ANTIKAMNIA
The Nostrum and Its Method of Exploitation
Our readers will be interested to learn some of the remarkable properties which, according to the statements of the manufacturers, this Antikamnia possesses. We quote from the advertising literature:
The well-known nerve specialist (?), Dr. Harley, in an interview published in the London Daily Express, says: “I have treated more than one American for nervousness and ‘brain fag’ directly due to their incessant energy. I had a young man in here this morning who complained of headache ‘in the back of the neck.’ He was threatened with congestion of the brain, and seemed somewhat aggrieved when I told him he had been trying to do too much. I also treated a young American woman who, since her arrival in London, had apparently been living on Antikamnia tablets by the advice of her physician. It was the only thing, she said, which kept her ‘braced up’ for the strain of sight-seeing.”
(Why did the young woman consult this Dr. Harley—for the drug habit?)
Note the following:
For the severe pains of rheumatism, dysmenorrhea, neuralgia, gout, sciatica and lumbago, as well as for the lightning pains of locomotor ataxia, there can be no quicker and more lasting relief obtained than by the administration of Antikamnia and codeine tablets.
Imagine an intelligent physician trying to treat the diseases mentioned below with the various impotent means of the pharmacopeia and physiological therapy when he might depend on Antikamnia! We quote again:
As a Pain Reliever.—In headache, cephalalgia, hemicrania, migraine [some other words might have been thrown in so as still more to emphasize the headache business], myalgia, coryza, la grippe and its sequelae, the lightning pains of locomotor ataxia and all pains due to irregular menstruation.
As an Anodyne or Sedative.—In alcoholic delirium, indigestion, cardialgia, gastralgia, dyspepsia, hysteria, insomnia, inebriety, car-sickness, sea-sickness, worry and sight-seer’s fatigue.
As an Antipyretic.—In typhoid, intermittent, puerperal and malarial fevers, bronchitis, pneumonia, pleurisy, and tuberculosis.
As an Anti-Neuralgic.—In acute or chronic neuralgia, facial neuralgia, earache, pain about the teeth, angina pectoris, neurasthenia, palpitation, pains of locomotor ataxia and sciatica.
As an Anti-Rheumatic.—In acute or chronic rheumatism and gout, fever and pleurodynia.
There is no remedy so useful and attended with such satisfactory results as Antikamnia tablets in the treatment of melancholia with vasomotor disturbances, anemic headaches, emotional distress, and active delusions of apprehension and distrust. They increase arterial tension and promote digestion, as well as being particularly serviceable in relieving the persistent headache which accompanies nervousness.
In neurasthenia, in mild hysteroid affections, and in the various neuralgias, particularly ovarian, and in the nervous tremor so often seen in confirmed drunkards, they are of peculiar service. In angina pectoris this drug has a beneficial action; it relieves the pain and distress in many cases, even when amyl nitrite and nitroglycerin have failed entirely. In pseudo-angina, frequently observed in hysterical women, its action is all that can be desired.
Patients who suffer from irritable, weak, or palpitating heart, needing at times a pain reliever, can take Antikamnia tablets, without untoward after-effects, knowing that the heart is being fortified. In delirium tremens, they relieve when there are great restlessness, insomnia, the general lowering of the nerve power.
Only the vivid picture of a crisis in locomotor ataxia or the agony of a true migraine, can impress the observer with the full value of this pain reliever.
The following testimonials are from physicians:
Dr. Caleb Lyon, an old Bellevue practitioner, in referring to antikamnia and codein tablets, says:
In my practice they accompany the maid from her virgin couch to her lying-in chamber, assuaging the perplexities of maidenhood and easing the trials of maternity with most gratifying results. I earnestly hope that the proprietors of this valuable remedial agent will keep it up to its present standard of purity and excellence.
Dr. Walter M. Fleming, A.M., M.D., New York City, writes:
... With all the experience of more than a quarter of a century, in the treatment of winter cough, and all its complications of laryngeal, bronchial and pulmonary irritability, dyspnea, asthmatic spasms, and finally whooping cough—usually the most persistent and tenacious of all these membranous maladies—I find no one remedy more strongly indicated, or which yields more prompt and satisfactory results than Antikamnia and heroin tablets, composed of Antikamnia 5 grains and heroin hydrochloride 1⁄12 grain.... Result: a prompt and efficient expectorant, at once relaxing the harsh and rasping cough, releasing the tenacious, sticky and gelatinous mucus which is soon readily expectorated, while the soothing influence of the Antikamnia is at once manifested, greatly to the comfort and contentment of the patient.
... Independent of the fact of the direct applicability of this remedy to the various membranous maladies of the lungs, bronchi, fauces and nose, it proves also, an invariable remedy in all febrile cases where anodyne is required. This, together with its analgesic and antipyretic merits, eminently qualify this combination for a responsive agent in the treatment of nearly all the numerous febrile attacks characterized by pain, nervousness, insomnia and their accompanying symptoms.
“Antikamnia and Quinin”
If there is any virtue in the particular combination known as “Antikamnia,” a physician prescribing the tablets supposed to contain combinations of “Antikamnia” and some other drugs should have some guarantee that they contain those remedies. Take, for example, the tablets advertised and sold as “Antikamnia and quinin.” It might reasonably be supposed that the tablets contained the combination known as “Antikamnia”; this, however, seems not to be the case. Previous analyses, as published[105] by us, have shown that antikamnia contains approximately 20 per cent. of sodium bicarbonate, yet two chemists, working separately, have been unable to find this ingredient in the tablets advertised and sold as “Antikamnia and quinin.” Are we to understand, therefore, that the manufacturers do not consider the bicarbonate of sodium of importance in their preparation, Antikamnia; or are they guilty of misrepresentation and of misleading physicians in omitting this constituent from their product Antikamnia when that is combined with the bisulphate of quinin? The above statement regarding the omission of bicarbonate of sodium from the quinin combination may be verified by any physician who desires to make a few simple chemical tests—carbonic acid is not given off when the tablets are treated with dilute acids, as would be the case if sodium bicarbonate were present. Further, while the ordinary Antikamnia contains no constituent not soluble either in water or in chloroform, and while quinin bisulphate is readily soluble in water, the tablets said to contain Antikamnia and quinin bisulphate, when treated successively with water and with chloroform, leave a residue of more than 18 per cent.
One of the chemists who analyzed the preparation for us, in commenting on this in a letter, says: “The matter which is insoluble in water, alcohol or in chloroform, i. e., the substance which is neither ‘Antikamnia’ nor quinin bisulphate, amounts to more than 18 per cent. in ‘Antikamnia and quinin bisulphate tablets.’ The tablets weigh close to five grains and are said to contain 2.5 grains each of Antikamnia and quinin bisulphate. How is this possible when each tablet contains almost one grain of foreign substance (chiefly starch)?”
Further comment is superfluous. We have presented facts to our readers and leave, them to draw their own conclusions.—(From The Journal A. M. A., July 1, 1905.)
Adding Insult to Injury
When the Council on Pharmacy and Chemistry began its work of independent and scientific investigation of proprietary preparations, some of the questions asked were:
“What guarantee has the medical profession that the formulas of these proprietary medicines are not changed at the will of the manufacturers? How can the physician who confidingly prescribes them for his patients know that the preparation which he orders to-day is the same as that which was furnished him last year, or which may be given him next year, under the same name?”
At once a wail, as of injured innocence, went up from countless venders of proprietary medicines, who replied with one voice:
“The honor and reputation of the proprietors and manufacturers is sufficient guarantee of the stability and permanence of these preparations.”
So vehement were their protestations and so well simulated were their declarations of Pecksniffian virtue that many physicians were deceived thereby. Many medical journals (whose views were, perhaps, slightly biased by the consideration of fat advertising contracts) also were apparently convinced. But the fact was overlooked that guarantees based on honor are of value only in proportion to the amount and quality of honor possessed by the guarantors.
The enactment of the national Food and Drugs Act is bringing many things to light. Some of them are interesting, some would be amusing were they not so utterly despicable. Among other things, it has furnished a demonstration of the value of the “honorable assurances” of nostrum venders.
The nostrum Antikamnia has pointed out many a moral in the campaign in the last two years. It was hardly to be hoped that it would deliberately furnish a demonstration of the utter lack of honesty on the part of a certain class of proprietary manufacturers. Yet, relying apparently on the ignorance of the public and the long-continued lethargy of the medical profession, its promoters have, in the last few weeks, unwittingly convicted and stultified themselves. When the pure food law went into effect, the proprietors of this mixture found themselves in a sad dilemma; if they labeled their mixture in accordance with the provisions of the law they would have to admit that it contained acetanilid and that the charges against them were true. Failing to comply with the law, they must go out of business. The latter alternative was not to be thought of. The profits gained by selling, with the aid of careless or ignorant physicians, a five- or ten-cent mixture for $1 were too great to be surrendered without a struggle. The same brilliant intellect, perhaps, that first saw the commercial possibilities in the business said: “Change the formula. Phenacetin is about as cheap as acetanilid; the patent has just expired and consequently we can get it at a low price. Let us substitute phenacetin for acetanilid.”
As a result the profession is treated to an edifying exhibition of virtue triumphant, a wolf so completely covered by the harmless coat of a sheep that he flatters himself that his wolfish nature is completely concealed. No longer are skulls and skeletons sent out in calendar form as grinning advance agents to be displayed in every doctor’s office, but instead a beautiful domestic scene, showing a convalescent child nestling in the arms of its mother. The familiar “AK,” however, as usual, is in the lower right-hand corner. And what a change in labels! No longer is Antikamnia a chemical entity, but the label now openly but ingenuously declares that “Antikamnia tablets in this original package contain 350 grains of acetphenetidin, U. S. P., per ounce. Guaranteed under the Food and Drugs Act, June 30, 1906. Serial No. 10.” While, below, as an entirely unnecessary display of conformity to the Pure Food Act, appears this statement:
The Antikamnia tablets in this original ounce package contain no acetanilid, antifebrin, antipyrin, alcohol, morphin, opium, codein, heroin, cocain, alpha- or beta-eucain, arsenic, strychnin, chloroform, cannabis indica or chloral hydrate.
Truly, Satan is appearing as an angel of light. What a gratification it is to the long exploited profession to know that Antikamnia contains no alcohol, no chloroform, no cannabis indica, no chloral hydrate. How unfortunate that this spontaneous display of confidence is not carried far enough to inform the profession of the ingredients, aside from phenacetin, contained in the mixture!
The label is an admission that the nostrum does not contain what it was never supposed to contain, with the exception of acetanilid, and is directly an attempt to conceal the real contents. The proprietors know that the dear public, whose “pains, headaches, neuralgias, women’s aches and ills, grippal neuroses, nervousness, insomnia, rheumatism, lightning pains of locomotor ataxia, sciatica, etc.,” they are longing to assuage, will not know that acetphenetidin is the official designation for what is popularly known as phenacetin, and that this dangerous product is found in the new mixture in the proportion of approximately 4 grains to a 5-grain tablet. Evidently they also presume considerably on the ignorance of our profession, or why should they make the brazen statement that four grains of phenacetin is the “most reliable remedy” for the long list of diseases enumerated on their advertising calendar?
A reduced reproduction of a full-page Antikamnia advertisement appearing in the New York World Almanac, 1911.
When the formula for which such wonderful virtues were claimed was suddenly thrown overboard, was the medical profession, which by its short-sighted patronage had built up this business, notified in any way of the change? Search the new advertising matter of this nostrum from beginning to end and you will not find one word to show that “The Antikamnia tablets in this original ounce package” differ in the slightest particular from those sold to the profession and the public for years past. This being true (and the statements of the promoters themselves are our authority for it), what remains of the pratings of “honor” and the “guarantee of the manufacturers”? Has a physician no right to know when a change is made in the formula of a preparation which he has been prescribing for years?
What assurance has the profession that, at any moment, a cheaper or more dangerous drug may not be substituted for “acetphenetidin” if thereby the law can be evaded or the profits of the delectable business enhanced?
How can any conscientious physician prescribe, for those who confide their lives to his care, a preparation the stability of the formula of which must depend absolutely on its owner’s whim?
How can a physician with the slightest sense of responsibility to his patients allow his office to be used as a free advertising bureau for a preparation manifestly founded and developed on deceit and misrepresentation?
How can any medical journal, except those avowedly and unblushingly seeking to aid the nostrum maker to exploit the profession, whose interests they claim to serve, continue to carry the deceptive and misleading advertisement of a twice exposed fraud?
How can any physician with a particle of self-respect or manhood continue to support, by subscription or contribution, any medical journal which, by accepting such advertising, allies itself with the army of deceit and chicanery?—(Abstracted from The Journal A. M. A., Jan. 26, 1907.)
Still Further Duplicity
When the Food and Drugs Act went into effect the manufacturers of this preparation, instead of continuing to put out the same mixture as they had been doing radically changed the composition by substituting acetphenetidin (phenacetin) for acetanilid. By doing this the company avoided the disagreeable necessity for acknowledging on the label that the nostrum contained acetanilid, as was shown by the analysis published in The Journal, June 3, 1905. In addition to stating that the package of Antikamnia contained acetphenetidin, the company also stated that it contained no “acetanilid, antifebrin, antipyrin, alcohol, morphin, opium, codein, heroin, cocain, strychnin, chloroform, cannabis indica, or chloral hydrate.” Knowing that the nostrum was being advertised in Great Britain and Canada as well as in the United States, The Journal obtained some Antikamnia from London, and it was analyzed in the Association’s laboratory. As was suspected, the analysis showed that Antikamnia as sold abroad has the same composition now as it had in the United States before the Food and Drugs Act went into force, viz.: Acetanilid, 67.75 per cent.; caffein, 4.88 per cent., and citric acid and sodium bicarbonate, by difference, 25.36 per cent. This corresponds with the analysis previously made and published in The Journal, June 3, 1905. The Antikamnia on the market in this country was also analyzed and it was found to contain: acetphenetidin (phenacetin), 72.05 per cent.; caffein, 13.95 per cent.; citric acid and sodium bicarbonate, 14 per cent. The preparation sold as “Antikamnia and Quinin” was also analyzed, and it was found that starch had been substituted for the bicarbonate of sodium which is found in the Antikamnia itself. The details of the analyses are given with the following comments: “The above are brief statements of bald facts. Two of these should be emphasized: (1) When the Food and Drugs Act went into force, January, 1907, the manufacturers of Antikamnia, rather than acknowledge the truth of the past—we can imagine no other reason—materially and radically changed the composition of their preparation, and did this without notifying the medical profession or intimating in any way, so far as we can learn, that such a change had been made. We have no doubt they believed they had a right to do as they pleased with their own; that it was nobody’s business but theirs what they did with their own preparation, or how they changed it. As they never had told physicians what it contained, there was no reason why they should do so now. This is logical and we cannot blame the manufacturers so long as the medical profession is willing to be humbugged. (2) For the same reason, we presume, they claim that they have a right to continue to use acetanilid in the product for the foreign market. The Food and Drugs Act applies only to the United States, of course, and acetanilid being cheaper, why not use it? What is the difference if one is more dangerous than the other? The fact that the Antikamnia sold abroad differs from that sold in this country some may say is of no special interest to us. Still this fact is worth noting: The dose of acetphenetidin—phenacetin—(71⁄2 grains) is nearly double that of acetanilid (4 grains): one becoming accustomed to a certain dosage of the nostrum as sold in this country might, while abroad, unwittingly be led to take a double dose of acetanilid.—(Abstracted from The Journal A. M. A., Feb. 8, 1908.)
Samples, Form Letters and “Prescriptions” Sent to the Laity
To the Editor:—The enclosed “literature” is being sent broadcast to the laity by the Antikamnia people and still a great many of the physicians throughout the country are prescribing the preparation thus advertised. Will the time ever come when the medical fraternity will awaken to the fact that it has been humbugged by a great many manufacturing concerns? I certainly hope so.
J. W. DuVal, M.D., Wichita Falls, Texas.
Comment:—The “literature” referred to by our correspondent consists of a form letter and a small pamphlet. The letter was similar to the one reproduced herewith.
The pamphlet accompanying the letter is entitled “Practical Prescriptions,” and contains a list of diseases and morbid states arranged alphabetically from “Alcoholism,” “Asthma” and “Backache,” to “Wind,” “Women’s Pains” and “Worry.” For the one hundred and twenty-two conditions listed, “Antikamnia,” “Antikamnia and Codein” or “Laxative Antikamnia and Quinin” are prescribed, demonstrating that the “prescriptions” are more “practical” than scientific.
In many respects the methods of the proprietors of “headache powders” and “anti-pain pills” are less offensive to one’s sense of professional decency than the course pursued by the Antikamnia people. The former have at least never recommended their products as “ethical proprietaries”; they have not used medical men as their unpaid agents; the claims made for their products have been no more exaggerated; and they have not found it necessary, from the requirements of the Food and Drugs Act, to substitute acetphenetidin for acetanilid to avoid giving the lie to their former claims.
As to the query propounded by our correspondent: We are optimistic enough to believe that the time he longs for is already here. The fact that the proprietors of nostrums of the Antikamnia type are finding it necessary to advertise to the laity is, in itself, evidence of the diminishing demand for such products on the part of the medical profession.—(From The Journal A. M. A., April 18, 1908.)
Antikamnia in America and Great Britain
The following letter from the Antikamnia Chemical Company to The Journal was received about August 1, 1912:
“You have at various times represented in your Journal that the Antikamnia sold in foreign countries, particularly in Great Britain, has a different formula from the Antikamnia sold in the United States, and you have also published alleged formulas of each to show wherein they are supposed to differ.
“We hereby respectfully notify you that the Antikamnia formula is the same for all countries, and the publication of any statements to the effect that the formula of Antikamnia is different in Great Britain, or any other foreign country, from that sold in the United States is a libel, and will be prosecuted as such.”
On the receipt of this a letter was written to a correspondent in London requesting him to purchase in the open market a package of Antikamnia. This was done and the original sealed package reached the Association’s laboratory a few days ago. Careful analysis of this specimen shows it to contain acetanilid but no acetphenetidin, while the Antikamnia sold in the United States contains acetphenetidin but no acetanilid. The company’s protest to the contrary notwithstanding, the formula of some Antikamnia, at least, is still different in Great Britain from that sold in the United States. It is possible, of course, that some time in the future the composition of every package of this nostrum on sale in the United Kingdom will be similar to that of every package sold in the United States. It is even possible that “Antikamnia & Quinin” tablets will—or do—actually consist of quinin and the mixture called Antikamnia—although, as The Journal has shown, this has not been the case in the past. Since the patent expired on acetphenetidin, this drug has become so cheap—it can be bought at wholesale for less than 6 cents an ounce—that, commercially it must make very little difference whether acetanilid or acetphenetidin is used in the manufacture of Antikamnia. But the question arises: Have our British confrères been notified of the change in formula? A careful study of the Antikamnia advertisements in English medical journals shows that the British medical profession has been given no more consideration by this concern than was the American medical profession when the change in composition was made on this side. But then why should it be? Physicians, British or American, who are addicted to the prescribing of secret proprietaries such as Antikamnia have little need of formulas—“Theirs not to reason why!” The medical profession on both sides of the Atlantic has never known the exact composition of Antikamnia and does not know it now. Physicians who call for preparations of the Antikamnia type are prescribing names, not drugs.—(From The Journal A. M. A., Oct. 26, 1912.)
Again, Antikamnia
Reproductions of portions of pages in the booklets sent out by the Antikamnia Chemical Company to physicians (on the right), and laymen (on the left), respectively. Those who do not realize the character of the Antikamnia concern naturally imagine the quotation here given from The Journal is a comparatively recent one. Notice that no dates are given. As a matter of fact, it is twenty-two years old. Dr. McIntyre, who wrote it, has been dead eleven years.
In season and out of season The Journal has exposed the Antikamnia fraud until it would seem that its readers would become weary of the very name. There is nothing new to say about this dangerous stuff, and yet the number of inquiries indicates that thousands of The Journal’s readers do not know of the previous exposures. More than fifteen years ago The Journal ceased carrying the Antikamnia advertisement; more than ten years ago it notified its readers that the nostrum was being advertised to the public by means of circular letters; more than six years ago it proved that, when the Food and Drugs Act went into effect, acetphenetidin had been substituted for acetanilid in Antikamnia evidently in order that the presence of the older drug, of whose dangers the public had been made aware might not have to be admitted; more than five years ago The Journal showed that the Antikamnia sold in the British Isles still contained acetanilid, and as late as last October it verified this statement although threatened with prosecution for libel by the Antikamnia Chemical Company.
Yet, in spite of all these exposures, not a week passes that we do not receive one or more letters calling attention to the Antikamnia fraud. Most of these letters deal with one, or more, of three points: first, the fact that the stuff is being advertised to the public by means of circular letters and that sample “vest-pocket boxes” of this dangerous drug are being sent through the mail to laymen; second, that Antikamnia is being advertised in newspapers, and, third, that in the booklets sent out by the Antikamnia Chemical Company both to the medical profession and to the public, a paragraph is quoted from an article by Dr. John H. McIntyre that appeared in The Journal.
Photographic reproductions of two typical Antikamnia advertisements now appearing in newspapers all over the country. These tablets are advertised in various newspapers as being “safe” and neither “depressant” nor “habit-forming”—three separate and distinct falsehoods.
The first two points have already been discussed so frequently that it seems hardly worth while to take them up again in detail, though it might be said that the medical profession has at last become so familiar with this widespread humbug that the Antikamnia Chemical Company has finally gone over body and soul to the newspapers. So far as we can learn only three publications professing to be medical journals still carry the Antikamnia advertisement. These three are:
| Southern Practitioner | Pacific Medical Journal |
| Therapeutic Record |
As is usual in such cases, the British medical journals are not so particular, and we still find Antikamnia advertised in:
| Medical Press and Circular | Lancet |
| Glasgow Medical Journal | Canada Lancet |
| Journal Tropical Medicine and Hygiene | Practitioner |
| Dublin Journal Medical Science |
The reproduction of the McIntyre quotation is evidently adopted by the Antikamnia concern as a means of “playing even” with The Journal for the unpleasant things it has said about it. In quoting Dr. McIntyre, the Antikamnia Chemical Company carefully avoids giving the date on which the article appeared. As a matter of fact, the article was printed in The Journal over twenty years ago (July 4, 1891), and Dr. McIntyre himself has been dead for eleven years. Presumably, however, the Antikamnia Chemical Company will continue to mislead, either directly or by inference, until the end of the chapter.—(From The Journal A. M. A., April 12, 1913.)