Chaulmoogra Oil and the Treatment of Leprosy by John Parascandola

Chaulmoogra Oil and the Treatment of Leprosy by John Parascandola* Leprosy is perhaps the most feared, and the most misunderstood, disease in history. Although we have drugs today to control the disease, and we now know that it is one of the least contagious of the infectious diseases, the stigma attached to leprosy has still not been completely erased from the public mind. The connotations associated with the word leprosy have even led to an effort to rename the condition Hansen’s disease, after the man who discovered the bacterial cause of the disease in the nineteenth century. Not surprisingly, many different substances were tried in an effort to treat this disease over the centuries, almost all of them worthless before the introduction of the sulfones in the 1940s. A 1964 monograph on the disease summarized past treatment efforts as follows: “A search of the literature during the past one hundred years or more reveals that almost every type of drug has been used in the attempt to bring about a cure of this disease. Very few remedies advocated during the past thirty or forty years are really new remedies. They have been tried by some workers at one time or another. These remedies include potassium iodide, arsenic, antimony, copper, sera, vaccines, and aniline dyes.”1 A quick perusal of the section on treatment in a 1925 book on the disease allows one to add another batch of failed remedies to the above list, including thymol, strychnine, baths of various kinds, X-rays, radium, and electrical currents.2 The two distinguished authors of this volume then go on to discuss in some detail what they call the “one remedy which has been very generally recognized for many years as of value in leprosy, namely, Chaulmoogra oil.3 Chaulmoogra Oil Enters Western Medicine Chaulmoogra oil entered Western medicine only in the nineteenth century, but it had been used in the East against leprosy and various skin conditions for many hundreds of years. One traditional story concerning the discovery of the use of the oil against leprosy is believed to be based on Burmese folklore. According to this tale, a Burmese prince contracted leprosy and was advised by the gods to withdraw from the world and to go into the forest to meditate. In the woods he was directed by the gods to a tree with a large fruit with many seeds. He was told to eat the seeds, which he did, and was thereupon cured of leprosy.4 Another version of the origins of the oil attributes the discovery to Rama, who was once king of the Indian city of Benares (now Varanasi) but abdicated his throne in favor of his son because he had contracted leprosy. Rama went into isolation in the jungle, where he lived off herbs and roots. He especially ate the fruit and leaves of the Kalaw tree, which cured him of leprosy. Next he met a young woman named Piya, who was living in a cave in the jungle. Piya, an Indian princess, has also been banished to the jungle because she had leprosy. Rama cured her of the disease with the Kalaw, and took her for his wife. The miraculous Kalaw tree, according to the legend, belonged to the genus Hydnocarpus, several species of which are the source of Chaulmoogra oil.5 Whatever we think of this mythical explanation of the origin of the drug, it appears clear that Chaulmoogra oil has a long history in Asia. The oil was long used in traditional Ayurvedic medicine in India for the treatment of leprosy and various skin conditions. It seems to also have been used for the treatment of leprosy in other Asian countries such as China and Burma.6 The oil was introduced into Western medicine by British physician Frederic John Mouat in 1854. Mouat, who came from a family of army surgeons, took his medical degree at 2 Edinburgh in 1839. The following year he entered the Indian Medical Service, where he served for 30 years. From 1841 to 1853, Mouat was professor at the Bengal Medical College, and it was during this period that he first became acquainted with chaulmoogra oil. He had an opportunity to try the remedy himself when he became first Physician to the Medical College Hospital in Calcutta in 1853.7 In an 1854 paper in the Indian Annals of Medical Science, he wrote: “It is with considerable reluctance that I venture to submit for consideration of the profession in India, a few remarks upon the Chaulmoogra, as the opportunities which I have hitherto had of employing it are too few and restricted to enable me to recommend it with the confidence that I could wish. Its success was, however, so remarkable and indisputable in one well-marked case of the worst form of leprosy, that I venture to hope an external application of it to that most loathsome and intractable of diseases, may prove so successful, as to secure the general introduction of the remedy.”8 Mouat notes that the oil comes from the seeds of the fruit of the tree known by the natives as Chaulmoogra. The seeds are beat up with a clarified butter into a soft mass which is used in the treatment of cutaneous diseases. The seeds also yield by expression an oil with a peculiar and slightly unpleasant smell and taste. He goes on to say: “It appears to have been long known to, and prized by the Natives in the treatment of leprosy, and few of the faquirs traveling about the country are unacquainted with its properties. I was first informed of its properties by Mr. Jones, the Headmaster of the Hindoo College, a gentleman of eminent acquirements, who brought it to the notice of other practitioners in this city, and at whose recommendation it was tried at the Leper 3 Asylum, with a favorable result.”9 Mouat decided to try the oil on two cases of leprosy in his ward. He dressed the external ulcers of the patients with the oil, and also gave it to them internally in the form of a pill, made by beating the seeds into a pulp. He reported that the ulcers healed and the patients improved. He believed that the results were sufficiently encouraging to justify further trials.10 He admitted that the remedy required “much more extended employment before any sound judgement can be framed of its modus operandi, and probable value.” He added that his main objective in publishing these “crude notes” was to call the remedy to the attention of the profession. The oil was cheap and readily procurable, and might turn out to be efficient in the treatment of a large “and not unimportant class of cases met with in all Indian hospitals.” In this connection, he mentioned that he had sent a quantity of the oil to a hospital in China and to a hospital in the Mauritius to be tried against leprosy.11 Mouat indicates that the remedy and its use in cutaneous diseases was apparently first described by William Roxburgh under the name of Chaulmoogra odorata. In 1815, Roxburgh, a surgeon and naturalist, published a catalog of the plants in the East India Company’s botanical garden in Calcutta. In this work, he mistakenly identified the seeds of the Kalaw tree, which according to the legend discussed above was a cure for leprosy, as those of the tree Chaulmoogra odorata under a different name.12 The tree, indigenous to East India, was also known under the name of Gynocardia odorata. Throughout the 19th century, Gynocardia was believed to be the source of the seeds used to produce chaulmoogra oil. Then in 1901, Sir David Prain identified the true chaulmoogra seeds of the Calcutta bazaar and of the Paris and London drugs sellers as coming from the tree Taraktogenos kurzii, which grows in Burma and Northeast 4 India.13 It appears that the chaulmoogra oil mentioned in early Ayurvedic texts, and available in South India, was from yet another tree. This tree, known as Tuvakara in Sanskrit, is Hydnocarpus wightiana, and is called “chaulmugra” in Hindu and Persian. It is a close relative of the Taraktogenos tree.14 Chaulmoogra oil was reintroduced as a treatment for leprosy in the Madras Leper Hospital in India in 1874. It had apparently been used there in the first half of the nineteenth century, but then abandoned for some reason. Although the oil continued to find some use, especially in India, it was not until the turn of the twentieth century that the remedy began to receive more attention from the medical profession in Europe and the United States.15 F. B. Power and the Chemistry of Chaulmoogra Although there had been some work in the nineteenth century on the chemical constituents of chaulmoogra, the first comprehensive chemical analysis of the remedy was carried out by Frederick B. Power and his colleagues at the Wellcome Chemical Research Laboratories in London in the first decade of the twentieth century. Power had begun his career as a pharmacist, obtaining his pharmacy degree from the Philadelphia College of Pharmacy in 1874. After working for two years in the Philadelphia pharmacy of Edward Parrish, he went to Germany to undertake graduate studies. In 1880, he received his Ph.D. from the University of Strassburg for a thesis in plant chemistry under the direction of the eminent pharmacognosist Freidrich Flückiger. Upon returning to the United States he served for a year as professor of analytical chemistry at the Philadelphia College of Pharmacy before being called to the University of Wisconsin in 1883 to establish a school of pharmacy there.

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