Introduction - Uppsala Monitoring Centre

4) There was less risk of having an ADR because most medicines were mild herbs,
many without any activity at all and had few adverse effects compared with our
present day synthetic drugs. The drugs, which might affect the cause of illnesses,
were very few, e.g. cinchona bark, mercury. The sudden increase in the
availability of synthetic drugs in the early 20th century meant there would have
been an exponential rise in the numbers of ADRs. In some Asian and African
countries 80% of the population still depend on traditional medicines for primary
health care ( WHO Fact Sheet No. 134, 2008)
3. Recognition
There are several factors that need to be considered before a diagnosis of a druginduced
reaction can be made. Of the various factors that need to be considered
and the one that patients will use is the time to onset of the adverse effect. The
shorter the time between taking the drug and the adverse events the more likely that
the patient/doctor will consider the herb/drug as the cause.
For the doctor the most important factor will be the alternative diagnoses. Even in
Hippocrates’ days there were ‘epidemics of jaundice’ which later was called
‘catarrhal jaundice’ or ‘acute yellow atrophy’ and probably today would be
recognised as viral hepatitis (A, B, etc). The latter was not recognised prior to 1937
and the many cases during World War II stimulated further research. In Hippocrates’
works he gives individual case histories and from these we can appreciate his
thorough examination of the patient, first by interrogation and then by observation.
All the body secretions and excretions were examined. We know, from Laennec,
that Hippocrates listened to the lungs by placing his ear on the chest (Laennec,
1819) and that the latter believed that it fell out of use until the 19 th century. I have
found no record of Hippocrates using palpation of the abdomen. In 1707 Floyer
introduced timing of the pulse rate by a pulse-watch, but the importance of the pulse
had been known since 2,500 BC and Herophilus (c330–260 BC) of Chalcedon had
used a water clock for timing the pulse in 280 BC. The first measurement of blood
pressure by Stephen Hale in a horse required opening an artery and over the next
few years various improvements were discovered, which could be used in man for
routine usage 184 . Although the mercury thermometer was invented in 1709 it wasn’t
until 1865 that the small, efficient clinical thermometer came into practice.
Auenbrugger started using chest percussion for diagnosis in 1761, but it only came
into popular usage in 1808. The discovery that heating urine with acetic acid could
cause it to coagulate, because of the presence of albumin was a great
advancement for the diagnosis of renal disease (Decker, 1694; Cotugno, 1770). In
1816 Laennec introduced the stethoscope. The introduction of the opthalmoscope in
184 Blood pressure measurement see http://www.bloodpressurehistory.com/dates.html. Accessed
15th August 2009