Case 122 --
Lash's Bitters: Biochemical Analysis
Ethanol: Lash's Bitters contained large amounts of ethanol. The label on this bottle listed an alcohol content of 21%, approximately the same as sherry. One can see how several doses of Lash's bitters may have made a patient feel better indeed. The ethanol content of another famous bitters, Dr. J. Hostetter's Bitters, was as high as 43%. (1). Abuse of proprietary medicines for their alcohol content was a social and medical problem for large numbers of people who became addicted. For example, one popular and inexpensive medicine was called Peruna and had an alcohol content of 28%. Its widespread abuse led to the term "Peruna drunk" entering the American lexicon. Some proprietary medicine companies even offered medicines that could cure the "Peruna habit". (2)
Even when not abusing a medicine for its ethanol content, patients could inadvertently take in large quantities of alcohol in their attempts to self medicate their illnesses. A physician wrote a letter to the Journal of the American Medical society in 1921 describing a patient with symptoms of liver cirrhosis and Bright's disease (an obsolete and nonspecific term for renal disease) who self medicated himself with 91 bottles of Lash's Bitters over a 36 day period, the equivalent of 20 oz of straight whiskey a day. (6) Manufacturers of proprietary medicines defended the use of ethanol by claiming that it was added to prevent their products from spoiling and freezing. The manufacture of Hostetter's Bitters explained the product "averaging thirty-nine per cent. of alcohol by volume in finished product, being only sufficient to hold in solution the extracted medicinal properties of barks, roots, herbs, and seeds contained therein". (1)
Methanol: We also detected a small amount of methanol. Methanol is metabolized by the same enzymes as ethanol, but results in a different, and very toxic, end product. Methanol is initially oxidized by the liver enzyme alcohol dehydrogenase to formaldehyde. Next, the formaldehyde is oxidized by aldehyde dehydrogenase to produce formic acid. Formic acid can cause serious acidosis and optic neuropathy and can lead to blindness and death. Ironically, the high ethanol content in Lash's Bitters would have provided some measure of protection as the ethanol would have saturated the hepatic enzymes, slowing the metabolism of methanol to formic acid, leading to lower serum concentrations of formic acid (7).
Plant material: Lash's Bitters was advertised as an extract from the bark of the buckthorn tree, Rhamnus purshiana. This prolific tree is found in many parts of the United States and is also known by the name Cascara sagrada or "sacred bark", a name given to it by Spanish priests in California. The laxative effect is due to anthraquinone and its derivative, 1,8-dihydroxyanthraquinone (also known as Danthron) which stimulates Auerbach's plexus, increasing colonic motility. Despite the manufacturer's claims, we did not detect significant levels of either of these compounds in our bottle of Lash's Bitters. We did detect trace amounts of a substance that may represent danthron and are working to further identify this substance.
Rhamnus purshiana is still valued today for its laxative properties and can be found in many herbal remedies. Adverse effects are largely abdominal pain and excessive laxative effect, though large doses can cause nephritis. Renal excretion can also cause the urine to turn reddish brown. Nursing mothers should avoid this laxative as sufficient amounts are secreted in breast milk to affect the baby. (8)
The use of Rhamnus purshiana in Lash's Bitters illustrates the widespread utilization of plant material in proprietary medicines (as well as "ethical drugs"). Many people during this time period believed that God or Nature had provided herbal remedies for various illnesses and, further, had provided clues to a plant's appropriate use. For example, a thistle plant might be useful to relieve a stitch in the side or a walnut extract may benefit a cracked skull. (9) Furthermore, God had placed specific remedies in the very same geographic locations in which the illnesses were found. This point of view contributed greatly to the interest in North American medical botany and also to an interest in Native American herbal medicines. Rhamnus purshiana, for example, was known and utilized by Native Americans for its laxative properties. Unfortunately, Native American knowledge of plants was used less to develop effective medications than it was for marketing purposes. Many medications, such as Kickapoo Indian Cough Cure, exploited the link between Native Americans and herbal medicines. The manufacturers often advertised with incredible stories of the discovery of their cures. The stories typically were variations on a theme in which the proprietor was given a secret Native American medicinal cure in gratitude for an incredible act of bravery on the proprietor's part, acts of bravery which included rescuing children from bears or pretty maidens from a horrible sacrificial death at the hands of an enemy tribe. (4,9)
While it is certainly true that some proprietary medications had medicinal value, most did not. Many proprietary medicines were based on substances of no therapeutic value and many contained harmful substances. In other cases, such as our case, the advertised herb was simply not present, or present in only trace and non-therapeutic amounts. Untold numbers of people suffered as they bought these quack remedies in the hopes of being cured. Meanwhile, fortunes were made by the manufacturers of many of these remedies. (9)
In the midst of this sea of charlatans, there were many proprietors who firmly believed in their medications, however worthless, and were not simply trying to make money. In addition, there were many individuals who did have extensive knowledge of herbs and prepared medicines that helped, and healed, numerous individuals, often providing medical care to those with the least access to conventional medicine, such as rural farmers and poor coal miners. (10)
Sugars and Organic Acids: Numerous other small organic compounds were identified in Lash's Bitters. The major ones were, in descending amounts: lactic acid, 2,3-butandiol, glycerol, succinic acid, mesotartic acid, and many others. It is not possible to know if these many small organic molecules came from plant material, sweeteners, or had other origins, but a number of them are commonly used in the food industry.
Metals: This bottle of Lash's Bitters contained significant levels of lead, with each tablespoon (0.5 oz, about 15 ml) . The label on the bottle suggested a dose of three to four tablespoons. If taken only occasionally and in small doses, the lead level in Lash's Bitters may not have been especially dangerous to an adult. But if taken frequently, or in large doses, acute and/or chronic lead poisoning could have resulted. The lead would have been particularly harmful to children and malnourished individuals.
Glass can be contaminated with lead and we cannot say for certain whether the lead we detected was introduced into the product during the manufacturing process or perhaps leached out from the glass bottle. In any case, it appears that lead that leaches into a liquid from contaminated glass rises rapidly and plateaus within about 10 days. (11) The lead in Lash's Bitters would have been a health hazard regardless of the source.
The interpretation of the lead level in Lash's Bitters needs to be interpeted with some caution as the glass of the bottle may have contained lead that leached out into the bitters.
The iron, zinc, and copper levels in Lash's Bitters would have been of minor nutritional benefit, if any.