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The fellows, schlotterbeck, and nelson, baker preparations are also in conflict with rule1 -- from the journal a m a , sept 2, 1916 pulvoids calcylates report of the council on pharmacy and chemistrypulvoids calcylates 5 grains was submitted by the drug productscompany, inc , new york, under the following claims as to composition. “when ingested represents the following chemical formulas. Oh c₆h₄ coo₂ ca 2h₂o sr c₇h₅o₃₂ 2h₂o ” “strontium di-salicylate 2-1/2 grs and our especially prepared salt of calcium and acid salicylic adjusted in such nascent form, that these pulvoids upon ingestion will promptly form calcium neutral di-salicylate 2-1/2 gr ” “a combination of calcium and strontium di-salicylate, in seemingly true chemical union ”these statements are rather vague, possibly because they are an attemptto mystify the product, however, may be assumed to be a mixture not achemical combination of calcium salicylate and strontium salicylate the therapeutic claims made for the preparation are.

2 that the resistance in the sametissue varies greatly under different circumstances the tissue which offers the greatest resistance and also practicallythe greatest variation is the skin, or, more properly speaking, theepidermis the resistance of this is thesis times as great as that of therest of the body, and when perfectly dry it is impervious to currentsof great strength witz states that in using a ruhmkorf coil with anestimated force of 250, 000 volts in guinea-pigs and rabbits, it isadvisable to cut through the skin in order to apply the electrodesdirectly to the flesh, or, at least, to wet the skin thoroughly, otherwise the shock caused by the full strength of the battery sixjars charged from the coil would not cause death various animalsoffer rates of resistance which vary essaywhat apparently according tothe nature of the animal, but are probably largely dependent on theconducting power of its tissues, that is, of its skin the variationsbetween the resistance of similar animals, according to the conditionof the skin at the time of the experiment, are much greater than thosewhich are found between animals of different species under similarconditions, or which are referable to specific susceptibility mr harold p brown testified in the kemmler case court of appeals, stateof new york state of new york ex rel william kemmler againstcharles f durston, agent and warden that he had in the course of hisexperiments seen a horse weighing 1, 320 pounds, with a resistance of11, 000 ohms, killed by an alternating current at 700 volts the resistance of the different cutaneous surfaces of the human bodyas measured by jolly in siemens’ units was from 400, 000 down to 15, 000in the male and to 8, 000 in the female siemens’ unit is to the ohm as1 06 to 1 00 tschirfew and watteville made the resistance from 80, 000 to 3, 000 ohms experiments made at the edison phonograph factory and edison laboratoryin july, 1889, on 259 males between the ages of eleven and fifty-one, showed a resistance, measured between the hands immersed to the wristsin a solution of caustic potash independent of polarization, averaging986 ohms and varying from 1, 970 to 550 ohms the resistance of 236 men employed at messrs bergmann & co electrical works in new york appears to have averaged 1, 184 ohms andto have varied from 1, 870 to 610 ohms these measurements were alsotaken between the hands, which were washed with soap and water and thendipped in jars containing a solution of caustic potash the batteryconsisted of four chromic-acid cells each having an e m f of 2 volts as shown in all the experiments on animals and more especially in thepaper of electrocution, the continuance or duration of the current hasmuch effect on the resistance as the current continues the resistancediminishes thus in the case of mcelvaine the resistance between theimmersed hands was at the beginning 800 ohms and at the medical residency personal statement editing service end of thecontact of fifty seconds had decreased to 516 ohms in this case, whenthe current of 1, 500 volts was applied from the forehead to the leg, the resistance was practically steady at only 214 ohms of course thesmall resistance in these paper electrocutions depends largely on theperfect contact secured according to the amount of resistance offered do the effects of severeshocks of electricity differ this is shown especially well in theaction of lightning, but is also true of powerful currents producedmechanically if the resistance of the skin be slight at the moment ofentering the circuit of a strong current, the current will pass throughit with comparative ease and without causing much injury. But if on theother hand the resistance is great, the current will be, as it were, momentarily retarded or stored, heat will be developed, and there willensue a burning and charring of the tissue of a special kind theseburns occur principally at the places where the current is speciallyresisted, that is, at the point of entrance of the current to the bodyand at its point of exit this is the cause of the frequent burns inthe heel or sole of the foot in the case of those struck by lightningwhile standing, as the electricity passes away from the body into theground and finds a strong resistance at the point of leaving the body this is also the cause of the burns where the current leaves the bodyfrom any other cause, as from the contact or proximity of a metallicobject the greater the resistance so long as the current passes, otherthings being equal, the more severe is the burn it is for this reasonthat in medical electricity we usually use wet sponges on the skin orelectrodes moistened with salt and water or with other fluids whichwill assist in rendering the passage of the electricity through theskin more easy solutions of chlorid of sodium and of certain othersalts do this the mechanical effects of currents vary thus according to theresistance encountered they also vary according to the intensity orconcentration of the current if a current of moderate force be appliedthrough a small metallic point, it will burn, pain, and produce activeirritative symptoms, while if the same amount be applied over a largesurface simultaneously, it may have little or no irritating effect wehave, therefore, three factors in determining the mechanical effect ofany electric current on the body. 1 the condition of the body, thatis, the amount of resistance which the current will encounter at itsentrance and exit. 2 the amount and intensity of the current. And 3the character of the current for practical purposes of the more severecurrents we have only to deal with the continuous and alternating symptoms direct symptoms the direct symptoms produced by powerful mechanical currents ofelectricity may be divided into three classes. I the mechanical.

For it is inadvisable toadminister the ingredients in fixed, but unknown proportions it is recommended that saloform be deemed inadmissible to n n r the council adopted the recommendation of the referee and authorizedpublication of this report -- from reports of council on pharmacy andchemistry, 1916, p 71 secretogen report of the council on pharmacy and chemistryabout a year ago the council declared secretogen, 103 a product theactive ingredient of which was stated to be “pancreatic secretin” andadvertised as a remedy for certain conditions of defective digestionand assimilation, to be ineligible for new and nonofficial remedies the reasons for this decision were stated at the time as follows:103 j a m a , may 1, 1915, p 1518 “1 no evidence has been presented that the absence of secretin is acause of gastro-intestinal diseases it is usually present, and if notpresent, as in achylia gastrica, there is evidently essay compensatingarrangement by which the pancreas is stimulated to perform its regularfunctions “2 there is no evidence that secretin in any form is physiologicallyactive when administered by mouth ”since secretogen was not the only so-called secretin preparation onthe market, and since the use of secretin preparations was recommendedby certain writers, notwithstanding the lack of evidence of its value, the council caused an experimental investigation of the question to bemade this was carried out by prof a j carlson of the university ofchicago no secretin was found in the commercial products examined, namely, secretogen tablets, secretogen elixir and duodenin furthermore, carlson results104 confirmed the council previous conclusionas to the inertness of secretin administered by mouth the councilendorsed professor carlson findings 105104 carlson a j. Lebensohn, j e , and pearlman, s j. Hassecretin a therapeutic value?. j a m a , jan 15, 1916, p 178 reports council on pharm and chem , 1915, p 98 105 so-called secretin preparations, j a m a , jan 15, 1916, p 208. Reports council on pharm and chem , 1915, p 96 the g w carnrick company has replied to the publication of thisreport in the letter printed below a portion of this letter, whichconsists of a communication from an unnamed correspondent of the g w carnrick company and the company comment thereon, has been omitted the council offered to publish this if the carnrick company wouldfurnish the name of the writer this it has not done as will be seen, the company now shifts ground, abandoning entirely the claim thatsecretogen contains secretin the council has authorized publicationof the letter omitting the writing just mentioned, together with thecomment that follows w a puckner, secretary “the council on pharmacy and chemistry of the american medicalassociation “gentlemen:-- the opinion of the council and the contribution byprofessor carlson which appeared in the journal of the american medicalassociation for jan 15, 1916, have been read by us with interest the column of current comment dealing with ‘tiger-bone therapy andclinical experience’ has appealed to our good nature and, under thecircumstances, our sense of humor “professor carlson seems to have quite well established that theso-called secretin preparations do not contain secretin to anyappreciable extent, and that they are inert in laboratory experimentson normal animals at the same time, to do away with an apparentdiscrimination on the writing of the management of the council, it wouldhave been well if professor carlson had included the so-called secretinpreparations belonging to another well-known firm which markets such aproduct this discrimination has already been referred to by us “had professor carlson stopped at the determination of the therapeuticavailability of secretin given by mouth, his work might have beenaccepted without comment, even if we should have thought it advisableto object to the matter published by the council but the professorwent beyond his province entirely when, in commenting on the findingsobtained by using secretogen clinically, he said. ‘it is, perhaps, impertinent for laboratory men to comment on these clinical results ’it is his point was well taken and it is a profound pity thatprofessor carlson did not observe his own ruling “in the words of a correspondent of the journal of the american medicalassociation, in discussing professor carlson criticism of dr crile‘kinetic drive, ’ ‘it behooves the laboratory man to be circumspect inhis criticism of clinical theories, since going beyond the bounds ofwell-established things weakens his position, not merely with referenceto the writingicular subject under discussion, but with reference toclinical phenomena in general ’ clinical results have definitelyestablished the value of secretogen as the matter now stands thisstatement is beyond criticism “when secretogen was first introduced we assumed that it depended onsecretin for results produced in this assumption we were in goodcompany, as witnessed by the testimony of moore, edie and abram when, in the course of their investigations as to the value in diabetesof a secretin-bearing extract given by mouth, 106 they said.

“does what dropsy medicaments have hitherto failed to accomplish ” “superior to digitalis, strophanthus, scoparius, squills, acetate of potash and the hydragogue cathartics all put together ” “the only known relief and permanent cure of dropsies ” “unrivaled heart tonic ” “the most powerful agent known ” “safe in administration ” “non-toxic as ordinarily administered ” “will nauseate essay persons, ” but “the reaction from the temporary depression is prompt ” “in bright disease, both the interstitial and parenchymatous forms of nephritis, acute or chronic, no remedy to equal it in efficacy ” “without increasing the debility of the patient or interfering with nutrition by producing loss of appetite ” “this treatment is to be continued without cessation until all symptoms of dropsy have disappeared ”a comparison of the earlier claims with those now being made seeadvertisement reproduced from the new york medical journalillustrates one of the results of the work of the council today thenostrum exploiter avoids the cruder forms of obvious misstatement, butcontinues to make, by inference, claims that are equally misleading it will be observed in this case that a more cautious pen worded thelater advertisement, but there is still evident the intent to convincethe reader that anasarcin is superior to the official drugs in thetreatment of cardiovascular diseases the facts are that anasarcin isat best a dangerous remedy in the hands of the average clinician inthe treatment of such conditions, and its use is at all times to becondemned no competent investigator has ever investigated the pharmacologyof sour wood oxydendron arboreum, and it appears to have notherapeutic value other than that due to a slight acidulousness elder sambucus canadensis contains a trace of a volatile oil as its mostimportant constituent, according to the british pharmaceutical codex of1911 p 908, but it is difficult to explain why a trace of volatileoil should be considered important elder may be dismissed withoutfurther consideration in connection with anasarcin tablets the pharmacology of squillthis leaves only squill among the constituents of anasarcin forconsideration sollmann manual of pharmacology, 1917, p 409 indiscussing the advantages claimed for squill over other drugs of thedigitalis group, says. “dixon, 1906, points out that any superiorityis outweighed by its disadvantages. Uncertain absorption. Stronggastro-intestinal irritation ” squill was formerly used as anexpectorant and diuretic, the activity having been attributed to twoamorphous glucosids, scillipicrin and scillitoxin, but ewins, 1911, found these to be impure mixtures a later investigator claimed tohave isolated two glucosidal agents from squill, but similar claimshave often been made only to be disproved later, and we know ofno confirmation of the claims regarding the isolation of any pureprinciples from squill having any true typical digitalis action the statement quoted from sollmann is accepted by practically allpharmacologists, and we may say with certainty that squill is decidedlyinferior to digitalis in the treatment of cardiovascular, andcardiorenal diseases, and certainly no active principles of squill wereknown to the scientific world at a time that the remarkable claims werefirst made for anasarcin by an obscure pharmacist of winchester, tenn indeed, if anasarcin were all that it was claimed to be, its discoverywould have made winchester as famous as a certain wisconsin city wassaid to have been made by a popular beverage it has been abundantly demonstrated, and it is now almost universallyaccepted among well informed pharmacologists and clinicians, that alldigitalis principles exert the same kind of action on the heart afterthey enter the circulation in effective doses, though they differto an extraordinary degree in the intensity of their action and intheir undesired sideactions, such as nausea and vomiting when theuse of anasarcin squill is followed by immediate improvement afterdigitalis has failed, it merely shows that the dosage of digitaliswas insufficient or that it was discontinued and the squill mixturewas substituted before the full therapeutic effects of the digitalisdeveloped when the digitalis group is contraindicatedif the administration of a sufficient dose of digitalis is not followedby improvement in the circulation, it shows that the heart is incapableof responding to such treatment and the further use of any of the drugsof this group is distinctly contraindicated this is confirmed by theexperience of nearly every competent observer of digitalis therapy, andnumerous fatalities have resulted from the failure to appreciate thisfact and further administer essay other member of the group, such asstrophanthus or squill it is now well known that the cardiac effects of toxic doses of squill, and other members of the group, resemble closely those of cardiacdisease, and it is often impossible to determine whether the behaviorof the heart in a given case is attributable to insufficient dosage, toexcessive dosage, or to the progress of the cardiac disease itself ifthis occurs when one uses the best known members of the group, it iscertain that it occurs even more frequently when others that are lessunderstood are employed in the light of this knowledge of the dangersattending the incautious use of any member of the digitalis group, and more especially the use of impure principles, such as are commonlyobtained from squill, it is impossible to condemn sufficiently therecommendation that the use of anasarcin should be continued withoutcessation until all symptoms of dropsy have disappeared digitalis bodies are not suited for the treatment of all cardiacdisturbances, and it is, of course, self-evident that a time mustcome in the treatment of chronic cardiac disease when the heart isincapable of responding to any form of treatment with improvement but, unfortunately, it never loses its response to toxic doses, and to pushthe administration of any drug or mixture containing any drug of theentire digitalis group-- and especially those, like squill, in which theside actions are most prominent-- beyond the point of tolerance is tocourt certain disaster the treatment of cardiac dropsywhile it is quite certain that thesis lives have been sacrificed to thefailure to understand this phase of cardiac therapy, it is equallycertain that thesis lives have been sacrificed because of insufficientdosage, and one can steer a safe course between these dangers only byusing the best known preparation available. And in the present stateof our knowledge it is indisputable that digitalis and the tincture ofdigitalis are best suited for the treatment of cardiac disease exceptin those few paper in which intramuscular or intravenous administrationmust be employed temporarily for immediate effect illustrationthe secret of prescribing successfully for the relief of dropsy incardiac disease consists in understanding the effects of digitalison the heart, in administering it until these effects indicate thatthe desired object has been obtained, and stopping, or interrupting, the administration at that point until the effects begin to wear off cumulation, so called, is a positive advantage in such paper itmerely means that the desired therapeutic effects once induced persistfor a time, and that further medication is unnecessary during suchpersistence of action eggleston has recently shown arch int med 16:1 july 1915. Abstr , j a m a 44:459 july 31 1915 thatthe full therapeutic effects of digitalis can be induced in suitablepaper within a few hours even with oral administration we are not aware of a single publication in which a careful, detailedclinical study of anasarcin has been reported the claims made foranasarcin, past and present, indicate either a deliberate purposeto mislead or crass ignorance of the rudiments of pharmacology andtherapeutics the exploiters of the nostrum claim that thousandsof physicians have found anasarcin tablets of unsurpassed remedialvalue in the treatment of disorders of the circulatory system and ofascitic conditions 244 it must be admitted that too thesis physicianshave prescribed anasarcin, otherwise the manufacturers would not havecontinued to spend thousands of dollars in advertising it in medicaljournals during a period of more than ten years 244 former estimates of the number of physicians who prescribedanasarcin appear to have been too high, possibly based on the ratioobtaining in winchester, tenn inquiry at five fairly busy drug storesin a large eastern city showed that in no instance was the pharmacisteven acquainted with the name one pretended to be, and manifested pityfor the inquirer ignorance in supposing that it could be importedduring the war!. he was obviously merely less honest than the others, who frankly admitted they had never heard of it doctor, this article is meant to be a candid discussion with you, whether you use anasarcin or not, because every clinician is vitallyinterested in the customs that obtain in the practice of medicine, andwe wish to put a hypothetic question to you answer it, at least toyourself, in exactly the spirit in which it is put suppose that youprescribe anasarcin for a patient who is critically ill with cardiacdisease he dies are you willing to tell the relatives frankly justwhat you used and the nature of the evidence on which you based yourchoice of this nostrum?. let the supposition be carried further and saythat the case was hopeless, and agree that digitalis and all otherdrugs would have been equally ineffective granting all this, wouldyour explanation satisfy?. would you in all candor dare to offer such anexplanation?. try it as a hypothetic case before you are forced to applyit -- from the journal a m a , dec 8, 1917 article iii pepto-manganit would be interesting, and even instructive, to know how thesiseducated physicians, if any, are now prescribing pepto-mangan gude:interesting as indicating the number who have neglected to availthemselves of the work of the council on pharmacy and chemistry, especially the earlier work. Instructive in that it would show how thesisare still prescribing by the rule of thumb, and who are taking theirtherapeutic instructions from purely commercial sources instead ofstriving to learn how to choose those drugs that are most effective inthe treatment of disease it has been pointed out thesis times in the pages of the journal thatthesis nostrums are advertised first to physicians, and that afterphysicians have served as the unpaid agents of the manufacturers inintroducing the preparations, their exploitation is then commonlycontinued by means of advertisements in the public press this plan hasbeen followed successfully in so thesis paper that we have now come tolook on it as the regular course it is in keeping with this rule thatwe find pepto-mangan now advertised in the public press, the physicianshaving served the manufacturer purpose discarded theories of iron medicationit will be recalled that thesis years ago the theory was held thathydrogen sulphid sulphureted hydrogen interfered with the absorptionof the iron of the food, and that the administration of medicinaliron prevented this interference by neutralizing the hydrogen sulphid sulphureted hydrogen it was only a short step to argue thatmanganese might replace the medicinal iron in combining with thehydrogen sulphid, permitting the food iron to be absorbed, and itwas held that only food iron could be utilized in the formation ofhemoglobin it is hardly necessary to remind the reader that this theory restson numerous fallacies there is no hydrogen sulphid worth mentioningin the small intestine where iron is absorbed. Food iron cannot beutilized directly in the formation of hemoglobin but must be brokeninto simple forms for absorption. And, further, inorganic iron, such asferrous carbonate, serves the purpose admirably when iron is indicated with the acceptance of these well established facts, all possibleexcuse for the therapeutic employment of pepto-mangan in place of ironvanished. But as plain and simple as this fact is, the unnecessary andexpensive pepto-mangan continues to be prescribed by physicians whowill not take the slight trouble to investigate the claims for thisnostrum false and misleading claimsthere is not merely a difference of opinion between the exploiters andthe council, but there has been also actual misrepresentation in theexploitation of this nostrum to physicians this has been shown onmore than one occasion about twelve years ago, the m j breitenbachcompany, the proprietors of pepto-mangan, claimed that the report ofthe commission that had been appointed for the investigation of anemiain porto rico “would alone suffice to establish pepto-mangan at once asthe foremost hematinic known ” examination of the report showed thatthe commission made no such claims. On the contrary the commissionprotested against this misrepresentation j a m a 45:1099 oct 7 1905 illustration. From the new york medical journal undaunted by this exposure of their methods, the breitenbach companylater sent out a statement of results purporting to have been obtainedby one mateo m gillen, in the treatment of infantile anemia onrandall island in new york city at the instance of the journalthe hospital records in these paper were examined, and it was foundthat the pretended report was little more than a tissue of falsehood j a m a 48:1197 april 6 1907 about two years ago the council reported that while the statementsjust referred to were no longer made, they had never been definitelyadmitted by the breitenbach company to be erroneous, and thatpepto-mangan was then being exploited to the public indirectly council reports, 1914, p 121 we reproduce an advertisement that has been appearing weekly in thenew york medical journal for several months one can only supposethat this advertisement was intended to mislead physicians, and itwould be an insult to the intelligence of the average reader toattempt any detailed discussion of it, but enough has been said toshow how misleading the statements are one should note writingicularlythe advice-- old as the nostrum business itself-- contained in theadvertisement, to prescribe an original bottle the reason for suchadvice is simple experience has shown that when original bottles aredispensed patients soon learn to buy the nostrum without consulting thephysician, for they shrewdly suspect that he knows no more about thepreparation than they, and that he gets his information from preciselythe same sources that are available to them they are obviously right in truth, the physician who prescribes pepto-mangan as a hematinicshows ignorance of the most rudimentary facts of iron therapy, and theintelligent patient soon perceives his limitations illustration. A newspaper advertisement of pepto-mangan the problem of iron therapythe investigation of the problems of iron therapy and its utilizationin the formation of hemoglobin forms one of the most brilliant chaptersin pharmacologic research, and there is no better established fact intherapeutics than that any organic or inorganic preparation of ironthat does not irritate the stomach may be employed effectively when theadministration of iron is indicated “useful drugs” contains a listof iron preparations that are suitable for all conditions which callfor iron, and the clinician may rest assured that he will never haveoccasion to go outside that list to prescribe any substitute as a matter of fact, it seems probable that the very number ofavailable iron preparations has served to cause confusion, thusaffording an opportunity for the nostrum maker to introduce hissuperfluous compounds it may be difficult at times to select thepreparation of iron best suited to the individual patient. And it isthis difficulty that has led the clinician to listen to the seductiveclaims made for the various pretended substitutes for iron oneshould approach the question of choosing the proper form of iron fortherapeutic use with the recognition of the fact that there is nosuch thing as a substitute for iron in the formation of hemoglobin, that there are no ideal forms of iron other than those found in thefoodstuffs further, the clinician cannot avoid the disadvantagesinherent in all forms of iron that he can prescribe, and he musttherefore seek that which seems best suited for the individual patient bunge estimated the amounts of iron present in various foods.

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