vice, have called attention to the frequency with which thyroid preparations are being used in the anti-fat nostrums. As in the case of the remedies just discussed, so, with thyroid extracts, have physicians become extremely cautious in their employment. These preparations were primarily used for the cure of goitre, and while they produced a marked reduction in the size of the tumor it was also found that they caused a marked loss in bodily weight, amounting in some instances from 2 to 11 pounds a week, all of which naturally suggested their employment for the reduction of obesity. But the careful observer soon found that these results were not without serious risks to the general health and practically abandoned the remedy except in some well-selected cases. The manufacturer of proprietary remedies seized, however, very promptly upon the opportunity to incorporate what must be considered dangerous remedies with other ingredients and offered them as "Obesity Food," -"Rengo Fruit," "Kellogg's Obesity Food," "Arbolum Mixture," "Marmola," with the usual assurances of being scientific and effective preparations for the reduction of fat. Since thyroid extract is characterized by Dr. Reid Hunt as "the most powerful tissue-destroying drug known" the effects upon the unfortunate victims of misplaced confidence can be imagined. The employment of these agents for this purpose is, however, of such recent date that no fatalities have been reported. We know, however, that several fatal cases were reported when employed under the supervision of competent physicians and, in November, 1906, in an editorial in the "Journal of the American Medical Association,” the danger of "organotherapy" in producing arterial degeneration was pointed out, as well as the necessity of being "careful in the application of such remedies, and especially not to hand over the employment of them too freely to the public under such circumstances that they will be used over prolonged periods without proper safeguards and the careful observation of a trained medical mind."

THE NOSTRUM EVIL IN GENERAL.*

Our sociological study of 1,217 families in this city shows that they expended $2,032.39 per annum for patent or proprietary medicines. The annual expenditure in the United States has been estimated to be not less than $62,000,000. The far-reaching consequences of this traffic, which impoverishes the health and depletes the pocketbook of a large class of persons, has been made, in a fearless and most commendable manner, the subject of popular education, notably by the "Ladies Home

*The author is indebted to Dr. M. G. Motter for valuable references to the literature of the subject.

Journal," "Collier's Weekly," the "Journal of the American Medical Association," "Pharmaceutical Journal" and by Professor Harvey W. Wiley and his associate, Dr. Lyman F. Kebler of the Bureau of Chemistry, U. S. Department of Agriculture.

The writer has long since taken a keen interest in the subject because as a sanitarian he felt convinced that the harmful effects of this nefarious business upon the health and general welfare of the community have never been sufficiently emphasized, even by the medical profession. The American Medical Association adopted the following principles over fifty years ago: "It is equally derogatory to professional character for physicians to hold patents for any surgical instruments or medicines; to accept rebates on prescriptions or surgical appliances; to assist unqualified persons to evade legal restrictions governing the practice of medicine; or to dispense, or promote the use of, secret medicines, for if such nostrums are of real efficacy, any concealment regarding them is inconsistent with beneficence and professional liberality, and if mystery alone can give them public notoriety, such craft implies either disgraceful ignorance or fraudulent avarice. It is highly reprehensible for physicians to give certificates attesting the efficacy of secret medicines, or other substances used therapeutically."

No effective work in the propaganda for reform in Proprietary Medicines was done, however, until the creation of the Council on Pharmacy and Chemistry in the American Medical Association in February, 1905. This Council has rendered, and will continue to render, most meritorious services to the cause of humanity. To show the enormity of the traffic and corresponding dangers, the following statement (the data to December 31st, 1900, having been originally collected for my "Oration on State Medicine," delivered before the American Medical Association June 8th, 1901) is herewith presented.

Patents issued by the United States Patent Office:

Under date of November 17th, 1908, the Commissioner of Patents informs me that trademarks have been reclassified, and since January 1st, 1901, there have been issued in sub class No. 6, Chemicals, Medicines and Pharmaceutical Preparations, approximately 2,105 trademarks. This means that up to October 31st, 1908, the office has issued 2,140 patents and 8,398 trademarks on drugs, chemicals and medical compounds.

By the term patent medicine as properly employed, it must be understood that the composition is known and can be seen at the Patent Office. The proprietary medicine is a secret preparation protected by a trademark and hence preferred by the owner, but both are vaguely termed by the public patent medicines.

The proprietary medicines are subject to the control of the State authorities and, if containing alcohol in sufficient quantity to be intoxicants, are subject to internal revenue laws. But up to the enactment of the Pure Food and Drugs Law, June 30, 1906, nothing was done to control the sale of secret remedies and medicinal preparations containing habit-forming drugs, the composition of which need not even be disclosed to the patent office.

Fortunately, Section 8 of the Act referred to provides that an article shall be deemed to be misbranded *** if the package fails to bear a statement on the label of the quantity or proportion of any alcohol, morphine, opium, cocaine, heroin, alpha or beta eucaine, chloroform, cannabis indica, chloral hydrate or acetanilid or any derivative or preparation of any such substances contained therein. In consequence of this very wise provision of the law we are now enabled to estimate the enormity of the harm which must inevitably result from promiscuous use of such preparations.

A most excellent report on "Secret Drugs, Cures and Foods" was presented by Special Commissioner Octavius C. Beale to the Parliament of the Commonwealth of Australia, August 8, 1907, in which he discusses the subject under six headings, viz.: Prevention of Conception and Feticide; 2. Infanticide and Infantile Mortality; 3. Injury and Death to the Adolescent; 4. Injury and Death to Adults; 5. Advertisements; 6. Legislation. In view of the importance of the subject, it is deemed desirable to present here a brief summary of the most important facts collected by this painstaking investigator, not only in Australia, but also in the United States, Canada, Great Britain, Germany and France.

PREVENTION OF CONCEPTION AND FETICIDE-REGULATION OF FAMILIES.

In this section Commissioner Beale writes: "The practice of interference with the sexual function is so common and the knowledge of it

so universal that it would be thinnest hypocrisy upon the part of any grown person to pretend that modesty may be shocked at considering its causes and consequences. The disastrous effects upon men and women are set forth in plain and decent language in the Report of the New South Wales Royal Commission upon the decline in birth rate and upon mortality of children, which it would be well to reproduce by another inquiry over a wider sphere, or indeed merely to reprint for broadest distribution. Just because deception and falsehood are widespread there is occasion to confront them by candid truth. *** Before me is a copy of the second volume *** there upon page after page are photographs of the advertisements of obscene creatures who corrupt society at its core and live like larve upon their own poison and the corruption it causes. The announcements appear today just as before, only more of them. To debauch and degrade humanity is a profitable trade. On those pages are also photographs of numbers of preparations to prevent births, of contrivances towards obscene practices. *** There is only one remedy-morality by Act of Parliament, enforced by severe penalties. ** * No attempt will be made to give a comprehensive statement of the means adopted to induce miscarriage. The unnatural practice is assisted by the free sale of drugs, often at exorbitant prices, under proprietary names. These are openly advertised in Anglo-Saxon countries, which differ therein from one another only in degree, the names and descriptions of the drugs being well understood by dealers and users." In order amply to elucidate the subject of criminal abortion by drugs, Mr. Beale quotes the following extract from Taylor's "Medical Jurisprudence," Vol. II, pages 166, et seq.: "The following generalization, which is strictly warranted by facts, conveys a warning to would-be abortionists, whether professional or habitual, or lay and occasional. There is no drug, and no combination of drugs, which will, when taken by the mouth, cause a healthy uterus to empty itself, unless it be given in doses. sufficiently large to seriously endanger by poisoning the life of the woman who takes it."

In this country, as explained by Dr. Kebler, the publication of advertising matter inviting attention to means whereby conception can be prevented or abortion produced is specifically prohibited by law. In order to circumvent the law, however, the advertising literature is so framed as to clearly indicate the purpose for which the preparation is intended, such as "French Female Pills, a safe, certain relief for suppressed menstruation. Never known to fail. Safe, sure, speedy," etc. Vital statistics show that the birth rate in England has dropped from 34.3 per 1,000 in 1878 to 28 per 1,000 in 1901; in South Australia

from 39 in 1885 to 24 in 1906; in Germany from 40.4 in 1881 to 35.3 in 1894. The great decline in the birth rate in France has been a matter of much comment, and the latest statistics show little or no increase in the French population. The birth rate of Paris, already low in 1881, has further declined from 23.3 to 16.6 in 1894. We have no reliable birth rates for the United States as a whole. The census statistics of 1900 show that the birth rate has increased from 26.9 in 1890 to 27.2 per 1,000 of the mean population in 1900. Harrington, in speaking of the decline in birth rates in foreign countries says among the descendants of the original colonists and earlier immigrants the same decline is most evident. *** In Massachusetts the statistics of 1898 show that the greatest proportion of the number of births belongs to the foreign born, the children of native parentage on both sides representing 32.36, those of mixed parentage 19.42 and those of foreign-born parentage 48.22 per cent of the total births. The crude birth rate was 27.37."

Mr. Roosevelt is quoted to have said that "there are fewer descendants of the Revolutionary forefathers living today than there were fifty years ago. We must either alter our ways or we must make way for the other races, Asiatic or whatever they are, that will certainly replace Every thoughtful physician and layman realizes that the declining birth rates are chiefly the effects of vice, unnatural interference and actual homicide.

Dr. H. S. Pomeroy of Boston over twenty years ago presented the moral, social and medical aspects of prevention in his book, "The Ethics of Marriage," which evoked the unqualified approval of the late Mr. W. E. Gladstone. The President of the United States has uttered notes of warning on the "race suicide problem," and Professor Emmet, the eminent gynecologist, asks: "Can anyone accustomed to treating the diseases of women say in truth the statement is exaggerated that we can see on any one day more sorrow and misery resulting from the abuse of the married state than would be found in a month from uncomplicated child bearing?"

Dr. Kebler has furnished me with a list of 51 so-called female pills or regulators advertised in this country (see appendix). While quite a number may act as abortifacients, the majority are worthless and frauds pure and simple. Among a number of fraud orders issued by the Postmaster General during the past two years the following transcript from the records of the Assistant Attorney-General's office, submitted May 29th, 1908, in the case of Mrs. A. Kirk and the Reliable Remedy Company, 2317 Brooklyn avenue and 18th and Grove streets, Kansas City, Mo., will be of interest: "It will be remembered that on October 29th, 1907, a fraud order was issued against the Dr. Price Remedy Co., its