Chapter XXV: Part III: Contributions From the Journal: Nostrums (6)

And here a case of “hungry tired nerves”:

“I have just had a recovery in a remarkable case which scores a
victory for Sanatogen. The patient, a man 63, had been treated for
some years past for heart trouble. When he came to me, however,
I diagnosed his trouble as ‘hungry tired nerves.’ I put him on
Sanatogen and eupeptics. In a month he was much improved.”

In a serious case of the “American disease”:

“I tried Sanatogen on a woman suffering from extreme neurasthenia
and debility. For the past six weeks I have had, and still have,
her under rest-cure treatment, during which time I have given her
Sanatogen. I have been very much elated with the treatment.”

Anemia in a girl of 23 working in a bookbindery:

“I promptly decided to use Sanatogen. In addition, I was able to
secure the girl’s absence from work so that she had the advantage
of outdoor life and sunshine. Improvement was rapid.... Both a
priori and from results obtained it seems almost justifiable to
speak of Sanatogen as a specific in ordinary uncomplicated anemia.”

Note that in all these cases two or more remedial factors were introduced, yet any favorable result is promptly ascribed to only one factor, Sanatogen! And the factor of spontaneous improvement irrespective of all remedial measures is also ignored.

A “SCIENTIFIC” TESTIMONIAL

Every physician knows that the kind of evidence just quoted has the same scientific value as that of the average “patent medicine” testimonial--none whatever. The exploiters of Sanatogen put forward some testimony, however, that purports to have a certain authority. This is a statement to the effect that “Sanatogen acts as a strong stimulus as far as the recuperative powers of the blood are concerned.”

This claim is based on biologic experiments carried out by two physicians, Drs. G. Mann and J. G. Gage, the record of whose work was published in the _Lancet_, Oct. 19, 1912. The article of Mann and Gage was gone over with some care and the experiments there described did not seem to justify the conclusions reached by the authors. As it had been published in the _Lancet_, a medical journal of standing, whose publishers apparently thought it of sufficient importance to warrant the expense of a colored plate insert, it seemed worth while to have the work of Mann and Gage reviewed and its conclusions checked by parallel experiments. A. J. Carlson, professor of physiology at the University of Chicago, was asked to do this work and kindly undertook it. His report follows:

Report of Professor Carlson

I am asked to review the work done by Drs. G. Mann and J. G. Gage, from which they draw the following conclusions:

“Sanatogen [sodium caseinogenate glycerophosphates] further
stimulates blood cells to undergo nuclear division, which during the
early period is mostly amitotic.... Therefore, it is evident that
Sanatogen acts as a strong stimulus as far as the recuperative powers
of the blood are concerned.”

Three series of experiments were made and reported by Drs. Mann and
Gage, comparing the histology of the blood in starvation and during
the height of digestion. The experiments of the first series were
made on six students, the starvation period being thirty-six hours,
ordinary food being taken after the thirty-six hours’ fast, so far as
can be gathered from Dr. Mann’s report. It was found that during the
height of digestion the nuclei of the lymphocytes and leukocytes stain
more deeply, and that there is a slight decrease in the cytoplasm and
consequent diminution in the size and number of the granules of the
neutrophil and the eosinophil cells, in comparison with the blood
during fasting.

The experiments of the second series were made on 100 frogs that had
starved for months, blood-films being taken at varying periods after
feeding 1 gm. Sanatogen. The changes noted in the white blood-cells
of the frogs were practically identical with those described in the
case of the six students. Increased cell division is stated to occur.
The nuclei of the erythrocytes stain more deeply and the cells are
increased in size, and exhibit increased cell division twenty-four
hours after the feeding.

The third series consisted of one experiment on Dr. Mann himself. He
fasted twenty hours and then took 15 gm. of Sanatogen in a cup of
water. Practically the only change noted in the blood after the feeding
was a deeper staining of the nuclei of the white cells. To quote:

“The changes in the granules of the polymorphonuclear leukocytes
and in the eosinophils were much less marked than in the specimens
supplied by the students, and the diminution in the size of the
white cells was so insignificant as to be hardly noticeable.”

Assuming that the blood-changes reported are correct, is the conclusion
warranted that Sanatogen is a powerful recuperative stimulant to the
blood?

In the first place, it remains to be proved, for there is as yet
positively no evidence, that the deeper staining of the nuclei during
digestion and absorption of a protein meal represents “recuperative
power of the blood” or processes of “feeding” on the part of the white
cells. The actual significance of these changes requires further
investigation. The increased division of the blood-cells described by
Dr. Mann in the frogs was not observed by him in man. This phenomenon
in the frogs is, in all probability, associated with the extraordinary
length of the starvation period (months) and the well-known seasonal
variations in the physiology of this species.

In the second place, waiving for the moment the question of the
significance of the blood-changes observed, the evidence, so far as it
goes, points to the conclusion that the greater affinity of the nuclei
of the white cells for the stain is brought about by the feeding of any
protein food. The experiments do not demonstrate any different or more
marked effect from Sanatogen than from other protein foods.

The test on the six students with ordinary food can be considered
as a control on the single Sanatogen test on Dr. Mann himself. The
blood-changes in the students were more marked than in Dr. Mann.

Although Mann and Gage say that six frogs were used as controls, they
do not say how the controls were treated, or draw any comparisons
between the controls and the frogs fed with Sanatogen. So far as the
report goes, therefore, the only basis for comparison is afforded by
the work of one of Dr. Mann’s pupils, H. G. Butterfield. This worker,
as quoted by Mann, found that on feeding newts after two weeks’
starvation with a worm the size of a wooden match, the nuclei of all
tissues (excepting nerve cells) take a much deeper stain than in the
control animals. To pronounce Sanatogen, on the basis of the facts
reported, a “powerful stimulus” to blood-formation is a piece of
special pleading, if not of downright disingenuousness. Considered on
its own merits, the work would not have appeared to me worthy of being
repeated for the purpose of checking up such obviously unwarranted
conclusions. In order to comply with the request made of me, however, I
have repeated Dr. Mann’s experiments:

EXPERIMENTS BY PROFESSOR CARLSON

I. TESTS ON MAN (A. J. C.)

1. Thirty-six hours’ fast followed by a meal of 25 gm. Sanatogen in
water.

2. Thirty-six hours’ fast followed by a meal of 25 gm. casein in
water.

3. Thirty-six hours’ fast followed by a meal of 200 c.c. of milk.

II. TESTS ON RATS

1. Four animals, seventy-two hours’ fast followed by a meal of
Sanatogen in water.

2. Two animals, seventy-two hours’ fast followed by a meal of
crackers and milk.

3. Two animals, seventy-two hours’ fast followed by a meal of
casein in water.

4. Two animals, seventy-two hours’ fast followed by a meal of
casein and sodium glycerophosphate in water.

Blood-films were taken at intervals during the fasting period and for
twenty-four hours after feeding was resumed. The technic of fixing and
staining given by Drs. Mann and Gage was followed in every detail in
order to make my results comparable with their findings.

RESULTS

My results may be summarized as follows:

1. The only change in the blood-cells that could be detected with
certainty in rats or in man, after feeding with Sanatogen or after
feeding with other foods, was a deeper staining of the nuclei of the
white cells in the films taken after feeding as compared with the
films taken during fasting. This difference is generally distinct,
and unmistakable, although individual cells can always be found in
the fasting and the feeding preparations that show no difference in
affinity for the dyes. To this extent my results confirm those of Mann
and Gage. I was not able, however, to make out any constant difference
in the size of the cells, quantity of cytoplasm, or size and number of
cytoplasmic granules similar to those reported by Mann and Gage.

2. There was no difference in the affinity for stains on the part of
the white blood-cells in films taken after feeding Sanatogen and those
taken after feeding milk, crackers, casein, and casein and sodium
glycerophosphate. This is true for the tests both on man and on rats.

3. The above-mentioned difference in the staining of the cell nuclei
was somewhat more marked in the tests on rats than in the tests on man,
probably owing to the longer starvation period in the case of rats.

It has already been stated that the significance of this increased
affinity for dyes in the nuclei of the white blood-cells must be
determined by further investigation. It may be related to the change
in the titration alkalinity of the blood rather than an evidence of
“recuperative power” on the part of the blood, as it is well known that
starvation induces acidosis, while during digestion the alkalinity of
the blood is distinctly increased. If we assume that increased staining
reaction during digestion indicates “increased recuperative power of
the blood” it follows that such common and inexpensive foods as milk,
crackers and casein are just as “powerful stimuli” to this recuperation
as Sanatogen.

The extensive researches of Mendel and Osborne have shown that casein
is in a certain sense a perfect food in that it is, in normal animals,
capable of promoting growth and maintaining nitrogenous equilibrium,
at least for long periods of time. The burden of proof, however, rests
with the promoters of Sanatogen to show that the casein in Sanatogen is
superior to the natural product of the cow.

Conclusion

From the findings in Professor Carlson’s report on this disguised puff
of a mendaciously exploited proprietary, about all that remains to be
said is that it is humiliating to find such pseudo-science, not only
built up by members of a profession trained in science, but also given
currency and authority by a medical journal of high standing.--(_From
the Journal A. M. A., Sept. 26, 1914._)

As to Sanatogen

For several years it has been known by physiologists that all proteins taken into the stomach are disintegrated into their fundamental components, the amino-acids, and that they are not absorbed at all as proteins, except in most minute amounts under exceptional conditions. Therefore, no matter what protein is taken as food, the material obtained from this protein by the body is a group of amino-acids, always pretty much the same except in relative proportions, whatever the food. A few proteins lack certain essential amino-acids, but any ordinary diet supplies enough, and more than enough, of each and every amino-acid. Furthermore, since the proteins are completely disintegrated before absorption, it follows that any adventitious chemical substance that is bound to a protein taken in the food does not enter the blood and circulate in the body in the same protein compound.

All the facts stated above are elementary, and should be known by any and every physician who pretends to keep even approximately abreast of the science of medicine. If there are any who do not know these fundamentals, and from certain unwelcome evidence we fear there are, they must be resigned to being told just where they stand. Certainly they have no good excuse for their lack of information, for the physiologists and biochemists have informed them of modern advances in innumerable ways. For ten years and more these facts have been discussed and demonstrated in societies and in medical publications. And yet--there is Sanatogen, prescribed by Geheimrats, Hofrats and also by doctors, and testimonialed as abundantly by men with medical degrees as Duffy’s whisky is by centenarians. One can merely throw up his hands. If, as the exploiters of Sanatogen declare, the product “has been endorsed by von Noorden, Ewald, Duhrssen, Eulenburg, Neiser, Binswanger, Leyden, Krafft-Ebing, Tillmanns, Tunnicliffe and thousands of other earnest, reputable physicians,” we can only say that their earnestness has not been in the direction of grasping fundamental advances in medical sciences, however great the reputation they have gained may be.

The article by John Phillips Street that follows is another report of exact experimental observation which shows, as was obvious beforehand, that Sanatogen has the properties of its constituents, namely, casein and glycerophosphates. Nothing more nor nothing less could be the case. Bottling dried cottage cheese plus some glycerophosphates, and raising the price many times, may increase its psychic effect, but it will not alter its physiologic action. These facts we have presented often enough, but the amount of paid advertising the proprietors of this compound find it profitable to carry in the United States makes us feel obliged to give them this bit free. That laymen may be persuaded to purchase Sanatogen in the belief that it possesses some occult powers not to be found in its constituents is not surprising. By blatant and persistent advertising, the public can be fooled into buying any product--however valueless--for which medicinal claims are made. But that physicians should prove equally gullible is a sorry commentary on the scientific attainments of the followers of a learned profession.--(_Modified from Editorial in The Journal A. M. A._, Nov. 21, 1914._)

THE FEEDING VALUE OF SANATOGEN COMPARED WITH COMMERCIAL CASEIN
WITH RESPECT TO MAINTENANCE AND GROWTH

John Phillips Street, M.S.
Chemist Connecticut Agricultural Experiment Station
NEW HAVEN, CONN.

The proprietary preparation “Sanatogen” is claimed to consist of about 95 per cent. casein and 5 per cent. sodium glycerophosphate. The analysis of C. B. Morison[122] is as follows:

[122] Morison, C. B.: Rept. Conn. Agri. Exper. Station, 1912, p. 197.

Water 9.97
Total nitrogen 12.81
Nitrogen, ppt. by acetic acid 12.54
Casein 80.01
Ether extract 0.11
Ash 5.59
Sulphur, total 0.73
Sulphur in casein 0.64
Phosphorus, total 1.49
Phosphorus in casein 0.69
Phosphorus in inorganic form 0.11

In connection with the above analysis it was demonstrated that sodium glycerophosphate was present. Sanatogen, therefore, consists essentially, on the water-free basis, of about 90 per cent. casein and 5 per cent. sodium glycerophosphate, with a small amount of an unidentified nitrogenous compound containing both sulphur and phosphorus, and a small amount of phosphorus in organic combination. The manufacturers claim that the two essential ingredients exist in Sanatogen as a definite chemical compound. Certain authorities, on the other hand, have insisted that the casein and glycerophosphate have not been chemically combined and that Sanatogen is simply a mechanical mixture of the two. Which claim is correct we will not consider here, for indeed it is of little importance, for whether or not chemically combined the action of the digestive fluids of the body would speedily break down the alleged compound into its constituents, and the body would have casein and the glycerophosphate offered for its use, just the same as though they had been offered as a mere mechanical mixture.

It being apparent that Sanatogen consists almost entirely of casein and sodium glycerophosphate, the former well-known ingredient making up nine-tenths of its weight, the question naturally arises how a mixture of these two common substances can acquire, simply by that admixture, unusually valuable properties not possessed by the two components. Leading physiologists quite generally agree that phosphorus in the form of glycerophosphates influences metabolism very little. Furthermore, it is obvious that the food value of the small amount of glycerin present must be slight. It is apparent therefore, that whatever nutriment or energy Sanatogen supplies must be dependent on its main constituent casein.

Sanatogen is commonly sold at retail in 100 gm. or 200 gm. packages for $1 and $1.90, respectively. It is possible that in larger quantities these prices might be shaded somewhat, but the fact remains that the ordinary retail purchaser of Sanatogen pays for it about 1 cent per gram, or about $4.50 per pound. If the value of Sanatogen depends on its casein, one might ask, in all fairness, why should the patient pay $4.50 per pound for Sanatogen when he can secure ordinary commercial casein for 8.5 to 10 cents per pound! (The Casein Mfg. Co. of New York quoted to me their No. 60 casein at 10 cents per pound in 5-pound lots, 8.5 cents per pound f. o. b. Bainbridge, N. Y., in 100-pound lots, and 8.5 cents per pound, freight paid, in 500-pound lots.) I have purchased Sanatogen from a wholesale druggist at the rate of $2.75 for 400 gm., or $3.12 per pound, so that under the most favorable conditions the cost of Sanatogen is more than thirty times as great as the commercial casein in question.

Is the consumer justified in paying this exceedingly high price for purified casein? The following feeding experiments were carried out to answer this query.

FEEDING EXPERIMENTS

White rats were chosen for the experimental animals because of their adaptability for tests of this kind, as shown by the extended successful experience of Osborne and Mendel, and also because, by using white rats, I could take advantage of the equipment and the experience of my colleagues, Dr. T. B. Osborne, Prof. L. B. Mendel and Miss Edna L. Ferry.

The value of Sanatogen as compared with commercial casein was studied from two points of view:

1. Its value in maintaining the weight of mature rats.

2. Its value in promoting the growth of young rats.

I. THE MAINTENANCE OF WEIGHT OF MATURE RATS

The Sanatogen used contained 12.88 per cent. of nitrogen, and the
casein, 12.82 per cent., so that from the point of view of nitrogen
content they were practically equivalent, gram for gram.

Six healthy male animals were selected, Rats 1, 2 and 3 being
fed the casein ration and Rats 4, 5 and 6 the Sanatogen ration.
At the beginning of the experiment the casein rats were 257, 360
and 376 days old; the Sanatogen rats, 249, 321 and 275 days old,
respectively. These weight conditions, if anything, slightly favored
the Sanatogen rats, as they were slightly less mature, and a greater
growth might naturally be expected.

The rations fed had the following percentage composition:

Ration 1 Ration 2
Casein 20 Sanatogen 20
Protein-free milk[BA] 28 Protein-free milk[BA] 28
Lard 8 Lard 14
Unsalted butter 18 Unsalted butter 18
Corn starch 26 Corn starch 20

[BA] Osborne and Mendel: Feeding Experiments with Isolated Food
Substances, Carnegie Inst. of Washington, Publ. 156, 1911, Part 2,
p. 80.

The rats were weighed twice a week for nine weeks, a record of the
food consumed also being kept. Table 1 shows the weekly weights of
the casein rats, the weekly gain or loss, and the weekly consumption
of food. Table 2 gives similar data for the Sanatogen rats.

Certainly the above data show no superiority of Sanatogen over commercial casein. In fact the results might be taken to suggest a slight advantage for the cheaper article, if one were warranted in drawing fine distinctions from a limited number of animals.

To conclude, _a comparative feeding of six male white rats during nine weeks showed no nutritive superiority of Sanatogen, costing $3.12 per pound, over commercial casein costing 10 cents per pound_.

II. THE PROMOTION OF GROWTH IN YOUNG RATS

In the second series of experiments ten male rats were used with
four different rations. In these, casein and Sanatogen were
compared, using both Osborne and Mendel’s “protein-free milk” and
their “artificial protein-free milk IV.”[123] Butter fat was also
substituted for the unsalted butter used in Rations 1 and 2.

[123] Osborne and Mendel: Jour. Biol. Chem., 1913, xv, 317.

The percentage composition of the rations fed was as follows:

Ration 3 Ration 5
Casein 20 Casein 20
Protein-free milk 28 Artificial p.-f. milk IV 29
Lard 8 Lard 8
Butter-fat 18 Butter-fat 18
Corn starch 26 Corn starch 25

Ration 4 Ration 6
Sanatogen 20 Sanatogen 20
Protein-free milk 28 Artificial p.-f. milk IV 29
Lard 14 Lard 14
Butter-fat 18 Butter-fat 18
Corn starch 20 Corn starch 19

Two male rats were used with each of Rations 3 and 4, and three with
each of Rations 5 and 6. They were all healthy young rats ranging
from 57 to 71 days old. As in the first series of experiments
the rats were weighed twice a week and a record kept of the food
consumed. Rations 3 and 4 were fed for seventy-seven days, Rations 5
and 6 for thirty-five days.

Table 3 shows the weekly weights and gains or losses of the rats fed
Rations 3 and 4.

Rat 8 suffered more or less from diarrhea during a considerable part
of the experiment, covering a period from March 16 to April 9, and
from April 13 to May 11. The food intake correspondingly decreased
during those periods.

TABLE 1.--WEIGHTS OF CASEIN RATS, ON RATION NO. 1,
OVER A PERIOD OF NINE WEEKS[BB]

=======+====================+====================+=====================
| Rat 1 | Rat 2 | Rat 3
+-------+-----+------+-------+-----+------+-------+-----+-------
Date |Weight,|Gain |Food |Weight,|Gain |Food |Weight,|Gain |Food
| gm. | or |Eaten,| gm. | or |Eaten,| gm. | or |Eaten,
| |Loss,| gm. | |Loss,| gm. | |Loss,| gm.
| | gm. | | | gm. | | | gm. |
-------+-------+-----+------+-------+-----+------+-------+-----+-------
1/2 | 240.0 | -- | -- | 264.6 | -- | -- | 314.1 | -- | --
1/9 | 250.8 |+10.8| 73.7| 270.9 | +6.3| 85.2| 314.6 | +0.5| 95.7
1/16 | 264.3 |+13.5| 89.3| 284.9 |+14.0| 99.2| 308.7 | -5.9| 117.9
1/23 | 274.9 |+10.6| 90.7| 293.5 | +8.6| 107.7| 313.8 | +5.1| 116.5
1/30 | 278.6 | +3.7| 80.2| 304.5 |+11.0| 100.5| 322.2 | +8.4| 116.7
2/6 | 278.3 | -0.3| 82.4| 294.2 |-10.3| 97.0| 311.2 |-11.0| 119.9
2/13 | 288.7 |+10.4| 85.5| 281.5 |-12.7| 94.2| 308.2 | -3.0| 125.6
2/20 | 286.4 | -2.3| 86.1| 293.3 |+11.8| 86.8| 309.0 | +0.8| 126.8
2/27 | 287.6 | +1.2| 81.1| 297.6 | +4.3| 100.7| 303.4 | -5.6| 129.3
3/6 | 292.6 | +5.0| 80.1| 307.4 | +9.8| 103.1| 292.4 |-11.0| 101.0
Total | -- |+52.6| 759.1| -- |+42.8| 874.4| -- |-21.7|1,049.4
| | | | | | | | |
Average| | | | | | | | |
per | | | | | | | | |
week | -- |+ 5.8| 84.3| -- |+4.8 | 97.2| -- |-2.4 | 116.6
-------+-------+-----+------+-------+-----+------+-------+-----+-------

[BB] The growth curves of Rats 1, 2 and 3 are given in Chart 1.

TABLE 2.--WEIGHTS OF SANATOGEN RATS, RATION NO. 2,
OVER A PERIOD OF NINE WEEKS[BC]

=======+====================+=============+======+=======+=====+======
| Rat 4 | Rat 5 | Rat 6
+-------+-----+------+-------+-----+------+-------+-----+------
Date |Weight,|Gain |Food |Weight,|Gain |Food |Weight,|Gain |Food
| gm. | or, |Eaten,| gm. | or |Eaten,| gm. | or |Eaten,
| |Loss | gm. | |Loss,| gm. | |Loss,| gm.
| | gm. | | | gm. | | | gm. |
-------+-------+-----+------+-------+-----+------+-------+-----+------
1/2 | 251.8 | -- | -- | 290.6 | -- | -- | 294.0 | -- | --
1/9 | 257.1 |+ 5.3| 73.4 | 297.2 |+ 6.6| 86.3| 289.1 |- 4.9| 58.4
1/16 | 262.4 |+ 5.3| 89.8 | 292.4 |- 4.8| 88.9| 286.1 |- 3.0| 76.8
1/23 | 274.4 |+12.0| 97.3 | 295.7 |+ 3.3| 92.8| 287.6 |+ 1.5| 85.8
1/30 | 282.7 |+ 8.3| 95.5 | 299.5 |+ 3.8| 92.3| 298.6 |+11.0| 90.9
2/6 | 279.8 |- 2.9| 97.7 | 284.2 |-15.3| 87.7| 292.9 |- 5.7| 89.8
2/13 | 271.2 |- 8.6| 96.1 | 280.0 |- 4.2| 94.9| 295.1 |+ 2.2| 99.7
2/20 | 257.5 |-13.7| 91.6 | 274.9 |- 5.1| 96.4| 296.0 |+ 0.9| 93.9
2/27 | 258.0 |+ 0.5| 93.5 | 273.0 |- 1.9| 103.3| 295.0 |- 1.0| 95.1
3/6 | 270.9 |+12.9| 94.8 | 278.1 |+ 5.1| 94.9| 306.3 |+11.3| 89.4
Total | -- |+19.1|829.7 | -- |-12.5| 837.5| -- |+12.3| 779.8
| | | | | | | | |
Average| |+ 2.7| | | | | | |
per | | | | | | | | |
week | -- | | 92.2 | -- |- 1.4| 93.1| -- |+ 1.4| 86.6
-------+-------+-----+------+-------+-----+------+-------+-----+------

[BC] The growth curves of Rats 4, 5 and 6 are given in Chart 2.

TABLE 3.--COMPARATIVE WEIGHTS OF RATS FED RATIONS 3 AND 4

=====+=============================+=============================
| Weights of Rats, Ration 3, | Weights of Rats, Ration 4,
|Casein, Protein-Free Milk |Sanatogen, Protein-Free Milk
+-------------+---------------+-----------------------------
| Rat 7 | Rat 8 | Rat 9 | Rat 10
Date +-------+-----+-------+-------+-------+------+-------+------
|Weight,|Gain |Weight,|Gain |Weight,|Gain |Weight,|Gain
| gm. | or | gm. | or | gm. | or | gm. | or
| |Loss,| |Loss, | |Loss, | |Loss,
| | gm. | | gm. | | gm. | | gm.
-----+-------+-----+-------+-------+-------+------+-------+------
3/9 | 142.2 | -- | 108.0 | -- | 127.8 | -- | 107.0 | --
3/16 | 152.8 |+10.6| 120.3 | +12.3 | 129.1 | +1.3| 116.0 | +9.0
3/23 | 165.7 |+12.9| 135.1 | +14.8 | 144.6 | +15.5| 134.5 | +18.5
3/30 | 178.6 |+12.9| 140.4 | +5.3 | 160.0 | +15.4| 149.8 | +15.3
4/6 | 187.8 | +9.2| 148.8 | +8.4 | 173.1 | +13.1| 143.8 | -6.0
4/13 | 198.5 |+10.7| 157.6 | +8.8 | 185.6 | +12.5| 166.1 | +22.3
4/20 | 204.6 | +6.1| 164.6 | +7.0 | 194.8 | +9.2| 179.4 | +13.3
4/27 | 210.3 | +5.7| 167.2 | +2.6 | 204.6 | +9.8| 191.0 | +11.6
5/4 | 223.0 |+12.7| 179.6 | +12.4 | 222.9 | +18.3| 204.7 | +13.7
5/11 | 223.6 | +0.6| 191.6 | +12.0 | 236.4 | +13.5| 210.8 | +6.1
5/18 | 231.5 | +7.9| 203.6 | +12.0 | 240.0 | +3.6| 218.6 | +7.8
5/25 | 237.4 | +5.9| 213.9 | +10.3 | 247.3 | +7.3| 226.7 | +8.1
Total| -- |+95.2| -- | +105.9| -- |+119.5| -- |+119.7
-----+-------+-----+-------+-------+-------+------+-------+------

The difference in the gains in weight shown by the four rats are not great and certainly do not warrant the conclusion that Sanatogen possesses any marked superiority over the commercial casein in promoting growth. The slightly increased gains shown by Rats 9 and 10 are entirely incommensurate with the cost of the Sanatogen. All of the rats showed a vigorous growth and exceeded the average weight expected for rats of their respective ages, based on the long series of observations of Osborne and Mendel, as shown in Table 4.

TABLE 4.--WEIGHT OF RATS 7 TO 10 COMPARED WITH AVERAGE WEIGHT
OF RAT OF SAME AGE

=======+==============+==============+==============
| | |Average Weight
Rat | Age in Days | Final weight,| for rat of
| | gm. | Same Age, gm.
-------+--------------+--------------+--------------
7 | 148 | 237 | 204
8 | 138 | 214 | 201
9 | 145 | 247 | 204
10 | 134 | 227 | 197
-------+--------------+--------------+--------------

TABLE 5.--WEIGHTS OF RATS FED RATION 5, CASEIN, ARTIFICIAL
PROTEIN-FREE MILK[BD]

=====+==================+==================+==================
| Rat 11 | Rat 12 | Rat 13
+--------+---------+--------+---------+--------+-------
Date | Weight,|Gain or | Weight,|Gain or | Weight,|Gain or
| gm. |Loss, gm.| gm. |Loss, gm.| gm. |Loss, gm.
-----+--------+---------+--------+---------+--------+---------
3/9 | 132.1 | -- | 110.0 | -- | 99.0 | --
3/16 | 130.4 | -1.7 | 116.8 | +6.8 | 110.3 | +11.3
3/23 | 136.8 | +6.4 | 130.8 | +14.0 | 108.6 | -1.7
3/30 | 137.1 | +0.3 | 138.0 | +7.2 | 100.2 | -8.4
4/6 | 127.1 | -10.0 | 143.9 | +5.9 | 95.5 | -4.7
4/13 | 112.4 | -14.7 | 143.6 | -0.3 | 90.0 | -5.5
Total| -- | -19.7 | -- | +33.6 | -- | -9.0
4/20 | 146.7 | +33.7 | 170.7 | +27.1 | 104.0 | +14.0
-----+--------+---------+--------+---------+--------+---------

[BD] Date 4/20 covers use of mixed food.

Rat 13 suffered more or less from diarrhea throughout the whole experiment, and Rat 16 suffered similarly during the first two weeks.

The results secured by Rations 5 and 6 compared with Rations 3 and 4, the only difference being that natural protein-free milk was used in the latter and artificial protein-free milk in the former, are most striking. Such results were anticipated from the experience of Osborne and Mendel in feeding similar materials. All of my rats, except Rat 13, a casein rat, showed a decided loss in weight after five weeks’ feeding on rations containing artificial protein-free milk. These losses amounted to 19.7, 9.0, 23.1, 6.7 and 27.6 gm., whereas rats fed on the same rations, except for the form of protein-free milk, gained, during the same period of five weeks, 56.3, 49.6, 57.8 and 59.1 gm. The fact that one casein

TABLE 6.--WEIGHTS OF RATS FED RATION 6.--SANATOGEN, ARTIFICIAL
PROTEIN-FREE MILK[BE]

=====+==================+========+=========+========+=========
| Rat 14 | Rat 15 | Rat 16
+--------+---------+--------+---------+--------+---------
Date | Weight,|Gain or | Weight,|Gain or | Weight,|Gain or
| gm. |Loss, gm.| gm. |Loss, gm.| gm. |Loss, gm.
-----+--------+---------+--------+---------+--------+---------
3/9 | 118.4 | -- | 111.3 | -- | 101.3 | --
3/16 | 126.2 | +7.8 | 116.2 | +4.9 | 100.0 | -1.3
3/23 | 126.6 | +0.4 | 123.4 | +7.2 | 98.0 | -2.0
3/30 | 124.7 | -1.9 | 123.3 | -0.1 | 98.7 | +0.7
4/6 | 110.2 | -14.5 | 112.3 | -11.0 | 88.7 | -10.0
4/13 | 95.3 | -14.9 | 104.6 | -7.7 | 73.7 | -15.0
Total| -- | -23.1 | -- | -6.7 | -- | -27.6
4/20 | 130.3 | +35.0 | 135.3 | +30.7 | 106.4 | +32.7
-----+--------+---------+--------+---------+--------+---------

[BE] Date 4/20 covers use of mixed food.

rat fed on the artificial protein-free milk showed a substantial gain is without significance, as such exceptions to the general rule occur occasionally, and, furthermore, this rat also during the last week of the experiment likewise lost weight. The extent of these losses compared with what the average normal male rat weighs at a corresponding age is shown in Table 7.

TABLE 7.--WEIGHT OF RATS 11 TO 16 COMPARED WITH AVERAGE WEIGHT
OF RAT OF SAME AGE

=====+===========+===============+================
| | | Average Weight
Rat | Age, Days | Final Weight, | of Rat of
| | gm. | Same Age, gm.
-----+-----------+---------------+----------------
11 | 106 | 112 | 167
12 | 106 | 144 | 167
13 | 99 | 90 | 162
14 | 106 | 95 | 167
15 | 92 | 105 | 153
16 | 96 | 74 | 158
-----+-----------+---------------+-----------------

That these losses in weight were not due to any inherent weakness in the rats is shown by the fact that by feeding Rats 11 to 16 for one week after the termination of the experiment with Osborne and Mendel’s “mixed food” (a mixture of dog bread, sunflower seeds, vegetables and meat) very large gains were secured in every instance, ranging from 14 to 35 gm.

The growth curves for Rats 7 to 16 are shown in Charts 3, 4 and 5.

To conclude, A COMPARATIVE FEEDING OF FOUR MALE WHITE RATS DURING ELEVEN WEEKS, SHOWED, IF ANYTHING, A SLIGHTLY GREATER, BUT INSIGNIFICANT, INCREASE IN WEIGHT FOR SANATOGEN OVER COMMERCIAL CASEIN. IN A RATION IN WHICH ARTIFICIAL HAD BEEN SUBSTITUTED FOR NATURAL PROTEIN-FREE MILK, SANATOGEN SHOWED NO ADVANTAGE OVER COMMERCIAL CASEIN IN CHECKING THE FAILURE IN WEIGHT OF THE RATS.--(_From The Journal A. M. A., Nov. 21, 1914._)

POEHL’S SPERMIN IN ARTERIOSCLEROSIS

A physician addressed the following inquiry to The Journal:

“In a recent number of the _Gazette méd. belge_, I read a detailed
report of five cases of arteriosclerosis in which the patients were
all markedly improved and some of them apparently cured by a course
of ‘Sperminum Poehl,’ an advertised remedy which I have always
distrusted and never prescribed. I am now suffering myself from a
somewhat advanced case of arteriosclerosis and would like to try this
remedy if the Council has learned anything in favor of it and if
there is no reason to fear bad effects from it.”

X. Y. Z.

The Journal replied:

Apparently the exploitation of Poehl’s spermin passed several years ago from the domain of experimental medicine to that of nostrums advertised to the laity. So far as we know, it has received no recent discussion from reliable clinicians or experimenters. In some medical journals, as also in lay journals, it is true, one still reads that Poehl’s spermin is successfully applied in “neurasthenia, senile marasmus, anemia, rachitis, gout, chronic rheumatism, syphilis, hysteria, tuberculosis, typhus, diseases of the heart, nephritis, tabes dorsalis, paralysis, neurasthenic impotence, overwork, acute diseases, and for convalescents.” Few quack advertisements would differ much from this puff of Poehl’s spermin. So far as we know, there is no reason to fear injurious results from the use of the remedy; neither might any good be expected from its use in arteriosclerosis.--(_From The Journal A. M. A., April 15, 1911._)

SYRUP OF COCILLANA COMPOUND

A physician in a small town in Nebraska writes: “In looking over a prescription file not long ago I found a prescription which I copied and am sending to you. It is a good example of shotgun prescribing. I do not give the name of the prescriber, and you will please not mention from whence this comes. The doctor who wrote this has had about ten years’ experience.”

Here is the prescription given exactly as transmitted by our correspondent:

Sp. sticta Gtt xv
Sp. ipecac Gtt x
Sp. bryonia Gtt x
Sp. macrotys Ʒi
Bromoform Bronchial Anodyne ℥ii
Syrup Cocillana Comp. q. s. ad ℥vi
Teaspoonful every two or three hours.

It is evident that the prescriber is an eclectic. As a matter of fact, in a second letter from the physician who forwarded the prescription, we are informed that the prescriber is a graduate of an eclectic institution not a thousand miles from where he practices. The “Sp.” in the prescription does not mean “Spiritus,” but specific tincture. The prescriber is an advocate of specific remedies, one of which should fit the condition, but he is broad-minded enough to call help from the outside, and so adds fifteen other remedies to the specific selected, including alcohol. The inability of one mind to remember all the ingredients of so complex a mixture will explain the fact that ipecac is duplicated, occurring both as a specific tincture and as an ingredient of Bromoform Bronchial Anodyne. The latter, the manufacturers tell us, contains in one fluidounce:

Alcohol 5 per cent.
Bromoform 8 drops
Ipecac 1/2 gr.
Ammonium bromid 24 grs.
Benzoin 1 gr.

Syrup Cocillana Comp., one of the “elegant specialties” of Parke Davis & Co., of which they certainly ought to be very proud, contains, we are told, in one fluidounce:

Alcohol 5 per cent.
Heroin hydrochlorid 8/24 gr.
Tinct. of euphorbia pilulifera 120 min.
Syrup of wild lettuce 120 min.
Tinct. of cocillana 40 min.
Syrup of squill comp. 24 min.
Cascarin, P. D. & Co. 8 grs.
Menthol 8/100 gr.

This “elegant specialty” of Parke, Davis & Co. is not only a shotgun prescription, but has as one of its ingredients a mixture itself containing three ingredients, namely: Syrup Squill Comp. (Coxe’s Hive Syrup), making ten in all--a beautiful example of scientific pharmacy.

We wonder if our eclectic brother really appreciated that his prescription, written out, would be as follows:

Sp. sticta Gtt xv
Sp. ipecac Gtt x
Sp. bryonia Gtt x
Sp. macrotys Ʒi
Alcohol 5 per cent.
Bromoform 8 drops
Ipecac 1/2 gr.
Ammonium bromid 24 grs.
Benzoin 1 gr.
Alcohol 5 per cent.
Heroin hydrochlorid 8/24 gr.
Tinct. of euphorbia pilulifera 120 min.
Syrup of wild lettuce 120 min.
Tinct. of cocillana 40 min.
Fluidextract of squill 60 min.
Fluidextract of senega 60 min.
Antimony and potassium tartate 1 gr.
Cascarin, P. D. & Co. 8 grs.
Menthol 8/100 gr.

To use a slang expression, this is certainly going some!--(_From The Journal A. M. A., March 18, 1911._)

“A Cough Syrup with a History”

The following letter was received from Dr. Geo. P. Tolman, Watsonville, Cal.:

_To the Editor_:--The enclosed advertisement was underscored and mailed to me by my druggist. The properties of cocillana are similar to ipecac. The dose of the fluidextract is from 10 to 20 minims. Each fluidounce of the extraordinary (!) dark-colored cough marvel of P. D. & Co. contains 40 minims of the tincture. If the tincture of cocillana is 10 per cent. (the average tincture strength) you can see that to get a minimal dose of the drug you would have to take 2-1/2 fluidounces of the syrup.

“Query: Can we still hang on to the old-fashioned cough mixtures freshly compounded by our druggists or shall we put our shoulders to the wheel and help P. D. & Co. save the nation and make a few dollars for the druggist?”

“The secret of its prompt recognition lay in its unusual composition.” Nay; its prompt recognition lay in liberal and persistent advertising. “It quickly made a ‘hit’ with physicians”--because too many physicians, like other human beings, are susceptible to the psychology of advertising. Here is the “unusual composition,” as given by the manufacturers:

“Tinct. Euphorbia pilulifera, 120 mins.; Syrup Wild Lettuce, 120
mins.; Tinct. Cocillana, 40 mins.; Syrup Squill Compound, 24 mins.;
Cascarin (P. D. & Co.), 8 grs.; Heroin hydrochloride, 8-24 gr.;
Menthol, 8-100 gr.”

The following is a reproduction of the advertisement referred to:

+------------------------------------------------------------+
| A cough syrup with a history. |
| |
| =Syrup Cocillana Compound= established itself with the |
| medical profession in a single season. It was introduced |
| in 1906. The secret of its prompt recognition lay in its |
| unusual composition. The formula showed a rare combination |
| of astringents and sedatives. It quickly made a “hit” with |
| physicians. The name “Syrup Cocillana Compound” soon began |
| to appear on prescriptions. Today this agent is the most |
| widely prescribed of all preparations for cough. |
| |
| =Syrup Cocillana Compound= is a profitable product for |
| the druggist to sell. It commands a good price. Being |
| totally unlike the common, ordinary dark-colored “cough |
| mixtures” it does not enter into competition with them. |
| Be prepared to dispense it. |
| |
| Supplied in pint, 5-pint and gallon bottles. |
| |
| Home Offices and Laboratories, PARKE, DAVIS & CO. |
| Detroit, Michigan. |
+------------------------------------------------------------+
]

As we have said above, Parke, Davis & Co. should be proud of this “elegant specialty.” It would be hard to find a better specimen of a shotgun prescription; not only does the prescription contain eight ingredients, but one of these ingredients (compound syrup of squill) itself contains three.

As our correspondent correctly states, the drug from which the name (not the action) of the preparation is derived comes from Bolivia and has properties similar--but evidently inferior--to ipecac. That it possesses but little therapeutic value is perhaps best evidenced by the fact that, in spite of the propaganda made for it by Parke, Davis & Co., neither the drug nor any preparation of it is listed, so far as we know, by any other large pharmaceutical house, with one exception. Besides cocillana the preparation contains two other obsolete drugs, wild lettuce and euphorbia pilulifera. The activity of the “cough syrup,” it is needless to say, depends in the main on the drug which is more or less buried in the published formula: heroin hydrochlorid. At one time Parke, Davis & Co. admitted that the preparation owed its chief value to heroin. In a letter to the Council on Pharmacy and Chemistry the firm said:

“The physiologic action of this syrup is that which would be
suggested by the constituents. Because of its activity the
most prominent action would be that characteristic of heroin
hydrochlorid.”

Without doubt the important ingredient, from the point of view of therapeutic potency, is the heroin; and it is this drug doubtless, that makes the mixture a good “repeater.” Syrup Cocillana Compound is a nostrum sailing under false colors. Whether its continued use is due to its mysterious, meaningless, misleading name or merely to insistent and persistent advertising methods of Parke, Davis & Co. is a question. Neither explanation is any credit to the medical profession which tolerates it, or to the physician who prescribes it.--(_From The Journal A. M. A., Feb. 15, 1913._)

AUBERGIER’S SYRUP OF LACTUCARIUM

That clause in the Federal Food and Drugs Act which requires certain potent drugs to be declared on the label of the proprietary mixtures containing them has been responsible for clearing up many mysteries. Physicians have frequently wondered why they were unable to obtain from the syrup of lactucarium, U. S. P., the therapeutic results which they were able to obtain from a proprietary product known as Aubergier’s Syrup of Lactucarium, sold by Fougera & Co. at an exorbitant price and put up in “patent-medicine” style. The milk-juice of lettuce once bore the reputation of being a soporific--a reputation that has been artificially maintained largely through the effects of the Aubergier preparation. With the advent of the Food and Drugs Act the secret of the soporific effect of the Aubergier product was explained--it contains morphin.[124]

[124] Technically, this is incorrect, as the company had inconspicuously stated in the “literature”--not on the label--that the preparation contained “extract of opium.”

The practical difficulties of making a satisfactory syrup of lactucarium are not realized by most physicians. To such the following note, presented at a meeting of the Pennsylvania Pharmaceutical Association by Mr. Louis Emanuel, president of the Pennsylvania Pharmacy Board, will prove enlightening:

“Did you ever make a syrup of lactucarium direct from the crude drug?
If you did, shake hands, and let me hail you as a brother, a brother
pharmacist in fact worthy of the title. If you did not, I am sorry
for you; you have missed something worth knowing.

“The _American Journal of Pharmacy_ tells us that in 1851 ‘Aubergier
cultivated lactuca and poppy on a larger scale, in order to
obtain lactucarium and opium. Please note the latter for further
reference. In lactucarium he found lactucin, mannite, resin, cerin,
asparmid, brown coloring-substance and oxalic acid.’ In 1860, in
the same publication, Proctor says: ‘The attention of the medical
practitioners has of late been turned to the syrup of lactucarium,
and the preparation sold usually by apothecaries in this city is
that known as Aubergier’s, a French preparation, made by dissolving
30 parts of alcoholic extract of lactucarium in 500 parts of boiling
water, straining the liquor and adding 15,000 parts of boiling simple
syrup, which is kept boiling, and albuminous water added from time to
time until it is clarified.’ In ’66, ’77, ’78, ’82 and ’84 various
writers produced elaborate dissertations on the supposed improved
methods of making this syrup, but not one has had the temerity of
inquiring into the therapeutic value of this preparation, or to
examine the French preparation to ascertain whence comes its vaunted
superiority.

“The French, it is said, are an impressionable people, but they
appear to have a limit; they do not take any chances on _plain_ syrup
of lactucarium. Theirs contains the added product, extract of opium.
This implies a lack of faith in soporific properties of lactucarium,
and displays a recklessness in regard to cost and labor.

“The National Dispensatory, fifth edition, says:

“The utility of retaining lactucarium as an official medicine is
very doubtful. It may possibly be desirable as a hypnotic for very
impressionable persons, with whom faith in a remedy supplies its
want of intrinsic efficiency.”

“The official modus operandi for making this syrup looks laborious,
but the innocent-looking task of reducing the drug to a coarse powder
is a revelation to the uninitiated.

“It was {a} hot day in July and it took my 175-pound clerk and me all
that day to reduce 50 gm. of lactucarium to a satisfactory condition.
The stuff looked like old pieces of discarded rubber shoes, and it
really appeared to act like rubber. After perspiring all day with the
Pharmacopeia and iron mortar, imagine our disgust, if you can, on
reading in the National Dispensatory the following:

“This alcoholic preparation of lactucarium is quite as valueless
and more objectionable than the syrup of the same drug.”

“Moral: Why pay $6.50 a pound for material that has no medicinal
value, and is so hard to manipulate as lactucarium when decrepit
rubber shoes are so cheap? You can have just as much fun on a hot
summer day in reducing the latter to a coarse powder with clean sand
in an iron mortar as you can with the more expensive material.”

One of the advantages claimed for ready-made prescriptions over the made-to-order variety, or even over pharmacopeial preparations, is that they are more elegant in appearance and less offensive to the nostrils and palate. This is the common experience of physicians who, having prescribed some ready-made mixture, wish to change the dose of one of its constituents and write a prescription or ask their pharmacists to prepare a similar preparation. The inability of the pharmacist to prepare a preparation even approaching the original in appearance, color or taste usually leads to increased confidence in the skill of the manufacturer of the proprietary and a correspondingly decreased belief in the pharmacist’s professional attainments. But these conclusions, although natural, are based on false premises. As the proprietary did not have the composition declared on the label, a mixture based on the formula differed more or less widely from the proprietary it was expected to resemble.--(_From The Journal A. M. A., Nov. 9, 1912._)

A Protest and a Reply

Three months after publishing the foregoing we received a nine-page communication from Comar & Co. of Paris, the promotors of Aubergier’s Syrup of Lactucarium, in which they took issue with some of the statements in our article. The company claimed that a possible reason for the difficulty experienced by Mr. Louis Emmanuel in trying to make the Syrup of Lactucarium from the crude drug is that he did not use the same variety of Lactucarium that it employs. Furthermore, it said that the presence of morphin in the product was acknowledged before the passage of the Food and Drugs Act. On more careful investigation, we find that this is true--that the presence of “a certain proportion of extract of opium” in the preparation was mentioned even before the federal Food and Drugs Act compelled the morphin content to be published on the label. Technically, then, The Journal was incorrect in making the implication that the medical profession was not apprised of the fact that Aubergier’s Syrup of Lactucarium contained morphin; practically it was right. The information that Comar & Co. gave to physicians was buried in its advertising “literature” so that it is fair to assume that not one physician in ten thousand knew--previous to the Food and Drugs Act--that Aubergier’s Syrup of Lactucarium contained morphin.--(_From The Journal A. M. A., Nov. 9, 1912._)

TARTARLITHINE

Tartarlithine was examined by two chemists whose reports indicate that it is an effervescing preparation composed approximately of 20 per cent. of carbonate of lithium and about 80 per cent. of tartaric acid. Thus it is simply another of the hundreds of lithia preparations on the market offered for the cure of rheumatism. This in spite of the fact that scientific investigation and clinical experience have demonstrated that lithia is of very little use in the treatment of that disease. While the advertisement carries the idea that Tartarlithine is a product of the Tartarlithine Company, and that McKesson and Robbins are simply selling agents, we are informed that the business is owned by McKesson and Robbins, who under this style manufacture a remedy for rheumatism.--(_Abstracted from The Journal A. M. A., April 23, 1907._)

THOXOS

Thoxos is a “specialty” of John Wyeth and Brother. From an advertising circular we learn that it “offers to the physician a rational treatment for Rheumatism, both the Subacute and Chronic forms, Lithemia, Rheumatic Arthritis, Gout, Sciatica and the various manifestations of uric diathesis,” and that “it is a palatable solution of Strontium and Lithium soluble salts, thirty-two grains, combined with twenty-four minims Wine of Colchicum Seed and a vegetable alterative, in each fluidounce, flavored with aromatics.” This “formula” does not indicate the acid with which the metals strontium and lithium are combined, or what the “vegetable alterative” is; it is essentially a secret preparation. To learn what the missing and presumably active ingredients are an analysis was made by our chemists.

LABORATORY REPORT

One original bottle of Thoxos, John Wyeth and Brother, Philadelphia,
was purchased and submitted to analysis. The bottle contained a
brown liquid having an aromatic odor and a sweet taste. The specific
gravity of the liquid was 1.118 at 15 C. (60 F.) The solution
was acid to litmus. Qualitatively the following constituents
were detected: strontium, potassium, sodium, lithium, ammonium,
salicylate, iodid, glycerin, alkaloid, alcohol and water. By the
smell and taste, oil of wintergreen, or methyl salicylate, and oil
of sassafras were recognized. Positive tests for a saponin-like body
indicated the probable presence of sarsaparilla.

Quantitatively the following results were obtained:

Ammonia (NH_{3}) 0.006 per cent.
Lithium (Li) 0.13 per cent.
Sodium (Na) 0.03 per cent.
Strontium (Sr.) 1.03 per cent.
Iodid (I) 0.46 per cent.
Salicylate (C_{6}H_{4}.OH.COO) 4.19 per cent.
Glycerin 19.2 per cent.

From the analytic results it would appear that the preparation
contains approximately potassium iodid, 0.67 gm. per hundred c.c., or
3 grains per fluidounce; lithium salicylate [Li(C_{7}H_{5}O_{3})],
0.9 gm. per hundred c.c., or 4 grains per fluidounce; strontium
salicylate [Sr(C_{7}H_{5}O_{3})_{2}-2H_{2}O], 5.75 gm. per hundred
c.c., or 26 grains per fluidounce, and some salicylic acid combined
with sodium and also in the free state. The total salicylate found is
equal to 5.47 gm. of sodium salicylate per hundred c.c., or 25 grains
per fluidounce.

As strontium salicylate and lithium salicylate are now generally considered to differ but slightly, if at all, in their action from that of sodium salicylate, each dose of Thoxos, 1 teaspoonful or 4 c.c., may be considered the equivalent of 0.2 gm. or 3 grains of sodium salicylate with a fractional dose of colchicum. Hence this nostrum--for this is the correct definition--is a mixture of no more value than a prescription of sodium salicylate with a fractional dose of potassium iodid and colchicum, one that any doctor could write and any druggist dispense. Yet it is doubtless prescribed by physicians under the belief that it possesses some occult power not to be found in ordinary drugs and their combinations. To prescribe Thoxos is to prescribe a name, and the patient who takes it would be as well off if he went to the nearest drug store and purchased a bottle of any of the thousand and one rheumatism cures with which the country is flooded.--(_From The Journal A. M. A., March 21, 1914._)

TRYPSOGEN

Besides exploiting a clay poultice--“Antithermoline”--the G. W. Carnrick Company appears to be chiefly concerned in the promotion of “internal secretion” specialties; a class of preparations the therapeutic value of which is problematical. Thus it markets the diabetes remedy, “Trypsogen” tablets, said to contain “the enzyme of the islands of Langerhans with the tryptic and amylolytic ferments of the pancreas” along with gold bromid and arsenic bromid; Secretogen Elixir, said to be “prepared from gastric secretin obtained from the pyloric antrum and pancreatic secretin from the duodenum, combined with the enzymes of the peptic glands, and one-twentieth of one per cent. HCl”; Secretogen Tablets, said to be “prepared from prosecretin and succus entericus obtained from the epithelial cells of the duodenum, combined with pancreatic extract”; Kinazyme, “a preparation of extract of spleen, reinforced with trypsin, amylopsin and calcium lactate.”

While great claims have been made for Trypsogen and while it has been most widely advertised, it is the consensus of opinion of the most eminent students of the question that pancreas is not really efficacious in diabetes. Were it of any value in this disease, it would have won world-wide recognition for itself ere now, in view of the great enthusiasm with which the discovery of the relation of the pancreas to diabetes was received and of the enormous amount of clinical, as well as animal, experimentation that followed. As the conditions of experiment in this question are extremely complex, it is not surprising that occasionally apparently positive results should have been obtained. Were it really useful, it should have yielded positive results much more uniformly.

Furthermore, if pancreas were really efficacious in the treatment of diabetes mellitus, the addition of arsenic, of gold, of bromid would be entirely unnecessary.

Even were it granted that pancreas extracts are valuable in the treatment of diabetes, and that gold and arsenic also have beneficial effects, it is our opinion that Trypsogen should be considered an unscientific shotgun mixture, because fixed combinations of remedies of different potencies, such as arsenic, gold, bromid and pancreas, are therapeutically erroneous, as they do not permit of that accurate adjustment of dosage of each ingredient that is indispensable to obtain maximum benefit with minimum danger of poisoning.

Antithermoline and Trypsogen were at one time described in New and Nonofficial Remedies. These preparations were omitted when the Council’s rules were revised some years ago.