Chapter XXXVII: Part III: Contributions From the Journal: Proprietary Products (5)

+---------------------------------------------------------------------+ | _TREATMENT OF INFLUENZA_ 408-10-12 West 13th Street | | By A. LAMBERT, M. D., New York. Pres. A. M. A. New York City | | | | Dear Doctor: | | | | “The ‘Flu’ is coming back in October to scourge the whole world. | | I expect the plague to come back as soon as people begin to live | | indoors again. The death toll Will be serious, but I do not | | expect it will be as bad as it was last winter.” | | | | --Dr. Royal S. Copeland, _Chief of the New York Health Department_. | | | | “The persistent spraying of the nose and pharynx with some form of | | silver salt, or some form of mild disinfectant, materially aids in | | confining the infection in its early stages to the upper passages, | | and this procedure gives the impression, when tried in a large | | number of patients, that it prevents in many cases the spread down- | | ward into the bronchi and thus limits pulmonary complications.” | | --Extract from “The Treatment of Influenza,” by A. Lambert, M.D., | | in the Journal of the American Medical Association, August 2nd, | | 1919. | | | | =We have letters from a large number of physicians confirming the | | above extract, and with the further statement that as a _preventive_| | and _relieving_ agent there is no combination before the profession | | today so satisfactory as Pineoleum.= | | | | =If you have not received recently, a complimentary Outfit, return | | this card with 36 cents in stamps and we will forward a regular | | $1.00 package by prepaid Parcels Post.= | | | | _THE PINEOLEUM COMPANY_ | +---------------------------------------------------------------------+

Postal card capitalizing the name and position of the President of
the American Medical Association.]

Kindly do me the favor to publish this letter in The Journal as a protest against the dishonesty of this method of advertising. What is quoted from an article that I wrote appeared originally in the _New York State Journal of Medicine_ and was abstracted in The Journal of the American Medical Association of August 2, 1919. The obvious inference to be drawn from this postal is that I referred to the products of the Pineoleum Company in that article. I did not have the products of the Pineoleum Company in my mind. I never have used their products and never prescribed them.

This form of advertising is done with intent to deceive and did deceive the doctor in Oklahoma. It was therefore a successful falsehood, its success depending on the false use of the name of the President of the American Medical Association to bolster up the sale of the product.

I resent the use of my name in connection with the quack advertising of nostrum venders. The low, vulpine cunning of the method used is on the same level as the deceit and dishonesty which use this form of advertising to the injury of my name and reputation. As President of the American Medical Association I must insist that you protect me by publishing this letter in The Journal, giving it as widespread publicity as possible.

Alexander Lambert.

[Comment.--“Pineoleum” is a “patent medicine” advertised in the cheapest and most effective way--by the aid of the easy going and complacent physician. In 1906 Pineoleum was being marketed by the Winslow Laboratory of New York City, which also put out three or four other nostrums--“Morumalt,” “Egeriol,” “Digestylin,” and “Ford’s Nucleo-Peptone.” Pineoleum was advertised to the public then as it is advertised now, via the medical profession. Physicians are circularized and are offered a petty graft in the form of a cheap nebulizer and a sample bottle of Pineoleum. Some time ago the company seems to have developed a scheme whereby physicians could make money “dispensing Pineoleum nebulizer outfits at more than 140 per cent. profit.” The Pineoleum concern for years has also polluted the stream at its source by attempting to get the secretary of the senior class of every medical school to distribute its free nebulizer outfits to members of the class and receive therefor 5 cents for each outfit distributed! The life history of Pineoleum is that of the typical nostrum. Epidemics, of course, are utilized as opportunities for pushing the product. In 1911 a card was sent out featuring “A Special LaGrippe Offer”; in 1916 the profession was circularized recommending Pineoleum as “The Ideal Prophylactic” in infantile paralysis; during the past year influenza has again been the selling point.

The case described by Dr. Lambert is not the first example of the misuse of names and statements of physicians. Last December the Pineoleum concern was sending out an advertising card in which Dr. McCoy of the United States Public Health Service was quoted as recommending Pineoleum as the “bulwark of prevention” and “battery of relief” in influenza. Of course, Dr. McCoy never said anything of the sort. A protest against this particular falsehood resulted in another card being sent out several months later by the Pineoleum people purporting to explain and apologize for the misquotations and putting the blame on the printer. The “apology” ended with a postscript (in larger and bolder face type than the body of the card) that urged physicians to “secure our liberal introductory advertising proposition on improved oil nebulizer outfits.” From the standpoint of publicity for Pineoleum, the “explanation and apology” was doubtless as good an advertisement as the original card of misrepresentation.--Ed.]--(_From The Journal A. M. A., Nov. 1, 1919._)

“PROTEAL THERAPY” AND HENRY SMITH WILLIAMS

_To the Editor_:--Will you please advise as to the success and
safeness in using the Proteal treatment for tuberculosis by Henry
Smith Williams, M.D., LL.D., 104 East 40th Street, New York?

C. P. Burchard, Alamogordo, N. M.

_To the Editor_:--Kindly send me any available information on
“The Proteal Treatment for Cancer.” An article by Dr. Henry Smith
Williams, 120 West 32 Street, New York City, in April _Hearst’s_
has caused relatives to request its use in a case of carcinoma of
the liver under my care.

M. M. Reppard, Middlebourne, W. Va.

_To the Editor_:--I am enclosing a leaflet, mailed to me on
request, by Dr. Henry Smith Williams of New York City, who
published a series of articles during the last year in _Hearst’s
Magazine_ on “Proteal Therapy.” If you have investigated this man
and his proteal treatment, I should like to know the result of
your findings. I am a consumptive and am, therefore, particularly
interested in its alleged benefactions for the treatment of
tuberculosis.

Michael A. Long, Glen Lake Sanitarium, Hopkins, Minn.

_To the Editor_:--What information can you give me regarding Henry
Smith Williams, M.D., LL.D., 104 East Fortieth Street, New York,
and the therapeutic value of the “Proteal Therapy” that he has
originated?

M. D. Baker, M.D., San Jose, Calif.

The above letters are selected from many received on the subject. Henry Smith Williams is better known in the journalistic world than in the field of scientific medicine. He was graduated by the Chicago Medical College in 1884. In the thirteen issues of medical directories of the United States that have been published during the past thirty years Dr. Williams’ name does not appear--except for the issues of 1890 and 1893--until the 1914 edition. So far as we have been able to find, Dr. Williams had not until 1915 contributed any articles to medical journals. The catalog of the Surgeon General’s Library contains no reference to any articles of Dr. Williams except those that have appeared in popular magazines. The volumes of the Index Medicus from 1907 until 1914, inclusive, also contain no references to any articles by him in medical journals. The Journal‘s author index to current medical literature from 1900 to 1914, inclusive, fails to record any articles by Dr. Williams in medical journals. Dr. Williams’ articles, however, in popular magazines have been voluminous and numerous. Sometimes his articles have been under his own name and sometimes under the nom de plume, “Stoddard Goodhue, M.D.” Under the latter name the _Cosmopolitan_ published articles on “Adding Years to Your Life,” “Battle of the Microbes,” “Do You Choose Your Children?” and “What is the Matter With Your Brain?” Under his own name articles have appeared in popular magazines on such subjects as “Burbank’s Way with Flowers,” “Every Woman Her Own Burbank,” “Why Not Live Forever?” “Science of Breeding Kings,” “New Cancer Treatment” and “New Hope for Rheumatism Sufferers.” In addition, Dr. Williams has published books on such subjects as “History of the Art of Writing,” “Historians’ History of the World,” “Story of Nineteenth Century Science,” “Luther Burbank,” “Twilight Sleep” and others. The Goodhue Company of New York City, which publishes some of Dr. Williams’ books has, we understand, for its president, Dr. Henry Smith Williams, for its vice president, Dr. Williams’ wife, and for its secretary-treasurer, Dr. Williams’ daughter.

Readers of The Journal will remember the publicity given in 1915 and 1916 to an alleged treatment for cancer, sometimes called the “Horowitz-Beebe Autolysin Treatment.” The method was heralded widely both in a certain portion of the medical press and in popular magazines and newspapers. A popular article by Henry Smith Williams on “The New Cancer Treatment” appeared in the _Illustrated World_ for October, 1915, with pictures of Dr. Horowitz, Dr. Beebe, etc. A month or two later, physicians received, gratis, from the Goodhue Company a neatly bound little book on “Alcohol Hygiene and Legislation,” by E. H. Williams, M.D. (brother of Henry Smith Williams). Enclosed with it was a letter from the Goodhue Company asking physicians to accept the book. The body of the letter was devoted to calling the attention of physicians to an “important work” by Dr. Henry Smith Williams on “The Autolysin Treatment of Cancer” that the Goodhue Company was publishing. With the letter, there was a small advertising pamphlet “Issued by the Autolysin Laboratory” and advertising that product. In addition, the last thirteen pages of the book on “Alcohol Hygiene” contained advertisements of the Goodhue Company’s publications with particular emphasis (four pages of it) on the “Autolysin Treatment of Cancer,” by Henry Smith Williams.

In May, 1917, physicians in the West received a letter from the “Ellison-White Chautauqua System” informing them that Dr. Henry Smith Williams was to lecture at “your Chautauqua” and reminding them that “he has recently issued two volumes, ‘The Autolysin Treatment of Cancer’ which he believes will be his greatest contribution to medical science.” The present “Proteal” treatment appears to be a modification of the “Autolysin” treatment. Dr. Williams, in attempting to justify the use of his “Proteal” in tuberculosis, cancer, rheumatism, etc., takes advantage of certain investigations bearing on the nonspecific reactions resulting from the parental injection of foreign proteins. So far as we can discover, there is no scientific evidence to indicate that the “Proteal” treatment expounded by Williams is of value in the treatment of cancer, tuberculosis or the other numerous diseases for which the “Proteals” are recommended.

It is a question whether such articles as those on “The Proteal Treatment of Cancer,” “New Hope for Rheumatism Sufferers,” etc., published in popular magazines or newspapers serve any useful public purpose. May they not, on the contrary, by raising false hopes, cause much mental suffering and do scientific medicine great harm?--(_From The Journal A. M. A., July 6, 1918._)

PROTEOGENS

Commercial Therapeutics[M]

[M] See index for additional articles on proteogens.

A report of the Council on Pharmacy and Chemistry that appears elsewhere[253] in this book deals with another attempt to foist on our profession a series of essentially secret preparations whose therapeutic value has not been scientifically demonstrated. Grotesquely extravagant claims are advanced as to the therapeutic potency and range of action of substances of whose nature and effects we have no trustworthy information. Physicians are advised to use--and many undoubtedly are using--these alleged remedies in the treatment of diseases in which delay in the proper kind of treatment may be of the greatest danger to the patient. As stated, there is available no reliable information regarding the effects of these substances when they are introduced in the human body. They may have no effect whatever, or they may produce more or less direct injury; in either case, there is the chance that damage, even irreparable to the patient, may result because rational treatment is withheld.

[253] Page 227.

If we accept the statement that the preparations are largely vegetable proteins, it is a fair inference that, under certain conditions, they may cause a febrile reaction of the same general nature as that caused by other foreign proteins when injected into the body. We know that such reactions are not without danger and that the treatment of certain infections by induced reactions to foreign proteins is strictly an experimental procedure to be undertaken only under very special conditions. There is, therefore, no known valid reason why a physician should assume the responsibility for using these alleged remedies in the treatment of his patients; there is a very obvious reason why he should not--the therapeutic instructions of “the House of Merrell, always interested in the progress of plant therapy” to the contrary notwithstanding. It is the old story of exploiting physicians through commercial pseudoscience; of trading on the credulity of the profession to the detriment of the public. As Osler[254] recently protested so vigorously:

[254] Advance pages, the Oxford Medicine, 1919, Vol. 1, Part. 3, p. 245.

Some time ago a pamphlet came from X and Company, characterized by
brazen therapeutic impudence, and indicating a supreme indifference
to anything that could be called intelligence on the part of the
recipients. That these firms [manufacturing pharmacists] have the
audacity to issue such trash indicates the state of thraldom in
which they regard us. And I would protest against the usurpation
on the part of these men of our function as teachers. Why, for
example, should Y and Company write as if they were directors of
large genito-urinary clinics instead of manufacturing pharmacists?
It is none of their business what is the best treatment for
gonorrhea--by what possibility could they ever know it, and
why should their literature pretend to the combined wisdom of
Neisser and Guyon? What right have Z and Company to send on a
card directions for the treatment of anemia and dyspepsia, about
which subjects they know as much as an unborn babe, and, if they
stick to their legitimate business, about the same opportunity of
getting information? For years the profession has been exploited
in this way, until the evil has become unbearable, and we need as
active a crusade against the pseudoscience in the profession as
has been waged of late against the use of quack medicines by the
public. We have been altogether too submissive, and have gradually
allowed those who should be our willing helpers to dictate terms
and to play the rôle of masters. FAR TOO LARGE A SECTION OF THE
TREATMENT OF DISEASE IS TODAY CONTROLLED BY THE BIG MANUFACTURING
PHARMACISTS, WHO HAVE ENSLAVED US IN A PLAUSIBLE PSEUDOSCIENCE.

What shall the profession do to protect itself against this humiliation--to throw off the credulity that extols pseudoscience and makes commercialized empiricism financially profitable? Osler says the remedy is obvious: “Give our students a firsthand acquaintance with disease, and give them a thorough practical knowledge of the great drugs, and we will send out independent, clear-headed, cautious practitioners who will do their own thinking and be no longer at the mercy of the meretricious literature, which has sapped our independence.” Excellent! But must humanity wait a generation? Why not stop this evil at once? The American Medical Association has provided the means whereby this can be done, if physicians will only make use of it--the Council on Pharmacy and Chemistry.--(_Editorial from The Journal A. M. A., July 12, 1919._)

An Alleged Endorsement of Proteogens Repudiated

_To the Editor_:--I note in the issue of The Journal for July 12, a statement regarding the so-called “Proteogens” manufactured by the Wm. S. Merrell Company of Cincinnati.

My attention has been called to the fact that salesmen of this company have been exhibiting a letter purporting to show that this department has endorsed their products in the treatment of venereal diseases. The letter in question was written by a physician employed in one of the clinics conducted jointly by this department and the U. S. Public Health Service, and the stationery of the department was used without authority. The physician in question has made numerous efforts to recall the letter, but the Merrell people profess an inability to control its use.

I need not add that this department has not endorsed and will not endorse these products, and has no evidence that they are of any value whatsoever.

Allen W. Freeman, M.D., Commissioner of Health,
State of Ohio, State Department of Health.

--(_Correspondence in The Journal A. M. A., July 26, 1919._)

The Manufacturer’s Protest and a Reply

_To the Editor_:--Allow us to direct your attention to several misstatements which appear in the letter signed, “Allen W. Freeman, M.D., Commissioner of Health, State of Ohio,” published in The Journal of the American Medical Association for July 26.

1. Salesmen of this company have _not_ been exhibiting a “letter purporting to show that this department has endorsed their products in the treatment of venereal diseases,” as stated by Dr. Freeman.

2. The author of the letter has _not_ “made numerous efforts to recall the letter, but the Merrell people profess an inability to control its use,” as stated by Dr. Freeman.

A physician employed in one of the clinics used our Proteogens Nos. 10 and 11 extensively and is still using them to a large extent in his private practice. He is a man of standing in the community in which he practices and is also a professor in one of the leading medical colleges in the state.

The letter in question cites the case of a man who had been under treatment for three years with 606, 914 and most of the other treatments in general use, and on August 31, a year ago, still gave a Wassermann test plus 4. He was given Proteogen No. 10, and by the middle of December the Wassermann was negative and the man was discharged as cured.

While this letter was written on the stationery of the Bureau of Venereal Diseases of the Department of Health, State of Ohio, it was written in the first person, and made no pretension in any way to being official nor was any such pretense made or authorized by the Merrell Company.

The author of the letter has _not_ made “numerous efforts to recall the letter,” nor has the Merrell Company “professed an inability to control its use.”

The physician did ask that the letter be returned to him, and his request was complied with promptly.

[Then follows the full text of the letter in question. As its contents have no bearing on the question under discussion, it is omitted.--Ed.]

In over ninety-one years of honorable service as manufacturers of medicinal preparations, the Wm. S. Merrell Company has never endeavored to advance its interests through misrepresentation.

The Wm. S. Merrell Company,
Chas. G. Merrell, Pres.

[The letter above was submitted to Dr. Allen W. Freeman, Commissioner of Health of the State of Ohio. Dr. Freeman’s comments appear below.--Ed.]

_To the Editor_:--The plain issue of veracity raised in the communication of the Merrell Company must be settled on the evidence, which is unfortunately too voluminous to be published in full in The Journal. Copies of the correspondence in the case have been furnished the editor, and the originals are on file in the office of the state department of health in Columbus.

1. Whether or not the photographic reproduction of a letter written on the letter head of this department, and the distribution of copies to salesmen for display to physicians, was a conscious effort on the part of the firm in question to create the impression that the letter was an official one is perhaps a matter of inference. That it did create such an impression is evidenced by the letters of inquiry received from physicians who saw it.

2. The statement that the Merrell Company refused to return the _letter_ is perhaps erroneous. They did apparently return the original letter but not the _photographic copies_ which had been distributed to their salesmen. On May 22 the firm wrote as follows:

“A number of physicians who are in cooperation with both state
and national bureaus of venereal diseases have been using our
Proteogens with marked success and there are doubtless many letters
carried by our salesmen--reports from some of these physicians.”

This was interpreted to mean that the firm had no method of knowing what letters were carried by their salesmen and was not responsible for them. Whether or not this interpretation is correct is again, perhaps, a matter of opinion.

The purpose of the original communication was to make plain to those of the profession who have already seen or might subsequently see the letter referred to that the communication was the expression of an individual and not of the Department.

A. W. Freeman, Commissioner.

--(_Correspondence in The Journal A. M. A., Sept. 6, 1919._)

Details of the Alleged Endorsement of Proteogens

Our readers will remember the recent correspondence published in The Journal of July 26 and September 6, by Dr. A. W. Freeman, Commissioner of Health of the State of Ohio and the Wm. S. Merrell Co. The letters dealt with the use that had been made by the Wm. S. Merrell Co. of a letter, written on the official stationery of the Bureau of Venereal Diseases of the State Department of Health of Ohio, puffing one of the company’s proprietary remedies--Proteogen No. 10.

Dr. Freeman wrote to The Journal calling the attention of the profession to the use of this letter and explaining that the letter was merely the expression of opinion of an individual, and not an expression from the State Department of Health. The Wm. S. Merrell Co. took exception to certain inferences made in Dr. Freeman’s letter and in the course of a letter to The Journal regarding this, incorporated the contents of the testimonial letter. The Journal, in publishing the Merrell letter, omitted this testimonial on the ground that the _contents_ of the letter had no bearing on the question under discussion.

We have now received a letter from the company protesting against this omission. The Journal, therefore, takes this opportunity of briefly restating such facts as it has been able to get regarding the entire matter and publishing the letter. The facts are as follows:

1. In February of this year a Cincinnati physician, Dr. C. J. Broeman, wrote to Dr. A. S. Horovitz relative to alleged results with Proteogen No. 10. The letter was written--without authority--on the official stationery of the Bureau of Venereal Diseases of the State Department of Health of Ohio.

2. The Wm. S. Merrell Co. had linen mounted photographs made of Dr. Broeman’s letter and distributed them to their Proteogen detail men. Accompanying these photographic copies was a communication to these detail men describing the photographed letter as one written by:

“... a Cincinnati physician who is now Acting Assistant Surgeon,
U. S. Public Health Service, cooperating with the Bureau of
Venereal Diseases of the Department of Health of the State of Ohio.”

3. The right hand top corner of the official stationery, as can be seen by the reproduction, bore the name of “James D. Bauman, Deputy Commissioner.” Dr. Broeman’s signature was rather illegible and could easily be mistaken, by those not knowing the handwriting of either man, for the signature of Deputy Commissioner Bauman. In at least one instance it was so mistaken, and the physician who was misled wrote to the Director of the Bureau asking whether the testimonial for Proteogen No. 10 which had been shown him by the Merrell detail man was really an official communication.

4. On May 15, 1919, Commissioner of Health Freeman wrote to the Merrell Co. stating that he had been informed that one of the Merrell representatives was using as an advertisement a letter bearing the letterhead of the Bureau of Venereal Diseases of the State Department of Health and what purported to be a report signed by “Mr. Bauman, Deputy Commissioner.”

5. On May 19, the Wm. S. Merrell Co. wrote Dr. Freeman that he was certainly mistaken in regard to the use of any “report signed by Mr. Bauman.” Dr. Freeman then sent to the company the letter he had received from the physician who had mistaken Broeman’s letter for an official letter by Bauman. Although it would seem that this letter and Commissioner Freeman’s protest should have made plain to the Wm. S. Merrell Co., the fact that the letter, incorrectly referred to as Mr. Bauman’s, was in reality Dr. Broeman’s, the company remained silent regarding its use of the Broeman letter and, on May 22, merely reiterated that there had been “no letter circulated by this company containing a testimonial of your Mr. Bauman.” On May 28 (six days later) the Merrell company sent to its Proteogen detail men another general letter, “for personal use of agents,” in which it again called their attention to the “photographic copy mounted on linen” of Dr. Broeman’s letter. This communication to the detail men also declared that it “has been suggested that the further use of Dr. Broeman’s letter might antagonize the State Department of Health” and, therefore the detail men were told to “discontinue using the photographic copy in question” and to return the photographs to the head office.

Here, briefly are the bald facts in the case. The essential point at issue is whether these photographic copies of Dr. Broeman’s letter would or would not be likely--whether or not they were so intended--to mislead physicians into believing that the endorsement was an official one by the State Board of Health rather than an individual one. One can but wonder why, if, as the Merrell company so vehemently asserts, there was no intention of misleading physicians on this point, the company should have gone to the trouble and expense of _photographing_ the entire letter, including the letterhead, rather than making typewritten or mimeographed copies of the _contents_ of the letter.--(_From The Journal A. M. A., Sept. 27, 1919._)

Dr. Broeman’s Final Report on Proteogens

_To the Editor_:--In the September 27 issue of The Journal my name was mentioned in connection with the Merrell Chemical Company’s “Proteogens” in the treatment of syphilis. The Merrell Chemical Company promised not to use my name at any time in connection with their “Proteogens” injection and they know that the use of my name has been distinctly against my wishes. I feel that in justice to myself, as well as the public, I should report the result of my experiments with their “Proteogens” in private practice.

In explanation I might say that I began the use of their “Proteogens” in April, 1918, and I feel that I now have enough data to give a complete report. I might say that all my results have been practically nil; particularly is this true in my cases of syphilis, which all had a four plus Wassermann reaction when I discontinued using this form of treatment.

Very truly yours,

C. J. Broeman, M.D., Cincinnati.

--(_Correspondence in The Journal A. M. A., Oct. 11, 1919._)

PULVANE

In a twelve-page pamphlet, sent out by the Pulvane Laboratories, Inc., of Des Moines, Iowa, and purporting to deal with “The Therapy of Pulvane, an advanced method for the treatment of Respiratory Diseases,” we are told that Pulvane “was developed in a United States Army General Hospital by officers of the Medical Department.”

Pulvane “originally was intended only for its germicidal action upon tubercle bacilli in the lung,” but it is now also recommended for asthma, hay fever, bronchitis, rhinitis, laryngitis and “other affections of the air passages.” Of the alleged action of Pulvane on tuberculosis we read:

“It destroys the spores of the bacilli as well as the germs
themselves. It prevents infection of new areas by aspiration,
gravity or surface contact.

“In cases where sputum is positive it is a very noteworthy fact
that shortly after treatment is begun, the bacilli begin to
disappear, gradually diminish in number, and finally the sputum
becomes negative.”

Pulvane is administered, by inhalation, at the offices of the Pulvane Laboratories, Inc. Its “discoverer” chanced on a method of “introducing into solution and volatizing a certain germicide, extremely rare in its usage because of its resistance heretofore to attempts to bend it to scientific will.” This “rare” medicament is alpha naphthol! But since the discovery of this volatizing method “three other ingredients of high therapeutic value have been added.” What are these other ingredients?

“They would be named were it not that Pulvane requires special
technique in its preparation and administration. Our medical
directors do not consider it advisable to identify them here
because of the possibility of incompetent hands attempting their
use. The medical directors, however, will be glad to name every
ingredient of Pulvane for any reputable member of the profession.
Pulvane Laboratories reserve only the method of compounding.”

Presumably, therefore, if physicians desire to know what Pulvane is, the Pulvane Laboratories, Inc., “will be glad to name every ingredient of Pulvane.” It is worth noting that nothing is said about quantities. It is also worth remembering that “Peruna” and some other “patient medicines” have for years printed on the label the _names_ of the alleged ingredients. How much longer is the medical profession going to be fooled with the trick of nostrum exploiters pretending a frankness that means nothing?

From a recent issue of a Des Moines newspaper we learn that the Pulvane Laboratories are about to establish a sanatorium where the Pulvane treatment can be given. This announcement is said to be made by John P. Mosher, the alleged discoverer of Pulvane. Mosher is not a physician. The newspaper article states, further, that Mosher’s experiments were tried out “under the observation of Major Sharpe,” commander at Fort Des Moines. It appears also that an ex-newspaper reporter is connected with the Pulvane Laboratories. The value of having a good publicity man is obviously recognized. There also seems to be connected with the concern a Dr. Harry P. Hall. We find in the records reference to one Harry P. Hall who was graduated by the Medical Department of Drake University of Des Moines, Iowa, in 1894, and was licensed in Iowa in 1896. Our records indicate that he has not been in practice for some years. We also find in our files some newspaper clippings regarding a Dr. Harry P. Hall who, in 1914, pleaded guilty to a charge of using the mails to defraud and was fined in the federal courts. Whether there is any connection between these two names, we do not know.

Reverting to the claims made by the Pulvane Laboratories that Pulvane was “developed in a United States Army General Hospital by officers of the Medical Department” the following statement has recently been received by The Journal from Surgeon-General Ireland of the United States Army:

“It has been brought to my attention that a concern in Des Moines,
Iowa, known as the Pulvane Laboratories, has issued a pamphlet in
which statements are made which would naturally lead medical men to
believe that the experiments, etc., referred to therein were made
with the approval of and more or less under the direction of the
Medical Department of the Army. I wish to say that this is not so;
that the Medical Department had nothing whatever to do with the
matter and that it thoroughly disapproves of the methods used by the
promoters of this concern.--(_From The Journal A. M. A., March 11,
1922._)

SAL HEPATICA

Sal Hepatica is a saline laxative sold by the Bristol-Myers Company of New York. Little information is given, or, apparently, ever has been given, concerning the composition of this product. Many years ago the stock medical journal advertisement contained this statement:

“_Composition._--Sal Hepatica contains all of the Tonic, Alterative
and Laxative Salts of the celebrated ‘Bitter Waters’ of Europe,
especially those of Bohemia, as determined by actual chemical
analysis of these waters, and fortified by the addition of Lithium
and Sodium Phosphates.”[255]

[255] Some of the Sal Hepatica advertising has claimed that it “is a saline combination with the addition of Sodium Phosphate and _Lithia Citrate_!”

Sal Hepatica no longer “contains all the tonic, alterative and laxative salts ...,” etc., for the label on a package recently purchased reads:

“SAL HEPATICA is an effervescent saline combination possessing
medicinal properties similar to the natural ‘Bitter Waters’ of
Europe, and fortified by the addition of Sodium Phosphate.”

In 1909, the _Druggists Circular_ published an analysis of Sal Hepatica which showed that the preparation contained only 0.04 per cent. of lithium phosphate. By referring to the two quotations just given it will be noticed that today the manufacturers make no claim that their preparation is fortified with any salt of lithium. A circular accompanying recent trade packages states:

“Sal Hepatica is composed solely of harmless salts, being
absolutely free from Acetanilid, Phenacetin, Caffein, Calomel,
opium or coal tar derivatives.”

Since neither the names nor the amounts of the “harmless salts” are mentioned, the composition of Sal Hepatica is secret. It is a trick of the nostrum exploiter, old but ever popular, to mention numerous drugs which his preparation does _not_ contain; it helps to distract attention from the fact that he does not tell what the preparation _does_ contain!

In the old-time medical journal advertisements, one reads, “Sal Hepatica is the most powerful solvent of Uric Acid known.” (The same advertisement as it appeared in those days in The Journal shows that claim toned down to, “Sal Hepatica is a powerful solvent of Uric Acid.”) In those easy going days, the Bristol-Myers Company declared that “diabetes is treated with decided advantage by means of Sal Hepatica ... it ... possesses the property of arresting the secretion of sugar in the liver.” In the old days, too, Sal Hepatica was recommended in the treatment of cirrhosis of the liver, Bright’s disease, gravel, phthisis, etc.

The present advertising circular recommends Sal Hepatica as an eliminant, laxative or cathartic in gout, autointoxication, “Bilious Attacks,” rheumatism, acute indigestion, catarrhal conditions of the stomach, pyorrhea, headache, dizziness, heart burn, “Summer Complaints,” “Derangements of the Stomach and Liver,” skin diseases, colic, alcoholic excesses, and as a “preventive of Seasickness.”

In 1914 the Council on Pharmacy and Chemistry published[256] a report on Sal Hepatica declaring it secret in composition and sold under exaggerated and unwarranted claims.

[256] J. A. M. A., Feb. 7, 1914, p. 472.

In view of the inquiries which The Journal continues to receive it seemed worth while to make a chemical examination of the present-day product. Accordingly specimens were purchased and analyzed in the A. M. A. Chemical Laboratory. The report that follows was submitted by the chemists:

“Sal Hepatica is a white, granular, odorless powder. It effervesces on the addition of water in which it eventually dissolves. The aqueous solution, after boiling to remove carbon dioxid, has an acid reaction to litmus.

“Since a great many medicinal substances are sold in effervescent form, and since practically no information is given by the manufacturer concerning the composition of Sal Hepatica, it became necessary to test for a considerable number of therapeutic agents. The absence of acetanilid, acetphenetidin, alkaloids, ammonium salts, benzoates, caffein, citrates, heavy metals, hexamethylenamin, magnesium, potassium, salicylates and sugars was demonstrated by appropriate tests. The presence of a carbonate (probably in the form of a bicarbonate), a phosphate, a sulphate, a chlorid, tartaric acid, sodium and traces of lithium was shown by qualitative tests.

“Quantitative analysis indicated that the composition of the specimens examined was essentially as follows:

Sodium phosphate, anhydrous 4.4 per cent.
Sodium sulphate, anhydrous 26.5 per cent.
Sodium tartrate, anhydrous 12.7 per cent.
Sodium bicarbonate 19.5 per cent.
Tartaric Acid, free 20.8 per cent.
Sodium chlorid 8.9 per cent.
Lithium phosphate trace
Water of hydration (by difference) 7.2 per cent.

“From the results of the analysis, it appears probable that the composition of the mixture before ‘granulation’ was approximately as follows:

Sodium phosphate 4 per cent.
Sodium sulphate 25 per cent.
Sodium bicarbonate 30 per cent.
Tartaric Acid 30 per cent.
Sodium chlorid 8 per cent.
Lithium phosphate trace
Water of hydration (by difference) 3 per cent.

“Sal Hepatica, therefore, is essentially an effervescing mixture of dried sodium sulphate (Glauber’s salt) and sodium tartrate with a little dried sodium phosphate and table salt added. It is similar to the effervescent artificial Carlsbad Salt described in the National Formulary.

“In 1909 the _Druggists Circular_ published the following analysis of Sal Hepatica:

Sodium phosphate 29.80 parts
Sodium sulphate (Glauber’s salt) 26.27 parts
Sodium bicarbonate (baking soda) 18.00 parts
Sodium chlorid (salt) 13.05 parts
Lithium phosphate 0.04 parts
Citric and tartaric acids (to make 100) 12.84 parts

“A comparison of the recent analysis with the earlier one would seem to indicate that considerable changes have been made in the formula since the first examination. The proportions of sodium phosphate have been greatly reduced, while the sodium bicarbonate and tartaric acid have been increased and the citric acid entirely eliminated.”

Sal Hepatica, then, is a simple effervescent saline laxative, essentially secret in composition and sold under claims that would be laughed at were the full formula of the product a matter of public knowledge.--(_From The Journal A. M. A., Oct. 29, 1921._)

SALICON

“Salicon” is marketed by the K. A. Hughes Company, Boston, as “an improved aspirin.” In a circular sent out to the public a little over a year ago the following claims were made for it:

“We rendered aspirin absolutely harmless and yet retained all its
virtues as a medicine.”

“It positively will not depress the heart nor upset the stomach no
matter how large amounts of it are taken.”

“... the Massachusetts state medical authorities ... adopted its
use at all the state camps for fighting the Spanish influenza....”

The first two statements quoted above are obviously false. The third statement might have been true although it seemed unlikely. A letter was, therefore, written to the Department of Public Health of the Commonwealth of Massachusetts and the claim of the K. A. Hughes Company relative to the adoption of Salicon in all the state camps by the “state medical authorities” was brought to their attention. The reply of the department on this point was emphatic:

“The State Department of Health of Massachusetts did not endorse the use of Salicon for any purpose.”

Some Salicon was purchased on the open market and submitted to the A. M. A. Chemical Laboratory for analysis. Here is the chemists’ report.

“One original bottle of ‘Salicon’ (K. A. Hughes Company, Boston) was submitted by the Propaganda department of The Journal to the Association’s Chemical Laboratory for examination. The bottle contained 100 white tablets having an average weight of 0.407 gram (6.3 grains), each. The amount of ash was 20.9 per cent. Qualitative tests indicated the presence of magnesium, carbonate, starch, acetylsalicylic acid and a trace of calcium; a very small amount of a petrolatum-like substance was present. Alkaloids and drugs used for a laxative effect were not found. The amount of acetylsalicylic acid extracted by chloroform was 50.7 per cent. The amount of magnesium present as magnesium oxid was 14.3 per cent. The amount of magnesium oxid derived from magnesium carbonate U. S. P. is variable; but calculating on the lowest limit, 14.3 per cent. of magnesium oxid is equivalent to at least 35.5 per cent. of magnesium carbonate. This figure agreed closely with that obtained from the U. S. P., method of assay. The acetylsalicylic acid was not combined with the magnesium. From the above, it may be stated that each tablet consisted essentially of a mixture of 3.2 grains of acetylsalicylic acid (aspirin), 2.2 grains of magnesium carbonate and some starch. Although labeled 5 grains, each tablet did not contain 5 grains of the most active ingredient, acetylsalicylic acid.”

The same old story. An ordinary mixture of well known drugs put on the market as a new discovery and foisted on the public under false and misleading claims.--(_Correspondence in The Journal A. M. A., Feb. 5, 1921._)

SO-CALLED SECRETIN PREPARATIONS

In China the administration of powdered tiger-bone is--or was--a favorite form of treatment in cases of supposed cardiac weakness. The theory is, presumably, that the cardiac strength of the tiger would be a good thing for the patient to acquire. Since many patients have recovered after taking tiger-bone, and no one has proved that they might not have died had they failed to take it, “clinical experience” stands back of the treatment; and where is the skeptic so rash as to challenge that? The Chinese physician believes in his tiger-bone therapy, and, with the best interests of his patient at heart, insists on obtaining absolutely true and authentic tiger-bone. Not satisfied with the assertions of the dealers, the conscientious Chinese physician subjects his tiger-bone to a kind of physiologic standardization. He offers the bone in question to a dog! If it is an ox-bone--a frequent form of substitution--the dog will seize and eagerly gnaw it, whereas, according to all the teachings of Chinese pharmacognosy, if it is a tiger-bone the dog will depart hurriedly with his tail between his legs. Very foolish? Yes! But before we smile superciliously at the Chinese medical man, let us turn to the report of the Council on Pharmacy and Chemistry on “So-Called Secretin Preparations.”[257] After reading this report let us put to ourselves, squarely and honestly, the question: Has the attitude toward secretin therapy, of a certain portion of those who represent Western modern medicine, really been much more scientific than that of the Chinese medical profession toward tiger-bone therapy? On the basis of a hypothesis scarcely less crude and unsubstantiated than that which assumes that tiger-bone is of value in heart disease, it has been assumed that secretin is of value in gastro-intestinal diseases. On the ground of “clinical evidence” scarcely more critical than that exhibited by our confrères in the antipodes, it has been asserted that alleged secretin preparations actually are efficious. Indeed, in one respect the methods of the Chinese physician appear more scientific than those of his Western brethren. To the best of his ability, the Oriental at least makes sure that he is administering genuine tiger-bone; he does not rely on the unverified word of his dealer alone. The American physician has not been making the least effort to ascertain whether his supposed secretin preparations are truly such; and, as a matter of fact, scientific investigation seems to indicate that some of these products contained no secretin at all! Whatever one may think of the validity of his test, the Chinese physician does his best according to his lights. As to “clinical experience,” Dr. Jacobi has well said that some people make the same mistake a hundred times and call it “experience.”--(_Editorial from The Journal A. M. A., Jan. 15, 1916._)

[257] Page 64.

SUCCUS CINERARIA MARITIMA

Another Illustration of One of the Weaknesses of the Federal
Food and Drugs Act

The Walker Pharmacal Company of St. Louis was, we understand, if it is not still, one of the subsidiary concerns of the Luyties Homeopathic Pharmacy Company. It has for years sold a nostrum, “Succus Cineraria Maritima,” under the claim that by simply dropping this stuff into the eye, twice daily, cataract and other opacities of the eye will be cured. For instance:

“... the only remedy for the relief of cataract and other opacities
of vision, which stands before the medical fraternity on a firm
foundation of accomplished results....”

“... possesses a specific power in removing the obstruction to
vision.”

“In this class of cases [cataract] physicians can place reliance
on Succus Cineraria Maritima (Walker) which does not require the
services of a specialist but is simply dropped into the eye with an
ordinary medicine dropper twice daily....”

“... has been used with success in cataract, both lenticular and
capsular, pterygium and opacities of the cornea, softening the
opaque deposits, causing dissolution, and by its stimulating
properties, hastening absorption.”

Succus Cineraria Maritima is advertised to the medical profession in true “patent medicine” style by means of testimonials from doctors, obscure and deceased. The preparation is valueless for the purposes for which it is sold and “has about as much effect on the dissolution or dispersal of opacities due to organic changes in the lens as pouring the same down the back of the patient’s neck!” More than five years ago the Council on Pharmacy and Chemistry reported on the worthlessness of the drug, Cineraria maritima, and, at the same time, The Journal pointed out that the drug would have been forgotten long ago had it not been for the prodigal use of printers’ ink by the Walker Pharmacal Company in advertising its Succus Cineraria Maritima.

These facts are given for the purpose of refreshing the memory of our readers and are but incidental to the object of this article. In due time the federal authorities proceeded against the Walker Pharmacal Company charging that Succus Cineraria Maritima was misbranded under the federal Food and Drugs Act. The government chemists reported that analysis “showed that the product was essentially an aqueous solution of glycerin, boric acid and vegetable drug extractives carrying tannin-like bodies.” The direct and inferential claims made in the advertising matter accompanying the trade package were quoted by the federal authorities, who pointed out that the Walker Pharmacal Company was selling the nostrum under claims that would create in the minds of the purchasers the belief that Succus Cineraria Maritima was a remedy for cataract and other opacities of the eye causing impaired vision and that it was a cure for senile cataract, trachoma, secondary opacities, etc. These claims the government charged were “false and fraudulent in that the same were applied to the article knowingly, and in reckless and wanton disregard of their truth or falsity,” because “in truth and in fact it was not, in whole or in part, composed of, and did not contain, such ingredients and medicinal agents” as would produce the therapeutic effects claimed.

These charges put the matter flatly up to the Walker Pharmacal Company. This company has for years been telling physicians that their stuff _could_ and _would_ do just what the federal authorities insisted it can _not_ and will _not_ do. Did the Walker Pharmacal Company attempt to defend its claims? Did it demonstrate that Succus Cineraria Maritima would cure cataract? Did it produce evidence of the numerous cases of recovery from blindness or partial blindness which must have been available if the preparation had the powers claimed for it? No! The Walker Pharmacal Company in February, 1916, pleaded guilty--and was fined a paltry $10 and costs.

This, however, is not the end of the story. The company was prosecuted because it had published the false and fraudulent claims in the trade package, thus bringing the claims within the purview of the federal Food and Drugs Act. Had the Walker Pharmacal Company confined its false statements to medical journal advertisements, to the circular letters sent to physicians or to any other advertising matter not part of the trade package, it could have snapped its fingers at the Food and Drugs Act.

It was in February, 1916, that the Walker Pharmacal Company pleaded guilty to the charge of making false and fraudulent claims for Succus Cineraria Maritima. In October, 1916, they were still sending out circular letters to physicians urging the use of Succus Cineraria Maritima in the treatment of cataract and enclosing the usual booklet of testimonials claiming cures for cataract and other opacities of the lens and cornea!

Can one conceive a better illustration of the inadequacy of the Food and Drugs Act? The dishonest exploiter of proprietary medicines cares little that the law requires him to keep within certain bounds of truthfulness in the advertising that accompanies the trade package. It isn’t the claims in the trade packages that sell the product; it’s the advertising in medical journals, in circular letters, etc. Yet, the Food and Drugs Act offers no check or curb on false statements or fraudulent claims made for proprietary or “patent medicines” in any other place than the trade packages.

A few weeks ago The Journal called attention to a flagrant case of fraud; and at that time it said, “It is justifiable to assume that when any man, whatever his business, admits in court that he has made fraudulent claims and then continues to make the same claims through channels that are not controlled by penal enactment, that man’s standard of business ethics is such that the public needs protection against it. There are many such men in the ‘patent medicine’ world. The only way in which the public may properly be protected against being defrauded in such cases is for the federal Food and Drugs Act to have its scope extended to cover _all_ advertising of the products coming under the purview of the act.”--(_From The Journal A. M. A., March 17, 1917._)

TEKARKIN

Edward Percy Robinson’s “Cure” for Cancer

From various parts of the country The Journal has received a sixteen page pamphlet, _Therapeutic Leaves_. The publication, which has a saffron colored cover, is said to be published by the National Bio-Chemical Laboratory, Mount Vernon, N. Y. The National Bio-Chemical Laboratory seems to be a style used by Dr. Edward Percy Robinson. The “editorial offices” of _Therapeutic Leaves_ are given as “501 Knox Bldg., 5th Ave. at 40th St., New York,” which is a roundabout way of describing 452 Fifth Ave., the office address of Edward Percy Robinson. The first number (February, 1921) of _Therapeutic Leaves_ gives the names of the “editors” as “E. P. Robinson, M.D., and W. A. Jenner, B.A.” In addition, there is “Assistant Editor, F. J. Geiger,” and “Gen’l Manager, Beverly K. Robinson.” The first and second numbers of _Therapeutic Leaves_ (February and March, 1921) are practically identical, being evidently printed from the same plates. _Therapeutic Leaves_ purports to be a periodical published as “a medium for the dissemination of knowledge, pertaining to therapeusis.” Actually, it is an advertising medium dealing with the products of the National Bio-Chemical Laboratory: “Osmo-Calcic Solution,” “Tekarkin” and “Osmotic Mangano-Potassic Solution.”

These preparations are said to be the “formulas” of Dr. Edward Percy Robinson who lives in Mt. Vernon, N. Y., and has an office at 452 Fifth Ave., New York City. They are used by Dr. Robinson in the treatment of cancer. At an earlier stage they seem to have been known under different names: “Tekarkin” was first “Hypotonic Sal-Cella” and then “Neoanabolin-X;” “Osmo-Calcic Solution” was “Osmotonic Calcic” while “Osmotic Mangano-Potassic Solution” was “Osmotonic Drops.” The three solutions are put up in one package containing 4 c.c. (about 65 minims) of “Tekarkin” and 1 ounce each of the other preparations. The package sells for $10.00. “Remittance with order ... We have no agents.”

Most of the material in _Therapeutic Leaves_ is a rehash of four papers published by Edward Percy Robinson in the New York _Medical Record_ of various dates between September, 1917, and July, 1920. In these Robinson advances the theory that cancer is caused by an excess of sodium chlorid (table salt) in the blood and tissues and that it can be cured by administering a solution of potassium nitrate. Such a treatment sounds ideally simple. One might assume that all that was necessary was to make up a solution of potassium nitrate and inject it. One might further wonder how it would be possible to commercialize such a “treatment.” “Homemade solutions,” says Dr. Robinson, “are apt to be disappointing.” Their use is likely to cause “considerable swelling at the site of an injection, accompanied with tenderness and some heat.” Moreover, “a wide hyperemic area with red blotches has been observed in a number of instances.” In order to avoid “accidents of this sort” which would “bring discredit upon an excellent agent,” Dr. Robinson, “after considerable experimental work” has obtained “a solution of this chemical which would meet the ideal requirements.” This is available under the name “Tekarkin.” Dilute potassium nitrate solution sold under the name “Tekarkin” sells for $67 an ounce. The physician can make his own solution, of the purest and highest grade potassium nitrate on the market, at an expense, for the chemical, not exceeding 5 cents an ounce.

_Therapeutic Leaves_ also contains the usual number of those “clinical reports” which bulk so large in the literature of “cures” for cancer. Then there is a full page advertisement of a side-line of the National Bio-Chemical Laboratory: “Vitamines (Compressed) Tekarkin Brand;” “They have a meaty taste.”

The medical profession, naturally, is interested in knowing more about the physician who admits that he has discovered the cause and cure of cancer. According to our records, Edward Percy Robinson was born in 1871 and was graduated in 1897 by Bellevue Hospital Medical College. He was licensed in New York State the same year and has practiced in New York City continuously since that time. He is not, and apparently never has been, a member of his local medical society.

In 1914 Robinson was specializing in “facial contouring.” One piece of advertising purports to be the reprint of an interview with “Dr. E. P. Robinson, Specialist, as he sat in his office at 116 West 39th Street, having questions fired at him by the reporter.” Thus Dr. Robinson: