Chapter XVI: Part I: Council Reports (11)

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

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

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

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

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

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

CONCLUSIONS

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

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

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

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

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

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

VIN MARIANI

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

The report concludes:

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

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

W. A. Puckner, Secretary.

VIN MARIANI MADE IN THIS COUNTRY

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

ADVERTISED TO THE PUBLIC

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

AN ETHICAL CURE-ALL

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

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

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

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

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

WHY BLAME THE LAYMAN FOR USING NOSTRUMS?

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

MEMBER OF PROPRIETARY ASSOCIATION

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

VIROL

Report of the Council on Pharmacy and Chemistry

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

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

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

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

“... a complete food for children.”

“... a complete nutrient.”

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

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

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

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

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

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

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

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

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

He then continues:

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

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

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

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