Chapter XII: Part I: Council Reports (7)

In order to get a fair conception of the actual food value of these
various preparations, it is desirable to make some comparison which
can be readily comprehended by every physician. The amount of good
milk necessary each twenty-four hours to sustain the vitality of
a patient during a serious illness is not less than 64 ounces, or
approximately 2,000 c.c. The food value in calories represented by
this amount of good milk may be placed at 1,430. This includes not
only the proteid and carbohydrate matter, but the fat as well. By
comparing this available potential energy with the total energy
available in the predigested foods under consideration, it can be
readily seen that if a physician depends on the representations made
by some of the manufacturers, and feeds his patient accordingly, he
is resorting to a starvation diet. The largest number of available
calories, including alcohol, present in any of the recommended daily
doses, is less than one-fifth of the number of calories represented
by 2,000 c.c. of milk; and the calories represented by the daily dose
of the preparation poorest in food products is only one-twenty-fifth
of the amount present in 2,000 c.c. of milk. These figures tell their
own story.

Making 2,000 c.c. of milk the basis of calculation, and estimating
the amount of the various preparations required to yield this number
of calories, it is found that the quantity to be administered daily
to supply 1,430 calories, including alcohol, varies from 716.2 to
1,506.2 c.c. In many cases the amount of alcohol exhibited by these
quantities would keep the patient in an alcoholic stupor continually.
The cost necessary to supply this energy varies from $1.48 to $3.39.
Compare these prices with the cost of two quarts of milk. Is further
comment necessary?

It is urged in justification of the use of preparations of this class
that they contain constituents not found in our ordinary foods and in
a more perfectly assimilable condition. As pointed out above, these
so-called predigested foods contain no fats; the carbohydrates in
them are the ordinary sugars present in our common foods, while the
proteins belong to the peptone or albumose class. It is for these
latter that the greatest claims are made, but even here no value can
be pointed out not found in whey, peptonized full milk or peptonized
skimmed milk.

There is likewise another point of considerable importance to
consider in this connection. The terms _peptone_ and _albumose_
include bodies of very uncertain composition, and their suitableness
as food substances depends largely on how they are prepared. Animal
experiments have shown that nitrogen equilibrium may be maintained,
for a time at least, by use of enzymic hydrolytic products of the
proteins, even where the hydrolysis has been carried far beyond the
so-called peptone stage, but it appears to be likewise true that the
mixtures secured by acid or high temperature steam hydrolysis have no
such value. Some of these, indeed, may exhibit a toxic behavior. This
is true in particular of some of the commercial varieties of peptone,
and until more is known of the source of the bodies of protein
character employed in the makeup of these “predigested” mixtures
it is unwise to assume anything concerning the food value of the
nitrogen compounds found in them by analysis or even to dignify them
by the name of foods.--(_Abstracted from The Journal A. M. A., May
11, 1907._)

MIGRAININ

Report of the Council on Pharmacy and Chemistry

The Council, having voted to rescind the acceptance of Migrainin and to omit it from New and Nonofficial Remedies (Appendix), directed publication of the report given below.

W. A. Puckner, Secretary.

SUPPLEMENTAL REPORT ON MIGRAININ

_To the Council_:--Koechl & Co., American agents for Migrainin (Meister Lucius & Bruning) asserted that this preparation was a mixture of antipyrin 85 parts, caffein 9 parts and citric acid 6 parts. The experiments of F. Zernik (_Apoth.-Ztg._, 1906, p. 686), however, showed that Migrainin consisted of antipyrin 90.88 parts, caffein 8.4 parts and citric acid 0.45 parts. When the attention of Koechl & Co. was called to this they informed the Council, on June 20, 1907, that the formula they gave was given them direct by the manufacturers abroad and that they, Koechl & Co., did not question its accuracy. They, however, offered to “write abroad and have the manufacturers confirm the formula as given.” On July 23, 1907, Koechl & Co. wrote the secretary of the Council that the manufacturers had informed them that Migrainin contains 90 per cent. antipyrin and 9.1 per cent. caffein citrate. This being an acknowledgment that the former statement submitted was incorrect, the Council voted that the approval of Migrainin should be reconsidered. Examination of the product, therefore, was taken up in the Association’s laboratory and an original specimen, purchased in Chicago, was found to contain moisture 0.7 per cent., antipyrin 90.93 per cent., and instead of caffein citrate 9.1 per cent., citric acid 0.51 per cent., caffein 8.53 per cent. This analysis agreed essentially with the composition of Migrainin as found by Zernik.

While the discrepancies between the statement of the firm and the facts are perhaps not great, nevertheless they show that even the formula last given is incorrect, and that the statements of Koechl & Co., while no doubt made in good faith, were in this instance unreliable.

In recent advertising matter issued by Koechl & Co., “phenozon-caffein citrate” is given as a synonym for Migrainin, one circular stating that “Migrainin is phenozon-caffein citrate,” etc. In the same circular the following also appears: “In the treatment of migraine with phenacetin or antipyrin, the attack is delayed, while with Migrainin it is usually permanently stayed.” This will, no doubt, lead physicians to infer that Migrainin is not a mixture of antipyrin and caffein citrate, but that it is some new compound. While the firm disclaims any intention to mislead, it does not offer to withdraw or modify this circular. It is recommended, therefore, that the approval of Migrainin be rescinded and that it be omitted from New and Nonofficial Remedies.--(_From The Journal A. M. A., June 5, 1909._)

NEURILLA

Report of the Council on Pharmacy and Chemistry

The following report was adopted by the Council. Its publication was authorized to show how a practically worthless mixture may be exploited by means of ill-considered testimonials.

W. A. Puckner, Secretary.

Neurilla, which appears to be the sole product of the Dad Chemical Company, New York, is advertised as

“The Ideal Nerve Calmant.”

“... a nerve tonic ... indicated in cases where the nerve centers
are poorly nourished and over-sensitive ...”

“... a stimulant to the nervous system.”

“A Valuable Aid in the Treatment of Fevers, Colds, La Grippe, etc.”

The following non-quantitative and indefinite formula is given on the label of a recently purchased bottle of Neurilla:

“Prepared from Scutellaria Lateriflora, Passiflora Incarnata and
Aromatics.”

“Proportion of Alcohol 20.3%.

“Made by Dad Chemical Co., New York, U. S. A.

“Dose, One Teaspoonful Four Times a Day.”

According to the formula, then, this mixture contains, aside from alcohol and aromatics, two vegetable drugs, scutellaria and passiflora, on which the alleged virtues of the preparation must be presumed to depend.

Scutellaria lateriflora, or skullcap, is a bitter drug, one of the many “herbs” to which, on wholly unreliable “clinical evidence,” therapeutic properties were at one time ascribed. Most pharmacologists do not mention the drug, and those who do generally state that it has very feeble therapeutic properties. It was admitted to the Pharmacopeia, but in 1909 its deletion was recommended by a committee of the Section on Practice of Medicine of the American Medical Association (The Journal A. M. A., Sept. 4, 1909, p. 792). We understand that the next edition of the Pharmacopeia will omit mention of skullcap.

Passiflora incarnata, or passion-flower, is another “herb,” which, although known for about seventy years, has never gained the confidence of the medical profession and has not even been admitted to the Pharmacopeia. According to a Council Report:

“None of the evidence is sufficient to show that passiflora has therapeutic value; hence it is deemed inadvisable to include the drug in the list of nonofficial remedies” (The Journal A. M. A., March 19, 1910, p. 983).

On these two obsolescent “herbs,” then, rest the remarkable claims made for Neurilla. A certain degree of appetizing effect may be expected from the bitter taste and a very slight degree of physical stimulus from the alcohol. Except for these effects--and they are largely delusive and temporary--the preparation is therapeutically inert and worthless.

The evidence on which the manufacturers of Neurilla base their therapeutic claims appears to consist of testimonials from physicians. As a matter of fact, this is true of practically all of the large group of nostrums of which Neurilla is typical. An analysis of these Neurilla testimonials brings out clearly what such “evidence” is worth.

ILL-CONSIDERED TESTIMONIALS

The testimonials for Neurilla have been given with reference to indefinite conditions of nervousness that border on the psychic and include hysteria, neurasthenia, neuralgia and the like. Nervousness and indigestion are two diseases in which suggestion, especially when aided by bitters and alcohol, produces temporarily a feeling of improvement. As an illustration, take the following testimonial:

“But more striking was the following case: One evening between
5 and 6 o’clock I was sent for, family lives near me, and I was
informed that the young lady had promised to be bridesmaid, a
function she had never performed. Her mother said the daughter
would certainly drop in her tracks as she walked up to the altar
with the procession, and they had about concluded to send a note
saying to the parents of the bride that she could not come,
although that would be very disagreeable (and no less offensive,
said I). They agreed with me. I ordered Neurilla for two hours.
She went to church, and, I was informed the next morning, passed
through the dreaded ordeal simply fatigued, and was now fast asleep
on account of the nice effect of Neurilla.”

It might provoke a smile to think that a manufacturer would publish so silly a testimonial were it not that the very fact of its publication indicates that there are medical men thoughtless enough to read and accept such stuff as reliable evidence as to the value of any product.

TESTIMONIALS GIVEN LONG AGO--THE REMEDY ABANDONED

A number of physicians who had given testimonials were asked in writing whether the testimonials were genuine and whether they still entertained the high opinion of Neurilla expressed at a former date. Several replied that, if they had ever given such testimonials, they had forgotten the circumstance. From the replies received we select the following:

The testimonial which bears Dr. A’s name reads:

“_I am using Neurilla with most satisfactory results._”

Dr. A now says:

“=As to its positive value as a therapeutic agent I have not used
it enough to know.... If the language you quote ... appears as
given in or as a ‘testimonial’ it must in some way be garbled and
appears wholly without my knowledge or consent.=”

Dr. B is quoted as having written:

“_I do not often lend my influence to furthering the fame of a
proprietary remedy, but I have achieved such excellent results
from the use of Neurilla as a calmative in hysteria and other
nervous disorders, that I feel its manufacturers are entitled to an
acknowledgment of gratitude from me._”

Dr. B writes:

“=I have not prescribed a dose of the nostrum in years. The use of
my name in connection with Neurilla is unauthorized.=”

Dr. C once wrote:

“_I have used Neurilla with good results._”

Dr. C now writes:

=“In re ‘Neurilla’ I think I used the preparation once or twice and
it seemed to do good work, but if due to the preparation or other
influences, I am not able to verify. I have not used it since nor
will, as I am opposed to using these preparations except in certain
cases where the ℞ contains remedies whose value I have verified
under the most rigid tests.=

“=P. S. This testimonial must have been given many years ago.=”

Dr. D’s testimonial is admitted to be based on a single case:

“_I am using Neurilla in a bad case of neuralgic tic with very good
results on an aged lady. She has taken several bottles, and is
still taking it with very good results._”

Dr. D sums up his later experience by saying:

“=I have long since abandoned the use of Neurilla in practice.=”

The following bears Dr. E’s name:

“_I endorse Neurilla without hesitation. It meets all indications
for which it is intended._”

This is what Dr. E writes now:

“=As to the enclosed testimonial in regard to Neurilla said to
be written by me I have no recollection. I am not prescribing
Neurilla.=”

Dr. F’s experience is similar. The testimonial credited to him reads:

“_I have prescribed Neurilla in nervous disorders with good
results._”

Dr. F now writes:

“=I don’t remember of ever having prescribed ‘Neurilla’ or of
having given a testimonial for it or any other patent medicine if I
knew it to be so.=”

SUMMARY

In the booklet from which the foregoing are taken, there are forty testimonials. Those which we quote are merely samples. To sum up the results of this analysis: Of the testimonials some are said to be unauthorized; a number were written with so little thought that the writers had since forgotten their very existence; the conclusions expressed in most are not in fact justified by the writers’ mature judgment and experience. A number of writers admit that their experience is insufficient to determine whether the supposed good results were due to the medicine used or to other influences. Of course such evidence is unworthy of credit and happily, very little is now being furnished by doctors; even our courts refuse to admit it.

In short, the published formula shows that Neurilla is nothing more than a preparation of discredited drugs; it is exploited largely by means of carelessly formed and thoughtlessly expressed opinions of physicians. It is recommended that this report be published as an illustration of such methods and as a protest against them.

[Editorial Comment.--Neurilla is advertised in the following publications:

_Archives of Pediatrics_,
_Atlanta Journal Record of Medicine_,
_Charlotte Medical Journal_,
_Indianapolis Medical Journal_,
_International Journal of Surgery_,
_Journal of Nervous and Mental Diseases_,
_Medical Herald_,
_New York Medical Record_,
_Medical Review of Reviews_,
_Medical Sentinel_,
_Medical Standard_,
_Pacific Medical Journal_,
_Southern Practitioner_,
_Texas Medical Journal_,
_Woman’s Medical Journal_,
_Eclectic Medical Journal_,
_Ellingwood’s Therapeutist_,
_Journal of the American Institute of Homeopathy_.]
--(_From The Journal A. M. A., March 27, 1914._)

NEUROSINE, DIOVIBURNIA, GERMILETUM AND PALPEBRINE

Report of the Council on Pharmacy and Chemistry

Neurosine, Dioviburnia, Germiletum and Palpebrine are “shotgun” proprietaries typical of the polypharmacy of the past three or four decades. They are marketed by the Dios Chemical Company, St. Louis, Mo. On the recommendation of the referee, the Council has authorized the publication of this report.

W. A. Puckner, Secretary.

Neurosine

According to the manufacturers, each fluidounce of Neurosine represents:

“Bromid of potassium, C. P. 40 grains
“Bromid of sodium, C. P. 40 grains
“Bromid of ammonium, C. P. 40 grains
“Bromid of zinc 1 grain
“Extract Lupulin 32 grains
“Cascara sagrada, fl. ex. 40 minims
“Extract Henbane .075 grain
“Extract Belladonna .075 grain
“Extract Cannabis indica .60 grain
“Oil Bitter Almonds .060 grain
“Aromatic Elixirs.”

No physician would think for a moment of prescribing all of the drugs contained in Neurosine for any one condition. Yet physicians are urged to use this nostrum in insomnia, hysteria, neurasthenia, migraine, neuralgia, delirium tremens and in a host of other conditions.

It is recommended in the treatment of epilepsy on this ground:

“Neurosine is presented in a very palatable and agreeable form
and can be administered for an indefinite time without untoward
by-effects as so often attends the use of the commercial bromides.
In order to secure lasting benefits the treatment should be
extended over a long period of time.”

The evident implication here is that the recognized drawbacks of bromid medication are due to impurities present in the commercial bromids and that the teachings of modern medicine with regard to caution in the use of bromids do not apply in the case of Neurosine.

The assurance is offered:

“Neurosine contains no chloral, morphin or other objectionable
drug--a fact of the utmost importance when administering medicines
to neurotic women.”

“As a nerve-calmative and sleep-producer nothing can excel
Neurosine ... It should be borne in mind that this preparation
contains no opium, morphine, chloral or habit-forming drugs ...
Neurosine being a harmless remedy is especially indicated for
neurotic individuals.”

Apart from cannabis indica, Neurosine contains no efficient hypnotic. Cannabis indica is a dangerous drug, whose administration to “neurotic individuals” is by no means free from danger--especially when it is given under a proprietary name that carries no warning of its presence.

Here is another recommendation--this time for chorea:

“All authorities recommend the bromides, hyoscyamus and cannabis
indica in this disease. These remedies are all combined in
Neurosine, the ideal calmative for both children and adults.”

On the contrary, practically “all [medical] authorities” will admit that it is undesirable to keep a child under the influence of bromids if this can be avoided. Such treatment is mentioned only for use as a last resort in extreme cases. Hyoscyamus and cannabis indica are mentioned in connection with chorea by few authorities, and then merely as probably valueless.

Not content with recommending the promiscuous use of this already too complex mixture, the Dios Chemical Company advises physicians to combine it with iron, when chalybeate and tonic effects are to be combined with “a nervine,” with acetanilid for “irritable cough,” headache and neuralgia, with antipyrin in asthma and with Dioviburnia--another Dios nostrum--in all female ailments.

Dioviburnia[AE]

[AE] For articles on other viburnum preparations, see pp. 218 and 409.

Dioviburnia, another Dios nostrum, according to the label, has the following composition:

“Every fl. oz. contains 3-4 dr. each of the fl. extracts,
Viburnum Prunifolium, Viburnum Opulus, Dioscorea Villosa, Aletris
Farinosa, Helonias Dioica, Mitchellae [_sic_] Repens, Caulophyllum
Thalictroides, Scutellaria Laterifolia.” [Lateriflora?--Ed.]

Further, according to the label, Dioviburnia contains 18 per cent. alcohol. If this statement is correct then the “formula” is false, for the fluid extracts named contain from 25 to 73 per cent. of alcohol. As--according to the “formula”--these fluid extracts constitute three-fourths of Dioviburnia, the average alcohol-content in the whole mixture must of necessity be much above 18 per cent.[59] According to the makers, Dioviburnia is “unexcelled” for:

“Amenorrhea, Dysmenorrhea, Leucorrhea, Puerperal Convulsions,
Prolapsus Uteri, Menorrhagia, Threatened Abortion, Parturition,
Subinvolution, Miscarriage, and a general relaxed condition of the
uterus and appendages, together with the various aches and pains
peculiar to women.”

[59] Five of these fluidextracts have their alcohol-content determined by the Pharmacopeia or National Formulary. Three are not recognized and hence their alcohol-content is not defined by law. The alcohol-content of the mixture of fluidextracts said to be in Dioviburnia has been kindly furnished by five leading pharmaceutical houses. If the lowest alcohol-content of the several fluidextracts is made the basis of calculation, Dioviburnia should contain at least 30.75 per cent. of alcohol, or more than half as much again as the amount declared on the label.

Around the sample bottle of Dioviburnia is wrapped a booklet entitled “A Treatise on Uterine Diseases and Obstetrical Hints,” said to be “For the Profession Only.” The booklet has been prepared, physicians are told, to present “some very valuable suggestions” regarding the treatment of female disorders and the attention of the medical profession is “earnestly” called to the “very remarkable medicine,” Dioviburnia. Further, it is said that Dioviburnia was devised by the Dios Chemical Company because there was an “absolute necessity” for some really efficient internal treatment in female diseases. The company backs up its statements by such claims as:

“The most valuable preparation, therapeutically, ever offered.”

“[Contains] every essential for toning up the female organs of
generation, and relieving pain.”

“A general and special tonic, antispasmodic and invigorating
cordial.”

While the company directs the attention of physicians to the “well-known, therapeutical effects of each individual constituent” of Dioviburnia, there is in reality little positive evidence regarding the action of any of the drugs contained in the nostrum. Most writers on materia medica do not even mention these drugs and the few who do discuss them, either question or deny their medicinal value. But if every drug claimed to be present in Dioviburnia had some actual demonstrated therapeutic properties, it still would be impossible to predict the action of such a combination in the many and varied conditions for which it is exploited. Certainly there is no warrant for such statements as:

“In Painful Dysmenorrhea [_sic_] Dioviburnia is especially
indicated, and its continued use will invariably give relief.”

“In cases of Leucorrhea of long standing, Dioviburnia, together
with local treatment, invariably gives relief.”

“Dioviburnia is efficient in cases of subinvolution; it cures by
its tonic effects....”

The effects of the drugs alleged to be present in Dioviburnia are not such as to justify the hope of either “cure” or “invariable relief.” In a way the Dios Chemical Company seems to recognize the inefficiency of Dioviburnia since it frequently suggests that it be used in combination with drugs of known value; but it ascribes all favorable results to its own product:

“In chronic constipation fluid extract of cascara sagrada aromatic
may be combined with Dioviburnia.”

“In cases of habitual abortion, depending on syphilitic taint, a
prescription containing the following should be used during the
entire pregnancy:

℞ “Hydrarg. Chlor. Corros gr. 1
“Potass. Iodid dram 1
“Dioviburnia ounces 16”

“An Anemic or Chlorotic patient, suffering with absence of the
menstrual flow, should take DIOVIBURNIA combined with Iron.”

“In leucorrhea depending on endocervicitis, hot astringent douches
once daily should be given. Local applications of iodin are useful
in chronic conditions. Internally, D i o v i b u r n i a promotes
healing.”

“Rest in bed, hot douches of a one-half per cent. solution of
compound cresol solution and D i o v i b u r n i a internally, a
teaspoonful every 3 hours will rarely fail to cure endometritis in
a few days.”

“In specific vaginitis, a solution of potassium permanganate (1 to
1000) should be used as a douche twice daily. Internally give the
following:

“Sodii benzoate 1/2 ounce
“Dioviburnia 16 ounces
“M. sig., Teaspoonful every three hours.”

“Prolapsus Uteri is benefited, and often cured, by DIOVIBURNIA
combined with local treatment in the shape of tampons, pessaries,
electricity, etc.”

If Dioviburnia will cure specific vaginitis, anemia, etc., so will a cobblestone make excellent soup. All that is necessary in the former case is to add certain potent drugs that might be indicated in the pathologic conditions mentioned and, in the latter case, to combine suitable amounts of beef, chicken, green turtle or vegetables, with herbs and other seasoning.

Germiletum

Germiletum is a member of the large class of alkaline antiseptic solutions with excessively complex formulas. In this case not only is the formula complex but also the Dios Chemical Company finds it impossible even to assign a constant composition to it--at least the “formulas” which appear on the different styles of Germiletum labels and advertising circulars vary greatly.

The company says:

“We appeal only to the Doctor’s judgment of his estimation of the
formula.”

“Doctor you will readily determine from the formula the class of
cases in which you have a right to expect satisfactory results.”

Yet the “formulas” given present so great a variety and such confusion that it is not clear even to a chemist just what the Dios Company wants the medical profession to regard as the composition of Germiletum.

The following statements of “composition” have appeared at various times:

1. In an advertising circular sent out some time ago:

“[HBF_{4} + BOH (OC_{6}H_{4}COOH)_{2}
+ BOH (OC_{6}H_{3}COOH)_{2} + C_{3}H_{5}BO_{3}
+ CH_{2}O + C_{10}H_{14}O
+ C_{10}H_{20}O + C_{24}H_{28}N_{3}Cl.]”

2. In advertising circulars which have been received of late, being wrapped with a sample package and with the “large size” trade package:

“[C_{7}H_{6}O_{2} + H_{3}BO_{3} + C_{3}H_{5}BO_{3}
+ (CH_{2}O)_{3} + C_{10}H_{20}O + C_{10}H_{14}O + C_{2}H_{6}O]”

3. In another advertising circular:

“Germiletum is a slightly alkaline chemical solution of
Borohydrofluoric Acid, Borosalylbenzoic Acid, Boroglycerine,
Formaldehyde with Menthol, Thymol and Antiseptic Aromatics.”

4. On the label of a sample package sent through the mails during 1914, and on the label of a “small size” trade package purchased in 1914:

“FORMULA.--Borohydrofluoric Acid, Borosalylbenzoic Acid,
Boroglycerine, Formaldehyde with Menthol, Thymol, Amyl Acetate and
other Antiseptic Aromatics.”

5. In the circular which was wrapped around the sample package referred to above, and around the “large size” trade package purchased at the same time that the “small size” package was bought:

“Germiletum is a slightly alkaline chemical solution of Borobenzoic
Acid, Boroglycerine Formaldehyde, with Menthol, Thymol and other
Antiseptec [_sic_] Aromatics.”

6. On the sample package, on the “small size” trade package and on the wrappers of the “large size” trade package:

“Alcohol 18 per cent.; Formalin 3/4 M. per oz.; Amyl Acetate 1/3 M.
per oz.” (also written “Acetate Amyl.”)

The label on the large trade package states that Germiletum contains “Formalin 1/2 M. per oz.”

One and all of these various formulas spell mystery. The existence of some of the constituents is problematic; even if the theoretical possibility of such combinations be conceded, some of them could not exist in Germiletum, for they would be broken up by the alkaline fluid. As illustrating the contradictions which the formulas present: While the wrapper of the “large size” trade package claims that Germiletum contains 3/4 minims Formalin (Formalin is a proprietary name for a 40 per cent. formaldehyd solution) the label on the bottle claims only 1/2 minim. Again, while the composition expressed in chemical symbols asserts that “H_{3}BO_{3}” (boric acid) is a constituent of Germiletum, the “formula” which follows it states that Germiletum has an alkaline reaction; hence it cannot contain much boric acid. Finally, the “small size” bottle of Germiletum purchased at the same time as the “large size” bottle and also the label of a sample package sent through the mails to a physician in 1914, give as a constituent “Borohydrofluoric Acid,” which is mentioned neither on the label of the “large size” trade package nor in the pamphlet wrapped around it. The only information which these contradictory “formulas” can convey to a physician is that Germiletum is an unscientific, varying mixture of many drugs.

A trade package, having the name “Germiletum” blown in the glass, bears on the label recommendations for its use in the treatment of “catarrh,” “Gastritis, Stomatitis, Gastric and Intestinal Catarrh,” “Leucorrhea and Uterine Diseases,” “Hemorrhoids,” “Whooping Cough,” “Tonsilitis and other forms of sore throat” and “Eczema.”

The following statement on the label is designed to induce physicians to place false confidence in Germiletum to the danger of their patients:

“The lying-in-room should be thoroughly sprayed with Germiletum.
Can be relied upon to destroy the living particles which so
generally constitute contagion.”

This claim, as well as the assertion which appears on the label of a sample package and of the “small size” trade package that it is “PAR-EXCELLENT IN OBSTETRICAL PRACTICE” is almost criminal, as Fussell[60] has said, since to depend on any preparation of this sort is to court disaster.

[60] Fussell, M. H.: Dangers of Certain Ethical Proprietary Preparations to Both Physicians and Public, The Journal A. M. A., Oct. 7, 1911, p. 1196.

The booklet around the trade package makes the claim that Germiletum “is the best antiseptic”--evidently largely because it is claimed to be “the blandest of all”--and that it is “thoroughly germicidal” and even that it is “the best disinfectant obtainable.” It also contains such unwarranted and misleading claims and suggestions as:

“... preparatory to all operative work--Germiletum should be used
freely in spraying the atmosphere ...”

“Operative wounds, whether large or small, can be rendered
thoroughly antiseptic by freely spraying them with Germiletum....”

“... it may be given internally in many dyspepsias and in all
zymotic diseases.... In such conditions Germiletum is the ideal
internal antiseptic and disinfectant.”

In the present advertising, no evidence whatever is offered for the value of Germiletum, the Dios Company contenting itself with unsupported claims and cant phrases such as

“... the truth is only reached through a final appeal to
intelligent practical experience.”

In the old circulars only crude, uncritical and meaningless tests to establish the antiseptic value of Germiletum are reported and none whatever as to its germicidal action. In the advertising matter sent out some time ago, for instance, were given “Microscopical, Bacteriological and Chemical Tests, Comparing Germiletum with Carbolic Acid.” These tests have no value whatever, unless it be to show the worthlessness of the preparation. This is particularly true as regards a series of experiments on “Germiletum as a Preventive of Lactic Fermentation,” in which one part of Germiletum in thirty parts of milk did not prevent fermentation. Such effect as indicated is probably due to the formaldehyd present. The tests show the absurdity of using the preparation for internal and external purposes. The referee challenges the therapeutic claims on the basis that they are extravagant and unsubstantiated. (The Chemical Laboratory of the American Medical Association reports that the alkalinity of Germiletum corresponds approximately to a 1 per cent. borax solution.)

Palpebrine

According to the Dios Chemical Company, Palpebrine is “A Reliable External Ocular Antiseptic” having, it is said, the following composition:

“... each fluid ounce contains 1/116 grain Sulphate of Morphia, 1/7
grain Sulphate of Zinc, 1/11 grain Bi-Chloride of Mercury, 5-3/8
grains Boric Acid, 3/4 grain Salicylic Acid.”

The essential virtues ascribed to Palpebrine, according to its makers, are its harmlessness and its therapeutic efficiency due, presumably, to its complex composition:

“Attention is called to the constituents of this formula, each
one of which is used by ophthalmologists. Their combination in
Palpebrine is such as to blend their action in a very happy manner.
Palpebrine acts as an antiseptic, an irritant, an astringent, and a
nerve tonic to the mucous membrane of the eye.”

“Palpebrine is superior in its action to the remedies now in use.
It contains all the constituents of Aqua Conradi ... But to these
are added a number of other agents which will prove it to be of
much greater value and give it a broader field for action.”

In all external afflictions of the eye the free use of Palpebrine is suggested in such statements as:

“They [general practitioners] will therefore gladly receive from
our hands an efficacious preparation which may be used with perfect
safety.”

“The name of our preparation--Palpebrine, is derived from the Latin
_palpebra_, the eyelid, and is well fitted, as it designates at a
glance the sphere of action of Palpebrine.”

“With the assistance of Palpebrine the general practitioner can
successfully treat all cases of external eye disease ordinarily
encountered in his practice.”

One of the members of the Council staff of clinical consultants calls attention to the fact that much vitally valuable time might be lost in a case of iritis, for example, which being unrecognized, should be treated with Palpebrine on the strength of the Dios Chemical Company’s advertisements. Even more dangerous is the recommendation of Palpebrine for the prevention of ophthalmia in the newborn, especially as this recommendation is coupled with an attempt to discredit the established treatment with silver nitrate solution:

“The use of severe remedies for this purpose has been discarded by
most physicians....”

While it is doubtless true that ophthalmia neonatorum may be averted by other drugs than silver salts, it is utterly unjustifiable to suggest that the established method of treatment by means of silver salt irrigations has been generally discarded.

[Editorial Note.--The four nostrums mentioned above have been grouped
together for publication to call attention to one phase of the
proprietary business. A fact not mentioned in the Council’s report
is that these nostrums are manufactured and promoted by a concern
that belongs to a type we have often designated “pseudo-chemical”
companies. By this is meant companies that are not in the legitimate
business of pharmacy or chemistry, but organized to exploit one, two
or in some instances half a dozen proprietaries. “Patent medicines”
are exploited by this class of “companies.” The Dios Chemical Company
is not a chemical company, except in name. J. H. Chambers, the
founder so far as we can learn, never claimed any special knowledge
of chemistry, pharmacy or medicine. The officers at the present time
are: J. H. Chambers, president; M. E. Chambers, vice-president;
Leslie T. Chambers, treasurer, and Arthur Chambers, secretary. M. E.
is the wife of J. H., and Leslie T. and Arthur are sons.

This is simply one illustration of the fact noted above. Some
physicians have been and are prescribing nostrums originated,
manufactured and advertised by laymen who are not in the legitimate
pharmacy business. In addition, such physicians have been accepting
the statements of laymen, not only as to the composition of the
nostrums, but as to their use. In every state the practice of
pharmacy is regulated by law: before assuming the responsibility of
compounding medicines a druggist must have studied and passed an
examination in pharmacy. Public safety demands and the law requires
it. There are some doctors, however, who will allow laymen who are
not chemists, pharmacists or physicians to formulate and compound a
prescription and tell them what it is good for and how to use it.

The Dios Chemical Company is not an isolated instance: we have already referred to some; we shall take occasion to refer to others in the future. That such concerns flourish is a reflection not so much on the shrewd laymen who exploit the medical profession--and through it the public--as it is on the physicians who cast their scientific training to the winds and permit themselves to be thus exploited.]--(_From The Journal A. M. A., Jan. 9, 1915._)

OXYCHLORINE

Report of the Council on Pharmacy and Chemistry

The following report on Oxychlorine has been submitted to the Council by the subcommittee to which it was assigned:

_To the Council on Pharmacy and Chemistry_:--Your subcommittee
submits the following report: The Oxychlorine Chemical Company, 1326
Wabash Avenue, Chicago, states in its advertising literature that:

“Chemically, Oxychlorine is the tetraborate of sodium and potassium
combined with oxychlorid of boron, thus: 6 (NaKB_{4}O_{7})
BOCl_{3}.”

Analysis of Oxychlorine showed:

Potassium 12.26 per cent.
Sodium 8.20 per cent.
Chloric acid--CLO_{3} 25.32 per cent.
Nitric acid--NO_{3} 21.70 per cent.
Boric acid anhydrid--B_{2}O_{3} 18.63 per cent.
Water, calculated 13.29 per cent.

Thus, Oxychlorine is not a definite chemical substance of the composition claimed, but instead is a mixture of alkali chlorate and nitrate with boric acid. Assuming that the chlorate is present as potassium chlorate and the nitrate as sodium nitrate, the analysis above quoted corresponds to a mixture approximately as follows:

Potassium chlorat 37.19
Sodium nitrate 29.76
Sodium and potassium tetraborate 2.18
Boric acid 30.52
Undetermined 0.35
------
100.00

Your committee recommends that Oxychlorine be not approved and that this report be published.

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

W. A. Puckner, Secretary.

In commenting on the above report it is hardly necessary to call attention to the palpable untruthfulness of the furnished formula or its lack of correspondence to the real composition of the preparation, to the imposing claims made by its pseudo-scientific exploiters or the absurdities, from a chemical standpoint, of the statements made in their literature. These features are more or less common to all nostrums. The physician who prescribes or uses Oxychlorine under the impression that he is getting a definite and unique chemical compound described as tetraborate of sodium and potassium combined with oxychlorid of boron is, according to our chemists, getting simply a mixture of potassium chlorate, sodium nitrate (or, perhaps, sodium chlorate and potassium nitrate), and boric acid in about equal amounts. More than one-third of this mixture is potassium (or sodium) chlorate, drugs by no means harmless.

In order that there may be no suspicion of unfairness to the promoters of the preparation, we quote from one of the advertising circulars sent out by the Oxychlorine Company:

“Oxychlorine owes its recognition as a therapeutic agent to its six
principal qualities:

“1. It will oxygenate the blood at the seat of application,
maintain nutrition and heal an uninfected solution of continuity of
first intention without scar formation.

“2. It will disorganize all pus and ferment-producing
micro-organisms, their toxins, ferments and ptomains.

“3. It will restore an inflamed mucous membrane to its normal
condition, except where the membrane is sclerosed or atrophied.

“4. It will destroy pathogenic micro-organisms and their toxins in
the blood current.

“5. It will stimulate the blood to absorb more oxygen in the lungs
than it at the time carries. [We do not know what this means;
perhaps the Oxychlorine Company does.]

“6. It is absolutely harmless to the tissues and will not destroy a
living cell.”

Surely these people must have access to physiologic and chemical authorities not found in modern medical libraries, or else their esoteric researches into the mysteries of life must have carried them far beyond the ken of our most advanced workers along these lines. The scientific world would receive with great interest information as to how a mixture of potassium chlorate, sodium nitrate and boric acid oxygenates blood, maintains nutrition and causes healing without scar formation. A mixture which will destroy micro-organisms and yet will not destroy a living cell certainly shows a fine sense of selection and discrimination not heretofore expected of a combination of chemicals or of a chemical compound. How like the wonderful elixir of medieval times, which was to the Christian a tonic and to the heathen a poison!

Here is another claim made for this nostrum:

“Two or three rectal injections of a one or two per cent. solution
of Oxychlorine and ten grain doses given six to eight times per day
is the best and most reliable treatment for typhoid fever.”

If 80 grains of Oxychlorine contain 30 grains of potassium chlorate, three rectal injections each consisting of 1 pint of 2 per cent. solution, would contain approximately 160 grains of potassium chlorate. Such an injection might prove decidedly dangerous, especially when used by one ignorant of its true composition. However, the physician, not the promoters, bears the responsibility.

Oxychlorine sells at $3.50 a pound; the ingredients can be obtained for about 44 cents a pound. Perhaps the margin of profit is intended as a reward due the promoters for the profound physiologic discoveries announced in their reading matter.--(_From The Journal A. M. A., July 6, 1909._)

PAM-ALA, ANOTHER WORTHLESS QUININ SUBSTITUTE

Report of the Council on Pharmacy and Chemistry

The following report of a referee on Pam-ala, an asserted malaria specific, was adopted by the Council and its publication authorized.

W. A. Puckner, Secretary.

Soon after publication of the Council’s report on Sinkina, an alleged malaria specific proved worthless, the referee’s attention was called to Pam-ala, which is sold under very similar claims.

According to the advertisements which have been appearing in Southern medical journals, Pam-ala is “A new and effective remedy for MALARIA.”

The label describes Pam-ala as “An Effective Vegetable Remedy For MALARIA. Guaranteed free of any Quinine, or other harmful [_sic_] drugs.” It is said to be indicated in “Malarial Intermittent and Remittent Fevers, especially curative in Chronic Malaria and Malarial Cachexia and all conditions even where Quinine fails.” One tablespoonful three times a day is said to be the “Curative Dose,” while one tablespoonful three times a week is stated to be a “Prophylactic Dose.” The label further claims that Pam-ala “Surpasses Quinine in its action and has none of its Disadvantages.” Assertions that Pam-ala is superior to quinin are followed by the usual “guarantee” claim: “Guaranteed by the Pam-Ala Co. under the Drugs Act, June, 1906, Ser. No. 2909 A.” Finally, the label says that it is “Endorsed by Medical Authorities Throughout the world.”

As regards the composition, a circular says that “PAM-ALA is a purely vegetable remedy for the cure, without Quinine, of all forms of Malaria.” “‘PAM-ALA’ is derived from a plant of the genus Umbelliferae, a native of the mountainous regions of Mexico and northern parts of South America. Its medicinal properties have not been known to anyone but the native Indians, who for years past have used it as a specific in all forms of fever and malarial diseases so prevalent in tropical countries. The seeds are more active as a therapeutic agent than the dried-up plant; hence their collection for medicinal purposes requires special skill in the selection of the same so as to be able to extract all the possible medicinal properties from them, viz., its active principle. An oil may be abstracted from the seeds which is of a yellow color with an intense characteristic odor.”

At the close of the circular the following unenlightening formula appears:

Each fluid ounce contains:
Ext. Fid. Pam-ala 10 per cent.
Alcohol 15 per cent.
Ol. Aurant Syr. Sacchari aqua ad. q. s. 100 per cent.

In addition to being a cure for malaria, Pam-ala is claimed to have a “favorable influence upon the broncho-pneumonia of measles ...,” “will avert an attack of acute catarrh,” and “abort acute tonsilitis.”

The testimonials are of the usual character. Most of them seem to have been given some four years ago by physicians in Italy, Cuba, Porto Rico, Guatemala, etc., and therefore cannot readily be looked into. Two are of more recent date and come from physicians in this country. They furnish good illustrations of the manner in which proprietary concerns make use of opinions hastily formed and thoughtlessly put in writing. One testimonial was given in July, 1912:

“I take pleasure in testifying to the seemingly marvelous and
gratifying effect of Pam-ala in 2 cases of malaria....”

On Jan. 2, 1914, its writer, in reply to an inquiry whether in the light of continued experience, his first estimate of Pam-ala had been confirmed, wrote:

“... Since then I tried Pam-ala on a number of cases without any
results whatever; in fact my patients seemed to get worse until
I resorted to the usual treatment of malaria, mercurial laxative
followed with quinin. I was too hasty in stating that Pam-ala cured
malaria. I now know and have known since August, 1912, that Pam-ala
will not cure malaria....”

The writer of the second testimonial is reported to have written that he tried Pam-ala “on a most pronounced case of malarial spleen with the most excellent results” and that he “also tried Pam-ala on a case of Malarial Cystitis and Hematuria, with entire satisfaction.” In reply to inquiry this physician admits that he was “very favorably impressed with the preparation at the time.” He states that at that time he was also trying out Sinkina and that after six months he “discontinued the use of both as the results did not warrant further investigation.” He concludes:

“With due allowance for the fact that certain cases will for a
time improve on any kind of treatment, new or old, I see no reason
for supplanting or even augmenting, the recognized treatment for
malarial conditions, with either Pam-ala or Sinkina.”

Incidentally it should be mentioned that this physician also noted the general similarity of Sinkina and Pam-ala. He observes:

“The physical appearance and properties of the two preparations
seem to be identical, the advertising matter and literature are
surprisingly alike and the only marked difference seems to be that
one remedy is purported to be prepared from a ‘new’ South American
plant and the other from an equally fresh discovered addition to
Asiatic flora.”

WHAT IS PAM-ALA?

From a comparison of the statements regarding the composition which are made for Sinkina and for Pam-ala, as well as from the physical characteristics of the preparation, particularly the odor and taste, it seems evident that the essential constituent is oil of cumin. Although definite proof that oil of cumin forms the essential constituent of Pam-ala would have shown the worthlessness of this nostrum for the reason that the clinical investigation of Sinkina proved the worthlessness of oil of cumin, it did not seem worth while to the referee that this be demonstrated by chemical analysis. It seemed to him that in such cases as these, the secrecy with which the identity of the preparation is surrounded, as well as the extravagant and highly improbable claims, should be sufficient to condemn it.--(_From The Journal A. M. A., Feb. 28, 1914._)

PAPAYANS BELL[AF]

Report of the Council on Pharmacy and Chemistry

[AF] See also Bell-Ans (Papayans Bell), p. 282.

The following report of a subcommittee was submitted to, and adopted by, the Council and its publication directed.

W. A. Puckner, Secretary.

Papayans (Bell) made by Bell & Co., Orangeburg, N. Y., is said to consist of the “digestive principle obtained by our own exclusive process from the fruit of _Carica papaya_, combined with willow charcoal, chemically pure sodium bicarbonate and aromatics.” The following statement appears on the package: “For the treatment of dyspepsia, flatulence, nausea, vertigo, hyperacidity, palpitation and other symptoms of indigestion and the vomiting of pregnancy. Peritonitis, cholera morbus, alcoholism and seasickness.” “Digests every variety of food, removes every symptom of indigestion, restores the entire digestive tract to a normal condition.” The dosage is recommended as follows: “From one to three tablets before meals, or two hours after eating. In severe cases, three tablets dissolved in hot water and repeated as necessary.”

A circular which accompanies the package details the therapeutic virtues of the preparation and contains what purports to be extracts from medical journals, in which Papayans is recommended.

Examination of specimens purchased in the open market showed them to contain the following ingredients: Charcoal, sodium bicarbonate, ginger, saccharin and oil of gaultheria. As the product is said to contain papain, the presence of enzymes was tested for, with the result that it was found to possess neither proteolytic nor amylolytic properties. The results of our examination are in accord with the results obtained by a member of the Council, who examined the product independently, and who writes:

“We have made some extended tests with Papayans Bell, and find that
the tablets consist essentially of sodium bicarbonate and charcoal,
with a little flavoring matter. We find no digesting power for starch
or egg albumin. At any rate, no appreciable change follows in the
albumin in three hours, and no conversion to sugar in the same time,
or change of starch to a point where the iodin reaction is weakened.
The product seems to be practically inert.”

It is recommended that Papayans Bell be refused recognition, and that publication of this report be authorized.

Comment: It will be remembered that two other products of Messrs. Bell & Company have been discussed in this department: Salacetin (Bell)[61] and Sal-Codeia (Bell).[62] Salacetin was examined with several “synthetics” which all turned out to be mere acetanilid mixtures. Salacetin, advertised as “a combination, with heat, of Salicylic and Glacial Acetic Acids and Phenylamine” when examined “was found to be a mixture and to contain the following ingredients approximately in the proportion given: Acetanilid 43; sodium bicarbonate, 21; and ammonium carbonate, 20.” Sal-Codeia (Salacetin-Codein) therefore, would be the same with codein added.

[61] See p. 356.

[62] See p. 357.

Papayans (Bell) seems to be consistently fulfilling the life-history of the average nostrum. Made of well-known drugs and invested by its manufacturers--or exploiters--with virtues absurdly disproportionate to the known properties of the alleged constituents of the nostrum, the preparation was introduced to the world via the medical profession. With the help of thoughtless physicians, aided by a skilful and aggressive advertising campaign and augmented by the “free sample” device, the business grew and prospered. The bottles with the name and address of the company blown in the glass and with the varied therapeutic indications for the nostrum printed both on the label and on the circular in which the bottle is wrapped, have carried the manufacturer’s message to the drug-taking public.

Apropos of this point, the recent “literature” contains what purports to be endorsements of the nostrum by medical journals. Thus there is quoted from the _New York Medical Journal_, Jan. 2, 1909, in part, the following recommendation: “... we venture to suggest to our readers who have not tried this remedy that they prescribe one _original sealed package_ of Papayans (Bell) and that they carefully note the results from its use.” [Italics ours.--Ed.] Having seen an “original sealed package” we believe that we can predict the “results from its use.” On any patient not mentally unbalanced, the result would be that the next dose of Papayans (Bell) he thought that he needed would be purchased from the druggist direct.

That such results are not hypothetical is evidenced by the statements of the exploiters of Papayans (Bell) that “the annual sale now exceeds four hundred million tablets.” Assuming that statement to be true, it would be necessary for every physician in the United States to prescribe over three thousand of these tablets every year--if they reached patients only through the physician! The company’s own figures indicate that the time is about ripe to take care of this vast army of self-drugging laymen and recent circular letters seem to recognize it. The physician is notified that druggists are now furnished with Papayans (Bell) “in sealed packages of thirty and one hundred tablets.” The medical man is told that the firm has “not forgotten the days when physicians’ orders made our success possible” and it says it is “sincerely grateful to the doctors who gave us orders in the days when we were struggling for recognition.” This tacit admission of the value of the physician as an unpaid agent for nostrum houses should be given thought by those physicians who prescribe such preparations.

While, so far as we know, Bell & Co. have not yet advertised in the daily press, they are not averse to furnishing the laity with samples when requested. An Ohio physician sent us the following letter received by a young woman who had written asking for samples:

+----------------------------------------------------------+
| |
| Miss X---- Y----, |
| Z----. |
| |
| Dear Madam: As requested, we are mailing you sample of |
| our Papayans (Bell) for Indigestion. |
| |
| If a sufferer from Indigestion, we want you to give it a |
| thorough trial as directed and note remarkable results |
| that we believe you will get from its use. |
| |
| Kindly write us if you are unable to obtain it from your |
| local druggist, as it is stocked by nearly every good |
| drugstore in the United States. Yours truly, |
| Bell & Co. |
| |
+----------------------------------------------------------+

Evidently Bell & Co., while admitting that their financial success is largely due to the kindly, though misguided, efforts of physicians, are not going to let a little thing like loyalty to the medical profession interfere with a possible sale of their tablets.

THE L. D. JOHNS COMPANY

A discussion of the methods of Bell & Company would not be complete without reference to a concern which seems to be closely connected with it: the L. D. Johns Company, whose “only product” is a sugar-coated laxative tablet. Regarding the “sugar coated” tablet, a visitor at the place of business of Bell & Company and the L. D. Johns Company wrote: “These companies apparently are not in possession of any tablet coating machines and in questioning on this point stated that some of their tablets were sent out to be coated.” There is a sameness regarding the claims for the laxative tablets of the two companies that might lead one to suspect that the same individual prepared both circulars. For instance:

CASCARANS (BELL)

“Taken as directed, it permanently removes the great majority of
cases of habitual constipation.”

“... a harmless vegetable preparation.”

“... for the removal of pimples, yellowness and greasiness of the
skin ...”

“... one tablet at night, one night and morning, or, in severe
cases, one three time a day, gradually decreasing the frequency of
the dose as improvement permits.”

DR. JOHNS’ TABLETS

“Taken as directed ... permanently remove the great majority of
cases of habitual constipation, torpid liver and sick headache.”

“A harmless vegetable remedy.”

“... removes pimples, blotches, sallowness and greasiness of the
skin ...”

“One at night, one night and morning, or, in severe cases, one
three times a day. Gradually decrease the frequency of the dose as
improvement permits.”

According to a leaflet sent out with samples by the L. D. Johns Company, the company is capitalized for $500,000, divided into 50,000 shares at $10 each; these shares are sold to those physicians who will agree “to prescribe the tablets at every suitable opportunity, to introduce them to other physicians” and “to promote their sale in every ethical way!” If the list of physicians’ names and addresses which the company sends out as comprising the eastern stockholders is to be relied on, it would seem that many medical men are promoting their sale. In prescribing it is, of course, “necessary to specify ‘Dr. Johns’ Tablets No XXX (_Original bottle_).’” As the name is on the bottle, it is not unbelievable that, as the company says in its prospectus, because of “our method of advertising, a large and very profitable business is being created.” That the L. D. Johns Company expects to profit by the self-drugging which this method of prescribing fosters is evident: