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At the outset of the twentieth century the British Medical Association began a campaign against the sale of ‘patent medicines’. Some of these were innocuous tonics or cold cures such as Beecham's pills, but others claimed to cure the incurable including consumption and cancer. The BMA commissioned a chemist to analyse the medicines and cost the ingredients. His results were published in a BMJ series called ‘Secret remedies’. The first articles appeared in 1907, and were such a success that they were reprinted as a book of the same name (Figure 1) in 19091. In editorials the BMJ subsequently noted with annoyance that press reaction had been mixed. The Daily Telegraph and the Manchester Guardian had accepted advertisements, but the Express, Star, Graphic and News of the World had not (and had refused to review the book). A few weeks later the BMA recorded that, despite this ‘conspiracy of silence’, sales were mounting. Altogether 150 000 copies of the book were sold in the UK and the Empire. In 1910-1914 further analyses were published in the BMJ, and More Secret Remedies was published in 1912. The emphasis of the campaign changed and, together with the pharmacists, the BMA successfully lobbied the Government to investigate the matter: a Select Committee on Patent Medicines was set up the same year.
Singled out both in Secret Remedies and in the BMJ articles was ‘Stevens' Consumption Cure’, which was being advertised with a money-back offer: ‘I do not say consumption is curable, but I say if you are consumptive I will guarantee to cure you or return your money in full’. According to the manufacturer the formula was 80 grains of umckaloabo root with 13½ grains of chichitse per ounce prepared according to British Pharmacopoeia methods. According to the BMA's chemist,
‘The medicine was a clear red liquid and analysis showed it to contain in 100 fluid parts, 23.1 alcohol, 1.8 glycerine, and 4 parts solids; about 1 part of tannin and 0.2 part ash. The solid substance agreed in all respects with the solids of decoction of krameria, or a mixture of this decoction with a little kino. The formula thus seems to be: Rectified spirit of wine... 23.7 parts, glycerine 1.8 parts, decoction of krameria (1 in 3) to 100 parts. Or it may be made with a tincture of krameria... estimated cost for 2 fl oz—1½ d’.
Krameria or rhatany root is an astringent still used in herbal and homeopathic remedies.
Stevens had an eventful life. Born in 1880, at age 17 he consulted his doctor in Birmingham with chest symptoms. ‘You're for it my lad’ said the doctor. ‘The only hope is to go to South Africa’. There he was treated by a native doctor called Mike Chichitse (Kijitse) with a brew of umckaloabo root (which made him vomit) and a herb that he later called chichitse. He made a marvellous recovery and returned home cured, but with the idea of using his knowledge to help others.
Back in South Africa, for a short time he ran a motor cycle repair garage (burnt down) and started to develop his ‘cure’ sold locally as ‘Lungsava’ and then ‘Sacco’. He obtained quite a good income from their sale, but returned to England (with supplies of materials) bankrupt in 1907. He offered various explanations for this misfortune: he had given a lot of money and cures away; he had been blackmailed; he had been arrested and fined for providing alcohol to the local population.
By the time Secret Remedies was published Stevens was 29 and CH Stevens Co had been established in London, with the encouragement of several doctors who had been sent free samples of ‘Sacco’ from South Africa. In 1905 The Lancet was very scathing about the remedies: ‘We've heard all this before... we are just waiting for the material from. Mount Ararat left there by Noah’. Truth also gave him a bad review, but quickly changed it when challenged, although by 1908 the cure was on its ‘cautionary list’, saying ‘Stevens has acquired a number of testimonials from medical men, who must now regret their precipitate action.’ He advertised in the press an ‘absolute cure for the white plague’, and in 1908 the company accounts revealed takings of £4415, and £457 spent on basic materials from Dyer and Dyer in Cape Town. He wrote to the Brompton Hospital inviting them to inoculate him with the bacilli of tuberculosis, so he could prove his cure—the only stipulation being that they then administer the cure to their patients at his expense. The reply some months later was (not surprisingly) ‘your offer is of a nature we are unable to accept’.
The BMA kept a worried eye on Stevens and a BMJ editorial (27 August 1910) noted that, following a legal action, the widow of a deceased patient had succeeded in recovering £10 from him. They were pleased to record the judge's comments that the cure was ‘an intentional and well-considered fraud’, that the remedies had not the slightest value and that if Stevens had said it was extract of ‘high-cockalorum-jig-jig-jig’ it would have been equally informative.
The Select Committee interviewed 42 witnesses including the BMA secretary, Dr Alfred Cox, who was asked how many libel suits were pending as a result of publication of Secret Remedies. The answer was one—Stevens versus the BMA, which was fully recorded in the BMJ and also in The Times, in October 1912 and July 1914. Both sides used lawyers, and the trial was held in front of a jury. At the outset Stevens was asked why he had delayed the action so long, and replied that when Secret Remedies first appeared he had not regarded it as a threat, but later he found that every doctor had a copy on his desk, with a second to lend to patients. Reading the proceedings with hindsight it seems that Stevens had a good case, in that he could prove the BMA analysis was incorrect, and he produced both doctors and patients to support his claim for efficacy. Sacks of the root (and chichitse) were produced, to show it really existed and was not just ‘krameria’. Mr E Harrison, the BMA analyst, was asked to taste tinctures of krameria and Stevens cure, and had to admit they were different. He withdrew his description of Stevens as a swindler but maintained he was a ‘quack’. Finally the BMA implied that they never said the cure contained krameria but that it was ‘like krameria’, although a look at the actual analysis makes this a very fine point.
The BMA aimed to discredit Stevens. Why, they asked, had he no shares in the company? Answer: because his bankruptcy prevented him holding any. At this stage, The Times noted, Stevens broke down and wept, saying he had been blackmailed. How much had he repaid on his ‘bonds’? £60 he said, and following publication of Secret Remedies his income had fallen to £2900. While little medical evidence against the cure was presented, Stevens was accused of ‘trapping and lying to vulnerable people’. Stevens' bacteriologist was asked about the correspondence, which was said to number up to a hundred letters a day, making work for five ladies in an attic. Dr Aubrey Latham, a physician from Portland Place, stated for the BMA that there was no known cure for consumption but that 20% of cases recovered spontaneously.
In a final speech Stevens declared that the BMA analysis of his medicine was libellous; producing the sacks of roots, he told the jury they should be grateful he had not produced hundreds of satisfied patients as witnesses. The judge in summing-up reminded the jury of Stevens' News of the World advertisement (15 May 1910), which was misleading in that it looked like a request to participate in an official trial (free), and noted that there were two kinds of quack—the one who believes and the one who does not: it was for the jury to decide into which group Stevens fell. The trial had lasted from 24 to 31 October 1912. After an hour and three-quarters the jury returned to say that, however long they had, they would never agree on a verdict.
In 1913 there was little to report. The Select Committee had a final meeting in June and issued an account of its proceedings, and the BMJ reported on a relevant legal case—Latham versus Stevens. This concerned a Mr Hogson, who had been referred (by Stevens) to Latham for a check-up on his consumptive state. Latham sent Hogson's sputum to the bacteriologist to the Royal Household and duly issued him with a ‘clearance certificate’, without knowing that he had had the Stevens cure. Latham's letter was then reproduced in advertisements that appeared in three newspapers, though Stevens nowhere stated that Latham approved of his cure. The court therefore did not hold Stevens guilty, but he agreed to pay all legal costs.
1914 saw the BMA in the ascendant. The Select Committee Report (891 pages) vindicated Secret Remedies and urged the Government to introduce legislation. Two pages of recommendations included a list of diseases such as cancer and consumption for which remedies of this sort should be banned. Only The Times and the New Statesman mentioned the report. The BMJ noted that the press had an income of two million pounds a year from advertising patent medicines.
The second trial was held from 16 to 23 July 1914, and this time the jury took only 15 minutes to record a verdict in favour of the BMA. Stevens conducted his own case and the BMA had a much stronger argument. The gloves were off. The BMA declared that the ingredients of the product did not appear in the British Pharmacopoeia, and accused Stevens of taking money under false pretences. Professor Bulloch reported laboratory tests showing that Stevens' mixture did not kill tubercle bacteria in ten minutes as claimed—or even in 48 hours.
Stevens called patients to testify, and another witness was a Dr Bennett, recently returned (so he said) from Liberia. Bennett said that umckaloabo, which Stevens had already called by its African name of ‘blood spitting’, grew in Liberia and was called ‘life everlasting’. When asked his role in Liberia he stated he was a ‘commissioner’, adding ‘I could hang you if you committed an offence’. ‘Was this a paid job?’ ‘Yes I was sometimes paid’. This testimony cannot have helped Stevens' case, and it later transpired that the witness was an imposter who had served three jail sentences; the real Dr Bennett was in Australia. The BMA also attacked Dr Lord, Stevens' bacteriologist, suggesting he had been paid 5 shillings a week to address envelopes when not writing slightly misleading documents which were sent out with the medicine bottles. Did Mr Stevens know Lord was now in a Church Army home for dipsomaniacs? Whatever the merits of his case Stevens was routed, and was ordered to pay costs for both sides.
An appeal next year for the case to be reopened was refused. Thus Secret Remedies had won—or so it seemed. War intervened. In 1920 a Bill implementing the recommendations of the Select Committee was prepared in the Lords. However, when a member inquired about the Bill's future, the answer came back... we hope in the next session. Afterwards, vested interests came into play (manufacturers, newspapers), including the Government itself. Duty on the sale of ‘secret medications’ was levied following the ‘Stamp Act’ of 1804 as amended in 1812; in 1908, forty-one million items were stamped, providing £334 141 in revenue (the public spent £3.2 million pounds on the remedies). The tax was doubled during the war, and thereafter Parliament spent more time discussing whether this imposition was fair than in debating the recommendations of the Select Committee. In 1926 the duty raised was £1.34 millions—‘a sum not to be despised in a time like the present’ said the Minister of Health.
Stevens served with distinction in the Royal Flying Corps during the war, ending up as a major. The cure presumably continued in production and the next significant event was publication of The Treatment of Tuberculosis with Umckaloabo (Stevens' Cure)2 by Dr Adrien Sechehaye from Geneva. Originally written in French it was translated into German, Rumanian and English. The English version (Figure 2) was published in 1930 and accounts for my interest, in that I purchased a copy in a Cumbrian bookshop, and on opening it found a letter from the publishers to the editor of the West Cumberland Times, requesting a review. The contents seemed a bit too medical for readers of that newspaper and I wondered what was behind it. Sechehaye, who disclaimed any meeting with Stevens, recounted the history of the cure, and then described how he had used it since 1920. The results in his first patient were so good he had shown her to a meeting of the Geneva Medical Society. Altogether he had treated 800 patients, and wrote in detail about 64. He concluded that, while not infallible, the cure was a definite advance in treatment of tuberculosis. In 1931 a companion book (Figure 3), Tuberculosis, its Treatment and Cure with the Help of Umckaloabo (Stevens)3 was published by ‘An English Physician’ (MRCS, LRCP, 1893) said to be the medical correspondent of a prominent British newspaper. Fifty-five case histories were presented in reasonable detail. All patients were now well, many certified free from tuberculosis; however, none of them had been treated by the author—merely assessed at a single visit. The text is much more readable than Sechehaye's, as might be expected from a journalist. Patients are identified by numbers from 385 to 8332, these presumably being the ‘Stevens’ numbers—in which case the book was probably written at his instigation. By this time production of the ‘cure’ in Wimbledon (Figure 4) was in full swing, employing 50 people occupying three houses, two on Worple Road and a third nearby. A package insert describes three formulations—a lozenge, an extract (with alcohol and glycerine) and capsules of pure ground root; chichitse was no longer listed.
The two books, with a later book and a pamphlet from Sechehaye, were published by B Fraser and Co, of Cottenham Park, London, but in many of the books and advertisements the publisher's address is blacked out. Was it changed? What else did Frasers publish? Internet searches of second-hand book sales reveal only these four. Many copies contain a red label stating where the medicine can be obtained. Sechehaye's book does not seem to have been reviewed in the West Cumberland Times, but my copy of the ‘English Physician’ came together with reprints of articles dated 1931-2 from The Lancaster Guardian, The Nottingham Journal, The Chemist and Druggist of Australia, and Health and Strength, all praising the cure; in one Major Stephens is described as having had a distinguished war career and being ‘well known on the turf’.
Despite opposition from the medical establishment, Stevens and his cure prospered, and he continued to fight for recognition. In The Doom of 150 000 People4 in 1931 the Minister of Health was castigated for allowing ‘condemnation without investigation’. Sir Waldron Smithers MP raised the question of umckaloabo in the Commons, and was told ‘there were insufficient grounds for investigating its value’. He was also on the Committee of Investigation on Treatments of Tuberculosis formed in 1935 following a visit of Sechehaye to London. The cure was mentioned during discussions on a private member's Bill on Medicines and Surgical Appliances (Advertisement) put to the House of Commons in 19365. Captain Elliston cited it as an example of the need for regulation, but had been shaken to receive 1350 letters from strong supporters of the remedy. He asked the secretary of the Joint Tuberculosis Council for a follow-up: of 604 individuals who had received the ‘cure’, 31 were untraceable, 137 had not been notified as having tuberculosis, 122 were working, 115 were ill, 62 were seriously ill and 77 were dead. The Bill did not get a second reading. Stevens was still selling in 1939 and in 1941 was again asking patients to lobby MPs against another threatened Government Bill. Since the cure was still being sold in 1953, this cannot have materialized—so, in the last analysis, he prevailed in his battle with Secret Remedies.
Did the cure work? Sechehaye observed in 1948 that, during the war when supplies were cut off, many patients relapsed6. One former patient whom I have personally encountered gives a very convincing story of being diagnosed after bronchoscopy in the late 1930s at the Hammersmith Hospital, of spending six months in the Colindale Chest Hospital languishing with fever and watching his friends die around him, but then taking the cure for two years (looked like dog biscuits), improving and now having an active and healthy old age; an X-ray taken in 1963 showed old scars of tuberculosis. This individual is critical of the Government's refusal to take up the repeated offers of a trial, and notes that several relevant Government documents (PRO, MH 55/1170, 1171) remain on the Official Secrets list despite being originally scheduled for disclosure in 2002.
‘Google’ currently lists 266 items under umckaloabo. Most relate to a cure for coughs and chest conditions on sale in Germany. The plant has been identified as a Pelargonium species, and modern biochemical analysis reveals coumarins and other chemicals with some antibacterial activity. A team under Dr P Taylor at the London University School of Pharmacy is investigating the antimicrobial activity; some definitely exists, although whether it includes mycobacteria remains to be seen. Sechehaye thought that the drug might be an immunostimulant. Many questions remain unanswered. What were the findings of the Committee of Investigation on Treatments of Tuberculosis? Why did the Minister of Health refuse to investigate? What is in the secret documents? Just how many patients did Stevens treat, and what was the outcome?
I am grateful to Prof J Hamilton Miller and Dr P Taylor for encouragement, and to Mr P Learney and Dr Thomas Dormandy for valuable data.