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Year : 2020  |  Volume : 11  |  Issue : 5  |  Page : 872-873  

Adverse drug reactions to adverse drug eruptions: A brief historical account from Hammurabi (c. B.C.1810–1750) to Morrow (A.D.1846 -–1913)

Consultant Dermatologist, “Pranab”, Ismile, Asansol, West Bengal, India

Date of Submission10-Apr-2020
Date of Decision04-May-2020
Date of Acceptance22-Jun-2020
Date of Web Publication19-Sep-2020

Correspondence Address:
Amiya K Mukhopadhyay
“Pranab”, Ismile, Near Dharmaraj Mandir, Asansol - 713 301, West Bengal
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/idoj.IDOJ_228_20

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How to cite this article:
Mukhopadhyay AK. Adverse drug reactions to adverse drug eruptions: A brief historical account from Hammurabi (c. B.C.1810–1750) to Morrow (A.D.1846 -–1913). Indian Dermatol Online J 2020;11:872-3

How to cite this URL:
Mukhopadhyay AK. Adverse drug reactions to adverse drug eruptions: A brief historical account from Hammurabi (c. B.C.1810–1750) to Morrow (A.D.1846 -–1913). Indian Dermatol Online J [serial online] 2020 [cited 2021 Oct 23];11:872-3. Available from: https://www.idoj.in/text.asp?2020/11/5/872/295564

   Introduction Top

October 1960.

Kassel, Germany.

At the the 59th meeting of the German Paediatric Society in October 1960, Pfeiffer and Kosenow presented cases of two infants with aplasia of the thumbs, radii, tibiae along with upper lip capillary hemangioma and duodenal stenosis in a paper, Mikrmilie, haemangiom und duodenalstenose. Weidemann noted 13 cases in 10 months. In 1961, Lenz in Germany and McBride in Australia opined that these deformities happened to those babies whose mothers were taking thalidomide for morning sickness. This led to the withdrawal of the so called 'safe' drug (as was promoted by the manufacturer Chemie Grünenthal, Germany) Thalidomide on November 25, 1961. But by that time the world witnessed the tragedy in 46 countries affecting no less than 10,000 newborns![1]

This was a big blow and alerted the medical world about adverse drug reaction (ADR) and a new era of pharmacovigilance began. If one looks back at the history of medicine one can see that the issue of ADR is not new

This small account describesthe early history of ADR encompassing two landmarks: the code of Hammurabi and Morrow's publication of the first book on drug eruptions in 1887.

   an Eye for an Eye Top

The discovery of a huge 2.25-meter tall basalt stele [Figure 1] in 1901 in the acropolis of Susa revealed the first-ever engraved codification of public laws (282 in number) by the order of Hammurabi, the sixth king of first Babylonian dynasty (c.B.C. 1792–1750) for the wellbeing of his people. It was written in Akkadian language in cuneiform scripts (c. B.C.1754).
Figure 1: Hammurabi accepting the royal insignia from the god Shamash, the Babylonian god of justice. The Code of Hammurabi engraved below the relief. (Credit: The Hammurabic Code. A basalt stela inscribed with the Code of Laws of Hammurabi, King of Babylon. Credit: Wellcome Collection.Attribution 4.0 International (CC BY 4.0)

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Among various issues like punishments for different crimes, the subjectof remuneration of a physician for successful treatment and punishment for adverse effects has been described in the Code. Code 218 mentioned:

If a physician operate on a man for a severe wound with a bronze lancet and caused the man's death; or open an abscess (in the eye) with a bronze lancet and destroy the man's eye, they shall cut off his fingers.[2]

This was probably the first mention of the adverse reaction of treatment in history.

   Adr in Otherancient Literatures Top

The medical systems of other ancient civilizations observed about the untoward reactions of treatment. More than 2500 years back Charaka Samhita and Susruta Samhita, the oldest Ayurvedic text cautioned regarding improper patient selection, wrong medicine, and erroneous dosage and situations arose there from. One can find concern about ADR in other ancient systems namely Chinese traditional medicine, Unani, the Japanese system of Kampo as well.[3]

   Modern Era and Morrow Top

Though we get a mention of ADR in Charles Ann Lorry's Tractatus de morbis cutaneis (1777) and Bell described eczema mercuriale in 1796, the first book devoted entirely to ADR Die Nebenwirkungen der Arzneimittel was written by Louis Lewin in 1881. J.J. Mulheron published its English translation as The untoward effects of drugs. A pharmacological and clinical manual in 1883.

The pioneering work of cutaneous manifestations of ADR came from Prince A. Morrow in his treatise Drug Eruptions: A clinical study of the irritant effects of drugs upon the skin in 1887 published by William Wood and Company, New York [Figure 2]. It contained 196 pages with a page of color illustration. The book focused upon definition, pathogenesis, diagnosis, management, and detailed enlisting of ADR of different medicines.[4]
Figure 2: The figure of drug eruptions due to iodide of potassium and the title page of Morrow's Drug eruptions. (Credit: Drug eruptions: a clinical study on the irritant effects of drugs upon the skin. https://creativecommons.org/publicdomain/mark/1.0)

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   Epilogue Top

Since the early days of human civilization, physicians have been revered as a demigod. They are there to fight the evils of diseases armed with their store of remedies. But at times some annoying situation arises in the form ofADR. To avert these undesirable events, pharmacovigilance is the only solution and keen observation of any drug eruption plays the central role. The book Drug Eruptions marks the beginning of the subject and landmark in the history of medicine in general and dermatology in particular.

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Conflicts of interest

There are no conflicts of interest.

   References Top

Lenz W, Knapp K. Foetal malformations due to Thalidomide. Ger Med Mthly 1962;7:253-8.  Back to cited text no. 1
Harper RF. Code of Hammurabi. The king of Babylon. Chicago (English translation): The University of Chicago Press; 1904.  Back to cited text no. 2
Yuan H, Qianqian M, Li Y, Piao G. The traditional medicine and natural medicine from natural products. Molecules 2016;21:559.  Back to cited text no. 3
Morrow PA. Drug Eruptions: A Clinical Study of the Irritant Effects of Drugs Upon the Skin. New York: William Wood and Co.;1887.  Back to cited text no. 4


  [Figure 1], [Figure 2]


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