History

Integrity Essay


Nor is itpossible to foresee with certainty the direction which they are goingto take it is just this point which makes the clinical evidence somuch more difficult to interpret than laboratory evidence, in whichthe conditions can be more or less exactly controlled, and any changesforeseen it is on this account, also, that clinical experiments mustbe surrounded with extra painstaking precautions in brief, while the “proof” of a remedy is on the patient, that is notthe whole story, but merely an introduction the real problem is toestablish the causative connection between the remedy and the events the imperfect realization of this has blocked therapeutic advance, hasdisgusted critical men to the point of therapeutic nihilism, and hasfertilized the ground for the commercial exploitation of drugs that areof doubtful value or worse this has been impressed on me writingicularly by my service on the councilon pharmacy and chemistry in the course of its work of passing on theclaims advanced for commercial remedies, this council is forced toinquire critically into the basis of the claims of manufacturers it is interesting to note the qualitative differences in the evidencefor the various kinds of claims. The chemical data are usuallypresented in such a form that it is possible to tell at a glancewhether or not they are based on demonstrated facts, which couldusually be verified or refuted without special difficulty thedeductions are usually such as can be legitimately drawn from the data, or else they are obviously absurd all this agrees with the relativelyexact status of chemical science in passing to data and deductions from animal experiments, a distinctchange is noticeable. Not only are the data less reliable, and lessworthy of confidence, but they are more often stated in a lessstraightforward manner the presentation of the data often showsevidence of manipulation of the results, so as to make them mostfavorable to a preconceived conclusion that would recommend the drug this is not always intentional, but is writingly due to the less exactnature of animal experimentation, which leaves a wider play to thearbitrary interpretation of the reporter a certain amount of thisis unavoidable no serious objection can be raised, provided theexperimenter presents all the essential data, and discusses fairly allof the interpretations that would apply to them on the whole, it is usually possible to form a fairly definite estimateof the value of experimental data when one comes to the clinical evidence, an entirely differentatmosphere obtains when the council demands evidence of the usefulnessof a remedy, the manufacturers generally respond with every sign ofenthusiasm they may have ready a series of articles already published, or they instruct their agents to bring in letters from physicians thelast method seems to meet the most cordial response, judging from thedeluge of letters and opinions that floods the council the quality of the published papers is a fair reflection of thedeficiencies of what is still the common type of clinical evidence a little thought suffices to show that the greater writing cannotbe taken as serious evidence at all essay of the data are merelyimpressions-- usually the latest impressions of an impressionableenthusiast-- the type of man who does not consider it necessary topresent evidence for his own opinions. The type of man who does noteven realize that scientific conclusions must be based on objectivephenomena essay of the papers masquerade as “clinical reports, ” essaytimes with asplendid disregard for all details that could enable one to judge oftheir value and bearing, essaytimes with the most tedious presentationof all sorts of routine observations that have no relation to theproblem the majority of reports obtained by the agents belong to these classes, notwithstanding the fact that they are often written for the specialuse of the council, and therefore with the realization that theyare likely to be subjected to a thorough examination, and thereforepresumably representing the best type of work of which the reporter iscapable so, at least, one would suppose it is also possible, however, that essay of these reports are writtenmerely out of thoughtlessness, or perhaps often to get rid of animportunate agent this is illustrated by the following correspondence, taken literally from the files of the council a letter from a prominent physician “a, ” endorsing a certainpreparation “d, ” having been submitted to the council, the secretarywas directed to write to dr a as follows:dear dr a:-- the b company of c has requested the council on pharmacyand chemistry to admit its preparation d to new and nonofficialremedies as writing evidence for the value of the preparation, thecompany submitted a letter from you which contains the following. So far as my experience has thus far gone, they are certainly superior to a number of other iodine compounds now on the market, and i should judge that they ought to take a superior place in therapy involving the use of iodine the referee of the council in charge of d writes that he was interestedby your letter and asks that i inquire. As compared with sodium orpotassium iodid, what would you say are the differences between, and real advantages of, d and the alkaline iodids?. did you make anycomparative experiments and keep a record of them?.

Canada med jour , 1867, iii , p 195 - man executed;drop six feet. Second cervical vertebra torn from attachment to third;medulla torn across. Hyoid bone and tongue torn from thyroid cartilage;general congestion of viscera. Lenses normal. Eyes congested. Clotbetween sclerotic and choroid coats left eye 85 dyer. Trans amer ophthal soc , 1866, p 13 - man, age 24;weight one hundred and seventy-four and a half pounds. Drop three feet;knot under left ear. For two minutes at intervals, slight motion ofabdomen, like effort at respiration, and at same time knees drawn upa little death speedy and quiet cut down at end of thirty minutes necroscopy thirty-five minutes after drop body and head moist andwarm. Emission of semen. Face livid. Upper lid discolored. Abrasionof skin under right ear. Deep red mark around neck eyeballs notprominent. Eyelids closed. Corneæ dull.

The ratio of calcium metabolism to its enormous integrity essay waste in pregnancy, the diseases of infancy and childhood and the rapidly growing group of ‘acidoses’ make its availability in kalak of double value ”the first writing of this statement is untrue. The last writing is muddledand without much meaning evidently the “acidosis” fad is to beoverworked as was the old “uric acid diathesis, ” of unsavory memory again this. “one of the most important characteristics of kalak is the close approximation of its formula to the correlation of the contained salts as they occur in the human body, together with its freedom from salts foreign to the human economy another is its almost unbelievable palatability, considering its high degree of alkalinity, it being eleven times greater than any other known mineral water, artificial or natural ”these statements are false the salts dissolved here bear nodiscernible relation to the needs of the body, as disclosed by thecomposition of the blood or solid tissues or as shown by the characterof the urinary excretion the last statement concerning the highalkalinity is neither clear nor accurate then, this warning and remedy. “it seems to be an unappreciated fact that the degree of urinary acidity, checked with the acidity of the saliva, is in direct ratio to the existing acid toxemia, and a urine acid to methyl red should be the signal for immediate and adequate alkalinizing treatment “startling clinical results have been observed by physicians who have used kalak thoughtfully and sufficiently in the more serious types of acidosis associated with diabetes, nephritis, rheumatism, gout and the acute infections there is also evidence of its good effect in acute alcoholism and the respiratory edemas. In fact a certain few have hailed kalak as a possible solution of the annual hay fever problem of perhaps supreme importance, however, is the use of kalak throughout pregnancy as preventive medicine against the inevitable ‘toxemia of pregnancy ’”also this. “kalak has accomplished certain unexplainable things for the diabetic and nephritic, and if, in future years, diabetes and nephritis should prove to be constitutional diseases, based upon functionation or its lack, kalak therapy, the embodiment of physiological alkalescence may come into its own, for if acidity retards, alkalinity must normalize functionation ”it is not necessary to quote further in order to insure that everyonewill recognize the great need of kalak it is advised to test the urinefor acidity by means of a group of indicator solutions sent out to thephysicians methyl red is one of these and any urine showing an acidreaction with this is said to be open to suspicion paranitrophenol isanother of the indicators and the explanations given of the behavior ofthe two and the conclusions to be drawn are questionable the methylred solution furnished is too concentrated for proper use and perfectlynormal urines from normal individuals have given a rather marked colorwith it this indicator gives essay color at h 1 2 × 10^{-6} and astrong reaction at 3 × 10^{-3} to condemn a urine on such a finding isentirely unwarranted sodium bicarbonate is the main constituent of the water the valueof the phosphate in such a combination, with so much calcium, isproblematical in case an alkaline reaction in the intestine is reachedessay of it would be left as insoluble phosphate a few grams ofbicarbonate daily would have equal therapeutic value with this water the advice based on the indications of methyl red and the urine is bad the committee report was sent to the kalak water company for comment the company promised to withdraw the advertising circular referred toin the report and disclaimed responsibility for the accuracy and valueof the set of indicators which it sent out, but, on the whole, theprevious advertising claims were insisted on in view of the absurd and false claims made for the product the councildeclared kalak water inadmissible to n n r -- from reports ofcouncil on pharmacy and chemistry, 1917, p 148 minson soluble iodin “kelpidine” not admitted to n n r report of the council on pharmacy and chemistryminson soluble iodin “kelpidine” was submitted to the council byj j minson, washington, d c , trading as the kelpidine company, with the statement that in future “literature” it was to be known asminson soluble iodin, only the following statement of compositionwas furnished. “minson soluble iodin is essaywhat of an indefinite character, chemically its formula is, iodin 4 per cent , distilled water 6 per cent , and absolute alcohol q s 100 per cent by a process of chilling and heating an iodid of uncertain character is produced, and because of the extreme sensitiveness of the product to chemical tests, it is hard to determine so far as i have been able to judge, however, the result is about 3 or 3-1/2 per cent free iodin and from 1/2 per cent to 1 per cent iodid, possibly ethyl and hydrogen iodid in combination ”the a m a chemical laboratory reports that the preparation is analcoholic solution containing free iodin and iodid, probably hydrogeniodid and ethyl iodid, but that the free iodin content was only2 69 gm per 100 c c it is claimed that the “therapeutic indications” of minson solubleiodin are the “same as those of all iodin and iodid preparations, internally, externally, hypodermically and intravenously. Excepting, however, counter irritation ” it is admitted that there are no“clinical reports” as to the hypodermic and intravenous use, but thebelief is expressed “that in an emergency it is a safe remedy underproper dilution ” it is further claimed that “for all practicalpurposes it is nontoxic and nonirritating” and that “it has none ofthe undesirable features such as is the case with the iodids and theorganic preparations of iodin, proprietary or otherwise ”it was assigned for consideration to the committee on pharmacology, whose referee reported:“according to the information submitted, this is a tincture of iodin;differing from the official tincture in that it is more dilute and inthat hydrogen and ethyl iodid is the solvent in place of potassiumiodid it is practically immaterial for internal administration, whether the cation of the solvent iodid is hydrogen, ethyl, potassiumor sodium it would certainly be inadvisable to inject a preparationcontaining free iodin hypodermically it is not ‘a safe remedy’ forintravenous injection and it would not be nonirritant the statementthat ‘it has none of the undesirable features’ of other iodin compoundsis inherently impossible apparent freedom of any iodin preparationfrom undesirable effects is generally due to the use of small doses such claims are plainly therapeutic exaggerations and therefore inconflict with rule 6 even should these be removed, the preparationmust be held an unessential modification of the official tincture, andtherefore in conflict with rule 10 ”the report was agreed to by the committee and adopted by the counciland minson soluble iodin “kelpidine” declared inadmissible to newand nonofficial remedies -- from reports of council on pharmacy andchemistry, 1917, p 152 nutone report of the council on pharmacy and chemistrynutone nutone company, lowell, mass is a “nutritive tonic” said tohave the following complex composition. Cod liver oil, pure norwegian, 25 per cent malt extract, 9-1/3 per cent beef juice, glycerine, hypophosphite lime, hypophosphite soda, chemically pure, 1-1/2 grs each to the oz fl ext nux vomica, 3/64 of a minimum in each teaspoonful it is advertised with claims that will lead thoughtless physiciansand a confiding public to depend on it in paper in which fresh air, hygienic surroundings and nutritious food are of prime importance a sample package the phrase “as recommended by your physician” andother statements suggest that it is expected to be given the patientby the physician and thus effectively advertise nutone to the publicdescribes nutone as an “agreeable concentrated nutritive tonic emulsionof malt extract, beef juice and cod liver oil, combined with nervetonics and bone nutrients ” emphasizing the nutritive value of this“malt extract, beef juice, and cod liver oil” preparation, it isadvised, “as nutone is rich in nutritive properties, it is well tobegin with one-fourth teaspoonful, gradually increasing to regulardose, which is. Adults, 1 to 2 teaspoonfuls after meals and at bedtime children according to age ” it thus appears that adults are to takethis preparation as a “nutritive” in doses which represent from 3 to12 grains of sugar on the assumption that malt extract may contain asmuch as 50 per cent sugar and 8 to 30 minims of cod liver oil withunstated, but probably equally small, amounts of beef juice a consideration of the negligible food value of nutone as well asof the inefficiency of the other components and the claim that itis indicated in “malnutrition, ” “wasting diseases” and “incipientphthisis” classes nutone with that large group of shotgun mixtureswhich do harm in that dependence is placed on them in conditions inwhich the patient will probably be restored to health if proper medicaland hygienic measures are adopted in time the council declared nutone inadmissible to new and nonofficialremedies because it is an irrational shotgun mixture advertisedindirectly to the public with unwarranted therapeutic claims and anondescriptive therapeutically suggestive name -- from reports ofcouncil on pharmacy and chemistry, 1917, p 154 tri-arsenole, l o compound no 1 and l o compound no 2 report of the council on pharmacy and chemistrytri-arsenole -- according to the advertising of themedical supply company of atlanta, ga , “tri-arsenole” is“merco-arseno-benzo-chloride, ” and the claim is made. “this compound is the result of thesis years’ research the toxicity has been fully tested upon animals before using clinically, the latter having proven such complete success, we take pleasure in presenting it to the public ” “the manufacturers of tri-arsenol, before placing it upon the market, tested it biologically ”tri-arsenole is “recommended and suitable for the treatment of primary, secondary, tertiary and hereditary syphilis it has also been foundvery useful in pellagra and malaria ” the preparation is supplied inampules containing varying amounts of the dry substance it is to bedissolved in water and is to be administered intravenously in theadvertising attention is called to the yellow color of tri-arsenole;this, and the style of package suggest that it is a preparation similarto salvarsan in reply to a request sent the medical supply company for thequantitative composition and chemical formula of the compound“merco-arseno-benzo-chloride” and for the details of the biologic testby which its toxicity is claimed to have been determined and evidencefor its efficiency, the following statement was received. “tri-arsenole no 1 equals to each ampoule, gr sodium chlorid 4-1/2 hydrarg chlor -cor 1/4 arsenous acid 1/4 sodium benzoate 4 hydrastin resinoid 2 tri-arsenole no 2 equals to each ampoule, sodium chlorid 4 hydrarg chlor -cor 1/2 arsenous acid 1/2 sodium benzoate 4 hydrastin resinoid 2 tri-arsenole no 3 equals to each ampoule, sodium chlorid 3-1/2 hydrarg chlor -cor 3/4 arsenous acid 3/4 sodium benzoate 4 hydrastin resinoid 2 tri-arsenole no 4 equals to each ampoule, sodium chlorid 3 hydrarg chlor -cor 1 arsenous acid 1 sodium benzoate 4 hydrastin resinoid 2the request for information regarding the animal experiments said tohave determined the toxicity was ignored, nor were references suppliedto clinical reports demonstrating the value of the product the council declared tri-arsenole inadmissible to new and nonofficialremedies because of conflict with the rules as follows:in the absence of details of the method used, the claim that thepreparation has been tested biologically is in conflict with rule 2, which requires that for preparations claimed to be physiologicallystandardized the method of testing must be published so as to permit ofcontrol by independent investigators the claims that “merco-arseno-benzo-chloride” is “the result of thesisyears research, ” that its “toxicity has been fully tested upon animalsbefore using clinically” and that clinical use has “proven suchcomplete success” have not been substantiated by evidence and must beheld as unwarranted the name is in conflict with rule 8, which requires that pharmaceuticalmixtures shall bear names descriptive of their composition further, the name “tri-arsenole” by its similarity to diarsenol, the canadianbrand of arseno-phenolamin hydrochlorid, suggests that thispharmaceutical mixture is a chemical compound similar to salvarsan moreover, the danger of confusion is increased by the addition ofthe hydrastis preparation which imwritings a yellow color like that ofsalvarsan to the solution obtained when the colorless mercury andarsenic compounds of the mixture are dissolved again, the synonym“merco-arseno-benzo-chloride” conveys the false impression thattri-arsenole is a definite chemical compound the label does not declare the poisonous constituents claimed tobe contained in the mixture. Namely, “arsenous acid” and corrosivemercuric chlorid rule 7 there is no evidence that arsenous acid arsenic trioxid usedintravenously is efficient and safe as a spirocheticide, and theadministration of this drug in conjunction with mercuric chloridin fixed proportion is irrational and dangerous-- writingicularly sobecause of the implied similarity of tri-arsenole to arsenphenolaminhydrochlorid salvarsan, diarsenol rule 10 l o compound no 1 and l o compound no 2 -- in submitting thesepreparations to the council, the medical supply company stated that“no 1” was “composed of the following ingredients. Chloral, camphor, menthol, iodin, and oil of gualtheria, incorporated in a fatty base each ounce contains fifteen grains of chloral hydrate, nine grainsof resublimed iodine ” “no 2” was said to have the same compositionas “no 1” except that the oil of gaultheria had been omitted themedical supply company was informed that the rules of the councilrequired declaration of the amounts of each therapeutic constituentof pharmaceutical mixtures and that, therefore, in addition to theinformation furnished the amounts of camphor, menthol and oil ofgualtheria should be given for “no 1” and the amount of camphor andmenthol for “no 2 ” the following reply was received.

And the horoscope should be inspected, the plantsgathered at the critical moment, &c culpeper was a writer and translator of several works, the mostcelebrated of which is his herbal, “being an astrologo-physicaldiscourse of the common herbs of the nation. Containing a completemethod or practice of physic, whereby a man may preserve his body inhealth, or cure himself when sick, with such things only as grow inengland, they being most fit for english constitutions ”this celebrated, and useful physician died at his house inspitalfields, in the year 1654 this book will remain as a lastingmonument of his skill and industry “culpeper, the man that first ranged the woods and climbed the mountains in search of medicinal and salutary herbs, has undoubtedly merited the gratitude of posterity ” dr johnson theenglish physicianenlarged amara dulcis considering divers shires in this nation give divers names to one andthe same herb, and that the common name which it bears in one county, is not known in another. I shall take the pains to set down all thenames that i know of each herb. Pardon me for setting that name first, which is most common to myself besides amara dulcis, essay call itmortal, others bitter-sweet. Essay woody night-shade, and othersfelon-wort descript it grows up with woody stalks even to a man height, andessaytimes higher the leaves fall off at the approach of winter, andspring out of the same stalk at spring-time. The branch is compassedabout with a whitish bark, and has a pith in the middle of it. Themain branch branches itself into thesis small ones with claspers, layinghold on what is next to them, as vines do. It bears thesis leaves, theygrow in no order at all, at least in no regular order. The leaves arelongish, though essaywhat broad, and pointed at the ends. Thesis of themhave two little leaves growing at the end of their foot-stalk. Essayhave but one, and essay none the leaves are of a pale green colour;the flowers are of a purple colour, or of a perfect blue, like toviolets, and they stand thesis of them together in knots. The berries aregreen at first, but when they are ripe they are very red. If you tastethem, you shall find them just as the crabs which we in sussex callbittersweet, viz sweet at first and bitter afterwards place they grow commonly almost throughout england, especially inmoist and shady places time the leaves shoot out about the latter end of march, if thetemperature of the air be ordinary. It flowers in july, and the seedsare ripe soon after, usually in the next month government and virtues it is under the planet mercury, anda notable herb of his also, if it be rightly gathered under hisinfluence it is excellently good to remove witchcraft both in menand beasts, as also all sudden diseases whatsoever being tied roundabout the neck, is one of the most admirable remedies for the vertigoor dizziness in the head. And that is the reason as tragus saith thepeople in gerthesis commonly hang it about their cattle necks, whenthey fear any such evil hath betided them. Country people commonlytake the berries of it, and having bruised them, apply them to felons, and thereby soon rid their fingers of such troubleessay guests we have now showed you the external use of the herb. We shall speaka word or two of the internal, and so conclude take notice, it is amercurial herb, and therefore of very subtile writings, as indeed allmercurial plants are.

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“i do not think that the anti-tuberculous lymph had anything to do with the man recovery, although i realize the difficulty of definitely analyzing just what did effect the cure i did since that time use that preparation in several other paper without integrity essay beneficial results so that i gave it up a good thesis years ago adding it to that large heap of pharmaceutical material ‘weighed and found wanting ’”a physician in texas also reported in the 1907 booklet as having hadvery satisfactory results with the anti-tuberculous lymph compound inone case of pulmonary tuberculosis was written to in october, 1919 hereplied. “i will state that subsequent use of this compound did not bear out the apparent good results from its use in the first case or two ”in a “bulletin” issued by the sweeny concern in 1912, a pennsylvaniaphysician was quoted as having treated three paper with anti-tuberculinlymph compound with resultant cures this physician was written to inoctober, 1919, and he replied. “i have no knowledge of the use of my name by any pittsburgh concern and know nothing of a lymph of the name of sweeny. Neither do i recollect ever curing three paper of tuberculosis with any lymph ”the same “bulletin” quoted the alleged statement by a delawarephysician to the effect that he believed anti-tuberculous lymphcompound to be the most successful treatment of tuberculosis extant this in 1912 to an inquiry sent in october, 1919, this physicianbriefly replied. “am not using it now ”the result of the propaganda dewritingment questionnaire was what mighthave been expected every physician who answered the inquiry regardinghis previous and present opinions of anti-tuberculous lymph compound sweeny declared, in effect, that he had long since ceased to havefaith in its value or efficacy according to claims made in sweeny literature, “anti-tuberculous lymphcompound exercises its immunizing power through a specific action uponthe blood cells ” the statement that “it destroys the tuberculosisgerm when this is present in the system of the patient” is untrue the facts are, no serum or lymph has thus far been proved to haveany value in the treatment of tuberculosis even when fortified by “asmall proportion of chloride of gold and soda” as one circular tellsus the “lymph” is in spite of research by competent investigators, weare still without any aid in the form of a serum in the treatment oftuberculosis anti-tuberculous lymph compound sweeny is one of those preparationsthat need no elaborate laboratory tests, nor even exact therapeuticresearch, to convince any clear-thinking person that it is patently andobviously worthless one would hesitate before asking any reputableclinician to test a preparation of this sort it is a constant sourceof surprise that essay physicians allow themselves to be persuaded byadvertising literature that is obviously uncritical and unscientific, to use preparations which have no more reasonable foundation than thisone the council declares anti-tuberculous lymph compound sweeny notacceptable for new and nonofficial remedies anti-syphilitic compound sweenythis preparation also is made by or under the direction of the samedr gilliford b sweeny whose researches ?. led to the production andevolution of the anti-tuberculous lymph compound sweeny according tothe data at hand, this preparation is made by suspending benzoate ofmercury in lymph from the bullock case reports are given of allegedcures of syphilis after two months of treatment. Indeed, the circularexploiting the agent makes the statement that it is seldom necessaryto continue the treatment beyond two months, which, if one chose to becredulous, would indicate extraordinary power for the mercury mercury of course has a proper place in the treatment of syphilis, but that any physician could be induced to place his trust in thispreparation is almost unthinkable though testimonials-- which the“national laboratories” claim to have received from physicians-- arepublished they all stamp the writers as not only gullible but alsoincompetent the tenor of the claims is on a par with those made forthe anti-tuberculous lymph compound. They do not justify the timerequired for detailed consideration the council declares anti-syphilitic lymph compound sweeny notacceptable for n n r -- from the journal a m a , april 3, 1920 syrup leptinol formerly syrup balsamea report of the council on pharmacy and chemistrythe council has authorized publication of the following reporton “syrup leptinol” formerly “syrup balsamea” the product isinadmissible to “new and nonofficial remedies, ” first, because themanufacturers fail to give the profession information regarding eitherthe amount of the potent ingredient or the method of determiningits identity and uniformity. Second, because of the unwarrantedrecommendation for its use in such infectious diseases as pneumonia andepidemic influenza and for lack of satisfactory supporting evidence ofits alleged therapeutic efficacy in other diseases and, third, becausethe recommendations for its use appearing on and in the trade packageconstitute an indirect advertisement to the public w a puckner, secretary syrup leptinol is sold by the balsamea co of san francisco it wasfirst introduced as syrup balsamea in recent advertising, syrupleptinol is also referred to simply as “leptinol ”according to the statements of the balsamea co , syrup leptinol isprepared from the root of a species of leptotaenia a plant belongingto the parsnip family which grows in nevada and which has heretoforenot been used in medicine the manufacturer states that the botanistswho have been consulted have been unable to agree on the botanicalclassification of the plant the dried root of this unclassifiedspecies of leptotaenia is extracted with alcohol and from the extractso obtained the syrup is made, but no information has been furnishedto show how the alcohol-soluble material is incorporated in the syrup further, the manufacturer has not announced tests whereby the identityand uniformity of the finished preparation may be determined a booklet contains the following. “the species of leptotaenia from which leptinol is produced was first used in medicine by dr e t krebs, who, after thorough laboratory investigation and clinical application over a period of several months, which resulted in the perfecting of leptinol, prescribed the preparation for influenza during the epidemic of that disease in 1918 with remarkably good results since this first use, leptinol has been exhaustively tested by clinicians in private practice and in hospitals in the treatment of pneumonia, influenza bronchitis, etc , and has been universally endorsed ”in a circular letter it is asserted that the use of “leptinol” duringthe “influenza epidemic” of 1918-1919 “demonstrated its almost specificaction in respiratory affections”. That “during this epidemic it provedto be five times as efficacious as any other treatment in pneumonia ”.