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VOL. III.

106

EDITORIAL COMMENT

THE NEW YEAR.

COLORADO MEDICINE brings a greeting to all its readers and wishes them a prosperous and happy new year. Up to date We have been prosperous but not happy. As the shadows of 1905 grew long and the last dying embers began to flicker we were forced to move the editorial rooms one flight nearer our future home, where we expected to draw inspiration from the cloudless skies and pure ozone of the only Colorado. But alas and alack! The fumes of second-hand lime and 25 years' accumulation of microbes that have constantly filled our sanctum have not served to improve our inspiration or make us feel that "Valhalla" was anywhere close by. If we survive the present attack of bronchitis we may at least be able to draw our own breath, if not any great amount of inspiration.

COLORADO MEDICINE proposes to be prosperous. We begin the year with a fair start in the advertising line which promises to be largely increased before the end of 1906. It is a fair guess that COLORADO MEDICINE can be made self supporting.

In addition to the State Society papers the editor has received quite a few good papers that have been read before constituent societies and whose authors show their loyalty by sending them to our own journal.

It is also pleasing to note that good reports from constituent societies are on the increase. A united profession working in harmony will soon place Colorado medically, where nature placed her physically, above all others.

No. I

Secretaries should send in reports of annual meetings as soon as possible. Here's to the New Year!

THE DENVER CITY AND COUNTY MEDICAL SOCIETY.

The above society renewed its youth on January 2nd by holding its annual meeting and electing officers.

Dr. T. M. Burns for president and Dr. W. C. Bane for vice president were elected unanimously, and most of the other officers were re-elected. The retiring president, Dr. Wm. J. Rothwell, delivered a well prepared address full of good sensible ideas. He was particularly severe on poly-pharmacy and the advertising in medical journals of proprietary preparations, and designated this practice as "weeds growing in the garden of medicine."

We are sorry we cannot furnish the address to the readers of COLORADO MEDICINE, but in a moment of forgetfulness the doctor gave it to a journal that cultivates "weeds" by accepting advertisements that would not be approved by the A. M. A. Committee on Pharmacy and Chemistry.

A serious condition confronts the Denver City and County Medical Society. A medical writer in the Rocky Mountain News of January 7th informs the public that several of our best members are to be expelled and that the "society will miss the members more than the members will miss the society." This is certainly a sad thing to contemplate, but COLORADO MEDICINE would advise the Board of Censors to do their duty regardless of consequences.

It is also to be hoped that the new board will find more time to attend to

business than did the old board. When When called on for an annual report the chairman rose and stated that the only report they had was a suggestion that two of their members be re-elected. This may be taken to mean that some good may yet come from this delayed activity. The eyes of the members of the State Medical Society are watching the action of the Denver County Board of Censors.

Is it too much to ask for JUSTICE?

PROPRIETARY MEDICINES, PATENT MEDICINES, NOSTRUMS AND SECRET SYNTHETICS.* We must call attention to the confusion of terms so generally used in the literature upon the subject of proprietary remedies, patent medicines and nostrums. There is great need for clearness in the selection of terms which will definitely convey the intended meaning of those who speak or write upon this question, which has become such a live one to the general public as well as to the medical profession. The authority for the proper use of the words hereinafter defined is based upon the definitions given in the dictionary, and the United States patent law. A proprietary medicine is an article which any person or firm has the exclusive right to manufacture or sell; which definition includes a medicine of known formula or published process of manufacture, as well as a medicine of unknown formula or secret process of manufacture. The word proprietary should only be used generically, and should never be limited in its application as a synonym of the word nostrum. Proprietary medicines include: I. Patent medicines, all of which are of known process of manufacture; II. Pharmaceutical mixtures of known quantity and quality of ingredients; III. Nostrums, such as

*Reprinted by request from the New York State Journal of Medicine.

secret pharmaceutical mixtures, and the so-called synthetics, of secret formulæ protected by a trademark.

A patent medicine is a new and useful definite chemical compound of known formula. The process of manufacture is made public in the patent papers issued by the Government; therefore, all patent medicines are ethical. A nostrum is a medicine, the composition of which is secret, a quack medicine, or any recipe of charlatan character.

The trademark protects a class of secret synthetics which are nostrums, they being secret mixtures of some coal-tar product, advertised with a formula such as C, H, N, O. They are not patented, because they cannot conform to the patent law which demands that they shall be new and useful, definite chemical compounds.

The public and the profession have a right to be protected from the fraud practiced by the exploiters of nostrums which represent the only class of medicines offered to the medical profession which should be condemned as an insult to its intelligence and honesty. Any internal or external medicine, the formula of which does not state the quantity of its ingredients, and in the case of a synthetic, which does not state the process of its manufacture, is a nostrum or secret proprietary medicine. All nostrums thrive on false statements as to their therapeutic value. And it is the nostrum or secret proprietary venders who rave profited by the confusion of terms used in articles written by the authorities in medicine, who should know better than to play into the hands of the nostrum people, who must be considered as parasites on individual and public health.

Within two years articles have appeared by able teachers of scientific medicine, which illustrate the confusion of terms referred to. Transactions of State med

ical societies and medical journals contain the articles from which the following quotations are made:

I. "The wide use of many proprietary pills or mixtures is distinct evidence of the great power of foolishness and fraud even when directly opposed to honesty and instructed wisdom."

II. "There are no hard and fast lines which separate patent from proprietary remedies. In their secrecy of composition and method of exploitation they are comparable."

III. "The patent medicines are more particularly directed to the lay public and therefore use the public press as the medium of advertising, while the proprietary literature is addressed more particularly to the medical public."

IV. "If there is any apology for the use of proprietary medicines, it must be due to some deficiency in the physician himself, either to his lack of knowledge of chemistry and pharmacology and physiology and clinical therapeutics, or to his inertia." V. "The difference between a proprietary and a patent medicine is more apparent than real. There is no good excuse for using these preparations."

These are fair extracts from the articles which do more harm than good, as many of the most valuable remedies used by physicians are proprietary medicines, and should not be condemned as nostrums. Many writers have strongly condemned. the use of patent medicines in the face of the fact that all medicines now protected by a patent granted by our Government are ethical because the process of their manufacture is known. Recently an editorial and article have been published which distinguishes between a patent and a patented medicine; such a distinction is of recent origin, and if not killed in its infancy will surely lead to greater confusion

than that which now exists in the minds of the profession and of the public.

The old prejudice against a patent medicine dates from the time when a prescription of a simple or compound mixture could be patented, but such mixtures have not been patented in many years, so that the patent medicines of to-day represent only new and useful definite chemical compounds, the patent covering the process of manufacture, and any competent pharmaceutical chemist, by following the process described in the patent, can reproduce the identical preparation found upon the market; but the patent protects against a commercial use of such pubmeets every condition necessary to make lished process, which in being made public a patent medicine ethical.

The subject of monopoly in drugs and other therapeutic agents is a sociological one, and not essentially a medical question. To use the word "patent" as the synonym, and the word "patented" as the antonym of nostrum, as is being done by some of the workers in this field, is to increase rather than to clear up the fog which surrounds this important subject. The literature is full of such tautology as secret nostrums; the word "nostrums" means secret remedy, which makes qualifying it by word "secret" equivalent to saying that one should heed the voice of the vox populi. The reader often leaves the several articles in the medical journals upon the question of proprietary remedies, patent medicines and nostrums, and the discussion of the subject as reported in the transactions of the several State medical societies, in a condition of mind. best described as confusion worse confounded; which is largely due to the careless use of terms, and the questionable remedies suggested, for this evil. It is not unusual to read in many of the discussions before medical societies, which

have been reported within the past five years, such advice as: Why not limit the prescribing of physicians to the articles mentioned in the pharmacopoeia? Or should not the profession agree not to use any patent medicine; or that all proprietary medicines should be excluded from the advertising pages of medical journals, and should not be used by physicians? It is such advice which supplies the nostrum journals with the telling arguments in opposition to this great work, which is so often made ridiculous through misstatement and misunderstanding. The medical profession should be in possession of a criterion which should help it to decide which of the many samples of medicines left in a physician's office should find their way to the trash-basket. Samples of secret mixtures, protected by trademark, but

not patented, which are exploited as definite chemical compounds—or coal-tar syn

thetics should be considered as an insult to the intelligence of every physician receiving them. The information about such articles, so often limited to the statement that they do not depress the heart, at once suggests that they are more or less dangerous mixtures of acetanilid exploited as definite chemical compounds with popular names valuable only as commercial assets. Often the workmen in nostrum manufactories who know the secret of some special mixture will exploit such mixture under new, popular names, furnishing formulas such as C3, H1o, O2o, N30, and then circularize and sample the medical profession expecting physicians to accept such samples, and prescribe such nostrums or secret proprietary medicines, to their patients, which represent, as all nostrums do, fraud as to their composition, and false statements as to their therapeutic value.

To sum up: I. Proprietary remedies include ethical preparations and nostrums.

II. All medicines protected by a patent are ethical.

III. Nostrums include secret proprietary mixtures and secret synthetics protected by the trademark law.

All samples of secret medicines should be deposited in the trash-basket, as every scientific physician should know the quantity of the ingredients in the mixture or mixtures which he uses, and should beware of secret synthetics.

The Council of Pharmacy of the American Medical Association has the courage of its conviction and is doing splendid along the lines of scientific medicine, and work in educating the medical profession away from the nostrum evil, and, with the cooperation of the Ladies' Home Journal, Everybody's Magazine and Collier's Weekly, the same thing is being done for the general public. By the study of pharmacology the United States Pharmacopoeia will come into more general use and scientific medication will be correspondingly advanced throughout the United States. E. ELIOT HARRIS, M. D.

ORIGINAL PAPERS

LOOSE BODIES IN THE KNEE JOINT, WITH REPORT OF CASES.

By F. GREGORY CONNELL, M. D., Salida, Colo.

Attending Surgeon to the D. & R. G. R. R. Hospital.

The Corpora Libera Articulorum, the Corpora Mobilia, the Mures Articulorum, the Gelenkmaus of the Germans, the Corps Etranger Articulaires of the French and the Loose or Floating Bodies of the English, have been classified into:

(a) Those in normal joints, or if the joint is diseased this disease is the result of the presence of the floating body.