In the past, therapeutic agents and apparatus have been controlled

by patents and trademarks for profit. If there have been exceptions,

they have been rare. The Principles of Medical Ethics of the American

Medical Association contain this statement: “It is unprofessional

to receive remuneration from patents for surgical instruments or

medicines.” This does not mean that the patenting is wrong in itself;

there are occasions when it is wise, if not necessary, to obtain a

patent in the interest of the public, and, in the case of surgical

instruments and medicines, of the medical profession. In certain

instances it is absolutely necessary that the article produced shall

maintain a definite standard of quality and purity--and, it may be

added, shall be sold at a reasonable price. Enterprising pharmaceutical

manufacturers have usually been ready to appropriate the results of

scientific research by investigators or therapeutic measures suggested

by practicing physicians. Not infrequently, in such instances, the

desire for financial gain has caused the marketing of such products

with extravagant, if not false, claims as to their value. Yet the

patent laws may be used so as to protect and benefit the public and the

medical profession. In research laboratories, work is being carried on

resulting in the production of new therapeutic agents. It is important

that these agents shall be so controlled that they may be made

available without subordination to commercial interests. It has become

practically necessary, therefore, for research workers to protect

their products in the interest of the public welfare and scientific

medicine. It has not been an easy matter to decide how best to bring

about the desired results. This question has been before the Board of

Trustees of the American Medical Association; and, in 1914, the House

of Delegates passed a resolution authorizing the board to accept at its

discretion patents for medical and surgical instruments and appliances;

as trustees, for the benefit of the profession and the public,

provided that neither the Association nor the patentee should receive

remuneration from these patents. The Rockefeller Institute for Medical

Research has solved the problem in a similar manner. In connection with

the report of the discovery of several new arsenic compounds, Jacobs

and Heidelberger,[302] working in the Rockefeller Institute, say:

[302] Jacobs, W. A., and Heidelberger, M.: Aromatic Arsenic Compounds,

II, The Amides and Alkyl Amides of _N_--Arylglycine Arsonic Acids, J.

Am. Chem. Soc. =41=:1587 (Oct.) 1919.

It may be appropriate to mention here that this substance and

related compounds, described in the present and following papers of

the series, are covered by U. S. Patents Nos. 1280119-27. Patents

have also been applied for in foreign countries. All discoveries

made at the Rockefeller Institute are made freely available to

the public, in accordance with the philanthropic purposes of the

institution. In order to insure purity of product and protection

against exploitation, it has been deemed necessary in certain

instances to protect the discoveries by patents. It is the purpose

of the institute to permit any drugs which may prove of practical

therapeutic value to be manufactured under license by suitable

chemical firms and under conditions of production which will

insure the biological qualities of the drugs and their marketing

at reasonable prices. Other than through the issuance of license,

the Rockefeller Institute does not participate in any way in the

commercial preparation or sale of the manufactured chemicals; and it

receives no royalties or other pecuniary benefits from the licenses

it issues.

Here we have medicine at its best. The altruism of pure science

operating for the benefit of the general public: scientific

therapeutics freed from commercial domination.--(_Editorial from The

Journal A. M. A., Oct. 18, 1919._)

PHARMACEUTICAL BARNUMS

Does the public love to be humbugged? We doubt it. That we, whether

sage or fool, _are_ humbugged is undeniable. We are humbugged just

to the extent that we are ignorant. There lies one of the most

powerful factors operating to the advantage of the “patent medicine”

maker and the quack. The layman’s ignorance of the possibilities and

limitations of drugs is wide and deep. Hence the ease with which he

is fooled on this subject. A seeming frankness in advertising being

the order of the day, the nostrum maker makes a pretense of telling

what is in his stuff without disclosing any facts that will tend to

lift the veil of mystery and thus destroy his greatest asset. So the

exploiter of nostrums to the medical profession, realizing that at

least a pretense must be made of giving the composition of medicaments

offered to the physician, declares that his clay poultice has for its

base “anhydrous and levigated argillaceous mineral.” This sounds much

more imposing than dry and finely powdered clay, and satisfies by its

very sonorousness. Now comes a product exploited chiefly to members

of the dental profession but also, it seems, to physicians. Tablets,

“activated tablets,” if you please! They are “an anodyne, analgesic

febrifuge sedative, exorcising [_sic!_] antineuralgic and antirheumatic

action.” And their composition? Simply “an activated, balanced

combination of the mono-acetyl-derivative of para-amidophenetol

together with a feebly basic substance in the alkaloidal state from the

Thea-Sinensis.” As clear as the Missouri River! Some day some dentist

or physician is going to investigate and find that this awe-inspiring,

polysyllabic example of exuberant verbosity means nothing more

mysterious than our old friends acetphenetidin (phenacetin) and

caffein. In the meantime, the exploiters may smile softly and murmur,

“Barnum was right!”--(_Editorial from The Journal A. M. A., Jan. 1,

1921._)

THE PHARMACOPEIA

The Ninth Decennial Revision

The ninth revision of the United States Pharmacopeia became official

this week, Sept. 1, 1916. It is more fully reviewed elsewhere;[303]

here we desire merely to call attention to two points; what the book

is and what it is not. It is a book of standards for drugs; it is

not a book of standard remedies. The Committee of Revision of the

Pharmacopeia included physicians and pharmacists (retail, wholesale

and manufacturing), but the pharmacists were in the majority and

in control. The majority of the representatives of the medical

profession on this committee would have preferred to see the bulk

of the Pharmacopeia reduced and its value as a work of reference

enhanced by the rejection of therapeutically worthless drugs. The

representatives of commercial interests, on the other hand, argued that

it was necessary for the Pharmacopeia to provide standards for drugs

in more or less general use, whether worthless or otherwise. The force

of this argument is somewhat impaired by the fact that the National

Formulary, which has also been made a book of legal standards, now

includes individual drugs as well as combinations; the new edition of

the Formulary, in fact, contains a large number of drugs which had been

dropped from the U. S. Pharmacopeia VIII. The principle of making use

the sole criterion for admission to the Pharmacopeia, however, on the

whole carried the day. It has not been strictly observed; good results

from the efforts of the medical contingent are to be observed here and

there, as in the deletion of elixir of the phosphates of iron, quinin

and strychnin and of emulsion of cod liver oil with hypophosphites.

That these instances were not expressions of policy on the part of the

Committee on Revision, but merely deviations from policy, may be seen

by a glance at the contents of the new Pharmacopeia. These include

substances which have been shown to be inert, like the hypophosphites

(calcium, potassium and sodium hypophosphites), complex and obsolete

mixtures, like the compound syrup of sarsaparilla, and drugs which

have been tried and found wanting, like saw palmetto berries. Even

substances seldom used by the medical profession, but chiefly or

altogether by the public, like sassafras, hops and peppermint (the

herb), are standardized and made official. It seems difficult to

discover any principle by which the sphere of the Pharmacopeia may be

definitely marked off from that of the National Formulary. There is

one great advantage in specifying U. S. P. drugs and preparations:

Physicians who do so invoke legal standards of purity and identity. The

only way to be sure of obtaining substances of therapeutic efficiency,

however, is to exercise discrimination. The Pharmacopeia is no guide.

Being prepared mainly by pharmacists to meet the needs of pharmacists,

the Pharmacopeia of course contains much matter of little interest to

physicians and entirely foreign to scientific medicine.--(_Editorial

from The Journal A. M. A., Sept. 2, 1916._)

[303] J. A. M. A. =67=:764 (Sept. 2) 1916.

Review of Ninth Revision

The ninth revision of the United States Pharmacopeia, which has been

in the hands of the Committee of Revision for more than six years, has

just appeared. As was to be expected, the desire of medical men on the

Committee of Revision to have therapeutic value made a requirement for

admission to the Pharmacopeia has not been fully realized; it remains

a book of standards for therapeutically good, bad and indifferent

remedies. Among the drugs of little or no therapeutic importance

or value are musk, arnica, eriodictyon, quassia, pumpkin seed, saw

palmetto berries, sarsaparilla and couch grass. Many superfluous

drugs and preparations are included. For instance, of the nine forms

of quinin described (quinin alkaloid, bisulphate, dihydrochlorid,

hydrobromid, hydrochlorid, salicylate, sulphate and tannate, and quinin

and urea hydrochlorid), at least four might well have been eliminated.

Two insoluble forms (the alkaloid and the tannate), two soluble forms

(the hydrochlorid and quinin and urea hydrochlorid), and a moderately

soluble form (the sulphate) are all that could reasonably be demanded

by even the most extreme partisans of the doctrine of “pharmaceutic

necessity.” Further, the use of quinin salicylate for its salicylic

acid content and of quinin hydrobromid for its bromid content is

unscientific. The inclusion of these salts in the Pharmacopeia is

regrettable.

Those interested in the promotion of rational therapy will also regret

the inclusion of a number of fluidextracts of violently toxic drugs,

such as aconite and gelsemium (dose 1/2 minim each), belladonna root,

digitalis, nux vomica and ipecac (dose 1 minim each), and lobelia (dose

2-1/2 minims). The more diluted forms, the tinctures, of these drugs

are preferable. The inclusion of such fluidextracts in the Pharmacopeia

is playing into the hands of certain pharmaceutical manufacturers, who

recommend the tincture be prepared from fluidextracts--an unscientific

procedure.

The efforts of the medical members of the committee, however, have

not been entirely fruitless. Of the articles described in the U. S.

Pharmacopeia VIII, 243 have been deleted; sixty-seven new articles have

been added. The loss of 167 titles may be set down as a gain. Moreover,

most of the new substances give promise of therapeutic usefulness.

Thirty-six are taken over from New and Nonofficial Remedies; nineteen

are substances which are in the edition of Useful Drugs now in the

press. It cannot be said, however; that all of the additions have been

judiciously selected. It is an infelicitous time to add calcium and

sodium glycerophosphate just when grave doubts of their therapeutic

efficiency are being felt. The addition of the extracts of aconite,

hydrastis and viburnum prunifolium is likewise unfortunate. All are

superfluous preparations, the first because a drug so powerful that

an average dose of the extract is only 10 mg. or 1/6 grain is better

given in the form of tincture; the second because hydrastis is a drug

of uncertain value, already represented by three preparations, and the

third because viburnum prunifolium has been discarded and discredited

by the best therapeutic authorities. It must be accounted clear gain,

on the other hand, that the deletions include many inert, obsolete

or superfluous substances like bismuth citrate, kaolin cataplasm,

pipsissewa, coca leaves, ladyslipper, wahoo, cotton root bark,

compound acetanilid powder and compound syrup of hypophosphites, not to

mention nine salts of iron and thirty-eight fluidextracts of various

drugs. Wines, unmedicated and medicated, whisky and brandy are also

among the articles dropped.

A number of new features are introduced, such as microscopic standards

for powdered drugs, standard abbreviations for titles, the use of

the term “mil” instead of “cubic centimeter,” and a chapter each on

sterilization, diagnostic reagents, biologic assays, electrolytic

determination of metals and the determination of alcohol, the melting

point, the boiling point and the congealing point.

The chemical nomenclature is substantially the same as that adopted in

the previous revision; so is the nomenclature of drugs. The addition of

official abbreviations for the Latin titles of drugs will doubtless be

found a useful feature.

Less commendable is the change from the familiar “Cc.” to “mil.” The

term “cubic centimeter” is so thoroughly established and so widely

used, wherever the metric system is employed, that it cannot be

expected that it will be universally displaced by the word “mil.” The

latter is therefore only a superfluous synonym, and as such out of

harmony with the simplicity of the metric system. Perhaps it may even

be taken for the abbreviation of “millimeter,” “milligram” or other

words derived from “mille,” which would be equally entitled to the same

abbreviation.--(_Book Review in The Journal A. M. A., Sept. 2, 1916._)

PHYSICIAN’S STOCK IN PRESCRIPTION PRODUCTS

The letter that follows comes from a physician who feels that he has a

grievance regarding a company in which he holds stock:

“In 1914, I bought some stock of the ---- ---- Company, and in 1917

bought some more stock in the same company. I notice that the company

advertises in The Journal of the American Medical Association, and I

believe it does this not so much to acquaint the medical profession

with its product, as to acquaint physicians with its name in order that

its stock salesmen can keep on unloading more stock to members of the

medical profession.

“The company gets the doctors’ money through the sale of stocks, it

gets its product on the market with the doctors’ assistance and through

their influence, and it looks to me as if the doctors were getting very

little in return, as the dividend checks have been few and far between

since I have known anything of the company.

“It is not my idea to criticize the product; but I do believe and feel

that the stockholders are entitled to a square deal from a company

which in turn is expecting so much from them, and again I feel that the

publishers of The Journal should be made aware of these conditions so

that they do not either consciously or unconsciously foster a concern

that is depriving the physician of his hard-earned money.

“If this letter is unfair, I am willing to be shown otherwise. Kindly

publish it in The Journal, omitting my name and address.”

The company to which our correspondent refers put out a proprietary

product prescribed by physicians and used by the public. Some years ago

the company in question advertised its product in The Journal until its

stock-selling scheme was brought to the attention of The Journal; the

advertisements were then rejected. Some years later, on evidence that

the company had discontinued its stock-selling methods to physicians,

its product was again admitted to the advertising pages of The Journal.

Our correspondent says that he believes that the physicians who hold

stock in this company “are entitled to a square deal.” What about the

public? Is it getting a square deal when physicians are financially

interested in the products that they may be called on to prescribe?

Is the average layman’s confidence in the medical profession likely

to be enhanced when he learns that the physician to whom he went for

treatment has a financial interest in the therapeutic agent which

was prescribed? Our correspondent’s complaint against the company

seems to be, not that the company sold stock to physicians, but that

“the dividend checks have been few and far between,” the assumption

being that had the dividends come regularly, there would have been no

complaint. It cannot be too often emphasized that it is against public

interest and scientific medicine for physicians to be financially

interested in the sale of products which they may be called on to

prescribe for the sick. It is perfectly true that there are many

physicians who would not consciously permit financial considerations

to warp their judgment; but it is not humanly possible to remain

unbiased in cases of this sort. It is conceivable that a judge on the

bench might make every effort to dispense impartial justice in a suit

in which one of the parties was a firm in which he, the judge, had

financial interest. Nevertheless, it would be obviously improper for

such a judge to try a case of this kind. Yet, in this supposititious

case the only harm that could result would be of a financial nature. In

the case of the physician, the harm is not to the public’s purse but to

the public’s health.--(_From The Journal A. M. A., Dec. 11, 1920._)

PITUITARY GLAND PREPARATIONS

The importance of the standardization of preparations of the posterior,

or infundibular, lobe of the pituitary gland (the liquor hypophysis

of the new United States Pharmacopeia, pituitary solution, pituitary

extract, etc.) is exemplified by a recent publication of Roth.[304] As

is well known, the active constituent or constituents of this gland

have not been isolated, and there is no chemical method of determining

the activity and therapeutic value of various preparations. There

are, however, certain physiologic methods by which the activity of

such preparations may be determined with a considerable degree of

exactness. The last revision of the Pharmacopeia, recognizing that

the best attested field of usefulness for such preparations is in

obstetrics, adopted as a test their activity on the uterus of the

guinea-pig; the details of the method adopted by the Pharmacopeia are

those described by Roth.[305] Roth now reports on the activity of

seven samples of commercial infundibular extracts, the products of

five American manufacturing pharmacists. Four of these samples were

found to be of Pharmacopeia strength; the other three were much weaker.

Of the latter, one had but one tenth, another but one fifth and the

third but one fourth of the required activity. Those preparations

which had been accepted by the Council on Pharmacy and Chemistry

for inclusion in New and Non-official Remedies corresponded to the

Pharmacopeia requirements. Roth also compared the activity of these

seven preparations on the blood pressure, another method by which

it has been proposed to standardize infundibular extracts. The four

preparations which were equally active on the uterus were found to be

equally active on the blood pressure; the other three were much weaker.

Roth points out, however, that the results of the two methods are not

necessarily parallel; in one instance, for example, two samples caused

equal rises of blood pressure, but one was twice as active as the other

on the uterus. Hence it is evident that the blood pressure test is not

a satisfactory method for determining the activity of a preparation on

the uterus, and vice versa.

[304] Roth, G. B.: Pituitary Standardization, Bull 109, Hyg. Lab.,

U. S. P. H. S., 1917.

[305] Roth, G. B.: Bull 100, Hyg. Lab., U. S. P. H. S.

The subject of pituitary standardization, or perhaps it may be said

the application of the present method is, however, in need of further

study. Thus the statement has recently been made[306] that commercial

preparations are on the market which have from three to five times

the activity of the Pharmacopeia standard; this was not the case,

however, with the preparations examined by Roth. It is probable that

some have used for comparison a weaker standard than that proposed

by the Pharmacopeia; this, of course, would lead to the conclusion

that the commercial preparations were stronger than the Pharmacopeia

standard. Roth suggests that the employment of standards of unequal

activity by the various supply houses could easily be eliminated by

having a central laboratory distribute material for use as a standard.

It will be recalled that before the United States Public Health Service

established and began the distribution of standards for diphtheria and

tetanus antitoxins, the commercial preparations of these varied even

more in activity than do those of the pituitary extracts at present.

[306] Pittenger, P. S., and Vanderkleed, C. E.: Jour. Am. Pharm. Assn.

=6=:131, 1917.

It is unnecessary to emphasize the importance of this subject; this is

sufficiently evident to those who have followed the recent clinical

literature on the use of pituitary extracts in obstetrics. These

preparations are used in times of emergency; a weak preparation is

valueless, whereas overdosage, either from too strong a preparation

or from too free use of a preparation of the official strength, is

often followed by disaster to the mother or child or both. Roth cites

a number of cases of ruptured uterus and other injuries resulting from

their use.--(_Editorial from The Journal A. M. A., May 5, 1917._)

PROPRIETORSHIP IN MEDICINE

_To the Editor_:--I am enclosing a reprint of my article on the

“Present Status of Pituitary Extract in Labor,” which appeared in The

Journal, June 2, 1917, p. 1601, and also the September issue of Parke,

Davis and Company’s _Therapeutic Notes_, on page 89 of which they quote

this article, that you may compare the two. The _Therapeutic Notes_

article is ostensibly a copy, but as a matter of fact, it gives it only

in part, which seems to me to be a gross misrepresentation, and one

which I do not think should go unnoticed.

Joseph J. Mundell, M.D., Anacostia, D. C.

[Comment.--_Therapeutic Notes_ is one of the house organs of Parke,

Davis and Company. A part of each issue is usually devoted to

“excerpts” from current literature. The _Therapeutic Notes_ may be

judged from the manner of “excerpting” the article of Dr. Mundell.

Naturally the interest of Parke, Davis and Company is in those sections

of the article which may be expected to promote the use of Parke, Davis

and Company’s proprietary preparation of pituitary extract--pituitrin.

The following passages from the article of Dr. Mundell were not among

those “excerpted” in _Therapeutic Notes_:

“Used here in properly selected cases, after due consideration by

one who has good obstetric judgment, its results are usually happy,

and it is a boon to the tired mother and her attendants.”

“To step beyond these narrow confines of indications is indeed

entering on dangerous territory. Especially is this true as regards

the life of the baby. It is recommended in small doses by some good

authorities and is frequently used in cases of slight contraction

at the brim with sometimes very good results if the birth occurs

within a few minutes, but frequently with disastrous results

to the baby if delivery is delayed. In such cases, forceps are

urgently indicated. Its use in such cases is risky beyond question.

Pituitary extract is recommended in cases of postpartum hemorrhage,

but ergot is undoubtedly to be preferred.”

“All means should be exhausted to arrive at a definite diagnosis,

and the dangers of its use should be fully appreciated and due

consideration given before its administration in any case, for such

a powerful drug, used indiscriminately, will surely produce sad

results to mother or child or both.”

“During the past two years a number of untoward effects and

consequences of severe character have arisen. As far as the

maternal accidents and complications are concerned, I firmly

believe that were the slogan of the hour “safety first” borne

in mind, a number of them could have been prevented, for beyond

question this drug has been greatly abused, as it has been given

in too large doses, in cases in which its use was strongly

contraindicated, and often, I am sorry to say, for no reason other

than the accoucheur’s expediency. Its use has been reckless and

careless. The many reports of its rapid and safe action have been

one of the greatest dangers. DeLee says, ‘It provides for the

physician and his brother gynecologist a lot of chronic sufferers,

often incurable, even after mutilating operations.’”

“An analysis of the detailed reports of all these cases of ruptured

uterus with one or two exceptions reveals the fact that pituitary

extract was abused, being given to patients who should not have

had it. To my mind, to give a dose of pituitary extract to a woman

who has a contracted pelvis, mild or severe, when the head has not

passed through the pelvis, is criminal and, if the obstetrician is

not aware of the contraction, he is still little short of being a

criminal.”

In the latter part of his article in The Journal, Dr. Mundell analyzes

the reports of twelve cases of rupture of the uterus, thirty-four cases

of fetal deaths, and forty-one cases of asphyxia pallida in which

“resuscitation was effected only after prolonged and vigorous efforts.”

These also were not excerpted.--Ed.]--(_Correspondence in The Journal

A. M. A., Nov. 24, 1917._)

The Manufacturer’s Protest

_To the Editor_:--The article in The Journal, November 24, page 1818,

on proprietorship in medicine does us a gross injustice, and in reply

thereto we beg leave to submit the following:

For reasons which every publisher (yourself included) understands,

it is not practicable for us to reproduce in full, in the columns of

_Therapeutic Notes_, all the clinical papers to which we wish to direct

the attention of our readers. But that the article of Dr. Mundell was

not garbled to make capital for Parke, Davis & Co. is quite apparent

on comparison of the omitted portions with a previous paper by the

same author, reprinted in the January (1917) issue of the _Notes_,

and herewith submitted together with clippings from other issues of

the _Notes_ which prove that we have not hesitated to present to our

readers the dangers incidental to the misuse of Pituitrin as well as

the advantages of its proper use.

_Therapeutic Notes_, in quoting other journals, puts into its readers’

hands the means of investigating the fairness of its quotations. It is

a house organ--true enough; but the organ of a house which has always

appealed to the honor as well as to the progressiveness of the medical

profession. Its publishers could not afford to resort to deception in

advertising their products, through this or any other medium.

The profession is indebted to Parke, Davis & Co. for Pituitrin (among

other medicaments), and it is to the profession that the manufacturers

look for the ultimate verdict. The contraindications are quite as

important as the indications, and, as the excerpts submitted show, we

have taken account of these, not only in forming our own estimate, but

in presenting the evidence to the readers of _Therapeutic Notes_.

We cite these facts that you may give us a square deal in an early

issue of The Journal if so disposed.

Parke, Davis & Co., Detroit.

[Comment.--The Journal has no desire to discuss Parke, Davis and

Company’s motives in omitting certain parts of Dr. Mundell’s paper.

What The Journal did was to publish those parts of Dr. Mundell’s paper

on the “Present Status of Pituitary Extract in Labor” that Parke, Davis

and Company left out of their circular. That it is not practicable,

as Parke, Davis and Company points out, for the manufacturers of

proprietary products to reproduce in full all clinical papers dealing

with such products is obvious. It is not so obvious why such concerns

in abstracting or quoting papers of this kind should delete those parts

that are unfavorable to the products dealt with rather than those

that are favorable. Curiously, however, whenever an author is quoted

only in part those parts are almost invariably those favorable to the

product.--Ed.]--(_Correspondence in The Journal A. M. A., Dec. 8,

1917._)

Why Proprietaries Flourish

_To the Editor_:--The following experiences seem to add one more to

the many reasons offered to explain why proprietaries and ready-made

preparations flourish at the expense of the official drugs and

preparations: A few days ago I prescribed Troches of Ammonium Chloride,

U. S. P., for a patient of exceptional perseverance. The next day he

had not yet secured the troches and told me that he had submitted the

prescription to seven pharmacies, including the largest, and three of

the best known and admittedly the best equipped in New York. All told

him that these troches were “not being made any more,” and that they

were therefore unable to supply him. He thereupon communicated with

one of the largest wholesale manufacturing pharmaceutical houses in

America and received precisely the same answer. I then took the matter

up with a first class pharmacist whom I knew and induced him to prepare

this difficult (!) troche, for which the U. S. Pharmacopeia gives

the following directions: “Rub the powders together until they are

thoroughly mixed; then form a mass with syrup of tolu and divide ...”

Seven pharmacists declined to fill a prescription for an official

preparation because they could not buy the preparation from a

wholesaler, and it required some persuasion to get the eighth to make

the preparation. But even worse, several of the pharmacists offered my

patient some ready-made troche more or less resembling the official, or

offered compressed tablets of ammonium chlorid.

That this is not an isolated example of what often poses as pharmacy

is shown by the fact that I have found it extremely difficult to find

a pharmacist who would extemporaneously coat pills with gelatin.

Most want the physician to alter his prescription so that one of the

ready-made gelatin coated pills can be dispensed, if a gelatin coating

is necessary. Some gelatin, hot water, a large cork, and a few domestic

sewing needles are all that is required for very satisfactory coating

of pills with gelatin, yet few pharmacists seem willing to perform this

simple procedure.

Two other illustrations, not so recent, have come to me from a

colleague. A few years ago he was unable to obtain from either of two

pharmacists an emulsion of cod liver oil without the hypophosphites

because, as both said, “It does not come without hypophosphites.”

On another occasion four of the best drug stores in Boston were

asked for the Compound Laxative Pill, U. S. P., then official in the

Pharmacopeia. In every case he was told that he must have meant the

compound cathartic pill, which in no way resembles the pill he sought.

With this attitude on the part of the men supposed to be serving the

public and the medical profession by the practice of pharmacy, is it

any wonder that it is difficult to induce the medical profession to

prescribe official preparations or combinations of official drugs in

place of ready-made commercial substitutes largely drawn from among the

proprietaries or specialties? Real pharmacy by real pharmacists is a

necessity if we are to succeed in combating the proprietary evil.

Cary Eggleston, M.D., New York.

--(_Correspondence in The Journal A. M. A., Aug. 21, 1920._)

PHILIP RAHTJEN AND HIS DISCOVERIES

Recent newspaper reports regarding the alleged “discovery of the Germ

of Pernicious Anemia” and the development of “an antitoxin and serum”

by Dr. Philip Rahtjen of Pasadena, California, have brought inquiries

of which the two that follow are typical. This from a physician in

Indiana:

“Please let me know about the supposed recent discovery of Dr.

Philip Rahtjen concerning pernicious anemia. The information I have

is from a newspaper clipping of October 21, Pasadena, California.

Kindly omit my name.”

A New York physician writes:

“If you could send me any information as to the enclosed I

would appreciate it. The article impresses one as absolutely

inconclusive. However, I promised the patient I would investigate

the matter.”

The enclosures referred to consisted of a reprint and a letter from

“Ph. Rahtjen, M.A., Ph.D.,” Pasadena, Calif., both of which had

been sent to a layman who had written to Rahtjen. The reprint was

a translation of a brief article by Rahtjen “On the Etiology of

Idiopathic Anemia,” translated from the _Centralblatt für Bakteriologie

Parasitenkunde und Infektionskrankheiten_. Rahtjen’s letter to the

layman read:

“Your inquiry relative to my isolation and classification of the

Germ of Anemia received.

“I herein enclose my paper published in August in the _Central

Magazine of Bacteriology_.

“I have succeeded in immunizing goats against the Germ therein

described. Five thousand injections of the Serum have been given.

Three hundred cases diagnosed as Anemia and Chlorosis were treated

under observation. Six cases of Pernicious Anemia were observed

under treatment. All responded favorably.

“The Serum is at your disposal from my laboratory here for the use

of your physician. The price is five dollars for twelve ampoules

each containing 1 ccm., the amount of one injection.

“The treatment consists of intramuscular injection every second day

accompanied with a nitrogenous free diet, preferably milk diet.

Your attending physician should very easily give them.”

Just what Rahtjen’s serum is we do not know. Nor have we been able

to find any information on the subject in any available medical

literature. In fact, a rather careful search of American medical

literature for some years past fails to reveal any article by Rahtjen

on any subject.

Philip Rahtjen is not a physician. In the Propaganda files is a

circular issued in 1917 by the “Rahtjen Tuberculosis Sanatorium” of San

Francisco, Calif. This exploits “The Rahtjen Cure for Tuberculosis” and

tells of “The Discovery of Dr. Philip Rahtjen.” The circular states

that:

“Dr Rahtjen studied in Heidelberg, Berlin, Munich, Marburg, and

Rostock, Germany, from which latter school in 1904, he graduated

in chemical pathology as Doctor of Philosophy. He became assistant

professor of pathology at the Imperial Biological Station at

Heligoland, and was later appointed assistant to Dr. Piorkowsky,

head of the _Deutsche Schutz und Heilserum Gesellschaft_.”

The same circular summarizes the potentialities of “Rahtjen’s Cure for

Tuberculosis” thus:

“The remedy seems to cure tuberculosis in all its forms with equal

celerity and certainty. The evidences indicate that it does not

matter how far the disease has progressed, if there be tissue

of the attacked organ remaining sufficient to sustain life, the

disease can be wholly eradicated and the patient restored to

health. This is indicated alike in tuberculosis of the lungs, of

the throat, of the bladder, of the kidneys.”

The booklet stated further that patients might be treated at one of two

places: at the offices of the sanatorium in the city of San Francisco,

or at the sanatorium itself near Glenwood. The cost of treatment at

the sanatorium was to be $1,000, which would entitle “the patient

to residence and attention there for four months.” According to the

leaflet, “This is regarded as a period sufficient to restore the

patient to health whatever be the stage of his disease; provided only,

as we remark, that he has enough left of the infected organ to sustain

life with the T. B. expelled.”

“At the end of four months the patient is sent to his home, not

alone relieved of his disease, but in a highly vigorous state of

health.”

All this, as stated previously, was in 1917. And yet people are still

dying of tuberculosis!

In March, 1920, Rahtjen (so the newspapers have it) was offering a

“New-Life Fluid.” According to a San Francisco paper, Dr. Philip

Rahtjen “announces the discovery that by the injection of secretions

from the ductless glands the human body may be reinvigorated.” The

paper described the discovery “as a long step forward in the fight

to counteract old age” and stated that a syndicate was being formed

by Rahtjen and others to “produce the extract in such quantity that

it may be available for every one.” The newspaper article showed the

learned doctor in a laboratory apron in the characteristic pose of

the newspaper “scientist” pouring something from a beaker into a test

tube--and gazing intently at the camera while doing it! This was in

March, 1920; yet people still grow old.

Within the last month the _Los Angeles Examiner_ has heralded some more

wonderful accomplishments of Rahtjen. According to this paper Rahtjen

has:

1. Isolated the “germ of pernicious anemia.”

2. Found the “serum” for the cure of this disease.

3. Discovered the secret of human virility.

4. Evolved a fluid “from the glands of selected bulls and cows” which

will “restore ‘pep’ for worn-out human bodies! Give added weight,

clearer eyes, brighter minds, quicker bodies and a generally ‘firmer

grip’ on oneself!”

This “amazing discovery” was, according to the Los Angeles paper, the

culmination of “five years of continuous study” and had only just been

revealed by Rahtjen.

“Dr. Rahtjen has for years been working silently in a bio-chemical

laboratory in Pasadena, surrounded by microscopes, scales,

test-tubes, acids, alkalis, reagents and all the accompanying stage

settings that spell bio-chemical science.”

All of these wonders might still have been a closed book to the public

had not “friends” of Dr. Rahtjen brought the matter to the attention of

the _Examiner_.

“Dr. Rahtjen yesterday, with the usual reserve of the ethical

scientist, was disinclined to talk of his work until publication of

it in a scientific journal.”

Fortunately for a palpitating public, the _Los Angeles Examiner_ “was

able to learn the essence of his study” and pass the information on. It

seems from this newspaper report that Rahtjen first made his extracts

from the glands of goats and sheep but these extracts “were found to

be too strong.” As a result “Dr. Rahtjen is now using the glands of

specially selected Mexican bulls and cows.” The male patients who are

“weak, uninterested in life, unable to concentrate in thought” are

given the extract of bull; the female patients who are in a similarly

deplorable condition receive an “injection of the cow gland extract.”

We have not yet learned whether the _Los Angeles Examiner_ has

deprecated Dr. Rahtjen’s use of Mexican bovines. Remembering the

attitude of the Hearst papers toward all things Mexican, one may look

for the suggestion that Mr. Rahtjen use 100 per cent. American

bull.--(_From The Journal A. M. A., Nov. 26, 1921._)

SODIUM CACODYLATE IN SYPHILIS

_To the Editor_:--I was much interested in the study of this subject by

Dr. H. N. Cole (The Journal, Dec. 30, 1916, p. 2012.)

In 1913 I treated a series of cases of syphilis with sodium cacodylate;

but, not getting the desired results, I discontinued its use. In 1915,

I became interested again because of the writings of Dr. J. B. Murphy,

and applied it in three cases in which the patients had initial lesions:

CASE 1.--J. M., man aged 21, single, shoeworker, came to me with

an initial lesion of the penis to the right of the frenum. I began

intramuscular injections of sodium cacodylate, 5 grains, in ampules

made by Parke, Davis & Co., every day for ten days. Then I halted

for ten days and repeated ten more injections. The sore on the penis

entirely disappeared about the ninth day. There was a slight, faintly

macular eruption of the forearms and abdomen, which soon disappeared.

There was no alopecia. When he returned, after the last series of

ten injections, there were mucous patches in the throat and some

involvement of the left tonsil. I put the patient on mixed treatment,

which cleared his throat. He had, at end of twenty doses of 5 grains of

sodium cacodylate each, a positive Wassermann reaction. After mercury

and potassium iodid for two months there was a positive Wassermann

reaction. To date, after three salvarsan treatments intravenously there

have been two negatives.

CASE 2.--F. S., man, aged 28, married, machinist, had an initial lesion

on the penis. Treatment with sixty injections of 5 grains of sodium

cacodylate gave results as follows: The initial sore on the penis

disappeared in ten injections; there were severe mucous patches of the

mouth; the tonsils were badly infected. There was a positive Wassermann

reaction. There were syphilids of both arms and shins; marked papular

eruption; malaise, and a slight trace of albumin in the urine. I

placed the patient on mercurials and at last give him three salvarsan

injections three weeks apart. The result was a negative Wassermann

reaction, the skin was clear and the patient felt fine.

CASE 3.--D. C., woman, aged 21, single, seamstress, had an initial

lesion on the left side of the cervix, and a macular eruption on the

face, neck and shoulders, and also, though faint, on the forearms.

Thirty injections of sodium cacodylate of 5 grains each were given. The

initial lesion disappeared in one week. Mucous patches of the mouth

appeared and persisted. The Wassermann reaction was positive. I gave

mercurials and potassium iodid for seven months, and salvarsan once.

The Wassermann reaction is now negative.

My conclusion after two trials of the use of sodium cacodylate in small

or large doses is that it has no effect toward curing the condition; in

fact, the throat symptoms were seemingly increased in severity by its

use. It has no effect on syphilids of the forearms and shins, and if

anything makes them worse.

It improves the appetite, as one would expect. It has some effect on

the kidneys, as noted in Case 2; it has some effect in healing the

initial lesion, as noted in all three of this series; why, I do not

know.

I am entirely satisfied that it has no beneficial effect on syphilitics

and have discontinued its use entirely in my practice.

I am glad to have read Cole’s excellent article, as it shows me that I

was correct in my decision not to use it again, as it was worthless.

William G. Ward, M.D., Lynn, Mass.

_To the Editor_:--Dr. William G. Ward’s letter (The Journal, Feb. 3,

1917, p. 390), and the recent admirable article by Dr. Harold N. Cole

(The Journal, Dec. 30, 1916, p. 2012) recall to mind Dr. J. B. Murphy’s

clinical note on the use of sodium cacodylate in the treatment of

syphilis (The Journal, Sept. 24, 1910, p. 1113), and the experimental

work of Cap. H. J. Nichols, U. S. Army (The Journal, Feb. 18, 1911,

p. 492). The results of Nichols’ work conclusively proved, at least

from a laboratory standpoint, that this drug was of very little value

as a spirocheticide in combating syphilis. Prior to the publication of

Dr. Murphy’s letter I had employed sodium cacodylate extensively as a

remedy in psoriasis, and I still continue to use it in selected cases

of the disease.

Adopting Dr. Murphy’s suggestion, I gave the agent an extensive trial

in syphilis in all stages of the disease. The results were extremely

disappointing, from both clinical and serologic points of view. More

recently, during the scarcity of salvarsan, I gave the drug a second

trial, employing it in large dosage in the hope that the previous

failure had been due to the employment of insufficient amounts. The

results were not tabulated, but, judging roughly from my experience in

a score of cases, its therapeutic value as an antisyphilitic was nil. A

few of the patients underwent a temporary improvement, probably owing

to the tonic effect of the drug, but in every instance the serologic

findings were unaffected.

R. L. Sutton, M.D., Kansas City, Mo.

--(_Correspondence in The Journal A. M. A., Feb. 3, 1917._)

TABLETS: DEPENDABILITY OF DOSAGE

The tablet form of administering medicines is popular among many

physicians because of its convenient availability and dosage. There

is no doubt about the convenience of tablets, but the accuracy of the

dosage content is not always to be depended on. One reason for this

is that the demand for palatable and convenient “medicaments has led

manufacturers to attempt to produce in tablet form mixtures which, from

the nature of the case, are not suited to that method of compounding.”

In a series of painstaking experiments[307] on bismuth, opium and

phenol tablets, conducted a number of years ago in the A. M. A.

Chemical Laboratory, it was shown that no tablets on the market then

contained the amount of phenol the label indicated, the variation

being from 12.3 to 112.5 per cent. Similarly, the laboratory found

that in the case of several different brands of Aromatic Digestive

Tablets,[308] the amount of hydrochloric acid present in these absurd

combinations was true to label in only one half of the specimens,

notwithstanding the fact that the amounts claimed to be present were

ridiculously small; in two specimens, there was no hydrochloric

acid whatever present, while a third contained only a trace. These

examples illustrated clearly the very evident unwisdom of attempting

the pharmaceutically impossible merely for the sake of convenience or

pharmaceutical “elegance.”

[307] Puckner, W. A., and Clark, A. H.: Examination of Tablets of

Bismuth, Opium and Phenol, The Journal A. M. A., July 25, 1908,

p. 330. Puckner, W. A., and Hilpert, W. S.: Tablets of Bismuth, Opium

and Phenol, Dec. 17, 1910, p. 2169, May 6, 1911, p. 1344. Unreliable

Pharmaceutical Products, editorial, May 6, 1911, p. 1335.

[308] Puckner, W. A., and Warren, L. E.: Aromatic Digestive Tablets,

The Journal A. M. A., Aug. 20, 1910, p. 710.

Another reason for doubting the accuracy of dosage, irrespective of

the characteristics of the drugs composing the tablets, has been the

manifest lack of care in their manufacture. In 1914, Kebler[309]

reported the results of a far-reaching investigation of tablet

compounding in which he pointed out that tablets on the market were

not as uniform or accurate as was generally believed, the variations

being “unexpectedly large in numbers and amount.” During the past year,

the Connecticut Agricultural Experiment Station[310] undertook the

examination of tablets--proprietary and nonproprietary--taken from the

stock of dispensing physicians. The variations found in _weights_ of

the tablets were strikingly similar to those reported by Kebler.

[309] Kebler, L. F.: The Tablet Industry, Jour. Am. Pharm. Assn., 1914,

3, 820, 937, 1062.

[310] Bull. 200, Connecticut Agricultural Station, Food and Drug

Products, 1917, p. 161.

VARIATION IN WEIGHTS OF TABLETS

Kebler Connecticut

Variation Per Cent. Per Cent.

Less than 10 per cent. 43 44

More than 10 per cent. 57 56

More than 12 per cent. 44 35

More than 15 per cent. 28 26

More than 20 per cent. 9 10

The determinations of the _composition_ of the tablets when compared

with that claimed for them showed wide variation--from 54 per cent.

above to 70.5 per cent. below; in almost two thirds of the tablets

examined, the variation amounted to more than 10 per cent.; in three

fifths of the tablets, the variation was more than 15 per cent.; in one

fourth, more than 20 per cent., and in one twentieth, more than 50 per

cent.; only in one eighth of the tablets was the variation less than 5

per cent.

The Connecticut investigators substantiate once again the work

previously reported, namely, that there are a number of firms who are

either incompetent or careless. For tablets of simple composition,

a variation from the declaration of 10 per cent. should be amply

sufficient to compensate for the errors of careful manufacture. It may

be added that the best tablets originate generally from firms having

competent chemical control.--(_From The Journal A. M. A., July 27,

1918._)

THERAPEUTIC EVIDENCE: ITS CRUCIAL TEST[O]

Torald Sollmann, M.D., Cleveland

[O] Read before the Section on Pharmacology and Therapeutics at the

Sixty-Eighth Annual Session of the American Medical Association, New

York, June, 1917.

[O] This article clearly states the difficulties experienced by the

Council in estimating the merits of a proprietary medicinal product

and clearly defines the method which has been found to be practical in

judging of the therapeutic value of such preparations. The Council has

approved this discussion of the subject and has directed that the paper

be published in the annual Council reports.

W. A. Puckner, Secretary.

According to the good old truism, the last and crucial proof of the

pudding is in the eating thereof; and so, the last and crucial test of

a therapeutic agent is its consumption by a patient. There is, however,

one essential difference: When the pudding is eaten, with a sense of

satisfaction, we know that it was a good, or at least an eatable,

pudding.

If the patient improves after taking a remedy, we do not yet know

that he improved on account of the remedy. The _post hoc_ type of

reasoning or logic is not respectable; but it is all too apt to creep

in unawares, unless one takes great precautions indeed.

Clinical evidence needs especially to be on its guard against this

pitfall, for the conditions of disease never remain constant; nor is it

possible to foresee with certainty the direction which they are going

to take. It is just this point which makes the clinical evidence so

much more difficult to interpret than laboratory evidence, in which

the conditions can be more or less exactly controlled, and any changes

foreseen. It is on this account, also, that clinical experiments must

be surrounded with extra painstaking precautions.

In brief, while the “proof” of a remedy is on the patient, that is not

the whole story, but merely an introduction. The real problem is to

establish the causative connection between the remedy and the events.

The imperfect realization of this has blocked therapeutic advance, has

disgusted critical men to the point of therapeutic nihilism, and has

fertilized the ground for the commercial exploitation of drugs that are

of doubtful value or worse.

This has been impressed on me particularly by my service on the Council

on Pharmacy and Chemistry. In the course of its work of passing on the

claims advanced for commercial remedies, this Council is forced to

inquire critically into the basis of the claims of manufacturers.

It is interesting to note the qualitative differences in the evidence

for the various kinds of claims: The chemical data are usually

presented in such a form that it is possible to tell at a glance

whether or not they are based on demonstrated facts, which could

usually be verified or refuted without special difficulty. The

deductions are usually such as can be legitimately drawn from the data,

or else they are obviously absurd. All this agrees with the relatively

exact status of chemical science.

In passing to data and deductions from animal experiments, a distinct

change is noticeable: Not only are the data less reliable, and less

worthy of confidence, but they are more often stated in a less

straightforward manner. The presentation of the data often shows

evidence of manipulation of the results, so as to make them most

favorable to a preconceived conclusion that would recommend the drug.

This is not always intentional, but is partly due to the less exact

nature of animal experimentation, which leaves a wider play to the

arbitrary interpretation of the reporter. A certain amount of this

is unavoidable. No serious objection can be raised, provided the

experimenter presents all the essential data, and discusses fairly all

of the interpretations that would apply to them.

On the whole, it is usually possible to form a fairly definite estimate

of the value of experimental data.

When one comes to the clinical evidence, an entirely different

atmosphere obtains. When the Council demands evidence of the usefulness

of a remedy, the manufacturers generally respond with every sign of

enthusiasm. They may have ready a series of articles already published,

or they instruct their agents to bring in letters from physicians. The

last method seems to meet the most cordial response, judging from the

deluge of letters and opinions that floods the Council.

The quality of the published papers is a fair reflection of the

deficiencies of what is still the common type of clinical evidence.

A little thought suffices to show that the greater part cannot

be taken as serious evidence at all. Some of the data are merely

impressions--usually the latest impressions of an impressionable

enthusiast--the type of man who does not consider it necessary to

present evidence for his own opinions; the type of man who does not

even realize that scientific conclusions must be based on objective

phenomena.

Some of the papers masquerade as “clinical reports,” sometimes with a

splendid disregard for all details that could enable one to judge of

their value and bearing, sometimes with the most tedious presentation

of all sorts of routine observations that have no relation to the

problem.

The majority of reports obtained by the agents belong to these classes,

notwithstanding the fact that they are often written for the special

use of the Council, and therefore with the realization that they

are likely to be subjected to a thorough examination, and therefore

presumably representing the best type of work of which the reporter is

capable. So, at least, one would suppose.

It is also possible, however, that some of these reports are written

merely out of thoughtlessness, or perhaps often to get rid of an

importunate agent. This is illustrated by the following correspondence,

taken literally from the files of the Council.

A letter from a prominent physician “A,” endorsing a certain

preparation “D,” having been submitted to the Council, the secretary

was directed to write to Dr. A as follows:

_Dear Dr. A_:--The B Company of C has requested the Council on Pharmacy

and Chemistry to admit its preparation D to New and Nonofficial

Remedies. As part evidence for the value of the preparation, the

company submitted a letter from you which contains the following:

So far as my experience has thus far gone, they are certainly

superior to a number of other iodine compounds now on the market,

and I should judge that they ought to take a superior place in

therapy involving the use of iodine.

The referee of the Council in charge of D writes that he was interested

by your letter and asks that I inquire: As compared with sodium or

potassium iodid, what would you say are the differences between,

and real advantages of, D and the alkaline iodids? Did you make any

comparative experiments and keep a record of them? If so, the referee

would like to receive an account of your trials. In what direction

could D be expected to occupy a superior place in iodin therapy?

I hope that you can give the information asked by the referee and

thus aid the Council in arriving at a correct estimate regarding

the value of D.

The following reply was received from the physician in response to the

foregoing:

_Dear Professor Puckner_:--In reply to yours of January 19, I

did not proceed far enough in the investigation of D to draw

conclusions of any particular value for the purpose of the Council

on Pharmacy and Chemistry; and I so stated in my letter to the

proprietors of that remedy.

Answers to the questions you put in your letter require an amount

of investigation of the remedy far beyond anything I undertook.

As a matter of fact, I returned about five sixths of the capsules

sent me, because of lack of time and opportunity to carry out the

extensive clinical experiments that I plainly saw would be required

to give an opinion at all worth while. I believe you had better not

consider me in the matter at all.

The report was furnished by a physician for whom I have a high personal

regard. I introduce it here, not so much in a spirit of criticism,

but as a justification of the opinion that I have formed of clinical

evidence obtained by manufacturers through their clinical adjutors.

When commercial firms claim to base their conclusions on clinical

reports, the profession has a right to expect that these reports

should be submitted to competent and independent review. When such

reports are kept secret, it is impossible for any one to decide what

proportion of them are trustworthy, and what proportion thoughtless,

incompetent or accommodating. However, if this were done it is quite

possible that such firms would find much more difficulty in obtaining

the reports. Those who collaborate should realize frankly that under

present conditions they are collaborating, not so much in determining

the scientific value, but rather in establishing the commercial value

of the article.

Often the best type of clinical reports--those in which the

observations are directed to the significant events and not to mere

side lines, and in which the significant events are correctly and

adequately reported--generally lack one important essential, namely, an

adequate control of the natural course of the disease.

Since this cannot be controlled directly, it must be compensated

indirectly. For this purpose, there are available two methods:

The first is the statistical method, in which alternate patients

receive or do not receive the treatment. This method can usually

only be of value when a very large series of patients is available.

Even then, its value is limited or doubtful, because it cannot take

sufficient account of the individuality of cases.

The second method consists in the attempt to distinguish unknown

preparations by their effects--the method that might be called the

“comparative method” or the “blind test.”

In this, the patient, or a series of patients, is given the preparation

which is to be tested, and another preparation which is inactive,

and the observer aims to distinguish the two preparations by their

effects on the patient. Surely if the drug has any actions at all it

will be possible to select correctly in a decided majority of the

administrations.

The same principle can be applied in distinguishing the superiority

of one preparation over another. In this case, the two preparations

would be given alternately to different patients, and the observer

would try to distinguish them by their effects. Here again, if one

drug is really superior or otherwise different from another, to a

practically important extent, the observer will surely be able to make

the distinction.

This method is really the only one that avoids the pitfalls of clinical

observation; it is the only method that makes the results purely

objective, really independent of the bias of the observer and the

patient. It is the only method, therefore, which determines whether it

was really the pudding that was eaten and not some other dessert.

In principle this method does not usually offer any very great

difficulties. It is, of course, necessary that the two preparations

to be compared shall resemble each other so closely or shall be

flavored, etc., so that they cannot be distinguished by their physical

properties. This is usually not a very difficult matter. The method

does not jeopardize the interests of the patient, for it is understood

that no drug would be tested in this way unless there is some reason

to believe that it has a value. When the patient’s condition is such

as to demand treatment, then he would be receiving either the standard

drug or the drug which the experimenter believes may be superior to the

standard.

CONCLUSIONS

The final and crucial test of a remedy is on the patient; but the

test must be framed so as to make it really crucial. Most clinical

therapeutic evidence falls far short of this. The “blind test” is urged

to meet the deficiencies.--(_From The Journal A. M. A., July 21, 1917._)

“VACCINES IN TOXIC CONDITIONS”

Commercialized Propaganda in the Guise of Science

Under the title “Vaccines in Toxic Conditions,” what purports to be

a scientific contribution appears in the original department of the

official organ of a state medical society.[311] The apparent purpose of

the article is to overcome any hesitancy on the part of practitioners

to use vaccines in toxic infectious conditions for fear that they

might thereby cause harm. Such a thesis is interesting and might be

important--if true. Two outstanding facts, however, give pause. First,

the theory promulgated is contrary to the experience of those who

have studied the subject; second, the man who writes the article is

in the business of making and selling vaccines! The former fact is a

matter of fairly general knowledge among the better informed members

of the medical profession; the latter fact is nowhere made evident in

the article, which the reader might infer came from a disinterested

investigator in the realms of immunology.

[311] Sherman, G. H.: Vaccines in Toxic Conditions, Illinois M.J. 38:

314 (Oct.) 1920.

The article purports to prove that the special investigations carried

on by its author show that there is no basis for the well-grounded

fear that vaccines might be harmful to a patient suffering from toxic

infectious conditions. Thus:

From a closer study of these infective processes we find that this

toxic condition is due to the rapid multiplication of the infecting

organisms with the incidental production of ferments which the

germs secrete to digest the food on which they live. These toxic

ferments have a distinct destructive tendency on tissue cells,

without any marked influence in stimulating tissue cells for

antibody production. The crying need, however, in these extensive

acute infections is rapid antibody formation to neutralize these

germ-produced poisons and to eliminate the germs.

Now vaccines, we are informed, are not toxic and so stimulate the

production of antibodies. In other words, the same organism that in

the body is toxic and without marked antigenic properties becomes

nontoxic and actively antigenic when converted into a vaccine. The

details of the experiments of the “closer study” made by the author of

this paper (and the manufacturer of vaccines) which give such definite

and convincing results are not published. Possibly the article is a

preliminary contribution, and future issues of the same publication

will carry further articles on the same subject. The follow-up system

is well recognized in the advertising world. At all events, this

“closer study” has convinced the author of the article that:

... even in extreme toxic conditions, in acute infections,

bacterial vaccines may be employed without the least fear of doing

any harm. In fact, we find that in extreme acute infections,

bacterial vaccines not only give the best clinical results, but

they may also be given in larger doses at shorter intervals with

less reactions than in minor or chronic infections and the earlier

they are given the better the results.

Here again no details are given; there are no comparative results of

the careful study of a series of cases. The sum and substance of this

remarkable contribution to a scientific publication is to the effect

(1) that the organism that in the body is toxic becomes nontoxic when

introduced in vaccine form; (2) that the organism that in the body is

but little antigenic becomes when introduced in vaccine form actively

antigenic, and (3) that “in extreme acute infections” when the body

is affected profoundly by the infectious agent and its product, the

oftener and the more one injects of these very materials, the better

the results!

And this astounding plea for the use of vaccines in conditions in which

vaccines are generally held to be contraindicated, or even injurious,

is made by one whose business is the manufacture of vaccines and

selling them to the medical profession!--(_Editorial from The Journal

A. M. A., Oct. 23, 1920._)

VITAMINS: THEIR DISTRIBUTION

Our knowledge of the accessory food factors, commonly spoken of

as vitamins, is so recent, comparatively speaking, and the exact

nature of these factors still so enveloped in mystery, that it was

inevitable that the public’s lack of knowledge on the subject should be

capitalized. It is not surprising that there are on the market a number

of preparations of the “patent medicine” type that are being sold under

the claim that they are rich in vitamins--although the exploiters

of these fail to explain which, if any, of the three accessory

food factors their products contain. The renaissance of yeast as a

therapeutic agent has given an opportunity to the manufacturers of this

product of unduly stressing the fact that yeast is particularly rich in

the antineuritic vitamin (water-soluble B). Because milk and certain

milk products are rich in the fat-soluble A factor, the dairy interests

would apparently have the public believe that this particular vitamin

is to be obtained only from their products. Thus, a journal devoted to

the dairy interests recently claimed that those who want vitamins must

get them in their milk, butter, cheese and other milk products. The

truth is, the accessory food factors are so well distributed throughout

the dietary of modern man that, generally speaking, the individual

who uses ordinary judgment in selecting his food is in no danger of

suffering from a deficiency of any of these three factors. It would

be well if every physician might read the excellent monograph on the

present state of knowledge concerning accessory food factors written

by a committee appointed jointly by the Lister Institute and Medical

Research Committee. In this report the distribution of the vitamins in

our common foodstuffs is thus briefly summarized: “... broadly speaking

it is safe to say that the individual always finds sufficient supply

of vitamins in his food so long as that food is reasonably varied and

has received no artificial or accidental separation into parts, and so

long as no destructive influence has been applied to it.” At the end

of the committee’s report is a table (reproduced on page 562) which

shows the distribution of the three accessory factors in the commoner

foodstuffs.--(_Editorial from The Journal A. M. A., Aug. 13, 1921._).

DISTRIBUTION OF THREE ACCESSORY FACTORS IN COMMONER FOODSTUFFS

Classes Fat-Soluble A Water-Soluble B Anti-

of or Anti- or Antineuritic scorbutic

Foodstuff rachitic (Antiberiberi) Factor

Factor Factor

_Fats and Oils_:

Butter +++

Cream ++

Cod-liver oil +++

Mutton fat ++

Beef fat or suet ++

Peanut oil +

Fish oil, ++

whale oil, etc.

Margarin prepared Value in

from animal fat proportion to

amount of

animal fat

contained

Nut butters +

_Meat, Fish, etc._:

Lean meat (beef,

mutton, etc.) + + +

Liver ++ ++ +

Kidneys ++ +

Heart ++ +

Brain + ++

Sweetbreads + ++

Fish, white very slight,

if any

Fish, fat (salmon,

herring, etc.) ++ very slight,

if any

Fish roe + ++

Canned meats ? very slight

_Milk, Cheese, etc._:

Milk, cow’s whole, raw ++ + +

Milk, skim, raw + +

Milk, dried whole less than ++ + less than +

Milk, boiled, whole undetermined + less than +

Milk, condensed,

sweetened + + less than +

Cheese, whole milk +

_Eggs_:

Fresh ++ +++ ?

Dried ++ +++ ?

_Cereals, Pulses, etc._:

Wheat, maize, rice,

whole grain + +

Wheat germ ++ +++

Wheat, maize, bran ++

Linseed, millet ++ ++

Dried peas, lentils,

etc. ++

Soy beans, haricot beans + ++

Germinated pulses or

cereals + ++ ++

_Vegetables and Fruits_:

Cabbage, fresh (raw) ++ + +++

Cabbage, fresh (cooked) + +

Cabbage, dried + + very slight

Cabbage, canned very slight

Swede (rutabaga) raw

expressed juice + +++

Lettuce ++ +

Spinach (dried) ++ +

Carrots, fresh raw + + +

Carrots, dried very slight +

Beetroot, raw,

expressed juice less than +

Potatoes, raw + +

Potatoes, cooked +

Beans, fresh, scarlet

runners, raw ++

Onions, cooked + at least

Lemon juice, fresh +++

Lemon juice, preserved ++

Lime juice, fresh ++

Lime juice, preserved very slight

Orange juice, fresh +++

Raspberries ++

Apples +

Bananas + + very slight

Tomatoes (canned) ++

Nuts + ++

_Miscellaneous_:

Yeast, dried +++

Yeast, extract and

autolyzed ? +++

Malt extract + in some

specimens

Our Knowledge of Vitamins

Commenting on the trend of medical research concerning vitamins, the

latest report of the British Medical Research Council says:

The present situation is a curious one, upon which posterity will

probably look back with great interest. We still have almost no

knowledge of the nature of these elusive food substances or of their

mode of action, but we have gained empiric knowledge already of the

greatest practical value for the prevention of scurvy and of other

grave diseases and for the promotion of health and beauty in the

population.

This statement, it will be noted, emphasizes the foundation on which

rests our present use of vitamins. From time to time The Journal

has commented on our lack of actual knowledge of these mysterious

substances, emphasizing particularly the generally accepted fact that

the taking of a well-balanced diet results in providing the individual

with such vitamins as are necessary to his growth and nutrition. Last

week appeared a brief report of a meeting of the Chicago Medical

Society devoted to this subject, and it was gratifying to have the

conservative view which The Journal has emphasized substantiated by

many of those who took part in the discussion. Moreover, the _British

Medical Journal_, in its leading editorial for February 11, reiterates

that an abundant supply of vitamins exists in all fresh vegetables,

and that a considerable quantity occurs in milk and meat, provided

the latter substances are obtained from animals fed on fresh foods.

“A normal adult,” it says, “living on an ordinary diet containing a

reasonable proportion of fresh vegetables is, therefore, certain of

obtaining a plentiful supply of vitamins.” Of all the mass of evidence

which has accumulated relative to these substances, this fact is the

point of greatest importance. It is, however, very unfortunately,

the one point which those commercially inclined are unwilling to

recognize.--(_Editorial from The Journal A. M. A., March 11, 1922._)

The Demand for Vitamins

Thus the _British Medical Journal_ in its current issue:

In spite of the fact that ordinary fresh foods are the simplest,

cheapest and richest sources of vitamins, the public apparently demands

to be supplied with vitamins in the form of medicinal products.

The public “demands” vitamins in pill form! Why? For the same reason

that the public, lay or medical, demands many things today that it

does not need--because the whole trend of modern advertising is toward

creating demands, rather than supplying needs. Vitamin concentrates

are being “demanded” by the public because shrewd and forward-looking

“patent medicine” exploiters are using all the subtle arts of modern

advertising to convince the public that it is in serious danger of

vitamin starvation, and that the only hope lies in buying these

alleged concentrates to make up a hypothetical deficiency. It seems

inconceivable that a rational man would pay a tremendously high price

for certain food factors which are already present in his ordinary

diet. But he will; and advertising is the reason. Advertising

campaigns such as these of the vitamins constitute a vicious circle;

an artificial demand is created and then the manufacturer excuses his

business on the ground that he is merely supplying a demand! As our

British contemporary says, “ordinary fresh foods are the simplest,

cheapest and richest sources of vitamins.”--(_Editorial from The

Journal A. M. A., March 18, 1922._)

THE WILLIAM A. WEBSTER CO. AND THE DIRECT PHARMACEUTICAL CO.

The following letter from a Detroit physician was received a few days

ago.

_To the Editor_:--I have just received a letter from the Direct

Pharmaceutical Co. of St. Louis, Mo., quoting prices on drugs

which are not more than one half what the leading manufacturers

are quoting on the same drugs. I have received previous literature

from this company but have not done business with them. I would be

unwilling to prescribe their drugs unless I were satisfied that

they are what is claimed for them. I would be glad to receive any

information regarding this firm that may be available.

The Journal has also received some letters from physicians regarding

the William A. Webster Co. of Memphis, Tenn., relative to a letter the

concern was sending physicians in the form of a testimonial (reproduced

in miniature on this page) and alleged to be from Dr. F. W. P. Butler

of Columbia, S. C. Typical letters on the Webster advertising follow:

_To the Editor_:--Is there not some way through which the dignity

of the medical profession can be protected from the circulation of

such idiotic drivel as the enclosures display?

_To the Editor_:--I am sending you an example of the sort of

“evidence” which some so-called ethical pharmaceutical houses

expect physicians to take for scientific proof. It is pathetic that

there are some in our profession who “fall for” such rot. I trust

you will continue your campaign for honest and intelligent medicine.

The “evidence” to which one of the correspondents refers and which

another characterizes as “idiotic drivel” is reproduced on the

following page in miniature. It is a testimonial for William A. Webster

Company’s “Ferritonic-Woods.”

Our readers may wonder why we are discussing in one article the William

A. Webster Company of Memphis, Tenn., and the Direct Pharmaceutical Co.

of St. Louis. The reason is that the Direct Pharmaceutical Co. of St.

Louis is apparently merely a sales agency for the William A. Webster

Company of Memphis. It appears that orders sent in to the Direct

Pharmaceutical Co. go to Memphis to be filled.

The following information regarding some of the products that have

in the past been put out by the William A. Webster Company should be

of interest to the profession. In government bulletins issued by the

Department of Agriculture in October, 1913, there were reported some

cases of adulteration and misbranding on the part of the William A.

Webster Co., of Memphis, Tenn. A “Pure Concentrated Extract of Lemon”

shipped by this concern was found by the federal chemists to be colored

with a coal-tar dye “whereby inferiority was concealed,” and while

purporting to be a concentrated lemon extract, “in fact, it was not a

concentrated lemon extract.” Some “Pure Concentrated Extract of Banana”

was found to have mixed with it an imitation banana flavor and an

artificial color so as to “injuriously affect its quality and strength”

and so that “its inferiority was concealed.” “Pure Concentrated

Extract of Pineapple” was found to have had mixed with it “an imitation

extract of pineapple artificially colored.” “Pure Concentrated Extract

of Strawberry” had been mixed with “an imitation strawberry extract

artificially colored.” The same bulletins described the case of the

government against a shipment of “Syrup Iron Iodide” made by the

Webster concern in which the amount of iron iodid was less than half

that claimed on the label. In each of the cases just described, the

company pleaded guilty and was fined.

[Illustration: Reproduction (reduced) of a testimonial letter sent to

physicians by William A. Webster Company of Memphis, Tenn. Those who

operate this concern also have a sales agency in St. Louis, Mo., known

as the Direct Pharmaceutical Co.]

In a similar bulletin issued August, 1914, there were recorded several

more cases of adulteration and misbranding charged against the William

A. Webster Company. Some “Wine Coca Leaves” was held adulterated in

that the amount of alcohol present was wrongly declared on the label;

it was held misbranded in that while it contained cocain, the label

failed to bear any statement regarding the quantity of proportion of

this drug. Tablets of “Acetanilid and Sodium Bromid Compound” were

found deficient in strength. “Anti-Vomit Tablets,” “Aspirin Tablets,”

“Bismuth and Calomel Tablets,” “Quinin Laxative Tablets,” “Salol

Tablets,” “Sodium Salicylate Tablets,” “Neuralgic Tablets,” “Diarrhea

Calomel Pills” and “Morphin Sulphate Hypodermic Tablets” were also

misbranded in that the amount of certain ingredients found in them

failed to tally with the amount declared on the label. In all of these

cases also the William A. Webster Company pleaded guilty and was fined.

In a government bulletin issued in June, 1917, the same company was

charged with adulterating and misbranding a quantity of Aspirin tablets

which, instead of containing 5 grains as labeled, contained only a

fraction over 1 grain. In this case, too, the company pleaded guilty

and was fined. The table that follows briefly summarizes some of the

cases just referred to:

Amount Claimed Amount Found

“Syrup Iron Iodid, U. S. P.”

Ferrous Iodid 10% 4.6%

“Acetanilid and Sodium Bromid Tablets”

Acetanilid 3.50 gr. 2.94 gr.

“Anti-Vomit Tablets”

Bismuth subnitrate 2.50 gr. 1.76 gr.

Cerium Oxalate 2.50 gr. 1.78 gr.

Cocain Hydrochl. 0.0833 gr. 0.0637 gr.

“Aspirin Tablets” 5.0 gr. 3.82 gr.

“Bismuth and Calomel Comp. Tablets”

Bismuth subnitrate 0.1 gr. 0.22 gr.

Calomel 0.1 gr. 0.22 gr.

“Quinin Laxative Tablets”

Acetanilid 2.0 gr. 1.69 gr.

“Salol Tablets” 2.50 gr. 2.05 gr.

“Sodium Calicylate Tablets” 5.0 gr. 3.88 gr.

“Neuralgic Pills”

Morphin sulphate 0.05 gr. 0.015 gr.

“Diarrhea Calomel Pills”

Morphin sulphate 0.062 gr. 0.05 gr.

“Morphin Sulphate Hypodermic Tablets” 0.25 gr. 0.21 gr.

“Aspirin Tablets” 5.00 gr. 1.13 gr.

X/

--(_From The Journal A. M. A., Oct. 18, 1919._)

YEAST

From time to time yeast has attained a transitory popularity as a

therapeutic agent. Its use in this way in practical medicine has been

based essentially on empiric considerations. Yeast is rich in nucleic

acid, but this has not found any special applications. The fatlike

substances obtainable from yeast have been recommended in certain

alimentary conditions, without finding any widespread acceptance.

More recently yeast has acquired interest from somewhat different

angles. In these days of food shortage and enforced conservation,

it has come to be realized that the minute yeast cells are endowed

with a remarkable capacity of synthesizing one of the most valued

nutrients, namely, protein. This substance can be built up out of the

simplest forms of nitrogenous compounds by yeasts, in contrast with

the incapacity of the higher organisms to construct protein out of

anything less complex than the ready made aminoacids. It is reported

that in Europe yeast has actually been grown on a large scale in

solutions of sugar, salt and simple nitrogenous compounds for the

sake of securing the much desired proteins. The utilization of yeast

protein for cattle feeding is a current practice abroad; and the

satisfactory digestibility and availability of the same product by the

human organism has repeatedly been announced since the beginning of

the war. In this country the yeast which is produced as a by-product

of the brewing industry is for the most part discarded as waste; in

the distilleries it becomes a part of the distillers’ grains that are

extensively employed as feeds in the dairy industry.

Still newer is the indication that yeast is comparatively rich in at

least one of the as yet unidentified accessory factors in nutrition

now popularly spoken of as vitamins. Hopkins of the University of

Cambridge, England, first directed attention to this unique property of

yeast. It has been verified by Funk and Macallum, and recently Osborne

and Mendel have given substantial evidence of the potency of yeast to

render a diet not otherwise capable of inducing maintenance effective

in nutrition.

Yeast has been used, like extracts of rice polishings, to cure the

experimental polyneuritis induced in birds by a diet of polished rice.

From the experiments of Osborne and Mendel it appears that less than 2

per cent. of dried brewers’ yeast suffices to induce small experimental

animals to grow on artificial food mixtures on which alone they fail

to thrive. How the use of yeast as an adjuvant to otherwise inadequate

food mixtures exerts its beneficial effect is not yet made clear.

Satisfactory growth in these cases is promoted by liberal eating.

Anything which renders food more palatable may stimulate one to eat

more liberally of it. This can scarcely be the explanation of the

potency of the yeast as it is effective even when fed apart from the

rest of the food. It may have a favorable effect on the metabolism and

thus improve the general condition so that more food is consumed. Small

quantities of milk and extracts of many of the common plant foods,

such as the cereal grains, have been found to act in the same way.

There seems to be little doubt, therefore, that yeast also contains

something comparable with the so-called water-soluble vitamins of the

diet. A specific need for yeast can scarcely be predicated on this

fact, however; for any well selected human dietary containing the usual

variety of animal and vegetable foods is not likely to be devoid of

the widely distributed water-soluble type of vitamin. We mention this

to check premature enthusiasm for a new vitamin.--(_Editorial from The

Journal A. M. A., Sept. 8, 1917._)

Yeast and Its Uses

_To the Editor_:--Is there available information concerning the

medicinal use of yeast? How is it taken? I should like to know

whether the use of it would cause any digestive disturbance, and

whether the flesh gained is normal and permanent.

S. E. L., Bridgeport, Conn.

ANSWER.--Yeast is one of those remedies that have undergone alternating

cycles of use and of disuse; just at present it appears again to be

in its ascendency. No doubt, the reason for these cycles has been

excessive praise and uncritical use, followed by disappointment and

consequent discard.

Hawk and his associates (Hawk, P. B.; Knowles, F. C.; Rehfuss, M. E.,

and Clarke, J. A.: The Use of Bakers’ Yeast in Diseases of the Skin and

of the Gastro-Intestinal Tract, The Journal, Oct. 13, 1917, p. 1243)

have recently called renewed attention to its laxative qualities.

When from one-half to one cake of yeast was given three times daily

before meals, it produced regular bowel movements in a number of

patients suffering from constipation. That this result is not due

to any vital processes in the yeast is shown by the fact that yeast

killed by boiling water was employed with success. It is suggested that

such yeast might be preferred for patients troubled with flatulence.

Aside from the tendency of living yeast to produce diarrhea, and the

possibility that it may aggravate flatulence, no digestive disturbance

has been charged against it. Aaron, in his “Diseases of the Digestive

Organs,” speaks favorably of its use in atonic constipation.

The much debated question whether yeast may serve as a food can be

answered in the affirmative in view of such work as that of the Germans

on “Nährhefe”--yeast food (Schottelius, _Deutsch. med. Wchnschr._, July

8, 1915, p. 817) and Boruttau (_ibid._, July 29, 1915, p. 924) and

of Hawk and his associates. There is no reason to assume that weight

gained under its use would be more readily lost than weight gained

from any other food. However, in view of its laxative action, the

average individual can ingest only from 1 to 2 gm. of nitrogen a day in

this form. This obviously greatly limits its value as a food. Owing to

its high nuclein content, it is contraindicated in gout.

As a source of water soluble growth promoting as well as antineuritic

vitamin, yeast has become thoroughly established as the result of

the recent works of numerous investigators. However, as such common

foods as milk, rice, wheat, oats and beans also contain such vitamin,

there is little likelihood of its proving of therapeutic value on that

account. In other words, yeast and other vitamin containing foods have

specific growth promoting qualities only when the stunting is due to

lack of vitamin. A minute amount of this substance suffices to produce

maximal results. More is of no use. Hess (_Proc. Soc. Exper. Biol. &

Med._ =13=:145, 1916) found yeast of no value in infantile scurvy.

The most important question in connection with yeast therapy is to what

extent it is endowed with “antibiotic” power, that is, to what degree

it is capable of inhibiting the growth of other organisms. That this

frequently occurs in cultures in vitro is shown by the fact that yeast

contamination may practically eradicate the growth of certain other

organisms. That, on the other hand, this is not true for all forms of

bacterial life is shown by the fact that there is definite symbiosis

between yeast and lactic acid bacilli (Northrup: _Soc. Tech. Bull._ 15,

Mich. Agr. Expa. Sta., 1912).

That its “antiseptic power is, on the whole insignificant” has

been shown by Palier (_Diet. & Hyg. Gaz._, March, 1906), who found

commercial yeasts commonly contaminated with numerous bacteria, the

most frequent being _Bacillus coli-communis_ or one of its congeners.

An antagonistic action by yeast is claimed against _Staphylococcus

pyogenes_, and on the strength of this, Buchholtz (Ueber Acne und eine

neue erfolgreiche Behandlung derselben, _Berl. klin. Wchnschr._, Feb.

2, 1914, p. 215) employed it locally in the treatment of acne and

obtained a positive but temporary effect. He believes that the effect

is improved by the combination of yeast with an equal quantity of boric

acid. He employed this as a dusting powder applied freely to the skin

once daily, after the application of a thin layer of a boric acid salve

(boric acid powder from 40 to 50, glycerin and water, of each 100) to

make it stick better. In cases in which the nose was markedly involved,

he also used this as a snuff. Yeast poultices have been employed with

asserted great benefit in the treatment of wound infection of all kinds

(Kempf, E. J.: _Ind. M. J._, September, 1904, p. 97).

The use in leukorrhea was recommended by Hippocrates Abraham (_Mon.

Geb. Sym._, 1910) and many others report favorable results from yeast

in the treatment of gonorrheal vaginitis. In various gastro-intestinal

infections, yeast has been lauded by many, among others, Thiercelin and

Chevrey. It has been given by mouth, but most especially in high rectal

enemas.

Still more from a theoretical standpoint is the reassertion of the

curative value of the oral administration of yeast in various cutaneous

disorders. Thus Hawk and his collaborators report cure or improvement

in all of seventeen cases of acne vulgaris and eight cases of acne

rosacea. They also report seventeen cases of furunculosis, in all but

one of which there was cure or improvement from yeast treatment. They

are unable to decide whether the result is due to the laxative action,

the production of leukocytosis, or to other influences.

Yeast is probably best taken incorporated in food. Hawk and his

associates found that yeast may well be incorporated in wheat biscuits,

and that in this way a yeast-wheat combination of most agreeable flavor

was produced: that, in fact, the biscuits with the yeast tasted better

than those without it. They found by tests that in bread making as

much as 20 per cent. of the flour might be replaced by dry yeast, and

that thereby a loaf would be produced that was excellent in every

way and possessed of an attractive flavor. The dry yeast was prepared

by desiccating compressed yeast at 105 C. in a current of air, and

then milling it to produce a flour of the approximate fineness of

ordinary wheat flour. They also found that yeast may be added to meat

preparations, such as Hamburger steak, to the extent of 2.5 per cent.,

yielding a preparation of very satisfactory taste.--(_Query in The

Journal A. M. A., Aug. 23, 1919._)

BRIEFER PARAGRAPHS

Laxol and Lysol--The Short and Catchy Proprietary Name

A laborer went to a Brooklyn physician for treatment and was given

three prescriptions. One of the prescriptions, according to the _Food

and Drug Bulletin_ of the Department of Health, City of New York,

called for “Laxol,” the word being written on a piece of blank paper

without directions. The drug clerk misread the prescription and

dispensed an “original” bottle of “Lysol” which bore the usual poison

label with skull and cross bones. The man drank the entire 3 ounces

of Lysol and died half an hour later. The case is now in the hands of

the District Attorney, the drug clerk being held under $10,000 bail.

“Laxol,” as our readers know, is castor oil sweetened with saccharin

and flavored with peppermint. There is no excuse for prescribing the

product. The official Aromatic Castor Oil (Ol. Ricin. Arom.) of the

National Formulary would answer every purpose served by the proprietary

preparation.--(_Editorial from The Journal A. M. A., May 29, 1920._)

Look Up Its Rating

Modern business has become so complex that it is no longer possible for

those engaged in trade to know, offhand, the financial responsibility

of their prospective customers. The commercial agency is a natural

development; it aims to supply the technical (financial) information

which the conservative business man needs but is otherwise unable

to get. When John Doe & Co. contemplates entering into business

arrangements with Henry Roe & Son to a degree that involves financial

obligations, it looks up Roe in the rating book of Dun or Bradstreet

and probably calls for a special commercial report on the concern.

These facts are so elemental and obvious as to be trite. The complexity

of modern medicine, especially in the pharmacologic field, has made it

a physical impossibility for physicians to know the scientific status

of scores of pharmaceutical products put out under proprietary or

brand names. It was recognition of this fact that brought about the

creation by the American Medical Association of the Council on Pharmacy

and Chemistry. This body of experts, serving without remuneration and

reporting without fear or favor on the newcomers to the pharmaceutical

world, places at the disposal of physicians unbiased information, free

alike from prejudice or prepossession. As the commercial agency reports

on the commercial probity of individuals and firms, so the Council on

Pharmacy and Chemistry reports on what might be called the scientific

probity of proprietary and unofficial pharmaceutical products. The

commercial agency issues, at no small expense to its customers, rating

books; the council on Pharmacy and Chemistry issues, at a nominal

price, “New and Nonofficial Remedies.” The commercial agency, for a

substantial fee, will furnish reports on business concerns; the Council

on Pharmacy and Chemistry will, without any expense to the profession,

furnish reports on proprietary products used for the relief or cure of

human ailments. The careful business man avails himself of the services

of the commercial agency; there are financial interests at stake. The

conscientious physician will avail himself of the services of the

Council; there are, it may well be, lives at stake.--(_Editorial from

The Journal A. M. A., April 24, 1920._)

The Medical Profession and Commercial Interests

Last week The Journal published a letter received by a physician in

Milwaukee from a firm of lawyers representing the Farbwerke-Hoechst

Company. In this communication the physician was threatened with suit

if he published further unfavorable reports regarding that firm’s

preparation. Quoting from the attorney’s letter:

“Mr. Metz directs us to inform you that the publication of this

article and the statements therein were seriously damaging to the

Farbwerke-Hoechst Company, and directs us to say further to you

that he and the corporation will hold you personally responsible

for any repetition, oral or written, of the same or of similar

statements to the same effect.”

We were under the impression that the time had passed when a

proprietary medicine manufacturer would presume to threaten a physician

for making an honest report of his results with any therapeutic

agent. Such condition did exist once, before the Council on Pharmacy

and Chemistry undertook its work. Now comes Mr. Metz to revive this

relic of an historic but infamous period in the history of American

proprietary medicine manufacturing. Even Mr. Vanderbilt regretted that

he ever said “The public be d----.” One of the elementary principles

in the practice of medicine is that the individual physician shall let

others know his results, whether good or bad, in any line of treatment.

It is by such interchange of knowledge and experience that progress in

medicine is possible. Yet Mr. Metz would interfere with the diffusion

of such knowledge and experience when it applies to proprietary

medicines. His legal threat against Dr. Sargent is “terrorism” applied

to the medical profession.--(_Editorial from The Journal A. M. A., June

8, 1918._)

Rabbit-Foot Therapy

Few but ignorant darkies have any great faith in the therapeutic

efficacy of the left hind foot of a rabbit caught in the churchyard

in the dark of the moon. In the light of modern therapeutics one is

tempted to believe, however, that had some one person or firm an

exclusive proprietary right to this particular brand of rabbits’

feet, there would be many intelligent people--and not all of them

laymen--ready to swear by rabbits’ foot therapy. In medical journals

(whose advertising pages set forth the virtues of the pedal extremities

of _Lepus sylvaticus_) many solemnly scientific articles would probably

appear relating the success that the writers had had with this form

of therapy in the treatment of some distressing stubborn conditions

that had failed to respond to all previous efforts. Is it ubiquity

that has saved the homely cotton-tail from being a therapeutic

hero?--(_Editorial from The Journal A. M. A., Sept. 29, 1917._)

Secret Remedies and the Principles of Ethics

Many hundreds, possibly thousands, of inquiries are received each

year by The Journal from physicians asking for information on, or

an opinion of certain proprietary remedies. In many instances the

preparations in question are essentially secret in composition,

although advertised to the profession under a fair-seeming exterior of

apparent frankness. There are on the market today--and used by members

of the American Medical Association--dozens, yes scores, of widely

advertised proprietaries that are, to all intents and purposes, secret.

The physicians who prescribe them do not know and cannot know what they

are giving their patients. On this point Section 6 of Chapter II of the

Principles of Medical Ethics of the American Medical Association says:

“... it is ... unethical to prescribe or dispense secret medicines

or other secret remedial agents, or manufacture or promote their

use in any way.”

The inherent and basic reasonableness of the various requirements of

the Principles of Medical Ethics needs no exposition or defense. A

large number of proprietary remedies which at present degrade medicine

would be wiped out of existence or, at any rate, go over to the “patent

medicine” class, where they belong, if physicians would live up to

Section 6, Chapter II, of the Principles.--(_Editorial from The Journal

A. M. A., Sept. 27, 1919._)

“Sterling Violet Ray Generator”

_To the Editor_:--I am curious to learn the value of the violet

ray in the treatment of disease. The violet ray seems to be much

in evidence in Canada at the present time in various towns. It is

well advertised, not in the same way as a “patent medicine” would

be, but as a genuine form of treatment. The enclosed booklet gives

a brief outline of what the agents for the “Sterling Violet Ray

Generator” claim it will do. The reason I am troubling you about

the matter is that I feel if there is anything in it as is claimed,

it should be better known. It also seems that if this treatment is

not capable of doing what is claimed for it, it is a rather serious

thing for a person who may defer calling a physician.

J. A. G.

ANSWER.--The “Sterling Violet Ray Generator” is a small high frequency

apparatus with some vacuum and possibly other electrodes. There is a

violet color in these vacuum electrodes when they are energized. The

apparatus is not one for producing violet or ultraviolet rays in the

scientific meaning of those words. The apparatus certainly will not do

the things claimed for it in the booklet which includes the treatment

of practically every ailment known to mankind.--(_Correspondence in The

Journal A. M. A., April 14, 1917._)

Strontium Salicylate Not Superior to Sodium Salicylate

Sodium salicylate is a valuable drug. It is official and cheap; it

is the compound generally relied on when salicylate effects are

desired. And there is no mystery about it. With the other salicylates,

mystery begins. For this reason, such studies as that of Blankenhorn

on strontium salicylate are of special value. Blankenhorn shows that

strontium salicylate possesses no advantages over sodium salicylate,

as regards either therapeutic efficacy or freedom from undesirable

by-effects. He calls attention to the fact that “the salicyl content

of strontium salicylate is about four-fifths that of sodium salicylate

based on the amount of available anion.” The question naturally arise

whether this smaller salicylate content may not contribute to the

notion that strontium salicylate is less likely to cause salicylism.

The impression as to the greater freedom of this salt from undesirable

by-effects may have arisen in part also from the fact that the more

expensive preparations are more likely to be given in small doses

than is the cheaper sodium salicylate. As Blankenhorn suggests, when

once such a tradition gains currency, it will be “lugged along”

from one textbook to another, with little or no attempt at critical

examination.--(_Editorial from The Journal A. M. A., Jan. 29, 1916._)

Vaccine As a Prophylactic in Influenza

_To the Editor_:--I am chief surgeon for a large steel industry in

Canton, and desire to do all in my power to prevent the threatened

recurrence of influenza. What is the status of the various vaccines

as a preventive or prophylactic measure? Would you advise their use

as a preventive measure, to immunize the workers in the industries?

M.D., Canton, Ohio.

ANSWER.--The status of vaccine therapy as a prophylactic for influenza

may be ascertained from the two articles appearing in The Journal,

Aug. 9, 1919: that of E. C. Rosenow and B. F. Sturdivant entitled

“Studies in Influenza and Pneumonia: Further Results of Prophylactic

Inoculations,” and that of G. W. McCoy, director, Hygienic Laboratory,

U. S. Public Health Service, on “Status of Prophylactic Vaccination

Against Influenza.” In brief, the conclusion of Rosenow and Sturdivant

is: “It appears from all of the facts at hand that by the use of a

properly prepared vaccine it is possible to rob influenza of some of

its terrors.” On the other hand, McCoy states: “The general impression

gained from uncontrolled use of vaccines is that they are of value in

the prevention of influenza; but, in every case in which vaccines have

been tried under perfectly controlled conditions, they have failed to

influence in a definite manner either the morbidity or the mortality.”

To make a conservative statement: The use of vaccine as a prophylactic

in influenza is an experiment.--(_Query in The Journal A. M. A., Sept.

27, 1919._)

Vaccines for “Colds”

_To the Editor_:--Has there been work done of sufficient extent to

be of value in justifying use of mixed “shotgun” vaccines to abort

or immunize “common colds,” that is, rhinitis, pharyngitis, acute

bronchitis, coryza, etc.?

Charles E. Bennett, M.D., Aneta, N. D.

ANSWER.--We know of no investigation which demonstrates that the use

of the commercial mixed vaccines are of value in the prevention or

treatment of “common colds” or of similar affections. The Council on

Pharmacy and Chemistry accepts for New and Nonofficial Remedies mixed

vaccines only on condition that their usefulness has been established

by acceptable clinical evidence; so far it has not admitted any of the

“influenza” or “catarrhal” mixed vaccines.--(_Correspondence in The

Journal A. M. A., Nov. 10, 1917._)

To the Editor:--Please advise me of the latest and best vaccine for

common colds.

L. J. Smith, M.D., Wilson, N. C.

Health Officer, City and County Health Department.

ANSWER.--There is no scientific evidence that common colds can be

prevented by the use of vaccines, despite the glowing recommendations

of vaccine makers and the patter of the detail man. Colds characterized

by catarrhal inflammation of the mucous membranes of the nose and

throat are caused by various organisms, including a number of the

commoner cocci and the bacillus of Pfeiffer. They are contagious,

and spread rapidly from one person to another by the transfer of the

bacteria concerned, so that small epidemics of colds are continually

occurring in homes and communities. The organism concerned in one small

epidemic may be different from that in another, and it is impossible to

anticipate what organism is about to invade the household or community.

The inoculation of mixed vaccines in the hope of providing against

a number of possible invaders fails to produce immunity sufficient

to prevent the infection of mucous membranes. Where completely

controlled experiments have been made with large numbers of persons,

colds have occurred among the inoculated in as large proportion as

among the uninoculated. During the war, some evidence was obtained

which indicated that preventive inoculation of troops with a vaccine

containing large numbers of pneumococci reduced the incidence and

mortality of pneumonia. In the case of superficial infection of the

nasal and pharyngeal mucous membranes with diverse etiology, less can

be expected, and practical results indicate that this skepticism based

on theoretical considerations is well founded.--(_Query in The Journal

A. M. A., Nov. 13, 1920._)

INDEX AND BIBLIOGRAPHY

[See Closing Paragraph to Preface, Page IV.]

PAGE

Abbott Laboratories--

B. Coli-Combined-Bacterin, 185

Barbital, 371

Calcidin Tablets, 465

M. Catarrhalis-Combined-Bacterin, 184

Neuro-Lecithin, 53

Pertussis-Combined-Bacterin, 185

Procain-Abbott, 356

Streptococcus-Rheumaticus-Combined-Bacterin, 185, 186

Streptococcus-Viridans-Combined-Bacterin, 185, 186

Triple Arsenates with Nuclein, 256

Abrams, Albert, 472

Abrams, Albert, defense of, by Upton Sinclair, 477

Acetanilid and Sodium Bromid Tablets, 566

Acetanilid Compound, Mulford, 206

Acet-Phenetidin Compound, P.-M. Co., Tablets (Pitman-Moore Co.),

Reports Council Pharm. & Chem., 1918, p. 73.

Acetylsalicylic Acid: See also Aspirin.

Acetylsalicylic Acid, American-made, examination of, 344

Acetylsalicylic Acid (Aspirin) Monsanto, 347

Acetylsalicylic Acid, M. C. W, 347

Acetylsalicylic Acid, Millikin, 347

Acetylsalicylic Acid, not Aspirin, 480

Acetylsalicylic Acid, P. W. R, 347

Acetylsalicylic Acid, Squibb, 347

Acetylsalicylic Acid--“What’s in a Name.”, 482

Adreno-Spermin Comp., Caps, 219

Advertising by means of “original” articles in medical journals, 560

Advertising principles--lay and medical, 483

Agar-lac (E. Fougera & Co., Inc.), The Journal, Nov. 14, 1914,

p. 1777; Reports Council Pharm. & Chem., 1914, p. 124;

Propaganda, ed. 9, p. 10.

Agmel (Maguey Products Co.), The Journal, Oct. 12, 1912, p. 1392.

Akoz, lead in, 328

Akoz Medicinal Mineral Water, 328

Akoz Ointment, 328

Akoz Powder, 328

Akoz Suppositories, 328

Albolene, Liquid, 106

Albolene, Liquid (McKesson & Robbins), The Journal, July 26, 1913,

p. 296; Reports Council Pharm. & Chem., 1916, p. 65.

Alborum (The Whitehouse Chemical Co., Inc.), The Journal, Dec. 12,

1914, p. 2148; Reports Council Pharm. & Chem., 1914, p. 129.

Alcohol, Hygiene and Legislation, 495

Alcresta Dental Lotion-Lilly (Eli Lilly & Co.), The Journal,

Oct. 29, 1921, p. 1441.

Alcresta Ipecac, 153

Alcresta Ipecac (Eli Lilly & Co.), The Journal, Oct. 20, 1917,

p. 1373; Reports Council Pharm. & Chem., 1917, p. 62.

Alcresta Lotion, 465

Aletrin, The Journal, Nov. 13, 1909, p. 1655; Reports Council Pharm.

& Chem., 1909, p. 135.

Aletris Compound, Elixir (Parke, Davis & Co.; Ray Chemical Co.);

Reports Council Pharm. & Chem., 1912, p. 46.

Aletris Cordial (Rio Chemical Co.), The Journal, Oct. 17, 1914,

p. 1411; Feb. 13, 1915, p. 606; Reports Council Pharm. & Chem.,

1914, p. 99; Propaganda, ed. 9, p. 43.

Alexander, H. M., Company--

Dixon’s Tubercle Bacilli Extract and Dixon’s Suspension of Dead

Tubercle Bacilli, 158

Alfatone, 28

Alfatone (Norwich Pharmacal Company), The Journal, Aug. 7, 1915,

p. 548; Reports Council Pharm. & Chem., 1915, p. 62.

Alkaline Digestine (Parke, Davis & Co.), Reports Council Pharm.

& Chem., 1912, p. 44.

Alkalithia, 242

Alkalithia (Keasbey and Mattison Company), Reports Council Pharm.

& Chem., 1919, p. 65.

Alkalol (Alkalol Co.), The Journal, Nov. 6, 1915, p. 1665; Reports

Chem. Lab., 1915, p. 110.

Alleotone (B. F. Copeland), The Journal, Feb. 1, 1908, p. 379;

Propaganda, ed. 9, p. 264.

Allied Medical Associations of America, 486

Alphozone, 99

Alphozone (Frederick Stearns & Co.), Reports Council Pharm.

& Chem., 1916, p. 50.

Ambrine, analysis of, 332

“Ambrine” and Paraffin Films, 330

Ambrine, The Journal, April 7, 1917, p. 1057; May 19, 1917, p. 1497;

Reports Chem. Lab., 1917, p. 20.

American Animal Therapy Co, 528

American Elixir of Bitter Wine, Triner’s, 139

American-made synthetic drugs, 344, 369

American Medical Association Chemical Laboratory, foreword, 322

American Medical Association Chemical Laboratory, work of, 322

American Medical Association Council on Pharmacy and Chemistry, delays

in passing on products, 20

American Medical Association Council on Pharmacy and Chemistry,

foreword, 1

American Medical Association Council on Pharmacy and Chemistry offers

services similar to Dun and Bradstreet, 570

American Medical Association Council on Pharmacy and Chemistry,

official rules of, 3

American Medical Association Council on Pharmacy and Chemistry,

present and future, 12

American Medical Association Council on Pharmacy and Chemistry

endorsed by The Journal of the Missouri State Medical

Association, 19

American Organotherapy Company, 527

Ammonium Chloride, Troches of, druggists refuse to supply, 552

Ammonium Hypophosphite, 98

Ammonium Hypophosphite, Gardner’s Syrup of, 100

Ammonium Hypophosphite, Reports Council Pharm. & Chem., 1916, p. 51.

Ammonol, 393

Ammonol (Ammonol Chemical Co.), The Journal, June 3, 1905, p. 1791;

Feb. 2, 1918, p. 337; Reports Council Pharm. & Chem., 1905, 1908,

p. 7; Propaganda, ed. 9, p. 9.

Amolin Deodorant Powder (Amolin Chemical Co.), The Journal, Feb. 22,

1908, p. 626; Reports Chem. Lab., 1909, p. 63.

Anadol (Wheeler Chemical Works), The Journal, May 21, 1910, p. 1704;

Propaganda, ed. 9, p. 245.

Analutos and Analutos Tablets (Royal Pharmaceutical Works, Meppel,

Holland), The Journal, Feb. 20, 1915, p. 684; Reports Council Pharm.

& Chem., 1915, p. 135; Reports Chem. Lab., 1915, p. 131.

Anasarcin, 383

Anasarcin advertising, 407

Anasarcin (Anasarcin Chemical Co.), The Journal, May 4, 1907, p. 1535;

Dec. 8, 1917, p. 1992; Reports Council Pharm. & Chem., 1905-8,

p. 54; Propaganda, ed. 9, p. 11.

Anderson System for Treatment of Alcoholism (The Anderson

Laboratories), Reports Council Pharm. & Chem., 1916, p. 51.

Anedemin, 383

Anedemin (Anedemin Chemical Co.), The Journal, May 4, 1907, p. 1535;

Dec. 8, 1917, p. 1992; Reports Council Pharm. & Chem., 1905-8,

p. 54; Propaganda, ed. 9, p. 11.

Anesthesin, 276

Angier’s Emulsion (Angier Chemical Co.), The Journal, Sept. 12, 1914,

p. 962; Reports Council Pharm. & Chem., 1914, p. 48; Reports Chem.

Lab., 1914, p. 55; Propaganda, ed. 9, p. 169.

Anglo-French Drug Co., Ltd.--

Collosol Cocaine, 221

Collosol preparations, 223

Cuprase, 222

Sukro-Serum, 273

Supsalvs, 274

Anistamina (M. Olivetti), Reports Council Pharm. & Chem., 1915,

p. 162.

Antero-Pituitary Comp., Caps, 219

Antidiabeticum, Bauer (Sanin-Gesellschaft), The Journal, July 30,

1910, p. 418; Propaganda, ed. 9, p. 267.

Antidysenteric Serum (Farbwerke-Hoechst Co.), Reports Council Pharm.

& Chem., 1917, p. 146.

Antikamnia (Antikamnia Chemical Co.), The Journal, June 3, 1905,

p. 1791; Feb. 8, 1908, p. 467; Reports Council Pharm. & Chem.,

1905-8, p. 7; Reports Chem. Lab., to 1909, p. 60; Propaganda,

ed. 9, pp. 9, 268, 307.

Antikamnia and Quinin (Antikamnia Chemical Co.), The Journal, July 1,

1905, p. 55.

Anti-Malta Fever Serum (H. K. Mulford Co.), Reports Council Pharm.

& Chem., 1917, p. 136.

Antimeristem-Schmidt, 408

Antimeristem-Schmidt (Laboratorium W. Schmidt), The Journal, March 8,

1913, p. 766; Dec. 6, 1919, p. 1787.

Antiphlogistine, 409

Antiphlogistine (Denver Chemical Mfg. Co.), The Journal, June 1, 1907,

p. 1875; Feb. 23, 1918, p. 557.

Anti-Pneumococcic Oil (Eimer and Amend), The Journal, Jan. 3, 1920,

p. 46; Reports Council Pharm. & Chem., 1919, p. 52.

“Anti-Pneumococcic Oil” and the use of camphor in pneumonia, 257

Antipneumococcus Serum (Farbwerke-Hoechst Co.), Reports Council Pharm.

& Chem., 1917, p. 146.

Antiseptic Powder, Maignen (Maignen Institute), The Journal, Nov. 14,

1914, p. 1778; Reports Council Pharm. & Chem., 1914, p. 57;

Propaganda, ed. 9, p. 19.

Antiseptic Powder, Tyree’s, 462

Antiseptic Powder, Tyree’s (J. S. Tyree), The Journal, Oct. 20, 1906,

p. 1316; Aug. 24, 1912, p. 666; March 30, 1918, p. 949; Reports

Council Pharm. & Chem., 1905-8, p. 22; Propaganda, ed. 9, pp. 21,

404; May 17, 1919, p. 1482.

Antiseptic Tablets Clover (Sharp & Dohme), The Journal, Aug. 26,

1911, p. 755.

Antiseptic, Tyree’s, 401

Antistaphylococcus Serum (Burroughs Wellcome & Co.), Reports Council

Pharm. & Chem., 1917, p. 137.

Antistreptococcus Serum, Aronson’s (Schering & Glatz, Inc.), Reports

Council Pharm. & Chem., 1917, p. 146.

Antistreptococcus Serum “Hoechst” (Farbwerke-Hoechst Co.), Reports

Council Pharm. & Chem., 1917, p. 146.

Anti-Syphilitic Compound (Sweeny), 268, 330

Anti-Syphilitic Compound Sweeny (National Laboratories of Pittsburgh),

The Journal, April 3, 1920, p. 965; Reports Council Pharm. & Chem.,

1920, p. 12.

Antithermoline (G. W. Carnrick Co.), The Journal, Nov. 1, 1913,

p. 1649.

Antithyroid Preparations (Antithyroidin-Moebius and

Thyreoidectin), 202

Antithyroid Preparations, Reports Council Pharm. & Chem., 1918, p. 50.

Antithyroidin-Moebius (Merck & Co.), Reports Council Pharm. & Chem.,

1918, p. 50.

Antithyroidin-Moebius and Thyreoidectin, Antithyroid Preparations, 202

Anti-Tuberculous Lymph Compound (Sweeny), 266

Anti-Tuberculous Lymph Compound, Sweeny (National Laboratories of

Pittsburgh), The Journal, April 3, 1920, p. 965; Reports Council

Pharm. & Chem., 1920, p. 12.

Anti-Vomit Tablets, 566

Anusol Suppositories, 182

Anusol Suppositories (Schering & Glatz, Inc.), The Journal, Oct. 2,

1909, p. 1112; Oct. 11, 1913, p. 1392; Jan. 31, 1914, p. 395;

March 9, 1918, p. 719; Reports Chem. Lab., 1909, p. 32; Propaganda,

ed. 9, pp. 227, 280, 281.

Apergols (H. K. Wampole Co., Inc.), The Journal, Dec. 12, 1914,

p. 2149; Reports Council Pharm. & Chem., 1914, p. 64; Propaganda,

ed. 9, p. 26.

Aphlegmatol, 273

Aphlegmatol (G. Giambalvo & Co.), The Journal, Aug. 21, 1920, p. 556;

Reports Council Pharm. & Chem., 1920, p. 23.

Apothesine, 260

Aquazone (Oxygen Water), 290

Aquazone (Oxygen Water) (Aquazone Laboratories, Inc.), Reports Council

Pharm. & Chem., 1920, p. 50.

Arbor Vitae, Reports Council Pharm. & Chem., 1912, p. 38.

Arhovin, 243

Arhovin (Schering & Glatz, Inc.), Reports Council Pharm. & Chem.,

1919, p. 66.

Armervenol, 249

Armervenol (Hille Laboratories), Reports Council Pharm. & Chem.,

1919, p. 82.

Armour and Company--

Duodenin, 76

Lecithol, 53

Pineal Gland Preparations, 213

Red Bone-Marrow Preparations, 213

Thymus Gland Preparations, 214

“Arrhenal”, 492

Arrhenal (E. Fougera & Co.) The Journal, Feb. 26, 1921, p. 595.

Arsenates, Triple, with Nuclein, 256

Arsenic and Mercury, Solution of, 231

Arsenic and Mercury, Solution of (New York Intravenous Laboratory),

The Journal, Aug. 2, 1919, p. 353; Reports Council Pharm. & Chem.,

1919, p. 26.

Arsenic, Iron and Phosphorus Compound, Hypodermic Solution No. 13, 275

“Arsenicals”, 491

Arsenicals, pharmacology of, 492

Arseno-Meth. Hyd.: See Arsenic and Mercury, Solution of.

“Arsenoven, S. S.”, 231

Arsenoven, S. S. (S. S. Products Co.), The Journal, Aug. 2, 1919,

p. 353; Reports Council Pharm. & Chem., 1919, p. 26.

Arsphenamin, 491, 494

Aseptikons (Chinosol Co.), The Journal, Nov. 14, 1914, p. 1778;

Reports Council Pharm. & Chem., 1914, p. 124; Propaganda,

ed. 9, p. 26.

Aseptinol, 401

Aseptinol (Aseptinol Mfg. Co.), The Journal, March 30, 1918,

p. 949.

Aspirin: See also Acetylsalicylic Acid.

Aspirin, 116, 544

Aspirin (The Bayer Co., Inc.), The Journal, Jan. 20, 1917; April 13,

1918, p. 1097; June 12, 1920, p. 1664; May 14, 1921, p. 1356;

June 11, 1921, p. 1697; Reports Council Pharm. & Chem., 1916, p. 43.

Aspirin--a common name, 484

Aspirin, Acetylsalicylic Acid not Aspirin, 480

Aspirin advertisements, 483

Aspirin Bayer, 116, 347, 480

“Aspirin Bayer” and the Sterling Products Company, 485

Aspirin, Lehn and Fink, 347

Aspirin Tablets, 566

Aspiro-Lithine (McKesson & Robbins), The Journal, May 28, 1910,

p. 1803; Propaganda, ed. 9, p. 281.

Atlanta Journal-Record of Medicine and Gray’s Glycerine Tonic, 429

Atophan, 313, 373, 419

Atophan (Phenylcinchoninic Acid, U.S.P.), Cinchophen, 373

“Auto-Hemic Serum”, 409

Auto-Hemic Serum (L. D. Rogers), The Journal, Feb. 14, 1920, p. 477.

Autolysin (Autolysin Laboratory), The Journal, July 24, 1915, p. 336;

Nov. 6, 1915, pp. 1647, 1662.

“Autolysin” advertising, 413

B. Coli-Combined-Bacterin, 185

B. Coli-Combined-Bacterin (The Abbott Laboratories), The Journal,

June 22, 1918, p. 1967; Reports Council Pharm. & Chem., 1918, p. 11.

B. Iodine, 198

B. Iodine (B. Iodine Chemical Co.), The Journal, Feb. 1, 1919, p. 365;

Reports Council Pharm. & Chem., 1918, p. 44.

B. Iodine Product, 199

B. Oleum Iodine, 198

B. Oleum Iodine (B. Iodine Chemical Co.), The Journal, Feb. 1, 1919,

p. 365; Reports Council Pharm. & Chem., 1918, p. 44.

Baby Taeniafuge-Grape (Grape Capsule Co.), Reports Council Pharm.

& Chem., 1915, p. 174.

Bacilli Emulsion, Bovine (Farbwerke-Hoechst Co.), Reports Council

Pharm. & Chem., 1917, p. 146.

Bacilli Emulsion, Koch’s (Farbwerke-Hoechst Co.), Reports Council

Pharm. & Chem., 1917, p. 146.

Bacillicide (Prophytol Products Co.), The Journal, Nov. 14, 1914,

p. 1778; Reports Council Pharm. & Chem., 1914, p. 125.

Bacillus Acidophilus Cultures, The Journal, Dec. 20, 1919, p. 1895;

Reports Council Pharm. & Chem., 1919, p. 51.

Bacillus Vaccine, Friedländer. See Friedländer Bacillus Vaccine.

Bacterial Vaccine, Special, Nos. 2, 3, 4, 5, 11, 15 and 16, 254

Bakurol (Sharp & Dohme), The Journal, July 10, 1915, p. 175.

Baldwin, Z. L., and the Allied Medical Associations of America, 490