Granny's Meds - Medicine in the Bad Old Days
© Rosemary Jacobs 1999
In The British Medical Journal on May 12, 1917 p. 624 there is an article entitled "Herb Growing in the British Empire", in which the author laments the fact that by the time of the First World War England had become dependent on the continent for synthetic chemicals & herbal medicines that had been formerly grown and manufactured at home noting that, "A medical friend who collected his own digitalis and prepared his own tincture had told him that he found that foxglove growing on a hot sandy bank protected by a wood gave him the best results."
In 1924 Parke, Davis &Co., the drug company, published the MANUAL OF THERAPY to promote, describe and explain the use of their products to physicians. On p. 166 they state, "There is hardly a drug in the Pharmacopoeia that is the occasion of so much concern to the pharmacist and the physician as digitalis. While it is universally recognized as the most dependable heart tonic, it is at the same time an extremely unstable drug in all forms."
Besides being unstable, the border line between the therapeutic dose, the one which benefits the patient, was very close to the toxic one, so much so in fact that the desired effects sometimes appeared right along with the harmful ones. (Underhill p.233).
With dye plants the control used to determine efficacy was color. With botanical plants it was the pharmaceutical effect produced in people and animals taking it. When a dye plant was not standardized to the degree necessary to produce the desired color, it could mean economic disaster. When a botanical drug was not sufficiently standardized, it could mean death to the patient.
In CHEMISTRY IN MEDICINE published in 1929, Robert A. Hatcher, Ph.D., M.D. says, "Desperate conditions often justify desperate remedies, and when a physician has a patient who will surely die within a few hours if relief is not afforded he may be compelled to adopt a measure that sometimes leads to recovery and sometimes results fatally. There is probably no physician who has been in general practice during many years who has not found himself confronted by such a situation more than once.
Formerly the physician whose patient suffered with cardiac disease of such serious nature had no way of knowing the activity of the digitalis that he was compelled to use. He was forced, therefore to administer a dose that in his judgement was best - sometimes it was just right, but often it was too little or too much, and in either of these cases the result was a tragedy." (p.501)
On p. 496 Hatcher notes that there were hundreds of thousands of substances with therapeutic effects, but only about a hundred of them were considered to be essential drugs for treating the sick. He says that there were two reasons for this. For many there were better agents available while others had very bad side effects that made them dangerous. I like to think of it as ingredients in a soup. Some add to the flavor. Others subtract from it. The trick is knowing the bad from the good and removing the former. That is a trick for a chemist not a physician.
Hatcher continues, "Peruvian bark was used for the cure of malaria during nearly two centuries before quinine came into common use, and one may ask why we do not use it today. It was a wonderful discovery for those who had no better remedy against malaria that claimed millions of victims, but we hear little today of the many failures that attended its use." (p.498).
He goes on to say that no two specimens of Peruvian bark contain the same amounts of the active ingredient quinine. Therefore, it was impossible to know just how much of the raw botanical a patient needed. As a result, the doctor usually gave him about as much as he thought that he could stand without being harmed. Sometimes the amount of quinine absorbed was insufficient to cure the patient. Sometimes he absorbed more than he required which could result in loss of hearing, or worse yet, death. Hatcher and other scientists of the day realized that such a hit-and-miss method of making drugs had to be replaced with a more reliable one.
Active, beneficial ingredients had to be extracted from natural substances, and active harmful ones had to be eliminated or minimized to tolerable levels. Doses needed to be standardized and delivered in a potency sufficient to effectively treat the illness without seriously harming the patient since most any substance potent enough to benefit a person also has the potential of causing him harm. The pharmaceutical industry developed to work out these problems, one baby step at a time and one drug at a time since no two are exactly alike.
"Standardization" is the title of the first chapter in P.D &Co.'s MANUAL OF THERAPY. It opens with, "One of the most important developments in pharmaceutical practice during the past fifty years, if indeed it may not be counted the most important, has been the establishment of definite standards for medicinal products on the basis of chemical or physiological assays. This is so generally recognized at the present time as a necessity that it is hard to realize that it is less than thirty years since we encountered strong opposition and violent criticism because of our introduction of chemical assay methods as a means of standardizing fluid extracts." (p.1).
In 1879 P. D .&Co. had introduced a standardized fluid preparation of Ergot, "Liquor Ergotae Purificatus". The assay used appeared crude in the light of the knowledge that they had in 1924, but it had marked the beginning of the scientific attempt to standardize drugs for potency.
Since the best research at the time, which was later disproved, had indicated that sclerotic acid was probably the active ingredient in ergot, the amount that was precipitated out of the extract with lead acetate was used to give a crude estimate of the amount contained in the preparation. It was the first crude chemical assay that P.D.&Co. performed.
When chemical assays could not be developed, biological ones had to be relied on. According to Blumgarten, "The preparations of the members of the digitalis group are standardized by their effect on animals under standard conditions because the glucoside content of the crude plants is variable." (p.326) On p. 322 Blumgarten notes that, "A cat unit is the amount of digitalis which stops the beating of a cat's heart when given intravenously."
On p. 333 he refers to the New and Nonofficial Preparation called Digipuratum or digitan. "These are tablets made from specially grown digitalis leaves from which many of the inactive substances have been removed. They are not so apt to cause nausea and vomiting. Each dose contains enough digitoxin to kill a frog weighing 30.0 Gms. by stopping its heart beat."
Just as the process of transferring a dye from a plant to fiber was often difficult and tedious, so to was it sometimes difficult to get a botanical into a patient in a way that would effectively treat his illness. The May 12, 1917 issue of The British Medical Journal has an article entitled, "The Administration of Male Fern", a treatment for worms, in which the author claims that the failure of the drug to produce the desired effect was often due to the way in which it was given. Taking it on an empty stomach was not enough. The contents of the stomach had to be removed with a saline aperient like Epsom salts or sodium sulphate along with 8 to 10 ounces of water. The fern had to be administered two to three hours after the aperient had acted. The drug was often vomited and for that reason it was necessary to combine it with a carminative. Either a petroleum emulsion or milk flavored with peppermint oil were recommended.
Since the remedy killed parasitic worms but did not cause their expulsion, the patient then had to take a purgative like castor oil to complete the treatment. (p.624)
Synthetic drugs, just like natural ones, had to be standardized for purity and potency. In 1929 Arsphenamine (Salvarsan), an arsenic preparation used to treat syphilis, was subjected to both chemical and biological assays because toxic impurities were easiest to determine through the use of animal tests. (CHEMISTRY IN MEDICINE p.414) In reality a drug is a drug is a drug. The origin is irrelevant. What counts is the way it effects the person taking it. What counts is its safety, efficacy, purity and potency.
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