Cures of Yesteryear - Some Early Remedies

This article about some notable cures used in the past is the fifth pharmacy article prepared for our website and newsletters by long-time Rockhampton Pharmacist and pharmacy historian, the late Dr Barry Bryant OAM.

It cannot be denied that many wonderful medicinal products from digitalis to penicillin have come from nature, nor can it be denied that many toxic substances and those of dubious therapeutic value come from the same source, animal, (eg snake venoms), vegetable (eg strychnine) and mineral (eg arsenic). That many (most?) modern synthetic drugs are toxic but "natural" remedies are harmless is a dangerous delusion often encountered by today's mainstream health care practitioners - an irrational assumption that "natural" remedies are not sources of iatrogenic (ie drug - or doctor-induced) disease. Coupled with this dangerous, sometimes fatal misconception, seems to be a vague belief that medicines of the pre-scientific era "have a special virtue" twinned with a "nostalgia for a past golden age which in fact never existed".

Paracelsus (1493-1541) phrased it rather well by pointing out that "All things are poisons and there is nothing that is harmless, the dose alone decides that something is not a poison". Although the origins of herbal medicine are lost in the mists of time, one cannot help but wonder at those intrepid souls who through experiment, serendipity or fatal misadventure explored the highs and terminal lows of herbal therapeutics, laid the foundations of folk medicine and ultimately pharmacology. [Serendipity even today may play a role: sildenafil was initially developed as an anti-anginal drug, but on noting its particular and spectacular adverse effect, led to re-evaluation and a new marketing direction, resulting in the Viagra (TM) familiar, at least by repute, to us all].

It is generally conceded that association of ideas played a part in the evolution of folk medicine. According to the "doctrine of signatures", where a disease occurred, nearby there would also be found a cure provided by a munificent Mother Nature. For example, people living in moist, swampy environments almost inevitably suffered from a variety of arthritic and rheumatic afflictions. Happily, nature provided relief in the form of the bark of willow trees (Salix alba, S. discolour, S. nigra, S. fragilis and S. purpura), which contain salicin, from which is derived the pain-killer acetylsalicylic acid (aspirin).

One of nature's subtler yet major poisoners is ergot, the resting stage (sclerotium) of a fungus (Claviceps purpurea) which occurs on grasses especially rye, as a small purple spindle 1-4cm long. Consumption of bread made from infected rye was the cause of epidemics of painful gangrene of the fingers, toes and limbs due to the powerful vaso-constrictive actions of ergot's component alkaloids. Extensive outbreaks are documented in the Middle Ages and up until the late 1700's in Europe, although seldom occurring in England where rye was little grown. The disease became known as St Anthony's Fire, as sufferers found relief by visiting the shrine of St Anthony in Padova, Italy, coincidentally away from those areas where contaminated grain was consumed. As well as "gangrenous" ergotism, "convulsive" ergotism also occurred due to the ability of some ergot components (mycotoxins) to induce hallucinations (compare the structures of ergot alkaloids and LSD). The curious reader is directed to Lewis, Macinnis, Laurence & Bennett, or other textbook of clinical pharmacology.

On the therapeutic "credit side", extracts from ergot had been used by midwives in Germany as far back as the sixteen century to influence labour. It was then known as mutterkorn "mothers' corn" - the association is self-evident. In more modern times, pharmacologists have investigated ergotamine (1906) which is now used for migraines and isolated ergometrine (1935) for the management of labour.

Medicinal plants and their active constituents need a long and thorough process of botanical identification, extraction, purification, characterisation of active ingredient(s), assay and standardisation. Drugs from medicinal plants are almost universally derived from cultivated specimens, wherein control may be established of species or varieties having the desired characteristics, predictable growth patterns and improved yields of active constituents. Plant development and yield may be markedly affected by temperature, humidity, soil conditions and nutrients, control of pests and harmful disease organisms. It should also be remembered that different extractive methods, or the use of different parts of the plant in question may lead to very different outcomes. Castor oil, for example, grandma's reliable cure for constipation, is obtained by cold compression of castor oil seeds. However the Bulgarians used a pellet of highly toxic ricin (also extracted from the castor oil seed) fired from a modified umbrella tip to assassinate the dissident Georgi Markov in 1978.

Alkaloids are nitrogen-containing organic basic compounds found in plants, typically with bitter taste and usually possessing potent pharmacological actions. Some examples are morphine (first isolated in 1817), atropine, cocaine, quinine, nicotine and caffeine. Alkaloidal content may vary seasonally and even with the time of day, as may the cardiac glycoside content of digitalis used in congestive heart failure.

The origin of Fowler's Solution which contained 1% of potassium arsenite, is traced back to the reign of George III of England and became known and widely used in hospitals under the influence of a Dr Fowler. It became official in the London Pharmacopoeia of 1809. Both prostitutes and also "respectable" women of the time used it to improve their complexions. Furthermore it was advertised as being "an efficient cure for intermittent fevers even when Jesuit's Bark (quinine) failed".

Arsenical Solution of the British Pharmacopoeia was a cherished nostrum amongst the racing stable fraternity as a (horse) appetite and general stimulant. While some of the arsenic was retained in the horse, much was excreted via the bowel. (Suggestions have regularly surfaced that the legendary racehorse Phar Lap was poisoned by an overdose of arsenic in America). The important corollary of this was that responsible gardeners NEVER obtained their manure supplies from horse stables as the arsenic therein was downright lethal to their plants.

A favourite stratagem of Victorian era poisoners was to obtain the arsenic out of fly papers to use on their victim. In 1832, an English chemist, James Marsh, was so incensed at the acquittal of an accused murderer who later admitted the crime, that he developed the "Marsh Test", capable of detecting minute amounts of arsenic in food or tissues.

Dilute Hydrocyanic Acid solutions containing 2% w/w of HCN is an interesting preparation which appeared in the BPC of 1934, as well as in Belgian, Norwegian and Polish Pharmacopoeias. In doses up to 0.3 mL it reputedly had a sedative effect on the stomach and was used for vomiting and for the pain of dyspepsia. It might fairly be said that too large a dose would certainly alleviate the above complaints.

Dover's Powder contained powdered ipecacuanha, powdered opium and lactose. It was commonly used even until the 1950's to induce sweating in febrile conditions and for aborting incipient colds. It was also frequently prescribed with aspirin (especially during evening surgery hours thereby preventing the poor pharmacist from going home on time due to the need to mix the individual powders extemporaneously). In small doses, the ipecacuanha acted as an expectorant and in larger doses as an emetic, especially for ingested poisons.

Opium was also used externally in such preparations as Lotion of Lead with Opium which was claimed to be efficient in herpes zoster, urticaria, pruritus and haemorrhoids. As the body has now been proved to have peripheral morphine receptors in tissues, and morphine in Intrasite Gel (TM) is used for painful necrotic ulcers, perhaps the old therapists were not far wide of the mark in using topical opium. Orally, extracts of opium were also found in Paregoric and Chlorodyne, both available into the middle of last century.

Coca wine containing an extract of the coca leaf Erythroxylon coca of which cocaine is the active ingredient, was promoted as a tonic and restorative wine - the ancient Incas were right! Cocaine itself occurred in toothache drops and probably went far to lightening the mood as well as curing the pain.

Fellow's Compound Syrup of Hypophosphites contained 1/64 grain of strychnine per fluid drachm (teaspoonful) while Easton's Syrup contained iron 60 mg, quinine 50 mg and strychnine 1 mg per 4 mL. Hypophosphites were widely used as a tonic although no scientific evidence was ever found that they had any physiological effect, apart from the sodium, potassium, manganese, calcium and ferric bases. Strychnine probably derived its reputation as a "nerve tonic" from its undoubted stimulant effect on the central nervous system. A perfect example of "dosis facit venenum" or "the only difference between a drug and a poison is the dose".

Carbolised Eucalyptus Ointment was another widely used medication which was applied to boils, carbuncles and claimed to be especially useful for Barcoo Rot. Its basis was lard, the young apprentice being commissioned to buy several pound weight from the butcher shop down the street. Manufacture always seemed to coincide with a hot summer's day as the lard had to be gently melted over a gas flame before the other ingredients such as Friar's Balsam (Compound Tincture of Benzoin) and Oil of Eucalyptus were carefully added. For the uninitiated person, a brief word about "Barcoo Rot" may not be out of place. This was an affliction especially of the bush population in arid areas such as the Barcoo River district in the far south-west of the State. Small insignificant abrasions rapidly turned into chronic septic ulcerations. The monotonous diet lacking in green vegetables (the anti - scurvy vitamin C ), lack of meat other than steak, the liver and kidneys (ie offal) being usually thrown away, led to a state of hypo-vitaminosis (A, E, C and B group) accompanied by dehydration due to the hot dry and dusty climate. This condition was also familiar to troops in places such as Gallipoli, Egypt, Palestine, Sinai, Iraq, in the 1914-1918 conflict.

The original formulation was that of Tom Ingham who produced his own eucalyptus oil from distilleries in the district. On selling his pharmacy in 1897 to E N Symons, the proprietary rights to this product were vested in the new owner. Coincidently (or not) a number of ostensibly similar products were marketed by several other local pharmacies of the early twentieth century (imitation being the sincerest form of flattery)?

Vitamin Compound Mixture was a flavoursome and beneficial multivitamin preparation, made by the long-suffering apprentice to restore the flagging energy of the citizens of this city of "sin, sweat and sorrow" as Anthony Trollope described it in 1871. Due to an errant yeast gaining access to the bulk product, fermentation was not unknown and the fascinated eyes of the dispensary staff watched and waited for the gradual distension of the five litre plastic cask until self-defence and a mounting apprehension compelled action before explosion.

Gentian violet solution was that indescribably bright purple antiseptic paint applied liberally to sundry skin infections such as impetigo (school sores). It was not only indescribable but also indelible and had to wear off in the normal process of shedding skin surface cells. Soap and water were relatively ineffective. The dye ingredient came packed in a 50 g bottle sealed with a wide-mouth cork stopper. Imagine then, the apprentice's chagrin and horror when the cork was incautiously rammed into the bottle by an over-vigorous thumb during attempted removal. The resultant shower of purple dye spattered floor, walls, benches and apprentice who resembled a sufferer from a particularly virulent skin disease for a week afterwards.

Cholera and Diarrhoea Mixture contained chalk, kaolin, light magnesium carbonate, Tincture of Opium, Compound Tincture of Cardamom, Tincture of Catechu. Local variants of this preparation included Syrup of Ginger, bismuth carbonate or cinnamon water.

Lest the alert reader should think "cholera" was a misprint or anachronism for "colic", it should be remembered that cholera was an all too real threat in the early days of the colony. A certain Dr Cutfield, for example, was appointed Queensland Medical Officer of Health in 1884 for the treatment of cholera as a result of 18 people dying on board the ship "Dorunda" on passage from Thursday Island to Moreton Bay.

Another early medical man, Dr Archibald Robertson who will be met with again in a further article in this series is reported in Hermann as stating that the construction of the main drain through Rockhampton had robbed him of 300 pounds income per annum. However to remedy this situation, it was considered that the Municipal Baths (then opposite the City Hall) were a valuable aid to the financial affairs of the medical fraternity of the city. It is to be hoped these were tongue in cheek opinions.

Bibliography

Cribb AB & JW 1990. Wild Medicine in Australia, Angus & Robertson, North Ryde.

Davis H 1954. Bentley�s Textbook of Pharmaceutics, Bailil�re Tindall & Cox, London.

Dilling W J 1935. Bruce and Dilling's Materia Medica And Therapeutics 14th ed. Cassell and Company, London.

Driver J E 1957. Bentley and Driver's Textbook of Pharmaceutical Chemistry Oxford University Press, London.

Hermann E A 1964. Development of Rockhampton. The Perrier Collection Rockhampton Municipal Library.

Laurence D R Bennett P N 1987. Clinical Pharmacology, Churchill Livingstone, Edin.

Lewis J J 1964. An Introduction to Pharmacology. E & S Livingstone, Edin.

Macinnis P 2004. The Killer Bean of Calabar, Allen & Unwin, Crow�s Nest.

Pearn J 1992. Health History and Horizons, University of Queensland.

Trease G E 1957. A Textbook of Pharmacognosy. Bailli�re,Tindall & Cox, Lond.

Barry Bryant OAM MSc (UNSW), Hon MSc (CQU), PhC, FPS, MAIBiol, JP(CDec)

17 June 2009