Bezoar

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For the animal, see Bezoar ibex.
Bezoar
Bezoar stones were seen as valuable commodities, sometimes with magical healing properties, as in the early modern English case Chandelor v Lopus.[1]
Pronunciation
SpecialtyEmergency medicine Edit this on Wikidata

A bezoar (

gastrointestinal system,[2] though it can occur in other locations.[3][4] A pseudobezoar is an indigestible object introduced intentionally into the digestive system.[5]

There are several varieties of bezoar, some of which have

inorganic constituents and others organic
. The term has both modern (medical, scientific) and traditional usage.

Types

By content

By location

Cause

Esophageal bezoars discovered in nasogastrically fed patients on mechanical ventilation and sedation are reported to be due to the precipitation of certain food types rich in casein, which are precipitated with gastric acid reflux to form esophageal bezoars. Bezoars can also be caused by gastroparesis due to the slowing of gastric emptying, which allows food to form a bolus.[12]

History

The word bezoar is derived from the Persian pād-zahr (پادزهر), literally 'antidote'.[13] The myth of the bezoar as an antidote reached Europe from the Middle East in the 11th century and remained popular until it started to fall into disrepute by the 18th century.[14] People believed that a bezoar had the power of a universal antidote and would work against any poison - a drinking glass which contained a bezoar could allegedly neutralize any poison poured into it.

Finger ring with a bezoar stone, from 17th century

Ox bezoars (niu-huang (牛黃) or

gallstones or gallstone substitutes formed from ox or cattle bile. Some products allegedly remove toxins
from the body.

The Andalusian physician Ibn Zuhr (d. 1161), known in the West as Avenzoar, is thought[by whom?] to have made the earliest description of bezoar stones as medicinal items.[15] Extensive reference to bezoars also appears in the Picatrix.

In 1567, French surgeon Ambroise Paré did not believe that it was possible for the bezoar to cure the effects of any poison and described an experiment to test the properties of the stone. A cook in the King's court was sentenced to death and chose to be poisoned rather than hanged, under the condition that he would be given a bezoar after the poison. Paré administered the bezoar stone to the cook, but it had no effect, and the cook died in agony seven hours after taking the poison, proving that - contrary to popular belief - the bezoar could not cure all poisons.[16]

Modern examinations of the properties of bezoars by Gustaf Arrhenius and Andrew A. Benson of the Scripps Institution of Oceanography show that when bezoars are immersed in an arsenic-laced solution, they can remove the poison. The toxic compounds in arsenic are arsenate and arsenite; each is acted upon differently by the bezoars: arsenate is removed by being exchanged for phosphate in brushite found in the stones, while arsenite is bound to sulfur compounds in the protein of degraded hair, which is a key component in bezoars.[17]

A famous case in the common law of England (Chandelor v Lopus, 79 Eng Rep. 3, Cro. Jac. 4, Eng. Ct. Exch. 1603) announced the rule of caveat emptor ("let the buyer beware") if the goods purchased are not in fact genuine and effective. The case concerned a purchaser who sued for the return of the purchase price of an allegedly fraudulent bezoar.

Bezoars were important objects in cabinets of curiosity and in natural-history collections, mainly for their use in early-modern pharmacy and in the study of animal health.[18][19]

The Merck Manual of Diagnosis and Therapy notes that consumption of unripened persimmons has been identified as the main cause of epidemics of intestinal bezoars and that up to 90 percent of bezoars that occur from excessive consumption require surgery for removal.[20]

A 2013 review of three databases identified 24 publications presenting 46 patients treated with Coca-Cola for phytobezoars. Clinicians administered the cola in doses of 500 ml (18 imp fl oz; 17 US fl oz) to up to 3,000 ml (110 imp fl oz; 100 US fl oz) over 24 hours, orally or by gastric lavage. A total of 91.3% of patients had complete resolution after treatment with Coca-Cola: 50% after a single treatment, with others requiring cola plus endoscopic removal. Doctors resorted to surgical removal in four cases.[21]

See also

References

  1. ^ (1603) 79 ER 3
  2. ^ "bezoar" at Dorland's Medical Dictionary
  3. PMID 19070299
    .
  4. PMID 12795814
    .
  5. ^
    S2CID 3274380
    .
  6. S2CID 72704953
    .
  7. ^ Kishan, Asn; Kadli, NK (2001). "Bezoars". Bombay Hospital Journal. Archived from the original on 28 August 2008. Retrieved 31 October 2008.
  8. PMID 16330268
    .
  9. PMID 18309693. Archived from the original
    on 22 July 2011. Retrieved 19 December 2008.
  10. PMID 19077219
    . Referring to past reports [1-9], the period from the administration of Coca-Cola until the disappearance of the bezoars was a minimum of 1 day and a maximum of 2 months.
  11. PMID 19018222
    .
  12. ^ "Gastroparesis". Johns Hopkins Medicine. Johns Hopkins University. Retrieved 26 May 2021.
  13. ^ Harper, Douglas. "bezoar". Online Etymology Dictionary.
  14. PMID 24672418
    . Bezoars were introduced to Europe from the Middle East during the 11th century, and they were popular as medicinal remedies; however, their use started to fall out of favor by the 18th century.
  15. ISBN 978-1598842531
    .
  16. ^ Paget, Stephen (1897). Ambroise Paré and His Times, 1510–1590. G.P. Putnam's Sons. pp. 186–187.
  17. ^ "Bezoar Stones". Archived from the original on 16 January 2013. Retrieved 30 November 2012. Modern examinations of the properties of bezoars by Gustaf Arrhenius and Andrew A. Benson of the Scripps Institution of Oceanography have shown that they could, when immersed in an arsenic-laced solution, remove the poison. The toxic compounds in arsenic are arsenate and arsenite. Each is acted upon differently, but effectively, by bezoar stones. Arsenate is removed by being exchanged for phosphate in the mineral brushite, a crystalline structure found in the stones. Arsenite is found to bond to sulfur compounds in the protein of degraded hair, which is a key component in bezoars.
  18. S2CID 4947361
    .
  19. ^ Borschberg, Peter (2010). "The Euro-Asian trade in bezoar stones (approx. 1500 to 1700)". In North, Michael (ed.). Artistic and Cultural Exchanges between Europe and Asia, 1400-1900. Burlington: Ashgate.
  20. ^ Merck Manual, Rahway, New Jersey, Sixteenth Edition, Gastrointestinal Disorders, Section 52, p. 780
  21. PMID 23252775
    .

Bibliography

Further reading

  • Borschberg, Peter, "The Euro-Asian Trade in Bezoar Stones (approx. 1500-1700)", Artistic and Cultural Exchanges between Europe and Asia, 1400–1900: Rethinking Markets, Workshops and Collections, ed. Thomas DaCosta Kaufmann and Michael North, Aldershot: Ashgate, 2010, pp. 29–43.
  • Borschberg, Peter, "The Trade, Forgery and Medicinal Use of Porcupine Bezoars in the Early Modern Period (c.1500–1750)", ed. Carla Alferes Pinto, Oriente, vol. 14, Lisbon: Fundação Oriente, 2006.

External links

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