The Propaganda for Reform in Proprietary Medicines, Vol. 2 of 2

by Council on Pharmacy and Chemistry

[Article V]

Ammonol and Phenalgin

At the time that synthetic chemical drugs were coming into fame and when every manufacturer who launched a new headache mixture claimed to have achieved another triumph in synthetic chemistry, Ammonol and Phenalgin were born. Of course, these twins of analgesic pseudotherapy were claimed to be synthetics and were duly christened with “formulas.” They were among the first of the nostrums examined for the Council on Pharmacy and Chemistry, and the false claims made for them were exposed.

The analyses made for the Council showed that Ammonol and Phenalgin were simple mixtures, having the following composition:

	ACETANILID	SODIUM BICARBONATE	AMMONIUM CARBONATE
Ammonol	50	25	20
Phenalgin	57	20	10

The reports of the Council on, and numerous references to, these two nostrums may be found in The Journal of various dates.[245] The reports will prove interesting to those who are not familiar with, or have forgotten, the methods of nostrum exploiters at the time the Council was formed. Following the Council’s exposure of the false claims made by the manufacturers of Phenalgin, the Medical Record published an advertisement of that nostrum in which an attempt was made to discredit the Council’s report. The editor of the Medical Record was requested by the Council to publish the facts in the case but he refused to do so.

Long after the death of Dr. Cyrus Edson, the claim was made that Phenalgin was made under his direction and that it was his “discovery.” As a matter of fact, Dr. Edson had favored the use of Ammonol at one time, and when the Council exposed the false claims then being made for Phenalgin, The Journal charged that a fraud was being perpetrated on the medical profession. Despite the exposure of the methods used in exploiting Ammonol and Phenalgin, one finds just as glaringly false statements made in the advertisements of Phenalgin today as were made in its unsavory past. This would seem to indicate either that physicians have short memories or that they are strangely indifferent to the welfare of their patients, to their own reputations and to the good name of medicine.

The New York Medical Journal of Dec. 22, 1917, contained an advertisement of Phenalgin—it has been running for months—from which the following is quoted:

“For the relief of PAIN the ‘logical supplanter of opium and other habit-forming drugs’ is Phenalgin. No matter how severe or where located pain is promptly and satisfactorily controlled by this effective anodyne—and without disturbing the digestion, suppressing the secretions, causing constipation or inducing a drug habit.

“This is why Phenalgin has superseded opium and its derivatives for relieving Headaches, Rheumatism, Gout, La Grippe, Lumbago, Neuralgia, Disorders of the Female, Dysmenorrhea, and Painful Conditions generally. To thousands of physicians Phenalgin ‘is the one dependable analgesic—the logical supplanter of opium.’ ”

If we are to suppose that the composition of Phenalgin is today essentially the same as when it was examined, the claims just quoted are obviously false for, of course, such a mixture must have the properties of acetanilid with all of its drawbacks and limitations. We may contrast the statements made in the advertisement just quoted with those made in Bulletin 126 of the Bureau of Chemistry of the U. S. Department of Agriculture. This bulletin on “The Harmful Effects of Acetanilid, Antipyrin and Phenacetin” summarizes the replies received from 400 physicians to whom a questionnaire had been sent. The information thus gained was tabulated and the figures that follow are from these tables. There were reported no fewer than 614 cases of poisoning by acetanilid with 16 deaths and 112 cases of its habitual use. The larger number of cases of poisoning followed the administration of the drug, by physicians, in doses larger than those now regarded as fairly safe. This large number reported by only 400 physicians indicated an excessively large number in the whole country. Since the questionnaire was sent to nearly a thousand physicians, of whom about 500 failed to reply, it may be assumed that had it been sent to the entire 130,000 physicians in the country, at least 75,000 cases of poisoning would have been reported.

Prior to the passage of the federal Food and Drugs Act (the “Pure Food Law”) many nostrum makers had declared that their preparations contained no acetanilid. When that law went into effect, some of these manufacturers triumphantly pointed to the fact that they were still able to make the same claim without conflicting with the requirements of the law. This was accomplished in fact by changing the formula and substituting acetphenetidin (phenacetin) for the acetanilid. While acetphenetidin is somewhat less toxic than acetanilid, bulk for bulk, the toxicity and therapeutic activity of the two drugs are nearly proportional.

The claim made by many proprietary medicine manufacturers that they are “strictly ethical” because they advertise only to physicians is mere verbal camouflage. There may be no more certain way of insuring the continued use of a nostrum by the public than to have it prescribed by physicians; and none know this better than the makers of nostrums. A proprietary individuality is obtained by giving some special form to the tablets and package or a special coloring to the capsules (“Specify ‘Phenalgin Pink Top Capsules’ ”) so as to indicate the identity of the products in such a way that the patient may in the future procure them without the advice or warning of the physician. When a proprietary preparation with the name or initials stamped on it or attached to it is prescribed, the patient immediately is aware of the fact, and his respect for the physician’s intelligence and wisdom is naturally lessened.

The physician should never place such dangerous drugs as acetanilid and acetphenetidin, or ready made mixtures of them, in the hands of the patient in such a way that they can be employed without his supervision or control. He should never prescribe more than is needed at the time and should not form the habit of using fixed doses or combinations of drugs without a special reference to the particular needs of the individual.

Certain forms of headache yield more readily to a mixture of caffein and acetanilid or caffein and acetphenetidin than to either acetanilid or acetphenetidin alone. When the physician wishes to prescribe such a mixture he may combine 1 grain of caffein or 2 grains of citrated caffein with 3 grains of acetanilid or 4 grains of acetphenetidin in a powder or capsule. Under supervision such a dose may be repeated at intervals of from two to four hours if necessary to control pain. It is necessary to remember, however, that when small doses fail to give relief, increase in the dose is useless. This fact is especially important, and disregard or ignorance of it has been responsible for many cases of poisoning. Further, it should be remembered that while it was taught for many years that the admixture of caffein with acetanilid lessened the effect of the latter drug on the heart, Hale has shown that this is not the case and such mixtures must be used with special caution.—(From The Journal A. M. A., Feb. 2, 1918.)

---