Shotgun Nostrums
Formerly it was customary to prescribe mixtures of many drugs on the assumption that if one of the ingredients missed the mark another might be expected to hit it, just as a poor marksman is more likely to hit a target at short range with a blunderbuss than with a high powered rifle. Increased precision in every branch of science has become the outstanding feature of civilization. The soldier today must shoot straight with a rifle that sends a single ball. There is none of the disposition to rely on chance as when the blunderbuss was used. A capable physician directs his drug straight at the seat of the trouble, and we now have many drugs that can be depended on to exert definite actions. The complex mixture is just as preposterous in modern therapeutics as the blunderbuss would be on a modern battlefield.
Every drug exerts undesired side actions, and it is the aim of the modern physician to try to select the one which will have a maximum of therapeutic with a minimum of undesired actions. When a complex mixture is employed, it is obvious that only the best is utilized, whereas all the undesired side actions come into play. We do not pretend that even the best studied drug has not much to be learned about it; but the nostrum maker who exploits a complex mixture either knows practically nothing of the side actions that it will exert, or, if he knows, he conceals that knowledge. He knows that massive doses of hydrated chloral combined with various narcotics can be relied on to cause unconsciousness in nearly all cases, but he prefers to speak of this as a hypnotic action. This is plain gambling with human life. When the patient dies, it is difficult to prove that death was caused by the mixture alone.
The Council on Pharmacy and Chemistry has expended a great deal of time and energy in combating the “shotgun” nostrum evil. It is easy to understand the disadvantages of such mixtures but it is not so easy to demonstrate the misleading character of the claims made, with an entire disregard of the truth, for these mixtures. No one believes that a pot of gold lies at the end of the rainbow, but no one has actually gone there to see for himself.
BROMIDIA
There are many types of “shotgun” nostrum. Some are dangerous, as in the case of “Bromidia”; some are preposterous, therapeutic monstrosities which excite the contempt of educated physicians, as in the case of “Tongaline”; some are merely useless mixtures of well known drugs, sold under grotesquely exaggerated claims, as in the case of “Peacock’s Bromides.”
Various formulas have been given for Bromidia. The manufacturers appear to be more cautious under those circumstances in which falsehood might lead them into collision with the federal authorities, than when giving reign to fancy and considering only the best means of winning the favor of the physician. It is said to consist of hydrated chloral, potassium bromid, Indian cannabis, and hyoscyamus. It is impossible to determine from the published formulas just how much hydrated chloral and potassium bromid it contains, but is probable that there are about 15 grains of each of these two drugs to the fluidram, and variable amounts of Indian cannabis and a small amount of either extract or tincture of hyoscyamus.
This much is certain: Bromidia is a distinctly dangerous mixture for indiscriminate use. The claim of the manufacturers, implied, rather than directly stated, that it is superior to an extemporaneously prepared mixture of those drugs is especially reprehensible because it tends to create the impression that the nostrum is safer in effective doses, conducing to a false sense of security on the part of those who are deluded into prescribing it in larger doses than they would a mixture of the same drugs prepared extemporaneously.
A report of the Council on Pharmacy and Chemistry published in The Journal, May 16, 1914, p. 1573, mentions three instances in which death is reported to have followed the use of Bromidia. The manufacturers of Bromidia have no magic power to render hydrated chloral harmless, while it retains its hypnotic action. It depresses the central nervous system, and it is nothing less than monstrous for any one to pretend to rob this drug of its dangerous properties while it retains its hypnotic effects. If the patient requires a hypnotic, the physician should choose that one which his judgment and experience dictate as the best for that particular patient. If he needs hydrated chloral, the physician should prescribe exactly as much as he believes the patient needs. If the effect is slightly greater or slightly less than anticipated, no harm is done and the physician has gained experience that will be valuable in future prescribing. If Bromidia is prescribed and unexpected effects are induced, it is impossible to know whether these were due to the hydrated chloral or to one of the other narcotics or to a synergistic action; and there is nothing to guide in the further use of the nostrum, for mixtures of narcotics commonly have much less uniformity of action than a single drug.
The irritant action of hydrated chloral on the stomach can be avoided by the use of bland fluids or dilute solutions. The following serves as an example of the way in which it may be prescribed conveniently: