Chapter XXIX: Part IV: Contributions From the Journal: Miscellaneous Matter (3)

Whether or not “adrenalin” is superior to “adrin,” “suprarenalin,” “suprarenin,” “adnephrin,” or to any other of the preparations is entirely immaterial in this connection. The point is that the active principle of the suprarenal gland is on the market under various trade names, and that a name common to all has been selected to be used when no particular brand is referred to. The fact that “adrenalin” is regarded by many, both here and abroad, as a common, generic name does not alter the fact that it is claimed as a trade name by a commercial house and, therefore, presumably at least, cannot be used except as such.

Among the facts brought out in this discussion, one stands out clearly: that Abel deserves as much credit for the discovery as any other man, if not more. Credit belongs to Takamine for making use of reactions which were already well known. His work was a step in the progress of knowledge of the substance, but it was a step which he could not have taken but for what others, Abel especially, had accomplished and published. Abel’s magnificent work, covering several years, deserves as much credit, to say the least, as that of Takamine. And it should be kept in mind that the former worked in the interest of science, and published his results for the benefit of all. He had no hope of pecuniary reward, asked for none, and received none.

Let us repeat, however, that these are side issues; the question is simply that of name. It cannot be too strongly emphasized that “epinephrin” is a true scientific name for the active principle of the suprarenal gland, and that it should be used on all occasions when the active principle and not some particular firm’s make is referred to.--(_From The Journal A. M. A., March 25, 1911._)

THE HORD SANITARIUM

“_Propaganda for Reform Department_:--One often hears it declared
that the present time is the worst ever known for a young man to
make a fortune or get a start to one.

“All a mistake, as the enclosed letter from the Hord Skinatarium
will certify. At $25 this equals $2,500 for 100 cases, $25,000 for
1,000 cases, and all any young doctor needs is a little push to be
as rich as J. D. in a few months. If you know of any cases send ’em
in and get your $25. “K. T. Crossen, M.D., Carbondale, Ohio.”

With his letter Dr. Crossen encloses a circular letter from the Hord Sanitarium, “For Liquor and Drug Habits, A Cure Positively Guaranteed,” and an unsigned check on the Farmers National Bank, Shelbyville, Indiana, for $25 payable to himself. Printed on the check in large red letters is the statement:

“THIS CHECK WILL BE COUNTERSIGNED UPON YOU BRINGING OR SENDING US A PATIENT.”

The Journal has received these circular letters and unsigned checks by the hundreds from physicians who have expressed very frankly their contempt of the kind of business the Hord Sanitarium is engaged in. These correspondents seem to have overlooked the fact that The Journal has already commented editorially on this particular insult to the medical profession. For this reason we reprint the editorial note, “Ethics!” from The Journal, Sept. 27, 1913:

“We will pay you $25 for each patient that you bring or send us.”
Thus, to physicians, writes the Hord Sanitarium of Shelbyville,
Indiana, and continues: “We have a perfect and an absolute cure
for all liquor and drug addictions.” Fearing doubtless that those
to whom these offers are made may be disgusted with the first
proposition and will realize the evident falsity of the second,
the concern encloses a list of references “showing the high moral
and professional standing of our sanitarium.” The Hord Sanitarium
emphasizes further that it does a strictly “no cure no pay” business.
Suspiciously similar is the offer made by the Mizer Sanatorium of
Coshocton, Ohio, Blake V. Mizer, manager. Not many months ago Mr.
Mizer was running the Hord Sanitorium (the concern’s own spelling),
which at that time advertised “the only guaranteed cure.” Now, Mr.
Mizer hurls invectives at those concerns that make “unreasonable
guarantees” and adds virtuously that “we resort to no such unethical
and pretended guarantee in order to do business.” Nevertheless, in
small type in the northwest corner of his stationery, Mr. Mizer
admits that his “proposition” is no cure no pay. The fees of the
Mizer Sanatorium “are $125 to $250, depending on the room.” The
physician’s rake-off is “20 per cent. of the above.” “This,” explains
Mr. Mizer blandly, “is simply a matter between ourselves and does not
concern the patient in any way.” Of course not. All the patient has
to do is to pay the bills. And the Mizer Sanatorium is “conducted
along ethical ... lines”--Mr. Mizer says so. The Mizer Sanatorium
has odd ideas of what constitutes ethics, medical or otherwise, for
not long ago it advertised, in such medical journals as would accept
its “copy,” that “medical ethics prevents the statement here of the
whole truth about the Mizer treatment.” Of course medical ethics
never prevented truthful statements of any kind. A dirty business;
no other words express it. When the Hord Sanitarium and the Mizer
Sanatorium claim to cure all cases of drug or liquor addiction, they
make claims that are false--cruelly false. When these concerns try
to drum up trade by offering secret commissions to physicians they
insult an honorable profession. The fact that they send out this
sort of advertising matter is presumptive proof that there are some
physicians who will patronize them. Such as do so are unfair to their
patients and untrue to the ideals of medicine.--(_From The Journal
A. M. A., Jan. 31, 1914._)

THE GERMAN PROPAGANDA FOR REFORM

Appreciation by a German Lay Publication

Of all those interested in the reform of the proprietary drug business, the patient has the most at stake--and the public is beginning to understand this fact. If physicians are slow in recognizing the necessity for improvement, laymen will eventually demand reform in their own interests. The movement, therefore, will not be halted by the indifference of the unprogressive element of the medical profession. New evidence of this fact is furnished by a recent editorial comment by the German lay periodical, _Wohlfahrt und Wirtschaft_ (Public Welfare and Economics), on the Arzneimittel-Kommission, a German organization resembling in purpose if not in scope the Council on Pharmacy and Chemistry of the American Medical Association.

“One would suppose,” says this lay journal, “that medicinal
preparations which did not win the approval of scientific medicine
would not be used by any physician, but the contrary is the case. In
fact, those new medicinal preparations or old ones with new names
that flood the market far surpass the actual demand according to the
judgment of all authorities. The impartial advisers in this field,
practitioners and members of medical faculties, demand, as a matter
of public welfare that this overproduction should be regulated in
the interests of the sick, the consumers; but, unfortunately, a
medical man, like any one else, is impressed by the suggestion from
advertising done on a large scale.”

The movement for reform, _Wohlfahrt und Wirtschaft_ goes on to explain, is not exclusively a medical one. It is a part of the reaction of “economic common sense” against a too individualistic commercial system which leads to overproduction. In other words, it is a reaction against the system of making things because they can be sold rather than because they are needed. The interests of producers need to be harmonized with those of consumers, not merely in the drug trade alone, but throughout the commercial world. _Wohlfahrt und Wirtschaft_ quotes with unqualified approval the ArzneimittelKommission’s statement of its position: An industry which serves the science of healing must be guided by that science. (_Eine Industrie die der Heilwissenschaft dient, hat sich nach der Heilwissenschaft zu richten._)

The movement for reform in Germany has apparently gathered sufficient impetus among the laity to go on of its own momentum, even though, with one exception, German medical journals, reluctant to lose the advertising of drug houses by publishing criticisms of their wares, have become lukewarm, if not antagonistic, to the efforts of the ArzneimittelKommission. The one exception is the _Therapeutische Monatshefte_, which, in its May issue, quotes in full the editorial just referred to and makes the following comment: “These lines reveal such intimate knowledge and correct judgment of existing conditions that the suggestions advanced in regard to possible reforms deserve serious consideration. For us physicians the editorial is important in that it recognizes that the efforts of the profession to accomplish the reforms aimed at are rational and beneficial from the standpoint of general economics and the public welfare.”--(_From The Journal A. M. A., June 13, 1914._)

THE GERMAN COUNCIL ON PHARMACY AND CHEMISTRY

At the meeting of the German Congress for Internal Medicine in 1911, a German council on pharmacy and chemistry, Die Arzneimittelkommission des Kongresses für innere Medizin, was organized, with purposes similar to those for which the Council on Pharmacy and Chemistry of the American Medical Association was created. As practically nothing has been done to restrict the advertising of proprietaries in Germany, the task of the commission was tremendous. Its work has been noted in The Journal from time to time.[150] A review of what has been done up to the present is given by Heubner,[151] and indicates some differences between conditions in Germany and this country. The members of the commission found confronting them the same evils that met the early efforts of the American council, namely, dominant proprietary interests, a subservient and financially interested medical press and an indifferent profession. Moreover, the pecuniary interest of the editors of German medical journals in the profits of advertising seems to be more direct and more important than in America. The German commission, in Heubner’s opinion, was placed at a disadvantage compared with the American council from the first. Funds for investigation were lacking, and the commission had no journal in which its objects could be presented to the medical profession. At the beginning of its work the commission established rules very similar to those of the American Council on Pharmacy and Chemistry. It listed the articles advertised in German medical journals in three groups: (1) those which conformed to the rules of the commission in the method of advertising; (2) those which violated the rules, and (3) those whose classification could not be determined. This amounted to an attack on advertising in medical journals and was undoubtedly premature. It aroused at once the antagonism not only of the proprietary interests but also of the medical press.

[150] A German Council on Pharmacy and Chemistry, Propaganda, The Journal A. M. A., July 27, 1912, p. 291; Current Comment, Aug. 10, 1912, p. 452. Reform in the Advertising of Proprietary Medicinal Articles, Berlin Letter, Dec. 7, 1912, p. 2081. Heubner, W.: Wünsche zur Reform des Arzneivertriebes, Therap. Monatsh., 1912, xxvi, No. 11; abstr., The Journal A. M. A., Dec. 14, 1912, p. 2195.

[151] Heubner: Die Arzneimittelkommission des deutschen Kongresses für innere Medizin, Therap. Monatsh., 1914, xxviii, 185.

“The establishment of the lists of medicines encountered opposition
or hindrance from three sources,” says Heubner, “first, from the
pharmaceutical and chemical manufacturing interests; second, from
the medical press, and third, from the medical profession itself.
The ‘trade’ naturally was irritated at any attempt to interfere with
‘business,’ and brought forward a number of reasons why the procedure
adopted by the commission was especially calculated to injure the
‘general welfare.’ This opposition was to be expected and might be
disregarded. The extent to which the medical press was dependent on
the drug trade, however, had not been foreseen. The same journals
in which for many years all sorts of articles on the evils in the
trade in medicines had appeared showed themselves decidedly cool or
emphatically critical toward the accomplished fact of the ‘lists of
remedies.’ In hastily written articles a whole series of mistakes
in general and in particular were published.... One thing, however,
was not explicitly stated--namely, that in any event the lists of
remedies must be rejected, and for this the cogent reason was anxiety
in regard to advertisements. The editors had been sufficiently
warned. The _Therapeutische Monatshefte_, which had not submitted to
the wish of a great industrial firm in another matter, was punished
for this offense by the withdrawal of all its advertisements. None of
the other publishers wanted to risk such a reduction in income, and
none of the editors was willing to undertake the risk to the extent
of a conflict with his publisher. Curiously, the idea does not seem
to have arisen that if the threatened publishers had made common
cause they might have freed their editors from the distressing burden
of improper advertisements with scarcely any risk at all.”

Heubner believes that another motive influencing the editors was the fact that their efforts in behalf of reform, sporadic and ineffective at the best, had been replaced by the propaganda of the commission. It seems clear that the opposition from the press was due not to principle chiefly but to financial pressure. The editors, however unworthy their motives, nevertheless exerted, as in other cases, a powerful influence on public opinion. Among the medical public, opposition was encountered because many physicians were interested--sometimes financially--in one or more of the discredited remedies. The mass of the profession either were not interested or misunderstood the position of the council.

Despite the obstacles encountered and the difficulties involved, the council and the Congress of Internal Medicine have not wavered. Heubner, however, sums up the work of the council in a rather pessimistic tone, as follows:

“What are the results of the great amount of labor, self-sacrifice,
hopeful courage and wasted money? Two journals pretend to be doing
wonders in that they are eliminating some of the worst misstatements,
distortions, obscurations and concealments of truth in the
advertisements. Physicians at certain intervals receive lists of
preparations, the manufacturers of which as a rule do not need to
pay any attention to the council because their dealings are directly
with the public, because their advertisements are usually made to
physicians by word of mouth, or their preparations have already a
sufficient reputation--no matter for what reason....

“There is little doubt that the results have not paid for the
efforts expended. There is no doubt that the whole enterprise will
amount to nothing more than a splash in the water if the work is not
extended, just as a preliminary skirmish must remain without effect
unless followed up by the main army. The main army in this case is
the German medical profession. However gratifying the progressive
attitude of some individuals and, in fact, of some associations, such
as that of Wurtemburg, may be, the fact remains that the profession
[in Germany] is not advancing but rather tends to retrograde. The
support which the executive committee of the Aerztevereinsbund at
first accorded to the efforts of the council was later limited. All
further progress depends on the developments of the near future. Will
sufficient power be given to the German medical profession after
settlement with the insurance societies to permit them to follow the
example of their American colleagues?

“It should be made perfectly clear,” Heubner insists, “that we are
concerned with questions of importance for the standing and influence
of the medical profession among the people, and, consequently, for
the conditions of its future existence. But even now the consequences
of the prevailing indifference to the traffic in nostrums are making
themselves felt. The prevalence of self-medication, which was lately
recognized by a Berlin court as the normal for ‘slight’ affections
and which has already been made an argument against the extension
of the compulsory prescription law, is merely a result of the great
evil based on the loss of control by the medical profession of the
remedies it employs. Only centralized and energetic measures on the
part of the organized profession can secure a reformation of the
intolerable conditions that prevail in the field of modern industry
in medicine and foodstuffs. The American Medical Association and the
German Arzneimittelkommission have shown that a little sacrifice
and energy can secure a condition in which the medical profession
becomes a powerful factor, able to dictate in the field of the trade
in medicine instead of letting itself be dictated to.”--(_From The
Journal A. M. A., April 18, 1914._)

GRAND PRIX AND GOLD MEDALS FOR SALE

Max Kaiser Offers to Procure “Awards of Merit” at
Various International Exhibitions--Price,
Four Hundred Dollars

There was a time when the manufacturer who could point to the “Grand Prix” or the “Gold Medal” his product had been awarded at some exhibition was considered to have a valuable advertising asset. Possibly there was a time when medals and prizes were awarded with an eye single to the excellencies of the goods and bore no relation to the amount of money paid by exhibitors to the organizers of the exhibition. Possibly there are, even today, occasional awards made on a basis of pure merit, but they are probably few and far between. The matter which follows throws an interesting light on this subject. Within the past two months manufacturers have received a letter on the stationery of the “International Exhibition, Paris, 1914.” The letter came from the “Commissioner-General” of the exhibition, one Max Kaiser, 24 Holborn, London, E. C. Here it is:

“_Dear Sirs_:--I beg to draw your attention to the great
INTERNATIONAL EXHIBITION of Alimentation, Pure Food, Hygiene,
Beverages, Drugs and allied trades, which will be held at Paris
in March, 1914, inviting you to partake with your manufacture at
this INTERNATIONAL EXHIBIT. I beg to point out that the aim of this
Exhibition is to introduce Foreign Manufactured Goods, Proprietary
Articles, Patents, etc., to the French and Foreign Markets, and to
open up or extend new channels for such goods.

“A Commercial Office at the Exhibition Building, under the
Commissioner General’s own supervision, with a well-trained staff,
will do everything required in the interest of Exhibitors, such as
effect sales by circularizing, or inviting prominent buyers to call
at your particular stall to judge for themselves the merits of your
Exhibit, and in this way bring the American Manufacturers in direct
touch with the Foreign Markets and the Buying Public.

“This Commercial Office will also negotiate with the
Representatives on your behalf: at the same time undertaking to
arrange your Exhibit, supply all necessary fittings, decoration,
the display, maintenance, repacking and returning of the Exhibit,
and also to represent you before the Public and Jury in such a
manner as to make certain that your Exhibit shall be awarded first
honors (GRAND PRIZE OR GOLD MEDAL).

“You will understand that such an award obtained at this
INTERNATIONAL EXHIBITION means an everlasting advertisement as
an official acknowledgment and convincing proof to the Superior
Quality of your goods, and will certainly put you in front of your
competitors on the home market, and naturally increase your sales
considerably.

“I might mention here that many a big business has been built up
and small concerns been prominently brought to the notice of the
Public by Exhibiting. In many cases I have been able to interest
Authorities and Reigning Houses in Exhibits under my care, and I
have opened up or extended markets for firms Exhibiting under my
direction.

“I enclose herewith a list containing some of the most prominent
American and English Firms whom I have represented at European
Exhibitions and for whom I achieved splendid results.

“I could arrange your Exhibit for the amount of $400, to be paid
one-half on allotment and the balance on receipt of an award (Grand
Prize or Gold Medal).

“Trusting that this will be of interest to you, I shall be pleased
to receive your reply by return mail, and give you any further
particulars you may desire. Yours faithfully,

The Commissioner General.
(Signed) Max Kaiser.

“I can also accept Exhibits on exactly the same terms for the
INTERNATIONAL EXHIBITION, Rome, 1914.”

The list Mr. Kaiser enclosed with his letter was a printed sheet, giving the names of a number of American and British manufacturers whom Kaiser claims to have “represented” at various “International Exhibitions.” The majority of the concerns named are breweries, but there is a good sprinkling of “patent medicine” companies and a few miscellaneous manufacturers. In the American list there are two nostrum concerns named that will be more or less familiar to our readers. They are:

_Alonzo O. Bliss Company_, Washington, D. C. This company sells “the Great Blood Purifier, Kidney and Liver Regulator” known as “Bliss’ Native Herbs.” According to Max Kaiser, the Alonzo O. Bliss Company obtained one Grand Prize and one Gold Medal.

_Waterbury Chemical Company_, Des Moines, Iowa. This company exploits what used to be known as “Waterbury’s Cod-Liver Oil Compound,” which, from its lack of cod-liver oil,[152] was impelled to change its name to “Waterbury’s Compound.” Kaiser states that the Waterbury Chemical Company received four Grand Prix and four Gold Medals.

[152] See Waterbury’s Compound, pp. 54, 57 and 291.

Briefly the proposition submitted by Max Kaiser is this: For $400 he will make all arrangements for a manufacturers’ exhibit at one of the numerous “International Exhibitions.” Further, he practically guarantees that this exhibit will receive either a “grand prize” or a “gold medal”; in fact, the manufacturer need not complete the payment of Kaiser’s charges until the prize or medal has been awarded!

The value of “awards” obtained in this way is, of course, evident. As the public becomes better informed on the subject of international exhibitions, the grand prix, gold medals, and other “awards” made at such exhibitions will be appraised at their true value.--(_From The Journal A. M. A., March 14, 1914._)

THE HYPOPHOSPHITE FALLACY

An Example of the Perpetuation of a False Theory by Advertising

A false therapeutic notion born of speculation soon dies a natural death if exposed unsupported to the cold world of facts, but when nursed by commercial interests it may be kept alive for generations. Interesting examples of this, to name but two or three, are the misconceptions perpetuated during the past half century concerning “lithia,” the “natural” salicylates and the hypophosphites.

Take, for instance, the lithia delusion. The supposed solvent powers of lithium compounds for uric acid were soon disproved to the satisfaction of scientists, but proprietors of lithia waters and nostrums for gout and rheumatism still harp on the old string and utilize long-exploded theories. Take, again, the alleged superiority of “natural” to “synthetic” salicylates. In spite of experimental proof to the contrary, proprietary interests have been able for twenty years to persuade a large part of the medical profession that the effects of pure salicylic acid made artificially differ from the effects of the same substance obtained from natural sources.

The altogether undeserved continued popularity of hypophosphites affords a striking example of the influence of advertising in perpetuating therapeutic error, for hypophosphites are given on a theory long since disproved. It may be interesting to trace the origin and history of the theory on which the practice of prescribing the hypophosphites is founded. The early part of the last century was prolific in chemical discoveries, and, as a corollary, in chemical theories of disease. Many of the theories arose from the hasty application of the chemical properties of new elements and compounds to the explanation of the processes in the living body, without due consideration of the conditions prevailing in the animal organism.

THE ELEMENT PHOSPHORUS

The element phosphorus is eager for oxygen and readily oxidizable. When taken into the system it acts as a violent poison, and, in view of this, it was at first supposed--although the supposition was based on no scientific data--that it would prove to be a powerful therapeutic agent when given in minute doses. In its elementary form, phosphorus is difficult to handle, and therefore not convenient for use. Hence it was natural that a compound should be sought which could be used as a substitute for the element.

Broadly speaking, phosphorus forms three classes of salts varying in the degree of oxidation: the phosphates, containing the most oxygen, the phosphites, containing less, and the hypophosphites, least of the three. The phosphates, being saturated with oxygen, undergo little change in the body, and because of this were thought to be of little value in therapeutics. The phosphites contain less oxygen, are unstable and are not used in medicine. The hypophosphites, containing still less oxygen, stand nearest to elementary phosphorus and are easily decomposed and readily oxidized to phosphates. Hence the theory that the hypophosphites would furnish an admirable source from which to obtain the action of the element phosphorus.

CHURCHILL’S THEORY

The hypophosphites were introduced into medicine about 1855, as a substitute for elementary phosphorus by a Dr. Churchill of Paris, and later of London, who advocated their use as a specific remedy for consumption. Churchill conceived the theory that phthisis is caused by a lack of oxygen in the tissues; he therefore sought an agent capable of increasing oxidation. He was led to the use of hypophosphites for this purpose on the supposition that phosphorus exists in the organism as a biologic element in a lower degree of oxidation than the phosphate. He supposed that this form of phosphorus acts by its chemical affinity as an initiatory agent in attracting and utilizing the inspired oxygen. He believed that when this form of phosphorus, which he called the “phosphide element,” is deficient in quantity (because it had been oxidized into phosphate, or because the supply from natural sources was deficient), the degree of oxidation of the tissues is less than normal. Therefore he advocated the use of hypophosphites to supply the lacking oxidizing constituent. He believed this “phosphide element” not only to be essential for the oxidation of the tissues, but also to be the source of energy of the nervous system.

THE FACTS

The theory was a pretty one; the facts, however, did not support it. Subsequent investigations indicate that instead of consumption being due to a lack of oxygen, there is in that disease really an increased oxidation; in other words, the respiratory exchanges in this disease are exaggerated. The existence in the system of a form of phosphorus less highly oxidized than the phosphates is unproved. No evidence has been produced to show that phosphorus acts as an energizer of oxidation. There is no proof that the hypophosphites enter into general metabolism or affect disease processes in any way. Not only is there no scientific evidence for the utility of the hypophosphites, but science has long since demonstrated their worthlessness.

In 1895 Boddaert[153] published researches showing that hypophosphites are rapidly eliminated through the kidneys unchanged. Similar results have been reached by Paquelin and Joly, who attributed to the hypophosphites only the action of diuretics. In 1901 Massol and Gamel[154] found by animal experimentation that the hypophosphites did not act as diuretics, but that the hypophosphorous acid was completely eliminated in the form of sodium hypophosphite. The urea was not increased and the relation of urea to total nitrogen remained the same. Their results indicated no increase of oxidizing actions within the system. Finally, Massol and Gamel examined the urine of patients taking hypophosphites and found the same conditions: the results were the same as in the experiments on animals.

[153] Boddaert: Arch. de pharmacod., 1895, 2.

[154] Massol and Gamel: Jour. de pharm. et de chem., 1901, xiv, 337.

PROPRIETARY THERAPEUTICS

In spite of these facts the hypophosphites continue to be employed by many practitioners. Why? Because the theory, being plausible at the time when such chemical theories were popular, gained a certain recognition and was accepted without scientific investigation. Thus the hypophosphites came into use. It was not long before they were taken up by certain manufacturers, and the theory on which their use was based became a commercial asset. As a result the theory, which uncommercialized would have died of inanition, was kept alive by continued advertisement.

The manufacturer of proprietaries having settled on a plausible theory on which to sell his products has no further need for science. Thus, while these theories are no longer to be found in accredited text-books, they are still preached by the proprietary interests. An elaborate pamphlet on “Iodine and Phosphorus,” containing statements which are known to be false, is one firm’s text-book supplied to physicians to-day, and contains long quotations from Dr. Churchill’s writings of sixty years ago. This book contains no intimation that these theories have been overthrown. It is poor economy to waste money in changing literature when the old theories and the old plausible reasoning will sell goods just as well. Consequently the old errors are drummed into those physicians who are willing to read their physiology from the neat monographs of proprietary literature and to sit at the feet of glib salesmen who expound to them the proprietary theory of therapeutics.--(_From The Journal A. M. A., April 25, 1914._)

BUFFALO LITHIA WATER

Contains One-Fifth as Much Lithium as Potomac River Water

Some years ago, Alexander Haig evolved the theory that most diseases are due to uric acid. The data on which he founded his theory were not corroborated by scientific men, and investigation showed that his methods were unreliable. In spite of the fact that Haig’s theories are utterly discredited, and have been for years, the uric acid fallacy still persists, although it is now largely confined to the public. Shrewd business men, especially those who are more intent on making money than they are concerned with the manner in which that money is made, owe much to Haig’s theory. As a business proposition, uric acid has been one of the best-paying fallacies on the market--and possibly still is. It is only necessary to refer to The Journal’s recent article[155] on the Turnock mail-order medical fraud to emphasize this fact.

[155] The Journal A. M. A., May 23, 1914, p. 1675.

Contemporary with, and to a certain extent a corollary of, the uric acid fallacy was another, _viz._, that lithium would eliminate uric acid. This at once gave a good working principle for the proprietary men. Uric acid, we were told, causes disease; lithium, we were also told, would eliminate uric acid; therefore, lithium is the new elixir of life! Could anything be simpler?

Accepting this theory, it was inevitable that mineral waters containing lithium salts should become highly popular. Many exploiters of mineral waters began to place most emphasis on the lithium salts in their waters even in those cases in which lithium was present in such infinitesimal amounts as to render its detection impossible by any but spectroscopic methods.

One of the best known, because most widely advertised, of the so-called lithia waters is Buffalo Lithia Water--or what used to be called Buffalo Lithia Water. After the Federal Food and Drugs Act came into effect, by which falsification on the label was penalized, the name of Buffalo Lithia Water was changed to Buffalo Lithia Springs Water. The reason for this change was that when Buffalo Lithia Water was subjected to examination by the government chemists it was found to contain so little lithium that the amount present was unweighable--it could be demonstrated only by the spectroscope. It was evidently, therefore, not a lithia water in that it did not contain--at least in quantities that could be consumed--an amount of lithium that would give the therapeutic effects of lithium: Possibly the company imagined that by changing the name from “Buffalo Lithia Water” to “Buffalo Lithia Springs Water” it had cleverly evaded the federal law. Their argument was to this effect: The springs from which this water is taken are known as Buffalo Lithia Springs; therefore, it is not a misstatement of facts to call this Buffalo Lithia Springs Water.

WHAT IS A LITHIA WATER?

The Supreme Court of the District of Columbia, holding a district court, has recently given an opinion on the Buffalo Lithia Springs Water case. The findings of the court are refreshingly simple, and characterized by that broad commonsense view that is becoming increasingly more common among modern jurists. Read Judge Gould’s opinion as to what constitutes a lithia water:

“Speaking generally, and as an individual of average intelligence and
information, it would seem that if one were offered a water which the
vendor told him was a ‘lithia’ water, one would have the right to
expect enough lithium in the water to justify its characterization
as such, thus differentiating it from ordinary potable water; and
this amount would reasonably be expected to have some effect on the
consumer of the water by reason of the presence of the lithium.”

Certainly a reasonable attitude, and one which the man in the street not only can understand but will agree with. Then came the question as to the actual lithium content of Buffalo Lithia Springs Water, and the court said:

“For a person to obtain a therapeutic dose of lithium by drinking
Buffalo Lithia Water he would have to drink from one hundred and
fifty thousand to two hundred and twenty-five thousand gallons of
water per day. It was further testified, without contradiction, that
Potomac River water contains five times as much lithium per gallon as
the water in controversy.”

SOME TESTIMONIALS

Here, then, is a water that has for years been advertised first, in medical journals, and later, in lay publications, as a “lithia water” yet, actually, it contains less lithium, five to one, than is to be found in ordinary river water. This is a point for physicians to ponder well over. Turn to the back volumes of medical journals and read, both in the advertising and reading pages, the elaborate testimonials, given by men high in the medical profession, on the marvelous effects obtained by the use of Buffalo Lithia Water. Read the following in light of the fact that the water from the Potomac River contains five times as much lithium as Buffalo Lithia Water:

“In the class of cases in which lithia, soda and potash are
regarded as most specially indicated, I have obtained far better
results from the Buffalo Lithia Waters than from any of the
preparations of the lithium salts of the Pharmacopeia.” (_Statement
by a member of the Faculty of Medicine of Paris, France_, _etc._)

“Its [Buffalo Lithia Water] therapeutic effects, in my practice,
have been vastly superior to those obtained from Lithia Tablets or
other Lithia preparations.” (_Statement by an ex-president of the
University College of Medicine, Richmond, Va._, _etc._)

“It [Buffalo Lithia Water] is strikingly superior to emergency
solutions of lithia tablets and pure water, even where the said
solution is an exceedingly strong one.” (_Statement by a former
Professor of Clinical Medicine of the College of Physicians and
Surgeons, New York, and vice-president of the American Medical
Association_, _etc._)

“When Lithia is indicated, I prescribe Buffalo Lithia Water in
preference to the Salts of Lithia, because it is therapeutically
superior to laboratory preparations of Lithia.” (_Statement
by a former professor in the Medical College of Virginia and
ex-president of the Medical Society of Virginia_, _etc._)

“Buffalo Lithia Water ... by its richness of composition of Lithia,
is of marvelous efficacy, in cases of gout, of chronic, articular,
and muscular rheumatism ...” etc. (_Statement by former Physician
in Ordinary to the Pope; Member of Academy of Rome_, _etc._)

“I have tried carbonate of lithia dissolved in water in various
proportions; but it certainly does not have the same effect as
Buffalo Lithia Water.” (_Statement by a former Surgeon-General of
the U. S. Army_, _etc._)

These are but a few of many testimonials from physicians that might be quoted. They are interesting from many points of view. They show the worthlessness of testimony of this sort--no matter from what source--and the fallacy of that based on so-called clinical evidence.

To go back to the court’s findings: In the case of the government against Buffalo Lithia Springs Water, one other judicial opinion is worthy of attention, that referring to the attempt on the part of the exploiters of the water to circumvent, on a technicality, the evident intent of the Food and Drugs Act. Said Judge Gould:

“The argument seems to be that if Buffalo Lithia Springs are falsely
named, being called ‘Lithia’ Springs, when they do not flow water
containing lithium, therefore the proprietors have the right to sell
the product as being Buffalo Lithia Springs Water, thus perpetuating
on the public the misnomer connected with the origin of the water. It
is not apparent how the deceit practiced on the public by the label
is mitigated by carrying it back to the designation of the spring
from which the water comes.”

For years no one, apparently, ever criticized the claims made for this product. Finally, we got the Food and Drugs Act and the federal officials, acting under the authority vested in them by that law, in December, 1910, declared Buffalo Lithia Water misbranded. Thus this old established vested interest was attacked. The company, of course, fought. It first demurred to the charge brought, and in April, 1912, the demurrer was sustained. At the same time an amended libel was filed by the government, which the company again demurred to. This demurrer was overruled in June, 1912, whereon the company in December, 1912, filed an answer denying that the water was misbranded. The question has now (1914) been finally decided by the court sitting as a jury, the matter having been submitted by agreement to the court.

Buffalo Lithia Water has been sold since 1878. During this period undoubtedly many physicians have prescribed enormous quantities of this water, and many more laymen have taken the water on their own initiative, based on the advertised claims made for it. Practically all who purchased the water, whether directly or on the advice of physicians, did so in the belief that they were getting lithium. Had they known that, to get a therapeutic dose of lithium they would have had to drink 200,000 gallons of Buffalo Lithia Water, they would have felt, and rightly so, that they were the victims of an expensive hoax.--(_From The Journal A. M. A., June 13, 1914._)

MEAT EXTRACTS AND MEAT JUICES[BM]

Their Composition and Relative Values

[BM] See Report of the Council on Pharmacy and Chemistry on “Meat and Beef Juices,” p. 123.

The Bureau of Chemistry of the Department of Agriculture has recently given in Bulletin No. 114 much new and valuable data regarding the commercial meat products. The work contained in this bulletin is practically an elaboration or continuation of that published in The Journal of May 11, 1907, p. 1612. It was taken up to determine the condition and quality of meat preparations in general and from the results obtained to prepare tentative standards for the preparation and composition of such meat preparations. The results as well as the methods of analysis of many meat products are given, showing the composition and relative value of the various preparations. The comments of many investigators regarding the food value of such products is also a valuable contribution to the knowledge of meat extracts, and will help in deciding the real value of the preparations.

The preparations taken up are divided into three general classes (1) Solid and Fluid Meat Extracts; (2) Meat Juices; (3) Miscellaneous Preparations. For each of these the tentative standards submitted by the Committee on Food Standards of the Association of Official Agricultural Chemists are given along with the tabulated results of the chemical analysis. The preparations examined showed, for the most part, that they conformed to the standards, and only those which are at variance in one or more particulars will be mentioned in this review.

SOLID MEAT EXTRACTS

For solid meat extracts the following are the requirements:

“Meat extract is the product obtained by extracting meat with boiling
water and concentrating the liquid portion by evaporation after
removal of fat, and contains not less than 75 per cent. total solids
of which not over 27 per cent. is ash and not over 12 per cent. is
sodium chlorid (calculated from the total chlorin present), not over
0.6 per cent. is fat and not less than 7 per cent. is nitrogen. The
nitrogenous compounds contain not less than 40 per cent. of meat
bases and not less than 10 per cent. of kreatin.”

With the above as the standard, several of the solid meat extract preparations examined were not up to grade on one or more points, though in some cases it is true they were very slightly below the standard set. The following products were found wanting in some respects and the requirements which they failed to meet are given:

“REX” BRAND BEEF EXTRACT (Cudahy Packing Co., Omaha) contained 26.50
per cent. water instead of the standard 25 per cent.

EXTRACT OF BEEF PREMIER (Libby, McNeil & Libby, Chicago) contained
30.92 per cent. of ash instead of the standard 27 per cent.; 18.32
per cent. of sodium chlorid (standard, 12 per cent.); 6.02 nitrogen
(standard, 7 per cent.).

BEEF EXTRACT (Swift & Co., Chicago) contained 13.51 per cent. sodium
chlorid (standard, 12 per cent.); 6.60 per cent. nitrogen (standard,
7 per cent.).

BEEF EXTRACT, COIN SPECIAL (G. H. Hammond Co., Hammond, Ind.)
contains 13.25 per cent. of sodium chlorid (standard, 12 per cent.);
and 6.86 per cent. nitrogen (standard, 7 per cent.).

With these few exceptions, the solid meat extracts were found to comply with the standards given.

FLUID MEAT EXTRACTS

For fluid meat extract the following standards have been suggested:

“Fluid meat extract is identical with meat extract except that it is concentrated to a lower degree and contains not more than 75 per cent. and not less than 50 per cent. of total solids.”

According to this standard all excepting one of the fluid meat extracts examined were found to be below grade in one respect, that of solids. The following are preparations examined and the percentage of solids found:

Per cent.
CONCENTRATED FLUID BEEF EXTRACT
(Armour & Co., Chicago) 42.25
MEAT JUICE
(Valentine’s Meat Juice Co., Richmond, Va.) 42.36
BEEF JUICE
(John Wyeth & Bro., Philadelphia) 41.16
VIGORAL
(Armour & Co., Chicago) 50.06
“REX” FLUID BEEF EXTRACT
(Cudahy Packing Co., Omaha) 44.01
FLUID EXTRACT OF BEEF
(Cibilis Co., New York) 35.37
FLUID BEEF JELLY
(Mosquera-Julia Food Co., Detroit) 31.03

Special notice is directed to the price of some of these preparations, which in spite of their large water content, are higher priced than some of the solid meat extracts.

MEAT JUICES

The following is given as the standard for preparations of meat juice:

“Meat juice ... is the fluid portion of muscle fiber obtained by
pressure or otherwise, and may be concentrated by evaporation at a
temperature below the coagulating point of the soluble proteids.
The solids contain not more than 15 per cent. of ash, not more than
2.5 per cent. of sodium chlorid (calculated from the total chlorin
present), not more than 4 per cent. nor less than 2 per cent. of
phosphoric acid (P_{2}O_{5}), and not less than 12 per cent. of
nitrogen. The nitrogenous bodies contain not less than 35 per cent.
of coagulable proteids and not more than 40 per cent. of meat bases.”

It is especially noticeable among the meat juices, so called, that none shows any appreciable amount of coagulable proteids. Valentine’s Meat Juice and Wyeth’s Beef Juice, besides being below the standard in total solids as fluid extracts, are misbranded when called meat or beef juices, as can readily be seen by comparing the results of the analyses and the standard.

Wyeth’s Beef Juice is advertised as containing “all the albuminous principles of beef in an active and soluble form” and “in an unaltered form”--two statements that are on the face of them untrue and misleading. To say that all the albuminous principles of meat are present is to say that not only the juice of the meat but all the fiber is present, which evidently is not true. Then again, to say that it is present in an unaltered form is far from the facts, for, as is stated on page 18 of the Bulletin: “It appears impracticable to prepare a true meat juice for market, as the temperature necessary for the preservation of food products in hermetically sealed packages coagulates the proteids and changes the nature of the product.” On page 55: “When prepared under the best possible conditions a commercial meat extract is, of necessity, in order that it may not spoil, deprived of the greater part of the coagulable proteids, which constitute the chief nutritious elements of the juice.”

On examining the tables of analysis, it is seen that Wyeth’s Beef Juice contains but 23 per cent. of its total proteids in a coagulable form, while the standard calls for 35 per cent., thus showing it to be no more valuable as a food product than any other so-called meat juice, the statements of the manufacturers to the contrary notwithstanding.

In the case of Valentine’s Meat Juice we note a large discrepancy between the standard requirements and the results of the government analysis, for instead of the proteid matter containing 35 per cent. in the coagulable form, it contains but 1.6 per cent. These figures show, then, that Valentine’s preparation contains practically no coagulable proteids, and since the quantity of these measures the food value of such preparations, the conclusion must be drawn that Valentine’s Meat Juice has practically no value as a food and should certainly not be classed as a meat juice.

Bovinine, another widely advertised meat preparation, which, according to statements on “The Bovinine Co.’s” letter head, is “a concentrated beef juice” and “the only perfect food in the world” was analyzed and found below the standard set for meat juices, since it contains only 3.38 per cent. of coagulable proteids. Yet in spite of this discrepancy, the manufacturers of Bovinine persist in exploiting it as a food, stating it to be “... a concentrated easily assimilable, nitrogenous food,” and in another place it is stated that Bovinine “is an ideal food.” As it is deficient in coagulable proteids and thus below the requirements as a food, it is misbranded when called a food of any sort, for to quote again the Bulletin, page 55: “... meat extracts ... must not be looked on as representing in any notable degree the food value of the beef or other meat from which they are derived”; and, again: “They are not, however, concentrated foods, having, on the contrary, but comparatively little nutritive value.”

Taken individually or as a class, meat extracts are not to be considered foods, and should, therefore, not be advertised as such, a conclusion which the government officials have come to and voiced in the conclusion of the Bulletin as follows:

VALUE AND LIMITATIONS

“It seems to be the consensus of opinion among scientific
investigators who have studied this question that the food value of
these meat extracts is rather limited, and although they are a source
of energy to the body they must not be looked on as representing
in any notable degree the food value of the beef or other meat
from which they are derived. When prepared under the best possible
conditions a commercial meat extract is of necessity, in order that
it may not spoil, deprived of the greater part of the coagulable
proteids, which constitute the chief nutritious elements of the
juice.”--(_From The Journal A. M. A., Jan. 23, 1908._)

PHARMACEUTICAL MANUFACTURERS AND THE GREAT AMERICAN FRAUD

At various times we have given more or less complete accounts of the prosecutions the United States Government has brought against nostrum exploiters under the Food and Drugs Act. One of the more recent of these, while of comparatively little interest _per se_, is of importance to the medical profession, because of certain elements connected with it. The case is known technically as “Notice of Judgment No. 284” and deals with the “Alleged Misbranding of Danderine.” The gist of the case is as follows: Casks of Danderine--a widely advertised “hair tonic”--were shipped in carload lots from Michigan to West Virginia, where the product was bottled, labeled and put in condition to be retailed. Danderine contains a percentage of alcohol which, while given on the labels of the bottles in which it is sold, was not stated on the casks in which the preparation was shipped in bulk. The government sought to confiscate, under the Food and Drugs Act, sixty-five casks thus shipped because the quantity or proportion of alcohol in the casks was not stated. The Knowlton Danderine Company resisted the confiscation and the court upheld the company’s claim.

The point in this case which is--or should be--of interest to the medical profession is to be found in the “statement of facts” presented by the Knowlton Danderine Company in its own defense. Here it is said that: “Parke, Davis & Co., who are mentioned in the said libel as shippers ... are under contract with the said Knowlton Danderine Company ... to compound the said formula ...” Elsewhere it is stated: “Parke, Davis & Co. were ... the manufacturing agents, under contract, of the owner, the Danderine Company ...”

This evidently means that Parke, Davis & Co., who are generally supposed to manufacture only “ethical” preparations--proprietary or otherwise--and as such to desire the respect and good wishes of the medical profession, are in the business of furnishing the supplies for nostrum venders. What Danderine is, it is hardly necessary to specify. The widely distributed advertisements of this “hair tonic” nostrum with the slogan: “Danderine Grows Hair and We Can Prove It” are sufficiently well-known to all who read to make a lengthy disquisition on the product unnecessary.

It is interesting in this connection to note that according to newspaper dispatches the Danderine Company has absorbed the Sterling Remedy Company, which exploits “Cascarets.” Three years ago a physician, who is also a pharmacist, wrote to the _Medical World_ regarding the manufacture of Cascarets:

“... I have positive evidence, which I will gladly submit, that P.,
D. & Co., make all of them [Cascarets], and that they have a contract
with the Cascaret people not to make anything similar for any one
else.”

In the circular which comes in the Danderine packages two other “specialties” are advertised: “Neuralgine” for “sick, weak, tired nerves” and “Drake’s Palmetto Compound” for “weak stomachs, sluggish livers, disordered kidneys,” and various other derangements of the system. The question naturally arises, are these, too, shipped in casks from Parke, Davis & Co., and merely bottled and labelled in West Virginia?

Not that the Danderine case is the first one in which Parke, Davis & Co. have been exposed as manufacturers of nostrum supplies. “Vitaopathy” a method of “treatment” practiced by the notorious New York Institute of Physicians and Surgeons in the person of “Prof.” Adkin and apparently consisting of “absent treatment” and pills, was finally put out of business by a fraud-order from the post office department. The concern used to advertise:

“In Professor Adkin’s laboratory, his chemists are daily engaged
in extracting the life-and-health-giving principle from rare
vegetables, fruits and plants.”

“Prof.” Adkin had no laboratory; his chemists, according to the government report, were Parke, Davis & Co., from whom he purchased the tablets which formed part of his stock-in-trade of quackery.

The Nutriola Company of Chicago was declared fraudulent by the postal authorities and a full account of the methods of this fake medical concern appeared in The Journal, April 28, 1906. Nutriola was advertised as:

“The greatest Chemical-Medical Preparation ever prepared by the
skill of man.”

“Nutriola and Nature are the only invincible conquerors of diseases
ever known.”

The promoter of this scheme was one Edward F. Hanson, who was questioned by the government inspectors regarding the manufacture of the Nutriola nostrum. Quoting from the government report:

“_Q._ Please name the chemists who now manufacture the remedies of
the Nutriola Company.”

“_A._ Parke, Davis & Company, Detroit; E. L. Patch Manufacturing
Company, Stoneham, Mass.; Seabury & Johnson, New York.”

Not that the course pursued by Parke, Davis & Co. is by any means an exceptional one in the pharmaceutical world. It may be recalled that The Journal has previously referred to the fact that Sharp & Dohme are reported to make or to have made the “Getwell Tablets” for the “patent medicine” concern which exploits the nostrum; and that Frederick Stearns & Co. make or did make the widely advertised “cures” Shac and Zymole Trokeys also has been mentioned. That Seabury & Johnson made preparations for a fake medicine concern was brought to light by Mr. Adams in the “Great American Fraud” series. And unquestionably there are many others. The attitude taken by such houses seems to be that they are willing to furnish anything in the pharmaceutical line that anyone is willing to pay for, whether it is for legitimate use of the physician or pharmacist or for furthering the business by which the ignorant or gullible sick are humbugged and defrauded.--(_From The Journal A. M. A., July 2, 1910._)

DOWD’S PHOSPHATOMETER

Dowd’s Phosphatometer, according to its inventor, is a device “for taking the phosphatic index or pulse of the nervous system.” Its originator, J. Henry Dowd, M.D., Buffalo, N. Y., writes enthusiastically of his instrument:

“Physicians who use the Phosphatometer are sending 50 per cent.
less patients away for consultation, getting 75 per cent. better
results at home, because the Phosphatometer tells the cause and
what to do, and the Comp. Phosphorus Tonic gives results in 80 per
cent. of all conditions of illness.”