Chapter XXVI: Part III: Contributions From the Journal: Nostrums (7)

When the Council was first organized it undertook only the correction of the most serious abuses that had become a part of the proprietary medicine business, and paid less attention to the therapeutic worth of a remedy; thus at that time it admitted both Antithermoline and Trypsogen to New and Nonofficial Remedies. Since then the Council has modified its rules to exclude unscientific mixtures marketed under names that are misleading or therapeutically suggestive. Accordingly it rescinded the acceptance of Antithermoline, which was essentially the official clay poultice, Cataplasma Kaolini, U. S. P. For similar reasons and because the therapeutic claims were held unwarranted Trypsogen has been omitted from New and Nonofficial Remedies.

It is to be regretted that the progress of research should be hindered and the value of genuine products of internal secretion be depreciated by confusion with such shotgun mixtures and asserted remedies, whose claims have received no scientific confirmation.--(_From The Journal A. M. A., Nov. 1, 1913._)

TYREE’S ANTISEPTIC POWDER[BF]

Now Advertised Direct to the Public as the “Best Preventative Known”

[BF] See also report, p. 21.

When the history of the “patent medicine” business comes to be written impartially and fairly, it will be realized that we, the medical profession, have been in no small degree responsible for its growth. Not a few widely advertised nostrums owe their commercial success solely to the ill considered use accorded them by physicians, to whom they were first exploited. As a well-known and brilliant advertising man once said:

“The patent medicine of the future is one that will be advertised
only to doctors. Some of the most profitable remedies of the
present time are of this class. They are called proprietary
remedies. The general public never hears of them through the daily
press. All their publicity is secured through the medical press,
by means of the manufacturer’s literature, sometimes gotten out in
the shape of a medical journal, and through samples to doctors....
The medical papers will reap the harvest and the physician himself,
always so loud in the denunciation of ‘patent medicines,’ will be
the most important medium of advertising at the command of the
proprietary manufacturer. In fact, he is that to-day.”

Of the conditions here described probably no better example can be found than Tyree’s Antiseptic Powder. For years this preparation was advertised to the medical profession under claims that were fraudulent as to both composition and therapeutic effect. Analysis published in The Journal[125] proved that the formula given out by Tyree was absolutely false and that the preparation was, essentially, nothing but a simple mixture of sulphate of zinc and boric acid.

[125] Oct. 20, 1906, and May 18, 1907.

From the first it would seem that the manufacturers of this mixture had for their objective point that period when, thanks to the use of the nostrum by physicians, it would be widely purchased by the public. Lavish advertising was done in medical journals and Tyree’s Antiseptic Powder gained admission to the pages of even those journals which required the publication of a “formula”--for a formula was forthcoming. The Journal itself, until seven years ago, carried the advertisements with a “formula” until chemical examination proved the falsity of the formula, and of the therapeutic claims made for the product. The medical profession in its turn prescribed the nostrum and the “original package” scheme did the rest.

Now, it seems, Tyree considers his preparation so well known that he can be independent either of the assistance of the physician or of his good-will. For Tyree’s powder now goes to the public direct and newspaper readers find it advertised as:

“Ideal for douche.”
“Unequalled as a douche.”
“Best preventative known.”
“Unequalled as a preventative.”
“Has no equal as a preventative.”

And the following, whose very truth must bring the blush of shame to all physicians who have the interest of scientific medicine at heart:

“Prescribed by physicians all over the world for twenty-one years.”

“Ask your doctor or send for booklet.”

“Used by doctors for the last twenty-one years.”

“One of the highest tributes paid Tyree’s Antiseptic Powder is the
fact that the most successful physicians have been using it for the
last twenty-one years.”

Not that Tyree has entirely forsaken the medical journals, although he seems to be dropping them one by one. At the beginning of this year at least fifteen medical journals were carrying the Tyree advertisement; by March the number had fallen to seven, while in June the only journals carrying it were:

_Medical Record
American Journal of Obstetrics
Chicago Medical Recorder
Pacific Medical Journal_

Those who answer the newspaper advertisements receive a free sample of the powder and several leaflets and circulars giving the various uses (?) of the nostrum. Incidentally these leaflets advertise, in addition, Tyree’s “Elixir Buchu and Hyoscyamus Comp.,” which is recommended, in various combinations, for such conditions as acute nephritis, epilepsy, neurasthenia, gonorrhea and delirium tremens.

Bearing in mind the claim that is made in the newspaper advertisements that Tyree’s Antiseptic Powder is the “best preventative” known, it is interesting to see what Tyree has to say to those druggists whom he offers to supply with circulars for free distribution:

“As these circulars deal with the care of rubber goods, for both
medicinal and toilet purposes, they are of great value to the
customer and will be retained for further reference. They are
boosters for your rubber goods sales, too.”

That a nostrum of this sort should go to the public is not surprising, but that it should have reached the public through the instrumentality of the medical profession is a serious reflection on the judgment of physicians. But the incident has a bright side. That the exploiters of this nostrum no longer find it profitable to use medical journals as a means of getting their stuff to the public but must needs use the more expensive newspaper advertising, is cause for optimism. It means that physicians are no longer prescribing, indiscriminately, proprietary products and that they are refusing to be, what they have been in the past, the unpaid distributing agents for nostrum venders.--(_From The Journal A. M. A., Aug. 24, 1912._)

VAPO-CRESOLENE

Vapo-Cresolene has been examined in the American Medical Association’s laboratory and the chemists’ report follows:

According to the statements on the trade package, Vapo-Cresolene “is
a product of coal-tar possessing far greater power than carbolic
acid in destroying germs of disease.” It is recommended as a remedy
for a number of diseases, including croup, catarrh and diphtheria.
According to the manufacturers, it should be used only in “the
Cresolene vaporizer,” which makes it “unequaled for the disinfection
of sick rooms” and the “safest and simplest method of destroying
infection and purifying the air.” From the examination we conclude
that Vapo-Cresolene is essentially cresol and corresponds in every
respect to cresol U. S. P. (Physician’s Manual, page 36).

This report indicates that Vapo-Cresolene is a member of that class of proprietaries in which an ordinary product is endowed, by the manufacturer, with extraordinary virtues. The type is so common and has been referred to so frequently that but for the dangers attendant on the inhalation of any of the phenols, this particular product need not have been mentioned.--(_From The Journal A. M. A., April 4, 1908._)

VASOGEN AND IODOVASOGEN

Another Case in Which Independent Analyses and
Manufacturers’ Labels Disagree

Vasogen, a product of Pearson & Company, Hamburg, Germany, has been put on the market under the various designations, “oxygenated vaseline,” “water-soluble hydrocarbon” and “oxygenated carbon.” The manufacturers, and also their American agents, Lehn & Fink, claim that by a special process the apparent impossibility of saponifying petrolatum has been overcome with Vasogen as the result. Disinterested chemists who have analyzed Vasogen find that the product consists essentially of an ammonium soap and petrolatum--practically an ammonia liniment mixed with petrolatum.

Just as petrolatum under its various trade names was at one time recommended as a universal ointment base, so vasogen is recommended promiscuously as a vehicle for remedies applied externally and even for internal medication--needless to say in many cases in which it is directly contra-indicated.

Iodovasogen, recommended for external application as a substitute for tincture of iodin, was examined by Zernik in 1905, who found that the iodin existed not as a free iodin, but chiefly as ammonium iodid. The therapeutic character of the preparation is thus entirely different from that to be inferred from the labels and elsewhere, since the counter-irritant effects of free iodin are of course absent in ammonium iodid. Pearson & Co. now claim that when Zernik’s findings were published they immediately modified their statements on the label in accordance with the truth. This is denied by Dr. Lungwitz, the editor of the _Therapeutische Rundschau_ (_Apotheker Zeitung_, 1908, p. 900), who vigorously criticizes the misrepresentation made by Pearson & Co. in regard to Iodovasogen. He calls attention to the fact that, while Zernick’s results were published over three years ago, the labels which are in use today still bear the statement that Iodovasogen consists of Vasogen 90 parts and resublimed iodin 10 parts, and Vasogen 94 parts and resublimed iodin 6 parts, respectively.

As Iodovasogen and Vasogen in various combinations are being advertised to the physicians in the United States, the above information from our German exchanges is worthy of consideration.--(_From The Journal A. M. A., Feb. 13, 1909._)

VIBURNUM COMPOUND--AND OTHER NOSTRUMS

A number of drugs have some reputation for therapeutic value without there being any particular evidence to substantiate the claims. Viburnum, concerning which we recently received the following letter, is one of these drugs:

_To the Editor_:--Have you made an analysis of Viburnum Compound?
Extravagant claims are being made for it and I cannot put my hand on
any data. A patient has asked me concerning it and I wish to advise
her honestly. I do not know but that there may be several “viburnum
compounds.” I rarely use any of these “put-up” preparations, and
hence know but little about them.

A. J. Hesser, M.D., Pittsburgh, Pa.

No analysis of Hayden’s Viburnum Compound, to which our correspondent refers, has been made in the Association laboratory. According to advertising circulars, the preparation contains American skullcap (_Scutellaria lateriflora_), cramp-bark (_Viburnum opulus_) and wild yam (_Dioscorea villosa_). Since these drugs contain no well-defined therapeutically active ingredients, an analysis of the preparation would necessarily be unsatisfactory.

A number of drugs have in some way obtained a reputation as being valuable in the treatment of diseases of women, without their therapeutic claims ever having been proved. It is said that some were used by the aborigines for such affections and we find a considerable number of them combined in various nostrums (sometimes with therapeutically active drugs) and exploited for the cure of female disorders, under most extravagant and usually absurd claims. Thus “Pierce’s Favorite Prescription” is advertised as containing black cohosh, blue cohosh, goldenseal, lady’s-slipper and false unicorn-root; “Dioviburnia” (Dios Chemical Co.) as containing American skullcap, cramp-bark, wild yam, blue cohosh, black haw, star-grass, trailing arbutus and false unicorn-root; “Viburnumal” (Louisville Pharmacal Works) as containing American skullcap, cramp-bark, wild yam, star-grass and motherwort.

Most pharmaceutical houses, following the lead of nostrum-makers, put similar mixtures on the market; for example: “Elixir of Viburnum Compound” (Nelson, Baker & Co.) is said to contain cramp-bark, American skullcap and wild yam; “Elixir of Hydrastis and Viburnum Compound” (Smith, Kline & French Co.), cramp-bark, goldenseal, Jamaica dogwood and pulsatilla; “Elixir of Hydrastis and Cramp Bark Compound” (Parke, Davis & Co.), cramp-bark, hydrastis, Jamaica dogwood and pulsatilla; “Fluid Extract of Cramp Bark Compound” (H. K. Mulford Co.), American skullcap, cramp-bark and wild yam; “Mother’s Cordial” (Eli Lilly & Co.), cramp-bark, blue cohosh, false unicorn and squaw vine; “Uterine Sedative Elixir” (Eli Lilly & Co.), cramp-bark, goldenseal, Jamaica dogwood and pulsatilla; “Vibutero” (Fred. Stearns & Co.), cramp-bark, wild yam, black haw, squaw vine, Jamaica dogwood, saw palmetto and pulsatilla. Practically all of these drugs except goldenseal are ignored in the standard works on pharmacology. Further, the results of careful examination by the Council on Pharmacy and Chemistry of the therapeutic claims made for most of them shows that these claims are not sustained by reliable clinical experience.

The fact is that the popularity of preparations of this kind is purely an artificially created one. A nostrum containing, let us say, extractives of some little-used or worthless drugs is put on the market and heavily advertised. Should it be advertised in a manner to make it sell, a host of imitations appear and the large pharmaceutical houses put out substitutes for it. The uncritical physician does the rest. He prescribes it indiscriminately in the class of cases for which it is advertised. Naturally, a certain proportion of the patients who take it recover, and the recoveries are credited to the nostrum. A vicious circle is thus established and the demand for the stuff increases. Its sale, together with the sale of similar products, continues until the overwhelming experience of those who have prescribed it proves its uselessness. In the meantime the manufacturers have reaped a harvest, at the expense both of the public and of the medical profession. And the manufacturers’ excuse for putting such absurd “specialties” on the market is that physicians prescribe them!--(_From The Journal A. M. A., Aug. 31, 1912._)

WHEELER’S NERVE VITALIZER

Names of nostrums often mislead by the use of fake nomenclature giving erroneous ideas regarding the composition of the preparation or misrepresenting the true action of the nostrum. As an example of the latter class Wheeler’s Nerve Vitalizer was examined in the Association laboratory and found to be not a vitalizer, as the name implies, but rather a nerve sedative. The results of the examination follow:

Wheeler’s Nerve Vitalizer was packed in a carton bearing the name
of the preparation, its manufacturers, “The J. W. Brant Co., Ltd.,
Albion, Mich.,” and an exhaustive list of the diseases for which
the product is intended, besides the general statement that it is
a cure for “all nervous diseases.” The “Vitalizer” is a brown,
syrupy liquid having a peculiar salty taste partially masked by
licorice. Qualitative tests showed the presence of sodium, potassium
and bromin, and no other acid radicals except small quantities of
chlorin. It was decided therefore that the preparation contained a
mixture of sodium and potassium bromids. In order to separate the
chlorin and bromin the preparation was evaporated, charred, extracted
with water and acetic acid and potassium permanganate added and the
mixture distilled with steam until all the bromin had been distilled
over, thus leaving the chlorin in the distilling flask. The solution
in the distilling flask was then treated with silver nitrate and
the chlorin estimated in the usual way. The quantity thus obtained
was subtracted from the total silver bromid and chlorin obtained by
precipitating a solution of the preparation with silver nitrate and
the remainder calculated to bromin.

By this method several samples of 5 c.c. each of the preparation
yielded an average of 0.0059 cm. silver chlorid or 0.0012 gm. per
c.c. The total silver haloids obtained by direct precipitation of the
diluted preparation was found to be 0.3158 gm. per c.c., thus leaving
0.3146 gm. silver bromid to be calculated to bromin.

The total sodium and potassium was obtained in the usual way and
the potassium determined as the chlor-platinate and the sodium
calculated from the difference. By this method the quantity of sodium
found calculated to sodium bromid gave the following results: (a)
0.0629 gm. and (b) 0.0632 gm., or an average of 0.063 gm. per c.c.
From the potassium estimations the following were calculated: (a)
0.1264 gm. potassium bromid and (b) 0.1259 gm. potassium bromid per
c.c., an average of 0.1261 gm. potassium bromid per c.c.

The bromids calculated from the sodium and potassium determinations
were found to be 0.0630 gm. sodium bromid and 0.1261 gm. potassium
bromid per c.c., the equivalent of 0.3139 gm. silver bromid. The
total silver bromid obtained was 0.3146 gm., showing practical
agreement with the total bromids calculated from the sodium and
potassium determinations.

The preparation contained then 6.30 gm. sodium bromid and 12.61 gm.
potassium bromid per 100 c.c., or 9.73 grains of potassium bromid and
4.86 grains sodium bromid, a bromid content equal to 15.35 grains
potassium bromid per fluid dram.

ZYMOTOID

A Fraud of the Liquozone-Oxytonic-Septicide Type

Dr. Arnold’s Zymotoid, a nostrum manufactured by Arnold’s Zymotoid Company, Rockford, Ill., is claimed to be an “antiseptic, germicide and antiphlogistic” which “has absolutely no peer in medicine.” According to the statements of the manufacturer, Zymotoid is “successfully employed not only as an external dressing on all wounded and diseased surfaces, but in all zymotic conditions wherein a reliable antiseptic and germicide is needed internally.” And in telling physicians of the great value of Zymotoid the company says:

“We assured them that if they would simply place Zymotoid ‘next’
to any wounded surface--and nothing else--they would have no
inflammation, no suppuration, no infection or blood poison. Its
prompt use in all cases where such trouble arises gives immediate
and certain relief.”

This is a large contract to be undertaken by Zymotoid--or any other preparation--which, as will be shown, consists principally of boric acid and water. The company also appends to its announcement concerning Zymotoid a number of the usual testimonials and a lot of alleged “case reports.”

Zymotoid seems to be exploited principally by circulars addressed to physicians and by agents who attempt to sell it to physicians. They also try to work factories and other large employers of labor. In their circular to physicians they claim that “Zymotoid is strictly ethical.” And “we publish its composition.” The composition given is: “sulphur, niter, cinnamon and boric acid in gaseous solution.” It is also claimed to be “a chemical compound--not a mixture--which is wholly non-toxic and can be used as freely as desired internally absolutely without harm to the smallest child.” On the label of the Zymotoid package is the following:

“Zymotoid is a concentrated chemical compound consisting of the
solids and gases of sulphur, potassium nitrate, cinnamon and carbon
held in a solution of boric acid.”

A specimen of Zymotoid was examined by our chemists and their report follows. As will be seen, it is simply another fraud of the Liquozone-Oxytonic-Septicide type.

LABORATORY REPORT ON ZYMOTOID

Zymotoid is a pale yellow liquid having a strong odor like sulphur
dioxid. No odor suggestive of cinnamon was observed even after
the sulphur dioxid had been fixed by the addition of an alkali.
Qualitative tests indicated the presence of boric acid, sulphuric
acid, sulphur dioxid and traces each, of a nitrate, potassium
and some unidentified organic matter. Alkaloids, cinnamic acid,
glycerin and soaps were absent. From the results of the quantitative
examination it is concluded that the composition of Zymotoid is
essentially as follows:[126]

[126] Details of the analysis appear in the annual reports of the Chemical Laboratory.

Boric acid (H_{3}BO_{3}) 0.637 gm.
Sulphur dioxid (SO_{2}) 0.129 gm.
Sulphuric acid (H_{2}SO_{4}) 0.048 gm.
Potassium nitrate trace
Unidentified organic matter trace
Water (by difference) to make 100 c.c.

The analysis shows that but for the presence of boric acid the composition of Zymotoid is similar to other fraudulent “microbe killers” which have been exploited in recent years and of which some have been declared misbranded by the federal government. For example, “Radam’s Microbe Killer”[127] was found by the federal chemists to be composed of water, containing small quantities of sulphur dioxid and sulphuric acid. “Liquozone,” another nostrum which was widely exploited a few years ago, is said to have a similar composition.[128] According to an analysis made at the North Dakota Agricultural Experiment Station,[129] “Oxytonic” has a similar composition. The nostrum “Septicide,” was found by the federal chemists to be composed of water with small quantities of sulphur dioxid, sulphuric acid and a trace of a nitrate.--(_From The Journal A. M. A., April 6, 1912._)

[127] The Journal A. M. A., July 16, 1910, p. 235.

[128] The Journal A. M. A., March 28, 1908, p. 1065.

[129] The Journal A. M. A., Jan. 1, 1910, p. 63.