_Dear Doctor_: Mrs. ---- has absorbed and is still absorbing some

killed tumor tissue. She has absorbed some three pounds, I judge.

The results of the absorption are intoxication quite general

(nervous, muscular, perhaps nephritic). The myocardium at present

shows no signs of poisoning but the skeletal muscles and nerve

do. The important toxin liberated by the killed tissue is methyl

cyanimide which combines ammonia (NH₂) from the amino acids, and

thus becomes methyl guanidine. This latter has produced in my

patients an intoxication varying in similarity to: idiopathic

tetany in children, chorea in children, eclampsia in women, and

has even been so severe as tetanus in some of the muscle spasms; a

toxic albuminuria has resulted in some of my cases.

All of my cases have cleaned up so far. Of course, I cannot predict

in any individual case, except that when the absorption has been

completed and the toxin all eliminated, everything should return to

normal, unless the toxin has destroyed tissue beyond physiological

repair. My suggestions as to treatment would be elimination, saving

the kidneys as much as possible, by whatever methods you find best

and necessary.

At present I am treating symptomatically thus--atropin as a

guanidine antidote, arsenic as a chorea coupled antidote as a

prevention to the production of guanidine from the cyanimide, the

use of dilute hydrochloric acid has proven successful to me. Even

a urine boiling solid--albumen has cleared up in one case in three

days just by taking large quantities of 1/2 per cent HCl. I am

explaining the factors I have contended with in these cases, but

do not want to influence your plan of treatment when your judgment

finds me insufficient.

Sincerely,

Wm. F. Koch.

I shall have a publication out very soon on the treatment of these

tetanics and eclampsia with HCl.

It is worth noting that this letter of Dr. Koch’s was written June 28,

just three days before Dr. de Tarnowsky saw Mrs. ---- and less than a

week before she died of generalized carcinoma.

Not the least important element in the story which these two letters

tell is the optimism engendered in the husband of the poor cancer

patient by the widely vaunted treatment of Koch. And herein lies one

of the most pernicious features connected with the exploitation of

alleged cures for cancer, tuberculosis, etc. All such remedies, whether

fraudulent both in their inception and exploitation or those which

while equally worthless are at least honestly put forward and are based

on a certain amount of scientific investigation, produce a profound

and marked temporary change in the patient’s condition. It is this

that tends to warp the judgment not only of the unscientific layman,

but also of the physician. The psychic element in cancer has been well

described by Weil:

“It is, indeed, very remarkable that a patient who has been consigned

to death as a victim of a hopeless malady, should regain his spirits

and his appetite, when he is again confronted with the hope of a

cure, and of the eradication of his disease? It is a phenomenon

well known to every student of the disease that a large proportion

of cases responds in just this manner to any treatment which is

offered them. Osler has described a case of cancer of the stomach

in which the mere visit to a consultant of sanguine temperament,

though poor judgment, whose assurance of the patient that there

was no possibility of cancer, resulted in the disappearance of all

the symptoms and a gain of 18 pounds in weight. It is this psychic

influence, which has occasionally deluded the honest student of

cancer cure, and which has also so generously played into the hands

of the dishonest.”--(_From The Journal A. M. A., Feb. 19, 1921._)

THE LUCAS LABORATORIES’ PRODUCTS

The Journal has received several inquiries about the products put out

by the Lucas Laboratories, Incorporated, of New York City. A typical

inquiry is that received from Dr. F. A. Jewett of Brooklyn, who writes:

“The enclosed circular is sent out to the medical profession by Dr.

William Lucas, 287 W. 70th St., New York. What do you know of this

man and his methods?”

William H. Lucas was graduated by the Medical College of Ohio in 1895

and was licensed in 1897. He is not a member of his local medical

society. The products put out by the Lucas Laboratories are for

intravenous use, and their method of exploitation indicates that the

concern is less interested in the science of therapeutics than it is

in taking commercial advantage of the present fad for intravenous

medication. The Journal has protested editorially against the

unnecessary use of the intravenous administration of drugs, and the

abuse of this method of drug giving prompted the Council on Pharmacy

and Chemistry recently to emphasize the danger of indiscriminate

intravenous medication.

The products of the Lucas Laboratories, Inc., have not been examined

either by the A. M. A. Chemical Laboratory or by the Council on

Pharmacy and Chemistry. The composition of these products is

essentially secret, which in itself should be sufficient to deter

physicians from using them. Of course, in accordance with all the

tenents of orthodox nostrum exploitation, “formulas” are furnished.

Even the crude hieroglyphics that used to be palmed off on the

medical profession by nostrum exploiters under the guise of “graphic

formulas” are outdone by the Lucas Laboratories in publishing the

alleged formulas of its preparations. If we, as physicians, knew

more chemistry, the Lucas Laboratories would not find it profitable

to publish such ineffable nonsense as that which characterizes their

“literature.” For instance:

“‘Luvein’ Arsans (Plain)” is said to be: “Di hypo sodio calcio

phosphite hydroxy arseno mercuric iodid.” The first part of this

“formula” might stand for sodium and calcium hypophosphite. The

remainder is meaningless except that it suggests (but does not

insure) the presence of arsenic and mercury iodide.

“‘Luvein’ Arsans, Nos. 1, 2 and 3.”--“Meta hydroxy iodide sodio

arsano mercuric dimethyl benzo sodio arsenate, ai oxy sodio tartaria

sulpho disheuyl hydrazin.” Who can venture even a conjecture as to

the possible significance of this?

“‘Luvein’ Creosophite.”--“Ammonio hydroxy calcio sodio hypo-phosphite

arsenous pentoxy iodide.” While the name suggests creosote, the

“formula” gives no hint of this. It might refer to hypophosphites of

ammonium, calcium and sodium with iodide of arsenic. Whether arsenous

(trivalent arsenic) or arsenic (pentavalent arsenic) iodide or both

are intended, is a question.

“‘Luvein’ Hexacol.”--“Hexa methylenepyro catechin mono methyl amino

ether glycerite.” By moving these syllables around like the old

“fifteen puzzle” they can be arranged to represent hexamethylenamin

and monomethyl-ether of pyrocatechin, or guaiacol, having the

“glycerite” left over.

It is futile to discuss the therapeutic claims made for the various

preparations put out by the Lucas Laboratories. One might as profitably

discuss the therapeutic claims made for “Peruna” or “Paine’s Celery

Compound” for the exploitation of the latter products is on just as

high a scientific plane as the exploitation of the “Luvein” nostrums.

The proposition offered to physicians by the Lucas Laboratories, Inc.,

is an insult to the intelligence of the medical profession. Not that

the products themselves are necessarily any worse or any better than

many offered for intravenous use; the selling methods are more crude,

that is all.

The facts are, we have entered a new cycle of nostrum development. The

unscientific mixtures for oral administration that characterized so

large and disreputable a part of the proprietary medicine business of

the past two or three decades are giving way to equally unscientific

mixtures for intravenous use. The dangers of the older nostrums

are accentuated in the newer by the added element of risk that is

inseparable from intravenous therapy. Add to this the temptation to

the physician in the way of more substantial fees which, legitimately

enough, may be charged when intravenous administration is called for,

and the menace of the new style nostrum becomes evident. The Journal

can only reiterate the warning that intravenous therapy should be

employed only when most positively indicated. Further, because of the

danger that is inseparable from this method of drug administration,

physicians should be doubly careful to see that products employed

for intravenous use come from firms of unquestioned scientific

standing.--(_From The Journal A. M. A., Sept. 20, 1919._)

“PHYLACOGENS”[L]

[L] This matter was largely reprinted in the Propaganda for Reform,

eighth and ninth editions.

A physician in Florida writes:

“I am enclosing a copy of a circular letter just received from

Parke, Davis & Company, and will call your attention to a marked

paragraph in this letter on which I would like to have an

expression of your opinion.”

The circular letter which the doctor forwards is devoted to singing

the praises of “Pneumonia Phylacogen.” It opens with the statement:

“Influenza, we learn, has appeared in your section.” The paragraph

marked by our correspondent reads:

“Pneumonia Phylacogen has been found to be a dependable means of

preventing and treating pneumonic complications of Influenza. In

one large city it became a routine measure to give all persons

affected with Influenza an injection of Pneumonia Phylacogen as a

prophylactic of pneumonia. The results were remarkable. Not only

did the cases improve rapidly, but in a great majority of them the

pneumonia did not occur.”

The “Phylacogens” were repeatedly discussed in The Journal during 1913

and 1914 when these products were being pushed with much vigor by the

manufacturers. We know of no evidence that calls for a revision of

the statements then made regarding them. The injection of phylacogens

is simply the administration of a mixture of the filtered products

of several bacterial species. The results which follow represent the

reaction of the bacterial protein--a reaction for good or evil. There

is no scientific evidence to show that they possess any specific

prophylactic virtue. To recommend their use in cases of influenza,

as a prophylactic against pneumonia, is unwarranted, and the

physician who acts on the advice of the manufacturer must assume the

responsibility for the results. In case of mishap he cannot fall back

on the manufacturer; he will find no scientific evidence to support

him.--(_From The Journal A. M. A., Nov. 15, 1919._)

PINEOLEUM ADVERTISING METHODS

Capitalizing the Name and Position of the President of the

American Medical Association

_To the Editor_:--Enclosed is a postal card which a physician in

Oklahoma has sent me together with thirty-six cents in stamps. The

envelop was addressed to me at the address of the Pineoleum Company.

The postoffice corrected the address and sent it to me. It is evident,

therefore, that the physician in Oklahoma thought I was sending these

postals as an employee of the Pineoleum Company, or, at least, was

endorsing their products.

[Illustration:

+---------------------------------------------------------------------+

| _TREATMENT OF INFLUENZA_ 408-10-12 West 13th Street |

| By A. LAMBERT, M. D., New York. Pres. A. M. A. New York City |

| |

| Dear Doctor: |

| |

| “The ‘Flu’ is coming back in October to scourge the whole world. |

| I expect the plague to come back as soon as people begin to live |

| indoors again. The death toll Will be serious, but I do not |

| expect it will be as bad as it was last winter.” |

| |

| --Dr. Royal S. Copeland, _Chief of the New York Health Department_. |

| |

| “The persistent spraying of the nose and pharynx with some form of |

| silver salt, or some form of mild disinfectant, materially aids in |

| confining the infection in its early stages to the upper passages, |

| and this procedure gives the impression, when tried in a large |

| number of patients, that it prevents in many cases the spread down- |

| ward into the bronchi and thus limits pulmonary complications.” |

| --Extract from “The Treatment of Influenza,” by A. Lambert, M.D., |

| in the Journal of the American Medical Association, August 2nd, |

| 1919. |

| |

| =We have letters from a large number of physicians confirming the |

| above extract, and with the further statement that as a _preventive_|

| and _relieving_ agent there is no combination before the profession |

| today so satisfactory as Pineoleum.= |

| |

| =If you have not received recently, a complimentary Outfit, return |

| this card with 36 cents in stamps and we will forward a regular |

| $1.00 package by prepaid Parcels Post.= |

| |

| _THE PINEOLEUM COMPANY_ |

+---------------------------------------------------------------------+

Postal card capitalizing the name and position of the President of

the American Medical Association.]

Kindly do me the favor to publish this letter in The Journal as a

protest against the dishonesty of this method of advertising. What is

quoted from an article that I wrote appeared originally in the _New

York State Journal of Medicine_ and was abstracted in The Journal

of the American Medical Association of August 2, 1919. The obvious

inference to be drawn from this postal is that I referred to the

products of the Pineoleum Company in that article. I did not have the

products of the Pineoleum Company in my mind. I never have used their

products and never prescribed them.

This form of advertising is done with intent to deceive and did deceive

the doctor in Oklahoma. It was therefore a successful falsehood, its

success depending on the false use of the name of the President of the

American Medical Association to bolster up the sale of the product.

I resent the use of my name in connection with the quack advertising

of nostrum venders. The low, vulpine cunning of the method used is

on the same level as the deceit and dishonesty which use this form

of advertising to the injury of my name and reputation. As President

of the American Medical Association I must insist that you protect

me by publishing this letter in The Journal, giving it as widespread

publicity as possible.

Alexander Lambert.

[Comment.--“Pineoleum” is a “patent medicine” advertised in the

cheapest and most effective way--by the aid of the easy going and

complacent physician. In 1906 Pineoleum was being marketed by the

Winslow Laboratory of New York City, which also put out three or four

other nostrums--“Morumalt,” “Egeriol,” “Digestylin,” and “Ford’s

Nucleo-Peptone.” Pineoleum was advertised to the public then as it is

advertised now, via the medical profession. Physicians are circularized

and are offered a petty graft in the form of a cheap nebulizer and a

sample bottle of Pineoleum. Some time ago the company seems to have

developed a scheme whereby physicians could make money “dispensing

Pineoleum nebulizer outfits at more than 140 per cent. profit.” The

Pineoleum concern for years has also polluted the stream at its source

by attempting to get the secretary of the senior class of every medical

school to distribute its free nebulizer outfits to members of the

class and receive therefor 5 cents for each outfit distributed! The

life history of Pineoleum is that of the typical nostrum. Epidemics,

of course, are utilized as opportunities for pushing the product. In

1911 a card was sent out featuring “A Special LaGrippe Offer”; in 1916

the profession was circularized recommending Pineoleum as “The Ideal

Prophylactic” in infantile paralysis; during the past year influenza

has again been the selling point.

The case described by Dr. Lambert is not the first example of the

misuse of names and statements of physicians. Last December the

Pineoleum concern was sending out an advertising card in which Dr.

McCoy of the United States Public Health Service was quoted as

recommending Pineoleum as the “bulwark of prevention” and “battery of

relief” in influenza. Of course, Dr. McCoy never said anything of the

sort. A protest against this particular falsehood resulted in another

card being sent out several months later by the Pineoleum people

purporting to explain and apologize for the misquotations and putting

the blame on the printer. The “apology” ended with a postscript (in

larger and bolder face type than the body of the card) that urged

physicians to “secure our liberal introductory advertising proposition

on improved oil nebulizer outfits.” From the standpoint of publicity

for Pineoleum, the “explanation and apology” was doubtless as good an

advertisement as the original card of misrepresentation.--Ed.]--(_From

The Journal A. M. A., Nov. 1, 1919._)

“PROTEAL THERAPY” AND HENRY SMITH WILLIAMS

_To the Editor_:--Will you please advise as to the success and

safeness in using the Proteal treatment for tuberculosis by Henry

Smith Williams, M.D., LL.D., 104 East 40th Street, New York?

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

_To the Editor_:--Kindly send me any available information on

“The Proteal Treatment for Cancer.” An article by Dr. Henry Smith

Williams, 120 West 32 Street, New York City, in April _Hearst’s_

has caused relatives to request its use in a case of carcinoma of

the liver under my care.

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

_To the Editor_:--I am enclosing a leaflet, mailed to me on

request, by Dr. Henry Smith Williams of New York City, who

published a series of articles during the last year in _Hearst’s

Magazine_ on “Proteal Therapy.” If you have investigated this man

and his proteal treatment, I should like to know the result of

your findings. I am a consumptive and am, therefore, particularly

interested in its alleged benefactions for the treatment of

tuberculosis.

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

_To the Editor_:--What information can you give me regarding Henry

Smith Williams, M.D., LL.D., 104 East Fortieth Street, New York,

and the therapeutic value of the “Proteal Therapy” that he has

originated?

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

The above letters are selected from many received on the subject.

Henry Smith Williams is better known in the journalistic world than

in the field of scientific medicine. He was graduated by the Chicago

Medical College in 1884. In the thirteen issues of medical directories

of the United States that have been published during the past thirty

years Dr. Williams’ name does not appear--except for the issues of

1890 and 1893--until the 1914 edition. So far as we have been able

to find, Dr. Williams had not until 1915 contributed any articles to

medical journals. The catalog of the Surgeon General’s Library contains

no reference to any articles of Dr. Williams except those that have

appeared in popular magazines. The volumes of the Index Medicus from

1907 until 1914, inclusive, also contain no references to any articles

by him in medical journals. The Journal‘s author index to current

medical literature from 1900 to 1914, inclusive, fails to record any

articles by Dr. Williams in medical journals. Dr. Williams’ articles,

however, in popular magazines have been voluminous and numerous.

Sometimes his articles have been under his own name and sometimes

under the nom de plume, “Stoddard Goodhue, M.D.” Under the latter name

the _Cosmopolitan_ published articles on “Adding Years to Your Life,”

“Battle of the Microbes,” “Do You Choose Your Children?” and “What is

the Matter With Your Brain?” Under his own name articles have appeared

in popular magazines on such subjects as “Burbank’s Way with Flowers,”

“Every Woman Her Own Burbank,” “Why Not Live Forever?” “Science of

Breeding Kings,” “New Cancer Treatment” and “New Hope for Rheumatism

Sufferers.” In addition, Dr. Williams has published books on such

subjects as “History of the Art of Writing,” “Historians’ History of

the World,” “Story of Nineteenth Century Science,” “Luther Burbank,”

“Twilight Sleep” and others. The Goodhue Company of New York City,

which publishes some of Dr. Williams’ books has, we understand, for

its president, Dr. Henry Smith Williams, for its vice president, Dr.

Williams’ wife, and for its secretary-treasurer, Dr. Williams’ daughter.

Readers of The Journal will remember the publicity given in 1915

and 1916 to an alleged treatment for cancer, sometimes called the

“Horowitz-Beebe Autolysin Treatment.” The method was heralded widely

both in a certain portion of the medical press and in popular magazines

and newspapers. A popular article by Henry Smith Williams on “The New

Cancer Treatment” appeared in the _Illustrated World_ for October,

1915, with pictures of Dr. Horowitz, Dr. Beebe, etc. A month or two

later, physicians received, gratis, from the Goodhue Company a neatly

bound little book on “Alcohol Hygiene and Legislation,” by E. H.

Williams, M.D. (brother of Henry Smith Williams). Enclosed with it

was a letter from the Goodhue Company asking physicians to accept the

book. The body of the letter was devoted to calling the attention of

physicians to an “important work” by Dr. Henry Smith Williams on “The

Autolysin Treatment of Cancer” that the Goodhue Company was publishing.

With the letter, there was a small advertising pamphlet “Issued by

the Autolysin Laboratory” and advertising that product. In addition,

the last thirteen pages of the book on “Alcohol Hygiene” contained

advertisements of the Goodhue Company’s publications with particular

emphasis (four pages of it) on the “Autolysin Treatment of Cancer,” by

Henry Smith Williams.

In May, 1917, physicians in the West received a letter from the

“Ellison-White Chautauqua System” informing them that Dr. Henry Smith

Williams was to lecture at “your Chautauqua” and reminding them that

“he has recently issued two volumes, ‘The Autolysin Treatment of

Cancer’ which he believes will be his greatest contribution to medical

science.” The present “Proteal” treatment appears to be a modification

of the “Autolysin” treatment. Dr. Williams, in attempting to justify

the use of his “Proteal” in tuberculosis, cancer, rheumatism, etc.,

takes advantage of certain investigations bearing on the nonspecific

reactions resulting from the parental injection of foreign proteins.

So far as we can discover, there is no scientific evidence to indicate

that the “Proteal” treatment expounded by Williams is of value in the

treatment of cancer, tuberculosis or the other numerous diseases for

which the “Proteals” are recommended.

It is a question whether such articles as those on “The Proteal

Treatment of Cancer,” “New Hope for Rheumatism Sufferers,” etc.,

published in popular magazines or newspapers serve any useful public

purpose. May they not, on the contrary, by raising false hopes, cause

much mental suffering and do scientific medicine great harm?--(_From

The Journal A. M. A., July 6, 1918._)

PROTEOGENS

Commercial Therapeutics[M]

[M] See index for additional articles on proteogens.

A report of the Council on Pharmacy and Chemistry that appears

elsewhere[253] in this book deals with another attempt to foist on

our profession a series of essentially secret preparations whose

therapeutic value has not been scientifically demonstrated. Grotesquely

extravagant claims are advanced as to the therapeutic potency and

range of action of substances of whose nature and effects we have

no trustworthy information. Physicians are advised to use--and many

undoubtedly are using--these alleged remedies in the treatment of

diseases in which delay in the proper kind of treatment may be of

the greatest danger to the patient. As stated, there is available

no reliable information regarding the effects of these substances

when they are introduced in the human body. They may have no effect

whatever, or they may produce more or less direct injury; in either

case, there is the chance that damage, even irreparable to the patient,

may result because rational treatment is withheld.

[253] Page 227.

If we accept the statement that the preparations are largely vegetable

proteins, it is a fair inference that, under certain conditions,

they may cause a febrile reaction of the same general nature as that

caused by other foreign proteins when injected into the body. We know

that such reactions are not without danger and that the treatment of

certain infections by induced reactions to foreign proteins is strictly

an experimental procedure to be undertaken only under very special

conditions. There is, therefore, no known valid reason why a physician

should assume the responsibility for using these alleged remedies in

the treatment of his patients; there is a very obvious reason why he

should not--the therapeutic instructions of “the House of Merrell,

always interested in the progress of plant therapy” to the contrary

notwithstanding. It is the old story of exploiting physicians through

commercial pseudoscience; of trading on the credulity of the profession

to the detriment of the public. As Osler[254] recently protested so

vigorously:

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

Some time ago a pamphlet came from X and Company, characterized by

brazen therapeutic impudence, and indicating a supreme indifference

to anything that could be called intelligence on the part of the

recipients. That these firms [manufacturing pharmacists] have the

audacity to issue such trash indicates the state of thraldom in

which they regard us. And I would protest against the usurpation

on the part of these men of our function as teachers. Why, for

example, should Y and Company write as if they were directors of

large genito-urinary clinics instead of manufacturing pharmacists?

It is none of their business what is the best treatment for

gonorrhea--by what possibility could they ever know it, and

why should their literature pretend to the combined wisdom of

Neisser and Guyon? What right have Z and Company to send on a

card directions for the treatment of anemia and dyspepsia, about

which subjects they know as much as an unborn babe, and, if they

stick to their legitimate business, about the same opportunity of

getting information? For years the profession has been exploited

in this way, until the evil has become unbearable, and we need as

active a crusade against the pseudoscience in the profession as

has been waged of late against the use of quack medicines by the

public. We have been altogether too submissive, and have gradually

allowed those who should be our willing helpers to dictate terms

and to play the rôle of masters. FAR TOO LARGE A SECTION OF THE

TREATMENT OF DISEASE IS TODAY CONTROLLED BY THE BIG MANUFACTURING

PHARMACISTS, WHO HAVE ENSLAVED US IN A PLAUSIBLE PSEUDOSCIENCE.

What shall the profession do to protect itself against this

humiliation--to throw off the credulity that extols pseudoscience and

makes commercialized empiricism financially profitable? Osler says

the remedy is obvious: “Give our students a firsthand acquaintance

with disease, and give them a thorough practical knowledge of the

great drugs, and we will send out independent, clear-headed, cautious

practitioners who will do their own thinking and be no longer at

the mercy of the meretricious literature, which has sapped our

independence.” Excellent! But must humanity wait a generation? Why not

stop this evil at once? The American Medical Association has provided

the means whereby this can be done, if physicians will only make use

of it--the Council on Pharmacy and Chemistry.--(_Editorial from The

Journal A. M. A., July 12, 1919._)

An Alleged Endorsement of Proteogens Repudiated

_To the Editor_:--I note in the issue of The Journal for July 12, a

statement regarding the so-called “Proteogens” manufactured by the Wm.

S. Merrell Company of Cincinnati.

My attention has been called to the fact that salesmen of this company

have been exhibiting a letter purporting to show that this department

has endorsed their products in the treatment of venereal diseases.

The letter in question was written by a physician employed in one of

the clinics conducted jointly by this department and the U. S. Public

Health Service, and the stationery of the department was used without

authority. The physician in question has made numerous efforts to

recall the letter, but the Merrell people profess an inability to

control its use.

I need not add that this department has not endorsed and will not

endorse these products, and has no evidence that they are of any value

whatsoever.

Allen W. Freeman, M.D., Commissioner of Health,

State of Ohio, State Department of Health.

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

The Manufacturer’s Protest and a Reply

_To the Editor_:--Allow us to direct your attention to several

misstatements which appear in the letter signed, “Allen W. Freeman,

M.D., Commissioner of Health, State of Ohio,” published in The Journal

of the American Medical Association for July 26.

1. Salesmen of this company have _not_ been exhibiting a “letter

purporting to show that this department has endorsed their products in

the treatment of venereal diseases,” as stated by Dr. Freeman.

2. The author of the letter has _not_ “made numerous efforts to recall

the letter, but the Merrell people profess an inability to control its

use,” as stated by Dr. Freeman.

A physician employed in one of the clinics used our Proteogens Nos. 10

and 11 extensively and is still using them to a large extent in his

private practice. He is a man of standing in the community in which

he practices and is also a professor in one of the leading medical

colleges in the state.

The letter in question cites the case of a man who had been under

treatment for three years with 606, 914 and most of the other

treatments in general use, and on August 31, a year ago, still gave

a Wassermann test plus 4. He was given Proteogen No. 10, and by

the middle of December the Wassermann was negative and the man was

discharged as cured.

While this letter was written on the stationery of the Bureau of

Venereal Diseases of the Department of Health, State of Ohio, it was

written in the first person, and made no pretension in any way to being

official nor was any such pretense made or authorized by the Merrell

Company.

The author of the letter has _not_ made “numerous efforts to recall the

letter,” nor has the Merrell Company “professed an inability to control

its use.”

The physician did ask that the letter be returned to him, and his

request was complied with promptly.

[Then follows the full text of the letter in question. As its contents

have no bearing on the question under discussion, it is omitted.--Ed.]

In over ninety-one years of honorable service as manufacturers of

medicinal preparations, the Wm. S. Merrell Company has never endeavored

to advance its interests through misrepresentation.

The Wm. S. Merrell Company,

Chas. G. Merrell, Pres.

[The letter above was submitted to Dr. Allen W. Freeman, Commissioner

of Health of the State of Ohio. Dr. Freeman’s comments appear

below.--Ed.]

_To the Editor_:--The plain issue of veracity raised in the

communication of the Merrell Company must be settled on the evidence,

which is unfortunately too voluminous to be published in full in The

Journal. Copies of the correspondence in the case have been furnished

the editor, and the originals are on file in the office of the state

department of health in Columbus.

1. Whether or not the photographic reproduction of a letter written on

the letter head of this department, and the distribution of copies to

salesmen for display to physicians, was a conscious effort on the part

of the firm in question to create the impression that the letter was

an official one is perhaps a matter of inference. That it did create

such an impression is evidenced by the letters of inquiry received from

physicians who saw it.

2. The statement that the Merrell Company refused to return the

_letter_ is perhaps erroneous. They did apparently return the original

letter but not the _photographic copies_ which had been distributed to

their salesmen. On May 22 the firm wrote as follows:

“A number of physicians who are in cooperation with both state

and national bureaus of venereal diseases have been using our

Proteogens with marked success and there are doubtless many letters

carried by our salesmen--reports from some of these physicians.”

This was interpreted to mean that the firm had no method of knowing

what letters were carried by their salesmen and was not responsible for

them. Whether or not this interpretation is correct is again, perhaps,

a matter of opinion.

The purpose of the original communication was to make plain to those

of the profession who have already seen or might subsequently see the

letter referred to that the communication was the expression of an

individual and not of the Department.

A. W. Freeman, Commissioner.

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

Details of the Alleged Endorsement of Proteogens

Our readers will remember the recent correspondence published in The

Journal of July 26 and September 6, by Dr. A. W. Freeman, Commissioner

of Health of the State of Ohio and the Wm. S. Merrell Co. The letters

dealt with the use that had been made by the Wm. S. Merrell Co. of a

letter, written on the official stationery of the Bureau of Venereal

Diseases of the State Department of Health of Ohio, puffing one of the

company’s proprietary remedies--Proteogen No. 10.

Dr. Freeman wrote to The Journal calling the attention of the

profession to the use of this letter and explaining that the letter

was merely the expression of opinion of an individual, and not an

expression from the State Department of Health. The Wm. S. Merrell Co.

took exception to certain inferences made in Dr. Freeman’s letter and

in the course of a letter to The Journal regarding this, incorporated

the contents of the testimonial letter. The Journal, in publishing

the Merrell letter, omitted this testimonial on the ground that

the _contents_ of the letter had no bearing on the question under

discussion.

We have now received a letter from the company protesting against this

omission. The Journal, therefore, takes this opportunity of briefly

restating such facts as it has been able to get regarding the entire

matter and publishing the letter. The facts are as follows:

1. In February of this year a Cincinnati physician, Dr. C. J. Broeman,

wrote to Dr. A. S. Horovitz relative to alleged results with Proteogen

No. 10. The letter was written--without authority--on the official

stationery of the Bureau of Venereal Diseases of the State Department

of Health of Ohio.

2. The Wm. S. Merrell Co. had linen mounted photographs made of Dr.

Broeman’s letter and distributed them to their Proteogen detail men.

Accompanying these photographic copies was a communication to these

detail men describing the photographed letter as one written by:

“... a Cincinnati physician who is now Acting Assistant Surgeon,

U. S. Public Health Service, cooperating with the Bureau of

Venereal Diseases of the Department of Health of the State of Ohio.”

3. The right hand top corner of the official stationery, as can be

seen by the reproduction, bore the name of “James D. Bauman, Deputy

Commissioner.” Dr. Broeman’s signature was rather illegible and could

easily be mistaken, by those not knowing the handwriting of either

man, for the signature of Deputy Commissioner Bauman. In at least one

instance it was so mistaken, and the physician who was misled wrote to

the Director of the Bureau asking whether the testimonial for Proteogen

No. 10 which had been shown him by the Merrell detail man was really an

official communication.

4. On May 15, 1919, Commissioner of Health Freeman wrote to the

Merrell Co. stating that he had been informed that one of the Merrell

representatives was using as an advertisement a letter bearing the

letterhead of the Bureau of Venereal Diseases of the State Department

of Health and what purported to be a report signed by “Mr. Bauman,

Deputy Commissioner.”

5. On May 19, the Wm. S. Merrell Co. wrote Dr. Freeman that he was

certainly mistaken in regard to the use of any “report signed by

Mr. Bauman.” Dr. Freeman then sent to the company the letter he had

received from the physician who had mistaken Broeman’s letter for an

official letter by Bauman. Although it would seem that this letter

and Commissioner Freeman’s protest should have made plain to the Wm.

S. Merrell Co., the fact that the letter, incorrectly referred to

as Mr. Bauman’s, was in reality Dr. Broeman’s, the company remained

silent regarding its use of the Broeman letter and, on May 22, merely

reiterated that there had been “no letter circulated by this company

containing a testimonial of your Mr. Bauman.” On May 28 (six days

later) the Merrell company sent to its Proteogen detail men another

general letter, “for personal use of agents,” in which it again called

their attention to the “photographic copy mounted on linen” of Dr.

Broeman’s letter. This communication to the detail men also declared

that it “has been suggested that the further use of Dr. Broeman’s

letter might antagonize the State Department of Health” and, therefore

the detail men were told to “discontinue using the photographic copy in

question” and to return the photographs to the head office.

[Illustration: Reproduction (reduced) of one of the photographic

copies sent out by the Wm. S. Merrell Co. to its Proteogen detail men

to be shown to physicians. While the letter is a private one, it was

written (without authority) on official stationery. Some physicians

were misled into thinking it was an official endorsement of Proteogens.

The Merrell concern denied any intention to mislead and claimed that

it was interested only in bringing to the attention of physicians the

_contents_ of the letter!]

Here, briefly are the bald facts in the case. The essential point at

issue is whether these photographic copies of Dr. Broeman’s letter

would or would not be likely--whether or not they were so intended--to

mislead physicians into believing that the endorsement was an official

one by the State Board of Health rather than an individual one. One can

but wonder why, if, as the Merrell company so vehemently asserts, there

was no intention of misleading physicians on this point, the company

should have gone to the trouble and expense of _photographing_ the

entire letter, including the letterhead, rather than making typewritten

or mimeographed copies of the _contents_ of the letter.--(_From The

Journal A. M. A., Sept. 27, 1919._)

Dr. Broeman’s Final Report on Proteogens

_To the Editor_:--In the September 27 issue of The Journal my name

was mentioned in connection with the Merrell Chemical Company’s

“Proteogens” in the treatment of syphilis. The Merrell Chemical Company

promised not to use my name at any time in connection with their

“Proteogens” injection and they know that the use of my name has been

distinctly against my wishes. I feel that in justice to myself, as well

as the public, I should report the result of my experiments with their

“Proteogens” in private practice.

In explanation I might say that I began the use of their “Proteogens”

in April, 1918, and I feel that I now have enough data to give a

complete report. I might say that all my results have been practically

nil; particularly is this true in my cases of syphilis, which all had

a four plus Wassermann reaction when I discontinued using this form of

treatment.

Very truly yours,

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

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

PULVANE

In a twelve-page pamphlet, sent out by the Pulvane Laboratories, Inc.,

of Des Moines, Iowa, and purporting to deal with “The Therapy of

Pulvane, an advanced method for the treatment of Respiratory Diseases,”

we are told that Pulvane “was developed in a United States Army General

Hospital by officers of the Medical Department.”

Pulvane “originally was intended only for its germicidal action

upon tubercle bacilli in the lung,” but it is now also recommended

for asthma, hay fever, bronchitis, rhinitis, laryngitis and “other

affections of the air passages.” Of the alleged action of Pulvane on

tuberculosis we read:

“It destroys the spores of the bacilli as well as the germs

themselves. It prevents infection of new areas by aspiration,

gravity or surface contact.

“In cases where sputum is positive it is a very noteworthy fact

that shortly after treatment is begun, the bacilli begin to

disappear, gradually diminish in number, and finally the sputum

becomes negative.”

Pulvane is administered, by inhalation, at the offices of the Pulvane

Laboratories, Inc. Its “discoverer” chanced on a method of “introducing

into solution and volatizing a certain germicide, extremely rare in

its usage because of its resistance heretofore to attempts to bend it

to scientific will.” This “rare” medicament is alpha naphthol! But

since the discovery of this volatizing method “three other ingredients

of high therapeutic value have been added.” What are these other

ingredients?

“They would be named were it not that Pulvane requires special

technique in its preparation and administration. Our medical

directors do not consider it advisable to identify them here

because of the possibility of incompetent hands attempting their

use. The medical directors, however, will be glad to name every

ingredient of Pulvane for any reputable member of the profession.

Pulvane Laboratories reserve only the method of compounding.”

Presumably, therefore, if physicians desire to know what Pulvane is,

the Pulvane Laboratories, Inc., “will be glad to name every ingredient

of Pulvane.” It is worth noting that nothing is said about quantities.

It is also worth remembering that “Peruna” and some other “patient

medicines” have for years printed on the label the _names_ of the

alleged ingredients. How much longer is the medical profession going to

be fooled with the trick of nostrum exploiters pretending a frankness

that means nothing?

From a recent issue of a Des Moines newspaper we learn that the Pulvane

Laboratories are about to establish a sanatorium where the Pulvane

treatment can be given. This announcement is said to be made by John P.

Mosher, the alleged discoverer of Pulvane. Mosher is not a physician.

The newspaper article states, further, that Mosher’s experiments were

tried out “under the observation of Major Sharpe,” commander at Fort

Des Moines. It appears also that an ex-newspaper reporter is connected

with the Pulvane Laboratories. The value of having a good publicity

man is obviously recognized. There also seems to be connected with the

concern a Dr. Harry P. Hall. We find in the records reference to one

Harry P. Hall who was graduated by the Medical Department of Drake

University of Des Moines, Iowa, in 1894, and was licensed in Iowa in

1896. Our records indicate that he has not been in practice for some

years. We also find in our files some newspaper clippings regarding a

Dr. Harry P. Hall who, in 1914, pleaded guilty to a charge of using the

mails to defraud and was fined in the federal courts. Whether there is

any connection between these two names, we do not know.

Reverting to the claims made by the Pulvane Laboratories that Pulvane

was “developed in a United States Army General Hospital by officers

of the Medical Department” the following statement has recently been

received by The Journal from Surgeon-General Ireland of the United

States Army:

“It has been brought to my attention that a concern in Des Moines,

Iowa, known as the Pulvane Laboratories, has issued a pamphlet in

which statements are made which would naturally lead medical men to

believe that the experiments, etc., referred to therein were made

with the approval of and more or less under the direction of the

Medical Department of the Army. I wish to say that this is not so;

that the Medical Department had nothing whatever to do with the

matter and that it thoroughly disapproves of the methods used by the

promoters of this concern.--(_From The Journal A. M. A., March 11,

1922._)

SAL HEPATICA

Sal Hepatica is a saline laxative sold by the Bristol-Myers Company of

New York. Little information is given, or, apparently, ever has been

given, concerning the composition of this product. Many years ago the

stock medical journal advertisement contained this statement:

“_Composition._--Sal Hepatica contains all of the Tonic, Alterative

and Laxative Salts of the celebrated ‘Bitter Waters’ of Europe,

especially those of Bohemia, as determined by actual chemical

analysis of these waters, and fortified by the addition of Lithium

and Sodium Phosphates.”[255]

[255] Some of the Sal Hepatica advertising has claimed that it “is a

saline combination with the addition of Sodium Phosphate and _Lithia

Citrate_!”

Sal Hepatica no longer “contains all the tonic, alterative and laxative

salts ...,” etc., for the label on a package recently purchased reads:

“SAL HEPATICA is an effervescent saline combination possessing

medicinal properties similar to the natural ‘Bitter Waters’ of

Europe, and fortified by the addition of Sodium Phosphate.”

In 1909, the _Druggists Circular_ published an analysis of Sal Hepatica

which showed that the preparation contained only 0.04 per cent. of

lithium phosphate. By referring to the two quotations just given

it will be noticed that today the manufacturers make no claim that

their preparation is fortified with any salt of lithium. A circular

accompanying recent trade packages states:

“Sal Hepatica is composed solely of harmless salts, being

absolutely free from Acetanilid, Phenacetin, Caffein, Calomel,

opium or coal tar derivatives.”

Since neither the names nor the amounts of the “harmless salts” are

mentioned, the composition of Sal Hepatica is secret. It is a trick

of the nostrum exploiter, old but ever popular, to mention numerous

drugs which his preparation does _not_ contain; it helps to distract

attention from the fact that he does not tell what the preparation

_does_ contain!

In the old-time medical journal advertisements, one reads, “Sal

Hepatica is the most powerful solvent of Uric Acid known.” (The same

advertisement as it appeared in those days in The Journal shows

that claim toned down to, “Sal Hepatica is a powerful solvent of

Uric Acid.”) In those easy going days, the Bristol-Myers Company

declared that “diabetes is treated with decided advantage by means

of Sal Hepatica ... it ... possesses the property of arresting the

secretion of sugar in the liver.” In the old days, too, Sal Hepatica

was recommended in the treatment of cirrhosis of the liver, Bright’s

disease, gravel, phthisis, etc.

The present advertising circular recommends Sal Hepatica as an

eliminant, laxative or cathartic in gout, autointoxication, “Bilious

Attacks,” rheumatism, acute indigestion, catarrhal conditions of

the stomach, pyorrhea, headache, dizziness, heart burn, “Summer

Complaints,” “Derangements of the Stomach and Liver,” skin diseases,

colic, alcoholic excesses, and as a “preventive of Seasickness.”

In 1914 the Council on Pharmacy and Chemistry published[256] a report

on Sal Hepatica declaring it secret in composition and sold under

exaggerated and unwarranted claims.

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

In view of the inquiries which The Journal continues to receive it

seemed worth while to make a chemical examination of the present-day

product. Accordingly specimens were purchased and analyzed in the

A. M. A. Chemical Laboratory. The report that follows was submitted by

the chemists:

“Sal Hepatica is a white, granular, odorless powder. It effervesces on

the addition of water in which it eventually dissolves. The aqueous

solution, after boiling to remove carbon dioxid, has an acid reaction

to litmus.

“Since a great many medicinal substances are sold in effervescent form,

and since practically no information is given by the manufacturer

concerning the composition of Sal Hepatica, it became necessary to

test for a considerable number of therapeutic agents. The absence of

acetanilid, acetphenetidin, alkaloids, ammonium salts, benzoates,

caffein, citrates, heavy metals, hexamethylenamin, magnesium,

potassium, salicylates and sugars was demonstrated by appropriate

tests. The presence of a carbonate (probably in the form of a

bicarbonate), a phosphate, a sulphate, a chlorid, tartaric acid, sodium

and traces of lithium was shown by qualitative tests.

“Quantitative analysis indicated that the composition of the specimens

examined was essentially as follows:

Sodium phosphate, anhydrous 4.4 per cent.

Sodium sulphate, anhydrous 26.5 per cent.

Sodium tartrate, anhydrous 12.7 per cent.

Sodium bicarbonate 19.5 per cent.

Tartaric Acid, free 20.8 per cent.

Sodium chlorid 8.9 per cent.

Lithium phosphate trace

Water of hydration (by difference) 7.2 per cent.

“From the results of the analysis, it appears probable that the

composition of the mixture before ‘granulation’ was approximately as

follows:

Sodium phosphate 4 per cent.

Sodium sulphate 25 per cent.

Sodium bicarbonate 30 per cent.

Tartaric Acid 30 per cent.

Sodium chlorid 8 per cent.

Lithium phosphate trace

Water of hydration (by difference) 3 per cent.

“Sal Hepatica, therefore, is essentially an effervescing mixture of

dried sodium sulphate (Glauber’s salt) and sodium tartrate with a

little dried sodium phosphate and table salt added. It is similar to

the effervescent artificial Carlsbad Salt described in the National

Formulary.

“In 1909 the _Druggists Circular_ published the following analysis of

Sal Hepatica:

Sodium phosphate 29.80 parts

Sodium sulphate (Glauber’s salt) 26.27 parts

Sodium bicarbonate (baking soda) 18.00 parts

Sodium chlorid (salt) 13.05 parts

Lithium phosphate 0.04 parts

Citric and tartaric acids (to make 100) 12.84 parts

“A comparison of the recent analysis with the earlier one would seem to

indicate that considerable changes have been made in the formula since

the first examination. The proportions of sodium phosphate have been

greatly reduced, while the sodium bicarbonate and tartaric acid have

been increased and the citric acid entirely eliminated.”

Sal Hepatica, then, is a simple effervescent saline laxative,

essentially secret in composition and sold under claims that would be

laughed at were the full formula of the product a matter of public

knowledge.--(_From The Journal A. M. A., Oct. 29, 1921._)

SALICON

“Salicon” is marketed by the K. A. Hughes Company, Boston, as “an

improved aspirin.” In a circular sent out to the public a little over a

year ago the following claims were made for it:

“We rendered aspirin absolutely harmless and yet retained all its

virtues as a medicine.”

“It positively will not depress the heart nor upset the stomach no

matter how large amounts of it are taken.”

“... the Massachusetts state medical authorities ... adopted its

use at all the state camps for fighting the Spanish influenza....”

The first two statements quoted above are obviously false. The third

statement might have been true although it seemed unlikely. A letter

was, therefore, written to the Department of Public Health of the

Commonwealth of Massachusetts and the claim of the K. A. Hughes Company

relative to the adoption of Salicon in all the state camps by the

“state medical authorities” was brought to their attention. The reply

of the department on this point was emphatic:

“The State Department of Health of Massachusetts did not endorse the

use of Salicon for any purpose.”

Some Salicon was purchased on the open market and submitted to the

A. M. A. Chemical Laboratory for analysis. Here is the chemists’ report.

“One original bottle of ‘Salicon’ (K. A. Hughes Company, Boston)

was submitted by the Propaganda department of The Journal to the

Association’s Chemical Laboratory for examination. The bottle contained

100 white tablets having an average weight of 0.407 gram (6.3 grains),

each. The amount of ash was 20.9 per cent. Qualitative tests indicated

the presence of magnesium, carbonate, starch, acetylsalicylic acid and

a trace of calcium; a very small amount of a petrolatum-like substance

was present. Alkaloids and drugs used for a laxative effect were not

found. The amount of acetylsalicylic acid extracted by chloroform was

50.7 per cent. The amount of magnesium present as magnesium oxid was

14.3 per cent. The amount of magnesium oxid derived from magnesium

carbonate U. S. P. is variable; but calculating on the lowest limit,

14.3 per cent. of magnesium oxid is equivalent to at least 35.5 per

cent. of magnesium carbonate. This figure agreed closely with that

obtained from the U. S. P., method of assay. The acetylsalicylic acid

was not combined with the magnesium. From the above, it may be stated

that each tablet consisted essentially of a mixture of 3.2 grains of

acetylsalicylic acid (aspirin), 2.2 grains of magnesium carbonate and

some starch. Although labeled 5 grains, each tablet did not contain 5

grains of the most active ingredient, acetylsalicylic acid.”

The same old story. An ordinary mixture of well known drugs put on the

market as a new discovery and foisted on the public under false and

misleading claims.--(_Correspondence in The Journal A. M. A., Feb. 5,

1921._)

SO-CALLED SECRETIN PREPARATIONS

In China the administration of powdered tiger-bone is--or was--a

favorite form of treatment in cases of supposed cardiac weakness. The

theory is, presumably, that the cardiac strength of the tiger would

be a good thing for the patient to acquire. Since many patients have

recovered after taking tiger-bone, and no one has proved that they

might not have died had they failed to take it, “clinical experience”

stands back of the treatment; and where is the skeptic so rash as

to challenge that? The Chinese physician believes in his tiger-bone

therapy, and, with the best interests of his patient at heart, insists

on obtaining absolutely true and authentic tiger-bone. Not satisfied

with the assertions of the dealers, the conscientious Chinese physician

subjects his tiger-bone to a kind of physiologic standardization. He

offers the bone in question to a dog! If it is an ox-bone--a frequent

form of substitution--the dog will seize and eagerly gnaw it, whereas,

according to all the teachings of Chinese pharmacognosy, if it is a

tiger-bone the dog will depart hurriedly with his tail between his

legs. Very foolish? Yes! But before we smile superciliously at the

Chinese medical man, let us turn to the report of the Council on

Pharmacy and Chemistry on “So-Called Secretin Preparations.”[257] After

reading this report let us put to ourselves, squarely and honestly,

the question: Has the attitude toward secretin therapy, of a certain

portion of those who represent Western modern medicine, really been

much more scientific than that of the Chinese medical profession toward

tiger-bone therapy? On the basis of a hypothesis scarcely less crude

and unsubstantiated than that which assumes that tiger-bone is of

value in heart disease, it has been assumed that secretin is of value

in gastro-intestinal diseases. On the ground of “clinical evidence”

scarcely more critical than that exhibited by our confrères in the

antipodes, it has been asserted that alleged secretin preparations

actually are efficious. Indeed, in one respect the methods of the

Chinese physician appear more scientific than those of his Western

brethren. To the best of his ability, the Oriental at least makes sure

that he is administering genuine tiger-bone; he does not rely on the

unverified word of his dealer alone. The American physician has not

been making the least effort to ascertain whether his supposed secretin

preparations are truly such; and, as a matter of fact, scientific

investigation seems to indicate that some of these products contained

no secretin at all! Whatever one may think of the validity of his test,

the Chinese physician does his best according to his lights. As to

“clinical experience,” Dr. Jacobi has well said that some people make

the same mistake a hundred times and call it “experience.”--(_Editorial

from The Journal A. M. A., Jan. 15, 1916._)

[257] Page 64.

SUCCUS CINERARIA MARITIMA

Another Illustration of One of the Weaknesses of the Federal

Food and Drugs Act

The Walker Pharmacal Company of St. Louis was, we understand, if it is

not still, one of the subsidiary concerns of the Luyties Homeopathic

Pharmacy Company. It has for years sold a nostrum, “Succus Cineraria

Maritima,” under the claim that by simply dropping this stuff into

the eye, twice daily, cataract and other opacities of the eye will be

cured. For instance:

“... the only remedy for the relief of cataract and other opacities

of vision, which stands before the medical fraternity on a firm

foundation of accomplished results....”

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

vision.”

“In this class of cases [cataract] physicians can place reliance

on Succus Cineraria Maritima (Walker) which does not require the

services of a specialist but is simply dropped into the eye with an

ordinary medicine dropper twice daily....”

“... has been used with success in cataract, both lenticular and

capsular, pterygium and opacities of the cornea, softening the

opaque deposits, causing dissolution, and by its stimulating

properties, hastening absorption.”

Succus Cineraria Maritima is advertised to the medical profession in

true “patent medicine” style by means of testimonials from doctors,

obscure and deceased. The preparation is valueless for the purposes for

which it is sold and “has about as much effect on the dissolution or

dispersal of opacities due to organic changes in the lens as pouring

the same down the back of the patient’s neck!” More than five years ago

the Council on Pharmacy and Chemistry reported on the worthlessness

of the drug, Cineraria maritima, and, at the same time, The Journal

pointed out that the drug would have been forgotten long ago had it

not been for the prodigal use of printers’ ink by the Walker Pharmacal

Company in advertising its Succus Cineraria Maritima.

These facts are given for the purpose of refreshing the memory of our

readers and are but incidental to the object of this article. In due

time the federal authorities proceeded against the Walker Pharmacal

Company charging that Succus Cineraria Maritima was misbranded under

the federal Food and Drugs Act. The government chemists reported that

analysis “showed that the product was essentially an aqueous solution

of glycerin, boric acid and vegetable drug extractives carrying

tannin-like bodies.” The direct and inferential claims made in the

advertising matter accompanying the trade package were quoted by the

federal authorities, who pointed out that the Walker Pharmacal Company

was selling the nostrum under claims that would create in the minds of

the purchasers the belief that Succus Cineraria Maritima was a remedy

for cataract and other opacities of the eye causing impaired vision and

that it was a cure for senile cataract, trachoma, secondary opacities,

etc. These claims the government charged were “false and fraudulent in

that the same were applied to the article knowingly, and in reckless

and wanton disregard of their truth or falsity,” because “in truth

and in fact it was not, in whole or in part, composed of, and did not

contain, such ingredients and medicinal agents” as would produce the

therapeutic effects claimed.

[Illustration: Facsimile of a letter, dated October, 1916, suggesting

the use of “Succus Cineraria Maritima” as a cure for cataract and

other opacities of vision. Eight months previously (February, 1916),

the Walker Pharmacal Company had pleaded guilty to the charge that the

claims that “Succus Cineraria Maritima” was a cure for cataract and

other eye opacities were false and fraudulent and applied knowingly and

in reckless and wanton disregard of their truth or falsity. The federal

Food and Drugs Act does not apply to claims made in circular letters or

elsewhere than in the trade package.]

These charges put the matter flatly up to the Walker Pharmacal Company.

This company has for years been telling physicians that their stuff

_could_ and _would_ do just what the federal authorities insisted it

can _not_ and will _not_ do. Did the Walker Pharmacal Company attempt

to defend its claims? Did it demonstrate that Succus Cineraria Maritima

would cure cataract? Did it produce evidence of the numerous cases of

recovery from blindness or partial blindness which must have been

available if the preparation had the powers claimed for it? No! The

Walker Pharmacal Company in February, 1916, pleaded guilty--and was

fined a paltry $10 and costs.

This, however, is not the end of the story. The company was prosecuted

because it had published the false and fraudulent claims in the trade

package, thus bringing the claims within the purview of the federal

Food and Drugs Act. Had the Walker Pharmacal Company confined its false

statements to medical journal advertisements, to the circular letters

sent to physicians or to any other advertising matter not part of the

trade package, it could have snapped its fingers at the Food and Drugs

Act.

It was in February, 1916, that the Walker Pharmacal Company pleaded

guilty to the charge of making false and fraudulent claims for Succus

Cineraria Maritima. In October, 1916, they were still sending out

circular letters to physicians urging the use of Succus Cineraria

Maritima in the treatment of cataract and enclosing the usual booklet

of testimonials claiming cures for cataract and other opacities of the

lens and cornea!

[Illustration: Facsimile of some of the pages from the booklet that

accompanied the letter reproduced herewith. The obvious intent of

this booklet was to lead physicians to believe that Succus Cineraria

Maritima will cure “Opacity of the Cornea,” “Opacity of the Lens,”

“Senile Cataract,” “Incipient Cataract,” “Double Cataract,” etc.]

Can one conceive a better illustration of the inadequacy of the Food

and Drugs Act? The dishonest exploiter of proprietary medicines cares

little that the law requires him to keep within certain bounds of

truthfulness in the advertising that accompanies the trade package.

It isn’t the claims in the trade packages that sell the product; it’s

the advertising in medical journals, in circular letters, etc. Yet,

the Food and Drugs Act offers no check or curb on false statements or

fraudulent claims made for proprietary or “patent medicines” in any

other place than the trade packages.

A few weeks ago The Journal called attention to a flagrant case of

fraud; and at that time it said, “It is justifiable to assume that

when any man, whatever his business, admits in court that he has made

fraudulent claims and then continues to make the same claims through

channels that are not controlled by penal enactment, that man’s

standard of business ethics is such that the public needs protection

against it. There are many such men in the ‘patent medicine’ world. The

only way in which the public may properly be protected against being

defrauded in such cases is for the federal Food and Drugs Act to have

its scope extended to cover _all_ advertising of the products coming

under the purview of the act.”--(_From The Journal A. M. A., March 17,

1917._)

TEKARKIN

Edward Percy Robinson’s “Cure” for Cancer

From various parts of the country The Journal has received a sixteen

page pamphlet, _Therapeutic Leaves_. The publication, which has

a saffron colored cover, is said to be published by the National

Bio-Chemical Laboratory, Mount Vernon, N. Y. The National Bio-Chemical

Laboratory seems to be a style used by Dr. Edward Percy Robinson. The

“editorial offices” of _Therapeutic Leaves_ are given as “501 Knox

Bldg., 5th Ave. at 40th St., New York,” which is a roundabout way of

describing 452 Fifth Ave., the office address of Edward Percy Robinson.

The first number (February, 1921) of _Therapeutic Leaves_ gives the

names of the “editors” as “E. P. Robinson, M.D., and W. A. Jenner,

B.A.” In addition, there is “Assistant Editor, F. J. Geiger,” and

“Gen’l Manager, Beverly K. Robinson.” The first and second numbers

of _Therapeutic Leaves_ (February and March, 1921) are practically

identical, being evidently printed from the same plates. _Therapeutic

Leaves_ purports to be a periodical published as “a medium for the

dissemination of knowledge, pertaining to therapeusis.” Actually, it

is an advertising medium dealing with the products of the National

Bio-Chemical Laboratory: “Osmo-Calcic Solution,” “Tekarkin” and

“Osmotic Mangano-Potassic Solution.”

These preparations are said to be the “formulas” of Dr. Edward Percy

Robinson who lives in Mt. Vernon, N. Y., and has an office at 452 Fifth

Ave., New York City. They are used by Dr. Robinson in the treatment

of cancer. At an earlier stage they seem to have been known under

different names: “Tekarkin” was first “Hypotonic Sal-Cella” and then

“Neoanabolin-X;” “Osmo-Calcic Solution” was “Osmotonic Calcic” while

“Osmotic Mangano-Potassic Solution” was “Osmotonic Drops.” The three

solutions are put up in one package containing 4 c.c. (about 65 minims)

of “Tekarkin” and 1 ounce each of the other preparations. The package

sells for $10.00. “Remittance with order ... We have no agents.”

[Illustration]

Most of the material in _Therapeutic Leaves_ is a rehash of four

papers published by Edward Percy Robinson in the New York _Medical

Record_ of various dates between September, 1917, and July, 1920. In

these Robinson advances the theory that cancer is caused by an excess

of sodium chlorid (table salt) in the blood and tissues and that it

can be cured by administering a solution of potassium nitrate. Such a

treatment sounds ideally simple. One might assume that all that was

necessary was to make up a solution of potassium nitrate and inject it.

One might further wonder how it would be possible to commercialize such

a “treatment.” “Homemade solutions,” says Dr. Robinson, “are apt to be

disappointing.” Their use is likely to cause “considerable swelling at

the site of an injection, accompanied with tenderness and some heat.”

Moreover, “a wide hyperemic area with red blotches has been observed

in a number of instances.” In order to avoid “accidents of this sort”

which would “bring discredit upon an excellent agent,” Dr. Robinson,

“after considerable experimental work” has obtained “a solution of this

chemical which would meet the ideal requirements.” This is available

under the name “Tekarkin.” Dilute potassium nitrate solution sold under

the name “Tekarkin” sells for $67 an ounce. The physician can make his

own solution, of the purest and highest grade potassium nitrate on the

market, at an expense, for the chemical, not exceeding 5 cents an ounce.

_Therapeutic Leaves_ also contains the usual number of those “clinical

reports” which bulk so large in the literature of “cures” for cancer.

Then there is a full page advertisement of a side-line of the National

Bio-Chemical Laboratory: “Vitamines (Compressed) Tekarkin Brand;” “They

have a meaty taste.”

The medical profession, naturally, is interested in knowing more about

the physician who admits that he has discovered the cause and cure of

cancer. According to our records, Edward Percy Robinson was born in

1871 and was graduated in 1897 by Bellevue Hospital Medical College. He

was licensed in New York State the same year and has practiced in New

York City continuously since that time. He is not, and apparently never

has been, a member of his local medical society.

In 1914 Robinson was specializing in “facial contouring.” One piece of

advertising purports to be the reprint of an interview with “Dr. E. P.

Robinson, Specialist, as he sat in his office at 116 West 39th Street,

having questions fired at him by the reporter.” Thus Dr. Robinson:

“There are physicians everywhere who abandon the general, or

family, practice of medicine, to devote their life to some

specialty. My specialty is the improvement of the facial features

and the beautifying of the shoulders, neck and arms. I round

out hollow cheeks, build up the neck, eradicate wrinkles, make

irregular noses perfect and remove defects by a process which

is my own secret. I claim no superhuman power or ability; I have

simply bent my whole professional study and energy to the one line

of remodeling--so to speak--the human features, and I employ only

scientific methods and aids in my operations.”

In another piece of advertising, a little booklet bearing Edward Percy

Robinson’s name, we find the following:

“This is what I accomplish....

“Remove all wrinkles and traces of age from the forehead, or about

the eyes and mouth. Lift sag from cheeks and chin.

“Round out hollow cheeks.

“Remove depressions and defects from the chin.

“Build up the neck and shoulders.

“Build up and enlarge the bust.

“Round out and give symmetry to unshapely arms and remove the lines

of age from the hands.

“Correct many of the defects not mentioned here, but which may be

possessed by exceptional cases.”

[Illustration: Reproduction (reduced) of some advertising matter

issued in 1914 when Edward Percy Robinson was specializing in “facial

contouring.”]

Still another advertising leaflet purports to be a reprint of an

“editorial” from the _Mercantile and Financial Times_ of March

11, 1914. It is a pretentious puff of Robinson, telling about his

“scientific attainments” and his marvelous secret preparations used

in “Youthifying the Face.” The _Mercantile and Financial Times_ is

an utterly discredited sheet run for the purpose of selling what

appear to be editorial comments. Such “editorial” puffs are paid for

through the purchase of a certain number of copies of the paper by

the party who desires the publicity. The Associated Advertising Clubs

of the World exposed this publication in a special bulletin issued

in June, 1919, and described it as an “example of publications that

serve as convenient tools of fake promoters.” In 1911 the _Mercantile

and Financial Times_ published an “editorial” endorsement of the

consumption cure “Nature’s Creation.” It has done the same for a fakish

device known as the “Ideal Sight Restorer.” It published a puff on the

“Oxypathor,” a swindle so preposterous that the exploitation of this

“gaspipe” fake was debarred from the U. S. mails and its exploiter was

sent to the federal penitentiary.

[Illustration:

+ - - - - - - - - - - - - - - - - - - - +

| The Jean Downs Co., |

| New York |

| |

| My dear Mrs. Downs, |

| |

| The package of your “Get Slim” remedy for obesity has |

| been given to a patient of mine with beneficial results. |

| |

| In observing the action of the remedy I noted no laxative |

| effect on the bowels, or any disturbance of the stomach. |

| |

| In fact there were no physical sensations that any |

| remedy had been taken, and there was a very satisfactory |

| reduction in weight. |

| |

| “Get Slim” remedy, being a purely vegetable combination |

| is not fraught with any risk to the individual’s health, |

| and may be safely given. |

| |

| I would not hesitate to prescribe it for a child |

| suffering from obesity. |

| |

| This statement is based on the fact that I am acquainted |

| with the ingredients entering into its manufacture. |

| |

| I would add that this remedy for obesity might be intro- |

| duced to the regular physicians with some advantage to |

| you. |

| |

| Yours truly, |

| E P ROBINSON M D |

| 1402 Broadway |

+-----------------------------------------------------------+

Reproduction (reduced) of a testimonial for an obesity

cure fake, “Get Slim.” The A. M. A. chemists reported that this

“vegetable combination” consisted of baking soda and pink-tinted

tartaric acid and sugar.]

We also find in our files a testimonial signed E. P. Robinson, M.D.,

1402 Broadway (Edward Percy Robinson’s address in 1912), extolling

the virtues of a foolish piece of quackery, the obesity cure “Get

Slim.” This nostrum was exposed in The Journal some years ago and

was also exposed by Dr. Wiley in _Good Housekeeping_. The “Get Slim”

concern sued _Good Housekeeping_ for libel but a jury decided that

_Good Housekeeping_ had told the truth. In the “Get Slim” testimonial

Robinson is quoted as saying that he is “acquainted with the

ingredients entering into its manufacture” and he describes it, as did

the “Get Slim” concern, as “a purely vegetable combination.” The fact

is the Association’s chemists found this “purely vegetable combination”

to consist of sugar and tartaric acid, each colored pink, and baking

soda.

And this is the gentleman who claims to have discovered the cause of,

and offers for sale a cure for, one of the most baffling scourges known

to modern medicine--cancer. Except for the articles that have been

published during the past three years in the _Medical Record_, we are

unable to find anywhere in representative medical literature anything

to indicate that Edward Percy Robinson can lay any claim to special

knowledge of, or skill in the treatment of, cancer. What we do find are

advertisements describing Edward Percy Robinson’s alleged abilities

as a “face beautifier,” puffs from utterly uncritical or discredited

sources and a testimonial to the value of a preposterous “fat cure”

fake.

With the best brains of the world at work on the problem of cancer, it

is reasonable to assume that any man who has found out even a little

more than has previously been discovered or is able to accomplish

even a little better results than the average in the treatment of this

dreaded disease, would be well known to scientific medicine.

* * * * *

After this article was in type physicians began sending in No. 3

(April, 1921) of _Therapeutic Leaves_. This is still another reprint

of Nos. 1 and 2, with minor changes. In the first two, Tekarkin is

described as “a solution of potassium nitrate of special strength;” in

No. 3 it becomes “a special solution containing potassium nitrate.”

In Nos. 1 and 2, Robinson described an alleged case of “Cancer of the

Rectum _Treated_ with Tekarkin.” In No. 3 this becomes “Medicinal

Treatment _Cures_ Cancer of the Rectum.” In No. 3 the names of the

editors, assistant editor and general manager are eliminated.

[Illustration]

The inside back cover of No. 3 contains an advertisement of Tekarkin,

in which physicians are warned that “Cancer of the Lung May Present

Diagnostic Signs of Tuberculosis.” It contains the further startling

information that the particular micro-organism responsible for

pulmonary tuberculosis is the Klebs-Loeffler bacillus! Thus:

“The Klebs-Loeffler bacillus may find a suitable habitat in a

malignant area of lung tissue and thrive therein. The presence of

the bacillus does not necessarily exclude the presence of cancer.

A chronic cough with blood-streaked sputum may be the result of

tuberculosis and cancer.”--(_From The Journal A. M. A., May 28,

1921._)

TYREE’S ANTISEPTIC POWDER AGAIN

The “Ethical and Commercial Requirements” of the Drug Business

“I am fond of the retail drug business and follow it every day of

my life. I know and observe to the fullest extent its ethical and

commercial requirements.” This from a circular letter recently received

by physicians, and signed J. S. Tyree, who asks that he be forgiven for

writing you personally, but there are several reasons why he thinks

the circumstances warrant it. All of which is preliminary to calling

attention to an enclosure, which accompanies the circular letter, and

is described as a “short memorandum” submitted for “your consideration.”

The “memorandum” is a four-page leaflet of which three pages are

devoted to “Tyree’s Antiseptic Powder.” One of these three pages

is a reproduction of a letter on the stationery of the Surgeon

General’s Office of the War Department, and signed “W. M. Gray,

M.D., Microscopist, Army Medical Museum; Pathologist to Providence

Hospital.” The letter describes a series of “bacteriological and

comparative tests” made by Dr. Gray with Tyree’s Antiseptic Powder.

The entire second page of the circular is given over to the results of

these bacteriologic tests which compare various strengths of Tyree’s

Antiseptic Powder with “mercuric bichlorid,” phenol and formaldehyde.

The physicians who received this advertising material in April, 1919,

might easily overlook the fact that Dr. Gray has been dead several

years, that the letter which is reproduced is dated Jan. 3, 1890, and

that the bacteriologic tests were made in 1889--thirty years ago!

The Council on Pharmacy and Chemistry in 1906[258] published the

results of an analysis of Tyree’s Antiseptic Powder which showed that

although the stuff was advertised as a mixture of borax and alum, it

was in fact essentially a mixture of zinc sulphate and boric acid. The

publication of the Council’s report in 1906, showing the falsity of the

formula, brought out the admission that the composition had recently

been changed. Certain it is, however, that for at least a decade past,

the Tyree product has been a zinc sulphate-boric acid preparation.

Yet, according to the manufacturer’s own statement, Tyree’s Antiseptic

Powder in 1889, when Dr. Gray made his bacteriologic tests, was an

entirely different substance from the present mixture.

[258] At this time Tyree’s Antiseptic Powder was an “ethical

proprietary”--heaven save the mark!--and advertised only to physicians.

Later, as _The Journal_ has shown, it entered the “patent medicine”

field as “ideal for douche” and the “best preventative known.” The

articles on this nostrum are reprinted in the ninth edition of “The

Propaganda for Reform.”

Here then we have a manufacturer publishing in 1919, in behalf of

a certain product, tests that were made in 1889 with a product of

different composition, although of the same name! Is this observing “to

the fullest extent” the “ethical and commercial requirements” of the

“retail drug business”?

There is no scientific excuse for such a mixture as Tyree’s Antiseptic

Powder. If, however, physicians feel that they must use an irrational

conglomeration such as this, why not prescribe Pulvis Antisepticus,

N. F.? Like the Tyree product, this, too, is essentially a mixture

of zinc sulphate and boric acid, with minute amounts of phenol,

eucalyptol, menthol and thymol, to say nothing of a dash of salicylic

acid. This official article has at least the virtue of constancy of

strength, composition and purity assured under the federal Food and

Drugs Act.--(_From The Journal A. M. A., May 17, 1919._)

WHEELER’S TISSUE PHOSPHATES

“The Commissioner of Health directs me to call to your attention

the enclosed advertisement issued by T. B. Wheeler, M.D., Company,

Montreal, Canada, in which the name of the Association’s _Journal_

is being used.”

Accompanying this brief note to The Journal from the secretary of Dr.

Haven Emerson, Commissioner of the Department of Health of the City

of New York, was a four page leaflet devoted to the exploitation of

“Wheeler’s Tissue Phosphates.” The trend of the circular is to lead

the average reader to infer that The Journal of the American Medical

Association has endorsed Wheeler’s Tissue Phosphates. For example, in

describing the preparation one reads:

“It embodies ... the best recent scientific opinion concerning

the treatment of the disease (tuberculosis) as stated ... by the

official Journal A. M. A.”

Elsewhere in the circular The Journal’s criticisms of the

hypophosphites and the glycerophosphates (proprietary preparations

which are competitors of the Wheeler product) are quoted and twisted

into a tribute to the ingredients of Wheeler’s Tissue Phosphates.

Garbling quotations, distorting statements, separating phrases from

their contexts and omitting qualifying clauses, all for the purpose

of making out a case for some proprietary remedy is a trick as old as

quackery itself. That it should be used in advertising Wheeler’s Tissue

Phosphates is entirely fitting. Obviously, the T. B. Wheeler, M.D.,

Company esteems the opinion of The Journal on pharmacologic matters.

This being the case, it should, in the interest of truth and scientific

accuracy, publish in its advertising circulars just what The Journal

has said about Wheeler’s Tissue Phosphates. It could not do this better

than by quoting from a recent editorial note which commented on a

report of the Chemical Laboratory on this preparation. Here is part of

the The Journal’s comment:

“‘Wheeler’s Tissue Phosphates’ is an unscientific shotgun mixture

whose most active and powerful drug is the alcohol it contains.

That it was not years ago relegated to the realms of obsolete

and discarded preparations is a commentary alike on the lack of

scientific discrimination and on the power of advertising.”

Here we have “Wheeler’s Tissue Phosphates” stripped of the verbal

camouflage with which its exploiters have invested it.--(_Editorial

from The Journal A. M. A., Sept. 22, 1917._)

BRIEFER PARAGRAPHS

Alcresta Lotion

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

L. T. A. Hotten, M.D., Paris, Idaho.

According to a circular in our files, “Alcresta Dental Lotion-Libby”

contains “Emetin, the active amebicidal principle of Ipecac, together

with Benzoic Acid, Thymol, Eucalyptol and Aromatics.” The theory

that emetin is an active amebicide against pyorrhea alveolaris has

been exploded. In this connection, it is interesting to note that

the firm does not list the product in the latest catalogue in our

files.--(_Query from The Journal A. M. A., Oct. 29, 1921._)

Calcidin Tablets (Abbott)

_To the Editor_:--What is the composition of calcidin tablets

(Abbott) and what is their value?

J. S.

ANSWER.--Calcidin is claimed to be a mixture of iodin, lime and starch.

In contact with water, the iodin and lime react to form calcium iodid

and calcium iodate. By the acid of the gastric juice, the calcium iodid

and calcium iodate are decomposed with liberation of free iodin. The

administration of calcidin tablets amounts to giving free (elementary)

iodin. In the past, the advertising for calcidin has contained the

unwarranted claim more or less directly that it was the most effective

and only noninjurious preparation of iodin for internal use, and that

it possesses all of the valuable properties of the iodin with all of

the objectionable effects left out. So far as we know, the effects

produced by the administration of free iodin do not differ from those

produced by the administration of iodids and, therefore, calcidin has

no advantage over the iodids, such as sodium iodid.--(_Query in The

Journal A. M. A., Sept. 25, 1920._)

Di-Crotalin Treatment of Epilepsy

_To the Editor_:--Do you have any literature or information

relative to the Di-Crotalin treatment for epilepsy? I will be

very grateful if you can furnish information as to method of

preparation, rationale of the treatment, etc.

R. C. Decker, Captain, M. R. C.,

U. S. Soldiers’ Home, Washington, D. C.

ANSWER.--Di-Crotalin is a rattlesnake venom preparation sold by the

Swan-Myers Company of Indianapolis as a “Treatment for Epilepsy,

Chorea, Bronchial Asthma, Chronic or Hereditary Nervous Headache,

Nervous Prostration Incident to Change of Life, Hysteria-Mania,

Insomnia, Neurasthenia, etc.” Dr. Thomas J. Mays of Philadelphia

advocated the use of rattlesnake venom for tuberculosis. Later his

former assistant, Dr. R. H. Spangler, used the same material in the

treatment of epilepsy. That any measure of success sufficient to

justify the adoption of the rattlesnake venom or crotalin treatment

for epilepsy has resulted is not to be concluded from the available

reports. Still less evidence is there for the use of rattlesnake

venom in the list of conditions for which the Swan-Myers Company has

recommended its preparation. There are a number of good reasons why a

cautious physician will shun the administration of this treatment and

advise against it. J. F. Anderson, working in the hygienic laboratory

of the United States Public Health Service, reported a death from the

crotalin treatment in consequence of infection, and reports that the

market supply of crotalin solution and crotalin tablets is highly

contaminated. He also found both crotalin and crotalin solution to

vary in activity. The use of rattlesnake venom was discussed in The

Journal, March 15, 1913, p. 850.--(_Query in The Journal A. M. A., Aug.

17, 1918._)

Estivin

_To the Editor_:--What is “Estevin,” or something like that? It is

said to be good in hay-fever.

Constant Reader.

ANSWER.--The product called “Estivin” is sold by Schieffelin and

Company, New York. A request for a statement of the composition of this

preparation sent to Schieffelin and Company by the Council on Pharmacy

and Chemistry brought the indefinite and, therefore, meaningless

statement that “‘Estivin’ is an extract of Rosa Gallica containing no

alcoholic or foreign ingredients.”--(_Query from The Journal A. M. A.,

Nov. 12, 1921._)

Iron Arsenite

_To the Editor_:--Can you inform me how iron arsenite can be

prepared for subcutaneous injection? A commercial firm furnishes

physicians with ampules of arsenite of iron. Is this really

arsenite of iron?

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

ANSWER.--Ferric arsenite (iron arsenite) is in itself relatively

insoluble in water, but may be treated with ammonium citrate, the

resulting product thus being soluble; the latter substance was

at one time described in New and Nonofficial Remedies as “Ferric

Arsenite, Soluble” and is sometimes sold as a solution in ampule

form. In 1912, the Council on Pharmacy and Chemistry deleted “Ferric

Arsenite, Soluble” from New and Nonofficial Remedies because “one

cannot, in administering Ferric Arsenite, Soluble, give a useful

dose of iron without giving too much arsenic; and, vice versa, one

cannot give a safe dose of arsenic without giving too little iron.”

The Council, therefore, held the preparation to be irrational and

unscientific.--(_Query in The Journal A. M. A., Feb. 19, 1921._)

K-Y Lubricating Jelly

_To the Editor_:--1. What is the composition of “K-Y Lubricating

Jelly”? 2. Can you furnish a formula for a simple nongreasy

lubricating jelly?

S. T.

ANSWER.--1. The composition of “K-Y Lubricating Jelly” has not

been divulged. Examination of the advertising matter reveals only

meaningless statements, such as: “This is a judicious combination of

vegetable products ... Combined in well balanced proportions with

non-irritating antiseptics ...,” “It incorporates a sufficient quantity

of mild antiseptics (of the Thymol class) ...” and “... contains _NO_

formaldehyde.”

2. Probably a simple tragacanth jelly, which can be made cheaply, will

produce the same effects as those of the proprietary preparation. The

following formula was published by Mr. J. K. Thum, apothecary at the

German Hospital, Philadelphia (_Druggists Circular_, September, 1915,

p. 586):

LUBRICATING JELLY

Tragacanth, whole 3 gm.

Glycerin 25 c.c.

Phenol 1.5 gm.

Distilled water, a sufficient quantity to make 300 c.c. The

tragacanth is broken in small pieces, and put into a wide-mouthed

bottle; the other ingredients are added and the bottle frequently

shaken.

In regard to this formula, Mr. Thum writes:

It has been used in our gynecologic department for years.... For

the last six years we have been dispensing it in collapsible tubes

throughout the hospital for general work.--(_Correspondence in The

Journal A. M. A., May 12, 1917._)

“Nikalgin”

_To the Editor_:--_Collier’s_ has a special article this week on

“Nikalgin.” Have you any information on this subject? It sounds

like nostrum stuff.

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

ANSWER.--“Nikalgin” is said to be the “invention” of Gordon Edwards, an

engineer. Large claims for its anesthetic and antiseptic virtues have

been made. While no very definite information seems to be forthcoming

regarding the preparation, it has been said to be “composed of quinin,

hydrochloric acid and urea.” This would indicate that “Nikalgin” may

be nothing more wonderful than the well known local anesthetic, quinin

and urea hydrochlorid, the _Quininae et Ureae Hydrochloridum_ of the

U. S. Pharmacopeia, or a modification of it.--(_Query in The Journal

A. M. A., Sept. 22, 1917._)

Pertussin and Syrup of Thyme

_To the Editor_:--A short time ago I received a sample of

“Pertussin” and used some in an obstinate case of bronchitis

with excellent results. I have since received a catalog from a

pharmaceutical firm, which advertises syrup of thyme. I have

searched for a formula to make my own syrup of thyme, but have not

been able to find one. Will you publish one?

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

ANSWER.--The subjoined formula yields a product very similar to

“Pertussin” in taste, flavor, composition, and probably in activity as

well:

Fluidextract of thyme 15 c.c.

Glycerin 15 c.c.

Syrup to make 100 c.c.

The original German preparation contained 1.5 gm. of sodium bromid

in each hundred cubic centimeters, and this might be added to the

foregoing formula with advantage, so far as action is concerned.

However, a sample of “Pertussin” purchased in the open market in the

United States failed to respond to tests for bromids.

As fluidextract of thyme is not official, this formula is presented as

furnishing an acceptable preparation:

Thyme, in No. 60 powder 100 gm.

Moisten with a mixture of:

Water 25 c.c.

Alcohol 15 c.c.

Glycerin 10 c.c.

After standing five hours, pack in a percolator. Exhaust with a

menstruum of alcohol, 1 volume, and water, 3 volumes. Reserve the first

85 c.c. of percolate. Concentrate the weak percolate to a soft extract

and dissolve in the reserved portion. Make up to 100 c.c. by addition

of a mixture of alcohol, 1 volume, and water, 3 volumes.

Other aromatic expectorants, such as terebene, terpin hydrate or

creosote, might be expected to have similar but greater effect in

chronic bronchitis. (_Query in The Journal, A. M. A., March 27, 1920._)

Quinin and Urea Hydrochlorid

_To the Editor_:--Could you tell me why quinin and urea

hydrochlorid has not become more popular for local anesthesia? Is

it less efficacious or more toxic than other preparations? If it is

useful, can you name some trustworthy firm or brand? Please omit my

name in answering.

L. F. C., M.D., Mexico.

ANSWER.--Quinin and urea hydrochlorid “has the actions of quinin.

When injected hypodermically it exerts an anesthetic action much more

prolonged than that of cocain” (Useful Drugs, Ed. 4, 1920, p. 127).

It has been pointed out editorially in The Journal (Feb. 14, 1920,

p. 462) that quinin has been regarded for more than half a century

by toxicologists as a protoplasmic poison capable of destroying

various forms of animal and vegetable cells, and hence it need not be

surprising that tissue necrosis may be produced by strong solutions

of the quinin salts. That this deleterious reaction actually does

occur and has militated against the general use of quinin and urea

hydrochlorid is confirmed by the report of the Committee on the

Advantages and Disadvantages of Local Anesthesia in Nose and Throat

Work (The Journal, July 31, 1920, p. 315). To quote:

The only local anesthetic that produces edema and sloughing is

quinin and urea hydrochlorid. So many statements were found in the

literature that this anesthetic has been abandoned in other fields

of medicine because of edema and sloughing, that writers who had

presented favorable reports in nose and throat operations were

communicated with by your committee. One writer who had recorded

390 cases of tonsillectomies extolling this anesthetic, which he

had used for four years and is still so recorded, now states that

he has not used it in two years, although no publication has been

made retracting his former endorsement. Still another writer, who

stated that quinin-urea came nearest the ideal local anesthetic,

now states that he has ceased using it. Your committee finds that

as far as nose and throat operations are concerned, this drug has

practically gone into “innocuous desuetude.”

The anesthesia produced by this drug at the time of operation is

good and the recovery of the patient might often be enhanced by its

use if it did not have the serious drawback. The product is official

in the U. S. Pharmacopeia, and may be obtained from any reputable

pharmaceutical house.--(_Query in The Journal A. M. A., Aug. 21, 1920._)

Ricord Pills and House Organ Therapeutics

_To the Editor_:--My mail is frequently cluttered with

pseudo-scientific data from various manufacturers of proprietary

remedies which contain as much real scientific information as the

_Police Gazette_. I am enclosing a sample page of such a periodical.

The article has been so cleverly worded in the first paragraph, as to

impress the unthinking with the idea that sodium cacodylate is superior

to arsphenamin, when we know in reality that sodium cacodylate has

been proved practically worthless in syphilis (_vide_ “Venarsen”). One

case is reported, in which twenty injections of sodium cacodylate were

administered intravenously, from October 23 to December 14. On December

18, a Wassermann test proved negative, it had been strongly positive on

October 20, but during the same interval from October 23 to December

14, the patient had been taking by mouth “Ricord pills” each containing

half a grain of yellow iodid of mercury; granted that he had taken

these pills regularly, during all that time, it might well be that

the Wassermann would be sharply influenced by them. Again, a negative

Wassermann in the midst of treatment proves little; it might be

positive again in a few days. The article stimulates the further use of

a product of known worthlessness in the treatment of syphilis. How any

one can use sodium cacodylate in preference to arsphenamin in syphilis

is beyond me. If I mistake not, the Propaganda Department has not taken

up the matter of these various pamphlets of the drug companies, such

as the _Doctor’s Factotum_, _Therapeutic Notes_, etc., lauding to the

skies such articles as “Seng,” “Cactina Pillets,” etc., _ad nauseam_.

The saddest part of the whole thing is that it must bring returns from

the unthinking, otherwise they would soon disappear, which would be a

great relief for the scrubwomen who empty our waste baskets.

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

[Comment.--The “sample page” sent by Dr. Bechet is from the

March-April, 1918, number of Parke, Davis & Company’s _Therapeutic

Notes_. It contains an “Original Communication” on “The Treatment of

Syphilis with Sodium Cacodylate, by Adolph Lappner, M.D., Detroit,

Mich.” The “article,” while nominally devoted to the praise of sodium

cacodylate, is virtually a puff for “Ricord Pills.” a Parke, Davis

& Co. product.]--(_Correspondence in The Journal A. M. A., July 13,

1918._)

Stannoxyl

_To the Editor_:--I am very anxious to know whether tin or stannous

oxid (SnO) has or has had any place among useful drugs. I have seen

such a prescription given in the treatment of mucous colitis, and

would be very glad to learn what its use may be.

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

ANSWER.--Recently, on the assumption that tin workers are less troubled

with boils than the average person, two French investigators proposed

the use of tin compounds in the treatment of staphylococcic infections.

Based on their work, a proprietary preparation--Stannoxyl--has

been placed on the market which is claimed to be “composed of

stannous oxide and specially purified metallic tin.” Absurd claims

are made for the product: for instance, “... We have no hesitation

in offering STANNOXYL--in Tablets or Cachets--as the only true

specific for diseases of Staphylococcus origin.” The available

evidence is unconvincing and in no way warrants such exaggerated

statements.--(_Query in The Journal A. M. A., March 6, 1920._)

_To the Editor_:--I was much interested in your answer to a query

about Stannoxyl (The Journal, March 6, p. 629). I submit the following

experience as a confirmatory note:

While serving with the Royal Army Medical Corps in Egypt, I for some

time had charge of the medical division of a hospital in which most

of the skin diseases occurring among soldiers in the district were

treated. The most common conditions were boils and septic sores,

chiefly due to staphylococcal infection, though several of the latter

cases were diphtheritic. The treatment adopted was that in ordinary

use, namely, incision and evacuation of pus, application of antiseptic

dressings, and in most cases employment of the specific vaccine. It was

possible to judge of the efficacy of any variations of treatment, as

there were always plenty of cases undergoing the usual treatment with

which the results could be controlled.

An available supply of Stannoxyl, a proprietary remedy consisting of

a mixture of metallic tin and tin oxid, enabled me to give it a fair

trial in full doses in eight cases of boils of average severity, in

which culture revealed the infecting organism to be _Staphylococcus

aureus_. The boils were treated locally as usual, but no vaccine was

given. No improvement could be demonstrated in these cases that could

not be shown in other cases similarly treated with the omission of

Stannoxyl; in fact, three of the treated cases were much longer in

clearing up than the untreated controls. Eight cases do not constitute

a very large series from which to draw conclusions; but if the

preparation were as good as the descriptive literature would lead one

to believe, one should have expected an evident result in at least one

of these cases.

It has been stated that Stannoxyl does not inhibit the growth of

staphylococci, but only renders the growth less virulent. It is known

that a certain amount of tin may be absorbed from the intestine, and

Salant, Rieger and Treuhardt have shown that in certain cases tin

may be retained for some time in the skin; but it is questionable

whether, when preparations of tin are given by mouth, any reaches

the staphylococci in the boils, or at any rate enough materially to

influence their growth or virulence.

In the cases treated by me, the results did not at all suggest that

Stannoxyl was a “specific for diseases of staphylococcal origin.”

J. W. C. Gunn, M.A., M.B., Ch.B., Cape Town.

Professor of Pharmacology, University of Cape Town.

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

Syphilodol

_To the Council on Pharmacy and Chemistry_:--If you have not

already done so, will you kindly examine and report on “Syphilodol”

advertised in the enclosed pamphlet?

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

_To the Editor_:--Have you any information concerning the enclosed

half page advertisement [of Syphilodol] from the _Urologic and

Cutaneous Review_?

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

_To the Editor_:--I am enclosing an advertisement for a substance

called “Syphilodol” manufactured in New York. Am not familiar with

this article nor have I seen it advertised in the higher class

journals. Can you tell me whether The Journal’s department of New

and Nonofficial Remedies has passed on this article or whether you

have any data concerning it? It looks a trifle fishy to me.

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

_To the Editor_:--I am sending the enclosed correspondence

[Syphilodol letters] to you as it looks as if it might have some

interesting features from the point of view of your nostrum

department.

Isadore Dyer, New Orleans, La.

ANSWER.--These are but some of the inquiries that have been received on

this subject and it is encouraging to note the scientifically critical

attitude of physicians toward new therapeutic agents. According to the

French Medicinal Company, Inc., which markets this product, “Syphilodol

is a synthetic chemical product of silver, arsenic and antimony....”

Nowhere in the advertising matter is there any more definite statement

as to the composition of this new “synthetic” than that just quoted.

The product is now under examination in the Association’s laboratory

and when this is completed a more detailed report will doubtless be

forthcoming. At present the work has progressed sufficiently to show

that Syphilodol tablets contain considerable quantities of mercury!

Although the advertising leaflets claim that the preparation is

“the formula of the late Dr. Alfred Fournier of Paris” and had been

exhaustively tested by Metchnikoff, who is alleged to have found

it superior to salvarsan and neosalvarsan, yet, strange to say, a

careful search of French medical journals fails to show any reports on

Syphilodol. _Verb. sap._--(_Query in The Journal A. M. A., Feb. 23,

1918._)

Thialion

_To the Editor_:--Kindly inform me regarding thialion, manufactured

by the Vass Chemical Company, Danbury, Conn. Please omit my name

and address in answering in The Journal.

H. C. W.

ANSWER.--Thialion is an heirloom of the days when lithium salts were

supported to be nature’s antidote for all kinds of ailments, supposedly

due to excess of uric acid. It was advertised as a uric acid eliminant

and therefore good for all kinds of diseases. The Council on Pharmacy

and Chemistry published a report on thialion in The Journal, Nov.

3, 1906. At that time thialion was advertised by the Vass Chemical

Company as a “laxative salt of lithia” with the chemical formula

“3Li₂O.NaO.SO₃.7HO,” and an elaborate structural formula was also

furnished. The Council reported that the product was not a definite

chemical compound, but a mixture consisting chiefly of sodium sulphate,

sodium citrate and small amounts of lithia. In recent advertisements,

thialion is referred to as “A Non-Effervescing Lithiated Laxative

Salt,” “a non-hygroscopic, non-deliquescent, granular salt of lithia,”

etc., but the chemical formula does not appear, nor is any definite

statement of composition furnished. According to this advertisement,

the “indications” for thialion are: “gout, rheumatism, uric acid

diathesis, constipation, acute and chronic, sluggish liver, Bright’s

disease, albuminuria of pregnancy, asthma, incontinence of urine,

gravel, cystitis, chronic lead poisoning, headache, neuralgia,

neurasthenia and lumbago, Hay fever, etc.”--(_Query in The Journal

A. M. A., Dec. 6, 1919._)

Venarsen

_To the Editor_:--The following is a copy of a letter sent to the

Intravenous Products Company, which needs no explanation:

June 8, 1917.

_The Intravenous Products Co., Denver, Colo._

Gentlemen:--In reply to your circular letter under date of June 3,

may I say that after using a great quantity of Venarsen both in

clinical and private cases, I can see no more effect upon these

cases than if so much water had been administered.

This is also the report of Don R. Black, pathologist for Bell

Memorial Hospital, University of Kansas. In our experiments all

bloods were tested before and after each administration of this

product.

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

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