A brief pictorial and historical introduction to guaiacum – from a putative cure for syphilis to an actual screening method for colorectal cancer

Table of Links

LIGANDS
Heme
β‐haemoglobin

This Table lists key ligands in this article that are hyperlinked to corresponding entries in http://www.guidetopharmacology.org, the common portal for data from the IUPHAR/BPS Guide to PHARMACOLOGY 1.

Having re‐emerged on a global scale during the last few decades, with an estimated incidence in adults of 10.6 million cases in 2008 2, syphilis (Lues venerea), a bacterial infection caused by Treponema pallidum, was first mentioned in European medical writings in the 1490s, as a consequence of the return of Columbus's crew to Europe in 1492 and the later epidemic during the French invasion of Naples in 1495. While the presence of the disease in the Old World prior to Columbus's voyages has long been at the heart of a heated palaeopathological debate 3, reconstructing the historical presentations and evolutionary history of the disease and its treatment can be achieved both via analysis of ancient human remains as well as consultation of literary and artistic sources 4, 5. With respect to the latter, we would like to highlight an engraving by Philip Galle (1537–1612), reproducing the artist Jan van der Straet's (1523–1605) painting, dating back to the late 16th century, of a scene depicting a wealthy man receiving treatment for syphilis by means of Guaiacum officinale (Figure 1). From a pharmacological perspective, this denotes the immense reputation that this plant acquired as a putative cure for syphilis in the course of the 16th century. It was the first drug administered to treat syphilis in Europe, after being first imported in 1508 from the Dominican Republic. Its use became widespread due to its alleged miraculous effects, much discussed by physicians and prominent victims, such as the humanist Ulrich von Hutten (1488–1523) 6. The then widespread belief that remedies could be found where their target diseases originated is likely to have facilitated its entrance into the European pharmacopoeia. Guaiacum treatment requirements were diarrhoea induced by enemas and profuse sweating by resting for 40 days in a dark and hot room, following a strict fasting therapy. Guaiacum was administered externally in ointments and internally in potions. As with other remedies that were not effective in the way they were proclaimed to be, guaiacum eventually fell into disuse. Historical records state that 21 tons of guaiacum reached Seville between 1568 and 1608, while by the 18th century guaiacum imports disappeared from Spanish trade records 7. It was not until 1864, with Izaac Van Deen's (1805–1869) discovery of guaiacum's property of detecting blood in the urine and faeces, by making use of the pseudoperoxidase action of the heme in haemoglobin, which oxidizes guaiac acid to guaiac blue, that its medicinal use was rehabilitated. Today, the guaiac‐based faecal occult blood test (gFOBT) or guaiac test (a modified method according to Greegor) is used for the biochemical detection of macroscopically invisible blood in the stool 8. The newest generation of guaiac tests provides excellent sensitivity and specificity. FOBT screening is currently recommended by most screening guidelines as it has proved to reduce colorectal cancer mortality 9. This shows that even ancient misconceived medications can make their way back into clinical practice eventually contributing to the advancement of medicine.

Figure 1.

Engraving by Philip Galle, after Jan van der Straet's original painting, showing the implementation of guiacum therapy in the 16th century. Image in the public domain (under the following terms https://creativecommons.org/licenses/by/4.0/deed.en) from the Wellcome Library, London: https://wellcomeimages.org/indexplus/image/L0011152.html (last accessed 15 February 2017). No changes were made to the image in this publication

Competing Interests

There are no competing interests to declare.

The authors wish to thank the Mäxi Foundation for supporting this research.

Eppenberger, P. , Galassi, F. , and Rühli, F. (2017) A brief pictorial and historical introduction to guaiacum – from a putative cure for syphilis to an actual screening method for colorectal cancer. Br J Clin Pharmacol, 83: 2118–2119. doi: 10.1111/bcp.13284.