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Dr Livingstone’s rousers

October 15, 2013
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A miracle cure marketed for malaria – by Martin Duke

Dr David Livingstone. Wellcome Library

Dr David Livingstone. Wellcome Library

What is the story linking ‘Livingstone Rousers’, a pharmaceutical product marketed by Burroughs Wellcome & Co., back to David Livingstone, the heroic 19th-century explorer, missionary and doctor who has become forever associated with the famous four words spoken by Henry Stanley upon meeting him in Africa: “Dr Livingstone, I presume?”

Born on 19 March 1813 in Blantyre, Lanarkshire, Scotland, Livingstone began working in a cotton factory at the age of ten. Taught to read at home, he attended classes after work, and in 1836 entered Andersonian University, Glasgow (also known as Anderson’s University), where he studied medicine for two years. A year spent at the London Missionary Society was followed by the completion of his medical studies in London and by his qualification in November 1840 as a Licentiate of the Faculty of Physicians and Surgeons of Glasgow. He was ordained as a missionary that same month and almost immediately set sail for Cape Town, South Africa.

From that time until his death in 1873, Livingstone devoted himself to exploring southern and central Africa, keeping detailed records of his travels and experiences. On two short return visits to England, his lectures and books were received by the public with enthusiasm similar to that shown towards today’s astronauts. One of the major medical achievements of his life, however, was his remedy for malaria, the illness from which so many died while travelling in Africa at a time when the continent was often referred to as the ‘white man’s grave’.

It was the accepted theory of the time that malaria was caused by breathing poisonous vapours present in the air over swampy locations. The word comes from the Latin ‘malus aria’ and the Italian ‘mala aria’, meaning bad or evil air. During the 17th century, Spanish Jesuit missionaries noticed that Peru’s indigenous Quechua people successfully treated this disorder by chewing the bark of the cinchona tree. The Jesuits brought this remedy back to Europe, although it was not until 1820 that the French chemists Pierre-Joseph Pelletier and Joseph Caventou isolated quinine, the active antimalarial ingredient within the bark.

Later, Livingstone described his plan of treatment for malaria in his well-known publication Narrative of an Expedition to the Zambesi and its Tributaries; and of the Discovery of the Lakes Shirwa and Nyassa, 1858–1864:

A remedy composed of from six to eight grains of resin of jalap, the same of rhubarb, and three each of calomel and quinine, made up into four pills, with tincture of cardamoms, usually relieved all the symptoms in five or six hours. Four pills are a full dose for a man – one will suffice for a woman. They received from our men the name of ‘rousers’, from their efficacy in rousing up even those most prostrated. When their operation is delayed, a dessert-spoonful of Epsom salts should be given. Quinine after or during the operation of the pills, in large doses every two or three hours, until deafness or cinchonism ensued, completed the cure.

Like everyone else at the time, Livingstone was unaware of the life cycle of the mosquito-born parasite responsible for malaria, a discovery that would not be made until several years after his death. And, although familiar with the benefits of quinine in treating this disease, he could not have known how the medication acted upon the parasites within the body. His remedy – large doses of quinine together with the cathartic resin of jalap, rhubarb and calomel – would, he believed, help rid the body of malaria toxins by means of its purging action on the bowels, a commonly accepted practice then in vogue for treating many disorders.

In addition to any discomfort that these appropriately named ‘rousers’ may have caused, his patients would also have experienced symptoms related to cinchonism, a condition produced by the quinine and characterised by ringing in the ears, deafness, headaches, nausea and visual disturbances. Despite this, Livingstone’s treatment worked well. By giving quinine to patients until the signs and symptoms of cinchonism appeared, he had demonstrated that larger amounts of this medication than had previously been used “completed the cure”.

Burroughs Wellcome & Co. marketed the 'Livingstone' medicine chest. Wellcome Library

Burroughs Wellcome & Co. marketed the ‘Livingstone’ medicine chest. Wellcome Library

Livingstone died in 1873 and was buried in Westminster Abbey, recognised for his work in Africa as an explorer, missionary and anti-slavery advocate. Several years later, the pharmaceutical concern of Burroughs Wellcome & Co., founded in 1880 and known for its ‘Tabloid’ trademark and successful marketing techniques, added Livingstone’s name to the impressive roster of well-known explorers (Byrd, Peary, Stanley and others) associated in various ways with its products.

Livingstone’s observations on the treatment of malaria had appeared in medical journals such as the Lancet and the British Medical Journal. In view of this, and of his global reputation, it seemed a good business decision for Burroughs Wellcome to market his remedy. Thus for three or four decades, the catchy name of ‘Livingstone Rousers’ or ‘Rouser’ appeared on the labels of bottles of this Burroughs Wellcome product and in the company’s publication Wellcome’s Excerpta Therapeutica. During these years, the composition of the pills remained unchanged from the original recipe described by Livingstone, although the directions for taking them varied. There was also a line of ‘Livingstone’ medicine chests for travellers – containing, of course, plenty of quinine. Burroughs Wellcome continued to manufacture and sell Livingstone’s medical recipe until the 1920s. After this, Livingstone Rousers, having completed their role as a miracle cure, slipped into medical history to become part of the legendary life of David Livingstone, whose story continues to fascinate us today.

Martin Duke MD is a retired cardiologist from Manchester, Connecticut, USA. His published works include The Development of Medical Techniques and Treatment: From leeches to heart surgery (International Universities Press, 1991), Tales My Stethoscope Told Me (Fithian Press, 1998) and numerous articles on cardiology and medical history. Martin welcomes enquiries at martinsetpoint@yahoo.com.

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