SAL HEPATICA
Sal Hepatica is a saline laxative sold by the Bristol-Myers Company of New York. Little information is given, or, apparently, ever has been given, concerning the composition of this product. Many years ago the stock medical journal advertisement contained this statement:
“Composition.—Sal Hepatica contains all of the Tonic, Alterative and Laxative Salts of the celebrated ‘Bitter Waters’ of Europe, especially those of Bohemia, as determined by actual chemical analysis of these waters, and fortified by the addition of Lithium and Sodium Phosphates.”[255]
Sal Hepatica no longer “contains all the tonic, alterative and laxative salts ...,” etc., for the label on a package recently purchased reads:
“Sal Hepatica is an effervescent saline combination possessing medicinal properties similar to the natural ‘Bitter Waters’ of Europe, and fortified by the addition of Sodium Phosphate.”
In 1909, the Druggists Circular published an analysis of Sal Hepatica which showed that the preparation contained only 0.04 per cent. of lithium phosphate. By referring to the two quotations just given it will be noticed that today the manufacturers make no claim that their preparation is fortified with any salt of lithium. A circular accompanying recent trade packages states:
“Sal Hepatica is composed solely of harmless salts, being absolutely free from Acetanilid, Phenacetin, Caffein, Calomel, opium or coal tar derivatives.”
Since neither the names nor the amounts of the “harmless salts” are mentioned, the composition of Sal Hepatica is secret. It is a trick of the nostrum exploiter, old but ever popular, to mention numerous drugs which his preparation does not contain; it helps to distract attention from the fact that he does not tell what the preparation does contain!
In the old-time medical journal advertisements, one reads, “Sal Hepatica is the most powerful solvent of Uric Acid known.” (The same advertisement as it appeared in those days in The Journal shows that claim toned down to, “Sal Hepatica is a powerful solvent of Uric Acid.”) In those easy going days, the Bristol-Myers Company declared that “diabetes is treated with decided advantage by means of Sal Hepatica ... it ... possesses the property of arresting the secretion of sugar in the liver.” In the old days, too, Sal Hepatica was recommended in the treatment of cirrhosis of the liver, Bright’s disease, gravel, phthisis, etc.
The present advertising circular recommends Sal Hepatica as an eliminant, laxative or cathartic in gout, autointoxication, “Bilious Attacks,” rheumatism, acute indigestion, catarrhal conditions of the stomach, pyorrhea, headache, dizziness, heart burn, “Summer Complaints,” “Derangements of the Stomach and Liver,” skin diseases, colic, alcoholic excesses, and as a “preventive of Seasickness.”
In 1914 the Council on Pharmacy and Chemistry published[256] a report on Sal Hepatica declaring it secret in composition and sold under exaggerated and unwarranted claims.
In view of the inquiries which The Journal continues to receive it seemed worth while to make a chemical examination of the present-day product. Accordingly specimens were purchased and analyzed in the A. M. A. Chemical Laboratory. The report that follows was submitted by the chemists:
“Sal Hepatica is a white, granular, odorless powder. It effervesces on the addition of water in which it eventually dissolves. The aqueous solution, after boiling to remove carbon dioxid, has an acid reaction to litmus.
“Since a great many medicinal substances are sold in effervescent form, and since practically no information is given by the manufacturer concerning the composition of Sal Hepatica, it became necessary to test for a considerable number of therapeutic agents. The absence of acetanilid, acetphenetidin, alkaloids, ammonium salts, benzoates, caffein, citrates, heavy metals, hexamethylenamin, magnesium, potassium, salicylates and sugars was demonstrated by appropriate tests. The presence of a carbonate (probably in the form of a bicarbonate), a phosphate, a sulphate, a chlorid, tartaric acid, sodium and traces of lithium was shown by qualitative tests.
“Quantitative analysis indicated that the composition of the specimens examined was essentially as follows:
Sodium phosphate, anhydrous | 4.4 | per cent. |
Sodium sulphate, anhydrous | 26.5 | per cent. |
Sodium tartrate, anhydrous | 12.7 | per cent. |
Sodium bicarbonate | 19.5 | per cent. |
Tartaric Acid, free | 20.8 | per cent. |
Sodium chlorid | 8.9 | per cent. |
Lithium phosphate | trace | |
Water of hydration (by difference) | 7.2 | per cent. |
“From the results of the analysis, it appears probable that the composition of the mixture before ‘granulation’ was approximately as follows:
Sodium phosphate | 4 | per cent. |
Sodium sulphate | 25 | per cent. |
Sodium bicarbonate | 30 | per cent. |
Tartaric Acid | 30 | per cent. |
Sodium chlorid | 8 | per cent. |
Lithium phosphate | trace | |
Water of hydration (by difference) | 3 | per cent. |
“Sal Hepatica, therefore, is essentially an effervescing mixture of dried sodium sulphate (Glauber’s salt) and sodium tartrate with a little dried sodium phosphate and table salt added. It is similar to the effervescent artificial Carlsbad Salt described in the National Formulary.
“In 1909 the Druggists Circular published the following analysis of Sal Hepatica:
| Sodium phosphate | 29.80 | parts |
| Sodium sulphate (Glauber’s salt) | 26.27 | parts |
| Sodium bicarbonate (baking soda) | 18.00 | parts |
| Sodium chlorid (salt) | 13.05 | parts |
| Lithium phosphate | 0.04 | parts |
| Citric and tartaric acids (to make 100) | 12.84 | parts |
“A comparison of the recent analysis with the earlier one would seem to indicate that considerable changes have been made in the formula since the first examination. The proportions of sodium phosphate have been greatly reduced, while the sodium bicarbonate and tartaric acid have been increased and the citric acid entirely eliminated.”
Sal Hepatica, then, is a simple effervescent saline laxative, essentially secret in composition and sold under claims that would be laughed at were the full formula of the product a matter of public knowledge.—(From The Journal A. M. A., Oct. 29, 1921.)