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

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Title: The Propaganda for Reform in Proprietary Medicines, Vol. 1 of 2

Author: Council on Pharmacy and Chemistry

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is no longer a matter of doubt."

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cross-reference to Tables 8 and 10 but these do not exist.

THE PROPAGANDA
FOR REFORM

--IN--

Proprietary Medicines

Part I. Council Reports

Part II. Laboratory Contributions

Part III. Contributions from the Journal: Nostrums

Part IV. Contributions from the Journal: Miscellany

[Ninth Edition]

REPRINTED FROM THE JOURNAL OF THE
AMERICAN MEDICAL ASSOCIATION

PREFACE

From time to time The Journal of the American Medical Association has
published the reports of the Council on Pharmacy and Chemistry and the
Chemical Laboratory, as well as other matter on proprietary medicines.
Repeated requests for some of the matter have led to the compilation
of “The Propaganda for Reform in Proprietary Medicines,” which, in the
present volume, attains its ninth edition.

The seventh, eighth and ninth editions have been compiled on slightly
different principles from their predecessors. The therapeutic reform
work of The Journal and of the Association’s Chemical Laboratory was
at first confined almost entirely to the criticism and analysis of the
so-called ethical proprietaries. This was right; the medical profession
owed it to the public to combat the nostrum evil within its own ranks.

As the more flagrant evils of the “ethical proprietary” question
were mitigated, the Association has turned the light on the more
widespread and dangerous “patent medicine” evil. The articles devoted
to “patent medicines” or quackery being naturally of greater interest
to the general public than to the medical profession, the number
of inquiries from laymen regarding various quacks and nostrums has
steadily increased. It has been thought best, therefore, to publish
separately[1] all of the matter from The Journal relative to quackery
and to those nostrums exploited only or chiefly to the public, and to
include in the Propaganda for Reform practically none of the matter
that is of direct interest primarily to laymen. In one or two instances
in which the subjects were of equal interest to the profession and to
the public matter that has already appeared in “Nostrums and Quackery”
is also given here; but as a general rule the contents of the ninth
edition of “The Propaganda for Reform” are of strictly professional
interest. Those physicians who are desirous of obtaining in convenient
form the matter dealing with “patent medicines” should order the book
“Nostrums and Quackery” or the various pamphlets on the same subjects
that have been issued since “Nostrums and Quackery” came from the press.

[1] This matter appears in “Nostrums and Quackery,” a 700-page book,
and also in various pamphlets. Write for the descriptive price-list of
publications dealing with the nostrum evil.

The ninth edition of “Propaganda for Reform” contains a number of new
articles, greatly increasing the size of the book. It also contains
one novel feature which greatly enhances its value. The index includes
references not only to articles in the book, but also to matter on
proprietaries not accepted by the Council on Pharmacy and Chemistry
which appeared in The Journal of the American Medical Association and
elsewhere. This index makes of this edition of “Propaganda for Reform”
a very full work of reference on proprietaries which are undeserving of
recognition. It should be understood, however, that not all articles
indexed are condemned; some are merely discussed and compared.

TABLE OF CONTENTS

PART I: COUNCIL REPORTS

PAGE

Acetanilid Mixtures 9

Agar-Lac 10

Anasarcin and Anedemin 11

Maignen Antiseptic Powder 19

Tyree’s Antiseptic Powder 21

Apergels 26

Aseptikons 26

Betul-Ol 27

Peacock’s Bromides and Chionia 28

Bromidia 31

Cactus Grandiflorus 36

Calcreose 40

Campho-Phenique 40

Celerina, Aletris Cordial and Kennedy’s Pinus Canadensis,
Light and Dark 43

Cineraria Maritima 49

Hagee’s Cordial of the Extract of Cod Liver Oil Compound 51

Wampole’s Perfected and Tasteless Preparation of an Extract
of Cod Liver 52

Waterbury’s Metabolized Cod-Liver Oil Compound 54

Waterbury’s Compound 57

Colchi-Sal 58

Cypridol Capsules 59

Cystogen, Cystogen Aperient and Cystogen-Lithia 60

Cysto-Sedative 61

Taka-Diastase and Liquid Taka-Diastase 62

Digalen Omitted from N. N. R. 68

Dioradin Refused Recognition 73

Echinacea 79

Echtisia, Ecthol and Echitone 81

Ergoapiol 82

Erpiol (Dr. Schrader) 83

False Unicorn (Helonias) 84

Formurol 85

Gastrogen Tablets 87

Glyco-Heroin, Smith 88

Glyco-Thymoline 92

Glycozone 95

Gardner’s Syrup of Hydriodic Acid 97

Hyperol 100

Ingluvin 101

Intestinal Antiseptic W-A 103

Bannerman’s Intravenous Solution 105

Iodalia 106

Iodex 107

Iodia 108

Burnham’s Soluble Iodine 110

Iodotone 113

Iosaline 113

Nourry Wine 115

Labordine 115

Lactobacilline Omitted from N. N. R. 120

Reexamination of Lactopeptine 121

Meat and Beef Juices 123

Valentine’s Meat Juice 129

Medicinal Foods 131

Migrainin 135

Neurilla 136

Neurosine, Dioviburnia, Germiletum and Palpebrine 139

Oxychlorine 147

Pam-Ala, Another Worthless Quinin Substitute 149

Papayans Bell 151

Passiflora and Daniel’s Concentrated Tincture of Passiflora 156

Liquid Combinations Containing Pepsin and Pancreatin 157

Pepto-Mangan (Gude) 159

Liquid Petrolatum or “Russian Mineral Oil” 161

Clinical Experience with Liquid Paraffin (Liquid Petrolatum) 167

Angier’s Emulsion 169

Phecolates, Phecolax, Phecozymes and Phecotones 174

Phenol Sodique 175

Phytin and Fortossan 178

Prunoids 178

Sal Hepatica 179

Sanmetto 182

Secretogen 185

Sinkina 188

Somnos 193

Succus Alterans 195

Sulpho-Lythin 196

Taurocol 198

Tri-Iodides, Three Chlorides and Maizo-Lithium 198

Thialion 205

Unguentum Selenio Vanadic (V. Roemer) 207

Unicorn Root, Wild Yam and Wild Indigo 208

Proprietary Vanadium Preparations 209

Venarsen 212

Venodine 214

Veracolate 216

Hayden’s Viburnum Compound 218

Vin Mariani 221

Virol 225

PART II: CONTRIBUTIONS FROM THE CHEMICAL LABORATORY

Anusol Hemorrhoidal Suppositories 227

Aromatic Digestive Tablets 229

Burnham’s Soluble Iodin 233

“Hydrocyanate of Iron-Tilden” 235

Hymosa 238

Micajah’s Medicated Uterine Wafers 240

Noitol and Anadol 245

Pix Cresol 247

Saliodin 249

Theobromin Sodium Salicylate Versus “Diuretin”;
The Economical Aspect 251

Unguentine 254

Uricedin 256

Uriseptin 256

Zemacol 259

Zyme-Oid 261

PART III: CONTRIBUTIONS FROM THE JOURNAL: NOSTRUMS

Alleotone 264

Baume Analgésique Bengué 267

Antidiabeticum-Bauer 267

Antikamnia 268

Anusol Suppositories 280

Aspiro-Lithine 281

Bell-Ans (Pa-Pay-Ans, Bell) 282

Biosol 284

Bromin-Iodin Compound 285

Calmine 286

Camphenol 287

Chologen 288

Hagee’s Cordial of Cod-Liver Oil 289

Waterbury’s Compound Once More 291

Collyrium-Wyeth 292

Diatussin 293

Enteronol 294

Expurgo (Sanol) Anti-Diabetes 299

Formamint 303

Gomenol 304

Headache Cures 305

Hectine 308

Hydronaphthol 308

Hydrozone 309

Hypoquinidol 310

Iodonucleoid 310

Iridium 312

Iron Tropon 313

Kutnow’s Powder 314

Lymph Compound R-H and Orchitic Fluid Tablets 317

Lysol--The Evolution of a Proprietary 318

Thompson’s Malted Food Company 319

Manola 323

Mercol 326

Midol and Nurito 327

Mu-col 329

Narkine 329

Papine 330

Pasadyne 332

Pas-Avena 333

Pertussin 334

Phenalgin--A Typical Example 335

Pheno-Bromate 343

Phenolphthalein 343

Mixed Vaccine and Phylacogens 346

The Danger in Protonuclein, a Preparation Containing Thyroid 348

Purgen 349

Pyo-Atoxin 350

Resinol 352

Resor-Bisnol 353

Robinol and Sevetol 353

Salacetin 356

Sal-Codeia-Bell 357

Sanatogen 358

Sanatogen: a Scientific Investigation of Its Alleged Action
on the Recuperating Powers of the Blood 378

The Feeding Value of Sanatogen Compared with Commercial
Casein with Respect to Maintenance and Growth 385

Poehl’s Spermin in Arteriosclerosis 395

Syrup of Cocillana Compound 396

Aubergier’s Syrup of Lactucarium 399

Tartarlithine 401

Thoxos 402

Trypsogen 403

Tyree’s Antiseptic Powder 404

Vapo-Cresolene 408

Vasogen and Iodovasogen 408

Viburnum Compound--and other Nostrums 409

Wheeler’s Nerve Vitalizer 411

Zymotoid 412

PART IV: CONTRIBUTIONS FROM THE JOURNAL: MISCELLANEOUS MATTER

Acetphenetidin and Phenacetin--Their Relative Purity 414

Clean Advertising 418

Lippincott’s Magazine 419

Medical Journal Advertising 422

Medical Journals and the Great American Fraud 426

The Army and Navy Medical Record 432

The Medical Times Advertisements 438

Cause for Optimism 440

The Comparative Nutrient Value of Cod Liver Oil and Cod Liver
Oil Cordials 442

Diabetic Foods Offered for Sale in the United States 446

The Jireh Diabetic Food Company 451

The Name “Epinephrin” Versus the Name “Adrenalin” 454

The Hord Sanitarium 456

The German Propaganda for Reform 458

The German Council on Pharmacy and Chemistry 459

Grand Prix and Gold Medals for Sale 462

The Hypophosphite Fallacy 464

Buffalo Lithia Water 467

Meat Extracts and Meat Juices 470

Pharmaceutical Manufacturers and the Great American Fraud 474

Dowd’s Phosphatometer 476

Amorphous Phosphorus 478

THE PROPAGANDA FOR REFORM IN PROPRIETARY MEDICINES

PART I

COUNCIL REPORTS

ACETANILID MIXTURES[A]

Report of the Council on Pharmacy and Chemistry

[A] See also Labordine, p. 115; Headache Cures, p. 305; Anadol, p. 244;
Phenalgin, 335.

_To the Council on Pharmacy and Chemistry_:

In response to the request of your chairman we have investigated the
below-mentioned preparations and report as follows:

Specimens of the articles were bought in different cities in the open
market, and in original sealed packages, and were analyzed by some of
us or under our direction. Each article was examined by at least two
chemists, and some were subjected to several analyses. While certain
of the preparations are represented as being chemical compounds,
the specimens examined were all found to be mixtures, the principal
ingredient being acetanilid. The percentage proportions of acetanilid
given below are the minimum obtained by any of the analysts.

Soda and ammonia, combined with carbonic acid, are calculated and
reported as sodium bicarbonate and as ammonium carbonate (U. S. P.)
respectively. Salicylic acid is calculated and reported as sodium
salicylate. Diluents and other constituents than those reported were
not determined.

AMMONOL

According to the analyses of the contents of the original sealed
packages as purchased, this was found to be a mixture, and to contain
the following ingredients approximately in the proportions given:

Acetanilid. Sodium Bicarb. Ammonium Carb.
50. 25. 20.

ANTIKAMNIA[B]

[B] See also Antikamnia, The Nostrum and Its Method of Exploitation,
page 268.

Acetanilid Caffein Citric Acid Sodium Bicarb.
68. 5. 5. 20.

KOEHLER’S HEADACHE POWDERS

Acetanilid Caffein
76. 22.

ORANGEINE

Acetanilid Sodium Bicarb. Caffein
43. 18. 10.

Other constituents said to be present were not determined.

PHENALGIN[C]

[C] See also Phenalgin--A Typical Example, p. 335.

Acetanilid Sodium Bicarb. Ammonium Carb.
57. 29. 10.

Certain packages of phenalgin were purchased which on analysis did not
show ammonium carbonate.

SALACETIN[D]

[D] See also Salacetin, p. 356.

Acetanilid Sodium Bicarb. Sodium Salicylate
43. 21. 20.

We recommend that this report be printed in The Journal of the American
Medical Association.

Respectfully submitted,

J. H. Long, M.S., Sc.D., }
W. A. Puckner, Ph.G., } Committee on Chemistry,
S. P. Sadtler, Ph.D., } Council on Pharmacy and
J. Stieglitz, Ph.D., } Chemistry of the A. M. A.
H. W. Wiley, M.D., Ph.D., }

(_From The Journal A. M. A., June 3, 1905_).

AGAR-LAC

Report of the Council on Pharmacy and Chemistry

Agar-lac, said to be the product of “Agar-lac, Inc.,” is sold by E.
Fougera and Company, New York. The following “formula” for Agar-lac is
published:

“Agar-Agar with Lactic Ferments Grs. 4-1/2
Phenolphthalein Grs. 1/2”

Regarding the “lactic ferment,” the identity of which is not declared by
the manufacturer and for the viability of which no precautions appear
to be taken, the Council’s expert on lactic acid ferments reported that
_Bacillus bulgaricus_ was present in small numbers only and that there
were at least two other bacteria present, one of which is a gas-former
of the _Bacillus coli_ type.

The Council found that the amount of agar-agar in Agar-lac and
the identity of the “lactic ferment” are not declared; that the
name “Agar-lac” is blown in the glass and that the method of its
exploitation will lead laymen to use it to their detriment; that the
claims that it “facilitates assimilation of proteids” and that it is
of value as an aid to “gastro-intestinal digestion” give a false value
to the mixture and that the claims emphasize the action of agar-agar
when from the composition it is evident that the phenolphthalein action
will predominate; that the name does not indicate its predominating
constituent, phenolphthalein, and that the use of a ready-made
combination of cathartic drugs, such as agar-agar and phenolphthalein
with lactic acid ferments, is unscientific. The Council therefore
refused recognition to Agar-lac.--(_From The Journal A. M. A., Nov. 14,
1914._)

ANASARCIN AND ANEDEMIN

Reports of the Council on Pharmacy and Chemistry and Comments Thereon

The following reports were submitted to the Council by the subcommittee
to which these articles were assigned:

ANASARCIN

_To the Council on Pharmacy and Chemistry_:--Your subcommittee to
whom Anasarcin (Anasarcin Chemical Co., Winchester, Tenn.) was
assigned, herewith submits its report:

This remedy is offered in two forms: “Anasarcin Tablets,” a pretended
combination of the active principles of oxydendron arboreum, sambucus
canadensis, and urginea scilla; and “Anasarcin Elixir,” said to
contain the active principles of oxydendron, sambucus, hepatica and
potassium nitrate. The advertisements of these articles conflict with
the rules of the Council as follows:

With Rules 1 and 2: The composition of these articles is kept secret,
in that the proportion of the ingredients is not furnished. The
statement that it contains the “active principles” is misleading,
since these are for the most part unknown.

With Rule 6: The description of the pharmacologic action of Anasarcin
agrees practically with that of squill. No material part of its
effects can be attributed to the other ingredients. Nevertheless, the
advertisement studiously cultivates the impression that Anasarcin
has no relation whatever to the digitalis group in which scilla is
commonly placed. The claims are therefore misleading. The claim
of its infinite superiority to digitalis, the claims that it cures
neurasthenia, eliminates uric acid in rheumatism, and is useful in
obesity, cystitis, lumbago and eclampsia, dyspepsia and asthma, and
that it works wonders in exophthalmic goiter, appear exaggerated or
false.

The recommendation of its indiscriminate use in nephritis, for
lowering the blood-pressure and the statement (contradicted in the
firm’s own literature) that it is not depressing, are actually
dangerous.

It is recommended that the articles be refused recognition, and that
the report, with explanations, be published.

ANEDEMIN

_To the Council_:--Your subcommittee to whom Anedemin (Anedemin
Chemical Co., Winchester, Tenn.) was assigned herewith submits its
report:

Anedemin is an evident imitation of Anasarcin. It is marketed
as tablets, said to contain the isolated active principles of
strophanthus, apocynum, squill and sambucus, chemically combined.
The quantities are not stated. The therapeutic claims are copied
almost literally from the Anasarcin circulars and are equally false.
Anedemin, therefore, conflicts with Rules 1, 5, 6 and 7.

It is recommended that this report be published, with comments.

The reports were adopted by the Council and are herewith published.

W. A. Puckner, Secretary.

Anasarcin

This wonderful remedy, Anasarcin, has already been exposed in these
columns (The Journal A. M. A., Jan. 27, 1906), but it deserves
additional mention, as it teaches several important lessons of general
application. It is a typical example of the revival, under a new name
and a thin disguise, of an old, time-worn article, squill, presumably
because experience has demonstrated its general inferiority to other
drugs. Anasarcin further illustrates the dangers involved in the use
of semi-secret nostrums. It also shows how a short experience with
a widely advertised but little understood drug is apt to lead to
conclusions which more extensive experience demonstrates to be entirely
fallacious.

The first lesson is, that formulas are not always what they seem. A
hasty glance at the formula of Anasarcin tablets, the basis of the
Anasarcin dropsy cure, creates the impression that it is a non-secret
remedy; for it is said to represent a combination of the active
principles of oxydendron, sambucus and scilla. As a matter of fact,
it is a secret nostrum of the insidious kind. A formula which omits
the quantities of its potent ingredients means very little. Further
than this, we do not hesitate to charge that the claimed composition
is a deliberate deception. The circulars emphasize the claim that
Anasarcin consists of the _isolated principles_, and not of the crude
drugs. Now, the isolated active principles of sambucus and oxydendron
are not on the market, for the good and sufficient reason that no
active principles have ever been isolated. Are we to believe that
the Anasarcin Company has surpassed the accredited chemists and has
discovered such principles and is isolating them? We shall have more
to say on this subject presently; but any one in the least familiar
with the difficulties attending the isolation of organic principles
knows such an idea to be preposterous. Indeed, it is absolutely
incompatible with the exhibition of ignorance of the elementary facts
of pharmaceutical chemistry which is given by these people when they
call the active principles of digitalis and squill “alkaloids.”

It is an axiom that the effects of a mixture can only be understood
if the action of its components are known. So far as we know, the
physiologic effects of oxydendron and sambucus have never been
scientifically investigated, for the simple reason that they are too
slight and indefinite to promise results. Both are credited with some
slight, obscure diuretic action. Oxydendron, the sour wood or sorrel
tree, is a small tree of the heath family, the acid leaves of which
are said to be chewed by hunters for their pleasant taste and for the
relief of thirst. Sambucus is the common elder. It is most unlikely
that these two innocuous substances should play any part in the claimed
powerful effect of Anasarcin; they are evidently put in the formula,
we do not say in the preparation, to obscure the fact that Anasarcin
is composed principally of squill. That this is so can be gathered
unmistakably from a study of the pharmacologic action of Anasarcin as
described by its promoters:

Acting primarily on the heart and arterial systems through the
nerve ganglia, a natural physiologic balance is established
between the arterial and venous systems, whereby effusions ... are
eliminated.... Coincident with this action there is a noteworthy
_slowing_ of the pulse.... If the remedy is pushed, can be brought
down to 20 or 30 beats per minute.... Its physiological action
is to stimulate the cardiac motor-ganglia through the cardiac
plexus of the sympathetic system and at the same time exert an
inhibitory influence upon the cardiac fibers of the pneumogastric,
thereby dilating the arterioles, slowing the heart’s action, and
increasing the force of the systole.... The prolonged diastole
allows the ventricle time to completely fill, and the more forcible
contraction causes the mitral valve to close more thoroughly and at
the same time increases pressure in the coronary arteries, serving
thereby the double purpose of relieving pulmonary engorgement and
increasing heart nutrition.

Anasarcin will nauseate some persons.

To appreciate fully the meaning of this description of the actions of
Anasarcin, it should be compared with the effects of the digitalis
group, to which squill belongs. The following account is quoted
literally from a recent text-book of pharmacology (Sollmann):

The phenomena of the therapeutic stage of digitalis action are said
to be:

1. Slowing of the heart, with systole and diastole both lengthened.

2. Increased strength of beat, leading to greater efficiency of the
individual contractions, and to an increase in the total efficiency.

3. A tendency to the systolic phase.

4. A rise of blood-pressure, due mainly to the increased action of
the heart, but partly also to a vasoconstriction.

The therapeutic action may be explained, in part, as follows:

A larger amount of blood will be thrown into the aorta and coronary
circulation. The first effect will be an improved nutrition of the
heart.... The tonic action ... narrows the ring of the valves, brings
them together, narrows the orifice.... The venous congestion will
tend to be relieved. This relief ... will fall in the first place on
the lungs.... The lowering of the venous pressure will tend to cause
absorption of the effusions.

The nauseant action of squill, which is alluded to in connection with
Anasarcin, is too well known to require more than a mention.

In brief, then, it appears from the statements of the Anasarcin Company
that the action of the remedy is that of squill and that the other
ingredients are a mere blind. It is, of course, well known that squill
can be used as a substitute for digitalis in cardiac dropsy, although
it is generally considered very inferior to the latter drug. Rose
Bradford, for instance, states: “Squill is not used to any extent in
the treatment of cardiac disease and cardiac dropsy, digitalis being
a far more efficient and less toxic substance.” However, it has been
frequently observed that digitalis occasionally fails, and it may then
be replaced successfully by another member of the group. At all events,
it is very likely that squill is a fairly efficient substitute for
digitalis, especially when it is supplemented by a very free course
of Epsom salts and by potassium nitrate (the active ingredient of
Anasarcin Elixir), both of which are stated to be essential adjuvants
to the Anasarcin (or squill) tablets. There can be no objection to the
use of squill when it is indicated; but any one who wishes to use it
should do so with his eyes open, knowing what substance he is using and
how much (which he does not in Anasarcin); knowing also that it has the
same indications and limitations as digitalis. He should not be misled
by such statements as the following:

“Does what dropsy medicaments have hitherto failed to accomplish.”

“Superior to digitalis, strophanthus, scoparius, squills, acetate
of potash and the hydragogue cathartics all put together.”

“The only known relief [how modest!] and permanent cure of
dropsies.”

“Unrivaled heart tonic.” “The most powerful agent known.”

Any one wishing to use squill should take the trouble to acquaint
himself with the results obtained by competent and independent
observers, and not rely on it in eclampsia, septicemia, “vices of
civilization,” all forms of neurasthenia, as “an active eliminator of
uric acid in rheumatism,” in hepatic cirrhosis, dyspepsia, asthma,
obesity, cystitis (!), lumbago, exophthalmic goiter, etc.

He should also learn the contra-indications to the use of squill,
deducible from the fact that it causes vasoconstriction and raises
the blood-pressure (prohibiting its use in Bright’s disease and
arteriosclerosis), and that it produces marked gastric irritation,
consequently nausea and depression, that it is a very toxic agent, and
that the dangers of cumulative action must be borne in mind. In respect
to these the advertisements of the Anasarcin people are little short of
criminal, for these state:

“Safe in administration.” “Non-toxic as ordinarily administered.”
“Will nauseate some persons,” but “the reaction from the temporary
depression is prompt.” “In Bright’s disease, both the interstitial
and parenchymatous forms of nephritis, acute or chronic, no remedy
... to equal it in efficacy.” “Without increasing the debility of
the patient or interfering with nutrition by producing loss of
appetite....” “This treatment is to be continued without cessation
until all symptoms of dropsy have disappeared.”

Physicians who are inclined to disregard this warning, and who follow
the advice of the Anasarcin people, should remember that their
patients--or their friends--will put the blame for the results, which
are bound to follow sooner or later, on the prescribers, and not on the
deceptive advertisements of the Anasarcin Chemical Company.

There is another little matter which throws an illuminating side-light
on the Anasarcin Company. They take every occasion to say that
Anasarcin is “not offered to the laity,” “never sold to the laity,”
etc.; but witness the following, which was found in the _Retail
Druggist_ of May, 1906, p. 179. The italics are ours.

CURE FOR DROPSY.

“As every druggist knows, dropsy has been one of the incurable
diseases when caused either from heart, liver or kidney trouble. A
_pharmacist_ in Winchester, Tenn., _has worked out a remedy_ called
Anasarcin, which he is exploiting to the physicians, and his remedy
is showing itself as possessing great merit. Several hopeless cases
have been treated as a last resort by Anasarcin and in a very short
time the patient has shown marked improvement and has effected
permanent cures.

“The result of the cases as handled by the physician with the aid
of Anasarcin has been so easily and quickly cured that physicians
of Tennessee and the southern states are high in their praises of
the remedy. The company which now manufactures and sells it is
known as the Anasarcin Chemical Co., of Winchester, Tenn. _Any
druggist who knows of a case of dropsy would be conferring a favor
on the patient and mankind in general by telling the party_ or
his physician _of the southern pharmacist_, and we have no doubt
but what a prompt relief and permanent cure would be affected.”
[Probably means effected.--Ed.]

Anedemin

If we are disposed to doubt the vaunted scientific ability of the
Anasarcin Company, we are forced to admire their business methods,
at least, if there is any truth in the saying that imitation is the
seal of success. Anasarcin has had this rather undesirable compliment
paid to it, for its native town of Winchester has given birth to
another remedy, Anedemin, which looks like a fair-haired twin
brother. The Anedemin Company has adopted Anasarcin almost bodily.
The name--“opposed to edema”--is about as close as the copyright laws
permit. The pharmacologic and therapeutic claims agree almost literally
with those of Anasarcin and contain the same exaggerations and
dangerous misstatements. There is the same emphasis on free purgation
with Epsom salts. The dose is the same. Both are marketed at $2.00 for
a box of 100--only the Anedemin people have adopted the prize package
device of throwing in 20 or 30 tablets extra, for good measure, and
give a discount of 75 cents or so.

[Illustration: Laboratory and Warehouse of the Anasarcin Chemical
Company, Winchester, Tenn.]

In short, the Anedemin Company has appropriated all of Anasarcin which
they considered of any value. It is, therefore, rather suggestive
that they drew the line at the formula. Anasarcin is said to contain
squill, sambucus and oxydendron; Anedemin discards the oxydendron and
reinforces the squill with strophanthus and apocynum. Notwithstanding
this material change in composition, the actions are described as
identical; this is again rather suggestive.

The Anedemin Company, like the Anasarcin Company, scorns crude
drugs and claims to use only the isolated principles. It was saved
the trouble of discovering active principles for strophanthus and
apocynum, for these are known; but it managed to find some scope for
its inventive genius, “both drugs being so chemically treated and
disposed as to absolutely eliminate all objectionable and disagreeable
properties and effects” so as to convert a vasoconstrictor action into
a dilator action; so as to render them non-toxic and non-cumulative;
so as to deprive apocynum of its characteristic nauseant effect. Who
can say that the days of miracles are past? Even this is not the limit
of Anedemin alchemy; if we are to believe their claims, they have
succeeded in forcing strophanthin, apocynum, scillain, etc., to combine
with each other: “It is a _definite chemical compound_ of the active
principles” of these drugs! This makes the achievements of Emil Fischer
in synthesizing sugars and proteids appear as mere child’s play.

Since the formulas were completed, however, clinical reports have
been numerous enough--almost too numerous, if we are to believe
them. Anedemin has been on the market for less than three years;
the circulars emphasize that testimonials and endorsements are not
solicited. Nevertheless, we are told that it is “endorsed by over fifty
thousand clinicians throughout the United States.” Since the total
number of physicians in the United States and Canada is only about
128,000, this means that nearly every second physician has endorsed
Anedemin. The Anasarcin Company solicits endorsements and they seem
to do the larger business. Hence the majority of physicians of the
United States must have written an endorsement of either Anedemin or
Anasarcin, or both. Or is this statement another “invention”? It is a
little peculiar that nearly all the endorsements come from small towns
in sparsely settled districts; practically none from the centers of
population. Does this mean that dropsy is more common in the rural
communities than in the cities?

THE INVENTORS OF ANASARCIN AND ANEDEMIN

Even the newspapers, when they tax our credulity with pretended
scientific “discoveries,” feel the moral obligation of justifying
themselves by telling us something of the personality and experience
of the discoverers. We may ask, therefore, who are these expert
pharmaceutic and synthetic chemists, these manufacturers of active
principles, these skilled clinicians of wide experience, who have
“intelligently built up the formula by wide application”? What are
we told of these men who ask us to believe, on their mere assurance,
in miracles and feats of magic; who tell us that they have converted
neutral principles into alkaloids, that they have effected definite
chemical compounds between these neutral principles, that they have
discovered principles that do not exist, that they have changed the
actions of these principles to suit their wishes, that, in short, they
have reversed the laws of Nature?

These companies are located in Winchester, Tenn., a town of about 1,500
inhabitants, situated in an agricultural country. The town boasts of
neither scientific schools, colleges, universities nor laboratories.
The Anasarcin Company was organized in 1902, the incorporators
and directors being Dr. John W. Grisard and his sons, Dr. John P.
Grisard, B. A. Grisard, and A. F. Grisard, and Will E. Walker, all of
Winchester. Dr. John W. Grisard seems to be the originator and promoter
of Anasarcin. W. E. Walker is an insurance solicitor of Winchester
and is not actively identified with the business. We are informed
that he owns but a single share of stock having a face value of $100,
and that he was added to the company in order to comply with the laws
of Tennessee, which require five directors for any corporation. Dr.
John W. Grisard, the father, has practically retired, but still has a
general supervising interest in the business. There is no regularly
licensed pharmacist or chemist connected with the company. The office
is in the rear of a jewelry store in the business part of Winchester
and on the second floor above. According to our reporter, an office
force of about ten stenographers and clerks handles the correspondence
and labels and sends out the preparation which is made in a crude frame
building located on a side street and without laboratory equipment.
According to our reporter, the work is done by the Grisards and a
colored man.

The Anedemin Chemical Company was organized in 1905 with a capital of
$20,000, the incorporators and directors being Dr. T. B. Anderton,
Floyd Estill, J. J. Lynch, J. M. Littleton and I. G. Phillips, all
residents of Winchester, and all lawyers with the exception of Dr.
T. B. Anderton. A Mr. Gordon, a clerical employee of the company, is
reported to have active charge of the business, to prepare the medicine
and conduct the correspondence. The office headquarters, laboratory and
complete outfit of the Anedemin Company comprises two rooms over the
law office of Estill & Littleton. No one connected with the company is
a regularly licensed pharmacist or graduate chemist.

Of the six physicians located in Winchester, three (50 per cent.)
are engaged in the dropsical cure business. Poor Winchester! Aside
from their connection with these two nostrums, these physicians may
be estimable and worthy citizens, but where, pray, did they find the
extensive clinical facilities and pharmaceutical knowledge necessary
for their wonderful and epoch-making discovery? Were they aided
in their scientific work by the four lawyers connected with the
Anedemin Company or by the insurance solicitor who is a director of
the Anasarcin Company? Did the 1,500 inhabitants of the town furnish
the vast clinical material necessary for discovering and working out
the formulas of these two preparations? If so, we fear that dropsical
affections are much more prevalent in Winchester than in any other
known spot on the globe. This matter should be investigated. Without
doubt the vital statistics of Franklin County would be most interesting
and we commend them to the special attention of the medical profession
in Tennessee.--(_From The Journal A. M. A., May 4 and 11, 1907._)

MAIGNEN ANTISEPTIC POWDER

Report of the Council on Pharmacy and Chemistry

The report which appears below was submitted by a referee and after
adoption by the Council was sent to the manufacturer for comment, in
accordance with the Council’s regular procedure in such cases. The
manufacturer’s comments were transmitted to a second referee, who
reported that after a careful consideration of the manufacturer’s
reply he saw no valid reason for a modification of the report. The
referee also reported that a visit to the Maignen Institute further
served to convince him of the viciousness of the treatment as given and
that the records made by the persons in the employ of the institute
were too inadequate to serve as clinical evidence. On the referee’s
recommendation, the report as originally adopted was reendorsed by the
Council and authorized for publication.

W. A. Puckner, Secretary.

Maignen Antiseptic Powder is marketed by the “Maignen Institute for
the Study of Bacterial Diseases,” Philadelphia. It is claimed to be
a mixture of calcium hydroxid, sodium carbonate, aluminum sulphate
and boric acid, but no statement as to the amount of the several
constituents is furnished. Its action depends on the sodium hydroxid
which is formed when the powder is treated with water, 1 Gm. of the
powder as now submitted to the Council yielding 0.32 Gm. of sodium
hydroxid (NaOH) and a specimen obtained a year ago yielding 0.28 Gm.
Its promiscuous use is recommended both to physicians and to the public
with claims which are extravagant, preposterous and even dangerous.

A pamphlet, clearly intended for the laity, entitled “What Is Catarrh?”
gives direction for the “sterilization” of the nose, throat, stomach,
lungs, eyes, gums, mouth and the genito-urinary tract. The following,
taken from this pamphlet, illustrates the absurdity of the claims made
for Maignen Antiseptic Powder:

“STERILIZATION OF THE STOMACH

“TAKE of the Maignen Antiseptic Powder half the quantity raised on
a dime, scant.

“ADD to a tumbler of water, preferably warm, and stir.

“DRINK SLOWLY.

“THIS IS WHAT MAY HAPPEN:

“1). Belching may be the first indication of the sterilization of
the stomach.

“2). The excess of acidity is corrected.

“3). The fermentation is stopped.

“4). The sterilization extends to the Intestinal Tract.

“5). The bowels are regulated without purgation.

“6). The whole metabolic process is improved.

“WHEN AND HOW OFTEN TO DRINK THE ANTISEPTIC SOLUTION.

“a). For Indigestion, whenever distressed, before or after meals.

“b). For Constipation, half an hour before breakfast or last thing
at night.

“c). For Gastro-Intestinal troubles, such as Typhoid Fever,
Dysentery and Cholera, which are the most serious forms of
catarrhal inflammation, take half a tumbler or a whole tumbler of
hot water with half the quantity of Powder raised on a dime every
hour, and between times a glass of generous [sic] wine.

“REMARKS

“The sterilization recommended here is a plain disinfecting process
which does not interfere with medical treatment. It is, on the
contrary, of great assistance to it.

“It has been found very effective in breaking up the cigarette
habit. It does away with the craving by removing the morbid
irritation of the mucous membrane.”

Eighty-eight disorders are listed in a pamphlet entitled “Antiseptic
Therapeutics” all of which are reported as having been treated with
success. The dangerous character of the Maignen “sterilization”
propaganda is illustrated by a pamphlet “First Aid to Baby-Sick” and by
the recommendation on the trade package:

“To prevent Blood Poisoning, Lockjaw, Hydrophobia and Infectious
Diseases.”

The legend on the trade package and the advertising matter contained in
it are likely to lead the public to place dependence on a weak sodium
hydroxid solution as a means of preventing blood-poison, lockjaw,
hydrophobia and infectious diseases. The pamphlet “First Aid to
Baby-Sick” recommends its use in sore eyes, teething and sore mouth,
sore throat, running ears, running nose, sore chest, summer complaint,
skin troubles and infection after vaccination; if any trust is put in
these claims, they are bound to lead to the sacrifice of many infants
through neglect of proper treatment.

Patent No. 1,086,339 has been granted on this powder to P. J. A.
Maignen of Philadelphia by the U. S. patent office on the following
specification of claim made in the application:

“1. A process for destroying microorganisms on living tissue,
without injuring the latter ... whereby the growth of such
organisms is inhibited and their substance dissolved without
deleterious effect upon contiguous healthy tissue.”

With brazen assurance this grant has been twisted by the unscrupulous
promoters into a government endorsement of the preparation. It, of
course, means nothing of the sort, as, no doubt, in accordance with
legal routine the patent was granted without any investigation by the
patent office to determine the effectiveness of the powder for the
purpose claimed.

In view of the dangerous, unwarranted and absurd claims made for
Maignen Antiseptic Powder the referee recommends that it be refused
recognition, and that the Council declare its agreement with views
expressed in the article “Maignen Pulv.” published in The Journal, Feb.
15, 1913, p. 537, particularly the following:

“The germicidal powers of strong alkalies have long been known,
but the inconvenience of their application to tissues and
mucous membranes has prevented their use. That they will be of
service when sufficiently diluted not to irritate the tissues is
improbable, for the antiseptic power of such solution is slight and
the disinfectant value practically nil.”

Because the Maignen Institute has twisted the granting of U. S. patent
No. 1,086,339 into a quasi-endorsement of the claims made for Maignen
Antiseptic Powder it is recommended that a copy of this report be sent
to the Commissioner of Patents as a protest against the present law,
which authorizes the granting of patents on unproved and improbable
medical claims.--(_From The Journal A. M. A., Nov. 14, 1914._)

TYREE’S ANTISEPTIC POWDER[E]

Report of the Council on Pharmacy and Chemistry with Comments

[E] See also Tyree’s Antiseptic Powder, p. 404.

Tyree’s antiseptic powder was assigned for examination to a
subcommittee of the Council, which made the following report:

_To the Council on Pharmacy and Chemistry_:--Your subcommittee, to whom
was assigned Tyree’s Pulv. Antiseptic Comp., marketed by J. S. Tyree,
Washington, D. C., reports as follows: The label on the package states:
“This preparation is a scientific combination of borate of sodium,
alumen, carbolic acid, glycerin and the crystallized principles of
thyme, eucalyptus, gaultheria and mentha, in the form of a powder,” etc.

The statement that the powder contains the crystalline principles of
thyme, eucalyptus, gaultheria and mentha is vague and misleading,
since the chief medical constituents of eucalyptus and gaultheria are
liquids, but it tends to convey the impression that the powder contains
the essential constituents of these drugs, namely, thymol, oil of
eucalyptus or eucalyptol, oil of wintergreen, or methyl salicylate, and
menthol.

The literature supplied to physicians _claims_ its composition to
be: “Parts, sod. bor., 50; alumen, 50; ac. carbol., 5; glycerin, 5;
the cryst. principles of thyme, 5; eucalyptus, 5; gaultheria, 5, and
mentha, 5.”

The composition, therefore, might be expressed as follows:

Sodium borate (borax) 50 parts, or 38.46 per cent.
Alum 50 parts, or 38.46 per cent.
Phenol (carbolic acid) 5 parts, or 3.85 per cent.
Glycerin 5 parts, or 3.85 per cent.
Thymol 5 parts, or 3.85 per cent.
Oil of eucalyptus or eucalyptol 5 parts, or 3.85 per cent.
Oil of gaultheria
(or methyl salicylate) 5 parts, or 3.85 per cent.
Menthol 5 parts, or 3.85 per cent.

Analysis of specimens purchased from different sources in the open
market were made under our direction. The reports of the chemists
show that Tyree’s antiseptic powder contains no borax, or mere traces
only, and that it contains no alum, or mere traces only. Instead, the
analyses show that boric acid and zinc sulphate are the essential
constituents. The amounts of carbolic acid, thymol, menthol, etc.,
contained in the powder, if present, were far below the quantities
indicated by the formula. The presence of glycerin could not be
demonstrated, and, if present, the amount must be very small.

One chemist reports: The result of analysis shows that different
samples differ slightly in composition, but that the following
indicates the average composition of the product:

Per Cent.
Zinc sulphate, anhydrous 15.56
Boric acid 81.26
Volatile matter at 100° C. for four hours 0.45

The undetermined portion consists of salicylic acid, carbolic acid,
menthol and eucalyptol; possibly other antiseptic agents may be present
in very minute quantities.

From the above findings we conclude that Tyree’s antiseptic powder is
a mixture of boric acid and dried zinc sulphate and antiseptic bodies,
such as menthol, salicylic acid and carbolic acid, eucalyptol, etc.
From this it can be readily seen that the label, which is supposed
to set forth the composition of Tyree’s antiseptic powder, is not in
accord with the facts. The powder does not contain either borate of
sodium or alum, and the presence of glycerin could not be established.
The antiseptic agents, exclusive of the boric acid, are present only in
small amounts.

The report of another analysis concludes as follows:

It evidently contains less than the amount stated of the principles of
thyme, eucalyptus, wintergreen and mint. It also contains a very small
amount indeed of carbolic acid, much less than that stated. We have
been unable to identify certainly the presence of glycerin, and it is
doubtful if it be present.

From the result of the analysis we feel confident that the preparation
is to all intents and purposes a mixture of boric acid and sulphate of
zinc.

The carbolic acid, thyme, eucalyptus, wintergreen, etc., if present,
are present only in sufficient amount to give the compound a
satisfactory odor.

In view of the fact that J. S. Tyree has given wide publicity to
a formula which the preceding report has shown to be a deliberate
misrepresentation of facts, it is recommended that the article be
refused recognition by the Council on Pharmacy and Chemistry, and
that this report be published in The Journal of the American Medical
Association.

The recommendation of the subcommittee was adopted by the Council in
accordance with which the report is published.

W. A. Puckner, Secretary.

Mr. Tyree, in a letter to Dr. Simmons (which he states he writes at
the request of Dr. Kebler of the Drug Laboratory of the Department
of Agriculture, though he is under no moral or financial obligation
to do so), says that it has been his intention to inform the medical
profession of his reasons for changing the formula of Tyree’s
Antiseptic Powder from an alum and borax base to a boracic acid and
zinc base. He states that this change was made at the suggestion
of prominent physicians connected with hospital clinics on nose
and throat, venereal and other conditions and that he has had in
contemplation the omission from the label of the various conditions to
which the preparation is applicable.

Mr. Tyree, it will be seen, assumes the right to sell to physicians a
preparation with a descriptive formula which he acknowledges is false,
and he presumes to use his own pleasure as to the time when he will
inform them of its true composition.

Mr. Tyree does not state when he changed the formula. We do not know
whether it was a year ago, five years ago or ten years ago, but we do
know that the package which was used in making the first analysis was
purchased as early as last February, and the first chemist’s report
was submitted to the Council March 5, 1906. On April 4 Mr. Tyree was
notified by the Council that the composition of Tyree’s Antiseptic
Powder did not correspond to the formula published by him.

Whether or not Mr. Tyree is justified in offering our profession a
preparation as composed chiefly of borax and alum when in reality it is
chiefly composed of boric acid and zinc sulphate, we leave physicians
to judge.

Discrepancies Between Facts and Claims--Unfortunate
Attempts of Mr. Tyree at Explanation

A report from the Council on Pharmacy and Chemistry on Tyree’s
Antiseptic Powder appeared in The Journal, Oct. 20, 1906. This showed
that the preparation, advertised as a “scientific combination of
borate of sodium, alumen, carbolic acid, glycerin and the crystallized
principles of thyme, eucalyptus, gaultheria and mentha, in the form
of a powder.” was essentially a mixture of boric acid and sulphate
of zinc--approximately four-fifths of the former to one-fifth of
the latter. “The carbolic acid, thyme, eucalyptus, wintergreen,
etc., if present, are present only in sufficient amount to give
the compound a satisfactory odor.” As will be remembered, in the
correspondence published at that time, Mr. Tyree attempted to explain
the discrepancies between his statements and the proved facts by
intimating that he had recently changed the formula, and that it was
his intention “on or about the first of February to state to the
medical profession his reasons for changing the formula,” and that
the change had been made “a short time ago, at the suggestion of
several prominent gentlemen.” Since that time, through circulars and
other advertisements, Mr. Tyree has attempted to explain the matter
in various ways. In his latest circular letter he seems to make a
deliberate attempt to mislead our profession and to misrepresent
facts to a degree that makes it almost impossible to believe that the
circular came from a man who claims to be honorable.

First, however, we shall take this opportunity to publish some matter
which we have had in reserve since the first exposé was made last
October. When it was realized that Mr. Tyree intended to defend himself
by claiming that a change had recently been made in the powder, we took
occasion to try to secure some of the preparation that had been on the
market for a long time. In this we succeeded very well. From a Chicago
druggist one package was bought which had been in the store at least
since July, 1902--how much longer is not known. The druggist from whom
the powder was obtained bought the drug store in July, 1902, and this
powder was on hand at that time, none having been bought since. This
particular powder was analyzed by a chemist, who found the composition
practically the same as that given in the Council’s report, this
chemist estimating that it contained approximately 81 per cent. boric
acid and 14 per cent. anhydrous zinc sulphate. Bearing in mind that for
at least four years and ten months Tyree’s Powder has been essentially
the same as it is today, this letter is very interesting: (The comments
in brackets are, of course, ours.)

“J. S. TYREE,
“Chemist,
“WASHINGTON, D. C.

“April 16, 1907.

“Dr. --------,

“----,

“_My Dear Sir_:--Doctors and medical publications of extreme and
prejudicial minds often hold and express opinions in honorable
faith, but like all critics, they are not always familiar with
the conditions composing their opinions, and are often given to
expressing them without knowledge of the true motives and facts in
the case.

“If you will read an article that appeared in one of the medical
weeklies some time ago [The Journal of the American Medical
Association, of course] and which has been copied by several of its
offsprings [not many we regret to say] relating to Tyree’s Antiseptic
Powder, you will see that I had previously informed the editor as
well as his council of investigators, that at the suggestion of
prominent physicians, extensive clinical experimenting [sic] were
being made with some slight [! ! !] changes in my powder, the object
being to develop and extend its usefulness in new lines [It had
already been recommended for about everything[2]] and at the same
time make it more acceptable to the general run of the profession.
I also notified this editor that these investigations would not be
completed until the first of the present year, after which time
these slight [! ! !] changes in the formula of Tyree’s Powder would
be announced. [It is now the middle of May; when and where were the
changes announced?[3]]

[2] From the circular accompanying a package bought over a year ago,
we find the powder recommended for the following conditions: “For
Leucorrhea, Gonorrhea, Vaginitis, Pruritus, Ulcerated conditions of
the mucus membrane.... Scrofulous, Syphilitic and Varicose Ulcers
... for Spraying the Nose and Throat, ... for immediate deodorizing
and disinfecting ... for prickly heat, poison oak, squamous eczema
and other conditions of similar nature.... As a deodorant and
prophylactic in dental work, ... for disinfecting offensive cavities
... for profuse and offensive perspiration, swelling, soreness and
burning of the body and feet.... As a delightful toilet preparation
after the bath and shaving.”

[3] Last January the national Food and Drugs Act went into effect;
one of its provisions is that the label must not lie. This is not the
exact verbiage, but it means the same thing. So, instead of repeating
the old false statements, the new label of Tyree’s antiseptic powder
contains nothing whatever about the composition; the law does not
require that it should--unless the preparation contains certain
specified drugs. Why is the formula omitted?

“There is nothing new, startling or dangerous in such changes
in formulas. The Pharmacopeias and national books of authority
are continuously improving their formulas. It is the same with
every preparation on the market. [Mr. Tyree, as a nostrum maker,
is in a position to know. His plea evidently is: “I am no worse
than others.”] The apparent difficulty in my case is caused by my
exceptional frankness [“exceptional frankness” is good under the
circumstances] with the profession in telling them [when and where?]
about this improvement before I was ready to announce full details
and particulars, or place my improved [sic] powder on the market.

“Yours very truly,
“J. S. Tyree.”

For years Mr. Tyree has been misleading physicians by making false
statements regarding the composition of his powder and regarding
its value as a therapeutic agent. When exposed he tries to defend
himself and his business by statements and excuses that are worthy of
a schoolboy trying to get out of a bad scrape. We would respectfully
suggest to him that he either take his wonderful powder off the
market, or--which would probably amount to the same thing--tell the
truth, and the whole truth, about it.--(_From The Journal A. M. A., May
18, 1907._)

APERGOLS[F]

Abstract of Report of the Council on Pharmacy and Chemistry

[F] For abstract of report on Ergoapiol see p. 82; for the unabridged
report of the Council’s action on Apergols, see Reports Council Pharm.
and Chem., 1914, p. 64.

Apergols, put out by H. K. Wampole Co., Inc., is alleged to be a
“Uterine Stimulant.” Apergols is apparently an inversion of the name
Ergoapiol and the preparation appears to have essentially the same
formula, namely:

Apiol 5 min.
Oil Savine 1/2 min.
Ergotin 1 gr.
Aloin 1/8 gr.
Aromatics q. s.

As in Ergoapiol, the constituent referred to in the formula as “Apiol”
appears to be oleoresin of parsley-seed instead of the definite
substance apiol described in New and Nonofficial Remedies. In general
the claims made for Apergols are the same as those made for Ergoapiol
(see p. 82). The Council refused admission to Apergols because they are
advertised indirectly to the public, because of unwarranted therapeutic
claims, because of the non-descriptive name and because the product is
unscientific.--(_From The Journal A. M. A., Dec. 12, 1914._)

ASEPTIKONS

Report of the Council on Pharmacy and Chemistry

Aseptikons are vaginal suppositories sold by the Chinosol Co. of New
York. Each suppository is said to contain:

Ac. Salicylici 2 gr.
Ac. Borici 10 gr.
Quin. purae (Alkal.) 1 gr.
Chinosol 2 gr.
But. Cacao 60 gr.

The following claims appear in advertisements:

“These suppositories are indicated in cervicitis, leucorrhea,
specific and non-specific vulvo-vaginitis and in all cases where
complete vaginal antisepsis is desired.”

“Non Toxic, Non Irritating; No Damage to Membranes. Yet a More
Powerful Antiseptic than Bichloride.”

The Council decided that the foregoing claims in the absence of
evidence must be held exaggerated and likely to mislead, and also
that the claim “Stronger than Bichloride” which appears on the box is
misleading.

The position of the Council is that “In the case of pharmaceutical
preparations or mixtures the trade name must be so framed as to
indicate the most potent ingredients.” The name Aseptikons does not
give any indication of the ingredients of the product.

The Council holds that “The combination of two or more remedies in a
mixture must be considered contrary to scientific medicine unless a
distinct reason exists for such combination.” No evidence has been
submitted to establish the value of the combination in Aseptikons.

On the basis of the evidence submitted the Council voted that
Aseptikons be refused recognition because unwarranted and misleading
therapeutic claims are made, because the name does not indicate its
potent constituents, and because the combination of two or more
remedies in a mixture is considered contrary to scientific medicine
unless a distinct reason exists for such combination.--(_From The
Journal A. M. A., Nov. 14, 1914._)

BETUL-OL[G]

Abstract of Report of the Council on Pharmacy and Chemistry

[G] For the unabridged report of the Council’s action on Betul-ol, see
Reports Council Pharm. and Chem., 1914, p. 62.

Betul-ol (E. Fougera and Co., New York) is a methyl salicylate
preparation advertised to physicians (and indirectly to the public)
as an external analgesic and anti-rheumatic. The statements regarding
its composition are vague, misleading and, as shown by examination in
the Chemical Laboratory of the American Medical Association, untrue.
The therapeutic claims are based on discarded theories. Although the
alleged superiority of natural over synthetic salicylates has been
disproved, physicians are urged to use Betul-ol because it contains,
or is alleged to contain, a natural salicylate. Another discarded
theory is pressed into service in the claim that the chloral in
the mixture will be absorbed and converted into chloroform in the
blood. The recommendations for the use of Betul-ol in rheumatism are
likely to lead the public to the self-treatment of rheumatism. In
view of the serious complications and sequelae of rheumatic fever
this recommendation is utterly unjustifiable and a danger to public
health--even if the external application of this mixture in uncertain
doses were as effective as a proper internal use of salicylates--a
theory contrary to experience and unsupported by adequate evidence.

The Council therefore refused recognition to Betul-ol.--(_From The
Journal A. M. A., Dec. 12, 1914._)

PEACOCK’S BROMIDES AND CHIONIA

Reports of the Council on Pharmacy and Chemistry

The Council has authorized publication of the following reports on
Peacock’s Bromides and Chionia, sold by the Peacock Chemical Company,
St. Louis.

W. A. Puckner, Secretary.

PEACOCK’S BROMIDES

This is another nostrum of the ordinary mixture type. Of the various
statements concerning composition furnished by the company, the
following gives as much information as any:

“In Peacock’s Bromides it is designed to unite fifteen grains of
the purest bromides of Potassium, Sodium, Ammonium, Calcium and
Lithium, in such proportion as to insure the bromine equivalent of
potassium bromide. Each fluid drachm about equals, in medicinal
strength, fifteen grains of potassium bromide.”

The label on the trade package indicates the presence of 10 per cent.
of alcohol. It will be observed that the proportions of the different
bromids are not stated. Hence, the assertion of the Peacock Chemical
Company that “there is nothing secret in this compound” cannot be true.
A physician prescribing it cannot know how much of each ingredient he
is giving; it may be 14-1/2 grains of potassium bromid and 1/8 grain
each of sodium, ammonium, calcium and lithium bromid, or any other of
an enormous number of possible permutations of the proportions.

While the theoretical basis of bromid medication is not yet fully
settled, the weight of the best pharmacologic authority and clinical
experience is decidedly against the dogmatic claim of the Peacock
Chemical Company that “the best result is obtained by prescribing
a combination of bromides.” And if there were any advantage in
prescribing such a combination, the physician ought to regulate the
proportions.

The following quotations are from the advertising matter:

“Being uniform in purity and therapeutic power, it can be relied
upon to produce clinical results which it is believed cannot be
obtained from the use of commercial bromide substitutes.”

“The purity, quality and constant uniformity of this high grade
product have long made it a standard bromide preparation.”

These claims are unfounded. The analyses published in the concern’s own
advertising “literature” show a variation of 8 per cent., in the bromid
content, which certainly indicates a sufficient lack of uniformity.

Again quoting:

“In order to insure the best results the bromides must be pure,
i. e., free from alkalies and almost free from chlorides. The
U. S. P. allows three per cent. of chlorides. Peacock’s Bromides
contains the least possible amount of this impurity. Bromism is
therefore less frequent in those cases in which this preparation is
employed.”

In view of the claim of low chlorid content, it is interesting to note
that the analyses above referred to show that the chlorid content is
actually higher than that of some other bromid preparations on the
market.

The claim of merit on the ground of freedom from chlorids is, of
course, absurd, and must be regarded as an attempt to play upon the
credulity of the doctor. As a matter of fact, the average individual
takes with his food many times the amount of chlorid he could possibly
take in contaminated bromid. The 10 per cent. of alcohol would
undoubtedly have a greater disturbing influence on the bromid action
than the amount of chlorid that might be present in any bromid on the
market.

Then we have the statement that, owing to this freedom from chlorids:

“Bromism is therefore less in those cases in which the preparation
is employed.”

Sodium chlorid, even as an impurity, would retard rather than favor the
development of bromism; sodium chlorid is even used as an antidote in
bromid poisoning.

The therapeutic claims lay stress on the value of the bromids in
sleeplessness, epilepsy, sexual excitement, tetanus, infantile
convulsions, chorea, delirium tremens, the climacteric, migraine,
headache due to pelvic conditions, ovarian neuralgia, etc. These
and other claims, while too vague to be branded as falsehoods, are
misleading and not in accordance with modern teaching or practice; the
latter recognize the limitations of bromid therapy as well as its scope
and advantages. For instance, in epilepsy the company asserts that:

“Large doses must be given if we expect to control the convulsions.
We are to be guided by the frequency and the severity of the
seizures, the saturation of the system by bromides and by the age
of the patient. The rule is ‘large doses for long periods but with
occasional periodic monthly or quarterly omissions.’ When we have
succeeded in controlling the convulsions in so far as greatly
diminishing the frequency and severity of the attacks we may then
attempt to decrease the dose, but the results must be carefully
watched. Increase in frequency of convulsive seizures is a sign
that the bromides must again be pushed as before.”

The best modern clinical teaching concerning the treatment of epilepsy
is that bromids should be avoided except as a last resort. Bromids
do not cure, and the amount necessary to control the convulsions may
produce a degree of mental hebetude that is a greater evil than the
disease itself.

It is recommended that the preparation be held ineligible for admission
to N. N. R., because of its conflict with Rules 1, 4, 6 and 10 of the
Council, and that this report be published.

CHIONIA

Chionia, according to the statement of the Peacock Chemical Company,
which exploits the product, contains 19 per cent. alcohol and is “A
Preparation of Chionanthus Virginica.”[4]

[4] Of Chionanthus Virginica or fringe-tree, the Council on Pharmacy
and Chemistry in its 1912 report on “Some Unimportant Drugs” said:
“The drug is much used by eclectics and homeopathists, especially as
a depurant in hepatic and syphilitic disorders.... The claims for
this remedy are not supported by experimental evidence and clinical
reports of its use fail to show indications of discriminating critical
observation. It is not noticed by most pharmacologic authorities.”

This preparation is advertised particularly as “a potent hepatic
stimulant” and special claims are made for it in various disturbances
of the liver:

“Chionia is very well adapted in the treatment of hepatic
congestion owing to its specific action in depleting the portal
circulation.”

In passive congestion of the liver, the manufacturers would have us
believe

“... we have a drug in Chionia that will stimulate the circulation
of the blood and lymphatics of the liver as well as stimulate its
physiological activities and instead of the patient vomiting the
blood an internal depletion of the liver occurs.”

“... in cases of simple jaundice due to circulatory (congestive)
changes in the liver, Chionia is the drug ‘par excellence’ that
will rapidly cause a disappearance of this symptom.”

As a prophylactic against eclampsia, if a history of torpidity of the
liver is obtained:

“CHIONIA should be used during the major portion of child-bearing
period because it acts directly on the liver stimulating its
functional activity.”

_Chionanthus virginica_ has never been shown to have the slightest
pharmacologic activity and no evidence is presented that its offspring,
Chionia, has any therapeutic value whatever in any disturbance of
the liver. The promoters themselves indicate a lack of faith in
their own preparation, for they advise the use of old and efficient
forms of treatment along with Chionia--heart tonics and laxatives in
passive congestion of the liver, mercurial purge or podophyllin and
sodium phosphate in “biliousness,” and quinin in malaria. Finally,
with delightful English and elaborate insouciance, they advise in the
treatment of eclampsia:

“In all cases the uterus should be emptied as quick as possible.
(Version of Cæsarian Section.)”

The physician who prescribes Chionia promotes a fraud.

The Council held Chionia ineligible for admission to N. N. R.

[Editorial Comment: In Peacock’s Bromides and Chionia the Peacock
Chemical Company has, for a third of a century, been foisting on the
medical profession nostrums composed of drugs that are easily combined
in any proportion that the physician may want to prescribe. The company
has been inflicting on the unthinking physician pseudo-scientific
rubbish in the form of advertising literature that should long ago
have been regarded as an insult to the intelligence of the medical
profession. The following medical journals are carrying advertisements
of Peacock’s Bromides and Chionia:

_Alienist and Neurologist_
_American Journal of Surgery_
_American Medicine_
_Archives of Pediatrics_
_Atlanta Journal-Record of Medicine_
_Buffalo Medical Journal_
_Charlotte Medical Journal_
_Chicago Medical Recorder_
_Denver Medical Times and Utah Medical Journal_
_Eclectic Medical Journal_
_Ellingwood’s Therapeutist_
_Indianapolis Medical Journal_
_International Journal of Surgery_
_Lancet-Clinic_
_Louisville Monthly Journal of Medicine and Surgery_
_Maryland Medical Journal_
_Medical Brief_
_Medical Fortnightly_
_Medical Herald_
_Medical Record_
_Medical Review of Reviews_
_Medical Sentinel_
_Medical Standard_
_Medical Summary_
_Medical Times_
_Medical World_
_Nashville Journal of Medicine and Surgery_
_New Orleans Medical and Surgical Journal_
_New York Medical Journal_
_Pacific Medical Journal_
_Southern Practitioner_
_Texas Medical Journal_
_Texas Medical News_
_Therapeutic Gazette_
_Wisconsin Medical Recorder_
_Woman’s Medical Journal_]

--(_From The Journal A. M. A., April 3, 1915._)

BROMIDIA

Report of the Council on Pharmacy and Chemistry

The following report was submitted to the Council by a member of its
Committee on Therapeutics, with the recommendation that publication be
authorized. This recommendation was adopted.

W. A. Puckner, Secretary.

Bromidia (Battle & Co., St. Louis) at once suggests bromids; yet
Bromidia is essentially a chloral rather than a bromid preparation.
This nostrum illustrates the need of the provision in the Council’s
Rule 8 under which recognition is refused pharmaceutical mixtures
whose names do not indicate their most potent ingredients. While the
chloral content of Bromidia has been given considerable publicity, yet
the preparation is used both by physicians and by the public without
due consideration of its potent ingredient. This fact is attested not
only by the fatal results which have followed its use but also by the
many reports of habit formation. As long ago as in 1887 a fatal case
of poisoning was reported[5] to the medical society of the District of
Columbia due to an overdose taken by a Bromidia addict. The physician
who reported this case also gave his experience with another patient
who had the Bromidia habit. In the discussion of the paper a number of
cases were reported by others present in which Bromidia had been taken
without a physician’s advice and with more or less grave symptoms of
poisoning.

[5] The Journal A. M. A., July 9, 1887, p. 55.

In the report of a death of one who had been a slave to Bromidia it was
said:[6] “When the body was found, there were eleven one-ounce Bromidia
bottles about the room or on his person. Nine were entirely empty and
the other two were about half full. None of these bottles indicated
that they had been purchased on a physician’s prescription, only the
druggist’s label marked ‘Bromidia’ being on them.”

[6] The Journal A. M. A., April 21, 1906, p. 1220.

Dr. Horatio C. Wood, Jr., gave[7] a striking illustration of how
preparations like Bromidia come to be used even by physicians without
consideration of their constituents:

[7] The Journal A. M. A., April 21, 1906, p. 1220.

“Within an hour after his father, a Brooklyn physician, had given
him a dose of bromid, H.G.P., a prodigal son, died yesterday at
his father’s home in Brooklyn. Two years ago, when he appeared to
have sown his wild oats, the father made him superintendent of his
country place, near Grants Mills, Delaware County. A week ago the
son left his place, and at 1 o’clock yesterday morning appeared at
his father’s Brooklyn home. He was nervous, and at 9 a. m. begged
for a sedative.

“‘I prescribed the usual quantity of bromidia,’ the young man’s
father told a reporter. ‘He was weak and had suffered from weak
heart and kidney trouble for some time.’

“An hour later the father found the son dying and administered
restoratives, but to no avail.”

A circular, “The Advantages of Bromidia,” makes it plain how physicians
come to use a preparation like Bromidia without consideration of its
potent constituent. In this circular the presence of chloral is at
first frankly admitted, then it is suggested that in the combination
the evil effects of chloral are completely eliminated and in the end
the impression is left that Bromidia is practically innocuous. Thus at
the beginning while arguing that Bromidia is better than extemporaneous
preparations the chloral content is plainly acknowledged:

“In the untoward effects so frequently attending the use of
extemporaneously prepared mixtures of chloral and the bromides, may
be found the reason for BROMIDIA’S preference when the need for a
hypnotic agent arises. Were it not for the well known disadvantages
of these drugs which become still more marked with their continued
use, there could be no special need for such a preparation as
BROMIDIA (Battle), for the therapeutic powers of chloral and the
bromides are among the most positive facts in medicine.”

Again:

“It was to meet the growing professional demand for a combination
of chloral and the bromides with their evil effects eliminated,
that led to the manufacture of BROMIDIA (Battle).”

Then, suggesting the indiscriminate use of Bromidia--as an entity as
Dr. Wood suggests--the claim is made that:

“... its constituents have been chosen with a view of enabling
Bromidia to meet every requirement for an agent of its class.”

“Owing to the exceptional purity of its component parts and its
freedom from untoward effects when continued over long periods,
this product will be found of the highest utility in epilepsy.”

“... its action is that of chloral and the bromides minus their
evil effects.”

Finally Bromidia becomes a simple bromid preparation. Thus an
advertisement reads:

“Bromidia’s (Battle) Marked Sedative and Antispasmodic Qualities
eminently fit it for the treatment of Maniacal Excitement,
Epilepsy, Spasmodic Asthma, Convulsive Seizures of Reflex Origin,
Sexual Neuroses, and other disorders attendant upon nervous
irritability.

“Through its exhibition, the fullest therapeutic power of the
bromides may be secured with a minimum of their evil effects; a
feature of the greatest service when the necessity for continued
treatment becomes necessary.”

In addition to the general invitation to use Bromidia in epilepsy
and various nervous disorders, a circular also recommends its use in
typhoid, a recommendation, which, if followed, may turn the scale in
favor of a fatal result. The circular states:

“As a soothing agent in the extreme restlessness and irritability
of typhoid fever and other infectious diseases, BROMIDIA (Battle)
is a therapeutic weapon of definite service. Relief of the headache
of typhoid may also be secured through the use of BROMIDIA
(Battle). By means of its administration for the above purposes,
the patient’s strength is conserved and as a result he is much
better prepared to stand the force of the infection.”

Particularly vicious is the recommendation that it be given to
children. Thus, in a pamphlet entitled “Effective Drugs Effectively
Combined”:

“Another point of advantage to be found in bromidia is the ease
with which it is borne by children. Owing to this tolerance, it
is of distinct service in a considerable list of disorders of
childhood. Thus, of course, employed with care and an understanding
of its potency, bromidia has a field of usefulness in chorea,
laryngismus stridulus, and whooping-cough. In other nervous
disorders of childhood--those attending acute infections, for
instance--bromidia is a definitely indicated therapeutic aid, owing
to the soothing influence exerted by even a moderate dose and the
absence of untoward effects. More specifically, the correcting
influence of bromidia in the night-terrors of children may be
mentioned.”

Formerly advertisements asserted that each fluidram of Bromidia
contained:

“Chloral hydrate 15 grains
“Potassium bromid 15 grains
“Extract of Cannabis indica 1/8 grain
“Extract of henbane 1/8 grain”

This formula also appears on the label of a sample package sent through
the mails during 1914. A recent circular contains a somewhat different
formula. Instead of “1/8 gr. each of gen. Imp. Ext. Cannabis Ind. and
Hyoscyam.” as was formerly claimed, each fluidram of Bromidia is now
said, not to “contain” but to “represent,” not the extracts but the far
less potent drugs “Cannabis indica 1/8 grain, Hyoscyamus 1/8 grain,”
thus:

“Chloral hydrate 15 grains
“Pot. brom. 15 grains
“Cannabis indica 1/8 grain
“Hyoscyamus 1/8 grain”

Furnishing still greater variety, the labels on a recently purchased
bottle of Bromidia, where under the Food and Drugs Act the presence of
narcotic drugs must be declared, read:

“Alcohol 10 per cent., Chloral Hydrate, 91 grs. per ounce. Cannabis
indica indeterminate in finished product.”

“In the manufacture of BROMIDIA to each drachm of fluid used are
added 15 grains of pure chloral hydrate and purified brom. pot.,
and 1/8 grain each of gen. imp. ext. cannabis ind. and hyosciam.”

These various statements as to the composition of Bromidia leave
one very much “in the air.” As chloral and potassium bromid are
easily determined and since lying on the labels of widely exploited
proprietaries has become somewhat risky recently, it is probable that
the statements on the trade package are to be depended on and that each
fluidram of Bromidia contains something like 12 grains each of chloral
and potassium bromid and not 15 grains as the medical profession has
been and is being told.

Pharmacists who have attempted to put up a nonproprietary preparation
similar to or, more correctly, having the alleged composition of
Bromidia have found it practically impossible to do so. The reason is
that extract of cannabis indica is almost insoluble in a menstruum
such as that found in Bromidia. The National Formulary, first edition,
listed Mistura Chlorali et Potassii Bromidi Composita of which it
was said: “Each fluidram contains 15 grains each of Chloral and of
Bromid of Potassium, and 1/8 grain each of Extract of Indian Cannabis
and Extract of Hyoscyamus.” In this the pharmacists attempted to
incorporate the cannabis indica by using the tincture of the drug
and suspending it by the addition of tincture of soap bark. In the
present edition of the National Formulary, the preparation is made
by triturating the extract of cannabis indica with pumice stone
and then filtering the finished product. This gives an “elegant”
preparation--but one from which the cannabis indica is filtered out! A
sad commentary on the National Formulary. It should not be supposed,
however, that the manufacturers of Bromidia have solved the problem
that has baffled the pharmacists; not at all. Bromidia probably
contains no more cannabis indica than does its National Formulary
prototype. The statement on the present trade packages, that the amount
of cannabis indica in Bromidia is “indeterminate,” is but a tardy
acknowledgment of the fact that the stuff has not, and never had, the
amount of cannabis indica claimed for it for so many years.

The “indications” named on the Bromidia labels are, in common with
nostrums of this type, but suggestions for self-drugging. They will
appeal to the layman who has purchased, either by prescription or
otherwise, an “original package” of Bromidia and who may imagine he
suffers from “nervousness,” “sleeplessness,” “headache” or “neuralgia.”

But while the manufacturers in their advertising matter have on the
whole not disguised the presence of chloral so much as they have
attempted to make it appear that the chloral has been robbed of its
dangers--for all hypnotics if used thoughtlessly are dangerous--after
all the name has created the false impression that Bromidia is a bromid
preparation. It is because of this false impression carried by its
name, that Bromidia came to be used indiscriminately by the profession
and in the course of time still more indiscriminately and recklessly
by the public. Bromidia is a vicious chloral preparation masquerading
under a misleading name. That physicians have been impressed by the
claims of its harmlessness and by the mystery connected with the
formula is not a credit to the intelligence of our profession. There is
no doubt but that physicians are responsible for the use and abuse of
this chloral preparation by the public.

There is no scientific or rational excuse for a ready-made preparation
of this sort. When chloral or a bromid is indicated the proper dose of
each of these, if they are to be combined, should be determined for
each patient. Potassium bromid and chloral hydrate both are readily
soluble in water, syrup or elixirs and it is a simple matter to
prescribe the required dose of chloral and of bromid dissolved in some
aromatic water like cinnamon-water (Aqua Cinnamomi), in some syrup like
syrup of orange (Syrupus Aurantii) or in an elixir like the aromatic
elixir (Elixir Aromaticum) or adjuvant elixir (Elixir Adjuvans). If
this mixture is prescribed thus the physician is alive, alike to the
dangers and the limitations of the drugs; if it is prescribed under
a misleading proprietary name, the physician endangers his patient,
stultifies his profession and tends to perpetuate the great American
fraud.

[Editor’s Note.--A list of some of the medical journals that advertise
Bromidia:

_Texas Medical News_
_Nashville Journal of Medicine & Surgery_
_Medical Brief_
_Annals of Surgery_
_Charlotte Medical Journal_
_Medical Sentinel_
_Memphis Medical Monthly_
_Laryngoscope_
_Medical World_
_Medical Review of Reviews_
_Louisville Monthly Journal_
_Indianapolis Medical Journal_
_Monthly Cyclopedia & Medical Bulletin_
_Journal of Nervous & Mental Diseases_
_Maryland Medical Journal_
_Merck’s Archives_
_Iowa Medical Journal_
_Medical Standard_
_Southern Practitioner_
_New Orleans Medical & Surgical Journal_
_Therapeutic Gazette_
_Medical Herald_
_Medical Times_
_Texas Medical Journal_
_Wisconsin Medical Recorder_
_International Journal of Surgery_
_Vermont Medical Monthly_
_Atlanta Journal-Record of Medicine_
_St. Paul Medical Journal_
_Hospital Bulletin of the University of Maryland_
_Denver Medical Times_
_Buffalo Medical Journal_
_Medical Review_
_Ellingwood’s Therapeutist_
_Eclectic Medical Journal_
_Massachusetts Medical Journal_]

--(_From The Journal A. M. A., May 16, 1914._)

CACTUS GRANDIFLORUS

Report of the Council on Pharmacy and Chemistry[H]

[H] A reprint of various articles discussing Cactus Grandiflorus,
Cactin--now called Cactoid--(Abbott Alkaloidal Company) and Cactina
Pillets (Sultan Drug Company) will be sent on receipt of a 2-cent stamp.

The Council voted that cactus grandiflorus should not be accepted for
New and Nonofficial Remedies, and that a statement be prepared for The
Journal giving the reasons for this action. Accordingly the following
report has been adopted by the Council and its publication authorized.

W. A. Puckner, Secretary.

Cactus Grandiflorus

The therapeutic value of this plant has been variously estimated by
different observers. Experimental evidence as to its action is scanty
and no complete chemical examination has ever been made.

Reputable men have testified that some of the plants of the cactus
family contain very active principles, but so far experiments seem to
prove that cactus grandiflorus has neither the action of digitalis
nor that of strychnin. The principal contributions, clinical and
experimental, for and against the drug, are set out below.

EXPERIMENTAL EVIDENCE

O. H. Myers[8] worked with a product which he calls cactina and which
he regards as the active principle of the drug. (As no such substance
as cactina is described in any materia medica, it is impossible to
state what Myers really used.) He found that it had a strychnin-like
action and raised the blood-pressure.

[8] New York Med. Jour., 1891, liii, 681-683.

Hatcher comes to the conclusion: “Either Myers’ work was a pure
fabrication or he was dealing not with cactin but with a substance
similar to the pellotin of Heffter, the action of which resembles that
of strychnin to a certain extent.”

E. Boinet and J. Boy-Teissier[9] experimented with an aqueous extract,
an alcoholic extract, and with an alkaloid which they call “cactine.”
They concluded from three sets of experiments on frogs that extract of
cactus produces, in ten minutes, a temporary increase in the heart’s
action which frequently repeated doses are required to maintain; and
that large doses slow the heart and produce arrhythmia.

[9] Bull. gén. de thérap., 1891, cxxi, 343-349.

L. E. Sayre[10] experimented with a preparation of cactus, made from
the stem of the plant, by injecting it into the dorsal lymph space
of the frog. There was seemingly an increase in the amplitude of the
heart’s action and an indication of a strengthened beat or increased
force.

[10] Am. Pharm. Assn., 1906, liv, 405.

R. A. Hatcher[11] states that it is possible that cactus grandiflorus,
under certain conditions, may contain a principle with a strychnin-like
action. But Hatcher made ten experiments on frogs, four on cats, six
on dogs, two on rabbits, and one on a guinea-pig, with Cactina pillets
of the Sultan Drug Company and the Cactin of the Abbott Alkaloidal
Company. From 1 to 15 pillets in frogs and up to 25 in dogs were
used at each dose. In no single instance was there any evidence of a
digitalis-like or strychnin-like action, or, in fact, of any decided
action of any kind whatever.

[11] The Journal A. M. A., Sept. 21, 1907, pp. 1021-1024.

Gordon Sharp[12] was unable to obtain either alkaloid or glucosid from
the plant, but found a series of resins that caused contraction of the
blood-vessels of a frog. This was not a digitalis-like contraction, but
depended, he believed, on simple acidity. On the heart of the frog the
resins have little or no effect, comparisons being made with digitalis
in the same animals. There is no proof that cactus grandiflorus itself
shortens diastole, or in fact, that it has any special action on the
heart muscle at all. Sharp experimented on himself with large doses of
an extract made with alcohol 1 to 5, but got no noticeable results. He
thinks that the plant may have some slight diuretic action.

[12] Practitioner, London, 1894, iii, 444-446.

Sayre submitted the preparation which he used in his experiments for
more careful testing to E. M. Houghton, who reported that it had
practically no action on the heart.

In commenting on Houghton’s results, Reid Hunt said that they were
confirmed by his own experiments. He did not deny, however, that the
drug might have some therapeutic effect and that, in very large doses,
it did affect the kidneys.

S. A. Matthews[13] found one preparation of cactus (cactin--Abbott)
absolutely inert so far as any effect on the heart is concerned. He
found that cactina (Sultan Drug Co.) in very large doses depressed
both the circulation and respiration. In this regard it differs from
strychnin, and it has no resemblance to the action of digitalis,
strophanthus or any of the heart stimulants. A dose of from 10 to
12 pillets administered intravenously to a 10 to 12 kg. dog exerted
little or no influence on the heart or circulation; the larger dose may
cause a slight fall in blood-pressure. When 70 or more pillets were
administered within two and a half hours the animal generally died.

[13] The Journal A. M. A., March 21, 1908, pp. 956-958.

The work of Boinet and Boy-Teissier also has been criticized by Hatcher
on the ground that their most positive results were obtained with an
alkaloid which no one at this day is able to prepare. The results
quoted in this report, however, were obtained by the use of extracts of
cactus so that it does not seem that they should be entirely rejected,
whatever their value may be.

CLINICAL EVIDENCE

Clinical observations have been more abundant than exact, and a
favorable action of the drug in some organic diseases of the heart
has been reported; other observers would limit its use to functional
arrhythmia, insisting that it is not a substitute for digitalis or
aconite, but that it occupies a place distinct from either of those
remedies.

P. W. Williams[14] recommends cactus for functional heart disease, but,
as a rule, found it useless in organic disease. He thinks it one of a
class of remedies which act on the accelerator nerves and sympathetic
ganglia, shortening the diastole and stimulating the spinal vasomotor
nerve centers. Williams apparently relied on Myers for his knowledge
of the pharmacologic action, and his paper is a fair example of the
clinical studies of cactus.

[14] Practitioner, London, 1891, xlvii, 266-273.

Ellingwood[15] claims that cactus is a cardiac tonic, acting on the
accelerator nerves and heart ganglia, increasing muscular force and
arterial tension. He recommends it in both organic and functional
diseases.

[15] Med. Rec., New York, 1905, lxvii, 857.

Boinet and Boy-Teissier found that therapeutic doses of 40 drops of
tincture of cactus were without effect on the normal heart. In patients
with noisy asystole (_asystolie bruyante_) the same dose produced no
appreciable effect. In the period of latent non-compensation of true
cardiac patients, from 80 to 100 drops a day increased the force of the
failing heart. In patients with secondary heart disease with arrhythmia
of nervous origin, daily doses of 80, 100 and 120 drops of the tincture
were well tolerated for weeks; they seemed to increase the fulness of
the pulse and regulated its rhythm. In spite of such large doses, these
observers never noticed any symptoms that could be attributed to a
cumulative action. It must be remembered that the precise preparation
of cactus which they used is not known.

Aulde[16] recommends it as a cardiac tonic free from cumulative effects.

[16] Practitioner, London, xlvii, 223; Therap. Gaz., 1890.

Gordon Sharp says: “The therapeutics of the subject, I think, are clear
enough. Cactus grandiflorus cannot be included in our list of cardiac
drugs. It is not even a simple stomachic tonic and at most all one can
say is that it has small diuretic action.”

Hatcher says: “Clinical testimony is so conflicting that between the
extreme views of Gordon Sharp and those of Ellingwood there is room for
an honest difference of opinion concerning cactus grandiflorus.”

Matthews himself took 100 granules of cactin (1/67 gr.--1 mg. each), 25
every four hours, without experiencing the least effect.

CONCLUSIONS

Reliable conclusions regarding the therapeutic use of cactus
grandiflorus are rendered difficult on account of several factors.

1. It is uncertain what part of the plant contains the active principle
if one exists; and its nature is unknown. The National Standard
Dispensatory states that its “activity must be confined to the flower
in some special stage of its development or to a certain part of it
or to some parts gathered with it.” This uncertainty may explain the
negative results obtained by some observers, but it makes the drug one
that cannot be generally relied on and gives an excellent opportunity
for the exploitation of proprietary preparations.

2. Some of the experimental work and much of the clinical evidence
has been obtained and published under proprietary auspices. For this
reason many of the therapeutic claims made for the drug must be viewed
as merely the reflection of the exaggerated statements made by the
advertisers of proprietary preparations.

3. The value of clinical evidence when unsupported by an animal
experimentation is much diminished by the tendency of enthusiastic and
untrained observers to attribute to the drug given the effect really
due to general remedial measures, psychic suggestion and so forth.
While it must be admitted that valuable remedies may exist whose
therapeutic properties cannot be revealed by animal experimentation,
yet in the absence of such experimental evidence conclusions should be
drawn with extreme caution.

Bearing these conditions in mind, the following statements seem
to be justified: (_a_) The botanical, chemical and pharmaceutical
properties of cactus are not sufficiently determined to make any
available preparation a reliable remedy. (_b_) There is some evidence
that cactus may be capable of affecting the animal heart and nervous
system, but its action is not that ordinarily attributed to it. It
does not increase the force of the heart-beat. (_c_) While there is
some clinical testimony as to its usefulness in functional diseases of
the heart, the indications for its administration are at present too
uncertain to afford a safe basis for recommending it.

4. While the drug may be deserving of further experimental and clinical
investigation, this should be carried on in reliable pharmacologic
laboratories and in clinics provided with facilities for exact
observation.--(_From The Journal A. M. A., March 12, 1910._)

CALCREOSE

Report of the Council on Pharmacy and Chemistry

In response to inquiries and in view of the extensive advertising
propaganda, the Council, on Dec. 19, 1913, took up for consideration
Calcreose (Maltbie Chemical Company, Newark, N. J.). Examination showed
that the preparation contained, in loose combination, approximately
equal weights of creosote and lime. The claims made in the advertising
“literature” were extravagant and uncritical, and the Council therefore
held Calcreose ineligible for New and Nonofficial Remedies.

In June, 1914, at the request of the Maltbie Chemical Company, the
Council undertook a reconsideration of the preparation. The advertising
claims were now found more conservative. Before the existing claims
could be judged, however, the Council deemed it necessary to require
from the company satisfactory proof (1) that the large doses of
Calcreose recommended and administered actually furnish large amounts
of creosote to the blood, and (2) that patients taking these large
doses do not suffer from digestive disturbances, loss of nutrition,
albumin in the urine or phenol urine, as claimed. The Council
accordingly advised the company of this requirement, at the same
time stipulating that nothing in the report should be interpreted as
indicating a belief on the part of the Council that enormous doses of
creosote are necessary for, or will promote a cure of tuberculosis.

The Maltbie Chemical Company has not up to the present date furnished
this proof, but has evinced a disposition to make the Council’s holding
Calcreose under advisement appear in the guise of a quasi-approval.
It is therefore recommended that Calcreose be refused recognition for
conflict with Rule 6.--(_From the Journal A. M. A., June 26, 1915._)

CAMPHO-PHENIQUE

Report of the Council on Pharmacy and Chemistry
and Some Comments Thereon

The following report was submitted to the Council on Pharmacy and
Chemistry by the subcommittee to which Campho-Phenique had been
assigned:

_To the Council on Pharmacy and Chemistry_:--Campho-Phenique, sold by
the Campho-Phenique Co., St. Louis, Mo., is claimed to be composed of
phenol 49 per cent., and camphor 51 per cent.

Examination of specimens, purchased in the open market, made under
our direction, demonstrates that the statements made in regard to
the composition are not true. Instead of containing 49 per cent. of
phenol (carbolic acid), the analysis showed that it contains not more
than 20 per cent. Instead of containing 51 per cent. of camphor, the
analysis demonstrates that the amount of camphor is not more than 38
per cent. Besides phenol and camphor, a third substance was found
which proved to be liquid petrolatum and to be present to the extent
of 38 per cent. or more.

Since the statements made in regard to the composition of
Campho-Phenique are deliberate misrepresentations of the facts, it is
recommended that the article be not approved.

Besides Campho-Phenique, the above-mentioned firm also sells a
preparation labeled Campho-Phenique Powder. While no statement in
regard to the composition of this product is made on the label or in
the literature, such expressions as “Campho-Phenique in a powdered
form” and “Powdered Campho-Phenique” lead to the inference that it
has essentially the same composition as that stated for the liquid
preparation. An examination of a specimen of Campho-Phenique Powder
purchased in the open market showed that 92 per cent. of it was a
talcum-like inorganic substance. The remaining 8 per cent. consisted
chiefly of camphor with a small amount of phenol.

In view of the fact that Campho-Phenique Powder contains very little
phenol, but instead consists chiefly of an inorganic talcum-like
substance, its name is misleading and deceptive. It having been shown
that Campho-Phenique Powder corresponds to a camphorated talcum
powder, the claims that it “has no equal as a dry dressing,” that
it is “absolutely superior to iodoform,” and that it has “all the
excellent properties of aristol and iodoform,” are unwarranted. It is
recommended that the article be not approved, and that this report be
published.

The recommendations of the subcommittee were adopted by the Council,
and in accordance therewith the above report is published.

W. A. Puckner, Secretary.

Campho-Phenique

The above report on a much advertised “ethical” proprietary medicine
is worthy of the thoughtful consideration of the members of the
medical profession, as it illustrates admirably some of the conditions
connected with this proprietary medicine business.

THE FORMULA A FAKE

First, it illustrates the fact that the published formulas of the
“ethical” proprietaries are not always reliable. The Campho-Phenique
Company has been very willing to give out a formula, purporting
their product to be 51 per cent. camphor and 49 per cent. phenol
(carbolic acid). Now, these two drugs will make a liquid mixture,
and any druggist can make it, and the mixture will have about the
same consistency and appearance as Campho-Phenique. But its effect
differs decidedly from that of Campho-Phenique. Some months ago a very
intelligent physician, in discussing the proprietary medicine business,
said that in some cases physicians could not get druggists to make
preparations which were as satisfactory as those which could be bought
ready-made. He cited Campho-Phenique as an illustration. He said that
he had used this preparation for burns, etc., but as he did not like
to use preparations put up by companies about which he knew nothing,
he asked his druggist to make the mixture in accordance with the
published formula. The druggist’s preparation was not satisfactory; it
had a decidedly different effect from Campho-Phenique, and so he tried
another druggist. This druggist also followed the published formula,
but his results, too, differed materially from the proprietary article.

The various analyses that have been made show why the preparations
put up by the druggists did not resemble that made by the company;
since, according to the analyses, Campho-Phenique consists of 40 per
cent. liquid petrolatum, which is an inert but soothing diluent,
while instead of 49 per cent. of carbolic acid, as claimed, it
really contains less than 20 per cent. This is an entirely different
proposition. Now, if the physician referred to above will have his
druggist make a mixture of 20 per cent. of carbolic acid, 40 per cent.
of camphor and 40 per cent. of liquid petrolatum, and will then compare
this resulting compound with Campho-Phenique, he will find that there
is not much difference. Furthermore, he will realize that there is
nothing either new or wonderful about the preparation. Camphorated
oil and carbolized oil are both in common use. Campho-Phenique is
apparently simply a mixture of the two.

THE POWDER STILL WORSE

So much for the liquid. The powder seems to be something entirely
different, for, according to the chemist’s report, over 90 per cent.
of it is inert, absorbent, talcum-like material. There is enough
camphor and carbolic acid to give the powder an odor and thus mislead
physicians, especially those who are in the habit of taking for
granted that whatever statements nostrum manufacturers make are true.
Perhaps it is a fairly good dressing for wounds--at least it will do
no harm--but its name is misleading and deceptive. For all practical
purposes it is essentially a camphorated talcum powder.

COMPANY A “PATENT-MEDICINE” CONCERN

The second interesting phase of this “ethical” proprietary is that
it illustrates another point, i. e., that many of these articles
are supplied to our profession by those who are not legitimate
manufacturing pharmacists. The Campho-Phenique Company of St. Louis,
according to all reports, is owned and controlled by a gentleman named
Ballard. This “company” supplies the medical profession with the
preparations under consideration and also with Chloro-Phenique and
Scrofonol. We are informed that this same Mr. Ballard is the principal
owner, if not the sole owner, of quite a number of “patent-medicine”
companies, such as Ballard-Snow Liniment Co., Brown’s Iron Bitters Co.,
Mayfield Medicine Mfg. Co., Smith Bile Beans Co., Swain’s Laboratory,
and several others. We learn from the wholesale drug trade lists that
these various “companies” make and sell, besides the Campho-Phenique
preparations, Ballard-Snow Liniment, Ballard’s Herbine, Brown’s Iron
Bitters, Dr. Herrick’s Pills, Richardson’s Life-Preserving Bitters,
Smith’s Bile Beans, Swain’s All Healing Ointment, and several other
“patent medicines.”

It is hardly necessary to make any further comments. The whole business
is nauseating to those who know the actual conditions of this nostrum
business and how our profession is being deluded. The Campho-Phenique
matter is not an exception; it is simply another illustration of these
conditions.

The majority of “ethical” proprietaries are foisted on our profession,
either without any formula accompanying them, or with a “formula” that
is a fake. The majority of the “ethical” proprietaries are manufactured
and supplied to physicians, with instructions regarding their use,
by men who bear the same relation to legitimate pharmacy that the
veriest quack that ever swindled a credulous public bears to scientific
medicine.--(_From The Journal A. M. A., April 20, 1907._)

CELERINA, ALETRIS CORDIAL AND KENNEDY’S PINUS CANADENSIS,
LIGHT AND DARK

Report of the Council on Pharmacy and Chemistry

The following reports on products of the Rio Chemical Company have
been submitted by a referee. The Council recommends that they be
published, as the preparations discussed are glaring instances of
nostrums exploited through physicians on unscientific claims and false
representations.

W. A. Puckner, Secretary.

Celerina

Celerina belongs to what Samuel Hopkins Adams calls the “bracer” type
of nostrum. According to the label it contains 42 per cent. alcohol
(whisky contains about 50 per cent.). The other ingredients of Celerina
are declared to be as follows:

“Each fluidounce represents Forty grains each Kola, Viburnum,
Forty-eight grains Celery, Twenty grains Cypripedium, Sixteen
grains Xanthoxylum and Aromatics.

“Dose--1 or 2 teaspoonfuls 3 times a day.”

Kola contains a very small percentage each of caffein and theobromin.
It is impossible for the infinitesimal amounts of these alkaloids in an
ordinary dose of Celerina to produce any physiologic effect.

Viburnum has been called a “uterine sedative,” whatever that may be.
Its only real activity is the psychic one due to its taste and odor.

Celery at one time was credited with being both an antispasmodic and
a nerve stimulant--a remarkable combination of opposing qualities!
Scientific investigation has failed to show that celery has any
physiologic or therapeutic activities. If it had the slightest
medicinal value, the rational course would be to prescribe it in its
fresh and natural state. The small dose contained in a teaspoonful of
Celerina is inappreciable and not even equivalent to that contained in
a stalk of celery.

Ladyslipper, more imposing under the Latin name of “cypripedium,” is a
flowering plant with a legendary reputation as an “antispasmodic and
nerve stimulant.” It has been in the therapeutic scrap-heap for years.
It contains a little tannic acid, gallic acid and a volatile oil.
Even a tannic acid action cannot be expected from a teaspoonful of a
preparation containing 20 grains of ladyslipper to the ounce.

Prickly ash (xanthoxylum) has never been shown to have any activity
other than that of a local irritant, especially to mucous membranes.
The slight “bite” from this drug would be entirely covered up by the
alcohol in Celerina. Any stimulating effect which this drug may have on
the stomach is greatly inferior to that produced by a very small glass
of ordinary ginger ale.

In short, there is no ingredient in Celerina, except the alcohol,
that has any recognizable activity; and the alcohol content is
nearly as great as that of ordinary whisky. Some of the claims and
recommendations for this nostrum are:

“Celerina (Nerve Tonic), for Nervousness, Hysteria, Insomnia,
Nervous Indigestion, Languid and Debilitated Conditions, Recovery
from Alcoholic Excess.”

Think of prescribing an alcoholic nostrum four times a day to promote
recovery from alcoholic excess!

“NEURASTHENIA: The bane of the general practitioner; the puzzle
of the neurologist; the juicy fruit of the quack and faddist;
the opportunity of the intelligent therapist.... For the medical
treatment CELERINA is the preparation of wide utility.”

The _sang froid_ with which the exploiters of this nostrum refer to
other “quacks and faddists” as reaping “juicy fruit” from neurasthenics
would command admiration were it not so pitiful.

“Celerina has substantial endorsement in nervous disorders
characterized by Aphonia (nervous).”

Of course, the disappearance of nervous aphonia might follow the
application of any treatment whatever, be it Eddyism, Chiropractic,
Peruna or Celerina.

“CLIMACTERIC (the Menopause) flattering results have been reported
from a combination of equal parts Celerina and Aletris Cordial Rio.”

“Teaspoonful doses after meals and upon retiring have proven
efficacious [in “dyspepsia”] when other remedies have failed.”

Here is a good example of proprietary-house therapeutics: Such widely
different conditions as digestive trouble and the climacteric are to be
treated with a combination of alcohol, simple bitters and aromatics!
Why not order a cocktail under its own name? It would be equally
efficacious, less mysterious and its dangers might be better realized!

“A teaspoonful or two in three tablespoonfuls of boiling hot water
[for insomnia] upon retiring.”

Any other hot toddy at bedtime (and it need not cost a dollar a bottle)
might give relief; but the intelligent physician to-day recognizes the
danger of prescribing alcohol in such conditions.

“In the case of brain workers who suffer from nervous excitability
and mental fatigue, the administration of Celerina in teaspoonful
doses, three times a day and at bedtime, rapidly controls the
condition and increases mental capacity.”

And the same effect follows its use:

“In cases involving worry, anxiety, overwork, and excesses of
various kinds....”

Moreover:

“Celerina is the most prompt and efficient of remedies for
devitalized or broken-down constitutions--doses four times a day.”

The statement made by its manufacturers that this preparation is free
from narcotics or habit-forming drugs is not true. Alcohol is both a
narcotic and a habit-forming drug.

As in the case of other nostrums containing no potent drugs but
alcohol, Celerina is recommended for various diseased conditions in
combination with a familiar form of treatment by drugs of more or
less value. The physician who thoughtlessly prescribes one of these
combinations will without doubt unthinkingly attribute any subsequent
improvement to the Celerina. Thus, for malaria, a prescription of
quinin and Celerina is advised; for chorea in children, arsenic with
Celerina; in “Convalescence from La Grippe,” strychnin sulphate,
Fowler’s solution, and Celerina; for impotence, nux vomica, dilute
phosphoric acid and Celerina. In none of these conditions would
Celerina affect favorably anything except the pockets of the
exploiters; in some, as in the chorea of children, the alcohol would
be positively detrimental. Of course, the value of such prescriptions
(so far as they have any apart from the fictitious value lent by the
alcohol) resides altogether in the standard drugs prescribed with
Celerina.

There is no possible excuse for writing a prescription for Celerina,
either in original package or mixed with well-known or valuable drugs.
The sooner it is realized that this preparation has no place in
medicine, should never be prescribed by physicians and is essentially
nothing but alcohol and bitters exploited under a fancy name, the
better for the public health and the science of medicine. The continued
sale and use of Celerina is a disgrace to the medical profession.

Aletris Cordial

Aletris Cordial is a nostrum containing therapeutically worthless drugs
in alcohol (28 per cent.).

The “formula” on the label reads:

“Each fluidounce represents ten grains Aletris, thirty grains
Helonias and thirty grains Scrophularia.”

At one time these drugs had some vogue, chiefly as domestic remedies.
They have been discarded as valueless by modern scientific medicine.

Aletris, or unicorn root (Aletris farinosa), contains a bitter
principle and starch. The remarkable uterine tonic properties formerly
ascribed to it have not been confirmed by reliable observers. It is
practically worthless.[17]

[17] See Unicorn Root, Wild Yam, and Wild Indigo, p. 208.

Helonias, or false unicorn (Chamaelirium luteum), is asserted to be a
hemostatic and uterine tonic. No trustworthy evidence has ever been
offered in support of the claims made for this drug; reliable medical
literature contains no reference to it; it has no valid claim on the
attention of physicians.[18]

[18] See False Unicorn (Helonias), p. 84.

Scrophularia, or figwort (Scrophularia marilandica), contains a
principle which has a digitalis-like action on the heart. Its activity
is so slight in comparison with that of digitalis, however, that there
was nothing to be gained by studying it. The drug is consequently
little known and is not mentioned in critical works on pharmacology. If
the drug were therapeutically active in the quantities used, another
danger would be added to that of the alcohol content of Aletris
Cordial. Since the recommended dose (a teaspoonful) contains, if the
formula be correct, only about 4 grains of figwort, this drug too may
be regarded as practically inert in this preparation.

Not one of these drugs has been deemed worthy of mention in the
Pharmacopeia. The Council has previously discussed them and declared
them valueless (Reports Council Pharm. and Chem., 1909, p. 146; 1910,
p. 10; 1912, p. 42).

In Aletris Cordial, then, there is no ingredient capable of producing
any other effect than the alcohol stimulation and such psychic effect
as may be due to the bitter taste. Yet physicians are asked to believe
that

“Probably no remedy is so uniformly successful in the prevention of
threatened miscarriage as ALETRIS CORDIAL Rio.”

“HABITUAL MISCARRIAGE can be effectually overcome by the systematic
use of Aletris Cordial Rio.”

“... regulates the local circulation and imparts normal tone and
strength to the uterine muscle.”

“The use of Aletris Cordial Rio throughout pregnancy goes far to
assure normal, uncomplicated labor.”

Such claims as these, when made for a mixture containing no
therapeutically active constituent except alcohol, are absolutely
preposterous. It should be noted that the declared alcohol content
of Aletris Cordial is much higher than that of the strongest wines,
and, in the light of medical experience, quite high enough to promote
the formation of the alcohol habit in a steady user. The following
recommendation, taken from the company’s “Budding into Womanhood”
circular, therefore, is outrageous:

“Many medical practitioners recommend to mothers the use of Aletris
Cordial Rio for their growing daughters, ranging in age from twelve
to eighteen years....”

It is to be hoped that no medical practitioner is so heedless of
consequences as to prescribe for adolescent girls a worthless nostrum
capable of creating a craving for alcohol. The temperance societies
might with profit take steps to inform laymen, especially women,
concerning the worthlessness of this nostrum, the risk involved in
taking it, and the outrageous character of the recommendations made for
it by the manufacturers.

Kennedy’s Pinus Canadensis, Light and Dark

(Abican and Darpin)

Kennedy’s Pinus Canadensis, Light (recently renamed “Abican”) and Dark
(renamed “Darpin”) are also exploited by the Rio Chemical Company.
Although they have been on the market some thirty or forty years they
appear to have achieved no marked degree of commercial success. Yet
they have been imitated by most of the pharmaceutic houses. They are
of interest chiefly through the barefaced fraud involved in their
exploitation.

COMPOSITION CLAIMED

Apparently the dark preparation (“Darpin”) was first put on the market;
then the light one (“Abican”) was offered, to be used only “as an
injection and externally.” The reason for the existence of the light
preparation evidently was the objectionable property of the dark, which
stained linen. The two preparations are both said to be extracts of
Pinus Canadensis or hemlock bark. A circular issued some years ago
contained the following statement:

“Pinus Can. (Ken.)--_Dark_--A non-alcoholic extract of Pinus
Canadensis, to each fluidounce of which is added 0.48 grains Thymol.

“Pinus Can. (Ken.)--_Light_--A non-alcoholic extract of Pinus
Canadensis, to each fluidounce of which is added 24 grains each of
pure Alum Potash and Sulphate of Zinc and 0.48 grains of Thymol.”

The labels on the packages of the light and dark preparations sent
out to-day bear, respectively, only the following references to
composition, the first on the dark and the second on the light:

“Each fluidounce also contains 0.48 grains Thymol.”

“A non-alcoholic preparation of Pinus Canadensis, to which is added
twenty-four grains each pure alum potash and sulphate of zinc and
0.48 grains thymol to the fluidounce.”

ACTUAL COMPOSITION

“Darpin” or Kennedy’s Pinus Canadensis, Dark, does contain tannin, but,
as the simplest of chemical tests demonstrate, Pinus Canadensis, Light,
does not contain tannin. It might as truthfully be called maple syrup
or beef tea.

It is almost a work of supererogation to discuss the therapeutic claims
made for preparations sold under false pretenses as to composition. It
is enough to mention that Kennedy’s Pinus Canadensis, Dark or Light, is
recommended in

Albuminuria
Diarrhea-Dysentery
Fetid Perspiration
Endometritis
Fissures
Fistula
Gonorrhea
Hemorrhage from the Nose
Uterine Hemorrhage
Leucorrhea
Nasal and Pharyngeal Catarrh
Piles
Sore Throat
Ulceration of the Cervix

The intelligent physician of to-day knows that his forefathers in the
days of the stage-coach employed tannic acid in its crude form and
treated intestinal disease in a very unsatisfactory manner; he knows,
further, that advances in our knowledge of pathology have rendered
the use of tannic acid in gastro-intestinal therapeutics largely
unnecessary and that when it is used it should be in some form that
will pass the stomach unchanged. So far as its use as local application
is concerned, he knows, without need of instruction from the Rio
Chemical Company, when tannin is indicated, and the Pharmacopeia
furnishes a suitable preparation for the physician so that he need not
resort to an unscientific nostrum like Darpin.

The physician who is competent to treat a case of gonorrhea does not
need to be told that alum and zinc sulphate may be useful in such
conditions, and he does not want them palmed off on him for something
else under the name of Pinus Canadensis, Light, Abican or what not.
Also, he prefers to use them, when they are needed, singly and in
strength suited to the conditions of the individual case.

[Editorial Comment.--Celerina, Aletris Cordial and Kennedy’s Pinus
Canadensis, Light and Dark, appear to be the entire output of the
Rio Chemical Company, which was one of the earliest of the various
companies organized by James J. Lawrence of _Medical Brief_ fame. The
business was moved from St. Louis to New York City in 1901. According
to what we believe to be reliable information, the Rio Chemical Company
is now composed of James P. Dawson, president; William W. Conley,
vice-president and treasurer; and E. D. Pinkerton, secretary. These
also constitute the directors. It appears that James P. Dawson is a
member of the law firm of Dawson and Garven, St. Louis; E. D. Pinkerton
is said to be Miss Effie D. Pinkerton, stenographer for Dawson and
Garven. We know little concerning William W. Conley except that he
appears to be in charge of the establishment in New York. We find no
evidence that he is either a chemist or a pharmacist; his name does not
appear in the membership list of the American Chemical Society or of
the American Pharmaceutical Association, nor can we discover that he
has published anything in the way of chemistry or pharmacy. As a matter
of fact, the Rio Chemical Company is another of the pseudo-chemical
companies created to exploit one or more proprietaries--in this
instance Celerina, Aletris Cordial and Pinus Canadensis. The following
medical journals carry advertisements of the Rio products (or did late
in 1914): _American Journal of Surgery_, _American Medicine_, _Denver
Medical Times and Utah Medical Journal_, _Eclectic Medical Journal_,
_International Journal of Surgery_, _Interstate Medical Journal_,
_Massachusetts Medical Journal_, _Medical Brief_, _Medical Century_,
Medical Council, _Medical Review of Reviews_, _Medical Sentinel_,
_Medical Standard_, _Texas Medical Journal_ and _Woman’s Medical
Journal_.].--(_From The Journal A. M. A., Feb. 13, 1915._)

CINERARIA MARITIMA

Report of the Council on Pharmacy and Chemistry

Occasional inquiries in regard to the therapeutic value of _Cineraria
maritima_ caused the Council to consider the drug with reference to its
fitness for inclusion in N. N. R. among non-official, non-proprietary
remedies. The following report, having been submitted to the Council by
a subcommittee, was adopted and its publication authorized.

W. A. Puckner, Secretary.

_To the Council_:--The juice of a plant referred to as _Cineraria
maritima_ was at one time supposed to be of value in the treatment
of cataract and certain other affections of the eye. No scientific
evidence is available to show that the drug is therapeutically active,
and its value is no doubt correctly estimated by Dr. Casey Wood, who
(“Ophthalmic Therapeutics,” p. 446; Cleveland Press, Chicago, 1909)
says:

“Still, a few respectable names have been associated with its
[_Cineraria maritima_] employment in that capacity and it only
remains to be said that the instillation into the conjunctival
sac of a preparation of this or any other member of the _Senecio_
family has about as much effect on the resolution or dispersal of
opacities due to organic changes in the lens as pouring the same
down the back of the patient’s neck!”

The plant from which _Cineraria maritima_ juice is claimed to be
prepared is commonly referred to in literature as _Cineraria maritima_,
but is more correctly described as _Senecio cineraria_, D. C.

It may be considered a matter of indifference whether a remedy like
this be advertised for the treatment of such diseases as cataract,
providing its application could do no harm, but it must be remembered
that it is recommended also for other diseases of the eye in which its
use, by postponing efficient treatment, would be the means of serious
damage or even loss of vision.

Since there is no evidence to show that this drug is of any therapeutic
value, it is recommended that it be not admitted to the list of
non-official, non-proprietary remedies in N. N. R., and that the
Council formally expresses its opinion that the drug, as judged by
the evidence which is available, is without value in the treatment of
cataract or similar diseases of the eye.

[Editorial Comment.--_Cineraria maritima_ would long since have been
relegated to the limbo of discarded and discredited drugs had it
not been given a semiproprietary character by a St. Louis nostrum
house--the Walker Pharmacal Company--which, like the Manola Chemical
Company, is, we understand, practically a subsidiary concern of the
Luyties Homeopathic Pharmacy Company. The Walker concern exploits
this drug under the name Succus Cineraria Maritima (Walker). Its
method of exploitation consists in publishing testimonials, which it
dignifies with the name “clinical reports,” from men whom it designates
as “representative physicians.” As indicative of what constitutes
representative physicians, we find that of the seven testimonials given
in their pamphlet the names of three of the signers are not to be found
in any medical directory.

The exploitation of Succus Cineraria Maritima (Walker) is the
oft-repeated story of the resurrection of discarded and worthless drugs
for the purpose of creating proprietorship in a nostrum. _Cineraria
maritima_ is worthless; its therapeutic value is _nil_. By the prodigal
use of printers’ ink, the medical profession--and through it the
public--has been humbugged into believing that it possesses curative
value.]--(_From The Journal A. M. A., Nov. 11, 1911._)

HAGEE’S CORDIAL OF THE EXTRACT OF COD LIVER OIL COMPOUND[I]

Report of the Council on Pharmacy and Chemistry

[I] See also the reports on Wampole’s Preparation and Waterbury’s
Compound, following this; also Hagee’s Cordial, p. 289; The Comparative
Nutrient Value of Cod Liver Oil and Cod Liver Oil Cordials, p. 442.

This is one of the “oilless” cod liver cordials. Like other
manufacturers of such extracts, the Katharmon Chemical Company, St.
Louis, which owns Hagee’s Cordial, attempts to trade on the reputation
long enjoyed by cod liver oil as a promoter of growth and nutrition.
The following is the statement of composition furnished by the company:

“Each fluid ounce of Hagee’s Cordial of the extract of Cod Liver
Oil Compound represents the extract obtainable from 1/8 fluid
ounce of Cod Liver Oil (the fatty portion being eliminated), 6
grs. Calcium Hypophosphite, 3 grs. Sodium Hypophosphite, 1/2 gr.
Salicylic Acid (made from Oil Wintergreen), with Glycerin and
Aromatics.”

And here are some of the therapeutic claims:

“Tonic, Stimulant, Alterative, Reconstructive, Nutritive and
Digestive.”

“Useful in phthisis pulmonalis, scrofula and all chronic pectoral
complaints, coughs, colds, brain exhaustion, nervous debility,
palsy, chronic cutaneous eruptions and impaired digestion.”

Of course, these absurd claims hark back to the time of the prevalence
of the now discarded theory that the valuable properties of cod liver
oil reside, not in the fat, but in certain nitrogenous, alkaloid-like
constituents present in infinitesimal amounts. Further “playing up”
this theory:

“The prescriber may know that in our preparation he is getting, in
easily assimilable and palatable form, the very properties that
make cod liver oil the best of reconstructives.

“When you prescribe cod liver oil you are after the active
principles--why not give the active principles themselves.”

Proprietary manufacturers usually ignore scientific investigations
which establish facts adverse to proprietary claims; but the same
proprietary manufacturers are quick to seize on any theory that can be
twisted into support of their interests. Thus, recent investigations
having shown that cod liver oil, like butter and egg yolk, possesses
certain growth-promoting properties not found in some other fats, the
promoters of Hagee’s Cordial claim these properties of cod liver oil
for their extract. They assert:

“Recent Chemical Investigations of Cod Liver Oil show that the
active principles contain the nutritive qualities attributed to the
whole oil.”

The Council has previously expressed the opinion[19] that the
preponderance of evidence indicates that whatever therapeutic value
cod liver oil may have depends chiefly, if not entirely, on its fat
(oil). There never was any evidence or scientific authority for the
theory that the therapeutic value of cod liver oil was independent of
its fat content. The fact that the fat is the growth-promoting element
has already been shown, and J. P. Street, chemist for the Connecticut
Agricultural Experiment Station (The Journal A. M. A., Feb. 20, 1915,
p. 638), in a series of experiments on a number of the so-called
extracts of cod liver or cod liver oil (including Hagee’s Cordial) has
conclusively demonstrated that the growth-promoting properties of the
oil are not to be found in the extracts. Street placed rats on a ration
not sufficient to maintain normal nutrition and growth for an extended
period. After the rats had been on this ration for some time and a
failure to maintain weight was indicated, an amount of dealcoholized
Hagee’s Cordial was substituted for a portion of the lard contained in
the ration. Later Hagee’s Cordial was replaced by cod liver oil.

[19] The Journal A. M. A., Oct. 9, 1909, p. 1201.

Street says:

“None of the four rats did well on Hagee’s Cordial; in fact, they
lost 1.2 to 15.4 gm. during feeding periods of from seven to
fourteen days.”

“The rats failed so quickly when put on Hagee’s Cordial that in two
cases the animals did not recover even when put on the full cod
liver oil ration.”

“... the four rats during the Hagee period, instead of gaining the
normal 24 gm., actually lost 36.2 gm., while during the cod liver
oil period instead of gaining 114 gm., they gained 156.4 gm.”

“_The inferiority of Hagee’s Cordial as a reconstructive and a
nutrient compared with ordinary cod liver oil is apparent._”

Hagee’s Cordial of the Extract of Cod Liver Oil Compound has neither
the nutritive qualities nor the reconstructive efficacy of cod liver
oil. This mixture is worthless for the conditions for which it is
advertised, and is marketed under misleading and unwarranted claims.
It is recommended that Hagee’s Cordial be held ineligible for New and
Nonofficial Remedies.--(_From The Journal A. M. A., April 10, 1915._)

WAMPOLE’S PERFECTED AND TASTELESS PREPARATION OF
AN EXTRACT OF COD LIVER[J]

Report of the Council on Pharmacy and Chemistry

[J] See also reports on Hagee’s Cordial preceding and Waterbury’s
Compound following this; also The Comparative Nutrient Value of Cod
Liver Oil and Cod Liver Oil Cordials, p. 442.

Wampole’s Preparation is another of the oil-free “extracts” of
cod liver. The following formula (which, be it observed, is
non-quantitative and therefore practically worthless) is published by
the owners, Henry K. Wampole & Co., Inc.:

“Contains a solution of an extractive obtainable from fresh cod
livers, the oily or fatty portion being afterward eliminated. This
extractive is combined with Liquid Extract of Malt, Fluid Extract
of Wild Cherry and Compound Syrup of Hypophosphites (containing
Calcium, Sodium, Potassium, Iron, Manganese, Quinin and Strychnin).”

An alcohol content of 17 per cent. is declared on the label. The
following claims are typical of those made for the preparation:

“This grease, or oil, is not present in Wampole’s Preparation
of the Extract, which is _palatable_ and, at the same time,
very efficient as a stimulant to the centers of nutrition and
assimilation. It is unsurpassed as a reconstructive tonic ...”

“[Cases] with a marked tendency to pulmonary troubles,... if a
timely impulse be given them will easily shake off the impending
evil. Wampole’s Preparation gives that timely impulse ...”

In the Council’s opinion, as previously expressed,[20] such therapeutic
value as there may be in cod liver oil is chiefly, if not altogether,
due to the fat (oil). Lately, the investigations of J. P. Street
of the Connecticut Agricultural Experiment Station have definitely
disproved the claims made for the Wampole’s and similar preparations.
In Street’s experiments, rats were placed on a ration insufficient for
normal nutrition and growth. After the rats had been on the ration for
a time long enough for inability to maintain weight to become evident,
dealcoholized Wampole preparation was substituted for a portion of
the lard contained in the ration. Later the Wampole preparation was
replaced by cod liver oil. From these experiments it appears that,
although the Wampole preparation is said to contain malt extract and
sugar, it does not show the advantage over ordinary cod liver oil as
a source of nutriment which is claimed for it by the manufacturers.
Street emphasizes that the Wampole preparation does not possess to any
marked degree the reconstructive properties of cod liver oil, butter
fat and egg yolk, on which foods rats gain weight rapidly and steadily
after having been on a deficient diet. Street calls attention to the
fact that the amount of alcohol consumed daily by the user of the
Wampole preparation (the equivalent of 0.7 fluidounces of whiskey)
explains to a considerable extent the asserted tonic virtues of the
preparation.

[20] The Journal A. M. A., Oct. 9, 1909, p. 1201. (See following
report, this volume.)

Though offered as an efficient substitute for cod liver oil, Wampole’s
“Perfected and Tasteless Preparation of an Extract of Cod Liver” lacks
both the nutritive and the reconstructive properties and is marketed
under an indefinite name and unwarranted and untrue claims. It is
recommended that Wampole’s Preparation be held ineligible for New and
Nonofficial Remedies.--(_From The Journal A. M. A., April 10, 1915._)

WATERBURY’S METABOLIZED COD-LIVER OIL COMPOUND[K]

Report of the Council on Pharmacy and Chemistry and Laboratory
Contribution on Which It Is Based

[K] See also preceding reports on Hagee’s Cordial and Wampole’s
Preparation; also Waterbury’s Compound once more, p. 291; The
Comparative Nutrient Value of Cod Liver Oil and Cod Liver Oil Cordials,
p. 422.

The following report has been adopted by the Council and its
publication directed

W. A. Puckner, Secretary.

_To the Council_:--Your committee on pharmacology has read with
interest the contribution from the Association’s laboratory on
Waterbury’s Metabolized Cod-Liver Oil Compound. The report shows that
misleading and false statements are made in regard to the composition
of the product and also that exaggerated and unwarranted claims are
made for its therapeutic value. In view of the attempt of the Waterbury
Chemical Co. to create a false impression in regard to the therapeutic
value of the composition of its product, it is recommended that the
following report be adopted and published:

The Council believes that there is a preponderance of evidence to
indicate that whatever therapeutic value cod-liver oil has, that value
depends chiefly, if not entirely, on its fat (oil). In the opinion of
the Council, the word cod-liver oil should not be used in connection
with any preparation unless it consists to a large extent (25 per cent.
or more) of cod-liver oil. Since Waterbury’s Metabolized Cod-Liver Oil
Compound contains no appreciable quantity of cod-liver oil, the name
is incorrect and misleading, and as a cod-liver oil preparation it is
believed to be wholly valueless. The Council has previously voted that
Waterbury’s Cod-Liver Oil Compound be refused recognition because of
conflict with Rules 1 and 6.--(_From The Journal A. M. A., Oct. 9,
1909._)

[CONTRIBUTION FROM THE CHEMICAL LABORATORY OF THE AMERICAN MEDICAL
ASSOCIATION]

Waterbury’s Metabolized Cod-Liver Oil Compound

W. A. Puckner and L. E. Warren

A full page advertisement of Waterbury’s Metabolized Cod-Liver Oil
Compound appeared in the _Iowa Medical Journal_, March 15, 1909, in
the form of a letter purporting to give the results of an analysis
of the product made for the firm by a Chicago chemist. In this
letter-advertisement the chemist states at the outset that the results
of his examination “are somewhat at variance with the statements made
in The Journal.” These statements he quotes as follows:

1. It is a clear liquid and no globules of oil are seen under the
microscope. It is therefore not an emulsion.

2. It is of acid reaction when mixed with water and remains clear
when strongly acidified. Hence it does not contain a soap, and is
not a saponification of fat.

3. It mixes with water without precipitation, hence, it can not
contain more than traces of a fatty acid.

The chemist admits in his letter to the firm that his analyses verify
statements 1 and 3, but regarding statement 2 he says: “I find that
your preparation is acid in reaction, but when strongly acidified gives
a distinct turbidity within 10 minutes and a voluminous precipitate
within 1 hour. This precipitate is shown to consist of fatty acids of
cod-liver oil, which are thrown down by the splitting of the soaps,
on acidifying either with sulphuric or hydrochloric acid.” From these
results he states that to him it seems that the “preparation does not
deserve the statement that it contains no soap, as there is no question
whatever of the presence of cod-liver oil.”

While in the letter published in this advertisement the chemist claims
to have demonstrated the presence in the product of “saponified
cod-liver oil,” he _omits to mention the quantities_ of the soap
present. In the article that originally appeared in The Journal (Oct.
13, 1906), in addition to the three paragraphs quoted by the chemist,
the following statements were made:

“By these simple tests a physician is easily able to demonstrate
that the preparation does not contain cod-liver oil. It is therefore
valueless for the purpose of nutrition for which we give the oil. More
careful analysis confirms the results of these tests and shows that it
contains no fat or fatty acids (except the merest traces)....”

At the time these statements were published in The Journal, the _St.
Paul Medical Journal_, October, 1906, contained an advertisement for
Waterbury’s Metabolized Cod-Liver Oil Compound, which contained this
statement:

“The only tasteless preparation on the market which contains
Cod-Liver Oil in its entirety. The metabolized product is obtained
by the action of digestive ferments on pure Cod-Liver Oil.”

In the _Ohio Medical Journal_ of Feb. 15, 1907, there appeared in
the form of an advertisement what purported to be an analysis of
Waterbury’s Metabolized Cod-Liver Oil Compound by Prof. C. N. Kinney of
Drake University. While Professor Kinney made a quantitative analysis
of the preparation, the quantities were omitted from the analysis as
published. A footnote added by the Waterbury Chemical Company called
attention to this fact and closed as follows:

“Any physician who is not satisfied with the analysis we will
be only too glad to furnish the complete analysis by our
representatives.”

If this weirdly constructed sentence meant anything, it meant that
the complete analysis would be furnished on request. Such requests
to the company, however, from various sources failed to elicit the
information required nor was the “complete analysis” forthcoming. The
inference to be drawn is fairly plain.

In a circular accompanying the product as sold at present, this
statement occurs:

As previous examination disclosed only the merest traces of cod-liver
oil in the product though claims were made that it “represents
cod-liver oil in its entirety,” and in view of the fact, too, that
present advertisements emphatically declare that cod-liver oil is
present in the preparation as now sold, it was thought best to examine
some of the preparation with especial reference to the quantities of
fatty acids from cod-liver oil.

[Illustration: OLD LABEL NEW LABEL

It is interesting in this connection to note that this product is no
longer being sold under the name “Metabolized Cod Liver Oil Compound.”
See the illustrations of the old and new labels.]

The results of the examination are briefly as follows: The total
quantity of acids isolated amounted to about 0.3 per cent., and of this
amount about two-thirds was _salicylic acid_. Thus it appears from
the examination of the specimens bought on the open market that the
preparation contains at most but 0.1 per cent. of the fatty acids from
cod-liver oil, a totally insignificant quantity.

Notwithstanding the protestations by the manufacturers, in the form
of published analyses and circulars, it is seen that the statements
published in The Journal, Oct. 13, 1906, p. 1207, are essentially
substantiated; it is further evident that the product does not deserve
to be designated as a cod-liver oil preparation. To obtain a medicinal
dose of cod-liver oil the patient would be compelled to swallow the
contents of a bottle of this mixture, and as the product contains 11
per cent. alcohol the patient who did so would probably experience a
degree of exhilaration not referable to cod-liver oil.--(_From The
Journal A. M. A., Oct. 9, 1909._)

Declared Misbranded

This product of the Waterbury Chemical Company, of Des Moines, Iowa,
was exposed in The Journal of the American Medical Association, October
9, 1909. In May, 1910, the United States Government issued a notice
of judgment in which it was declared that Waterbury’s Metabolized Cod
Liver Oil Compound was misbranded. The court rendered its decree of
condemnation and forfeiture.--[_Notice of Judgment, No. 303._]

WATERBURY’S COMPOUND

Report of the Council on Pharmacy and Chemistry

The Waterbury Chemical Company having requested that the Council
reconsider its action of four years ago (see preceding report) on the
product then known as Waterbury’s Cod-Liver Oil Compound, now called
Waterbury’s Compound, the matter was submitted to a referee. The
referee reported that the statement now made as to the composition of
this product is as follows:

“Made from Cod Liver Oil, Digestive Ferments, Malt Extract
Unfermented, Hypophosphites Comp. Special, Ext. Cherry, Eucalyptus,
Aromatics, etc.”

He held that the Waterbury Chemical Company has not submitted
satisfactory evidence to indicate that the objections of the Council’s
former unfavorable report have been met; that there is no evidence
that the product is a substitute for cod-liver oil in any way; and
that under the present methods of exploitation it constitutes what
is at least an inferential fraud; and recommended that no further
consideration be given to Waterbury’s Compound. The report was adopted
by the Council.--(_From The Journal A. M. A., March 20, 1915._)

COLCHI-SAL

Report of the Council on Pharmacy and Chemistry

Colchi-Sal, said to be made by the Anglo-American Pharmaceutical Co.,
Ltd., New York, is advertised, sold and “guaranteed” (sic) by E.
Fougera and Co., Inc., New York. According to the label of a recently
purchased specimen:

“Each Capsule contains Cannabis Indica (Active Principle of)
1-500th Grain (1/8 Milligram); Colchicine (Crystallized) 1-250th
Grain (1/4 Milligram); Methyl Salicylate 20 Centigrams.”

The advertising circular around the bottle adds that the mixture also
contains “appropriate aromatic adjuvants.”

It is recommended in “Gouty and Chronic Rheumatic Manifestations,”
“acute cases of Gout,” “intestinal auto-intoxication or dyspepsia,”
“bilious headaches,” etc. Salicylates are generally recognized as
valuable in acute manifestations of acute articular rheumatism;
colchicum is useless in these conditions. Both salicylates and
colchicum are practically useless in chronic rheumatic and in chronic
gouty affections. For dyspepsia, bilious headache, etc., salicylates
are distinctly contra-indicated and the drastic purgation produced by
colchicum would not be thought desirable. Though methyl salicylate
administered internally is not generally considered so efficient as
sodium salicylate, it is asserted that the former

“... is found far more effective than salicylate of soda or other
salicylic derivatives when given in conjunction with colchicine as
Colchi-Sal.”

Further, the highly improbable and unsubstantiated claim is made
that “the active principle of _Cannabis indica_” (whatever that
may be) “corrects any tendency of the colchicine to irritate the
gastro-intestinal tract” and that the “appropriate aromatic adjuvants”
“prevent intolerance of the methyl salicylate.”

Colchi-Sal is put up in a way to appeal to the public; the bottle
has the name “Colchi-Sal” blown in the glass; the label gives full
instruction for the use of Colchi-Sal, and also the price, suggesting
that the preparation may be freely purchased. Wrapped around the bottle
is a circular advising its use in various affections.

The physician who acts on the advice that it is well to “insist on
the pharmacist dispensing original bottles ...” of the “little green
capsules” actually suggests to his patient the use of this preparation
of methyl salicylate and colchicum in conditions in which these drugs
may do much harm and in which proper treatment is imperative.

Colchi-Sal is typical of unscientific ready-to-take proprietaries. It
was held ineligible for New and Nonofficial Remedies because of its
secret composition, viz., the unknown nature of the “active principle
of Cannabis indica” (Rule 1); because the circular in the package
and the name blown in the bottle constitute advertisement to the
laity (Rule 4); because the claim that cannabis indica removes the
gastro-intestinal irritation, and the claim of the superiority of
methyl salicylate are unwarranted therapeutic claims (Rule 6); because
the name does not indicate the presence of the habit-forming cannabis
indica, and because of its unscientific composition (Rule 10).--(_From
The Journal A. M. A., March 20, 1915._)

CYPRIDOL CAPSULES

Report of the Council on Pharmacy and Chemistry

Having voted that Cypridol Capsules be refused recognition, the Council
directed that for the information of physicians publication of the
following report be authorized.

W. A. Puckner, Secretary.

Cypridol Capsules, sold by E. Fougera & Co., New York, are stated to
be “Bottled in the New York Laboratories of Vial, late Rigaud and
Chapoteaut, Paris,” and to contain, in each capsule, 2 mg. (1/32 grain)
mercuric iodid (biniodid of mercury) dissolved in a fatty oil. They
are claimed to permit the administration of mercury without danger of
salivation--an obvious misrepresentation.[21] Cypridol Capsules are
marketed in a way to appeal to the public. If they are once prescribed,
the directions on the bottle and the full instructions for the
treatment of syphilis by means of Cypridol and by other proprietaries
sold by Fougera & Co. is likely to lead the patient to attempt the
treatment of this malady on his own accord, and thus probably to
forfeit his chances of cure. Cypridol is a vicious example of the
“ready-to-take” proprietaries.

[21] Physicians who desire to use a solution of mercuric iodid in oil
should direct their pharmacist to prepare it according to the method
suggested by Lemaire (Repert. pharm., xxi, 97-102, from Chem. Abst.,
1909, p. 1444), viz.: One gm. of mercuric iodid is dissolved in 50 c.c.
sterilized castor oil by warming to about 70 degrees, 3 gm. guaiacol
are added and the solution made up to 100 c.c. with sterilized poppy
oil. Or according to a later suggestion (Dunning: Proc. Am. Pharm.
Assn., 1910, p. 1123): one gm. of mercuric iodid is dissolved in 99 gm.
of a mixture of equal parts of sterilized castor and olive oils, by
warming on the water-bath.

Cypridol Capsules are in conflict with the rules of the Council as
follows:

Rule 4: The dosage, price, etc., on the label, and the name “Cypridol”
blown in the bottle, all tend to a direct self-prescribing by the
public. In addition to the objectionable statements on the bottle
itself, the preparation is put up in patent medicine style and is
accompanied by a circular giving full directions for the use of this
and of other proprietaries for the treatment of syphilis in all of its
stages. The circular states that “a 1 per cent. solution of bin-iodide
of mercury in an aseptic oil” is “An Improved Specific in the Treatment
of Syphilis,” and after lauding the virtues of Cypridol, gives full
directions for the treatment of syphilis in its various stages by
means of Capsules of Cypridol augmented, during periodical cessation
of treatment, by “small doses of iodide of strontium (Paraf-Javal’s
standard solution, thirty grains to the ounce).” Further, the circular
expounds the need of “a toning up of the general system” and by means
of obsolete theories and obviously untrue assertions recommends
“_Chapoteaut’s Wine_ [another of their proprietary preparations], each
ounce of which contains 10 grains of phospho-glycerate of lime. This is
a delicious, nutritive tonic. A pint bottle costs $1.00.”

Rule 6: Whereas it is evident that Cypridol, depending for its effects
on mercuric iodid, the ordinary well-known hydrargyri iodidum rubrum
of the U. S. Pharmacopeia, must naturally have the properties of a
mercuric compound, unwarranted claims such as the following are made:

“CYPRIDOL does not render patients anemic. Ptyalism never follows
the administration of the capsules or injections. On the contrary,
patients rapidly put on flesh and keep well. There are no
diarrhoeas or other symptoms of intolerance even when the dose is
pushed.”

Rule 8: The non-informing name “Cypridol” for a mercuric iodid
preparation is bound to lead to its use without consideration of the
fact that a potent mercury preparation is being used, requiring a
careful adjustment of dosage, a consideration of the needs of the
individual case, a correct diagnosis, etc. While the advertising
propaganda argues that “physicians recognize the advantage of
prescribing this solution of mercuric iodide in an aseptic oil under
the name of ‘Cypridol,’ because it does not betray to the laity the
fact that mercury is being used,” not only the physician but also the
patient has a right to know, and ought to know, the potent character of
the remedy which is being administered.

It is recommended that Cypridol be refused recognition and that
publication of this report be authorized.--(_From The Journal A. M. A.,
Dec. 19, 1914._)

CYSTOGEN, CYSTOGEN APERIENT AND CYSTOGEN-LITHIA[L]

Abstract of Report of the Council on Pharmacy and Chemistry

[L] For the unabridged report of the Council’s action on Cystogen,
Cystogen Aperient and Cystogen-Lithia, see Reports Council Pharm. and
Chem., 1914, p. 66.

Cystogen is the therapeutically suggestive name applied to
hexamethylenamin by the Cystogen Chemical Company. While investigation
has shown that hexamethylenamin yields formaldehyd only in the presence
of an acid and consequently can produce an antiseptic effect only in
the gastric juice and in the urine, it is claimed that Cystogen is
an “intestinal antiseptic” and that it “bears its disinfectant and
antitoxic qualities into well-nigh every important bodily cavity.”

As the sale of a simple drug even with the aid of the most extravagant
claims probably did not offer sufficient opportunity for an extensive
proprietary propaganda, the Cystogen Company has put out two other
preparations, Cystogen Aperient and Cystogen-Lithia, and finds it an
easy matter by means of extravagant claims, unwarranted assertions and
pseudo-scientific arguments to recommend the use of one or another, or
often all three, in a well-nigh endless number of diseases.

As the continued patronage of the medical profession cannot be relied
on for proprietaries of this sort, the Cystogen Chemical Company takes
good care that every Cystogen prescription is likely to spread the
Cystogen gospel among the people. The Council has directed publication
of its report on the Cystogen products to call attention to the way
in which a simple drug of established value may be made the basis of
an extensive proprietary propaganda. A conservative discussion of
the action of hexamethylenamin appears in the Council’s publication,
“Useful Drugs.” The Council therefore refused recognition to Cystogen,
Cystogen Aperient and Cystogen-Lithia.--(_From The Journal A. M. A.,
Dec. 12, 1914._)

CYSTO-SEDATIVE

Report of the Council on Pharmacy and Chemistry

Cysto-Sedative is sold by Strong, Cobb and Company, Cleveland, Ohio,
with the claim:

“Each fluid ounce represents:
Thuja Occidentalis, 3-1/2 grains.
Pichi, 18 grs.
Saw Palmetto berries, 36 grs.
Triticum Repens, 36 grs.
Hyoscyamus 8 grs.
All inert extractive matter being eliminated.”

The therapeutically active constituents of arbor vitæ, pichi, saw
palmetto and couch grass have never been isolated--indeed, it has not
been proved that all of these drugs contain any therapeutically active
constituents. Yet the absurd claims are made that all inert matter
has been eliminated and each lot of drug used in the preparation of
Cysto-Sedative is “tested in reference to its medicinal activity.”
Equally preposterous is the claim:

“In formulating Cysto-Sedative each drug entering into its
composition was subjected to careful study clinically to determine
the exact proportion required when combined to increase their
efficiency as a whole. Cysto-Sedative is scientifically prepared,
the proportion of each individual drug being so finely adjusted as
to increase their therapeutic action in the conditions for which
they are intended, forming a preparation always reliable and of the
very highest medicinal activity.”

Some other extravagant claims made for this complex unscientific
mixture are:

“It gives relief in almost every form of cystitis and
prostatitis....”

“The best results are obtained in the worst chronic cases of
cystitis and prostatitis....”

“In Cystitis, Urethritis, Prostatitis, Inflammation of the Vesicle
Neck, complicated with Gonorrhoea, Enuresis, Painful Micturition,
the action of Cysto-Sedative is prompt.”

The Council voted that Cysto-Sedative be refused recognition.--(_From
The Journal A. M. A., Dec. 12, 1914._)

TAKA-DIASTASE AND LIQUID TAKA-DIASTASE

Report of the Council on Pharmacy and Chemistry

Some time ago it was decided that a reexamination should be made of
Taka-Diastase and Liquid Taka-Diastase, both of which had previously
been rejected, to ascertain whether or not the preparations were in
accord with the claims made for them by the manufacturers. Accordingly,
the matter was referred to a committee of the Council, and an
examination of specimens of these two preparations bought in the market
was made. The referee’s report, which appears below, according to the
usual procedure, and before final confirmation by the Council, was
first submitted to the manufacturers of Taka-Diastase for comment.
The report recommends that the rejection of Taka-Diastase and Liquid
Taka-Diastase be allowed to stand, and that the report be published.
Parke, Davis & Co., in their reply, which is given in full below, claim
that the report is unjust concerning Liquid Taka-Diastase, because the
period of activity of the preparation has been greatly prolonged by
reducing the amount of alcohol from 18 per cent. to 10 per cent. and by
adding glycerin. They reiterate their claims for the digestive power of
Taka-Diastase, but admit that it will not reduce the stated amount of
starch to the colorless end-point in ten minutes (the standard method
for the valuation of diastase). They further state that they would
change the word “digest” on the label to “liquefy.”

The conclusion of the report having been questioned, the entire
matter was referred to a member of the Council’s staff of clinical
consultants. His report, which, also, is given in full below, states
that the material before him was sufficient to decide the matter,
and no further tests were necessary. He concludes that the claims
of the manufacturers regarding the strength and properties of the
material are erroneous and exaggerated; that the literature still sent
out by Parke, Davis & Co. is misleading; and that if substitution
of the word “liquefy” for “digest” were endorsed by the Council
confusion would result which would give an exaggerated and false
value to Taka-Diastase. He therefore recommends that the report of
the reinvestigation of Taka-Diastase be accepted by the Council and
published.

This report of the second referee was referred to Parke, Davis & Co.
with the request that they state more definitely the actual amylolytic
strength of their preparations. To this they replied that they had
no desire to discuss the subject further, or to make any additional
statements.

In accordance with the second referee’s recommendations, the Council
confirmed its provisional action and voted that the rejection of
Taka-Diastase and Liquid Taka-Diastase be allowed to stand, and that
the report which appears below be authorized for publication.

W. A. Puckner, Secretary.

_REFEREE’S REPORT ON TAKA-DIASTASE AND LIQUID TAKA-DIASTASE_

Following is the report of the committee to which was referred the
reexamination of Taka-Diastase and Liquid Taka-Diastase:

Some time ago a comparison was made of the various methods proposed for
the valuation of preparations claimed to have amylolytic power. This
work was reported in The Journal,[22] and the method proposed for the
testing of diastase preparations now appears in New and Nonofficial
Remedies.[23] In view of the incorrect and exaggerated claims made
for Taka-Diastase, the Council in 1908 was obliged to rescind its
acceptance and to direct its omission from New and Nonofficial
Remedies. The report contained the following reference to Taka-Diastase
(Parke, Davis & Company), a product that had been accepted for
inclusion with New and Nonofficial Remedies:

[22] The Journal A. M. A., July 11, 1908, p. 140.

[23] New and Nonofficial Remedies, 1912, p. 68; The Journal A. M. A.,
April 15, 1911, Part 2, p. 18.

“The widest discrepancy between the values as claimed by the
manufacturer and those found by actual tests seems to be shown in
the case of Taka-Diastase. The liquid preparation has been tested a
number of times in different samples and has always been found weak.
Some samples, in fact, were quite inert. This ferment appears to lose
strength very rapidly in solution, as the manufacturers now concede.
The stability of the solid product is also far from satisfactory, and
appears to be less than that of the ferment as marketed some years
ago. The two samples examined recently were weak.”

More than three years have now elapsed since the publication of the
Council’s findings regarding Taka-Diastase--sufficient time, it is
believed, for the manufacturers to modify either their claims or the
product itself, and thus again make it eligible for inclusion with
New and Nonofficial Remedies. With this idea in mind new specimens of
Taka-Diastase and Liquid Taka-Diastase were purchased from a Chicago
drug house and the preparations reinvestigated. The following is the
report of this reinvestigation.

REPORT OF THE REEXAMINATION

In our report on the diastase preparations three years ago, it was
recommended that Taka-Diastase be removed from New and Nonofficial
Remedies, because the examinations showed that it did not have
the digestive strength claimed for it. This was true both for
Taka-Diastase itself and for Liquid Taka-Diastase. So far as the
latter was concerned, the starch-converting power was practically
_nil_ in those preparations which had been in the drug stores for
some months.

During the last few weeks new tests have been carried out with
several samples of the Taka-Diastase preparations and the results
obtained are essentially the same as those obtained in the former
examinations. The liquid preparation is still extremely weak in
starch-converting power, while we found that Taka-Diastase itself
would convert only 16.6 parts of pure anhydrous starch to the
colorless end-point in ten minutes, as explained below.

In our method of experimentation we determine the weight of the
diastase in question which will convert a given weight of starch in
uniform paste to the so-called colorless end-point in ten minutes,
that is to the point where it will no longer give any color reaction
with a standard iodin solution. The standard starch weight in 50 c.c.
always is 1 gm. or 1,000 mg. and to a series of flasks containing
this amount of starch, maintained at a constant temperature of 40 C.,
the diastase dilutions are added. These diastase dilutions are made
by dissolving small, accurately weighed amounts of the sample in
some small, constant volume of water, usually 5 or 10 c.c. and they
are then poured into the starch flasks at the right temperature, and
agitated regularly.

Tests are made by taking a few drops from each flask and mixing
with the iodin solution. The end-point is reached when a dilution
is found which, at ten minutes from the mixing time, gives no color
with the iodin reagent. The first set of tests is taken as a general
guide, and quite accurate results may be obtained in a second set of
dilutions.

We first used a sample of Taka-Diastase bought in the open market. It
was found that 140 mg. were required to convert the gram of starch as
explained. This is equivalent to a conversion of 7.14 parts of starch
by 1 part of the Taka-Diastase.

A new, and possibly fresher, sample was then obtained and the
test repeated. With this new sample it was found that 60 mg. were
necessary to convert the gram of starch to the colorless end-point
in ten minutes, from which it follows that 1 part of the ferment
will convert 16.6 parts of starch to the colorless end-point in
the same time. With a new sample of Liquid Taka-Diastase obtained
simultaneously it was found that 3.5 c.c. were necessary to convert
1 gram of starch to the colorless end-point in ten minutes. As a
fluidounce of this liquid is said to contain 20 grains of the solid
it will be seen that the results approximately agree with those of
the first sample of the solid, and that they are both very low.

In the earlier tests 16 parts of starch converted by 1 part of the
ferment was the value found. These results are in close agreement
with values reported by Sherman (_Jour. Am. Chem. Soc._, xxxii, 1073)
for a sample of recent purchase. He found a conversion of 51 parts of
starch to the colorless end-point in _thirty_ minutes for one sample,
while for another he found 66 parts, in the same time. It will be
noted that our time limit is _ten_ minutes. It is worthy of note
that for a perfectly fresh and specially prepared sample furnished
by Dr. Takamine, a conversion of 278 parts in _thirty_ minutes was
found by Sherman. Taking the time into consideration, it will be seen
that the results are about the same for the market samples as those
found by us and much lower than claimed, as well as much lower than
for other makes of similar products. The difference in the behavior
of fresh specially prepared Taka-Diastase and the market sample is
very clearly shown. No one questions the fact that fresh laboratory
samples of Taka-Diastase may show a moderate converting power on
starch. But we have to deal with the _activity of market samples
only_, and Sherman’s work and our own show the low digesting power of
the product as physicians may secure it on the market.

The marked difference in activity between perfectly fresh and
ordinary market samples of Taka-Diastase is very clearly shown also
in a recent paper published by Wohlgemuth.[24] In the digestion
of starch paste to the “dextrin” stage Wohlgemuth found in the
commercial sample a strength approximately a hundred times less than
that observed in a fresh sample sent him by Dr. Takamine.

[24] Wohlgemuth: Biochem. Ztschr., March 18, 1912.

Wohlgemuth’s results were obtained by a method not essentially
different from ours, with this difference, however, that he digested
through 24 hours in the cases reported, and carried the reaction
to the “dextrin” stage only, in place of to a colorless end-point.
Making the proper reductions, it is evident that the actual values
found by him for the market samples bought in Germany are not greater
than those reported by us.

The reference to the work of Sherman is made because, in a following
paper in the same journal, he recommends the use of salt as an
activator in finding the strength of certain diastase preparations.
It is well known that dialyzed diastase preparations and starch of
highest purity have but slight action on each other; a little salt
increases the activity greatly, and also increases the activity of
commercial diastase preparations. These facts Sherman utilizes in
working out a method for valuation of commercial diastases. The facts
were well known to us at the time of our former report, but it was
not thought best to depart from the general method which had been
in use by all analysts following the general scheme of Roberts.
Quite recently, I. Bang has published a paper on the investigation
of diastase (_Biochem. Ztschr._, xxxii, 417) in which he studies the
behavior of sodium chlorid and other salts on the rapidity of starch
conversion, and finds that a much smaller amount of salt than Sherman
recommends brings the maximum increase.

The method employed in our former tests is a good comparative method,
and this is all that may be claimed at present for any method. By
adding salt to our starch solution the activity of Panase and other
ferments is likewise greatly increased. For Panase, a preparation
possessing rather high starch-converting power, we have recently
found an increase of about 30 per cent. in the converting power,
with salt present. Working to loss of blue color, merely, it is
possible in this way to get a higher value than that claimed by the
manufacturer. There is no practical gain in using the salt for our
purpose as the methods are at best arbitrary, and the results only
comparative.

Taking all the facts into consideration, it is recommended that the
rejection of Taka-Diastase and Liquid Taka-Diastase be allowed to
stand and that, in view of their extensive exploitation, this report
be authorized for publication so that physicians may know the facts.

This report was referred to Parke, Davis & Co., and they made the
following reply:

“The report submitted in your letter of the 23d is, we contend,
erroneous and unjust: first, to our Liquid Taka-Diastase, because
over three years ago we changed our formula, reducing the alcohol
from 18 per cent. to 10 per cent., increasing the glycerin and thus
prolonging greatly the period of activity.

“As for our regular Taka-Diastase, our claim is and has been for
years simply that Taka-Diastase will digest or hydrolyze 150 times
its weight of starch in ten minutes, under proper conditions. We
do not claim, we do not permit our representatives to claim, that
Taka-Diastase will completely transform starch, to the colorless
end-point, into sugars. Taka-Diastase is used to supplement a
deficiency of ptyalin and converts the starch into soluble material
with great rapidity, thus giving the gastric fluid immediate access
to the proteids.

“If in the enclosed labels the word ‘digest’ were replaced with the
word ‘liquefy,’ the claim could not be assailed by the most carping
critic. To save any possible question, we shall therefore make this
change in our label, having it read: ‘Taka-Diastase will liquefy 150
times its weight of starch in ten minutes, under proper conditions.’
Is there the slightest question in your mind that this statement as
just quoted is entirely correct and entirely supported by clinical
experience?

“It is our conviction that Taka-Diastase has a very remarkable power
to hydrolyze starch either in the test-tube or in the stomach, and
that this property is of great utility in clinical work. We do not
claim that its conversion of the starch into sugars is complete, to
the colorless end-point of the Johnson test; and on this point we
have been perfectly frank with the Council, as well as with every
physician who has taken sufficient interest to inquire.”

In view of the above protest, the matter was submitted to a second
referee, who reported as follows:

“Your referee on the matter of Taka-Diastase has made a careful
investigation of the reports and correspondence submitted, and begs
to make the following report:

“The question at issue, viz., whether Taka-Diastase should be
included in New and Nonofficial Remedies, I believe, can be
determined by the material before me, and further tests of the
material are not necessary.

“The letter of the makers of Taka-Diastase admits that the early
claims regarding the strength and properties of the material were
erroneous and exaggerated. Since the product was once admitted to New
and Nonofficial Remedies, it may be claimed that as the Council on
Pharmacy and Chemistry must have been in error then, it may be now.
Your referee does not consider this supposition worth discussing. The
conclusion he draws is that the Council was too hasty in accepting
the preparation, and that the incident shows how much better it would
be in all cases to accept no remedy until sufficient time has been
given for conclusive tests.

“The literature still sent out by Parke, Davis & Co. regarding
Taka-Diastase is misleading and of a kind more appropriate for a
nostrum than a standard chemical substance. What would we think if
morphin, quinin or even heroin were advertised in the same way? I
cite the statement, ‘Taka-Diastase digests starchy food with vigor
and directness.’ It seems to the referee that the proposition to
modify the label to indicate the amount of starch which is liquefied
rather than the amount which is saccharified, in accordance with the
Council’s standard, is bound to lead to confusion and to give an
exaggerated and false value to Taka-Diastase.

“Your referee recommends that the report of the reinvestigation of
Taka-Diastase which has been submitted to me, be made available to
the medical profession, and that the rejection of Taka-Diastase and
Liquid Taka-Diastase be allowed to stand.”

This report of the second referee was submitted to Parke, Davis & Co.,
with the request that they state more explicitly their claims regarding
the activity of Taka-Diastase and Liquid Taka-Diastase, in order that,
if they decided to revise their claims for the preparations, such
revision of claims might be published along with the reports of the
Council. They replied:

“Answering your note of the 15th instant: We have no desire to
discuss further the subject of your letter of February 24, or to make
any statement beyond that set forth in our letter to you of Dec. 27,
1911.”--(_From The Journal A. M. A., July 6, 1912._)

DIGALEN OMITTED FROM N. N. R.

Report of the Council on Pharmacy and Chemistry

Digalen is a proprietary said to contain a soluble form (digitoxinum
solubile Cloetta) of digitoxin, the chief active principle of
digitalis. This preparation was accepted[25] by the Council in 1909
for inclusion in New and Nonofficial Remedies. The Council had not
at that time determined whether Digalen contained “soluble amorphous
digitoxin,” as claimed, or not. The product was accepted merely as a
standardized soluble and fairly stable digitalis preparation.

[25] The Journal A. M. A., Sept. 11, 1909, p. 869.

After the acceptance of Digalen, the therapeutic claims made for it by
the manufacturers increased in extravagance. Meanwhile, evidence was
brought forward by various independent investigators which tended not
only to show that these therapeutic claims were unfounded, but also
to discredit the claim that Digalen contained a principle chemically
identical with digitoxin. In view of the obscurity of the whole subject
of the chemistry of the digitalis principles, the latter claim (that
Digalen was a solution of “amorphous digitoxin”) had been an academic
issue at the time of the acceptance of the product. When, however, the
manufacturers of Digalen sought to mislead physicians by increased and
unwarranted therapeutic claims, the Council felt that investigation of
the whole matter was imperatively demanded to decide whether or not
Digalen should be retained in N. N. R.

The questions at issue were: (1) the presence in Digalen of “amorphous
digitoxin”; (2) the constancy of composition and reliability of action
of Digalen, and (3) the claim that it causes less gastric disturbance
than digitoxin. No satisfactory proof has yet been offered that Digalen
contains “amorphous digitoxin.” The mass of evidence tends to show that
Digalen is not constant in composition or reliable in action, and that,
when given in doses corresponding in therapeutic activity, Digalen
causes quite as much gastric disturbance as the official galenical
preparations of digitalis.

The outcome of protracted negotiations between the Council and the
Hoffmann-La Roche Chemical Works may be summed up as follows: 1. The
manufacturers promise to hold in abeyance the claim regarding the
presence of “amorphous digitoxin.” 2. They refuse to concede the
variable composition of Digalen. 3. They reassert the claim that
Digalen is superior to other digitalis products with respect to
liability to cause gastric irritation and consequent vomiting.

In view of the unsatisfactory character of the reply on the second and
third points, the Council voted that Digalen be omitted from N. N. R.
and that publication of the report on Digalen which appears below be
authorized, as well as of the two reports[26] (A and B) referred to
therein.

[26] These reports (A, first report on Digalen and B, examination of
Digalen Tablets) will be published in the 1914 Annual Council Reports.
A reprint of the entire matter dealing with the rejection of Digalen
will be sent on receipt of a two-cent stamp.

W. A. Puckner, Secretary.

Referee’s Report on Digalen

Because of persistent conflict with Rule 6 (unwarranted therapeutic
claims) and Rule 1 (composition) it is recommended that Digalen be
omitted from New and Nonofficial Remedies; also that a copy of the
report be sent to the manufacturers, and that publication of this
report and the two previous reports submitted to the Council be
authorized.

The nature of the problems involved necessitates a somewhat extended
discussion of the subject.

Digalein (liquid) is said to contain 1 part of soluble amorphous
digitoxin Cloetta in 1,000 parts of glycerin and 1,600 parts of water
with 7.5 per cent. of alcohol. One c.c. is said to contain 0.0003 gm.
of the amorphous digitoxin.

Digalen was accepted by the Council[27] and the following footnote
was appended to the description in New and Nonofficial Remedies:

[27] The Journal A. M. A., Sept. 11, 1909, p. 869.

“The Council has not determined whether digalen contains ‘soluble
amorphous digitoxin’ or not, but accepts it simply as a soluble
digitalis preparation.”

Tablets of Digalen were accepted by the Council as a dosage form of
Digalen. Each tablet is said to represent 0.5 c.c. (eight minims) of
Digalen (liquid).

One of the principal considerations which led the Council to accept
Digalen was that it was regarded as affording a fairly constant
and stable preparation of digitalis suitable for intravenous
administration. If Digalen is not fairly stable and of fairly constant
composition it has no obvious advantage over an active soluble
digitalis preparation, such as digitalein.

The evidence now at hand seems to show: 1. Digalen is not of constant
composition or activity. 2. The manufacturers, or their agents,
continue to make misleading statements. 3. It is merely a solution of
certain digitalis principles, probably of digitalen mainly, in impure
form.

COMPOSITION

Cloetta[28] prepared a soluble amorphous substance which he called
“Digitoxinum solubile Cloetta,” but no information concerning the
method of preparation has been published.

[28] Cloetta: München. med. Wchnschr., 1904, No. 33.

Cloetta reported the result of an elementary analysis of his product
which he compared to the analyses of digitoxin (crystalline) made by
Schmiedeberg and by Kiliani, and stated that there could be no doubt
concerning the chemical identity of the two substances.

Kiliani[29] characterized as preposterous Cloetta’s claim that the
active constituent of Digalen is chemically identical with digitoxin
and stated that Digalen was merely an impure digitalein. Kiliani
has recently reiterated the statement that the so-called “amorphous
digitoxin” is not identical with digitoxin.[30]

[29] Kiliani: München. med. Wchnschr., 1907, p. 886.

[30] Kiliani: Am. Jour. Pharm., 1913, lxxxv, 224.

Cloetta’s failure to publish his method of preparing Digalen places
an additional burden of proof on him (or the manufacturers of
Digalen), concerning the identity of the product, and in the face of
Kiliani’s denial of the correctness of Cloetta’s contention we must
have strong corroborative evidence of Cloetta’s claim before we can
accept it as being established.

The difficulties of dealing with the chemistry of digitalis are so
well known that they hardly require further mention here, but under
the circumstances Cloetta cannot be considered as being wholly
unprejudiced, and, while the same might perhaps be said of Kiliani,
such evidence as can be deduced tends strongly to support Kiliani’s
view, and to disprove the contention of Cloetta.

There is much confusion regarding the names which have been applied
to the various principles obtained from digitalis, and while it is
undesirable that an established name should be given to a newly
discovered principle, one might overlook this if no effort were made
to associate the therapeutic actions of the two substances to an
extent which the truth did not justify.

While the Council at that time did not challenge the existence of
“amorphous digitoxin” and made no attempt to determine the identity
with digitoxin of the substance forming the basis of Digalen, the
manufacturers of Digalen have sought to show that Digalen and
digitoxin were identical so far as their therapeutic actions were
concerned, but that Digalen lacked the disadvantages of digitoxin.
What was a purely academic question when the acceptance of Digalen
was under discussion by the Council becomes a matter of very great
practical importance when the manufacturers of Digalen seek to
mislead the physician by these claims.

The evidence which lends support to the view that Digalen and
digitoxin are wholly dissimilar may be summarized as follows: Digalen
differs greatly in its physical properties from digitoxin and in
certain of its physiologic actions, as the manufacturers themselves
state, Digalen being amorphous, and soluble in water, while digitoxin
is crystalline and insoluble in water. The manufacturers state that
Digalen differs from digitoxin in certain of its physiologic actions,
but the two substances do indeed differ far more than they admit.

Cloetta and the manufacturers of Digalen lay especial stress on the
claim that Digalen is cumulative to a far less extent than digitoxin,
and that it has far less tendency to cause gastric disturbance than
the latter. The first of these claims is true; the second is the
very opposite of the truth, as we shall show.

We know nothing of the structure of any of the digitalis principles,
and even though one were to admit (purely for the sake of argument)
that Digalen and digitoxin were chemical isomers, that fact could
not be taken to lend any support to the contention that the two
substances were identical, in the face of the established fact
that they differ physically and physiologically in nearly every
particular, and agree only in that they both cause standstill of the
heart in the same way--an action possessed also by so dissimilar a
substance as barium.

The manufacturers of Digalen support the claim of the identity of
their product with digitoxin by stating that “Digalen is a solution
of the most active glucoside of digitalis.”[31] Of course, it is very
generally admitted that digitoxin is the most active principle of
digitalis, though there is some question concerning its glucosidal
nature.

[31] Clinical Suggestions and Reports, December, 1912, p. 24.

Digalen is in fact far less active than digitoxin, as has been shown
by a number of independent observers[M] (Worth Hale, 1910; Hatcher
and Brody, 1910; Neave, 1907; Miller, 1908; the referee; Weis, 1912).

[M] Owing to lack of space a portion of the report is here omitted. A
detailed discussion of these results is included in the full report
contained in the reprint.

The essential fact which appears from the investigation of Weis is
that _Digalen did not behave like digitoxin in any case_.

Hale also found that Digalen gave atypical actions in which the
effects on the central nervous system became prominent. The referee
can corroborate these observations of Hale’s on frogs, but the
convulsive symptoms were prominent with some specimens of Digalen on
mammals, though not with others, the more recent specimens of the
preparation showing the action prominently.

The results of all these biologic tests, as well as of the physical
tests made by Weis, certainly lend no support to the contention of
Cloetta that the potent constituent of Digalen is identical with
digitoxin, but, on the contrary, they show conclusively that the
two substances differ widely in many essentials, and the continued
claim of the manufacturers that the “amorphous digitoxin” said to be
contained in Digalen is the same as digitoxin, or that it is the most
active glucosid of digitalis, can be considered only as misleading,
and therefore in conflict with the rules of the Council.

CONSTANCY OF COMPOSITION AND ACIDITY

The manufacturers of Digalen continue to claim that it is of constant
and uniform activity,[32] and they imply this even when they do
not state it in those words; for example, a substance cannot be
considered reliable if it is variable in activity. “Digalen is
Absolutely _Reliable_. It is _Standardized_ and consequently _always
uniform_. It _does not produce gastric disturbances_.”

[32] Advertisement Brit. Med. Jour., April 26, 1913.

That the foregoing is absolutely untrue can be shown abundantly.
Hale[33] found digalen not to be uniformly stable; Weis found very
different degrees of activity for Digalen in the liquid and tablet
forms, the tablets being but one-third as active as the liquid, and
the referee found very great variations in the activity of different
specimens of Digalen, one specimen being almost inert. The results
obtained by Miller show that Digalen is sometimes very slightly
active, or not at all so.

[33] Hale: Hyg. Lab. Bull., 74.

The foregoing citations show conclusively that Digalen is not
of uniform activity. When _reliability_ is claimed for Digalen
in contrast to the known variability of digitalis, it must be
considered as tantamount to the claim that Digalen is not subject
to such variability and it must be held that the manufacturers make
misleading statements when they assert that Digalen is absolutely
reliable.

The manufacturers claim that Digalen does not produce gastric
disturbances (see advertisement cited).

It is quite true that when small doses of Digalen are used
therapeutically it fails to produce gastric disturbances because it
is of such slight activity, as previously stated, but when it is used
in amounts which correspond in activity to such doses of the ordinary
galenical preparations of digitalis as commonly cause nausea and
vomiting it does cause gastric disturbances quite as readily as the
latter.

Among the clinicians who have found that Digalen causes gastric
disturbances may be cited: Veiel,[34] Mueller,[35] Eichhorst[36] and
Teichmann.[37]

[34] Veiel: München. med. Wchnschr., 1906, liii, 2140.

[35] Mueller: München. med. Wchnschr., 1909, lvi, 904.

[36] Eichhorst: Deutsch. med. Wchnschr., 1905, xxxi, 49.

[37] Teichmann: Therap. d. Gegenw., 1907, xlviii, 199.

Eggleston and Hatcher[38] compared the emetic and cardiac activity
of Digalen and numerous other digitalis bodies and preparations and
found that the emetic activity of Digalen was decidedly greater in
proportion to its cardiac (or therapeutic) action than was that of
digitalis or digitoxin.

[38] Eggleston, Cary, and Hatcher, Robert, A.: The Emetic Action of
the Digitalis Bodies, The Journal A. M. A., Feb. 15, 1913, p. 499.

In the absence of any evidence to controvert this clinical and
experimental evidence, the continued claim that Digalen does not
disturb the stomach must be looked on as deliberate misrepresentation.

MISLEADING THERAPEUTIC CLAIMS

The recommendation that Digalen be dismissed from N. N. R. is made
with the full appreciation of the fact that the manufacturers of
Digalen and their agents have repeatedly stated that they desired to
comply with the rules of the Council, and that they have withdrawn
several statements to which the Council has taken

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