An aural question
BMJ 2010; 340 doi: https://doi.org/10.1136/bmj.c164 (Published 12 January 2010) Cite this as: BMJ 2010;340:c164All rapid responses
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Sir,
Thomas Dalrymple should consider sanguinarine for the poison that
killed King Hamlet. (Between the Lines, BMJ 2010;340:c164)
Sanguinarine is an extract of Bloodroot (Sanguinaria canadensis) and
other plants, such as the Greater Celandine(Chelidonium majus). A local
American name is “tetterwort”, which is of interest when we consider the
Ghost’s description of the symptoms of his death,
“And curd, like eager droppings into milk,
The thin and wholesome blood: so did it mine;
And a most instant tetter bark'd about,
Most lazar-like, with vile and loathsome crust,
All my smooth body.”
For ‘tetter’ was a skin eruption and sanguinine is toxic to the
cellular sodium pump mechanism. By topical application it causes a
chemical burn, or systemically it causes oedema and congestive heart
failure. Could Claudius have spilt this extract on his brother, the burn
including his ear where a perforated eardrum allowed entry of the drug to
the more permeable middle ear, absorption and heart failure?
Dr.John Davies FRCA
Albert House,
Haverbreaks,
Lancaster LA1 5BN
Competing interests:
None declared
Competing interests: No competing interests
Whether aural administration of poison actually would work may have
been less interesting than the possibility that it might do so. Eden and
Opland pointed out in 1982 (New England Journal of Medicine, vol
307,pp.259-261) that Shakespeare's barbershop reading could well have
included Eustachio's 1564 treatise on the the tubes he had recently
discovered. The notion of poisoning through the ear did not appear in any
work before Hamlet (1604). The Old Bill didn't miss a trick.
Competing interests:
None declared
Competing interests: No competing interests
The Murder of King Hamlet
BMJ 2010 ; 340:c164
Dr Dalrymple asks about the practicality of the aural route for
poisoning as illustrated by the untimely dispatch of Hamlet’s father. He
is correct to assume that the skin lined external canal is a barrier to
most toxins, unless we credit Claudius with anticipating the invention of
such nerve agents as Tabun or Sarin by some centuries!
There is no suggestion that King Hamlet was afflicted with any
hearing deficit, but, had he a perforated tympanic membrane and a patent
Eustachian tube, a crafty murderer would find this the ideal and cryptic
route for any orally active poison, however.
Egyptian henbane is a product of Hyoscyanus Niger and is well known
for causing Scopolamine intoxication. Whilst excellent at crossing the
blood brain barrier, this drug is only slowly absorbed through skin, even
when applied as a transdermal patch and death after administration “in the
porches of the ear” seems unlikely.
Other possibilities include iced water, surprisingly. The caloric
effect, on an elderly gentleman, attempting to rise from sleep suddenly,
could have caused him to fall but the degree of injury suffered could
hardly be guaranteed. A similar reflex effect on autonomic centres could
have induced profound bradycardia and arrhythmia, if one must murder via
this unlikely route!
In practice, the poison in the ear is an allegory for deceit,
temptation and falsehood oft used by Shakespeare eg where Lady Macbeth
asks “Hie thee hither, that I may pour my sprits in thine ear”.
There are several papers in the ENT literature speculating on the
practicality of this dastardly deed, most recently Kotsias’ paper, freely
available on line (1)
Liam M Flood FRCS
Consultant ENT Surgeon, Middlesbrough UK
1. Kotsias BA (2002) Scopolamine and the Murder of King Hamlet. Arch Otolaryngol Head Neck Surg 128; 847-9
Competing interests:
None declared
Competing interests: No competing interests