needs of individual patients without which there can be no rational drug
therapy. On the contrary, with the use of such mixtures, therapeutic treat-
ment becomes haphazard and mere Order Paxil guesswork.
The Council, appreciating that long established Order Paxil customs cannot be changed
at once, has applied Rule 10 concerning the recognition of mixtures with the
greatest leniency compatible with consistency. When there has been a reason-
able doubt concerning the value of a mixture it has frequently directed that
Rule 10 should not apply, pending further clinical trial of such mixture.
In no instance has subsequent experience shown that a strict interpretation
of Order Paxil the rule would have worked hardship or injustice. The Council feels thax
there is no longer any warrant for the admission of complex mixtures to New
and Nonofficial Remedies or for the retention of any that have been admitted
unless definite evidence of the therapeutic value of such combinations is avail-
able. In accordance with this decision, several mixtures now described in New
and Nonofficial Remedies will be omitted as soon as the three year period for
which articles are accepted has expired.
The following preparations are included in New Order Paxil
and Nonofficial Remedies,
Holadin and Bile Salts-Fairchild. A mixture of holadin, 5 parts, with bile
salts-Fairchild, 1 part, put up in 3 grain capsules.
208 PROPAGANDA FOR REFORM
Capsules of Bile Salts, Succinate of Soda and Phenolphthalein. Each cap-
sule contains bile salts-Fairchild, 0.065 Gm. (1 grain) ; sodium succinate exsic-
cated, 0.2 Gm. (3 grains), and phenolphthalein, 0.03 Gm. ( l /2 grain).
Capsules of Holadin, Bile Salts and Phenolphthalein. Each capsule con-
tains holadin, 0.13 Gm. (2 grains) ; bile salts-Fairchild, 0.03 Order Paxil Gm. (% grain),
and phenolphthalein, 0.065 Gm. (1 grain).
Capsules of Holadin, Succinate of Soda and Bile Salts. Each capsule
contains holadin, 0.20 Gm. (3 grains) ; sodium succinate exsiccated, 0.20 Gm.
(3 grains), and bile salts-Fairchild, 0.03 Gm. (Vfc grain).
Oxbile has long been credited with a cholagogue action, which, however, has
probably been greatly overestimated. When pure bile salts were placed on
the market some years ago, they and their compounds were admitted to N.
Holadin is said to represent Order Paxil
all the constituents of the pancreas and to
possess great potency in respect to the several enzymes, trypsin, amylopsin,
lipase, and the milk-curdling ferment.
It is not clear when such a substance is indicated therapeutically. While
it may be useful when there is a deficiency of pancreatin and gastric secretion,
it should be used alone.
It is also quite possible that bile salts may have a distinct, though limited,
field of usefulness when there is a deficiency of biliary secretion; but the bile
salts are best administered alone, or in combination with such laxatives as may
be deemed necessary by the physician while keeping in mind the fact that
different patients show the widest difference in their reaction to laxatives,
making combinations Order Paxil
of these agents in fixed proportion irrational.
Phenolphthalein was popularized by nostrum makers ; and while it has some
therapeutic value, this has been greatly overestimated, and it should be used
only in amounts deemed necessary for each patient, preferably alone.
Succinate of sodium was introduced as a saline cathartic, with the claim
that it exerts an antiseptic action on the biliary passages and gallbladder. There
is no satisfactory evidence to substantiate this claim.
The Council maintains a liberal attitude toward new preparations, but it
feels Order Paxil
that it is impossible to determine the^ value of the several constituents
of such complex mixtures when used as such; it holds that these mixtures
are superfluous and that the several substances of which they are composed
should be used singly or at most with greater attention to the individual require-
ments of the patient than is possible when these fixed mixtures are prescribed.
Despite the fact that these mixtures have been in use for more than nine
years, there is no satisfactory evidence that they possess any advantage over
the simple laxatives or the preparations of bile or pancreatic extract. They
are therefore held to be in conflict with Rule 10, and the Council has directed
that they be not included in N. N. R. after Dec. 31, 1918.
Having adopted the preceding report, the Council, in accordance with its
regular procedure, submitted this to Fairchild Bros, and Foster for comment.
The following reply was Order Paxil
We are entirely at variance with you in the arbitrary conclusion expressed concerning the
inimical influence of mixtures on therapeutic progress, the practice of medicine and the public
If the combinations of Holadin and Bile Salts, etc., in capsules, were ever properly within
the scope of New and Nonofficial Remedies, they should be retained. If, however, complex
mixtures are to be held as, a priori, unworthy of consideration, the rejection of all would
naturally be a logical proceeding.
We believe that the particular combination of Holadin and Bile Salts etc., have been clearly
in the line of therapeutic progress a natural evolution, improvement and development.
For many years combinations of pancreatic extract and ox gall had naturally suggested
When we realized the fact that the bile salts were quite clearly the active principles of the
bile, and that they must necessarily exist in greatly varying percentages in the official inspis-
sated or ox gall, and also because these ox gall products of pharmacy were of extremely
COUNCIL REPORTS 209
varying density, even from that of treacle to resin and of other objectionable Order Paxil character, we
undertook to prepare bile salts.
These combinations are now further justified in view of physiological considerations, the
simultaneous secretion of the pancreas and bile, and the state of our knowledge of the function
of bile salts, and as co-ferments, promoting and supplementing the pancreas enzymes.
The question suggested as to whether the cholagogic action of ox gall (and bile salts) has
been overestimated seems to us no clear purport. The bile salts are obviously employed as
the means of administering and thus realizing whatever properties this secretion may have in
medicine, of which the cholagogic action is Order Paxil by no means the only consideration.
As for phenolphthalein, which is credited with purely laxative properties, we are at a loss
to see any bearing in the remark that phenolphthalein was popularized by nostrum makers.
We cannot see that the physician's or chemist's estimate of phenolphthalein, its properties
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