PERTUSSIN
Dr. L. A. Roberts, Dorchester, Mass., writes: “Please tell me what the composition of Pertussin is.”
Pertussin is a proprietary whooping-cough remedy manufactured by the Kommandantan Apotheke, Berlin. A “physician’s sample” bottle of this preparation sent out by Lehn & Fink bears a label on which appears the following:
| “100 parts Pertussin contains: | |
| 1⁄2 | Ol. Thymi, et Thymol |
| 211⁄2 | Ext. Thymi ‘Taeschner’ |
| 50 | Saccharum |
| 2 | Glycerinum |
| 61⁄4 | Alcohol |
| 193⁄4 | Aqua Destillata” |
While it never has had much vogue in this country it has been and still is used in Germany. It belongs to that class of vegetable preparations which, since they contain no distinctive principle, are difficult to analyze—particularly as concerns the “joker” in the formula, in this case “Ol. Thymi, et Thymol” and “Ext. Thymi ‘Taeschner’”—hence there has been much dispute in Germany as to the composition of this nostrum. In general, it appears that whatever virtues it has are due to some preparation of common thyme in a menstruum containing water, sugar and alcohol. At one time the preparation was found to contain potassium bromid; but tests recently made in the A. M. A. Chemical Laboratory indicated the absence of either bromids or iodids.—(From The Journal A. M. A., March 8, 1913.)
PHENALGIN—A TYPICAL EXAMPLE[AN]
Last June[112] we devoted considerable space to the extravagant therapeutic claims made for “Phenalgin” by its venders. At this time we propose to refer to the misinformation—to use a conservative term—that the Etna Chemical Company has promulgated regarding the composition of their preparation.
In June, 1905, the Council on Pharmacy and Chemistry officially published to the medical profession of the United States the information that repeated examinations showed that “Phenalgin” is a simple mixture of acetanilid and sodium bicarbonate or ammonium carbonate. So far as we know, no direct denial of the truth of this has been made. There has appeared what we presume is meant as an answer; it is couched in this sentence,
Phenalgin is just what we have always said it to be.
From this expression—which has been repeated in bold, black letters in practically all the advertisements since last June—we presume that we are to understand that in the past they have stated what it is.
It would have been just as easy and more satisfactory if the Phenalgin people, instead of saying: “Phenalgin is just what we have always said it to be,” had said what it is, since the average physician has neither the time nor the inclination to look up their literature.
For the benefit of those who desire to know what the venders of Phenalgin “have said it to be,” we have gone over their advertising literature of the past, with the following results, which are in the form of quotations from their advertisements:
An American Coal-Tar Product—Phenalgin—the only synthetic stimulant, non-toxic, antipyretic, analgesic and hypnotic.
Phenalgin is the ONLY ammoniated Synthetic Coal-Tar Product made from Chemically Pure Materials [What have the Ammonol people to say to this?—Ed.]
A synthetic Coal-Tar Product of the Amido-Benzine series, containing Nascent Ammonia.
These two chemicals [“stimulant ammonia of coal-tar origin” and “chemically pure phenylacetamid”] combine under certain conditions so as to obtain a produce which he [Dr. Cyrus Edson] named Phenalgin or Ammoniated Phenylacetamide.
Phenalgin is a compound of peculiar character which can not be extemporaneously made into tablets from the powdered drug, without seriously changing and impairing its medicinal qualities.
We believe these quotations are sufficient to show what the Etna Chemical Company has “always said it to be.” In going over the literature for several years past we find the above stated in the same, or similar, words in nearly all of it. From the above four statements may be deduced: 1. They have stated that Phenalgin is a synthetic[113] preparation; 2, they have conveyed the impression that Phenalgin is a chemical compound; 3, they have announced repeatedly that it is the “only” preparation of the kind, and 4, they have claimed that Phenalgin is non-toxic.
We believe that these four statements represent in plain English what the above quotations mean. They are all absolutely false. Phenalgin is not synthetic; it is not a chemical compound; it is not the only ammoniated phenylacetamide, or the only acetanilid mixture containing carbonate of ammonium—and it is most positively toxic.
In one place it is stated that Dr. Cyrus Edson
Employed his great facilities for chemical research and opportunities for chemical experiment for the purpose of producing a formula for a combination of stimulant ammonia of coal-tar origin (sic) and chemically pure phenylacetamide, also a coal-tar product ... which he named phenalgin, or ammoniated phenylacetamide.
In another place we read that Phenalgin is made
Under the immediate personal supervision of the original inventor of ammoniated coal-tar products.
By comparing this last quotation—which is from a current—1905—advertisement—with the preceding one it will be noticed that we are asked to believe that Phenalgin is made “under the immediate supervision of” Dr. Cyrus Edson—and yet Dr. Cyrus Edson died Dec. 2, 1903. This is equal to Lydia Pinkham’s prescribing for the suffering women of America when the dear old soul had been dead for over twenty years.
We have before us a full-page advertisement taken from a recent number of a weekly medical journal, which possibly is meant as an answer to the announcement of the Council on Pharmacy and Chemistry that Phenalgin is a simple acetanilid mixture. The advertisement is divided into two parts; the first part is as follows:
Facts About Acetanilidum (Ancient History)
It has long been recognized that Acetanilidum and most other coal-tar products are apt to exert a depressing influence upon the heart, but there has never been any doubt about its great value as a pain reliever and temperature reducer. Its therapeutic value has, however, been practically nullified by the danger of cyanosis and other evils caused by its well-known depressant action and the difficulty of obtaining it in a pure state. It being known that certain deleterious substances are often to be found in Commercial Acetanilidum and that much of the injurious effect attributed to this drug is entirely traceable to these impurities.[114]
The above are also falsehoods. The therapeutic value of acetanilid is not “practically nullified ... by the difficulty of obtaining it in a pure state.” Neither is it true that “much of the injurious effect attributed to this drug is entirely traceable to these impurities.” While deleterious substances may be found in commercial acetanilid, they are not found in the substance offered as medicinally pure acetanilid by reputable firms. Pure medicinal acetanilid is a cheap article, costing less than 30 cents a pound, for it is a substance that is easily and cheaply purified. It is a fact that the injurious effects are in the acetanilid itself and not in the impurities it may occasionally contain.
The second half of the advertisement in part is as follows:
Facts About Phenalgin (Modern Science)
More than a decade ago the late Dr. Cyrus Edson, then Health Commissioner for New York City and New York State, recognizing the value of chemically pure Acetanilidum as a therapeutic agent, if it could be deprived of its depressant quality, employed his great facilities for chemical research and opportunities for chemical experiment for the purpose of producing a formula for a combination of Stimulant Ammonia of coal-tar origin and chemically pure Phenylacetamide, also a coal-tar product. These two chemicals combine under certain conditions so as to obtain a product which he named Phenalgin or Ammoniated Phenylacetamide.
There is more of the same character. In the first place, we call attention to the fact that “Phenylacetamide” is substituted for “Acetanilidum” when it is to go into Phenalgin. To mystify is one of the “tricks of the trade.” Few physicians keep up with chemical terms and, therefore, are not supposed to know that Phenylacetamide is one of the chemical names for Acetanilid.
The reference here to Dr. Cyrus Edson brings up another fact, and that is that the Etna Chemical Company tries to convey the idea that Dr. Edson was the originator of Phenalgin. We have always understood that Dr. Cyrus Edson had something to do with pushing Ammonol and, if we remember rightly, got into some trouble thereby. We do not know the exact facts, but the following letter shows that he had a leaning toward another “ammoniated phenylacetamid.” The letter is dated “New York, Oct. 6, 1894,” and is addressed to the “Ammonol Chemical Company.”
“During the past six or eight months I have used Ammonol extensively in my private practice. I have found it excellent in the treatment of neuralgias and for rheumatism. I have also verified your statement in two cases that were suffering from alcoholism. My experience justifies me in saying that it is the safest and best of the analgesic coal-tar derivatives.
“Very truly yours,
Cyrus Edson, M.D.”
It may be of interest to know that the principal member of the firm of the Etna Chemical Company was at one time a member of the Ammonol Company, and it is usually understood, we believe, that Phenalgin is practically the same as Ammonol—in fact, the analyses published regarding the two preparations show this to be a fact.
We must make one more quotation:
It makes little difference to a physician whether Phenalgin is a mixture or a compound or a synthetic, with a name that would destroy the orthographic balance of the universe, provided it is just what he has always found it to be.
Very complimentary to the intelligence and common sense of physicians, is it not?
Suppose some fellow should get up a scheme to exploit a mixture of quinin and some cheap, harmless substance, say, starch—equal parts of each. Suppose he gives it a fanciful name, puts it on the market at a high price, say $1.25 an ounce, and announces it as a new synthetic with wonderful therapeutic qualities. Suppose that the schemer then adopts the nostrum vender’s methods of fooling physicians into using his product by getting some to give testimonials, others to furnish write-ups, and then subsidizes medical journals through liberal advertising to print both the testimonials and the write-ups. The preparation would, of course, prove to be a good thing if it were used in liberal quantities where quinin would ordinarily be used, and some patients using it would get well even if quinin were not indicated. Then with the psychologic effect of the testimonials, the write-ups, and good, strong claims rightly pushed, unthinking physicians would do the rest. And then, after a while, when the schemer had gotten to the point where, each year, he was making a fortune out of his preparation, suppose some “self-appointed chemists” should examine into the preparation and discover that it was nothing but quinin and starch, and so announce to the doctors of the country; what would the doctors say? That it makes little difference “provided it is just what he has always found it to be!”
This analogy is not far-fetched, for it is practically what has been done with Phenalgin. One difference is that since quinin costs as much per ounce as acetanilid does per pound, the profits on the acetanilid mixture would be sixteen times greater than that of our imaginary preparation. Another difference is that acetanilid is really a dangerous drug, unless used with care, both in its immediate and in its remote effects; quinin is far less so.
“Little difference” indeed, whether we are being buncoed or not! Evidently!
In conclusion, we charge the Etna Chemical Company with intentionally misleading and deceiving the members of the medical profession, in that the said company has in its literature and its advertisements conveyed the impression (whether directly stated or not): First, that its preparation, Phenalgin, is a synthetic compound; second, that Phenalgin requires special skill in its preparation; third, that Phenalgin has therapeutic values which it does not possess; and, fourth, that Phenalgin is non-toxic.
We also charge that on account of these and other misrepresentations, this company has inveigled physicians into prescribing and using a simple mechanical mixture of common well-known cheap drugs—for which an extravagantly high price is charged—under the supposition that this combination of cheap drugs is a chemical compound of special and peculiar merit as a therapeutic agent, and, therefore, worthy of their confidence.
Our object in again giving space to this preparation—and practically all we have said applies to the other acetanilid mixtures that are exploited under fictitious names or as chemical compounds (such as ammonol, antikamnia and salacetin or sal-codeia—Bell)—is to impress on physicians, by a typical example, the shamefulness of the deceptions practiced on them by nostrum manufacturers to the great injury of the public and of the medical profession.
A Pharmaceutical Secret Which Should Not Be Lost
Dr. Gregory Costigan, New York City, writes under date of January 21, as follows:
“I have been carefully reading and enthusiastically approving your articles on the nostrum evil, and have been impressed more than usual on the existence of quack advertising in medical journals as set forth in last paragraph and quotation on page 206, bottom of first column, of your issue of Jan. 20, 1906.
“In Merck’s Archives, page 11, we are told in an advertisement on ‘Phenalgin’ that it ‘is a compound of peculiar character which cannot be extemporaneously made from powdered drug’ and ‘our process of manufacturing tablets is coincident with the manufacture of Phenalgin and is the result of a long series of careful experiments by which we are able to produce tablets of Phenalgin in a friable condition without losing any of its volatile constituents or undergoing chemical changes from heat or moisture’! Inasmuch as Phenalgin tablets are not covered with a waterproof coating I think this is a remarkable statement to make, and the manufacturing of a drug coincident with the manufacture of a tablet must be a very remarkable performance, especially because it ‘retains the full therapeutic value of the drug unimpaired’ while the advertisement asserts that no other manufacturer is cognizant of this wonderful method. This ad. is for the perusal of physicians only. The Etna Chemical Company owes it to the medical and pharmaceutical world not to let this secret die with the company’s dissolution. It owes it as a duty to the coming generations of science immediately to jot down the full data of this wonderful performance, to put it away in an age-proof safe and not allow it to be lost to humanity as were a great many other arts that were well known to the ancients. Let them keep it secret now and profit by it, but do not let it be lost to posterity.”—(From The Journal A. M. A., Jan. 13, 1906, and Jan. 29, 1906.)
An Ethical (?) Proprietary Exploited Under Fraudulent and Lying Claims
“PHENALGIN IS JUST WHAT WE HAVE ALWAYS
SAID IT TO BE.”
—Etna Chemical Co. in 1905.
| “Phenalgin is a synthetic coal-tar product.” —Etna Chem. Co. in 1898. | “Unlike the coal-tar synthetic, phenalgin is a stimulant rather than a depressant.” —Etna Chem. Co. in 1910. | ||
| TEMPUS OMNIA REVELAT! | |||
“Phenalgin is a synthetic coal-tar product”—thus ran the advertisements some years ago, when the medical profession was willing to take—or was compelled to take—the word of the manufacturer of proprietary remedies at its face value. Then the Council on Pharmacy and Chemistry was brought into existence. One of the first pieces of work done by the Council was the publication of the results of a number of analyses of headache powders. Phenalgin was among them. Analysis showed that Phenalgin was not a synthetic but a simple mixture of the following ingredients in the proportions given:
| Acetanilid | 57 parts |
| Sodium bicarbonate | 29 parts |
| Ammonium carbonate | 10 parts |
The Etna Chemical Company, which puts out this product, was considerably disturbed by the Council’s exposure. It “came back” at the American Medical Association with the slogan “Phenalgin is just what we have always said it to be.” What, up to that time, the Etna Chemical Company had “always said” Phenalgin to be, was:
1.—Phenalgin is a synthetic.
2.—Phenalgin is the only preparation of the kind.
3.—Phenalgin is non-toxic.
These, in brief, were the three things that Phenalgin had been asserted to be. Each statement has been proved to be a definite and unequivocal falsehood. Phenalgin is not and never was a “synthetic.” Phenalgin is not and never was the only acetanilid mixture containing carbonate of ammonium. Phenalgin is not and never was in any sense of the word non-toxic. Phenalgin, in short, possesses the properties—both good and bad—that are common to acetanilid. It is a mixture that the merest tyro in pharmacy could dispense and for which any sophomore medical student could write a prescription without stopping to think. Acetanilid sells at 8 cents an ounce wholesale; Phenalgin at $1.00 an ounce, wholesale.
All these facts and many more were given to the profession by the Council on Pharmacy and Chemistry in The Journal more than six years ago—before even the Food and Drugs Act came into effect. After that law became operative, the Etna Chemical Company was compelled to say something on the label that it had never said before, namely, that Phenalgin contained 50 per cent. acetanilid. But the law not only required them to add a fact to their label, but it also compelled them to remove a falsehood. When the pure food law went into effect, Phenalgin was labeled a “malaria germicide.” It is not a malaria germicide and never was a malaria germicide, and the Etna Chemical Company dared not risk taking the question into court so it removed the statement.
Unfortunately the Food and Drugs Act exercises no control over the lying statements that may be made for drugs elsewhere than on the label. So it is that physicians within the last two or three weeks have received a booklet on Phenalgin containing the following assertions for this acetanilid mixture:
“Without the slightest harm, injury or depressing effect.”
“Is never followed by depression.”
“Its prolonged administration does not give rise to destructive blood metamorphosis.”
“Is of great value in the treatment of neuralgia (especially in the anemic.)”
“Freedom from the deleterious action or habit-forming tendencies of the opiates.”
“It aids in destroying the malarial parasite.”
“Safest and most dependable of analgesics.”
It will be seen by this that while the Food and Drugs Act has forced a certain degree of truthfulness on the Phenalgin labels, the advertising matter is as fraudulent and as untruthful as ever it was. It is true that the assertion that it is a synthetic is no longer made, possibly because the medical profession has been so thoroughly enlightened on the much-overworked “synthetic” fraud that the falsehood is no longer profitable. In other respects, the assertions are just as false as ever. It is said to have no depressing effect—and yet it is acetanilid. It is said to produce no habit—and yet it is acetanilid. It is said to have no injurious effect on the blood—and yet it is acetanilid. It is said to be the safest analgesic—and yet it is acetanilid. How long will the medical profession continue to be hoodwinked by means of such transparent falsehoods?
The Phenalgin concern takes much credit to itself because on the cartons in which the bottles of Phenalgin come, it is stated that the product is “for dispensing purposes only.” Yet, as a matter of fact, practically any layman can go to any drug store and obtain this product, for the druggist appraises this spectacular piece of Pecksniffian virtue at its face value—a joke. Why, if intended only for physicians, would it be necessary to include with every bottle a circular naming the diseases, for which this acetanilid mixture is supposed to be good—“headache,” “colds,” “lumbago,” “scanty menstruation,” “pain in any part of the body”—and why is the name of the product and of the firm making it blown into the bottle?
To sum up then, Phenalgin is as big a humbug as Peruna ever was. It is sold to-day under claims that are just as false as those used six years ago. The Etna Chemical Company is perpetrating a stupendous fraud on the medical profession to-day and it is doing it not only through the agency of the United States mail, but with the aid and support of the following medical journals—and others—in which the Phenalgin advertisement appears:
| Medical Record | American Journal of Obstetrics |
| New York Medical Journal | Medical Century |
| Pediatrics | Pacific Medical Journal |
| Lancet-Clinic | Dietetic and Hygienic Gazette |
| American Journal of Surgery | Medical Standard |
| International Journal of Surgery | Eclectic Medical Journal |
| American Medicine | Am. Jour. of Clinical Medicine |
It is conceivable that in some cases it is not easy for those editors and publishers of medical journals who insist on relying on their own judgment to satisfy themselves that certain preparations are not worthy of being advertised. No such difficulty occurs in the case of Phenalgin. Here the issues are clear cut. The product is exploited under claims that are both false and vicious and their falsity and viciousness are perfectly evident to any freshman medical student. The only charitable explanation of the appearance of the Phenalgin advertisements in the medical journals listed is that the editors and publishers have not given the subject the attention it deserves and to which their readers are entitled. Perhaps it would help if their attention were called to the matter by their subscribers.—(From The Journal A. M. A., Jan. 27, 1912.)