PART I COUNCIL REPORTS (continued 4)

BOVININE

Bovinine, advertised as a “condensed beef juice prepared by a cold process” is a mixture of alcohol, glycerin, added sodium chlorid, and apparently some form of defibrinated blood. According to the manufacturer’s literature egg albumin was used formerly but this ingredient is said to be no longer employed. It is not a meat juice in any sense of the word. Numerous mis­rep­re­sen­ta­tions will be found on the label and in the literature of Bovinine, of which the following are typical:

“The blood of selected steers prepared by a cold process, furnishing a perfect food, free from insoluble elements.”

“The rapidity with which Bovinine is absorbed and assimilated in the stomach ...”

“It supplies complete nutrition to the patient.”

“Bovinine contains all the elements of the animal, vegetable and mineral kingdoms for the production of new blood with great rapidity. Its principal constituents have been selected with a view to furnish the largest amount of nutriment in the most condensed form and all the resources of modern chemical analysis have been brought to bear on this important problem.”

A series of experiments carried out with dogs under anesthesia, by injecting Bovinine into the stomach, the pyloric end of which was ligated, shows that Bovinine is not readily absorbed and assimilated by the stomach as claimed. The amount of protein material found in the stomach at the end of one-half hour to one hour and a quarter was practically equal to the amount introduced by the Bovinine.

It is also represented that Bovinine is of great service in case of an irritable stomach. This is not borne out by experiment. Bovinine fed to dogs by the mouth, either alone or mixed with food, induced vomiting, which was less marked when Bovinine was given with the regular diet. An examination of the urine of these animals showed a marked diminution of the amount of indican, while the ethereal sulphates were enormously increased, both absolutely and relatively, when Bovinine was given. Experiments on rabbits have shown that Bovinine injected into the peritoneal cavity was invariably followed by large quantities of albumin in the urine, which persisted for from twenty-four to forty-eight hours. Thirty to 50 c.c. per kilo given by mouth daily caused emaciation and weakness; in some cases, irritation of the gastro-intestinal canal, with death of the animal in from seven to twelve days.

CARNINE

Carnine is a French preparation imported into the United States by Fougera & Co., of New York City. In physical appearance it looks like highly concentrated food, but analysis shows that it consists of a small proportion of defibrinated blood dissolved in a mixture of syrup and glycerol, the whole agreeably flavored. It is represented as a “juice of rare meat, prepared by cold process. Each tablespoonful represents 100 gm. of raw meat, or 3¹⁄₂ ounces.” It is clear that Carnine is not a meat juice in any sense of the word.

VALENTINE’S MEAT JUICE

Valentine’s Meat Juice resembles in physical appearance taste, odor and by chemical analysis a diluted meat extract. The nutritive value of meat extracts is virtually nil, as is well known by the medical profession. Notwithstanding the composition of Valentine’s Meat Juice and the fact that beef extract represents little nutritive value, the manufacturer makes the following misleading representations:

“The two-ounce oval bottle, adopted for the Meat Juice contains the concentrated juice of four pounds of the best beef, exclusive of fat; or the condensed essence of one and a half pints of pure liquid juice which is obtained from the flesh of beef.”

“The use of hot water with the Meat Juice changes its character and impairs its value.” [Italics in original.—Ed.]

The company must certainly be aware of the fact that its product contains little, if any, coagulable proteids.

CONCLUSIONS

In conclusion: Neither Bovinine nor Carnine is a meat juice, the former is anything but palatable and the latter soon cloys. “Valentine’s Meat Juice” and “Wyeth’s Beef Juice” are virtually diluted meat extracts, which are known to possess little food value. A physician depending on any of the foregoing products to supply material nourishment, in case of serious illness, is deceiving himself, starving his patients, and may be lessening their chances for recovery. If a patient recovers while using these commodities, it is certainly not due to the food value contained in them​—(From The Journal A. M. A., Nov. 20, 1909.)

VALENTINE’S MEAT JUICE[V]

Report of the Council on Pharmacy and Chemistry

Some time ago the Council authorized publication of a report[V] dealing with the composition and claims made for a number of the more generally advertised meat and beef juices. Among these was Valentine’s Meat Juice. This it was shown was sold under an incorrect name, the claims for its composition were not truthfully stated and its exploiters made false and misleading claims in regard to its food value. As Valentine’s Meat Juice is still widely advertised the referee in charge of this class of products deemed a reexamination of the product advisable. This was made and on it was based the following report which has been submitted to the Council, adopted, and its publication authorized.

W. A. Puckner, Secretary.

Your referee has had examined recently purchased specimens of Valentine’s Meat Juice (Valentine’s Meat Juice Company, Richmond, Va.). The examination shows that it has virtually the same composition as that given in the report of the Council “Meat and Beef Juices” published in The Journal, Nov. 20, 1909. It contains practically no coagulable protein material, one of the products characteristic of a meat juice. It is essentially a diluted meat extract.

The following statement found in former circulars now seems to have been eliminated:

“The two-ounce oval bottle, adopted for the Meat Juice contains the concentrated juice of four pounds of the best beef, exclusive of fat; or the condensed essence of one and a half pints of pure liquid juice which is obtained from the flesh of beef.”

An endeavor is still made, however, to convey the idea that the product contains coagulable protein, as shown by the following:

“Boiling water changes the character of the preparation.”

“The use of boiling water with the Meat-Juice changes the character of the Preparation.”

The proprietors undoubtedly know that the product does not contain any coagulable material and that the statements just quoted are plain mis­rep­re­sen­ta­tions.

The advertising circular contains a large number of “Testimonials of the Medical Profession.” As all are undated, one cannot tell how old these testimonials are. One physician recommends it highly for hypodermic use; another says, “I have kept cases on it and it alone for days, without attempting to give any other food, and the results have been entirely satisfactory.” According to another, it is “most invaluable in typhoid fever and also in diphtheria.”

Valentine’s Meat Juice conflicts with the following rules of the Council:

Rule 1, in that its composition is not correctly given;

Rule 6, in that unwarranted therapeutic claims are made, the profession being led to believe that the product is highly nutritious and is valuable in the treatment of pneumonia, diphtheria and typhoid fever;

Rule 8, in that the name is objectionable, for while sold as a meat juice, in reality it has the character of a meat extract.

Valentine’s Meat Juice is a fraud on the public, and in view of its continued exploitation under false claims, the referee recommends that the Council reiterate its former condemnation and authorize the publication of this report.

[Editor’s Note.—The difference between meat extracts and meat juices was fully discussed in the previous report of the Council, Meat “juices” are made by the cold expression of meat with subsequent evaporation, in such a way that the nutritious coagulable proteins remain in solution. In making meat “extracts,” heat is used which almost completely removes the coagulable proteins and thus renders it practically devoid of nutrient qualities.

A list of some of the medical journals that carry advertisements of Valentine’s Meat Juice, follows:

PediatricsVirginia Medical Semi-Monthly

Old Dominion Journal of Medicine & SurgeryMedical Times

American Medicine.]

Medical World —(From The Journal A. M. A., May 2, 1914.)

MEDICINAL FOODS

A report, of which the following is an abstract, was submitted to the Council on Pharmacy and Chemistry by the subcommittee which examined the medicinal foods:

In order to determine the food value of any food product it is necessary to consider the following points: Chemical composition; available potential energy; absorbability and cost. No attempt is made in this article to discuss each of these features separately, but they are utilized as required.

The ingredients on which the food value of any article of food depends are the proteid substances, carbohydrates, fats, certain inorganic bodies and—​under certain conditions—​alcohol. The amount of each of these present in a preparation must be established by chemical analysis. From the results thus obtained it is possible to calculate the potential energy represented by a given food product. In this report the potential or food value is expressed in the large or kilocalorie, that is, the amount of heat required to raise the temperature of one kilogram of water one degree centigrade.

The factors employed in this report for expressing in calories the actual amount of energy utilized by the system are 4.8 for proteid substances, 4.1 for carbohydrates, and 9.2 for fats.

The accompanying table embodies the results obtained by submitting all the well-known so-called “predigested foods” to chemical examination. The table as published in The Journal included columns on: Price of bottle, number of cubic centimeters in a bottle, cost per 500 cubic centimeters, reaction, specific gravity, percentage of non-volatile residue, ash, percentage of nitrogen, calories as proteids in 500 grams, carbohydrates before inversion, alcohol by volume, average recommended adult dose per diem in cubic centimeters, cost per diem to supply 1,430 calories. These columns were eliminated from this abstract, as they were unessential, so far as the practical value of the article is concerned. In most cases two samples of the same brand were purchased at an interval of about six months. All the analyses were made before Jan. 1, 1907. Some of the preparations contain much glycerin which does not, so far as known at present, possess any recognized food value, although there are a number of experiments on record to indicate that it influences metabolism.

The percentage of nitrogen accredited to each of these products represents the total amount of nitrogen, irrespective of the nature of the nitrogenous substances, although some of this nitrogen has no nutritive value.

By multiplying the percentage of nitrogen found by the factor 6.25 we obtain the percentage of nitrogenous matter (proteids) contained in the various preparations. By multiplying the number of grams of nitrogenous matter present in 500 grams of material by the factor 4.8 it is found that the potential energy available by the nitrogenous matter varies from 10.3 calories to 153.1 calories. Five hundred grams of the material is made the basis of calculation, because it approximates a pint, the amount usually believed to be present in the various trade packages, and because it affords a ready basis of calculation.

The carbohydrates are represented by cane sugar, maltose, dextrin and invert sugar. Lactose is probably also present in some, but it is impossible to establish this. By multiplying the number of grams of carbohydrates present in 500 grams of the foods by the factor 4.1 we obtain the potential energy represented by the carbohydrate, which varies from 11.3 to 319.2 calories. The total calorific value of both proteids and carbohydrates ranges from 54.7 to 397.5 calories. The total food value of an equal quantity of milk, including fat, approximates 360 calories.

The value of alcohol as a food product pure and simple in disease is, however, an open question. There is no doubt whatever but that it acts to a certain degree as a food even here, not as a tissue builder, but as a saver of fat and carbohydrate material, and in order to give the preparations in question full value as food products, the calories represented by the alcohol, are credited to each preparation, as are the proteids and carbohydrates. The factor usually recognized for expressing the calorific value of alcohol is 7. By multiplying the number of grams of alcohol present in 500 grams of material by 7, the number of calories varies from 420 to 658.

On looking over the literature and printed matter distributed by some manufacturers, the physician is frequently left under the impression that these preparations contain all the essential constituents necessary for maintaining normal nutrition of the body, as is clearly shown by the following quotation: “Contains sufficient nutritive material to maintain normal nutrition of the body, a valuable food in typhoid fever, pneumonia, tuberculosis,... and all the conditions of the system associated with enfeebled digestion and malnutrition.”

In order to show the insidiousness of such representations it is only necessary to give the actual food value of the average daily dose (the average amount to be taken for twenty-four hours) recommended by the various manufacturers for their products. The average adult daily dose recommended varies from 50 to 150 c.c. The total available calories per daily dose based on the proteid and carbohydrate bodies varies from 9.8 to 110.5. Adding to these figures the amount of energy represented by the alcohol, in each case, the total available calories varies from 55.0 to 299.5. The number of calories per diem in sickness should not fall much below 1,500 during twenty-four hours.

TABULATED RESULTS OF EXAMINATIONS OF MEDICINAL FOODS

Column Headings: 2 = Glycerin and undetermined matter 3 = Per cent nitrogenous matter (6.26) 4 = Calories as proteids in 500 grams 5 = Carbohydrates after inversion 6 = Calories as carbohydrates in 500 grams 7 = Calories as proteids and carbohydrates in 500 grams 8 = Alcohol, by weight 9 = Calories as alcohol in 500 grams 10 = Calories as proteids and carbohydrates per diem dose 11 = Total calories in per diem dose* 12 = Number c.c. required per diem to supply 1,430 calories

Name of Preparation and Manufacturer23456789101112

Carpanutrine—John Wyeth & Brother28.454.28102.75.34109.5212.212.5437.525.578.01,100.7

Carpanutrine—John Wyeth & Brother21.296.24149.85.78118.5268.314.0490.032.291.0942.9

Liquid Peptones—Eli Lilly & Company.3.634.50108.06.05124.0232.018.0630.069.6258.6829.4

Liquid Peptones, with Creosote—Eli Lilly & Company4.343.8492.213.47276.1368.318.0630.0110.5299.5716.2

Nutrient Wine of Beef Peptone—Armour & Company14.970.6415.415.43316.3331.717.5612.566.3188.8757.4

Nutrient Wine of Beef Peptone—Armour & Company13.700.4310.315.57319.2329.517.0595.065.9184.9773.3

Nutritive Liquid Peptone—Parke, Davis & Company1.021.8644.612.89264.2308.818.8658.074.2232.1739.5

Nutritive Liquid Peptone—Parke, Davis & Company1.951.1627.813.19270.4298.217.7619.571.5220.2779.2

Peptonic Elixir—Wm. Merrell Chemical Company3.212.5461.011.46234.9295.916.5577.553.3157.2818.6

Tonic Beef S. & D.—Sharp & Dohme12.913.4081.62.3648.4130.012.0420.013.055.01,300.0

Tonic Beef S. & D.—Sharp & Dohme12.633.2878.72.2245.5124.213.0455.012.457.91,234.4

Liquid Peptone—Stevenson & Jester Company0.441.8143.40.5511.354.712.0420.09.885.41,506.8

Cow’s Milk (3.8 per cent. fat)....3.5084.04.8098.4182.4........7.31,429.62,000.0

*: Total calories per diem dose includes the calories of alcohol in the liquid medicinal foods and the calories of the fat in milk.

In order to get a fair conception of the actual food value of these various preparations, it is desirable to make some comparison which can be readily comprehended by every physician. The amount of good milk necessary each twenty-four hours to sustain the vitality of a patient during a serious illness is not less than 64 ounces, or approximately 2,000 c.c. The food value in calories represented by this amount of good milk may be placed at 1,430. This includes not only the proteid and carbohydrate matter, but the fat as well. By comparing this available potential energy with the total energy available in the predigested foods under consideration, it can be readily seen that if a physician depends on the representations made by some of the manufacturers, and feeds his patient accordingly, he is resorting to a starvation diet. The largest number of available calories, including alcohol, present in any of the recommended daily doses, is less than one-fifth of the number of calories represented by 2,000 c.c. of milk; and the calories represented by the daily dose of the preparation poorest in food products is only one-twenty-fifth of the amount present in 2,000 c.c. of milk. These figures tell their own story.

Making 2,000 c.c. of milk the basis of calculation, and estimating the amount of the various preparations required to yield this number of calories, it is found that the quantity to be administered daily to supply 1,430 calories, including alcohol, varies from 716.2 to 1,506.2 c.c. In many cases the amount of alcohol exhibited by these quantities would keep the patient in an alcoholic stupor continually. The cost necessary to supply this energy varies from $1.48 to $3.39. Compare these prices with the cost of two quarts of milk. Is further comment necessary?

It is urged in justification of the use of preparations of this class that they contain constituents not found in our ordinary foods and in a more perfectly assimilable condition. As pointed out above, these so-called predigested foods contain no fats; the carbohydrates in them are the ordinary sugars present in our common foods, while the proteins belong to the peptone or albumose class. It is for these latter that the greatest claims are made, but even here no value can be pointed out not found in whey, peptonized full milk or peptonized skimmed milk.

There is likewise another point of considerable importance to consider in this connection. The terms peptone and albumose include bodies of very uncertain composition, and their suitableness as food substances depends largely on how they are prepared. Animal experiments have shown that nitrogen equilibrium may be maintained, for a time at least, by use of enzymic hydrolytic products of the proteins, even where the hydrolysis has been carried far beyond the so-called peptone stage, but it appears to be likewise true that the mixtures secured by acid or high temperature steam hydrolysis have no such value. Some of these, indeed, may exhibit a toxic behavior. This is true in particular of some of the commercial varieties of peptone, and until more is known of the source of the bodies of protein character employed in the makeup of these “predigested” mixtures it is unwise to assume anything concerning the food value of the nitrogen compounds found in them by analysis or even to dignify them by the name of foods.​—(Abstracted from The Journal A. M. A., May 11, 1907.)

MIGRAININ

Report of the Council on Pharmacy and Chemistry

The Council, having voted to rescind the acceptance of Migrainin and to omit it from New and Nonofficial Remedies (Appendix), directed publication of the report given below.

W. A. Puckner, Secretary.

SUPPLEMENTAL REPORT ON MIGRAININ

To the Council:—Koechl & Co., American agents for Migrainin (Meister Lucius & Bruning) asserted that this preparation was a mixture of antipyrin 85 parts, caffein 9 parts and citric acid 6 parts. The experiments of F. Zernik (Apoth.-Ztg., 1906, p. 686), however, showed that Migrainin consisted of antipyrin 90.88 parts, caffein 8.4 parts and citric acid 0.45 parts. When the attention of Koechl & Co. was called to this they informed the Council, on June 20, 1907, that the formula they gave was given them direct by the manufacturers abroad and that they, Koechl & Co., did not question its accuracy. They, however, offered to “write abroad and have the manufacturers confirm the formula as given.” On July 23, 1907, Koechl & Co. wrote the secretary of the Council that the manufacturers had informed them that Migrainin contains 90 per cent. antipyrin and 9.1 per cent. caffein citrate. This being an acknowledgment that the former statement submitted was incorrect, the Council voted that the approval of Migrainin should be reconsidered. Examination of the product, therefore, was taken up in the Association’s laboratory and an original specimen, purchased in Chicago, was found to contain moisture 0.7 per cent., antipyrin 90.93 per cent., and instead of caffein citrate 9.1 per cent., citric acid 0.51 per cent., caffein 8.53 per cent. This analysis agreed essentially with the composition of Migrainin as found by Zernik.

While the discrepancies between the statement of the firm and the facts are perhaps not great, nevertheless they show that even the formula last given is incorrect, and that the statements of Koechl & Co., while no doubt made in good faith, were in this instance unreliable.

In recent advertising matter issued by Koechl & Co., “phenozon-caffein citrate” is given as a synonym for Migrainin, one circular stating that “Migrainin is phenozon-caffein citrate,” etc. In the same circular the following also appears: “In the treatment of migraine with phenacetin or antipyrin, the attack is delayed, while with Migrainin it is usually permanently stayed.” This will, no doubt, lead physicians to infer that Migrainin is not a mixture of antipyrin and caffein citrate, but that it is some new compound. While the firm disclaims any intention to mislead, it does not offer to withdraw or modify this circular. It is recommended, therefore, that the approval of Migrainin be rescinded and that it be omitted from New and Nonofficial Remedies.​—(From The Journal A. M. A., June 5, 1909.)

NEURILLA

Report of the Council on Pharmacy and Chemistry

The following report was adopted by the Council. Its publication was authorized to show how a practically worthless mixture may be exploited by means of ill-considered testimonials.

W. A. Puckner, Secretary.

Neurilla, which appears to be the sole product of the Dad Chemical Company, New York, is advertised as

“The Ideal Nerve Calmant.” “... a nerve tonic ... indicated in cases where the nerve centers are poorly nourished and over-sensitive ...” “... a stimulant to the nervous system.” “A Valuable Aid in the Treatment of Fevers, Colds, La Grippe, etc.”

The following non-quantitative and indefinite formula is given on the label of a recently purchased bottle of Neurilla:

“Prepared from Scutellaria Lateriflora, Passiflora Incarnata and Aromatics.” “Proportion of Alcohol 20.3%. “Made by Dad Chemical Co., New York, U. S. A. “Dose, One Teaspoonful Four Times a Day.”

According to the formula, then, this mixture contains, aside from alcohol and aromatics, two vegetable drugs, scutellaria and passiflora, on which the alleged virtues of the preparation must be presumed to depend.

Scutellaria lateriflora, or skullcap, is a bitter drug, one of the many “herbs” to which, on wholly unreliable “clinical evidence,” therapeutic properties were at one time ascribed. Most pharmacologists do not mention the drug, and those who do generally state that it has very feeble therapeutic properties. It was admitted to the Pharmacopeia, but in 1909 its deletion was recommended by a committee of the Section on Practice of Medicine of the American Medical Association (The Journal A. M. A., Sept. 4, 1909, p. 792). We understand that the next edition of the Pharmacopeia will omit mention of skullcap.

Passiflora incarnata, or passion-flower, is another “herb,” which, although known for about seventy years, has never gained the confidence of the medical profession and has not even been admitted to the Pharmacopeia. According to a Council Report:

“None of the evidence is sufficient to show that passiflora has therapeutic value; hence it is deemed inadvisable to include the drug in the list of nonofficial remedies” (The Journal A. M. A., March 19, 1910, p. 983).

On these two obsolescent “herbs,” then, rest the remarkable claims made for Neurilla. A certain degree of appetizing effect may be expected from the bitter taste and a very slight degree of physical stimulus from the alcohol. Except for these effects—​and they are largely delusive and temporary—​the preparation is therapeutically inert and worthless.

The evidence on which the manufacturers of Neurilla base their therapeutic claims appears to consist of testimonials from physicians. As a matter of fact, this is true of practically all of the large group of nostrums of which Neurilla is typical. An analysis of these Neurilla testimonials brings out clearly what such “evidence” is worth.

ILL-CONSIDERED TESTIMONIALS

The testimonials for Neurilla have been given with reference to indefinite conditions of nervousness that border on the psychic and include hysteria, neurasthenia, neuralgia and the like. Nervousness and indigestion are two diseases in which suggestion, especially when aided by bitters and alcohol, produces temporarily a feeling of improvement. As an illustration, take the following testimonial:

“But more striking was the following case: One evening between 5 and 6 o’clock I was sent for, family lives near me, and I was informed that the young lady had promised to be bridesmaid, a function she had never performed. Her mother said the daughter would certainly drop in her tracks as she walked up to the altar with the procession, and they had about concluded to send a note saying to the parents of the bride that she could not come, although that would be very disagreeable (and no less offensive, said I). They agreed with me. I ordered Neurilla for two hours. She went to church, and, I was informed the next morning, passed through the dreaded ordeal simply fatigued, and was now fast asleep on account of the nice effect of Neurilla.”

It might provoke a smile to think that a manufacturer would publish so silly a testimonial were it not that the very fact of its publication indicates that there are medical men thoughtless enough to read and accept such stuff as reliable evidence as to the value of any product.

TESTIMONIALS GIVEN LONG AGO—THE REMEDY ABANDONED

A number of physicians who had given testimonials were asked in writing whether the testimonials were genuine and whether they still entertained the high opinion of Neurilla expressed at a former date. Several replied that, if they had ever given such testimonials, they had forgotten the circumstance. From the replies received we select the following:

The testimonial which bears Dr. A’s name reads:

“I am using Neurilla with most satisfactory results.”

Dr. A now says:

“As to its positive value as a therapeutic agent I have not used it enough to know.... If the language you quote ... appears as given in or as a ‘testimonial’ it must in some way be garbled and appears wholly without my knowledge or consent.”

Dr. B is quoted as having written:

“I do not often lend my influence to furthering the fame of a proprietary remedy, but I have achieved such excellent results from the use of Neurilla as a calmative in hysteria and other nervous disorders, that I feel its manufacturers are entitled to an acknowledgment of gratitude from me.”

Dr. B writes:

“I have not prescribed a dose of the nostrum in years. The use of my name in connection with Neurilla is unauthorized.”

Dr. C once wrote:

“I have used Neurilla with good results.”

Dr. C now writes:

“In re ‘Neurilla’ I think I used the preparation once or twice and it seemed to do good work, but if due to the preparation or other influences, I am not able to verify. I have not used it since nor will, as I am opposed to using these preparations except in certain cases where the ℞ contains remedies whose value I have verified under the most rigid tests.

“P. S. This testimonial must have been given many years ago.”

Dr. D’s testimonial is admitted to be based on a single case:

“I am using Neurilla in a bad case of neuralgic tic with very good results on an aged lady. She has taken several bottles, and is still taking it with very good results.”

Dr. D sums up his later experience by saying:

“I have long since abandoned the use of Neurilla in practice.”

The following bears Dr. E’s name:

“I endorse Neurilla without hesitation. It meets all indications for which it is intended.”

This is what Dr. E writes now:

“As to the enclosed testimonial in regard to Neurilla said to be written by me I have no recollection. I am not prescribing Neurilla.”

Dr. F’s experience is similar. The testimonial credited to him reads:

“I have prescribed Neurilla in nervous disorders with good results.”

Dr. F now writes:

“I don’t remember of ever having prescribed ‘Neurilla’ or of having given a testimonial for it or any other patent medicine if I knew it to be so.”

SUMMARY

In the booklet from which the foregoing are taken, there are forty testimonials. Those which we quote are merely samples. To sum up the results of this analysis: Of the testimonials some are said to be unauthorized; a number were written with so little thought that the writers had since forgotten their very existence; the conclusions expressed in most are not in fact justified by the writers’ mature judgment and experience. A number of writers admit that their experience is insufficient to determine whether the supposed good results were due to the medicine used or to other influences. Of course such evidence is unworthy of credit and happily, very little is now being furnished by doctors; even our courts refuse to admit it.

In short, the published formula shows that Neurilla is nothing more than a preparation of discredited drugs; it is exploited largely by means of carelessly formed and thoughtlessly expressed opinions of physicians. It is recommended that this report be published as an illustration of such methods and as a protest against them.

[Editorial Comment.—Neurilla is advertised in the following publications:

Archives of Pediatrics,Medical Sentinel,

Atlanta Journal Record of Medicine,Medical Standard,

Charlotte Medical Journal,Pacific Medical Journal,

Indianapolis Medical Journal,Southern Practitioner,

International Journal of Surgery,Texas Medical Journal,

Journal of Nervous and Mental Diseases,Woman’s Medical Journal,

Medical Herald,Eclectic Medical Journal,

New York Medical Record,Ellingwood’s Therapeutist,

Medical Review of Reviews,Journal of the American Institute of Homeopathy.]

—(From The Journal A. M. A., March 27, 1914.)

NEUROSINE, DIOVIBURNIA, GERMILETUM AND PALPEBRINE

Report of the Council on Pharmacy and Chemistry

Neurosine, Dioviburnia, Germiletum and Palpebrine are “shotgun” proprietaries typical of the polypharmacy of the past three or four decades. They are marketed by the Dios Chemical Company, St. Louis, Mo. On the recommendation of the referee, the Council has authorized the publication of this report.

W. A. Puckner, Secretary.

Neurosine

According to the manufacturers, each fluidounce of Neurosine represents:

“Bromid of potassium, C. P.40grains

“Bromid of sodium, C. P.40grains

“Bromid of ammonium, C. P.40grains

“Bromid of zinc1grain

“Extract Lupulin32grains

“Cascara sagrada, fl. ex.40minims

“Extract Henbane .075grain

“Extract Belladonna .075grain

“Extract Cannabis indica .60 grain

“Oil Bitter Almonds .060grain

“Aromatic Elixirs.”

No physician would think for a moment of prescribing all of the drugs contained in Neurosine for any one condition. Yet physicians are urged to use this nostrum in insomnia, hysteria, neurasthenia, migraine, neuralgia, delirium tremens and in a host of other conditions.

It is recommended in the treatment of epilepsy on this ground:

“Neurosine is presented in a very palatable and agreeable form and can be administered for an indefinite time without untoward by-effects as so often attends the use of the commercial bromides. In order to secure lasting benefits the treatment should be extended over a long period of time.”

The evident implication here is that the recognized drawbacks of bromid medication are due to impurities present in the commercial bromids and that the teachings of modern medicine with regard to caution in the use of bromids do not apply in the case of Neurosine.

The assurance is offered:

“Neurosine contains no chloral, morphin or other objectionable drug—a fact of the utmost importance when administering medicines to neurotic women.”

“As a nerve-calmative and sleep-producer nothing can excel Neurosine ... It should be borne in mind that this preparation contains no opium, morphine, chloral or habit-forming drugs ... Neurosine being a harmless remedy is especially indicated for neurotic individuals.”

Apart from cannabis indica, Neurosine contains no efficient hypnotic. Cannabis indica is a dangerous drug, whose administration to “neurotic individuals” is by no means free from danger—​especially when it is given under a proprietary name that carries no warning of its presence.

Here is another recommendation—this time for chorea:

“All authorities recommend the bromides, hyoscyamus and cannabis indica in this disease. These remedies are all combined in Neurosine, the ideal calmative for both children and adults.”

On the contrary, practically “all [medical] authorities” will admit that it is undesirable to keep a child under the influence of bromids if this can be avoided. Such treatment is mentioned only for use as a last resort in extreme cases. Hyoscyamus and cannabis indica are mentioned in connection with chorea by few authorities, and then merely as probably valueless.

Not content with recommending the promiscuous use of this already too complex mixture, the Dios Chemical Company advises physicians to combine it with iron, when chalybeate and tonic effects are to be combined with “a nervine,” with acetanilid for “irritable cough,” headache and neuralgia, with antipyrin in asthma and with Dioviburnia—​another Dios nostrum—​in all female ailments.

Dioviburnia[W]

Dioviburnia, another Dios nostrum, according to the label, has the following composition:

“Every fl. oz. contains 3-4 dr. each of the fl. extracts, Viburnum Prunifolium, Viburnum Opulus, Dioscorea Villosa, Aletris Farinosa, Helonias Dioica, Mitchellae [sic] Repens, Caulophyllum Thalictroides, Scutellaria Laterifolia.” [Lateriflora?—Ed.]

Further, according to the label, Dioviburnia contains 18 per cent. alcohol. If this statement is correct then the “formula” is false, for the fluid extracts named contain from 25 to 73 per cent. of alcohol. As—​according to the “formula”—​these fluid extracts constitute three-fourths of Dioviburnia, the average alcohol-content in the whole mixture must of necessity be much above 18 per cent.59 According to the makers, Dioviburnia is “unexcelled” for:

“Amenorrhea, Dysmenorrhea, Leucorrhea, Puerperal Convulsions, Prolapsus Uteri, Menorrhagia, Threatened Abortion, Parturition, Subinvolution, Miscarriage, and a general relaxed condition of the uterus and appendages, together with the various aches and pains peculiar to women.”

Around the sample bottle of Dioviburnia is wrapped a booklet entitled “A Treatise on Uterine Diseases and Obstetrical Hints,” said to be “For the Profession Only.” The booklet has been prepared, physicians are told, to present “some very valuable suggestions” regarding the treatment of female disorders and the attention of the medical profession is “earnestly” called to the “very remarkable medicine,” Dioviburnia. Further, it is said that Dioviburnia was devised by the Dios Chemical Company because there was an “absolute necessity” for some really efficient internal treatment in female diseases. The company backs up its statements by such claims as:

“The most valuable preparation, therapeutically, ever offered.”

“[Contains] every essential for toning up the female organs of generation, and relieving pain.”

“A general and special tonic, antispasmodic and invigorating cordial.”

While the company directs the attention of physicians to the “well-known, therapeutical effects of each individual constituent” of Dioviburnia, there is in reality little positive evidence regarding the action of any of the drugs contained in the nostrum. Most writers on materia medica do not even mention these drugs and the few who do discuss them, either question or deny their medicinal value. But if every drug claimed to be present in Dioviburnia had some actual demonstrated therapeutic properties, it still would be impossible to predict the action of such a combination in the many and varied conditions for which it is exploited. Certainly there is no warrant for such statements as:

“In Painful Dysmenorrhea [sic] Dioviburnia is especially indicated, and its continued use will invariably give relief.”

“In cases of Leucorrhea of long standing, Dioviburnia, together with local treatment, invariably gives relief.”

“Dioviburnia is efficient in cases of subinvolution; it cures by its tonic effects ...”

The effects of the drugs alleged to be present in Dioviburnia are not such as to justify the hope of either “cure” or “invariable relief.” In a way the Dios Chemical Company seems to recognize the inefficiency of Dioviburnia since it frequently suggests that it be used in combination with drugs of known value; but it ascribes all favorable results to its own product:

“In chronic constipation fluid extract of cascara sagrada aromatic may be combined with Dioviburnia.”

“In cases of habitual abortion, depending on syphilitic taint, a prescription containing the following should be used during the entire pregnancy:

℞ “Hydrarg. Chlor. Corrosgr. 1

“Potass. Iodiddram 1

“Dioviburniaounces16”

“An Anemic or Chlorotic patient, suffering with absence of the menstrual flow, should take DIOVIBURNIA combined with Iron.”

“In leucorrhea depending on endocervicitis, hot astringent douches once daily should be given. Local applications of iodin are useful in chronic conditions. Internally, Dioviburnia promotes healing.”

“Rest in bed, hot douches of a one-half per cent. solution of compound cresol solution and Dioviburnia internally, a teaspoonful every 3 hours will rarely fail to cure endometritis in a few days.”

“In specific vaginitis, a solution of potassium permanganate (1 to 1000) should be used as a douche twice daily. Internally give the following:

“Sodii benzoate¹⁄₂ounce

“Dioviburnia16ounces

“M. sig., Teaspoonful every three hours.”

“Prolapsus Uteri is benefited, and often cured, by DIOVIBURNIA combined with local treatment in the shape of tampons, pessaries, electricity, etc.”

If Dioviburnia will cure specific vaginitis, anemia, etc., so will a cobblestone make excellent soup. All that is necessary in the former case is to add certain potent drugs that might be indicated in the pathologic conditions mentioned and, in the latter case, to combine suitable amounts of beef, chicken, green turtle or vegetables, with herbs and other seasoning.

Germiletum

Germiletum is a member of the large class of alkaline antiseptic solutions with excessively complex formulas. In this case not only is the formula complex but also the Dios Chemical Company finds it impossible even to assign a constant composition to it—​at least the “formulas” which appear on the different styles of Germiletum labels and advertising circulars vary greatly.

The company says:

“We appeal only to the Doctor’s judgment of his estimation of the formula.”

“Doctor you will readily determine from the formula the class of cases in which you have a right to expect satisfactory results.”

Yet the “formulas” given present so great a variety and such confusion that it is not clear even to a chemist just what the Dios Company wants the medical profession to regard as the composition of Germiletum.

The following statements of “composition” have appeared at various times:

1. In an advertising circular sent out some time ago:

“[HBF₄ + BOH (OC₆H₄COOH)₂ + BOH (OC₆H₃COOH)₂ + C₃H₅BO₃ + CH₂O + C₁₀H₁₄O + C₁₀H₂₀O + C₂₄H₂₈N₃Cl.]”

2. In advertising circulars which have been received of late, being wrapped with a sample package and with the “large size” trade package:

“[C₇H₆O₂ + H₃BO₃ + C₃H₅BO₃ + (CH₂O)₃ + C₁₀H₂₀O + C₁₀H₁₄O + C₂H₆O]”

3. In another advertising circular:

“Germiletum is a slightly alkaline chemical solution of Boro­hydro­fluoric Acid, Boro­salyl­benzoic Acid, Boro­glycerine, Formaldehyde with Menthol, Thymol and Antiseptic Aromatics.”

4. On the label of a sample package sent through the mails during 1914, and on the label of a “small size” trade package purchased in 1914:

“FORMULA.—Boro­hydro­fluoric Acid, Boro­salyl­benzoic Acid, Boro­glycerine, Formaldehyde with Menthol, Thymol, Amyl Acetate and other Antiseptic Aromatics.”

5. In the circular which was wrapped around the sample package referred to above, and around the “large size” trade package purchased at the same time that the “small size” package was bought:

“Germiletum is a slightly alkaline chemical solution of Borobenzoic Acid, Boro­glycerine Formaldehyde, with Menthol, Thymol and other Antiseptec [sic] Aromatics.”

6. On the sample package, on the “small size” trade package and on the wrappers of the “large size” trade package:

“Alcohol 18 per cent.; Formalin ³⁄₄ M. per oz.; Amyl Acetate ¹⁄₃ M. per oz.” (also written “Acetate Amyl.”)

The label on the large trade package states that Germiletum contains “Formalin ¹⁄₂ M. per oz.”

One and all of these various formulas spell mystery. The existence of some of the constituents is problematic; even if the theoretical possibility of such combinations be conceded, some of them could not exist in Germiletum, for they would be broken up by the alkaline fluid. As illustrating the contradictions which the formulas present: While the wrapper of the “large size” trade package claims that Germiletum contains ³⁄₄ minims Formalin (Formalin is a proprietary name for a 40 per cent. formaldehyd solution) the label on the bottle claims only ¹⁄₂ minim. Again, while the composition expressed in chemical symbols asserts that “H₃BO₃” (boric acid) is a constituent of Germiletum, the “formula” which follows it states that Germiletum has an alkaline reaction; hence it cannot contain much boric acid. Finally, the “small size” bottle of Germiletum purchased at the same time as the “large size” bottle and also the label of a sample package sent through the mails to a physician in 1914, give as a constituent “Boro­hydro­fluoric Acid,” which is mentioned neither on the label of the “large size” trade package nor in the pamphlet wrapped around it. The only information which these contradictory “formulas” can convey to a physician is that Germiletum is an unscientific, varying mixture of many drugs.

A trade package, having the name “Germiletum” blown in the glass, bears on the label recommendations for its use in the treatment of “catarrh,” “Gastritis, Stomatitis, Gastric and Intestinal Catarrh,” “Leucorrhea and Uterine Diseases,” “Hemorrhoids,” “Whooping Cough,” “Tonsilitis and other forms of sore throat” and “Eczema.”

The following statement on the label is designed to induce physicians to place false confidence in Germiletum to the danger of their patients:

“The lying-in-room should be thoroughly sprayed with Germiletum. Can be relied upon to destroy the living particles which so generally constitute contagion.”

This claim, as well as the assertion which appears on the label of a sample package and of the “small size” trade package that it is “PAR-EXCELLENT IN OBSTETRICAL PRACTICE” is almost criminal, as Fussell60 has said, since to depend on any preparation of this sort is to court disaster.

The booklet around the trade package makes the claim that Germiletum “is the best antiseptic”—​evidently largely because it is claimed to be “the blandest of all”—​and that it is “thoroughly germicidal” and even that it is “the best disinfectant obtainable.” It also contains such unwarranted and misleading claims and suggestions as:

“... preparatory to all operative work—Germiletum should be used freely in spraying the atmosphere ...”

“Operative wounds, whether large or small, can be rendered thoroughly antiseptic by freely spraying them with Germiletum....”

“... it may be given internally in many dyspepsias and in all zymotic diseases.... In such conditions Germiletum is the ideal internal antiseptic and disinfectant.”

In the present advertising, no evidence whatever is offered for the value of Germiletum, the Dios Company contenting itself with unsupported claims and cant phrases such as

“... the truth is only reached through a final appeal to intelligent practical experience.”

In the old circulars only crude, uncritical and meaningless tests to establish the antiseptic value of Germiletum are reported and none whatever as to its germicidal action. In the advertising matter sent out some time ago, for instance, were given “Microscopical, Bacteriological and Chemical Tests, Comparing Germiletum with Carbolic Acid.” These tests have no value whatever, unless it be to show the worthlessness of the preparation. This is particularly true as regards a series of experiments on “Germiletum as a Preventive of Lactic Fermentation,” in which one part of Germiletum in thirty parts of milk did not prevent fermentation. Such effect as indicated is probably due to the formaldehyd present. The tests show the absurdity of using the preparation for internal and external purposes. The referee challenges the therapeutic claims on the basis that they are extravagant and unsubstantiated. (The Chemical Laboratory of the American Medical Association reports that the alkalinity of Germiletum corresponds approximately to a 1 per cent. borax solution.)

Palpebrine

According to the Dios Chemical Company, Palpebrine is “A Reliable External Ocular Antiseptic” having, it is said, the following composition:

“... each fluid ounce contains ¹⁄₁₁₆ grain Sulphate of Morphia, ¹⁄₇ grain Sulphate of Zinc, ¹⁄₁₁ grain Bi-Chloride of Mercury, 5³⁄₈ grains Boric Acid, ³⁄₄ grain Salicylic Acid.”

The essential virtues ascribed to Palpebrine, according to its makers, are its harmlessness and its therapeutic efficiency due, presumably, to its complex composition:

“Attention is called to the constituents of this formula, each one of which is used by ophthalmologists. Their combination in Palpebrine is such as to blend their action in a very happy manner. Palpebrine acts as an antiseptic, an irritant, an astringent, and a nerve tonic to the mucous membrane of the eye.”

“Palpebrine is superior in its action to the remedies now in use. It contains all the constituents of Aqua Conradi ... But to these are added a number of other agents which will prove it to be of much greater value and give it a broader field for action.”

In all external afflictions of the eye the free use of Palpebrine is suggested in such statements as:

“They [general practitioners] will therefore gladly receive from our hands an efficacious preparation which may be used with perfect safety.”

“The name of our preparation—Palpebrine, is derived from the Latin palpebra, the eyelid, and is well fitted, as it designates at a glance the sphere of action of Palpebrine.”

“With the assistance of Palpebrine the general practitioner can successfully treat all cases of external eye disease ordinarily encountered in his practice.”

One of the members of the Council staff of clinical consultants calls attention to the fact that much vitally valuable time might be lost in a case of iritis, for example, which being unrecognized, should be treated with Palpebrine on the strength of the Dios Chemical Company’s advertisements. Even more dangerous is the recommendation of Palpebrine for the prevention of ophthalmia in the newborn, especially as this recommendation is coupled with an attempt to discredit the established treatment with silver nitrate solution:

“The use of severe remedies for this purpose has been discarded by most physicians....”

While it is doubtless true that ophthalmia neonatorum may be averted by other drugs than silver salts, it is utterly unjustifiable to suggest that the established method of treatment by means of silver salt irrigations has been generally discarded.

[Editorial Note.—The four nostrums mentioned above have been grouped together for publication to call attention to one phase of the proprietary business. A fact not mentioned in the Council’s report is that these nostrums are manufactured and promoted by a concern that belongs to a type we have often designated “pseudo-chemical” companies. By this is meant companies that are not in the legitimate business of pharmacy or chemistry, but organized to exploit one, two or in some instances half a dozen proprietaries. “Patent medicines” are exploited by this class of “companies.” The Dios Chemical Company is not a chemical company, except in name. J. H. Chambers, the founder so far as we can learn, never claimed any special knowledge of chemistry, pharmacy or medicine. The officers at the present time are: J. H. Chambers, president; M. E. Chambers, vice-president; Leslie T. Chambers, treasurer, and Arthur Chambers, secretary. M. E. is the wife of J. H., and Leslie T. and Arthur are sons.

This is simply one illustration of the fact noted above. Some physicians have been and are prescribing nostrums originated, manufactured and advertised by laymen who are not in the legitimate pharmacy business. In addition, such physicians have been accepting the statements of laymen, not only as to the composition of the nostrums, but as to their use. In every state the practice of pharmacy is regulated by law: before assuming the responsibility of compounding medicines a druggist must have studied and passed an examination in pharmacy. Public safety demands and the law requires it. There are some doctors, however, who will allow laymen who are not chemists, pharmacists or physicians to formulate and compound a prescription and tell them what it is good for and how to use it.

The Dios Chemical Company is not an isolated instance: we have already referred to some; we shall take occasion to refer to others in the future. That such concerns flourish is a reflection not so much on the shrewd laymen who exploit the medical profession—​and through it the public—​as it is on the physicians who cast their scientific training to the winds and permit themselves to be thus exploited.]​—(From The Journal A. M. A., Jan. 9, 1915.)

OXYCHLORINE

Report of the Council on Pharmacy and Chemistry

The following report on Oxychlorine has been submitted to the Council by the subcommittee to which it was assigned:

To the Council on Pharmacy and Chemistry:—Your subcommittee submits the following report: The Oxychlorine Chemical Company, 1326 Wabash Avenue, Chicago, states in its advertising literature that:

“Chemically, Oxychlorine is the tetraborate of sodium and potassium combined with oxychlorid of boron, thus: 6 (NaKB₄O₇) BOCl₃.”

Analysis of Oxychlorine showed:

Potassium12.26per cent.

Sodium8.20per cent.

Chloric acid—CLO₃25.32per cent.

Nitric acid—NO₃21.70per cent.

Boric acid anhydrid—B₂O₃18.63per cent.

Water, calculated13.29per cent.

Thus, Oxychlorine is not a definite chemical substance of the composition claimed, but instead is a mixture of alkali chlorate and nitrate with boric acid. Assuming that the chlorate is present as potassium chlorate and the nitrate as sodium nitrate, the analysis above quoted corresponds to a mixture approximately as follows:

Potassium chlorat37.19

Sodium nitrate29.76

Sodium and potassium tetraborate2.18

Boric acid30.52

Undetermined0.35

————

100.00

Your committee recommends that Oxychlorine be not approved and that this report be published.

The report of the subcommittee was adopted by the Council, and in accordance with the recommendation is published herewith.

W. A. Puckner, Secretary.

In commenting on the above report it is hardly necessary to call attention to the palpable untruthfulness of the furnished formula or its lack of correspondence to the real composition of the preparation, to the imposing claims made by its pseudo-scientific exploiters or the absurdities, from a chemical standpoint, of the statements made in their literature. These features are more or less common to all nostrums. The physician who prescribes or uses Oxychlorine under the impression that he is getting a definite and unique chemical compound described as tetraborate of sodium and potassium combined with oxychlorid of boron is, according to our chemists, getting simply a mixture of potassium chlorate, sodium nitrate (or, perhaps, sodium chlorate and potassium nitrate), and boric acid in about equal amounts. More than one-third of this mixture is potassium (or sodium) chlorate, drugs by no means harmless.

In order that there may be no suspicion of unfairness to the promoters of the preparation, we quote from one of the advertising circulars sent out by the Oxychlorine Company:

“Oxychlorine owes its recognition as a therapeutic agent to its six principal qualities:

“1. It will oxygenate the blood at the seat of application, maintain nutrition and heal an uninfected solution of continuity of first intention without scar formation.

“2. It will disorganize all pus and ferment-producing micro-organisms, their toxins, ferments and ptomains.

“3. It will restore an inflamed mucous membrane to its normal condition, except where the membrane is sclerosed or atrophied.

“4. It will destroy pathogenic micro-organisms and their toxins in the blood current.

“5. It will stimulate the blood to absorb more oxygen in the lungs than it at the time carries. [We do not know what this means; perhaps the Oxychlorine Company does.]

“6. It is absolutely harmless to the tissues and will not destroy a living cell.”

Surely these people must have access to physiologic and chemical authorities not found in modern medical libraries, or else their esoteric researches into the mysteries of life must have carried them far beyond the ken of our most advanced workers along these lines. The scientific world would receive with great interest information as to how a mixture of potassium chlorate, sodium nitrate and boric acid oxygenates blood, maintains nutrition and causes healing without scar formation. A mixture which will destroy micro-organisms and yet will not destroy a living cell certainly shows a fine sense of selection and discrimination not heretofore expected of a combination of chemicals or of a chemical compound. How like the wonderful elixir of medieval times, which was to the Christian a tonic and to the heathen a poison!

Here is another claim made for this nostrum:

“Two or three rectal injections of a one or two per cent. solution of Oxychlorine and ten grain doses given six to eight times per day is the best and most reliable treatment for typhoid fever.”

If 80 grains of Oxychlorine contain 30 grains of potassium chlorate, three rectal injections each consisting of 1 pint of 2 per cent. solution, would contain approximately 160 grains of potassium chlorate. Such an injection might prove decidedly dangerous, especially when used by one ignorant of its true composition. However, the physician, not the promoters, bears the responsibility.

Oxychlorine sells at $3.50 a pound; the ingredients can be obtained for about 44 cents a pound. Perhaps the margin of profit is intended as a reward due the promoters for the profound physiologic discoveries announced in their reading matter.​—(From The Journal A. M. A., July 6, 1909.)

PAM-ALA, ANOTHER WORTHLESS QUININ SUBSTITUTE

Report of the Council on Pharmacy and Chemistry

The following report of a referee on Pam-ala, an asserted malaria specific, was adopted by the Council and its publication authorized.

W. A. Puckner, Secretary.

Soon after publication of the Council’s report on Sinkina, an alleged malaria specific proved worthless, the referee’s attention was called to Pam-ala, which is sold under very similar claims.

According to the advertisements which have been appearing in Southern medical journals, Pam-ala is “A new and effective remedy for MALARIA.”

The label describes Pam-ala as “An Effective Vegetable Remedy For MALARIA. Guaranteed free of any Quinine, or other harmful [sic] drugs.” It is said to be indicated in “Malarial Intermittent and Remittent Fevers, especially curative in Chronic Malaria and Malarial Cachexia and all conditions even where Quinine fails.” One tablespoonful three times a day is said to be the “Curative Dose,” while one tablespoonful three times a week is stated to be a “Prophylactic Dose.” The label further claims that Pam-ala “Surpasses Quinine in its action and has none of its Disadvantages.” Assertions that Pam-ala is superior to quinin are followed by the usual “guarantee” claim: “Guaranteed by the Pam-Ala Co. under the Drugs Act, June, 1906, Ser. No. 2909 A.” Finally, the label says that it is “Endorsed by Medical Authorities Throughout the world.”

As regards the composition, a circular says that “PAM-ALA is a purely vegetable remedy for the cure, without Quinine, of all forms of Malaria.” “‘Pam-ala’ is derived from a plant of the genus Umbelliferae, a native of the mountainous regions of Mexico and northern parts of South America. Its medicinal properties have not been known to anyone but the native Indians, who for years past have used it as a specific in all forms of fever and malarial diseases so prevalent in tropical countries. The seeds are more active as a therapeutic agent than the dried-up plant; hence their collection for medicinal purposes requires special skill in the selection of the same so as to be able to extract all the possible medicinal properties from them, viz., its active principle. An oil may be abstracted from the seeds which is of a yellow color with an intense characteristic odor.”

At the close of the circular the following unenlightening formula appears:

Each fluid ounce contains:

Ext. Fid. Pam-ala10 per cent.

Alcohol15 per cent.

Ol. Aurant Syr. Sacchari aqua ad. q. s.100 per cent.

In addition to being a cure for malaria, Pam-ala is claimed to have a “favorable influence upon the broncho-pneumonia of measles ...,” “will avert an attack of acute catarrh,” and “abort acute tonsilitis.”

The testimonials are of the usual character. Most of them seem to have been given some four years ago by physicians in Italy, Cuba, Porto Rico, Guatemala, etc., and therefore cannot readily be looked into. Two are of more recent date and come from physicians in this country. They furnish good illustrations of the manner in which proprietary concerns make use of opinions hastily formed and thoughtlessly put in writing. One testimonial was given in July, 1912:

“I take pleasure in testifying to the seemingly marvelous and gratifying effect of Pam-ala in 2 cases of malaria....”

On Jan. 2, 1914, its writer, in reply to an inquiry whether in the light of continued experience, his first estimate of Pam-ala had been confirmed, wrote:

“... Since then I tried Pam-ala on a number of cases without any results whatever; in fact my patients seemed to get worse until I resorted to the usual treatment of malaria, mercurial laxative followed with quinin. I was too hasty in stating that Pam-ala cured malaria. I now know and have known since August, 1912, that Pam-ala will not cure malaria....”

The writer of the second testimonial is reported to have written that he tried Pam-ala “on a most pronounced case of malarial spleen with the most excellent results” and that he “also tried Pam-ala on a case of Malarial Cystitis and Hematuria, with entire satisfaction.” In reply to inquiry this physician admits that he was “very favorably impressed with the preparation at the time.” He states that at that time he was also trying out Sinkina and that after six months he “discontinued the use of both as the results did not warrant further investigation.” He concludes:

“With due allowance for the fact that certain cases will for a time improve on any kind of treatment, new or old, I see no reason for supplanting or even augmenting, the recognized treatment for malarial conditions, with either Pam-ala or Sinkina.”

Incidentally it should be mentioned that this physician also noted the general similarity of Sinkina and Pam-ala. He observes:

“The physical appearance and properties of the two preparations seem to be identical, the advertising matter and literature are surprisingly alike and the only marked difference seems to be that one remedy is purported to be prepared from a ‘new’ South American plant and the other from an equally fresh discovered addition to Asiatic flora.”

WHAT IS PAM-ALA?

From a comparison of the statements regarding the composition which are made for Sinkina and for Pam-ala, as well as from the physical characteristics of the preparation, particularly the odor and taste, it seems evident that the essential constituent is oil of cumin. Although definite proof that oil of cumin forms the essential constituent of Pam-ala would have shown the worthlessness of this nostrum for the reason that the clinical investigation of Sinkina proved the worthlessness of oil of cumin, it did not seem worth while to the referee that this be demonstrated by chemical analysis. It seemed to him that in such cases as these, the secrecy with which the identity of the preparation is surrounded, as well as the extravagant and highly improbable claims, should be sufficient to condemn it.​—(From The Journal A. M. A., Feb. 28, 1914.)

PAPAYANS BELL[X]

Report of the Council on Pharmacy and Chemistry

The following report of a subcommittee was submitted to, and adopted by, the Council and its publication directed.

W. A. Puckner, Secretary.

Papayans (Bell) made by Bell & Co., Orangeburg, N. Y., is said to consist of the “digestive principle obtained by our own exclusive process from the fruit of Carica papaya, combined with willow charcoal, chemically pure sodium bicarbonate and aromatics.” The following statement appears on the package: “For the treatment of dyspepsia, flatulence, nausea, vertigo, hyperacidity, palpitation and other symptoms of indigestion and the vomiting of pregnancy. Peritonitis, cholera morbus, alcoholism and seasickness.” “Digests every variety of food, removes every symptom of indigestion, restores the entire digestive tract to a normal condition.” The dosage is recommended as follows: “From one to three tablets before meals, or two hours after eating. In severe cases, three tablets dissolved in hot water and repeated as necessary.”

A circular which accompanies the package details the therapeutic virtues of the preparation and contains what purports to be extracts from medical journals, in which Papayans is recommended.

Examination of specimens purchased in the open market showed them to contain the following ingredients: Charcoal, sodium bicarbonate, ginger, saccharin and oil of gaultheria. As the product is said to contain papain, the presence of enzymes was tested for, with the result that it was found to possess neither proteolytic nor amylolytic properties. The results of our examination are in accord with the results obtained by a member of the Council, who examined the product independently, and who writes:

“We have made some extended tests with Papayans Bell, and find that the tablets consist essentially of sodium bicarbonate and charcoal, with a little flavoring matter. We find no digesting power for starch or egg albumin. At any rate, no appreciable change follows in the albumin in three hours, and no conversion to sugar in the same time, or change of starch to a point where the iodin reaction is weakened. The product seems to be practically inert.”

It is recommended that Papayans Bell be refused recognition, and that publication of this report be authorized.

Comment: It will be remembered that two other products of Messrs. Bell & Company have been discussed in this department: Salacetin (Bell)61 and Sal-Codeia (Bell).62 Salacetin was examined with several “synthetics” which all turned out to be mere acetanilid mixtures. Salacetin, advertised as “a combination, with heat, of Salicylic and Glacial Acetic Acids and Phenylamine” when examined “was found to be a mixture and to contain the following ingredients approximately in the proportion given: Acetanilid 43; sodium bicarbonate, 21; and ammonium carbonate, 20.” Sal-Codeia (Salacetin-Codein) therefore, would be the same with codein added.

Papayans (Bell) seems to be consistently fulfilling the life-history of the average nostrum. Made of well-known drugs and invested by its manufacturers—​or exploiters—​with virtues absurdly dis­pro­por­tion­ate to the known properties of the alleged constituents of the nostrum, the preparation was introduced to the world via the medical profession. With the help of thoughtless physicians, aided by a skilful and aggressive advertising campaign and augmented by the “free sample” device, the business grew and prospered. The bottles with the name and address of the company blown in the glass and with the varied therapeutic indications for the nostrum printed both on the label and on the circular in which the bottle is wrapped, have carried the manufacturer’s message to the drug-taking public.

Apropos of this point, the recent “literature” contains what purports to be endorsements of the nostrum by medical journals. Thus there is quoted from the New York Medical Journal, Jan. 2, 1909, in part, the following recommendation: “... we venture to suggest to our readers who have not tried this remedy that they prescribe one original sealed package of Papayans (Bell) and that they carefully note the results from its use.” [Italics ours.—Ed.] Having seen an “original sealed package” we believe that we can predict the “results from its use.” On any patient not mentally unbalanced, the result would be that the next dose of Papayans (Bell) he thought that he needed would be purchased from the druggist direct.

That such results are not hypothetical is evidenced by the statements of the exploiters of Papayans (Bell) that “the annual sale now exceeds four hundred million tablets.” Assuming that statement to be true, it would be necessary for every physician in the United States to prescribe over three thousand of these tablets every year—​if they reached patients only through the physician! The company’s own figures indicate that the time is about ripe to take care of this vast army of self-drugging laymen and recent circular letters seem to recognize it. The physician is notified that druggists are now furnished with Papayans (Bell) “in sealed packages of thirty and one hundred tablets.” The medical man is told that the firm has “not forgotten the days when physicians’ orders made our success possible” and it says it is “sincerely grateful to the doctors who gave us orders in the days when we were struggling for recognition.” This tacit admission of the value of the physician as an unpaid agent for nostrum houses should be given thought by those physicians who prescribe such preparations.

While, so far as we know, Bell & Co. have not yet advertised in the daily press, they are not averse to furnishing the laity with samples when requested. An Ohio physician sent us the following letter received by a young woman who had written asking for samples:

Miss X—— Y——, Z——.

Dear Madam: As requested, we are mailing you sample of our Papayans (Bell) for Indigestion.

If a sufferer from Indigestion, we want you to give it a thorough trial as directed and note remarkable results that we believe you will get from its use.

Kindly write us if you are unable to obtain it from your local druggist, as it is stocked by nearly every good drugstore in the United States. Yours truly,

Bell & Co.

Evidently Bell & Co., while admitting that their financial success is largely due to the kindly, though misguided, efforts of physicians, are not going to let a little thing like loyalty to the medical profession interfere with a possible sale of their tablets.

THE L. D. JOHNS COMPANY

A discussion of the methods of Bell & Company would not be complete without reference to a concern which seems to be closely connected with it: the L. D. Johns Company, whose “only product” is a sugar-coated laxative tablet. Regarding the “sugar coated” tablet, a visitor at the place of business of Bell & Company and the L. D. Johns Company wrote: “These companies apparently are not in possession of any tablet coating machines and in questioning on this point stated that some of their tablets were sent out to be coated.” There is a sameness regarding the claims for the laxative tablets of the two companies that might lead one to suspect that the same individual prepared both circulars. For instance:

Cascarans (Bell) Dr. Johns’ Tablets

“Taken as directed, it permanently removes the great majority of cases of habitual constipation.” “... a harmless vegetable preparation.” “... for the removal of pimples, yellowness and greasiness of the skin ...” “... one tablet at night, one night and morning, or, in severe cases, one three time a day, gradually decreasing the frequency of the dose as improvement permits.” “Taken as directed ... permanently remove the great majority of cases of habitual constipation, torpid liver and sick headache.” “A harmless vegetable remedy.” “... removes pimples, blotches, sallow­ness and greasiness of the skin ...” “One at night, one night and morning, or, in severe cases, one three times a day. Gradually decrease the frequency of the dose as improve­ment permits.”

According to a leaflet sent out with samples by the L. D. Johns Company, the company is capitalized for $500,000, divided into 50,000 shares at $10 each; these shares are sold to those physicians who will agree “to prescribe the tablets at every suitable opportunity, to introduce them to other physicians” and “to promote their sale in every ethical way!” If the list of physicians’ names and addresses which the company sends out as comprising the eastern stockholders is to be relied on, it would seem that many medical men are promoting their sale. In prescribing it is, of course, “necessary to specify ‘Dr. Johns’ Tablets No XXX (Original bottle).’” As the name is on the bottle, it is not unbelievable that, as the company says in its prospectus, because of “our method of advertising, a large and very profitable business is being created.” That the L. D. Johns Company expects to profit by the self-drugging which this method of prescribing fosters is evident:

“Physicians not stockholders in this company suffer from the continual refilling of their prescriptions and from the recommendation of the preparation prescribed by patients to others. [Italics ours.—Ed.] Our stockholders benefit by the refilling of their prescriptions and by these recommendations.”

Put baldly the case amounts to this: Physicians who prescribe “Dr. Johns’ Tablets” not only are likely to foster self-drugging, but they will reap dividends therefrom. Truly a nice business to be in!

While Bell & Company and the L. D. Johns Company are said to be entirely distinct, they are to be found at the same address at Orangeburg, New York, and as will be seen, the officers of the two companies are more or less related.

BELL & CO.L. D. JOHNS CO.

PresidentJohn L. DodgePresident

SecretaryGeo. C. TennantVice-President

Vice-PresidentChas. B. SmithSecretary and Treasurer

EXPLOITING THE PROFESSION

Nostrum promoters have two simple ways of “working” the medical profession. The first—​and the more profitable—​is, by lavish distribution of free samples, to get physicians to prescribe the blown-in-the-glass “original package” with the inevitable result of large sales direct to the laity. By the second method, which is merely a modification of the first, the physician furnishes the capital for floating the nostrum and then takes his share of the resulting profits. There may not be quite as much money in the second method for the promoter, but then the risks are correspondingly less. If the firm fails, the stockholders are the losers; the promoter is not necessarily “out” anything. From a commercial standpoint, a combination of the two methods is, of course, ideal​—(From The Journal A. M. A., Aug. 14, 1909.)

PASSIFLORA AND DANIEL’S CONCENTRATED TINCTURE OF PASSIFLORA[Y]

Report of the Council on Pharmacy and Chemistry

The Council has voted that the drug passiflora (passion flower) be not accepted for New and Nonofficial Remedies, and has recommended that the following article be published in The Journal. It is considered important to call attention, not only to the lack of reliable evidence of the therapeutic value of passiflora, but also to the absurdity of the claims which are made for Daniel’s Concentrated Tincture of Passiflora, a preparation which has been already refused recognition.

W. A. Puckner, Secretary.

Passiflora

Although passiflora was introduced into medicine nearly seventy years ago, the literature concerning it is not very extensive; it is not mentioned in the standard works on pharmacology and its chemistry seems never to have been worked out. There appears, also, to be no record of experimental investigations of the drug with reference to its pharmacologic action, except an article by I. Ott,63 who used “Daniel’s Concentrated Tincture.” Ott claimed that it lessened the reflex irritability of the cord and paralyzed motion by acting on the motor centers in the cord, and that it increased the rate of respiration. He also stated that because of its action on the vasomotor centers it reduced the frequency of the heart-beat and lowered arterial tension, but that these effects were only temporary.

On the clinical side the reports are not numerous and such as have been made do not appear to be based on very extensive trials nor on conditions of observation that would entitle them to more than slight consideration. S. D. Bullington64 reports good results, but no cure, in one case of epilepsy, and improvement in a case of insomnia. W. J. Stapleton65 recommends it in the form of a concentrated tincture (not the one advertised so extensively), and states that he has used it with great success in insomnia, hysteria, neurasthenia, neuralgia, nervous and physical prostration, and in alcoholism. In his opinion its action is most apparent in cases of nervousness due to causes other than pain. S. Harnsberger66 reports two cases in which partial blindness followed the taking of potassium bromid and passion flower.

Extravagant and inconsistent claims are made for Daniel’s concentrated tincture of passiflora in the advertising literature, where it is recommended for such a wide range of diseases as asthma, typhoid fever, convulsions and paralysis.

None of the evidence is sufficient to show that passiflora has therapeutic value; hence it is deemed inadvisable to include this drug in the list of nonofficial remedies.​—(From The Journal A. M. A., March 19, 1910.)

LIQUID COMBINATIONS CONTAINING PEPSIN AND PANCREATIN [Z]

Report of the Council on Pharmacy and Chemistry of the American Medical Association

The following report was submitted to the Council by a subcommittee:

To the Council on Pharmacy and Chemistry:—The U. S. Pharmacopeia, 8th revision, pages 334–​5, states: “Pepsin and pancreatin in solution are incompatible with one another. If the solution be neutral or alkaline the pancreatin gradually destroys the pepsin, and if acid the pepsin destroys the pancreatin.” The correctness of this statement has been amply demonstrated by the reports which have been submitted to the Council from time to time on liquid preparations claimed to contain these two ferments.

Thus an elixir was investigated which was by the manufacturers claimed to contain “the five active agents of digestion, pepsin, veg. ptyalin, pancreatin, lactic and hydrochloric acids,” and to be “superior to all other remedies in dyspepsia and diseases arising from imperfect digestion,” and the committee which investigated the article in question reported that “it was impossible to establish the presence of either the proteolytic or the amylolytic ferment.”

Similarly, on another liquid preparation, which was said to contain “pancreatin, pepsin, lactic and muriatic acids, etc.” ... “the combined principles of digestion to aid in digesting animal and vegetable cooked food, fatty and amylaceous substances,” the committee reported “this product possessed only very slight proteolytic action and failed to digest 2 per cent. of its own weight of starch.”

Again, the report on still another preparation stated: “But while it was said to contain pancreatin, the U. S. P. test for the valuation of pancreatin failed to indicate this ferment.”

The report on yet another elixir, claimed to be “the only true digestant, because it contains the enzymes of all the glands which are necessary for digestion,” showed that this article did not contain “any appreciable enzyme activity, either amylolytic or proteolytic.”

The correctness of these findings of the committee of the Council was generally acknowledged by the manufacturers when their attention was called to the matter. Thus, one manufacturer of digestive ferments writes: “We will ask you to hold this matter up until you hear from us further on the subject. The reason for this request is that we have been going over our liquid preparations very carefully in order to be sure that after aging they would contain the ferments that we put into them. The pancreatic ferments in alcoholic liquids seem to lose their strength.”

The chemist for a large manufacturing house writes: “There are now on the market a number of preparations in which pepsin and pancreatin are combined in liquid form, and the result is that we have had numberless requisitions from our representatives that we also market such a preparation. As the result of this we have carried out a series of experiments no less than four or five times in order to determine whether pepsin, diastase, and pancreatin would retain their activity in the form of a syrup, wine or elixir. We have proved in­con­tro­vert­ibly that this cannot be done. While any two of these substances, or even all three of them, can be dispensed in the form of a liquid by the retail druggist and will retain their normal activity for as long a period as three to six weeks, yet if allowed to stand sufficiently long, they mutually destroy each other; so that in a combination of pancreatin and pepsin the pancreatic enzyme is lost and the pepsin greatly injured, and where diastase is present, both diastase and pepsin (or diastase and pancreatin) mutually destroy each other.”

Since it has been demonstrated that pepsin and pancreatin cannot exist in one and the same solution for any reasonable length of time, it becomes apparent that liquid preparations said to contain these two ferments are sold under impossible claims. It is therefore recommended:

1. That the Council on Pharmacy and Chemistry refuse to approve liquid preparations that are claimed to contain both pepsin and pancreatin.

2. That the medical profession through the Journal of the American Medical Association be advised of the fallacy of employing such combinations.

3. That the attention of manufacturers be called to the worthlessness of such incompatible liquid preparations of pepsin and pancreatin, and that they be urged to cease offering such products to the profession.

4. That, since the National Formulary has recognized a preparation of this kind under the title “Elixir Digestivum Compositum,” the American Pharmaceutical Association be requested to instruct its committee on the National Formulary to omit this preparation from the next edition.

The recommendations of the subcommittee were adopted by the Council and publication of the report directed.​—(From The Journal A. M. A., Feb. 2, 1907.)

W. A. Puckner, Secretary.

PEPTO-MANGAN (GUDE)

Report of the Council on Pharmacy and Chemistry

The following report was adopted by the Council and its publication authorized.

W. A. Puckner, Secretary.

About ten years ago the M. J. Breitenbach Company circulated what pretended to be an abstract of the report of a government commission for the investigation of the anemia then prevalent in Porto Rico. The company asserted that “this report alone would suffice to establish Pepto-Mangan at once as the foremost hematinic known.” Examination of the official report of the commission67 revealed the fact that the administration of iron in hookworm anemia was considered of secondary importance, and that of the various preparations of iron, Blaud’s pill was found to be more efficient than Pepto-Mangan (Gude). A protest68 was made at this time by the commission against the unwarranted use of its report by the Breitenbach Company.

Later the Breitenbach Company sent out a report pretending to prove that at the Infants Hospital, Randall’s Island, New York City, Pepto-Mangan (Gude) had been found a most superior preparation in the treatment of infantile anemia. Inspection of the hospital records and daily charts of the cases disclosed69 a remarkable disparity between the claims of the Pepto-Mangan pamphlet and the real results of treatment. And so here, also, as well as in the Porto Rico commission’s report the trials, selected by the Breitenbach Company prove the limitations and non-superiority of Pepto-Mangan.

The preceding false reports, though no longer circulated, have never been definitely withdrawn and while it is now generally conceded that the good results in anemia are obtained by the administration of the various simple inorganic iron preparations the Breitenbach Company still attempts to convey the impression that Pepto-Mangan (Gude) is of most superior efficacy. Thus the present Pepto-Mangan circular attempts to discredit by obsolete and absurd or untrue statements the various preparations of iron which are in general use and to carry the impression that only iron and manganese, in the particular form and proportion in which they are contained in Pepto-Mangan—​namely, 3 parts Fe to 1 part Mn—are useful for the treatment of anemia, chlorosis, etc. Thus contrary to general conceptions, the impression is given that the now generally accepted course of chlorosis is due to the three varieties of insufficiency of certain blood elements: (1) insufficiency of manganese, (2) insufficiency of iron, (3) insufficiency of iron and manganese; and that the administration of iron often fails because manganese is not supplied to the system at the same time and in sufficient amounts. The following statement is made:

“Doctor:

“If you have a case of ANAEMIA, CHLOROSIS, or AMENORRHOEA, that shows no visible sign of improvement, and you have exhausted the entire list of Nauseating Iron preparations with little or no effect, it is because the blood is deficient in that essential oxidizing constituent, MANGANESE, in a soluble, readily assimilable form, the best being in combination with iron.”

Another extravagant claim:

“Usually after taking it for a week its restorative influence on the functions of the stomach is felt; appetite reappears, and the general health is improved by the increase in bodily warmth, an effect directly due to manganese.”

The following statement implies that Pepto-Mangan is absorbed unchanged, for which there is no justification:

“As the ferruginous and manganic ingredients of Pepto-Mangan (Gude) exist in the form of organic peptonates, they have already undergone the changes necessary to insure prompt absorption and appropriation by the circulating fluid.”

The following declaration implies that it repairs the individual defective blood-cells which is, of course, also ridiculous:

“That Pepto-Mangan (Gude) quickly and efficiently builds up defective red blood cells, and generates, or at least potently encourages the formation of new ones, and materially increases their richness in hemoglobin, has been abundantly demonstrated....”

The M. J. Breitenbach Company is still trying to mislead physicians; it also aims to make use of them in its direct appeal to the physicians’ patients. For instance, the name “Pepto-Mangan (Gude)” blown in the bottle, the advertising circular suggesting Pepto-Mangan as the treatment for anemia, etc., and the recommendation to physicians that it be prescribed in “original bottles” all tend to encourage the use of Pepto-Mangan by the public with the likelihood that it will be depended on where good food and fresh air are of prime importance. The attempt to exploit it directly to the public is further attested by the advertisements of department-store drug departments.

It is evident from the foregoing that Pepto-Mangan (Gude) is in conflict with Rules 4 and 6 and therefore not eligible for admission to New and Nonofficial Remedies.​—(From Reports Council Pharm. and Chem., 1914, p. 121.)

LIQUID PETROLATUM OR “RUSSIAN MINERAL OIL” [AA]

Report of the Council on Pharmacy and Chemistry

The following report was submitted to the Council by a referee and its publication authorized by the Council.

W. A. Puckner, Secretary.

Petroleum has been in use as a medicine from time immemorial. It was known to Herodotus 400 years before Christ and is mentioned by Plutarch, Dioscorides, Pliny and other early writers. It was extensively used by the Arabians and evidently played an important part in the practice of medicine in India, being known to the Bengalese as Muthe Katel. The raw product was the substance used in earlier times and differed much in character and composition, as obtained from different sources.

As an internal remedy it was early employed in chronic pulmonary affections, in obstinate skin diseases, in rheumatism, and for the expelling of tapeworms. It was extensively used for these several purposes in France under the name of “Oleum Gabianum” and in North America as “Seneka oil.”

The internal use of the refined product may be traced to a patent granted to Robert A. Chesebrough of New York, in June, 1872, for the manufacture of a “new and useful product from petroleum, named vaseline.” This name was originally applied only to a semisolid preparation, but later a liquid product known as liquid vaseline was marketed and for a time exploited as a cure for coughs, colds, consumption and a number of other diseases and conditions.

The liquid petrolatum has since become known under a variety of names, proprietary and otherwise, in addition to being used as a substitute or an adulterant for other, more costly, fats and oils. Some of the names applied to the product are:

Adepsine oilNeutralol

AmileeOlo

AtoleineParaffin Oil

AtolinParoline

BlandinePetralol

CrysmalinPetro

DeelinePetrolax

GlycoPetrolia

GlycolinePetronol

GlymolPetrosio

Heavy petroleum oilRock Oil

Liquid AlboleneRussian liquid petrolatum

Liquid CosmolineRussian mineral oil

Liquid FossilineRussian paraffin oil

Liquid GeolineRussol

Liquid ParaffinSaxol

Liquid PetrolatumTerraline

Liquid SaxolineTerralbolia

Liquid VaselineUsoline

Mineral GlycerinWater-white mineral oil

Mineral OilWhite paraffin oil.

A preparation similar to that official in the Pharmacopeia of the United States as liquid petrolatum has been included in many, if not all, of the foreign pharmacopeias, the official titles under which this preparation is recognized being as follows:

Petrolatum Liquidum, U. S. Pharmacopeia; Paraffinum Liquidum, pharmacopeias of Great Britain, Germany, the Netherlands, Japan, Belgium, Austria, Denmark, Switzerland, Sweden, Servia, Italy, Hungary and Russia; Oleum Paraffinae, Spanish Pharmacopeia; Vaselinum Liquidum, French Pharmacopeia, and Oleum Vaselini (as a synonym) pharmacopeias of Denmark and Russia.

The requirements of the several pharmacopeias differ somewhat and the specific gravity as given is as follows:

U. S. P. VIII, 19050.870to 0.940at 25°

Ph. Brit. IV, 18950.885to 0.890at 15.5°

B. P. C. II, 1911, usually0.875or lowerat 15°

Ph. Germ. V, 1910, at least0.885at 15°

Ph. Ross. VI, 19100.880to 0.885at 15°

Ph. Hung. III, 19090.88to 0.89at 15°

Ph. Ital. III, 19090.875to 0.890at 15°

Ph. Fr. V, 1908, about0.875at 15°

Ph. Serb. II, 1908, about0.880at 15°

Ph. Svec. IX, 19080.88to 0.90at 15°

Ph. Helv. IV, 19070.880to 0.885at 15°

Ph. Dan. VII, 1907, at least0.880at 15°

Ph. Austr. VIII, 1906, at least0.880at 15°

Ph. Belg. III, 1906, not below0.880at 15°

Ph. Japon. III, 19060.875to 0.945at 15°

Ph. Ndl. IV, 1905, not below0.860at 15°

Ph. Hisp. VII, 19050.840at 15°

For pharmaceutical purposes, liquid petrolatum may be divided into two grades, the lighter or more limpid oil, used extensively as a vehicle for oil sprays, and the heavier, more viscid oil generally recognized in European pharmacopeias and used as an ingredient of ointments and more recently as a remedy in the treatment of intestinal stasis.

Under petrolatum liquidum the U. S. P. recognizes a mixture of hydrocarbons, chiefly of the methane series, which occurs as a colorless or very slightly yellowish, oily, transparent liquid without odor or taste and having a specific gravity of about 0.870 to 0.940 at 25 C. For the U. S. P. IX, it is proposed to change this requirement somewhat so as to have it apply to a transparent liquid free from fluorescence, without odor or taste and having a specific gravity of from 0.845 to 0.940 at 25 C.

Such a requirement would include all of the available paraffin oils irrespective of origin. The now commonly available commercial liquid petrolatum, used for pharmaceutical purposes, is practically colorless and all of the better grades are free from odor or taste. The specific gravity varies from 0.855 to 0.895. The lighter oils, having a specific gravity of from 0.860 to 0.870, are usually preferred in the making of oil sprays or solutions of substances to be used as local applications. The product having a specific gravity above 0.875 evidently contains a considerable amount of dissolved solid paraffin which separates out at temperatures at or below 0 C., but readily dissolves again at temperatures above 10 C.

There is considerable difference in the chemical composition of the paraffin oils obtained from various sources. The American oil consists largely of hydrocarbons of the methane series, while the Russian oil contains naphthenes or hydrocarbons of the benzene series, having the empirical composition of ethylene, (C_nH_2n) which may be considered as hydrogenated aromatic hydrocarbons, though they behave with reagents very much in the same way as do the hydrocarbons of the methane series.

Mineral oils with a naphthene base are best suited for making white petrolatum, and at the present time the production of the colorless water-white liquid petrolatum appears to be confined largely or almost exclusively to the crude product of the Baku district of Russia, though it is asserted that it is now also made from the Hanover (Germany) crude oil and that some is being produced by “cracking” the white solid paraffin.

It is also said that the American oil can be made water white but that it is not being so produced at present for economic reasons; the yellowish oil, free from fluorescence, having a very wide sale, both as a lubricant and as a substitute for lard oil and other of the more costly lubricating oils.

From a pharmaceutical point of view it would appear important to note the physical characteristics of the oil and to insist on absence of color, absence of odor and taste, absence of acid and of alkali and a specific gravity in harmony with the purposes for which the oil is to be used.

During the past year or two liquid petrolatum has attracted considerable attention as a remedy in the treatment of intestinal stasis or chronic constipation, the practice of using it having been developed largely through its recommendation by Sir W. Arbuthnot Lane and his associates. This use of liquid petrolatum and of petrolatum products generally is by no means novel. N. A. Randolph70 of Philadelphia was among the first to suggest its use for this purpose in an article published in 1885. Randolph also appears to have been the first to experiment with petrolatum and to determine its non-absorbability from the intestinal tract. In an article71 in 1884 he concludes that “pure petrolatum while entirely unirritating to the digestive tract is valueless as a foodstuff.”

The experiments recorded by Randolph were evidently prompted by the fact that vaseline and a number of imitation products then on the market were being sold as substitutes for lard and butter, and opinions regarding the food value of petroleum products appear to have differed very materially. Following the experiments of Randolph, Robert Hutchison in 1899 made a series of experiments to demonstrate that petroleum, petrolatum, paraffin and related products were absolutely unassailable by any of the digestive fluids, despite the “large vogue that had of late years been given to various petroleum emulsions, chiefly by ingenious and unterrified advertising.” He came to practically the same conclusions arrived at by Randolph fifteen years earlier and pointed out that “liquid paraffin in one sense may be regarded as an artificial intestinal mucus and might in that way have some value on certain forms of constipation.”

William Duffield Robinson72 reports on the use of a perfectly refined colorless and odorless petrolatum, supposedly of American origin. He was able to show that all of the product passed unchanged through the intestinal tract and could be regained from the feces. In his conclusions he expressed the belief that the effect of the administration of these petroleum products is far more than as a simple intestinal lubricant. In over fifty selected cases in which nutrition, digestion and body-weight were impaired, and the purest oil administered in 1- or 2-dram doses each day for a period of from four to six months, there was in every instance an improvement of weight, health and feeling of well-being. The administration of refined paraffin oil gave no discomfort in any instance, even in cases in which nearly a pint was given in a few hours.

William Ewart73 suggests liquid paraffin as a safe agent for the local treatment of the lesions in typhoid fever. He says in part: “Mineral oil, such as petrolatum or paraffin, is neither absorbed nor dissolved; therefore, after all absorbable ingestions are taken up by the lacteals, it will still remain in the bowel. In this way pure liquid paraffin is valuable, precisely because it is inert; moreover, it might some day, perhaps, be made the vehicle for effective topical remedies.”

A. D. Schmidt74 quotes Stubenrath as having given liquid paraffin in the treatment of chronic constipation, and he himself gave as much as 20 gm. of liquid paraffin to adults without observing any injurious effect whatever. He says, “As a result of the administration of liquid paraffin, the feces are softened considerably and are found under the microscope to contain numerous minute globules of paraffin.” He was, however, unable to recover from the feces the entire quantity of paraffin administered and believes that a certain portion of it, probably the fractions with a low boiling-point, are absorbed or possibly oxidized in the organism.

Maurice Vejux Tyrode75 also refers to the use of liquid petroleum in the treatment of constipation.

Sir W. Arbuthnot Lane in his recommendations of liquid petrolatum calls it an ideal remedy for stasis, but cautions against the use of the lighter oil as extensively prescribed in this country as a vehicle for sprays in nose and throat work.

Paraffin oil is not absorbed from the alimentary tract and so far as known exerts no deleterious influence. It is usually given in quantities of from 10 to 20 c.c. half an hour or an hour before meals or in larger doses, from 30 to 50 c.c., at one time on retiring. From available evidence it appears that comparatively huge doses may be administered without the production of any untoward results. According to many observers, liquid paraffin should not be given with or after meals because of the inhibiting influence that it may have on the digestion of food. It is not soluble in water or the ordinary solvents and therefore cannot be diluted. The denser oils are preferably slightly warmed or drunk with warm water so as to obviate the disagreeable slimy sensation that persists when taken cold.

Volatile oils may be used in moderate amounts to give a distinctive taste to the otherwise rather insipidly tasteless paraffin oil. Among the more desirable oils to be used for this purpose would be oil of peppermint, oil of cinnamon, oil of betula or methyl salicylate and oil of cloves. From 2 to 10 drops of any of these oils can be added to a pint of the oil. When larger doses of the oil are to be given at one time, it would, of course, be advisable to use a comparatively smaller quantity of the volatile oil as a flavor.76

From the foregoing it would appear that apart from the Pharmacopeia of the United States, practically all other known pharmacopeias describe a water-white mineral oil under the title “Paraffinum Liquidum” or “Liquid Paraffin” as a colorless, odorless, tasteless, non-fluorescent, oily liquid, free from acids, alkalies and organic impurities. As explained before, the specific gravity of the preparation as recognized in other countries and as offered on the American market at the present time varies considerably, and there appears to be some difference of opinion as to the exact nature of the product that is preferable for use for different purposes. This matter requires further investigation.

Since the definition of liquid petrolatum in the U. S. Pharmacopeia permits the use of fluorescent products of widely varying specific gravities, it is recommended that physicians who desire the water-white non-fluorescent (Russian) mineral oil should use the term “Petrolatum Liquidum, Grave,” or “Paraffinum Liquidum, B. P.,” if the heavy product recommended by Lane is desired, and “Petrolatum Liquidum, Leve” if the light varieties are required. It is further recommended that under the foregoing names, manufacturers and pharmacists be requested to dispense the products, in accordance with the following descriptions:

Petrolatum Liquidum, Grave.—Heavy (Russian) Liquid Petrolatum.—Paraffinum Liquidum, B. P., liquid paraffin.—​A transparent, colorless, tasteless, non-fluorescent, oily liquid, odorless when cold but giving off a faint petroleum odor on heating. This preparation should correspond to the requirements of the British Pharmacopeia for liquid paraffin and have a specific gravity of about 0.885 to 0.890 at 15 C. It is insoluble in water or alcohol but soluble in boiling absolute alcohol and readily soluble in ether, chloroform, carbon disulphid, petroleum benzin, benzene and fixed and volatile oils. It serves as a solvent for volatile oils and related substances like camphor, menthol and thymol.

This is the type of preparation used by Sir W. Arbuthnot Lane, and his associates for internal administration. It is also used as a basis for ointments and salves and as a local application to wounds, ulcers and in certain forms of skin diseases in which a simple protective is desired.

Petrolatum Liquidum, Leve.—Light (Russian) Liquid Petrolatum.—A transparent, colorless, tasteless, non-fluorescent, oily liquid, odorless when cold, but giving off a faint petroleum odor on heating. In other respects this preparation should correspond to the pharmacopeial tests for liquid petrolatum and have a specific gravity of about 0.860 to 0.875 at 15 C. Like the heavy variety of liquid petrolatum, it is insoluble in water and alcohol, but soluble in boiling absolute alcohol and rapidly soluble in ether, chloroform, carbon disulphid, petroleum benzin, benzene and fixed and volatile oils. It serves as a solvent for volatile oils and related substances like camphor, menthol and thymol.

This is a type of preparation extensively used as a vehicle for the oily sprays in nose and throat work. It is also being used as one of the constituents in the now popular paraffin oil cold cream and has been used to some extent for internal administration in the treatment of chronic stasis. Being more limpid than the preparation preferred by Lane, it is more readily taken, though greater care must be exercised in securing a sample devoid of the lighter fractions of petroleum distillates.​—(From The Journal A. M. A., May 30, 1914.)

CLINICAL EXPERIENCE WITH LIQUID PARAFFIN (LIQUID PETROLATUM) [AB]

A Comparative Investigation Made Under the Auspices of the Council on Pharmacy and Chemistry [AC]

W. A. Bastedo, M.D., New York

During the past three or four years, “mineral oil” has come into extensive use in the treatment of constipation. Preparations of the Russian and the American oil, both heavy and light, have appeared on the market, but there have been no satisfactory data on which to base a selection of oil for use. Therefore, in order to obtain reliable clinical information concerning the relative efficiency of the different oils, the Therapeutic Research Committee of the Council on Pharmacy and Chemistry of the American Medical Association submitted samples of the oils to various clinicians for testing. The following is a synopsis of the investigation, which I have prepared at the request of the committee.