The term “patent medicine” is loosely used to designate all remedies of a secret, non secret, or proprietary character, which are widely advertised to the public. This use of the name is erroneous, and it is better first to understand the exact difference between the different classes of medicines generally comprised under this heading. Only in this way can one comprehend their right and wrong use.
A Patent Medicine is a remedy which is patented. In order to secure this patent, an exact statement of the ingredients and the mode of manufacture must be filed with the government. These true “patent medicines” are generally artificial products of chemical manufacture, such as phenacetin. The very fact of their being patented makes them non secret, and if an intelligent idea is held of their nature and mode of action, they may be properly used. Physicians with a full knowledge of their uses, limitations, and dangers often, and legitimately, prescribe them, and thus used they are the safest and most useful of all drugs and compounds of this class.
A Nostrum. The Century Dictionary defines a nostrum as “a medicine the ingredients of which, and the methods of compounding them, are kept secret for the purpose of restricting the profits of sale to the inventor or proprietor.” Some nostrums have stated, on their label, the names of their ingredients, but not the amount. There has been no restriction upon their manufacture or sale in this country, therefore the user has only the manufacturer’s statement as to the nature of the medicine and its uses, and these statements, in many instances, have been proved utterly false and unreliable.
A Proprietary Medicine is a non secret compound which is marketed under the maker’s name. This is usually done because the manufacturer claims some particular merit in his product and its mode of preparation, and as these drugs are perfectly ethical and largely used by physicians, it is to the maker’s interest to maintain his reputation for the purity and accuracy of the drug. Familiar instances of this class are: Squibb’s Ether and Chloroform, and Powers & Weightman’s Quinine.
From the above definition it may be seen that the only unreliable medicines are those which are, in reality, nostrums. In regard to all of these medicines the following rules should be observed:
First. Don’t use any remedy that does not show its formula on the label.
Second. No matter what your confidence in the medicine, or how highly recommended it is, consult a physician before using very much of it.
Third. Take no medicine internally without a physician’s advice.
Throughout this chapter the word “patent medicine” will be used in its widely accepted form, in the everyday sense, without regard to its legal definition, and will be held to include any of the above mentioned classes, unless a direct statement is made to the contrary.
In Germany the contents of patent medicines are commonly published, and in this country, notably in Massachusetts, the State Boards of Health are analyzing these preparations, and making public their findings. In North Dakota a law has been passed which requires that a proprietary medicine containing over five per cent of alcohol, or any one of a number of specified drugs, be labeled accordingly.
PURE FOOD BILL. A far reaching and important step, in the movement for reform of patent medicines and for the protection of the public, has now been taken by the United States Government. On June 30, 1906, an act was approved forbidding the manufacture, sale, or transportation of adulterated, misbranded, or poisonous or deleterious foods, drugs, medicines, or liquors. This act regulates interstate commerce in these articles, and went into effect January 1, 1907. Section 7 of this act states:
“That for the purposes of this Act an article shall be deemed to be adulterated: in case of drugs:
” First. If, when a drug is sold under or by a name recognized in the United States Pharmacopoeia or National Formulary, it differs from the standard of strength, quality, or purity, as determined by the test laid down in the United States Pharmacopoeia or National Formulary official at the time of investigation; Provided , that no drug defined in the United States Pharmacopoeia or National Formulary shall be deemed to be adulterated under this provision if the standard of strength, quality, or purity be plainly stated upon the bottle, box or other container thereof although the standard may differ from that determined by the test laid down in the United States Pharmacopoeia or National Formulary.
” Second. If its strength or purity fall below the professed standard or quality under which it is sold.”
Section 8 states that a drug shall be deemed misbranded:
” First. If it be an imitation of or offered for sale under the name of another article.
” Second. If it (the package, bottle or box) fails to bear a statement on the label of the quantity or proportion of any alcohol, morphine, opium, cocaine, heroin, alpha or beta eucaine, chloroform, cannabis indica, chloral hydrate, or acetanilid, or any derivative or preparation of any such substances contained therein.”
What are the motives which impel persons to buy and use patent medicines? The history of medicine offers a partial explanation. In somewhat remote times we find that the medicines in use by regular physicians were of the most vile, nauseating, and powerful nature. We read of “purging gently” with a teaspoonful of calomel. Then during the wonderful progress of scientific medicine, beginning a little more than a half century ago, the most illustrious and useful workers were so busily engaged in finding the causes of disease and the changes wrought in the various organs, in observing the noticeable symptoms and in classifying and diagnosticating them, that treatment was given but scant attention. This was nowhere more noticeable than in Germany, the birthplace, home, and world center of scientific medicine, to which all the medical profession flocked. Patients became simply material which could be watched and studied. This was an exemplary spirit, but did not suit the patients who wanted to be treated and cured. This fact, together with the peculiar wording of the laws regulating the practice of medicine, which allow anyone with the exception of graduates to treat patients, but not to prescribe or operate upon them, accounts for the number of quacks in Germany.
Dr. Jacobi states that “there is one quack doctor to every two regular physicians in Saxony and Bavaria.”[12]
Another cause for the use of patent medicines is mysticism. Ignorance is the mother of credulity. It is reported[13] that Cato, the elder, recommended cabbages as a panacea for all sorts of ills, that he treated dislocations of the limbs by incantations, and ordered the Greek physicians out of Rome. The ignorant are greatly influenced by things that they cannot understand. Therefore, as the mass of people are utterly ignorant of the changes in structure and function of the body caused by disease, and also the limitations of medicines in their power of healing such alterations, their belief in the mysterious power said to attach to patent medicines is not surprising. When testimonials of the efficacy of patent medicines purporting to come from respectable divines, merchants, and statesmen are offered, the proof of their power seems incontestable.
Economy and convenience are added incentives to the employment of patent medicines. This method of saving the doctor’s fee is engendered by those physicians who themselves write prescriptions for nostrums. “Why not, indeed, eliminate this middleman (the doctor) and buy the nostrums direct?” So say the unthinking. But what doctor worthy of the name would prescribe a medicine the composition of which he was ignorant? Yet it is frequently done. As Dr. Cabot has so aptly put it, what would be thought of a banker or financial adviser who recommended his client to buy a security simply on the recommendation of the exploiter of the security? Yet that is exactly the position of a doctor who recommends a nostrum.
In view of the fact, therefore, that persons of undoubted intelligence are in the habit of purchasing and using remedies of this character and since many of the most widely advertised preparations are extremely harmful, even poisonous, we have taken the liberty of pointing out a few “danger signals,” in the guise of extravagant assertions and impossible claims, which are characteristic signs of the patent medicines to be avoided.
DANGER SIGNALS. There are many picturesque and easily grasped features in the literature, labels, and advertising of patent medicines that spell danger. When these features are seen, the medicine should be abandoned immediately, no matter what your friends tell you about it, or how highly recommended it may have been by others than your physician.
Claiming a Great Variety of Cures. Perhaps of all features of patent medicine advertising, this is the most alluring. No one drug or combination of drugs, with possibly one or two exceptions, can or does “cure” any disease. Patients recover only when the resistance of the body is greater than the strength of the disease. This body resistance varies in different persons, and is never just alike in any two individuals or illnesses. The patient must be treated and not the disease, so it is the aim of every conscientious physician to conserve and strengthen the vital forces and, at the same time, guard against further encroachment of the disease. There is no cure all, and even if a drug or combination of drugs were helpful in any single case, they might easily be totally unsuited, or even harmful, in another case, with apparently similar symptoms. When a maker claims that his particular concoction will cure a long list of diseases, the assertion bears on its face evidence of its falsity.
One of the most widely advertised and largely sold catarrh remedies claims to cure pneumonia, consumption, dyspepsia, enteritis, appendicitis, Bright’s disease, heart disease, canker sores, and measles. This is absolute fraud. No matter what virtues this medicine might have in the treatment of one or two ailments, no one remedy could possibly be of service in such a varied list of diseases, and it could not “cure” one of them.
Another remedy bases its assertion of “cures” on the fact that it claims to be a germ killer, and assumes that all disease is caused by germs. To quote from its advertising literature, it claims to cure thirty seven diseases which are mentioned by name, and then follows the assertion that it cures “all diseases that begin with fever, all inflammations, all catarrhal contagious diseases, all the results of impure or poisoned blood. In nervous diseases acts as a vitalizer, accomplishing what no drugs can do.” It would seem that an intellect of any pretensions would recognize the fraudulent nature of this claim, yet thousands of bottles of this stuff are annually sold to a gullible public. These wide and unjustifiable claims are real danger signals, and any medicine making them should be avoided. There are many other remedies for which just as great claims are made; the two instances cited are merely representative of a large class. It is a waste of time, money, and health to buy them with any idea that they can fulfill their pretensions.
Claiming to Cure Headaches. The use of any “headache powders” or “tablets” should be avoided, except on the advice of a physician. The presence of pain in the head, or in any other part of the body, may be a symptom of a serious and deep seated disorder, and it may often be a serious matter to temporize with it. At the best, these “pain relievers” can give only temporary relief, and their use may prove to be dangerous in the extreme. Their action is dependent upon one of the modern coal tar products, usually acetanilid, because it is the cheapest. But, unfortunately, acetanilid is also the one with the most depressant action on the heart. The danger of headache powders lies in the habit which they induce, because of their quick pain relieving qualities and their easy procurability, and from overdosage. If a person is otherwise in good health, the use of one headache powder will in all probability do no harm, but the dose should not be repeated without a doctor’s authority. Many deaths have occurred from their continued use, or because of an idiosyncrasy on the part of the taker, but it is their abuse more than their use which has brought upon them such almost universal condemnation. Therefore, while the physician may advocate their use, do not take them without his advice and specific directions as to kind and dosage.
Claiming Exhilaration. These medicines, by their insidious character, constitute a particularly dangerous variety. They depend, for their effect, upon the amount of alcohol that they contain. Many conscientious temperance workers have not only unsuspectingly taken them, but have actually indorsed them. Recently the published analyses of several State Boards of Health and the investigations made by Samuel Hopkins Adams, and published in his series on “The Great American Fraud” have shown that a majority of the “tonics,” “vitalizers,” and “reconstructors” depend for their exhilarating effect upon the fact that they contain from seventeen to fifty per cent of alcohol; while beer contains only five per cent, claret eight per cent, and champagne nine per cent. Pure whisky contains only fifty per cent of alcohol, yet few people would drink “three wineglassfuls in forty five minutes”[14] as a medicine pure and simple. The United States Government has prohibited the sale of one of these medicines to the Indians, simply on account of the fact that as an intoxicant it was found too tempting and effective.[15]
If one must have a stimulant it is better to be assured of its purity. These medicines are not only costly, but contain cheap, and often adulterated, spirits.
Their worst feature is that they often induce the alcoholic habit in otherwise upright people. Commencing with a small dose, the amount is gradually increased until the user becomes a slave to drink. Could the true history of these widely used medicines be written, it would undoubtedly show that many drunkards were started on their downward career by medicinal doses of these “tonics” and “bracers.”
Claiming Pain relieving or Soothing Qualities. The properties of this class of remedies depend generally upon the presence of cocaine, opium, or some equally subtle and allied substance. It should be needless to state that such powerful drugs should be taken only upon a physician’s prescription. Habit forming and insidious in character, they are an actual menace. When present in cough syrups, they give by their soothing qualities a false sense of security, and when present in “soothing syrups” or “colic cures” for babies, they may be given with fatal result. Never take a medicine containing these drugs without a full understanding of their dangerous character, and a realization of the possible consequences.
Testimonials. These may mean anything or nothing; generally the latter. They are usually genuine, but, as Mr. Adams observes, “they represent, not the average evidence, but the most glowing opinions which the nostrum vender can obtain, and generally they are the expression of a low order of intelligence.”[16] It is a sad commentary on many men and women, prominent in public life, that they lend their names and the weight of their “testimony” to further the ends of such questionable ventures. Political and newspaper interests are responsible for the collection of this class of testimonials. An investigation of some men, who permitted the use of their names for this purpose, revealed that many of them had never tasted the compound, but that they were willing to sign the testimonials for the joy of appearing in print as “prominent citizens.”[17] “Prominent ministers” and “distinguished temperance workers” are often cited as bearing testimony to the virtues of some patent medicine. It has been shown that, while the testimonials were real, the people who signed them had little right of credence, and were possessed of characters and attributes which would show their opinions to be of little value. Money and energy can be productive of any number of testimonials for any remedy. While some of them may be authentic, yet the fact that a medicine “cured” any one of the signers is no evidence that it will cure or even help anyone else. Many people recover from diseases with no medicine at all, and isolated “cures” can never be taken as a criterion of the value of any remedy or method.
Offering “Money Back Unless Cured.” Careful reading of this clause in most advertising literature will show that there is “a string attached.” The manufacturers are usually safe in making this proposition. In the first place, the average person will not put the matter to a test. The second reason why this is a safe proposition for the maker is, that if the medicine does not cure, the patient may die, and dead men are hardly possible claimants.
Claiming to Cure Diseases Incurable by Medicine Alone. Probably no class of people are greater users of patent medicines than those unfortunates afflicted with the so called incurable diseases. The very fact of the serious nature of their complaint, and the dread of surgical intervention, makes them easy victims to the allurement of “sure cures.”
The committee on the prevention of tuberculosis of the Charity Organization Society of New York City has announced in decided terms that there is no specific medication for consumption. Cancer, likewise, cannot be cured by the use of internal medicine alone. Surgery holds out the greatest hope in this dread disease. The medicines claiming to cure these diseases are, therefore, of the most fraudulent nature. Their use is positively harmful, for in taking them priceless time is lost.
Never temporize if there is any suspicion of the existence of such diseases as consumption or cancer. Self treatment with patent medicines in such cases is worse than useless it is actually dangerous to life itself. Consult a physician at the earliest possible moment, and put no faith in patent medicines.
There are, however, as has been pointed out, certain patent and proprietary medicines which may properly be employed by the physician. These include the newly discovered, manufactured chemicals of known composition and action; and single substances or combinations of known drugs in known proportions, which can only be made to best advantage by those having the adequate facilities. The habit of prescribing proprietary mixtures of several substances for special diseases is, however, generally a matter of laziness, carelessness, or ignorance on the doctor’s part. This follows because no disease is alike in any two patients; because any one disease has many phases and stages; and because a doctor should always treat the patient and not the disease. Thus a doctor, after carefully questioning and examining the patient, should adjust the remedy to the peculiarities of the patient and disease. It is impossible to make a given combination of drugs fit all patients with the same disease.
The quantity of patent medicine sold in the United States is enormous. A series of articles by Samuel Hopkins Adams appeared in Collier’s Weekly during 1905 and 1906, in which he not only showed the fraudulent character of many of the best known patent medicines, giving their names and most minute details concerning them, but furnished much reliable information in an interesting and convincing manner. In the course of these articles he pointed out that about one hundred millions of dollars are paid annually for patent medicines in the United States. As explaining this, in part, he affirmed that as many as five companies each expended over one million dollars annually in advertising patent medicines.
What Are the Good Ones Good For? In any great movement, when a dormant public suddenly awakens to the fact that a fraud has been perpetrated or a wrong committed, the instinctive and overwhelming desire is for far reaching reform. In efforts to obtain needed and radical improvement, and with the impetus of a sense of wrong dealing, the pendulum of public opinion is apt to swing too far in an opposite direction. There are bad patent medicines the proof of their fraudulent character is clear and overwhelming; but there are good ones whose merits have been obscured by the cloud of wholesale and popular condemnation. It is true that the manufacturers of even some of the valuable ones have an absurd habit of claiming the impossible. This attitude is to be regretted, for the makers have thus often caused us to lose faith in the really helpful uses to which their products might be put.
However, it is well in condemning the bad not to overlook the good. The mere fact that a medicine is patented, or that it is a so called proprietary remedy, does not mean that it is valueless or actually harmful. The safety line is knowledge of the medicine’s real nature, its uses and its dangers; the rules given above should be rigorously followed.
It is far easier to give general indications for the guidance of those wishing to shun unworthy patent medicines than to enable the reader to recognize the worthy article. It is safe to assume, however, that there are certain simple remedies, particularly those for external application, which have a definite use and are dependable. In justice it must be said that great improvement has taken place, and is now taking place in the ethical character of patent medicines, owing to recent agitation, and what is true concerning them to day may not be true to morrow.
The only proper, ethical patent medicine is the one showing its exact composition, and refraining from promise of a cure in any disease. Such a one might, nevertheless, advertise its purity, reliability, advantageous mode of manufacture, and the excellence of its ingredients with more modest and truthful claims as to its use.
The purchaser of a patent medicine pays not only for the ingredients, the cost of combining them, and the maker’s just profit, but he also pays the exploiter’s bills for advertising and distributing the finished product. With such standard remedies as those mentioned above, this added cost is usually a good investment for the purchaser, because trade marked remedies which have “made good” possess two advantages over those less advertised, and over their prototypes in crude form: procurability and integrity.
Even at remote cross roads stores, it is possible to obtain a popular remedy, one which has been well pushed commercially. And an article sold in packages sealed by the makers gets to the consumer just as pure as when it left the laboratory. This is not always true of ingredients held in bulk by the retailer; witness the evidence brought forward in recent prosecutions for drug adulteration.
It is not the purpose of this chapter, in any sense, to advertise or place the seal of its unrestricted approval upon any one article of a class. Its position in the matter is absolutely impartial. But in order that it may be as helpful as possible, it definitely mentions the most widely known, and therefore the most easily obtainable, remedies. There are other equally good remedies in each case, but as it would be almost impossible to mention each individual remedy with similar virtues now on the market, the ones discussed must be taken as representative of their class in each instance.
Do not forget that the use of these simple remedies does not justify their abuse. They may make great claims while their use is really limited. Do not rely upon them to do the impossible.
Vaseline. This is pure and refined petroleum, and will be found of much service in many forms of skin irritation. It is useful in the prevention of “chapping,” for softening rough skin, for preventing and healing bleeding and cracked lips, as a protective dressing in burns, cuts, or any acute inflammation of the skin where the cuticle has been injured or destroyed, or where it is desirable that a wound should be protected and kept closed from the air. Rubbed over the surface of the body when a patient is desquamating or “peeling” after scarlet fever or measles, it keeps the skin smooth, soothes the itching, and prevents the scales from being carried about in the air and so infecting others. Vaseline is a soothing, nonirritating, and bland protective ointment for external use. It is perfectly harmless, but should not be used for severe skin disease or for internal use, unless recommended by a physician in conjunction with other means of healing.
Pond’s Extract. Although the makers have claimed special virtues for this remedy, it is in reality an extract of hamamelis or witch hazel, and probably differs little in its application or results from the ordinary marketed extract made by the average druggist. It is mild and bland, harmless when used externally, but should not be used internally unless ordered by a physician. It is soothing and healing when applied to wounds, sprains, and bruises; diluted with water it is a pleasant gargle for a sore throat, and may be applied externally on the throat by means of a flannel wrung out in a solution of it in hot water. For nosebleed it is often efficient when snuffed up the nose, or when pledgets of cotton are soaked in it and placed in the nostrils. It may be used as an application in ulcers or varicose veins, and from two to four teaspoonfuls with an equal amount of water injected into the rectum two or three times daily will often prove of great help in piles, particularly if bleeding. It gives relief when used for sore or inflamed eyes or eyelids, but in this, as in all other serious inflammations, it is not a “cure all,” and the physician should be consulted if the relief is not prompt.
Listerine. Of the many mild liquid antiseptics “Listerine” is probably the best known. The remarks and recommendations concerning it, however, are equally applicable to many other remedies of a somewhat similar nature, such as glycothymoline, borolyptol, lythol, alkalol, formalid, etc.
Listerine is a solution of antiseptic substances with the addition of thymol and menthol in quantities sufficient to give it a pleasant odor and taste. It has a very strong hold on the public, and is a deservedly useful remedy.
Listerine has many helpful uses. It is potent enough to kill many germs, and is excellent for this purpose when used as a mouth wash, particularly during illness. In acute cold in the head it is soothing to the mucous membrane of the nose, if used diluted with warm water as a nasal douche. It serves a similar purpose when used as a gargle in mild sore throat.
If there is any reason to suspect that dirt or other foreign matter has come in contact with a sore or cut, the wound may be freely washed with a solution of listerine in order to clean it and render it as nearly aseptic as possible. When there are distinct signs of inflammation it should not be relied upon. Do not use it internally without a physician’s advice.
Scott’s Emulsion. This is a good emulsion of cod liver oil, widely prescribed by physicians for the many patients who are too delicate stomached to retain the pure oil. For those who can take the refined oil straight, Peter Möller’s brand is in a class by itself.
In certain conditions cod liver oil is one of the most valuable remedies known. As a concentrated and reconstructive food in many wasting diseases it is of great service. Weak and puny children, and all suffering from malnutrition may take it with benefit. It does help produce flesh, increase strength, and add to the body’s resisting powers. It does not contain any medicinal properties, and its virtue is largely in its fat or oil, but as an aid to other remedies, or alone, when increased nutrition is desired, it is a reliable and helpful remedy.
Antiphlogistine. There are many clay poultices on the market: antiphlogistine, antithermoline, cretamethyl, sedol, unguentum, yorkelin, and the Emplastrum Kaolini of the U. S. Pharmacopoeia. Antiphlogistine, being probably the most widely known, is here discussed. It is of value when a poultice is indicated. It is preferable to the homemade varieties in that it retains heat for a longer period of time and is antiseptic.
It should never be used in deep seated inflammations, such as peritonitis, appendicitis, deep abscesses of any part of the body, or other serious conditions, unless recommended by a physician; for such ailments need more thorough treatment than can be afforded by any poultice. It is perfectly harmless, and may be used with decided benefit in aborting or preventing many inflammatory diseases. Applied in the early stages of a boil, felon, or carbuncle it may either abort the trouble or, if the disease has already progressed too far, it will hasten suppuration and shorten the course of the disease. When a poultice is indicated in bronchitis or pleurisy it is an excellent one to use; it will afford much comfort, and often hasten recovery. In nursing mothers, when the breasts become full and tender and signs of beginning inflammation are present, antiphlogistine spread in a warm and thick coat over the breasts will often afford relief.
Platt’s Chlorides. When it is desirable to use a liquid disinfectant Platt’s Chlorides will be found a useful article, as will lysol and other marketed products. The source of a foul smell or dangerous infection should never be overlooked. No disinfectant can offer a safeguard if plumbing is defective, or other unsanitary conditions exist; in fact, disinfectants are often deprecated, since they afford a false sense of security. If a contagious disease exists in a household, other means than the use of a disinfectant must be taken in order to prevent the spread of the contagion. Disinfectants do have their uses, however, and are often essential. In case of an illness of a contagious or infectious nature, a solution of Platt’s Chlorides or a similar disinfectant should be kept in all vessels containing or receiving discharges from the body. Pails containing such a solution should be in readiness to receive all cloths, bedding, or washable clothes which have come, in any way, in contact with the patient.
FOOTNOTES:
[11] The publishers announce this chapter as prepared independent of Dr. Winslow or any of the Advising Editors. Considered as an effort to give helpful information, free of advertising on the one hand and sensational exposures on the other, the article meets with the approval of conservative physicians. But the problems dealt with are too involved at present for discussion direct from the profession to the public.
[12] Jacobi, Jour. Am. Med. Assn., Sept. 29, 1906.
[13] Ibid.
[14] S. H. Adams, “The Great American Fraud.”
[15] Ibid.
[16] S. H. Adams, “The Great American Fraud.”
[17] S. H. Adams, “The Great American Fraud.”