Why not complete the circle of ideas-it would not be a "vicious circle"-by printing on labels, in advertisements and circulars, the words: "Accepted by the Council on Pharmacy and Chemistry."Missouri State Medical Journal.

FRAUDULENT "CURES" FOR VENEREAL
DISEASES SEIZED.

By order of the Federal Courts more than 450 seizures have been made recently in different parts of the United States of so-called cures for venereal diseases. They were made on information furnished by officials of the United States Department of Α Agriculture through its Bureau of Chemistry. campaign to end the false labeling of such preparations is being conducted by the officials charged with enforcing the Federal Food and Drugs Act.

The goods seized include a great variety of compounds. Some of the labels bear the claim of the manufacturer that the contents are sure cures for venereal diseases. Some even contain statements that cures will be effected within definite periods, varying from three days to a few weeks. In others indirect statements, suggestive names or deceptive devices are craftily used to make it appear that the use of the preparation will be followed by a cure of the disease.

In all the seizure actions the Government alleged the preparations to be falsely and fraudulendy labeled, because the ingredients could not produce the results claimed on the labels.

The officials state that such preparations are sold largely because of plausible but false claims regarding their curative effect. Many sufferers with dangerous contagious venereal diseases are led to believe that cures will be effected by these preparations, and adequate treatment under competent medical supervision is neglected until permanent injury to health and even danger to life has resulted. Thus is created one of the greatest obstacles to the proper control and eradication by health officials of venereal diseases. In many instances had such sufferers secured competent advice, early and complete cures might have been effected.

Self-treatment with worthless concoctions causes not only continued suffering but sometimes permanent injury to the unfortunate victims and makes of them a menace to the public health because of the extreme danger of others contracting the disease from them.

Action under the Federal Food and Drugs Act in reference to venereal disease preparations coming under its jurisdiction and sold under proprietary names is limited by the terms of the act largely to the prevention of false or fraudulent labeling. The

act does not prevent the sale of any mixture as medicine, however worthless it may be, if there is directly or indirectly no false or fraudulent labeling. The officials in charge of the enforcement of the act are of the opinion, however, that by causing the elimination of false labeling, upon which the sale of such preparations largely depends, the evils and dangers resulting from their indiscriminate use can be greatly checked, and substantial aid rendered to public health officials.

THE HARRISON ACT.

THE PHYSICIANS OF WESTERN AND NORTHERN MICHIGAN.

Sirs:

Hereafter in the case of KNOWN addicts, for whom you refuse to prescribe for the satisfaction of their needs or the relief of their suffering as addicts, we earnestly request that you report the case and the facts AT ONCE to the State Commissioner of Health, Lansing, Mich., and through him our offices will be kept informed.

Under Act 94 of the Public Acts of Michigan of 1913, provision is made for the treatment and relief of such addicts, if necessary at the public ex

pense.

Therefore, such persons need not hopelessly suffer if the drug is denied them.

In case of persons suffering from a proven incurable disease such as cancer or advanced tuberculosis the reputable physician directly in charge of bona fide patients suffering from such disease, may in the course of his professional practice, and strictly for legitimate medical purposes, prescribe narcotic drugs for the immediate needs of such patients, provided that such patients are personally attended by the physician and that he regulates the dosage himself.

The prescriptions in such cases should bear the endorsement of the attending physician, to the effect that the drug is to be dispensed to his patient in the treatment of an incurable disease. As to frequency of prescriptions in such case, the danger of furnishing such persons who are addicts with a supply of Narcotics must be borne in mind because such patients may use the Narcotics wrongfully, either by taking excessive quantities, or by disposing of a portion of the supply to other addicts or persons not lawfully entitled to the drug.

Care and the UTMOST GOOD FAITH are required.

May we not have your full and hearty co-operation in this difficult and IMPORTANT matter? Dated, Grand Rapids, Mich., Aug. 9, 1919. Respectfully.

MYRON H. WALKER,

United States Attorney, Western District of Michigan. EMANUEL J. DOYLE, Collector of Internal Revenue, Fourth District of Michigan.

PROPAGANDA FOR REFORM. Partola.-A physician reports that a patient taking Partola as a blood purifier is now in a rundown condition, with discoloration of the skin and a craving for the drug and that another patient took three tablets before going to bed, developed cramps and aborted the next day in her third month of pregnancy. Analysis indicated Partola to be tablets containing 2.64 grains phenolphthalein per tablet, sugar, starch and oil of peppermint (Jour. A.M.A., July 5, 1919, p. 55).

Commercial Therapeutics.-The Merrell Proteogens present another attempt to foist on the medical profession a series of essentially secret preparations whose therapeutic value has not been scientifically demonstrated. It is the old story of exploiting physicians through commercial pseudoscience, of trading on the credulity of the profession to the detriment of the public. Sir William Osler says the remedy against the commercial denomination of therapeutics is obvious: "Give our students a first hand acquaintance with disease, and give them a thorough practical knowledge of the great drugs, and we will send out independent, clearheaded, cautious practitioners who will do their own thinking and be no longer at the mercy of the meretricious literature, which has sapped our independence." Excellent! But must humanity wait a generation? Why not stop this evil at once? The American Medical Association has provided the means whereby this may be done, if physicians will only make use of it. The Council on Pharmacy and Chemistry (Jour. A.M.A., July 12, 1919, p. 109).

Tyree's Antiseptic Powder.-An advertisement appearing in the New York Medical Record contains a bacteriologic report on Tyree's Antiseptic Powder by W. M. Gray, M.D., Microscopist, Army

Medical Museum, and Pathologist to Providence Hospital. Every person who sees this advertisement and is not familiar with the facts will naturally suppose that this report, written on the stationery of the Surgeon-General's office, War Department, is a recent report. As a matter of fact, the report was issued January 3, 1890, nearly thirty years ago. Furthermore, the product that Dr. Gray examined was a different substance from the present Tyree's Antiseptic Powder. All these facts were brought out in the Journal A.M.A., May 17, 1919, yet the Medical Record persists in publishing this inherently dishonest advertisement without explanations or apology (Jour. A.M.A., July 12, 1919, p. 129).

Protecting the Sick Soldiers.-The Council on Pharmacy and Chemistry, aided by the A.M.A. Chemical Laboratory, did a great work in investigating and passing on the many medicinal products offered to the Surgeon-General for the treatment of the sick soldiers in the hospitals and in the field. Fakes of every description were offered the government and it is a well-known fact that no matter how fraudulent, how fakish, or how ridiculous the wares might be, their promoters were able to get political influence, even certain congressmen and senators being secured to help him. Automatically all medicinal preparations offered to the SurgeonGeneral were referred to the Council and thus many worthless preparations were barred from use by the government. It has been well said that our soldiers were better protected than our civilians; for while the government does not take any chances on the acceptance of useless if not worthless medicinal preparations, yet there are any number of doctors who fail to profit by the findings of the Council on Pharmacy, and Chemistry (Jour. Ind. State Med. Assn., July 15, 1919, p. 196).

Proteogens of the Wm. S. Merrell Co.-The Council on Pharmacy and Chemistry report that Proteogen No. 1 (Plantex) for Cancer, Proteogen No. 2 for Rheumatism, Proteogen No. 3 for Tuberculosis, Proteogen No. 4 for Hay Fever, and Bronchial Asthma, Proteogen No. 5 for Dermatosis, Proteogen No. 6 for Chlorosis, Proteogen No. 7 for Secondary Anemia, Proteogen No. 8 for Pernicious Anemia, Proteogen No. 9 for Goitre, Proteogen No. 10 for Syphilis, Proteogen No. 11 for Gonorrhea, and Proteogen No. 12 for Influenza and Pneumonia inadmissible to New and Nonofficial Remedies because their composition is secret; because the

therapeutic claims made for them are unwarranted; and because the secrecy and complexity of their composition makes the use of these preparations irrational. The Proteogens are said to be prepared "Under the personal supervision of the originator, Dr. A. S. Horowitz," who also originated Autolysin (an alleged cancer remedy, exploited some years ago). At one time the advertising for Proteogen No. 1 (Plantex) gave, the impression that this was essentially the same as Autolysin. A study of the medical literature revealed no evidence establishing the value of the Proteogens; in fact, no evidence was found other than that appearing in the advertising matter of the manufacturer. The range of diseases in which Proteogens are recommended is so wide as to make obvious the lack of scientific judgment which characterizes their exploitation. Considering the grave nature of the diseases for which Proteogens are recommended, the want of a rational basis for the method of treatment and the general tenor of the advertising, it appears safe to concluded that De Sanctis' pills are essentially five definite advance in therapeutics (Jour. A.M.A., July 12, 1919, p. 128).

Dr. De Sanctis' Gout Pills. The American agent for these pills is E. Fougera and Co., Inc. When examined in the A.M.A. Chemical Laboratory they were found to contain powdered colchicum seed, benzoic acid and milk sugar. There was also present fatty material which resembled the fat of colchicum seed, but might be in part added fatty acid. It was concluded that Dr. Sanctis' pills are essentially five grain doses of colchicum seed. Here then we have sold for self medication, an extremely poisonous drug with no warning of the risk the public runs in using it (Jour. A.M.A., July 19, 1919, p. 213).

Dr. Miles' Heart Treatment.-According to the Miles Medicine Company this is "a strengthening regulator and tonic for the weak heart." No information regarding the composition of Miles' Heart Treatment is vouchsafed by the manufacturer beyond the statement of the alcohol content (11 per cent.) as required by the law. However, quotations in the advertising suggest that the preparation contains digitalis and cactus. To determine the presence or absence of digitalis in Miles' Heart Treatment, physiologic tests were made. The question as to the presence of cactus was not considered of interest because cactus grandiflorus has been shown to have no physiologic action. The physiologic tests

indicated that there were no digitalis bodies present in the preparation (in amounts that could have any therapeutic effects) in doses containing enough alcohol to induce narcosis. Examination in the A.M.A. Chemical Laboratory showed Miles' Heart Treatment to be a solution of a compound or compounds of iron representing about 0.12 gm. metallic iron in 100 c. c. A solution of iron glycerophosphate in 10 per cent. alcohol, with about 5 per cent. glycerin, and a little sugar or glucose had much the same chemical properties as Miles' Heart Treatment (Jour. A.M.A., July 26, 1919, p. 287).

Tannin Albuminate Exsiccated-Merck.-A compound of tannic acid and albumin thoroughly exsiccated and containing about 50 per cent. tannic acid in combination. It was first introduced as tannalbin. The use of tannin albuminate is based on the assumption that the tannin would pass the stomach largely unchanged, and thus the astringent action be exercised in the intestine where the compound would be decomposed by the intestinal fluid. It is used in diarrhea, particularly that of children and in phthisis. Merck and Col, New York.

Swan's Pertussis Bacterin (No. 38) (Prophylactic). Marketed in packages of three 1-Cc. vials, con taining, respectively, 50, 100 and 200 million killed pertussis bacilli. For a discussion on Pertussis Bacillus Vaccine, see New and Nonofficial Remedies, 1919, p. 287.

Schick Test-Lederle.-A diphtheria immunity test marketed in vials containing diphtheria toxin sufficient for ten tests, accompanied by the required amount of sterile diluent to make the proper dilution of the toxin. For a description of the Diphtheria Immunity Test (Schick Test), see New and Nonofficial Remedies, 1919, p. 305. Schieffelin and Co., New York (Jour. A.M.A., April 19, 1919, p. 1136).

Diphtheria Toxin-Antitoxin Mixture.-A far more durable immunity against diphtheria can be established with a mixture of diphtheria toxin and antitoxin than with antitoxin alone. The immunity does not appear until a considerable period of time has elapsed, and hence the mixture is not applicable in an outbreak of disease. In general the overneutralized mixture is preferred. Several doses are usually required to induce immunity. Only those persons who are positive to the Schick test need be immunized, and the progress of the immunization may be determined by the response to this test.

Vol. XVII

Original Articles

TABES DORSALIS.*

FRANK R. STARKEY, M.D.
DETROIT, MICH.

In this paper it is not my intention to go into the literature of the subject, for I believe this always to be tedious at a meeting of this kind, but rather to express my personal views on the subject above and will not even go fully into the matter from this angle for I have done so in a previous article published in the Medical Record of March, 1916.

My object here is to try to impress upon you that tabes can no longer be looked upon as simply a condition confined to the posterior columns of the spinal cord but must be viewed in a much broader sense. The spirachaeta pallida may attack any structure of the human economy and the disease or symptom complex expresses the function of the tissues affected. Any function of the nervous system, from the simplest reflexes to the highest and most intricate intellectual processes, may be disturbed by syphilitic infection of the nervous system and the diverse phenomena, which may be the sequence, can only be constituted into a disease by the most arbitrary methods. Although tabes and paresis are spoken of as diseases, in reality we should consider but two factors in the morbid

manifestations of syphilis of the nervous system, namely; the character of the infection and the site of its anatomical location. The consequent symptomatology necessarily expresses the physiology of the structures involved. However, tabes is a convenient term to express the fact that the columns of Goll and Burdack are bearing the principal brunt of the destructive process, while by the term general paresis of the insane we signify that the cerebral cortex is chiefly attacked, with involvement of the higher centers thereof. Necessarily in syphilitic pro

*Read before Michigan State Medical Society, May 21, 1919.

No. 10

cesses of the nervous system the form assumed by the disease is determined by the site of the destruction, and the course it runs depends upon the natural history of the pathological process. However, since Sherrington gave us our present ideas of the integrative action of the nervous system we know that we cannot look upon an isolated tract or system of the nervous mechanism as being only involved, for we know that by this integrative action the nervous apparatus as a whole is disturbed and this is particularly true in tabes. Not only is the sensory mechanism upset but the paleokinetic and even the neokinetic apparatus is involved, and the cerebellum, which is the organ that controls muscle tonus and the synergies of movement and is closely related to posture and equilibrium, does not exercise its. normal function as manifested by the marked hypotonus and asynergia of tabes. And even the autonomic and sympathetic systems show considerable involvement which is discernible by trophic and vasomotor changes. The peripheral nerves, both motor and sensory, and the glands of internal secretion, particularly the pituitary, thyroid and the sex glands, are frequently disturbed in their function in a manner characteristic of this disease. Therefore, we would look upon tabes rather as a somatic nervous disease than simply one confined to the posterior columns. Tabes attacks persons of almost all ages and of all races. It is, however, very rare in the young and unusual late in life. Its most frequent time of incidence is between the ages of twenty and forty-five. The colored races seem less susceptible than the white and in proportion to the prevalence of syphilis it seems to be comparatively rare among the Chinese and Japanese.

ETIOLOGY.

Although the exact etiological factor has been in dispute from time to time, it is now generally accepted and dogmatically asserted that syphilis alone is the cause, yet there are very many cases

of tabes in which the history of syphilis cannot be obtained and no laboratory or other manifestations of the infection determined. It has been demonstrated that lesions of the kidney and other tissues, due to focal infection at a distance, cannot be distinguished pathologically from syphilitic lesions in the same tissues. So, that although we are still confident that 100 per cent. of cases are due to syphilis, notwithstanding absolute negative findings in this regard in a considerable percentage, it may be that, as time goes on and we progress in our knowledge and laboratory technic, we may deviate from this very positive view and be willing to admit that other forms of infection than syphilitic may be the determining cause. Paralysis agitans is one of the diseases concerning the pathology of which we have most recently altered our ideas, thanks, particularly, to the work of J. Ramsey Hunt. The history of the evolution of our knowledge of tabes is replete with complete reversals of opinion as to the etiology of this condition. Such distinguished neurologists as Duchenne, Leyden, Wunderlich, Moebius, Erb and Fournier believed at one time that tabes was due to fatigue, chill, excessive venery or trauma and they were just as positive in their beliefs as we are in ours today, and as they were the leaders and moulders of thought in medical matters of their times, their views were accepted and as dogmatically reiterated as the present conception of syphilis being the one etiological factor. It was due to the research of two of these gentlemen, in particular, namely: Moebius and Erb, who came to believe in the specific role of syphilis in relation to tabes that our present attitude came into vogue and this present conception has been greatly strengthened by the work of Noguchi and Moore, who found the spirochete in the tissues of the cord in a very few instances and their work has been confirmed by many other competent observers. However, other organisms, even the colon bacillus, have been found in the tissues of the central nervous system and we know that the pathogenicity and even the morphology of various strains of bacteria are subject to transmutability, so that I think it has not been thoroughly proven that the posterior columns of the cord are vulnerable to the spirochete only and it would not surprise me at all if the future would show us that other organisms, especially those responsible for focal infection, may produce lesions of the posterior columns and other tissues of the nervous system which cannot be distinguished from those of the spirochete. This

thought is dropped at this point simply as a hint for future investigation, for I am fully aware that there is not now sufficient evidence to establish it as a fact. The mechanism of invasion is believed now to be through the spinal fluid and the initial phenomena are the same as would be manifested in other tissues in similar circumstances, namely: oedema, then granular degeneration, then fatty degeneration, then glia formation. That it is a primary degeneration due to a toxic process involving the columns of Goll and Burdach alone does not seem rational nor conform to our knowledge of syphilitic processes.

SYMPTOMATOLOGY.

The symptomatology of tabes is by no means uniform in its onset. The first manifestation may be optic atrophy or ptosis, paralysis of extrinsic muscles of the eye with consequent diplopia; or the first symptom may be of the vegetative nervous system with usual pupillary changes. Sensory symptoms are not infrequently the first to manifest themselves. Lightning pains which are of an atrocious character, coming on at any time or place without warning. and very transitory in character, not accompained by redness, swelling or increased temperature of the part or tenderness to pressure or passive movement, but are increased by sneezing, coughing, straining at stool or anything that temporarily increases the blood pres sure, the patient has an interval of complete absence of pain subsequent to the paroxysm; parasthesias of various kinds; numbness of the extremities; sensation of walking on cushions or loss of sense of position, may be the first to arrest the patient's attention and cause him to seek medical attention. Such a case I recently saw in which the patient complained of an itchy, burning sensation about the waist which caused him to consult numerous dermatologists, but upon examination I found that he had no skin disease but had the classical symptoms of tabes, although in a mild degree, without ataxia. Motor disturbances may be the first to manifest themselves; inability to walk in the dark or with the eyes closed or to dance, may be the first indication that attracts the patient's attention. Patient stands with feet far apart to give wide base, lifts his feet too high and brings them down with undue force, when walking fixes his eyes on his feet; disturbances of vesical or rectal sphincters or the erectal power is sometimes the very first symptom. Crises of various kinds, gastric, with