Now, milk of magnesia is relatively harmless, yet let us see what the doctor has to say about this:

While milk of magnesia is a very mild laxative, and is often prescribed for babies without seeming to do them any harm, it must be remembered that even this is not wholly without possibilities of evil. Where it has been used for long periods, in the large doses which one is obliged to employ to produce a cathartic effect in an adult "stomach stones" or "Alvine concretions" sometimes form. These remain in the gastric cavity, for magnesium is a mineral, and the formation of stones by deposit of salts can take place here as in any other part of the body.

Like common constipation, colds is a subject for advertising in every newspaper and magazine in the country, almost, and one of the most frequent ads is that for "Grove's Laxative Bromo-Quinine." "The right and wrong about colds. Facts it will pay every person to know." Despite the fact that no one knows precisely what colds are due to, and no one knows how to prevent them, these people are going to rid us of colds in a day, and the thing I want to point out in this advertisement particularly is the statement that Grove's Laxative Bromo-Quinine contains nothing harmful and is absolutely safe." Now, "Grove's Laxative Bromo-Quinine" contains acetanilid, which has been responsible for scores of deaths. Many years ago, about 25 deaths were reported and, with its increasing consumption, I am sure that number has mounted.

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Senator HEBERT. You mean deaths caused by laxative bromoquinine?

Mr. KALLET. Deaths caused by acetanilid, one of the constituents of this product, and yet they are willing to advertise it as safe, without giving any warning to the public.

Here is another advertisement directed at constipation, and here again we have an advertisement which the present bill Senate 2800 would not affect in the slightest.

"Millions have made a pleasant discovery!"

I dare say it is true that those who have taken castor oil and have taken a chocolate laxative have decided they have made a pleasant discovery.

"Ex Lax, the perfect laxative ", it says. There you have, Mr. Chairman, a puffery, an example of trade puffing. No one can complain about it.

Here it says, "Ex Lax ", the perfect laxative.

Ex Lax contains phenolphthalein. I would like to read Dr. Montague's statement about phenolphthalein.

Perhaps you can scarcely believe that in this day and age a substance which is poisonous is being used for its laxative effect, yet we find that phenolphthalein, which is a definite poison is actually being used in literally hundreds of patent medicine preparations sold for laxative purposes.

Phenolphthalein is, however, a poison and it is known to be such by every one trained in chemistry. Like most poisons it can be harmless if taken in small doses at long intervals. However, all people are not alike in their ability to tolerate this poison, even in small amounts and the reactions which are produced by taking it vary from a skin eruption to a severe kidney irritation. It must stand to reason that if in very small doses severe physical reaction can be produced, the constant repetition of these doses of poison will damage the system to an even greater extent. Indeed, several deaths have been directly attributed to the taking of this drug. By curious irony the organ for whose benefit the laxative is primarily taken, namely, the colon, is the one which suffers most acutely when the drug is used over a period of time. Some of the 43076-34-19

most severe cases of spastic colitis I have ever seen have been due to the prolonged use of phenolphthalein cathartics.

A historical survey of the poisonous effects of phenolphthalein might be begun with a description of the cases shown before a medical society some 15 years ago by 2 New York skin specialists. They presented 5 patients suffering from an unusual skin eruption consisting of large bluish-gray patches, which were at first bright in color and itched furiously, but later ceased itching and faded out to a pale brown, in which state they persisted for several months before disappearing entirely.

During the next 2 or 3 years after this first announcement, as many as 30 such cases following the use of such laxative containing phenolphthalein were reported before associations of skin specialists and in the medical journals. No effort was made, however, to interfere with the limited sales of laxatives containing the drug, nor even to suggest, on the label or elsewhere that certain people could not use phenolphthalein without suffering from skin eruptions or other unpleasant reactions.

Medical literature reveals many cases in which the reaction was still more severe. A number of patients have been seen with ulcers of the mouth and lips, at times so severe and extensive as to make eating nearly impossible. Many "reducing" medicines contain phenolphthalein, and a number of cases of illness and poisoning from their use by obese women have been reported. One patient is reported as having told her doctor that she was taking such a remedy and had been most successful in losing weight. However, the medicine had produced an obstinate diarrhea, which did not cease when she stopped taking it. A careful examination showed that she was suffering from an acute inflammation of the kidneys which might easily have proven fatal had she continued to take the "antifat" pills.

Further on he says: It may with truth be argued that an overdose of any medicine is likely to have disastrous results and that we should not condemn it because the directions which accompanied it were not followed. In the case where an overdose was taken such reasoning may apply. However, when the laxatives containing phenolphthalein were taken precisely as the printed label directed yet severe skin rashes, loss of the nails, sores in the mouth and nose, and even grave kidney disease resulted, this alibi for the manufacturers does not hold.

That advertising for Ex Lax, by the way, appears largely in magazines for parents.

"The candy laxative" is in itself a bad thing because it helps and encourages the formation of "laxative habit" in early life, which the unfortunate individual may retain when grown up. When this "candy" " is employed to camouflage a deadly poison, its unrestricted employment becomes little less than a crime.

And your law proposes to do nothing about that crime. There is one series of advertising which even the advertising men are ashamed of. Printers' Ink, the most reactionary of all of the advertising magazines, has pointed with shame to the advertising of Fleischmann's yeast because of their fake testimoniais from foreign physicians, and other things.

Here is one of the advertisements:

Dr. Sternberg, of Vienna, says "3 out of 4 of all my abdominal operations result from constipation."

The advertising advices everyone to take Fleischmann's yeast. I doubt, Mr. Chairman, if there is anything in that advertisement that your law could control. Perhaps some doctor has made a statement about it, which is his honest opinion or paid opinion, I don't know, but the courts probably would find it quite satisfactory.

As to yeast, I should like first to put on the record a letter which was addressed to the journal of the American Medical Association by Dr. Ernst Pick, dean of the medical faculty and director of the pharmacologic department, in which he points out that these great

physicians whom we are lead to believe are the leading gastro-intestinal specialists in the world, or leading dermatologists, are making statements on behalf of Fleischmann's yeast, and in this letter to the American Medical Association, he points out that they are not even professors who are heads of department, but merely are given the - privilege of teaching in the university. I won't read the entire letter but will merely offer it in the record.

(The letter referred to is as follows:)

Testimonials for yeast.

To the editor: It has been brought to the attention of the Vienna medical faculty that medical testimonials favoring one of the yeast preparations placed on the market by the Fleischmann Yeast Co. in New York have been placed at the disposal of this company by certain members of the medical faculty in Vienna, and that these testimonials are spread and misused for advertising purposes in American illustrated and other magazines in quack fashion. Even though the testifiers in question cannot personally be responsible for this misuse, since they have no power of might against the unfair methods employed by the yeast firm, nevertheless the Vienna medical faculty instituted an extensive inquiry into this matter in June 1932. The members at fault were officially sharply reproved by the dean, and all members of the faculty were forbidden to give any testimonials intended for advertising purposes in the future.

All of the 328 members of the medical faculty were officially advised of these proceedings. Incidentally, not a single member of the board of professors (heads of departments) of the medical faculty is involved in this affair. Seven private dozents not included on the board, and not one of whom either has the official position of teacher or is in charge of a department, are concerned here. (Private dozents, according to the statutes of the universities of Austria, are not appointed by the State but merely permitted by the State to teach.)

In consideration of the fact that through the impropriety of these advertisements the reputation and esteem of the Vienna Medical School could be seriously affected among the medical men and people of America, we ask the American Medical Association to take cognizance of the foregoing explanation of the situation and to spread this information among its members through its publishing organ and if possible also publicly.

PROF. DR. ERNST PICK,

Dean of the Medical Faculty and Director

of the Pharmacologic Department. PROF. DR. ROLAND GRASSBERGER,

Former Dean of the Medical Faculty and Director
of the Hygienic Department, Vienna, Austria.

I have a letter from H. H. Hazen, of Washington, D.C., which appeared in the American Medical Association correspondence column on March 18, 1933. In this letter, Dr. Hazen said:

Despite the marvelous account of the value of yeast, written by the advertising agents of the yeast companies and supported by the foreign legion of physicians, the relative percentage of acne cases among dermatoses has not decreased. In addition, at least half of the patients suffering from acne have previously tried yeast without any benefit to themselves. But that the administration of yeast may actually induce acne vulgaris seems to have escaped attention. The report of the following three cases of acne is of some passing interest:

Case 1. A white man, aged 26, had suffered from a mild acne between the ages of 16 and 20, but had been entirely well for 6 years. Because of some indigestion he decided to take yeast, and after he had done so for 3 weeks there was no change in his gastro-intestinal condition and, in addition, there had developed a severe pustular acne vulgaris of the forehead and cheeks; this spontaneously disappeared 2 weeks after the yeast was discontinued and has not recurred for 3 years.

Case 2. A white youth, aged 21, twice developed an acne vulgaris within 3 weeks after the administration of yeast was begun. The condition continued with increasing severity during the taking of the preparation and disappeared spontaneously within 2 weeks of the time that the yeast was discontinued.

Case 3. This was in all particulars the same as in the second case reported, except that the patient was a girl.

In all three of these cases the patients were well known to me, and the observations noted are correct.

We have this letter from a Chicago surgeon:

As for Fleischmann's yeast, it is only an extraordinarily expensive protein food. An exposure of the methods used to secure the endorsements of European physicians and the inducement offered and the actual professional standing of many of these foreign "experts" and "specialists" would make a most amusing magazine article he puts experts and "specialists" in quotation marks and will be written some day no doubt by some American newspaperman abroad, if he could find a suitable American publication not already too heavily subsidized by Fleischmann advertising.

Another letter recently appeared in the journal of the American Medical Association on this subject, a doctor writing to the editor wanted to know if there was any fact to the widely advertised claim, supported by foreign medical authorities, which he puts in quotation marks, that yeast is beneficial in constipation and skin troubles, and the answer in part was:

That it is of much value in other kinds of skin trouble, such as acne or furnunculosis is doubtful, as many patients who keep on suffering from these conditions in spite of liberal ingestion of yeast are willing to testify. That among the host of persons taking yeast a skin disorder clears up occasionally is not surprising. The association might be entirely accidental. Finally, here is what Dr. Montague says about it:

Yeast is a micro-organism which can, under certain conditions, give rise to disease in human beings. Some cases of this kind are on record in the medical journals, so it is wise not to accept wholly the claims made in the advertisements to the effect that yeast is harmless. We all agree that it has virtue in remedying certain cases of constipation where there has been a deficiency of the vitamin B. The laxative action which accompanies the continued feeding of yeast cells is due partly, however, to the fact that they add considerable bulk to the bowel material, and, hence, stimulate the intestines to contract. But on the whole yeast is an unreliable laxative. There are many people in which the feeding of yeast causes the production of irritating byproducts and an actual unhealthy frequency of bowel movement. Then, too, there are cases in which it gives rise to tremendous flatulence, due to the formation of gas.

Mr. CHAIRMAN. Not all advertisements are dangerous to health as those which I have just read are, in my opinion, but a very, very great proportion of all other advertising for drug and cosmetic products and for food products for which any health claims are made is false and is an attack on the pocketbook of the consumer.

As I said before, and I need not say it, because I am sure you all know it, no one knows of any remedy for colds. They may be relieved slightly, and the discomfort, perhaps, can be relieved slightly, but none know what to do for a cold, and yet here we find Bayer's aspirin advertising how to relieve a cold quick as you caught it, and in their cartoon, which is the latest and most profitable apparently of the advertising techniques, they give the impression that by taking Bayer's aspirin liberally the cold is going to go away in one single day. And similarly Vapex.

I do not doubt that Vapex is good to relieve congestion of the nasal passages, but that is not enough for these advertisers, they are

not going to cheat the public sufficiently if that is all they advertise it for, so they say:

No longer a victim of colds since he discovered this easy vaportent way to clear them up.

Also, in the advertisement they say Vapex is a famous war-time discovery now used by millions of intelligent people who refuse to dose themselves. These things are all famous discoveries. Let us see what the American Medical Association says about this famous discovery.

Vapex had a somewhat mystical, war-time origin. Certain chemists in a plant engaged in important experiments for the British Government were found to be unaffected by influenza which struck. heavily among the workers in other departments of the concern. This gave rise to the belief that the products with which they were experimenting had in some way protected them, and so with scientific insight they decided that an important medical discovery had been made. Unlike medical scientists, however, they did not publish their findings to the world in the journals of their profession, but kept the method of making the product a secret.

The composition of Vapex is probably not of very great importance, but various tests have been made in Holland and in this country. A substance very similar to Vapex in physical and chemical property may be made accord ing to the following very simple formula:

Mr. Chairman, so far my remarks with relation to advertising have dealt with companies which make no pretensions to being in business, that is, they make no pretensions whatsoever, outside of such hearings as this, to be in business for the welfare of the public. They are in business for profit and everybody knows it, but, the same thing, though to a lesser degree is true of the so-called "ethical companies", or, at least, it is true of many of them.

Here, for example, is an advertisement of Squibb's dental cream. "Do not be satisfied with one fifth in dentrifices ", and it gives at least five ways that Squibbs dental cream can do various and sundry things.

In Drug and Cosmetic Industry for December 1933 we read, "A.D.A., that is the American Dental Association, omits from accepted remedies Squibb's dental cream, because E. R. Squibb & Sons advertise Squibb's dental cream to the public and to the profession with therapeutic claims in conflict with the liberal provisions of the council for dentrifices.

The seal of approval is also withdrawn from Pebeco toothpaste, but everyone knows what Pebeco is.

The current papers also carry advertising for Squibb's Adex. Here is a typical advertisement:

Everyone has cause to fear exposure, but more than most people with low resistances, and everyone, not alone children and invalids, but everyone is advised to take Squibb's Adex to build up resistance.

I would like to read a statement made by the Consumers' Research a statement that had the approval of physicians before being published.