Famed children's author Roald Dahl greatly admired doctors who pioneered new medicines and even dedicated his 1981 book George's Marvelous Medicine—in which a young boy cooks up a potion using various ingredients around his family farm—to "doctors everywhere." Copies of the book contain a disclaimer to readers, warning them not to try to make George's concoction at home, as it could be dangerous. And now a recent paper published in the annual Christmas issue of the British Medical Journal (BMJ) has determined just how toxic the concoction could be if ingested.
The BMJ's Christmas issue is typically more light-hearted in nature, although the journal maintains that the papers published therein still "adhere to the same high standards of novelty, methodological rigour, reporting transparency, and readability as apply in the regular issue." Past years have included papers on such topics as why 27 is not a dangerous age for musicians, and the side effects of sword swallowing, among others. The most widely read was 1999’s infamous “Magnetic resonance imaging of male and female genitals during coitus and female sexual arousal.” (We wrote about the paper last year to mark the 20th anniversary of its publication.)
(Spoilers for the 1981 children's book below.)
In Dahl's book, eight-year-old George Kranky is home alone with his bossy, bullying grandmother, and he decides to concoct his own magic potion to replace her usual medicine as a way of getting even. Among the ingredients he collects from around the family farm: deodorant, shampoo, floor polish, horseradish sauce, gin, engine oil, antifreeze, brown paint, sheep dip, and "purple pills for hoarse horses." When his grandmother drinks it, she grows as tall as a house; so do the family chickens when George gives them a taste of the medicine. When his parents find out, George's father comes up with a scheme to raise giant animals to get rich and end world hunger.
But George can't quite replicate his original recipe, and the fourth version has the opposite effect, causing those who drink it to shrink. George's grandmother mistakes it for tea and drinks the whole thing, shrinking out of existence. In typical Dahl fashion, the family shrugs off the granny's disappearance, and the book ends with George pondering the potential of this new magical world he has discovered. (You can watch/listen to an audio reading of the book on YouTube courtesy of Storyvision Studios UK: Part 1, Part 2, and Part 3.)
Graham Johnson and Patrick Davies of the University of Nottingham's School of Medicine decided to analyze the therapeutic effects and toxicity of the marvelous medicine, using ToxBase, a national database of poisons in the UK. And while they clearly had fun with the project, there is a more serious underlying objective: more than 28,000 children receive treatment for poisoning in the UK each year, according to the authors, and more than 3,000 children die each year across the European Union. Most unintentional poisonings occur in the home. And with so many young children being home-schooled during the pandemic, there is an increased risk of accidental poisoning via common household items like those George used in his marvelous medicine.
Currently home educators themselves, Johnson and Davies thought it would be fun to concoct a similar mixture to George's, "but without using unsuspecting recipients such as cranky grandmas." With their five young "helpers," the pair conducted the study between March and April of this year. (There are actually three different versions of the paper corresponding to the different ages and reading levels of the helpers.)
Everyone read the book and noted down the ingredients mentioned on paper. Those ingredients were then cross-referenced with ToxBase. In at least one case (the purple pills for hoarse horses) there was no exact matching ingredient, so the authors matched it to pale purple tablets of an anti-inflammatory, non-steroidal drug called phenylbutazone, often used to treat an equine disease known as "the strangles" (basically an upper respiratory infection).
The team identified 34 different ingredients from the bathroom (10), the bedroom (4), the laundry room (5), the kitchen (6), the shed (6), and the garage (3). The most common symptoms associated with those ingredients were vomiting, depression of the central nervous system, diarrhea, and myocarditis or arrhythmia. "Our findings suggest that far from being marvelous, George's medicine is in fact incredibly toxic," the authors wrote.
Dahl's descriptions of the likely initial effects proved remarkably accurate. For example, Grandma complains that her stomach is on fire at one point, which could have been caused by the sheep dip, shoe polish, and floor polish. Then Grandma begins to swell, before being punctured and deflating. The authors note that four of the ingredients could cause foaming and gastrointestinal bloating, although "puncture" is not a medically recognized treatment for either. When Grandma's body twists and jerks, that could be a reaction to the sheep dip, antifreeze, engine oil, or grease. As for her impressive growth spurt, "from this point the account of the effects of the medicine diverges from reality," the authors concede.
A more realistic description of the effects of George's medicine would include vigorous vomiting with severe esophageal burns, followed by rapid drowsiness and coma, eventually leading to aspiration pneumonitis and possibly even complete airway obstruction and suffocation. If Grandma survived that stage, she could then develop seizures, myocarditis or arrhythmia, and organ failure, among other lethal symptoms.
In short, "Far from experiencing major growth and invigoration, grandmas and other equally unfortunate recipients would be at high risk of death," the authors concluded. While they are in favor of encouraging scientific exploration and experimentation in children, "It would be wise for parents of budding pharmacists to remain vigilant, particularly during lockdown."
Johnson and Davies also devised an amusing interactive tool to accompany their paper, enabling readers to create their own unique mixture by choosing different combinations of George's many ingredients and then seeing the likely effects of their custom concoction on the human body. That's a much better virtual outlet for bored kids to explore their chemical creativity.
DOI: BMJ, 2020. 10.1136/bmj.m4467 (About DOIs).
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