Historically Speaking: Aspirin, a Pioneering Wonder Drug

The winding, millennia-long route from bark to Bayer.

The Wall Street Journal

February 1, 2024

For ages the most reliable medical advice was also the most simple: Take two aspirin and call me in the morning. This cheap pain reliever, which also thins blood and reduces inflammation, has been a medicine cabinet staple ever since it became available over the counter nearly 110 years ago.

Willow bark, a distant ancestor of aspirin, was a popular ingredient in ancient remedies to relieve pain and treat skin problems. Hippocrates, the father of medicine, was a firm believer in willow’s curative powers. For women with gynecological troubles in the fourth century B.C., he advised burning the leaves “until the steam enters the womb.”

That willow bark could reduce fevers wasn’t discovered until the 18th century. Edward Stone, an English clergyman, noticed its extremely bitter taste was similar to that of the cinchona tree, the source of the costly malaria drug quinine. Stone dried the bark and dosed himself to treat a fever. When he felt better, he tested the powder on others suffering from “ague,” or malaria. When their fevers disappeared, he reported triumphantly to the Royal Society in 1763 that he had found another malaria cure. In fact, he had identified a way to treat its symptoms.

Willows contain salicin, a plant hormone with anti-inflammatory, fever-reducing and pain-relieving properties. Experiments with salicin, and its byproduct salicylic acid, began in earnest in Europe in the 1820s. In 1853 Charles Frédéric Gerhardt, a French chemist, discovered how to create acetylsalicylic acid, the active ingredient in aspirin, but then abandoned his research and died young.

There is some debate over how aspirin became a blockbuster drug for the German company Bayer. Its official history credits Felix Hoffmann, a Bayer chemist, with synthesizing acetylsalicylic acid in 1897 in the hopes of alleviating his father’s severe rheumatic pain. Bayer patented aspirin in 1899 and by 1918 it had become one of the most widely used drugs in the world.

ILLUSTRATION: THOMAS FUCHS

But did Hoffman work alone? Shortly before his death in 1949, Arthur Eichengrün, a Jewish chemist who had spent World War II in a concentration camp, published a paper claiming that Bayer had erased his contribution. In 2000 the BMJ published a study supporting Eichengrün’s claim. Bayer, which became part of the Nazi-backing conglomerate I.G. Farben in 1925, has denied that Eichengrün had a role in the breakthrough.

Aspirin shed its associations with the Third Reich after I.G. Farben sold off Bayer in the early 1950s, but the drug’s pain-relieving hegemony was fleeting. By 1956 Bayer’s British affiliate brought acetaminophen to the market. Ibuprofen became available in 1962.

The drug’s fortunes recovered after the New England Journal of Medicine published a study in 1989 that found the pill reduced the threat of a heart attack by 44%. Some public-health officials promptly encouraged anyone over 50 to take a daily aspirin as a preventive measure.

But as with the case with Rev. Stone, it seems the science is more complicated. In 2022 the U.S. Preventive Services Task Force officially advised against taking the drug prophylactically, given the risk of internal bleeding and the availability of other therapies. Aspirin may work wonders, but it can’t work miracles.

Historically Speaking: The Quest to Understand Skin Cancer

The 20th-century surgeon Frederic Mohs made a key breakthrough in treating a disease first described in ancient Greece.

The Wall Street Journal

June 30, 2022

July 1 marks the 20th anniversary of the death of Dr. Frederic Mohs, the Wisconsin surgeon who revolutionized the treatment of skin cancer, the most common form of cancer in the U.S. Before Mohs achieved his breakthrough in 1936, the best available treatment was drastic surgery without even the certainty of a cure.

Skin cancer is by no means a new illness or confined to one part of the world; paleopathologists have found evidence of it in the skeletons of 2,400- year-old Peruvian mummies. But it wasn’t recognized as a distinct cancer by ancient physicians. Hippocrates in the 5th century B.C. came the closest, noting the existence of deadly “black tumors (melas oma) with metastasis.” He was almost certainly describing malignant melanoma, a skin cancer that spreads quickly, as opposed to the other two main types, basal cell and squamous cell carcinoma.

ILLUSTRATION: THOMAS FUCHS

After Hippocrates, nearly 2,000 years elapsed before earnest discussions about black metastasizing tumors began to appear in medical writings. The first surgical removal of a melanoma took place in London in 1787. The surgeon involved, a Scotsman named John Hunter, was mystified by the large squishy thing he had removed from his patient’s jaw, calling it a “cancerous fungus excrescence.”

The “fungoid disease,” as some referred to skin cancer, yielded up its secrets by slow degrees. In 1806 René Laënnec, the inventor of the stethoscope, published a paper in France on the metastatic properties of “La Melanose.” Two decades later, Arthur Jacob in Ireland identified basal cell carcinoma, which was initially referred to as “rodent ulcer” because the ragged edges of the tumors looked as though they had been gnawed by a mouse.

By the beginning of the 20th century, doctors had become increasingly adept at identifying skin cancers in animals as well as humans, making the lack of treatment options all the more frustrating. In 1933, Mohs was a 23-year-old medical student assisting on cancer research in rats when he noticed the destructive effect of zinc chloride on malignant tissue. Excited by its potential, within three years he had developed a zinc chloride paste and a technique for using it on cancerous lesions.

He initially described it as “chemosurgery” since the cancer was removed layer by layer. The results for his patients, all of whom were either inmates of the local prison or the mental health hospital, were astounding. Even so, his method was so novel that the Dane County Medical Association in Wisconsin accused him of quackery and tried to revoke his medical license.

Mohs continued to encounter stiff resistance until the early 1940s, when the Quislings, a prominent Wisconsin family, turned to him out of sheer desperation. Their son, Abe, had a lemon-sized tumor on his neck which other doctors had declared to be inoperable and fatal. His recovery silenced Mohs’s critics, although the doubters remained an obstacle for several more decades. Nowadays, a modern version of ”Mohs surgery,” using a scalpel instead of a paste, is the gold standard for treating many forms of skin cancer.

WSJ Historically Speaking: A Risky Skin Game: Tans, Fashion and Cancer

ILLUSTRATION: THOMAS FUCHS

ILLUSTRATION: THOMAS FUCHS

The suntan was born as a fashion accessory in France in 1923—or so legend has it. The French like to claim Coco Chanel started the trend after she turned an accidental sunburn into a fashion statement while sailing with her lover, the duke of Westminster.

But the Americans have an equal shot at the title with Gerald and Sara Murphy, wealthy expatriates who fell in love with the French Riviera and established themselves in Cap D’Antibes the same year. A glittering roster visited them there, from Picasso to the American writer John Dos Passos, helping to turn the sleepy backwater into a glamorous destination. Continue reading…

WSJ Historically Speaking: Resolved to Lose Weight in ’16? Join a Venerable Club

English Romantic poet George Gordon Noel Byron (from around 1810). To keep his weight down, he subsisted on a diet of flattened potatoes drenched in vinegar. PHOTO: HULTON ARCHIVE/GETTY IMAGES

English Romantic poet George Gordon Noel Byron (from around 1810). To keep his weight down, he subsisted on a diet of flattened potatoes drenched in vinegar. PHOTO: HULTON ARCHIVE/GETTY IMAGES

Resolutions and Jan. 1 have a fatal attraction for one another—much like beer and pizza. The vow most often cited, “to go on a diet,” also happens to be the one most quickly abandoned. According to a 2013 British study, two out of five dieters don’t make it beyond the first week.

The problem isn’t that people are lazy or spoiled. It’s that the purpose of a diet has become divorced from its original intentions. The ancient Greeks were largely responsible for the concept. “Diatia” means “way of life” or “regimen.” How a person approached the business of eating was as important as what entered his stomach. Balance, self-control and proper order were thought to be three key aspects to living the good life. Only barbarians, such as the Persians, gorged on luxuries.

The two greatest doctors of the classical world, Hippocrates (around 460 to 375 B.C.) and Galen (A.D. 129 to about 216) had strong ideas about the kind of diatia everyone should follow. They argued that the mind and body were controlled by four humors: blood, phlegm, black bile and yellow bile. The goal was to keep them in equilibrium. A surplus of phlegm, for example, could make a patient lethargic, requiring more citrus in the diet. Too much black bile, on the other hand, made a person melancholic—which, Galen thought, required bloodletting or purging to remove the noxious humors from the body.

Continue reading…