Pharmacy’s Twelve Days of Christmas
Sarah Marshall finds the pharmacy in “The 12 days of Christmas”
Sarah Marshall finds the pharmacy in “The 12 days of Christmas”.
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I have fond childhood memories of singing “The 12 days of Christmas” in September. I hasten to add that the occasion was my father climbing the pear tree in our garden to pick the fruit and that my maiden name was Partridge.
The song refers to the festive season from Christmas day until 5 January. It describes a succession of presents given daily by a true love, beginning with a partridge in a pear tree and becoming increasingly extravagant.
Opinions as to the origins of the carol vary. Some regard it as a 16th century English “memory and forfeit” game played on Twelfth night while others view it as a French romantic ballad.
A partridge in a pear tree
Several Partridges are professors in the fields of medicine, pathology or pharmacy. Linda Partridge is the director of the Institute of Healthy Ageing at University College London.
The institute carries out multidisciplinary research into the biology of ageing and ageing related diseases. It has been demonstrated that there are similarities in the way that different organisms age so models, such as fruit flies, nematodes and mice, are being used to conduct experiments to give insights into the ageing process in humans.
Recent laboratory discoveries are that single gene mutations, restricted food intake and changes to the insulin-signalling pathway can prolong life, thus providing potential targets for drugs that can prevent the biological damage that occurs with ageing.
The work of this particular Partridge and her colleagues may lead eventually to the ultimate Christmas gift for us all: a longer and healthier life.
Two turtle doves
The word “dove” has an ancient Germanic origin. However, in modern street language “dove” or “doves” are used as slang for various forms of methylenedioxymethamfetamine (MDMA).
Indeed, many street names for illicit drugs are avian-related.
“Eggs”, for example, has referred to temazepam capsules (before they were withdrawn because addicts were injecting their liquid or gel contents and losing their limbs as a result of ischaemia) and “birds” is the slang term for amobarbital.
Coincidentally, “leapers” (see later) in street parlance describes amphetamines so the innocuous carol could be construed as having darker pharmaceutical connotations.
Three French hens
The French hens featured in the carol were likely to be chickens. The domesticated hen lays eggs until a certain number have accumulated in the nest, so if some are removed it will carry on laying.
Hens’ eggs are used in the preparation of influenza vaccines. The virus is grown in embryonated hens’ eggs, and subsequently inactivated and purified so that it retains its antigenic properties. It takes about six months to produce a vaccine.
Cell culture techniques offer a faster alternative, with more consistent efficacy, quality and purity.
Recently, an influenza vaccine has been licensed which uses a mammalian cell line rather than eggs for antigen production. Cell culture methods are also being developed for generating H5N1 vaccines in the event of an avian influenza pandemic.
This avoids the problems of rapid chick embryo death caused by the virus and a potential shortage of eggs should poultry have to be culled.
Four calling birds
Originally the fourth verse of the carol referred to four colly birds, “colly” meaning as black as coal. Thus the term was an archaic one for blackbirds.
The blackbird is known for its mellifluous song but it also has a strident alarm call when disturbed.
An alarm was raised this year over the stress levels being experienced by pharmacists. A 60 per cent increase in prescription volume in the past decade and pressure to take on new roles and meet associated targets have led to a significant increase in workload.
The Pharmacists’ Defence Association is carrying out an audit to try to quantify the problem. Early results indicate that 78 per cent of pharmacists have reported that they often or always work “intensely”.
A similar proportion commented that they felt under such pressure that they are worried about their patients. Almost a third of respondents have been stressed enough to lose sleep.
Five gold rings
Gold in the form of a wedding band has been used in folk medicine to heal styes, warts, cuts and ringworm and to protect the wearer from epilepsy.
In orthodox medical literature it has been reported that gold wedding rings might delay erosion of adjacent joints in rheumatoid arthritis. Possible mechanisms for this effect include gold molecules passing through skin, mimicking a disease modifying antirheumatic drug, and a mechanical effect, limiting the flow of inflammatory substances.
Gold rings have also been reported to have adverse effects on wearers. In North America, following the 1939–45 war, industrial radioactively contaminated gold was inadvertently used to make jewellery and, decades later, wearers of radioactive gold wedding bands developed dermatitis and malignant lesions on their ring fingers.
Six geese a-laying
Goose grease was used as an ointment for centuries to treat burns, itches and rashes.
Culpeper describes goose grease being used to soften skin, “help gnawing sores, stiffness of the womb, and mitigate pain”. Mixed with turpentine it was used to treat colds and fevers: a forerunner of the decongestant rubs used today.
Older pharmacists may even recall goose fat being smeared upon brown paper, which was then applied to the chest or back as a poultice. Sore throats were cured with a spoonful of goose grease.
Geese may yet prove to have modern day medicinal uses. Antibodies against West Nile virus are being harvested from geese and have been found to cure rodents infected with the virus.
Seven swans a-swimming
I was reminded recently of the old adage regarding the paradox of the swan: calmness and serenity above the water and frantic paddling beneath. In some ways pharmacists are expected to be like this.
Although our traditional white (coat) plumage is no longer compulsory, we are required to remain cool and professional on the exterior while juggling all the demands placed on us.
Britain’s first case of avian influenza occurred when a single swan infected with the highly pathogenic H5N1 strain was found dead on the Scottish coast in April 2006. To date there have been 387 cases in humans worldwide, two thirds of which have proved fatal.
Should the infection reach pandemic proportions pharmacists will need swan-like composure as never before. This year (2008), the Government proposed giving pharmacists extra emergency supply powers during a flu pandemic.
Eight maids a-milking
The milkmaid who has had the greatest influence in medicine was Sarah Nelmes.
She worked in the Gloucestershire village of Berkeley where Edward Jenner — who developed the smallpox vaccine and is regarded as the founder of immunology — practised as a doctor.
Smallpox was widespread in the 18th century and outbreaks led to high mortality, disfigurement or blindness. Jenner noted that infection with cowpox, a relatively mild disease that could be contracted from cattle, seemed to offer protection against smallpox.
In 1796 Sarah Nelmes had fresh cow pox blisters on her hand, which Jenner used to infect eight-year-old James Phipps. The boy became slightly ill but recovered after a few days. Several weeks later, in an experiment that would have had him struck off nowadays, he deliberately inoculated the child with smallpox. James did not contract the disease.
Jenner spent his life promoting smallpox vaccination. It soon became compulsory and vaccination hospitals were established, but not all doctors were as thorough in their methods as Jenner.
Poor medical hygiene, lack of isolation and deliberate contamination of vaccines meant that vaccination was a risky business. In echoes of the controversies of recent years there was an outcry against the procedure, particularly as the disease became less prevalent and the benefit of vaccination less clear.
In 1934, the disease was eliminated from the UK. However it was not until 1980 that the disease was eradicated worldwide. Recently, however, the threat of smallpox as a biological weapon has been highlighted.
In 2007 the Food and Drug Administration approved a new smallpox vaccine that can be produced quickly using cell-culture techniques should it prove necessary.
Nine ladies dancing
The first lady to become a full member of the Pharmaceutical Society was Isabella Clarke Keer in 1879.
Twenty six years later, on on 15 June 1905, as the women’s suffragette movement was getting under way, a group of more than 50 female pharmacists met at her home. Their aim was to start up a trade union-style organisation that represented their interests and worked towards equal pay and better working conditions.
Prevailing attitudes by male pharmacists of the time were that the fairer sex was inferior, weak and liable to blush when faced with intimate issues, such as the use of suppositories.
Women were perceived as a “petticoat peril” threatening the future of pharmacy. In 1905, there were only 195 women on the register, comprising about 1 per cent of the membership. They formed what would become the National Association of Women Pharmacists, a group that is still active in pharmacy to promote the interests of women today.
Women now represent more than 50 per cent of the profession, and the figure is rising. However they are still under-represented in senior pharmacy posts and less active in pharmacy politics than their male colleagues.
One lord who has had an enduring effect on pharmacy was Jesse Boot (1850–1931). He founded Boots The Chemists and was given a peerage in 1929.
He began by taking over his father’s herbalist shop in Goosegate, Nottingham, in 1877 and selling remedies at prices the poor could afford.
The first pharmacist was appointed in 1884. By 1900 there were 181 branches and the company was also manufacturing pharmaceutical products. Now as part of Alliance Boots the company is the dominant pharmaceutical chain in the UK and has more than 110,000 employees, including 5,500 pharmacists.
Another peer seeking to influence pharmacy has been Lord Darzi. The full impact of his NHS next stage review upon the profession remains to be seen.
Eleven pipers piping
Like drums, wind instruments, such as the pipe, have been played all over the world for thousands of years. Early pipes included the shepherd’s pipe and the first flutes were made out of mammoth and swan bone and date back at least 36,000 years.
Asthma patients are often encouraged to take up playing a wind instrument to improve their breathing and there is some evidence to support this.
However, playing a wind instrument may not always prove beneficial and there are reports of a variety of medical problems occurring in wind musicians such as musculoskeletal problems, haemoptysis, diminished pulmonary function, raised intracranial pressure leading to stroke and increased intraocular pressure.
Research has indicated that playing a didgeridoo reduces daytime sleepiness and snoring in people with moderate obstructive sleep apnoea, probably by strengthening muscles in the upper airways.
(For partners of snorers it might not be too late to include a didgeridoo in a letter to Saint Nicholas!)
Twelve drummers drumming
Drums have been played in ancient cultures all over the world since at least 6000BC.
Drum circles are becoming increasingly popular both here and in North America. Participants play, copy and compose rhythms on hand drums and other percussion instruments.
Studies have shown that such recreational music making can reduce burnout and improve mood states in such diverse groups as long-term care workers, nurses and business men.
Reversal of the human stress response has been demonstrated as a consequence of group drumming. This has been linked to modulated natural killer cell activity, reduced gene expression levels of stress induced cytokines and decreased cortisol levels.
Drumming is being used for people with Alzheimer’s disease, cancer patients and autistic children. Drums are also being used by people with Parkinson’s disease and stroke victims to improve muscle control and co-ordination.
Depending on interpretation the singer may receive 78 gifts or 364 if he or she receives the gifts described in each verse each day. Since 1984, the US bank PNC has used the value of the items described in the carol as an economic indicator.
The Christmas Price Index (CPI) calculates the current prices of the gifts given or of hiring the people mentioned, based on figures from zoos, plant nurseries, dance companies and musician’s unions. Originally intended as financial trivia it has been found to track other, more conventional, measures of economic growth.
In 2008, the total cost of all goods and services was at an all time high of US$21,080 (£14,205). The 8.1 per cent leap over 2007 prices was the second largest ever recorded and followed a rise in the minimum wage for unskilled workers (milkmaids) and an increase in the price of swans.
However the value of retail gold has dropped this year as shops try to entice customers in a slowing economy.
I have often mused upon the fantasy gifts I would like to make my professional and personal life easier, should I have a magnanimous and omnipotent true love. My presents would include cures for all malignant conditions, vaccines against HIV, malaria, avian influenza and the common cold (and the “terrible twos”) as well as robust good health for my children.
A spot of peace on earth and goodwill to all would also not go amiss. A little further down on my list is also a new professional body that cares about part-timers. With the reintroduction of the part-time retention fee maybe somebody is listening.
Sarah Marshall is a freelance pharmaceutical writer from Aberdeenshire
Citation: The Pharmaceutical Journal URI: 10043694
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