DOWD’S PHOSPHATOMETER

Dowd’s Phosphatometer, according to its inventor, is a device “for taking the phosphatic index or pulse of the nervous system.” Its originator, J. Henry Dowd, M.D., Buffalo, N. Y., writes en­thu­si­as­tic­ally of his instrument:

“Physicians who use the Phosphatometer are sending 50 per cent. less patients away for consultation, getting 75 per cent. better results at home, because the Phosphatometer tells the cause and what to do, and the Comp. Phosphorus Tonic gives results in 80 per cent. of all conditions of illness.”

The “Comp. Phosphorus Tonic” referred to in the above quotation is a sideline of Dr. Dowd’s, put out by the Richardson Company, of Buffalo. The stationery of the Richardson Company gives its address as 334 Franklin Street, but directs that all communications be addressed to 40 North Pearl Street, which is the private address of J. Henry Dowd. According to the Buffalo directories, 334 Franklin Street is the drug store of Arthur E. Reimann.

To those who read the Dowd “literature,” the Phosphatometer will appear to be either one of the wonders of the age or an unscientific absurdity. To the thinking man it will be the latter. It pretends to determine the amount of phosphates in the system. This is accomplished—​alleged—​by taking the second urine passed in the morning and mixing a portion of it in the instrument with a solution which is the well-known magnesia mixture. The height to which the crystals settle in ten minutes determines, according to Dowd, the amount of phosphates! Was ever a test devised that violated more of the first principles of quantitative chemical analysis? If so, we never heard of it. Dowd’s system does not require any determination of the amount of urine passed in twenty-four hours or even of the amount passed at the second micturition in the morning.

If a patient whose urine was being “tested” by the Dowd method, should drink two cups of coffee for breakfast instead of one, his urine might be so dilute that the phosphates would fall below the “normal” mark. Dowd says that his Phosphatometer “takes the pulse of the nervous system.” What about the patient who eats several eggs or consumes a sweetbread or other nuclein-containing articles of diet? The increased amount of phosphates in such a diet might easily lead to an apparent excess in the urine. Every physician, nay, every sophomore medical student, knows that the amount and kind of food ingested governs almost entirely the amount of phosphates excreted in the urine.

What actually does “Dowd’s Phosphatometer,” when used according to instructions, show? It shows the presence of phosphates in the urine; it permits a guess—​with not the slightest claim to accuracy—​as to the amount in the specimen tested; it gives no possible clue to the normal or abnormal relation of the phosphates in the urine or as to whether the source of the crystals precipitated is the nerve tissue or the food. Yet here are some of the claims made for it:

“The Phosphatometer shows nervous metabolism the same as the ureometer shows muscular; the former errs in about 3 per cent.; the latter in 40 per cent.”

“The Phosphatometer shows the amount of nerve food being used and present in the nerve cells.”

“Over 50 per cent. of pain and human suffering is due to the nerves crying for food; the Phosphatometer will show the true cause in ten minutes.”

“The Index not only tells the present condition, but foretells the future, thus preventing serious complications which might arise.”

“The Phosphatometer measures the amount of phosphorus in the system.”

“The Dowd Phosphatometer not only takes blood-pressure, it tells how to regulate it.”

“The Phosphatometer measures the amount of phosphorus in the nerve cells; it is as positive in nerve troubles as the x-ray in fractures.”

These claims are essentially false. As a matter of fact, a simple examination of the urine for phosphates cannot tell us the condition of the nervous system. This must be evident from the fact that only a portion of the phosphates is excreted in the urine, a very considerable part passing out with the feces. Further, the bulk of the phosphorus excreted comes from the food and only a small portion from the waste of the nervous system. The amount excreted by the urine which comes from torn-down nerve tissue is so small that it is practically impossible to estimate variations in it even by the most careful analytic methods.

In brief, Dowd’s “scientific method” is nothing more than unscientific humbug.​—(From The Journal A. M. A., Dec. 20, 1913.)

AMORPHOUS PHOSPHORUS[AV]

A Practically Inert Substance Introduced as a Valuable Therapeutic Agent

Amorphous phosphorus is a chemical anomaly contrasting markedly with ordinary phosphorus in its physical, chemical and pharmacologic properties. Ordinary phosphorus is soluble in certain solvents, such as oil; amorphous phosphorus is insoluble. Ordinary phosphorus is poisonous; amorphous phosphorus is not poisonous. Ordinary phosphorus has been regarded as of some therapeutic value; amorphous phosphorus, because of its insolubility and other physical properties, has never been so regarded. Pharmacologists, therefore, have paid very little attention to it. Some of them do not even mention it, though there are a few accounts of experimental work.

Noé,[156] in experiments on the action of phosphorus with yeast, found that yeast acted on ordinary phosphorus, producing PH3 (hydrogen phosphid), but on amorphous phosphorus it had no action. His experiments show that amorphous phosphorus was not toxic to animals.

Thornton[157] quotes Reese as publishing a report of a case in which 30 grains of amorphous phosphorus were taken by a young woman with suicidal intent, but no toxic symptoms were manifested. Thornton found it non-toxic to animals.

Witthaus and Becker (Medical Jurisprudence, Forensic Medicine and Toxicology, iv, 635) say: “The form of phosphorus is practically non-poisonous, probably by reason of its insolubility. It has been administered to dogs to the extent of 200 gm. (nearly half a pound) in twelve days without causing poisoning.”

C. D. F. Phillips (Materia Medica, Pharmacology and Therapeutics, Inorganic Substances, Ed. 3, p. 46) makes the following statement: “Amorphous phosphorus has been, by some observers, credited with physiologic activity. Thus, Bednar used it for a long period in small doses, and observed symptoms of excitation, trembling and clonic convulsions; but as much as 1 ounce has been given to dogs without perceptible effect. Thompson, in twelve carefully observed cases, found its action nil, and plausibly attributes its supposed powers to a slight admixture of ordinary phosphorus (Pharm. Jour., 1875). I believe it is practically inert.”

HOW INTRODUCED

The foregoing represents our scientific knowledge as to the action of amorphous phosphorus. Now, however, comes Dr. I. L. Nascher and introduces amorphous phosphorus as a remedy of remarkable value for the arterio­scler­osis of old age. The method of introduction is somewhat peculiar. The treatment seems first to have been brought to notice through a printed slip sent to medical journals generally. This slip consisted of an extract from Nascher’s book on old age, which at the time had not been published! Nascher also published an article on this subject in an obscure journal, the American Practitioner, for December, 1913. Neither the matter copied from his book nor the article referred to contain a single scientific fact that would warrant the claims made for it as a therapeutic agent. No record is given of animal experiments, and the clinical evidence presented certainly cannot be regarded as scientific.

As already stated, this form of phosphorus has not been previously used and has been regarded as without effect on the human system because of its insolubility in any of the liquids of the body. Nascher himself has not been able to find any new way to dissolve it. He says: “I made a number of experiments to find a solvent. The only substance which appears to dissolve it is serum, but I am still uncertain whether it is a solution or a very fine suspension. The phosphorus is precipitated in a few days, but the serum remains tinged.” The fact that it separates from the serum on standing is quite conclusive evidence that it is insoluble in that liquid. Since no way of making it soluble has been discovered, there is no reason for expecting it to have any effect on the system. An insoluble and non-absorbable substance can produce no general systemic effect; if, when ingested, it produces any effect whatever, this effect must be local and will be shown by symptoms of gastro-intestinal disturbance. Nascher, however, took 15 grains, and no symptoms of gastro-intestinal disturbance followed. Hence, we must conclude that it is without effect on the gastro-intestinal mucous membrane. While Nascher records no experiments on animals which is much to be regretted, he did experiment on himself and says:

“Ten grains produced a frontal headache, restlessness, excessive mental stimulation, ideas arising with such vividness as to appear as actual occurrences. There was a sense of weight or oppression in the stomach and priapism, the latter probably psychic, as I was looking for such a result. These symptoms passed away in a few hours.”

Without doubt his explanations of the priapism can be applied to the whole experience; whatever symptoms there were, they were unquestionably psychic. The consideration of these subjective symptoms may be dismissed, since it is reasonable to assume that an insoluble, unabsorbable substance which produces no disturbance of the gastro-intestinal tract will have no effect on the rest of the organism.

Amorphous phosphorus did not produce such symptoms as Nascher relates in experiments similar to his made by us. The drug was taken in 10-grain doses by six different individuals. In no case did the symptoms described by Nascher follow; in fact, there were no symptoms whatever.

NASCHER’S THEORY

Nascher, after relating his subjective experiences and those of his patients, proceeds to build a theory to account for the unproved action of amorphous phosphorus in disease, especially in arterio­scler­osis. It would have been more appropriate if before advancing the theory, he had made some experiments to prove that the substance has some action. But we give his theory as found in the quotation from his book, sent to medical journals, as already referred to. Here it is:

“Amorphous Phosphorus in Senile Arteriosclerosis: The author has used the red amorphous phosphorus in senile arterio­scler­osis for several years. Given originally as a substitute for ordinary phosphorus in senile debility, it was found that it was eliminated as amorphous phosphate of lime and that the lime elimination was thereby increased. Weil’s experiments showed that the lime elimination in arterio­scler­osis was diminished. Phosphorus has the property of combining with lime and increasing the lime assimilation. In the small doses which can be given when the ordinary phosphorus is employed, the phosphorus will combine with the lime of the food and increase the amount of lime salts in the body. When given as amorphous phosphorus, the dose is 2 grains or more several times a day, and with a lime-free diet the lime required for the combination necessary to secure the elimination of the phosphorus excess is drawn from the abnormal lime deposits. This appears to be the rationale of the treatment and explains the good results obtained from its use. From ‘Diseases of Old Age,’ by I. L. Nascher, M.D., to be published shortly.”

Thus, according to Nascher, the phosphorus, after being oxidized to phosphoric acid, catches the calcium and drags it out of the system! What are the facts? The human body contains a large store of phosphates which are excreted in the urine in combination with sodium and potassium—​and yet these do not draw the calcium from the blood, brain and bones! To be blunt, Nascher’s theory is absurd. The calcium in its various deposits in the body is already combined with phosphoric acid. Why should the phosphorus introduced take calcium from the phosphate radical with which it is already in combination? Nascher asserts that the phosphorus which is introduced as amorphous phosphorus is excreted as amorphous phosphate of lime within twenty-four hours. How does he know it is? It is, of course, very appropriate that amorphous phosphorus should form the amorphous phosphate of lime, but, unfortunately, phosphates made from the ordinary phosphorus also are precipitated in the amorphous condition. By what private mark does Dr. Nascher identify the amorphous phosphate produced by his amorphous phosphorus? Is it not a fact that he found the urine alkaline and detected a precipitate of amorphous calcium phosphate—​always present in alkaline urine—​and concluded that this must be his particular amorphous phosphorus in combination with calcium?

Dr. Nascher makes no record of examinations of the feces, although a great part—​sometimes the greater part—​of ingested phosphorus is found in the feces in experimental work on phosphorus metabolism. If he had examined the feces he would doubtless have found the total quantity of amorphous phosphorus unchanged.

Nascher refers to several cases in which he has used this remedy and states that he had the most gratifying results. So far as we can learn, the benefit was entirely in the subjective symptoms of the patient. It seems evident, therefore, that his claims for the value of this remedy rest on no better foundation than an unproved theory without experimental basis.

ITS COMMERCIALIZATION

Thus far we have considered only the scientific aspects of amorphous phosphorus therapy. It is unfortunate that we cannot stop here. Some of our readers will have seen in recent medical journals half-page advertisements of amorphous phosphorus reading:

The striking physical and chemical properties possessed by common phosphorus, together with the fact that phosphorus is one of the constituents of nerve-tissue, are probably responsible for the reputation which this element acquired generations ago as a remedy for sexual impotence and mental decay. Among scientific men this reputation was a fleeting one, for, when put to the test, the product failed. Like so many products with a similar history, the unearned reputation it obtained from medical men survived in the minds of the laity, and, as is always the case, the survival has been taken advantage of by quacks. Among charlatans and nostrum makers phosphorus is still in vogue. “Weak men’s specialists” and venders of “lost manhood” and alleged aphrodisiac drugs “play up” the phosphorus fallacy for all it is worth.

It is worth noting that the present exploitation of amorphous phosphorus is following along somewhat similar lines. The asserted actions of amorphous phosphorus are such as may be calculated to appeal to the sexual neurasthenic. There is no doubt that the Sharp & Dohme advertisements will bring about an extensive use of this remedy, especially by the uncritical. The psychic element—​which plays so large a part in the sexual neurasthenic—​will result in favorable reports being given on the drug. Articles may be expected to appear in a certain class of medical journals, telling of the marvelous results that Dr. John Doe has had in the use of “Pill Phosphorus Amorphous S. & D.” A luxuriant crop of testimonials may be expected to follow, and the tout ensemble will go far to sustain the Sharp & Dohme propaganda.

Reproduction—reduced—of half-page ad­ver­tise­ment ap­pear­ing in medi­cal jour­nals.

We are prompted to believe that Messrs. Sharp & Dohme do not fully realize the potentialities for harm that lie in their present exploitation of amorphous phosphorus. It hardly seems possible that a firm of standing would knowingly put on the market and advertise a worthless drug with an appeal to susceptible, infirm old men. The function of introducing new remedies to the medical profession is a responsible one, and a firm that assumes it should have among its officers some one sufficiently conversant with pharmacologic science to prevent such unscientific absurdities as that exhibited in the marketing of amorphous phosphorus, especially under such claims as those contained in the advertisements.​—(From The Journal A. M. A., March 7, 1914.)

Dr. Nascher’s Reply to The Journal’s Article—Comments

To the Editor:—Regarding the article on Amorphous Phosphorus in the March 7 issue of The Journal of the American Medical Association, I want first of all to clear myself of the implied charge of commercialism in connection with the marketing of the Pill Phosphorus Amorphous by Sharpe & Dohme. I have never had anything to do with the manufacture or sale of those pills, never had any business dealings with Sharpe & Dohme and I have no commercial interest whatsoever in either this or any other drug or drug house. I knew nothing about the advertisement which you reproduced until I saw it in the medical journals. I immediately protested against this unwarranted use of my name and was assured that the statement “Made under the direction of Doctor I. L. Nascher, New York,” was not made for the purpose of misleading and that the ad. would be immediately withdrawn. I gave my approval to the pills made by this firm as I would give my approval to the pills made by any other reliable house for I claim the right to endorse any drug or preparation which I believe to be of value whether it is approved by the Council of [on] Pharmacy and Chemistry or not.

In your general charge of commercialism you make it appear that the exploitation of amorphous phosphorus had the ulterior purpose of appealing to the sexual neurasthenic along the lines of the “lost manhood” ads. So far as this relates to Sharpe & Dohme, I have no interest, but you have included me in your general denunciation. The only reference I ever made to aphrodisiac effects of Amorphous Phosphorus, in all my writings, is contained in these words in the four-page article in the American Practitioner, “In a few cases aphrodisiac effects were noticed.” I have never recommended amorphous phosphorus as an aphrodisiac and in the chapters on “Impotence and Neurasthenia” in my book on “Diseases of Old Age,” I have not mentioned amorphous phosphorus at all.

You say “the treatment seems first to have been brought to notice through a printed slip sent to medical journals generally.” This slip containing an extract from my book which was then in press was sent out about four months ago while I have referred to amorphous phosphorus repeatedly in medical articles during the past three years. In my paper on Senile Debility, Medical Record, Jan. 21, 1911, I said amorphous phosphorus had no effect, as I was then looking for the usual effects of the ordinary phosphorus. In a paper on Senile Mentality, International Clinics, Vol. 4, 21st series, I said I was using amorphous phosphorus but had not yet determined its value. I recommended it in several of my papers, articles and lectures in 1912 and 1913 after I had found that under its use in some cases of senile arterio­scler­osis, symptoms were relieved. I sent these slips to the medical journals as a general reply to many inquiries I received about amorphous phosphorus and I stated this in the letters I sent with the slips to some editors. Further inquiries for more information led me to write the paper which appeared in the December issue of that “obscure journal” the American Practitioner. I felt that a medical journal which carried articles by Sir James Barr, ex-president of the British Medical Association, Sir R. W. Philip, R. Murray Leslie, Halliday Sutherland, and such American authorities as Adami, Hare, Brooks, Hirschberg, Knopf, Starkey, Ely, Bissell, Wilcox, Col. Maus, U. S. A., etc., was a representative high class journal and I was pleased to have my paper in it.

To take up the scientific criticism of amorphous phosphorus, permit me to say at the outset that I am a general practitioner, specially interested in geriatrics, and more concerned about obtaining favorable clinical results in my cases than in solving laboratory problems. Nevertheless I have tried for years to obtain the cooperation of expert laboratory workers to help me determine the properties, chemical, physical and physiological, of amorphous phosphorus. In 1909 or 1910 the Rockefeller Institute, in reply to my request for permission to experiment there with amorphous phosphorus, said it did not accept volunteer workers. Four heads of college laboratories could not spare the time. I asked the Council on Pharmacy and Chemistry last November to take up its investigation and was informed that it could not do so at present. I have been perforce compelled to depend mainly on empirical methods with such little experimentation as the facilities of the physician’s office permitted and such little literature as I could find.

You reject empirical methods as being unscientific notwithstanding the fact that most of our therapeutic knowledge is based on empiricism. (I use the terms empirical and empiricism here in the sense of knowledge obtained from experience and observation, not in the bad sense in which they might be construed.) It would therefore be folly on my part to argue with you that I have obtained beneficial results from amorphous phosphorus in many cases of senile arterio­scler­osis. I did not obtain such results from a single dose, but gave it in some cases for many weeks or months. It is unfair to judge of the value of a drug from a single dose or several doses unless it is a drug which is expected to show immediate effects. It would be greater folly on my part to pit my knowledge of pharmacy and chemistry against the knowledge of your staff of experts. I can but repeat what I have said on many occasions that under the persistent use of amorphous phosphorus in cases of senile arterio­scler­osis symptoms were frequently relieved. I never claimed that amorphous phosphorus will cure arterio­scler­osis. In the chapter on Arteriosclerosis in my book I say: “Senile arterio­scler­osis being a natural, normal condition, is incurable in the sense that it can be neither prevented nor removed. The best that we can hope for is to retard its progress and relieve disagreeable symptoms, etc.”

You say in reference to the elimination of the amorphous phosphorus as amorphous phosphate of calcium, “Is it not a fact that he (I) found the urine alkaline and detected a precipitate of amorphous calcium phosphate—​always present in alkaline urine—​and concluded that this must be his particular amorphous phosphorus in combination with calcium?” No. The specimens of urine were examined in reliable laboratories and I have reports showing acid and neutral urine as well as alkaline urine having the amorphous phosphate precipitate. Nor is the amorphous phosphate “always present in alkaline urine.”

As for the theory I advanced, it is simply a theory based on reasoning without facts to prove it. If I had facts to prove it, it would no longer be a theory or open for discussion. Being a theory, it is the province of the wise man to ridicule it and call it absurd. I will confess that your criticism of it is not clear to me and I still do not see its absurdity. I don’t see what relation your argument, that the phosphates of sodium and potassium do not draw the calcium from the blood, brains and bones, has to the theory I advanced. It is true that I have no private mark by which I can identify the amorphous phosphate produced by amorphous phosphorus, but such argument is puerile. When medical science has so far progressed that the physician will be able to put his tag on the molecule of drug substance and follow it through the various metabolic processes to its final elimination we will not need any Council on Pharmacy and Chemistry to decry what it cannot understand. Let me say here that scientific criticism does not stoop to ridicule for ridicule is usually based on animus or bias.

The conclusive proof of the value of a drug is not its action on the healthy dog, frog or guinea-pig but its action on the individual patient, and no amount of animal experimentation can dispose of the personal factor which is so marked in senile cases. This is no criticism of animal experimentation as a whole but of the insistence on animal experimentation to determine the value of a drug in a class of cases for which the healthy animal can furnish no comparison.

You say amorphous phosphorus is practically inert and quote Noé, Witthaus and Becker, Thornton and Phillips. The quotations of the first three are little more than statements that amorphous phosphorus is non-toxic. Phillips makes two references, one of which is to Badner who obtained decided effects from its prolonged use. Thornton, whom you quote in your contention that amorphous phosphorus is inert, says that on prolonged use in doses of 3⁄10 grains every two hours it produced headache, vertigo, mental excitement, priapism, etc. (See footnote under Phosphorus, U. S. Dispensatory). Shoemaker’s Materia Medica and Therapeutics says it is toxic and is called the servant-girl’s poison. Phillips suggested that Badner probably used an impure drug. I suggested that Thornton probably used an impure drug. On the other hand, Badner and Thornton obtained positive results from prolonged use, not from the single dose.

You say it has not been used on account of its insolubility in any of the liquids of the body. Roscoe and Schorlemmer, quoting Neuman, said if injected into the blood the usual symptoms of phosphorus poisoning appear. In a letter from Dr. Hatcher he says Nassé injected 0.2 gm. of the purest amorphous phosphorus into a rabbit’s vein and the animal presented the usual symptoms of phosphorus poisoning. There are also references to amorphous phosphorus action in Kobert’s Lehrbuch der Intoxicationen, in Blythe’s Poisons, etc.

You say of your four quotations, “the foregoing represents our scientific knowledge as to the action of amorphous phosphorus.” Did you not know of these other authorities, or are their statements unscientific, or were they omitted because they disprove your contention that amorphous phosphorus is practically inert?

Your denunciation of ordinary phosphorus has no bearing on the subject as I do not recommend the amorphous phosphorus as a substitute for the other.

I have worked for eight years to arouse medical and public interest in the aged and their ailments and I cannot afford charges of commercialism, foisting worthless drugs as aphrodisiacs or other unethical conduct to stand against me. As for the charge of unscientific work, I can only point to my work on Diseases of Old Age, and my medical papers, and express the hope that others better equipped for laboratory research will take up the laboratory investigation of amorphous phosphorus. I have faith in its therapeutic value and believe competent clinical observers will have favorable results from it in suitable cases.

I. L. Nascher, M.D., New York.

Comment.—Accompanying the preceding letter was a note from Dr. Nascher in which he says: “I want this published in full without elision or change. If you do not intend to publish it as written, I want it returned and enclose postage.” The letter therefore is given in full in spite of the fact that much of it is irrelevant to the question discussed.

Dr. Nascher’s protest to Sharpe and Dohme against the “unwarranted use” of his name in connection with “Pill Phosphorus Amorphous, S & D” seems to have resulted in various modifications of the phrases connecting his name with the exploitation of this pill. What was apparently the original advertisement, contained the phrase:

“Made under the direction of Dr. I. L. Nascher, New York.”

Later advertisements, while identical in all other respects with the first, had this phrase modified to read:

“Made at the suggestion of Dr. I. L. Nascher, New York.”

Still other advertisements, also identical with the first in other respects, are modified to read:

“Made with the approval of Dr. I. L. Nascher, New York.”

That Dr. Nascher was directly or indirectly connected with the commercializing of this product, The Journal has never suggested, inferentially or otherwise. That the exploitation of amorphous phosphorus by Sharpe and Dohme is one that appeals to the sexual neurasthenic, no one who has read the advertisements can deny. As a matter of fact, it would be difficult to sell phosphorus in any form as a medicament, without appealing to the sexual neurasthenic. The word “phosphorus” has become, in the minds of both laymen and physicians, more or less synonymous with the treatment of so-called sexual weakness and it is a practical impossibility to divorce the word from the idea suggested. How true this is, Dr. Nascher himself unwittingly admits when he tells that the result of his first experiment on himself with amorphous phosphorus was a priapism that he acknowledges was “probably psychic, as I was looking for such a result.” But the Sharpe and Dohme advertisements plainly state that the amorphous phosphorus pill they are marketing is a “new and successful method of treatment for ... functional and senile impotence....”

Dr. Nascher’s explanation of how he came to send out the slip regarding amorphous phosphorus to medical journals leaves him the victim of an unfortunate coincidence. It is at least unusual for authors to send out advance extracts from books that are about to be published, especially when such extracts deal wholly with a drug that is coincidently being introduced as a new proprietary product by some enterprising pharmaceutical house.

Dr. Nascher takes exception to our statement that the treatment seems first to have been brought to notice through the printed slip sent to medical journals, and states that he has “referred to amorphous phosphorus repeatedly in medical articles appearing during the last three years.” His articles for 1912 and 1913 have been examined for the purpose of learning when the treatment as now presented to the profession was first announced. In his article “Errors in the Treatment of Senile Cases,” New York Medical Journal, Oct. 12, 1912, he speaks of the iodids in senile arterio­scler­osis, but says nothing about amorphous phosphorus. It may be assumed, therefore, that the treatment had not been brought to general notice at that time. The new treatment is very briefly described in the New York Medical Journal, July 13, 1913, in an article whose title, “Longevity and Rejuvenescence” gave no indication that it dealt with amorphous phosphorus. Under the circumstances, it is not strange that its therapeutic value was not learned of until Dr. Nascher’s printed slips were sent out.

Dr. Nascher admits that his theory is based on empirical methods. Most of the serious errors in therapeutics have had their origin in this very method. It was on just such methods that physicians reported wonderful results in the use of alleged “lithia waters” that actually contained less lithium than ordinary river water! So unscientific is the empirical method that it is hardly worth taking the space to demonstrate its imperfections.

Neither is it worth while to discuss the question of a constant occurrence of a sediment of amorphous calcium phosphate in alkaline urine. If there are exceptions to this rule, they must be rare indeed.

In The Journal’s article authors were quoted to show that amorphous phosphorus is regarded as inert. It was not suggested that the authorities referred to were all that could be found. Dr. Nascher refers to Thornton, Shoemaker, Neuman, Blythe and Kobert, and asks whether the various statements on the subject, made by these men, are unscientific or were “omitted because they disproved” the contention that amorphous phosphorus is practically inert. Thornton’s article was omitted because it is unscientific in that he does not report experiments made by himself, but refers to an unpublished paper by one Kelly. Who Kelly is, or was, he does not tell us. Kelly’s report, therefore, should be and was disregarded, since it is the work of an unknown author and there is nothing in the article to indicate that Thornton was in any position to vouch for Kelly’s work. Incidentally, it may be said that Kelly’s report merely recorded subjective symptoms; Dr. Nascher himself indicates his distrust of Kelly’s alleged results by suggesting that an impure preparation was used!

Shoemaker’s report was not given, for a similar reason. Shoemaker says:

“Amorphous phosphorus is almost completely destitute of taste or odor, has no immediate caustic effect, and is claimed to be less toxic than white phosphorus; but in the form of matches [Italics ours.—​Ed.] has caused many deaths and is known as the ‘servant girls’ poison.’”

It is well known that commercial amorphous phosphorus is usually impure, and it is more than probable that if toxic effects were produced by the ingestion of match-heads, these matches were made either of white phosphorus or of very impure red phosphorus. In any case, Shoemaker’s statement has no bearing whatever on the pharmacologic action of pure amorphous phosphorus.

The statement of Neuman quoted from Roscoe and Schorlemmer, as well as that of Nassé, referred to by Hatcher, had no bearing on the question at issue, as these men injected the material into the blood-stream. If, when the amorphous phosphorus is injected into the blood, it produces the ordinary symptoms of phosphorus poisoning, one would naturally expect the same symptoms when the substance is given by mouth—​if amorphous phosphorus were soluble or absorbable. The fact that such symptoms are not produced when amorphous phosphorus is taken into the alimentary canal, sustains the views held by chemists, pharmacologists and physicians, that the drug is practically insoluble and unabsorbable—​in other words, inert.

Dr. Nascher declares that he “never claimed that amorphous phosphorus will cure arterio­scler­osis.” Yet he insists that amorphous phosphorus removes lime from the “abnormal lime deposits” that occur in arterio­scler­osis. What is this but claiming curative action?

Summed up, Dr. Nascher’s own admissions amply confirm the main contentions of The Journal’s article. He admits that he has no experimental basis for the use of this remedy; he admits that his theory “is simply a theory without facts to prove it.” The only conclusions that can be reached from his reply coincide closely with the very statement made by The Journal, and which we here reiterate:

“It seems evident, therefore, that his claims for the value of this remedy rest on no better foundation than an unproved theory without experimental basis.”​—(From The Journal A. M. A., March 28, 1914.)