CONTRIBUTIONS FROM THE JOURNAL: PROPRIETARY PRODUCTS
NOSTRUMS IN RETROSPECT
A Series of Nine Articles Reviewing Worthless or Unscientific
Proprietary Mixtures Previously Criticized
S. Q. Lapius, M.D.
[FOREWORD.--It is more than twelve years since the Council on Pharmacy
and Chemistry of the American Medical Association was created. Since
then there have been but few issues of The Journal that have not called
the attention of the medical profession to the debasing influence
on scientific medicine of unscientific or worthless proprietary
mixtures advertised to physicians for their use in prescribing. The
Council on Pharmacy and Chemistry has investigated and shown many of
these preparations to be fraudulent in one way or another, and these
reports have been published in The Journal. In spite of this, these
preparations have been advertised continuously to physicians, through
medical journals and otherwise, and prescribed by a large number of
physicians. One reason for this is that there are many physicians who
have never seen these reports--who were not in active practice at the
time, or who were not reading The Journal. We probably have among our
readers at the present time 35,000 or 40,000 physicians who were not
among the readers of The Journal twelve years ago. It is desirable,
then, that we should take up, in more or less detail, several of the
more widely advertised products that have been the subjects of previous
reports. It has been repeatedly stated in The Journal that many of the
proprietary mixtures--the so-called ethical proprietaries advertised
to physicians--were no better and no worse than “patent medicines”
advertised to the public.
Every physician who has the welfare of medicine at heart should put
these questions squarely to himself if he has not already taken a firm
stand on this whole problem: What is my attitude toward the work of
the Council? Are its reports worthy of acceptance? Am I upholding the
Council in its efforts to place therapeutics on a rational basis, not
by blind faith alone, but by an honestly critical attitude toward it?
Am I following the path of indolence by taking the advice of nostrum
makers without any serious effort to determine whether they are true or
false? In a word, am I really practicing medicine, or am I an unpaid
agent and a dupe of nostrum makers? There are other revolutions than
political. The public can be wronged just as certainly by the abuse of
its confidence in clinicians as by the usurpers of political power, and
when the public is thoroughly aroused the heavy hand of retribution
is not likely to be too discriminating. That the sins of clinicians
are standing out plain for any one who wishes to read is becoming more
and more evident. There is but one short and ugly word that properly
characterizes the physician who accepts a fee for prescribing that
about which he has no more knowledge than has the one for whom he
prescribes it. Are you with the nostrum makers or with decent medicine?
The article below is the first of a series written for The Journal
by one who is thoroughly conversant with the work of the Council on
Pharmacy and Chemistry and can speak authoritatively on questions
dealing with the action of drugs and the treatment of diseases. We
believe that these articles will prove of interest and profit and that
they will help physicians to answer the questions just propounded.]
[ARTICLE I]
Bell-Ans (Pa-Pay-Ans Bell)[H]
[H] See also ????.{sic}
Bell-ans, for years advertised only in medical journals under the name
“Pa-pay-ans (Bell),” is now advertised in newspapers as a remedy that
“Absolutely Removes Indigestion.” As it is still being advertised to
physicians, we propose to analyze the claims made for it with as much
care as would be exercised in the discussion of the newest discovery in
medicine, because we believe that it is desirable to show the trend of
exploitation of a certain type of preparation in the medical press.
In the _New York Medical Journal_ the following advertisement recently
appeared on the front cover:
[Illustration:
+-------------------------------------------------------------+
| =Acute Indigestion= |
| |
| Yesterday a great soldier and today the head of a big trust |
| succumbed to an attack of Acute Indigestion, and every day |
| we hear from some physician of some case he has saved with |
| BELL-ANS by giving SIX (6) tablets dissolved in a glass of |
| hot water and repeating if necessary. Can any doctor who |
| reads this fail to provide himself with the free supply of |
| BELL-ANS which we will gladly send for his emergency case? |
| |
| Bell & Co. (Inc.) Mfg. Chemists Orangeburg New York U S A |
+-------------------------------------------------------------+
Typical of Bell-ans advertisements as appearing in medical journals.]
A recently purchased package of Bell-ans contained a circular in which
it was stated that Bell-ans removes flatulence, vertigo, weakness and
other symptoms of indigestion quickly and pleasantly; that it aids
the digestion of food and tends to restore the digestive tract to a
normal condition; that it relieves vomiting in pregnancy, alcoholism,
seasickness and cholera morbus, besides being pleasant, harmless and
effective for colic, sour stomach, feverishness, and wakefulness of
infants and children. The circular contained paragraphs purporting
to be taken from various medical journals, including the _New York
Medical Journal_, _Wisconsin Medical Recorder_, the _Lancet Clinic_,
_International Journal of Surgery_, and _Massachusetts Medical
Journal_. No exact references were given to permit verification or to
determine whether or not the quotations were from “reading notices”
(advertisements) or from the scientific part of the journals in
question. To quote one of the statements given:
“The results from the use of Bell-ans (Pa-Pay-ans Bell) in the
treatment of indigestion are so prompt and so generally good--and
the evidence of this fact is accumulating so rapidly and from such
reliable sources--that we venture to suggest to our readers who
have not tried this remedy that they prescribe one original sealed
package of Bell-ans (Pa-pay-ans Bell) and that they carefully note
the results from its use.
“We suggest an original sealed package because the preparation is
widely and badly imitated, and unless such a package is specified
an imitation of little value may be substituted and the experiment
be thus rendered useless.”
It is possible that Bell-ans has been imitated, but it is not true
that it is widely imitated, for no such imitation has ever been called
to our attention, and we strongly suspect that the main reason for
desiring that an original package be dispensed is that the patient may
see for himself the name BELL-ANS plainly blown in the glass.
The circular in question states that there is no derangement of the
digestive organs on which the proper dose of Bell-ans will not act
quickly and pleasantly! These are samples of the claims made for
Bell-ans. Let us inquire into the nature of the conditions for which
the preparation is recommended and the treatment advised by well known
clinicians.
The subject of indigestion is discussed by Robert Hutchison and Robert
Saundby under the general title of dyspepsia in the “Index of Treatment
by Various Writers,” Edition 6, 1912, pp. 260-265. Hutchison says:
“In the first place it must be remembered that in many patients who
complain of ‘indigestion’ the seat of the trouble is not in the stomach
at all.”
[Illustration:
+-----------------------------------------------------------------+
| A Philadelphia Doctor writes: |
| |
| “Your BELL-ANS for ingestion do just what you claim and more |
| too. I, personally, had a bad case of intestinal indigestion |
| with gastric vertigo. I had taken almost everything and got no |
| relief, until I commenced to take BELL-ANS--four to six tablets |
| in a large glassful of hot water after each meal. You have my |
| permission to use this statement, with my name and address if |
| you wish. I prescribe BELL-ANS constantly” |
| |
| =BELL-ANS= |
| FOR INDIGESTION |
| 25c package at every drug store in the U. S. |
+-----------------------------------------------------------------+
Newspaper advertisement of Bell-ans, capitalizing the statements of
physicians.]
The general principles to be observed in the treatment of functional
dyspepsia, as given by Hutchison, are: (1) to remove the cause; (2) to
adapt the diet to the impaired functional power of the stomach; (3)
to administer such drugs as are calculated to stimulate or correct
the particular function or functions which happen to be impaired,
or disordered. Proper diet, proper mastication of food, hygiene of
the mouth, and constipation are enumerated as deserving attention.
Careful attention to securing a proper diet is essential. The choice
of drugs depends, of course, on the conditions that give rise to
indigestion, and he calls attention to the necessity of avoiding all
routine treatment and compiling one’s prescription with an eye to the
special disorder or disorders of function, whether secretory, motor or
sensory, believed to be present. Hutchison gives the following typical
prescriptions to illustrate the use of drugs in the different disorders
of function:
FOR HYPERSECRETION (HYPERCHLORHYDRIA, ACID DYSPEPSIA, ETC.)
Sodium bromid 10 grains
Bismuth subcarbonate 15 grains
Chloroform water 1/2 ounce
This mixture to be taken before meals.
Sodium bicarbonate.
Bismuth subcarbonate.
Heavy magnesium carbonate, of each equal parts.
A small teaspoonful of the powder to be taken mixed with a little
water or milk about two hours after meals.
FOR DEFICIENT SECRETION (HYPOCHYLIA, ACHYLIA, GASTRITIS, ETC.)
Sodium bicarbonate 10 grains
Tincture of nux vomica 10 minims
Spirit of chloroform 8 minims
Compound infusion of gentian 1/2 ounce
This mixture to be taken before meals.
Dilute hydrochloric acid and glycerin, of each 15 minims with
enough water to make half an ounce, to be taken about twenty
minutes after meals.
FOR DEFECTIVE MOTILITY (ATONIC DYSPEPSIA, GASTROPTOSIS, ETC.)
Hutchison recommends the use of 10 minims of tincture of nux vomica
in an aromatic vehicle, such as infusion of quassia and compound
tincture of cardamom; but another aromatic bitter, such as the
compound tincture of gentian, will serve quite as well, of course.
This is to be taken before each meal, and for the flatulence that
often accompanies this trouble he gives menthol, aromatic spirit of
ammonia and spirit of chloroform, as may be needed.
FOR ACID DYSPEPSIA
Robert Saundby recommends the following to be used before each
meal for the relief of acid dyspepsia: sodium bicarbonate, bismuth
subcarbonate, magnesium carbonate, of each 10 grains; mucilage of
tragacanth 15 minims, and enough peppermint water to make an ounce.
These are only a few of the conditions that are discussed by Hutchison
and Saundby, but they serve to show that the treatment of indigestion
by a single prescription or combination is wholly irrational.
Bell-ans, both under its present name and under its older name,
“Pa-pay-ans (Bell),” has always been alleged by its manufacturers to
contain papain or to be a preparation of the digestive juice from
the fruit of _Carica papaya_ (papaw) with other substances. Various
chemists have attempted to find papain present and to determine the
digestive power of the tablets, but without success. For this reason
The Journal suggested that the change of name from “Pa-pay-ans (Bell)”
to “Bell-ans” was probably not made entirely for euphonious reasons,
as alleged, especially when one considers that the name of a nostrum
is its most valuable asset. It is much more likely that as analyses
indicated there was not and probably never had been any papain present
in the product, the name was changed for fear that some day the
misleading term “Pa-pay-ans” might bring the preparation in conflict
with the federal Food and Drugs Act.
Pa-pay-ans (Bell) was examined for the Council on Pharmacy and
Chemistry in 1909 and the tablets were found to consist of charcoal,
sodium bicarbonate, ginger, saccharin and oil of gaultheria. No
digestive ferment could be detected in the tablets. Sodium bicarbonate
is antacid and serves to dissolve mucus; ginger, if in sufficient
amount, causes the expulsion of flatus, and charcoal, while an
absorbent in the dry state, is probably useless for any therapeutic
purpose whatever after it becomes saturated with gastric juice.
Bell-ans, then, has all of the virtues, which are few, and all of
the limitations, which are many, of a tablet of sodium bicarbonate
and ginger. Its value in the treatment of acute indigestion would be
limited to the value of a tablet of such a composition. It is absurd to
suppose that it could have the slightest value in the far more serious
conditions attended with intestinal indigestion, with the toxemia and
autointoxication to which they give rise.
Bell-ans is now advertised directly to the public--but it is no less
valuable on that account. True, it is a “patent medicine” in the
commonly accepted sense of the term, but it is no more a “patent
medicine” today than it was fifteen years ago when it reached the
public, not through the direct medium of the newspapers but the more
indirect route of the medical journals and undiscriminating physicians.
It is true that, in view of the serious nature of many conditions
which are loosely spoken of by the public as “indigestion,” its present
method of exploitation is likely to make it just that much more
dangerous because of the larger publicity that will be given. The point
to be borne in mind is that Bell-ans is now in fact what it has always
been in essence, a “patent medicine.”
[Illustration:
+ - - - - - - - +
| BUSINESS NOTICE |
|
| BELL-ANS |
| Absolutely Removes |
| Indigestion. One |
| package proves it. |
| 25c at all druggists. |
+ - - - - - - - +
Typical of Bell-ans advertisements as appearing in newspapers.]
Again we ask the question: How do you wish to be classified,
Doctor--among those who follow blindly the lead of a firm of nostrum
makers, or among the intelligent members of the profession who study
their cases carefully and prescribe intelligently? The manufacturers of
Bell-ans claim that 100,000 American physicians now prescribe Bell-ans,
and that 600,000,000 of the tablets are sold annually. If this is
even approximately true it is a serious reflection on the medical
profession, for the Council examined Bell-ans and reported its findings
nearly eight years ago (_J. A. M. A._ =53=:569 [Aug. 14] 1909), and the
statements made in that report are as incontrovertible today as they
were then.--(_From The Journal A. M. A., Nov. 24, 1917._)
[ARTICLE II]
Anasarcin and Anedemin
“Anasarcin” and “Anedemin” are the twin nostrums of cardiac
pseudotherapy. They are dubbed “twin nostrums” not so much because of
any similarity in their formulas, that being a minor consideration
in the average nostrum, but because of the close similarity in their
methods of exploitation, the therapeutic claims made for them, and the
time and place of their birth.
It may be remembered that they both claim Winchester, Tenn., as their
birthplace, and they appeared on the market at about the same time;
furthermore, a comparison of the claims formerly made for both of them
indicated that one mind conceived the main idea that lies back of their
exploitation. While Anasarcin is especially dealt with in this article,
much of the discussion applies with equal force to Anedemin.
A LUSH FIELD FOR NOSTRUMS
Cardiac disease, with its resultant renal involvement, is frequently
encountered; and running, as it does, a chronic course, it offers an
almost ideal field of exploitation for the typical nostrum vender. By
a typical nostrum vender we mean one whose knowledge of his product
is far below that of his appreciation of a certain element of human
character. On this element rests the whole secret of the nostrum
vender’s success. It is variously termed credulity, gullibility and
childlike simplicity, but it is that which often causes even the most
conscientious clinician to turn aside from the use of the best known
and most dependable drugs at his command, in the face of disappointment
and failure, and employ some vaunted mixture which, in his saner
moments, he scorns to use.
Anedemin is said to consist of a “Scientific Combination of three of
the more recently investigated members of the Digitalis Series, with
Sambucus”; that is, of apocynum, strophanthus and squill with elder.
It is difficult to know just what idea the statement that it is a
“scientific combination” of these drugs is intended to convey, for
it is unscientific to mix three drugs of this group for use in fixed
proportion in a wide range of conditions, if indeed, there is ever any
indication for their use.
The great disadvantages of strophanthus and apocynum pertain to the
extreme uncertainty of their absorption from the gastro-intestinal
tract. Strophanthus is occasionally absorbed promptly, sometimes
so slowly that the therapeutic effects are not induced until an
amount equal to several times that which would prove fatal if all of
it were absorbed into the circulation has been administered, and,
unfortunately, one cannot control the absorption which may continue
until a fatal effect is induced. This is true to an even greater degree
of apocynum, and it was due to the recognition of this fact that
apocynum was not admitted to the U. S. Pharmacopeia IX, the committee
on dosage having agreed that no safe and effective dose could be given.
THE COUNCIL’S PREVIOUS FINDINGS
In 1907 the Council on Pharmacy and Chemistry examined the literature
used in the exploitation of Anasarcin and Anedemin and published its
report. Anasarcin tablets, it was pointed out, were said to contain
the active principles of _Oxydendron arboreum_ (sour wood), _Sambucus
canadensis_ (elder) and _Urginea scilla_ (squill), and the following
claims were made for the nostrum:
“Does what dropsy medicaments have hitherto failed to accomplish.”
“Superior to digitalis, strophanthus, scoparius, squills, acetate
of potash and the hydragogue cathartics all put together.”
“The only known relief and permanent cure of dropsies.”
“Unrivaled heart tonic.”
“The most powerful agent known.”
“Safe in administration.”
“Non-toxic as ordinarily administered.”
“Will nauseate some persons,” but “the reaction from the temporary
depression is prompt.”
“In Bright’s disease, both the interstitial and parenchymatous
forms of nephritis, acute or chronic, no remedy ... to equal it in
efficacy.”
“Without increasing the debility of the patient or interfering with
nutrition by producing loss of appetite ...”
“This treatment is to be continued without cessation until all
symptoms of dropsy have disappeared.”
A comparison of the earlier claims with those now being made (see
advertisement reproduced from the _New York Medical Journal_)
illustrates one of the results of the work of the Council. Today the
nostrum exploiter avoids the cruder forms of obvious misstatement, but
continues to make, by inference, claims that are equally misleading.
It will be observed in this case that a more cautious pen worded the
later advertisement, but there is still evident the intent to convince
the reader that Anasarcin is superior to the official drugs in the
treatment of cardiovascular diseases. The facts are that Anasarcin is
at best a dangerous remedy in the hands of the average clinician in
the treatment of such conditions, and its use is at all times to be
condemned.
No competent investigator has ever investigated the pharmacology
of sour wood (_Oxydendron arboreum_), and it appears to have no
therapeutic value other than that due to a slight acidulousness. Elder
(_Sambucus canadensis_) contains a trace of a volatile oil as its most
important constituent, according to the British Pharmaceutical Codex of
1911 (p. 908), but it is difficult to explain why a trace of volatile
oil should be considered important. Elder may be dismissed without
further consideration in connection with Anasarcin tablets.
THE PHARMACOLOGY OF SQUILL
This leaves only squill among the constituents of Anasarcin for
consideration. Sollmann (Manual of Pharmacology, 1917, p. 409) in
discussing the advantages claimed for squill over other drugs of the
digitalis group, says: “Dixon, 1906, points out that any superiority
is outweighed by its disadvantages: uncertain absorption; strong
gastro-intestinal irritation.” Squill was formerly used as an
expectorant and diuretic, the activity having been attributed to two
amorphous glucosids, scillipicrin and scillitoxin, but Ewins, 1911,
found these to be impure mixtures. A later investigator claimed to
have isolated two glucosidal agents from squill, but similar claims
have often been made only to be disproved later, and we know of
no confirmation of the claims regarding the isolation of any pure
principles from squill having any true typical digitalis action.
The statement quoted from Sollmann is accepted by practically all
pharmacologists, and we may say with certainty that squill is decidedly
inferior to digitalis in the treatment of cardiovascular, and
cardiorenal diseases, and certainly no active principles of squill were
known to the scientific world at a time that the remarkable claims were
first made for Anasarcin by an obscure pharmacist of Winchester, Tenn.
Indeed, if Anasarcin were all that it was claimed to be, its discovery
would have made Winchester as famous as a certain Wisconsin city was
said to have been made by a popular beverage.
It has been abundantly demonstrated, and it is now almost universally
accepted among well informed pharmacologists and clinicians, that all
digitalis principles exert the same kind of action on the heart after
they enter the circulation in effective doses, though they differ
to an extraordinary degree in the intensity of their action and in
their undesired sideactions, such as nausea and vomiting. When the
use of Anasarcin (squill) is followed by immediate improvement after
digitalis has failed, it merely shows that the dosage of digitalis
was insufficient or that it was discontinued and the squill mixture
was substituted before the full therapeutic effects of the digitalis
developed.
WHEN THE DIGITALIS GROUP IS CONTRAINDICATED
If the administration of a sufficient dose of digitalis is not followed
by improvement in the circulation, it shows that the heart is incapable
of responding to such treatment and the further use of any of the drugs
of this group is distinctly contraindicated. This is confirmed by the
experience of nearly every competent observer of digitalis therapy, and
numerous fatalities have resulted from the failure to appreciate this
fact and further administer some other member of the group, such as
strophanthus or squill.
It is now well known that the cardiac effects of toxic doses of squill,
and other members of the group, resemble closely those of cardiac
disease, and it is often impossible to determine whether the behavior
of the heart in a given case is attributable to insufficient dosage, to
excessive dosage, or to the progress of the cardiac disease itself. If
this occurs when one uses the best known members of the group, it is
certain that it occurs even more frequently when others that are less
understood are employed. In the light of this knowledge of the dangers
attending the incautious use of any member of the digitalis group,
and more especially the use of impure principles, such as are commonly
obtained from squill, it is impossible to condemn sufficiently the
recommendation that the use of Anasarcin should be continued without
cessation until all symptoms of dropsy have disappeared.
Digitalis bodies are not suited for the treatment of all cardiac
disturbances, and it is, of course, self-evident that a time must
come in the treatment of chronic cardiac disease when the heart is
incapable of responding to any form of treatment with improvement. But,
unfortunately, it never loses its response to toxic doses, and to push
the administration of any drug or mixture containing any drug of the
entire digitalis group--and especially those, like squill, in which the
side actions are most prominent--beyond the point of tolerance is to
court certain disaster.
THE TREATMENT OF CARDIAC DROPSY
While it is quite certain that many lives have been sacrificed to the
failure to understand this phase of cardiac therapy, it is equally
certain that many lives have been sacrificed because of insufficient
dosage, and one can steer a safe course between these dangers only by
using the best known preparation available; and in the present state
of our knowledge it is indisputable that digitalis and the tincture of
digitalis are best suited for the treatment of cardiac disease except
in those few cases in which intramuscular or intravenous administration
must be employed temporarily for immediate effect.
[Illustration]
The secret of prescribing successfully for the relief of dropsy in
cardiac disease consists in understanding the effects of digitalis
on the heart, in administering it until these effects indicate that
the desired object has been obtained, and stopping, or interrupting,
the administration at that point until the effects begin to wear off.
Cumulation, so called, is a positive advantage in such cases. It
merely means that the desired therapeutic effects once induced persist
for a time, and that further medication is unnecessary during such
persistence of action. Eggleston has recently shown (_Arch. Int. Med._
=16=:1 [July] 1915; abstr., _J. A. M. A._ =44=:459 [July 31] 1915) that
the full therapeutic effects of digitalis can be induced in suitable
cases within a few hours even with oral administration.
We are not aware of a single publication in which a careful, detailed
clinical study of Anasarcin has been reported. The claims made for
Anasarcin, past and present, indicate either a deliberate purpose
to mislead or crass ignorance of the rudiments of pharmacology and
therapeutics. The exploiters of the nostrum claim that thousands
of physicians have found Anasarcin tablets of unsurpassed remedial
value in the treatment of disorders of the circulatory system and of
ascitic conditions.[244] It must be admitted that too many physicians
have prescribed Anasarcin, otherwise the manufacturers would not have
continued to spend thousands of dollars in advertising it in medical
journals during a period of more than ten years.
[244] Former estimates of the number of physicians who prescribed
Anasarcin appear to have been too high, possibly based on the ratio
obtaining in Winchester, Tenn. Inquiry at five fairly busy drug stores
in a large eastern city showed that in no instance was the pharmacist
even acquainted with the name. One pretended to be, and manifested pity
for the inquirer’s ignorance in supposing that it could be imported
during the war! He was obviously merely less honest than the others,
who frankly admitted they had never heard of it.
Doctor, this article is meant to be a candid discussion with you,
whether you use Anasarcin or not, because every clinician is vitally
interested in the customs that obtain in the practice of medicine, and
we wish to put a hypothetic question to you. Answer it, at least to
yourself, in exactly the spirit in which it is put. Suppose that you
prescribe Anasarcin for a patient who is critically ill with cardiac
disease. He dies. Are you willing to tell the relatives frankly just
what you used and the nature of the evidence on which you based your
choice of this nostrum? Let the supposition be carried further and say
that the case was hopeless, and agree that digitalis and all other
drugs would have been equally ineffective. Granting all this, would
your explanation satisfy? Would you in all candor dare to offer such an
explanation? Try it as a hypothetic case before you are forced to apply
it.--(_From The Journal A. M. A., Dec. 8, 1917._)
[ARTICLE III]
Pepto-Mangan
It would be interesting, and even instructive, to know how many
educated physicians, if any, are now prescribing Pepto-Mangan (Gude):
interesting as indicating the number who have neglected to avail
themselves of the work of the Council on Pharmacy and Chemistry,
especially the earlier work; instructive in that it would show how many
are still prescribing by the rule of thumb, and who are taking their
therapeutic instructions from purely commercial sources instead of
striving to learn how to choose those drugs that are most effective in
the treatment of disease.
It has been pointed out many times in the pages of The Journal that
many nostrums are advertised first to physicians, and that after
physicians have served as the unpaid agents of the manufacturers in
introducing the preparations, their exploitation is then commonly
continued by means of advertisements in the public press. This plan has
been followed successfully in so many cases that we have now come to
look on it as the regular course. It is in keeping with this rule that
we find Pepto-Mangan now advertised in the public press, the physicians
having served the manufacturer’s purpose.
DISCARDED THEORIES OF IRON MEDICATION
It will be recalled that many years ago the theory was held that
hydrogen sulphid (sulphureted hydrogen) interfered with the absorption
of the iron of the food, and that the administration of medicinal
iron prevented this interference by neutralizing the hydrogen sulphid
(sulphureted hydrogen). It was only a short step to argue that
manganese might replace the medicinal iron in combining with the
hydrogen sulphid, permitting the food iron to be absorbed, and it
was held that only food iron could be utilized in the formation of
hemoglobin.
It is hardly necessary to remind the reader that this theory rests
on numerous fallacies. There is no hydrogen sulphid worth mentioning
in the small intestine where iron is absorbed; food iron cannot be
utilized directly in the formation of hemoglobin but must be broken
into simple forms for absorption; and, further, inorganic iron, such as
ferrous carbonate, serves the purpose admirably when iron is indicated.
With the acceptance of these well established facts, all possible
excuse for the therapeutic employment of Pepto-Mangan in place of iron
vanished; but as plain and simple as this fact is, the unnecessary and
expensive Pepto-Mangan continues to be prescribed by physicians who
will not take the slight trouble to investigate the claims for this
nostrum.
FALSE AND MISLEADING CLAIMS
There is not merely a difference of opinion between the exploiters and
the Council, but there has been also actual misrepresentation in the
exploitation of this nostrum to physicians. This has been shown on
more than one occasion. About twelve years ago, the M. J. Breitenbach
Company, the proprietors of Pepto-Mangan, claimed that the report of
the commission that had been appointed for the investigation of anemia
in Porto Rico “would alone suffice to establish Pepto-Mangan at once as
the foremost hematinic known.” Examination of the report showed that
the commission made no such claims; on the contrary the commission
protested against this misrepresentation (_J. A. M. A._ =45=:1099 [Oct.
7] 1905).
[Illustration: From the _New York Medical Journal_.]
Undaunted by this exposure of their methods, the Breitenbach Company
later sent out a statement of results purporting to have been obtained
by one Mateo M. Gillen, in the treatment of infantile anemia on
Randall’s Island in New York City. At the instance of The Journal
the hospital records in these cases were examined, and it was found
that the pretended report was little more than a tissue of falsehood
(_J. A. M. A._ =48=:1197 [April 6] 1907).
About two years ago the Council reported that while the statements
just referred to were no longer made, they had never been definitely
admitted by the Breitenbach Company to be erroneous, and that
Pepto-Mangan was then being exploited to the public indirectly.
(Council Reports, 1914, p. 121.)
We reproduce an advertisement that has been appearing weekly in the
_New York Medical Journal_ for several months. One can only suppose
that this advertisement was intended to mislead physicians, and it
would be an insult to the intelligence of the average reader to
attempt any detailed discussion of it, but enough has been said to
show how misleading the statements are. One should note particularly
the advice--old as the nostrum business itself--contained in the
advertisement, to prescribe an original bottle. The reason for such
advice is simple. Experience has shown that when original bottles are
dispensed patients soon learn to buy the nostrum without consulting the
physician, for they shrewdly suspect that he knows no more about the
preparation than they, and that he gets his information from precisely
the same sources that are available to them. They are obviously right.
In truth, the physician who prescribes Pepto-Mangan as a hematinic
shows ignorance of the most rudimentary facts of iron therapy, and the
intelligent patient soon perceives his limitations.
[Illustration: A newspaper advertisement of Pepto-Mangan.]
THE PROBLEM OF IRON THERAPY
The investigation of the problems of iron therapy and its utilization
in the formation of hemoglobin forms one of the most brilliant chapters
in pharmacologic research, and there is no better established fact in
therapeutics than that any organic or inorganic preparation of iron
that does not irritate the stomach may be employed effectively when the
administration of iron is indicated. “Useful Drugs” contains a list
of iron preparations that are suitable for all conditions which call
for iron, and the clinician may rest assured that he will never have
occasion to go outside that list to prescribe any substitute.
As a matter of fact, it seems probable that the very number of
available iron preparations has served to cause confusion, thus
affording an opportunity for the nostrum maker to introduce his
superfluous compounds. It may be difficult at times to select the
preparation of iron best suited to the individual patient; and it is
this difficulty that has led the clinician to listen to the seductive
claims made for the various pretended substitutes for iron. One
should approach the question of choosing the proper form of iron for
therapeutic use with the recognition of the fact that there is no
such thing as a substitute for iron in the formation of hemoglobin,
that there are no ideal forms of iron other than those found in the
foodstuffs. Further, the clinician cannot avoid the disadvantages
inherent in all forms of iron that he can prescribe, and he must
therefore seek that which seems best suited for the individual patient.
Bunge estimated the amounts of iron present in various foods; and a
table based on this, and other data, is given in “Pharmacology of
Useful Drugs” (published by the American Medical Association). Ordinary
foods in an ample diet contain enough iron to supply the normal daily
loss, which amounts to only a few milligrams, but many persons who
have poor appetites take an insufficient amount of iron in their food
and become anemic. In such cases the additional iron required can be
supplied best by adding spinach, eggs, apples, or other iron-rich food
to the dietary.
SOME IRON COMBINATIONS
William Hunter discusses the subject of anemia and its treatment at
considerable length in the “Index of Treatment,” Ed. 6, pp. 17-37,
and gives many prescriptions containing iron for use under different
conditions; and while it is unnecessary to reproduce all of these here,
a few may be given in order to suggest suitable methods of prescribing
iron when it cannot be given in sufficient amounts in the food.
In chlorosis Hunter advises that that form of iron which experience has
shown to be least disturbing to the patient’s stomach should be used,
and he suggests separate stomachic mixtures to be used simultaneously,
not mixed with the iron itself. When constipation exists--and this is a
very common accompaniment of chlorosis--he gives the following aperient
iron combination:
Gm. or c.c.
℞ Ferrous sulphate |25 gr. iv
Magnesium sulphate 4| Ʒ i
Aromatic sulphuric acid |5 ♏ vii
Tincture of ginger |7 ♏ x
Compound infusion of gentian (B. P.) q. s., ad 30| ℥ i
This, constituting a single dose, is to be taken twice daily--at
11 a. m. and 6 p. m. A little compound tincture of gentian and
water may be used in place of the compound infusion of the British
Pharmacopeia. He modifies this somewhat as occasion demands by using
sodium sulphate and adding sodium bicarbonate (which converts the
sulphate of iron into ferrous carbonate) and adds 10 minims of spirit
of chloroform to act as a stomachic.
Hunter also suggests the use of pills of aloes and iron in place of
the mixture described above, and when constipation has been corrected,
the aloes may be omitted and the pill of ferrous carbonate alone may
be used for the iron. Hunter’s comment regarding this pill is, “very
satisfactory.”
The same form of iron is available in the compound iron mixture,
formerly official, which Hunter says is exceedingly good. In this
country the compound solution of iron and ammonium acetate, Basham’s
mixture, so called, has long enjoyed a wide reputation as causing very
little disturbance of the stomach, and the homely tincture of ferric
chlorid is probably useful in a large majority of cases in which the
stomach is not especially irritable.
We may say with assurance that one of the forms suggested here
will suffice for practically every case in which it is necessary
to reinforce the amount of iron available in the food by some
pharmaceutical preparation. If these do not satisfy your requirements,
consult a really competent pharmacist and enlist his aid in devising
a mixture especially suited to your individual patient.--(_From the
Journal A. M. A., Dec. 29, 1917._)
[ARTICLE IV]
Cactina Pillets
This preparation may be considered briefly in view of the recent
discussion in this series of articles of the pharmacology of the
digitalis group and the principles of treatment in cardiovascular
disease. The manufacturers maintain that cactina is wholly unlike
digitalis, and that is the truth, as we shall show; but since they
claim that it is useful in certain conditions of the heart in which
digitalis is commonly employed by well informed clinicians, it is
necessary to consider its cardiac actions--or its lack of them! It is
difficult to determine just what action cactina is supposed to exert on
the heart. For example, one advertisement contains the following:
“Cactina Pillets. A gentle cardiac tonic that supports and sustains
the heart through its capacity to improve cardiac nutrition.”
Just how the cardiac nutrition is to be improved without an improved
coronary circulation is not explained. It would be interesting to know
in what other way this is to be accomplished, and how an improved
coronary circulation can be induced without acting on the heart or
vessels. But that is what digitalis does, and you should remember that
cactina is so very different from digitalis! Then again:
“Cactina Pillets. A remedy that steadies and strengthens the heart
by imparting tone to the heart muscle.”
That is a pretty direct statement, but digitalis imparts tone; and we
must not forget that “cactina” is wholly unlike digitalis, and we are
told that “cactina” is:
“Invaluable in all functional cardiac disorders such as
tachycardia, palpitation, arrhythmia, and whenever the heart’s
action needs regulating or support.”
If these are merely functional disorders of the heart, it is highly
desirable to know what are the symptoms of really serious cardiac
disease! Since the manufacturers give us no information concerning
the mode of action of “cactina” we will turn to the literature of
disinterested observers. If one attempts to discover the origin of
“cactina,” he will probably meet with disappointment, for various
bibliographies fail to mention the name of Sultan, who is said to have
isolated “cactina” from _Cactus grandiflorus_. It seems that Sultan
worked with _Cactus_, or some other plant, when a student of pharmacy,
and it is to be remembered that Cactina Pillets are manufactured by the
Sultan Drug Company.
It is doubtful whether Sultan actually worked with genuine _Cactus
grandiflorus_; and, in fact, there is good reason for thinking that
he did not, for all subsequent workers who have taken pains to secure
genuine _Cactus grandiflorus_ have failed to detect the presence of any
active principle, except possible traces that are of no therapeutic
importance whatever.
WHAT THE COUNCIL FOUND
The Council on Pharmacy and Chemistry examined the literature relating
to cactus and certain proprietary preparations, including Cactina
Pillets, alleged to be made from cactus, and has reported the results
of its investigation (_J. A. M. A._ =54=:888 [March 12] 1910) and we
will quote from that report.
“The therapeutic value of this plant has been variously estimated by
different observers. Experimental evidence as to its action is scanty
and no complete chemical examination has ever been made.
“Reputable men have testified that some of the plants of the cactus
family contain very active principles, but so far experiments seem to
prove that _Cactus grandiflorus_ has neither the action of digitalis
nor that of strychnin. The principal contributions, clinical and
experimental, for and against the drug are set out below.”
[Illustration: Typical advertisements of “Cactina Pillets” from the
Medical Record and New York Medical Journal, respectively.]
The report then proceeds to analyze the work of O. H. Myers, R. A.
Hatcher, Boinet and Boy-Teissier, Sayre, Gordon Sharp, S. A. Matthews,
P. W. Williams, Aulde and Ellingwood, and comes to conclusions that are
set forth as follows, in brief:
1. It is uncertain what part of the plant contains the active
principle, if any such principle exists.
2. Part of the experimental and clinical work has been published under
proprietary auspices.
3. The value of clinical evidence when unsupported by animal
experimentation is much diminished by the tendency of enthusiastic and
untrained observers to attribute to the drug given the effect really
due to general remedial measures, psychic suggestion and so forth.
In other words, the literature does not afford a report of a single
piece of careful painstaking work the results of which lend support to
the claims made for Cactina Pillets as stated above, for it is obvious
that if _Cactus grandiflorus_ contains no active principle, no active
principle can be extracted from it. Some time after the report of
the Council was published, Hatcher and Bailey secured genuine _Cactus
grandiflorus_ directly from a competent botanist, Dr. C. A. Purpus,
of Vera Cruz, Mexico, and studied it experimentally. They reported
(_J. A. M. A._ =56=:26 [Jan. 7] 1911) in part as follows:
“We have been unable to obtain any evidence that the true Mexican
_Cactus grandiflorus_ possesses any pharmacologic action whatever;
but, on the contrary, it appears to be a singularly inert substance
when administered either by the mouth or by the vein.”
When colossal doses of _Cactus grandiflorus_ are given by the vein,
they sometimes--but not always--appear to exert an extremely feeble
action on the heart; but this action is so slight that its nature
could not be determined. Even the most colossal doses of _Cactus
grandiflorus_ administered by the mouth to cats, dogs and frogs exert
no perceptible effect.
Sollmann thus satirizes the absurd claims made by the exploiters of
proprietary forms of cactus: “Should the heart be too slow, cactus
quickens it; if the heart is too fast, cactus slows it; should the
heart be too weak, cactus strengthens it; if the heart is too strong,
cactus weakens it; does the heart wobble, cactus steadies it; if the
heart is normal, cactus does not meddle with it” (_J. A. M. A._ =51=:52
[July 4] 1908).
Will physicians continue to accept the statements of an interested
nostrum vender--who submits not a shred of evidence to support his
claims, but who has a financial interest in convincing them--even when
his statements are diametrically opposed to all the evidence that the
Council on Pharmacy and Chemistry has been able to secure?--(_From The
Journal A. M. A., Jan. 19, 1918._)
[ARTICLE V]
Ammonol and Phenalgin
At the time that synthetic chemical drugs were coming into fame and
when every manufacturer who launched a new headache mixture claimed
to have achieved another triumph in synthetic chemistry, Ammonol and
Phenalgin were born. Of course, these twins of analgesic pseudotherapy
were claimed to be synthetics and were duly christened with “formulas.”
They were among the first of the nostrums examined for the Council on
Pharmacy and Chemistry, and the false claims made for them were exposed.
The analyses made for the Council showed that Ammonol and Phenalgin
were simple mixtures, having the following composition:
ACETANILID SODIUM BICARBONATE AMMONIUM CARBONATE
AMMONOL 50 25 20
PHENALGIN 57 20 10
The reports of the Council on, and numerous references to, these two
nostrums may be found in The Journal of various dates.[245] The reports
will prove interesting to those who are not familiar with, or have
forgotten, the methods of nostrum exploiters at the time the Council
was formed. Following the Council’s exposure of the false claims made
by the manufacturers of Phenalgin, the _Medical Record_ published an
advertisement of that nostrum in which an attempt was made to discredit
the Council’s report. The editor of the _Medical Record_ was requested
by the Council to publish the facts in the case but he refused to do so.
[245] J. A. M. A. 44: 1791 (June 3) 1905; ibid. 44: 1997 (June 24)
1905; ibid. 45: 935 (Sept. 23) 1905; ibid. 46: 134 (Jan. 13) 1906;
ibid. 46: 290 (Jan. 27) 1906; ibid. 58: 280 (Jan. 27) 1912.
Long after the death of Dr. Cyrus Edson, the claim was made that
Phenalgin was made under his direction and that it was his “discovery.”
As a matter of fact, Dr. Edson had favored the use of Ammonol at one
time, and when the Council exposed the false claims then being made
for Phenalgin, The Journal charged that a fraud was being perpetrated
on the medical profession. Despite the exposure of the methods used in
exploiting Ammonol and Phenalgin, one finds just as glaringly false
statements made in the advertisements of Phenalgin today as were
made in its unsavory past. This would seem to indicate either that
physicians have short memories or that they are strangely indifferent
to the welfare of their patients, to their own reputations and to the
good name of medicine.
The _New York Medical Journal_ of Dec. 22, 1917, contained an
advertisement of Phenalgin--it has been running for months--from which
the following is quoted:
“For the relief of PAIN the ‘logical supplanter of opium and
other habit-forming drugs’ is PHENALGIN. No matter how severe or
where located pain is promptly and satisfactorily controlled by
this effective anodyne--and without disturbing the digestion,
suppressing the secretions, causing constipation or inducing a drug
habit.
“This is why Phenalgin has superseded opium and its derivatives
for relieving HEADACHES, RHEUMATISM, GOUT, LA GRIPPE, LUMBAGO,
NEURALGIA, DISORDERS OF THE FEMALE, DYSMENORRHEA, AND PAINFUL
CONDITIONS GENERALLY. To thousands of physicians Phenalgin ‘is the
one dependable analgesic--the logical supplanter of opium.’”
If we are to suppose that the composition of Phenalgin is today
essentially the same as when it was examined, the claims just quoted
are obviously false for, of course, such a mixture must have the
properties of acetanilid with all of its drawbacks and limitations.
We may contrast the statements made in the advertisement just quoted
with those made in Bulletin 126 of the Bureau of Chemistry of the
U. S. Department of Agriculture. This bulletin on “The Harmful
Effects of Acetanilid, Antipyrin and Phenacetin” summarizes the
replies received from 400 physicians to whom a questionnaire had been
sent. The information thus gained was tabulated and the figures that
follow are from these tables. There were reported no fewer than 614
cases of poisoning by acetanilid with 16 deaths and 112 cases of its
habitual use. The larger number of cases of poisoning followed the
administration of the drug, by physicians, in doses larger than those
now regarded as fairly safe. This large number reported by only 400
physicians indicated an excessively large number in the whole country.
Since the questionnaire was sent to nearly a thousand physicians, of
whom about 500 failed to reply, it may be assumed that had it been sent
to the entire 130,000 physicians in the country, at least 75,000 cases
of poisoning would have been reported.
Prior to the passage of the federal Food and Drugs Act (the “Pure
Food Law”) many nostrum makers had declared that their preparations
contained no acetanilid. When that law went into effect, some of these
manufacturers triumphantly pointed to the fact that they were still
able to make the same claim without conflicting with the requirements
of the law. This was accomplished in fact by changing the formula and
substituting acetphenetidin (phenacetin) for the acetanilid. While
acetphenetidin is somewhat less toxic than acetanilid, bulk for bulk,
the toxicity and therapeutic activity of the two drugs are nearly
proportional.
The claim made by many proprietary medicine manufacturers that they are
“strictly ethical” because they advertise only to physicians is mere
verbal camouflage. There may be no more certain way of insuring the
continued use of a nostrum by the public than to have it prescribed by
physicians; and none know this better than the makers of nostrums. A
proprietary individuality is obtained by giving some special form to
the tablets and package or a special coloring to the capsules (“Specify
‘Phenalgin Pink Top Capsules’”) so as to indicate the identity of the
products in such a way that the patient may in the future procure them
without the advice or warning of the physician. When a proprietary
preparation with the name or initials stamped on it or attached to
it is prescribed, the patient immediately is aware of the fact, and
his respect for the physician’s intelligence and wisdom is naturally
lessened.
The physician should never place such dangerous drugs as acetanilid and
acetphenetidin, or ready made mixtures of them, in the hands of the
patient in such a way that they can be employed without his supervision
or control. He should never prescribe more than is needed at the time
and should not form the habit of using fixed doses or combinations
of drugs without a special reference to the particular needs of the
individual.
Certain forms of headache yield more readily to a mixture of caffein
and acetanilid or caffein and acetphenetidin than to either acetanilid
or acetphenetidin alone. When the physician wishes to prescribe such
a mixture he may combine 1 grain of caffein or 2 grains of citrated
caffein with 3 grains of acetanilid or 4 grains of acetphenetidin in
a powder or capsule. Under supervision such a dose may be repeated
at intervals of from two to four hours if necessary to control pain.
It is necessary to remember, however, that when small doses fail to
give relief, increase in the dose is useless. This fact is especially
important, and disregard or ignorance of it has been responsible for
many cases of poisoning. Further, it should be remembered that while it
was taught for many years that the admixture of caffein with acetanilid
lessened the effect of the latter drug on the heart, Hale has shown
that this is not the case and such mixtures must be used with special
caution.--(_From The Journal A. M. A., Feb. 2, 1918._)
[ARTICLE VI]
Fellows’ Syrup, and Other Preparations of the Hypophosphites
We hope that it is clear to those who have read the several articles
of this series that their purpose is to present evidence that will
enable the reader to form a correct estimate of the literature
employed in the exploitation of various nostrums. The distinction
between mere assertion--however plausible, and from however eminent
an authority--and evidence should again be emphasized. Satisfactory
evidence rests on careful observation by those who are capable of
accurately determining to what extent any changes that may be observed
are due to the therapeutic agent employed and not mere accompaniments
of such treatment.
When the Council on Pharmacy and Chemistry was organized in 1905,
the greater part of the literature of the nostrums was so palpably
misleading, the statements often so ludicrously false, that it was only
necessary to call attention to this fact to have those claims collapse.
As a result of the Council’s work, the exploiters of worthless nostrums
have developed a greater degree of shrewdness in avoiding the easily
exploded falsehoods. This has made it increasingly difficult to point
out the exact statements on which many of the false claims now rest,
even though the exploitation as a whole is as inherently dishonest as
before. If a nostrum is worthless, any exploitation must be false and
misleading in effect, even though not one single false direct statement
is made.
A platitude may be given an appearance of importance if uttered in an
impressive manner, and it may be employed to suggest far more than it
categorically affirms. These two facts are appreciated by many nostrum
exploiters and we find that they have adopted the impressive manner to
secure attention, and the platitude to suggest far more than they could
defend in direct statement. Thus we have the “lie with circumstance.”
FELLOWS’ SYRUP
A full page advertisement, which has been appearing regularly for
about a year and which must represent a good deal of money, is used to
give an appearance of importance to a few words which, if printed in
ordinary type, would either pass wholly unnoticed or would lead one to
assume that something essential to the full meaning had been omitted.
The statement, in full reads:
“Fellows’ Syrup differs from other preparations of the
hypophosphites. Leading clinicians in all parts of the world have
long recognized this important fact. Have you? To insure results,
prescribe the genuine ℞ Syr. Hypophos. Comp. Fellows’. Reject cheap
and inefficient substitutes. Reject preparations ‘just as good.’”
The only direct statement contained in the advertisement is to the
effect that many clinicians have observed that Fellows’ syrup and other
preparations of the hypophosphites are not alike. In truth, Fellows’
is not like the better preparations of this type, since after standing
it contains a muddy looking deposit that any pharmaceutical tyro would
be ashamed of. Technically, then, the statement is true, but it is
hardly credible that the manufacturer is paying for an entire page in a
medical journal to make this statement without any attempt to suggest
something else.
The advertising pages of six medical journals were examined in the
order in which they chanced to come to hand. In five of these, the
entire advertisement of Fellows’ syrup was in the words just quoted;
not a single word more. In one there was the further statement:
“Not a new-born prodigy or an untried experiment, but a remedy
whose usefulness has been fully demonstrated during half a century
of clinical application.”
These advertisements show that the exploiters of Fellows’ Syrup are
spending a great deal of money to induce physicians to prescribe the
preparation, and it is equally evident that they wish to convey the
impression that the preparation has some therapeutic value. Since we
find nothing directly false, in the first mentioned advertisement at
least, we must take the evident intent for consideration and determine
what therapeutic value, if any, this preparation has, and whether it is
advisable for physicians to employ it in any case.
The preparation, according to the statement just cited, has been in
use for fifty years. As the exploiter of any preparation cites the
most convincing evidence in his possession in support of his views,
this claim may be assumed to be the strongest available, and if this
evidence fails we must reject the contention as not proved. Here
we face a dilemma, for examination of the literature used in the
exploitation of Fellows’ Syrup fails to disclose any evidence of the
kind that we have described as satisfactory; and we are, therefore,
forced to conclude that none has ever been found. By this it is not
to be implied that no reputable physician has ever reported favorably
concerning the therapeutic effects of this preparation. It is quite
possible that an extensive literature of that sort might be found if
one examined the older medical journals. But the day has passed when
every improvement that follows the administration of a preparation is
blindly attributed to the drug in question. Clinical research today is
far more exacting.
We will assume that the reader who has investigated the question with
an open mind will have come to the decision that the contention that
Fellows’ syrup is of especial therapeutic value is not proved. We might
rest with that assumption and ask the clinician whether he is prepared
to use a nostrum that has been before the medical profession for half
a century without any satisfactory evidence having been gained that
it possesses therapeutic value. We might ask him whether he would be
willing to tell his patients that he was prescribing such a nostrum
for them in the face of the absence of any such evidence of its value.
THE INERTNESS OF THE HYPOPHOSPHITES
But we prefer to go even further and show him that not only is there
an entire absence of any evidence of its therapeutic value so far as
we have been able to learn, but in addition there is an abundance of
evidence that the hypophosphites are devoid of any such therapeutic
effect as they were formerly reputed to have, and that, in fact,
they are, so far as any effect based on their phosphorus content is
concerned, singularly inert.
While we have thus far taken the Fellows’ preparation as the subject
of the discussion, we may take a broader view and examine the subject
of the hypophosphites in general, and the substitutes containing
phosphorus that have been introduced from time to time. It hardly needs
to be said that if the hypophosphites are without therapeutic value, it
is impossible to give them value by combining them in a muddy-looking,
ill-made preparation such as Fellows’ Syrup. Such evidence was
submitted to the medical profession in a report of the Council on
Pharmacy and Chemistry (_J. A. M. A._ =67=:760 [Sept. 2] 1916); and we
would strongly advise any one who is disposed to act on the suggestion
contained in the advertisements of Fellows’, and other hypophosphite
preparations, to read that report in full and to think the matter over
before prescribing one of these nostrums. Quoting briefly from the
report in question:
“Although the overwhelming weight of evidence was against the
probability that the hypophosphite preparations are of value as
therapeutic agents, the Council thought it well to investigate the
subject. Dr. W. McKim Marriott of Baltimore was therefore requested
to review the evidence for and against the therapeutic usefulness
of the hypophosphites and to conduct such experiments as seemed
necessary.”
The Council was not content to rest on the mere absence of evidence
for the value of these preparations or any one of them, but sought
to obtain evidence that would fulfil the conditions mentioned above,
and in pursuance of this plan it secured the cooperation of a trained
investigator, one who would work under the best of conditions for
learning the truth. The results of Dr. Marriott’s investigation were
published in The Journal, Feb. 12, 1916, p. 486, and should be read by
everyone who has any interest in the problem. Lest some of our readers
may fail to refer to the original of Marriott’s paper, we will quote
briefly from it:
“None of the subjects of the experiment experienced any effect
whatsoever from the administration of the drug ... Almost all of the
ingested hypophosphite is eliminated unchanged....
“These experiments (Forbes) demonstrate conclusively that the
hypophosphites possess no specific value as a source of phosphorus
for the body.... It is doubtful if there are any conditions in which
the body suffers from lack of phosphorus. Even should such conditions
exist, phosphorus, in the form that it occurs in the ordinary foods,
or as phosphates, is more efficient in supplying the deficit than
hypophosphites that must be oxidized before utilization and which are
only about 15 per cent. oxidized if at all. For example, half a glass
of milk contains more available phosphorus than three large doses of
hypophosphites of 15 grains each, as great a dosage as is usually
given.
“What then, is the therapeutic value of hypophosphites? There is no
reliable evidence that they exert a physiologic effect; it has not
been demonstrated that they influence any pathologic process; they
are not ‘foods.’ If they are of any use, that use has never been
discovered.”
The case seems to stand about like this: A nostrum maker spends
thousands of dollars to tell physicians that his cloudy preparation is
not like other preparations, and physicians are expected to accept
that as convincing evidence that they should prescribe and their
patients, perforce, take it. This too, in spite of the evidence gained
by careful scientific investigators that the hypophosphites in fairly
large doses contain less available phosphorus than half a glass of
milk, and that there is no evidence available that they exert any
therapeutic effects at all.
Should we take the meaningless statement of a nostrum maker, who does
not submit evidence of any therapeutic value of his preparation--unless
one can call certain careless habits of prescribing evidence--and
assume the responsibility of prescribing a nostrum that according to
all scientific evidence available is useless, and of no more effect
than a few teaspoonfuls of milk, so far as its hypophosphite content is
concerned? It may be argued that it possesses some value because of its
bitter nature. We will not deny that it is bitter; so is strychnin, so
is quinin, so are scores of simple drugs, but what physician would care
to admit to his patients that he did not know how to prescribe a simple
bitter, such as nearly every layman can select for himself, without
recourse to a preparation such as Fellows’ Syrup?
We have felt that it is not wholly satisfactory to discourage the use
of a given nostrum without making an effort to assist the physician in
choosing wisely in the treatment of the condition for which the nostrum
is claimed to be useful. In the present instance, however, we fear that
would prove a task beyond our powers, for the hypophosphites have been
used in such a variety of conditions that the discussion would have to
include nearly the whole materia medica if we were to follow our usual
procedure.--(_From the Journal A. M. A. Feb. 16, 1918._)
[ARTICLE VII]
Shotgun Nostrums
Formerly it was customary to prescribe mixtures of many drugs on the
assumption that if one of the ingredients missed the mark another
might be expected to hit it, just as a poor marksman is more likely
to hit a target at short range with a blunderbuss than with a high
powered rifle. Increased precision in every branch of science has
become the outstanding feature of civilization. The soldier today
must shoot straight with a rifle that sends a single ball. There is
none of the disposition to rely on chance as when the blunderbuss was
used. A capable physician directs his drug straight at the seat of the
trouble, and we now have many drugs that can be depended on to exert
definite actions. The complex mixture is just as preposterous in modern
therapeutics as the blunderbuss would be on a modern battlefield.
Every drug exerts undesired side actions, and it is the aim of the
modern physician to try to select the one which will have a maximum of
therapeutic with a minimum of undesired actions. When a complex mixture
is employed, it is obvious that only the best is utilized, whereas all
the undesired side actions come into play. We do not pretend that even
the best studied drug has not much to be learned about it; but the
nostrum maker who exploits a complex mixture either knows practically
nothing of the side actions that it will exert, or, if he knows, he
conceals that knowledge. He knows that massive doses of hydrated
chloral combined with various narcotics can be relied on to cause
unconsciousness in nearly all cases, but he prefers to speak of this
as a hypnotic action. This is plain gambling with human life. When the
patient dies, it is difficult to prove that death was caused by the
mixture alone.
The Council on Pharmacy and Chemistry has expended a great deal of time
and energy in combating the “shotgun” nostrum evil. It is easy to
understand the disadvantages of such mixtures but it is not so easy to
demonstrate the misleading character of the claims made, with an entire
disregard of the truth, for these mixtures. No one believes that a pot
of gold lies at the end of the rainbow, but no one has actually gone
there to see for himself.
BROMIDIA
There are many types of “shotgun” nostrum. Some are dangerous,
as in the case of “Bromidia”; some are preposterous, therapeutic
monstrosities which excite the contempt of educated physicians, as in
the case of “Tongaline”; some are merely useless mixtures of well known
drugs, sold under grotesquely exaggerated claims, as in the case of
“Peacock’s Bromides.”
Various formulas have been given for Bromidia. The manufacturers appear
to be more cautious under those circumstances in which falsehood might
lead them into collision with the federal authorities, than when giving
reign to fancy and considering only the best means of winning the favor
of the physician. It is said to consist of hydrated chloral, potassium
bromid, Indian cannabis, and hyoscyamus. It is impossible to determine
from the published formulas just how much hydrated chloral and
potassium bromid it contains, but is probable that there are about 15
grains of each of these two drugs to the fluidram, and variable amounts
of Indian cannabis and a small amount of either extract or tincture of
hyoscyamus.
This much is certain: Bromidia is a distinctly dangerous mixture for
indiscriminate use. The claim of the manufacturers, implied, rather
than directly stated, that it is superior to an extemporaneously
prepared mixture of those drugs is especially reprehensible because it
tends to create the impression that the nostrum is safer in effective
doses, conducing to a false sense of security on the part of those
who are deluded into prescribing it in larger doses than they would a
mixture of the same drugs prepared extemporaneously.
A report of the Council on Pharmacy and Chemistry published in The
Journal, May 16, 1914, p. 1573, mentions three instances in which death
is reported to have followed the use of Bromidia. The manufacturers
of Bromidia have no magic power to render hydrated chloral harmless,
while it retains its hypnotic action. It depresses the central nervous
system, and it is nothing less than monstrous for any one to pretend
to rob this drug of its dangerous properties while it retains its
hypnotic effects. If the patient requires a hypnotic, the physician
should choose that one which his judgment and experience dictate as
the best for that particular patient. If he needs hydrated chloral,
the physician should prescribe exactly as much as he believes the
patient needs. If the effect is slightly greater or slightly less than
anticipated, no harm is done and the physician has gained experience
that will be valuable in future prescribing. If Bromidia is prescribed
and unexpected effects are induced, it is impossible to know whether
these were due to the hydrated chloral or to one of the other narcotics
or to a synergistic action; and there is nothing to guide in the
further use of the nostrum, for mixtures of narcotics commonly have
much less uniformity of action than a single drug.
The irritant action of hydrated chloral on the stomach can be avoided
by the use of bland fluids or dilute solutions. The following serves as
an example of the way in which it may be prescribed conveniently:
Gm. or c.c.
Hydrated chloral 2|6 gr. xl
Syrup of orange peel |
Water of each 30| fl ℥ i
A tablespoonful (15.0 c.c.) of this mixture, containing 10 grains
(0.65 gm.) of hydrated chloral, will often induce sleep in the absence
of severe pain or serious disturbance, and seldom does this dose have
to be repeated more than once in such simple cases. Hydrated chloral
is often used in somewhat smaller doses in combination with potassium
bromid, which may be prescribed in a mixture such as the following:
Gm. or c.c.
Hydrated chloral 1|3 gr. xx
Potassium bromid 3|9 gr. lx
Syrup of orange peel |
Water of each 30| fl ℥ i
In producing sleep when severe pain is absent this is as effective as
the preceding, in similar doses. The use of repeated doses of hydrated
chloral in such a mixture as this, or in the form of Bromidia or other
nostrum when sleeplessness is due to severe pain is highly dangerous.
It should be remembered that while hydrated chloral is an effective
hypnotic in case of simple sleeplessness, it is not actively analgesic
except in distinctly dangerous doses. Bromidia in repeated doses will
induce sleep even in the presence of pain, of course; but any active
narcotic does that, and it is correspondingly dangerous. Small doses of
morphin given alone are preferable when sleeplessness is due to severe
pain.
TONGALINE
“Tongaline” is an example of the type of “shotgun” nostrum that
would be merely ludicrous if we could look on anything that degrades
therapeutics so lightly. A report was made to the Council on Pharmacy
and Chemistry, and published in The Journal, July 17, 1915, p. 269, and
in this report it is stated that Tongaline is said to consist of tonga,
cimicifuga racemosa, sodium salicylate, colchicum, and pilocarpin.
Whether the formula was cut short just there because the office boy
ran out of breath at that point, or because the discoverers of this
wonderful combination had not heard of the eminently potent substances
that the witches added to their cauldron, we can leave to the reader’s
imagination, for it is manifestly impossible to present an orderly
discussion of the pharmacology and therapeutics of such a preposterous
jumble of drugs.
PEACOCKS BROMIDES
“Peacock’s Bromides” belongs to a slightly different class. It is said
to consist of the bromids of sodium, potassium, ammonium, calcium and
lithium. In the absence of a logical explanation of the pretended
superiority of this mixture over one that is made extemporaneously, the
exploiters seem to have been driven to the necessity of pretending that
its freedom from contaminating chlorids explains its claimed advantages
over mixtures of the official or commercial bromids. The truth is that
the chlorids are used as antidotes in bromid poisoning.
Disregard the claims made for Peacock’s Bromides, and ask yourself the
question whether you have ever actually seen any ill results following
the use of the official bromids that you could reasonably attribute to
contaminating chlorids. Furthermore, carefully consider the relative
advantage of a single bromid (say the bromid of potassium, or bromid
of sodium, if you prefer it), with the opportunity of observing its
effects and adjusting the dose in accordance with the results of your
experience, and a mixture such as Peacock’s Bromides, the composition
of which you do not know, and which the manufacturer can alter to suit
his own convenience.
While it is true that the therapeutic art will not degenerate in its
entirety merely because some physicians continue to use the most
fraudulent and worthless nostrums, yet, on the other hand, to the
extent that a physician continues to be guided by the false teachings
of nostrum venders who have no therapeutic training, he is plunged into
therapeutic chaos.--(_From The Journal A. M. A., March 2, 1918._)
[ARTICLE VIII]
Tyree’s Antiseptic and Aseptinol
It may seem paradoxic to say that recent progress in the medical
sciences has made therapeutic chaos possible, but it is true
nevertheless. Revolutions are sometimes slow and orderly, sometimes
sudden and attended with confusion. The revolutionary changes in
the medical sciences have been so numerous and so rapid that the
general practitioner has been unable to keep pace with them, and in
the resulting confusion the nostrum maker has seen his opportunity
for exploiting his useless, dangerous or unscientific preparations.
The greater the confusion, the greater his opportunity; and it is
no exaggeration to say that he has been the most potent factor in
maintaining the chaos of therapeutics.
The majority of our readers would probably say that the existing
scientific medical literature insures the permanence of established
beliefs, but every one who has delved into the literature has found
instances of truths that had been established and forgotten--buried
under the ever-increasing avalanche of contributions to that literature.
[Illustration: Typical half-page Tyree advertisement appearing in
medical journals.]
Rapid advances are still being made in the medical sciences and unless
constant vigilance is exercised therapeutics will return to the chaotic
condition from which it has so recently emerged. It was in recognition
of these facts--the danger of this return to chaos, and the difficulty,
in fact, impossibility, of any individual’s keeping pace with all of
the medical sciences--that the American Medical Association secured
the cooperation of men in various branches of medicine in the Council
on Pharmacy and Chemistry, in order that it may place the results of
therapeutic progress before the readers of The Journal in an impartial
manner.
Are you profiting by this work, or are you still depending on your
unaided efforts to distinguish the false teachings of the nostrum
venders from that of scientific medicine? Are you prescribing
“Antikamnia” and “Ammonol” or a simple member of the group, such as
acetanilid or phenacetin? Are you depending on “Tyree’s Antiseptic,”
so called, or are you using an antiseptic about which there is no
mystery, for which no false claims are made, and one which is really
effective? In short, are you using drugs of unquestioned value, such
as are described in “Useful Drugs,” or are you taking your therapeutic
instructions from nostrum makers’ circulars?
Perhaps you have been led to believe that the Council on Pharmacy and
Chemistry is composed of “theorists” and that the nostrums represent
the work of “practical men.” Every one should strive to be practical,
of course, and it is worth while to inquire whether scientific
experimenters, who so largely mold medical literature, should be termed
theorists, or practical men. A practical man practices that which is
useful in the treatment of the sick, and he must determine who is
capable of furnishing him with a better materia medica. A perusal of
medical literature will convince any unbiased mind that medical science
progresses only by means of experiment, hence experimenters must be
considered the really practical men while those who cling to outworn
theories are really the “theorists.”
[Illustration: Typical Aseptinol advertisement.]
When Lister introduced antiseptic methods into surgery he inaugurated a
veritable revolution, which afforded the nostrum makers opportunities
for reaping rich harvests through the exploitation--under extraordinary
claims--of cheap mixtures of little, or no, value. There is no lack
of antiseptics of extraordinary activity in the test tube that are
practically harmless to man, and it would seem natural to suppose that
such antiseptics could be used to control the development of bacteria
in such diseases as typhoid fever, but, unfortunately, such hopes have
not been fulfilled. Ehrlich experimented with many phenol derivatives
that showed decided antiseptic activity in the test tube, in the hope
that he might find some that could be used to combat such common
diseases as diphtheria and typhoid fever, but while many of these are
of low toxicity for man, he was unable to find even one that could
be used effectively in the treatment of any of these diseases. His
discovery of arsphenamin (“salvarsan”) resulted from quite another type
of investigation.
Many practitioners lose sight of the essential difference between
antiseptics and disinfectants and employ antiseptics in cases in which
only a disinfectant action would be of value. An antiseptic does not
destroy bacteria, it merely inhibits their growth; and when it is
diluted too much, it loses its effects and the bacteria may begin to
multiply as though no antiseptic had been used. This is especially
true after the use of weak antiseptics in the mouth. These are soon
diluted or removed by the saliva, and the bacteria continue to multiply
with only a momentary interruption at best; hence to advise the use
of an oral antiseptic as an effective means of treating diphtheria is
little short of criminal.
“Tyree’s Antiseptic Powder” was submitted to the Council nearly twelve
years ago. The label on the package stated:
“This preparation is a scientific combination of borate of sodium,
alumen, carbolic acid, glycerin and the crystallized principles of
thyme, eucalyptus, gaultheria and mentha in the form of a powder.”
[Illustration: One of the older newspaper advertisements of Tyree’s
Antiseptic Powder.]
A leaflet issued several years ago by the Aseptinol Manufacturing
Company states that “Pulv. Aseptinol Comp.” combines in an elegant form
boric acid, the salts of aluminum, crystallized phenol, and the active
crystalline principles of thymus, mentha and gaultheria.
A comparison of these formulas would justify the designation of the
two preparations as twins, but even one twin may have a wart where
the other lacks it. The formula of Pulv. Aseptinol Comp. given in the
leaflet also includes _Hydrastis canadensis_, but we believe that a
wart should be quite as much of an addition to the anatomy of man as
the hydrastis is to this already preposterous formula. Similar as the
formulas of these two nostrums were said to be, the general methods of
exploiting them were even more similar. A partial list of the diseases
for which each has been recommended by its exploiters shows the
similarity of methods pursued:
TYREE’S WAS SAID TO BE USEFUL PULV. ASEPTINOL COMP. WAS SAID TO
IN THE TREATMENT OF: BE USEFUL IN THE TREATMENT OF:
Leucorrhea Leucorrhea
Gonorrhea Gonorrhea
Vaginitis Vaginal inflammation
Pruritus Pruritus
Ulcerated conditions of Ulceration of vagina or
the mucous membrane cervix
Scrofulous ulcers Chronic ulcers
Syphilitic ulcers Prophylactic against
specific disease
Disinfecting offensive Cleansing pus cavities
cavities
Deodorant Deodorant
Profuse and offensive Checks abnormal secretion
perspiration
We stated that the formula furnished by Tyree was that given above, but
the Council was never able to learn when Tyree actually employed the
formula except for advertising purposes; and analysis of the powder
showed that Tyree’s Antiseptic Powder was essentially a mixture of
boric acid and zinc sulphate, with insignificant amounts of odorous
principles.
A remarkable fact brought out in the course of the consideration of
the preparation by the Council was that Tyree admitted that he had
changed the formula without having published the new one. The Council
then showed that a specimen of the “antiseptic” that had been kept in
a retail drug store for several years was essentially similar to that
sold at the later date. Thus it would seem that Mr. Tyree had been
making his powder by one formula and publishing an entirely different
one for years before the Council published the facts in the case.
If Tyree found it necessary to change the formula of his powder--if
indeed, he ever used the published formula--why did the Aseptinol
Manufacturing Company adopt it, or one so closely resembling it?
It is obvious that both of these twin nostrums are utterly unfit
for treating the various conditions for which they are or have been
recommended; and in view of the misrepresentation in one case, it
is difficult to understand why it should be taken as the model for
the other. Do physicians believe that a simple mixture of boric acid
and zinc sulphate, or a mixture such as that given in the formula of
“Aseptinol” powder, is in any way superior to a prescription such as
any physician could write?
There is a far more important question to consider than the relative
merits of such nostrums and a prescription of the physician’s own
devising. That question is whether the medical profession is going
to help perpetuate the chaotic conditions that the use of such
nostrums fosters or to assist in therapeutic progress by maintaining
its independence of such false teachers, and seeking to aid in the
establishment of a rational use of drugs and remedial measures.--(_From
The Journal A. M. A., March 30, 1918._)
[ARTICLE IX]
Neurosine and the Original Package Evil
We called attention recently to the skill which the nostrum vender
displays in avoiding the particular thorn that pricks him, and his
development of the art of impressively saying, “Nothing in General,” as
exemplified in the advertisements of Fellows’ Syrup. Nostrum sellers
are more canny than original; and when once an idea finds lodgment with
one of them, it is made to serve many masters. Formerly exploiters of
either vicious or worthless nostrums were wont to boast that their
preparations were exploited in a “strictly ethical manner.” Recent
perusal of as choice a lot of advertisements as can be found in the
most degraded of medical journals failed to disclose this claim in a
single instance, although the claim that a preparation is “advertised
only to physicians” is still common.
The advertisement of “Neurosine,” which we reproduce, was the first
one which came to our attention when we searched through some medical
journals for one that would illustrate a discussion of the “original
package” evil. This is the only reason for selecting Neurosine rather
than another. Such half page advertisements and others of similar
size in various medical journals cost a good deal of money and they
presuppose that the Dios Chemical Company is interested in having
original bottles of Neurosine dispensed every time that nostrum is
prescribed.
Why should the firm have any such deep interest in seeing that an
original _bottle_ gets to the patient? Why should it be necessary
to do anything more than see that the genuine _mixture_ reaches the
patient? Does it seem within the bounds of reason that substitution
is so commonly practiced by pharmacists that this firm must go to
large expense to prevent the substitution of spurious mixtures for its
product? Is dishonesty the rule among pharmacists? Common sense rejects
the plea as placing too great a strain on one’s credulity. Obviously,
then, the advertisement does not tell the whole truth, though it does
indeed tell exactly what the nostrum maker wishes to have done, that
is, to have only _original bottles_ dispensed when physicians prescribe
that nostrum. The fact we have; the reason is not far to seek.
[Illustration]
When the pharmacist puts up an ordinary, nonproprietary prescription,
the patient gets no clue from the package as to the nature of the
prescription employed. But when an original bottle of Neurosine is
dispensed, even though the pharmacist puts his own prescription label
on it, the patient sees the difference at once and knows just why
the usual prescription bottle was not employed. He also knows that
he can get the medicine with its original wrapper or label by merely
showing the bottle to the druggist, for the words “Neurosine” and “Dios
Chemical Co.” are blown in the glass. Here, then, may be a plausible
reason for desiring that only original bottles be dispensed.
You may ask, “What difference does it make if the patient does learn
the name of the nostrum, he must go to his physician for advice
concerning its use?” Having learned the name of the remedy that has
been prescribed for sleeplessness, let us say, he proceeds to use
it whenever he imagines that he needs it; and that need, real or
imaginary, has a way of increasing in frequency. As a result, the
patient takes far more Neurosine than the physician would think of
permitting if the matter had not passed entirely beyond his control.
Not only has the patient acquired a dangerous habit of
self-prescribing, but he takes especial delight in recommending his
favorite remedy to friends whose symptoms, real and imaginary, seem to
resemble his own. This offers him an opportunity to prescribe with an
air of authority. It was prescribed for him by Dr. Blank, and it gave
relief, _ergo_ it may be depended on to give relief to others! Thus is
the basis laid for its general use by the laity, when this process is
multiplied sufficiently. The statement is susceptible of easy proof
by any one who cares to investigate the matter for himself. There is
probably no physician worthy of the name who will attempt to deny
that the promiscuous use of hypnotics and narcotics is dangerous, and
certainly no careful physician will deliberately place a narcotic in
the hands of patients to be used freely and without control.
Since we have selected Neurosine at random, so far as this particular
discussion is concerned, it is worth while to inquire into its
composition, the claims that have been made for it and the evidence, if
any exists, for or against its therapeutic value. Even the most active
of hypnotics are worse than useless if they are inferior to other
readily available hypnotics, or if they have undesired side-actions
that outweigh any advantages that they might otherwise have.
The Council on Pharmacy and Chemistry investigated the literature
relating to Neurosine and published its report in The Journal, Jan. 9,
1915, p. 165. According to this report the manufacturers of Neurosine
claimed that each fluidounce contained:
Bromid of potassium, C. P. 40 grains
Bromid of sodium, C. P. 40 grains
Bromid of ammonium, C. P. 40 grains
Bromid of zinc 1 grain
Extract lupulin 32 grains
Cascara sagrada, fl. ex. 40 minims
Extract henbane 0.075 grain
Extract belladonna 0.075 grain
Extract cannabis indica 0.60 grain
Oil bitter almonds 0.60 grain
Aromatic elixir
This chemical blunderbuss was recommended for use in insomnia,
hysteria, neurasthenia, migraine, neuralgia, delirium tremens, epilepsy
and many other conditions. Also it was called an ideal calmative for
children suffering from chorea, the exploiters claiming that “All
authorities recommend the bromids, hyoscyamus and cannabis indica in
this disease.” Oliver T. Osborne, professor of therapeutics in Yale
Medical School, does not mention one of these three drugs in his
discussion of the Medicinal Treatment of Chorea, in the Handbook of
Therapy, though he quotes several authorities in this article. Indeed,
he does not mention one of the ten drugs included in the above formula
of Neurosine in connection with the treatment of this disease. It is a
curious fact that Osborne gives the greatest prominence to the use of
that drug which is claimed to be wanting in the formula of Neurosine,
namely, hydrated chloral.
Perhaps you may have seen temporary relief follow the administration
of Neurosine in chorea, and may argue that theorizing is of little
value in the face of personal experience. We shall not deny that some
may have had that experience, for Osborne calls attention to the fact
that the success of any medicinal treatment must be judged in the
light of the fact that chorea is self-limited, and the intensity of
the symptoms will abate in from two to four weeks. In view of this, we
would hardly dispute the claim that one may administer narcotics, such
as those contained in Neurosine, and the symptoms of chorea may abate
in spite of such mistreatment. In all the years that Neurosine has been
exploited to physicians with such remarkable claims, we have never seen
a report of a careful clinical study in which the product has been used
under the conditions which scientific investigation demands. Would you
prescribe any nonproprietary preparations which had never been studied
clinically, if a horse-shoer or grocer’s boy told you it would cure
epilepsy or malaria?
According to an editorial note appended to the report of the Council
on Neurosine, the Dios Chemical Company consisted at that time (1915)
of J. H. Chambers, his wife and two sons. It appeared that Chambers
never claimed to have any special knowledge of chemistry, pharmacy or
medicine, yet we find that he arrogated to himself or to his employees
the right to offer therapeutic advice to the medical profession, and
even to direct them as to how they should prescribe a given mixture.
We sometimes fail to see the forest because of the trees. It may help
us to obtain a better perspective, in a problem that concerns us
intimately, by resorting to a hypothetic case, if a close analogy is
maintained. In order that we may see ourselves as others see us in
such a situation, let us consider the following imaginary case: You
become involved in a lawsuit in which an effort is made to deprive you
of your property and your liberty. You seek what you had reason to
believe was competent legal advice; but, nevertheless, you lose your
case and find yourself deprived of your property and your liberty. Now
let us suppose further that you discover, when too late to permit you
to correct your mistake, that your legal adviser (we can hardly call
such a man a lawyer) had been acting all along under the guidance of a
plumber who made no pretense of knowing anything about law. How would
you feel regarding that pretended lawyer? Would you feel that you had
been treated fairly? Would you feel disposed to speak with all charity
of him, to recommend him to those in need of legal advice?
You would probably feel toward such a lawyer as patients must feel
toward physicians who prescribe proprietary nostrums based on
information and advice offered by those who, though without any special
knowledge of chemistry, pharmacy or medicine, will be benefited
financially if their information and advice are accepted and acted
on.--(_From The Journal A. M. A., April 27, 1918._)
ANASARCIN ADVERTISING[I]
[I] See index for other articles on Anasarcin.
_To the Editor_:--As an old Fellow of the A. M. A. I beg to present
the following facts to you, and to ask if anything can be done by you
to expose the methods of these people: A concern calling itself “The
Anasarcin Chem. Co.” of Winchester, Tenn., has caused to be sent to
physicians a chart on the subject of “Diagnostics of Renal Diseases.”
This chart contains eighteen plates, which were all taken without
knowledge or permission of either myself or my publishers, William
Wood & Co., from the third edition of my book on “Urinary Analysis
and Diagnosis.” The plates are partly composite plates, but mostly
portions of plates, exactly reproduced from my book. I at once caused
my publishers to write to the Anasarcin Company; and a few days ago I
received a letter from a Dr. H. Elliott Bates of 118 East Twenty-Eighth
Street, New York, whose letterhead says, “Medical Advertising.” In this
letter the writer says that it was he who suggested the sending of such
a chart, and admits that all the plates were taken from my book. In
this letter he offers to have a letter sent to every physician of the
country “in which it is explicitly stated that the cuts on the chart
were taken from your book, and that complete information regarding
the matters treated on the chart can be found in your book.” In other
words he offers to advertise my book free of cost to me, so that I
should take no further steps in the matter. I consider this entire
matter an outrage, and thought it best to write to you for advice,
since my publishers seem to think that in spite of the violation of the
copyright nothing can be done.
Besides the cuts, some of the text on the chart is bodily taken from
my book, while some of the other text, not taken from my book, but
apparently compiled from different articles, is in part entirely wrong,
so much so that I must be ashamed of its being associated with any of
my own work.
By giving this letter your early consideration, and advising me what
you think it best for me to do, you would greatly oblige
Louis Heitzman, M.D., New York.
[Comment.--Readers of The Journal are, of course, familiar with the
articles[246] that have been published on “Anasarcin,” the “dropsy
cure”! Knowing the standard of ethics that the Anasarcin concern adopts
in the exploitation of its ridiculous squill mixture, our readers
will not be surprised at the standard of commercial ethics which
would justify the appropriation of copyrighted scientific material
for nostrum advertising purposes. The statement of Dr. Heitzmann’s
publishers that “in spite of a violation of copyright nothing can be
done” is, of course, incorrect. Something _can_ be done by those who
hold the copyright.--Ed.]--(_From The Journal A. M. A., Oct. 18, 1919._)
[246] J. A. M. A. =46=:288 (Jan. 27) 1906; ibid. =48=:1535 (May 4) 1907;
ibid. =48=:1614 (May 11) 1907, and ibid. =49=:1992 (Dec. 8) 1917.
ANTIMERISTEM-SCHMIDT
Some, possibly many, of our readers have received a letter from
Cologne, Germany, from the “Bakteriologisch-Chemisches Laboratorium
Wolfgang Schmidt.” The letter contains a circular directing the
attention of American physicians to “Antimeristem-Schmidt.” It also
contains some advertising leaflets. One physician in sending this
material to The Journal writes:
“A copy of the enclosed circulars has been sent to many of the
physicians in this city, and probably elsewhere. Perhaps it has
already been called to your attention. Let us be as liberal as
possible with our recent enemies. The sooner the old channels of
scientific communication are re-opened, the better. But let us
not allow such blatant commercialism from a foreign country to go
unprotested, any more than we should if it were from our own.”
It should be noted in passing that the envelop in which the Wolfgang
Schmidt letter came has on its face a rubber-stamped impress to the
effect: “Concerns Cancer Treatment.” The circular letter declares that
by means of Antimeristem-Schmidt “either a cure or improvement has been
effected in numerous inoperable cases” of malignant tumors. American
physicians are asked “to employ the preparation when occasion arises”
and are assured that “every medical man in city or country will be
able to carry out treatment without preliminary knowledge.” With the
letter are two leaflets discussing the use and administration of the
product; one contained what was called a “Synopsis of some of the more
recent publications regarding the employment of Antimeristem-Schmidt in
inoperable malignant tumors.” The “recent” publications comprised three
articles published in 1910 and one published in 1912!
Antimeristem-Schmidt was rather widely exploited some six or seven
years ago. As was explained in The Journal, March 8, 1913, p. 766, it
is a preparation claimed to be useful in the treatment of inoperable
cancer and as a supplementary treatment after operations for cancer.
The treatment is founded on a theory advanced by one O. Schmidt that
the cause of cancer is found in a fungus, _Mucor racemosus_, which,
Schmidt at first asserted, carried a protozoon which he regarded as
the real cause of the disease. The vaccine is said to be prepared from
cultures from this fungus. While Schmidt claims that he has been able
to produce cancer by means of the organism, scientific research has not
verified his claims. Extensive clinical trials have shown the treatment
to be without effect. The Journal also advised its readers on April 19,
1913, that no license for the sale of Antimeristem-Schmidt had been
granted by the Treasury Department and, therefore, its importation into
this country was prohibited. Neither the therapeutic nor the legal
status of the product has been changed since then.--(_From The Journal
A.M.A., Dec. 6, 1919._)
ANTIPHLOGISTINE
_To the Editor_:--Last September, my chief, Dr. J. S. Millard,
received a letter from the Denver Chemical Mfg. Co., manufacturers of
“Antiphlogistine.” This letter purported to quote many large commercial
concerns as testifying to the value of Antiphlogistine. Recently, I
doubted the veracity of these claims and wrote to some of those quoted.
I quote from the original letter of the Antiphlogistine company:
“The surgeon to the electric light and electric railroad company in
New Orleans says that Antiphlogistine is the finest thing he has
ever used in burns, especially flash and brush burns.
“The physician to the New York Edison Co. makes a similar
statement. He says that the application gives speedy relief and the
burns heal quickly without scars.”
I wrote to Dr. John Woodman, the physician to the New York Edison Co.,
who replied in part as follows:
“The Denver Chemical Manufacturing Company have no authority to
quote me.... I gave Antiphlogistine a thorough trial, and found it
had a very limited use, and I cannot recommend it for burns....”
Again, the Antiphlogistine letter said:
“It may be of interest to you to know that at the emergency
hospital of the Ford Automobile Co. in Detroit, Antiphlogistine is
carried in stock and is used extensively by the three physicians
in burns, bruises, infected wounds, sprains and other traumatic
conditions which are constantly arising in such a plant....”
I wrote to Dr. Mead who replied as follows:
“In answer to your letter of January 25th, will state that no
Antiphlogistine has been purchased or used in this hospital for
years past, and I cannot imagine why the representative of the
Denver Chemical Company should make such a statement as attributed
to him....”
He adds that “Antiphlogistine has never been used” in his department
“on an open wound, abrasion or burn.” Is there not some way that such
exploitation of our large companies can be prevented?
A. G. Gould, M.D., Akron, Ohio.
Plant Physician, the Goodyear Tire & Rubber Co.-(_From the Journal
A.M.A., Feb. 23, 1918._)
“AUTO-HEMIC SERUM”
A Cure for Laziness, Ugliness, Frigidity and Many Other Things
The following letters are typical of many that have been received
asking for information regarding Dr. L. D. Rogers and his “Auto-Hemic
Serum.” This from a physician in New York state:
“Can you give me any information in reference to Dr. Rogers of
Chicago, Ill., who has an Auto-Hemic Institute?”
And this from Kansas:
“Just received a letter from a Dr. L. D. Rogers, 2812 North Clark
St., who is anxious to sell me a course in ‘Auto-Hemic Therapy.’
Would you kindly inform me what he has to sell? He did not tell me
what it consisted of; am inclined to believe it is a rank fake.
Kindly let me know what _The Journal_ thinks about it. Just what is
it? In the letter they claim that it is practically a panacea for
every blood disease.”
This from Maine:
“What is Auto-Hemic Therapy? I have a handsome red and yellow
circular from the Ideal Life Extension Press, 2812 North Clark St.,
Chicago, soliciting subscriptions to their publication, offering
as a bonus this book, ‘Auto-Hemic Therapy’ by L. D. Rogers, A.M.,
M.D., LL.D., Chicago, and membership in the American Medical Union.”
THE NATIONAL MEDICAL UNIVERSITY
In order better to appreciate the probable scientific status of
“Auto-Hemic Serum,” it is well briefly to sketch some of the previous
activities of its discoverer, Dr. L. D. Rogers. For many years Rogers
was the head and chief owner of the National Medical University of
Chicago, a low-grade school of the “sun-down” variety. The “university”
is now out of existence and for some time before it went out of
existence was not recognized either by the board of health of the state
in which it operated or by the boards of the majority of the other
states in the Union. The report of the Carnegie Foundation on medical
education had this to say about the laboratory facilities of Rogers’
school:
“The school occupies a badly lighted building, containing nothing
that can be dignified by the name of equipment. There has been
no dissecting thus far (October to the middle of April, 1909),
anatomy being didactically taught. Persistent inquiry for the
‘dissecting-room’ was, however, finally rewarded by the sight of
a dirty, unused, and almost inaccessible room containing a putrid
corpse, several of the members of which had been hacked off. There
is a large room called the chemical laboratory, its equipment
‘locked up,’ the tables spotless. ‘About ten’ oil-immersion
microscopes are claimed--also ‘locked up in the storeroom.’ There
is not even a pretense of anything else. Classes in session were
all taking dictation.”
Dr. Rogers is, or was, if he is not still, “Permanent Secretary” of
the “National Association of Panpathic Physicians”--whatever that is.
In fact, one of Dr. Rogers’ specialties seems to be the founding of
quasimedical organizations--organizations, apparently, which may prove
useful in the promulgation of such projects as he may, at the time,
be interested in. A few years ago, Rogers was exploiting a “cancer
serum” and, _presto_, the “American Cancer Research Society” came into
being, L. D. Rogers, president. Soon thereafter certain members of the
profession were circularized urging them to purchase shares in the
“Cancer Research Laboratory and Hospital,” par value $10. Apparently,
the profession did not invest.
A few years ago, also, L. D. Rogers’ name appeared on the “Faculty”
list of the “American Post-Graduate School,” a concern which
granted--on the mail-order plan--a long line of sonorous degrees and an
equally complete line of ornate diplomas.
THE JAPANESE CONSUMPTION CURE
Then, in 1915, there appeared in the classified columns of certain
newspapers the following advertisement:
TUBERCULOSIS--New Japanese treatment;
to prove merits and give discovery quick
publicity will send 10 days’ treatment free.
DR. ROGERS, 546 Surf St., Chicago.
So far as we have been able to learn, Rogers, for some unexplained
reason, did not call into existence out of the vastly deep a
“Japanese-American Tuberculosis Research Society.” This consumption
cure apparently died of inanition.
Then came the “Auto-Hemic Serum” with its inevitable sequel, the
“National Society of Auto-Hemic Practitioners.” Another adjunct to the
serum exploitation is the _North American Journal of Homeopathy_, the
official organ of the “Auto-Hemic Practitioners” and of the “American
Medical Union” and possibly of some other “societies”--but not
representative of homeopathy!
WHAT IS AUTO-HEMIC THERAPY
What is this new therapy? According to a very lurid poster, it is
described as “The Missing Link in Medicine”--possibly referring to
the ease with which one may make monkeys of certain physicians. More
specifically, although still vaguely, we learn:
“It consists in giving the patient a solution made by attenuating,
hemolizing, incubating and potenizing a few drops of his or her
own blood, and administering it according to a refined technic
developed by the author.”
Elsewhere it is said to consist:
“... in taking five drops (or some multiple of five) of blood from
a vein and putting it into nineteen times as much sterilized,
distilled water, and incubating it at fever temperature for
twenty-four hours, and then making further dilutions according to
the needs of the case, as can be determined only by a physician
skilled in its use.”
Neither of these statements, of course, describes the “refined technic”
of those “skilled in its use,” but those who are interested can, by
sending Dr. L. D. Rogers, “One Hundred Dollars cash-in-advance” get a
mail-order course in this new marvel.
But if it is rather expensive to learn just how to use “Auto-Hemic
Serum,” it does not cost so much to learn what the “serum” will do.
Rogers has written a book on the subject, “Auto-Hemic Therapy,” which
is used as a premium for subscriptions to the _North American Journal
of Homeopathy_, price $5.00 per year, payable in advance. In the book
Dr. Rogers modestly assures his readers that he considers his discovery
more important than that of Alexis Carrel, winner of a Nobel Prize.
A CURE FOR LAZINESS
One of the chief virtues claimed for this serum is that of developing
in the patient who takes it an unbounded energy that, apparently,
makes him want to work himself to death. In some sensational articles
that have appeared in Sunday editions of newspapers on Rogers’ serum,
the stuff has been described as “Lazy Serum.” One of the first
cases described in the Rogers book is that of a young waiter, “a
good-for-nothing lazy fellow who would not work and would not pay for
medical services” and who was turned over to Dr. Rogers’ free clinic.
He was given the serum on Thursday and was told to report Saturday. He
did not return until Monday, his excuse being that “he worked all day
Saturday until midnight and all day Sunday and felt as if he could work
all day and all night without rest.” The “case report” ends: