Chapter VII: Part I: Council Reports (2)

_Chionanthus virginica_ has never been shown to have the slightest pharmacologic activity and no evidence is presented that its offspring, Chionia, has any therapeutic value whatever in any disturbance of the liver. The promoters themselves indicate a lack of faith in their own preparation, for they advise the use of old and efficient forms of treatment along with Chionia--heart tonics and laxatives in passive congestion of the liver, mercurial purge or podophyllin and sodium phosphate in “biliousness,” and quinin in malaria. Finally, with delightful English and elaborate insouciance, they advise in the treatment of eclampsia:

“In all cases the uterus should be emptied as quick as possible.
(Version of Cæsarian Section.)”

The physician who prescribes Chionia promotes a fraud.

The Council held Chionia ineligible for admission to N. N. R.

[Editorial Comment: In Peacock’s Bromides and Chionia the Peacock Chemical Company has, for a third of a century, been foisting on the medical profession nostrums composed of drugs that are easily combined in any proportion that the physician may want to prescribe. The company has been inflicting on the unthinking physician pseudo-scientific rubbish in the form of advertising literature that should long ago have been regarded as an insult to the intelligence of the medical profession. The following medical journals are carrying advertisements of Peacock’s Bromides and Chionia:

_Alienist and Neurologist_
_American Journal of Surgery_
_American Medicine_
_Archives of Pediatrics_
_Atlanta Journal-Record of Medicine_
_Buffalo Medical Journal_
_Charlotte Medical Journal_
_Chicago Medical Recorder_
_Denver Medical Times and Utah Medical Journal_
_Eclectic Medical Journal_
_Ellingwood’s Therapeutist_
_Indianapolis Medical Journal_
_International Journal of Surgery_
_Lancet-Clinic_
_Louisville Monthly Journal of Medicine and Surgery_
_Maryland Medical Journal_
_Medical Brief_
_Medical Fortnightly_
_Medical Herald_
_Medical Record_
_Medical Review of Reviews_
_Medical Sentinel_
_Medical Standard_
_Medical Summary_
_Medical Times_
_Medical World_
_Nashville Journal of Medicine and Surgery_
_New Orleans Medical and Surgical Journal_
_New York Medical Journal_
_Pacific Medical Journal_
_Southern Practitioner_
_Texas Medical Journal_
_Texas Medical News_
_Therapeutic Gazette_
_Wisconsin Medical Recorder_
_Woman’s Medical Journal_]

--(_From The Journal A. M. A., April 3, 1915._)

BROMIDIA

Report of the Council on Pharmacy and Chemistry

The following report was submitted to the Council by a member of its Committee on Therapeutics, with the recommendation that publication be authorized. This recommendation was adopted.

W. A. Puckner, Secretary.

Bromidia (Battle & Co., St. Louis) at once suggests bromids; yet Bromidia is essentially a chloral rather than a bromid preparation. This nostrum illustrates the need of the provision in the Council’s Rule 8 under which recognition is refused pharmaceutical mixtures whose names do not indicate their most potent ingredients. While the chloral content of Bromidia has been given considerable publicity, yet the preparation is used both by physicians and by the public without due consideration of its potent ingredient. This fact is attested not only by the fatal results which have followed its use but also by the many reports of habit formation. As long ago as in 1887 a fatal case of poisoning was reported[5] to the medical society of the District of Columbia due to an overdose taken by a Bromidia addict. The physician who reported this case also gave his experience with another patient who had the Bromidia habit. In the discussion of the paper a number of cases were reported by others present in which Bromidia had been taken without a physician’s advice and with more or less grave symptoms of poisoning.

[5] The Journal A. M. A., July 9, 1887, p. 55.

In the report of a death of one who had been a slave to Bromidia it was said:[6] “When the body was found, there were eleven one-ounce Bromidia bottles about the room or on his person. Nine were entirely empty and the other two were about half full. None of these bottles indicated that they had been purchased on a physician’s prescription, only the druggist’s label marked ‘Bromidia’ being on them.”

[6] The Journal A. M. A., April 21, 1906, p. 1220.

Dr. Horatio C. Wood, Jr., gave[7] a striking illustration of how preparations like Bromidia come to be used even by physicians without consideration of their constituents:

[7] The Journal A. M. A., April 21, 1906, p. 1220.

“Within an hour after his father, a Brooklyn physician, had given
him a dose of bromid, H.G.P., a prodigal son, died yesterday at
his father’s home in Brooklyn. Two years ago, when he appeared to
have sown his wild oats, the father made him superintendent of his
country place, near Grants Mills, Delaware County. A week ago the
son left his place, and at 1 o’clock yesterday morning appeared at
his father’s Brooklyn home. He was nervous, and at 9 a. m. begged
for a sedative.

“‘I prescribed the usual quantity of bromidia,’ the young man’s
father told a reporter. ‘He was weak and had suffered from weak
heart and kidney trouble for some time.’

“An hour later the father found the son dying and administered
restoratives, but to no avail.”

A circular, “The Advantages of Bromidia,” makes it plain how physicians come to use a preparation like Bromidia without consideration of its potent constituent. In this circular the presence of chloral is at first frankly admitted, then it is suggested that in the combination the evil effects of chloral are completely eliminated and in the end the impression is left that Bromidia is practically innocuous. Thus at the beginning while arguing that Bromidia is better than extemporaneous preparations the chloral content is plainly acknowledged:

“In the untoward effects so frequently attending the use of
extemporaneously prepared mixtures of chloral and the bromides, may
be found the reason for BROMIDIA’S preference when the need for a
hypnotic agent arises. Were it not for the well known disadvantages
of these drugs which become still more marked with their continued
use, there could be no special need for such a preparation as
BROMIDIA (Battle), for the therapeutic powers of chloral and the
bromides are among the most positive facts in medicine.”

Again:

“It was to meet the growing professional demand for a combination
of chloral and the bromides with their evil effects eliminated,
that led to the manufacture of BROMIDIA (Battle).”

Then, suggesting the indiscriminate use of Bromidia--as an entity as Dr. Wood suggests--the claim is made that:

“... its constituents have been chosen with a view of enabling
Bromidia to meet every requirement for an agent of its class.”

“Owing to the exceptional purity of its component parts and its
freedom from untoward effects when continued over long periods,
this product will be found of the highest utility in epilepsy.”

“... its action is that of chloral and the bromides minus their
evil effects.”

Finally Bromidia becomes a simple bromid preparation. Thus an advertisement reads:

“Bromidia’s (Battle) Marked Sedative and Antispasmodic Qualities
eminently fit it for the treatment of Maniacal Excitement,
Epilepsy, Spasmodic Asthma, Convulsive Seizures of Reflex Origin,
Sexual Neuroses, and other disorders attendant upon nervous
irritability.

“Through its exhibition, the fullest therapeutic power of the
bromides may be secured with a minimum of their evil effects; a
feature of the greatest service when the necessity for continued
treatment becomes necessary.”

In addition to the general invitation to use Bromidia in epilepsy and various nervous disorders, a circular also recommends its use in typhoid, a recommendation, which, if followed, may turn the scale in favor of a fatal result. The circular states:

“As a soothing agent in the extreme restlessness and irritability
of typhoid fever and other infectious diseases, BROMIDIA (Battle)
is a therapeutic weapon of definite service. Relief of the headache
of typhoid may also be secured through the use of BROMIDIA
(Battle). By means of its administration for the above purposes,
the patient’s strength is conserved and as a result he is much
better prepared to stand the force of the infection.”

Particularly vicious is the recommendation that it be given to children. Thus, in a pamphlet entitled “Effective Drugs Effectively Combined”:

“Another point of advantage to be found in bromidia is the ease
with which it is borne by children. Owing to this tolerance, it
is of distinct service in a considerable list of disorders of
childhood. Thus, of course, employed with care and an understanding
of its potency, bromidia has a field of usefulness in chorea,
laryngismus stridulus, and whooping-cough. In other nervous
disorders of childhood--those attending acute infections, for
instance--bromidia is a definitely indicated therapeutic aid, owing
to the soothing influence exerted by even a moderate dose and the
absence of untoward effects. More specifically, the correcting
influence of bromidia in the night-terrors of children may be
mentioned.”

Formerly advertisements asserted that each fluidram of Bromidia contained:

“Chloral hydrate 15 grains
“Potassium bromid 15 grains
“Extract of Cannabis indica 1/8 grain
“Extract of henbane 1/8 grain”

This formula also appears on the label of a sample package sent through the mails during 1914. A recent circular contains a somewhat different formula. Instead of “1/8 gr. each of gen. Imp. Ext. Cannabis Ind. and Hyoscyam.” as was formerly claimed, each fluidram of Bromidia is now said, not to “contain” but to “represent,” not the extracts but the far less potent drugs “Cannabis indica 1/8 grain, Hyoscyamus 1/8 grain,” thus:

“Chloral hydrate 15 grains
“Pot. brom. 15 grains
“Cannabis indica 1/8 grain
“Hyoscyamus 1/8 grain”

Furnishing still greater variety, the labels on a recently purchased bottle of Bromidia, where under the Food and Drugs Act the presence of narcotic drugs must be declared, read:

“Alcohol 10 per cent., Chloral Hydrate, 91 grs. per ounce. Cannabis
indica indeterminate in finished product.”

“In the manufacture of BROMIDIA to each drachm of fluid used are
added 15 grains of pure chloral hydrate and purified brom. pot.,
and 1/8 grain each of gen. imp. ext. cannabis ind. and hyosciam.”

These various statements as to the composition of Bromidia leave one very much “in the air.” As chloral and potassium bromid are easily determined and since lying on the labels of widely exploited proprietaries has become somewhat risky recently, it is probable that the statements on the trade package are to be depended on and that each fluidram of Bromidia contains something like 12 grains each of chloral and potassium bromid and not 15 grains as the medical profession has been and is being told.

Pharmacists who have attempted to put up a nonproprietary preparation similar to or, more correctly, having the alleged composition of Bromidia have found it practically impossible to do so. The reason is that extract of cannabis indica is almost insoluble in a menstruum such as that found in Bromidia. The National Formulary, first edition, listed Mistura Chlorali et Potassii Bromidi Composita of which it was said: “Each fluidram contains 15 grains each of Chloral and of Bromid of Potassium, and 1/8 grain each of Extract of Indian Cannabis and Extract of Hyoscyamus.” In this the pharmacists attempted to incorporate the cannabis indica by using the tincture of the drug and suspending it by the addition of tincture of soap bark. In the present edition of the National Formulary, the preparation is made by triturating the extract of cannabis indica with pumice stone and then filtering the finished product. This gives an “elegant” preparation--but one from which the cannabis indica is filtered out! A sad commentary on the National Formulary. It should not be supposed, however, that the manufacturers of Bromidia have solved the problem that has baffled the pharmacists; not at all. Bromidia probably contains no more cannabis indica than does its National Formulary prototype. The statement on the present trade packages, that the amount of cannabis indica in Bromidia is “indeterminate,” is but a tardy acknowledgment of the fact that the stuff has not, and never had, the amount of cannabis indica claimed for it for so many years.

The “indications” named on the Bromidia labels are, in common with nostrums of this type, but suggestions for self-drugging. They will appeal to the layman who has purchased, either by prescription or otherwise, an “original package” of Bromidia and who may imagine he suffers from “nervousness,” “sleeplessness,” “headache” or “neuralgia.”

But while the manufacturers in their advertising matter have on the whole not disguised the presence of chloral so much as they have attempted to make it appear that the chloral has been robbed of its dangers--for all hypnotics if used thoughtlessly are dangerous--after all the name has created the false impression that Bromidia is a bromid preparation. It is because of this false impression carried by its name, that Bromidia came to be used indiscriminately by the profession and in the course of time still more indiscriminately and recklessly by the public. Bromidia is a vicious chloral preparation masquerading under a misleading name. That physicians have been impressed by the claims of its harmlessness and by the mystery connected with the formula is not a credit to the intelligence of our profession. There is no doubt but that physicians are responsible for the use and abuse of this chloral preparation by the public.

There is no scientific or rational excuse for a ready-made preparation of this sort. When chloral or a bromid is indicated the proper dose of each of these, if they are to be combined, should be determined for each patient. Potassium bromid and chloral hydrate both are readily soluble in water, syrup or elixirs and it is a simple matter to prescribe the required dose of chloral and of bromid dissolved in some aromatic water like cinnamon-water (Aqua Cinnamomi), in some syrup like syrup of orange (Syrupus Aurantii) or in an elixir like the aromatic elixir (Elixir Aromaticum) or adjuvant elixir (Elixir Adjuvans). If this mixture is prescribed thus the physician is alive, alike to the dangers and the limitations of the drugs; if it is prescribed under a misleading proprietary name, the physician endangers his patient, stultifies his profession and tends to perpetuate the great American fraud.

[Editor’s Note.--A list of some of the medical journals that advertise Bromidia:

_Texas Medical News_
_Nashville Journal of Medicine & Surgery_
_Medical Brief_
_Annals of Surgery_
_Charlotte Medical Journal_
_Medical Sentinel_
_Memphis Medical Monthly_
_Laryngoscope_
_Medical World_
_Medical Review of Reviews_
_Louisville Monthly Journal_
_Indianapolis Medical Journal_
_Monthly Cyclopedia & Medical Bulletin_
_Journal of Nervous & Mental Diseases_
_Maryland Medical Journal_
_Merck’s Archives_
_Iowa Medical Journal_
_Medical Standard_
_Southern Practitioner_
_New Orleans Medical & Surgical Journal_
_Therapeutic Gazette_
_Medical Herald_
_Medical Times_
_Texas Medical Journal_
_Wisconsin Medical Recorder_
_International Journal of Surgery_
_Vermont Medical Monthly_
_Atlanta Journal-Record of Medicine_
_St. Paul Medical Journal_
_Hospital Bulletin of the University of Maryland_
_Denver Medical Times_
_Buffalo Medical Journal_
_Medical Review_
_Ellingwood’s Therapeutist_
_Eclectic Medical Journal_
_Massachusetts Medical Journal_]

--(_From The Journal A. M. A., May 16, 1914._)

CACTUS GRANDIFLORUS

Report of the Council on Pharmacy and Chemistry[H]

[H] A reprint of various articles discussing Cactus Grandiflorus, Cactin--now called Cactoid--(Abbott Alkaloidal Company) and Cactina Pillets (Sultan Drug Company) will be sent on receipt of a 2-cent stamp.

The Council voted that cactus grandiflorus should not be accepted for New and Nonofficial Remedies, and that a statement be prepared for The Journal giving the reasons for this action. Accordingly the following report has been adopted by the Council and its publication authorized.

W. A. Puckner, Secretary.

Cactus Grandiflorus

The therapeutic value of this plant has been variously estimated by different observers. Experimental evidence as to its action is scanty and no complete chemical examination has ever been made.

Reputable men have testified that some of the plants of the cactus family contain very active principles, but so far experiments seem to prove that cactus grandiflorus has neither the action of digitalis nor that of strychnin. The principal contributions, clinical and experimental, for and against the drug, are set out below.

EXPERIMENTAL EVIDENCE

O. H. Myers[8] worked with a product which he calls cactina and which he regards as the active principle of the drug. (As no such substance as cactina is described in any materia medica, it is impossible to state what Myers really used.) He found that it had a strychnin-like action and raised the blood-pressure.

[8] New York Med. Jour., 1891, liii, 681-683.

Hatcher comes to the conclusion: “Either Myers’ work was a pure fabrication or he was dealing not with cactin but with a substance similar to the pellotin of Heffter, the action of which resembles that of strychnin to a certain extent.”

E. Boinet and J. Boy-Teissier[9] experimented with an aqueous extract, an alcoholic extract, and with an alkaloid which they call “cactine.” They concluded from three sets of experiments on frogs that extract of cactus produces, in ten minutes, a temporary increase in the heart’s action which frequently repeated doses are required to maintain; and that large doses slow the heart and produce arrhythmia.

[9] Bull. gén. de thérap., 1891, cxxi, 343-349.

L. E. Sayre[10] experimented with a preparation of cactus, made from the stem of the plant, by injecting it into the dorsal lymph space of the frog. There was seemingly an increase in the amplitude of the heart’s action and an indication of a strengthened beat or increased force.

[10] Am. Pharm. Assn., 1906, liv, 405.

R. A. Hatcher[11] states that it is possible that cactus grandiflorus, under certain conditions, may contain a principle with a strychnin-like action. But Hatcher made ten experiments on frogs, four on cats, six on dogs, two on rabbits, and one on a guinea-pig, with Cactina pillets of the Sultan Drug Company and the Cactin of the Abbott Alkaloidal Company. From 1 to 15 pillets in frogs and up to 25 in dogs were used at each dose. In no single instance was there any evidence of a digitalis-like or strychnin-like action, or, in fact, of any decided action of any kind whatever.

[11] The Journal A. M. A., Sept. 21, 1907, pp. 1021-1024.

Gordon Sharp[12] was unable to obtain either alkaloid or glucosid from the plant, but found a series of resins that caused contraction of the blood-vessels of a frog. This was not a digitalis-like contraction, but depended, he believed, on simple acidity. On the heart of the frog the resins have little or no effect, comparisons being made with digitalis in the same animals. There is no proof that cactus grandiflorus itself shortens diastole, or in fact, that it has any special action on the heart muscle at all. Sharp experimented on himself with large doses of an extract made with alcohol 1 to 5, but got no noticeable results. He thinks that the plant may have some slight diuretic action.

[12] Practitioner, London, 1894, iii, 444-446.

Sayre submitted the preparation which he used in his experiments for more careful testing to E. M. Houghton, who reported that it had practically no action on the heart.

In commenting on Houghton’s results, Reid Hunt said that they were confirmed by his own experiments. He did not deny, however, that the drug might have some therapeutic effect and that, in very large doses, it did affect the kidneys.

S. A. Matthews[13] found one preparation of cactus (cactin--Abbott) absolutely inert so far as any effect on the heart is concerned. He found that cactina (Sultan Drug Co.) in very large doses depressed both the circulation and respiration. In this regard it differs from strychnin, and it has no resemblance to the action of digitalis, strophanthus or any of the heart stimulants. A dose of from 10 to 12 pillets administered intravenously to a 10 to 12 kg. dog exerted little or no influence on the heart or circulation; the larger dose may cause a slight fall in blood-pressure. When 70 or more pillets were administered within two and a half hours the animal generally died.

[13] The Journal A. M. A., March 21, 1908, pp. 956-958.

The work of Boinet and Boy-Teissier also has been criticized by Hatcher on the ground that their most positive results were obtained with an alkaloid which no one at this day is able to prepare. The results quoted in this report, however, were obtained by the use of extracts of cactus so that it does not seem that they should be entirely rejected, whatever their value may be.

CLINICAL EVIDENCE

Clinical observations have been more abundant than exact, and a favorable action of the drug in some organic diseases of the heart has been reported; other observers would limit its use to functional arrhythmia, insisting that it is not a substitute for digitalis or aconite, but that it occupies a place distinct from either of those remedies.

P. W. Williams[14] recommends cactus for functional heart disease, but, as a rule, found it useless in organic disease. He thinks it one of a class of remedies which act on the accelerator nerves and sympathetic ganglia, shortening the diastole and stimulating the spinal vasomotor nerve centers. Williams apparently relied on Myers for his knowledge of the pharmacologic action, and his paper is a fair example of the clinical studies of cactus.

[14] Practitioner, London, 1891, xlvii, 266-273.

Ellingwood[15] claims that cactus is a cardiac tonic, acting on the accelerator nerves and heart ganglia, increasing muscular force and arterial tension. He recommends it in both organic and functional diseases.

[15] Med. Rec., New York, 1905, lxvii, 857.

Boinet and Boy-Teissier found that therapeutic doses of 40 drops of tincture of cactus were without effect on the normal heart. In patients with noisy asystole (_asystolie bruyante_) the same dose produced no appreciable effect. In the period of latent non-compensation of true cardiac patients, from 80 to 100 drops a day increased the force of the failing heart. In patients with secondary heart disease with arrhythmia of nervous origin, daily doses of 80, 100 and 120 drops of the tincture were well tolerated for weeks; they seemed to increase the fulness of the pulse and regulated its rhythm. In spite of such large doses, these observers never noticed any symptoms that could be attributed to a cumulative action. It must be remembered that the precise preparation of cactus which they used is not known.

Aulde[16] recommends it as a cardiac tonic free from cumulative effects.

[16] Practitioner, London, xlvii, 223; Therap. Gaz., 1890.

Gordon Sharp says: “The therapeutics of the subject, I think, are clear enough. Cactus grandiflorus cannot be included in our list of cardiac drugs. It is not even a simple stomachic tonic and at most all one can say is that it has small diuretic action.”

Hatcher says: “Clinical testimony is so conflicting that between the extreme views of Gordon Sharp and those of Ellingwood there is room for an honest difference of opinion concerning cactus grandiflorus.”

Matthews himself took 100 granules of cactin (1/67 gr.--1 mg. each), 25 every four hours, without experiencing the least effect.

CONCLUSIONS

Reliable conclusions regarding the therapeutic use of cactus grandiflorus are rendered difficult on account of several factors.

1. It is uncertain what part of the plant contains the active principle if one exists; and its nature is unknown. The National Standard Dispensatory states that its “activity must be confined to the flower in some special stage of its development or to a certain part of it or to some parts gathered with it.” This uncertainty may explain the negative results obtained by some observers, but it makes the drug one that cannot be generally relied on and gives an excellent opportunity for the exploitation of proprietary preparations.

2. Some of the experimental work and much of the clinical evidence has been obtained and published under proprietary auspices. For this reason many of the therapeutic claims made for the drug must be viewed as merely the reflection of the exaggerated statements made by the advertisers of proprietary preparations.

3. The value of clinical evidence when unsupported by an animal experimentation is much diminished by the tendency of enthusiastic and untrained observers to attribute to the drug given the effect really due to general remedial measures, psychic suggestion and so forth. While it must be admitted that valuable remedies may exist whose therapeutic properties cannot be revealed by animal experimentation, yet in the absence of such experimental evidence conclusions should be drawn with extreme caution.

Bearing these conditions in mind, the following statements seem to be justified: (_a_) The botanical, chemical and pharmaceutical properties of cactus are not sufficiently determined to make any available preparation a reliable remedy. (_b_) There is some evidence that cactus may be capable of affecting the animal heart and nervous system, but its action is not that ordinarily attributed to it. It does not increase the force of the heart-beat. (_c_) While there is some clinical testimony as to its usefulness in functional diseases of the heart, the indications for its administration are at present too uncertain to afford a safe basis for recommending it.

4. While the drug may be deserving of further experimental and clinical investigation, this should be carried on in reliable pharmacologic laboratories and in clinics provided with facilities for exact observation.--(_From The Journal A. M. A., March 12, 1910._)

CALCREOSE

Report of the Council on Pharmacy and Chemistry

In response to inquiries and in view of the extensive advertising propaganda, the Council, on Dec. 19, 1913, took up for consideration Calcreose (Maltbie Chemical Company, Newark, N. J.). Examination showed that the preparation contained, in loose combination, approximately equal weights of creosote and lime. The claims made in the advertising “literature” were extravagant and uncritical, and the Council therefore held Calcreose ineligible for New and Nonofficial Remedies.

In June, 1914, at the request of the Maltbie Chemical Company, the Council undertook a reconsideration of the preparation. The advertising claims were now found more conservative. Before the existing claims could be judged, however, the Council deemed it necessary to require from the company satisfactory proof (1) that the large doses of Calcreose recommended and administered actually furnish large amounts of creosote to the blood, and (2) that patients taking these large doses do not suffer from digestive disturbances, loss of nutrition, albumin in the urine or phenol urine, as claimed. The Council accordingly advised the company of this requirement, at the same time stipulating that nothing in the report should be interpreted as indicating a belief on the part of the Council that enormous doses of creosote are necessary for, or will promote a cure of tuberculosis.

The Maltbie Chemical Company has not up to the present date furnished this proof, but has evinced a disposition to make the Council’s holding Calcreose under advisement appear in the guise of a quasi-approval. It is therefore recommended that Calcreose be refused recognition for conflict with Rule 6.--(_From the Journal A. M. A., June 26, 1915._)

CAMPHO-PHENIQUE

Report of the Council on Pharmacy and Chemistry
and Some Comments Thereon

The following report was submitted to the Council on Pharmacy and Chemistry by the subcommittee to which Campho-Phenique had been assigned:

_To the Council on Pharmacy and Chemistry_:--Campho-Phenique, sold by
the Campho-Phenique Co., St. Louis, Mo., is claimed to be composed of
phenol 49 per cent., and camphor 51 per cent.

Examination of specimens, purchased in the open market, made under
our direction, demonstrates that the statements made in regard to
the composition are not true. Instead of containing 49 per cent. of
phenol (carbolic acid), the analysis showed that it contains not more
than 20 per cent. Instead of containing 51 per cent. of camphor, the
analysis demonstrates that the amount of camphor is not more than 38
per cent. Besides phenol and camphor, a third substance was found
which proved to be liquid petrolatum and to be present to the extent
of 38 per cent. or more.

Since the statements made in regard to the composition of
Campho-Phenique are deliberate misrepresentations of the facts, it is
recommended that the article be not approved.

Besides Campho-Phenique, the above-mentioned firm also sells a
preparation labeled Campho-Phenique Powder. While no statement in
regard to the composition of this product is made on the label or in
the literature, such expressions as “Campho-Phenique in a powdered
form” and “Powdered Campho-Phenique” lead to the inference that it
has essentially the same composition as that stated for the liquid
preparation. An examination of a specimen of Campho-Phenique Powder
purchased in the open market showed that 92 per cent. of it was a
talcum-like inorganic substance. The remaining 8 per cent. consisted
chiefly of camphor with a small amount of phenol.

In view of the fact that Campho-Phenique Powder contains very little
phenol, but instead consists chiefly of an inorganic talcum-like
substance, its name is misleading and deceptive. It having been shown
that Campho-Phenique Powder corresponds to a camphorated talcum
powder, the claims that it “has no equal as a dry dressing,” that
it is “absolutely superior to iodoform,” and that it has “all the
excellent properties of aristol and iodoform,” are unwarranted. It is
recommended that the article be not approved, and that this report be
published.

The recommendations of the subcommittee were adopted by the Council,
and in accordance therewith the above report is published.

W. A. Puckner, Secretary.

Campho-Phenique

The above report on a much advertised “ethical” proprietary medicine is worthy of the thoughtful consideration of the members of the medical profession, as it illustrates admirably some of the conditions connected with this proprietary medicine business.

THE FORMULA A FAKE

First, it illustrates the fact that the published formulas of the “ethical” proprietaries are not always reliable. The Campho-Phenique Company has been very willing to give out a formula, purporting their product to be 51 per cent. camphor and 49 per cent. phenol (carbolic acid). Now, these two drugs will make a liquid mixture, and any druggist can make it, and the mixture will have about the same consistency and appearance as Campho-Phenique. But its effect differs decidedly from that of Campho-Phenique. Some months ago a very intelligent physician, in discussing the proprietary medicine business, said that in some cases physicians could not get druggists to make preparations which were as satisfactory as those which could be bought ready-made. He cited Campho-Phenique as an illustration. He said that he had used this preparation for burns, etc., but as he did not like to use preparations put up by companies about which he knew nothing, he asked his druggist to make the mixture in accordance with the published formula. The druggist’s preparation was not satisfactory; it had a decidedly different effect from Campho-Phenique, and so he tried another druggist. This druggist also followed the published formula, but his results, too, differed materially from the proprietary article.

The various analyses that have been made show why the preparations put up by the druggists did not resemble that made by the company; since, according to the analyses, Campho-Phenique consists of 40 per cent. liquid petrolatum, which is an inert but soothing diluent, while instead of 49 per cent. of carbolic acid, as claimed, it really contains less than 20 per cent. This is an entirely different proposition. Now, if the physician referred to above will have his druggist make a mixture of 20 per cent. of carbolic acid, 40 per cent. of camphor and 40 per cent. of liquid petrolatum, and will then compare this resulting compound with Campho-Phenique, he will find that there is not much difference. Furthermore, he will realize that there is nothing either new or wonderful about the preparation. Camphorated oil and carbolized oil are both in common use. Campho-Phenique is apparently simply a mixture of the two.

THE POWDER STILL WORSE

So much for the liquid. The powder seems to be something entirely different, for, according to the chemist’s report, over 90 per cent. of it is inert, absorbent, talcum-like material. There is enough camphor and carbolic acid to give the powder an odor and thus mislead physicians, especially those who are in the habit of taking for granted that whatever statements nostrum manufacturers make are true. Perhaps it is a fairly good dressing for wounds--at least it will do no harm--but its name is misleading and deceptive. For all practical purposes it is essentially a camphorated talcum powder.

COMPANY A “PATENT-MEDICINE” CONCERN

The second interesting phase of this “ethical” proprietary is that it illustrates another point, i. e., that many of these articles are supplied to our profession by those who are not legitimate manufacturing pharmacists. The Campho-Phenique Company of St. Louis, according to all reports, is owned and controlled by a gentleman named Ballard. This “company” supplies the medical profession with the preparations under consideration and also with Chloro-Phenique and Scrofonol. We are informed that this same Mr. Ballard is the principal owner, if not the sole owner, of quite a number of “patent-medicine” companies, such as Ballard-Snow Liniment Co., Brown’s Iron Bitters Co., Mayfield Medicine Mfg. Co., Smith Bile Beans Co., Swain’s Laboratory, and several others. We learn from the wholesale drug trade lists that these various “companies” make and sell, besides the Campho-Phenique preparations, Ballard-Snow Liniment, Ballard’s Herbine, Brown’s Iron Bitters, Dr. Herrick’s Pills, Richardson’s Life-Preserving Bitters, Smith’s Bile Beans, Swain’s All Healing Ointment, and several other “patent medicines.”

It is hardly necessary to make any further comments. The whole business is nauseating to those who know the actual conditions of this nostrum business and how our profession is being deluded. The Campho-Phenique matter is not an exception; it is simply another illustration of these conditions.

The majority of “ethical” proprietaries are foisted on our profession, either without any formula accompanying them, or with a “formula” that is a fake. The majority of the “ethical” proprietaries are manufactured and supplied to physicians, with instructions regarding their use, by men who bear the same relation to legitimate pharmacy that the veriest quack that ever swindled a credulous public bears to scientific medicine.--(_From The Journal A. M. A., April 20, 1907._)

CELERINA, ALETRIS CORDIAL AND KENNEDY’S PINUS CANADENSIS,
LIGHT AND DARK

Report of the Council on Pharmacy and Chemistry

The following reports on products of the Rio Chemical Company have been submitted by a referee. The Council recommends that they be published, as the preparations discussed are glaring instances of nostrums exploited through physicians on unscientific claims and false representations.

W. A. Puckner, Secretary.

Celerina

Celerina belongs to what Samuel Hopkins Adams calls the “bracer” type of nostrum. According to the label it contains 42 per cent. alcohol (whisky contains about 50 per cent.). The other ingredients of Celerina are declared to be as follows:

“Each fluidounce represents Forty grains each Kola, Viburnum,
Forty-eight grains Celery, Twenty grains Cypripedium, Sixteen
grains Xanthoxylum and Aromatics.

“Dose--1 or 2 teaspoonfuls 3 times a day.”

Kola contains a very small percentage each of caffein and theobromin. It is impossible for the infinitesimal amounts of these alkaloids in an ordinary dose of Celerina to produce any physiologic effect.

Viburnum has been called a “uterine sedative,” whatever that may be. Its only real activity is the psychic one due to its taste and odor.

Celery at one time was credited with being both an antispasmodic and a nerve stimulant--a remarkable combination of opposing qualities! Scientific investigation has failed to show that celery has any physiologic or therapeutic activities. If it had the slightest medicinal value, the rational course would be to prescribe it in its fresh and natural state. The small dose contained in a teaspoonful of Celerina is inappreciable and not even equivalent to that contained in a stalk of celery.

Ladyslipper, more imposing under the Latin name of “cypripedium,” is a flowering plant with a legendary reputation as an “antispasmodic and nerve stimulant.” It has been in the therapeutic scrap-heap for years. It contains a little tannic acid, gallic acid and a volatile oil. Even a tannic acid action cannot be expected from a teaspoonful of a preparation containing 20 grains of ladyslipper to the ounce.

Prickly ash (xanthoxylum) has never been shown to have any activity other than that of a local irritant, especially to mucous membranes. The slight “bite” from this drug would be entirely covered up by the alcohol in Celerina. Any stimulating effect which this drug may have on the stomach is greatly inferior to that produced by a very small glass of ordinary ginger ale.

In short, there is no ingredient in Celerina, except the alcohol, that has any recognizable activity; and the alcohol content is nearly as great as that of ordinary whisky. Some of the claims and recommendations for this nostrum are:

“Celerina (Nerve Tonic), for Nervousness, Hysteria, Insomnia,
Nervous Indigestion, Languid and Debilitated Conditions, Recovery
from Alcoholic Excess.”

Think of prescribing an alcoholic nostrum four times a day to promote recovery from alcoholic excess!

“NEURASTHENIA: The bane of the general practitioner; the puzzle
of the neurologist; the juicy fruit of the quack and faddist;
the opportunity of the intelligent therapist.... For the medical
treatment CELERINA is the preparation of wide utility.”

The _sang froid_ with which the exploiters of this nostrum refer to other “quacks and faddists” as reaping “juicy fruit” from neurasthenics would command admiration were it not so pitiful.

“Celerina has substantial endorsement in nervous disorders
characterized by Aphonia (nervous).”

Of course, the disappearance of nervous aphonia might follow the application of any treatment whatever, be it Eddyism, Chiropractic, Peruna or Celerina.

In

“CLIMACTERIC (the Menopause) flattering results have been reported
from a combination of equal parts Celerina and Aletris Cordial Rio.”

“Teaspoonful doses after meals and upon retiring have proven
efficacious [in “dyspepsia”] when other remedies have failed.”

Here is a good example of proprietary-house therapeutics: Such widely different conditions as digestive trouble and the climacteric are to be treated with a combination of alcohol, simple bitters and aromatics! Why not order a cocktail under its own name? It would be equally efficacious, less mysterious and its dangers might be better realized!

“A teaspoonful or two in three tablespoonfuls of boiling hot water
[for insomnia] upon retiring.”

Any other hot toddy at bedtime (and it need not cost a dollar a bottle) might give relief; but the intelligent physician to-day recognizes the danger of prescribing alcohol in such conditions.

“In the case of brain workers who suffer from nervous excitability
and mental fatigue, the administration of Celerina in teaspoonful
doses, three times a day and at bedtime, rapidly controls the
condition and increases mental capacity.”

And the same effect follows its use:

“In cases involving worry, anxiety, overwork, and excesses of
various kinds....”

Moreover:

“Celerina is the most prompt and efficient of remedies for
devitalized or broken-down constitutions--doses four times a day.”

The statement made by its manufacturers that this preparation is free from narcotics or habit-forming drugs is not true. Alcohol is both a narcotic and a habit-forming drug.

As in the case of other nostrums containing no potent drugs but alcohol, Celerina is recommended for various diseased conditions in combination with a familiar form of treatment by drugs of more or less value. The physician who thoughtlessly prescribes one of these combinations will without doubt unthinkingly attribute any subsequent improvement to the Celerina. Thus, for malaria, a prescription of quinin and Celerina is advised; for chorea in children, arsenic with Celerina; in “Convalescence from La Grippe,” strychnin sulphate, Fowler’s solution, and Celerina; for impotence, nux vomica, dilute phosphoric acid and Celerina. In none of these conditions would Celerina affect favorably anything except the pockets of the exploiters; in some, as in the chorea of children, the alcohol would be positively detrimental. Of course, the value of such prescriptions (so far as they have any apart from the fictitious value lent by the alcohol) resides altogether in the standard drugs prescribed with Celerina.

There is no possible excuse for writing a prescription for Celerina, either in original package or mixed with well-known or valuable drugs. The sooner it is realized that this preparation has no place in medicine, should never be prescribed by physicians and is essentially nothing but alcohol and bitters exploited under a fancy name, the better for the public health and the science of medicine. The continued sale and use of Celerina is a disgrace to the medical profession.

Aletris Cordial

Aletris Cordial is a nostrum containing therapeutically worthless drugs in alcohol (28 per cent.).

The “formula” on the label reads:

“Each fluidounce represents ten grains Aletris, thirty grains
Helonias and thirty grains Scrophularia.”

At one time these drugs had some vogue, chiefly as domestic remedies. They have been discarded as valueless by modern scientific medicine.

Aletris, or unicorn root (Aletris farinosa), contains a bitter principle and starch. The remarkable uterine tonic properties formerly ascribed to it have not been confirmed by reliable observers. It is practically worthless.[17]

[17] See Unicorn Root, Wild Yam, and Wild Indigo, p. 208.

Helonias, or false unicorn (Chamaelirium luteum), is asserted to be a hemostatic and uterine tonic. No trustworthy evidence has ever been offered in support of the claims made for this drug; reliable medical literature contains no reference to it; it has no valid claim on the attention of physicians.[18]

[18] See False Unicorn (Helonias), p. 84.

Scrophularia, or figwort (Scrophularia marilandica), contains a principle which has a digitalis-like action on the heart. Its activity is so slight in comparison with that of digitalis, however, that there was nothing to be gained by studying it. The drug is consequently little known and is not mentioned in critical works on pharmacology. If the drug were therapeutically active in the quantities used, another danger would be added to that of the alcohol content of Aletris Cordial. Since the recommended dose (a teaspoonful) contains, if the formula be correct, only about 4 grains of figwort, this drug too may be regarded as practically inert in this preparation.

Not one of these drugs has been deemed worthy of mention in the Pharmacopeia. The Council has previously discussed them and declared them valueless (Reports Council Pharm. and Chem., 1909, p. 146; 1910, p. 10; 1912, p. 42).

In Aletris Cordial, then, there is no ingredient capable of producing any other effect than the alcohol stimulation and such psychic effect as may be due to the bitter taste. Yet physicians are asked to believe that

“Probably no remedy is so uniformly successful in the prevention of
threatened miscarriage as ALETRIS CORDIAL Rio.”

“HABITUAL MISCARRIAGE can be effectually overcome by the systematic
use of Aletris Cordial Rio.”

“... regulates the local circulation and imparts normal tone and
strength to the uterine muscle.”

“The use of Aletris Cordial Rio throughout pregnancy goes far to
assure normal, uncomplicated labor.”

Such claims as these, when made for a mixture containing no therapeutically active constituent except alcohol, are absolutely preposterous. It should be noted that the declared alcohol content of Aletris Cordial is much higher than that of the strongest wines, and, in the light of medical experience, quite high enough to promote the formation of the alcohol habit in a steady user. The following recommendation, taken from the company’s “Budding into Womanhood” circular, therefore, is outrageous:

“Many medical practitioners recommend to mothers the use of Aletris
Cordial Rio for their growing daughters, ranging in age from twelve
to eighteen years....”

It is to be hoped that no medical practitioner is so heedless of consequences as to prescribe for adolescent girls a worthless nostrum capable of creating a craving for alcohol. The temperance societies might with profit take steps to inform laymen, especially women, concerning the worthlessness of this nostrum, the risk involved in taking it, and the outrageous character of the recommendations made for it by the manufacturers.

Kennedy’s Pinus Canadensis, Light and Dark

(Abican and Darpin)

Kennedy’s Pinus Canadensis, Light (recently renamed “Abican”) and Dark (renamed “Darpin”) are also exploited by the Rio Chemical Company. Although they have been on the market some thirty or forty years they appear to have achieved no marked degree of commercial success. Yet they have been imitated by most of the pharmaceutic houses. They are of interest chiefly through the barefaced fraud involved in their exploitation.

COMPOSITION CLAIMED

Apparently the dark preparation (“Darpin”) was first put on the market; then the light one (“Abican”) was offered, to be used only “as an injection and externally.” The reason for the existence of the light preparation evidently was the objectionable property of the dark, which stained linen. The two preparations are both said to be extracts of Pinus Canadensis or hemlock bark. A circular issued some years ago contained the following statement:

“Pinus Can. (Ken.)--_Dark_--A non-alcoholic extract of Pinus
Canadensis, to each fluidounce of which is added 0.48 grains Thymol.

“Pinus Can. (Ken.)--_Light_--A non-alcoholic extract of Pinus
Canadensis, to each fluidounce of which is added 24 grains each of
pure Alum Potash and Sulphate of Zinc and 0.48 grains of Thymol.”

The labels on the packages of the light and dark preparations sent out to-day bear, respectively, only the following references to composition, the first on the dark and the second on the light:

“Each fluidounce also contains 0.48 grains Thymol.”

“A non-alcoholic preparation of Pinus Canadensis, to which is added
twenty-four grains each pure alum potash and sulphate of zinc and
0.48 grains thymol to the fluidounce.”

ACTUAL COMPOSITION

“Darpin” or Kennedy’s Pinus Canadensis, Dark, does contain tannin, but, as the simplest of chemical tests demonstrate, Pinus Canadensis, Light, does not contain tannin. It might as truthfully be called maple syrup or beef tea.

It is almost a work of supererogation to discuss the therapeutic claims made for preparations sold under false pretenses as to composition. It is enough to mention that Kennedy’s Pinus Canadensis, Dark or Light, is recommended in

Albuminuria
Diarrhea-Dysentery
Fetid Perspiration
Endometritis
Fissures
Fistula
Gonorrhea
Hemorrhage from the Nose
Uterine Hemorrhage
Leucorrhea
Nasal and Pharyngeal Catarrh
Piles
Sore Throat
Ulceration of the Cervix

The intelligent physician of to-day knows that his forefathers in the days of the stage-coach employed tannic acid in its crude form and treated intestinal disease in a very unsatisfactory manner; he knows, further, that advances in our knowledge of pathology have rendered the use of tannic acid in gastro-intestinal therapeutics largely unnecessary and that when it is used it should be in some form that will pass the stomach unchanged. So far as its use as local application is concerned, he knows, without need of instruction from the Rio Chemical Company, when tannin is indicated, and the Pharmacopeia furnishes a suitable preparation for the physician so that he need not resort to an unscientific nostrum like Darpin.

The physician who is competent to treat a case of gonorrhea does not need to be told that alum and zinc sulphate may be useful in such conditions, and he does not want them palmed off on him for something else under the name of Pinus Canadensis, Light, Abican or what not. Also, he prefers to use them, when they are needed, singly and in strength suited to the conditions of the individual case.

[Editorial Comment.--Celerina, Aletris Cordial and Kennedy’s Pinus Canadensis, Light and Dark, appear to be the entire output of the Rio Chemical Company, which was one of the earliest of the various companies organized by James J. Lawrence of _Medical Brief_ fame. The business was moved from St. Louis to New York City in 1901. According to what we believe to be reliable information, the Rio Chemical Company is now composed of James P. Dawson, president; William W. Conley, vice-president and treasurer; and E. D. Pinkerton, secretary. These also constitute the directors. It appears that James P. Dawson is a member of the law firm of Dawson and Garven, St. Louis; E. D. Pinkerton is said to be Miss Effie D. Pinkerton, stenographer for Dawson and Garven. We know little concerning William W. Conley except that he appears to be in charge of the establishment in New York. We find no evidence that he is either a chemist or a pharmacist; his name does not appear in the membership list of the American Chemical Society or of the American Pharmaceutical Association, nor can we discover that he has published anything in the way of chemistry or pharmacy. As a matter of fact, the Rio Chemical Company is another of the pseudo-chemical companies created to exploit one or more proprietaries--in this instance Celerina, Aletris Cordial and Pinus Canadensis. The following medical journals carry advertisements of the Rio products (or did late in 1914): _American Journal of Surgery_, _American Medicine_, _Denver Medical Times and Utah Medical Journal_, _Eclectic Medical Journal_, _International Journal of Surgery_, _Interstate Medical Journal_, _Massachusetts Medical Journal_, _Medical Brief_, _Medical Century_, Medical Council, _Medical Review of Reviews_, _Medical Sentinel_, _Medical Standard_, _Texas Medical Journal_ and _Woman’s Medical Journal_.].--(_From The Journal A. M. A., Feb. 13, 1915._)

CINERARIA MARITIMA

Report of the Council on Pharmacy and Chemistry

Occasional inquiries in regard to the therapeutic value of _Cineraria maritima_ caused the Council to consider the drug with reference to its fitness for inclusion in N. N. R. among non-official, non-proprietary remedies. The following report, having been submitted to the Council by a subcommittee, was adopted and its publication authorized.

W. A. Puckner, Secretary.

_To the Council_:--The juice of a plant referred to as _Cineraria maritima_ was at one time supposed to be of value in the treatment of cataract and certain other affections of the eye. No scientific evidence is available to show that the drug is therapeutically active, and its value is no doubt correctly estimated by Dr. Casey Wood, who (“Ophthalmic Therapeutics,” p. 446; Cleveland Press, Chicago, 1909) says:

“Still, a few respectable names have been associated with its
[_Cineraria maritima_] employment in that capacity and it only
remains to be said that the instillation into the conjunctival
sac of a preparation of this or any other member of the _Senecio_
family has about as much effect on the resolution or dispersal of
opacities due to organic changes in the lens as pouring the same
down the back of the patient’s neck!”

The plant from which _Cineraria maritima_ juice is claimed to be prepared is commonly referred to in literature as _Cineraria maritima_, but is more correctly described as _Senecio cineraria_, D. C.

It may be considered a matter of indifference whether a remedy like this be advertised for the treatment of such diseases as cataract, providing its application could do no harm, but it must be remembered that it is recommended also for other diseases of the eye in which its use, by postponing efficient treatment, would be the means of serious damage or even loss of vision.

Since there is no evidence to show that this drug is of any therapeutic value, it is recommended that it be not admitted to the list of non-official, non-proprietary remedies in N. N. R., and that the Council formally expresses its opinion that the drug, as judged by the evidence which is available, is without value in the treatment of cataract or similar diseases of the eye.

[Editorial Comment.--_Cineraria maritima_ would long since have been relegated to the limbo of discarded and discredited drugs had it not been given a semiproprietary character by a St. Louis nostrum house--the Walker Pharmacal Company--which, like the Manola Chemical Company, is, we understand, practically a subsidiary concern of the Luyties Homeopathic Pharmacy Company. The Walker concern exploits this drug under the name Succus Cineraria Maritima (Walker). Its method of exploitation consists in publishing testimonials, which it dignifies with the name “clinical reports,” from men whom it designates as “representative physicians.” As indicative of what constitutes representative physicians, we find that of the seven testimonials given in their pamphlet the names of three of the signers are not to be found in any medical directory.

The exploitation of Succus Cineraria Maritima (Walker) is the oft-repeated story of the resurrection of discarded and worthless drugs for the purpose of creating proprietorship in a nostrum. _Cineraria maritima_ is worthless; its therapeutic value is _nil_. By the prodigal use of printers’ ink, the medical profession--and through it the public--has been humbugged into believing that it possesses curative value.]--(_From The Journal A. M. A., Nov. 11, 1911._)

HAGEE’S CORDIAL OF THE EXTRACT OF COD LIVER OIL COMPOUND[I]

Report of the Council on Pharmacy and Chemistry

[I] See also the reports on Wampole’s Preparation and Waterbury’s Compound, following this; also Hagee’s Cordial, p. 289; The Comparative Nutrient Value of Cod Liver Oil and Cod Liver Oil Cordials, p. 442.

This is one of the “oilless” cod liver cordials. Like other manufacturers of such extracts, the Katharmon Chemical Company, St. Louis, which owns Hagee’s Cordial, attempts to trade on the reputation long enjoyed by cod liver oil as a promoter of growth and nutrition. The following is the statement of composition furnished by the company:

“Each fluid ounce of Hagee’s Cordial of the extract of Cod Liver
Oil Compound represents the extract obtainable from 1/8 fluid
ounce of Cod Liver Oil (the fatty portion being eliminated), 6
grs. Calcium Hypophosphite, 3 grs. Sodium Hypophosphite, 1/2 gr.
Salicylic Acid (made from Oil Wintergreen), with Glycerin and
Aromatics.”

And here are some of the therapeutic claims:

“Tonic, Stimulant, Alterative, Reconstructive, Nutritive and
Digestive.”

“Useful in phthisis pulmonalis, scrofula and all chronic pectoral
complaints, coughs, colds, brain exhaustion, nervous debility,
palsy, chronic cutaneous eruptions and impaired digestion.”

Of course, these absurd claims hark back to the time of the prevalence of the now discarded theory that the valuable properties of cod liver oil reside, not in the fat, but in certain nitrogenous, alkaloid-like constituents present in infinitesimal amounts. Further “playing up” this theory:

“The prescriber may know that in our preparation he is getting, in
easily assimilable and palatable form, the very properties that
make cod liver oil the best of reconstructives.

“When you prescribe cod liver oil you are after the active
principles--why not give the active principles themselves.”

Proprietary manufacturers usually ignore scientific investigations which establish facts adverse to proprietary claims; but the same proprietary manufacturers are quick to seize on any theory that can be twisted into support of their interests. Thus, recent investigations having shown that cod liver oil, like butter and egg yolk, possesses certain growth-promoting properties not found in some other fats, the promoters of Hagee’s Cordial claim these properties of cod liver oil for their extract. They assert: