Chapter XXXVI: Part III: Contributions From the Journal: Proprietary Products (4)

_Dear Doctor_:--Regarding Infantile Paralysis, it is conceded that
the source of infection is through the Nose, Mouth and Throat.

Taking this measure to be correct, we believe that there is no
safer prophylactic measure than the use of Glyco-Thymoline, with
three parts of water, as a mouth, tooth and nasal wash, by means of
the K. & O. Nasal Douche and the toothbrush.

Glyco-Thymoline tends to promote exosmosis, and prevents the
absorption of the germ or toxic matter.

We would be glad to send you samples of both Glyco-Thymoline and
the Douche should you so desire.

With best wishes, we beg to remain,

Yours very truly,

Kress & Owen Company.

Glyco-Thymoline has been discussed in these pages. A report of the Council on Pharmacy and Chemistry pointed out that this “patent medicine” is simply a weak antiseptic, so feeble that even in full strength it does not kill _Staphylococcus aureus_ in four hours and is of little, if any, greater therapeutic value than sterile salt solution. Yet, Glyco-Thymoline has been recommended by its manufacturers, either directly or inferentially, for such diseases as diphtheria, ophthalmia neonatorum and consumption. Today its manufacturers put it forward as one of the safest prophylactic measures against infantile paralysis and have the effrontery to make this suggestion, not to the uninstructed public but to the medical profession. Presumably, as a business organization, the concern believes it will convince a sufficient number of physicians of the therapeutic efficacy of its product to pay for the cost of this advertising campaign. If it appraises the situation correctly there need no longer be any wonder expressed that in the recent suit against The Journal, “patent medicine” makers were able to enlist the help of medical men.--(_From The Journal A. M. A., Sept. 16, 1916._)

GLYKERON: COLD STORAGE TESTIMONIALS[K]

[K] Glyco-Heroin

The law which limits the length of time that food products may be kept in cold storage could with advantage have its scope extended to include “patent medicine” testimonials. Physicians recently received through the mails--at a time when the mails were frightfully congested with Christmas business--a sixteen page pamphlet sent out in a plain envelop as first class matter. The caption of the pamphlet reads: “Cough and Its Treatment in Pulmonary and Laryngeal Tuberculosis: By Henry Levien, M.D., While Medical Director and Physician-in-Charge of the Liberty Sanitarium, Liberty, N. Y. From the _Buffalo Medical Journal_.” The pamphlet is devoted to the alleged virtues of that dangerous and widely advertised nostrum, “Glyco-Heroin (Smith),” whose more recent and less descriptive name is now “Glykeron.” Physicians might assume, and doubtless will assume, from the pamphlet that this reprint represents a recent pronouncement on the subject with which it deals. The facts are that the “Liberty Sanitarium” has, apparently, been out of existence for at least fifteen years, while the article itself originally appeared more than eighteen years ago--September, 1901. One of many physicians who sent in the copies received called attention to the fact that he had left the address to which the pamphlet was directed, more than six years ago. Even at that, the mailing lists of the concern that sells this heroin-containing nostrum are more than twelve years ahead of its “clinical reports.”--(_Editorial from The Journal A. M. A., Jan. 17, 1920._)

GRAY’S GLYCERINE TONIC: “WHOSE BREAD I EAT HIS SONG I SING”

Last September the United States Department of Agriculture issued a press bulletin describing the work of the Bureau of Chemistry in prosecuting the venders or manufacturers of fraudulently exploited “patent medicines.” At the end of the bulletin was a tabulated list of “other preparations against which the government’s charge that they were falsely or fraudulently labeled was sustained by the federal courts.” Tucked away in the list was a product often euphemistically described as an “ethical proprietary” but none the less essentially a “patent medicine”--“Gray’s Glycerine Tonic.” The editor of the _Atlanta Journal of Medicine_, apparently not having read the bulletin with any great degree of care, published it verbatim. Thus it was that the _Atlanta Journal-Record of Medicine_ for September, 1915, presented the interesting sight of a half-page advertisement of “Gray’s Glycerine Tonic” in the same issue that contained the government’s article classifying “Gray’s Glycerine Tonic” among the false and fraudulent products! What happened? In the very next issue the _Atlanta Journal-Record of Medicine_ apologized thus editorially:

“In our September issue, Gray’s Glycerine Tonic Comp. was
inadvertently included in a list that seemed to be under the ban
of the Government and very likely an injustice has been done
the Purdue Frederick Company which we desire to undo as far as
possible.”

Did the editor mean by “inadvertently included,” that he would have omitted “Gray’s Glycerine Tonic” from the government’s list had he noticed it in time? If so, on what grounds? It is a fact that “Gray’s Glycerine Tonic” was one of the “Fifty Falsely Labeled Medicines”; it is also a fact that it is one of the products that government officials and the federal courts have declared to be sold under claims that are “false, fraudulent and misleading.” If “Gray’s Glycerine Tonic” was fraudulently exploited--and the government and the courts have so declared it--why is it necessary for the editor of a medical journal to apologize to his subscribers for having told them so?--(_Editorial from The Journal A. M. A., Jan. 1, 1916._)

HAGEE’S CORDIAL OF COD LIVER OIL

“Under the deceptive heading ‘Making Cod Liver Oil Palatable,’ the _Charlotte Medical Journal_ in its December issue prints a boost for ‘Cord. Ext. Ol. Morrhuae Comp. (Hagee),’ or, as it is generally known to the drug trade, ‘Hagee’s Cordial of Cod Liver Oil.’

“The boost intimates that this is a preparation in which cod liver oil has in some way been rendered palatable, and then goes on to say that this is a cod liver oil product which has not suffered the least loss of those essential elements which make the crude oil such a high-class reconstructive.

“At first sight one might question whether a cod liver oil product which contains absolutely no cod liver oil had not suffered the loss of essential elements. But a closer reading discloses a significant qualification, namely, the phrase, ‘those elements which make the crude oil such a high-class reconstructive.’

“The boost is misleading from beginning to end. The manufacturers have not succeeded in this preparation in ‘making cod liver oil palatable,’ nor does their preparation in any way possess the virtues of cod liver oil. These claims have again and again been refuted, but they continue to be published--at a price but rarely in reputable medical journals.”

The above is quoted from the _Weekly Bulletin_ of the Department of Health of the City of New York. The Bulletin is issued for the enlightenment of the public.--(_From The Journal A. M. A., Jan. 8, 1916._)

HYPNO-BROMIC COMPOUND

A physician in Vermont writes:

“This is simply a word of inquiry--and of possible warning to
other practitioners--regarding a preparation known as Hypno-Bromic
Compound manufactured by H. K. Wampole & Co. This compound is
dispensed by druggists without prescription and contains in each
ounce:

“Cannabis indica 1 gr.
“Morphin 1/4 gr.
“Potassium bromid 48 gr.
“Hyoscyamus 1 gr.
“Chloral hydrate 96 gr.

“I have at the present time three young women who are addicts to
this preparation as the result of thoughtless prescriptions from
physicians. This mixture evades the working of the Harrison Act and
may be dispensed freely at the discretion of the druggist and, as
a result, these three cases of mine have been able, by visiting at
the various drug stores in town, to keep an ample supply on hand at
all times.”

“Hypno-Bromic Compound” is more than an unscientific mixture; it is a dangerous product and should not be sold indiscriminately over the drug counter. Before the Harrison Narcotic Law went into effect, “Hypno-Bromic Compound” contained half a grain of morphin sulphate to the ounce instead of its present one-fourth grain. Physicians remember that Section 6 of the Harrison law contains a joker--put over by the “patent medicine” interests--that exempts proprietary remedies containing one-fourth grain of morphin or less to the ounce from the restrictions of that act. While it is illegal for a physician to write a prescription which contains morphin, no matter how small the amount, unless he conforms in all ways to the requirements of the Harrison Narcotic Law, “patent medicine” concerns can sell indiscriminately nostrums containing morphin up to this amount and the public can buy them without let or hindrance. No reputable druggist would sell a layman over 700 grains of chloral hydrate or 2 grains of morphin or 8 grains of extract of cannabis indica, without a prescription, yet, the druggist may hand over 8 ounce bottles of Hypno-Bromic Compound which contain 768 grains of choral hydrate, 2 grains of morphin sulphate, 8 grains of extract of cannabis indica, 8 grains of hyoscyamus and 384 grains of potassium bromid! Physicians who prescribe such products as Hypno-Bromic Compound and druggists who indiscriminately sell such stuff are disgracing two honorable professions.--(_From The Journal A. M. A., Feb. 7, 1920._)

INTRAVENOUS COMPOUND (LOFFLER)

Its Composition and the Peculiar Methods by Which It Is Exploited

For some time past inquiries have been received regarding Charles Lyman Loffler, his Post-graduate Course in Intravenous Therapy and especially relative to “Intravenous Compound (Loffler).” For instance, a physician writes:

“Can you tell me anything about the Physicians Drug Syndicate....
They are pushing the sale of Thymozene and offering One Hundred
Dollars’ worth of stock fully paid and non-assessable, free to
those sending in their order, and also a copy of Dr. Loffler’s
Lectures on the Blood.”

And from another physician:

“What do you know of Charles Loffler, M.D., and his Intravenous
Compound? A few evenings ago a man who appeared to be about 40
years old came to my office and tried to interest me in the
above-mentioned article; he claimed to be Dr. Charles Loffler
of Chicago. With him was a young lady whom he introduced as
Miss B----. Miss B---- said that she had been with Dr. X---- [a
physician of high standing in Los Angeles] for two months and
that he was using the Intravenous Compound; also quoted other
physicians.... His whole layout looks quackish, and were it not for
the fact that he showed me a letter that appeared to be from Dr.
X----, I should not have given him a second thought.”

And this also:

“Charles Loffler, M.D., or his agent was traveling around inducing
one M.D. in each town to take up his methods of blood examination
and treatment and with a little advertising of blood examinations
free the doctor selected gets quite a run of patronage.”

Another physician writes:

“My attention has been called by another physician to Loffler’s
Intra-Venous Compound. May I trouble you to give me any information
that you may have with regard to its composition and its value as a
therapeutic agent?”

C. L. Loffler does business from Rooms 1101-1102, Venetian Bldg., Chicago, the location of the “Intravenous Chemical Co.,” the “Physicians Drug Syndicate” and the “Ma-Oze Chemical Co.” Of these, more later. The Journal has in its files a large amount of material regarding Loffler. A brief résumé of that part of the material dealing with Loffler’s professional activities will be given for the purpose of allowing physicians to evaluate the scientific status of Loffler’s “Lectures,” “Post-Graduate Courses,” his therapeutic “discoveries” and his products.

It seems that Loffler was reared in Yankton, S. D. In 1898-1899, Loffler was a senior student at John Creighton Medical College, but, for reasons that need not be gone into here, he was never graduated. He received a diploma from Barnes Medical College in 1900, and in the same year was licensed to practice in South Dakota. In 1902 he was at Le Mars, Iowa; in 1904 his name appears in the medical directory, under Sioux Falls, S. D., as “Specialist in Chronic Troubles.”

THE INTRAVENOUS COMPANY IN COLORADO

Charles L. Loffler’s “specialty” is “Intravenous Medication.” In 1912 and 1913, as the Intravenous Company of Colorado Springs, he was sending out a booklet entitled “Consumption.” This described the alleged marvelous results to be obtained in the treatment of tuberculosis by the use of “Intravenous Compound”; there was also a side line, “The Loffler Internal Bath Plate.” At that time the administration of “Intravenous Compound” was recommended intravenously, hypodermically, by rectum, by mouth and even by insufflation. When the stuff was to be given by rectum, the recommendation was made: “First wash out the bowels with a preliminary injection of two or three quarts of warm water, using for this purpose the Loffler Internal Bath.”

In 1913 Loffler sought a larger field for his peculiar talents and left Colorado Springs. After a short stay in Denver he is next found in Minneapolis, where he was also “engaged in the practice of intravenous therapy” and, incidentally, seems to have been an organizer and manager of a common law concern known as the Automatic Thrasher Co.

THE PHYSICIANS’ DRUG SYNDICATE

In 1919 we find Loffler in Chicago as president of the “Physicians Drug Syndicate.” This concern--another common law organization--had for its vice president one A. E. Erling, M.D., and for its secretary and treasurer, Arthur C. Hanson. Erling was discussed[251] in an article that appeared in The Journal, July 5, 1919, on the egregious “Allied Medical Association of America” of which organization C. L. Loffler was “President” in 1918.

[251] Here is what _The Journal_ published on Erling:

A. E. Erling according to the stationery, is “Chairman” of “Censors.” Our records fail to show that Erling ever graduated in medicine. The Health Department of Milwaukee, however, says that Erling, when interviewed, claimed to have “a diploma from the German Medical College of Chicago, but refused to show or present the same.” The American Medical Directory has this item:

_German Medical College, Chicago. Chartered Dec. 28, 1891, by
Johann Malok. Fraudulent. Extinct._

A few years ago Erling was in La Crosse, Wis., and in 1908 a circular letter bearing his name and picture was sent out, from which the following extracts are taken. Capitalization as in the original:

“Dear Friend:--Permit me to call your attention to the fact that
Dr. A. E. Erling, the eminent specialist, after many years of
travel, practice and medical research, has given up his extensive
road practice and severed his connection with the several medical
institutes which have heretofore occupied considerable of his
attention.... Dr. Erling’s success in the treatment of all CHRONIC
DISEASES IS TRULY REMARKABLE. NERVOUSNESS, ALL BLOOD DISEASES,
RHEUMATISM, DISEASES PECULIAR TO WOMEN; CATARRH, DEAFNESS, CHRONIC
CONSTIPATION ... APPENDICITIS ... PILES, STOMACH TROUBLES, PARTIAL
PARALYSIS, etc., give way as if by magic under his skilful method
of treatment.... Understand, please, that Dr. Erling DOES NOT
ACCEPT A CASE FOR TREATMENT unless he can PROMISE A SPEEDY AND
POSITIVELY PERMANENT CURE.”

_The Journal_ also has in its files advertisements (vintage of 1915), from some Wisconsin country newspapers; which notify the afflicted that “Drs. Erling and Karass, the expert German Specialists,” could be seen in their offices in the “Schlegel Hotel,” the “Schlitz Hotel,” etc., as the case might be. Whether one of these “German Specialists” was Dr. Arnold E. Erling, _The Journal_ does not know. Official medical records fail to show, at least, that there is any other Erling in the state of Wisconsin.

Hanson, the secretary and treasurer of the Physicians Drug Syndicate, is said to have hailed originally from Minot, N. D., where he was in the drug business. His name appears in the Propaganda files as the manager of the Ma-Oze Chemical Co. of Minneapolis, which, in October, 1919, was advertising in a daily paper of that city:

“Protect yourself against influenza. Don’t let the germs get a
foothold in your system. Kill them with Ma-Oze Antiseptic Powder.
Use it as a gargle. It is ... sure death to all kinds of disease
germs.”

In a preliminary statement sent out by Hanson in the early part of 1919 it seems that the Physicians Drug Syndicate was conceived “primarily to supply physicians with a product to be used in Leucorrhea and personal cleanliness of women.” This product, apparently, was the Ma-Oze of influenza fame in Minneapolis. It was to be put out, however, under the name of “Thymozene,” which, “packed in 4 ounce unlabeled carton for dispensing,” would “show nearly 100 per cent. profit to the organization over the profit which you make if you dispense your own drug.”

THYMOZENE, FREE STOCK--AND EVERYTHING

In October, 1919, the Physicians Drug Syndicate was circularizing physicians in Iowa trying to get them to send in $6 for “1 Dozen Thymozene 4 oz.” For this $6 the doctors were to get, in addition to the marvelous Thymozene, the following rights, privileges and emoluments:

1. A free Post-Graduate Course in Intravenous Therapy by Dr. Charles Loffler.

2. A gift of $100 worth of stock in the Physicians Drug Syndicate.

3. A copy of Dr. Loffler’s Lectures on Blood.

4. The privilege of purchasing future supplies of Thymozene “at wholesale prices less discount of 33-1/3 per cent.”

The letter making these offers mentioned incidentally:

“Besides our product Thymozene we have been forced to add a Uterine
Wafer to be used in connection with hot Thymozene douches in
Leucorrhea. These wafers are simply miracle workers.”

In addition to this circular letter there was a membership blank leaflet detailing the marvels of “Thymozene.” There was another leaflet headed in very large, black type “Influenza” and recommending “Ma-Oze Antiseptic Powder” or “Thymozene” for this condition. Still another leaflet accompanying it lauded “Intravenous Compound (Loffler)” and reprinted laudatory puffs of this preparation that were credited to H. H. Witherstine, M.D., Rochester, Minn., Joseph B. Klinehans, M.D., Chicago, and the “Loring Park Sanatorium” of Minneapolis.

In addition to the Intravenous Compound (Loffler) there is, of course, certain “apparatus for the giving of the treatment” which the Intravenous Chemical Co. supplies. The “compound” must be given just so, and the Intravenous Chemical Co. “reserves the right to refuse to supply any physician with Intravenous Compound (Loffler) who, either through lack of proper apparatus or proper care in preparation of solution, or for any reason, uses it in such a manner that will cast discredit upon it.”

The complete apparatus, including 2 ounces of Intravenous Compound (Loffler), sells for $24. What is Intravenous Compound? Apparently, nobody knows except Charles L. Loffler, who asks physicians to inject--and we regret to say some are injecting--this nostrum of unknown composition into the veins of their patients. To a physician who had raised the point of secrecy Loffler wrote in part:

“I am sure that you will agree with me that it is far better to
place this treatment in the hands of competent physicians, such as
Dr. Witherstine, and many more whose names I will gladly send you,
and to protect the honest and competent doctor who investigates
and takes up the work, than to publish the formula and give to the
unscrupulous a chance to try to make the product and no doubt to
claim to cure disease that is beyond hope. The formula is not kept
secret for profit ... but is so kept upon the advice of a number
of good men who have the interest of the doctor at heart.... I
am willing and anxious to place the product and the results in
thousands of cases before the A. M. A. on the one condition that
the formula shall be kept secret for the benefit of the reputable
physician.”

In another letter written more recently to a physician who called attention to the secrecy of the nostrum, Loffler wrote:

“The Intravenous Compound contains approximately 58 per cent.
oxygen, 12 per cent. chlorine, 16 per cent. potassium, 9 per cent.
sodium and 5 per cent. boron. I have no hesitancy in giving it, and
it was due to an incompetent man in this office that this was not
given fully in the booklet. He made the changes without my consent
and has caused me to answer many inquiries by physicians.”

A seeming frankness is a trick as old as nostrum exploitation itself. Loffler’s “formula” is meaningless. A quack who was putting out a mixture of 1 part baking soda and 2 parts common salt might with equal frankness say that his marvelous combination contained approximately 35.4 per cent. sodium, 4.8 per cent. carbon, 19 per cent. oxygen, 40.4 per cent. chlorin, and 0.4 per cent. hydrogen.

In order that the profession might know more about this product a specimen was turned over to the A. M. A. Chemical Laboratory for analysis. Here is what the chemists report:

CHEMISTS’ REPORT

“One original 2 ounce bottle of ‘Intravenous Compound (Loffler) for Intravenous Use’ was submitted to the Association’s Chemical Laboratory for examination. According to the label, the product is sold by the ‘Intravenous Chemical Co., Chicago.’ The bottle contained a white granular substance, which appeared as if the ingredients had been fused together. The product responded to tests for sodium, potassium, chlorate, borate and nitrate. As this same set of chemical radicals was found by Puckner and Hilpert (J. A. M. A., May 22, 1908, p. 1706) to be present in ‘Oxychlorin’ and ‘Zyme-oid,’ a quantitative comparison of ‘Intravenous Compound (Loffler)’ was made.

“The analysis indicated that all three products are essentially the same:

INTRAVENOUS
OXYCHLORIN, ZYME-OID, COMPOUND,
Per Cent. Per Cent. Per Cent.
Potassium (K+) 12.26 13.50 13.79
Sodium (Na+) 8.20 9.84 9.82
Boric acid anhydride (B₂O₃) 18.63 13.42 15.20
Chlorate (ClO₃-)  25.52 27.53 26.44
Nitrate (NO₃-)  21.70 24.22 23.75
Water calculated 13.29 10.42 11.72

“Assuming that the chlorate in ‘Intravenous Compound (Loffler)’ is present as potassium chlorate and the nitrate is present as sodium nitrate, the figures obtained by the analysis correspond to a mixture approximately as follows:

Potassium chlorate (KClO₃) 38.6 per cent.
Sodium nitrate (NaNO₃) 32.6 per cent.
Potassium borate (K₂B₄O₇) 4.9 per cent.
Sodium borate (Na₂B₄O₇) 4.0 per cent.
Boric acid  21.1 per cent.

“From the results of the examination it is concluded that this preparation is a mixture of alkali chlorate and nitrate and boric acid, probably produced by fusing together the constituents. It is practically the same mixture as Oxychlorine and Zyme-oid as analyzed nearly fourteen years ago in the A. M. A. Chemical Laboratory.”

Throughout the advertising of “Intravenous Compound (Loffler)” the physician is reminded of the financial returns that the product offers.

“... The financial return will prove as interesting to yourself as
results are to the patients.”

“And lastly but not less interesting, the financial returns are
commensurate with results.”

“... the instruction given me in the use of your Intravenous
Compound and the opportunity presented adds four to five hundred
dollars per month to my bank account.”

“... will not only give you more positive results than have
ever obtained in chronic and progressive diseases but a very
remunerative business.”

“Intravenous Compound (Loffler) is supplied in granular form, 2
ounces to a bottle, at $2 per bottle. An ounce will average fifteen
treatments and treatments are at from $3 to $5 each, according to
the ability of the patient to pay.”

A physician whose name the Intravenous Chemical Company had given as a user of Intravenous Compound (Loffler) was written to by another physician who was interested in the matter and he was asked frankly for his opinion. He replied in part:

“The treatment makes a profound impression on the recipient and is
usually followed by a marked improvement mentally, and I have not
been keen enough to draw the line of just how far the physical or
material improvement went and when the psychical began.

“For the office ‘specialist’ of the advertising type this would be
a boon, but I am not entirely satisfied that its use completely
justifies its claims.”

SUMMARY

Intravenous Compound (Loffler) stands revealed as a nostrum of secret composition which physicians are asked to inject into the veins of their patients. It must be purchased in connection with some supplementary material, “a complete set of apparatus,” sold by the same concern. Its successful administration is said to depend on following a technic detailed either in a booklet sent out by Loffler or given by Loffler in a “Post-graduate Course” which costs physicians $50 unless they have purchased six dollars’ worth of another nostrum, “Thymozene.”

The intravenous administration of drugs is impressive. To the patient the technic is mysterious and its psychic effect striking. Its dangers--infection, air embolism, intravascular clotting, sudden death--are matters of record. Every conservative physician will admit that there is no excuse for the intravenous administration of even those drugs that are well known and whose effects have been carefully studied, except when distinct advantages are to be secured. As The Journal has stated before, “Little is known of the results to be expected from intravenous therapy even with simple substances.”

What, then, can be said of the physician who subjects his patients to the intravenous injection--“at from $3 to $5 each, according to the ability of the patient to pay”--of a preparation of whose composition he is as ignorant as he must be of its effects? Intravenous Compound (Loffler) has been on the market ten years; it is unmentioned in the literature of scientific medicine. The name of its exploiter, while not unknown in the twilight zone of professionalism as the exploiter of a nostrum, as a “Specialist” in “Chronic Troubles” and “Intravenous Therapy,” as well as in other capacities even less savory, is equally unknown to scientific medicine.--(_From The Journal A. M. A., Nov. 12, 1921._)

INTRAVENOUS SPECIALTIES

_To the Editor_:--There is a salesman here in Salt Lake City making
extravagant claims about the medicines advertised in the enclosed
pamphlet. Would you kindly advise me as to your opinion of it?

W. C. Schulte, M.D., Salt Lake City.

_To the Editor_:--I am interested in knowing the attitude of the
Council on Pharmacy and Chemistry regarding the products of the
Intravenous Products Company of America, 121 Madison Avenue, New
York City. If the Council has already reported, please refer me to
the appropriate number of _The Journal_. If it has not, please give
me any information available.

H. B. Gessner, M.D., New Orleans.

ANSWER.--The Intravenous Products Company of America has not requested the Council on Pharmacy and Chemistry to examine any of its intravenous specialties, nor have they been discussed in The Journal or examined in the American Medical Association Chemical Laboratory. The firm’s list of specialties bears a striking resemblance to those of other “intravenous specialty” firms. Endoarsan, like Venarsen of the Intravenous Products Company of Denver, is stated to contain a cacodylate (dimethylarsenate) along with mercury and iodid. Venarsen was reported on unfavorably by the Council (The Journal, May 22, 1915, p. 1780), the inferior efficacy of sodium cacodylate was discussed (The Journal, March 25, 1916, p. 978) and the worthlessness of sodium cacodylate as a spirocheticide confirmed by H. N. Cole (The Journal, Dec. 30, 1916, p. 2012), William G. Ward (The Journal, Feb. 3, 1917, p. 390), and R. L. Sutton (The Journal, Feb. 17, 1917, p. 566). Endosal, like Venosal of the Intravenous Products Company of Denver, is said to contain salicylate and a colchicum preparation (the latter is also said to contain iodids). Venosal was found unacceptable for New and Nonofficial Remedies by the Council on Pharmacy and Chemistry. Like other “intravenous” firms, this company advertises the intravenous administration of drugs such as sodium iodid and hexamethylenamin. The objections to and the dangers of indiscriminate administration of drugs intravenously was recently emphasized in a report of the Council on Pharmacy and Chemistry “Some of Loeser’s Intravenous Solutions” (The Journal, April 16, 1921, p. 1120).--(_Query from The Journal A. M. A., Dec. 10, 1921._)

IODEX

At fairly frequent intervals physicians receive through the mail free samples of “Iodex,” a black ointment sent out in small, circular aluminum boxes. Iodex is sold by Menley and James, Ltd., New York City, under the claim that it is a preparation of free iodin,[252] minus the objectionable features that go with free iodin. The preparation was examined in the A. M. A. Chemical Laboratory in 1915, and found practically devoid of free iodin. The laboratory also reported that when 1 or 2 grams of Iodex was rubbed on the skin of the forearm on several subjects and the urine collected and tested for iodin, the results were negative. This disproved the claim that “thirty minutes after inunction [with Iodex] iodine can be found in the urine.”

[252] “Free” or elementary iodin (such as the tincture of iodin) is used externally for its local irritant and antiseptic effects. “Combined iodin” (_e. g._, iodid of potassium), does not produce these effects; and when preparations containing iodin in combined form are used, it is with the expectation of obtaining the systemic (“alterative”) effects such as are produced by iodids.

The findings of the laboratory, which were summed up in a report (The Journal, June 19, 1915) of the Council on Pharmacy and Chemistry on Iodex, were essentially as follows:

1. The composition is incorrectly stated; the actual iodin content is
only about half of that claimed.

2. The action of Iodex is _not_ essentially that of free iodin,
although that is the impression conveyed by the advertising.

3. The assertion that iodin may be found in the urine shortly after
Iodex has been rubbed on the skin has been experimentally disproved.

At the time the laboratory reported its findings, it pointed out the obvious contradiction in the claim that Iodex is not only an “effective free iodine application without drawbacks” but also a means of “really efficient external iodine therapy without stain or irritation.” It is impossible to have free iodin present in sufficient quantities to be therapeutically efficient and not get skin stains and irritation.

In a recent issue of the house organ, _Pharmacal Advance_, there was a large display advertisement of Iodex under the heading: “For prophylaxis and to ‘Double Cross’ Disease,” with the claims:

“Free Iodine.”

“Rub Through Skin.”

“Does Not Irritate nor Stain.”

On other pages of the same issue these claims appeared:

“There is no therapeutic virtue in Iodex which is not
inherent--though often latent--in Free Iodine; and there is no
virtue in Free Iodine which is not available in Iodex.”

“In Iodex all the beneficent properties of Iodine are emphasized
and all its disadvantages are eliminated--in a word, Iodex is
Pure Free Iodine presented therapeutically active and efficient,
ready for use in all conditions, with all the well-known powers
of Free Iodine, but without the sequelæ of unpleasant effects, as
irritation, corrosion, desquamation, staining, etc., which defeat
the ends of treatment when ordinary preparations of Iodine are
used. The fact that Free Iodine in the form of Iodex can now be
used in rectal and vaginal treatment, without irritation, speaks
volumes for its penetrability and bland action.”

These quotations are sufficient to show that the manufacturers of Iodex still persist in their claim that the product contains free iodin. In view of this, the A. M. A. Chemical Laboratory has again examined Iodex, having recently purchased specimens on the open market. It reports that Iodex gives no test for free iodin, or at most, but minute traces.

An interesting side-light on the methods of Menley and James is also brought out in the issue of _Pharmacal Advance_ just quoted. Under a “department” misnamed “Book Reviews” the following appears:

“THE ACTIONS OF DRUGS.--Torald Sollmann, M.D. Published by W. B.
Saunders Co., Philadelphia. This is a book of lectures designed
for students in pharmacy and deals with the subject in plain and
simple language. The author in his introduction has brought out the
fact that over-counter prescribing is baneful both to the public
and to the pharmacist himself. Among some of the interesting points
brought out that _Pharmacol Advance_ has always maintained, namely,
that ‘Potassium iodid is not absorbed efficiently by the skin;
hence the ointment of potassium iodid is unscientific.’

“We would especially call attention to Ungt. Iodi U. S. P.,
containing Potassium Iodid, used as a solvent for its iodin
content. Accepting Sollmann’s statement, it is to be assumed that
Ungt. Iodi U. S. P. has not 100 per cent. efficiency.”

Garbling statements from scientific works for the purpose of puffing proprietaries is not unusual in nostrum exploitation. The facts are that the statement in Sollmann’s book, introduced in the Menley and James house organ under the guise of a book review, appeared in a discussion of iodin compounds. In this the author points out that to obtain systemic iodid effects, it is irrational to apply iodin preparations externally. So far as the free iodin content of the official ointment of iodin is concerned, L. E. Warren (Reports of the A. M. A. Chemical Laboratory, 1917) has shown that even after more than six months this ointment still contains about 75 per cent. of the free iodin originally added. The official ointment (Unguentum Iodi, U. S. P.), therefore, so far as its free iodin content is concerned, is far superior to Iodex, which contains no iodin in its free state.--(_From The Journal A. M. A., May 3, 1919._)

THE WILLIAM F. KOCH CANCER REMEDY

A number of inquiries have been received of which those that follow are typical. This from a Philadelphia physician:

“Would you give me any information you have about one so-called
‘Dr. W. S. Koch,’ Detroit, Michigan? This man is said to claim to
have in his possession a cure for cancer, the nature of which I do
not know. I know, however, that he obtained a very large fee not
very long ago in treating a case, but without success ...”

While a Chicago physician writes:

“I have at hand a pamphlet from Wm. F. Koch, M.D., Ph.D., of
Detroit, Mich., which is supposed to be a reprint from the _Medical
Record_ of Oct. 30, 1920, entitled ‘A New and Successful Diagnosis
and Treatment of Cancer.’ Will you kindly advise me what you know
about this man’s work on this subject and how much stock I can put
in the claims he makes in this article?”

And this from a physician in Seattle, received a few days ago:

“Has your office any knowledge of the cancer cure devised by Dr.
William F. Koch, Ph.D., M.D., of Detroit? He published an article
on it in the _Medical Record_, Oct. 30, 1920.... I enclose copy
of letter received by one of our patients from his ‘western
representative’ which reads like pure quackery. I do not find Dr.
Koch’s name in either the A. M. A. or Polk’s medical directories.”

The letter referred to in the last inquiry as coming from Dr. Koch’s “western representative” was addressed to a woman who had written to Dr. Koch with reference to his alleged cancer cure. The letter, dated Jan. 19, 1921, was signed “Chas. L. Tisdale, 1898 Geary Street, San Francisco.” It read:

“_Dear Madam_:--Your letter of January 10th written to Dr. Koch of
Detroit in reference to his cancer cure has been sent to me by Dr.
Koch. I am the western representative of Dr. Koch and am giving the
treatments with his remedy. I am now treating 14 cases here with
some most wonderful results. The amount of the remedy that Dr. Koch
can supply me with is limited and it is a very expensive substance.
None of it can be sent to Seattle or any other place for I have
only enough to treat the cases that are constantly presenting
themselves here. If you could come to San Francisco and have the
money to pay a reasonable fee, say enough to pay for the remedy, I
would be very glad to do everything I can for you.

“The results that have already shown in many of these cases warrant
me in believing that almost any case of cancer can be cured if the
treatment is persisted in.”

According to our records, Dr. William F. Koch of Detroit was born in 1885. Some years ago he graduated in chemistry and for some time held the position of professor of physiology and physiologic chemistry at the Detroit College of Medicine and Surgery. In 1918, Dr. Koch received his degree in medicine from this same college. Less than a year after his graduation, Dr. Koch declared that he had “developed a real specific cure for cancer.” In the _Detroit Medical Journal_ for July, 1919, there appeared a brief article by William F. Koch, entitled “A New and Successful Treatment and Diagnosis of Cancer.” A more extensive article bearing the same title was published in the _New York Medical Journal_ of Oct. 30, 1920.

As a result of the publicity that was given the Koch treatment, the Wayne County (Detroit) Medical Society appointed a committee to investigate the treatment. Its first report appeared in the Bulletin of the society for Dec. 22, 1919. Briefly, this report said that the Board of Health of Detroit had placed at the disposal of the committee twelve beds in a local hospital with the necessary special nurses and everything else required free of charge. The committee sent certain patients to the hospital; and there were also some other patients recommended by different physicians as proper cases for treatment. There were nine altogether. After going over the cases carefully, the committee found some in which the diagnosis was doubtful. There were five cases, however, of undoubted cancer, a positive diagnosis having been made from specimens and microscopic examination. The management and treatment of these patients were turned over to Dr. Koch.

Dr. Koch seems to have raised certain objections and to have made certain criticisms. He also insisted that he ought to have some representative on the committee. The committee offered to put on any and all he would name. He failed to name any. The committee reported further that Dr. Koch was very negligent in his treatment of the patients and finally, on November 26, the committee met with Koch and went over all the cases with him. At that time he gave the patients injections and promised to attend to the treatment regularly in the future. According to the report, he saw the patients only once more (three days later) and then did not come near them again. As the patients became disgusted with the neglect, some of them left and the committee sent the rest home and closed its connections with the investigation of the subject.

In the same issue of the Bulletin of the county society in which this committee’s report was published, the editor of the Bulletin stated that from all sections of the country inquiries were coming relative to the treatment and “from long distances patients are coming to Detroit to be ‘cured’ of cancer.” The editor further stated: “It is reported that Dr. Koch is treating many patients, promising much and charging well.” To this Dr. Koch retorted that only about 30 per cent. of his patients had “contributed.” The rest were treated free.

The Wayne County Medical Society Bulletin for Jan. 5, 1920, was devoted almost exclusively to another discussion of Dr. Koch’s “cancer cure.” It was there stated that a second committee had been appointed to gather what information could be obtained from outside sources relative to cases treated by Dr. Koch. This committee reported that of fifty-six cases of which it was able to obtain data, only three of the patients showed clinical improvement; twenty-one of the patients were dead. Three more patients treated both by the Koch injections and by operation were reported as clinically improved. The condition of eighteen of the patients was reported as stationary, or unimproved. In eleven of the cases, the results were unknown but the surgeons reported unfavorably.

The committee reported further that Dr. Koch’s records were incomplete and that he had submitted no proof that his injections have any particular merit and the committee concluded that the study “is entirely experimental and improperly supervised.”

Evidently, the most that can be said of Dr. Koch’s alleged “cure” for cancer is that the claims made for it have not been supported by independent investigators.--(_From The Journal A. M. A., Feb. 12, 1921._)

Further Comment

Last week some space was given to the alleged cure for cancer put out by Dr. William F. Koch of Detroit. Incidentally, it should be mentioned that Dr. Koch’s article of Oct. 30, 1920, to which reference was made, appeared not in the _New York Medical Journal_, as stated, but in the New York _Medical Record_.

The following correspondence throws additional light on the subject:

_To the Editor_:--To the number of inquiries which you have received
regarding the alleged cure of cancer by Dr. Koch, permit me to add
the following personal experience. On July 1, 1920, I was asked to
examine an ex-patient of mine whom I had not seen professionally for
many years. Her husband frankly told me that for several months his
wife had been treated by Dr. W. F. Koch for inoperable carcinoma of
the pelvic organs, that he wished Dr. Koch to retain charge of the
treatment but hoped I would give my opinion regarding certain nervous
manifestations in the patient which were causing him (her husband)
much concern.

At the same time, he showed me a letter written by Dr. Koch
purporting to explain the symptoms and offering suggestions regarding
treatment. I called on the patient and found her in the last stages
of generalized carcinomatosis. Simple palpation of the abdomen
revealed multiple nodules involving both lower and upper abdominal
quadrants. I did not feel justified in making a pelvic examination
but noted a profuse foul-smelling discharge on the vulvar pad. My
prognosis did not meet with the deluded husband’s approval. The
patient died within a week and a necropsy confirmed the clinical
picture of carcinomatosis. Enclosed is Dr. Koch’s letter; the
patient’s name should, of course, be omitted if you see fit to
publish this note.

George de Tarnowsky, M.D., Chicago.

The letter from Dr. Koch which Dr. de Tarnowsky enclosed with his own, follows. We have, of course, deleted the name of the patient.

_Dear Doctor_: Mrs. ---- has absorbed and is still absorbing some
killed tumor tissue. She has absorbed some three pounds, I judge.
The results of the absorption are intoxication quite general
(nervous, muscular, perhaps nephritic). The myocardium at present
shows no signs of poisoning but the skeletal muscles and nerve
do. The important toxin liberated by the killed tissue is methyl
cyanimide which combines ammonia (NH₂) from the amino acids, and
thus becomes methyl guanidine. This latter has produced in my
patients an intoxication varying in similarity to: idiopathic
tetany in children, chorea in children, eclampsia in women, and
has even been so severe as tetanus in some of the muscle spasms; a
toxic albuminuria has resulted in some of my cases.

All of my cases have cleaned up so far. Of course, I cannot predict
in any individual case, except that when the absorption has been
completed and the toxin all eliminated, everything should return to
normal, unless the toxin has destroyed tissue beyond physiological
repair. My suggestions as to treatment would be elimination, saving
the kidneys as much as possible, by whatever methods you find best
and necessary.

At present I am treating symptomatically thus--atropin as a
guanidine antidote, arsenic as a chorea coupled antidote as a
prevention to the production of guanidine from the cyanimide, the
use of dilute hydrochloric acid has proven successful to me. Even
a urine boiling solid--albumen has cleared up in one case in three
days just by taking large quantities of 1/2 per cent HCl. I am
explaining the factors I have contended with in these cases, but
do not want to influence your plan of treatment when your judgment
finds me insufficient.

Sincerely,

Wm. F. Koch.

I shall have a publication out very soon on the treatment of these
tetanics and eclampsia with HCl.

It is worth noting that this letter of Dr. Koch’s was written June 28, just three days before Dr. de Tarnowsky saw Mrs. ---- and less than a week before she died of generalized carcinoma.

Not the least important element in the story which these two letters tell is the optimism engendered in the husband of the poor cancer patient by the widely vaunted treatment of Koch. And herein lies one of the most pernicious features connected with the exploitation of alleged cures for cancer, tuberculosis, etc. All such remedies, whether fraudulent both in their inception and exploitation or those which while equally worthless are at least honestly put forward and are based on a certain amount of scientific investigation, produce a profound and marked temporary change in the patient’s condition. It is this that tends to warp the judgment not only of the unscientific layman, but also of the physician. The psychic element in cancer has been well described by Weil:

“It is, indeed, very remarkable that a patient who has been consigned
to death as a victim of a hopeless malady, should regain his spirits
and his appetite, when he is again confronted with the hope of a
cure, and of the eradication of his disease? It is a phenomenon
well known to every student of the disease that a large proportion
of cases responds in just this manner to any treatment which is
offered them. Osler has described a case of cancer of the stomach
in which the mere visit to a consultant of sanguine temperament,
though poor judgment, whose assurance of the patient that there
was no possibility of cancer, resulted in the disappearance of all
the symptoms and a gain of 18 pounds in weight. It is this psychic
influence, which has occasionally deluded the honest student of
cancer cure, and which has also so generously played into the hands
of the dishonest.”--(_From The Journal A. M. A., Feb. 19, 1921._)

THE LUCAS LABORATORIES’ PRODUCTS

The Journal has received several inquiries about the products put out by the Lucas Laboratories, Incorporated, of New York City. A typical inquiry is that received from Dr. F. A. Jewett of Brooklyn, who writes:

“The enclosed circular is sent out to the medical profession by Dr.
William Lucas, 287 W. 70th St., New York. What do you know of this
man and his methods?”

William H. Lucas was graduated by the Medical College of Ohio in 1895 and was licensed in 1897. He is not a member of his local medical society. The products put out by the Lucas Laboratories are for intravenous use, and their method of exploitation indicates that the concern is less interested in the science of therapeutics than it is in taking commercial advantage of the present fad for intravenous medication. The Journal has protested editorially against the unnecessary use of the intravenous administration of drugs, and the abuse of this method of drug giving prompted the Council on Pharmacy and Chemistry recently to emphasize the danger of indiscriminate intravenous medication.

The products of the Lucas Laboratories, Inc., have not been examined either by the A. M. A. Chemical Laboratory or by the Council on Pharmacy and Chemistry. The composition of these products is essentially secret, which in itself should be sufficient to deter physicians from using them. Of course, in accordance with all the tenents of orthodox nostrum exploitation, “formulas” are furnished. Even the crude hieroglyphics that used to be palmed off on the medical profession by nostrum exploiters under the guise of “graphic formulas” are outdone by the Lucas Laboratories in publishing the alleged formulas of its preparations. If we, as physicians, knew more chemistry, the Lucas Laboratories would not find it profitable to publish such ineffable nonsense as that which characterizes their “literature.” For instance:

“‘Luvein’ Arsans (Plain)” is said to be: “Di hypo sodio calcio
phosphite hydroxy arseno mercuric iodid.” The first part of this
“formula” might stand for sodium and calcium hypophosphite. The
remainder is meaningless except that it suggests (but does not
insure) the presence of arsenic and mercury iodide.

“‘Luvein’ Arsans, Nos. 1, 2 and 3.”--“Meta hydroxy iodide sodio
arsano mercuric dimethyl benzo sodio arsenate, ai oxy sodio tartaria
sulpho disheuyl hydrazin.” Who can venture even a conjecture as to
the possible significance of this?

“‘Luvein’ Creosophite.”--“Ammonio hydroxy calcio sodio hypo-phosphite
arsenous pentoxy iodide.” While the name suggests creosote, the
“formula” gives no hint of this. It might refer to hypophosphites of
ammonium, calcium and sodium with iodide of arsenic. Whether arsenous
(trivalent arsenic) or arsenic (pentavalent arsenic) iodide or both
are intended, is a question.

“‘Luvein’ Hexacol.”--“Hexa methylenepyro catechin mono methyl amino
ether glycerite.” By moving these syllables around like the old
“fifteen puzzle” they can be arranged to represent hexamethylenamin
and monomethyl-ether of pyrocatechin, or guaiacol, having the
“glycerite” left over.

It is futile to discuss the therapeutic claims made for the various preparations put out by the Lucas Laboratories. One might as profitably discuss the therapeutic claims made for “Peruna” or “Paine’s Celery Compound” for the exploitation of the latter products is on just as high a scientific plane as the exploitation of the “Luvein” nostrums. The proposition offered to physicians by the Lucas Laboratories, Inc., is an insult to the intelligence of the medical profession. Not that the products themselves are necessarily any worse or any better than many offered for intravenous use; the selling methods are more crude, that is all.

The facts are, we have entered a new cycle of nostrum development. The unscientific mixtures for oral administration that characterized so large and disreputable a part of the proprietary medicine business of the past two or three decades are giving way to equally unscientific mixtures for intravenous use. The dangers of the older nostrums are accentuated in the newer by the added element of risk that is inseparable from intravenous therapy. Add to this the temptation to the physician in the way of more substantial fees which, legitimately enough, may be charged when intravenous administration is called for, and the menace of the new style nostrum becomes evident. The Journal can only reiterate the warning that intravenous therapy should be employed only when most positively indicated. Further, because of the danger that is inseparable from this method of drug administration, physicians should be doubly careful to see that products employed for intravenous use come from firms of unquestioned scientific standing.--(_From The Journal A. M. A., Sept. 20, 1919._)

“PHYLACOGENS”[L]

[L] This matter was largely reprinted in the Propaganda for Reform, eighth and ninth editions.

A physician in Florida writes:

“I am enclosing a copy of a circular letter just received from
Parke, Davis & Company, and will call your attention to a marked
paragraph in this letter on which I would like to have an
expression of your opinion.”

The circular letter which the doctor forwards is devoted to singing the praises of “Pneumonia Phylacogen.” It opens with the statement: “Influenza, we learn, has appeared in your section.” The paragraph marked by our correspondent reads:

“Pneumonia Phylacogen has been found to be a dependable means of
preventing and treating pneumonic complications of Influenza. In
one large city it became a routine measure to give all persons
affected with Influenza an injection of Pneumonia Phylacogen as a
prophylactic of pneumonia. The results were remarkable. Not only
did the cases improve rapidly, but in a great majority of them the
pneumonia did not occur.”

The “Phylacogens” were repeatedly discussed in The Journal during 1913 and 1914 when these products were being pushed with much vigor by the manufacturers. We know of no evidence that calls for a revision of the statements then made regarding them. The injection of phylacogens is simply the administration of a mixture of the filtered products of several bacterial species. The results which follow represent the reaction of the bacterial protein--a reaction for good or evil. There is no scientific evidence to show that they possess any specific prophylactic virtue. To recommend their use in cases of influenza, as a prophylactic against pneumonia, is unwarranted, and the physician who acts on the advice of the manufacturer must assume the responsibility for the results. In case of mishap he cannot fall back on the manufacturer; he will find no scientific evidence to support him.--(_From The Journal A. M. A., Nov. 15, 1919._)

PINEOLEUM ADVERTISING METHODS

Capitalizing the Name and Position of the President of the
American Medical Association

_To the Editor_:--Enclosed is a postal card which a physician in Oklahoma has sent me together with thirty-six cents in stamps. The envelop was addressed to me at the address of the Pineoleum Company. The postoffice corrected the address and sent it to me. It is evident, therefore, that the physician in Oklahoma thought I was sending these postals as an employee of the Pineoleum Company, or, at least, was endorsing their products.