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Monday, May 2, 2016

Dover's Powder

By Verner Stillner, 2001


Dover's Powder, developed and described by the British physician Thomas Dover in 1732, was one of the more popular and enduring of the opium-based medications that were widely used in the United States and Europe prior to the twentieth century. The medication combined Opium with what we know today as ipecac (ipecacuanha), a substance that induces vomiting. The result was a pain-reducing potion that might induce a sense of euphoria but could not be ingested in large quantities because of its emetic properties. Taken as a nonprescription medicine by the general public for over 200 years, it was also prescribed by physicians for home and hospital use. Versions of the preparation are still listed in pharmaceutical formularies in which "Dover's Powder" commonly denotes any opium-based mixture that includes ipecacuanha. The wide use of Dover's Powder declined in the early 1900s largely because of the addiction that resulted from the prolonged use of Opiates, because of the introduction of other nonaddicting Analgesics (painkillers), mainly aspirin, and because of laws regulating sales of opium products.

Thomas Dover (1662-1742) studied medicine at Oxford University in the 1680s. He claimed to have served an apprenticeship with Dr. Thomas Sydenham, the illustrious seventeenth-century practitioner and teacher, who originated the formula for Laudanum, another early and popular opium-based medicine. Dover practiced medicine for over fifty years, although during his lifetime he was more famous for his exploits as an adventurer and privateer. His involvement in the early slave trade and in the plundering of Spanish settlements off the coast of South America brought him fortune and fame. On one of his voyages he found the shipwrecked Alexander Selkirk, who, on being returned to London, created a sensation and was to become the inspiration for Daniel Defoe's Robinson Crusoe. Dover retired from his merchant sailing career a wealthy man, but poor investments led him to resume his medical career first in Gloucestershire and later in London.

In 1732, probably to attract patients to his new practice in London, Dover published An Ancient Physician's Legacy to His Country, one of the earliest medical treatises written for the general public. The book listed forty-two ailments with successful treatments used by Dover, and included the testimonial letters of many "cured" patients. The book enjoyed popular success and was reprinted eight times, the last in 1771, nearly thirty years after his death. One remedy described in the book, the use of mercury, earned him the nickname during his lifetime of the Quicksilver Doctor, but the formula for Dover's Powder, which appears unchanged in all eight editions, has proven to be his most enduring legacy. Appearing on page 18 of the original edition as a treatment for gout, the directions read:

"Take Opium one ounce, Salt-Petre and Tartar vitriolated each four ounces, Ipecacuana one ounce, Liquorish one ounce. Put the Salt Petre and Tartar into a red hot mortar, stirring them with a spoon until they have done flaming. Then powder them very fine; after that slice your opium, grind them into powder, and then mix the other powders with these. Dose from forty to sixty or seventy grains in a glass of white wine Posset going to bed, covering up warm and drinking a quart or three pints of the Posset—Drink while sweating."

Dover's familiarity with opium most probably resulted from his association with Thomas Sydenham and thereby his acquaintance with the benefits of laudanum (an alcoholic tincture of opium). Dover's ingenious use of opium with ipecacuanha seems to have been original. His unique formula, Pulvis Ipecacuanha Compositus, with its specificity of ingredients, produced a relatively reliable and consistent potion in an era when there was no regulation of medications and little standardization in their preparation. Medications could be purchased at apothecary shops with or without doctors' prescriptions or at back-street stores that sold drugs along with food, clothing, and other necessities of life. The major issue at the time in the use of opiate-based medications was not that they contained what we now know to be a Narcotic, but whether the consistency of the formula or the misuse by the patient caused overdoses of what could be poisonous ingredients. Dover's Powder provided a stable product that, because of the ipecacuanha, could not be taken in excess at any one time. The powder came to be trusted by the general public and widely prescribed by physicians. It was considered such a safe remedy that it was even prescribed for children.

Although Dover originated his powder as treatment for gout, it was used throughout the eighteenth and nineteenth centuries along with many other opium-based patent and official preparations by large numbers of people for a wide variety of disorders. Opium, used as a healing plant for over 6,000 years, was an ingredient in countless formulas that were openly available and credited with curing the most common disorders of the time. Mixed in a tincture, it was found in laudanum; in a camphorated formula it became Paregoric; and it was also included in preparations for lozenges, plasters, enemas, liniments, and other general medications.

Opium-based medicines were used for many disorders, including insomnia, diarrhea, bronchitis, tuberculosis, chronic headache, insanity, menstrual disorders, pain, malaria, syphilis, and smallpox. Often both physicians and patients mistook its narcotic properties, which relieved pain and created a sense of well-being, as curative rather than palliative, and little was understood of the darker side of opiate medications—the destructive nature of addiction—until well into the nineteenth century. By this time, it was common for middle- and upper-class people, especially women and those with chronic diseases, to be addicted to opiates that were frequently seen in innocuous health elixirs or in remedies that had been originally prescribed by physicians. Widespread prescribing by physicians and easy availability of the opiate medications made addiction a frequent result of medical therapeutics.

By the middle of the nineteenth century, the issue of opium addiction began to appear with more frequency in the medical literature, and in both the United States and England there were pressures to regulate both the pharmacy trade and the use of narcotic medications, especially the patent medicines containing opiates. Even then, it was not until the end of the century—as a result of better education of physicians and pharmacists, advances in diagnosis and therapeutics, and a growing understanding of the nature of addiction—that opium-based medications were supplanted by other curative treatments and by nonaddictive salicylate analgesics such as aspirin. Opium-based medicines used today, such as Mor-Phine and Codeine, are government-regulated and can be purchased legally only by prescription.

Dover's Powder in its original form is now an obsolete medication. It should be recognized for its place in the history of pharmacology as a relatively reputable medicine used from 1732 until the 1930s, an era in which opium-based medications were one of the few remedies that brought relief to suffering patients. Many of these medications came to be misused by both patients and physicians who had little understanding of addiction and few options for Pain relief. Thomas Dover, seen as an adventurer and opportunist by many during his lifetime, developed a preparation that allowed patients to use a narcotic while limiting its ingestion. More precise knowledge of the healing as well as the addictive properties of narcotics allows modern physicians and pharmacologists to deal specifically with the dosage of narcotic medications. Nevertheless, Dover's Powder, an ingenious and effective solution to a thorny problem, became a household name long after its originator's medical career had ended and his medical treatise had been published.

BIBLIOGRAPHY
Berridge, V., & Edwards, G. (1981). Opium and the people: Opiate use in nineteenth century England. London: Allen Lane.

Boyes, J. H. (1931). Dover's Powder and Robinson Crusoe. New England Journal of Medicine, 204, 440-443.

Courtwright, D. T. (1982). Darkparadise: Opiate addiction in America before 1940. Cambridge, MA: Harvard University Press.

Duke, M. (1985). Thomas Dover—physician, pirate and powder, as seen through the looking glass of the 20th-century physician. Connecticut Medicine, 49, 179-182.

Osler, W. (1896). Thomas Dover, M. B. (of Dover's Powder), physician and buccaneer. Bulletin of the Johns Hopkins Hospital, 7, 1-6.

From: encyclopedia.com


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