Mr Willoughby’s Healthy Balls

Outlander Science Club

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A Dram of Outlander Voyager Read-Along
Chapters 25-26

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This week’s installment of Outlander Science Club is inspired by Mr. Willoughby and his healthy balls. Ahem. No, not those. We are discussing Mr. Willoughby’s hangover remedy, Chinese Medicine Balls. (Need a refresher on the science behind hangovers? Check out this post from season one!)

Mr. Willoughby suffers from a hangover and an intense headache, and Claire apologizes, telling him she doesn’t have any medicines with her to help. He assures her he will be just fine because he has healthy balls.

Huh? Hold on a minute. Did we all miss the lecture in medical school discussing the connection between testicular health and headache?

Claire comes to learn that Mr. Willoughby is referring to a pair of jade spheres, “larger than marbles and smaller than baseballs,” – Chinese Medicine Balls or Baoding Balls.

baoding-balls
Photo: Wikipedia Commons

Baoding Balls are thought to have likely first originated in China during the Ming Dynasty (1368-1644). Initially made of iron, they came to be made from varied materials including steel and tungsten, and stones such as jade, agate and marble. Many contain a chime that rings as the balls are moved.

Both balls are held in the palm and rotated, initially maintaining constant contact, and eventually rotating without contacting each other at all as hand strength improves.

Health benefits attributed to the use of Baoding Balls:

  • improved strength and dexterity of the hand muscles
  • improved brain function and reduced stress
  • improved circulation in the body
  • relief of the pain and stiffness of arthritis
  • decreased blood pressure
  • increased energy levels
  • improved concentration

Mr. Willoughby found relief from hangovers by using the Baoding balls. An accupressure point called Joining the Valley is located on the hand in the web space between the thumb and index finger. Stimulation of this point is thought to relieve pain, especially frontal headaches related to hangovers.

In addtion to using the Baoding balls, Mr. Willoughby likely applied other remedies of Traditional Chinese Medicine, including the use of herbs:

  • Cayenne to reduce pain and improve blood flow
  • Meadowsweet for its anti-inflammatory properties
  • Chamomile for relaxation
  • Valerian for sedation (a favorite of Claire’s)
  • Chrysanthemum or Yarrow to soothe the liver

What else could Mr. Willoughby have tried? A quick search for Hangover Cures yields all sorts of remedies, some more appetizing than others…

Outlander Science Club encourages responsible drinking. These remedies are presented for your entertainment and general education and is not intended as medical advice!

 

Poland

pickles
Photo:  Wikipedia Commons

Drinking pickle juice or eating sauerkraut – the high sodium content is thought to replenish electrolytes

 

 

 

 

 

Ecuador

800px-oregano_1
Photo: Wikipedia Commons

Oregano tea to settle the stomach

 

 

 

 

 

South Korea

korean_soup-bogeo_haejangguk-01
Photo: Wikipedia Commons

Haejangguk, “a soup to chase a hangover,” containing dried napa cabbage, vegetables, beef broth and congealed ox blood. Said to soothe the stomach.

 

 

Japan

umeboshi
Photo: Wikipedia Commons

Pickled ume fruit, very sour in taste, is thought to help digestion and liver function and to prevent nausea.

 

 

 

Germany

fischbro%cc%88tchen
Photo: Public Domain

Rollmops – Raw pickled herring wrapped around pieces of gherkin and onion, thought to restore electrolytes.

 

 

 

USA

prairie_oyster_
Photo: Wikipedia Commons

The Prairie Oyster – a whole raw egg with hot sauce, salt, pepper and a few dashes of Worcestershire sauce, the thinking being that the spices will combat the alcohol toxins and the egg provides nutrients.

 

 

 

 

Haiti

doll_with_pins_in_it_museum_of_witchcraft
Photo: Public Domain

“Curse the Bottle” – stick 13 black headed pins into the cork of a bottle to curse the sickness that the bottle is attempting to curse you with!

 

 

 

 

 

Italy

linea_doubleespresso
Photo: Public Domain

Several cups of strong espresso to provide caffeine for headache relief.

 

 

 

 

 

 

Mongolia

1280px-tomato_juice
Photo: Wikipedia Commons

Tomato juice and pickled sheep eyes. Likely some hydration and electrolytes from tomato juice but it is unclear what the sheep eyes provide!

 

 

 

Bangladesh

coconut_drink_pangandaran
Photo: Wikipedia Commons

Coconut water provides hydration as well as a supply of potassium, magnesium and antioxidants

 

 

 

 

Las Vegas, Nevada

450px-intravenuos_administration
Photo: Wikipedia Commons

Mobile hangover cure buses (and house calls) providing IV fluids, vitamins, and medications for nausea, pain and inflammation.

 

 

 

 

 

 

And my personal favorite, Eggs Benedict.

eggs_benedict
Photo: Wikipedia Commons

The story goes that in the late 1894, wealthy socialite Lemuel Benedict, hurting from a night of excess, ordered at the Waldorf Hotel “buttered toast, poached eggs, crisp bacon and a hooker of hollandaise,” the dish that would evolve into the beloved Eggs Benedict!

 

 

 

Mr. Willoughby’s remedy seems to be an easily tolerated and readily portable method to potentially treat some of the symptoms of a hangover, and greatly preferable to some of the less savory options outlined above (sheep’s eyes, anyone?). Always learning and generally quite open-minded, it is evident that Claire will appreciate learning a few new techniques from Mr. Willoughby, so long as she can keep her shoes on!

Who else is eagerly awaiting the casting news of Mr. Willoughby? Can’t wait to see these scenes on screen!

 

cahonasscotland

We here at Outlander Science Club encourage healthy balls of all kinds! Encourage the men in your life to do regular self exams and check out Cahonas Scotland, a Scottish charity working to increase awareness and decrease the stigma surrounding male cancers!

 

 

 

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205: A Historical Perspective on Alcohol in Pregnancy

205 screenshot

When viewed through our 21st century eyes, it does seem as though our pregnant heroine is drinking an awful lot of alcohol.

Throughout history, alcohol was not always thought to be something to avoid in pregnancy.  Alcohol was often medicine – whisky for colds or laryngitis, hot brandy punch for cholera, rum-soaked cherries for a cold.  Doctors prescribed champagne as a treatment for morning sickness. Pregnant women in labor would take a shot or two of liquor to ease their discomfort. Wine was often recommended during pregnancy to help pregnant women relax.

beehive-brandy

General opinion maintained that alcohol was not dangerous in pregnancy, though throughout the years, some have voiced concern. Aristotle is quoted to have warned against the hazard of drinking during pregnancy, “foolish, drunken, and harebrained women most often bring forth children like unto themselves, morose and languid.”  In 1899, English physician William Sullivan noted that among his patients in a Liverpool prison, stillbirth rates were 250% higher for his alcoholic female prisoners than for their sober counterparts. He also noted that the children of women with no (or limited) access to alcohol during pregnancy were healthier, leading him to hypothesize, “a direct toxic action on the embryo, owing to continued excesses during pregnancy.”

In an issue of the Quarterly Journal of Inebriety published the same year, an editorial contended, “habitual intemperance on the part of the female when pregnant must tend to impair the development of the fetus in utero by impairing cell growth. What we know now is that maternal use of alcohol during pregnancy can have deleterious effects on the growing fetus and lead to a number of problems.”  Many other physicians observed and reported similar findings in the 19th and early 20th century, describing outcomes that would later come to be recognized as symptoms of Fetal Alcohol Syndrome.

slides_196parents600
World’s and National Woman’s Christian Temperance Union, 1914   source

It seems, though, that as soon as prohibition ended in the US, attitudes regarding alcohol in pregnancy shifted again, and public discussion of the risk and medical research on the question, seemed to disappear.  The medical community seemed to turn direction completely, with a statement in 1953 in Clinical Obstetrics stating, “alcohol, as such, is not injurious and need not be eliminated during pregnancy.”   As recently as the 1960s-1980s in the US, alcohol was given intravenously to women in preterm labor as a tocolytic – a medication to stop uterine contractions calm and halt preterm labor.

A fetus is vulnerable to alcohol particularly because alcohol crosses the placenta, yet the fetus has lower levels of the enzyme alcohol dehydrogenase to metabolize the alcohol than does the mother. The fetus is thus exposed to alcohol for a much longer period of time.

The effects of alcohol manifest in different ways depending on the stage of pregnancy. Exposure in the first trimester can lead to characteristic abnormalities in the face as well as devastating heart defects and abnormalities of the bone structure, kidneys, eyes and hearing. Second trimester alcohol exposure increases the risk of miscarriage and stillbirth. In the third trimester, fetal exposure to alcohol affects weight, length and brain growth.

FASkid
By NIH/National Institute on Alcohol Abuse and Alcoholism

Fetal Alcohol Spectrum Disorders are the conditions that may occur in persons who were exposed to alcohol in utero. Problems can include abnormal appearance with characteristic facial abnormalities, short height, low body weight, small head size, poor coordination, low intelligence, behavioral problems and hearing and vision problems. It is thought to affect 2-5% of people in the US and Western Europe. Worldwide incidence is approximately 1 in 2000 live births.

It wasn’t until the 1970s that Fetal Alcohol Syndrome was defined and fully recognized. Work to educate pregnant women of the dangers of alcohol in pregnancy began in earnest after researchers at the University of Washington identified a pattern of abnormalities in infants born to alcoholic mothers.  Animal studies in monkeys then followed that confirmed that alcohol was indeed responsible.  Rather than naming the syndrome after themselves, as is common in the discovery of medical syndromes historically, the University of Washington researchers, Drs Kenneth Lyons Jones and David Weyhe Smith, chose the name Fetal Alcohol Syndrome after the agent responsible for the problem, to raise awareness of the problem alcohol in pregnancy.

1988 brought the Alcoholic Beverage Labeling Act in the US, mandating that the labels of alcoholic beverages carry a government warning.

warning

Today, the official statement from American Congress of Obstetricians and Gynecologists reads:

“Women should avoid alcohol entirely while pregnant or trying to conceive because damage can occur in the earliest weeks of pregnancy, even before a woman knows that she is pregnant.”

Other societies of providers of obstetric care phrase it a bit less stringently, with the European Board and College of Obstetrics and Gynecology advising:

“Based on what is known as well as the continuing uncertainty as to whether any safe consumption threshold exists […] women should ideally abstain from alcohol during pregnancy or when planning pregnancy.”

Similarly, the Royal College of Obstetricians and Gynaecologists in the UK advises:

“If you are pregnant or planning a pregnancy, the safest approach is not to drink alcohol at all, to keep risks to your baby to a minimum. Drinking in pregnancy can lead to long-term harm to the baby, with the more you drink the grater the risk. […] The risk of harm to the baby is likely to be low if a woman has drunk only small amounts of alcohol before she knew she was pregnant or during pregnancy.”

Pregnancy in the 18th century was a scary proposition indeed. Reliable records of maternal death in the time are difficult to come by but studies of death records in the UK in the time suggest about 2.5-3% maternal death rate per baptism recorded.  Given an average of 5-6 pregnancies per woman, this would result in 11-16% risk for the average 18th century mother to die in childbirth or shortly after in her lifetime, and perhaps even higher given that the risk subsequent births are not necessarily independent of previous births.  Maybe we can understand why the women of the time (and their concerned partners) would encourage alcohol to help them relax and briefly forget about the fact they may not survive childbirth, especially without knowledge the alcohol would be doing any harm.  Compare this to the current risk of maternal mortality today in the US of 0.019%.

Even with her medical knowledge, Claire is coming from the reference point of the 1940’s when the medical community was of the opinion that alcohol was not hazardous to pregnancy, and actually was considered beneficial.  Seeing these huge shifts in the medical community’s understanding of the risk of alcohol, it makes one wonder what we will come to know in the future as an undeniable risk we assume is healthy today!

camels_doctors_whiteshirt
source

Questions, comments, concerns, or suggestions for future Outlander medicine topics?  I’d love to hear from you!  Leave a comment here or find me on twitter @SassenachDoctor.

107: Gueule de bois (The Hangover)

The end of The Garrison Commander left us with Claire drinking large amounts of whisky and coming to terms with the fact she would tomorrow be marrying a Scot.

wedding contract
source: Starz

One James Alexander Malcolm MacKenzie Fraser, to be exact.

One of my few criticisms of the TV adaptation of the Outlander story was Claire telling Jamie on their wedding day that she couldn’t marry him because she didn’t even know his name. As we just saw above, at the end of The Garrison Commander, Claire is reading the marriage contract which we can see lists Jamie’s full name. However, let us assume perhaps she forgot because of all the whisky.

claire takes the bottle from dougal
source:  Starz

And how about all that whisky?

The next morning, Murtagh wakes a very hungover Claire.  It is time to dress for the wedding in the absolutely breathtaking gown which Ned Gowan has obtained (and hopefully he hasn’t obtained any other lasting gifts from his new friends that night – more on that in a future post!)

hangover claire
source:  Starz

The symptoms of hangover are universally known but scientists are still working to determine what exactly causes it. Some theories include:

1. The effect of the byproducts of ethanol as the body digests it.
After ingestion, ethanol is converted to acetaldehyde by the enzyme alcohol dehydrogenase. It is then converted to acetic acid. Acetaldehyde is more toxic than alcohol itself and remains at elevated levels for many hours after ethanol is ingested.

2. The effect of other substances in the beverage, known as congeners
Many alcohol drinks also contain other substances, either as flavoring or as a byproduct of the fermentation or aging process. These can include amines, amides, acetones, polyphenols, methanol, histamines, esters and tannins, many of which are toxic.

Different types of alcoholic beverages have differing amounts of congeners and in general, the darker the liquor, the higher the concentration. The amount found in bourbon is 37 times higher than that found in vodka.  This doesn’t bode well for our whisky drinking Scots!

3. Dehydration
Ethanol increases urine production (diuresis) and dehydration may be responsible for some of the symptoms of a hangover – thirst, dizziness and lightheadedness. Initially thought to be contributory, studies show that electrolyte changes are minimal after drinking, though.

4. Stomach acid
Nausea and vomiting may be due to the effect alcohol has on the stomach by stimulating the production of hydrochloric acid and delaying stomach emptying.

5. Low blood sugar
Alcohol can cause blood sugar to fall, causing fatigue, weakness and shakiness

6. Effect on blood vessels
Alcohol causes blood vessels to expand, leading to headaches

7. Immune response
Alcohol can cause an inflammatory response, causing the concentration of several cytokines (immune system communication signals) to be significantly increased. In fact, researchers have found if healthy subjects are injected with cytokines, the persons will have the symptoms of hangover such as nausea, headache, chills and fatigue!

8. Genetics
Some ethnic groups have a mutation in the alcohol dehydrogenase gene making the conversion from ethanol to acetaldehyde very fast. Others convert acetaldehyde to acetic acid more slowly and see a larger buildup of the more toxic acetaldehyde than other groups. Accumulation of acetaldehyde causes an alcohol flush reaction – redness to the face, neck and shoulders, or even the entire body, nausea and tachycardia (rapid heart rate).

Remember Henri de Toulouse-Lautrec from our discussion of Colum’s deformed legs?  He was an artist in France at the end of the 19th century who suffered from the condition and for whom it was named.  Below is one of his works depicting a hangover.

lautrec painting hangover
“Gueule de bois” (The Hangover), 1888 by Henri de Toulouse-Lautrec (1846-1901) / (source)

What to do?
1. Hydrate!  
2. Anti-inflammatories! If the mechanism of hangover is an inflammatory response, then anti-inflammatory medications may be the key. In fact, we already saw Claire thinking ahead and stockpiling willow bark for hangovers in preparation for The Gathering!
3. Eat! Get that blood sugar up and eat some carbs. Hopefully Murtagh has brought something for Claire when he came to wake her.
4. Caffeine! If the headache in a hangover is due to dilated blood vessels, then caffeine may counteract this with its action to constrict the blood vessels in the brain.

And if you are in modern day Scotland, packing fluids, caffeine and carbs in the form of  Irn-Bru is the thing to try!
irnbru

An older Scottish cure was the “Highland Fling” –  mix a tablespoon of cornflower into a pint of buttermilk.  Add salt and pepper and drink!

Cornflower has anti-inflammatory properties, so between that, the hydration and fats/carbs it provides, this remedy may be helpful!

cornflower
Cornflower / (source)

Throughout the course of the wedding night, Claire drank no less than eight glasses of whisky by my count.

what claire did all day
source:  Starz

Perhaps someone will be nice enough to prepare a Highland Fling for her!

 

Resources:

Top 10 Hangover Cures from around the World

Hangovers, Why?

A Few Too Many – is there any hope the hungover?