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

Chapter XVII: Part II: Contributions From the Chemical Laboratory (1)

Text size

ANUSOL HEMORRHOIDAL SUPPOSITORIES[AO]

W. A. Puckner and L. E. Warren

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

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

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

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

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

Calculated to percentages the formula reads:

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

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 In the meta-dioxybenzol C_{6}H_{4}(OH)_{2}, the resorcin, one H has been replaced by one I, and for another H the sulfonic-acid group SO_{2}-OH has been substituted, so that meta-dioxybenzol is transformed into C_{6}H_{2}ISO_{2}-OH(OH)_{2}.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

According to this formula “anusol” should contain:

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

And the “anusol” suppositories should contain:

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

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

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

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

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

AROMATIC DIGESTIVE TABLETS

W. A. Puckner and L. E. Warren

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

BURNHAM’S SOLUBLE IODIN[AP]

W. A. Puckner and A. H. Clark

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

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

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

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

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

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

BURNHAM’S SOLUBLE IODIN TABLETS

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

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

COMMENT

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

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

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

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

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

“HYDROCYANATE OF IRON--TILDEN”

W. A. Puckner and W. S. Hilpert

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

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

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

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

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

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

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

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

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

EXAMINATION OF THE TABLETS

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

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

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

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

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

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

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

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

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

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

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

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

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

HYMOSA

W. A. Puckner and W. S. Hilpert

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

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

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

“Contains no Salicylic Acid.”

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

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

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

“Negative results from salicylates--Hymosa cures.”

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

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

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

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

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

“Could not tolerate the salicylates.”

Finally in a letter issued to physicians we are told:

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

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

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

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

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

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

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

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

MICAJAH’S MEDICATED UTERINE WAFERS

W. A. Puckner and W. S. Hilpert

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

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

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

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

LABORATORY FINDINGS

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

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

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

“Price per box $1.00.”

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

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

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

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

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

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

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

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

COMMENT

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

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

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

The Firm Replies

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

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

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

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

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

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

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

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

Micajah & Company, Warren, Pa.

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

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

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

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

NOITOL AND ANADOL

W. A. Puckner and L. E. Warren

Noitol

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

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

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

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

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

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

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

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

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

Anadol

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

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

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

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

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

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

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

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

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

Anadol Declared Misbranded

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

PIX CRESOL

W. A. Puckner and W. S. Hilpert

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

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

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

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

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

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

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

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

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

“It kills the germs.”

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

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

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

“It destroys the spores and toxins utterly.”

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

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

Previous Next

Comments

The Propaganda for Reform in Proprietary Medicines, Vol. 1 of 2Chapter XVII: Part II: Contributions From the Chemical Laboratory (1)

0%36 min left in chapter