Chapter XLVIII: Part II: contains descriptions of drugs. This is a new feature. The (3)

Hawk and his associates (Hawk, P. B.; Knowles, F. C.; Rehfuss, M. E., and Clarke, J. A.: The Use of Bakers’ Yeast in Diseases of the Skin and of the Gastro-Intestinal Tract, The Journal, Oct. 13, 1917, p. 1243) have recently called renewed attention to its laxative qualities. When from one-half to one cake of yeast was given three times daily before meals, it produced regular bowel movements in a number of patients suffering from constipation. That this result is not due to any vital processes in the yeast is shown by the fact that yeast killed by boiling water was employed with success. It is suggested that such yeast might be preferred for patients troubled with flatulence. Aside from the tendency of living yeast to produce diarrhea, and the possibility that it may aggravate flatulence, no digestive disturbance has been charged against it. Aaron, in his “Diseases of the Digestive Organs,” speaks favorably of its use in atonic constipation.

The much debated question whether yeast may serve as a food can be answered in the affirmative in view of such work as that of the Germans on “Nährhefe”--yeast food (Schottelius, _Deutsch. med. Wchnschr._, July 8, 1915, p. 817) and Boruttau (_ibid._, July 29, 1915, p. 924) and of Hawk and his associates. There is no reason to assume that weight gained under its use would be more readily lost than weight gained from any other food. However, in view of its laxative action, the average individual can ingest only from 1 to 2 gm. of nitrogen a day in this form. This obviously greatly limits its value as a food. Owing to its high nuclein content, it is contraindicated in gout.

As a source of water soluble growth promoting as well as antineuritic vitamin, yeast has become thoroughly established as the result of the recent works of numerous investigators. However, as such common foods as milk, rice, wheat, oats and beans also contain such vitamin, there is little likelihood of its proving of therapeutic value on that account. In other words, yeast and other vitamin containing foods have specific growth promoting qualities only when the stunting is due to lack of vitamin. A minute amount of this substance suffices to produce maximal results. More is of no use. Hess (_Proc. Soc. Exper. Biol. & Med._ =13=:145, 1916) found yeast of no value in infantile scurvy.

The most important question in connection with yeast therapy is to what extent it is endowed with “antibiotic” power, that is, to what degree it is capable of inhibiting the growth of other organisms. That this frequently occurs in cultures in vitro is shown by the fact that yeast contamination may practically eradicate the growth of certain other organisms. That, on the other hand, this is not true for all forms of bacterial life is shown by the fact that there is definite symbiosis between yeast and lactic acid bacilli (Northrup: _Soc. Tech. Bull._ 15, Mich. Agr. Expa. Sta., 1912).

That its “antiseptic power is, on the whole insignificant” has been shown by Palier (_Diet. & Hyg. Gaz._, March, 1906), who found commercial yeasts commonly contaminated with numerous bacteria, the most frequent being _Bacillus coli-communis_ or one of its congeners. An antagonistic action by yeast is claimed against _Staphylococcus pyogenes_, and on the strength of this, Buchholtz (Ueber Acne und eine neue erfolgreiche Behandlung derselben, _Berl. klin. Wchnschr._, Feb. 2, 1914, p. 215) employed it locally in the treatment of acne and obtained a positive but temporary effect. He believes that the effect is improved by the combination of yeast with an equal quantity of boric acid. He employed this as a dusting powder applied freely to the skin once daily, after the application of a thin layer of a boric acid salve (boric acid powder from 40 to 50, glycerin and water, of each 100) to make it stick better. In cases in which the nose was markedly involved, he also used this as a snuff. Yeast poultices have been employed with asserted great benefit in the treatment of wound infection of all kinds (Kempf, E. J.: _Ind. M. J._, September, 1904, p. 97).

The use in leukorrhea was recommended by Hippocrates Abraham (_Mon. Geb. Sym._, 1910) and many others report favorable results from yeast in the treatment of gonorrheal vaginitis. In various gastro-intestinal infections, yeast has been lauded by many, among others, Thiercelin and Chevrey. It has been given by mouth, but most especially in high rectal enemas.

Still more from a theoretical standpoint is the reassertion of the curative value of the oral administration of yeast in various cutaneous disorders. Thus Hawk and his collaborators report cure or improvement in all of seventeen cases of acne vulgaris and eight cases of acne rosacea. They also report seventeen cases of furunculosis, in all but one of which there was cure or improvement from yeast treatment. They are unable to decide whether the result is due to the laxative action, the production of leukocytosis, or to other influences.

Yeast is probably best taken incorporated in food. Hawk and his associates found that yeast may well be incorporated in wheat biscuits, and that in this way a yeast-wheat combination of most agreeable flavor was produced: that, in fact, the biscuits with the yeast tasted better than those without it. They found by tests that in bread making as much as 20 per cent. of the flour might be replaced by dry yeast, and that thereby a loaf would be produced that was excellent in every way and possessed of an attractive flavor. The dry yeast was prepared by desiccating compressed yeast at 105 C. in a current of air, and then milling it to produce a flour of the approximate fineness of ordinary wheat flour. They also found that yeast may be added to meat preparations, such as Hamburger steak, to the extent of 2.5 per cent., yielding a preparation of very satisfactory taste.--(_Query in The Journal A. M. A., Aug. 23, 1919._)

BRIEFER PARAGRAPHS

Laxol and Lysol--The Short and Catchy Proprietary Name

A laborer went to a Brooklyn physician for treatment and was given three prescriptions. One of the prescriptions, according to the _Food and Drug Bulletin_ of the Department of Health, City of New York, called for “Laxol,” the word being written on a piece of blank paper without directions. The drug clerk misread the prescription and dispensed an “original” bottle of “Lysol” which bore the usual poison label with skull and cross bones. The man drank the entire 3 ounces of Lysol and died half an hour later. The case is now in the hands of the District Attorney, the drug clerk being held under $10,000 bail. “Laxol,” as our readers know, is castor oil sweetened with saccharin and flavored with peppermint. There is no excuse for prescribing the product. The official Aromatic Castor Oil (Ol. Ricin. Arom.) of the National Formulary would answer every purpose served by the proprietary preparation.--(_Editorial from The Journal A. M. A., May 29, 1920._)

Look Up Its Rating

Modern business has become so complex that it is no longer possible for those engaged in trade to know, offhand, the financial responsibility of their prospective customers. The commercial agency is a natural development; it aims to supply the technical (financial) information which the conservative business man needs but is otherwise unable to get. When John Doe & Co. contemplates entering into business arrangements with Henry Roe & Son to a degree that involves financial obligations, it looks up Roe in the rating book of Dun or Bradstreet and probably calls for a special commercial report on the concern. These facts are so elemental and obvious as to be trite. The complexity of modern medicine, especially in the pharmacologic field, has made it a physical impossibility for physicians to know the scientific status of scores of pharmaceutical products put out under proprietary or brand names. It was recognition of this fact that brought about the creation by the American Medical Association of the Council on Pharmacy and Chemistry. This body of experts, serving without remuneration and reporting without fear or favor on the newcomers to the pharmaceutical world, places at the disposal of physicians unbiased information, free alike from prejudice or prepossession. As the commercial agency reports on the commercial probity of individuals and firms, so the Council on Pharmacy and Chemistry reports on what might be called the scientific probity of proprietary and unofficial pharmaceutical products. The commercial agency issues, at no small expense to its customers, rating books; the council on Pharmacy and Chemistry issues, at a nominal price, “New and Nonofficial Remedies.” The commercial agency, for a substantial fee, will furnish reports on business concerns; the Council on Pharmacy and Chemistry will, without any expense to the profession, furnish reports on proprietary products used for the relief or cure of human ailments. The careful business man avails himself of the services of the commercial agency; there are financial interests at stake. The conscientious physician will avail himself of the services of the Council; there are, it may well be, lives at stake.--(_Editorial from The Journal A. M. A., April 24, 1920._)

The Medical Profession and Commercial Interests

Last week The Journal published a letter received by a physician in Milwaukee from a firm of lawyers representing the Farbwerke-Hoechst Company. In this communication the physician was threatened with suit if he published further unfavorable reports regarding that firm’s preparation. Quoting from the attorney’s letter:

“Mr. Metz directs us to inform you that the publication of this
article and the statements therein were seriously damaging to the
Farbwerke-Hoechst Company, and directs us to say further to you
that he and the corporation will hold you personally responsible
for any repetition, oral or written, of the same or of similar
statements to the same effect.”

We were under the impression that the time had passed when a proprietary medicine manufacturer would presume to threaten a physician for making an honest report of his results with any therapeutic agent. Such condition did exist once, before the Council on Pharmacy and Chemistry undertook its work. Now comes Mr. Metz to revive this relic of an historic but infamous period in the history of American proprietary medicine manufacturing. Even Mr. Vanderbilt regretted that he ever said “The public be d----.” One of the elementary principles in the practice of medicine is that the individual physician shall let others know his results, whether good or bad, in any line of treatment. It is by such interchange of knowledge and experience that progress in medicine is possible. Yet Mr. Metz would interfere with the diffusion of such knowledge and experience when it applies to proprietary medicines. His legal threat against Dr. Sargent is “terrorism” applied to the medical profession.--(_Editorial from The Journal A. M. A., June 8, 1918._)

Rabbit-Foot Therapy

Few but ignorant darkies have any great faith in the therapeutic efficacy of the left hind foot of a rabbit caught in the churchyard in the dark of the moon. In the light of modern therapeutics one is tempted to believe, however, that had some one person or firm an exclusive proprietary right to this particular brand of rabbits’ feet, there would be many intelligent people--and not all of them laymen--ready to swear by rabbits’ foot therapy. In medical journals (whose advertising pages set forth the virtues of the pedal extremities of _Lepus sylvaticus_) many solemnly scientific articles would probably appear relating the success that the writers had had with this form of therapy in the treatment of some distressing stubborn conditions that had failed to respond to all previous efforts. Is it ubiquity that has saved the homely cotton-tail from being a therapeutic hero?--(_Editorial from The Journal A. M. A., Sept. 29, 1917._)

Secret Remedies and the Principles of Ethics

Many hundreds, possibly thousands, of inquiries are received each year by The Journal from physicians asking for information on, or an opinion of certain proprietary remedies. In many instances the preparations in question are essentially secret in composition, although advertised to the profession under a fair-seeming exterior of apparent frankness. There are on the market today--and used by members of the American Medical Association--dozens, yes scores, of widely advertised proprietaries that are, to all intents and purposes, secret. The physicians who prescribe them do not know and cannot know what they are giving their patients. On this point Section 6 of Chapter II of the Principles of Medical Ethics of the American Medical Association says:

“... it is ... unethical to prescribe or dispense secret medicines
or other secret remedial agents, or manufacture or promote their
use in any way.”

The inherent and basic reasonableness of the various requirements of the Principles of Medical Ethics needs no exposition or defense. A large number of proprietary remedies which at present degrade medicine would be wiped out of existence or, at any rate, go over to the “patent medicine” class, where they belong, if physicians would live up to