REPORT 31 REPORT. Report from the Select Committee on Patent Medicines. (Issued as a Parliamentary Paper, 414, i-xxviii.)-The Select Committee was appointed to consider and inquire into the question of the sale of patent and proprietary medicines and medical preparations and appliances, and advertisements relating thereto, and to report what amendments, if any, in the law are necessary or desirable.The Com- mittee held thirty-three public sittings and examined forty-two witnesses, of whom more than 14,000 questions were asked. The witnesses included representatives of Government departments, medical men, analysts, wholesale and manufacturing druggists, and manufacturers or proprietors of proprietary medicinal preparations. The evidence laid before the Committee shows that there is a large and increasing sale in this country of these remedies and appliances and of medicated wines.The remedies are of widely differing characters, comprising genuine scientific preparations, unobjectionable remedies for simple ailments, and many remedies making grossly exaggerated claims of efficiency, causing injury by leading sick persons to delay in securing medical treatment, containing in disguise large proportions of alcohol, sold for improper purposes, professing to cure diseases incurable by medication, or essentially and deliberately fraudulent.This last class of remedies contains none which springs from therapeutical or medical knowledge. They are put on the market by ignorant persons, and in many cases by cunning swindlers, who exploit for their own profit the apparently invincible credulity of the public.Whilst in British Dominions and foreign countries there exist severe legal restrictions, with a tendency to still further strengthen the law against these articles, in this country there is no Department of State or public officer oharged with the duty of controlling the sale and advertisement of proprietary remedies.The Home Office and the Local Govern- ment Board are virtually powerless in this respect ; and the Privy Council Office, though supposed to be specially concerned with the sale of drugs, has no initiative32 REPORT in the matter, and fulfils no useful function in t-his connection. The Stamp Acts (Medicine Stamp Duties), the Pharmacy Acts, 1868 and 1869, the Poisons and Pharmacy Act, 1908, the Merchandise Marks Act, 1887, the Sale of Food and Drugs Acts, the Indecent Advertisements Act, and the Larceny Act, are of little value in dealing with the subject, and the anomalies and curiosities of the law and official practice are numerous and remarkable.For instance, any number of different names may be secured as trade-marks for the same drug.The retailer of “Win- carnis ” must hold an off wine licence (costing at least $2 ~OS.), but the Commissioners of Inland Revenue decided that the addition of 1 grain of quinine hydrochloride per fluid ounce makes it a medicated wine, and the retailer need then only hold a patent medicine licence (costing 5s.). Naturally, the proprietors of a medicated wine are induced to add precisely that amount of quinine which will enable the wine to be sold by retailers holding the less expensive licence. Again, in all cases where the name of an ailment is mentioned in connection with a medicine the Commissioners require duty to be paid; where no ailment, but only the organ of the body which is the seat of the ailment is mentioned, the medicine is not dutiable.cough mixture ” is dutiable, ‘‘ chest mixture ” is not ; corn paint ” is dutiable, L L toe paint” is not.An alleged cure for asthma only escapes duty because no organ of the body can be named as specially the seat of that ailment. For all practical purposes British law is powerless to prevent any person from procuring any drug or making any mixture, whether potent or without any therapeutical activity whatever (so long as it does not contain a scheduled poison), advertising it in decent terms as a cure for any disease or ailment, rocommending it by bogus testimonials and the invented opinions and facsimile signatures of fictitious physicians, and selling it under any name he chooses, on the payment of a small stamp duty, for any price he can persuade the public to pay, I n speaking of the relation of the newspaper and periodical Press to secret remedies, the Committee point out that the better class of papers exercise some censorship over these advertisements, but that the large sum (62,000,000 or more per annum) spent in advertising the remedies leads newspapers, either from discretion or compulsion, to exclude from their columns criticism or discussion of secret remedies.The extent to which criticism of secret medicines is excluded from the Press may probably be judged by anyone who will take the trouble to see how much attention is bestowed by the newspapers upon the present report. As regards the analysis of secret remedies, it is mentioned that a large proportion of drugs consist of inorganic substances, or compounds of these with organic sub- stances; practically all of these are recognisable, and their quantities may be determined by competent analysis. A further group consists of manufactured com- pounds, practically all recognisable by analysis.There remains a group of vegetable extracts, of which dandelion and gentian are familiar examples. But even simple vegetable extracts are really highly complex bodies, whose exact composition is still unknown, and unless one of these possesses a marked smell or taste, or if, possessing such, its smell or taste is masked by that of some other similar substance, it cannot in many cases be specifically identified.The medicinal effect of a vegetable extract is, however, often due to the presence of an alkaloid or mineral constituent, and these can be accurately discovered and estimated.A maker of a secret remedy, by Thus,REPORT 33 mixing together, whether with or without scientific or therapeutical knowledge, a number of vegetable extracts, can truthfully state that the composition of his remedy cannot be discovered by analysis. A mixture of tinctures, infusions, decoctions, or extracts of such familiar yet complex bodies as treacle, honey, aloes, cinnamon, liquorice, linseed, coltsfoot, cubebs, pepper, horehound, ginger, gentian, dandelion, rhubarb, saffron, etc., may defy all chemical, microscopical, spectroscopical, olfactory, or physiological analysis.There are thus distinct limits to analysis ; but in practice these limits are narrower than would appear, for in a large majority of cases the essential nature of the principal constituents of any medicine can be detected with almost perfect certainty and estimated with reasonable accuracy.The report also deals with medicated wines, the relation of the medical profession to secret remedies, the question of the patent medicine stamp as an advertisement, etc. Numerous instances are given of the composition and fraudulent nature of patent medicines.As a result of the inquiry, the following recommendstihs are made : 1. That the administration of the law governing the advertisement and sale of patent, secret, and proprietary medicines and appliances be co-ordinated and combined under the authority of one Department of State. 2. That this administration be part of tho functions of the Ministry of Public Health when such a Department is created, and that in the meantime it be under- taken by the Local Government Board.3. That n competent officer be appointed to the Department, with the duty of advising the Minister at the head of the Department regarding the enforcement of the law in respect of the remedies. 4. That there be established at the Department concerned a register of manu- facturers, proprietors, and importers of patent, secret, and proprietary remedies, and that every such person be required to apply for a certificate of registration and to furnish the principal address of the responsible manufacturer or representative in this country, as well as:& list of the medicine or medicines proposed to be made or imported.5. That an exact and complete statement of the ingredients and the proportions of the same of every patent, secret, and proprietary remedy; of the contents other than wine, and the alcoholic strength of every medicated wine, and a full statement of the therapeutic claims made or to be made; and a specimen of every appliance for the cure of ailments other than recognised surgical appliances be furnished to this Department, such information not to be disclosed except as hereinafter recom- mended, the Department to control such statement, at their discretion, by analyses made confidentially by the Government Chemist.6. That a special Court or Commission be constituted, with the power to permit or to prohibit in the public interest, or on the ground of non-compliance with the law, the sale and advertisement of any patent, secret, or proprietary remedy or appliance, and that the Commission appointed for the purpose be a judicial authority, such as a Metropolitan police magistrate sitting with two assessors, one appointed by the Department, and the other by some such body as the London Chamber of Commerce.7. That the President of the Local Government Board (or Minister of Health)34 REPORT have power to institute the necessary proceedings to enforce compliance with the law, the sale and advertisement of any patent, secret, or proprietary remedy or appliance.8. That a registration number be assigned to every remedy permitted to be sold, and that every bottle or package of it be required to bear the imprint ‘( R.N. . . .” (with the number), and that no other words referring to the registration be permitted. 9. That in the case of a remedy the sale of which is prohibited, the proprietor or manufacturer be entitled to appeal to the High Court against the prohibition. 10. That the Department be empowered to require the name and proportion of any poisonous or potent drug forming an ingredient of any remedy, to be exhibited upon the label.11. That inspectors be placed at the disposal of the Department to examine advertisements and observe the sale of proprietary remedies and appliances. 12. That an annual fee be payable in respect of every registration number issued. The Committee consider that the Stamp Acts should be consolidated and amended to remove numerous existing anomalies and unreasonable exceptions, and that the Indecent Advertisements Act should be amended on the lines of Lord Braye’s Bill.The following legislative enactments are also recommended : 1. That every medicated wine, and every proprietary remedy containing more alcohol than that required for pharmacological purposes, be required to state upon the label the proportion of alcohol contained in it.2. That the advertisement andrsale (except by a doctor’s order) of medicines purporting to cure the following diseases be prohibited : Cancer, consumption, lupus, deafness, diabetes, paralysis, fits, epilepsy, locomotor ataxy, Bright’s disease, rupture (without operation or appliance). 3. That all advertisements of remedies for diseases arising from sexual intercourse or referring to sexual weakness be prohibitedr 4.That all advertisements likely to suggest that a medicine is an abortifacient be prohibited. 5. That it be a breach of the law to change the composition of a remedy without informing the Department of the proposed change. 6. That fancy names for recognised drugs be subject to regulation.7. That the period of validity of a name used as a trade-mark for a drug be limited, as in the case of patents and copyrights. 8. That it be a breach of the law to give a false trade description of any remedy, and that the following be a definition of a false trade description : “ A statement, design, or device regarding any article or preparation, or the drugs or ingredients or substances contained therein, or the curative or therapeutic effect thereof, which is false or misleading in any particular.” And that the onus of proof that he had reasonable ground for belief in the truth of any statement by him regarding a remedy be placed upon the manufacture or proprietor of such remedy.9. That it be a breach of the law-(a) To enclose with one remedy printed matter recommending another remedy ; ( b ) to invite sufferers from any ailment toLAW REPORTS 35 correspond with the vendor of a remedy; (c) to make use of the name of a fictitious person in connection with a remedy (but it should be within the power of the Department to permit the exemption of an old-established remedy from this pro- vision) ; (d) to make use of fictitious testimonials; (e) to publish a recommendation of a secret remedy by a medical practitioner unless his or her full name, qualifica- tions, and address be given; (f) to promise to return money paid if a cure is not effected. I n conclusion, the Committee believe that departmental and legislative action as outlined above will not inflict injustice upon any patent or proprietary medicine or appliance ; that it will afford the public efficient and urgently needed protection against injury and fraud ; and that no measures of smaller scope will secure this result, w. P. s. e+B+B+3+3