Many afternoons, as I remember it, my mother would get a headache, take a Vincent’s powder and retire to her room for a lie down. Vincent’s, wrapped in flat papers in their trademark blue and yellow box, were a fixture in our home for a number of years – along with red-labelled bottles of Waterbury’s Compound, a box of Disprin and a little bottle of bright yellow acriflavine in the medicine cabinet, next to the Band-aids and the tube of Savlon cream.
Mum had inherited a strong belief in Waterbury’s – a weird mix of alcohol, creosote and other stuff that somehow managed to taste nice – from her mother, and she spooned it into my brother and I almost daily. But her own daily Vincent’s ritual came, she told me, from a girl she used to work with. I got the impression that, in the 1950s and 1960s, taking Vincent’s or Bex powders was just something that people – especially women – did.
Vincent’s and Bex were a class of over-the-counter drug known as “APCs”. That’s because their main ingredients were aspirin, phenacetin and caffeine. It seems the main selling point was the caffeine, or rather the surge of energy that this stimulant could provide. Vincent’s used to advertise widely in magazines and newspapers. The ads were invariably aimed at women, telling them they could have freedom, confidence and health by using “totally safe” APC powders. I certainly remember the radio jingle that advertised the product: “It’s your day, don’t share it with a headache! Vincents helps when you need help with pain.” It has been stated – although I haven’t seen any evidence – that some workplaces supplied the powders to employees free of charge.
Women responded in large numbers and it turned out that, very soon, a significant portion of users found themselves dependent on these little helpers, taking enormous numbers of powders. I don’t think my mother took more than one or two Vincent’s a day and at a certain point, I guess in the 1970s, she quit them. By that time the terrible truth had been revealed: APCs hadn’t been safe after all. The powders had been killing people, right under the noses of medical practitioners who didn’t see the signs.
It was a South African-born doctor, Priscilla Kincaid-Smith, and her doctor husband, Ken Fairley, who discovered the deadly secret of APCs after they came to Australia in 1958. Both highly trained medicos, the pair was surprised at the backwardness of much of Australia’s medical establishment. Dr Fairley easily got an appointment at Royal Melbourne Hospital but Dr Kincaid-Smith was astounded to discover that Australia did not approve of married women in the workforce. In a much-cited interview she said: “I’d been senior registrar and I’d been offered a consultant position at Hammersmith, but when I came to Melbourne nobody wanted me. Married women were unemployable, virtually. In Australia, when women married they lost their jobs. You couldn’t be a married woman and employed in a university or hospital position. So to my absolute amazement and dismay, I was jobless. I did do a bit of research, but I had no status and I had no base or patients or real responsibility for a number of years.” [As a sidelight I might add here that my mother had a similar experience, in that she was obliged to leave her clerical job in 1961 when she became pregnant with me – a fact that rankled with her for the rest of her life.]
Sick kidneys on the autopsy table
In her role as a research assistant, however, Dr Kincaid-Smith was destined to leave an indelible mark. A very capable pathologist with a strong interest in kidneys, she described attending the Alfred Hospital’s autopsy room where, on the table, were “three sets of kidneys with a condition that I’d never seen in six years in London, even although I’d gone to the autopsy room every day”. When she asked about this strange kidney problem she was told it was “papillary necrosis” and that it was common with infections. She knew the condition was rarely seen in London, irrespective of infections, and that these sick kidneys hid some mystery that needed to be solved. In later years Dr (later to be Professor) Kincaid-Smith’s daughter described how her parents loved to share their research findings with each other at home. It was likely this co-operation that helped unlock the mystery of the fatal Australian kidney ailment.
Professor Kincaid-Smith credited her husband with being the first to actually find the crucial clue. He was, she said, extremely thorough in taking patients’ histories, and he discovered that some people with severe kidney failure were addicted to APCs, like Vincent’s and Bex. She explained that, “because some of these patients passed little bits of black material in the urine, I sectioned those and found they were papillae. I realised these were the same things I’d seen on the autopsy table. So that was how the connection first came up, and it followed on from there.”
Some people were heavily addicted to the caffeine-laden powders. According to the Professor: “If you went into the supermarket, every second trolley that you saw people wheeling out would have two great big gross-boxes of Bex or Vincents on top as their week’s supply.” It emerged that many users were taking 30 or 40 powders a day – some much more than that. Because the caffeine was a stimulant, many factories and workplaces supplied the powders to workers free of charge on the basis that productivity would be improved. It was caffeine that made APCs such a perfect product from the sellers’ point of view. Users of the powders would get pounding caffeine-withdrawal headaches that would drive them to take another powder, and then later yet another, and another and another. In some ways the actual pain-killing ingredients, the aspirin and the phenacetin, were somewhat incidental.
Except it turned out that phenacetin in high doses was an effective destroyer of kidneys. It was phenacetin in the APCs that was causing the papillary necrosis in so many of the kidneys appearing on Australian autopsy tables.
Of course, the companies that made the products were not happy to hear this. Nor did they appreciate this upstart female doctor from South Africa taking such pains to spread the word about the link between their highly profitable products and fatal kidney disease. In the event, despite the seemingly clear-cut evidence, it took years for the government to impose controls on the products. The companies hated her, she said, and she believed their wealth and influence had detrimental effects on her career. Once, on a flight to Singapore, she said she overheard a conversation between executives of one of the firms, talking angrily about the impact her work had had on their sales in Australia. In fact, they were en route to Malaysia to find new markets to replace the lost sales in Australia.
In Australia, it appears the Hunter Valley and Newcastle area was a serious hotspot for kidney disease caused by APC abuse, with perhaps the highest rates in the country. I’m told that family doctors commonly recommended APCs to many patients and workers in the coal mining industry were among the worst-affected.
Australia wasn’t the only hot-spot for APC abuse and what became known as “analgesic nephropathy”. Sweden, for example, also had a serious problem.
The Wikipedia page for Vincent’s is an interesting read. The product was created by an Australian doctor, Harry Clayton, who marketed it through a partnership that included pharmacist J.A. Vincent. Vincent sold out of the business, which kept his name as its brand. He evidently regretted the sale in later years, since the product became immensely profitable. According to Wikipedia, Vincent’s took phenacetin out of its formula “some time before 1972” – obviously after the link with kidney disease became undeniable. Phenacetin was banned in the US in 1983 and replaced in many pain-treating formulations by its close relative, paracetamol.
Bex (“a cup of tea, a Bex and a good lie down”) was also an Australian product, created by Beckers Pty Ltd, originally based in South Australia. Its formula was much the same as Vincent’s and so were its effects on peoples’ kidneys.
POSTSCRIPT: It’s worth noting that a new wave of pharmaceutically induced kidney disease may be on the way, with the widely used non-steroidal anti-inflammatories (NSAIDs) implicated in a variety of types of kidney damage.
I remember Waterbury’s Compound. I recall our local GP advising my mother to give it to us children whenever we were not well (1940s). I suspect the alcohol in it was an attraction.
I also remember the woman who lived in our block of flats, her front door opposite ours. She would start the day with an APC and say, “Now I can get on with everything.” No doubt the caffeine.
“A Cup of Tea, a Bex and a Good Lie Down” was the name of a revue at Sydney’s Philip Street Theatre in the 1960’s. By 1970 it became clear that phenacetin caused renal disease, but also cancer of the lining of the urinary tract. This was described by Stuart Taylor, a Urologist at Royal Newcastle Hospital. We saw this problem until the 1990’s by which time it declined because phenacetin had been removed from use some years earlier.
And Waterbury’s Compound! My mother gave me a bottle, and despite the unusual taste I took a dose each day. The bottle broke and the spilt liquid dissolved the varnish on the floor boards. I took this as a warning about what it could do to my stomach.