None of these “formulas” gives the quantity of the product containing the 1 gm. of salicylate, etc., but presumably it refers to the contents of 1 ampule or 20 c.c. This inference is in accord with the analysis of the product made in the Chemical Laboratory of the American Medical Association. The analysis also brought out the fact that the amount of iron in a given ampule was 0.0008 gm. (about 1⁄80 grain). This trace of iron in the presence of salicylate gives the product a purple color.
Venosal is recommended for the treatment of “rheumatism,” meaning, the context would indicate, infectious rheumatic fever. As colchicum has no special action on this disease and as there is no apparent reason for the employment of the trace of iron present, these additions in fixed proportions are unscientific, if not absurd. According to the advertising matter:
“Venosal ... eliminates unpleasant digestive disturbances which frequently forbid the use of salicylates by mouth and, in addition, insures their full therapeutic value.”
The statement is misleading, as the cases in which the oral administration of the salicylates is contraindicated are not “frequent” but exceptional and there is no evidence to justify the implication that the “full therapeutic value” of salicylates cannot readily be attained by their oral use. Still more astonishing is the following claim:
“Venosal is a combination carrying the true salicylates (sodii) in doses much larger than given by mouth. With this preparation given intravenously, there is no nausea or disagreeable digestive after-effects, tinnitus aurium, or the accumulating effects of the drug; yet the specific action of the salicylates seems to be increased many-fold, according to reports received.”
What are the facts? By mouth sodium salicylate is given in doses of from 3 to 15 gm. in a day; whereas Venosal is advised as 1 gm., in from one to three day intervals; as a matter of elementary arithmetic it is plain that these doses of Venosal are smaller instead of being “much larger.” The absence of digestive ill effects, tinnitus, etc., is explained by the small dosage. That the specific action of the salicylates should be increased by intravenous administration is surprising when it is remembered that the drug is absorbed rapidly and completely from the intestines; in fact, the quoted statement is incredible.
The company further alleges that, on the basis of “clinical reports” it has received, it does not “hesitate to recommend this product for routine use in all streptococcic infections.” Such a therapeutic suggestion is, to put it conservatively, gross exaggeration.
The whole question of the justification of using salicylates intravenously is open to grave doubt. Since it is possible to obtain the salicylate effects promptly and certainly by oral administration, the inherent dangers of intravenous medication render its routine employment unwarranted. A further objection to Venosal, especially at this time when economy is a national policy, is the unnecessarily high expense of Venosal itself and of its administration.
The referee recommends that Venosal be declared ineligible to New and Nonofficial Remedies because of conflicts with Rule 1 (indefinite chemical composition), Rule 6 (therapeutic exaggerations) and Rule 10 (unscientific composition).—(From The Journal A. M. A., Jan. 5, 1918.)