Category Archives: Medicine

A Ghost of Medicinal Misnomers Past

Old advertisements on a wall, corner of Regent's Square / Sidmouth Street, London (Photo:Tim Jones)
Old advertisements for medicines on a wall, corner of Regent’s Square / Sidmouth Street, London (Photo:Tim Jones)

Aspirin by any other name

Drugs have at least two names: a generic or scientific name, and then any number of manufacturers’ brand names for what is essentially the same thing.

So the generic names for two well-known painkillers are aspirin (acetylsalicyclic acid) and paracetamol (acetaminophen), but on Wikipedia you’ll find at least a hundred alternative brand names for paracetamol alone.  My favourites are the cuddly ‘Panda’ and the bemusing ‘Europain’.

It’s done of course to differentiate a commercial product, or identify a mixture of drugs – like aspirin and caffeine in Anadin.  But it hinders keeping track of particular chemicals that suit you, for a cold or whatever.   Also annoying are brands that list different drugs by application under the same headline brand, especially when the contents vary between countries.

Ghost Sign

As much as I enjoy banging on about how brands can obfuscate choice and cloud rational decision-making – and not just in medicines – this post is really about that photo of a building above, that I took yesterday in Regent Square, London.   It’s an unlikely and incongruous survivor.   A wall covered in early hand-painted advertisements for medicines from a bygone age.  It’s a ghost sign.


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Probably Victorian, when salve and laxatives were all the rage, the full spiel for one of the products, ‘King’s Citrate of Magnesia’, made by Bates & Company, reads:

King’s Citrate of Magnesia

Invented in 1844

The Original Safest

& Best

W.W. King was a Liverpool chemist of mixed fortune.   I found him listed twice in sources for 1851.  First as a prize winner in the Catalogue of the Great Exhibition1 – for his ‘effervescent citrate of magnesia’, but also in Charles Dickens’s Household Narrative2 for that year, in his regular round-up of bankrupts.

King's Effervescent Citrate of Magnesia won a prize at the Great Exhibition of 1851(Wikipedia)
King’s Effervescent Citrate of Magnesia won a prize at the Great Exhibition of 1851

Citrate of Magnesia induces a Motion

It was no secret that the article was entirely wanting in both citric acid and magnesia3

The Pharmaceutical Journal and Transactions, October 1, 1870

Magnesium Citrate, or Citrate of Magnesia, is still used as a uncontentious  saline laxative and magnesium supplement.  But it has a 19th century history that echos some of today’s complexities around drug names, descriptions, and branding.

We expect boxes and bottles of medicine to contain what the label says.  But by 1870, a situation had developed where products labelled citrate of magnesia were more often than not found to contain a mixture of “tartaric acid, sugar, and carbonate of soda3 .  It made for a nice fizzy summer drink, but little else.

A hapless public bought the mis-named drug in spite of the unrealistically low street price; it wasn’t like they could slip on glasses and read the small print, because compulsory ingredients listing hadn’t been invented.  That some brands, including King’s (of our wall fame), appeared to ship the real deal didn’t simplify the big picture.

All this threatened the reputation of professional pharmacists, so, as reported in the October 1st 1870 edition of the Pharmaceutical Journal and Transactions3 , some of them met to discuss a formal motion that would set things right – they hoped.

What’s in a name?

19th century Britons got their medicines from a variety of sources: via a doctor’s prescription, from an apothecary, chemist, or druggist, but also as commercial articles from the general store or local  grocer.  It’s like us going to the doctor, the pharmacy at Boots or RiteAid, or shopping at Tescos or Walmart.  The difference is we get the same drug wherever we go, while for 19th Century folk it was more of a lottery.  General commercial outlets were especially problematic – where unscrupulous quacks plied their mischievous trade of old.  At worst, the more renegade outlets might be guilty of “applying definite chemical names to articles not having the composition thereby designated3 “.

A quack from an earlier age (Credit:Tufts University)
A quack from an earlier age (Credit:Tufts University)

The pharmacists thought renaming the product might be the answer, but that idea just got them in a mess.  Do you call a thing what it is, or what it should be?   Suggestions included “citrate of magnesia of commerce“, “citrate of magnesia so called” , “citrate of magnesia of pharmacy“, “granular effervescent citrate of magnesia“, or the more vague “granular effervescent salt“.  Also names closer to the common composition, like “granulated tartrate of soda“; or  “citro-tartrate of soda” – whose sponsor claimed special privilege because it was already listed in the British Pharmacopoeia (an early list of approved drug standards published in 1867).

Interior of typical victorian pharmacy
Interior of typical victorian pharmacy (Credit: Wellcome Library London)

In the end, relative sense prevailed, with options smacking of inaccuracy and deception, however pragmatic, being rejected in favour of scientific purity.

…this Conference, as representing and expressing the highest aims of pharmacy, ought to maintain a scientific purity and exactness in its nomenclature3

The Pharmaceutical Journal and Transactions, October 1, 1870

Not that everyone was behind an honest naming regime.  It would confuse the public, said some, and open a Pandora’s Box of renaming obligations; hundreds of ambiguous favourites would be challenged: from ‘Salt of Lemons’, to ‘Seidlitz Powders’, to ‘Soda Water’.

From this strained conflict of pragmatism with scientific integrity a final motion was passed: a bit lame on specific actions, but a signal that professional pharmacists would not countenance inaccurate naming driven by commerce or tradition.   At least for Citrate of Magnesia that is, by now firmly established as the tip of a misnomer ice-berg.

That this Conference is of opinion that the term ‘citrate of magnesia’ as applied to the ordinary granulated preparation of commerce is a misnomer, and ought to be discouraged as inconsistent with the true interests of pharmacy. (The final form of the motion)

The Pharmaceutical Journal and Transactions, October 1, 1870

 

Legislation

Motions from professional bodies are all well and good, but they’re not law.  ‘Discouragement’ without legislation is toothless, and laws in this area had been slow in coming and often contested.

Prosecutions for drug misnomers were made under the Food Adulteration Act (Photo: Tim Jones)
Prosecutions for drug misnomers were brought under the Food Adulteration Act (Photo: Tim Jones)

Earlier legislation, like the Apothecaries Act of 1815, defined standards and training for licensed apothecaries without actually outlawing unqualified practitioners, druggists, or quacks.   The Medical Act of 18584 was more about regulating doctors, and explicitly excluded from its provision chemists, druggists, etc. involved in the sale of medicines (although it did action the earlier mentioned British Pharmacopoeia).

The Pharmacy Acts of 1852 and 1868, established under the auspices of the pharmacists’ own professional society – the Pharmaceutical Society of Great Britain (est 1841) gave them powers to control drugs, and may explain why this was such an issue in 1870.  But with those acts focused on poisons and dangerous drugs, legal actions against peddlers of mis-named versions of the pedestrian citrate of magnesia were brought under the more generic Food Adulteration Act (1860) or Adulteration of Food and Drugs Act (1872).  Coincidently, these same legislations helped reduce the sawdust content of sausages, and alum and chalk in bread.

In this 1873 case, the defendant was found guilty under the Adulteration of Food and Drugs Act (1872), and fined £10 – about £1000 today – plus the cost of analysing his product:

Prosecution under the Food Adulteration Act for mis-selling citrate of magnesia (The Times, Nov 1, 1873)
Prosecution under the Food Adulteration Act for mis-selling citrate of magnesia (The Times, Nov 1, 1873)

Gradually things moved along, with further legislation on dangerous and controlled drugs appearing in the 1920s.  The Medicines Act 1968 split drugs into the prescription, pharmacy, and general sales categories we have now.   The naming of medicines in the UK is today administered by the Medicines and Healthcare products Regulatory Agency (MHRA), an agency essentially tasked with resolving the sort of issues our pharmacist friends were facing in 1870.

There’s no doubt controls over the naming and description of medicines has progressed massively since 1870.  But with outstanding issues around the labelling and promotion of homeopathic products, and the classification and control of herbal remedies, the job’s far from over.

 

References

1. Official Catalogue of the Great Exhibition of the Works of Industry of All Nations 1851, Cambridge University Press, 2011

2. The Household Narrative of 1851, Ed Charles Dickens

3. The Pharmaceutical Journal and Transactions, October 1, 1870, P.275

4. Medical Act of 1858 (here at legislation.gov.uk)

 

Of Related Interest on Zoonomian

Monkey Brand Comes Clean (re: nineteenth century soap ads.)

 

Further Reading

More about Ghost Signs at Sam Roberts’s ghostsigns.co.uk

More medical ghostsigns at the History of Advertising Trust

Blogger Sebastien Ardouin says more about Bates & Co here.

More recent legal developments, more so for dangerous drugs, in: Shipman Enquiry, Fourth Report, Chapter 3 (pdf here)

More on the fight against food adulteration here at the Royal Society of Chemistry.

A Visit to Great Malvern and Annie Darwin’s Grave

Anne Darwin's Grave at Malvern Priory (Photo:Tim Jones)
I suspect Darwin would be happy to see squirrels running over his daughter’s grave. ‘Annie’ Darwin’s Grave at Malvern Priory (Photo:Tim Jones)

Until last week, I’d only seen the Worcestershire town of Great Malvern from the air.  Flying light aircraft in the nineties, one of my favourite sightseeing tours was to head out west from my local airfield near Stratford, turn south over Worcester racecourse towards the Malvern Hills, and watch the sun set over the waters of the Severn estuary.

The ‘Malverns’ are odd.  An isolated stretch of peaks, nine miles long and 1394 feet at the highest point.  Rising half way up the Eastern side, like a carpet pushed up against a wall, is the town of Great Malvern.  In an aeroplane it’s a nice spot to practice steep-banked turns, while distracting your passenger with one of England’s greener and pleasanter views.   We mostly got cloud and rain last week – so here’s a view in brighter conditions:

Malvern Hills (WikiCommons)
Malvern Hills (WikiCommons)
Malvern's gas lamps may have inspired the opening to C.S.Lewis's Narnia (Photo:Tim Jones)
Malvern’s gas lamps may have inspired the opening to C.S.Lewis’s Narnia (Photo:Tim Jones)

Amongst the famous folk associated with Malvern are C.S.Lewis and J.R.R.Tolkien, whose experiences walking together in the hills, it’s said, fed into their fantasy worlds.  For sure, I can see how elves and dwarves might emerge from the cloudy scrumpy cider we sampled at the Unicorn pub – the authors’ favourite after-hike watering hole.

The composer Sir Edward Elgar was a local, and rests with his wife in nearby Little Malvern.

And the private school Malvern College gave many influential political, military, and media people their educational start – including journalist Jeremy Paxman; but not so many scientists or engineers it seems.

That said, it’s a scientist, Charles Darwin, that I associate most strongly with Malvern.  A regular visitor from 1849, Darwin made the two-day journey to Malvern to partake of the town’s popular water therapy, hoping it might relieve the chronic vomiting and headaches that plagued him for much of his life (and caused some now think by Chagas’s disease1 contracted on his Beagle voyage to South America).  He would later return with his seriously ill daughter Annie.

Ten year old Annie had weakened from scarlet fever over the previous two years, and, with her condition worsening, on 24th March 1851 Darwin made the trip with her to Malvern and Dr James Gully.

Pioneers of hydrotherapy, or hydropathy as they called it, Gully and his colleague James Wilson set up the first of several specialist clinics in the town.  Like other spa towns in England, the geographic and economic growth of Malvern was largely driven by the perceived value of its natural waters.

First Water Cure Establishment in Great Malvern (Photo:Tim Jones)
First Water Cure Establishment in Great Malvern (Photo:Tim Jones)
Plaque to the first purpose built water cure establishment (Photo:Tim Jones)
Plaque to the first purpose built water cure establishment (Photo:Tim Jones)

Despite Gully’s efforts, Annie was beyond any water-cure, and Darwin was to leave her in Malvern, permanently, a month later.   She died at their lodgings in Montreal House on the Worcester Road, and is buried in the grounds of nearby Great Malvern Priory – literally a stone’s throw from our hotel.  Gully described Annie’s condition at death as a “Bilious fever with typhoid character”2; it’s now thought more likely she died from tuberculosis.

Anne Elizabeth Darwin, 1848 (Wikipedia)
Anne Elizabeth Darwin, 1848 (Wikipedia)
House on Worcester Road, Great Malvern, where Anne Darwin died (Photo:Tim Jones)
Montreal House on Worcester Road, Great Malvern, where Charles and Anne lodged with Eliza Partington, and Anne Darwin died on 23rd April 1851 (Photo:Tim Jones)
Plaque to Charles and Anne Darwin (Photo:Tim Jones)
Plaque to Charles and Anne Darwin (Photo:Tim Jones)
Great Malvern Priory (Photo:Tim Jones)
Great Malvern Priory (Photo:Tim Jones)
'Annie' Darwin's gravestone at Great Malvern Priory (Photo:Tim Jones)
‘Annie’ Darwin’s gravestone at Great Malvern Priory (Photo:Tim Jones)

From a modern perspective, Gully’s water treatments were doomed to failure.  The enthusiastic Gully might wrap a patient in wet sheets, subject them to heavy douches from above and below, or enroll them for a course of ‘spinal washing’.

The core water treatment might be augmented with anything from hill walks to homeopathy, to clairvoyancey, to what amounted to a light baking under oil lamps.  Hydropathy’s enthusiastic adoption and questionable effectiveness groups it with the electrical and magnetic treatments popular with Victorian physicians at the time, eager to apply new insights on nature, however misguided, to human well-being.

Some of the water treatments Gully and Wilson would have used. From: Hydropathy, or, The water-cure: its principles, modes of treatment. Joel Shew, Wiley & Putnam 1844 (Ref.5)
Some of the water treatments Gully and Wilson would have used. From: Hydropathy, or, The water-cure: its principles, modes of treatment. Joel Shew, Wiley & Putnam 1844 (Ref.3)

Perceived benefits were most likely due less to the watery aspects of Gully’s therapy, and more to the generally healthy context of their delivery.  Plain eating, abstention from alcohol, and daily exercise in a calming environment could do a lot for a bloated Victorian gentleman.  But that didn’t stop Gully and like-minded advocates publishing elaborate treatises and supposedly affirmative case studies4 directly linking water therapy to the cure of all kinds of disease.

Clairvoyance - after George CruikshankDarwin hung in with Gully’s ideas for years before concluding any benefit was limited and purely psychosomatic.  He never bought into homeopathy, and seems to have gone along with the more spiritual add-ons from Gully’s palette to keep their relationship.  Darwin was open to new ideas, but he always judged them against the standard of reason.

Annie was a special favourite among Darwin’s children, and her death took a lasting toll on his mental state.  The poignant memorial he wrote to Annie is here at the Darwin Correspondence Project5

Annie’s story also formed the background to the movie Creation (my earlier review here), with Paul Bettany as Darwin, Jennifer Connelly as his wife Emma, and Bill Paterson as Dr Gully.  The film, based on Darwin’s descendent Randal Keynes’s book Annie’s Box, is worth watching if you can forgive a bit of historical license-taking (for one thing, Darwin’s other children don’t age through a series of flashbacks involving Annie).  Also, note that the town where they shoot the Malvern scenes, which I can now vouch has the feel of the place, is actually Bedford-on-Avon).

 

 References

1. The Mystery of Darwin’s Ill Health.  The Darwin Correspondence Project

2. Darwin, Desmond and Moore, Pub.Michael Joseph, 1991, p.384

3. Hydropathy, or, The water-cure: its principles, modes of treatment, &c., illustrated with many cases : compiled chiefly from the most eminent English authors on the subject. Shew, Joel, 1816-1855. New York : Wiley & Putnam, 1844. Link to text at U.S. Library of Medicine here.

4. The Water Cure in Chronic Disease.  James Manby Gully, M.D., 1850, John Churchill, London

5. The death of Anne Elizabeth Darwin.  The Darwin Correspondence Project

6. Note on the IHS monogram here at History from Headstones

 

Clairvoyance cartoon from George Cruikshank’s Table Book, 1845

Book Review – Here Is a Human Being, by Misha Angrist

Here Is a Human Being

  • Hardcover: 352 pages
  • Publisher: HarperCollins; 1 edition (1 Dec 2010)
  • Language English
  • ISBN-10: 0061628336
  • ISBN-13: 978-0061628337
  • Product Dimensions: 15.2 x 2.9 x 22.9 cm

 

 

 

Between 2006 and 2010, half a million 40-69 year olds, including yours truly, joined the UKBioBank project.  We agreed to share lifestyle and medical information – not to mention blood, saliva, and urine samples – all to help researchers get a better handle on the incidence, cause, and treatment of disease.  With enough subjects, the logic goes, associations between an individual’s characteristics and their health can inform our understanding and treatment of the wider population.

No surprise then that only a few pages in to Misha Angrist’s  Here Is a Human Being: At the Dawn of Personal Genomics I spotted the obvious link between his experience as the fourth subject in Harvard Medical School’s Personal Genome Project (‘PGP) – the theme of his book – and my own humble contribution to medicine.  Both projects are based on ideas around association, to one degree or another involve genomics in support of healthcare goals, and as James Watson said to Angrist on the value of personal genomics, they create “a more compassionate, better society”.

Clearly, there must be differences, otherwise I’d have got to write the book and hang out with the likes of Stephen Pinker – with Angrist settling for the return bus fare to a medical testing center in Croydon.  The distinction is mainly down to issues of privacy, plus the fact that Angrist’s genome was sequenced when it was still a big expensive deal to do that.

UKBiobank data is anonymised.  Even the researchers working with my genome (if and when it’s ever sequenced) won’t know my name .  Angrist’s PGP data, however, is public: genome, life style, medical history; it’s just out there – totally, with his name on it.  To take part in PGP you have to take an exam to show you know what you’re doing; those in the spearhead PGP-10 group required a Masters level training in genetics.  More importantly, as Angrist gets to see his own stuff under the PGP rules, he can share the motivations, emotions, excitement and anxieties that go with that kind of exposure and self-knowledge.  (How effective promises of confidentiality in programs that have them really are is a whole different, but related, topic.)

Human genomics is a young field.  The first composite human genome was published by the U.S. government’s Human Genome Project (HGP) in 2003.  A parallel commercial project led by Craig Venter and the Celera Corporation published Venter’s personal genome in 2007.   Early processes were slow and costs correspondingly high; but the promise, particularly for medicine, was great.  Now, as the dream of a medical revolution fades, and free-falling costs open the way for mass genomic profiling, attention has turned more to protecting the public from what some see as a useless, possibly dangerous, product of an immature science – peddled by an exploitative industry.  Insurance companies circle round the latest hot tool for risk minimisation, ready to turn our genome against us.   Bridging the exclusive and commodity phases on the human gemonics timeline, Angrist brings an insiders eye to bear on an uncertain period.  As he says “I had arrived at the theatre early enough to grab a good seat, but the carpenters were still building the sets.”

It’s fashionable to talk about personal genomics in terms of its profound complexities and limitations, and not its useful applications.  You can see why though.  In predicting disease, genes tell only part of the story alongside environmental factors.  As Angrist says, we need to link environment (was a child exposed to lead paint), phenotype (how much did it weigh), and lifestyle (what did I have for breakfast) with personal genomic profiles.  He cites rheumatoid arthritis as an example where from twin studies we know the risk is only 50% genome related.  Disease  is sometimes associated with single defective genes, but more often is the combined expression of many genes interacting with each other and the environment.  Relevant genes may exist anywhere throughout the genome, requiring researchers to search the whole smash – with no clues on appearance or location.  To complicate things further, the same disease is caused by different gene combinations in different people.

That’s not to say some genetic associations don’t give personal genome candidates pause for thought.  When, in a separate study, James Watson’s genome was sequenced, he chose not to know his risk of the incurable Altzheimer’s disease; Angrist’s fellow PGPer Stephen Pinker made the same choice.  As interesting perhaps is the fact that many people do want to know their Altzheimer’s risk – despite the disease’s incurability, and that studies show they can handle the knowledge.  Angrist has a special interest in the breast cancer gene variants BRCA1 and BRCA2, as his daughters would be at an 80% life-time risk were he to pass on defective versions; it seems personal genomes aren’t so personal after all.  In one of the most human moments in the book, Angrist sits  alone with his genome report, about to discover this type of information for the first time.

Angrist is at pains to show where human genomics contributes beyond disease prediction, pointing to work on: drug efficacy across ethnic groups and individuals (testing for hyper-sensitivity to warfarin blood thinner), resolution of paternity disputes (10% of  fathers are not biological), donor screening (of blood and sperm), and identification of lost racial origins or heritance.  One company specialises in providing genome-based nutritional advice, perhaps advising someone whose gene mix inhibits calcium absorption to consider taking a supplement.  Ethically intriguing applications include the use of genetic selection to identify our ideal partner or love match.  These on top of the widely used law enforcement applications of DNA we know and love from TV shows like CSI.

Angrist weaves plenty of historical, technical, and commercial detail into his personal story, much of it original and drawn from interviews with fellow PGP’ers (a truly mixed bag of characters and motivations in their own right), PGP Founder George Church, and a host of specialists in genomics and medicine – including some insightful tid-bits from former HGP Director Francis Collins and James Watson.

You won’t retain it all – I sometimes lost track of who exactly developed what, when, and where; who went bust and reappeared again, etc. – but the main take-away is clear enough.  That despite any limitations and historical hype – “the marketing of personal genomics has outpaced the science” – personal human genomics is far from valueless, and has great potential if we hang in with it.  Specifically, Angrist believes the tangled complexity of genotype-phenotype associations may unravel if a sufficiently large sample of cross-referenced data is available.  And with over a thousand active participants in the PGP in 2012, and thousands more in the queue, it looks like that might just happen.

RECOMMENDED.

Misha Angrist blogs at GenomeBoy.

 

Also of interest:

http://thednaexchange.com/2013/11/29/the-fda-calls-a-penalty-on-23andme/

Medicinal Whiskey

Medicinal Whiskey from the prohibition period (photo: Tim Jones)
Case for medicinal whiskey from the prohibition period (photo: Tim Jones)

Medicinal whiskey? Sounds like a joke doesn’t it.  But from midnight on 17th January 1920, this was the real deal in the USA, and one of the very few ways you’d legitimately get your hands on booze until the repeal of Prohibition in December 1933.

I found this old (regretably empty) case yesterday in the back of a garage – the kind of place all such boxes migrate to over the years.  It once contained Rye Whiskey made by the New Hellam Distillery company in Pennsylvania and distributed by John A Dougherty & Sons; from the stamping on the box, made in 1919 and bottled in 1931.

    Case for medicinal whiskey from the prohibition period (photo: Tim Jones)
Case for medicinal whiskey from the prohibition period (photo: Tim Jones)

In the build-up to the passing of the Volstead Act that enabled prohibition, the various evangelical groups and temperance advocates sponsoring the legislation downplayed evidence for the medicinal properties of alcohol (1).  It was the sort of controversy reserved today for psychoactive drugs like marijuana and psilocybin.

    Case for medicinal whiskey from the prohibition period (photo: Tim Jones)
Case for medicinal whiskey from the prohibition period (photo: Tim Jones)

Like any controlled medicine, you would need a prescription to get some.

Prescription form for medicinal liquor (Wikicommons)
Prescription form for medicinal liquor (Wikicommons)

I haven’t found a definitive list of conditions that warranted alcohol as a cure – just vague references to whiskey as a ‘tonic’, whatever that means, used to soothe stomach conditions, nervous complaints, and to aid sleep.  Today, we recognize the benefit of moderate alcohol consumption for the prevention or amelioration of conditions including heart disease, and specific drinks – including whiskey – pop up now and again for a special mention.

Other exemptions to the Volstead Act allowed wine for sacremental purposes, and bakers could use syrups derived from alcohol for cakes.  Uses in scientific research and industrial applications were also okay.  But in general, if you could easily drink it, it was out (2).

 

References

(1) A Prohibition Problem: Liquor as Medicine 1920–1933. Jones BC,  J Hist Med Allied Sci (1963) XVIII (4): 353-369. doi: 10.1093

(2) Discussion and full reproduction of the Volstead Act clarifying exemptions here

Charles Dickens’s Mudfrog Homeopathy

Charles DickensNice to see as early as 1837 Charles Dickens doing his bit to comically debunk the efficacy of infinitesimal doses in medicine.  Okay, he’s not quite talking about the bottles of total nothingness you can buy at the chemist and are an insult to reason today, but still interesting that similar ideas were an issue 175 years ago.

This passage from ‘The Mudfrog Pages‘, in the monthly magazine Bentley’s Miscellany, is a fictitious report from the first meeting of the ‘Mudfrog Society for the Advancement of Everything’, a satirical fun-poke at the recently founded British Association for the Advancement of Science :

Professor Muff related a very extraordinary and convincing proof of the wonderful efficacy of the system of infinitesimal doses, which the section were doubtless aware was based upon the theory that the very minutest amount of any given drug, properly dispersed through the human frame, would be productive of precisely the same result as a very large dose administered in the usual manner. Thus, the fortieth part of a grain of calomel was supposed to be equal to a five-grain calomel pill, and so on in proportion throughout the whole range of medicine. He had tried the experiment in a curious manner upon a publican who had been brought into the hospital with a broken head, and was cured upon the infinitesimal system in the incredibly short space of three months. This man was a hard drinker. He (Professor Muff) had dispersed three drops of rum through a bucket of water, and requested the man to drink the whole. What was the result ? Before he had drunk a quart, he was in a state of beastly intoxication; and five other men were made dead drunk with the remainder. ” The President wished to know whether an infinitesimal dose of soda-water would have recovered them ?  Professor Muff replied that the twenty-fifth part of a tea- spoonful, properly administered to each patient, would have sobered him immediately. The President remarked that this was a most important discovery, and he hoped the Lord Mayor and Court of Aldermen would patronize it immediately. ” A Member begged to be informed whether it would be possible to administer — say, the twentieth part of a grain of bread and cheese to all grown-up paupers, and the fortieth part to children, with the same satisfying effect as their present allowance. ” Professor Muff was willing to stake his professional reputation on the perfect adequacy of such a quantity of food to the support of human life — in workhouses; the addition of the fifteenth part of a grain of pudding twice a week would render it a high diet.”

By John Leech, Punch, 1846

References

The Mudfrog Papers  http://www.archive.org/stream/mudfogpapersetcn00dickrich/mudfogpapersetcn00dickrich_djvu.txt

Sprinting is Good for the Heart (but not so good for the planet)

Inevitably, spring cleaning and winnowing of the paper archives throws up blasts from the past – often in the form of faded, pre-digital-age photographs.   They waft the embers of dormant memories.

Triumph Dolomite Sprint - first commercial 16v motor car
Triumph Dolomite Sprint – first production car with a 16v engine

This memory concerns a charity drive I made with my brother 19 years ago in support of the British Heart Foundation.  The Round Britain Reliability Run involved a group of car enthusiasts loyal to the Triumph brand, driving non-stop (save for pit-stop style re-fueling and the occasional sandwich break) around the UK. That’s a distance of about 2000 miles in something like 40 hours, taking a route from London to John O’Groats to Lands End, and back to London.

The Route
The Route

A number of thoughts struck me, looking at the photo of our ride – a 1981 Triumph Dolomite Sprint; but two in particular.

Firstly,  nobody in 1990 had heard of global warming, so all were oblivious to the carbon footprint of the event or any incongruity with the charitable tone of the challenge (not that heart health and global warming are directly related).

Secondly, this was a reliability run; part of the perverse thrill lay in not knowing with any certainty your vehicle would  hack the 2000 miles round trip. Alright, some of these cars were from the 1950’s, but mechanical reliability – even into the ’70s and ’80s – did not compare to today’s standards.  The Sprint in particular was prone to engine overheating – a defect which, when it occurred, could be ameliorated by driving with the heaters full on and the windows open.

Club Triumph Round Britain Beer Mug
Reward!

And guess what?  They are still running these events – every two years.  What’s more, the Club Triumph Round Britain Reliability Run has from last year been carbon neutral.  The carbon impact in terms of off-setting equivalent has been calculated at £10 per car – which is duly charged to the drivers.  The beneficiary charity  seems to change with each event, but an impressive total of  £270,000 has been generated for various causes since 1990.

I never repeated this sort of stunt.  For starters, all the Triumphs in our family wore out or were sold off (we had six over the years).  And I moved on to more mature transport related pastimes, like throwing bags of flour out of aeroplanes (the science and technology of flour bombing is a post for another day).

Anyhow, a few more of these blast from the past photos were  loosed along with this one from the box file of history so, if you’re really unlucky, there could be further posts in Zoonomian’s nostalgia category :-).

Virtual Medicine

In this podcast I meet a team from Imperial College who are leading the field in the application of virtual worlds for medical training. The package was originally broadcast on the radio show Mission Impossible on ICradio.com on 23rd June 2009.

1137

 

 

Rip-Off Meds

Time for a short rant on a topic that consistently bugs me, and brought to mind by the tardy unpacking of goodies from my US trip: the relative cost of common drugs in the UK and America.

Generic Ibuprofen
Generic Ibuprofen

Take the common anti-inflammatory (NSAID) painkiller Ibuprofen.  Consider the various ways a UK consumer can buy the standard 200mg tablet (price per tablet in UK pennies, 100 pennies = £1):

High street branded Nurofen  (16) 15p

High street branded Nurofen (96)  11p

High street retailer’s own brand (Boots Ltd) (16) 6.2p

High street retailer’s own brand (Boots Ltd) (96) 6.2p

UK internet vendor (e.g.Chemist4u) (16) 3.7p

UK internet vendor (e.g.Chemist4u) (96) 2.2p

US internet vendor selling into UK (e.g. International Drugstore) in £ (500) 1.8p

US high street price at £1=$1.5) 1.7p

That’s a price range of nearly 900% for the same thing !     What are the messages – several:

1. For best value, a UK customer should buy ibuprofen  from a US internet retailer selling into the UK at the prevailing exchange rate (example International Drugstore)

2. On the same shelf, branded product carries a 240% mark-up.  That’s one expensive glossy box – you better buy into the placebo effect.

3. Boots do not give any volume discount (I suspect they have a special bean-counter dedicated to avoiding this on many of their products)

4. With the exchange rate shift, there is no longer any significant advantage (£0.01)  to physically buying this product in the US and bringing it to the UK (for example on your holidays)

5. Again, with the latest exchange rate moves, my premise that drugs are cheaper in the US is only now true – at least for ibuprofen – for the highstreet; internet prices are similar.

Take the above for what it is – half an hour’s research.  But you don’t need ten decimal places or to be a procurement professional to see what’s going on.

 

Update 29/6/11

May also be of interest: Generic drug ruling leaves out consumers (L.A.Times)


Hot Pungency At Simpson’s

What do Charles Dickens, Benjamin Disraeli, William Gladstone, and Tim Jones have in common?

I leave you to cogitate over the more obvious parallels in literary and political acumen shared by these well known London gentlemen – they are irrelevant to the point. More pertinent is that we have all four, variously over two centuries, enjoyed roast beef in the Grand Divan at Simpson’s-in-the-Strand; roast beef served in the traditional manner: carved at the table, with a good dollop of coarsely shredded horseradish sauce.

Grand Divan, Simpsons in the Strand
Stylish dining in the Grand Divan at Simpsons in the Strand (Photo:Tim Jones)

For me, the recent occasion for this most English of dining extravagances was my wife’s birthday. She with whom, amongst the chandeliers and paneled oak, I once again shared a fulfillment that only the stimulating permeation of allyl isothiocyanate into nasal mucosa can deliver.

In truth, I had no idea what caused the alarming pungency of the horseradish, and no amount of distracted shuffling of fork about the savoy cabbage and roast potatoes helped explain the strange sensation – quite unlike the ‘hotness in the mouth’ of a curry or the ponderous burn of ginger. So what’s it all about?

Capsaicin
Allyl isothiocyanate

It turns out the active ingredient in horseradish – allyl isothiocyanate – is a volatile irritant. Being volatile, it can quickly get to the nasal passages where the endings of the trigeminal nerve complex come close to the surface. On the other hand, the main active compound in chili and curry, capsaicin, is a non-volatile, oil-soluble, molecule that travels most readily through the lipid membranes of the oral cavity; it makes your mouth and tongue feel hot. Interestingly, the menthol found in mint is both volatile and oil soluble, giving us that difficult to describe sensation of heating and cooling in both nose and mouth.

I also discovered during my research that allyl isothiocyanate is used to make adhesive for sailmaking, and stumbled across this patent describing the applications of horseradish as a treatment for nasal and sinus dysfunction, delivered by literally squirting the stuff up your nose. Something to try between courses maybe?


Fireworks (and the Very Useful Application of Bishops)

As we approach the 5th November, many people in the UK will be considering which firework party to attend. But on the night, they probably won’t be thinking too hard about why they’re standing out in the cold, gripping a baked potato, and “oohing” and “aahing” to the explosive delights. Because the British public have been doing this for a while – 403 years to be exact, since that fateful day when a bunch of disgruntled catholics tried unsuccessfully to vapourise King James I and the English parliament. There you have it: gunpowder, treason and plot.

Thankfully, science as a social construct goes beyond applying the physical consequences of rapid combustion under containment to the government of the day. Centuries before Guido Fawkes got his catholic knickers in a twist, enterprising chemists were delighting expectant crowds at fireworks displays.

Vauxhall Gardens Fireworks - 1800s

A popular 18th and 19th century venue for fireworks was the Vauxhall Gardens pleasure park in London. While the elaborate promenades, bandstands, and the ‘firework temple’ have all disappeared, youngsters can still be found unwittingly (and illegally) maintaining the firework tradition on the patch of public park that remains, as this picture from 2003 shows.

Fireworks - Vauxhall Gardens 2003. Photo: Tim Jones

The manufacture of fireworks has always been a risky business. Factories typically comprise many small and separated work units, such that if one goes up in smoke the remainder are isolated from the blast. This aerial photograph well illustrates the layout at the now defunct Standard Fireworks plant.

Fireworks manufacturies do not make for good neighbours, as this 1858 newspaper report of a terrible accident in central London illustrates (interestingly the year before Vauxhall Gardens’ final closure). While regrettable, the event deliciously opportuned some wry social commentary towards the religious establishment and aristocracy of the day.

Also of interest:

Coke and Borg’s Biography of Vauxhall Gardens (Guardian review by PD Smith here)