Chapter XXXIV: Part III: Contributions From the Journal: Proprietary Products (2)

These advertisements show that the exploiters of Fellows’ Syrup are spending a great deal of money to induce physicians to prescribe the preparation, and it is equally evident that they wish to convey the impression that the preparation has some therapeutic value. Since we find nothing directly false, in the first mentioned advertisement at least, we must take the evident intent for consideration and determine what therapeutic value, if any, this preparation has, and whether it is advisable for physicians to employ it in any case.

The preparation, according to the statement just cited, has been in use for fifty years. As the exploiter of any preparation cites the most convincing evidence in his possession in support of his views, this claim may be assumed to be the strongest available, and if this evidence fails we must reject the contention as not proved. Here we face a dilemma, for examination of the literature used in the exploitation of Fellows’ Syrup fails to disclose any evidence of the kind that we have described as satisfactory; and we are, therefore, forced to conclude that none has ever been found. By this it is not to be implied that no reputable physician has ever reported favorably concerning the therapeutic effects of this preparation. It is quite possible that an extensive literature of that sort might be found if one examined the older medical journals. But the day has passed when every improvement that follows the administration of a preparation is blindly attributed to the drug in question. Clinical research today is far more exacting.

We will assume that the reader who has investigated the question with an open mind will have come to the decision that the contention that Fellows’ syrup is of especial therapeutic value is not proved. We might rest with that assumption and ask the clinician whether he is prepared to use a nostrum that has been before the medical profession for half a century without any satisfactory evidence having been gained that it possesses therapeutic value. We might ask him whether he would be willing to tell his patients that he was prescribing such a nostrum for them in the face of the absence of any such evidence of its value.

THE INERTNESS OF THE HYPOPHOSPHITES

But we prefer to go even further and show him that not only is there an entire absence of any evidence of its therapeutic value so far as we have been able to learn, but in addition there is an abundance of evidence that the hypophosphites are devoid of any such therapeutic effect as they were formerly reputed to have, and that, in fact, they are, so far as any effect based on their phosphorus content is concerned, singularly inert.

While we have thus far taken the Fellows’ preparation as the subject of the discussion, we may take a broader view and examine the subject of the hypophosphites in general, and the substitutes containing phosphorus that have been introduced from time to time. It hardly needs to be said that if the hypophosphites are without therapeutic value, it is impossible to give them value by combining them in a muddy-looking, ill-made preparation such as Fellows’ Syrup. Such evidence was submitted to the medical profession in a report of the Council on Pharmacy and Chemistry (_J. A. M. A._ =67=:760 [Sept. 2] 1916); and we would strongly advise any one who is disposed to act on the suggestion contained in the advertisements of Fellows’, and other hypophosphite preparations, to read that report in full and to think the matter over before prescribing one of these nostrums. Quoting briefly from the report in question:

“Although the overwhelming weight of evidence was against the
probability that the hypophosphite preparations are of value as
therapeutic agents, the Council thought it well to investigate the
subject. Dr. W. McKim Marriott of Baltimore was therefore requested
to review the evidence for and against the therapeutic usefulness
of the hypophosphites and to conduct such experiments as seemed
necessary.”

The Council was not content to rest on the mere absence of evidence for the value of these preparations or any one of them, but sought to obtain evidence that would fulfil the conditions mentioned above, and in pursuance of this plan it secured the cooperation of a trained investigator, one who would work under the best of conditions for learning the truth. The results of Dr. Marriott’s investigation were published in The Journal, Feb. 12, 1916, p. 486, and should be read by everyone who has any interest in the problem. Lest some of our readers may fail to refer to the original of Marriott’s paper, we will quote briefly from it:

“None of the subjects of the experiment experienced any effect
whatsoever from the administration of the drug ... Almost all of the
ingested hypophosphite is eliminated unchanged....

“These experiments (Forbes) demonstrate conclusively that the
hypophosphites possess no specific value as a source of phosphorus
for the body.... It is doubtful if there are any conditions in which
the body suffers from lack of phosphorus. Even should such conditions
exist, phosphorus, in the form that it occurs in the ordinary foods,
or as phosphates, is more efficient in supplying the deficit than
hypophosphites that must be oxidized before utilization and which are
only about 15 per cent. oxidized if at all. For example, half a glass
of milk contains more available phosphorus than three large doses of
hypophosphites of 15 grains each, as great a dosage as is usually
given.

“What then, is the therapeutic value of hypophosphites? There is no
reliable evidence that they exert a physiologic effect; it has not
been demonstrated that they influence any pathologic process; they
are not ‘foods.’ If they are of any use, that use has never been
discovered.”

The case seems to stand about like this: A nostrum maker spends thousands of dollars to tell physicians that his cloudy preparation is not like other preparations, and physicians are expected to accept that as convincing evidence that they should prescribe and their patients, perforce, take it. This too, in spite of the evidence gained by careful scientific investigators that the hypophosphites in fairly large doses contain less available phosphorus than half a glass of milk, and that there is no evidence available that they exert any therapeutic effects at all.

Should we take the meaningless statement of a nostrum maker, who does not submit evidence of any therapeutic value of his preparation--unless one can call certain careless habits of prescribing evidence--and assume the responsibility of prescribing a nostrum that according to all scientific evidence available is useless, and of no more effect than a few teaspoonfuls of milk, so far as its hypophosphite content is concerned? It may be argued that it possesses some value because of its bitter nature. We will not deny that it is bitter; so is strychnin, so is quinin, so are scores of simple drugs, but what physician would care to admit to his patients that he did not know how to prescribe a simple bitter, such as nearly every layman can select for himself, without recourse to a preparation such as Fellows’ Syrup?

We have felt that it is not wholly satisfactory to discourage the use of a given nostrum without making an effort to assist the physician in choosing wisely in the treatment of the condition for which the nostrum is claimed to be useful. In the present instance, however, we fear that would prove a task beyond our powers, for the hypophosphites have been used in such a variety of conditions that the discussion would have to include nearly the whole materia medica if we were to follow our usual procedure.--(_From the Journal A. M. A. Feb. 16, 1918._)

[ARTICLE VII]

Shotgun Nostrums

Formerly it was customary to prescribe mixtures of many drugs on the assumption that if one of the ingredients missed the mark another might be expected to hit it, just as a poor marksman is more likely to hit a target at short range with a blunderbuss than with a high powered rifle. Increased precision in every branch of science has become the outstanding feature of civilization. The soldier today must shoot straight with a rifle that sends a single ball. There is none of the disposition to rely on chance as when the blunderbuss was used. A capable physician directs his drug straight at the seat of the trouble, and we now have many drugs that can be depended on to exert definite actions. The complex mixture is just as preposterous in modern therapeutics as the blunderbuss would be on a modern battlefield.

Every drug exerts undesired side actions, and it is the aim of the modern physician to try to select the one which will have a maximum of therapeutic with a minimum of undesired actions. When a complex mixture is employed, it is obvious that only the best is utilized, whereas all the undesired side actions come into play. We do not pretend that even the best studied drug has not much to be learned about it; but the nostrum maker who exploits a complex mixture either knows practically nothing of the side actions that it will exert, or, if he knows, he conceals that knowledge. He knows that massive doses of hydrated chloral combined with various narcotics can be relied on to cause unconsciousness in nearly all cases, but he prefers to speak of this as a hypnotic action. This is plain gambling with human life. When the patient dies, it is difficult to prove that death was caused by the mixture alone.

The Council on Pharmacy and Chemistry has expended a great deal of time and energy in combating the “shotgun” nostrum evil. It is easy to understand the disadvantages of such mixtures but it is not so easy to demonstrate the misleading character of the claims made, with an entire disregard of the truth, for these mixtures. No one believes that a pot of gold lies at the end of the rainbow, but no one has actually gone there to see for himself.

BROMIDIA

There are many types of “shotgun” nostrum. Some are dangerous, as in the case of “Bromidia”; some are preposterous, therapeutic monstrosities which excite the contempt of educated physicians, as in the case of “Tongaline”; some are merely useless mixtures of well known drugs, sold under grotesquely exaggerated claims, as in the case of “Peacock’s Bromides.”

Various formulas have been given for Bromidia. The manufacturers appear to be more cautious under those circumstances in which falsehood might lead them into collision with the federal authorities, than when giving reign to fancy and considering only the best means of winning the favor of the physician. It is said to consist of hydrated chloral, potassium bromid, Indian cannabis, and hyoscyamus. It is impossible to determine from the published formulas just how much hydrated chloral and potassium bromid it contains, but is probable that there are about 15 grains of each of these two drugs to the fluidram, and variable amounts of Indian cannabis and a small amount of either extract or tincture of hyoscyamus.

This much is certain: Bromidia is a distinctly dangerous mixture for indiscriminate use. The claim of the manufacturers, implied, rather than directly stated, that it is superior to an extemporaneously prepared mixture of those drugs is especially reprehensible because it tends to create the impression that the nostrum is safer in effective doses, conducing to a false sense of security on the part of those who are deluded into prescribing it in larger doses than they would a mixture of the same drugs prepared extemporaneously.

A report of the Council on Pharmacy and Chemistry published in The Journal, May 16, 1914, p. 1573, mentions three instances in which death is reported to have followed the use of Bromidia. The manufacturers of Bromidia have no magic power to render hydrated chloral harmless, while it retains its hypnotic action. It depresses the central nervous system, and it is nothing less than monstrous for any one to pretend to rob this drug of its dangerous properties while it retains its hypnotic effects. If the patient requires a hypnotic, the physician should choose that one which his judgment and experience dictate as the best for that particular patient. If he needs hydrated chloral, the physician should prescribe exactly as much as he believes the patient needs. If the effect is slightly greater or slightly less than anticipated, no harm is done and the physician has gained experience that will be valuable in future prescribing. If Bromidia is prescribed and unexpected effects are induced, it is impossible to know whether these were due to the hydrated chloral or to one of the other narcotics or to a synergistic action; and there is nothing to guide in the further use of the nostrum, for mixtures of narcotics commonly have much less uniformity of action than a single drug.

The irritant action of hydrated chloral on the stomach can be avoided by the use of bland fluids or dilute solutions. The following serves as an example of the way in which it may be prescribed conveniently:

Gm. or c.c.
Hydrated chloral 2|6 gr. xl
Syrup of orange peel |
Water of each 30| fl ℥ i

A tablespoonful (15.0 c.c.) of this mixture, containing 10 grains (0.65 gm.) of hydrated chloral, will often induce sleep in the absence of severe pain or serious disturbance, and seldom does this dose have to be repeated more than once in such simple cases. Hydrated chloral is often used in somewhat smaller doses in combination with potassium bromid, which may be prescribed in a mixture such as the following:

Gm. or c.c.
Hydrated chloral 1|3 gr. xx
Potassium bromid 3|9 gr. lx
Syrup of orange peel |
Water of each 30| fl ℥ i

In producing sleep when severe pain is absent this is as effective as the preceding, in similar doses. The use of repeated doses of hydrated chloral in such a mixture as this, or in the form of Bromidia or other nostrum when sleeplessness is due to severe pain is highly dangerous. It should be remembered that while hydrated chloral is an effective hypnotic in case of simple sleeplessness, it is not actively analgesic except in distinctly dangerous doses. Bromidia in repeated doses will induce sleep even in the presence of pain, of course; but any active narcotic does that, and it is correspondingly dangerous. Small doses of morphin given alone are preferable when sleeplessness is due to severe pain.

TONGALINE

“Tongaline” is an example of the type of “shotgun” nostrum that would be merely ludicrous if we could look on anything that degrades therapeutics so lightly. A report was made to the Council on Pharmacy and Chemistry, and published in The Journal, July 17, 1915, p. 269, and in this report it is stated that Tongaline is said to consist of tonga, cimicifuga racemosa, sodium salicylate, colchicum, and pilocarpin. Whether the formula was cut short just there because the office boy ran out of breath at that point, or because the discoverers of this wonderful combination had not heard of the eminently potent substances that the witches added to their cauldron, we can leave to the reader’s imagination, for it is manifestly impossible to present an orderly discussion of the pharmacology and therapeutics of such a preposterous jumble of drugs.

PEACOCKS BROMIDES

“Peacock’s Bromides” belongs to a slightly different class. It is said to consist of the bromids of sodium, potassium, ammonium, calcium and lithium. In the absence of a logical explanation of the pretended superiority of this mixture over one that is made extemporaneously, the exploiters seem to have been driven to the necessity of pretending that its freedom from contaminating chlorids explains its claimed advantages over mixtures of the official or commercial bromids. The truth is that the chlorids are used as antidotes in bromid poisoning.

Disregard the claims made for Peacock’s Bromides, and ask yourself the question whether you have ever actually seen any ill results following the use of the official bromids that you could reasonably attribute to contaminating chlorids. Furthermore, carefully consider the relative advantage of a single bromid (say the bromid of potassium, or bromid of sodium, if you prefer it), with the opportunity of observing its effects and adjusting the dose in accordance with the results of your experience, and a mixture such as Peacock’s Bromides, the composition of which you do not know, and which the manufacturer can alter to suit his own convenience.

While it is true that the therapeutic art will not degenerate in its entirety merely because some physicians continue to use the most fraudulent and worthless nostrums, yet, on the other hand, to the extent that a physician continues to be guided by the false teachings of nostrum venders who have no therapeutic training, he is plunged into therapeutic chaos.--(_From The Journal A. M. A., March 2, 1918._)

[ARTICLE VIII]

Tyree’s Antiseptic and Aseptinol

It may seem paradoxic to say that recent progress in the medical sciences has made therapeutic chaos possible, but it is true nevertheless. Revolutions are sometimes slow and orderly, sometimes sudden and attended with confusion. The revolutionary changes in the medical sciences have been so numerous and so rapid that the general practitioner has been unable to keep pace with them, and in the resulting confusion the nostrum maker has seen his opportunity for exploiting his useless, dangerous or unscientific preparations. The greater the confusion, the greater his opportunity; and it is no exaggeration to say that he has been the most potent factor in maintaining the chaos of therapeutics.

The majority of our readers would probably say that the existing scientific medical literature insures the permanence of established beliefs, but every one who has delved into the literature has found instances of truths that had been established and forgotten--buried under the ever-increasing avalanche of contributions to that literature.

Rapid advances are still being made in the medical sciences and unless constant vigilance is exercised therapeutics will return to the chaotic condition from which it has so recently emerged. It was in recognition of these facts--the danger of this return to chaos, and the difficulty, in fact, impossibility, of any individual’s keeping pace with all of the medical sciences--that the American Medical Association secured the cooperation of men in various branches of medicine in the Council on Pharmacy and Chemistry, in order that it may place the results of therapeutic progress before the readers of The Journal in an impartial manner.

Are you profiting by this work, or are you still depending on your unaided efforts to distinguish the false teachings of the nostrum venders from that of scientific medicine? Are you prescribing “Antikamnia” and “Ammonol” or a simple member of the group, such as acetanilid or phenacetin? Are you depending on “Tyree’s Antiseptic,” so called, or are you using an antiseptic about which there is no mystery, for which no false claims are made, and one which is really effective? In short, are you using drugs of unquestioned value, such as are described in “Useful Drugs,” or are you taking your therapeutic instructions from nostrum makers’ circulars?

Perhaps you have been led to believe that the Council on Pharmacy and Chemistry is composed of “theorists” and that the nostrums represent the work of “practical men.” Every one should strive to be practical, of course, and it is worth while to inquire whether scientific experimenters, who so largely mold medical literature, should be termed theorists, or practical men. A practical man practices that which is useful in the treatment of the sick, and he must determine who is capable of furnishing him with a better materia medica. A perusal of medical literature will convince any unbiased mind that medical science progresses only by means of experiment, hence experimenters must be considered the really practical men while those who cling to outworn theories are really the “theorists.”

When Lister introduced antiseptic methods into surgery he inaugurated a veritable revolution, which afforded the nostrum makers opportunities for reaping rich harvests through the exploitation--under extraordinary claims--of cheap mixtures of little, or no, value. There is no lack of antiseptics of extraordinary activity in the test tube that are practically harmless to man, and it would seem natural to suppose that such antiseptics could be used to control the development of bacteria in such diseases as typhoid fever, but, unfortunately, such hopes have not been fulfilled. Ehrlich experimented with many phenol derivatives that showed decided antiseptic activity in the test tube, in the hope that he might find some that could be used to combat such common diseases as diphtheria and typhoid fever, but while many of these are of low toxicity for man, he was unable to find even one that could be used effectively in the treatment of any of these diseases. His discovery of arsphenamin (“salvarsan”) resulted from quite another type of investigation.

Many practitioners lose sight of the essential difference between antiseptics and disinfectants and employ antiseptics in cases in which only a disinfectant action would be of value. An antiseptic does not destroy bacteria, it merely inhibits their growth; and when it is diluted too much, it loses its effects and the bacteria may begin to multiply as though no antiseptic had been used. This is especially true after the use of weak antiseptics in the mouth. These are soon diluted or removed by the saliva, and the bacteria continue to multiply with only a momentary interruption at best; hence to advise the use of an oral antiseptic as an effective means of treating diphtheria is little short of criminal.

“Tyree’s Antiseptic Powder” was submitted to the Council nearly twelve years ago. The label on the package stated:

“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.”

A leaflet issued several years ago by the Aseptinol Manufacturing Company states that “Pulv. Aseptinol Comp.” combines in an elegant form boric acid, the salts of aluminum, crystallized phenol, and the active crystalline principles of thymus, mentha and gaultheria.

A comparison of these formulas would justify the designation of the two preparations as twins, but even one twin may have a wart where the other lacks it. The formula of Pulv. Aseptinol Comp. given in the leaflet also includes _Hydrastis canadensis_, but we believe that a wart should be quite as much of an addition to the anatomy of man as the hydrastis is to this already preposterous formula. Similar as the formulas of these two nostrums were said to be, the general methods of exploiting them were even more similar. A partial list of the diseases for which each has been recommended by its exploiters shows the similarity of methods pursued:

TYREE’S WAS SAID TO BE USEFUL PULV. ASEPTINOL COMP. WAS SAID TO
IN THE TREATMENT OF: BE USEFUL IN THE TREATMENT OF:

Leucorrhea Leucorrhea
Gonorrhea Gonorrhea
Vaginitis Vaginal inflammation
Pruritus Pruritus
Ulcerated conditions of Ulceration of vagina or
the mucous membrane cervix
Scrofulous ulcers Chronic ulcers
Syphilitic ulcers Prophylactic against
specific disease
Disinfecting offensive Cleansing pus cavities
cavities
Deodorant Deodorant
Profuse and offensive Checks abnormal secretion
perspiration

We stated that the formula furnished by Tyree was that given above, but the Council was never able to learn when Tyree actually employed the formula except for advertising purposes; and analysis of the powder showed that Tyree’s Antiseptic Powder was essentially a mixture of boric acid and zinc sulphate, with insignificant amounts of odorous principles.

A remarkable fact brought out in the course of the consideration of the preparation by the Council was that Tyree admitted that he had changed the formula without having published the new one. The Council then showed that a specimen of the “antiseptic” that had been kept in a retail drug store for several years was essentially similar to that sold at the later date. Thus it would seem that Mr. Tyree had been making his powder by one formula and publishing an entirely different one for years before the Council published the facts in the case.

If Tyree found it necessary to change the formula of his powder--if indeed, he ever used the published formula--why did the Aseptinol Manufacturing Company adopt it, or one so closely resembling it?

It is obvious that both of these twin nostrums are utterly unfit for treating the various conditions for which they are or have been recommended; and in view of the misrepresentation in one case, it is difficult to understand why it should be taken as the model for the other. Do physicians believe that a simple mixture of boric acid and zinc sulphate, or a mixture such as that given in the formula of “Aseptinol” powder, is in any way superior to a prescription such as any physician could write?

There is a far more important question to consider than the relative merits of such nostrums and a prescription of the physician’s own devising. That question is whether the medical profession is going to help perpetuate the chaotic conditions that the use of such nostrums fosters or to assist in therapeutic progress by maintaining its independence of such false teachers, and seeking to aid in the establishment of a rational use of drugs and remedial measures.--(_From The Journal A. M. A., March 30, 1918._)

[ARTICLE IX]

Neurosine and the Original Package Evil

We called attention recently to the skill which the nostrum vender displays in avoiding the particular thorn that pricks him, and his development of the art of impressively saying, “Nothing in General,” as exemplified in the advertisements of Fellows’ Syrup. Nostrum sellers are more canny than original; and when once an idea finds lodgment with one of them, it is made to serve many masters. Formerly exploiters of either vicious or worthless nostrums were wont to boast that their preparations were exploited in a “strictly ethical manner.” Recent perusal of as choice a lot of advertisements as can be found in the most degraded of medical journals failed to disclose this claim in a single instance, although the claim that a preparation is “advertised only to physicians” is still common.

The advertisement of “Neurosine,” which we reproduce, was the first one which came to our attention when we searched through some medical journals for one that would illustrate a discussion of the “original package” evil. This is the only reason for selecting Neurosine rather than another. Such half page advertisements and others of similar size in various medical journals cost a good deal of money and they presuppose that the Dios Chemical Company is interested in having original bottles of Neurosine dispensed every time that nostrum is prescribed.

Why should the firm have any such deep interest in seeing that an original _bottle_ gets to the patient? Why should it be necessary to do anything more than see that the genuine _mixture_ reaches the patient? Does it seem within the bounds of reason that substitution is so commonly practiced by pharmacists that this firm must go to large expense to prevent the substitution of spurious mixtures for its product? Is dishonesty the rule among pharmacists? Common sense rejects the plea as placing too great a strain on one’s credulity. Obviously, then, the advertisement does not tell the whole truth, though it does indeed tell exactly what the nostrum maker wishes to have done, that is, to have only _original bottles_ dispensed when physicians prescribe that nostrum. The fact we have; the reason is not far to seek.

When the pharmacist puts up an ordinary, nonproprietary prescription, the patient gets no clue from the package as to the nature of the prescription employed. But when an original bottle of Neurosine is dispensed, even though the pharmacist puts his own prescription label on it, the patient sees the difference at once and knows just why the usual prescription bottle was not employed. He also knows that he can get the medicine with its original wrapper or label by merely showing the bottle to the druggist, for the words “Neurosine” and “Dios Chemical Co.” are blown in the glass. Here, then, may be a plausible reason for desiring that only original bottles be dispensed.

You may ask, “What difference does it make if the patient does learn the name of the nostrum, he must go to his physician for advice concerning its use?” Having learned the name of the remedy that has been prescribed for sleeplessness, let us say, he proceeds to use it whenever he imagines that he needs it; and that need, real or imaginary, has a way of increasing in frequency. As a result, the patient takes far more Neurosine than the physician would think of permitting if the matter had not passed entirely beyond his control.

Not only has the patient acquired a dangerous habit of self-prescribing, but he takes especial delight in recommending his favorite remedy to friends whose symptoms, real and imaginary, seem to resemble his own. This offers him an opportunity to prescribe with an air of authority. It was prescribed for him by Dr. Blank, and it gave relief, _ergo_ it may be depended on to give relief to others! Thus is the basis laid for its general use by the laity, when this process is multiplied sufficiently. The statement is susceptible of easy proof by any one who cares to investigate the matter for himself. There is probably no physician worthy of the name who will attempt to deny that the promiscuous use of hypnotics and narcotics is dangerous, and certainly no careful physician will deliberately place a narcotic in the hands of patients to be used freely and without control.

Since we have selected Neurosine at random, so far as this particular discussion is concerned, it is worth while to inquire into its composition, the claims that have been made for it and the evidence, if any exists, for or against its therapeutic value. Even the most active of hypnotics are worse than useless if they are inferior to other readily available hypnotics, or if they have undesired side-actions that outweigh any advantages that they might otherwise have.

The Council on Pharmacy and Chemistry investigated the literature relating to Neurosine and published its report in The Journal, Jan. 9, 1915, p. 165. According to this report the manufacturers of Neurosine claimed that each fluidounce contained:

Bromid of potassium, C. P. 40 grains
Bromid of sodium, C. P. 40 grains
Bromid of ammonium, C. P. 40 grains
Bromid of zinc 1 grain
Extract lupulin 32 grains
Cascara sagrada, fl. ex. 40 minims
Extract henbane 0.075 grain
Extract belladonna 0.075 grain
Extract cannabis indica 0.60 grain
Oil bitter almonds 0.60 grain
Aromatic elixir

This chemical blunderbuss was recommended for use in insomnia, hysteria, neurasthenia, migraine, neuralgia, delirium tremens, epilepsy and many other conditions. Also it was called an ideal calmative for children suffering from chorea, the exploiters claiming that “All authorities recommend the bromids, hyoscyamus and cannabis indica in this disease.” Oliver T. Osborne, professor of therapeutics in Yale Medical School, does not mention one of these three drugs in his discussion of the Medicinal Treatment of Chorea, in the Handbook of Therapy, though he quotes several authorities in this article. Indeed, he does not mention one of the ten drugs included in the above formula of Neurosine in connection with the treatment of this disease. It is a curious fact that Osborne gives the greatest prominence to the use of that drug which is claimed to be wanting in the formula of Neurosine, namely, hydrated chloral.

Perhaps you may have seen temporary relief follow the administration of Neurosine in chorea, and may argue that theorizing is of little value in the face of personal experience. We shall not deny that some may have had that experience, for Osborne calls attention to the fact that the success of any medicinal treatment must be judged in the light of the fact that chorea is self-limited, and the intensity of the symptoms will abate in from two to four weeks. In view of this, we would hardly dispute the claim that one may administer narcotics, such as those contained in Neurosine, and the symptoms of chorea may abate in spite of such mistreatment. In all the years that Neurosine has been exploited to physicians with such remarkable claims, we have never seen a report of a careful clinical study in which the product has been used under the conditions which scientific investigation demands. Would you prescribe any nonproprietary preparations which had never been studied clinically, if a horse-shoer or grocer’s boy told you it would cure epilepsy or malaria?

According to an editorial note appended to the report of the Council on Neurosine, the Dios Chemical Company consisted at that time (1915) of J. H. Chambers, his wife and two sons. It appeared that Chambers never claimed to have any special knowledge of chemistry, pharmacy or medicine, yet we find that he arrogated to himself or to his employees the right to offer therapeutic advice to the medical profession, and even to direct them as to how they should prescribe a given mixture.

We sometimes fail to see the forest because of the trees. It may help us to obtain a better perspective, in a problem that concerns us intimately, by resorting to a hypothetic case, if a close analogy is maintained. In order that we may see ourselves as others see us in such a situation, let us consider the following imaginary case: You become involved in a lawsuit in which an effort is made to deprive you of your property and your liberty. You seek what you had reason to believe was competent legal advice; but, nevertheless, you lose your case and find yourself deprived of your property and your liberty. Now let us suppose further that you discover, when too late to permit you to correct your mistake, that your legal adviser (we can hardly call such a man a lawyer) had been acting all along under the guidance of a plumber who made no pretense of knowing anything about law. How would you feel regarding that pretended lawyer? Would you feel that you had been treated fairly? Would you feel disposed to speak with all charity of him, to recommend him to those in need of legal advice?

You would probably feel toward such a lawyer as patients must feel toward physicians who prescribe proprietary nostrums based on information and advice offered by those who, though without any special knowledge of chemistry, pharmacy or medicine, will be benefited financially if their information and advice are accepted and acted on.--(_From The Journal A. M. A., April 27, 1918._)

ANASARCIN ADVERTISING[I]

[I] See index for other articles on Anasarcin.

_To the Editor_:--As an old Fellow of the A. M. A. I beg to present the following facts to you, and to ask if anything can be done by you to expose the methods of these people: A concern calling itself “The Anasarcin Chem. Co.” of Winchester, Tenn., has caused to be sent to physicians a chart on the subject of “Diagnostics of Renal Diseases.” This chart contains eighteen plates, which were all taken without knowledge or permission of either myself or my publishers, William Wood & Co., from the third edition of my book on “Urinary Analysis and Diagnosis.” The plates are partly composite plates, but mostly portions of plates, exactly reproduced from my book. I at once caused my publishers to write to the Anasarcin Company; and a few days ago I received a letter from a Dr. H. Elliott Bates of 118 East Twenty-Eighth Street, New York, whose letterhead says, “Medical Advertising.” In this letter the writer says that it was he who suggested the sending of such a chart, and admits that all the plates were taken from my book. In this letter he offers to have a letter sent to every physician of the country “in which it is explicitly stated that the cuts on the chart were taken from your book, and that complete information regarding the matters treated on the chart can be found in your book.” In other words he offers to advertise my book free of cost to me, so that I should take no further steps in the matter. I consider this entire matter an outrage, and thought it best to write to you for advice, since my publishers seem to think that in spite of the violation of the copyright nothing can be done.

Besides the cuts, some of the text on the chart is bodily taken from my book, while some of the other text, not taken from my book, but apparently compiled from different articles, is in part entirely wrong, so much so that I must be ashamed of its being associated with any of my own work.

By giving this letter your early consideration, and advising me what you think it best for me to do, you would greatly oblige

Louis Heitzman, M.D., New York.

[Comment.--Readers of The Journal are, of course, familiar with the articles[246] that have been published on “Anasarcin,” the “dropsy cure”! Knowing the standard of ethics that the Anasarcin concern adopts in the exploitation of its ridiculous squill mixture, our readers will not be surprised at the standard of commercial ethics which would justify the appropriation of copyrighted scientific material for nostrum advertising purposes. The statement of Dr. Heitzmann’s publishers that “in spite of a violation of copyright nothing can be done” is, of course, incorrect. Something _can_ be done by those who hold the copyright.--Ed.]--(_From The Journal A. M. A., Oct. 18, 1919._)

[246] J. A. M. A. =46=:288 (Jan. 27) 1906; ibid. =48=:1535 (May 4) 1907; ibid. =48=:1614 (May 11) 1907, and ibid. =49=:1992 (Dec. 8) 1917.

ANTIMERISTEM-SCHMIDT

Some, possibly many, of our readers have received a letter from Cologne, Germany, from the “Bakteriologisch-Chemisches Laboratorium Wolfgang Schmidt.” The letter contains a circular directing the attention of American physicians to “Antimeristem-Schmidt.” It also contains some advertising leaflets. One physician in sending this material to The Journal writes:

“A copy of the enclosed circulars has been sent to many of the
physicians in this city, and probably elsewhere. Perhaps it has
already been called to your attention. Let us be as liberal as
possible with our recent enemies. The sooner the old channels of
scientific communication are re-opened, the better. But let us
not allow such blatant commercialism from a foreign country to go
unprotested, any more than we should if it were from our own.”

It should be noted in passing that the envelop in which the Wolfgang Schmidt letter came has on its face a rubber-stamped impress to the effect: “Concerns Cancer Treatment.” The circular letter declares that by means of Antimeristem-Schmidt “either a cure or improvement has been effected in numerous inoperable cases” of malignant tumors. American physicians are asked “to employ the preparation when occasion arises” and are assured that “every medical man in city or country will be able to carry out treatment without preliminary knowledge.” With the letter are two leaflets discussing the use and administration of the product; one contained what was called a “Synopsis of some of the more recent publications regarding the employment of Antimeristem-Schmidt in inoperable malignant tumors.” The “recent” publications comprised three articles published in 1910 and one published in 1912!

Antimeristem-Schmidt was rather widely exploited some six or seven years ago. As was explained in The Journal, March 8, 1913, p. 766, it is a preparation claimed to be useful in the treatment of inoperable cancer and as a supplementary treatment after operations for cancer. The treatment is founded on a theory advanced by one O. Schmidt that the cause of cancer is found in a fungus, _Mucor racemosus_, which, Schmidt at first asserted, carried a protozoon which he regarded as the real cause of the disease. The vaccine is said to be prepared from cultures from this fungus. While Schmidt claims that he has been able to produce cancer by means of the organism, scientific research has not verified his claims. Extensive clinical trials have shown the treatment to be without effect. The Journal also advised its readers on April 19, 1913, that no license for the sale of Antimeristem-Schmidt had been granted by the Treasury Department and, therefore, its importation into this country was prohibited. Neither the therapeutic nor the legal status of the product has been changed since then.--(_From The Journal A.M.A., Dec. 6, 1919._)

ANTIPHLOGISTINE

_To the Editor_:--Last September, my chief, Dr. J. S. Millard, received a letter from the Denver Chemical Mfg. Co., manufacturers of “Antiphlogistine.” This letter purported to quote many large commercial concerns as testifying to the value of Antiphlogistine. Recently, I doubted the veracity of these claims and wrote to some of those quoted. I quote from the original letter of the Antiphlogistine company:

“The surgeon to the electric light and electric railroad company in
New Orleans says that Antiphlogistine is the finest thing he has
ever used in burns, especially flash and brush burns.

“The physician to the New York Edison Co. makes a similar
statement. He says that the application gives speedy relief and the
burns heal quickly without scars.”

I wrote to Dr. John Woodman, the physician to the New York Edison Co., who replied in part as follows:

“The Denver Chemical Manufacturing Company have no authority to
quote me.... I gave Antiphlogistine a thorough trial, and found it
had a very limited use, and I cannot recommend it for burns....”

Again, the Antiphlogistine letter said:

“It may be of interest to you to know that at the emergency
hospital of the Ford Automobile Co. in Detroit, Antiphlogistine is
carried in stock and is used extensively by the three physicians
in burns, bruises, infected wounds, sprains and other traumatic
conditions which are constantly arising in such a plant....”

I wrote to Dr. Mead who replied as follows:

“In answer to your letter of January 25th, will state that no
Antiphlogistine has been purchased or used in this hospital for
years past, and I cannot imagine why the representative of the
Denver Chemical Company should make such a statement as attributed
to him....”

He adds that “Antiphlogistine has never been used” in his department “on an open wound, abrasion or burn.” Is there not some way that such exploitation of our large companies can be prevented?

A. G. Gould, M.D., Akron, Ohio.

Plant Physician, the Goodyear Tire & Rubber Co.-(_From the Journal A.M.A., Feb. 23, 1918._)

“AUTO-HEMIC SERUM”

A Cure for Laziness, Ugliness, Frigidity and Many Other Things

The following letters are typical of many that have been received asking for information regarding Dr. L. D. Rogers and his “Auto-Hemic Serum.” This from a physician in New York state:

“Can you give me any information in reference to Dr. Rogers of
Chicago, Ill., who has an Auto-Hemic Institute?”

And this from Kansas:

“Just received a letter from a Dr. L. D. Rogers, 2812 North Clark
St., who is anxious to sell me a course in ‘Auto-Hemic Therapy.’
Would you kindly inform me what he has to sell? He did not tell me
what it consisted of; am inclined to believe it is a rank fake.
Kindly let me know what _The Journal_ thinks about it. Just what is
it? In the letter they claim that it is practically a panacea for
every blood disease.”

This from Maine:

“What is Auto-Hemic Therapy? I have a handsome red and yellow
circular from the Ideal Life Extension Press, 2812 North Clark St.,
Chicago, soliciting subscriptions to their publication, offering
as a bonus this book, ‘Auto-Hemic Therapy’ by L. D. Rogers, A.M.,
M.D., LL.D., Chicago, and membership in the American Medical Union.”

THE NATIONAL MEDICAL UNIVERSITY

In order better to appreciate the probable scientific status of “Auto-Hemic Serum,” it is well briefly to sketch some of the previous activities of its discoverer, Dr. L. D. Rogers. For many years Rogers was the head and chief owner of the National Medical University of Chicago, a low-grade school of the “sun-down” variety. The “university” is now out of existence and for some time before it went out of existence was not recognized either by the board of health of the state in which it operated or by the boards of the majority of the other states in the Union. The report of the Carnegie Foundation on medical education had this to say about the laboratory facilities of Rogers’ school:

“The school occupies a badly lighted building, containing nothing
that can be dignified by the name of equipment. There has been
no dissecting thus far (October to the middle of April, 1909),
anatomy being didactically taught. Persistent inquiry for the
‘dissecting-room’ was, however, finally rewarded by the sight of
a dirty, unused, and almost inaccessible room containing a putrid
corpse, several of the members of which had been hacked off. There
is a large room called the chemical laboratory, its equipment
‘locked up,’ the tables spotless. ‘About ten’ oil-immersion
microscopes are claimed--also ‘locked up in the storeroom.’ There
is not even a pretense of anything else. Classes in session were
all taking dictation.”

Dr. Rogers is, or was, if he is not still, “Permanent Secretary” of the “National Association of Panpathic Physicians”--whatever that is. In fact, one of Dr. Rogers’ specialties seems to be the founding of quasimedical organizations--organizations, apparently, which may prove useful in the promulgation of such projects as he may, at the time, be interested in. A few years ago, Rogers was exploiting a “cancer serum” and, _presto_, the “American Cancer Research Society” came into being, L. D. Rogers, president. Soon thereafter certain members of the profession were circularized urging them to purchase shares in the “Cancer Research Laboratory and Hospital,” par value $10. Apparently, the profession did not invest.

A few years ago, also, L. D. Rogers’ name appeared on the “Faculty” list of the “American Post-Graduate School,” a concern which granted--on the mail-order plan--a long line of sonorous degrees and an equally complete line of ornate diplomas.

THE JAPANESE CONSUMPTION CURE

Then, in 1915, there appeared in the classified columns of certain newspapers the following advertisement:

TUBERCULOSIS--New Japanese treatment;
to prove merits and give discovery quick
publicity will send 10 days’ treatment free.
DR. ROGERS, 546 Surf St., Chicago.

So far as we have been able to learn, Rogers, for some unexplained reason, did not call into existence out of the vastly deep a “Japanese-American Tuberculosis Research Society.” This consumption cure apparently died of inanition.

Then came the “Auto-Hemic Serum” with its inevitable sequel, the “National Society of Auto-Hemic Practitioners.” Another adjunct to the serum exploitation is the _North American Journal of Homeopathy_, the official organ of the “Auto-Hemic Practitioners” and of the “American Medical Union” and possibly of some other “societies”--but not representative of homeopathy!

WHAT IS AUTO-HEMIC THERAPY

What is this new therapy? According to a very lurid poster, it is described as “The Missing Link in Medicine”--possibly referring to the ease with which one may make monkeys of certain physicians. More specifically, although still vaguely, we learn:

“It consists in giving the patient a solution made by attenuating,
hemolizing, incubating and potenizing a few drops of his or her
own blood, and administering it according to a refined technic
developed by the author.”

Elsewhere it is said to consist:

“... in taking five drops (or some multiple of five) of blood from
a vein and putting it into nineteen times as much sterilized,
distilled water, and incubating it at fever temperature for
twenty-four hours, and then making further dilutions according to
the needs of the case, as can be determined only by a physician
skilled in its use.”

Neither of these statements, of course, describes the “refined technic” of those “skilled in its use,” but those who are interested can, by sending Dr. L. D. Rogers, “One Hundred Dollars cash-in-advance” get a mail-order course in this new marvel.

But if it is rather expensive to learn just how to use “Auto-Hemic Serum,” it does not cost so much to learn what the “serum” will do. Rogers has written a book on the subject, “Auto-Hemic Therapy,” which is used as a premium for subscriptions to the _North American Journal of Homeopathy_, price $5.00 per year, payable in advance. In the book Dr. Rogers modestly assures his readers that he considers his discovery more important than that of Alexis Carrel, winner of a Nobel Prize.

A CURE FOR LAZINESS

One of the chief virtues claimed for this serum is that of developing in the patient who takes it an unbounded energy that, apparently, makes him want to work himself to death. In some sensational articles that have appeared in Sunday editions of newspapers on Rogers’ serum, the stuff has been described as “Lazy Serum.” One of the first cases described in the Rogers book is that of a young waiter, “a good-for-nothing lazy fellow who would not work and would not pay for medical services” and who was turned over to Dr. Rogers’ free clinic. He was given the serum on Thursday and was told to report Saturday. He did not return until Monday, his excuse being that “he worked all day Saturday until midnight and all day Sunday and felt as if he could work all day and all night without rest.” The “case report” ends:

“... finally remarking, ‘I feel like a bird’ he flew out of the
classroom and we never saw him again.”

HOUSEWIVES TAKE NOTICE

The next case described is that of a servant girl who had not worked for a year; within a week after taking the “Auto-Hemic Serum,” “she voluntarily beat carpets till she blistered her hands.” Then there was the rooming house keeper who had spent more than half of each day in bed. After an “Auto-Hemic” injection she “discharged her maid and janitor ... and did all the work of her twelve room house herself, beating rugs, firing furnace and carrying out ashes besides doing some of the laundry.” “Case No. 7176” is interesting: A man, generally considered the laziest person in his community and with a habit of “drinking thirty whiskies a day,” took “Auto-Hemic Serum.” He stopped drinking, shaved himself and changed from “a “bum” to that of a sober, clean, wholesome, bright and honest workman.” Then there was the case of the “lady physician” who “took the serum one evening and the next morning reported that she had the ‘giggles’ all day”; also she became “more magnetic.” More remarkable still was the case of the young woman clerk in a retail store who, after taking the serum, “astonished her employer by volunteering to work overtime.” In the chapter dealing with “Ills Peculiar to Women” Dr. Rogers details the moving story of a _man_ to whom the “serum” was given and who reported that “about the third twenty-four hours after taking it his bowels moved forty times”--nevertheless, “he felt no exhaustion.”

In all phases of human activity the serum seems to work wonders. “The cases are numerous in which the frigidity of both sexes have [_sic_] melted after Auto-Hemic treatment.” A young married woman with a morbid dislike for her husband took the serum and within a week “became normal.” The discoverer suggests that in some cases there is no doubt that this serum “would prevent divorce.” A 40 year old woman who could not endure to wear any waists but white or black was able, it seems, after taking the serum to tolerate a veritable Jacob’s coat.

Is, then, “Auto-Hemic Serum” good for everything? Let Dr. Rogers answer:

“Briefly stated, without any great exaggeration, this new modified
serum treatment is good for anything that is the matter with you,
provided the cause is not organic, mechanical or bacterial.”

One infers that in the inorganic, mental, spiritual and nonbacterial spheres the stuff is supreme. But it has its limitations. For instance, Dr. Rogers states that he once had “a very troublesome cough which lasted several weeks, but did not yield to this serum.” Reaching the conclusion that some other treatment was necessary “he had the bones of his neck ‘adjusted’ and got immediate relief.”

AS A COMPLEXION BEAUTIFIER

The serum “cannot be made up by the barrel and sold at wholesale or retail”:

“If it could be bottled and stored and sold at retail like a patent
medicine, the demand for it as a complexion beautifier alone would
net the proprietor millions. More than one person a few days after
taking the treatment has been wrongly accused of painting.”

Should any of The Journal readers decide to take the $100 mail-order course in “Auto-Hemic Therapy” he should realize that even after he has done so there are certain restrictions in the practice of this “therapy.” In no case must he administer “a course of Auto-Hemic Treatment” for “less than $100, paid in advance.” The only exceptions to this rule are “cases of absolute charity, expectant mothers and to persons positively unable to pay that amount.” Furthermore, Dr. Rogers says that for the reputation of his method, as well as for the good of all concerned, “I insist that the entire fee be paid in advance and that the course extend over a period of one year whether the patient needs few or many treatments.”

DOLLARS AND CENTS

For those who do not wish to take the mail-order course, Rogers offers to prepare individual specimens of the “serum” from blood that is sent to him by the physician. The cost of this “serum” is $5.00, “in advance,” of course.