PIL. MIXED TREATMENT (CHICHESTER)

Report of the Council on Pharmacy and Chemistry

The Council has authorized publication of the following report:

W. A. Puckner, Secretary.

“Pil. Mixed Treatment (Chichester)” is a proprietary preparation of the Hillside Chemical Co., Newburgh, N. Y. It is sold in the form of pills, each said to contain ¹⁄₂₀ grain of mercuric iodid and 5 grains of potassium iodid.

In 1907 the Council examined the therapeutic claims advanced for this preparation and found that they were unwarranted, exaggerated and misleading. It found, also, many misleading statements in regard to the product itself. Furthermore, the A. M. A. Chemical Laboratory found the pills to be “short weight” in potassium iodid content.

At the time that the Council examined Pil. Mixed Treatment (Chichester), a dermatologist of recognized standing, to whom the “literature” for this product had been submitted for an opinion, made the following report:

“Assuming that this pill contains what is claimed for it, one-twentieth (¹⁄₂₀) of a grain of biniodid of mercury and five (5) grains of potassium iodid, it presents neither an original nor a very useful formula.

“The literature furnished by the company abounds in suggestions that the mixture, as they prepare it, represents some unusual potency which is not possessed by the ordinary mixture of these same drugs in the same proportion. These suggestions may of course be dismissed without consideration. There is nothing mysterious in a mixture of potassium iodid and biniodid of mercury and this formula is no more entitled to special consideration than any other pill or tablet of the same composition prepared by any reputable pharmaceutical firm.

“The formula of this pill, however, does not represent a good combination. It is offered for use both during the active secondary period of syphilis and for tertiary lesions. The pill does not contain enough mercury to be an efficient remedy for secondary syphilis and not enough potassium iodid to be satisfactory in the treatment of tertiary lesions. It is neither fish, flesh, fowl, nor good red herring. A patient with secondary syphilis should not be dosed all the time with potassium iodid and for the treatment of tertiary lesions he should have a very much larger quantity of potassium iodid than can be given in these pills without giving toxic doses of mercury.

“The statement that this pill ‘does not impair the appetite nor disturb digestion and is well borne by patients who cannot tolerate iodids otherwise administered’ is a bald claim which cannot be justified by experience. The most unsatisfactory way of administering potassium iodid is in solid form. A patient who can stand potassium iodid in pill form, as it is furnished in this preparation, can stand it in any form in which it is ever administered.

“In short this preparation is neither agreeable nor efficient. The greatest objection to it is its inefficiency, for it is offered as an adequate preparation for the treatment of syphilis in all of its stages, whereas it is neither satisfactory for the treatment of secondary syphilis nor of tertiary lesions.”

During the fourteen years which have elapsed since the Council’s first examination of Pil. Mixed Treatment (Chichester), arsphenamin has been added to the syphilographer’s armamentarium and much has been learned about syphilis and its treatment. While there exist differences of opinion as to the exact value of arsphenamin in the treatment of syphilis and there are even some who desist from the use of arsenic compounds of any kind, no syphilographer of standing countenances the routine treatment of syphilis with a fixed combination of mercuric iodid and potassium iodid. The use of Pil. Mixed Treatment (Chichester) is on a par with the use of certain “blood purifiers” which were advocated at a time when the treatment of syphilis was a baffling problem.

PRESENT DAY CLAIMS

The present advertising, which reads as if it had been written in the heyday of proprietary license, is, in effect, an invitation to treat syphilis in its various stages and manifestations with Pil. Mixed Treatment (Chichester). If heeded by those who read the advertising of the Hillside Chemical Co., it will result in much harm to the public and the profession. For this reason, the present report of the Council is published as a protest against any advertising propaganda advocating the routine treatment of a disease which requires that each case be studied carefully so that prompt and efficient measures may be applied to the various manifestations of the disease.

The following advertisement appeared recently in several medical journals:

“Medicine is an Exact Science—on Paper Only!” Every general practitioner of medicine is called upon to treat Syphilis occasionally. He cannot depend upon the use of arsenicals alone. In most cases, “mixed treatment” the giving of mercury and iodides is required to get satisfactory results. Pil. Mixed Treatment (Chichester) accurately and successfully meets the indications and assures definite action. Important advantages:

Ready solubility of mercury in combination with Potassium Iodide.

Avoidance of gastric, buccal or intestinal disturbance.

Easy administration, can be taken at any time, anywhere.

Economical, both drugs in one combination.

Accurate adjustment of dosage to each individual case.

Full physiological action—assured by purity of content.

Secrecy—patient or friends do not know nature of medicine. Pil Mixed Treatment (Chichester) has been time tested and trial proven. It needs no introduction to the thousands of physicians who prescribe or dispense it.

While the advertisement does not directly so advise, yet it is a subtle invitation to the general practitioner to use Pil. Mixed Treatment (Chichester) and thus save himself and his patient the time and inconvenience which the rational treatment of syphilis imposes. A circular “The Treatment of Syphilis Simplified and Improved” begins:

“No therapeutic fact is more conspicuously and decisively established than that a radical cure of syphilis can be effected by the continuous administration, from the period of development, of a proper combination of mercury with iodine.”

Continuing, it is admitted that mercury is the most efficacious drug in the primary and secondary stages of syphilis and iodin in the tertiary stage, but it is asserted that:

“... it is now granted by all syphilologists that the antiluetic action of these drugs is immeasurably augmented by properly combining them, and that the best results are obtained when they are conjunctively administered throughout the entire course of the disease.”

Arguing along the same lines, this circular continues:

“... it was not until mercury and iodine in the form of Pil. Mixed Treatment (Chichester) was evolved that the marked advantages of the combined employment of these drugs in the various stages of syphilis became a scientific certainty.”

Further we are asked to believe that:

“Because of the greatly increased potency of mercury and iodine when combined, as in Pil. Mixed Treatment (Chichester), the foremost syphilologists are now agreed that the employment of these drugs in such form should be enjoined as soon as the disease develops, and should be thus continued until a cure has been effected; in other words, Pil. Mixed Treatment (Chichester) should be made the sole antisyphilitic medication throughout all stages of the disease.”

The circular illustrates the extent to which our knowledge of drugs may be distorted and misrepresented and the public health jeopardized in the exploitation of a proprietary medicine.

One reason scientific medicine lags. Uncritical medical journals perpetuate—for a price—the use of nostrums.

PROPRIETARY CLAIMS

In its advertising, the Hillside Chemical Co. claims that Pil. Mixed Treatment (Chichester) both as to formula and method of preparation “in the incapsulated powder form” was “brought to the notice of the profession by Dr. W. R. Chichester of New York, an eminent Syphilographer and recognized authority in the therapeutics of Syphilis.” It is claimed that this pill “is perfectly soluble, tasteless, nonirritant, and therefore well adapted to a sensitive stomach.” It is claimed that the pill “is always preferable to one extemporaneously prepared, which, even if identical in composition, often gives negative results.”

An examination made in the chemical laboratory of the association to determine if the product now marketed contains the claimed amount of potassium iodid indicated that this was the case. The chemist who made this examination commented as follows on the claim that in this pill, potassium iodid is rendered tasteless, that the pill is “perfectly soluble” and that extemporaneous pills of “identical ... composition often give negative results.”

“That the potassium iodid has been rendered tasteless is false, naturally; the pills when placed in the mouth, after removal of the coating, have the characteristic taste of alkali iodids. The claim that the pills are entirely soluble is incorrect; they contain a large amount of insoluble material, probably kaolin. The assertion that an extemporaneous compound prescription even if identical in composition with the Chichester pill is often inert, is absurd and a reprehensible attack by suggestion of the ideal that the physician shall write his prescription to meet the individual needs of his patient and that the pharmacist shall compound the prescriptions of the physician as they are required. It should also be pointed out that while much is said about the potassium iodid in the Chichester pill being in powdered form, the pill mass is solid and very slowly soluble and the claim of being in powdered form is, if immaterial, also incorrect.”

As to the asserted standing of the alleged discoverer of the formula for Pil. Mixed Treatment: Dr. William R. Chichester appears to have lived and practiced in New York since 1886 or longer, but the claim that he is an “eminent syphilographer” seems to have originated with the exploiters of “Pil. Mixed Treatment.” Search failed to show the name of W. R. Chichester among authors of textbooks of syphilis or any other branch of medicine or among authors of contemporary literature in the Index Medicus from 1907 down to the present; nor did a search of the catalogue to the Surgeon-General’s Library reveal W. R. Chichester as ever having published anything on syphilis or any other subject.

Pil. Mixed Treatment (Chichester) is sold under therapeutic claims which are unwarranted and misleading. The preparation well illustrates the abuses which are connected with the exploitation as proprietaries of established drugs or mixtures of established drugs.—(From The Journal A. M. A., Oct. 22, 1921.)