History And Mystery

Love and death in Wagner's Tristan und Isolde—an epic anticholinergic crisis

BMJ 2003; 327 doi: https://doi.org/10.1136/bmj.327.7429.1469 (Published 18 December 2003) Cite this as: BMJ 2003;327:1469
  1. Gunther Weitz (weitzg{at}telda.net), internist1
  1. 1Department of Internal Medicine I, Medical University Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, D-23538 Lübeck, Germany

    In Wagner's opera Tristan und Isolde the main protagonists take a love potion, which has various side effects and possibly causes Isolde's death. Gunther Weitz argues that the symptoms fit with severe anticholinergic syndrome

    In the opera Tristan und Isolde Richard Wagner reports the poisoning of Tristan and Isolde by a “love potion.” Shortly after ingestion of the potion, the protagonists declare their love, and both die during the opera. The opera has been extensively interpreted by psychoanalysts13 and musicologists,46 but, although at least Isolde's death remains unexplained and might be due to the potion, the medical profession has not yet analysed the case. I present evidence to suggest that the lovers were affected by a severe anticholinergic syndrome and that this is the most likely cause of Isolde's death.

    The story of Tristan and Isolde (Iseult), who fell in immortal love after drinking a magic potion, originated in the 6th century and was told in England, Ireland, and the north of France. It first appeared in writing in the 12th century, and Wagner used as his source the poetry of Gottfried von Strassburg, from around 1210.7 Although Strassburg was familiar with alchemy,8 he did not report the side effects of the love potion. Wagner's detailed description of the symptoms suffered by the protagonists may indicate his attention to possible ingredients.

    Presentation of the case

    Tristan, nephew of King Marke and knight of the Cornish court, and Isolde, princess of Ireland and King Marke's bride, try to commit suicide together by drinking poison which, however, turns out to be a “love potion.” Within moments the first symptoms of an intoxication occur that can be interpreted as tachycardia, flush, and blurred vision (see synopsis of symptoms in the table). Tristan and Isolde fall passionately in love, but confusion and disorientation ensue. A few days later in a nocturnal scene (Act II), light intolerance is evident. At dawn Tristan is injured in a fight with a rival and later dies from his injuries (Act III). Shortly afterwards, Isolde experiences hallucinations and dies.

    Synopsis of the symptoms caused by the love potion described by Wagner9 and the symptoms of an anticholinergic syndrome caused by Solanaceae10-12

    View this table:

    Wagner's use of the “Tristan chord” (fig 1) every time the potion or its effects are mentioned5 sheds some light on the toxicology of the active agent. Shortly after the drug is ingested, the Tristan chord changes from one notation to another, indicating a rapid onset of action. The symptoms described in the next scene are clearly attributed to the potion, and the Tristan chord is repeated prominently. In a love scene a few days later (Act II, scene 2) both protagonists express marked light intolerance, and that this is caused by the potion is suggested by a cluster of Tristan chords. At the moment of Tristan's death there is no Tristan chord, whereas Isolde's remarkable behaviour before her demise is explained as being due to the potion by the occurrence of a Tristan chord. This latter scene is widely known as the “Liebestod” (fig 2).

    Fig 1
    Fig 1

    The “Tristan chord” in Wagner's Tristan und Isolde

    Love medicine in Europe

    Medieval strategies for modulating mood drew extensively on Roman ideas.13 Food was believed to influence humors, and for specific effects meals were prepared according to elaborate and refined ceremonies.14 Many ingredients that were associated with aphrodisiac properties—such as egg, peacock, fowl, beef, venison, crustaceans, leek, turnip, asparagus, pomegranate, mustard, and pepper14 15—would not be recognised as such nowadays. Others have reproducible effects: cantharidin, an extract from dried bodies of blister beetles, causes urethral irritation sometimes followed by erection. Yohimbine, a central acting α receptor blocker derived from the bark of an African tree, has since been recommended for the treatment of impotence.1517

    Fig 2
    Fig 2

    The “Liebestod” in a picture by Wilhelm von Kaulbach (1866)

    The variety of psychotropic drugs in medieval Europe was small, since only a few local plants are able to exert an action on the central nervous system. Wine and beer were widespread, but the most effective hallucinogenic agents were derived from nightshade plants (Solanaceae).1820 Recipes of love stimulants frequently contained such plants, especially henbane (Hyoscyamus niger), mandrake (Mandragora officinarum), and in later times thorn apple (Datura stramonium).14 19 21 These plants have in common high concentrations of hyoscyamine, atropine, and scopolamine—anticholinergic alkaloids that act on both the peripheral and central nervous system. Hyoscyamine and atropine are found to have more exciting properties, and scopolamine more relaxing and hallucinogenic properties.22

    Knowledge of the pharmacological properties of Solanaceae was handed down in folk medicine,18 21 and they were often referred to by Shakespeare in his plays.19 23 Their use as hallucinogens declined during the 19th century with the increasing availability of more effective drugs such as cannabis and cocaine.21

    Discussion

    Wagner's presentation of Tristan and Isolde's symptoms is as close to intoxication by Solanaceae as can be suggested in an opera (see table). The rapid onset of peripheral anticholinergic symptoms and the symptoms marked by the Tristan chord are typical of an overdose of this agent. The initial presentation of dry mouth and intense thirst is not described, perhaps because of difficulties in illustration. Instead, tremor is indicated, which would be unusual because the biochemical lesion is predominantly at muscarinic and not nicotinic sites except in massive overdosing, which is not described in the first scene. Hallucinations caused by Solanaceae are mostly visual and consist of simple images in natural colours—in contrast to other hallucinogens such as lysergic acid diethylamide (LSD) or mescaline, which typically produce a brilliant and shifting interplay of light and colour.10 However, auditory hallucinations as in the “Liebestod” have also been described after ingestion of Solanaceae,11 and emphasising the audible may be a stylistic device in an opera. Fatalities in adults as a result of overdose of Solanaceae are rare and can be secondary to cardiac or respiratory arrest.10 12

    The symptoms of an intoxication usually resolve within 24-48 hours; however, pupillary dilatation can persist for several days,10 as described in Act II. Much later, in his dying scene, Tristan is no longer intoxicated (no Tristan chord), and his death must therefore be attributed to his injuries. Isolde's psychotic behaviour when she approaches Tristan's body might be interpreted as hysteria, but this could not explain her death. Wagner's use of a Tristan chord in the moment of her death indicates that both hallucinations and death are attributable to the love potion. It is likely that she took a further draught. Wagner, unlike Gottfried von Strassburg, makes no reference to there being no love potion left after the first ingestion.

    Alkaloids from Solanaceae may induce a delirious state, but, despite their frequent use in medieval love potions, they do not have specific eroticising properties. Wagner takes this into account by illustrating that Tristan and Isolde are in love before drinking the potion, though unable to admit it. Hence, the “love potion” only has a liberating effect. The German novelist Thomas Mann claimed that Tristan and Isolde could as well have drunk a glass of water.7 Nevertheless, Wagner's close description of an anticholinergic syndrome favours an ingestion of a potion containing Solanaceae and underlines his careful treatment of this issue.

    Summary points

    The article analyses the composition of the lovepotion in Wagner's opera Tristan und Isolde from a medical view

    The libretto and the music suggest that an anticholinergic compound is the active agent

    Medieval love potions often contained anticholinergic alkaloids from plants of the Solanaceae family

    The knowledge of the properties of Solanaceae was handed down in folk medicine until the 19th century

    The unexplained death of Isolde at the end of the opera could be explained by a severe anticholinergic crisis

    Acknowledgments

    I gratefully acknowledge the substantial support of Jonathan Folb (London) in preparing the manuscript and the technical assistance of Sven Süfke (Lübeck).

    Footnotes

    • Competing interests None declared.

    References

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