Scatology — the study of excrement — has long fascinated my co-author and me.1 Nevertheless, until our most recent discovery, even we would have conceded that the most dedicated coprophile would be hard pressed to find a link between dog droppings, medicine and Christmas. At the Nativity, despite the manger’s rural setting, was there a dog, let alone dog droppings, to be seen? Cows, goats, sheep aplenty and a camel or three, but Rover seemed conspicuously absent. Rudolph is a reindeer, not a red setter. And, over those 12 days of Christmas, our True Love trucked in a whole aviary of birds but, for some reason, never a dog a-barking.

Perhaps this absence is related to the popular view that dog faeces rate towards the lower end of the general desirability scale. In Australia, many a local authority finds menace in every deposit of dog excrement2 — it seems that dog droppings are deemed a health hazard, despite a distinct lack of scientific evidence. Statistically, on an average walk in the park, you are far more likely to be killed or injured by dog bites,3 broken glass,4 or discarded syringes5 than infected by stepping in dog excrement. Slipping over and fracturing a hip is a potential hazard, but we have failed to find a report of the same; however, there has been a report of a fall involving a slip on puppy urine.6

Imagine our delight to find out — after meandering along little-travelled byways of medical history — that dog excrement has not always been so reviled and that it does have a prior, however slight, association with Christmas.

A little while ago, we purchased the fourth English edition of Laurence (more properly, Lorenz) Heister’s A general system of surgery, published in London in 1750 (Box 1). It was considered the first truly modern surgical text in the English language,7 and was the greatest surgical text of the 18th century, running to seven German, ten English and three Latin editions as well as being translated into Italian, French and Dutch. Profusely illustrated (by the standard of the day), Heister’s text combined practical surgical technique with sound anatomical knowledge, both of which he had gained by first hand experience.

Who were its past owners? Were any of them practising surgeons? Alack, our copy of Heister is pristine in every detail with no markings to indicate prior ownership. Judging by its unsullied pages, this book was never used as an everyday reference by student or surgical practitioner. However, deep within its pages, there is one tantalising clue to suggest that at least one of the unknown previous owners of this book had intended on practising the art of surgery. That clue came in the form of a piece of interposita — that extraneous matter that tends to accumulate within the pages of a book (Box 2).

The piece of interposita in question is a single sheet of watermarked paper measuring 8 by 10 inches (255 by 210 mm) (Box 3). On holding the paper up to the light, a large watermark of the Pro Patria (“For the Fatherland”) type can be seen, indicating that the paper itself was probably produced in Holland at some time in the 18th century, but could have been used elsewhere, particularly in the United States.8

Our interposita was folded in four when we found it. On one side, in a series of ruled-off compartments, was a collection of ten recipes, mostly medicinal, neatly hand-written in ink. Its unsoiled nature, the fact that the writing and ink are the same throughout, and that there are no corrections, suggests that the piece was compiled at one sitting from sources already at hand. The intent, we presume, was to create a permanent document for future reference, an aide-mémoire kept for safety and ease of access in the standard surgical reference of the time. But, seemingly both the book and interposita were little used from that day to this.

Although the author is unknown, we feel the evidence indicates he was a young, enthusiastic but inexperienced doctor of the later decades of the 18th century. In all probability he had just finished his apprenticeship and was about to embark on a career of his own. An established practitioner would not need recourse to such an aide-mémoire, having already acquired his own favourite nostrums.

Our English Heister edition dates from 1750. From the fine, undamaged condition of the interposita, it seems unlikely it would predate this. We believe, most likely, it was made fresh and placed immediately within the edition. Several other pointers lead us to the conclusion that it does not post-date the end of the 18th century. Firstly, the writer routinely employs what is now an archaic form of the letter “s”, known as the long s located at the beginning or in the middle of words, while the modern s form, the short or terminal s, appeared at the end. Secondly, the writer uses what are now obsolete spellings. For example, he spells the word “garlic” with a “k” — garlick. The k had been dropped from English usage by the turn of the 19th century. The Oxford English Dictionary records a usage of the k-less form in 1796 and constantly thereafter. Likewise plaister is an antique variant of plaster. But we have left our strongest evidence till last — the recipes themselves.

In all, the interposita lists ten recipes — eight medical:

• Plaister for Cuts or Wounds;

• Recipe for Eye water;

• A good recipe for the piles;

• An infallible recipe for the Dropsy;

• A cure for an obstinate cough;

• The famous American recipe for the Rheumatism;

• Bitters, and Bitters [a second variation];

and two culinary:

• Recipe for little cakes; and,

• for a plum pudding.

Of course, to our minds, such recipes, in particular that for an “infallible” cure for dropsy, would seem to be nothing but fanciful imagination. But what else could a young and inexperienced practitioner have relied upon at a time when no satisfactory alternatives existed? They are good examples of what Voltaire (1694–1778) described as the art of amusing a patient while Nature takes its course. An “infallible recipe” for dropsy would have to wait upon William Withering’s ground-breaking An account of the foxglove and some of its medical uses, published in Birmingham in 1785. The effect of foxglove was to quickly consign such ineffectual remedies to the dust-bins of history.

Our writer noted “the famous American recipe for the Rheumatism” and recorded “£100 has been given for the Recipe”. Would you have paid such a price for a recipe which combined garlic(k) with gum ammoniac (a foetid plant resin) into boluses (large round pills) to be taken twice a day with strong sassafras tea?

Both bitters recipes are based on Peruvian bark (genus Cinchona), which was introduced to Europe in 1640; however, the plant which produced it was not known to botanists until 1737.9

But, with Christmas (and dog droppings) uppermost in our minds at the moment, and medicine ever-present, let us turn our specific attention to another recipe in this collection.

We do not refer to the recipe for a plum pudding (although we do think the experience of “one large nutmeg” could well be overpowering, capable of evoking strong emotions, just like dog turd), but rather to that to help haemorrhoids (Box 3).

The recipe begins, innocently enough, with oil of red roses,10 a volatile oil obtained from the distillation of the fresh flowers of the Gallica rose, Rosa gallica. Then comes frankincense,9 the ingredient with the ultimate Christmas connection:

Frankincense, otherwise known as olibanum, is the dried resin from trees of the genus Boswellia, known to grow in regions surrounding the Red Sea. It was highly valued particularly for its fragrance, and has been widely traded throughout the Near East for millennia. Topical application of frankincense to the colonic mucosa is reputed to have anti-inflammatory properties, but whether this can withstand rigorous scientific scrutiny is debat-able.11

The surprise appearance of dog turd, coming so soon after frankincense — a substance steeped in Christmas tradition and reverence — would no doubt jar most modern sensitivities to the core. Turd is an Anglo-Saxon word of ancient origin (proto-European), pushed aside from genteel conversation: “not now in polite use” as the Oxford English Dictionary quaintly puts it. Presumably, dog turd was included for the same “cleansing and purifying properties” that made dried “dogs’ dung” (also known as “pure”) desirable for dressing leather in the 19th century.12 However, as dogs do not suffer from haemorrhoids, we are slightly tempted to think it may have some mysterious power to suppress their appearance.

The recipe is completed with honey, aloes Socotrine9 and egg yolk.13 In pharmacy, honey finds use as a demulcent which soothes inflamed mucous membranes. All aloes, in general, act as large-bowel stimulants, promoting the transport of material through the bowel lumen. Its inclusion here was probably to expedite bowel emptying. We doubt whether the author appreciated the minutiae of pharmacological niceties within the range of aloes. He probably specified the Socotrine form more because of availability or price. Egg yolk is slightly alkaline and has the virtue of not being readily broken down by acids or other electrolytes. We believe that in this preparation it was used to bind the active ingredients together.

On balance, we feel that this recipe — in its day — would have found acceptance as “a good recipe for the piles”, easing the pain and discomfort of this common condition. However, we are not so sure about the desirability of dog turd as a medicinal ingredient today.

1 Frontispiece of Heister’s surgery text

3 The interposita with the “recipe for the piles” enlarged