From these quotations it is evident that Sal Hepatica is in conflict with:
Rule 1, in that its composition is not disclosed, although statements are made which are likely to give a false impression as to what it is;
Rule 4, in that the statements on the label and in the circular around the bottle advertise it to the public and thus make the physician who recommends it an advance agent for the nostrum;
Rule 6, in that exaggerated and unwarranted claims are made for its therapeutic qualities, and,
Rule 8, in that its name fails to indicate its chief constituents, but does suggest its use in liver disorders.
The absurd claims made for this preparation are such as to put it in the “patent medicine” class. Even the most credulous members of the medical profession certainly can take no stock in the claim that a preparation can be an “eliminant” of uric acid, a hepatic stimulant, a remedy for gout, rheumatism, liver disease, indigestion, etc. Why then should such a preparation be tolerated?
In its conflict with Rule 4 Sal Hepatica belongs to that class of nostrums which have been so successfully exploited by manufacturers through the unwitting efforts of thoughtless and careless physicians. The Bristol-Myers Company has been most liberal in distributing free samples, evidently with the assurance that physicians would do the rest. Thus, at the present time, the profession is being supplied with a package containing one regular 25-cent bottle and five single-dose vials bearing the name Sal Hepatica. If only a small percentage of the physicians who receive these samples distribute them, the increase in Sal Hepatica consumers may be imagined. How successful this scheme of the Bristol-Myers Company has been is only too evident. Sal Hepatica is one of the best-selling laxatives in department stores and drug stores to-day.
While the evils of indiscriminate purgation are now generally recognized, the referee wishes to quote and to indorse the pertinent comments on this subject by The Journal:[79]
“The abuse of saline cathartics by the public is an evil deserving of serious attention. Rightly or wrongly, the laity fear constipation and naturally take what they are taught to believe is the cheapest and simplest course for its relief, self-drugging by means of saline cathartics or the extensively advertised purgative mineral waters. This habit is responsible for much of the distressing spastic constipation that exists, and its accompanying neurasthenia. The advertisement and sale to the laity of such a nostrum as “Sal Hepatica” can only increase these evil results and the physician who aids and abets the evil by using the preparation should reflect whether he is thereby not only encouraging a fraud on the public but also, what is even worse, helping to impair the public health.”
It is recommended that this report be authorized for publication in order that physicians may know the extent to which they have been made to act as advance agents for “patent medicines.” It is hoped its publication may suggest to those who in thoughtlessness have recommended Sal Hepatica, that they go to their materia medica and renew acquaintance with the host of simple and efficient laxative salts which are available—magnesium sulphate, sodium sulphate, sodium phosphate and the palatable effervescing preparations of these which the Pharmacopeia provides—effervescent magnesium sulphate (Magnesii Sulphas Effervescens, U. S. P.), effervescent sodium phosphate (Sodii Phosphas Effervescens, U. S. P.).—(From The Journal A. M. A., Feb. 7, 1914.)