SOMNOS
Report of the Council on Pharmacy and Chemistry
To the Council on Pharmacy and Chemistry of the American Medical Association:—Your subcommittee, to whom was assigned Somnos, H. K. Mulford Company, submits the following report of experiments, undertaken to compare the effects of Somnos with those of chloral hydrate. These experiments demonstrate that the statements made in regard to the action of Somnos are in conflict with Rule 6 of the Council, which requires: “No article will be admitted or retained concerning which the manufacturer or his agents make unwarranted, exaggerated or misleading statements as to the therapeutic value.” It is, therefore, recommended that Somnos be not approved for inclusion in the book until the claims made for it are corrected. It is also recommended that the report be published:
The Pharmacology of Somnos
When these experiments were begun, April, 1906, there was nothing in the advertising literature on Somnos to indicate whether this article is a solution or a pure substance. On the label on the bottle, in the circular accompanying the bottle, and in the booklet “Somnos,” the word Somnos seemed to be used as a synonym of “Chorethanal alcoholate,” C9H11O5Cl9, and physicians were prescribing and pharmacists dispensing it in the belief that it was a pure substance. “The pure substance; some kind of an alcohol; nothing to do with choral,” was the way the druggist from whom the samples were purchased put it. Thus information absolutely indispensable for any rational comparison of Somnos with other hypnotics was withheld from the physician.[86]
Hence, before beginning the physiologic experiments it was necessary to determine the strength of the preparation; for this purpose three chlorin determinations (by the Carius method) were made. On the assumption that all the chlorin present was in combination as chloral glycerate, C3H5[CCl3.C(OH)2]3 = C9H11O6Cl9, and calculating the percentage of this in Somnos, the following results were obtained: (1) 5.11 per cent.; (2) 5.15 per cent.; (3) 5.10 per cent.
Somnos, therefore, was found to contain approximately 5 per cent. of chloral glycerate and its physiologic action was compared with that of a 5 per cent. solution of hydrated chloral. In some experiments the hydrated chloral was dissolved in water; in others, in 10 per cent. alcohol (Somnos was found to contain at this time about this percentage of alcohol); in other experiments glycerin was added, as Somnos was found to contain this substance. No very marked differences were found in the physiologic action of the three solutions.
FATAL DOSE OF SOMNOS FOR THE LOWER ANIMALS
The booklet on Somnos states that “Somnos has no toxicology”; that while chloral hydrate causes “acute poisoning,” “deep coma,” etc., Somnos is “harmless in twenty times the dose prescribed,” “coma unknown, etc.” The physician would scarcely suspect from such statements that Somnos is as poisonous a substance as solutions containing hydrated chloral in corresponding amount; that such is the case is shown by the following experiments. These experiments were necessarily made on the lower animals. While such results do not enable us to draw very definite conclusions as to the absolute toxicity of poison for man, the results on animals are conclusive as regards the relative toxicity for man of such closely related drugs as hydrated chloral and Somnos.[87]
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CONCLUSIONS
To sum up our results on the physiologic action of Somnos: We have been completely unable to verify the claims of the manufacturers that Somnos is less toxic than hydrated chloral, or that it has a less depressing effect on temperature, respiration or circulation. On the contrary, the physiologic effects are indistinguishable from those of hydrated chloral, doubtless because the action of Somnos is simply the action of hydrated chloral. We can see nothing in the animal experiments or in the chemical composition which would suggest that Somnos would possess therapeutic advantages over an elixir of hydrated chloral of corresponding strength.[88]
It is to be hoped that physicians who have been blindly using Somnos without even knowing the strength of the preparation, much less what it is, will compare its effects with those of a 5 per cent. elixir of hydrated chloral.[88]—(Abbreviated from The Journal A. M. A., Sept. 15, 1906.)