Were the remedies or
patented drugs of yesterday beneficial to Influenza patients in 1918?
In 1918, disease and various illnesses in Winnebago County was a part
of daily living. There were frequent outbreaks of measles, scarlet fever,
whooping cough, diptheria, chickenpox, influenza, typhoid fever, and occasionally
smallpox. During severe outbreaks, the City Health Department would quarantine
the homes and placards would be nailed to the front door of the house
specifying what disease was present and warning people to stay away. Most
ill people were taken care of at home, relying on home remedies.
Many of the aforementioned drugs prescribed by physicians for the Spanish
influenza were controlled substances such as heroine, codeine, cocaine,
opium, and morphine. The Dispensatory of the United States of America
did note the potential hazards of these drugs in its description of uses
(15). Few pharmacists would sell more than an ounce of these drugs because
of their habit forming potential. Many remedies contained a large percentage
of alcohol (9-11). Interestingly, some of the patented medicines contained
compounds derived from phenol such as salol and phenacetin (para-acetamidophenetol).
Salol was prepared by heating salicylic acid with phenol in the presence
of phosphorous pentchloride or phosphorous oxychloride yielding 35% phenol,
64% salicylic acid (12). It was considered to be an internal antiseptic
and was often prescribed in treating influenza. Phenacetin was used as
pain relieving drug. It was prepared by distilling phenol and subsequently
reducing it with hydrochloric and glacial acetic acid(12). Another commonly
prescribed drug for influenza patients was acetanilid. It was derived
by heating alinine in glacial acetic acid and used as antipyretic or analgesic
(12).
We know today that the concentrations of phenol used
in this time period were very high. Phenol is highly toxic (17). Skin
exposure to high levels of phenol has resulted in liver damage, diarrhea,
dark urine, and hemolytic anemia (17). However, phenol is still used in
some throat sprays at a concentration of 4.1% or less.
Vick's Vaporub, a proprietary combination of menthol, camphorated oil,
eucalyptus oil, and terpentine oil, has passed the test of time. It is
used today to relieve nasal and catarrhal congestion associated with colds/influenza.
It is typically rubbed on the chest or back or added to hot water and
used as an inhalant. It does contain ingredients that are toxic if ingested
in high concentrations. Pine oil (which was used in some remedies), turpentine,
and camphor oil belong to a group of chemicals called terpines. All terpenes
are local irritants. Ingestion produces gastrointestinal signs and symptoms,
aspiration, and pulmonary toxicity; absorption is associated with alteration
in mental status, ranging from coma to seizures. Renal and liver toxicity
has been reported (18). Following ingestion, pine oil may be concentrated
in the lungs, resulting in chemical pneumonitis without evidence of aspiration.
In 1983, the FDA required that the concentration of camphor in products
not exceed 11% (19). In summary, it appears that some of the ingredients
used in influenza home remedies, patent medicines, and prescriptions used
in 1918 are still used today but in much lower (safer) concentrations.
"Surely every medicine is an invention; and he or she that will not apply new remedies must expect new evils."
Sir Francis Bacon (1561-1626)
