OK, for the first time on this blog I will post something I originally posted under my nom du medicine , Seamus Mac Suibhne. Or sort of did, since it is credited to a mysteriously named Seamus Mac Suibhne (Sweeney).
Both letters, appropriately enough, had serendipitous origins. In some compendium of random facts I came across the first, attributed to Culpeper. Later, in J C McKeown’s Cabinet of Roman Curiosities I came across the same advice, attributed to Isidore of Seville. Isidore’s work was itself a compendium of more ancient medical texts, so presumably this advice is even older. I am unaware of any actual clinical trials.
Nicholas Culpeper (1616–1654) was an English physician, herbalist, botanist and astrologer. He lived at a time when these fields overlapped to a considerable extent, and unlike many of his contemporaries he took an empirical approach to the healing enterprise, cataloguing medicinal plant and their effects for himself rather than appealing to tradition. Recent commentators have placed Culpeper in the context of a radical democratization of medical knowledge and authority (Woolley, 2004).
Culpeper’s works have all been immensely influential, being consulted regularly by complementary/alternative practitioners to this day. ‘Culpeper’s Herbal’, the popular name given to his 1653 work ‘The Complete Herbal’, contains the following advice under the section on the medicinal use of living creatures: ‘Eels, being put into wine or beer, and suffered to die in it, he that drinks it will never endure that sort of liquor again’ (Culpeper, 2006 [1653]).
To an early twenty-first (or late twentieth) century medical reader, this is extremely reminiscent of the use of disulfiram as an aversive treatment in problematic alcohol use. Disulfiram has been used in the manufacture of synthetic rubber since the 1800s, and while its range of unpleasant physical reactions to alcohol ingestion in those exposed to it in the process were well known within the rubber industry, it was the mid-1930s before a medical researcher noted the fact (Williams, 1937). The use of disulfiram for aversion treatment of alcohol dependency dates from 1948, when it was serendipitously rediscovered by two Danish researchers who were experimenting with disulfiram as a possible treatment for helminthic parasites (Hald and Jacobsen, 1948; Steffen, 2005). A Danish psychiatrist, Martensen-Larsen, subsequently developed the chemical as a treatment for alcoholism (Martensen-Larsen, 1948).
Naturally occurring substances with analogous action to disulfiram are known—the most prominent being the ink cap mushroom (Broadhurst-Zingrich, 1978), Culpeper’s reference to allowing eels to die in alcoholic beverages and using the resulting concoction to induce aversion to alcohol is suggestive of a similar approach to the aversive pharmacotherapeutic one of disulfiram, one which given his empirical approach Culpeper may have tried himself. Even more suggestively, eel skins have themselves been used to manufacture rubber-like materials. Given the serendipitous route by which disulfiram entered the pharmacopeia of alcohol addiction treatment, it is important that contemporary researchers maintain an alert mind attuned to possible therapeutic strategies of the past.
REFERENCES
↵Broadhurst-Zingrich L. Ink caps and alcohol. BMJ 1978;6111:511.
↵Culpeper N. The Complete Herbal. Carlisle: Applewood Books; 2006 [1653].
↵Hald J, Jacobsen E. A drug sensitizing the organism to ethyl alcohol. Lancet 1948;2:1001-4.Medline
↵Martensen-Larsen O. Treatment of alcoholism with a sensitizing drug. Lancet 1948;2:1004.Medline
↵Jenkins R, Jessen H, Steffen VSteffen V; Jenkins R, Jessen H, Steffen V, editors. Managing uncertainty: ethnographic studies of illness, risk and the struggle for control. Challenging Control: Antabuse Medication in Denmark Copenhagen: Museum Tusculanum Press; 2005:173-196.
↵Williams EE. Effects of alcohol on workers with carbon disulfide. JAMA 1937;109:1472-1473.
↵Woolley B. The herbalist: Nicholas Culpeper and the fight for medical freedom. Toronto: Harper Collins; 2004.
Isidore of Seville, Eels and Disulfiram
Seamus P.M. MacSuibhne (Sweeney)
In 2010 I corresponded with this journal (Mac Suibhne, 2010) about intriguing parallels between a comment made by the 17th Century English botanist, physician, astrologer and herbalist Thomas Culpeper in his ‘Complete Herbal’ and the use of disulfiram. Culpeper’s specific words were ‘eels, being put into wine or beer, and suffered to die in it, he that drinks it will never endure that sort of liquor again’ (Culpeper, 2006 [1653]).
I wish to the journal readership’s attention to an even earlier citation of the same advice, in Isidore of Seville’s (c. 560–636) encylopaedia Etymologiae. Compiled towards the end of his life, Etymologiae was the first attempt by a Christian writer to produce a compilation of the knowledge of antiquity. It serves as the only remaining source of much classical learning.
Chapter 12 of this work deals with animals; at section 6, verse 41 we find the following: ‘Eels originate from mud; hence, when one is caught, it is so slippery that the tighter you hold it, the more quickly it slips away. They say that the river Ganges, in the East, produces eels 30 feet long. When eels are killed in wine, whoever drinks it then develops a distaste for wine (Isidore of Seville, 2006 [c. 630]).
As this work is a compilation of ancient sources, many of which are lost, it is clear that this advice has an even older origin. In my previous correspondence I outlined the serendipitous discovery of disulfiram as an aversive agent, its derivation from the rubber industry, and linked this naturally occurring disulfiram analogues (Broadhurst-Zingrich, 1978) and with the use of eel skins to produce rubber-like products. It is possible that this form of aversive therapy has even older roots.
↵Broadhurst-Zingrich L. Ink caps and alcohol. BMJ 1978;6111:511.
↵Culpeper N. The Complete Herbal. Carlisle: Applewood Books; 2006 [1653].
↵Isidore of Seville. Etymologiae. (Barney, Lewis, Beach, Berghof, trans). Cambridge: Cambridge University Press; 2006 [c. 630].
↵Mac Suibhne S. Commentary: Nicholas Culpeper, eels and disulfiram. Alcohol Alcohol 2010;45:589.
A Medical Education 
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