Warburg's tincture was a pharmaceutical drug, now obsolete. It was invented in 1834 by Dr. Carl Warburg.
Warburg's tincture was well known in the Victorian era as a medicine for fevers, especially tropical fevers, including malaria. It was considered, by some, to be superior to quinine.
Warburg's Tincture was a secret, proprietary remedy. The formula was not published until 1875. Later, it was included in the first edition of Martindale: The Extra Pharmacopoeia . Warburg's Tincture included an array of ingredients, including quinine. [1] [2] [3]
List of alternative names by which Warburg's Tincture was known or referred to:
As its name implies, Warburg's Tincture was originally available only in liquid form. It was deep brown to golden yellow in colour; its taste was bitter and not very palatable. It was sold in small bottles of unique design, containing about one ounce. [3] The label affixed to each bottle bore the registered trademark, which depicted an image of the bottle accompanied by a facsimile of Carl Warburg's signature. [9] By 1888 the drug was available in tablet form. [10]
Warburg's Tincture was invented by Dr Carl Warburg in 1834, in British Guiana (now Guyana). It was introduced into Europe in 1839. [7] [11] Warburg's Tincture received medical trials in British Guiana in the 1830s, and then elsewhere around the world in the 1840s and 1850s. In 1846, Warburg's Tincture was extensively trialled in Austria and, the following year, it was adopted as an official medicine by the Austrian Empire, by imperial order. [8]
Warburg's Tincture was sold as a secret, proprietary medicine for over forty years, and was marketed and manufactured by Carl Warburg for many decades. He wanted the British Government to procure the formula of Warburg's Tincture from him, but such an arrangement never came to fruition. Nevertheless, the British Government was a significant client, procuring Warburg's Tincture for military forces serving overseas in India and Ceylon (now Sri Lanka); in Africa, in Gold Coast (now Ghana), Gambia and Sierra Leone; in the West Indies; and in Cyprus, Corfu, Mauritius and China. [2] [3] In 1867, in the House of Commons of the United Kingdom, Sir Robert Anstruther, 5th Baronet asked the Secretary of War why Warburg's Tincture was not being supplied in larger quantities to troops in India. [12]
Writing in 1870, Carl Warburg lamented that his eponymous drug was "comparatively unknown". [2] The formula was disclosed by him in November 1875 when it was published on his behalf in The Lancet and The Medical Times. [3] [13] In 1855, it retailed at 6s/6d a bottle. [14]
Famous Victorians who are documented to have used Warburg's Tincture include:
Warburg's Tincture was promoted by its inventor, Dr Carl Warburg, as a medicine suitable for treating all types of fevers, but especially tropical fevers, including malaria and yellow fever; and that it could also be used as a tonic in debility and convalescence. He claimed that his eponymous tincture was superior to any other antipyretic, including quinine. "I assert that for perfect safety, for efficacy, rapidity of action, and for economy, my tincture has no rival, nor any approach to it". He also stated that quinine only "relieves", whereas Warburg's Tincture "cures". He advocated that Warburg's Tincture could be employed at all stages of fever, as well as a prophylactic. [2]
" [Warburg’s Tincture] is an unfailing remedy in all cases of Intermittent, Continued, Continued-Remittment, Nervous and Typhus Fevers; Cholera, Diarrhoea, and Dysentery; Scrofula in all its forms; Incipient Consumption, Chronic Bronchitic Cough, Want of Appetite, Delirium Tremens, Morbid Digestion, arising from excess in the use of spirituous drinks, Scurvy and every disease of a scorbutic character. "
- Official advertisement, 1855 [25]
In the Victorian era Warburg's Tincture was principally employed in the treatment of tropical fevers, including malaria, yellow fever and typhus. It was therefore an antipyretic, and an antimalarial drug. [2] [3] [26]
Warburg's Tincture was vaunted as being superior to quinine in the treatment of malaria by many in the Victorian era. Quinine remained the first-line antimalarial drug of choice until the 1940s, when other drugs replaced it. Until recently Chloroquine was the most widely used antimalarial drug. [ citation needed ] Warburg's Tincture was included in Burroughs Wellcome & Company's tabloid medicine cases of the late 19th and early 20th centuries.
"There is now no exact equivalent of Warburg's Tincture ....The most similar modern preparation is ammoniated tincture of quinine. This omits aloes and rhubarb, whose function was a laxative to 'purge' the patient's system, an approach to fever treatment now redundant. Ammoniated tincture of quinine last appeared in the British Pharmaceutical Codex of 1963, but still remains an official preparation that could be prepared if necessary....it was popular as an over the counter medicine for colds until c. 1980, but is now rarely used." [27]
'Warburg's Tincture' was a well-known drug in the Victorian era. [10] [28] [29] It earned itself a well regarded international reputation in certain quarters of the medical profession, many attesting to its efficacy and value. [2] [30] [31]
One of the most notable and strongest advocates of Warburg's Tincture was Surgeon-General W. C. Maclean, C.B, (1811–1898), Professor of Military Medicine at the Army Medical School, at Chatham and later at the Royal Victoria Military Hospital, Netley, from 1860 until 1885. [32] [33] [34] Maclean contributed the chapters on malarial fevers and dysentery in A System of Medicine, edited by Sir John Russell Reynolds (the latter being "an eminent and highly influential physician in the Victorian era who held the Presidencies of the Royal College of Physicians of London, and of the British Medical Association" [35] ). Maclean considered Warburg's Tincture to be the best drug for the treatment of malaria and, in his lectures and writings on tropical diseases, he strongly recommended its use. [3] [36] [37] [38]
" I have treated remittent fevers of every degree of severity contracted in the jungles of the Deccan and the Mysore, at the base of the mountain ranges in India, on the Coromandel Coast, in the pestilential highlands of the northern division of the Madras Presidency, on the malarial rivers of China, and in men brought to [Royal Victoria Military Hospital, Netley] from the swamps of the Gold Coast, and I affirm that I have never seen quinine, when given alone, act in the characteristic of this tincture....I have never seen a single dose of [quinine] given alone, to the extent of nine grains and half, suffice to arrest an exacerbation of remittent fever, much less prevent its recurrence, while nothing is more common than to see the same quantity of the alkaloid in Warburg’s tincture bring about both results. "
- Surgeon-General W. C. Maclean, Professor of Military Medicine at the Army Medical School, Netley - The Lancet , 1875 [3]
In addition to Surgeon-General Maclean, Warburg's Tincture was highly praised by many other eminent medical professionals of the Victorian era, including:
As a consequence of Warburg's Tincture being sold as a secret, proprietary remedy, many in the medical profession, particularly in England, derided, distrusted and dismissed it as a 'patent medicine' or 'quack medicine', and disliked it and criticised Carl Warburg on grounds of professional ethics. [2] [3]
The formula of Warburg's Tincture was disclosed by its inventor in November 1875 when it was published in The Lancet and The Medical Times on his behalf. [3]
Ingredients and directions for preparation
The ingredient list calls for: 4 ounces each of Socotrine aloes, Rhubarb root (East India), Angelica seeds, and Confectio Damocratis (Damocrates' Confection); 2 ounces each of Helenis root (Elecampane root), Saffron, Fennel seeds, and Prepared chalk; and 1 ounce each of Gentian root, Zedoary root, Cubelis (tailed pepper), Myrrh, Camphor, and boletus laricis (Polyporus officinalis, a fungus).
Finally, the articles states:
The above ingredients to be digested with 500 ounces of proof spirit in a water-bath for 12 hours; then expressed and ten ounces of disulphate of quinine added; the mixture to be replaced in the water-bath till all quinine is dissolved. The liquor, when cool, is to be filtered, and is then fit for use.
Warburg's Tincture therefore contained quinine in addition to various purgatives, aromatics and carminatives.
The ingredient "Confectio Damocratis" (Damocrates' Confection) is a complex preparation, sometimes consisting of 46 different ingredients. [43]
The prepared chalk was used to correct the otherwise extremely acrid taste of the tincture.
Dosage
A bottle of Warburg's Tincture contained about one ounce of liquid. The drug was to be administered in two equal doses, a few hours apart.
Malaria is a mosquito-borne infectious disease that affects vertebrates. Human malaria causes symptoms that typically include fever, fatigue, vomiting, and headaches. In severe cases, it can cause jaundice, seizures, coma, or death. Symptoms usually begin 10 to 15 days after being bitten by an infected Anopheles mosquito. If not properly treated, people may have recurrences of the disease months later. In those who have recently survived an infection, reinfection usually causes milder symptoms. This partial resistance disappears over months to years if the person has no continuing exposure to malaria.
Quinine is a medication used to treat malaria and babesiosis. This includes the treatment of malaria due to Plasmodium falciparum that is resistant to chloroquine when artesunate is not available. While sometimes used for nocturnal leg cramps, quinine is not recommended for this purpose due to the risk of serious side effects. It can be taken by mouth or intravenously. Malaria resistance to quinine occurs in certain areas of the world. Quinine is also used as an ingredient in tonic water and other beverages to impart a bitter taste.
Laudanum is a tincture of opium containing approximately 10% powdered opium by weight. Laudanum is prepared by dissolving extracts from the opium poppy in alcohol (ethanol).
Cinchona is a genus of flowering plants in the family Rubiaceae containing at least 23 species of trees and shrubs. All are native to the tropical Andean forests of western South America. A few species are reportedly naturalized in Central America, Jamaica, French Polynesia, Sulawesi, Saint Helena in the South Atlantic, and São Tomé and Príncipe off the coast of tropical Africa, and others have been cultivated in India and Java, where they have formed hybrids.
Tonic water is a carbonated soft drink in which quinine is dissolved. Originally used as a prophylactic against malaria, modern tonic water typically has a significantly lower quinine content and is often more sweetened than the original medicinal form. It is consumed for its distinctive bitter flavor and is frequently used in mixed drinks, particularly in gin and tonic.
Paregoric, or camphorated tincture of opium, also known as tinctura opii camphorata, is a traditional patent medicine known for its antidiarrheal, antitussive, and analgesic properties.
Antimalarial medications or simply antimalarials are a type of antiparasitic chemical agent, often naturally derived, that can be used to treat or to prevent malaria, in the latter case, most often aiming at two susceptible target groups, young children and pregnant women. As of 2018, modern treatments, including for severe malaria, continued to depend on therapies deriving historically from quinine and artesunate, both parenteral (injectable) drugs, expanding from there into the many classes of available modern drugs. Incidence and distribution of the disease is expected to remain high, globally, for many years to come; moreover, known antimalarial drugs have repeatedly been observed to elicit resistance in the malaria parasite—including for combination therapies featuring artemisinin, a drug of last resort, where resistance has now been observed in Southeast Asia. As such, the needs for new antimalarial agents and new strategies of treatment remain important priorities in tropical medicine. As well, despite very positive outcomes from many modern treatments, serious side effects can impact some individuals taking standard doses.
A pharmacopoeia, pharmacopeia, or pharmacopoea, in its modern technical sense, is a book containing directions for the identification of compound medicines, and published by the authority of a government or a medical or pharmaceutical society.
Plasmodium falciparum is a unicellular protozoan parasite of humans, and the deadliest species of Plasmodium that causes malaria in humans. The parasite is transmitted through the bite of a female Anopheles mosquito and causes the disease's most dangerous form, falciparum malaria. It is responsible for around 50% of all malaria cases. P. falciparum is therefore regarded as the deadliest parasite in humans. It is also associated with the development of blood cancer and is classified as a Group 2A (probable) carcinogen.
Blackwater fever is a complication of malaria infection in which red blood cells burst in the bloodstream (hemolysis), releasing hemoglobin directly into the blood vessels and into the urine, frequently leading to kidney failure. The disease was first linked to malaria by the Sierra Leone Creole physician John Farrell Easmon in his 1884 pamphlet entitled The Nature and Treatment of Blackwater Fever. Easmon coined the name "blackwater fever" and was the first to successfully treat such cases following the publication of his pamphlet.
Artemether is a medication used for the treatment of malaria. The injectable form is specifically used for severe malaria rather than quinine. In adults, it may not be as effective as artesunate. It is given by injection in a muscle. It is also available by mouth in combination with lumefantrine, known as artemether/lumefantrine.
Artesunate (AS) is a medication used to treat malaria. The intravenous form is preferred to quinine for severe malaria. Often it is used as part of combination therapy, such as artesunate plus mefloquine. It is not used for the prevention of malaria. Artesunate can be given by injection into a vein, injection into a muscle, by mouth, and by rectum.
Brigadier Sir Neil Hamilton Fairley, was an Australian physician, medical scientist, and army officer who was instrumental in saving thousands of Allied lives from malaria and other diseases.
Artemether/lumefantrine, sold under the trade name Coartem among others, is a combination of the two medications artemether and lumefantrine. It is used to treat malaria caused by Plasmodium falciparum that is not treatable with chloroquine. It is not typically used to prevent malaria. It is taken by mouth.
The history of malaria extends from its prehistoric origin as a zoonotic disease in the primates of Africa through to the 21st century. A widespread and potentially lethal human infectious disease, at its peak malaria infested every continent except Antarctica. Its prevention and treatment have been targeted in science and medicine for hundreds of years. Since the discovery of the Plasmodium parasites which cause it, research attention has focused on their biology as well as that of the mosquitoes which transmit the parasites.
Intermittent preventive therapy or intermittent preventive treatment (IPT) is a public health intervention aimed at treating and preventing malaria episodes in infants (IPTi), children (IPTc), schoolchildren (IPTsc) and pregnant women (IPTp). The intervention builds on two tested malaria control strategies to clear existing parasites and to prevent new infections (prophylaxis).
Carl Warburg, also known as Charles Warburg, was a physician and scientist. He was the inventor of 'Warburg's Tincture', a medicine well known in the 19th century for treating fevers, including malaria.
Project 523 is a code name for a 1967 secret military project of the People's Republic of China to find antimalarial medications. Named after the date the project launched, 23 May, it addressed malaria, an important threat in the Vietnam War. At the behest of Ho Chi Minh, Prime Minister of North Vietnam, Zhou Enlai, the Premier of the People's Republic of China, convinced Mao Zedong, Chairman of the Chinese Communist Party, to start the mass project "to keep [the] allies' troops combat-ready", as the meeting minutes put it. More than 500 Chinese scientists were recruited. The project was divided into three streams. The one for investigating traditional Chinese medicine discovered and led to the development of a class of new antimalarial drugs called artemisinins. Launched during and lasting throughout the Cultural Revolution, Project 523 was officially terminated in 1981.
Pregnancy-associated malaria (PAM) or placental malaria is a presentation of the common illness that is particularly life-threatening to both mother and developing fetus. PAM is caused primarily by infection with Plasmodium falciparum, the most dangerous of the four species of malaria-causing parasites that infect humans. During pregnancy, a woman faces a much higher risk of contracting malaria and of associated complications. Prevention and treatment of malaria are essential components of prenatal care in areas where the parasite is endemic – tropical and subtropical geographic areas. Placental malaria has also been demonstrated to occur in animal models, including in rodent and non-human primate models.
Intermittent fever is a type or pattern of fever in which there is an interval where temperature is elevated for several hours followed by an interval when temperature drops back to normal. This type of fever usually occurs during the course of an infectious disease. Diagnosis of intermittent fever is frequently based on the clinical history but some biological tests like complete blood count and blood culture are also used. In addition radiological investigations like chest X-ray, abdominal ultrasonography can also be used in establishing diagnosis.