Chapter XIV: Part I: Council Reports (9)

No antiseptic, whatever its composition, could by any possibility accomplish anything like what is claimed for Phenol Sodique, so that the composition of the article is really of little importance. This is evidently appreciated by the manufacturers, for they have kept the composition a profound secret, except in so far as it is implied in the name. An inquiry addressed to Hance Bros. & White, under date of April 27, 1907, six months ago, has remained unanswered. The Council, therefore, directed an analysis of Phenol Sodique. This was carried out at the chemical laboratory of the American Medical Association, and a check analysis was made by an independent firm of chemists.

This shows that Phenol-Sodique contains something like 0.5 or 0.66 per cent. of phenols, dissolved in about 0.75 per cent. of sodium hydroxid. In other words, it appears to be essentially a very dilute alkaline solution of some impure coal-tar product, presumably a crude carbolic acid. The analysis could not profitably be carried further, because the amount of the antiseptic agent is so very small.

The consideration of this analysis, in connection with the claims made for Phenol-Sodique, leaves little doubt as to one reason for the secrecy concerning its composition; although no educated physician could be deceived into believing for a moment that Phenol-Sodique could fulfil the promises of its promoters, even if it were “the best antiseptic, hemostatic and disinfectant on the market,” as the manufacturers say in their advertisements.

From its composition, it can only have the very moderate and ordinary antiseptic qualities of a dilute phenol or cresol solution, modified only to a very slight extent by the free alkali. According to the manufacturers, however, “Phenol-Sodique is a wonderful preparation.” Just how wonderful appears from these extracts from the dissertations in the pamphlet which is enclosed in the package.

“_Catarrh, Old Colds, etc._--Drink every morning and evening a
glass of water containing ten to thirty drops of Phenol-Sodique ...”

“_Small-Pox._--To prevent attack take internally three or four
times a day, fifteen or twenty drops of Phenol-Sodique in one
tablespoonful of sugar and water....

“_Measles, Scarlatina and Erysipelas._--Same treatment as for
Small-pox.”

“_Typhoid Fever._--To prevent attack take internally three or four
times a day, fifteen or twenty drops of Phenol-Sodique.”

“_Cholera._--To prevent, spread sawdust or sand, wet with
Phenol-Sodique, in apartments.

“The very best precaution is to drink, morning and evening,
a glass of water containing from fifteen to thirty drops of
Phenol-Sodique....

“... _Premonitory Diarrhea._--... Drink a teaspoonful of
Phenol-Sodique diluted in an ounce of water....”

This is the kind of therapeutics and prophylaxis taught to the medical profession by their self-appointed instructors, the proprietors!

But this matter has a serious as well as a ludicrous side: What is the proper epithet to apply to those who, knowingly and intentionally, impress on the ignorant lay public that one can with impunity expose himself to smallpox, cholera, typhoid or scarlet fever, or measles, by taking a few drops of very dilute carbolic acid, or by sprinkling a little on sawdust? What must be the consequences to those who trust in these assurances? And what should be the lawful penalty for those whose blunted moral instincts permit them wilfully to endanger the lives of others for a little financial gain? It would be interesting to know the real opinion of the responsible members of the firm of Hance Bros. & White on these questions.

The Montyon Prize was awarded by the French Institute in 1861--forty-six years ago--how many victims a year?--(_From The Journal A. M. A., Nov. 9, 1907._)

PHYTIN AND FORTOSSAN

Report of the Council on Pharmacy and Chemistry

Phytin, manufactured by the Society of Chemical Industry, Basel, Switzerland, and sold by A. Klipstein and Co., is an organic phosphorus compound said to be the “Acid Calcium-Magnesium Salt of Phytinic Acid (Inosit Phosphoric Acid or Anhydro-Oxymethylene-Diphosphoric Acid)” obtained from cereals and legumes.

The trade package of Phytin constitutes an indirect advertisement to the public.

The Council rejected Phytin because unwarranted and exaggerated therapeutic claims are made for this product based on the entirely undemonstrated assumptions: (1) that phosphorus is assimilated only from organic combinations (it is even implied that this must be in the form of Phytin, and that milk is incapable of supplying the phosphorus needs of infants); (2) that a long list of diseases, ranging from rickets to hysteria, are due to deranged phosphorus metabolism; (3) that all these diseases are cured or markedly benefited by Phytin.

In brief, the claims rehearse every point of the more or less discredited phosphorus propaganda, in exactly the same way as it was rehearsed successively by the exploiters of hypophosphites, lecithin, glycerophosphates, and amorphous phosphorus. It is conceded by the writers of the advertising pamphlets for Phytin that the preceding claims were erroneous; but no evidence is given to warrant the belief that the Phytin claims are less erroneous.

The misleading statements are most extreme. By the use of bold type particular stress is laid on the preposterous and vicious claim that Phytin

“radically and permanently removes sexual debility.”

Fortossan is a preparation of Phytin and sugar of milk, also manufactured by the Society of Chemical Industry, Basel, Switzerland, and sold by A. Klipstein and Co. Since Fortossan is a simple preparation of Phytin the Council voted that the rejection of Phytin should also apply to Fortossan.--(_From The Journal A. M. A., Jan. 30, 1915._)

PRUNOIDS

Report of the Council on Pharmacy and Chemistry

Prunoids are tablets put out by the Sultan Drug Company, St. Louis. They are said to be:

“Made of Phenolphthalein (one and one-half grains in each), Cascara
Sagrada, De-emetinized Ipecac and Prunes.”

The following report on the composition of Prunoids is submitted by the Association’s Laboratory:

“From an examination of Prunoids it is concluded that the amount of cascara or extract of cascara in the preparation is very small. Also the quantity of “de-emetinized ipecac” is insignificant. The claim is made:

“The levulose of prunes, a constituent of Prunoids, is hygroscopic
and thus when brought into contact with the saliva of the mouth or
contents of the stomach, disintegrates and prompt medication is
insured.”

“Actually the amount of prunes which may be present in Prunoids is negligible. For all practical purposes, therefore, Prunoids are phenolphthalein.”

According to the information included on and in the box Prunoids are

“An Ideal Laxative, Purgative, and Intestinal Tonic” ...
“particularly adapted to the treatment of constipation ...”

They are said to act as an “intestinal tonic”--a claim which in the light of the examination is obviously unwarranted--and because of this, it is said that they:

“Will permanently remove constipation without causing after
constipation.”

The trade package assures the purchaser that Prunoids are:

“Recommended by Physicians Generally.”

A circular sent to physicians makes the unwarranted claim that Prunoids are “especially serviceable” in “... Neurasthenia, Jaundice, Chlorosis, Rheumatism, Gout ...” and that

“... their success in gouty diathesis and vague rheumatic symptoms
tends to confirm the opinion expressed by some physicians that they
have a solvent action on uric acid.”

In the following the haphazard and ill-considered use of purgatives is suggested:

“For the expectant mother, or in the treatment of female diseases,
for bowel elimination, no happier or _safer_ selection can be made.”

The Council refused recognition to Prunoids because the statement of composition is incomplete and therefore meaningless; because unwarranted therapeutic claims are made for them; because the name “Prunoids” gives the false impression that they depend on prunes for their effect; and because it is irrational and a detriment to medicine to disguise a well-known drug by means of a misleading name and to attempt to create the impression of special virtues by combining it with superfluous drugs.--(_From The Journal A. M. A., Jan. 2, 1915._)

SAL HEPATICA

Report of the Council on Pharmacy and Chemistry

Sal Hepatica, marketed by the Bristol-Myers Co. of New York, has been refused recognition by the Council, because its composition is secret; because it is advertised indirectly to the public for the treatment of diseases; because exaggerated and unwarranted claims are made for its therapeutic qualities; and because the name fails to indicate its chief constituents but does suggest its use in liver disorders.

The Council has authorized the publication of the report of its referee, because it is an important illustration of the ways in which physicians are being made parties to the introduction to the public of a patent medicine, whose indiscriminate use must often have resulted in harm, direct or indirect.

W. A. Puckner, Secretary.

The report of the referee follows:

Sal Hepatica is a saline laxative sold by the Bristol-Myers Company of New York. No information seems to be given regarding its composition except such as is contained in the following vague and uninforming phrases:

“Effervescent saline combination, hepatic stimulant, laxative and
an eliminant of irritating toxins.”

“Sal Hepatica is a saline combination containing the alterative
and laxative properties similar to the natural ‘Bitter Waters’ of
Europe with the addition of sodium phosphate.”

“... more palatable and efficient than sodium phosphate alone or
other salines.”

A circular around the bottle contains the following:

“We invite the physicians’ careful consideration of the merits
of Sal Hepatica in the treatment of Rheumatism and Gout, in
Constipation and Auto-intoxication, and to its highly important
property of cleansing the entire alimentary tract, thereby
eliminating and preventing the absorption of irritating toxins and
relieving the conditions arising from indiscretion in eating and
drinking.”

In the same circular, its promiscuous use is invited in these terms:

“Owing to its palatability, Sal Hepatica is particularly well
adapted to the requirements of childhood or the feeble and
delicate.”

Further suggesting its use in the treatment of that popular, if somewhat vague ailment, “biliousness,” we read:

“It is especially valuable where there is intestinal sluggishness
arising from functional derangements of the liver or portal
circulation....”

As further suggestive of its all-around “goodness,” are the claims:

“It increases the appetite and promotes digestion by stimulating
the flow of gastric juice.”

“In rheumatism and gout Sal Hepatica furnishes the physician with
an ideal eliminant, usually affording prompt relief.”

The label on the Sal Hepatica bottle suggests--both to physicians and to the public--its use in the following diseases and conditions:

“Derangements of the stomach and liver.”
“Affections of the kidneys.”
“Bilious attacks.”
“‘Summer complaints,’ colic and alcoholic excesses.”
“Headache, dizziness, heartburn and seasickness.”
“Acute indigestion.”
“Gastric, hepatic and renal disorders.”
“Especially beneficial in rheumatism and gout.”

From these quotations it is evident that Sal Hepatica is in conflict with:

_Rule 1_, in that its composition is not disclosed, although statements are made which are likely to give a false impression as to what it is;

_Rule 4_, in that the statements on the label and in the circular around the bottle advertise it to the public and thus make the physician who recommends it an advance agent for the nostrum;

_Rule 6_, in that exaggerated and unwarranted claims are made for its therapeutic qualities, and,

_Rule 8_, in that its name fails to indicate its chief constituents, but does suggest its use in liver disorders.

The absurd claims made for this preparation are such as to put it in the “patent medicine” class. Even the most credulous members of the medical profession certainly can take no stock in the claim that a preparation can be an “eliminant” of uric acid, a hepatic stimulant, a remedy for gout, rheumatism, liver disease, indigestion, etc. Why then should such a preparation be tolerated?

In its conflict with Rule 4 Sal Hepatica belongs to that class of nostrums which have been so successfully exploited by manufacturers through the unwitting efforts of thoughtless and careless physicians. The Bristol-Myers Company has been most liberal in distributing free samples, evidently with the assurance that physicians would do the rest. Thus, at the present time, the profession is being supplied with a package containing one regular 25-cent bottle and five single-dose vials bearing the name Sal Hepatica. If only a small percentage of the physicians who receive these samples distribute them, the increase in Sal Hepatica consumers may be imagined. How successful this scheme of the Bristol-Myers Company has been is only too evident. Sal Hepatica is one of the best-selling laxatives in department stores and drug stores to-day.

While the evils of indiscriminate purgation are now generally recognized, the referee wishes to quote and to indorse the pertinent comments on this subject by The Journal:[79]

[79] The Journal A. M. A., March 26, 1910, p. 1071.

“The abuse of saline cathartics by the public is an evil deserving
of serious attention. Rightly or wrongly, the laity fear constipation
and naturally take what they are taught to believe is the cheapest
and simplest course for its relief, self-drugging by means of
saline cathartics or the extensively advertised purgative mineral
waters. This habit is responsible for much of the distressing
spastic constipation that exists, and its accompanying neurasthenia.
The advertisement and sale to the laity of such a nostrum as “Sal
Hepatica” can only increase these evil results and the physician
who aids and abets the evil by using the preparation should reflect
whether he is thereby not only encouraging a fraud on the public but
also, what is even worse, helping to impair the public health.”

It is recommended that this report be authorized for publication in order that physicians may know the extent to which they have been made to act as advance agents for “patent medicines.” It is hoped its publication may suggest to those who in thoughtlessness have recommended Sal Hepatica, that they go to their materia medica and renew acquaintance with the host of simple and efficient laxative salts which are available--magnesium sulphate, sodium sulphate, sodium phosphate and the palatable effervescing preparations of these which the Pharmacopeia provides--effervescent magnesium sulphate (Magnesii Sulphas Effervescens, U. S. P.), effervescent sodium phosphate (Sodii Phosphas Effervescens, U. S. P.).--(_From The Journal A. M. A., Feb. 7, 1914._)

SANMETTO

Report of the Council on Pharmacy and Chemistry

The following report on Sanmetto (Od Chemical Company, New York) has been adopted by the Council on Pharmacy and Chemistry, which authorized its publication.

W. A. Puckner, Secretary.

Sanmetto is one of the oldest proprietaries on the market. Its advertisements have been familiar to the readers of medical journals for several decades past. It is a typical nostrum. It is secret although the promoters have published various “near-formulas.” The following are some of the statements regarding composition:

“A Scientific Blending of _True_ Santal and Saw Palmetto with
Soothing Demulcents in a Pleasant Aromatic Vehicle.”

As this did not disclose the identity of the demulcents or the quantity of the alleged active constituents, the “formula” was, of course, meaningless.

Again it is:

“A Scientific blending of _true_ Santal and Saw Palmetto in a
pleasant aromatic vehicle.”

Here the reference to “soothing demulcents” is omitted. The information furnished physicians at the present time is:

“It is a blend of harmonizing drugs.”

A letter from a physician requesting information as to the exact composition of Sanmetto recently elicited the following reply:

“... Sanmetto is a blending of true santal and saw palmetto with
soothing demulcents in a pleasant aromatic vehicle. The demulcents
are introduced not only for the purpose of modifying the irritant
properties of the santal, but to add distinctively to the soothing
properties of the finished product upon the mucous membrane of
the urinary tract, and are not mentioned in our published formula
for the simple fact that if we gave them, then we would do the
advertising and the substitute manufacturer would engage in the
‘unfair competition’ of putting on the market his concoction,
claiming to be made exactly after our formula, without spending
a cent for advertising, relying upon our propaganda work to sell
his substitute, although not the same article as nor equivalent to
Sanmetto, from the fact that he would be working in the dark as
to the processes in the manufacture of our product. There is no
mineral substance in Sanmetto, nor any other ingredient that is
detrimental in any way whatsoever....
“OD CHEM. CO.,
“M. Haman, Pres’t.”

THE VALUE OF SANTAL AND SAW PALMETTO

The foregoing warrants the assumption that the active ingredients of the mixture are sandalwood oil and saw palmetto.

There was a period when the internal treatment of gonorrhea had a marked vogue. Balsamic remedies received the approbation of the medical profession as the most specific of internal remedies for this disease. As a representative of this class, sandalwood oil was very highly esteemed and had great popularity. As in other similar instances, this popularity was commercialized and the drug became the basis of many secret or semisecret mixtures, including “specialties” of pharmaceutical houses.

Sabal or saw palmetto is an official drug which at one time was used in genito-urinary affections, but now is seldom used, presumably because it has been found practically worthless. It is not mentioned by most pharmacologists, and those who do mention it regard it as of doubtful value. It is included among the preparations recommended for deletion as given in the report of the Committee on the Pharmacopeia of the American Medical Association (The Journal, Sept. 4, 1909, p. 792).

Even granting that sandalwood oil and saw palmetto do have therapeutic value, no one would think of regarding either or both of these preparations as of use except in inflammatory conditions of the genito-urinary tract, especially gonorrhea.

If one is to believe the advertisements, however, the combination of these drugs in Sanmetto is a wonderful medicine. One might even conclude that there are few conditions in which it cannot be given with profit. For instance:

“In Nervous Diseases, especially Neurasthenic cases with origin
in some sexual or genito-urinary disorder, for its action as a
vitalizing tonic and reconstructive, restoring nutrition to germ
plasm, relieving pathological conditions and for soothing and
sustaining the nerves controlling the parts.”

Bear in mind in reading the foregoing statement and the following that we are concerned with two drugs whose effects are exerted on mucous membranes especially of the genito-urinary tract.

“In Gestation Cases, showing tendency to albumin and convulsions,
for toning the pelvic organs, clearing up the urine and cleansing
the urinary bladder and outlet. In the Lying-in-Room for relieving
the affections of urethra and bladder, painful strangury of the
urethra and painful micturition due to the pressure of fœtal head
upon the neck of the bladder and upon the urethra during labor, and
infection, either septic or gonorrheal.”

“In Weakness of the Kidneys, causing loss in tone and general
health and Impairment of Eyesight--for strengthening the kidneys
and bladder and toning the nervous system; and also for aiding in
the constitutional treatment of Gonorrheal Infection of the Eyes.

“In the treatment of the Prostate, Testes, Mammæ, Ovaries,
and Urethra, Kidneys and Bladder, for its soothing, slightly
antiseptic, aphrodisiac, toning and restoring action to the mucous
membrane and glands. By its use the parts affected in many cases
returning to their normal condition.”

While the reference to its aphrodisiac action and to the restoration of parts to the normal may have little interest to physicians, it may be counted on to appeal to the sexual neurasthenic. In premature senility:

“Sanmetto ... is unexcelled as a vitalizing tonic to the withered
glands of the reproductive system, promoting their normal secretory
activity.”

These claims are not only absurd but also harmful; they tend to perpetuate a hypochondriacal state of mind in the class of patients appealed to--the sexual neurasthenic. There is, however, a more serious side; the tendency of certain other claims made for the preparation are vicious and dangerous as well as misleading. The advertising claims are likely to induce some physicians--those who accept advertising “literature” as dependable--to belittle the importance of serious diseases of the sexual organs and to be content with Sanmetto, which, even if it gave as good results as other balsamic remedies, would be, at best, only a halfway measure. This in an advertising pamphlet physicians are given this advice as to the treatment of gonorrhea.

“To provide the needed rest the patient should be instructed to
simply keep the parts clean with warm water for the first week and
let the discharge continue until you can control it by internal
medication. I wish to emphasize the fact that there is no way
that any acutely inflamed portion of the genito-urinary tract
can get the rest required so completely as by administration of
Sanmetto.... After the acute gonorrhea has begun to subside the
Sanmetto should be aided by mild astringent injections.”

If there is any well-established fact in medicine, it is that gonorrhea is a serious disease--serious alike to the sufferer and to the community--and one which needs careful attention from the very first. To claim, either directly or by implication, that it can be cured by such a mixture designed to act on the kidneys, bladder and nervous system is false and dangerous doctrine.

The physician who prescribes Sanmetto prescribes a secret medicine for conditions which he is presumably competent to treat with simple remedies of which he knows the origin and action and which he can vary to suit the needs of the individual.

Sanmetto is a secret nostrum the exploitation of which is an invitation to haphazard, uncritical therapy and a menace to public health.--(_From The Journal A. M. A., March 13, 1915._)

SECRETOGEN

Report of the Council on Pharmacy and Chemistry

The Council has authorized publication of the following report dealing with two internal secretion specialties--Secretogen Elixir and Secretogen Tablets--to call attention to the unfounded and extravagant claims made for this class of products.

W. A. Puckner, Secretary.

Test tube experiments show that pepsin hydrolyzes proteins in acid solutions; that pancreatin digests protein in alkaline liquids, and that diastase converts starch into sugar. Based on these facts, it was assumed that these ferments would aid digestion. This assumption was correct if limited to certain cases of dyspepsia in which it can be shown that certain ferments are absent or deficient. But this limitation was not realized or remembered; on the contrary, the indiscriminate use of digesting ferments in all kinds of cases of indigestion became widespread and still continues, although to a less extent. Herein lies the great disappointment that has followed the use of these ferments.

More recently hormones were discovered, and while their importance has not been fully worked out, it has been assumed that they are responsible for the secretion of digestive ferments, and that in their absence this secretion fails. Without waiting for proof of this assumption, that is, that digestive failure is due to lack of hormones, proprietary medicine promoters are already placing on the market various secretion specialties.

As an example of this new class of specialties and of the unfounded claims made for them, your referee presents the following report on Secretogen Elixir and Secretogen Tablets offered to physicians by the G. W. Carnrick Company.

Secretogen Elixir is said to contain pancreatic secretin obtained from the duodenum with 1/10 of 1 per cent. of hydrochloric acid. Secretogen Tablets are said to be prepared from pure secretin and succus entericus obtained from the epithelial cells of the duodenum. The claims for Secretogen are based on the physiologic action of secretin as described by various observers. To determine whether these claims are justified it becomes necessary to review the evidence advanced to prove that secretin stimulates the digestive glands.

Secretin is a hormone, a chemical substance produced by the action of hydrochloric acid on a previously formed substance, “prosecretin,” contained in the cells of the intestinal mucous membrane, especially of the duodenum. Secretin is absorbed by the blood and carried to the pancreas, liver and intestinal mucosa, which are thereby stimulated to produce their characteristic secretions, namely, bile, pancreatic juice and succus entericus. When secretin is injected into the blood, it causes an increase in the flow of these secretions. Some observers have claimed that secretin is absent in cases of diabetes in which the pancreas is still found normal. Wentworth[80] reported several cases of marasmus in which he found no evidence of prosecretin. This deficiency, he believes, is the cause of this disease.

[80] Wentworth, A. H.: The Cause of Infantile Atrophy, Deduced from a Study of Secretin in Normal and Atrophic Infants, The Journal A. M. A., July 20, 1907, p. 204.

The Carnrick Company, adopting the foregoing views, namely, that secretin is necessary to secure the normal action of pancreas, liver and intestine, as proved, placed on the market their specialty “Secretogen,” to take the place of the missing secretin.

The foregoing conclusion cannot, however, be sustained. There are numerous cases in which no hydrochloric acid is produced in the stomach and hence--as it is produced by the action of hydrochloric acid--no secretin can be produced in the intestine. Yet in these cases the pancreatic juice and bile are secreted in normal amounts and digestion goes on normally after the food leaves the stomach. In such cases the pancreas and liver must be stimulated to secretion by some other mechanism than secretin.

The proof that the absence of secretin is characteristic of diabetes or of marasmus is not yet available. Sweet and Pemberton[81] found that many circumstances interfered with the extraction of secretin, so that the mere failure to obtain it in a given case is not proof of its absence, unless the various inhibiting influences are given due consideration. The conclusions reached by these authors are that “the evidence so far adduced that secretin is absent in some varieties (of diabetes) does not seem conclusive,” and that “the specific absence or deficiency of secretin in marasmus seems to remain as yet unproven.”

[81] Sweet, J. E., and Pemberton, R.: Experimental Observations on Secretin, Arch. Int. Med., February, 1908, p. 231.

The favorable reports of Moore[82] in regard to the use of secretin in diabetes are not confirmed by the experience of Foster[83] in five cases, or by the case reported by Dakin and Ransom.[84]

[82] Moore, Edie and Abram: Biochem. Jour., 1906, i, 28; ibid., i, 446.

[83] Foster, N. B.: Cases of Diabetes Treated with Secretin, Jour. Biol. Chem., January, 1907.

[84] Dakin, H. D., and Ransom, C. C.: Treatment of Case of Diabetes with Secretin, Jour. Biol. Chem., January, 1907.

In regard to the use of secretin in intestinal disorders, the G. W. Carnrick Company refers to an article by J. W. Beveridge.[85] An examination of this article shows it to be unscientific and uncritical. The author presents four cases to “demonstrate the peculiar potency exercised by secretin.” Of the first he says:

[85] Beveridge, J. Wallace: Secretin, Am. Jour. Gastro-Enterology, April, 1914, p. 170.

“Stomach was dilated, food delay, seventy-two hours; hyperacidity,
vomiting daily, five to twelve times, urine high specific gravity,
over 3 per cent. urea, trace albumen.”

The patient improved somewhat after gastro-enterostomy with removal of the gallbladder; the vomiting ceased, but the stools continued clay-colored and the high urea output still kept up. Secretin was given, and after this the report continues:

“The stools became normal in color at the end of the second month,
weight gradually increased until 122-3/4 pounds was reached, and
the urea is now normal, averaging about 1 per cent.”

This case is offered to prove the absence of secretin and its effect when given by the mouth. As evidence of hepatic insufficiency the author apparently relies on the color of the stools, and for pancreatic insufficiency he cites the high urea output. He claims that when the pancreas does not furnish an efficient secretion, the proteins of the food fail to be converted into amino-acids, and instead, raise the percentage of urea. Consequently, he concludes that a high percentage of urea indicates the absence of secretin. It is usually held that a high percentage of urea depends on two factors, ingestion of a large amount of protein and concentration of the urine. The author gives no data as to the amount of albuminous food, the amount of urine, or whether the percentage of urea was learned by examining a single specimen or the total quantity for twenty-four hours. The mildest judgment that can be passed on such clinical data is that they are totally inadequate. Without doubt the percentage of urea could have been reduced to “normal” by causing the patient to drink water freely. The remaining cases show similar hasty conclusions from insufficient data, rendering them worthless as evidence.

The G. W. Carnrick Company introduces a number of testimonials as to the value of Secretogen. These testimonials are similar to all testimonials. They include no evidence of careful diagnosis, and present an uncritical estimate of the results. They show that the writers have given Secretogen Elixir or Tablets indiscriminately in almost the whole range of digestive disorders, in nephritis, neuralgia, liver disease and gallstones, exophthalmic goiter, neurasthenia, epilepsy, etc. As dependable evidence, these testimonials are not worthy of consideration.

A rational basis for the therapeutic value of Secretogen is lacking for the following reasons:

1. No evidence has been presented that the absence of secretin is a cause of gastro-intestinal diseases. It is usually present, and if not present, as in achylia gastrica, there is evidently some compensating arrangement by which the pancreas is stimulated to perform its regular functions.

2. There is no evidence that secretin in any form is physiologically active when administered by the mouth.

REFERENCES

Fleig, M. C.: Action de la sécrétine, Arch. gén. de méd., lxxx, 24.

Charles, J. R.: Treatment of Diabetes with Secretin, Bristol
Med.-Chir. Jour., September, 1906; Med. Press and Circular, Nov. 21,
1906.

Meltzer, S. J.: Animal Experimentation in Relation to our Knowledge
of Secretions, Especially in Internal Secretions, The Journal
A. M. A., May 7, 1910, p. 1506.

Wentworth, A. H.: The Cause of Infantile Atrophy, Deduced from
A Study of Secretin in Normal and Atrophic Infants, The Journal
A. M. A., July 20, 1907, p. 204.

Bambridge and Beddard: Guy’s Hospital Reports, 1907, lxi, 161.

Enriquez and Hallion: Nuevas nociones sobre la digestion. Secretin,
Importancia fisiologica y patologica, Transactions of 14th Int. Med.
Congress, Madrid, 1904.

Enriquez: La Sécrétine Médication acide duodénale Stimulation de
function sécrétiniques chez l’homm., Rev. de. thérap. méd.-chir.,
Paris, 1904, lxxi, 187.

--(_From The Journal A. M. A., May 1, 1915._)

SINKINA

Report of the Council on Pharmacy and Chemistry

Sinkina is a malaria “cure” put on the market by the Metropolitan Pharmacal Company, New York. The product was presented to the Council on Pharmacy and Chemistry for admission to New and Nonofficial Remedies and was rejected because insufficient evidence was submitted to substantiate the improbable claims made for it. The manufacturers were sent a copy of the report stating that their product was refused recognition. In view of the advertising that was persisted in after its rejection, the Council’s referee for Sinkina submitted the preparation to clinical tests. Both the original report and the results of the clinical tests are given in the following report, which was submitted to the Council and recommended for publication. The complete report having been sent to the manufacturers and their reply considered, the Council authorizes its publication.

W. A. Puckner, Secretary.

THE COUNCIL’S FIRST REPORT

The Council, after investigating the claims made for Sinkina, declared the product unworthy of recognition and adopted the following report, which was sent to the manufacturers:

No experimental evidence regarding the therapeutic value has been
submitted. The clinical evidence is scant and not of such character
as to deserve much consideration, no sufficient precautions having
been adopted to avoid wrong conclusions. Judging from the evidence at
hand the preparation is simply a dilute sugar-alcohol-water solution
containing a little oil of cumin--Roman caraway. It is highly
improbable that such a liquid would have the therapeutic effects
claimed for it by the Metropolitan Pharmacal Company. In view of the
improbable claims made for Sinkina, and the failure to substantiate
them by suitable evidence, it is recommended that the preparation be
refused recognition without at this time considering the claims made
in regard to the identity and amount of the drug claimed to be the
essential constituent.

In spite of its rejection Sinkina was persistently advertised. It was thought advisable, therefore, to submit the preparation to clinical tests. This was done and the results are given in the following report:

THE CLINICAL REPORT

The following quotations indicate the claims made for this preparation:

“In malarial conditions there is nothing that acts so promptly and
efficaciously as Sinkina. Sinkina destroys radically every trace of
the parasite in the blood from the time of its first appearance,
builds up the damaged corpuscles, revitalizes the system, and
completely eliminates every trace of the disease. Sinkina is
deservedly termed the _Specific_ for Malaria.”

These claims were supported by testimonials which usually gave no indication of a demonstration of the presence or absence of malarial plasmodia in the blood. The following is an example showing the character of most of the evidence presented by the manufacturers:

“Three weeks ago I prescribed Sinkina for a negro man 40 years
of age suffering from a double tertian malarial infection having
a chill every afternoon for four consecutive days. He came to my
office about 8 a. m. and was due to have a chill about 6 p. m.
I gave him the sample of Sinkina and directed him to take a
tablespoonful at once, also at noon and again at 4 p. m., and to
continue taking it in same size dose three times a day till he had
taken it all. He reported to me in a week from that date and told
me he was feeling fine and that he hadn’t had any more chills. The
patient up to this time is apparently cured.”

As the claims were supported by a few testimonials purporting to be based on exact investigations, the Council submitted the preparation to careful laboratory and clinical tests. For this investigation the Council was fortunate in securing the help of physicians actively engaged in the study of malaria.

Experiments were made _in vitro_ with the preparation; 1 ounce of Sinkina was used, and its action was compared with that of 10 grains of quinin sulphate. When these were added to cultures of malarial plasmodia in proportion corresponding to 1 ounce of Sinkina or 10 grains of quinin sulphate for a 150-pound man, the quinin was found to be unfailingly antagonistic to the malarial organism, the drug prevented the segmentation of the organism, and finally killed it in about thirty-six hours. The Sinkina did not kill the parasite after seventy-two hours of continued action, and the parasites segmented in the presence of it just as actively as they did in the control.

The investigator was furnished with two sets of preparations in plain prescription bottles so as to avoid all influence of the personal equation. One set consisted of Sinkina, the other of a mixture of alcohol, sugar and water with some oil of cumin. The investigator reported that, so far as the tests on the cultures of malarial plasmodia were concerned, he could not determine any difference in the results obtained with the oil of cumin preparation, made in the laboratory of the Association, and those obtained with the Sinkina of the Metropolitan Pharmacal Company. Clinical trials were made by three independent investigators. Two of them received the two sets of preparations described.

FIRST INVESTIGATION

The first investigator treated two cases with Sinkina: one was of the ordinary estivo-autumnal type and the other an ordinary tertian.

CASES 1 AND 2.--A good many schizonts were present in the blood of
each patient forty-eight hours after the administration of Sinkina.
In the instance of the case of tertian the patient had his chill
forty-eight hours after the medicine had been started. As the Sinkina
failed to produce any effect the patients were then put on quinin to
stop the disease.

CASE 3.--The patient had taken 10 grains of quinin on the day on
which the experiment was begun. He had the tertian form of the
disease, and plasmodia were quite numerous at the beginning. The
quinin was discontinued and Sinkina was given in doses of 1 ounce
three times a day. The day following the administration of 10 grains
of quinin and 1 ounce of Sinkina, no parasites could be found in
the blood. The Sinkina was continued in the doses mentioned. On the
seventh day the patient had another chill, and a great many parasites
were found in his blood. The Sinkina was discontinued and the patient
was at once relieved by quinin.

This investigator gives it as his opinion, based on these observations, that the preparation (Sinkina) is absolutely worthless in the treatment of malaria, and he does not think it necessary to make any further experiments with it.

SECOND INVESTIGATION

The second investigator treated two cases of tertian malarial fever with these preparations until it was satisfactorily proved that the drug was having no effect on the presence of the parasites in the blood, when he began the administration of quinin.

CASE 4.--After the use of the remedies for one week the investigator
still found young rings half-grown and gametes present in the blood.
Apparently there was a relative increase in the number of parasites.
He then began the administration of quinin. Blood-smears taken the
next day after 40 grains of quinin had been taken showed one parasite
after eighteen minutes’ search of one slide, and two after thirty
minutes’ search of a second slide. At the end of a week’s treatment
the patient was discharged recovered. The blood examination of two
slides was negative.

CASE 5.--This was a case of tertian malaria. After treatment for
five days with Sinkina the blood still showed tertian parasites with
increase in the size of the spleen, and the preparation was without
effect on the clinical course of the disease. Quinin was then begun,
and the blood examination became negative at the end of three days.

The investigator concludes that the preparations furnished him were absolutely worthless in the treatment of two cases of the tertian form of malarial fever, and that these solutions had no effect on the presence of the parasites in the peripheral circulation. In a case of quartan malaria, both of the preparations (cumin oil mixture and Sinkina), sent by the Association Laboratory, were without effect on the plasmodia in the blood. This investigator employed the solution made by the Association Laboratory (cumin oil mixture) as well as Sinkina, and was unable to note any differences between them.

THIRD INVESTIGATION

The third investigator began the trial of Sinkina at the instance of the manufacturers, and used it in three cases, two of them being benign tertian malaria and one case of mixed infection (benign tertian and estivo-autumnal).

CASE 6.--This was one of the cases of benign tertian malaria. The
patient gave a clinical history of malaria with chills occurring
on alternate days for a little over a week. There was an immediate
cessation of all clinical symptoms, and three days after the patient
had been on 1/2 ounce of Sinkina three times daily there was no
evidence of any plasmodia in his blood; his additional treatment
consisted of 5 grains of calomel the evening of the first day
with a saline the next morning. Before the patient was put on
treatment, numerous parasites of both the asexual and sexual forms
were observed. The patient remained in bed for a few days, and then
returned to work. A week later he was again taken ill with a return
of all of his previous clinical symptoms.

CASE 7.--This case was one of mixed infection (benign tertian and
estivo-autumnal). The patient had a clinical history of malaria
dating back two weeks, with a maximum temperature of 104 on
admission. Tertian rings, estivo-autumnal rings and crescents were
found in the blood. The patient was placed in bed, given thorough
eliminating treatment, and 1/2 ounce of Sinkina was administered
four times daily. His clinical symptoms ran on for two days with
no change, and there was no difficulty in finding the plasmodia
in blood-smears, which were taken twice daily. The dose was then
doubled and at the end of four days more there was no change in
either his clinical symptoms or the blood-findings. The patient was
then placed on 10 grains of quinin sulphate with 15 drops of diluted
hydrochloric acid three times daily, to which he responded in less
than forty-eight hours and made an uneventful recovery.

CASE 8.--This was the other case of benign tertian malaria. The
patient had chills every other day while on the treatment, and
laboratory diagnosis confirmed the clinical findings. Experimental
treatment was carried on for four days, with a negative result.

The investigator calls attention to the fact that the first case in which improvement resulted does not show any necessary connection with the Sinkina administered, for many cases of benign tertian malaria will clear up in just as short a time under any line of treatment, while practically all will eventually do so. This investigator later reported another case and transmitted a clinical chart.

CASE 9.--This patient was admitted to the hospital, Dec. 30, 1912,
with a history of having had malaria for some weeks. The diagnosis
was confirmed by a blood examination. He was then carried for four
days without treatment other than rest in bed and a liquid diet. His
symptoms subsided by the third day. On the fourth day a count of
the parasites was made which showed that there were 1,160 asexual
parasites and 260 sexual forms to every thousand leukocytes. The
following day he was placed on Sinkina, 1 ounce three times daily.
There was exacerbation of symptoms on the following day, which
gradually increased until the fourth day, remaining about stationary
for a day or so. The fifth day after the patient had been placed
on Sinkina, another count of the parasites showed 5,600 asexual
parasites and 300 sexual forms to the thousand leukocytes, this being
an increase of 4,440 asexual forms and forty sexual forms to every
thousand leukocytes. With the second count of parasites the dose of
Sinkina was increased to 2 ounces every four hours, the patient being
kept on this until January 14, without result. He was then placed on
quinin, with a complete reduction of the temperature to normal and
the disappearance of the parasites from the blood.

The investigator also reported a case of benign tertian malaria.

CASE 10.--This was in a child of 8 years which was treated by the
investigator’s confrère and gave similar negative results. Blood
examination showed numerous parasites. The child was placed on 1
ounce of Sinkina three times a day and kept on it for two weeks.
The clinical picture remained unaltered, and parasites could be
detected in numbers whenever examinations were conducted. A gradually
increasing enlargement of the spleen was also noted. At the end of
two weeks quinin was substituted, and the child went on to a rapid
and uneventful recovery.

This investigator also concludes that the claim put forth by the Metropolitan Pharmacal Company that Sinkina is a specific in the treatment of the malarial fevers is entirely without foundation, and that the firm will be unable to demonstrate to the contrary.

These investigations demonstrate that Sinkina is not a specific against malaria, and that it has no more effect than a mixture of oil of cumin, sugar, alcohol and water. They further show the fallacy, first, of concluding from a temporary cessation of the symptoms in malaria that the disease has been cured and, second, of ascribing such temporary improvement to the influence of a remedy which has no known effect on the malarial organism.--(_From the Journal A. M. A., Sept. 27, 1913._)

SOMNOS

Report of the Council on Pharmacy and Chemistry

_To the Council on Pharmacy and Chemistry of the American Medical Association:_--Your subcommittee, to whom was assigned Somnos, H. K. Mulford Company, submits the following report of experiments, undertaken to compare the effects of Somnos with those of chloral hydrate. These experiments demonstrate that the statements made in regard to the action of Somnos are in conflict with Rule 6 of the Council, which requires: “No article will be admitted or retained concerning which the manufacturer or his agents make unwarranted, exaggerated or misleading statements as to the therapeutic value.” It is, therefore, recommended that Somnos be not approved for inclusion in the book until the claims made for it are corrected. It is also recommended that the report be published:

The Pharmacology of Somnos

When these experiments were begun, April, 1906, there was nothing in the advertising literature on Somnos to indicate whether this article is a solution or a pure substance. On the label on the bottle, in the circular accompanying the bottle, and in the booklet “Somnos,” the word Somnos seemed to be used as a synonym of “Chorethanal alcoholate,” C_{9}H_{11}O_{5}Cl_{9}, and physicians were prescribing and pharmacists dispensing it in the belief that it was a pure substance. “The pure substance; some kind of an alcohol; nothing to do with choral,” was the way the druggist from whom the samples were purchased put it. Thus information absolutely indispensable for any rational comparison of Somnos with other hypnotics was withheld from the physician.[86]

[86] Two weeks ago (Journal A. M. A., Sept. 1, 1906, p. 695) it was pointed out that the manufacturers now give this information, but in a wholly unnecessarily obscure form.

Hence, before beginning the physiologic experiments it was necessary to determine the strength of the preparation; for this purpose three chlorin determinations (by the Carius method) were made. On the assumption that all the chlorin present was in combination as chloral glycerate, C_{3}H_{5}[CCl_{3}.C(OH)_{2}]_{3} = C_{9}H_{11}O_{6}Cl_{9}, and calculating the percentage of this in Somnos, the following results were obtained: (1) 5.11 per cent.; (2) 5.15 per cent.; (3) 5.10 per cent.

Somnos, therefore, was found to contain approximately 5 per cent. of chloral glycerate and its physiologic action was compared with that of a 5 per cent. solution of hydrated chloral. In some experiments the hydrated chloral was dissolved in water; in others, in 10 per cent. alcohol (Somnos was found to contain at this time about this percentage of alcohol); in other experiments glycerin was added, as Somnos was found to contain this substance. No very marked differences were found in the physiologic action of the three solutions.

FATAL DOSE OF SOMNOS FOR THE LOWER ANIMALS

The booklet on Somnos states that “Somnos has no toxicology”; that while chloral hydrate causes “acute poisoning,” “deep coma,” etc., Somnos is “harmless in twenty times the dose prescribed,” “coma unknown, etc.” The physician would scarcely suspect from such statements that Somnos is as poisonous a substance as solutions containing hydrated chloral in corresponding amount; that such is the case is shown by the following experiments. These experiments were necessarily made on the lower animals. While such results do not enable us to draw very definite conclusions as to the absolute toxicity of poison for man, the results on animals are conclusive as regards the relative toxicity for man of such closely related drugs as hydrated chloral and Somnos.[87]

[87] That portion of the report describing the experiments on animals is here omitted. It was printed in full in The Journal and in the Report of the Council on Pharmacy and Chemistry, 1905-1908.

* * * * *

CONCLUSIONS

To sum up our results on the physiologic action of Somnos: We have been completely unable to verify the claims of the manufacturers that Somnos is less toxic than hydrated chloral, or that it has a less depressing effect on temperature, respiration or circulation. On the contrary, the physiologic effects are indistinguishable from those of hydrated chloral, doubtless because the action of Somnos is simply the action of hydrated chloral. We can see nothing in the animal experiments or in the chemical composition which would suggest that Somnos would possess therapeutic advantages over an elixir of hydrated chloral of corresponding strength.[[88]

It is to be hoped that physicians who have been blindly using Somnos without even knowing the strength of the preparation, much less what it is, will compare its effects with those of a 5 per cent. elixir of hydrated chloral.[88]--(_Abbreviated from The Journal A. M. A., Sept. 15, 1906._)

[88] The booklet on Somnos, “Somnos, a Pharmacological Report,” which is referred to here, contains a “Therapeutic Index to the Usefulness of Somnos.” We give below a list of diseases mentioned in this index to show the wide range of usefulness (?) that is claimed for this chloral compound. Abortions. Abscess--of brain, kidney, liver, tonsils, parotid gland, mediastinum; in appendicitis, glanders, perinephritic, retropharyngeal, pyemic, pelvic, ovarian. Somnos lessens pain and quiets nervous state. Tablespoonful, repeated once or twice. Use liberally. Alcoholism--full doses repeated often. Gives calm sleep. No blood changes like those produced by chloral. Anemias--progressive and secondary. Somnos has no deleterious action on blood as is common with other hypnotics. Aneurism. Angina. Apoplexy. Appendicitis. Arthritis. Arsenical poisoning. Arteriosclerosis. Asthma. Biliary colic, Bright’s disease. Carbuncle. Carcinoma. Catarrh. Cellulitis. Cerebrospinal fever. Chlorosis. Cholecystitis. Chordee. Chorea. Cirrhosis. Coccydynia. Colic. Colitis. Concussion. Confusional Insanity. Contusions. Convulsions. Coryza. Cough. Cramps. Cystitis. Delirium. Diabetes. Diarrhea. Diphtheria. Dropsy. Dysmenorrhea. Dyspnea. Ear. Emphysema. Empyema. Endocarditis. Endometritis. Epididymitis. Epilepsy. Erysipelas. Fevers. Fistula. Gallstones. Gastralgia or Gastrodynia. Gastritis. Gonorrhea. Goiter. Gout. Hallucinations. Hay fever. Headache. Heart Disease. Hemicrania. Hiccough. Hydronephrosis. Hydrophobia, Hydrothorax. Hyperesthesia. Hysteria. Indigestion. Inflammation. Insomnia. Kidney disease. Laryngitis. Liver abscess. Cirrhosis. Lobar pneumonia. Lockjaw. Locomotor ataxia. Lumbago. Mal de mere. Malarial fever. Meningitis. Migraine. Melancholia. Metritis. Morphinism. Muscular rheumatism. Myelitis. Myocarditis. Myositis. Nephritis. Nervous dyspepsia. Neuralgia, occipito-cervical, etc. Neurasthenia. Neuritis. Night sweats. Orchitis. Otitis media. Parethesia. Paralysis. Parotitis. Peliosis rheumatica. Pericarditis. Perimetritis. Perihepatitis. Perichondritis. Peritonitis. Pertussis. Petit mal. Pharyngitis. Phthisis. Pleurisy. Pneumonia. Post-epilepsy. Prolapsed uterus. Pseudo angina pectoris. Purpura. Rabies. Rheumatic fever. Salpingitis. Sarcoma. Scarlet fever. Smallpox. Spasms. Stomach. Stomatitis. Sunstroke. Tenesmus. Tetanus. Tonsillitis. Trauma. Trismus. Typhoid fever. Typhus fever. Ulcers. Urticaria. Varicella. Vomiting. Vulvitis. Yellow fever.

SUCCUS ALTERANS

Report of the Council on Pharmacy and Chemistry

The following report was adopted by the Council:

It is, believed that unwarranted and exaggerated therapeutic claims are made for Succus Alterans by its manufacturers, Eli Lilly & Co., Indianapolis. In view of the disastrous results which may follow, if, from the statements made, physicians should be led to rely on the product as a treatment for syphilis, it is recommended that Succus Alterans be refused recognition and that this fact be published with comments.

W. A. Puckner, Secretary.

Comment: Succus Alterans is a preparation which has been put on the market for some years by Eli Lilly & Co., as a remedy for syphilis. The serious character of this disease and especially the deplorable results that ensue from its improper or insufficient treatment, should make a firm hesitate to advise any treatment for it which experience has not demonstrated to be at least as efficacious as that which is generally accepted and well proved. Succus Alterans is the result of a combination of circumstances; no one person is responsible for it. It was probably the natural desire for a remedy free from the occasional injurious results of mercury that led Dr. J. Marion Sims to advocate the use of a collection of indigenous American plant drugs, sarsaparilla, stillingia, xanthoxylum, etc., which had a local reputation for the cure of syphilis. These drugs are supposed to be inert when the dried plants were used, and this gave an opportunity for the development of a nostrum. The ingredients are well known, but as their virtues are supposed to be lost in drying, the physician can not have his druggist compound them, but must, perforce, prescribe the proprietary combination.

Those who consented to experiment with the new remedy soon found that the claims to curative properties were unfounded, but the strong commercial interests backing it have prolonged its life to the present time. Authorities on syphilis either say nothing about the preparation or mention it merely to condemn; but the proprietors of the nostrum continue to assert that it is not only practically a specific in syphilis, but now recommend it for various derangements of the blood and all sorts of skin diseases.

This being the case, what shall the wise physician do? Shall he blindly follow an authority of a past generation or shall he recognize that the claims of an interested manufacturer ought not to weigh against the consensus of his present-day confrères who have given the treatment of syphilis their special attention? The exploitation of such a preparation is deserving of strong censure. By such methods the firm places itself on the same plane as those nostrum venders, who advertise certain antiseptic sprays and gargles as cures for epidemic meningitis and diphtheria and thereby deprive credulous victims of the curative antitoxin treatment. Succus Alterans is not a new remedy on trial for its possibilities of improvement in therapeutics; it is an old mixture which has been tried and found wanting.--(_From the Journal A. M. A., June 26, 1909._)

SULPHO-LYTHIN

Report of the Council on Pharmacy and Chemistry

Sulpho-Lythin is sold by the Laine Chemical Company, New York. In the literature sent to physicians it is said: “This product, the sulpho-phosphite of sodium and lithium (non-effervescent), is entirely new and is unique in its action.”

Chemical analysis of a specimen of Sulpho-Lythin purchased in the open market indicated its composition to be:

Sodium sulphate, anhydrous 10.51
Disodium hydrogen phosphate, anhydrous 56.67
Sodium thiosulphate, anhydrous 20.78
Sodium chlorid 5.98
Lithium, as citrate 3.12
Sulphur, free 0.16
Moisture 1.53
Loss 1.25