Page 17 - HCMA Bulletin Spring 2023

A Medical History
Aspirin: From Willow Bark to Wonder Drug
S. Aaron Laden, MD, MBA nedalleumas@yahoo.com
Before plastic pill bottles. Before child-proof caps. Before Tylenol or Motrin. Before tamper-proof seals. There was aspirin.
During my childhood in the 1950’s, I knew of only one pain reliever and fever reducer. It came in a narrow- neck glass bottle or in a flat rectangu- lar tin box, and
it was present in almost every medicine cabinet in America. It was aspirin. Most commonly, it was Bayer aspirin.
Before aspirin? In the dim mists of his- tory, as much as 3500 years ago, there were herbal remedies including a preparation of the bark of the willow tree that was used for pain and fever. This was documented in the famous Ebers Papyrus dating back to about 1500 B.C. that described more than 150 vegetable-based treatments. Willow bark was recorded in ancient Sumeria and Egypt and later in Greece and Rome. Wil- low bark was famously prescribed by Hip- pocrates for pain relief during childbirth. In 1763, the Reverend Edward Stone of Oxfordshire, England studied the effects of willow bark on patients suffering from “aguish,” a febrile illness possibly related to malaria, and found it to be “efficacious in curing aguish and intermitting disorders.”
In 1828, Johann Buchner extracted the active ingredient of willow bark, which he called Salicin. Raffaele Piria then further refined Salicin in 1838 resulting in a more concentrated chemi- cal which he called salicylic acid.
Salicin and salicylic acid had some of the beneficial effects now associated with aspirin such as alleviation of fever and pain and reduction of inflammation, but there were also serious side effects mainly in the form of severe gastric irritation and ulcer formation. Salicylic acid continues to be used, not internally for fever and pain, but as a topical wart remover.
Aspirin (acetylsalicylic acid) does not occur in nature. It is a laboratory synthesized product created by acetylation of salicylic acid. It was first produced in 1897 by Felix Hoffman working for Bayer, a German dye manufacturer turned phar- maceutical company. Aspirin is one of the earliest and most successful examples of laboratory synthesis of pharmaceuticals. The name aspirin is a concocted word derived from the genus for the willow plant: Spyraea modified with the prefix “a” for the added acetyl group.
Initially, aspirin was sold to pharmacists, doctors, and hospitals as a powder and dis- tributed only by prescription. When confronted by compe- tition, Bayer began producing aspirin in pill form with the iconic Bayer “cross” logo.
Aspirin proved to be at least as efficacious as it’s precursors but with a much more favor- able safety profile. Gastric upset was far less pronounced, leading to sensational com- mercial success. Aspirin be- came the most widely used drug in the world.
During the worldwide Spanish Flu pandemic of 1918, aspirin was one of the few ef- fective and readily available
antipyretics and may have played a role in saving thousands of lives.
Beyond the traditional uses of fever reduction and allevia- tion of pain and inflammation, aspirin came to be recognized as valuable in prevention of platelet clumping and was prescribed for prevention of heart attacks and strokes in appropriate indi- viduals.
It was not until 1971 that Dr. John Vane, working at the University of London, published the report of his demonstra- tion that aspirin worked by inhibiting the synthesis of prosta-
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HCMA BULLETIN, Vol 68, No. 4 – Spring 2023
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