I. COUNCIL REPORTS (part 2 of 2)

It seems, moreover, by all the evidence available, that F. M. Turner is not authorized to use the title M.D.; yet, under this title his name appeared on cards representing the Vanadium Chemical Company and under this title, also, he published an article in a medical journal recommending to the medical profession the use of Vanadiol. Later this article was distributed as an advertising circular by the Vanadium Chemical Company. Turner’s connection with the Dr. Turner Company is known and acknowledged by the Vanadium Chemical Company, yet it still retains him as general manager!

While there is not necessarily any direct relation between the personnel of a proprietary manufacturing company and the value of that company’s product, it is natural that the medical profession should view with distrust any concern managed by one who has previously been connected with such a fraud as the Turner obesity cure.

The committee therefore recommends that the preparations of the Vanadium Chemical Company be refused recognition, and that this report be authorized for publication.--(From The Journal A. M. A., Jan. 18, 1913.)

VENARSEN

Report of the Council on Pharmacy and Chemistry

The report which appears below was sent to the Intravenous Products Company for consideration. Having considered the firm’s reply, the Council has authorized publication of its report along with the explanation sent by the Intravenous Products Company in reference to the variable composition reported for Venarsen, namely, that “only the first few experimental ampules, sent to the doctors for clinical tests, were made without the Mercuric Iodide.”

W. A. Puckner, Secretary.

This product is prepared by the Intravenous Products Company, Denver. The advertising circulars contain inconsistent statements as to its composition. According to one circular Venarsen is

“... a comparatively non-toxic organic arsenic compound, 0.6 Gm. representing 247 Mg. (3-3/4 grains) of metallic arsenic in chemical combination....”

According to another circular Venarsen is

“... a comparatively non-toxic organic arsenic compound, 0.6 Gm., representing 247 Mg. (3-3/4 grains) of metallic arsenic and .78 Mg. (3/250 grain) metallic mercury in chemical combination.”

Neither one of these statements gives any information as to the actual composition of the product. Inquiry addressed to the manufacturers elicited the reply that:

“Venarsen contains in each 5 c.c. 0.6 Gm. Sodium Dimethyl Arsenate, .0016 grams of Mercuric Iodide, .0048 grams of Sodium Iodide in solution in a suitable vehicle for intravenous administration.”

The following report of the examination of Venarsen is submitted by the Association’s Chemical Laboratory:

LABORATORY REPORT

Three ampules of Venarsen were examined. The first ampule was labeled

“A comparatively non-toxic organic arsenic compound, representing 247 Mg. (3-3/4 grs.) of metallic arsenic in chemical combination. 5 c.c.--0.6 Gm.”

Practically the same statement appeared in an advertising circular wrapped around the ampule. The second and third ampules bore labels identical with the first. The circulars differed from that accompanying the first ampule in that the presence of mercury is also announced, thus:

“Venarsen is a comparatively non-toxic organic arsenic compound, 0.6 Gm., representing 247 Mg. (3-3/4 grains) of metallic arsenic and .78 Mg. (3/250 grain) metallic mercury in chemical combination and is so prepared and enhanced as to present the ingredients to the blood in their most acceptable form.”

Thus, although the potent elements said to be contained in Venarsen are named, its chemical character (the combination in which the elements occur) is not disclosed.

The ampules contained a transparent, odorless solution, possessing the yellow color of salvarsan solution (an aqueous solution of sodium cacodylate, mercuric iodid and sodium iodid in the amounts said to be present in Venarsen is colorless). Qualitative tests demonstrated the presence in each of the three ampules of sodium cacodylate (sodium dimethyl arsenate), and the absence of arsenites, arsenates, phosphates, arsanilates (atoxyl, soamin) and arsenphenolamins (salvarsan, neosalvarsan). Titrated with normal hydrochloric acid, using methyl orange as indicator (as outlined in New and Nonofficial Remedies, 1915, p. 40), the three ampules were found to contain the equivalent of respectively, 0.219, 0.253 and 0.216 Gm., or an average of 0.244 Gm. arsenic. (According to statements of the firm each 5 c.c. of Venarsen contains 0.6 Gm. sodium dimethyl arsenate [sodium cacodylate], equivalent to 0.247 Gm. arsenic or 41.66 per cent. Sodium dimethyl arsenate, as described in New and Nonofficial Remedies, contains 3 molecules of water and 35 per cent. arsenic. This indicates that the sodium dimethyl arsenate used in Venarsen contains less water of crystallization than the N. N. R. product).

Neither mercury nor iodid could be found in the first ampule. (The company has since explained that mercury was absent only from the first experimental samples.) The second and third ampules contained iodid and mercury in small amount. The exact quantity was not determined because, on the basis of the mercury content declared, a single accurate mercury estimation would have required the purchase of something like 25 to 100 ampules. As each ampule sells for two dollars, the cost of the material was considered prohibitive.

From the foregoing we conclude that the first ampule examined consisted essentially of a solution containing 0.625 Gm. of sodium cacodylate, N. N. R., while the second and third ampules contained 0.722 Gm. and 0.617 Gm. sodium cacodylate, respectively, and in addition, a mercury compound, probably mercuric iodid, dissolved by sodium iodid.

In other terms, Venarsen as now marketed is a simple solution containing approximately 9 grains of sodium cacodylate, 1/40 grain of mercury “biniodide” and 3/4 grain of sodium iodid to each full dose.

In the past the preparation has been in conflict--especially serious because of the potent character of the drug--with Rule 1 (secrecy of composition). The manufacturers have removed this conflict by furnishing a statement of composition; and it is to be expected that they will likewise take steps to remove the manifestly erroneous impression now likely to be gathered from the circulars, namely, that the preparation is rather analogous to salvarsan. These conflicts, however, call for comment, since physicians have doubtless used the material under misapprehensions.

As to therapeutic claims, the preparation is said to be effective and safe in syphilis; “lower toxicity and greater spirochaetacidal power than other known arsenic compounds” are among the claims. No real evidence for either of these claims is presented. Sodium cacodylate has been tried as an antisyphilitic, but with indifferent success; certainly the results have not been comparable to those of salvarsan. The mercury could conceivably enhance its effect, but the dosage appears too small and the course too short for this influence to be pronounced. Moreover, a careful physician would not give arsenic and mercury in fixed proportions.

The claim of comparative non-toxicity is probable enough from what is known about the cacodylate. No physician should feel “safe,” however, when injecting intravenously 0.6 gm. of sodium cacodylate every four to six days. Aside from the grave dangers of intravenous injection in general, the possibility of idiosyncrasies to arsenicals should always be borne in mind.

Finally, Venarsen is claimed to be “indicated” in pellagra, tuberculosis, anemia, etc. No evidence is presented on which to base an opinion as to its efficiency in pellagra. Those who have studied that disease would not be likely to resort to this treatment. In tuberculosis and anemia, there is no sufficient advantage in giving the cacodylate intravenously.

To summarize, Venarsen treatment consists essentially in the intravenous injection of large doses of sodium cacodylate. The other ingredients, as well as the name, merely constitute so much mystification. While the cacodylate probably has some effect on the conditions for which it is advised, there is no evidence that its value even approaches that of salvarsan in syphilis, or that the intravenous use is preferable to the ordinary methods. The dangers are manifest, although they may not be so great as with salvarsan. No justification has been established for its use in tuberculosis and pellagra.

Physicians who wish to try intravenous cacodylate administration should have a full realization of the dangers of such treatment, and in order to avoid further risks, will do well to refrain from combining other drugs with the cacodylate in fixed proportions.

It is recommended that Venarsen be held in conflict with Rule 6 (unwarranted therapeutic claims), Rule 7 (poisonous ingredients not stated on label), Rule 8 (name does not express the chemical composition) and Rule 10 (unscientific combination) and that this report be published.--(From The Journal A. M. A., May 22, 1915.)

VENODINE

Report of the Council on Pharmacy and Chemistry

Venodine (The Intravenous Products Co., Denver), according to information sent to the Council, is “an Intravenous Iodine Compound” put up in ampules each of which contains “28 grains of Sodium Iodide, 1/8 grain each of Beechwood Creosote and Guaiacol in a suitable vehicle, and excipients to enhance its compatibility with the circulating blood.”

The “Therapeutic Indications” include “infectious diseases, such as syphilis, tuberculosis, bronchitis, bacteraemias associated with chronic and acute nephritis (Bright’s disease), and other infections.” The Council held as unwarranted and grossly exaggerated the following therapeutic claims: (1) that the full therapeutic value of iodin medication cannot be readily obtained except by intravenous injection; (2) that Venodine is “of exceptional value in tuberculosis”; (3) that in pneumonia Venodine “combines the anaesthetic properties of creosote and guaiacol with the germicidal value of iodine”; (4) that “Venodine (or its iodine component) has long enjoyed an exceptional reputation” as of great value in many infectious diseases including bacteremias. The facts on these points are the following:

1. Since iodids are easily absorbed from the mucous membrane of the gastro-intestinal tract and are usually well tolerated by the stomach, there is no reason for resorting to intravenous injection in their administration.

2. The indiscriminate administration of iodids for pulmonary tuberculosis is strongly to be condemned. The cases in which they can be given to tuberculous patients without doing harm must be very carefully selected.

3. There is no evidence either that creosote is excreted by the lungs in sufficient quantity to exert an anesthetic influence or that iodin is present in the circulation of the lungs or in the bronchial secretions in a form which is capable of exerting any germicidal action whatever.

4. It is generally held that the systemic administration of iodin compounds in bacteremias is useless.

The Council also held the name “Venodine” objectionable in that it fails to indicate the chief ingredient (sodium iodid) of this simple pharmaceutical mixture. The statement in a circular that “Venodine is a sterile solution representing 1.54 Gm. (24 grains) of iodine in chemical combination together with creosote and guaiacol” is likely to lead physicians to use the preparation without considering that its chief constituent is the well-known substance sodium iodid, particularly so since no reference to sodium iodid is made in the circular.

Furthermore, the Council held that the combination of two such similar substances as creosote and guaiacol (the second a constituent of the first) as given in the published formula, stamps Venodine as unscientific; it adds mystery to the preparation, but does not increase its efficiency, and is therefore against the best interests of the public.

The Council voted that Venodine be held ineligible for conflict with Rules 6, 8 and 10.

This report having been submitted to the manufacturers, in accordance with the Council’s custom, and the reply affording no reason for modifying the findings, its publication has now been authorized.--(From The Journal A. M. A., June 26, 1915.)

VERACOLATE[AM]

Report of the Council on Pharmacy and Chemistry

[AM] For report on a similar compound, see Taurocol, p. 198.

“Veracolate (plain),” “Veracolate with Pancreatin and Pepsin” and “Veracolate with Iron, Quinine and Strychnine” are proprietary tablets marketed by the Marcy Company, Boston.

“Veracolate (plain).”--For this the following non-quantitative formula is given:

“A compound containing the bile acids, sodium glycocholate, sodium taurocholate with cascara sagrada and phenolphthalein.”

The dose is three tablets. Examination in the Chemical Laboratory of the American Medical Association of a specimen of “Veracolate (plain)” indicated that there was about 20 mg. (1/3 grain) of phenolphthalein to each tablet. One dose, therefore (three tablets), would contain 1 grain of phenolphthalein--an average dose.

“Veracolate with Pepsin and Pancreatin.”--The following “formula” is given for this mixture:

“Veracolate 1-1/4 grain “Pure Pancreatin 1 grain “Pepsin aseptic (1:3,000) 1/2 grain “Oil peppermint 1/10 min.”

(Note the presence of two mutually incompatible digestive ferments.)

“Veracolate with Iron, Quinine and Strychnine.”--This is stated to have the following “formula”:

“Veracolate 1-1/8 grain “Reduced Iron 1 grain “Quinine Sulphate 3/8 grain “Strychnine Sulphate 1/100 grain”

It will be noticed that these mixtures increase in complexity until a combination of seven diverse ingredients, a veritable shotgun mixture, is evolved. In none of the “formulas” are the proportions of the purgative drugs in Veracolate stated. In the second “formula,” the digestants might as well be omitted, for the pancreatin is destroyed by peptic digestion and hence cannot pass the stomach while the pepsin is useless without hydrochloric acid, and, at any rate, of no value in the intestine. If one is indicated, the other is not. Yet this unscientific and complex combination of purgatives, mutually incompatible digestive ferments, and oil of peppermint is called:

“A scientific Blending of Digestive Ferments, Cholagogues and Carminatives.”

“... for all forms of indigestion and dyspepsia.”

And the third, an equally irrational and complex combination, is termed “The Ideal Cholagogic Tonic”!

Extravagant and Misleading Claims.--True to type, the claims are magnified in accordance with the number of ingredients. For instance, of “Veracolate (plain),” we are told:

“Veracolate is a true cholagogue and biliary disinfectant as it directly stimulates the liver cells producing an increased flow of limpid bile. Although not a purgative, it moves the bowels and is definite and dependable in its action.”

“The action of Veracolate is to bring about a profuse flow of healthy bile which prevents bile stasis. As the flow of bile is stimulated so antiseptic action ensues, calculi softened and the concretion and mucous eliminated. Mucosal swelling is diminished and the infection which is usually present is antagonized. Relief is in plain evidence. As a result of the treatment the skin, eyes and urine become normal in appearance in a short time, the appetite and digestion improve and soreness in the region of the gall-bladder is entirely relieved.”

Similarly, it is said of “Veracolate with Pancreatin and Pepsin” that:

“It causes a natural flow of bile which checks fermentation, prevents the absorption of toxines and causes the food elements to be emulsified and thus rendered easy of assimilation. All this conduces to a natural movement of the bowels. Digestion is at once improved and the epigastric pain, nervous symptoms and headache disappear.”

“Veracolate with Iron, Quinine and Strychnine” is said to be indicated in:

“Hepatic Torpor accompanied by Anemia, Chlorosis, Debility, Neurasthenia and Neuroses.”

And the physician is asked to believe that it will:

“... give gratifying results in all nervous, anemic, and ‘run down’ conditions in which the liver function is usually subnormal.”

The objections to “Veracolate (plain)” are that it is semi-secret in composition, unscientific in combination and exploited under unwarranted claims. The same criticisms hold with reference to “Veracolate with Pancreatin and Pepsin” and “Veracolate with Iron, Quinine and Strychnine.”

These products are discreditable to the medical and pharmaceutical profession alike and their use is against the public good. The Council therefore refused recognition to Veracolate and its preparations.--(From The Journal A. M. A., April 24, 1915.)

HAYDEN’S VIBURNUM COMPOUND[AN]

Report of the Council on Pharmacy and Chemistry

[AN] See also report on Dioviburnia, p. 141, and article on Viburnum Compound and Other Nostrums, p. 409.

The following report on Hayden’s Viburnum Compound was prepared by a member of the Council’s Committee on Therapeutics. The Council held the preparation in conflict with its rules and authorized publication of the referee’s report.

W. A. Puckner, Secretary.

Hayden’s Viburnum Compound, according to the advertising circulars, was first compounded in 1860 by W. R. Hayden. The medical profession is told that W. R. Hayden

“... found by his experiments that a combination of the active principles of Viburnum Opulus, Dioscorea Villosa, combined with aromatics, proved a valuable remedy for Spasmodic Dysmenorrhea.”

As in 1860 W. R. Hayden was not a physician (he received a diploma from the Eclectic Medical College, New York, in 1867), and, so far as we can learn, he was not a pharmacist or chemist, one wonders what kind of “experiments” he made. Hayden’s Viburnum Compound is put on the market by the New York Pharmaceutical Company of Bedford Springs, Mass. The name of this concern may sound imposing, until it is realized that it is merely a trade name adopted by Hayden in exploiting his nostrum.

The advertising matter formerly claimed that Scutellaria (skull-cap) was one of the ingredients of Hayden’s Viburnum Compound. As this is no longer mentioned, it is fair to assume that even the manufacturer does not consider the composition to be of vital importance. Stress is laid on the superior efficacy of viburnum opulus in the conditions for which the preparation is recommended; it is emphasized that it is viburnum opulus, and not viburnum prunifolium, that is the important ingredient of Hayden’s Viburnum Compound. The label, in accordance with the requirements of the Food and Drugs Act, declares that the preparation contains 50 per cent. alcohol. The claim is made:

“It is free from all narcotics and leaves no unpleasant after-effects.”

The medical profession is told that Hayden’s Viburnum Compound is a remedy in:

“Hysteria, Bilious Colic, Cramps of Cholera Morbus, Muscular Cramps,... Nervous Diseases of Pregnancy, Threatened Abortion, Post-Partum Pains, Puerperal Convulsions, Rigid Os, Dysmenorrhea, Menorrhagia.”

DISCUSSION OF ALLEGED INGREDIENTS

Viburnum Opulus (Cramp Bark).--Botanists and pharmaceutical chemists declare that this drug has not been on the American market for many years, if ever, and that the drug used and even described as viburnum opulus is really the bark of another plant. Viburnum opulus and its preparations are therefore to be dropped from the next United States Pharmacopeia. The principal constituents of viburnum opulus are stated to be a glucosid, viburnin, a bitter resin, and a little tannin, with small amounts of earthy carbonates and phosphates and organic acids (Culbreth, Ed. 4, 1906, p. 591). The glucosid and resin being bitter, the drug might have a slight stomachic action (if, indeed, any such effect is actually produced by “bitters”); the small amount of tannin might make it slightly astringent; its fruit acids (citric and malic) might make it slightly diuretic. Even if viburnum opulus were present in Hayden’s Viburnum Compound there is no clinical or laboratory proof that it, if given alone--without alcohol or other drug--has any antispasmodic or nervous sedative action.

Dioscorea Villosa (Wild Yam).--This drug contains a saponin and an acrid, irritant resin. It has never been proved clinically or experimentally that this drug has any action whatever except that its irritant resin might, if taken in sufficient quantity, cause irritation of the stomach and vomiting.

Aromatics.--The irritation produced by concentrated aromatics causes increased peristalsis and consequently may, if there is no obstruction, relieve intestinal stasis and intestinal colics. Therefore, a preparation containing large amounts of aromatics, especially if given in hot water, would have practically the same effects in the “cramps of a cholera morbus” or other forms of acute diarrhea as a home-brewed cup of spiced tea--and no more.

Alcohol.--This drug is a muscle relaxant, and sufficient doses might, by relieving spasm, relax a muscularly contracted os uteri and relieve post-partum pains. Alcohol dilates the blood-vessels both in the abdomen and on the surface of the body. It may thus either relieve uterine bleeding by lowering the blood-pressure and causing more blood to go to other parts, or increase uterine bleeding by relieving arterial and muscle spasm. Alcohol is also a habit-forming narcotic (Hayden’s Viburnum Compound is advertised as “free from all narcotics”!) and when habitually used by either males or females tends to impair the capacity to produce normal offspring.

Even if the manufacturer’s “formula” be accepted, Hayden’s Viburnum Compound contains no therapeutically active ingredient except alcohol and aromatics. The recommended dose of this preparation is “... two teaspoonfuls in six of boiling hot water or milk and one teaspoonful of sugar, every fifteen or twenty minutes until relief is obtained.”

“Frequently after taking the Viburnum Compound the patient will sleep soundly for several hours from the sudden cessation of pain; in such cases she should never be awakened through any fear of oversleeping, as Hayden’s Viburnum Compound does not contain any narcotic whatever, nor does it leave any disagreeable after-effects, and it may be given to a child when necessary without any special caution.”

Read the foregoing and then remember that it means that one teaspoonful of alcohol (the equivalent of two teaspoonfuls of whisky) is to be given in hot water, every fifteen or twenty minutes until relief is obtained and the patient is asleep. Why not use plain language and say “until she is drunk”?

The thoughtful physician would consider it decidedly unwise to give alcohol to a young girl, to a prospective mother, or to a young mother, except under extraordinary circumstances. He would know that the menstrual pains for which this preparation is recommended are likely to be recurrent, and that the repeated taking of alcohol for recurrent pain is fraught with danger--the danger of initiating the alcohol habit. If, however, a physician does elect to give alcohol as a drug, he must let the conditions that govern each individual case determine whether it is not better to give it as whisky, or to disguise it in a prescription of his own. Above all the physician should be conscious that he is giving the drug, alcohol; and this is not the case when he prescribes a ready-made nostrum. If he writes a prescription containing whisky or other alcoholic he will take measures to avert the dangers inseparable from the use of this drug.

CONCLUSIONS

1. Even if the manufacturer’s formula for Hayden’s Viburnum Compound be accepted, it is apparent that any therapeutic activity the preparation may have is due essentially to the alcohol and aromatics.

2. Alcohol is a narcotic drug, and a habit-forming drug. Physicians ordering this preparation may, by so doing, be initiating the alcohol habit.

3. Whatever result is obtained by the use of Hayden’s Viburnum Compound in the treatment of uterine or pelvic disturbances, is due to the alcohol it contains. The fact that menstrual pains are likely to recur might, when this preparation is relied on, become a factor in the formation of the alcohol habit.

4. Whatever result is obtained by the administration of Hayden’s Viburnum Compound in the treatment of gastro-intestinal disturbances is due to the alcohol and the aromatics it contains.

5. Whisky has the same alcoholic content (50 per cent.) as Hayden’s Viburnum Compound; the dangers in the use of whisky are well known and its value as a therapeutic agent is being questioned more and more every year.

Holding the exploitation of this proprietary a danger to the public and a detriment to scientific medicine, the referee recommends publication of this report as a protest against such irrational therapeutics. The profession should recognize that most, if not all, of the preparations recommended for painful menstruation and for all kinds of pelvic pain contain large percentages of alcohol, and that whatever physiologic effect is produced is, for all practical purposes, due to the alcohol.--(From The Journal A. M. A., Jan. 23, 1915.)

VIN MARIANI

Report by Council on Pharmacy and Chemistry--With Comments Thereon

This preparation was assigned to a subcommittee of the Council and the following is an abstract of the report of the committee:

Samples of Vin Mariani and of the literature distributed by the manufacturers were examined.

It appears that the beverage or medicine known as “Vin Mariani” is a preparation of red wine, apparently imported from Bordeaux, and fortified, in this country, by an alcoholic preparation of coca leaves or other parts of the coca plant.

The committee considered first, the character of the red wine as imported. A sample received from the port of New York, March 10, 1905, from Henry Clausel & Co., Bordeaux, and consigned to Mariani & Co., on analysis was found to have the following composition:

Specific gravity 0.9959 Alcohol by volume per cent. 10.99 Extract per cent. 2.279 Volatile acids per cent. 0.0914 Ash per cent. 0.2801 Reducing sugar trace. Pol. direct degrees --0.8 Pol. invert degrees --0.7 K.So M. per liter 0.092

A sample of Vin Mariani, as bought in the open market in an original package, has also been analyzed and found to have the following composition:

Specific gravity 1.0125 Alcohol by volume per cent. 16.15 Extract per cent. 8.602 Ash per cent. 0.277 Glycerin per cent. 0.444 Volatile acid per cent. 0.0747 Tartaric acid per cent. 0.2400 Alkaloids (coca bases) per cent. 0.0250 Cane sugar per cent. 2.35 Reducing sugar per cent. 3.38

The increased alcoholic strength of Vin Mariani over the Bordeaux wine from which it is made, as shown by this analysis, doubtless comes from the alcohol extract containing the coca bases, as already stated. Approximately 6 per cent. of sugar is also added to the wine. Judging from the analysis, therefore, Vin Mariani corresponds to a mixture of an alcoholic preparation of coca leaves and ordinary Bordeaux red wine, with the addition of about 6 per cent. of sugar.

Vin Mariani conflicts with Rule 5, which requires that “No article will be admitted or retained, concerning which the manufacturer or his agents make misleading statements as to geographical source, raw material from which made, or method of collection, or preparation,” by stating in the advertising literature that: “The United States government, under the Pure Food Law of March 3, 1903, further emphasizes all previous analyses of Vin Mariani by admitting Mariani’s wine as absolutely pure and unadulterated.”

Whatever may have been the intent of the above statement, its effect is to deceive. The conjunction of the terms “Vin Mariani” and “Mariani’s wine” can only be construed as meaning the same thing. Inasmuch as it does not appear that Vin Mariani is imported into this country, it would not have been possible for the United States government to inspect it, and as to the wine obtained from Henry Clausel & Co., from Bordeaux, it is not in any sense Mariani’s wine except that of ownership. It is the opinion of the committee that this phrase can only result in deception and the construction of the language strongly favors the supposition that it is intentionally meant to deceive.

This false claim is practically repeated in the other pamphlets published by the Vin Mariani Company, although not always in the same words.

This preparation also conflicts with Rule 6, which states that “No article will be admitted or retained of which the manufacturer or his agents make unwarranted, exaggerated or misleading statements as to therapeutic value,” in that the firm’s letter-heads have printed on them the following:

“Vin Mariani purifies the blood stream, strengthens the circulation, stimulates muscular fiber and nerve tissue, is a respiratory stimulant, strengthens the heart muscles, and is an emergency food in the absence of all other nutriment. Successfully employed as an adjuvant in anemia, debility, diseases of the chest, nervous troubles, muscular or mental overstrain, neurasthenia, and allied conditions, and in certain cases of protracted convalescence.”

The committee believes that Vin Mariani is intended as a beverage rather than as a medicine.

The report concludes:

“The committee recommends, therefore, that Vin Mariani be refused recognition and that this report be published in full or in part.”

In accordance with this recommendation the above extract of the report is herewith published.

W. A. Puckner, Secretary.

VIN MARIANI MADE IN THIS COUNTRY

According to the above report, Vin Mariani as imported is simply an ordinary cheap French wine, the preparation sold in this country as Vin Mariani being compounded in this country. Yet the advertising literature, the label on the bottle, etc., state directly or indirectly that it is a French preparation. Until recently--presumably until the vendors realized that the truth regarding this point would come out--the advertisements in medical journals contained an analysis made by a chemist in Paris. The shape of the bottle, the character of the printed matter accompanying the bottle, etc., are evidently intended to convey the impression that it is imported. So far, then, as this point is concerned, Vin Mariani is sold under gross misrepresentations and is a fraud.

ADVERTISED TO THE PUBLIC

Vin Mariani was at one time advertised to the public in this country, but, so far as we know, it is not at the present time; at least, not directly. Yet it is most effectively advertised to the public indirectly, and this with little expense to the promoters, the cost of the circular around the bottle being the only expense--doctors who prescribe it do the rest. If those who are in the habit of prescribing Vin Mariani will examine the advertising that goes into the hands of their patients they will realize how true it is that our profession is responsible for much of the “patent-medicine” taking. Few laymen could withstand the temptation to buy the stuff for any ailment that comes along when they read in the circular that this “medicine,” which their doctor evidently thinks is a good thing, is so highly recommended, for all the ills that befall us mortals, by the Pope of Rome, the Czar and the Czarina of Russia, the Queen of England, the Shah of Persia, the King of Norway and Sweden, the Queen of Portugal, the Queen of Saxony, the Crown Prince of Cambodia, Ferdinand of Bulgaria, and by a whole list of ambassadors, generals, politicians, musicians, actresses, etc. The testimonials of these great men and women are enough to convince the most skeptical that this remarkable medicine will do everything but raise the dead--and under favorable circumstances accomplish even this. And still more--it will win battles! Witness this from the governor-general of Madagascar: “We were refreshed by Vin Mariani, and before morning carried the stronghold.” Alexander Dumas and Emile Zola are credited with calling it “the elixir of life.” One very strange thing about the testimonials in the circular used in this country is that all are written by foreigners. But Americans (President McKinley--think of it--among others) are honored by having their testimonials quoted in the circulars used on the other side of the Atlantic. Why? Is it possible that the testimonials are fakes?

AN ETHICAL CURE-ALL

Here are a few of the conditions that the circular says Vin Mariani is good for: “Anemia, winter cough, debility, vocal weakness, la grippe, continued fevers, bronchitis, nervous troubles, muscular weakness, diseases of the aged, malaria, melancholia, overwork, neurasthenia, impotence, malnutrition, depression, heart troubles, wasting diseases, mental overstrain, and in certain cases of protracted convalescence.”

The following quotations are taken from blotters--circulated in this country--which are evidently intended for the laity, as well as for physicians:

“Vin Mariani creates and sustains vigor and energy. Guards against wasting diseases. When everything else has failed try it to prove merits.”

“Lung, Throat and Stomach Troubles benefited by Vin Mariani; this Ideal French Tonic strengthens entire system of Body, Brain and Nerves.”

“Most Efficacious, Most Agreeable, Unequaled by anything in Fortifying, Strengthening, Refreshing.”

WHY BLAME THE LAYMAN FOR USING NOSTRUMS?

Can we blame the layman for using Peruna, Wine of Cardui, etc., simply because they are advertised, when there are physicians who, for the same reason, prescribe concoctions that are just as quackish and just as useless? And can editors of medical journals consistently find fault with newspapers for carrying advertisements of fraudulent “patent medicines” when they themselves admit to their pages advertisements of nostrums that are no less fraudulent and of no more value?

MEMBER OF PROPRIETARY ASSOCIATION

One word more: There is an organization known as the Proprietary Association of America, but it is usually referred to in common parlance as the “patent-medicine” men’s association. It will be remembered that last year we printed a list of the members of this body, among which was the Vin Mariani Company. It will be remembered also that in the list were the names of certain firms who were supplying medicines to physicians, but practically all these resigned from membership and their resignations were published by us. We have not had the pleasure of publishing the resignation of the Vin Mariani Company. On the contrary, we note that at the last annual meeting of the “patent-medicine” men’s association this firm was still an active member, Mr. A. L. Jaros, who stands for the Mariani Company in this country, being one of those registered at the meeting.--(From The Journal A. M. A., Nov. 26, 1906.)

VIROL

Report of the Council on Pharmacy and Chemistry

Virol, sold in the United States by the Etna Chemical Company, is put out by Virol, Ltd., London, England. It is said to be

“A preparation of bone marrow, red bone marrow of medullary structure of ox rib and calf bones, eggs, malt extract, and lemon syrup made from fresh fruit.”

“Marrow fat is emulsified with extract of malt, lemon syrup and eggs, it is further enriched with soluble phosphates of lime, iron and soda, and glycerine solution of red bone marrow.”

Many of the therapeutic claims made for Virol the Council considered grossly exaggerated; among them are the following:

“... a complete food for children.”

“... a complete nutrient.”

“The value of the Lime-Salts (representing the Egg Shells) contained in Virol is fully illustrated in its influence upon Rickets; whilst Struma, Chronic Bronchitis, Anaemia and Influenza are all combated by its use in a degree, which, we venture to say, has never been approached.”

“The fat, as represented by the Marrow-bone and Egg Yolk, is so minutely divided that it admits of even far more rapid absorption by the villi of the intestine than milk.”

“It is an ideal form of food, readily digested and assimilated in the weakest of conditions.”

“Virol has a marked effect on the metabolism of the body, increasing the production of opsonins and stimulating phagocytosis. As an adjuvant to the natural defensive processes of the patient in all diseases of bacterial origin its value can scarcely be over-estimated.”

The objections of the Council were transmitted to Virol, Ltd. The firm’s reply was reported to the Council by the referee of the Committee on Therapeutics who held that no adequate or satisfactory answer had been made to the objections raised against the advertising claims for Virol.

The claims made for Virol being unsubstantiated and unwarranted, the Council voted that the preparation be refused recognition.

In accordance with the practice of the Council, the exploiters of Virol were afforded an opportunity to comment on the foregoing statement before its publication. On their objecting to the findings, the entire matter was turned over to a second referee. This referee, in making his report, reviewed the claims made for Virol and commented on the lack of evidence to substantiate these claims. He stated that a chemical analysis of the preparation had yielded the following result:

“Sugar, as maltose 60.0 per cent. “Fat 13.2 per cent. “Proteins 3.2 per cent. “Ash 1.6 per cent. “Water and volatile matter 21.6 per cent.

“There is no appreciable diastatic action. A little glycerol is present in the volatile matter. The preparation is therefore an extract of malt with fat and a small amount of protein.”

He then continues:

“That Virol has food value cannot be denied, but that it has sufficient value to warrant the claims of the manufacturers is not evident. Virol cannot be considered a complete food, as the advertising literature reiterates, or an ideal food for infants. The amount of protein is far too low in comparison with the carbohydrates to warrant this view. The dosage recommended is not large. Thirty gm. a day would furnish only about 1 gm. of protein and 4 gm. of fat. The 3 teaspoonfuls a day recommended for children would furnish protein and fat even below this.

“If employed alone it cannot be a complete or sufficient food, and if employed along with other articles of diet--milk and bread, for example--it is not easy to see wherein lies the efficacy of the small weights of fat and protein added in the form of Virol. Here the demand made on our credulity is too great, as the protein in the preparation is the familiar protein of eggs, meat and malt, and the fat largely that from the egg-yolk and marrow, according to the claims. It is not known that any specific virtues reside in these bodies, or in the egg-shells, also claimed as present.

“In the opinion of the present referee there is nothing in the composition of Virol to justify the claims made for it. The judgment and recommendations of the first referee follow from the facts and must be accepted by the Council.”

The Council directed that the previously prepared report be allowed to stand and that it be published along with a suitable reference to the report of the second referee.--(From The Journal A. M. A., Feb. 20, 1915.)

Spotted a typo or a problem in this chapter? Tell us

II. CONTRIBUTIONS FROM THE CHEMICAL LABORATORY

ANUSOL HEMORRHOIDAL SUPPOSITORIES[AO]

W. A. Puckner and L. E. Warren

[AO] See also Anusol Suppositories, p. 280.

An abstract of an article concerning “anusol suppositories” was published in The Journal, Jan. 23, 1909. This gave the results of an analysis by a foreign chemist, J. F. Suyver, which were to the effect that “anusol suppositories” contained no “anusol.” Schering & Glatz, the American agents for “anusol” suppositories, took exceptions to the abstract, asked that The Journal retract, and submitted the findings of a chemist in support of their claim that the suppositories do contain “anusol.” To determine the composition of “anusol hemorrhoidal suppositories” as they are found on the American market, trade packages were purchased (April 6, 1909) and submitted to examination[90] in the Association’s laboratory.

[90] Details of the quantitative analysis of “Anusol Hemorrhoidal Suppositories” appear in the annual report for 1909 of the Chemical Laboratory of the American Medical Association.

According to the claims of the manufacturers, 12 suppositories contain:

“Anusoli 7.5 grams. “Zinc oxid 6.0 grams “Balsam Peruv 1.5 grams “Ol. theobrom 19.0 grams “Ungt. cerat 2.5 grams”

Calculated to percentages the formula reads:

Anusoli 20.54 per cent. Zinc oxid 16.44 per cent. Balsam Peruv 4.11 per cent. Ol. theobrom 52.06 per cent. Ungt. cerat 6.85 per cent.

When this product was submitted to the Council some time ago, Schering & Glatz stated that, according to the manufacturer, “anusol” is the “iodo resorcin sulphonate of bismuth, having the following rational formula: [C_{6}H_{2}ISO_{2}.O(OH){2}]{3}Bi. In the meta-dioxybenzol C_{6}H_{4}(OH){2}, the resorcin, one H has been replaced by one I, and for another H the sulfonic-acid group SO{2}-OH has been substituted, so that meta-dioxybenzol is transformed into C_{6}H_{2}ISO_{2}-OH(OH)_{2}. In the sulfonic acid the H of OH is replaced by Bi and, as Bi is trivalent the above rational formula results.”

According to this formula “anusol” should contain:

Iodin 32.99 per cent. Sulphur 8.34 per cent. Bismuth 18.07 per cent.

And the “anusol” suppositories should contain:

Iodin 6.77 per cent. Sulphur 1.71 per cent. Bismuth 3.71 per cent.

Examination showed that the suppositories contain about 0.08 per cent. iodin, or 1.2 per cent. of the amount claimed; 0.28 per cent. sulphur, or 16.3 per cent. of what is claimed; 0.71 per cent. bismuth, or 19 per cent. of what is claimed; and zinc equivalent to 16.5 per cent. zinc oxid, or about 100 per cent. of claim.

From the standpoint of the iodin content alone, assuming that all of the iodin found is present in the form of “anusol,” the results of the examination of the product (as found on the American market) verifies, for all practical purposes, Suyver’s statement that “anusol suppositories contain no anusol,” for the quantity of iodin present is so minute (about 1/82 of that required by the formula) as to be unworthy of serious consideration. The presence of sulphid in appreciable amounts was demonstrated showing that the sulphur is present, at least in part, in the form of sulphid and not as sulphonate as is claimed. In a measure, too, this is in accord with the findings of Suyver, who concluded that, in the product which he examined, the bismuth was present in the form of sulphid. The proportions of sulphur and of bismuth (respectively about 1/6 and 1/5 of the required amounts) indicate still further that the product is not all that it is claimed to be.

A specimen submitted by Schering & Glatz to the Council two years ago contained 0.99 per cent. iodin, or 1.3 per cent. of the amount claimed; 0.23 per cent. sulphur, or 13.4 per cent. of the claimed amount; and 0.52 per cent. bismuth, or 14 per cent. of what is claimed by the formula. Since the above determinations were made another specimen of Anusol Hemorrhoidal Suppositories was received from Schering & Glatz, July 16, 1909. This sample was found to contain about: 0.075 per cent. iodin, or 1.1 per cent. of the amount required by the formula; 0.265 per cent. of sulphur, or 15.5 per cent. of the requirement and 0.88 per cent. bismuth, or 23.7 per cent. of the required amount. It will thus be seen that the composition of the oldest specimen and also that of the specimen recently sent, corresponds in a general way to that of the one first examined.

Whether judgment be based on the determination of the bismuth, the sulphur or the iodin, the results just given clearly show that the claims made concerning the composition of “Anusol Hemorrhoidal Suppositories” are not substantiated by the facts.--(From The Journal A. M. A., Oct. 2, 1909.)

AROMATIC DIGESTIVE TABLETS

W. A. Puckner and L. E. Warren

It has been amply demonstrated[91] that pepsin and pancreatin, when in solution, mutually destroy each other; if the solution be acid, the pepsin destroys the pancreatin; if alkaline, the pancreatin destroys the pepsin. By using the characteristic effect of pepsin on proteids in acid medium and that of pancreatin on proteids and starches in an alkaline solution it can readily be demonstrated that commercial liquid preparations labeled as containing both of these ferments actually contain only one ferment. They are misbranded.

[91] U.S. Pharmacopeia, 8th revision, p. 334.

Besides the liquid a goodly number of solid preparations, chiefly tablets, containing pepsin and pancreatin are offered to the profession. Among these are tablets consisting simply of pepsin and pancreatin. Since pepsin and pancreatin interact only when in solution, it is quite possible to prepare tablets which contain these ferments. The use of such tablets is, however, unscientific, since one or the other of the ferments is destroyed when it comes in contact with the fluids of the digestive tract. In addition to simple tablets containing pepsin and pancreatin only there is at present a host of “digestive tablets” on the market. Among these are some which must be classed with the “digestive impossibilities” (Reports of the Council on Pharmacy and Chemistry, 1910, Vol. 1, p. 41). The preparations referred to are tablets claimed to contain pepsin, pancreatin, diastase, hydrochloric acid and lactic acid. When it is considered that the United States Pharmacopeia defines hydrochloric acid as “a liquid composed of 31.9 per cent. by weight of absolute hydrochloric acid (HCl = 36.16) and 68.1 per cent. of water,” i. e., a solution of hydrogen chlorid, a gas, in water, it would at first appear that the incorporation of any appreciable quantity of hydrochloric acid in tablets would be impracticable. Hydrochloric acid, however, possesses to a limited extent the property of combining loosely with protein substances so that it becomes possible to bring about its combination with pepsin and similar substances to form compounds which are relatively stable at ordinary temperatures. Because of the volatility of the free acid and its limited combining power with protein substances (100 gm. boiled beef combine with 2 gm. absolute hydrochloric acid[92]), the quantity of acid in any tablet can never be large, much less than sufficient to be of any therapeutic value.

[92] Hemmeter, Diseases of the Stomach, Edition 3, p. 250.

A number of firms offer “digestive tablets” for sale having formulas of which the following may be considered typical:

Sacch. Pepsin 4 grains Pure Pancreatin 1 grain Diastase 1/4 grain Aromatic Powder 1/4 grain Lactic Acid 1/8 grain Hydrochloric acid 1/8 grain

Some manufacturers use United States Pharmacopeia pepsin in place of the saccharated article; others do not give the exact quantities of hydrochloric acid which their product is supposed to contain, but make use of the indefinite expression “q. s.;” still others state merely that hydrochloric acid is present, but make no claim whatever concerning the quantity.

From purely theoretical considerations it is possible that the tablets referred to might contain appreciable amounts of hydrochloric acid. Since the formulas for some of the tablets furnish no information concerning the content of hydrochloric acid, it seemed worth while to determine the quantity, if any, actually present in some of the tablets on the market. Accordingly a trade package of “digestive aromatic tablets,” as put up under the label of each of six American manufacturers, was purchased and submitted to examination in the Association laboratory.

Qualitative tests made on specimens from each brand of tablets demonstrated the absence of uncombined hydrochloric acid in each. Further tests[93] showed that hydrochloric acid in protein combination was present essentially in the amounts claimed in three of the specimens. In two of the others hydrochloric acid was entirely absent; in the remaining one only the merest traces of hydrochloric acid could be found.

[93] Details of this analysis appear in the annual report for 1910 of the Chemical Laboratory of the American Medical Association.

In the above formula each tablet is said to contain 1/8 grain hydrochloric acid. This amount is equivalent to 0.002584 gm. (1/25 grain) absolute hydrochloric acid. Analysis demonstrated that each tablet contains about 0.00267 gm. hydrochloric acid (absolute HCl) or essentially the amount claimed. The average dose of diluted hydrochloric acid United States Pharmacopeia is 1 c.c., equivalent to 0.1049 gm. absolute hydrochloric acid. To obtain this quantity from the above preparation the patient would be required to swallow more than three dozen of the tablets.

Calculation shows that each tablet should contain about 0.0031 gm. of absolute hydrochloric acid. The analysis indicated that each tablet contains about 0.0030 gm. hydrochloric acid (absolute HCl) in protein combination, or practically the amount claimed. One pharmacopeial dose of hydrochloric acid is contained in 35 of the tablets.

Chlorid is present in small amounts, but quantitative examination indicated that hydrochloric acid, either free or in protein combination is absent. An ammonium salt is present in small quantities.

Small quantities of chlorid are present. Quantitative examination indicated that hydrochloric acid in protein combination is present only in very small amounts, each tablet containing but about 0.00034 gm. of absolute acid, or about 0.34 per cent. of the pharmacopeial dose. Ammonia is absent. Inasmuch as more than 300 of these tablets would be required to furnish a pharmacopeial dose of hydrochloric acid, this firm’s interpretation of the expression “q. s.” would prove interesting.

+-----------------------------------------+ | TRUAX, GREENE & COMPANY | | “SYNERGIA” | +-----------------------------------------+

“Synergia” is claimed to be composed of “pepsin, pancreatin, veg. diastase, lactic acid, hydrochloric acid and aromatics; dose, 1 to 3 tablets.” The specimen contained no hydrochloric acid, either free or in protein combination. A trace of ammonia and small quantities of chlorid were found.

According to the formula hydrochloric acid (31.9 per cent. absolute HCl) represents 3 parts in 101 of the preparation from which the tablets are made. Each tablet (containing 5 grains of the mixture) should have 0.00307 gm. absolute hydrochloric acid. Analysis showed that each tablet contains hydrochloric acid in protein combination equivalent to an average of 0.003066 gm. absolute hydrochloric acid, or essentially the amount claimed. It would be necessary to give 34 tablets to administer a pharmacopeial dose of hydrochloric acid.

[Editorial Note: The above indicates that the use of such tablets is irrational, unscientific and that it should be condemned. The only constituent of these tablets, other than the aromatics, which might possibly be of benefit in stomach troubles, is the pepsin. But even if it be assumed that the diastase and pancreatin could exert their characteristic effects, their aid to digestion (metabolism) would be but slight, because their amounts in the tablets are too small to be of any value.

It is claimed that the tablets contain diastase in amounts varying from 1/20 to 1/4 grain. Assuming the diastase used to be of first-class quality, i. e., capable of converting 200 times its own weight of starch into soluble products, the quantity of one tablet would be capable at the most of digesting but from 10 to 50 grains of starch, an amount equal at the most to but a small spoonful of oatmeal or a very dainty bite of bread. In the same way the quantity of pancreatin is insufficient to be of any material aid in digestion should it in some way escape destruction in the stomach and still retain its full activity when it reaches the alkaline juices of the intestines. One grain of pancreatin of full United States Pharmacopeia strength will digest only 25 grains of starch or the proteids in about 100 c.c. of milk.

Saccharated pepsin, which was formerly official, was required to digest 300 times its own weight of moist egg albumin, while the pepsin that is now official is required to digest ten times that amount, or 3,000 times its own weight. It is evident, therefore, that the tablets should contain sufficient pepsin to digest appreciable amounts of protein. No intelligent physician would prescribe these tablets simply for the pepsin they contain or are supposed to contain; if he wanted to give pepsin he would prescribe the drug in the simple form.

Clinical experience has shown that in the majority of cases of so-called dyspepsia the stomach contents contain too much rather than too little hydrochloric acid, and wherever there is a sufficiency of acid there is usually no decrease in the secretion of pepsin. In many of such cases, too, digestion is normal, or even more active than normal, but even when it is imperfect there is seldom any lack of pepsin.

Insufficient digestive power is most often due to a deficiency of hydrochloric acid and not to lack of pepsin in the stomach contents. In the tablets under consideration, however, hydrochloric acid is present--if at all--in the most ridiculously minute quantities; quantities that are so small as to preclude any therapeutic effect except that due to the psychic element.

These tablets, with their six or more ingredients, are typical “shotgun prescriptions.” Such prescriptions catch the unthinking doctor as well as the self-drugging public, for, while clinical experience and physiologic experiments have demonstrated that the old ideas regarding the value of these digestives and ferments were erroneous, the public and many members of the medical profession still seem to be influenced by the old theories.

In conclusion we must not lay all the blame on the manufacturing firms for supplying these absurd combinations; the physician who prescribes them should assume a large share of it. If the doctors did not use them the manufacturing concerns would soon stop putting them on the market. We hope, however, that those manufacturing concerns that like to be classed as reputable will cease to disgrace their catalogues with what they know to be therapeutic absurdities.]--(From The Journal A. M. A., Aug. 20, 1910.)

BURNHAM’S SOLUBLE IODIN[AP]

W. A. Puckner and A. H. Clark

[AP] See also report on Burnham’s Soluble Iodine, p. 110

Burnham’s Soluble Iodin, according to the manufacturers, is one of the most noteworthy “discoveries” of the age. The advertisements aim to create an impression that while the product contains iodin, pure and simple, yet by some secret process this element has been so changed as no longer to possess its usual properties. The Burnham Soluble Iodin Company makes such extravagant claims for its product and gives such wide publicity to these claims that it seemed advisable, in the interests of the profession, to determine the nature of the preparation. Its examination was accordingly taken up in the laboratory of the American Medical Association.

From the analysis, we conclude that Burnham’s Soluble Iodin is a solution of iodin in alcohol made miscible with water by the presence of some iodid. Wilbert[94] and other investigators have arrived at practically the same conclusion.

[94] Proc. Am. Pharm. Assn., 1903, li, 409.

Whatever the secret process, hinted at in the advertisements, by which this preparation is evolved, the fact remains that when one prescribes Burnham’s Soluble Iodin, one is prescribing iodin, together with an iodid, the nature of which is hard to determine. The iodid is not present as potassium iodid, nor, entirely, at least, as hydrogen iodid (hydriodic acid), but this is of slight importance compared with the fact that it is a solution in alcohol of free iodin and an iodid, and therefore is essentially the same as Lugol’s solution.

The amount of iodin found corresponds approximately to 3 gm. of free iodin and 2 gm. of combined iodin in 100 c.c. of the solution. Lugol’s solution contains 5 gm. free iodin, and 10 gm. potassium iodid in 100 c.c.

BURNHAM’S SOLUBLE IODIN TABLETS

Burnham’s Soluble Iodin Tablets are light brown compressed tablets, stamped with the letters B. S. I. in monogram. Each tablet is said to contain 3 minims Burnham’s Soluble Iodin.

The average weight of each tablet was found to be 0.3526 gm.; since Burnham’s Soluble Iodin was found to have a specific gravity of .8527 and to contain 4.5 per cent. total iodin, the tablets should contain approximately 2.3 per cent. total iodin, about one-half to two-thirds of which, depending on the condition of the “Soluble Iodin” from which they are made, should be free iodin. Instead of this, only 0.317 per cent. free iodin and 1.57 per cent. total iodin was found. Analysis shows that Burnham’s Soluble Iodin tablets contain approximately one-fourth the amount of free iodin and approximately two-thirds the amount of total iodin which should be contained therein if, in accordance with the label, each tablet contains 3 minims of Burnham’s Soluble Iodin.

COMMENT

The literature put out by the Burnham Soluble Iodin Company is in itself enough to condemn the products it advertises. The much emphasized statement of the company that

“=Something had to be done; and Burnham’s Soluble Iodin is that which has been done=”

fulfils, in its blatant assertiveness, all the requirements of nostrum advertising. The results of the analyses are not, therefore, a surprise.

Secrecy is just as essential today to the successful exploitation of this class of proprietaries as it was before the demand for formulas became so universal. The requirement of publicity is evaded, therefore, in one of two ways: Either a formula is given which is false, or at least meaningless, or else the claim is made that the method of preparing the product is a unique and remarkable secret that is possessed only by the manufacturers. The Burnham Soluble Iodin Company uses the latter device.

Meanwhile, physicians will be perfectly justified in viewing with suspicion all claims based on such conspicuously unscientific premises, more especially so when these claims fail to find substantiation on careful and painstaking analyses. In brief, whenever the physician wishes to administer free iodin, Lugol’s solution (Liquor Iodi Compositus, U. S. P., Physician’s Manual, page 84) is an inexpensive and perfectly available preparation.--(From the Journal A. M. A., March 28, 1908.)

“HYDROCYANATE OF IRON--TILDEN”

W. A. Puckner and W. S. Hilpert

Among the many inquiries received regarding the composition of secret remedies was one in reference to “Hydrocyanate of Iron” manufactured by the Tilden Company, New Lebanon, N. Y. This preparation is advertised as being “unexcelled as a remedy for epilepsy, hysteria, chorea, neurasthenia, locomotor ataxia, neuralgia, migraine, anemic headaches, and all convulsive or reflex neuroses dependent on impairment of the brain or spinal cord.” It is also said to be “valuable in uterine reflex neuroses due to congestion; in amenorrhea due to anemia and chlorosis and suppressed menstruation.”

The term “hydrocyanate of iron” is an unfamiliar one and is not found in any available reference work on chemistry. Thinking that the term might have been loosely applied to ferrocyanid of iron, or Prussian blue (a compound once suggested for epilepsy, but long ago considered useless), the correspondent wrote to the manufacturers asking if such were the case. The Tilden Company answered:

“... our preparation Hydrocyanate of Iron is not Prussian blue in any sense of the word. Prussian blue has no curative properties as applied to all forms of epilepsy. Prussian blue is Ferrocyanid of Iron while our preparation is Hydrocyanate of Iron.”

The only statements in the Tilden Company’s advertising matter regarding the composition of hydrocyanate of iron are the following:

“Hydrocyanate of Iron (Tilden’s) is a correct and scientific combination of well known principles.”

“Hydrocyanate of Iron (Tilden’s) combines well known properties of ferruginous salts with the sedative action of Hydrocyanic acid.”

The last statement would lead one to expect the presence of available iron and cyanogen ions. In fact, the inference to be drawn from all the company’s “literature” is that “hydrocyanate of iron” is a definite chemical compound in the same sense as is ferrocyanid of iron, and that inference is still further borne out in the letter to our correspondent. This being the case, the Tilden Company was again written to and asked for the chemical formula of “hydrocyanate of iron,” with the following result:

“Replying to your inquiry regarding the formula of Hydrocyanate of Iron we beg to state the composition of this preparation is a trade secret and we therefore do not care to furnish the desired information.”

This reply verified the opinion already formed that “hydrocyanate of iron” is a secret preparation. Its analysis was then taken up in the Association’s laboratory.

EXAMINATION OF THE TABLETS

The product appears on the market in cartons said to contain one ounce of one-grain tablets. On the cartons, in addition to the name of the preparation and the name and address of the manufacturers, are the names of diseases for which it is recommended. The tablets, in the specimens analyzed, were dark blue, rather hard and slightly bitter in taste and had an average weight of 0.1382 gm., or about 2 grains. They were found to be practically insoluble in water and dilute mineral acids; aqueous oxalic acid solution partially dissolved them, yielding a blue solution. Boiling with alkali hydroxid solution decomposed the tablets, yielding iron in an insoluble form and a solution of alkali ferrocyanid, as demonstrated by the appearance of a deep blue precipitate on the addition of ferric chlorid solution. The portion insoluble in alkali when boiled with hydrochloric acid yielded a solution containing iron, approximately equivalent to 50 per cent. Prussian blue. These properties are all characteristic of Prussian blue, and, taken together, identify Prussian blue as a constituent of “hydrocyanate of iron (Tilden).” The insoluble residue from the iron determination possessed the properties and constituents of talc and constituted practically one-half of the tablets. Extraction of the tablets with chloroform or ether in the presence of ammonium hydroxid yielded a small amount of organic material which contained bodies having the properties of, and responding to tests for, quinin or cinchona alkaloids and caffein. The presence of a salicylate was also indicated.[95]

[95] Details of the quantitative analysis of “Hydrocyanate of Iron--Tilden” appear in the annual report for 1909 of the Chemical Laboratory of the American Medical Association.

From the analysis it is concluded that “hydrocyanate of iron (Tilden)” is essentially a mixture of approximately equal parts of talc and Prussian blue, containing traces of organic matter having the general properties of alkaloids.

Comment: When a firm exploits an abandoned remedy for so hopeless a disease as epilepsy under a name not known to chemistry and with a false representation of its pharmacologic qualities, such action may rightly be assumed to show ignorance or worse. “Hydrocyanate of iron,” if it means anything, means the cyanid of iron, but the preparation put out under that name is, according to our chemists, not cyanid of iron, but the ferrocyanid of iron commonly known as Prussian blue. This substance has been tried for epilepsy and abandoned. Yet the firm recommends it as a “peerless remedy” for this disease:

“The Tilden Company holds the key to the situation in the treatment of epilepsy. We have the remedy that does the work.”

Not that epilepsy is the only disease for which this hypothetical chemical compound may be prescribed. Torticollis has been “successfully treated with hydrocyanate of iron.” In chorea, we are told “a richer and better blood supply” should be furnished the nervous and vascular system and “the irritation of the motor centers” must be allayed.

“Hydrocyanate of iron serves admirably to accomplish both of these purposes. It carries the hemoglobin to the blood in its most easily assimilable form and its hydrocyanic acid possesses remarkable sedative powers....”

It is not possible for it to have any value in anemia because of its insolubility, yet we are told:

“In conditions marked by poverty of the blood producing anemia or chlorosis, reacting on the nervous system and calling for a chalybeate, hydrocyanate of iron (Tilden’s) takes a front rank among the remedies of this class, combining as it does the blood enriching qualities of ferrum with the sedative action of hydrocyanic acid.”

As Prussian blue yields no appreciable quantity of hydrocyanic acid under the conditions existing in the animal organism, “the sedative action of hydrocyanic acid” must be as hypothetical as the chalybeate properties attributed to it.

It is strange that a manufacturer, in introducing a new chemical compound, should have to assure his customers that it “contains no opium or alkaloid of that drug, cocain, chloral hydrate, conium or any of the bromids.” Imagine a firm putting, let us say, potassium iodid--a definite chemical compound--on the market and solemnly guaranteeing that it contained no cocain or chloral hydrate!

Would the Tilden Company of twenty-five years ago have served such mental pabulum in its advertising matter?

One would think that the dictates of common humanity would protect the unfortunate epileptic from the machinations of the nostrum maker, especially from the exploitation of a remedy that has been tried and found wanting. A nostrum, however, merely has to measure up to one standard: Will it pay? Meeting this requirement nothing else matters.--(From the Journal A. M. A., June 19, 1909.)

HYMOSA

W. A. Puckner and W. S. Hilpert

Frequent requests for information regarding the composition of hymosa, manufactured by the Walker Pharmacal Co., St. Louis, and a perusal of the extensive and nostrum-like advertising the product is receiving, made a chemical examination of this preparation seem desirable. If the label is to be believed, hymosa has been of use in “acute and chronic muscular and articular rheumatism, gout, sciatica, lumbago, pleurodynia and neuralgia, whether due to uric acid diathesis or not ...”

The composition of hymosa as given by the proprietors is set forth in the following statement:

“... Hymosa, in which the remedies Frangula, Actea Spicata, Stellaria Media, Franciscea Uniflora, Rhus Toxicodendron, Passiflora Incarnata, Phytolacca Decandra and Echinacea Angustifolia are combined in the proportions which experience has shown will obtain the quickest and best results without any of the stomach and heart complications so often following the administration of salicylic acid.”

“Contains no Salicylic Acid.”

Thus the explicit statement is made that hymosa contains certain vegetable drugs (most of them obsolete and valueless) and that it does not contain salicylic acid. By inference the claim repeatedly is made that the nostrum does not contain any salicylates.

“... Hymosa has achieved most remarkable results in overcoming rheumatism in cases where salicylates have been tried in vain ...”

“Salicylic acid was not successful in this case of rheumatism of the stomach.”

“Negative results from salicylates--Hymosa cures.”

“... the salicylates didn’t help? Then we must try Hymosa.”

Still harping on the undesirability of salicylates and the value of hymosa the advertising pamphlets state:

“Salicylic Acid Replaced. The Use of This Dangerous Agent in Rheumatism Obviated.”

“It seems that the use of the dangerous and ineffective salicylic acid will soon be given up and hymosa take its place.”

“Former methods of treating rheumatism ... have been very unsatisfactory ... because of the heart and stomach difficulties brought on by salicylates of which most rheumatism remedies are composed.”

“Could not tolerate the salicylates.”

Finally in a letter issued to physicians we are told:

“... you will find hymosa to possess prompt and positive curative action with the additional advantage of avoiding the heart and stomach complications, which the salicylates too often cause.”

It is evident from the above quotations, in which the salicylates are denounced specifically or by implication, and from the label which states that no salicylic acid is present, that the exploiters of the nostrum deliberately intended to give the impression that hymosa is free from salicylates or salicylic acid and contains only the vegetable or plant drugs enumerated. The very fact that the proprietors make such repeated efforts to give the impression that hymosa is free from salicylates is in itself sufficient to arouse suspicion and hence in the examination particular attention was given to the detection of salicylic acid or salicylates with the following results:

Examination.--Hymosa as purchased on the market is a dark brown liquid with an odor of sassafras and a rather sweetish taste, reacting acid to litmus. Qualitative tests having indicated the presence of salicylate, iodid, sodium, potassium, alcohol and some organic matter, presumably sugars and some plant extractives, these were determined quantitatively.[96] It was found that a part of the salicylate was present as free salicylic acid and part in a combined form. The sodium determinations indicated that all the salicylate, excepting that in the form of free salicylate acid, was present as sodium salicylate. From the results of the potassium estimations, it was evident that the iodin was present in the form of potassium iodid.

[96] Details of this analysis appear in the annual report for 1910 of the Chemical Laboratory of the American Medical Association.

From the results of the analysis it is believed that the preparation has approximately the following composition:

Salicylic Acid 0.32 gm. Sodium Salicylate 1.15 gm. Potassium Iodid 0.32 gm. Sugars and extractives 4.60 gm. Alcohol, U. S. P. 16.86 c.c. Water to make 100.00 c.c.

These results indicate that hymosa is essentially a solution containing salicylic acid, sodium salicylate, potassium iodid, alcohol, sugars and plant extractives in the proportions given above, and show that the various statements referred to, regarding the absence of salicylic acid and salicylates are misleading and untrue. It further illustrates the repeatedly demonstrated fact that nostrums exploited as wonderful and new discoveries are new in name only--and whatever therapeutic value they possess depends on old and tried medicinal agents.

[Editorial Note: In describing the methods employed by the manufacturers of Manola in exploiting their product, attention was called to the fact that the Manola Company was reported as being a subsidiary affair of the Luyties Homeopathic Pharmacy Company of St. Louis. It is reported that this same company also operates the Walker Pharmacal Company, which exploits Hymosa and Psa-avena.]--(From the Journal A. M. A., June 11, 1910.)

MICAJAH’S MEDICATED UTERINE WAFERS

W. A. Puckner and W. S. Hilpert

Evidently touched by the generosity of the manufacturer in sending him a sample and literature, but not too favorably impressed by the claims made for the preparation referred to, a correspondent writes:

I enclose a valuable sample and literature just received. Such a palpable humbug as Micajah’s Uterine Wafers would hardly seem to need notice were it not probably true that many practitioners habituated to the use of samples are still influenced by the glowing accounts of cures wrought; especially when attested by such a name and title as “Elmore Palmer, M.D., Ex-President Western New York Medical Society.” This secret gynecologic medicament is recommended for anything from “Pruritis Vulvæ,” “Enlargement of the Womb,” “Displacements,” “Cystocele and Rectocele,” to the “Menopause.”

Following the definition that by her “stomach” a woman means anything from her chin to her knees, the ex-president with truly noble impartiality has with the wonderful Micajah wafers wrought lightning cures all the way from “stone-bruise” of the heel to nasal polyp and influenza, and some of them are male patients too.

With the foregoing as an impetus to investigate the nature of this much advertised nostrum, the wafers were submitted to analysis by the Association laboratory. The report follows:

LABORATORY FINDINGS

Trade packages of the wafers purchased on the open market bear the name of the preparation and that of the manufacturers, Micajah & Co., Warren, Pa. The label states that the nostrum is a:

“Disinfectant, astringent and local alterative of the greatest virtue. A remedy for the local treatment of the diseases of women. Inflammation, engorgement and prolapse of the womb, vaginitis, leucorrhea, menstrual derangements and the disturbances incidental to the menopause. Also highly recommended for affections of the mucous membranes in general, particularly those of the nose, the throat, the rectum, and for gonorrhea, cystitis, etc.”

“This box contains wafers for three months’ treatment.”

“Price per box $1.00.”

The box contained 25 tablets, and a circular entitled, “Hints on the treatment of diseases of women,” in which directions for the treatment of many diseases are given. It ends with a paragraph which contains the following statement:

“There is no doubt that the field of usefulness of Micajah’s Wafers can be indefinitely enlarged by the ingenuity and therapeutic skill of the physician.”

Much of the advertising “literature” is in the form of leaflets, brochures and small pamphlets full of testimonials by physicians.

Micajah’s uterine wafers as found on the market are white, hexagonal tablets, odorless and possessing an astringent taste. The wafers are soluble in water with extreme difficulty. Hot hydrochloric acid and alkali hydroxids dissolve the powdered tablets readily, leaving a slight residue which under the microscope and by physical tests was identified as lycopodium.

The acid solution of the wafers responded to qualitative tests which indicated the presence of potassium, sodium, aluminum sulphate, borate and a mere trace of a fatty material. Quantitative estimation of boric acid, aluminum sulphate, sodium and potassium were made, which indicated that Micajah’s Uterine Wafers consist of alum more or less anhydrous or “burnt,” boric acid and borax in approximately the following proportions:[97]

[97] Details of this analysis appear in the annual report for 1910 of the Chemical Laboratory of the American Medical Association.

Alum, dried 59.86 per cent. Borax, dried 15.62 per cent. Boric acid 5.67 per cent. Water of hydration 18.85 per cent.

The average weight of the tablets is 0.7791 gm (11.8 grains) and allowing for the fact that the quantity of water present in commercial exsiccated alum varies, each tablet would contain approximately 0.4986 gm. (7.8 grains) burnt alum; 0.2337 gm. (3.6 grains) crystallized borax, and 0.0467 gm. (0.7 grain) boric acid.

COMMENT

Judging from the “literature” that goes with the packages of this nostrum, one might imagine that it was put up absolutely for the layman, but this is not the case. It is advertised only in medical journals and not directly to the public. But direct advertising to the public is not necessary; for every physician who prescribes these wafers at the same time places in the hands of his patient advertising matter intended to influence that patient--and it usually does. As a result this preparation is being bought by the public direct. To what extent we do not know, but physicians are responsible for it. Probably if physicians realized that the same interests that control Piso’s Consumption Cure also control Micajah’s Medicated Uterine Wafers they would not be so ready to act as the unpaid agents for the concern.

That such simple astringents and feeble antiseptics as alum, borax and boric acid could have such remarkable curative effects on uterine diseases is absurd. The serious aspect of the matter is, that, by the encouragement given them in the advertising literature to treat themselves, women may neglect proper surgical or medical attention in the early stages of serious diseases such as cancer or dangerous pelvic infections, until they get beyond the hope of proper management. But when nostrum promoters urge the use of such inefficient remedies in the treatment of gonorrhea, it is time to look at the matter seriously. Considering the vital social significance of the venereal diseases, the employment of useless remedies can only favor the spread of these infections, which cause such a large proportion of the diseases which afflict women particularly.

The medical profession for the most part has become mentally calloused to the exaggerated claims of the nostrum makers and does not make sufficient effort to condemn them. There may be some physicians, however, who use such preparations as these wafers in their practice, as is indicated by the circulars wherein the manufacturers suggest that their “usefulness can be indefinitely enlarged by the ingenuity and therapeutic skill of the physician.” It is only occasionally that a physician voices his indignation as to these humbugs, as in the case of the physician whose letter is quoted above.--(From the Journal A. M. A., March 26, 1910.)

The Firm Replies

To the Editor:--We have read with interest the report of your committee on pharmacology recently published in The Journal, on the subject of Micajah’s Medicated Uterine Wafers, and your comments thereon.

We are of the opinion that, in your laudable efforts to reform the practice of pharmacology, it is not your desire or intention to act other than justly and fairly, and therefore, with this belief, we submit the following statements for your consideration, with the hope that you will see fit to publish them.

1. We do not seek by word or deed the patronage of the laity, and what few sales are made to the public are not of our contriving, nor should we be held responsible for them, any more than is the manufacturer of quinin to be blamed for the universal use of that drug.

2. Our literature should not be considered extravagant, for it is for the most part made up of clinical reports received from physicians and based on the unsolicited testimonials in our possession from hundreds of practitioners, many of whom have used Micajah’s Wafers in practice from five to twenty years and they are therefore as well grounded as are the clinical reports concerning any preparation.

3. In the past year we have endeavored to place our preparation on a higher ethical basis by stating in our advertisements what our wafers contain, and by eliminating whatever seems to us open to criticism.

4. That the ingredients of the preparation are “simple” is no reason for considering them valueless. H. A. Kelly, in his work on medical gynecology, page 266, recommends these ingredients in a variety of conditions. Bandler also made important recommendations bearing on this subject in his “Medical Gynecology,” 1909 edition, page 472. We feel we have the right to recommend this preparation for these and similar conditions, especially when our statements are backed up by the clinical experience of numerous general practitioners.

5. That the owner of Micajah’s Wafers holds stock in a corporate firm which manufactures proprietary medicines and toilet articles, advertised to the laity, should not militate for or against our right to market a meritorious preparation on strictly ethical lines to the medical profession, inasmuch as many of the largest drug houses cater to both the doctor and the proprietary interests, and several are actively engaged in exploiting so-called nostrums.

6. We enclose a recent advertisement which has been accepted after investigation of our methods by careful medical journals, and we now believe we are conducting our business in entire conformity with the best interests of the medical profession and we feel certain of the true merits of our article.

Micajah & Company, Warren, Pa.

[Comment: This letter brings out still more strongly the points raised in the article which appeared in The Journal, March 26, 1910. Being unable to analyze motives we must perforce, accept Micajah & Co.’s statement that they “do not seek by word or deed the patronage of the laity.” In the comments on the laboratory’s report it was very explicitly stated that this nostrum was advertised only in medical journals and not directly to the public. Inasmuch, however, as the container in which this product comes has printed on it the various diseases in which the “wafers” are indicated, as, moreover, within the container there is a leaflet which describes in detail the use of the preparation in a list of pathologic states varying from “enlargement of the womb” to “gonorrhea in the male,” and, finally, as the name “uterine wafers” would seem in itself to be a plain bid to the public, we still maintain that “one might imagine that is was put up absolutely for the layman.”

The proposition that advertising matter should not be considered extravagant because it is largely “made up of clinical reports received from physicians” is an argument that is as old as the nostrum business itself--and as fallacious as it is old. Unfortunately, as our files show, the most extravagant statements made for proprietary products frequently emanate from men who legally are entitled to write M.D. after their name. The fact that it is not the manufacturer but a Buffalo physician who tells of the marvelous results he obtained from the use of Micajah’s Medicated Uterine Wafers in forty-three cases comprising no fewer than thirty-six pathologic conditions from “otitis media” to “injured toe,” and from “bunion” to “ophthalmia neonatorum” does not exempt the firm that prints such stuff from the charge that its “literature” is not merely extravagant, but ridiculously so.

As Micajah & Co. say, because the ingredients of their preparation are simple is no reason for considering them valueless. On the contrary, if the “wafers” were truthfully exploited for what they are and what they will do, their very simplicity would be a virtue. But such has not been done. And therein lies the viciousness of nostrums. Simple mixtures of well-known drugs are foisted on the medical profession with no hint as to their composition and with claims made that are not only false, but would immediately be recognized as absurd, if their actual composition were known.

That a mixture of borax and alum may be of value in some of the simple ailments of the female genital tract can easily be granted. That relief might follow the use of suppositories made of these ingredients--especially when supplemented by an increased attention to simple cleanliness--can also be admitted. To say, however, that such medicaments will quickly and permanently cure gonorrhea, urethritis, endometritis, etc., is foolish, false and vicious.]--(From the Journal A. M. A., April 16, 1910.)

NOITOL AND ANADOL

W. A. Puckner and L. E. Warren

Noitol

The Journal received an inquiry concerning the composition of Noitol, a preparation which is being advertised to the medical profession as a “specific” for the cure of eczema and certain other cutaneous diseases. The preparation is manufactured by the Wheeler Chemical Works, Chicago. Trade packages of Noitol were purchased and examined in the Association laboratory. On the label of the package, Noitol--an inversion of the word “lotion”--is described as follows:

+--------------------------------------------------------------+ | NOITOL | | (Dr. Bradbury’s Eczema Lotion.) | | For External Application Only! | | Our Most Popular Specialty. | | A specific for the cure of Eczema, Scrofulous and Syphilitic | | Eruptions, Lupus, Salt Rheum, Tetter, Itch. This remedy is | | composed of valuable Oils, combined with Vegetable and | | Mineral Acids in such proportions as cause a rapid and | | permanent cure of the above complaints. | +--------------------------------------------------------------+

Noitol is a clear, nearly colorless, acid solution, the greater portion of which is water. Its specific gravity is 1.0097 at 25 C.

Qualitative tests demonstrated the presence of a chlorid, a nitrate, a mercuric salt, free acid and glycerin. No “oils” or “vegetable acids” could be found.

Analysis[98] of the preparation indicated that its composition is essentially as follows:

[98] Details of this analysis are published in the annual report for 1910 of the Chemical Laboratory of the American Medical Association.

Mercuric Chlorid 0.0463 gm. in 100 c.c. Mercuric Nitrate 0.0450 gm. in 100 c.c. Glycerin 1.3021 gm. in 100 c.c. Nitric Acid 1.0265 gm. in 100 c.c. Water (by difference) 98.5545 gm. in 100 c.c.

From the above it appears that Noitol is simply a weak, acid solution of mercury salts--the total being approximately equivalent to a 1 to 1,000 bichlorid of mercury solution--exploited under a meaningless name. It is but one more example of the old, old story of a well-known remedy being sold at a high price under a name which is in no way indicative of its composition, and under claims which are absurdly false.

The price of the mixture is $2.00 a pint; the estimated cost, exclusive of the container, is about 6 cents a gallon, or, put another way: the price of a pint bottle, it is estimated, would make a barrel (31 gallons) of the nostrum. The incorrect statement concerning its components, the unwarranted therapeutic claims made for it, and the exorbitant price easily place Noitol in the front rank among the “patent medicine” frauds. Yet it is advertised to physicians as an ethical proprietary and is evidently being prescribed by them.

Anadol

In the circular matter accompanying the trade package of the preparation, “Noitol,” described above, a preparation called “Anadol” is described. Anadol is claimed to be an analgesic and antipyretic. In the descriptive circular there is no information concerning the composition of the preparation, but from the general therapeutic description the physician might easily be led to believe that “Anadol” is a distinct chemical substance.

To reduce temperature the physician is advised to push the administration of Anadol in 10 grain doses until the febrile condition is under control or until a maximum of 70 grains of the preparation has been ingested. The circular further states:

“... in this lies the special value of ANADOL; there are no annoying by-effects; the stomach bears the remedy well and neither circulation, respiration, nor the nerve centers show the least disturbance.”

As no evidence could be obtained concerning the composition of Anadol and, as the preparation is being brought to the attention of physicians by means of circulars in connection with the distribution of Noitol, it seemed worth while to take up its examination in the Association laboratory. Accordingly a trade package of the material which had passed into interstate commerce was purchased.

Qualitative tests demonstrated the presence of sodium, a carbonate, caffein and acetanilid, the latter in considerable quantities. Analysis[99] indicated that the composition of the specimen examined is essentially as follows:

Acetanilid 79 per cent. Caffein 1 per cent. Sodium bicarbonate 20 per cent.

[99] Details of this analysis are published in the annual report for 1910 of the Chemical Laboratory of the American Medical Association.

Since, according to the circular, it is permissible to prescribe 70 grains of this preparation within 2-1/2 hours, a patient thus treated would receive no less than 55 grains of acetanilid! In view of the numerous cases of poisoning due to the misuse of acetanilid (“The Harmful Effects of Acetanilid, Antipyrin and Phenacetin,” U. S. Dept. Agric., Bur. Chem., Bull. No. 126) the physician should be apprised of the composition of Anadol.

[Editorial Note: The chemical investigations reported above emphasize once more the need of such an institution as the Association’s laboratory and again demonstrates the value of its work. At first sight it seems disheartening to find that physicians are so easily humbugged. Yet when it is remembered that it is impracticable for physicians either to analyze such products themselves or to go to the expense of having chemists do it for them, it is evident that the fault lies not so much with the physicians as with the conditions that make the exploitation of such frauds possible. It is on the public that the burden ultimately falls, for it is the layman who has to pay two dollars for a few cents’ worth of medicine. But--and this is far more serious--that the physician should be urged to dose his patient with an insidiously dangerous drug to a point far beyond the limits of safety, is little less than criminal. Yet so long as unknown medicinal products are prescribed just so long will this danger be a very real one.]--(From the Journal A. M. A., May 21, 1910.)

Anadol Declared Misbranded

Anadol was analyzed at the Bureau of Chemistry and the chemists reported that it contained over 82 per cent. of Acetanilid. As the labels did not bear any statement as to the quantity of acetanilid contained in the nostrum, the stuff was declared misbranded and the defendant, on pleading guilty, was fined.--[Notice of Judgment No. 795.]

PIX CRESOL

W. A. Puckner and W. S. Hilpert

In a paper on “The Abuse of Chemical Formulas”[100] several examples were given of the various methods employed by “patent-medicine” concerns to give standing to their products by assigning to them a chemical formula. In some cases the formulas given are impossible, in other cases they may represent the chemical composition of only one constituent or it may be an attempt at both. To a chemist such formulas are absurd and on seeing a formula which he knows to be wrong he naturally thinks “Fake,” “Ignorance,” or both. Just such a formula (C_{5}H_{6}N.SO) applied to a product called Pix Cresol, manufactured by the Pix Cresol Chemical Co., Kansas City, Mo., attracted our attention. No mention of such a formula can be found in such works as Richter’s most complete Index of Carbon Compounds, nor the three supplemental volumes published, 1901-1905, by the German Chemical Society and Beilstein’s Organic Chemistry (3d Ed.). This fact, supplemented by inquiries from correspondents as to the composition of the substance made it seem worth while to make a chemical examination of it.

[100] Puckner, W. A.: Report of the Chemical Laboratory of the American Medical Association, iii, 7.

The examination was made and showed that the essential constituent was oxyquinolin sulphate. As potassium sulphate was also found it was concluded that Pix Cresol was a preparation containing a mixture of oxyquinolin sulphate and potassium sulphate, which has also been known in the past under the proprietary name, “Chinosol.” At this time a letter was referred to the laboratory containing the report of an analysis of Pix Cresol, which showed the presence of oxyquinolin sulphate but no potassium sulphate. As this indicated that Pix Cresol contained as its essential constituent the substance now sold as Chinosol, the laboratory purchased a new specimen of Pix Cresol from the Chicago representative of the Pix Cresol Co. The examination[101] of this specimen showed that it consisted of approximately 21 per cent. oxyquinolin sulphate, about 8.3 per cent. potassium sulphate and the remainder almost entirely milk sugar.

[101] The analytical details will be published in the annual report of the laboratory.

It is evident, then, that both the specimen of Pix Cresol obtained directly from the manufacturers and also the one purchased more recently from the Chicago agent, contain as an essential constituent Chinosol of the composition sold formerly. The substance now sold under the name Chinosol and described in New and Nonofficial Remedies is pure oxyquinolin sulphate, and as the exploiters of Pix Cresol probably obtain their supply of oxyquinolin sulphate from the Chinosol Company, the sole American agents for Chinosol, it is to be expected that Pix Cresol should change in composition. It is probable that the analysis referred to the laboratory deals with a more recent specimen than the two examined in the Association laboratory.

Editorial Note: In view of the Council on Pharmacy and Chemistry’s findings, viz., that chinosol is a powerful antiseptic but a feeble germicide and considering that Pix Cresol contains but 21 per cent. oxyquinolin sulphate, the absurdity of the following claims made for Pix Cresol require no further comment:

“Pix Cresol is an Absolutely Sure and Yet Perfectly Safe, Never Failing Destroyer of Pus (Staph. Pyogenes Aureus.)”

“It is germicidal, bactericidal, bacillicidal. It is certain as a micro-organism destroyer. It destroys absolutely.”

“Ridding the blood of germs, it aids in rendering it replete with oxygen----.”

“It kills the germs.”

“No organism that is causative of morbid processes can withstand it.”

“It destroys micro-organisms of all kinds. It destroys them absolutely.”

“The germ’s tenacity of life does not avail against its action as germicide.”

“It destroys the spores and toxins utterly.”

A further estimate of the pseudo-chemical company, bearing the name of this “strongest, safest, least expensive medical antiseptic, disinfectant and deodorizer known” may be gained by a cursory glance at some of its “specialties”:

“Maizinin compound, Positive Chill and Malaria Specific” the firm says, “prepares the parasites for execution by the leukocytes.” It is said to contain arsenic, while the name implies the presence of some plant drug.

“Psora, the Syphilis Specific,” is a shot-gun mixture said to be “the scientific combination of the soluble Triple Iodids with the active principles of Echinacea, Cascara amagra, Berberis aquif., and Phytolacca rad.,” and is claimed to make “the syphilitic lesions disappear and fail to return.”

“Rectoids--Cones for the treatment of all rectal trouble,” are said to be “a combination of Rectin (Pix) compounded from Buckeye, Collinsonia, Hamamelis, Belladonna, Pix Cresol.”

“Tablets for the Female--Pix Cresol Uterettes,” it is said, “for sanitary purposes may be continued forever ...”

When one realizes that this sort of pseudo-scientific twaddle is accepted by many physicians at its face value, the outlook for therapeutics seems dark, indeed. So long as the existence of such concerns is tolerated by the medical profession, so long will there be a crying need for a “Propaganda for Reform in Proprietary Medicines.”--(From The Journal A. M. A., June 10, 1911.)

SALIODIN

W. A. Puckner and A. H. Clark

[The Council on Pharmacy and Chemistry refused recognition to Saliodin because it conflicts with Rules 1 and 6, and directed publication of the following.

W. A. Puckner, Secretary.]

Saliodin is sold by the Saliodin Chemical Co., Scranton, Pa. In the literature and on the trade package the following “formula” is given:

This formula being indefinite and vague, the examination of saliodin was taken up in the Association laboratory.

From the analysis we calculate the composition of saliodin to be approximately equivalent to a mixture of:

Sodium salicylate 57.54 Potassium iodid 1.18 Potassium acetate 30.00 Matter volatile at 130° (oil of anise, oil of gaultheria, moisture, etc.) 8.10 Undetermined (extractive?) 3.18 ------ 100.00

The analysis shows that the formula is not only indefinite and vague, but incorrect and false.

To emphasize the incorrectness of the published formula the following comment on its first two items is offered:

In the “formula” it is stated that 20 grains of saliodin contain approximately “salicylic acid (aceto-salicylate) Grs. XV.” The statement is not clear, but conveys the impression that 20 grains of saliodin contain an amount of aceto-salicylate, a salt of acetyl-salicylic acid (aspirin), equivalent to 15 grains of salicylic acid. But the chemical examination shows that it contains neither acetyl-salicylic acid, nor salt of acetyl-salicylic acid, nor even salicylic acid itself. In the place of these, the analysis shows that over half of saliodin is the common, every-day sodium salicylate.

According to the “formula,” each 20 grains of saliodin contains “iodin (iodate), equivalent to iodid potass. Grs. XV.” This statement, too, is vague, but conveys the impression that 20 grains of saliodin contain an amount of iodin, in combination as an iodate, which corresponds in iodin content to 15 grains of potassium iodid. But the analysis shows that the product does not contain any iodate whatever, and that the amount of iodin contained in it is sufficient to account for only 1/4 grain of potassium iodid in each 20 grains of saliodin.

COMMENTS

The above report is published simply as another example of the “ethical proprietaries” that physicians are asked to prescribe. It is not unique. It is neither better nor worse than hundreds of others.

To show what absurdities appear in the “literature” (?) that is sent to physicians, we reproduce a paragraph from an advertising pamphlet. The promoters’ statement as to the composition of the product is absurd, but not more so than are the claims made for it as a therapeutic agent. There is not a “patent medicine” on the market for which any more blatant, extravagant and ridiculous claims are made.

The manner of exploiting saliodin is another illustration of the tendency on the part of nostrum-makers to advertise their wares through pseudo-scientific articles published in a certain class of medical journals. In the pamphlet sent out by the Saliodin Company appears a reprint of an article from the Philadelphia Medical Summary of February, 1905. It is entitled “A Similarity in the Etiologic Factors of Rheumatism and Malaria,” and was written by J. C. Denston, M.D. In it occurs this statement: “The manufacturers (of saliodin) publish their formula and, I think, distribute samples and literature on request.” The charming ingenuousness of this statement is fully realized when it is understood that J. C. Denston is the president of the Saliodin company. This is also another illustration of what is now a common occurrence, viz.: men who are engaged in manufacturing proprietary products and who have an M.D. degree use that degree as a commercial asset, and by this means the average reader is led to think that articles written by them in praise of their own products are spontaneous tributes from practicing physicians.--(From The Journal A. M. A., Oct. 26, 1907.)

THEOBROMIN SODIUM SALICYLATE VERSUS “DIURETIN”: THE ECONOMICAL ASPECT

W. A. Puckner and Paul N. Leech

The following inquiry is from Dr. Reid Hunt, recently appointed professor of pharmacology at Harvard Medical School:

“Have you ever made an examination of the theobromin sodium salicylates on the market to determine if they are identical with ‘Diuretin?’ The description of theobromin sodium salicylate in New and Nonofficial Remedies agrees with the statements as to the composition of Diuretin, but I wondered if, at times at least, the theobromin sodium salicylate on the market might be a simple mixture of theobromin and sodium salicylate just as the Caffeinae Sodio-Salicylas, N. F., seems to be a simple mixture. Diuretin is quoted in current price-lists at $1.75 an ounce, whereas the price of theobromin sodium salicylate is only 35 cents an ounce. Many hospitals use diuretin, and both physicians and students often have only hazy ideas as to what it is. If the preparations of theobromin sodium salicylate now on the market are identical with Diuretin they should certainly be used, not only because they are less expensive, but because the descriptive name will continually remind the physicians of what they are using.”

Theobromin for some time has been regarded as a valuable therapeutic agent. The obstacle to its use has been its insolubility and the consequent uncertainty of the degree of its absorption. For this reason a soluble salt of theobromin, theobromin sodium salicylate, first introduced and advertised under the proprietary name “Diuretin,” has come to be used to a considerable extent.

Theobromin sodium salicylate--also called theobromin and sodium salicylate--is prepared by interaction, in molecular proportions, of theobromin, sodium hydroxid and sodium salicylate, the theobromin first being treated with sodium hydroxid in the presence of a suitable solvent, then the sodium salicylate added and the whole brought to dryness. The soluble compound which is formed is generally considered to be a double salt of theobromin sodium and sodium salicylate.

Theobromin sodium salicylate is described in New and Nonofficial Remedies and in several foreign pharmacopeias. It is also to be described in the forthcoming United States Pharmacopeia.

Although the product is not controlled by patents of any kind, and although it is offered for sale under its chemical name by the leading chemical manufacturers at from 35 to 45 cents per ounce, the proprietary product, Diuretin, sells for $1.75 an ounce. This is probably because the manufacturers think that those who have been using it under its chemically non-descriptive but therapeutically suggestive title, Diuretin, will remain ignorant of the fact that the same product is on the market under its chemical name. In view of these conditions, emphasized by Dr. Hunt’s letter, it was deemed important to examine the market-supply of theobromin sodium salicylate and to compare the several specimens with the proprietary brand Diuretin.

The following specimens, purchased in 1-ounce original packages, were examined:

Diuretin, “Knoll,” Knoll & Co.

Theobromine and Sodium Salicylate, Mallinckrodt Chemical Works.

Theobromine and Sodium Salicylate, Merck & Co.

Theobromine and Sodium Salicylate Powder, Powers-Weightman-Rosengarten Co.

Theobromine and Sodium Salicylate, “Roche,” Hoffmann-La Roche Chemical Works.

Theobromine and Sodium Salicylate, Squibb, E. R. Squibb & Sons.

The theobromin content prescribed for theobromin sodium salicylate by the various standards ranges from 45 to 50 per cent., that of New and Nonofficial Remedies being the highest. A requirement of not less than 46.5 per cent. theobromin in the dried powder has been proposed for the new U. S. Pharmacopeia.

The methods of quantitative estimation laid down by the various authorities are all very similar and consist, in the main, of a determination of water, of the sodium hydroxid, free and in combination with theobromin, and of the theobromin itself. For the theobromin estimation the following method was employed:

A weighed sample (about 2 gm) which had previously been dried, under slightly reduced pressure, over sulphuric acid, to constant weight, was dissolved in five times its weight of warm water. Two drops of phenolphthalein were added, and the solution titrated with normal hydrochloric acid. To the neutral solution, 1 drop of 10 per cent. ammonium hydroxid solution was added, and the mixture allowed to stand, with occasional stirring, for three and one-half hours at the temperature of 15 C. The precipitate was filtered on a weighed Gooch crucible, washed with just ten times the weight (of the original sample taken) of water (temperature 15 C.) and the precipitate dried at from 100 to 104. To the weight obtained, a correction factor (proved satisfactory by quantitative extraction experiments on the filtrate) of 0.13 gm. was added, for every 2 grams of the original sample taken.

The full details of the examination will be published in the 1914 Reports of the A. M. A. Chemical Laboratory. The results of the examination have been abstracted and are compiled in the accompanying table:

SUMMARY OF ANALYSIS ============+==========+=======+=====+=====+========+========+======== | |Gm. in |Price|Mois-|Alkalin.|Theo- |Theo- |Physical |1-Ounce|per |ture,|as NaOH |bromin. |bromin. |Appearance|Bottle |Ounce|Per |on Dry |in Dry |in Orig. | [AQ] | | |Cent.|Powder |Powder |Specimen | | | | |[AR] Per|[AR] Per|[AR] Per | | | | |Cent. |Cent. |Cent. ------------+----------+-------+-----+-----+--------+--------+-------- Diuretin | 3 | 28.5 |$1.75| 0.01| 10.44 | 48.61 | 48.61 |Pure White| | | | | | | | | | | | | Theo. | 3 | | | | | | Sod. Sal. |Pure White| 27.5 | 0.35| 1.89| 9.95 | 46.11 | 45.24 M. C. W | | | | | | | | | | | | | | Theo. | 1 | | | | | | Sod. Sal. |Pure White| 29.0 | 0.35| 0.48| 10.38 | 47.87 | 47.58 Merck | | | | | | | | | | | | | | Theo. | 3 | Sod. Sal. |Pure White| 29.1 | 0.35| 2.46| 10.30 | 47.57 | 46.39 P. W. R. Co.| | | | | | | | | | | | | | Theo. | 3 | | | | | | Sod. Sal. | Pink | 28.6 | 0.35| 2.27| 9.92 | 49.05 | 47.92 Roche | | | | | | | | | Theo. | 1 | | | | | | Sod. Sal. |Pure White| 26.8 | 0.45| 0.39| 9.97 | 46.82 | 46.63 Squibb | | | | | | | ------------+----------+-------+-----+-----+--------+--------+--------

[AQ] In this column, 1, 2 and 3 denote the following:

1. Quite crystalline, under microscope.

2. Fairly crystalline, under microscope.

3. Not crystalline, under microscope.

[AR] Average of determinations.

While the results show some variation in the moisture content and also in the actual theobromin content of the dried specimens, the variation is unimportant. The products in their original state (undried), as compared in relation to the theobromin content (the highest percentage of theobromin being 48.61, the lowest 45.24), reveal a variation of only about 3 per cent.--a variation which is negligible in the case of drugs such as theobromin.

From the preceding investigation, it is concluded that (1) practically there is no difference between the non-proprietary brands of “theobromin sodium salicylate” and “Diuretin;” (2) the several specimens examined were not simple mixtures of “theobromin” and “sodium salicylate”; (3) essentially all the brands complied with the standards laid down and can be rated as satisfactory; (4) “Diuretin,” though sold at an exorbitant price, is not superior to the product supplied under the descriptive term “theobromin sodium salicylate,” and (5) “Diuretin” sells wholesale for $1.75 an ounce, against 35 cents for the “theobromin sodium salicylate,” and therefore its employment cannot be interpreted otherwise than as a useless and unnecessary expense.--(From The Journal A. M. A., April 4, 1914.)

UNGUENTINE

W. A. Puckner and A. H. Clark

Attention has been called at various times to the fact that the value of a published “formula” to a proprietary remedy is in direct ratio to the reliability of the manufacturer publishing it. When medical journals first insisted on their advertisers letting physicians know the contents of the remedies they wished to sell them, medical literature reeked with formulas--some of them of weird and wonderful design. Since the advent of the Food and Drugs Act, which requires that labels shall approximate truthfulness, and particularly since the Council on Pharmacy and Chemistry has investigated a number of proprietary remedies, the publication of “formulas” is not so common.

Unguentine, manufactured by the Norwich Pharmacal Co., is one of those remedies whose advertisement for years always included “a formula”; more recently, however, this is not in evidence. In an advertisement which appeared about ten years ago, the “formula” given is:

“Carbolic acid 2 per cent. “Ichthyol 5 per cent. “Alum 15 to 16 per cent.”

It was claimed that, by a special process of their own, the manufacturers had eliminated most of the astringent properties of the alum, rendering it non-irritant. It was also stated that “the base of Unguentine is pure petrolatum.” Later the manufacturers seem to have changed the composition of their product, or at least the “formula” given in the advertisements was changed. Thus it appeared:

“Alum 15 per cent. “Zinc oxid 5 per cent. “Carbolic acid 2 per cent. “Ichthyol 5 per cent. “Aromatics and antiseptic oils with specially prepared petrolatum and animal fat base.”

The introduction of zinc oxid, aromatic and antiseptic oils and animal fat was a new feature. Somewhat later, and particularly since the passage of the national Food and Drugs Act, no formula or other statement regarding the composition seems to have appeared in the advertisements in the medical press. In the 1906 price-list (p. 170) the following formula appears:

“Unguentine represents: “Alum (non-irritating) 15 per cent. “Phenol 2 per cent. “Ichthyol 5 per cent. “Zinc oxid 5 per cent. “Aromatic and antiseptic oils, with especially prepared petrolatum and purified animal fat.”

In the price-list issued for 1908--after the Food and Drugs Act went into effect--the following appears:

“Unguentine represents: “Alum compound (non-irritating) “Phenol, “Ichthyol, “Zinc oxid, “Aromatic and antiseptic oils, with especially prepared petrolatum and purified animal fat.”

Thus the proportions are omitted, and alum becomes “alum compound,” whatever that may mean.

In view of the conflicting statements made by the Norwich Pharmacal Company, in regard to their leading specialty, Unguentine, and especially because much stress was laid on the filing of their “guarantee” under the Food and Drugs Act, it was decided to ascertain of what Unguentine really consists.

From our analysis we conclude that Unguentine contains not alum but aluminum acetate (small amounts of alum may be present as impurities in the aluminum acetate), zinc oxid, or more probably impure zinc carbonate, and that the entire quantity of both does not exceed 5 per cent. It contains no ichthyol, or if any but the merest traces, and less than 1 per cent. of phenol. The aromatic oils amount to not more than approximately 1 per cent. in all. The ointment-base is, in the main, petrolatum.

In Unguentine we have, therefore, another proprietary “specialty,” regarding the composition of which indefinite, false or misleading statements have been made--this irrespective of protestation of honesty by the firm.--(From The Journal A. M. A., March 27, 1909.)

URICEDIN

W. A. Puckner and A. H. Clark

In view of the results of investigations by Zernik of Uricedin as sold in Germany, and because it is being advertised to physicians in this country, an examination of this product was made in the laboratory of the American Medical Association. Zernik’s report shows how this remedy has varied in its composition as put on the market in Germany. From their analysis the authors find that Uricedin is not a definite chemical compound as is claimed, but is a simple mixture whose composition is approximately:

Sodium sulphate (anhydrous) 61.52 per cent. Sodium citrate (anhydrous) 29.62 per cent. Sodium chlorid 2.13 per cent. Citric acid (anhydrous) 3.25 per cent. Moisture 2.53 per cent. Undetermined 0.95 per cent. ------ 100.00

Uricedin, therefore, is not a definite chemical compound as claimed, but a simple mixture which consists essentially of sodium sulphate (dried Glauber salt) 2/3, and sodium citrate 1/3. It is, therefore, a typical nostrum, and, as it appears, one the composition of which is changed from time to time to suit the whim of the manufacturer. The therapeutic claims made for it are of the usual extravagant character. According to a recent advertisement it is “used successfully for Gouty Diathesis, urinary Calculi, Rheumatoid Arthritis,” “useful in Migraine, Occipital Headache, Epilepsy, Hay Fever, Asthma,” etc. If such a simple mixture will do all that this one is claimed to do, let us use it, but prescribe its ingredients under their proper names. Such a mixture would cost only a few cents a pound, but this nostrum is listed at $1.25 a bottle of five ounces, or probably $1.75 at retail, and this for the benefit of its foreign manufacturers and their agents.--(Abstracted from The Journal A. M. A., Nov. 23, 1907.)

URISEPTIN

W. A. Puckner and W. S. Hilpert

“Uriseptin,” manufactured by the Gardner-Barada Chemical Co. of Chicago and claimed to be a “urinary antiseptic, uric acid solvent and diuretic,” was examined in the laboratory of the American Medical Association to determine to what extent the claims made for it are justified.

The preparation as purchased in the open market bears a label which presents the claims of the manufacturers, emphasized by the chemical analysis duly signed by an analyst and attested by a notary. Accompanying is a reproduction of part of the label.

Before the examination had extended very far it was found that discrepancies existed between facts and claims, and by the time the analysis was complete Uriseptin was found to be in the same class as many other proprietary remedies that have been discussed in these columns.

Our examination shows that the most misleading statement is that concerning the “lithium-formaldehyd” compound the presence of which is claimed, more or less directly, by both the manufacturers and the analyst employed by the manufacturers. Although the chemical properties of lithium and formaldehyd indicate in themselves that the existence of such a compound would be most improbable, yet considerable time was spent in searching the chemical literature for such a compound. Thorough search, however, demonstrated that no such compound, nor any that even approximated it, has been described.

The question then arose as to the form in which the lithium and the formaldehyd are present. The statements regarding its properties as a urinary antiseptic and the fact that the preparation is said to liberate formaldehyd slowly in the bladder point strongly to the presence of hexamethylenamin.

Tests[102] were applied to demonstrate whether the formaldehyd was present as a lithium compound, and if not, whether it existed in the form of hexamethylenamin. By these the presence of hexamethylenamin was proved and the absence of formaldehyd in other combinations demonstrated. This fact alone shows that the preparation is deliberately marketed under a false claim, and it shows further that the analysis on the label is worthless. The quantitative method of analysis demonstrated the presence of 5.51 gm. hexamethylenamin per 100 c.c. (25.15 grains per fluidounce).

[102] These appear in the annual report for 1908 of the Chemical Laboratory of the American Medical Association; they were also published in full in Jour. Am. Chem. Soc., September, 1908; an outline of the analysis appeared in The Journal A. M. A., Aug. 29, 1908.

Besides the hexamethylenamin, Uriseptin contains lithium and a benzoate. Concerning the latter nothing is said in the analysis, whose worthlessness is again demonstrated. By quantitative methods Uriseptin was found to contain lithium and a benzoate in such proportions as would indicate that the lithium and the benzoate radicle exist as lithium benzoate. This fact is further indicated by the claims made for the preparation regarding its properties as a uric acid solvent, for which purpose lithium benzoate is often used. Again, the demonstration that the formaldehyd present is in combination as hexamethylenamin precluded any possible chemical combination between lithium and formaldehyd and adds another strong point in support of the conclusion that the lithium and benzoic acid are in combination as lithium benzoate.

CONCLUSION

By chemical analysis the active ingredients of Uriseptin are shown to be hexamethylenamin, approximately 5.5 gm. per 100 c.c. (about 25 gr. to each fluidounce), and lithium benzoate, approximately 0.70 gm. per 100 c.c. (about 11 grains to each fluidounce), neither of which compounds is mentioned in the advertising matter on the label or in the so-called “analysis” on the label. The statements concerning the composition of Uriseptin are false and appear to be a deliberate attempt to mislead physicians.

Comment.--Investigation of the various “patent” and so-called “ethical proprietaries” advertised to the public and to the medical profession shows that those that have any value as therapeutic agents depend for that value on some well known drug or drugs. Hence, while many proprietaries have some virtue, the ingredients which are of any value are so concealed by the coined and “near-scientific” names applied to them that these drugs are usually unrecognizable. The many and various acetanilid mixtures furnish examples of this class of proprietaries. And now we find another example in that much advertised nostrum, Uriseptin.

According to our chemists, the chief ingredients of Uriseptin are hexamethylenamin and lithium benzoate. Hexamethylenamin is a valuable so-called urinary antiseptic--probably one of the best we have. It is a pity that more physicians do not know the value of this drug in and of itself; it is a common ingredient of many proprietaries, and yet too seldom prescribed under its true name. There is no reason for its being given in the form of a nostrum; it requires no skill in compounding, for it is best given in its powdered form, either in capsules or otherwise. So that, like acetanilid, the old argument of the nostrum men that the preparation needs skill in compounding will not hold. If a physician wants to prescribe hexamethylenamin let him prescribe it in its simplest and best form, and thus know exactly what he is giving.

Lithium benzoate also has its rightful place in the materia medica, but not hidden in a proprietary mixture to be prescribed unknowingly. It is hard to conceive of any one thing that operates more disastrously against scientific therapeutics than the vicious practice of marketing under proprietary names standard and valuable drugs, with their identity purposely concealed. Yet how frequently it is done. Well-known drugs of unquestioned worth are combined with those that are little known and of doubtful value, or more likely absolutely worthless, the mixture is put on the market under a high-sounding name and it is exploited through physicians as a panacea for all kinds of diseases.

In this, as in so many other instances, an “analysis” made to order is given to lend an air of apparent respectability and scientific standing to the preparation or to its exploiters, with the object, of course, of misleading physicians into thinking they are reading unbiased testimony. In addition, the “literature” accompanying the preparation is usually a jargon of pseudo-scientific verbiage put in to serve the same purpose as the analysis--that of catching the careless physician.

This state of affairs will continue just so long as the medical profession will tolerate it--and no longer. So long as members of our profession will prescribe proprietaries on the statements of their owners--as to both their composition and their therapeutic value--just so long will pseudo-chemical and pseudopharmaceutical companies fatten at the expense of the medical profession and to the detriment of the public health.--(From The Journal A. M. A., Aug. 29, 1908.)

ZEMACOL

W. A. Puckner and W. S. Hilpert

Attention has been called to the vague and mysterious statements regarding a preparation called Zemacol, manufactured by the Norwich Pharmacal Co., Norwich, N. Y. Because of the unsatisfactory statements regarding the composition of the preparation, it was considered of sufficient interest to make an analysis and determine its chemical constituents. Accordingly specimens of the preparation were obtained and examined.

The preparation Zemacol (Norwich Pharmacal Co.), as found on the market, is a thick, pink, mucilaginous liquid, highly perfumed and having besides a suggestion of a phenolic odor. The bottle bears a label on which appear the following statements:

“A colloidal emollient containing extract of the rete mucosum of the healthy yearling lamb, combined with glycerin, salicylic acid and other antiseptic and aromatic oils. Useful in eczema and diseases of the integument where cell destruction is a prominent factor.”

In the advertising matter the following claims are made:

“An advance in animal therapy....”

“... increases the nutritive activity of the cell tissue of the skin through the absorbable extract of the rete mucosum.”

“... clinical tests show its efficacy in both the so-called moist and dry eczematous conditions of all parts of the cutaneous surfaces.”

“... rich in animal cells.”

Since nothing could be found in the literature regarding the therapeutic action of an extract of the rete mucosum of the sheep, it was thought possible that the statements on the label were given simply as a vague and mysterious means of indicating the presence of wool-fat (lanolin), and tests were made to determine the presence or absence of the latter substance. A substance was isolated from Zemacol which had the physical properties of, and responded to some of the chemical tests for, wool-fat; but it was found in such small quantities as to indicate that it was not present as an active constituent. Since there are no definite tests for the detection of serums or animal extracts the presence or absence of these could not be demonstrated. Further examination indicated the presence of salicylic acid, a gummy material, having the properties of tragacanth and glycerin. It is practically free from inorganic matter. By distillation a small quantity of oil was isolated, which possesses the characteristic odor of the preparation.

Quantitative estimations[103] indicated the presence of the above-mentioned constituents in approximately the following quantities:

[103] Details of this analysis appear in the annual report for 1910 of the Chemical Laboratory of the American Medical Association.

Per Cent. Gummy matter having the properties of tragacanth 2.02 Salicylic acid 0.67 Matter having the general properties of wool-fat (lanolin) 0.20 Glycerin 5.50 Volatile matter (water and alcohol) 91.00 Aromatic oils and phenol-like bodies Trace

The results of the above analysis, together with advertising matter regarding Zemacol, were submitted to Dr. William Allen Pusey, professor of dermatology and clinical dermatology, College of Physicians and Surgeons, Chicago, and past chairman of the Section on Dermatology of the American Medical Association, with the inquiry whether or not there was any record of investigations regarding the therapeutic value of an extract of the rete mucosum of the sheep and whether in his opinion the claims made for Zematol would be warranted. The following reply was received:

“So far as I know, nobody ever thought of or proposed the use of an extract of rete mucosum as a therapeutic agent and if a serious suggestion of that sort had ever been made I believe I would know it. I can conceive of no service which such an extract could render and I think the suggestion of it is a highly fantastic idea. From the analysis which you furnish I should say that the mixture described is substantially the ordinary 2 per cent. solution of tragacanth in glycerin and water with a little antiseptic added to keep it from decomposing. That is a commonly known lotion, modifications of which are used in practically every hospital as a hand lotion, and has no magical virtues whatever. Incidentally, I should think it cost, aside from the labor, about twenty cents a gallon to make it.”--(From The Journal A. M. A., May 14, 1910.)

ZYME-OID

W. A. Puckner and W. S. Hilpert

Zyme-oid, manufactured by the Oxychlorine Chemical Company of Chicago, is advertised as “a powerful gastro-intestinal antiferment” which will “arrest and prevent bacterial fermentation in any portion of the intestinal tract, whether the media be acid or alkaline.” These extravagant statements, like many others made regarding the properties of zyme-oid, are very similar in character to those made in the circulars accompanying the preparation oxychlorine, manufactured by the same firm and exposed in The Journal, July 6, 1907, page 54. (See page 147 of this book.)

As examples, several parallel statements help to show this similarity. The formula (?) of oxychlorine, as expounded on the label, is given in full, while in the case of zyme-oid only a hint is given as to its composition, but still sufficient to point to a similarity between the two:

OXYCHLORINE ZYME-OID

“Oxychlorine is a tetraborate “Zyme-Oid is a double borate of sodium and potassium com- salt.” bined with oxychlorid of boron, thus: (6NaKB_{4}O_{7}) BOCl_{3}.”

In the matter of claims for chemical stability the two seem to be very closely allied:

Oxychlorine is “a stable salt Zyme-oid is “a product which is under all conditions until stable enough for keeping pur- brought in contact with sub- poses, but which readily yields oxygenated organic matter.” nascent oxygen in the presence of bacterial products.”

The therapeutic properties attributed to these sister products are even more similar, for we find that:

“Oxychlorine is adapted to all “Zyme-oid is a powerful gastro- morbid and abnormal fermentative intestinal antiferment.” alimentary states.”

Many more statements and claims could be quoted to show a similarity between, amounting almost to an identity of, oxychlorine and zyme-oid.

With these facts in mind, the analysis of zyme-oid was undertaken in order to compare it with the previously examined oxychlorine and to determine to what extent the claims made for zyme-oid are upheld by its composition. The analysis indicated, as was expected, that zyme-oid is essentially the same as oxychlorine as is shown in the following, quoted from the report of the analysis of each:

ANALYSIS OF OXYCHLORINE ANALYSIS OF ZYME-OID Potassium (K) 12.26 Potassium (K) 13.50 Sodium (Na) 8.20 Sodium (Na) 9.84 Chlorate (ClO_{3}) 25.32 Chlorate (ClO_{3}) 27.50 Nitrate (NO_{3}) 21.70 Nitrate (NO_{3}) 24.22 Boric acid anhydrid Boric acid anhydrid (B_{2}O_{3}) 18.63 (B_{2}O_{3}) 13.42 Water, calculated 13.29 Water, calculated 10.42

Assuming that the chlorate in zyme-oid is present as potassium chlorate and the nitrate is present as sodium nitrate, the figures obtained by analysis correspond to a mixture approximately as follows:

Potassium chlorate (KClO_{3}) 40.43 Sodium Nitrate (NaNO_{3}) 33.22 Potassium tetraborate (K_{2}B_{4}O_{7}) 1.60 Sodium tetraborate (Na_{2}B_{4}O_{7}) 3.31 Boric acid 21.14

From the results of the analysis and from the physical properties of zyme-oid we conclude, just as was done in the case of oxychlorine, that the preparation is not a definite chemical compound, but is essentially a mixture of alkali chlorate and nitrate with boric acid, probably produced by fusing together the constituents.

COMMENT

An examination of the claims made for the firm’s two products, while, as already proved, disclosing many points of similarity, will also show one remarkable difference. We refer to the skilful indefiniteness that pervades the claims made for zyme-oid and which defies scientific refutation. This verbal obscurity is becoming daily more common in the “literature” of firms marketing nostrums. Since the Council has analyzed many of the much-advertised articles and proved the unreliability of the pseudo-scientific claims made for them, the more cautious of the nostrum-mongers have modified the matter descriptive of their products. They have called to their aid the principle that words were given to man to conceal thought rather than to express it, and they have reduced equivocation to a fine art. Wherever it was possible to put forward claims by implication rather than by expression this has been done.

To substantiate further the claims made by the manufacturers of zyme-oid for their product, a laboratory report is brought in evidence. This report, which is written more in the style of a peruna testimonial than that of a conservative scientific statement, fails to verify the claim that zyme-oid is a “double borate salt,” but confines itself to a statement of its harmlessness and its anti-fermentative properties. In passing, it seems regrettable that scientific laboratories should, for a pecuniary consideration, be willing to jeopardize their reputations by lending their names to the furtherance of nostrum exploitation. The results of the examination of zyme-oid demonstrate that the product is no more worthy of the physician’s consideration than its close, and equally worthless, relative, oxychlorine.--(From The Journal A. M. A., May 23, 1908.)

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I. COUNCIL REPORTS (part 2 of 2)…

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I. COUNCIL REPORTS (part 2 of 2)

II. CONTRIBUTIONS FROM THE CHEMICAL LABORATORY