A Drop of History 121

The history of aspirin
When the famous drug was rejected by Bayer as useless

The woman writhed in the throes of labour, crying out as though she was being torn asunder. By her side, the father of medicine, Hippocrates, could do nothing to ease her pain except give her to chew strips of willow bark, one of the commonest trees around. Don’t laugh at this primitive cure, because the great Hippocrates gave the labouring woman exactly what a modern doctor would give today: aspirin. The famous drug was born out of salicylic acid, the basic component of willow bark.

Hippocrates had noted the analgesing effect of the tree’s bark in the 5th century BCE, but several more centuries had to pass before the most famous painkiller of all time was created and developed in the form we all know today. The next reference to salicylic acid was made by a British clergyman: in 1763, Edmund Stone advised his parishioners to chew on willow bark when they were in pain. Later, scientists would discover that salicylic acid is an effective analgesic, at the same time capable of protecting one’s system from infection. Unfortunately, the acid is highly corrosive to the stomach, and not few of those who used it would vomit. Until the 19th century, many attempts were made to use the particular acid in medicine and find ways to avoid its side effects.

Completely by chance, in 1853, French chemist Charles Frédéric Gerhardt mixed salicylic acid with acetyl chloride. He had just created aspirin, without even knowing it, but he lost the title of “father of aspirin”, because he did not continue producing it, considering the procedure exceedingly complex. The title went, a few years later, in 1897, to German chemist Felix Hoffmann, who worked for the Bayer pharmaceutical research facility.

Hoffmann’s father suffered from rheumatoid arthritis and took salicylic acid to ease the pain. Hoffmann senior, however, could not cope with the drug’s side effects, so his son tried to find a way to make its administration more tolerable. In fact, young Hoffmann did what Gerhardt had, the only difference being that salicylic acid could be synthesised in the laboratory and not extracted from the trees, so the resulting chemical compound was more stable. After his success, Hoffmann proudly presented the result of his research to the company management, but Heinrich Dreser rejected it as useless and potentially dangerous. That was the very same drug that was to turn the little pharmaceutical company into a giant.

Besides, around the same time, Hoffmann, being very productive, had discovered another compound, diacetylmorphine, which had some amazing effects. According to contemporary studies, the new discovery created a unique sense of euphoria and made workers feel like heroes, that is why the compound was later named heroin. Because of heroin, whose first application was in cough syrup, Bayer had no interest to spare for Hoffmann’s lesser discovery, aspirin.

Hoffmann, however, did not stay idle; instead, he took his new discovery to Berlin hospitals. Recognition for the drug came from the patients themselves. Only then did Bayer deign to look at aspirin again. Soon Hoffmann saw his discovery go into mass production, but the poor man had not thought of patenting it, so aspirin brought profit to the company instead of himself. Bayer patented the drug in March 1899 and Hoffmann did not receive a single penny of the profit; instead, he retired and studied art history in Switzerland.

Until the end of World War I, Bayer had a monopoly on the manufacture and distribution of the drug, but after Germany lost the war, Britain, Russia, France and the USA claimed part of the rights. Not a bad move at all, considering that aspirin is in mass production even today. It is estimated that eighty billion tablets are consumed in the USA every year, and fifty billion in Europe.

© Dimitris Kambourakis 2003, All Rights Reserved
Translation from the Greek © M.A.K. 2008, All Rights Reserved

A Drop of History 116

Yellow fever
The disease that exterminated five million people

In 1894, renowned French developer Ferdinand de Lesseps, after some rest on the laurels of the Suez Canal construction, started the second great project of his life: the construction of another canal, this time in Panama, that would join the Atlantic and Pacific Oceans. But the Sinai desert had nothing on the jungles of Central America. An epidemic broke out on the huge construction site, killing two-thirds of the workmen and, shortly afterwards, Lesseps himself. That was the infamous yellow fever. The project was abandoned, and was finished much later by the Americans, only after a way to fight the disease had been found.

Yellow fever was first mentioned in 1648, and is up there with the greatest and most lethal infections that humankind has known, like the plague of the Peloponnesian War, the disease that Mark Antony’s legions brought to Rome from Mesopotamia, the Black Death of the Middle Ages, the Great Plague of London. Yellow fever was considered a disease of the New World, because that is where it was first noted, but, as it was proven much later, it had existed long before in Africa.

The particular disease was awful and its symptoms horrible. It started with pain in the stomach, the joints and bones, followed by convulsions and black viscous vomit, and continued with rashes all over the body, fever, coma and death. That development unfolded within five days and its mortality rate was almost 100%. It first appeared in Guadelupe in 1648, before moving to Cuba, New York, South Carolina, Boston. Wherever it arrived, people died in droves. All the traditional defence methods – quarantines, isolations, disinfections – proved useless. For two centuries, yellow fever appeared out of the blue and killed people without anyone knowing how it was transmitted. In the tropics it was endemic. In temperate places it appeared in spring and summer. Neither the cremation of the dead nor the disinfection of houses and ships could stop it.

In 1741, yellow fever exterminated three-quarters of the English troops at the siege of Cartagena. In 1799, it killed 31,000 people around the Caribbean. In 1878, another 25,000 victims followed suit. The disease was terrifyingly contagious. In 1781, a frigate sailed from the Honduras towards Port Royal, in Jamaica; it never arrived, and, when found drifting aimlessly, some time later, it was revealed that the entire crew had died of yellow fever.

Years went by, the fever claimed more and more victims, but medicine could not find a cure. The English and French sugarcane plantation owners, to save themselves, abandoned Jamaica and Martinique and returned to their cooler countries, leaving their properties and slaves in the hands of their halfbreed overseers. Medicine, wrapped in a cocoon of conservatism, refused for decades to adopt new ideas in order to find the cause of the disease. Yellow fever had been classified as a contagious miasma, an incurable disease of the New World, and was persistently ignored, despite its lethality. Two of its worst outbreaks occurred in New Orleans in 1853 and in the American Southwest in 1878, with 25,000 victims.

On 14 August 1881, a pioneer doctor named Carlos Finlay overcame traditional beliefs and, in a speech before the Royal Academy of Havana, expressed for the first time the view that yellow fever was transmitted by mosquitoes of the genus Aedes Aegypti. The Academy doctors laughed and rejected Finley’s theories, branding them ridiculous. Twenty more years passed, and the disease kept killing. An eminent bacteriologist, Giuseppe Sanarelli, based on the old views, claimed that the fever was caused by a bacillus that he called “icteroid”. His theory was immediately accepted and acclaimed, while the unknown doctor’s view had been ridiculed.

Three decades later, the Americans who occupied Cuba, seeing that the disease would not abate, remembered Carlos Finlay, who was old by that time. Finlay helped, despite his bitterness, and the appointed committee concluded that the fever was spread by the mosquitoes. So, in order to fight it, they had to disinfect the standing waters in the marshes and cisterns and destroy the mosquitoes’ eggs. The American military accomplished that by putting fish in the cisterns, that ate the floating eggs. Yellow fever receded from Cuba.

In the rest of America, however, civilian doctors refused to accept the conclusions of their military colleagues; the usual medical rivalries. So, while the problem was solved in Cuba, there was a new outbreak in the mainland, which was not treated, as yellow fever was still considered an incurable disease. Only when the epidemic crossed over to Cuba again and was repelled once more did they deign to check the new method and adopt it. After 1910, yellow fever was practically eradicated, after exterminating an estimated five million people in two centuries.

I am left with the impression that, in the end, history allows medicine to cure a grave disease only when the conditions are ripe for the surfacing of another, much more lethal, one which will also be considered incurable for a long time.

© Dimitris Kambourakis 2003, All Rights Reserved
Translation from the Greek © M.A.K. 2008, All Rights Reserved

A Drop of History 86

Wilhelm Conrad Röntgen
When X-rays were considered striptease

In 1895, German professor Wilhelm Conrad Röntgen, while experimenting with cathode rays, discovered by chance that a barium platinocyanide screen in his lab shimmered when the rays hit it. So he started experimenting with that strange phenomenon, until he discovered that any object that came between the screen and the tube producing the rays turned transparent, as the rays went through it without any obstruction.

At some point, he dared put his hand in the place of the object, and he saw, in amazement, the skeleton of his hand on the screen. He had just discovered X-rays, which revolutionised medicine with their practical application and earned Röntgen the Nobel prize. But Röntgen’s road was not smooth, at least not at first. He announced his findings to the scientific community, and the community started mocking him and ridiculing his invention.

The common people in particular misunderstood the new rays completely. Most of them believed they were a new photographic technique that would replace older cameras. So the London Electrician wondered, in its main article: “Revolution? What revolution? Who will accept to be photographed using this new machine, and, instead of his portrait, see only his skull, bones, metal buttons and rings?”

A certain New Jersey governor considered the invention diabolical, because he believed that X-rays went through clothing and exposed the human body to indiscreet eyes. So he decreed, in 1896, that incorporating X-rays to opera glasses was forbidden, so that the spectators would not see the actors naked on stage.

Contrariwise, the invention was hailed with enthusiasm by the various organisations against smoking or alcohol. Not knowing that only the hard parts of the body are impenetrable, and thus revealed by X-rays, they suggested subjecting drinkers and smokers to scanning, so that they could see for themselves the condition of their insides. When the president of the Abstinence Society brought up the suggestion, those drinkers and smokers replied with a convention, the results of which were sarcastically announced by chairman Joe Rogers: “These rays cannot possibly penetrate the fumes in the atmosphere around us; consequently, you are striving in vain.”

As the general impression was that X-rays were nothing but a sort of electromagnetic striptease, a shrewd American manufacturer of ladies’ underwear launched a line of “impenetrable” lingerie and sales soared. The line in question sold out, as that was the period when everyone believed there were X-ray spectacles clandestinely available on the market.

Diagnostic radiology took a long time to be established in European and American hospitals, because even eminent surgeons opposed it with an incredible argument: “These rays reveal cases of faulty bone healing or formation, while the patient has recovered and suffers no aftereffects. Therefore, they calumniate the medical community.” We can judge for ourselves how much water such an argument holds.

Still, despite all reactions, radiology equipment started to find its way into hospitals, although in inconspicuous places (basements and attics), while the first specialist doctors did not enjoy great prestige among their colleagues. However, once more things did not move smoothly. About fifteen years after the machines started operating, radiologists starting dying like flies. Only then did research reveal how harmful the accumulation of radiation was. The first recorded victim, in 1912, was Italian doctor Emilio Tiraboschi, aged forty-nine, who had virtually disintegrated from the inside, as the post-mortem showed. After that, protection measures were established in radiology labs, including metal barriers and uniforms for the staff.

As for clandestine striptease, other ways were found to advertise it.

© Dimitris Kambourakis 2003, All Rights Reserved
Translation from the Greek © M.A.K. 2008, All Rights Reserved