TRI-IODIDES, THREE CHLORIDES AND MAIZO-LITHIUM
Report of the Council on Pharmacy and Chemistry
As an illustration of unreliability of claims and the unscientific character of proprietary mixtures, the Council has authorized publication of the following reports on Tri-Iodides, Three Chlorides and Maizo-Lithium, products of the Henry Pharmacal Co. (J. F. Ballard, proprietor).
W. A. Puckner, Secretary.
Tri-Iodides (Henry)
Tri-Iodides (Henry Pharmacal Co., St. Louis) is a nostrum whose ingredients apparently were selected at random. Since the effects of such a mixture cannot be predicted, no thoughtful physician would think of prescribing in any one condition all the drugs named in the formula of Tri-Iodides—if he had to write out the prescription. Yet because the misleading name of the preparation gives it the semblance of a therapeutic entity—and because it is advertised in medical journals—a certain number of physicians thoughtlessly prescribe this shotgun mixture.
LABORATORY REPORT
Regarding the composition of “Tri-Iodides” the Association’s Chemical Laboratory makes the following report:
A trade package of Henry’s Tri-Iodides purchased in 1910 bore the following formula on the label:
“Colchicin, 1-20 grain,
“Phytolaccin, 1-10 grain,
“Solanin, 1-3 grain,
“Sodium Salicylate, C. P., 10 grains,
“Iodic Acid (equal to 7⁄32 gr. of Iodine)
in two fluid drachms of Aromatic Cordial.”
In the circular which was wrapped with the bottle the wording of the formula differs somewhat from the foregoing, “iodic acid” of the label being replaced by “hydro-iodic acid.” While the label on the bottle named “phytolaccin” as one of the constituents the label on the carton which contained the bottle gave “decandrin.” The following formula appears on a trade package purchased June, 1914:
“Colchicine, 1-200 Grain,
“Phytolacca, 1 1-5 Grain,
“Mydriatic Alkaloids, 1-500 Grain.
“Sodium Salicylate, 3 1-2 Grain.
“Iodic Acid (equal to 7-125 Grain of Iodine)
in two fluid drachms.”
The differences between the formulas are striking. Colchicin has been reduced from 1⁄20 grain to 1⁄200 grain; sodium salicylate from 10 grains to 31⁄2 grains; iodin (claimed to be present as iodic acid) from 7⁄32 grain to 7⁄125 grain. “Phytolaccin” (“Decandrin”) has been replaced by “Phytolacca” and “Solanin” by “Mydriatic Alkaloids.” While the formula for the preparation has been changed, the circular accompanying the package still refers to “solanin” (in some parts of the circular wrongly spelled “salonin”) and “phytolaccin.” As no principle having the characteristic effects of poke-root is known to have been isolated the terms “decandrin” and “phytolaccin” are meaningless.
The circular states that solanin is an alkaloid obtained from the sprouts of Solanum tuberosum, but wrongly calls this plant “bittersweet” instead of potato. At the market price the amount of solanin claimed, according to the old formula, to be present in a bottle of Tri-Iodides, would cost $1.60, although a bottle of the preparation sold at wholesale for 67 cents.
Tri-Iodides is a dark brown, mobile liquid having a faint clove-like odor and a mawkish, sweet taste. Salicylate was found in considerable amounts. Traces of alkaloids were found, a portion of which appeared to be colchicin. Iodic acid and its salts were absent, although claimed by the formula to be present. Potassium iodid was present. Determinations of the iodin by distillation with ferric ammonium sulphate solution and sulphuric acid indicated the presence of about 1.68 gm. of iodin (equivalent to 2.18 gm. of potassium iodid) in each 100 c.c. of the preparation. This is equivalent to about 7.65 grains of iodin per fluidounce, or more than thirty-four times the amount claimed by the formula on the bottle. An approximate determination of the salicylic acid by extraction of the acidified preparation with ether and evaporation of the solvent indicated about 2.67 gm. in 100 c.c., equivalent to 3.09 gm. of sodium salicylate, or about 14.11 grains per fluidounce. Since the amount of sodium salicylate claimed is 3.5 grains in 2 fluidrams or 14 grains in each fluidounce, the amount found agrees essentially with the claims.
ABSURD CLAIMS
It should be unnecessary, after pointing out the conflict between the name and the published formula, between the formula and the actual composition, and between the composition and all established therapy, to discuss this heterogeneous and unscientific mixture further. A few specimen absurdities, however, may be quoted from the advertising “literature”:
“... Free of the Disagreeable Effects of the Alkaline Iodides.”
[Tri-Iodides, according to the laboratory report, depends for its iodin action on potassium iodid.]
“... we have an assimilable form of vegetable hydriodates.
“The hydriodates of these valuable vegetable alkaloids afford the specific alterative action of iodine without such disagreeable results as the iodism produced by the ordinary iodides.”
[“The hydriodates” is an obsolete term formerly applied to iodids of vegetable alkaloids. Iodids of vegetable alkaloids, if present at all in Tri-Iodides, are present in negligible amounts.]
“Containing Iodine in an available form, it is obvious that the formula must be beneficial in the majority of syphilitic skin lesions.”
The falsity of the first two of these claims and the mischievousness of the last are self-evident.
It would be possible, but is unnecessary, to produce an almost unlimited amount of evidence to show the transparent character of the deception by which this preparation is exploited.
The referee feels that the nostrum will have been sufficiently characterized when he has mentioned further that the name “Henry’s Tri-Iodides” is blown in the glass of the bottle, that the label contains the recommendation “For Gout, Rheumatism and other Diathetic Diseases,” and that the circular accompanying the bottle recommends the use not only of Tri-Iodides, but also of Three Chlorides, Maizo-Lithium, Campho-Phenique and Satyria in the treatment of many diseases.
Three Chlorides (Henry)
Three Chlorides (Henry) is advertised as:
“An oxygen-carrying ferruginous preparation, suitable for prolonged treatment of children, adults and the aged. Indicated in anemia and convalescence from acute diseases and surgical operations.”
The following report on the composition of Three Chlorides is submitted by the Association’s Chemical Laboratory:
LABORATORY REPORT
It is claimed that each fluidram of Henry’s Three Chlorides contains:
“Mercuric Bichlorid | 1-72 Gr. |
“Arsenic Chloride | 1-40 Gr. |
“Proto-Chloride Iron | 2-25 Gr. |
| “... in a cordial of Calisaya Alkaloids.” |
The preparation is a pale yellow, clear solution having an odor of alcohol. The addition of potassium ferricyanid solution does not produce any blue coloration, thus demonstrating the absence of ferrous chlorid (iron protochlorid). Instead potassium ferrocyanid solution produces at once an intense blue precipitate and potassium sulphocyanate solution an intense red coloration, thus proving the presence of iron in the ferric condition. It is obvious that the claimed superiority of Three Chlorides over preparations containing ferric iron is absurd. Since it contains iron in the ferric condition, Three Chlorides decomposes soluble iodids with the liberation of free iodin. The assertion that it is a suitable “vehicle” for the administration of iodids is likely to lead the physician unwittingly to administer free iodin.
As the laboratory report shows, the “formula” of Three Chlorides (Henry) is incorrect, for protochlorid of iron (ferrous chlorid) was absent from the preparation. There is, however, a more serious objection to the formula than the misstatement of fact. When the physician is dealing with conditions that call for mercury, arsenic or iron, it is irrational and unscientific to prescribe a preparation containing these three drugs in fixed proportions.
OBJECTIONABLE ADVERTISING
Three Chlorides is marketed in bottles having the name “Three Chlorides” blown in the glass, in a carton containing a circular extolling the curative powers of this and other proprietaries of the same concern. Thus a physician who prescribes Three Chlorides is likely to place in the hands of his patient the advice that
“Three Chlorides ... is suitable for the prolonged treatment of children ...”
“In tertiary syphilis, with or without potassium iodide, it holds first rank among remedies directed against the specific taint ...”
Further, that “Maizo-Lithium” is:
“A Genito-Urinary Sedative” and a “remarkable uric-acid solvent.”
Also that “Satyria” is:
“An Ideal Genito Tonic and Nerve Reconstituent.”
“Indicated in Prostatic trouble, Cystitis, Urethritis, Gonorrhea, Gleet, Leucorrhea, Sexual Debility and Impotence.”
We are told that
“As a hematinic, the protochloride of iron justifies the confidence of the medical profession.”
“The protochloride, more than any other salt of iron, stimulates the paptic [sic] and hydrochloric glandular system of the stomach, increasing the flow of acid gastric juice.”
It is unnecessary to discuss the truth or falsity of these assertions, since Three Chlorides does not contain the protochlorid of iron. For the same reason, it is obvious that the small amount of iron which it contains is the only possible justification for the claim that the preparation is
“... Non-Productive of ... Constipation or Teeth Discoloration.”
It is hardly necessary to point out that it is a therapeutic exaggeration to claim that Three Chlorides is of particular value in the treatment of tertiary syphilis, that in eczema it is “the most effective remedy,” that in any form of constipation it is “the remedy par excellence,” or that
“After arresting malarial attacks with quinine, the combination of iron, arsenic and mercury with calisaya is an essential requisite.”
“Whenever gastric troubles and digestive disturbances furnish a contra-indication to iron, this contra-indication disappears when the iron is combined with arsenic.”
“The simultaneous exhibition of small doses of arsenic and bichloride of mercury, besides augmenting the effect of iron upon the red blood-cells, completely obviates the tendency to vascular congestion and hemorrhage.”
Finally, the suggestion that by the use of Three Chlorides iodids may be prevented from causing iodism is absurd.
In short, whatever may be the advisability of prescribing iron, arsenic or mercury in any given case, it is irrational to prescribe them in fixed proportions. A physician who is induced by the exaggerated advertising claims to prescribe these drugs in a proprietary mixture, under a non-informative name, does grave injustice to his patients.
Maizo-Lithium
Maizo-Lithium (Henry Pharmacal Co., St. Louis) is one of the many proprietary lithium preparations based on the disproved theory that lithium dissolves uric acid deposits in the body. The label on a trade package states that:
“Maizo-Lithium promptly facilitates the elimination of the uric and phosphatic deposits from the system.”
As might be expected, the promoter of Maizo-Lithium ascribes a long list of ills to “uric and phosphatic deposits,” and argues that, therefore, Maizo-Lithium is the proper treatment:
“In lithemia, hematuria, incipient diabetes, cystitis, urethritis, pyelitis and ALL inflamed conditions requiring a non-irritating diuretic.”
“Inflamed conditions,” naturally, include almost all of the real or imaginary ills of kidney, bladder, etc.
Maizo-Lithium is distinguished from its congeners chiefly by the claim that it contains a mythical or problematical compound, maizenate of lithium.
LABORATORY REPORT
The following report on the composition of Maizo-Lithium has been submitted by the Chemical Laboratory of the American Medical Association:
The promoter of Maizo-Lithium makes the following statement on the label concerning the composition of the preparation:
“Each fluid drachm contains two grains maizenate of lithium.”
The following is also found in a circular which is enclosed with the trade package of Maizo-Lithium:
“Maizo-Lithium, the remarkable uric acid solvent, is a nascent chemic union of maizenic acid, obtained from green corn silk, with the alkaline base lithium forming maizenate lithium, of which the mother liquid carries two grains to each drachm.”
Standard works on organic chemistry and pharmacology, such as Beilstein’s Organische Chemie and Cushny’s Pharmacology and Therapeutics, do not mention maizenic acid. Neither is it mentioned in comprehensive bibliographies of phyto-chemical investigations, such as Huseman-Hilger’s Die Pflanzenstoffe or Wehmer’s Die Pflanzenstoffe. The first to use the term appears to have been a Dr. Vautier (Arch. méd. belg.), but his publication is not available to the laboratory. Rademacher and Fischer (Amer. Jour. Pharm., 1886, lviii, 369) claim to have isolated the substance from green corn-silk, but the record of their work is unsatisfactory and indefinite and therefore their results could not be verified; it seems unlikely, however, that they isolated a pure proximate principle.
Examination of Maizo-Lithium demonstrated the absence of bromids, chlorids, phosphates, sulphates, acetates, benzoates, salicylates and tartrates—combinations in which lithium might be expected to be present. The presence of a citrate, however, was shown by the usual tests. Lithium and sodium were present. Free acid was absent. Determination of lithium citrate and of sodium citrate indicated the presence of a total of about 3.7 gm. of these two salts in each 100 c.c. of the preparation, or about 2.1 grains in each fluidram. About 25 per cent. of the total salts appeared to be lithium citrate. The examination, therefore, does not demonstrate the presence of “maizenate of lithium,” but does show that Maizo-Lithium contains a mixture of lithium citrate and sodium citrate. Tests for citric acid and citrates were made on a commercial specimen of fluidextract of corn-silk. The results were negative, although the preparation had an acid reaction to litmus. The presence of maizenate of lithium in Maizo-Lithium—in fact, its actual existence—thus failed of demonstration. In view of this fact, it was felt that the burden of proof rested on the promoter of Maizo-Lithium to supply some satisfactory evidence with regard to this substance. The following letter was therefore, sent to James F. Ballard:
“According to the label on a recently purchased bottle of Maizo-Lithium, each fluidram of this preparation contains 2 grains of ‘maizenate of lithium.’ From an examination made in this laboratory we are inclined to conclude that this statement is not in accordance with the facts. A search of chemical and pharmaceutical publications does not reveal that such a compound as ‘maizenate of lithium’ has ever been isolated and described, and we are very much inclined to question its existence. We should be pleased to receive from you any evidence which you may care to send in substantiation of your claim in regard to the content of ‘maizenate of lithium’ in Maizo-Lithium—particularly a specimen of ‘maizenate of lithium’ or the method by which it is produced.”
While this letter was sent Oct. 13, 1914, no evidence has been submitted up to date (January, 1915) to substantiate the asserted presence of maizenate of lithium in Maizo-Lithium.
The report just given shows that the manufacturer has found it expedient to surround his worthless nostrum with a cloak of mystery. A discussion of the jumble of uncritical claims, baseless assertions and evident falsehoods presented in favor of Maizo-Lithium would seem a waste of time when the secrecy of this nostrum is all-sufficient for its condemnation.
[Editorial Note.—When the Council on Pharmacy and Chemistry was started we announced that we did not see any clear line of demarcation between “patent medicines” and many so-called “ethical proprietaries.” Time has not caused us to change our opinion. As we have already shown, and as we shall have occasion to show in the future, not a few of the “ethical proprietaries” offered to physicians are being advertised by those who are pushing the rankest of “patent medicines.” The three preparations mentioned above are sold—and presumably manufactured—by Mr. Ballard, of St. Louis. Mr. Ballard is the promoter of Ballard’s Snow Liniment, Brown’s Iron Bitters, Herbine, Dr. Herrick’s Vegetable Liver Pills, Swaim’s Panacea, Renne’s Pain Killing Oil, etc. He is also the promoter of Campho-Phenique, exposed in The Journal some eight years ago.[89] The spectacle is not an edifying one. A manufacturer with one hand offers the public a profusion of cure-alls, while with the other he endeavors to foist on the medical profession preparations which are just as fraudulent. Some day our profession will awake to the disgrace of it all. It will also awake to the fact, which should have been evident ere this, that the nostrum business would cease if physicians would refuse to accept into their offices, even as a gift, the nostrum-promoting medical journals that live off this trade. Fraudulent “patent medicines” will continue to thrive just so long as newspapers will publish “patent medicine” advertisements; fraudulent “ethical proprietaries” will continue to exist just so long as medical journals will advertise such proprietaries. As the better class of newspapers are rejecting “patent medicine” advertising on their own volition, so are the better class of medical journals rejecting advertisements of fraudulent proprietaries. Some newspapers will continue to carry nostrum advertising until their subscribers raise a protest that will cause the business department to take notice; so, too, some medical journals will continue to share the profits with the nostrum exploiters until an outraged medical profession repudiates such publications.]—(From The Journal A. M. A., Feb. 6, 1915.)