The Propaganda for Reform in Proprietary Medicines, Vol. 1 of 2

Chapter VI: Part I: Council Reports (1)

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ACETANILID MIXTURES[A]

Report of the Council on Pharmacy and Chemistry

[A] See also Labordine, p. 115; Headache Cures, p. 305; Anadol, p. 244; Phenalgin, 335.

_To the Council on Pharmacy and Chemistry_:

In response to the request of your chairman we have investigated the below-mentioned preparations and report as follows:

Specimens of the articles were bought in different cities in the open market, and in original sealed packages, and were analyzed by some of us or under our direction. Each article was examined by at least two chemists, and some were subjected to several analyses. While certain of the preparations are represented as being chemical compounds, the specimens examined were all found to be mixtures, the principal ingredient being acetanilid. The percentage proportions of acetanilid given below are the minimum obtained by any of the analysts.

Soda and ammonia, combined with carbonic acid, are calculated and reported as sodium bicarbonate and as ammonium carbonate (U. S. P.) respectively. Salicylic acid is calculated and reported as sodium salicylate. Diluents and other constituents than those reported were not determined.

AMMONOL

According to the analyses of the contents of the original sealed packages as purchased, this was found to be a mixture, and to contain the following ingredients approximately in the proportions given:

Acetanilid. Sodium Bicarb. Ammonium Carb.
50. 25. 20.

ANTIKAMNIA[B]

[B] See also Antikamnia, The Nostrum and Its Method of Exploitation, page 268.

Acetanilid Caffein Citric Acid Sodium Bicarb.
68. 5. 5. 20.

KOEHLER’S HEADACHE POWDERS

Acetanilid Caffein
76. 22.

ORANGEINE

Acetanilid Sodium Bicarb. Caffein
43. 18. 10.

Other constituents said to be present were not determined.

PHENALGIN[C]

[C] See also Phenalgin--A Typical Example, p. 335.

Acetanilid Sodium Bicarb. Ammonium Carb.
57. 29. 10.

Certain packages of phenalgin were purchased which on analysis did not show ammonium carbonate.

SALACETIN[D]

[D] See also Salacetin, p. 356.

Acetanilid Sodium Bicarb. Sodium Salicylate
43. 21. 20.

We recommend that this report be printed in The Journal of the American Medical Association.

Respectfully submitted,

J. H. Long, M.S., Sc.D., }
W. A. Puckner, Ph.G., } Committee on Chemistry,
S. P. Sadtler, Ph.D., } Council on Pharmacy and
J. Stieglitz, Ph.D., } Chemistry of the A. M. A.
H. W. Wiley, M.D., Ph.D., }

(_From The Journal A. M. A., June 3, 1905_).

AGAR-LAC

Report of the Council on Pharmacy and Chemistry

Agar-lac, said to be the product of “Agar-lac, Inc.,” is sold by E. Fougera and Company, New York. The following “formula” for Agar-lac is published:

“Agar-Agar with Lactic Ferments Grs. 4-1/2
Phenolphthalein Grs. 1/2”

Regarding the “lactic ferment,” the identity of which is not declared by the manufacturer and for the viability of which no precautions appear to be taken, the Council’s expert on lactic acid ferments reported that _Bacillus bulgaricus_ was present in small numbers only and that there were at least two other bacteria present, one of which is a gas-former of the _Bacillus coli_ type.

The Council found that the amount of agar-agar in Agar-lac and the identity of the “lactic ferment” are not declared; that the name “Agar-lac” is blown in the glass and that the method of its exploitation will lead laymen to use it to their detriment; that the claims that it “facilitates assimilation of proteids” and that it is of value as an aid to “gastro-intestinal digestion” give a false value to the mixture and that the claims emphasize the action of agar-agar when from the composition it is evident that the phenolphthalein action will predominate; that the name does not indicate its predominating constituent, phenolphthalein, and that the use of a ready-made combination of cathartic drugs, such as agar-agar and phenolphthalein with lactic acid ferments, is unscientific. The Council therefore refused recognition to Agar-lac.--(_From The Journal A. M. A., Nov. 14, 1914._)

ANASARCIN AND ANEDEMIN

Reports of the Council on Pharmacy and Chemistry and Comments Thereon

The following reports were submitted to the Council by the subcommittee to which these articles were assigned:

ANASARCIN

_To the Council on Pharmacy and Chemistry_:--Your subcommittee to
whom Anasarcin (Anasarcin Chemical Co., Winchester, Tenn.) was
assigned, herewith submits its report:

This remedy is offered in two forms: “Anasarcin Tablets,” a pretended
combination of the active principles of oxydendron arboreum, sambucus
canadensis, and urginea scilla; and “Anasarcin Elixir,” said to
contain the active principles of oxydendron, sambucus, hepatica and
potassium nitrate. The advertisements of these articles conflict with
the rules of the Council as follows:

With Rules 1 and 2: The composition of these articles is kept secret,
in that the proportion of the ingredients is not furnished. The
statement that it contains the “active principles” is misleading,
since these are for the most part unknown.

With Rule 6: The description of the pharmacologic action of Anasarcin
agrees practically with that of squill. No material part of its
effects can be attributed to the other ingredients. Nevertheless, the
advertisement studiously cultivates the impression that Anasarcin
has no relation whatever to the digitalis group in which scilla is
commonly placed. The claims are therefore misleading. The claim
of its infinite superiority to digitalis, the claims that it cures
neurasthenia, eliminates uric acid in rheumatism, and is useful in
obesity, cystitis, lumbago and eclampsia, dyspepsia and asthma, and
that it works wonders in exophthalmic goiter, appear exaggerated or
false.

The recommendation of its indiscriminate use in nephritis, for
lowering the blood-pressure and the statement (contradicted in the
firm’s own literature) that it is not depressing, are actually
dangerous.

It is recommended that the articles be refused recognition, and that
the report, with explanations, be published.

ANEDEMIN

_To the Council_:--Your subcommittee to whom Anedemin (Anedemin
Chemical Co., Winchester, Tenn.) was assigned herewith submits its
report:

Anedemin is an evident imitation of Anasarcin. It is marketed
as tablets, said to contain the isolated active principles of
strophanthus, apocynum, squill and sambucus, chemically combined.
The quantities are not stated. The therapeutic claims are copied
almost literally from the Anasarcin circulars and are equally false.
Anedemin, therefore, conflicts with Rules 1, 5, 6 and 7.

It is recommended that this report be published, with comments.

The reports were adopted by the Council and are herewith published.

W. A. Puckner, Secretary.

Anasarcin

This wonderful remedy, Anasarcin, has already been exposed in these columns (The Journal A. M. A., Jan. 27, 1906), but it deserves additional mention, as it teaches several important lessons of general application. It is a typical example of the revival, under a new name and a thin disguise, of an old, time-worn article, squill, presumably because experience has demonstrated its general inferiority to other drugs. Anasarcin further illustrates the dangers involved in the use of semi-secret nostrums. It also shows how a short experience with a widely advertised but little understood drug is apt to lead to conclusions which more extensive experience demonstrates to be entirely fallacious.

The first lesson is, that formulas are not always what they seem. A hasty glance at the formula of Anasarcin tablets, the basis of the Anasarcin dropsy cure, creates the impression that it is a non-secret remedy; for it is said to represent a combination of the active principles of oxydendron, sambucus and scilla. As a matter of fact, it is a secret nostrum of the insidious kind. A formula which omits the quantities of its potent ingredients means very little. Further than this, we do not hesitate to charge that the claimed composition is a deliberate deception. The circulars emphasize the claim that Anasarcin consists of the _isolated principles_, and not of the crude drugs. Now, the isolated active principles of sambucus and oxydendron are not on the market, for the good and sufficient reason that no active principles have ever been isolated. Are we to believe that the Anasarcin Company has surpassed the accredited chemists and has discovered such principles and is isolating them? We shall have more to say on this subject presently; but any one in the least familiar with the difficulties attending the isolation of organic principles knows such an idea to be preposterous. Indeed, it is absolutely incompatible with the exhibition of ignorance of the elementary facts of pharmaceutical chemistry which is given by these people when they call the active principles of digitalis and squill “alkaloids.”

It is an axiom that the effects of a mixture can only be understood if the action of its components are known. So far as we know, the physiologic effects of oxydendron and sambucus have never been scientifically investigated, for the simple reason that they are too slight and indefinite to promise results. Both are credited with some slight, obscure diuretic action. Oxydendron, the sour wood or sorrel tree, is a small tree of the heath family, the acid leaves of which are said to be chewed by hunters for their pleasant taste and for the relief of thirst. Sambucus is the common elder. It is most unlikely that these two innocuous substances should play any part in the claimed powerful effect of Anasarcin; they are evidently put in the formula, we do not say in the preparation, to obscure the fact that Anasarcin is composed principally of squill. That this is so can be gathered unmistakably from a study of the pharmacologic action of Anasarcin as described by its promoters:

Acting primarily on the heart and arterial systems through the
nerve ganglia, a natural physiologic balance is established
between the arterial and venous systems, whereby effusions ... are
eliminated.... Coincident with this action there is a noteworthy
_slowing_ of the pulse.... If the remedy is pushed, can be brought
down to 20 or 30 beats per minute.... Its physiological action
is to stimulate the cardiac motor-ganglia through the cardiac
plexus of the sympathetic system and at the same time exert an
inhibitory influence upon the cardiac fibers of the pneumogastric,
thereby dilating the arterioles, slowing the heart’s action, and
increasing the force of the systole.... The prolonged diastole
allows the ventricle time to completely fill, and the more forcible
contraction causes the mitral valve to close more thoroughly and at
the same time increases pressure in the coronary arteries, serving
thereby the double purpose of relieving pulmonary engorgement and
increasing heart nutrition.

Anasarcin will nauseate some persons.

To appreciate fully the meaning of this description of the actions of Anasarcin, it should be compared with the effects of the digitalis group, to which squill belongs. The following account is quoted literally from a recent text-book of pharmacology (Sollmann):

The phenomena of the therapeutic stage of digitalis action are said
to be:

1. Slowing of the heart, with systole and diastole both lengthened.

2. Increased strength of beat, leading to greater efficiency of the
individual contractions, and to an increase in the total efficiency.

3. A tendency to the systolic phase.

4. A rise of blood-pressure, due mainly to the increased action of
the heart, but partly also to a vasoconstriction.

The therapeutic action may be explained, in part, as follows:

A larger amount of blood will be thrown into the aorta and coronary
circulation. The first effect will be an improved nutrition of the
heart.... The tonic action ... narrows the ring of the valves, brings
them together, narrows the orifice.... The venous congestion will
tend to be relieved. This relief ... will fall in the first place on
the lungs.... The lowering of the venous pressure will tend to cause
absorption of the effusions.

The nauseant action of squill, which is alluded to in connection with Anasarcin, is too well known to require more than a mention.

In brief, then, it appears from the statements of the Anasarcin Company that the action of the remedy is that of squill and that the other ingredients are a mere blind. It is, of course, well known that squill can be used as a substitute for digitalis in cardiac dropsy, although it is generally considered very inferior to the latter drug. Rose Bradford, for instance, states: “Squill is not used to any extent in the treatment of cardiac disease and cardiac dropsy, digitalis being a far more efficient and less toxic substance.” However, it has been frequently observed that digitalis occasionally fails, and it may then be replaced successfully by another member of the group. At all events, it is very likely that squill is a fairly efficient substitute for digitalis, especially when it is supplemented by a very free course of Epsom salts and by potassium nitrate (the active ingredient of Anasarcin Elixir), both of which are stated to be essential adjuvants to the Anasarcin (or squill) tablets. There can be no objection to the use of squill when it is indicated; but any one who wishes to use it should do so with his eyes open, knowing what substance he is using and how much (which he does not in Anasarcin); knowing also that it has the same indications and limitations as digitalis. He should not be misled by such statements as the following:

“Does what dropsy medicaments have hitherto failed to accomplish.”

“Superior to digitalis, strophanthus, scoparius, squills, acetate
of potash and the hydragogue cathartics all put together.”

“The only known relief [how modest!] and permanent cure of
dropsies.”

“Unrivaled heart tonic.” “The most powerful agent known.”

Any one wishing to use squill should take the trouble to acquaint himself with the results obtained by competent and independent observers, and not rely on it in eclampsia, septicemia, “vices of civilization,” all forms of neurasthenia, as “an active eliminator of uric acid in rheumatism,” in hepatic cirrhosis, dyspepsia, asthma, obesity, cystitis (!), lumbago, exophthalmic goiter, etc.

He should also learn the contra-indications to the use of squill, deducible from the fact that it causes vasoconstriction and raises the blood-pressure (prohibiting its use in Bright’s disease and arteriosclerosis), and that it produces marked gastric irritation, consequently nausea and depression, that it is a very toxic agent, and that the dangers of cumulative action must be borne in mind. In respect to these the advertisements of the Anasarcin people are little short of criminal, for these state:

“Safe in administration.” “Non-toxic as ordinarily administered.”
“Will nauseate some persons,” but “the reaction from the temporary
depression is prompt.” “In Bright’s disease, both the interstitial
and parenchymatous forms of nephritis, acute or chronic, no remedy
... to equal it in efficacy.” “Without increasing the debility of
the patient or interfering with nutrition by producing loss of
appetite....” “This treatment is to be continued without cessation
until all symptoms of dropsy have disappeared.”

Physicians who are inclined to disregard this warning, and who follow the advice of the Anasarcin people, should remember that their patients--or their friends--will put the blame for the results, which are bound to follow sooner or later, on the prescribers, and not on the deceptive advertisements of the Anasarcin Chemical Company.

There is another little matter which throws an illuminating side-light on the Anasarcin Company. They take every occasion to say that Anasarcin is “not offered to the laity,” “never sold to the laity,” etc.; but witness the following, which was found in the _Retail Druggist_ of May, 1906, p. 179. The italics are ours.

CURE FOR DROPSY.

“As every druggist knows, dropsy has been one of the incurable
diseases when caused either from heart, liver or kidney trouble. A
_pharmacist_ in Winchester, Tenn., _has worked out a remedy_ called
Anasarcin, which he is exploiting to the physicians, and his remedy
is showing itself as possessing great merit. Several hopeless cases
have been treated as a last resort by Anasarcin and in a very short
time the patient has shown marked improvement and has effected
permanent cures.

“The result of the cases as handled by the physician with the aid
of Anasarcin has been so easily and quickly cured that physicians
of Tennessee and the southern states are high in their praises of
the remedy. The company which now manufactures and sells it is
known as the Anasarcin Chemical Co., of Winchester, Tenn. _Any
druggist who knows of a case of dropsy would be conferring a favor
on the patient and mankind in general by telling the party_ or
his physician _of the southern pharmacist_, and we have no doubt
but what a prompt relief and permanent cure would be affected.”
[Probably means effected.--Ed.]

Anedemin

If we are disposed to doubt the vaunted scientific ability of the Anasarcin Company, we are forced to admire their business methods, at least, if there is any truth in the saying that imitation is the seal of success. Anasarcin has had this rather undesirable compliment paid to it, for its native town of Winchester has given birth to another remedy, Anedemin, which looks like a fair-haired twin brother. The Anedemin Company has adopted Anasarcin almost bodily. The name--“opposed to edema”--is about as close as the copyright laws permit. The pharmacologic and therapeutic claims agree almost literally with those of Anasarcin and contain the same exaggerations and dangerous misstatements. There is the same emphasis on free purgation with Epsom salts. The dose is the same. Both are marketed at $2.00 for a box of 100--only the Anedemin people have adopted the prize package device of throwing in 20 or 30 tablets extra, for good measure, and give a discount of 75 cents or so.

In short, the Anedemin Company has appropriated all of Anasarcin which they considered of any value. It is, therefore, rather suggestive that they drew the line at the formula. Anasarcin is said to contain squill, sambucus and oxydendron; Anedemin discards the oxydendron and reinforces the squill with strophanthus and apocynum. Notwithstanding this material change in composition, the actions are described as identical; this is again rather suggestive.

The Anedemin Company, like the Anasarcin Company, scorns crude drugs and claims to use only the isolated principles. It was saved the trouble of discovering active principles for strophanthus and apocynum, for these are known; but it managed to find some scope for its inventive genius, “both drugs being so chemically treated and disposed as to absolutely eliminate all objectionable and disagreeable properties and effects” so as to convert a vasoconstrictor action into a dilator action; so as to render them non-toxic and non-cumulative; so as to deprive apocynum of its characteristic nauseant effect. Who can say that the days of miracles are past? Even this is not the limit of Anedemin alchemy; if we are to believe their claims, they have succeeded in forcing strophanthin, apocynum, scillain, etc., to combine with each other: “It is a _definite chemical compound_ of the active principles” of these drugs! This makes the achievements of Emil Fischer in synthesizing sugars and proteids appear as mere child’s play.

Since the formulas were completed, however, clinical reports have been numerous enough--almost too numerous, if we are to believe them. Anedemin has been on the market for less than three years; the circulars emphasize that testimonials and endorsements are not solicited. Nevertheless, we are told that it is “endorsed by over fifty thousand clinicians throughout the United States.” Since the total number of physicians in the United States and Canada is only about 128,000, this means that nearly every second physician has endorsed Anedemin. The Anasarcin Company solicits endorsements and they seem to do the larger business. Hence the majority of physicians of the United States must have written an endorsement of either Anedemin or Anasarcin, or both. Or is this statement another “invention”? It is a little peculiar that nearly all the endorsements come from small towns in sparsely settled districts; practically none from the centers of population. Does this mean that dropsy is more common in the rural communities than in the cities?

THE INVENTORS OF ANASARCIN AND ANEDEMIN

Even the newspapers, when they tax our credulity with pretended scientific “discoveries,” feel the moral obligation of justifying themselves by telling us something of the personality and experience of the discoverers. We may ask, therefore, who are these expert pharmaceutic and synthetic chemists, these manufacturers of active principles, these skilled clinicians of wide experience, who have “intelligently built up the formula by wide application”? What are we told of these men who ask us to believe, on their mere assurance, in miracles and feats of magic; who tell us that they have converted neutral principles into alkaloids, that they have effected definite chemical compounds between these neutral principles, that they have discovered principles that do not exist, that they have changed the actions of these principles to suit their wishes, that, in short, they have reversed the laws of Nature?

These companies are located in Winchester, Tenn., a town of about 1,500 inhabitants, situated in an agricultural country. The town boasts of neither scientific schools, colleges, universities nor laboratories. The Anasarcin Company was organized in 1902, the incorporators and directors being Dr. John W. Grisard and his sons, Dr. John P. Grisard, B. A. Grisard, and A. F. Grisard, and Will E. Walker, all of Winchester. Dr. John W. Grisard seems to be the originator and promoter of Anasarcin. W. E. Walker is an insurance solicitor of Winchester and is not actively identified with the business. We are informed that he owns but a single share of stock having a face value of $100, and that he was added to the company in order to comply with the laws of Tennessee, which require five directors for any corporation. Dr. John W. Grisard, the father, has practically retired, but still has a general supervising interest in the business. There is no regularly licensed pharmacist or chemist connected with the company. The office is in the rear of a jewelry store in the business part of Winchester and on the second floor above. According to our reporter, an office force of about ten stenographers and clerks handles the correspondence and labels and sends out the preparation which is made in a crude frame building located on a side street and without laboratory equipment. According to our reporter, the work is done by the Grisards and a colored man.

The Anedemin Chemical Company was organized in 1905 with a capital of $20,000, the incorporators and directors being Dr. T. B. Anderton, Floyd Estill, J. J. Lynch, J. M. Littleton and I. G. Phillips, all residents of Winchester, and all lawyers with the exception of Dr. T. B. Anderton. A Mr. Gordon, a clerical employee of the company, is reported to have active charge of the business, to prepare the medicine and conduct the correspondence. The office headquarters, laboratory and complete outfit of the Anedemin Company comprises two rooms over the law office of Estill & Littleton. No one connected with the company is a regularly licensed pharmacist or graduate chemist.

Of the six physicians located in Winchester, three (50 per cent.) are engaged in the dropsical cure business. Poor Winchester! Aside from their connection with these two nostrums, these physicians may be estimable and worthy citizens, but where, pray, did they find the extensive clinical facilities and pharmaceutical knowledge necessary for their wonderful and epoch-making discovery? Were they aided in their scientific work by the four lawyers connected with the Anedemin Company or by the insurance solicitor who is a director of the Anasarcin Company? Did the 1,500 inhabitants of the town furnish the vast clinical material necessary for discovering and working out the formulas of these two preparations? If so, we fear that dropsical affections are much more prevalent in Winchester than in any other known spot on the globe. This matter should be investigated. Without doubt the vital statistics of Franklin County would be most interesting and we commend them to the special attention of the medical profession in Tennessee.--(_From The Journal A. M. A., May 4 and 11, 1907._)

MAIGNEN ANTISEPTIC POWDER

Report of the Council on Pharmacy and Chemistry

The report which appears below was submitted by a referee and after adoption by the Council was sent to the manufacturer for comment, in accordance with the Council’s regular procedure in such cases. The manufacturer’s comments were transmitted to a second referee, who reported that after a careful consideration of the manufacturer’s reply he saw no valid reason for a modification of the report. The referee also reported that a visit to the Maignen Institute further served to convince him of the viciousness of the treatment as given and that the records made by the persons in the employ of the institute were too inadequate to serve as clinical evidence. On the referee’s recommendation, the report as originally adopted was reendorsed by the Council and authorized for publication.

W. A. Puckner, Secretary.

Maignen Antiseptic Powder is marketed by the “Maignen Institute for the Study of Bacterial Diseases,” Philadelphia. It is claimed to be a mixture of calcium hydroxid, sodium carbonate, aluminum sulphate and boric acid, but no statement as to the amount of the several constituents is furnished. Its action depends on the sodium hydroxid which is formed when the powder is treated with water, 1 Gm. of the powder as now submitted to the Council yielding 0.32 Gm. of sodium hydroxid (NaOH) and a specimen obtained a year ago yielding 0.28 Gm. Its promiscuous use is recommended both to physicians and to the public with claims which are extravagant, preposterous and even dangerous.

A pamphlet, clearly intended for the laity, entitled “What Is Catarrh?” gives direction for the “sterilization” of the nose, throat, stomach, lungs, eyes, gums, mouth and the genito-urinary tract. The following, taken from this pamphlet, illustrates the absurdity of the claims made for Maignen Antiseptic Powder:

“STERILIZATION OF THE STOMACH

“TAKE of the Maignen Antiseptic Powder half the quantity raised on
a dime, scant.

“ADD to a tumbler of water, preferably warm, and stir.

“DRINK SLOWLY.

“THIS IS WHAT MAY HAPPEN:

“1). Belching may be the first indication of the sterilization of
the stomach.

“2). The excess of acidity is corrected.

“3). The fermentation is stopped.

“4). The sterilization extends to the Intestinal Tract.

“5). The bowels are regulated without purgation.

“6). The whole metabolic process is improved.

“WHEN AND HOW OFTEN TO DRINK THE ANTISEPTIC SOLUTION.

“a). For Indigestion, whenever distressed, before or after meals.

“b). For Constipation, half an hour before breakfast or last thing
at night.

“c). For Gastro-Intestinal troubles, such as Typhoid Fever,
Dysentery and Cholera, which are the most serious forms of
catarrhal inflammation, take half a tumbler or a whole tumbler of
hot water with half the quantity of Powder raised on a dime every
hour, and between times a glass of generous [sic] wine.

“REMARKS

“The sterilization recommended here is a plain disinfecting process
which does not interfere with medical treatment. It is, on the
contrary, of great assistance to it.

“It has been found very effective in breaking up the cigarette
habit. It does away with the craving by removing the morbid
irritation of the mucous membrane.”

Eighty-eight disorders are listed in a pamphlet entitled “Antiseptic Therapeutics” all of which are reported as having been treated with success. The dangerous character of the Maignen “sterilization” propaganda is illustrated by a pamphlet “First Aid to Baby-Sick” and by the recommendation on the trade package:

“To prevent Blood Poisoning, Lockjaw, Hydrophobia and Infectious
Diseases.”

The legend on the trade package and the advertising matter contained in it are likely to lead the public to place dependence on a weak sodium hydroxid solution as a means of preventing blood-poison, lockjaw, hydrophobia and infectious diseases. The pamphlet “First Aid to Baby-Sick” recommends its use in sore eyes, teething and sore mouth, sore throat, running ears, running nose, sore chest, summer complaint, skin troubles and infection after vaccination; if any trust is put in these claims, they are bound to lead to the sacrifice of many infants through neglect of proper treatment.

Patent No. 1,086,339 has been granted on this powder to P. J. A. Maignen of Philadelphia by the U. S. patent office on the following specification of claim made in the application:

“1. A process for destroying microorganisms on living tissue,
without injuring the latter ... whereby the growth of such
organisms is inhibited and their substance dissolved without
deleterious effect upon contiguous healthy tissue.”

With brazen assurance this grant has been twisted by the unscrupulous promoters into a government endorsement of the preparation. It, of course, means nothing of the sort, as, no doubt, in accordance with legal routine the patent was granted without any investigation by the patent office to determine the effectiveness of the powder for the purpose claimed.

In view of the dangerous, unwarranted and absurd claims made for Maignen Antiseptic Powder the referee recommends that it be refused recognition, and that the Council declare its agreement with views expressed in the article “Maignen Pulv.” published in The Journal, Feb. 15, 1913, p. 537, particularly the following:

“The germicidal powers of strong alkalies have long been known,
but the inconvenience of their application to tissues and
mucous membranes has prevented their use. That they will be of
service when sufficiently diluted not to irritate the tissues is
improbable, for the antiseptic power of such solution is slight and
the disinfectant value practically nil.”

Because the Maignen Institute has twisted the granting of U. S. patent No. 1,086,339 into a quasi-endorsement of the claims made for Maignen Antiseptic Powder it is recommended that a copy of this report be sent to the Commissioner of Patents as a protest against the present law, which authorizes the granting of patents on unproved and improbable medical claims.--(_From The Journal A. M. A., Nov. 14, 1914._)

TYREE’S ANTISEPTIC POWDER[E]

Report of the Council on Pharmacy and Chemistry with Comments

[E] See also Tyree’s Antiseptic Powder, p. 404.

Tyree’s antiseptic powder was assigned for examination to a subcommittee of the Council, which made the following report:

_To the Council on Pharmacy and Chemistry_:--Your subcommittee, to whom
was assigned Tyree’s Pulv. Antiseptic Comp., marketed by J. S. Tyree,
Washington, D. C., reports as follows: The label on the package states:
“This preparation is a scientific combination of borate of sodium,
alumen, carbolic acid, glycerin and the crystallized principles of
thyme, eucalyptus, gaultheria and mentha, in the form of a powder,” etc.

The statement that the powder contains the crystalline principles of
thyme, eucalyptus, gaultheria and mentha is vague and misleading,
since the chief medical constituents of eucalyptus and gaultheria are
liquids, but it tends to convey the impression that the powder contains
the essential constituents of these drugs, namely, thymol, oil of
eucalyptus or eucalyptol, oil of wintergreen, or methyl salicylate, and
menthol.

The literature supplied to physicians _claims_ its composition to
be: “Parts, sod. bor., 50; alumen, 50; ac. carbol., 5; glycerin, 5;
the cryst. principles of thyme, 5; eucalyptus, 5; gaultheria, 5, and
mentha, 5.”

The composition, therefore, might be expressed as follows:

Sodium borate (borax) 50 parts, or 38.46 per cent.
Alum 50 parts, or 38.46 per cent.
Phenol (carbolic acid) 5 parts, or 3.85 per cent.
Glycerin 5 parts, or 3.85 per cent.
Thymol 5 parts, or 3.85 per cent.
Oil of eucalyptus or eucalyptol 5 parts, or 3.85 per cent.
Oil of gaultheria
(or methyl salicylate) 5 parts, or 3.85 per cent.
Menthol 5 parts, or 3.85 per cent.

Analysis of specimens purchased from different sources in the open
market were made under our direction. The reports of the chemists
show that Tyree’s antiseptic powder contains no borax, or mere traces
only, and that it contains no alum, or mere traces only. Instead, the
analyses show that boric acid and zinc sulphate are the essential
constituents. The amounts of carbolic acid, thymol, menthol, etc.,
contained in the powder, if present, were far below the quantities
indicated by the formula. The presence of glycerin could not be
demonstrated, and, if present, the amount must be very small.

One chemist reports: The result of analysis shows that different
samples differ slightly in composition, but that the following
indicates the average composition of the product:

Per Cent.
Zinc sulphate, anhydrous 15.56
Boric acid 81.26
Volatile matter at 100° C. for four hours 0.45

The undetermined portion consists of salicylic acid, carbolic acid,
menthol and eucalyptol; possibly other antiseptic agents may be present
in very minute quantities.

From the above findings we conclude that Tyree’s antiseptic powder is
a mixture of boric acid and dried zinc sulphate and antiseptic bodies,
such as menthol, salicylic acid and carbolic acid, eucalyptol, etc.
From this it can be readily seen that the label, which is supposed
to set forth the composition of Tyree’s antiseptic powder, is not in
accord with the facts. The powder does not contain either borate of
sodium or alum, and the presence of glycerin could not be established.
The antiseptic agents, exclusive of the boric acid, are present only in
small amounts.

The report of another analysis concludes as follows:

It evidently contains less than the amount stated of the principles of
thyme, eucalyptus, wintergreen and mint. It also contains a very small
amount indeed of carbolic acid, much less than that stated. We have
been unable to identify certainly the presence of glycerin, and it is
doubtful if it be present.

From the result of the analysis we feel confident that the preparation
is to all intents and purposes a mixture of boric acid and sulphate of
zinc.

The carbolic acid, thyme, eucalyptus, wintergreen, etc., if present,
are present only in sufficient amount to give the compound a
satisfactory odor.

In view of the fact that J. S. Tyree has given wide publicity to
a formula which the preceding report has shown to be a deliberate
misrepresentation of facts, it is recommended that the article be
refused recognition by the Council on Pharmacy and Chemistry, and
that this report be published in The Journal of the American Medical
Association.

The recommendation of the subcommittee was adopted by the Council in
accordance with which the report is published.

W. A. Puckner, Secretary.

Mr. Tyree, in a letter to Dr. Simmons (which he states he writes at the request of Dr. Kebler of the Drug Laboratory of the Department of Agriculture, though he is under no moral or financial obligation to do so), says that it has been his intention to inform the medical profession of his reasons for changing the formula of Tyree’s Antiseptic Powder from an alum and borax base to a boracic acid and zinc base. He states that this change was made at the suggestion of prominent physicians connected with hospital clinics on nose and throat, venereal and other conditions and that he has had in contemplation the omission from the label of the various conditions to which the preparation is applicable.

Mr. Tyree, it will be seen, assumes the right to sell to physicians a preparation with a descriptive formula which he acknowledges is false, and he presumes to use his own pleasure as to the time when he will inform them of its true composition.

Mr. Tyree does not state when he changed the formula. We do not know whether it was a year ago, five years ago or ten years ago, but we do know that the package which was used in making the first analysis was purchased as early as last February, and the first chemist’s report was submitted to the Council March 5, 1906. On April 4 Mr. Tyree was notified by the Council that the composition of Tyree’s Antiseptic Powder did not correspond to the formula published by him.

Whether or not Mr. Tyree is justified in offering our profession a preparation as composed chiefly of borax and alum when in reality it is chiefly composed of boric acid and zinc sulphate, we leave physicians to judge.

Discrepancies Between Facts and Claims--Unfortunate
Attempts of Mr. Tyree at Explanation

A report from the Council on Pharmacy and Chemistry on Tyree’s Antiseptic Powder appeared in The Journal, Oct. 20, 1906. This showed that the preparation, advertised as a “scientific combination of borate of sodium, alumen, carbolic acid, glycerin and the crystallized principles of thyme, eucalyptus, gaultheria and mentha, in the form of a powder.” was essentially a mixture of boric acid and sulphate of zinc--approximately four-fifths of the former to one-fifth of the latter. “The carbolic acid, thyme, eucalyptus, wintergreen, etc., if present, are present only in sufficient amount to give the compound a satisfactory odor.” As will be remembered, in the correspondence published at that time, Mr. Tyree attempted to explain the discrepancies between his statements and the proved facts by intimating that he had recently changed the formula, and that it was his intention “on or about the first of February to state to the medical profession his reasons for changing the formula,” and that the change had been made “a short time ago, at the suggestion of several prominent gentlemen.” Since that time, through circulars and other advertisements, Mr. Tyree has attempted to explain the matter in various ways. In his latest circular letter he seems to make a deliberate attempt to mislead our profession and to misrepresent facts to a degree that makes it almost impossible to believe that the circular came from a man who claims to be honorable.

First, however, we shall take this opportunity to publish some matter which we have had in reserve since the first exposé was made last October. When it was realized that Mr. Tyree intended to defend himself by claiming that a change had recently been made in the powder, we took occasion to try to secure some of the preparation that had been on the market for a long time. In this we succeeded very well. From a Chicago druggist one package was bought which had been in the store at least since July, 1902--how much longer is not known. The druggist from whom the powder was obtained bought the drug store in July, 1902, and this powder was on hand at that time, none having been bought since. This particular powder was analyzed by a chemist, who found the composition practically the same as that given in the Council’s report, this chemist estimating that it contained approximately 81 per cent. boric acid and 14 per cent. anhydrous zinc sulphate. Bearing in mind that for at least four years and ten months Tyree’s Powder has been essentially the same as it is today, this letter is very interesting: (The comments in brackets are, of course, ours.)

“J. S. TYREE,
“Chemist,
“WASHINGTON, D. C.

“April 16, 1907.

“Dr. --------,

“----,

“_My Dear Sir_:--Doctors and medical publications of extreme and
prejudicial minds often hold and express opinions in honorable
faith, but like all critics, they are not always familiar with
the conditions composing their opinions, and are often given to
expressing them without knowledge of the true motives and facts in
the case.

“If you will read an article that appeared in one of the medical
weeklies some time ago [The Journal of the American Medical
Association, of course] and which has been copied by several of its
offsprings [not many we regret to say] relating to Tyree’s Antiseptic
Powder, you will see that I had previously informed the editor as
well as his council of investigators, that at the suggestion of
prominent physicians, extensive clinical experimenting [sic] were
being made with some slight [! ! !] changes in my powder, the object
being to develop and extend its usefulness in new lines [It had
already been recommended for about everything[2]] and at the same
time make it more acceptable to the general run of the profession.
I also notified this editor that these investigations would not be
completed until the first of the present year, after which time
these slight [! ! !] changes in the formula of Tyree’s Powder would
be announced. [It is now the middle of May; when and where were the
changes announced?[3]]

[2] From the circular accompanying a package bought over a year ago,
we find the powder recommended for the following conditions: “For
Leucorrhea, Gonorrhea, Vaginitis, Pruritus, Ulcerated conditions of
the mucus membrane.... Scrofulous, Syphilitic and Varicose Ulcers
... for Spraying the Nose and Throat, ... for immediate deodorizing
and disinfecting ... for prickly heat, poison oak, squamous eczema
and other conditions of similar nature.... As a deodorant and
prophylactic in dental work, ... for disinfecting offensive cavities
... for profuse and offensive perspiration, swelling, soreness and
burning of the body and feet.... As a delightful toilet preparation
after the bath and shaving.”

[3] Last January the national Food and Drugs Act went into effect;
one of its provisions is that the label must not lie. This is not the
exact verbiage, but it means the same thing. So, instead of repeating
the old false statements, the new label of Tyree’s antiseptic powder
contains nothing whatever about the composition; the law does not
require that it should--unless the preparation contains certain
specified drugs. Why is the formula omitted?

“There is nothing new, startling or dangerous in such changes
in formulas. The Pharmacopeias and national books of authority
are continuously improving their formulas. It is the same with
every preparation on the market. [Mr. Tyree, as a nostrum maker,
is in a position to know. His plea evidently is: “I am no worse
than others.”] The apparent difficulty in my case is caused by my
exceptional frankness [“exceptional frankness” is good under the
circumstances] with the profession in telling them [when and where?]
about this improvement before I was ready to announce full details
and particulars, or place my improved [sic] powder on the market.

“Yours very truly,
“J. S. Tyree.”

For years Mr. Tyree has been misleading physicians by making false statements regarding the composition of his powder and regarding its value as a therapeutic agent. When exposed he tries to defend himself and his business by statements and excuses that are worthy of a schoolboy trying to get out of a bad scrape. We would respectfully suggest to him that he either take his wonderful powder off the market, or--which would probably amount to the same thing--tell the truth, and the whole truth, about it.--(_From The Journal A. M. A., May 18, 1907._)

APERGOLS[F]

Abstract of Report of the Council on Pharmacy and Chemistry

[F] For abstract of report on Ergoapiol see p. 82; for the unabridged report of the Council’s action on Apergols, see Reports Council Pharm. and Chem., 1914, p. 64.

Apergols, put out by H. K. Wampole Co., Inc., is alleged to be a “Uterine Stimulant.” Apergols is apparently an inversion of the name Ergoapiol and the preparation appears to have essentially the same formula, namely:

Apiol 5 min.
Oil Savine 1/2 min.
Ergotin 1 gr.
Aloin 1/8 gr.
Aromatics q. s.

As in Ergoapiol, the constituent referred to in the formula as “Apiol” appears to be oleoresin of parsley-seed instead of the definite substance apiol described in New and Nonofficial Remedies. In general the claims made for Apergols are the same as those made for Ergoapiol (see p. 82). The Council refused admission to Apergols because they are advertised indirectly to the public, because of unwarranted therapeutic claims, because of the non-descriptive name and because the product is unscientific.--(_From The Journal A. M. A., Dec. 12, 1914._)

ASEPTIKONS

Report of the Council on Pharmacy and Chemistry

Aseptikons are vaginal suppositories sold by the Chinosol Co. of New York. Each suppository is said to contain:

Ac. Salicylici 2 gr.
Ac. Borici 10 gr.
Quin. purae (Alkal.) 1 gr.
Chinosol 2 gr.
But. Cacao 60 gr.

The following claims appear in advertisements:

“These suppositories are indicated in cervicitis, leucorrhea,
specific and non-specific vulvo-vaginitis and in all cases where
complete vaginal antisepsis is desired.”

“Non Toxic, Non Irritating; No Damage to Membranes. Yet a More
Powerful Antiseptic than Bichloride.”

The Council decided that the foregoing claims in the absence of evidence must be held exaggerated and likely to mislead, and also that the claim “Stronger than Bichloride” which appears on the box is misleading.

The position of the Council is that “In the case of pharmaceutical preparations or mixtures the trade name must be so framed as to indicate the most potent ingredients.” The name Aseptikons does not give any indication of the ingredients of the product.

The Council holds that “The combination of two or more remedies in a mixture must be considered contrary to scientific medicine unless a distinct reason exists for such combination.” No evidence has been submitted to establish the value of the combination in Aseptikons.

On the basis of the evidence submitted the Council voted that Aseptikons be refused recognition because unwarranted and misleading therapeutic claims are made, because the name does not indicate its potent constituents, and because the combination of two or more remedies in a mixture is considered contrary to scientific medicine unless a distinct reason exists for such combination.--(_From The Journal A. M. A., Nov. 14, 1914._)

BETUL-OL[G]

Abstract of Report of the Council on Pharmacy and Chemistry

[G] For the unabridged report of the Council’s action on Betul-ol, see Reports Council Pharm. and Chem., 1914, p. 62.

Betul-ol (E. Fougera and Co., New York) is a methyl salicylate preparation advertised to physicians (and indirectly to the public) as an external analgesic and anti-rheumatic. The statements regarding its composition are vague, misleading and, as shown by examination in the Chemical Laboratory of the American Medical Association, untrue. The therapeutic claims are based on discarded theories. Although the alleged superiority of natural over synthetic salicylates has been disproved, physicians are urged to use Betul-ol because it contains, or is alleged to contain, a natural salicylate. Another discarded theory is pressed into service in the claim that the chloral in the mixture will be absorbed and converted into chloroform in the blood. The recommendations for the use of Betul-ol in rheumatism are likely to lead the public to the self-treatment of rheumatism. In view of the serious complications and sequelae of rheumatic fever this recommendation is utterly unjustifiable and a danger to public health--even if the external application of this mixture in uncertain doses were as effective as a proper internal use of salicylates--a theory contrary to experience and unsupported by adequate evidence.

The Council therefore refused recognition to Betul-ol.--(_From The Journal A. M. A., Dec. 12, 1914._)

PEACOCK’S BROMIDES AND CHIONIA

Reports of the Council on Pharmacy and Chemistry

The Council has authorized publication of the following reports on Peacock’s Bromides and Chionia, sold by the Peacock Chemical Company, St. Louis.

W. A. Puckner, Secretary.

PEACOCK’S BROMIDES

This is another nostrum of the ordinary mixture type. Of the various statements concerning composition furnished by the company, the following gives as much information as any:

“In Peacock’s Bromides it is designed to unite fifteen grains of
the purest bromides of Potassium, Sodium, Ammonium, Calcium and
Lithium, in such proportion as to insure the bromine equivalent of
potassium bromide. Each fluid drachm about equals, in medicinal
strength, fifteen grains of potassium bromide.”

The label on the trade package indicates the presence of 10 per cent. of alcohol. It will be observed that the proportions of the different bromids are not stated. Hence, the assertion of the Peacock Chemical Company that “there is nothing secret in this compound” cannot be true. A physician prescribing it cannot know how much of each ingredient he is giving; it may be 14-1/2 grains of potassium bromid and 1/8 grain each of sodium, ammonium, calcium and lithium bromid, or any other of an enormous number of possible permutations of the proportions.

While the theoretical basis of bromid medication is not yet fully settled, the weight of the best pharmacologic authority and clinical experience is decidedly against the dogmatic claim of the Peacock Chemical Company that “the best result is obtained by prescribing a combination of bromides.” And if there were any advantage in prescribing such a combination, the physician ought to regulate the proportions.

The following quotations are from the advertising matter:

“Being uniform in purity and therapeutic power, it can be relied
upon to produce clinical results which it is believed cannot be
obtained from the use of commercial bromide substitutes.”

“The purity, quality and constant uniformity of this high grade
product have long made it a standard bromide preparation.”

These claims are unfounded. The analyses published in the concern’s own advertising “literature” show a variation of 8 per cent., in the bromid content, which certainly indicates a sufficient lack of uniformity.

Again quoting:

“In order to insure the best results the bromides must be pure,
i. e., free from alkalies and almost free from chlorides. The
U. S. P. allows three per cent. of chlorides. Peacock’s Bromides
contains the least possible amount of this impurity. Bromism is
therefore less frequent in those cases in which this preparation is
employed.”

In view of the claim of low chlorid content, it is interesting to note that the analyses above referred to show that the chlorid content is actually higher than that of some other bromid preparations on the market.

The claim of merit on the ground of freedom from chlorids is, of course, absurd, and must be regarded as an attempt to play upon the credulity of the doctor. As a matter of fact, the average individual takes with his food many times the amount of chlorid he could possibly take in contaminated bromid. The 10 per cent. of alcohol would undoubtedly have a greater disturbing influence on the bromid action than the amount of chlorid that might be present in any bromid on the market.

Then we have the statement that, owing to this freedom from chlorids:

“Bromism is therefore less in those cases in which the preparation
is employed.”

Sodium chlorid, even as an impurity, would retard rather than favor the development of bromism; sodium chlorid is even used as an antidote in bromid poisoning.

The therapeutic claims lay stress on the value of the bromids in sleeplessness, epilepsy, sexual excitement, tetanus, infantile convulsions, chorea, delirium tremens, the climacteric, migraine, headache due to pelvic conditions, ovarian neuralgia, etc. These and other claims, while too vague to be branded as falsehoods, are misleading and not in accordance with modern teaching or practice; the latter recognize the limitations of bromid therapy as well as its scope and advantages. For instance, in epilepsy the company asserts that:

“Large doses must be given if we expect to control the convulsions.
We are to be guided by the frequency and the severity of the
seizures, the saturation of the system by bromides and by the age
of the patient. The rule is ‘large doses for long periods but with
occasional periodic monthly or quarterly omissions.’ When we have
succeeded in controlling the convulsions in so far as greatly
diminishing the frequency and severity of the attacks we may then
attempt to decrease the dose, but the results must be carefully
watched. Increase in frequency of convulsive seizures is a sign
that the bromides must again be pushed as before.”

The best modern clinical teaching concerning the treatment of epilepsy is that bromids should be avoided except as a last resort. Bromids do not cure, and the amount necessary to control the convulsions may produce a degree of mental hebetude that is a greater evil than the disease itself.

It is recommended that the preparation be held ineligible for admission to N. N. R., because of its conflict with Rules 1, 4, 6 and 10 of the Council, and that this report be published.

CHIONIA

Chionia, according to the statement of the Peacock Chemical Company, which exploits the product, contains 19 per cent. alcohol and is “A Preparation of Chionanthus Virginica.”[4]

[4] Of Chionanthus Virginica or fringe-tree, the Council on Pharmacy and Chemistry in its 1912 report on “Some Unimportant Drugs” said: “The drug is much used by eclectics and homeopathists, especially as a depurant in hepatic and syphilitic disorders.... The claims for this remedy are not supported by experimental evidence and clinical reports of its use fail to show indications of discriminating critical observation. It is not noticed by most pharmacologic authorities.”

This preparation is advertised particularly as “a potent hepatic stimulant” and special claims are made for it in various disturbances of the liver:

“Chionia is very well adapted in the treatment of hepatic
congestion owing to its specific action in depleting the portal
circulation.”

In passive congestion of the liver, the manufacturers would have us believe

“... we have a drug in Chionia that will stimulate the circulation
of the blood and lymphatics of the liver as well as stimulate its
physiological activities and instead of the patient vomiting the
blood an internal depletion of the liver occurs.”

“... in cases of simple jaundice due to circulatory (congestive)
changes in the liver, Chionia is the drug ‘par excellence’ that
will rapidly cause a disappearance of this symptom.”

As a prophylactic against eclampsia, if a history of torpidity of the liver is obtained:

“CHIONIA should be used during the major portion of child-bearing
period because it acts directly on the liver stimulating its
functional activity.”

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The Propaganda for Reform in Proprietary Medicines, Vol. 1 of 2Chapter VI: Part I: Council Reports (1)

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