PART IV_The Propaganda for Reform in Proprietary Medicines, Vol. 1 of 2

CONTRIBUTIONS FROM THE JOURNAL: MISCELLANEOUS MATTER

ACETPHENETIDIN AND PHENACETIN--THEIR RELATIVE PURITY

Until six years ago the chemical product known as phenacetin was

patented both as to process and to product. As the patent ran out at

that time, anyone, of course, could manufacture it. It was placed

in the Pharmacopeia under the name “acetphenetidin.” It is on the

market now under both names, “phenacetin” and “acetphenetidin.” The

price of the former is five times[130] that of the latter, hence it

is rather important to know whether or not one is, in any way, better

or purer than the other. The original patentees or manufacturers, the

Farbenfabriken of Elberfeld Company, market the product under the

name “phenacetin” and also under the official name “acetphenetidin,”

the former at about 33 cents an ounce and the latter at about 6 or 7

cents an ounce. Evidently these people believe that acetphenetidin is

all right since their price-list says: “Our product is of the highest

standard of purity,” and in another place: “On account of the low

price of acetphenetidinum, U. S. P., it is especially suitable for the

manufacture of medicinal specialties, such as headache powders, etc.”

Remember that it is the manufacturers of phenacetin who say this.

[130] Phenacetin is listed at 33 cents an ounce, acetphenetidin at 98

cents a pound in quarter-pound lots.

The question arose whether or not phenacetin differs from

acetphenetidin. If it does, then physicians should know it. An inquiry

was addressed to Farbenfabriken of Elberfeld Company and also to Lehn

& Fink, two firms which market the product in this country under both

names, asking in what respect the two products differ. No answer was

received from either firm. With the object of answering the question

our chemists have investigated the preparations on the market, both

those sold under the name “phenacetin” and those under the official

title “acetphenetidin.” The following is a summary of their report:[131]

[131] Full details of analysis are published in Volume V of the annual

report of the Chemical Laboratory.

THE CHEMISTS’ REPORT

_Physical Appearance._--All the specimens were found to be fine

white crystalline powders, differing somewhat in appearance

as follows: Four specimens--Acetphenetidin (Farbenfabriken),

Phenacetin (Specimen 1[132]--Farbenfabriken), Phenacetin (Specimen

2[132]--Farbenfabriken) and Acetphenetidin (Squibb)--appeared very

much alike, each being a very fine crystalline powder, differing

only slightly as to fineness. Five other specimens--Phenacetin

(Lehn & Fink), Acetphenetidin, U. S. P. (Lehn & Fink),

Acetphenetidin (Merck), and two specimens of Acetphenetidin

(Powers-Weightman-Rosengarten), had the same general appearance,

each consisting of a fine crystalline powder containing a

considerable proportion of large rectangular plates. Three

specimens--Acetphenetidin (Mallinckrodt) and two specimens of

Acetphenetidin (Powers-Weightman-Rosengarten)--had the same general

appearance, being a moderately fine and homogeneous crystalline

powder. When examined microscopically with a low-power lens the

Mallinckrodt product appeared to consist principally of rectangular

prisms and the Powers-Weightman-Rosengarten product to be made up

largely of plates.

[132] “Specimen 1” is a specimen of the product regularly sold in

this country. “Specimen 2” is a specimen of a product sold in England

and whose resale in this country was prohibited by the manufacturers.

_Identity._--All of the specimens when tested side by side

responded to and complied with the identity tests of the United

States, British, German, Swiss, Dutch, Swedish, Spanish, and Danish

pharmacopeias. The reactions given by the several specimens were all

the same, showing no difference in any case.

_Melting-Points._--As a further proof of identity and similarity

the melting-points of the different specimens were taken and found

to be: Acetphenetidin (Farbenfabriken), 134.2 C.; Phenacetin

(Specimen 1--Farbenfabriken) 133.7 C.; Phenacetin (Lehn & Fink),

134.7 C.; Acetphenetidin (Lehn & Fink) 134.9 C.; Acetphenetidin

(Powers-Weightman-Rosengarten), (1) 134.3 C., (2) 133.6 C., (3) 134.7

C., (4) 134.7 C.; Acetphenetidin (Squibb) 134.2 C.; Acetphenetidin

(Merck), 134.8 C., and Acetphenetidin (Mallinckrodt), 134.2 C. The

melting-point is given as 135 C. in the British, French and Spanish

pharmacopeias, and as 134 to 135 C. in the United States, German,

Swiss, Danish, Swedish and Dutch pharmacopeias. Thus all comply with

the standard given in our pharmacopeia and most foreign pharmacopeias

with two exceptions and those respectively only 0.3 C. and 0.4 C. low.

_Absence of Acetanilid._--The absence of acetanilid in all the

specimens was indicated by the bromin test of the United States,

British, German, Swiss, Dutch, Swedish and Danish pharmacopeias.

_Absence of Carbonizable Matter._--The absence of carbonizable matter

was shown in all specimens by the sulphuric acid test of the United

States, British, German, French, Swiss, Dutch, Swedish and Spanish

pharmacopeias.

_Water-Soluble Matter._--All specimens when tested for excess of

water-soluble matter came well within the limit (0.50 per cent.) set

by the French pharmacopeia, the greatest amount being 0.20 per cent.

_Ash._--When heated, all the specimens were found to yield

practically no ash, the residues from 1 gm. samples weighing in no

case more than 0.0004 gm.

_Absence of Paraphenetidin._--When tested by the methods of the

United States, British, German and French pharmacopeias, the absence

of an impurity of paraphenetidin was shown in all specimens, with the

exception of one specimen obtained from Powers-Weightman-Rosengarten

Co., which gave a positive, though not strong, reaction and two other

specimens of the same firm which reacted still more faintly.

TABLE SHOWING RESULTS OF ANALYSES OF VARIOUS SPECIMENS OF

ACETPHENETIDIN AND PHENACETIN[BG]

COLUMN HEADINGS:

A = Melting Point (Corr.) C.

B = Water-Soluble Matter in, per Cent.

C = Ash, per Cent.

D = Paraphenetidin, U. S. P. Test[BH]

E = Paraphenetidin, Swiss Test[BH]

================+==================+=======+======+======+=====+====

Name | Appearance | A | B | C | D | E

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

Acetphenetidin | Very fine | 134.2 | 0.17 | 0.02 | - | +

(1) | crystalline | | | | |

| | | | | |

Phenacetin | Very fine | 133.7 | 0.06 | 0.00 | - | +

| | | | | |

Phenacetin | Fine crystalline | 134.7 | 0.11 | 0.02 | - | +

| | | | | |

Acetphenetidin | Fine crystalline | 134.8 | 0.13 | 0.00 | - | +

| | | | | |

Acetphenetidin | Homogeneous | 134.3 | 0.19 | 0.03 | + | +

(P. W. R.) (1) | crystalline | | | | |

| | | | | |

Acetphenetidin | Homogeneous | 134.7 | 0.16 | 0.02 | + | +

(P. W. R.) (2) | crystalline | | | | |

| | | | | |

Acetphenetidin | Homogeneous | 134.7 | 0.14 | 0.02 | + | +

(P. W. R.) (3) | crystalline | | | | |

| | | | | |

Acetphenetidin | Fine crystalline | 133.6 | 0.20 | 0.01 | - | -

(P. W. R.) (4) | powder | | | | |

| | | | | |

Acetphenetidin | Fine crystalline | 134.3 | 0.19 | 0.00 | - | +

| | | | | |

Acetphenetidin | Fine crystalline | 134.8 | 0.15 | 0.03 | - | -

| | | | | |

Acetphenetidin | Fine crystalline | 134.2 | 0.11 | 0.01 | - | -

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

[BG] In all cases identity was confirmed; acetanilid was absent;

carbonizable matter was absent.

[BH] In this column plus indicates presence; minus, absence.

While this firm’s product alone gave any reaction whatever

when the U. S. P. test for paraphenetidin was applied with

the test of the Swiss pharmacopeia, all but Acetphenetidin

(Mallinckrodt), Acetphenetidin (Merck) and one specimen of

Powers-Weightman-Rosengarten Co. gave positive, though very faint,

reactions, indicating that the majority of specimens, including

those of the original manufacturer, contain a minute trace of this

impurity.

Our findings regarding the product of Powers-Weightman-Rosengarten

Co. having been communicated to this firm, their correctness was

acknowledged. At the same time the firm wrote: “All that we have on

hand now gives negative tests for paraphenetidin, and we believe our

present records are correct when we state that all lots which we are

supplying now, and have been supplying for some time past, answer all

U. S. P. requirements.”

This examination appears to demonstrate that the chemical substance,

para-acetphenetidin, whether sold as acetphenetidin, U. S. P., or as

phenacetin, is practically identical. The impurity of the product of

some of the specimens coming from Powers-Weightman-Rosengarten Co. is

too slight to be considered dangerous. Furthermore, a comparison of the

“lot numbers” indicates that this firm has been improving its product

steadily so that in the future its assurances of an unimpeachable

product may be relied on. Inasmuch, therefore, as acetphenetidin

complies with all the pharmacopeial requirements as to identity and

purity, in just the same way as phenacetin, which sells for as high as

five times the price of acetphenetidin, physicians need not hesitate in

using the title of the U. S. P. “acetphenetidin” when prescribing this

produce.--(_From The Journal A. M. A., March 16, 1912._)

Acetphenetidin and Phenacetin

A physician-pharmacist writes: “If a prescription calls for

‘phenacetin,’ should the pharmacist dispense ‘phenacetin-Bayer’--that

is, the phenacetin manufactured by the original patentee--or would he

be justified in dispensing the official acetphenetidin, manufactured by

any reliable chemical or pharmaceutical house?”

Unless the pharmacist happens to know that the physician in writing

the prescription desired the Bayer brand, he would be justified in

dispensing acetphenetidin, U. S. P. As a general thing, physicians use

the word “phenacetin” without intending to prescribe any particular

brand or make, simply because they are familiar with this word and

are not familiar with the official term “acetphenetidin.” They will

doubtless continue to use the term “phenacetin” and we know of no

sufficient reason for doing otherwise. During the life of the patent

the word “phenacetin” became a familiar one, and the product became

generally known by this term. But a coined name for a patented

article loses its proprietary character and becomes the common name

of the article when the patent expires. In other words, when the

patent expires, not only the product but also the name itself becomes

common property. This principle has been recognized by the courts.

Those who formerly controlled the product and the name “phenacetin”

evidently recognized this principle, for they have taken no steps

to prosecute a firm in this country which sells the product openly

under the name “phenacetin.” It might be added that the preparation is

official in most foreign pharmacopeias under the name “phenacetin.”

In agreement also with this principle the Council on Pharmacy and

Chemistry (The Journal, April 27, p. 1298) lists in New and Nonofficial

Remedies such products as “lanolin,” “phenacetin,” “sulphonal” and

“trional” as non-proprietary names applied to Adeps lanæ hydrosus,

U. S. P., Acetphenetidinum, U. S. P., Sulphonmethanum, U. S. P., and

Sulphonethylmethanum, U. S. P., respectively.

In view of these facts--and also bearing in mind the findings of the

Association’s Chemical Laboratory (The Journal, March 16, p. 801)

that the preparations on the market under the title “acetphenetidin”

are of equal quality with the preparations sold under the name

“phenacetin”--the pharmacist should recognize that acetphenetidin is

identical with phenacetin, is prescribed, provided, of course, that no

special brand of phenacetin is ordered.

It is the physician’s privilege, of course, to specify the goods of a

particular manufacturer, but in view of the fact brought out above that

all brands of this chemical have tested up to the U. S. P. standard,

it is placing an unnecessary burden on the pharmacist to require him

to have on hand many different brands of one substance. The physician

should save this privilege for use when prescribing some product that

differs materially in its various forms on the market, as for example

in the case of certain fluidextracts.

Physicians will doubtless find that the above comments will interest

their local pharmacists. It is of mutual value for physicians to

talk these matters over with their pharmacists.--(_From The Journal

A. M. A., Oct. 5, 1912_).

CLEAN ADVERTISING

It is individual effort that counts for most in every movement for

better things--socially, economically or politically. Realizing this,

The Journal repeatedly urges physicians who write regarding various

fraudulent advertisements to enter their individual, personal protest

against the continuation of such advertisements.

Within the past few months The Journal has had brought to its attention

a good example of what may be accomplished by personal effort in

cleaning up the advertising pages of a fraternal publication.

_The Royal Neighbor_, official organ of a fraternal organization,

until comparatively recently, carried numerous fraudulent medical

advertisements. Fake liquor cures, rheumatism cures, tapeworm

expellers, tobacco-habit cures, asthma and hay-fever cures, epilepsy

cures, etc., disgraced its advertising pages. These called forth

protests from Dr. E. A. Hall, Henry, Ill., who addressed letters

to the official physicians of the fraternal order that the _Royal

Neighbor_ represents, objecting to such advertisements. These letters

in turn reached the advertising manager, and it was not long before

the board of managers took the matter up for consideration and decided

to eliminate this class of advertising from their official organ. By

December, 1913, the _Royal Neighbor_ came to its readers clean. There

is no doubt that the same results can be duplicated in similar cases.

Whether they are will depend on the amount of active work done by

individuals interested in the question of clean advertising.--(_From

The Journal A. M. A., Feb. 14, 1914._)

LIPPINCOTT’S MAGAZINE

Its Advertising--a Protest and an Excuse

A few days ago a physician wrote to The Journal enclosing two

advertisements taken from the current issue of _Lippincott’s_ magazine.

One of these was a half-page advertisement of that outrageous fraud,

the “Oxydonor;” the other was a full-page advertisement of J. B.

Lippincott Company, Philadelphia, calling for salesmen “to present

standard medical books to physicians only.”

The physician sending in this material asked us to send to

_Lippincott’s_ a pamphlet showing the fraudulence of the Oxydonor.

Instead of doing so, we sent the pamphlet to the physician and

suggested that he write a personal letter in the belief that individual

missionary work is the most effective way of fighting fraud.

Accordingly the doctor wrote to _Lippincott’s_ and received in reply

this letter from the advertising department of that publication:

“Your letter of the 23d received, and in reply beg to say that we

do not approve of fraudulent advertising, and we have never before

been advised that the advertisement to which you call our attention

was objectionable. _In fact, we know nothing whatever about it._

[Italics ours.--Ed.] It came to us, as do most of the others, through

an advertising agency, and while we do not willingly publish anything

that is fraudulent or objectionable, _it is not our custom to verify

the claims of advertisers_ [Italics, again, ours.--Ed.] especially

when the same copy is being run in almost every other high-grade

publication.

“We have a very high regard for the American Medical Association,

and they undoubtedly are doing a splendid work in ridding the

country of fake medical preparations, but the mere fact that they

condemn some of our advertisers is hardly sufficient proof for us to

refuse the advertising, because, _if the advertiser desires to do

so, he can make us prove in the courts that he is a faker, or claim

damages from us for refusing to publish his advertisement_. [Our

italics.--Ed.] If the American Medical Association will guarantee

to protect the publishers against loss from damage suits brought by

advertisers whose business they refuse to accept, then, we believe

that the publishers would gladly reject them, but not many of the

publishers are in a position to investigate the merits of all the

advertising that is offered, especially when the claims are backed up

by affidavits of reputable people who believe themselves to have been

cured by the preparation.

“We certainly do not wish to jeopardize our medical publications by

advertising fake schemes or propositions of any kind, and we thank

you for writing us concerning the matter and will now look into this

particular case.”

[Illustration: Photographic reproduction (much reduced) of two

advertisements from January, 1914, _Lippincott’s_. One of a fraudulent

quasi-medical device, the “Oxydonor”; the other, calling for salesmen

to introduce “standard medical books to physicians.”]

This letter discloses the workings of the brain of an advertising man

of the old school. The principles enunciated therein are those that

dominated the advertising field until quite recently. They represent

the _laissez faire_ doctrine as applied to advertising. At that time

the only unacceptable advertising copy was that which would debar

the publication using it from the United States mails. This was the

yardstick by which all advertising was measured at that time.

The economic conscience has since awakened. There are few reputable

magazines today, we venture to believe, that would be willing to go on

record to the effect that it is not their “custom to verify the claims

of advertisers.” The modern, progressive advertising man recognizes not

only the responsibilities his profession imposes, but also realizes

that, from the narrower view of enlightened self-interest, the

greatest menace to the future of modern advertising is the fraudulent

advertisement.

The claims on the part of the advertising department of _Lippincott’s_

that it dares not refuse to accept fraudulent advertisements because

the advertiser might bring suit against it for refusing to accept his

advertisement is a statement whose falsity is exceeded only by its

silliness. Equally preposterous is the statement that _Lippincott’s_

will willingly refuse to accept fraudulent advertisements provided the

American Medical Association will guarantee to protect the Lippincott

Company against loss from damage suits that may be brought by the

exploiters of the frauds whose advertisements are refused.

It may be news to _Lippincott’s_ to learn that there are a score and

more of newspapers and magazines that are accepting the findings of

the American Medical Association on medical frauds and rejecting

advertisements of such frauds. There are many newspapers that send us

the medical advertising “copy” submitted to them and ask for an opinion

on it. When that opinion is unfavorable, these papers refuse such

advertisements. This is being done daily. We have yet to hear of any

“patent medicine” faker or quack even threatening to bring suit because

his advertisements have been rejected.

The advertising department of _Lippincott’s_ may therefore take

heart. When an advertisement of an outrageous fake like the Oxydonor

is submitted to it, instead of accepting the money for it, meantime

muttering an inaudible protest at the unfortunate position in which

it has been placed, it may look the fraud in the eye and say Boo! The

faker will not bite.

Before leaving the subject, we are constrained to refer to Lippincott’s

medical publication, the _Annals of Surgery_. We begin to realize

now why that journal offers a welcome haven to such products as Sal

Hepatica, Bromidia, Papine, Gray’s Glycerin Tonic, Fellows’ Syrup

of Hypophosphites, et al. Presumably the same “custom” obtains in

the acceptance of advertising for the _Annals of Surgery_ as for

_Lippincott’s_, namely that the Lippincott Company does “not verify

the claims of advertisers.” Possibly the _Annals of Surgery_ is afraid

that, should it reject the Sal Hepatica advertisement, for instance,

it might he haled into court! Let us trust, for their peace of mind,

that the publishers of the _Annals of Surgery_ do not receive an

advertisement from Old Doc Hartman for a full page display of Peruna.

The mental anguish they would undergo in reluctantly accepting this

advertisement--under the fear that Hartman would “claim damages” if it

were rejected--is painful to contemplate.--(_From The Journal A. M. A.,

Feb. 7, 1914._)

MEDICAL JOURNAL ADVERTISING

And Methods of Obtaining Paid-Up Subscribers

Time was when the postal authorities were lenient with publishers.

The names of individuals who had ever subscribed for publications

of a certain class were carried on the books indefinitely, whether

they paid their subscriptions or not. This permitted a padding of the

circulation figures. Of late years, however, the postoffice department

requires publishers to have bona-fide paid-up subscriptions if they

wish their publications to be carried at the low second-class rate.

Certain medical journals have been hard put to it to get a circulation

that would be at all attractive to the advertisers, on whose money they

depend for continued existence.

Many and various have been the schemes devised whereby the dwindled

circulation might be “boosted.” Subscriptions could not be given away

because the postal laws forbade it. One ingenious method of obviating

this difficulty is worked in this fashion: Dr. John Doe writes an

article that appears in a reputable medical journal. A few days after

its appearance, Dr. Doe receives a letter from the editor and publisher

of a medical journal that is in need of a subscription list. He is

told that the editor has read his article with much interest and would

appreciate receiving from Dr. Doe a brief abstract of it. He does not

expect the doctor to go to the trouble of making this abstract for

nothing. He will, therefore, on receipt of the abstract credit Dr.

Doe with three years’ subscription for himself or for one year for

himself and one year for each of any other two doctors he may name.

For every doctor that bites on this scheme the publisher increases his

circulation by three copies and the federal officials are assured that

they are paid-up subscriptions--not paid for in cash, it is true, but

in “abstracts.”

All of this preliminary to a letter recently received:

_To the Editor_:--Enclosed find letter which speaks for itself.

Now what I should like to know from you is the following: Is the

_Charlotte Medical Journal_ all it should be? Should a doctor

contribute to a journal--thereby adding to its prestige and

circulation--that carries questionable matter in the advertising

pages? If the above journal is off color, does that act as a bar for

good men to contribute?

Very truly yours,

L. J. Genella, M.D., New Orleans, La.

The letter which our correspondent encloses is on the stationery of the

_Charlotte Medical Journal_ and signed by the editor of that journal.

Here it is:

“My Dear Doctor Genella:--I have just looked over an article of yours

published in the _New Orleans Medical and Surgical Journal_ entitled

‘Clinical Studies in Pituitary Irritation, with Report of Case.’ I

would be very glad indeed to have you send me a manuscript or article

for the _Charlotte Medical Journal_. Your style of writing is very

attractive.

“If you will send me an article for the journal, I will be glad to

publish same and will place your name on my complimentary mailing

list. Under separate cover I am sending you a copy of the journal.

“Of course I will expect the article to be typewritten.”

Whether or not this is a modification of the “abstract” scheme or an

attempt to boost the circulation of the _Charlotte Medical Journal_

are questions we shall not attempt to answer. As to the questions

propounded by our correspondent, they have been answered many times

in these pages. We turn to one of the recent copies of the _Charlotte

Medical Journal_ and examine its advertising pages. On one of the first

we find Anasarcin, a product whose fraudulent character was described

at some length in The Journal, May 4 and 11, 1907. On another page we

find Tongaline, which has also come in for a fair share of attention

(see The Journal, Sept. 23, 1906, and May 10, 1913). A little farther

over we find a half-page advertisement of Bannerman’s Intravenous

Solution, a nostrum first exploited as a “consumption cure” and now as

a cure-all (see The Journal, May 31, 1913). Cactina Pillets (see The

Journal, March 12, 1910), Hagee’s Cordial of the Extract of Cod-Liver

Oil (see The Journal, Oct. 13, 1906), Burnham’s Soluble Iodin (see The

Journal, March 28, 1908), Ecthol (see The Journal, March 13, 1909),

Bromidia (see The Journal, April 21, 1906), Papine (see The Journal,

April 29, 1911), Phenalgine--two advertisements (see The Journal,

Jan. 13, and 27, 1906, and Jan. 27, 1912) and Sal Hepatica (see The

Journal, March 26, 1910) are some more products which have attained

unenviable notoriety but found a safe haven in the advertising pages of

the _Charlotte Medical Journal_. Neither must we fail to refer to the

advertisement of Duffy’s Malt Whiskey (see The Journal, Nov. 23, 1912),

which looks thoroughly at home.

Does our correspondent--in fact, does any conscientious physician

having the interest of scientific medicine at heart--want to do

anything that will tend to perpetuate therapeutic fraud? Subscribing

for or contributing to medical journals whose income is largely derived

from nostrums that are as vicious as many of the “patent medicines”

advertised in the daily press hampers the medical profession in its

fight for honesty in therapeutics and renders largely abortive its

fight against fraudulent “patent medicines.” So long as the accredited

organs of the medical profession tolerate fraudulent “ethical

proprietaries” in their advertising pages, just so long will the

protests of physicians against the swindling advertisements of “patent

medicines” in the daily press fall largely on deaf ears--and justly

so.--(_From The Journal A. M. A., Oct. 11, 1913._)

A Physician Places the Responsibility for Fraudulent Advertising

Where It Belongs

“_To the Editor_:--The Journal has had much to say in recent years

regarding the ethics, or lack of same, in advertising matter

exploited by its contemporaries. It has been criticized by many for

the stringency of its attack; it has been criticized by very few

because it did not go far enough. Is it not about time to get to the

root of the matter?

“In the last number [see p. 426, this book] dissatisfaction is

expressed with the advertising policy of the _Medical Times_.

Nothing finer! Go to it! But is the method of attack right? I have

before me a sample copy of the _American Journal of Surgery_. Among

other articles is one on diseases of joints and the bone marrow by

a man very favorably known in Denver. He was ‘ethical’ enough to

be accorded a place on the program in the Section on Medicine at

Minneapolis. Another contributor from Baltimore remarks that he took

a patient to the University Hospital. Can it be possible that Johns

Hopkins is admitting men to its wards and clinics that are below par

in professional morals? Another article appears from a well-known

orthopedic man of Washington, D. C. Personally, I see very little

to commend in the advertising columns of the _American Journal of

Surgery_.

“I, who confess to a state bordering on youth, may be very wrong;

but I believe that the trouble will be solved only when men who

claim to have any professional distinction refuse to contribute to

journals whose pages are not clean from cover to cover. Pardon the

presumption, Mr. Editor, but were you ever tempted to print anything

like this:

“‘Last week’s issue of the _New York Medical Squall_ contains an

article on “Duodenal Ulcer” by John Doe, the well-known Chicago

surgeon. Dr. Doe doubtless knows as well as any one the disreputable

character of the _Squall’s_ advertising matter, but like most of

our great men, is unable to restrain his appetite for journalistic

publicity.’

“Physicians read medical journals because they contain literature

that is worth while. Jump on your erring editorial brethren, Mr.

Editor, but please remember that the problem of eliminating bogus

advertisements will be solved when the so-called leaders of our

profession show enough manhood to refuse literary support to

publications whose columns are in disrepute. While castigating the

little sinner, please don’t let the big sinner go scot free.

“Clinton E. Harris, M.D., Grinnell, Iowa.”

Dr. Harris sums up the situation correctly. No small degree of

responsibility rests on the prominent members of the medical profession

who lend their support either as subscribers for or contributors

to those medical journals whose advertising pages are a stench in

the nostrils of thinking physicians. Dr. Harris asks why The Journal

does not condemn the advertising columns of the _American Journal of

Surgery_. The Journal has done so more than once and in no uncertain

terms, both in the Propaganda department and editorially. At one time

it said:

“In circular letters and in an editorial announcement in its

December issue, the _American Journal of Surgery_ ‘features’--to use

a newspaper term--some of the contributors to its January issue.

The list comprises men who hold, or have held, high offices in the

American Medical Association. Presidents, vice-presidents, chairmen,

secretaries and members of sections of the Association--these

are some of the men whose names appear as contributors to this

nostrum-promoting publication. Is it any wonder that the proprietors

of the _American Journal of Surgery_ assume an attitude of

indifference to the class of proprietary preparations which they

admit to the pages of their publication?”

What was the result of The Journal thus directing the attention of its

readers to the _American Journal of Surgery_? In the next issue of the

_American Journal of Surgery_ appeared a seven-column editorial tirade,

entitled “An Unwarranted Attack on the President and Other Eminent

Members of the American Medical Association and on the Leading Medical

Journals of the Country.”

On many and various occasions has The Journal called attention to the

very evils that Dr. Harris deplores, and for the benefit of those who

care to look up the matter these references to some of the articles are

appended:

“The Mote and the Beam,” editorial, Nov. 18, 1911.

“Activity or Passivity--Sympathy or Sacrifice,” editorial, Dec. 9,

1911.

“Cui Bono,” editorial, Dec. 16, 1911.

“Medical Journals and the Great American Fraud,” Propaganda

Department, Dec. 16, 1911.

“The Profession Must Apply the Penalty,” editorial, Jan. 13, 1912.

“Fraudulent Advertising in High-Class Medical Journals,” editorial,

Jan. 4, 1913.

“Demand Clean Advertising,” editorial, Jan. 4, 1913.

“Medical Journals and the Great American Fraud,” editorial, Jan.

18, 1913.

“A Good Principle to Apply,” editorial, May 13, 1913.

“Medical Journal Advertising,” Propaganda Department, Oct. 11, 1913.

“Medical Journals and the Great American Fraud,” Propaganda

Department, Oct. 18, 1913.

“Medical Journals and the Great American Fraud,” Propaganda

Department, Nov. 1, 1913.

“The Medical Times’ Advertisements,” Propaganda Department, Nov. 8,

1913.

In another letter on the same subject its writer says: “I think the

time has arrived when we have a right to expect real leadership from

the ‘big men’ of the profession.”--(_From The Journal A. M. A., Nov.

22, 1913._)

MEDICAL JOURNALS AND THE GREAT AMERICAN FRAUD

How the Medical Times Aids and Abets Quackery, with the Moral Support

of Members of the Medical Profession

Two letters have been received, both from physicians. One comes from

New York City and the other from Alexandria, Va. Each letter contained

an advertisement of the Kellam Hospital, Richmond, Va., cut from the

_Medical Times_. Here is the New York letter:

“_To the Editor_:--I am enclosing an advertisement clipped from the

_Medical Times_. It seemed to me an especially flagrant example

of what may happen in the absence of proper supervision of the

advertising pages of a medical magazine. The condition would seem

all the worse in this instance as among the ‘Board of Contributing

Editors’ are listed men like Howard Lilienthal of New York and Almuth

C. Vandiver, who is Counsel for the Medical Society of the County

of New York. The _Medical Times_ is sent to two of the physicians

who live at this address without charge and without solicitation.

Many advertisements of proprietary preparations are inserted in type

indistinguishable from that of the body of the magazine and it is of

course possible that its financial backing comes entirely from the

manufacturers of these drugs.”

[Illustration: Fig. 1.--Photographic reproductions from the _Medical

Times_. Do the gentlemen whose names appear in the list of the “Board

of Contributing Editors” realize that they are lending an air of

respectability to an otherwise disreputable business?]

And this is from Virginia:

“_To the Editor_:--The statements made in the advertisement of the

Kellam Hospital in the October number of the _Medical Times_ are so

out of the ordinary that I ask you to tell us something if you can

of their institution and its methods of cure. Can such things as are

stated in this advertisement be true? ‘Physicians Treated Free?’

‘Endorsed by the Senate and Legislature of Virginia?’ What can all

this mean to the sufferer from cancer? If true, let the whole world

of sufferers know the glorious news.”

_Collier’s_ paid its respects to the Kellam concern some time ago and

we cannot do better than quote from its pages. Thus:

[Illustration: Fig. 2.--One way of drumming up trade in the “cancer

cure” business! The Kellam Hospital sends letters like this to the

postmasters of small towns asking these government officials to furnish

it with what, in the parlance of quackery, is known as a “sucker list.”

A delightful business, isn’t it? And this, gentlemen of the “Board of

Contributing Editors,” is the sort of thing to which you are lending

your influence and good names!]

“Grief is the portion of the Kellam Cancer Hospital, of Richmond,

Virginia, because in these editorials it has been grouped with other

exemplars of the Great American Fraud. It offers the invariable

and hollow mockery of testimonials and endorsements, which, as has

been repeatedly shown, can be wheedled, browbeaten or bribed out

of the victims of any form of quackery. It, of course, courts the

fullest investigation, and desires that we send a representative to

investigate whether its claims are not well founded. Unsuspected

by the Messrs. Kellam, our representative has already investigated

their claims, notably their statement that they are endorsed by the

Legislature of the State of Virginia. Upon request for a copy of

the endorsement they forwarded a weak subterfuge, and finally, on

pressure, admitted that they could not produce the proof they had

boasted. For their further consideration we present a brief parallel:

FROM THE KELLAM CIRCULAR FROM A KELLAM LETTER

The Cancer is removed without We do not claim to “_cure them

the use of the knife or X-Ray all_.” We go further, and on

... No roots or fibers left; our part, we agree to treat, free

_hence it can not return_. of charge, any patient _who

suffers a recurrence after having

been treated by our method_.

“The italics are our own, but we cheerfully present them for

elucidation to the Kellam Hospital. A little careful thought devoted

to reconciling the irreconcilable may help them to forget their

woe. Meanwhile, they make themselves out worse than they really are

by pretending to withhold from the bitter need of humanity a true,

non-surgical cure for cancer. If this were true; if, indeed, they had

solved the problem which has baffled the greatest minds of modern

science; if, having a genuine cure for the dreadful ailment which

claims its increasing thousands of tortured victims yearly, they

secrete their discovery for the sake of a few paltry dollars, then

they are as cold-hearted as the sailors who pass within fair hail of

the naked island on which some shipwrecked crew is starving, and keep

their stony eyes on the compass. They have not even the excuse of the

fanatical among the Christian Scientists who, denying the existence

of pain, refuse to take measures to ease the cancer victim’s

suffering even at the last. Human nature is seldom so callous.”

As for the _Medical Times_: This publication for years contained

comparatively little advertising. Then it came into the hands of

Romaine Pierson, who also owns the _Practical Druggist_. Mr. Pierson is

not a physician and to him the medical profession is but a commercial

problem. He is publishing a medical journal for the money there is in

it, and for this he is not to be censured. Questions of advertising

policy, in such circumstances, are determined on a commercial basis.

When an advertising contract is submitted, for a product that

physicians would know to be fraudulent, the question that arises is,

“Can it be put over?” Manifestly, a medical journal published purely

as a business venture would not dare long to fly in the face of the

opinions of those from whom it received its support--its subscribers

and contributors. If our correspondents will go through the advertising

columns of the _Medical Times_ they will find many, many other

frauds, less cruel perhaps than the Kellam advertisement, but no less

disreputable or discreditable to the medical profession.

After all is said and done, it is enlightened public opinion that

is causing publishers of lay magazines and newspapers to eliminate

fraudulent “patent medicine” and quack advertisements. Until the

medical profession takes an equally enlightened stand, physicians may

expect to be afflicted with such commercial medical journals as the

_Medical Times_, the _International Journal of Surgery_, the _American

Journal of Surgery_, _American Medicine_, and several other papers that

are published primarily in the interest of the advertiser. When such

journals as these find they cannot get a circulation among physicians

so long as they carry advertisements similar to many now appearing in

their pages, these advertisements will be eliminated, but not before.

Many physicians are receiving such journals at a nominal price or, as

one of our correspondents notes, free. The physician who permits such

journals to come to his office must share with the paid subscribers the

responsibility for the low standard of medical journalism.--(_From the

Journal A. M. A., Oct. 18, 1913._)

Two Physicians Express Themselves on the Ethics

of Medical Journalism

After the preceding article was in type, we received, in the same mail,

two letters that are so apropos that we reproduce them. The first was

from a town in Illinois, and was dated October 11. Here it is:

_To the Editor_:--About two weeks ago, a representative of the

Surgery Publishing Company, New York, N. Y., came to ---- Ill.

soliciting subscriptions for the _American Journal of Surgery_.

Together with numerous others I subscribed--chiefly on the strength

of the contributors whose articles appeared in the sample numbers

shown by the agent.

Since receiving the first number (October) one look at the

advertising pages has shown me why the subscription price for a year

and a quarter is one dollar. Anasarcin, Tongaline, Cactina Pillets,

Hagee’s Cordial of Ext. Cod Liver, Burnham’s Soluble Iodin, Papine,

Phenalgine, Anusol, etc., etc.

I have written to the Surgery Publishing Company, telling them in

no uncertain language that there is no room on my reading desk for

such. Have you ever exposed this journal, and the attitude of our

big, brilliant, eminent men in permitting their articles--presumably

original--to fill space in such a journal? [Yes! The Journal,

Dec. 16, 1911, pp. 2,000 and 2,013.] This letter is not for

publication--at least not with name of city. Keep up the good work....

The other, dated October 10, follows:

_To the Editor_:--That little story about medical journal advertising

and methods of obtaining paid-up subscribers, in this week’s Journal

makes me blush (p. 422, this book). I am guilty. Unlike Dr. Genella,

I swallowed the bait--but the bait was even more tempting in my case;

the flattering “editor” offered me twenty-five subscriptions to

distribute among my friends, all for an “abstract.” Thank goodness,

I only accepted five subscriptions, but worse luck, I sent them

to young men by preference. So I am a deep-dyed offender indeed.

Extenuating circumstances affected my susceptibility somewhat,

however. I have noticed that prominent men like Beverly Robinson,

A. Rose, Tom A. Williams, Wayne Babcock, and Morris--the latter, at

least, a really able man and a brilliant writer--contribute to these

peanut journals occasionally. If they do, why not I? There’s nothing

like being in big company, you know.

So far as I know, my “abstract” has not yet been published. On

looking over the sample copy of this monthly I found an advertisement

printed right in the list of contents--in fact, it was the second

“original article” in the issue, as brave and respectable as you

please! Then, with characteristic Hibernian impetuosity I got out my

machine and pounded that editor a strong protest with a dire command

not to use my “abstract” in his miserable organ. But I have never

received the manuscript, nor any reply to my stern rebuke. I wish I

had been cautious like Dr. Genella.

Wm. Brady, M.D., Elmira, N. Y.

--(_From The Journal A. M. A., Oct. 18, 1913._)

The Responsibility of Physicians

The responsibility of medical journals for the continued existence

of at least a part of the “great American fraud,” has been referred

to in these pages many times. Within the past few weeks The Journal

has called attention to the inconsistency of reputable physicians

of high ideals lending their moral, and often financial, support to

those medical journals whose advertising pages are a disgrace to the

profession. Specifically, the _Medical Times_--originally a homeopathic

medical journal--has been referred to, among others, as an example

of this type of journalism. It must, however, be regarded simply as

a type, for it is no better and no worse than many other medical

journals. Several letters have been received on the subject, some

of which we reproduce. The first one is from Dr. George G. Ross of

Philadelphia:

“I was very much jarred on receiving the last issue of The Journal

to find under the Propaganda for Reform an article concerning the

_Medical Times_, among the list of whose contributing editors my name

appears. I enclose you herewith a copy of my letter of resignation to

the _Medical Times_. I have a very dim recollection of what occurred

at the time that I was asked to give my name as a contributing

editor. As I recollect it, however, at that time the journal was a

respectable and ethical publication. I had been asked by a friend of

mine to write an article giving my opinion of the effects of college

athletics on undergraduates. This was at the time that Dr. Stokes had

issued his order about athletics at Annapolis. I want personally to

thank you and the committee for the exposure of this journal and for

having drawn my attention to the fact that I was unwittingly aiding

and abetting such a journal. I trust that if you have space in some

future number of The Journal, you will do me the justice to publish

all or part of this letter.”

Because he feels that he has “unwittingly been put in an unfavorable

light,” Dr. James A. Babbitt, also of Philadelphia, sends The Journal a

copy of a letter written by him to the editor of the _Medical Times_.

Here it is:

“For reasons of which you are probably cognizant, I deem it

advisable to resign from the board of contributing editors of the

_Medical Times_, and desire that this resignation be accepted at

once and my name not appear in further issues.”

What shall be done, asks Dr. Sidney Thompson of Humboldt, Tennessee, in

such cases as the following? Says Dr. Thompson:

“In the Propaganda for Reform, in The Journal, October 18, 1913, in

closing your article on ‘Medical Journals and the Great American

Fraud,’ you say: ‘The physician who permits such journals to come to

his office must share with the paid subscribers the responsibility

for the low standard of medical journalism.’ Now I agree with you in

everything you have said about the _Medical Times_, but what I want

to know is how to keep such journals from coming into your office.

The _Medical Times_ has been coming to me for a number of years with

repeated duns for the subscription price. I have written to them

several times that I did not want the journal and never expected to

pay for it, but still it comes. I have a vague recollection that I

bit at an offer to send it three or four months free, not knowing

what it was, but I never authorized them to enter my name as a

regular subscriber.”

The simplest course in such a case as that described by Dr. Thompson,

is to write on the unwelcome publication the word “refused” and either

drop it in the nearest mail-box or hand it back to the postman. The

courts have held that a person who continues to accept publications is

legally liable for the payment of such publications. The postoffice

department, however, has ruled that a magazine--either monthly or

weekly--may not be sent at second-class rates for more than one year

after the expiration of a bona fide subscription. At the expiration

of that time, stamps must be affixed and the publications sent at

third-class postal rates.--(_From The Journal A. M. A., Nov. 1, 1913._)

Medical Journals and Sanatogen[BI]

[BI] See also Sanatogen, p. 358.

We have frequently referred to the inquiries that are received by this

office from newspaper and magazine editors asking for information

about products whose advertisements they have been offered. One of the

greatest difficulties in the way of accomplishing the good that such

inquiries otherwise might lead to is the lack of uniform action on

the part of the medical press of the country. A specific instance may

be given. A layman wrote to a high-glass weekly magazine published in

New York City protesting against an advertisement of Sanatogen which

the magazine was carrying, and sending a reprint of The Journal’s

article on this product. The advertising manager of the magazine in

question wrote back that he had seen The Journal’s article, but had

sought further information regarding the preparation from the editor

of a medical journal in his city. The medical editor recommended that

the magazine accept the Sanatogen advertisement, so the advertising

manager said, and in view of this, the manager suggested that possibly

the article published by the American Medical Association in its

journal was inspired by some “personal prejudice.” Giving weight to

the probability that the advertising manager went for his information

to a source that he knew would be favorable to the acceptance of the

advertisement, the fact remains that it is a disgraceful state of

affairs when editors of medical journals will give vicious advice in

matters on which they are supposedly competent to pass. The probability

is, of course, that the medical journal whose editor was questioned

contained the self-same advertisement that the lay magazine was

carrying. And the advertising manager of the magazine was willing to

accept--because such information coincided with his wishes--information

that on its face must be biased, and rejected advice--that did not meet

his approval--because of a purely supposititious “personal prejudice.”

It is probably asking too much to expect advertising managers not to

go to sources that are likely to be favorable for information about

products whose advertisements are offered to them. But we have a

right to expect that physicians, editors of medical journals, should

no longer be _participes criminis_ in the furtherance of the great

American fraud. If our strictures on Sanatogen are unfair, if the

Council on Pharmacy and Chemistry rejected the product in mere pique,

if the opinions of such men as Billings, Cabot, Hektoen and Lusk

are to be brushed aside as “personal prejudice,” if this mixture of

cottage cheese and glycerophosphates really is the marvelous product

which its exploiters claim--then indeed not only have the editors of

medical journals a right to praise it, but it is also their duty to

proclaim these wonders in their editorial pages. If, on the other hand,

this much-vaunted preparation is a very ordinary mixture sold at an

extraordinary price, if indigent consumptives and others are being

inveigled into spending dollars for a preparation whose food value

could be duplicated for a few cents--then in the name of humanity and

common decency let the editors of medical journals proclaim these

facts, and not let their scientific judgment be blinded by the glitter

of advertising contracts.--(_Modified from The Journal A. M. A., Jan.

18, 1913._)

THE ARMY AND NAVY MEDICAL RECORD

A Fraudulent Publication Whose Editorial Opinions Are for Sale

Whenever a business assumes certain proportions, subsidiary businesses

spring up to cater to the needs of the larger enterprise. For some

years the nostrum business has grown so large that it has furnished

a more or less precarious life for many individuals who have catered

to it. There are, for instance, men whose trade it is to obtain

testimonials; others, claiming a long string of imposing degrees,

will furnish fake reports and bogus analyses; still others issue at

irregular intervals publications with high-sounding names which sell

editorial indorsement to the products of concerns such as are willing

to pay the price asked. “Journals” of this type have been called to

the attention of our readers at different times; the _New York Health

Journal_ and the _United States Health Reports_ come to mind at this

moment. Both of these had their day and died a natural death, as all

such publications must when once the public is cognizant of their true

character.

TWO LETTERS

More recently the attention of _The Journal_ has been called to a

publication calling itself the _Army and Navy Medical Record_. A

physician in the South sends a letter he has received from the _Army

and Navy Medical Record_ reading as follows:

“We have had many favorable reports reach us relative to your most

excellent institution, and, as you are doubtless aware, we come

in direct contact with a large number of Army and Navy and other

government attachés who have sons that they desire to provide with

a medical education combined with the higher course included in

your up-to-date laboratory methods and the sciences incidental to

clinical medical practice.

“If you will regard the proposition as confidential, we will agree

to carry a one-fourth page advertisement of your university at the

nominal rate of $38 per year, provided this amount is forwarded in

advance at the time copy is furnished; and _we will further promise

to editorially indorse and recommend your school and its methods

without qualification or exception_. [Our italics.--Ed.] This

article you should be able to use (and are authorized to do so)

after publication for advertising purposes.

“We will also be able, and are willing, to furnish you with a

desirable list of probable candidates from time to time.

“Kindly let us hear from you at once, if interested, and oblige,

“Yours with best wishes,

“The Army and Navy Medical Record,

“Arthur G. Lewis, Managing Editor.”

The physician to whom this was addressed made a notation on the letter

to the effect that “this looks crooked.” A few weeks later, Dr. V. C.

Vaughan, dean of the University of Michigan, Department of Medicine and

Surgery, sent in a letter from the _Army and Navy Medical Record_ which

he had received in his official capacity at the university. Here is the

letter; again the italics are ours:

“We are gratified to advise you that in our efforts to select a

strictly ethical and high-grade institution of medicine that this

magazine could consistently indorse and recommend, we have decided

on the University of Michigan, Department of Medicine and Surgery,

as the institution in your territory to whom our special publicity

concession will be made this year.

“You are doubtless aware that we come in direct contact with a

very large number of Army and Navy and other government attachés,

also physicians in private practice who have sons that they desire

to provide with a medical education, combined with the higher

courses included in your up-to-date methods.

“For personal reasons we are particularly anxious to favor your

institution, and frankly believe that we can prove of material

service to you. The special proposition, to be regarded by you as

strictly confidential, is that we will publish a full one-half page

announcement of your institution for the term of one year, you to

merely pay a nominal expense charge of $38 for the year’s service.

As our regular rate is $125 per annum for this service, _the

necessity of regarding the matter between ourselves is apparent_.

[Transparently so.--Ed.] We further propose, without expense to

you, to editorially indorse and recommend your institution and

its methods without qualification or exception. An electrotype

illustration may be used, without charge.

“It is important, however, that we hear from you promptly. Awaiting

your immediate reply, we are, with best wishes,

“Yours faithfully,

“The Army and Navy Medical Record,

“Arthur G. Lewis, Managing Editor.”

Dr. Vaughan, in forwarding the matter to The Journal, wrote that on

receipt of the offer just given, he “was uncertain whether its writer

was a knave or a fool.” After inquiring into the matter somewhat

thoroughly, he concluded that “the managing editor of the _Army and

Navy Medical Record_ is both a knave and a fool.”

THE ARMY AND NAVY MAGAZINE

The Journal had the _Army and Navy Medical Record_ under investigation

before these two letters were received and, as a result, the following

facts seem to be pretty well substantiated. Herbert C. Lewis, with his

brother, Arthur G., conducted from Washington, D. C., a publication

called the _Army and Navy Magazine_. In The Journal’s nostrum file

there is a booklet put out by the Renova Distributing Company

describing the wonderful virtues of its product, “Anti-Jag,” which, as

its name might intimate, is a “liquor cure” of the fake variety. One

page of this booklet is given over to what purports to be “A Letter

from a Great Magazine Editor.” The letter is dated June 19, 1900,

from Washington, D. C., and says that “the editor of the _Army and

Navy Magazine_ takes pleasure in stating that from his own personal

knowledge he has found ‘Anti-Jag’ to be one of the most reliable

medicines ever introduced for the permanent cure of drunkenness.”

And more to the same effect. The letter is signed “Herbert C. Lewis,

editor.”

The publishing offices of the _Army and Navy Magazine_ are at 606 F

Street, N. W., Washington, D. C. The building at this address is known

as the Baltic Building. Herbert C. Lewis is said to be a printer by

trade.

The _Army and Navy Medical Record_ seems to have been started within

the last few months by Arthur G. Lewis. It does business from two

addresses, the Baltic Building, Washington, D. C., and the Maple Villa

Sanitarium, Hammonton, N. J. Lewis is said to have purchased the Maple

Villa Sanitarium recently, but apparently his chief source of income

is the _Army and Navy Medical Record_. He is alleged to have claimed

that some medical officials of the government are interested with him

in this publication but that these officials do not wish their names

known. We do not blame them.

[Illustration: Photographic facsimile of a letter sent by the _Army and

Navy Medical Record_ to the dean of University of Michigan, Department

of Medicine and Surgery, offering one hundred and twenty-five dollars’

worth of advertising space for a “nominal” thirty-eight dollars--with

editorial indorsements and recommendations thrown in for good measure!]

ADVERTISEMENTS AS EDITORIALS

A glance through two issues of the _Army and Navy Medical Record_ makes

perfectly plain the character of the publication. The January-February,

1913, number leads off with articles by well-known medical officers

in the Army, the Navy and the Public Health Service. These have been

copied from other publications. Then comes an editorial entitled “A

Much Needed Dietary Reform,” devoted to the laudation of “Postum,” the

widely advertised coffee substitute. Following this is an editorial

on “The Philosophy of Hypnotics” in which aconitine, saline laxative

and digitalin are each given a “boost.” Then comes an “original

article” (save the mark!) entitled “The Physiological Pathology of

Consumption.” This is by “Alfred S. Gubb, M.D., L.R.C.P., London,

M.R.C.S., Eng., D.P.H., etc. etc., Aix-les-Bains, Savoie, France.”

Two pages are devoted to this. The “joker” appears in the third

paragraphs from the end--Fellows’ Syrup of Hypophosphites. Dioxogen

receives more than three pages of editorial mention under the

caption “The Sterilization of Milk with Dioxogen.” Under “Another

New Electrical Wonder--Magnified Sound,” the “Acousticon” is given

a two-and-a-quarter page write-up. “What Wise Men Wear” is the

title of a four-page article--unsigned--devoted to the laudation of

suspensories in general and the “O-P-C Suspensory” in particular. Dr.

H. F. Boatman, Los Angeles, contributes a short article on “A Case of

Advanced Pulmonic Tuberculosis Treated with Injections of Dioradin,”

while our good old friend Willard H. Morse, M.D., “F.S.Sc. (Lond.),”

the champion fake-testimonial-giver of the country, writes more or

less entertainingly on “Putting on a Mustard Plaster.” The article

has nothing to do with mustard plasters but has a good deal to do

with “Zumota,” a nostrum recommended as a substitute for the mustard

plaster. These are but a few of the nostrums to which the editorial and

reading pages of the _Army and Navy Medical Record_ are devoted.

In the June-July issue, Arthur G. Lewis becomes bolder. The leading

article is entitled “First Aid in the Navy,” by C. F. Stokes,

Surgeon-General, United States Navy. There is nothing to indicate

that this article was not contributed to the _Army and Navy Medical

Record_ by its author. As a matter of fact, it originally appeared in

an official publication, the _United States Naval Medical Bulletin_ for

January, 1913, and was reprinted by Lewis without credit and without

permission. Following the article by Dr. Stokes is another, unsigned,

entitled “The Passing of ‘The Pie Habit.’” This describes the surprise

of the students of Harvard University at being served breakfast cereals

instead of pie at their noonday meal and suggests that “Shredded Wheat

Biscuits” make a “delicious dessert.” A two-and-a-half page article on

the “Danger of Corrosive Sublimate in Vaginal Douche” is reprinted from

the _Lancet-Clinic_ of September, 1903. The reason for resurrecting

this ten-year-old article becomes apparent before one gets half through

it. It deals not so much with the danger of corrosive sublimate as with

the marvelous--alleged--properties of Tyree’s Antiseptic Powder. Dr.

Claude C. Keeler, Denver, has a three-page article on the “Medical

Treatment of Pulmonary Tuberculosis.” The “medical treatment” referred

to is Waterbury’s Compound. An editorial entitled “One Notch Ahead

of Morphin” is devoted to that vicious morphin solution sold under

the proprietary name “Papine.” Another on “The Treatment of Catarrh

by Palliatives and Curatives” deals with a widely advertised “patent

medicine,” “Kondon’s Catarrhal Jelly.” What appears to be a contributed

article by Charles Wardell Stiles of the United States Public Health

Service on “Country Schools and Rural Sanitation” has really been

“lifted” from an official publication without credit and, needless to

say, without Dr. Stiles’ permission.

But medicinal preparations are not the only things to which the _Army

and Navy Medical Record_ gives editorial indorsement. All advertising

matter, apparently, is grist to its mill. Sandwiched in between

articles on “Public Health Administrations” and “Important Army Medical

Lectures” is a dissertation on “The Millennium of Shirt Construction,”

in which are sung the virtues of the tailless shirt! A little farther

along the Hawaiian pineapple is extolled, while the last pages of the

issue are devoted to various banking concerns.

In addition to the advertisements appearing throughout the reading

and editorial pages of these two issues of the _Army and Navy Medical

Record_, there are a number of display advertisements. There is

no reason to suppose, at least in the majority of cases, that the

advertisers had the slightest reason to suspect the nature of the

_Army and Navy Medical Record_. Several pages are devoted to financial

advertisements, there being more than forty banks that have “fallen

for” the wiles of Arthur G. Lewis. In view of the letters received by

the deans of medical colleges and other educational institutions, the

display advertisements of schools and colleges have a special interest

to physicians. Schools for girls, polytechnics, colleges of music,

veterinary, dental and medical schools--all are to be found in this

cosmopolitan publication.

Among the therapeutic products advertised--in the advertising

pages--are:

Fellows’ Syrup of Hypophosphites 1 cover page

Kondon’s Catarrhal Jelly 1/2 page

Expurgo Anti-Diabetes 1/2 page

Laxol 1/2 page

Campho-Phénique 1/2 page

Palpebrine 1/2 page

Zumota 1/2 page

Sanmetto 1/4 page

While in the reading pages the following products are puffed:

Tyree’s Antiseptic Powder.

Waterbury’s Compound.

Papine.

Kondon’s Catarrhal Jelly.

Ranier Natural Soap.

Iodia (Battle).

Creo-Derma.

Fellows’ Syrup of Hypophosphites.

Tannalbin.

Expurgo Anti-Diabetes.

Zumota.

Sulfothen.

Dioxogen.

Palpebrine.

Bannerman’s Intravenous Solution.

Daniel’s Concentrated Tincture of Passiflora.

Peacock’s Bromides.

Aletris Cordial Rio.

Gonosan.

Digipuratum.

Dioradin.

Pepto-Fer.

Lactol.

Campho-Phénique.

Summed up: The _Army and Navy Medical Record_ is but another of the

parasites of quackery. It is not entered as second-class matter and

it has probably no bona-fide circulation. While it is claimed to be

“Devoted to the Interest of the Medical and Surgical Corps of the

Army and Navy, the Public Health Marine Hospital Service and the

Red Cross Society” it is actually devoted to none of these. It is

devoted to the exploitation of the advertising public for the special

financial benefit of the man who calls himself its editor--Arthur G.

Lewis. Advertising contracts are obtained under false and fraudulent

pretenses. In brief, Arthur G. Lewis is using the good name of the

various medical services of the United States government to further his

swindling operations. He has written letters to honorable physicians

making dishonest and insulting propositions to deceive and defraud the

public. Editorial indorsements of the _Army and Navy Medical Record_

mean nothing except that money has been paid for them. In short, the

_Army and Navy Medical Record_ is a fraud, and its “editor,” Arthur G.

Lewis, a faker.--(_From The Journal A. M. A., Oct. 25, 1913._)

THE MEDICAL TIMES ADVERTISEMENTS

In Which Are Discussed Some “Oversights” and

the Ethics of Journalism

Two or three weeks ago we published letters from two physicians calling

attention to an advertisement of a “cancer cure” hospital appearing in

the _Medical Times_. As a result of The Journal’s comments, some of the

physicians who were listed as “contributing editors” of the _Medical

Times_ wrote that they had requested that their names be withdrawn from

this list. In reply to at least some of these letters, the editor of

the _Medical Times_ wrote asking them to reconsider their decision and

offering as an excuse the statement that the appearance of the “cancer

cure” hospital advertisement was an oversight. In this connection the

following letter from the _Medical Times_, addressed to The Journal of

the American Medical Association, is pertinent:

“_Gentlemen_:--We note in your issue of October 18 an article

calling attention to an advertisement which appears in the columns

of this journal, and to which your editor rightly objects.

“The advertisement in the _Times_ was the result of an oversight,

and it will not reappear.

“While we are indebted to you for thus bringing the matter to our

attention, we cannot but feel that a letter written to us would

have been more in keeping with the ethics of journalism.

“Very truly yours,

The Medical Times.”

It will be noticed that this letter, like the letters sent to other

physicians, ignores altogether the most important point made by The

Journal in its criticism of that publication’s advertising policy. The

Journal said in this connection:

“If our correspondents will go through the advertising columns of the

_Medical Times_ they will find many, many other frauds, less cruel

perhaps than the Kellam advertisement, but no less disreputable or

discreditable to the medical profession.”

The _Medical Times_ apologizes for the advertisement of the Kellam

Cancer Cure Hospital but ignores altogether the fact that the hospital

advertisement was but one of many equally discreditable. We turn to

recent issues of the _Medical Times_ and we find it fairly reeking with

advertisements of proprietary preparations that are a disgrace to the

medical profession, many of them having been repeatedly exposed in The

Journal. We find, for instance, a quarter-page advertisement of the

Expurgo Manufacturing Company. “Expurgo Anti-Diabetes,” we are solemnly

told in the pages of the _Medical Times_ is:

“The only reliable and thoroughly tested remedy for the cure of

Diabetes Mellitus and Insipidus.”

This wretched fraud, which also is advertised in true “patent medicine”

style direct to the public, is presented to a presumably intelligent

profession as a “cure” for a disease which so far has baffled the best

brains in the scientific world.

“Expurgo Lapis” we are told, also via the _Medical Times_ is:

“The only known cure for gall-stones, kidney and bladder stones,

gravel and all kidney trouble arising from uric-acid origin.”

Did Kilmer’s Swamp-Root ever claim more? “Diabetes is no longer an

incurable disease” runs the advertisement of the Jireh Diabetic Food

Company, yet the editor of the _Medical Times_ must know that in The

Journal[133] and in the reports of state chemists the Jireh diabetic

foods have been shown time and again to be among the most dangerous and

fraudulently exploited products sold to the unfortunate diabetic.

[133] The Journal A. M. A., Dec. 14, 1912, March 22, 1913, and April 5,

1913; see also p. 451, this book.

Phenalgin,[134] twin brother to the Antikamnia fraud, shouts its

inferential falsehoods in a half-page display. Micajah’s Wafers,[135]

the alum-borax mixture long advertised as a cure for gonorrhea,

endometritis, etc., may also be found, as well as many other

preparations exposed at various times by The Journal. For example:

Anasarcin,[136] Campho-Phenique,[137] Papine,[138] Bromidia,[139]

Cactina Pillets,[140] Pluto Water,[141] Prunoids,[142] Sanatogen[143]

and Sal Hepatica.[144]

[134] Pages 10 and 335, this book.

[135] Page 240, this book.

[136] Page 11, this book.

[137] Page 40, this book.

[138] Page 330, this book.

[139] Nostrums and Quackery, Ed. 2, p. 589; page 31, this book.

[140] Page 36, this book.

[141] The Journal, March 29, 1913, p. 1013.

[142] Page 178, this book.

[143] Nostrums and Quackery, Ed. 2, p. 470; page 358, this book.

[144] Nostrums and Quackery, Ed. 2, p. 639; page 179, this book.

What excuse can the _Medical Times_ offer for the presence of these

frauds in its pages? Are these, too, “the result of an oversight”?

Presumably for thus bringing to its attention these various other

disreputable advertisements, The Journal will be accused again

of violating “the ethics of journalism.” If calling attention to

fraudulent advertisements is out of keeping with the ethics of

journalism, what, pray, must be said of publications that are willing

to share in the profits of such fraudulent exploitation? But, and

we cannot repeat it too often, the _Medical Times_ is but one of a

class, neither worse nor better than many other medical journals whose

financial support comes from the proprietary interests rather than from

the medical profession. The responsibility for the existence of these

journals really rests not on the business men who conduct them on a

commercial basis, but on the physicians who tolerate or encourage them

in any way.--(_From The Journal A. M. A., Nov. 8, 1913._)

CAUSE FOR OPTIMISM

A Clean Medical Journal--the South Texas Medical Record

Fortunately, there are forces at work in the medical profession that

make for optimism. An editorial in the last issue--April, 1915--of the

_South Texas Medical Record_, the official organ of the South Texas

District Medical Association, is especially significant. While not a

large journal, the _South Texas Medical Record_ could well stand as an

example to medical publications of a much more pretentious character.

Its advertising pages are above reproach and the journal is a credit

alike to its editors and to those members of the profession whose

support makes its existence possible. In the editorial referred to,

entitled, “Honest Advertising--Let Us Cleanse Our Own Linen First,” the

editor-in-chief, Dr. W. Burton Thorning, says:

“A recent editorial, entitled ‘Honest Advertising,’ in a daily

newspaper, furnished the occasion for an editorial comment in the

January number of the _Southwestern Hospital Reporter_. The latter,

while taking the ground that the newspaper was inconsistent in

uttering high editorial sentiments and in adjoining columns printing

patent medicine advertisements, implied that newspaper men should be

allowed some latitude in the matter of accepting advertising, on the

plea of being laymen and therefore not expected to possess the same

amount of information concerning patent ‘dope’ that medical men have.

“It would appear to be a fair assumption that a layman, even though a

highly educated and able editor of a great newspaper, does not know,

and cannot be expected to know, the depth of depravity to which the

consumption cure faker and the cancer quack can descend.

“Granting that the newspaper man accepts the advertisements through

ignorance of the facts concerning their possibilities for evil,

what can be offered in defense of the medical editor who accepts

advertising matter equally pernicious in its influence?

“Indeed, it is not so many years since many of the so-called ethical

medical journals carried the ads of some of the most notorious quacks

this country has ever known.

“Doubtless there are few, if any, who do so at the present time,

but, on the other hand, there are only a few who do not advertise

unethical institutions, and questionable proprietary medicines. As a

matter of fact some of the most widely advertised patent medicines of

today were formerly advertised as ethical proprietaries in medical

periodicals, the great majority of which are still serving as a sort

of preparatory school for advertisements that will presently appear

in the lay press.

“What shall be offered in defense of the medical publication

which continues to publish the advertising matter of hundreds of

proprietaries which the Council on Pharmacy and Chemistry of the

American Medical Association has shown to be either generally

worthless or an out and out fake?

“Can the medical editor plead ignorance? Hardly. To do so would be to

admit utter incapacity. There is only one inference to be drawn; the

publication needs the money and is not overparticular regarding its

source.

“There is a remedy, however, a remedy absolutely certain in its

results. If every physician in the United States for a period of

three months would positively refuse to receive at his desk a medical

journal containing questionable advertising, this blotch on medical

journalism could be erased.

“It is true that many of them would sink, never to rise again, but

the profession would be better off without those whose existence

depends upon ‘phoney’ advertising. There are, unfortunately, several

American journals whose reading pages are well and carefully edited

and a credit to medical literature, whose advertising pages carry

such undesirable matter that the educated physician can only feel a

sense of disgust.

“Such journals could very well succeed on the quality of their

reading matter and undoubtedly would increase their circulation

enough to more than offset the loss in advertising.”--(_From The

Journal A. M. A., May 29, 1915._)

THE COMPARATIVE NUTRIENT VALUE OF COD LIVER OIL AND

COD LIVER OIL CORDIALS[BJ]

John Phillips Street, M.S.

Chemist, Connecticut Agricultural Experiment Station

NEW HAVEN, CONN.

[BJ] See also reports on Hagee’s Cordial, pp. 51, 289; Wampole’s

Preparation, pp. 52, 442, and Waterbury’s Compound, pp. 54, 57, 291.

For a long time cod liver oil has been recognized as an easily

assimilable nutrient and reconstructive and of special value in

wasting diseases. The unpalatability of the oil, however, has led to

various devices to make it tasteless or to render it more acceptable

to the stomach. Emulsions containing the oil in mixture with other

substances were exploited, and doubtless served a useful purpose.

The oil, however, but imperfectly concealed, was still disagreeable

to many, and other preparations began to appear on the market, which

claimed to retain the therapeutic virtues of cod liver oil without its

disagreeable characteristics. This practice has been carried so far

that now we find for sale cod liver oil preparations from which the oil

has been removed in its entirety, and only the name remains. Certain

of these products claim to “represent” the oil and to retain all its

virtues; others are said to contain oil, while still others claim “all

the valuable constituents” of the oil without the oil itself.

In the past, cod liver oil has been considered a food rather than

a medicine, and its value attributed to the easily digestible and

metabolizable oil it contains. This position, however, has been

disputed. By some its therapeutic value has been attributed to the

small amount of iodin present in the oil, but in recent years the

suggestion has been made that its special potency depends on its

peculiar fatty acids. In this connection the U. S. Dispensatory[145]

says:

[145] U. S. Dispensatory, Ed. 19, p. 860.

“Other oleaginous substances, certainly not less nutritious, have not

been equally efficient, though taken in much larger quantities. If

this be the true explanation, persons living chiefly on milk, which

abounds in oil, or on fat pork, ought to show a special exemption

from scrofulous complaints. The probability appears to us to be that,

in consequence of some peculiar principle or principles it contains,

it exercises a stimulant and alterative influence on the processes

of assimilation and nutrition, thereby aiding in the production of

healthy tissue.”

Indeed, Osborne and Mendel[146] have shown in their experiments on

albino rats that by substituting cod liver oil for a portion of the

lard in their standard diets, growth was resumed after failure on foods

containing commercial lard alone as the source of fat. Similar results

were secured with butter-fat and egg yolk fat.

[146] Osborne, T. B., and Mendel, L. B.: Jour. Biol. Chem., 1914, xvii,

401.

In the light of the theories advanced for the therapeutic value of

cod liver oil, and the results secured by Osborne and Mendel with

the oil itself; it seemed a profitable study to examine some of the

prominent “oilless” preparations on the market to determine whether

or not the claims made for them as nutrients were justified. Certain

of the so-called cod liver oil preparations are termed “extracts” of

cod liver oil, and are not made from the oil, but from the cod livers

instead. As has been well said,[147] “They are preparations, which, if

honestly made, might be worthy of trial, but they are improperly called

‘extracts’ of cod liver oil, since they do not contain the fat, which

is the active constituent of the oil, but the extractives from the

liver, which may or may not possess therapeutic virtues. So far as we

know, however, no satisfactory evidence is forthcoming to indicate that

such extractives have any therapeutic value.”

[147] Fraud and Deception Connected with So-Called Cod Liver Oil

Preparations, The Journal A. M. A., Oct. 13, 1906, p. 1207.

It was with preparations of this class that our experiments were made.

Four of the more extensively advertised brands were selected, as they

represent rather distinct types of this class of products, as the

following claims of their label will show:

_Hagee’s Cordial of the Extract of Cod Liver Oil,

Compound._--“Tonic, stimulant, alterative, reconstructive,

nutritive and digestive.” “Each fluid ounce represents the extract

obtainable from 1/3 fluid ounce of cod liver oil (the fatty portion

being eliminated), 6 grs. calcium hypophosphite, 3 grs. sodium

hypophosphite, 1/2 gr. salicylic acid (made from oil wintergreen),

with glycerin and aromatics.”

_Vinol._--“The modern tonic reconstructor containing the medicinal

extractives of fresh cod livers with peptonate of iron.” “When the

blood is poor, when more fresh blood is needed, when the weak need

strength, when the throat and lungs are affected, TAKE VINOL.”

_Wampole’s Perfected and Tasteless Preparation of an Extract of

Cod Liver._--“Contains a solution of an extractive obtainable

from fresh cod livers, the oily or fatty portion being afterward

eliminated. This extractive is combined with liquid extract

of malt, fluid extract of wild cherry and compound syrup of

hypophosphites (containing calcium, sodium, potassium, iron,

manganese, quinine and strychnine).”

_Waterbury’s Compound, Plain._--“Made from cod liver oil, digestive

ferments, malt extract unfermented, hypophosphites comp. special,

ext. cherry, eucalyptus, aromatics, etc.”

Thus we have represented in our experiments an “extract” with

hypophosphites, one with peptonate of iron, one with malt extract

and hypophosphites and the alkaloids quinin and strychnin, and one

with malt extract and hypophosphites without alkaloids.

In order to prepare a dry ration of suitable keeping properties,

it was necessary to remove the alcohol and water from the various

preparations. This was done by evaporation under reduced pressure

at from 40 to 55 C. (104 to 131 F.). In the case of Hagee’s Cordial

it was claimed that one fluidounce of the preparation represented

1/3 fluidounce of cod liver oil, and in the subsequent substitution

for cod liver oil in our rations, this ratio was used for all four

products.... These are very dissimilar preparations, the alcohol

ranging from 7.50 to 18.69 per cent., the extract from 8.72 to

39.53 per cent. (10.81 of the 13.18 gm. of extract in Hagee’s

Cordial being glycerin), the ash from 0.305 to 1.967 per cent.,

the reducing sugars from 1.35 to 17.10 per cent., and the glycerin

from a trace to 10.81 per cent. Wampole’s contained quinin and

strychnin, the others no alkaloids; salicylates were present in

all but Wampole’s; saccharin in Hagee’s. The Pettenkoffer test for

biliary acids gave a negative result in Hagee’s and Wampole’s; in

Vinol and Waterbury’s, small amounts of fatty acids were obtained,

amounting to 0.016 and 0.032 gm. per hundred c.c., respectively,

quite insignificant amounts.

The feeding experiments were made on albino rats of both sexes,

which were placed, when about 6 weeks old, on a standard ration, No.

7, and after several months, when a failure to maintain weight was

indicated,[148] an amount of dealcoholized cordial extract equivalent

to 18 per cent. of cod liver oil was substituted for a portion of the

lard, the cordial extract later being replaced by an equivalent amount

of cod liver oil.

[148] Osborne and Mendel have shown (Jour. Biol. Chem., 1913, xv, 311)

that mixtures of purified protein, lard, starch and protein-free milk

have been singularly efficient for a time in promoting growth of young

rats. In from sixty to 100 days or more, however, normal growth stops;

the animals may remain at constant weight for a few days, or grow very

slowly, and then suddenly decline and die unless a change is made in

the diet. The substitution of butter-fat, egg yolk fat, or cod liver

oil for a portion of the lard in the ration, in the experiments of

these authorities, brought prompt recovery and continuation of normal

growth.

SUMMARY

Table 11 gives a summary of the actual gains of the fifteen rats on the

four rations, compared with the gains shown by cod liver oil and those

shown by normal rats at the same period of their life history.

TABLE 11.--SUMMARY OF RESULTS[BK]

=====================+========+========+=========+=========

| Total | Total | Average | Average

Rations | Normal | Actual | Normal | Actual

| Gain, | Gain, | Gain, | Gain,

| Gm. | Gm. | Gm. | Gm.

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

Hagee ration | 24 | -36.2 | 6 | -9.1

Cod liver oil ration | 114 | 156.4 | 28.5 | 39.1

| | | |

Vinol ration | 42 | -1.5 | 10.5 | -0.4

Cod liver oil ration | 42 | 87.5 | 10.5 | 21.9

| | | |

Wampole ration | 83 | 51.4 | 20.8 | 12.9

Cod liver oil ration | 62 | 81.5 | 15.5 | 20.4

| | | |

Waterbury ration | 32 | 0.3 | 10.7 | 0.1

Cod liver oil ration | 42 | 87.4 | 14 | 29.1

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

[BK] In this table are given the totals and averages of the figures

already presented in Tables 4, 6, 8 and 10.

In considering the effect of these preparations as general medicines,

their alcohol content must not be overlooked. Hagee’s Cordial contains

7.50 per cent. of alcohol by volume, Vinol 18.60 per cent., Wampole’s

Preparation 16.59 per cent., and Waterbury’s Compound 11.25 per cent.

Full strength whisky contains 50 per cent. of alcohol by volume.

By following the doses prescribed by the manufacturers of these

preparations, the user would consume daily the following equivalents of

full strength whisky:

In Hagee’s Cordial 0.24 fluidounce

In Vinol 0.8 fluidounce

In Wampole’s Preparation 0.7 fluidounce

In Waterbury’s Compound 0.6 fluidounce

These amounts of alcohol are by no means negligible and doubtless

explain to a considerable extent the source of the alleged tonic

virtues of these preparations.

The results of the experiments may be summarized as follows:

Hagee’s Cordial failed to sustain rats during periods of seven and

fourteen days, the rats showing a loss in weight of 36.2 gm., instead

of the normal gain of 24 gm.

Vinol in two cases sustained and in two cases failed to sustain growth

during periods of from eleven to thirty-five days, the net loss in

weight of the four rats being 1.5 gm., instead of the normal gain of

42 gm.

Wampole’s Preparation in three Cases sustained and in one case promoted

growth in rats during periods of eighteen and thirty-nine days,

showing, however, only 51.4 gm. gain in weight instead of the normal

83 gm.

Waterbury’s Compound in two cases sustained and in one case failed to

sustain rats during periods of fourteen and thirty days, the net gain

in weight, however, being but 0.3 gm. instead of the normal 32 gm.

Cod liver oil showed a gain of 42.4 gm. over the normal, while with

the same rats Hagee’s Cordial showed a loss of 60.2 gm. Cod liver

oil showed a gain of 45.5 gm. over the normal, while with the same

rats Vinol showed a net loss of 43.5 gm. Cod liver oil showed a gain

of 19.5 gm. over the normal, while with the same rats Wampole’s

Preparation showed a loss of 31.6 gm. Cod liver oil showed a gain of

45.4 gm. over the normal, while with the same rats Waterbury’s Compound

showed a net loss of 31.7 gm.

_Not only did cod liver oil show a marked superiority as a source

of nutriment over Hagee’s Cordial, Vinol, Wampole’s Preparation and

Waterbury’s Compound, but it also showed a remarkable reconstructive

and recuperative power in its ability to enable rats to gain weight

rapidly and steadily after having suffered from a deficiency in

nutriment when fed the four preparations named above._--(_Abbreviated

from The Journal A. M. A., Feb. 20, 1915._)

DIABETIC FOODS OFFERED FOR SALE IN THE UNITED STATES

A Preliminary Report

John Phillips Street, M.S.

Chemist, Connecticut Agricultural Experiment Station

NEW HAVEN, CONN.

Recent references in The Journal to gluten flours and certain other

foods offered for the use of diabetics suggest that a preliminary

report of an investigation just about completed in my laboratory by

Prof. L. B. Mendel and myself might be useful to many diabetics and to

physicians who are called on to arrange their dietaries.

In 1906 this laboratory, then under the direction of Dr. A. L.

Winton, who is now with the Department of Agriculture, made its first

examination of commercial diabetic foods. In nearly every year since it

has analyzed various other brands as they appeared on the market. The

demand for the reports on these foods and the many inquiries directed

to us have led us to make a more extensive review of the situation,

and to collect as far as possible all information as to the quality of

the so-called “diabetic” foods offered to the American public. That

the present state of the market is unsatisfactory is well known, and

the inferiority (from the diabetic’s point of view) of many of the

products at present offered is unfortunately familiar to all careful

dietitians. The most dangerous feature of the present situation is

that the unsuspecting patient is led to purchase foods, generally at

an exorbitant price, which are not only misrepresented but which may

be positively harmful to him. In this day of self-medication this

condition is all the greater menace to the diabetic.

Without any attempt to suggest methods of treatment for diabetes, which

is the province of the physician, I may say that it is well recognized

that diabetes is primarily a disturbance of nutrition, in which the

normal ability of the body to make use of carbohydrates is more or

less completely impaired. All recent authorities agree in placing the

chief emphasis on the role of diet in the management of this disease.

Janeway, Benedict, Joslin, Futcher, Falta, Strauss, von Noorden and

other writers on diabetes could be quoted at length in support of this

view. The importance of a restriction of the carbohydrates in certain

cases and certain aspects of diabetes is admitted by practically

all competent authorities. In order to prescribe a starch-free and

sugar-free dietary, which at times is necessary, and to know accurately

the actual amount of these carbohydrates contained in the various

available foods, the physician must rely on the cooperation of the

chemist to furnish this requisite information. This is our excuse, if

any be needed, for our present investigation.

There seems to be some uncertainty as to what sort of preparation is

entitled to be sold as a “diabetic” food. Granting the desirability

of feeding the patient all the carbohydrate he can tolerate, and

recognizing the possible value of the oatmeal, potato, rice and other

treatments, in which a relative abundance of carbohydrate is fed for a

limited period, it would seem that a low percentage of carbohydrates

should be a requisite for a “diabetic” food. Certainly no special food

containing nearly as much carbohydrate as a normal food of the same

class should be entitled to this appellation. Flours, breads, biscuits,

chocolates, breakfast-foods, macaroni, etc., containing only a slightly

lowered percentage of carbohydrates, are no more entitled to be called

“diabetic” foods than the normal foods themselves. It is true that,

when a patient’s carbohydrate tolerance is well established, the use

of foods containing 20, 25 and even 35 per cent. of carbohydrates

might be permissible, when used under the direction of a competent

physician; but when a strict diet is necessary, such as is required to

determine this tolerance, even these relatively low percentages are

objectionable, if not dangerous.

It has been our purpose to include in this investigation, as nearly as

possible, all available data on the composition of all diabetic foods

sold in America. Our report, therefore, will be in part compiled, but

in greater part will consist of our original analyses. It will show 539

analyses of about 400 brands, 200 of which are our own new analyses and

110 those made in this laboratory in previous years.

While the purpose of this preliminary note is to call attention to the

better preparations rather than to emphasize those which are obviously

objectionable and fraudulent, it may not be out of place to summarize

briefly our findings in general. The full details of the investigation

are now being prepared for publication and will shortly be issued as a

report from the Connecticut Agricultural Experiment Station.

One hundred and eight samples of sixty-eight brands of flours and meals

are included in the report. Sixty-seven of these were sold as “gluten”

flours, twenty of which did not even satisfy the low government

standard of 35 per cent. protein. Twelve samples contained less than 13

per cent. carbohydrates, while the remaining gluten flours ranged from

28 to 76 per cent.

The soy bean flours contained from 23 to 26 per cent. of carbohydrates,

the almond meals 17 per cent., and a cotton-seed flour 21 per cent.

Other “diabetic” flours, not specifically sold as “gluten” flours,

contained from 67 to 80 per cent.

The purchaser of gluten flours at the present time may obtain

preparations containing from 87 to 11 per cent. of protein and from 4

to 76 per cent. of carbohydrates, at a cost of from 9 cents to $1.56

per pound.

In view of the government’s low standard for gluten flour, and because

of the wide variations in composition found in the brands at present

on the market, proper protection of the diabetic demands that the

manufacturers of these flours should be required to state on the label

the guaranteed percentages of both protein and carbohydrates.

Three samples of American soft gluten breads contained from 35 to 37

per cent. of carbohydrates; two other brands contained 49 and 54 per

cent., little, if any, lower than found in ordinary wheat bread.

One hundred and forty-eight analyses of 112 brands of hard breads,

biscuits, rusks, cakes and other bakery products are included. Eight

brands of _Luftbrot_, or aerated bread, are reported; two of these

contained from 9 to 12 per cent. of carbohydrates, one 20 per cent.,

two from 31 to 33, and the other three from 44 to 54 per cent.

A number of the brands of rolls, biscuits, breads, etc., showed

satisfactorily low percentages of carbohydrates, thirty-five samples

containing from 1 to 25 per cent., forty-four samples containing from

35 to 55 per cent., and forty-one over 55 per cent., seven of the

latter exceeding 72 per cent.

The cost of the _Luft_ breads ranged from 71 cents to $2.33 per pound.

Biscuits, containing 11 per cent. or less of carbohydrates, cost from

72 cents to $3 per pound. A number of brands, containing from 43

to 77 per cent., cost from $3 to $3.60 per pound. Even the cheaper

preparations, containing from 50 to 77 per cent., no better, and in

some cases even worse, for the diabetic’s use than ordinary bread, cost

from 30 to 41 cents per pound.

Fourteen samples of breakfast-foods were analyzed, five of which

contained from 44 to 54 per cent. of carbohydrates, somewhat lower

percentages than normal. Seven of the ten brands of recommended

macaroni, noodles, etc., contained over 70 per cent. of carbohydrates,

the other three from 42 to 51 per cent.

The analyses are given of fourteen samples of peanut butter, five of

almond paste and butter, two of pine-nuts, one of almonds and ten

of miscellaneous nut foods. As was to be expected, most of these

preparations proved to be suitable diabetic foods. The peanut butters

contained from 12 to 20 per cent. of carbohydrates, with an average

of 15 per cent. The three almond pastes contained from 30 to 40 per

cent., one showing an addition of 11 per cent. cornstarch. The two

almond butters contained only 7 and 8 per cent., the pine-nuts from 3

to 8 per cent., and the almonds 16 per cent. The other nut preparations

contained from 6 to 44 per cent. carbohydrates.

Seven brands of diabetic chocolates contained from 10 to 50 per cent.

carbohydrates, while four cocoas contained from 21 to 51 per cent. The

chocolates cost from $1.63 to $2.06 per pound, and the cocoas were

similarly expensive.

Two sugar-free milks were examined which were true to name, containing

only the merest traces of carbohydrates. One “diabetic” baking-powder

examined contained no starch, another brand from 14 to 16 per cent.

Various jams, preserves and other fruit products were examined which

contained from 1.24 to 7 per cent. of invert sugar, percentages far

below the normal. A currant-juice contained only 0.85 per cent. of

invert sugar. Four of the fruit preparations were artificially colored

with a coal-tar dye--a permitted color to be sure, but seemingly quite

out of place in foods intended primarily for the use of invalids.

As already stated, the main purpose of this investigation was not

so much to detect fraud as to secure information which would be of

benefit to the diabetic and to the physician who seeks foods suitable

for a low carbohydrate diet. In the accompanying tabulations a summary

is given of the brands, _sold as diabetic foods_, which showed less

than 35 per cent. of carbohydrates, arranged in the order of their

carbohydrate[149] content. A date in parentheses following a brand name

signifies that the brand named showed variations in different years; in

other cases, in which the agreement was close, the results have been

averaged.

[149] In the tables “carbohydrates” is used as synonymous with

“nitrogen-free extract.”

BRANDS SHOWING UNDER 5 PER CENT. OF CARBOHYDRATES

Per Cent.

Casoid Baking Powder .0

Dr. Bouma Sugar-Free Fat-Milk .0

Whiting’s Sugar-Free Milk .0

Rademann’s Currant Juice “ohne Zucker” 0.9

Kalaria Batons (1909) 0.9

Glidine 1.0

Casoid Sugarless Marmalade 1.2

Casoid Sugarless Jam 1.5

Kalari Biscuit 1.7

Casoid Dinner Rolls 2.1

Casoid Flour 2.2

Jireh Diatetic Pine Nuts 3.4

Rademann’s Preserved Fruits, “entzuckert” 3.5

Kellogg’s Protose 3.6

Barker’s Gluten Food “A” 4.1

Kellogg’s Pine Nuts 4.2

Kellogg’s 80 Per Cent. Gluten Biscuit 4.4

Bischof’s Gluten Flour 5.0

BRANDS SHOWING FROM 5 TO 10 PER CENT. OF CARBOHYDRATES

Per Cent.

Casoid Biscuits No. 2 5.6

Rademann’s Preserved Fruits “in eigenen Saft” 5.7

Barker’s Gluten Food “B” 5.9

Kellogg’s Nuttolene 6.3

Nashville Sanitarium Nutcysa 6.3

Huntley and Palmer’s Akoll Biscuit 6.5

Nashville Sanitarium Nutfoda 6.8

Rademann’s Preserved Fruits “ohne Zucker” 7.0

Muller’s Tomatoes für Diabetiker 7.3

Barker’s Gluten Food “C” 7.7

Kalari Batons (1913) 7.7

Casoid Biscuits No. 3 7.8

Kellogg’s 80 Per Cent. Gluten (1912) 7.9

Casoid Biscuits No. 1 8.0

Kellogg’s Almond Butter 8.2

Fromm’s Uni Bread 9.0

Metcalf’s Vegetable Gluten (1913) 9.8

BRANDS SHOWING FROM 10 TO 15 PER CENT. OF CARBOHYDRATES

Per Cent.

Kellogg’s Pure Gluten Biscuit (1906) 10.2

Health Food Pure Washed Gluten Flour (1913) 11.1

Health Food Alpha Diabetic Wafers 11.3

Loeb’s Imported Gluten Flour 11.8

Health Food No. 1 Proto Puffs 11.9

Kellogg’s Potato Gluten Biscuit (1906, 1909) 11.9

Kellogg’s Nut Meal 12.1

Kellogg’s 80 Per Cent. Gluten (1909) 12.5

Nashville Sanitarium Nut Butter 13.0

Kellogg’s Nut Butter 13.9

Bischof’s Diabetic Gluten Bread 14.3

Jireh Diabetic Baking Powder 15.0

Peanut Butter (range from 12 to 20) 15.0

BRANDS SHOWING FROM 15 TO 20 PER CENT. OF CARBOHYDRATES

Per Cent.

Casoid Chocolate Almonds 16.1

California Paper Shell Almonds 16.3

Callard’s Cocoanut Biscuit 16.4

Rademann’s Diabetiker-Chokolade 16.9

Health Food Almond Meal 16.9

Callard’s Ginger Biscuit 18.1

Callard’s Prolactic Biscuit 19.3

BRANDS SHOWING FROM 20 TO 25 PER CENT. OF CARBOHYDRATES

Per Cent.

Callard’s Almond Shortbreads 20.7

Callard’s Casoid Rusks 20.8

Rademann’s Diabetiker-Makronen 20.8

Health Food Protosoy Diabetic Wafers 21.2

Jireh Patent Cotton-Seed Flour 21.3

Casoid Lunch Biscuit 21.6

Rademann’s Diabetiker-Chokolade Biscuit 21.9

Cereo Soy Bean Gruel Flour 23.7

Health Food Salvia Sticks 24.0

Health Food Protosoy Soy Flour 24.5

Metcalf’s Soja Bean Meal 25.0

BRANDS SHOWING FROM 25 TO 35 PER CENT. OF CARBOHYDRATES

Per Cent.

Jireh Soja Bean Meal 25.8

Brusson Chocolat with Added Gluten 26.4

Rademann’s Diabetiker-Stangen 27.0

Rademann’s Diabetiker-Dessert-Gebäck 27.5

Nashville Sanitarium Malted Nut Food 27.5

Metcalf’s Vegetable Gluten (1906) 28.1

Health Food Pure Washed Gluten Flour (1906) 29.5

Fromm’s Luft Bread 30.7

Spencer’s Almond Paste 31.6

Fromm’s Conglutin-Diabetiker-Schokolade 32.7

Health Food No. 2 Proto Puffs 33.3

Ferbuson Gluten Bread 33.6

Gum Gluten Breakfast Food 34.2

--(_From The Journal A. M. A., June 28, 1913._)

THE JIREH DIABETIC FOOD COMPANY

The Company Rises to Explain in a Brief Note of One Thousand Words

Exploiters of fraudulent and dangerous pharmaceutical products have

no love for The Journal. When such products are exposed in these

pages, their manufacturers seldom reply to the criticisms except

through indirect channels. Then the replies are frequently replete

with billingsgate and denunciation of The Journal and its editor, the

Association and the medical profession generally.

We have, at different times, had to call the attention of the public

and the medical profession to the fraudulence and dangers of some of

the products of the Jireh Diabetic Food Company. We have shown that

the Jireh company lied boldly and directly so long as it could do so

without getting into the courts, and that it lies inferentially still;

we have shown that Jireh flour had practically as much carbohydrate

as ordinary flour; we have shown that, probably to escape prosecution

under the Food and Drugs Act, the Jireh concern has coined the word

“diatetic” and substituted it for the word “diabetic,” which used to

appear in its advertisements; we have shown that the claim made for

the Jireh products that they are “starch-changed” was a false one, and

that the company has modified this to “starch-treated,” presumably to

avoid being haled into the courts under the “pure food law;” we have

shown, in short, the unreliability both of the Jireh concern and of its

products.

Two or three weeks ago a New York physician wrote to The Journal for

information regarding the Jireh products. We sent him such matter as

had been published on the subject, and he showed this material to

a patient who was using the Jireh products. The patient, in turn,

expressed her opinion of the product to the retailer from whom she

had been purchasing it. A day or two later she received a letter from

the Jireh Diabetic Food Company, which, in spite of its length and

discursiveness, we publish in full, so that physicians may know just

what this company thinks of them. The letter, which is dated Nov. 20,

1913, really belongs in the “Knocks and Boosts” department, but its

length prevents its use there. Here it is:

“We learned through Mess. Cushman Co. that you are a constant user

of Jireh Foods for some time past, and that recently a certain

derogatory statement was brought to your attention relative to our

product. We feel an explanation is due you for two reasons.

“First, because we want you to continue using Jireh Foods and thus

receive the benefits of the same; and second, that the remarks

called to your attention are not only libelous, but are in no way

pertinent enough to detract from the value of our product. In

the first place, we want to state that the particular journal in

question has been endeavoring to injure our business for some time

past and that we are not the only descent [_sic_] manufacturers of

foods that are suffering in this way at the hands of the editors

of this particular magazine. Since you are interested in the Jireh

Foods, you may be more interested to learn why this particular

magazine is so anxious to injure our reputation. The reason is very

obvious if you will take into account the fact that this magazine

is the official journal of the medical association of this country

which is known as the backer of the medical trust. It is very clear

to you, no doubt, that there are some physicians, particularly

those that are associated with the magazine, who are anxious to

stamp out of existance [_sic_] such concerns that offer a bona fide

product, a meritorious product which actually produces the required

results, without the aid of medicine.

“For the particular maladies for which we offer our foods, we

have been very successful, consequently the antagonism on the

part of this particular journal is the logical thing. In addition

to this, however, and perhaps more important to us, is the fact

that the editors of this magazine have made it known to us that

they will not approve of our product until such time that we

care to be dominated by the moving influence of the magazine in

question. They want us to supply them with the private formula

which we use for manufacturing our foods and to enlighten them

and show them the various processes applied to our products to

produce the required results. As a bona fide and ethical business

house, we absolutely and unqualifiedly refuse to comply with this

wish, and will always refuse to do so, no matter how often they

may attack us. We stand strictly on principle in this matter and

propose to run our business in our own way, and will not, under any

circumstances, allow a magazine or anybody else dictate to us under

what conditions we are allowed to do our business.

“The remarks which they make would perhaps hurt us some if they

emanated from a source that was qualified to judge the merits of

our food. The absurd side of the issue, and perhaps the comical

side of it, is the fact that the honorable gentlemen who assume

to condemn a product, know less about the disease for which the

product is offered, and much less about diet and foods than the

average layman. Consequently, we consider it simply absurd to allow

them to step into our business and dictate policy to us. This is

the jist [_sic_] of the discontent that prevails between the

magazine editors and ourselves, and as long as we refuse to comply

with their wish, we certainly cannot expect them to speak well of

us. It has become a notorious fact in the medical profession that

their criticisms are almost valueless, inasmuch as they stop at

nothing in order to create sensationalism, and have attacked not

only ourselves, but every bona fide manufacturer of foods and drugs

in this country who has refused to fall in line with them.

“This explanation, we trust, will appeal to your good judgment and

will convince you of what is said about us is untrue. Furthermore,

our business has grown to colossal proportions, notwithstanding

their endeavors to crush us. We call your attention to a most

peculiar fact: that is, that they make no comment whatsoever as

to the product and its therapeutic value in the treatment of

diabetes. You notice they make an awful play on our literature,

which was changed merely to suit conditions in business. We also

wish to call your attention to another peculiar fact, and that

is that a great majority of the physicians who are in with this

magazine readily recommended our foods, and we also believe that

your physician, after reading this letter, will feel the same way

as most physicians do in relation to our foods. We believe that

your physician is perfectly willing to be convinced that our foods

are as represented to be, and the very best clinical evidence as

this is the effect our foods have had upon you. Finally, if the

foods are palatable and wholesome and have alleviated the annoying

symptoms of Diabetes, then why should you be guided by the opinions

of demagogues and yellow journalists?

“You may be pleased to learn that our foods have received the

attention of Dr. Wiley, the well-known chemist and food scientist

of this country, and we have now in our possession his reports

showing the very high standard of our foods. This, in our opinion,

is of more consequence than all the harangue which those venerable

gentlemen of the magazine may indulge in.

“We want to convince you without an atom of doubt that we are

honest and bona fide in everything we say, and we extend to you a

hearty invitation to call at the first opportunity and shall be

glad to tell you anything you may wish to know. Thus awaiting the

pleasure of this visit, we beg to remain

“Yours very truly,

“Jireh Diabetic Food Co.”

We learn from this letter that The Journal’s “remarks” on the Jireh

product are “libelous.” We have made them many times and for several

years past; if libelous, the manufacturer has excellent grounds for

damages. We learn, too, that our remarks “are in no way pertinent

enough to detract from the value” of the Jireh products. Why, then,

take any notice of them? We learn, moreover, for the hundred-and-first

time, that The Journal is the official organ of the “medical trust,”

and we are told that “there are some physicians” that are opposed to

the Jireh Foods because these products cure diabetes without the use of

medicine! The Journal, so the company says, wants the Jireh Diabetic

Food Company to supply its “private formula” and to show the “various

processes” by which the Jireh products are made. Such statements

indicate that the Jireh Diabetic Food Company does not confine its

mendacity to the mere advertising of its product, where the necessity

for lying is naturally great.

The ambiguous remarks regarding Dr. Wiley are evidently intended to

convey the idea that the doctor approves of the Jireh products. Dr.

Wiley was sent a copy of the Jireh letter and his attention directed to

the statements appearing therein regarding himself. He replied:

The Propaganda for Reform in Proprietary Medicines, Vol. 1 of 2 · 第 10 / 12 章