Pharmacy Pills, Potions and Poisons…

The Belfast Telegraph reported this week that a respected colleague was forced to leave the profession for doing what, 50 years ago, every pharmacist did; make and supply medicines for his patients and clients. Known as nostrums, the content of these medicines often remained a trade secret and could add considerably to the value of a pharmacy business as good nostrums were commercially very successful. Patients would travel great distances to get the “pink stomach medicine” or the special “Tonic”. Nostrums were the origins of many of our famous household remedies “Mrs Cullen’s Powders” “Andrew Liver salts” and “Milk of Magnesia”, the later created by Belfast doctor, James Murray. Nostrums were wonderful concoctions with more than a hint of mystery surrounding their origins and many went on to command significant patient loyalty. In the US, John Pemberton created a nostrum tonic containing cocaine. This pick-me up eventually lost the cocaine and went on to become Coca Cola.

eye of newt and toe of frog’.

‘Double, double, toil and trouble;

Fire burn and cauldron bubble

Macbeth

Today nostrums are less tolerated by the authorities who are keen to extinguish a practice that has been with us for centuries. Macbeth’s witches were likely very skilled in creating potent potions and I often wonder if my practice is directly descended from them.

After the Thalidomide tragedy of the early 1960s government committed to better assure medicine safety. Indeed, the three pillars of the pharmacy profession are: quality, safety and efficacy and it is these standards that are woven into our ethical code. The Medicines Act 1968 required all medicines to be licensed but a loophole was created for the continuation of nostrums. Back then to abruptly ban nostrums would have been commercially fatal to many small pharmacy businesses. It was hoped that, with more licensed medicines, nostrums would just fade away. Not so, it seems.

35 years ago, my sister-in-law, then living in ROI, travelled home to Strabane each weekend to get supply of a “colic bottle” for my niece. She wasn’t the only one. Severe colic in an infant is difficult to witness but within minutes of a spoonful of this “colic bottle” a screaming demon was transformed into a sleeping angel. Parents paid handsomely for this miracle cure but even back then the authorities were trying to close it down as it was mainly based on laudanum tincture – opium; a fact never disclosed on the label.

Medicine regulation has progressively improved the quality and safety of the medicines we use today. The first law properly controlling supply of medicines was the Pharmacy Act 1868 which recognised the Chemist and Druggist – today’s pharmacist- as the custodian and seller of named poisons (as medicine was then formally known).   The government of the 1860s also brought in additional legislation, The Sale of Food and Drugs Act 1875, regulating the adulteration of foodstuffs which directly impacted quality of medicines.

The origins of both the 19^th Century laws are in an incident that forced the government of the day to legislate. The 1858 Bradford humbug incident involved the accidental arsenic poisoning of more than 200 people of which twenty-one died when sweets accidentally made with arsenics salts were sold from a market stall in Bradford.

Sugar, a major component of humbugs, was imported from the West Indies and in the 1850s cost two shillings a pound (£50 today). On 30 October 1858, James Archer was sent to collect “daff”, a cheap innocuous substitute for sugar, from a druggist Charles Hodgson who owned a pharmacy in Shipley.  Hodgson was present in his pharmacy but did not serve Archer owing to ill health. He instructed his assistant, William Goddard to make the sale and when Goddard asked Hodgson where the daff was kept, he was directed to a cask in a corner of the attic store. Rather than daff, Goddard sold Archer 12 pounds (5.4 kg) of arsenic trioxide.

The humbugs were manufacture without the mistake being detected but it was noted that the finished product looked different from the usual humbugs. The sweet-maker was suffering symptoms of illness during the sweet-making process and was ill for several days afterwards with vomiting and pain in his hands and arms,

Forty pounds (18 kg) of lozenges were sold to a sweet-seller who also noticed the sweets looked unusual and used this to obtain a discount. The sweet-seller, one of the first to taste the sweets, immediately became ill. Arsenic trioxide is a white, crystalline powder that closely resembles sugar in appearance but it has no odour or taste.

Five pounds (2.3 kg) of the sweets were sold from his market stall that night and within a day 21 people were dead with more than 200 severely ill. Unsurprisingly, the first deaths—those of two children—were thought to be cholera but growing casualties soon identified the humbugs. Goddard was arrested and stood trial in Bradford with druggist Hodgson later tried on charges of manslaughter but both got off. The law needed changing to protect the public and so the Pharmacy Act 1858. The case had a profound impact on the regulation of medicines that still resonates today.

The severe censuring of a respected colleague for manufacturing and supplying nostrum type medicines that were not properly quality controlled is a reminder of the rigour applied to assuring medicine safety. There is no suggestion he was using dangerous or unsafe ingredients in these nostrums; he just didn’t keep proper records. More generally it is also a reminder of how we as pharmacists use to practice, a practice I thought had long ago ceased.

I am a pharmacist in Belfast.