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A Case, of course
Mr. Cinchona is a 67 year old guy who comes to your clinic for primary care. He is proud that he is on no medications and feels great. Hes never been sick, oh except for the little stroke he had 4 years ago but aside from a little weakness in his fingers, he is back to feeling strong like bull. He says his cholesterol was 160 two years ago. His wife agrees but is also concerned about a polyp he had removed on a colonoscopy he had when he was followed up with screening around the time of his stroke.
The Case
You examine Mr. Cinchona and you find:
Afebrile, 137/92, 88, 14, 98% RA, he is bull like as he almost knocks you over with his arm strength. You also notice he smells like a pack of Marlboros and he admits to having a smokey treat every once in a while.
What can you offer Mr. Cinchona aside from the usual screening that might help keep him healthy? What about aspirin?
What is ASPIRIN?
Ahhh, Molecular Sructures and for those that loved playing with the models in orgo
That is Correct!
History has it
In 1638, Calantha used this product to treat the Countess of Chinchon, wife of the viceroy to Peru who fell ill to a wicked case of malaria. The Jesuits began importing this tree bark back to Europe where it became known as Peruvian or Jesuit bark. Call it what you want Cinchona, Jesuit, Peruvian, whatever it worked and was used for over a century to treat fevers when the active principle was finally isolated it was QUININE.
History rolls on
What does Quinine have to do with aspirin? Good Question. The bitterness of the quinine was the basis for the next chapter in the history of Aspirin. After a few Gin and TONICS (quinine) an English clergyman named Rev. Edward Stone, decided to walk through a marsh and start tasting bark from trees some one needed to be cut off!
Meadowsweet
1831 Johann Pagenstecher, a pharmacist from Berne, had obtained salicylaldehyde by distilling the flowers of meadowsweet, and sent it to a German chemist, Karl Lowig. 1835 Lowig oxidized it to an acid that he called spirsaure later proved to be identical to salicylic acid.
By Chance
Two sources of salicylic acid (meadowsweet and willow bark) were cultivated to keep up with the demand from those patients seeking relief of their fever and pain. Unfortunately though, no pain no gain .
ASPIRIN IS BORN!
1897 August 10th first sample prepared by Hoffman - tries it out on his pops, he loves the stuff for his rheumatism couldnt handle the sodium salicylate. A- Acetylation, SPIR Spiraea ulmaria (meadowsweet), IN thats what they were ending drug names with in those days. 1899 Bayer releases acetyl-salicylic acid in a powder form for medicinal purposes, credits Hoffman with the discovery, patent approved!
Eichengrn Ignored!
He actually narrows the spectrum of salicylic derivatives to find acetylsalicylic the superior form for efficacy and minimal side effects. Hoffman simply follows his instructions in the lab. 1946 - when Hoffman dies and is celebrated for his Aspirin, Eichengrn is forced silent by the Nazi regime. His discoveries of acetylcellulose in the Hall of Honour (chemical section) at the German Museum in Munich, remain uncredited to this day. 1949, the year he died, his letter is released reporting all this it remained largely ignored until the 1990s when many of his claims were verified.
So Back to Bayer
Mass production of ASA! Finally pill form in 1900 as 500mg tablets. Its uses spread like wildfire throughout US and Europe.
Others
1994 Metanalysis shows less DVT/PE. 1997 Aspirin endorsed for preventing migraines. 1999 HAPPY 100th BIRTHDAY ASPIRIN! 2002 Annals of IM metanalysis endorses aspirin use for the primary prevention of ischemic stroke, MI, and cardiovascular death if your Framingham risk is above 5% for 5years.
References:
1. Elwood PC. Aspirin: past, present and future. [Historical Article. Journal Article] Clinical Medicine. 1(2):132-7, 2001 Mar-Apr. 2. Sneader W. The discovery of aspirin: a reappraisal. [Biography. Historical Article. Journal Article] BMJ. 321(7276):1591-4, 2000 Dec 23-30. 3. Manley L. A look back: the wonder drug. [Historical Article. Journal Article] Journal of Emergency Nursing. 26(1):75, 2000 Feb. 4. Anonymous. The discovery of aspirin. [Biography. Historical Article. Journal Article] Nursing Standard. 13(21):33-4, 1999 Feb 1016. 5. http://www.aspirin.com/world_of_aspirin_en.html 6. http://www.bayeraspirin.com/press/factsheets/aspirin_history.pdf