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 3: Herb Qualities and Indications

By Anne Stobart

In my previous posts on the Working of Herbs (Part 1 and Part 2) I flagged up some problems in finding out how medicinal herbs might really work, or finding reliable sources on herbal ‘efficacy’. I set out to try to establish a protocol, or way of thinking about this issue by picking a specific medicinal recipe. My choice was a seventeenth-century recipe for ‘after throws’ (likely for pains after childbirth). The recipe contains hyssop, wild mint, groundsel, pennyroyal and balm. In this post I aim to get an overview of how these herbs might have been viewed at the time that the recipe was being copied, in the latter half of the seventeenth century.

Sources for past information on herbal qualities and  indications

Last time I mentioned a useful but dated source in Maud Grieve’s A Modern Herbal.[1] However, we can also look directly at past material written on medicinal plants, found in herbals, pharmacopoeia or medical advice books, as starting points in providing contemporary indications for medicinal use. There are quite a few 17th/18th century printed sources. My choice of sources is largely pragmatic, based on comprehensiveness and ease of access – especially sources that have indexes which are easy to use, or can be found in a text format which is readily searchable. Here I give selected details from two sources published before and after the likely compilation and recording of this later seventeenth-century recipe. Nicholas Culpeper’s translation of the Pharmacopoeia Londonesis of the Royal College of Physicians reflects views of medical therapeutics from the early 17th century while John Quincy’ Pharmacopoeia Officinalis was first published 1718. I started to use John Quincy’s book frequently as I am lucky to own

Quincy, John. Pharmacopoeia Officinalis & Extemporanea: Or, a Complete English Dispensatory, in Four Parts. 8th ed.  London: J. Osborn and T. Longman, 1730 (title page).
Figure 1. John Quincy. Pharmacopoeia Officinalis & Extemporanea: Or, a Complete English Dispensatory, in Four Parts. 8th ed. London: J. Osborn and T. Longman, 1730 (title page).

a hard copy of the 8th edition (much-thumbed) – it has both a Latin and common name index for the many items in the materia medica. Descriptions of these herbs often give both their qualities and indications for a range of conditions.[2]

According to Culpeper’s A Physicall Directory (1649, pages consulted are in brackets):

  • Hyssop – Help coughs, shortnesse of breath, wheezing, distillations upon the Lungues, it is of a cleansing quality, kill wormes in the body, amends the whol color of the body, helps the dropsie and spleen, sore throats and noise in the ears (41)
  • Wild Mint – [Of garden mints ] hot and dry in the third degree, [Of water mint and horse mint] ease pains of the belly, head-ach and vomiting, gravel in the kidnies, and stone. (45)
  • Groundsel – Groundsel, cold and moist according to Tragus, helps the Chollick, and pains or gripins in the belly, helps such as cannot make water, cleanseth the reins, purgeth Choller and sharp humors (32)
  • Pennyroyal – Penyroyal, hot and dry in the third degree, provokes urine, breaks the stone in the reins, … strengthens womens backs, provokes the terms, easeth their labour in child-bed, brings away the after-birth, staies vomiting, strengthens the brain, (yea the very smell of it) breaks wind and helps the vertigo (49-50)
  • Balm – Bawm, is hot and dry; inwardly, it is an excellent remedy for a cold and moist stomach, cheers the heart, refresheth the mind, takes away grief, sorrow, and care, instead of which it produceth joy and mirth (45)

According to Quincy’s Pharmacopoeia Officinalis (1730, pages consulted are in brackets):

  • Hyssop – (Balsamic section), a warm and detergent herb, ‘good for anything’ especially coughs and lung disorders (143)
  • Wild Mint – [mentha] (Diaphoretic section) warm and aperient – reckoned by some to promote menses and urine (176)
  • Groundsel – [Carduncellus] (Emetic section) a good and safe vomit (187)
  • Pennyroyal [Pulegium] – (Nervous simples section) warm and chief virtue is ‘absterging all Impurities from the Womb’ (89)
  • Balm [Melissa] (Diaphoretics section) of fine cordial flavour but weak and soon fades (177)
Figure 2. Pennyroyal (Mentha pulegium)
Figure 2. Pennyroyal (Mentha pulegium) 

Further sources could be consulted but, overall, these two sources identify four of the herbs in the recipe for after throws (hyssop, wild mint, pennyroyal (Figure 2) and balm (Figure 3))  as having qualities of heating and drying. One herb (groundsel) is regarded as cold and moist, a purging remedy and good for ‘pains or gripins in the belly’ while another (wild mint) can also ‘ease pains in the belly’. Pennyroyal is specifically indicated for bringing away the afterbirth and ‘absterging all Impurities from the Womb’. Hyssop is regarded as ‘cleansing’ and ‘good for anything’. Other specific indications for these herbs include lung complaints (hyssop) and grief (balm). A check of some other texts with seventeenth-century childbirth-related recipes reveals that hyssop was also an  ingredient in other remedies with titles such as ‘For a woman traveling with child’ and ‘An approved medicine to bring away a dead child’.[3]

Figure 3. Lemon balm (Melissa officinalis)
Figure 3. Lemon balm (Melissa officinalis)

But was this recipe used?

It does appear that some of the herbs in this recipe were considered by contemporary sources to have relevance in various complaints related to childbirth. And I have found that this particular recipe for ‘after throws’ was repeated at least five times in the recipe collections of one household (more on this in a later post!) so it is possible that it was actually used, or at least was thought to have some ‘efficacy’. However, we cannot assume that the past view of these herbs matches the likely effects based on today’s understanding. In my next post I will look at how these herbs are understood in the present day, and consider how herbal monographs may be useful in this endeavour to find out what the herbs can do.

Notes

[1] Maud Grieve, A Modern Herbal: The Medicinal, Culinary, Cosmetic and Economic Properties, Cultivation and Folklore of Herbs, Grasses, Fungi, Shrubs and Trees with All Their Modern Scientific Uses (First 1931 ed. London: Penguin, 1980).

[2] ‘Qualities’ can be thought of as the properties of herbs and  ‘indications’ are suggested uses. Sources used are: Nicholas Culpeper, A Physicall Directory, or, a Translation of the London Dispensatory Made by the Colledge of Physicians in London (London: Peter Cole, 1649); John Quincy, Pharmacopoeia Officinalis & Extemporanea: Or, a Complete English Dispensatory, in Four Parts. 8th ed. (London: J. Osborn and T. Longman, 1730). These texts are on Early English Books Online (EEBO) and Eighteenth Century Collections Online (ECCO) and can be accessed through the Wellcome Library website (membership is free).

[3] For example, see A Choice Manuall of Rare and Select Secrets in Physick and Chirurgery (London: R. Norton, 1653, pp. 48, 91); W. J., Dr Lowers and Several Other Eminent Physicians Receipts Containing the Best and Safest Method for Curing Most Dieases in Humane Bodies (London: John Nutt, 1700, p.37).

 

The Working of Herbs, Part 2: Take One Herbal Recipe

By Anne Stobart

In the first post of this series, I flagged up some problems in finding out how herbs might work in a medicinal recipe. The question of medicinal herbs and their historical efficacy is a rather difficult area.[1] Through study of one recipe, I hope to provide pointers to useful sources, to indicate their relevance and to suggest caution where appropriate. Any recipe would work, but the one I have chosen is of particular interest because it has cropped up several times in my study of the late seventeenth-century recipe collections of a Devon household.

A water for After throwes

The receit of the water for affter Throwes.
The receit of the water for affter Throwes.

Take two hanfull of Isope [hyssop] two of peneroyall and two hanfull of Groundsell one handfull of wild mints two hanfulls of balme: These hearbs Cleane pickt and Sume fare water put upun all these hearbs togeather wash them Claine [‘and lay them in’ crossed out] then lay them in a pott or Earthen vessell: Shred these hearbs and put them in a quart of Spring water and let them lye in the water for a day and a night: 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 andy Ayre it Makes the water mush better. [2]

We will have to assume for this discussion that these plants are correctly identified as hyssop, pennyroyal, groundsel, wild mint and balm–although plant identification is another uncertain factor in considering recipes! Ideally we need to know:

  • the seventeenth-century indications for these plants.
  • the key constituents.
  • the likely physiological actions of these constituents.
  • the potential combinations of herbs in a preparation.
  • the dosage and its likely effects in the body.
Hyssop (Hyssopus officinalis)
Hyssop (Hyssopus officinalis)

My first step is to explore Internet sources using hyssop as an example.The Internet brings a wealth of information, but finding out about a particular medicinal herb can be frustrating. This problem is worse if you seek a ‘historical’ source. Many sites readily repeat information about ‘traditional’ uses without reference to sources. For example, numerous sites claim that hyssop has been used for millennia and dates back to the Bible. If you search for ‘herbal medicine hyssop’ in Google, you are likely to draw up Wikipedia, Mrs Grieve’s herbal, commercial websites offering herbal medicines and medical databases.

Relatively few of these sites give accurate historical background. However, a reasonable starting point is Maud Grieve’s A Modern Herbal, which still provides more detail than most sources on medicinal constituents, actions, uses and preparations.[3] First published in 1931, the book is good value as a secondhand hard copy purchase and provides succinct information on many plants. Grieve draws on a variety of classical to early modern sources for constituents, medicinal actions and uses. But… A Modern Herbal needs considerable updating.

A more recent publication from Tobyn et al. follows selected herbs in texts from Dioscorides onwards, including hyssop, and provides details of therapeutic use with constituents and clinical research evidence.[4] Although limited to 27 plants, this text has a useful overview of relevant authors from classical to modern times.

Internet searching can be confusing if you are looking for reliable sources on historical use of plants and their consituents and medicinal actions. In my next two posts, I will outline some qualities and indications of the herbs in this recipe and the benefits of locating a good quality herb monograph.

Notes

[1] For example: John K. Crellin, ‘Revisiting Eve’s Herbs: Reflections on Therapeutic Outcomes’, In Herbs and Healers from the Ancient Mediterranean through the Medieval West: Essays in Honour of John M Riddle, edited by Anne Van Arsdall and Timothy Graham (Farnham, UK: Ashgate, 2012, pp.307-27).

[2] ‘The Right Honorable The Lady Receipt Booke Anno Dom 1690’, p.82, Ugbrooke House, Chudleigh, Devon. My thanks to Lord and Lady Clifford for permission to access their private archive.

[3] Maud Grieve, A Modern Herbal: The Medicinal, Culinary, Cosmetic and Economic Properties, Cultivation and Folklore of Herbs, Grasses, Fungi, Shrubs and Trees with All Their Modern Scientific Uses. First 1931 ed. (London: Penguin, 1980).

[4] Graeme Tobyn, Alison Denham, and Margaret Whitelegg, The Western Herbal Tradition: 2000 Years of Medicinal Plant Knowledge (Edinburgh: Churchill Livingstone/ Elsevier, 2010).