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Diagnosed bipolar, prescribed lithium

In the first part of a series looking into lithium, Laura Grace Simpkins recounts the beginning of her troubled relationship with this mysterious drug.

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Does mass media pave the way to fascism?

In the aftermath of World War II, psychoanalysts found the psychological roots of authoritarianism closer to home than was comfortable.

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Indian botanicals and heritage wars

Colonial botanical texts, as astonishingly beautiful as they are, may cast very dark shadows.

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  • Atropa belladonna L. Solanaceae. Deadly nightshade. Dwale. Morella, Solatrum, Hound's berries, Uva lupina, Cucubalus, Solanum lethale. Atropa derives from Atropos the oldest of the three Fates of Greek mythology who cut the thread of Life (her sisters Clotho and Lachesis spun and measured the thread, respectively). belladonna, literally, means 'beautiful lady' and was the Italian name for it. Folklore has it that Italian ladies put drops from the plant or the fruits in their eyes to make themselves doe-eyed, myopic and beautiful. However, this is not supported by the 16th and 17th century literature, where no mention is ever made of dilated pupils (or any of the effects of parasympathetic blockade). Tournefort (1719) says 'The Italians named this plant Belladonna, which in their language signifies a beautiful woman, because the ladies use it much in the composition of their Fucus [rouge or deceit or cosmetic] or face paint.' Parkinson says that the Italian ladies use the distilled juice as a fucus '... peradventure [perhaps] to take away their high colour and make them looke paler.' I think it more likely that they absorbed atropine through their skin and were slightly 'stoned' and disinhibited, which made them beautiful ladies in the eyes of Italian males. Distribution: Europe, North Africa, western Asia. Culpeper (1650) writes: 'Solanum. Nightshade: very cold and dry, binding … dangerous given inwardly … outwardly it helps the shingles, St Antonie's Fire [erysipelas] and other hot inflammation.' Most of the 16th, 17th and 18th century herbals recommend it topically for breast cancers. Poisonous plants were regarded as 'cold' plants as an excess of them caused death and the body became cold. They were regarded as opposing the hot humour which kept us warm and alive. Poultices of Belladonna leaves are still recommended for muscle strain in cyclists, by herbalists. Gerard (1633) writes that it: 'causeth sleep, troubleth the mind, bringeth madnesse if a few of the berries be inwardly taken, but if more be taken they also kill...'. He was also aware that the alkaloids could be absorbed through the skin for he notes that a poultice of the leaves applied to the forehead, induces sleep, and relieves headache. The whole plant contains the anticholinergic alkaloid atropine, which blocks the peripheral actions of acetylcholine in the parasympathetic nervous system. Atropine is a racemic mixture of d- and l- hyoscyamine. Atropine, dropped into the eyes, blocks the acetylcholine receptors of the pupil so it no longer constricts on exposure to bright light - so enabling an ophthalmologist to examine the retina with an ophthalmoscope. Atropine speeds up the heart rate, reduces salivation and sweating, reduces gut motility, inhibits the vertigo of sea sickness, and is used to block the acetylcholine receptors to prevent the effects of organophosphorous and other nerve gas poisons. It is still has important uses in medicine. Atropine poisoning takes three or for days to wear off, and the hallucinations experienced by its use are described as unpleasant. We have to be content with 'madness', 'frenzie' and 'idle and vain imaginations' in the early herbals to describe the hallucinations of atropine and related alkaloids as the word 'hallucination' in the sense of a perception for which there is no external stimulus, was not used in English until 1646 (Sir T. Browne, 1646). It is a restricted herbal medicine which can only be sold in premises which are registered pharmacies and by or under the supervision of a pharmacist (UK Medicines and Healthcare Products Regulatory Agency (MHRA)). Photographed in the Medicinal Garden of the Royal College of Physicians, London.
  • Gardenia jasminoides J.Ellis Rubiaceae. Cape jasmine - as erroneously believed to have come from South Africa. Distribution: China. Named for Dr Alexander Garden FRS (1730-1791) Scottish-born physician and naturalist who lived in Charles Town, South Carolina, and corresponded with Linnaeus and many of the botanists of his era. The fruits are used in China both as a source of a yellow dye, and for various unsubstantiated medicinal uses. Other species of Gardenia are found in tropical Africa and the roots and leaves have all manner of putative uses. Gardenia tenuifolia is used as an aphrodisiac, for rickets, diarrhoea, leprosy, gall bladder problems, toothache, liver complaints, diabetes, hypertension, malaria and abdominal complaints. It causes violent vomiting and diarrhoea. It, and other species, are used to poison arrows and to poison fish. Some native, muthi medicine, healers regard Gardenia as a ‘last chance’ medicine, given to patients when all else fails – the patient either dies or recovers (Neuwinger, 1996). Photographed in the Medicinal Garden of the Royal College of Physicians, London.
  • Aconitum carmichaelii Debeaux. Ranunculaceae. Chinese aconite, Chinese wolfsbane, Carmichael's monkshood. Herbaceous perennial. Distribution C. to W. China to N. America. Named for Dr J.R. Carmichael (d. 1877), English physician, plant collector and Protestant missionary from 1862-1877 in Guangdong and Shandong, China initially in Canton. He aided Francis Forbes to collect plants for Kew. Aconitum plants are so poisonous that Theophrastus states that death was the punishment for possessing them. Aconitine is the poison and was used - from Aconitum ferox - in the 'curry murder' in London in 2009. It causes respiratory paralysis, bradycardia (slowing of the pulse), cardiac arrhythmias, tingling, sweating, gastric cramps, diarrhoea and death, both by ingestion and by absorption through the mucous membranes and the skin. Despite this it is widely used in Chinese herbal medicine. It is a restricted herbal medicine which can only be dispensed by a herbal practitioner for external use following a one-to-one consultation, or by prescription from a registered doctor or dentist (UK Medicines and Healthcare Products Regulatory Agency (MHRA)). Photographed in the Medicinal Garden of the Royal College of Physicians, London.
  • Illicium verum Hook.f. Illiciaceae Chinese Star Anise Distribution: China. Illicium anisatum Japanese Star Anise. Distribution Japan. Illicium verum is used as a spice in Asian cooking and for Star Anise tea. The distilled oil is added to cough mixture used by children. Introduced to Europe in 1588 (Pharmacographia Indica, 1890). Illicium anisatum syn. religiosum, has been confused with it (Lindley, 1838, Bentley 1861) but is poisonous and was used to make incense in Japanese and Chinese temples. It was called Skimi by Kaempfer. The seed pods of both species contain shikimic acid (the name being derived from the Japanese word for the plant - shi-kimi) from which Tamiflu, the antiviral drug was synthesised. Photographed in the Medicinal Garden of the Royal College of Physicians, London.
  • Eranthis hyemalis Salisb. Ranunculaceae Winter Aconite Distribution: Europe. The reason it was called Winter aconite and linked to Aconitum napellus as being just as poisonous is because plants were classified according to leaf shape in the 16th century. L'Obel's Stirpium adversaria nova (1571) and Plantarum seu stirpium historia (1576) (with a full page illustration on page 384 showing Eranthis and Aconitum together) along with the knowledge that related plants have similar medical properties caused the belief that Eranthis are as poisonous as Aconitum. They are both in Ranunculaceae and while Eranthis (like all Ranunculaceae)is toxic if eaten, it does not contain the same chemicals as Aconitum. Caesalpino (Ekphrasis, 1616) pointed out the error in classifying according to leaf shape and recommended flower shape. It contains pharmacologically interesting chemicals such as khellin, also present in Ammi visnaga. This is a vasodilator but quite toxic, but can be converted into khellin analogues such as sodium cromoglicate – used as a prophylaxis against asthma attacks – and amiodarone which has anti-arrhythmia actions so is used for atrial fibrillation and other arrhythmias. It is endangered and protected in the wild (Croatia) because of over-collecting for horticulture. Photographed in the Medicinal Garden of the Royal College of Physicians, London.
  • Eranthis hyemalis Salisb. Ranunculaceae Winter Aconite Distribution: Europe. The reason it was called Winter aconite and linked to Aconitum napellus as being just as poisonous is because plants were classified according to leaf shape in the 16th century. L'Obel's 'Stirpium adversaria nova' published in 1571 and 'Plantarum seu stirpium historia' published 1576 (with a full page illustration on page 384 showing Eranthis and Aconitum together) along with the knowledge that related plants have similar medical properties caused the belief that Eranthis are as poisonous as Aconitum. They are both in Ranunculaceae and while Eranthis (like all Ranunculaceae) is toxic if eaten, it does not contain the same chemicals as Aconitum. Caesalpino (Ekphrasis, 1616) pointed out the error in classifying according to leaf shape and recommended flower shape. It contains pharmacologically interesting chemicals such as khellin, also present in Ammi visnaga. This is a vasodilator but quite toxic, which can be converted into khellin analogues such as sodium cromoglicate – used as a prophylaxis against asthma attacks – and amiodarone which has anti-arrhythmia actions so is used for atrial fibrillation and other arrhythmias. It is endangered and protected in the wild (Croatia) because of over-collecting for horticulture. Photographed in the Medicinal Garden of the Royal College of Physicians, London.
  • Taxus baccata L. Taxaceae European Yew. Trees are feminine in Latin, so while Taxus has a masculine ending (-us), its specific name, baccata (meaning 'having fleshy berries' (Stearn, 1994)), agrees with it in gender by having a female ending ( -a). Distribution: Europe. Although regarded as poisonous since Theophrastus, Gerard and his school friends used to eat the red berries (they are technically called 'arils') without harm. Johnson clearly ate the fleshy arils and spat out the seed, which is as poisonous as the leaves. It is a source of taxol, an important chemotherapeutic agent for breast and other cancers. It was first extracted from the bark of T. brevifolia, the Pacific yew tree, in 1966. About 1,100 kg of bark produces 10 g of taxol, and 360,000 trees a year would have been required for the needs of the USA – an unsustainable amount. In 1990 a precursor of taxol was extracted from the needles of the European yew so saving the Pacific trees. It is now produced in fermentation tanks from cell cultures of Taxus. Curiously, there is a fungus, Nodulisporium sylviforme, which lives on the yew tree, that also produces taxol. Because taxol stops cell division, it is also used in the stents that are inserted to keep coronary arteries open. Here it inhibits – in a different way, but like anti-fouling paint on the bottom of ships – the overgrowth of endothelial cells that would otherwise eventually block the tube. The economic costs of anticancer drugs are significant. Paclitaxel ‘Taxol’ for breast cancer costs (2012) £246 every 3 weeks
  • Lathyrus vernus (L.)Bernh. Papilionaceae previously Orobus vernus L. (Linnaeus, 1753) Spring vetchling. Distribution: Europe to Siberia. The seeds of several Lathyrus species are toxic, and when eaten cause a condition called lathyrism. The chemical diaminoproprionic acid in the seeds causes paralysis, spinal cord damage, aortic aneurysm, due to poisoning of mitochondria causing cell death. Occurs where food crops are contaminated by Lathyrus plants or where it is eaten as a 'famine food' when no other food is available. It is the Orobus sylvaticus purpureus vernus of Bauhin (1671) and Orobus sylvaticus angustifolius of Parkinson (1640) - who records that country folk had no uses for it. Photographed in the Medicinal Garden of the Royal College of Physicians, London.
  • Lathyrus vernus (L.)Bernh. Papilionaceae previously Orobus vernus L. (Linnaeus, 1753) Spring vetchling. Distribution: Europe to Siberia. The seeds of several Lathyrus species are toxic, and when eaten cause a condition called lathyrism. The chemical diaminoproprionic acid in the seeds causes paralysis, spinal cord damage, aortic aneurysm, due to poisoning of mitochondria causing cell death. Occurs where food crops are contaminated by Lathyrus plants or where it is eaten as a 'famine food' when no other food is available. It is the Orobus sylvaticus purpureus vernus of Bauhin (1671) and Orobus sylvaticus angustifolius of Parkinson (1640) - who records that country folk had no uses for it. Photographed in the Medicinal Garden of the Royal College of Physicians, London.
  • 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.
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