NOSTRUMS

BY H. C. WOOD, M.D.PHILADELPHIA, PA.

REPRINTED FROMTHE JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION

APRIL 29, 1899.

CHICAGOAmerican Medical Association Press

1899

NOSTRUMS.*

H. C. WOOD, M.D.

Very properly, in strict accordance with its etymo-logic significance, old Dr. Johnson defined nostrumto be “ a medicine not yet made public, butremainingin some single hand,” but under the present headingI propose to widen out the inquiry of the hour into amore general examination and review of the use inthe United States of medicines extrapharmacopeial intheir relations, and more or less secret or proprietaryin their origin.

Time was when the business of pharmacy partookof the nature of a profession, but more and more isthe old apothecary shop becoming a mere distributingstore, requiring little more scientific knowledge for itsmanagement than does the corner grocery. At onetime 80 per cent, of the receipts of the druggist werefrom preparations made or prescriptions compoundedin his own laboratory or shop. In 1890, Mr. M. N.Kline made an inquiry based upon the sales of thelarge wholesale druggists, and found that out of onehundred consecutive orders 58 per cent, were of pat-ented and proprietary articles, 6 per cent, were phar-maceutic preparations, about 1 per cent, were packetedgqods, the remainder apparently being crude drugs;or, taking the purchases for three months by five rep-resentative druggists, who bought their supplies fromone store, 64 per cent, were patented and proprietaryarticles, about 1 per cent, packeted goods, leaving 85per cent, as the proportion of legitimate pharmaceutic

*Read at Centennial Meeting of Medical and ChirurgicalFaculty ofMaryland, Baltimore, April 25-28, 1899.

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preparations and crude drugs. This would indicatethat about 40 per cent, of the sales of the retailer areconnected with legitimate pharmacy.

No one can have watched the progress of this mat-ter without being convinced that the sale of extra-pharmaoopeial remedies and nostrums is year by yearsteadily increasing. In order to get another view ofthe subject, I addressed the following questions tosundry druggists: What, judging from your experi-ence, is the proportion between the sales in the aver-age Philadelphia drug store of: 1, physicians’ prescrip-tions; 2, drugs and their preparations, not proprietarynor patent; 3, proprietary or patent medicines?

The replies received have not been very numerousor very satisfactory, but they show that the percentageof patent and proprietary medicines sold varies greatlyin different retail stores, and is large almost in propor-tion to the modern character of the store; there beingstill left in Philadelphia a few old-time apothecarieswho have been able to bring down from the past alegitimate trade for prescriptions and drugs, in whichthe proprietary medicines form but a smallpart. Ac-cording to the answers I received, in the modern drugstore theproprietary articles appear to constitute from50 to 60 per cent, of the sales.

The magnitude of the change is further shown inthe fact that twenty years ago there were in the cityof Philadelphia about thirty wholesale drug stores;to-day, I am informed there are but six, not includingthose who sell medicines not to the drug trade, but tocountry stores. More than this, according to a mem-ber of a successful firm, most of these wholesale drugstores are kept alive by their own specialties, a purelydistributing house being almost unknown; and three-fourths of the business is further said to be the sell-ing, not of standard drugs, but of proprietary articles.

If the business changes which we have noted con-sisted simply of the lessened sale of drugs, and showedthat the world was taking less medicine than twentyyears ago, there might be reason for congratulation

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and hope of progress, but the changes which havetaken place would seem to be not a diminished outputof medicine, but the substitution for the true andknown of the untrue and unknown. Surely there ismore hope for a nation that takes quinin than for onethat lives on vermin killer or health pills.

It is generally believed that the proprietary andpatent medicine business is one which invariablyyields great receipts; careful inquiry, however, seemsto show that this is a mistake, that it is a speculativerather than a legitimate business, one which does notyield a larger percentage for the investment than dothe ordinary occupations of life, but which, like ahuge lottery, gives great but barren promises to themany, and to the few money prizes which dazzle theeyes of the multitude. Careful inquiry among thosewdio are thoroughly familiar with thepatent-medicinebusiness shows that in this country, within the lasttwenty years, not more than fifty persons have suc-ceeded in making fortunes out of it; rarely have thesefortunes exceeded $lOO,OOO, and in not more thanhalf a dozen cases have they reached a million dol-lars. The profits of the business are enormous; theamount of business which has been done gigantic;where then have the profits gone? Into the news-papers and magazines, lay and medical! Thousandsof persons have been ruined by advertising beyondtheir means, and not having sufficient capital to meetthe obligations they had incurred, have passed intobankruptcy.

Almost every drug store in America has its own so-called “specialties,” which are of the nature of pro-prietary medicines; but leaving these out of sight,there are about three hundredfirms or companies whodo business on a large enough scale to be called “pro-prietors.” Of these three hundred, we are informedby competent authority, fifty spend $20,000 to SIOO,-000 a year in advertising, twenty from $300,000 to$500,000 a year, the balance from SIO,OOO to $20,000 ayear; making in all, as closely as can be determined,

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between fourteen to fifteen millions yearly spent inthe advertising of nostrums. This stream of goldpasses into the exchequers of the newspapers, themagazines and the advertising agents; cause it tocease, and a considerable proportion of the newspa-pers and of the medical journals of the UnitedStates would cease to live; a consummation most de-voutly to be prayed for. If there were only a halfdozen medical journals published in the UnitedStates, if every doctor who wrote an article that hadnot novelty or other valuable quality in it should bebeheaded within a fortnight, what a blessed worldwould it be to live in, but how soon would the pro-fession be depleted!

It is a matter of great interest to know what pro-portion of the nostrums swallowed by the public arepurveyed through the medical profession. It is prob-ably impossible to get accurate statistics, but a gen-tleman who is connected with one of the largest dis-tributing houses in the United States, and who haspaid especial attention to this subject, estimates forme that about 10 per cent, of the whole patent medi-cine and proprietary trade is carried on through thephysicians. This estimate seems to me under ratherthan over the truth,

We, as members of the medical profession, and es-pecially those of us connected wdth the medical press,are accustomed to inveigh against newspapers, secu-lar and religious, for accepting the advertisements ofpatent and proprietary medicines, whereas in truth,unless the pot be warranted in calling the kettle black,we ought to keep silence with shamefacedness.

All dealers in medicines of the class under consid-eration with whom I have come in contact are con-cordant in asserting that the most successful proprie-tary remedies of the day are those which are chieflyor often solely distributed through the physicians;and in my own consulting practice I have been as-tounded to so often find men of good repute andstanding using drugs of whose nature they have no

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knowledge; there certainly has been of late years arapid growth among physicians of the habit of pre-scribing proprietary medicines.

The ease of prescription, and the readiness of ad-ministration of the modern tablet is undoubtedlydoing much in increasing the use of nostrums. Ifthe user of the tablet could by its use simplify hispractice, it would be well. If he would ha\e tabletsof strychnin, tablets of cocain, tablets of digitalis andtablets of nitroglycerin, he might escape from poly-pharmacy and really become more scientific and suc-cessful in obtaining results; but in the majority ofcases the tablet links itself with polypharmacy. Thecardiac stimulant tablet will contain nitroglycerin,whose action is over in twenty-five minutes, and digi-talis, whose influence can not be felt under five or sixor more hours; or as in instances which we haveknown, he will have the nitroglycerin combined withiodids, bromids, and half a dozen other remedies hav-ing no relation one with the other, and perchanceantagonistic. Then again, prescriptions in whichnot even uniformity of size is maintained—shotgunprescriptions, in which BB is mixed with number 8,and even mustard seed—prescriptions invented on theprinciple of the sea captain, who gave to the sicksailor a little of everything in the sea-chest, saying,with an oath, that if the man died it was not hisfault, as he had given to him (the sailor) a littleof everything he had. From this to the abyss ofnostrumism is a steep and slippery path; facilis de-scensus Averni.

Not only, however, do members of the professionstultify themselves by prescribing nostrums, but evenmore depressing is the fact that, never mind howworthless a remedy may be, the proprietor can almostinvariably secure public recognition of excellence frommen eminent in the profession. One class of drugsmay be mentioned simply as an example. Exceptformalin solutions there is no disinfecting mixturesold which, in proportion to the price, is comparable

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in power to the simplest disinfectants recognized bythe pharmacopeia, and yet the markets of the UnitedStates are loaded down with proprietary disinfectionsolutions, most of them absolute frauds, many of themcertified to by leading members of the profession.These certificates have not been paid for, but have beenfree gifts from the members of the profession to thevarious firms. The profession is not corrupt, it is dis-gustingly weak—feeble as the molasses and vinegardrink of our childhood, Many of these certificates havean enormous pecuniary value; they have been givensimply because some smooth-tongued commercial trav-eler has asked for them. The doctor has received noequivalent for that which he has given, but none theless has he in the giving stultified himself, degradedhis profession, and assisted in the swindling of thepublic. Of those who have given certificates for disin-fecting solutions, how many have ever made any bac-terial experiments upon the solutions in question.Probably not one has ever carried such a trial to acareful comparison of the proprietary solution withthat of an ordinary disinfectant, or considered thequestion of relative price. Moreover, the doctor whogives a certificate based upon a thorough trial has noguarantee or reason for believing that the solutionfurnished one year after date, with his certificate at-tached, will be the same as that which he used in hisexperiment. So far as I can remember, personally Inever gave but one certificate concerning a drug or acommercial article, and so far as I know no greaterscoundrel ever misused a certificate than did the oneto whom I gave this lonely representative of personalweakness. It ought to be a first principle in ethicsthat no doctor should be allowed to give a certificate,a commendatory letter, or anything else recommenda-tory, to any proprietor of anything under the sun. Itis a great pity that the medical profession has notsuch a public sentiment as to make the giver of a cer-tificate feel that he risks ostracism by the giving.Esau, the Hairy One, was a pattern of shrewd foresight

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contrasted with many an American doctor; he did getone comforting mess of pottage for his birthright; theAmerican doctor hears only some words of honeyedflattery in the secrecy of his office, but is deaf to thederision in the outer world of those who have been“chestnutting” with him.

One undoubted cause of the increase in the use ofproprietary and patented medicines by the professionis the production of patented drugs which are of suchpeculiar therapeutic value that, whether he will or not,the doctor must use them. The difficulty of the situ-ation is, however, more apparent than real. All thephysician has to do is to make it a governing princi-ple that the only patented or proprietary drugs he willuse shall be simple organic principles.

The golden rule of living should be; give no certifi-cates; use no proprietary combinations of medicines.When we have done this then with polished weaponscan we make war upon those who batten on the mis-fortunes of mankind.

Having reached this principle for our own govern-ment, we are in a position to consider for a few mo-ments the subject of the general governmental con-trol of proprietary medicine; a subject which is at thepresent made more vital by the fact that the laws ofthe United States regarding it are now under consid-eration by the Federal authorities, for the purpose ofreorganization. The importance of the subject canhardly be estimated; hungry is the Anglo-Saxonthroat for medicine; never to be stopped is the damorof overcredulous, suffering humanity.

According to the Drugman, while thirty years agothe annual yearly revenue in Great Britain from taxeson patent medicines was $210,000, in 1892 it was$100,500,000, and the tide is still rising. I have noAmerican statistics to offer you, but certainly the av-erage Yankee is not in his hunger after pills anddraughts much behind his transatlantic cousin. Thesuccess of the various proprietary remedies rests inthe greater part upon a very curious fact, namely, that

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the embalmment of a lie in printer’s ink makes it to theordinary Anglo-Saxon mind as genuine and as inde-structible as an Egyptian mummy; and this trait ofcharacter belongs as much to the American as to theEnglishman.

Whether it be possible by law to control in thiscountry the enormous volume of the patent-medicinetrade is very uncertain; in France, before a proprie-tary medicine can be put upon sale the formula andthe process of its production must have been submit-ted to a committee of the Academy of Medicine, whichcommittee can alone give permission for its sale, andhas the power of fixing the highest price at which itcan be sold. Certainly the American proprietors, inthe ardency of their zeal for the salvation of theirfellow-men by drugs, would not be willing to be ham-pered by such bounds as these. It is possible that alaw recognizing the registration of medicinal formu-las, and perchance even one making it a requisite thatthe formula of thepatented medicine shall be printedupon the package in which the medicine is sold, mightbe enforced to some extent if once enacted; but atpresent the enactment of such a law seems even moreimprobable than its enforcement.

After all, there is no reason why the medical prac-titioner, as a medicalpractitioner, should be especiallyinterested in this matter. As already urged, proprie-tary formula compounds, protected in any way bylaw, are or ought to be an abomination to the profes-sional mind; but at this time to attack their use bythe people would be quixotic. The traffic in lies willnever cease. The gullibility of the human nature isunfathomable, and if we as a profession would onlykeep our own garments from being defiled, we couldwell afford to take no heed of the doings of the public,or the wolves that prey upon them. When the sheepwish to be devoured the wolf is scarcely to be blamed.On the other hand, the profession is and must remainvitally interested in all legal questions centeringaround distinct organic principles.

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The question whether patents should ever be takenout by members of the professions has been so muchdiscussed that every one must at least acknowledgethat there are to this, as to other problems, two sides,but at present we are not immediately concerned withthis subject, since the inventors or discoverers of newprinciples are chemists rather than practitioners ofmedicine. The reasons that justify the existence ofpatent laws at all apply to the work of these men asstrongly as they do to the work of mechanics, View-ing the matter as the lawgiver must viewT it, thechemists are certainly entitled to the protection oftheir labor; but what shall the protection be?

The intent of the patent laws is that the discoverershall be encouraged by the temporary right to his dis-covery, but that such right shall eventually lapse, sothat the invention shall become the property of thewhole people. The application of this principle throwsout at once the patenting of the names of drugs, sincethe name which usage has given to a remedy will, forthe mass of the people and even of the profession,adhere permanently to the product. Antipyrin, forexample, will be known in commerce as antipyrin tothe end of the chapter. Life is too short, and brainmatter too precious, to consume either in sayingphenyl-dimethyl-iso-pyrazolone. I have never heardof an American physician using the name adopted bythe British pharmacopeia, “ phenazone;” and I cannot remember having seen this name printed even inan English medical article. Now, if copyrights couldbe made to attach to the name antipyrin, the patentfor antipyrin would for practical purposes be therebyindefinitely extended.

No one has recognized more clearly than have ourpharmaceutic manufacturers the force of considera-tions such as those just given, and the effort has beenboth persistent and widespread to obtain permanentproprietorship of a remedy by making its popularname a trade-mark, and in this way to destroy theintent of the patent law by obtaining through the

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laws governing trade-marks an exclusive right whichhas no ending. t

A trade-mark is, however, the sign of the brand andnot of the article. Originally it was a design; a lionrampant stood for a lion brand of starch, sugar, orwhat not; and the design, which was the sign of theproduct of the firm’s factory or series of factories, wasnaturally theproperty of its inventor. Now it isclaimedthat a name may be made a trade-mark and registeredas such. This claim, however, probably can not besustained even under the present law. In the decisionrendered by the United States supreme court in thecase of the Columbia Mill Company of Minnesota vs.W. W. Alcorn & Co. of Pennsylvania, the presidingjudge said: “That to acquire the right to the exclu-sive use of a name, device or symbol as a trade-mark, itmust appear that it was adopted for thepurpose of iden-tifying the origin or ownership of articles to which it isattached, or that such trade-mark must point distinctly,eitherby itself orby association, to the origin, manufac-ture or ownership of the article on which it is stamped.It must be designed, as its primary object and purpose,to indicate the owner or producer of the commodityand to distinguish it from like articles manufacturedby others.” In another case it was affirmed by thejustices of the supreme court that: “The office ofthe trade-mark is to point out distinctly the originof ownership of the article to which it is affixed; or,in other words, to give notice as to who was theproducer.”

These decisions would appear to the lay mind tobe sufficiently distinct and authoritative, but de-decisions of the supreme court can, I suppose, becountermanded, so to speak, by subsequent de-cisions of the same tribunal; and certainly the lawshould be made so clear and positive in its state-ments that no manufacturer would think of attemptingevasion.

The question as to what the patent law should bein regard to medicinal principles invented or dis-

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covered is not easy to answer. Should there beproduct patents or should there be process patents ?

In other words, should the substance antipyrin(product) have been patented as a product, or shouldonly the process by which the original discovererproduced antipyrin be capable of being patented? Itis evident that the difference between process andproduct patents is not only clear but of vital impor-tance to the inventor or discoverer. Supposing thatan organic principle, of practical value in medicine,has been discovered and produced by a certain process;if the discoverer patents the drug he secures proprie-tary rights in its sale for the whole term of yearsprovided for by the patent law. If, however, he canonly patent the process of production, he acquiresproprietary right only until the time when some otherchemist invents a new process which may be better orworse than the old, but which enables the secondchemist to compete with the originator, so to speak,who therefore practically loses the value of his patent.This time may be three weeks, it may be three years,it may be the whole term of the patent.

The American Pharmaceutical Association has, Ibelieve, expressed itself as being in favor of grantingprocess patents only. The American PharmaceuticalAssociation is a most respectable, indeed a highlyhonorable, body, but it is to the interest of its mem-bers that the patent rights of chemic investigatorsshall be as loosely held as may be, and therefore it ispossible that the minds of its members are unconsci-ously biased. I can not myself see why the man whopractically invents a new principle such as antipyrinshould not have the same inalienable right to the resultof his labors as had he who first placed the eye in thefront of the sewing needle. It is probable that the lawought to recognize in its protection two classes of newremedies. No vegetable or mineral substance whichexists pre-formed in nature, ready for the use of man,should be capable of being patented. It can in nosense be called an invention; the discovery of its

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medicinal value is almost always largely the result ofchance, not of foresight. A process for the extractingfrom a drug of its active principle might, however, bepatented, so that process patents might be allowedfor medicines of this class. On the other hand, whenby synthetic methods a substance which is not foundfreely existing in nature has been made by a chemist,such substance may well be said to be an invention ofthe chemist, and to be therefore capable of patenting.

In Germany there are no product patents allowed,only process patents; but in Germany it is the habitof the courts to be very liberal in the interpretationof patent rights, throwing the whole burden of proofupon the inventor of the second or new process, andrequiring his process to be absolutely diverse fromthe first; whereas in the United States the courtsnarrow as far as possible the rights of the patentee,so that the new or second process may survive judicialdecisions, although it was really founded upon the firstprocess which had received the patent. This, at least,is the allegation of the chemic manufacturing housesof the country; exactly how correct it is only a long-time worshipper at the shrine ofpatentcourts could say.

Finally, colleagues of the medical profession, thetime allotted me by your patience has expired, and Imust leave the subject of my paper, though it bescarcely more than touched upon. To me this seemsfor us the final sum of the whole matter: so long asthere be trout to rise, so long will there be fishermento make their deadly casts. The credulous, theignorant, the men and women who want to be deceived,the despairing, who grasp at every floating straw, willexist until the coming of the millenium demonstratesthat through the succession of ages the suffering ofinnumerable human units has perfected humannature; but as members of the medical profession,let us see to it that we in no way aid those who,serving the father of all liars, wax rich and wanton onthe miseries of their fellows.

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