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It is easy, with the scientific arrogance of the twenty-first century, to forget that a century and a half ago most medicines were herbal remedies. The use of plants has a very long history indeed. We know that self-medication with the green pharmacy took place at least as long as 60,000 years ago. In a cave in Iraq, the grave of a Neanderthal man was found to contain many grains of pollen scattered about his body. Using modern scientific methods, the pollen was identified as coming from eight different species of flowering plants found today in the surrounding countryside. Most of these are still used as medicines by local people. One example is the shrub Ephedra, a remedy for asthma and a cardiac stimulant—a usage confirmed by modern science when the nerve stimulant ephedrine was extracted from it.[i]

Throughout the millennia ordinary people have sought remedies where they could, and plants offered an ever-ready supply to try, but were limited to the offerings of the local terrain and mediated by the seasons. We know very little about the early use of herbs since recipes were handed down orally through the wise men and women in peasant communities, however written records began to appear on tablets and stones as long ago as about 5,000 years. The stone tablets of the Sumerians (Southern Mesopotamia) include lists of useful herbal remedies. The public records of King Hammurabi of Babylon (1,754 BCE) were also written on stone and refer to healing plants. There is no doubt that herbs were and remain the principal medicine in India; as the world’s largest producer of medical herbs the subcontinent has been called the ‘botanical garden of the world’. The World Health Organisation has listed 2,500 species of medicinal plants of which 150 species are used on a large scale. Herbal medicine is also widely used in China. A Chinese researcher, Tu Youyou, has extracted artemisinin, the active ingredient of a plant that had been used to treat malaria for over 2,000 years. For this contribution to modern medicine Dr Tu shared the 2015 Nobel Prize for medicine.[ii]

Botanists classify herbs as seasonal, seed-producing plants that have flowers, and it is these parts that are mostly used in cooking. The flowers and other parts of the plant such as the bark, sap and roots are often used in herbal remedies. Originally herbs were picked where they grew and were used by all and sundry for maintaining health or the relief of symptoms. A glance around the well-stocked shelves of a pharmacy or a Chinese herbalist’s shop will show how popular they remain today.

The story of how plant remedies came to be pre-packaged staples of pharmacies and other retail outlets owes much to the early seafaring traders in the Middle East, Asia and later, the New World. Well before the eleventh century, the importation of herbs was such a lucrative international trade throughout the known world, that there is little doubt that merchants were among the first people to provide a continuous exchange of information and products. Interestingly, there is a remarkable resemblance between the ancient drug inventories extant in Mesopotamia, Egypt and India. The same herbs and minerals are frequently listed. The same minerals are also listed, together with other more exotic ingredients also used in remedies such as sulphur, antimony, iron, powdered precious stones and animal or human matter such as hair, fat, blood, faeces, urine (all of which were said to be consumed, not just applied!).[iii]

Traders were not the only ones to spread the use of herbs; soldiers were also responsible. Roman legions always travelled with healers and surgeons who found it expedient to carry their remedies wherever they went. Sometimes they planted the seeds and the herbs spread from one locality to another, leaving a legacy for the local healers. The spread of the madonna lily throughout Europe is thought to be a Roman legion legacy and an example of this. We also know that garlic was frequently used for coughs, colds, warding-off infections and as an antiseptic for wounds; while mustard (sinapis nigra) was used for poultices, as an emetic for food poisoning or upset stomachs, and as an aperient or laxative. Such was the army’s dependence on herbs, that one Roman soldier, Scribonius Largus, wrote descriptions of those found in Europe and the Mediterranean, including packing and transporting instructions. Not surprisingly, army healers were only interested in maintaining the supply of herbs for the health of their troops. The health of local populations was left to others. such as monks.

After Christianity arrived in England in the sixth century, Benedictine monks treated their own sick, the poor and the people in the surrounding district. Eventually they handed on their knowledge and skills to pupils outside the monastery as well as to the next generation of monks.

Welsh healers also influenced the development of herbal healing. The school for physicians, at Myddfai in Wales, was established in the sixth century and for over a thousand years they handed down their system of healing. Welsh healers are particularly interesting because they seemed to have had inquiring minds and sought the causes of illness. They were systematic in their approach, keeping careful records of repeated observations. Although the school grew its own herbs, most were culled from the countryside. Some herbs used in this period are well known and still in use today. Others sound exotic to modern ears and the conditions they treated seem very strange. For example, wood betony (stachys betonica) was used for headaches and nervous disorders, feverwort (erythraea centaurium) was used for fevers and tonics, vervain (verbena officinalis) for jaded appetites (used today in vermouth) and clivers (galium aparine) for scrofula and skin eruptions. For years clivers was used as a green brew in the spring to offset a seasonal tendency to scurvy and today herbal medicine practitioners use it for its diuretic properties.

The Welsh brewed herbal teas and made poultices by pulverizing their herbs and mixing them with lard. Like the monks, the Welsh physicians systematically added to the local ‘green pharmacy of the peasant’ and trained others in their use. These are two of the few sources of healing training that existed until the eleventh and twelfth centuries when the first universities were established in Europe. Although the monks and the Welsh were the first to establish schools, they were not the only ones interested in the education of early healers. The English ruler, King Alfred (870-899), actively encouraged learning of the healing arts. He corresponded with the Patriarch of Jerusalem and sent abroad for supplies of exotic remedies. King Alfred was the first to arrange for translations of the best medical texts into English. The written language of the medically-educated was Latin, so the use of the vernacular for a medical book was very unusual. In any event, the earliest Anglo-Saxon medical book that survives today is the Leech Book of Bald. Bald wrote this text for physicians—called leeches in the tenth century. Presumably this term referred to physician’s use of these parasites to draw blood from their patients and not to the high fees drawn from their pockets. Through the work of King Alfred, Bald, and others, new herbal concoctions were added to the European armoury of remedies.

From the eighth century on, it was the Arabs who dominated the trade in exotic herbs from India and Africa.[iv] Notwithstanding their enormous influence on trade, the contribution of the Arabs, and their influence, extended well beyond their commercial interests. Studies in preventative medicine and pharmacology had prospered within the Arabic medicinal and cultural systems. At least part of the reason for the Arabs continued interest in herbs came from the Muslim faith. It teaches that God had provided remedies for all man’s ailments and the belief in God’s beneficence provided the impetus for active investigation of plants, including the study of their potency; while dosage and possible toxicity were carefully recorded. The early Arabs were extremely industrious and innovative. They concocted a concentrated vegetable sap so that remedies could be formed into pills, syrups and electuaries (a paste made of the powdered herb and honey). Numerous ways of administering herbs were invented including ointments, conserves, elixirs, pills, confections, tinctures, suppositories and inhalations. The Arabs also introduced new production methods: evaporation, filtration and distillation. They passed on instructions for the production methods that they had invented revolutionizing the herbal industry.

Arab pharmacies had an immediate impact on preparation and processing throughout the known world. By the end of the eighth century, the preparation of remedies was an important profession. Since these new products added value and range to the existing repertoire of remedies, European apothecaries and physicians were quick see their advantages. One of the most popular was the introduction of senna (cassia senna) as a purgative. Since it had an unfortunate taste, aromatic spices were added. Manna (fraxinus ornus), tamarind (tamarindus indicus), rhubarb (rheum palmatum) and scammony (convolvulus scammonia) were other introduced purgatives, although the latter was so violent in its action that some European physicians later maintained it should never be used. However, purging was such a popular treatment that it did not stop others including scammony in their repertoire.

The Arabs were also influential writers on herbal matters. Having overrun the Mediterranean region, the Arabs collected an array of Greek and Roman medical texts and translated them into Arabic (see Chapter 3). Between the eighth and the eleventh centuries the pharmaceutical industry benefited from Arabic medicine’s high level of technical research and inventiveness.

Around In the tenth century Italian medicine began to catch up with that of the Arabs, and the Salerno Medical School was established at a time when Europe was ready for an expansion of knowledge. By the twelfth century texts were being translated into the language of the Christian Church, Latin. An African named Constantine had a profound influence on the development of herbal medicine at Salerno. As a drug merchant, he had travelled throughout the Near East collecting herbs and other remedies and had mastered several languages. Retiring to an abbey in 1067, he began translating Arabic, Greek and Byzantine texts. It was largely through his work that ancient exotic herbal wisdom filtered into Europe.

Beside the Arabs and Italians, the Chinese were also influential in the spread of herbs and the development of herbal remedies. Over 2000 years ago a Chinese herbalist, Shen Nong, listed three hundred and sixty-six plants used as drugs. The oldest surviving Chinese text (167 BC) gives prescriptions for fifty-two diseases and describes methods of collection and processing of minerals and the parts of plants and animals.[v]

Since the time of Marco Polo (1254-1324), news of Chinese medicines had travelled to Europe and some of the features of Chinese medicine began to appear among the practices of elite physicians in India and Europe.[vi] For example, advice on the treatment of ailments by a sixteenth century French physician recommended a Chinese root (probably ginseng) for the treatment of venereal disease. Since the Chinese were just as observant and inventive as the Arabs, they knew that plants could vary depending on the region where they were grown, and that roots should be harvested before a plant was mature since after that its strength was transferred to the foliage or flowers. Herbal processing in China included steaming, boiling in various liquids, decoction to a syrup, roasting with wine, brief heating at high temperatures (reduction of poisonous constituents), stir-frying and slow-drying of flowers and insects.[vii] Medicines were given as a pill, powder, syrup or an infusion, and prescriptions altered from day-to-day as an illness progressed or diminished.

Thus, by the sixteenth century, a vast store of herbal information and products was being exchanged throughout the known world. The English eagerly drew on this information, yet many symptoms remained difficult to treat, as this story of King Henry VIII’s personal interest in herbs illustrates. It was King Henry’s own health that drove him to invent recipes and to publish a small book containing potions devised ‘by the King’s Majesty’. Henry VIII (1491-1547) suffered from a variety of ailments over the course of his fifty-six years. One problem was the inflammation of his penis. Such inflammation may have occurred when he contracted syphilis. The granulating ulcers that are the early manifestation of syphilis are usually self-healing, although if the disease itself is untreated, it does cause other severe late effects. Various cooling potions, using a combination of herbs, were invented for King Henry’s inflammation. Another seemingly unyielding problem was the severe ulceration of his leg for which he invented a variety of poultices. Either an injury caused by falling off a horse, or varicose veins, probably caused his ulcers; even today these are extremely difficult to treat. Unfortunately, King Henry’s legs remained ulcerated until the day he died; neither his own remedies nor the concoctions of his learned doctors could effect a cure.

Ironically, given King Henry’s intense interest in remedies, his other actions had a dampening effect on the study of herbal medicine. During his reign, King Henry, for personal and political reasons to do with his six marriages and the Roman Catholic Church, closed many monasteries and abbeys, thereby curtailing the activities of monks and the significant contributions they made to healing and education. As a result, the actual study of medicinal plants lacked impetus in Britain for many years.

An even more pervasive negative influence was provided by the works of one of the fathers of medicine. Galen (131-200CE) had put forward such an all-embracing herbal classification system that he stifled European research for centuries. In particular, Galen’s classification system for herbal materia medica evaluated plants in terms of their reactions to the patient’s humours (supposedly bodily fluids, see Chapter 3). Galen went on to specify very complex herbal concoctions containing dozens of ingredients. This must have increased the business of the merchants and traders and it certainly suited early physicians. A physician who spent years mastering the complexities of Galen’s system would not want the lay public to think that any village healer, using readily available herbs, could adequately treat complaints—his wealthy patients expected more of him. Hence physicians came to think that the more complex the herbal remedy the better it was bound to be.

One example of a complex remedy was called galene (named for Galen who refined and added to its ingredients). The recipe called for viper’s flesh, dozens of different herbs (some of which were separately compounded), squills (a liliaceous plant that is an expectorant and diuretic), mineral substances, wine and honey. Herbs included crocus from Cilicia, dittany and scordium from Crete, iris from Illyria and poppies from Asia Minor. The brewing went on for forty days and the mixture was allowed to mature for a dozen years to reach its prime. Another example is theriac, a nostrum that included opium, wine and honey among its many ingredients. By the time Galen redeveloped it, the herbs in the mixture increased from sixty-four to more than one hundred. Theriac was very popular as a potent remedy, no doubt due in part to the opium and wine it contained. It became the panacea for everything and theriac remained in use until the late eighteenth century. The vast range of exotic ingredients required for these two remedies must have impressed patients and been a wonderful stimulant to international trade.

In the fifteenth and sixteenth centuries, the exploration of the New World stimulated the pursuit of new healing plants. The exploration and colonization of the Americas brought cinchona, coca, sarsaparilla and tobacco from South America, while North America and Canada yielded a harvest of sassafras, lobelia inflata (a vomit-inducing plant used to treat syphilis), and petroleum (gathered from surface pools and used to soothe aches and pains). Other imported herbs included the balsam of Peru, capsicum, vanilla and ginseng. The ginseng root was considered auspicious as a tonic and aphrodisiac, partly because it resembles the form of male genitalia. It is still a highly sought-after remedy by the Chinese and many other people throughout the western world.

Interestingly, it was the Spanish who noticed that Indian women used guaiacum wood, apparently successfully, against a disease that seemed similar to syphilis. We now know that syphilis is caused by the spirochete, treponema pallidum. The disease the women were treating was in fact yaws, another highly infectious disease that is due to a different spirochete, treponema pertenue. Nevertheless, guaiacum wood found favour as a cure for syphilis long enough for the importers to make huge profits out of what, in the end, turned out to be a useless remedy. A far more successful remedy from the New World was Peruvian, or cinchona, bark. A Jesuit priest brought it to Rome, a city where malaria flourished. Then known as the ague, malaria was endemic in many parts of Europe. The Romans found cinchona effective—it contained quinine. Even today, quinine can be a life-saving drug and remains the treatment of choice when one of the varieties of the plasmodium protozoa becomes resistant to other available therapies.

At the time of their first importation from the New World, many of the remedies must have seemed novel and extraordinary to eighteenth century Europeans. Today, it is the non-herbal ingredients that seem most extraordinary or even revolting. Some of these were metals, others were parts of animals and others were human products. For example, the urine from pregnant women was used for various complaints. This is not quite as strange as it appears, since the urine of pregnant mares has been used in the preparation of premarin for hormone replacement therapy. Early physicians did not know anything about hormones, so the use of pregnant women’s urine was probably based on superstition.

Other treatments included emulsions of almonds, ass, goats or woman’s milk, juice of river cress, chicken broth, river crab or wood-snail broth, or oysters and a little wine. These were said to be useful for fevers caused by passions of the mind, sadness, cares, hard labour, abstinence, and inordinate sex, as well as gonorrhoea, diarrhoea and running ulcers.[viii] In other words one of them was bound to affect one of the complaints nominated. The lists of extraordinary ingredients included many animal and human products. Among those listed were the flesh of vipers, crushed deer antlers, crab’s eyes, rhinoceros and unicorn horn, oil of earthworms, scorpions or swallows, powdered mummy, moss from a dead man’s skull, urine from a goat or a wild boar or a boy, and a bezoar stone (found in the gut of wild Persian goats). The Chinese also used exotic ingredients such as fossilized bones of dinosaurs (dragon’s bones), scales of anteaters, genitalia of sea lions and the clear urine of healthy boys under twelve years of age. It is a relief to know that most of these exotic ingredients are not used in those Chinese remedies that are manufactured under the modern conditions necessary for export to the USA and Australia. Even if such remedies were medically active, it is extremely doubtful whether medieval physicians knew enough to employ their action effectively. Seen through our eyes as twenty-first century consumers it seems very unlikely that many of these ingredients had a therapeutic action. It is far more likely that the exotic substances in these brews were listed simply to impress lay people and colleagues alike.

Not all physicians favoured the use of imported herbal remedies. In the sixteenth century, one Timothie Bright wrote a treatise on The Sufficiencie of English Medicine, proclaiming that the English countryside could provide every remedy a physician needed. The import trade did not diminish, however, too many physicians had come to rely on exotics for their complex compounds. The availability of new herbs did have one effect that Bright could not have foreseen, several the non-herbal ingredients in compound mixtures were dropped from the London Pharmacopoeia in 1746. These included ‘human fat, spider webs, moss from human skulls, unicorn’s horn, virgin’s milk (not the literal liquid but an alchemy remedy)’. Forty-two years later, animal products like bezoar (supposedly an antidote for poisoning), woodlice and vipers were also deleted.[ix] The burgeoning herbal knowledge and the increasing variety of exotics helped fill the purses of learned English physicians, but it led to an encroachment of their territory by an avaricious and ambitious group—the apothecaries.

Starting out as shopkeepers with more in common with grocers than with the healing professions, apothecaries were granted a charter in England in 1616. They were made Master and Wardens of the Society of the Art and Mystery of the Apothecaries for the City of London. The granting of a charter may not have raised their social status in the eyes of the physicians, but it certainly did in their own. In recognition of this they bought a barge for river pageants. The barge was decked out in crimson damask, flags and streamers. The apothecaries, resplendently dressed in gowns faced with satin and welted in velvet, sailed forth to be publicly admired. Despite their regalia and presumption of higher status, apothecaries soon ran afoul of the medical establishment by encroaching much too far into medical territory.

Apothecaries made up herbal preparations to order for the physicians, and sold herbs and other drugs over the counter just as the pharmacist does today. By the sixteenth century, learned physicians were feeling that their practice was being encroached on from too many quarters. One of them, John Cotta (1575-1659), attacked apothecaries, empirics and surgeons for practicing by experience only, since they were untutored. He was also critical of heretic and itinerant physicians, and those who diagnosed from urine samples (for being out to make a quick living and failing to follow the learned texts), as well as clerics, astrologers and wives (for interfering with the practice of the physicians). In a book he wrote on the subject, Cotta proclaimed that God had appointed learned physicians to do this work.[x] Thus while the apothecary’s charter was made by men, the physician’s charter was made in heaven—an idea which no doubt has appealed to physicians throughout the centuries.

By the eighteenth century, apothecaries had begun to make home visits, quite flagrantly encroaching on the practice of the learned doctors and even undercutting their fees. The knowledge that many of the apothecary’s prescriptions were made from the physician’s own herbal formulas was guaranteed to ruffle their feathers. Physicians had gleaned this knowledge from ancient texts to which their formal learning had given them access, so they thought it belonged to them. Fashionable physicians were quick to satirize apothecaries as evidenced in the following quote:

The apothecary, upon his arrival at your bedside: feels your pulse and with a fixed eye upon your countenance tells you your spirits are low. He orders a cordial (tonic). He then asks, ‘when were you at stool?’ He orders a laxative or a healing Clyster (enema). If you intimate a pain in your stomach, back or sides, he orders a plaister (ointment). The following day when you are no better or even worse, he would add another list of medications.

The expenditure for the first round:

Cordial Three to five shillings

Clyster Two shillings and sixpence

Plaister Two shillings and sixpence

Second round:

Cordial Apozem Three shillings

Carminative Clyster Three shillings

Another Cordial Three shillings

Hypnotic potion One shilling

In no time your expenses will run out to 20 or 30 pounds. [xi]

Nonetheless the apothecaries’ continuing efforts at recognition were rewarded by the Apothecaries Act (1815). From then on, all apothecaries were licensed once they had attended lectures and completed six months’ hospital clinical work. So, in effect they became the first general practitioners.

Many people still preferred to self-diagnose their ailments and medicate themselves with home remedies rather than paying for treatment and nostrums, so compendiums of recipes began circulating. Previously readership of such books as the Leech Book of Bald, or King Henry VIII’s recipes, was limited to the few who were literate. As literacy increased, distrust of regular physicians led to many home remedy and recipe books being circulated among the general population. A famous seventeenth century one, the Complete Herbal and English Physician by Culpepper, was used in both the UK and USA. It was based on an ancient idea that tied earthly remedies to the movement of heavenly bodies and it is still in print today. The eighteenth-century publications included one titled the Primitive Physic attributed to John Wesley, the evangelist. A French author, Samuel Tissot, published another titled Avis au Peuple sur la santé (advice to the people regarding their health). Domestic Medicine by William Buchan was popular enough to be used as far afield as Australia where physicians were few and home treatments a necessity. One early colonial recipe for a headache read: One scruple (three scruples equalled one dram) each of Aloes, Calomel (presumably mercurous chloride), and Rhubarb plus one and a half drams of Castille Soap—to be mixed into 20 pills. A recipe for venereal disease measured the ingredients by their cost: two pennyworths of Pelicotia, three pennyworths each of Gum Booge, bitter apple, and Calomels plus one pennyworth of Jalop mist.[xii]

Unfortunately, as cities became larger and the number of urban dwellers increased, herbal gardens decreased in numbers. So, in 1774, a physic garden in the grounds of the Pennsylvania Hospital was planned so that fresh herbs would be available to local physicians. Incredibly, a lack of funds delayed the project for nearly two centuries. Finally established in 1976, the physic garden has become an historical display of plants that were used in eighteenth century American medicine.[xiii] The Chelsea Physic Garden, another reminder of the early dependence on fresh herbs, still exists in the UK and is open to visitors.

In most cases herbal remedies only relieved symptoms—it was not until the nineteenth and twentieth centuries that some diseases could be effectively treated. The herbs that are effective continue to be used. The World Health Organization (WHO) estimates that twenty-five per cent of modern drugs, and at least 7,000 medical compounds in the modern pharmacopoeia were originally derived from plants. Four-fifths of the one hundred and twenty active compounds isolated and widely used today show a positive correlation between their modern and traditional usage. Even today, nearly four-fifths of Asian and African populations rely on traditional medicines based on plants and their components.[xiv] Altogether the (WHO) estimates that four billion people use herbal medicine for some form of primary health care. Pre-scientific trial and error methods did produce some useful herbal remedies.

The debt the pharmaceutical industry owes to the explorers, monks and kings, as well as the traditional healers, peddlers and early Arab pharmacists is mostly forgotten. When modern pharmaceutical manufacturers explore traditional herbal remedies in the hope of developing new drugs for modern medicine, it is their chemical composition that is important. Although the advice of tribal users is sometimes sought, an herb’s exotic provenance no longer has the relevance it once had in medical circles. Nevertheless, for the pre-packaged self-medication industry, the advertisers know that the traditional and long use of herbs remains an important factor in their popularity as we will see in the next two chapters.

[i] Solecki, (1975) Shanidar IV, A Neanderthal Flower Burial in Northern Iraq. Science, 28: 880–1.

[ii] Economist (2015). The 2015 Nobel Prizes. 10 October, p. 72.

[iii] Griggs, B. (1997). The Medicine of Mankind, Chapter One. In Green pharmacy: the history and evolution of Western herbal medicine. Rochester, Vermont: Healing Art Press. p. 7.

[iv] Mez-Mangold, L. (c1971). A history of drugs. Carnsworth, Lancaster: Parthenon Publishing, p. 49.

[v] Wachtel-Galor, S. & Benzie, F.F. Herbal Medicine, Chapter 1. http://www.ncbi.nlm.nih.gov/books (accessed July 2015)]

[vi] Hsu, E. (1999). The transmission of Chinese medicine. Cambridge: Cambridge University Press. p. 2.

[vii] Unschuld, P.U. (1998). Chinese medicine. Brookline, Ms: Paradigm Publishing. pp. 75–7.

[viii] Mortimer, P. (1974). Only when it hurts: being a curious collection of old fashioned remedies and dissertations on matters of health and hygiene. London: Wolfe Publishing. pp. 7–8.

[ix] Porter, R. (1997). The greatest benefit to mankind: a medical history of humanity to the present. London: Fontana Press, p. 269.

[x] Cotta, John (1575?–1659?). A short discoverie of the vnobserved dangers of seueall sorts of ignorant and vnconsiderate practisers of physicke in England. London: Imprinted for W. Jones and R. Boyle, New York: Da Capo Press, 1972.

[xi] Jameson, M.J. (1961). The natural history of quackery. London: Michael Joseph Ltd, (Abstract of a quote attributed to a Dr Radcliffe).

[xii] Martyr, P. (2002). Paradise of quacks. Sydney: Macleay Press. p. 33.

[xiii] Pennsylvania Hospital Web pages: http://www.uphs.upenn.edu/paharc/timeline/1751/index.html . [Accessed 8 July 2015]

[xiv] American Medical Association (June 1997). Report 12 of the Council on Scientific Affairs: Alternative Medicine. http:// www.ama.assn.org/ama/pub/article/3036-2523.html [Accessed 15 October 2003].