Before the second half of the 19th century, the dominant medical and popular notions of disease rested on a humoral theory of disease, first put forward by Hippocrates in Greece and later by Galen in Rome. According to this theory, there were four humours – phlegm, black bile, yellow bile and blood – and diseases resulted from an imbalance of these humours or between the humoral state of the individual and conditions in the environment. 1 The idea that masturbation or menstruation might lead to disease or madness stemmed from this theory, in that both involve a loss of secretions that supposedly disrupted the internal balance of the humours, leading to dysharmony.
A version of this theory survives to this day in the Chinese notions of yin and yang, and in the three dhosas of Ayurvedic medicine, both of which are popular in complementary medicine settings. In both yin and yang and humoral systems, what is aimed at is a state of harmony. Treatment consists of efforts to restore balance or internal equilibrium. Until the 19th century this was done by regulating diet, by bleeding, purging, inducing vomiting, raising blisters (in which noxious vapours could collect), or by giving a variety of tonics – agents that were stimulant or strengthening in some way. Diet and tonics of various sorts remain the most popular methods today.
Among the drugs used for nervous problems were black hellebore (a drastic purgative) and white veratrum, which produced vomiting. Shaving of the head was also employed to let the vapours out. Oleum cephalicum (oils for the head), which would blister the shaven scalp, were used. Iron was also in use, literally to strengthen the constitution. Camphor was a popular stimulant and bromides were used as sedatives. 2
These treatments may sound odd now, but essentially what physicians aimed at was to mimic the body’s own reactions: sweating, bleeding, purging, vomiting, the passage of water, etc. Producing what we would now call side effects such as these seemed to be the obvious thing to do and, far from suing the way patients might do nowadays, these side effects were taken as a welcome sign that the treatment was working.
Against this background, a large industry flourished, aimed at satisfying consumer needs (or profiting from their misery) through the provision of tonics, elixirs, and so on. The market was almost entirely consumer-led, as numerous plays, novels and operas, such as Donizetti’s L’Elixir d’Amour, attest. It was a regular feature of village life that the pedlar of medicines would come around with a range of potions for sale. Individuals regularly treated themselves with such compounds. Even when quite seriously ill, it was common until the 20th century for afflicted individuals to have a go at treating themselves first.
In the 19th century, patent medicines emerged – medicines containing ‘secret’ remedies. These were marketed vigorously in the popular press, and a great number of the techniques underpinning modern advertising developed in an effort to sell these compounds. Their success became an increasing problem in orthodox medical circles and among regulators. 3 The patent medicine industry still survives today in over-the-counter (OTC) medicines, and most clearly in the health food industry, whose food supplements are ‘drugs’ by another name. Some modern examples of this are the burgeoning phenomenon of smart drugs outlined in Chapter 18 and the growth in nutraceuticals such as lipid-lowering spreads.
The modern pharmaceutical industry took shape in the early 20th century as a reaction to these patent medicines. The newer drug companies that emerged, and which survive today, termed themselves ‘ethical’ companies in contrast to the patent medicine industry. The term ethical needs some clarification. These companies saw themselves as being ethical in that they were prepared to purify the compounds that went into their preparations and were willing to specify exactly what a medicine contained.
THE MAGIC BULLET
The development of specific theories of disease was the most significant factor affecting the outcome of competition between the ethical and patent pharmaceutical industries. The discovery by Pasteur of bacteria and their role in infection led to a growing belief in specific causes for specific diseases. The key breakthrough came with the development of diphtheria antitoxin, in 1896, which led to the eradication of diphtheria.
Allied to this, there was during the 19th century an increasing awareness that the many natural herbs and compounds that appeared to be helpful in the treatment of disease all contained specific compounds and that it was these compounds rather than the whole herb that were the curative factors. For example, it turned out to be the morphine in the poppy rather than the entire poppy that was helpful, the digitalis in foxglove and the salicylic acid in the bark of the willow tree (Salix alba). Other developments, such as the increasing use of anaesthesia for ever more specific surgical procedures, fostered the idea of specific illnesses and correspondingly the idea of specific cures. The growing trend found a notable expression in Paul Ehrlich’s concept of the magic bullet. Magic bullets would enter the body and act on a disease process specifically, leaving all other metabolic processes undisturbed. 4
The antibiotics have come closest to this ideal in practice. The idea, however, has taken hold that all modern drugs are magic bullets of some sort, and this leads many, if not all, of us who are prescribing or taking drugs to believe that we are taking something that will work specifically on just one faulty piece of the human machinery.
The reality, however, is quite different. It is not just that most drugs, particularly psychotropic drugs, may cause side effects but rather that they all act on a great number of body systems. For instance, the calcium-channel blockers have therapeutic actions on almost every system in the body. The antipsychotics may be used as anxiolytics, antipsychotics, antidepressants, antipruritic agents, antihypertensives or antiemetics. The marketing by modern drug companies, however, actively attempts to obscure this state of affairs.
Initially the ethical companies aimed at purifying natural compounds, such as digitalis, salicylic acid or morphine. The great advantage of purification was that the amount of a drug given could be controlled. In the case of foxglove, for example, crushing and administering the plant may help cardiac failure – if the dose is right – but it may be poisonous if the dose is too high. In principle, if there is an active ingredient in a natural compound it should always be possible to purify it and makes its use safer.
Related posts:
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
