INTRAVENOUS SPECIALTIES

“Besides our product Thymozene we have been forced to add a Uterine Wafer to be used in connection with hot Thymozene douches in Leucorrhea. These wafers are simply miracle workers.”

“Besides our product Thymozene we have been forced to add a Uterine Wafer to be used in connection with hot Thymozene douches in Leucorrhea. These wafers are simply miracle workers.”

In addition to this circular letter there was a membership blank leaflet detailing the marvels of “Thymozene.” There was another leaflet headed in very large, black type “Influenza” and recommending “Ma-Oze Antiseptic Powder” or “Thymozene” for this condition. Still another leaflet accompanying it lauded “Intravenous Compound (Loffler)” and reprinted laudatory puffs of this preparation that were credited to H. H. Witherstine, M.D., Rochester, Minn., Joseph B. Klinehans, M.D., Chicago, and the “Loring Park Sanatorium” of Minneapolis.

In addition to the Intravenous Compound (Loffler) there is, of course, certain “apparatus for the giving of the treatment” which the Intravenous Chemical Co. supplies. The “compound” must be given just so, and the Intravenous Chemical Co. “reserves the right to refuse to supply any physician with Intravenous Compound (Loffler) who, either through lack of proper apparatus or proper care in preparation of solution, or for any reason, uses it in such a manner that will cast discredit upon it.”

The complete apparatus, including 2 ounces of Intravenous Compound (Loffler), sells for $24. What is Intravenous Compound? Apparently, nobody knows except Charles L. Loffler, who asks physicians to inject—and we regret to say some are injecting—this nostrum of unknown composition into the veins of their patients. To a physician who had raised the point of secrecy Loffler wrote in part:

“I am sure that you will agree with me that it is far better to place this treatment in the hands of competent physicians, such as Dr. Witherstine, and many more whose names I will gladly send you, and to protect the honest and competent doctor who investigates and takes up the work, than to publish the formula and give to the unscrupulous a chance to try to make the product and no doubt to claim to cure disease that is beyond hope. The formula is not kept secret for profit... but is so kept upon the advice of a number of good men who have the interest of the doctor at heart.... I am willing and anxious to place the product and the results in thousands of cases before the A. M. A. on the one condition that the formula shall be kept secret for the benefit of the reputable physician.”

“I am sure that you will agree with me that it is far better to place this treatment in the hands of competent physicians, such as Dr. Witherstine, and many more whose names I will gladly send you, and to protect the honest and competent doctor who investigates and takes up the work, than to publish the formula and give to the unscrupulous a chance to try to make the product and no doubt to claim to cure disease that is beyond hope. The formula is not kept secret for profit... but is so kept upon the advice of a number of good men who have the interest of the doctor at heart.... I am willing and anxious to place the product and the results in thousands of cases before the A. M. A. on the one condition that the formula shall be kept secret for the benefit of the reputable physician.”

In another letter written more recently to a physician who called attention to the secrecy of the nostrum, Loffler wrote:

“The Intravenous Compound contains approximately 58 per cent. oxygen, 12 per cent. chlorine, 16 per cent. potassium, 9 per cent. sodium and 5 per cent. boron. I have no hesitancy in giving it, and it was due to an incompetent man in this office that this was not given fully in the booklet. He made the changes without my consent and has caused me to answer many inquiries by physicians.”

“The Intravenous Compound contains approximately 58 per cent. oxygen, 12 per cent. chlorine, 16 per cent. potassium, 9 per cent. sodium and 5 per cent. boron. I have no hesitancy in giving it, and it was due to an incompetent man in this office that this was not given fully in the booklet. He made the changes without my consent and has caused me to answer many inquiries by physicians.”

A seeming frankness is a trick as old as nostrum exploitation itself. Loffler’s “formula” is meaningless. A quack who was putting out a mixture of 1 part baking soda and 2 parts common salt might with equal frankness say that his marvelous combination contained approximately 35.4 per cent. sodium, 4.8 per cent. carbon, 19 per cent. oxygen, 40.4 per cent. chlorin, and 0.4 per cent. hydrogen.

In order that the profession might know more about this product a specimen was turned over to the A. M. A. Chemical Laboratory for analysis. Here is what the chemists report:

“One original 2 ounce bottle of ‘Intravenous Compound (Loffler) for Intravenous Use’ was submitted to the Association’s Chemical Laboratory for examination. According to the label, the product is sold by the ‘Intravenous Chemical Co., Chicago.’ The bottle contained a white granular substance, which appeared as if the ingredients had been fused together. The product responded to tests for sodium, potassium, chlorate, borate and nitrate. As this same set of chemical radicals was found by Puckner and Hilpert (J. A. M. A., May 22, 1908, p. 1706) to be present in ‘Oxychlorin’ and ‘Zyme-oid,’ a quantitative comparison of ‘Intravenous Compound (Loffler)’ was made.

“The analysis indicated that all three products are essentially the same:

Oxychlorin,Per Cent.Zyme-Oid,Per Cent.IntravenousCompound,Per Cent.Potassium (K+)12.2613.5013.79Sodium (Na+)8.209.849.82Boric acid anhydride (B2O3)18.6313.4215.20Chlorate (ClO3-)25.5227.5326.44Nitrate (NO3-)21.7024.2223.75Water calculated13.2910.4211.72

Potassium (K+)

Sodium (Na+)

Boric acid anhydride (B2O3)

Chlorate (ClO3-)

Nitrate (NO3-)

Water calculated

“Assuming that the chlorate in ‘Intravenous Compound (Loffler)’ is present as potassium chlorate and the nitrate is present as sodium nitrate, the figures obtained by the analysis correspond to a mixture approximately as follows:

Potassium chlorate (KClO3)38.6per cent.Sodium nitrate (NaNO3)32.6per cent.Potassium borate (K2B4O7)4.9per cent.Sodium borate (Na2B4O7)4.0per cent.Boric acid21.1per cent.

Potassium chlorate (KClO3)

Sodium nitrate (NaNO3)

Potassium borate (K2B4O7)

Sodium borate (Na2B4O7)

Boric acid

“From the results of the examination it is concluded that this preparation is a mixture of alkali chlorate and nitrate and boric acid, probably produced by fusing together the constituents. It is practically the same mixture as Oxychlorine and Zyme-oid as analyzed nearly fourteen years ago in the A. M. A. Chemical Laboratory.”

Throughout the advertising of “Intravenous Compound (Loffler)” the physician is reminded of the financial returns that the product offers.

“... The financial return will prove as interesting to yourself as results are to the patients.”“And lastly but not less interesting, the financial returns are commensurate with results.”“... the instruction given me in the use of your Intravenous Compound and the opportunity presented adds four to five hundred dollars per month to my bank account.”“... will not only give you more positive results than have ever obtained in chronic and progressive diseases but a very remunerative business.”“Intravenous Compound (Loffler) is supplied in granular form, 2 ounces to a bottle, at $2 per bottle. An ounce will average fifteen treatments and treatments are at from $3 to $5 each, according to the ability of the patient to pay.”

“... The financial return will prove as interesting to yourself as results are to the patients.”

“And lastly but not less interesting, the financial returns are commensurate with results.”

“... the instruction given me in the use of your Intravenous Compound and the opportunity presented adds four to five hundred dollars per month to my bank account.”

“... will not only give you more positive results than have ever obtained in chronic and progressive diseases but a very remunerative business.”

“Intravenous Compound (Loffler) is supplied in granular form, 2 ounces to a bottle, at $2 per bottle. An ounce will average fifteen treatments and treatments are at from $3 to $5 each, according to the ability of the patient to pay.”

A physician whose name the Intravenous Chemical Company had given as a user of Intravenous Compound (Loffler) was written to by another physician who was interested in the matter and he was asked frankly for his opinion. He replied in part:

“The treatment makes a profound impression on the recipient and is usually followed by a marked improvement mentally, and I have not been keen enough to draw the line of just how far the physical or material improvement went and when the psychical began.“For the office ‘specialist’ of the advertising type this would be a boon, but I am not entirely satisfied that its use completely justifies its claims.”

“The treatment makes a profound impression on the recipient and is usually followed by a marked improvement mentally, and I have not been keen enough to draw the line of just how far the physical or material improvement went and when the psychical began.

“For the office ‘specialist’ of the advertising type this would be a boon, but I am not entirely satisfied that its use completely justifies its claims.”

Intravenous Compound (Loffler) stands revealed as a nostrum of secret composition which physicians are asked to inject into the veins of their patients. It must be purchased in connection with some supplementary material, “a completeset of apparatus,” sold by the same concern. Its successful administration is said to depend on following a technic detailed either in a booklet sent out by Loffler or given by Loffler in a “Post-graduate Course” which costs physicians $50 unless they have purchased six dollars’ worth of another nostrum, “Thymozene.”

The intravenous administration of drugs is impressive. To the patient the technic is mysterious and its psychic effect striking. Its dangers—infection, air embolism, intravascular clotting, sudden death—are matters of record. Every conservative physician will admit that there is no excuse for the intravenous administration of even those drugs that are well known and whose effects have been carefully studied, except when distinct advantages are to be secured. AsThe Journalhas stated before, “Little is known of the results to be expected from intravenous therapy even with simple substances.”

What, then, can be said of the physician who subjects his patients to the intravenous injection—“at from $3 to $5 each, according to the ability of the patient to pay”—of a preparation of whose composition he is as ignorant as he must be of its effects? Intravenous Compound (Loffler) has been on the market ten years; it is unmentioned in the literature of scientific medicine. The name of its exploiter, while not unknown in the twilight zone of professionalism as the exploiter of a nostrum, as a “Specialist” in “Chronic Troubles” and “Intravenous Therapy,” as well as in other capacities even less savory, is equally unknown to scientific medicine.—(From The Journal A. M. A., Nov. 12, 1921.)

To the Editor:—There is a salesman here in Salt Lake City making extravagant claims about the medicines advertised in the enclosed pamphlet. Would you kindly advise me as to your opinion of it?W. C. Schulte, M.D., Salt Lake City.

To the Editor:—There is a salesman here in Salt Lake City making extravagant claims about the medicines advertised in the enclosed pamphlet. Would you kindly advise me as to your opinion of it?

W. C. Schulte, M.D., Salt Lake City.

To the Editor:—I am interested in knowing the attitude of the Council on Pharmacy and Chemistry regarding the products of the Intravenous Products Company of America, 121 Madison Avenue, New York City. If the Council has already reported, please refer me to the appropriate number ofThe Journal. If it has not, please give me any information available.H. B. Gessner, M.D., New Orleans.

To the Editor:—I am interested in knowing the attitude of the Council on Pharmacy and Chemistry regarding the products of the Intravenous Products Company of America, 121 Madison Avenue, New York City. If the Council has already reported, please refer me to the appropriate number ofThe Journal. If it has not, please give me any information available.

H. B. Gessner, M.D., New Orleans.

Answer.—The Intravenous Products Company of America has not requested the Council on Pharmacy and Chemistry to examine any of its intravenous specialties, nor have they been discussed inThe Journalor examined in the American Medical Association Chemical Laboratory. The firm’s list of specialties bears a striking resemblance to those of other “intravenous specialty” firms. Endoarsan, like Venarsen of the Intravenous Products Company of Denver, is stated to contain a cacodylate (dimethylarsenate) along with mercury and iodid. Venarsen was reported on unfavorably by the Council (The Journal, May 22, 1915, p. 1780), the inferior efficacy of sodium cacodylate was discussed (The Journal, March 25, 1916, p. 978) and the worthlessness of sodium cacodylate as a spirocheticide confirmed by H. N. Cole (The Journal, Dec. 30, 1916, p. 2012), William G. Ward (The Journal, Feb. 3, 1917, p. 390), and R. L. Sutton (The Journal, Feb. 17, 1917, p. 566). Endosal, like Venosal of the Intravenous Products Company of Denver, is said to contain salicylate and a colchicum preparation (the latter is also said to contain iodids). Venosal was found unacceptable for New and Non­official Remedies by the Council on Pharmacy and Chemistry. Like other “intravenous” firms, this company advertises the intravenous administration of drugs such as sodium iodid and hexa­methylen­amin. The objections to and the dangers of indiscriminate administration of drugs intravenously was recently emphasized in a report of the Council on Pharmacy and Chemistry “Some of Loeser’s Intravenous Solutions” (The Journal, April 16, 1921, p. 1120).—(Query from The Journal A. M. A., Dec. 10, 1921.)

At fairly frequent intervals physicians receive through the mail free samples of “Iodex,” a black ointment sent out in small, circular aluminum boxes. Iodex is sold by Menley and James, Ltd., New York City, under the claim that it is a preparation of free iodin,252minus the objectionable features that go with free iodin. The preparation was examined in the A. M. A. Chemical Laboratory in 1915, and found practically devoid of free iodin. The laboratory also reported that when 1 or 2 grams of Iodex was rubbed on the skin of the forearm on several subjects and the urine collected and tested for iodin, the results were negative. This disproved the claim that “thirty minutes after inunction [with Iodex] iodine can be found in the urine.”

The findings of the laboratory, which were summed up in a report (The Journal, June 19, 1915) of the Council on Pharmacy and Chemistry on Iodex, were essentially as follows:

1. The composition is incorrectly stated; the actual iodin content is only about half of that claimed.

2. The action of Iodex isnotessentially that of free iodin, although that is the impression conveyed by the advertising.

3. The assertion that iodin may be found in the urine shortly after Iodex has been rubbed on the skin has been experimentally disproved.

At the time the laboratory reported its findings, it pointed out the obvious contradiction in the claim that Iodex is not only an “effective free iodine application without drawbacks” but also a means of “really efficient external iodine therapy without stain or irritation.” It is impossible to have free iodin present in sufficient quantities to be thera­peutically efficient and not get skin stains and irritation.

In a recent issue of the house organ,Pharmacal Advance, there was a large display advertisement of Iodex under the heading: “For prophylaxis and to ‘Double Cross’ Disease,” with the claims:

“Free Iodine.”“Rub Through Skin.”“Does Not Irritate nor Stain.”

“Free Iodine.”“Rub Through Skin.”“Does Not Irritate nor Stain.”

On other pages of the same issue these claims appeared:

“There is no therapeutic virtue in Iodex which is not inherent—though often latent—in Free Iodine; and there is no virtue in Free Iodine which is not available in Iodex.”“In Iodex all the beneficent properties of Iodine are emphasized and all its disadvantages are eliminated—in a word, Iodex is Pure Free Iodine presented thera­peutically active and efficient, ready for use in all conditions, with all the well-known powers of Free Iodine, but without the sequelæ of unpleasant effects, as irritation, corrosion, desquamation, staining, etc., which defeat the ends of treatment when ordinary preparations of Iodine are used. The fact that Free Iodine in the form of Iodex can now be used in rectal and vaginal treatment, without irritation, speaks volumes for its penetrability and bland action.”

“There is no therapeutic virtue in Iodex which is not inherent—though often latent—in Free Iodine; and there is no virtue in Free Iodine which is not available in Iodex.”

“In Iodex all the beneficent properties of Iodine are emphasized and all its disadvantages are eliminated—in a word, Iodex is Pure Free Iodine presented thera­peutically active and efficient, ready for use in all conditions, with all the well-known powers of Free Iodine, but without the sequelæ of unpleasant effects, as irritation, corrosion, desquamation, staining, etc., which defeat the ends of treatment when ordinary preparations of Iodine are used. The fact that Free Iodine in the form of Iodex can now be used in rectal and vaginal treatment, without irritation, speaks volumes for its penetrability and bland action.”

These quotations are sufficient to show that the manufacturers of Iodex still persist in their claim that the product contains free iodin. In view of this, the A. M. A. Chemical Laboratory has again examined Iodex, having recently purchased specimens on the open market. It reports that Iodex gives no test for free iodin, or at most, but minute traces.

An interesting side-light on the methods of Menley and James is also brought out in the issue ofPharmacal Advancejust quoted. Under a “department” misnamed “Book Reviews” the following appears:

“The Actions of Drugs.—Torald Sollmann, M.D. Published by W. B. Saunders Co., Philadelphia. This is a book of lectures designed for students in pharmacy and deals with the subject in plain and simple language. The author in his introduction has brought out the fact that over-counter prescribing is baneful both to the public and to the pharmacist himself. Among some of the interesting points brought out thatPharmacol Advancehas always maintained, namely, that ‘Potassium iodid is not absorbed efficiently by the skin; hence the ointment of potassium iodid is unscientific.’“We would especially call attention to Ungt. Iodi U. S. P., containing Potassium Iodid, used as a solvent for its iodin content. Accepting Sollmann’s statement, it is to be assumed that Ungt. Iodi U. S. P. has not 100 per cent. efficiency.”

“The Actions of Drugs.—Torald Sollmann, M.D. Published by W. B. Saunders Co., Philadelphia. This is a book of lectures designed for students in pharmacy and deals with the subject in plain and simple language. The author in his introduction has brought out the fact that over-counter prescribing is baneful both to the public and to the pharmacist himself. Among some of the interesting points brought out thatPharmacol Advancehas always maintained, namely, that ‘Potassium iodid is not absorbed efficiently by the skin; hence the ointment of potassium iodid is unscientific.’

“We would especially call attention to Ungt. Iodi U. S. P., containing Potassium Iodid, used as a solvent for its iodin content. Accepting Sollmann’s statement, it is to be assumed that Ungt. Iodi U. S. P. has not 100 per cent. efficiency.”

Garbling statements from scientific works for the purpose of puffing proprietaries is not unusual in nostrum exploitation. The facts are that the statement in Sollmann’s book, introduced in the Menley and James house organ under the guise of a book review, appeared in a discussion of iodin compounds. In this the author points out that to obtain systemic iodid effects, it is irrational to apply iodin preparations externally. So far as the free iodin content of the official ointment of iodin is concerned, L. E. Warren (Reports of the A. M. A. Chemical Laboratory, 1917) has shown that even after more than six months this ointment still contains about 75 per cent. of the free iodin originally added. The official ointment (Unguentum Iodi, U. S. P.), therefore, so far as its free iodin content is concerned, is far superior to Iodex, which contains no iodin in its free state.—(From The Journal A. M. A., May 3, 1919.)

A number of inquiries have been received of which those that follow are typical. This from a Philadelphia physician:

“Would you give me any information you have about one so-called ‘Dr. W. S. Koch,’ Detroit, Michigan? This man is said to claim to have in his possession a cure for cancer, the nature of which I do not know. I know, however, that he obtained a very large fee not very long ago in treating a case, but without success...”

“Would you give me any information you have about one so-called ‘Dr. W. S. Koch,’ Detroit, Michigan? This man is said to claim to have in his possession a cure for cancer, the nature of which I do not know. I know, however, that he obtained a very large fee not very long ago in treating a case, but without success...”

While a Chicago physician writes:

“I have at hand a pamphlet from Wm. F. Koch, M.D., Ph.D., of Detroit, Mich., which is supposed to be a reprint from theMedical Recordof Oct. 30, 1920, entitled ‘A New and Successful Diagnosis and Treatment of Cancer.’ Will you kindly advise me what you know about this man’s work on this subject and how much stock I can put in the claims he makes in this article?”

“I have at hand a pamphlet from Wm. F. Koch, M.D., Ph.D., of Detroit, Mich., which is supposed to be a reprint from theMedical Recordof Oct. 30, 1920, entitled ‘A New and Successful Diagnosis and Treatment of Cancer.’ Will you kindly advise me what you know about this man’s work on this subject and how much stock I can put in the claims he makes in this article?”

And this from a physician in Seattle, received a few days ago:

“Has your office any knowledge of the cancer cure devised by Dr. William F. Koch, Ph.D., M.D., of Detroit? He published an article on it in theMedical Record, Oct. 30, 1920.... I enclose copy of letter received by one of our patients from his ‘western representative’ which reads like pure quackery. I do not find Dr. Koch’s name in either the A. M. A. or Polk’s medical directories.”

“Has your office any knowledge of the cancer cure devised by Dr. William F. Koch, Ph.D., M.D., of Detroit? He published an article on it in theMedical Record, Oct. 30, 1920.... I enclose copy of letter received by one of our patients from his ‘western representative’ which reads like pure quackery. I do not find Dr. Koch’s name in either the A. M. A. or Polk’s medical directories.”

The letter referred to in the last inquiry as coming from Dr. Koch’s “western representative” was addressed to a woman who had written to Dr. Koch with reference to his alleged cancer cure. The letter, dated Jan. 19, 1921, was signed “Chas. L. Tisdale, 1898 Geary Street, San Francisco.” It read:

“Dear Madam:—Your letter of January 10th written to Dr. Koch of Detroit in reference to his cancer cure has been sent to me by Dr. Koch. I am the western representative of Dr. Koch and am giving the treatments with his remedy. I am now treating 14 cases here with some most wonderful results. The amount of the remedy that Dr. Koch can supply me with is limited and it is a very expensive substance. None of it can be sent to Seattle or any other place for I have only enough to treat the cases that are constantly presenting themselves here. If you could come to San Francisco and have the money to pay a reasonable fee, say enough to pay for the remedy, I would be very glad to do everything I can for you.“The results that have already shown in many of these cases warrant me in believing that almost any case of cancer can be cured if the treatment is persisted in.”

“Dear Madam:—Your letter of January 10th written to Dr. Koch of Detroit in reference to his cancer cure has been sent to me by Dr. Koch. I am the western representative of Dr. Koch and am giving the treatments with his remedy. I am now treating 14 cases here with some most wonderful results. The amount of the remedy that Dr. Koch can supply me with is limited and it is a very expensive substance. None of it can be sent to Seattle or any other place for I have only enough to treat the cases that are constantly presenting themselves here. If you could come to San Francisco and have the money to pay a reasonable fee, say enough to pay for the remedy, I would be very glad to do everything I can for you.

“The results that have already shown in many of these cases warrant me in believing that almost any case of cancer can be cured if the treatment is persisted in.”

According to our records, Dr. William F. Koch of Detroit was born in 1885. Some years ago he graduated in chemistry and for some time held the position of professor of physiology and physiologic chemistry at the Detroit College of Medicine and Surgery. In 1918, Dr. Koch received his degree in medicine from this same college. Less than a year after his graduation, Dr. Koch declared that he had “developed a real specific cure for cancer.” In theDetroit Medical Journalfor July, 1919, there appeared a brief article by William F. Koch, entitled “A New and Successful Treatment and Diagnosis of Cancer.” A more extensive article bearing the same title was published in theNew York Medical Journalof Oct. 30, 1920.

As a result of the publicity that was given the Koch treatment, the Wayne County (Detroit) Medical Society appointed a committee to investigate the treatment. Its first report appeared in the Bulletin of the society for Dec. 22, 1919. Briefly, this report said that the Board of Health of Detroit had placed at the disposal of the committee twelve beds in a local hospital with the necessary special nurses and everything else required free of charge. The committee sent certain patients to the hospital; and there were also some other patients recommended by different physicians as proper cases for treatment. There were nine altogether. After going over the cases carefully, the committee found some in which the diagnosis was doubtful. There were five cases, however, of undoubted cancer, a positive diagnosis having been made from specimens and microscopic examination. The management and treatment of these patients were turned over to Dr. Koch.

Dr. Koch seems to have raised certain objections and to have made certain criticisms. He also insisted that he ought to have some representative on the committee. The committee offered to put on any and all he would name. He failed to name any. The committee reported further that Dr. Koch was very negligent in his treatment of the patients and finally, on November 26, the committee met with Koch and went over all the cases with him. At that time he gave the patients injections and promised to attend to the treatment regularly in the future. According to the report, he saw the patients only once more (three days later) and then did not come near them again. As the patients became disgusted with the neglect, some of them left and the committee sent the rest home and closed its connections with the investigation of the subject.

In the same issue of the Bulletin of the county society in which this committee’s report was published, the editor of the Bulletin stated that from all sections of the country inquiries were coming relative to the treatment and “from long distances patients are coming to Detroit to be ‘cured’ of cancer.” The editor further stated: “It is reported that Dr. Koch is treating many patients, promising much and charging well.” To this Dr. Koch retorted that only about 30 per cent. of his patients had “contributed.” The rest were treated free.

The Wayne County Medical Society Bulletin for Jan. 5, 1920, was devoted almost exclusively to another discussion of Dr. Koch’s “cancer cure.” It was there stated that a second committee had been appointed to gather what information could be obtained from outside sources relative to cases treated by Dr. Koch. This committee reported that of fifty-six cases of which it was able to obtain data, only three of the patients showed clinical improvement; twenty-one of the patients were dead. Three more patients treated both by the Koch injections and by operation were reported as clinically improved. The condition of eighteen of the patients was reported as stationary, or unimproved. In eleven of the cases, the results were unknown but the surgeons reported unfavorably.

The committee reported further that Dr. Koch’s records were incomplete and that he had submitted no proof that his injections have any particularmerit and the committee concluded that the study “is entirely experimental and improperly supervised.”

Evidently, the most that can be said of Dr. Koch’s alleged “cure” for cancer is that the claims made for it have not been supported by independent investigators.—(From The Journal A. M. A., Feb. 12, 1921.)

Last week some space was given to the alleged cure for cancer put out by Dr. William F. Koch of Detroit. Incidentally, it should be mentioned that Dr. Koch’s article of Oct. 30, 1920, to which reference was made, appeared not in theNew York Medical Journal, as stated, but in the New YorkMedical Record.

The following correspondence throws additional light on the subject:

To the Editor:—To the number of inquiries which you have received regarding the alleged cure of cancer by Dr. Koch, permit me to add the following personal experience. On July 1, 1920, I was asked to examine an ex-patient of mine whom I had not seen professionally for many years. Her husband frankly told me that for several months his wife had been treated by Dr. W. F. Koch for inoperable carcinoma of the pelvic organs, that he wished Dr. Koch to retain charge of the treatment but hoped I would give my opinion regarding certain nervous manifestations in the patient which were causing him (her husband) much concern.At the same time, he showed me a letter written by Dr. Koch purporting to explain the symptoms and offering suggestions regarding treatment. I called on the patient and found her in the last stages of generalized carcinomatosis. Simple palpation of the abdomen revealed multiple nodules involving both lower and upper abdominal quadrants. I did not feel justified in making a pelvic examination but noted a profuse foul-smelling discharge on the vulvar pad. My prognosis did not meet with the deluded husband’s approval. The patient died within a week and a necropsy confirmed the clinical picture of carcinomatosis. Enclosed is Dr. Koch’s letter; the patient’s name should, of course, be omitted if you see fit to publish this note.George de Tarnowsky, M.D., Chicago.

To the Editor:—To the number of inquiries which you have received regarding the alleged cure of cancer by Dr. Koch, permit me to add the following personal experience. On July 1, 1920, I was asked to examine an ex-patient of mine whom I had not seen professionally for many years. Her husband frankly told me that for several months his wife had been treated by Dr. W. F. Koch for inoperable carcinoma of the pelvic organs, that he wished Dr. Koch to retain charge of the treatment but hoped I would give my opinion regarding certain nervous manifestations in the patient which were causing him (her husband) much concern.

At the same time, he showed me a letter written by Dr. Koch purporting to explain the symptoms and offering suggestions regarding treatment. I called on the patient and found her in the last stages of generalized carcinomatosis. Simple palpation of the abdomen revealed multiple nodules involving both lower and upper abdominal quadrants. I did not feel justified in making a pelvic examination but noted a profuse foul-smelling discharge on the vulvar pad. My prognosis did not meet with the deluded husband’s approval. The patient died within a week and a necropsy confirmed the clinical picture of carcinomatosis. Enclosed is Dr. Koch’s letter; the patient’s name should, of course, be omitted if you see fit to publish this note.

George de Tarnowsky, M.D., Chicago.

The letter from Dr. Koch which Dr. de Tarnowsky enclosed with his own, follows. We have, of course, deleted the name of the patient.

Dear Doctor: Mrs. —— has absorbed and is still absorbing some killed tumor tissue. She has absorbed some three pounds, I judge. The results of the absorption are intoxication quite general (nervous, muscular, perhaps nephritic). The myocardium at present shows no signs of poisoning but the skeletal muscles and nerve do. The important toxin liberated by the killed tissue is methyl cyanimide which combines ammonia (NH2){sic} from the amino acids, and thus becomes methyl guanidine. This latter has produced in my patients an intoxication varying in similarity to: idiopathic tetany in children, chorea in children, eclampsia in women, and has even been so severe as tetanus in some of the muscle spasms; a toxic albuminuria has resulted in some of my cases.All of my cases have cleaned up so far. Of course, I cannot predict in any individual case, except that when the absorption has been completed and the toxin all eliminated, everything should return to normal, unless the toxin has destroyed tissue beyond physiological repair. My suggestions as to treatment would be elimination, saving the kidneys as much as possible, by whatever methods you find best and necessary.At present I am treating symptomatically thus—atropin as a guanidine antidote, arsenic as a chorea coupled antidote as a prevention to the production of guanidine from the cyanimide, the use of dilute hydrochloric acid has proven successful to me. Even a urine boiling solid—albumen has cleared up in one case in three days just by taking large quantities of1⁄2per cent HCl. I am explaining the factors I have contended with in these cases, but do not want to influence your plan of treatment when your judgment finds me insufficient.Sincerely,Wm. F. Koch.I shall have a publication out very soon on the treatment of these tetanics and eclampsia with HCl.

Dear Doctor: Mrs. —— has absorbed and is still absorbing some killed tumor tissue. She has absorbed some three pounds, I judge. The results of the absorption are intoxication quite general (nervous, muscular, perhaps nephritic). The myocardium at present shows no signs of poisoning but the skeletal muscles and nerve do. The important toxin liberated by the killed tissue is methyl cyanimide which combines ammonia (NH2){sic} from the amino acids, and thus becomes methyl guanidine. This latter has produced in my patients an intoxication varying in similarity to: idiopathic tetany in children, chorea in children, eclampsia in women, and has even been so severe as tetanus in some of the muscle spasms; a toxic albuminuria has resulted in some of my cases.

All of my cases have cleaned up so far. Of course, I cannot predict in any individual case, except that when the absorption has been completed and the toxin all eliminated, everything should return to normal, unless the toxin has destroyed tissue beyond physiological repair. My suggestions as to treatment would be elimination, saving the kidneys as much as possible, by whatever methods you find best and necessary.

At present I am treating symptomatically thus—atropin as a guanidine antidote, arsenic as a chorea coupled antidote as a prevention to the production of guanidine from the cyanimide, the use of dilute hydrochloric acid has proven successful to me. Even a urine boiling solid—albumen has cleared up in one case in three days just by taking large quantities of1⁄2per cent HCl. I am explaining the factors I have contended with in these cases, but do not want to influence your plan of treatment when your judgment finds me insufficient.

Sincerely,

Wm. F. Koch.

I shall have a publication out very soon on the treatment of these tetanics and eclampsia with HCl.

It is worth noting that this letter of Dr. Koch’s was written June 28, just three days before Dr. de Tarnowsky saw Mrs. —— and less than a week before she died of generalized carcinoma.

Not the least important element in the story which these two letters tell is the optimism engendered in the husband of the poor cancer patient by the widely vaunted treatment of Koch. And herein lies one of the most pernicious features connected with the exploitation of alleged cures for cancer, tuberculosis, etc. All such remedies, whether fraudulent both in their inception and exploitation or those which while equally worthless are at least honestly put forward and are based on a certain amount of scientific investigation, produce a profound and marked temporary change in the patient’s condition. It is this that tends to warp the judgment not only of the unscientific layman, but also of the physician. The psychic element in cancer has been well described by Weil:

“It is, indeed, very remarkable that a patient who has been consigned to death as a victim of a hopeless malady, should regain his spirits and his appetite, when he is again confronted with the hope of a cure, and of the eradication of his disease? It is a phenomenon well known to every student of the disease that a large proportion of cases responds in just this manner to any treatment which is offered them. Osler has described a case of cancer of the stomach in which the mere visit to a consultant of sanguine temperament, though poor judgment, whose assurance of the patient that there was no possibility of cancer, resulted in the disappearance of all the symptoms and a gain of 18 pounds in weight. It is this psychic influence, which has occasionally deluded the honest student of cancer cure, and which has also so generously played into the hands of the dishonest.”—(From The Journal A. M. A., Feb. 19, 1921.)

“It is, indeed, very remarkable that a patient who has been consigned to death as a victim of a hopeless malady, should regain his spirits and his appetite, when he is again confronted with the hope of a cure, and of the eradication of his disease? It is a phenomenon well known to every student of the disease that a large proportion of cases responds in just this manner to any treatment which is offered them. Osler has described a case of cancer of the stomach in which the mere visit to a consultant of sanguine temperament, though poor judgment, whose assurance of the patient that there was no possibility of cancer, resulted in the disappearance of all the symptoms and a gain of 18 pounds in weight. It is this psychic influence, which has occasionally deluded the honest student of cancer cure, and which has also so generously played into the hands of the dishonest.”—(From The Journal A. M. A., Feb. 19, 1921.)

The Journalhas received several inquiries about the products put out by the Lucas Laboratories, Incorporated, of New York City. A typical inquiry is that received from Dr. F. A. Jewett of Brooklyn, who writes:

“The enclosed circular is sent out to the medical profession by Dr. William Lucas, 287 W. 70th St., New York. What do you know of this man and his methods?”

“The enclosed circular is sent out to the medical profession by Dr. William Lucas, 287 W. 70th St., New York. What do you know of this man and his methods?”

William H. Lucas was graduated by the Medical College of Ohio in 1895 and was licensed in 1897. He is not a member of his local medical society. The products put out by the Lucas Laboratories are for intravenous use, and their method of exploitation indicates that the concern is less interested in the science of therapeutics than it is in taking commercial advantage of the present fad for intravenous medication.The Journalhas protested editorially against the unnecessary use of the intravenous administration of drugs, and the abuse of this method of drug giving prompted the Council on Pharmacy and Chemistry recently to emphasize the danger of indiscriminate intravenous medication.

The products of the Lucas Laboratories, Inc., have not been examined either by the A. M. A. Chemical Laboratory or by the Council on Pharmacy and Chemistry. The composition of these products is essentially secret, which in itself should be sufficient to deter physicians from using them. Of course, in accordance with all the tenents of orthodox nostrum exploitation, “formulas” are furnished. Even the crude hieroglyphics that used to be palmed off on the medical profession by nostrum exploiters under the guise of “graphic formulas” are outdone by the Lucas Laboratories in publishing the alleged formulas of its preparations. If we, as physicians, knew more chemistry, the Lucas Laboratories would not find it profitable to publish such ineffable nonsense as that which characterizes their “literature.” For instance:

“ ‘Luvein’ Arsans (Plain)” is said to be: “Di hypo sodio calcio phosphite hydroxy arseno mercuric iodid.” The first part of this “formula” might stand for sodium and calcium hypo­phosphite. The remainder is meaningless exceptthat it suggests (but does not insure) the presence of arsenic and mercury iodide.“ ‘Luvein’ Arsans, Nos. 1, 2 and 3.”—“Meta hydroxy iodide sodio arsano mercuric dimethyl benzo sodio arsenate, ai oxy sodio tartaria sulpho disheuyl hydrazin.” Who can venture even a conjecture as to the possible significance of this?“ ‘Luvein’ Creosophite.”—“Ammonio hydroxy calcio sodio hypo-phosphite arsenous pentoxy iodide.” While the name suggests creosote, the “formula” gives no hint of this. It might refer to hypo­phosphites of ammonium, calcium and sodium with iodide of arsenic. Whether arsenous (trivalent arsenic) or arsenic (pentavalent arsenic) iodide or both are intended, is a question.“ ‘Luvein’ Hexacol.”—“Hexa methylenepyro catechin mono methyl amino ether glycerite.” By moving these syllables around like the old “fifteen puzzle” they can be arranged to represent hexa­methylen­amin and monomethyl-ether of pyrocatechin, or guaiacol, having the “glycerite” left over.

“ ‘Luvein’ Arsans (Plain)” is said to be: “Di hypo sodio calcio phosphite hydroxy arseno mercuric iodid.” The first part of this “formula” might stand for sodium and calcium hypo­phosphite. The remainder is meaningless exceptthat it suggests (but does not insure) the presence of arsenic and mercury iodide.

“ ‘Luvein’ Arsans, Nos. 1, 2 and 3.”—“Meta hydroxy iodide sodio arsano mercuric dimethyl benzo sodio arsenate, ai oxy sodio tartaria sulpho disheuyl hydrazin.” Who can venture even a conjecture as to the possible significance of this?

“ ‘Luvein’ Creosophite.”—“Ammonio hydroxy calcio sodio hypo-phosphite arsenous pentoxy iodide.” While the name suggests creosote, the “formula” gives no hint of this. It might refer to hypo­phosphites of ammonium, calcium and sodium with iodide of arsenic. Whether arsenous (trivalent arsenic) or arsenic (pentavalent arsenic) iodide or both are intended, is a question.

“ ‘Luvein’ Hexacol.”—“Hexa methylenepyro catechin mono methyl amino ether glycerite.” By moving these syllables around like the old “fifteen puzzle” they can be arranged to represent hexa­methylen­amin and monomethyl-ether of pyrocatechin, or guaiacol, having the “glycerite” left over.

It is futile to discuss the therapeutic claims made for the various preparations put out by the Lucas Laboratories. One might as profitably discuss the therapeutic claims made for “Peruna” or “Paine’s Celery Compound” for the exploitation of the latter products is on just as high a scientific plane as the exploitation of the “Luvein” nostrums. The proposition offered to physicians by the Lucas Laboratories, Inc., is an insult to the intelligence of the medical profession. Not that the products themselves are necessarily any worse or any better than many offered for intravenous use; the selling methods are more crude, that is all.

The facts are, we have entered a new cycle of nostrum development. The unscientific mixtures for oral administration that characterized so large and disreputable a part of the proprietary medicine business of the past two or three decades are giving way to equally unscientific mixtures for intravenous use. The dangers of the older nostrums are accentuated in the newer by the added element of risk that is inseparable from intravenous therapy. Add to this the temptation to the physician in the way of more substantial fees which, legitimately enough, may be charged when intravenous administration is called for, and the menace of the new style nostrum becomes evident.The Journalcan only reiterate the warning that intravenous therapy should be employed only when most positively indicated. Further, because of the danger that is inseparable from this method of drug administration, physicians should be doubly careful to see that products employed for intravenous use come from firms of unquestioned scientific standing.—(From The Journal A. M. A., Sept. 20, 1919.)

A physician in Florida writes:

“I am enclosing a copy of a circular letter just received from Parke, Davis & Company, and will call your attention to a marked paragraph in this letter on which I would like to have an expression of your opinion.”

“I am enclosing a copy of a circular letter just received from Parke, Davis & Company, and will call your attention to a marked paragraph in this letter on which I would like to have an expression of your opinion.”

The circular letter which the doctor forwards is devoted to singing the praises of “Pneumonia Phylacogen.” It opens with the statement: “Influenza, we learn, has appeared in your section.” The paragraph marked by our correspondent reads:

“Pneumonia Phylacogen has been found to be a dependable means of preventing and treating pneumonic complications of Influenza. In one large city it became a routine measure to give all persons affected with Influenza an injection of Pneumonia Phylacogen as a prophylacticof pneumonia. The results were remarkable. Not only did the cases improve rapidly, but in a great majority of them the pneumonia did not occur.”

“Pneumonia Phylacogen has been found to be a dependable means of preventing and treating pneumonic complications of Influenza. In one large city it became a routine measure to give all persons affected with Influenza an injection of Pneumonia Phylacogen as a prophylacticof pneumonia. The results were remarkable. Not only did the cases improve rapidly, but in a great majority of them the pneumonia did not occur.”

The “Phylacogens” were repeatedly discussed inThe Journalduring 1913 and 1914 when these products were being pushed with much vigor by the manufacturers. We know of no evidence that calls for a revision of the statements then made regarding them. The injection of phylacogens is simply the administration of a mixture of the filtered products of several bacterial species. The results which follow represent the reaction of the bacterial protein—a reaction for good or evil. There is no scientific evidence to show that they possess any specific prophylactic virtue. To recommend their use in cases of influenza, as a prophylactic against pneumonia, is unwarranted, and the physician who acts on the advice of the manufacturer must assume the responsibility for the results. In case of mishap he cannot fall back on the manufacturer; he will find no scientific evidence to support him.—(From The Journal A. M. A., Nov. 15, 1919.)

To the Editor:—Enclosed is a postal card which a physician in Oklahoma has sent me together with thirty-six cents in stamps. The envelop was addressed to me at the address of the Pineoleum Company. The postoffice corrected the address and sent it to me. It is evident, therefore, that the physician in Oklahoma thought I was sending these postals as an employee of the Pineoleum Company, or, at least, was endorsing their products.

Postal card capitalizing the name and position of the President of the American Medical Association.

Postal card capitalizing the name and position of the President of the American Medical Association.

Kindly do me the favor to publish this letter inThe Journalas a protest against the dishonesty of this method of advertising. What is quoted from an article that I wrote appeared originally in theNew York State Journal of Medicineand was abstracted inThe Journalof the American Medical Association of August 2, 1919. The obvious inference to be drawn from this postal is that I referred to the products of the Pineoleum Company in that article. I did not have the products of the Pineoleum Company in my mind. I never have used their products and never prescribed them.

This form of advertising is done with intent to deceive and did deceive the doctor in Oklahoma. It was therefore a successful falsehood, its successdepending on the false use of the name of the President of the American Medical Association to bolster up the sale of the product.

I resent the use of my name in connection with the quack advertising of nostrum venders. The low, vulpine cunning of the method used is on the same level as the deceit and dishonesty which use this form of advertising to the injury of my name and reputation. As President of the American Medical Association I must insist that you protect me by publishing this letter inThe Journal, giving it as widespread publicity as possible.

Alexander Lambert.

[Comment.—“Pineoleum” is a “patent medicine” advertised in the cheapest and most effective way—by the aid of the easy going and complacent physician. In 1906 Pineoleum was being marketed by the Winslow Laboratory of New York City, which also put out three or four other nostrums—“Morumalt,” “Egeriol,” “Digestylin,” and “Ford’s Nucleo-Peptone.” Pineoleum was advertised to the public then as it is advertised now, via the medical profession. Physicians are circularized and are offered a petty graft in the form of a cheap nebulizer and a sample bottle of Pineoleum. Some time ago the company seems to have developed a scheme whereby physicians could make money “dispensing Pineoleum nebulizer outfits at more than 140 per cent. profit.” The Pineoleum concern for years has also polluted the stream at its source by attempting to get the secretary of the senior class of every medical school to distribute its free nebulizer outfits to members of the class and receive therefor 5 cents for each outfit distributed! The life history of Pineoleum is that of the typical nostrum. Epidemics, of course, are utilized as opportunities for pushing the product. In 1911 a card was sent out featuring “A Special LaGrippe Offer”; in 1916 the profession was circularized recommending Pineoleum as “The Ideal Prophylactic” in infantile paralysis; during the past year influenza has again been the selling point.

The case described by Dr. Lambert is not the first example of the misuse of names and statements of physicians. Last December the Pineoleum concern was sending out an advertising card in which Dr. McCoy of the United States Public Health Service was quoted as recommending Pineoleum as the “bulwark of prevention” and “battery of relief” in influenza. Of course, Dr. McCoy never said anything of the sort. A protest against this particular falsehood resulted in another card being sent out several months later by the Pineoleum people purporting to explain and apologize for the misquotations and putting the blame on the printer. The “apology” ended with a postscript (in larger and bolder face type than the body of the card) that urged physicians to “secure our liberal introductory advertising proposition on improved oil nebulizer outfits.” From the standpoint of publicity for Pineoleum, the “explanation and apology” was doubtless as good an advertisement as the original card of misrepresentation.—Ed.]—(From The Journal A. M. A., Nov. 1, 1919.)

To the Editor:—Will you please advise as to the success and safeness in using the Proteal treatment for tuberculosis by Henry Smith Williams, M.D., LL.D., 104 East 40th Street, New York?C. P. Burchard, Alamogordo, N. M.

To the Editor:—Will you please advise as to the success and safeness in using the Proteal treatment for tuberculosis by Henry Smith Williams, M.D., LL.D., 104 East 40th Street, New York?

C. P. Burchard, Alamogordo, N. M.

To the Editor:—Kindly send me any available information on “The Proteal Treatment for Cancer.” An article by Dr. Henry Smith Williams, 120 West 32 Street, New York City, in AprilHearst’shas caused relatives to request its use in a case of carcinoma of the liver under my care.M. M. Reppard, Middlebourne, W. Va.

To the Editor:—Kindly send me any available information on “The Proteal Treatment for Cancer.” An article by Dr. Henry Smith Williams, 120 West 32 Street, New York City, in AprilHearst’shas caused relatives to request its use in a case of carcinoma of the liver under my care.

M. M. Reppard, Middlebourne, W. Va.

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