CHLORON, CHLORAX AND NUMBER “3”

Report of the Council on Pharmacy and Chemistry

The report which appears below was sent to the Chlorine Products Company, Inc., May 14, 1919. In reply to an inquiry sent the Chlorine Products Company, July 8, the company wrote that it could send no reply because the medical director was still in France. However, Chloron and Chlorax are being advertised in medical journals; also essentially the same advertising as that discussed in the report was recently received by a physician from the Chlorine Products Company.

The preceding facts having been reported to the Council, publication of the report was authorized.

W. A. Puckner, Secretary.

Chloron, Chlorax and Number “3” are preparations of essentially similar composition put out by the Chlorine Products Company, Inc., New York.

Chloron

Chloron, according to the label, is “A stable CHLORINE remedy for the reduction of inflammation, relief of pain and for all wounds, burns, scalds and every description of sores except cancer and lupus.” Its composition is given as:

“Free chlorine, 0.200 per cent.; calcium chloride, 0.190 per cent.; mercurous chloride, 0.030 per cent.; lithium chloride, 0.035 per cent.; calcium hydrate, 0.010 per cent.; water to 100 parts.”

The Council asked the manufacturers for further information in regard to the composition or preparation of Chloron and received this reply:

“Chlorine gas is prepared in the usual way and purified and passed into water until a saturated solution is made.

“Water to the extent of three times the volume of the chlorine solution is used to dissolve the necessary amount of calcium chloride, and the two solutions are mixed.

“The necessary amounts of Lithium and Mercurous Chloride are then intimately mixed and made into solution. This solution is then added to the above and the whole is agitated for some minutes.”

A specimen of Chloron was examined in the A. M. A. Chemical laboratory and the chemists reported:

Qualitatively the presence of the following constituents was confirmed: calcium, mercury, lithium, chlorid, free chlorin. The solution was alkaline. Of course, the declaration that Chloron contains mercurous chlorid (calomel) is obviously incorrect, as mercurous chlorid cannot exist in a solution containing active (free) chlorin, but is oxidized to mercuric chlorid (corrosive sublimate). As the solution was alkaline in reaction, it seemed unlikely that all the active chlorin was present in the free state, as declared on the label. Quantitative determination of free chlorin and of total active (“available”) chlorin gave: free chlorin, 0.036 gm. per hundred c.c.; total “available” chlorin, 0.330 gm. per hundred c.c., or 165 per cent. of the claimed amount.

A comparison of the information sent to the Council with the analytic findings leads to the conclusion that Chloron is not of reliable composition.

As evidence of the therapeutic value of Chloron, the following “case reports” were submitted:

“In a case of second degree burn involving the most of one leg from the middle of the calf down, Chloron was the only dressing used. The burn was a bad one and the patient in a rundown anaemic condition, at no time was there any appearance of pus, the surface looked clean and bright and the healing was accomplished with practically no scar whatever. The burn was kept wet with the solution by hourly applications day and night. The skin which has grown on the wound is clear, healthy and firm.

In another case of Varicose veins of long standing, the result was surprising. The patient told of two years vibrating from Hospital to Hospital and getting no real relief. Each leg had large open running sores, the only dressing used was wet compresses of this solution. The pus disappeared at once, the wound began to cicatrise from the edges and in two weeks the man was discharged from the hospital practically cured.”

“Chloron was recently tried at the —— and —— Hospital on cases presenting ulcers and other sores which did not readily yield to other methods, with good results, in fact were of an indolent type. In these cases Chloron proved very valuable.”

“I have used Chloron on a series of cases (surgical) presenting pus foci and I have found the application very beneficial and healing, the pus early disappearing. In cases of Osteomyelitis, Suppurating Arthritis, Cellulitis and Chronic Ulcers, Chloron is particularly valuable, its good effects quickly observed and the time of restoration to health shortened.”

In the first case report, there is no evidence that Chloron is more efficient in the treatment of burns than any other commonly used procedure might have been. In the case of the varicose ulcers, while there was some apparent benefit from Chloron, no credit is given to rest and the general treatment which is known to be important in the treatment of such conditions. The evidence in the other case reports is quite inconclusive. Consideration of the “case reports” leads to the conclusion that clinical evidence for the value of Chloron is lacking.

Attention should be called to the fact that the amount of active chlorin, claimed to be present in Chloron as well as the amount found by the association laboratory, is less than that considered effective by Dakin, Dunham and others; seemingly in preparing Chloron no attention has been paid to the degree of alkalinity, yet the importance of this factor is now generally recognized.

Chloron fails to comply with the requirements for surgical solution of chlorinated soda (N. N. R., 1919, p. 133), yet the manufacturers make free use of the text of Dakin and Dunham’s Handbook of Antiseptics in their advertising pamphlet. Thus:

From the Chloron pamphlet:

“This ideal antiseptic effects com­plete ster­il­iza­tion within its sphere of action with­out caus­ing any dam­age to the cells or tis­sues. An im­por­tant method of judg­ing the in­juri­ous action of anti­sep­tics is to in­ves­ti­gate their ef­fects on the leuco­cytes. From ex­peri­ments in vitro by Parry Morgan and in vivo by Col. C. J. Bond with the strength of anti­sep­tics com­mon­ly used in sur­gery, it has been found that Chlorine anti­sep­tics and mer­cury salts have lit­tle ef­fect on phago­cyt­osis in com­pari­son with other germi­cides.

The ac­tivi­ty of the leuco­cytes from wounds which have re­cent­ly been treat­ed with CHLORON may be de­mon­strat­ed ex­peri­ment­ally.”

“In add­ition to its anti­sep­tic action CHLORON is a strong oxi­diz­ing agent and de­odor­ant and pos­ses­ses to a marked de­gree the prop­erty of de­com­pos­ing tox­ins. In this con­nec­tion it is in­ter­est­ing and per­tin­ent to note that Dean, by the regu­lat­ed action of hypo­chlor­ous acid, has pre­pared a non­toxic dys­en­tery vac­cine and it is now a com­mon ob­ser­va­tion that the free use of CHLORON may re­duce the con­sti­tu­tion­al symp­toms aris­ing from sep­tic pro­ces­ses and that they re­ap­pear on dis­con­tinu­ing the anti­sep­tic treat­ment.”

Dakin and Dunham Handbook of Antiseptics:

“The ideal surgical anti­sep­tic should ef­fect com­plete ster­il­iza­tion within its sphere of ac­tion with­out caus­ing any dam­age to ani­mal cells. At the mo­ment such a sub­stance does not ap­pear likely to be found, but on the other hand it is sur­pris­ing to see how lit­tle dam­age may be done to ani­mal tis­sues by some ac­tive anti­sep­tics. An im­por­tant me­thod of judg­ing of the in­juri­ous ac­tion of anti­sep­tics is to in­ves­ti­gate the con­di­tion of the leuco­cytes in wounds re­cent­ly treat­ed with the sub­stance under con­si­der­ation. In gener­al it appears from ex­peri­ments in vitro that, with the strength of anti­sep­tics com­mon­ly used in sur­gery, mer­cury salts and hypo­chlor­ites have rela­tive­ly lit­tle ef­fect on phago­cyt­osis as com­pared with phe­nol (Parry Morgan). It is a regu­lar phe­nom­enon to ob­serve ac­tivi­ty of the leuco­cytes ob­tained from wounds which have been re­cent­ly treat­ed with hypo­chlor­ites.

Ingenious methods for determin­ing the in­flu­ence in vivo of anti­sep­tics on the ac­tivi­ties of leuco­cytes have been worked out by Col. C. J. Bond.

“In addition to their dis­in­fect­ing ac­tion, the Chlorine anti­sep­tics are strong oxi­diz­ing agents and de­odor­ants and more­over pos­sess in high de­gree the pro­perty of de­com­pos­ing toxins. By the re­gu­lat­ed ac­tion of hypo­chlor­ous acid, Dean has pre­pared a non­toxic dys­entery vac­cine and it is a com­mon ob­ser­va­tion that the free use of hypo­chlor­ites may re­duce the con­sti­tu­tion­al symp­toms aris­ing from sep­tic pro­ces­ses and that they re­ap­pear on dis­con­tinu­ing the anti­sep­tic treat­ment.”

Chlorax

Chlorax is said to be “A stable CHLORINE solution for internal use,” in “Kidney Conditions,” “Diabetes,” “Acute Infections,” “Blood Dicrasias,” “Lithemias and Rheumatism,” and “Nervous Conditions.” It is claimed to have the same composition as that of Chloron with the addition of 0.016 per cent. of tincture of opium.

The A. M. A. Chemical Laboratory reported that the free chlorin in Chlorax was 0.01 gm. per hundred c.c. and the total amount of active (“available”) chlorin was 0.25 gm. per hundred c.c., or 125 per cent. of the amount claimed. The laboratory notes that though the chlorin content of Chloron and Chlorax is claimed to be the same, that of Chlorax actually is less. This is not surprising when the presence in Chlorax of reducing substances such as alcohol is borne in mind. The laboratory concludes that Chlorax is not of reliable composition.

The following is typical of the “case reports” submitted to show the value of Chlorax:

“In January last I used Chlorax on a case of Diabetes Mellitus and with excellent results.

“The patient had been suffering for about nine years and when first brought to my care Toxemia had set in, he was drowsy, irritable and unable to leave the house. I prescribed Chlorax in teaspoonful doses four times a day and am pleased to say that in one week he showed marked improvement. Soon after he was able to leave the house and attend to his business and after two months’ treatment resumed a normal diet and habits apparently without injurious effects.

“I believe that in this case Chlorax undoubtedly prolonged life.”

No mention is made of the dietary or other measures used. The wide variation in diabetes and its response to proper diet is so well known that the noncommittal statement concerning the beneficial effects of Chlorax amounts to no evidence at all in favor of the preparation.

The other “case reports” furnished by the Chlorine Products Company, Inc., which concern the treatment of gastric ulcers, acute alcoholic gastritis, tonsillitis, etc., are equally unconvincing. In fact, no satisfactory evidence for the clinical value of Chlorax has been presented.

The following from the advertising for Chlorax is unwarranted and absurd:

“Mercurous chloride (calomel) is perhaps the most widely used internal antiseptic and alterative and has established itself in the therapy of constipation, cholera, dysentery, cardiac dropsy, pleurisy, malignant fever, malaria, syphilis, worms, infectious diseases, gout and rheumatism; lithium chloride is particularly efficacious in acute and chronic parenchymatous nephritis and in various lithemic conditions; while Opium has no rival as an anodyne and can be used to stabilize and conserve the alkaline reserve of the body against the acidosing influence of infections.”

Further, on page 14 we find:

“In chills and fever malaria and other blood dicrasias, Chlorax is indicated as an internal antiseptic and it exerts a beneficial effect on the course of these diseases.”

The claims made for Chlorax are exaggerated and misleading.

Number “3”

According to the label, Number “3” is “A STABLE CHLORINE remedy for the purification of the blood,” with the composition:

“Free Chlorine, 0.35 per cent.; Calcium Chloride, 0.30 per cent.; Mercurous Chloride, 0.03 per cent.; Lithium Chloride, 0.04 per cent.; Calcium Hydrate, 0.01 per cent.; Opium, 0.02 per cent.; Ethyl Alcohol, 0.10 per cent.; water to 100 parts.”

It will be noticed that the composition claimed for Number “3” is essentially similar to that claimed for Chloron. It differs from Chloron in that the amounts of some of the constituents are somewhat greater, and in that, like Chlorax, it contains some tincture of opium.

The A. M. A. Chemical Laboratory reports that the free chlorin in a specimen of Number “3” was 0.024 gm. in 100 c.c. and the total active (“available”) chlorin 0.173 gm. per hundred c.c., or about 50 per cent. of the claimed amount. The examination indicates that Number “3” is of unreliable composition. The Chlorine Products Company, Inc., submitted no clinical evidence for Number “3” to which it refers as “our Syphilis remedy.” It stated that two physicians had used the preparation “with good results,” and admitted that “the company requires further evidence before pushing it.”

The Council declared “Chloron,” “Chlorax” and “Number ‘3’ ” in conflict with the rules governing admission to New and Non­official Remedies. All are of unreliable composition (conflict with Rule 1). The therapeutic claims made for the preparations are not substantiated by acceptable evidence and are unwarranted and misleading. Chloron is inferior as an antiseptic to the well-known surgical solution of chlorinated soda on account of its low chlorin content and uncontrolled reaction. There is no warrant for the claim that Chlorax is useful in the treatment of “Kidney Conditions,” “Diabetes,” “Acute Infections,” “Blood Dicrasias,” “Lithemias and Rheumatism,” and “Nervous Conditions,” nor is there warrant for the claim that “Number ‘3’ ” is a remedy for the purification of the blood or a “Syphilis remedy” (conflict with Rule 6).

The names of these pharmaceutical mixtures are not descriptive of their composition (conflict with Rule 8).

All three preparations are irrational. No evidence has been furnished that the lithium salt is of value in the mixtures. It is not rational to combine an active chlorin preparation and a mercury salt in one mixture, nor is there evidence that the addition of opium to the preparations proposed for internal use is of value or rational. Experimentation with Number “3” as a “Syphilis remedy” is to be severely condemned in that those on whom it is used will in the meantime be deprived of efficient medication (conflict with Rule 10).—(From Reports of Council on Pharmacy and Chemistry, 1919, p. 70)