Introduction - Uppsala Monitoring Centre

3. The drug was diluted with an inert substance, e.g. water or chalk, which was
deliberate and affected efficacy. Linguistic references: ‘as different as chalk
and cheese’ – the commercial adulteration of dairy products with chalk, used
to disguise rancidness, to whiten watered-down milk and to increase the
weight of cheeses; ‘sincere’, sans cere (without wax) – Roman bakers’
advertising that their bread was not bulked out with wax.
4. Diluted with an active substance, which was added deliberately and which
affected safety. Some modern Chinese traditional medicines contain modern
drugs such as cortisone and phenylbutazone.
5. Contaminated accidentally and affected safety. In 1902, 19 Punjabi villagers
given an experimental plague vaccine died of a tetanus contaminant (Ross,
1991) and in 1906 an American scientist in the Philippines inoculated 24
prisoners with an experimental cholera vaccine that inadvertently had been
contaminated with plague. 13 of the men died (Chemin et al., 1989).
6. Contaminated deliberately and affected safety, e.g. in 1982 in the US seven
people purchased a bottle of Extra Strength Tylenol (paracetamol), which had
been laced with cyanide. They all died.
Medical philosophies
Presumably ancient physicians or healers tried to balance the benefits of treatment
against its possible adverse effects for each individual patient. In doing so they would
have used the knowledge from their and others’ past experience as to the benefit of
the treatment. However, this would have been tempered by the current medical
philosophy, e.g. one of these philosophies was the Doctrine of Signatures. The main
categories of the doctrine uncovered were: similarity between the substance used
and the human organ; resemblance in shape or behaviour to a specific animal;
correlation between the colour of a substance and the colour of the symptoms;
similarities between the substance and the patient’s symptoms and the use of a
substance that might produce symptoms of a particular disease in a healthy person
to remedy those same symptoms in one who is sick. Put succinctly ‘Every natural
substance which possesses any medicinal virtue, indicated by an obvious and well
marked external character, the disease for which it is a remedy, or the object for
which it should be employed.’ (Paris, 1820). An early philosophy was that disease
was caused by demons and the treatment or preventive measure was to use
incantations and amulets to expel the demon from the body. This was slowly
replaced by the theory that it was that the ill balance of the body humours that
caused diseases and restoring that balance was the aim of all medicines. The idea
that an excess of a humour was the cause of a disease led to the practice of
increasing the excretion and secretion of body fluids via the bodies orifices, hence
purging, sweating, emesis, salivation, blood-letting, etc. Empedocles thought that
there were four elements: water, fire, earth and air. This merged with Hippocrates’