CAUSE FOR OPTIMISM
A Clean Medical Journal—the South Texas Medical Record
Fortunately, there are forces at work in the medical profession that make for optimism. An editorial in the last issue—April, 1915—of the South Texas Medical Record, the official organ of the South Texas District Medical Association, is especially significant. While not a large journal, the South Texas Medical Record could well stand as an example to medical publications of a much more pretentious character. Its advertising pages are above reproach and the journal is a credit alike to its editors and to those members of the profession whose support makes its existence possible. In the editorial referred to, entitled, “Honest Advertising—Let Us Cleanse Our Own Linen First,” the editor-in-chief, Dr. W. Burton Thorning, says:
“A recent editorial, entitled ‘Honest Advertising,’ in a daily newspaper, furnished the occasion for an editorial comment in the January number of the Southwestern Hospital Reporter. The latter, while taking the ground that the newspaper was inconsistent in uttering high editorial sentiments and in adjoining columns printing patent medicine advertisements, implied that newspaper men should be allowed some latitude in the matter of accepting advertising, on the plea of being laymen and therefore not expected to possess the same amount of information concerning patent ‘dope’ that medical men have.
“It would appear to be a fair assumption that a layman, even though a highly educated and able editor of a great newspaper, does not know, and cannot be expected to know, the depth of depravity to which the consumption cure faker and the cancer quack can descend.
“Granting that the newspaper man accepts the advertisements through ignorance of the facts concerning their possibilities for evil, what can be offered in defense of the medical editor who accepts advertising matter equally pernicious in its influence?
“Indeed, it is not so many years since many of the so-called ethical medical journals carried the ads of some of the most notorious quacks this country has ever known.
“Doubtless there are few, if any, who do so at the present time, but, on the other hand, there are only a few who do not advertise unethical institutions, and questionable proprietary medicines. As a matter of fact some of the most widely advertised patent medicines of today were formerly advertised as ethical proprietaries in medical periodicals, the great majority of which are still serving as a sort of preparatory school for advertisements that will presently appear in the lay press.
“What shall be offered in defense of the medical publication which continues to publish the advertising matter of hundreds of proprietaries which the Council on Pharmacy and Chemistry of the American Medical Association has shown to be either generally worthless or an out and out fake?
“Can the medical editor plead ignorance? Hardly. To do so would be to admit utter incapacity. There is only one inference to be drawn; the publication needs the money and is not overparticular regarding its source.
“There is a remedy, however, a remedy absolutely certain in its results. If every physician in the United States for a period of three months would positively refuse to receive at his desk a medical journal containing questionable advertising, this blotch on medical journalism could be erased.
“It is true that many of them would sink, never to rise again, but the profession would be better off without those whose existence depends upon ‘phoney’ advertising. There are, unfortunately, several American journals whose reading pages are well and carefully edited and a credit to medical literature, whose advertising pages carry such undesirable matter that the educated physician can only feel a sense of disgust.
“Such journals could very well succeed on the quality of their reading matter and undoubtedly would increase their circulation enough to more than offset the loss in advertising.”—(From The Journal A. M. A., May 29, 1915.)
THE COMPARATIVE NUTRIENT VALUE OF COD LIVER OIL AND COD LIVER OIL CORDIALS [AS]
John Phillips Street, M.S.
Chemist, Connecticut Agricultural Experiment Station
NEW HAVEN, CONN.
For a long time cod liver oil has been recognized as an easily assimilable nutrient and reconstructive and of special value in wasting diseases. The unpalatability of the oil, however, has led to various devices to make it tasteless or to render it more acceptable to the stomach. Emulsions containing the oil in mixture with other substances were exploited, and doubtless served a useful purpose. The oil, however, but imperfectly concealed, was still disagreeable to many, and other preparations began to appear on the market, which claimed to retain the therapeutic virtues of cod liver oil without its disagreeable characteristics. This practice has been carried so far that now we find for sale cod liver oil preparations from which the oil has been removed in its entirety, and only the name remains. Certain of these products claim to “represent” the oil and to retain all its virtues; others are said to contain oil, while still others claim “all the valuable constituents” of the oil without the oil itself.
In the past, cod liver oil has been considered a food rather than a medicine, and its value attributed to the easily digestible and metabolizable oil it contains. This position, however, has been disputed. By some its therapeutic value has been attributed to the small amount of iodin present in the oil, but in recent years the suggestion has been made that its special potency depends on its peculiar fatty acids. In this connection the U. S. Dispensatory[145] says:
“Other oleaginous substances, certainly not less nutritious, have not been equally efficient, though taken in much larger quantities. If this be the true explanation, persons living chiefly on milk, which abounds in oil, or on fat pork, ought to show a special exemption from scrofulous complaints. The probability appears to us to be that, in consequence of some peculiar principle or principles it contains, it exercises a stimulant and alterative influence on the processes of assimilation and nutrition, thereby aiding in the production of healthy tissue.”
Indeed, Osborne and Mendel[146] have shown in their experiments on albino rats that by substituting cod liver oil for a portion of the lard in their standard diets, growth was resumed after failure on foods containing commercial lard alone as the source of fat. Similar results were secured with butter-fat and egg yolk fat.
In the light of the theories advanced for the therapeutic value of cod liver oil, and the results secured by Osborne and Mendel with the oil itself; it seemed a profitable study to examine some of the prominent “oilless” preparations on the market to determine whether or not the claims made for them as nutrients were justified. Certain of the so-called cod liver oil preparations are termed “extracts” of cod liver oil, and are not made from the oil, but from the cod livers instead. As has been well said,[147] “They are preparations, which, if honestly made, might be worthy of trial, but they are improperly called ‘extracts’ of cod liver oil, since they do not contain the fat, which is the active constituent of the oil, but the extractives from the liver, which may or may not possess therapeutic virtues. So far as we know, however, no satisfactory evidence is forthcoming to indicate that such extractives have any therapeutic value.”
It was with preparations of this class that our experiments were made. Four of the more extensively advertised brands were selected, as they represent rather distinct types of this class of products, as the following claims of their label will show:
Hagee’s Cordial of the Extract of Cod Liver Oil, Compound.—“Tonic, stimulant, alterative, reconstructive, nutritive and digestive.” “Each fluid ounce represents the extract obtainable from 1⁄3 fluid ounce of cod liver oil (the fatty portion being eliminated), 6 grs. calcium hypophosphite, 3 grs. sodium hypophosphite, 1⁄2 gr. salicylic acid (made from oil wintergreen), with glycerin and aromatics.”
Vinol.—“The modern tonic reconstructor containing the medicinal extractives of fresh cod livers with peptonate of iron.” “When the blood is poor, when more fresh blood is needed, when the weak need strength, when the throat and lungs are affected, TAKE VINOL.”
Wampole’s Perfected and Tasteless Preparation of an Extract of Cod Liver.—“Contains a solution of an extractive obtainable from fresh cod livers, the oily or fatty portion being afterward eliminated. This extractive is combined with liquid extract of malt, fluid extract of wild cherry and compound syrup of hypophosphites (containing calcium, sodium, potassium, iron, manganese, quinine and strychnine).”
Waterbury’s Compound, Plain.—“Made from cod liver oil, digestive ferments, malt extract unfermented, hypophosphites comp. special, ext. cherry, eucalyptus, aromatics, etc.”
Thus we have represented in our experiments an “extract” with hypophosphites, one with peptonate of iron, one with malt extract and hypophosphites and the alkaloids quinin and strychnin, and one with malt extract and hypophosphites without alkaloids.
In order to prepare a dry ration of suitable keeping properties, it was necessary to remove the alcohol and water from the various preparations. This was done by evaporation under reduced pressure at from 40 to 55 C. (104 to 131 F.). In the case of Hagee’s Cordial it was claimed that one fluidounce of the preparation represented 1⁄3 fluidounce of cod liver oil, and in the subsequent substitution for cod liver oil in our rations, this ratio was used for all four products.... These are very dissimilar preparations, the alcohol ranging from 7.50 to 18.69 per cent., the extract from 8.72 to 39.53 per cent. (10.81 of the 13.18 gm. of extract in Hagee’s Cordial being glycerin), the ash from 0.305 to 1.967 per cent., the reducing sugars from 1.35 to 17.10 per cent., and the glycerin from a trace to 10.81 per cent. Wampole’s contained quinin and strychnin, the others no alkaloids; salicylates were present in all but Wampole’s; saccharin in Hagee’s. The Pettenkoffer test for biliary acids gave a negative result in Hagee’s and Wampole’s; in Vinol and Waterbury’s, small amounts of fatty acids were obtained, amounting to 0.016 and 0.032 gm. per hundred c.c., respectively, quite insignificant amounts.
The feeding experiments were made on albino rats of both sexes, which were placed, when about 6 weeks old, on a standard ration, No. 7, and after several months, when a failure to maintain weight was indicated,[148] an amount of dealcoholized cordial extract equivalent to 18 per cent. of cod liver oil was substituted for a portion of the lard, the cordial extract later being replaced by an equivalent amount of cod liver oil.
*******
SUMMARY
Table 11 gives a summary of the actual gains of the fifteen rats on the four rations, compared with the gains shown by cod liver oil and those shown by normal rats at the same period of their life history.
TABLE 11.—SUMMARY OF RESULTS*
| Rations | Total Normal Gain, Gm. | Total Actual Gain, Gm. | Average Normal Gain, Gm. | Average Actual Gain, Gm. | |||
| Hagee ration | 24 | -36 | .2 | 6 | -9 | .1 | |
| Cod liver oil ration | 114 | 156 | .4 | 28 | .5 | 39 | .1 |
| Vinol ration | 42 | -1 | .5 | 10 | .5 | -0 | .4 |
| Cod liver oil ration | 42 | 87 | .5 | 10 | .5 | 21 | .9 |
| Wampole ration | 83 | 51 | .4 | 20 | .8 | 12 | .9 |
| Cod liver oil ration | 62 | 81 | .5 | 15 | .5 | 20 | .4 |
| Waterbury ration | 32 | 0 | .3 | 10 | .7 | 0 | .1 |
| Cod liver oil ration | 42 | 87 | .4 | 14 | 29 | .1 | |
| * In this table are given the totals and averages of the figures alreadypresented in Tables [4], [6], 8 and 10. | |||||||
In considering the effect of these preparations as general medicines, their alcohol content must not be overlooked. Hagee’s Cordial contains 7.50 per cent. of alcohol by volume, Vinol 18.60 per cent., Wampole’s Preparation 16.59 per cent., and Waterbury’s Compound 11.25 per cent. Full strength whisky contains 50 per cent. of alcohol by volume. By following the doses prescribed by the manufacturers of these preparations, the user would consume daily the following equivalents of full strength whisky:
| In Hagee’s Cordial | 0.24 | fluidounce |
| In Vinol | 0.8 | fluidounce |
| In Wampole’s Preparation | 0.7 | fluidounce |
| In Waterbury’s Compound | 0.6 | fluidounce |
These amounts of alcohol are by no means negligible and doubtless explain to a considerable extent the source of the alleged tonic virtues of these preparations.
The results of the experiments may be summarized as follows:
Hagee’s Cordial failed to sustain rats during periods of seven and fourteen days, the rats showing a loss in weight of 36.2 gm., instead of the normal gain of 24 gm.
Vinol in two cases sustained and in two cases failed to sustain growth during periods of from eleven to thirty-five days, the net loss in weight of the four rats being 1.5 gm., instead of the normal gain of 42 gm.
Wampole’s Preparation in three Cases sustained and in one case promoted growth in rats during periods of eighteen and thirty-nine days, showing, however, only 51.4 gm. gain in weight instead of the normal 83 gm.
Waterbury’s Compound in two cases sustained and in one case failed to sustain rats during periods of fourteen and thirty days, the net gain in weight, however, being but 0.3 gm. instead of the normal 32 gm.
Cod liver oil showed a gain of 42.4 gm. over the normal, while with the same rats Hagee’s Cordial showed a loss of 60.2 gm. Cod liver oil showed a gain of 45.5 gm. over the normal, while with the same rats Vinol showed a net loss of 43.5 gm. Cod liver oil showed a gain of 19.5 gm. over the normal, while with the same rats Wampole’s Preparation showed a loss of 31.6 gm. Cod liver oil showed a gain of 45.4 gm. over the normal, while with the same rats Waterbury’s Compound showed a net loss of 31.7 gm.
Not only did cod liver oil show a marked superiority as a source of nutriment over Hagee’s Cordial, Vinol, Wampole’s Preparation and Waterbury’s Compound, but it also showed a remarkable reconstructive and recuperative power in its ability to enable rats to gain weight rapidly and steadily after having suffered from a deficiency in nutriment when fed the four preparations named above.—(Abbreviated from The Journal A. M. A., Feb. 20, 1915.)