Aspirin in Cardiovascular Disease

The Medicinal Use of Salicylates
The first recorded use of salicylates seems to have been by Hippocrates, who, around 400 BC., recommended a brew of leaves from the willow tree (Cortex salicis) for the relief of pain in childbirth. (1) The fact that the active ingredient in these is a salicylate was of course unknown, and Hippocrates made no attempt to define a dose.

Salicylates are widely distributed in plants and many herbal remedies probably depend on their presence. (2)

The attention of chemists seems to have been first drawn to salicylates by the Reverend Edward Stone of Chipping Norton. In 1763 Stone wrote to no less than the President of the Royal Society in London, the most prestigious scientific body in the world at that time. In common with many physicians, Stone believed that alongside many maladies Providence had provided the means for their cure. He was therefore attracted to the willow tree because it flourishes in moist and wet soils and it was in such situations that fevers were then common.

Stone reported how he had used increasing doses of a powder prepared from the bark of the common white willow tree, dried ‘upon the outside of a baker’s oven for more than three months’. He described the effective treatment with this powder of ‘fever in over 50 patients suffering from various agues’. (3)

Salicylic acid seems to have been first synthesised around 1859 by Kolbe in Germany. (4) It was prepared from carbolic acid and was first advertised as a ‘germ killer’. No doubt this recommendation was an expectation based on knowledge of carbolic acid, the use of which in surgery was being popularised by Lister around this time.

It was soon accepted that salicylic acid is of no value as an antiseptic, but its use in the relief of pain and fever continued - despite the fact that it was very irritant to the stomach.

Methyl salicylate occurs in a wide range of plants and is known as ‘oil of wintergreen’. It is still used, incorporated into ointments for joint and muscle pains, but apart from this, neither salicylic acid nor any other plant extract with salicylate is now available in western pharmacies.