“You also speak of the ‘high’ nuclein content (0.28 per cent. phosphorus): the largest recommended dose would contain only about 1⁄3 grain of nucleic acid—an amount which probably has not the slightest effect, especially when given by the mouth.
“A sample of ‘Protonuclein Special’ was found to have twice as much thyroid as the ordinary Protonuclein; this also was stated to be ‘perfectly harmless.’”—(From The Journal A. M. A., Feb. 1, 1913.)
PURGEN
The physicians of the United States are receiving a neat package containing samples of a German proprietary—Purgen. The container is an ingenious one and, besides the tablets, includes a circular in English, although mailed in Europe, describing the remarkable virtues of this “new synthetic aperient.” It has been considered strange that this proprietary, which has been advertised so thoroughly in Europe, Australia, etc., should not have made its appearance in this country. Now it is here, and it is well that physicians should know what Purgen is and not be mystified and misled by the literature that they may receive regarding the preparation.
The following appeared in The Journal, Jan. 5, 1907, page 64, and is reprinted now as being especially timely:
The report of a case of poisoning by Purgen (phenolphthalein) is the occasion for some pertinent observations by Dr. G. Brasch as to the proper introduction of such remedies to the medical profession (Ztschrift für Medizinalbeamte, Abst. in Apotheker-Zeitung, No. 59, 1906). He agrees with Best that all such remedies should first receive a thorough trial in an institution subject to state supervision, before they are advertised to the medical profession, so that their harmlessness in appropriate doses may be ascertained by a method free from liability to error. The manner in which the manufacturers introduced Purgen to the profession and the laity is to be condemned, and probably led to the symptoms of poisoning exhibited in the case of Dr. Best and tends to discredit a remedy which is harmless and efficient if used in proper doses. The manufacturer of such a preparation is inclined, for obvious reasons, to put the dose of his preparation much too high. The most important point, however, is the objectionable character of the names given to such articles. The organic compound phenolphthalein has been known for a long time and has been widely used as an indicator. Accidentally it was discovered that phenolphthalein possessed laxative properties and thereon it was proposed (1901) as a medicine under the name “Purgen.” It is sold in tablets containing 0.05, 0.1 and 0.5 grain phenolphthalein mixed with sugar and flavored with vanilla. The author says: “But it is very desirable—and I regard this as the most important part of my communication—that phenolphthalein should be received into the materia medica under its own name. The addition of vanilla and sugar is to the highest degree superfluous and the arbitrary dosage in three strengths with the ridiculous designations, ‘baby,’ ‘for adults,’ ‘for patients confined to bed,’ are merely calculated to prejudice the physician who is accustomed to individualize in his prescriptions, against a remedy which is in itself an excellent one.”
As explanatory to the last sentence, it should be stated that in Europe Purgen is put up in three dosage forms, “infant Purgen for children,” containing 3⁄4 of a grain; “adult Purgen for chronic constipation,” containing 11⁄2 grains, and “strong Purgen for invalids,” containing 71⁄2 grains. The form in which it is being sampled in this country is in the medium dose, 11⁄2 grains.
Physicians should remember that the promoters of Purgen are simply introducing a chemical well known to laboratory workers for the last twenty years, which has been recognized as an aperient for at least seven years, and which can be purchased for 40 cents an ounce, whereas an ounce of phenolphthalein in the form of Purgen will cost $3.20 wholesale. The enthusiastic praise of the remedy, found in the advertising circulars, should be subjected to critical judgment on account of its source and motives.