VENODINE
Report of the Council on Pharmacy and Chemistry
Venodine (The Intravenous Products Co., Denver), according to information sent to the Council, is “an Intravenous Iodine Compound” put up in ampules each of which contains “28 grains of Sodium Iodide, 1⁄8 grain each of Beechwood Creosote and Guaiacol in a suitable vehicle, and excipients to enhance its compatibility with the circulating blood.”
The “Therapeutic Indications” include “infectious diseases, such as syphilis, tuberculosis, bronchitis, bacteraemias associated with chronic and acute nephritis (Bright’s disease), and other infections.” The Council held as unwarranted and grossly exaggerated the following therapeutic claims: (1) that the full therapeutic value of iodin medication cannot be readily obtained except by intravenous injection; (2) that Venodine is “of exceptional value in tuberculosis”; (3) that in pneumonia Venodine “combines the anaesthetic properties of creosote and guaiacol with the germicidal value of iodine”; (4) that “Venodine (or its iodine component) has long enjoyed an exceptional reputation” as of great value in many infectious diseases including bacteremias. The facts on these points are the following:
1. Since iodids are easily absorbed from the mucous membrane of the gastro-intestinal tract and are usually well tolerated by the stomach, there is no reason for resorting to intravenous injection in their administration.
2. The indiscriminate administration of iodids for pulmonary tuberculosis is strongly to be condemned. The cases in which they can be given to tuberculous patients without doing harm must be very carefully selected.
3. There is no evidence either that creosote is excreted by the lungs in sufficient quantity to exert an anesthetic influence or that iodin is present in the circulation of the lungs or in the bronchial secretions in a form which is capable of exerting any germicidal action whatever.
4. It is generally held that the systemic administration of iodin compounds in bacteremias is useless.
The Council also held the name “Venodine” objectionable in that it fails to indicate the chief ingredient (sodium iodid) of this simple pharmaceutical mixture. The statement in a circular that “Venodine is a sterile solution representing 1.54 Gm. (24 grains) of iodine in chemical combination together with creosote and guaiacol” is likely to lead physicians to use the preparation without considering that its chief constituent is the well-known substance sodium iodid, particularly so since no reference to sodium iodid is made in the circular.
Furthermore, the Council held that the combination of two such similar substances as creosote and guaiacol (the second a constituent of the first) as given in the published formula, stamps Venodine as unscientific; it adds mystery to the preparation, but does not increase its efficiency, and is therefore against the best interests of the public.
The Council voted that Venodine be held ineligible for conflict with Rules 6, 8 and 10.
This report having been submitted to the manufacturers, in accordance with the Council’s custom, and the reply affording no reason for modifying the findings, its publication has now been authorized.—(From The Journal A. M. A., June 26, 1915.)
VERACOLATE[AE]
Report of the Council on Pharmacy and Chemistry
“Veracolate (plain),” “Veracolate with Pancreatin and Pepsin” and “Veracolate with Iron, Quinine and Strychnine” are proprietary tablets marketed by the Marcy Company, Boston.
“Veracolate (plain).”—For this the following non-quantitative formula is given:
“A compound containing the bile acids, sodium glycocholate, sodium taurocholate with cascara sagrada and phenolphthalein.”
The dose is three tablets. Examination in the Chemical Laboratory of the American Medical Association of a specimen of “Veracolate (plain)” indicated that there was about 20 mg. (1⁄3 grain) of phenolphthalein to each tablet. One dose, therefore (three tablets), would contain 1 grain of phenolphthalein—an average dose.
“Veracolate with Pepsin and Pancreatin.”—The following “formula” is given for this mixture:
| “Veracolate | 11⁄4 | grain |
| “Pure Pancreatin | 1 | grain |
| “Pepsin aseptic (1:3,000) | 1⁄2 | grain |
| “Oil peppermint | 1⁄10 | min.” |
(Note the presence of two mutually incompatible digestive ferments.)
“Veracolate with Iron, Quinine and Strychnine.”—This is stated to have the following “formula”:
| “Veracolate | 11⁄8 | grain |
| “Reduced Iron | 1 | grain |
| “Quinine Sulphate | 3⁄8 | grain |
| “Strychnine Sulphate | 1⁄100 | grain” |
It will be noticed that these mixtures increase in complexity until a combination of seven diverse ingredients, a veritable shotgun mixture, is evolved. In none of the “formulas” are the proportions of the purgative drugs in Veracolate stated. In the second “formula,” the digestants might as well be omitted, for the pancreatin is destroyed by peptic digestion and hence cannot pass the stomach while the pepsin is useless without hydrochloric acid, and, at any rate, of no value in the intestine. If one is indicated, the other is not. Yet this unscientific and complex combination of purgatives, mutually incompatible digestive ferments, and oil of peppermint is called:
“A scientific Blending of Digestive Ferments, Cholagogues and Carminatives.”
“... for all forms of indigestion and dyspepsia.”
And the third, an equally irrational and complex combination, is termed “The Ideal Cholagogic Tonic”!
Extravagant and Misleading Claims.—True to type, the claims are magnified in accordance with the number of ingredients. For instance, of “Veracolate (plain),” we are told:
“Veracolate is a true cholagogue and biliary disinfectant as it directly stimulates the liver cells producing an increased flow of limpid bile. Although not a purgative, it moves the bowels and is definite and dependable in its action.”
“The action of Veracolate is to bring about a profuse flow of healthy bile which prevents bile stasis. As the flow of bile is stimulated so antiseptic action ensues, calculi softened and the concretion and mucous eliminated. Mucosal swelling is diminished and the infection which is usually present is antagonized. Relief is in plain evidence. As a result of the treatment the skin, eyes and urine become normal in appearance in a short time, the appetite and digestion improve and soreness in the region of the gall-bladder is entirely relieved.”
Similarly, it is said of “Veracolate with Pancreatin and Pepsin” that:
“It causes a natural flow of bile which checks fermentation, prevents the absorption of toxines and causes the food elements to be emulsified and thus rendered easy of assimilation. All this conduces to a natural movement of the bowels. Digestion is at once improved and the epigastric pain, nervous symptoms and headache disappear.”
“Veracolate with Iron, Quinine and Strychnine” is said to be indicated in:
“Hepatic Torpor accompanied by Anemia, Chlorosis, Debility, Neurasthenia and Neuroses.”
And the physician is asked to believe that it will:
“... give gratifying results in all nervous, anemic, and ‘run down’ conditions in which the liver function is usually subnormal.”
The objections to “Veracolate (plain)” are that it is semi-secret in composition, unscientific in combination and exploited under unwarranted claims. The same criticisms hold with reference to “Veracolate with Pancreatin and Pepsin” and “Veracolate with Iron, Quinine and Strychnine.”
These products are discreditable to the medical and pharmaceutical profession alike and their use is against the public good. The Council therefore refused recognition to Veracolate and its preparations.—(From The Journal A. M. A., April 24, 1915.)
HAYDEN’S VIBURNUM COMPOUND[AF]
Report of the Council on Pharmacy and Chemistry
The following report on Hayden’s Viburnum Compound was prepared by a member of the Council’s Committee on Therapeutics. The Council held the preparation in conflict with its rules and authorized publication of the referee’s report.
W. A. Puckner, Secretary.
Hayden’s Viburnum Compound, according to the advertising circulars, was first compounded in 1860 by W. R. Hayden. The medical profession is told that W. R. Hayden
“... found by his experiments that a combination of the active principles of Viburnum Opulus, Dioscorea Villosa, combined with aromatics, proved a valuable remedy for Spasmodic Dysmenorrhea.”
As in 1860 W. R. Hayden was not a physician (he received a diploma from the Eclectic Medical College, New York, in 1867), and, so far as we can learn, he was not a pharmacist or chemist, one wonders what kind of “experiments” he made. Hayden’s Viburnum Compound is put on the market by the New York Pharmaceutical Company of Bedford Springs, Mass. The name of this concern may sound imposing, until it is realized that it is merely a trade name adopted by Hayden in exploiting his nostrum.
The advertising matter formerly claimed that Scutellaria (skull-cap) was one of the ingredients of Hayden’s Viburnum Compound. As this is no longer mentioned, it is fair to assume that even the manufacturer does not consider the composition to be of vital importance. Stress is laid on the superior efficacy of viburnum opulus in the conditions for which the preparation is recommended; it is emphasized that it is viburnum opulus, and not viburnum prunifolium, that is the important ingredient of Hayden’s Viburnum Compound. The label, in accordance with the requirements of the Food and Drugs Act, declares that the preparation contains 50 per cent. alcohol. The claim is made:
“It is free from all narcotics and leaves no unpleasant after-effects.”
The medical profession is told that Hayden’s Viburnum Compound is a remedy in:
“Hysteria, Bilious Colic, Cramps of Cholera Morbus, Muscular Cramps,... Nervous Diseases of Pregnancy, Threatened Abortion, Post-Partum Pains, Puerperal Convulsions, Rigid Os, Dysmenorrhea, Menorrhagia.”
DISCUSSION OF ALLEGED INGREDIENTS
Viburnum Opulus (Cramp Bark).—Botanists and pharmaceutical chemists declare that this drug has not been on the American market for many years, if ever, and that the drug used and even described as viburnum opulus is really the bark of another plant. Viburnum opulus and its preparations are therefore to be dropped from the next United States Pharmacopeia. The principal constituents of viburnum opulus are stated to be a glucosid, viburnin, a bitter resin, and a little tannin, with small amounts of earthy carbonates and phosphates and organic acids (Culbreth, Ed. 4, 1906, p. 591). The glucosid and resin being bitter, the drug might have a slight stomachic action (if, indeed, any such effect is actually produced by “bitters”); the small amount of tannin might make it slightly astringent; its fruit acids (citric and malic) might make it slightly diuretic. Even if viburnum opulus were present in Hayden’s Viburnum Compound there is no clinical or laboratory proof that it, if given alone—without alcohol or other drug—has any antispasmodic or nervous sedative action.
Dioscorea Villosa (Wild Yam).—This drug contains a saponin and an acrid, irritant resin. It has never been proved clinically or experimentally that this drug has any action whatever except that its irritant resin might, if taken in sufficient quantity, cause irritation of the stomach and vomiting.
Aromatics.—The irritation produced by concentrated aromatics causes increased peristalsis and consequently may, if there is no obstruction, relieve intestinal stasis and intestinal colics. Therefore, a preparation containing large amounts of aromatics, especially if given in hot water, would have practically the same effects in the “cramps of a cholera morbus” or other forms of acute diarrhea as a home-brewed cup of spiced tea—and no more.
Alcohol.—This drug is a muscle relaxant, and sufficient doses might, by relieving spasm, relax a muscularly contracted os uteri and relieve post-partum pains. Alcohol dilates the blood-vessels both in the abdomen and on the surface of the body. It may thus either relieve uterine bleeding by lowering the blood-pressure and causing more blood to go to other parts, or increase uterine bleeding by relieving arterial and muscle spasm. Alcohol is also a habit-forming narcotic (Hayden’s Viburnum Compound is advertised as “free from all narcotics”!) and when habitually used by either males or females tends to impair the capacity to produce normal offspring.
Even if the manufacturer’s “formula” be accepted, Hayden’s Viburnum Compound contains no therapeutically active ingredient except alcohol and aromatics. The recommended dose of this preparation is “... two teaspoonfuls in six of boiling hot water or milk and one teaspoonful of sugar, every fifteen or twenty minutes until relief is obtained.”
“Frequently after taking the Viburnum Compound the patient will sleep soundly for several hours from the sudden cessation of pain; in such cases she should never be awakened through any fear of oversleeping, as Hayden’s Viburnum Compound does not contain any narcotic whatever, nor does it leave any disagreeable after-effects, and it may be given to a child when necessary without any special caution.”
Read the foregoing and then remember that it means that one teaspoonful of alcohol (the equivalent of two teaspoonfuls of whisky) is to be given in hot water, every fifteen or twenty minutes until relief is obtained and the patient is asleep. Why not use plain language and say “until she is drunk”?
The thoughtful physician would consider it decidedly unwise to give alcohol to a young girl, to a prospective mother, or to a young mother, except under extraordinary circumstances. He would know that the menstrual pains for which this preparation is recommended are likely to be recurrent, and that the repeated taking of alcohol for recurrent pain is fraught with danger—the danger of initiating the alcohol habit. If, however, a physician does elect to give alcohol as a drug, he must let the conditions that govern each individual case determine whether it is not better to give it as whisky, or to disguise it in a prescription of his own. Above all the physician should be conscious that he is giving the drug, alcohol; and this is not the case when he prescribes a ready-made nostrum. If he writes a prescription containing whisky or other alcoholic he will take measures to avert the dangers inseparable from the use of this drug.
CONCLUSIONS
1. Even if the manufacturer’s formula for Hayden’s Viburnum Compound be accepted, it is apparent that any therapeutic activity the preparation may have is due essentially to the alcohol and aromatics.
2. Alcohol is a narcotic drug, and a habit-forming drug. Physicians ordering this preparation may, by so doing, be initiating the alcohol habit.
3. Whatever result is obtained by the use of Hayden’s Viburnum Compound in the treatment of uterine or pelvic disturbances, is due to the alcohol it contains. The fact that menstrual pains are likely to recur might, when this preparation is relied on, become a factor in the formation of the alcohol habit.
4. Whatever result is obtained by the administration of Hayden’s Viburnum Compound in the treatment of gastro-intestinal disturbances is due to the alcohol and the aromatics it contains.
5. Whisky has the same alcoholic content (50 per cent.) as Hayden’s Viburnum Compound; the dangers in the use of whisky are well known and its value as a therapeutic agent is being questioned more and more every year.
Holding the exploitation of this proprietary a danger to the public and a detriment to scientific medicine, the referee recommends publication of this report as a protest against such irrational therapeutics. The profession should recognize that most, if not all, of the preparations recommended for painful menstruation and for all kinds of pelvic pain contain large percentages of alcohol, and that whatever physiologic effect is produced is, for all practical purposes, due to the alcohol.—(From The Journal A. M. A., Jan. 23, 1915.)