Warburg's tincture was a

pharmaceutical A medication (also called medicament, medicine, pharmaceutical drug, medicinal drug or simply drug) is a drug used to diagnose, cure, treat, or prevent disease. Drug therapy (pharmacotherapy) is an important part of the medical field an ...

drug, now obsolete. It was invented in 1834 by Dr. Carl Warburg. Warburg's

tincture A tincture is typically an extract of plant or animal material dissolved in ethanol (ethyl alcohol). Solvent concentrations of 25–60% are common, but may run as high as 90%.Groot Handboek Geneeskrachtige Planten by Geert Verhelst In chemistr ...

was well known in the

Victorian era In the history of the United Kingdom and the British Empire, the Victorian era was the period of Queen Victoria's reign, from 20 June 1837 until her death on 22 January 1901. The era followed the Georgian period and preceded the Edwardia ...

as a medicine for

fevers Fever, also referred to as pyrexia, is defined as having a temperature above the normal range due to an increase in the body's temperature set point. There is not a single agreed-upon upper limit for normal temperature with sources using val ...

, especially tropical fevers, including malaria. It was considered, by some, to be superior to

quinine Quinine is a medication used to treat malaria and babesiosis. This includes the treatment of malaria due to '' Plasmodium falciparum'' that is resistant to chloroquine when artesunate is not available. While sometimes used for nocturnal le ...

. Warburg's Tincture was a secret, proprietary remedy. The formula was not published until 1875. Later, it was included in the first edition of '' Martindale: The Extra Pharmacopoeia''. Warburg's Tincture included an array of ingredients, including quinine.Warburg, Carl (1870, London), ''Warburg Tincture: Statement proving by numerous official documents its remarkable curative powers in fevers...''''The Lancet'', edition 1875-11-13, 'Professor Maclean, C.B., on the true composition and therapeutic value of Warburg's Tincture', pp. 716–718.

Synonyms

List of alternative names by which Warburg's Tincture was known or referred to: * 'Warburg Tincture' * 'The Warburg Tincture' * 'Warburg's Fever Tincture' * 'Warburg's Fever Tincture and Tonic Medicine' * 'Warburg Fever Tincture and Tonic Medicine' * 'Warburg's Vegetable Fever Tincture' * 'Dr Warburg's Vegetable Fever Drops' Warburg, Carl (1839, London), ''Specific for fever, now first introduced into Europe'', pamphlet * 'Warburg's Vegetable Fever Drops' * 'Dr Warburg's Tincture' * 'Dr Warburg's Fever Tincture' * 'Warburg Drops' * 'Warburg's Drops' * 'Warburg's Fever Drops' * 'Dr Warburg's Fever Drops' * 'Dr Warburg's Drops' * 'Tinctura Warburgi' * 'Tinctura Warburgii' * 'Tinctura antifebrilis Warburgi' * 'Tinctura antifebrilis Warburgii' * 'Tinctura Antiperiodica' * 'Antiperiodica Tincture' * 'Warburg' (informal)

Appearance and format

As its name implies, Warburg's Tincture was originally available only in liquid form. It was deep brown to golden yellow in colour; its taste was bitter and not very palatable. It was sold in small bottles of unique design, containing about one ounce. The label affixed to each bottle bore the registered trademark, which depicted an image of the bottle accompanied by a facsimile of Carl Warburg's signature. By 1888 the drug was available in tablet form.''The British Medical Journal'', edition 1888-12-01, p. 1232

History

Warburg's Tincture was invented by Dr Carl Warburg in 1834, in British Guiana (now Guyana). It was introduced into Europe in 1839.''The medico-chirurgical review and journal of medical science'', Volume 34, p. 658, 1839 Warburg's Tincture received medical trials in British Guiana in the 1830s, and then elsewhere around the world in the 1840s and 1850s. In 1846, Warburg's Tincture was extensively trialled in Austria and, the following year, it was adopted as an official medicine by the

Austrian Empire The Austrian Empire (german: link=no, Kaiserthum Oesterreich, modern spelling , ) was a Central-Eastern European multinational great power from 1804 to 1867, created by proclamation out of the realms of the Habsburgs. During its existence ...

, by imperial order.''Medical Times'', edition, 1851-1-4, pp. 700–702, letter from Carl Warburg Warburg's Tincture was sold as a secret, proprietary medicine for over forty years, and was marketed and manufactured by Carl Warburg for many decades. He wanted the British Government to procure the formula of Warburg's Tincture from him, but such an arrangement never came to fruition. Nevertheless, the British Government was a significant client, procuring Warburg's Tincture for military forces serving overseas in

India India, officially the Republic of India (Hindi: ), is a country in South Asia. It is the seventh-largest country by area, the second-most populous country, and the most populous democracy in the world. Bounded by the Indian Ocean on the so ...

and Ceylon (now Sri Lanka); in Africa, in

Gold Coast Gold Coast may refer to: Places Africa * Gold Coast (region), in West Africa, which was made up of the following colonies, before being established as the independent nation of Ghana: ** Portuguese Gold Coast (Portuguese, 1482–1642) ** Dutch G ...

(now

Ghana Ghana (; tw, Gaana, ee, Gana), officially the Republic of Ghana, is a country in West Africa. It abuts the Gulf of Guinea and the Atlantic Ocean to the south, sharing borders with Ivory Coast in the west, Burkina Faso in the north, and To ...

), Gambia and

Sierra Leone Sierra Leone,)]. officially the Republic of Sierra Leone, is a country on the southwest coast of West Africa. It is bordered by Liberia to the southeast and Guinea surrounds the northern half of the nation. Covering a total area of , Sierr ...

; in the West Indies; and in Cyprus, Corfu, Mauritius and China. In 1867, in the House of Commons of the United Kingdom, Sir Robert Anstruther, 5th Baronet asked the Secretary of War why Warburg's Tincture was not being supplied in larger quantities to troops in India. Writing in 1870, Carl Warburg lamented that his eponymous drug was "comparatively unknown". The formula was disclosed by him in November 1875 when it was published on his behalf in ''The Lancet'' and ''The Medical Times''. In 1855, it retailed at 6s/6d a bottle.

Famous users

Famous Victorian era, Victorians who are documented to have used Warburg's Tincture include: * Captain Sir Richard Francis Burton - explorer and diplomat * General Charles George Gordon of Khartoum - senior army officer and colonial administrator * Dr David Livingstone - missionary and explorer * Dante Gabriel Rossetti - Pre-Raphaelite Brotherhood, Pre-Raphaelite artist.letter from Rossetti to Frederic Shields, dated 1869-8-27 - ''The life and letters of Frederic Shields'

* Frederic Shields - artist and illustrator.

Medicinal uses

Medicinal claims

Warburg's Tincture was promoted by its inventor, Dr Carl Warburg, as a medicine suitable for treating all types of

, but especially tropical fevers, including malaria and yellow fever; and that it could also be used as a Herbal tonic, tonic in debility and convalescence. He claimed that his eponymous tincture was superior to any other antipyretic, including

. "I assert that for perfect safety, for efficacy, rapidity of action, and for economy, my tincture has no rival, nor any approach to it". He also stated that quinine only "relieves", whereas Warburg's Tincture "cures". He advocated that Warburg's Tincture could be employed at all stages of fever, as well as a prophylactic.

19th century

In the Victorian era Warburg's Tincture was principally employed in the treatment of tropical

, including malaria, yellow fever and typhus. It was therefore an antipyretic, and an antimalarial drug.

20th century

Warburg's Tincture was vaunted as being superior to quinine in the treatment of malaria by many in the Victorian era. Quinine remained the first-line antimalarial drug of choice until the 1940s, when other drugs replaced it. Until recently Chloroquine was the most widely used antimalarial drug. Warburg's Tincture was included in Burroughs Wellcome & Company's tabloid medicine cases of the late 19th and early 20th centuries. "There is now no exact equivalent of Warburg's Tincture ....The most similar modern preparation is ammoniated tincture of quinine. This omits aloes and rhubarb, whose function was a laxative to 'purge' the patient's system, an approach to fever treatment now redundant. Ammoniated tincture of quinine last appeared in the ''British Pharmaceutical Codex'' of 1963, but still remains an official preparation that could be prepared if necessary....it was popular as an over the counter medicine for colds until c. 1980, but is now rarely used."

Reputation and efficacy

'Warburg's Tincture' was a well-known drug in the Victorian era. It earned itself a well regarded international reputation in certain quarters of the medical profession, many attesting to its efficacy and value.Dr William Henry Broadbent, article, ''The Practitioner'', edition February 1877, pp.196–202. One of the most notable and strongest advocates of Warburg's Tincture was Surgeon-General W. C. Maclean, C.B, (1811–1898), Professor of Military Medicine at the Army Medical School, at Chatham and later at the Royal Victoria Military Hospital, Netley, from 1860 until 1885. Maclean contributed the chapters on malarial fevers and dysentery in ''A System of Medicine'', edited by Sir John Russell Reynolds (the latter being "an eminent and highly influential physician in the Victorian era who held the Presidencies of the Royal College of Physicians of London, and of the British Medical Association"). Maclean considered Warburg's Tincture to be the best drug for the treatment of malaria and, in his lectures and writings on tropical diseases, he strongly recommended its use. In addition to Surgeon-General Maclean, Warburg's Tincture was highly praised by many other eminent medical professionals of the Victorian era, including: * Sir James Johnson (surgeon and writer), James Johnson M.D. - physician extraordinary to King William IV. * Sir James Clark M.D. - royal physician to Queen Victoria and Albert, Prince Consort, Prince Albert. * Sir William Henry Broadbent, 1st Baronet, M.D. - St Mary's Hospital, London and London Fever Hospital, Physician in Ordinary to Queen Victoria and King Edward VII. ("Warburg’s Tincture has long held a high reputation in India, as a remedy of undoubted and indeed unequalled power in the treatment of the malignant malarial fevers of that country and of cholera. Testimony to its efficacy has come from men whose capability and opportunities of forming an opinion could not be disputed", 1877) * Dr Thomas Southwood Smith - London Fever Hospital, and recognised expert on the treatment of fevers. * Dr Benjamin Guy Babington - Guy's Hospital ("I consider it the most potent anti-intermittent medicine I have ever employed", 1851). * Dr F. C. Skey - St Bartholomew's Hospital, and Professor of Surgery to Royal College of Surgeons of England. * Sir James Gibson, M.D., K.C.B. - Director-General, Army Medical Department, Whitehall, London. * Andrew Halliday (physician), Sir Andrew Halliday, M.D. - Deputy Inspector General of Military Hospitals. * Dr Macgrath - Director-General, Army Medical Department, Madras, India. * Dr Joseph Johann Knolz - head of the civilian medical department of the Austrian Empire. * Dr Rieken - Belgium, physician to Leopold I of Belgium. * Count E Bylandt M.D. - physician to William II of the Netherlands * Dr Salgues - Dijon, France. * Dr Uyttrhoven - Brussels, Belgium.

Detractors, secret remedy

As a consequence of Warburg's Tincture being sold as a secret, proprietary remedy, many in the medical profession, particularly in England, derided, distrusted and dismissed it as a 'patent medicine' or 'quack medicine', and disliked it and criticised Carl Warburg on grounds of professional ethics.

Status, entries in pharmacopoeia, formulary and other pharmaceutical compendia

* Warburg's Tincture was adopted by the Austrian empire as an official medicine in 1847; it was added to the Austrian 'Materia Medica' under the name 'Tinctura Warburgi'. * Warburg's Tincture appeared in the first edition of '' Martindale: The Extra Pharmacopoeia'' (now known as ''Martindale: The complete drug reference'') in 1883, and was included until the 19th edition of 1928. * Warburg's Tincture was included in the National Formulary Section of ''The Dispensatory for the United States of America'' in the 20th edition in 1918, listed under the entry for 'Tinctura Antiperiodica'.''United States Dispensatory'' 20th Edition, p. 1834, 1918, Joseph P. Remington et al. * ''The Pocket Formulary, and synopsis of the British & Foreign pharmacopoeias: comprising standard and approved formulae for the preparation and compounds employed in medical practice'' London, by Henry Beasley. Included in various editions, e.g. 1851 (fifth edition), 1856, 1877. * ''Jahresbericht der Pharmazie'', 1910, Munich, Germany. * Warburg's Tincture is now obsolete as a medicinal drug. It last appeared in the Martindale: The Extra Pharmacopoeia in 1928.

Properties / formula

The formula of Warburg's Tincture was disclosed by its inventor in November 1875 when it was published in ''The Lancet'' and ''The Medical Times and Gazette, The Medical Times'' on his behalf - see below. Ingredients and directions for preparation Warburg's Tincture therefore contained quinine in addition to various purgatives, Aroma compound, aromatics and carminatives. The ingredient Confection Damocratric is a complex preparation which has not been obtainable for over a century; it contained many different aromatic substances. The prepared chalk was used to correct the otherwise extremely acrid taste of the tincture. Dosage A bottle of Warburg's Tincture contained about one ounce of liquid. The drug was to be administered in two equal doses, a few hours apart.