Drug Therapy &
by Arthur J. Cramp
“Therapeutic Thaumaturgy” in The American Mercury, December 1924 pp. 423-430
“To succeed in the world it is
much more necessary to possess the penetration to discover who is the
ignoramus than to discover who is the wise man”. - Talleyrand
Vis Medicatrix Natura
At an earlier date, before
government assumed the right to tell us what we should eat, what we should
drink, and howsoever we should be clothed, the motto of American business
was “Caveat Emptor”.
Today the tendency is to insist
that it is the seller who should beware - “Caveat Vendor”.
The earlier motto was that of a
race of individualists; it was a natural application of laissez-faire, a
natural functioning of the Manchester school.
And in general it worked very
True, the bucolic visitor to the
bright lights might be persuaded to part with perfectly good money for a
fictitious title to the Woolworth Building, but the balance of trade was
maintained when sophisticated and hardboiled urbanites visited the great
open spaces and were sold real estate which, if it was more material than
fake titles to skyscrapers, yet had no greater value.
In the barter, sale or exchange of
practically every line of merchandise save one, the purchaser has a chance
of learning, eventually, whether or not he has been swindled.
Even to the unexpert, time through
its agencies, wear and tear, makes clear whether one has made a good or a
bad bargain in the purchase of an automobile, a piano or a suit of clothes.
Conversely, the man who sells
cars, or musical instruments or raiment has nature as an opponent.
If the goods are not up to
specifications, it is but a matter of time before the purchaser learns the
fact, and so acquires knowledge which, if he has brains, may prevent him
making the same error the next time.
But there is one commodity in the
purchase of which the public never does and never can get an even break:
products or services that are sold for the alleged alleviation or cure of
For here the seller has nature,
not as an opponent, but as an assistant.
The healing power of nature: “Vis
Medicatrix Natura”, is such, fortunately for biologic perpetuity, that the
general tendency of the disordered animal economy is to get well.
Not always, it is true; there come
stages and conditions in which the tendency of the ailing body is to go on
But in probably 80%, of all human
ailments the afflicted person gets well whether he does something for his
indisposition or does nothing for it.
Herein lies the opportunity of the
quack and the nostrum vendor.
therapeutic effect lay outside the realm of fact
In that special branch of industry
commonly, though incorrectly, spoken of as the patent-medicine business, the
let-us-alone policy reached its highest degree of development just prior to
In no other field did
individualism in trade go to such lengths.
Although the business is one that
affects not merely the purse but also the very health and life of the
nation, it was subject to less control and reeked with more fraud and
chicanery than any other line.
Until 1st of January
1907, the manufacturers of the proprietary remedies commonly called
patent-medicines were under no restraint whatever save that imposed by their
own consciences, and it was rare, indeed, for them to have consciences.
True, the seller of nostrums, even in
those days, was in theory subject to the Common Law and it prohibited the
perpetration of fraud, but the public seemed to assume and the courts to
acquiesce in the assumption that claims for therapeutic effect lay outside
the realm of fact and belonged in the broad and elastic field of opinion.
No one ever heard of the manufacturer of a
sure cure for consumption or cancer being sued by a defrauded purchaser who
had failed to be cured.
particularly crude quacksalver was haled into court by the heirs of a victim
who had been poisoned by his vicious concoction, but no one ever thought of
bringing suit against a seller of the elixir of life because his preparation
merely failed to live up to the claims made for it.
Then, in 1907,
there went into effect what is known as the Pure Food and Drug Law - the
National Food and Drugs Act.
The enactment of
this statute reflected the influence of that large body of citizens who had
come either directly or through their near forbears from the more
paternalistic governments of continental Europe.
It was an effort
on the part of the Federal government to protect the uninformed from their
ignorance in a field in which ignorance is peculiarly helpless.
When the bill
which finally became the law was introduced it was fought tooth and nail by
the sophisticators of foods and the exploiters of nostrums, and much was
done during its consideration to tone down the restrictions originally
planned by those who framed it.
As it finally went
on the statute books the law said, in effect, that a patent-medicine or any
other drug product would be deemed misbranded “the package or label of which
shall bear any statement which shall be false or misleading in any
To the non-legal
mind such a statement seems fairly definite and clear cut; and it was so
interpreted by many courts and by most of the proprietary remedy fraternity.
The majority of
patent-medicine sellers, as soon as the law became effective, modified their
labels and packages so as to eliminate the false and misleading claims that
had previously appeared on them.
They began to
confine their mendacity to those avenues of publicity that were immune to
the law: newspaper advertisements, billboards, circulars for the drug
It took a
cancer-cure quack to show that what appeared to be a plain statement of fact
was really something to be interpreted only in a Pickwickian sense.
This man, when
proceeded against by the Federal authorities for making false therapeutic
claims regarding his “cure”, advanced the plea that the law was not intended
to cover questions of therapy.
The court in which
he was tried upheld his plea and, when the case was carried to the United
States Supreme Court, that august body, in a divided opinion, sustained the
lower court and held in effect that the statement “false or misleading in
any particular” really meant false or misleading in certain particulars.
The court admitted
that, "logically” interpreted, the Food and Drugs Act probably prohibited
the making of false statements regarding curative effects, but it held that
if interpreted “idiomatically” it did not so prohibit.
And the majority
of the court decided in favour of an idiomatic interpretation, and,
incidentally, in the interests of as vicious a gang of high-binders as ever
operated under the protection of law.
It is but fair to
record even at this late date that Justices Hughes, Harlan and Day,
decision was greeted with joy by the more crooked of the patent medicine
interests, but their victory was short-lived.
the interpretation had dealt the law a body blow, President Taft, in a
special message to Congress, urged the passage of an amendment that would
specifically prohibit false claims for therapeutic effects.
As a result, the
Sherley Amendment was passed.
In its original
form the amendment declared in effect that a patent-medicine or other drug
product would be deemed misbranded if the package or label bore any
statement regarding its curative effects which was “false or misleading.”
patent-medicine interests were able to force a change in this wording and to
substitute for the broad and inclusive phrase, “false or misleading,” the
narrower “false and fraudulent.”
As fraud, in the
eyes of the law, implies intent, and intent is a difficult thing to prove,
the change was of great tactical value to the fakers.
A comparison of
patent-medicine labels of pre-Pure Food Law days with those issued after the
passage of the act is an education in the art and science of mendacity.
Piso's "Cure for
Consumption' became a mere "Medicine for Coughs, Colds, Etc."
well-known alcoholic pick-me-up, which had previously appealed to suffering
womankind as "A Sure Cure For Falling of the Womb”, first dropped the “sure
cure” and eventually reached the comparatively innocuous, "Recommended for
the Treatment of Non Surgical Cases of Weakness and Disorders of the Female
Root, which used to "cure" various kidney diseases, was first made to
“correct” these troubles and finally was meekly “recommended” for them.
manufacturers of Castor Oil Pills, which "give the effect without the
taste”, were left in a predicament by the law.
As the pills
contained no castor oil, the name was so obvious a falsehood that not even
an idiomatic interpretation would release it from the law's penalties.
But the name of a
patent-medicine is really its most important commercial asset, the
composition being of minor moment.
It thus became
necessary for the exploiters of Castor Oil Pills, in casting about for a new
name, to coin one that, while passing muster, would not make all their
previous advertising a total loss.
That the name had
to be changed was obvious, but there was nothing to prevent the retention of
So it came to pass
that a public that continued to call for Castor Oil Pills was handed Casca
But the National Food and Drugs Act was not the only restraining influence
on the traffic in proprietary medicines. States and even municipalities,
awakened to the menace of the trade, enacted restrictive legislation.
As a result, the catarrh snuffs, loaded with cocaine and creators of
numberless “coke snuffers”, were practically put out of existence, while the
sellers of morphine-containing soothing syrups found it necessary to modify
Later came the Harrison Anti-Narcotic Act of 1915.
This, while it has pretty effectually eliminated the nostrums containing
cocaine, has not put an end to those containing morphine.
The proprietary medicine interests were able to get a joker in the law which
permits the presence of limited quantities of opium, morphine, heroine and
codeine in their preparations. This has brought about an anomalous state of
A licensed and registered physician is required under the law to fill out
elaborate forms, which become a public record, when he prescribes opium,
morphine, heroine or codeine in any amount.
But while the public cannot legally get the minutest doses of the drugs
proscribed by the Harrison Act in the prescription of a licensed and
registered physician except through the formality of elaborately devised
forms in which both the physician's and the patient's names are recorded,
this same public can buy these same drugs by the gallon in patent-medicines.
The only restriction made by the law relates to the amount of such habit
forming drugs that may be put by the manufacturer into each fluid ounce of
About the only
nostrum admittedly containing cocaine that the law has left on the market is
an alleged asthma remedy originally put out by the late Nathan Tucker of Mt.
The label of the
Tucker remedy declares-in accordance with the requirements of the Food and
Drugs Act: the presence of 5 grains of cocaine to the fluid ounce.
When the officials at Washington were asked how this nostrum could be sold
through the mails in plain violation of the Harrison Act they made the
excuse that the cocaine in the preparation became hydrolized in the process
of manufacture and that, therefore, the product, when it reached the
consumer, did not actually contain cocaine.
But even if this
were true it would be obvious that the remedy contains cocaine derivatives,
and the law applies just as pertinently to the derivatives of the alkaloids
specifically mentioned as it does to the alkaloids themselves.
This is proved by
the fact that the officials enforcing the law require physicians who wish to
prescribe apomorphine, an emetic and not a habit-forming drug, to go through
the usual formalities.
The label on the
Tucker remedy declares plainly that the preparation contains 5 grains of
cocaine to the fluid ounce.
If it doesn't
contain the drug in the amount stated, then the officials who have the
enforcement of the Food and Drugs Act are derelict in not declaring it
In either case, it
seems fairly evident that its sale violates a Federal statute.
importance of alcohol as an ingredient of patent-medicines, one might
suppose that national Prohibition would have put a serious added restraint
on the nostrum trade.
On the contrary,
the Eighteenth Amendment and the Volstead Act have increased enormously the
sale of nostrums containing alcohol.
have brought about the creation of many new alcoholic nostrums, all sold in
such a way as to appeal to those whose pre-war stock is exhausted and whose
thirst cannot be legitimately satisfied.
Take the case of Lyko, which came from Kansas City, Mo. During the war a
member of the Army Medical Corps at Fort Sam Houston sought information
about Lyko because, as he said, he understood the soldiers were using it as
a beverage; about the same time a county health officer in Tennessee wrote
that Lyko, while advertised as a great medicine, was being used, in his
section, almost exclusively for drinking purposes.
The product was introduced in an effective way.
The public was urged to get a free sample bottle at the nearest drug-store.
When Lyko was analyzed in the chemical laboratory of the American Medical
Association it was found to have twice the alcoholic strength of champagne
over 22%, but insufficient medication to prevent its use as a beverage.
Investigation showed that it came from the same address as that of a
distilling company in process of liquidation and that the original
incorporators of the concern making it had been employees of the distilling
An effective line in the Lyko advertising campaign was: "It Opens up
Wonderful Visions of the Future to the Down-Cast, Weary-Laden Souls
Depressed in Spirit and Body."
Then there was
Tona-Vin, which also burst on an arid nation by the free-sample and
newspaper advertising routes.
In Toledo alone
50,000 free bottles were given away “to prove the remarkable tonic effect of
this famous medicine.”
tasted like wine with a dash of wild cherry and a suspicion of bitters, had
all the elements of a good "repeater”.
It, too, was
analysed in the chemical laboratory of the American Medical Association,
which reported that, although the stuff contained 18% of alcohol, there was
not sufficient medication to prevent the public using it as a toddy.
True, it contained
some quinine and iron, but to get even 3 grains of quinine it would have
been necessary to drink about a quart of Tona-Vin, while an entire bottle
would have given only a normal dose of iron.
O malaria, where
is thy victory; O anaemia, where is thy sting Tona-Vin was manufactured
under a permit issued to a concern that dealt in toilet articles.
The label declared that its formula had been approved by the Bureau of
Internal Revenue and each bottle bore a “certificate” from the “American
Standardizing Bureaus”, Washington, D.C., declaring that the product was
made under their supervision and complied with the provisions of the National
The Tona-Vin slogan was: "Puts
Dash and Go Into Tired, Weary, Sick and Run-Down Men."
A more recent nostrum of the same
sort is Vita-Pep, which you are urged to buy by the case. Better still, you
are urged to get a discount by purchasing six cases.
Vita-Pep not only takes advantage
of the Prohibition drought, but also plays up the public's interest in and
ignorance of those comparatively newly discovered accessory food factors
According to the Vita-Pep label,
wine with an alcohol strength of 16%, is the basis of the product.
It also is claimed to contain
pepsin, rennin and a concentrate of Vitamin B, 3 substances that cannot in
the least interfere with the use of the wine as a beverage.
The amount of Vita-Pep that you
can drink would seem to be limited chiefly by your tolerance for alcohol.
As a prospective customer, you are
told that when you take a half wine glassful of Vita-Pep with an equal
amount of freshly pressed orange juice, you will get an "ample quantity" of
both Vitamin B and Vitamin C.
Possibly. It is also conceivable
that a half-wine glassful of Vita-Pep will mellow your outlook on life,
particularly if you are not used to alcoholic beverages. Some of the
Vita-Pep testimonials are gems of naivete.
A "well-known Pennsylvania oil
man" says that he thinks it "certainly worth while" and sends a check for
Another booster says that he
"lives much more easily with it than without it," which seems reasonable;
while a "prominent banker" sends in his check for a case with the statement
that every member of his family uses it. According to its manufacturers,
Vita-Pep "takes away that Tired, Run-down Feeling."
Then there is the old standby,
Hostetter's Celebrated Stomach Bitters, still going strong with an alcohol
content of 25%.
The history of this product is
As long ago as 1878 the question
of its use as a beverage was raised by the Alaska authorities.
A letter from the Commissioner of
Internal Revenue of that time stated that, in Sitka, Hostetter's Bitters
were sold "by the drink" in saloons.
In 1883 the Commissioner of
Internal Revenue concluded that, as the stuff contained no harmful drugs and
only 4%, of anything like a drug, he would probably be entirely justified in
classing anyone who sold it as a retail liquor-dealer.
But the Commissioner was hampered
by the fact that for many years the government had classified Hostetter's
Bitters as a "medicine" and had collected a stamp tax on it.
That being the case, he felt that
he was in a rather difficult position, for, said he: Should I hold it to be
a medicine, I should probably do violence to an almost irresistible tendency
of the mind to conclude that no genuine medicine needs so much whisky and so
few drugs in it, unless under very unusual circumstances.
On the other hand, should I decide
that it is no medicine at all, I would be confronted by a ten-years quasi
recognition by this office to the contrary, as well as by the practice of
many people who use it as such.
The decision finally arrived at
was worthy of Solomon. The Commissioner decided to "let the use give
character to it."
When Hostetter's Bitters was sold
as a bona fide medicine he would take no action; when it was sold as a drink
the seller would be taxed as a retail liquor-dealer.
Hostetter's has contained at
different times varying amounts of alcohol.
In 1906 the state chemists of
North Dakota reported finding 43%; in 1907, when the Food and Drugs Act went
into effect, the label declared the presence of 39%; at present, the amount
is 25%, or one-half that of straight whisky, that is, straight whisky of
Hostetter's contains some quinine
and has been recommended for malaria.
The chemists of the American
Medical Association who analyzed it reported that, in order to get the
minimum daily dose of quinine recommended by the Pharmacopeia as an
anti-malarial, it would be necessary to take about 20 ounces of Hostetter's
Bitters daily, or the equivalent of 10 ounces of straight whisky, 100 proof.
The question, Can
Hostetter's Bitters be used as a beverage? seems to have received a
pragmatic answer. The Baltimore Sun, some years ago, carried a news item
from Danville, Va., to the effect that the police in that town had had to
deal with a large number of drunks and that each inebriate admitted that he
became intoxicated on “a certain proprietary medicine that contains 25% of
should be said, had recently gone dry. In order to learn just what
proprietary medicine had been responsible for this oasis in the local
desert, a telegram was sent to the chief of police of Danville. His laconic
answer was: “Name of medicine Hostetter's Bitters.”
But while new
alcoholic nostrums have come on the market and some of the old ones still
retain their pre-Volsteadian strength, others have undergone certain
which for years contained alcohol: Warner's Safe Cure-has had its menstruum
changed from alcohol to glycerine.
brought such glowing testimonials from notables in the nineties: Paine's
Celery Compound, went out of existence entirely. Still others reduced to
some extent their percentages of alcohol.
Thus, S.S.S. now
contains 12% instead of the old 15%, and Manola is reduced from 18% to 15%.
before Prohibition was at 20%, has reduced its alcohol content for domestic
consumption to 12%, but still seems to put the old 20% kick into the product
made for export.
Possibly the most
interesting example of alcohol reduction is afforded by Wine of Cardui,
which was once sold widely in the South for the alleged cure of women's
For years it
contained 20% of alcohol, beside the extractives of an insignificant amount
of black haw and of an innocuous and long-discarded bitter, blessed thistle.
In 1916, when the Wine of Cardui concern sued the Journal of the American
Medical Association for some of the unkind things that publication had said
about it, the manufacturers undertook to prove in court how chemically
impossible it was to lower the alcohol content of their “tonic”.
Learned counsel earnestly pleaded that, ten years previously, their clients
had employed “one of the greatest chemists in the United States” in an
effort to tone down Wine of Cardui's 20% kick.
But it couldn't be done! They did get it down to 17%, but the stuff spoiled
on the druggists shelves. The story was a moving one.
Then along came the Eighteenth Amendment and the most powerful drug in Wine
of Cardui, alcohol, was cut exactly in half and a preservative added to
prevent its spoiling-thus demonstrating the superiority of law over
chemistry and the feasibility of modifying morality by act of Congress.
restrictions, a public awake to the tricks of the game and a growing
distrust in drug therapy have all caused the patent medicine gentry to
modify both their products and their appeal. As a result, the
nostrum of 1924 differs widely, not only in composition but also in its
method of presentation, from its prototype of 1904. But in spite of
all their efforts the manufacturers find the demand for their wares failing
in the United States, for the average American today spends 50 cents for
patent-medicines where he spent a dollar fifteen years ago. Yet as an industry
the patent-medicine business of the United States has not diminished, for as
domestic demand has fallen off the manufacturers have sought foreign
are now flooding the markets of the world and are especially in evidence
where advertising standards are lowest. In the newspapers
of Latin America are now to be found the same crude and blatant
patent-medicine advertisements that graced the newspapers and magazines of
the United States two decades ago.
Contrary to the
general idea, public intelligence bears little, if any, relation to the
popularity of nostrums. It is knowledge,
not intelligence, that diminishes credulity, especially when one goes into
the market to purchase relief from real or imaginary suffering. Experience shows
that the intelligentsia are more easily gulled by a quack who knows how to
word his appeal than the illiterate. We are using fewer
patent-medicines today than we were 20 years ago, not because we are less
gullible, but merely because the bait is stale. On fresh bait we
bite as avidly as ever.
In order to cash in on the public's new tendency toward therapeutic
nihilism, the American patent-medicine maker has put out a line of nostrums
that he claims are not medicines.
They are advertised as "food-tonics” or “tonic-foods’’ or “vitamin
One of the first and easily the best and most successful of the food-tonic
humbugs was Sanatogen, a product that admittedly was nothing but 95% casein
and 5% glycerophosphates.
It was put over by an advertising campaign whose very impertinence was so
stupendous as to command admiration.
The appeal was especially to the intelligent. Advertisements were offered to
and accepted by high-class magazines that would have scorned a contract for
Pink Pills for Pale People.
Yet the claims made for Sanatogen were no whit less preposterous than those
that are made for the cruder proprietary remedies.
Sanatogen flourished just as long as the advertising campaign was kept up.
The product itself contained no "repeater' element; it had neither seductive
nor powerful drugs; its physiologic action was only that of dried milk curd;
there was nothing to sell it except the advertising, but that sold it in
A few cents worth of dried cottage cheese, with a minute amount of a
discarded and therapeutically valueless drug, was sold for a dollar, and for
this dollar one got a product whose only virtue was its food value-and that
was equivalent to the value of 2 cents worth of dried beans.
When the war came Sanatogen, being an enemy-owned product, was taken over by
the Alien Property Custodian, the advertising ceased, and with it also the
An American patent medicine firm later purchased the right to manufacture
and sell the nostrum and attempted to resurrect it. But the public had lost
interest. An interesting but
abortive attempt to float another '''food-tonic" was exemplified in the
conception and birth of Susto. This was put on
the market by a concern that had for years sold a “tonic” containing small
but unrecorded quantities of well-known drugs and a large and recorded
quantity (18%) of alcohol.
It had been
featured as a cod-liver oil product without the oil, “Hamlet” minus the
melancholy Dane. The exploiters of
this preparation, possibly fearing that the time might come when alcoholic
tonics would no longer be good form and awake also to the public's interest
in “food-tonics”, decided to put out tablets containing malted milk and the
vitamins of yeast under the name of Susto. In order to float
the product under respectable auspices, a professor of physiologic chemistry
in a well-known eastern medical college was given the commission of
suggesting improvements in the product.
The professor did
his part by recommending that there be added a special brand of malted milk
and a widely advertised proprietary yeast. The “improved”
product was then tested on white rats, old ladies, undernourished infants
and others. Then the general
public, through the newspapers, and coincidentally the medical profession,
by 'clinical reports' sent through the mail, were apprised of the
accouchement of Susto. All the
advertising played up the professor, his college and the work claimed to
have been done in "perfecting" and "indorsing" Susto.
gravely told that rats which had been fed Susto were found to gain in
weight. As it was largely
malted milk, such a result might not have been unexpected, even without
experimental evidence and even by those less erudite than professors of
After the entire
matter was aired in the Journal of the American Medical Association, it was
not long before the exploiters of Susto, prohibited from playing up the
alleged scientific foundation for their product, seemed to abandon their
advertising campaign, and so Susto died a-borning.
Following the "‘food-tonic” fad and more or less contemporaneous with it
came a flood of patent-medicines, usually in pill form, alleged to contain
in concentrated form those comparatively newly discovered accessory food
factors, the vitamins.
There were probably two score of them, and many were sold under claims that
were worthy of old Doc Hartman at the crest of Peruna's fame.
The vast majority of these preparations were utterly worthless and contained
no vitamins, at least by the time they reached the public. The best that
could be said of them was that they were harmless; the worst, that they were
Today the popular
nostrum is of the so-called glandular extract or endocrine type. This phase of the
industry grew from a soil well prepared by sensational newspaper articles on
the alleged marvels in sex rejuvenation that were going to result from the
work of Steinach and Voronoff. None of the work
of these men had any relation to the oral administration of gland substance,
but the modern Fausts who would seek a renewal of sexual youth from
Mephistophelian nostrum exploiters are ignorant of this fact.
The new “gland”
proprietary remedy is thus endowed with aphrodisiac virtues. Many if not most
of these preparations actually contain gland substance or so-called extract,
for it is not difficult for fakers to get presumably reputable business
concerns to furnish them with the raw material for their faking. In one or two
instances active drugs are mixed with the glandular substance, and the
sexual neurasthenic who fondly imagines that the stimulation he receives
comes from testicular substance actually gets his kick from a dash of
Most of them
contain no substances having any physiological effect, and so whatever
results they accomplish are psychic, and depend upon the plausibility of the
advertising and the gullibility of the purchaser. In all such cases
the time must come when the static power of experience overcomes the dynamic
energy of advertising, and this is the death knell of the nostrum.
It them becomes
necessary for the quack to change the name of his product, rechristen his
company, revamp his appeal and spend another fortune on a new advertising
campaign. If skilful, he will get his money back with a high rate of
interest. The proprietary
medicine business will continue to flourish just so long as public credulity
lasts. The charlatan was not born, as Voltaire said, when the first knave
met the first fool, but when the first knave met the first ignoramus. It is lack of
knowledge and not a dearth of brains that breeds credulity. Life has been
defined by Spencer as the continuous adjustment of internal relations to
patent-medicine business adjusts its products and appeal-internal
relations-to its external relations represented by public health laws, a
more sophisticated public and a growing skepticism about drug therapy. Just so long as it
obeys this biologic law will it thrive.