advertisements have been familiar to the readers of medical journals
for several decades past. It is a typical nostrum. It is secret
although the promoters have published various “near-formulas.” The
following are some of the statements regarding composition:
“A Scientific Blending of _True_ Santal and Saw Palmetto with
Soothing Demulcents in a Pleasant Aromatic Vehicle.”
As this did not disclose the identity of the demulcents or the quantity
of the alleged active constituents, the “formula” was, of course,
meaningless.
Again it is:
“A Scientific blending of _true_ Santal and Saw Palmetto in a
pleasant aromatic vehicle.”
Here the reference to “soothing demulcents” is omitted. The information
furnished physicians at the present time is:
“It is a blend of harmonizing drugs.”
A letter from a physician requesting information as to the exact
composition of Sanmetto recently elicited the following reply:
“... Sanmetto is a blending of true santal and saw palmetto with
soothing demulcents in a pleasant aromatic vehicle. The demulcents
are introduced not only for the purpose of modifying the irritant
properties of the santal, but to add distinctively to the soothing
properties of the finished product upon the mucous membrane of
the urinary tract, and are not mentioned in our published formula
for the simple fact that if we gave them, then we would do the
advertising and the substitute manufacturer would engage in the
‘unfair competition’ of putting on the market his concoction,
claiming to be made exactly after our formula, without spending
a cent for advertising, relying upon our propaganda work to sell
his substitute, although not the same article as nor equivalent to
Sanmetto, from the fact that he would be working in the dark as
to the processes in the manufacture of our product. There is no
mineral substance in Sanmetto, nor any other ingredient that is
detrimental in any way whatsoever....
“OD CHEM. CO.,
“M. Haman, Pres’t.”
THE VALUE OF SANTAL AND SAW PALMETTO
The foregoing warrants the assumption that the active ingredients of
the mixture are sandalwood oil and saw palmetto.
There was a period when the internal treatment of gonorrhea had a
marked vogue. Balsamic remedies received the approbation of the medical
profession as the most specific of internal remedies for this disease.
As a representative of this class, sandalwood oil was very highly
esteemed and had great popularity. As in other similar instances,
this popularity was commercialized and the drug became the basis
of many secret or semisecret mixtures, including “specialties” of
pharmaceutical houses.
Sabal or saw palmetto is an official drug which at one time was used in
genito-urinary affections, but now is seldom used, presumably because
it has been found practically worthless. It is not mentioned by most
pharmacologists, and those who do mention it regard it as of doubtful
value. It is included among the preparations recommended for deletion
as given in the report of the Committee on the Pharmacopeia of the
American Medical Association (The Journal, Sept. 4, 1909, p. 792).
Even granting that sandalwood oil and saw palmetto do have therapeutic
value, no one would think of regarding either or both of these
preparations as of use except in inflammatory conditions of the
genito-urinary tract, especially gonorrhea.
If one is to believe the advertisements, however, the combination
of these drugs in Sanmetto is a wonderful medicine. One might even
conclude that there are few conditions in which it cannot be given with
profit. For instance:
“In Nervous Diseases, especially Neurasthenic cases with origin
in some sexual or genito-urinary disorder, for its action as a
vitalizing tonic and reconstructive, restoring nutrition to germ
plasm, relieving pathological conditions and for soothing and
sustaining the nerves controlling the parts.”
Bear in mind in reading the foregoing statement and the following that
we are concerned with two drugs whose effects are exerted on mucous
membranes especially of the genito-urinary tract.
“In Gestation Cases, showing tendency to albumin and convulsions,
for toning the pelvic organs, clearing up the urine and cleansing
the urinary bladder and outlet. In the Lying-in-Room for relieving
the affections of urethra and bladder, painful strangury of the
urethra and painful micturition due to the pressure of fœtal head
upon the neck of the bladder and upon the urethra during labor, and
infection, either septic or gonorrheal.”
“In Weakness of the Kidneys, causing loss in tone and general
health and Impairment of Eyesight--for strengthening the kidneys
and bladder and toning the nervous system; and also for aiding in
the constitutional treatment of Gonorrheal Infection of the Eyes.
“In the treatment of the Prostate, Testes, Mammæ, Ovaries,
and Urethra, Kidneys and Bladder, for its soothing, slightly
antiseptic, aphrodisiac, toning and restoring action to the mucous
membrane and glands. By its use the parts affected in many cases
returning to their normal condition.”
While the reference to its aphrodisiac action and to the restoration of
parts to the normal may have little interest to physicians, it may be
counted on to appeal to the sexual neurasthenic. In premature senility:
“Sanmetto ... is unexcelled as a vitalizing tonic to the withered
glands of the reproductive system, promoting their normal secretory
activity.”
These claims are not only absurd but also harmful; they tend to
perpetuate a hypochondriacal state of mind in the class of patients
appealed to--the sexual neurasthenic. There is, however, a more serious
side; the tendency of certain other claims made for the preparation are
vicious and dangerous as well as misleading. The advertising claims
are likely to induce some physicians--those who accept advertising
“literature” as dependable--to belittle the importance of serious
diseases of the sexual organs and to be content with Sanmetto, which,
even if it gave as good results as other balsamic remedies, would
be, at best, only a halfway measure. This in an advertising pamphlet
physicians are given this advice as to the treatment of gonorrhea.
“To provide the needed rest the patient should be instructed to
simply keep the parts clean with warm water for the first week and
let the discharge continue until you can control it by internal
medication. I wish to emphasize the fact that there is no way
that any acutely inflamed portion of the genito-urinary tract
can get the rest required so completely as by administration of
Sanmetto.... After the acute gonorrhea has begun to subside the
Sanmetto should be aided by mild astringent injections.”
If there is any well-established fact in medicine, it is that gonorrhea
is a serious disease--serious alike to the sufferer and to the
community--and one which needs careful attention from the very first.
To claim, either directly or by implication, that it can be cured by
such a mixture designed to act on the kidneys, bladder and nervous
system is false and dangerous doctrine.
The physician who prescribes Sanmetto prescribes a secret medicine
for conditions which he is presumably competent to treat with simple
remedies of which he knows the origin and action and which he can vary
to suit the needs of the individual.
Sanmetto is a secret nostrum the exploitation of which is an invitation
to haphazard, uncritical therapy and a menace to public health.--(_From
The Journal A. M. A., March 13, 1915._)
SECRETOGEN
Report of the Council on Pharmacy and Chemistry
The Council has authorized publication of the following report dealing
with two internal secretion specialties--Secretogen Elixir and
Secretogen Tablets--to call attention to the unfounded and extravagant
claims made for this class of products.
W. A. Puckner, Secretary.
Test tube experiments show that pepsin hydrolyzes proteins in acid
solutions; that pancreatin digests protein in alkaline liquids, and
that diastase converts starch into sugar. Based on these facts, it
was assumed that these ferments would aid digestion. This assumption
was correct if limited to certain cases of dyspepsia in which it can
be shown that certain ferments are absent or deficient. But this
limitation was not realized or remembered; on the contrary, the
indiscriminate use of digesting ferments in all kinds of cases of
indigestion became widespread and still continues, although to a less
extent. Herein lies the great disappointment that has followed the use
of these ferments.
More recently hormones were discovered, and while their importance
has not been fully worked out, it has been assumed that they are
responsible for the secretion of digestive ferments, and that in
their absence this secretion fails. Without waiting for proof of this
assumption, that is, that digestive failure is due to lack of hormones,
proprietary medicine promoters are already placing on the market
various secretion specialties.
As an example of this new class of specialties and of the unfounded
claims made for them, your referee presents the following report on
Secretogen Elixir and Secretogen Tablets offered to physicians by the
G. W. Carnrick Company.
Secretogen Elixir is said to contain pancreatic secretin obtained from
the duodenum with 1/10 of 1 per cent. of hydrochloric acid. Secretogen
Tablets are said to be prepared from pure secretin and succus entericus
obtained from the epithelial cells of the duodenum. The claims for
Secretogen are based on the physiologic action of secretin as described
by various observers. To determine whether these claims are justified
it becomes necessary to review the evidence advanced to prove that
secretin stimulates the digestive glands.
Secretin is a hormone, a chemical substance produced by the action of
hydrochloric acid on a previously formed substance, “prosecretin,”
contained in the cells of the intestinal mucous membrane, especially
of the duodenum. Secretin is absorbed by the blood and carried to the
pancreas, liver and intestinal mucosa, which are thereby stimulated
to produce their characteristic secretions, namely, bile, pancreatic
juice and succus entericus. When secretin is injected into the blood,
it causes an increase in the flow of these secretions. Some observers
have claimed that secretin is absent in cases of diabetes in which the
pancreas is still found normal. Wentworth[80] reported several cases of
marasmus in which he found no evidence of prosecretin. This deficiency,
he believes, is the cause of this disease.
[80] Wentworth, A. H.: The Cause of Infantile Atrophy, Deduced from a
Study of Secretin in Normal and Atrophic Infants, The Journal A. M. A.,
July 20, 1907, p. 204.
The Carnrick Company, adopting the foregoing views, namely, that
secretin is necessary to secure the normal action of pancreas, liver
and intestine, as proved, placed on the market their specialty
“Secretogen,” to take the place of the missing secretin.
The foregoing conclusion cannot, however, be sustained. There are
numerous cases in which no hydrochloric acid is produced in the stomach
and hence--as it is produced by the action of hydrochloric acid--no
secretin can be produced in the intestine. Yet in these cases the
pancreatic juice and bile are secreted in normal amounts and digestion
goes on normally after the food leaves the stomach. In such cases
the pancreas and liver must be stimulated to secretion by some other
mechanism than secretin.
The proof that the absence of secretin is characteristic of diabetes
or of marasmus is not yet available. Sweet and Pemberton[81] found
that many circumstances interfered with the extraction of secretin,
so that the mere failure to obtain it in a given case is not proof of
its absence, unless the various inhibiting influences are given due
consideration. The conclusions reached by these authors are that “the
evidence so far adduced that secretin is absent in some varieties (of
diabetes) does not seem conclusive,” and that “the specific absence or
deficiency of secretin in marasmus seems to remain as yet unproven.”
[81] Sweet, J. E., and Pemberton, R.: Experimental Observations on
Secretin, Arch. Int. Med., February, 1908, p. 231.
The favorable reports of Moore[82] in regard to the use of secretin in
diabetes are not confirmed by the experience of Foster[83] in five
cases, or by the case reported by Dakin and Ransom.[84]
[82] Moore, Edie and Abram: Biochem. Jour., 1906, i, 28; ibid., i, 446.
[83] Foster, N. B.: Cases of Diabetes Treated with Secretin, Jour.
Biol. Chem., January, 1907.
[84] Dakin, H. D., and Ransom, C. C.: Treatment of Case of Diabetes
with Secretin, Jour. Biol. Chem., January, 1907.
In regard to the use of secretin in intestinal disorders, the G. W.
Carnrick Company refers to an article by J. W. Beveridge.[85] An
examination of this article shows it to be unscientific and uncritical.
The author presents four cases to “demonstrate the peculiar potency
exercised by secretin.” Of the first he says:
[85] Beveridge, J. Wallace: Secretin, Am. Jour. Gastro-Enterology,
April, 1914, p. 170.
“Stomach was dilated, food delay, seventy-two hours; hyperacidity,
vomiting daily, five to twelve times, urine high specific gravity,
over 3 per cent. urea, trace albumen.”
The patient improved somewhat after gastro-enterostomy with removal
of the gallbladder; the vomiting ceased, but the stools continued
clay-colored and the high urea output still kept up. Secretin was
given, and after this the report continues:
“The stools became normal in color at the end of the second month,
weight gradually increased until 122-3/4 pounds was reached, and
the urea is now normal, averaging about 1 per cent.”
This case is offered to prove the absence of secretin and its effect
when given by the mouth. As evidence of hepatic insufficiency the
author apparently relies on the color of the stools, and for pancreatic
insufficiency he cites the high urea output. He claims that when the
pancreas does not furnish an efficient secretion, the proteins of the
food fail to be converted into amino-acids, and instead, raise the
percentage of urea. Consequently, he concludes that a high percentage
of urea indicates the absence of secretin. It is usually held that a
high percentage of urea depends on two factors, ingestion of a large
amount of protein and concentration of the urine. The author gives
no data as to the amount of albuminous food, the amount of urine,
or whether the percentage of urea was learned by examining a single
specimen or the total quantity for twenty-four hours. The mildest
judgment that can be passed on such clinical data is that they are
totally inadequate. Without doubt the percentage of urea could have
been reduced to “normal” by causing the patient to drink water freely.
The remaining cases show similar hasty conclusions from insufficient
data, rendering them worthless as evidence.
The G. W. Carnrick Company introduces a number of testimonials as
to the value of Secretogen. These testimonials are similar to all
testimonials. They include no evidence of careful diagnosis, and
present an uncritical estimate of the results. They show that the
writers have given Secretogen Elixir or Tablets indiscriminately in
almost the whole range of digestive disorders, in nephritis, neuralgia,
liver disease and gallstones, exophthalmic goiter, neurasthenia,
epilepsy, etc. As dependable evidence, these testimonials are not
worthy of consideration.
A rational basis for the therapeutic value of Secretogen is lacking for
the following reasons:
1. No evidence has been presented that the absence of secretin is a
cause of gastro-intestinal diseases. It is usually present, and if not
present, as in achylia gastrica, there is evidently some compensating
arrangement by which the pancreas is stimulated to perform its regular
functions.
2. There is no evidence that secretin in any form is physiologically
active when administered by the mouth.
REFERENCES
Fleig, M. C.: Action de la sécrétine, Arch. gén. de méd., lxxx, 24.
Charles, J. R.: Treatment of Diabetes with Secretin, Bristol
Med.-Chir. Jour., September, 1906; Med. Press and Circular, Nov. 21,
1906.
Meltzer, S. J.: Animal Experimentation in Relation to our Knowledge
of Secretions, Especially in Internal Secretions, The Journal
A. M. A., May 7, 1910, p. 1506.
Wentworth, A. H.: The Cause of Infantile Atrophy, Deduced from
A Study of Secretin in Normal and Atrophic Infants, The Journal
A. M. A., July 20, 1907, p. 204.
Bambridge and Beddard: Guy’s Hospital Reports, 1907, lxi, 161.
Enriquez and Hallion: Nuevas nociones sobre la digestion. Secretin,
Importancia fisiologica y patologica, Transactions of 14th Int. Med.
Congress, Madrid, 1904.
Enriquez: La Sécrétine Médication acide duodénale Stimulation de
function sécrétiniques chez l’homm., Rev. de. thérap. méd.-chir.,
Paris, 1904, lxxi, 187.
--(_From The Journal A. M. A., May 1, 1915._)
SINKINA
Report of the Council on Pharmacy and Chemistry
Sinkina is a malaria “cure” put on the market by the Metropolitan
Pharmacal Company, New York. The product was presented to the Council
on Pharmacy and Chemistry for admission to New and Nonofficial
Remedies and was rejected because insufficient evidence was submitted
to substantiate the improbable claims made for it. The manufacturers
were sent a copy of the report stating that their product was refused
recognition. In view of the advertising that was persisted in after its
rejection, the Council’s referee for Sinkina submitted the preparation
to clinical tests. Both the original report and the results of the
clinical tests are given in the following report, which was submitted
to the Council and recommended for publication. The complete report
having been sent to the manufacturers and their reply considered, the
Council authorizes its publication.
W. A. Puckner, Secretary.
THE COUNCIL’S FIRST REPORT
The Council, after investigating the claims made for Sinkina, declared
the product unworthy of recognition and adopted the following report,
which was sent to the manufacturers:
No experimental evidence regarding the therapeutic value has been
submitted. The clinical evidence is scant and not of such character
as to deserve much consideration, no sufficient precautions having
been adopted to avoid wrong conclusions. Judging from the evidence at
hand the preparation is simply a dilute sugar-alcohol-water solution
containing a little oil of cumin--Roman caraway. It is highly
improbable that such a liquid would have the therapeutic effects
claimed for it by the Metropolitan Pharmacal Company. In view of the
improbable claims made for Sinkina, and the failure to substantiate
them by suitable evidence, it is recommended that the preparation be
refused recognition without at this time considering the claims made
in regard to the identity and amount of the drug claimed to be the
essential constituent.
In spite of its rejection Sinkina was persistently advertised. It was
thought advisable, therefore, to submit the preparation to clinical
tests. This was done and the results are given in the following report:
THE CLINICAL REPORT
The following quotations indicate the claims made for this preparation:
“In malarial conditions there is nothing that acts so promptly and
efficaciously as Sinkina. Sinkina destroys radically every trace of
the parasite in the blood from the time of its first appearance,
builds up the damaged corpuscles, revitalizes the system, and
completely eliminates every trace of the disease. Sinkina is
deservedly termed the _Specific_ for Malaria.”
These claims were supported by testimonials which usually gave no
indication of a demonstration of the presence or absence of malarial
plasmodia in the blood. The following is an example showing the
character of most of the evidence presented by the manufacturers:
“Three weeks ago I prescribed Sinkina for a negro man 40 years
of age suffering from a double tertian malarial infection having
a chill every afternoon for four consecutive days. He came to my
office about 8 a. m. and was due to have a chill about 6 p. m.
I gave him the sample of Sinkina and directed him to take a
tablespoonful at once, also at noon and again at 4 p. m., and to
continue taking it in same size dose three times a day till he had
taken it all. He reported to me in a week from that date and told
me he was feeling fine and that he hadn’t had any more chills. The
patient up to this time is apparently cured.”
As the claims were supported by a few testimonials purporting to be
based on exact investigations, the Council submitted the preparation
to careful laboratory and clinical tests. For this investigation the
Council was fortunate in securing the help of physicians actively
engaged in the study of malaria.
Experiments were made _in vitro_ with the preparation; 1 ounce of
Sinkina was used, and its action was compared with that of 10 grains
of quinin sulphate. When these were added to cultures of malarial
plasmodia in proportion corresponding to 1 ounce of Sinkina or 10
grains of quinin sulphate for a 150-pound man, the quinin was found
to be unfailingly antagonistic to the malarial organism, the drug
prevented the segmentation of the organism, and finally killed it in
about thirty-six hours. The Sinkina did not kill the parasite after
seventy-two hours of continued action, and the parasites segmented in
the presence of it just as actively as they did in the control.
The investigator was furnished with two sets of preparations in plain
prescription bottles so as to avoid all influence of the personal
equation. One set consisted of Sinkina, the other of a mixture of
alcohol, sugar and water with some oil of cumin. The investigator
reported that, so far as the tests on the cultures of malarial
plasmodia were concerned, he could not determine any difference in
the results obtained with the oil of cumin preparation, made in the
laboratory of the Association, and those obtained with the Sinkina
of the Metropolitan Pharmacal Company. Clinical trials were made by
three independent investigators. Two of them received the two sets of
preparations described.
FIRST INVESTIGATION
The first investigator treated two cases with Sinkina: one was of the
ordinary estivo-autumnal type and the other an ordinary tertian.
CASES 1 AND 2.--A good many schizonts were present in the blood of
each patient forty-eight hours after the administration of Sinkina.
In the instance of the case of tertian the patient had his chill
forty-eight hours after the medicine had been started. As the Sinkina
failed to produce any effect the patients were then put on quinin to
stop the disease.
CASE 3.--The patient had taken 10 grains of quinin on the day on
which the experiment was begun. He had the tertian form of the
disease, and plasmodia were quite numerous at the beginning. The
quinin was discontinued and Sinkina was given in doses of 1 ounce
three times a day. The day following the administration of 10 grains
of quinin and 1 ounce of Sinkina, no parasites could be found in
the blood. The Sinkina was continued in the doses mentioned. On the
seventh day the patient had another chill, and a great many parasites
were found in his blood. The Sinkina was discontinued and the patient
was at once relieved by quinin.
This investigator gives it as his opinion, based on these observations,
that the preparation (Sinkina) is absolutely worthless in the treatment
of malaria, and he does not think it necessary to make any further
experiments with it.
SECOND INVESTIGATION
The second investigator treated two cases of tertian malarial fever
with these preparations until it was satisfactorily proved that the
drug was having no effect on the presence of the parasites in the
blood, when he began the administration of quinin.
CASE 4.--After the use of the remedies for one week the investigator
still found young rings half-grown and gametes present in the blood.
Apparently there was a relative increase in the number of parasites.
He then began the administration of quinin. Blood-smears taken the
next day after 40 grains of quinin had been taken showed one parasite
after eighteen minutes’ search of one slide, and two after thirty
minutes’ search of a second slide. At the end of a week’s treatment
the patient was discharged recovered. The blood examination of two
slides was negative.
CASE 5.--This was a case of tertian malaria. After treatment for
five days with Sinkina the blood still showed tertian parasites with
increase in the size of the spleen, and the preparation was without
effect on the clinical course of the disease. Quinin was then begun,
and the blood examination became negative at the end of three days.
The investigator concludes that the preparations furnished him were
absolutely worthless in the treatment of two cases of the tertian
form of malarial fever, and that these solutions had no effect on the
presence of the parasites in the peripheral circulation. In a case
of quartan malaria, both of the preparations (cumin oil mixture and
Sinkina), sent by the Association Laboratory, were without effect on
the plasmodia in the blood. This investigator employed the solution
made by the Association Laboratory (cumin oil mixture) as well as
Sinkina, and was unable to note any differences between them.
THIRD INVESTIGATION
The third investigator began the trial of Sinkina at the instance of
the manufacturers, and used it in three cases, two of them being benign
tertian malaria and one case of mixed infection (benign tertian and
estivo-autumnal).
CASE 6.--This was one of the cases of benign tertian malaria. The
patient gave a clinical history of malaria with chills occurring
on alternate days for a little over a week. There was an immediate
cessation of all clinical symptoms, and three days after the patient
had been on 1/2 ounce of Sinkina three times daily there was no
evidence of any plasmodia in his blood; his additional treatment
consisted of 5 grains of calomel the evening of the first day
with a saline the next morning. Before the patient was put on
treatment, numerous parasites of both the asexual and sexual forms
were observed. The patient remained in bed for a few days, and then
returned to work. A week later he was again taken ill with a return
of all of his previous clinical symptoms.
CASE 7.--This case was one of mixed infection (benign tertian and
estivo-autumnal). The patient had a clinical history of malaria
dating back two weeks, with a maximum temperature of 104 on
admission. Tertian rings, estivo-autumnal rings and crescents were
found in the blood. The patient was placed in bed, given thorough
eliminating treatment, and 1/2 ounce of Sinkina was administered
four times daily. His clinical symptoms ran on for two days with
no change, and there was no difficulty in finding the plasmodia
in blood-smears, which were taken twice daily. The dose was then
doubled and at the end of four days more there was no change in
either his clinical symptoms or the blood-findings. The patient was
then placed on 10 grains of quinin sulphate with 15 drops of diluted
hydrochloric acid three times daily, to which he responded in less
than forty-eight hours and made an uneventful recovery.
CASE 8.--This was the other case of benign tertian malaria. The
patient had chills every other day while on the treatment, and
laboratory diagnosis confirmed the clinical findings. Experimental
treatment was carried on for four days, with a negative result.
The investigator calls attention to the fact that the first case in
which improvement resulted does not show any necessary connection with
the Sinkina administered, for many cases of benign tertian malaria will
clear up in just as short a time under any line of treatment, while
practically all will eventually do so. This investigator later reported
another case and transmitted a clinical chart.
CASE 9.--This patient was admitted to the hospital, Dec. 30, 1912,
with a history of having had malaria for some weeks. The diagnosis
was confirmed by a blood examination. He was then carried for four
days without treatment other than rest in bed and a liquid diet. His
symptoms subsided by the third day. On the fourth day a count of
the parasites was made which showed that there were 1,160 asexual
parasites and 260 sexual forms to every thousand leukocytes. The
following day he was placed on Sinkina, 1 ounce three times daily.
There was exacerbation of symptoms on the following day, which
gradually increased until the fourth day, remaining about stationary
for a day or so. The fifth day after the patient had been placed
on Sinkina, another count of the parasites showed 5,600 asexual
parasites and 300 sexual forms to the thousand leukocytes, this being
an increase of 4,440 asexual forms and forty sexual forms to every
thousand leukocytes. With the second count of parasites the dose of
Sinkina was increased to 2 ounces every four hours, the patient being
kept on this until January 14, without result. He was then placed on
quinin, with a complete reduction of the temperature to normal and
the disappearance of the parasites from the blood.
The investigator also reported a case of benign tertian malaria.
CASE 10.--This was in a child of 8 years which was treated by the
investigator’s confrère and gave similar negative results. Blood
examination showed numerous parasites. The child was placed on 1
ounce of Sinkina three times a day and kept on it for two weeks.
The clinical picture remained unaltered, and parasites could be
detected in numbers whenever examinations were conducted. A gradually
increasing enlargement of the spleen was also noted. At the end of
two weeks quinin was substituted, and the child went on to a rapid
and uneventful recovery.
This investigator also concludes that the claim put forth by the
Metropolitan Pharmacal Company that Sinkina is a specific in the
treatment of the malarial fevers is entirely without foundation, and
that the firm will be unable to demonstrate to the contrary.
These investigations demonstrate that Sinkina is not a specific against
malaria, and that it has no more effect than a mixture of oil of cumin,
sugar, alcohol and water. They further show the fallacy, first, of
concluding from a temporary cessation of the symptoms in malaria that
the disease has been cured and, second, of ascribing such temporary
improvement to the influence of a remedy which has no known effect on
the malarial organism.--(_From the Journal A. M. A., Sept. 27, 1913._)
SOMNOS
Report of the Council on Pharmacy and Chemistry
_To the Council on Pharmacy and Chemistry of the American Medical
Association:_--Your subcommittee, to whom was assigned Somnos,
H. K. Mulford Company, submits the following report of experiments,
undertaken to compare the effects of Somnos with those of chloral
hydrate. These experiments demonstrate that the statements made in
regard to the action of Somnos are in conflict with Rule 6 of the
Council, which requires: “No article will be admitted or retained
concerning which the manufacturer or his agents make unwarranted,
exaggerated or misleading statements as to the therapeutic value.” It
is, therefore, recommended that Somnos be not approved for inclusion
in the book until the claims made for it are corrected. It is also
recommended that the report be published:
The Pharmacology of Somnos
When these experiments were begun, April, 1906, there was nothing in
the advertising literature on Somnos to indicate whether this article
is a solution or a pure substance. On the label on the bottle, in the
circular accompanying the bottle, and in the booklet “Somnos,” the word
Somnos seemed to be used as a synonym of “Chorethanal alcoholate,”
C_{9}H_{11}O_{5}Cl_{9}, and physicians were prescribing and pharmacists
dispensing it in the belief that it was a pure substance. “The pure
substance; some kind of an alcohol; nothing to do with choral,” was the
way the druggist from whom the samples were purchased put it. Thus
information absolutely indispensable for any rational comparison of
Somnos with other hypnotics was withheld from the physician.[86]
[86] Two weeks ago (Journal A. M. A., Sept. 1, 1906, p. 695) it was
pointed out that the manufacturers now give this information, but in a
wholly unnecessarily obscure form.
Hence, before beginning the physiologic experiments it was necessary
to determine the strength of the preparation; for this purpose three
chlorin determinations (by the Carius method) were made. On the
assumption that all the chlorin present was in combination as chloral
glycerate, C_{3}H_{5}[CCl_{3}.C(OH)_{2}]_{3} = C_{9}H_{11}O_{6}Cl_{9},
and calculating the percentage of this in Somnos, the following results
were obtained: (1) 5.11 per cent.; (2) 5.15 per cent.; (3) 5.10 per
cent.
Somnos, therefore, was found to contain approximately 5 per cent. of
chloral glycerate and its physiologic action was compared with that of
a 5 per cent. solution of hydrated chloral. In some experiments the
hydrated chloral was dissolved in water; in others, in 10 per cent.
alcohol (Somnos was found to contain at this time about this percentage
of alcohol); in other experiments glycerin was added, as Somnos was
found to contain this substance. No very marked differences were found
in the physiologic action of the three solutions.
FATAL DOSE OF SOMNOS FOR THE LOWER ANIMALS
The booklet on Somnos states that “Somnos has no toxicology”; that
while chloral hydrate causes “acute poisoning,” “deep coma,” etc.,
Somnos is “harmless in twenty times the dose prescribed,” “coma
unknown, etc.” The physician would scarcely suspect from such
statements that Somnos is as poisonous a substance as solutions
containing hydrated chloral in corresponding amount; that such is the
case is shown by the following experiments. These experiments were
necessarily made on the lower animals. While such results do not enable
us to draw very definite conclusions as to the absolute toxicity of
poison for man, the results on animals are conclusive as regards the
relative toxicity for man of such closely related drugs as hydrated
chloral and Somnos.[87]
[87] That portion of the report describing the experiments on animals
is here omitted. It was printed in full in The Journal and in the
Report of the Council on Pharmacy and Chemistry, 1905-1908.
* * * * *
CONCLUSIONS
To sum up our results on the physiologic action of Somnos: We have been
completely unable to verify the claims of the manufacturers that Somnos
is less toxic than hydrated chloral, or that it has a less depressing
effect on temperature, respiration or circulation. On the contrary,
the physiologic effects are indistinguishable from those of hydrated
chloral, doubtless because the action of Somnos is simply the action
of hydrated chloral. We can see nothing in the animal experiments or
in the chemical composition which would suggest that Somnos would
possess therapeutic advantages over an elixir of hydrated chloral of
corresponding strength.[[88]
It is to be hoped that physicians who have been blindly using Somnos
without even knowing the strength of the preparation, much less what
it is, will compare its effects with those of a 5 per cent. elixir of
hydrated chloral.[88]--(_Abbreviated from The Journal A. M. A., Sept.
15, 1906._)
[88] The booklet on Somnos, “Somnos, a Pharmacological Report,” which
is referred to here, contains a “Therapeutic Index to the Usefulness
of Somnos.” We give below a list of diseases mentioned in this index
to show the wide range of usefulness (?) that is claimed for this
chloral compound. Abortions. Abscess--of brain, kidney, liver, tonsils,
parotid gland, mediastinum; in appendicitis, glanders, perinephritic,
retropharyngeal, pyemic, pelvic, ovarian. Somnos lessens pain and
quiets nervous state. Tablespoonful, repeated once or twice. Use
liberally. Alcoholism--full doses repeated often. Gives calm sleep. No
blood changes like those produced by chloral. Anemias--progressive and
secondary. Somnos has no deleterious action on blood as is common with
other hypnotics. Aneurism. Angina. Apoplexy. Appendicitis. Arthritis.
Arsenical poisoning. Arteriosclerosis. Asthma. Biliary colic, Bright’s
disease. Carbuncle. Carcinoma. Catarrh. Cellulitis. Cerebrospinal
fever. Chlorosis. Cholecystitis. Chordee. Chorea. Cirrhosis.
Coccydynia. Colic. Colitis. Concussion. Confusional Insanity.
Contusions. Convulsions. Coryza. Cough. Cramps. Cystitis. Delirium.
Diabetes. Diarrhea. Diphtheria. Dropsy. Dysmenorrhea. Dyspnea.
Ear. Emphysema. Empyema. Endocarditis. Endometritis. Epididymitis.
Epilepsy. Erysipelas. Fevers. Fistula. Gallstones. Gastralgia or
Gastrodynia. Gastritis. Gonorrhea. Goiter. Gout. Hallucinations. Hay
fever. Headache. Heart Disease. Hemicrania. Hiccough. Hydronephrosis.
Hydrophobia, Hydrothorax. Hyperesthesia. Hysteria. Indigestion.
Inflammation. Insomnia. Kidney disease. Laryngitis. Liver abscess.
Cirrhosis. Lobar pneumonia. Lockjaw. Locomotor ataxia. Lumbago.
Mal de mere. Malarial fever. Meningitis. Migraine. Melancholia.
Metritis. Morphinism. Muscular rheumatism. Myelitis. Myocarditis.
Myositis. Nephritis. Nervous dyspepsia. Neuralgia, occipito-cervical,
etc. Neurasthenia. Neuritis. Night sweats. Orchitis. Otitis media.
Parethesia. Paralysis. Parotitis. Peliosis rheumatica. Pericarditis.
Perimetritis. Perihepatitis. Perichondritis. Peritonitis. Pertussis.
Petit mal. Pharyngitis. Phthisis. Pleurisy. Pneumonia. Post-epilepsy.
Prolapsed uterus. Pseudo angina pectoris. Purpura. Rabies. Rheumatic
fever. Salpingitis. Sarcoma. Scarlet fever. Smallpox. Spasms. Stomach.
Stomatitis. Sunstroke. Tenesmus. Tetanus. Tonsillitis. Trauma. Trismus.
Typhoid fever. Typhus fever. Ulcers. Urticaria. Varicella. Vomiting.
Vulvitis. Yellow fever.
SUCCUS ALTERANS
Report of the Council on Pharmacy and Chemistry
The following report was adopted by the Council:
It is, believed that unwarranted and exaggerated therapeutic claims
are made for Succus Alterans by its manufacturers, Eli Lilly & Co.,
Indianapolis. In view of the disastrous results which may follow, if,
from the statements made, physicians should be led to rely on the
product as a treatment for syphilis, it is recommended that Succus
Alterans be refused recognition and that this fact be published with
comments.
W. A. Puckner, Secretary.
Comment: Succus Alterans is a preparation which has been put on the
market for some years by Eli Lilly & Co., as a remedy for syphilis.
The serious character of this disease and especially the deplorable
results that ensue from its improper or insufficient treatment, should
make a firm hesitate to advise any treatment for it which experience
has not demonstrated to be at least as efficacious as that which is
generally accepted and well proved. Succus Alterans is the result
of a combination of circumstances; no one person is responsible for
it. It was probably the natural desire for a remedy free from the
occasional injurious results of mercury that led Dr. J. Marion Sims
to advocate the use of a collection of indigenous American plant
drugs, sarsaparilla, stillingia, xanthoxylum, etc., which had a local
reputation for the cure of syphilis. These drugs are supposed to be
inert when the dried plants were used, and this gave an opportunity
for the development of a nostrum. The ingredients are well known, but
as their virtues are supposed to be lost in drying, the physician can
not have his druggist compound them, but must, perforce, prescribe the
proprietary combination.
Those who consented to experiment with the new remedy soon found that
the claims to curative properties were unfounded, but the strong
commercial interests backing it have prolonged its life to the present
time. Authorities on syphilis either say nothing about the preparation
or mention it merely to condemn; but the proprietors of the nostrum
continue to assert that it is not only practically a specific in
syphilis, but now recommend it for various derangements of the blood
and all sorts of skin diseases.
This being the case, what shall the wise physician do? Shall he blindly
follow an authority of a past generation or shall he recognize that the
claims of an interested manufacturer ought not to weigh against the
consensus of his present-day confrères who have given the treatment
of syphilis their special attention? The exploitation of such a
preparation is deserving of strong censure. By such methods the firm
places itself on the same plane as those nostrum venders, who advertise
certain antiseptic sprays and gargles as cures for epidemic meningitis
and diphtheria and thereby deprive credulous victims of the curative
antitoxin treatment. Succus Alterans is not a new remedy on trial for
its possibilities of improvement in therapeutics; it is an old mixture
which has been tried and found wanting.--(_From the Journal A. M. A.,
June 26, 1909._)
SULPHO-LYTHIN
Report of the Council on Pharmacy and Chemistry
Sulpho-Lythin is sold by the Laine Chemical Company, New York. In
the literature sent to physicians it is said: “This product, the
sulpho-phosphite of sodium and lithium (non-effervescent), is entirely
new and is unique in its action.”
Chemical analysis of a specimen of Sulpho-Lythin purchased in the open
market indicated its composition to be:
Sodium sulphate, anhydrous 10.51
Disodium hydrogen phosphate, anhydrous 56.67
Sodium thiosulphate, anhydrous 20.78
Sodium chlorid 5.98
Lithium, as citrate 3.12
Sulphur, free 0.16
Moisture 1.53
Loss 1.25
The examination, therefore, shows that Sulpho-Lythin is a mixture
consisting mainly of sodium sulphate and sodium phosphate and sodium
thiosulphate. The statement that it is a “sulpho-phosphite of sodium
and lithium,” therefore, is not correct, and a statement that “it
is entirely new and unique in its action” appears unwarranted and
misleading. It is, therefore, recommended that the preparation be
refused recognition. It is also recommended that an article be prepared
for publication calling attention to the exaggerated claims made for
Sulpho-Lythin.
The recommendations of the subcommittee were adopted by the Council
and in accordance therewith the report is published with comments,
substantially as follows: The formula means that it is a solution
of well-known salts, some of them under partially disguised names.
Every one knows what Glauber’s salts are good for. Disodium hydrogen
phosphate is ordinary common sodium phosphate. Sodium thiosulphate is
familiar as sodium hyposulphite, the “hypo” of the photographers. Every
one knows, of course, that sodium chlorid is common salt. Examination
and analysis of various specimens of this product demonstrated that
its composition is not always the same. As an indication of the
ignorance of the promoters of this nostrum it is interesting to note
that the label on one of the bottles purchased states that it is a
“sulphophosphate” instead of a sulphophosphite. Extravagant claims are
made for this simple mixture of laxative salts, and these with the
methods of using it are printed on the labels, and while it is claimed
to be only advertised to the profession, the physician is repeatedly
advised in the advertisements to “order always an original (six ounce)
bottle to prevent substitution.” The natural result of this would
be, of course, to put the patient in the way of prescribing it for
himself and to spread the advertisement of the drug among the public.
Difficulty has been experienced in finding out who the promoters of
this nostrum are and the correspondence in regard to it is published.
They seem to prefer to be known by their corporate title of Laine
Chemical Company only. It is a sample of many other so-called ethical
proprietary drugs, most of which are simple mixtures of well-known
drugs which physicians are using every day and which require no skill
in their compounding. Their proprietors not only presume to sell and
advertise medicines but also to tell the physicians how to treat their
patients.--(_Abstracted from The Journal A. M. A., Dec. 8, 1906._)
TAUROCOL
Report of the Council on Pharmacy and Chemistry
The Paul Plessner Company, Detroit, places on the market Taurocol
Tablets and Taurocol Compound Tablets. The company makes a pretense of
giving the formula--minus any quantities--thus:
“Taurocol is a combination of bile salts, extracts of cascara
sagrada, phenolphthalein and aromatics.”
The “formula” given for Taurocol Compound Tablets is:
“Taurocol (Bile Salts) Gramme .1296
Pepsin 1-3000 " .0324
Pancreatic Ext " .0324
Extract Nux Vomica (1/8 gr.) " .0081
Aromatics Q. S.”
A comparison of these two “formulas” with those furnished for
Veracolate and Veracolate with Pancreatin and Pepsin shows that they
are nearly the same.
The claims made for the Taurocol preparations are essentially those
made for Veracolate preparations, as instance the following, which
appears on a physician’s sample of Taurocol:
“For Hepatic Insufficiency, Intestinal Putrefaction, Habitual
Constipation.”
Likewise the following, found on a Taurocol circular, duplicates claims
made for Veracolate:
“... Directly stimulates the liver cells, producing an abundant
flow of bile rich in cholates, solvent of cholesterin and a biliary
antiseptic.”
Taurocol is objectionable for the reasons that apply to Veracolate,
and Taurocol Compound Tablets are subject to the objections that apply
to Veracolate with Pepsin and Pancreatin. (See p. 216.) The Council
therefore refused recognition to Taurocol and its preparations.--(_From
The Journal A. M. A., April 24, 1915._)
TRI-IODIDES, THREE CHLORIDES AND MAIZO-LITHIUM
Report of the Council on Pharmacy and Chemistry
As an illustration of unreliability of claims and the unscientific
character of proprietary mixtures, the Council has authorized
publication of the following reports on Tri-Iodides, Three Chlorides
and Maizo-Lithium, products of the Henry Pharmacal Co. (J. F. Ballard,
proprietor).
W. A. Puckner, Secretary.
Tri-Iodides (Henry)
Tri-Iodides (Henry Pharmacal Co., St. Louis) is a nostrum whose
ingredients apparently were selected at random. Since the effects of
such a mixture cannot be predicted, no thoughtful physician would think
of prescribing in any one condition all the drugs named in the formula
of Tri-Iodides--if he had to write out the prescription. Yet because
the misleading name of the preparation gives it the semblance of a
therapeutic entity--and because it is advertised in medical journals--a
certain number of physicians thoughtlessly prescribe this shotgun
mixture.
LABORATORY REPORT
Regarding the composition of “Tri-Iodides” the Association’s Chemical
Laboratory makes the following report:
A trade package of Henry’s Tri-Iodides purchased in 1910 bore the
following formula on the label:
“Colchicin, 1-20 grain,
“Phytolaccin, 1-10 grain,
“Solanin, 1-3 grain,
“Sodium Salicylate, C. P., 10 grains,
“Iodic Acid (equal to 7/32 gr. of Iodine) in two fluid drachms
of Aromatic Cordial.”
In the circular which was wrapped with the bottle the wording of the
formula differs somewhat from the foregoing, “iodic acid” of the
label being replaced by “hydro-iodic acid.” While the label on the
bottle named “phytolaccin” as one of the constituents the label on
the carton which contained the bottle gave “decandrin.” The following
formula appears on a trade package purchased June, 1914:
“Colchicine, 1-200 Grain,
“Phytolacca, 1 1-5 Grain,
“Mydriatic Alkaloids, 1-500 Grain.
“Sodium Salicylate, 3 1-2 Grain.
“Iodic Acid (equal to 7-125 Grain of Iodine) in two
fluid drachms.”
The differences between the formulas are striking. Colchicin has been
reduced from 1/20 grain to 1/200 grain; sodium salicylate from 10
grains to 3-1/2 grains; iodin (claimed to be present as iodic acid)
from 7/32 grain to 7/125 grain. “Phytolaccin” (“Decandrin”) has been
replaced by “Phytolacca” and “Solanin” by “Mydriatic Alkaloids.”
While the formula for the preparation has been changed, the circular
accompanying the package still refers to “solanin” (in some parts
of the circular wrongly spelled “salonin”) and “phytolaccin.” As no
principle having the characteristic effects of poke-root is known
to have been isolated the terms “decandrin” and “phytolaccin” are
meaningless.
The circular states that solanin is an alkaloid obtained from
the sprouts of _Solanum tuberosum_, but wrongly calls this plant
“bittersweet” instead of potato. At the market price the amount of
solanin claimed, according to the old formula, to be present in a
bottle of Tri-Iodides, would cost $1.60, although a bottle of the
preparation sold at wholesale for 67 cents.
Tri-Iodides is a dark brown, mobile liquid having a faint clove-like
odor and a mawkish, sweet taste. Salicylate was found in considerable
amounts. Traces of alkaloids were found, a portion of which appeared
to be colchicin. Iodic acid and its salts were absent, although
claimed by the formula to be present. Potassium iodid was present.
Determinations of the iodin by distillation with ferric ammonium
sulphate solution and sulphuric acid indicated the presence of about
1.68 gm. of iodin (equivalent to 2.18 gm. of potassium iodid) in each
100 c.c. of the preparation. This is equivalent to about 7.65 grains
of iodin per fluidounce, or more than thirty-four times the amount
claimed by the formula on the bottle. An approximate determination of
the salicylic acid by extraction of the acidified preparation with
ether and evaporation of the solvent indicated about 2.67 gm. in 100
c.c., equivalent to 3.09 gm. of sodium salicylate, or about 14.11
grains per fluidounce. Since the amount of sodium salicylate claimed
is 3.5 grains in 2 fluidrams or 14 grains in each fluidounce, the
amount found agrees essentially with the claims.
ABSURD CLAIMS
It should be unnecessary, after pointing out the conflict between the
name and the published formula, between the formula and the actual
composition, and between the composition and all established therapy,
to discuss this heterogeneous and unscientific mixture further. A few
specimen absurdities, however, may be quoted from the advertising
“literature”:
“... Free of the Disagreeable Effects of the Alkaline Iodides.”
[Tri-Iodides, according to the laboratory report, depends for its iodin
action on potassium iodid.]
“... we have an assimilable form of vegetable hydriodates.
“The hydriodates of these valuable vegetable alkaloids afford the
specific alterative action of iodine without such disagreeable
results as the iodism produced by the ordinary iodides.”
[“The hydriodates” is an obsolete term formerly applied to iodids of
vegetable alkaloids. Iodids of vegetable alkaloids, if present at all
in Tri-Iodides, are present in negligible amounts.]
“Containing Iodine in an available form, it is obvious that the
formula must be beneficial in the majority of syphilitic skin
lesions.”
The falsity of the first two of these claims and the mischievousness of
the last are self-evident.
It would be possible, but is unnecessary, to produce an almost
unlimited amount of evidence to show the transparent character of the
deception by which this preparation is exploited.
The referee feels that the nostrum will have been sufficiently
characterized when he has mentioned further that the name “Henry’s
Tri-Iodides” is blown in the glass of the bottle, that the label
contains the recommendation “For Gout, Rheumatism and other Diathetic
Diseases,” and that the circular accompanying the bottle recommends
the use not only of Tri-Iodides, but also of Three Chlorides,
Maizo-Lithium, Campho-Phenique and Satyria in the treatment of many
diseases.
Three Chlorides (Henry)
Three Chlorides (Henry) is advertised as:
“An oxygen-carrying ferruginous preparation, suitable for prolonged
treatment of children, adults and the aged. Indicated in anemia and
convalescence from acute diseases and surgical operations.”
The following report on the composition of Three Chlorides is submitted
by the Association’s Chemical Laboratory:
LABORATORY REPORT
It is claimed that each fluidram of Henry’s Three Chlorides contains:
“Mercuric Bichlorid 1-72 Gr.
“Arsenic Chloride 1-40 Gr.
“Proto-Chloride Iron 2-25 Gr.
“ ... in a cordial of Calisaya Alkaloids.”
The preparation is a pale yellow, clear solution having an odor
of alcohol. The addition of potassium ferricyanid solution does
not produce any blue coloration, thus demonstrating the absence of
ferrous chlorid (iron protochlorid). Instead potassium ferrocyanid
solution produces at once an intense blue precipitate and potassium
sulphocyanate solution an intense red coloration, thus proving
the presence of iron in the ferric condition. It is obvious that
the claimed superiority of Three Chlorides over preparations
containing ferric iron is absurd. Since it contains iron in the
ferric condition, Three Chlorides decomposes soluble iodids with
the liberation of free iodin. The assertion that it is a suitable
“vehicle” for the administration of iodids is likely to lead the
physician unwittingly to administer free iodin.
As the laboratory report shows, the “formula” of Three Chlorides
(Henry) is incorrect, for protochlorid of iron (ferrous chlorid)
was absent from the preparation. There is, however, a more serious
objection to the formula than the misstatement of fact. When the
physician is dealing with conditions that call for mercury, arsenic
or iron, it is irrational and unscientific to prescribe a preparation
containing these three drugs in fixed proportions.
OBJECTIONABLE ADVERTISING
Three Chlorides is marketed in bottles having the name “Three
Chlorides” blown in the glass, in a carton containing a circular
extolling the curative powers of this and other proprietaries of the
same concern. Thus a physician who prescribes Three Chlorides is likely
to place in the hands of his patient the advice that
“Three Chlorides ... is suitable for the prolonged treatment of
children ...”
“In tertiary syphilis, with or without potassium iodide, it holds
first rank among remedies directed against the specific taint ...”
Further, that “Maizo-Lithium” is:
“A Genito-Urinary Sedative” and a “remarkable uric-acid solvent.”
Also that “Satyria” is:
“An Ideal Genito Tonic and Nerve Reconstituent.”
“Indicated in Prostatic trouble, Cystitis, Urethritis, Gonorrhea,
Gleet, Leucorrhea, Sexual Debility and Impotence.”
We are told that
“As a hematinic, the protochloride of iron justifies the confidence
of the medical profession.”
“The protochloride, more than any other salt of iron, stimulates
the paptic [_sic_] and hydrochloric glandular system of the
stomach, increasing the flow of acid gastric juice.”
It is unnecessary to discuss the truth or falsity of these assertions,
since Three Chlorides does not contain the protochlorid of iron. For
the same reason, it is obvious that the small amount of iron which it
contains is the only possible justification for the claim that the
preparation is
“... Non-Productive of ... Constipation or Teeth Discoloration.”
It is hardly necessary to point out that it is a therapeutic
exaggeration to claim that Three Chlorides is of particular value in
the treatment of tertiary syphilis, that in eczema it is “the most
effective remedy,” that in any form of constipation it is “the remedy
par excellence,” or that
“After arresting malarial attacks with quinine, the combination of
iron, arsenic and mercury with calisaya is an essential requisite.”
“Whenever gastric troubles and digestive disturbances furnish a
contra-indication to iron, this contra-indication disappears when
the iron is combined with arsenic.”
“The simultaneous exhibition of small doses of arsenic and
bichloride of mercury, besides augmenting the effect of iron upon
the red blood-cells, completely obviates the tendency to vascular
congestion and hemorrhage.”
Finally, the suggestion that by the use of Three Chlorides iodids may
be prevented from causing iodism is absurd.
In short, whatever may be the advisability of prescribing iron, arsenic
or mercury in any given case, it is irrational to prescribe them in
fixed proportions. A physician who is induced by the exaggerated
advertising claims to prescribe these drugs in a proprietary mixture,
under a non-informative name, does grave injustice to his patients.
Maizo-Lithium
Maizo-Lithium (Henry Pharmacal Co., St. Louis) is one of the many
proprietary lithium preparations based on the disproved theory that
lithium dissolves uric acid deposits in the body. The label on a trade
package states that:
“Maizo-Lithium promptly facilitates the elimination of the uric and
phosphatic deposits from the system.”
As might be expected, the promoter of Maizo-Lithium ascribes a long
list of ills to “uric and phosphatic deposits,” and argues that,
therefore, Maizo-Lithium is the proper treatment:
“In lithemia, hematuria, incipient diabetes, cystitis, urethritis,
pyelitis and ALL inflamed conditions requiring a non-irritating
diuretic.”
“Inflamed conditions,” naturally, include almost all of the real or
imaginary ills of kidney, bladder, etc.
Maizo-Lithium is distinguished from its congeners chiefly by the claim
that it contains a mythical or problematical compound, maizenate of
lithium.
LABORATORY REPORT
The following report on the composition of Maizo-Lithium has been
submitted by the Chemical Laboratory of the American Medical
Association:
The promoter of Maizo-Lithium makes the following statement on the
label concerning the composition of the preparation:
“Each fluid drachm contains two grains maizenate of lithium.”
The following is also found in a circular which is enclosed with the
trade package of Maizo-Lithium:
“Maizo-Lithium, the remarkable uric acid solvent, is a nascent
chemic union of maizenic acid, obtained from green corn silk, with
the alkaline base lithium forming maizenate lithium, of which the
mother liquid carries two grains to each drachm.”
Standard works on organic chemistry and pharmacology, such as
Beilstein’s Organische Chemie and Cushny’s Pharmacology and
Therapeutics, do not mention maizenic acid. Neither is it mentioned in
comprehensive bibliographies of phyto-chemical investigations, such as
Huseman-Hilger’s Die Pflanzenstoffe or Wehmer’s Die Pflanzenstoffe.
The first to use the term appears to have been a Dr. Vautier (_Arch.
méd. belg._), but his publication is not available to the laboratory.
Rademacher and Fischer (_Amer. Jour. Pharm._, 1886, lviii, 369) claim
to have isolated the substance from green corn-silk, but the record of
their work is unsatisfactory and indefinite and therefore their results
could not be verified; it seems unlikely, however, that they isolated a
pure proximate principle.
Examination of Maizo-Lithium demonstrated the absence of bromids,
chlorids, phosphates, sulphates, acetates, benzoates, salicylates
and tartrates--combinations in which lithium might be expected to
be present. The presence of a citrate, however, was shown by the
usual tests. Lithium and sodium were present. Free acid was absent.
Determination of lithium citrate and of sodium citrate indicated
the presence of a total of about 3.7 gm. of these two salts in each
100 c.c. of the preparation, or about 2.1 grains in each fluidram.
About 25 per cent. of the total salts appeared to be lithium citrate.
The examination, therefore, does not demonstrate the presence of
“maizenate of lithium,” but does show that Maizo-Lithium contains a
mixture of lithium citrate and sodium citrate. Tests for citric acid
and citrates were made on a commercial specimen of fluidextract of
corn-silk. The results were negative, although the preparation had
an acid reaction to litmus. The presence of maizenate of lithium
in Maizo-Lithium--in fact, its actual existence--thus failed of
demonstration. In view of this fact, it was felt that the burden
of proof rested on the promoter of Maizo-Lithium to supply some
satisfactory evidence with regard to this substance. The following
letter was therefore, sent to James F. Ballard:
“According to the label on a recently purchased bottle of
Maizo-Lithium, each fluidram of this preparation contains 2
grains of ‘maizenate of lithium.’ From an examination made in
this laboratory we are inclined to conclude that this statement
is not in accordance with the facts. A search of chemical and
pharmaceutical publications does not reveal that such a compound
as ‘maizenate of lithium’ has ever been isolated and described,
and we are very much inclined to question its existence. We should
be pleased to receive from you any evidence which you may care to
send in substantiation of your claim in regard to the content of
‘maizenate of lithium’ in Maizo-Lithium--particularly a specimen of
‘maizenate of lithium’ or the method by which it is produced.”
While this letter was sent Oct. 13, 1914, no evidence has been
submitted up to date (January, 1915) to substantiate the asserted
presence of maizenate of lithium in Maizo-Lithium.
The report just given shows that the manufacturer has found it
expedient to surround his worthless nostrum with a cloak of mystery.
A discussion of the jumble of uncritical claims, baseless assertions
and evident falsehoods presented in favor of Maizo-Lithium would seem
a waste of time when the secrecy of this nostrum is all-sufficient for
its condemnation.
[Editorial Note.--When the Council on Pharmacy and Chemistry was
started we announced that we did not see any clear line of demarcation
between “patent medicines” and many so-called “ethical proprietaries.”
Time has not caused us to change our opinion. As we have already shown,
and as we shall have occasion to show in the future, not a few of the
“ethical proprietaries” offered to physicians are being advertised by
those who are pushing the rankest of “patent medicines.” The three
preparations mentioned above are sold--and presumably manufactured--by
Mr. Ballard, of St. Louis. Mr. Ballard is the promoter of Ballard’s
Snow Liniment, Brown’s Iron Bitters, Herbine, Dr. Herrick’s Vegetable
Liver Pills, Swaim’s Panacea, Renne’s Pain Killing Oil, etc. He is also
the promoter of Campho-Phenique, exposed in The Journal some eight
years ago.[89] The spectacle is not an edifying one. A manufacturer
with one hand offers the public a profusion of cure-alls, while with
the other he endeavors to foist on the medical profession preparations
which are just as fraudulent. Some day our profession will awake to
the disgrace of it all. It will also awake to the fact, which should
have been evident ere this, that the nostrum business would cease if
physicians would refuse to accept into their offices, even as a gift,
the nostrum-promoting medical journals that live off this trade.
Fraudulent “patent medicines” will continue to thrive just so long as
newspapers will publish “patent medicine” advertisements; fraudulent
“ethical proprietaries” will continue to exist just so long as medical
journals will advertise such proprietaries. As the better class of
newspapers are rejecting “patent medicine” advertising on their own
volition, so are the better class of medical journals rejecting
advertisements of fraudulent proprietaries. Some newspapers will
continue to carry nostrum advertising until their subscribers raise a
protest that will cause the business department to take notice; so,
too, some medical journals will continue to share the profits with the
nostrum exploiters until an outraged medical profession repudiates such
publications.]--(_From The Journal A. M. A., Feb. 6, 1915._)
[89] The Journal A. M. A., April 20, 1907, reprinted in “Propaganda for
Reform,” 8th Edition.
THIALION
Report of the Council on Pharmacy and Chemistry
The following report was submitted to the Council by a subcommittee
which examined Thialion (Vass Chemical Company):
_To the Council on Pharmacy and Chemistry_:--We beg leave to report
on Thialion as follows:
Thialion is sold by the Vass Chemical Co., Danbury, Conn. In
the literature supplied to physicians and in the advertisements
in medical journals, Thialion is stated to be “a laxative salt
of lithia” with the chemical formula “3Li_{2}O.NaO.SO_{3}.7HO.”
“Sodio-trilithic anhydrosulphate” is given as a synonym. An elaborate
graphic or structural formula is also given.
According to analyses, this preparation is a mixture consisting
chiefly of sodium sulphate and sodium citrate with very small
amounts of lithium, the average of several estimations indicating the
following composition:
Sodium citrate 58.6
Sodium sulphate, anhydrous 26.6
Sodium chlorid 3.3
Lithium citrate, anhydrous 1.8
Water 9.7
Thus, the advertising literature is a deliberate misrepresentation
of the facts. It is, therefore, recommended that the preparation be
refused recognition, and that this report be published.
The recommendations of the subcommittee were adopted by the Council and
in accordance therewith the above report is published.
W. A. Puckner, Secretary.
In publishing the above report, the Council is presenting to the
medical profession another object lesson, and one that illustrates how
easily our profession is being humbugged. There are several things
that we may learn from the report on this nostrum, but at this time
we will take up only one phase of the lesson. Many of the scientific
chemical compounds and derivatives given us by the German chemists have
been distinct advancements and have proved to be valuable additions
to our therapeutic agents; further, they were received with so much
favor by physicians that they have been profitable for those who made
them. It is not strange, therefore, that imitators should appear. One
of the first was our old friend, Antikamnia (which was introduced as a
“new synthetical” compound). This was followed by Ammonol, Phenalgin,
Salacetin, and a host of others having acetanilid as their principal
ingredient.
[Illustration:
This picturesque “graphic formula” for Thialion appears with many of
the advertisements. To most of us it looks formidable, wonderfully and
deeply scientific and non-understandable; to a chemist it looks absurd.]
But there are hundreds of other so-called “new chemical” compounds
among the “ethical” proprietaries on the market aside from the
acetanilid mixtures. These wonderful compounds, by the mysterious union
of their ingredients, possess therapeutic properties different from,
or more powerful for good than the drugs from which they are made. At
least, this is what we are told, and this is what many believe or they
would not sell so well.
There is another factor worth noticing connected with this subject:
When to the claim that the mixture is a “chemical compound” is added a
complex chemical formula, it prevents the impertinent question, “What
is it?” For isn’t the “formula” there, and is not the information given
without the asking? Most of us have been so overcome by the display of
the chemical knowledge of the nostrum maker that we have been afraid
to expose our ignorance by asking for information or explanation. And
thus the promoter avoids perplexing questions, which, if answered
truthfully, would spell bankruptcy.
To a chemist the formula of Thialion furnished by the Vass Chemical
Company signifies nothing. To a physician who possesses but little
knowledge of chemistry, it will seem impressive, and he may absorb the
idea that it stands for a preparation that is the result of exhaustive
scientific research. To the chemist, this formula will appear as a
jumble of symbols and numbers that mean nothing.
It is not worth while to call attention to the simplicity of this
simple mixture of ordinary salts, for it is too self-evident. As to the
remarkable therapeutic qualities of Thialion, the reader is referred to
that ably edited “scientific” periodical, the _Uric Acid Monthly_, and
to the mass of “literature” relating to this wonderful remedy.
While there is a ridiculous side to this business, there is also a
serious one. Those who have been making money out of us undoubtedly
laugh in their sleeves at our gullibility, but to us as members
of a presumably learned and intelligent profession, it is not
a laughing matter. The whole nostrum business is a shame and a
disgrace.--(_Modified from The Journal A. M. A., Nov. 3, 1906._)
UNGUENTUM SELENIO VANADIC (V. ROEMER)
Report of the Council on Pharmacy and Chemistry
Unguentum Selenio Vanadic (v. Roemer) is an ointment manufactured by
A. von Roemer, Brooklyn, N. Y., and put on the market by Schering and
Glatz, New York. It is claimed to contain 1 per cent. of selenium
oxycyanid and 1 per cent. of vanadium chlorid “so prepared and
incorporated into a modified lanolin base as to insure complete
absorption.” The preparation is recommended in the later stages of
inoperable carcinoma, sarcoma, epithelioma and other malignant tumors,
as a substitute for morphin and other narcotics to control pain, as a
modifying (ante-operative) treatment in the middle stage of malignant
cases presenting the characteristics of being inoperable, and as a
prophylactic treatment of recurrences and metastases following excision
of malignant tumors. It is also recommended for use in slow-healing
surgical wounds, abscesses, tuberculous and mixed septic and gangrenous
processes, etc., in lupus, acne, eczema, psoriasis, scabies,
erythemata, adenomata, angiomata, papillomata, etc. The use of the
ointment is further recommended by systemic inunction in septicemia,
pneumonia, erysipelas, cerebrospinal meningitis, septic rheumatism,
septic neuritis, etc. The Council voted that the preparation be not
accepted for inclusion with New and Nonofficial Remedies because no
evidence has been submitted that the vanadium and selenium are absorbed
or that they produce any of the effects claimed.
When the preceding report was sent to Schering and Glatz, the firm
expressed surprise that evidence of the absorption of selenium and
vanadium should be requested. On June 8 the firm wrote that within
a few days one or more tests would be sent by which the presence of
selenium and vanadium in the urine could be demonstrated. These tests
were not received. So far (November, 1914) no evidence of the value
of the preparation either in carcinoma or in any of the very long
list of other diseases in which it is recommended has been submitted,
and, the pharmacologic evidence that such a preparation would be of
value in such conditions being practically nil, the Council authorized
publication of this report.--(_From The Journal A. M. A., Nov. 21,
1914._)
UNICORN ROOT, WILD YAM AND WILD INDIGO
Report of the Council on Pharmacy and Chemistry
The Council has voted that recognition be refused to the following:
Unicorn Root (_Aletris farinosa_), Wild Yam (_Dioscorea villosa_), and
Wild Indigo (_Baptisia tinctoria_) and has authorized the publication
of the following statements.
W. A. Puckner, Secretary.
Unicorn Root--Aletris Farinosa
Unicorn Root (_Aletris farinosa_) contains a bitter principle and
starch. Remarkable powers as a uterine tonic have been ascribed
to it but have not been realized by reliable observers, the drug
being practically valueless in these conditions. It enters into the
composition of a number of nostrums. As a bitter it is superfluous and
it should not be included among non-official drugs.
Wild Yam--Dioscorea Villosa
Wild Yam (_Dioscorea villosa_) has been little used in medicine.
It contains a saponin and an acrid resin, and is said to possess
expectorant, diaphoretic and--in large doses--emetic properties. It
has been recommended as a remedy in biliary colic and in muscular
rheumatism. Its value in such conditions has not been verified to an
extent entitling it to consideration as a useful remedy.
Wild Indigo--Baptisia Tinctoria
Wild Indigo (_Baptisia tinctoria_) has been in use--chiefly by the
eclectics--for about three-quarters of a century, but there is no
satisfactory evidence that it has any therapeutic value. The following
text-books on pharmacology do not even mention wild indigo: Cushny,
Brunton, Dixon, Binz, Sollmann. It is not official in the United States
or other leading pharmacopeias.
A preparation of wild indigo is advertised with extravagant claims
for its therapeutic action, but these claims are not supported by any
substantial evidence. Other virtues ascribed to wild indigo are its
properties as a cardiac and hepatic stimulant and its value in sepsis,
particularly in typhoid fever. It actually has emetic and cathartic
properties, but even these are inferior to those possessed by many
other drugs.
It is very evident that a drug possessing the extraordinary merits that
have been claimed for wild indigo would not have remained unnoticed by
the leading authorities on pharmacology and therapeutics, especially
after its prolonged use in medicine. Owing, therefore, to the lack of
substantial evidence of its usefulness, baptisia is not considered
as of sufficient importance to warrant its inclusion in the list of
non-official drugs. It is probably entirely superfluous.--(_From The
Journal A. M. A., Jan. 22, 1910._)
PROPRIETARY VANADIUM PREPARATIONS
Report of the Council on Pharmacy and Chemistry on Products of
Vanadium Chemical Co.: Vanadiol, Vanadioseptol,
Phospho-Vanadiol, Vanadoforme, etc.
Vanadiol and preparations thereof, the products of the Vanadium
Chemical Company, were submitted to the Council. After thorough
investigation it was concluded that the company has not, and never has
had, any reliable evidence for the therapeutic claims it has presented
to the medical profession regarding these products. Accordingly the
Council voted that the several products under consideration be not
accepted for inclusion with New and Nonofficial Remedies. The findings
of the Council having been submitted to the Vanadium Chemical Company
and its reply considered, the Council authorized publication of the
report which appears below.
W. A. Puckner, Secretary.
The Vanadium Chemical Company, Pittsburgh, Pa., submitted to
the Council on Pharmacy and Chemistry for inclusion in New and
Nonofficial Remedies the following products: Vanadiol, Vanadioseptol,
Phospho-Vanadiol, Vanadium Solution for Intravenous and Hypodermic Use
and Vanadoforme. At the same time, the company submitted statements
and “literature” regarding the composition and therapeutic value
of these products. The committee to which the matter was referred,
after carefully considering both the matter presented and certain
modifications in the advertising matter to which the company consented,
reported that the evidence, especially that relating to the therapeutic
value of the preparations, was insufficient to warrant the acceptance
of the articles. Since the validity of therapeutic claims can be
determined to a certain extent by experimental investigation, the
Council decided to postpone final action until sufficient dependable
evidence as to the therapeutic value had been submitted.
Accordingly, a series of questions was sent to the Vanadium Chemical
Company for the purpose of learning on what pharmacologic evidence
the therapeutic claims were based. After waiting several months, the
information requested not being furnished, the Council took final
action on the products. This action was based both on the evidence
originally submitted and on the advertising matter being sent out by
the company at the time.
Briefly, Vanadiol is said to contain a compound of vanadium with
oxygen and chlorin, which gives up its oxygen to readily oxidizable
substances, such as the blood. In addition to this compound it contains
an oxidizing agent (sodium chlorate) which is said to serve as a source
of oxygen, so that, according to the theory of the promoters, Vanadiol
acts in the animal system as an oxygen-carrier.
The following is quoted from an advertising circular:
“Most thorough and conclusive physiological tests were made on
guinea-pigs and other animals, which established undoubted evidence
as to the truth of this theory.
“INFLUENCE
“Under the influence of Vanadiol and the other derivatives, the
appetite is increased, there is greater ability to peptonize ingested
proteid material, and, through the improvement in the assimilative
powers and the checking of abnormal fermentations, leads to an
increase in weight. A greater excretion of urea follows their use.
Phagocytic action is promoted by an increase in the leucocytes. All
phases of the elimination of waste materials are favored by the
positive increase in the number of red blood corpuscles and the
percentage of hemoglobin, hematogenesis being thereby rendered more
perfect. The beneficent effect of nascent (active) oxygen, upon the
red corpuscles and upon tissue cells of low vitality are matters of
common knowledge. The results obtained from the vanadium derivatives
are not drug effects, but are due to improved metabolism, which in
turn is due to the removal of microbian toxins, and the general
stimulation of cell activity.
“In a tubercular organism, the action of Vanadiol is two-fold.
First, it acts as an antiseptic and antitoxin, combating the Koch
bacilli and neutralizing their poison. Second, as a reconstituent of
the economy, to which it furnishes nascent oxygen, fortifying the
defenseless cells by the very element that is necessary to make them
healthy and resistant.”
“In Anemia and Chlorosis, the blood cells lack oxygen, and in
Neurasthenia the nerve cells are deficient. Vanadiol brings both
blood and nerve cells from a condition of weakness and decay into
vital energy, by furnishing them with active oxygen in a manner that
had not been possible by any other medicine.”
“Vanadiol accelerates the work of digestion by producing HCl in
small doses; it does not hinder the peptonization of albuminoids as
do beta-naphthol, salicylic acid, boric acid, etc., when used as a
stomachal antiseptic, but on the contrary it favors, by hydrochloric
acid, the transformation of albuminoids into peptone without the
assistance of pepsin. Thus, Vanadiol, when given to consumptives,
favors the digestion of large amounts of proteid materials and
causes oxidation of toxins of the stomach. The stomachic action is
reflected in other parts of the organism by the stimulation of the
chief functions; the pulse becomes stronger and muscular strength
increases; and, last, but of greatest importance, is the tremendous
increase which will be noted in the hemoglobin and the red cell
count.”
“Phospho-Vanadiol, a combination of Vanadiol with an easily
assimilable organic phosphorus, is an active accelerator of general
nutrition with a special action on the nervous system.”
Such remarkable statements as these are past credence, certainly,
unless they are supported by scientific evidence. And evidence, either
in support or in contradiction of the claims made, could be obtained;
for many of these actions, at least, are capable of proof by animal
experimentation. The Vanadium Chemical Company was asked to furnish
such proof but failed to do so. The inference is plain! The committee
has concluded that the company has not, and never has had, any reliable
evidence on which to base the therapeutic claims it has presented to
the medical profession.
Here another fact should be noted. It is the connection shown in The
Journal, June 22, 1912, of the general manager of the Vanadium Chemical
Company, F. M. Turner, with a fraudulent obesity cure concern, the Dr.
Turner Company of Syracuse, N. Y.
It seems, moreover, by all the evidence available, that F. M. Turner
is not authorized to use the title M.D.; yet, under this title his
name appeared on cards representing the Vanadium Chemical Company and
under this title, also, he published an article in a medical journal
recommending to the medical profession the use of Vanadiol. Later this
article was distributed as an advertising circular by the Vanadium
Chemical Company. Turner’s connection with the Dr. Turner Company is
known and acknowledged by the Vanadium Chemical Company, yet it still
retains him as general manager!
While there is not necessarily any direct relation between the
personnel of a proprietary manufacturing company and the value of that
company’s product, it is natural that the medical profession should
view with distrust any concern managed by one who has previously been
connected with such a fraud as the Turner obesity cure.
The committee therefore recommends that the preparations of the
Vanadium Chemical Company be refused recognition, and that this report
be authorized for publication.--(_From The Journal A. M. A., Jan. 18,
1913._)
VENARSEN
Report of the Council on Pharmacy and Chemistry
The report which appears below was sent to the Intravenous Products
Company for consideration. Having considered the firm’s reply, the
Council has authorized publication of its report along with the
explanation sent by the Intravenous Products Company in reference to
the variable composition reported for Venarsen, namely, that “only the
first few experimental ampules, sent to the doctors for clinical tests,
were made without the Mercuric Iodide.”
W. A. Puckner, Secretary.
This product is prepared by the Intravenous Products Company, Denver.
The advertising circulars contain inconsistent statements as to its
composition. According to one circular Venarsen is
“... a comparatively non-toxic organic arsenic compound, 0.6 Gm.
representing 247 Mg. (3-3/4 grains) of metallic arsenic in chemical
combination....”
According to another circular Venarsen is
“... a comparatively non-toxic organic arsenic compound, 0.6 Gm.,
representing 247 Mg. (3-3/4 grains) of metallic arsenic and .78 Mg.
(3/250 grain) metallic mercury in chemical combination.”
Neither one of these statements gives any information as to the actual
composition of the product. Inquiry addressed to the manufacturers
elicited the reply that:
“Venarsen contains in each 5 c.c. 0.6 Gm. Sodium Dimethyl Arsenate,
.0016 grams of Mercuric Iodide, .0048 grams of Sodium Iodide in
solution in a suitable vehicle for intravenous administration.”
The following report of the examination of Venarsen is submitted by the
Association’s Chemical Laboratory:
LABORATORY REPORT
Three ampules of Venarsen were examined. The first ampule was labeled
“A comparatively non-toxic organic arsenic compound, representing
247 Mg. (3-3/4 grs.) of metallic arsenic in chemical combination. 5
c.c.--0.6 Gm.”
Practically the same statement appeared in an advertising circular
wrapped around the ampule. The second and third ampules bore labels
identical with the first. The circulars differed from that accompanying
the first ampule in that the presence of mercury is also announced,
thus:
“Venarsen is a comparatively non-toxic organic arsenic compound,
0.6 Gm., representing 247 Mg. (3-3/4 grains) of metallic arsenic
and .78 Mg. (3/250 grain) metallic mercury in chemical combination
and is so prepared and enhanced as to present the ingredients to
the blood in their most acceptable form.”
Thus, although the potent elements said to be contained in Venarsen are
named, its chemical character (the combination in which the elements
occur) is not disclosed.
The ampules contained a transparent, odorless solution, possessing
the yellow color of salvarsan solution (an aqueous solution of sodium
cacodylate, mercuric iodid and sodium iodid in the amounts said to
be present in Venarsen is colorless). Qualitative tests demonstrated
the presence in each of the three ampules of sodium cacodylate
(sodium dimethyl arsenate), and the absence of arsenites, arsenates,
phosphates, arsanilates (atoxyl, soamin) and arsenphenolamins
(salvarsan, neosalvarsan). Titrated with normal hydrochloric acid,
using methyl orange as indicator (as outlined in New and Nonofficial
Remedies, 1915, p. 40), the three ampules were found to contain the
equivalent of respectively, 0.219, 0.253 and 0.216 Gm., or an average
of 0.244 Gm. arsenic. (According to statements of the firm each
5 c.c. of Venarsen contains 0.6 Gm. sodium dimethyl arsenate [sodium
cacodylate], equivalent to 0.247 Gm. arsenic or 41.66 per cent. Sodium
dimethyl arsenate, as described in New and Nonofficial Remedies,
contains 3 molecules of water and 35 per cent. arsenic. This indicates
that the sodium dimethyl arsenate used in Venarsen contains less water
of crystallization than the N. N. R. product).
Neither mercury nor iodid could be found in the first ampule. (The
company has since explained that mercury was absent only from the first
experimental samples.) The second and third ampules contained iodid and
mercury in small amount. The exact quantity was not determined because,
on the basis of the mercury content declared, a single accurate mercury
estimation would have required the purchase of something like 25 to 100
ampules. As each ampule sells for two dollars, the cost of the material
was considered prohibitive.
From the foregoing we conclude that the first ampule examined consisted
essentially of a solution containing 0.625 Gm. of sodium cacodylate,
N. N. R., while the second and third ampules contained 0.722 Gm. and
0.617 Gm. sodium cacodylate, respectively, and in addition, a mercury
compound, probably mercuric iodid, dissolved by sodium iodid.
In other terms, Venarsen as now marketed is a simple solution
containing approximately 9 grains of sodium cacodylate, 1/40 grain of
mercury “biniodide” and 3/4 grain of sodium iodid to each full dose.
In the past the preparation has been in conflict--especially serious
because of the potent character of the drug--with Rule 1 (secrecy
of composition). The manufacturers have removed this conflict by
furnishing a statement of composition; and it is to be expected that
they will likewise take steps to remove the manifestly erroneous
impression now likely to be gathered from the circulars, namely, that
the preparation is rather analogous to salvarsan. These conflicts,
however, call for comment, since physicians have doubtless used the
material under misapprehensions.
As to therapeutic claims, the preparation is said to be effective and
safe in syphilis; “lower toxicity and greater spirochaetacidal power
than other known arsenic compounds” are among the claims. No real
evidence for either of these claims is presented. Sodium cacodylate
has been tried as an antisyphilitic, but with indifferent success;
certainly the results have not been comparable to those of salvarsan.
The mercury could conceivably enhance its effect, but the dosage
appears too small and the course too short for this influence to be
pronounced. Moreover, a careful physician would not give arsenic and
mercury in fixed proportions.
The claim of comparative non-toxicity is probable enough from what is
known about the cacodylate. No physician should feel “safe,” however,
when injecting intravenously 0.6 gm. of sodium cacodylate every four
to six days. Aside from the grave dangers of intravenous injection in
general, the possibility of idiosyncrasies to arsenicals should always
be borne in mind.
Finally, Venarsen is claimed to be “indicated” in pellagra,
tuberculosis, anemia, etc. No evidence is presented on which to base
an opinion as to its efficiency in pellagra. Those who have studied
that disease would not be likely to resort to this treatment. In
tuberculosis and anemia, there is no sufficient advantage in giving the
cacodylate intravenously.
To summarize, Venarsen treatment consists essentially in the
intravenous injection of large doses of sodium cacodylate. The
other ingredients, as well as the name, merely constitute so much
mystification. While the cacodylate probably has some effect on the
conditions for which it is advised, there is no evidence that its value
even approaches that of salvarsan in syphilis, or that the intravenous
use is preferable to the ordinary methods. The dangers are manifest,
although they may not be so great as with salvarsan. No justification
has been established for its use in tuberculosis and pellagra.
Physicians who wish to try intravenous cacodylate administration should
have a full realization of the dangers of such treatment, and in order
to avoid further risks, will do well to refrain from combining other
drugs with the cacodylate in fixed proportions.
It is recommended that Venarsen be held in conflict with Rule 6
(unwarranted therapeutic claims), Rule 7 (poisonous ingredients
not stated on label), Rule 8 (name does not express the chemical
composition) and Rule 10 (unscientific combination) and that this
report be published.--(_From The Journal A. M. A., May 22, 1915._)
VENODINE
Report of the Council on Pharmacy and Chemistry
Venodine (The Intravenous Products Co., Denver), according to
information sent to the Council, is “an Intravenous Iodine Compound”
put up in ampules each of which contains “28 grains of Sodium Iodide,
1/8 grain each of Beechwood Creosote and Guaiacol in a suitable
vehicle, and excipients to enhance its compatibility with the
circulating blood.”
The “Therapeutic Indications” include “infectious diseases, such as
syphilis, tuberculosis, bronchitis, bacteraemias associated with
chronic and acute nephritis (Bright’s disease), and other infections.”
The Council held as unwarranted and grossly exaggerated the following
therapeutic claims: (1) that the full therapeutic value of iodin
medication cannot be readily obtained except by intravenous injection;
(2) that Venodine is “of exceptional value in tuberculosis”; (3) that
in pneumonia Venodine “combines the anaesthetic properties of creosote
and guaiacol with the germicidal value of iodine”; (4) that “Venodine
(or its iodine component) has long enjoyed an exceptional reputation”
as of great value in many infectious diseases including bacteremias.
The facts on these points are the following:
1. Since iodids are easily absorbed from the mucous membrane of the
gastro-intestinal tract and are usually well tolerated by the stomach,
there is no reason for resorting to intravenous injection in their
administration.
2. The indiscriminate administration of iodids for pulmonary
tuberculosis is strongly to be condemned. The cases in which they
can be given to tuberculous patients without doing harm must be very
carefully selected.
3. There is no evidence either that creosote is excreted by the lungs
in sufficient quantity to exert an anesthetic influence or that
iodin is present in the circulation of the lungs or in the bronchial
secretions in a form which is capable of exerting any germicidal action
whatever.
4. It is generally held that the systemic administration of iodin
compounds in bacteremias is useless.
The Council also held the name “Venodine” objectionable in that it
fails to indicate the chief ingredient (sodium iodid) of this simple
pharmaceutical mixture. The statement in a circular that “Venodine
is a sterile solution representing 1.54 Gm. (24 grains) of iodine in
chemical combination together with creosote and guaiacol” is likely
to lead physicians to use the preparation without considering that
its chief constituent is the well-known substance sodium iodid,
particularly so since no reference to sodium iodid is made in the
circular.
Furthermore, the Council held that the combination of two such similar
substances as creosote and guaiacol (the second a constituent of
the first) as given in the published formula, stamps Venodine as
unscientific; it adds mystery to the preparation, but does not increase
its efficiency, and is therefore against the best interests of the
public.
The Council voted that Venodine be held ineligible for conflict with
Rules 6, 8 and 10.
This report having been submitted to the manufacturers, in
accordance with the Council’s custom, and the reply affording no
reason for modifying the findings, its publication has now been
authorized.--(_From The Journal A. M. A., June 26, 1915._)
VERACOLATE[AM]
Report of the Council on Pharmacy and Chemistry
[AM] For report on a similar compound, see Taurocol, p. 198.
“Veracolate (plain),” “Veracolate with Pancreatin and Pepsin” and
“Veracolate with Iron, Quinine and Strychnine” are proprietary tablets
marketed by the Marcy Company, Boston.
“_Veracolate_ (_plain_).”--For this the following non-quantitative
formula is given:
“A compound containing the bile acids, sodium glycocholate, sodium
taurocholate with cascara sagrada and phenolphthalein.”
The dose is three tablets. Examination in the Chemical Laboratory of
the American Medical Association of a specimen of “Veracolate (plain)”
indicated that there was about 20 mg. (1/3 grain) of phenolphthalein to
each tablet. One dose, therefore (three tablets), would contain 1 grain
of phenolphthalein--an average dose.
“_Veracolate with Pepsin and Pancreatin._”--The following “formula” is
given for this mixture:
“Veracolate 1-1/4 grain
“Pure Pancreatin 1 grain
“Pepsin aseptic (1:3,000) 1/2 grain
“Oil peppermint 1/10 min.”
(Note the presence of two mutually incompatible digestive ferments.)
“_Veracolate with Iron, Quinine and Strychnine._”--This is stated to
have the following “formula”:
“Veracolate 1-1/8 grain
“Reduced Iron 1 grain
“Quinine Sulphate 3/8 grain
“Strychnine Sulphate 1/100 grain”
It will be noticed that these mixtures increase in complexity until a
combination of seven diverse ingredients, a veritable shotgun mixture,
is evolved. In none of the “formulas” are the proportions of the
purgative drugs in Veracolate stated. In the second “formula,” the
digestants might as well be omitted, for the pancreatin is destroyed
by peptic digestion and hence cannot pass the stomach while the
pepsin is useless without hydrochloric acid, and, at any rate, of no
value in the intestine. If one is indicated, the other is not. Yet
this unscientific and complex combination of purgatives, mutually
incompatible digestive ferments, and oil of peppermint is called:
“A scientific Blending of Digestive Ferments, Cholagogues and
Carminatives.”
“... for all forms of indigestion and dyspepsia.”
And the third, an equally irrational and complex combination, is termed
“The Ideal Cholagogic Tonic”!
_Extravagant and Misleading Claims._--True to type, the claims are
magnified in accordance with the number of ingredients. For instance,
of “Veracolate (plain),” we are told:
“Veracolate is a true cholagogue and biliary disinfectant as it
_directly_ stimulates the liver cells producing an increased flow
of limpid bile. Although not a purgative, it moves the bowels and
is definite and dependable in its action.”
“The action of Veracolate is to bring about a profuse flow of
healthy bile which prevents bile stasis. As the flow of bile is
stimulated so antiseptic action ensues, calculi softened and the
concretion and mucous eliminated. Mucosal swelling is diminished
and the infection which is usually present is antagonized. Relief
is in plain evidence. As a result of the treatment the skin,
eyes and urine become normal in appearance in a short time, the
appetite and digestion improve and soreness in the region of the
gall-bladder is entirely relieved.”
Similarly, it is said of “Veracolate with Pancreatin and Pepsin” that:
“It causes a natural flow of bile which checks fermentation,
prevents the absorption of toxines and causes the food elements
to be emulsified and thus rendered easy of assimilation. All this
conduces to a natural movement of the bowels. Digestion is at once
improved and the epigastric pain, nervous symptoms and headache
disappear.”
“Veracolate with Iron, Quinine and Strychnine” is said to be indicated
in:
“Hepatic Torpor accompanied by Anemia, Chlorosis, Debility,
Neurasthenia and Neuroses.”
And the physician is asked to believe that it will:
“... give gratifying results in all _nervous, anemic_, and ‘run
down’ conditions in which the liver function is usually subnormal.”
The objections to “Veracolate (plain)” are that it is semi-secret
in composition, unscientific in combination and exploited under
unwarranted claims. The same criticisms hold with reference to
“Veracolate with Pancreatin and Pepsin” and “Veracolate with Iron,
Quinine and Strychnine.”
These products are discreditable to the medical and pharmaceutical
profession alike and their use is against the public good. The
Council therefore refused recognition to Veracolate and its
preparations.--(_From The Journal A. M. A., April 24, 1915._)
HAYDEN’S VIBURNUM COMPOUND[AN]
Report of the Council on Pharmacy and Chemistry
[AN] See also report on Dioviburnia, p. 141, and article on Viburnum
Compound and Other Nostrums, p. 409.
The following report on Hayden’s Viburnum Compound was prepared by a
member of the Council’s Committee on Therapeutics. The Council held the
preparation in conflict with its rules and authorized publication of
the referee’s report.
W. A. Puckner, Secretary.
Hayden’s Viburnum Compound, according to the advertising circulars, was
first compounded in 1860 by W. R. Hayden. The medical profession is
told that W. R. Hayden
“... found by his experiments that a combination of the active
principles of _Viburnum Opulus, Dioscorea Villosa_, combined with
aromatics, proved a valuable remedy for _Spasmodic Dysmenorrhea_.”
As in 1860 W. R. Hayden was not a physician (he received a diploma from
the Eclectic Medical College, New York, in 1867), and, so far as we can
learn, he was not a pharmacist or chemist, one wonders what kind of
“experiments” he made. Hayden’s Viburnum Compound is put on the market
by the New York Pharmaceutical Company of Bedford Springs, Mass. The
name of this concern may sound imposing, until it is realized that it
is merely a trade name adopted by Hayden in exploiting his nostrum.
The advertising matter formerly claimed that Scutellaria (skull-cap)
was one of the ingredients of Hayden’s Viburnum Compound. As this is no
longer mentioned, it is fair to assume that even the manufacturer does
not consider the composition to be of vital importance. Stress is laid
on the superior efficacy of viburnum opulus in the conditions for which
the preparation is recommended; it is emphasized that it is viburnum
opulus, and not viburnum prunifolium, that is the important ingredient
of Hayden’s Viburnum Compound. The label, in accordance with the
requirements of the Food and Drugs Act, declares that the preparation
contains 50 per cent. alcohol. The claim is made:
_“It is free from all narcotics and leaves no unpleasant
after-effects.”_
The medical profession is told that Hayden’s Viburnum Compound is a
remedy in:
“Hysteria, Bilious Colic, Cramps of Cholera Morbus, Muscular
Cramps,... Nervous Diseases of Pregnancy, Threatened Abortion,
Post-Partum Pains, Puerperal Convulsions, Rigid Os, Dysmenorrhea,
Menorrhagia.”
DISCUSSION OF ALLEGED INGREDIENTS
_Viburnum Opulus_ (_Cramp Bark_).--Botanists and pharmaceutical
chemists declare that this drug has not been on the American market
for many years, if ever, and that the drug used and even described as
viburnum opulus is really the bark of another plant. Viburnum opulus
and its preparations are therefore to be dropped from the next United
States Pharmacopeia. The principal constituents of viburnum opulus are
stated to be a glucosid, viburnin, a bitter resin, and a little tannin,
with small amounts of earthy carbonates and phosphates and organic
acids (Culbreth, Ed. 4, 1906, p. 591). The glucosid and resin being
bitter, the drug might have a slight stomachic action (if, indeed,
any such effect is actually produced by “bitters”); the small amount
of tannin might make it slightly astringent; its fruit acids (citric
and malic) might make it slightly diuretic. Even if viburnum opulus
were present in Hayden’s Viburnum Compound there is no clinical or
laboratory proof that it, if given alone--without alcohol or other
drug--has any antispasmodic or nervous sedative action.
_Dioscorea Villosa_ (_Wild Yam_).--This drug contains a saponin and
an acrid, irritant resin. It has never been proved clinically or
experimentally that this drug has any action whatever except that its
irritant resin might, if taken in sufficient quantity, cause irritation
of the stomach and vomiting.
_Aromatics._--The irritation produced by concentrated aromatics causes
increased peristalsis and consequently may, if there is no obstruction,
relieve intestinal stasis and intestinal colics. Therefore, a
preparation containing large amounts of aromatics, especially if given
in hot water, would have practically the same effects in the “cramps of
a cholera morbus” or other forms of acute diarrhea as a home-brewed cup
of spiced tea--and no more.
_Alcohol._--This drug is a muscle relaxant, and sufficient doses
might, by relieving spasm, relax a muscularly contracted os uteri and
relieve post-partum pains. Alcohol dilates the blood-vessels both
in the abdomen and on the surface of the body. It may thus either
relieve uterine bleeding by lowering the blood-pressure and causing
more blood to go to other parts, or increase uterine bleeding by
relieving arterial and muscle spasm. Alcohol is also a habit-forming
narcotic (Hayden’s Viburnum Compound is advertised as “free from all
narcotics”!) and when habitually used by either males or females tends
to impair the capacity to produce normal offspring.
Even if the manufacturer’s “formula” be accepted, Hayden’s Viburnum
Compound contains no therapeutically active ingredient except alcohol
and aromatics. The recommended dose of this preparation is “... two
teaspoonfuls in six of boiling hot water or milk and one teaspoonful of
sugar, every fifteen or twenty minutes until relief is obtained.”
“Frequently after taking the Viburnum Compound the patient will
sleep soundly for several hours from the sudden cessation of
pain; in such cases she should never be awakened through any
fear of oversleeping, as Hayden’s Viburnum Compound does not
contain any narcotic whatever, nor does it leave any disagreeable
after-effects, and it may be given to a child when necessary
without any special caution.”
Read the foregoing and then remember that it means that one teaspoonful
of alcohol (the equivalent of two teaspoonfuls of whisky) is to be
given in hot water, every fifteen or twenty minutes until relief is
obtained and the patient is asleep. Why not use plain language and say
“until she is drunk”?
The thoughtful physician would consider it decidedly unwise to give
alcohol to a young girl, to a prospective mother, or to a young mother,
except under extraordinary circumstances. He would know that the
menstrual pains for which this preparation is recommended are likely
to be recurrent, and that the repeated taking of alcohol for recurrent
pain is fraught with danger--the danger of initiating the alcohol
habit. If, however, a physician does elect to give alcohol as a drug,
he must let the conditions that govern each individual case determine
whether it is not better to give it as whisky, or to disguise it in a
prescription of his own. Above all the physician should be conscious
that he is giving the drug, alcohol; and this is not the case when he
prescribes a ready-made nostrum. If he writes a prescription containing
whisky or other alcoholic he will take measures to avert the dangers
inseparable from the use of this drug.
CONCLUSIONS
1. Even if the manufacturer’s formula for Hayden’s Viburnum Compound be
accepted, it is apparent that any therapeutic activity the preparation
may have is due essentially to the alcohol and aromatics.
2. Alcohol is a narcotic drug, and a habit-forming drug. Physicians
ordering this preparation may, by so doing, be initiating the alcohol
habit.
3. Whatever result is obtained by the use of Hayden’s Viburnum Compound
in the treatment of uterine or pelvic disturbances, is due to the
alcohol it contains. The fact that menstrual pains are likely to recur
might, when this preparation is relied on, become a factor in the
formation of the alcohol habit.
4. Whatever result is obtained by the administration of Hayden’s
Viburnum Compound in the treatment of gastro-intestinal disturbances is
due to the alcohol and the aromatics it contains.
5. Whisky has the same alcoholic content (50 per cent.) as Hayden’s
Viburnum Compound; the dangers in the use of whisky are well known
and its value as a therapeutic agent is being questioned more and more
every year.
Holding the exploitation of this proprietary a danger to the public and
a detriment to scientific medicine, the referee recommends publication
of this report as a protest against such irrational therapeutics. The
profession should recognize that most, if not all, of the preparations
recommended for painful menstruation and for all kinds of pelvic pain
contain large percentages of alcohol, and that whatever physiologic
effect is produced is, for all practical purposes, due to the
alcohol.--(_From The Journal A. M. A., Jan. 23, 1915._)
VIN MARIANI
Report by Council on Pharmacy and Chemistry--With Comments Thereon
This preparation was assigned to a subcommittee of the Council and the
following is an abstract of the report of the committee:
Samples of Vin Mariani and of the literature distributed by the
manufacturers were examined.
It appears that the beverage or medicine known as “Vin Mariani” is
a preparation of red wine, apparently imported from Bordeaux, and
fortified, in this country, by an alcoholic preparation of coca
leaves or other parts of the coca plant.
The committee considered first, the character of the red wine as
imported. A sample received from the port of New York, March 10,
1905, from Henry Clausel & Co., Bordeaux, and consigned to Mariani &
Co., on analysis was found to have the following composition:
Specific gravity 0.9959
Alcohol by volume per cent. 10.99
Extract per cent. 2.279
Volatile acids per cent. 0.0914
Ash per cent. 0.2801
Reducing sugar trace.
Pol. direct degrees --0.8
Pol. invert degrees --0.7
K.So M. per liter 0.092
A sample of Vin Mariani, as bought in the open market in an original
package, has also been analyzed and found to have the following
composition:
Specific gravity 1.0125
Alcohol by volume per cent. 16.15
Extract per cent. 8.602
Ash per cent. 0.277
Glycerin per cent. 0.444
Volatile acid per cent. 0.0747
Tartaric acid per cent. 0.2400
Alkaloids (coca bases) per cent. 0.0250
Cane sugar per cent. 2.35
Reducing sugar per cent. 3.38
The increased alcoholic strength of Vin Mariani over the Bordeaux
wine from which it is made, as shown by this analysis, doubtless
comes from the alcohol extract containing the coca bases, as already
stated. Approximately 6 per cent. of sugar is also added to the wine.
Judging from the analysis, therefore, Vin Mariani corresponds to
a mixture of an alcoholic preparation of coca leaves and ordinary
Bordeaux red wine, with the addition of about 6 per cent. of sugar.
Vin Mariani conflicts with Rule 5, which requires that “No article
will be admitted or retained, concerning which the manufacturer
or his agents make misleading statements as to geographical
source, raw material from which made, or method of collection, or
preparation,” by stating in the advertising literature that: “The
United States government, under the Pure Food Law of March 3, 1903,
further emphasizes all previous analyses of Vin Mariani by admitting
Mariani’s wine as absolutely pure and unadulterated.”
Whatever may have been the intent of the above statement, its effect
is to deceive. The conjunction of the terms “Vin Mariani” and
“Mariani’s wine” can only be construed as meaning the same thing.
Inasmuch as it does not appear that Vin Mariani is imported into
this country, it would not have been possible for the United States
government to inspect it, and as to the wine obtained from Henry
Clausel & Co., from Bordeaux, it is not in any sense Mariani’s wine
except that of ownership. It is the opinion of the committee that
this phrase can only result in deception and the construction of the
language strongly favors the supposition that it is intentionally
meant to deceive.
This false claim is practically repeated in the other pamphlets
published by the Vin Mariani Company, although not always in the same
words.
This preparation also conflicts with Rule 6, which states that “No
article will be admitted or retained of which the manufacturer or his
agents make unwarranted, exaggerated or misleading statements as to
therapeutic value,” in that the firm’s letter-heads have printed on
them the following:
“Vin Mariani purifies the blood stream, strengthens the
circulation, stimulates muscular fiber and nerve tissue, is a
respiratory stimulant, strengthens the heart muscles, and is an
emergency food in the absence of all other nutriment. Successfully
employed as an adjuvant in anemia, debility, diseases of the chest,
nervous troubles, muscular or mental overstrain, neurasthenia,
and allied conditions, and in certain cases of protracted
convalescence.”
The committee believes that Vin Mariani is intended as a beverage
rather than as a medicine.
The report concludes:
“The committee recommends, therefore, that Vin Mariani be refused
recognition and that this report be published in full or in part.”
In accordance with this recommendation the above extract of the report
is herewith published.
W. A. Puckner, Secretary.
VIN MARIANI MADE IN THIS COUNTRY
According to the above report, Vin Mariani as imported is simply an
ordinary cheap French wine, the preparation sold in this country as
Vin Mariani being compounded in this country. Yet the advertising
literature, the label on the bottle, etc., state directly or indirectly
that it is a French preparation. Until recently--presumably until
the vendors realized that the truth regarding this point would come
out--the advertisements in medical journals contained an analysis made
by a chemist in Paris. The shape of the bottle, the character of the
printed matter accompanying the bottle, etc., are evidently intended to
convey the impression that it is imported. So far, then, as this point
is concerned, Vin Mariani is sold under gross misrepresentations and is
a fraud.
[Illustration: Advertisements of Vin Mariani before and after national
Food and Drugs Act went into effect.]
ADVERTISED TO THE PUBLIC
Vin Mariani was at one time advertised to the public in this country,
but, so far as we know, it is not at the present time; at least,
not directly. Yet it is most effectively advertised to the public
indirectly, and this with little expense to the promoters, the cost
of the circular around the bottle being the only expense--doctors who
prescribe it do the rest. If those who are in the habit of prescribing
Vin Mariani will examine the advertising that goes into the hands of
their patients they will realize how true it is that our profession is
responsible for much of the “patent-medicine” taking. Few laymen could
withstand the temptation to buy the stuff for any ailment that comes
along when they read in the circular that this “medicine,” which their
doctor evidently thinks is a good thing, is so highly recommended, for
all the ills that befall us mortals, by the Pope of Rome, the Czar and
the Czarina of Russia, the Queen of England, the Shah of Persia, the
King of Norway and Sweden, the Queen of Portugal, the Queen of Saxony,
the Crown Prince of Cambodia, Ferdinand of Bulgaria, and by a whole
list of ambassadors, generals, politicians, musicians, actresses, etc.
The testimonials of these great men and women are enough to convince
the most skeptical that this remarkable medicine will do everything
but raise the dead--and under favorable circumstances accomplish even
this. And still more--it will win battles! Witness this from the
governor-general of Madagascar: “We were refreshed by Vin Mariani,
and before morning carried the stronghold.” Alexander Dumas and Emile
Zola are credited with calling it “the elixir of life.” One very
strange thing about the testimonials in the circular used in this
country is that all are written by foreigners. But Americans (President
McKinley--think of it--among others) are honored by having their
testimonials quoted in the circulars used on the other side of the
Atlantic. Why? Is it possible that the testimonials are fakes?
AN ETHICAL CURE-ALL
Here are a few of the conditions that the circular says Vin Mariani is
good for: “Anemia, winter cough, debility, vocal weakness, la grippe,
continued fevers, bronchitis, nervous troubles, muscular weakness,
diseases of the aged, malaria, melancholia, overwork, neurasthenia,
impotence, malnutrition, depression, heart troubles, wasting diseases,
mental overstrain, and in certain cases of protracted convalescence.”
The following quotations are taken from blotters--circulated in this
country--which are evidently intended for the laity, as well as for
physicians:
“Vin Mariani creates and sustains vigor and energy. Guards against
wasting diseases. When everything else has failed try it to prove
merits.”
“Lung, Throat and Stomach Troubles benefited by Vin Mariani; this
Ideal French Tonic strengthens entire system of Body, Brain and
Nerves.”
“Most Efficacious, Most Agreeable, Unequaled by anything in
Fortifying, Strengthening, Refreshing.”
WHY BLAME THE LAYMAN FOR USING NOSTRUMS?
Can we blame the layman for using Peruna, Wine of Cardui, etc., simply
because they are advertised, when there are physicians who, for the
same reason, prescribe concoctions that are just as quackish and just
as useless? And can editors of medical journals consistently find fault
with newspapers for carrying advertisements of fraudulent “patent
medicines” when they themselves admit to their pages advertisements of
nostrums that are no less fraudulent and of no more value?
MEMBER OF PROPRIETARY ASSOCIATION
One word more: There is an organization known as the Proprietary
Association of America, but it is usually referred to in common
parlance as the “patent-medicine” men’s association. It will be
remembered that last year we printed a list of the members of this
body, among which was the Vin Mariani Company. It will be remembered
also that in the list were the names of certain firms who were
supplying medicines to physicians, but practically all these resigned
from membership and their resignations were published by us. We have
not had the pleasure of publishing the resignation of the Vin Mariani
Company. On the contrary, we note that at the last annual meeting of
the “patent-medicine” men’s association this firm was still an active
member, Mr. A. L. Jaros, who stands for the Mariani Company in this
country, being one of those registered at the meeting.--(_From The
Journal A. M. A., Nov. 26, 1906._)
VIROL
Report of the Council on Pharmacy and Chemistry
Virol, sold in the United States by the Etna Chemical Company, is put
out by Virol, Ltd., London, England. It is said to be
“A preparation of bone marrow, red bone marrow of medullary
structure of ox rib and calf bones, eggs, malt extract, and lemon
syrup made from fresh fruit.”
“Marrow fat is emulsified with extract of malt, lemon syrup and
eggs, it is further enriched with soluble phosphates of lime, iron
and soda, and glycerine solution of red bone marrow.”
Many of the therapeutic claims made for Virol the Council considered
grossly exaggerated; among them are the following:
“... a complete food for children.”
“... a complete nutrient.”
“The value of the Lime-Salts (representing the Egg Shells)
contained in Virol is fully illustrated in its influence upon
Rickets; whilst Struma, Chronic Bronchitis, Anaemia and Influenza
are all combated by its use in a degree, which, we venture to say,
has never been approached.”
“The fat, as represented by the Marrow-bone and Egg Yolk, is so
minutely divided that it admits of even far more rapid absorption
by the _villi_ of the intestine than milk.”
“It is an ideal form of food, readily digested and assimilated in
the weakest of conditions.”
“Virol has a marked effect on the metabolism of the body,
increasing the production of opsonins and stimulating phagocytosis.
As an adjuvant to the natural defensive processes of the patient
in all diseases of bacterial origin its value can scarcely be
over-estimated.”
The objections of the Council were transmitted to Virol, Ltd. The
firm’s reply was reported to the Council by the referee of the
Committee on Therapeutics who held that no adequate or satisfactory
answer had been made to the objections raised against the advertising
claims for Virol.
The claims made for Virol being unsubstantiated and unwarranted, the
Council voted that the preparation be refused recognition.
In accordance with the practice of the Council, the exploiters of Virol
were afforded an opportunity to comment on the foregoing statement
before its publication. On their objecting to the findings, the entire
matter was turned over to a second referee. This referee, in making his
report, reviewed the claims made for Virol and commented on the lack
of evidence to substantiate these claims. He stated that a chemical
analysis of the preparation had yielded the following result:
“Sugar, as maltose 60.0 per cent.
“Fat 13.2 per cent.
“Proteins 3.2 per cent.
“Ash 1.6 per cent.
“Water and volatile matter 21.6 per cent.
“There is no appreciable diastatic action. A little glycerol is present
in the volatile matter. The preparation is therefore an extract of malt
with fat and a small amount of protein.”
He then continues:
“That Virol has food value cannot be denied, but that it has sufficient
value to warrant the claims of the manufacturers is not evident. Virol
cannot be considered a complete food, as the advertising literature
reiterates, or an ideal food for infants. The amount of protein is far
too low in comparison with the carbohydrates to warrant this view.
The dosage recommended is not large. Thirty gm. a day would furnish
only about 1 gm. of protein and 4 gm. of fat. The 3 teaspoonfuls a day
recommended for children would furnish protein and fat even below this.
“If employed alone it cannot be a complete or sufficient food, and
if employed along with other articles of diet--milk and bread, for
example--it is not easy to see wherein lies the efficacy of the small
weights of fat and protein added in the form of Virol. Here the demand
made on our credulity is too great, as the protein in the preparation
is the familiar protein of eggs, meat and malt, and the fat largely
that from the egg-yolk and marrow, according to the claims. It is not
known that any specific virtues reside in these bodies, or in the
egg-shells, also claimed as present.
“In the opinion of the present referee there is nothing in the
composition of Virol to justify the claims made for it. The judgment
and recommendations of the first referee follow from the facts and must
be accepted by the Council.”
The Council directed that the previously prepared report be allowed to
stand and that it be published along with a suitable reference to the
report of the second referee.--(_From The Journal A. M. A., Feb. 20,
1915._)