—
Reprinted from Collier's Weekly, Dec. 2, 1905.
IV. - THE SUBTLE POISONS
_________
Ignorance and credulous hope make the market for most proprietary remedies. Intelligent people are not given largely to the use of the glaringly advertised cure-alls such as Liquozone and Peruna. Nostrums there are, however, which reach the thinking classes as well as the readily gulled. Depending, as they do, for their success on the lure of some subtle drug concealed under a trademark name, or some opiate not readily obtainable under its own label, these are the most dangerous of all quack medicines, not only in their immediate effect, but because they create enslaving appetites, sometimes obscure and difficult of treatment, most often tragically obvious. Of these concealed drugs the headache powders are the most widely used, and of the headache powders Orangeine is the most conspicuous.
Orangeine prints its forumula. It is, therefore, its proprietors claim, not a secret remedy. But to all intents and purposes, it is secret, because to the uninformed public the vitally important word "acetanilid" in the formul means little or nothing. Worse than its secrecy is its policy of careful and dangerous deception. Orangeine, like practically all the headache powders, is simple a mixture of acetanilid with less potent drugs. Of course, there is no orange in it, except the orange hue of the boxes and wrappers which is its advertising symbol. But this is an unimportant deception. The wickedness of the fraud lies in this: that whereas the nostrum, by virtue of its acetanilid content, thins the blood, depresses the heart, and finally undermines the whole system, it claims to strengthen the heart and to produce better blood. Thus far in the patent medicine field I have no encountered so direct and specific an inversion of the true facts.
Recent years have added to the mortality records of our cities a surprising and alarming number of sudden deaths from heart failure. IN the year 1902 New York City alone reported a death rate from this cause of 1.34 per thousand of population; that is about six times as great as the typhoid fever death record. It was about that time that the headache powders were widely advertised, and there is every reason to believe that the increased mortality, which is still in evidence, is due largely to the secret weakening of the body by acetanilid. Occasionally a death occurs so definitely traceable to this poison that there is no room for doubt, as in the following report by Dr. J.L. Miller, of Chicago, in the Journal of the American Medical Association, on the death of Mrs. Frances Robson:
"I was first called to see the patient, a young lady physically sound, who had been taking Orangeine powders for a number of weeks for insomnia. The rest of the family noticed that she was very blue, and for this reason I was called. When I saw the patient she complained of a sense of faintness and inability to keep warm. At this time she had taken a box of six Orangeine powders within about eight hours. She was warned of the dangers of continuing the indiscriminate use of the remedy, but insisted that many of her friends had used it, and claimed that it was harmless. The family promised to see that she did not obtain any more of the remedy. Three days later, however, I was called to the house and found the patient dead. The family said that she had gone to her room the evening before in her usual health. The next morning, the patient not appearing, they investigated and found her dead. The case was reported to the coroner, and the coroner's verdict was: 'Death was from the effect of an overdose of Orangeine powders administered by her own hand, whether accidentally or otherwise, unknown to the jury.'"
Last July an 18-year-old Philadelphia girl got a box of Oranegine powders at a drug store, having been told that they would cure headache. There was nothing on the label or in the printed matter inclosed with the preparation warning her of the dangerous character of the nostrum. Following the printed advice, she took two powders. In three hours she was dead. Coronor Dugan's verdict follows:
"Mary A. Bispels came to her death from kidney and heart disease, aggravated by poisoning by acetanilid taken in Orangeine headache powders."
Prescribing Without Authority
Yet this poison is being recommended every day by people who know nothing of it and nothing of the susceptibility of the friends to whom they advocate it. For example, here is a testimonial from the Orangeine booklet:
"Miss A. A. Phillips, 66 Powers Street, Brooklyn, writes: 'I always keep Orangeine in my desk at school, and through its frequent applications to the sick I am called both "doctor and magician."'"
If the school herein referred to is a public school, the matter is one for the board of education; if a private school, for the Health Department or the county medical society. That a school teacher should be allowed to continue giving, however well meaning her follhardiness may be, a harmful and possibly fatal dose to the children instructed to her care seems rather a significant commentary on the quality of watchfulness in certain institutions.
Obscurity as to the real nature of the drug, fostered by careful deception, is the safeguard of the acetanilid vender. Were its perilous quality known, the headache powder would hardly be so widely used. And were the even more important fact that the use of these powders becomes a habit, akin to the opium or cocain habits, understood by the public, the repeated sales which are the basis of Orangeine's prosperity would undoubtedly be greatly cut down. Orangeine fulfills the prime requisite of a patent medicine in being a good "repeater." Did it not foster its own demand in the form of a persistent craving, it would hardly be profitable. Its advertising invites to the formation of an addiction to the drug. "Get the habit," it might logically advertise, in imitation of a certain prominent exploitation along legitimate lines. Not only is its value as a cure for nervousness and headaches insisted on, but its prospective dupes are advised to take this powerful drug as a bracer.
"When, as often, as you reach home tired in body and mind . . . take an Oranegine powder, lie down for thirty minutes' nap - if possible - anyway, relax, then take another."
"To induce sleep, take an Orangeine powder immediately before retiring. When wakeful, an Oranegine powder will have a normalizing, quieting effect."
It is also recommnded as a good thing to begin the day's work on in the morning - that, take Orangeine, night, morning and between meals!
These powders pretend to cure asthma, biliousness, headaches, colds, catarrh and grip (dose: powdere very four hours during the day for a week! - a pretty fair start on the Orangeine habit), diarrhea, hay fever, insomnia, influenze, neuralgia, seasickness and sciatica.
Of course, they do not cure any of these; they do practically nothing but give temporary relief by depressing the heart. With the return to normal conditions of blood circulation comes a currence of the nervousness, headache, or what not, and the incentive to more of the drug, until it becomes a necessity. In my own acquaintance, I know half a dozen persons who have come to depend on one or another of these headache preparations to keep them going. One young woman whom I have in mind told me quite innocently that she had been taking five or six Orangeine powders a day
for several months, having changed from Koehler's powders when some one told her that the latter were dangerous! Because of her growing paleness her husband had called in their physician, but neither of them had mentioned the little matter of the nostrum, having accepted with a childlike faith the asseverations of its beneficent qualities. Yet they were of an order of intelligence that would scoff at the idea of drinking Swamp-Root or Peruna. That particular victim had the beginning of the typical blue skin pictured in the street-car advertisements of Orangeins (the advertisements are a little mixed, as they put the blue hue on the "before taking," whereas it should go on the "after taking"). And, by the way, I can conscientiously recommend Orangeine, Koehler's powders, Royal Pain powders and other of that class to women who wish for a complexion of a dead, pasty white,
verging to a puffy blueness under the eyes and about the lips. Patient use of these drugs will even produce an interesting and picturesque, if not intrinsically beautiful, purplish-gray hue of the face and neck.
Drugs That Deprave.
Another acquaintance wrties me that he is unable to dissuade his wife from the constant use of both Orangeine and Bromo-Seltzer, although her health is breaking down. Often it is difficult for a physician to diagnose these cases because the symptoms are those of certain diseases in which the blood deteriorates, and, moreover, the victim, as in opium and cocain slavery, will positively deny having used the drug. A case of acetanlid addiction (in "cephalgin," an ethical propritary) is thus reported:
"When the drug was withheld the patient soon began to exhibit all the traits peculiar to the confirmed morphino-maniac - moral depravity and the like. She employed every possible means to obtain the drug, attempting even to bribe the nurse, and, this failing, even members of the family."
Another report of a similar case (and there are plenty of them to select from) reads:
"Stomach increasingly irritable; skin a grayish or light purplish hue; palpitation and slight enlargement of the heart; great prostration, with pains in the region of the heart; blood discolored to a chocolate hue. The patient denied that she had been using acetanilid, but it was discovered that for a year she had been obtaining it in the form of a proprietary remedy and had contracted a regular 'habit.' on the discontinuance of the drug the symptoms disappeared. She was discharged from the hospital as cured, but soon returned to the use of the drug and applied for readmission, displaying the former symptoms."
NEW YORK STATE'S NEW POISON LABEL.
On a cocain-laden medicine.
Where I have found a renegade physician making his million out of Peruna, or a professional promoter trading in the charlatanry of Liquozone, it has seemed superfluous to comment on the personality of the men. They are what their business connotes. With Orangeine the case is somewhat different. Its proprietors are men of standing in other and reputable spheres of activity. Charles L. Bartlett, its president, is a graduate of Yale University and a man of some prominence in its alumni affairs. Orangeine is a side issue with him. Professionally he is the western representative of Ivory Soap, one of the heaviest of legitimate advertisers, and he doubtless learned from this the value of skillful exploitation. Next to Mr. Bartlett, the largest owner of stock (unless he has recently sold out) is William Gillette, the actor, whose enthusiastic indorsement of the powders is known in a personal sense to the profession which he follows, and in print to hundreds of thousands of theater-goers who have read it in their programs. Whatever these gentlement may think of their product (and I understand that, incredible as it may seem, both of them are constant users of it and genuine believers in it), the methods by which it is sold and the essential and mendacious concealment of its real nature illustrate the level to which otherwise upright and decent men are brought by a business which can not profitably include either uprightness or decency in its methods.
Orangeine is less dangerous, except in extent of use, than many other acetanilid mixtures which are much the same thing under a different name. A friend of mine with a weak heart took the printed dose of Laxative Bromo Quinin and lay at the point of death for a week. There is no word of warning on the label. In many places samples of headache powders are distributed on the doorsteps. The St. Louis Chronicle records a result:
"Huntington, W. Va., Aug. 15, 1905. - While Mr.s Thomas Patterson was preparing supper last evening she was stricken with a violent headache and took a headache powder that had been thrown in at her door the day before. Immediately she was seized with spasms and in an hour she was dead."
That even the lower order of animals is not safe is shown by a canine tragedy in Altoona, Pa., where a prize collie dog incautiously devoured three sample tablets and died in an hour. Yet the distributing agents of these mixtures do not hesitate to lie about them. Rochester, N.Y., has an excellent ordinance forbidding the distribution of sample medicines, except by permission of the health officer. An agent for Miniature Headache Powders called on Dr. Goler with a request for leave to distribute 25,000 samples.
"What's your formula?" asked the official.
"Salicylate of soda and sugar of milk," replied the traveling man.
"and you pretend to cure headaches with that?" said the doctor. "I'll look into it."
Analysis showed that the powders were an acetanilid mixture. The sample man didn't wait for the result. He hasn't been back to Rochester since, although Dr. Goler is hopefully awaiting him.
Bromo-Seltzer is commonly sold in drug stores, both by the bottle and at soda fountains. The full dose is "a heaping teaspoonful." A heaping teaspoonful of Bromo-Seltzer means about ten grains of acetanlid. The United States Pharmacopeia dose is four grains; five grains have been known to produce fatal results. The prescribed dose of Bromo-Seltzer is dangerous and has been known to produce sudden collapse.
Megrimine is a warranted headache cure that is advertised in several of the magazines. A newly arrived guest at a Long Island house party brought along several lots and distributed them as a remedy for headache and that tired feeling. It was perfectly harmless, she declared; didn't the advertisement say "leaves no unpleasant effects?" As a late dance the night before had lefts its impress on the feminine members of the house party, there was a general acceptance of the "bracer." That night the local physician visited the house party (on special "rush" invitation), and was well satisfied to pull all his patients through. he had never before seen acetanilid poisoning by wholesale. A Chicago druggist writes me that the wife of a prominent physician buys Megrimine of him by the half-dozen lots secretly. She has the habit.
On October 9, W.H. Hawkins, superintendent of the American Detective Association, a man of powerful physique and apparently in good health, went to a drug store in Anderson, Ind., and took a dose of Dr. Davis' Headache Powders. He then boarded a car for Marion, and shortly after fell to the floor, dead. The coroner's verdict is reproduced on page 35. Whether these powders are made by a Dr. W.C. Davis, of Indianapolis who makes Anti-Headache, I am unable to state. Anti-Headache describes itself as "a compound of mild ingredients and positively contains no dangerous drugs." It is almost pure acetanlid.
In the "ethical" field the harm done by this class of proprietaries is perhaps as great as in the open field, for many of those which are supposed to be sold only in prescriptions are freely distributed to the laity as Peruna. And their advertising is hardly different.
Dangers of Antikamnia
Antikamnia, claming to be an "ethical" remedy, and advertising through the medical press by methods that would, with little alteration, fit any patent painkiller on the market, is no less dangerous or fraudulent than the Orangeine class which it almost exactly parallels in composition. It was at first exploited as a "new synthetical coal-tar derivative," which it isn't and never was. It is simply half or more acetanilid (some analyses show as high as 68 percent.) with other unimportant ingredients in varying proportions. In a booklet entitled "Light on Pain," and distributed on
doorsteps, I find under an alphabetical list of diseases this invitation to form the Antikamnia habit:
"Nervousness (overwork and excess) - Dose: One Antikamnia tablet every two or three hours.
"Shoppers' or Sightseers Headache - Dose: Two Antikamnia tablets every three hours.
"Worry (nervousness, 'the blues') - Dose: One or two Antikamnia and Codein tablets every three hours."
Codein is obtained from opium. The codein habit is well known to all institutions which treat drug addictions, and is recognized as being no less difficult to cure than the morphin habit.
A typical instance of what Antikamnia will do for its users is that of a Pennsylvania merchant, 50 years old, who had declined, without apparent cause, from 140 to 116 pounds, and was finally brought to Philadelphia in a state of stupor. His pulse was barely perceptible, his skin dusky and his blood of a deep chocolate color. On reviving he was questioned as to whether he had been taking headache powders. He had, for several years. What kind? Antikamnia; sometimes in the plain tablets, at other times Antikamnia with codein. How many? About twelve a day. He was greatly surprised to learn that this habit was responsible for his condition.
"My doctor gave it to me for insomnia," he said, and it appeared that the patient had never even been warned of the dangerous character of the drug.
Were it obtainable, I would print here the full name and address of that attending physician, as one unfit, either through ignorance or carelessness, to practice his profession. And there would be other physicians all over the country who would, under that description, suffer the same indictment within their own minds for starting innocent patients on a destructive and sometimes fatal course. For it is the careless or conscienceless physician who gets the customer for the "ethical" headache remedies, and the customer, once secured, pays a profit, very literally, with his own blood. Once having taken Antikamnia, the laymen, unless informed as to its true nature, will often return to the drug store and purchase it with the impression that it is a specific drug, like quinin or potassium chlorate, instead of a disguised poison, exploited and sold under patent rights by a private concern. The United States Postoffice, in its broad tolerance, permits the Antikamnia company to send through the mails little sample boxes containing tablets enough to kill an ordinary man, and these sample boxes are sent not only to physicians, as is the rule with ethical remedies, but to lawyers, business men, "brain workers," and other prospective purchasing classes. The box bears the lying statement: "No drug habit - no heart effect."
Just as this is going to press the following significant case comes in from Iowa:
"Farmington, Iowa, Oct. 6. - (Special to the Constitution-Democrat.) - Mrs. Hattie Kick, one of the best and most prominent ladies of Farmington, died rather suddenly Wednesday morning at 10 o'clock from an overdose of Antikamnia, which she took for a severe headache from which she was suffering. Mrs. Kick was subject to severe headaches and was a frequent user of Antikamnia, her favorite remedy for this ailment."
There is but one safeguard in the use of these remedies; to regard them as one would regard opium, and to employ them only with the consent of a physician who understands their true nature. Acetanilid has its uses, but not as a generic painkiller. Pain is a symptom; you can drug it away temporarily, but it will return, clamoring for more payment, until the final price is hopeless enslavement. Were the skull and bones on every box of this class of poison the danger would be greatly minimized.
With opium and cocain the case is different. The very words are danger signals. Legal restrictions safeguard the public, to a greater or less degree, from their indiscriminate use. Normal people do not knowingly take opium or its derivatives except with the sanction of a physician, and there is even spreading abroad a belief (surely an expression of the primal law of self-preservation) that the licensed practitioner leans too readily toward the convenient narcotics.
But this perilous stuff is the ideal basis for a patent medicine because its results are immediate (though never permanent), and it is its own best advertisement in that one dose imperatively calls for another. Therefore it behooves the manufacturer of opiates to disguise the use of the drug. This he does in varying forms, and he has found his greatest success in the "cough and consumption cures" and the soothing syrup class. The former of these will be considered in another article. As to the "soothing syrups," designed for the drugging of helpless infants, even the trade does not know how many have risen, made their base profit, and subsided. A few survive, probably less harmful than the abandoned ones, on the average, so that by taking the conspicuous survivors as a type I am at least doing no injustice to the class.
Some years ago I heard a prominent New York lawyer, asked by his office scrub woman to buy a ticket for some "association" ball, say to her: "How can you go to these affairs, Nora, when you have two young children at home?"
"Sure, they're all right," she returned blithely; "just wan teaspoonful of Winslow's an' they lay like the dead till mornin'."
What eventually became of the scrub woman's children I don't know. The typical result of this practice is described by a Detroit physician who has been making a special study of Michigan's high mortality rate:
"Mrs. Winslow's Soothing Syrup is extensively used among the poorer classes as a means of pacifying their babies. These children eventually come into the hands of physicians with a greater or less addiction to the opium habit. The sight of a parent drugging a helpless infant into a semi-comatose condition is not an elevating one for this civilized age, and it is a very common practice. I can give you one illustration from my own
A DANGEROUS SAMPLE BOX WHICH GOES THROUGH THE MAILS.
Enough tablets were contained in this package, marked "No Heart Effect," to stop the heart entirely, if taken all at once. The chief ingredient of antikamnia is acetanilid.
hospital experience, which was told me by the father of the girl. A middle-aged railroad man of Kansas City had a small daughter with summer diarrhea. For this she was given a patent diarrhea medicine. It controlled the trouble, but as soon as the remedy was withdrawn the diarrhea returned. At every withdrawal the trouble began anew, and the final result was that they never succeeded in curing the daughter of the opium habit which had taken its hold on her. It was some years afterward that the parents became aware that she had contracted the habit, when the physician took away the patent medicine and gave the girl morphin, with exactly the same result which she had experienced with the patent remedy. At the time the father told me this story his daughter was 19 years of age, an only child of wealthy parents, and one who could have had every advantage in life, but who was a complete wreck in every way as a result of the opium habit. The father told me, with tears in his eyes, that he would rather she had died with the original illness than to have lived to become the creature which she then was."
The proprietor of a drug store in San José, Cal., writes to Collier's as follows:
"I have a good customer, a married woman with five children, all under 10 years of age. When her last baby was born, about a year ago, the first thing she did was to order a bottle of Winslow's Soothing Syrup, and every
TO CATCH THE COCAIN-FIEND TRADE.
Were this drugstore display in Illinois instead of New York City, the druggist would be arrested and his stock confiscated. This is one of the favorite cocain powders used by victims of the cocain habit. The law now requires that it be labeled "Poison."
week another bottle was bought at first, until now a bottle is bought every third day. Why? Because the baby has become habituated to the drug. I am not well enough acquainted with the family to be able to say that the weaned children show any present abnormality of health due to the opium contained in the drug, but the after-effects of opium have been thus described. . . . Another instance, quite as startling, was that of a mother who gave large quantities of soothing syrup to two of her children in infancy; then, becoming convinced of its danger, abandoned its use. These children in middle life became neurotics, spirit and drug-takers. Three children born later and not given any drugs in early life grew up strong and healthy.
"I fear the children of the woman in question will all suffer for their mother's ignorance, or worse, in later life, and have tried to do my duty by sending word to the mother of the harmful nature of the stuff, but without effect.
"P. S. - How many neurotics, fiends and criminals may not 'Mrs Winslow' be sponsor for?"
This query is respectfully referred to the Anglo-American Drug Company, of New York, which makes its handsome profit from this slave trade.
Recent legislation on the part of the New York State Board of Pharmacy will tend to decrease the profit, as it requires that a poison label be put on each bottle of the product, as has long been the law in England.
An Omaha physician reports a case of poisoning from a compound bearing the touching name of "Kopp's Baby Friend," which has a considerable sale int he middle west and in central New York. It is made of sweetened water and morphin, about one-third grain of morphin to the ounce.
"The child (after taking four drops) went into a stupor at once, the pupils were pin-pointed, skin cool and clammy, heart and respiration slow. I treated the case as one of opium poisoning, but it took twelve hours before my little patient was out of danger."
As if to put a point of satirical grimness on the matter, the responsible proprietor of this particular business of drugging helpless babies is a woman, Mrs. J. A. Kopp, of York, Pa.
Making cocain fiends is another profitable enterprise. Catarrh powders are the medium. A decent druggist will not sell cocain as such, steadily, to any customer, except on prescription, but most druggists find salve for their consciences in the fact that the subtle and terrible drug is in the form of somebody's sure cure. There is need to say nothing of the effects of cocainn other than that it is destructive to mind and body alike, and appalling in its breaking down of all moral restraint. Yet in New York City it is distributed in "samples" at ferries and railway stations. You may see the empty boxes and the instructive labels littering the gutters of Broadway any Saturday night, when the drug trade is briskest.
Birney's Catarrhal Powder, Dr. Cole's Catarrh Cure, Dr. Gray's Catarrh Powder, and Crown Catarrh Powder are the ones most in demand. All of them are cocain; the other ingredients are unimportant - perhaps even superfluous.
Whether or not the bottles are labeled with the amount of cocain makes little difference. The habitues know. In one respect, however, the labels help them by giving information as to which nostrum is the most heavily drugged.
"People come in here," a New York City druggist tells me, "ask what catarrh powders we've got, read the labels, and pick out the one that's go the most cocain. When I see a customer comparing labels I know she's a fiend."
Naturally these owners and exploiters of these mixtures claim that the small amount of cocain contained is harmless. For instance, the "Crown Cure," admitting 2 1/2per cent., says:
"Of course, this is a very small and harmless amount. Cocain is now considered to be the most valuable addition to modern medicine . . . it is the most perfect relief known."
Birney's Catarrh Cure runs as high as 4 per cent. and can produce testimonials vouching for its harmlessness. Here is a Birney "testimonial" to the opposite effect, obtained "without solicitation or payment" (I have ventured to put it in the approved form), which no sufferer from catarrh can afford to miss:
READ WHAT
William Thompson, of Chicago,
says of
BIRNEY'S CATARRH CURE.
"Three years ago Thompson was a strong man.
Now he is without money, health, home, or friends."
Chicago Tribune.
- "I began taking Birney's Catarrh Cure (says Thompson) three years ago, and the longing for the drug has grown so potent that I suffer without it.
- "I followed the directions at first, then I increased the quantity until I bought the stuff by the dozen bottles."
A famous drink and drug cure in Illinois had, as a patient, not long ago, a 14-year-old boy, who was a slave to the Birney brand of cocain. He had run his father $300 in debt, so heavy were his purchases of the poison.
Chicago long ago settled this cocain matter in the only logical way. The proprietor of a large downtown drug store noticed several years ago that at noon numbers of the shop girls from a great department store purchased certain catarrh powders over his counter. He had his clerk warn them that the powders contained deleterious drugs. The girls continued to purchase in increasing numbers and quantity. He sent word to the superintendent of the store. "That accounts for the number of our girls that have gone wrong of late," was the superintendent's comment. The druggist, Mr. McConnell, had an analysis made by the Board of Health, which showed that the powder most called for was nearly 4 percent. cocain, whereon he threw it and similar powders out of stock. The girls went elsewhere. Mr. McConnell traced them and started a general movement against this class of remedies, which resulted in an ordinance forbidding their sale. Birney's Catarrhal Powders, as I am informed, to meet the new conditions, brought out a powder without cocain, which had the briefest kind of sale. For weeks thereafter the downtown stores were haunted by haggard young men and women, who begged for "the old powders; these new ones don't do any good." As high as $1.00 premium was paid for the 4 per cent. cocain species. To-day the Illinois druggist who sells cocain in this form is liable to arrest. Yet in New York, at the corner of Forty-second street and Broadway, I saw recently a show-window display of the Birney cure, and similar displays are not uncommon in other cities.
Regarding other forms of drugs there may be honest difference of opinion as to the limits of legitimacy in the trade. If mendacious advertising were stopped, and the actual ingredients of every nostrum plainly published and frankly explained, the patent medicine trade might reasonable claim to be a legitimate enterprise in many of its phases. But no label of opium or cocain, though the warning skull and cross-bones cover the bottle, will excuse the sale of products that are never safely used except by expert advice. I believe that the Chicago method of dealing with the catarrh powders is the right method in cocain- and opium-bearing nostrums. Restrict the drug by the same safeguards when sold under a lying pretence as when it flies its true colors. Then, and then only, will our laws prevent the shameful trade that stupefies helpless babies and makes criminals of our young men and harlots of our young woman.