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  • Photo story

Voices of the NHS

In the midst of the coronavirus pandemic, when millions of us are especially grateful for our NHS, hear the voices of nine exceptional health workers explaining their passion for medicine and for taking care of others.

  • Book extract

Ayurveda: Knowledge for long life

The story of medicine in India is rich and complex. Aarathi Prasad investigates how it came to be this way.

  • Article

Black pepper to fuel fiery fights and cure haemorrhoids

This common condiment was once very valuable and, until surprisingly recently, used as a versatile medicine.

  • Article

The extraction of the excruciating bladder stones

Among those vying to find alternatives to major surgery for bladder stones, young doctor Jean Civiale stood out, painstakingly honing a method that was to become the norm.

All stories (78)

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  • Veratrum nigrum L. Melanthiaceae Distribution: Europe. Cows do not eat Veratrum species in the meadows, and human poisoning with it caused vomiting and fainting. In the 1850s it was found to reduce the heart's action and slow the pulse (Bentley, 1861, called it an 'arterial sedative'), and in 1859 it was used orally in a woman who was having convulsions due to eclampsia. Dr Paul DeLacy Baker in Alabama treated her with drops of a tincture of V. viride. She recovered. It was used thereafter, as the first choice of treatment, and, when blood pressure monitoring became possible, it was discovered that it worked by reducing the high blood pressure that occurs in eclampsia. By 1947 death rates were reduced from 30% to 5% by its use at the Boston Lying-in Hospital. It works by dilating the arteries in muscles and in the gastrointestinal circulation. A further use of Veratrum species came to light when it was noted that V. californicum - and other species - if eaten by sheep resulted in foetal malformations, in particular only having one eye. The chemical in the plant that was responsible, cyclopamine, was found to act on certain genetic pathways responsible for stem cell division in the regulation of the development of bilateral symmetry in the embryo/foetus. Synthetic analogues have been developed which act on what have come to be called the 'hedgehog signalling pathways' in stem cell division, and these 'Hedgehog inhibitors' are being introduced into medicine for the treatment of various cancers like chondrosarcoma, myelofibrosis, and advanced basal cell carcinoma. The drugs are saridegib, erismodegib and vismodegib. All the early herbals report on its ability to cause vomiting. As a herbal medicine it is Prescription Only, via a registered dentist or physician (UK Medicines and Healthcare Products Regulatory Agency (MHRA)). Photographed in the Medicinal Garden of the Royal College of Physicians, London.
  • Scutellaria baicalensis Georgi Lamiaceae. Baikal skullcap. Distribution: China. There are several hundred species of Scutellaria, also known as skull caps, so correct identification is important - in particular from Scutellaria lateriflora an American species known as Blue skullcap. The latter is used as an abortifacient and to expel placenta by the Cherokee and for cleaning the throat by the Iroquois (Austin, 2004). Much vaunted as a treatment for rabies with unlikely statistics (1,400 cases cured by one doctor alone). Also as ‘antispasmodic, nervine, [for] chorea, convulsions, tetanus, tremors, delirium tremens, [and as a] diaphoretic and diuretic'. Toxicity symptoms include mental confusion, stupor, headache, vertigo, photophobia, dilated pupils, difficulty in micturition, bradycardia, tremulousness and languor, followed by wakefulness and restlessness (Milspaugh, 1974). Hutchens (1991) reported that it reduces sexual desire and was used for almost every nervous illness. Scutellaria baicalensis contains baicalin, baicalein and wogonin (European Medicines Agency, September 2010). It is used in Traditional Chinese Medicine for treating inflammation, cancer, bacterial and viral infections of the lungs and gut and is one of the '50 Chinese herbs' in the lists of some authors. Scutellaria lateriflora (combined with Verbena officinalis, Passiflora incarnata and the seed of Avena sativa (oats) is licensed for use in Britain as a herbal medicine for temporary relief of mild symptoms of stress such as mild anxiety and to aid sleep, based upon traditional use only. Scutellaria baicalensis is not licensed for use in the UK (UK Medicines and Healthcare Products Regulatory Agency (MHRA)). Photographed in the Medicinal Garden of the Royal College of Physicians, London.
  • Veratrum album L. Melanthiaceae Distribution: Europe. Cows do not eat Veratrum species in the meadows, and human poisoning with it caused vomiting and fainting. In the 1850s it was found to reduce the heart's action and slow the pulse (Bentley, 1861, called it an 'arterial sedative'), and in 1859 it was used orally in a woman who was having convulsions due to eclampsia. Dr Paul DeLacy Baker in Alabama treated her with drops of a tincture of V. viride. She recovered. It was used thereafter, as the first choice of treatment, and when blood pressure monitoring became possible, it was discovered that it worked by reducing the high blood pressure that occurs in eclampsia. By 1947 death rates were reduced from 30% to 5% by its use at the Boston Lying in Hospital. It works by dilating the arteries in muscles and in the gastrointestinal circulation. A further use of Veratrum species came to light when it was noted that V. californicum -and other species - if eaten by sheep resulted in foetal malformations, in particular only having one eye. The chemical in the plant that was responsible, cyclopamine, was found to act on certain genetic pathways responsible for stem cell division in the regulation of the development of bilateral symmetry in the embryo/foetus. Synthetic analogues have been developed which act on what have come to be called the 'hedgehog signalling pathways' in stem cell division, and these 'Hedgehog inhibitors' are being introduced into medicine for the treatment of various cancers like chondrosarcoma, myelofibrosis, and advanced basal cell carcinoma. The drugs are saridegib, erismodegib and vismodegib. All the early herbals report on its ability to cause vomiting. As a herbal medicine it is Prescription Only, via a registered dentist or physician (UK Medicines and Healthcare Products Regulatory Agency (MHRA)). Photographed in the Medicinal Garden of the Royal College of Physicians, London.
  • Papaver somniferum L. Papaveraceae Opium Poppy Distribution: Asia minor, but has been dated to 5000BC in Spanish caves. Now grows almost everywhere. The oldest medicine in continuous use, described in the Ebers' papyrus (1550 BC), called Meconium, Laudanum, Paregoric and syrup of poppies. Culpeper (1650) on Meconium '...the juyce of English Poppies boyled till it be thick' and 'I am of the opinion that Opium is nothing else but the juyce of poppies growing in hotter countries, for such Opium as Authors talk of comes from Utopia.[he means an imaginary land, I suspect]’]. He cautions 'Syrups of Poppies provoke sleep, but in that I desire they may be used with a great deal of caution and wariness...' and warns in particular about giving syrup of poppies to children to get them to sleep. The alkaloids in the sap include: Morphine 12% - affects ?-opioid receptors in the brain and causes happiness, sleepiness, pain relief, suppresses cough and causes constipation. Codeine 3% – mild opiate actions – converted to morphine in the body. Papaverine, relaxes smooth muscle spasm in arteries of heart and brain, and also for intestinal spasm, migraine and erectile dysfunction. Not analgesic. Thebaine mildly analgesic, stimulatory, is made into oxycodone and oxymorphone which are analgesics, and naloxone for treatment of opiate overdose – ?-opioid receptor competitive antagonist – it displaces morphine from ?-opioid receptors, and constipation caused by opiates. Protopine – analgesic, antihistamine so relieves pain of inflammation. Noscapine – anti-tussive (anti-cough). In 2006 the world production of opium was 6,610 metric tons, in 1906 it was over 30,000 tons when 25% of Chinese males were regular users. The Opium wars of the end of the 19th century were caused by Britain selling huge quantities of Opium to China to restore the balance of payments deficit. Laudanum: 10mg of morphine (as opium) per ml. Paregoric: camphorated opium tincture. 0.4mg morphine per ml. Gee’s Linctus: up to 60 mg in a bottle. J Collis Browne’s chlorodyne: cannabis, morphine, alcohol etc. Kaolin and Morph. - up to 60 mg in a bottle. Dover’s Powders – contained Ipecacuana and morphine. Heroin is made from morphine, but converted back into morphine in the body (Oakeley, 2012). One gram of poppy seeds contains 0.250mgm of morphine, and while one poppy seed bagel will make a urine test positive for morphine for a week, one would need 30-40 bagels to have any discernible effect. Photographed in the Medicinal Garden of the Royal College of Physicians, London.
  • Papaver somniferum L. Papaveraceae Opium Poppy Distribution: Asia minor, but has been dated to 5000BC in Spanish caves. Now grows almost everywhere. The oldest medicine in continuous use, described in the Ebers' papyrus (1550 BC), called Meconium, Laudanum, Paregoric and syrup of poppies. Culpeper (1650) on Meconium '...the juyce of English Poppies boyled till it be thick' and 'I am of the opinion that Opium is nothing else but the juyce of poppies growing in hotter countries, for such Opium as Authors talk of comes from Utopia [he means an imaginary land, I suspect]’. He cautions 'Syrups of Poppies provoke sleep, but in that I desire they may be used with a great deal of caution and wariness...' and warns in particular about giving syrup of poppies to children to get them to sleep. The alkaloids in the sap include: Morphine 12% - affects ?-opioid receptors in the brain and causes happiness, sleepiness, pain relief, suppresses cough and causes constipation. Codeine 3% – mild opiate actions – converted to morphine in the body. Papaverine, relaxes smooth muscle spasm in arteries of heart and brain, and also for intestinal spasm, migraine and erectile dysfunction. Not analgesic. Thebaine mildly analgesic, stimulatory, is made into oxycodone and oxymorphone which are analgesics, and naloxone for treatment of opiate overdose – ?-opioid receptor competitive antagonist – it displaces morphine from ?-opioid receptors, and reverses the constipation caused by opiates. Protopine – analgesic, antihistamine so relieves pain of inflammation. Noscapine – anti-tussive (anti-cough). In 2006 the world production of opium was 6,610 metric tons, in 1906 it was over 30,000 tons when 25% of Chinese males were regular users. The Opium wars of the end of the 19th century were caused by Britain selling huge quantities of Opium to China to restore the balance of payments deficit. Laudanum: 10mg of morphine (as opium) per ml. Paregoric: camphorated opium tincture. 0.4mg morphine per ml. Gee’s Linctus: up to 60 mg in a bottle. J Collis Browne’s chlorodyne: cannabis, morphine, alcohol etc. Kaolin and Morph. - up to 60 mg in a bottle. Dover’s Powders – contained Ipecacuana and morphine. Heroin is made from morphine, but converted back into morphine in the body (Oakeley, 2012). One gram of poppy seeds contains 0.250mgm of morphine, and while one poppy seed bagel will make a urine test positive for morphine for a week, one would need 30-40 bagels to have any discernible effect. Photographed in the Medicinal Garden of the Royal College of Physicians, London.
  • Catharanthus roseus (L.)G.Don Apocynaceae. Madagascar Periwinkle Distribution: Madagascar. It is the source of vincristine and vinblastine, which impair cell multiplication by interfering with microtubule assembly, causing metaphase arrest and are effective medications for leukaemias, lymphomas and some solid tumours. The mortality from childhood leukaemia fell from 100% to 30% once it was introduced - not a drug that could ethically be tested by double-blind trials. These chemicals were initially discovered by investigators in 1958 who were looking for cures for diabetes so tested this plant which was being used in the West Indies to reduce blood sugar levels. There are 70 different alkaloids present in this plant, and some - catharanthine, leurosine sulphate, lochnerine, tetrahydroalstonine, vindoline and vindolinine - lower blood sugar levels. However, the toxicity of this plant is such that this is not a plant to try at home for diabetic management. The vincristine content of the plant is 0.0003%, so two kilograms of leaf are required to produce sufficient vincristine for a single course of treatment for a child (6gm). Fortunately it is a vigorous weed and easy to grow in the tropics. Artificial synthesis has now been achieved. Photographed in the Medicinal Garden of the Royal College of Physicians, London.
  • Trifolium rubens L. Leguminosae. [Note the Family Leguminosae is preferred over Family Fabaceae as the former allows all the legumes to be in one Family and not three - one Family being the current consensus among botanists]. Red Feather Clover. Distribution: Europe. The white clover, Trifolium repens, is listed as a treatment for arthritis by Linnaeus (1782). This and Trifolium pratense, Red Clover, are the ones most used for pastures. All the clovers have root nodules which fix nitrogen from the air into the soil so have an important role in ensuring soil fertility. Trifolium rubens has the same nitrogen fixing ability, and is used as an ornamental garden plant where it still acts to improve fertility. Photographed in the Medicinal Garden of the Royal College of Physicians, London.
  • C18 Chinese woodcut: Lurking-cold pharyngitis
  • C18 Chinese woodcut: White laryngitis
  • C18 Chinese woodcut: Pale red laryngitis
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