Chapter XX: Part III: Contributions From the Journal: Nostrums (1)

ALLEOTONE

The formula of this preparation, given in the literature, reads as follows:

Alcoholici (Monatomic) gr. 1/1000
Quininæ Sulphatis gr. 1/384
Ac. Sulph. Dil. (10 per cent.) gtt. 2-1/2
Ac. Nitrici Dil. (10 per cent.) gtt. 1/77
Ac. Butanol-Dioic gr. 1/3
Tr. Ferri Chloridi gtt. 1/26
Aquæ gtt. xx

The formula is worthless. It can only mislead and mystify and the greater part of the literature is a mere jumble of inaccurate and mystifying statements. The various constituents of the preparation are taken up as follows. The advertising literature states:

“Monatomic Alcohol is one of the constituents of all nerve tissue:
It is a product of the replacement of one atom of hydrogen of the
hydrocarbons by their hydroxyl group H.O.”

This information does not inform, since there is a vast number of monatomic alcohols and of every description. The assertion that the preparation “contains a salt” would be perfectly analogous and just as enlightening. Of “Ferri Chlo” the literature says:

“Ferri Chlo is found with all proteids and nucleins and herein acts
as magnetic iron, aiding the play of the electrical travel.”

The first assertion is untrue, for iron does not exist as chlorid in the cells of the body, but as some organic iron compound; neither is it found in all proteids, but principally in nucleo-albumins; and not all proteids contain nucleo-albumins. The assertion that the iron chlorid “acts as magnetic iron aiding the play of the electric travel” is nonsensical and on a par with the electric belt method of exploitation, and suggests forcibly the class to which Alleotone belongs. The literature further states:

“Sulphuric and nitric acids act in removing hydrogen atoms and
substitute atoms of the radical NO_{2}; that is, as hydrogen
tranquilizes the speed of burning or oxidation, its action is
substituted by the atom nitrogen which is energy itself, nitrogen
being the base of all explosives.”

Sulphuric acid is certainly an oxidizing agent and in virtue thereof removes hydrogen; but not in a solution whose concentration with respect to sulphuric acid is approximately only 0.82 per cent. The statement that nitrogen is the “base of all explosives” is another example of the methods of the promoters. As it is a well-known fact, however, that nitrogen itself is one of the least reactive of gaseous elements, little confidence can be placed in such remarks as “Nitrogen which is energy itself.” Another mystifying term used in the formula is “Ac. Butanol-Dioic,” which is a true chemical name, certainly, but it is one by which few physicians will recognize simple malic acid, an ordinary vegetable acid widely distributed in ripe fruits, such as apples and pears, and possessing the properties simply of a relatively weak organic acid. To describe it as exercising any potent influence “in the oxidation of the phosphorus as lecithin in the cell”--especially in the extremely low concentration in which it is stated to exist in Alleotone--is simply an absurd juggling with words. It is not much to be wondered at that the public should be taken in by pseudoscientific “literature”; but it is not only strange, it is discreditable to our profession, that among its members should be found any to accept such rubbish as the above quoted “literature” as information worth acting on--yet such there are, judging from the testimonials.--(_Abstracted from The Journal A. M. A., Feb. 1, 1908._)

The Commercial Value of Adverse Criticism

For skilful attempts to convert a “knock” into a “boost,” commend us to the discredited nostrum exploiter. The federal Food and Drugs Act did much to bring out this amiable quality--possibly developed it. While somewhat ancient history, it is well to call to mind what happened when the excise authorities insisted either that the “patent medicine” booze, Peruna, have some medicine put in it, or else that its manufacturers should go into the saloon business. Hartman at once got out a new label stating that “for a number of years a multitude of grateful friends” had urged “that Peruna be given a slight laxative quality.” Thenceforth the innocents and near-innocents could get their perunaese jag only at the risk of a “bad quarter of an hour.”

One of the latest attempts to wriggle out of an uncomfortable position, and at the same time make capital out of the wriggling, is seen in the advertising of Alleotone, a nostrum of the pseudoscientific type, which was shown up in The Journal of Feb. 1, 1908. The “formula” furnished is for the most part a jargon of misleading and mystifying nonsense and fulfils the same purpose as the voluble “patter” of the gentleman who is manipulating three shells and a pea at the county fair.

Every constituent of the “formula” was discussed in The Journal and the absurdities and impossibilities of each dwelt on. Did the manufacturers of Alleotone feel downcast over the exposure of their humbug? Not to judge by their advertising, for they write to physicians that “since the A. M. A. analyzed Alleotone it has made great strides”--direction not specified. But the choicest piece of impudence, and one that but for its dishonesty would be laughable, is found in this portion of their advertising pamphlet:

In the original, the words “With amendments suggested in the Journal of the American Medical Association, Feb. 1, 1908,” and also “(Cholesterin.)” and “(Malic Acid.),” which we have underscored in the illustration, are printed in red and have been added to the original “formula.” Such are the uses of adversity.

What claim, if any, the exploiter of this nostrum--B. F. Copeland--has to medical or pharmaceutical knowledge, we do not know. In fact, to be consistent with the “ethics” of the nostrum business he need have none. Such knowledge, indeed, tends to hamper that free play of the imagination so necessary in this work. We understand that he has at different times been in charge of a stave factory and connected with a brokerage firm, which may exert some subtle influence in developing the ability to relieve suffering humanity, though the connection is not quite clear. One would imagine, however, that the keen business instinct, untrammeled by any considerations of conscience, which is exhibited in the exploitation of Alleotone, would in purely commercial pursuits have long since assured a competence.--(_From The Journal A. M. A., Oct. 17, 1908._)

BAUME ANALGESIQUE BENGUE

A physician writes asking for the formula of Baume Analgésique Bengué. This product is another of the “patent-medicine”–“ethical-proprietary” type of nostrums. In Great Britain, it is advertised to the public as “A Wonderful Remedy for Rheumatism, Gout, Neuralgia.” In this country, the exploiters find that space in cheap medical journals, reinforced by the aid of undiscriminating physicians, is a cheaper method of getting the stuff to the public. According to the statements of the manufacturers, Bengué’s Analgesic Balm contains “menthol, salicylate of methyl and lanolin.” When analyzed by the chemists of the British Medical Association, it was reported to have the following composition:

Menthol 18 per cent.
Methyl salicylate 20 per cent.
Lanolin, anhydrous 54 per cent.
A fat, apparently lard 8 per cent.

The estimated cost of the ingredients of a 50-cent tube of Bengué’s Analgesic Balm, according to the British chemists, is 2-1/2 cents. Evidently this imposingly named product is practically a lanolin ointment containing oil of wintergreen and menthol. Similar products are catalogued by various pharmaceutical houses under various names and with varying degrees of frankness concerning their composition. Two firms give the medical profession full details regarding the composition of their products: The H. K. Mulford Company, who sell it under the name “Methyl Salicylate Ointment,” and the Pitman-Myers Co., who name their product “Anodyne Balm, P-M Co.” Some other firms are not so frank. Parke, Davis & Co., for instance, sell “a combination of methyl salicylate and menthol with a lanolin base” under the name “Analgesic Balm,” but do not give the quantities of the ingredients; Frederick Stearns & Co. sell “Analgesic Cream, Stearns” without giving the quantities; Nelson Baker & Co. sell “Anti-Neuralgic Ointment,” and no quantities are given.--(_From The Journal A. M. A., Dec. 14, 1912._)

ANTIDIABETICUM--BAUER

In Germany the makers of nostrums, their methods and their products are systematically exposed by the Society for the Suppression of Quackery (Deutsche Gesellschaft zur Bekämpfung des Kurpfuschertums) through its publication, the _Geseundheitslehrer_, under the aggressive editorship of Dr. Kantor.

Ludwig Bauer,[104] the manufacturer of “Antidiabeticum,” inserted advertisements in daily papers asserting that for his “humanitarian efforts” the society “Opera Educativa pacifica” in Rome had granted him a diploma and placed his publications in the celebrated “Bibliotheca Marciazzi.” Dr. Kantor, editor of the _Gesundheitslehrer_, declared that, according to information received from the German Consulate in Rome, no such society existed there, and the library referred to probably was the Bibliotheca Marciana in Florence, which, like other public libraries, accepts all donations without critical examination. To offset these exposures, the promoter of Antidiabeticum published advertisements libeling Dr. Kantor and attacking the Society for Suppression of Quackery. This resulted in suits and counter-suits for libel between Dr. Kantor and the directors of the antiquackery society on the one side and the promoter of Antidiabeticum on the other. As a result of the recent combined trial, the court declared that Dr. Kantor’s charges had been substantiated and the manufacturer of Antidiabeticum was fined 600 marks or forty days’ imprisonment, while apparently on purely technical grounds Dr. Kantor was fined 50 marks or five days’ imprisonment. The costs were divided between Bauer and Dr. Kantor in the proportion of 11 to 1. As Bauer in the course of the trial made further libelous charges, Dr. Kantor has lately started new proceedings against Bauer. The incessant persecution of Dr. Kantor was described in an editorial in The Journal, May 20, 1911, p. 1486.

[104] According to a report in the _Allgemeine medizinische Central-Zeitung_ Jan. 6, 1912, p. 14.

The persecution of Dr. Kantor previously described shows no signs of abatement nor has Dr. Kantor given evidence of loss of courage. Some of the German medical societies have subscribed for the _Gesundheitslehrer_ for each of their members. It is written in popular style for the masses and is a sharp and effective weapon for the campaign against quackery.--(_From The Journal A. M. A., April 27, 1912._)

ANTIKAMNIA

The Nostrum and Its Method of Exploitation

Our readers will be interested to learn some of the remarkable properties which, according to the statements of the manufacturers, this Antikamnia possesses. We quote from the advertising literature:

The well-known nerve specialist (?), Dr. Harley, in an interview
published in the _London Daily Express_, says: “I have treated more
than one American for nervousness and ‘brain fag’ directly due to
their incessant energy. I had a young man in here this morning who
complained of headache ‘in the back of the neck.’ He was threatened
with congestion of the brain, and seemed somewhat aggrieved when I
told him he had been trying to do too much. I also treated a young
American woman who, since her arrival in London, had apparently
been living on Antikamnia tablets by the advice of her physician.
It was the only thing, she said, which kept her ‘braced up’ for the
strain of sight-seeing.”

(Why did the young woman consult this Dr. Harley--for the drug habit?)

Note the following:

For the severe pains of rheumatism, dysmenorrhea, neuralgia,
gout, sciatica and lumbago, as well as for the lightning pains of
locomotor ataxia, there can be no quicker and more lasting relief
obtained than by the administration of Antikamnia and codeine
tablets.

Imagine an intelligent physician trying to treat the diseases mentioned below with the various impotent means of the pharmacopeia and physiological therapy when he might depend on Antikamnia! We quote again:

As a Pain Reliever.--In headache, cephalalgia, hemicrania, migraine
[some other words might have been thrown in so as still more to
emphasize the headache business], myalgia, coryza, la grippe and
its sequelae, the lightning pains of locomotor ataxia and all pains
due to irregular menstruation.

As an Anodyne or Sedative.--In alcoholic delirium, indigestion,
cardialgia, gastralgia, dyspepsia, hysteria, insomnia, inebriety,
car-sickness, sea-sickness, worry and sight-seer’s fatigue.

As an Antipyretic.--In typhoid, intermittent, puerperal and
malarial fevers, bronchitis, pneumonia, pleurisy, and tuberculosis.

As an Anti-Neuralgic.--In acute or chronic neuralgia, facial
neuralgia, earache, pain about the teeth, angina pectoris,
neurasthenia, palpitation, pains of locomotor ataxia and sciatica.

As an Anti-Rheumatic.--In acute or chronic rheumatism and gout,
fever and pleurodynia.

There is no remedy so useful and attended with such satisfactory
results as Antikamnia tablets in the treatment of melancholia
with vasomotor disturbances, anemic headaches, emotional
distress, and active delusions of apprehension and distrust. They
increase arterial tension and promote digestion, as well as being
particularly serviceable in relieving the persistent headache which
accompanies nervousness.

In neurasthenia, in mild hysteroid affections, and in the various
neuralgias, particularly ovarian, and in the nervous tremor so
often seen in confirmed drunkards, they are of peculiar service.
In angina pectoris this drug has a beneficial action; it relieves
the pain and distress in many cases, even when amyl nitrite and
nitroglycerin have failed entirely. In pseudo-angina, frequently
observed in hysterical women, its action is all that can be desired.

Patients who suffer from irritable, weak, or palpitating heart,
needing at times a pain reliever, can take Antikamnia tablets,
without untoward after-effects, knowing that the heart is being
fortified. In delirium tremens, they relieve when there are great
restlessness, insomnia, the general lowering of the nerve power.

Only the vivid picture of a crisis in locomotor ataxia or the agony
of a true migraine, can impress the observer with the full value of
this pain reliever.

The following testimonials are from physicians:

Dr. Caleb Lyon, an old Bellevue practitioner, in referring to antikamnia and codein tablets, says:

In my practice they accompany the maid from her virgin couch to
her lying-in chamber, assuaging the perplexities of maidenhood and
easing the trials of maternity with most gratifying results. I
earnestly hope that the proprietors of this valuable remedial agent
will keep it up to its present standard of purity and excellence.

Dr. Walter M. Fleming, A.M., M.D., New York City, writes:

... With all the experience of more than a quarter of a century,
in the treatment of winter cough, and all its complications of
laryngeal, bronchial and pulmonary irritability, dyspnea, asthmatic
spasms, and finally whooping cough--usually the most persistent
and tenacious of all these membranous maladies--I find no one
remedy more strongly indicated, or which yields more prompt and
satisfactory results than Antikamnia and heroin tablets, composed
of Antikamnia 5 grains and heroin hydrochloride 1/12 grain....
Result: a prompt and efficient expectorant, at once relaxing the
harsh and rasping cough, releasing the tenacious, sticky and
gelatinous mucus which is soon readily expectorated, while the
soothing influence of the Antikamnia is at once manifested, greatly
to the comfort and contentment of the patient.

... Independent of the fact of the direct applicability of this
remedy to the various membranous maladies of the lungs, bronchi,
fauces and nose, it proves also, an invariable remedy in all
febrile cases where anodyne is required. This, together with
its analgesic and antipyretic merits, eminently qualify this
combination for a responsive agent in the treatment of nearly all
the numerous febrile attacks characterized by pain, nervousness,
insomnia and their accompanying symptoms.

“Antikamnia and Quinin”

If there is any virtue in the particular combination known as “Antikamnia,” a physician prescribing the tablets supposed to contain combinations of “Antikamnia” and some other drugs should have some guarantee that they contain those remedies. Take, for example, the tablets advertised and sold as “Antikamnia and quinin.” It might reasonably be supposed that the tablets contained the combination known as “Antikamnia”; this, however, seems not to be the case. Previous analyses, as published[105] by us, have shown that antikamnia contains approximately 20 per cent. of sodium bicarbonate, yet two chemists, working separately, have been unable to find this ingredient in the tablets advertised and sold as “Antikamnia and quinin.” Are we to understand, therefore, that the manufacturers do not consider the bicarbonate of sodium of importance in their preparation, Antikamnia; or are they guilty of misrepresentation and of misleading physicians in omitting this constituent from their product Antikamnia when that is combined with the bisulphate of quinin? The above statement regarding the omission of bicarbonate of sodium from the quinin combination may be verified by any physician who desires to make a few simple chemical tests--carbonic acid is not given off when the tablets are treated with dilute acids, as would be the case if sodium bicarbonate were present. Further, while the ordinary Antikamnia contains no constituent not soluble either in water or in chloroform, and while quinin bisulphate is readily soluble in water, the tablets said to contain Antikamnia and quinin bisulphate, when treated successively with water and with chloroform, leave a residue of more than 18 per cent.

[105] The Journal A. M. A., June 3, 1905; reproduced on page 9 of this book.

One of the chemists who analyzed the preparation for us, in commenting on this in a letter, says: “The matter which is insoluble in water, alcohol or in chloroform, i. e., the substance which is neither ‘Antikamnia’ nor quinin bisulphate, amounts to more than 18 per cent. in ‘Antikamnia and quinin bisulphate tablets.’ The tablets weigh close to five grains and are said to contain 2.5 grains each of Antikamnia and quinin bisulphate. How is this possible when each tablet contains almost one grain of foreign substance (chiefly starch)?”

Further comment is superfluous. We have presented facts to our readers and leave, them to draw their own conclusions.--(_From The Journal A. M. A., July 1, 1905._)

Adding Insult to Injury

When the Council on Pharmacy and Chemistry began its work of independent and scientific investigation of proprietary preparations, some of the questions asked were:

“What guarantee has the medical profession that the formulas of these proprietary medicines are not changed at the will of the manufacturers? How can the physician who confidingly prescribes them for his patients know that the preparation which he orders to-day is the same as that which was furnished him last year, or which may be given him next year, under the same name?”

At once a wail, as of injured innocence, went up from countless venders of proprietary medicines, who replied with one voice:

“The honor and reputation of the proprietors and manufacturers is sufficient guarantee of the stability and permanence of these preparations.”

So vehement were their protestations and so well simulated were their declarations of Pecksniffian virtue that many physicians were deceived thereby. Many medical journals (whose views were, perhaps, slightly biased by the consideration of fat advertising contracts) also were apparently convinced. But the fact was overlooked that guarantees based on honor are of value only in proportion to the amount and quality of honor possessed by the guarantors.

The enactment of the national Food and Drugs Act is bringing many things to light. Some of them are interesting, some would be amusing were they not so utterly despicable. Among other things, it has furnished a demonstration of the value of the “honorable assurances” of nostrum venders.

The nostrum Antikamnia has pointed out many a moral in the campaign in the last two years. It was hardly to be hoped that it would deliberately furnish a demonstration of the utter lack of honesty on the part of a certain class of proprietary manufacturers. Yet, relying apparently on the ignorance of the public and the long-continued lethargy of the medical profession, its promoters have, in the last few weeks, unwittingly convicted and stultified themselves. When the pure food law went into effect, the proprietors of this mixture found themselves in a sad dilemma; if they labeled their mixture in accordance with the provisions of the law they would have to admit that it contained acetanilid and that the charges against them were true. Failing to comply with the law, they must go out of business. The latter alternative was not to be thought of. The profits gained by selling, with the aid of careless or ignorant physicians, a five- or ten-cent mixture for $1 were too great to be surrendered without a struggle. The same brilliant intellect, perhaps, that first saw the commercial possibilities in the business said: “Change the formula. Phenacetin is about as cheap as acetanilid; the patent has just expired and consequently we can get it at a low price. Let us substitute phenacetin for acetanilid.”

As a result the profession is treated to an edifying exhibition of virtue triumphant, a wolf so completely covered by the harmless coat of a sheep that he flatters himself that his wolfish nature is completely concealed. No longer are skulls and skeletons sent out in calendar form as grinning advance agents to be displayed in every doctor’s office, but instead a beautiful domestic scene, showing a convalescent child nestling in the arms of its mother. The familiar “AK,” however, as usual, is in the lower right-hand corner. And what a change in labels! No longer is Antikamnia a chemical entity, but the label now openly but ingenuously declares that “Antikamnia tablets in this original package contain 350 grains of acetphenetidin, U. S. P., per ounce. Guaranteed under the Food and Drugs Act, June 30, 1906. Serial No. 10.” While, below, as an entirely unnecessary display of conformity to the Pure Food Act, appears this statement:

The Antikamnia tablets in this original ounce package contain
no acetanilid, antifebrin, antipyrin, alcohol, morphin, opium,
codein, heroin, cocain, alpha- or beta-eucain, arsenic, strychnin,
chloroform, cannabis indica or chloral hydrate.

Truly, Satan is appearing as an angel of light. What a gratification it is to the long exploited profession to know that Antikamnia contains no alcohol, no chloroform, no cannabis indica, no chloral hydrate. How unfortunate that this spontaneous display of confidence is not carried far enough to inform the profession of the ingredients, aside from phenacetin, contained in the mixture!

The label is an admission that the nostrum does not contain what it was never supposed to contain, with the exception of acetanilid, and is directly an attempt to conceal the real contents. The proprietors know that the dear public, whose “pains, headaches, neuralgias, women’s aches and ills, grippal neuroses, nervousness, insomnia, rheumatism, lightning pains of locomotor ataxia, sciatica, etc.,” they are longing to assuage, will not know that acetphenetidin is the official designation for what is popularly known as phenacetin, and that this dangerous product is found in the new mixture in the proportion of approximately 4 grains to a 5-grain tablet. Evidently they also presume considerably on the ignorance of our profession, or why should they make the brazen statement that four grains of phenacetin is the “most reliable remedy” for the long list of diseases enumerated on their advertising calendar?

When the formula for which such wonderful virtues were claimed was suddenly thrown overboard, was the medical profession, which by its short-sighted patronage had built up this business, notified in any way of the change? Search the new advertising matter of this nostrum from beginning to end and you will not find one word to show that “The Antikamnia tablets in this original ounce package” differ in the slightest particular from those sold to the profession and the public for years past. This being true (and the statements of the promoters themselves are our authority for it), what remains of the pratings of “honor” and the “guarantee of the manufacturers”? Has a physician no right to know when a change is made in the formula of a preparation which he has been prescribing for years?

What assurance has the profession that, at any moment, a cheaper or more dangerous drug may not be substituted for “acetphenetidin” if thereby the law can be evaded or the profits of the delectable business enhanced?

How can any conscientious physician prescribe, for those who confide their lives to his care, a preparation the stability of the formula of which must depend absolutely on its owner’s whim?

How can a physician with the slightest sense of responsibility to his patients allow his office to be used as a free advertising bureau for a preparation manifestly founded and developed on deceit and misrepresentation?

How can any medical journal, except those avowedly and unblushingly seeking to aid the nostrum maker to exploit the profession, whose interests they claim to serve, continue to carry the deceptive and misleading advertisement of a twice exposed fraud?

How can any physician with a particle of self-respect or manhood continue to support, by subscription or contribution, any medical journal which, by accepting such advertising, allies itself with the army of deceit and chicanery?--(_Abstracted from The Journal A. M. A., Jan. 26, 1907._)

Still Further Duplicity

When the Food and Drugs Act went into effect the manufacturers of this preparation, instead of continuing to put out the same mixture as they had been doing radically changed the composition by substituting acetphenetidin (phenacetin) for acetanilid. By doing this the company avoided the disagreeable necessity for acknowledging on the label that the nostrum contained acetanilid, as was shown by the analysis published in The Journal, June 3, 1905. In addition to stating that the package of Antikamnia contained acetphenetidin, the company also stated that it contained no “acetanilid, antifebrin, antipyrin, alcohol, morphin, opium, codein, heroin, cocain, strychnin, chloroform, cannabis indica, or chloral hydrate.” Knowing that the nostrum was being advertised in Great Britain and Canada as well as in the United States, The Journal obtained some Antikamnia from London, and it was analyzed in the Association’s laboratory. As was suspected, the analysis showed that Antikamnia as sold abroad has the same composition now as it had in the United States before the Food and Drugs Act went into force, viz.: Acetanilid, 67.75 per cent.; caffein, 4.88 per cent., and citric acid and sodium bicarbonate, by difference, 25.36 per cent. This corresponds with the analysis previously made and published in The Journal, June 3, 1905. The Antikamnia on the market in this country was also analyzed and it was found to contain: acetphenetidin (phenacetin), 72.05 per cent.; caffein, 13.95 per cent.; citric acid and sodium bicarbonate, 14 per cent. The preparation sold as “Antikamnia and Quinin” was also analyzed, and it was found that starch had been substituted for the bicarbonate of sodium which is found in the Antikamnia itself. The details of the analyses are given with the following comments: “The above are brief statements of bald facts. Two of these should be emphasized: (1) When the Food and Drugs Act went into force, January, 1907, the manufacturers of Antikamnia, rather than acknowledge the truth of the past--we can imagine no other reason--materially and radically changed the composition of their preparation, and did this without notifying the medical profession or intimating in any way, so far as we can learn, that such a change had been made. We have no doubt they believed they had a right to do as they pleased with their own; that it was nobody’s business but theirs what they did with their own preparation, or how they changed it. As they never had told physicians what it contained, there was no reason why they should do so now. This is logical and we cannot blame the manufacturers so long as the medical profession is willing to be humbugged. (2) For the same reason, we presume, they claim that they have a right to continue to use acetanilid in the product for the foreign market. The Food and Drugs Act applies only to the United States, of course, and acetanilid being cheaper, why not use it? What is the difference if one is more dangerous than the other? The fact that the Antikamnia sold abroad differs from that sold in this country some may say is of no special interest to us. Still this fact is worth noting: The dose of acetphenetidin--phenacetin--(7-1/2 grains) is nearly double that of acetanilid (4 grains): one becoming accustomed to a certain dosage of the nostrum as sold in this country might, while abroad, unwittingly be led to take a double dose of acetanilid.--(_Abstracted from The Journal A. M. A., Feb. 8, 1908._)

Samples, Form Letters and “Prescriptions” Sent to the Laity

_To the Editor_:--The enclosed “literature” is being sent broadcast to the laity by the Antikamnia people and still a great many of the physicians throughout the country are prescribing the preparation thus advertised. Will the time ever come when the medical fraternity will awaken to the fact that it has been humbugged by a great many manufacturing concerns? I certainly hope so.

J. W. DuVal, M.D., Wichita Falls, Texas.

Comment:--The “literature” referred to by our correspondent consists of a form letter and a small pamphlet. The letter was similar to the one reproduced herewith.

The pamphlet accompanying the letter is entitled “Practical Prescriptions,” and contains a list of diseases and morbid states arranged alphabetically from “Alcoholism,” “Asthma” and “Backache,” to “Wind,” “Women’s Pains” and “Worry.” For the one hundred and twenty-two conditions listed, “Antikamnia,” “Antikamnia and Codein” or “Laxative Antikamnia and Quinin” are prescribed, demonstrating that the “prescriptions” are more “practical” than scientific.

In many respects the methods of the proprietors of “headache powders” and “anti-pain pills” are less offensive to one’s sense of professional decency than the course pursued by the Antikamnia people. The former have at least never recommended their products as “ethical proprietaries”; they have not used medical men as their unpaid agents; the claims made for their products have been no more exaggerated; and they have not found it necessary, from the requirements of the Food and Drugs Act, to substitute acetphenetidin for acetanilid to avoid giving the lie to their former claims.

As to the query propounded by our correspondent: We are optimistic enough to believe that the time he longs for is already here. The fact that the proprietors of nostrums of the Antikamnia type are finding it necessary to advertise to the laity is, in itself, evidence of the diminishing demand for such products on the part of the medical profession.--(_From The Journal A. M. A., April 18, 1908._)

Antikamnia in America and Great Britain

The following letter from the Antikamnia Chemical Company to The Journal was received about August 1, 1912:

“You have at various times represented in your Journal that the
Antikamnia sold in foreign countries, particularly in Great
Britain, has a different formula from the Antikamnia sold in the
United States, and you have also published alleged formulas of each
to show wherein they are supposed to differ.

“We hereby respectfully notify you that the Antikamnia formula is
the same for all countries, and the publication of any statements
to the effect that the formula of Antikamnia is different in Great
Britain, or any other foreign country, from that sold in the United
States is a libel, and will be prosecuted as such.”

On the receipt of this a letter was written to a correspondent in London requesting him to purchase in the open market a package of Antikamnia. This was done and the original sealed package reached the Association’s laboratory a few days ago. Careful analysis of this specimen shows it to contain acetanilid but no acetphenetidin, while the Antikamnia sold in the United States contains acetphenetidin but no acetanilid. The company’s protest to the contrary notwithstanding, the formula of some Antikamnia, at least, _is_ still different in Great Britain from that sold in the United States. It is possible, of course, that some time in the future the composition of every package of this nostrum on sale in the United Kingdom will be similar to that of every package sold in the United States. It is even possible that “Antikamnia & Quinin” tablets will--or do--actually consist of quinin and the mixture called Antikamnia--although, as The Journal has shown, this has not been the case in the past. Since the patent expired on acetphenetidin, this drug has become so cheap--it can be bought at wholesale for less than 6 cents an ounce--that, commercially it must make very little difference whether acetanilid or acetphenetidin is used in the manufacture of Antikamnia. But the question arises: Have our British confrères been notified of the change in formula? A careful study of the Antikamnia advertisements in English medical journals shows that the British medical profession has been given no more consideration by this concern than was the American medical profession when the change in composition was made on this side. But then why should it be? Physicians, British or American, who are addicted to the prescribing of secret proprietaries such as Antikamnia have little need of formulas--“Theirs not to reason why!” The medical profession on both sides of the Atlantic has never known the exact composition of Antikamnia and does not know it now. Physicians who call for preparations of the Antikamnia type are prescribing names, not drugs.--(_From The Journal A. M. A., Oct. 26, 1912._)

Again, Antikamnia

In season and out of season The Journal has exposed the Antikamnia fraud until it would seem that its readers would become weary of the very name. There is nothing new to say about this dangerous stuff, and yet the number of inquiries indicates that thousands of The Journal’s readers do not know of the previous exposures. More than fifteen years ago The Journal ceased carrying the Antikamnia advertisement; more than ten years ago it notified its readers that the nostrum was being advertised to the public by means of circular letters; more than six years ago it proved that, when the Food and Drugs Act went into effect, acetphenetidin had been substituted for acetanilid in Antikamnia evidently in order that the presence of the older drug, of whose dangers the public had been made aware might not have to be admitted; more than five years ago The Journal showed that the Antikamnia sold in the British Isles still contained acetanilid, and as late as last October it verified this statement although threatened with prosecution for libel by the Antikamnia Chemical Company.

Yet, in spite of all these exposures, not a week passes that we do not receive one or more letters calling attention to the Antikamnia fraud. Most of these letters deal with one, or more, of three points: first, the fact that the stuff is being advertised to the public by means of circular letters and that sample “vest-pocket boxes” of this dangerous drug are being sent through the mail to laymen; second, that Antikamnia is being advertised in newspapers, and, third, that in the booklets sent out by the Antikamnia Chemical Company both to the medical profession and to the public, a paragraph is quoted from an article by Dr. John H. McIntyre that appeared in The Journal.

The first two points have already been discussed so frequently that it seems hardly worth while to take them up again in detail, though it might be said that the medical profession has at last become so familiar with this widespread humbug that the Antikamnia Chemical Company has finally gone over body and soul to the newspapers. So far as we can learn only three publications professing to be medical journals still carry the Antikamnia advertisement. These three are:

_Southern Practitioner_
_Therapeutic Record_
_Pacific Medical Journal_

As is usual in such cases, the British medical journals are not so particular, and we still find Antikamnia advertised in:

_Medical Press and Circular_
_Glasgow Medical Journal_
_Journal Tropical Medicine and Hygiene_
_Dublin Journal Medical Science_
_Lancet_
_Canada Lancet_
_Practitioner_

The reproduction of the McIntyre quotation is evidently adopted by the Antikamnia concern as a means of “playing even” with The Journal for the unpleasant things it has said about it. In quoting Dr. McIntyre, the Antikamnia Chemical Company carefully avoids giving the date on which the article appeared. As a matter of fact, the article was printed in The Journal over twenty years ago (July 4, 1891), and Dr. McIntyre himself has been dead for eleven years. Presumably, however, the Antikamnia Chemical Company will continue to mislead, either directly or by inference, until the end of the chapter.--(_From The Journal A. M. A., April 12, 1913._)

ANUSOL SUPPOSITORIES

“In Hemorrhoids and all Inflammatory Rectal Diseases, let your first thought Continue to be Anusol Hemorrhoidal Suppositories; they have Earned your lasting Confidence.” Thus speaks an attractive folder recently sent to physicians. With a prodigal use of superlatives, the medical profession is told that these suppositories have for years “maintained their World-Wide Reputation” as the “Most Effective, the Safest ... the Most Economical and ... the Most Credit-Bringing of all Topical Rectal Remedies.” The short memory of the public is notorious; from the point of view of the proprietary exploiter, the short memory of the medical profession must be equally well known. How, otherwise, would a firm try to make physicians believe that a product had “earned” their “lasting confidence” when the result of an examination by the Association’s chemists, published in The Journal,[106] had shown that Anusol Hemorrhoidal Suppositories contained practically no “anusol.” Moreover, as the Association’s findings were a practical verification of the findings of a foreign chemist who also had failed to find any “anusol” in Anusol Suppositories, it is not quite clear what is meant by the term “world-wide reputation.” Incidentally, the observant physician will notice that the list of the ingredients given on the Anusol Suppositories labels of 1913 differ from those of the vintage of four years ago. The label of the old boxes gave the ingredients thus:

Bismuth. iodo-resorcinsulfon (Anusol), Zinc oxydat. pur., Balsam
Peruv., Ol. cacao, Unguent cereum.

[106] Oct. 2, 1909; see p. 227 of this volume.

On the latest label, however, we find these ingredients given:

“Bismuth oxyiodid and resorcinsulphonate with Zinc oxid and Balsam
Peru, incorporated in suitable base.”

What will the formula be four years hence?--(_From The Journal A. M. A., Oct. 11, 1913._)

ANUSOL SUPPOSITORIES

_To the Editor_:--In the “Propaganda for Reform” department of the
October 11 issue of The Journal, you published a short notice on
Anusol Suppositories. We desire to correct the impression which
your readers may have received, viz.: that there is any actual
difference between Anusol Suppositories of the present and Anusol
Suppositories of the past. We wish, therefore, to state that the
composition of Anusol Suppositories has not been changed; the only
modification that we have made is a revision of the label to the
effect that the active medicinal ingredient of the preparation is a
mixture of bismuth oxyiodid and bismuth resorcinsulphonate in place
of bismuth iodoresorcin-sulphonate. The latter was originally claimed
by the manufacturers, discovered to be doubtful by an investigation
in the laboratory of the American Medical Association, as well as
by one on the part of a foreign chemist, and finally disproved to
our satisfaction by an independent investigation on our part. We
feel that the remark “What will the formula be four years hence?”
will carry the impression to your readers that the composition has
frequently been changed and is likely to be changed again, and it is
for this reason that we request the above correction and an assurance
to the contrary.

The statement in the note that “Anusol Suppositories have been proved
to contain no Anusol” is also likely to create an entirely erroneous
impression. We dropped the use of the word “anusol,” as designating
a definite chemical substance more than two years ago, and changed
all our propaganda matter accordingly. Schering & Glatz.--(_From The
Journal A. M. A., Jan. 31, 1914._)

ASPIRO-LITHINE

Aspiro-lithine is another comparatively new example of the custom of proprietary manufacturers in putting forward old drugs under a new name and with them bidding for the favor of physicians. An inquiry has been received concerning this mixture. It is prepared by McKesson & Robbins and is said to contain in each tablet 5 grains of acetysalicylic acid (aspirin) and 2-1/2 grains of acid citro-tartrate of lithium. It is recommended for all the purposes for which acetysalicylic acid is commonly used, and on account of the lithium added is claimed to have much greater virtues than either of these drugs alone or of both combined.

We had hoped that the time had passed for reputable houses to employ such time-worn methods, but probably they will not stop so long as physicians encourage them by continuing to use such preparations. Acetysalicylic acid is a good drug, whose value is pretty well known. It is further known that lithium salts do not possess any great medicinal virtue. Just what acid citro-tartrate of lithium may be is hard to tell, for chemistries do not recognize such a substance. The name presumably is intended to hide the real nature of the preparation.

But if there be any advantage in combining lithium salts with acetysalicylic acid in a prescription, it is a simple proposition and requires no great skill, either on the part of the physician who writes the prescription or on the part of the druggist who puts it up, and such mixtures as aspiro-lithine, with the exaggerated claims made for them, should be avoided in the physician’s prescribing.--(_From The Journal A. M. A., May 28, 1910._)

BELL-ANS (PA-PAY-ANS, BELL)[AS]

Another “Patent Medicine” Foisted on the Public Through the Medical
Profession

[AS] See also report on Papayans Bell, p. 151.

With such nostrums as Antikamnia and Resinol fresh in mind as flagrant examples of “patent medicines” introduced to the public through the medical profession, what follows regarding Bell-ans, or, as it is better remembered by physicians, Pa-pay-ans (Bell) will take on an added interest. Briefly, Bell-ans is the new name of a tablet that, according to chemists’ reports, is essentially charcoal, baking soda and ginger, flavored with oil of wintergreen. Its selling point, in the past at least, has been the alleged presence of papain. This drug, Bell & Co. allege, is present in their tablets and they claim is “the digestive principle obtained by our own exclusive process from the fruit of _Carica papaya_.” As long ago as 1909, the Council on Pharmacy and Chemistry attempted to find papain present in what was then called Pa-pay-ans (Bell) and to determine the digestive power of the tablets but with negative results.

The efforts of other chemists were equally unavailing.

In January, 1914, Bell and Company changed the name of the product “Pa-pay-ans (Bell)” to “Bell-ans.” As The Journal remarked soon after, it seemed probable that, as the name of a nostrum of this kind is the manufacturer’s most valuable asset, the name was hardly changed, as was alleged, for purely euphonious reasons. It seemed more likely that as analyses had indicated there was not, and probably never had been, any appreciable amount of papain in the product, the change of name might be due to the fear that some day the misleading name might bring the preparation in conflict with the federal Food and Drugs Act.

For years physicians have realized that the methods of exploitation of Pa-pay-ans (Bell) have been such as to make the medical profession a vast free advertising agency for the nostrum. So far as we know Pa-pay-ans (Bell) has never been advertised in lay journals--newspapers, etc. Certain medical journals, however, have, for a long time, carried the advertisements of Pa-pay-ans (Bell)--and later of Bell-ans--while Bell & Co. has been lavish in its distribution of free samples, blotters and other advertising paraphernalia direct to the medical profession.

Now it seems Bell and Company are going direct to the public by means of vest-pocket samples and letters. The letter, a miniature facsimile of which we reproduce, is one addressed to laymen and accompanies a vest-pocket box of the nostrum.

Here are some of the things that Bell and Company claim Bell-ans will do:

“It removes flatulence, vertigo, weakness and other symptoms of
indigestion quickly and pleasantly.”

“It relieves vomiting in pregnancy, alcoholism, seasickness and
cholera morbus....”

“To promote appetite, digestion and the elimination of toxic and
waste material prescribe the Bell-ans....”

“... prevent eruptions, nausea, vertigo, pain, etc....”

“... remove distention, pain, weakness, depression, etc....”

“There is no derangement of the digestive organs upon which the
proper dose of Bell-ans (Pa-pay-ans, Bell) will not act quickly,
pleasantly and favorably....”

There is no physician living who really believes such claims as these! Yet on the medical profession rests the responsibility for the exploitation of this nostrum. Those medical journals which accept advertisements for things of this kind are not so much to blame as those physicians who unprotestingly tolerate the journals that do so. Privately owned medical journals are published, usually, as a commercial proposition; they reflect, to a greater or less extent, the attitude of their readers, subscribers and contributors. There are at least three medical journals which carry the advertisements of Bell-ans. They are the _New York Medical Journal_, the _International Journal of Surgery_ and the _Massachusetts Medical Journal_.

Bell-ans (Pa-pay-ans, Bell) possesses the virtues--and they are few--and the limitations--and these are many--inherent to a mixture of bicarbonate of soda, ginger and charcoal. Any druggist could put up just as good a remedy, and any physician could write a prescription for a better one in those cases in which he might think it indicated. The whole secret of the commercial success of Bell-ans lies in the mystery of its composition and the fraudulence of the claims that have been made for it. The same tablets put out under a non-proprietary name, as an open formula and with claims that were reasonable and true, would have had practically no sale. The commercial success of Bell-ans is a monument whose foundation rests equally on the unscrupulousness of the manufacturer and on the gullibility of a learned profession.--(_From The Journal A. M. A., Jan. 16, 1915._)

BIOSOL

Dr. A. N. Lakin, State Line, Ind., writes:

“Kindly advise me concerning Biosol. I am sending you herewith a
pamphlet describing this product. On the last page note clinical
report from Dr. Buchman of the Indiana Medical Association and
president of the Department of Public Health, Fort Wayne, Ind.”

H. Hille, once of Heidelberg, now of Oak Park, Ill., having reached the conclusion that mineral starvation is the cause of all diseases, devoted his talents to finding a remedy. He claims to have found it and calls it “Biosol.” He published his discovery in a pamphlet entitled “Facts of Modern Science,” and recently published an article in the _Medical Record_ giving his ideas on this mineral point of view. Biosol is an indescribable mixture of alcohol, carbohydrates, and many and various mineral bodies--ranging all the way from sodium, potassium, calcium and magnesium to silicon, copper, uranium and thorium--the amount of each being in most cases extremely minute. It is said to be a valuable food as well as medicine. A dose of this food might keep a rabbit alive for several hours, and a man who could stand the expense and escape death from delirium tremens might live on three quarts of the mixture per day. Human beings have little occasion to fear mineral starvation, and may obviate whatever danger there may be with a drink of milk. Like other living creatures, we may be thankful that we are furnished in our own bodies with a living bioplasm which can use the minerals of the waters and the rocks and which has its own laboratory in which to prepare organic compounds to suit its needs.--(_From The Journal A. M. A., March 8, 1913._)

BROMIN-IODIN COMPOUND

The Life-History of a Nostrum

A correspondent writes for information concerning a remedy known as Bromin-Iodin Comp., which he says is manufactured by the Bromin-Iodin Chemical Company, formerly of Binghamton, N. Y., but now located in San Diego, Calif. In The Journal for Feb. 5, 1898, appeared an article by Dr. C. W. Ingraham, Binghamton, N. Y., entitled “Five Years’ Successful Experience with a Special Mode of Treating Pulmonary Tuberculosis.” This “special mode” of treatment consisted in using what Dr. Ingraham called “bromin-iodin compound,” which he said had the following formula:

Iodin gr. 1/2
Bromin gr. 1/14
Phosphorus gr. 1/100
Thymol gr. 2/3
Sterilized oil fl. dr. 1

This “hypodermic treatment of phthisis” was widely advertised in the late nineties by the Bromin-Iodin Chemical Co, Binghamton, N. Y., and was but one of the innumerable “treatments” for pulmonary tuberculosis that have risen, had their day and, more or less gracefully, retired. It was first sold “to physicians only” for hypodermic administration. In 1906, however, physicians were told by the company that “if we find it impossible to secure your cooperation ... we will be compelled to do business with the druggists in your locality ...” Apparently they found such cooperation impossible, because a leaflet was issued to the laity and the statement was made that they intended to advertise “all over North America in publications of national and international circulation, as well as in local newspapers ...” Naturally the laity couldn’t be expected to administer this treatment by the hypodermic method and it is not surprising to read that “experiment has proved that the same solution can be taken internally.” In addition to the advertising leaflet, the public also was provided with a “pocket calendar good for 200 years” which contained numerous testimonials from physicians laudatory of the “bromin-iodin” treatment. The layman who received one of the leaflets was told that if he was suffering from “asthma, bronchitis, colds, consumption, coughs, eczema, goiter, hay fever, neuralgia, rheumatism ... also constipation and kidney troubles,” and his recovery was “not as rapid as it should be,” should, moreover, his physician refuse to use the bromin-iodin compound “it might not be a bad idea to discharge him” and get a physician who would!

At the time this “treatment” was first tried by its “inventor,” the results given in fifty cases were: First stage, 90 per cent. cures; second stage, 50 per cent. cures; third stage, no cures, but improvement in several cases; this was in 1895. It now appears that this “treatment” has after a period of “patent-medicine” exploitation come back into the “ethical proprietary” field. Presumably a mixture such as that represented by the “formula” did not lend itself to administration by mouth; there was nothing to do, therefore, but enlist the aid of “easy” physicians in furthering its sale.--(_From The Journal A. M. A., June 4, 1910._)

CALMINE

New Names for Old Drugs

“Calmine, the new Hypnotic,” is another example of the ingenuity of the exploiters of proprietary preparations in coining new names for old drugs and the recklessness with which exploiters herald forth renamed remedies to the profession and the public as new and wonderful discoveries.

This is what the promoters, sustained by a calm confidence in the credulity of the profession, have to say:

In the medical circles throughout the country a good deal of
interest and even enthusiasm over this new hypnotic is noticeable.
Very few drug products have attracted so much attention as this one.

A really satisfactory hypnotic and sleep-inducer, which Calmine
certainly seems to be, has been awaited expectantly for many years.
Of course, we have always had agents of this sort--a new one has
come out at frequent intervals--but none of them have “filled the
bill”; they have been prescribed only because there was nothing
better to be had.

Now this new and wonderful discovery is nothing but Veronal-sodium (sodium diethyl-barbiturate) under another name. It is the sodium salt of the more or less favorably known hypnotic, Veronal (diethyl-barbituric acid). It is also sold as Medinal, and differs from Veronal only in that the combination with sodium has made it more readibly soluble, and thus, it is claimed, its absorption is more prompt. Veronal is protected abroad by a trade-mark and in this country by a patent, and this, undoubtedly, is responsible for the introduction of this sodium salt under these fanciful names, because Veronal could not be sold without infringing on the patent. This in turn induced the manufacturers of Veronal, in self-protection, also to put the sodium salt on the market, and now we have it under the name of Calmine. This probably is only the beginning; soon we may look for it under a host of other names and the usual result will follow: thoughtless physicians who have had poor results with it under one name will try it under others. Or worse still, physicians will thoughtlessly combine Veronal with Calmine or with Medinal in the same prescription, thus giving a dangerous dose.--(_From The Journal A. M. A., Jan. 14, 1911._)

CAMPHENOL

Camphenol is made by Johnson & Johnson, New Brunswick, N. J. Under the name of the article on the carton appears the following formula: C_{10}H_{16}O━C_{6}H_{4}(CH_{3})OH═C_{6}H_{5}OH. This formula consists of the chemical formulas for camphor, cresol and phenol, written one after another, and from this one would conclude that Camphenol is a compound of camphor, phenol and cresol in molecular proportions. Examination shows, however, that Camphenol is but a modification of the well-known camphorated phenol (the liquid produced when solid camphor and phenol are triturated together). In Camphenol a part of the phenol, in the camphorated phenol, has been replaced by cresol, and this liquid has been diluted and emulsified with gelatin or some similar substance and perfumed. In other words, this preparation is an emulsion containing relatively small quantities of cresol, phenol and camphor and is another illustration of the attempts of would-be pharmaceutical houses to produce new synthetics in the simplest manner possible--that of writing the chemical formulas of the constituents of a remedy in a way to indicate a chemical combination.--(_From The Journal A. M. A., Nov. 5, 1910._)

CHOLOGEN

The proprietary Chologen is interesting some of our readers and several have sent us samples and literature. Dr. Philip Marvel, Atlantic City, N. J., for example, writes: