Snake oil charms of popular medical history

The mention of ‘snake oil charms’ in the King’s speech at the opening of Parliament in July reminded me of one of the most unusual cases I encountered in my final years as a consultant surgeon, writes Bryan Rhodes.

European adder in dried grass next to a log.

Adder photo by Illuvis, Pixabay

A middle-aged man had gone for a stroll close to Fell Foot Park in the Lake District and sat down on a flattened patch of long grass. Suddenly, an adder appeared between his legs, and as he lifted his arm in self-defence, it bit him on the right hand. Despite the administration of two different types of anti-venom in A&E, by the following day swelling and discolouration was spreading up his arm, and I was beginning to consider whether an amputation could become necessary.

The adder is Britain’s only venomous snake, so mortality from snake bites is quite rare in the UK, roughly one a decade. Worldwide however, snakebite envenoming kills about 100,000 people a year, so it is perhaps surprising that the snake has become such a widespread symbol of health and healing. Certainly, our patient survived, and fortunately, no surgical intervention was required.

Indeed, the coat of arms of the British Orthopaedic Association features the Greek demi-god of healing Asclepius, pictured as usual with a large snake winding its way up his staff, the snake’s head perilously close to the demi-god’s abdomen. There are many theories about the ‘Rod of Asclepius’ and associated snake including one that the snake’s ability to shed its old skin and generate a new healthy skin explains its presence. Another theory links it to the Old Testament story in which God tells Moses to ‘make a bronze snake, put it on a pole, and place it where people can see it; anyone who is bitten by a snake can look at it and live’.

White marble statue of Asclepius, Greek demi-god of healing, with his staff and serpent.

Greek demi-god of healing Asclepius Photo by Michael F. Mehnert, Museum of Epidaurus Theatre, via Wikimedia Commons

 

Folklore

In English folklore, adders were thought to be deaf, and oil derived from adders was considered a valuable treatment for deafness and earache. To obtain the oil an adder was caught and killed, its skin was lacerated multiple times, and it was hung in a warm location with a container placed below it to catch the viscous liquid dripping from its carcass. The Oxford Dictionary of English Folklore indicates that provincial chemists would purchase this snake oil from snake-catchers, presumably for onward sale to their customers.

The adder’s shed skin was also thought to have healing power: able to help extract thorns and splinters from a person’s hand. Traditional cures for an adder bite included oil from the offending snake, wrapping the victim in a fresh sheepskin, or applying a flat ‘snakestone’ to the site. Of all the strange historical treatments provided for adder bites in the centuries before anti-venoms, perhaps the most bizarre was that discovered in Wiltshire by the notable antiquary and natural historian, John Aubrey FRS (1626 – 1697) which involved fastening a succession of live pigeons to the site of the snake bite.

Norman Morrison, a retired Scottish police officer who developed a fascination for adders and published ‘The Life Cycle of the Adder’ in 1924 was himself bitten on the right hand by an adder and wrote about the experience and some of the traditional Hebridean ‘cures’ in his later publication ‘My Story’.

Snake oil salesman

The term ‘snake oil salesman’ now means the archetypal charlatan: the fast-talking seller of quack or fake cure-all remedies. The term has also spread more widely such that it is often applied to politicians, businessmen and anyone offering false hope or dubious treatments. The poor reputation of snake oil salesmen appears to be largely attributable to a Texan called Clark Stanley (b. 1854). In the late 1880s, Chinese itinerant railway workers commonly used a Chinese liniment derived from water snake oil.

Stanley produced an American alternative which he claimed to contain rattlesnake oil, which was sold widely across the US. The Pure Food and Drug Act of 1906 brought in a new era of scrutiny for all American products claiming medicinal properties, and Stanley’s Snake oil liniment was analysed in 1916. The product was found to be almost entirely mineral oil and didn’t contain any snake oil at all. Stanley was found guilty of ‘misbranding’ his product and fined $20.

Since the release of Captopril in 1980, an ACE inhibitor and anti-hypertensive drug developed following research by John Vane and Sergio Ferreira on a component of Brazilian pit viper venom, there has been increasing interest in the therapeutic possibilities of snake venom. There seems to be much less enthusiasm for the charms of snake oil!

Bryan Rhodes is a retired consultant orthopaedic surgeon. He is the book review editor of BSHM and the chair of the Lancaster Health and Medical Museum Collection.

References and further reading:

  1. A Dictionary of English Folklore, Editors: Jaqueline Simpson and Steve Roud, 2003, OUP
  2. Oliveira, A.L. al.  The chemistry of snake venom and its medicinal potential, Nature Reviews Chemistry, 6, 2022, pp451-469
  3. Morrison, N., My Story, 1937 Published in Inverness

 

 

 

 

Robert Drane – a leader of pharmaceutical education in Wales, antiquarian and naturalist

Having never visited Wales before, 22 year old Robert Drane moved to Cardiff on 8 February 1856, and the history of pharmacy – and pharmacy education – in Cardiff are very much tied up with him.  Briony Hudson explains.

A contemporary described Drane as “a young man with a charming manner, a striking appearance and a vocabulary and diction that are the possession of but a few of the world’s geniuses.” He had, however, departed abruptly from the respected London firm of Allen & Hanburys after breaking house rules in the respected Quaker-run establishment by staying out after 11 pm and going to the theatre.

Drane first became assistant to the apothecary Griffith Phillips on Duke Street, Cardiff, but two years later, he moved to his own pharmacy at 11 Bute Street, Cardiff. In 1867, aged 34, he opened new, purpose built premises at Crockherbtown (renamed Queen Street in 1886), close to Cardiff Castle.

At that time, those wanting to make or sell medicines usually undertook an apprenticeship with an established chemist, as Drane had done. The Pharmaceutical Society, founded in London in 1841, had established a register of members, but it was voluntary. The Society also opened its School of Pharmacy, the first in the country, at its Bloomsbury Square, London, headquarters in 1842.

There were no pharmacy schools in Wales, although the Pharmaceutical Society and its London school had a Welsh presence from the start in the person of Theophilus Redwood from Boverton, Glamorgan, as the first professor of pharmacy, a post he held until 1885.

The Pharmacy and Poisons Act

Robert Drane as an older man- a photo from the Cardiff Naturalists' Society

In 1868, Parliament passed The Pharmacy and Poisons Act that required those wanting to practise as pharmacists to register with the Pharmaceutical Society in order to be able to dispense particular scheduled drugs, such as opium and strychnine. This Pharmaceutical Society register was then only open to those that had passed its minor or qualifying examination. Pharmacists, like Drane, who had been in business before 1868, were able to join the register without jumping this educational hurdle.

Drane called on the three other pharmacists in Cardiff in an attempt to produce some formal training in chemistry, pharmacy and botany for their assistants. His cooperative scheme intended that there would be nothing to pay, and the assistants would meet two nights a week to learn chemistry and pharmacy. They would also join Drane in Sophia Gardens, Cardiff’s first public park, adjacent to Cardiff Castle, at 7am on two mornings a week to learn botany, a class that he had already instituted soon after settling in Cardiff.

According to Drane’s later account, the scheme fell through because of the “indolence of the assistants” and “the ignorance of the pharmacists.” Despite this, his efforts had laid the foundation for pharmaceutical education in South Wales.

Aspiring pharmacists in South Wales had to wait for local technical education to provide what was missing. Cardiff Borough Council had begun running science and art classes in 1866, but it seems that formal pharmaceutical education in South Wales was unavailable until the establishment of a College of Pharmacy in Cardiff in 1919, five years after Drane’s death in 1914.

In addition to pharmacy, Drane had a strong interest in ceramics and co-wrote a history of the ceramic factories of Swansea and Nantgarw. He is also considered to be the founding father of the Cardiff Naturalists’ Society, which was established in his shop at 16 Queen Street, in 1867, according to many documented sources.

In 1927, the Cardiff Naturalists’ Society unveiled a plaque in his memory on the front of Drane’s shop in Queen Street (below).

The plaque commemorating Robet Drane as a naturalist, antiquary and connoisseur.

Briony Hudson, director of Amersham Museum, is a pharmacy historian, Honorary Lecturer at the Cardiff University School of Pharmacy and Pharmaceutical Sciences, and author of the publication that marked its centenary in 2019. This article is based on her presentation on the history of pharmacy education in Cardiff to the History of Medicine Society of Wales summer meeting on 29 June 2023.

With thanks to the Cardiff Naturalists’ Society for the photographs. See the Society’s web site for more information on Drane’s many interests.

Recycling Penicillin from Urine in Post-War Germany

Limited supplies of penicillin and Allied restrictions on German access to the drug in the immediate aftermath of World War II led to its recovery from the urine of treated patients. Susanne Krejsa MacManus explains.

German research on penicillin started only in 1942 and then on a very small scale.[1]  Gerhard Domagk (1895-1964), the German scientist who in 1935 had developed sulfonamides, had advised the Nazi government to concentrate on improving of “his” type of antibiotics instead of trying to get its own penicillin production going.

It took Germany till the end of 1943 to really understand the importance of penicillin, but because of the efforts of the Allies to restrict information and materials,[2] German scientists were not able to learn about the right mould, nor could they develop the process to get a good supply.

From autumn 1945, British and American forces increased the amount of penicillin flown into hospitals in Berlin – mostly for their own soldiers as a treatment for sexually transmitted diseases. But the occupying forces faced a dilemma: on one hand, they had to look after the health of the population of the occupied areas; on the other hand, there was a hostile atmosphere against the German population – at least in the first months after the end of the war. Germany was categorised as a “defeated enemy” – in contrast to Austria which was categorised as a “victim”.

There was even a third aspect. The German pharmaceutical industry was known as being innovative and effective. The occupying forces hoped for “penicillin made in Germany” and encouraged companies like I.G. Farben, Hoechst and Chemie-Grünenthal to start such an undertaking.

The USSR did not have penicillin production of its own, although they claimed two of their scientists had invented the antibiotic long before Alexander Fleming. As early as early May 1945, Soviet forces who were eager to get penicillin as part of German reparations were pushing the German company Schering .[3]

Since one of Schering’s production sites lay in British territory, the company got support from the British element of the occupation forces for building laboratories and getting raw material (as this ad shows.).[4] 

Salzburger Nachrichten, 9/1/1946  Schering AG produces penicillin Berlin,  As the British broadcast has reported, the Germany pharmaceutical company Schering AG in Berlin will manufacture penicillin for Germany. The British military government has promised its support to the company in procuring the laboratory and the necessary material, so far as it is available in Germany.

But sufficient output was not available before the end of 1946/the beginning of 1947.

Two-thirds excreted

During their struggle to set up a production site, scientists at Schering recalled that two- thirds of penicillin given by injection left the body very quickly, so quickly that injections had to be repeated every few hours.[5] “If we could get the urine of patients treated with penicillin”, the scientists speculated, “we might be able to reclaim and concentrate this substance.”

The British and American forces permitted them to collect the urine from their hospitals on the condition that they got their share of the recycled substance. From March 1946, Schering’s scientists organised milk-churns and bicycles and went from hospital to hospital to collect patients’ urine. The recycling process was successful, and in spring 1947 it was extended into American and British areas of West Germany. In April 1949, nearly 5000 liters of urine from 3153 patients were collected from hospitals. This activity lasted till 1950, when the manufacturers’ penicillin production was sufficient to meet demand.

Recycling penicillin from urine was not a new idea, but its use on this scale was was exceptional. It showed that the German researchers had clearly understood the character of penicillin being excreted from the organism so quickly. Secondly, the process of recycling penicillin purified the substance, which at the initial injection had produced sharp and unpleasant feelings for the patient. And third, it shows how Schering’s researchers could act on their own initiative, without having to ask boards and committees for permission as they would have to do today.

Susanne Krejsa MacManus PhD is an independent journalist, author and archivist in Vienna. She is a member of the History of Medicine/Medical Humanities working group of the Commission for History and Philosophy of the Sciences at the Austrian Academy of Sciences (ÖAW).

References

[1] I. Pieroth: Penicillinherstellung – Von den Anfängen bis zur Großproduktion, Heidelberger Schriften, 1992, p. 103.

[2] P. Rostock: Die Wunde, Berlin: De Gruyter, 1950, p. 290.

[3] J.-P. Gaudillière, B. Gausemeier: Molding National Research Systems, OSIRIS 2005, 20:180-202.

[4] Schering A.G. Berlin produziert Penizillin, Salzburger Nachrichten, 9. 1. 1946, p. 2.

[5] J.H. Humphrey: Excretion of Penicillin in Man, Nature 3920, 1944, 765.

 

 

Control and the therapeutic trial: the influence of insulin

How do we decide whether a drug, or other treatment, actually works? Martin Edwards describes the rhetorical strategy adopted by the Medical Research Council to establish its authority.

Patients’ variations in response to disease and treatment can render it fiendishly difficult to know whether a therapy is benefitting a particular individual. For centuries, the gold standard was the assessment of a wise and experienced clinician but during the first half of the twentieth century, new methodologies arising from the laboratory, hospital and statistical theory challenged this traditional model.

The stakes were high, no less than the moral authority to adjudicate how the therapeutic efficacy should properly be ascertained. Between the wars, the debate in Britain was frequently vitriolic – particularly between the Royal College of Physicians, which prioritised clinical acumen, and the Medical Research Council (MRC) which advocated newer methodologies.

The University of Toronto in 1921 granted British patent rights over insulin to the MRC and thus offered the MRC control, not only over insulin manufacture and supply, but also how to assess its effects and proper usage.

In fact, the MRC’s approach to testing was, as with other drugs at that time, highly eclectic; it sent samples of insulin to trusted clinicians in prestigious hospitals without any protocol or scheme for investigation – the clinicians were simply asked to report their experiences with the drug.

An unanticipated consequence of the MRC’s control of insulin supply was that it was on the receiving end of public clamour for the drug. Heartrending letters to the MRC described young people, typically in their teens or early twenties, dying slowly and horribly from diabetes, and pleaded for supplies of life-saving insulin.

Patients even turned up at the MRC, supported by loved ones. Landsborough Thomson, MRC Council Secretary, recalled the MRC administration being swamped by these requests and unable to fulfil its normal functions.

Reserved for controlled studies

In response, the MRC under the direction of its chairman Walter Morley Fletcher adopted a standard response to such requests, stressing that insulin was a new drug which needed to be reserved for ‘controlled studies’. The meaning of ‘controlled’ was not defined nor did it refer to the presence of a comparison group – none of the MRC insulin trials used one – but rather vaguely implied proper conduct, regulation and scrutiny.

So successful was this rhetorical strategy that the MRC repeated it when restricting supplies of penicillin in the 1930s and streptomycin and influenza vaccine in the 1940s. In each case, it stated that the drug should be reserved for ‘controlled trials’.

Control is a powerful word with implications of authority, power, regulation and order. Without defining it, the MRC appended the word to their own studies in the interwar years, using it as a rhetorical device in the battle for authority to adjudicate therapeutic efficacy.

By the time the MRC’s trial of streptomycin in tuberculosis – reckoned by many trial historians to be the first randomised controlled trial – was published in 1948, the MRC had successfully co-opted the word as applying exclusively to its own studies. It offered the streptomycin trial as an exemplar of how therapeutic trials should be conducted, describing the methodology as ‘the controlled trial’. By then, ‘controlled’ referred technically to the presence of a control group, though the other powerful associations of the word continued to resonate.

We have depended on the ‘controlled trial’ ever since. The MRC’s adoption of the potent word ‘control’ arguably began with insulin. Had it not been for MRC control of British insulin supply, might we simply refer nowadays to a ‘randomised trial’?

This text is an abstract of a talk given to a session of the Apothecaries’ History of Medicine Fellows 8/12/2021 to commemorate the 100th anniversary of the discovery of insulin.

References/further reading:

  1. A Landsborough Thomson, Half a Century of Medical Research vol. 2: The Programme of the Medical Research Council (UK) (London: HMSO 1975) pp 40, 230
  2. Liebenau, ‘The MRC and the Pharmaceutical Industry: The Model of Insulin’, in J, Austoker and L. Bryder (eds), Historical Perspectives on the Role of the MRC (Oxford: Oxford University Press, 1989) 163-80
  3. Edwards, Control and the Therapeutic Trial: Rhetoric and Experimentation in Britain 1918-48 (Amsterdam: Rodopi Publishing, 2007)

The Pharmacopoeia Londinensis

The Pharmacopoeia Londinensis was originally published in Latin by the Royal College of Physicians in 1618 and translated into English by Nicholas Culpepper in the middle of the seventeenth century. To celebrate its 400th anniversary an illustrated version of the book is to be published later this year.
I am delighted to be one of a number of contemporary botanical artists asked to contribute to this exciting project. I have selected to paint the beautiful and intriguing ‘Rosa damascena’ or the damask rose. A strongly scented rose it is famous for its use in perfume with the fresh petals either distilled as rose water or as one of the worlds most expensive essential oils, 100ml costs more than £1500.00, the petals are also used dried and the hips used fresh or dried. Rosa damascena essential oil is composed of hundreds of components, including citronellol, citral, carvone, citronellyl acetate, eugenol, ethanol, farnesol, stearpoten, methyl eugenol, nerol, nonanol, nonanal, phenylacetaldehyde, phenylmethyl acetate, and phenyl geraniol. There is evidence of its use medicinally going back to the seventh century with a particular link to Iran and the Middle East. Recent studies of the pharmacological effects of the damask rose show it has not only antibacterial and anti oxidant effects, but also anti-viral, anti-depressant, anti-diabetic, analgesic and hypnotic properties.

Detail of Rosa damascena  –  watercolour

All of the medicinal plants painted for this publication and accompanying exhibition can be found growing in the Royal College of Physicians medicinal garden near Regents Park in London. A lecture on the Pharmacopoeia Londinensis and tours of the garden will be part of the RCP/BSHM special event on 11th June 2018. See https://www.rcplondon.ac.uk/events/medicinal-plant-lecture-historical-sidelights-and-poynter-lecture

I was particularly interested in taking part in this medicinal plant project as I have a multidisciplinary art practice with a strong research base informed by my career as a horticulturalist working in therapeutic community gardens.  I use plants as a way of telling stories about our relationships with the natural world.


Ishtar

Julia Groves
info@juliagroves.co.uk
www.juliagroves.co.uk