Last week I told the tale of a German forager who mistook Gentiana lutea with Veratrum album – gentian root for white hellbore – with some not so pleasant effects. In describing the pharmacology and toxicology of the two plant species I briefly mentioned that the medicinally useful gentian root is used in the production of the soft drink “Moxie.” So today I thought I’d write a bit about Moxie, as well as a tidbit about Veratrum album and its harmful use in sneezing powders. Yes, sneezing powders.

Patent medicines are commercial products with dubious health benefits and were all the rage in the late 1800’s. These cure-alls claimed to treat or cure any number of illnesses through the use of exotic contents, and the more exotic, the better. Many of the classic patent medicines of this era drew upon Native American, African, and Asian imagery for the sales hook. Some of these liquid medicines contained ingredients that could be beneficial, though dangerous, like infant cough syrups containing opium. One that we all know and love, Coca-Cola, contained coca leaves, a source of cocaine*, and marketed as a nerve tonic. It was a prosperous market to be in.

* Coca-Cola contained cocaine, via coca leaves, up until 1903. Coca leaves are still used today, but with cocaine-free extracts.

Moxie, by Justin Brower

Enter Augustin Thompson. After serving in the Union army during the civil war, Thompson enrolled in Hahnemann Homeopathia College, now known as Drexel University College of Medicine (and we’ll just skip the homeopathic part). Now a physician, he set up shop in Massachusetts and built up one of the largest medical practices in the northeast. Flush with cash to invest, and no doubt seeing the money raked in by dubious patent medicines, he decided to enter the game with a product devoid of what he considered dangerous ingredients, namely alcohol and cocaine, and founded Moxie nerve tonic. The secret ingredient for his tonic, to treat paralysis, nervousness, and insomnia, was the exotic gentian root, sourced from South America. Trademarked in 1885, Moxie was the first bottle carbonated beverage in the United States, beating Coca-Cola (1886) to the punch. We all know how Coca-Cola turned out, but Moxie outsold Coca-Cola up until the 1930s and enjoyed huge, star-studded ad campaigns. Today, however, Moxie is very much a regional drink, and most readily found in the New England area. One could even say it has a cult following, and is the muse for several festivals, and is even the official soft drink of Maine, where Dr. Thompson was born and raised. (see reference 1 for a historical timeline of Moxie)

You all know my love of root beer and how upset I am that a scientist stole it from me, so one might expect I’d have a similar fondness for another root-based soft drink. But I don’t. The bitterness of the gentian root, coming by way of amarogentin, is too much for me. In my mouth, it has a strange, lingering, unpleasant aftertaste. I can’t quite describe it…maybe a combination of black licorice and cough syrup. It’s not for me, but if you ever come across it, try it out, you might become a fan.

A decent amount of my childhood was spent reading old comic books, most of them from the 1960s, 70s, and 80s, and part of the allure were the ads in the back. You could buy anything – plans for a hovercraft, sea monkeys, and x-ray specs (they didn’t work) – provided you had about $2.00, $0.50 for postage and handling, and the patience to wait 6 to 132 weeks for your crap treasure to arrive. A mainstay of these ads were novelty and gag jokes, like whoopie cushions, disappearing ink, joy buzzers, and sneezing powder. I always thought sneezing powder was just black pepper. I mean, that’s how it worked in every cartoon I ever watched, so I was a bit surprised when doing some research on Veratrum album to see sneezing powder pop up.

Comic book ad, via http://cartoonsnap.blogspot.com (copyright unknown)

In 1982 there was an epidemic of pediatric poisonings attributed to sneezing powder. This powder was sold as a gag, and manufactured by a company in Germany for distribution throughout Europe. In Paris, there were a reported 9 intoxications (2) and a combined 7 cases from Denmark, Norway, and Sweden (3). All presented to their emergency department (ED) after ingestion or inhalation of the powder, with a combination of symptoms including nausea, vomiting, GI distress, and the more serious bradycardia (slow heart rate) and hypotension (low blood pressure) – like was seen in the previous post on mistaken identity. Most of the children were given a gastric lavage (the collective roll of ER doctors’ eyes right now might throw the earth off its axis), and atropine to control hypotension. All completely recovered within 24 hours.

Analysis of the sneezy substance revealed the presence of 50% Veratrum album alkaloids and 50% Panama wood. We already know the dangers of Veratrum alkaloids, but panama wood plays a part too. Panama wood (Quillaja saponaria) contains a  variety of saponins that stimulate mucus in the airways, I guess adding to that “wet sneeze” effect. Ewwww. On the plus side, Paris authorities were quick to track down the manufacturer, who changed the formulation immediately. To black pepper and Panama wood. Much better, I guess, but at least it matched the cartoons.

So that’s the bonus material. If you like these little Toxic Tidbits, as I’ve categorized it, let me know. I usually have a lot of these types of things that get left on the cutting room floor.

References:

1. The History of Moxie (https://www.drinkmoxie.com/history)
2. Carlier, P., M.-L. Efthymiou, R. Garnier, J. Hoffelt, and E. Fournier. “Poisoning with Veratrum-containing Sneezing Powders.” Human Toxicology 2.2 (1983): 321-25.
3. Fogh, Anne, Per Kulling, and Elsa Wickstrom. “Veratrum Alkaloids in Sneezing-Powder a Potential Danger.” Journal of Toxicology: Clinical Toxicology 20.2 (1983): 175-79.