in 1908 as a preliminary step in the consideration of a preparation
containing it--“Gardner’s Syrup of Ammonium Hypophosphite”--because
the Council standardizes unofficial products before considering
preparations or mixtures of these.
The therapeutic use of hypophosphites being irrational (see, “The
Hypophosphite Fallacy,” Report of the Council on Pharmacy and
Chemistry, The Journal, Sept. 2, 1916, p. 760), the salt, ammonium
hypophosphite, deserves continued recognition only on condition that
this salt of ammonium is superior to other salts from which may be
obtained the effect of the ammonium radical. It has been claimed that
ammonium hypophosphite has a less objectionable taste than other
ammonium salts used for similar purposes. This claim would merit
serious consideration if in addition to being less objectionable to
the taste, the effects of ammonium hypophosphite were equal to or more
desirable than the official ammonium salts. There is no evidence that
this condition is met by the hypophosphite salt.
Ammonium hypophosphite has long been known, yet it is not official
in the Austrian, Belgian, British, French, German, Hungarian,
Italian, Swedish, Swiss or United States Pharmacopeias. Neither is it
mentioned in the leading textbooks on materia medica, pharmacology or
therapeutics. In short it appears to be an instance of an obscure and
superfluous salt selected for proprietary exploitation.
Since the continued recognition of ammonium hypophosphite would tend to
perpetuate the hypophosphite fallacy, and because there is no evidence
supporting its advantage as a means of securing the effect of ammonium
salts the Council directed its omission from New and Nonofficial
Remedies.--(_From Reports of Council on Pharmacy and Chemistry, 1916,
p. 51._)
ALPHOZONE OMITTED FROM N. N. R.
Report of the Council on Pharmacy and Chemistry
The following advertisement appeared in the _New Idea_ (September,
1916), a house organ of Frederick Stearns & Co., the proprietors of
Alphozone:
[Illustration]
In the light of our present knowledge the claim that Alphozone is a
preventive of infantile paralysis is without warrant and the advice
that the public depend on it for this purpose is reprehensible and
dangerous. Therefore, the Council directed that Alphozone be omitted
from New and Nonofficial Remedies.--(_From Reports of Council on
Pharmacy and Chemistry, 1916, p. 50._)
CALCIUM GLYCEROPHOSPHATE AND SODIUM GLYCEROPHOSPHATE
OMITTED FROM N. N. R.
Report of the Council on Pharmacy and Chemistry
Calcium glycerophosphate and sodium glycerophosphate were accepted
for New and Nonofficial Remedies chiefly in order that these products
might be standardized. These mixtures now being defined in the new
edition of the U. S. Pharmacopeia, this reason for including them
in N. N. R. no longer exists. The report of Marshall (The Journal,
Feb. 13, 1915, p. 573) which has the endorsement of the Council (The
Journal, Sept. 30, 1916, p. 1033) shows that organic phosphorus
compounds are split up into inorganic phosphates before absorption,
that the animal organism can synthesize its complex organic phosphorus
constituents from inorganic phosphates and consequently that the
glycerophosphates, so far as their phosphorus value is concerned, are
not superior to other phosphates. In fact, sodium and phosphate are
more effectively administered as neutral or acid phosphate. It is
evident that sodium glycerophosphate is a superfluous pharmaceutical
preparation, particularly when the difficulty of obtaining a pure
product and its high price is considered. So far as its calcium value
is concerned, calcium glycerophosphate has no advantages over such
calcium salts as the carbonate, phosphate, lactate, or chlorid. In view
of the foregoing, the Council directed that sodium glycerophosphate
and calcium glycerophosphate be omitted from New and Nonofficial
Remedies.--(_From Reports of Council on Pharmacy and Chemistry_, 1916,
p. 52.)
GARDNER’S SYRUP OF AMMONIUM HYPOPHOSPHITE OMITTED FROM N. N. R.
Report of the Council on Pharmacy and Chemistry
In recognition of the considerable revision of the therapeutic claims
made by the manufacturer, Gardner’s Syrup of Ammonium Hypophosphite
was retained in New and Nonofficial Remedies, 1916, and the proprietor
advised of this provisional retention.
In the most recent advertising for this ammonium hypophosphite syrup
the claim is made:
“Besides being an active expectorant Syrup of Ammonium
Hypophosphite (Gardner) is useful as an alterative and resolvent
and by virtue of its phosphorus element, which is in the form of a
hypophosphite, PH₂O₂, has a tonic value.”
As detailed in the report of the Council “The Hypophosphite Fallacy”
(The Journal, A. M. A., Sept. 2, 1916, p. 760) careful studies show
that the hypophosphites are devoid of the “alterative” and “tonic”
actions claimed by the manufacturer of Gardner’s Syrup of Ammonium
Hypophosphite. Accordingly the Council voted to omit Gardner’s Syrup of
Ammonium Hypophosphite from New and Nonofficial Remedies and authorized
publication of this report.--(_From Reports of Council on Pharmacy and
Chemistry, 1916, p. 55._)
GLUTEN PRODUCTS MADE BY THE KELLOGG FOOD COMPANY
Report of the Council on Pharmacy and Chemistry
For over two years the Council has had under consideration certain
products offered for the use of diabetics by the Kellogg Food Company
of Battle Creek, Mich. These are:
Pure Gluten Biscuit.
Pure Gluten Meal.
40 per cent. Gluten Biscuit.
40 per cent. Gluten Flour.
40 per cent. Gluten Meal.
20 per cent. Gluten Meal.
The Council found these products ineligible for New and Nonofficial
Remedies because the statements of composition (particularly of starch
content) were insufficient and because the exploitation of the products
to the laity was objectionable. June 21, 1915, the company promised to
place a statement of the starch content on the package of each gluten
product, to place on the gluten flour sacks a caution that diabetics
use the flour only on the advice of their physicians, and to revise its
advertising in accordance with the suggestions of the Council. Nothing
further having been heard from the company, in April, 1916, specimens
of the product were obtained, through a layman, direct from the
Kellogg Food Company. These specimens, together with the advertising
matter received at the same time, and also a letter of advice from the
company to another layman, were sent to the Council’s referee, whose
report follows. As will be seen, the referee finds that the amounts
of carbohydrates contained in Pure Gluten Flour, 40 per cent. Gluten
Flour and Pure Gluten Meal are greater than the amounts claimed in
the company’s published analyses; that in the two first mentioned the
amounts of protein are less than the amounts claimed; that exaggerated
claims are made on all the labels and in the advertising literature,
and that the company prescribes directly to the patient.
The following report was sent to the Kellogg Food Company for
consideration. In reply the firm stated that a revision of its
advertising was under consideration but would make no statement
as to how soon this revision would be carried into effect. As the
consideration had already consumed two years, the Council decided to
give the profession the facts and authorized publication of the report.
At the same time the Kellogg Food Company was advised that its products
would be considered further whenever any submitted evidence warranted
this.
W. A. Puckner, Secretary.
Referee’s Report
I submit herewith my report on certain foods offered by the Kellogg
Food Company for the use of diabetics. I shall discuss these products
from the standpoint of the claims made on the label, from the
standpoint of the company toward nonmedical treatment as revealed in a
letter to a layman, and lastly, on the basis of the claims made for the
foods in the company’s literature.
CLAIMS MADE ON THE LABEL
PURE GLUTEN BISCUIT
Referee Company
Water 8.30 5-10
Ash 2.04 1-2
Protein (N × 5.7) 73.87 75-80
Fiber 0.12 2.4-3
Carbohydrates 14.84 0-5
Fat 0.81 0.25-0.70
Starch 4.02 0-5
The sample analyzed does not contain the amount of protein claimed
for it. It also contains more starch than one might suspect from the
company’s analysis. A more conservative claim would be “starch less
than 5 per cent.” The company makes the error of using the terms
“starch” and “carbohydrates” as synonymous. If the maximum figures of
the company’s analysis are used, the carbohydrates would amount to
5 per cent., whereas I find 14.84 per cent. The claim on the label
“Guaranteed to contain less than 5 per cent. of carbohydrates” is
incorrect. The next claim, “Each ounce of this gluten contains 23 grams
of protein and represents 95 calories” is approximately correct, as my
analysis shows 20.9 grams of protein and 103 calories.
The following remarks under “Vegetable Proteins” are in my judgment
exaggerated:
“Leading authorities are now agreed that meat, fish, eggs and
other animal proteins are greatly inferior to vegetable proteins
in diabetes, often increasing the sugar output and the dangerous
acidosis which leads to diabetic coma.... After many years of
experimentation, we have succeeded in perfecting a process whereby
the carbohydrates are excluded.”
In this connection, von Noorden, whom the company constantly quotes,
says:
“In the slighter forms (of diabetes), the influence of meat
albumins is not great and it is difficult to demonstrate the
reaction of the patient to different forms of albumin. It may be
necessary to add more albumin than the patient can actually take
before glycosuria indication is reacted.... Once a medium amount of
albumin is exceeded, say 70 to 80 grams, the glycosuria increases,
no matter what the type of albumin is.”
My analysis also shows that the carbohydrates are not excluded from
this food as claimed above.
40 PER CENT. GLUTEN BISCUIT
Referee
Water 8.50
Ash 1.48
Protein (N × 5.7) 41.15
Fiber 0.08
Carbohydrates 47.81
Fat 0.98
Starch 36.98
No analysis is supplied by the company, but this may be called properly
a “40 per cent. Gluten Biscuit.” The company claims, however, that this
is “Best for Diabetics,” which is not true.
Here, as in the case of “40 per cent. Gluten Flour,” the company’s
label attributes to “Dr. Wm. Osler in ‘Practice of Medicine,’” the
following quotation: “Of Gluten Foods, many are very unpalatable,
others are frauds. A Good Gluten Flour is made by the Battle Creek
Sanatarium Co., Mich.” I have no way of knowing to which gluten flour
of the company Dr. Osler had reference. The “Pure Gluten Meal” might be
called properly a “good gluten flour,” but this “40 per cent. Gluten
Flour” is no better, and no worse, than the average gluten flour on the
market. The quotation from Osler gives an entirely false impression.
40 PER CENT. GLUTEN FLOUR
Referee Company
Water 8.62 5-10
Ash 0.89 0.5-1
Protein (N × 5.7) 33.63 40-45
Fiber 0.08 1-3
Carbohydrates 55.35 40-45
Fat 1.43 0.2-0.5
Starch 48.04 ...
My analysis shows 6.37 per cent. less protein than the company’s
minimum, and 10.35 more carbohydrates than their maximum. In past years
I have found the protein in this brand to range from 35.0 to 42.9 per
cent. (using the factor 5.7). It is true that the manufacturer does
not state what protein factor is used in his reported analysis, but as
in four other brands 5.7 is used, it is fair to assume that the same
factor applies to this as well. At least such should be the case, as
otherwise the manufacturer’s analyses would be meaningless. Even using
the factor 6.25 this later sample contains only 36.88 per cent. of
protein.
The following statement, in my judgment, as applied to a food
containing over 48 per cent. of starch, does not hold water: “This
food is of special service in cases of Glycosuria and in the milder
forms of Diabetes.” With this brand as with “40 per cent. Gluten
Biscuit” the manufacturer again uses the misleading quotation from
Osler.
40 PER CENT. GLUTEN MEAL
Referee Company
Water 7.30 5-10
Ash 1.36 1-2
Protein (N × 5.7) 41.55 40-45
Fiber 0.10 1-2
Carbohydrates 48.58 40-45
Fat 1.11 0.2-0.5
Starch 36.59 40-45
The claimed analysis is justified by my findings. I must take
exception, however, to the following statement: “Prepared with great
care from a good grade of Spring Wheat, by our special process, which
preserves the natural food properties of the product.” The company
evidently tries to carry water on both shoulders, on the one hand
claiming a reduction in the starch content, while on the other claiming
the preservation of all “the natural food properties.”
20 PER CENT. GLUTEN MEAL
Referee Company
Water 7.65 5-10
Ash 1.22 1-2
Protein (N × 5.7) 24.68 20-30
Fiber 0.12 1-2
Carbohydrates 65.41 65-70
Fat 0.92 1-2
Starch 51.24 65-70
The company’s analysis is confirmed. As the company claims directly
that this is “Not A Diabetic Food,” any criticism of its use for
that purpose is disarmed. However, again exception must be taken to
the statement that “the natural food properties of the product” are
preserved.
PURE GLUTEN MEAL
Referee Company
Water 4.60 5-10
Ash 0.96 1-2
Protein (N × 5.7) 76.78 75-80
Fiber 0.08 1-3
Carbohydrates 16.77 0-5
Fat 0.81 0.25-0.70
Starch 6.77 0-5
The minimum claim as to protein is justified. Again the company
confuses carbohydrates and starch, and the food instead of containing
from 0 to 5 per cent. of “carbohydrates (starch)” actually contains
16.77 per cent. of carbohydrates, of which 6.77 per cent. is starch.
Once more the statement that “the natural food properties” are
preserved is untrue as applied to a wheat product deprived of most of
its starch.
In justice to the company, it should be noted that on the labels of
“Pure Gluten Biscuit” and “Pure Gluten Meal” appears the warning:
“Every person suffering from diabetes should be under the care of
an experienced physician,” and on the label of “40 per cent. Gluten
Meal,” “Persons suffering from diabetes should use this food only on
the advice of a physician.” On the other hand, the suggestion on the
label of “Pure Gluten Meal,” “Write for a copy of Diabetic Foods and
How to Use Them” is a more or less direct invitation to self-treatment.
Moreover, a letter dated May 9, 1916, apparently dictated for the
Kellogg Food Company by one Ruth French, in reply to an inquiry from a
layman, gives direct advice with no reference whatever to a physician.
CLAIMS MADE IN A LETTER TO A LAYMAN
In addition to this inconsistent attitude the letter makes certain
clear misstatements, as follows:
“40 per cent. Gluten Flour actually contains 40 per cent. of pure
Gluten, making it a perfectly safe article of diet in all but the
gravest cases of diabetes. From our Gluten Flour excellent bread, gems
and puffs are made that perfectly satisfy the craving for bread with no
harmful results.” This flour contains 33.63 per cent. of gluten, not 40
per cent.; it is not “a perfectly safe article of diet in all but the
gravest cases of diabetes,” for if one reads the literature correctly,
starch restriction is more necessary in mild than in severe cases of
diabetes. Furthermore, the bread, gems and puffs made from such a flour
do not “satisfy the craving for bread with no harmful results.”
In the next paragraph of the letter, undue emphasis is laid on the
“objectionable properties” of flesh foods, a statement only in accord
with the tenets of extreme vegetarians. I also doubt very much whether
the statement is true that “under a diet of our diabetic foods the
thirst to which diabetics are so often subject is usually very much
relieved.”
In the next paragraph the assertion is made that “The diet indicated
... is in keeping with the ideas of the highest medical authorities....
Meat is entirely excluded from the dietary.” My reading of the
literature does not show that the leading authorities take any such
position. Later on reference is made to von Noorden’s claim as to the
superiority of vegetable over animal proteins, which I have already
discussed under “Pure Gluten Biscuit.” (Certain detached sentences of
von Noorden might justify such a statement, but a reading of all he
says on the subject leads to a very different conclusion.)
CLAIMS MADE IN AN ADVERTISING BOOKLET
The whole booklet is written from the standpoint of an extreme
vegetarian, and therefore is often misleading in its conclusions.
Page 5. “The researches of Ogata and others have shown that cane sugar
is a less wholesome food than the natural sugars found in fruits and
produced in the body by the digestion of starch, that is, fruit sugars
and malt sugars.” In opposition to this I quote from von Noorden, their
own authority, “Die Zuckerkrankheit und ihre Behandlung,” Berlin, 1910,
page 270:
“That levulose, milk sugar and inulin are more useful than the other
carbohydrates is a common opinion, but the importance of their use in
practice does not correspond with the theory. In light cases the form
of carbohydrates makes little difference; in severe cases the advantage
from using levulose, milk sugar, etc., is only slightly greater than
from using bread and flour.... Only in certain cases does it appear
to me that the special form of carbohydrates possesses any particular
significance.”
On page 92 of the same work von Noorden tells us that of the
carbohydrates dextrose is the worst, with maltose almost as bad (in
spite of the fact that Kellogg exploits his “Meltose,” the “new
carbohydrate,” as of special value for diabetics). He also says that
levulose increases glycosuria only about half as much as dextrose,
when used occasionally, but with long use it is as bad as dextrose and
starch.
Page 5. The company refers to sugar as “possibly also causing
diabetes.” Sugar or any other carbohydrate may under diabetic
conditions cause an increase of glucose in the urine, but I do not
believe that any food or any diet can cause diabetes.
Page 7. “That the large use of meat and eggs is not only detrimental
but positively dangerous in many cases of diabetes is now a well known
and recognized fact.” The dietaries of well known authorities on
diabetes are not in harmony with this statement.
Page 13. “It has been discovered that the complete suppression
of carbohydrates from the dietary is not only unnecessary but is
highly detrimental and even dangerous.” “The complete suppression of
carbohydrates from the dietary” is the only means the physician has to
determine the diabetic’s carbohydrate tolerance. If carbohydrate-poor
foods are so “highly detrimental and even dangerous,” why does the
company exploit foods like “Pure Gluten Flour” and “Pure Gluten
Biscuit,” whose chief claim to excellence is their comparative freedom
from carbohydrates?
Page 17. “Cream is an emulsion, and, with the exception of egg yolk,
is the only form in which animal fat is found in an emulsified state.”
Milk, Nature’s most wonderful emulsion, is apparently overlooked.
Page 19. “... these foods ... will be found of great value ...
especially as substitutes for the breads and meats which are the most
objectionable features of the ordinary diet, and which should, as far
as possible, be interdicted in this class of cases.” This is simply
special pleading for the Kellogg vegetarian diet.
Page 19. “Our glutens ... are all thoroughly standardized, so that in
their use the physician and the patient know just the amount of starch
eaten.” This standardization is largely mythical. For instance, “Pure
Gluten Biscuit” claims 0 to 5 per cent. “carbohydrates (starch),”
whereas I find 14.84 per cent. carbohydrates with 4.02 per cent.
starch. “40 per cent. Gluten Flour” claims 40 per cent. gluten and
40 to 45 per cent. carbohydrates, whereas I find 33.63 and 55.35
per cent., respectively. “Pure Gluten Meal” claims 0 to 5 per cent.
“carbohydrates (starch)” whereas I find 16.77 per cent. carbohydrates
and 6.77 per cent. starch. I have a record of six analyses each of “40
per cent. Gluten Flour” and “40 per cent. Gluten Biscuit,” which show
the hollowness of this claim of “standardization.” The flour showed
33.6, 35.0, 42.9, 36.8, 35.6, and 40.9 per cent. of protein, with from
40.8 to 55.4 per cent. of carbohydrates; the biscuits 32.7, 33.2, 39.5,
43.3, 33.9, and 41.2 per cent. of protein, with from 41.1 to 54.0 per
cent. of carbohydrates. In fact, my experience shows that the Kellogg
products are more poorly “standardized” than most of the diabetic foods
on the market.
Page 20. “May be made to carry a large amount of fat in the form of
butter, a most desirable thing in the treatment of diabetes,” while on
page 16 the company claims that in an experiment of Minkowski on a dog,
butter “passed through the body without change, none being absorbed”;
these are certainly contradictory statements. The explanation is that
on the one page the company is exploiting its biscuits, and on the
other its nut preparations.
Page 20. Again the incorrect claim is made for “40 per cent. Gluten
Flour” that “we believe this to be the only standardized gluten flour
made.”
Page 21. The claim is made that flesh foods are “objectionable on
account of the large amounts of ptomains and toxins which they
contain.” I was not aware that fresh meats contained any ptomains
whatever. On the same page the claim is again made that by the use of
the Kellogg nut foods “diabetics lose their thirst,” a claim which I
think is more than doubtful.
Page 22. “Nuts are a whole food, containing all the elements required
for the perfect nutrition of the body.” A marked characteristic of
nuts is that they are not “a whole food,” as with the exception of
a few varieties, such as the chestnut, they are extremely poor in
carbohydrates, which fact gives them their value in the diabetic diet.
Page 23. “With the exception of the potato, the beet and the carrot,
vegetables contain little sugar or starch.” Corn, beans and peas are
all vegetables which are relatively high in carbohydrates, and for this
reason are specifically excluded from the diabetic’s dietary.
From the foregoing considerations I would recommend that the company’s
analyses of “40 per cent. Gluten Biscuit,” “40 per cent. Gluten Meal,”
and “20 per cent. Gluten Meal” be accepted as correct. Before the
Council can accept any of these products, the following steps should be
taken:
The company on all its labels should correct the impression that
“carbohydrates” and “starch” are synonymous terms.
The labels of all the preparations examined should be changed in
accordance with the criticisms given above.
In all cases in which analytic data are given, it would be preferable
to state only the minimum of protein and the maximum of carbohydrates.
The booklet, “Practical Suggestions About Diet in Diabetes,” should
be radically changed along the lines noted above.--(_From Reports of
Council on Pharmacy and Chemistry, 1916, p. 56._)
IODO-MANGAN OMITTED FROM N. N. R.
Report of the Council on Pharmacy and Chemistry
Iodo-Mangan, made by the Chemische Fabrik Helfenberg A. G., near
Dresden, Germany, and sold in the United States by the Reinschild
Chemical Company, New York, is a solution said to contain iron,
manganese and iodin in combination with peptone. It is claimed to
be a reconstructive tonic and blood-making adjuvant, with favorable
action in affections of the glandular system. It was admitted to New
and Nonofficial Remedies in 1907, before the Council had adopted the
present Rule 10, which provides that no article shall be admitted
to New and Nonofficial Remedies which, because of its unscientific
composition, is useless or inimical to the best interests of the
public or of the medical profession. In 1911 the Council considered
the question whether or not this product was still eligible and
decided in the end to retain it as probably having some merit. To
determine if Iodo-Mangan was eligible for New and Nonofficial Remedies,
1917, the Reinschild Chemical Company was requested to send in the
current advertising matter. As this advertising was not sent in and
as apparently the product was not marketed at the present time, the
Council on Pharmacy and Chemistry voted to omit Iodo-Mangan from New
and Nonofficial Remedies. At the same time the Reinschild Chemical
Company was informed that the preparation might be submitted for
reconsideration at any time.--(_From Reports of Council on Pharmacy and
Chemistry, 1916, p. 64._)
LIQUID ALBOLENE
Report of the Council on Pharmacy and Chemistry
As now marketed, Liquid Albolene (McKesson and Robbins, New York), is
claimed to be made only from genuine Russian oil and hence to possess
distinct advantages over
“... Oils purporting to be Russian, most of which are imperfectly
purified and many of which are positively dangerous for continued
use.”
On the other hand, a short time ago, McKesson and Robbins claimed that
Liquid Albolene was then available.
“... Of as high a quality as we had supplied before the European
War. Thanks to the research and scientific achievement of Our
Chemists, we are now able to offer LIQUID ALBOLENE, using as a base
a specially refined Domestic Oil that is in every way suitable for
medicinal purposes, and having the same viscosity as Russian Oil.”
The advertising matter suggests the promiscuous, thoughtless and
irrational use of Liquid Albolene and of a number of Albolene
preparations by extravagant claims, such, for example, as the following:
“Albolene will never fail to bring a free, easy stool, no matter
what condition may be present, from obstinate atony of the bowel to
fissure, fistula, or even malignant disease, and in spite of the
failure of ordinary purgatives to which the patient may have become
habituated....
“Aromatic Liquid Albolene is actually the first laxative presented
to the medical profession that seems to have no drawback....
“It will not have been lost upon the physician who has read the
remarks on the use of Aromatic Liquid Albolene to regulate the
bowels in surgical cases, that there are many instances where
it would prove equally valuable during the treatment of acute
diseases. In the exanthemata, in pneumonia, for example, to cite
only a few of the conditions where it may be used to advantage, an
absolutely reliable laxative that will not in any way weaken or
distress the patient, presents obvious superiority to any of the
agents heretofore in common use.”
The Council held Liquid Albolene ineligible because the product is
marketed in a way to encourage its indiscriminate and irrational use by
the public (Rule 4) and because unwarranted therapeutic claims are made
for it (Rule 6).--(_From Reports of Council on Pharmacy and Chemistry,
1916, p. 65._)
NAPHEY’S MEDICATED UTERINE WAFERS
Report of the Council on Pharmacy and Chemistry
Naphey’s Medicated Uterine Wafers were submitted to the Council by the
manufacturers, Naphey & Co., some years ago and were rejected. Naphey &
Co. has recently requested reconsideration of the preparation, and has
submitted advertising matter, trade packages and sample packages. The
label of the trade package contains the following:
“Naphey’s Wafers. For the local treatment of diseases of women,
indicated in catarrhal conditions of the vagina, and of the uterine
cervix. As a [_sic!_] adjuvant for the physician to use in carrying
out treatment of disease of the uterus.”
“Zinc Sulphate, 3-3/4 gr., Sodium Sulphate, 3-1/2 gr., Sodium
Borate, 4 gr., Boric Acid, 3/4 gr.”
“Naphey & Co., Warren, Pa., U. S. A.”
“Each box contains 25 wafers, sufficient for three months’
treatment. Price per box, 25c.”
In name, composition, and general appearance of the package, Naphey’s
Medicated Uterine Wafers bear a strong resemblance to Micajah’s
Medicated Uterine Wafers (The Journal, A. M. A., March 26, 1910,
p. 1070). An advertising pamphlet reads:
“In every form of leucorrhea Naphey’s Medicated Uterine Wafers are
indicated ...”
“What is true of leucorrhea is also true of all other functional
troubles affecting the female genital canal; they are all treated
best by astringents and antiseptics. And these, to be effective,
must be applied in prolonged contact.”
The implication that all “functional troubles affecting the female
genital canal” are best treated by astringent tablets like Naphey’s
Medicated Uterine Wafers is an absurdity. The naming of disease
conditions on the label, the manifestly unwarranted and exaggerated
therapeutic claims, the name, which is non-descriptive of composition
but suggestive of use, and the fixed formula, which cannot rationally
be expected to give uniformly satisfactory results in the wide range
of conditions for which the product is recommended, render Naphey’s
Medicated Uterine Wafers ineligible for New and Nonofficial Remedies
under Rules 4, 6, 8 and 10.
The report having been sent to Naphey & Co., the manufacturer
offered, on condition that the preparation be accepted, to revise the
advertising matter in minor particulars, to remove disease names from
the trade package and to adopt the name Naphey’s Wafers or Naphey’s
Tablets. The Council advised Naphey & Co. that the proposed names do
not conform to the requirements for acceptance in New and Nonofficial
Remedies because they do not indicate the composition of this
pharmaceutical mixture, and moreover, that the routine use of a complex
formula such as that of these tablets is irrational.--(_From Reports of
Council on Pharmacy and Chemistry, 1916, p. 66._)
NUJOL
Report of the Council on Pharmacy and Chemistry
Nujol, a liquid petrolatum (Standard Oil Company of New Jersey,
Bayonne, N. J.), was submitted to the Council by the manufacturers.
The Council advised the company that, before Nujol could be made
eligible for New and Nonofficial Remedies, the advertising claims made
for it must be revised to conform to the rules of the Council and the
term “liquid petrolatum” must be used in connection with the brand
designation and given equal prominence on the labels, advertisements
and all circulars. The company thereupon submitted a label on which
the name “Nujol” appeared in large red letters and under it in small
letters the words “Liquid Petrolatum.” This did not meet the Council’s
requirement with regard to the name. Moreover, Nujol continued to be
advertised to the public under exaggerated and unwarranted claims.
The foregoing report was sent to the Standard Oil Company of New
Jersey, which thereupon submitted revised advertising copy. This
copy was decidedly less objectionable than the previous advertising
but still contained exaggerated statements. The copy for use in
lay journals particularly evidenced exaggeration. Observation on
many occasions of a similar fact has convinced the Council of the
inexpediency of admitting to New and Nonofficial Remedies any article
which is advertised to the public.[101]
[101] Since publication of this report the Council on Pharmacy and
Chemistry has revised its rule against recognition of articles
advertised to the public so that this shall not apply (_a_) to
disinfectants, germicides and antiseptics, provided the advertising be
limited to conservative recommendations for their use as prophylactic
applications to superficial cuts and abrasions of the skin and to the
mucous surfaces of the mouth, pharynx and nose, and provided they are
not advertised as curative agents, and (_b_) to non-medicinal food
preparations, except when advertised in an objectionable manner.
The Council held that conflict with Rules 3, 6 and 8 prevented
the acceptance of Nujol and authorized the publication of this
report.--(_From Reports of Council on Pharmacy and Chemistry, 1916,
p. 68._)
PULVOIDS NATRIUM COMPOUND
Report of the Council on Pharmacy and Chemistry
Pulvoids Natrium Compound was submitted to the Council by the Drug
Products Company, Inc., New York, with the statement that each pulvoid
(coated tablet, said to be made to dissolve in the intestinal tract)
represents the equivalent of:
Potassium Nitrate 2-1/2 grs.
Sodium Nitrite 1/2 gr.
Sodium Bicarbonate 2 grs.
Fl. Ext. Crataegus Oxycantha 1 min.
Nitroglycerin 1/250 gr.
According to the advertisements the tablets are “indicated in the
treatment of high blood pressure and all forms of hypertension of the
cardio-vascular system.” It is claimed that the tablets “will not
irritate the kidneys.”
The Council, having submitted its objections to the manufacturer and
considered the firm’s reply, held that Pulvoids Natrium Compound was
inadmissible to New and Nonofficial Remedies for the following reasons:
1. The claim is made that the tablets disintegrate in the intestines;
experiments conducted by the Council indicated that in most cases they
would be broken up in the stomach. It was found that the tablets were
visibly changed immediately after being put into gastric juice or even
into distilled water; they disintegrated within from three to four
hours, not only in gastric juice (obtained from a dog) at 37 C., but
also in distilled water. It is quite usual for solids to remain in
the stomach for more than three hours. If they make their way out of
the stomach in less than that time the gastric movements must be so
vigorous as further to hasten the disintegration of the tablets.
2. The rules of the Council require that the name of a pharmaceutical
mixture shall indicate the potent ingredients. The name of this mixture
does not indicate the presence of the nitrites, the potassium nitrate,
the bicarbonate or the extract of hawthorne and the nondescriptive name
is likely to lead physicians to use the tablets without fully realizing
what they are giving.
3. No evidence was submitted that the tablets, as found on the market,
contained the amount of sodium nitrite and nitroglycerin claimed.
That is, it does not appear that the manufacturer checks the sodium
nitrite and nitroglycerin content by analysis. The Council did not
determine the nitrite content of the tablets. It maintains that when
a manufacturer places a product on the market the burden of proof is
on that manufacturer to show that the facts are in accordance with
his claims for his product. Further, the examination by the Council
of one or several specimens of any commercial product (particularly
in the case of nitroglycerin preparations) would not be a guarantee
of the constancy of its composition so long as the manufacturer does
not himself control the composition by analysis. The necessity of
such control of tablets containing nitroglycerin is evident from the
report[102] of L. F. Kebler of the U. S. Bureau of Chemistry. Dr.
Kebler said:
[102] J. A. M. A., Nov. 2, 1912, p. 1604.
“... nitroglycerin tablets have in a majority of cases been found
deficient in the nitroglycerin content declared.”
“... these commodities are manufactured largely by rule of thumb.
Little checking obtains in their manufacture and generally no
analyst is employed.”
A further proof that nitroglycerin tablets are likely to be deficient
in strength is contained in the convictions under the Food and Drugs
Act of manufacturers who sold tablets below the declared strength,
recorded from time to time (Notices of Judgments Nos. 3405, 2059, 1843,
1799).
4. There is no good evidence, experimental or clinical, to justify the
simultaneous administration in fixed proportion of two vasodilators
like sodium nitrite and glyceryl trinitrate (nitroglycerin). Also there
is no rational excuse for combining extract of hawthorne, which is said
to have a tonic effect on the heart muscle, with nitrites, which cause
relaxation of the vascular system, or for the combination with these
constituents of potassium nitrate or of sodium bicarbonate.
In the absence of evidence for the combination, Pulvoids Natrium
Compound must be considered an irrational mixture, the use of which is
a detriment to sound drug therapy and, hence, not admissible to New
and Nonofficial Remedies.--(_From Reports of Council on Pharmacy and
Chemistry, 1916, p. 69._)
SALOFORM
Report of the Council on Pharmacy and Chemistry
A referee submitted the following report of the American Medical
Association Chemical Laboratory to the Council:
ANALYSIS OF SALOFORM
Saloform (Flexner) is advertised by the Robinson-Pettet Company of
Louisville, Ky. In the advertisements for the product it is stated that:
“Saloform is a definite chemical compound the component parts of
which are _Hexamethylene Tetramine_, _Salicylic Acid_ and Lithia.”
“As a Uric Acid Solvent it is indicated in _Rheumatism_, _Gout_, in
_Phosphaturia_, in _Gravel_, and in _Renal Colic_.”
“As a Genito-Urinary Antiseptic it limits suppuration anywhere
along the Urinary Tract, from the Kidneys down to the orifice of
Urethra.”
As, even after diligent search, no description of a compound of
hexamethylenamine (hexamethylenetetramine), salicylic acid and lithia
was found in chemical literature, it seemed probable that Saloform
is merely a mixture of hexamethylenamine and lithium salicylate.
Accordingly the separation of Saloform into its component parts by
means of selected solvents was attempted. By triturating the powder
with chloroform, filtering and evaporating the filtrate, a residue
was obtained which gave satisfactory tests for hexamethylenamine
but contained only traces of salicylic acid or lithium salicylate.
The portion insoluble in chloroform was dissolved in water. The
solution gave satisfactory tests for lithium salicylate but not for
hexamethylenamine. From these tests it is evident that Saloform
is a simple mixture of hexamethylenamine and lithium salicylate.
Quantitative examination indicated that the two ingredients,
hexamethylenamine and lithium salicylate, are present in approximately
equal amounts.
REFEREE’S RECOMMENDATION
The report of our Chemical Laboratory shows that Saloform is not a
definite compound as claimed, but a simple mixture of hexamethylenamin
and lithium salicylate. It is therefore in conflict with Rule 1. It is
also in conflict with Rule 6, for neither hexamethylenamin, lithium,
nor salicylate are therapeutically effective “uric acid solvents”; nor
would any of these have any effect on “phosphaturia.”
The mixture also conflicts with Rule 10; for it is inadvisable to
administer the ingredients in fixed, but unknown proportions.
It is recommended that Saloform be deemed inadmissible to N. N. R.
The Council adopted the recommendation of the referee and authorized
publication of this report.--(_From Reports of Council on Pharmacy and
Chemistry, 1916, p. 71._)
SECRETOGEN
Report of the Council on Pharmacy and Chemistry
About a year ago the Council declared Secretogen,[103] a product the
active ingredient of which was stated to be “pancreatic secretin” and
advertised as a remedy for certain conditions of defective digestion
and assimilation, to be ineligible for New and Nonofficial Remedies.
The reasons for this decision were stated at the time as follows:
[103] J. A. M. A., May 1, 1915, p. 1518.
“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 mouth.”
Since Secretogen was not the only so-called secretin preparation on
the market, and since the use of secretin preparations was recommended
by certain writers, notwithstanding the lack of evidence of its value,
the Council caused an experimental investigation of the question to be
made. This was carried out by Prof. A. J. Carlson of the University of
Chicago.
No secretin was found in the commercial products examined, namely,
Secretogen Tablets, Secretogen Elixir and Duodenin. Furthermore,
Carlson’s results[104] confirmed the Council’s previous conclusion
as to the inertness of secretin administered by mouth. The Council
endorsed Professor Carlson’s findings.[105]
[104] Carlson. A. J.; Lebensohn, J. E., and Pearlman, S. J.; Has
Secretin a Therapeutic Value? J. A. M. A., Jan. 15, 1916, p. 178.
Reports Council on Pharm. and Chem., 1915, p. 98.
[105] So-Called Secretin Preparations, J. A. M. A., Jan 15, 1916,
p. 208; Reports Council on Pharm. and Chem., 1915, p. 96.
The G. W. Carnrick Company has replied to the publication of this
report in the letter printed below. (A portion of this letter, which
consists of a communication from an unnamed correspondent of the G. W.
Carnrick Company and the company’s comment thereon, has been omitted.)
The Council offered to publish this if the Carnrick Company would
furnish the name of the writer. This it has not done. As will be seen,
the company now shifts ground, abandoning entirely the claim that
Secretogen contains secretin. The Council has authorized publication
of the letter (omitting the part just mentioned), together with the
comment that follows.
W. A. PUCKNER, Secretary.
“_The Council on Pharmacy and Chemistry of the American Medical
Association._
“Gentlemen:--The opinion of the Council and the contribution by
Professor Carlson which appeared in The Journal of the American Medical
Association for Jan. 15, 1916, have been read by us with interest.
The column of Current Comment dealing with ‘Tiger-Bone Therapy and
Clinical Experience’ has appealed to our good nature and, under the
circumstances, our sense of humor.
“Professor Carlson seems to have quite well established that the
so-called secretin preparations do not contain secretin to any
appreciable extent, and that they are inert in laboratory experiments
on normal animals. At the same time, to do away with an apparent
discrimination on the part of the management of the Council, it would
have been well if Professor Carlson had included the so-called secretin
preparations belonging to another well-known firm which markets such a
product. This discrimination has already been referred to by us.
“Had Professor Carlson stopped at the determination of the therapeutic
availability of secretin given by mouth, his work might have been
accepted without comment, even if we should have thought it advisable
to object to the matter published by the Council. But the professor
went beyond his province entirely when, in commenting on the findings
obtained by using Secretogen clinically, he said: ‘It is, perhaps,
impertinent for laboratory men to comment on these clinical results.’
It is. His point was well taken and it is a profound pity that
Professor Carlson did not observe his own ruling.
“In the words of a correspondent of The Journal of the American Medical
Association, in discussing Professor Carlson’s criticism of Dr. Crile’s
‘Kinetic Drive,’ ‘it behooves the laboratory man to be circumspect in
his criticism of clinical theories, since going beyond the bounds of
well-established things weakens his position, not merely with reference
to the particular subject under discussion, but with reference to
clinical phenomena in general.’ Clinical results have definitely
established the value of Secretogen. As the matter now stands this
statement is beyond criticism.
“When Secretogen was first introduced we assumed that it depended on
secretin for results produced. In this assumption we were in good
company, as witnessed by the testimony of Moore, Edie and Abram when,
in the course of their investigations as to the value in diabetes
of _a secretin-bearing extract given by mouth_,[106] they said: ‘In
the majority of these cases ... there has been no appreciable fall
in the output of sugar ... in some of these negative cases there has
been noted, however, improvement in the digestion and, in certain
cases, the patient’s weight has increased.’ They also state that
the secretin-bearing product ‘_appears to stimulate the functional
activity_ of the duodenum.’[106] They give a most significant
report.[107] We quote from the paper as follows:
[106] All italics are ours. G. W. Carnrick Company.
[107] Bio-Chem. Jour. =1=:28, 1906.
“‘The patient had been under observation for six months before
treatment and the sugar was not reducible by diet. _Almost at once the
dyspepsia from which he was suffering was relieved and his general
nutrition improved to such an extent that he regained over eighteen
pounds in weight, which he had previously lost, and this improvement
was accompanied by complete recovery_ of his physical and mental
energies.’[106]
“Inasmuch as this improvement could not have been due to the contained
secretin it must have been due to some other principle contained
in the extract. Our experience and that of the physicians who have
used Secretogen establish the fact that Moore, Edie and Abram made
no mistake when they came to the conclusion that what they termed a
secretin-bearing extract stimulates the functional activity of the
duodenum and improves the digestion.
“When Professor Carlson was investigating Secretogen he must have
realized that he was dealing essentially with an extract of the
duodenal mucosa. It is, therefore, all the more surprising, considering
his extensive researches into the literature, that he should have
ignored the testimony of some of his own authorities, particularly
Hallion, as to the value of extracts of the duodenal mucosa in duodenal
insufficiencies. The meticulous carefulness with which this evidence
was avoided is hardly worthy of the best traditions of physiology, a
science which has truth for its first and last aim.
“Hallion in his ‘La Pratique de l’Opothérapie’ says that the ‘aims of
duodenal opotherapy are: 1, To supply deficient duodenal juice. 2,
Above all to stimulate and to relieve this organ--_notably to aid the
production of secretin_[4]--and so profit by the stimulating action
which duodenal extract exercises on the duodenal mucosa which action
we, Enriquez and myself, believe and have experimentally proved,
conforms to the general principles of opotherapy. 3, By means of the
production of secretin, to reinforce the biliary, pancreatic and
intestinal secretions. 4, To stimulate intestinal peristalsis.
“‘Principal indications: Intestinal dyspepsias, intestinal
autointoxications, certain forms of constipation and duodenal
insufficiency.’
“At the International Congress of Medicine, Madrid, 1903, Hallion
said that he felt justified in stating that _duodenal opotherapy
correctly carried out must be classed under the very best methods of
treating dyspepsia_.[106] The results had been satisfactory and, in
many cases, remarkable. It had been nil in a few cases but it had
never been harmful in any degree. He pointed out that Marfan was the
first to employ this substance clinically. Marfan had had particularly
excellent results in children of 15 months to 4 years suffering with
marked malnutrition, anorexia and constipation. _Marfan prescribed
the duodenal extract given in milk._[106] Hallion further remarks that,
as he is not a practitioner, he had had only one opportunity to test
duodenal opotherapy clinically. The case was that of a man of 26 years
with obstinate intestinal dyspepsia and severe constipation which had
persisted from childhood. This patient had been treated by enemas,
laxatives, diet, etc. _Treatment with duodenal extract resulted in
a complete cure._[106] Hallion points out _that the most satisfactory
aspect of duodenal opotherapy is the permanent effect produced_,[106]
which bears out his statement that these extracts have the power to aid
in the restoration of function and structure of an organ.
“This has been so well established that the principle is now embodied
in a law which is frequently referred to as ‘Hallion’s Law’: ‘Extracts
of an organ exert on the same organ an exciting influence which lasts
for a longer or shorter time. When the organ is insufficient it is
conceivable that this influence augments its action and, when it is
injured, that it favors its restoration.’
“In ‘La Pratique de l’Opothérapie’ Hallion points out that ‘the
opotherapeutic product which corresponds to the affected organ
represents in some way the stimulating and elective food for that
organ, and if we supply the organ with a food which is more complete
than it necessarily needs, the affected organ can exercise its elective
action and take up only those substances of which it is in need.’
“Hallion’s observations on this point are beautifully borne out by
the classic work of J. W. Draper, as reported in The Journal of the
American Medical Association, Sept. 26, 1914. This report gives results
in both laboratory and clinical experiments.
“In order to show that fed jejunal and ileac epithelium exercise
some special detoxicating power, not yet understood but definitely
recognizable, Draper fed a control series of dogs with intestinal
obstruction, experimentally produced, on emulsified cells of liver,
spleen, pancreas and muscle tissue. These animals lived a few hours
longer than not-fed controls, but Draper says that it is evident
that these cells had either no detoxicating action, or a very feeble
one compared with intestinal epithelium. He used jejunal and ileac
epithelium clinically in two instances: 1st, In a female dog which had
had ‘chronic stomach trouble’ for six months. When Draper saw her she
had had complete intestinal obstruction for five days, with symptoms of
tachycardia, extreme nervousness and great weakness in the hind legs.
Draper removed a pebble from her intestine but her condition was still
grave.
“She was immediately put on small-intestine epithelium derived from
two dogs of different breed. Draper says that from a long experience
with duodenally obstructed dogs, he should not have expected her to
recover, but the symptoms gradually subsided and she lived. The second
instance in which he used the epithelium therapeutically was in the
case of a man who suffered from an annular cancer of the intestine with
definite symptoms of obstruction. After the operation, and realizing
that the patient was in a desperate condition, he fed him an emulsion
of intestinal epithelium from a dog. The pulse improved and the patient
lived.
“Some of Draper’s conclusions are as follows:
“‘Autotoxemia in intestinal obstruction undoubtedly arises from an
interference with cellular reactions of the intestinal epithelium....
When small-intestine epithelial cells of healthy animals are _placed
in the stomach_[106] of duodenally obstructed animals, such animals have
lived nearly twice as long as not-fed controlled animals. This evidence
is strongly opposed to the bacterial theory of origin of toxins.’
“The point to be emphasized is this: If this emulsion of intestinal
epithelium had been fed to a normal dog and a normal man, what would
have happened? Absolutely nothing. On the other hand, given as it was
to a dog and a man in desperate need it exercised a potent effect.
“Abundant clinical testimony can be cited in support of the opinions
of Moore, Edie and Abram, Hallion, Marfan and Draper as to the value
of extracts of the intestinal mucosa given by mouth in pathological
conditions. We have previously cited the published favorable opinions
of such gastroenterologists as Anthony Bassler, Lewis Brinton, G. R.
Lockwood, and R. C. Kemp, so there is no need to recapitulate their
experiences with what they honestly believed to be secretin-bearing
extracts, but which were essentially extracts of the duodenal mucosa.
“Supplementing the evidence of these men as to the value of these
extracts we submit an excerpt from a letter from one of the best known
physicians of Edinburgh:
“‘I can speak in very high praise of Secretogen, which I have used in
both tablet form and as the elixir. There is no doubt about its value
in a certain class of intractable indigestion which refuses to be
benefited by any other remedy. On several occasions I have been much
gratified by the definite relief obtained in this class of cases. It
hits the mark also in some types of obstinate constipation--I think
those cases where the trouble is wrapped up in impaired enervation
of the intestine, and where stasis occurs at certain segments of the
canal.’
“Hallion very pertinently points out[108] that it is now accepted that
opotherapy is not substitutive, but homostimulative and he remarks
further that it is well to bear in mind that the so-called active
substances which make the extract efficacious need not necessarily be
the hormones. ‘It may be the elements of tissue structure which may
come to the aid of the injured organ. The hormone should not therefore
be looked on as the only active agent of opotherapy and, while its
action is important, it need not necessarily be preponderant. The
chemical isolation of the hormones is, of course, of interest but may
not be as vital to organotherapy as we have thought.’ ...”
[108] Presse Médicale, 1912, p. 433.
COMMENT BY THE COUNCIL ON PHARMACY AND CHEMISTRY
The G. W. Carnrick Company, which formerly claimed that Secretogen was
efficacious because it contained secretin, now admits this claim to be
unfounded. Notwithstanding, the manufacturers still call their product
Secretogen and make for it practically the same therapeutic claims as
before. They now base these claims on vague “principles of opotherapy”
and on so-called “clinical testimony.” The burden of proof rests on
them to show that these old claims, already discredited but put forth
again on new grounds, are justified. Have they done so?
The “clinical te stimony” is not convincing. So much of it as is
definite enough to permit of criticism has already been dealt with. The
remainder consists of mere assertions; it is not through reliance on
such evidence that the Council can discharge its trust. On this side of
the question there is nothing new to be said--reassertion of a refuted
argument does not constitute fresh proof.
Nor is the case better on the experimental side. The statements of
Hallion, Enriquez, Zuelzer and others[109] as to the existence of a
“peristaltic hormone” not only have failed of confirmation, but also
have been positively discredited. With regard to Draper’s work, which
dealt with acute intestinal obstruction, it is difficult to see what is
its relevance to the present issue, particularly since Draper’s results
were obtained with a product derived from the mucosa of the jejunum
and ileum and _not with an extract of the duodenum_ such as Secretogen
purports to be.
[109] Cf. interal. Schagindweit, E.: Experimentelle Versuche mit
Hormonal, Arch. Internat. de Pharmacod., 1913, p. 77.
The innuendo that the Council discriminates in favor of certain
manufacturers, is itself a confession of weakness.
In publishing this correspondence the Council’s sole object is to put
the medical profession in possession of the exact facts of the case.
These may fairly be summed up as follows:
1. Secretogen was originally marketed as a preparation containing
secretin. None was found in it.
2. Notwithstanding proof of this fact, the G. W. Carnrick Company
retain the original name of the product, knowing that, by its
association with their former erroneous assertions concerning
Secretogen, this name must inevitably convey to a physician using
the product the impression that he is administering secretin. In the
advertising literature no hint is given that this original statement
was erroneous.
3. The product called “Secretogen” has not been shown, either
experimentally and by sound clinical evidence, to possess useful
therapeutic properties.
Under these circumstances the Council reaffirms its decision.--(_From
Reports of Council on Pharmacy and Chemistry, 1916, p. 72._)
IRON CITRATE GREEN
Report of the Council on Pharmacy and Chemistry
H. K. Mulford Company and E. R. Squibb and Sons submitted to the
Council ampules containing solutions of iron citrate green. It thus
became necessary to consider the eligibility of iron citrate green
itself for admission to New and Nonofficial Remedies. As the rules of
the Council provide that nonessential modifications of official or
nonproprietary preparations will not be recognized, the above named
firms were asked to state what advantages, if any, the so-called iron
citrate green had over the official iron and ammonium citrate. In reply
the H. K. Mulford Company wrote that it had come to the conclusion that
iron citrate green and ampules thereof would undoubtedly be considered
by the Council as a nonessential modification of an official product,
adding:
“It seems to differ from the official ferric citrate so far as
essentials go only in color, but custom, which is exceedingly hard
to change in South America, demands that this green variety of
ampules be used in place of the official product.”
In reply to a similar letter of inquiry E. R. Squibb and Sons wrote:
“Iron citrate green (iron and ammonium citrate green) differs from
the U. S. P. iron and ammonium citrate in that it contains less
iron and more citric acid and more ammonium citrate than does the
latter. It is of course a modification of the official salt and is
supplied to meet a real demand. Its reaction is quite decidedly
acid and our present stock contains Fe slightly below the U. S. P.
requirements for iron, assaying 15.74 per cent. instead of 16 per
cent. Fe. The tests used to control its quality are those for the
official product except as before indicated, it is always acid
instead of neutral, as the U. S. P. requires for that salt.”
The smaller iron content (98 per cent. of the U. S. P. requirement)
of the green variety referred to by E. R. Squibb and Sons is so small
as to be negligible. Further, the low iron content as well as the
acidity of the green salt would appear to be detriments rather than
advantages. Inasmuch as no evidence has been presented to show that
iron citrate green is superior in any way to the well-known iron and
ammonium citrate the Council held that iron citrate green, and with it
the dosage forms, was ineligible to N. N. R.
The preceding report was submitted to the Mulford Company and to E. R.
Squibb and Sons for comment before publication. The former firm replied
that in the present case it felt bound to supply the existing demand,
the latter replied that, to give the Council its support in this
matter, the sale of iron citrate green and ampules thereof would be
discontinued.--(_From The Journal A. M. A., Jan. 13, 1917._)
ASPIRIN
Report of the Council on Pharmacy and Chemistry
The referee’s report on Aspirin-Bayer which follows was submitted to
the Council and adopted by it and, in accordance with the referee’s
recommendation, was sent to the Bayer Company, Inc. The company’s reply
contained nothing to warrant the continued recognition of this product
by the Council. It was accordingly directed that Aspirin-Bayer be
omitted from New and Nonofficial Remedies.
W. A. Puckner, Secretary.
REFEREE’S REPORT
The referee’s attention has been called to the systematic campaign
of advertising aspirin to the public. He is informed that tablets
have been marketed for some time in “vest-pocket” boxes, bearing the
name “Aspirin” permanently affixed, which is in technical conflict
with the Council’s rule against indirect advertising to the public.
More recently, conspicuous advertisements have appeared in daily
papers. These are technically in conflict with the rule against direct
advertising to the public.
In addition to the plain technical conflicts with the Council’s rules
there is a feature of the case which has not hitherto been raised
and which should be fully considered: It may be remarked that the
advertisements contain no therapeutic recommendation, and do not, on
their face, urge the public to employ aspirin but apparently merely
tell the public how it may protect itself against sophistication.
In substance, they say: “If you are a user of aspirin, this is how
you may obtain the genuine.” It might be said that this is not an
attempt to increase the use or sale of aspirin--the ordinary object of
advertising--but that the means of protection against adulteration is
a “subject on which the public should be instructed.” The principle
of such exceptions is stated in the comments to Rule 3 (New and
Nonofficial Remedies, 1916, p. 15); and although the present case does
not come under the exceptions specified under these comments, it may be
urged that the exceptions need to be increased as occasion arises. The
notorious adulteration of aspirin may well be urged as establishing a
need for a similar exception in its use.
The general principle of protecting the public against fraud,
adulteration and substitution is directly in line with the objects of
the Council, and deserves commendation and support. It is obvious,
however, that the means adopted for this end must be efficient,
that they must not open the door to other, perhaps greater evils
and that they must be used in good faith. The policy of advertising
“Aspirin-Bayer” must be examined in these respects.
In the first place, the acceptance of a product by the Council implies
an agreement by the manufacturers or agents that they will adhere
strictly to the Council’s rules and will not depart from the letter or
spirit of these rules without notice to the Council. This principle has
been grossly infringed in the present case. There can be no doubt that
the agents were aware that their advertisements conflicted, at least
with the letter of Rule 3. Nevertheless, they did not, in any way,
inform the Council of the change in policy. In this respect, at least,
they have not acted in good faith.
Secondly, the wording of the advertisement implies that only the
tablets stamped with “The Bayer Cross” are genuine. This is misleading,
since every druggist has the right to make unstamped tablets of
aspirin, fully as genuine as those stamped with the cross.
Thirdly, the cross itself cannot be considered an efficient protection;
for people who imitate aspirin will not hesitate to imitate the
stamp. The remedy, in either case, and as with any other drug, is the
examination of trade samples, and the vigorous prosecution of those
guilty of violating the law.
Fourthly, the permanent affixing of the name “Aspirin” to the
vest-pocket boxes is also inefficient as a protection, and serves
mainly as an advertisement.
Fifthly, whatever may have been the motives of the advertisers, and
however carefully the advertisements are worded, they will inevitably
tend to increase the use of aspirin by the public, and this is directly
against the interests of public health. The public does not know, as
physicians do, that headaches are merely symptoms of other, sometimes
very serious conditions; and that they are often the signal for the
need of a thorough physical examination and diagnosis. It is true that
they are often also the symptoms of very minor derangements, which will
right themselves spontaneously; and that, in such cases, drugs like
aspirin may give relief and may do no harm. The patient, however, is
not educated to distinguish one class from the other, and therefore
anything that tends to promote the indiscriminate use of such remedies
as aspirin is detrimental to the public health. Furthermore, aspirin
itself is not always harmless. Alarming idiosyncrasies are sufficiently
common that the use of the first doses, at least, should require
medical supervision. With these considerations in mind, the referee is
of the opinion that the direct and indirect advertising of aspirin is
to be condemned.--(_From The Journal A. M. A., Jan. 20, 1917._)
PIL. CASCARA COMPOUND-ROBINS
Report of the Council on Pharmacy and Chemistry
A circular issued by the A. H. Robins Company of Richmond, Va.,
contains the following statement:
“PIL. CASCARA COMPOUND-ROBINS is a rational therapeutic formula,
composed of CASCARA, PODOPHYLLIN, COLOCYNTH and HYOSCYAMUS, which
promotes a natural flow of secretions, which is, in turn, the
physiologic stimulant of peristalsis. Thus, a normal evacuation is
produced without subsequent inhibition.
“They contain no Mercury, Strychnia nor Belladonna.
“An ideal aid to any remedial agent, when a Mild, Medium or Strong
alimentary stimulant is needed [_sic_].
“Made in two strengths, the dosage may be easily regulated so as
to obtain the effects of an Anti-Dyspeptic, Aperient, Laxative or
Cathartic, as desired. They never cause discomfort unless given in
larger dose than needed.”
This preparation is another example of the innumerable mixtures of
well-known drugs having nothing in the way of originality or of special
therapeutic value to recommend them.
The advertising implies that this particular combination has a special
action on the secretions of the gastro-intestinal tract; otherwise
it would be hard to explain the claim that the preparation is
antidyspeptic, if that means anything more than a laxative or cathartic.
The claim is made that this preparation contains no belladonna--yet
it admittedly contains hyoscyamus! This manifests either ignorance on
the part of the manufacturers, or an effort to impose on the medical
profession. Both belladonna and hyoscyamus contain variable amounts
of similar alkaloids, chiefly hyoscyamin. Hyoscyamus is feebler
than belladonna in its action, as it contains less alkaloid. The
qualitative differences between the two drugs, with reference to their
use as laxatives, is so slight as to make the company’s claim for
hyoscyamus appear either deliberately misleading or to be the result
of crass ignorance. Promoting this mixture of well-known laxatives and
cathartics as an “ideal aid to any remedial agent when a mild, medium
or strong alimentary stimulant is needed” is a slur on the intelligence
of physicians.
Pil. Cascara Compound-Robins is not acceptable for New and Nonofficial
Remedies.--(_From The Journal A. M. A., Jan. 27, 1917._)
CASTA-FLORA
Report of the Council on Pharmacy and Chemistry
Casta-Flora is one of those complex preparations which are offered
to the medical profession, with plausible arguments in support of
the claims made. It is put out by the Wm. S. Merrell Chemical Co.,
Cincinnati. Each fluidounce is said to represent:
“Castanea, fresh leaves, 40 gr.; Passiflora, fresh plant, 40 gr.;
Gelsemium, green tincture, 8 minims; Inula, represented by the
camphoraceous stearoptene Helenin, 20 grs.; Iodized Lime, 8 grs.;
Menthol, 1-4 grs.; Aromatic Syrup Yerba Santa, 60 minims.”
It is said to be:
“A new combination of well-tried remedies of especial value in
pertussis and other spasmodic coughs. It is composed of astringent,
antispasmodic, sedative and expectorant agents, that control the
paroxysms, relieve the irritation, promote expectoration, and give
tone to mucous membranes involved.”
Still more exaggerated claims are made for the individual constituents
of Casta-Flora, partly by direct statement, partly by inference. For
example:
“Castanea is almost a specific in whooping cough and other
spasmodic coughs.
“Passiflora is a narcotic, sedative and antispasmodic without
habit-forming properties, nor does it lock up the secretions and
upset digestion like opiates.
“Inula (elecampane) has been employed as a cough remedy in England
for centuries. Its action is similar to guaiacol and creosote. Its
active principle, helenin, is destructive of tubercle bacilli in
dilutions of 1 to 10,000.
“Iodized Lime, Menthol, and Yerba Santa are too well known as
expectorants and antiseptics to require more than passing mention.”
That Casta-Flora is a “new” combination may be admitted; it is
improbable that exactly this combination of obsolete drugs was ever
before selected for any purpose whatever, but the statement is
misleading in that no new principle of therapeutics is involved. On the
contrary, the combination is just what might be expected from haphazard
choosing of discarded and nearly forgotten drugs. It seems incredible
that a reputable firm of manufacturing pharmacists would make the
positive statement that castanea is _almost_ a specific in whooping
cough. Why not say it is a specific? It would be about as true. A
specific or “almost specific” for this disease would rank among great
medical discoveries; but castanea is merely a slightly astringent drug
neither better nor worse than scores of other astringent drugs that
have been tried, found valueless and discarded.
Hardly less surprising are the statements regarding passiflora. This
herb has been on the market about three quarters of a century. Not only
has it never established itself in scientific medicine, but it is not
even mentioned in modern standard works on therapeutics.
Of all the statements made in the circular perhaps the most remarkable,
in that it is so dangerously misleading, is that regarding helenin,
the active principle of elecampane. The statement that this principle
(helenin) is destructive of tubercle bacilli in dilutions of 1-10,000
can only mean that it is of extraordinary value in the treatment of
tuberculosis; in fact, it is definitely stated that the action of
elecampane is similar to that of guaiacol and creosote.
It is obvious that any drug which would destroy the tubercle bacilli in
the human lungs without exerting a toxic action on the patient would
be a great contribution to medicine. But although elecampane may have
been used for centuries it has proved to have little, if any, merit,
and even the National Standard Dispensatory, p. 848, says: “Elecampane
was formerly employed as a tonic, stimulant, diuretic, diaphoretic,
expectorant, and emmenagogue, but has now largely fallen into disuse.”
One looks in vain in the standard textbooks on therapeutics for a
description of the uses of inula (or elecampane), and of its so-called
“active principle,” helenin.
The circular to which reference has been made says, referring to the
use of castanea and passiflora in the treatment of whooping cough:
“Gelsemium, when made from the fresh, green plant--as is
Merrell’s--is an excellent adjuvant to the above drugs, and allays
the nervous irritability so frequently present.”
H. C. Wood, Jr. (Pharmacology and Therapeutics, 1916, p. 160), says of
gelsemium: “Gelsemium was originally employed as an arterial sedative
and febrifuge in the malarial fevers of the South, and subsequently
in sthenic fevers. It appears in some way to depress the bodily
temperature, but it does not appear probable that any advantage to be
derived from it will counterbalance the danger attending its employment
in the large doses required. In asthma, spasmodic laryngitis, whooping
cough, and nervous cough it has been recommended by Bartholow, but is
little used.”
That is about as favorable a statement for the drug as is to be found
in the textbooks, and it serves to illustrate how little new there is
in this mixture of obsolete drugs that Merrell seeks to market as one
possessing extraordinary therapeutic value.
Even though the ingredients, or certain of them, were singly useful in
the treatment of those conditions for which Casta-Flora is recommended,
no one could possibly foresee the effect in any given case of such a
jumble of drugs, both active and inert, as is said to be represented in
this preparation. The prescribing of such mixtures, the action of which
cannot in any way be foreseen, is plain charlatanism.
In addition, the various drugs in Casta-Flora are present in such
proportions that the dose of each of the several ingredients bears no
relation to the commonly accepted dose.
Casta-Flora is not acceptable for New and Nonofficial Remedies.--(_From
The Journal A. M. A., Jan. 27, 1917._)
FIRWEIN
Report of the Council on Pharmacy and Chemistry
Firwein is a product of The Tilden Company, New Lebanon, N. Y. It is
sold under the claim that when swallowed it has a “predilection” both
for the bronchial mucosa and also for the genito-urinary organs. To
quote:
“Expectorant, Sedative, Antispasmodic in the Treatment of
Inflammations of the Bronchial and Genito-Urinary Mucosæ.”
“Firwein being a bland, soothing balsam possesses a wide range of
adaptability and increased potency because of its healing virtues
and usefulness as an expectorant, sedative and antispasmodic in
bronchitis, and inflammation and catarrh of nose, throat and lungs.”
“Firwein has a special predilection for mucosæ, this being as
marked in diseases of the genito-urinary system as it is in the
respiratory organs. In inflammatory diseases of the genito-urinary
organs, its bland, curative properties are exerted in a gratifying
degree. In cystitis and uritis it is clearly indicated....”
Little information is given concerning the composition of Firwein. An
old circular says:
“Firwein contains Phosphorus, Iodin and Bromin finely blended with
a balsameous elixir made from the fir tree.”
From a more recent circular we quote:
“Firwein is prepared from the inside fresh green bark of the fir
tree ...”
The label on the product reads:
“Firwein is pleasantly and effectively blended with salts of iodin
and bromin, held in solution with 20 per cent. alcohol.”
The therapeutic claims made for Firwein and the mystery enshrouding
its composition make it obvious that the product is intended to appeal
to those who are either thoughtless or ignorant. This is emphasized by
the suggestion that Firwein be combined with (1) cod liver oil (under
the claim that it will “promote the efficiency of the oil”), with (2)
whisky for the treatment of bronchorrhea of the aged, and with (3)
syrup of hypophosphites for the treatment of persistent bronchitis.
As the composition of Firwein is secret, the therapeutic claims
unwarranted, and its use irrational, the Council declared it
inadmissible to New and Nonofficial Remedies.--(_From Journal A. M. A.,
Feb. 17, 1917._)
FIROLYPTOL PLAIN AND FIROLYPTOL WITH KREOSOTE
Report of the Council on Pharmacy and Chemistry
Firolyptol, another product of The Tilden Company, is, we are told,
composed of eucalyptol 10 drops, cottonseed oil 1/2 ounce and Firwein
enough to make 1 ounce. As the composition of Firwein is secret, it
is evident that the composition of Firolyptol is also unknown, except
to the manufacturers. “Firolyptol with Kreosote” is said to contain,
in addition to whatever may be the component parts of Firolyptol,
10 minims of creosote to each ounce. According to an advertisement,
Firolyptol with Kreosote is “antituberculous, antistrumous” and
“contains all the desired features of cod liver oil and is readily
assimilated.”
The advertisements of “Firolyptol Plain” and “Firolyptol with Kreosote”
seem to have for their key-note the assertion that cottonseed oil
is a particularly valuable nutriment and that when combined with
constituents of Firolyptol and Firolyptol with Kreosote becomes
particularly valuable to the tuberculous. To quote from an advertising
circular:
“Now that the reconstructive properties of cottonseed oil are
better appreciated by the profession, the advantages that follow
the administration of a palatable emulsion of this strengthening
and fattening food product are being demonstrated in hundreds
of cases where formerly reliance would have been placed in cod
liver oil.... A recent writer says that pure cottonseed oil is
the greatest and purest vegetable oil known to chemistry, and
will do much toward revolutionizing the treatment of the GREAT
WHITE PLAGUE.... If the treatment of tuberculosis could resolve
itself into the administration of a fatty substance in a readily
assimilated form, there would be no need for any part of FIROLYPTOL
but the Cottonseed Oil.... The toxic material constantly produced
in the system by the germs of tuberculosis tend to expose it
more and more to the ravages of the disease, and the physiologic
functions of the body suffer a constant depression. To neutralize
this germ activity with a consequent production of toxins it seems
most logical to employ such agents as have demonstrated their
suitability for such purposes, for which reason Eucalyptol and
Kreosote with Firwein are incorporated in FIROLYPTOL.”
The assertion that cottonseed oil is an especially valuable form
of fat is without warrant, but even if it were true the fat is
available in cheap and palatable forms in numerous other cottonseed
oil products. It is unnecessary to discuss the problematic value of
creosote in the treatment of tuberculosis or the value of eucalyptol
(now generally abandoned), or even of the secret mixture Firwein.
Food and fresh air, not drugs, constitute the fundamentals of the
treatment of tuberculosis, and it is both irrational and detrimental to
the interests of the tuberculous to administer various potent agents
in fixed and unknown amounts with such simple articles of food as
cottonseed oil. Neither of these products is acceptable for New and
Nonofficial Remedies.
Editorial Note.--Firwein[110] has been advertised to physicians
for twenty-five or thirty years and it is a sad commentary on the
intelligence of our profession that a preparation sold under such
obviously false and misleading, not to say silly, claims, should still
be in existence. Firwein is claimed to “prevent waste of tissue” in
tuberculosis. If it had this power, it would have found its place
long ago among the few great agents in drug therapy. As a matter of
fact, Firwein has gained virtually no recognition outside of the
“literature” of the Tilden concern. The claims made for Firwein are a
peculiar mixture of studied candor--when the truth is not likely to
hurt its sale--and inane vaporing--when the facts would not redound to
its credit. The Tilden Company declares that “Firwein stands without
a peer in its class.” But the company adds 10 drops of eucalyptol and
some cottonseed oil to this peerless product and an improvement is
born--“Firolyptol”! Then, to perfect the already perfectly perfected,
10 drops of creosote are added to “Firolyptol” and the profession is
offered “Firolyptol with Kreosote”! In just what verbal pyrotechnics
the Tilden Company might indulge, should it decide to add ten drops
of something else to “Firolyptol with Kreosote,” one shudders to
contemplate.
[110] Three other Tilden products have been the subject of deserved
and unfavorable comment in the J. A. M. A: “Narkine” in the issue of
Oct. 24, 1908, “Hydrocyanate of Iron-Tilden” in the issue of June 19,
1909, and “Febrisol,” in the issue of June 29, 1912. The first two
articles are reprinted in the latest (9th) edition of “The Propaganda
for Reform.”
If we are accused of exhibiting undue levity in discussing a
therapeutic problem, we can only answer that it is impossible to
consider seriously the Charlie Chaplins of the nostrum world.--(_From
The Journal A. M. A., Feb. 17, 1917._)
BINIODOL
Report of the Council on Pharmacy and Chemistry
In accordance with the usages of the Council, the report which
appears below along with the reports of the clinical investigation
by Drs. Cole and Keidel upon which the recommendations of the
referee were based were sent to the manufacturer for comment. The
reply of the manufacturer contained no evidence which justified the
Council in modifying the action already taken. Publication of the
report was therefore authorized.
W. A. Puckner, Secretary.
Biniodol was submitted to the Council by the manufacturer, Charles C.
Yarbrough, Memphis, Tenn. The manufacturer claims the product is a
solution of 1 per cent. of red mercuric iodid and 2.75 per cent. of
guaiacol in bland vegetable oil. It is marketed with the implication
that it is new and superior to other oil solutions of mercuric iodid.
For instance:
“... it is a straight solution of this mercurial compound, as
no alkaline iodide or other chemical is used to bring about the
solution.” “... It is probably the first and only one-percent oil
solution of straight mercury biniodide made in America....”
[The manufacturer, in a letter addressed to the secretary of the
Council, explains: “By straight solution, I mean that the solution
of the red mercuric iodid is effected without the aid of any
alkaline iodid or other chemicals.... Biniodol was first offered
early in 1912 ...”]
“Biniodol is, therefore, superior and much to be preferred to
other mercurials used for like purposes. It is highly active
therapeutically, producing the desired effects, usually without
the inevitable disadvantages of other mercurials. It rarely causes
salivation, diarrhea, or other symptoms of mercurial intolerance,
even when pushed to full therapeutic effect and when given for a
considerable period of time. Nor does it produce anemia.”
The Chemical Laboratory of the American Medical Association found that
Biniodol contained 1 per cent. of mercuric iodid and 2.5 per cent.
of guaiacol; hence the composition is essentially as claimed. It is
not true, however, that Biniodol is the “first and only one-percent
solution of straight mercury biniodide made in America.” As shown
in The Journal A. M. A., Dec. 9, 1914, p. 2247, formulas by Lemaire
and Dunning for making a “straight” solution of mercuric iodid were
published in this country in 1909 and 1910, respectively. Moreover, a
1 per cent. solution of mercuric iodid in oil is on the market and is
described in New and Nonofficial Remedies.
To determine whether or not Biniodol is “superior and much to be
preferred to other mercurials used for like purposes,” the Council
secured the cooperation of the Department of Dermatology and
Syphilology of the Western Reserve University cooperating with the
Cleveland City Hospital, and of the Johns Hopkins Hospital. Each
received three samples, labeled respectively, 1, 2 and 3: 1 contained
Biniodol; 2, a 1 per cent. solution of mercuric iodid in oil; 3, a
solution made up according to the formula of Biniodol, namely, 1 per
cent. of mercuric iodid and 2.5 per cent. of guaiacol in oil. All the
solutions were sterile. The investigators were not informed which
preparation was designated by the respective numbers, but they were
asked to use the preparations when intramuscular injections of a 1 per
cent. oily solution of mercuric iodid were indicated, and to note what
differences, if any, were observed following the use of the different
solutions regarding pain, discomfort, induration and any other
evidences of effects of the medicaments.
The Cleveland investigator reports that the patients were more or less
confused in their replies to inquiries and gave rather indefinite and
conflicting answers. After carefully tabulating the replies, however,
the following summary resulted:
1 was worse than 2 or 3 in 6 cases.
2 was worse than 1 or 3 in 5 cases.
3 was worse than 2 or 1 in 1 case.
The report from Johns Hopkins records a series of 117 injections
followed by the estimated reactions recorded below:
1. Severe, 13; mild, 14; none, 4; unrecorded, 8 = 39
2. Severe, 5; mild, 15; none, 16; unrecorded, 5 = 41
3. Severe, 7; mild, 25; none, 3; unrecorded, 2 = 37
That is, when recorded in percentages:
1. (Biniodol) severe, 33.3; mild, 35.9; none, 10.3;
unrecorded, 20.5.
2. (Without guaiacol) severe, 12.2; mild, 36.8; none, 39.0;
unrecorded, 12.2.
3. (With guaiacol) severe, 18.9; mild, 67.5; none, 8.1;
unrecorded, 5.5.
The manufacturer of Biniodol supplied the names of several physicians
who have used that preparation in their practice. Correspondence with
these elicited the following statements:
One had used Biniodol in forty-eight cases and states that “only a few
patients complain of pain at all and then only of a general soreness in
the muscle.” This physician reports a limited experience with the use
of another manufacturer’s “mercury biniodide oil solution” (apparently
six cases), but severe pain following the injections made it necessary
to abandon that preparation.
Another of these physicians named by the manufacturer, without
reference to any series of cases, reports that “Biniodol is superior to
any [oily solution of mercury biniodid] that I have tried.”
A third physician has “used it [Biniodol] a few times” and is
“convinced that it has no special action or virtue” over “any red
mercuric iodide in oil.”
This evidence, in its most favorable estimate, shows Biniodol to be
a good 1 per cent. solution of mercuric iodid in oil, but fails to
justify attributing to the preparation any unique characteristics. The
preparations made in the laboratory were as satisfactory, or better
than the Biniodol, and the presence or absence of the guaiacol was of
no consequence.
Biniodol conflicts with Rule 6, since claims of superior therapeutic
efficiency made for it are not established; and with Rules 8 and
10, since it is an unessential modification of an established
nonproprietary article marketed under a proprietary name.
In view of the foregoing, the referee recommends that Biniodol be
not accepted for New and Nonofficial Remedies, and that this report,
including the clinical investigations of Drs. Cole and Keidel, be
authorized for publication.
COMPARATIVE SYMPTOMS RESULTING FROM THE USE OF SEVERAL OILY
SUSPENSIONS OF RED MERCURIC IODID (MERCURY BINIODID)
Report of Dr. H. N. Cole[C]
[C] From the Department of Dermatology and Syphilology of the Western
Reserve University and of the Cleveland City Hospital.
At the request of Prof. Torald Sollmann of the Council on Pharmacy and
Chemistry of the American Medical Association, we made a comparative
study of several oily preparations of red mercuric iodid for
intramuscular injections in syphilis.
The information, concerning the preparations submitted to the
investigators, was as follows:
OILY SOLUTION OF RED MERCURIC IODID
“It is desired to ascertain whether there is any difference between
three preparations, each containing 1 per cent. of mercuric iodid, as
to pain, discomfort, induration, etc. The preparations will be labeled
“1,” “2” and “3.” They will be sterile.
“One of these preparations will be a plain solution in oil; another
will contain, in addition, 2.5 per cent. of guaiacol; the third will be
a proprietary preparation containing the guaiacol.
“It is also desirable to know how the oily solution compares with the
plain watery solution; but this is of secondary importance.”
The preparations all had the same appearance. The patients were taken
indiscriminately, and we attempted to keep them on the injections as
long as possible, in order to compare symptoms. Owing, however, to
discharge from hospital, symptoms of mercury intoxication, etc., we
were unable in all cases to give a thorough trial with each preparation.
In all, eleven patients were treated and seventy-one injections
given--by which time our experimental supply was exhausted.
In each case the drug was given intramuscularly in the buttocks and the
patients carefully observed for subjective symptoms of pain and for
objective symptoms of swelling, induration, abscess formation, etc. The
details are given in Table 1.
As will be noted, in several of the cases the patients were more or
less confused and gave rather indefinite and conflicting answers. In
attempting to compare the results from the different drugs, by careful
tabulation one finds that symptoms were more marked with the respective
sample as follows:
Preparation 1 was worse than Preparation 2 or 3 in six cases.
Preparation 2 was worse than Preparation 1 in two cases.
Preparation 2 was worse than Preparation 3 in five cases.
Preparation 3 was worse than Preparations 2 or 1 in one case.
TABLE 1.--DETAILS OF INVESTIGATION BY DR. COLE*
====+===+===+============+=======+======+===============+==============
| | | | | | Symptoms
| | | |Prepar-|Dose, +---------------+--------------
Case|Age|Sex| Date | ation | Grain| Induration-- | Objective
| | † | | | | Pain |
| | | | | | |
----+---+---+------------+-------+------+---------------+--------------
1 | 25| ♂ | 6/11/16 | 2 | 1/5 |None |Still painful
| | | 6/12/16 | 1 | 1/4 |None |None
| | | 6/13/16 | 2 | 1/5 |None |Quite painful
| | | 6/14/16 | 2 | 1/4 |Hurt for some |Very tender
| | | | | | time |
| | | 6/16/16 | 2 | 1/5 |Hurt for some |Very tender
| | | | | | time |
| | | 6/17/16 | 3 | 1/5 |Not so painful |Less tender
| | | | | | | than with
| | | | | | | Prepar-
| | | | | | | ation 2.
| | | 6/18/16 | 3 | 1/5 |Not so painful | Can sit on
| | |Discontinued| | | | area; as
| | |(salivation)| | | | needle prick
| | | | | | | is only place
| | | | | | | that it hurts
| | | 6/22/16 | 2 | 1/4 |Hurt, but not |Slight indur-
| | | | | | so long | ation and
| | | | | | | slight
| | | | | | | tenderness
| | | 6/24/16 | 2 | 1/4 |Hurt, but not |Pain “dead
| | | | | | so long | stinging”
| | | | | | | lasts 1 hour
| | | 6/25/16 | 1 | 1/4 |Not so bad |About the same
----+---+---+------------+-------+------+---------------+--------------
2 | 32| ♂ | 6/24/16 | 2 | 1/4 |Some pain |No induration
| | | 6/25/16 | 1 | 1/4 |More pain |Slight indur-
| | | | | | | ation
----+---+---+------------+-------+------+---------------+--------------
3 | ..| ♂ | 6/12/16 | 1 | 1/5 |No symptoms |Painful
| | | 6/13/16 | 2 | 1/4 |No symptoms |Painful
| | | 6/14/16 | 2 | 1/4 |Says the last |Painful
| | | 6/16/16 |Arseno-| | two have hurt |
| | | |benzol | | the more |
| | | 6/17/16 | 3 | 1/5 |More pain than |Small painful
| | | | | | previously | area
| | | 6/17/16 | 3 | 1/5 | |
| | | 6/18/16 | 3 | 1/5 |Not so much |Some indur-
| | | | | | pain: in | ation at site
| | | 6/19/16 | 3 | 1/5 | fact, patient | of injections
| | | 6/20/16 | 3 | 1/4 | says he is |
| | | 6/21/16 | 3 | 1/4 | over it in a |
| | | | | | very short |
| | | | | | while; com- |
| | | | | | plained of |
| | | | | | last one |
| | | 6/22/16 | 2 | 1/4 |Some pain |Considerable
| | | | | | | tenderness
| | | 6/24/16 | 2 | 1/4 |Not so much as | now after so
| | | | | | previously | many injec-
| | | 6/25/16 | 1 | 1/4 | | tions
----+---+---+------------+-------+------+---------------+--------------
4 | 36| ♂ | 6/22/16 | 2 | 1/4 |No pain |No tenderness
| | | 6/24/16 | 2 | 1/4 |Some pain |Some tender-
| | | | | | | ness
| | | 6/25/16 | 1 | 1/4 |Could not sleep|Some tender-
| | | | | | at night | ness; slight
| | | | | | | induration
----+---+---+------------+-------+------+---------------+--------------
5 | 32| ♂ | 6/20/16 | 3 | 20 |Some pain |No induration
| | | | |minims| |
| | | 6/21/16 | 3 | 25 |Some pain |
| | | | |minims| |
| | | 6/23/16 | 2 | 1/4 |Worse pain |No induration
| | | 6/24/16 | 2 | 1/4 |Worse pain |
| | | 6/25/16 | 1 | 1/4 |Worse than any |Slight tender-
| | | | | | |ness
----+---+---+------------+-------+------+---------------+--------------
6 | 20| ♂ | 6/ 8/16 | 1 | 1/6 |Very little |
| | | 6/10/16 | 1 | 1/5 |Very little |
| | | 6/13/16 | 1 | 1/4 |Very little |
| | | 6/14/16 | 2 | 1/4 |Bothered more |
| | | | | | than others |
| | | 6/17/16 | 2 | 1/5 |Quite a little |Still some
| | | | | | pain | soreness
| | | 6/18/16 | 2 | 1/5 |Quite a little |Still some
| | | | | | pain | soreness
| | | 6/19/16 | 3 | 1/4 |Considerably |Very little
| | | | | | less pain than| tenderness
| | | 6/20/16 | 3 | 1/4 | with Prepar- |
| | | 6/21/16 | 3 | 1/4 | ation 2 |
----+---+---+------------+-------+------+---------------+--------------
7 | 30| ♂ | 6/12/16 | 1 | 1/5 |Little pain |None
| | | 6/13/16 | 2 | 1/4 |No pain |
| | | 6/14/16 | 2 | 1/5 |Some pain |
| | | 6/16/16 |Arseno-| | |
| | | |benzol | | |
| | | 6/17/16 | 3 | 1/5 |Not so much |No tenderness
| | | 6/18/16 | 3 | 1/5 |Not so much |No tenderness
| | | 6/19/16 | 3 | 1/5 |Very little |Only slight
| | | | | | pain | amount of
| | | 6/20/16 | 3 | 1/4 | | induration
| | | 6/21/16 | 3 | 1/4 | |
| | | 6/22/16 | 2 | 1/4 |Some pain |Some little
| | | | | | | induration
| | | 6/24/16 | 2 | 1/4 |Considerable |Some indura-
| | | | | | pain | tion
| | | 6/25/16 | 1 | 1/4 |“Fine” |Slight indura-
| | | | | | | tion
----+---+---+------------+-------+------+---------------+--------------
8 | 28| ♂ | 6/13/16 | 2 | 1/5 |Little pain |Little pain
| | | | | | | afterward
| | | 6/15/16 | 2 | 1/5 |Little pain |Little pain
| | | | | | | afterward
----+---+---+------------+-------+------+---------------+--------------
9 | 28| ♀ | 6/17/16 | 2 | 1/5 |Some complaint |Very little
| | | | | | of pain. | induration
| | | 6/18/16 | 2 | 1/5 | Fairly severe |
| | | 6/19/16 | 3 | 1/5 |Some pain; says|Very slight
| | | | | | these have | induration
| | | 6/20/16 | 3 | 1/4 | hurt very much|
| | | 6/21/16 | 3 | 1/4 | less than |
| | | | | | others |
----+---+---+------------+-------+------+---------------+--------------
10 | 37| ♂ | 6/12/16 | 1 | 1/5 |No symptoms |None
| | | 6/13/16 | 1 | 1/4 |No symptoms |None
| | | 6/14/16 | 1 | 1/5 |No symptoms |None
| | | 6/15/16 | 3 | 1/5 |No symptoms |None
| | | 6/16/16 |Arseno-| | |
| | | |benzol | | |
| | | 6/17/16 | 3 | 1/5 |“Much less pain|None
| | | | | | than biniodid |
| | | | | | or grey oil” |
| | | 6/18/16 | 3 | 1/5 |No complaint |None
| | | 6/19/16 | 3 | 1/5 |Says he is over|Some indura-
| | | 6/20/16 | 3 | 1/4 | it in one hour| tion at site
| | | 6/21/16 | 3 | 1/4 | | of injection
----+---+---+------------+-------+------+---------------+--------------
11 | 30| ♀ | 6/11/16 | 1 | 20 |Considerable; |Considerable
| | | | |minims| not so much | pain and
| | | 6/12/16 | 2 | 20 | | tenderness on
| | | | |minims| | palpation
| | | | | | | over area
| | | 6/13/16 | 1 | 25 |Not much pain |Indurated area
| | | | |minims| | at pt. of
| | | | | | | each.
| | | | | | | Painful
| | | 6/14/16 | 1 | 25 |Not much pain |Slight indura-
| | | | |minims| | tion
----+---+---+------------+-------+------+---------------+--------------
* The diagnosis in Case 5 was primary syphilis, and in the other cases,
secondary syphilis.
† In this column, ♂ indicates male, and ♀ female. In no case did
Wassermann become negative.
The criticism may be raised that the number of cases and of injections
is too small to permit the drawing of any just conclusions. Even
should we grant it, the statistics certainly do not prove any marked
superiority of any one of the preparations over the others. We wish to
thank Dr. Sollmann for advising and directing us in this work, and Drs.
Bailey, Bernstein, Markus and Reycraft for assistance in carrying it
out.
Report of Dr. Albert Keidel
Twenty cases were chosen at random from the syphilitic patients
attending the clinic. They were given intramuscular injections of the
three solutions, in amounts varying from 1 to 2 c.c., at intervals (in
most instances) of two days. The injections were invariably made into
the gluteal muscles, at depths of from 2 to 2-1/2 inches, and ordinary
care exercised to preserve asepsis. After injection the patient was
allowed to depart, and the result was recorded at the succeeding
visit. The result was determined from the patient’s statement and our
examination. Some patients received injections of only one solution;
some were treated with first one and later with another, and one
patient received all three at different times. The solutions were never
mixed for a single injection, of course.
TABLE 2.--REACTIONS IN TWENTY CASES REPORTED BY DR. KEIDEL
==================================================================
Preparation Reactions Number of
┌────────────┴────────────┐ Injections
Severe Mild None Undetermined
1 13 14 4 8 39
2 5 15 16 5 41
3 7 25 3 2 37
---
117
------------------------------------------------------------------
The solutions are understood to contain a 1 per cent. solution of red
mercuric iodid in oil, two of them containing in addition 2.5 per
cent. of guaiacol, one of these being a proprietary preparation. The
solutions are designated as Preparations 1, 2 and 3, respectively,
corresponding to the numbers on the labels of the bottles in which they
were originally received. The local reactions are recorded as “severe”
(S), “mild” (M), “none” (O) and “Undetermined” (U). By “severe” is
meant very severe pain lasting for from several hours to several days;
by “mild” is meant slight pain or numbness for several hours, or less
than an hour; “none” indicates that there was no local reaction, and
“undetermined,” that the patient has failed to return after the last
injection.
In Table 3 all the details of the investigation are recorded. Under
“Local Reaction,” the letters represent the type of reaction after each
injection, in the order in which they were given; when two solutions
were used in the same case, the letters represent the reactions
following the solution opposite which they stand. In the fifth column
the plus and minus symbols indicate the Wassermann reaction; plus
indicates a completely positive, and minus a completely negative
reaction. When there is only one sign, it refers to the reaction at the
end of treatment; when there are two, to the reaction before and after.
The seventh column shows the clinical result at the end of treatment;
when no note is made, it means that there was no change noted. In the
eighth column are noted any objective results observed at the time of
examinations of the patients.
The injections were made and the result charted by Dr.
E. L. Zimmermann, of my staff, under my directions and
supervision.--(_Abstracted in The Journal A. M. A., Feb. 24, 1917._)
TABLE 3.--DETAILS OF INVESTIGATION BY DR. KEIDEL
====+===+=======+=========+========+======+=======+==========+==========+============
| | | | Total |Dura- |Effect | | |
Case|No.|Prepar-| Local | Amount | tion | on | Type of | Result | General
| | ation |Reaction |Solution| of |Wasser-| Case | | Remarks
| | | | Given, |Treat-| mann | | |
| | | | C.c. | ment | | | |
----+---+-------+---------+--------+------+-------+----------+----------+------------
1 | 3 | 2 | OOO | 3 | 6 da.| + |Latent | |
2 | 5 | 2 | MOSMS | 5.6 | 9 da.| + |Gummas....|Marked |
3 | 7 | 1 | MMM; | 9.5 | 3 mo.|- to + |Latent | improve- |
| | | others U| | | | | ment |
| 3 | 2 | UUU | | | | | |
4 | 1 | 2 | U | 0.75 | ... | + |Latent | |
5 | 4 | 1 | SSSM | 4.4 | 9 da.| - |Gummas....|..........|After 4th
| | | | | | | | | injection,
| | | | | | | | | developed
| | | | | | | | | diarrhea;
| | | | | | | | | melena
6 | 9 | 1 |OOUMSOSMU| 9.1 | 1 mo.| - |Latent | |
7 | 2 | 3 | MM | 3.8 | 2 da.| + |Latent |..........|Well
| | | | | | | | | tolerated
8 | 7 | 2 | OOOOMOU | 9.6 |17 da.|+ to + |Primary...|Primary |
| | | | | | | | healed |
9 | 4 | 1 | SMMU | 5.5 | 9 da.| |Gumma.....|Improved |
10 | 3 | 3 | MSS | 3 | 6 da.| + |Palmar |Markedly |
| | | | | | | syphilis;| improved |
| | | | | | | tertiary | |
11 | 7 | 3 | MSMMMMM | 10.6 |13 da.|+ to + |Latent | |
12 | 3 | 2 | MMO | 5.4 |14 da.| + |Secondary |Rash |Developed
| 2 | 1 | SM | | | | (papular)| disap- | toxic ery-
| | | | | | | | pearing.| thema on
| | | | | | | | | thighs.
| | | | | | | | | Cleared up
| | | | | | | | | on stopping
| | | | | | | | | HgCl₂ and
| | | | | | | | | under local
| | | | | | | | | treatment
13 |10 | 3 | MMMMMMMM| 12.6 |20 da.|+ to + |Secondary |Rash |Small
| | | MMU | | | | (lichen | not | induration
| | | | | | | syph.) | improved.| following
| | | | | | | | | injection
| | | | | | | | | of 1.2 c.c.
14 | 6 | 2 | OOMSMM | 7.2 |17 da.|+ to + |Old |..........|Responded to
| 2 | 1 | SM | | | | cerebro- | | doses of
| | | | | | | spinal | | 1 c.c. with
| | | | | | | syphilis | | salivation;
| | | | | | | | | fever after
| | | | | | | | | injection
| | | | | | | | | of 1.2 c.c.
15 | 4 | 1 | SOMS | 4.2 | 7 da.|+ to + |Secondary |No |
| | | | | | | (condyl- | improve- |
| | | | | | | omas) | ment |
16 | 9 | 3 |OMOMMSMSO| 10.4 |12 da.| + |Secondary |Pustules |Slight
| 2 | 2 | SO | | | | (pustular| dried up;| gingivitis
| | | | | | | syph.) | headache | following
| | | | | | | | and fever| dose of
| | | | | | | | gone | 1.5 c.c.
17 | 5 | 1 | SSMSU | 13.3 |18 da.|+ to + |Tertiary; |General |
| 2 | 2 | MS | | | | aortitis.| condition|
| 2 | 3 | MS | | | | | improved |
18 | 4 | 2 | OOMM | 9.5 |13 da.|- to + |Latent | |
| 2 | 1 | MM | | | | |Markedly |
| | | | | | | | improved |
19 | 2 | 3 | MU | 2.5 | 5 da.| + |Gumma.....| |
20 | 5 | 2 | MMMMO | 9 |14 da.|+ to + |Latent....|Marked |Small
| 2 | 3 | MS | | | | | general | induration
| | | | | | | | improve- | following
| | | | | | | | ment | No. 3
----+---+-------+---------+--------+------+-------+----------+----------+------------
CORPORA LUTEA (SOLUBLE EXTRACT), PARKE, DAVIS & CO.
Report of the Council on Pharmacy and Chemistry
Following inquiries, the Council took up for consideration “Corpora
Lutea (Soluble Extract),” marketed by Parke, Davis & Co. in the form of
ampules and proposed for hypodermic administration. The report which
appears below was submitted to the Council by a committee, and was
adopted by the Council. Corpora Lutea (Soluble Extract) was declared
inadmissible to New and Nonofficial Remedies, and publication of the
report authorized.
W. A. Puckner, Secretary.
Corpora Lutea (Soluble Extract) has not been submitted by the
manufacturer. The information of the referee is based, therefore, on
the claims made in the trade package, and on the statements in the
price list. These show that the product is essentially secret and
claims made for the actions and uses of the preparation do not make
clear the essentially experimental status of the article, and are
therefore misleading.
_Conflict with Rule 1._--No definite statement of composition appears
beyond the indefinite claim that it is an aqueous solution of “soluble
Corpora Lutea Extract,” each ampule corresponding to 0.2 Gm. of
desiccated gland. How these soluble products are obtained, whether they
represent _all_ the water-soluble principles, or whether some have been
eliminated, are questions that are not answered. Yet such information
is essential to intelligent and scientific use, for, as there is no
method of standardization, the method of preparation is the only mark
of identity. For instance, we do not know at this time whether proteins
have anything to do with the supposed value of corpora lutea. It is,
therefore, essential to know whether or not the proteins have been
eliminated.
_Conflict with Rule 6._--The circular in the package advises the
hypodermic use of this extract, not only in functional amenorrhea
and the ordinary reflex consequences of physiologic or artificial
menopause, but also in:
“‘neurasthenic’ symptoms during menstrual life”;
“sterility, not due to pyogenic infection or mechanical
obstruction”;
“repeated abortions, not due to disease or mechanical factors”;
“hyperemesis in the early months of pregnancy.”
These are not stated merely as conditions in which various enthusiasts
have tried corpus luteum, but as conditions “for which it will be found
serviceable.”
It is not necessary to inform the medical profession that this
statement is calculated to raise expectations which cannot possibly be
fulfilled. Even the manufacturers seem to realize this; at least they
speak somewhat indefinitely of “suitable cases,” “good judgment,” “real
indications,” etc. But they proceed to nullify this warning--if it was
intended as a warning--by their illustrations of unsuitable cases,
for instance, “amenorrhea due to extreme anemia, dysmenorrhea due to
cervical stenosis,” etc. Finally, they sum up the case:
“Therefore, additional emphasis on the necessity for the proper
selection of cases is essential in order that this useful
preparation may not be unjustly discredited.”
How these cases of sterility, abortions, etc., are to be selected
is not revealed. In other words, the restriction is no more than a
convenient device by which every improvement is to be attributed to the
medicine, and every failure to the physician.
The referee recommends that Corpora Lutea (Soluble Extract), Parke,
Davis & Co., be held ineligible to N. N. R., because it is a secret
preparation advertised under extravagant claims.
[Editorial Comment.--Was it not in Weir Mitchell’s “Adventures of
François” that the itinerant promised to pull teeth without any
pain, _if the patient would hold absolutely still_? And, _mirabile
dictu_, the ones who suffered were those who had not held absolutely
still!]--(_From The Journal A. M. A., April 7, 1917._)
WHEELER’S TISSUE PHOSPHATES
Report of the Council on Pharmacy and Chemistry
The Council held that the contribution from the A. M. A. Chemical
Laboratory, “Wheeler’s Tissue Phosphates,” demonstrates that this is a
semisecret, complex and irrational preparation, sold with misleading
claims concerning its medicinal constituents and therapeutic properties.
The Council directed that the report be included with the Annual
Council Reports and declared Wheeler’s Tissue Phosphates in conflict
with Rules 1, 6, 8 and 10.
W. A. Puckner, Secretary.
WHEELER’S TISSUE PHOSPHATES
L. E. Warren, Ph.C., B.S.
“Wheeler’s Tissue Phosphates,” known also as “Compound Elixir of
Phosphates and Calisaya,” is advertised as a nerve food and a
nutritive tonic. The label states that it contains calcium, iron,
sodium trihydrogen phosphates, alkaloids of Peruvian bark with 12-1/2
per cent. of alcohol. The preparation is sold by the T. B. Wheeler,
M. D. Co., of Rouses Point, New York. According to the manufacturer,
Wheeler’s Tissue Phosphates
“... is an _inorganic_ combination of the phosphates of iron and
calcium and hydrogen (phosphoric acid) together with hydrochloric
acid, hydrocyanic acid, and quinine, cheerful coloring, and a
delicious, cordial-like flavoring.”
“... The iron is the green, inorganic phosphate and the calcium the
simple white phosphate of your early student days....”
The preparation is a red liquid, having an acid reaction, a
sweet-bitter taste and the odor of wild cherry. Qualitative tests
indicated the presence of calcium, iron, a phosphate, a chlorid, a
sulphate, quinin or cinchona alkaloids, alcohol, sodium, cochineal
coloring and invert sugar. Ammonium salts, glycerol, citrates or
lactates were not found. From the quantitative values obtained the
preparation may be taken to represent:
Sp. gr at 25C./25C. 1.1087
Alcohol (per cent, by volume) 11.35
Gm. per 100 c.c.
Calcium phosphate [Ca₃(PO₄)₂]* 0.397
Iron phosphate (FePO₄.4H₂O)* 0.068
Chlorid (as hydrochloric acid) 0.407
Sodium sulphate (Na₂SO₄.10H₂O) 0.043
Quinin sulphate (U. S. P.) 0.041
Sodium phosphate (Na₂HPO₄.12H₂O) 0.065
Invert sugar 26.824
Water, cochineal and flavor, to make 100 c.c.
* It should be understood that the calcium and iron salts are held in
solution by the hydrochloric acid.
The dose of Wheeler’s Tissue Phosphates recommended by the manufacturer
is a tablespoonful or about 15 c.c. (1/2 oz.). The total calcium in a
dose of the preparation is equivalent to about one-sixth of an average
dose of the official calcium chlorid, and the total phosphate to each
dose is equivalent to about one-fourth of a dose of the official
diluted phosphoric acid. Each prescribed dose of the preparation
contains about 0.01 gm. (2/13 grain) of iron phosphate or about one
twenty-fifth of the average dose, and to obtain a Pharmacopeial dose of
iron phosphate the patient would be obliged to take three-fourths of
the contents of an entire bottle--or 12 ounces--of the preparation. If
it be assumed that all of the chlorid present is in the form of free
hydrochloric acid, each dose of the preparation contains the equivalent
of about two-thirds of one Pharmacopeial dose of diluted hydrochloric
acid. Each dose of the preparation contains about 0.0062 gm. (1/10
grain) of quinin sulphate, or about one-sixteenth of the average tonic
dose. In other words, to obtain the amount of quinin sulphate given in
the U. S. Pharmacopeia as the tonic dose, the patient would be required
to swallow 7-1/2 fluidounces of the proprietary preparation, or the
contents of nearly half a bottle. The fallacy of prescribing Wheeler’s
Tissue Phosphates either for its quinin or its iron content is apparent.
Wheeler’s Tissue Phosphates is, then, a mildly bitter flavored syrup
which contains nearly 12 per cent. of alcohol, small quantities each of
calcium phosphate and hydrochloric acid and insignificant amounts of
iron and quinin salts. In other words, essentially it is a sweetened
solution of small quantities of calcium phosphate in very dilute
hydrochlorid acid together with 12 per cent. of alcohol.
Bearing in mind the analysis of the preparation, how ludicrous some of
the claims appear:
“_Tissue Phosphates_ is not a hypophosphite preparation; it is
not a combination of glycerophosphates or other organic salts, or
so-called peptonates and manganates, all recently condemned by
the best therapeutic opinion here and in Europe, as much slower
and less active than the simpler salts. The iron is the green,
inorganic phosphite and the calcium the simple white phosphate of
your early student days. Nature takes these simple salts and builds
them rapidly into lecithin, bone, and other tissue, without the
delay incurred by splitting up the organic salts before she can
recombine them.”
“Tissue phosphates is in fact a _chemical food_.”
“The formula, suggested by Professor Dusart, of Paris, combines in
an easily assimilable and agreeable cordial; medium medicinal doses
of Phosphorus, the Generator of Nerve Force; Calcium Phosphate,
for Cell Development and Nutrition; Sodium Phosphate, a stimulant
of Liver and Pancreas and Corrective of Acid Fermentation in the
Alimentary Canal; Iron, generating in the Blood, Heat and Motion,
Phosphoric Acid, Tonic in Sexual Debility; Alkaloids of Calisaya,
Antimalarial and Antipyretic; Extract of Wild Cherry, Tonic, yet
Calming Irritation and Diminishing Nervous Excitement; Ethyl
Alcohol 12.5%; and Aromatics.”
Although the claim is made that the “formula” of Wheeler’s Tissue
Phosphates has been “suggested by Professor Dusart,” such of Dusart’s
papers as were available in this country[111] failed to disclose any
“formula” that was at all comparable to this product.
[111] Dusart, L.: Recherches expérimentales sur le rôle physiologique
et thérapeutique du phosphate de chaux, Paris, 1870; Quel est l’acide
du suc gastrique? Lille, 1874, unbound, 8 pages; Notice sur l’emploi et
les proprietés du lacto-phosphate de chaux, Clichy, 1868, unbound, 8
pages. Dusart and Blache: Recherches sur l’assimilation du phosphate de
chaux, Paris, 1868, unbound, 15 pages.
[Editorial Note.--The investigation verifies facts that must be obvious
to every physician who has given the matter thought. “Wheeler’s Tissue
Phosphates” is an unscientific, shotgun mixture whose most active and
powerful drug is the alcohol it contains. That it was not years ago
relegated to the realms of obsolete and discarded preparations is a
commentary alike on the lack of scientific discrimination and the
persuasive power of advertising. While in the past “Wheeler’s Tissue
Phosphates” has been advertised extensively in medical journals,
it seems that now the chief, if not the only beneficiary of the
advertising appropriation for this product is the _New York Medical
Journal_, which weekly heralds the “Delicious” and “Sustaining”
qualities of “The Ideal Tonic for Fastidious Convalescents.”]--(_From
The Journal A. M. A., May 5, 1917._)
THE CLAIMED GALACTAGOGUE EFFECTS OF NUTROLACTIS
AND GOAT’S RUE NOT SUBSTANTIATED
Report of the Council on Pharmacy and Chemistry