Category Archives: herbal medicine

“A very secure recipe for the cure of all kinds of tertian and quartan fevers”: Medicine and Malaria in Late-Colonial Lima

Albarello drug jar used for cinchona bark, Spain, 1731-1770. Image Credit: L0057419 Science Museum, London © Wellcome Images
Albarello drug jar used for cinchona bark, Spain, 1731-1770. Image Credit: L0057419 Science Museum, London © Wellcome Images

Stefanie Gänger

“Squeeze a serving of bitter oranges”, advised “The True Physician” (El Médico Verdadero), a manuscript recipe collection dated Lima 1771, “strain the juice through a canvas” and “blend that in a clean glazed pot with the same amount of pure water and with four ounces of white sugar”. “Bring that to a boil over the fire, then remove the (…) foam with a spoon (…) and when the decoction is clean you let it seethe a little longer and then remove it from the heat, let it cool, and (…) then add the amount of powdered cinchona they sell in the pharmacy for one real, or two adarmes of the said powder (…), tossing the decoction until it is well blended”. Taken “the day of the fever”, the recipe concluded, this was a most “secure” remedy “for the cure of all kinds of tertian and quartan fevers”. (1)

“The True Physician” is one of a handful of manuscript recipe collections from Lima and its environs that have survived into our present – in archives, private libraries or, as in this particular case, as transcriptions made by early-twentieth century historians. Virtually all of them contain one or several medicines against “tertian and quartan fevers” – afflictions that can retrospectively be diagnosed as plasmodium vivax and plasmodium malariae infections, forms of malaria that haunted the viceregal capital throughout the colonial period. Both vivax and malariae are nonfatal and more benign than the tropical form of malaria, falciparum, but both have relapses as their signature dynamic: large sectors of the Lima population in the late-colonial period would have been accustomed to suffering from bouts of malaria – chills and rigors that extend through febrile paroxysms every 48 or 72 hours – frequently in the course of their lives.

A number of publications in circulation in the city, from the yearly almanac to health advice manuals, counselled Lima’s inhabitants on how to prevent malarial fevers or afford relief if they struck. The anonymous author of “The True Physician” – the manuscript is only signed “un curioso, a term that referred broadly to persons who practised medicine without a medical degree – appears to have been an avid reader, particularly of the latter format. He had copied several passages from Manuel Gutierrez de los Rios’s handbook version of Francisco Solano de Luque’s 1732 Lapis Lydos Apollinis and of Benito Jerónimo Feijóo y Montenegro’s enlightened Teatro Crítico Universal (1726-1739), though he also adopted advice on nutriments from Ioannes Bruyerinus Campegius and cited a series of treatises on medicinal plants, from Pedanius Dioscorides and Ibn Masawaih to Hieronymus Bock. He probably belonged to the upper stratum of Spanish or elite Indian society in late-colonial Lima, the handful of men and women sufficiently well-off to be able to afford a medical library and not to mind spending a real or two on remedies. Possibly he was a householder, though one who felt called to dispense his knowledge beyond the circle of his family, to the men and women working on his estate and, occasionally – as transpires from his remarks – the priest of the local parish.

Though he cited profusely throughout the collection, the curioso also picked up ideas for recipes in conversation – orange juice to ease bladder irritations, for instance, from a story he heard about “the lawyer Casasola” who had “recovered from strangury accidentally just by eating sweet oranges”. He cited neither written nor oral authority, however, for his reliance on cinchona in the “very secure recipe”, perhaps because the bark was a widely shared empirical tradition by the late-eighteenth century. Cinchona had been part of Andean pharmacopeia long before it entered European materia medica in the mid-seventeenth century and a century later was administered by titled physicians, Indian healers and householders alike in Lima. The curioso found cinchona was a strikingly “infallible and certain” cure against malaria and so it was: the bark contains natural alkaloids that interfere with the growth and reproduction of the malarial parasites in the red blood cells and its administration would have afforded prompt relief from malarial fever. The bark requires no specific mode of preparation to unfold its curative properties. The reason behind the proliferation of culinary variations – especially sugary fruit concoctions – we find in medical notebooks like “The True Physician” presumably lay in the difficulty of getting a weakened sufferer to swallow the bark: cinchona tastes by all accounts sickeningly bitter.

I am still at the very beginning of my “Malaria and Medicine in Lima” project but I hope to have excited your anticipation; I will report more as the project progresses.

(1)    Receta muy segura para la curación de toda suerte de tercianas y quartanas de que siempre se han experimentado maravillosos efectos (1777), in: El Medico verdadero. Prontuario singular de varios selectisimos remedios, para los diversos males à que està expuesto el Cuerpo humano desde el instante que nace. You’ll find this and other Lima recipes transcribed in volume three of La medicina popular peruana, ed. Hermilio Valdizán and Angel Maldonado (Lima: Imprenta Torres Aguirre, 1922).

The Working of Herbs, Part 8: A Protocol for Evaluating Herbal Efficacy

By Anne Stobart

In a series of posts I have explored how we can know whether herbs might have really worked. It seems quite a while since the first post where I raised some historiographical questions (Part 1). In this eighth and last post of the series I want to conclude with (a) an overview of whether the herbs in a selected recipe might have had some efficacy and (b) a protocol for how historical researchers can approach the question of ‘Did the herbs work?’.

Did the herbs work in this recipe?

The recipe I originally picked to consider is the ‘water for affter Throwes’ (Part 2) which was much copied in a privately held seventeenth-century household recipe collection in South Devon (see Figure 1). A ‘throw’ is a ‘violent spasm or pang’, while ‘throwes’ refers to ‘labour-pangs’ (Oxford English Dictionary). Thus the ‘after throwes’ may have meant pains related to the expulsion of the placenta through uterine contraction, a normal part of childbirth (usually within 15–30 minutes of giving birth), or may have been related to more general pains in the hours following birth.

Figure 1. A water for affter Throwes (Lord and Lady Clifford recipe collection, 1689, in private archive, South Devon).
Figure 1. A water for affter Throwes (Lord and Lady Clifford recipe collection, 1689, in private archive, South Devon).

So back to my original question about this particular recipe, as to whether the herbs would have had any effect? This recipe for the ‘after throws’ contained five plants (hyssop, wild mint, groundsel, pennyroyal and balm). The historical indications (Part 3) for most of these plants are based on warming qualities, and longstanding use of several of the plants in women’s conditions including promoting the ‘courses’ (menstruation) and in childbirth-related contexts.

Based on today’s knowledge of constituents and their effects, this combination of herbs provides for a number of possible actions including both stimulant and anti-spasmodic effects on the uterus. The aromatic distilled herbal constituents would include terpenes to provide both antispasmodic relief (from the pains of afterbirth) and uterine stimulation (to help ensure that the contents of the womb are expelled after childbirth). Thus, this combination of herbs might not have a single effect but provides for several relevant and, at first sight, apparently opposite actions (antispasmodic and stimulant). However, it is likely that stimulating more effective uterine expulsion could help to reduce pains after birth, so the overall effect would be the intended one. Such herbal combinations, with a diverse range of therapeutic effects, appear often both in modern and historical contexts.

So the herbs in this recipe could have been effective. However, this effect would depend on the dose given. One version of this recipe indicates that it was made to be given as a drink (‘giue a gill of this water milke warme with some sugar, in it to the patient before sleepe after deliuery being laid in bed first’, Figure 1). Some therapeutic effect is possible since a ‘gill’ is a quarter of a pint (around 150 ml) though it is not feasible to gauge this accurately.

How to approach the question ‘Did the herbs work?’: A draft protocol for considering herbal efficacy

Herbal medicines in a variety of containers] Tacuini sanitatis Elluchasem Elimithar medici de Baldath, de sex rebus non naturalibus, Joannem Schottum, 1531 p. 111. Courtesy of the National Library of Medicine.
Figure 2. [Herbal medicines in a variety of containers] Tacuini sanitatis Elluchasem Elimithar medici de Baldath, de sex rebus non naturalibus, Joannem Schottum, 1531, p. 111. Courtesy of the National Library of Medicine.
I have argued that further understanding of  the way in which particular herbs might work can be assisted by use of good quality herbal monographs (Part 4) which identify constituents and herbal actions (Part 5 and Part 6). Additional considerations are the many ways in which a recipe might be prepared (Part 7) and dosage (this post, Part 8). My posts have dipped into a few examples – so much more could be said!

Overall, the protocol which I have followed involves the following steps:

(1) Clarify the recipe purpose and identify the recipe ingredients (including species and parts of plants)

(2) Identify sources for contemporary indications for the plants (for example based on printed herbals or medical advice books)

(3) Locate reliable modern sources on the plant constituents and actions (such as a referenced monograph)

(4) Consider the extraction processes and form of preparation, possible interaction of herbs, and the dosage (if known)

(5) Summarise the contemporary understanding of the plants alongside their potential efficacy according to best scientific evidence.

An assessment of (3) and (4), evaluating the herbal constituents and actions as well as the form of preparation, could be assisted by linking up with a clinical herbal practitioner. I hope that such partnerships can be further developed so that we are more able to understand potential efficacy. Of course, even if we understand today that the medicinal herbs might have been efficacious, this does not provide evidence that the recipe was used!

Conclusion

I started out on this series of posts to think through how we can use today’s knowledge about plants in interpreting the past. It bothered me that much information on herbs is so readily repeated without adequate referencing of sources. I hope that I have made some useful suggestions in these posts about how to find and use reliable sources. I would welcome queries and the thoughts of others on the ‘Working of Herbs’.

The Working of Herbs, Part 7: Preparing Herbs Together in a Recipe

By Anne Stobart

In a previous post I looked at how herbs in a recipe might work medicinally. But medicinal recipes rarely contain a single ingredient (which would be known as a ‘simple’), and so we should also assess how the herbal ingredients in a recipe might work together. Much depends on the kind of preparation used in a recipe and how the combination of herbs might work together.

What kind of preparation?

Fortunately many recipes tell us about the processing steps involved–which may include grinding, mixing, straining, heating and more. Once we identify the form of preparation, we can consider

  1. which medicinal constituents might be extracted
  2. the likely bio-availability of the constituents and
  3. other benefits or disadvantages arising from combining the herbs.

(1) Extracting medicinal constituents

The way in which recipe ingredients are processed is significant as, broadly speaking, different plant constituents will dissolve best in water or alcohol. Most of us are familiar with the process of standing leafy herbs in hot water to make tea, and such an infusion will dissolve constituents like tannins and alkaloids. A decoction is based on a lengthier process of boiling bark and roots and may extract more constituents. However aromatic or resinous constituents need to be dissolved in alcohol or evaporated. The process of distillation is likely to produce more aromatic results which I look at it in more detail below. Other processes might not involve liquids at all, for example when ingredients are burnt to ashes – leaving mostly mineral salts.

(2) Bio-availability and choice of preparation

Bio-availability refers to the extent of absorption of nutrients or medicaments in the body and the amount of active substance which is made available in the body. The type of preparation indicated in a recipe can have a considerable effect. For example, the use of oils and fats as a vehicle (or carrier) in an ointment is essential for plant constituents to be absorbed and penetrate the skin barrier. However, the importance of preparation and bio-availability is an aspect of herbal history which is poorly understood despite numerous research studies in ethnopharmacology.[1]

(3) Combining herbs

Synergy (the whole is greater than the parts) is an important concept in modern clinical herbal practice. Some plant constituents are known to enhance the action of others or make phytochemicals more readily available in the body.[2,3]

Distillation – the process

Woman with bellows. Michael Schrick, Von allen geprenten Wassern (Nürenberg: Jobst Gutknecht, 1530, title page). Image credit: National Library of Medicine.
Woman with bellows. Michael Schrick, Von allen geprenten Wassern (Nürenberg: Jobst Gutknecht, 1530, title page). Image credit: National Library of Medicine.

The process of distillation would have had a significant effect in isolating the more soluble and readily evaporated plant constituents, the terpenes. This usually involved boiling plants in water and collecting the steam when cooled back to a liquid, as in the image above.[4] The product of distillation includes both floral waters and essential oils which float on top of the water and so can be separated. As a rough guide, many plants yield around 1% of essential oil from steam-treated plant material, as well as larger quantities of a floral water. [5] The recipe I have been looking at in recent posts involves distillation.

The receit of the water for affter Throwes

Take two hanfull of Isope two of peneroyall and two hanfull of Groundsell one handfull of wild mints two hanfulls of balme: …. then still the hearbes and water togather in a rose still then let the Glass bottle stand in the Sume Sinnce two Months Close Stopped from any Ayre it Makes the water much better.

This recipe would have produced a distilled water containing small amounts of essential oils, known as a hydrolat.[6] Of particular note, the immediate products of a distillation are often chemically reactive and the instruction to let the distilled water stand for two months would give a more stable aromatic product. The resulting water would have contained greater quantities of terpenes or essential oils than an infusion and relatively few alkaloids.

Towards a protocol for the working of herbs

In this series of posts I have been aiming to make explicit the various issues and resources that may be relevant in thinking about the potential medicinal actions of herbs in recipes. In the next post (and last in the series of eight) I will overview the protocol as a whole.

Notes

[1] See ‘Introduction’ in Susan Francia and Anne Stobart, eds. Critical Approaches to the History of Western Herbal Medicine: From Classical Antiquity to the Early Modern Period. London: Bloomsbury, 2014, p.6 and n.22.

[2] Simon Mills and Kerry Bone. Principles and Practice of Phytotherapy. Churchill Livingstone, 2000, p.23.

[3] See Francis J. Brinker. Complex Herbs – Complete Medicines: A Merger of Eclectic & Naturopathic Visions of Botanical Medicine. Sandy, Oregon: Eclectic Medical Publications, 2004.

[4] See also Anne C. Wilson, Water of Life: A History of Wine-Distilling and Spirits, 500 BC-AD 2000. Totnes: Prospect Books, 2006.

[5] Jane Buckle. Clinical Aromatherapy: Essential Oils in Practice. 2nd ed. Philadelphia: Churchill Livingstone, 2003, pp.59-61.

[6] Shirley Price and Len Price. Understanding Hydrolats: The Specific Hydrosols for Aromatherapy. Edinburgh: Churchill Livingstone, 2004.

The Working of Herbs, Part 5: Medicinal Herb Constituents and Actions

By Anne Stobart

In this post I look at some plant constituents and actions. I am especially interested in the plants in a seventeenth-century recipe introduced in Working of Herbs, Part 2. Previously I raised issues related to finding out how medicinal herbs might work (Part 1), and locating modern herbal monographs (Part 4). Here I look at herb constituents and their actions because these are directly relevant to considering how a herb may take effect (or not) in a recipe. Of course, not everyone feels comfortable with the chemistry of plants so I have added some further suggestions in case this topic makes you go ‘AAArgh!’.

Phytochemicals and actions

Phytochemicals, or herb constituents, are fascinating (to me at least!). Knowing the likely effects of some key phytochemicals can be a great help in considering the herbs in recipes. Amongst the  thousands of chemicals in each plant, it is often the ‘secondary metabolites’ produced as a defence against pests and diseases that can be used to some effect in our own bodies.[1] Some have powerful effects, like Groundsel (Senecio vulgaris) which contains toxic alkaloids (Figure 1). Many phytochemicals are surprisingly well-researched so that we know about their likely effects – their herbal actions – even though clinical uses are much less well researched. Here I introduce an important group of plant constituents – the terpenes.

Figure 1. Groundsel (Senecio vulgaris) image from Wikipedia
Figure 1. Groundsel (Senecio vulgaris) image from Wikipedia

What are terpenes?

Terpenes consist of chains of carbon and hydrogen units. They act as a deterrent to insect pests as well as inhibiting fungi and bacteria. The terpenes and related compounds are highly aromatic: many evaporate readily and form the basis of essential oils extracted from plants by distillation.

Plants in the Mint family (Lamiaceae, previously known as Labiatae) contain terpenes which vary considerably in action from stimulant to sedative effects. The simpler stimulant monoterpenes include molecules like menthol with a recognisable minty aroma. Some of these smaller molecules are highly active, often metabolized quickly in the body, with significant neurotoxic effects. Thujone (Figure 2)  is one such monoterpene with a reputation for toxicity. It is found in wormwood (Artemisia absinthum), an extremely bitter-tasting plant in the Daisy family used in the making of absinthe.[2] Thujone is also found in some Mint family members like hyssop (Hyssopus officinalis) and sage (Salvia officinalis). This monoterpene acts on uterine muscle, causing contractions, and hence has a reputation as an abortifacient. Such plant constituents are one reason for caution regarding the use of essential oils in pregnancy.[3]

Figure 2. Thujone
Figure 2. Thujone

Other terpenes, such as diterpenes and sesquiterpenes, have a wide range of therapeutic effects – often particularly anti-spasmodic and calming actions. Both the Mint family (such as lemon balm (Melissa officinalis) and lavender (Lavandula angustifolia)), and the Daisy family (such as chamomile (Matricaria chamomilla) and yarrow (Achillea millefolium)  demonstrate these actions.

 

Other plant constituent groups

Figure 3. Cyanidin, a flavonoid (Wikipedia)
Figure 3. Cyanidin, a flavonoid (Wikipedia)

Another important group of constituents is that of flavonoids which can often be recognised by plant colouring (especially yellows, reds, purples). Flavonoids are polyphenols, consisting of linked rings of carbon atoms (Figure 3), and many are antinflammatory. Some other groups of plant constituents are less obvious, such as the colourless and odourless alkaloids. Alkaloids can significantly affect the nervous system either as stimulants (like caffeine in coffee berries) or as sedatives (morphine-like compounds in poppies). These and other kinds of plant constituents provide for an extensive range of herbal actions.

Conclusion – ask a herbal expert!

I guess some readers will be thinking ‘This is too much chemistry – help!’. If you are not so keen on the chemistry then perhaps you could link up with a clinical herbal practitioner who can help with understanding herb constituents and actions. In the UK you can find a herbalist through a professional organisation like the National Institute of Medical Herbalists. Alternatively you could consider posting a question to HIST-HERB-MED. This is a JISC-MAIL email discussion list which I help to co-ordinate for active researchers in the history of herbal medicine – replies are not guaranteed but might provide useful leads to helpful individuals or sources.

Notes

[1] A standard text on plant constituents is William C. Evans, Trease and Evans’ Pharmacognosy, 16th ed. (Elsevier, 2009). Also see Gunnar Samuelsson, Drugs of Natural Origin: A Textbook of Pharmacognosy (Stockholm: Swedish Pharmaceutical Press, 1992).

[2] However, the toxicity of absinthe may be partly due to the high level of alcohol consumed by regular drinkers, Karin M. Hold, et al., ‘A-thujone (the active component of absinthe): G-aminobutyric acid type a receptor modulation and metabolic detoxification’. Proc. Natl. Acad. Sci. USA 97, no. 8 (2000): 3826–31.

[3] More on herbs with abortifacient actions in John Riddle, Eve’s Herbs: A History of Contraception and Abortion in the West  (Cambridge: Harvard University Press, 1997).