Chapter XXIV: Part III: Contributions From the Journal: Nostrums (5)

The first impression on reading this sentence is that it suggests that _glycerophosphates_ are essential to the vital processes, although the statement strictly applies to phosphorus. The next sentence confirms this impression and the mind glissades from the accepted fact of the existence of phosphorus in nervous tissue to the unfounded hypothesis that the glycerophosphates are necessary to supply the essential element. In the next sentence the circular continues:

“In nervous and general debility the glycerophosphates as exhibited
in Robinol, are preferable to the mineral phosphates as they
contribute the essential constituent of nerve tissue and are
absorbed by the cells more readily than any phosphate of vegetable
or inorganic origin.”

This statement is utterly unfounded. It is in direct opposition to the conclusions of pharmacologists. The glycerophosphoric acid radical is, to be sure, found in the lecithin of nervous tissues, but its source is not known. There is no evidence either that it must be present in the food or that it must be taken as medicine in order that the brain and nervous tissues shall be nourished. When the glycerophosphates are taken there is no evidence that they enter into the composition of the brain or nervous tissue. They are excreted in the urine and feces as phosphates. It has never been shown that glycerophosphates are absorbed any more readily than other phosphates.

But the advertising circular has still more information to impart to physicians:

“In that group of maladies characterized by faulty nutrition, due
to the excessive elimination of phosphorus from the body, as is
evidenced by the fatigue and weakness following acute attacks and
present in many chronic affections, during the course of fevers and
in the later stages of phthisis and all diseases of the nervous
system, physicians will find the tonic chalybeate properties of the
glycerophosphates of great value.”

Physicians know, if the nostrum makers do not, how difficult it is to determine whether there is an excessive elimination of phosphorus from the body. The bulk of the phosphates found in the urine are derived from the food and so little comes from the metabolism of the nervous system that it is not easy to prove that any disease is due to excessive elimination of phosphorus from the body. That fatigue and weakness are due to such a loss of phosphorus is mere assumption, a convenient theory for the exploiters of glycerophosphates. But admitting that nervous waste or faulty nutrition is characterized by the loss of phosphorus, it is easier, cheaper and more rational to supply such loss by the use of phosphorus-containing foods, such as milk and eggs, and there is not the slightest evidence that the loss of phosphorus will be influenced in any way by giving a supply in the form of glycerophosphates. Thus, in order to bolster up the sale of a simple solution of glycerophosphates, vague theories and improbable hypotheses are dressed in all the dignity of scientific facts.

Sevetol

There was a time, perhaps a generation ago, when physiologists taught that fats were absorbed into the blood in the form of a fine emulsion. This theory has been definitely disproved and it is now known that fats enter the blood only after a chemical splitting into glycerol and fatty acids, the latter being, to a large extent, combined with alkalies in the form of soaps.

“Sevetol,” another Wyeth preparation, is presented to the profession under the claim that it is a very fine emulsion of fats, every portion of which “is readily absorbed through the intestinal wall.” To quote:

“The administration of Sevetol, therefore, does not tax the
digestive power of the patient, for it is absorbed with very
little effort on the part of the digestive apparatus; and even
if the organs of digestion be involved, neither the weakness
of the patient nor the severity of the symptoms necessarily
contra-indicates its use. The amount ingested is limited only by
the power of assimilation exhibited in the tissues, and it may
be given in large doses for a continued period of time, or until
symptoms of overfeeding are produced, such as coated tongue,
anorexia, constipation, headache and lassitude. When these symptoms
appear, the administration of Sevetol should be temporarily
discontinued and a mild but effective laxative given for several
days, after which its use may be resumed.”

While the language just quoted is a little more exalted and dignified than that found in typical “patent medicine” advertisements, the thought it expresses qualifies it for a place in the “Lydia Pinkham” or “Peruna” class. Every sophomore medical student knows, if he gives the matter any thought, that Sevetol must undergo the same process of digestion as any other fat. It must be broken up into a fatty acid and glycerol, and saponified before it can be absorbed. It is plainly evident that the amount of Sevetol which can be taken is limited not only by the power of assimilation, but also by the power of digestion. The symptoms mentioned in the advertisement and ascribed to overfeeding, are the symptoms, not of a system saturated with absorbed fat, but of digestive organs rebelling against an unusual diet.

The exploitation of Sevetol is but one more case of turning to commercial account an exploded theory. Isn’t it about time that our profession demanded that the purveyors of medicinal products tell the truth? And isn’t it time, too, that we cease taking our pharmacology and therapeutics from proprietary manufacturers?--(_From The Journal A. M. A., July 4, 1914._)

SALACETIN

Some time ago we wrote to Messrs. Bell & Co., calling their attention to the fact that we had made an examination[121] of their product, salacetin, and that as a result of such examination it was found to be a mixture, which did not coincide exactly with their description of it. They replied: “Our description of salacetin is correct and we have nothing more to impart except that anyone publishing any different formula from that given in our circulars will be held responsible by us.”

[121] The Journal A. M. A., June 3, 1905; reproduced on page 10 of this book.

The description they give is as follows:

Prepared by the interaction, with heat, of salicylic acid, glacial
acetic acid, and purified phenylamine.

This sounds very scientific, but when we remember that acetanilid is a result of the action of glacial acetic acid on phenylamine (anilin) their description is cute, to say the least. Of course, there is “interaction with heat” when salicylic acid is combining with bicarbonate of sodium to form salicylate of sodium. Further, there is, no doubt, some “interaction with heat” when the substances are rubbed together in mixing them and when they are going through the mill to form tablets, not to mention the heated imagination of the promoters of this “synthetic.”

The following taken from the advertising literature furnished by the manufacturers and distributed by them, is quoted to show the claims made for this preparation:

Salacetin is free from Toluodine and produces no harmful cyanosis.
In the treatment of Acute Bronchitis, Grippe, Influenza,
Tonsillitis, Lithemic Headaches, Rheumatism and Neuralgias, it
relieves pain, reduces inflammation and abnormal temperature,
and eliminates uric acid more quickly and thoroughly than the
salicylates, and without causing depression or stomachic or renal
irritation.

Have personally interviewed thousands of physicians, including
every prominent one in the East, and can honestly state that
we have never known of anything at once so efficient and so
unobjectionable in the removal of rheumatic and neuralgic pain
and other symptoms of the uric-acid accumulation.... In La Grippe
and Acute Bronchitis it relieves pain and coughing, reduces
inflammation and temperature, makes the patient comfortable, and
checks the progress of the disease. In Tonsillitis its action is
specific.... In Acid Cystitis, it neutralizes acidity, reduces
inflammation and removes irritation.... In Dysmenorrhea it relieves
pain and congestion with no hallucinations, constipation or danger
of a drug habit.

In Dysmenorrhea and Ovarian Neuralgias try Sal-Codeia--Bell. It
will relieve the pain as well as morphia. It will not check any
secretions, induce any habit, cause any depression or inconvenience
of any kind.

Of course, it is well understood that acetanilid is a valuable remedy in many instances, if used with caution and when indicated. It certainly has some therapeutic value. There is no doubt that it relieves pain of various kinds. It is to be presumed that combining salicylate of sodium with it will have certain beneficial effects in certain rheumatic conditions, on the supposition that salicylate of sodium and acetanilid are both used with more or less success in certain of these conditions. Also, the combining of bicarbonate of sodium, carbonate of ammonium, caffein, citric acid, one or several of these, may result in a fairly good combination, but these combinations can be found in the list of preparations of all our large manufacturing pharmaceutical houses, which supply them at one-tenth of the cost of these secret remedies. The physician in using these preparations put out by reputable recognized manufacturing pharmaceutical houses not only is prescribing preparations that are non-secret, but is using remedies that cost one-tenth as much as the secret preparations, which are exploited under fanciful names and pushed by ridiculous claims.--(_From The Journal A. M. A., July 1, 1905._)

SAL-CODEIA--BELL

According to the advertisements “Salacetin”

“... is a combination with heat of salicylic and glacial
acetic acids with phenylamine, the irritating, depressing and
blood-corpuscle destroying elements removed.”

According to the Committee on Chemistry of the Council on Pharmacy and Chemistry of the American Medical Association, whose report was published in _The Journal of the American Medical Association_ June 3, 1905, p. 1791, “Salacetin” is a mixture of acetanilid, salicylate of sodium and bicarbonate of sodium. Sal-Codeia (Salacetin-Codein) therefore would be the same as above with codein added. Of course, acetanilid and codein will relieve pain (it could not do otherwise) and consequently make a very good combination in certain conditions, if not used too often and if used with care. Although the continued use of codein is not likely to produce a drug habit, it, as well as acetanilid, does so sometimes, and it must be remembered that codein is a motor paralysant, and is not the best combination to be used with acetanilid. For those who wish to give a combination of acetanilid, salicylate of sodium and codein, the following prescription is suggested:

℞ Acetanilid Ʒ i 4|
Sodii bicarbonatis Ʒ ss 2|
Sodii salicylatis Ʒ ss 2|
Codein sulph. gr. vi |4
M. et div. chart No. xxiv.

This will make five-grain powders which may be put in papers, capsules, cachets or tablets. Each will contain 2-1/2 grains (0.15 gm.) of acetanilid and 1-1/4 grains (0.075 gm.) each of sodium salicylate and sodium bicarbonate, with 1/4 grain (0.015 gm.) of codein.

The doses of acetanilid and of codein approximate the average adult doses, but the sodium salicylate, to have any appreciable effect, must be increased, for 1-1/4 grains of salicylate of sodium in a dose is insignificantly small. Sodium salicylate with acetanilid makes a fairly good combination in certain rheumatic troubles, but it is not indicated by any means as a cure-all, as one would judge from the literature sent out by the Sal-Codeia-Bell people.--(_From The Journal A. M. A., Nov. 4, 1905._)

SANATOGEN

Cottage Cheese--The New Elixir of Life[AZ]

[AZ] See also Medical Journals and Sanatogen, p. 431.

The psychology of advertising is nowhere better exemplified than in the “patent medicine” and proprietary fields. The reason is evident. Knowing that the general tendency of the human organism is toward health rather than toward disease and that the “healing power of nature”--_vis medicatrix naturæ_--will account for a large proportion of recoveries from sickness, it is not to be wondered at that thousands of preparations sold for medicinal purposes receive credit that is entirely undeserved. The awarding of such undeserved credit is largely due to the universal tendency of those who are not trained in science to apply the _post hoc, ergo propter hoc_ argument in all matters relating to health and disease.

John Smith suffers from a passing indisposition. When he recovers he credits his recovery to whatever he may have done just preceding that recovery. If he has received medical attention, the physician gets the credit; if he has taken “absent treatment,” Christian Science is responsible; if he has taken sugar pills, “Prof.” Munyon gets the praise--while, as a matter of fact, if he had taken none of these he would have recovered since he was only temporarily indisposed.

Nor are laymen the only ones that fall into such errors. Many physicians who prescribe new, widely-advertised preparations are likely to give those products credit for whatever favorable change may take place in their patients’ condition. This failing is not a modern one. In 1842 Dr. Benjamin Brodie wrote: “We have no doubt that many well-instructed medical practitioners have not sufficiently considered what course a given disease would take if it were left to itself; and as to others, it is not possible that they should have any real knowledge on the subject. With the majority of persons a recovery will generally pass for a cure.”

THE POWER OF ADVERTISING

While every physician is perfectly familiar with the facts just stated, it seems worth while to give them as a probable explanation of what is to follow. Within the last few years the medical profession and the public of this country have been asked to believe that a combination of cottage cheese--or its equivalent--with a small amount of glycerophosphates is capable, when sold under a proprietary name and with the right kind of advertising, of producing physiologic effects that are little short of marvelous.

The name of this elixir of life is Sanatogen, and it is doubtful if the history of modern advertising furnishes any more notable example of the commercial potentialities of publicity than that exhibited in the exploitation of this product. The Sanatogen advertising campaign is probably the most skilful piece of work of its kind ever done. On both sides of the Atlantic, every effort has been made to endow the advertisements with a dignity which, to those who know the very ordinary nature of the product advertised, is grotesquely out of keeping. Only the highest-class magazines and newspapers have been patronized; the “copy” has been so written as to appeal not to the ignorant but to the intelligent. Testimonials from men whose names are well known, even though by training and education they are incompetent to pass judgment on a product of this kind, and fulsomely laudatory letters from men whose education and training should have taught them better--both have been used with all the skill of the trained publicity man. In short, Sanatogen stands as a monument to the power of printers’ ink.

The claims for this product have already been referred to in The Journal, but it will do no harm to bring them again before our readers. Here are some taken from advertisements:

“The Re-Creator of Lost Health.”

“Sanatogen is ... a rebuilding food.”

“... revitalizes the overworked nervous system.”

“Specific nerve tonic action.”

“Most reliable and scientific of all nutrients.”

“... _in certain diseases_ it exerts a _specific action_ which
renders it a valuable adjunct to other curative measures.”

“It stimulates metabolic activity of tissue cells and secures more
complete oxidation of energy-yielding elements.”

“Sanatogen nourishes the system in a persistent, gradual,
cumulative way, so that its best effects unfold themselves in a
systematic, substantial progression to health and strength. It
follows that a regular and prolonged administration of Sanatogen is
necessary for the attainment of lasting results.”

“Sanatogen is a scientific compound, every particle of which
represents the finest concentrated, tissue-constructing nutriment,
endowed with unique revitalizing and rejuvenating powers.”

“Sanatogen contains over 700 per cent. more tissue-building, life
sustaining nourishment than wheat flour.”

Truly a wonderful preparation--if these statements are true! But they are false--most of them at least. And in that many who can ill afford it may be led to pay a ruinously high price for a very ordinary food, the statements are viciously and cruelly false.

In view of the properties with which Sanatogen is credited, its composition is naturally a matter of more than ordinary interest. What is this life-giving product? A package of Sanatogen was purchased and subjected to examination and analysis in the Association’s laboratory. Our chemists report:

LABORATORY REPORT

Sanatogen is a fine, nearly white powder having a faint yellowish
tinge. A circular which is enclosed in the package states:

“Sanatogen is a definite organic combination of 95 per cent.
of pure, specially prepared casein and 5 per cent. of sodium
glycerophosphate,...”

Qualitative tests indicated the presence in Sanatogen of casein, sodium, a phosphorous compound and glycerin or a glycerin compound. Starch and sugars were absent. Quantitative analysis showed that the composition of the specimen was essentially as follows:

Water (loss at 130 C.) 8.60
Ash 6.23
Casein and other proteins (N × 6.38) 83.10
Casein (N in precipitated casein × 6.38) 80.57
Proteins other than casein (by difference) 2.53
Sodium glycerophosphate (NaC_{3}H_{7}O_{6}P) (P in
filtrate from casein precipitation × 6.79) 5.59
Insoluble matter 0.84
Undetermined 1.87

While these results show that the claims concerning the composition of Sanatogen are not entirely correct, they indicate that the essential element in Sanatogen is casein.

The slight variation between the composition claimed for Sanatogen and the composition as determined by chemical analysis is of minor importance. Whether there is 83 per cent. of casein as found by the Association’s chemists or 95 per cent. as asserted by the manufacturers matters little. The important fact is that casein makes up about nine-tenths of the preparation and, as must be perfectly evident, Sanatogen derives whatever food value it may have from that casein. Casein is known in its commonest form as the curd in milk, or as “cottage cheese.” After the cream has been separated, the milk which remains contains nearly all the casein and milk sugar originally present but practically none of the fat.

WHY NOT COTTAGE CHEESE?

Whence comes the stimulation of metabolic activity, the wonderful nourishment of the system, the marvelous revitalizing and rejuvenating power claimed for Sanatogen? Not from the sodium glycerophosphate, for the consensus of opinion among leading physiologists indicates that phosphorus in the form of glycerophosphates has little influence on metabolism. Not from the glycerin, surely, for even granting that glycerin has food value the amount present is so small as to be negligible. The real source of energy in Sanatogen, then, lies in the casein which comprises about nine-tenths of its ingredients.

=======================+=========+==============+============
| | Cost of | Calories.
Kind of Food Material |Price per|1,000 Calories|Energy for
| Pound | Energy | One Dollar
-----------------------+---------+--------------+------------
Sanatogen | $4.54 | $3.01 | 332
Celery | .05 | .77 | 1,300
Eggs ($0.36 per doz.) | .24 | .16 | 6,300
Milk ($0.07 per qt.) | .035 | .11 | 8,850
Pork, loin roast | .12 | .10 | 10,350
Butter | .30 | .09 | 11,250
Mackerel, salt dressed | .10 | .08 | 11,850
Beef, stew meat | .05 | .07 | 15,300
Wheat bread | .06 | .05 | 20,000
Rice | .08 | .05 | 20,250
Sugar | .06 | .03 | 29,200
Pork, fat salt | .12 | .03 | 29,500
Potatoes | .01 | .03 | 29,500
Beans, white | .05 | .03 | 30,400
Oatmeal | .04 | .02 | 45,000
Cornmeal | .025 | .02 | 65,400
Wheat flour | .025 | .02 | 65,400
-----------------------+---------+--------------+------------

Of course Sanatogen, being composed largely of casein, has some food value. What that food value is may be seen by the accompanying table which compares the yield of energy for Sanatogen with that of a number of staple food products, the figures for the latter having been adapted from Professor Atwater’s calculations. This table shows that, from the standpoint of economy in the purchase of energy, no other food in the list is so poor as Sanatogen. While the manufacturers claim that “Sanatogen contains over 700 per cent. more tissue-building, life-sustaining nourishment than wheat flour,” the table shows that one dollar’s worth of wheat flour contains as much energy as one hundred and ninety-seven dollars’ worth of Sanatogen!

AN INQUIRY

Like all “patent medicines,” Sanatogen is exploited by the testimonial route. Actors, authors, politicians and not a few physicians--the latter, to the credit of the American profession, be it said, being chiefly Europeans--have testified to the wonderful properties of this product. Believing that it would be of interest to learn what scientific men thought of Sanatogen a letter of inquiry was written to several men whose training particularly fits them to express an impartial opinion on a question of this kind. The following inquiry, expressed in practically the same words, was propounded:

Is it possible for a product, even if it has the composition claimed for Sanatogen, to have properties as a food and medicine which are claimed for this preparation?

The replies to this inquiry are interesting and instructive, although they are what might have been expected from men whose judgment has not been warped by the glittering claims of the Sanatogen publicity agents.

THE REPLIES

Dr. Lewellys F. Barker, professor of medicine, Johns Hopkins University, medical department, says in part:

“If Sanatogen consists simply of casein and sodium glycerophosphate,
it is pretty obvious that all of its good effects (except perhaps
the psychic influence of taking an expensive and, to the layman,
mysterious remedy) can be gotten by including milk and eggs in the
food....

“The objection to Sanatogen lies, it seems to me, not in the
assertion of its proprietors that it is a ‘food and a tonic,’ but
in the misleading of the public and physicians into the belief that
it possesses extraordinary powers which make it worth while to pay
the price charged for it in order to get it. Very extravagant claims
are being made for it in advertisements in the lay press. If just as
much, and more, good in the form of ‘food and tonic’ can be obtained
from a dollar’s worth of milk and eggs as from a dollar and ninety
cents’ worth of Sanatogen, it is surely the duty of the medical
profession to inform the public of that fact.”

Dr. Frank Billings, professor of medicine and head of the Department of Medicine, University of Chicago, expresses his opinion thus:

“Of course, the thing is a fraud both as a food and as a tonic. Even
if it met all the requirements of the statements made of it by the
makers, it would not be any more of a food than as much casein taken
in milk and probably not as good; or any more than some other albumin
taken in some other form. I do not know just what pharmacologists
say of the glycerophosphate of soda, but so far as my own clinical
observations go I never saw any result from its use that could be
called specific, that is, due to the drug.”

Dr. Richard C. Cabot, assistant professor of clinical medicine, Harvard Medical School, says:

“In reply to your letter respecting the properties of Sanatogen, I
would say that in my opinion it is vastly improbable that it has the
properties claimed for it in the advertisements which you enclosed to
me. I have no doubt that it is a fairly good food. I see no reason to
believe that the phosphorus that it contains has any special action.”

Otto Folin, professor of biological chemistry, Harvard Medical School, expresses himself thus:

“For myself, or for any one who would take my advice, I would prefer
a glass of milk to Sanatogen when hungry and plain glycerophosphate
to Sanatogen when in need of a tonic.

“Medicated feed used to be sold for horses. To me the ‘food tonic’
combination represents one of the most unscrupulous fake ideas used
by manufacturers of patented articles to fool the public.”

Ludvig Hektoen, professor of pathology, University of Chicago, says in part:

“In my opinion, no attention whatsoever should be paid to the claims
advanced in favor of ‘Sanatogen’ as food and as medicine, because
the statements made in the advertisements of this product are
extravagant, misleading and quackish.”

J. H. Long, professor of chemistry and director of chemical laboratories, Northwestern University Medical School, expresses the following opinion:

“With every reading of the advertising literature of the Sanatogen
Company I am more and more impressed by the gross exaggeration of the
claims made for this mixture of casein and sodium glycerophosphate.
Cow’s milk contains 3-1/2 to 4 per cent. of casein, associated with
soluble phosphates. It is absurd to think that this casein after
precipitation from the milk has a greater nutritive value than it has
in its native condition. Casein, at best, is probably less valuable
as a food than are certain other proteins, because of its lack of
some of the amino groups essential in tissue building, and the
addition of a glycerophosphate cannot supply this deficiency.

“This is not the first attempt to exploit casein preparations. The
earlier efforts failed in practice because they were based on a wrong
conception concerning the physiologic value and importance of this
protein. The assumption that in the case of Sanatogen a ‘definite
organic combination’ with the glycerophosphate is formed cannot be
taken seriously by chemists. We have witnessed many such efforts to
palm off mixtures as definite organic compounds, and in this way to
claim for them a value in excess of that which they actually possess.”

Graham Lusk, professor of physiology, Cornell University Medical College, after calling attention to the falsity of the claim that Sanatogen is “a life-sustaining agent in disease,” says:

“If one considers the casein content alone, the dose of Sanatogen
recommended in the circular would furnish, at best, about what is
contained in a pint of milk, or one-fourth of the total of the
protein necessities of the body--using a low protein requirement.
That sodium glycerophosphate has any distinctly beneficial
physiologic action has never, to my knowledge, been shown.

“It is a great pity that the public does not realize the splendid
and economical value of milk, bread and the ordinary vegetables,
cereals and meats, as true ‘tonic food stuffs,’ in contradistinction
to prepared nostrums whose sale depends on a psychic stimulus applied
to a susceptible populace.”

H. Gideon Wells, associate professor of pathology, University of Chicago, says:

“There is nothing in my knowledge of physiologic chemistry which
would lead me to believe that a mixture of chemically isolated casein
and sodium glycerophosphate would possess any effect more favorable
than that of a corresponding amount of milk. I can easily believe
that it would be less valuable than milk. The successful practice
of many commercial houses, of isolating one of the constituents of
our food, and ascribing to it marvelous nutritive or therapeutic
properties, is one of the most telling bits of evidence of the
inadequacy of the education of the medical profession in physiology
and physiologic chemistry that can be conceived.”

The consensus of opinion thus expressed is only what might have been expected from men who could discuss the problem in a purely judicial spirit and with a freedom from that bias which seems to be inseparable from the consideration of the simplest of mixtures that have been glorified by a proprietary name.

THE TYRANNY OF WORDS

Herr Teufelsdröckh was right when he panegyrized clothes. And the worship of clothes is carried to the extreme nowhere so much as in the case of word-clothes. The most plebeian things when bedecked in sufficiently imposing word-finery are endowed with the attributes of royalty before which the average intellect bows down. Neither cottage-cheese nor glycerophosphates, when exposed naked to the world, commands any overweening respect; combined and dressed in the magic word “Sanatogen,” they receive the homage of those whose judgment is blinded by the glittering trappings of word-finery. Some day, possibly, there will be a democracy of intellect which will refuse to prostrate itself before mere word-raiment and will insist on appraising things at their naked worth. When that day comes, proprietary humbugs like Sanatogen will have become as extinct as the dodo and the great auk.--(_From The Journal A. M. A., April 20, 1912._)

The Bauer Chemical Company’s “Reply”

_To the Editor_:--Our attention has been called to a most unfair and unwarranted attack on Sanatogen which appears in your esteemed publication [April 20, p. 1216]. The article is such a perversion of the actual facts, and so completely--if not intentionally--misleading that we request, as a matter of common justice, that you give this reply equal publicity to your attack. The admiration and respect we have felt for your journal and our appreciation of the place it holds in the field of medical journalism, made your attack on a product like Sanatogen, representing so definitely the most painstaking and scientific research, the last thing expected. Indeed, it seems inconceivable that a journal apparently so alive to its responsibilities could publish broadcast an article so calculated to do harm, without first giving those whose interests are most at stake an opportunity to substantiate their claims.

There never has been a time that we have not been ready to meet any request from The Journal, or the respected gentlemen composing the Council on Pharmacy and Chemistry, for all information and data concerning Sanatogen. Had we had the slightest inkling that our product--or the claims made for it--were open to question or criticism, we would gladly have submitted all of the evidence, clinical, experimental, and theoretical, on which every statement, however simple, has been based.

To make a response is difficult, because your article is not written in a fair, unprejudiced spirit. In fact, although one would expect a sober, serious consideration of a matter so fraught with importance (if your contention is right) your whole attitude is one of ridicule and jocularity. Is it right to present scientific material in such a way and show so little respect for those who have offered you no affront or done you no injury? A little investigation would have shown you that the statements we have made about Sanatogen are based on the experiences and opinions of such men as von Noorden, C. A. Ewald, Duhrssen, Eulenburg, Neisser, Binswanger, von Leyden, Krafft-Ebing, Tillmanns, Tunnicliffe, and thousands of other earnest, reputable physicians. Any one might differ with their conclusions, but is it courteous or decent to hold them up to ridicule and contumely?

Can a discussion thus conducted hope to solve a scientific problem or accomplish any real good?

It would hardly seem so, and with all due respect we cannot help but feel that the situation has its analogy in the legal doctrine, “when you have no evidence, ridicule and abuse your opponent and his client.”

Sanatogen is a definite organic combination of (in round numbers) 95 per cent. casein and 5 per cent. glycerophosphate of sodium. The analysis as published in The Journal fails to show that this statement is untrue. The slight deviation as to the amount of casein present is explained by the fact that The Journal’s figures include the moisture, while ours are on the dry substance. Inasmuch as nearly all the moisture is absorbed after the product leaves the laboratories and is therefore added weight, the figures should be on the dry substance. It is hinted in the article that Sanatogen is a mere mixture of ingredients, in fact one of the gentlemen you quote openly intimates so. To this we say most emphatically that _anyone asserting Sanatogen to be a mere mechanical mixture of ingredients and not a definite chemical compound either wilfully misstates the facts or does not know_. Sanatogen represents a new idea or discovery in the domain of invalid dietetics and as such its process of manufacture as well as the product are protected by U. S. Letters Patent.

Assuredly it is the definite chemical combination found in Sanatogen on which the special value of this product as a medicinal food and tonic depends. A mere mixture of ingredients would represent only the sum-total of their individual virtues, but a definite combination of such ingredients means the formation of a new compound with properties of its own which far transcend those of any simple mixture of the original ingredients.

To compare Sanatogen to cottage cheese is the height of absurdity--as it was probably intended to be. The casein of Sanatogen is perhaps the most carefully purified milk protein available, and this fact is of essential importance when considering the value of Sanatogen as a medicinal food. To compare the casein of Sanatogen with crude commercial casein or with cottage cheese is as ridiculous as to compare a crude drug with the refined element. The same applies to the matter of cost. We suggest that an attempt be made to prepare purified casein according to Hammarsten’s method, if one wishes to determine what labor and expense is involved in the operation. Possibly it will be found cheaper to buy Hammarsten’s casein in the open market where the price is $3.50 per pound wholesale! And it is not a proprietary product, either.

Further, to compare the economic value of Sanatogen on the basis of calories is as unscientific as it is deliberately misleading. If the caloric standard only counted, a pound of oleomargarine would be as valuable as fifty eggs, a pound of laundry soap as valuable as a pound of choice beef. Sanatogen is not intended or recommended to replace ordinary foodstuffs. It is not recommended as a caloric or heat producer, but as a food-tonic supplying the essential elements of tissue construction and cell-repair in easily and perfectly assimilable form.

Digestibility, ease and completeness of assimilation count a great deal, and are the sole determining factors in cases of illness. Again, starch and fat are not essential substances to life. Without protein we cannot live. Exclude everything else from a patient’s dietary, and he will live. Exclude protein and it is only a question of time before he dies. It is evident, therefore, that to measure the value of a given food in calories only is misleading and dangerous, and an editorial in your valuable publication of November 4 last distinctly points this out.

According to the most careful and extensive experiments, covering a large number of scientifically studied cases, Sanatogen is not approached in the matter of rapidity of digestion and absorption by any other known foodstuff. That such a product does exert a definite stimulating or activating effect on the digestive and assimilative functions, thus promoting the digestion and appropriation of nutritive material has been demonstrated over and over again. That the organic phosphorus of Sanatogen is almost completely retained and assimilated has been proved beyond doubt by carefully conducted metabolism experiments. That from this, and from the stimulating action on phosphorus and nitrogen metabolism, a favorable effect on the nervous system could result, is conceivable. That such an effect does actually take place has been demonstrated clinically in literally thousands of cases.

As to our advertisements and literature: Every claim made emanates from the freely recorded statements of competent observers, checked and rechecked by men who have been absolutely free from all bias or prejudice. And these opinions, moreover, are not the superficial, passing views of a few physicians. Instead our claims are based on the voluntary, unbiased written reports of clinical experiences by over 15,000 practicing physicians--among whom a goodly proportion are members of your esteemed Association--and on over 150 published articles in the leading medical journals of the world, some of which your journal has considered of sufficient importance to present to its readers in abstract form, suppressing, it is true, all mention of Sanatogen, although thereby the original was sadly emasculated, if not actually falsified.

Among the physicians who have carefully tested Sanatogen and determined its dietetic and therapeutic properties are many men of truly international reputation, men who are as far above suspicion as was Caesar’s wife. At least one of these men was the honorary guest of your Association a few years ago.

It is such men that your article holds up to contempt and dishonor when you allow the false inference to go forth that Sanatogen is a mixture of casein and glycerophosphates. It is such men’s careful researches and experience that you attempt to offset by the snap judgment of men whom we claim, without the slightest intent of disparaging them, to be in the present instance unfitted to give an opinion on Sanatogen inasmuch as they--with perhaps one honorable exception--have never tested or used the product. Their lack of definite knowledge of Sanatogen is shown by their persistent references to casein and the glycerophosphates, as though these two ingredients were separate and not chemically combined. To consider Sanatogen a mixture is to lose the vital detail of its specific value.

Now after all, is this a fair, judicial spirit, is this true scientific enquiry? Are we to accept offhand judgments in preference to the opinions of those who speak from years of observation of the effects of Sanatogen? In the name of justice and fair play, is it right for the great Journal of the A. M. A. to ignore and suppress the accumulated evidence in favor of Sanatogen and cite instead the cursory opinions of men who have never seen Sanatogen, tested or observed its effect, who by the very nature of your enquiry must have been influenced subconsciously in favor of your side of the matter.

During the twelve years Sanatogen has been used, prescribed and recommended by thousands of competent physicians, it has been free from all secrecy. The truth has been told at all times. From the first we have cooperated with the profession. Never have we failed to safeguard the doctor’s interests. Never have we suggested by word or inference that any person should employ Sanatogen to the exclusion of medical treatment. Not a day passes but we refer people who inquire about this or that bodily ill, to their physicians for advice.

We regret the length of this letter but feel that the scientific character of Sanatogen, its well-defined chemistry and the respect we owe to the men who have not hesitated to give their honest opinions concerning its food and tonic effects, make it imperative that we refute at once errors and misleading statements, and correct to the best of our ability the wrong impression you have allowed to go forth. The clinical reports and statements and the scientific evidence on which we have based our claims are constantly available and may be examined by any responsible person for verification or any other legitimate purpose.

We have tried to make this article temperate, fair and free from ill temper and ill feeling. We only ask for justice and feel that you will be willing--possibly anxious--to correct, so far as you can, the great wrong you have done us.

The Bauer Chemical Co.
By F. W. Hehmeyer, Resident Manager.

[Comment: We devote considerable space to the above free advertisement of Sanatogen, as The Journal does not want to be accused of being unfair, even to patent medicine venders. As our readers will recognize, the above is simply a reiteration of the statements that have been published in the advertisements of Sanatogen. The song that runs through all the advertising matter is that Sanatogen is a chemical compound, and since it is a chemical compound it therefore possesses properties not to be found in the ordinary mixture. It is the old, old story; the “synthetic” argument is as hoary as the nostrum business itself but fortunately the medical profession is no longer easily fooled by it.

As a matter of fact, even assuming for the sake of argument that the casein and glycerophosphate in Sanatogen are in chemical combination, it would be a union of the loosest kind, which on entering the digestive tract must be broken up into its more stable components, casein and glycerophosphate. To claim that Sanatogen possesses any properties not possessed by its essential constituents is a silly piece of pseudo-scientific claptrap.

Of the testimonials on Sanatogen we shall at this time have nothing to say; The Journal has in the past repeatedly shown the worthlessness of this kind of evidence.

We have nothing to retract, rather we would emphasize and, had we space, enlarge on what we have already published, for we believe that a large and unfortunate portion of the public, that can ill afford it, is paying a ruinously high price for a substance having a very mediocre food value. That indigent consumptives, for instance, should be led by glittering falsehoods to squander on Sanatogen money that should go for “food tonics” of infinitely greater value, such as eggs, milk, vegetables and meats, is not only economic waste but inhuman cruelty.--Ed.]--(_From The Journal A. M. A., May 18, 1912._)

The Sanatogen “Grand Prix”

A number of letters have been received recently expressing surprise that Sanatogen had been granted a “grand prix” at the Exhibition of Medical and Surgical Material held in London at the same time that the Seventeenth International Congress of Medicine was in session. The correspondents have asked what such an “honor” meant. The company which exploits Sanatogen in the United States has not been slow to apprise the American public of the award. It has gone further and has written the advertising managers of magazines--including those that had refused Sanatogen advertisements--directing their attention to the fact that Sanatogen was awarded a “grand prize” and opining that “this unusual distinction” should make plain “the desirability of the presence of Sanatogen in the advertising columns of your esteemed publication.”

Those familiar with the methods of awarding prizes, medals and certificates to commercial firms and their products at expositions and exhibitions attach little weight to the “honors” thus conferred. It is a fact that most purchasers of large--and expensive--exhibit space at such exhibitions receive some kind of award which, it is tacitly understood, will be a useful advertising asset. Every one can call to mind many food products of mediocre quality that have flaunted on their labels the gold medals received at various expositions.

Nevertheless, it seemed worth while to find out just what the connection was between the commercial exhibition at which Sanatogen received the grand prize and the Seventeenth International Congress of Medicine. The following facts were developed: The commercial exhibition was entirely distinct and separate from the scientific exhibit of the Congress. It was managed and conducted by a British drug journal which had been giving annual “exhibitions” of its own for some years past, and this took the place of its regular exhibition. Immediately after the awards were made public the advertising pages of this drug journal were filled with full-page advertisements of the various products that received prizes. It may interest our readers to know that while the cottage-cheese-glycerophosphate product Sanatogen received a “grand prize” two other proprietary cottage-cheese-glycerophosphate products received “gold medals” at the same time. In the pharmaceutical department of the exhibit a widely--and fraudulently--advertised “patent medicine” received a silver medal! From the facts given it should not be difficult to appraise at its right value the “honor” conferred on Sanatogen. The fact that the exploiters of this preparation are trying to make capital out of this “award” is significant.

Among the members of the Award Jury whose names were given by this drug journal were three men of prominence in Great Britain, to whom we have written. A reply has been received from one, Dr. Stephen Paget, who says: “I was not on the jury, nor do I know anything about the matter.... I had nothing whatever to do with the awarding of prizes.”--(_From The Journal A. M. A., Oct. 11, 1913._)

A Restatement of the Case

The case against Sanatogen has been pretty plainly given at different times in The Journal, but the sale of the stuff goes on--thanks to the power of advertising. One criticism that has been made of this patent medicine is the exorbitant price charged for it. This objection, although but an incidental one, is the one that apparently appeals to the layman more strongly than the much more serious criticism, fraud in exploitation. You arrest the attention of the average man when you appeal to his purse; he resents paying an exorbitant price for anything. This probably accounts for the fact that this particular criticism has apparently hurt the sale of Sanatogen to a greater degree than the more serious objections made to the preparation. This also accounts, doubtless, for the fact that the attempts to answer The Journal criticisms, by those who are selling Sanatogen, have been largely devoted to the one point--its outrageously high price.

The fundamental objection to Sanatogen is not its high price, but the attempt to ascribe to a mixture of casein and glycerophosphates powers not possessed by these ingredients--in other words, the misleading and fraudulent claims made for it. Even if it were sold at cost price, the stuff, as at present advertised, would still be a fraud. The nub of the whole matter is: The claims made for Sanatogen are unwarranted, misleading and fraudulent.

SOME FRAUDULENT CLAIMS

The constituents of Sanatogen are casein and sodium glycerophosphate. These two very ordinary substances possess, so the Sanatogen people would have us believe, peculiar properties when they are brought together in chemical combination. Sanatogen, they claim, is a chemical combination of these constituents. The claim may be a good “selling-point,” but it cannot be, and is not, seriously taken by chemists. But even supposing, for the sake of argument, that sodium glycerophosphate and casein could be combined, there is not a scintilla of evidence to show that such a combination could survive the destructive influence of digestion and be absorbed. Whether Sanatogen is a chemical combination of casein and sodium glycerophosphate or a mere mechanical mixture of these two substances is really immaterial. In either case, it would be separated into its constituent parts by the digestive juices and would have the properties of sodium glycerophosphate and casein, and nothing more.

Remembering this, let us examine once more some of the claims made for this patent medicine:

“Sanatogen is a nerve and tissue food for which the brain, spinal
cord and the nerves have a special predilection.”

“... practically identical with the main ingredient of nerve and
muscle cells....”

“Sanatogen stands pre-eminent in its power to feed the nerve
centers, to promote healthy digestion, to give strength and
endurance to the entire system.”

“... food for tired nerves....”

“... a rational, scientific nerve-food.”

To the physiologist, the term “nerve-food” is an absurdity. The processes of digestion reduce the albuminous substances (proteins, such as casein) of the food to simpler forms. This is true no matter what may be their source. Whether the proteins are derived from the gluten of wheat, the casein of milk or the albumin of egg, one will “feed the nerves” just as well as the other. And Sanatogen “feeds the nerves” no more than, in fact not as much as, do bread and meat and eggs. Of course, the casein in Sanatogen has food-value, but so has ordinary casein--cottage cheese, “pot cheese,” or the German _Schmierkäse_, for instance--and it is both false and fraudulent to claim for the casein in Sanatogen any greater nutritive value than that possessed by the casein in ordinary milk. To pretend that there are wonderful properties in the protein of Sanatogen when just as good protein can be purchased (for much less money) from the milkman, is to perpetrate a fraud on the purchaser. Here are some more claims:

“... marvelous revitalizer of nerve health.”

“... Sanatogen has positive reconstructive force in neurasthenia.”

“If You need New Strength and Vitality You should at once get
acquainted with Sanatogen.”

Strangely like the “lost manhood” advertisements, this last. And this, also:

“... has brought new strength, new vitality and new relish of life
to thousands upon thousands who suffered from starved nerves....”

“Countless people ... have regained fresh health and vigor through
the vitalizing and invigorating effects of Sanatogen.”

Of course Sanatogen is not sold as a “consumption cure.” No such crude claims as these emanate from the skilled advertising agents employed by the Sanatogen people. If they did they could not get space in high-grade magazines! As a preventive of consumption, however, we find:

“Sanatogen ... creates new tissue and nerve capital ... This nerve
capital will ... save the individual from attacks of acute disease.
Against tuberculosis it is an excellent investment.”

Also, it is a pick-me-up! Thus:

“Sanatogen promises to pick you up when run down--_it does so_.”

Most people are under the necessity of working for a living. If we are to believe the Sanatogen advertisements, it seems remarkable that the human race has managed to jog along for so many centuries without this product, for we read:

“It is practically indispensable to all who are unable to take
prolonged rest....”

Naturally we do not expect to find the coarse, “free-to-you-my-sister” type of claims in Sanatogen advertisements. Nevertheless:

“Women ... find in Sanatogen a genuine sustaining agent.”

Finally, we would respectfully direct the attention of those gentlemen of the medical profession who have so far forgotten the dignity of their calling as to give fulsome puffs for this casein-glycerophosphate product to the following claims and ask whether they really subscribe to them:

“... it revivifies the nerves, promoting sleep and helping
digestion....”

“... it builds up the blood, creating new strength and the power to
do and accomplish.”

“... Sanatogen is a _natural_, healthful food and tonic....”

“... a health and strength giving food and tonic composed of those
very elements which make cell and tissue grow.”

“Blood and tissues alike hunger for Sanatogen as their concentrated
nourishment.”

“Sanatogen is the one food tonic that commands your absolute
confidence.”

How many intelligent physicians really believe that there is the slightest basis of fact for the claims we have quoted? Yet it is by means of these claims that Sanatogen is being foisted on a public that looks to the medical profession for enlightenment and truth. And every quotation in this article is taken from advertising matter issued during the current year, 1913!

In closing, let us reiterate: The objections to Sanatogen are primarily the objection to any fraud. It is being sold under unscientific, misleading and fraudulent claims; moreover, although this is of less importance, the purchaser pays an extraordinary price for a most ordinary product. We believe the time will come when even the artificial stimulus of vast advertising appropriations will be insufficient to overcome the inertia inherent in a product of small merit. When that time comes, Sanatogen will die a natural death. In the meantime, its exploiters are reaping a golden harvest, of which no small part is being divided among publishers, medical and otherwise. And the credulous among the sick and suffering pay the bills!--(_From The Journal A. M. A., Dec. 6, 1913._)

SANATOGEN: A SCIENTIFIC INVESTIGATION OF ITS ALLEGED ACTION ON THE
RECUPERATING POWERS OF THE BLOOD

Sanatogen, the new elixir of life compounded of casein and glycerophosphates, has been noticed in _The Journal_ from time to time. It will be remembered that, while it has been claimed that “Sanatogen contains over 700 per cent. more tissue-building, life sustaining nourishment than wheat flour,” the facts are that one dollar’s worth of wheat flour contains as much energy as one hundred and ninety-seven dollars’ worth of Sanatogen! To this the manufacturers rejoin, in effect, that the casein and glycerophosphates in Sanatogen, being in chemical combination, possess a mystical and esoteric virtue not measurable in terms of the food-value of the several ingredients. The fact is, of course, that even assuming, for the sake of argument, that the ingredients of Sanatogen are in chemical combination, the compound cannot have any effect on the organism different from that of the uncombined casein and glycerophosphate, for the union must be of the loosest kind and must be broken up as soon as the preparation enters the digestive tract.

Testimonials are published in the Sanatogen “literature” which show results in a variety of conditions; cerebral concussion, alcoholic gastritis, anemia, etc. The patient is given a chance to recover with rest, proper diet--and Sanatogen. And the recovery which ensues is attributed to Sanatogen!

Not all of these testimonials are as naive as that of the Right Reverend the Bishop of Bath and Wells, who contributes the following bit of second-hand testimony:

“You may like to hear that I am informed by my private secretary
that a member of his family has derived _very remarkable benefit_
from using Sanatogen.”

Jar 1 contains 3-1/3 ounces of the casein-glycerophosphate combination made abroad and sold under the name “Sanatogen;” it costs One Dollar.

Jar 2 contains 2 pounds 13-1/2 ounces of a casein-glycerophosphate combination made by an American casein company; it costs One Dollar. For the same money, then, one gets nearly 15 times as much of this casein-glycerophosphate combination made in America as when the casein-glycerophosphate combination is sold under the name “Sanatogen” and manufactured abroad.

Jar 3 contains one dollar’s worth of pure casein. The casein entirely fills the jar, although the weight of the material is the same as the weight of the casein-glycerophosphate combination in Jar 2. Pure casein is more bulky than the casein-glycerophosphate combination.

Again we would emphasize that the chief objection to Sanatogen is not its high price, but the fraudulent claims under which it is sold.]

The following selections perhaps fairly represent the value to science of the clinical evidence offered. Describing a case of vomiting from cerebral concussion:

“I ordered an ice-bag to the head, a mustard leaf to the
epigastrium, absolute recumbency in bed and small feeds of
Sanatogen with water. This diet was continued for three days, but
the vomiting ceased the second day.”