Thursday, July 24, 2014

CAN YOU GIVE ME SOME MEDICINE, DOC?



THE DOCTOR'S BAG

- the blog about Medicine in the 19th Century 

A PRIMER ABOUT SOME OF THE DRUG THAT DOCTORS COULD MAKE UP


Keith Souter



In he Doctor's Bag this month we shall look at some of the drugs that the town doctor in the Old west could dispense to his or her patients.

In how many movies have you heard a character ask the town doctor for some medicine to cure some complaint or another. Very often  it is a request for  a painkilling drug and more often than not the doctor just happens to have a bottle of laudanum all ready in his bag. When you write a Western novel and have such a scene intended, you may want to stretch the request beyond a need for laudanum. Having your town doctor treat other conditions may make the doctor-patient interaction more realistic.

Doc Adams in Gunsmoke could always make and dispense a remedy. At a recent visit to the National Cowboy Museum in Oklahoma City I sought out Doc Adams and found him with some of the accoutrements of his trade. As I am sure you all know, he was played beautifully by Milburn Stone.


The G stood for Galen. Interestingly, this was a name chosen by Milburn Stone when the show transferred from radio to television.  It was a great choice, since Galen of Pergamum  131-201 AD) was an ancient Greek physician whose teachings dominated medical thought for well over a thousand years. He moved around a lot and at one time was the physician to a gladiator school.

A group of medicines were referred to as Galenicals, after him. Essentially, these were drugs that were used to balance the four vital fluids of the body, or humours as they were referred to. This was an archaic belief that the  body contained these four fluids - blood, black and yellow bile and phlegm - an that imbalance resulted in disease associated with the excess or deficiency of one or other of them. various herbs and minerals were known to have particular effects, so they were given to correct perceived imbalances. The cucumber, for example was used in medicines as a cooling galenical - hence, as cool as a cucumber. There is some rational, actually, since it is rich in natural salicylates, which like aspirin the modern day wonder drug, has anti-inflammatory effect and reduces abnormal temperature. Doctors in the 19th century were still practising the art of medicine rather than the science. It was a mixture of theories, empirical observation and peddling of treatments passed on from one generation to the other.

Just look at the bottom of the picture of Doc Adams and you will see his pestle and mortar. This is something that most doctors would have, for pounding ingredients when making medicines.


Mortar and pestle from author's collection

The mortar is the bowl and the pestle is the club-like implement used to grind and pulverise. They are tools that have been used to compound medicines for millennia.

A brief history of the pill
It probably comes as no surprise to learn that the ancient Egyptians invented the pill as a means of taking medicine. The Ebers papyrus of about 1550 BC outlines different ways of taking medicines, by enema, lozenges or pills. The pills were made of clay reread with the medication mixed through. Often they used the feces of animals as a binder and as a medicine.

The Persian physician Rhazes (865-925 AD) improved it by using a psyllium-seed mucilage that made the pills less bitter and nauseating.

A century later, the Persian polymath Avicenna (980-1037 AD) improved it further by using a fine coating of gold or silver foil.

Over the following centuries, other coatings were used, but they all had a disadvantage in that they allowed for only partial absorption of the active ingredient into the body. The problem was that many coatings were too difficult for the body to digest and much of the medication could simply pass straight through. On the other hand, sometimes too much would be released and absorbed, producing side effects from too much. We refer to a drug's bioavailability. That means the readiness with which it is made available to the body.

In 1834 the French pharmacist Mohes invented the gelatine capsule, which is rapidly digested allowing  good bioavailability. We still use these today, of course.

One of the greatest advances came in 1884 when Dr William Upjohn (1853-1932) patented a 'friable pill,' which was made by compressing powder into a pill shape. This would then dissolve in the stomach and be absorbed quickly. It had good bioavailability. 



Dr Upjohn lived, qualified and practiced in Michigan. He knew that his invention was a winner, the problem being to persuade other doctors to use his friable pills rather than their own hard pellets. He did it by sending thousands of pine boards along with traditionally made pills and his own friable pills to doctors all over the country, inviting them to  try to hammer the traditional pills into the board. They often did so without breaking, showing how hard it was for the body to absorb. In comparison, one of his friable pills could be turned into powder, ready to be absorbed, merely with the pressure of the thumb. It was a brilliant and persuasive image which became the logo of The Upjohn  Pill and Granule Company that he and his brother formed in Kalamazoo in 1886. It was to become one of the pharmaceutical giants of the 20th Century.





It changed the face of medicine.

The town doctor of the Old West had some effective medicines
Nowadays with our modern drugs is is easy to be smug and think that the town doctor on the frontier would have little to offer the patients under his or her care. That actually is not quite true. In fact, there were quite  number of medicines that he was able to obtain or manufacture. Your town doctor in some future novel may lie to use one or two of these.

In preparing drugs he would probably have a copy of the Pharmacopoeia of the United States of America. A Pharmacopoeia is a book of drugs with all their ingredients, actions and side effects.The first London Pharmacopoeia of 1618 contained recipes for 38 pills. In the early 19th century doctors in the USA used the European ones, until the first American one was published by the Massachusetts Medical Society in 1808. Another was published by the New York Hospital in 1816. Then in 1817 it was decided to produce a national one. This went through a lengthy production and was finally published in English and Latin in 1820.The fifth edition was produced in 1873. I use the sixth edition (in writing Western novels) of 1880.

A frontier town doctor could compound his medicines using some rudimentary equipment, a mortar and pestle, some pipettes, flasks etc. He would need a set of balance scales and various measuring devices. And he would need various reagents. All are listed in the Pharmacopoeia.


Apothecaries’ measurement
Weighing out ingredients for remedies was a complex business and a whole system of Apothecaries measures were used.

One pound or one grain
One pound = 12 ounces
One ounce = 8 drachms
One drachm – 3 scruples or 60 grain

An apothecary’s teaspoon was used to measure one fluid drachm.  This was equivalent to a quarter of a tablespoon.
           
When the household teaspoon size increased it became the equivalent of a third of a tablespoon, which it remains to this day. The Apothecary’s teaspoon, however, remained the same measure.

One could imagine the potential dangers that could ensue with drugs, many of which were extremely toxic, if the wrong spoon was used.




Digitalis
 This is one of the most effective drugs that the doctor would have had. It was used to treat dropsy, or heart failure. We still use it as digoxin. It is one of our oldest effective drugs in cardiology. It is a type of drug called a cardiac glycoside. 

It is  a purified drug that was first extracted from the foxglove plant, Digitalis lanata. It was discovered by William Withering (1741-1799), an English physician in 1785. He had noted that an old woman who practiced herbal medicine used a concoction for treating dropsy, which was the archaic name for heart failure. She achieved dramatic results and he analysed her concoction of twenty ingredients and worked out that the digitalis was the active beneficial agent. Digoxin increases the strength of the heart contractions and slows down the heart. Its effect would have been almost miraculous. 

Dover's Powder
This is a mixture of opium, ipecacuanha and sugar of milk. It was sedative in action, so could calm folk down. It also induces a perspiration reaction. We call these diaphoretic drugs. Back then it was believed that you could sweat an illness out. It was commonly used.

Arnica
This was made from the fried flowers of the plant, a native of the Old west. Made into a tincture, it dealt with strains and bruises.

Tartar emetic
Rather like giving a diaphoretic to induce sweating, it was thought that making someone sick could get poison out of their system. We cal these drugs emetics. This one was made from crystals of antimony and potassium tartrate. The antimony is emetic and also a diaphoretic.

Ipecacuanha emetic
This is another general purpose emetic. We used it a lot in casualty departments (Emergency Rooms in the USA) in hospital, after someone was brought in having taken a drug overdose or poison.

Laudanum
Of course, this is tincture of opium. It contains about ten per cent opium and it is reddish-brown. It was very bitter. It was an analgesic and sedative. In small doses it is also a cough suppressant. Indeed, the doctor could make up various types of cough remedy, often incorporating this.




Carrying case from the author's collection. It has a spring inside the bottom of the cylinder to cushion the medicine bottle inside. A good idea if it was in the doctor's bag being jostled in a buggy or a special medical saddlebag

Calomel 
This is an extremely old medicine. It was a white powder of mercuric chloride. It had profound laxative qualities and was a mainstay of treatment for infective conditions and syphilis.

Nux vomica
This was another of the multi-use medicines. It is prepared from the beans of an east Indian tree. It contains strychnine, which of course, is a highly poisonous agent. It was used as a stimulant, as indeed other poisonous substances like arsenic were used throughout the 19th century. It was used for digestive problems, heart disorders, depression (referred to as melancholy then), and erectile dysfunction in men.

Here are the Pharmacopeia of the United States of America, 1880 instructions:

ABSTRACTUM NUCIS VOMICJE. 
ABSTRACT OF NUX VOMICA. 
Nu x Vomica, in No. 60 powder, two hundred parts...., 200 
•Sugar of Milk, recently dried and in fine powder, 
Alcohol, 
Water , each, a sufficient quantity, 
To make one hundred parts.... 100 

Mix Alcohol and Water in the proportion of eight (8) parts of Alcohol to> 
one (1) part of Water, and, having moistened the Kux Vomica with one 
hundred (100) parts of the menstruum, pack firmly in a cylindrical perco
lator ; then add enough of the menstruum to saturate the powder and 
leave a stratum above it. When the liquid begins to drop from the per
colator, close the lower orifice, and, having, closely covered the percolator,, 
macerate for forfcy-eight hours. Then allow the percolation to proceed, 
gradually adding menstruum, until the Nux Vomica is exhausted. Be-
serve the first one hundred and seventy (170) parts of the percolate, distil 
off the alcohol from the remainder, and mix the residue with the reserved 
portion. Place the mixture in an evaporating dish, and, having added 
fifty (50) parts of Sugar of Milk, cover it with a piece of thin muslin gauze, 
and set aside in a warm place, where the temperature will not rise above 
50° C. (122° IT.), until the mixture is dry. Lastly, having added enough 
Sugar of Milk to make the mixture weigh one hundred (100) parts, reduce 
it to a fine, uniform powder. 
Preserve the powder in a well-stopped bottle. 

Seidlitz Powder
This was an effective antacid for stomach acidity. It was effervescent when added to water, because it contained an acid and an alkali. They react to produce carbon dioxide.

PULVIS EFFERVESCENS CQMPOSITUS, 
COMPOUND EFFERVESCING POWDER. 
[PULVERES EFFERVESCENTES APERIENTES, Pharm., 1870.—SEIDLITZ POWDER.] Grains. 

  
Bicarbonate of Sodium, infine powder, 

  
four hundred and eighty grains 

 480  grains

  
Tartrate of Potassium and Sodium, infine powder, 

  
fourteen hundred and forty grains 

 1440 grains

  
Tartari c Acid, in fine powder, 

  
four hundred and twenty grains 

 420 grains 




Herbal preparations
In addition to the formal medicines of the day, many doctors would also use herbal preparations. remember that frontier doctors were a disparate group, many having had no formal training, or perhaps having simply served as an assistant to a doctor until they acquired sufficient experience and training to go it alone. Some, of course, merely bought a qualification from one of the many diploma mills. If you are interested in what types of doctor practiced back then, you can refer back to my very first Doctor's Bag blog.

Herbal medicines have been used for centuries and there were many such preparations used by Native American medicine men. We shall have a look at some of the herbal remedies used in a later blog.

 Samuel Thomson (1769-1843) the founder of Thomsonian Medicine

My alter ego Clay More has a couple of recent releases.  

The Doctor published by Western Fictioneers in the  West of the Big River series

- my novel based on events in the life of Dr George E. Goodfellow





Redemption Trail published by Western Trail Blazer
- a novelette- novella



Sam Gibson used to be a lawman, until the day he made a terrible mistake that could never be taken back. Since then, he has alternated between wishing there were a way he could redeem himself and believing he deserved punishment. 


He’s about to get both… 




And coming soon from Hale


Fate handed Hank Hawkins the opportunity of achieving his ambition of buying a ranch, and all he has to do to make it happen is to make it easy for a gang to rob the stage in Devil's Bones Canyon. Hank soon realizes, however, that the robbers never had any intention of leaving anyone alive and had planned a dry gulching. He survives but regains consciousness back in Hastings Fork, he vows to track down the murderers who betrayed him and have his revenge. But, when he sets off, he finds he has a companion - Helen Curtis, the fiancee of the messenger whose death lies on his conscience. Hank has many things to figure out, such as why there was one body missing and things are about to get even more complicated with the threat of death for both of them never far away.


12 comments:

  1. Dr. Keith,

    Another outstanding and informative post. You are going to get a plethora of comments stating so!

    I for one am guilty of using laudanum for serious injuries in many of my stories when a character is seriously injured. But Doc, what else would they use for pain? And for milder pain, I used aspirin powders. Sure hope I was right.

    How fortunate we are to have such an esteemed and educated colleague among us!

    Charlie

    ReplyDelete
  2. Great resource, Keith. Thanks so much. We tend to underestimate the balance and complexity involved in manufacturing those tiny tablets that help cure our ills.

    ReplyDelete
    Replies
    1. Thanks Tom. Over in the UK some family doctor practices still do their own dispensing, although nowadays this is mainly in rural areas or on the islands. Back in the 1950s and 1960s a lot more were doing it, making up their own remedies and doing their own side room tests on urine and blood samples. Some frontier doctors who were scientifically minded would have done that, too - and I am going to look at some of the tests that they did in a later post. Nowadays, everything is standardised and even the testing of urine is done with pre-prepared test strips. And as for drugs, they are all manufactured by pharmaceutical companies. As I am sure everyone knows, it is big business.

      Delete
  3. Thanks, Charlie. Laudanum would be very apt. It was readily available and would be used for severe pain. They could also make it up (it is Tincture of opium) with various other things, so it could be use, for example, with valerian as a sedative, with physostigmine from Calabar bean as an anti-epileptic, with kaolin as an anti-diarrhoeal.

    They could use a variety of herbs for various other pains. They also used plasters and poultices a lot. I will be talking about this in a later post.

    Aspirin was discovered by Felix Hoffman in 1897. The German pharmaceutical company Bayer patented it in 1899. Aspirin is acetylsalicylic acid. The acetylation of salicylic acid dramatically reduces the stomach side effects of salicylic acid. It does not do so for everyone, of course, and many people simply cannot take it without side effects (some of which can be highly dangerous). But you are quite correct before 1897 in having doctors prescribe salicinum, salicylic acid or salix, a preparation of willow. Aspirin was originally prepared from meadowsweet.

    I can get boring talking about aspirin. If you are interested, my book An Aspirin a Day, p/b or ebook details its history and the pros and cons of the drug, with the research done to the time of publication in 2011.

    ReplyDelete
  4. As always, a fascinating, informative, and very useful post.

    ReplyDelete
  5. Keith, I always love your posts. This is no exception. I'm going to have to file it away for future reference. This is all just fascinating. I think we tend to believe that aspirin has been around much longer than it really has been--I know I always thought so. I really appreciate these interesting posts of yours--so informative and needed!
    Cheryl

    ReplyDelete
  6. Thanks, Jim and Cheryl. The ancient Egyptians used willow and the Greeks and Romans had painkillers which had salicylate a in them. But the true wonder of aspirin is not its painkilling function, but the anti-inflammatory effect and also in its ability to affect the COX enzymes. This seems to give it the incredible ability to reduce the risk of heart disease, stroke and many cancers. These are effects that salicylic acid does not have. It all comes about from the acetyl group addition to the salicylic acid molecule. Scientifically that is fascinating.

    ReplyDelete
  7. YAHOO for a Michigander! Thank goodness for Dr. Upjohn. And thanks for such great info, Keith! or should I say Doc?

    ReplyDelete
    Replies
    1. Thanks, Meg. Yes, Dr Upjohn certainly made his mark and we have all benefitted from his idea.

      Delete
  8. Fascinating as usual. We have a compounding pharamacy here in town, and they have a display of some of the early medicines. I found them intriquing, and now I know what some of them were used for. Thanks Doris

    ReplyDelete
    Replies
    1. Thanks, Doris. I always want to know the history of things, which is why I study the history of medicine and science and it is one of the reasons that I write Westerns. We take so much for granted these days.

      Delete
  9. Well I commented quite a few days ago, but it doesn't seem to have come through ...

    Another great post Keith and thanks again! I love reading your medical information.

    One of the most interesting things I was able to do recently was to read an actual 1875 almanac at the San Francisco library - chock full of "cures" and advertisements for what we'd consider quack medicine today, and absolutely fascinating!

    ReplyDelete