The fight against rheumatism: from willow bark to COX-1 sparing drugs

Man has been fighting rheumatism for thousands of years. Early therapy began with the use around the world of decoctions or extracts of herbs or plants such as willow bark or leaves. Most or all of these turned out to contain salicylates. The first record was about 3,500 years ago in the Ebers papyrus. Hippocrates, Celsus, Pliny the Elder, Dioscorides and Galen all recommended decoctions containing salicylate for rheumatic pain. A country parson, the Reverend Edward Stone of Chipping Norton in Oxfordshire, made the first "clinical trial" of willow bark (1). He was surprised by its bitter taste, which reminded him of cinchona bark (containing quinine), then being used to treat malaria. He harvested a pound of willow bark, dried it, pulverized it and dispersed it in tea, small beer or water. He found in 50 patients that doses of 1 dram (1.8g) cured their fever. He concluded "I have no other motives for publishing this valuable specific, than that it may have a fair and full trial in all its variety of circumstances and situations, and that the world may reap the benefits accruing from it". Salicylic acid was chemically synthesised in 1860 by Kolbe in Germany and its ready supply led to even more extended usage as an external antiseptic, as an antipyretic and in the treatment of rheumatism.