Bovinine was given with the regular diet. An examination of the urine of these animals showed a marked diminution of the amount of indican, while the ethereal sulphates were enormously increased, both absolutely and relatively, when Bovinine was given. Experiments on rabbits have shown that Bovinine injected into the peritoneal cavity was invariably followed by large quantities of albumin in the urine, which persisted for from twenty-four to forty-eight hours. Thirty to 50 c.c. per kilo given by mouth daily caused emaciation and weakness; in some cases, irritation of the gastro-intestinal canal, with death of the animal in from seven to twelve days.

CARNINE

Carnine is a French preparation imported into the United States by Fougera & Co., of New York City. In physical appearance it looks like highly concentrated food, but analysis shows that it consists of a small proportion of defibrinated blood dissolved in a mixture of syrup and glycerol, the whole agreeably flavored. It is represented as a “juice of rare meat, prepared by cold process. Each tablespoonful represents 100 gm. of raw meat, or 3¹⁄₂ ounces.” It is clear that Carnine is not a meat juice in any sense of the word.

VALENTINE’S MEAT JUICE

Valentine’s Meat Juice resembles in physical appearance taste, odor and by chemical analysis a diluted meat extract. The nutritive value of meat extracts is virtually nil, as is well known by the medical profession. Notwithstanding the composition of Valentine’s Meat Juice and the fact that beef extract represents little nutritive value, the manufacturer makes the following misleading representations:

The company must certainly be aware of the fact that its product contains little, if any, coagulable proteids.

CONCLUSIONS

In conclusion: Neither Bovinine nor Carnine is a meat juice, the former is anything but palatable and the latter soon cloys. “Valentine’s Meat Juice” and “Wyeth’s Beef Juice” are virtually diluted meat extracts, which are known to possess little food value. A physician depending on any of the foregoing products to supply material nourishment, in case of serious illness, is deceiving himself, starving his patients, and may be lessening their chances for recovery. If a patient recovers while using these commodities, it is certainly not due to the food value contained in them​—(From The Journal A. M. A., Nov. 20, 1909.)

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Some time ago the Council authorized publication of a report[V] dealing with the composition and claims made for a number of the more generally advertised meat and beef juices. Among these was Valentine’s Meat Juice. This it was shown was sold under an incorrect name, the claims for its composition were not truthfully stated and its exploiters made false and misleading claims in regard to its food value. As Valentine’s Meat Juice is still widely advertised the referee in charge of this class of products deemed a reexamination of the product advisable. This was made and on it was based the following report which has been submitted to the Council, adopted, and its publication authorized.

W. A. Puckner, Secretary.

Your referee has had examined recently purchased specimens of Valentine’s Meat Juice (Valentine’s Meat Juice Company, Richmond, Va.). The examination shows that it has virtually the same composition as that given in the report of the Council “Meat and Beef Juices” published in The Journal, Nov. 20, 1909. It contains practically no coagulable protein material, one of the products characteristic of a meat juice. It is essentially a diluted meat extract.

The following statement found in former circulars now seems to have been eliminated:

An endeavor is still made, however, to convey the idea that the product contains coagulable protein, as shown by the following:

The proprietors undoubtedly know that the product does not contain any coagulable material and that the statements just quoted are plain mis­rep­re­sen­ta­tions.

The advertising circular contains a large number of “Testimonials of the Medical Profession.” As all are undated, one cannot tell how old these testimonials are. One physician recommends it highly for hypodermic use; another says, “I have kept cases on it and it alone for days, without attempting to give any other food, and the results have been entirely satisfactory.” According to another, it is “most invaluable in typhoid fever and also in diphtheria.”

Valentine’s Meat Juice conflicts with the following rules of the Council:

Rule 1, in that its composition is not correctly given;

Rule 6, in that unwarranted therapeutic claims are made, the profession being led to believe that the product is highly nutritious and is valuable in the treatment of pneumonia, diphtheria and typhoid fever;

Rule 8, in that the name is objectionable, for while sold as a meat juice, in reality it has the character of a meat extract.

Valentine’s Meat Juice is a fraud on the public, and in view of its continued exploitation under false claims, the referee recommends that the Council reiterate its former condemnation and authorize the publication of this report.

[Editor’s Note.—The difference between meat extracts and meat juices was fully discussed in the previous report of the Council, Meat “juices” are made by the cold expression of meat with subsequent evaporation, in such a way that the nutritious coagulable proteins remain in solution. In making meat “extracts,” heat is used which almost completely removes the coagulable proteins and thus renders it practically devoid of nutrient qualities.

A list of some of the medical journals that carry advertisements of Valentine’s Meat Juice, follows:

Pediatrics	Virginia Medical Semi-Monthly
Old Dominion Journal of Medicine & Surgery	Medical Times
	American Medicine.]
Medical World	—(From The Journal A. M. A., May 2, 1914.)

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A report, of which the following is an abstract, was submitted to the Council on Pharmacy and Chemistry by the subcommittee which examined the medicinal foods:

In order to determine the food value of any food product it is necessary to consider the following points: Chemical composition; available potential energy; absorbability and cost. No attempt is made in this article to discuss each of these features separately, but they are utilized as required.

The ingredients on which the food value of any article of food depends are the proteid substances, carbohydrates, fats, certain inorganic bodies and—​under certain conditions—​alcohol. The amount of each of these present in a preparation must be established by chemical analysis. From the results thus obtained it is possible to calculate the potential energy represented by a given food product. In this report the potential or food value is expressed in the large or kilocalorie, that is, the amount of heat required to raise the temperature of one kilogram of water one degree centigrade.

The factors employed in this report for expressing in calories the actual amount of energy utilized by the system are 4.8 for proteid substances, 4.1 for carbohydrates, and 9.2 for fats.

The accompanying table embodies the results obtained by submitting all the well-known so-called “predigested foods” to chemical examination. The table as published in The Journal included columns on: Price of bottle, number of cubic centimeters in a bottle, cost per 500 cubic centimeters, reaction, specific gravity, percentage of non-volatile residue, ash, percentage of nitrogen, calories as proteids in 500 grams, carbohydrates before inversion, alcohol by volume, average recommended adult dose per diem in cubic centimeters, cost per diem to supply 1,430 calories. These columns were eliminated from this abstract, as they were unessential, so far as the practical value of the article is concerned. In most cases two samples of the same brand were purchased at an interval of about six months. All the analyses were made before Jan. 1, 1907. Some of the preparations contain much glycerin which does not, so far as known at present, possess any recognized food value, although there are a number of experiments on record to indicate that it influences metabolism.

The percentage of nitrogen accredited to each of these products represents the total amount of nitrogen, irrespective of the nature of the nitrogenous substances, although some of this nitrogen has no nutritive value.

By multiplying the percentage of nitrogen found by the factor 6.25 we obtain the percentage of nitrogenous matter (proteids) contained in the various preparations. By multiplying the number of grams of nitrogenous matter present in 500 grams of material by the factor 4.8 it is found that the potential energy available by the nitrogenous matter varies from 10.3 calories to 153.1 calories. Five hundred grams of the material is made the basis of calculation, because it approximates a pint, the amount usually believed to be present in the various trade packages, and because it affords a ready basis of calculation.

The carbohydrates are represented by cane sugar, maltose, dextrin and invert sugar. Lactose is probably also present in some, but it is impossible to establish this. By multiplying the number of grams of carbohydrates present in 500 grams of the foods by the factor 4.1 we obtain the potential energy represented by the carbohydrate, which varies from 11.3 to 319.2 calories. The total calorific value of both proteids and carbohydrates ranges from 54.7 to 397.5 calories. The total food value of an equal quantity of milk, including fat, approximates 360 calories.

The value of alcohol as a food product pure and simple in disease is, however, an open question. There is no doubt whatever but that it acts to a certain degree as a food even here, not as a tissue builder, but as a saver of fat and carbohydrate material, and in order to give the preparations in question full value as food products, the calories represented by the alcohol, are credited to each preparation, as are the proteids and carbohydrates. The factor usually recognized for expressing the calorific value of alcohol is 7. By multiplying the number of grams of alcohol present in 500 grams of material by 7, the number of calories varies from 420 to 658.

On looking over the literature and printed matter distributed by some manufacturers, the physician is frequently left under the impression that these preparations contain all the essential constituents necessary for maintaining normal nutrition of the body, as is clearly shown by the following quotation: “Contains sufficient nutritive material to maintain normal nutrition of the body, a valuable food in typhoid fever, pneumonia, tuberculosis,... and all the conditions of the system associated with enfeebled digestion and malnutrition.”

In order to show the insidiousness of such representations it is only necessary to give the actual food value of the average daily dose (the average amount to be taken for twenty-four hours) recommended by the various manufacturers for their products. The average adult daily dose recommended varies from 50 to 150 c.c. The total available calories per daily dose based on the proteid and carbohydrate bodies varies from 9.8 to 110.5. Adding to these figures the amount of energy represented by the alcohol, in each case, the total available calories varies from 55.0 to 299.5. The number of calories per diem in sickness should not fall much below 1,500 during twenty-four hours.

TABULATED RESULTS OF EXAMINATIONS OF MEDICINAL FOODS

Column Headings:
 2 = Glycerin and undetermined matter
 3 = Per cent nitrogenous matter (6.26)
 4 = Calories as proteids in 500 grams
 5 = Carbohydrates after inversion
 6 = Calories as carbohydrates in 500 grams
 7 = Calories as proteids and carbohydrates in 500 grams
 8 = Alcohol, by weight
 9 = Calories as alcohol in 500 grams
10 = Calories as proteids and carbohydrates per diem dose
11 = Total calories in per diem dose*
12 = Number c.c. required per diem to supply 1,430 calories

Name of Preparation and Manufacturer	2		3		4		5		6		7		8		9		10		11		12
Carpanutrine—John Wyeth & Brother	28	.45	4	.28	102	.7	5	.34	109	.5	212	.2	12	.5	437	.5	25	.5	78	.0	1,100	.7
Carpanutrine—John Wyeth & Brother	21	.29	6	.24	149	.8	5	.78	118	.5	268	.3	14	.0	490	.0	32	.2	91	.0	942	.9
Liquid Peptones—Eli Lilly & Company.	3	.63	4	.50	108	.0	6	.05	124	.0	232	.0	18	.0	630	.0	69	.6	258	.6	829	.4
Liquid Peptones, with Creosote—Eli Lilly & Company	4	.34	3	.84	92	.2	13	.47	276	.1	368	.3	18	.0	630	.0	110	.5	299	.5	716	.2
Nutrient Wine of Beef Peptone—Armour & Company	14	.97	0	.64	15	.4	15	.43	316	.3	331	.7	17	.5	612	.5	66	.3	188	.8	757	.4
Nutrient Wine of Beef Peptone—Armour & Company	13	.70	0	.43	10	.3	15	.57	319	.2	329	.5	17	.0	595	.0	65	.9	184	.9	773	.3
Nutritive Liquid Peptone—Parke, Davis & Company	1	.02	1	.86	44	.6	12	.89	264	.2	308	.8	18	.8	658	.0	74	.2	232	.1	739	.5
Nutritive Liquid Peptone—Parke, Davis & Company	1	.95	1	.16	27	.8	13	.19	270	.4	298	.2	17	.7	619	.5	71	.5	220	.2	779	.2
Peptonic Elixir—Wm. Merrell Chemical Company	3	.21	2	.54	61	.0	11	.46	234	.9	295	.9	16	.5	577	.5	53	.3	157	.2	818	.6
Tonic Beef S. & D.—Sharp & Dohme	12	.91	3	.40	81	.6	2	.36	48	.4	130	.0	12	.0	420	.0	13	.0	55	.0	1,300	.0
Tonic Beef S. & D.—Sharp & Dohme	12	.63	3	.28	78	.7	2	.22	45	.5	124	.2	13	.0	455	.0	12	.4	57	.9	1,234	.4
Liquid Peptone—Stevenson & Jester Company	0	.44	1	.81	43	.4	0	.55	11	.3	54	.7	12	.0	420	.0	9	.8	85	.4	1,506	.8
Cow’s Milk (3.8 per cent. fat)	....		3	.50	84	.0	4	.80	98	.4	182	.4	....		....		7	.3	1,429	.6	2,000	.0

*: Total calories per diem dose includes the calories of alcohol in the liquid medicinal foods and the calories of the fat in milk.

In order to get a fair conception of the actual food value of these various preparations, it is desirable to make some comparison which can be readily comprehended by every physician. The amount of good milk necessary each twenty-four hours to sustain the vitality of a patient during a serious illness is not less than 64 ounces, or approximately 2,000 c.c. The food value in calories represented by this amount of good milk may be placed at 1,430. This includes not only the proteid and carbohydrate matter, but the fat as well. By comparing this available potential energy with the total energy available in the predigested foods under consideration, it can be readily seen that if a physician depends on the representations made by some of the manufacturers, and feeds his patient accordingly, he is resorting to a starvation diet. The largest number of available calories, including alcohol, present in any of the recommended daily doses, is less than one-fifth of the number of calories represented by 2,000 c.c. of milk; and the calories represented by the daily dose of the preparation poorest in food products is only one-twenty-fifth of the amount present in 2,000 c.c. of milk. These figures tell their own story.

Making 2,000 c.c. of milk the basis of calculation, and estimating the amount of the various preparations required to yield this number of calories, it is found that the quantity to be administered daily to supply 1,430 calories, including alcohol, varies from 716.2 to 1,506.2 c.c. In many cases the amount of alcohol exhibited by these quantities would keep the patient in an alcoholic stupor continually. The cost necessary to supply this energy varies from $1.48 to $3.39. Compare these prices with the cost of two quarts of milk. Is further comment necessary?

It is urged in justification of the use of preparations of this class that they contain constituents not found in our ordinary foods and in a more perfectly assimilable condition. As pointed out above, these so-called predigested foods contain no fats; the carbohydrates in them are the ordinary sugars present in our common foods, while the proteins belong to the peptone or albumose class. It is for these latter that the greatest claims are made, but even here no value can be pointed out not found in whey, peptonized full milk or peptonized skimmed milk.

There is likewise another point of considerable importance to consider in this connection. The terms peptone and albumose include bodies of very uncertain composition, and their suitableness as food substances depends largely on how they are prepared. Animal experiments have shown that nitrogen equilibrium may be maintained, for a time at least, by use of enzymic hydrolytic products of the proteins, even where the hydrolysis has been carried far beyond the so-called peptone stage, but it appears to be likewise true that the mixtures secured by acid or high temperature steam hydrolysis have no such value. Some of these, indeed, may exhibit a toxic behavior. This is true in particular of some of the commercial varieties of peptone, and until more is known of the source of the bodies of protein character employed in the makeup of these “predigested” mixtures it is unwise to assume anything concerning the food value of the nitrogen compounds found in them by analysis or even to dignify them by the name of foods.​—(Abstracted from The Journal A. M. A., May 11, 1907.)

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The Council, having voted to rescind the acceptance of Migrainin and to omit it from New and Nonofficial Remedies (Appendix), directed publication of the report given below.

W. A. Puckner, Secretary.

SUPPLEMENTAL REPORT ON MIGRAININ

To the Council:—Koechl & Co., American agents for Migrainin (Meister Lucius & Bruning) asserted that this preparation was a mixture of antipyrin 85 parts, caffein 9 parts and citric acid 6 parts. The experiments of F. Zernik (Apoth.-Ztg., 1906, p. 686), however, showed that Migrainin consisted of antipyrin 90.88 parts, caffein 8.4 parts and citric acid 0.45 parts. When the attention of Koechl & Co. was called to this they informed the Council, on June 20, 1907, that the formula they gave was given them direct by the manufacturers abroad and that they, Koechl & Co., did not question its accuracy. They, however, offered to “write abroad and have the manufacturers confirm the formula as given.” On July 23, 1907, Koechl & Co. wrote the secretary of the Council that the manufacturers had informed them that Migrainin contains 90 per cent. antipyrin and 9.1 per cent. caffein citrate. This being an acknowledgment that the former statement submitted was incorrect, the Council voted that the approval of Migrainin should be reconsidered. Examination of the product, therefore, was taken up in the Association’s laboratory and an original specimen, purchased in Chicago, was found to contain moisture 0.7 per cent., antipyrin 90.93 per cent., and instead of caffein citrate 9.1 per cent., citric acid 0.51 per cent., caffein 8.53 per cent. This analysis agreed essentially with the composition of Migrainin as found by Zernik.

While the discrepancies between the statement of the firm and the facts are perhaps not great, nevertheless they show that even the formula last given is incorrect, and that the statements of Koechl & Co., while no doubt made in good faith, were in this instance unreliable.

In recent advertising matter issued by Koechl & Co., “phenozon-caffein citrate” is given as a synonym for Migrainin, one circular stating that “Migrainin is phenozon-caffein citrate,” etc. In the same circular the following also appears: “In the treatment of migraine with phenacetin or antipyrin, the attack is delayed, while with Migrainin it is usually permanently stayed.” This will, no doubt, lead physicians to infer that Migrainin is not a mixture of antipyrin and caffein citrate, but that it is some new compound. While the firm disclaims any intention to mislead, it does not offer to withdraw or modify this circular. It is recommended, therefore, that the approval of Migrainin be rescinded and that it be omitted from New and Nonofficial Remedies.​—(From The Journal A. M. A., June 5, 1909.)

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The following report was adopted by the Council. Its publication was authorized to show how a practically worthless mixture may be exploited by means of ill-considered testimonials.

W. A. Puckner, Secretary.

Neurilla, which appears to be the sole product of the Dad Chemical Company, New York, is advertised as

The following non-quantitative and indefinite formula is given on the label of a recently purchased bottle of Neurilla:

According to the formula, then, this mixture contains, aside from alcohol and aromatics, two vegetable drugs, scutellaria and passiflora, on which the alleged virtues of the preparation must be presumed to depend.

Scutellaria lateriflora, or skullcap, is a bitter drug, one of the many “herbs” to which, on wholly unreliable “clinical evidence,” therapeutic properties were at one time ascribed. Most pharmacologists do not mention the drug, and those who do generally state that it has very feeble therapeutic properties. It was admitted to the Pharmacopeia, but in 1909 its deletion was recommended by a committee of the Section on Practice of Medicine of the American Medical Association (The Journal A. M. A., Sept. 4, 1909, p. 792). We understand that the next edition of the Pharmacopeia will omit mention of skullcap.

Passiflora incarnata, or passion-flower, is another “herb,” which, although known for about seventy years, has never gained the confidence of the medical profession and has not even been admitted to the Pharmacopeia. According to a Council Report:

“None of the evidence is sufficient to show that passiflora has therapeutic value; hence it is deemed inadvisable to include the drug in the list of nonofficial remedies” (The Journal A. M. A., March 19, 1910, p. 983).

On these two obsolescent “herbs,” then, rest the remarkable claims made for Neurilla. A certain degree of appetizing effect may be expected from the bitter taste and a very slight degree of physical stimulus from the alcohol. Except for these effects—​and they are largely delusive and temporary—​the preparation is therapeutically inert and worthless.

The evidence on which the manufacturers of Neurilla base their therapeutic claims appears to consist of testimonials from physicians. As a matter of fact, this is true of practically all of the large group of nostrums of which Neurilla is typical. An analysis of these Neurilla testimonials brings out clearly what such “evidence” is worth.

ILL-CONSIDERED TESTIMONIALS

The testimonials for Neurilla have been given with reference to indefinite conditions of nervousness that border on the psychic and include hysteria, neurasthenia, neuralgia and the like. Nervousness and indigestion are two diseases in which suggestion, especially when aided by bitters and alcohol, produces temporarily a feeling of improvement. As an illustration, take the following testimonial:

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

TESTIMONIALS GIVEN LONG AGO—THE REMEDY ABANDONED

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

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

Dr. A now says:

Dr. B is quoted as having written:

Dr. B writes:

Dr. C once wrote:

Dr. C now writes:

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

Dr. D sums up his later experience by saying:

The following bears Dr. E’s name:

This is what Dr. E writes now:

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

Dr. F now writes:

SUMMARY

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

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

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

Archives of Pediatrics,	Medical Sentinel,
Atlanta Journal Record of Medicine,	Medical Standard,
Charlotte Medical Journal,	Pacific Medical Journal,
Indianapolis Medical Journal,	Southern Practitioner,
International Journal of Surgery,	Texas Medical Journal,
Journal of Nervous and Mental Diseases,	Woman’s Medical Journal,
Medical Herald,	Eclectic Medical Journal,
New York Medical Record,	Ellingwood’s Therapeutist,
Medical Review of Reviews,	Journal of the American Institute of Homeopathy.]
—(From The Journal A. M. A., March 27, 1914.)

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

W. A. Puckner, Secretary.

According to the manufacturers, each fluidounce of Neurosine represents:

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

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

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

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

The assurance is offered:

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

Here is another recommendation—this time for chorea:

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

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

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

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

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

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

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

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

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

The company says:

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

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

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

“[HBF₄ + BOH (OC₆H₄COOH)₂
+ BOH (OC₆H₃COOH)₂ + C₃H₅BO₃
+ CH₂O + C₁₀H₁₄O
+ C₁₀H₂₀O + C₂₄H₂₈N₃Cl.]”

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

“[C₇H₆O₂ + H₃BO₃ + C₃H₅BO₃
+ (CH₂O)₃ + C₁₀H₂₀O + C₁₀H₁₄O + C₂H₆O]”

3. In another advertising circular:

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

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

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

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

One and all of these various formulas spell mystery. The existence of some of the constituents is problematic; even if the theoretical possibility of such combinations be conceded, some of them could not exist in Germiletum, for they would be broken up by the alkaline fluid. As illustrating the contradictions which the formulas present: While the wrapper of the “large size” trade package claims that Germiletum contains ³⁄₄ minims Formalin (Formalin is a proprietary name for a 40 per cent. formaldehyd solution) the label on the bottle claims only ¹⁄₂ minim. Again, while the composition expressed in chemical symbols asserts that “H₃BO₃” (boric acid) is a constituent of Germiletum, the “formula” which follows it states that Germiletum has an alkaline reaction; hence it cannot contain much boric acid. Finally, the “small size” bottle of Germiletum purchased at the same time as the “large size” bottle and also the label of a sample package sent through the mails to a physician in 1914, give as a constituent “Boro­hydro­fluoric Acid,” which is mentioned neither on the label of the “large size” trade package nor in the pamphlet wrapped around it. The only information which these contradictory “formulas” can convey to a physician is that Germiletum is an unscientific, varying mixture of many drugs.

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

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

This claim, as well as the assertion which appears on the label of a sample package and of the “small size” trade package that it is “PAR-EXCELLENT IN OBSTETRICAL PRACTICE” is almost criminal, as Fussell60 has said, since to depend on any preparation of this sort is to court disaster.

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

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

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

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

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

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

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

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

[Editorial Note.—The four nostrums mentioned above have been grouped together for publication to call attention to one phase of the proprietary business. A fact not mentioned in the Council’s report is that these nostrums are manufactured and promoted by a concern that belongs to a type we have often designated “pseudo-chemical” companies. By this is meant companies that are not in the legitimate business of pharmacy or chemistry, but organized to exploit one, two or in some instances half a dozen proprietaries. “Patent medicines” are exploited by this class of “companies.” The Dios Chemical Company is not a chemical company, except in name. J. H. Chambers, the founder so far as we can learn, never claimed any special knowledge of chemistry, pharmacy or medicine. The officers at the present time are: J. H. Chambers, president; M. E. Chambers, vice-president; Leslie T. Chambers, treasurer, and Arthur Chambers, secretary. M. E. is the wife of J. H., and Leslie T. and Arthur are sons.

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

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

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

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

Analysis of Oxychlorine showed:

Potassium	12.26	per cent.
Sodium	8.20	per cent.
Chloric acid—CLO3	25.32	per cent.
Nitric acid—NO3	21.70	per cent.
Boric acid anhydrid—B2O3	18.63	per cent.
Water, calculated	13.29	per cent.

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

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

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

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

W. A. Puckner, Secretary.

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

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

Surely these people must have access to physiologic and chemical authorities not found in modern medical libraries, or else their esoteric researches into the mysteries of life must have carried them far beyond the ken of our most advanced workers along these lines. The scientific world would receive with great interest information as to how a mixture of potassium chlorate, sodium nitrate and boric acid oxygenates blood, maintains nutrition and causes healing without scar formation. A mixture which will destroy micro-organisms and yet will not destroy a living cell certainly shows a fine sense of selection and discrimination not heretofore expected of a combination of chemicals or of a chemical compound. How like the wonderful elixir of medieval times, which was to the Christian a tonic and to the heathen a poison!

Here is another claim made for this nostrum:

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

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

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

W. A. Puckner, Secretary.

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

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

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

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

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

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

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

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

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

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

The writer of the second testimonial is reported to have written that he tried Pam-ala “on a most pronounced case of malarial spleen with the most excellent results” and that he “also tried Pam-ala on a case of Malarial Cystitis and Hematuria, with entire satisfaction.” In reply to inquiry this physician admits that he was “very favorably impressed with the preparation at the time.” He states that at that time he was also trying out Sinkina and that after six months he “discontinued the use of both as the results did not warrant further investigation.” He concludes:

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

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

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

WHAT IS PAM-ALA?

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

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

W. A. Puckner, Secretary.

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

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

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

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

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

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

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

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

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

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

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

THE L. D. JOHNS COMPANY

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

Cascarans (Bell)		Dr. Johns’ Tablets
“Taken as directed, it permanently removes the great majority of cases of habitual constipation.”  “... a harmless vegetable preparation.”  “... for the removal of pimples, yellowness and greasiness of the skin ...”  “... one tablet at night, one night and morning, or, in severe cases, one three time a day, gradually decreasing the frequency of the dose as improvement permits.”		“Taken as directed ... permanently remove the great majority of cases of habitual constipation, torpid liver and sick headache.”  “A harmless vegetable remedy.”  “... removes pimples, blotches, sallow­ness and greasiness of the skin ...”  “One at night, one night and morning, or, in severe cases, one three times a day. Gradually decrease the frequency of the dose as improve­ment permits.”

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

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

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

BELL & CO.		L. D. JOHNS CO.
President	John L. Dodge	President
Secretary	Geo. C. Tennant	Vice-President
Vice-President	Chas. B. Smith	Secretary and Treasurer

EXPLOITING THE PROFESSION

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

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

W. A. Puckner, Secretary.

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

On the clinical side the reports are not numerous and such as have been made do not appear to be based on very extensive trials nor on conditions of observation that would entitle them to more than slight consideration. S. D. Bullington64 reports good results, but no cure, in one case of epilepsy, and improvement in a case of insomnia. W. J. Stapleton65 recommends it in the form of a concentrated tincture (not the one advertised so extensively), and states that he has used it with great success in insomnia, hysteria, neurasthenia, neuralgia, nervous and physical prostration, and in alcoholism. In his opinion its action is most apparent in cases of nervousness due to causes other than pain. S. Harnsberger66 reports two cases in which partial blindness followed the taking of potassium bromid and passion flower.

Extravagant and inconsistent claims are made for Daniel’s concentrated tincture of passiflora in the advertising literature, where it is recommended for such a wide range of diseases as asthma, typhoid fever, convulsions and paralysis.

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

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

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

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

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

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

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

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

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

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

1. That the Council on Pharmacy and Chemistry refuse to approve liquid preparations that are claimed to contain both pepsin and pancreatin.

2. That the medical profession through the Journal of the American Medical Association be advised of the fallacy of employing such combinations.

3. That the attention of manufacturers be called to the worthlessness of such incompatible liquid preparations of pepsin and pancreatin, and that they be urged to cease offering such products to the profession.

4. That, since the National Formulary has recognized a preparation of this kind under the title “Elixir Digestivum Compositum,” the American Pharmaceutical Association be requested to instruct its committee on the National Formulary to omit this preparation from the next edition.

The recommendations of the subcommittee were adopted by the Council and publication of the report directed.​—(From The Journal A. M. A., Feb. 2, 1907.)

W. A. Puckner, Secretary.

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

W. A. Puckner, Secretary.

About ten years ago the M. J. Breitenbach Company circulated what pretended to be an abstract of the report of a government commission for the investigation of the anemia then prevalent in Porto Rico. The company asserted that “this report alone would suffice to establish Pepto-Mangan at once as the foremost hematinic known.” Examination of the official report of the commission67 revealed the fact that the administration of iron in hookworm anemia was considered of secondary importance, and that of the various preparations of iron, Blaud’s pill was found to be more efficient than Pepto-Mangan (Gude). A protest68 was made at this time by the commission against the unwarranted use of its report by the Breitenbach Company.

Later the Breitenbach Company sent out a report pretending to prove that at the Infants Hospital, Randall’s Island, New York City, Pepto-Mangan (Gude) had been found a most superior preparation in the treatment of infantile anemia. Inspection of the hospital records and daily charts of the cases disclosed69 a remarkable disparity between the claims of the Pepto-Mangan pamphlet and the real results of treatment. And so here, also, as well as in the Porto Rico commission’s report the trials, selected by the Breitenbach Company prove the limitations and non-superiority of Pepto-Mangan.

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

Another extravagant claim:

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

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

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

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

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

W. A. Puckner, Secretary.

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

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

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

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

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

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

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

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

U. S. P. VIII, 1905	0.	870	to 0.940	at 25°
Ph. Brit. IV, 1895	0.	885	to 0.890	at 15.5°
B. P. C. II, 1911, usually	0.	875	or lower	at 15°
Ph. Germ. V, 1910, at least	0.	885		at 15°
Ph. Ross. VI, 1910	0.	880	to 0.885	at 15°
Ph. Hung. III, 1909	0.	88	to 0.89	at 15°
Ph. Ital. III, 1909	0.	875	to 0.890	at 15°
Ph. Fr. V, 1908, about	0.	875		at 15°
Ph. Serb. II, 1908, about	0.	880		at 15°
Ph. Svec. IX, 1908	0.	88	to 0.90	at 15°
Ph. Helv. IV, 1907	0.	880	to 0.885	at 15°
Ph. Dan. VII, 1907, at least	0.	880		at 15°
Ph. Austr. VIII, 1906, at least	0.	880		at 15°
Ph. Belg. III, 1906, not below	0.	880		at 15°
Ph. Japon. III, 1906	0.	875	to 0.945	at 15°
Ph. Ndl. IV, 1905, not below	0.	860		at 15°
Ph. Hisp. VII, 1905	0.	840		at 15°

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

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

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

There is considerable difference in the chemical composition of the paraffin oils obtained from various sources. The American oil consists largely of hydrocarbons of the methane series, while the Russian oil contains naphthenes or hydrocarbons of the benzene series, having the empirical composition of ethylene, (C_nH_2n) which may be considered as hydrogenated aromatic hydrocarbons, though they behave with reagents very much in the same way as do the hydrocarbons of the methane series.

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

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

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

During the past year or two liquid petrolatum has attracted considerable attention as a remedy in the treatment of intestinal stasis or chronic constipation, the practice of using it having been developed largely through its recommendation by Sir W. Arbuthnot Lane and his associates. This use of liquid petrolatum and of petrolatum products generally is by no means novel. N. A. Randolph70 of Philadelphia was among the first to suggest its use for this purpose in an article published in 1885. Randolph also appears to have been the first to experiment with petrolatum and to determine its non-absorbability from the intestinal tract. In an article71 in 1884 he concludes that “pure petrolatum while entirely unirritating to the digestive tract is valueless as a foodstuff.”

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

William Duffield Robinson72 reports on the use of a perfectly refined colorless and odorless petrolatum, supposedly of American origin. He was able to show that all of the product passed unchanged through the intestinal tract and could be regained from the feces. In his conclusions he expressed the belief that the effect of the administration of these petroleum products is far more than as a simple intestinal lubricant. In over fifty selected cases in which nutrition, digestion and body-weight were impaired, and the purest oil administered in 1- or 2-dram doses each day for a period of from four to six months, there was in every instance an improvement of weight, health and feeling of well-being. The administration of refined paraffin oil gave no discomfort in any instance, even in cases in which nearly a pint was given in a few hours.

William Ewart73 suggests liquid paraffin as a safe agent for the local treatment of the lesions in typhoid fever. He says in part: “Mineral oil, such as petrolatum or paraffin, is neither absorbed nor dissolved; therefore, after all absorbable ingestions are taken up by the lacteals, it will still remain in the bowel. In this way pure liquid paraffin is valuable, precisely because it is inert; moreover, it might some day, perhaps, be made the vehicle for effective topical remedies.”

A. D. Schmidt74 quotes Stubenrath as having given liquid paraffin in the treatment of chronic constipation, and he himself gave as much as 20 gm. of liquid paraffin to adults without observing any injurious effect whatever. He says, “As a result of the administration of liquid paraffin, the feces are softened considerably and are found under the microscope to contain numerous minute globules of paraffin.” He was, however, unable to recover from the feces the entire quantity of paraffin administered and believes that a certain portion of it, probably the fractions with a low boiling-point, are absorbed or possibly oxidized in the organism.

Maurice Vejux Tyrode75 also refers to the use of liquid petroleum in the treatment of constipation.

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

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

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

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

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

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

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

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

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

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

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

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

CONCLUSIONS

The conclusions to be drawn from the clinical reports are:

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

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

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

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

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

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

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

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

In the reports, one clinician noted no differences that were not negligible. Another was slightly in favor of No. 2 (heavy Russian) as regards taste. A third reporter did not make comparative tests. A fourth is slightly in favor of “B” (heavy Russian) as regards taste and general suitability. All of the findings of this investigation are based on hospital cases. A fifth reporter favored No. 1 (light Russian petrolatum). He considered it the most prompt in its effect, the most uniform in results, and the most prone to give a satisfactory admixture of the oil with the other materials. The difference, however, from the other oils was not marked. Another reporter noted no special differences.

SUMMARY

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

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

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

W. A. Puckner, Secretary.

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

A PETROLEUM PRODUCT

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

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

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

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

FIRST ADVERTISED AS A “FOOD-MEDICINE”

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

In 1897 it was an:

In 1899 it:

In 1902 it:

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

LATER ADVERTISED AS NON-ABSORBABLE

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

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

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

In 1914 medical men are advised through the advertising pages of the British Medical Journal of the:

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

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

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

UNWARRANTED AND MISLEADING CLAIMS

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

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

COMPOSITION AND FORMULAS

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

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

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

LABORATORY REPORT

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

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

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

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

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

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

Phecotone contains ten ingredients.

Extravagant claims such as the following are made:

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

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

W. A. Puckner, Secretary.

COMMENTS

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

The trade package assures the purchaser that Prunoids are:

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

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

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

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

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

W. A. Puckner, Secretary.

The report of the referee follows:

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

A circular around the bottle contains the following:

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

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

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

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

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

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

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

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

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

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

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

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

“The abuse of saline cathartics by the public is an evil deserving of serious attention. Rightly or wrongly, the laity fear constipation and naturally take what they are taught to believe is the cheapest and simplest course for its relief, self-drugging by means of saline cathartics or the extensively advertised purgative mineral waters. This habit is responsible for much of the distressing spastic constipation that exists, and its accompanying neurasthenia. The advertisement and sale to the laity of such a nostrum as “Sal Hepatica” can only increase these evil results and the physician who aids and abets the evil by using the preparation should reflect whether he is thereby not only encouraging a fraud on the public but also, what is even worse, helping to impair the public health.”

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

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

W. A. Puckner, Secretary.

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

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

Again it is:

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

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

THE VALUE OF SANTAL AND SAW PALMETTO

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

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

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

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

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

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

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

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

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

The physician who prescribes Sanmetto prescribes a secret medicine for conditions which he is presumably competent to treat with simple remedies of which he knows the origin and action and which he can vary to suit the needs of the individual.

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

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

W. A. Puckner, Secretary.

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

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

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

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

Secretin is a hormone, a chemical substance produced by the action of hydrochloric acid on a previously formed substance, “prosecretin,” contained in the cells of the intestinal mucous membrane, especially of the duodenum. Secretin is absorbed by the blood and carried to the pancreas, liver and intestinal mucosa, which are thereby stimulated to produce their characteristic secretions, namely, bile, pancreatic juice and succus entericus. When secretin is injected into the blood, it causes an increase in the flow of these secretions. Some observers have claimed that secretin is absent in cases of diabetes in which the pancreas is still found normal. Wentworth80 reported several cases of marasmus in which he found no evidence of prosecretin. This deficiency, he believes, is the cause of this disease.

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

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

The proof that the absence of secretin is characteristic of diabetes or of marasmus is not yet available. Sweet and Pemberton81 found that many circumstances interfered with the extraction of secretin, so that the mere failure to obtain it in a given case is not proof of its absence, unless the various inhibiting influences are given due consideration. The conclusions reached by these authors are that “the evidence so far adduced that secretin is absent in some varieties (of diabetes) does not seem conclusive,” and that “the specific absence or deficiency of secretin in marasmus seems to remain as yet unproven.”

The favorable reports of Moore82 in regard to the use of secretin in diabetes are not confirmed by the experience of Foster83 in five cases, or by the case reported by Dakin and Ransom.84

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

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

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

The G. W. Carnrick Company introduces a number of testimonials as to the value of Secretogen. These testimonials are similar to all testimonials. They include no evidence of careful diagnosis, and present an uncritical estimate of the results. They show that the writers have given Secretogen Elixir or Tablets in­dis­crim­in­ate­ly in almost the whole range of digestive disorders, in nephritis, neuralgia, liver disease and gallstones, exophthalmic goiter, neurasthenia, epilepsy, etc. As dependable evidence, these testimonials are not worthy of consideration.

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

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

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

REFERENCES

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

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

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

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

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

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

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

—(From The Journal A. M. A., May 1, 1915.)

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

W. A. Puckner, Secretary.

THE COUNCIL’S FIRST REPORT

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

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

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

THE CLINICAL REPORT

The following quotations indicate the claims made for this preparation:

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

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

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

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

FIRST INVESTIGATION

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

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

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

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

SECOND INVESTIGATION

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

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

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

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

THIRD INVESTIGATION

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

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

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

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

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

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

The investigator also reported a case of benign tertian malaria.

Case 10.—This was in a child of 8 years which was treated by the investigator’s confrère and gave similar negative results. Blood examination showed numerous parasites. The child was placed on 1 ounce of Sinkina three times a day and kept on it for two weeks. The clinical picture remained unaltered, and parasites could be detected in numbers whenever examinations were conducted. A gradually increasing enlargement of the spleen was also noted. At the end of two weeks quinin was substituted, and the child went on to a rapid and uneventful recovery.

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

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

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

When these experiments were begun, April, 1906, there was nothing in the advertising literature on Somnos to indicate whether this article is a solution or a pure substance. On the label on the bottle, in the circular accompanying the bottle, and in the booklet “Somnos,” the word Somnos seemed to be used as a synonym of “Chorethanal alcoholate,” C₉H₁₁O₅Cl₉, and physicians were prescribing and pharmacists dispensing it in the belief that it was a pure substance. “The pure substance; some kind of an alcohol; nothing to do with choral,” was the way the druggist from whom the samples were purchased put it. Thus information absolutely indispensable for any rational comparison of Somnos with other hypnotics was withheld from the physician.86

Hence, before beginning the physiologic experiments it was necessary to determine the strength of the preparation; for this purpose three chlorin determinations (by the Carius method) were made. On the assumption that all the chlorin present was in combination as chloral glycerate, C₃H₅[CCl₃.C(OH)₂]₃ = C₉H₁₁O₆Cl₉, and calculating the percentage of this in Somnos, the following results were obtained: (1) 5.11 per cent.; (2) 5.15 per cent.; (3) 5.10 per cent.

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

FATAL DOSE OF SOMNOS FOR THE LOWER ANIMALS

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

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CONCLUSIONS

To sum up our results on the physiologic action of Somnos: We have been completely unable to verify the claims of the manufacturers that Somnos is less toxic than hydrated chloral, or that it has a less depressing effect on temperature, respiration or circulation. On the contrary, the physiologic effects are in­dis­tin­guish­able from those of hydrated chloral, doubtless because the action of Somnos is simply the action of hydrated chloral. We can see nothing in the animal experiments or in the chemical composition which would suggest that Somnos would possess therapeutic advantages over an elixir of hydrated chloral of corresponding strength.88

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

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The following report was adopted by the Council:

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

W. A. Puckner, Secretary.

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

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

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

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

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

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

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

The recommendations of the subcommittee were adopted by the Council and in accordance therewith the report is published with comments, substantially as follows: The formula means that it is a solution of well-known salts, some of them under partially disguised names. Every one knows what Glauber’s salts are good for. Disodium hydrogen phosphate is ordinary common sodium phosphate. Sodium thiosulphate is familiar as sodium hyposulphite, the “hypo” of the photographers. Every one knows, of course, that sodium chlorid is common salt. Examination and analysis of various specimens of this product demonstrated that its composition is not always the same. As an indication of the ignorance of the promoters of this nostrum it is interesting to note that the label on one of the bottles purchased states that it is a “sulphophosphate” instead of a sulphophosphite. Extravagant claims are made for this simple mixture of laxative salts, and these with the methods of using it are printed on the labels, and while it is claimed to be only advertised to the profession, the physician is repeatedly advised in the advertisements to “order always an original (six ounce) bottle to prevent substitution.” The natural result of this would be, of course, to put the patient in the way of prescribing it for himself and to spread the advertisement of the drug among the public. Difficulty has been experienced in finding out who the promoters of this nostrum are and the correspondence in regard to it is published. They seem to prefer to be known by their corporate title of Laine Chemical Company only. It is a sample of many other so-called ethical proprietary drugs, most of which are simple mixtures of well-known drugs which physicians are using every day and which require no skill in their compounding. Their proprietors not only presume to sell and advertise medicines but also to tell the physicians how to treat their patients.​—(Abstracted from The Journal A. M. A., Dec. 8, 1906.)

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

The “formula” given for Taurocol Compound Tablets is:

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

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

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

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

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

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

W. A. Puckner, Secretary.

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

LABORATORY REPORT

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

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

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

The differences between the formulas are striking. Colchicin has been reduced from ¹⁄₂₀ grain to ¹⁄₂₀₀ grain; sodium salicylate from 10 grains to 3¹⁄₂ grains; iodin (claimed to be present as iodic acid) from ⁷⁄₃₂ grain to ⁷⁄₁₂₅ grain. “Phytolaccin” (“Decandrin”) has been replaced by “Phytolacca” and “Solanin” by “Mydriatic Alkaloids.” While the formula for the preparation has been changed, the circular accompanying the package still refers to “solanin” (in some parts of the circular wrongly spelled “salonin”) and “phytolaccin.” As no principle having the characteristic effects of poke-root is known to have been isolated the terms “decandrin” and “phytolaccin” are meaningless.

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

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

ABSURD CLAIMS

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

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

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

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

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

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

Three Chlorides (Henry) is advertised as:

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

LABORATORY REPORT

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

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

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

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

OBJECTIONABLE ADVERTISING

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

Further, that “Maizo-Lithium” is:

Also that “Satyria” is:

We are told that

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

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

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

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

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

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

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

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

LABORATORY REPORT

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

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

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

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

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

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

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

[Editorial Note.—When the Council on Pharmacy and Chemistry was started we announced that we did not see any clear line of demarcation between “patent medicines” and many so-called “ethical proprietaries.” Time has not caused us to change our opinion. As we have already shown, and as we shall have occasion to show in the future, not a few of the “ethical proprietaries” offered to physicians are being advertised by those who are pushing the rankest of “patent medicines.” The three preparations mentioned above are sold—​and presumably manufactured—​by Mr. Ballard, of St. Louis. Mr. Ballard is the promoter of Ballard’s Snow Liniment, Brown’s Iron Bitters, Herbine, Dr. Herrick’s Vegetable Liver Pills, Swaim’s Panacea, Renne’s Pain Killing Oil, etc. He is also the promoter of Campho-Phenique, exposed in The Journal some eight years ago.89 The spectacle is not an edifying one. A manufacturer with one hand offers the public a profusion of cure-alls, while with the other he endeavors to foist on the medical profession preparations which are just as fraudulent. Some day our profession will awake to the disgrace of it all. It will also awake to the fact, which should have been evident ere this, that the nostrum business would cease if physicians would refuse to accept into their offices, even as a gift, the nostrum-promoting medical journals that live off this trade. Fraudulent “patent medicines” will continue to thrive just so long as newspapers will publish “patent medicine” advertisements; fraudulent “ethical proprietaries” will continue to exist just so long as medical journals will advertise such proprietaries. As the better class of newspapers are rejecting “patent medicine” advertising on their own volition, so are the better class of medical journals rejecting advertisements of fraudulent proprietaries. Some newspapers will continue to carry nostrum advertising until their subscribers raise a protest that will cause the business department to take notice; so, too, some medical journals will continue to share the profits with the nostrum exploiters until an outraged medical profession repudiates such publications.]​—(From The Journal A. M. A., Feb. 6, 1915.)

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

To the Council on Pharmacy and Chemistry:—We beg leave to report on Thialion as follows:

Thialion is sold by the Vass Chemical Co., Danbury, Conn. In the literature supplied to physicians and in the advertisements in medical journals, Thialion is stated to be “a laxative salt of lithia” with the chemical formula “3Li₂O.NaO.SO₃.7HO.” “Sodio-trilithic anhydrosulphate” is given as a synonym. An elaborate graphic or structural formula is also given.

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

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

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

The recommendations of the subcommittee were adopted by the Council and in accordance therewith the above report is published.

W. A. Puckner, Secretary.

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

But there are hundreds of other so-called “new chemical” compounds among the “ethical” proprietaries on the market aside from the acetanilid mixtures. These wonderful compounds, by the mysterious union of their ingredients, possess therapeutic properties different from, or more powerful for good than the drugs from which they are made. At least, this is what we are told, and this is what many believe or they would not sell so well.

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

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

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

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

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Unguentum Selenio Vanadic (v. Roemer) is an ointment manufactured by A. von Roemer, Brooklyn, N. Y., and put on the market by Schering and Glatz, New York. It is claimed to contain 1 per cent. of selenium oxycyanid and 1 per cent. of vanadium chlorid “so prepared and incorporated into a modified lanolin base as to insure complete absorption.” The preparation is recommended in the later stages of inoperable carcinoma, sarcoma, epithelioma and other malignant tumors, as a substitute for morphin and other narcotics to control pain, as a modifying (ante-operative) treatment in the middle stage of malignant cases presenting the characteristics of being inoperable, and as a prophylactic treatment of recurrences and metastases following excision of malignant tumors. It is also recommended for use in slow-healing surgical wounds, abscesses, tuberculous and mixed septic and gangrenous processes, etc., in lupus, acne, eczema, psoriasis, scabies, erythemata, adenomata, angiomata, papillomata, etc. The use of the ointment is further recommended by systemic inunction in septicemia, pneumonia, erysipelas, cerebrospinal meningitis, septic rheumatism, septic neuritis, etc. The Council voted that the preparation be not accepted for inclusion with New and Nonofficial Remedies because no evidence has been submitted that the vanadium and selenium are absorbed or that they produce any of the effects claimed.

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

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The Council has voted that recognition be refused to the following: Unicorn Root (Aletris farinosa), Wild Yam (Dioscorea villosa), and Wild Indigo (Baptisia tinctoria) and has authorized the publication of the following statements.

W. A. Puckner, Secretary.

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

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

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

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

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

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

W. A. Puckner, Secretary.

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

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

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

The following is quoted from an advertising circular:

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

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

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

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

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

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

W. A. Puckner, Secretary.

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

According to another circular Venarsen is

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

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

LABORATORY REPORT

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

“Veracolate (plain).”—For this the following non-quantitative formula is given:

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

“Veracolate with Pepsin and Pancreatin.”—The following “formula” is given for this mixture:

“Veracolate	11⁄4	grain
“Pure Pancreatin	1	grain
“Pepsin aseptic (1:3,000)	1⁄2	grain
“Oil peppermint	1⁄10	min.”

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

“Veracolate with Iron, Quinine and Strychnine.”—This is stated to have the following “formula”:

“Veracolate	11⁄8	grain
“Reduced Iron	1	grain
“Quinine Sulphate	3⁄8	grain
“Strychnine Sulphate	1⁄100	grain”

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

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

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

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

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

And the physician is asked to believe that it will:

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

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

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

W. A. Puckner, Secretary.

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

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

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

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

DISCUSSION OF ALLEGED INGREDIENTS

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

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

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

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

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

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

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

CONCLUSIONS

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

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

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

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

5. Whisky has the same alcoholic content (50 per cent.) as Hayden’s Viburnum Compound; the dangers in the use of whisky are well known and its value as a therapeutic agent is being questioned more and more every year.

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

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

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

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

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

Specific gravity		0	.9959
Alcohol by volume	per cent.	10	.99
Extract	per cent.	2	.279
Volatile acids	per cent.	0	.0914
Ash	per cent.	0	.2801
Reducing sugar		trace.
Pol. direct	degrees	—0	.8
Pol. invert	degrees	—0	.7
K.So	M. per liter	0	.092

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

Specific gravity		1	.0125
Alcohol by volume	per cent.	16	.15
Extract	per cent.	8	.602
Ash	per cent.	0	.277
Glycerin	per cent.	0	.444
Volatile acid	per cent.	0	.0747
Tartaric acid	per cent.	0	.2400
Alkaloids (coca bases)	per cent.	0	.0250
Cane sugar	per cent.	2	.35
Reducing sugar	per cent.	3	.38

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

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

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

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

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

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

The report concludes:

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

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

W. A. Puckner, Secretary.

VIN MARIANI MADE IN THIS COUNTRY

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

ADVERTISED TO THE PUBLIC

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

AN ETHICAL CURE-ALL

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

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

WHY BLAME THE LAYMAN FOR USING NOSTRUMS?

Can we blame the layman for using Peruna, Wine of Cardui, etc., simply because they are advertised, when there are physicians who, for the same reason, prescribe concoctions that are just as quackish and just as useless? And can editors of medical journals consistently find fault with newspapers for carrying advertisements of fraudulent “patent medicines” when they themselves admit to their pages advertisements of nostrums that are no less fraudulent and of no more value?

MEMBER OF PROPRIETARY ASSOCIATION

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

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

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

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

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

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

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

“There is no appreciable diastatic action. A little glycerol is present in the volatile matter. The preparation is therefore an extract of malt with fat and a small amount of protein.”

He then continues:

“That Virol has food value cannot be denied, but that it has sufficient value to warrant the claims of the manufacturers is not evident. Virol cannot be considered a complete food, as the advertising literature reiterates, or an ideal food for infants. The amount of protein is far too low in comparison with the carbohydrates to warrant this view. The dosage recommended is not large. Thirty gm. a day would furnish only about 1 gm. of protein and 4 gm. of fat. The 3 teaspoonfuls a day recommended for children would furnish protein and fat even below this.

“If employed alone it cannot be a complete or sufficient food, and if employed along with other articles of diet—​milk and bread, for example—​it is not easy to see wherein lies the efficacy of the small weights of fat and protein added in the form of Virol. Here the demand made on our credulity is too great, as the protein in the preparation is the familiar protein of eggs, meat and malt, and the fat largely that from the egg-yolk and marrow, according to the claims. It is not known that any specific virtues reside in these bodies, or in the egg-shells, also claimed as present.

“In the opinion of the present referee there is nothing in the composition of Virol to justify the claims made for it. The judgment and recommendations of the first referee follow from the facts and must be accepted by the Council.”

The Council directed that the previously prepared report be allowed to stand and that it be published along with a suitable reference to the report of the second referee.​—(From The Journal A. M. A., Feb. 20, 1915.)

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An abstract of an article concerning “anusol suppositories” was published in The Journal, Jan. 23, 1909. This gave the results of an analysis by a foreign chemist, J. F. Suyver, which were to the effect that “anusol suppositories” contained no “anusol.” Schering & Glatz, the American agents for “anusol” suppositories, took exceptions to the abstract, asked that The Journal retract, and submitted the findings of a chemist in support of their claim that the suppositories do contain “anusol.” To determine the composition of “anusol hemorrhoidal suppositories” as they are found on the American market, trade packages were purchased (April 6, 1909) and submitted to examination90 in the Association’s laboratory.

According to the claims of the manufacturers, 12 suppositories contain:

“Anusoli	7.5	grams.
“Zinc oxid	6.0	grams
“Balsam Peruv	1.5	grams
“Ol. theobrom	19.0	grams
“Ungt. cerat	2.5	grams”

Calculated to percentages the formula reads:

Anusoli	20.54	per cent.
Zinc oxid	16.44	per cent.
Balsam Peruv	4.11	per cent.
Ol. theobrom	52.06	per cent.
Ungt. cerat	6.85	per cent.

When this product was submitted to the Council some time ago, Schering & Glatz stated that, according to the manufacturer, “anusol” is the “iodo resorcin sulphonate of bismuth, having the following rational formula: [C₆H₂ISO₂.O(OH)₂]₃Bi. In the meta-dioxybenzol C₆H₄(OH)₂, the resorcin, one H has been replaced by one I, and for another H the sulfonic-acid group SO₂-OH has been substituted, so that meta-dioxybenzol is transformed into C₆H₂ISO₂-OH(OH)₂. In the sulfonic acid the H of OH is replaced by Bi and, as Bi is trivalent the above rational formula results.”

According to this formula “anusol” should contain:

Iodin	32.99	per cent.
Sulphur	8.34	per cent.
Bismuth	18.07	per cent.

And the “anusol” suppositories should contain:

Iodin	6.77	per cent.
Sulphur	1.71	per cent.
Bismuth	3.71	per cent.

Examination showed that the suppositories contain about 0.08 per cent. iodin, or 1.2 per cent. of the amount claimed; 0.28 per cent. sulphur, or 16.3 per cent. of what is claimed; 0.71 per cent. bismuth, or 19 per cent. of what is claimed; and zinc equivalent to 16.5 per cent. zinc oxid, or about 100 per cent. of claim.

From the standpoint of the iodin content alone, assuming that all of the iodin found is present in the form of “anusol,” the results of the examination of the product (as found on the American market) verifies, for all practical purposes, Suyver’s statement that “anusol suppositories contain no anusol,” for the quantity of iodin present is so minute (about ¹⁄₈₂ of that required by the formula) as to be unworthy of serious consideration. The presence of sulphid in appreciable amounts was demonstrated showing that the sulphur is present, at least in part, in the form of sulphid and not as sulphonate as is claimed. In a measure, too, this is in accord with the findings of Suyver, who concluded that, in the product which he examined, the bismuth was present in the form of sulphid. The proportions of sulphur and of bismuth (respectively about ¹⁄₆ and ¹⁄₅ of the required amounts) indicate still further that the product is not all that it is claimed to be.

A specimen submitted by Schering & Glatz to the Council two years ago contained 0.99 per cent. iodin, or 1.3 per cent. of the amount claimed; 0.23 per cent. sulphur, or 13.4 per cent. of the claimed amount; and 0.52 per cent. bismuth, or 14 per cent. of what is claimed by the formula. Since the above determinations were made another specimen of Anusol Hemorrhoidal Suppositories was received from Schering & Glatz, July 16, 1909. This sample was found to contain about: 0.075 per cent. iodin, or 1.1 per cent. of the amount required by the formula; 0.265 per cent. of sulphur, or 15.5 per cent. of the requirement and 0.88 per cent. bismuth, or 23.7 per cent. of the required amount. It will thus be seen that the composition of the oldest specimen and also that of the specimen recently sent, corresponds in a general way to that of the one first examined.

Whether judgment be based on the determination of the bismuth, the sulphur or the iodin, the results just given clearly show that the claims made concerning the composition of “Anusol Hemorrhoidal Suppositories” are not substantiated by the facts.​—(From The Journal A. M. A., Oct. 2, 1909.)

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It has been amply demonstrated91 that pepsin and pancreatin, when in solution, mutually destroy each other; if the solution be acid, the pepsin destroys the pancreatin; if alkaline, the pancreatin destroys the pepsin. By using the characteristic effect of pepsin on proteids in acid medium and that of pancreatin on proteids and starches in an alkaline solution it can readily be demonstrated that commercial liquid preparations labeled as containing both of these ferments actually contain only one ferment. They are misbranded.

Besides the liquid a goodly number of solid preparations, chiefly tablets, containing pepsin and pancreatin are offered to the profession. Among these are tablets consisting simply of pepsin and pancreatin. Since pepsin and pancreatin interact only when in solution, it is quite possible to prepare tablets which contain these ferments. The use of such tablets is, however, unscientific, since one or the other of the ferments is destroyed when it comes in contact with the fluids of the digestive tract. In addition to simple tablets containing pepsin and pancreatin only there is at present a host of “digestive tablets” on the market. Among these are some which must be classed with the “digestive impossibilities” (Reports of the Council on Pharmacy and Chemistry, 1910, Vol. 1, p. 41). The preparations referred to are tablets claimed to contain pepsin, pancreatin, diastase, hydrochloric acid and lactic acid. When it is considered that the United States Pharmacopeia defines hydrochloric acid as “a liquid composed of 31.9 per cent. by weight of absolute hydrochloric acid (HCl = 36.16) and 68.1 per cent. of water,” i. e., a solution of hydrogen chlorid, a gas, in water, it would at first appear that the incorporation of any appreciable quantity of hydrochloric acid in tablets would be impracticable. Hydrochloric acid, however, possesses to a limited extent the property of combining loosely with protein substances so that it becomes possible to bring about its combination with pepsin and similar substances to form compounds which are relatively stable at ordinary temperatures. Because of the volatility of the free acid and its limited combining power with protein substances (100 gm. boiled beef combine with 2 gm. absolute hydrochloric acid92), the quantity of acid in any tablet can never be large, much less than sufficient to be of any therapeutic value.

A number of firms offer “digestive tablets” for sale having formulas of which the following may be considered typical:

Sacch. Pepsin	4	grains
Pure Pancreatin	1	grain
Diastase	1⁄4	grain
Aromatic Powder	1⁄4	grain
Lactic Acid	1⁄8	grain
Hydrochloric acid	1⁄8	grain

Some manufacturers use United States Pharmacopeia pepsin in place of the saccharated article; others do not give the exact quantities of hydrochloric acid which their product is supposed to contain, but make use of the indefinite expression “q. s.;” still others state merely that hydrochloric acid is present, but make no claim whatever concerning the quantity.

From purely theoretical considerations it is possible that the tablets referred to might contain appreciable amounts of hydrochloric acid. Since the formulas for some of the tablets furnish no information concerning the content of hydrochloric acid, it seemed worth while to determine the quantity, if any, actually present in some of the tablets on the market. Accordingly a trade package of “digestive aromatic tablets,” as put up under the label of each of six American manufacturers, was purchased and submitted to examination in the Association laboratory.

Qualitative tests made on specimens from each brand of tablets demonstrated the absence of uncombined hydrochloric acid in each. Further tests93 showed that hydrochloric acid in protein combination was present essentially in the amounts claimed in three of the specimens. In two of the others hydrochloric acid was entirely absent; in the remaining one only the merest traces of hydrochloric acid could be found.

H. K. Mulford Company
“DIGESTIVE AROMATIC”
“Pepsin, Sacch.	4	grains
“Pancreatin	1⁄2	grain
“Diastase	1⁄16	grain
“Acid Lactic	1⁄8	grain
“Acid Hydrochloric	1⁄8	grain
“Aromatic Powder	1⁄4	grain
“Dose: 1 or 2 tablets.”

In the above formula each tablet is said to contain ¹⁄₈ grain hydrochloric acid. This amount is equivalent to 0.002584 gm. (¹⁄₂₅ grain) absolute hydrochloric acid. Analysis demonstrated that each tablet contains about 0.00267 gm. hydrochloric acid (absolute HCl) or essentially the amount claimed. The average dose of diluted hydrochloric acid United States Pharmacopeia is 1 c.c., equivalent to 0.1049 gm. absolute hydrochloric acid. To obtain this quantity from the above preparation the patient would be required to swallow more than three dozen of the tablets.

Wm. S. Merrell Chemical Company
“DIGESTIVE AROMATIC, 5 GRAINS”
“Pepsin	80	parts
“Pancreatin	10	parts
“Diastase	1	part
“Acid Lactic	1	part
“Acid Hydrochloric	3	parts
“Aromatic Powder	5	parts”

Calculation shows that each tablet should contain about 0.0031 gm. of absolute hydrochloric acid. The analysis indicated that each tablet contains about 0.0030 gm. hydrochloric acid (absolute HCl) in protein combination, or practically the amount claimed. One pharmacopeial dose of hydrochloric acid is contained in 35 of the tablets.

Parke, Davis & Company
“DIGESTIVE AROMATIC”
“Saccharated Pepsin	4	grains
“Pure Pancreatin	1	grain
“Diastase	1⁄4	grain
“Aromatic Powder	1⁄4	grain
“Lactic Acid.
“Hydrochloric Acid.
“Dose: 1 to 3 tablets.”

Chlorid is present in small amounts, but quantitative examination indicated that hydrochloric acid, either free or in protein combination is absent. An ammonium salt is present in small quantities.

Sharp & Dohme
“DIGESTIVE AROMATIC”
“Pepsin, Sacch., U. S. P.	4	grains
“Pancreatin, pure	1	grain
“Diastase	1⁄4	grain
“Aromatic Powder	1⁄4	grain
“Lactic Acid		q. s.”
“Hydrochloric Acid		q. s.”

Small quantities of chlorid are present. Quantitative examination indicated that hydrochloric acid in protein combination is present only in very small amounts, each tablet containing but about 0.00034 gm. of absolute acid, or about 0.34 per cent. of the pharmacopeial dose. Ammonia is absent. Inasmuch as more than 300 of these tablets would be required to furnish a pharmacopeial dose of hydrochloric acid, this firm’s interpretation of the expression “q. s.” would prove interesting.

Truax, Greene & Company

“SYNERGIA”

“Synergia” is claimed to be composed of “pepsin, pancreatin, veg. diastase, lactic acid, hydrochloric acid and aromatics; dose, 1 to 3 tablets.” The specimen contained no hydrochloric acid, either free or in protein combination. A trace of ammonia and small quantities of chlorid were found.

The Fraske Tablet Company
“Pepsin Sacch.	80	parts
“Pancreatin, Pure	10	parts
“Diastase	1	part
“Lactic Acid	1	part
“Hydrochloric Acid	3	parts
“Aromatic Powder	6	parts
“Dose: 1 to 2 tablets.
“Each tablet represents (5) grains of the above mixture.”

According to the formula hydrochloric acid (31.9 per cent. absolute HCl) represents 3 parts in 101 of the preparation from which the tablets are made. Each tablet (containing 5 grains of the mixture) should have 0.00307 gm. absolute hydrochloric acid. Analysis showed that each tablet contains hydrochloric acid in protein combination equivalent to an average of 0.003066 gm. absolute hydrochloric acid, or essentially the amount claimed. It would be necessary to give 34 tablets to administer a pharmacopeial dose of hydrochloric acid.

[Editorial Note: The above indicates that the use of such tablets is irrational, unscientific and that it should be condemned. The only constituent of these tablets, other than the aromatics, which might possibly be of benefit in stomach troubles, is the pepsin. But even if it be assumed that the diastase and pancreatin could exert their characteristic effects, their aid to digestion (metabolism) would be but slight, because their amounts in the tablets are too small to be of any value.

It is claimed that the tablets contain diastase in amounts varying from ¹⁄₂₀ to ¹⁄₄ grain. Assuming the diastase used to be of first-class quality, i. e., capable of converting 200 times its own weight of starch into soluble products, the quantity of one tablet would be capable at the most of digesting but from 10 to 50 grains of starch, an amount equal at the most to but a small spoonful of oatmeal or a very dainty bite of bread. In the same way the quantity of pancreatin is insufficient to be of any material aid in digestion should it in some way escape destruction in the stomach and still retain its full activity when it reaches the alkaline juices of the intestines. One grain of pancreatin of full United States Pharmacopeia strength will digest only 25 grains of starch or the proteids in about 100 c.c. of milk.

Saccharated pepsin, which was formerly official, was required to digest 300 times its own weight of moist egg albumin, while the pepsin that is now official is required to digest ten times that amount, or 3,000 times its own weight. It is evident, therefore, that the tablets should contain sufficient pepsin to digest appreciable amounts of protein. No intelligent physician would prescribe these tablets simply for the pepsin they contain or are supposed to contain; if he wanted to give pepsin he would prescribe the drug in the simple form.

Clinical experience has shown that in the majority of cases of so-called dyspepsia the stomach contents contain too much rather than too little hydrochloric acid, and wherever there is a sufficiency of acid there is usually no decrease in the secretion of pepsin. In many of such cases, too, digestion is normal, or even more active than normal, but even when it is imperfect there is seldom any lack of pepsin.

Insufficient digestive power is most often due to a deficiency of hydrochloric acid and not to lack of pepsin in the stomach contents. In the tablets under consideration, however, hydrochloric acid is present—​if at all—​in the most ridiculously minute quantities; quantities that are so small as to preclude any therapeutic effect except that due to the psychic element.

These tablets, with their six or more ingredients, are typical “shotgun prescriptions.” Such prescriptions catch the unthinking doctor as well as the self-drugging public, for, while clinical experience and physiologic experiments have demonstrated that the old ideas regarding the value of these digestives and ferments were erroneous, the public and many members of the medical profession still seem to be influenced by the old theories.

In conclusion we must not lay all the blame on the manufacturing firms for supplying these absurd combinations; the physician who prescribes them should assume a large share of it. If the doctors did not use them the manufacturing concerns would soon stop putting them on the market. We hope, however, that those manufacturing concerns that like to be classed as reputable will cease to disgrace their catalogues with what they know to be therapeutic absurdities.]​—(From The Journal A. M. A., Aug. 20, 1910.)

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Burnham’s Soluble Iodin, according to the manufacturers, is one of the most noteworthy “discoveries” of the age. The advertisements aim to create an impression that while the product contains iodin, pure and simple, yet by some secret process this element has been so changed as no longer to possess its usual properties. The Burnham Soluble Iodin Company makes such extravagant claims for its product and gives such wide publicity to these claims that it seemed advisable, in the interests of the profession, to determine the nature of the preparation. Its examination was accordingly taken up in the laboratory of the American Medical Association.

From the analysis, we conclude that Burnham’s Soluble Iodin is a solution of iodin in alcohol made miscible with water by the presence of some iodid. Wilbert94 and other investigators have arrived at practically the same conclusion.

Whatever the secret process, hinted at in the advertisements, by which this preparation is evolved, the fact remains that when one prescribes Burnham’s Soluble Iodin, one is prescribing iodin, together with an iodid, the nature of which is hard to determine. The iodid is not present as potassium iodid, nor, entirely, at least, as hydrogen iodid (hydriodic acid), but this is of slight importance compared with the fact that it is a solution in alcohol of free iodin and an iodid, and therefore is essentially the same as Lugol’s solution.

The amount of iodin found corresponds approximately to 3 gm. of free iodin and 2 gm. of combined iodin in 100 c.c. of the solution. Lugol’s solution contains 5 gm. free iodin, and 10 gm. potassium iodid in 100 c.c.

BURNHAM’S SOLUBLE IODIN TABLETS

Burnham’s Soluble Iodin Tablets are light brown compressed tablets, stamped with the letters B. S. I. in monogram. Each tablet is said to contain 3 minims Burnham’s Soluble Iodin.

The average weight of each tablet was found to be 0.3526 gm.; since Burnham’s Soluble Iodin was found to have a specific gravity of .8527 and to contain 4.5 per cent. total iodin, the tablets should contain approximately 2.3 per cent. total iodin, about one-half to two-thirds of which, depending on the condition of the “Soluble Iodin” from which they are made, should be free iodin. Instead of this, only 0.317 per cent. free iodin and 1.57 per cent. total iodin was found. Analysis shows that Burnham’s Soluble Iodin tablets contain approximately one-fourth the amount of free iodin and approximately two-thirds the amount of total iodin which should be contained therein if, in accordance with the label, each tablet contains 3 minims of Burnham’s Soluble Iodin.

COMMENT

The literature put out by the Burnham Soluble Iodin Company is in itself enough to condemn the products it advertises. The much emphasized statement of the company that

“Something had to be done; and Burnham’s Soluble Iodin is that which has been done”

fulfils, in its blatant assertiveness, all the requirements of nostrum advertising. The results of the analyses are not, therefore, a surprise.

Secrecy is just as essential today to the successful exploitation of this class of proprietaries as it was before the demand for formulas became so universal. The requirement of publicity is evaded, therefore, in one of two ways: Either a formula is given which is false, or at least meaningless, or else the claim is made that the method of preparing the product is a unique and remarkable secret that is possessed only by the manufacturers. The Burnham Soluble Iodin Company uses the latter device.

Meanwhile, physicians will be perfectly justified in viewing with suspicion all claims based on such conspicuously unscientific premises, more especially so when these claims fail to find substantiation on careful and painstaking analyses. In brief, whenever the physician wishes to administer free iodin, Lugol’s solution (Liquor Iodi Compositus, U. S. P., Physician’s Manual, page 84) is an inexpensive and perfectly available preparation.​—(From the Journal A. M. A., March 28, 1908.)

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Among the many inquiries received regarding the composition of secret remedies was one in reference to “Hydrocyanate of Iron” manufactured by the Tilden Company, New Lebanon, N. Y. This preparation is advertised as being “unexcelled as a remedy for epilepsy, hysteria, chorea, neurasthenia, locomotor ataxia, neuralgia, migraine, anemic headaches, and all convulsive or reflex neuroses dependent on impairment of the brain or spinal cord.” It is also said to be “valuable in uterine reflex neuroses due to congestion; in amenorrhea due to anemia and chlorosis and suppressed menstruation.”

The term “hydrocyanate of iron” is an unfamiliar one and is not found in any available reference work on chemistry. Thinking that the term might have been loosely applied to ferrocyanid of iron, or Prussian blue (a compound once suggested for epilepsy, but long ago considered useless), the correspondent wrote to the manufacturers asking if such were the case. The Tilden Company answered:

The only statements in the Tilden Company’s advertising matter regarding the composition of hydrocyanate of iron are the following:

The last statement would lead one to expect the presence of available iron and cyanogen ions. In fact, the inference to be drawn from all the company’s “literature” is that “hydrocyanate of iron” is a definite chemical compound in the same sense as is ferrocyanid of iron, and that inference is still further borne out in the letter to our correspondent. This being the case, the Tilden Company was again written to and asked for the chemical formula of “hydrocyanate of iron,” with the following result:

This reply verified the opinion already formed that “hydrocyanate of iron” is a secret preparation. Its analysis was then taken up in the Association’s laboratory.

EXAMINATION OF THE TABLETS

The product appears on the market in cartons said to contain one ounce of one-grain tablets. On the cartons, in addition to the name of the preparation and the name and address of the manufacturers, are the names of diseases for which it is recommended. The tablets, in the specimens analyzed, were dark blue, rather hard and slightly bitter in taste and had an average weight of 0.1382 gm., or about 2 grains. They were found to be practically insoluble in water and dilute mineral acids; aqueous oxalic acid solution partially dissolved them, yielding a blue solution. Boiling with alkali hydroxid solution decomposed the tablets, yielding iron in an insoluble form and a solution of alkali ferrocyanid, as demonstrated by the appearance of a deep blue precipitate on the addition of ferric chlorid solution. The portion insoluble in alkali when boiled with hydrochloric acid yielded a solution containing iron, approximately equivalent to 50 per cent. Prussian blue. These properties are all characteristic of Prussian blue, and, taken together, identify Prussian blue as a constituent of “hydrocyanate of iron (Tilden).” The insoluble residue from the iron determination possessed the properties and constituents of talc and constituted practically one-half of the tablets. Extraction of the tablets with chloroform or ether in the presence of ammonium hydroxid yielded a small amount of organic material which contained bodies having the properties of, and responding to tests for, quinin or cinchona alkaloids and caffein. The presence of a salicylate was also indicated.95

From the analysis it is concluded that “hydrocyanate of iron (Tilden)” is essentially a mixture of approximately equal parts of talc and Prussian blue, containing traces of organic matter having the general properties of alkaloids.

Comment: When a firm exploits an abandoned remedy for so hopeless a disease as epilepsy under a name not known to chemistry and with a false representation of its pharmacologic qualities, such action may rightly be assumed to show ignorance or worse. “Hydrocyanate of iron,” if it means anything, means the cyanid of iron, but the preparation put out under that name is, according to our chemists, not cyanid of iron, but the ferrocyanid of iron commonly known as Prussian blue. This substance has been tried for epilepsy and abandoned. Yet the firm recommends it as a “peerless remedy” for this disease:

Not that epilepsy is the only disease for which this hypothetical chemical compound may be prescribed. Torticollis has been “successfully treated with hydrocyanate of iron.” In chorea, we are told “a richer and better blood supply” should be furnished the nervous and vascular system and “the irritation of the motor centers” must be allayed.

It is not possible for it to have any value in anemia because of its insolubility, yet we are told:

As Prussian blue yields no appreciable quantity of hydrocyanic acid under the conditions existing in the animal organism, “the sedative action of hydrocyanic acid” must be as hypothetical as the chalybeate properties attributed to it.

It is strange that a manufacturer, in introducing a new chemical compound, should have to assure his customers that it “contains no opium or alkaloid of that drug, cocain, chloral hydrate, conium or any of the bromids.” Imagine a firm putting, let us say, potassium iodid—​a definite chemical compound—​on the market and solemnly guaranteeing that it contained no cocain or chloral hydrate!

Would the Tilden Company of twenty-five years ago have served such mental pabulum in its advertising matter?

One would think that the dictates of common humanity would protect the unfortunate epileptic from the machinations of the nostrum maker, especially from the exploitation of a remedy that has been tried and found wanting. A nostrum, however, merely has to measure up to one standard: Will it pay? Meeting this requirement nothing else matters.​—(From the Journal A. M. A., June 19, 1909.)

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Frequent requests for information regarding the composition of hymosa, manufactured by the Walker Pharmacal Co., St. Louis, and a perusal of the extensive and nostrum-like advertising the product is receiving, made a chemical examination of this preparation seem desirable. If the label is to be believed, hymosa has been of use in “acute and chronic muscular and articular rheumatism, gout, sciatica, lumbago, pleurodynia and neuralgia, whether due to uric acid diathesis or not ...”

The composition of hymosa as given by the proprietors is set forth in the following statement:

Thus the explicit statement is made that hymosa contains certain vegetable drugs (most of them obsolete and valueless) and that it does not contain salicylic acid. By inference the claim repeatedly is made that the nostrum does not contain any salicylates.

Still harping on the undesirability of salicylates and the value of hymosa the advertising pamphlets state:

Finally in a letter issued to physicians we are told:

It is evident from the above quotations, in which the salicylates are denounced specifically or by implication, and from the label which states that no salicylic acid is present, that the exploiters of the nostrum deliberately intended to give the impression that hymosa is free from salicylates or salicylic acid and contains only the vegetable or plant drugs enumerated. The very fact that the proprietors make such repeated efforts to give the impression that hymosa is free from salicylates is in itself sufficient to arouse suspicion and hence in the examination particular attention was given to the detection of salicylic acid or salicylates with the following results:

Examination.—Hymosa as purchased on the market is a dark brown liquid with an odor of sassafras and a rather sweetish taste, reacting acid to litmus. Qualitative tests having indicated the presence of salicylate, iodid, sodium, potassium, alcohol and some organic matter, presumably sugars and some plant extractives, these were determined quantitatively.96 It was found that a part of the salicylate was present as free salicylic acid and part in a combined form. The sodium determinations indicated that all the salicylate, excepting that in the form of free salicylate acid, was present as sodium salicylate. From the results of the potassium estimations, it was evident that the iodin was present in the form of potassium iodid.

From the results of the analysis it is believed that the preparation has approximately the following composition:

Salicylic Acid	0.32	gm.
Sodium Salicylate	1.15	gm.
Potassium Iodid	0.32	gm.
Sugars and extractives	4.60	gm.
Alcohol, U. S. P.	16.86	c.c.
Water to make	100.00	c.c.

These results indicate that hymosa is essentially a solution containing salicylic acid, sodium salicylate, potassium iodid, alcohol, sugars and plant extractives in the proportions given above, and show that the various statements referred to, regarding the absence of salicylic acid and salicylates are misleading and untrue. It further illustrates the repeatedly demonstrated fact that nostrums exploited as wonderful and new discoveries are new in name only—​and whatever therapeutic value they possess depends on old and tried medicinal agents.

[Editorial Note: In describing the methods employed by the manufacturers of Manola in exploiting their product, attention was called to the fact that the Manola Company was reported as being a subsidiary affair of the Luyties Homeopathic Pharmacy Company of St. Louis. It is reported that this same company also operates the Walker Pharmacal Company, which exploits Hymosa and Psa-avena.]​—(From the Journal A. M. A., June 11, 1910.)

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Evidently touched by the generosity of the manufacturer in sending him a sample and literature, but not too favorably impressed by the claims made for the preparation referred to, a correspondent writes:

With the foregoing as an impetus to investigate the nature of this much advertised nostrum, the wafers were submitted to analysis by the Association laboratory. The report follows:

LABORATORY FINDINGS

Trade packages of the wafers purchased on the open market bear the name of the preparation and that of the manufacturers, Micajah & Co., Warren, Pa. The label states that the nostrum is a:

The box contained 25 tablets, and a circular entitled, “Hints on the treatment of diseases of women,” in which directions for the treatment of many diseases are given. It ends with a paragraph which contains the following statement:

Much of the advertising “literature” is in the form of leaflets, brochures and small pamphlets full of testimonials by physicians.

Micajah’s uterine wafers as found on the market are white, hexagonal tablets, odorless and possessing an astringent taste. The wafers are soluble in water with extreme difficulty. Hot hydrochloric acid and alkali hydroxids dissolve the powdered tablets readily, leaving a slight residue which under the microscope and by physical tests was identified as lycopodium.

The acid solution of the wafers responded to qualitative tests which indicated the presence of potassium, sodium, aluminum sulphate, borate and a mere trace of a fatty material. Quantitative estimation of boric acid, aluminum sulphate, sodium and potassium were made, which indicated that Micajah’s Uterine Wafers consist of alum more or less anhydrous or “burnt,” boric acid and borax in approximately the following proportions:97

Alum, dried	59.86	per cent.
Borax, dried	15.62	per cent.
Boric acid	5.67	per cent.
Water of hydration	18.85	per cent.

The average weight of the tablets is 0.7791 gm (11.8 grains) and allowing for the fact that the quantity of water present in commercial exsiccated alum varies, each tablet would contain approximately 0.4986 gm. (7.8 grains) burnt alum; 0.2337 gm. (3.6 grains) crystallized borax, and 0.0467 gm. (0.7 grain) boric acid.

COMMENT

Judging from the “literature” that goes with the packages of this nostrum, one might imagine that it was put up absolutely for the layman, but this is not the case. It is advertised only in medical journals and not directly to the public. But direct advertising to the public is not necessary; for every physician who prescribes these wafers at the same time places in the hands of his patient advertising matter intended to influence that patient—​and it usually does. As a result this preparation is being bought by the public direct. To what extent we do not know, but physicians are responsible for it. Probably if physicians realized that the same interests that control Piso’s Consumption Cure also control Micajah’s Medicated Uterine Wafers they would not be so ready to act as the unpaid agents for the concern.

That such simple astringents and feeble antiseptics as alum, borax and boric acid could have such remarkable curative effects on uterine diseases is absurd. The serious aspect of the matter is, that, by the encouragement given them in the advertising literature to treat themselves, women may neglect proper surgical or medical attention in the early stages of serious diseases such as cancer or dangerous pelvic infections, until they get beyond the hope of proper management. But when nostrum promoters urge the use of such inefficient remedies in the treatment of gonorrhea, it is time to look at the matter seriously. Considering the vital social significance of the venereal diseases, the employment of useless remedies can only favor the spread of these infections, which cause such a large proportion of the diseases which afflict women particularly.

The medical profession for the most part has become mentally calloused to the exaggerated claims of the nostrum makers and does not make sufficient effort to condemn them. There may be some physicians, however, who use such preparations as these wafers in their practice, as is indicated by the circulars wherein the manufacturers suggest that their “usefulness can be indefinitely enlarged by the ingenuity and therapeutic skill of the physician.” It is only occasionally that a physician voices his indignation as to these humbugs, as in the case of the physician whose letter is quoted above.​—(From the Journal A. M. A., March 26, 1910.)

To the Editor:—We have read with interest the report of your committee on pharmacology recently published in The Journal, on the subject of Micajah’s Medicated Uterine Wafers, and your comments thereon.

We are of the opinion that, in your laudable efforts to reform the practice of pharmacology, it is not your desire or intention to act other than justly and fairly, and therefore, with this belief, we submit the following statements for your consideration, with the hope that you will see fit to publish them.

1. We do not seek by word or deed the patronage of the laity, and what few sales are made to the public are not of our contriving, nor should we be held responsible for them, any more than is the manufacturer of quinin to be blamed for the universal use of that drug.

2. Our literature should not be considered extravagant, for it is for the most part made up of clinical reports received from physicians and based on the unsolicited testimonials in our possession from hundreds of practitioners, many of whom have used Micajah’s Wafers in practice from five to twenty years and they are therefore as well grounded as are the clinical reports concerning any preparation.

3. In the past year we have endeavored to place our preparation on a higher ethical basis by stating in our advertisements what our wafers contain, and by eliminating whatever seems to us open to criticism.

4. That the ingredients of the preparation are “simple” is no reason for considering them valueless. H. A. Kelly, in his work on medical gynecology, page 266, recommends these ingredients in a variety of conditions. Bandler also made important recommendations bearing on this subject in his “Medical Gynecology,” 1909 edition, page 472. We feel we have the right to recommend this preparation for these and similar conditions, especially when our statements are backed up by the clinical experience of numerous general practitioners.

5. That the owner of Micajah’s Wafers holds stock in a corporate firm which manufactures proprietary medicines and toilet articles, advertised to the laity, should not militate for or against our right to market a meritorious preparation on strictly ethical lines to the medical profession, inasmuch as many of the largest drug houses cater to both the doctor and the proprietary interests, and several are actively engaged in exploiting so-called nostrums.

6. We enclose a recent advertisement which has been accepted after investigation of our methods by careful medical journals, and we now believe we are conducting our business in entire conformity with the best interests of the medical profession and we feel certain of the true merits of our article.

Micajah & Company, Warren, Pa.

[Comment: This letter brings out still more strongly the points raised in the article which appeared in The Journal, March 26, 1910. Being unable to analyze motives we must perforce, accept Micajah & Co.’s statement that they “do not seek by word or deed the patronage of the laity.” In the comments on the laboratory’s report it was very explicitly stated that this nostrum was advertised only in medical journals and not directly to the public. Inasmuch, however, as the container in which this product comes has printed on it the various diseases in which the “wafers” are indicated, as, moreover, within the container there is a leaflet which describes in detail the use of the preparation in a list of pathologic states varying from “enlargement of the womb” to “gonorrhea in the male,” and, finally, as the name “uterine wafers” would seem in itself to be a plain bid to the public, we still maintain that “one might imagine that is was put up absolutely for the layman.”

The proposition that advertising matter should not be considered extravagant because it is largely “made up of clinical reports received from physicians” is an argument that is as old as the nostrum business itself—​and as fallacious as it is old. Unfortunately, as our files show, the most extravagant statements made for proprietary products frequently emanate from men who legally are entitled to write M.D. after their name. The fact that it is not the manufacturer but a Buffalo physician who tells of the marvelous results he obtained from the use of Micajah’s Medicated Uterine Wafers in forty-three cases comprising no fewer than thirty-six pathologic conditions from “otitis media” to “injured toe,” and from “bunion” to “ophthalmia neonatorum” does not exempt the firm that prints such stuff from the charge that its “literature” is not merely extravagant, but ridiculously so.

As Micajah & Co. say, because the ingredients of their preparation are simple is no reason for considering them valueless. On the contrary, if the “wafers” were truthfully exploited for what they are and what they will do, their very simplicity would be a virtue. But such has not been done. And therein lies the viciousness of nostrums. Simple mixtures of well-known drugs are foisted on the medical profession with no hint as to their composition and with claims made that are not only false, but would immediately be recognized as absurd, if their actual composition were known.

That a mixture of borax and alum may be of value in some of the simple ailments of the female genital tract can easily be granted. That relief might follow the use of suppositories made of these ingredients—​especially when supplemented by an increased attention to simple cleanliness—​can also be admitted. To say, however, that such medicaments will quickly and permanently cure gonorrhea, urethritis, endometritis, etc., is foolish, false and vicious.]​—(From the Journal A. M. A., April 16, 1910.)

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The Journal received an inquiry concerning the composition of Noitol, a preparation which is being advertised to the medical profession as a “specific” for the cure of eczema and certain other cutaneous diseases. The preparation is manufactured by the Wheeler Chemical Works, Chicago. Trade packages of Noitol were purchased and examined in the Association laboratory. On the label of the package, Noitol—​an inversion of the word “lotion”—​is described as follows:

Noitol is a clear, nearly colorless, acid solution, the greater portion of which is water. Its specific gravity is 1.0097 at 25 C.

Qualitative tests demonstrated the presence of a chlorid, a nitrate, a mercuric salt, free acid and glycerin. No “oils” or “vegetable acids” could be found.

Analysis98 of the preparation indicated that its composition is essentially as follows:

Mercuric Chlorid	0.0463 gm.	in 100 c.c.
Mercuric Nitrate	0.0450 gm.	in 100 c.c.
Glycerin	1.3021 gm.	in 100 c..c.
Nitric Acid	1.0265 gm.	in 100 c.c.
Water (by difference)	98.5545 gm.	in 100 c.c.

From the above it appears that Noitol is simply a weak, acid solution of mercury salts—​the total being approximately equivalent to a 1 to 1,000 bichlorid of mercury solution—​exploited under a meaningless name. It is but one more example of the old, old story of a well-known remedy being sold at a high price under a name which is in no way indicative of its composition, and under claims which are absurdly false.

The price of the mixture is $2.00 a pint; the estimated cost, exclusive of the container, is about 6 cents a gallon, or, put another way: the price of a pint bottle, it is estimated, would make a barrel (31 gallons) of the nostrum. The incorrect statement concerning its components, the unwarranted therapeutic claims made for it, and the exorbitant price easily place Noitol in the front rank among the “patent medicine” frauds. Yet it is advertised to physicians as an ethical proprietary and is evidently being prescribed by them.

In the circular matter accompanying the trade package of the preparation, “Noitol,” described above, a preparation called “Anadol” is described. Anadol is claimed to be an analgesic and antipyretic. In the descriptive circular there is no information concerning the composition of the preparation, but from the general therapeutic description the physician might easily be led to believe that “Anadol” is a distinct chemical substance.

To reduce temperature the physician is advised to push the administration of Anadol in 10 grain doses until the febrile condition is under control or until a maximum of 70 grains of the preparation has been ingested. The circular further states:

As no evidence could be obtained concerning the composition of Anadol and, as the preparation is being brought to the attention of physicians by means of circulars in connection with the distribution of Noitol, it seemed worth while to take up its examination in the Association laboratory. Accordingly a trade package of the material which had passed into interstate commerce was purchased.

Qualitative tests demonstrated the presence of sodium, a carbonate, caffein and acetanilid, the latter in considerable quantities. Analysis99 indicated that the composition of the specimen examined is essentially as follows:

Acetanilid	79	per cent.
Caffein	1	per cent.
Sodium bicarbonate	20	per cent.

Since, according to the circular, it is permissible to prescribe 70 grains of this preparation within 2¹⁄₂ hours, a patient thus treated would receive no less than 55 grains of acetanilid! In view of the numerous cases of poisoning due to the misuse of acetanilid (“The Harmful Effects of Acetanilid, Antipyrin and Phenacetin,” U. S. Dept. Agric., Bur. Chem., Bull. No. 126) the physician should be apprised of the composition of Anadol.

[Editorial Note: The chemical investigations reported above emphasize once more the need of such an institution as the Association’s laboratory and again demonstrates the value of its work. At first sight it seems disheartening to find that physicians are so easily humbugged. Yet when it is remembered that it is impracticable for physicians either to analyze such products themselves or to go to the expense of having chemists do it for them, it is evident that the fault lies not so much with the physicians as with the conditions that make the exploitation of such frauds possible. It is on the public that the burden ultimately falls, for it is the layman who has to pay two dollars for a few cents’ worth of medicine. But—​and this is far more serious—​that the physician should be urged to dose his patient with an insidiously dangerous drug to a point far beyond the limits of safety, is little less than criminal. Yet so long as unknown medicinal products are prescribed just so long will this danger be a very real one.]​—(From the Journal A. M. A., May 21, 1910.)

Anadol was analyzed at the Bureau of Chemistry and the chemists reported that it contained over 82 per cent. of Acetanilid. As the labels did not bear any statement as to the quantity of acetanilid contained in the nostrum, the stuff was declared misbranded and the defendant, on pleading guilty, was fined.—​[Notice of Judgment No. 795.]

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In a paper on “The Abuse of Chemical Formulas”100 several examples were given of the various methods employed by “patent-medicine” concerns to give standing to their products by assigning to them a chemical formula. In some cases the formulas given are impossible, in other cases they may represent the chemical composition of only one constituent or it may be an attempt at both. To a chemist such formulas are absurd and on seeing a formula which he knows to be wrong he naturally thinks “Fake,” “Ignorance,” or both. Just such a formula (C₅H₆N.SO) applied to a product called Pix Cresol, manufactured by the Pix Cresol Chemical Co., Kansas City, Mo., attracted our attention. No mention of such a formula can be found in such works as Richter’s most complete Index of Carbon Compounds, nor the three supplemental volumes published, 1901–1905, by the German Chemical Society and Beilstein’s Organic Chemistry (3d Ed.). This fact, supplemented by inquiries from correspondents as to the composition of the substance made it seem worth while to make a chemical examination of it.

The examination was made and showed that the essential constituent was oxyquinolin sulphate. As potassium sulphate was also found it was concluded that Pix Cresol was a preparation containing a mixture of oxyquinolin sulphate and potassium sulphate, which has also been known in the past under the proprietary name, “Chinosol.” At this time a letter was referred to the laboratory containing the report of an analysis of Pix Cresol, which showed the presence of oxyquinolin sulphate but no potassium sulphate. As this indicated that Pix Cresol contained as its essential constituent the substance now sold as Chinosol, the laboratory purchased a new specimen of Pix Cresol from the Chicago representative of the Pix Cresol Co. The examination101 of this specimen showed that it consisted of approximately 21 per cent. oxyquinolin sulphate, about 8.3 per cent. potassium sulphate and the remainder almost entirely milk sugar.

It is evident, then, that both the specimen of Pix Cresol obtained directly from the manufacturers and also the one purchased more recently from the Chicago agent, contain as an essential constituent Chinosol of the composition sold formerly. The substance now sold under the name Chinosol and described in New and Nonofficial Remedies is pure oxyquinolin sulphate, and as the exploiters of Pix Cresol probably obtain their supply of oxyquinolin sulphate from the Chinosol Company, the sole American agents for Chinosol, it is to be expected that Pix Cresol should change in composition. It is probable that the analysis referred to the laboratory deals with a more recent specimen than the two examined in the Association laboratory.

Editorial Note: In view of the Council on Pharmacy and Chemistry’s findings, viz., that chinosol is a powerful antiseptic but a feeble germicide and considering that Pix Cresol contains but 21 per cent. oxyquinolin sulphate, the absurdity of the following claims made for Pix Cresol require no further comment:

A further estimate of the pseudo-chemical company, bearing the name of this “strongest, safest, least expensive medical antiseptic, disinfectant and deodorizer known” may be gained by a cursory glance at some of its “specialties”:

“Maizinin compound, Positive Chill and Malaria Specific” the firm says, “prepares the parasites for execution by the leukocytes.” It is said to contain arsenic, while the name implies the presence of some plant drug.

“Psora, the Syphilis Specific,” is a shot-gun mixture said to be “the scientific combination of the soluble Triple Iodids with the active principles of Echinacea, Cascara amagra, Berberis aquif., and Phytolacca rad.,” and is claimed to make “the syphilitic lesions disappear and fail to return.”

“Rectoids—Cones for the treatment of all rectal trouble,” are said to be “a combination of Rectin (Pix) compounded from Buckeye, Collinsonia, Hamamelis, Belladonna, Pix Cresol.”

“Tablets for the Female—Pix Cresol Uterettes,” it is said, “for sanitary purposes may be continued forever ...”

When one realizes that this sort of pseudo-scientific twaddle is accepted by many physicians at its face value, the outlook for therapeutics seems dark, indeed. So long as the existence of such concerns is tolerated by the medical profession, so long will there be a crying need for a “Propaganda for Reform in Proprietary Medicines.”​—(From The Journal A. M. A., June 10, 1911.)

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[The Council on Pharmacy and Chemistry refused recognition to Saliodin because it conflicts with Rules 1 and 6, and directed publication of the following.

W. A. Puckner, Secretary.]

Saliodin is sold by the Saliodin Chemical Co., Scranton, Pa. In the literature and on the trade package the following “formula” is given:

This formula being indefinite and vague, the examination of saliodin was taken up in the Association laboratory.

From the analysis we calculate the composition of saliodin to be approximately equivalent to a mixture of:

Sodium salicylate	57.54
Potassium iodid	1.18
Potassium acetate	30.00
Matter volatile at 130° (oil of anise, oil of
gaultheria, moisture, etc.)	8.10
Undetermined (extractive?)	3.18
————
100.00

The analysis shows that the formula is not only indefinite and vague, but incorrect and false.

To emphasize the incorrectness of the published formula the following comment on its first two items is offered:

In the “formula” it is stated that 20 grains of saliodin contain approximately “salicylic acid (aceto-salicylate) Grs. XV.” The statement is not clear, but conveys the impression that 20 grains of saliodin contain an amount of aceto-salicylate, a salt of acetyl-salicylic acid (aspirin), equivalent to 15 grains of salicylic acid. But the chemical examination shows that it contains neither acetyl-salicylic acid, nor salt of acetyl-salicylic acid, nor even salicylic acid itself. In the place of these, the analysis shows that over half of saliodin is the common, every-day sodium salicylate.

According to the “formula,” each 20 grains of saliodin contains “iodin (iodate), equivalent to iodid potass. Grs. XV.” This statement, too, is vague, but conveys the impression that 20 grains of saliodin contain an amount of iodin, in combination as an iodate, which corresponds in iodin content to 15 grains of potassium iodid. But the analysis shows that the product does not contain any iodate whatever, and that the amount of iodin contained in it is sufficient to account for only ¹⁄₄ grain of potassium iodid in each 20 grains of saliodin.

COMMENTS

The above report is published simply as another example of the “ethical proprietaries” that physicians are asked to prescribe. It is not unique. It is neither better nor worse than hundreds of others.

To show what absurdities appear in the “literature” (?) that is sent to physicians, we reproduce a paragraph from an advertising pamphlet. The promoters’ statement as to the composition of the product is absurd, but not more so than are the claims made for it as a therapeutic agent. There is not a “patent medicine” on the market for which any more blatant, extravagant and ridiculous claims are made.

The manner of exploiting saliodin is another illustration of the tendency on the part of nostrum-makers to advertise their wares through pseudo-scientific articles published in a certain class of medical journals. In the pamphlet sent out by the Saliodin Company appears a reprint of an article from the Philadelphia Medical Summary of February, 1905. It is entitled “A Similarity in the Etiologic Factors of Rheumatism and Malaria,” and was written by J. C. Denston, M.D. In it occurs this statement: “The manufacturers (of saliodin) publish their formula and, I think, distribute samples and literature on request.” The charming ingenuousness of this statement is fully realized when it is understood that J. C. Denston is the president of the Saliodin company. This is also another illustration of what is now a common occurrence, viz.: men who are engaged in manufacturing proprietary products and who have an M.D. degree use that degree as a commercial asset, and by this means the average reader is led to think that articles written by them in praise of their own products are spontaneous tributes from practicing physicians.​—(From The Journal A. M. A., Oct. 26, 1907.)

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The following inquiry is from Dr. Reid Hunt, recently appointed professor of pharmacology at Harvard Medical School:

“Have you ever made an examination of the theobromin sodium salicylates on the market to determine if they are identical with ‘Diuretin?’ The description of theobromin sodium salicylate in New and Nonofficial Remedies agrees with the statements as to the composition of Diuretin, but I wondered if, at times at least, the theobromin sodium salicylate on the market might be a simple mixture of theobromin and sodium salicylate just as the Caffeinae Sodio-Salicylas, N. F., seems to be a simple mixture. Diuretin is quoted in current price-lists at $1.75 an ounce, whereas the price of theobromin sodium salicylate is only 35 cents an ounce. Many hospitals use diuretin, and both physicians and students often have only hazy ideas as to what it is. If the preparations of theobromin sodium salicylate now on the market are identical with Diuretin they should certainly be used, not only because they are less expensive, but because the descriptive name will continually remind the physicians of what they are using.”

Theobromin for some time has been regarded as a valuable therapeutic agent. The obstacle to its use has been its insolubility and the consequent uncertainty of the degree of its absorption. For this reason a soluble salt of theobromin, theobromin sodium salicylate, first introduced and advertised under the proprietary name “Diuretin,” has come to be used to a considerable extent.

Theobromin sodium salicylate—also called theobromin and sodium salicylate—​is prepared by interaction, in molecular proportions, of theobromin, sodium hydroxid and sodium salicylate, the theobromin first being treated with sodium hydroxid in the presence of a suitable solvent, then the sodium salicylate added and the whole brought to dryness. The soluble compound which is formed is generally considered to be a double salt of theobromin sodium and sodium salicylate.

Theobromin sodium salicylate is described in New and Nonofficial Remedies and in several foreign pharmacopeias. It is also to be described in the forthcoming United States Pharmacopeia.

Although the product is not controlled by patents of any kind, and although it is offered for sale under its chemical name by the leading chemical manufacturers at from 35 to 45 cents per ounce, the proprietary product, Diuretin, sells for $1.75 an ounce. This is probably because the manufacturers think that those who have been using it under its chemically non-descriptive but therapeutically suggestive title, Diuretin, will remain ignorant of the fact that the same product is on the market under its chemical name. In view of these conditions, emphasized by Dr. Hunt’s letter, it was deemed important to examine the market-supply of theobromin sodium salicylate and to compare the several specimens with the proprietary brand Diuretin.

The following specimens, purchased in 1-ounce original packages, were examined:

Diuretin, “Knoll,” Knoll & Co.

Theobromine and Sodium Salicylate, Mallinckrodt Chemical Works.

Theobromine and Sodium Salicylate, Merck & Co.

Theobromine and Sodium Salicylate Powder, Powers-Weightman-Rosengarten Co.

Theobromine and Sodium Salicylate, “Roche,” Hoffmann-La Roche Chemical Works.

Theobromine and Sodium Salicylate, Squibb, E. R. Squibb & Sons.

The theobromin content prescribed for theobromin sodium salicylate by the various standards ranges from 45 to 50 per cent., that of New and Nonofficial Remedies being the highest. A requirement of not less than 46.5 per cent. theobromin in the dried powder has been proposed for the new U. S. Pharmacopeia.

The methods of quantitative estimation laid down by the various authorities are all very similar and consist, in the main, of a determination of water, of the sodium hydroxid, free and in combination with theobromin, and of the theobromin itself. For the theobromin estimation the following method was employed:

A weighed sample (about 2 gm) which had previously been dried, under slightly reduced pressure, over sulphuric acid, to constant weight, was dissolved in five times its weight of warm water. Two drops of phenolphthalein were added, and the solution titrated with normal hydrochloric acid. To the neutral solution, 1 drop of 10 per cent. ammonium hydroxid solution was added, and the mixture allowed to stand, with occasional stirring, for three and one-half hours at the temperature of 15 C. The precipitate was filtered on a weighed Gooch crucible, washed with just ten times the weight (of the original sample taken) of water (temperature 15 C.) and the precipitate dried at from 100 to 104. To the weight obtained, a correction factor (proved satisfactory by quantitative extraction experiments on the filtrate) of 0.13 gm. was added, for every 2 grams of the original sample taken.

The full details of the examination will be published in the 1914 Reports of the A. M. A. Chemical Laboratory. The results of the examination have been abstracted and are compiled in the accompanying table:

SUMMARY OF ANALYSIS

While the results show some variation in the moisture content and also in the actual theobromin content of the dried specimens, the variation is unimportant. The products in their original state (undried), as compared in relation to the theobromin content (the highest percentage of theobromin being 48.61, the lowest 45.24), reveal a variation of only about 3 per cent.—​a variation which is negligible in the case of drugs such as theobromin.

From the preceding investigation, it is concluded that (1) practically there is no difference between the non-proprietary brands of “theobromin sodium salicylate” and “Diuretin;” (2) the several specimens examined were not simple mixtures of “theobromin” and “sodium salicylate”; (3) essentially all the brands complied with the standards laid down and can be rated as satisfactory; (4) “Diuretin,” though sold at an exorbitant price, is not superior to the product supplied under the descriptive term “theobromin sodium salicylate,” and (5) “Diuretin” sells wholesale for $1.75 an ounce, against 35 cents for the “theobromin sodium salicylate,” and therefore its employment cannot be interpreted otherwise than as a useless and unnecessary expense.​—(From The Journal A. M. A., April 4, 1914.)

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Attention has been called at various times to the fact that the value of a published “formula” to a proprietary remedy is in direct ratio to the reliability of the manufacturer publishing it. When medical journals first insisted on their advertisers letting physicians know the contents of the remedies they wished to sell them, medical literature reeked with formulas—​some of them of weird and wonderful design. Since the advent of the Food and Drugs Act, which requires that labels shall approximate truthfulness, and particularly since the Council on Pharmacy and Chemistry has investigated a number of proprietary remedies, the publication of “formulas” is not so common.

Unguentine, manufactured by the Norwich Pharmacal Co., is one of those remedies whose advertisement for years always included “a formula”; more recently, however, this is not in evidence. In an advertisement which appeared about ten years ago, the “formula” given is:

“Carbolic acid		2	per cent.
“Ichthyol		5	per cent.
“Alum	15 to	16	per cent.”

It was claimed that, by a special process of their own, the manufacturers had eliminated most of the astringent properties of the alum, rendering it non-irritant. It was also stated that “the base of Unguentine is pure petrolatum.” Later the manufacturers seem to have changed the composition of their product, or at least the “formula” given in the advertisements was changed. Thus it appeared:

“Alum	15	per cent.
“Zinc oxid	5	per cent.
“Carbolic acid	2	per cent.
“Ichthyol	5	per cent.
“Aromatics and antiseptic oils with specially prepared petrolatum and animal fat base.”

The introduction of zinc oxid, aromatic and antiseptic oils and animal fat was a new feature. Somewhat later, and particularly since the passage of the national Food and Drugs Act, no formula or other statement regarding the composition seems to have appeared in the advertisements in the medical press. In the 1906 price-list (p. 170) the following formula appears:

“Unguentine represents:
“Alum (non-irritating)	15	per cent.
“Phenol	2	per cent.
“Ichthyol	5	per cent.
“Zinc oxid	5	per cent.
“Aromatic and antiseptic oils, with especially prepared petrolatum and purified animal fat.”

In the price-list issued for 1908—after the Food and Drugs Act went into effect—​the following appears:

“Unguentine represents:
“Alum compound (non-irritating)
“Phenol,
“Ichthyol,
“Zinc oxid,
“Aromatic and antiseptic oils, with especially prepared
petrolatum and purified animal fat.”

Thus the proportions are omitted, and alum becomes “alum compound,” whatever that may mean.

In view of the conflicting statements made by the Norwich Pharmacal Company, in regard to their leading specialty, Unguentine, and especially because much stress was laid on the filing of their “guarantee” under the Food and Drugs Act, it was decided to ascertain of what Unguentine really consists.

From our analysis we conclude that Unguentine contains not alum but aluminum acetate (small amounts of alum may be present as impurities in the aluminum acetate), zinc oxid, or more probably impure zinc carbonate, and that the entire quantity of both does not exceed 5 per cent. It contains no ichthyol, or if any but the merest traces, and less than 1 per cent. of phenol. The aromatic oils amount to not more than approximately 1 per cent. in all. The ointment-base is, in the main, petrolatum.

In Unguentine we have, therefore, another proprietary “specialty,” regarding the composition of which indefinite, false or misleading statements have been made—​this irrespective of protestation of honesty by the firm.​—(From The Journal A. M. A., March 27, 1909.)

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In view of the results of investigations by Zernik of Uricedin as sold in Germany, and because it is being advertised to physicians in this country, an examination of this product was made in the laboratory of the American Medical Association. Zernik’s report shows how this remedy has varied in its composition as put on the market in Germany. From their analysis the authors find that Uricedin is not a definite chemical compound as is claimed, but is a simple mixture whose composition is approximately:

Sodium sulphate (anhydrous)	61.52	per cent.
Sodium citrate (anhydrous)	29.62	per cent.
Sodium chlorid	2.13	per cent.
Citric acid (anhydrous)	3.25	per cent.
Moisture	2.53	per cent.
Undetermined	0.95	per cent.
———
100.00

Uricedin, therefore, is not a definite chemical compound as claimed, but a simple mixture which consists essentially of sodium sulphate (dried Glauber salt) ²⁄₃, and sodium citrate ¹⁄₃. It is, therefore, a typical nostrum, and, as it appears, one the composition of which is changed from time to time to suit the whim of the manufacturer. The therapeutic claims made for it are of the usual extravagant character. According to a recent advertisement it is “used successfully for Gouty Diathesis, urinary Calculi, Rheumatoid Arthritis,” “useful in Migraine, Occipital Headache, Epilepsy, Hay Fever, Asthma,” etc. If such a simple mixture will do all that this one is claimed to do, let us use it, but prescribe its ingredients under their proper names. Such a mixture would cost only a few cents a pound, but this nostrum is listed at $1.25 a bottle of five ounces, or probably $1.75 at retail, and this for the benefit of its foreign manufacturers and their agents.​—(Abstracted from The Journal A. M. A., Nov. 23, 1907.)

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“Uriseptin,” manufactured by the Gardner-Barada Chemical Co. of Chicago and claimed to be a “urinary antiseptic, uric acid solvent and diuretic,” was examined in the laboratory of the American Medical Association to determine to what extent the claims made for it are justified.

The preparation as purchased in the open market bears a label which presents the claims of the manufacturers, emphasized by the chemical analysis duly signed by an analyst and attested by a notary. Accompanying is a reproduction of part of the label.

Before the examination had extended very far it was found that discrepancies existed between facts and claims, and by the time the analysis was complete Uriseptin was found to be in the same class as many other proprietary remedies that have been discussed in these columns.

Our examination shows that the most misleading statement is that concerning the “lithium-formaldehyd” compound the presence of which is claimed, more or less directly, by both the manufacturers and the analyst employed by the manufacturers. Although the chemical properties of lithium and formaldehyd indicate in themselves that the existence of such a compound would be most improbable, yet considerable time was spent in searching the chemical literature for such a compound. Thorough search, however, demonstrated that no such compound, nor any that even approximated it, has been described.

The question then arose as to the form in which the lithium and the formaldehyd are present. The statements regarding its properties as a urinary antiseptic and the fact that the preparation is said to liberate formaldehyd slowly in the bladder point strongly to the presence of hexa­methylen­amin.

Tests102 were applied to demonstrate whether the formaldehyd was present as a lithium compound, and if not, whether it existed in the form of hexa­methylen­amin. By these the presence of hexa­methylen­amin was proved and the absence of formaldehyd in other combinations demonstrated. This fact alone shows that the preparation is deliberately marketed under a false claim, and it shows further that the analysis on the label is worthless. The quantitative method of analysis demonstrated the presence of 5.51 gm. hexa­methylen­amin per 100 c.c. (25.15 grains per fluidounce).

Besides the hexa­methylen­amin, Uriseptin contains lithium and a benzoate. Concerning the latter nothing is said in the analysis, whose worthlessness is again demonstrated. By quantitative methods Uriseptin was found to contain lithium and a benzoate in such proportions as would indicate that the lithium and the benzoate radicle exist as lithium benzoate. This fact is further indicated by the claims made for the preparation regarding its properties as a uric acid solvent, for which purpose lithium benzoate is often used. Again, the demonstration that the formaldehyd present is in combination as hexa­methylen­amin precluded any possible chemical combination between lithium and formaldehyd and adds another strong point in support of the conclusion that the lithium and benzoic acid are in combination as lithium benzoate.

CONCLUSION

By chemical analysis the active ingredients of Uriseptin are shown to be hexa­methylen­amin, approximately 5.5 gm. per 100 c.c. (about 25 gr. to each fluidounce), and lithium benzoate, approximately 0.70 gm. per 100 c.c. (about 11 grains to each fluidounce), neither of which compounds is mentioned in the advertising matter on the label or in the so-called “analysis” on the label. The statements concerning the composition of Uriseptin are false and appear to be a deliberate attempt to mislead physicians.

Comment.—Investigation of the various “patent” and so-called “ethical proprietaries” advertised to the public and to the medical profession shows that those that have any value as therapeutic agents depend for that value on some well known drug or drugs. Hence, while many proprietaries have some virtue, the ingredients which are of any value are so concealed by the coined and “near-scientific” names applied to them that these drugs are usually unrecognizable. The many and various acetanilid mixtures furnish examples of this class of proprietaries. And now we find another example in that much advertised nostrum, Uriseptin.

According to our chemists, the chief ingredients of Uriseptin are hexa­methylen­amin and lithium benzoate. Hexamethylenamin is a valuable so-called urinary antiseptic—​probably one of the best we have. It is a pity that more physicians do not know the value of this drug in and of itself; it is a common ingredient of many proprietaries, and yet too seldom prescribed under its true name. There is no reason for its being given in the form of a nostrum; it requires no skill in compounding, for it is best given in its powdered form, either in capsules or otherwise. So that, like acetanilid, the old argument of the nostrum men that the preparation needs skill in compounding will not hold. If a physician wants to prescribe hexa­methylen­amin let him prescribe it in its simplest and best form, and thus know exactly what he is giving.

Lithium benzoate also has its rightful place in the materia medica, but not hidden in a proprietary mixture to be prescribed unknowingly. It is hard to conceive of any one thing that operates more disastrously against scientific therapeutics than the vicious practice of marketing under proprietary names standard and valuable drugs, with their identity purposely concealed. Yet how frequently it is done. Well-known drugs of unquestioned worth are combined with those that are little known and of doubtful value, or more likely absolutely worthless, the mixture is put on the market under a high-sounding name and it is exploited through physicians as a panacea for all kinds of diseases.

In this, as in so many other instances, an “analysis” made to order is given to lend an air of apparent respectability and scientific standing to the preparation or to its exploiters, with the object, of course, of misleading physicians into thinking they are reading unbiased testimony. In addition, the “literature” accompanying the preparation is usually a jargon of pseudo-scientific verbiage put in to serve the same purpose as the analysis—​that of catching the careless physician.

This state of affairs will continue just so long as the medical profession will tolerate it—​and no longer. So long as members of our profession will prescribe proprietaries on the statements of their owners—​as to both their composition and their therapeutic value—​just so long will pseudo-chemical and pseudo­pharma­ceut­ical companies fatten at the expense of the medical profession and to the detriment of the public health.​—(From The Journal A. M. A., Aug. 29, 1908.)

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Attention has been called to the vague and mysterious statements regarding a preparation called Zemacol, manufactured by the Norwich Pharmacal Co., Norwich, N. Y. Because of the unsatisfactory statements regarding the composition of the preparation, it was considered of sufficient interest to make an analysis and determine its chemical constituents. Accordingly specimens of the preparation were obtained and examined.

The preparation Zemacol (Norwich Pharmacal Co.), as found on the market, is a thick, pink, mucilaginous liquid, highly perfumed and having besides a suggestion of a phenolic odor. The bottle bears a label on which appear the following statements:

In the advertising matter the following claims are made:

Since nothing could be found in the literature regarding the therapeutic action of an extract of the rete mucosum of the sheep, it was thought possible that the statements on the label were given simply as a vague and mysterious means of indicating the presence of wool-fat (lanolin), and tests were made to determine the presence or absence of the latter substance. A substance was isolated from Zemacol which had the physical properties of, and responded to some of the chemical tests for, wool-fat; but it was found in such small quantities as to indicate that it was not present as an active constituent. Since there are no definite tests for the detection of serums or animal extracts the presence or absence of these could not be demonstrated. Further examination indicated the presence of salicylic acid, a gummy material, having the properties of tragacanth and glycerin. It is practically free from inorganic matter. By distillation a small quantity of oil was isolated, which possesses the characteristic odor of the preparation.

Quantitative estimations103 indicated the presence of the above-mentioned constituents in approximately the following quantities:

Per Cent.
Gummy matter having the properties of tragacanth	2.02
Salicylic acid	0.67
Matter having the general properties of wool-fat (lanolin)	0.20
Glycerin	5.50
Volatile matter (water and alcohol)	91.00
Aromatic oils and phenol-like bodies	Trace

The results of the above analysis, together with advertising matter regarding Zemacol, were submitted to Dr. William Allen Pusey, professor of dermatology and clinical dermatology, College of Physicians and Surgeons, Chicago, and past chairman of the Section on Dermatology of the American Medical Association, with the inquiry whether or not there was any record of investigations regarding the therapeutic value of an extract of the rete mucosum of the sheep and whether in his opinion the claims made for Zematol would be warranted. The following reply was received:

“So far as I know, nobody ever thought of or proposed the use of an extract of rete mucosum as a therapeutic agent and if a serious suggestion of that sort had ever been made I believe I would know it. I can conceive of no service which such an extract could render and I think the suggestion of it is a highly fantastic idea. From the analysis which you furnish I should say that the mixture described is substantially the ordinary 2 per cent. solution of tragacanth in glycerin and water with a little antiseptic added to keep it from decomposing. That is a commonly known lotion, modifications of which are used in practically every hospital as a hand lotion, and has no magical virtues whatever. Incidentally, I should think it cost, aside from the labor, about twenty cents a gallon to make it.”​—(From The Journal A. M. A., May 14, 1910.)

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Zyme-oid, manufactured by the Oxychlorine Chemical Company of Chicago, is advertised as “a powerful gastro-intestinal antiferment” which will “arrest and prevent bacterial fermentation in any portion of the intestinal tract, whether the media be acid or alkaline.” These extravagant statements, like many others made regarding the properties of zyme-oid, are very similar in character to those made in the circulars accompanying the preparation oxychlorine, manufactured by the same firm and exposed in The Journal, July 6, 1907, page 54. (See page 147 of this book.)

As examples, several parallel statements help to show this similarity. The formula (?) of oxychlorine, as expounded on the label, is given in full, while in the case of zyme-oid only a hint is given as to its composition, but still sufficient to point to a similarity between the two:

OXYCHLORINE		ZYME-OID
“Oxychlorine is a tetraborate of sodium and potassium combined with oxychlorid of boron, thus: (6NaKB4O7) BOCl3.”		“Zyme-Oid is a double borate salt.”

In the matter of claims for chemical stability the two seem to be very closely allied:

Oxychlorine is “a stable salt under all conditions until brought in contact with sub-​oxygenated organic matter.”

Zyme-oid is “a product which is stable enough for keeping purposes, but which readily yields nascent oxygen in the presence of bacterial prod­ucts.”

The therapeutic properties attributed to these sister products are even more similar, for we find that:

“Oxychlorine is adapted to all morbid and abnormal fer­men­ta­tive alimentary states.”

“Zyme-oid is a powerful gastro­intestinal antiferment.”

Many more statements and claims could be quoted to show a similarity between, amounting almost to an identity of, oxychlorine and zyme-oid.

With these facts in mind, the analysis of zyme-oid was undertaken in order to compare it with the previously examined oxychlorine and to determine to what extent the claims made for zyme-oid are upheld by its composition. The analysis indicated, as was expected, that zyme-oid is essentially the same as oxychlorine as is shown in the following, quoted from the report of the analysis of each:

ANALYSIS OF OXYCHLORINE			ANALYSIS OF ZYME-OID
Potassium (K)	12.26		Potassium (K)	13.50
Sodium (Na)	8.20		Sodium (Na)	9.84
Chlorate (ClO3)	25.32		Chlorate (ClO3)	27.50
Nitrate (NO3)	21.70		Nitrate (NO3)	24.22
Boric acid anhydrid (B2O3)	18.63		Boric acid anhydrid (B2O3)	13.42
Water, calculated	13.29		Water, calculated	10.42

Assuming that the chlorate in zyme-oid is present as potassium chlorate and the nitrate is present as sodium nitrate, the figures obtained by analysis correspond to a mixture approximately as follows:

Potassium chlorate (KClO3)	40.43
Sodium Nitrate (NaNO3)	33.22
Potassium tetraborate (K2B4O7)	1.60
Sodium tetraborate (Na2B4O7)	3.31
Boric acid	21.14

From the results of the analysis and from the physical properties of zyme-oid we conclude, just as was done in the case of oxychlorine, that the preparation is not a definite chemical compound, but is essentially a mixture of alkali chlorate and nitrate with boric acid, probably produced by fusing together the constituents.

COMMENT

An examination of the claims made for the firm’s two products, while, as already proved, disclosing many points of similarity, will also show one remarkable difference. We refer to the skilful indefiniteness that pervades the claims made for zyme-oid and which defies scientific refutation. This verbal obscurity is becoming daily more common in the “literature” of firms marketing nostrums. Since the Council has analyzed many of the much-advertised articles and proved the unreliability of the pseudo-scientific claims made for them, the more cautious of the nostrum-mongers have modified the matter descriptive of their products. They have called to their aid the principle that words were given to man to conceal thought rather than to express it, and they have reduced equivocation to a fine art. Wherever it was possible to put forward claims by implication rather than by expression this has been done.

To substantiate further the claims made by the manufacturers of zyme-oid for their product, a laboratory report is brought in evidence. This report, which is written more in the style of a peruna testimonial than that of a conservative scientific statement, fails to verify the claim that zyme-oid is a “double borate salt,” but confines itself to a statement of its harmlessness and its anti-fermentative properties. In passing, it seems regrettable that scientific laboratories should, for a pecuniary consideration, be willing to jeopardize their reputations by lending their names to the furtherance of nostrum exploitation. The results of the examination of zyme-oid demonstrate that the product is no more worthy of the physician’s consideration than its close, and equally worthless, relative, oxychlorine.​—(From The Journal A. M. A., May 23, 1908.)

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