Category Archives: herbal medicine

Testing Drugs and Trying Cures Workshop Summary

By Ashley Buchanan and Tillman Taape

What did it mean to test a drug or try a cure in the early modern world? This was the central question for a group of scholars who gathered for a workshop at Max Planck Institute for the History of Science in Berlin, Germany.  Since recipes emerged as one of the key themes throughout the workshop, and because the conference’s location in Berlin made it difficult for scholars outside of Europe to attend, we thought we might share a brief summary of the “Testing Drugs and Trying Cures” papers, in the hopes that we could bring the workshop’s key ideas and discussions to a larger audience.  What emerged from an exhilarating two days of discussion and debate was the conclusion that historians of science and medicine should not privilege experiment and experimentation as fixed categories, but should understand the multiple ways in which physicians, apothecaries, artisans, institutions, and individuals in the early modern world tested, tried, investigated, experienced, modified, observed, and measured medicinal remedies and materiae medicae.

As written forms of medical and pharmaceutical knowledge and practice, recipes played an important part in the testing of drugs and cures, and our discussion raised larger questions surrounding the nature and purpose of an early modern recipe.

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A miniature depicting the Schola Medica Salernitana from a copy of Avicenna’s Canons.  From Wikimedia Commons.

Michael McVaugh’s paper opened the discussion by exploring how medieval physicians went about testing drugs. Learned doctors in the Middle Ages might appear helplessly hidebound, and inclined to follow ancient authorities over experimentation. In contrast, McVaugh showed how a group of Montpellier physicians in the fourteenth century established something of an experimental program. Medieval physicians, however, were not testing to find a cure, but to determine the quality, strength, and effectiveness of a drug as it pertained to a particular person’s complexion. McVaugh underscored an important difference in the purpose of medieval drug testing. Physicians tested not for universal effectiveness, but to determine the quality of a drug – was it hot, cold, moist, or dry.

Duclos-title-page
Title page of the Academy’s Observations sur les eaux minérales (1675). From http://cures.hypotheses.org/the-workshop/programme-2/bycroft-michael

Although it became clear in our roundtable discussion that we should be wary of labeling such practices as obvious precursors to the experimental philosophies of the Scientific Revolution, many of the papers showed that the importance of specific tests resonated throughout the early modern period. Evan Ragland’s paper, for example, traced the use of the phrase periculum facere (‘to make a trial’) in physicians’ writings on medicine, anatomy and chemistry. Similarly, Michael Bycroft showed that French physicians and chemical experts of the Académie des Sciences became increasingly interested in the exact composition of mineral waters. Contrived tests such as color indicators or the analysis of residues after evaporation increasingly became the touchstone of proper inquiry.

McVaugh, Ragland, and Bycroft’s papers all underscored the need to understand the specific nature and purpose of testing in each historical context. Continuing to emphasize the importance of historical context, Francesco Paulo de Ceglia’s paper showed just how different the purpose of testing could be in the context of seventeenth century blood miracles in the Kingdom of Naples. Catholics tested the liquefaction of the blood of their patron saint to explore the limits of nature. By discovering nature’s limits, you could then determine what was truly miraculous. Protestants, on the other hand, tested various materials and recipes to recreate the liquefaction of blood to cast doubt on the alleged miracle.

san-gennaro
Reliquary containing a glass ampoule of San Gennaro’s blood. From La Repubblica.

In the context of testing, drugs and cures are often under scrutiny in the form of recipes detailing their production and administration. While recipes emerged from many of the papers as very important forms of knowledge, it proved virtually impossible to define exactly what a recipe was. Recipes can be very short or very detailed, ranging from a mere list of ingredients to careful step-by-step instructions. If there is one thing recipes have in common, it is the need for testing, trying, modifying and adapting to different conditions. While constructing an all-encompassing definition of a recipe proved futile, all agreed that it was fruitful to understand recipes as an important genre in early modern science and medicine.

apotheke_enhausen_l
From http://www.gn.geschichte.uni-muenchen.de/aktuelles/archiv_2011/archiv_2013/science_and_medicine/index.html

For her investigation on the testing practices of Venetian apothecaries, Valentina Pugliano emphasized the difference between experiment and experience. Venetian apothecaries were less concerned with testing drugs (in a traditional sense) than they were with the experience or truthfulness of their ingredients. Testing by inspection, smell and taste was also important in this pharmaceutical context, to ensure that the ingredients were what the merchant had promised them to be, and not a cheap substitute with inferior properties. For Pugliano’s apothecaries, the important issue that required testing was the authenticity of the ingredients rather than the efficacy of the finished product; after all, most preparations had proved their worth since antiquity. Like McVaugh, Pugliano questioned traditional “Baconian” understandings of what it meant to experiment and test and argued for more nuanced notions of testing and trying, which included observing, measuring, evaluating, and experiencing.

Image_Samir
Title page of Johannes Christophorus Homann’s Dissertatio inauguralis medica de medicinae cum geosophia nexu quam auspice deo prpitio (Hala Madgeburica, Hendelius, 1725). From http://cures.hypotheses.org/the-workshop/programme-2/boumediene-samir

With early modern Europeans’ increasing forays into the New World, however, more and more materiae medicae were found which were absent from ancient medical writings. Pliny and Dioscorides were silent on such substances as guaiacum wood, Peruvian bark or New World balsam, so their medicinal properties had to be newly investigated. Antonio Barrera-Osorio and Samir Boumediene’s papers added America, or the New World, into the discussion. Both emphasized the role of new drugs and materia medica in the rise of European experimental practices. New drugs and new medicinal recipes required new ways of testing.

Antonio Barrera-Osorio’s paper argued for an empirical culture in the Spanish empire, which was well suited to respond to these challenges. He showed how his protagonists gathered information about New World remedies from natives or travellers and experimented with ways of preparing them. Some of these drugs and recipes were deemed so important for the economy and health of the empire that the Spanish crown ordered tests in hospitals all over Castile. Samir Boumediene’s paper elaborated on the issue of making workable recipes for newly discovered drugs. Once more, taste and smell were important assays, but drugs such as guaiacum and Peruvian bark were also tested on a larger scale. Dispensing them to the poor inmates of charitable hospitals (as happened in France and Germany) helped to determine their effect, and to establish recipes, which indicated how to adjust the treatment in individual cases.

books
Andreas Cleyer, Specimen Medicinae Sinicae (Frankfurt, 1682). From http://cures.hypotheses.org/the-workshop/programme-2/hanson-marta-and-pomata-gianna

Gianna Pomata and Marta Hanson’s paper showed how recipes also functioned as vehicles of knowledge between different cultures. Recipes, as either formula or prescription, were both found in European and Chinese medical cultures. According to Pomata and Hanson, it was the familiar genre of the recipe that facilitated the transmission of Chinese pharmacology to Europe in the second half of the seventeenth century. Similarly, Carla Nappi argued that the Manchu medicinal recipes of the Qing court were spaces of encounter and medical translation in the early modern world. Pomata, Hanson, and Nappi demonstrated how the recipe served as the common ground between European and Chinese medicine and made the translation of Chinese pulse medicine and the transmission of Chinese materia medica possible in the seventeenth and eighteenth centuries.

Although recipes are difficult to characterize as a genre, it is clear that they are fascinating objects of historical study. More often than not, they are fluid rather than fixed forms of knowledge, requiring adaptation at every turn. They bring together ingredients, practices and often practitioners from all over the world, and themselves have a tendency to aggregate into larger collections. As written manifestations of gestures and processes, they play an important part in testing, assessing and modifying drugs and cures.

“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.