Chapter XXVII: Part IV: Contributions From the Journal: Miscellaneous Matter (1)

ACETPHENETIDIN AND PHENACETIN--THEIR RELATIVE PURITY

Until six years ago the chemical product known as phenacetin was patented both as to process and to product. As the patent ran out at that time, anyone, of course, could manufacture it. It was placed in the Pharmacopeia under the name “acetphenetidin.” It is on the market now under both names, “phenacetin” and “acetphenetidin.” The price of the former is five times[130] that of the latter, hence it is rather important to know whether or not one is, in any way, better or purer than the other. The original patentees or manufacturers, the Farbenfabriken of Elberfeld Company, market the product under the name “phenacetin” and also under the official name “acetphenetidin,” the former at about 33 cents an ounce and the latter at about 6 or 7 cents an ounce. Evidently these people believe that acetphenetidin is all right since their price-list says: “Our product is of the highest standard of purity,” and in another place: “On account of the low price of acetphenetidinum, U. S. P., it is especially suitable for the manufacture of medicinal specialties, such as headache powders, etc.” Remember that it is the manufacturers of phenacetin who say this.

[130] Phenacetin is listed at 33 cents an ounce, acetphenetidin at 98 cents a pound in quarter-pound lots.

The question arose whether or not phenacetin differs from acetphenetidin. If it does, then physicians should know it. An inquiry was addressed to Farbenfabriken of Elberfeld Company and also to Lehn & Fink, two firms which market the product in this country under both names, asking in what respect the two products differ. No answer was received from either firm. With the object of answering the question our chemists have investigated the preparations on the market, both those sold under the name “phenacetin” and those under the official title “acetphenetidin.” The following is a summary of their report:[131]

[131] Full details of analysis are published in Volume V of the annual report of the Chemical Laboratory.

THE CHEMISTS’ REPORT

_Physical Appearance._--All the specimens were found to be fine
white crystalline powders, differing somewhat in appearance
as follows: Four specimens--Acetphenetidin (Farbenfabriken),
Phenacetin (Specimen 1[132]--Farbenfabriken), Phenacetin (Specimen
2[132]--Farbenfabriken) and Acetphenetidin (Squibb)--appeared very
much alike, each being a very fine crystalline powder, differing
only slightly as to fineness. Five other specimens--Phenacetin
(Lehn & Fink), Acetphenetidin, U. S. P. (Lehn & Fink),
Acetphenetidin (Merck), and two specimens of Acetphenetidin
(Powers-Weightman-Rosengarten), had the same general appearance,
each consisting of a fine crystalline powder containing a
considerable proportion of large rectangular plates. Three
specimens--Acetphenetidin (Mallinckrodt) and two specimens of
Acetphenetidin (Powers-Weightman-Rosengarten)--had the same general
appearance, being a moderately fine and homogeneous crystalline
powder. When examined microscopically with a low-power lens the
Mallinckrodt product appeared to consist principally of rectangular
prisms and the Powers-Weightman-Rosengarten product to be made up
largely of plates.

[132] “Specimen 1” is a specimen of the product regularly sold in
this country. “Specimen 2” is a specimen of a product sold in England
and whose resale in this country was prohibited by the manufacturers.

_Identity._--All of the specimens when tested side by side
responded to and complied with the identity tests of the United
States, British, German, Swiss, Dutch, Swedish, Spanish, and Danish
pharmacopeias. The reactions given by the several specimens were all
the same, showing no difference in any case.

_Melting-Points._--As a further proof of identity and similarity
the melting-points of the different specimens were taken and found
to be: Acetphenetidin (Farbenfabriken), 134.2 C.; Phenacetin
(Specimen 1--Farbenfabriken) 133.7 C.; Phenacetin (Lehn & Fink),
134.7 C.; Acetphenetidin (Lehn & Fink) 134.9 C.; Acetphenetidin
(Powers-Weightman-Rosengarten), (1) 134.3 C., (2) 133.6 C., (3) 134.7
C., (4) 134.7 C.; Acetphenetidin (Squibb) 134.2 C.; Acetphenetidin
(Merck), 134.8 C., and Acetphenetidin (Mallinckrodt), 134.2 C. The
melting-point is given as 135 C. in the British, French and Spanish
pharmacopeias, and as 134 to 135 C. in the United States, German,
Swiss, Danish, Swedish and Dutch pharmacopeias. Thus all comply with
the standard given in our pharmacopeia and most foreign pharmacopeias
with two exceptions and those respectively only 0.3 C. and 0.4 C. low.

_Absence of Acetanilid._--The absence of acetanilid in all the
specimens was indicated by the bromin test of the United States,
British, German, Swiss, Dutch, Swedish and Danish pharmacopeias.

_Absence of Carbonizable Matter._--The absence of carbonizable matter
was shown in all specimens by the sulphuric acid test of the United
States, British, German, French, Swiss, Dutch, Swedish and Spanish
pharmacopeias.

_Water-Soluble Matter._--All specimens when tested for excess of
water-soluble matter came well within the limit (0.50 per cent.) set
by the French pharmacopeia, the greatest amount being 0.20 per cent.

_Ash._--When heated, all the specimens were found to yield
practically no ash, the residues from 1 gm. samples weighing in no
case more than 0.0004 gm.

_Absence of Paraphenetidin._--When tested by the methods of the
United States, British, German and French pharmacopeias, the absence
of an impurity of paraphenetidin was shown in all specimens, with the
exception of one specimen obtained from Powers-Weightman-Rosengarten
Co., which gave a positive, though not strong, reaction and two other
specimens of the same firm which reacted still more faintly.

TABLE SHOWING RESULTS OF ANALYSES OF VARIOUS SPECIMENS OF
ACETPHENETIDIN AND PHENACETIN[BG]

COLUMN HEADINGS:
A = Melting Point (Corr.) C.
B = Water-Soluble Matter in, per Cent.
C = Ash, per Cent.
D = Paraphenetidin, U. S. P. Test[BH]
E = Paraphenetidin, Swiss Test[BH]
================+==================+=======+======+======+=====+====
| Physical | | | | |
Name | Appearance | A | B | C | D | E
----------------+------------------+-------+------+------+-----+----
Acetphenetidin | Very fine | 134.2 | 0.17 | 0.02 | - | +
(Farbenfabriken)| homogeneous | | | | |
(1) | crystalline | | | | |
| powder | | | | |
| | | | | |
Phenacetin | Very fine | 133.7 | 0.06 | 0.00 | - | +
(Farbenfa- | homogeneous | | | | |
briken) | crystalline | | | | |
| powder | | | | |
| | | | | |
Phenacetin | Fine crystalline | 134.7 | 0.11 | 0.02 | - | +
(Lehn & Fink) | powder, not | | | | |
| uniform | | | | |
| | | | | |
Acetphenetidin | Fine crystalline | 134.8 | 0.13 | 0.00 | - | +
(Lehn & Fink) | powder, not | | | | |
| uniform | | | | |
| | | | | |
Acetphenetidin | Homogeneous | 134.3 | 0.19 | 0.03 | + | +
(P. W. R.) (1) | crystalline | | | | |
| powder | | | | |
| | | | | |
Acetphenetidin | Homogeneous | 134.7 | 0.16 | 0.02 | + | +
(P. W. R.) (2) | crystalline | | | | |
| powder | | | | |
| | | | | |
Acetphenetidin | Homogeneous | 134.7 | 0.14 | 0.02 | + | +
(P. W. R.) (3) | crystalline | | | | |
| powder | | | | |
| | | | | |
Acetphenetidin | Fine crystalline | 133.6 | 0.20 | 0.01 | - | -
(P. W. R.) (4) | powder | | | | |
| | | | | |
Acetphenetidin | Fine crystalline | 134.3 | 0.19 | 0.00 | - | +
(Squibb) | powder | | | | |
| | | | | |
Acetphenetidin | Fine crystalline | 134.8 | 0.15 | 0.03 | - | -
(Merck) | powder | | | | |
| | | | | |
Acetphenetidin | Fine crystalline | 134.2 | 0.11 | 0.01 | - | -
(Mallinckrodt) | powder | | | | |
----------------+------------------+-------+------+------+-----+----

[BG] In all cases identity was confirmed; acetanilid was absent; carbonizable matter was absent.

[BH] In this column plus indicates presence; minus, absence.

While this firm’s product alone gave any reaction whatever
when the U. S. P. test for paraphenetidin was applied with
the test of the Swiss pharmacopeia, all but Acetphenetidin
(Mallinckrodt), Acetphenetidin (Merck) and one specimen of
Powers-Weightman-Rosengarten Co. gave positive, though very faint,
reactions, indicating that the majority of specimens, including
those of the original manufacturer, contain a minute trace of this
impurity.

Our findings regarding the product of Powers-Weightman-Rosengarten
Co. having been communicated to this firm, their correctness was
acknowledged. At the same time the firm wrote: “All that we have on
hand now gives negative tests for paraphenetidin, and we believe our
present records are correct when we state that all lots which we are
supplying now, and have been supplying for some time past, answer all
U. S. P. requirements.”

This examination appears to demonstrate that the chemical substance, para-acetphenetidin, whether sold as acetphenetidin, U. S. P., or as phenacetin, is practically identical. The impurity of the product of some of the specimens coming from Powers-Weightman-Rosengarten Co. is too slight to be considered dangerous. Furthermore, a comparison of the “lot numbers” indicates that this firm has been improving its product steadily so that in the future its assurances of an unimpeachable product may be relied on. Inasmuch, therefore, as acetphenetidin complies with all the pharmacopeial requirements as to identity and purity, in just the same way as phenacetin, which sells for as high as five times the price of acetphenetidin, physicians need not hesitate in using the title of the U. S. P. “acetphenetidin” when prescribing this produce.--(_From The Journal A. M. A., March 16, 1912._)

Acetphenetidin and Phenacetin

A physician-pharmacist writes: “If a prescription calls for ‘phenacetin,’ should the pharmacist dispense ‘phenacetin-Bayer’--that is, the phenacetin manufactured by the original patentee--or would he be justified in dispensing the official acetphenetidin, manufactured by any reliable chemical or pharmaceutical house?”

Unless the pharmacist happens to know that the physician in writing the prescription desired the Bayer brand, he would be justified in dispensing acetphenetidin, U. S. P. As a general thing, physicians use the word “phenacetin” without intending to prescribe any particular brand or make, simply because they are familiar with this word and are not familiar with the official term “acetphenetidin.” They will doubtless continue to use the term “phenacetin” and we know of no sufficient reason for doing otherwise. During the life of the patent the word “phenacetin” became a familiar one, and the product became generally known by this term. But a coined name for a patented article loses its proprietary character and becomes the common name of the article when the patent expires. In other words, when the patent expires, not only the product but also the name itself becomes common property. This principle has been recognized by the courts. Those who formerly controlled the product and the name “phenacetin” evidently recognized this principle, for they have taken no steps to prosecute a firm in this country which sells the product openly under the name “phenacetin.” It might be added that the preparation is official in most foreign pharmacopeias under the name “phenacetin.” In agreement also with this principle the Council on Pharmacy and Chemistry (The Journal, April 27, p. 1298) lists in New and Nonofficial Remedies such products as “lanolin,” “phenacetin,” “sulphonal” and “trional” as non-proprietary names applied to Adeps lanæ hydrosus, U. S. P., Acetphenetidinum, U. S. P., Sulphonmethanum, U. S. P., and Sulphonethylmethanum, U. S. P., respectively.

In view of these facts--and also bearing in mind the findings of the Association’s Chemical Laboratory (The Journal, March 16, p. 801) that the preparations on the market under the title “acetphenetidin” are of equal quality with the preparations sold under the name “phenacetin”--the pharmacist should recognize that acetphenetidin is identical with phenacetin, is prescribed, provided, of course, that no special brand of phenacetin is ordered.

It is the physician’s privilege, of course, to specify the goods of a particular manufacturer, but in view of the fact brought out above that all brands of this chemical have tested up to the U. S. P. standard, it is placing an unnecessary burden on the pharmacist to require him to have on hand many different brands of one substance. The physician should save this privilege for use when prescribing some product that differs materially in its various forms on the market, as for example in the case of certain fluidextracts.

Physicians will doubtless find that the above comments will interest their local pharmacists. It is of mutual value for physicians to talk these matters over with their pharmacists.--(_From The Journal A. M. A., Oct. 5, 1912_).

CLEAN ADVERTISING

It is individual effort that counts for most in every movement for better things--socially, economically or politically. Realizing this, The Journal repeatedly urges physicians who write regarding various fraudulent advertisements to enter their individual, personal protest against the continuation of such advertisements.

Within the past few months The Journal has had brought to its attention a good example of what may be accomplished by personal effort in cleaning up the advertising pages of a fraternal publication. _The Royal Neighbor_, official organ of a fraternal organization, until comparatively recently, carried numerous fraudulent medical advertisements. Fake liquor cures, rheumatism cures, tapeworm expellers, tobacco-habit cures, asthma and hay-fever cures, epilepsy cures, etc., disgraced its advertising pages. These called forth protests from Dr. E. A. Hall, Henry, Ill., who addressed letters to the official physicians of the fraternal order that the _Royal Neighbor_ represents, objecting to such advertisements. These letters in turn reached the advertising manager, and it was not long before the board of managers took the matter up for consideration and decided to eliminate this class of advertising from their official organ. By December, 1913, the _Royal Neighbor_ came to its readers clean. There is no doubt that the same results can be duplicated in similar cases. Whether they are will depend on the amount of active work done by individuals interested in the question of clean advertising.--(_From The Journal A. M. A., Feb. 14, 1914._)

LIPPINCOTT’S MAGAZINE

Its Advertising--a Protest and an Excuse

A few days ago a physician wrote to The Journal enclosing two advertisements taken from the current issue of _Lippincott’s_ magazine. One of these was a half-page advertisement of that outrageous fraud, the “Oxydonor;” the other was a full-page advertisement of J. B. Lippincott Company, Philadelphia, calling for salesmen “to present standard medical books to physicians only.”

The physician sending in this material asked us to send to _Lippincott’s_ a pamphlet showing the fraudulence of the Oxydonor. Instead of doing so, we sent the pamphlet to the physician and suggested that he write a personal letter in the belief that individual missionary work is the most effective way of fighting fraud. Accordingly the doctor wrote to _Lippincott’s_ and received in reply this letter from the advertising department of that publication:

“Your letter of the 23d received, and in reply beg to say that we
do not approve of fraudulent advertising, and we have never before
been advised that the advertisement to which you call our attention
was objectionable. _In fact, we know nothing whatever about it._
[Italics ours.--Ed.] It came to us, as do most of the others, through
an advertising agency, and while we do not willingly publish anything
that is fraudulent or objectionable, _it is not our custom to verify
the claims of advertisers_ [Italics, again, ours.--Ed.] especially
when the same copy is being run in almost every other high-grade
publication.

“We have a very high regard for the American Medical Association,
and they undoubtedly are doing a splendid work in ridding the
country of fake medical preparations, but the mere fact that they
condemn some of our advertisers is hardly sufficient proof for us to
refuse the advertising, because, _if the advertiser desires to do
so, he can make us prove in the courts that he is a faker, or claim
damages from us for refusing to publish his advertisement_. [Our
italics.--Ed.] If the American Medical Association will guarantee
to protect the publishers against loss from damage suits brought by
advertisers whose business they refuse to accept, then, we believe
that the publishers would gladly reject them, but not many of the
publishers are in a position to investigate the merits of all the
advertising that is offered, especially when the claims are backed up
by affidavits of reputable people who believe themselves to have been
cured by the preparation.

“We certainly do not wish to jeopardize our medical publications by
advertising fake schemes or propositions of any kind, and we thank
you for writing us concerning the matter and will now look into this
particular case.”

This letter discloses the workings of the brain of an advertising man of the old school. The principles enunciated therein are those that dominated the advertising field until quite recently. They represent the _laissez faire_ doctrine as applied to advertising. At that time the only unacceptable advertising copy was that which would debar the publication using it from the United States mails. This was the yardstick by which all advertising was measured at that time.

The economic conscience has since awakened. There are few reputable magazines today, we venture to believe, that would be willing to go on record to the effect that it is not their “custom to verify the claims of advertisers.” The modern, progressive advertising man recognizes not only the responsibilities his profession imposes, but also realizes that, from the narrower view of enlightened self-interest, the greatest menace to the future of modern advertising is the fraudulent advertisement.

The claims on the part of the advertising department of _Lippincott’s_ that it dares not refuse to accept fraudulent advertisements because the advertiser might bring suit against it for refusing to accept his advertisement is a statement whose falsity is exceeded only by its silliness. Equally preposterous is the statement that _Lippincott’s_ will willingly refuse to accept fraudulent advertisements provided the American Medical Association will guarantee to protect the Lippincott Company against loss from damage suits that may be brought by the exploiters of the frauds whose advertisements are refused.

It may be news to _Lippincott’s_ to learn that there are a score and more of newspapers and magazines that are accepting the findings of the American Medical Association on medical frauds and rejecting advertisements of such frauds. There are many newspapers that send us the medical advertising “copy” submitted to them and ask for an opinion on it. When that opinion is unfavorable, these papers refuse such advertisements. This is being done daily. We have yet to hear of any “patent medicine” faker or quack even threatening to bring suit because his advertisements have been rejected.

The advertising department of _Lippincott’s_ may therefore take heart. When an advertisement of an outrageous fake like the Oxydonor is submitted to it, instead of accepting the money for it, meantime muttering an inaudible protest at the unfortunate position in which it has been placed, it may look the fraud in the eye and say Boo! The faker will not bite.

Before leaving the subject, we are constrained to refer to Lippincott’s medical publication, the _Annals of Surgery_. We begin to realize now why that journal offers a welcome haven to such products as Sal Hepatica, Bromidia, Papine, Gray’s Glycerin Tonic, Fellows’ Syrup of Hypophosphites, et al. Presumably the same “custom” obtains in the acceptance of advertising for the _Annals of Surgery_ as for _Lippincott’s_, namely that the Lippincott Company does “not verify the claims of advertisers.” Possibly the _Annals of Surgery_ is afraid that, should it reject the Sal Hepatica advertisement, for instance, it might he haled into court! Let us trust, for their peace of mind, that the publishers of the _Annals of Surgery_ do not receive an advertisement from Old Doc Hartman for a full page display of Peruna. The mental anguish they would undergo in reluctantly accepting this advertisement--under the fear that Hartman would “claim damages” if it were rejected--is painful to contemplate.--(_From The Journal A. M. A., Feb. 7, 1914._)

MEDICAL JOURNAL ADVERTISING

And Methods of Obtaining Paid-Up Subscribers

Time was when the postal authorities were lenient with publishers. The names of individuals who had ever subscribed for publications of a certain class were carried on the books indefinitely, whether they paid their subscriptions or not. This permitted a padding of the circulation figures. Of late years, however, the postoffice department requires publishers to have bona-fide paid-up subscriptions if they wish their publications to be carried at the low second-class rate. Certain medical journals have been hard put to it to get a circulation that would be at all attractive to the advertisers, on whose money they depend for continued existence.

Many and various have been the schemes devised whereby the dwindled circulation might be “boosted.” Subscriptions could not be given away because the postal laws forbade it. One ingenious method of obviating this difficulty is worked in this fashion: Dr. John Doe writes an article that appears in a reputable medical journal. A few days after its appearance, Dr. Doe receives a letter from the editor and publisher of a medical journal that is in need of a subscription list. He is told that the editor has read his article with much interest and would appreciate receiving from Dr. Doe a brief abstract of it. He does not expect the doctor to go to the trouble of making this abstract for nothing. He will, therefore, on receipt of the abstract credit Dr. Doe with three years’ subscription for himself or for one year for himself and one year for each of any other two doctors he may name. For every doctor that bites on this scheme the publisher increases his circulation by three copies and the federal officials are assured that they are paid-up subscriptions--not paid for in cash, it is true, but in “abstracts.”

All of this preliminary to a letter recently received:

_To the Editor_:--Enclosed find letter which speaks for itself.
Now what I should like to know from you is the following: Is the
_Charlotte Medical Journal_ all it should be? Should a doctor
contribute to a journal--thereby adding to its prestige and
circulation--that carries questionable matter in the advertising
pages? If the above journal is off color, does that act as a bar for
good men to contribute?

Very truly yours,
L. J. Genella, M.D., New Orleans, La.

The letter which our correspondent encloses is on the stationery of the _Charlotte Medical Journal_ and signed by the editor of that journal. Here it is:

“My Dear Doctor Genella:--I have just looked over an article of yours
published in the _New Orleans Medical and Surgical Journal_ entitled
‘Clinical Studies in Pituitary Irritation, with Report of Case.’ I
would be very glad indeed to have you send me a manuscript or article
for the _Charlotte Medical Journal_. Your style of writing is very
attractive.

“If you will send me an article for the journal, I will be glad to
publish same and will place your name on my complimentary mailing
list. Under separate cover I am sending you a copy of the journal.

“Of course I will expect the article to be typewritten.”

Whether or not this is a modification of the “abstract” scheme or an attempt to boost the circulation of the _Charlotte Medical Journal_ are questions we shall not attempt to answer. As to the questions propounded by our correspondent, they have been answered many times in these pages. We turn to one of the recent copies of the _Charlotte Medical Journal_ and examine its advertising pages. On one of the first we find Anasarcin, a product whose fraudulent character was described at some length in The Journal, May 4 and 11, 1907. On another page we find Tongaline, which has also come in for a fair share of attention (see The Journal, Sept. 23, 1906, and May 10, 1913). A little farther over we find a half-page advertisement of Bannerman’s Intravenous Solution, a nostrum first exploited as a “consumption cure” and now as a cure-all (see The Journal, May 31, 1913). Cactina Pillets (see The Journal, March 12, 1910), Hagee’s Cordial of the Extract of Cod-Liver Oil (see The Journal, Oct. 13, 1906), Burnham’s Soluble Iodin (see The Journal, March 28, 1908), Ecthol (see The Journal, March 13, 1909), Bromidia (see The Journal, April 21, 1906), Papine (see The Journal, April 29, 1911), Phenalgine--two advertisements (see The Journal, Jan. 13, and 27, 1906, and Jan. 27, 1912) and Sal Hepatica (see The Journal, March 26, 1910) are some more products which have attained unenviable notoriety but found a safe haven in the advertising pages of the _Charlotte Medical Journal_. Neither must we fail to refer to the advertisement of Duffy’s Malt Whiskey (see The Journal, Nov. 23, 1912), which looks thoroughly at home.

Does our correspondent--in fact, does any conscientious physician having the interest of scientific medicine at heart--want to do anything that will tend to perpetuate therapeutic fraud? Subscribing for or contributing to medical journals whose income is largely derived from nostrums that are as vicious as many of the “patent medicines” advertised in the daily press hampers the medical profession in its fight for honesty in therapeutics and renders largely abortive its fight against fraudulent “patent medicines.” So long as the accredited organs of the medical profession tolerate fraudulent “ethical proprietaries” in their advertising pages, just so long will the protests of physicians against the swindling advertisements of “patent medicines” in the daily press fall largely on deaf ears--and justly so.--(_From The Journal A. M. A., Oct. 11, 1913._)

A Physician Places the Responsibility for Fraudulent Advertising
Where It Belongs

“_To the Editor_:--The Journal has had much to say in recent years
regarding the ethics, or lack of same, in advertising matter
exploited by its contemporaries. It has been criticized by many for
the stringency of its attack; it has been criticized by very few
because it did not go far enough. Is it not about time to get to the
root of the matter?

“In the last number [see p. 426, this book] dissatisfaction is
expressed with the advertising policy of the _Medical Times_.
Nothing finer! Go to it! But is the method of attack right? I have
before me a sample copy of the _American Journal of Surgery_. Among
other articles is one on diseases of joints and the bone marrow by
a man very favorably known in Denver. He was ‘ethical’ enough to
be accorded a place on the program in the Section on Medicine at
Minneapolis. Another contributor from Baltimore remarks that he took
a patient to the University Hospital. Can it be possible that Johns
Hopkins is admitting men to its wards and clinics that are below par
in professional morals? Another article appears from a well-known
orthopedic man of Washington, D. C. Personally, I see very little
to commend in the advertising columns of the _American Journal of
Surgery_.

“I, who confess to a state bordering on youth, may be very wrong;
but I believe that the trouble will be solved only when men who
claim to have any professional distinction refuse to contribute to
journals whose pages are not clean from cover to cover. Pardon the
presumption, Mr. Editor, but were you ever tempted to print anything
like this:

“‘Last week’s issue of the _New York Medical Squall_ contains an
article on “Duodenal Ulcer” by John Doe, the well-known Chicago
surgeon. Dr. Doe doubtless knows as well as any one the disreputable
character of the _Squall’s_ advertising matter, but like most of
our great men, is unable to restrain his appetite for journalistic
publicity.’

“Physicians read medical journals because they contain literature
that is worth while. Jump on your erring editorial brethren, Mr.
Editor, but please remember that the problem of eliminating bogus
advertisements will be solved when the so-called leaders of our
profession show enough manhood to refuse literary support to
publications whose columns are in disrepute. While castigating the
little sinner, please don’t let the big sinner go scot free.

“Clinton E. Harris, M.D., Grinnell, Iowa.”

Dr. Harris sums up the situation correctly. No small degree of responsibility rests on the prominent members of the medical profession who lend their support either as subscribers for or contributors to those medical journals whose advertising pages are a stench in the nostrils of thinking physicians. Dr. Harris asks why The Journal does not condemn the advertising columns of the _American Journal of Surgery_. The Journal has done so more than once and in no uncertain terms, both in the Propaganda department and editorially. At one time it said:

“In circular letters and in an editorial announcement in its
December issue, the _American Journal of Surgery_ ‘features’--to use
a newspaper term--some of the contributors to its January issue.
The list comprises men who hold, or have held, high offices in the
American Medical Association. Presidents, vice-presidents, chairmen,
secretaries and members of sections of the Association--these
are some of the men whose names appear as contributors to this
nostrum-promoting publication. Is it any wonder that the proprietors
of the _American Journal of Surgery_ assume an attitude of
indifference to the class of proprietary preparations which they
admit to the pages of their publication?”

What was the result of The Journal thus directing the attention of its readers to the _American Journal of Surgery_? In the next issue of the _American Journal of Surgery_ appeared a seven-column editorial tirade, entitled “An Unwarranted Attack on the President and Other Eminent Members of the American Medical Association and on the Leading Medical Journals of the Country.”

On many and various occasions has The Journal called attention to the very evils that Dr. Harris deplores, and for the benefit of those who care to look up the matter these references to some of the articles are appended:

“The Mote and the Beam,” editorial, Nov. 18, 1911.

“Activity or Passivity--Sympathy or Sacrifice,” editorial, Dec. 9,
1911.

“Cui Bono,” editorial, Dec. 16, 1911.

“Medical Journals and the Great American Fraud,” Propaganda
Department, Dec. 16, 1911.

“The Profession Must Apply the Penalty,” editorial, Jan. 13, 1912.

“Fraudulent Advertising in High-Class Medical Journals,” editorial,
Jan. 4, 1913.

“Demand Clean Advertising,” editorial, Jan. 4, 1913.

“Medical Journals and the Great American Fraud,” editorial, Jan.
18, 1913.

“A Good Principle to Apply,” editorial, May 13, 1913.

“Medical Journal Advertising,” Propaganda Department, Oct. 11, 1913.

“Medical Journals and the Great American Fraud,” Propaganda
Department, Oct. 18, 1913.

“Medical Journals and the Great American Fraud,” Propaganda
Department, Nov. 1, 1913.

“The Medical Times’ Advertisements,” Propaganda Department, Nov. 8,
1913.

In another letter on the same subject its writer says: “I think the time has arrived when we have a right to expect real leadership from the ‘big men’ of the profession.”--(_From The Journal A. M. A., Nov. 22, 1913._)

MEDICAL JOURNALS AND THE GREAT AMERICAN FRAUD

How the Medical Times Aids and Abets Quackery, with the Moral Support
of Members of the Medical Profession

Two letters have been received, both from physicians. One comes from New York City and the other from Alexandria, Va. Each letter contained an advertisement of the Kellam Hospital, Richmond, Va., cut from the _Medical Times_. Here is the New York letter:

“_To the Editor_:--I am enclosing an advertisement clipped from the
_Medical Times_. It seemed to me an especially flagrant example
of what may happen in the absence of proper supervision of the
advertising pages of a medical magazine. The condition would seem
all the worse in this instance as among the ‘Board of Contributing
Editors’ are listed men like Howard Lilienthal of New York and Almuth
C. Vandiver, who is Counsel for the Medical Society of the County
of New York. The _Medical Times_ is sent to two of the physicians
who live at this address without charge and without solicitation.
Many advertisements of proprietary preparations are inserted in type
indistinguishable from that of the body of the magazine and it is of
course possible that its financial backing comes entirely from the
manufacturers of these drugs.”

And this is from Virginia:

“_To the Editor_:--The statements made in the advertisement of the
Kellam Hospital in the October number of the _Medical Times_ are so
out of the ordinary that I ask you to tell us something if you can
of their institution and its methods of cure. Can such things as are
stated in this advertisement be true? ‘Physicians Treated Free?’
‘Endorsed by the Senate and Legislature of Virginia?’ What can all
this mean to the sufferer from cancer? If true, let the whole world
of sufferers know the glorious news.”

_Collier’s_ paid its respects to the Kellam concern some time ago and we cannot do better than quote from its pages. Thus:

“Grief is the portion of the Kellam Cancer Hospital, of Richmond,
Virginia, because in these editorials it has been grouped with other
exemplars of the Great American Fraud. It offers the invariable
and hollow mockery of testimonials and endorsements, which, as has
been repeatedly shown, can be wheedled, browbeaten or bribed out
of the victims of any form of quackery. It, of course, courts the
fullest investigation, and desires that we send a representative to
investigate whether its claims are not well founded. Unsuspected
by the Messrs. Kellam, our representative has already investigated
their claims, notably their statement that they are endorsed by the
Legislature of the State of Virginia. Upon request for a copy of
the endorsement they forwarded a weak subterfuge, and finally, on
pressure, admitted that they could not produce the proof they had
boasted. For their further consideration we present a brief parallel:

FROM THE KELLAM CIRCULAR FROM A KELLAM LETTER

The Cancer is removed without We do not claim to “_cure them
the use of the knife or X-Ray all_.” We go further, and on
... No roots or fibers left; our part, we agree to treat, free
_hence it can not return_. of charge, any patient _who
suffers a recurrence after having
been treated by our method_.

“The italics are our own, but we cheerfully present them for
elucidation to the Kellam Hospital. A little careful thought devoted
to reconciling the irreconcilable may help them to forget their
woe. Meanwhile, they make themselves out worse than they really are
by pretending to withhold from the bitter need of humanity a true,
non-surgical cure for cancer. If this were true; if, indeed, they had
solved the problem which has baffled the greatest minds of modern
science; if, having a genuine cure for the dreadful ailment which
claims its increasing thousands of tortured victims yearly, they
secrete their discovery for the sake of a few paltry dollars, then
they are as cold-hearted as the sailors who pass within fair hail of
the naked island on which some shipwrecked crew is starving, and keep
their stony eyes on the compass. They have not even the excuse of the
fanatical among the Christian Scientists who, denying the existence
of pain, refuse to take measures to ease the cancer victim’s
suffering even at the last. Human nature is seldom so callous.”

As for the _Medical Times_: This publication for years contained comparatively little advertising. Then it came into the hands of Romaine Pierson, who also owns the _Practical Druggist_. Mr. Pierson is not a physician and to him the medical profession is but a commercial problem. He is publishing a medical journal for the money there is in it, and for this he is not to be censured. Questions of advertising policy, in such circumstances, are determined on a commercial basis. When an advertising contract is submitted, for a product that physicians would know to be fraudulent, the question that arises is, “Can it be put over?” Manifestly, a medical journal published purely as a business venture would not dare long to fly in the face of the opinions of those from whom it received its support--its subscribers and contributors. If our correspondents will go through the advertising columns of the _Medical Times_ they will find many, many other frauds, less cruel perhaps than the Kellam advertisement, but no less disreputable or discreditable to the medical profession.

After all is said and done, it is enlightened public opinion that is causing publishers of lay magazines and newspapers to eliminate fraudulent “patent medicine” and quack advertisements. Until the medical profession takes an equally enlightened stand, physicians may expect to be afflicted with such commercial medical journals as the _Medical Times_, the _International Journal of Surgery_, the _American Journal of Surgery_, _American Medicine_, and several other papers that are published primarily in the interest of the advertiser. When such journals as these find they cannot get a circulation among physicians so long as they carry advertisements similar to many now appearing in their pages, these advertisements will be eliminated, but not before. Many physicians are receiving such journals at a nominal price or, as one of our correspondents notes, free. The physician who permits such journals to come to his office must share with the paid subscribers the responsibility for the low standard of medical journalism.--(_From the Journal A. M. A., Oct. 18, 1913._)

Two Physicians Express Themselves on the Ethics
of Medical Journalism

After the preceding article was in type, we received, in the same mail, two letters that are so apropos that we reproduce them. The first was from a town in Illinois, and was dated October 11. Here it is:

_To the Editor_:--About two weeks ago, a representative of the
Surgery Publishing Company, New York, N. Y., came to ---- Ill.
soliciting subscriptions for the _American Journal of Surgery_.
Together with numerous others I subscribed--chiefly on the strength
of the contributors whose articles appeared in the sample numbers
shown by the agent.

Since receiving the first number (October) one look at the
advertising pages has shown me why the subscription price for a year
and a quarter is one dollar. Anasarcin, Tongaline, Cactina Pillets,
Hagee’s Cordial of Ext. Cod Liver, Burnham’s Soluble Iodin, Papine,
Phenalgine, Anusol, etc., etc.

I have written to the Surgery Publishing Company, telling them in
no uncertain language that there is no room on my reading desk for
such. Have you ever exposed this journal, and the attitude of our
big, brilliant, eminent men in permitting their articles--presumably
original--to fill space in such a journal? [Yes! The Journal,
Dec. 16, 1911, pp. 2,000 and 2,013.] This letter is not for
publication--at least not with name of city. Keep up the good work....

The other, dated October 10, follows:

_To the Editor_:--That little story about medical journal advertising
and methods of obtaining paid-up subscribers, in this week’s Journal
makes me blush (p. 422, this book). I am guilty. Unlike Dr. Genella,
I swallowed the bait--but the bait was even more tempting in my case;
the flattering “editor” offered me twenty-five subscriptions to
distribute among my friends, all for an “abstract.” Thank goodness,
I only accepted five subscriptions, but worse luck, I sent them
to young men by preference. So I am a deep-dyed offender indeed.
Extenuating circumstances affected my susceptibility somewhat,
however. I have noticed that prominent men like Beverly Robinson,
A. Rose, Tom A. Williams, Wayne Babcock, and Morris--the latter, at
least, a really able man and a brilliant writer--contribute to these
peanut journals occasionally. If they do, why not I? There’s nothing
like being in big company, you know.

So far as I know, my “abstract” has not yet been published. On
looking over the sample copy of this monthly I found an advertisement
printed right in the list of contents--in fact, it was the second
“original article” in the issue, as brave and respectable as you
please! Then, with characteristic Hibernian impetuosity I got out my
machine and pounded that editor a strong protest with a dire command
not to use my “abstract” in his miserable organ. But I have never
received the manuscript, nor any reply to my stern rebuke. I wish I
had been cautious like Dr. Genella.

Wm. Brady, M.D., Elmira, N. Y.
--(_From The Journal A. M. A., Oct. 18, 1913._)

The Responsibility of Physicians

The responsibility of medical journals for the continued existence of at least a part of the “great American fraud,” has been referred to in these pages many times. Within the past few weeks The Journal has called attention to the inconsistency of reputable physicians of high ideals lending their moral, and often financial, support to those medical journals whose advertising pages are a disgrace to the profession. Specifically, the _Medical Times_--originally a homeopathic medical journal--has been referred to, among others, as an example of this type of journalism. It must, however, be regarded simply as a type, for it is no better and no worse than many other medical journals. Several letters have been received on the subject, some of which we reproduce. The first one is from Dr. George G. Ross of Philadelphia:

“I was very much jarred on receiving the last issue of The Journal
to find under the Propaganda for Reform an article concerning the
_Medical Times_, among the list of whose contributing editors my name
appears. I enclose you herewith a copy of my letter of resignation to
the _Medical Times_. I have a very dim recollection of what occurred
at the time that I was asked to give my name as a contributing
editor. As I recollect it, however, at that time the journal was a
respectable and ethical publication. I had been asked by a friend of
mine to write an article giving my opinion of the effects of college
athletics on undergraduates. This was at the time that Dr. Stokes had
issued his order about athletics at Annapolis. I want personally to
thank you and the committee for the exposure of this journal and for
having drawn my attention to the fact that I was unwittingly aiding
and abetting such a journal. I trust that if you have space in some
future number of The Journal, you will do me the justice to publish
all or part of this letter.”

Because he feels that he has “unwittingly been put in an unfavorable light,” Dr. James A. Babbitt, also of Philadelphia, sends The Journal a copy of a letter written by him to the editor of the _Medical Times_. Here it is:

“For reasons of which you are probably cognizant, I deem it
advisable to resign from the board of contributing editors of the
_Medical Times_, and desire that this resignation be accepted at
once and my name not appear in further issues.”

What shall be done, asks Dr. Sidney Thompson of Humboldt, Tennessee, in such cases as the following? Says Dr. Thompson:

“In the Propaganda for Reform, in The Journal, October 18, 1913, in
closing your article on ‘Medical Journals and the Great American
Fraud,’ you say: ‘The physician who permits such journals to come to
his office must share with the paid subscribers the responsibility
for the low standard of medical journalism.’ Now I agree with you in
everything you have said about the _Medical Times_, but what I want
to know is how to keep such journals from coming into your office.
The _Medical Times_ has been coming to me for a number of years with
repeated duns for the subscription price. I have written to them
several times that I did not want the journal and never expected to
pay for it, but still it comes. I have a vague recollection that I
bit at an offer to send it three or four months free, not knowing
what it was, but I never authorized them to enter my name as a
regular subscriber.”

The simplest course in such a case as that described by Dr. Thompson, is to write on the unwelcome publication the word “refused” and either drop it in the nearest mail-box or hand it back to the postman. The courts have held that a person who continues to accept publications is legally liable for the payment of such publications. The postoffice department, however, has ruled that a magazine--either monthly or weekly--may not be sent at second-class rates for more than one year after the expiration of a bona fide subscription. At the expiration of that time, stamps must be affixed and the publications sent at third-class postal rates.--(_From The Journal A. M. A., Nov. 1, 1913._)

Medical Journals and Sanatogen[BI]

[BI] See also Sanatogen, p. 358.

We have frequently referred to the inquiries that are received by this office from newspaper and magazine editors asking for information about products whose advertisements they have been offered. One of the greatest difficulties in the way of accomplishing the good that such inquiries otherwise might lead to is the lack of uniform action on the part of the medical press of the country. A specific instance may be given. A layman wrote to a high-glass weekly magazine published in New York City protesting against an advertisement of Sanatogen which the magazine was carrying, and sending a reprint of The Journal’s article on this product. The advertising manager of the magazine in question wrote back that he had seen The Journal’s article, but had sought further information regarding the preparation from the editor of a medical journal in his city. The medical editor recommended that the magazine accept the Sanatogen advertisement, so the advertising manager said, and in view of this, the manager suggested that possibly the article published by the American Medical Association in its journal was inspired by some “personal prejudice.” Giving weight to the probability that the advertising manager went for his information to a source that he knew would be favorable to the acceptance of the advertisement, the fact remains that it is a disgraceful state of affairs when editors of medical journals will give vicious advice in matters on which they are supposedly competent to pass. The probability is, of course, that the medical journal whose editor was questioned contained the self-same advertisement that the lay magazine was carrying. And the advertising manager of the magazine was willing to accept--because such information coincided with his wishes--information that on its face must be biased, and rejected advice--that did not meet his approval--because of a purely supposititious “personal prejudice.” It is probably asking too much to expect advertising managers not to go to sources that are likely to be favorable for information about products whose advertisements are offered to them. But we have a right to expect that physicians, editors of medical journals, should no longer be _participes criminis_ in the furtherance of the great American fraud. If our strictures on Sanatogen are unfair, if the Council on Pharmacy and Chemistry rejected the product in mere pique, if the opinions of such men as Billings, Cabot, Hektoen and Lusk are to be brushed aside as “personal prejudice,” if this mixture of cottage cheese and glycerophosphates really is the marvelous product which its exploiters claim--then indeed not only have the editors of medical journals a right to praise it, but it is also their duty to proclaim these wonders in their editorial pages. If, on the other hand, this much-vaunted preparation is a very ordinary mixture sold at an extraordinary price, if indigent consumptives and others are being inveigled into spending dollars for a preparation whose food value could be duplicated for a few cents--then in the name of humanity and common decency let the editors of medical journals proclaim these facts, and not let their scientific judgment be blinded by the glitter of advertising contracts.--(_Modified from The Journal A. M. A., Jan. 18, 1913._)

THE ARMY AND NAVY MEDICAL RECORD

A Fraudulent Publication Whose Editorial Opinions Are for Sale

Whenever a business assumes certain proportions, subsidiary businesses spring up to cater to the needs of the larger enterprise. For some years the nostrum business has grown so large that it has furnished a more or less precarious life for many individuals who have catered to it. There are, for instance, men whose trade it is to obtain testimonials; others, claiming a long string of imposing degrees, will furnish fake reports and bogus analyses; still others issue at irregular intervals publications with high-sounding names which sell editorial indorsement to the products of concerns such as are willing to pay the price asked. “Journals” of this type have been called to the attention of our readers at different times; the _New York Health Journal_ and the _United States Health Reports_ come to mind at this moment. Both of these had their day and died a natural death, as all such publications must when once the public is cognizant of their true character.

TWO LETTERS

More recently the attention of _The Journal_ has been called to a publication calling itself the _Army and Navy Medical Record_. A physician in the South sends a letter he has received from the _Army and Navy Medical Record_ reading as follows:

“We have had many favorable reports reach us relative to your most
excellent institution, and, as you are doubtless aware, we come
in direct contact with a large number of Army and Navy and other
government attachés who have sons that they desire to provide with
a medical education combined with the higher course included in
your up-to-date laboratory methods and the sciences incidental to
clinical medical practice.

“If you will regard the proposition as confidential, we will agree
to carry a one-fourth page advertisement of your university at the
nominal rate of $38 per year, provided this amount is forwarded in
advance at the time copy is furnished; and _we will further promise
to editorially indorse and recommend your school and its methods
without qualification or exception_. [Our italics.--Ed.] This
article you should be able to use (and are authorized to do so)
after publication for advertising purposes.

“We will also be able, and are willing, to furnish you with a
desirable list of probable candidates from time to time.

“Kindly let us hear from you at once, if interested, and oblige,

“Yours with best wishes,
“The Army and Navy Medical Record,
“Arthur G. Lewis, Managing Editor.”

The physician to whom this was addressed made a notation on the letter to the effect that “this looks crooked.” A few weeks later, Dr. V. C. Vaughan, dean of the University of Michigan, Department of Medicine and Surgery, sent in a letter from the _Army and Navy Medical Record_ which he had received in his official capacity at the university. Here is the letter; again the italics are ours:

“We are gratified to advise you that in our efforts to select a
strictly ethical and high-grade institution of medicine that this
magazine could consistently indorse and recommend, we have decided
on the University of Michigan, Department of Medicine and Surgery,
as the institution in your territory to whom our special publicity
concession will be made this year.

“You are doubtless aware that we come in direct contact with a
very large number of Army and Navy and other government attachés,
also physicians in private practice who have sons that they desire
to provide with a medical education, combined with the higher
courses included in your up-to-date methods.

“For personal reasons we are particularly anxious to favor your
institution, and frankly believe that we can prove of material
service to you. The special proposition, to be regarded by you as
strictly confidential, is that we will publish a full one-half page
announcement of your institution for the term of one year, you to
merely pay a nominal expense charge of $38 for the year’s service.
As our regular rate is $125 per annum for this service, _the
necessity of regarding the matter between ourselves is apparent_.
[Transparently so.--Ed.] We further propose, without expense to
you, to editorially indorse and recommend your institution and
its methods without qualification or exception. An electrotype
illustration may be used, without charge.

“It is important, however, that we hear from you promptly. Awaiting
your immediate reply, we are, with best wishes,

“Yours faithfully,
“The Army and Navy Medical Record,
“Arthur G. Lewis, Managing Editor.”

Dr. Vaughan, in forwarding the matter to The Journal, wrote that on receipt of the offer just given, he “was uncertain whether its writer was a knave or a fool.” After inquiring into the matter somewhat thoroughly, he concluded that “the managing editor of the _Army and Navy Medical Record_ is both a knave and a fool.”

THE ARMY AND NAVY MAGAZINE

The Journal had the _Army and Navy Medical Record_ under investigation before these two letters were received and, as a result, the following facts seem to be pretty well substantiated. Herbert C. Lewis, with his brother, Arthur G., conducted from Washington, D. C., a publication called the _Army and Navy Magazine_. In The Journal’s nostrum file there is a booklet put out by the Renova Distributing Company describing the wonderful virtues of its product, “Anti-Jag,” which, as its name might intimate, is a “liquor cure” of the fake variety. One page of this booklet is given over to what purports to be “A Letter from a Great Magazine Editor.” The letter is dated June 19, 1900, from Washington, D. C., and says that “the editor of the _Army and Navy Magazine_ takes pleasure in stating that from his own personal knowledge he has found ‘Anti-Jag’ to be one of the most reliable medicines ever introduced for the permanent cure of drunkenness.” And more to the same effect. The letter is signed “Herbert C. Lewis, editor.”

The publishing offices of the _Army and Navy Magazine_ are at 606 F Street, N. W., Washington, D. C. The building at this address is known as the Baltic Building. Herbert C. Lewis is said to be a printer by trade.