Gwendol Bowling shares some insightful comments about Van Gogh and camphor.

To post-diagnose can lead one down many wrong paths. Given the letters and the paintings as visual evidence, we have ample "facts" to work with. This is currently the only letter online which mentions the camphor. There are a number of other intsances in the 3 Volume printed versions where Vincent mentions this use of camphor. He seems to have had a proclivity toward self-treatment. Given some of the thoughts and practices of the era, he was not necessarily that bizarre in some of his choices of treatment. Below, for general information there is a definition of camphor, along with a portion of a paper from the American Pediatrics Association. There are some excellent references regarding toxicology. It is entirely possible that Vincent suffered from no particular disease, but rather a series of symptoms and reactions to more than one compound. Camphor is noted to be a ketone....one of the simple ketones is acetone. Diabetes tells us that our bodies do not like that by tossing it out in the urine. (I am in no way implying that Vincent was a diabetic....think of poor Theo's kidneys and camphor, though!!) I did locate a reference to camphormania. I will try to research later. The red in the articles below are my highlights.

Physically I am well, the wound is healing very well and the great loss of blood is being made up, because I eat and digest well. What is to be feared most is insomnia, and the doctor has not spoken about it to me, nor have I spoken of it to him either. Bit I am fighting it myself.

I fight this insomnia by a very, very strong dose of camphor in my pillow and mattress, and if you ever can't sleep, I recommend this to you. I was very much afraid of sleeping alone in the house, and I have been afraid I should not be able to sleep. But that is quite over and I dare to think that it will not reappear.

camphor

C10H16O, white, crystalline solid ketone with a characteristic pungent odor and taste. It melts at 176° C and boils at 204° C. The natural variety, Japan camphor, is obtained by steam distillation of the wood of the camphor tree (Cinnamomum camphora) native to China, Japan, and Taiwan (its chief natural source). Since this source is inadequate, camphor is widely synthesized from alpha-pinene, which is obtained from oil of turpentine. Camphor is widely used as a plasticizer in the manufacture of celluloid and some lacquers. It is used in medicine as a stimulant, a diaphoretic, and an inhalant. Camphor ice is a mixture, containing principally camphor and wax, used for external application. Camphor is practically insoluble in water but soluble in alcohol, ether, chloroform, and other solvents. The alcoholic solution is known as spirits of camphor.

Pediatrics Volume 94, Number 1 July 1994, p 127-128

AMERICAN ACADEMY OF PEDIATRICS

Committee on Drugs

This commentary updates a previous AAP statement developed by the Committee on Drugs concerning camphor.

Initial symptoms of camphor toxicity have occurred within 5 to 15 minutes of ingestion. With mild poisoning, gastrointestinal tract effects such as burning of the mouth, nausea, vomiting, and epigastric distress are more frequently reported than neurologic effects.

Severe poisonings are characterized by central nervous system signs of restlessness, excitement, delirium, and seizures. Seizures may be associated with apnea and asystole. Although as much as 42 g of camphor has been ingested by adults who have recovered, the ingestion of 2 g generally produces dangerous effects. In children, ingestions of 0.7 to 1.0 g of camphor have proven fatal. If a product containing 5% camphor is ingested, 20 mL, or 4 teaspoons, is a potentially lethal dose. Death results from respiratory depression (apnea) or complications of status epilepticus.

Every pharmacologically active agent has risks and benefits, and most can potentially cause severe toxic reactions if an inappropriate dose or route of administration is used. The risks of a known toxin such as camphor, however, must be weighed against the potential benefits. Alternative agents exist for all the approved uses of camphor-for topical analgesia and anesthesia, benzocaine and tetracaine agents; for topical antipruritic action, hydrocortisone; and for antitussive effects, multiple oral agents that contain dextromethorphan.

In the recommendation of any therapeutic agent, the following considerations should be entertained: the risks and benefits, the safest agent in the smallest effective dose, and a delivery medium that has the lowest potential for misuse. The potential medical benefits from the use of camphor-containing products pale in comparison to their well-documented toxicity. In 1978, the Committee on Drugs asked in the title of the original statement, "Camphor: Who Needs It?" In 1993, the Committee on Drugs has the same answer as before: no one.

RECOMMENDATIONS

1. In accordance with FDA regulations, over-the-counter drug products may not contain concentrations of camphor which exceed 11%. Despite this ruling, the toxicity of camphor-containing products continues. As part of anticipatory guidance and poison prevention measures, parents should be made aware of common camphor-containing products and the potential dangers of these products.

2. Since alternative therapies exist for all indications for camphor therapy, other therapeutic agents that do not contain camphor should be considered.

COMMITTEE ON DRUGS, 1992-1993
Ralph E. Kauffman, MD, Chairperson
William Banner, Jr, MD, PhD
Cheston M. Berlin, Jr, MD
Jeffrey L. Blumer, PhD, MD
Richard L. Gorman, MD
George H. Lambert, MD
Geraldine S. Wilson, MD

LIAISON REPRESENTATIVES
Donald R. Bennett MD, PhD, American Medical Association
Joseph Mulinare, MD, MSPH, Centers for Disease Control & Prevention
Paul Kaufman, MD, Pharmaceutical Manufacturers' Association
Sam A. Licata, MD, Health Protection Branch, Canada
Paul Tomich, MD, American College of OB/GYN
Gloria Troendle, MD, Food and Drug Administration
Sumner J. Yaffe, MD, National Institutes of Health

AAP SECTION LIAISON
Charles J. Cote, MD, Section on Anesthesiology

CONSULTANT
Anthony R. Temple, MD

REFERENCES

1. Committee on Drugs. Camphor. Who needs it? Pediatrics. 1978;62:404-406
2. Food Drug Administration. Proposed rules: external analgesic drug products for over-the-counter human use; tentative final monograph. Federal Register. 1983;48:5852-5869
3. Ellenhorn MJ, Barceloux DG. Medical Toxicology. Diagnosis and Treatment of Human Poisoning. New York, NY: Elsevier; 1988: chap 22
4. Goldfrank LR, Flomenbaum NE, Lewin NA, Weisman RS, Howland MA. Goldfrank's Toxicologic Emergencies. 4th ed. East Norwalk, Conn: Appleton and Lange; 1990: chap 67
5. Gibson DE, Moore GP, Pfaff JA. Camphor ingestion. Am J Emerg Med. 1989;7:41-43
6. Siegel E, Wason S. Camphor toxicity. Pediatr Clin North Am. 1986;33:375-379
7. Litovitz TL, Normann SA, Veltri JC. 1985 annual report of the American Association of Poison Control Centers national data collection system. Am J Emerg Med. 1986;4:427-458
8. Litovitz TL, Martin TG, Schmitz BF. 1986 annual report of the American Association of Poison Control Centers national data collection system. Am J Emerg Med. 1987;5:405-445
9. Litovitz TL, Schmitz BF, Matyunas N, Martin TG. 1987 annual report of the American Association of Poison Control Centers national data collection systems. Am J Emerg Med. 1988;6:479-515
10. Litovitz TL, Schmitz BF, Holm KC. 1988 annual report of the American Association of Poison Control Centers national data collection system. Am J Emerg Med. 1989;7:495-545
11. Litovitz TL, Schmitz BF, Bailey KM. 1989 annual report of the American Association of Poison Control Centers national data collection system. Am J Emerg Med. 1990;8:394-442

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