Chapter XXVIII: Part IV: Contributions From the Journal: Miscellaneous Matter (2)

The _Army and Navy Medical Record_ seems to have been started within the last few months by Arthur G. Lewis. It does business from two addresses, the Baltic Building, Washington, D. C., and the Maple Villa Sanitarium, Hammonton, N. J. Lewis is said to have purchased the Maple Villa Sanitarium recently, but apparently his chief source of income is the _Army and Navy Medical Record_. He is alleged to have claimed that some medical officials of the government are interested with him in this publication but that these officials do not wish their names known. We do not blame them.

ADVERTISEMENTS AS EDITORIALS

A glance through two issues of the _Army and Navy Medical Record_ makes perfectly plain the character of the publication. The January-February, 1913, number leads off with articles by well-known medical officers in the Army, the Navy and the Public Health Service. These have been copied from other publications. Then comes an editorial entitled “A Much Needed Dietary Reform,” devoted to the laudation of “Postum,” the widely advertised coffee substitute. Following this is an editorial on “The Philosophy of Hypnotics” in which aconitine, saline laxative and digitalin are each given a “boost.” Then comes an “original article” (save the mark!) entitled “The Physiological Pathology of Consumption.” This is by “Alfred S. Gubb, M.D., L.R.C.P., London, M.R.C.S., Eng., D.P.H., etc. etc., Aix-les-Bains, Savoie, France.” Two pages are devoted to this. The “joker” appears in the third paragraphs from the end--Fellows’ Syrup of Hypophosphites. Dioxogen receives more than three pages of editorial mention under the caption “The Sterilization of Milk with Dioxogen.” Under “Another New Electrical Wonder--Magnified Sound,” the “Acousticon” is given a two-and-a-quarter page write-up. “What Wise Men Wear” is the title of a four-page article--unsigned--devoted to the laudation of suspensories in general and the “O-P-C Suspensory” in particular. Dr. H. F. Boatman, Los Angeles, contributes a short article on “A Case of Advanced Pulmonic Tuberculosis Treated with Injections of Dioradin,” while our good old friend Willard H. Morse, M.D., “F.S.Sc. (Lond.),” the champion fake-testimonial-giver of the country, writes more or less entertainingly on “Putting on a Mustard Plaster.” The article has nothing to do with mustard plasters but has a good deal to do with “Zumota,” a nostrum recommended as a substitute for the mustard plaster. These are but a few of the nostrums to which the editorial and reading pages of the _Army and Navy Medical Record_ are devoted.

In the June-July issue, Arthur G. Lewis becomes bolder. The leading article is entitled “First Aid in the Navy,” by C. F. Stokes, Surgeon-General, United States Navy. There is nothing to indicate that this article was not contributed to the _Army and Navy Medical Record_ by its author. As a matter of fact, it originally appeared in an official publication, the _United States Naval Medical Bulletin_ for January, 1913, and was reprinted by Lewis without credit and without permission. Following the article by Dr. Stokes is another, unsigned, entitled “The Passing of ‘The Pie Habit.’” This describes the surprise of the students of Harvard University at being served breakfast cereals instead of pie at their noonday meal and suggests that “Shredded Wheat Biscuits” make a “delicious dessert.” A two-and-a-half page article on the “Danger of Corrosive Sublimate in Vaginal Douche” is reprinted from the _Lancet-Clinic_ of September, 1903. The reason for resurrecting this ten-year-old article becomes apparent before one gets half through it. It deals not so much with the danger of corrosive sublimate as with the marvelous--alleged--properties of Tyree’s Antiseptic Powder. Dr. Claude C. Keeler, Denver, has a three-page article on the “Medical Treatment of Pulmonary Tuberculosis.” The “medical treatment” referred to is Waterbury’s Compound. An editorial entitled “One Notch Ahead of Morphin” is devoted to that vicious morphin solution sold under the proprietary name “Papine.” Another on “The Treatment of Catarrh by Palliatives and Curatives” deals with a widely advertised “patent medicine,” “Kondon’s Catarrhal Jelly.” What appears to be a contributed article by Charles Wardell Stiles of the United States Public Health Service on “Country Schools and Rural Sanitation” has really been “lifted” from an official publication without credit and, needless to say, without Dr. Stiles’ permission.

But medicinal preparations are not the only things to which the _Army and Navy Medical Record_ gives editorial indorsement. All advertising matter, apparently, is grist to its mill. Sandwiched in between articles on “Public Health Administrations” and “Important Army Medical Lectures” is a dissertation on “The Millennium of Shirt Construction,” in which are sung the virtues of the tailless shirt! A little farther along the Hawaiian pineapple is extolled, while the last pages of the issue are devoted to various banking concerns.

In addition to the advertisements appearing throughout the reading and editorial pages of these two issues of the _Army and Navy Medical Record_, there are a number of display advertisements. There is no reason to suppose, at least in the majority of cases, that the advertisers had the slightest reason to suspect the nature of the _Army and Navy Medical Record_. Several pages are devoted to financial advertisements, there being more than forty banks that have “fallen for” the wiles of Arthur G. Lewis. In view of the letters received by the deans of medical colleges and other educational institutions, the display advertisements of schools and colleges have a special interest to physicians. Schools for girls, polytechnics, colleges of music, veterinary, dental and medical schools--all are to be found in this cosmopolitan publication.

Among the therapeutic products advertised--in the advertising pages--are:

Fellows’ Syrup of Hypophosphites 1 cover page
Kondon’s Catarrhal Jelly 1/2 page
Expurgo Anti-Diabetes 1/2 page
Laxol 1/2 page
Campho-Phénique 1/2 page
Palpebrine 1/2 page
Zumota 1/2 page
Sanmetto 1/4 page

While in the reading pages the following products are puffed:

Tyree’s Antiseptic Powder.
Waterbury’s Compound.
Papine.
Kondon’s Catarrhal Jelly.
Ranier Natural Soap.
Iodia (Battle).
Creo-Derma.
Fellows’ Syrup of Hypophosphites.
Tannalbin.
Expurgo Anti-Diabetes.
Zumota.
Sulfothen.
Dioxogen.
Palpebrine.
Bannerman’s Intravenous Solution.
Daniel’s Concentrated Tincture of Passiflora.
Peacock’s Bromides.
Aletris Cordial Rio.
Gonosan.
Digipuratum.
Dioradin.
Pepto-Fer.
Lactol.
Campho-Phénique.

Summed up: The _Army and Navy Medical Record_ is but another of the parasites of quackery. It is not entered as second-class matter and it has probably no bona-fide circulation. While it is claimed to be “Devoted to the Interest of the Medical and Surgical Corps of the Army and Navy, the Public Health Marine Hospital Service and the Red Cross Society” it is actually devoted to none of these. It is devoted to the exploitation of the advertising public for the special financial benefit of the man who calls himself its editor--Arthur G. Lewis. Advertising contracts are obtained under false and fraudulent pretenses. In brief, Arthur G. Lewis is using the good name of the various medical services of the United States government to further his swindling operations. He has written letters to honorable physicians making dishonest and insulting propositions to deceive and defraud the public. Editorial indorsements of the _Army and Navy Medical Record_ mean nothing except that money has been paid for them. In short, the _Army and Navy Medical Record_ is a fraud, and its “editor,” Arthur G. Lewis, a faker.--(_From The Journal A. M. A., Oct. 25, 1913._)

THE MEDICAL TIMES ADVERTISEMENTS

In Which Are Discussed Some “Oversights” and
the Ethics of Journalism

Two or three weeks ago we published letters from two physicians calling attention to an advertisement of a “cancer cure” hospital appearing in the _Medical Times_. As a result of The Journal’s comments, some of the physicians who were listed as “contributing editors” of the _Medical Times_ wrote that they had requested that their names be withdrawn from this list. In reply to at least some of these letters, the editor of the _Medical Times_ wrote asking them to reconsider their decision and offering as an excuse the statement that the appearance of the “cancer cure” hospital advertisement was an oversight. In this connection the following letter from the _Medical Times_, addressed to The Journal of the American Medical Association, is pertinent:

“_Gentlemen_:--We note in your issue of October 18 an article
calling attention to an advertisement which appears in the columns
of this journal, and to which your editor rightly objects.

“The advertisement in the _Times_ was the result of an oversight,
and it will not reappear.

“While we are indebted to you for thus bringing the matter to our
attention, we cannot but feel that a letter written to us would
have been more in keeping with the ethics of journalism.

“Very truly yours,
The Medical Times.”

It will be noticed that this letter, like the letters sent to other physicians, ignores altogether the most important point made by The Journal in its criticism of that publication’s advertising policy. The Journal said in this connection:

“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.”

The _Medical Times_ apologizes for the advertisement of the Kellam Cancer Cure Hospital but ignores altogether the fact that the hospital advertisement was but one of many equally discreditable. We turn to recent issues of the _Medical Times_ and we find it fairly reeking with advertisements of proprietary preparations that are a disgrace to the medical profession, many of them having been repeatedly exposed in The Journal. We find, for instance, a quarter-page advertisement of the Expurgo Manufacturing Company. “Expurgo Anti-Diabetes,” we are solemnly told in the pages of the _Medical Times_ is:

“The only reliable and thoroughly tested remedy for the cure of
Diabetes Mellitus and Insipidus.”

This wretched fraud, which also is advertised in true “patent medicine” style direct to the public, is presented to a presumably intelligent profession as a “cure” for a disease which so far has baffled the best brains in the scientific world.

“Expurgo Lapis” we are told, also via the _Medical Times_ is:

“The only known cure for gall-stones, kidney and bladder stones,
gravel and all kidney trouble arising from uric-acid origin.”

Did Kilmer’s Swamp-Root ever claim more? “Diabetes is no longer an incurable disease” runs the advertisement of the Jireh Diabetic Food Company, yet the editor of the _Medical Times_ must know that in The Journal[133] and in the reports of state chemists the Jireh diabetic foods have been shown time and again to be among the most dangerous and fraudulently exploited products sold to the unfortunate diabetic.

[133] The Journal A. M. A., Dec. 14, 1912, March 22, 1913, and April 5, 1913; see also p. 451, this book.

Phenalgin,[134] twin brother to the Antikamnia fraud, shouts its inferential falsehoods in a half-page display. Micajah’s Wafers,[135] the alum-borax mixture long advertised as a cure for gonorrhea, endometritis, etc., may also be found, as well as many other preparations exposed at various times by The Journal. For example: Anasarcin,[136] Campho-Phenique,[137] Papine,[138] Bromidia,[139] Cactina Pillets,[140] Pluto Water,[141] Prunoids,[142] Sanatogen[143] and Sal Hepatica.[144]

[134] Pages 10 and 335, this book.

[135] Page 240, this book.

[136] Page 11, this book.

[137] Page 40, this book.

[138] Page 330, this book.

[139] Nostrums and Quackery, Ed. 2, p. 589; page 31, this book.

[140] Page 36, this book.

[141] The Journal, March 29, 1913, p. 1013.

[142] Page 178, this book.

[143] Nostrums and Quackery, Ed. 2, p. 470; page 358, this book.

[144] Nostrums and Quackery, Ed. 2, p. 639; page 179, this book.

What excuse can the _Medical Times_ offer for the presence of these frauds in its pages? Are these, too, “the result of an oversight”? Presumably for thus bringing to its attention these various other disreputable advertisements, The Journal will be accused again of violating “the ethics of journalism.” If calling attention to fraudulent advertisements is out of keeping with the ethics of journalism, what, pray, must be said of publications that are willing to share in the profits of such fraudulent exploitation? But, and we cannot repeat it too often, the _Medical Times_ is but one of a class, neither worse nor better than many other medical journals whose financial support comes from the proprietary interests rather than from the medical profession. The responsibility for the existence of these journals really rests not on the business men who conduct them on a commercial basis, but on the physicians who tolerate or encourage them in any way.--(_From The Journal A. M. A., Nov. 8, 1913._)

CAUSE FOR OPTIMISM

A Clean Medical Journal--the South Texas Medical Record

Fortunately, there are forces at work in the medical profession that make for optimism. An editorial in the last issue--April, 1915--of the _South Texas Medical Record_, the official organ of the South Texas District Medical Association, is especially significant. While not a large journal, the _South Texas Medical Record_ could well stand as an example to medical publications of a much more pretentious character. Its advertising pages are above reproach and the journal is a credit alike to its editors and to those members of the profession whose support makes its existence possible. In the editorial referred to, entitled, “Honest Advertising--Let Us Cleanse Our Own Linen First,” the editor-in-chief, Dr. W. Burton Thorning, says:

“A recent editorial, entitled ‘Honest Advertising,’ in a daily
newspaper, furnished the occasion for an editorial comment in the
January number of the _Southwestern Hospital Reporter_. The latter,
while taking the ground that the newspaper was inconsistent in
uttering high editorial sentiments and in adjoining columns printing
patent medicine advertisements, implied that newspaper men should be
allowed some latitude in the matter of accepting advertising, on the
plea of being laymen and therefore not expected to possess the same
amount of information concerning patent ‘dope’ that medical men have.

“It would appear to be a fair assumption that a layman, even though a
highly educated and able editor of a great newspaper, does not know,
and cannot be expected to know, the depth of depravity to which the
consumption cure faker and the cancer quack can descend.

“Granting that the newspaper man accepts the advertisements through
ignorance of the facts concerning their possibilities for evil,
what can be offered in defense of the medical editor who accepts
advertising matter equally pernicious in its influence?

“Indeed, it is not so many years since many of the so-called ethical
medical journals carried the ads of some of the most notorious quacks
this country has ever known.

“Doubtless there are few, if any, who do so at the present time,
but, on the other hand, there are only a few who do not advertise
unethical institutions, and questionable proprietary medicines. As a
matter of fact some of the most widely advertised patent medicines of
today were formerly advertised as ethical proprietaries in medical
periodicals, the great majority of which are still serving as a sort
of preparatory school for advertisements that will presently appear
in the lay press.

“What shall be offered in defense of the medical publication
which continues to publish the advertising matter of hundreds of
proprietaries which the Council on Pharmacy and Chemistry of the
American Medical Association has shown to be either generally
worthless or an out and out fake?

“Can the medical editor plead ignorance? Hardly. To do so would be to
admit utter incapacity. There is only one inference to be drawn; the
publication needs the money and is not overparticular regarding its
source.

“There is a remedy, however, a remedy absolutely certain in its
results. If every physician in the United States for a period of
three months would positively refuse to receive at his desk a medical
journal containing questionable advertising, this blotch on medical
journalism could be erased.

“It is true that many of them would sink, never to rise again, but
the profession would be better off without those whose existence
depends upon ‘phoney’ advertising. There are, unfortunately, several
American journals whose reading pages are well and carefully edited
and a credit to medical literature, whose advertising pages carry
such undesirable matter that the educated physician can only feel a
sense of disgust.

“Such journals could very well succeed on the quality of their
reading matter and undoubtedly would increase their circulation
enough to more than offset the loss in advertising.”--(_From The
Journal A. M. A., May 29, 1915._)

THE COMPARATIVE NUTRIENT VALUE OF COD LIVER OIL AND
COD LIVER OIL CORDIALS[BJ]

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

[BJ] See also reports on Hagee’s Cordial, pp. 51, 289; Wampole’s Preparation, pp. 52, 442, and Waterbury’s Compound, pp. 54, 57, 291.

For a long time cod liver oil has been recognized as an easily assimilable nutrient and reconstructive and of special value in wasting diseases. The unpalatability of the oil, however, has led to various devices to make it tasteless or to render it more acceptable to the stomach. Emulsions containing the oil in mixture with other substances were exploited, and doubtless served a useful purpose. The oil, however, but imperfectly concealed, was still disagreeable to many, and other preparations began to appear on the market, which claimed to retain the therapeutic virtues of cod liver oil without its disagreeable characteristics. This practice has been carried so far that now we find for sale cod liver oil preparations from which the oil has been removed in its entirety, and only the name remains. Certain of these products claim to “represent” the oil and to retain all its virtues; others are said to contain oil, while still others claim “all the valuable constituents” of the oil without the oil itself.

In the past, cod liver oil has been considered a food rather than a medicine, and its value attributed to the easily digestible and metabolizable oil it contains. This position, however, has been disputed. By some its therapeutic value has been attributed to the small amount of iodin present in the oil, but in recent years the suggestion has been made that its special potency depends on its peculiar fatty acids. In this connection the U. S. Dispensatory[145] says:

[145] U. S. Dispensatory, Ed. 19, p. 860.

“Other oleaginous substances, certainly not less nutritious, have not
been equally efficient, though taken in much larger quantities. If
this be the true explanation, persons living chiefly on milk, which
abounds in oil, or on fat pork, ought to show a special exemption
from scrofulous complaints. The probability appears to us to be that,
in consequence of some peculiar principle or principles it contains,
it exercises a stimulant and alterative influence on the processes
of assimilation and nutrition, thereby aiding in the production of
healthy tissue.”

Indeed, Osborne and Mendel[146] have shown in their experiments on albino rats that by substituting cod liver oil for a portion of the lard in their standard diets, growth was resumed after failure on foods containing commercial lard alone as the source of fat. Similar results were secured with butter-fat and egg yolk fat.

[146] Osborne, T. B., and Mendel, L. B.: Jour. Biol. Chem., 1914, xvii, 401.

In the light of the theories advanced for the therapeutic value of cod liver oil, and the results secured by Osborne and Mendel with the oil itself; it seemed a profitable study to examine some of the prominent “oilless” preparations on the market to determine whether or not the claims made for them as nutrients were justified. Certain of the so-called cod liver oil preparations are termed “extracts” of cod liver oil, and are not made from the oil, but from the cod livers instead. As has been well said,[147] “They are preparations, which, if honestly made, might be worthy of trial, but they are improperly called ‘extracts’ of cod liver oil, since they do not contain the fat, which is the active constituent of the oil, but the extractives from the liver, which may or may not possess therapeutic virtues. So far as we know, however, no satisfactory evidence is forthcoming to indicate that such extractives have any therapeutic value.”

[147] Fraud and Deception Connected with So-Called Cod Liver Oil Preparations, The Journal A. M. A., Oct. 13, 1906, p. 1207.

It was with preparations of this class that our experiments were made. Four of the more extensively advertised brands were selected, as they represent rather distinct types of this class of products, as the following claims of their label will show:

_Hagee’s Cordial of the Extract of Cod Liver Oil,
Compound._--“Tonic, stimulant, alterative, reconstructive,
nutritive and digestive.” “Each fluid ounce represents the extract
obtainable from 1/3 fluid ounce of cod liver oil (the fatty portion
being eliminated), 6 grs. calcium hypophosphite, 3 grs. sodium
hypophosphite, 1/2 gr. salicylic acid (made from oil wintergreen),
with glycerin and aromatics.”

_Vinol._--“The modern tonic reconstructor containing the medicinal
extractives of fresh cod livers with peptonate of iron.” “When the
blood is poor, when more fresh blood is needed, when the weak need
strength, when the throat and lungs are affected, TAKE VINOL.”

_Wampole’s Perfected and Tasteless Preparation of an Extract of
Cod Liver._--“Contains a solution of an extractive obtainable
from fresh cod livers, the oily or fatty portion being afterward
eliminated. This extractive is combined with liquid extract
of malt, fluid extract of wild cherry and compound syrup of
hypophosphites (containing calcium, sodium, potassium, iron,
manganese, quinine and strychnine).”

_Waterbury’s Compound, Plain._--“Made from cod liver oil, digestive
ferments, malt extract unfermented, hypophosphites comp. special,
ext. cherry, eucalyptus, aromatics, etc.”

Thus we have represented in our experiments an “extract” with
hypophosphites, one with peptonate of iron, one with malt extract
and hypophosphites and the alkaloids quinin and strychnin, and one
with malt extract and hypophosphites without alkaloids.

In order to prepare a dry ration of suitable keeping properties,
it was necessary to remove the alcohol and water from the various
preparations. This was done by evaporation under reduced pressure
at from 40 to 55 C. (104 to 131 F.). In the case of Hagee’s Cordial
it was claimed that one fluidounce of the preparation represented
1/3 fluidounce of cod liver oil, and in the subsequent substitution
for cod liver oil in our rations, this ratio was used for all four
products.... These are very dissimilar preparations, the alcohol
ranging from 7.50 to 18.69 per cent., the extract from 8.72 to
39.53 per cent. (10.81 of the 13.18 gm. of extract in Hagee’s
Cordial being glycerin), the ash from 0.305 to 1.967 per cent.,
the reducing sugars from 1.35 to 17.10 per cent., and the glycerin
from a trace to 10.81 per cent. Wampole’s contained quinin and
strychnin, the others no alkaloids; salicylates were present in
all but Wampole’s; saccharin in Hagee’s. The Pettenkoffer test for
biliary acids gave a negative result in Hagee’s and Wampole’s; in
Vinol and Waterbury’s, small amounts of fatty acids were obtained,
amounting to 0.016 and 0.032 gm. per hundred c.c., respectively,
quite insignificant amounts.

The feeding experiments were made on albino rats of both sexes, which were placed, when about 6 weeks old, on a standard ration, No. 7, and after several months, when a failure to maintain weight was indicated,[148] an amount of dealcoholized cordial extract equivalent to 18 per cent. of cod liver oil was substituted for a portion of the lard, the cordial extract later being replaced by an equivalent amount of cod liver oil.

[148] Osborne and Mendel have shown (Jour. Biol. Chem., 1913, xv, 311) that mixtures of purified protein, lard, starch and protein-free milk have been singularly efficient for a time in promoting growth of young rats. In from sixty to 100 days or more, however, normal growth stops; the animals may remain at constant weight for a few days, or grow very slowly, and then suddenly decline and die unless a change is made in the diet. The substitution of butter-fat, egg yolk fat, or cod liver oil for a portion of the lard in the ration, in the experiments of these authorities, brought prompt recovery and continuation of normal growth.

SUMMARY

Table 11 gives a summary of the actual gains of the fifteen rats on the four rations, compared with the gains shown by cod liver oil and those shown by normal rats at the same period of their life history.

TABLE 11.--SUMMARY OF RESULTS[BK]

=====================+========+========+=========+=========
| Total | Total | Average | Average
Rations | Normal | Actual | Normal | Actual
| Gain, | Gain, | Gain, | Gain,
| Gm. | Gm. | Gm. | Gm.
---------------------+--------+--------+---------+---------
Hagee ration | 24 | -36.2 | 6 | -9.1
Cod liver oil ration | 114 | 156.4 | 28.5 | 39.1
| | | |
Vinol ration | 42 | -1.5 | 10.5 | -0.4
Cod liver oil ration | 42 | 87.5 | 10.5 | 21.9
| | | |
Wampole ration | 83 | 51.4 | 20.8 | 12.9
Cod liver oil ration | 62 | 81.5 | 15.5 | 20.4
| | | |
Waterbury ration | 32 | 0.3 | 10.7 | 0.1
Cod liver oil ration | 42 | 87.4 | 14 | 29.1
---------------------+--------+--------+---------+---------

[BK] In this table are given the totals and averages of the figures already presented in Tables 4, 6, 8 and 10.

In considering the effect of these preparations as general medicines, their alcohol content must not be overlooked. Hagee’s Cordial contains 7.50 per cent. of alcohol by volume, Vinol 18.60 per cent., Wampole’s Preparation 16.59 per cent., and Waterbury’s Compound 11.25 per cent. Full strength whisky contains 50 per cent. of alcohol by volume. By following the doses prescribed by the manufacturers of these preparations, the user would consume daily the following equivalents of full strength whisky:

In Hagee’s Cordial 0.24 fluidounce
In Vinol 0.8 fluidounce
In Wampole’s Preparation 0.7 fluidounce
In Waterbury’s Compound 0.6 fluidounce

These amounts of alcohol are by no means negligible and doubtless explain to a considerable extent the source of the alleged tonic virtues of these preparations.

The results of the experiments may be summarized as follows:

Hagee’s Cordial failed to sustain rats during periods of seven and fourteen days, the rats showing a loss in weight of 36.2 gm., instead of the normal gain of 24 gm.

Vinol in two cases sustained and in two cases failed to sustain growth during periods of from eleven to thirty-five days, the net loss in weight of the four rats being 1.5 gm., instead of the normal gain of 42 gm.

Wampole’s Preparation in three Cases sustained and in one case promoted growth in rats during periods of eighteen and thirty-nine days, showing, however, only 51.4 gm. gain in weight instead of the normal 83 gm.

Waterbury’s Compound in two cases sustained and in one case failed to sustain rats during periods of fourteen and thirty days, the net gain in weight, however, being but 0.3 gm. instead of the normal 32 gm.

Cod liver oil showed a gain of 42.4 gm. over the normal, while with the same rats Hagee’s Cordial showed a loss of 60.2 gm. Cod liver oil showed a gain of 45.5 gm. over the normal, while with the same rats Vinol showed a net loss of 43.5 gm. Cod liver oil showed a gain of 19.5 gm. over the normal, while with the same rats Wampole’s Preparation showed a loss of 31.6 gm. Cod liver oil showed a gain of 45.4 gm. over the normal, while with the same rats Waterbury’s Compound showed a net loss of 31.7 gm.

_Not only did cod liver oil show a marked superiority as a source of nutriment over Hagee’s Cordial, Vinol, Wampole’s Preparation and Waterbury’s Compound, but it also showed a remarkable reconstructive and recuperative power in its ability to enable rats to gain weight rapidly and steadily after having suffered from a deficiency in nutriment when fed the four preparations named above._--(_Abbreviated from The Journal A. M. A., Feb. 20, 1915._)

DIABETIC FOODS OFFERED FOR SALE IN THE UNITED STATES

A Preliminary Report

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

Recent references in The Journal to gluten flours and certain other foods offered for the use of diabetics suggest that a preliminary report of an investigation just about completed in my laboratory by Prof. L. B. Mendel and myself might be useful to many diabetics and to physicians who are called on to arrange their dietaries.

In 1906 this laboratory, then under the direction of Dr. A. L. Winton, who is now with the Department of Agriculture, made its first examination of commercial diabetic foods. In nearly every year since it has analyzed various other brands as they appeared on the market. The demand for the reports on these foods and the many inquiries directed to us have led us to make a more extensive review of the situation, and to collect as far as possible all information as to the quality of the so-called “diabetic” foods offered to the American public. That the present state of the market is unsatisfactory is well known, and the inferiority (from the diabetic’s point of view) of many of the products at present offered is unfortunately familiar to all careful dietitians. The most dangerous feature of the present situation is that the unsuspecting patient is led to purchase foods, generally at an exorbitant price, which are not only misrepresented but which may be positively harmful to him. In this day of self-medication this condition is all the greater menace to the diabetic.

Without any attempt to suggest methods of treatment for diabetes, which is the province of the physician, I may say that it is well recognized that diabetes is primarily a disturbance of nutrition, in which the normal ability of the body to make use of carbohydrates is more or less completely impaired. All recent authorities agree in placing the chief emphasis on the role of diet in the management of this disease. Janeway, Benedict, Joslin, Futcher, Falta, Strauss, von Noorden and other writers on diabetes could be quoted at length in support of this view. The importance of a restriction of the carbohydrates in certain cases and certain aspects of diabetes is admitted by practically all competent authorities. In order to prescribe a starch-free and sugar-free dietary, which at times is necessary, and to know accurately the actual amount of these carbohydrates contained in the various available foods, the physician must rely on the cooperation of the chemist to furnish this requisite information. This is our excuse, if any be needed, for our present investigation.

There seems to be some uncertainty as to what sort of preparation is entitled to be sold as a “diabetic” food. Granting the desirability of feeding the patient all the carbohydrate he can tolerate, and recognizing the possible value of the oatmeal, potato, rice and other treatments, in which a relative abundance of carbohydrate is fed for a limited period, it would seem that a low percentage of carbohydrates should be a requisite for a “diabetic” food. Certainly no special food containing nearly as much carbohydrate as a normal food of the same class should be entitled to this appellation. Flours, breads, biscuits, chocolates, breakfast-foods, macaroni, etc., containing only a slightly lowered percentage of carbohydrates, are no more entitled to be called “diabetic” foods than the normal foods themselves. It is true that, when a patient’s carbohydrate tolerance is well established, the use of foods containing 20, 25 and even 35 per cent. of carbohydrates might be permissible, when used under the direction of a competent physician; but when a strict diet is necessary, such as is required to determine this tolerance, even these relatively low percentages are objectionable, if not dangerous.

It has been our purpose to include in this investigation, as nearly as possible, all available data on the composition of all diabetic foods sold in America. Our report, therefore, will be in part compiled, but in greater part will consist of our original analyses. It will show 539 analyses of about 400 brands, 200 of which are our own new analyses and 110 those made in this laboratory in previous years.

While the purpose of this preliminary note is to call attention to the better preparations rather than to emphasize those which are obviously objectionable and fraudulent, it may not be out of place to summarize briefly our findings in general. The full details of the investigation are now being prepared for publication and will shortly be issued as a report from the Connecticut Agricultural Experiment Station.

One hundred and eight samples of sixty-eight brands of flours and meals are included in the report. Sixty-seven of these were sold as “gluten” flours, twenty of which did not even satisfy the low government standard of 35 per cent. protein. Twelve samples contained less than 13 per cent. carbohydrates, while the remaining gluten flours ranged from 28 to 76 per cent.

The soy bean flours contained from 23 to 26 per cent. of carbohydrates, the almond meals 17 per cent., and a cotton-seed flour 21 per cent. Other “diabetic” flours, not specifically sold as “gluten” flours, contained from 67 to 80 per cent.

The purchaser of gluten flours at the present time may obtain preparations containing from 87 to 11 per cent. of protein and from 4 to 76 per cent. of carbohydrates, at a cost of from 9 cents to $1.56 per pound.

In view of the government’s low standard for gluten flour, and because of the wide variations in composition found in the brands at present on the market, proper protection of the diabetic demands that the manufacturers of these flours should be required to state on the label the guaranteed percentages of both protein and carbohydrates.

Three samples of American soft gluten breads contained from 35 to 37 per cent. of carbohydrates; two other brands contained 49 and 54 per cent., little, if any, lower than found in ordinary wheat bread.

One hundred and forty-eight analyses of 112 brands of hard breads, biscuits, rusks, cakes and other bakery products are included. Eight brands of _Luftbrot_, or aerated bread, are reported; two of these contained from 9 to 12 per cent. of carbohydrates, one 20 per cent., two from 31 to 33, and the other three from 44 to 54 per cent.

A number of the brands of rolls, biscuits, breads, etc., showed satisfactorily low percentages of carbohydrates, thirty-five samples containing from 1 to 25 per cent., forty-four samples containing from 35 to 55 per cent., and forty-one over 55 per cent., seven of the latter exceeding 72 per cent.

The cost of the _Luft_ breads ranged from 71 cents to $2.33 per pound. Biscuits, containing 11 per cent. or less of carbohydrates, cost from 72 cents to $3 per pound. A number of brands, containing from 43 to 77 per cent., cost from $3 to $3.60 per pound. Even the cheaper preparations, containing from 50 to 77 per cent., no better, and in some cases even worse, for the diabetic’s use than ordinary bread, cost from 30 to 41 cents per pound.

Fourteen samples of breakfast-foods were analyzed, five of which contained from 44 to 54 per cent. of carbohydrates, somewhat lower percentages than normal. Seven of the ten brands of recommended macaroni, noodles, etc., contained over 70 per cent. of carbohydrates, the other three from 42 to 51 per cent.

The analyses are given of fourteen samples of peanut butter, five of almond paste and butter, two of pine-nuts, one of almonds and ten of miscellaneous nut foods. As was to be expected, most of these preparations proved to be suitable diabetic foods. The peanut butters contained from 12 to 20 per cent. of carbohydrates, with an average of 15 per cent. The three almond pastes contained from 30 to 40 per cent., one showing an addition of 11 per cent. cornstarch. The two almond butters contained only 7 and 8 per cent., the pine-nuts from 3 to 8 per cent., and the almonds 16 per cent. The other nut preparations contained from 6 to 44 per cent. carbohydrates.

Seven brands of diabetic chocolates contained from 10 to 50 per cent. carbohydrates, while four cocoas contained from 21 to 51 per cent. The chocolates cost from $1.63 to $2.06 per pound, and the cocoas were similarly expensive.

Two sugar-free milks were examined which were true to name, containing only the merest traces of carbohydrates. One “diabetic” baking-powder examined contained no starch, another brand from 14 to 16 per cent. Various jams, preserves and other fruit products were examined which contained from 1.24 to 7 per cent. of invert sugar, percentages far below the normal. A currant-juice contained only 0.85 per cent. of invert sugar. Four of the fruit preparations were artificially colored with a coal-tar dye--a permitted color to be sure, but seemingly quite out of place in foods intended primarily for the use of invalids.

As already stated, the main purpose of this investigation was not so much to detect fraud as to secure information which would be of benefit to the diabetic and to the physician who seeks foods suitable for a low carbohydrate diet. In the accompanying tabulations a summary is given of the brands, _sold as diabetic foods_, which showed less than 35 per cent. of carbohydrates, arranged in the order of their carbohydrate[149] content. A date in parentheses following a brand name signifies that the brand named showed variations in different years; in other cases, in which the agreement was close, the results have been averaged.

[149] In the tables “carbohydrates” is used as synonymous with “nitrogen-free extract.”

BRANDS SHOWING UNDER 5 PER CENT. OF CARBOHYDRATES

Per Cent.
Casoid Baking Powder .0
Dr. Bouma Sugar-Free Fat-Milk .0
Whiting’s Sugar-Free Milk .0
Rademann’s Currant Juice “ohne Zucker” 0.9
Kalaria Batons (1909) 0.9
Glidine 1.0
Casoid Sugarless Marmalade 1.2
Casoid Sugarless Jam 1.5
Kalari Biscuit 1.7
Casoid Dinner Rolls 2.1
Casoid Flour 2.2
Jireh Diatetic Pine Nuts 3.4
Rademann’s Preserved Fruits, “entzuckert” 3.5
Kellogg’s Protose 3.6
Barker’s Gluten Food “A” 4.1
Kellogg’s Pine Nuts 4.2
Kellogg’s 80 Per Cent. Gluten Biscuit 4.4
Bischof’s Gluten Flour 5.0

BRANDS SHOWING FROM 5 TO 10 PER CENT. OF CARBOHYDRATES

Per Cent.
Casoid Biscuits No. 2 5.6
Rademann’s Preserved Fruits “in eigenen Saft” 5.7
Barker’s Gluten Food “B” 5.9
Kellogg’s Nuttolene 6.3
Nashville Sanitarium Nutcysa 6.3
Huntley and Palmer’s Akoll Biscuit 6.5
Nashville Sanitarium Nutfoda 6.8
Rademann’s Preserved Fruits “ohne Zucker” 7.0
Muller’s Tomatoes für Diabetiker 7.3
Barker’s Gluten Food “C” 7.7
Kalari Batons (1913) 7.7
Casoid Biscuits No. 3 7.8
Kellogg’s 80 Per Cent. Gluten (1912) 7.9
Casoid Biscuits No. 1 8.0
Kellogg’s Almond Butter 8.2
Fromm’s Uni Bread 9.0
Metcalf’s Vegetable Gluten (1913) 9.8

BRANDS SHOWING FROM 10 TO 15 PER CENT. OF CARBOHYDRATES

Per Cent.
Kellogg’s Pure Gluten Biscuit (1906) 10.2
Health Food Pure Washed Gluten Flour (1913) 11.1
Health Food Alpha Diabetic Wafers 11.3
Loeb’s Imported Gluten Flour 11.8
Health Food No. 1 Proto Puffs 11.9
Kellogg’s Potato Gluten Biscuit (1906, 1909) 11.9
Kellogg’s Nut Meal 12.1
Kellogg’s 80 Per Cent. Gluten (1909) 12.5
Nashville Sanitarium Nut Butter 13.0
Kellogg’s Nut Butter 13.9
Bischof’s Diabetic Gluten Bread 14.3
Jireh Diabetic Baking Powder 15.0
Peanut Butter (range from 12 to 20) 15.0

BRANDS SHOWING FROM 15 TO 20 PER CENT. OF CARBOHYDRATES

Per Cent.
Casoid Chocolate Almonds 16.1
California Paper Shell Almonds 16.3
Callard’s Cocoanut Biscuit 16.4
Rademann’s Diabetiker-Chokolade 16.9
Health Food Almond Meal 16.9
Callard’s Ginger Biscuit 18.1
Callard’s Prolactic Biscuit 19.3

BRANDS SHOWING FROM 20 TO 25 PER CENT. OF CARBOHYDRATES

Per Cent.
Callard’s Almond Shortbreads 20.7
Callard’s Casoid Rusks 20.8
Rademann’s Diabetiker-Makronen 20.8
Health Food Protosoy Diabetic Wafers 21.2
Jireh Patent Cotton-Seed Flour 21.3
Casoid Lunch Biscuit 21.6
Rademann’s Diabetiker-Chokolade Biscuit 21.9
Cereo Soy Bean Gruel Flour 23.7
Health Food Salvia Sticks 24.0
Health Food Protosoy Soy Flour 24.5
Metcalf’s Soja Bean Meal 25.0

BRANDS SHOWING FROM 25 TO 35 PER CENT. OF CARBOHYDRATES

Per Cent.
Jireh Soja Bean Meal 25.8
Brusson Chocolat with Added Gluten 26.4
Rademann’s Diabetiker-Stangen 27.0
Rademann’s Diabetiker-Dessert-Gebäck 27.5
Nashville Sanitarium Malted Nut Food 27.5
Metcalf’s Vegetable Gluten (1906) 28.1
Health Food Pure Washed Gluten Flour (1906) 29.5
Fromm’s Luft Bread 30.7
Spencer’s Almond Paste 31.6
Fromm’s Conglutin-Diabetiker-Schokolade 32.7
Health Food No. 2 Proto Puffs 33.3
Ferbuson Gluten Bread 33.6
Gum Gluten Breakfast Food 34.2

--(_From The Journal A. M. A., June 28, 1913._)

THE JIREH DIABETIC FOOD COMPANY

The Company Rises to Explain in a Brief Note of One Thousand Words

Exploiters of fraudulent and dangerous pharmaceutical products have no love for The Journal. When such products are exposed in these pages, their manufacturers seldom reply to the criticisms except through indirect channels. Then the replies are frequently replete with billingsgate and denunciation of The Journal and its editor, the Association and the medical profession generally.

We have, at different times, had to call the attention of the public and the medical profession to the fraudulence and dangers of some of the products of the Jireh Diabetic Food Company. We have shown that the Jireh company lied boldly and directly so long as it could do so without getting into the courts, and that it lies inferentially still; we have shown that Jireh flour had practically as much carbohydrate as ordinary flour; we have shown that, probably to escape prosecution under the Food and Drugs Act, the Jireh concern has coined the word “diatetic” and substituted it for the word “diabetic,” which used to appear in its advertisements; we have shown that the claim made for the Jireh products that they are “starch-changed” was a false one, and that the company has modified this to “starch-treated,” presumably to avoid being haled into the courts under the “pure food law;” we have shown, in short, the unreliability both of the Jireh concern and of its products.

Two or three weeks ago a New York physician wrote to The Journal for information regarding the Jireh products. We sent him such matter as had been published on the subject, and he showed this material to a patient who was using the Jireh products. The patient, in turn, expressed her opinion of the product to the retailer from whom she had been purchasing it. A day or two later she received a letter from the Jireh Diabetic Food Company, which, in spite of its length and discursiveness, we publish in full, so that physicians may know just what this company thinks of them. The letter, which is dated Nov. 20, 1913, really belongs in the “Knocks and Boosts” department, but its length prevents its use there. Here it is:

“We learned through Mess. Cushman Co. that you are a constant user
of Jireh Foods for some time past, and that recently a certain
derogatory statement was brought to your attention relative to our
product. We feel an explanation is due you for two reasons.

“First, because we want you to continue using Jireh Foods and thus
receive the benefits of the same; and second, that the remarks
called to your attention are not only libelous, but are in no way
pertinent enough to detract from the value of our product. In
the first place, we want to state that the particular journal in
question has been endeavoring to injure our business for some time
past and that we are not the only descent [_sic_] manufacturers of
foods that are suffering in this way at the hands of the editors
of this particular magazine. Since you are interested in the Jireh
Foods, you may be more interested to learn why this particular
magazine is so anxious to injure our reputation. The reason is very
obvious if you will take into account the fact that this magazine
is the official journal of the medical association of this country
which is known as the backer of the medical trust. It is very clear
to you, no doubt, that there are some physicians, particularly
those that are associated with the magazine, who are anxious to
stamp out of existance [_sic_] such concerns that offer a bona fide
product, a meritorious product which actually produces the required
results, without the aid of medicine.

“For the particular maladies for which we offer our foods, we
have been very successful, consequently the antagonism on the
part of this particular journal is the logical thing. In addition
to this, however, and perhaps more important to us, is the fact
that the editors of this magazine have made it known to us that
they will not approve of our product until such time that we
care to be dominated by the moving influence of the magazine in
question. They want us to supply them with the private formula
which we use for manufacturing our foods and to enlighten them
and show them the various processes applied to our products to
produce the required results. As a bona fide and ethical business
house, we absolutely and unqualifiedly refuse to comply with this
wish, and will always refuse to do so, no matter how often they
may attack us. We stand strictly on principle in this matter and
propose to run our business in our own way, and will not, under any
circumstances, allow a magazine or anybody else dictate to us under
what conditions we are allowed to do our business.

“The remarks which they make would perhaps hurt us some if they
emanated from a source that was qualified to judge the merits of
our food. The absurd side of the issue, and perhaps the comical
side of it, is the fact that the honorable gentlemen who assume
to condemn a product, know less about the disease for which the
product is offered, and much less about diet and foods than the
average layman. Consequently, we consider it simply absurd to allow
them to step into our business and dictate policy to us. This is
the jist [_sic_] of the discontent that prevails between the
magazine editors and ourselves, and as long as we refuse to comply
with their wish, we certainly cannot expect them to speak well of
us. It has become a notorious fact in the medical profession that
their criticisms are almost valueless, inasmuch as they stop at
nothing in order to create sensationalism, and have attacked not
only ourselves, but every bona fide manufacturer of foods and drugs
in this country who has refused to fall in line with them.

“This explanation, we trust, will appeal to your good judgment and
will convince you of what is said about us is untrue. Furthermore,
our business has grown to colossal proportions, notwithstanding
their endeavors to crush us. We call your attention to a most
peculiar fact: that is, that they make no comment whatsoever as
to the product and its therapeutic value in the treatment of
diabetes. You notice they make an awful play on our literature,
which was changed merely to suit conditions in business. We also
wish to call your attention to another peculiar fact, and that
is that a great majority of the physicians who are in with this
magazine readily recommended our foods, and we also believe that
your physician, after reading this letter, will feel the same way
as most physicians do in relation to our foods. We believe that
your physician is perfectly willing to be convinced that our foods
are as represented to be, and the very best clinical evidence as
this is the effect our foods have had upon you. Finally, if the
foods are palatable and wholesome and have alleviated the annoying
symptoms of Diabetes, then why should you be guided by the opinions
of demagogues and yellow journalists?

“You may be pleased to learn that our foods have received the
attention of Dr. Wiley, the well-known chemist and food scientist
of this country, and we have now in our possession his reports
showing the very high standard of our foods. This, in our opinion,
is of more consequence than all the harangue which those venerable
gentlemen of the magazine may indulge in.

“We want to convince you without an atom of doubt that we are
honest and bona fide in everything we say, and we extend to you a
hearty invitation to call at the first opportunity and shall be
glad to tell you anything you may wish to know. Thus awaiting the
pleasure of this visit, we beg to remain

“Yours very truly,
“Jireh Diabetic Food Co.”

We learn from this letter that The Journal’s “remarks” on the Jireh product are “libelous.” We have made them many times and for several years past; if libelous, the manufacturer has excellent grounds for damages. We learn, too, that our remarks “are in no way pertinent enough to detract from the value” of the Jireh products. Why, then, take any notice of them? We learn, moreover, for the hundred-and-first time, that The Journal is the official organ of the “medical trust,” and we are told that “there are some physicians” that are opposed to the Jireh Foods because these products cure diabetes without the use of medicine! The Journal, so the company says, wants the Jireh Diabetic Food Company to supply its “private formula” and to show the “various processes” by which the Jireh products are made. Such statements indicate that the Jireh Diabetic Food Company does not confine its mendacity to the mere advertising of its product, where the necessity for lying is naturally great.

The ambiguous remarks regarding Dr. Wiley are evidently intended to convey the idea that the doctor approves of the Jireh products. Dr. Wiley was sent a copy of the Jireh letter and his attention directed to the statements appearing therein regarding himself. He replied:

“In regard to the Jireh products and their claims that our reports
show the very high standing of their foods, I would say that I
consider such a claim entirely false.... We did examine five or six
products in our own laboratory, however, and found them to be of very
fair composition per se, but _not of a composition that afforded any
legitimate basis for their claims_. _We entirely disapproved ...
three of the products making special claim as to their fitness for
diabetics._ [Italics ours.--Ed.] These were the Wheat Nuts, the Jireh
Flour and the Patent Barley. Two of the other products were passed
with a non-committal rating, which means that they are not actually
disapproved, but the star marking is not accorded. These products
were the dietetic Rusks and the Macaroni. For the latter especially
no specific claims seem to be made. We called attention, however, to
the generally objectionable juggling of terms indulged in by this
company....”

The Jireh concern says that in spite of the efforts of The Journal to “crush” it, “our business has grown to colossal proportions.” Of this the New York physician who sends us the letter says: “Their ‘colossal proportions’ must have received a slight jar or they would not have taken time to write such a letter.”--(_From The Journal A. M. A., Dec. 20, 1913._)

THE NAME “EPINEPHRIN” VERSUS THE NAME “ADRENALIN”[BL]

[BL] A reprint of the letter from Parke, Davis & Co. referred to in this article, together with the discussion thereof, will be sent on receipt of a 2-cent stamp.

There are thirty or more different brands of the blood-pressure-raising principle of the suprarenal gland on the market, five being in this country alone. These products are identical so far as their chief constituent is concerned; they differ, however as to the solvent and preservative used. The processes of manufacture of some of them are patented; all of them are sold under trade names.

Until two years ago there was no common name applicable to this active principle; whenever reference was made to it a trade name had to be used. At that time the Council on Pharmacy and Chemistry, realizing the need of a generic term, adopted “epinephrin” as such a term. This name was selected in part because Abel had adopted it in 1899; in part because, so far as could be discovered, it was the name under which, through Abel’s publications, the substance first appeared in medical literature; and in part because it seemed to be the only suitable one not already appropriated by some commercial firm.

After the publication of the Council’s report, The Journal began gradually to use the term in those cases in which it seemed clear that the proprietary term was used in a generic sense. The substitution of the name “epinephrin” for “adrenalin” in the abstracts of certain foreign articles caused Parke, Davis & Co. to write a letter of protest which called forth the discussion appearing in the Propaganda Department of this issue.

The amount of space devoted to this matter may be criticized and considered unwarranted by those who do not realize the importance of the subject. The criticism is to a certain degree, just. The somewhat inordinate length of the article is due in part to the unfortunate fact that, in availing themselves of the courtesy extended by The Journal, Parke, Davis & Co., in their reply, have injected into the discussion side-issues, such as the priority of discovery, the superiority of their product, etc., whereas the question under discussion is simply that which relates to the name. It is, however, not altogether a matter for regret that the discussion has been thus broadened, for it brings before our readers many facts regarding the discovery of an important medicinal agent that are not generally known, at least by physicians.