105: In Which Ned Smokes a Pipe for his Health

Episode 105:  Rent

Rent Party
source:  Starz

The rent party travels through the MacKenzie lands collecting payment and drumming up support for the Jacobite cause. The medical highlights are the 18th century treatment of asthma and more bumps, bruises and lacerations for our Highlanders.

 

Here we meet the lovely Ned Gowan.  Claire and Ned seem to be kindred spirits, recognizing their shared love for the poetry of John Donne.

ned and claire meet
source:  Starz

It becomes clear Ned is suffering from a respiratory ailment with a persistent cough. He explains to Claire that this cough happens every year, in the same season. Ned suspects it is something in the wind that “sets my lungs afire.”

coughing ned
source:  Starz

Claire has just the solution. She prepares Ned a pipe of thornapple to smoke. Ned sees the irony in this but tries it and indeed is relieved of his symptoms.

lighting the pipe 2
source:  Starz

 

Asthma is a lung disease that causes inflammation and narrowing of the airways in the lungs. The airways of asthmatics are sensitive to particular triggers which vary from person to person but can include airborne allergens (pollen, dander, mold, dust mites), respiratory infections, physical activity, cold air, air pollutants, certain medications, and gastric reflux disease.

Asthma_attack-illustration_NIH
Effects of asthma on the airways / source

These triggers cause the airways in the lungs of asthmatics to become constricted and inflamed, and often obstructed with mucous, what we call an asthma attack, characterized by difficulty breathing, cough, wheezing and chest tightness.

Treatment varies based on the severity of symptoms. Depending on the frequency of symptoms, patients will take asthma controller medications to prevent asthma attacks as well as a “rescue inhaler” to use when attacks occur, specifically, a beta-2-selective adrenergic agonist.

inhalers
© Can Stock Photo Inc. / Merinka

In a nutshell, these medications are modified forms of epinephrine, or adrenaline. Adrenaline stimulates receptors in many parts of the body, particularly in the heart, as well as blood vessels in the body, smooth muscles of the body and smooth muscles of the bronchus and bronchioles, which are part of the airways in the lungs. The inhalers used for the symptoms of asthma primarily have their effect on the group of receptors that relax the airways, minimizing the cardiac side effects.

Less available now, epinephrine inhalers like Primatene Mist have been sold over the counter to treat asthma. As they are not specific for the receptors in the lungs, they effect the beta 1 receptors in the heart and the alpha receptors in the blood vessels, leading to elevated blood pressure, tachycardia (fast heart rate), irregular heart rhythm, chest pain and the risk of stroke.

 

Options were limited, though, for our 18th century friends. Claire has indeed provided Ned with something to relieve his symptoms of asthma.

thornapple
source:  Starz

Thornapple, also called Jimson Weed, is actually in the same family of plants as the belladonna that Claire used to reverse the effects of the poison on the young Tammas Baxter (episode 103:  The Way Out).  Thornapple does not have action on the adrenergic receptors like the medications used for asthma attacks today. Rather, its action in relieving asthma is due to atropine which you’ll recall was the active compound in belladonna as well! In this case, atropine causes bronchodilation, or opening of the airways in the lungs, and reduces the production of mucous in the airways by inhibiting a different receptor in the cells. Thornapple acts more strongly on the lungs than belladonna, making it the preferable choice.

450px-Jimson_Weed_(Datura_inoxia),_opening_flower
Thornapple source

Thornapple, or Jimson weed has long been known to help in asthma and respiratory ailments. As recently as the 1950’s, “asthma cigarettes” containing Jimson weed were widely used. However, as an anticholinergic, it also causes dilated pupils, blurred vision, hallucinations, confusion, competitive behavior and difficulty urinating. Severe toxicity can cause coma and seizures. Of late, it has become a concern of public health officials and the DEA as a drug of abuse.

Ned likely suffers from allergic asthma and reacts to an airborne pollen, given that these symptoms always occur each year during the same season. In the book, Claire falls through the stones near Beltane, in May, and the rent party would be traveling in late spring.  In the Starz adaptation, Claire travels back in time near Samhain so now we are deep in autumn.  Despite Claire’s lovely fur-trimmed traveling coat, perhaps we can still assume the Highlands has not yet had its first frost of the season and autumn allergens are still in the air.

 

A very interesting tidbit I came across was that Scotland has the highest allergy rates in the world with 1 in 3 Scots affected by asthma, eczema and allergies! Researchers suspect this is due to low levels of Vitamin D absorbed from the sunlight, particularly during the long winter months. I do wonder, though, whether the 18th Scots would have been affected by the lack of sunlight as much as their 21st century countrymen as the very nature of their day to day life had them outside quite a bit more.

 

Rent collecting continues. Claire is winning the respect of the men. At the last tavern, the MacKenzie men defend Claire’s honor, resulting in 3 split lips, 2 bloody noses, 12 smashed knuckles and 4 loosened teeth. And a partridge in a pear tree? Claire is becoming very experienced in caring for bruised and battered Highlanders.

poor angus
source:  Starz

 

The episode closes with Dougal questioning Claire again about her identity when they are approached by a large group of redcoats. This can’t be good.

 

Resources:

https://www.aacc.org/community/divisions/tdm-and-toxicology/toxin-library/jimson-weed

http://www.australianprescriber.com/magazine/26/2/33/5
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5904a3.htm

http://www.deadiversion.usdoj.gov/drug_chem_info/jimson_w.pdf

http://www.deadlinenews.co.uk/2012/10/26/lack-of-sunlight-could-explain-why-scots-have-worlds-highest-allergy-rate/

http://medplant.nmsu.edu/Diseases/asthma/asthma_JimsonWeed.htm

http://www.ncbi.nlm.nih.gov/m/pubmed/9274142/

http://www.deadlinenews.co.uk/2012/10/26/lack-of-sunlight-could-explain-why-scots-have-worlds-highest-allergy-rate/

Malick, MJ.  (2014).  21st Century Herbal:  A Practical Guide for Healthy Living Using Nature’s Most Powerful Plants.  New York, NY:  Rodale

Orr, S.  (2014).  The New American Herbal.  New York, NY:  Clarkson Potter.

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One thought on “105: In Which Ned Smokes a Pipe for his Health

  1. Pingback: If Mary Poppins Had A Medical Bag – Sassenach Doctor

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