10 Dubious Victorian Cures From the First Merck Manual of Diagnosis and Therapy

Wellcome Images // CC BY 4.0 (cropped)
Wellcome Images // CC BY 4.0 (cropped)

In his work Of the Epidemics, the Greek physician Hippocrates encouraged doctors to “have two special objects in view with regard to disease, namely, to do good or to do no harm.” Yet the history of medicine has been an exercise in trial and error, with remedies sometimes proving more dangerous than the disease.

Examples of such dubious and sometimes potentially deadly cures abound in the first edition of The Merck Manual of Diagnosis and Therapy, the oldest continuously published English-language medical textbook. First published by the American drug manufacturer Merck & Co in 1899, the manual’s original edition suggests remedies such as hot baths for heat exhaustion, coffee for insomnia, nitroglycerin for headaches, and opium for constipation.

“What’s most fascinating to me are drugs that have an immediate dangerous effect,” says Robert S. Porter, M.D., editor-in-chief of the manual’s 20th edition, which was published earlier this year. “Cocaine for angina? Cocaine is a vasoconstrictor that causes heart attack. Give it to someone with angina and they might die. The bulk of the book is things that simply don't work—that are useless or odd—but these ones really raise questions as to how people could recommend them.”

Here's a selection of puzzling remedies from the first edition, some of which went on to be recommended for decades.

1. ARSENIC FOR ANEMIA

A page from the Merck Manual about anemia
Merck's 1899 Manual of the Materia Medica, Internet Archive // Public Domain

Arsenic was one of the top remedies the manual recommended for anemia. Though arsenic had been known as a poison since ancient times, medicines containing small doses of the substance were long used for conditions ranging from anthrax to syphilis to anemia. By the 19th century, arsenic was being inhaled as vapors, ingested, injected, and given in enemas for a variety of ailments. In fact, so many people suffered symptoms—such as rashes, stomach distress, and headaches—from taking arsenic remedies during the Victorian era that their ailments are now sometimes referred to as “Fowler’s disease," after the popular remedy Fowler’s Solution, which contained potassium arsenite.

2. LAXATIVES FOR CHICKENPOX

A page from the Merck Manual about chickenpox
Merck's 1899 Manual of the Materia Medica, Internet Archive // Public Domain

Before chickenpox vaccinations became available in the U.S. in 1995, an average of 4 million people each year suffered through itchy outbreaks. When the Merck Manual was first published, part of the comprehensive treatment plan for an "eruptive fever"—whether it was chickenpox, smallpox, or scarlet fever—was laxatives, ideally a dose of castor oil. The idea was to purge the body of the infectious disease, but such treatment usually just compounded the misery and forced the patient to stay close to the toilet.

3. STRYCHNINE FOR CONSTIPATION

A page from the Merck Manual about constipation
Merck's 1899 Manual of the Materia Medica, Internet Archive // Public Domain

Even a tiny dose of strychnine can cause convulsions. Yet the Merck Manual, following the medical practice of the day, recommended small amounts as a treatment for acute constipation. Commonly derived from the plant Strychnos nux-vomica, strychnine was thought to improve gastric function. (Strychnine injections were also recommended for both flatulence and ulcers.) Opium and turpentine were also recommended, but patients probably derived more relief from the less dramatic manual-recommended regimens, such as eating apples and figs or drinking coffee.

4. CHLOROFORM FOR HICCUPS

A page from the Merck Manual about hiccups
Merck's 1899 Manual of the Materia Medica, Internet Archive // Public Domain

Bad case of the hiccups? Today, you might be told to hold your breath or drink water. But in 1899, your doctor might recommend inhaling chloroform. An organic compound that also a popular anesthetic in the 19th and early 20th century, chloroform eventually fell out of favor because of its potential to damage the nervous system, liver, and kidneys. Other hiccup remedies listed in the Merck manual included nitroglycerin and the slightly less toxic sugar and vinegar.

5. INHALING SMOKE FOR ASTHMA

A page from the Merck Manual about asthma
Merck's 1899 Manual of the Materia Medica, Internet Archive // Public Domain

As counterintuitive as it seems today, the manual noted that "smoking is sometimes beneficial" for asthma, adding that “cannabis indica can be used in chronic cases.” The manual was far from alone in recommending the practice; throughout the late 19th and early 20th centuries, inhaling the fumes of tobacco and cannabis, as well as stramonium (a hallucination-inducing nightshade) and lobelia (a flowering plant known for its sedative properties) were popular treatments for asthmatics. There were even special anti-asthma cigarettes. We now know that inhaling any kind of smoke has been shown to damage and eventually reduce the number of cilia—the fine lung filaments which, when healthy, help transport mucus in the lungs—which only leads to a worsening of asthma symptoms.

6. BLOODLETTING FOR NAUSEA

A page from the Merck Manual about nausea
Merck's 1899 Manual of the Materia Medica, Internet Archive // Public Domain

Bloodletting—with leeches or other means—has been used to treat various ailments, including excessive bleeding, for thousands of years. The Ancient Greek physicians thought that it was sometimes necessary to balance blood and other bodily fluids, known as humors. The practice remained a standard treatment for many ailments, including nausea and morning sickness during pregnancy, well into the 19th century. It was thought to regulate the pulse, alleviate fever, and calm pain. While bloodletting can actually help with a few conditions, such as hemochromatosis (a genetic disorder leading to abnormal iron accumulation in the liver), doctors eventually realized that bleeding could also weaken patients and that frequent cutting could lead to infections.

As well as this traditional remedy, the manual’s first edition also recommended cocaine, the wonder drug of the day, to treat all kinds of nausea. Better and less stomach-turning effects could have been achieved with another recommended remedy: cinnamon.

7. COLD DOUCHES FOR INSOMNIA

A page from the Merck Manual about insomnia
Merck's 1899 Manual of the Materia Medica, Internet Archive // Public Domain

Alcohol, cannabis indica, and “cold douches” were effective remedies for insomnia, according to the Merck Manual. Cold douches—being blasted with cold water—might not seem sleep-inducing, yet in the late 19th and early 20th century this form of hydrotherapy was recommended as a way to improve circulation, fight infection, and treat headaches as well as insomnia. “By this means, the brain is enabled to resume a healthier mode of action, and sleep follows as a matter of course,” wrote Dr. Henry M. Lyman in his 1885 book Insomnia and Other Disorders of Sleep. Other remedies the manual recommended for insomnia included coffee, alcohol, and putting hot water bags on your feet while applying cold ones to your head.

8. BELLADONNA FOR COLIC

A page from the Merck Manual about colic
Merck's 1899 Manual of the Materia Medica, Internet Archive // Public Domain

Misguided medical notions were also applied to easing colic—the severe bouts of stomach pain often suffered by very young babies. The Merck Manual recommended ammonia, turpentine, and belladonna—a poisonous plant in the deadly nightshade family—for relief from colic spasms. Belladonna is still used modern medicines for adults (it's the main ingredient in the drops your eye doctor uses to dilate your eyes), but according to the FDA, “there is no known safe dose or toxic dose of belladonna in children.” In 2010, the FDA warned against its use in homeopathic teething tablets.

9. LEECHES FOR EARACHES

A page from the Merck Manual about leeches for earaches
Merck's 1899 Manual of the Materia Medica, Internet Archive // Public Domain

Using leeches for an ear infection might sound disgusting at best, but there was some medical justification for the manual's recommendation. Once leeches are firmly attached to their host, they can numb pain, while peptides and proteins in their saliva prevent blood clotting, so they can help drain an infection. Modern medicine has recently taken another look at leeches: In 2004, the FDA decided the creatures met the definition of a live medical device, since their tiny jaws (and anticoagulants) keep blood flowing, which helps wounds to heal. They can also be used to break up blood clots, treat varicose veins, and improve other circulatory disorders.

10. COCAINE FOR ALCOHOLISM

A page from the Merck Manual about alcoholism
Merck's 1899 Manual of the Materia Medica, Internet Archive // Public Domain

In the 1880s, Sigmund Freud helped popularize the idea of using cocaine to treat alcoholism, calling it a “magical drug.” In its heyday, cocaine was also promoted as a cure for morphine addiction, depression, anxiety, fatigue, and migraines. It was available over the counter in tonics, powders, wines, and soft drinks. Patients likely felt energized by regular cocaine infusions, but they soon became habituated. (Freud experimented on himself for a few years until the mounting evidence of cocaine’s addictive nature proved too much to ignore; the drug was made illegal in the U.S. in 1914.) The 1899 manual also offered simpler, less dangerous—but also likely ineffective—ways to battle alcohol cravings, including slowly sucking an orange or drinking water hot ("one pint drunk as hot as possible an hour before meals will remove craving"), or cold in small sips.

17 Funny Facts About Schitt's Creek

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Schitt’s Creek is a classic fish-out-of-water story: After they lose their entire video store fortune to the government because their business manager hasn't been paying their taxes, the Rose family—parents Johnny (Eugene Levy) and Moira (Catherine O'Hara) and their adult children David (Daniel Levy) and Alexis (Annie Murphy)—head to the only asset the government has allowed them to keep: the town of Schitt’s Creek. The cosmopolitan Roses, who had purchased the town as a joke, move in to the local motel, where they share two adjoining rooms; they stick out like sore thumbs in their new home.

But at its heart, Schitt’s Creek is a show about family. “We’ve used a fish out of water scenario to help dramatize that story,” co-creator and star Daniel Levy told Assignment X, “forcing them into a motel room and ... examining what it means to be a family and what relationships are and having the time to concentrate and focus on who they are to each other and what they mean to each other.” Here are a few things you might not have known about the series.

1. Reality TV inspired some elements of Schitt's Creek.

Annie Murphy as Alexis Rose and Jennifer Robertson as Jocelyn Schitt in Schitt's Creek.
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Daniel told Out in 2015 that “It really just started with me being in Los Angeles, knowing that I wanted to write. I had been watching some reality TV at the time and was concentrating on what would happen if one of these wealthy families would lose everything. Would the Kardashians still be the Kardashians without their money?”

Annie Murphy recounted at 92Y Talks in 2018 that she looked to the Kardashians for inspiration for her character. “I watched a bunch of clips—YouTube clips, because I couldn’t bring myself to watch entire shows—of, you know, Kardashians and that kind of thing” for some of Alexis’s tone and mannerisms, including the particular way she holds her hands, she explained. “When they hold their handbags, they hold their purses [on their arms] with their broken wrist this way,” Murphy said, pantomiming someone holding a bag with their hand hanging limply, palm up. For Alexis, she flipped her wrist so that her hand was hanging palm down (you can see it in action here).

2. Schitt's Creek is a family affair.

To flesh out his idea, Levy turned to his dad, frequent Christopher Guest collaborator (and American Pie star) Eugene. The two had never worked together before; in fact, pre-Schitt’s, Daniel had been adamant about doing his own thing. “People are so quick to judge children of people in entertainment,” he told Assignment X. “I just thought, if nobody knows the association and I’m able to build something for myself, then I can introduce my dad—when people actually respect me for what I’ve done, as opposed to snap-judge why I got the job or what I was doing.”

Why go to him for Schitt’s? As Daniel explained to NPR, he had seen the family-loses-it-all idea “played out on mainstream television and sitcoms, but I'd never really seen it explored through the lens of a certain style of realist comedy that my dad does so well. So I came to him and pitched the idea and asked him if he would be interested at all in just fleshing it out and seeing if there was anything there. And fortunately, there was some interest and we started talking.”

Eugene told The New York Times that he was thrilled to have the chance to collaborate with his son: “My heart was actually palpitating. You could see it over my shirt.”

(Eugene and Daniel aren't the only Levys on the show, either: Sarah Levy, daughter of Eugene and sister of Daniel, also appears on Schitt’s Creek as Twyla Sands, the lone waitress at the town’s most happening diner, Cafe Tropical.)

3. Eugene Levy came up with the title Schitt's Creek.

“It was actually just out of coincidence really," Daniel told Out. "He was having a dinner conversation a few weeks prior, about this theoretical town of Schitt's Creek: You would have Schitt Hardware and Schitt Grocers." When they were researching ways that people had lost their fortunes, they came across stories of people who had bought towns for various reasons and later ended up bankrupt. “We thought, well, what if this family, as a joke for the son's 16th birthday, found this town called Schitt's Creek, bought it as a joke because of the name and then ended up having to live there?” Daniel said.

The show’s name can make promotional tours interesting: Not all TV or radio outlets can say it, for fear of being fined for using profanity. On The Late Show with Stephen Colbert, for example, the name of the show has to appear on screen every time it’s spoken aloud.

4. Annie Murphy also auditioned for the role of Stevie Budd.

At a 92Y Talks discussion in 2016, Murphy revealed that she auditioned for both Stevie Budd—the deadpan concierge at the Schitt’s Creek motel where the Roses make their home—and Alexis, the self-centered socialite character she would eventually play. “I’ve never worked so hard at an audition in my life,” she said. “I made my husband rehearse it with me just into the ground.”

In the presentation pilot—which is meant to secure a season order and not destined to air on TV—Alexis had been played by Abby Elliott, who couldn’t continue on the show because of another project. So auditions were held in Los Angeles, where Daniel said they saw “hundreds” of people for the role.

“There had to be some kind of intrinsic likeability to this family, otherwise there’s really no reason to watch—because on paper they’re not very likeable,” he said. “I had been sitting through two days of auditions, and you see these girls come in and they’re dressed like Paris Hilton and they’re playing that part, which was essentially the part that was written on paper. But what I was looking for was what Annie brought in, which was this wonderfully natural likeability to this girl who is so unlikeable, who is so, like, horrifyingly self-involved … It all kind of fell into place, and I called my dad and said ‘I found Alexis, thank god.’”

But Eugene’s immediate response, according to Daniel, was that Murphy had brown hair, unlike the blonde vision of Alexis he had in his head from the pilot. So they had Murphy read for Stevie, because, Daniel said, “I’m not not having her on the show.” When Murphy landed the role of Alexis, she dyed her hair blonde, and Emily Hampshire was cast as Stevie (who had been played by Lindsay Sloane in the pilot).

5. Emily Hampshire doesn't remember anything about her audition.

Emily Hampshire as Stevie Budd in Schitt's Creek.
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When she got the audition for Schitt's Creek, Hampshire was living in L.A. and going through a rough time. "I literally had $800 in my bank account, hadn't worked in a year, was getting a divorce," she tells Mental Floss.

To make matters worse, she was also breaking out into hives when she went out on auditions. So when her agent called about Schitt's, Hampshire said she absolutely couldn't go read in person; what she could do instead was put herself on tape. But at her agent’s insistence, Hampshire went in to audition in front of Daniel and a casting director—and it was a memorable experience for everyone involved but her: Hampshire says she doesn't remember any of it.

Thankfully, Levy does. “Emily came in and immediately said, ‘I’m sorry, this is going to be terrible,’” he recalled at 92Y Talks in 2018. “She did it, and it was great, and I remember saying … ‘Why don’t we just try it where she gets a little more kick out of these people. She’s not just judging them, she’s like, enjoying them, too.’ So she did it again, and you can tell when it clicks … and I remember saying, ‘Great, we’re good,’ and she was like, ‘no, it was—oh god, it was terrible, it was so bad.’” Then, she covered her head with her shirt to hide. Hampshire doesn’t remember that part, either, but, said Levy, “I remember it fondly.”

6. Stevie is the audience's stand-in.

“The character of Stevie has always acted as the eyes of the audience," Daniel said during a 92Y Talks in 2018. "She is the person who is going to say the things that the audience is probably saying to each other while watching it. And I think it’s always important to have that one character on the show that you can trust.”

That was something that resonated with Hampshire. "I think what I connected to in Stevie is that she really stands in for the audience in a way," Hampshire says, "and I felt like I just had to watch these people around me and take them in in an honest way and it would be funny."

In the character breakdown she received when she auditioned, Hampshire says that Stevie was described as "being from a small town, and she's very deadpan." But over the course of four seasons, Stevie has evolved. In season one, Hampshire says, "I don’t think she had any attachment to the motel or to anyone—on purpose. To not be attached or kind of be emotionally invested in anything is a much safer place to be. Over four seasons, she has opened up. I think Stevie grows up a lot this season and really learns to take responsibility for things that I don't think she ever wanted to take responsibility for."

In the fourth season, viewers will see how deep Stevie and David's friendship is, and her partnership with Johnny in running the motel gives her "a new support system that allows her to bloom into whatever kind of special thing she's going to become," Hampshire says.

7. Catherine O'Hara brought something special to the character of Moira Rose.

It was Eugene who suggested O’Hara—his frequent collaborator in Guest’s mockumentaries—for the part of Moira Rose. “I was not going to say, ‘No, that’s not a good idea,’” Daniel told The New York Times. “When he offers up Catherine O’Hara, you take it and run with it.”

And Moira’s eccentricities are all O’Hara’s doing. “We always knew Moira was an actress, an ex-soap star, who became a socialite, chairing major charity events around the world,” Eugene told The Hollywood Reporter. “But Catherine, who always brings something so creative to the table, added a very extreme affectation to her actress character that made Moira so much funnier than we had imagined her.”

O’Hara told Awards Daily that her character’s voice is “kind of a mix of people I’ve met. There’s one woman who’s very feminine and lovely. She just has a unique way of putting sentences together.” Inspiration can come from other sources, too: In the Season 3 episode “New Car,” O’Hara at one point had to use a British accent. “There’s a woman on Sirius radio who claims to be a dog whisperer or pet psychic. Have you heard this woman?” she asked Awards Daily. “That’s basically the accent I’m doing.”

8. Moira's aesthetic is based on Daphne Guinness.

Eugene Levy as Johnny Rose and Catherine O'Hara as Moira Rose in Schitt's Creek.
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“Catherine came in with a reference, when we first started exploring what the aesthetic of this strange woman would be, and she brought in a picture of Daphne Guinness, who is the heir to the Guinness fortune,” Daniel said at 92Y Talks in 2018. “And she was a McQueen muse, and I looked at it, and I said ‘How do we translate this to television?’ And we thought if we kept it in black and whites and went just far enough, I think we can sort of rein it in.”

Moira’s over-the-top looks (which include a number of wigs that, according to Hampshire, have names) are created by Dan and Debra Hanson. “They shop all year because these characters have to have extremely high-end, designer wardrobes, but [the Roses] don’t have that money anymore,” O’Hara told Awards Daily. “I’ve never enjoyed wardrobe fittings in my life until now!”

9. The wardrobe on Schitt's Creek tells a story.

“Dan plays a big hand in the costuming, along with the costume designer Debra Hanson, who is amazing,” Murphy told Build. “Catherine and I do hours and hours of fittings before we start shooting. And I’ll come out of the room and Dan will be like, ‘Mm mm,’ and send me back in.”

After joking that that “makes me sound crazy,” Daniel said that “the mandate, from a creative standpoint … was that the wardrobe on this show is able to tell a story that we don’t have to write … we’re constantly reminded of who these people are and where they came from.”

Because the show is on a tight budget, lots of the wardrobe, he said, comes from eBay and thrift stores. Levy told Vulture in 2019 that all the clothes have to come from around the time when the Roses lost their money—and that the most he'll pay for any item is $200.

10. The location of Schitt's Creek is purposefully ambiguous.

Schitt’s Creek is a Canadian production, and the Rose family had a place in New York, but when people ask him where the town of Schitt’s Creek is located, Eugene says that he tells them it’s wherever they think it should be. “We didn’t set Schitt’s Creek in any location or any country, it’s just Schitt’s Creek,” he said at 92Y Talks in 2016. “We honestly wanted the focus of the show to be on this town, and if you put it in a country with real states or put it in a country with real provinces, then things become tangible … it kind of diffuses the focus to me.”

11. There's not a lot of improv on the Schitt's Creek set.

That fact might surprise fans of Eugene and O'Hara’s work on Guest films like Waiting for Guffman and Best in Show, where the cast works from an outline of the action with no dialogue rather than a traditional script. “[Schitt’s] is completely a scripted show, but we do an awful lot of playing around with the lines when we get to the set,” Eugene told The Hollywood Reporter. “What looked good on paper doesn’t always play when you hear the words out loud. So, we do change things until they end up sounding right.”

“When we get the script, I kind of work on it on my own and play with it then,” O’Hara told Awards Daily. “The Levy gentlemen give me respect, and I respect them and email them with possibilities. I don’t feel the need to improvise because our scripts are great.”

Which is not to say that everything is shot as written: Levy said at 92Y Talks in 2018 that Murphy’s “you get murdered first!” from the pilot episode was improvised.

12. The baseball team in the town where Schitt's Creek films changed its name to honor the show.

Schitt’s Creek films in Canada, in Goodwood, Ontario. “We did dingy up the town tremendously,” Daniel told NPR. “It is a lovely town that we had turned into the town of ‘Schitt's Creek.’”

All of the show's interiors are shot at a studio, but the buildings are actual structures in Goodwood, dressed to look like Schitt's Creek. According to Hampshire, many of the buildings are on a single intersection. "There’s Bob’s Garage, which is a garage, but we put a sign up, and then the café and the apothecary are stores," Hampshire says. "When we shoot there, we make them into our stores." The motel was, at one point, actually a motel. "It’s been since turned into this basketball boys club sleeping quarters camp thing," she says. "When we go in, it really smells like a locker room."

In the first season, locals set up lawn chairs to watch filming and wandered through shots; by the second season, Eugene told 92Y Talks in 2016, they were “proud citizens of Schitt’s Creek.” The town seems to have embraced its alter ego, as evidenced by the actions of its minor league baseball team. “They had a minor league kind of baseball team there that actually changed their name from the Goodwood Bears to the Schitt's Creek Bears for an entire month,” Eugene told NPR.

13. When it comes to Schitt's Creek, Daniel Levy leaves no detail unconsidered.

And that includes the wear and tear on the carpets in the mote. “In my head it’s like, ‘We should all know that they don’t vacuum their carpets all the time,’” Levy told GQ in 2019. "These are lived-in carpets. We’re in a motel. If we’re going to vacuum the carpets, which I know has to be done, we also need to scuff them up a bit after." He does all the scuffing himself: "It’s in the details for me, and when the details aren’t executed perfectly, I get a bit … ornery," he said. (But Daniel doesn't bring that energy to set: "It’s crazy how comfortable he is doing this, how calm and confident he is running the show," O'Hara told GQ.)

14. Chris Elliot makes Eugene break constantly.

Eugene Levy as Johnny Rose and Chris Elliott as Roland Schitt in Schitt's Creek.
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According to Murphy, Eugene “giggles like a schoolboy” in scenes with Chris Elliot, who plays Schitt’s Creek Mayor Roland Schitt. “He’s got my number,” Levy said in an interview with Build. “He’s constantly making me laugh on set … He does it intentionally, of course, and he actually succeeds.”

One scene in the show’s third season was particularly tough to get through and resulted in hours of outtakes: “[Chris] gets in kind of behind me, trying to show me how to hold a [golf] club properly,” Levy recalled. “That’s one of the times I think I laughed the hardest in the three seasons, was trying to get through that scene.” He couldn’t stop laughing and was eventually admonished by the director. (They did eventually get the shot.)

15. Cafe Tropical's menu is Murphy's favorite prop.

Jennifer Robinson as Jocelyn Schitt and Catherine O'Hara as Moira Rose in Schitt's Creek.
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Cafe Tropical’s huge menu is often played for laughs on Schitt’s Creek, and it’s Murphy’s favorite prop on the show. “I wish everyone could see the inside of the menu because it’s very detailed and there’s literally every dish you could possibly imagine,” Murphy said at 92Y Talks in 2018. “There are literally 150 things you could order on this menu, and they’re all described.” The props department couldn’t find a big enough real-life menu, so they ended up creating massive ones in a custom size.

16. Hampshire regularly borrows Stevie's clothes.

With her Chucks, flannels, and overalls, Stevie easily has the most comfortable wardrobe on Schitt's Creek. It's so comfortable, in fact, that Hampshire often borrows items to wear on her time off. "I always take this one pair of Stevie’s jeans that I love—they’re like the perfect baggy boyfriend roll-up jeans," Hampshire says. "I take hoodies. I actually take Stevie’s Converse because they’re better than my exact Converse for some reason. I always take her stuff, which Dan doesn't understand at all. He’s like, 'What is there to take? Like, why would you ever borrow this stuff?' But for some reason, the wardrobe women, they just find the perfect hoodie or the perfect jean—so I take those."

17. Season 6 of Schitt's Creek will be its last.

Daniel announced the news on Twitter in a letter written by himself and Eugene. "We are so grateful to have been given the time and creative freedom to tell this story in its totality, concluding with a final chapter that we had envisioned from the very beginning," they wrote. "It’s not lost on us what a rare privilege it is in this industry to get to decide when your show should take its final bow. We could never have dreamed that our fans would grow to love and care about these characters in the ways that you have.” The final season, which will consist of 14 episodes, will air on the CBC and Pop in 2020.

This piece was updated in 2019.

12 Famous Non-Brits Who Have Been Named Honorary Knights and Dames

Queen Elizabeth II attends The Order of the Garter Service in 2010 at St. George's Chapel, Windsor Castle in Windsor, England. The Order of the Garter is the most senior and the oldest British Order of Chivalry and was founded by Edward III in 1348.
Queen Elizabeth II attends The Order of the Garter Service in 2010 at St. George's Chapel, Windsor Castle in Windsor, England. The Order of the Garter is the most senior and the oldest British Order of Chivalry and was founded by Edward III in 1348.
Alastair Grant/WPA-Pool/Getty Images

Although chivalric orders for military members date back to the medieval period, King George V ushered in a new era for knights and dames when he established The Most Excellent Order of the British Empire in 1917. Appointees to the OBE don't have to see battle to be on the receiving end of the ceremonial sword tap (or its rather dull modern equivalent, the firm handshake), so long as they make a significant contribution to the arts, sciences, or any charitable organization outside the civil service.

In fact, you don't even have to be a British citizen to receive the honor. A large number of Americans have been awarded knighthood or damehood, and the privilege is potentially open to any non-Brit around the world. Though non-Commonwealth subjects are not extended the privilege of styling themselves Sir or Dame, as far as anything else is concerned, these famous figures are knights and dames just like any other.

1. Steven Spielberg

In 2001, director and producer Steven Spielberg received an honorary knighthood via British ambassador to the U.S., Sir Christopher Meyer. The ambassador noted that while Spielberg's commitment to movie magic had made a global impact, its effects on British cinema in particular were significant enough to double movie ticket sales since the early '80s (likely beginning with 1981's Raiders of the Lost Ark and 1982's E.T. The Extra-Terrestrial). Behind the scenes, Spielberg was also known to be a supporter of the local film industry, choosing to shoot massive productions like 2001's multi-part series Band of Brothers on location in England. Then-Prime Minister Tony Blair's son even got in on the action, spending a week on set for work experience.

"This is the stuff that all of our childhood fantasies come from," Spielberg said after his investiture. "You know, courtliness, civility, and honor."

2. Franco Zeffirelli

Spielberg was later joined in the ranks of honorary knights by fellow filmmaker Franco Zeffirelli, the first Italian to be so recognized. Zeffirelli earned his KBE in 2004 for "valuable services to British performing arts," including multiple acclaimed Shakespeare adaptations to film and stage, and 1999's Tea With Mussolini, a film that starred no fewer than three British dames: Judi Dench, Maggie Smith, and Joan Plowright. An Oscar nominee, Zeffirelli joyously proclaimed the knighthood to be "the greatest conquest, recognition, I have received in my life, practically."

3. Bono

Bono poses after receiving a knighthood in recognition of his services to the music industry and his humanitarian work in 2007.
Bono poses after receiving a knighthood in recognition of his services to the music industry and his humanitarian work in 2007.
ShowBizIreland/Getty Images

Paul Hewson—a.k.a. U2 lead singer Bono—falls into the category of honorary knights because he is an Irish citizen (like fellow honorary knight, Irishman Pierce Brosnan). Though Ireland is part of the British Isles, its citizens are not British and therefore not eligible for "substantive" knighthood (i.e., he can't style his name as Sir Bono, such as Sirs Elton John and Patrick Stewart, both British citizens, can). In the same year he shared the title of TIME Magazine's Person(s) of the Year with fellow philanthropists Bill and Melinda Gates, Bono was presented with honorary knighthood by the British ambassador to Ireland for his humanitarian work. The 2005 ceremony was made all the sweeter for taking place in Dublin, Bono's hometown.

4. and 5. Bill and Melinda Gates

Queen Elizabeth II presents Bill Gates with an honorary knighthood in 2005. His wife, Melinda Gates, would be named an honorary dame in 2014.
Queen Elizabeth II presents Bill Gates with an honorary knighthood in 2005. His wife, Melinda Gates, would be named an honorary dame in 2014.
Chris Young/ROTA/Getty Images

In addition to managing sums of wealth inconceivable to the average person, Bill Gates is also an honorary knight of the British Empire. In keeping with his multi-hyphenate role as billionaire-businessman-tech mogul-philanthropist, Gates was honored in 2005 for a string of contributions, from the 2000 British jobs created by Microsoft to the $210 million in scholarship grants from the Bill & Melinda Gates Foundation to Cambridge University to subsidize international graduate students. That number is just a fraction of the further $750 million the Foundation gave to help establish Gavi (once called the Global Alliance for Vaccines and Immunisation), a cornerstone of the couple's commitment to leveraging their wealth to improve public health in developing countries.

Melinda Gates attended her husband's ceremony with the Queen, but she had to wait nearly another decade to be honored for her role in the Foundation's charitable work—it wasn't until 2014 that she was named an honorary Dame Commander. In a simple message sent out on Twitter to accompany a photo from her ceremony, Gates said, "Honored to be named a Dame of the British Empire. The UK is a leader in fighting global poverty."

6. Ralph Lauren

In 2018, it was announced that Ralph Lauren would become the first American fashion designer to be honorarily knighted. In accordance with Lauren's penchant for putting his name on things, the Ralph Lauren Corporation established The Ralph Lauren Centre for Breast Cancer Research at the Royal Marsden Hospital in London, along with two other cancer centers in the United States. British Consul General Antony Phillipson recognized his commitment to public health research and treatment, along with his "key role in forging transatlantic cultural and economic connections" as "a vanguard for the global fashion industry." Lauren certainly has fans in high places: Duchesses Kate Middleton and Meghan Markle have both been known to wear his clothing, and one of the late Princess Diana's most iconic looks—a beaded, white, halter column gown—was a Lauren design she wore while honoring him at a fundraiser for his first cancer hospital.

7. Angelina Jolie

Queen Elizabeth II presents Angelina Jolie with the Insignia of an Honorary Dame Grand Cross of the Most Distinguished Order of St. Michael and St. George in 2014.
Queen Elizabeth II presents Angelina Jolie with the Insignia of an Honorary Dame Grand Cross of the Most Distinguished Order of St. Michael and St. George in 2014.
Anthony Devlin—WPA Pool/Getty Images

Despite first achieving fame for her Oscar-winning acting career, Angelina Jolie's royal accolade isn't an acknowledgment of her work in Hollywood. The Order of St. Michael and St. George, originally conceived as a means of honoring high-ranking officers of the Napoleonic Wars, has since been expanded to recognize "extraordinary or important non-military service in a foreign country." Jolie was appointed to the order in 2014 after years of humanitarian work, particularly with the United Nations and the Preventing Sexual Violence Initiative in the UK.

The announcement of Jolie's honor coincided with her co-chairing of the End Sexual Violence in Conflict global summit in London, when she gratefully received the news and reaffirmed that foreign policy is "what I wish to dedicate my working life to." She later received the title officially during a private audience with the Queen at Buckingham Palace.

8. Pelé

Considering soccer's venerated status as the national pastime (though technically, cricket is the country's national sport), it comes as no surprise that Britain's highest chivalric orders include more than a dozen professional footballers (as well as a large number of OBEs, like David Beckham). Onetime Brazilian Minister of Sport and UNESCO Goodwill Ambassador Edson Arantes do Nascimento—better known as Pelé—was once voted FIFA's "greatest footballer in the history of the game" and has certainly earned his right to be there. Although the honorary KBE was ostensibly granted in recognition of his humanitarian and environmental activism, in part as a United Nations ambassador for ecology and the environment, his holding the Guinness World Record for most career goals (at 1283) probably didn't hurt.

In 2017, 20 years later after his knighting ceremony, Pelé tweeted a throwback photo of himself proudly lifting his medal, and said the moment would "stay always in [his] memory."

9. and 10. Rudy Giuliani and Michael Bloomberg

Former New York Mayor Rudolph Giuliani shows of his Knighthood of the British Empire (KBE) medal in 2002.
Former New York Mayor Rudolph Giuliani shows of his Knighthood of the British Empire (KBE) medal in 2002.
Sion Touhig/Getty Images

In a true show of international diplomacy, Queen Elizabeth II bestowed an honorary knighthood on former New York City mayor Rudy Giuliani in 2002. Prince Andrew, Duke of York, made the formal announcement on Giuliani's home turf, declaring his nation's thanks for Giuliani's "outstanding help and support to the bereaved British families" in the wake of the September 11, 2001 attacks.

Giuliani later traveled to Buckingham Palace to join his fellow honorees before the Queen. She personally reiterated her gratitude for his leadership and wished him "less stress in [his] life now."

Michael Bloomberg, another notable NYC mayor, was also welcomed as an honorary Knight Commander of the British Empire for his "prodigious entrepreneurial and philanthropic endeavors." Bloomberg called the honor "especially meaningful" because he had long considered Britain a "second home." His official investiture was in 2015, though The New York Times reported that, in jest, someone once helped Bloomberg celebrate the opening of his company's London office decades before by donning full military regalia and dubbing him with a sword.

11. Plácido Domingo

For famed tenor Plácido Domingo, 2002 was a banner year. Shortly after the Spanish singer (one-third of the acclaimed opera supergroup The Three Tenors, with José Carreras and Luciano Pavarotti) was presented with the Presidential Medal of Freedom from President George W. Bush in July, he was invited to the British embassy in Washington, D.C. to be knighted by British Foreign Secretary Jack Straw in October. At age 61, Domingo had done performances at the Royal Opera House in London's Covent Garden for three decades, occasions that he considered "among [his] greatest experiences." At the time of his investiture, he'd sung 119 distinct operatic roles throughout his career, a higher number than anyone else in history. It only seems right that Domingo should also have a pile of commendations to match.

12. Douglas Fairbanks Jr.

Actor Douglas Fairbanks Jr. in 1958 wearing the mantle and insignia of a Knight of Justice of the Order of St. John.
Actor Douglas Fairbanks Jr. in 1958 wearing the mantle and insignia of a Knight of Justice of the Order of St. John.
Associated Press Wire Photo, Wikimedia Commons // Public Domain

When longtime leading man Douglas Fairbanks Jr. died in 2000, British newspaper The Independent lauded him as "Hollywood royalty and knight of the realm." For an American who never relinquished his citizenship, Fairbanks devoted a significant portion of his personal and professional life to England. As a lieutenant commander in the U.S. Navy during WWII, he served directly under Lord Mountbatten and played a key role in a number of combined British-American operations. His distinguished service earned him a knighthood from King George VI in 1949 for "furthering Anglo-American amity," and after taking a hiatus from acting, he and his family moved to London. Fairbanks kept a home in London for two decades and entertained acquaintances no less eminent than the royal family itself before retiring to the most American of locales: Palm Beach, Florida.

Never one for subtlety, Fairbanks took full advantage of his honorary knighthood. Though he was unable to style himself "Sir," he nonetheless designed a custom coat of arms with the Latin motto Fides, Conatus et Fidelitas, meaning "Faith, Striving, and Loyalty," in written along a scroll. It also features both a bald eagle and the circlet of the Order of the British Empire, perfectly befitting a man who loved countries.

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