Chapter IX: Introduction: The Council on Pharmacy and Chemistry was established (2)

The Council on Pharmacy and Chemistry of the American Medical Association is a department of our national organization that has not received the plaudits and encomiums of a wildly joyous medical profession nor the grateful praises of the enthusiastic manufacturer of pharmaceuticals. The Council seems indeed to be the unloved child of the entire family of subsidiary bodies of the association. Perhaps the reason for this may be found in the character of its duties, for the Council must expose fraud, sometimes in high places, and protect the physician from being duped by avaricious persons and by persons who are themselves sometimes the victims of their own credulity. It thus happens that the sale of some proprietary article previously held in high esteem by the practitioner proves valueless, perhaps even fraudulent. The practitioner, however, may have credited much of his success in treating certain conditions to that preparation and the maker has had success in accumulating dollars from its sale and both parties emit a loud and vicious roar against the Council, because they both lose money. Nobody wants to be “protected” against making money--make it honestly, if possible, but make it--but this black sheep among the Councils of the American Medical Association insists on their making their money honestly!

Despite many obstacles thrown into its path, the Council on Pharmacy and Chemistry has serenely pursued its allotted tasks, corrected its mistakes, improved its methods, and today stands as the only medium to which the honest physician may turn for information--not misinformation--regarding proprietary articles. During the war the Council and the chemical laboratory were in close cooperation with the Surgeon-General’s Office, testing and investigating every article offered to the government for the treatment of sick soldiers. The variety and the number of fakish and fraudulent stuff offered to the Surgeon-General was a pitiable exhibit of the mental gymnastics of some people. Just now the Council and the laboratory have a new and important field before them, i. e., to protect the physicians against worthless and useless serums, vaccines and synthetics. It will be the Council’s unpleasant duty to expose the fraudulent and useless among these articles and stamp truth on those found worthy.

We seem to have wandered from the topic in our caption, but not so in reality, because the burden of our thought is to lend our influence to the spread of the motto of the Advertising Clubs of the World, namely, “Truth in Advertising.” It is our purpose to stimulate a larger degree of enthusiasm for the work of the Council on Pharmacy and Chemistry and the Chemical Laboratory, a more generous flow of inquiries concerning articles unfamiliar to the physician, and particularly to urge that the words “Accepted by the Council on Pharmacy and Chemistry of the American Medical Association” be printed on the label and on all advertising circulars of proprietary articles that have been admitted to New and Nonofficial Remedies. Then, when pamphlets and circulars are received by physicians they will read the statements of manufacturers with sympathetic understanding and with full confidence in the verity of the declarations. The importance of creating just that sort of receptivity in the mind of the prospective buyer is so well known to the astute publicity expert that it is needless for us to dwell on its advantages. Every proprietary article advertised in our journal, in The Journal of the American Medical Association, and in the other state association journals, as well as in several well-edited privately owned journals, does in effect say to the reader that the articles so advertised are accepted by the Council because only proprietary articles so accepted are accepted by us. The fact is further acknowledged when these firms are permitted to exhibit their goods at our annual sessions for again the rule is enforced that only proprietary articles which have been approved by the Council may be placed on display.

Why not complete the circle of ideas--it would not be a “vicious circle”--by printing on labels, in advertisements and circulars, the words: “Accepted by the Council on Pharmacy and Chemistry”?--(_From The Journal A. M. A., Aug. 2, 1919._)

HELPING THE COUNCIL

If they were built that way, the members of the Council on Pharmacy and Chemistry of the American Medical Association might become discouraged at the apparent indifference of many members of the medical profession to their efforts. There are many physicians who, while figuratively patting the Council on the back, actually do nothing to aid its efforts. On the other hand, there are men in the profession who give the Council active support instead of merely passive appreciation. The letter that follows was written by such a man to a pharmaceutical concern:

I am receiving circular advertising from you concerning ---- ----
solution, and I am writing to suggest that until these products
have been approved by the Council on Pharmacy and Chemistry of
the American Medical Association, you are wasting your postage
on the practice. Aside from the fact that these products do not
appeal to me personally, I feel that I am not in a position to
judge the value of such products and I depend entirely on the large
clinical opportunities of the Council on Pharmacy and Chemistry of
the American Medical Association in addition to their laboratory
facilities, in such matters as these. I may, therefore, with all
due respect, suggest that ... it will pay you to eliminate my name
from your mailing list.

The members of the Council on Pharmacy and Chemistry are working week in and week out without remuneration. Few appreciate how much these scientific men are doing for rational therapeutics; fewer still realize how much has been accomplished through their efforts, or how much more could be accomplished if every physician who at least believes in the work of the Council would give it his full support.--(_Editorial from The Journal A. M. A., Nov. 6, 1920._)

DELAYS IN PASSING ON PRODUCTS

Report of the Council on Pharmacy and Chemistry

The Council has adopted the following report and authorized its publication.

W. A. Puckner, Secretary.

The Council frequently receives inquiries--some of them accompanied by expressions of impatience--concerning articles, reports on which appear to be delayed. It therefore seems advisable to make a statement of some of the factors which enter into this problem.

The Council fully realizes the importance of giving prompt information to the profession with regard to proprietary medicines under consideration. It therefore acts as soon as sufficient information is available to justify a definite judgment, and publishes its conclusions as soon as possible. When adequate information is available at the outset, there is no delay in the publication of the Council’s conclusions.

Unfortunately, but very naturally, there are many cases in which the information available at the time the product is submitted is not sufficient to justify the Council in coming to definite conclusions for or against the preparation. In some cases the manufacturer possesses the required information, but to obtain it from him takes time; in other cases the manufacturer does not possess the information--perhaps he did not realize the inadequacy of his evidence until the subject was brought to his attention by the Council.

Such cases might be dealt with in either one of two ways: The Council might at once reject the article because the claims for it are not supported by adequate evidence; or, the Council might suspend judgment and give the manufacturer an opportunity to supply the information.

The first method--immediate rejection--would obviously be felt by manufacturers as a hardship. To afford the fullest possible opportunity for the presentation of the case, the Council follows the second method; that is, it suspends judgment and withholds publication of a report until reasonable time has been afforded for furnishing the required information, provided the manufacturer or agent appears to be making honest and diligent efforts to supply it. The collection and compilation of such information is sometimes a lengthy process, especially when the products are of foreign manufacture.

Although it would be easier for the Council to render an immediate decision than to assist manufacturers to supply the data necessary for the formation of an authoritative judgment, the Council cannot yield to importunities for hasty action. It must rely on the medical profession to bear in mind that the character of a product under consideration by the Council has not yet been determined. The Council holds that, during this stage, a product is suitable, at most, for experimental use.--(_From Reports of Council on Pharmacy and Chemistry, 1915, p. 119._)

COOPERATION OF THE PHARMACEUTICAL HOUSES

Report of the Council on Pharmacy and Chemistry

In reply to the suggestion made last year by President Bevan that there should be closer cooperation between the large pharmaceutical houses and the Council on Pharmacy and Chemistry, the Council submitted to the Board of Trustees of the American Medical Association the statement which appears below:

“COOPERATION OF THE PHARMACEUTICAL HOUSES: At the opening meeting
of the House of Delegates last year, President Arthur Dean Bevan
suggested the desirability of greater cooperation between the large
pharmaceutical houses and the Council on Pharmacy and Chemistry. The
need of such cooperation has been recognized by the Council from the
first. In no one direction has the Council made greater effort than
in its endeavor to secure the fullest cooperation of the various
pharmaceutical houses. The difficulty has been, and always must
be, the fundamental antagonism between objectives that are largely
commercial on the one hand and purely scientific on the other.
Nevertheless, the Council has always believed--and has acted on the
belief--that there is a possible middle ground wherein the interests
of therapeutics would not be injured but would go hand in hand with a
commercial development based on enlightened self-interest.

“The profits to be made by a pharmaceutical house from the sale of a
staple drug--a pharmacopeial, National Formulary, or nonproprietary
preparation--which enters into free competition with other drugs
of the same kind, are moderate; the profits to be made from the
sale of a proprietary medicine on which the manufacturer holds a
monopoly are usually large--sometimes enormous. There are, broadly,
two kinds of proprietary preparations advertised to physicians:
One represents laborious research ending in the production of
a new medicinal chemical; this product can be patented and the
manufacturer can obtain a seventeen-year monopoly on its manufacture
and sale. The other represents no research but comprises simple
mixtures--frequently of the “shotgun” variety--of well known
pharmaceuticals, or biologic products sold under trade names. As
these do not represent anything new or original the manufacturer is
unable to obtain a patent, but by means of the trade name he can and
does obtain a perpetual monopoly. This, from a business standpoint,
is more valuable than the limited monopoly granted by a patent. It is
not surprising that proprietary remedies of the latter type flourish
so long as physicians unthinkingly accept and prescribe them solely
on the manufacturer’s valuation.

“The Council has practically the undivided support of
manufacturers of medicinal chemicals; that is, of proprietaries
of the first mentioned type. But pharmaceutical firms which
have found it profitable to promote proprietaries of the second
type--“specialties,” unscientific or ordinary mixtures of
pharmaceuticals or biologic products sold under trade names--have not
supported the Council.

“When the Council was organized, it was hoped and believed that all
the large pharmaceutical houses would find it possible and desirable,
if not actually more profitable, to shape their business methods so
as to make their proprietary and other articles conform to those
conservative standards on which the Council bases its rules, and thus
render such articles acceptable for New and Nonofficial Remedies.
It soon developed, however, that the methods of the pseudochemical
companies, whose sales propaganda in the interest of unscientific
nostrums with its attending damage to scientific medicine had led to
the establishment of the Council, had found their lodgment in most
of the pharmaceutical houses. It was a genuine disappointment to the
Council to find that some of the large and old-established firms
were not only unwilling to cooperate with the Council, but in many
instances exhibited a definite antagonism to the Council’s work.

“The object--and duty--of the officers of pharmaceutical houses is
primarily to pay dividends to their stockholders. Through skilful
advertising or the persuasiveness of “detail men,” they are able
to induce physicians to prescribe their controlled products, on
which there are large profits, even though such products have not
only not been accepted by the Council, but in many instances, have
been disapproved. Is it any wonder that concerns which put out such
products are indifferent or openly antagonistic to the work of the
Council? The matter is largely one of business policy. When the
medical profession as a unit will support the Council in its work,
then such firms will find it good business policy to accede to Dr.
Bevan’s suggestion--but not before.”

Evidently the problem resolves itself into this: The Council, constituted of scientific men, working without remuneration in the interest of scientific medicine and the medical profession, expects--and rightfully--the cooperation and support of the members of that profession. What is needed, therefore, is the active, sympathetic cooperation of physicians; the cooperation of pharmaceutical houses will follow as a matter of course. (_J. A. M. A._ =74=:1235 [May 1] 1920.)

The following is the recommendation of the Reference Committee to which the Report of the Board of Trustees was referred: “A perusal of the Trustees’ Report, ‘Cooperation of the Pharmaceutical Houses’, is well worth the time of every member of the profession, and your committee would emphasize the statement of the Trustees: ‘The Council, constituted of scientific men, working without remuneration in the interest of scientific medicine and the medical profession expects--and rightfully--the cooperation and support of the members of that profession. What is needed, therefore, is the active sympathetic cooperation of physicians; the cooperation of pharmaceutical houses will follow as a matter of course.’

“Your committee would go still further and move that a vote of thanks of the House be extended to those scientific men who have devoted so much valuable time to the welfare of the Association.”

(_J. A. M. A._, =74=:1322 [May 8] 1920; _from Reports of Council on Pharmacy and Chemistry_, 1920, p. 56).

W. A. Puckner, Secretary.

BUDWELL’S EMULSION OF COD-LIVER OIL, NOS. 1 AND 2

Report of the Council on Pharmacy and Chemistry

The Budwell Pharmacal Company, Lynchburg, Virginia, which markets these preparations, claims that “No. 1” contains cod liver oil, “Iodide of Arsenic,” “Iodide of Calcium,” and “Iodide of Manganese.” “No. 2” is said to contain in addition to the ingredients of No. 1, creosote carbonate and guaiacol.

It is known that arsenous iodid is decomposed by contact with water. It is recognized that creosote carbonate is unstable and prone to liberate creosote. Iodide of manganese not being official, the supply on the market is not controlled in any way: Tests of purity are not prescribed by the Pharmacopeia, the National Formulary, New and Nonofficial Remedies or other books of standards. Therefore doubt must be expressed as to the accuracy of the formulas as given. The Council cannot accept such statements of composition without further evidence.

“No. 1” is commended for use in

“Chronic Rheumatism, Glandular Swellings, later forms of Syphilis,
convalescence from Scarlet Fever, La Grippe and Malaria, Chronic
Malarial Infection, Marasmus, Joint or other suppuration of
standing, diseases of skin, chorea, anaemia, neurasthenia,
obstinate neuralgia, scrofulous affections in general, and diarrhea
or dysentery (subacute or chronic) in childhood.”

“No. 2” is said to be

“Prepared especially for the treatment of Chronic Throat, Nasal,
Bronchial and Pulmonary Diseases.”

In the advertising circular statements regarding the various ingredients of Budwell’s Emulsion are quoted from obsolete text books. These statements, for the most part, do not represent modern opinions on the subject. For instance, the circular praises the action of guaiacol as eliminated directly by the lungs, thus exerting a beneficial local effect and causing bacilli to diminish in numbers or to disappear. All of this is directly contradicted in authoritative modern publications on pharmacology, which hold that the excretion of guaiacol by the lungs is infinitesimal and its action on bacilli is nil. The Council held the preparations in conflict with its rules as follows:

1. Many of the therapeutic claims are exaggerations.

2. The method of exploitation amounts to an indirect invitation to the public to use these preparations as “consumption cures.”

3. The preparations are unscientific, they constitute a reprehensible invitation to uncritical prescribing and their use is inimical to the best interests of the profession and the public. It is difficult to imagine in what conditions such a combination would be indicated. These preparations are a remnant of the days of polypharmacy. Their use is not in keeping with present medical thought and practice.--(_From The Journal A. M. A., Feb. 20, 1915._)

RHEUMALGINE

Report of the Council on Pharmacy and Chemistry

Rheumalgine (Eli Lilly & Co., Indianapolis) is put up both in tablet form and as a liquid. Each tablet, or teaspoonful of the liquid, is said to contain:

“Strontium salicylate from Natural Oil 5 gr.
Hexamethylenamin 2 gr.
Colchicine 1/200 gr.”

The advertising matter contains several statements regarding the individual ingredients to which objection must be made.

It is claimed (quoting from Hare) that strontium salicylate

“... is not so disagreeable to the taste as the corresponding
sodium salts, and more important still, it is far less apt to
disorder the stomach.”

“Taste” is a difficult subject to dispute; but in the experience of the referee, patients object more to the strontium than to the sodium salt. No evidence is submitted to prove that the strontium salt is less apt to disorder the stomach. In observations made under the direction of the referee, the nauseant and emetic doses are about the same as, or even less than, those of sodium salicylate.

Under hexamethylenamin, the recommendations are not confined to its recognized use as a urinary antiseptic; it is also said to be “unexcelled” as a “germicide,” and to prevent the formation of urate and phosphate deposits. These statements are contrary to facts.

“Rheumalgine ... may be used in all cases where the salicylates
are indicated. It is superior to preparations containing sodium
salicylate, in that it does not cause nausea or disturb the
digestion.”

Both the preceding statements are misleading. The necessity of giving 1/200 grain of colchicin for each 5 grains of salicylate would certainly interfere with the use of adequate doses of the latter. The colchicin would produce digestive disturbance quite apart from the salicylate.

The mixture is described as:

“... ANTIRHEUMATIC, ANTIPYRETIC, URINARY ANTISEPTIC, AND URIC
ACID ELIMINANT. Useful in Acute Articular and Chronic Rheumatism,
Muscular Pains, Lumbago, Sciatica, Migraine of the Rheumatic, Gout,
and in Nervous Irritability of the Gouty or Lithemic.”

The facts are: Salicylates are useful in some of these conditions, colchicin occasionally in a few, hexamethylenamin in none. The combination is conducive to uncritical prescribing. For instance, salicylates are effective in acute articular rheumatism; hexamethylenamin and colchicin are useless; salicylates are of very little use in chronic rheumatism, sciatica and nervous irritability, while hexamethylenamin and colchicin are useless in these conditions; colchicin is sometimes effective in gout, salicylates perhaps also; hexamethylenamin is not.

Attention should also be called to the high dosage of colchicin, namely, 1/100 to 1/50 of a grain of the alkaloid, every three or four hours, the dose then to be “slightly reduced,” but continued for several days; or in chronic cases, 1/100 to 1/30 grain per day, continued indefinitely. This dosage appears high, if a really active preparation is used.

Finally, the name “Rheumalgine” encourages thoughtless and unscientific prescribing. If a mixture is used at all, the prescriber should be constantly reminded of its composition.

It is therefore recommended that Rheumalgine be held in conflict with Rules 6 (unwarranted therapeutic claims), 8 (nondescriptive name) and 10 (unscientific composition).--(_From The Journal A. M. A., June 26, 1915._)

GRAY’S GLYCERINE TONIC

Report of the Council on Pharmacy and Chemistry

The Council adopted the following report and authorized its publication.

W. A. Puckner, Secretary.

Gray’s Glycerine Tonic Comp. (Purdue Frederick Company, New York) is a mixture said to be made according to a prescription of the late Dr. John P. Gray, superintendent of the state hospital, Utica, New York. As to the composition, the following statement is furnished by the company:

“This preparation is a combination of Glycerine, Sherry Wine,
Gentian, Taraxacum and Phosphoric Acid with carminatives.”

The label declares the presence of 11 per cent. alcohol, and the dose is given at from two teaspoonfuls to a tablespoonful. A study of the ingredients will show that, aside from the alcohol, the mixture contains but one really active drug, gentian. Essentially, then, “Gray’s Glycerine Tonic” is a mixture which, in addition to the narcotic effect of the alcohol, depends on a bitter, gentian, for whatever therapeutic action it may possess.

The bitters, of which gentian is a type, were once credited with many therapeutic virtues which time has shown they do not possess. Pharmacologic research has demonstrated that their utility consists in stimulating the appetite through their action on the taste buds. On this account they were believed also to increase the secretion of the gastric juice by a psychic impression. More recently, however, even this has been questioned--by Carlson, for instance.

These facts are fully understood, presumably, by all physicians. Yet, according to the advertising circular, this “tonic,” which, for all practical purposes, is merely a simple bitter, is good for thirty-two diseases ranging from amenorrhea to whooping cough!

The conditions in which Gray’s Glycerine Tonic is asserted to be especially efficient are described on the label of the bottle and the outside wrapper, in popular terms, more or less typical of “patent medicine” exploitation, such as “catarrhal conditions,” and “stomach derangements.” Similar statements are contained in the leaflet accompanying the trade package. For instance:

“It is, therefore, an effective, reliable tonic in nervous
exhaustion, general debility, impoverished conditions of the blood
and nervous system, Bright’s disease, diseases of the liver,
disorders of the urinary organs, etc.”

“It is an unexcelled restorative in that very common class of cases
in which there is no positive organic disease, but the patient
complains that he ‘does not feel well’ or ‘is out of sorts.’”

Here are some of the claims made in other advertising matter:

“All stages of bronchitis ... are rapidly improved by the use
of Gray’s Glycerine Tonic Comp. This remedy has a direct tonic
influence upon the circulation of the respiratory mucous membrane;
it relieves congestion and restores tone to weakened blood vessels.”

“... improves the appetite, gives valuable aid to the digestive and
absorptive processes, and reinforces cellular nutrition in ways
that insure a notable gain in vitality and strength.”

+-----------------------------------------------------------------+
| In Gastro-Intestinal Catarrh |
| |
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| by muscular weakness and glandular insufficiency--there is no |
| remedy more prompt and effective in its action than |
| |
| Gray's Glycerine Tonic Comp. |
| |
| Under its systematic administration the appetite is restored, |
| the alimentary processes greatly improved, the nutrition |
| promoted and every vital function throughout the body given a |
| new and substantial impetus. As the digestive and assimilative |
| functions are restored to their normal efficiency, a notable |
| increase in the restorative and recuperative powers of the body |
| naturally follow. |
| |
| THE PURDUE FREDERICK CO. |
| 135 Christopher Street, New York City |
+-----------------------------------------------------------------+
Mention ILLINOIS MEDICAL JOURNAL when writing to advertisers.

Even granting that gentian may improve the appetite, how absurd it is to claim that this mixture “relieves congestion,” “restores tone to weakened blood vessels,” “gives aid to the absorptive processes,” “reinforces cellular nutrition,” or increases vitality!

Neither the composition of Gray’s Glycerine Tonic nor the clinical evidence warrants the belief that it has any therapeutic value other than that due to the psychic effect of the bitter drug gentian. Physicians who have prescribed it have done so because of the advertising. This nostrum has been kept so constantly before the eyes of medical men that they think of Gray’s Glycerine Tonic when they cannot remember the official drugs that may be indicated in the case. The moral is that liberal advertising will sell anything.

It is recommended that Gray’s Glycerine Tonic Comp. be declared not eligible for inclusion in New and Nonofficial Remedies on account of conflict with Rules 1, 6, 8 and 10.

[Editorial Note.--An old practice in hospitals--happily now practically obsolete--was to have certain stock mixtures prepared in bulk. Among these there was usually a so-called tonic mixture, used in a more or less haphazard manner when nothing in particular seemed indicated. Such a stock mixture was used in the State Hospital for the Insane at Utica, N. Y., during the many years that Dr. John P. Gray was superintendent (from the early fifties to the early eighties), although it is very doubtful whether he originated the mixture. After the death of Dr. Gray--so the story runs--one of his sons, with a partner, formed the firm of Purdue Frederick Company, and began the exploitation of the elder Dr. Gray’s name, in connection, presumably, with this stock preparation. As indicated in the Council’s report, Gray’s Glycerine Tonic Comp.--and what an absurd name!--is simply a mixture of ordinary drugs, requiring no skill whatever in compounding. If there is a physician living who cannot write a prescription offhand as good as this formula, that physician should either go back to a medical school or change his vocation. There is, and can be, no excuse for prescribing such a ready-made mixture, for every cross-roads drugstore has the ingredients and any pharmacist worthy of the name could compound it. Among the scores of nostrums that disgrace the medical profession of this country, none is more typical of all that is inimical to scientific medicine, to the medical profession and above all to the public--for, after all is said, it is the public that ultimately is humbugged.]--(_From The Journal A. M. A., July 10, 1915._)

TONGALINE AND PONCA COMPOUND

Report of the Council on Pharmacy and Chemistry

The Council, having considered “Tongaline,” “Tongaline Tablets,” “Tongaline and Lithia Tablets,” “Tongaline and Quinine Tablets” and “Ponca Compound Tablets,” found these preparations ineligible for New and Nonofficial Remedies and authorized publication of the following report.

W. A. Puckner, Secretary.

TONGALINE

Tongaline (Mellier Drug Co., St. Louis) is a fancy name given to what is essentially a sodium salicylate mixture. The air of mystery created by the name permits the manufacturers to make claims for the product which would be ludicrous if the medical profession was fully conversant with the very ordinary character of the preparation.

Tongaline receives its name from tonga, an inert, long-discarded mixture of various barks and herbs said to be gathered and prepared by Fiji Islanders. Its constituents evidently tend to vary with the collector. The history of the introduction of this indefinite combination of simples is thus given in The Journal, May 10, 1913.

“A supply of the crude drug was carried to England by a man who had
lived for a short time in the Fiji Islands and it was placed in the
hands of a retail house in London. This occurred about 1879. In
1880, two English physicians of repute published laudatory articles
on the therapeutic value of tonga in neuralgia and rheumatism. This
created a demand for the drug which extended to the United States.”

Time showed that tonga was inert therapeutically, and authorities on pharmacology now no longer notice it. As the Council previously reported,[12] the indefinite character of the mixture should, alone, be sufficient to exclude it from practical therapeutics. During the temporary popularity of tonga, the proprietary mixture Tongaline was put on the market for physicians’ use by the Mellier Drug Company, St. Louis. In this, tonga was named as the active ingredient. The commercial interests thus involved have faithfully nourished and kept alive the “tonga” myth.

[12] Reports of the Council on Pharm. and Chem., 1912, p. 40.

In a recent advertising booklet, “The Therapeutic Properties of the Ingredients of Tongaline,” the virtues of tonga, blue cohosh, colchicum, jaborandi and salicylic acid are discussed. The label of a recently purchased bottle reads:

“Tongaline contains Tonga, Cimicifuga Racemosa, Salicylate of
Sodium (the salicylic acid being made from pure natural oil)
Colchicum and Pilocarpin.”

It will be noticed that Tongaline is “made from the pure, natural oil.” In fact, the statement is repeated in red ink, in large letters running across the face of the label, thus emphasizing the alleged importance of this assertion. In this connection it is only necessary to recall that it has been proved clinically, chemically and physiologically that there is absolutely no difference between the salicylic acid made from the natural oil and the synthetic.

The formula was thus commented on in the article previously quoted from The Journal:

“Tongaline ... is essentially a preparation of sodium salicylate,...
The Mellier Drug Company realized the impossibility of creating
any marked demand for a nostrum unless it had some real drugs
in it--hence the presence of the salicylates. What the actual
composition of Tongaline is, no one but the manufacturers know. At
one time the following was given as the formula:

Fluid Tonga 30 grains
Extract of Cimicifuga Racemosa 20 grains
Sodium Salicylate 10 grains
Pilocarpin Salicylate 1/100 grain
Colchin Salicylate 1/500 grain

“These amounts refer to the quantity of drugs in each fluidram of the
preparation. Whether the nostrum still has this composition we do
not know, but assuming that it has, it is quite evident that sodium
salicylate is the essential and active ingredient.”

The therapeutic indications given on the label of the bottle are:

“Rheumatism, Neuralgia, Grippe, Gout, Nervous Headache, Sciatica,
Lumbago, Malaria, Tonsillitis, Heavy Colds, Excess of Uric Acid,
and wherever the use of the Salicylates is indicated.”

In a recent booklet this semisecret salicylate mixture is recommended, not only in conditions in which salicylates are indicated, but also combined with aconite for rheumatic fever, with benzoate of soda in the treatment of “grippe,” with potassium bromid in nervous headaches, with gelsemium, glycerin and whisky for “heavy colds,” with ammonium chlorid, stramonium and cimicifuga in “rheumatic dysmenorrhea,” and even with mercury biniodid as a treatment of syphilitic eruptions!

“When administered with good judgment, Tongaline exerts a
stimulating effect upon every organ of elimination; cleansing
the complex sewerage system and putting it into working order.
When this is done, the sluggish blood current begins to flow more
freely; the lymphatic and glandular systems to give up and carry
off the toxic products, so long retained ...”

TONGALINE TABLETS

Then because of a “desire to put Tongaline in a more compact and convenient form,” the same concern puts on the market Tongaline Tablets. Whether Tongaline Tablets are of the same composition, the doctor who prescribes them is not advised. In this form we have Tongaline and Lithia Tablets, and Tongaline and Quinin Tablets. Presumably those who are attracted by the word “lithia” are sufficiently uncritical to be content with the statement that:

“The addition of Lithia to Tongaline presents a most useful
combination which does not rely upon its action on the kidneys
alone as is the case with Lithia salts or Lithia waters as
administered ...”

And the foregoing quotation, be it remembered, is for the information of the medical profession! Tongaline and Lithia Tablets, we are informed, are:

“... particularly indicated for certain diseases which are caused
by deposits of urates in the joints and kidneys, and can be used
with much benefit for many people who indulge in generous or
intemperate habits of living.”

Tongaline and Quinine Tablets are also exploited without statement of composition. The promoters are probably justified in feeling that physicians who prescribe quinin in combination with “Tongaline” care little about the dosage.

It is unnecessary to discuss the silly claims made for Tongaline and its combinations, although it is worth while to point out that the prescribing of such nostrums by physicians is an imposition, if not a fraud, on the public.

PONCA COMPOUND

Ponca Compound, also made by the Mellier Drug Company, St. Louis, is a “female weakness remedy” in tablet form. The name suggests that “ponca” is a medicinal substance, and, in fact, at one time, “Ext. Ponca” was named as an ingredient. The nature of “Ext. Ponca” was apparently never explained. It is now replaced in the “formula” by “senecin,” and the only information concerning the composition at present given is:

“Ponca Compound Tablets Contain Extract of Mitchella Repens,
Senecin, Helonin, Caulophyllin and Viburnin.”

This “formula” is practically meaningless, not only because the amount of each ingredient is not stated, but also because “senecin,” “helonin,” “caulophyllin” and “viburnin” are in themselves variable mixtures of unknown composition.[13]

[13] See Report of the Council on Pharmacy and Chemistry on “Resinoids and Concentrations,” J. A. M. A., Nov. 13, 1909, p. 1655.

Presumably, “senecin,” “helonin,” “caulophyllin” and “viburnin” are extractives of some kind prepared, respectively, from senecio aureus (life root), helonias dioica (false unicorn), calophyllum thalictroides (blue cohosh) and viburnum prunifolium or opulus (black haw or cramp bark). These are, one and all, practically inert drugs. There is no reason to believe that any or all of them can have any beneficial influence in the many and varied conditions for which Ponca Compound is advertised.

The following are excerpts from the advertising matter:

“Ponca Compound is a remedy of a very beneficial character for
Functional, Uterine and Ovarian troubles, which will respond to
internal treatment, especially when digital examination or surgical
interference is undesirable.”

“Ponca Compound is also valuable during gestation and after
parturition.”

“Uterine Alterative for Leucorrhoea, Dysmenorrhoea, Amenorrhoea,
Metritis, Endometritis, Menorrhagia, Metrorrhagia, Irregular
Menstruation, Subinvolution, Painful Pregnancy.”

It is recommended that Tongaline and Ponca Compound and all their preparations be held in conflict with Rule 1, in view of their semisecret and indefinite composition; with Rule 6, for the grossly exaggerated therapeutic claims made for them; with Rule 8, because of their misleading names, and with Rule 10, in view of their unscientific character as irrational combinations. It is also recommended that this report be published.--(_From The Journal A. M. A., July 17, 1915._)

ALFATONE

Report of the Council on Pharmacy and Chemistry

The Council has found Alfatone ineligible for New and Nonofficial Remedies and has authorized publication of the following report.

W. A. Puckner, Secretary.

Alfalfa is good cattle feed but only nostrum exploiters have suggested its use as a medicine for human beings. While it may seem a waste of time to discuss the medicinal value of alfalfa its recent exploitation by the Norwich Pharmacal Company, Norwich, N. Y., as “a reconstructive tonic and nutrient” in the form of a mixture called “Alfatone,” calls for comment. According to the label on the preparation:

“Each fluidounce represents:
Alcohol 15 per cent.
Medicago sativa (Alfalfa) 120 grains
Taraxacum 2-1/2 grains
Gentian 1 grain
Berberine Hydrochloride 1/40 grain
Glycerin and Aromatics.”
“Dose.--One to three fluidrams (4 to 12 c.c.) 4 times daily.”

Each maximum dose, therefore, should represent 45 grains of alfalfa, 1 grain of taraxacum (dandelion), 3/8 grain of gentian, 1/100 grain of berberin hydrochlorid, and 27 minims of alcohol. Since the bitter drugs are present in such small amounts that the preparation is almost devoid of bitterness, and as the medicinal value of alfalfa is practically nil, it is evident that whatever action Alfatone may have is due to the stimulant effects of the alcohol.

Some of the claims made for Alfatone are:

“A reconstructive nutritive tonic indicated in general debility,
neurasthenia, convalescence, etc.”

“... a Galactagogue of merit as well.”

“... improves the appetite, aids the processes of digestion and
assimilation, facilitates elimination and effects gradual but
decided gains in strength, vitality and weight.”

It is suggested that:

“... in case of idiosyncrasy the addition of Tr. Nux Vomica 5 to 10
minims to the dose, unless contraindicated, will secure excellent
results.”

The Norwich Pharmacal Company naively remarks:

“The dearth of medical literature on Alfalfa has lead us to present
below a few of the findings of the Bureau of Plant Industry of the
Department of Agriculture ... as well as those from several state
experiment stations ...”

Here are the “findings”:

“... Digestible nutrients in 100 pounds of Alfalfa,... Protein,
11.0 pounds; Carbohydrates, 39.6 pounds; Ether Extract, 1.2 pounds.”

“... The high value of Alfalfa is due to the amount of protein that
it contains; to the large percentage of protein that is digestible
and the palatability of Alfalfa.”

“... Table showing pounds of elements removed from the soil by one
ton of crop.

Alfalfa Wheat
Potash 49.79 12.52
Phosphoric Acid 8.27 9.08
Lime 43.51 2.95
Nitrogen 44.01 22.30”

“... The abundance of muscle and bone producing material in Alfalfa
makes this crop especially good.”

Thus estimates of the value of a farm crop and cattle fodder are made to do service as testimonials to its therapeutic merit for human beings! Has the “patent medicine” promoter ever dared to insult the intelligence of his patrons by a cruder absurdity? Yet it is not to the nontechnical and unscientific public, but to a profession presumably scientifically trained in pharmacology and therapeutics that this concern presumes to offer its fodder tincture on the basis of testimony to the agricultural value of the fodder plant.

Alfatone is a worthless alcoholic cordial. The audacity of the attempt to promote its sale by a discourse on the merits of a well-known fodder plant is the sole reason for devoting any attention to it. It is recommended that Alfatone be held ineligible for New and Nonofficial Remedies, and that this report be published.

[Editorial Note.--What a comment on American medicine that a concern can even contemplate the possibility of making a commercial success of the sale of such a silly nostrum as Alfatone! And yet, when one remembers that a proprietary in which oats constitutes one ingredient (“Pas-Avena”) for years has been advertised to physicians and presumably prescribed by them, it is not altogether inexplicable that business men should get the impression that the medical profession is “easy” enough to “fall for” anything in the line of proprietary mixtures. Perhaps we may look forward to being offered proprietaries based on other cheap and well-known fodder plants. Tincture of Timothy Hay, Blue Grass Tonic, Cornhusk Wine! Why not? The enterprising companies that may put them out can easily publish tables to show the digestible nutrients in each and indubitable testimony can be furnished to prove the excellence of any of them as stock feed. If a pitchforkful of timothy hay makes a good fattening ration for a growing steer why should not a teaspoonful of tincture of timothy hay make a “reconstructive tonic and nutrient” dose for a man? If an arm load of thistles (carduus) makes a luscious food for _equus asinus_ why should not a pinch of thistle in alcohol and water be a good “tonic”? Great are the possibilities! They are limited only by the gullibility of the medical profession and the public. Certain it is that some proprietary manufacturers are firmly convinced that no combination can be too preposterous to be worth trying on the medical profession.]--(_From The Journal A. M. A., Aug. 7, 1915._)

ARTICLES REFUSED RECOGNITION

Report of the Council on Pharmacy and Chemistry

Below appear abstracts of the Council’s actions on articles refused recognition which were not deemed of sufficient importance to require lengthy reports.

Uricsol

Uricsol is marketed by the Uricsol Chemical Company, formerly of Los Angeles, now of Boston. Regarding its composition only vague statements are made. In an advertising pamphlet it is promised that the formula will be sent to physicians on request. Such a request from a physician elicited the following statement:

“URICSOL is a non-irritating, alkaline solution, containing Lithium
Citrate, Acid Citric and Potassium Nitrate, together with a saline
laxative in the form of Glycero Sodium Phosphate, with Vegetable
Tonics added.”

The Association Laboratory has made an examination of Uricsol to determine its composition and reports as follows:

LABORATORY REPORT

A trade package purchased in March, 1915, from a wholesale drug house was labeled:

“Uricsol Rheumatic Remedy, Uric Acid Solvent, Kidney and Liver
Stimulant, Manufactured by the Uricsol Chemical Co., Los Angeles,
Cal.”

This package was wrapped in a circular entitled “The Great California Remedy--Uricsol.” The preparation is a viscid, slightly turbid light brown liquid, with a faintly aromatic odor and a salty, bitter taste. The diluted solution is acid in reaction toward litmus and phenolphthalein and alkaline toward methyl orange.

Qualitative tests showed a presence of phosphate, citrate, nitrate, sodium, glycerin, and a small amount of lithium in aqueous solution. Besides these a small amount of some organic, nonalkaloidal substance was found, which from its bitter taste suggested gentian. From the qualitative tests it appeared that the phosphate was the predominating ingredient and accordingly a phosphate determination was made. The results, calculated to sodium phosphate, U. S. P., indicated the presence of 64.20 gm. per 100 c.c., held in solution by citric acid and sodium nitrate.

Uricsol evidently is a solution containing a large amount of sodium phosphate with small amounts of lithium, nitrate, citric acid and glycerin, with probably some vegetable extract.

In general Uricsol is similar to the once widely exploited proprietary “Melachol,” which has been frequently imitated. A preparation essentially identical is in the United States Pharmacopeia, under the title “Compound Solution of Sodium Phosphate.”

The Uricsol Company calls its preparation

“... the latest word in the treatment of Rheumatism and that allied
group of ailments which is caused by an excess of Uric Acid.”

Hay fever, bronchial asthma and neuritis are conditions in which it is recommended. The claim is made that

“Uricsol quickly controls Vasomotor Rhinitis and eliminates such
conditions from the system.” “In fact, it will correct FAULTY
METABOLISM.”

To a few practitioners of an older generation the pharmacologic basis of a remedy for rheumatism was sufficiently defined by saying that it increased the solubility of uric acid or affected it in some way. This theory is obsolete; there is not, and never was, any reliable evidence on which to base the theory that rheumatism is in any way caused by uric acid. The exploitation of Uricsol as a “uric acid solvent” is merely another illustration of the way in which nostrum manufacturers play on disproved theories. Of course the claim that sodium phosphate has any particular power to control vasomotor rhinitis, hay fever, asthma, and to correct faulty metabolism is foolish.

To summarize: Uricsol is a mixture of well-known drugs, marketed with false claims as to therapeutic action, with misleading and meaningless statements as to composition and under a name which invites uncritical prescribing. Uricsol is held ineligible to inclusion in New and Nonofficial Remedies.

Jubol

The following ridiculous statements are addressed, not to the laity, but to the medical profession:

DO YOU SUFFER FROM Constipation--Hemorrhoids--Enteritis--Mucous
discharge--Pituita--Acidity of the stomach--Vertigo--Sick
Headache--Disturbed Sleep--Insomnia--Sallow Complexion--Coated
Tongue--Offensive breath--Fatigue and depression--Boils--Pimples?

“ONE of these symptoms alone shows that there is defective or
insufficient function of the intestines, even if the stools are
regular.

“Excrements remain too long in the intestine and set up
fermentation. The harmful poisons and Ptomains which they produce
are re-absorbed by the blood and poison the whole system.

“The Intestines must be cleared and re-educated with JUBOL.

“Jubolise your Intestines.”

Jubol tablets are sold in the United States by Geo. J. Wallau, Inc., New York, and are said to be prepared by J. L. Chatelain, Paris, France. The following incomplete and nonquantitative “formula” is furnished:

“... compounded chiefly [!] of Agar-Agar, Biliary Extracts and pure
Extracts from all the intestinal Glands.”

It is asserted that

“The tablets are coated with a protective covering in order that
they may act on the intestine only.”

The tablets contained in a regular-size trade package, obtained direct from the agent, readily separated into two halves and disintegrated within a few minutes when agitated with water. It is thus evident that, under ordinary conditions, the intestinal ferments in Jubol (if they are present, as claimed) would be destroyed during their passage through the stomach. In direct tests, however, practically no tryptic activity was demonstrated.

The composition of Jubol is not declared; grossly unwarranted and incorrect claims are made for its therapeutic actions; the name does not indicate the alleged ingredients and so much of the composition as is declared indicates an unscientific mixture. The Council decided that Jubol should be held ineligible for New and Nonofficial Remedies, and that this report should be published.

Urodonal

Urodonal is said to be “produced in the laboratory of J. L. Chatelain,” Paris, France. It is marketed in this country by Geo. J. Wallau, Inc., New York.

The preparation is claimed to be a chemical compound, and the advertising matter furnishes a “formula,” which consists of the formulas of lysidin, sidonal and hexamethylenamin, connected by plus signs:

{H₂C Az  } CO₂H--C--OH AzH Az
{H₂C C--CH₃} + { H₂C CHOH } {H₂C  CH₂} {H₂C CH₂   CH₂}
{ AzH  } {OHHC CH₂ } {H₂C  CH₂} + {Az.CH₂ Az.CH₂ Az}
{ CHO  } { AzH } {  CH₃ }

That the substance is a chemical compound is highly improbable, and no evidence has been submitted to substantiate the claim. On the contrary, in the following statement the phrase “based on” is a virtual admission that the preparation is merely a mixture:

“Urodonal ... is a granular effervescent preparation based on
methylglyoxalidine [Lysidine], quinate of diethylene-diamine
[Sidonal] and hexamethylene-tetramine [Formin, urotropine].”

Mystery is added by the mention of undefined “special products” in the following:

“The fact of combining these two salts [lysidin and sidonal] in
Urodonal, in strictly determined proportions and in the presence of
special products, gives this preparation very considerable power in
dissolving uric acid.”

These contradictory statements of composition conflict with Rule 1.

Urodonal is marketed in typical “patent medicine” style: the name “Urodonal” is blown in the bottle and the label contains a list of “Indications,” including rheumatism, gout and gravel (Rule 4). That this form of marketing has introduced it to the public is suggested by the following in an advertising circular:

“... Urodonal is now popular--even classic--throughout the world,
where thousands of doctors and millions of patients agree in
asserting that ‘Urodonal is to rheumatism what quinine is to
fever.’”

There are also other indications that the mixture is to be exploited to the laity. For instance, the U. S. distributor sends out a portrait of Sarah Bernhardt bearing the legend:

“I am positive that URODONAL preserves youth’s freshness with
clearness and strength to brain and heart. I have taken it for two
years with the greatest benefit. Sarah Bernhardt.”

A circular advises this mixture

“For all who suffer from Arthritis, Rheumatism, Arterio-Sclerosis,
Renal and Bilious Lithiasis, Headache, Gout, Gravel, Lumbago,
Sciatic Pains, Neuralgia and all uric acid troubles.”

“In fact, Urodonal is five times more active than piperazine, and
thirty-seven times more active than lithia. We are, therefore,
entitled to say that no other eliminator of uric acid can be
compared with it.”

“Being _37 times more active than lithia_, it clears the heart
valves of any sandy substances which may clog them, and checks the
atheromatous degeneration of the blood vessels.”

These extracts indicate sufficiently the extravagant tone of the advertising (Rule 6): None of the ingredients are notably active in dissolving uric acid when administered by mouth. None produce any marked increase of uric acid elimination. No intelligent physician would use a uric acid solvent for “bilious lithiasis”; and their usefulness in the other conditions is open to doubt, to put it mildly.

Although the preparation is a simple mixture, the name does not indicate the components, but inclines to therapeutic suggestion (Rule 8).

Nothing is to be gained by combining several drugs which are useless, severally, for the purpose intended, as in the present case (Rule 10).

Urodonal is marketed under inconsistent statements of composition and with exaggerated therapeutic claims; the name is nondescriptive and the mixture is unscientific. The Council decided that the preparation should be declared ineligible for conflict with Rules 1, 4, 6, 8 and 10 and that this report should be published.--(_From The Journal A. M. A., Aug. 14, 1915._)

FORMAMINT

Report of the Council on Pharmacy and Chemistry

The following report has been authorized for publication.

W. A. Puckner, Secretary.

Formamint is a proprietary medicine manufactured by the A. Wulfing Company (New York, London and Berlin), which is affiliated with the Bauer Chemical Company.

It has been widely advertised in Europe for several years, and is now on the American market;[14] it is advertised in this country both in newspapers and medical journals.

[14] The Journal A. M. A., Feb. 24, 1912, p. 572.

Following is a brief review of the more important alleged investigations that have been reported from time to time in various European journals.

In “The Therapeutical Value of Foramint in Septic Affections of the Oro-Pharynx,” De Santi[15] quotes Rosenberg,[16] who reports the successful use of Formamint in cases of streptococcus infections, tonsillitis and acute symptoms of chronic sore throat. According to Seifert,[17] Formamint is a chemical combination of formaldehyd and milk sugar. When the tablets are dissolved in the saliva, 0.01 per cent. of formaldehyd in its “status nascendi” is liberated and exercises a strong disinfectant action. Seifert states that the preparation is markedly palatable, since it contains a little citric acid to render the taste cool and refreshing. In some experiments with streptococci, pneumococci, typhoid and diphtheria bacilli, Seifert found that a solution of one tablet in 10 c.c. of water destroyed these germs in from five to ten minutes. A solution of the same strength was also added to culture tubes of broth, agar, and gelatin, with the result that no growth occurred in them, while distinct and characteristic development of the bacteria took place in control tubes. He does not state, however, how much Formamint solution was added to the mediums.

[15] De Santi: Medical Magazine =16=:141, 1907.

[16] Rosenberg: Lancet, London =2=:1871, 1905.

[17] Seifert: Pharmakol. u. therap. Rundschau, 1904, No. 14; quoted by De Santi (Note 2).

Daus[18] reports successful treatment of tonsillitis, mumps and middle ear diseases. In these cases no other gargles or mouth washes were used. He states that no indication of irritant or other injurious action made its appearance even after large doses. In the same article, F. Levy reports experiments as follows: Agar plates were prepared with a culture of streptococcus from a severe case of quinsy. One half of the plate was rubbed with saliva containing Formamint in solution. (The strength of the solution used is not given.) In twenty-four hours streaks of growth had appeared on one portion of the plates while the part on which the Formamint saliva had been rubbed remained sterile. Daus also found that agar and broth cultures of streptococcus shaken with Formamint saliva remained sterile.

[18] Daus: Med. Klin. =2=:4110, 1906.

Rheinboldt,[19] investigating the effects of Formamint and of ordinary formaldehyd on animals, concludes that formaldehyd is toxic in action while Formamint is not.

[19] Rheinboldt: Deutsch. med. Wchnschr. =32=:587, 1906.

Rosenberg[20] corroborates this statement. He also found that agar plates of _Bacillus prodigiosus_ were killed by Formamint solutions in about four hours. He fails, however, to give the strength of his Formamint solutions.

[20] Rosenberg: Therap. d. Gegen. =7=:55, 1905.

Wingrave[21] suggests the use of Formamint for infants! He recommends that a tablet be crushed and wrapped in “butter cloth.” The ends of the cloth are to be tied with thread, the Formamint is to be moistened, and the packet is to be held in the mouth of the baby several times each day.

[21] Wingrave: Lancet, London =2=:1067, 1906.

Young[22] published the results of some experiments by himself and Delépine on the human throat. They dissolved a tablet in the mouth and made swab cultures with the following results:

Immediately after taking the tablet 0 colonies
10 minutes after taking the tablet 35 colonies
30 minutes after taking the tablet 150 colonies

[22] Young: Lancet, London =1=:975, 1908.

They found no staphylococci at any time. Other results of swabbing various parts of the throat before and after the use of Formamint, reported by these investigators, show enormous reductions in the count, claimed to be due to the action of Formamint. The count was made on agar at 37 C., but they fail to state the time elapsing between taking the Formamint and making the swab. Young also reports favorable clinical results in cases of scarlet fever, diphtheria, sore throat, and the like. It must be noted, however, that they state that the mouth and fauces must first be thoroughly cleansed by swabbing and douching before Formamint is used.

THE “CHEMICAL COMPOUND” CLAIM

The claims made in the advertising literature of Formamint are very extravagant. Many are highly improbable. These statements will be discussed later.

The statement is made that Formamint is a new chemical compound:

“Formamint is Pentamethanallactose, 5 CHOH + C₁₂H₂₂O₁₁. It is an
original combination of Formaldehyde with Lactose, a definite
chemical compound. The Formaldehyde molecule is locked up in it
until solution in the saliva takes place, when the Formaldehyde is
liberated in its _nascent_ state and is therefore active without
being irritant.”

Furthermore the makers contend that this new chemical compound is entirely harmless. For example, Daus,[5] in an article on “The Disinfectant Action of Formic Aldehyde on Mucous Membranes,” declares:

“No indication of irritant or other injurious action made its
appearance even after large doses. The urine remained free from
albumin and sugar.”

Such statements as these are found in the advertising literature:

“Formamint tablets are absolutely harmless and innocuous, even to
little children.”

“When dissolved in the saliva, Formamint Tablets liberate slowly
Nascent Formaldehyde in a most active yet non-irritant form.”