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The one-time prevalent custom of usingill-considered combinations of remedial agents has been thoroughlydiscredited and is generally abandoned by progressive practitioners such arguments as that “laxatives, tonics, carminatives, diuretics arecombined with distinct advantage” have led to the use of irrationalmixtures such as the compound syrup of hypophosphites and the electuaryof theriaca the council is confident that no one who has studied thecauses and treatment of digestive disorders will find occasion toprescribe at one time all the ingredients stated to be contained incarminzym, and certainly not in the fixed proportions present therein the comments in the council report concerning ipecac certainlydoes apply to all active therapeutic agents ipecac was mentioned inthe report because the several constituents of carminzym were underdiscussion and hence it was necessary to point out the futility of thesmall dosage of ipecac in this mixture the announcement that “carminzym has proved of constantly increasingservice” is not convincing the council does not know of a singleclinical study of the action of carminzym under conditions which wouldhave afforded satisfactory evidence of its therapeutic value -- fromthe journal a m a , sept 28, 1918 phillips’ phospho-muriate of quinine comp report of the council on pharmacy and chemistrythe following report on phillips’ phospho-muriate of quinine comp hasbeen adopted by the council and authorized for publication w a puckner, secretary phillips’ phospho-muriate of quinine comp 125 is sold by the charlesh phillips chemical co , new york according to the published formula, each fluidram contains. Phosphoric acid 2 minims potassium phosphate } magnesium phosphate } calcium phosphate } 2-1/4 grains ferric phosphate } quinin muriate equal to nearly 1/2 gr bi-sulph 1/4 grain strychnin 1/120 grain flavoring, glycerin and syrup, q s 125 the evolution of “phillips’ phospho-muriate of quinine comp ”from “phillips’ wheat phosphates” may be interesting every oneknows that therapeutics tends to fashions, and “phillips’ wheatphosphates” appears to have had its inception as the result of theobservation that super-refined white flour contains less phosphatesthan the corresponding amount of wheat it was assumed that suchflour must be deficient in an essential constituent, and the wheatphosphates preparation was apparently designed to fill the want it wasexploited for the relief of numerous conditions that were supposed, without satisfactory evidence, to result from this deficiency wheniron, quinin and strychnin mixtures became the vogue a quarter of acentury ago, it was only natural to ride on the wave of popularityand the already widely advertised “wheat phosphates” was furtherenhanced-- commercially-- by the addition of the iron, quinin andstrychnin, the amount of alkaloid added being practically negligible those who are not familiar with the various phases of the phosphorus, phosphoric acid, lactophosphate, lecithin, nuclein and glycerophosphatepropaganda are referred to a report of the council on pharmacy andchemistry in the journal a m a , sept 30, 1916, p 1033 essay typical claims made for the preparation are. “with marked beneficial action upon the nervous system to be relied on where a deficiency of the phosphates is evident ” “ brace those tired nerves and aid that worn stomach with phillips’ phospho-muriate of quinine ” “the maintenance of a satisfactory blood pressure level free from intervals of depression may be accomplished by the use of phillips’ phospho-muriate of quinine compound in appropriate doses ” “the quantities of quinin and strychnin in this preparation are so well balanced that they relieve the depression and fatigue from mental or physical exertion, without the necessity of recourse to alcoholic stimulation ” “the other ingredients of phillips’ phospho-muriate of quinine-- phosphoric acid, and the phosphates of potash, magnesia, lime, and iron-- are the most rational as well as convenient means of administering these tissue remedies, and of introducing phosphorus-- the vitalizing constituent of the nervous system-- into the organism ”the action of such a mixture as a whole is practically that of the sumof the actions of its constituents the therapeutic action of strychninand quinin are described in every text-book of therapeutics, but itis necessary to distinguish carefully between the various conditionsin which these alkaloids have been used without discrimination, andthose conditions in which they have been proved to be of value while both have been widely used in a great variety of conditions, neither is of proved value in more than a distinctly limited rangeof diseases the manufacturers of phillips’ phospho-muriate ofquinine comp seem to appeal to the less discriminating who use thesealkaloids without any definite conception of exactly what they seekto accomplish with them quinin, although used by the uncritical in ahost of diseases, has a definite field of usefulness in the treatmentof malaria, both prophylactic and curative, but the required dose inthe treatment of malaria is thesis times larger than that recommended inthe phillips’ preparation the claim that the “strychnin and quininin this preparation are so well balanced that they produce a mild, buoyant effect, so advantageous, instead of alcoholic stimulation, torelieve depression and fatigue from mental or physical exertion” isnonsensical, if, indeed, it is not mendacious balderdash calcium and potassium have important functions in the body, but anydeficiency that may arise is usually attributable to an inability ofthe body to utilize that which is supplied, for there is seldom anydeficiency of these salts in the food, and when they are needed theyare best supplied as simple solutions of the salts in appropriate doseswithout all of the other constituents of phillips’ phospho-muriate ofquinine comp phosphoric acid exerts practically the same actions as other mineralacids, hydrochloric being usually preferred for internal administrationin certain forms of indigestion, aside from which they are seldom usedas such in the more recent literature for phillips’ phospho-muriate of quininecomp , we find the attempt to utilize the well known craze aboutphosphorus, which has been through so thesis phases, every one of whichhas had its day and has been discarded the phosphoric acid and phosphates present in phillips’ phospho-muriateof quinine are of no more value in nervous diseases than is simplesodium phosphate which does not require the addition of a host of otheringredients for its action as a matter of fact, the phosphates ofcalcium and potassium present in a dose of phillips’ phospho-muriate ofquinine are probably devoid of appreciable effect in practically allconditions to pretend that one who suffers from physical and nervous exhaustioncan be materially benefited by this mixture is sheer nonsense and isunworthy of a moment consideration by a clinician who is called on totreat such patients iron is useful in anemia, as every one knows iron has practically noother field of usefulness in therapeutics when it is indicated itshould be administered in a simple form, such as the pill of ferrouscarbonate, for example, and not in a “shotgun” mixture that is quite aslikely to do harm as good the claim that a satisfactory level of blood pressure can be maintainedby phillips’ phospho-muriate of quinine is mentioned only to condemnas the limit of impudent therapeutic claims it is an insult to theintelligence of any practitioner to pretend that any known agent orcombination of remedial agents can maintain a uniform blood pressure inany one of innumerable conditions in short, phillips’ phospho-muriate of quinine comp is a complex andirrational mixture exploited by means of unwarranted claims it isa survival of the old days of therapeutic chaos when impossible andfantastic chemical formulas were gravely published and as solemnlyaccepted without question, and also without the slightest understandingon the writing of thesis.

Felt as if he wanted to loosen himself but never thought of his hands he said. “you cannot move your arms or legs to save yourself. You cannot raise your arms. You cannot think ” taylor823 mentions the case of scott, the american diver, who was in the habit of making public exhibitions of hanging the last time he hung for thirteen minutes, the spectators not suspecting that he had died it is supposed that the ligature had slipped taylor also reports a case from dr elliott of a boy, age 11, who, to frighten his parents, tied a knot in a handkerchief and put it around a knob and his neck in one continuous ligature the pressure against the trachea was so effective that he became unconscious and died before he could relieve himself second stage. The subject is unconscious and convulsions usuallyoccur the convulsed face, however, is a writing of the general agitationand does not indicate pain in judicial paper the face is coveredwith a cap essaytimes there are no spasms urine, fæces, and semenmay be discharged in any stage jaquemin, however, in forty-onepaper of hanging, noted discharge of urine and fæces only twice semen has, however, been found in the urethra where none was ejectedexternally 824third stage. All is quiet except the beating of the heart as a rule, the pulse may be felt for ten minutes blankenship825 reports an execution of a man by hanging after the rope was adjusted the pulse was 121.

Iodin gr 1 bromin gr 1/4 phosphorus gr 1/100 thymol gr 2/3 menthol gr 2/3 sterilized oil gr 1the only statement regarding its method of preparation is the line“solution in cod liver oil, norwegian ” according to the promoters, “bromin-iodin” is. “a powerful anti-tubercular agent for hypodermic use in pulmonary and laryngeal tuberculosis useful in other forms of tubercular diseases, and in non-tubercular pulmonary diseases of a sub-acute or chronic nature ”the “formula, ” in the form in which the manufacturers publish it, iseither impossible or meaningless, according to the interpretation thatmay be given it is impossible if it is intended to indicate the actualcomposition of the product because that would mean that the oil isalleged to contain free or uncombined iodin, bromin and phosphorus both on theoretical grounds and also in the light of the findings ofthe chemical laboratory of the american medical association, it isnot possible that all these constituents can be present in the freestate the formula is meaningless if it is intended to convey the idea, merely, that iodin, bromin, phosphorus, thymol, menthol and sterilizedoil are combined to form “bromin-iodin ” in the absence of any detailsof the method of manufacture, it is futile to attempt to pass judgmenton the actual composition of the preparation the use of an almost identical product said, however, to containonly 1/2 grain iodin to each fluidram was described in 1908 by dr ingraham of binghamton, n y , in “five years successful experiencewith a special mode of treating pulmonary tuberculosis ” in 1910 thejournal1 characterized the preparation as “one of the innumerable‘treatments’ for pulmonary tuberculosis that have arisen, had theirday and, more or less gracefully, retired ” if the preparation hadvalue for the purpose for which it is recommended, its use during thesetwelve years should have secured its general recognition there is nosatisfactory evidence of its therapeutic efficacy the council refusedrecognition to bromin-iodin comp and, after submitting this report tothe bromin-iodin chemical company, authorized its publication -- fromthe journal a m a , dec 23, 1916 ammonium hypophosphite omitted from n n r report of the council on pharmacy and chemistryammonium hypophosphite was admitted to new and nonofficial remediesin 1908 as a preliminary step in the consideration of a preparationcontaining it-- “gardner syrup of ammonium hypophosphite”-- becausethe council standardizes unofficial products before consideringpreparations or mixtures of these the therapeutic use of hypophosphites being irrational see, “thehypophosphite fallacy, ” report of the council on pharmacy andchemistry, the journal, sept 2, 1916, p 760, the salt, ammoniumhypophosphite, deserves continued recognition only on condition thatthis salt of ammonium is superior to other salts from which may beobtained the effect of the ammonium radical it has been claimed thatammonium hypophosphite has a less objectionable taste than otherammonium salts used for similar purposes this claim would meritserious consideration if in addition to being less objectionable tothe taste, the effects of ammonium hypophosphite were equal to or moredesirable than the official ammonium salts there is no evidence thatthis condition is met by the hypophosphite salt ammonium hypophosphite has long been known, yet it is not officialin the austrian, belgian, british, french, german, hungarian, italian, swedish, swiss or united states pharmacopeias neither is itmentioned in the leading textbooks on materia medica, pharmacology ortherapeutics in short it appears to be an instance of an obscure andsuperfluous salt selected for proprietary exploitation since the continued recognition of ammonium hypophosphite would tend toperpetuate the hypophosphite fallacy, and because there is no evidencesupporting its advantage as a means of securing the effect of ammoniumsalts the council directed its omission from new and nonofficialremedies -- from reports of council on pharmacy and chemistry, 1916, p 51 alphozone omitted from n n r report of the council on pharmacy and chemistrythe following advertisement appeared in the new idea september, 1916, a house organ of frederick stearns & co , the proprietors ofalphozone:illustrationin the light of our present knowledge the claim that alphozone is apreventive of infantile paralysis is without warrant and the advicethat the public depend on it for this purpose is reprehensible anddangerous therefore, the council directed that alphozone be omittedfrom new and nonofficial remedies -- from reports of council onpharmacy and chemistry, 1916, p 50 calcium glycerophosphate and sodium glycerophosphate omitted from n n r report of the council on pharmacy and chemistrycalcium glycerophosphate and sodium glycerophosphate were acceptedfor new and nonofficial remedies chiefly in order that these productsmight be standardized these mixtures now being defined in the newedition of the u s pharmacopeia, this reason for including themin n n r no longer exists the report of marshall the journal, feb 13, 1915, p 573 which has the endorsement of the council thejournal, sept 30, 1916, p 1033 shows that organic phosphoruscompounds are split up into inorganic phosphates before absorption, that the animal organism can synthesize its complex organic phosphorusconstituents from inorganic phosphates and consequently that theglycerophosphates, so far as their phosphorus value is concerned, arenot superior to other phosphates in fact, sodium and phosphate aremore effectively administered as neutral or acid phosphate it isevident that sodium glycerophosphate is a superfluous pharmaceuticalpreparation, writingicularly when the difficulty of obtaining a pureproduct and its high price is considered so far as its calcium valueis concerned, calcium glycerophosphate has no advantages over suchcalcium salts as the carbonate, phosphate, lactate, or chlorid in viewof the foregoing, the council directed that sodium glycerophosphateand calcium glycerophosphate be omitted from new and nonofficialremedies -- from reports of council on pharmacy and chemistry, 1916, p 52 gardner syrup of ammonium hypophosphite omitted from n n r report of the council on pharmacy and chemistryin recognition of the considerable revision of the therapeutic claimsmade by the manufacturer, gardner syrup of ammonium hypophosphitewas retained in new and nonofficial remedies, 1916, and the proprietoradvised of this provisional retention in the most recent advertising for this ammonium hypophosphite syrupthe claim is made. “besides being an active expectorant syrup of ammonium hypophosphite gardner is useful as an alterative and resolvent and by virtue of its phosphorus element, which is in the form of a hypophosphite, ph₂o₂, has a tonic value ”as detailed in the report of the council “the hypophosphite fallacy” the journal, a m a , sept 2, 1916, p 760 careful studies showthat the hypophosphites are devoid of the “alterative” and “tonic”actions claimed by the manufacturer of gardner syrup of ammoniumhypophosphite accordingly the council voted to omit gardner syrup ofammonium hypophosphite from new and nonofficial remedies and authorizedpublication of this report -- from reports of council on pharmacy andchemistry, 1916, p 55 gluten products made by the kellogg food company report of the council on pharmacy and chemistryfor over two years the council has had under consideration certainproducts offered for the use of diabetics by the kellogg food companyof battle creek, mich these are. Pure gluten biscuit pure gluten meal 40 per cent gluten biscuit 40 per cent gluten flour 40 per cent gluten meal 20 per cent gluten meal the council found these products ineligible for new and nonofficialremedies because the statements of composition writingicularly of starchcontent were insufficient and because the exploitation of the productsto the laity was objectionable june 21, 1915, the company promised toplace a statement of the starch content on the package of each glutenproduct, to place on the gluten flour sacks a caution that diabeticsuse the flour only on the advice of their physicians, and to revise itsadvertising in accordance with the suggestions of the council nothingfurther having been heard from the company, in april, 1916, specimensof the product were obtained, through a layman, direct from thekellogg food company these specimens, together with the advertisingmatter received at the same time, and also a letter of advice from thecompany to another layman, were sent to the council referee, whosereport follows as will be seen, the referee finds that the amountsof carbohydrates contained in pure gluten flour, 40 per cent glutenflour and pure gluten meal are greater than the amounts claimed inthe company published analyses. That in the two first mentioned theamounts of protein are less than the amounts claimed. That exaggeratedclaims are made on all the labels and in the advertising literature, and that the company prescribes directly to the patient the following report was sent to the kellogg food company forconsideration in reply the firm stated that a revision of itsadvertising was under consideration but would make no statementas to how soon this revision would be carried into effect as theconsideration had already consumed two years, the council decided togive the profession the facts and authorized publication of the report at the same time the kellogg food company was advised that its productswould be considered further whenever any submitted evidence warrantedthis w a puckner, secretary referee reporti submit herewith my report on certain foods offered by the kelloggfood company for the use of diabetics i shall discuss these productsfrom the standpoint of the claims made on the label, from thestandpoint of the company toward nonmedical treatment as revealed in aletter to a layman, and lastly, on the basis of the claims made for thefoods in the company literature claims made on the label pure gluten biscuit referee company water 8 30 5-10 ash 2 04 1-2 protein n × 5 7 73 87 75-80 fiber 0 12 2 4-3 carbohydrates 14 84 0-5 fat 0 81 0 25-0 70 starch 4 02 0-5the sample analyzed does not contain the amount of protein claimedfor it it also contains more starch than one might suspect from thecompany analysis a more conservative claim would be “starch lessthan 5 per cent ” the company makes the error of using the terms“starch” and “carbohydrates” as synonymous if the maximum figures ofthe company analysis are used, the carbohydrates would amount to5 per cent , whereas i find 14 84 per cent the claim on the label“guaranteed to contain less than 5 per cent of carbohydrates” isincorrect the next claim, “each ounce of this gluten contains 23 gramsof protein and represents 95 calories” is approximately correct, as myanalysis shows 20 9 grams of protein and 103 calories the following remarks under “vegetable proteins” are in my judgmentexaggerated. “leading authorities are now agreed that meat, fish, eggs and other animal proteins are greatly inferior to vegetable proteins in diabetes, often increasing the sugar output and the dangerous acidosis which leads to diabetic coma after thesis years of experimentation, we have succeeded in perfecting a process whereby the carbohydrates are excluded ”in this connection, von noorden, whom the company constantly quotes, says. “in the slighter forms of diabetes, the influence of meat albumins is not great and it is difficult to demonstrate the reaction of the patient to different forms of albumin it may be necessary to add more albumin than the patient can actually take before glycosuria indication is reacted once a medium amount of albumin is exceeded, say 70 to 80 grams, the glycosuria increases, no matter what the type of albumin is ”my analysis also shows that the carbohydrates are not excluded fromthis food as claimed above 40 per cent gluten biscuit referee water 8 50 ash 1 48 protein n × 5 7 41 15 fiber 0 08 carbohydrates 47 81 fat 0 98 starch 36 98no analysis is supplied by the company, but this may be called properlya “40 per cent gluten biscuit ” the company claims, however, that thisis “best for diabetics, ” which is not true here, as in the case of “40 per cent gluten flour, ” the companylabel attributes to “dr wm osler in ‘practice of medicine, ’” thefollowing quotation. “of gluten foods, thesis are very unpalatable, others are frauds a good gluten flour is made by the battle creeksanatarium co , mich ” i have no way of knowing to which gluten flourof the company dr osler had reference the “pure gluten meal” might becalled properly a “good gluten flour, ” but this “40 per cent glutenflour” is no better, and no worse, than the average gluten flour on themarket the quotation from osler gives an entirely false impression 40 per cent gluten flour referee company water 8 62 5-10 ash 0 89 0 5-1 protein n × 5 7 33 63 40-45 fiber 0 08 1-3 carbohydrates 55 35 40-45 fat 1 43 0 2-0 5 starch 48 04 my analysis shows 6 37 per cent less protein than the companyminimum, and 10 35 more carbohydrates than their maximum in past yearsi have found the protein in this brand to range from 35 0 to 42 9 percent using the factor 5 7 it is true that the manufacturer doesnot state what protein factor is used in his reported analysis, but asin four other brands 5 7 is used, it is fair to assume that the samefactor applies to this as well at least such should be the case, asotherwise the manufacturer analyses would be meaningless even usingthe factor 6 25 this later sample contains only 36 88 per cent ofprotein the following statement, in my judgment, as applied to a foodcontaining over 48 per cent of starch, does not hold water. “thisfood is of special service in paper of glycosuria and in the milderforms of diabetes ” with this brand as with “40 per cent glutenbiscuit” the manufacturer again uses the misleading quotation fromosler 40 per cent gluten meal referee company water 7 30 5-10 ash 1 36 1-2 protein n × 5 7 41 55 40-45 fiber 0 10 1-2 carbohydrates 48 58 40-45 fat 1 11 0 2-0 5 starch 36 59 40-45the claimed analysis is justified by my findings i must takeexception, however, to the following statement. “prepared with greatcare from a good grade of spring wheat, by our special process, whichpreserves the natural food properties of the product ” the companyevidently tries to carry water on both shoulders, on the one handclaiming a reduction in the starch content, while on the other claimingthe preservation of all “the natural food properties ”20 per cent gluten meal referee company water 7 65 5-10 ash 1 22 1-2 protein n × 5 7 24 68 20-30 fiber 0 12 1-2 carbohydrates 65 41 65-70 fat 0 92 1-2 starch 51 24 65-70the company analysis is confirmed as the company claims directlythat this is “not a diabetic food, ” any criticism of its use forthat purpose is disarmed however, again exception must be taken tothe statement that “the natural food properties of the product” arepreserved pure gluten meal referee company water 4 60 5-10 ash 0 96 1-2 protein n × 5 7 76 78 75-80 fiber 0 08 1-3 carbohydrates 16 77 0-5 fat 0 81 0 25-0 70 starch 6 77 0-5the minimum claim as to protein is justified again the companyconfuses carbohydrates and starch, and the food instead of containingfrom 0 to 5 per cent of “carbohydrates starch” actually contains16 77 per cent of carbohydrates, of which 6 77 per cent is starch once more the statement that “the natural food properties” arepreserved is untrue as applied to a wheat product deprived of most ofits starch in justice to the company, it should be noted that on the labels of“pure gluten biscuit” and “pure gluten meal” appears the warning:“every person suffering from diabetes should be under the care ofan experienced physician, ” and on the label of “40 per cent glutenmeal, ” “persons suffering from diabetes should use this food only onthe advice of a physician ” on the other hand, the suggestion on thelabel of “pure gluten meal, ” “write for a copy of diabetic foods andhow to use them” is a more or less direct invitation to self-treatment moreover, a letter dated may 9, 1916, apparently dictated for thekellogg food company by one ruth french, in reply to an inquiry from alayman, gives direct advice with no reference whatever to a physician claims made in a letter to a laymanin addition to this inconsistent attitude the letter makes certainclear misstatements, as follows:“40 per cent gluten flour actually contains 40 per cent of puregluten, making it a perfectly safe article of diet in all but thegravest paper of diabetes from our gluten flour excellent bread, gemsand puffs are made that perfectly satisfy the craving for bread with noharmful results ” this flour contains 33 63 per cent of gluten, not 40per cent.

“filudine restores the liver functions it is define essay to the liver what digitalis is to the heart. It overcomes the insufficiency and stimulates the debilitated organ ” in malaria “it is the only true specific when associated with quinine ” “filudine is the ideal medication for tuberculosis, conforming as it does with the most recent researches in the therapeusis of this affection ” “we will not go as far as to say that opotherapy completely restores unhealthy livers, for although the lesions of the hepatic parenchyma may be obliterated by regeneration, the lesions of the connective tissues are permanent, and may be observed at the postmortem examination the new cells, however, do not present the same unhealthy conditions as those of the former diseased gland which they have replaced, and the liver can therefore function normally, so that the patient lives on. And he is satisfied with that ” “therefore, while regenerating the liver with filudine, we cleanse it and combat its congested state with urodonal we cause it to produce urea from the excess of uric acid which it contains ” “by the judicious and harmonious combination of the beneficial effects of filudine and urodonal, physicians not only possess the means of treating by rational methods cirrhosis of the liver in its various forms which is one of the most terrible diseases which can afflict anyone but what is still better, they can cure it ” “the liver of a person suffering from obesity being incapable of fulfilling its functions in regard to the fatty tissues, the rational and up-to-date method of treatment is therefore to restore to the system, in the form of filudine, the liver extracts which are lacking ”filudine is a mixture of semisecret composition the therapeuticclaims are manifestly unwarranted the name is not indicative of thecomposition, whatever that may be, and no rational excuse is offeredfor the combination of liver and spleen extracts with or without bileextracts with “thiomethylarsinate” or “thiocinnamate” of caffein the council therefore held filudine ineligible for new and nonofficialremedies -- from the journal a m a , sept 18, 1915 lactopeptine and elixir lactopeptine report of the council on pharmacy and chemistrymixtures of pepsin and pancreatin are therapeutically irrational;the two substances are not indicated in the same conditions, nor canthey act together under physiologic conditions, such mixtures arechemically impossible. In a liquid medium the ingredients destroy eachother lactopeptin is manufactured by the new york pharmacal association, yonkers, n y it is sold under the claim that it contains, pepsin, diastase, pancreatin, lactic acid and hydrochloric acid this productwas among the first proprietary preparations examined by the council onpharmacy and chemistry the report of the investigation was publishedin the journal, march 16, 1907, p 959 the preparation was found to bepractically inert-- “essentially a weak saccharated pepsin, ” devoid oftryptic activity six years later it was still widely advertised with the same irrationalclaims a referee a therefore examined lactopeptine powdered forthe council in 1913, and confirmed the previous findings the refereereport was published in the journal, aug 2, 1913, p 358 nearly four months after this publication, the manufacturer protestedagainst the report, maintaining, contrary to the findings of thecouncil, that lactopeptine possesses pancreatic activity and contains“loosely combined” hydrochloric acid referee a therefore repeatedhis examination, and a second referee b, independently, examinedspecimens of lactopeptine powder purchased on the open market for thepurpose shortly before a few specimens examined by these two referees showed a slight trypticactivity. Most of them showed none the amount of hydrochloric acidpresent was insignificant the reports of the two referees were referred to the manufacturers, whoagain protested vehemently against these findings, this time on theground that the specimens were old the manufacturers also cited thework of three chemists to disprove the findings of the referees, anddemanded that the council reexamine lactopeptine, making use of freshspecimens the council refused for the following reasons:1 so long as the packages of lactopeptine are not dated, the activityof specimens known to be fresh is of no practical importance theactivity of the actual market supply is the only question of interestto the profession the only fair test is that made on specimensrepresentative of the product sold to the ultimate consumer 2 the evidence presented by the manufacturers did not warranta reexamination, since the work of two of the chemists citedsubstantially corroborates the results obtained by the councilreferees from the fresher specimens the figures for tryptic activityobtained by the third chemist cited by the manufacturers could not beaccepted by the council, since it was at variance with all other knownresults of investigations of lactopeptine 3 as stated at the outset, whatever the tryptic activity of themixture, it is therapeutically useless a demonstration of trypticactivity in a mixture containing both pepsin and pancreatin is ofmerely theoretical interest such activity, of course, cannot be expected, even on theoreticalgrounds, in liquid mixtures like elixir lactopeptine the council therefore again declared lactopeptine powder and tabletsand elixir lactopeptine ineligible for new and nonofficial remedies andauthorized publication of the following statement w a puckner, secretary the council reportlactopeptine powder new york pharmacal association, yonkers, n y was examined by the council in 1907 at that time it was claimed tocontain “ the five active agents of digestion-- pepsin, diastase veg ptyalin, pancreatin, lactic acid and hydrochloric acid-- combined in the proper proportion to insure the best results ”the examination showed that the preparation was essentially “a weaksaccharated pepsin, ” containing but small amounts of pepsin, nohydrochloric acid, or mere traces only, and no diastase or pancreatin the journal, march 16, 1907 in 1913, the product was reexamined, because the claims, as to bothcomposition and therapeutic value, were still being made sampleswere tested both of the american product, and of a british productfrom john morgan richards & sons, london the original findings wereconfirmed and the results were published in the journal, aug 2, 1913, p 358 nearly four months later november 24 the new yorkpharmacal association wrote to the council, objecting to the findingsand maintaining that lactopeptine possesses pancreatic activity andcontains “in loose chemical combination” hydrochloric acid inaccordance with the custom of the council, the work was sent back forreview to the referee a, whose conclusions were then tested by asecond referee b, a physiologic chemist, not a member of the council, selected because of his special knowledge of the subject in december, 1913, referee a made a large number of new tests todetermine proteolytic and amylolytic power his results show thatthe ferment activity of the preparation is so low as to merit norecognition in practical use the tests also show that the amount oflactic acid or “loosely combined hcl” or both present is too small tohave any appreciable physiologic activity and therefore to be of anytherapeutic value nine samples of lactopeptine purchased in the open market in december, 1913, and january, 1914, were examined by referee b early in 1914 hisstudies show absence of amylase in all samples. Presence of pepsin, giving weak reactions even when compared with those of old pepsinpreparations. Complete absence of trypsin in seven out of nine samples, tryptic reaction being obtained in two samples, in one of which thereaction, “slight at best and of no practical import, ” was obtainedonly after treatment for twelve hours or more the presence of tryptic activity in two out of the nine samples maybe due to the fresher condition of these specimens, as indicatedby the serial numbers the evidence shows that it is a commercialimpossibility to market mixtures of pepsin, pancreatin and lactic acidso that they can display any material tryptic activity it should be reaffirmed that mixtures combining peptic and pancreaticactivities are not feasible, because pepsin cannot act except in thepresence of acid, and pancreatin is destroyed by acid and by pepticactivity furthermore, in conditions in which pancreatin is calledfor, pepsin is not, and vice versa. Therefore the administration ofmixtures of pepsin and pancreatin would be unjustified, even if bothconstituents could be expected to exert activity the foregoing observations apply to lactopeptine in powder and tabletform while mixtures of pepsin and pancreatin are unscientific andunjustified, theoretically the two substances may coexist in a solidpreparation, and the activity of such a preparation is consequently aproper subject of investigation theoretically as well as practically, however, pepsin and pancreatin cannot exist together in solution theclaims made for elixir lactopeptine and all other liquid preparationssold as mixtures of pepsin and pancreatin are therefore impossible the council has previously taken action the journal, feb 2, 1907, p 434 refusing to approve for inclusion with new and nonofficialremedies such preparations, calling the attention of the medicalprofession and of manufacturers to their worthlessness, and requestingthe american pharmaceutical association to instruct its committee onthe national formulary to omit from the next edition of that work aliquid preparation of pepsin and pancreatin recognized under the titleof “elixir digestivum compositum ”it is recommended that the council reaffirm this previous action, and that lactopeptine and elixir lactopeptine be declared ineligiblefor new and nonofficial remedies because of conflict with rule 10 “no article will be admitted which, because of its unscientificcomposition, is useless or inimical to the best interests of the publicor of the medical profession” manufacturers’ protest and council answerthe foregoing was submitted, together with the findings of the tworeferees, to the manufacturers they protested again, alleging that. Age of specimensfirst -- the specimens of lactopeptine examined by the second refereewere old the dates of manufacture corresponding to the several batchnumbers are supplied by the manufacturers as follows.

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3 unwarranted therapeutic claims are madefor them. 4 the name is misleading and not descriptive of theircomposition, and 5 the statement of their composition is indefiniteand incorrect -- from the journal a m a , july 9, 1921 toxicide report of the council on pharmacy and chemistrythe council has authorized the publication of the following report. W a puckner, secretary toxicide toxicide laboratories, chicago is alleged to be a remedywhich “increases systemic resistance, ” is “used for immunizing againstseptic infections” and “is indicated in any case of septic infection, capable of inducing inflammation and pus formation, regardless oflocation or kind of tissue involved ” the following statementsbearing on the composition of the preparation are furnished by themanufacturers. “toxicide contains lachesis 12x, tarantula 6x, psorinum special 15x, silicia 6x and excipient q s the excipient is sweet milk “these remedies are combined in the sweet milk and put through a process of development, which produces the curative agent which we call ‘toxicide’ “put up in tablet form, sugar coated and colored red ”no information is given as to the proportions, either relative oractual, of the ingredients neither is any information given regardingthe “process of development” to which the mixture is subjected, nor theamount of the finished mixture which is contained in toxicide tablets the toxicide laboratories present the following “theory”. “in combining these remedies and processing with milk, we develop a latent immunizing active principle, which usually controls the most virulently, active, septic infections promptly ”illustration. Photographic reproduction reduced of an advertisementof the “originator” of toxicide. It ran for thesis months in the programof a burlesque theater located in ruckel neighborhood there is no evidence, however, that any effort has been made todemonstrate the presence of a “latent immunizing active principle” byscientific methods of modern immunology the following claims for theuse of toxicide appear on the label.