SANATOGEN: A SCIENTIFIC INVESTIGATION OF ITS ALLEGED ACTION ON THE RECUPERATING POWERS OF THE BLOOD
Sanatogen, the new elixir of life compounded of casein and glycerophosphates, has been noticed in The Journal from time to time. It will be remembered that, while it has been claimed that “Sanatogen contains over 700 per cent. more tissue-building, life sustaining nourishment than wheat flour,” the facts are that one dollar’s worth of wheat flour contains as much energy as one hundred and ninety-seven dollars’ worth of Sanatogen! To this the manufacturers rejoin, in effect, that the casein and glycerophosphates in Sanatogen, being in chemical combination, possess a mystical and esoteric virtue not measurable in terms of the food-value of the several ingredients. The fact is, of course, that even assuming, for the sake of argument, that the ingredients of Sanatogen are in chemical combination, the compound cannot have any effect on the organism different from that of the uncombined casein and glycerophosphate, for the union must be of the loosest kind and must be broken up as soon as the preparation enters the digestive tract.
Testimonials are published in the Sanatogen “literature” which show results in a variety of conditions; cerebral concussion, alcoholic gastritis, anemia, etc. The patient is given a chance to recover with rest, proper diet—and Sanatogen. And the recovery which ensues is attributed to Sanatogen!
Not all of these testimonials are as naive as that of the Right Reverend the Bishop of Bath and Wells, who contributes the following bit of second-hand testimony:
“You may like to hear that I am informed by my private secretary that a member of his family has derived very remarkable benefit from using Sanatogen.”
Above is a photographic reproduction of one of the exhibits made at Atlantic City at the last annual meeting of the American Medical Association.
Jar 1 contains 31⁄3 ounces of the casein-glycerophosphate combination made abroad and sold under the name “Sanatogen;” it costs One Dollar.
Jar 2 contains 2 pounds 131⁄2 ounces of a casein-glycerophosphate combination made by an American casein company; it costs One Dollar. For the same money, then, one gets nearly 15 times as much of this casein-glycerophosphate combination made in America as when the casein-glycerophosphate combination is sold under the name “Sanatogen” and manufactured abroad.
Jar 3 contains one dollar’s worth of pure casein. The casein entirely fills the jar, although the weight of the material is the same as the weight of the casein-glycerophosphate combination in Jar 2. Pure casein is more bulky than the casein-glycerophosphate combination.
Again we would emphasize that the chief objection to Sanatogen is not its high price, but the fraudulent claims under which it is sold.
The following selections perhaps fairly represent the value to science of the clinical evidence offered. Describing a case of vomiting from cerebral concussion:
“I ordered an ice-bag to the head, a mustard leaf to the epigastrium, absolute recumbency in bed and small feeds of Sanatogen with water. This diet was continued for three days, but the vomiting ceased the second day.”
And here a case of “hungry tired nerves”:
“I have just had a recovery in a remarkable case which scores a victory for Sanatogen. The patient, a man 63, had been treated for some years past for heart trouble. When he came to me, however, I diagnosed his trouble as ‘hungry tired nerves.’ I put him on Sanatogen and eupeptics. In a month he was much improved.”
In a serious case of the “American disease”:
“I tried Sanatogen on a woman suffering from extreme neurasthenia and debility. For the past six weeks I have had, and still have, her under rest-cure treatment, during which time I have given her Sanatogen. I have been very much elated with the treatment.”
Anemia in a girl of 23 working in a bookbindery:
“I promptly decided to use Sanatogen. In addition, I was able to secure the girl’s absence from work so that she had the advantage of outdoor life and sunshine. Improvement was rapid.... Both a priori and from results obtained it seems almost justifiable to speak of Sanatogen as a specific in ordinary uncomplicated anemia.”
Note that in all these cases two or more remedial factors were introduced, yet any favorable result is promptly ascribed to only one factor, Sanatogen! And the factor of spontaneous improvement irrespective of all remedial measures is also ignored.
A “SCIENTIFIC” TESTIMONIAL
Every physician knows that the kind of evidence just quoted has the same scientific value as that of the average “patent medicine” testimonial—none whatever. The exploiters of Sanatogen put forward some testimony, however, that purports to have a certain authority. This is a statement to the effect that “Sanatogen acts as a strong stimulus as far as the recuperative powers of the blood are concerned.”
This claim is based on biologic experiments carried out by two physicians, Drs. G. Mann and J. G. Gage, the record of whose work was published in the Lancet, Oct. 19, 1912. The article of Mann and Gage was gone over with some care and the experiments there described did not seem to justify the conclusions reached by the authors. As it had been published in the Lancet, a medical journal of standing, whose publishers apparently thought it of sufficient importance to warrant the expense of a colored plate insert, it seemed worth while to have the work of Mann and Gage reviewed and its conclusions checked by parallel experiments. A. J. Carlson, professor of physiology at the University of Chicago, was asked to do this work and kindly undertook it. His report follows:
Report of Professor Carlson
I am asked to review the work done by Drs. G. Mann and J. G. Gage, from which they draw the following conclusions:
“Sanatogen [sodium caseinogenate glycerophosphates] further stimulates blood cells to undergo nuclear division, which during the early period is mostly amitotic.... Therefore, it is evident that Sanatogen acts as a strong stimulus as far as the recuperative powers of the blood are concerned.”
Three series of experiments were made and reported by Drs. Mann and Gage, comparing the histology of the blood in starvation and during the height of digestion. The experiments of the first series were made on six students, the starvation period being thirty-six hours, ordinary food being taken after the thirty-six hours’ fast, so far as can be gathered from Dr. Mann’s report. It was found that during the height of digestion the nuclei of the lymphocytes and leukocytes stain more deeply, and that there is a slight decrease in the cytoplasm and consequent diminution in the size and number of the granules of the neutrophil and the eosinophil cells, in comparison with the blood during fasting.
The experiments of the second series were made on 100 frogs that had starved for months, blood-films being taken at varying periods after feeding 1 gm. Sanatogen. The changes noted in the white blood-cells of the frogs were practically identical with those described in the case of the six students. Increased cell division is stated to occur. The nuclei of the erythrocytes stain more deeply and the cells are increased in size, and exhibit increased cell division twenty-four hours after the feeding.
The third series consisted of one experiment on Dr. Mann himself. He fasted twenty hours and then took 15 gm. of Sanatogen in a cup of water. Practically the only change noted in the blood after the feeding was a deeper staining of the nuclei of the white cells. To quote:
“The changes in the granules of the polymorphonuclear leukocytes and in the eosinophils were much less marked than in the specimens supplied by the students, and the diminution in the size of the white cells was so insignificant as to be hardly noticeable.”
Assuming that the blood-changes reported are correct, is the conclusion warranted that Sanatogen is a powerful recuperative stimulant to the blood?
In the first place, it remains to be proved, for there is as yet positively no evidence, that the deeper staining of the nuclei during digestion and absorption of a protein meal represents “recuperative power of the blood” or processes of “feeding” on the part of the white cells. The actual significance of these changes requires further investigation. The increased division of the blood-cells described by Dr. Mann in the frogs was not observed by him in man. This phenomenon in the frogs is, in all probability, associated with the extraordinary length of the starvation period (months) and the well-known seasonal variations in the physiology of this species.
In the second place, waiving for the moment the question of the significance of the blood-changes observed, the evidence, so far as it goes, points to the conclusion that the greater affinity of the nuclei of the white cells for the stain is brought about by the feeding of any protein food. The experiments do not demonstrate any different or more marked effect from Sanatogen than from other protein foods.
The test on the six students with ordinary food can be considered as a control on the single Sanatogen test on Dr. Mann himself. The blood-changes in the students were more marked than in Dr. Mann.
Although Mann and Gage say that six frogs were used as controls, they do not say how the controls were treated, or draw any comparisons between the controls and the frogs fed with Sanatogen. So far as the report goes, therefore, the only basis for comparison is afforded by the work of one of Dr. Mann’s pupils, H. G. Butterfield. This worker, as quoted by Mann, found that on feeding newts after two weeks’ starvation with a worm the size of a wooden match, the nuclei of all tissues (excepting nerve cells) take a much deeper stain than in the control animals. To pronounce Sanatogen, on the basis of the facts reported, a “powerful stimulus” to blood-formation is a piece of special pleading, if not of downright disingenuousness. Considered on its own merits, the work would not have appeared to me worthy of being repeated for the purpose of checking up such obviously unwarranted conclusions. In order to comply with the request made of me, however, I have repeated Dr. Mann’s experiments:
EXPERIMENTS BY PROFESSOR CARLSON
I. TESTS ON MAN (A. J. C.)
1. Thirty-six hours’ fast followed by a meal of 25 gm. Sanatogen in water.
2. Thirty-six hours’ fast followed by a meal of 25 gm. casein in water.
3. Thirty-six hours’ fast followed by a meal of 200 c.c. of milk.
II. TESTS ON RATS
1. Four animals, seventy-two hours’ fast followed by a meal of Sanatogen in water.
2. Two animals, seventy-two hours’ fast followed by a meal of crackers and milk.
3. Two animals, seventy-two hours’ fast followed by a meal of casein in water.
4. Two animals, seventy-two hours’ fast followed by a meal of casein and sodium glycerophosphate in water.
Blood-films were taken at intervals during the fasting period and for twenty-four hours after feeding was resumed. The technic of fixing and staining given by Drs. Mann and Gage was followed in every detail in order to make my results comparable with their findings.
RESULTS
My results may be summarized as follows:
1. The only change in the blood-cells that could be detected with certainty in rats or in man, after feeding with Sanatogen or after feeding with other foods, was a deeper staining of the nuclei of the white cells in the films taken after feeding as compared with the films taken during fasting. This difference is generally distinct, and unmistakable, although individual cells can always be found in the fasting and the feeding preparations that show no difference in affinity for the dyes. To this extent my results confirm those of Mann and Gage. I was not able, however, to make out any constant difference in the size of the cells, quantity of cytoplasm, or size and number of cytoplasmic granules similar to those reported by Mann and Gage.
2. There was no difference in the affinity for stains on the part of the white blood-cells in films taken after feeding Sanatogen and those taken after feeding milk, crackers, casein, and casein and sodium glycerophosphate. This is true for the tests both on man and on rats.
3. The above-mentioned difference in the staining of the cell nuclei was somewhat more marked in the tests on rats than in the tests on man, probably owing to the longer starvation period in the case of rats.
It has already been stated that the significance of this increased affinity for dyes in the nuclei of the white blood-cells must be determined by further investigation. It may be related to the change in the titration alkalinity of the blood rather than an evidence of “recuperative power” on the part of the blood, as it is well known that starvation induces acidosis, while during digestion the alkalinity of the blood is distinctly increased. If we assume that increased staining reaction during digestion indicates “increased recuperative power of the blood” it follows that such common and inexpensive foods as milk, crackers and casein are just as “powerful stimuli” to this recuperation as Sanatogen.
The extensive researches of Mendel and Osborne have shown that casein is in a certain sense a perfect food in that it is, in normal animals, capable of promoting growth and maintaining nitrogenous equilibrium, at least for long periods of time. The burden of proof, however, rests with the promoters of Sanatogen to show that the casein in Sanatogen is superior to the natural product of the cow.
Conclusion
From the findings in Professor Carlson’s report on this disguised puff of a mendaciously exploited proprietary, about all that remains to be said is that it is humiliating to find such pseudo-science, not only built up by members of a profession trained in science, but also given currency and authority by a medical journal of high standing.—(From the Journal A. M. A., Sept. 26, 1914.)
As to Sanatogen
For several years it has been known by physiologists that all proteins taken into the stomach are disintegrated into their fundamental components, the amino-acids, and that they are not absorbed at all as proteins, except in most minute amounts under exceptional conditions. Therefore, no matter what protein is taken as food, the material obtained from this protein by the body is a group of amino-acids, always pretty much the same except in relative proportions, whatever the food. A few proteins lack certain essential amino-acids, but any ordinary diet supplies enough, and more than enough, of each and every amino-acid. Furthermore, since the proteins are completely disintegrated before absorption, it follows that any adventitious chemical substance that is bound to a protein taken in the food does not enter the blood and circulate in the body in the same protein compound.
All the facts stated above are elementary, and should be known by any and every physician who pretends to keep even approximately abreast of the science of medicine. If there are any who do not know these fundamentals, and from certain unwelcome evidence we fear there are, they must be resigned to being told just where they stand. Certainly they have no good excuse for their lack of information, for the physiologists and biochemists have informed them of modern advances in innumerable ways. For ten years and more these facts have been discussed and demonstrated in societies and in medical publications. And yet—there is Sanatogen, prescribed by Geheimrats, Hofrats and also by doctors, and testimonialed as abundantly by men with medical degrees as Duffy’s whisky is by centenarians. One can merely throw up his hands. If, as the exploiters of Sanatogen declare, the product “has been endorsed by von Noorden, Ewald, Duhrssen, Eulenburg, Neiser, Binswanger, Leyden, Krafft-Ebing, Tillmanns, Tunnicliffe and thousands of other earnest, reputable physicians,” we can only say that their earnestness has not been in the direction of grasping fundamental advances in medical sciences, however great the reputation they have gained may be.
The article by John Phillips Street that follows is another report of exact experimental observation which shows, as was obvious beforehand, that Sanatogen has the properties of its constituents, namely, casein and glycerophosphates. Nothing more nor nothing less could be the case. Bottling dried cottage cheese plus some glycerophosphates, and raising the price many times, may increase its psychic effect, but it will not alter its physiologic action. These facts we have presented often enough, but the amount of paid advertising the proprietors of this compound find it profitable to carry in the United States makes us feel obliged to give them this bit free. That laymen may be persuaded to purchase Sanatogen in the belief that it possesses some occult powers not to be found in its constituents is not surprising. By blatant and persistent advertising, the public can be fooled into buying any product—however valueless—for which medicinal claims are made. But that physicians should prove equally gullible is a sorry commentary on the scientific attainments of the followers of a learned profession.—(Modified from Editorial in The Journal A. M. A., Nov. 21, 1914.)