212: The Hail Mary
Claire’s amazingly well stocked medical bag seem to be the healer’s equivalent of Mary Poppins’ never ending carpet bag.
Always prepared and ready for anything, Claire has got right at hand the remedy for whatever might be ailing ye! And for the record, this bag is FABULOUS and if anyone knows where I can get my hands on one, please share!
Alex Randall’s condition has worsened significantly and he is dying of tuberculosis (more about TB here). As is sadly becoming a common theme in Outlander, nothing can be done to cure Alex. In fact, prior to the mid-20th century, approximately 80% of people who developed active tuberculosis died of it. All that can be done is to provide comfort and dignity in his final days.
Alex’s tuberculosis has significantly progressed, causing him to have excessive sputum, coughing and wheezing. Claire is able to mitigate his suffering a bit, allowing him to breathe a bit easier. She prepares a pipe of thornapple and coltsfoot, and the smoke of these will provide some relief. We’ve seen her use thornapple before, when Ned Gowan was suffering from asthma. (I do hope we see Ned again, he’s been missed!)
Thornapple, also known as Jimson Weed, acts as a bronchodilator, opening Alex’s constricted airways via the action of atropine as well as reducing mucous production obstructing the flow of air.
The leaf of the coltsfoot plant has been used historically as an inhalant to ease cough and wheezing. Its scientific name is Tussilago fanfara, (tussis – “cough”, ago – “to act on”), very appropriate given its expectorant, antitussive and anti-inflammatory effects.
Smoking various medicinal herbs via pipe, cigarette, or cigar, was indeed an effective historical remedy for the symptoms of lung disease. These often contained Stramonium, aka thornapple!
However, Alex is in such severe distress, he cannot purse his lips and draw breath from a pipe. Ever resourceful, Claire has a solution.
Claire has contrived a way to deliver the medication to Alex, much like an inhaler and spacer. Alex can freely inhale the medicinal smoke without needing to try to take a forceful or deeper breath. And indeed, it seems to provide him some relief.
Claire splits her time between caring for Alex Randall in his final days, and attending to Colum MacKenzie, who continues to suffer debilitating pain from the destructive Toulouse-Lautrec Syndrome.
Claire offers Colum laudanum for pain relief. Colum replies with “Laudanum just dulls the senses. I would prefer something more final.”
What is laudanum?
An alcoholic solution containing opium. Used primarily as a pain reliever. Also used as a cough suppressant and for the treatment of diarrhea. Overdose and death can occur with as little as 3 teaspoons in those unhabituated to opiates.
Colum asks Claire to give him a quick death, like Geillis Duncan gave her husband Arthur. Well, as it turns out, Arthur’s demise wasn’t all that quick. (See the post What Was Ailing Arthur Duncan!) After trying to kill him for months by poisoning him with arsenic, and causing unending gastrointestinal misery, Geillis ultimately dosed Arthur with cyanide and he dies a quick, though agonizing and quite public, death in the Great Hall.
Claire points out that cyanide poisoning would be a terrible way to die and pulls from her well stocked medicine bag a vial, telling him, “This is yellow jasmine. It will be like drifting off into a deep sleep. For when you are ready.”
Well, that sounds like a much better option.
Except for the fact that yellow jasmine might also cause an agonizing death.
Yellow jasmine, or Gelsemium sempervirens, is indeed extremely toxic, but rather than allow one to drift peacefully off to sleep, it suffocates the victim by paralysis:
The symptoms of yellow jasmine toxicity are depressed respiration, tremors, paralysis of the extremities, convulsions, urination, defecation, retching and salivation. In large doses (as Claire gave Colum), it paralyzes the respiratory centers. Large doses paralyze the spinal cord and cause almost complete loss of muscular power. Death is due to asphyxiation.
In order to allow Colum to drift peacefully off to sleep, perhaps Claire has added a very strong sedative? It would have taken A LOT of laudanum to have this effect on Colum, as no doubt he has been taking large doses of laudanum regularly for many many years and is quite habituated to it. But then, she does have that medicine bag of wonders and perhaps is able to whip up something to quickly cause sedation so that the yellow jasmine could take its effect without causing undue distress.
However, this is an interesting excerpt, describing a poisoning with yellow jasmine which does sound like what Claire intended:
Gelsemium in lethal doses paralyzes the nerves, both sensory and motor. The motor nerves are first influenced, the paralysis of sensation more slowly following. The writer observed a case of poisoning where the patient had taken sixty minims of the fluid extract within forty-five minutes. A sensation of general oppression occurred rather suddenly. The patient rose to her feet, noticed that vision had failed almost completely, walked two or three steps, then fell in a mass upon the floor in a state of complete muscular relaxation. There was no alarm or fear, a rather tranquil feeling mentally, and in this case there was no great difficulty of breathing, although we have observed dyspnea from single doses of two or three minims of the fluid extract. The recovery of this patient was rapid, although muscular weakness was present for several days.
From the American Materia Medica, Therapeutics and Pharmacognosy by Finley Ellingwood, MD. 1919. Pages 225-6.
In the end, Colum ended his life on his own terms, and hopefully in the peaceful way Claire intended.
And here is a fun find for those who like quirky historical medicine facts… Enjoy!
Other Applications for Medicinal Smoke?
Interestingly enough, tobacco smoke enemas were actually used in the past for the treatment of a number of different ailments such as gut pain and in the resuscitation of drowning victims. Indeed, it is the origin of the term “blowing smoke up your arse!” Let’s hope Claire doesn’t find a need to explore this modality further!
Dutt, V., Thakur, S., Dhar, V. J., & Sharma, A. (2010). The genus Gelsemium: An update. Pharmacognosy Reviews, 4(8), 185–194. http://doi.org/10.4103/0973-7847.70916
Ellingwood, Finley. (1919). American Materia Medica, Therapeutics and Pharmacognosy. (available to read online here)
Questions, comments, concerns, or suggestions for future Outlander medicine topics? I’d love to hear from you! Leave a comment here, email or find me on twitter @sassenachdoctor