Tales told with a spoonful of sugar
Readers may be able to recall the scene in ‘Mary Poppins’ when she administers medicine to her charges. Michael is astonished to discover that the crimson liquid tastes of strawberry ice, whereas for Jane the same bottle yields a lime cordial flavoured silvery green mixture. Mary Poppins’s own dose tastes of rum punch.
Sarah Marshall takes a look at how medicine has featured in some children’s books
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Many consider John Newbery to be the first person to write books for children when he published ‘A little pretty pocket-book’ in 1744. Newbery, a shrewd business man, also sold patent medicines. He advertised his products in his literature, although some of his product placement methods would be inappropriate today.
For example, in his book ‘Little goody two shoes’ the heroine’s father dies of a fever since he is unable to purchase Dr James’s Fever Powder, as sold by Newbery. Thus it can be seen that medicines and children’s literature have been connected since the earliest times.
Several doctors are mentioned in children’s books, with greatly differing characters. Dr Carr (‘What Katy did’, Susan Coolidge 1872), is the epitome of a good country physician, caring deeply about his patients, conscientious and wise. Dr Spencer (‘Danny the champion of the world’, Roald Dahl 1975) is much loved and respected but partial to poaching and punishing patients who mistreat his dog.
Nurses also feature in children’s literature. In the Harry Potter stories, Madam Pomfrey is the magical matron of Hogwarts School of Witchcraft and Wizardry. An independent prescriber, she is able to treat any illness, including disappearing bones, dragon bites, and petrified students. She is highly competent, diligent with her medicine rounds and strict, especially about visiting hours, patient’s privacy and hygiene.
Pharmacists, however, are rarely mentioned in children’s books, with pharmacy premises providing a greater source of inspiration to authors. For example, Mary Poppins finds the gigantic bottles in the windows of the chemist shop particularly satisfactory for admiring her reflection (‘Mary Poppins comes back’, P. L. Travers 1934). And the apothecary shop in Diagon Alley (‘Harry Potter and the philosopher’s stone’, J. K. Rowling 1997), smells of bad eggs and rotten cabbages and sells barrels of suspicious looking materials, as well as products from protected species and unicorns.
Similarly, medicines tend to feature more prominently in stories than their suppliers. Children’s books can give insights into past treatment of minor ailments. For example, Nana, the canine Newfoundland nurse in ‘Peter Pan’ (J. M. Barrie 1928) ties a stocking around the neck of a child with a cough.
Mustard plasters, which were a popular home remedy in the 19th and 20th centuries are mentioned in both ‘The story of Dr Dolittle’ (Hugh Lofting 1920) and ‘Mary Poppins comes back’. A mustard plaster generally comprised ground mustard seeds mixed with flour and then water or egg white. The latter was reputed to minimise the risk of burning. The paste was spread on a piece of linen and this was applied to the affected area.
Mustard plasters were used to treat a diverse range of conditions, from mental illness and pneumonia to pain and bruising. Mustard has a rubefacient action but it contains powerful irritants, such as allyl isothiocyanate, so if applied to the skin for longer than 30 minutes the plasters could cause burning or blistering.
There was a tendency to assume, particularly in Victorian and Edwardian times, that bad behaviour in children could be treated medicinally. When Michael Banks (‘Mary Poppins’, P. L. Travers 1934) decides to spend a day being thoroughly bad, his mother assumes a dose of syrup of figs will sort him out.
In contrast, in Travers’s sequel, Miss Andrew’s remedy for bad behaviour is brimstone and treacle, a popular Victorian laxative and tonic. (Brimstone, a form of sulphur, has been used medicinally since prehistoric times. Sulphur has keratolytic, antiseptic and antifungal properties.)
Tigger’s strengthening medicine
A general dislike of medicine seems common. In ‘Winnie the Pooh’ (A. A. Milne 1926), Kanga gives Extract of Malt to a protesting Roo. Malt extract has been used for many years as a nutritional supplement. Prepared from malted grain of barley, to which malted grain of wheat may be added, it comprises more than 50 per cent maltose, as well as smaller quantities of dextrin, glucose and other carbohydrates and proteins. It has also been used to mask tastes in cod-liver and halibut-liver oil preparations.
When Tigger arrives in the forest this “strengthening medicine” proves to be his favourite food and he has it for breakfast, dinner and tea. The monotonous diet seems to have no deleterious effects on his health. Roo goes on to take his medicine without demure, so obviously Tigger’s example has a positive effect.
In ‘Peter Pan’, non-adherence is crucial to the plot. Michael refuses to take his medicine and his father, Mr Darling, is forced into taking his own “nasty, sticky, sweet” medicine as an example. However he slips it into Nana’s bowl, forcing Nana to drink it.
In his petulance at the family’s reaction to his unkindness and their sympathy for Nana rather than for him, he banishes her from the nursery and, as a consequence, Peter Pan is able to take the children off to Neverland, unhindered.
The story of Peter Pan has proved to be of enduring value to unwell children since, in 1929, J. M. Barrie donated all his rights to royalties from ‘Peter Pan’ to the Great Ormond Street Hospital for Children.
Another much loved children’s author, Roald Dahl, admitted to a fascination with all aspects of medicine, which was evident from both his writing and his legacies. (The Roald Dahl Foundation still gives grants to children with neurological or haematological conditions.)
In Dahl’s ‘George’s marvellous medicine’, (1981) serendipity plays a part in drug discovery. Eight-year old George Kranky lives with his farming parents and grandmother, whom he is suspects is a witch. Left alone to care for her and worn down by her bullying and abuse, he decides to “shake her up a bit”.
George notes that the medicine, which she takes four times daily, does not seem to help her — she is just as horrid after it as before. He muses that “the whole point of medicine, surely, was to make a person better. If it didn’t do that, then it was quite useless.”
Blissfully unaware of the guiding medical principle of primum non nocere (first do no harm) he resolves to make a new medicine either to cure her or to blow off the top of her head. He makes his innovative medicine from household products, including various toiletries, cosmetics, cleaning agents, shoe polish, pungent spices, a bottle of gin, and veterinary medicines, including sheep dip, and various items from the garage, heating up the mixture in an enormous saucepan.
And, because the colour does not match that of Grandma’s medicine, he adds brown paint. He decants his finished product into Grandma’s medicine bottle and cools it under a tap. After being dosed with the liquid Grandma grows uncontrollably, eventually emerging through the roof.
Unusually, George decides to carry out his animal testing after his first trial in humans, giving doses to several farm animals, which grow to enormous proportions. His father immediately sees the potential — they must build a marvellous medicine factory to supply farmers so that worldwide food shortages can be overcome.
George, however, realises he cannot remember all the hundreds of different ingredients in his medicine. (Had he but followed standard operating procedures, an audit trail would have been maintained and all would have been well.) Alas, although George and his father try to reconstruct the process subsequent batches fail to have the same effect.
Clearly, the possibility of medicines captured Dahl’s imagination. In ‘Charlie and the great glass elevator’ (1973) Willy Wonka offers Charlie’s elderly grandparents Wonka-vite, a rapid acting and powerful rejuvenating vitamin, which has taken him a mere 132 days to develop, formulate and test (rather than the usual 13 years or so).
Each pill takes 20 years off a patient’s age and costs about $1m. The price is a reflection of the many exotic ingredients, including four tentacles of a quadropus, two hairs from the head of a hippocampus, and the three feet of a snozzwanger, as well as one ton of chocolate per pill.
The elderly people ignore written and verbal warnings regarding the dose and each take four pills. As a result of the overdose, two revert to babies and Grandma Georgina, who has lost 80 years when she was only aged 78, vanishes into Minusland.
In July this year (2009) reports appeared in the media of a “wonder pill” that could increase lifespan by 20 years. Ironically it too was made of ingredients from an exotic place. The compound is a product of the micro-organism Streptomyces hygroscopicus found in the soil of the remote Easter Island and is named rapamycin after the Polynesian name for the island Rapa Nui.
Also known as sirolimus, this immunosuppressant drug was shown to increase life expectancy significantly when fed to middle-aged and elderly mice. The results give intriguing insights into ageing, although an elixir of life for human consumption is not yet in sight.
Hugh Lofting was another author who looked to future medicines. In ‘The story of Dr Dolittle’, the eponymous hero, who prefers animal to human patients, travels to Africa to treat a strange sickness affecting primates. Arriving he finds a pandemic under way, with many monkeys and apes dead. He immediately separates those who are sick and need nursing from the healthy, whom he vaccinates.
At the time it was published, this story would have resonated with its readers because the Spanish Influenza pandemic, caused by an unusually virulent and deadly strain of H1N1 influenza A, was still in people’s minds. The pandemic was responsible for 50–100 million deaths and although some diseases were preventable by vaccination at this time a vaccine against influenza was not developed until the 1940s.
Pheasants and hookahs
The straightforward taking of medicines does not make for the most scintillating plot (even for a pharmacist’s children) so most children’s books feature their inappropriate use. Although hypnotics are prone to abuse this usually relates to their ability to induce tolerance and dependence rather than unusual applications of the drugs in non-human species.
In ‘Danny the champion of the world’, Danny and his father plan to poach all the pheasants belonging to a wicked local landowner. They prepare sedative-laden raisins, each containing a quarter of a sleeping capsule, basing the dose on the size difference between an adult human and a pheasant.
They succeed in giving the pheasants the raisins, working out that it will take about 30 minutes to work (although Danny, obviously a pharmacist in the making, points out that the duration of action may be different in birds). The plan goes awry when the drug proves less effective than expected and the pheasants wake up.
Drug misuse is also hinted at in ‘Alice’s adventures in Wonderland’ (Lewis Carroll 1865). Written as a whimsical story for Alice Liddell and her sisters, it has also been seen as a satire on Victorian attitudes to children and the moral, educational and legal systems of the time.
In fact, some may be shocked to read this book as adults, when they realise it features drug and child abuse, violence and insanity.
Alice, having followed a white rabbit down a hole, finds a bottle with a paper label around the neck with the words “drink me” on it in large letters.
Having checked that it is not marked “poison” since “if you drink much from a bottle marked ‘poison’ it is almost certain to disagree with you sooner or later” she tastes it. Finding it palatable, she drinks the lot and promptly shrinks to 10 inches high.
Some critics have suggested that the bottle may have contained laudanum: a mixture of opiates with alcohol, also known as opium tincture. Laudanum was particularly valued as an analgesic or antitussive. It was widely available without prescription in Victorian times and cheaper than wine or gin. Unsurprisingly many became addicted and it was only in 1868 that The Pharmacy Act, restricted, for the first time, the sale of a range of poisons, including opium.
Later, Alice encounters a hookah-smoking caterpillar on top of a giant mushroom. The caterpillar is languid and sleepy, suggesting he is smoking an illicit substance, such as opium.
He grumpily advises her to eat the mushroom: “one side will make you grow taller, and the other side will make you grow shorter”. Carroll may have meant this to be a reference to hallucinogenic mushrooms.
Literature specifically for children did not emerge until the mid 18th century. This was in part because, before then, children were not considered entities in their own right, but miniature adults.
Unfortunately, it has taken the pharmaceutical world more than two centuries to catch up with this concept and we are still in the situation where children’s medicines are mostly based on those of adults, and are often not tested in children.
Sarah Marshall is a freelance pharmaceutical writer from Aberdeenshire
Citation: The Pharmaceutical Journal URI: 10989631
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