Clinicians have not been slow in following the lead suggested by the
therapeutic experiments in animals. It is perfectly proper that this
should be the case. In dealing with a disease of the character of
cancer, in many instances entirely beyond our power to influence, no
one can question the advisability of trying any and every agent which
holds out the slightest promise. Unfortunately, a closer analysis of
the animal experiments fails to vindicate even that degree of faith.
When one considers the facts which have been analyzed in the preceding
discussion, it would appear not only futile but actually dangerous to
attempt to benefit cancer sufferers by means of any of the agencies
which have been employed in animal experimentation. Nevertheless, the
fact remains that a variety of preparations have been used in the human
clinic. The various types of preparations may be satisfactorily grouped
under four classes, namely:
1. The crystalline salts of selenium.
2. Selenium in colloidal solution.
3. Other metals in colloidal solution.
4. Compounds of metals with organic radicals.
These substances have been administered by injection or by the mouth.
In the case of injection, the injections have been made either into the
subcutaneous tissues, intramuscularly, or intravenously, or finally,
directly into the tumors. Before passing to a further consideration
of this subject in detail, it may be well to recall the fact that in
the experimental tumors of animals, no matter what preparation has
been used, it has been possible to accomplish therapeutic effects only
by the use of relatively enormous doses of the medicament, of doses,
in fact, which were scarcely lower than the lethal dose. Certain
experimenters have noted that smaller doses actually stimulated the
growth of the tumors. In the second place, it has almost invariably
been found necessary to administer the treatment intravenously,
inasmuch as the other modes of administration failed of therapeutic
effect. It is quite apparent that a procedure in human beings in any
degree analogous to that pursued in animals is entirely impossible. The
doses used, with one notable exception to be subsequently mentioned,
have invariably been relatively small. Hence it is apparent at the
outset that at least one fundamental condition of success in the
treatment of animal tumors has been necessarily excluded in the
clinical application.
The salt used by Wassermann is not stated in his original publication.
Wolff[281] speaks of it as a sodium salt, whereas Keysser says that it
was a combination with potassium cyanid. In only one instance, as far
as I am aware, has the sodium salt been used therapeutically in human
beings. Delbet[282] states that he employed this salt intravenously
in one case, and that its use was shortly followed by death.
Unquestionably the salts of selenium are very much too toxic to be used
in this way.
[281] Wolff: Die Lehre von der Krebs Krankheit =3=:1913.
[282] Delbet, P.: Bull. de l’Assn. franç. pour l’étude du cancer
=5=:121, 1912; ibid. =6=:85, 1913.
The majority of those who have worked with selenium have used it in
colloidal form, either preparing it themselves or employing one of the
preparations put on the market by the pharmaceutic firms. Of the latter
the best known are the electro-selenium of Clin, and the Seleniol of
Couturieux. Of those who have made use of selenium in these forms
may be mentioned Cade and Girard,[283] Bougeaut and Galliot,[284]
Blumenthal,[285] Thiroloix and Lancien,[286] Delbet, Laurent and
Bohec,[287] and most extensively of all, M. Touche.[288] All of these
authors have described cases of malignant new growths of the most
varied character which were treated by these preparations.
[283] Cade and Girard: Bull. Soc. méd. d. hôp. de Lyon =11=:397, 1912.
[284] Bougeaut and Galliot: Clinique, Paris =7=:501, 1912.
[285] Blumenthal, A.: Jour. méd. de Bruxelles, 1912, =17=:325; Presse
méd. belge =65=:919, 1913.
[286] Thiroloix and Lancien, A: Bull. et mém. Soc. méd. d. hôp. de
Paris =33=:197, 1912.
[287] Laurent, M., and Bohec, J.: Med. Press and Circular =94=:461,
1912.
[288] Touche, M.: Bull. et mém. Soc. méd. d. hôp. de Paris =35=:451,
1913.
The results obtained are fairly concordant. The intravenous injection
of the preparation produces but slight disturbance. There is
leukocytosis, a moderate rise of temperature, and not infrequently
a chill. Otherwise the substance seems to possess no toxicity. The
effects produced on the tumors have almost invariably been described
as encouraging. Touche, who treated twenty-seven cases in this way and
has described each case in detail, states that under the treatment the
surface of the tumors, if ulcerated, became cleaner and healthier;
the tumors became softer; the rate of growth was arrested, and there
was relief of pain and of the accompanying functional disturbances;
often, too, there was a gain in weight and an improvement in general
well-being.
Touche concludes his article with the statement that “it is certain
that the effect is not curative but it is actually palliative.” Delbet,
on the other hand, states that he has seen no beneficial effects from
the use of colloidal selenium injected intravenously. In the discussion
on Delbet’s paper, Ledoux-Lebard states that he has observed nothing
from selenium further than the temporary improvement which is shown
by almost all cancer cases on the application of any new therapeutic
measure. In one or two instances the claim is made in the literature of
an actual cure of malignant growth through the use of selenium. Such,
for example, is the case described by Blumenthal. From the clinical
description this might have been a cancer of the tongue, and was judged
to have been such in view of the negative Wassermann reaction. No
microscopic examination was made. Arsphenamin was given. The patient
recovered. It is clear that instances of this type cannot be accepted
as beyond criticism, and it is safe to say that nothing more convincing
in the way of actual cure is offered in the rather voluminous
literature on the use of selenium.
Numerous compounds of selenium, some of them claiming to circulate in
colloidal form, have been described, and have been put on the market
for use in malignant disease. Such are Walker’s sulpho-selene, and
selenio-vanadium, which has been prepared in the form of an ointment by
Schering and Glatz. These preparations lay claim to the same palliative
effects which have been previously described for colloidal selenium.
Of the other metals in colloidal form, chiefly silver and copper have
come into use. Colloidal silver was first recommended for malignant
growths by Vogel. It is obtainable on the market in proprietary
form under the name of fulmargin, and also as electrargol. Recently
Rohdenburg[289] has made a careful study of the effects of colloidal
silver in experimental and in human tumors, and finds that they have
no value. Colloidal copper has been used in recent times for the same
purpose by Gaube du Gers and by others. I have recently examined the
effects of colloidal copper on malignant tumors in man, and have been
unable to find that it has any therapeutic value. Furthermore, a study
of the distribution of the copper in tumors obtained at operation or by
necropsy from individuals so treated failed to show that the copper had
been deposited therein.
[289] Rohdenburg, H.: J. M. Research =26=:331, 1915.
Finally, preparations similar to those used by Werner and by Caspari in
animals have also been used in human beings. In these cases also the
authors have been able to record palliative effects on the tumor, but
in no instance cures.
We have seen that it has been quite impossible to duplicate in human
beings the therapeutic technic employed in animal experiments. We
have seen further that the use of a modified technic in animal
experimentation has never been productive of favorable results even
at the hands of enthusiastic adherents. In striking contrast to these
conclusions are the observations made in human therapeutics. For
every type of preparation described in the preceding paragraphs, the
claim has been made practically without exception that it exercises a
markedly beneficial effect on malignant diseases in the human being.
Not only are the subjective symptoms alleviated, but also the tumors
appear to become cleaner and softer; the rate of growth is retarded;
necrosis and metastasis are prevented, and inoperable tumors become
operable. How are we to interpret these observations? How are we to
explain the fact that they are the almost invariable accompaniment
of the most diverse methods of treatment? I have already quoted the
statement of Ledoux-Lebard that every therapeutic novelty appears to
exercise a favorable effect on cancer cases. The same fact has been
observed in a variety of other diseases, such as locomotor ataxia.
In order to arrive at a safe and reliable estimate as to the value
of any new or experimental procedure in cases of cancer, it seems
advisable to accept certain definite therapeutic criteria by which the
cases are to be judged. In the absence of such a method, alterations
in symptoms which are actually of no real value or importance receive
undue emphasis. The natural course of the disease is associated
with such fluctuations that a sanguine therapeutist can gain some
encouragement from even the most hopeless cases. Hence it follows that
every mode of treatment has found adherents. The market is flooded
with cancer drugs, and cancer charlatans flourish in the most highly
educated communities. Unfortunately, even well trained, honest and
reputable physicians have fallen victims to this fallacy, and have
lent their names to the support of modes of treatment which in reality
produce no determinable effect on the natural evolution of the disease.
It was the desire to combat this unfortunate tendency which led me
some time ago to attempt to establish a reliable set of criteria of
therapeutic effects in cancer. These were embodied in an article[280]
which appeared two years ago, and I may be here permitted to quote them
in extenso:
CRITERIA OF THERAPEUTIC EFFECTS
In determining the effects of any given mode of treatment on a tumor,
a variety of criteria may be relied on. Circulatory changes in the
tumor, the relief of pain and the restoration of a secondarily
impaired function are certain of the criteria on which stress has
been laid by the majority of observers in the past. Important as are
these criteria in determining the progress of purely inflammatory
processes, it is unquestionable that their value in judging of the
effects of therapeutic methods when applied to malignant disease is
open to criticism. It is a curious and interesting fact that almost
every therapeutic claim made in recent years in connection with
cancer has included among its virtues the relief of pain. This is
true of vaccination with cancer tissue, of Hodenpyl’s method and of
many others. In view of this very general effect, not much stress
can be laid on this symptom, and it is probably fair to assume that
in the great majority of these cases the result is in no small
measure psychic. The improvement of function is also largely a
subjective phenomenon, and as such requires most careful criticism.
Osler relates that he has known a patient with gastric cancer to be
relieved of digestive disturbances and to gain 18 pounds in weight as
the result simply of the visit of a sanguine consultant who denied
the presence of a tumor. Improvement in the ability to chew food, to
articulate words or to move a limb are phenomena familiar to those
who attempt to treat cases of cancer. The victims of this disease
seem to be in a very high degree “suggestible” and impressionable and
respond nobly to every therapeutic effort.
Circulatory changes in tumors offer an interesting group of clinical
symptoms. The observation has often been made, especially in
ulcerated new growths, that treatment is associated with swelling,
peripheral hyperemia, and an altered character of the discharge.
In spite of the fact that there is no reasonable relationship
between this congeries of symptoms and the actual cure of the tumor,
they generally receive considerable emphasis and are cited as an
indication of the specific local action of the agent employed. It
is also true, however, that the growth may continue to advance in
spite of their presence. It is of some importance to inquire into the
mechanism which produces these circulatory changes and into their
clinical interpretation. It is a well known fact that many drugs,
when introduced into the body either by the mouth or through the
skin, are excreted not only by the normal channels of elimination,
such as the kidney or the intestine, but also from such ulcerated
surfaces as may be present on the body. This is easily shown to
be true, for example, of certain of the anilin dyes, which, when
introduced by way of the veins, produce an intense discoloration
of the dressings over ulcers. It is likewise true of certain of
the metals, such as arsenic. In order to understand the series of
events previously enumerated it is therefore only necessary to
assume that the therapeutic agent is excreted from the ulcerated
surface of tumors. If an irritant, it will tend to produce hyperemia
of the margins of the ulcer, and an increase of the secretions. If
an astringent, however, it may produce just the opposite of these
effects. Such a result, however striking, is purely accidental, and
has no necessary bearing on the growth or destruction of the tumor
itself. It constitutes a symptom on which no reliance should be
placed.
Excluding from consideration all of these secondary factors, we may
conclude that the observation of the size of the tumor itself is
the sole criterion on which we can place reliance in judging of the
effect of therapeutic measures. This implies, in the first place,
that a tumor must be accessible to fairly accurate measurement.
Tumors of the uterus, for example, and intra-abdominal growths
will only exceptionally fall into this class. In the second place,
indirect evidence of a decrease in the size of tumors, such as is
afforded by the increased permeability of obstructed passages, as
in the case of tumors of the esophagus, pylorus or intestine, must
be accepted only with great reserve. Remissions in the obstructive
symptoms characteristic of such tumors are a frequent feature of
the normal evolution of the clinical history of such growths. The
relief of obstruction, however, may be due either to necrosis of the
obstructing portions of the tumor, while the remainder continues
to grow progressively, or to a relief of the accompanying muscular
spasm. Finally, evidence of decrease afforded by the roentgenogram
is not sufficiently exact in most cases to afford ground for so
important a conclusion as that at present in question.
Not only must there be unquestionable evidence, however, of the
diminution in size of the tumor, but this diminution must be of a
kind not ordinarily attributable to the natural evolution of the
tumor.... It is safe to say that multiple tumors offer enormous
difficulties in the matter of interpreting therapeutic results. At
present we have in the wards of the hospital a patient with multiple
metastatic carcinomas of the skin. For several months we have at
intervals made accurate measurements of certain of these tumors
and have found that some have undergone retrogression, others have
entirely disappeared, while still others have continued to grow
steadily. In the case which afforded the ascitic fluid used in
Hodenpyl’s experiments, many of the lymphatic metastases underwent
complete retrogression, while the metastatic process in the liver, as
was demonstrated at necropsy, increased progressively, and ultimately
almost destroyed that organ. Thus, in multiple carcinosis, the
retrogression of individual nodules is no indication that therapeutic
intervention has produced an improvement.
I shall not delay to emphasize those variations in the size of solid
tumors which accompany hemorrhage and its absorption, edematous
swelling, necrosis in the depths, and other familiar factors which
clinically simulate, or induce, the softening and the reduction
that are so often attributed to therapeutic interference. But it is
important to draw attention to a similar feature in that type of
superficial epithelioma known as rodent ulcer. These new growths not
infrequently advance at one point of the periphery, while they recede
at another, and thus cicatrization and contracture may simulate a
partial recovery. This effect is due in part to alterations not
in the growth itself, but in the accompanying ulcerative process.
The secretions from the growths, especially if confined under
dressings, may have eroded and destroyed the surrounding skin, and
it is tempting to interpret a recession of the associated ulcerative
disease as an indication of a favorable effect on the new growth.
It is unquestionably this aspect of rodent ulcers which plays so
generously into the hands of the numerous venders of nostrums for
this disease.
_In brief, the demonstrable reduction in size of a tumor, of a kind
not to be attributed to the natural processes of evolution of that
tumor or of its associated lesions, is the one essential feature of
effective therapeutic intervention._
When the various methods of treatment which have been discussed in
this paper are judged by the standard advocated above, it is apparent
that none of them can lay claim to therapeutic effectiveness. The
modifications of the disease attributed to them are modifications which
occur spontaneously in a very large proportion of cases as a result
of the natural evolution of the disease process. This is a fact which
cannot be too strongly emphasized. Owing unfortunately to the hopeless
character of cancer, men are not prone to study with care all the
lesser changes which the disease and the patient present under ordinary
conditions; but when a “cure” is under investigation, the patient and
his medical attendant note every apparent improvement with painstaking
attention and enthusiasm. As a result, some evidence of improvement in
treatment is entered on the books.--(_From The Journal A. M. A., April
17, 1915._)
THE DIRECT SALES COMPANY
During the past four or five years, The Journal has had inquiries
similar in effect to this, just received from Dr. E. P. Jewett of
Gardner, Mass.:
“Will you kindly inform me regarding a drug manufacturing company
by the name of the Direct Sales Company, Buffalo, New York? Are
their products standard and reliable so far as you know?”
The Direct Sales Company, Inc., Buffalo, has, according to its
letterhead, the following officers:
Geo. J. Dotterweich, President and Treasurer,
C. K. Dotterweich, Vice-President,
Louis B. Seufert, Secretary.
This concern circularizes physicians and emphasizes that it sells
“Only by Mail.” It also features a “profit sharing rebate” scheme,
whereby purchasers receive a coupon representing 10 per cent. of the
invoice value of each purchase. After $100 worth of merchandise has
been purchased the $10 worth of coupons when “presented for redemption
at one time” will be “honored as cash”--presumably on the purchase of
additional goods.
The Direct Sales Company catalogues have for some years, carried a
guaranty, which reads, in part:
“We absolutely guarantee all preparations to be in exact accordance
with the National Pure Food and Drugs Act, June 30, 1906.
“We also absolutely guarantee all preparations bearing our label to
be equal, if not superior, to any on the market.”
In one of the Quarterly Bulletins of the State Board of Health of New
Hampshire, issued last year, this paragraph appeared:
“The Direct Sales Company, Inc., Buffalo, N.Y., is a pharmaceutical
concern which until recently has done business direct with New
Hampshire physicians. In two or three instances complaints have
been received by this department that the preparations sold seemed
to be lacking in potency. Some time ago a physician sent us a
specimen of codein sulphate tablets, one-fourth grain, concerning
which he was suspicious, admission being made that the price paid
was very much less than current quotations. The amount of codein
sulphate actually found per tablet proved to be but one-sixteenth
grain. Later on, having subsequently received a new lot from this
source, the same physician sent us a second sample, the composition
of which was found to be practically identical with the first.
Acting under the federal law, 500 lot packages of the following
preparations were next purchased of the company direct, the
analytical results indicating serious deficiency in every case, as
follows:
“Tablets salicylic acid, 5 grains ... 1.72 grains found.
“Tablets acetylsalicylic acid, 5 grains ... 2.31 grains found.
“Tablets acetanilid, 3 grains ... 1.88 grains found.
“Tablets codein sulphate, 1/4 grain ... 1/15 grain found.
“Tablets nux and pepsin No. 2, claiming pepsin 1 grain, extract nux
vomica, 1/10 grain, found to have a gross average weight per tablet
of only 1.17 grains, 0.54 grains of which was represented by sugar
and other medicinally inert material.
“Tablets Infant’s Anodyne (Waugh) showed serious discrepancy from
formula.”
The Bulletin added the statement that, as the company could not be
reached under the New Hampshire laws, the federal authorities were
appealed to. The result of this appeal appeared in _Chemical Supplement
54_, issued Aug. 21, 1918, by the Bureau of Chemistry of the U. S.
Department of Agriculture. This government bulletin contained Notice
of Judgment No. 6193, which describes cases of adulteration and
misbranding of some of the drugs put out by the Direct Sales Company.
Briefly, it may be said that some 2 grain acetanilid tablets sold by
this concern were found by the government chemists to contain, roughly,
about 1-2/3 (1.61) grains; some 1/4 grain calomel tablets were found
to contain only about 1/6 (0.163) grain; some 1 grain quinin sulphate
tablets were found to have only about 2/3 (0.63) grain; some 2-1/2
grain salol tablets contained only about 1-1/3 (1.39) grain; some 5
grain sodium salicylate tablets contained less than half that amount
(2.32 grain). In addition, the federal chemists found that some Elixir
of Iron pyrophosphate Quinin and Strychnin (_Elix. Ferr. Pyrophos.
Quin. et Strych. N. F._) fell considerably below the standard of
strength laid down by the National Formulary by having less than
one-eighth the amount of quinin sulphate which the official standard
calls for, and only about one-fifth the amount of sugar, saccharine,
which is not a normal ingredient of the official preparation, having
been substituted for part of the sugar. The chemists found, too, that
some hydriodic acid sold by the same concern, instead of containing, as
the label declared and as the United States Pharmacopeia requires, 1
per cent. of absolute hydriodic acid, contained less than one half of 1
per cent. The Direct Sales Company pleaded guilty in this case and was
fined $700.--(_From The Journal A. M. A., Sept. 27, 1919._)
DISCOVERIES AND DISCOVERERS
In spite of the wonderful achievements of modern science, it seems
impossible to get the public to think in scientific terms. This is
doubtless due to a fundamental weakness in our educational system.
The tendency still is to think in terms of the eighteenth century
rather than of the twentieth. Many times The Journal has been chided,
even by its friends, for failing to take seriously preposterous
claims made for alleged discoveries in medicine by well-meaning but
self-deluded enthusiasts or by shrewd and conscienceless charlatans.
Far too often the attitude is that any alleged discovery in medicine,
no matter how bizarre or how humanly improbable, should be taken up
in all seriousness and subjected to the tests of modern laboratory
methods. It was only a few years ago that a quack of unsavory
antecedents brought forth an alleged cure for consumption--a disease
that for years has been the subject of study by the best brains in the
world--and a medical college spent thousands of dollars “investigating”
the “cure,” thereby giving it a standing that it would never have
received otherwise and incidentally obtaining for the school an amount
of publicity that may or may not have been desired. As The Journal
said at the time, it would have been just as pertinent for a body of
astronomers to determine by scientific methods whether or not the moon
is really made of green cheese.
The point we would make is that the strides made by modern science
have practically eliminated the possibility of men without training
or special knowledge evolving any epoch-making discovery. In this
connection an editorial in the _Scientific American_ of recent date,
dealing with the mechanical sciences rather than the medical, is well
worth quoting in part. The editorial discussed the “Garabed” incident.
“Garabed,” as Our readers know, was a name given to a device which one
Garabed T. K. Giragossian claimed to have developed and which, so far
as could be learned from the generalities in which Mr. Giragossian
indulged, would take energy out of the cosmos and transfer it directly
into mechanical motion. Mr. Giragossian would give no details regarding
his “engine,” but was so able to hypnotize Congress into a belief that
he had something worth looking into that it passed a joint resolution
calling for the appointment of five scientists to pass on the claims
for Garabed. The investigation proved, as might have been expected,
that the thing was unsound in principle and nonoperative as a device.
The methods by which Garabed was brought before the public savored
strongly of those used by quacks in the medical world, the one
difference being that Giragossian was apparently perfectly sincere
and unequivocally honest. The point that we bring out, however, and
which, as we have said before, was so well expressed by the _Scientific
American_, is the utter futility of wasting the time of scientific
men on alleged inventions or discoveries by men without training
who substitute secrecy and glittering generalities for facts and
accomplishments. Quoting the _Scientific American_:
Scientific discovery, once an open field for all comers, is today
becoming more and more a matter calling for the most intensive
special qualifications. As the body of human knowledge broadens and
deepens, it becomes increasingly difficult to make any material
addition to it. Any one undertaking such a task must of necessity
bring to it a long and careful training, acquired either in the
refined atmosphere of the laboratory, or in the rougher school
of close contact with the operation of apparatus constructed by
those who have already qualified. In particular, he must possess a
carefully developed power of making accurate observations and drawing
correct conclusions. It is rather the habit to point to men like
Edison and Maxim in refutation of these necessities; but they are not
to be so refuted. These men are examples, raised to the _n_th power,
of the great inventor who has qualified in the University of Hard
Knocks and Long Experience.
On these grounds, when a man comes before us in the self-assigned
rôle of a great inventor, it is incumbent upon him to answer, not
necessarily the bald question “Who are you?” but certainly the more
searching one, “What are your qualifications to undertake this
work?” Only by his answer can we decide whether he possesses a
competence deserving of attention, or is but a dilettante playing
with fire. Yet this obligation was one which Mr. Giragossian, far
from meeting, did not even appear to comprehend. To every effort to
ascertain his qualifications he replied in the same terms, that he
was an honest man, and could prove it by letters from his technically
nondescript collection of friends and sponsors. The very fact that
more than personal integrity is necessary in a man who would unravel
the secrets of the creation of energy appears to have escaped his
comprehension.
The fundamentals thus stated apply with equal force to the sphere
of medical discovery. At the time when medicine was pure empiricism
it was not only possible but also probable that the medicinal value
of certain products or combinations of products might be stumbled
on by those untrained and unskilled. That time has passed. Today,
while it is not impossible, it is so improbable that there is no
justification in taking up the time of scientific men in investigating
alleged discoveries by men who are utterly lacking in the fundamental
qualifications needed for the study of the complex problems of human
pathology.--(_Editorial from The Journal A. M. A., Aug. 10, 1918._)
“DRUG REFORM”
As It Appears to the Cleveland Medical Journal
The matter which follows appeared originally as an editorial in the
_Cleveland Medical Journal_, November, 1915. It expresses, we believe,
the attitude of the thinking physician toward the subject discussed:
Physicians have come to the realization that drugs are as a two-edged
sword--under proper conditions, striking against the disease;
otherwise, against the patient’s health. The first condition for their
proper use is adequate knowledge of their composition and purity; of
their actions and malefactions; their field and limitations. Slowly
and painstakingly--sometimes painfully--this scientific knowledge has
been gathered, is still being gathered, by chemists and pharmacists,
pharmacologists and clinicians, with increasing thoroughness, care and
discrimination.
Where wisdom fears to venture, unwisdom and cupidity find ample room.
The wise physician knows that there are ills that drugs cannot cure;
that drugs generally only aid or relieve; and that to obtain even
this aid efficiently and safely, the existing scientific knowledge
is none too great. Not so the unwise. He who sees in disease only a
name, to him a name is a sufficient cure. Let there be a mixture with
a convenient and suggestive name and a pleasant taste, a compendious
index of diseases and symptoms--and a lively imagination--and the cure
is accomplished. Few things could be easier, and few more false. It
is not surprising that the “man on the street” should fall into these
errors; it is sad that any physician should be misled by the sophistry
of interested drug vendors.
Physicians have the moral obligation to instruct the public in matters
of health. Preaching before practice is of little avail. It behooves
the medical profession to make at least a reasonable effort to clean
its own house before it passes the broom to the public. Realizing
this responsibility, the American Medical Association some years ago
established its Council on Pharmacy and Chemistry. This Council is
strictly an educational agency--it collects and disseminates knowledge
about drugs, especially those drugs that are advertised to physicians
and that are not described in the legal pharmacopeias. Physicians are
thus put in a position to discriminate. Many have done so; others will,
a few may never see the light on this earth.
Journals can no longer claim that they mislead their readers in good
faith. Some--the _Cleveland Medical Journal_ among the first--have
frankly acknowledged their obligations, and sacrificed a lucrative
income from advertisements; others are still occupied in compounding
the matter with their conscience. Manufacturers are in a similar
position. Those who are on the side of scientific progress--or to put
it materially, those who realize that honesty is the best policy--are
taking the opportunity to separate themselves from the dishonest and
ignorant.
Altogether, the medical profession may safely advise the public on
the subject of drugs without laying itself open to the charge that it
preaches what it is unwilling to practice.
Meantime, the public itself has had a somewhat similar awakening. The
progress of the profession has necessarily spread more or less to the
laymen. All sorts of educational agencies have been working to convince
the public that individual and national health is too precious an asset
to be entrusted to any quack who may spell his praise in printer’s
ink. Legislators have passed food, drug, and antinarcotic laws which
have aroused interest and discussion. Even the “drugless cults” have
somewhat offset their harm by causing the public to reflect that
drugging is not a panacea for all ills. All this has not been without
effect. The public is in a receptive mood; it is not convinced, but
wishes to learn. Legislators are prepared to follow public opinion. The
purveyors of patent medicines are watching events.
What, under these conditions, should be the attitude of the medical
profession? Plainly, it should continue to be what it always has
been: to stand aggressively for the protection of the public health,
without any compromise. In doing so, it is true, physicians will
expose themselves to the imputation of selfish motives. Selfishly
commercial minds cannot or will not understand the unselfish ideals
of a profession--that is their loss. Physicians, however, must be
careful not to give a semblance of reason to the charge; for that would
diminish the effect of their attitude. They must confine themselves to
informing the public of the facts; and to guarding the health of the
public at large, and of their own patients in particular.
No one, in a free country, can force a diseased individual to seek
effective treatment or prevent him from using an ineffective treatment,
unless his disease imperils the health of others. At that point, and
not before, the government can and should take personal measures.
However, it is a well recognized function of the government to protect
individuals against their own ignorance. It does this when it forces
the child to go to school; it does this when it places the swindler in
jail.
On exactly the same principle, the government has the right and the
duty to protect the uninformed public against the flagrant evil of the
patent medicine traffic--and the patent medicine traffic as now carried
on is a flagrant evil and series of evils. The government should
protect the public against advertisements that are framed to suggest
or create imaginary ailments, with their attendant miseries; it should
protect the public against being deluded by false promises of cure;
against the specious relief that merely hides the disease and blinds
the patient to its dangers; against drugs that may and do work positive
harm; against the veil of mystery that makes these abuses possible.
The individual layman cannot protect himself against these dangers,
and has a right to expect that the government will prohibit the
indiscriminate sale of any medicine that may be harmful to him. He has
a right to expect, when the government permits the sale of a patent
medicine, that the medicine will do him no harm; just as he has a right
to expect that any physician whom the government permits to practice,
should be competent.
These are some of the reasons why physicians oppose patent medicines
as they are now exploited; and for these reasons, physicians should
take an absolutely uncompromising attitude, and use every opportunity
to educate the public. The patent medicine interests naturally try
to obscure the issue. By the art in which they are so skilful, they
aim to suggest to the public that physicians are opposed to patent
medicines, in order to drive patients to their offices. They “forget”
to mention that physicians have never conducted a “campaign” against
really efficient preventive public-health measures, no matter how many
prospective patients were involved. No physician has ever refused to
give diphtheria antitoxin because this would diminish the number of his
visits. A short memory is a very convenient asset for self-interested
persons. It is not so convenient for the public--but it is all too
frequent. Physicians must, therefore, make it plain that their stand is
not against patent medicines, but for the protection of the health of
the public.--(_From The Journal A. M. A., March 4, 1916._)
DRUG THERAPY: THE FALLIBILITY OF TEXTBOOKS
Until very recently, we were compelled to acknowledge that little,
if any, progress was being made in internal medicine so far as drug
therapy was concerned. Everybody knows of the progress made in other
branches--in bacteriology, in pathology, in biologic chemistry,
in surgery, in etiology and in application of technical methods
to diagnosis. Recently, however, pharmacologic research and the
application of scientific methods in the study of the physiologic
action of drugs are resulting in definite, positive progress. An
important lesson, incidentally learned through this scientific
investigation, is the fallibility of the drug therapy described in
textbooks. The explanation is, of course, that many of these textbooks
are mere compilations containing false statements, unproved theories,
and unverified clinical evidence representing the guesswork of ancient
uncritical observers. Many drugs have been, and still are, vaunted in
textbooks as valuable in a variety of conditions, whereas scientific
investigation and controlled clinical observation have proved them to
be totally worthless; others are proving to be of value in an extremely
limited number of conditions. The sooner writers of textbooks realize
this fact and enter into the spirit of the new era, the better for
the public and for scientific medicine.--(_Editorial from The Journal
A. M. A., May 27, 1916._)
THOMAS WEBSTER EDGAR
Tired Rabbits for Diabetes; Ring-Tailed Monkeys for Sex Stimulation
During the last two or three years The Journal has received inquiries
regarding one Thomas Webster Edgar, M.D., of New York City, first,
relative to his alleged treatment for diabetes and more recently about
his “monkey gland” treatment for sex stimulation. Here is one from a
physician in Washington:
“Have you any knowledge of the efficacy of a serum made from the
pancreas of rabbits for the relief or cure of diabetes? It is made
by Dr. T. W. Edgar of 766 West End Ave., New York City.”
And this from a layman in Pennsylvania:
“Last year there was published in the _New York_ Herald an account
of the new treatment for diabetes in which a serum was injected in
the veins and as a result it was claimed that over sixty-five per
cent. of the treatments made were successful. The account further
stated that they proposed to establish some sort of a sanitarium in
New York City used especially for the treatment. The writer having
mislaid the account, wrote the _New York Herald_ as to the doctor
who had charge of it and in return was given the name and address.
Dr. Edgar in a letter under date of last year stated that the cost
of the treatment was $300.00, payable beginning of the treatment,
and he gave very little information as to the success of it, with
the exception that if the treatment did not give the desired effect
after the end of three months, it would be continued without any
further cost. The writer wrote and asked him the names of one or
two of the patients who had been cured, because it seemed rather
unusual that if the treatment were a success, it was necessary for
a patient to pay the cost of the treatment in advance. To that
letter I have never received a reply.”
While a physician from Illinois writes:
“I am enclosing a clipping from a Chicago paper relative to
Dr. Thomas Webster Edgar of New York and his operation for
transplanting the glands of ring-tailed monkey. I note that he is
a member of the New York County Medical Society! What is there to
this? I have seen no mention of these wonders in _The Journal_.”
Thomas Webster Edgar was born in 1889. The records show that he was
graduated in medicine by the University and Bellevue Hospital Medical
College in 1913, and was licensed to practice medicine in the State of
New York the same year. In March, 1919, an article by T. Webster Edgar
appeared in the _New York Medical Journal_ on “Diabetes Mellitus.” In
this Edgar gave a theory of the cause of diabetes mellitus and stated
that he had “treated successfully, twenty cases of definite diabetes.”
In the article he spoke positively of the successful results he had
obtained by the “intramuscular injections of my diabetic serum.” No
information was given regarding this serum except that he mentioned
vaguely that it was “prepared from normal blood after the animal is
exercised to the point of fatigue.”
[Illustration: Photographic reproduction (reduced) of a few of the
newspaper items that appeared in various parts of the country regarding
Thomas Webster Edgar’s alleged serum for diabetes.]
A few days after the appearance of this article in the _New York
Medical Journal_, newspaper articles appeared regarding a cure for
diabetes perfected by “Dr. Thomas Webster Edgar, 766 West End Avenue,
New York City.” According to these reports, Edgar said:
“I tried the blood of rabbits and found what I wanted. In obtaining
the blood I first put the rabbit upon a treadmill and keep it there
until it reaches a stage of fatigue. Then I draw the blood, and
after heating it to 60 degrees centigrade separate the corpuscles
from the serum. When the serum has been treated after the method I
have discovered, I inject it immediately subcutaneously.
“I have attained success in 65 per cent. of my cases and I have
had 100 cases. I do not say that the cure is infallible, but I am
now certain that it will work in most cases, particularly when
the patient observes the rules laid down and undergoes faithful
treatment.”
In April, 1919, a physician in Kansas wrote to Edgar at the request
of a diabetic patient asking for information about the “serum.” Edgar
replied that it would be impossible to send the physician any of
the serum for administration unless the “patient is willing to pay
me for the cost of same, which will be approximately the sum of $25.”
He stated further that, in a few months’ time, he hoped to be able to
manufacture the serum in larger quantities which would “more than cut
the expense in half.”
In the same month a layman in Chicago who read the newspaper story
wrote to Edgar and asked for details regarding terms and the
arrangements that would have to be made to take the “treatment.” Edgar
replied that he expected to be in Chicago in a few weeks’ time and
would see the man in consultation with his regular physician, that
he would administer the first injection and give instructions to the
physician as to subsequent injections. Edgar added:
“My custom is to have all fees paid in advance and my charge is
$200.00 by certified cheque or money-order.”
A layman in one of the smaller cities of New York wrote to Edgar in
May, 1919, and received a reply from Edgar’s secretary stating that
the treatment extends “over a period of three months, cost $150.”
He was also told that the serum could be sent to his physician for
administration “for the sum of $25 prepaid by money-order.” The letter
closed with the statement that Edgar “has been very successful with the
serum.”
[Illustration: Photographic reproduction (greatly reduced) of small
portion of the publicity that has been given to Edgar relative to his
operation for “sex stimulation” by the transplantation of the glands of
ring-tailed monkeys!]
A layman in South Carolina who wrote to Edgar in June, 1919, was told
that the treatment as administered by Edgar “extends over a period of
two months; fee $300” and that if he wanted the serum administered by
his own physician the cost would be “$50 prepaid.”
In May, 1920, Edgar had another article on diabetes, also in the _New
York Medical Journal_. In this, too, he refers to his serum in the
following words:
“In conclusion I may state that I have been able to produce some
rather startling results by the use of my serum, which is prepared
from the blood of rabbits after they have undergone a series of
maneuvres capable of activating the various internal secretory
glands to increased action. The serum contains the internal
secretions in hormone form.”
Gradually the newspaper publicity on Edgar’s diabetic “serum” died
down. Then, in November, 1920, there appeared--again in the _New York
Medical Journal_--an article by Edgar on “Sterility, Sex Stimulation
and Endocrines.” Edgar there stated that he wished to place himself
“on record as being interested in sex stimulation” and that he wanted
to notify the profession that he had another serum which he was using
“with success in the treatment of this condition.” Thus:
“... I feel entitled to state that I have a distinctly beneficial
serum for the alleviation of presenile and senile deficiency; and
that my product is capable of producing a new lease of life in
those whose functions have been reduced to a minimum.”
How long Edgar has been featuring his “serum” for “sex stimulation”
it is difficult to determine, but during the last year the newspapers
have carried sporadic reports of alleged remarkable results produced
by “Dr. Thomas Webster Edgar of 766 West End Ave., New York,” through
the transplantation of the “interstitial gland” taken from “a special
species of orangoutang.” A layman who wrote Edgar some months ago
regarding this “gland implantation” received a letter from Edgar’s
secretary stating that the treatment “has been most successful in
all cases” and assuring him that “the experimental stage had been
passed, and the operation is advised in all cases presenting symptoms
of presenility or age.” A week later the same man received a letter
written by Edgar himself in which he reiterated the claim that all
of the operations had been successful. Edgar added that he was now
treating all cases “by operation instead of the serum,” and that
“the fee for operation is $500, inclusive of the sanitarium,” the
patients remaining in the “sanitarium” “for from two to three days.”
A month or two later the prospective patient received another letter
signed, “Thomas Webster Edgar, M.D.,” assuring him that “the effect is
permanent, and does not wear off. No ill effects can possibly result.”
Commencing, Oct. 1, 1921, a series of sensational articles appeared
regarding one of Edgar’s alleged monkey gland implantations performed
on an individual described as “one time lawyer and then a writer.”
These articles purport to be written partly by one of the newspaper
staff, partly by the man undergoing the “operation” and at least
one by Thomas Webster Edgar. The material is played up in the style
typical of yellow journalism. In addition to repeated pictures of the
individual who is being operated on, there also are given pictures of
Thomas Webster Edgar and one of his “ring-tailed monkeys.” Doubtless
the “story” has sold many newspapers. Its sensational character, the
element of mystery and above all its sex slant will appeal to that
large class of newspaper readers that hunger for stuff of this sort.
Doubtless, too, it has proved a large advertising asset for Thomas
Webster Edgar.
The statement that appears in the series to the effect that Edgar “is a
member of the County Medical Society of New York” is incorrect. Edgar
is not a member.
The further newspaper claim that Edgar is “an authority on glandular
transplantation” should also be accepted with reservations.
“Authorities” are created with ease in the pages of newspapers. Edgar
may possibly be termed an authority in a newspaper or, shall we say,
Pickwickian sense.--(_From The Journal A. M. A., Oct. 15, 1921._)
The Journal Receives a Letter Denouncing “Medical Clerks” and
“Biased Sceptres”
The Journal recently published in this department some inquiries
regarding Thomas Webster Edgar, M.D., of New York City, relative to
some alleged serums that Dr. Edgar had developed for diabetes and sex
stimulation, respectively, and relative also to the newspaper publicity
given Dr. Edgar in connection with the alleged transplantation of
glands from “ring-tailed monkeys.”
We are in receipt of a letter signed, “Thomas Webster Edgar, M.D.,” and
reading as follows. It is given _verbatim et literatim_:
“_Gentlemen_:--I have read with great interest your editorial
regarding the publicity given my work in metabolism, and gland
implantation.
“Your pseudo, expose, and distinctly libelous
insinuations are unjust, and they lead me to believe that you are
going to be called to account at a very early date.
“My profession is the practice of medicine, and the policy of my
practice is not controlled by the editorial department of the
journal. I am progressive, and a firm believer that legitiment
medicine and surgery can not be practiced if the physician be
governed by a set of medical clerks, who disdainfully boast that
they control, and govern the healing art through out the breadth
of the land, with a sceptre that is biased and steeped in the
unadulterated commercialism of a certain medical clique.
“Aside from the fact that I am an associate editor on a medical
publication, it is disgraceful, as well as unjust that you have
written such an editorial with out first investigating the
therapeutic value of my serum, and implantation operation.
“The psychology of your editorial, only reflects on your editorial
department, and will tend to belittle some of the greatest surgeons
in the country.
“It may be to your advantage to know, that this very afternoon, I
was on the program with the following men.
“Dr. Lewis Gregory Cole--New York
“Dr. Charles H. Mayo--Rochester, Minn.
“Dr. John B. Deaver--Philadelphia
“Dr. Charles Peck--New York.
“My paper was entitled--Senility, its etiology and treatment
by gland implantation. I am sure the above mentioned gentlemen
are thoroughly ashamed of your actions in the matter, as well
as thoroughly disgusted with the baby like attitude you have
displayed. You have no sense of fair play, and if it is with in
my power to undue the wrong which you have wrought me, I shall
endeavor to vindicate myself in the eyes of the clear thinking
members of the profession.
“I sincerely trust you will publish this communication, in order
that my brethren shall understand and appreciate that your thrust
has not gone unnoticed.
“It is my hope that the various medical societies through out the
country, will call upon me to read a paper on my work, so that I
may be able to offer substantial evidence to the fact that you have
done me an injustice.
“Very truly yours,
TWE/AEL [Signed] “Thomas Webster Edgar, M.D.”
Dr. Edgar’s statement that he had been on the program with Drs. Cole,
Mayo, Deaver and Peck was sufficiently startling to prompt further
investigation. It was found that the program in question was that of
the annual meeting of the New York and New England Association of
Railway Surgeons. It was further found that Edgar’s name did appear on
some of the printed programs but not on others. It was rather naturally
assumed that the name had been put on the program before the officers
of this organization had seen the crude publicity to which The Journal
recently called attention. It was found, however, that after several
hundred programs had been printed about 150 more were needed and “in
the meantime, Dr. Edgar had come into the limelight” in his ring-tailed
monkey gland transplantation rôle and “was invited to read a paper on
the subject.” While he accepted this invitation the secretary of the
organization tells us that Edgar did not read his paper but, when the
paper was called, declined, saying it was time for him to be in his
office!
As for the rest of Dr. Edgar’s communication, The Journal
appreciates that courtesy is due “an associate editor on a medical
publication”--referring doubtless to the _Western Medical Times_.
Dr. Edgar’s pronouncement that “legitimate medicine and surgery can
not be practiced if the physician be governed by a set of medical
clerks” seems reasonable--if cryptic. But it is when he charges that
these “clerks” govern the healing art “with a sceptre that is biased
and steeped in the unadulterated commercialism of a certain medical
clique,” that he really shines. Whatever opinion one may hold of Dr.
Edgar’s ability to compound serums, surely no one can question his
skill as a mixer of metaphors. His reference to “sceptres” deserves
to be embalmed in every textbook on rhetoric with the classic of the
Hibernian statesman who passionately declared: “I smell a rat! I see
it floating in the air! But, mark you, Sir, I shall nip it in the
bud!”--(_From The Journal A. M. A., Dec. 3, 1921._)
GLYCEROPHOSPHATES
Physicians who prescribe on definite principles must often be puzzled
by the number and variety of glycerophosphates on the market. All
available evidence indicates that, as sources of phosphorus to the
animal organism, the glycerophosphates possess no advantages over the
ordinary inorganic phosphates.[290] The glycerophosphates are split
up in the intestine, and liberate inorganic phosphates. In this form
they are absorbed and utilized, if they are utilized at all. There is
no evidence that glycerophosphates have any pharmacologic action to
warrant the belief that they are of use as therapeutic agents. The
theory that organic phosphorus compounds are more readily assimilable
than inorganic compounds and hence a better means of introducing
phosphorus into the system is still kept alive in the promotion of
certain proprietary mixtures, in spite of the scientific evidence that
the organism can assimilate phosphorus quite as readily from inorganic
as from organic phosphorus compounds.[291] The glycerophosphates will
continue to be manufactured until physicians refuse to prescribe them.
A chemist in the “research laboratory” of a well known manufacturing
firm has recently given a rather interesting reason for the use of
glycerophosphates--from the manufacturers’ point of view. He is quoted
as saying: “On account of the instability of phosphorus in elixir of
phosphorus, nux vomica and damiana we have quite recently replaced
the phosphorus by glycerophosphates. Such a preparation is apparently
equally as effective, for we continue to have a great demand for it.”
This is doubtless a sufficient reason for the substitution from the
manufacturers’ point of view; but how about the patient, who, after
all, is the one to be considered? Is it not a matter of considerable
importance to the patient whether he receives phosphorus, one of
the most powerful drugs known, or the inert glycerophosphates? The
chemist’s statement seems to imply that it is not. It may be of
interest to recall that a member of the firm whose chemist gives
this “reason” for the use of glycerophosphates, in a recent address,
was rather severe in his condemnation of institutions of learning,
hospitals, etc., for their lack of cooperation with manufacturers: he
said that “they should welcome an opportunity to let any manufacturer
try out or test his products in their clinics, laboratories, etc.”
A test as to whether there is a difference between the action of
glycerophosphates and ordinary poisonous yellow phosphorus, especially
when the former are mixed with extracts of nux vomica and damiana,
would not be likely to appeal to many hospitals and laboratories as
a very promising field of research at this day since, as has been
stated, the scientific evidence at present available does not furnish
any warrant for the therapeutic use of glycerophosphates.--(_Editorial
from The Journal A. M. A., April 15, 1916._) [290] Organic Phosphorus
Compounds, Editorial, J. A. M. A. 40: 1958 (June 21) 1913. Marshall,
E. K.: The Therapeutic Value of Organic Phosphorus Compounds,
J. A. M. A. 44: 573 (Feb. 13) 1915.
[291] Marshall, E. K.: The Therapeutic Value of Organic Phosphorus
Compounds, J. A. M. A. 44: 573 (Feb. 13) 1915.
INFLUENZA VACCINES
With the appearance of the epidemic of influenza, reports began to
appear, chiefly in newspapers, as to new serums, vaccines, drugs and
other methods for checking and even for curing the disease. A few
samples of such as have come to The Journal appear in our Tonics
and Sedatives Department this week. In Massachusetts, Commissioner
E. R. Kelly appointed two committees to investigate the value of
influenza vaccines as a preventive agent and as a treatment of
the disease. The first committee, a special board for scientific
investigation, consisting of Dr. M. J. Rosenau, chairman, and Frederick
P. Gay and George W. McCoy, was appointed to consider the evidence
available on the prophylactic and therapeutic use of vaccines against
influenza. This committee presented the following conclusions:
1. The evidence at hand affords no trustworthy basis for regarding
prophylactic vaccination against influenza as of value in
preventing the spread of the disease, or of reducing its severity.
The evidence from the present epidemic, though meager, suggests
that the incidence of the disease among the vaccinated is smaller
than among the nonvaccinated. The board, therefore, concludes that
further experimental evidence should be collected.
2. The evidence at hand convinces the board that the vaccines
we have considered have no specific value in the treatment of
influenza.
3. There is evidence that no unfavorable results have followed the
use of the vaccines.
The second committee, known as the Special Board of Statistical
Investigation, consisted of Dr. George C. Whipple, chairman, William H.
Davis and F. C. Crum. This committee reported:
1. The weight of such statistical evidence as we have been able to
accumulate indicates that the use of the influenza vaccine which we
have investigated is without therapeutic benefit. Exceptional cases
where apparent benefit has resulted from the use of the vaccine can
be matched by other cases where similar recoveries have been made
without vaccination.
2. The statistical evidence, as far as it goes, indicates a
probability that the use of this influenza vaccine has some
prophylactic value.
3. There is also some evidence to the effect that other methods
of protection, such as open-air treatment and the use of proper
masks, are effective in protecting exposed attendants, and the
use of vaccine should not be taken as an excuse for omitting such
safeguards.
As a result, the following recommendations were made:
That the state encourage the distribution of influenza vaccine
intended for prophylactic use, but in such manner as will secure
scientific evidence of the possible value of the agent. The use of
such vaccine is to be regarded as experimental.
That the state shall neither furnish nor endorse any vaccine at
present in use for the treatment of influenza.
These reports are conservative, and offer to other health commissioners
and their communities a reliable guide as to procedures that should
be adopted before subjecting or trying out on the public any method
of prevention or treatment that may be offered. These matters are the
domain of medical science, and medical scientists of recognized ability
should be called on to make the decision.--(_Editorial from The Journal
A. M. A., Oct. 19, 1918._)
Serums and Vaccines
With respect to serums and vaccines in influenza, there are certain
simple facts and considerations that physicians will do well to keep
in mind at this times. The main point to keep always in sight is that
unfortunately we as yet have no specific serum or other specific means
for the cure of influenza, and no specific vaccine or vaccines for its
prevention. Such is the fact, all claims and propagandist statements
in the newspapers and elsewhere to the contrary notwithstanding. This
being the case, efforts at treatment and prevention by serums and
vaccines, now hurriedly undertaken, are simply experiments in a new
field, and the true value of the results cannot be predicted by any
one. Indeed, the exact results can be determined if at all only after a
time, in most cases probably not until the epidemic is past and all the
returns fully canvassed. Consequently, the physician must keep his head
level and not allow himself to be led into making more promises than
the facts warrant. This warning applies especially to health officers
in their public relations.
As to serum treatment, the only noteworthy new method so far is the
injection in severe cases of influenzal pneumonia of the serum of
patients who have recovered from such pneumonia.[292] The principle of
this method is rational; analogous procedures have given seemingly
good results in scarlet fever and other diseases; and the results
reported in influenzal pneumonia appear promising. Further trial
of this treatment under proper conditions consequently seems to be
warranted. It should be borne in mind, however, that McGuire and
Redden[292] made their observations in the declining phase of the
epidemic when the organism or organisms concerned appeared to be losing
virulence. For this and other reasons, the expectations as to what may
be accomplished by this method must be kept within reasonable bounds.
Influenza is a self-limited disease with variable complications and of
variable severity in different places, thus offering great difficulties
in the way of evaluation of different methods of treatment.
[292] McGuire, L. W., and Redden, W. R.: Treatment of Influenza
Pneumonia by the Use of Convalescent Human Serum: Preliminary Report,
J. A. M. A. =71=:1311 (Oct. 19) 1918.
At least two kinds of vaccine are in use in the hope that they may
have preventive effects. One consists solely of killed influenza
bacilli; it being extensively used in the East. We have as yet no
decisive figures as to its effects, but there is an impression that it
may have some value. The other vaccine is a mixed vaccine of the more
important bacteria in the respiratory tract in influenza, principally
pneumonococci, streptococci and influenza bacilli. It appears that
vaccines of this nature are in extensive use, but we have no evidence
that any benefit will be derived from them. To say that thousands
have been vaccinated with apparently good results means nothing at
all, simply because we are still in the midst of the outbreak, in
many places even in the earlier stages. How slender the basis of
this anti-influenzal vaccination when it is considered that the real
nature of influenza is still unknown! In any event, it will require
many carefully elaborated and controlled observations before anything
definite may be learned in regard to the effect of these vaccines,
and it is probably safe to say that nothing on which to rely in the
future can be learned from the indiscriminate vaccination now going
on. There is, therefore, no basis on which promise of protection from
vaccines may be made. They may be harmless, and they may or may not be
of preventive value.--(_Editorial from The Journal A. M. A., Oct. 26,
1918._)
INTRAVENOUS THERAPY
The intravenous administration of drugs is a new departure in therapy,
but one which is rapidly increasing in use. Among its reputed
advantages are that it is the quickest means of obtaining the effects
of a drug, the effects are obtained with a certainty not obtained by
other methods, and they are so marked that they cannot fail to impress
the observer. These advantages in many cases are apparent rather than
real; but even were they real advantages, they should not blind us
to the various and serious dangers which this method involves. The
technic, although not difficult, must be thoroughly mastered, or
undue pain, infection, air embolism, or even death may result. Such
accidents, however, are ordinarily easily avoided, and should be
considered quite inexcusable. More serious is the fact that the drugs
given intravenously reach the system, and especially the heart, in a
different manner and concentration from that to which physicians are
accustomed with ordinary methods of administration. Pharmacologists
have long practiced intravenous administration, when studying acute
effects of drugs, and they have observed that frequently the immediate
result of such injections is a prompt fall of blood pressure, not
obtained when the same drugs are given by mouth or even hypodermically.
This fall in blood pressure is commonly attributed to irritation of
the endocardium. It is usually of short duration, but is certainly
undesirable and sometimes may have serious results.
It has also been observed that several drugs, for instance, quinin and
potassium, depress the cardiac muscle when given intravenously much
more than when given in other ways. Furthermore, any substance which
tends to precipitate proteins must be injected slowly and with extreme
caution, or it will produce intravascular clotting and sudden death.
Deaths have resulted not only from a lack of knowledge of the technic
of intravenous therapy, but also from a lack of knowledge of drugs
which may be so administered. Sudden death has been reported following
the injection of an iron preparation containing peptone, and also
following intravenous injection of ether. Intravenous injections, while
sometimes superior to the slower methods, are distinctly inferior when
a continuous, rather than a sudden, action is desired. Drugs leave the
blood system with great rapidity, and therefore their action on the
circulation will cease promptly unless they are continuously supplied.
It would be undesirable to inject intravenously such drugs as iodids,
nitrites, iron or salicylates.
With these dangers and disadvantages in mind, it seems unwise to
resort to promiscuous intravenous medication until the effects of
this method have been studied in detail for the drugs employed, and
unless there are distinct advantages to be secured. This is the case
when an immediate action is necessary in emergencies, as in the use of
strophanthin for cardiac collapse, quinin in pernicious malaria, etc.,
or if the drug would be destroyed in the stomach or tissues as in the
case of salvarsan, or when the drug is not adequately absorbed by any
other channel, as in the case of epinephrin.
Intravenous therapy will be most securely advanced if its employment
is restricted to such well defined fields. These fields can be
satisfactorily determined only by a scientific pharmacologic study of
the action of these drugs when so administered in animals, as well as
in man, under conditions in which the results are carefully controlled.
The intravenous method is an impressive one, approaching in preparation
almost to that which goes with a surgical operation. The patient is
usually interested and impressed by this new, and to him, mysterious
method. There is a psychic element in his reaction to the injection
which is not a factor in his reaction to the same drug when given by
mouth. The intravenous injection of a complex mixture would appear to
be particularly reprehensible. Little is known, as has been stated,
of the results to be expected from intravenous therapy, even with
simple substances. The use of complex mixtures will without doubt react
against the proper use of the method.--(_Editorial from The Journal
A. M. A., Nov. 11, 1916._)
IODIN FUMES
One of the important factors connected with therapeutics as a science
is the method of administration of medicinal substances. Drugs
may be given by mouth, by hypodermic or intravenous injection, by
inhalation, by inunction or, less frequently, by the use of other
entrances into the body. In choosing a method, the physical characters
of the substance to be administered and the immediate effects of the
substance on the body tissues with which it may come in contact must be
especially taken into consideration.
These factors apply particularly in the case of substances like
iodin, arsenic, mercury or the biologic products in which the mode
of administration radically modifies the action. For some time,
manufacturers have urged substitutes for tincture of iodin, claiming
that their substitutes were free from the undesirable properties of the
tincture, and, at the same time, possessed special virtues which the
tincture could not possess. More recently, attention has been directed
to the administration of iodin in the form of vapor. The diffusing and
penetrating powers of gases have particularly attracted the attention
of therapeutists, since by this method drugs may be applied to rather
inaccessible portions of the body, such as the lining of the lungs,
the throat and the mucous membranes of the genito-urinary tract.
Furthermore, it has been asserted that iodin in the form of fumes has
increased combining powers, and is thus far more potent in effect than
iodin administered by any other route. There do not seem to have been
any adequate scientific investigations of the subject, however, until
the recently published results of Luckhardt and his collaborators[293]
at the University of Chicago. In their experiments, both on man and on
animals, accurately determined quantities of iodin were vaporized in a
special device, and the fumes applied to the skin. At the same time,
the tincture was applied to the skin of other persons as a control.
Iodin was also applied to the skin of dogs with hyperplastic thyroid
glands; and the effects on the gland, before and after administration,
studied. Dogs were also used to determine whether iodin fumes were
absorbed from the lungs. As a result of these investigations, which are
reported in great detail, it was found that iodin, when deposited on
the skin in the form of fumes, is absorbed. More iodin was recovered
from the urine, following the application of the tincture, than was
recovered following the use of the fumes. This result is explained
by the authors on the ground that probably more iodin was actually
applied, and that the iodin so deposited was held in combination with
the protein during the process of coagulation of the latter by the
alcohol of the tincture, leading to a state of continuous absorption.
It is probable, furthermore, that the iodin deposited on the skin in
the form of fumes is revaporized to some extent by the heat of the body.
[293] Luckhardt, A. B.; Koch, F. C.; Schroeder, W. F.; and Weiland,
A. H.: The Physiological Action of Fumes of Iodin, J. Pharmacol &
Exper. Therap. 15: 1 (March) 1920.
Most important were the effects of iodin administered intratracheally
in the forms of fumes. Iodin given in this way seems to be rapidly and
completely absorbed; but it was found that the administration of the
fumes of iodin by inhalation through the respiratory passages, even in
small quantities, is fraught with great danger. Such administration
induces dyspnea; and when it is given in large quantities, acute and
fatal pulmonary edema ensues within twenty-four hours. When respiratory
disorders are present at the time of administration, the fatal edema
supervenes very quickly. Thus far, no device designed to deliver fumes
controls the dosage.
It is interesting to consider, as do the authors, the fact that the
fumes of iodin have the same effect as those of two other halogens,
bromin and chlorin. The results of these experiments with iodin fumes
on the dog, as shown by necropsy findings, are practically identical
with those reported by military surgeons as found in soldiers gassed
with chlorin during the war.
The results of these researches are additional evidence as to
how scientific research may confirm or deny conclusions based on
empiric therapeutic observations. The work may well serve as a model
for similar experiments, now being made, on the therapeutic use,
intravenously, of such substances as nonspecific proteins or organic
preparations of toxic drugs. The patient should at least have the
chance that is afford him by preliminary experiments, scientifically
performed on animals in the research laboratory.--(_Editorial from The
Journal A.M.A., May 29, 1920._)
ITALIAN PHYSICO-CHEMICAL COMPANY
Many and various are the letters received by The Journal asking for
information about an alleged scientific organization in Italy styled
_l’Académie Physico-Chimique Italienne_. This Italian Physico-Chemical
Academy is operated from Palermo, Italy. Here is the scheme: Dr. John
Doe, an American physician receives an imposing-looking letter bearing
the Palermo, Sicily, postmark and addressed to “_Monsieur le Docteur
John Doe, Médecin_.” On opening the letter “_Monsieur le Docteur_”
finds that the “Council” of _l’Académie Physico-Chimique Italienne_
has nominated him “Honorary Member of this Academy” and furthermore
has bestowed on him “a First Class Medal for technical work and
scientific merit.” All this, “in consideration of your many dignities
and great learning.” Dr. Doe is told that as soon as he will write an
acceptance of this honor “in conformity with Section 19 and 22 of the
Constitution” he will be sent “the Medal, Diploma and all the other
documents relating to the title accorded.” The joker in the scheme lies
in the necessity for Dr. John Doe “conforming” with “Section 19 and 22
of the Constitution.” Here are the sections:
[Illustration: Reduced photographic reproduction of the stock letter
sent to American physicians by the Italian Physico-Chemical Academy.
The “joker” lies in the requirement around which we have drawn a line.]
“_Sec. 19._--The entrance fee to cover office and postal expenses,
including postage of diploma is 5 Dollars, and is payable once at
the admission to the Academy by special bulletin filled up, stamped
and signed.”
“_Sec. 22._--Those to whom medals are awarded and who wish to
possess them must pay for their coinage 10 Dollars as the Academy
does not, at present, possess the necessary funds for this
purpose....”
In short the whole thing means that if Dr. Doe is willing to send $15
in good American money he will receive in due time from the academy a
“diploma” and a gilt (not gold) medal.
About four years ago when the “Academy” seemed to be making a
particularly heavy bid for American dollars the member of The Journal
staff in charge of the Propaganda Department wrote to the “Academy,”
on his personal stationery, asking about the cost of membership in the
“Academy” and asking also for a copy of the “prospectus.” And that
was all. In reply he received a letter stating that “in consideration
of” his “many dignities and great learning” he had been nominated “an
officer of this academy” and had been awarded “_la médaille de première
classe_” for humanitarian work and scientific merit. In order to obtain
these tokens of the “Academy’s” regard it would be necessary to inform
the “Academy” of acceptance “in conformity with Section 19 and 22 ...”
As the Propaganda Department did not consider the diploma and gilt
medal worth $15 even as exhibit for its museum of fakes, the “Form of
Acceptance” was not filled in and returned “in accordance with Section
19 and 22.”
[Illustration: Photographic reproduction (reduced) of the “Form of
Acceptance” to “membership” in the “Italian Physico-Chemical Academy.”
Filling out this blank and sending it _with $15.00_ to the “Academy”
will bring the gilt medal and “diploma.”]
The leading spirits in the operation of this diploma and medal mill are
D. and G. Bandiera, who, so far as we can learn, are neither physicians
nor pharmacists nor have any scientific standing. The “Academy” has
been referred to at various times[294] by The Journal.--(_From The
Journal A. M. A., Feb. 26, 1916._)
[294] J. A. M. A. 48: 2196 (June 29) 1907; Editorial 57: 1373, Berlin
letter, p. 1380 (Oct. 21) 1911; 58: 1455 (May 11) 1912; 60: 770 (March
8) 1913; 60: 1480 (May 10) 1913; 61: 1737 (Nov. 8) 1913.
WHAT IS LIQUID PETROLATUM?
The use of liquid petrolatum in chronic constipation, which has
recently become the vogue, has naturally been commercialized; as a
result, also naturally, claims of superiority of one brand over another
have been made. Some of these claims may have been well founded; others
certainly are not. Some have claimed superiority for those products
made from Russian oil over those made from American oils. As naphthene
hydrocarbons predominate in Russian crude petroleums, and paraffin
hydrocarbons in many or most American crude petroleums, it was assumed
that the petrolatums derived from these sources differed from one
another in like manner. Both the naphthenes and the paraffins are
chemically inert; but some unexplained therapeutic superiority has been
assumed to reside in the naphthenes. Consequently, it has been urged
that the American liquid petrolatums should not be used internally. So
far these claims and counterclaims have been based on much theory and
little fact. The Journal publishes this week a contribution by Benjamin
T. Brooks, Senior Fellow in charge of petroleum investigations at
Mellon Institute, Pittsburgh. Brooks calls attention to the fact that
Marcusson, in 1913, pointed out that most of the so-called “mineral
oils” used for therapeutic purposes contain no paraffin hydrocarbons
whatever; that they consist solely of naphthenes and polynaphthenes.
Brooks confirms this statement so far as American liquid petrolatums
are concerned. He states that many American petroleums, such as most
of those from the Gulf region, are like the Russian in containing no
paraffin; and that, in the case of those petroleums that do contain
it, the customary refinery method of removing paraffin is sufficient
to produce true naphthene and polynaphthene petrolatums. “The claim
that only Russian oils belong in this class,” he says, “has no basis
in fact and has been advanced presumably for business reasons.” The
name “paraffin oil” applied to these liquid petrolatums, then, is a
misnomer. The new name, “white naphthene oils,” suggested by Brooks,
seems superfluous, however, since the pharmacopeial title, “liquid
petrolatum,” is subject to no such objection.--(_Editorial from The
Journal A. M. A., Jan. 1, 1916._)
THE LOWENTHAL POSTGRADUATE COURSE
Which Tells How to Make Diagnoses Accurately, Scientifically Check
the Christian Scientists and Increase Your Earning Power
During the past year The Journal has received letters from physicians
in various cities asking for information regarding the “Post Graduate
Course of Lectures and Clinics on Nervous and Mental Diseases” which
was going to be given in their respective cities by Dr. Albert A.
Lowenthal of Chicago. The following inquiries are typical:
“_To the Editor._--Please note the enclosed letter from the
American Organotherapy Company which appears to be conducted by
Lowenthal. The proposition of conducting these clinics impresses me
as a piece of colossal gall which is amazing even in these days. Do
you know anything about this matter?”
“_To the Editor._--Who the dickens is Albert A. Lowenthal, M.D.?
Note the circular enclosed. I have blue circled the remarks he
evidently thinks will attract.”
In May, 1919, Chicago physicians received a form letter, signed,
and on the stationery of, Albert A. Lowenthal, notifying them that
Dr. Lowenthal was about to “give a Post Graduate Course of Lectures
and Clinics on nervous and mental diseases” in the “Banquet Hall,
Morrison Hotel.” Enclosed was a “Programme and Reservation Card” and
a self-addressed envelop for physicians to notify Dr. Lowenthal that
they would be present. In addition to showing physicians “how to make
diagnoses accurately,” Dr. Lowenthal offered to “explain fully how to
scientifically check the Christian Scientists and increase your earning
power!” And all for nothing!
At later dates similar letters were received by physicians in other
cities, on the stationery of the “American Organotherapy Company, Room
902, 31 North State St., Chicago.” Dr. Lowenthal, whose Chicago office
is Room 901, 31 North State St., is, apparently, president, treasurer
and practical owner of this company. Enclosed with each of these
letters--which offered the same inducements, free--was an envelop
addressed to Albert A. Lowenthal in care of the hotel at which Dr.
Lowenthal would stay while in that city. There was also a “Programme
and Reservation Card” as in the case of the letters sent to Chicago
physicians.
According to our records, Dr. Albert A. Lowenthal was born in Chicago
in 1874 and was graduated by the College of Physicians and Surgeons,
Chicago, in 1895, receiving his license the same year.
In a leaflet issued some time ago by Albert A. Lowenthal, M.D., “for
the sole purpose of enlightening Prospective Patients in regard to
the therapeutic value of the Organo Therapy Treatment for Nervous
Diseases,” we learn that Dr. Lowenthal is, or was:
“Professor Nervous and Mental Diseases, Chicago Hospital College of
Medicine.”
“Formerly Professor Nervous and Mental Diseases, Dearborn Medical
College, Jenner Medical College.”
“Adjunct Professor on Neurology and Psychiatry, University of
Illinois College of Medicine.”
“Formerly Physician Illinois Eastern Hospital for the Insane.”
“Formerly Supt., Riverview Hospital for Nervous Diseases, Kankakee,
Ill.”
“Formerly on Advisory and Associated Attending Staff Cook County
Hospital.”
In Polk’s Medical Directory for 1904, Dr. Albert A. Lowenthal’s name
appeared, under Chicago, at 910-912 Chicago Opera House Building.
He was described as “Superintendent of Lowenthal’s Sanitarium.” In
the same issue of the directory, there was a display advertisement
of the Lowenthal Sanitarium, which, while located at Kankakee, Ill.,
had its “main offices” at 912 Chicago Opera House Bldg., Chicago. The
advertisement was headed “GOAT LYMPH TREATMENT,” and read in part:
“Goat Lymph has revolutionized medicine, and has been adopted by
the scientific medical world as the only therapeutical agent that
will absolutely bring about positive results in chronic conditions,
such as Neurasthenia, Nervous Collapse, Paralysis, Locomotor
Ataxia, Brain Fag, Oncoming Insanity, Chronic Stomach Disorders, in
fact such diseases needing cell stimulation.”
It mentioned further that Dr. Albert Lowenthal “introduced Goat Lymph
to the medical world as a curative agent.”
A few years ago a Chicago concern, known as the “American Animal
Therapy Co.,” put out such products as “Lymphoid Compound (Lowenthal),”
“Ova Mammoid (Lowenthal),” “Prostoid (Lowenthal),” etc. The American
Animal Therapy Co. had for its manager James M. Rainey. Rainey also
operated the “Rainey Medicine Co.,” a mail-order “patent medicine”
concern that sold “Vitaline,” a “general debility cure.” The Rainey
“Vitaline” quackery was exposed in The Journal, Oct. 1, 1910, and the
matter appears in “Nostrums and Quackery.”
When the American Animal Therapy Company was operating from 84 Adams
St., Chicago, it claimed to have a hospital and laboratory at Kankakee.
At the same time letters were being sent out on the stationery of
“The Lymph Hospital,” signed Albert A. Lowenthal, M.D. Although this
“hospital” was at Kankakee, Ill., the address on the stationery was 84
Adams St., Chicago, and its telephone number was that of the American
Animal Therapy Company. According to the stationery, the “Medical
Department” of the Lymph Hospital was “under the personal direction
of Dr. Albert A. Lowenthal, who introduced the Lymph Compound and
Lymphoid Compound to the Scientific Medical World as a curative agent
in Chronic Nervous conditions.” A layman received a letter from the
“Lymph Hospital” urging him to take “Lymphoid Compound.” Later he
received a “follow-up” letter, from which the following extracts are
made. Capitals used as in the original:
[Illustration: Some letterheads (greatly reduced) of concerns in which
Dr. Albert A. Lowenthal has been interested.]
“Do you know that the doctors of this country are using the
LYMPHOID COMPOUND EXCLUSIVELY in all cases, where the nervous
system is greatly involved, with the most MARVELOUS RESULTS. ISN’T
THAT SUFFICIENT PROOF as to the merit of the remedy?”
“... Nobody can tell you there is something just as good, because
THERE IS NOTHING JUST AS GOOD AS THE LYMPH--in fact IT IS THE ONLY
THING THAT CAN BE DEPENDED UPON.”
“... Our Dr. Lowenthal gives his personal attention to all cases
at the Hospital and devotes a portion of his time advising by
mail those persons under treatment who are unable to come to the
Hospital. He is a man of WORLD WIDE REPUTATION IN TREATING NERVOUS
DISEASES--HIS ADVICE ON CASES LIKE YOURS IS WORTH EVERYTHING TO
YOU.”
“Think this over and if you do, you will write an order today for
the Lymphoid Compound. The home treatment costs $9.50 for thirty
three days--think of that. You have our physician’s advice and care
free of charge--could anybody ofter more to you?”
In 1908 Dr. Lowenthal appeared as a witness for Edward R. Hibbard,
who was being prosecuted by the federal authorities. Hibbard operated
a “men’s specialist” office in Chicago; it had two entrances and a
different name for each entrance--the “Boston Medical Institute” and
the “Bellevue Medical Institute.” Hibbard was found guilty of fraud in
the operation of this concern and was fined $1,500. The transcript of
the testimony in the Hibbard case records that Dr. Albert A. Lowenthal,
when on the stand, claimed to “have treated as many nerve patients as
any nerve specialist in Chicago.” He further declared, according to the
transcript, that physicians who make a specialty of nervous diseases
“mature in about ten years” and that after that time most of them
become nervous wrecks or insane. This was in 1908. In this connection
it is worth noting that in letters sent out by Lowenthal in May, 1919,
he claimed:
“In the past twenty-five years I have limited my work to
neurological and psychological cases....”
In 1908 also, Dr. Lowenthal was sending out letters to Illinois
physicians in his capacity as secretary of the “Physicians’ League of
Illinois.” The “league” issued a “report on candidates for governor
and members of legislature,” giving the names of the various political
candidates for office whom “the members of the league can safely
support.” There were no “membership” fees and a physician who wrote
asking “who foots the bills” received no reply.
In 1915 Albert A. Lowenthal, whose “valuable discoveries in the
domains of Organo Therapy, Neurology and Pediatrics, have given him an
international reputation as a Neurologist, Alienist and Climatological
Expert of high standing,” was “Medical Superintendent” of the “National
Sanitarium Information Bureau.” This purported to represent the
“Leading Sanitariums and Health Resorts in the U. S.” The “Bureau”
expected to make its “profit from the 10 per cent. honorarium received
on every referred patient.” The “Business Manager” of this concern was
one Hubert Miller, M.D. The following advertisement appeared in the
classified department of the _St. Louis Post Dispatch_ in 1915:
[Illustration]
A layman who wrote in answer to this advertisement received a letter
from Dr. Lowenthal in which he said that it was his intention to take
about thirty patients south with him for four months--cost of trip
$500, which includes medical treatment, board, etc. Dr. Lowenthal
stated further:
“I have treated probably more cases of Locomotor Ataxia and
Paralysis than any Physician in United States and can honestly
state that with Organo Therapy Treatment your walk can be improved
and pains controlled.”
In March, 1919, Dr. Lowenthal paid a visit to Spokane, Wash., and
Portland, Ore. A Portland paper heralded his coming and printed a
picture of “Dr. A. A. Lowenthal, World famous alienist.” The paper
described Dr. Lowenthal as “the alienist consulted in the Harry Thaw
case” and the one “who treated John Alexander Dowie of Zion City
fame and Pope Leo XIII.” The fulsome puffery that Dr. Lowenthal got
while in Spokane drew criticism from one or two members of the local
medical profession, who wrote to the newspapers protesting. One of
the physicians who thus wrote declared that Lowenthal’s “coming was
announced in a circular sent through the Owl Drug Company which is
agent for the sale of products of an organo-therapy company.”
Apparently, it was after Dr. Lowenthal’s return from the Pacific Coast
that he commenced to announce his “Post-Graduate Course of Lectures and
Clinics” to the physicians of Chicago, Denver, St. Louis, Columbus,
etc.--and, incidentally, to bring to the attention of the medical world
the alleged virtues of the products of the American Organo-Therapy
Company.--(_From The Journal A. M. A., July 3, 1920._)
MEDICAL SOCIETY OF THE UNITED STATES
From “Division of Fees” to “Down with Autocracy”
The “Medical Society of the United States” has for its “Honorary
President” one A. H. Ohmann-Dumesnil, A.M., M.D., M.E., Sc.D., Ph.D.,
and for its “Secretary and Treasurer” one Emory Lanphear, M.D., C.M.,
Ph.D., LL.D. As originally planned, the “society” seems to have been
based on the idea of organizing the “fee-splitters.” In May, 1916,
the birth of the organization was announced to the medical profession
through a letter signed Emory Lanphear, written on the stationery of
the “Medical Society of the United States.” Even in its embryonic
state the society had A. H. Ohmann-Dumesnil, A.M., M.D., M.E., for its
president, and Emory Lanphear, M.D., Ph.D., LL.D., as its treasurer.
The letter read in part:
“We--the majority of the medical profession--who believe in
division of fees (_i. e._, that the surgeon should not ‘hog’
the whole of a patient’s money and leave nothing for the family
doctor), are no longer welcome in the A. M. A. We are therefore
organizing the Medical Society of the United States, which will not
be conducted for the benefit of a few selfish egotists. We would
like to have you with us.
“It costs only $1.00 to join. This covers dues for 1916, and
includes expense for the beautiful certificate of membership
(suitable for framing), which you will receive on admission. Fill
enclosed blank and return to me with $1.00.”
But presumably the idea of organizing on a basis of “fee splitting”
did not make a hit, so the lure was changed. Today physicians are
approached with the plea that the “Medical Society of the United
States” will make the medical world free for democracy; it is, we are
assured, a “Society of Protest Against the Autocracy of the A. M. A.,”
and a “Society of Medical Democracy.”
Membership costs “only $1.00 ... including the cost of a beautiful
certificate of membership.” No penalties or punishments are involved
for belonging to other societies, and:
“Joining our body need not affect your membership in any other
society--even the A. M. A., if you wish to belong to it, and be
‘bossed’ by the ‘Simmons Gang’.”
The dollar for the “beautiful certificate” and membership is solicited
by means of circular letters signed “Emory Lanphear,” coming from 3447
Pine St., St. Louis, Mo., the address of what has been variously
called the “American Polyclinic,” the “American Hospital,” and later,
the “German Hospital.” The “Surgeon-in-Charge” of the “German Hospital”
is Emory Lanphear, M.D., C.M., Ph.D., LL.D. When running under the
name of the “American Hospital,” Lanphear solicited operative work on
a “division of fees” basis, which, the general practitioner was told,
meant that “you are to have 40 per cent. of all fees received from your
patients sent to our staff for operation or treatment.”
With the change in name from “American Hospital,” to “German Hospital,”
Lanphear appealed for a “portion of your operative work on a basis of
pure reciprocity.” This “pure reciprocity” seems to have been a still
more liberal distribution of the patient’s money, for from a 40 per
cent. basis it was raised to an even fifty-fifty. Said Lanphear, in a
letter sent out a few months ago:
[Illustration: The “Medical Society of the United States,” was
originally organized on a basis of “fee-splitting,” as is shown by the
reduced facsimile of a letter sent broadcast in 1916, announcing the
birth of the new “society.” Apparently, “fee-splitting” as a rallying
point did not bring in the desired returns, so today the “Medical
Society of the United States” is alleged to be a “Society of Protest
Against the Autocracy of the A. M. A.”]
“I wish also to inform you in spite of the despicable opposition
of the hypocritical gang in charge of the A. M. A., and the no
less contemptible action of the St. Louis Medical Society, I am
going to remain in St. Louis and continue to do surgical work upon
a ‘division of fee’ basis. To be more explicit, if you bring me a
case for operation I shall allow you one half of the fee for your
time, trouble, responsibility and help in the management of the
case.”
Before leaving the interesting professional personality of Lanphear,
and carefully avoiding any details of a personal nature, we may remind
our readers that as long ago as 1908 Lanphear was the “Dean” of the
“Hippocratean College of Medicine,” with A. H. Ohmann-Dumesnil, A.M.,
M.D., M.E., Sc.D., “Vice-Dean.” At that time Lanphear sent out letters
to physicians proposing the organization of a “Post Graduate Faculty”
on the following basis:
“Those who hold full professorships shall purchase stock in the
corporation to the amount of $1,000.00; those who become lecturers
or instructors shall pay in the sum of $500.00; those who are to be
merely clinical assistants will buy ten shares of stock, $100.00.”
The “Hippocratean College” was a “sundown” affair; it never graduated a
student, and expired in 1910.
[Illustration: Reduced facsimile of the letter-heads of an institution
known variously as the “American Hospital” and the “German Hospital.”
The change in name from “American” to “German” seems to have taken
place early in 1915--when things German were more popular and
profitable than they are today!]
But to come back to the “Society of Medical Democracy”: The “Medical
Society of the United States” seems to have been born in 1916. Its
parents, so far as is apparent, seem to have been Lanphear and
Ohmann-Dumesnil. The latter, it may be remembered, used to be the
editor and proprietor of the _St. Louis Medical and Surgical Journal_,
a publication so obviously venal, that its value to the nostrum makers,
whose interests it espoused, must have been small. Advertising pages,
“original articles” and “editorials”--all were used to puff nostrums of
the crudest type. It was Ohmann-Dumesnil and his journal that came to
the defense of the “patent medicine” interests when they were so hard
hit by Mr. Adam’s “Great American Fraud” series. In commenting on this
phase of “patent medicine” activities, _Collier’s_, in January, 1907,
said:
“Headache powders came in for a considerable share of attention in
the patent medicine articles. There was much talk of libels among
the headache powder makers, but they decided upon the safer methods
of hiring a meretricious medical publication, the _St. Louis
Medical and Surgical Journal_, to print an article in which the
_Collier’s_ statements were branded as lies, and the _Collier’s_
editors and writers as liars and libelers. This article the
Proprietary Association of America circulated in pamphlet form. The
journal which printed it died a natural death a few weeks later.
Its editor, one A. H. Ohmann-Dumesnil, has just appeared in the
public prints in an unsavory connection with a corrupt lobbying
project in St. Louis.”
Some of the nostrums that Ohmann-Dumesnil has recommended are:
“Sanmetto,” “Gonosan,” “Cactina Pillets,” “Pepto-Mangan,” “Satyria,”
“Campho-Phenique,” “Tongaline,” “Germiletum,” “Narkogen,” “Nosophen,”
“Mercauro,” “Arsenauro,” and “Hydrozone.” Many of these testimonials
were, of course, used by the manufacturers in their advertising
“literature.”
At the time that the Medical Society of the United States was being
organized--in 1916--there was published what purported to be a
preliminary program of its first meeting. The meeting was held in St.
Louis, and the program, while containing the names of men with special
fads or interests to exploit, also contained the names of some men of
standing. It appeared, however, on investigation, that at least some
of the latter had but a hazy conception of the use to which their
names were being put, and protested vigorously on learning the facts,
repudiating the organization.
[Illustration: Reduced facsimile of a letter sent out in 1912,
soliciting the purchasing of stock in the “American Hospital” on a
division of fee basis--forty-sixty!]
Now, in 1918, another drive is on for membership; letters signed “Emory
Lanphear” are being sent to various selected groups of physicians. For
example, the Eclectics are being coaxed by a letter which commences:
“We want every reputable Eclectic practitioner in this country to
join our society of protest against the iniquities of the A. M. A.”
An identical letter has been addressed to Homeopaths, the words
“Homeopathic practitioner” being substituted for “Eclectic
practitioners.” In all of the letters the “beautiful certificate
of membership” is emphasized, and the trivial cost--“only $1.00 a
year”--is referred to, while the plea: “surely you are willing to help
to that amount to ‘down’ the ‘gang’ in charge of the A. M. A.,” is
featured. Another group of letters has gone out to the graduates of the
Barnes Medical College. This commences:
“Most graduates of ‘Old Barnes’ have joined our society of protest
against the iniquities of the A. M. A. Why should you also not come
in? It costs only $1.00 to become a member, including the cost of a
beautiful certificate of membership.”
Still another group appeal is based on sex; thus Lanphear:
“We want every reputable ‘lady physician’ in this country to join
our society of protest against the iniquities of the A. M. A.”
And yet another:
“You formerly belonged to the Tri-State Medical Society, of which I
was Treasurer for 20 years. It is now dead. I wish you would join
our new society which has superseded Tri-State in this territory.”
With these various letters is enclosed a “preliminary program” of the
1918 meeting which is to be held October 8 and 9 in Chicago. As might
be expected, many of the names on the program are characteristic of the
organization and an interesting “story” might be made from the material
in The Journal’s files on the individuals. Such names are of men, who,
professionally speaking, range from faddists, who ride grotesque and
bizarre medical hobbies, to those who with special interests to exploit
and unable to use reputable medical organizations for that purpose,
take refuge in such hybrid conglomerations as the Medical Society of
the United States. Not that the program contains the names of crude
quacks, or obvious medical swindlers. It is representative, rather, of
that twilight zone of professionalism, the penumbra, in whose uncertain
light it is difficult to distinguish between the unbalanced visionary,
with a fad, and the more sinister near-quack, with a “scheme.”--(_From
The Journal A. M. A., Oct. 5, 1918._)
THE NATIONAL FORMULARY--A REVIEW OF THE FOURTH EDITION
The fourth edition of the National Formulary appears simultaneously
with the U. S. Pharmacopeia IX, and is to become official at the same
time (September 1). The principles which determine its scope, as
frankly set forth in the preface, are apparently the same as those
applied, though more faint-heartedly, in the compilation of the
Pharmacopeia. A statement in the preface of the new National Formulary
runs:
“The scope of the present National Formulary is the same as in
previous issues, and is based on medical usage rather than on
therapeutic ideals. The committee consists entirely of pharmacists,
or of men with a pharmaceutical training, and it cannot presume
either to judge therapeutic practice or to follow any particular
school of therapeutic practice. The question of the addition or
deletion of any formula was judged on the basis of its use by
physicians and its pharmaceutical soundness. The considerable use
by physicians of any preparation was considered sufficient warrant
for the inclusion of its formula in the book, and a negligible or
diminishing use as justifying its exclusion.”
Part I of the volume contains formulas, good, bad and indifferent,
including the equivalents of a large number of shotgun proprietaries.
Part II contains descriptions of drugs. This is a new feature. The
purpose is to provide standards for those drugs not described in
the Pharmacopeia but used in N. F. preparations. Many of these drugs
were described in the U. S. Pharmacopeia VIII, but have not been
included in the ninth revision. Practically all are either worthless
or superfluous. Part III contains descriptions of special tests and
reagents.
Among the therapeutically useful formulas are those for aromatic castor
oil, emulsion of castor oil, sprays or nebulae, solution of aluminum
acetate, solution of aluminum subacetate and wine of antimony. The two
last named are also included in “Useful Drugs.” Several formulas for
new classes of preparations which may or may not be found superior
to old forms are paste pencils for the application of medicaments to
limited areas of the skin, mulls, which are ointments spread like
plasters, and fluidglycerates, which are fluidextracts in which
glycerin takes the place of alcohol. It should be noted also that, as a
result of criticism, the alcohol content of some preparations has been
reduced.
As a whole, the present edition of the National Formulary, like its
predecessors, is “pharmaceutically useful but not a therapeutic
necessity.” To say that it is not a therapeutic necessity is to
state the matter mildly, since most of the formulas and almost all
of the drugs described have been discarded long since by rational
therapeutists. So long as there are physicians who prescribe
therapeutic monstrosities, however, the druggist should have the
aid that is furnished by this book in compounding them. From the
pharmacist’s point of view, therefore, the book is a valuable one.
Physicians who have a scientific training in the pharmacology of drugs
will not want it; others will be better off without the temptations
offered by its many irrational formulas.--(_Book Review in The Journal
A. M. A., Sept. 2, 1916._)
NONSPECIFIC PROTEIN THERAPY
The treatment by nonspecific methods in a series of cases of influenzal
pneumonia has been the subject of two recent papers.[295] These methods
are a development of the work of Ichikawa, Kraus, Lüdke, Jobling and
Petersen, and others on the treatment of typhoid fever and of Miller
and Lusk’s work on arthritis. In the original work in this field it
was recognized that there were certain inherent dangers in the method
and that wide application would be permissible only with the greatest
caution and under careful control.
[295] Roberts, Dudley, and Cary, E. G.: Bacterial Protein Injections
in Influenzal Pneumonia, J. A. M. A. =72=:922 (March 29) 1919. Cowie,
D. M., and Beaven, P. W.: Nonspecific Protein Therapy in Influenzal
Pneumonia, J. A. M. A. =72=:1117 (April 19) 1919.
When vaccines and other toxic protein substances are injected
intravenously a train of reactions takes place that includes: (_a_)
a primary leukopenia, followed by a leukocytosis; (_b_) a primary
lessening of the coagulability of the blood, followed after some
interval by a reduction of the coagulation time; (_c_) a pronounced
lymphagogue effect, the flow of lymph from the thoracic duct being
increased threefold; (_d_) a hyperperistalsis of the intestinal tract,
and (_e_) a marked splanchnic engorgement with a resulting lowering of
the systemic blood pressure. The alteration of the coagulability of the
blood, together with the vascular engorgement of the splanchnic area
and the coincident increase in motility of the intestinal tract that
follow the therapeutic injection, all tend to increase the possibility
of intestinal hemorrhage. Protein therapy is therefore not a safe
procedure in this particular disease. That we are able to terminate a
certain number of cases of typhoid fever by crisis by means of such
injections is of very great interest from a theoretical point of view.
In the treatment of arthritis, the results seem much more satisfactory.
The work of Miller and Lusk[296] has been confirmed by a number of
observers, among them Culver, Cecil, Snyder, Cowie and Calhoun; and
there seems little doubt that we may be able to give prompt relief and
even permanent freedom from symptoms in a considerable percentage of
cases of acute and subacute arthritis, especially those classed as of
rheumatic origin--and this with practically no risk to the patient.
[296] Miller, J. L., and Lusk, F. B.: The Treatment of Arthritis by the
Intravenous Injection of Foreign Protein, J. A. M. A. 66: 1756 (June 3)
1916; The Use of Foreign Protein in the Treatment of Arthritis, ibid.
67: 2010 (Dec. 30) 1916.
As with other new therapeutic measures, there is still some uncertainty
as to the proper dosage, which is a matter of considerable importance,
in order to arrive at a just estimate of the relative advantage or
danger in the treatment. Typhoid vaccines have been extensively used
because they are readily procured and give a prompt and sharp reaction.
However, they have the disadvantage of inexactitude in the bacterial
count, as well as being of varying degrees of toxicity, the latter
factor depending not only on the use of different strains of bacteria
in their preparation but on the age of the vaccine. Synder,[297]
as well as other workers, is of the opinion that the primary dose
should be small--from five to ten million organisms--and that the
dose of typhoid bacilli injected should never exceed two hundred and
fifty million. While a sharp reaction on the part of the patient
is apparently a desideratum, a sufficient response can usually be
elicited with a relatively small dose. There is no object in subjecting
the patient to the risk of the profound depression that follows
occasionally in the wake of large doses. Indeed, the only serious
results so far ascribed as due to this form of therapy have followed
very large doses or the use of relatively large doses in moribund
patients; or such unreasonable procedures as the intravenous injection
of milk. It is true that milk injections were recommended by some of
the German investigators, but they were always used intramuscularly.
[297] Snyder, R. G.: A Clinical Report of Nonspecific Protein Therapy
in the Treatment of Arthritis, Arch. Int. Med. 22: 224 (Aug.) 1918.
In the treatment of pneumonia, Roberts and Cary[4] have employed a
vaccine made up of 100 million of each of the following organisms per
cubic centimeter: influenza bacilli, pneumococci, staphylococci and
streptococci. Of this vaccine they injected, intravenously, first
0.5 c.c., later 1 c.c. In the series of 200 patients so treated there
was no evidence of injury to the patients in any way. The mortality in
this series was 9.5 per cent.; in a series of eighty-six patients not
treated with vaccine, the mortality was 31.2 per cent. In the untreated
series, 20 per cent. recovered by crisis; in the treated, 36 per cent.
so recovered. Before any reliance is placed on such statistics they
should be analyzed and compared carefully according to age periods, as
the death rate may vary at different ages. Cowie and Beaven[298] used
typhoid vaccine in the treatment of their patients, and they consider
the vaccine shock as indicated only in the early stages of pneumonia.
[298] Report of International Health Board, Social Medicine, Medical
Economics and Miscellany, J. A. M. A. 72: 751 (March 8) 1919.
Before applying the treatment to such diseases as pneumonia it would
seem that prudence would demand a thorough familiarity with the range
of the reaction and the degree of toxicity of the preparation it is
intended to use by first employing it in some arthritic cases. In
pneumonia we must ever keep before us the vital factor of cardiac
impairment; and certainly we must not undertake any measure that may
depress the function of the heart. In arthritis this danger is largely
a negligible one; and, with proper precaution, nonspecific therapy is
not only without risk but indeed frequently followed by gratifying
clinical improvement. Only in the light of experience gained in the
manner indicated would it seem permissible for us to attempt to extend
this form of therapy to more acute infections.--(_Editorial from The
Journal A. M. A., May 17, 1919_.)
WILLARD EALON OGDEN
A “Specialist in Proctology” and His “Clinics”
Within the past few weeks a number of inquiries have reached _The
Journal_ from physicians in Ohio, Indiana and Pennsylvania. Those that
follow are typical:
“I am in receipt of literature from H. L. Roberts, 1126 Masonic
Temple, Chicago, advertising clinic in Cleveland by Dr. Willard E.
Ogden who claims to be a member of the Chicago Medical Society and
the A. M. A. What can you say of this man and his methods?”
“I am enclosing a folder received a short time ago. I would be glad
to know if Dr. Ogden is a member of the A. M. A. as he claims to
be.”
“The enclosed folder has been sent to many doctors in Indiana. The
purpose is plain. The attached post card on this one was returned
to him for further literature.”
[Illustration: Photographic reproduction of one of Ogden advertisements
in Chicago newspapers at the time he was at 36 W. Randolph Street.]
In each case the correspondents send in a four-page folder bearing the
title “Proctology, A Clinic. Who? Where? Why?” Three of the four pages
purport to answer the interrogations given on the title page. Under
“Who?” we read:
DR. WILLARD E. OGDEN
Chicago, Ill.
SPECIALIST IN PROCTOLOGY
_Member Chicago Medical Society and A. M. A._
_Author of “Improved Method of Treating Rectal Diseases”
Formerly associated with Drs. Burleson & Burleson
Grand Rapids, Mich._
Under the question “Where?” there appears the statement that “Dr.
Ogden Will Hold a Clinic for The Treatment of Rectal Diseases” and the
name of the city and the dates of the “clinic” are inserted with a
typewriter.
Under “Why?” we read:
“Dr. Ogden does not use the usual surgical methods. His many years
of experience in the treatment of Rectal Diseases (during which
time he has been associated with the leading Proctologists of
America) have enabled him to develop a system of office treatment
_which is not taught by any other practitioner_.
“Tear off, sign and mail attached postcard and I will send you a
booklet giving you full particulars as to the course.
Yours truly,
H. L. Roberts, Business Manager.
“Eighty-three per cent. of the people have some Rectal trouble.
THIS IS THE DAY OF SPECIALISTS. Why not fit yourself to specialize
in Proctology?”
The fourth page is a post card addressed to “H. L. Roberts, Room 1126,
Masonic Temple, Chicago.” On the reverse side there is a printed
statement which the recipient is expected to sign to the effect that
he is interested in “Dr. Ogden’s Clinic” and wishes to have “full
particulars of the course.”
A visit to Room 1126, Masonic Temple, failed to disclose the name of
H. L. Roberts, either on the door (or doors, for there are two rooms
having this number) or on the office building directory board. In fact,
Rooms 1126 seem to contain a somewhat miscellaneous assortment. The
signs, either on the door or on the directory board, show that there
is a public stenographer (who operates a “Mailing Service,” and does
“Addressing, Mailing, Multigraphing, Mimeographing”), a bookstore, a
chocolate company, a publishing company, a lumber company, and one or
two other concerns; but the name of “H. L. Roberts” does not appear.
Incidentally, no “H. L. Roberts” is to be found listed in the Chicago
telephone directory.
A few yards away from Rooms 1126 and on the same floor there appears
the name, “Dr. Willard E. Ogden” on Room 1102.
According to our records, Willard Ealon Ogden was born in 1866. Before
taking up the study of medicine he seems to have been a preacher. In
1899 he was graduated by the Saginaw Valley Medical College, Saginaw,
Mich. He was licensed in Michigan in 1900, in Illinois and Indiana in
1913, and in Wisconsin in 1921. From 1900 until 1904 he practiced in
Lyons, Mich.; from 1906 until 1911 he was at Ionia, Mich.
In 1911, he was in Grand Rapids, Mich., and was associated with
Burleson and Burleson, an advertising pile cure concern. From some
of the voluminous Burleson advertising on file, we learn that they
“cure all diseases of the rectum (except cancer);” and claim to have
“the most successful method ever discovered,” and to have cured “many
desperate cases that have been given up to die.” Furthermore, they
“guarantee to cure in every case or make no charge.”
On Jan. 1, 1914, Ogden was sending out a card to physicians in which
he stated that he had removed from Grand Rapids, Mich., and LaPorte,
Ind., to 36 W. Randolph St., Chicago, and that he would limit himself
“exclusively to the treatment of diseases of the rectum.” Later, Ogden
was sending out an advertising booklet filled with testimonials.
In 1914, Ogden was carrying display advertisements in Chicago papers
reading, in part, in large back-faced type: “Piles Cured Absolutely
Without Knife, Anesthetics, Pain or Loss of Time.... Cure Guaranteed or
Money Refunded.”
In March, 1918, he became a member of the Chicago Medical Society and
qualified for Fellowship in the American Medical Association, August,
1918.
In 1921, Ogden had a copyrighted mail-order course on the “Treatment
of Rectal Diseases by Improved Method.” This “course” consisted of
thirty-eight pages of foolscap printed on one side in imitation
typewriting. The material abounded in typographical errors. Among
the proprietary products recommended in this “course” as “essential”
to those taking it, was “Mecca Ointment.” This nostrum, made by a
Chicago concern, was declared misbranded in 1916 because of false
and fraudulent claims made knowingly, recklessly and wantonly. The
“course” was divided into ten parts, and with it, apparently, came
ten consecutively numbered sealed envelops, and the purchaser was
instructed to open these envelops, one at a time, as he completed the
corresponding part in the “course.” He would there find questions which
were to be answered and returned to Ogden. This, according to the
description, was to enable Ogden to determine whether it was necessary
to “enter more into detail upon that particular subject,” which, he
stated, he would gladly do if necessary.
[Illustration: Photographic reproduction (reduced) of the first page of
a booklet Ogden was sending out in the latter part of 1914.]
Furthermore, the purchaser had the privilege of asking questions of
Ogden relative to symptoms, diagnosis and treatment for a period of
six months after the purchase of the “course.” Although, in Ogden’s
opinion, “you should have the subject well understood long before that
time.”
The charge for this course and “services as outlined” was $200, but in
order to show his confidence in the ability of those who purchased it,
Ogden was willing to take $100 down and the other $100 paid in “five
per cent. of monies received from CURED patients” until the balance was
paid.
Reverting to the present “post-graduate course” and “clinic”: Those
who send in the postal card to “H. L. Roberts” receive a form-letter,
signed “H. L. Roberts” in facsimile handwriting, stating that
information was enclosed “regarding THE OGDEN METHODS” and stating
that Dr. Ogden would be in Indianapolis or Cleveland or Pittsburgh, as
the case might be, on a certain date and that the fee for the “clinic”
would be $100. With this letter is an eight-page pamphlet entitled
“Some Facts Concerning the Ogden Method of Treating Rectal Diseases.”
The first page is headed in black-faced type: “About References
and Endorsements.” It then states that the “usual references and
endorsements are omitted from this booklet.” Further:
“As to Dr. Willard E. Ogden: The professional and social standing
of Dr. Ogden is such that he does not need to offer any.
“As to ‘THE OGDEN METHOD’ and its value to you in your professional
work: What others say or think has little if any weight. You are
your own man. You do your own thinking. You decide for yourself--Do
you not?”
[Illustration: Photographic reproduction (greatly reduced) of an
advertisement of the Burleson concern with which Ogden was connected
previous to 1914, and which connection he is capitalizing in his
present advertising.]
The booklet gives an outline of the “Course of Instruction,” which is
almost identical, word for word, with the outline given in the letter
advertising the mail-order course previously referred to.
The booklet further states that “THE OGDEN METHOD has entirely
eliminated the use of cautery, the ligature or any injections, in the
treatment of hemorrhoids,” but that “the use of the electric current
has proved to be the very correct method in such cases, as will be
demonstrated at the clinic.” The booklet reiterates the statement that
Ogden’s association with the Burleson and Burleson concern at Grand
Rapids makes him “eminently well qualified to instruct members of the
medical profession in this important branch of the medical science!”
In addition to this booklet there is a four-page advertising
leaflet illustrating and describing the “Ogden Rectal Cabinet” and
also the “Ogden Rectal Table and Stool.” There is also a little
postcard--addressed, of course, to “H. L. Roberts”--for the physician
to fill in stating that “you may enroll me as intending to attend Dr.
Ogden’s Clinic in Proctology, to be held at----.” Should the recipient
not fill in and mail this enrolment card he gets another form letter
calling attention to the fact that the enrolment card has not been
received and stating further that “available hotel facilities make it
necessary to limit our enrolment to twenty students.”
Careful search fails to disclose that Dr. Willard Ealon Ogden has ever
distinguished himself in the practice of the specialty in which he now
wishes to instruct physicians. Equally careful search fails to show
that Dr. Ogden has ever published a paper either on any proctologic
subjects or on any other phase of medicine or surgery. Neither does
there seem to be any evidence for the claim that Dr. Ogden “has been
associated with the leading Proctologists of America.”--(_From The
Journal A. M. A., Feb. 4, 1922._)
“PATENTS”
Patent Laws and Patent Office Practice
The inequity of our patent laws, or possibly it would be more correct
to say, of the interpretation of our patent laws, has been commented on
many times in The Journal. The Journal also has had occasion to call
attention to patents that have been issued for obviously unscientific
and quackish devices and preparations. The cases of the preposterous
gas-pipe fake “Oxydonor” and the creatinin mixture for the alleged
conferring of immunity against diphtheria, pneumonia, scarlet fever,
syphilis, tuberculosis, etc., are cases in point.
In a patent issued the early part of this year for the “discovery” of
a method of flavoring Epsom salt, the patent office has, in fatuity,
piled Pelion on Ossa. The “inventor” declares that his invention
relates to a pharmaceutical preparation and a special method of
treatment of the medicinal agents whereby said agent will be rendered
much more efficient in character. He further avows that the “prime
object” of his “invention” is to “disguise the normal taste and impart
an agreeable odor or smell to salts commonly employed as a cathartic.”
Parenthetically it may be said that probably not a day passes that
some physician in the United States does not do substantially the same
thing when writing a prescription. The “inventor” further claims that
the object of his “invention” is to utilize the salts as a vehicle
to carry an antiseptic and anesthetic agent whereby the salts when
administered as a cathartic “will also act beneficially on the entire
digestive tract” and “whereby cramped and spasmodic conditions are at
once relieved with a resulting cure of flatulency, indigestion, sick
and sour stomach, colic and the destruction of worms, etc.”
Such claims are so absurd that the only excuse for commenting on
them is the effect they have on the public mind. The layman reading
the specifications of this patent would naturally conclude that an
invention of great importance had been made--of such importance as to
warrant the government in rewarding its inventor by granting him a
seventeen-year monopoly on the sale of his invention.
The law requires that, to be patentable, inventions shall be new and
useful and shall show a higher degree of skill in their inception than
is naturally to be expected from those who are skilled in the arts to
which the inventions belong. It has been decided again and again that
physicians’ prescriptions are not patentable because it is assumed
that an educated physician will utilize his knowledge of pharmacy in
devising proper compounds of medicines to meet the indications of
disease. When a physician prescribes a dose of Epsom salt to be taken
in one of the official aromatic waters, he does not produce or create a
new invention by so doing. Of course, in one sense every prescription
is an invention--an invention to meet the conditions presented by the
patient--but such inventions are not patentable, because they represent
the ordinary skill of a physician in carrying on his vocation.
If the patent office goes on granting patents for such “inventions” as
flavored Epsom salt, and it should be found financially profitable to
secure such patents and place the products on the market, it will only
be a matter of time before the materia medica will be so restricted
that a physician will be unable to write a prescription without
infringing on somebody’s patent.
The splendid conception of the framers of our constitution in providing
a plan for promoting progress in science and useful arts by granting
to inventors for a limited time the exclusive use of their inventions,
in exchange for the publication of full knowledge thereof, is being
debased. No branch of our government is of greater importance to the
progress of the country than the patent office, provided that office is
intelligently administered. When the patent office is used, however,
for an extention of the nostrum business, founded on the abuse of
patent and trade-mark laws, it becomes a menace to the public health.
The objects of the patent law are being defeated by the practices of
the patent office.--(_Editorial from The Journal A. M. A., June 23,
1917._)
Our Archaic Patent Laws
In this issue we publish two reports of the Council on Pharmacy and
Chemistry which illustrate the weaknesses of the present working of the
United States patent laws. In the first report the Council presents
an investigation of a recently granted patent, and shows that the
patent was issued on the mere claims of the applicant and without the
presentation of any evidence for such claims. The second report--“Need
for Patent Law Revision”--is an appeal to the Patent Office for a
more enlightened administration of the patent law, and it presents a
few illustrations of the unfair protection which has been granted by
the Patent Office. The protest of the Council appears at an opportune
time. In _Science_[299] _the “Patent Office Society,”_ an association
of employees of the U. S. Patent Office, announces that a committee
has been created on request of the National Research Council to make
a study of the U. S. Patent Office and its service to science and
arts. It states that this committee will meet in Washington shortly
to consider the adequacy of the present Patent Office equipment and
the simplification of procedure as well as responsiveness to present
national and international requirements. The committee also hopes
to coordinate, in the interest of an improved public service, the
endeavors of the various national societies, manufacturing interests,
patent bar associations and all others aiming at genuine patent reform.
Unquestionably, there is a growing conviction that in the case of
medicines the monopoly given by the patent laws, if granted at all,
should be granted with greater consideration of the public welfare.
Too often the United States Patent Law has been used to obtain an
unfair monopoly on a medicament or to abet quackery. There is no
question that one of two things is needed: either a radical change
in the patent law itself or the application of more brains in its
administration.--(_Editorial from The Journal A. M. A., Jan. 12, 1918._)
[299] Dec. 28, 1917, p. 629.
Patents Perpetuated by Trade Names
The patent on aspirin[300] (acetylsalicylic acid), controlled by
the Bayer Company, American representative of the Farbenfabriken of
Elberfeld Company, will expire next year (1917). The Journal has
previously stated that the grant of this patent was regrettable and
worked injustice to American citizens. It is unnecessary again to go
into the grounds for this statement; neither in the Farbenfabriken’s
home country, Germany, nor in any other country except in the United
States, has a patent been granted for this product. Owing to their
monopoly, the manufacturers have been able to exact a much higher
price for acetylsalicylic acid, or aspirin, in this country, than
elsewhere. Naturally, the Bayer Company, the American agents, view with
disfavor the prospect of being compelled to share this rich field with
competitors. The foregoing furnishes the answer to inquiries which have
reached us from all over the country with regard to the campaign of
publicity which the Bayer Company has inaugurated in the lay press. A
presumably authentic and apparently candid exposition of the methods
used and the motives behind the aspirin advertising is furnished in
_Printers’ Ink_:[301]
[300] Granted Feb. 27, 1900.
[301] Printers’ Ink, June 29, 1916, p. 189; July 13, 1916, p. 100.
“The manufacturers of aspirin are about to launch an extensive
advertising campaign to clinch the market as far as possible before
the expiration of their patent rights next year.... The purpose
of the campaign is to identify the product with the trademark of
the Bayer Company and to this extent hamper competition after the
expiration of the patent.”
The business of the Bayer Company, the article goes on to say, has been
hurt by the sale of worthless or even harmful imitations put on the
market by irresponsible and unauthorized persons when the present war
stopped importations from Germany.
“The public knew aspirin, but did not know who made it [italics
ours].... When the Bayer Company, Inc., took over the manufacture
of aspirin in this country, the first steps were taken to identify
the product with the firm who made it.... Of course, there are good
reasons why the makers were loth to advertise the product or to
exploit their trademark. As every one knows, the advertising of a
medical proposition is an extremely ticklish subject.... It is easy
to make a misstep. Aspirin is one of those proprietary drugs that
are extensively prescribed by physicians. If anything were done
that might possibly associate this drug with the patent medicines
that are in disfavor with the profession, the valuable influence
and cooperation of thousands of doctors might be lost. It is
believed that this knotty phase of the question is being answered
in the present advertising.... Since nothing is mentioned about
‘medicine,’ ‘cures’ or ‘ailments,’ it is anticipated that there
will be but little objection to the copy. All that the advertising
attempts to do is to link up the name ‘Bayer’ with aspirin....
The nearest the copy gets to medical talk is in this sentence in
very small type at the bottom of the advertisement, ‘The trademark
“Aspirin” (Reg. U. S. Patent Office) is a guarantee that the
monoacetic acid ester of salicylic acid in these tablets is of the
reliable Bayer manufacture.’”
From this it appears that, not content with seventeen years of
monopoly, the aspirin people are attempting to retain a hold on
the market _in perpetuo_ by associating the name of the company
with the trade name “aspirin.” There can be no better time than the
present, therefore, for the medical profession to substitute, for
the nondescriptive name “aspirin,” the descriptive and correct name
acetylsalicylic acid.--(_Editorial from The Journal A. M. A., Aug. 12,
1916._)
Patenting Therapeutic Agents