“In regard to the Jireh products and their claims that our reports

show the very high standing of their foods, I would say that I

consider such a claim entirely false.... We did examine five or six

products in our own laboratory, however, and found them to be of very

fair composition per se, but _not of a composition that afforded any

legitimate basis for their claims_. _We entirely disapproved ...

three of the products making special claim as to their fitness for

diabetics._ [Italics ours.--Ed.] These were the Wheat Nuts, the Jireh

Flour and the Patent Barley. Two of the other products were passed

with a non-committal rating, which means that they are not actually

disapproved, but the star marking is not accorded. These products

were the dietetic Rusks and the Macaroni. For the latter especially

no specific claims seem to be made. We called attention, however, to

the generally objectionable juggling of terms indulged in by this

company....”

The Jireh concern says that in spite of the efforts of The Journal to

“crush” it, “our business has grown to colossal proportions.” Of this

the New York physician who sends us the letter says: “Their ‘colossal

proportions’ must have received a slight jar or they would not have

taken time to write such a letter.”--(_From The Journal A. M. A., Dec.

20, 1913._)

THE NAME “EPINEPHRIN” VERSUS THE NAME “ADRENALIN”[BL]

[BL] A reprint of the letter from Parke, Davis & Co. referred to in

this article, together with the discussion thereof, will be sent on

receipt of a 2-cent stamp.

There are thirty or more different brands of the blood-pressure-raising

principle of the suprarenal gland on the market, five being in this

country alone. These products are identical so far as their chief

constituent is concerned; they differ, however as to the solvent and

preservative used. The processes of manufacture of some of them are

patented; all of them are sold under trade names.

Until two years ago there was no common name applicable to this active

principle; whenever reference was made to it a trade name had to be

used. At that time the Council on Pharmacy and Chemistry, realizing

the need of a generic term, adopted “epinephrin” as such a term. This

name was selected in part because Abel had adopted it in 1899; in part

because, so far as could be discovered, it was the name under which,

through Abel’s publications, the substance first appeared in medical

literature; and in part because it seemed to be the only suitable one

not already appropriated by some commercial firm.

After the publication of the Council’s report, The Journal began

gradually to use the term in those cases in which it seemed clear that

the proprietary term was used in a generic sense. The substitution

of the name “epinephrin” for “adrenalin” in the abstracts of certain

foreign articles caused Parke, Davis & Co. to write a letter of

protest which called forth the discussion appearing in the Propaganda

Department of this issue.

The amount of space devoted to this matter may be criticized and

considered unwarranted by those who do not realize the importance of

the subject. The criticism is to a certain degree, just. The somewhat

inordinate length of the article is due in part to the unfortunate fact

that, in availing themselves of the courtesy extended by The Journal,

Parke, Davis & Co., in their reply, have injected into the discussion

side-issues, such as the priority of discovery, the superiority of

their product, etc., whereas the question under discussion is simply

that which relates to the name. It is, however, not altogether a matter

for regret that the discussion has been thus broadened, for it brings

before our readers many facts regarding the discovery of an important

medicinal agent that are not generally known, at least by physicians.

Whether or not “adrenalin” is superior to “adrin,” “suprarenalin,”

“suprarenin,” “adnephrin,” or to any other of the preparations is

entirely immaterial in this connection. The point is that the active

principle of the suprarenal gland is on the market under various trade

names, and that a name common to all has been selected to be used

when no particular brand is referred to. The fact that “adrenalin” is

regarded by many, both here and abroad, as a common, generic name does

not alter the fact that it is claimed as a trade name by a commercial

house and, therefore, presumably at least, cannot be used except as

such.

Among the facts brought out in this discussion, one stands out clearly:

that Abel deserves as much credit for the discovery as any other man,

if not more. Credit belongs to Takamine for making use of reactions

which were already well known. His work was a step in the progress

of knowledge of the substance, but it was a step which he could not

have taken but for what others, Abel especially, had accomplished and

published. Abel’s magnificent work, covering several years, deserves

as much credit, to say the least, as that of Takamine. And it should

be kept in mind that the former worked in the interest of science,

and published his results for the benefit of all. He had no hope of

pecuniary reward, asked for none, and received none.

Let us repeat, however, that these are side issues; the question

is simply that of name. It cannot be too strongly emphasized that

“epinephrin” is a true scientific name for the active principle of the

suprarenal gland, and that it should be used on all occasions when

the active principle and not some particular firm’s make is referred

to.--(_From The Journal A. M. A., March 25, 1911._)

THE HORD SANITARIUM

“_Propaganda for Reform Department_:--One often hears it declared

that the present time is the worst ever known for a young man to

make a fortune or get a start to one.

“All a mistake, as the enclosed letter from the Hord Skinatarium

will certify. At $25 this equals $2,500 for 100 cases, $25,000 for

1,000 cases, and all any young doctor needs is a little push to be

as rich as J. D. in a few months. If you know of any cases send ’em

in and get your $25. “K. T. Crossen, M.D., Carbondale, Ohio.”

With his letter Dr. Crossen encloses a circular letter from the Hord

Sanitarium, “For Liquor and Drug Habits, A Cure Positively Guaranteed,”

and an unsigned check on the Farmers National Bank, Shelbyville,

Indiana, for $25 payable to himself. Printed on the check in large red

letters is the statement:

“THIS CHECK WILL BE COUNTERSIGNED UPON YOU BRINGING OR SENDING US A

PATIENT.”

[Illustration: Fig. 1.--Photographic reproduction of the unsigned check

that the Hord Sanitarium sends to physicians.]

[Illustration: Fig. 2.--Part of the letter that accompanies the check

for twenty-five dollars.]

The Journal has received these circular letters and unsigned checks

by the hundreds from physicians who have expressed very frankly their

contempt of the kind of business the Hord Sanitarium is engaged in.

These correspondents seem to have overlooked the fact that The Journal

has already commented editorially on this particular insult to the

medical profession. For this reason we reprint the editorial note,

“Ethics!” from The Journal, Sept. 27, 1913:

“We will pay you $25 for each patient that you bring or send us.”

Thus, to physicians, writes the Hord Sanitarium of Shelbyville,

Indiana, and continues: “We have a perfect and an absolute cure

for all liquor and drug addictions.” Fearing doubtless that those

to whom these offers are made may be disgusted with the first

proposition and will realize the evident falsity of the second,

the concern encloses a list of references “showing the high moral

and professional standing of our sanitarium.” The Hord Sanitarium

emphasizes further that it does a strictly “no cure no pay” business.

Suspiciously similar is the offer made by the Mizer Sanatorium of

Coshocton, Ohio, Blake V. Mizer, manager. Not many months ago Mr.

Mizer was running the Hord Sanitorium (the concern’s own spelling),

which at that time advertised “the only guaranteed cure.” Now, Mr.

Mizer hurls invectives at those concerns that make “unreasonable

guarantees” and adds virtuously that “we resort to no such unethical

and pretended guarantee in order to do business.” Nevertheless, in

small type in the northwest corner of his stationery, Mr. Mizer

admits that his “proposition” is no cure no pay. The fees of the

Mizer Sanatorium “are $125 to $250, depending on the room.” The

physician’s rake-off is “20 per cent. of the above.” “This,” explains

Mr. Mizer blandly, “is simply a matter between ourselves and does not

concern the patient in any way.” Of course not. All the patient has

to do is to pay the bills. And the Mizer Sanatorium is “conducted

along ethical ... lines”--Mr. Mizer says so. The Mizer Sanatorium

has odd ideas of what constitutes ethics, medical or otherwise, for

not long ago it advertised, in such medical journals as would accept

its “copy,” that “medical ethics prevents the statement here of the

whole truth about the Mizer treatment.” Of course medical ethics

never prevented truthful statements of any kind. A dirty business;

no other words express it. When the Hord Sanitarium and the Mizer

Sanatorium claim to cure all cases of drug or liquor addiction, they

make claims that are false--cruelly false. When these concerns try

to drum up trade by offering secret commissions to physicians they

insult an honorable profession. The fact that they send out this

sort of advertising matter is presumptive proof that there are some

physicians who will patronize them. Such as do so are unfair to their

patients and untrue to the ideals of medicine.--(_From The Journal

A. M. A., Jan. 31, 1914._)

THE GERMAN PROPAGANDA FOR REFORM

Appreciation by a German Lay Publication

Of all those interested in the reform of the proprietary drug business,

the patient has the most at stake--and the public is beginning to

understand this fact. If physicians are slow in recognizing the

necessity for improvement, laymen will eventually demand reform in

their own interests. The movement, therefore, will not be halted by the

indifference of the unprogressive element of the medical profession.

New evidence of this fact is furnished by a recent editorial comment by

the German lay periodical, _Wohlfahrt und Wirtschaft_ (Public Welfare

and Economics), on the Arzneimittel-Kommission, a German organization

resembling in purpose if not in scope the Council on Pharmacy and

Chemistry of the American Medical Association.

“One would suppose,” says this lay journal, “that medicinal

preparations which did not win the approval of scientific medicine

would not be used by any physician, but the contrary is the case. In

fact, those new medicinal preparations or old ones with new names

that flood the market far surpass the actual demand according to the

judgment of all authorities. The impartial advisers in this field,

practitioners and members of medical faculties, demand, as a matter

of public welfare that this overproduction should be regulated in

the interests of the sick, the consumers; but, unfortunately, a

medical man, like any one else, is impressed by the suggestion from

advertising done on a large scale.”

The movement for reform, _Wohlfahrt und Wirtschaft_ goes on to explain,

is not exclusively a medical one. It is a part of the reaction of

“economic common sense” against a too individualistic commercial

system which leads to overproduction. In other words, it is a reaction

against the system of making things because they can be sold rather

than because they are needed. The interests of producers need to be

harmonized with those of consumers, not merely in the drug trade alone,

but throughout the commercial world. _Wohlfahrt und Wirtschaft_ quotes

with unqualified approval the ArzneimittelKommission’s statement of

its position: An industry which serves the science of healing must be

guided by that science. (_Eine Industrie die der Heilwissenschaft

dient, hat sich nach der Heilwissenschaft zu richten._)

The movement for reform in Germany has apparently gathered sufficient

impetus among the laity to go on of its own momentum, even though,

with one exception, German medical journals, reluctant to lose the

advertising of drug houses by publishing criticisms of their wares,

have become lukewarm, if not antagonistic, to the efforts of the

ArzneimittelKommission. The one exception is the _Therapeutische

Monatshefte_, which, in its May issue, quotes in full the editorial

just referred to and makes the following comment: “These lines reveal

such intimate knowledge and correct judgment of existing conditions

that the suggestions advanced in regard to possible reforms deserve

serious consideration. For us physicians the editorial is important in

that it recognizes that the efforts of the profession to accomplish

the reforms aimed at are rational and beneficial from the standpoint

of general economics and the public welfare.”--(_From The Journal

A. M. A., June 13, 1914._)

THE GERMAN COUNCIL ON PHARMACY AND CHEMISTRY

At the meeting of the German Congress for Internal Medicine in 1911, a

German council on pharmacy and chemistry, Die Arzneimittelkommission

des Kongresses für innere Medizin, was organized, with purposes

similar to those for which the Council on Pharmacy and Chemistry

of the American Medical Association was created. As practically

nothing has been done to restrict the advertising of proprietaries

in Germany, the task of the commission was tremendous. Its work has

been noted in The Journal from time to time.[150] A review of what has

been done up to the present is given by Heubner,[151] and indicates

some differences between conditions in Germany and this country.

The members of the commission found confronting them the same evils

that met the early efforts of the American council, namely, dominant

proprietary interests, a subservient and financially interested

medical press and an indifferent profession. Moreover, the pecuniary

interest of the editors of German medical journals in the profits

of advertising seems to be more direct and more important than in

America. The German commission, in Heubner’s opinion, was placed at a

disadvantage compared with the American council from the first. Funds

for investigation were lacking, and the commission had no journal in

which its objects could be presented to the medical profession. At the

beginning of its work the commission established rules very similar to

those of the American Council on Pharmacy and Chemistry. It listed the

articles advertised in German medical journals in three groups: (1)

those which conformed to the rules of the commission in the method of

advertising; (2) those which violated the rules, and (3) those whose

classification could not be determined. This amounted to an attack

on advertising in medical journals and was undoubtedly premature. It

aroused at once the antagonism not only of the proprietary interests

but also of the medical press.

[150] A German Council on Pharmacy and Chemistry, Propaganda, The

Journal A. M. A., July 27, 1912, p. 291; Current Comment, Aug. 10,

1912, p. 452. Reform in the Advertising of Proprietary Medicinal

Articles, Berlin Letter, Dec. 7, 1912, p. 2081. Heubner, W.: Wünsche

zur Reform des Arzneivertriebes, Therap. Monatsh., 1912, xxvi, No. 11;

abstr., The Journal A. M. A., Dec. 14, 1912, p. 2195.

[151] Heubner: Die Arzneimittelkommission des deutschen Kongresses für

innere Medizin, Therap. Monatsh., 1914, xxviii, 185.

“The establishment of the lists of medicines encountered opposition

or hindrance from three sources,” says Heubner, “first, from the

pharmaceutical and chemical manufacturing interests; second, from

the medical press, and third, from the medical profession itself.

The ‘trade’ naturally was irritated at any attempt to interfere with

‘business,’ and brought forward a number of reasons why the procedure

adopted by the commission was especially calculated to injure the

‘general welfare.’ This opposition was to be expected and might be

disregarded. The extent to which the medical press was dependent on

the drug trade, however, had not been foreseen. The same journals

in which for many years all sorts of articles on the evils in the

trade in medicines had appeared showed themselves decidedly cool or

emphatically critical toward the accomplished fact of the ‘lists of

remedies.’ In hastily written articles a whole series of mistakes

in general and in particular were published.... One thing, however,

was not explicitly stated--namely, that in any event the lists of

remedies must be rejected, and for this the cogent reason was anxiety

in regard to advertisements. The editors had been sufficiently

warned. The _Therapeutische Monatshefte_, which had not submitted to

the wish of a great industrial firm in another matter, was punished

for this offense by the withdrawal of all its advertisements. None of

the other publishers wanted to risk such a reduction in income, and

none of the editors was willing to undertake the risk to the extent

of a conflict with his publisher. Curiously, the idea does not seem

to have arisen that if the threatened publishers had made common

cause they might have freed their editors from the distressing burden

of improper advertisements with scarcely any risk at all.”

Heubner believes that another motive influencing the editors was the

fact that their efforts in behalf of reform, sporadic and ineffective

at the best, had been replaced by the propaganda of the commission. It

seems clear that the opposition from the press was due not to principle

chiefly but to financial pressure. The editors, however unworthy their

motives, nevertheless exerted, as in other cases, a powerful influence

on public opinion. Among the medical public, opposition was encountered

because many physicians were interested--sometimes financially--in one

or more of the discredited remedies. The mass of the profession either

were not interested or misunderstood the position of the council.

Despite the obstacles encountered and the difficulties involved,

the council and the Congress of Internal Medicine have not wavered.

Heubner, however, sums up the work of the council in a rather

pessimistic tone, as follows:

“What are the results of the great amount of labor, self-sacrifice,

hopeful courage and wasted money? Two journals pretend to be doing

wonders in that they are eliminating some of the worst misstatements,

distortions, obscurations and concealments of truth in the

advertisements. Physicians at certain intervals receive lists of

preparations, the manufacturers of which as a rule do not need to

pay any attention to the council because their dealings are directly

with the public, because their advertisements are usually made to

physicians by word of mouth, or their preparations have already a

sufficient reputation--no matter for what reason....

“There is little doubt that the results have not paid for the

efforts expended. There is no doubt that the whole enterprise will

amount to nothing more than a splash in the water if the work is not

extended, just as a preliminary skirmish must remain without effect

unless followed up by the main army. The main army in this case is

the German medical profession. However gratifying the progressive

attitude of some individuals and, in fact, of some associations, such

as that of Wurtemburg, may be, the fact remains that the profession

[in Germany] is not advancing but rather tends to retrograde. The

support which the executive committee of the Aerztevereinsbund at

first accorded to the efforts of the council was later limited. All

further progress depends on the developments of the near future. Will

sufficient power be given to the German medical profession after

settlement with the insurance societies to permit them to follow the

example of their American colleagues?

“It should be made perfectly clear,” Heubner insists, “that we are

concerned with questions of importance for the standing and influence

of the medical profession among the people, and, consequently, for

the conditions of its future existence. But even now the consequences

of the prevailing indifference to the traffic in nostrums are making

themselves felt. The prevalence of self-medication, which was lately

recognized by a Berlin court as the normal for ‘slight’ affections

and which has already been made an argument against the extension

of the compulsory prescription law, is merely a result of the great

evil based on the loss of control by the medical profession of the

remedies it employs. Only centralized and energetic measures on the

part of the organized profession can secure a reformation of the

intolerable conditions that prevail in the field of modern industry

in medicine and foodstuffs. The American Medical Association and the

German Arzneimittelkommission have shown that a little sacrifice

and energy can secure a condition in which the medical profession

becomes a powerful factor, able to dictate in the field of the trade

in medicine instead of letting itself be dictated to.”--(_From The

Journal A. M. A., April 18, 1914._)

GRAND PRIX AND GOLD MEDALS FOR SALE

Max Kaiser Offers to Procure “Awards of Merit” at

Various International Exhibitions--Price,

Four Hundred Dollars

There was a time when the manufacturer who could point to the “Grand

Prix” or the “Gold Medal” his product had been awarded at some

exhibition was considered to have a valuable advertising asset.

Possibly there was a time when medals and prizes were awarded with an

eye single to the excellencies of the goods and bore no relation to the

amount of money paid by exhibitors to the organizers of the exhibition.

Possibly there are, even today, occasional awards made on a basis of

pure merit, but they are probably few and far between. The matter which

follows throws an interesting light on this subject. Within the past

two months manufacturers have received a letter on the stationery of

the “International Exhibition, Paris, 1914.” The letter came from the

“Commissioner-General” of the exhibition, one Max Kaiser, 24 Holborn,

London, E. C. Here it is:

“_Dear Sirs_:--I beg to draw your attention to the great

INTERNATIONAL EXHIBITION of Alimentation, Pure Food, Hygiene,

Beverages, Drugs and allied trades, which will be held at Paris

in March, 1914, inviting you to partake with your manufacture at

this INTERNATIONAL EXHIBIT. I beg to point out that the aim of this

Exhibition is to introduce Foreign Manufactured Goods, Proprietary

Articles, Patents, etc., to the French and Foreign Markets, and to

open up or extend new channels for such goods.

“A Commercial Office at the Exhibition Building, under the

Commissioner General’s own supervision, with a well-trained staff,

will do everything required in the interest of Exhibitors, such as

effect sales by circularizing, or inviting prominent buyers to call

at your particular stall to judge for themselves the merits of your

Exhibit, and in this way bring the American Manufacturers in direct

touch with the Foreign Markets and the Buying Public.

“This Commercial Office will also negotiate with the

Representatives on your behalf: at the same time undertaking to

arrange your Exhibit, supply all necessary fittings, decoration,

the display, maintenance, repacking and returning of the Exhibit,

and also to represent you before the Public and Jury in such a

manner as to make certain that your Exhibit shall be awarded first

honors (GRAND PRIZE OR GOLD MEDAL).

“You will understand that such an award obtained at this

INTERNATIONAL EXHIBITION means an everlasting advertisement as

an official acknowledgment and convincing proof to the Superior

Quality of your goods, and will certainly put you in front of your

competitors on the home market, and naturally increase your sales

considerably.

“I might mention here that many a big business has been built up

and small concerns been prominently brought to the notice of the

Public by Exhibiting. In many cases I have been able to interest

Authorities and Reigning Houses in Exhibits under my care, and I

have opened up or extended markets for firms Exhibiting under my

direction.

“I enclose herewith a list containing some of the most prominent

American and English Firms whom I have represented at European

Exhibitions and for whom I achieved splendid results.

“I could arrange your Exhibit for the amount of $400, to be paid

one-half on allotment and the balance on receipt of an award (Grand

Prize or Gold Medal).

“Trusting that this will be of interest to you, I shall be pleased

to receive your reply by return mail, and give you any further

particulars you may desire. Yours faithfully,

The Commissioner General.

(Signed) Max Kaiser.

“I can also accept Exhibits on exactly the same terms for the

INTERNATIONAL EXHIBITION, Rome, 1914.”

[Illustration: Photographic reproduction (reduced) of the letter-head

of the stationery on which Max Kaiser offers to “make certain”

that those who exhibit their products under his direction--price,

$400--shall receive a Grand Prix or Gold Medal.]

The list Mr. Kaiser enclosed with his letter was a printed sheet,

giving the names of a number of American and British manufacturers

whom Kaiser claims to have “represented” at various “International

Exhibitions.” The majority of the concerns named are breweries, but

there is a good sprinkling of “patent medicine” companies and a few

miscellaneous manufacturers. In the American list there are two nostrum

concerns named that will be more or less familiar to our readers. They

are:

_Alonzo O. Bliss Company_, Washington, D. C. This company sells “the

Great Blood Purifier, Kidney and Liver Regulator” known as “Bliss’

Native Herbs.” According to Max Kaiser, the Alonzo O. Bliss Company

obtained one Grand Prize and one Gold Medal.

_Waterbury Chemical Company_, Des Moines, Iowa. This company exploits

what used to be known as “Waterbury’s Cod-Liver Oil Compound,” which,

from its lack of cod-liver oil,[152] was impelled to change its name

to “Waterbury’s Compound.” Kaiser states that the Waterbury Chemical

Company received four Grand Prix and four Gold Medals.

[152] See Waterbury’s Compound, pp. 54, 57 and 291.

Briefly the proposition submitted by Max Kaiser is this: For $400 he

will make all arrangements for a manufacturers’ exhibit at one of

the numerous “International Exhibitions.” Further, he practically

guarantees that this exhibit will receive either a “grand prize” or a

“gold medal”; in fact, the manufacturer need not complete the payment

of Kaiser’s charges until the prize or medal has been awarded!

The value of “awards” obtained in this way is, of course, evident. As

the public becomes better informed on the subject of international

exhibitions, the grand prix, gold medals, and other “awards” made at

such exhibitions will be appraised at their true value.--(_From The

Journal A. M. A., March 14, 1914._)

THE HYPOPHOSPHITE FALLACY

An Example of the Perpetuation of a False Theory by Advertising

A false therapeutic notion born of speculation soon dies a natural

death if exposed unsupported to the cold world of facts, but when

nursed by commercial interests it may be kept alive for generations.

Interesting examples of this, to name but two or three, are the

misconceptions perpetuated during the past half century concerning

“lithia,” the “natural” salicylates and the hypophosphites.

Take, for instance, the lithia delusion. The supposed solvent powers

of lithium compounds for uric acid were soon disproved to the

satisfaction of scientists, but proprietors of lithia waters and

nostrums for gout and rheumatism still harp on the old string and

utilize long-exploded theories. Take, again, the alleged superiority of

“natural” to “synthetic” salicylates. In spite of experimental proof

to the contrary, proprietary interests have been able for twenty years

to persuade a large part of the medical profession that the effects of

pure salicylic acid made artificially differ from the effects of the

same substance obtained from natural sources.

The altogether undeserved continued popularity of hypophosphites

affords a striking example of the influence of advertising in

perpetuating therapeutic error, for hypophosphites are given on a

theory long since disproved. It may be interesting to trace the origin

and history of the theory on which the practice of prescribing the

hypophosphites is founded. The early part of the last century was

prolific in chemical discoveries, and, as a corollary, in chemical

theories of disease. Many of the theories arose from the hasty

application of the chemical properties of new elements and compounds

to the explanation of the processes in the living body, without due

consideration of the conditions prevailing in the animal organism.

THE ELEMENT PHOSPHORUS

The element phosphorus is eager for oxygen and readily oxidizable. When

taken into the system it acts as a violent poison, and, in view of

this, it was at first supposed--although the supposition was based on

no scientific data--that it would prove to be a powerful therapeutic

agent when given in minute doses. In its elementary form, phosphorus

is difficult to handle, and therefore not convenient for use. Hence it

was natural that a compound should be sought which could be used as a

substitute for the element.

Broadly speaking, phosphorus forms three classes of salts varying in

the degree of oxidation: the phosphates, containing the most oxygen,

the phosphites, containing less, and the hypophosphites, least of the

three. The phosphates, being saturated with oxygen, undergo little

change in the body, and because of this were thought to be of little

value in therapeutics. The phosphites contain less oxygen, are unstable

and are not used in medicine. The hypophosphites, containing still

less oxygen, stand nearest to elementary phosphorus and are easily

decomposed and readily oxidized to phosphates. Hence the theory that

the hypophosphites would furnish an admirable source from which to

obtain the action of the element phosphorus.

CHURCHILL’S THEORY

The hypophosphites were introduced into medicine about 1855, as a

substitute for elementary phosphorus by a Dr. Churchill of Paris, and

later of London, who advocated their use as a specific remedy for

consumption. Churchill conceived the theory that phthisis is caused by

a lack of oxygen in the tissues; he therefore sought an agent capable

of increasing oxidation. He was led to the use of hypophosphites

for this purpose on the supposition that phosphorus exists in the

organism as a biologic element in a lower degree of oxidation than

the phosphate. He supposed that this form of phosphorus acts by its

chemical affinity as an initiatory agent in attracting and utilizing

the inspired oxygen. He believed that when this form of phosphorus,

which he called the “phosphide element,” is deficient in quantity

(because it had been oxidized into phosphate, or because the supply

from natural sources was deficient), the degree of oxidation of

the tissues is less than normal. Therefore he advocated the use of

hypophosphites to supply the lacking oxidizing constituent. He believed

this “phosphide element” not only to be essential for the oxidation of

the tissues, but also to be the source of energy of the nervous system.

THE FACTS

The theory was a pretty one; the facts, however, did not support it.

Subsequent investigations indicate that instead of consumption being

due to a lack of oxygen, there is in that disease really an increased

oxidation; in other words, the respiratory exchanges in this disease

are exaggerated. The existence in the system of a form of phosphorus

less highly oxidized than the phosphates is unproved. No evidence

has been produced to show that phosphorus acts as an energizer of

oxidation. There is no proof that the hypophosphites enter into general

metabolism or affect disease processes in any way. Not only is there no

scientific evidence for the utility of the hypophosphites, but science

has long since demonstrated their worthlessness.

In 1895 Boddaert[153] published researches showing that hypophosphites

are rapidly eliminated through the kidneys unchanged. Similar

results have been reached by Paquelin and Joly, who attributed to

the hypophosphites only the action of diuretics. In 1901 Massol and

Gamel[154] found by animal experimentation that the hypophosphites did

not act as diuretics, but that the hypophosphorous acid was completely

eliminated in the form of sodium hypophosphite. The urea was not

increased and the relation of urea to total nitrogen remained the same.

Their results indicated no increase of oxidizing actions within the

system. Finally, Massol and Gamel examined the urine of patients taking

hypophosphites and found the same conditions: the results were the same

as in the experiments on animals.

[153] Boddaert: Arch. de pharmacod., 1895, 2.

[154] Massol and Gamel: Jour. de pharm. et de chem., 1901, xiv, 337.

PROPRIETARY THERAPEUTICS

In spite of these facts the hypophosphites continue to be employed

by many practitioners. Why? Because the theory, being plausible at

the time when such chemical theories were popular, gained a certain

recognition and was accepted without scientific investigation. Thus

the hypophosphites came into use. It was not long before they were

taken up by certain manufacturers, and the theory on which their use

was based became a commercial asset. As a result the theory, which

uncommercialized would have died of inanition, was kept alive by

continued advertisement.

The manufacturer of proprietaries having settled on a plausible

theory on which to sell his products has no further need for science.

Thus, while these theories are no longer to be found in accredited

text-books, they are still preached by the proprietary interests. An

elaborate pamphlet on “Iodine and Phosphorus,” containing statements

which are known to be false, is one firm’s text-book supplied to

physicians to-day, and contains long quotations from Dr. Churchill’s

writings of sixty years ago. This book contains no intimation that

these theories have been overthrown. It is poor economy to waste money

in changing literature when the old theories and the old plausible

reasoning will sell goods just as well. Consequently the old errors are

drummed into those physicians who are willing to read their physiology

from the neat monographs of proprietary literature and to sit at the

feet of glib salesmen who expound to them the proprietary theory of

therapeutics.--(_From The Journal A. M. A., April 25, 1914._)

BUFFALO LITHIA WATER

Contains One-Fifth as Much Lithium as Potomac River Water

Some years ago, Alexander Haig evolved the theory that most diseases

are due to uric acid. The data on which he founded his theory were

not corroborated by scientific men, and investigation showed that his

methods were unreliable. In spite of the fact that Haig’s theories are

utterly discredited, and have been for years, the uric acid fallacy

still persists, although it is now largely confined to the public.

Shrewd business men, especially those who are more intent on making

money than they are concerned with the manner in which that money is

made, owe much to Haig’s theory. As a business proposition, uric acid

has been one of the best-paying fallacies on the market--and possibly

still is. It is only necessary to refer to The Journal’s recent

article[155] on the Turnock mail-order medical fraud to emphasize this

fact.

[155] The Journal A. M. A., May 23, 1914, p. 1675.

[Illustration: Showing how “Buffalo Lithia Water” in the course of time

became “Buffalo Lithia _Springs_ Water.” The government has shown that,

to obtain a therapeutic dose of lithium from Buffalo Lithia Springs

Water, it would be necessary to drink 200,000 gallons of the water. The

government also declared that Potomac River water contained five times

as much lithium as does Buffalo Lithia Springs Water.]

Contemporary with, and to a certain extent a corollary of, the uric

acid fallacy was another, _viz._, that lithium would eliminate uric

acid. This at once gave a good working principle for the proprietary

men. Uric acid, we were told, causes disease; lithium, we were also

told, would eliminate uric acid; therefore, lithium is the new elixir

of life! Could anything be simpler?

Accepting this theory, it was inevitable that mineral waters containing

lithium salts should become highly popular. Many exploiters of mineral

waters began to place most emphasis on the lithium salts in their

waters even in those cases in which lithium was present in such

infinitesimal amounts as to render its detection impossible by any but

spectroscopic methods.

One of the best known, because most widely advertised, of the so-called

lithia waters is Buffalo Lithia Water--or what used to be called

Buffalo Lithia Water. After the Federal Food and Drugs Act came into

effect, by which falsification on the label was penalized, the name of

Buffalo Lithia Water was changed to Buffalo Lithia Springs Water. The

reason for this change was that when Buffalo Lithia Water was subjected

to examination by the government chemists it was found to contain so

little lithium that the amount present was unweighable--it could be

demonstrated only by the spectroscope. It was evidently, therefore, not

a lithia water in that it did not contain--at least in quantities that

could be consumed--an amount of lithium that would give the therapeutic

effects of lithium: Possibly the company imagined that by changing the

name from “Buffalo Lithia Water” to “Buffalo Lithia Springs Water” it

had cleverly evaded the federal law. Their argument was to this effect:

The springs from which this water is taken are known as Buffalo Lithia

Springs; therefore, it is not a misstatement of facts to call this

Buffalo Lithia Springs Water.

WHAT IS A LITHIA WATER?

The Supreme Court of the District of Columbia, holding a district

court, has recently given an opinion on the Buffalo Lithia Springs

Water case. The findings of the court are refreshingly simple,

and characterized by that broad commonsense view that is becoming

increasingly more common among modern jurists. Read Judge Gould’s

opinion as to what constitutes a lithia water:

“Speaking generally, and as an individual of average intelligence and

information, it would seem that if one were offered a water which the

vendor told him was a ‘lithia’ water, one would have the right to

expect enough lithium in the water to justify its characterization

as such, thus differentiating it from ordinary potable water; and

this amount would reasonably be expected to have some effect on the

consumer of the water by reason of the presence of the lithium.”

Certainly a reasonable attitude, and one which the man in the street

not only can understand but will agree with. Then came the question as

to the actual lithium content of Buffalo Lithia Springs Water, and the

court said:

“For a person to obtain a therapeutic dose of lithium by drinking

Buffalo Lithia Water he would have to drink from one hundred and

fifty thousand to two hundred and twenty-five thousand gallons of

water per day. It was further testified, without contradiction, that

Potomac River water contains five times as much lithium per gallon as

the water in controversy.”

SOME TESTIMONIALS

Here, then, is a water that has for years been advertised first, in

medical journals, and later, in lay publications, as a “lithia water”

yet, actually, it contains less lithium, five to one, than is to be

found in ordinary river water. This is a point for physicians to ponder

well over. Turn to the back volumes of medical journals and read, both

in the advertising and reading pages, the elaborate testimonials,

given by men high in the medical profession, on the marvelous effects

obtained by the use of Buffalo Lithia Water. Read the following in

light of the fact that the water from the Potomac River contains five

times as much lithium as Buffalo Lithia Water:

“In the class of cases in which lithia, soda and potash are

regarded as most specially indicated, I have obtained far better

results from the Buffalo Lithia Waters than from any of the

preparations of the lithium salts of the Pharmacopeia.” (_Statement

by a member of the Faculty of Medicine of Paris, France_, _etc._)

“Its [Buffalo Lithia Water] therapeutic effects, in my practice,

have been vastly superior to those obtained from Lithia Tablets or

other Lithia preparations.” (_Statement by an ex-president of the

University College of Medicine, Richmond, Va._, _etc._)

“It [Buffalo Lithia Water] is strikingly superior to emergency

solutions of lithia tablets and pure water, even where the said

solution is an exceedingly strong one.” (_Statement by a former

Professor of Clinical Medicine of the College of Physicians and

Surgeons, New York, and vice-president of the American Medical

Association_, _etc._)

“When Lithia is indicated, I prescribe Buffalo Lithia Water in

preference to the Salts of Lithia, because it is therapeutically

superior to laboratory preparations of Lithia.” (_Statement

by a former professor in the Medical College of Virginia and

ex-president of the Medical Society of Virginia_, _etc._)

“Buffalo Lithia Water ... by its richness of composition of Lithia,

is of marvelous efficacy, in cases of gout, of chronic, articular,

and muscular rheumatism ...” etc. (_Statement by former Physician

in Ordinary to the Pope; Member of Academy of Rome_, _etc._)

“I have tried carbonate of lithia dissolved in water in various

proportions; but it certainly does not have the same effect as

Buffalo Lithia Water.” (_Statement by a former Surgeon-General of

the U. S. Army_, _etc._)

These are but a few of many testimonials from physicians that might

be quoted. They are interesting from many points of view. They show

the worthlessness of testimony of this sort--no matter from what

source--and the fallacy of that based on so-called clinical evidence.

To go back to the court’s findings: In the case of the government

against Buffalo Lithia Springs Water, one other judicial opinion is

worthy of attention, that referring to the attempt on the part of the

exploiters of the water to circumvent, on a technicality, the evident

intent of the Food and Drugs Act. Said Judge Gould:

“The argument seems to be that if Buffalo Lithia Springs are falsely

named, being called ‘Lithia’ Springs, when they do not flow water

containing lithium, therefore the proprietors have the right to sell

the product as being Buffalo Lithia Springs Water, thus perpetuating

on the public the misnomer connected with the origin of the water. It

is not apparent how the deceit practiced on the public by the label

is mitigated by carrying it back to the designation of the spring

from which the water comes.”

For years no one, apparently, ever criticized the claims made for

this product. Finally, we got the Food and Drugs Act and the federal

officials, acting under the authority vested in them by that law, in

December, 1910, declared Buffalo Lithia Water misbranded. Thus this

old established vested interest was attacked. The company, of course,

fought. It first demurred to the charge brought, and in April, 1912,

the demurrer was sustained. At the same time an amended libel was filed

by the government, which the company again demurred to. This demurrer

was overruled in June, 1912, whereon the company in December, 1912,

filed an answer denying that the water was misbranded. The question has

now (1914) been finally decided by the court sitting as a jury, the

matter having been submitted by agreement to the court.

Buffalo Lithia Water has been sold since 1878. During this period

undoubtedly many physicians have prescribed enormous quantities of

this water, and many more laymen have taken the water on their own

initiative, based on the advertised claims made for it. Practically

all who purchased the water, whether directly or on the advice of

physicians, did so in the belief that they were getting lithium. Had

they known that, to get a therapeutic dose of lithium they would have

had to drink 200,000 gallons of Buffalo Lithia Water, they would have

felt, and rightly so, that they were the victims of an expensive

hoax.--(_From The Journal A. M. A., June 13, 1914._)

MEAT EXTRACTS AND MEAT JUICES[BM]

Their Composition and Relative Values

[BM] See Report of the Council on Pharmacy and Chemistry on “Meat and

Beef Juices,” p. 123.

The Bureau of Chemistry of the Department of Agriculture has recently

given in Bulletin No. 114 much new and valuable data regarding the

commercial meat products. The work contained in this bulletin is

practically an elaboration or continuation of that published in The

Journal of May 11, 1907, p. 1612. It was taken up to determine the

condition and quality of meat preparations in general and from the

results obtained to prepare tentative standards for the preparation

and composition of such meat preparations. The results as well as

the methods of analysis of many meat products are given, showing

the composition and relative value of the various preparations. The

comments of many investigators regarding the food value of such

products is also a valuable contribution to the knowledge of meat

extracts, and will help in deciding the real value of the preparations.

The preparations taken up are divided into three general classes (1)

Solid and Fluid Meat Extracts; (2) Meat Juices; (3) Miscellaneous

Preparations. For each of these the tentative standards submitted

by the Committee on Food Standards of the Association of Official

Agricultural Chemists are given along with the tabulated results of

the chemical analysis. The preparations examined showed, for the most

part, that they conformed to the standards, and only those which are at

variance in one or more particulars will be mentioned in this review.

SOLID MEAT EXTRACTS

For solid meat extracts the following are the requirements:

“Meat extract is the product obtained by extracting meat with boiling

water and concentrating the liquid portion by evaporation after

removal of fat, and contains not less than 75 per cent. total solids

of which not over 27 per cent. is ash and not over 12 per cent. is

sodium chlorid (calculated from the total chlorin present), not over

0.6 per cent. is fat and not less than 7 per cent. is nitrogen. The

nitrogenous compounds contain not less than 40 per cent. of meat

bases and not less than 10 per cent. of kreatin.”

With the above as the standard, several of the solid meat extract

preparations examined were not up to grade on one or more points,

though in some cases it is true they were very slightly below the

standard set. The following products were found wanting in some

respects and the requirements which they failed to meet are given:

“REX” BRAND BEEF EXTRACT (Cudahy Packing Co., Omaha) contained 26.50

per cent. water instead of the standard 25 per cent.

EXTRACT OF BEEF PREMIER (Libby, McNeil & Libby, Chicago) contained

30.92 per cent. of ash instead of the standard 27 per cent.; 18.32

per cent. of sodium chlorid (standard, 12 per cent.); 6.02 nitrogen

(standard, 7 per cent.).

BEEF EXTRACT (Swift & Co., Chicago) contained 13.51 per cent. sodium

chlorid (standard, 12 per cent.); 6.60 per cent. nitrogen (standard,

7 per cent.).

BEEF EXTRACT, COIN SPECIAL (G. H. Hammond Co., Hammond, Ind.)

contains 13.25 per cent. of sodium chlorid (standard, 12 per cent.);

and 6.86 per cent. nitrogen (standard, 7 per cent.).

With these few exceptions, the solid meat extracts were found to comply

with the standards given.

FLUID MEAT EXTRACTS

For fluid meat extract the following standards have been suggested:

“Fluid meat extract is identical with meat extract except that it is

concentrated to a lower degree and contains not more than 75 per cent.

and not less than 50 per cent. of total solids.”

According to this standard all excepting one of the fluid meat extracts

examined were found to be below grade in one respect, that of solids.

The following are preparations examined and the percentage of solids

found:

Per cent.

CONCENTRATED FLUID BEEF EXTRACT

(Armour & Co., Chicago) 42.25

MEAT JUICE

(Valentine’s Meat Juice Co., Richmond, Va.) 42.36

BEEF JUICE

(John Wyeth & Bro., Philadelphia) 41.16

VIGORAL

(Armour & Co., Chicago) 50.06

“REX” FLUID BEEF EXTRACT

(Cudahy Packing Co., Omaha) 44.01

FLUID EXTRACT OF BEEF

(Cibilis Co., New York) 35.37

FLUID BEEF JELLY

(Mosquera-Julia Food Co., Detroit) 31.03

Special notice is directed to the price of some of these preparations,

which in spite of their large water content, are higher priced than

some of the solid meat extracts.

MEAT JUICES

The following is given as the standard for preparations of meat juice:

“Meat juice ... is the fluid portion of muscle fiber obtained by

pressure or otherwise, and may be concentrated by evaporation at a

temperature below the coagulating point of the soluble proteids.

The solids contain not more than 15 per cent. of ash, not more than

2.5 per cent. of sodium chlorid (calculated from the total chlorin

present), not more than 4 per cent. nor less than 2 per cent. of

phosphoric acid (P_{2}O_{5}), and not less than 12 per cent. of

nitrogen. The nitrogenous bodies contain not less than 35 per cent.

of coagulable proteids and not more than 40 per cent. of meat bases.”

It is especially noticeable among the meat juices, so called, that none

shows any appreciable amount of coagulable proteids. Valentine’s Meat

Juice and Wyeth’s Beef Juice, besides being below the standard in total

solids as fluid extracts, are misbranded when called meat or beef

juices, as can readily be seen by comparing the results of the analyses

and the standard.

Wyeth’s Beef Juice is advertised as containing “all the albuminous

principles of beef in an active and soluble form” and “in an unaltered

form”--two statements that are on the face of them untrue and

misleading. To say that all the albuminous principles of meat are

present is to say that not only the juice of the meat but all the

fiber is present, which evidently is not true. Then again, to say

that it is present in an unaltered form is far from the facts, for,

as is stated on page 18 of the Bulletin: “It appears impracticable to

prepare a true meat juice for market, as the temperature necessary

for the preservation of food products in hermetically sealed packages

coagulates the proteids and changes the nature of the product.” On page

55: “When prepared under the best possible conditions a commercial meat

extract is, of necessity, in order that it may not spoil, deprived of

the greater part of the coagulable proteids, which constitute the chief

nutritious elements of the juice.”

On examining the tables of analysis, it is seen that Wyeth’s Beef Juice

contains but 23 per cent. of its total proteids in a coagulable form,

while the standard calls for 35 per cent., thus showing it to be no

more valuable as a food product than any other so-called meat juice,

the statements of the manufacturers to the contrary notwithstanding.

In the case of Valentine’s Meat Juice we note a large discrepancy

between the standard requirements and the results of the government

analysis, for instead of the proteid matter containing 35 per cent. in

the coagulable form, it contains but 1.6 per cent. These figures show,

then, that Valentine’s preparation contains practically no coagulable

proteids, and since the quantity of these measures the food value of

such preparations, the conclusion must be drawn that Valentine’s Meat

Juice has practically no value as a food and should certainly not be

classed as a meat juice.

Bovinine, another widely advertised meat preparation, which, according

to statements on “The Bovinine Co.’s” letter head, is “a concentrated

beef juice” and “the only perfect food in the world” was analyzed

and found below the standard set for meat juices, since it contains

only 3.38 per cent. of coagulable proteids. Yet in spite of this

discrepancy, the manufacturers of Bovinine persist in exploiting it

as a food, stating it to be “... a concentrated easily assimilable,

nitrogenous food,” and in another place it is stated that Bovinine

“is an ideal food.” As it is deficient in coagulable proteids and

thus below the requirements as a food, it is misbranded when called

a food of any sort, for to quote again the Bulletin, page 55: “...

meat extracts ... must not be looked on as representing in any notable

degree the food value of the beef or other meat from which they are

derived”; and, again: “They are not, however, concentrated foods,

having, on the contrary, but comparatively little nutritive value.”

Taken individually or as a class, meat extracts are not to be

considered foods, and should, therefore, not be advertised as such, a

conclusion which the government officials have come to and voiced in

the conclusion of the Bulletin as follows:

VALUE AND LIMITATIONS

“It seems to be the consensus of opinion among scientific

investigators who have studied this question that the food value of

these meat extracts is rather limited, and although they are a source

of energy to the body they must not be looked on as representing

in any notable degree the food value of the beef or other meat

from which they are derived. When prepared under the best possible

conditions a commercial meat extract is of necessity, in order that

it may not spoil, deprived of the greater part of the coagulable

proteids, which constitute the chief nutritious elements of the

juice.”--(_From The Journal A. M. A., Jan. 23, 1908._)

PHARMACEUTICAL MANUFACTURERS AND THE GREAT AMERICAN FRAUD

At various times we have given more or less complete accounts of

the prosecutions the United States Government has brought against

nostrum exploiters under the Food and Drugs Act. One of the more

recent of these, while of comparatively little interest _per se_, is

of importance to the medical profession, because of certain elements

connected with it. The case is known technically as “Notice of Judgment

No. 284” and deals with the “Alleged Misbranding of Danderine.”

The gist of the case is as follows: Casks of Danderine--a widely

advertised “hair tonic”--were shipped in carload lots from Michigan

to West Virginia, where the product was bottled, labeled and put in

condition to be retailed. Danderine contains a percentage of alcohol

which, while given on the labels of the bottles in which it is sold,

was not stated on the casks in which the preparation was shipped in

bulk. The government sought to confiscate, under the Food and Drugs

Act, sixty-five casks thus shipped because the quantity or proportion

of alcohol in the casks was not stated. The Knowlton Danderine Company

resisted the confiscation and the court upheld the company’s claim.

The point in this case which is--or should be--of interest to the

medical profession is to be found in the “statement of facts” presented

by the Knowlton Danderine Company in its own defense. Here it is

said that: “Parke, Davis & Co., who are mentioned in the said libel

as shippers ... are under contract with the said Knowlton Danderine

Company ... to compound the said formula ...” Elsewhere it is stated:

“Parke, Davis & Co. were ... the manufacturing agents, under contract,

of the owner, the Danderine Company ...”

This evidently means that Parke, Davis & Co., who are generally

supposed to manufacture only “ethical” preparations--proprietary or

otherwise--and as such to desire the respect and good wishes of the

medical profession, are in the business of furnishing the supplies for

nostrum venders. What Danderine is, it is hardly necessary to specify.

The widely distributed advertisements of this “hair tonic” nostrum with

the slogan: “Danderine Grows Hair and We Can Prove It” are sufficiently

well-known to all who read to make a lengthy disquisition on the

product unnecessary.

It is interesting in this connection to note that according to

newspaper dispatches the Danderine Company has absorbed the Sterling

Remedy Company, which exploits “Cascarets.” Three years ago a

physician, who is also a pharmacist, wrote to the _Medical World_

regarding the manufacture of Cascarets:

“... I have positive evidence, which I will gladly submit, that P.,

D. & Co., make all of them [Cascarets], and that they have a contract

with the Cascaret people not to make anything similar for any one

else.”

In the circular which comes in the Danderine packages two other

“specialties” are advertised: “Neuralgine” for “sick, weak, tired

nerves” and “Drake’s Palmetto Compound” for “weak stomachs, sluggish

livers, disordered kidneys,” and various other derangements of the

system. The question naturally arises, are these, too, shipped in

casks from Parke, Davis & Co., and merely bottled and labelled in West

Virginia?

Not that the Danderine case is the first one in which Parke, Davis

& Co. have been exposed as manufacturers of nostrum supplies.

“Vitaopathy” a method of “treatment” practiced by the notorious New

York Institute of Physicians and Surgeons in the person of “Prof.”

Adkin and apparently consisting of “absent treatment” and pills, was

finally put out of business by a fraud-order from the post office

department. The concern used to advertise:

“In Professor Adkin’s laboratory, his chemists are daily engaged

in extracting the life-and-health-giving principle from rare

vegetables, fruits and plants.”

“Prof.” Adkin had no laboratory; his chemists, according to the

government report, were Parke, Davis & Co., from whom he purchased the

tablets which formed part of his stock-in-trade of quackery.

The Nutriola Company of Chicago was declared fraudulent by the

postal authorities and a full account of the methods of this fake

medical concern appeared in The Journal, April 28, 1906. Nutriola was

advertised as:

“The greatest Chemical-Medical Preparation ever prepared by the

skill of man.”

“Nutriola and Nature are the only invincible conquerors of diseases

ever known.”

The promoter of this scheme was one Edward F. Hanson, who was

questioned by the government inspectors regarding the manufacture of

the Nutriola nostrum. Quoting from the government report:

“_Q._ Please name the chemists who now manufacture the remedies of

the Nutriola Company.”

“_A._ Parke, Davis & Company, Detroit; E. L. Patch Manufacturing

Company, Stoneham, Mass.; Seabury & Johnson, New York.”

Not that the course pursued by Parke, Davis & Co. is by any means an

exceptional one in the pharmaceutical world. It may be recalled that

The Journal has previously referred to the fact that Sharp & Dohme are

reported to make or to have made the “Getwell Tablets” for the “patent

medicine” concern which exploits the nostrum; and that Frederick

Stearns & Co. make or did make the widely advertised “cures” Shac and

Zymole Trokeys also has been mentioned. That Seabury & Johnson made

preparations for a fake medicine concern was brought to light by Mr.

Adams in the “Great American Fraud” series. And unquestionably there

are many others. The attitude taken by such houses seems to be that

they are willing to furnish anything in the pharmaceutical line that

anyone is willing to pay for, whether it is for legitimate use of the

physician or pharmacist or for furthering the business by which the

ignorant or gullible sick are humbugged and defrauded.--(_From The

Journal A. M. A., July 2, 1910._)

DOWD’S PHOSPHATOMETER

Dowd’s Phosphatometer, according to its inventor, is a device

“for taking the phosphatic index or pulse of the nervous system.”

Its originator, J. Henry Dowd, M.D., Buffalo, N. Y., writes

enthusiastically of his instrument:

“Physicians who use the Phosphatometer are sending 50 per cent.

less patients away for consultation, getting 75 per cent. better

results at home, because the Phosphatometer tells the cause and

what to do, and the Comp. Phosphorus Tonic gives results in 80 per

cent. of all conditions of illness.”

The “Comp. Phosphorus Tonic” referred to in the above quotation is a

sideline of Dr. Dowd’s, put out by the Richardson Company, of Buffalo.

The stationery of the Richardson Company gives its address as 334

Franklin Street, but directs that all communications be addressed to

40 North Pearl Street, which is the private address of J. Henry Dowd.

According to the Buffalo directories, 334 Franklin Street is the drug

store of Arthur E. Reimann.

To those who read the Dowd “literature,” the Phosphatometer will

appear to be either one of the wonders of the age or an unscientific

absurdity. To the thinking man it will be the latter. It pretends

to determine the amount of phosphates in the system. This is

accomplished--alleged--by taking the second urine passed in the morning

and mixing a portion of it in the instrument with a solution which

is the well-known magnesia mixture. The height to which the crystals

settle in ten minutes determines, according to Dowd, the amount of

phosphates! Was ever a test devised that violated more of the first

principles of quantitative chemical analysis? If so, we never heard of

it. Dowd’s system does not require any determination of the amount of

urine passed in twenty-four hours or even of the amount passed at the

second micturition in the morning.

If a patient whose urine was being “tested” by the Dowd method, should

drink two cups of coffee for breakfast instead of one, his urine might

be so dilute that the phosphates would fall below the “normal” mark.

Dowd says that his Phosphatometer “takes the pulse of the nervous

system.” What about the patient who eats several eggs or consumes a

sweetbread or other nuclein-containing articles of diet? The increased

amount of phosphates in such a diet might easily lead to an apparent

excess in the urine. Every physician, nay, every sophomore medical

student, knows that the amount and kind of food ingested governs almost

entirely the amount of phosphates excreted in the urine.

What actually does “Dowd’s Phosphatometer,” when used according to

instructions, show? It shows the _presence_ of phosphates in the urine;

it permits a guess--with not the slightest claim to accuracy--as to the

amount in the specimen tested; it gives no possible clue to the normal

or abnormal relation of the phosphates in the urine or as to whether

the source of the crystals precipitated is the nerve tissue or the

food. Yet here are some of the claims made for it:

“The Phosphatometer shows nervous metabolism the same as the

ureometer shows muscular; the former errs in about 3 per cent.; the

latter in 40 per cent.”

“The Phosphatometer shows the amount of nerve food being used and

present in the nerve cells.”

“Over 50 per cent. of pain and human suffering is due to the nerves

crying for food; the Phosphatometer will show the true cause in ten

minutes.”

“The Index not only tells the present condition, but foretells the

future, thus preventing serious complications which might arise.”

“The Phosphatometer measures the amount of phosphorus in the

system.”

“The Dowd Phosphatometer not only takes blood-pressure, it tells

how to regulate it.”

“The Phosphatometer measures the amount of phosphorus in the

nerve cells; it is as positive in nerve troubles as the x-ray in

fractures.”

These claims are essentially false. As a matter of fact, a simple

examination of the urine for phosphates cannot tell us the condition

of the nervous system. This must be evident from the fact that only a

portion of the phosphates is excreted in the urine, a very considerable

part passing out with the feces. Further, the bulk of the phosphorus

excreted comes from the food and only a small portion from the waste of

the nervous system. The amount excreted by the urine which comes from

torn-down nerve tissue is so small that it is practically impossible to

estimate variations in it even by the most careful analytic methods.

In brief, Dowd’s “scientific method” is nothing more than unscientific

humbug.--(_From The Journal A. M. A., Dec. 20, 1913._)

AMORPHOUS PHOSPHORUS[BN]

A Practically Inert Substance Introduced as

a Valuable Therapeutic Agent

[BN] The so-called amorphous phosphorus is in reality a crystalline

body and is more correctly called red phosphorus to distinguish it

from the ordinary or yellow phosphorus. It is the ordinary or yellow

phosphorus which is official as “Phosphorus.”

Amorphous phosphorus is a chemical anomaly contrasting markedly with

ordinary phosphorus in its physical, chemical and pharmacologic

properties. Ordinary phosphorus is soluble in certain solvents, such

as oil; amorphous phosphorus is insoluble. Ordinary phosphorus is

poisonous; amorphous phosphorus is not poisonous. Ordinary phosphorus

has been regarded as of some therapeutic value; amorphous phosphorus,

because of its insolubility and other physical properties, has never

been so regarded. Pharmacologists, therefore, have paid very little

attention to it. Some of them do not even mention it, though there are

a few accounts of experimental work.

Noé,[156] in experiments on the action of phosphorus with yeast,

found that yeast acted on ordinary phosphorus, producing PH_{3}

(hydrogen phosphid), but on amorphous phosphorus it had no action. His

experiments show that amorphous phosphorus was not toxic to animals.

[156] Noé, J.: Action comparée du phosphore blanc et du phosphore rouge

sur la matière vivante, Compt. rend. Soc. de biol., 1899, 105, i, 380.

Thornton[157] quotes Reese as publishing a report of a case in which

30 grains of amorphous phosphorus were taken by a young woman with

suicidal intent, but no toxic symptoms were manifested. Thornton found

it non-toxic to animals.

[157] Thornton, E. Q.: The Advantages of Amorphous Phosphorus over

the Official Form, Therap. Gaz., 1894, xxxv, 19. Tr. Pan. Am. Med.

Congress, 1893, Washington, 1895, p. 1,438.

Witthaus and Becker (Medical Jurisprudence, Forensic Medicine and

Toxicology, iv, 635) say: “The form of phosphorus is practically

non-poisonous, probably by reason of its insolubility. It has been

administered to dogs to the extent of 200 gm. (nearly half a pound)

in twelve days without causing poisoning.”

C. D. F. Phillips (Materia Medica, Pharmacology and Therapeutics,

Inorganic Substances, Ed. 3, p. 46) makes the following statement:

“Amorphous phosphorus has been, by some observers, credited with

physiologic activity. Thus, Bednar used it for a long period in small

doses, and observed symptoms of excitation, trembling and clonic

convulsions; but as much as 1 ounce has been given to dogs without

perceptible effect. Thompson, in twelve carefully observed cases,

found its action nil, and plausibly attributes its supposed powers to

a slight admixture of ordinary phosphorus (_Pharm. Jour., 1875_). I

believe it is practically inert.”

HOW INTRODUCED

The foregoing represents our scientific knowledge as to the action

of amorphous phosphorus. Now, however, comes Dr. I. L. Nascher and

introduces amorphous phosphorus as a remedy of remarkable value for the

arteriosclerosis of old age. The method of introduction is somewhat

peculiar. The treatment seems first to have been brought to notice

through a printed slip sent to medical journals generally. This slip

consisted of an extract from Nascher’s book on old age, which at the

time had not been published! Nascher also published an article on

this subject in an obscure journal, the _American Practitioner_, for

December, 1913. Neither the matter copied from his book nor the article

referred to contain a single scientific fact that would warrant the

claims made for it as a therapeutic agent. No record is given of animal

experiments, and the clinical evidence presented certainly cannot be

regarded as scientific.

As already stated, this form of phosphorus has not been previously used

and has been regarded as without effect on the human system because of

its insolubility in any of the liquids of the body. Nascher himself

has not been able to find any new way to dissolve it. He says: “I made

a number of experiments to find a solvent. The only substance which

appears to dissolve it is serum, but I am still uncertain whether it is

a solution or a very fine suspension. The phosphorus is precipitated in

a few days, but the serum remains tinged.” The fact that it separates

from the serum on standing is quite conclusive evidence that it is

insoluble in that liquid. Since no way of making it soluble has been

discovered, there is no reason for expecting it to have any effect on

the system. An insoluble and non-absorbable substance can produce no

general systemic effect; if, when ingested, it produces any effect

whatever, this effect must be local and will be shown by symptoms of

gastro-intestinal disturbance. Nascher, however, took 15 grains, and

no symptoms of gastro-intestinal disturbance followed. Hence, we must

conclude that it is without effect on the gastro-intestinal mucous

membrane. While Nascher records no experiments on animals which is much

to be regretted, he did experiment on himself and says:

“Ten grains produced a frontal headache, restlessness, excessive

mental stimulation, ideas arising with such vividness as to appear

as actual occurrences. There was a sense of weight or oppression

in the stomach and priapism, the latter probably psychic, as I was

looking for such a result. These symptoms passed away in a few

hours.”

Without doubt his explanations of the priapism can be applied to

the whole experience; whatever symptoms there were, they were

unquestionably psychic. The consideration of these subjective

symptoms may be dismissed, since it is reasonable to assume that an

insoluble, unabsorbable substance which produces no disturbance of the

gastro-intestinal tract will have no effect on the rest of the organism.

Amorphous phosphorus did not produce such symptoms as Nascher relates

in experiments similar to his made by us. The drug was taken in

10-grain doses by six different individuals. In no case did the

symptoms described by Nascher follow; in fact, there were no symptoms

whatever.

NASCHER’S THEORY

Nascher, after relating his subjective experiences and those of his

patients, proceeds to build a theory to account for the unproved action

of amorphous phosphorus in disease, especially in arteriosclerosis. It

would have been more appropriate if before advancing the theory, he had

made some experiments to prove that the substance has some action. But

we give his theory as found in the quotation from his book, sent to

medical journals, as already referred to. Here it is:

“Amorphous Phosphorus in Senile Arteriosclerosis: The author has

used the red amorphous phosphorus in senile arteriosclerosis for

several years. Given originally as a substitute for ordinary

phosphorus in senile debility, it was found that it was eliminated

as amorphous phosphate of lime and that the lime elimination

was thereby increased. Weil’s experiments showed that the lime

elimination in arteriosclerosis was diminished. Phosphorus has

the property of combining with lime and increasing the lime

assimilation. In the small doses which can be given when the

ordinary phosphorus is employed, the phosphorus will combine with

the lime of the food and increase the amount of lime salts in the

body. When given as amorphous phosphorus, the dose is 2 grains

or more several times a day, and with a lime-free diet the lime

required for the combination necessary to secure the elimination

of the phosphorus excess is drawn from the abnormal lime deposits.

This appears to be the rationale of the treatment and explains the

good results obtained from its use. From ‘Diseases of Old Age,’ by

I. L. Nascher, M.D., to be published shortly.”

Thus, according to Nascher, the phosphorus, after being oxidized to

phosphoric acid, catches the calcium and drags it out of the system!

What are the facts? The human body contains a large store of phosphates

which are excreted in the urine in combination with sodium and

potassium--and yet these do not draw the calcium from the blood, brain

and bones! To be blunt, Nascher’s theory is absurd. The calcium in

its various deposits in the body is already combined with phosphoric

acid. Why should the phosphorus introduced take calcium from the

phosphate radical with which it is already in combination? Nascher

asserts that the phosphorus which is introduced as amorphous phosphorus

is excreted as amorphous phosphate of lime within twenty-four hours.

How does he know it is? It is, of course, very appropriate that

amorphous phosphorus should form the amorphous phosphate of lime, but,

unfortunately, phosphates made from the ordinary phosphorus also are

precipitated in the amorphous condition. By what private mark does Dr.

Nascher identify the amorphous phosphate produced by his amorphous

phosphorus? Is it not a fact that he found the urine alkaline and

detected a precipitate of amorphous calcium phosphate--always present

in alkaline urine--and concluded that this must be his particular

amorphous phosphorus in combination with calcium?

Dr. Nascher makes no record of examinations of the feces, although a

great part--sometimes the greater part--of ingested phosphorus is found

in the feces in experimental work on phosphorus metabolism. If he had

examined the feces he would doubtless have found the total quantity of

amorphous phosphorus unchanged.

Nascher refers to several cases in which he has used this remedy and

states that he had the most gratifying results. So far as we can learn,

the benefit was entirely in the subjective symptoms of the patient.

It seems evident, therefore, that his claims for the value of this

remedy rest on no better foundation than an unproved theory without

experimental basis.

ITS COMMERCIALIZATION

Thus far we have considered only the scientific aspects of amorphous

phosphorus therapy. It is unfortunate that we cannot stop here. Some

of our readers will have seen in recent medical journals half-page

advertisements of amorphous phosphorus reading:

The striking physical and chemical properties possessed by common

phosphorus, together with the fact that phosphorus is one of the

constituents of nerve-tissue, are probably responsible for the

reputation which this element acquired generations ago as a remedy for

sexual impotence and mental decay. Among scientific men this reputation

was a fleeting one, for, when put to the test, the product failed.

Like so many products with a similar history, the unearned reputation

it obtained from medical men survived in the minds of the laity, and,

as is always the case, the survival has been taken advantage of by

quacks. Among charlatans and nostrum makers phosphorus is still in

vogue. “Weak men’s specialists” and venders of “lost manhood” and

alleged aphrodisiac drugs “play up” the phosphorus fallacy for all it

is worth.

It is worth noting that the present exploitation of amorphous

phosphorus is following along somewhat similar lines. The asserted

actions of amorphous phosphorus are such as may be calculated to

appeal to the sexual neurasthenic. There is no doubt that the Sharp

& Dohme advertisements will bring about an extensive use of this

remedy, especially by the uncritical. The psychic element--which plays

so large a part in the sexual neurasthenic--will result in favorable

reports being given on the drug. Articles may be expected to appear in

a certain class of medical journals, telling of the marvelous results

that Dr. John Doe has had in the use of “Pill Phosphorus Amorphous S. &

D.” A luxuriant crop of testimonials may be expected to follow, and the

_tout ensemble_ will go far to sustain the Sharp & Dohme propaganda.

[Illustration: Reproduction--reduced--of half-page advertisement

appearing in medical journals.]

We are prompted to believe that Messrs. Sharp & Dohme do not fully

realize the potentialities for harm that lie in their present

exploitation of amorphous phosphorus. It hardly seems possible that

a firm of standing would knowingly put on the market and advertise

a worthless drug with an appeal to susceptible, infirm old men. The

function of introducing new remedies to the medical profession is

a responsible one, and a firm that assumes it should have among its

officers some one sufficiently conversant with pharmacologic science

to prevent such unscientific absurdities as that exhibited in the

marketing of amorphous phosphorus, especially under such claims as

those contained in the advertisements.--(_From The Journal A. M. A.,

March 7, 1914._)

Dr. Nascher’s Reply to The Journal’s Article--Comments

_To the Editor_:--Regarding the article on Amorphous Phosphorus

in the March 7 issue of The Journal of the American Medical

Association, I want first of all to clear myself of the implied

charge of commercialism in connection with the marketing of the

Pill Phosphorus Amorphous by Sharpe & Dohme. I have never had

anything to do with the manufacture or sale of those pills, never

had any business dealings with Sharpe & Dohme and I have no

commercial interest whatsoever in either this or any other drug

or drug house. I knew nothing about the advertisement which you

reproduced until I saw it in the medical journals. I immediately

protested against this unwarranted use of my name and was assured

that the statement “Made under the direction of Doctor I. L.

Nascher, New York,” was not made for the purpose of misleading and

that the ad. would be immediately withdrawn. I gave my approval

to the pills made by this firm as I would give my approval to

the pills made by any other reliable house for I claim the right

to endorse any drug or preparation which I believe to be of

value whether it is approved by the Council of [on] Pharmacy and

Chemistry or not.

In your general charge of commercialism you make it appear that the

exploitation of amorphous phosphorus had the ulterior purpose of

appealing to the sexual neurasthenic along the lines of the “lost

manhood” ads. So far as this relates to Sharpe & Dohme, I have no

interest, but you have included me in your general denunciation.

The only reference I ever made to aphrodisiac effects of Amorphous

Phosphorus, in all my writings, is contained in these words in

the four-page article in the _American Practitioner_, “In a few

cases aphrodisiac effects were noticed.” I have never recommended

amorphous phosphorus as an aphrodisiac and in the chapters on

“Impotence and Neurasthenia” in my book on “Diseases of Old Age,” I

have not mentioned amorphous phosphorus at all.

You say “the treatment seems first to have been brought to notice

through a printed slip sent to medical journals generally.” This

slip containing an extract from my book which was then in press was

sent out about four months ago while I have referred to amorphous

phosphorus repeatedly in medical articles during the past three

years. In my paper on Senile Debility, _Medical Record_, Jan. 21,

1911, I said amorphous phosphorus had no effect, as I was then

looking for the usual effects of the ordinary phosphorus. In a

paper on Senile Mentality, _International Clinics_, Vol. 4, 21st

series, I said I was using amorphous phosphorus but had not yet

determined its value. I recommended it in several of my papers,

articles and lectures in 1912 and 1913 after I had found that under

its use in some cases of senile arteriosclerosis, symptoms were

relieved. I sent these slips to the medical journals as a general

reply to many inquiries I received about amorphous phosphorus and I

stated this in the letters I sent with the slips to some editors.

Further inquiries for more information led me to write the paper

which appeared in the December issue of that “obscure journal”

the _American Practitioner_. I felt that a medical journal which

carried articles by Sir James Barr, ex-president of the British

Medical Association, Sir R. W. Philip, R. Murray Leslie, Halliday

Sutherland, and such American authorities as Adami, Hare, Brooks,

Hirschberg, Knopf, Starkey, Ely, Bissell, Wilcox, Col. Maus,

U. S. A., etc., was a representative high class journal and I was

pleased to have my paper in it.

To take up the scientific criticism of amorphous phosphorus,

permit me to say at the outset that I am a general practitioner,

specially interested in geriatrics, and more concerned about

obtaining favorable clinical results in my cases than in solving

laboratory problems. Nevertheless I have tried for years to obtain

the cooperation of expert laboratory workers to help me determine

the properties, chemical, physical and physiological, of amorphous

phosphorus. In 1909 or 1910 the Rockefeller Institute, in reply

to my request for permission to experiment there with amorphous

phosphorus, said it did not accept volunteer workers. Four heads

of college laboratories could not spare the time. I asked the

Council on Pharmacy and Chemistry last November to take up its

investigation and was informed that it could not do so at present.

I have been perforce compelled to depend mainly on empirical

methods with such little experimentation as the facilities of the

physician’s office permitted and such little literature as I could

find.

You reject empirical methods as being unscientific notwithstanding

the fact that most of our therapeutic knowledge is based on

empiricism. (I use the terms empirical and empiricism here in

the sense of knowledge obtained from experience and observation,

not in the bad sense in which they might be construed.) It would

therefore be folly on my part to argue with you that I have

obtained beneficial results from amorphous phosphorus in many cases

of senile arteriosclerosis. I did not obtain such results from a

single dose, but gave it in some cases for many weeks or months.

It is unfair to judge of the value of a drug from a single dose

or several doses unless it is a drug which is expected to show

immediate effects. It would be greater folly on my part to pit

my knowledge of pharmacy and chemistry against the knowledge of

your staff of experts. I can but repeat what I have said on many

occasions that under the persistent use of amorphous phosphorus

in cases of senile arteriosclerosis symptoms were frequently

relieved. I never claimed that amorphous phosphorus will cure

arteriosclerosis. In the chapter on Arteriosclerosis in my book I

say: “Senile arteriosclerosis being a natural, normal condition,

is incurable in the sense that it can be neither prevented nor

removed. The best that we can hope for is to retard its progress

and relieve disagreeable symptoms, etc.”

You say in reference to the elimination of the amorphous phosphorus

as amorphous phosphate of calcium, “Is it not a fact that he

(I) found the urine alkaline and detected a precipitate of

amorphous calcium phosphate--always present in alkaline urine--and

concluded that this must be his particular amorphous phosphorus

in combination with calcium?” No. The specimens of urine were

examined in reliable laboratories and I have reports showing acid

and neutral urine as well as alkaline urine having the amorphous

phosphate precipitate. Nor is the amorphous phosphate “always

present in alkaline urine.”

As for the theory I advanced, it is simply a theory based on

reasoning without facts to prove it. If I had facts to prove it,

it would no longer be a theory or open for discussion. Being a

theory, it is the province of the wise man to ridicule it and

call it absurd. I will confess that your criticism of it is not

clear to me and I still do not see its absurdity. I don’t see what

relation your argument, that the phosphates of sodium and potassium

do not draw the calcium from the blood, brains and bones, has to

the theory I advanced. It is true that I have no private mark by

which I can identify the amorphous phosphate produced by amorphous

phosphorus, but such argument is puerile. When medical science

has so far progressed that the physician will be able to put his

tag on the molecule of drug substance and follow it through the

various metabolic processes to its final elimination we will not

need any Council on Pharmacy and Chemistry to decry what it cannot

understand. Let me say here that scientific criticism does not

stoop to ridicule for ridicule is usually based on animus or bias.

The conclusive proof of the value of a drug is not its action

on the healthy dog, frog or guinea-pig but its action on the

individual patient, and no amount of animal experimentation can

dispose of the personal factor which is so marked in senile cases.

This is no criticism of animal experimentation as a whole but of

the insistence on animal experimentation to determine the value of

a drug in a class of cases for which the healthy animal can furnish

no comparison.

You say amorphous phosphorus is practically inert and quote Noé,

Witthaus and Becker, Thornton and Phillips. The quotations of

the first three are little more than statements that amorphous

phosphorus is non-toxic. Phillips makes two references, one of

which is to Badner who obtained decided effects from its prolonged

use. Thornton, whom you quote in your contention that amorphous

phosphorus is inert, says that on prolonged use in doses of 3/10

grains every two hours it produced headache, vertigo, mental

excitement, priapism, etc. (See footnote under Phosphorus, U. S.

Dispensatory). Shoemaker’s Materia Medica and Therapeutics says

it is toxic and is called the servant-girl’s poison. Phillips

suggested that Badner probably used an impure drug. I suggested

that Thornton probably used an impure drug. On the other hand,

Badner and Thornton obtained positive results from prolonged use,

not from the single dose.

You say it has not been used on account of its insolubility in any

of the liquids of the body. Roscoe and Schorlemmer, quoting Neuman,

said if injected into the blood the usual symptoms of phosphorus

poisoning appear. In a letter from Dr. Hatcher he says Nassé

injected 0.2 gm. of the purest amorphous phosphorus into a rabbit’s

vein and the animal presented the usual symptoms of phosphorus

poisoning. There are also references to amorphous phosphorus action

in Kobert’s _Lehrbuch der Intoxicationen_, in Blythe’s Poisons, etc.

You say of your four quotations, “the foregoing represents our

scientific knowledge as to the action of amorphous phosphorus.” Did

you not know of these other authorities, or are their statements

unscientific, or were they omitted because they disprove your

contention that amorphous phosphorus is practically inert?

Your denunciation of ordinary phosphorus has no bearing on the

subject as I do not recommend the amorphous phosphorus as a

substitute for the other.

I have worked for eight years to arouse medical and public interest

in the aged and their ailments and I cannot afford charges of

commercialism, foisting worthless drugs as aphrodisiacs or

other unethical conduct to stand against me. As for the charge

of unscientific work, I can only point to my work on Diseases

of Old Age, and my medical papers, and express the hope that

others better equipped for laboratory research will take up the

laboratory investigation of amorphous phosphorus. I have faith in

its therapeutic value and believe competent clinical observers will

have favorable results from it in suitable cases.

I. L. Nascher, M.D., New York.

Comment.--Accompanying the preceding letter was a note from Dr. Nascher

in which he says: “I want this published in full without elision or

change. If you do not intend to publish it as written, I want it

returned and enclose postage.” The letter therefore is given in full

in spite of the fact that much of it is irrelevant to the question

discussed.

Dr. Nascher’s protest to Sharpe and Dohme against the “unwarranted use”

of his name in connection with “Pill Phosphorus Amorphous, S & D” seems

to have resulted in various modifications of the phrases connecting

his name with the exploitation of this pill. What was apparently the

original advertisement, contained the phrase:

“Made under the direction of Dr. I. L. Nascher, New York.”

Later advertisements, while identical in all other respects with the

first, had this phrase modified to read:

“Made at the suggestion of Dr. I. L. Nascher, New York.”

Still other advertisements, also identical with the first in other

respects, are modified to read:

“Made with the approval of Dr. I. L. Nascher, New York.”

That Dr. Nascher was directly or indirectly connected with the

commercializing of this product, The Journal has never suggested,

inferentially or otherwise. That the exploitation of amorphous

phosphorus by Sharpe and Dohme is one that appeals to the sexual

neurasthenic, no one who has read the advertisements can deny. As a

matter of fact, it would be difficult to sell phosphorus in any form as

a medicament, without appealing to the sexual neurasthenic. The word

“phosphorus” has become, in the minds of both laymen and physicians,

more or less synonymous with the treatment of so-called sexual weakness

and it is a practical impossibility to divorce the word from the idea

suggested. How true this is, Dr. Nascher himself unwittingly admits

when he tells that the result of his first experiment on himself with

amorphous phosphorus was a priapism that he acknowledges was “probably

psychic, as I was looking for such a result.” But the Sharpe and Dohme

advertisements plainly state that the amorphous phosphorus pill they

are marketing is a “new and successful method of treatment for ...

functional and senile impotence....”

Dr. Nascher’s explanation of how he came to send out the slip regarding

amorphous phosphorus to medical journals leaves him the victim of an

unfortunate coincidence. It is at least unusual for authors to send out

advance extracts from books that are about to be published, especially

when such extracts deal wholly with a drug that is coincidently

being introduced as a new proprietary product by some enterprising

pharmaceutical house.

Dr. Nascher takes exception to our statement that the treatment seems

first to have been brought to notice through the printed slip sent

to medical journals, and states that he has “referred to amorphous

phosphorus repeatedly in medical articles appearing during the last

three years.” His articles for 1912 and 1913 have been examined for

the purpose of learning when the treatment as now presented to the

profession was first announced. In his article “Errors in the Treatment

of Senile Cases,” _New York Medical Journal_, Oct. 12, 1912, he speaks

of the iodids in senile arteriosclerosis, but says nothing about

amorphous phosphorus. It may be assumed, therefore, that the treatment

had not been brought to general notice at that time. The new treatment

is very briefly described in the _New York Medical Journal_, July

13, 1913, in an article whose title, “Longevity and Rejuvenescence”

gave no indication that it dealt with amorphous phosphorus. Under the

circumstances, it is not strange that its therapeutic value was not

learned of until Dr. Nascher’s printed slips were sent out.

Dr. Nascher admits that his theory is based on empirical methods. Most

of the serious errors in therapeutics have had their origin in this

very method. It was on just such methods that physicians reported

wonderful results in the use of alleged “lithia waters” that actually

contained less lithium than ordinary river water! So unscientific

is the empirical method that it is hardly worth taking the space to

demonstrate its imperfections.

Neither is it worth while to discuss the question of a constant

occurrence of a sediment of amorphous calcium phosphate in alkaline

urine. If there are exceptions to this rule, they must be rare indeed.

In The Journal’s article authors were quoted to show that amorphous

phosphorus is regarded as inert. It was not suggested that the

authorities referred to were all that could be found. Dr. Nascher

refers to Thornton, Shoemaker, Neuman, Blythe and Kobert, and asks

whether the various statements on the subject, made by these men, are

unscientific or were “omitted because they disproved” the contention

that amorphous phosphorus is practically inert. Thornton’s article

was omitted because it is unscientific in that he does not report

experiments made by himself, but refers to an unpublished paper by

one Kelly. Who Kelly is, or was, he does not tell us. Kelly’s report,

therefore, should be and was disregarded, since it is the work of an

unknown author and there is nothing in the article to indicate that

Thornton was in any position to vouch for Kelly’s work. Incidentally,

it may be said that Kelly’s report merely recorded subjective symptoms;

Dr. Nascher himself indicates his distrust of Kelly’s alleged results

by suggesting that an impure preparation was used!

Shoemaker’s report was not given, for a similar reason. Shoemaker says:

“Amorphous phosphorus is almost completely destitute of taste or

odor, has no immediate caustic effect, and is claimed to be less

toxic than white phosphorus; but in the _form of matches_ [Italics

ours.--Ed.] has caused many deaths and is known as the ‘servant

girls’ poison.’”

It is well known that commercial amorphous phosphorus is usually

impure, and it is more than probable that if toxic effects were

produced by the ingestion of match-heads, these matches were made

either of white phosphorus or of very impure red phosphorus. In

any case, Shoemaker’s statement has no bearing whatever on the

pharmacologic action of pure amorphous phosphorus.

The statement of Neuman quoted from Roscoe and Schorlemmer, as well as

that of Nassé, referred to by Hatcher, had no bearing on the question

at issue, as these men injected the material into the blood-stream.

If, when the amorphous phosphorus is injected into the blood, it

produces the ordinary symptoms of phosphorus poisoning, one would

naturally expect the same symptoms when the substance is given by

mouth--if amorphous phosphorus were soluble or absorbable. The fact

that such symptoms are not produced when amorphous phosphorus is

taken into the alimentary canal, sustains the views held by chemists,

pharmacologists and physicians, that the drug is practically insoluble

and unabsorbable--in other words, inert.

Dr. Nascher declares that he “never claimed that amorphous phosphorus

will cure arteriosclerosis.” Yet he insists that amorphous phosphorus

removes lime from the “abnormal lime deposits” that occur in

arteriosclerosis. What is this but claiming curative action?

Summed up, Dr. Nascher’s own admissions amply confirm the main

contentions of The Journal’s article. He admits that he has no

experimental basis for the use of this remedy; he admits that his

theory “is simply a theory without facts to prove it.” The only

conclusions that can be reached from his reply coincide closely with

the very statement made by The Journal, and which we here reiterate:

“It seems evident, therefore, that his claims for the value of this

remedy rest on no better foundation than an unproved theory without

experimental basis.”--(_From The Journal A. M. A., March 28, 1914._)

INDEX

(Including References to Articles Not Contained in This Book)

The following is an index (1) to topics discussed in this volume, and

(2) to products discussed in reports and other articles not included

here:

1. The references to topics discussed or mentioned in this volume are

printed in CAPITALS.

2. The references to articles published elsewhere are printed in small

letters. These references include papers published in The Journal of

the American Medical Association, papers published in the “Annual

Reports of the Council on Pharmacy and Chemistry” and a few published

in the “Annual Reports of the Chemical Laboratory of the American

Medical Association.” A number of these papers have appeared both in

The Journal and in the Council Reports. In such cases, for the benefit

of those who may not have access to files of both The Journal and the

Council Reports, references are given to both sources. Some of this

matter is also issued in reprint form.

PAGE

ABBOTT ALKALOIDAL COMPANY, 37, 103, 344

ABICAN, 47

ACETANILID, HARMFUL EFFECTS OF, 305

ACETANILID MIXTURES, 9

ACETPHENETIDIN AND PHENACETIN--THEIR RELATIVE PURITY, 414

ACETPHENETIDIN, HARMFUL EFFECTS OF, 305

ACOUSTICON, 436

ADEPSINE OIL, 161

ADKIN, “PROFESSOR”, 475

ADRENALIN, NAME, VERSUS THE NAME EPINEPHRIN, 454

ADVERTISING, CLEAN, 418

AGAR-LAC AND AGAR-LAC, INC., 10

Agmel (Maguey Products Co.), The Journal, Oct. 12, 1912, p. 1392.

Agurin Tablets (Bayer Co.), Reports Council Pharm. & Chem., 1915,

p. 162.

AKOLL BISCUIT, 449

ALBOLENE, LIQUID, 161

Alborum (Whitehouse Chemical Co., Inc.), The Journal, Dec. 12, 1914,

p. 2148; Reports Council Pharm. & Chem., 1914, p. 129.

Aletrin, The Journal, Nov. 13, 1909, p. 1655;

Reports Council Pharm. & Chem., 1909, p. 135.

Aletris Compound, Elixir (Parke, Davis and Co., Ray Chemical Co.),

Reports Council Pharm. & Chem., 1912, p. 46.

ALETRIS CORDIAL, 46

ALETRIS FARINOSA, 208

Alfatone (Norwich Pharmacal Company), The Journal, Aug. 7, 1915,

p. 548; Reports Council Pharm. & Chem., 1915, p. 62.

ALIENIST AND NEUROLOGIST, ADVERTISING IN, 31

Alkaline Digestine (Parke, Davis and Co.), Reports Council Pharm.

& Chem., 1912, p. 44.

Alkalol (Alkalol Company), The Journal, Nov. 6, 1915, p. 1665.

ALLEOTONE, 264

ALMOND PREPARATIONS, VARIOUS DIABETIC, 450

AMERICAN JOURNAL OF CLINICAL MEDICINE, ADVERTISING IN, 303, 304, 342

AMERICAN JOURNAL OF OBSTETRICS, ADVERTISING IN, 342

AMERICAN JOURNAL OF SURGERY, ADVERTISING IN, 31, 49, 342, 424, 429

AMERICAN MALTED FOOD COMPANY, 319

AMERICAN MEDICINE, ADVERTISING IN, 31, 49, 131, 304, 342, 429

VON AMERONGEN, E. M., 299

AMILEE, 161

Amolin Deodorant Powder (Amolin Chemical Co.), The Journal, Feb. 22,

1908, p. 626; Reports Chem. Lab., 1909, p. 63.

AMMONOL, 9

AMMONOL CHEMICAL COMPANY, 338

AMORPHOUS PHOSPHORUS, 478

ANADOL, 246

ANALGESIC BALM, BENGUÉ’S, 267

ANALGESIC CREAM, STEARNS’, 267

ANALGINE-LABORDINE, 117

Analutos and Analutos Tablets (Royal Pharmaceutical Works, Meppel,

Holland), The Journal, Feb. 20, 1915, p. 684; Reports Council

Pharm. & Chem., 1915, p. 135.

ANASARCIN, 11, 12

ANASARCIN CHEMICAL COMPANY, 11, 18

ANDERTON, DR. T. B., 18

ANEDEMIN, 11, 12, 16

ANEDEMIN CHEMICAL COMPANY, 12, 16, 18

ANGIER CHEMICAL COMPANY, 170

ANGIER’S PETROLEUM EMULSION, 169

ANGIER’S THROAT TABLETS, 173

ANGLO-AMERICAN PHARMACEUTICAL COMPANY, LTD., 58

ANIMAL THERAPY COMPANY, 317

Anistamina (M. Olivetti), Reports Council Pharm. & Chem., 1915,

p. 162.

ANNALS OF SURGERY, ADVERTISING IN, 35, 421

ANODYNE BALM, P-M COMPANY, 267

ANTIDIABETICUM-BAUER, 267

ANTI-JAG, 434

ANTIKAMNIA, 9, 268, 307

Antikamnia and Quinin (Antikamnia Chemical Co.), The Journal,

July 1, 1905, p. 55.

ANTIKAMNIA CHEMICAL COMPANY, 277, 279, 307

Antimeristem-Schmidt (Laboratorium W. Schmidt), The Journal,

March 8, 1913, p. 766.

ANTI-NEURALGIC OINTMENT, 267

Antiphlogistine (Denver Chemical Manufacturing Company), The

Journal, June 1, 1907, p. 1875.

ANTIPYRIN, HARMFUL EFFECTS OF, 305

ANTISEPTIC POWDER, MAIGNEN, 19

ANTISEPTIC POWDER, TYREE’S, 21, 404, 436

Antiseptic Tablets, Clover (Sharp & Dohme), The Journal, Aug. 26,

1911, p. 755.

ANTISEPTIC W-A, INTESTINAL, 103

ANTITHERMOLINE, 403

ANUSOL HEMORRHOIDAL SUPPOSITORIES, 227, 280, 281

APERGOLS, 26

Arbor Vitae, Reports Council Pharm. & Chem., 1912, p. 38.

ARCHIVES OF PEDIATRICS, ADVERTISING IN, 31

ARMOUR & CO., 133, 472

ARMY AND NAVY MAGAZINE, 434

ARMY AND NAVY MEDICAL RECORD, 292, 300, 432

ARNOLD’S ZYMOTOID AND ARNOLD’S ZYMOTOID COMPANY, 412

AROMATIC DIGESTIVE TABLETS, 229

ASEPTIKONS, 26

ASPIRO-LITHINE, 281

ASPIROPHEN, 85

ATLANTA JOURNAL-RECORD OF MEDICINE, ADVERTISING IN, 31, 35, 296

ATOLEINE, 161

ATOLIN, 161

AUBERGIER’S SYRUP OF LACTUCARIUM, 399

Autolysin (Autolysin Laboratory), The Journal, July 24, 1915,

p. 336; Nov. 6, 1915, pp. 1647, 1662.

Avenin Compound Tablets (Parke, Davis & Co.), Reports Council Pharm.

& Chem., 1912, p. 44.

Baby Taeniafuge Grape (Grape Capsule Co.), Reports Council Pharm. &

Chem., 1915, p. 174.

Bacillicide (Prophytol Products Co.), The Journal, Nov. 14, 1914,

p. 1778; Reports Council Pharm. & Chem., 1914, p. 125.

BAKING POWDER, CASOID, 449

BAKING POWDER, JIREH DIABETIC, 450

Bakurol (Sharp & Dohme), The Journal, July 10, 1915, p. 175.

BALLARD, J. F., 112, 198

BALLARD-SNOW LINIMENT COMPANY, 43

BALLARD’S SNOW LINIMENT, 205

Baneberry, Reports Council Pharm. & Chem., 1912, p. 38.

Baptisin, The Journal, Nov. 13, 1909, p. 1655; Reports Council

Pharm. & Chem., 1909, p. 135.

BANNERMAN, WM., & CO., AND BANNERMAN’S INTRAVENOUS SOLUTION, 105

BAPTISIA TINCTORIA, 209

BARKER’S GLUTEN FOODS, 449, 450

BATTLE & CO., 31, 81, 108, 330

BAUER, CHARLES, 299

BAUER, LUDWIG, 267

BAUER CHEMICAL COMPANY, 366

BAUME ANALGÉSIQUE BENGUÉ, 267

Bee, Honey, Reports Council Pharm. & Chem., 1912, p. 38.

BEEF EXTRACTS, JUICES AND PREPARATIONS, 123, 133, 471, 472

BELL & CO., 151, 282, 356

BELL-ANS (PA-PAY-ANS, BELL), 151, 282

Benetol (Northern Chemical Assn.), The Journal, April 15, 1911,

p. 1128; Reports Chem. Lab., 1911, p. 82.

BETUL-OL, 27

BEYER, CHARLES AND FRANK, 299

BIOSOL, 284

BISCHOF’S DIABETIC GLUTEN BREAD, 450

BISCHOF’S GLUTEN FLOUR, 449

BISCHOFF & CO., 293, 344

BISCUIT, VARIOUS DIABETIC, 449, 450

Bismuth Iodo-Resorcin Sulphonate, The Journal, Feb. 11, 1911,

p. 441; Reports Chem. Lab., 1911, p. 14.

Bismuth, Opium and Phenol Tablets (Hance Bros. & White, Wm. S.

Merrell Chemical Co., Parke, Davis & Co., Sharp & Dohme, F. Stearns

& Co., Truax, Greene & Co., H. K. Wampole & Co., Wm. R. Warner

& Co.), The Journal, July 25, 1908, p. 330; Dec. 17, 1910, p. 2169;

May 6, 1911, p. 1344; Reports Chem. Lab., 1909, p. 28; 1910, p. 85;

1911, p. 22.

Bitter Bark, Reports Council Pharm. & Chem., 1912, p. 39.

Bladder Wrack, Reports Council Pharm. & Chem., 1912, p. 39.

BLANDINE, 161

Blandine Laxative, Mulford (H. K. Mulford Co.), Reports Council

Pharm. & Chem., 1914, p. 136.

Blaud Capsules and Blaud Arsenic and Strychnine Capsules, Frosst’s

(C. E. Frosst & Co.), Reports Council Pharm. & Chem., 1915, p. 164.

BLISS, ALONZO O., COMPANY, 463

Blood Tonic, Alterative (Parke, Davis & Co.), Reports Council Pharm.

& Chem., 1912, p. 47.

Blue Cohosh, The Journal, Sept. 11, 1915, p. 972.

BOATMAN, H. F., 436

Boneset, Tall, Reports Council Pharm. & Chem., 1912, p. 45.

BOONE, URIEL S., 307

Borolyptol (Palisade Mfg. Co.), The Journal, Nov. 15, 1913, p. 1812.

BOUMA, DR., SUGAR-FREE FAT-MILK, 449

BOVININE, 123, 125, 126

BOVININE COMPANY, 123

BRADBURY’S ECZEMA LOTION, 245

BRANT, J. W., COMPANY, LTD, 411

BREADS, VARIOUS DIABETIC, 450

BREAKFAST FOOD, GUM GLUTEN, 450

BREITENBACH, M. J., COMPANY, 159

BRISTOL-MYERS COMPANY, 87, 179

Brobor (Gaynor-Bagstad Co.), Reports Council Pharm. & Chem., 1915,

p. 164.

Bromides with Cypripedium Compound (Truax, Greene & Co.), Reports

Council Pharm. & Chem., 1912, p. 43.

BROMIDES, PEACOCK’S, 28