Editorial

The Poultice

RiChaRD h. DaFFneR, mD, FaCR

Apoultice, as defined by the Google English Dictionary is “a soft, moist mass of material, typically of plant material or flour, applied to the body to relieve soreness and inflammation and kept in place with a cloth.” The name derives from the Greek word “poltos”, meaning “porridge.” They are also known as cataplasms. The typical poultice is a moist concoction of herbs, bread, or flour that is typically heated and is spread on an injury, or wound, and held in place with a cloth. Poultices are sometimes known as “plasters.” They have been used as a mainstay of primitive medicine throughout history with various success, particularly in treating muscle and tendon injuries through their counter-irritant properties. Poultices made with moldy bread (penicillium chrysogenum) have been used to treat infected wounds. Poultices were popular medical treatments up until the 1940’s. Today, they are used to treat inflamed legs in horses.

So, why mention this bygone treatment now? The COVID-19 pandemic has spawned many false narratives on the use of hydroxychloroquine, an anti-malarial drug, and ivermectin, a drug used to treat intestinal parasites in farm animals, as potential prophylaxis and treatment for the disease. The main purveyors of these and other conspiracy theories come from the “usual suspects:” QAnon, anti-vaxers, and telehealth companies. So far, scientific trials have shown neither of these drugs to be effective for dealing with the virus. Unfortunately, both have been shown to have serious side effects (cardiac arrythmias with hydroxychloroquine and cardiac, respiratory, and mental problems with ivermectin). So, what does this have to do with poultices?

Decades ago, I read an editorial in a medical journal, the source of which I cannot remember, by a physician who was a medical intern during the 1918 -1919 influenza pandemic. He was treating a young mother who was severely ill with the disease. He and his colleagues had done all they could with the available technology and drugs of the day to try and save their patient. However, nothing seemed to work. The author reported that he told the family that they (the medical team) had done everything medically possible, but the woman’s prognosis was not good. “Have you tried a mustard poultice?” the distraught husband asked. The intern, fresh out of medical school, where he had learned the latest in medical therapy, told the family that the use of mustard poultices for severe pneumonia was an “Old Wives Tale,” and that it would not work. (Today, the family might have attempted to get a court order for the folk treatment.)

As expected, the woman died. The intern, once again, told the family that they had done everything medically possible. “No, you didn’t,” the bereaved husband said. “You didn’t use the mustard poultice. If you had, my wife, the mother of my children would still be alive!”

The case haunted the physician for decades and he wrote that in his heart of hearts he knew (as did his attendings) that the poultice would not have made a difference. However, he also knew, in the eyes of the family, he and his colleagues had not done everything possible. They believed he had killed their loved one.

There is a moral to this story. Folk medicine treatments have been around for as long as humans have been on this planet. Many of them work; most don’t. Many herbal drugs have serious side effects or react with traditional medications. And some have a placebo effect, giving the patient a sense that they are getting better. Author Gerald Green’s 1956 novel, The Last Angry Man, that was made into a movie in 1959, is a story of Dr. Sam Abelman, a testy old general practitioner. In one scene, Dr. Abelman told a young colleague the importance of catering to the patient’s needs. He showed the young physician a machine with brightly flickering lights. “You know what that does?” he asked. “Absolutely nothing. But it impressed the patients, who think it’s helping them.”

The author of the editorial, I remember, echoed the same theme. We are obligated by the Hippocratic Oath to alleviate suffering in our patients. The author concluded that if a folk remedy does not cause any untoward side effects, it should be used, if requested by the patient or his/her family, even though it doesn’t work. Regarding the current pandemic, hydroxychloroquine and ivermectin are not folk remedies, have been shown by credible research to be ineffective, and have serious side effects.

Dr. Daffner is a retired radiologist, who practiced at Allegheny General Hospital for over 30 years. He is Emeritus Clinical Professor of Radiology at Temple University School of Medicine and is an amateur historian.

The opinion expressed in this column is that of the writer and does not necessarily reflect the opinion of the Editorial Board, the Bulletin, or the Allegheny County Medical Society.

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