Chapter XXI: Part III: Contributions From the Journal: Nostrums (2)

“By the way, I am to-day sending you by mail a package which the
Council on Pharmacy and Chemistry may care to tackle, or it may
not. I shall not be insulted any way, but since these chologen
preparations are being used a good deal by various globe trotters,
who sometimes hook up for a short stay here, I feel it might be of
some interest to know ‘what fools these mortals be’ and how much the
profession is being fooled with them.”

Chologen as a medical treatment for gall-stones has been before the German public for a number of years, and it is somewhat singular that so simple a method, which could be easily prescribed by the physician if it had merit, should exhibit such remarkable vitality in proprietary form in spite of evidence going to show that it rests on erroneous principles. The Council rejected it as an unscientific mixture. The treatment is somewhat liberal, consisting of the use, in varying successions, of three kinds of tablets: No. 1, calomel and podophyllin; No. 2, calomel, and No. 3, calomel, podophyllin, camphor and menthol. The proprietors tell us that the treatment should be proceeded with in spite of disturbances, such as diarrhea and pain in the abdomen, and that it should be repeated regularly in intervals for some years, so long as any trouble exists or recurrence is threatened. “A course” of Chologen tablets should be taken two or three times a year, No. 1 being given for ten days, then Nos. 1 and 2 for forty days and No. 3 for ten days.

It is worthy of note that experimental work seems to have been performed in the attempt to show that bile produced by this remedy will cause the disintegration and solution of gall-stones. Normal bile has a certain solvent action on gall-stones, but calomel and podophyllin have no demonstrable effect in increasing the amount of bile. We had imagined that these facts were generally known.

It is somewhat discouraging to reflect that some physicians entertain so low an estimate of their ability to prescribe such well-known remedies as calomel and podophyllin that they must use them in the fixed combinations provided by Dr. Glaser. If the self-respecting physician does not consider himself insulted by a proprietary manufacturer who presumes to tell him how to use such well-known remedies, this is a good sign that he needs to take a postgraduate course in materia medica and elementary prescription-writing. We feel that medical writers must be short of subjects when they devote papers to the exploitation of proprietaries consisting of these simple ingredients.--(_From The Journal A. M. A., Feb. 1, 1913._)

HAGEE’S CORDIAL OF COD-LIVER OIL[AT]

Fraud and Deception Connected with So-Called
Cod-Liver Oil Preparations

[AT] See also report on Hagee’s Cordial, p. 51.

The introduction of cod-liver oil as a supposedly easily assimilable nutrient and reconstructive was followed by its extensive use in wasting diseases, especially in phthisis, in the treatment of which it came to be considered almost essential, as it was supposed to possess some mysterious power different from that of other oils. Its unpalatable character led to various devices to render it tasteless and make it more acceptable to the stomach. Emulsions containing the oil in mixture with other substances were put on the market and served a useful purpose. But the oily nature, imperfectly concealed, was disagreeable to many, and gradually other preparations appeared which attempted to retain the supposed therapeutic virtues of cod-liver oil while dispensing with its disagreeable character. This attempt has been carried to the extreme that in many of the cod-liver oil preparations now on the market the oil has been entirely eliminated and all that is left of the oil is the name. This is a species of fraud which has been tolerated too long, but which will be kept up so long as physicians are willing to be duped. Some of these articles are said to “represent” the oil and to possess all its virtues. Others are said to contain oil, while still others are stated to contain “all the valuable constituents.” What is the standard by which we may determine the true value of these preparations and by which we may determine whether or not we, and through us our patients, are being humbugged?

A FOOD OR MEDICINE--WHICH?

Is cod-liver oil to be considered a food or a medicine? A food, certainly. As a food its value will consist in the fats it contains. These fats are more easily oxidizable and are considered more digestible than other fats because of the presence of compounds derived from the liver which favor its emulsification and enable it to penetrate the mucous membrane more easily than other fats. Aside from their nutrient properties we have no evidence that the fats of cod-liver oil possess any therapeutic value; if the oil possesses therapeutic qualities they must reside in its non-fatty constituents, and the activity of these non-fatty constituents is not acknowledged by those who have investigated them scientifically. Most pharmacologists believe that whatever virtue there is in cod-liver oil depends on its qualities as an easily assimilable fat.

On the whole, we must conclude with Cushny that “cod-liver oil has not been shown to have any action apart from that of an easily digested food, and its superiority to some other fats and oils has not been satisfactorily established.”

If, then, the value of cod-liver oil depends on the presence of fat as its nutritive constituent, the amount of fat a preparation contains will determine the worth or worthlessness of such a preparation; at all events, a preparation claiming to represent cod-liver oil which does not contain fat in some form is fraudulent.

HOW TO PROVE OR DISPROVE THE PRESENCE OF COD-LIVER OIL

Fats may be changed to fatty acids or to soaps, as occurs under the influence of pancreatic juice in digestion, and still retain their nutritive value, but it is not possible to manipulate them in any way so that they are still valuable as food, and yet do not respond to easily applied chemical tests which demonstrate their fatty nature.

Any preparation of cod-liver oil in which fat or fatty acid is not recognizable by proper tests is valueless as food, since its food value depends on the amount of fat or fatty acid present. An elementary knowledge of chemistry and the application of a few simple tests will enable any physician to learn for himself whether or not a preparation contains fat or fatty acids.

The preparations claiming to “represent” cod-liver oil are in liquid form, and if they contain oil it must be one of the following forms:

1. An emulsion of the oil which may be miscible with water, but from which the fat tends to separate and rise to the top. In this form the fat can be seen as globules under the microscope.

2. A solution, resulting from the saponification of the oil, containing a soap which usually will be alkaline in reaction, especially when mixed with water, and from which fatty acids are separated as a precipitate when the solution is acidified.

3. A solution of fatty acids. This will be acid in reaction and will be precipitated by the addition of water, in which the fatty acids are not soluble.

Hagee’s Cordial of Cod-Liver Oil

Hagee’s Cordial of Cod-Liver Oil Compound is said to “represent 33 per cent. of pure Norwegian cod-liver oil,” with other ingredients, in perfect solution. It is also claimed, according to the advertising pamphlet, that “in this preparation we have every beneficial constituent of the best and purest Norwegian cod-liver oil.” Put to the above three tests, however, Hagee’s cordial of cod-liver oil is not, 1, an emulsion of cod-liver oil; 2, is not a saponification of cod-liver oil; and, 3, does not contain fatty acids. It therefore contains no cod-liver oil. The only nutrients in the mixture, revealed by analysis, are sugar, alcohol and glycerin, none of which is contained in cod-liver oil.

In this case the manufacturer misleads by the use of the word “represents”; he is careful not to say “contains,” although the average reader would not be apt to notice the nice distinction. The manufacturer unwittingly admits that it contains no oil when he says that it “contains everything of value except the grease.” What else there is of value in cod-liver oil besides the “grease” we do not know. Certainly, if we estimate the value of the remedy by its nutrient properties, it must be set down as practically worthless, if not fraudulent, for although a mixture of sugar, alcohol and glycerin does possess certain nutrient value, the materials can be purchased for it far more cheaply in the open market. It is evident that claims are made for this preparation which cannot be substantiated.

Again, some of the so-called cod-liver oil preparations are termed extracts of cod-liver oil, but are not in fact made from the oil, but from the cod-livers instead. They are preparations which, if honestly made, might be worthy of trial, but they are improperly called “extracts” of cod-liver oil, since they do not contain the fat, which is the active constituent of the oil, but the extractives from the liver which may or may not possess therapeutic virtues. So far as we know, however, no satisfactory evidence is forthcoming to indicate that such extractives have any therapeutic value.

The attempt to modify cod-liver oil for therapeutic purposes may be pronounced a failure and the large variety and extensive sale of these preparations appear to be owing to the fact that physicians do not recall the ordinary facts of chemistry and fail to apply simple tests with little technical skill, but too readily accept as facts the statements of the manufacturers.--(_Modified from The Journal A. M. A., Oct. 13, 1906._)

WATERBURY’S COMPOUND ONCE MORE[AU]

[AU] See pp. 54, 57 and 442.

Most of our readers will remember what The Journal has published about a product that used to be sold as “Waterbury’s Metabolized Cod-Liver Oil Compound.” Briefly, it was shown by a report of the Council on Pharmacy and Chemistry and a contribution from the Association’s laboratory, that this “Cod-Liver Oil Compound” contained practically no cod-liver oil! Later the federal government declared the stuff misbranded.

The product is now sold under the name “Waterbury’s Compound.” It was recently stated in this department that “Waterbury’s Compound” was one of the proprietary preparations advertised both in “display” form and also in the form of an “original article,” in the _Army and Navy Medical Record_--a fraudulent publication that offered its editorial pages for sale. Physicians are now receiving from the Waterbury Chemical Company a reprint of what purports to be an editorial from the _Army and Navy Medical Record_ entitled, “One of America’s Most Valuable Preparations.” The preparation, of course, is “Waterbury’s Compound.” The company in sending out this reprint also reproduces on the reverse side the title-heading of the _Army and Navy Medical Record_. All of which goes to show that some concerns not only do not mind being found in bad company, but seem proud of it. By the way, we wonder whether those physicians who are still prescribing this nostrum think they are prescribing a preparation containing cod-liver oil!--(_From The Journal A. M. A., Nov. 15, 1913._)

COLLYRIUM-WYETH

“I should be glad of any information about Wyeth’s Collyrium and
would also like to know if the position taken by this concern
measures up to the requirements of the Council on Pharmacy and
Chemistry.”

This inquiry was received from a Boston physician, who enclosed with his note the letter quoted below that he had received from John Wyeth & Brother, Philadelphia, the makers of the preparation in question:

“We have your letter of the 22d inst., in which you request us to
send to you formula for ‘Collyrium,’ and in reply thereto, beg to
advise, being a corporation you will, we think appreciate why we
are not at liberty to disclose the various formulas under which our
preparations are made. Such is the competition in the trade that
secrecy in this respect is a valuable asset.

“You will not for a moment think that we take this position through
any distrust of your discretion or good faith, but because we feel
that our duty to the stockholders of the company prohibits us from
disclosing our formulas.

“Let us assure you however, that the eyewash contains only the
simplest and most harmless remedies well known to the medical
profession.”

John Wyeth & Brother seek the patronage of the medical profession and desire physicians to use their preparations, but “being a corporation” they “are not at liberty to disclose the various formulas” of these preparations. In other words, they expect physicians of the country to prescribe “patent medicines” of whose composition they must be ignorant and to rely wholly on the word of John Wyeth & Brother as to the innocuousness of these products.

The letter is an insult to the physician to whom it was written. If physicians were not so apathetic in cases of this kind, the corporation of John Wyeth & Brother would long since have been forced “off the fence”--it would have become either a “patent medicine” concern or would have confined its activities to the manufacture of pharmaceutical products and ethically exploited proprietaries. Now what about this Collyrium-Wyeth? It was analyzed in the Chemical Laboratory of the American Medical Association and the chemists report:

“The specimen of Collyrium-Wyeth examined was a clear, colorless liquid having a faint odor like benzaldehyd. Qualitative tests demonstrated the presence of antipyrin, free boric acid and sodium borate. Acetanilid, ammonium salts, glycerin, nitrates, phosphoric acid and pyramidon were absent. Such potent alkaloids as atropin, cocain, homatropin and pilocarpin, which are often used in ocular surgery, were not found. Preparations of goldenseal were not present. Quantitive examination indicated that the composition of the preparation examined is essentially as follows:

“Antipyrin 0.41 gm.
“Sodium borate 0.55 gm.
“Boric acid 2.14 gm.
“Water (by difference) to make 100.00 c.c.”

The secret of such a formula must indeed be a “valuable asset!” We venture the assertion that if the medical profession did its duty, the corporation of John Wyeth & Brother would find that its “duty to the stockholders of the company” constrained it to abandon secret “patent medicines” and to confine its activities to a legitimate line of pharmaceutical products. An examination of the firm’s pricelist reveals but a very few secret-formula preparations of the type represented by Collyrium, hence it would probably not seriously damage the business of the firm either to eliminate all such formulas from its pricelist or to enable the physician to use them intelligently, if they deserve it.--(_From The Journal A. M. A., May 17, 1913._)

DIATUSSIN

Dr. I. Fleiss, New York, writes:

“Please state the value of Diatussin, of Bischoff & Co, in pertussis.
Since pertussis is such an intractable disease, anything which
promises improvement is apt to attract the physician’s attention.”

According to an advertising circular, issued by E. Bischoff & Co, purporting to be a “reprint from the _Munich Medical Weekly_,” Diatussin is “... a dialysate of Herbæ Thymi and Pinguiculae.” The latter is said to be known in the Alps as “blue fatweed.” The only further information as to the composition of this preparation is the statement that “the dialysate of this blue fatweed is said by the manufacturer to contain a proteolytic ferment.” The writer of the article recounts how, after trying a host of remedies, he finally had such success in the treatment of whooping-cough that “... a whole procession of mothers with children affected by whooping-cough came to me from a neighboring village, only because several children from this place had been quickly cured by the dialysate.” Nevertheless, while the “procession of mothers” appears to have been impressed by the virtues of Diatussin, the writer of the article, rather modestly for contributors of this sort, admits that “I am, of course, well aware, that the small number of cases under my observation allows of no decisive conclusion; it is only the object of these lines to interest a wider circle in tests.”--(_From The Journal A. M. A., May 17, 1913._)

ENTERONOL

The “Greatest Germicide Known to Science!”

This preparation is put on the market by the Enteronol Company, Oswego, N. Y., which declares that Enteronol is “the greatest antiseptic and germicide known to science,” and that it “destroys the germs of typhoid fever, acute and chronic diarrhea, dysentery, cholera infantum, cholera morbus, summer complaint, Asiatic cholera, etc., within two hours.” The formula furnished by the company reads as follows: “Ipecac, sub. nit. bismuth, latalia rad., camphor, lupulin, caffein and rheum.” The attention of the Council on Pharmacy and Chemistry of the American Medical Association was directed to this preparation by a correspondent who had received a circular from the Enteronol Company. He sent a dollar to the company asking for a sample of “latalia rad.” that he might study the drug botanically, as he was unfamiliar with it. He expected to receive by return mail a sample of root or bark, but instead, he received three boxes of Enteronol and the information that as “latalia rad.” costs from $25 to $45 a pound the company could not afford to send samples. In a circular letter sent out by this company “latalia rad.” is said to grow on the sides of the Himalaya Mountains in India, and that the company is unable to obtain enough for its own use. This statement is probably correct, and no one else could secure the drug either. A sample of Enteronol was submitted to Professor Day, of the University of Illinois, and to Professor Kraemer of the Philadelphia College of Pharmacy. Professor Day reports that he was “unable to find any mention of the drug of ‘latalia rad.’ which is stated as one of the ingredients of this preparation. I have searched the usual works of reference on pharmacognosy without being able to find any reference to a drug of this name. A microscopic examination of the tablets shows the presence of rhubarb and of ginger, but no lupulin, at least not in substance; nor could I locate definitely any ipecac, also stated to be one of the ingredients. Since ginger is not stated to be one of the ingredients of the compound, it, perhaps, may be the mysterious stranger ‘latalia rad.’ I was unable to locate any of the ordinary astringent drugs, such as kino, krameria, or nutgall.” The results of Professor Kraemer’s examination were practically identical with those obtained by Professor Day. A report from the chemical laboratory of the American Medical Association states that as Professors Kraemer and Day suggested the presence of alum, tests were made for this substance. The analysis, details of which are given, leads to the conclusion that alum is the chief constituent of Enteronol. The report adds strongly to the impression that “latalia rad.” is simply a ruse to catch the unwary and trusting physician who lacks the time to look into the botany of every new plant discovered, and who is willing to trust the honesty of every manufacturer. Attention is also directed to the fact that while bismuth and caffein are mentioned as ingredients tests made in the laboratory failed to discover either of these substances. Since there is no lupulin, no ipecac, no caffein, no bismuth, and possibly no “latalia rad.” one is forced to the conclusion that the “formula” is meaningless and worthless, and that it is simply used to satisfy the demand for formulas for proprietary remedies. This is one more beautiful illustration of the absurdity of accepting a preparation because the “formula is on every package.”--(_Abstracted from The Journal A. M. A., March 21, 1908._)

An Invitation to The Journal to Humbug the Profession

The Journal has received a circular letter from the Enteronol Company, in which the following liberal offer is made:

“We are willing to take one-fourth or one-half page ‘ad’ in your
Journal for a year at the regular rate, on condition that you
accept payment therefor in our GUARANTEED 7 per cent., preferred
stock at par; or if you desire, in ENTERONOL at the net wholesale
price to physicians.”

Not that this offer is made exclusively to The Journal:

“A large number of medical journals have accepted the foregoing
proposition; many carrying this advertising for several years
already.”

“Our company is cooperative; we paying no cash for advertising. The
company is owned principally by physicians, medical journals, and
druggists.”

The journals of which we have record that carry the enteronol advertisement are: _Kansas City Medical Record_, _Milwaukee Medical Journal_, _Toledo Medical and Surgical Reporter_, _Proctologist_, _Pediatrics_, and the _Atlanta Journal-Record of Medicine_. If the statements made by the Enteronol Co. are true, we might infer that these journals are being paid for advertising space either with “preferred stock” or with the nostrum itself. As we have previously shown, however, the veracity of the enteronol advertising matter is by no means unimpeachable.

Enteronol, it will be remembered, was exposed in The Journal, March 21, 1908. It is advertised as the “greatest antiseptic and germicide known to science,” and possesses (?) such remarkable power that it “destroys the germs of typhoid fever, acute and chronic diarrhea, dysentery, cholera infantum, cholera morbus, summer complaint, Asiatic cholera, etc., within two hours.” “The original product is found only high up on the sides of the loftiest mountains in the world--the Himalayas of India.”

THE “LITERATURE” FORMULA

Of course, it has a “formula”:

Ipecac Lupulin
Sub. nit bismuth Latalia rad. Caffein
Camphor Rheum

This seems very open and above board, except as to quantities, until one tries to find out what “latalia rad.” is; then it is discovered that it is the “mysterious stranger” of pharmacognosy. Experts to whom this “remedy” was submitted were unable even to find mention of such a drug or plant as “latalia rad.” Nor was this the only fake found concerning the stuff; carefully conducted experiments repeatedly carried out in the Association’s laboratory failed to disclose even a trace of bismuth subnitrate or caffein. These experiments did show, however, that the tablets contained an amount of aluminum corresponding to over 25 per cent. of crystallized alum. This led to the conclusion that alum, whose presence is not even hinted at in the “formula,” is the chief constituent of enteronol and as a corollary that the formula is meaningless and worthless.

THE LABEL FORMULA

There is a curious lack of coordination between the “formula” as printed on the label and that given in the “literature.” The Food and Drugs Act, it will be remembered, makes lying on the label illegal, and therefore dangerous; statements in advertising matter that does not accompany the product, however, are not controlled by that law. The “formula” in the “literature” we have already given; the “formula” on the label gives the following ingredients:

Ipecac Lupulin
Sub. nit. bismuth Opium, 1/4 gr. Caffein
Camphor Rheum

Two things about this are worth noting: One is that the name of the ingredient on which the manufacturer lays so much stress--latalia rad., the mysterious Himalayan plant--is absent from the label. This would seem to indicate that what has already been intimated by The Journal--namely, that latalia rad. is a figment of the imagination--is a fact. The second noticeable thing about the label “formula,” as distinct from the “formula” in the advertising matter, is that on the label we find there is opium in the preparation. Why is no mention made of the presence of this potent drug in the advertising matter?

To determine how nearly the present statements made by the Enteronol Company approximate truthfulness, our chemists were asked to examine the nostrum as it is now sold. Their report follows:

LABORATORY FINDINGS

An original package of enteronol tablets was purchased on the open
market and submitted to the Association laboratory for examination.
In general appearance, odor and taste the new tablets are similar
to those previously examined. The formula for the old tablets was
given as “Ipecac, Sub. nit. bismuth, Latalia rad., Camphor, Lupulin,
Caffein, Rheum,” and is still used in the circular. But the label
on the trade package no longer mentions “latalia rad.” Since the
presence of “latalia rad.,” in the old tablets, was questioned,
and as new labels have ceased to display the name, it was thought
possible that caffein and bismuth might now be constituents of
enteronol, as the drugs are still mentioned in the new formula on the
label. Accordingly, enteronol was examined chemically to verify the
statements on the label regarding the presence of caffein and bismuth
in the tablets.

The specimen submitted to the laboratory some time ago was found to
contain neither bismuth nor caffein. By employing the same methods
as were used before (the usual tests for detecting caffein and
bismuth), neither caffein nor bismuth could be demonstrated. It is
thus evident that this new specimen of enteronol, the statement on
the label to the contrary notwithstanding, contains neither bismuth
nor caffein--at least, in appreciable quantities.

One would think that the discrepancy between “formulas” and facts would prove of interest to the stockholders of the Enteronol Company, especially as we are told that the policy of the company is to have “practical men as stockholders.” We are informed:

“Therefore, we have physicians, advertising experts, printers,
publishers, engravers, boxmakers, lithographers, druggists,
lawyers, traveling salesmen, officers and men holding executive
positions in various manufacturing and commercial corporations,
editors of medical publications, bishops, clergymen and
missionaries--men from all the fields particularly valuable
commercially for our great enterprise.”

Yet if the physician-stockholders do not care to concern themselves about the composition of the nostrum from the sale of which they derive dividends, it can hardly be expected that the boxmakers or traveling salesmen will be interested.

STOCK FOR SALE

Medical journals are not alone in being invited to participate in the exploitation of this nostrum, _vide_ a circular letter from the Enteronol Company addressed “To Investors”:

“We offer at par of $10 each, 1,000 shares of our Guaranteed 7 per
cent. Preferred Stock, cumulative dividends, payable quarterly ...
Profits on business done last year were 54 cents for every dollar
expended ... _We guarantee absolute security for your investment.
Safer than a bank._” [Italics ours.--Ed.]

We are told that at present the Enteronol Company manufactures two products: a castor-oil preparation, known as fig-ol, and enteronol. Very shortly, however, the company expects to “add seven equally efficient products.”

“The average cost to manufacture, ready to ship, a dollar’s worth
of these goods is less than ten cents.”

“In enteronol alone, the company has fortunes and the only thing
needed to bring tremendous results and dividends of 100 per cent.
is the proper amount of judicious advertising.”

Here are some samples of the judicious (?) advertising:

“One Christian missionary, the Rev. Paul Singh of Jubbulpore,
India, testifies that he cured thirteen severe cases of Asiatic
Cholera with a box containing less than thirty tablets” [of
enteronol].

“Wm. F. Oldham, bishop of Southern Asia, writes us that enteronol
cured nine cases out of ten of Asiatic Cholera. Now just think of
India and China with their 800,000,000 people who are dying by the
thousands of a disease which we have the power to cure so easily.”

How like a discourse by that delightful character of Mark Twain’s--the visionary Colonel Sellers--this reads. As he said about his “Infallible, Imperial, Oriental Optic Liniment”:

“Why in the Oriental countries ... every square mile of
ground upholds its thousands on thousands of struggling human
creatures--and every separate and individual devil of them’s got
the ophthalmia.”

The prospective stockholder is told that an ordinary business concern reaches the limit of financial possibilities in a few years, but:

“Not so with the Enteronol Company--it is a mail-order business and
the world is its territory.”

Even so with Colonel Sellers’ “Optic Liniment”:

“... it’s a patent medicine whose field of operations is the solid
earth.”

And we are told elsewhere that “about four-fifths of the outstanding stock is held by the medical profession alone”!

And this stuff is advertised in medical journals!!

We are sometimes in danger of being too optimistic regarding the results of the propaganda for reform in proprietary medicine. Cases like this act as a corrective.--(_From The Journal A. M. A., Nov. 20, 1909._)

EXPURGO (SANOL) ANTI-DIABETES

One More Fraudulent Nostrum for Diabetes

Expurgo Anti-Diabetes is sold and advertised in the United States by the Expurgo Manufacturing Company, Chicago. The concern is the United States branch of a Canadian company, the Sanol Manufacturing Company, Ltd., Winnipeg, which sells its product in Canada under the name of “Sanol Anti-Diabetes.” The parent company is said to have been incorporated under the Manitoba laws in 1912 and to have for its officers and directors the following men:

Charles Beyer, President.
Frank Beyer, Vice-President.
Charles Bauer, Secretary-Treasurer and Manager.

The manager of the United States branch in Chicago is said to be one E. M. von Amerongen.

The stuff is such an evident fraud that one would imagine that even intelligent laymen could not be deceived by it. Nevertheless medical journals both in the United States and Canada have accepted advertisements for this preparation and physicians--of a certain type--have been found to give testimonials for it. The medical profession is circularized widely by the concern and “write-ups” have appeared in pseudomedical journals. Some of the claims made for Expurgo Anti-Diabetes are:

“The only positive cure for Diabetes.”

“It never fails to effect a Cure in every case of this disease, in
whatever form it may present itself provided the patient has not
reached the last stages of the malady.”

“Expurgo Anti-Diabetes is the New Cure for this deadly affliction.”

“Diabetes is certainly curable by our new discovery--Expurgo
Anti-Diabetes, provided that the course of the disease has not
progressed to the extent that the vital organs are irreparably
damaged.”

“... thanks to the discovery of Expurgo Anti-Diabetes, the cure of
this dread disease is no longer a matter of doubt.”

“With the exception of very advanced cases of Diabetes ... all
diabetes can be cured by Expurgo Anti-Diabetes.”

Such claims one would imagine would be more than sufficient to make plain, even to the most uncritical of physicians, the evident fraudulence of Expurgo Anti-Diabetes. Nevertheless, the advertisements of this fraud have appeared during 1913 in the following medical journals:

_Medical Times_
_Medical Brief_
_Medical Summary_
_Buffalo Medical Journal_
_Louisville Monthly Journal_
_Iowa Medical Journal_
_Canada Lancet_
_Detroit Medical Journal_
_Medical Herald_
_Medical Review of Reviews_
_Medical Standard_
_Medical Review_
_Therapeutic Record_
_Medical Fortnightly_
_Indianapolis Medical Journal_
_Southwest Journal of Medicine and Surgery_
_Western Canada Medical Journal_
_Dominion Medical Monthly_
_Canadian Medical Association Journal_
_Canadian Practitioner and Review_
_Massachusetts Medical Journal_

Physicians will recognize that, with but few exceptions, most of these journals are utterly unrepresentative of scientific medicine.

The _Army and Navy Medical Record_, shown in The Journal recently as a journalistic fraud, contained an editorial puff of Expurgo Anti-Diabetes. The fact that the Expurgo Company reprints the “editorial” from the _Army and Navy Medical Record_ as a “voluntary and unsolicited reference” and distributes it among physicians, indicates how rotten are the props on which the superstructure of this fraud rest.

Another alleged “voluntary and unsolicited reference” used by the Expurgo Company is taken from the _Therapeutic Record_ of Louisville, Kentucky. The advertising pages of the _Therapeutic Record_ reek with frauds and it has more than once given editorial endorsement to some of the frauds that it advertises. The following enlightening letter is alleged to have been written by the editor of the _Therapeutic Record_ to the Expurgo Company in February, 1913:

_Gentlemen_:--Your favor of February 14th came duly to hand. Let me
advise you to pay no earthly attention to the proceedings of the
Medical Society where your product was criticized. These people
exert no influence with the practical up-to-date element of the
profession and are doing you as they do others. _Never fear--you
will succeed--your remedy is all right. No man can talk down a
meritorious product. I stand ready to help you in any way at any
time._

With sincere regards, I am,

Robert C. Kenner, M.D.,
Editor, the _Therapeutic Record_.

This, it will be noticed, was written in February. Soon thereafter the _Therapeutic Record_ was carrying the Expurgo advertisement, and the June, 1913, issue contained a puff on Expurgo, entitled “A Contribution to the Medical Treatment of Diabetes.” The _quid pro quo_ is fairly evident.

THE ALLEGED FORMULA

The formula for this nostrum is never published, although in some of the advertising matter it is claimed that it is “at the disposal of physicians.” A physician wrote to the Expurgo Manufacturing Company, asking for the formula. He was told that the preparation was “exclusively derived from the vegetable kingdom,” from which one may recognize a family likeness to the “dope” put out by the immortal Lydia Pinkham. Further, to copy the letter exactly:

“The ingredients of which Antidiabetes is composed are chiefly:
“fructus syzigii jambulani
“cortex syzigii jambulani
“flores Rosmarini
“fructus Anisi stellati
“Extr. fl. Colæ
“Extr. fl. Condurango
“Extr. fl. Chinæ spir. spiss.
“Extr. fl. Calami
“Extr. fl. Gentianæ.”

The recipient of this noncommittal and uninforming “formula” again wrote the Expurgo Manufacturing Company, asking for quantities. Evidently this nostrum concern considered such a request a piece of impertinent inquisitiveness, for it replied to the physician in these terms, given _verbatim et literatim_:

“_Dear Sir_:--Yours of the 16th duly to hand. We note that you
state ‘... I do not like to be working in the dark, and you can
readily see that this is the case unless I know how much of each
ingredient I am giving....’

“In your letter of the 6th you asked for the composition, which
you promptly received. We would like to state that we are dealing
with about 600 Doctors. Some of them asked for the formula, which
they received. They are all very conscientious gentlemen and none
of them ever pretended ‘to work in the dark.’ You know furthermore
that none of these ingredients is harmful in any way and yet ‘work
in the dark.’ You know that if there were any harmful ingredients
in our preparations, we would expose ourselves to imprisonment.
If you are so anxious to know all about it, why do you not
analyse our medicine? This would enlighten you in your ‘perfect
darkness.’ If you want to deprive your patients and yourselves of
the indisputable good of our preparations, simply do not prescribe
them. Why finally do you not write to the Doctors whose names we
gave, who know enough to be able to enlighten those who need it.

Truly yours
The Expurgo Mfg. Co.,
C. M. v. Amerongen, Manager.

More than a year ago, a Wisconsin physician, himself a sufferer from diabetes, wrote The Journal that for three months he had been using Expurgo Anti-Diabetes which the Expurgo people had sent him. He declared that the nostrum had greatly reduced the percentage of sugar in his urine. In its reply, The Journal asked him whether, in testing his urine he had used portions of twenty-four hour specimens or merely individual specimens. His attention was called to the fact that most of the nostrums for diabetes are diuretics which, by increasing the amount of urine passed, give an apparent decrease in the amount of sugar excreted. A few days later, the physician wrote again, stating that he had committed the very error The Journal had suspected, and reporting that an examination of a twenty-four-hour specimen showed that the glucose-excretion, instead of being diminished, actually increased. This matter was referred to editorially in The Journal, Nov. 9, 1912, under the title, “A Possible Fallacy in Testing Diabetic Urine.”

Specimens of Expurgo Anti-Diabetes were examined in the Association’s laboratory and the chemist’s report follows:

LABORATORY REPORT

“The specimen of Expurgo Anti-Diabetes (Sanol Anti-Diabetes)
examined, was a light-brown, opaque liquid, having a faintly aromatic
odor and bitter taste. The specimen contained considerable amounts
of brown, insoluble residue resembling the deposits often found in
fluid extracts. The absence of ammonium salts, iodids, glycerin,
hexamethylenamin, of antipyrin, pyramidon and similar substances and
of such purgatives as aloes, frangula, rhubarb, etc., was indicated.
Potent alkaloids such as aconitin, cocain, morphin and strychnin
were not found. Qualitative tests indicated the presence of traces
of phosphates, sulphates, reducing sugars, caffein and cinchona
alkaloids. Alcohol was present only in traces. Small quantities of
chlorids, sodium and a salicylate were found. The residue on drying
amounted to 2.9 gm. in each 100 c.c. A determination of the salicylic
acid indicated approximately 0.17 gm. in each 100 c.c., which is
equivalent to less than 0.2 gm. of sodium salicylate per 100 c.c.
(about 1 grain to the ounce). Evidently the preparation contains
plant extractives in aqueous solution and small amounts of sodium
salicylate and sodium chlorid.”

Summed up, the chemist’s report shows that Expurgo Anti-Diabetes is essentially a watery solution of plant extractives with small quantities of sodium salicylate and salt. The exploiters claim their stuff contains the fruit and bark of jambul, rosemary, star anise and fluid extract of calamus, cinchona, cola, condurango, and gentian. Since fluidextracts in general are strongly alcoholic and since the laboratory’s analysis shows that the preparation contains only traces of alcohol, the fluidextracts of the various drugs, if present at all, must be in an infinitesimal amount.

Jambul was in vogue as a remedy for diabetes about twenty years ago. It was tried and found wanting, and has long since been relegated to the therapeutic scrap heap. Sanol, therefore, is but one more proprietary humbug, foisted on the profession under fraudulent claims, and having for its essential constituent a drug that has long been discarded by scientific men and resurrected for the purposes of quackery. Expurgo will probably be used by uncritical and unthinking physicians and its existence will be artificially prolonged through the venality of pseudo-medical journals. That the medical profession should tolerate such an evident fraud is not to its credit. There is no excuse, either moral or otherwise, for a physician giving his patients nostrums of whose composition he is ignorant, and that is what is done whenever Expurgo Anti-Diabetes is prescribed.--(_From The Journal A. M. A., Jan. 24, 1914._)

FORMAMINT

The Profession to Be Worked Again

Formamint Tablets are widely advertised and extravagantly exploited to the laity in Great Britain. Large and expensive advertisements appear in the English magazines and newspapers and the tablets are pushed under the most preposterous claims. The preparation is put out, we understand, by the same concern that exploits Sanatogen. The medical profession of this country is now being circularized and advertisements are appearing in medical journals. They already appear in the _Medical Record_, _New York Medical Journal_ and _American Journal of Clinical Medicine_.

It seems then that this is another product which, for the time being at least, is to be a “patent medicine” on the other side of the Atlantic and an “ethical proprietary” on this. Doubtless the distinction will be a temporary one and as soon as American physicians have furnished the requisite number of testimonials and have recommended it to a sufficient number of their patients the advertisements will be quietly dropped from the American medical journals and the advertising pages of newspapers and magazines will be called into service.--(_From The Journal A. M. A., Jan. 27, 1912._)

The So-Called Germ-Killing Throat Tablet

Formamint tablets have recently been put on the American market by the same concern that exploits Sanatogen, the “food tonic” or “tonic food”--according to whether one reads European or American newspapers. Formamint tablets are being introduced to the American public by that cheapest of all methods of advertising “patent medicines,” through the medical profession. It is not advertised in American newspapers or lay magazines--at present. For some years this product has been advertised in newspapers and other periodicals in Europe under such claims as the following:

“Formamint shields humanity against infectious disease.”

“Cures and prevents sore throat.”

“The dangers of infection from diseases like diphtheria, scarlet
fever, measles, tonsillitis, sore throat, mumps, etc., have now
been reduced to an absolute minimum. This is due to the discovery
of Wulfing’s Formamint--the ‘germ-killing throat tablet.’”

“Cleanses the mouth and throat from disease germs as easily and
rapidly as dirt is removed from the skin.”

“Formamint will certainly prevent diphtheria.”

“Quickly render the whole mouth and throat thoroughly antiseptic.”

“Formamint destroys these [diphtheria] germs so rapidly that when
a physician mixed a little Formamint with water and added it to
the germs taken from the throat of a patient dangerously ill with
diphtheria they were all killed within ten minutes.”

Such are some of the claims by which Formamint goes to the European public. Doubtless it will be only a matter of time when the required number of testimonials from American physicians are forthcoming when we may expect to find the newspapers of this country heralding through their advertising pages the fact that Formamint is “recommended by thousands of American physicians.” The medical journals that are lending their pages to this preliminary advertising campaign are the following:

_New York Medical Journal_
_Medical Record_
_American Medicine_
_American Journal of Clinical Medicine_
_Medical Review of Reviews_

How much longer will the medical profession permit itself to be used as an unwitting agency for the exploitation of “patent medicines”? The game has been worked so often that it has become transparently thin. It is evidently not worn out, however, or shrewd nostrum promoters would not waste their time or money on it. That it should still be considered workable is complimentary neither to the standard of advertising ethics of medical journals that accept the Formamint advertisements nor to the intelligence of the members of the medical profession who will “fall for it.”--(_The Journal A. M. A., Feb. 24, 1912._)

GOMENOL

A correspondent sends some advertising matter on Gomenol and calls attention to the number of diseases for which the preparation is recommended:

Gomenol is apparently a volatile oil. It is a proprietary said to come from France, and to be prepared from a species of cajuput (_Melaleuca viridiflora_, Gaertn.). This plant is closely related to the cajuput tree or swamp tea-tree (_Melaleuca leucodendron_, Linné) from which the official oil of cajuput is obtained. The oils from these two plants are very similar in composition and presumably in therapeutic properties. The oil of the first-named plant appears not to be marketed except in the form of the proprietary, Gomenol. It probably has no advantage over the official oil of cajuput, while in the form of Gomenol it costs about four times as much. The following are some of the claims made for Gomenol in the advertising circulars. They need no comment.

“A real specific for suppurations and catarrh.... It immunizes
tissues, excites their vitality and favors the formation of new
cells....

“The least trace of Gomenol prevents the growth _in vitro_
of the streptococcus, the tuberculous bacillus and the
gonococcus.”--(_From The Journal A. M. A., April 4, 1914._)

HEADACHE CURES[AV]

Harmful Effects of Acetanilid, Antipyrin and Acetphenetidin

[AV] See also report on Acetanilid Mixtures, p. 9.

The United States Department of Agriculture Bulletin[107] No. 126, issued July 3, 1909, sets forth the results of an investigation conducted by the Bureau of Chemistry with regard to the harmful effects of acetanilid, antipyrin and acetphenetidin. During recent years the use of these remedies and preparations containing them by the people at large, without the supervision of the physician, has increased rapidly and investigation has shown that coincidently there has been a marked increase in the number of cases of poisoning reported, in the number of fatalities, and in the number of instances of habitual use.

[107] The Harmful Effects of Acetanilid, Antipyrin and Phenacetin, by L. F. Kebler, Ph.G., M.D., chief Division of Drugs, Bureau of Chemistry, with the collaboration of Drs. F. P. Morgan and Philip Rupp, assistant chemists.

Since the passage of the Food and Drugs Act, June 30, 1906, the attention of the Department of Agriculture has been directed to this subject, particularly in connection with the branding of drug products containing one or more of these agents, and an attempt has been made to obtain full and reliable data with regard to their poisonous qualities with the object of furnishing information to the public which would enable them to understand that these remedies should be employed with caution in the absence of reliable medical advice.

The information obtained with regard to the number of an inquiry addressed to medical practitioners in the United States with regard to their personal experience with these drugs; and, second, the study of the cases of poisoning recorded in medical literature. Nearly a thousand letters, each containing eighteen questions, were addressed by the department to physicians throughout the country, the object being to secure information which would represent as closely as possible the conditions existing among the people at large so far as the harmful effects of the drugs in question are concerned. Four hundred replies were received.

The information obtained with regard to the number of instances quoted in medical literature in which poisoning, death, or habitual use has been known to result from the administration of acetanilid, antipyrin, and acetphenetidin is set forth in Section A of the accompanying table. The information summarized in Section B is based on the data submitted by physicians. Granting that the 525 physicians who did not reply had no cases to report, the question may profitably be asked, if 925 physicians have observed 814 cases of poisoning by these drugs, 28 deaths which are attributed to their use, and 136 instances of habitual use, how many such cases have in all probability been observed by the 125,000 physicians scattered throughout the United States? The summary, C, includes both the number of cases recorded in medical literature and those reported by physicians.

POISONING BY ACETANILID, ANTIPYRIN AND PHENACETIN

A.--Cases Recorded in Medical Literature

HABITUAL
POISONING. DEATH. USE.
Acetanilid 297 13 32
Antipyrin 488 10 ..
Acetphenetidin 70 3 1
--- -- --
Total 855 26 33

B.--Data Submitted by Physicians

HABITUAL
POISONING. DEATH. USE.
Acetanilid 614 16 112
Antipyrin 105 5 7
Acetphenetidin 95 7 17
--- -- --
Total 814 28 136

C.--Total Number of Cases

HABITUAL
POISONING. DEATH. USE.
Acetanilid 911 29 144
Antipyrin 593 15 7
Acetphenetidin 165 10 18
---- -- ---
Total 1,669 54 169

The bulletin contains information with regard to dosage, the extent to which these drugs are employed by physicians, poisoning and habitual use, the nature of the ill effects produced, etc. It also contains references to the recorded cases of poisoning, together with a brief abstract of each case.--(_From The Journal A. M. A., July 31, 1909._)

Sanatoriums and the Acetanilid Habit

_To the Editor_:--I enclose herewith a “form” letter and question blank which I received recently from St. Louis. I may be entirely too wary but I am suspicious that this is a collection of “statistics” to combat the work of the medical profession in educating the physician and the laity in the harmfulness of acetanilid and similar preparations.

G. H. Benton, M.D., Chester, W. Va.
Sterling-Worth Sanitarium.

Comment: The letter which Dr. Benton encloses is in facsimile form and purports to come from Uriel S. Boone, M.D., of St. Louis, who states that he is “preparing an exhaustive article for publication in a leading medical journal” on the question, “Is acetanilid a habit-forming drug?” To obtain the necessary data Dr. Boone is “writing to every hospital and sanitarium in the United States.” Examination of the question blank which accompanies the form letter discloses the fact that information is wanted regarding not acetanilid alone, but also antipyrin and acetphenetidin (phenacetin). The last question asked runs as follows:

“If your records [of cases of habitual use of these drugs] are
incomplete, would you allow a reputable physician to investigate
the above-mentioned cases so that he could write with positiveness
about them, and, if necessary, _make oath to the truth of his
report_?” [Italics ours.--Ed.]

Dr. Boone opines that the recipients of his queries “may hesitate to answer” the question just quoted, but he trusts that its importance will be evident when he explains that “it is currently reported that the manufacturers of acetanilid, phenacetin, etc., _have decided to prosecute all libelers of these drugs_” [Italics again ours.--Ed.] and he wishes to make no statement that he “can not substantiate under oath.” Surely the life {of} the collector of medical statistics is unusually hazardous.

For the purpose of aiding Dr. Boone in his arduous search for truth on the “much mooted question, ‘Is acetanilid a habit-forming drug?’” we direct his attention to a work that should prove of invaluable assistance. We refer to Bulletin 126 of the Bureau of Chemistry, entitled “The Harmful Effects of Acetanilid, Antipyrin and Phenacetin.” This interesting study to which we have previously called attention records 112 cases of the acetanilid habit. Of this number at least 50, or 44.6 per cent. of the cases were those of patients who took proprietary preparations of the drug.

From this we would not wish to give any bias to Dr. Boone’s statistics. We hardly expect, however, that such will be the case. Dr. Boone’s name appears as the author of an article entitled “A Therapeutic Study of Antikamnia and Heroin Tablets”--an article that has been very extensively “quoted” and has been sent out in its entirety by the Antikamnia Chemical Company. Under these circumstances we may be forgiven if we venture the opinion that Dr. Boone is not likely to be unduly prejudiced against “headache tablets” in general and fake “synthetic” coal-tar mixtures in particular. We await with breathless interest the appearance of Dr. Boone’s “exhaustive article” and we must confess to some degree of curiosity regarding the name of the “leading medical journal” in which these valuable data will appear.--(_Modified from The Journal A. M. A., Aug. 14, 1909._)

HECTINE

Hectine is a French proprietary and is stated to be, chemically, sodium benzosulphoamino-phenyl-arsenate. If the asserted composition is correct, Hectine is similar to atoxyl, which is described in New and Nonofficial Remedies, 1914, page 38. Hectine has not been examined by the Council on Pharmacy and Chemistry.--(_From The Journal A. M. A., Aug. 8, 1914._)

HYDRONAPHTHOL

A correspondent having requested information regarding the composition of “Hydronaphthol,” the product was investigated in the Association laboratory, which reports as follows:

Hydronaphthol is sold by Seabury & Johnson. The label on a trade package of Hydronaphthol gives no clew as to the nature of the product. The statements on the labels do, however, make the claim that Hydronaphthol is an antiseptic of great power, also that it is non-toxic and therefore may be used with impunity; thus the following statements are made:

“A harmless, practically odorless, non-poisonous, non-corrosive
antiseptic....”

“... it is non-poisonous and can be employed with perfect immunity
as a preservative....”

The substance has the characteristic appearance, odor and taste of naphthol. It responded to all the tests of the United States Pharmacopeia for betanaphthol, with the exception of the melting point, which was found to be 119 C. instead of 122 C., an indication of impurity. It is evident, therefore, that Hydronaphthol is merely a trade-name for betanaphthol. While resublimed betanaphthol is listed at 10 cents an ounce, Hydronaphthol is listed at 75 cents an ounce.

Hydronaphthol thus furnishes one more illustration of the fact that
most proprietary medicines for which the most extravagant claims
are made are but old and well-known remedies sold under a fancy
name at a price far in advance of that charged for the constituent
or constituents. The exploiters are extremely positive in their
statements regarding the non-toxic character of the preparation. Yet,
as a matter of fact, betanaphthol is by no means harmless; it has
been absorbed by the diseased skin with injury to the kidney and with
fatal results. In some cases injury to the eye has also occurred.
These toxic actions should be known to the practitioner. From 3
to 4 gm. (1 dram) applied to the skin has produced death (Stern:
_Therap. Monatshefte_, 1900, p. 165). When a manufacturer advertises
a preparation which possesses potentialities for harm, and especially
when he puts it out under a name which conceals its identity, it
is incumbent on him to warn the customer of possible injurious or
inconvenient actions instead of proclaiming that the preparation is
harmless.--(_From The Journal A. M. A., Sept. 3, 1910._)

HYDROZONE

The moral principle governing the action of secret proprietary and patent medicine men is an unknown quantity; sometimes it would seem to be a negative one. Just how much lower in the scale of humanity a man can go than to prey on the fears of a people in the time of a terrible epidemic for the sake of a few dollars we do not know. There may be something more despicable, but what is it? Two weeks ago we referred to the cold-blooded methods of the Peruna people; this week we reproduce an advertisement from the New Orleans _States_ that tells another story of man’s inhumanity to man.

This brings up the problem that we are trying to solve, viz.: “What is the difference between a ‘secret proprietary medicine’ advertised in medical journals to physicians and a ‘patent medicine’ advertised in newspapers to the public?” Hydrozone is being advertised in nearly all medical journals, and at the same time in newspapers. Where shall we place it? And if hydrozone, with the methods recently adopted to exploit it, is tolerated in the medical press, why not peruna?

HYPOQUINIDOL