|Publisher:||Duke University Press|
|Sold by:||Barnes & Noble|
|File size:||569 KB|
About the Author
John K. Crellin, Clinch Professor of the History of Medicine at Memorial University of Newfoundland, is a physician, pharmacist, and historian. His books include Medical Ceramics in the Wellcome Institute and Home Medicine: The Newfoundland Experience.
Before her death in 1997, Jane Philpott was Professor Emerita in the Department of Botany and the School of Forestry and Environmental Studies at Duke University.
Read an Excerpt
Trying to Give Ease
Tommie Bass and the Story of Herbal Medicine
By John K. Crellin, Jane Philpott
Duke University PressCopyright © 1989 Duke University Press
All rights reserved.
Medicinal Plants and Their Traditions: A Complex of Ideas
This plant has given ease ever since time.
Much of the faith Mr. Bass and his visitors place in herbs rests on longtime beliefs as well as on such concepts as the role of sensory characteristics in determining medicinal properties. By illuminating such features, the historical perspective given in this volume provides a sense of why herbal knowledge persists with a strong cultural presence, if not force, within a popular tradition. The account as a whole also provides some explanation for the uneven persistence of knowledge about certain herbs by covering many factors ranging from changing opinions about physiological effects to the changing influence of such symbolism as life-giving properties "seen" in certain evergreen plants.
"DISCOVERING" MEDICINAL PROPERTIES
One of the most perplexing features of traditional—and regular—therapy is why so many seemingly diverse uses have been recorded for medicinal plants. Confusion arises not only because of the effects of changing theories and the introduction from time to time of new uses and regimens, but also because the same use is sometimes described from a variety of viewpoints. For example, a plant may be listed as a diuretic (function), a kidney cleanser (action), or a cure (e.g., for kidney stones). In other words, functions, actions, and uses, all closely related, may be listed together as distinct entities. This has to be constantly borne in mind whenever medicinal properties are listed either in present or past use.
The beginnings of Western therapy as recorded on Mesopotamian clay tablets and Egyptian papyri, and the Greek and Roman writings by Theophrastus, Galen, Pliny, and Dioscorides are not considered here, except to note that they pose questions that are pertinent to the story of therapy in many eras. How has man learned about the medicinal properties of plants? How does he view the relations between empiricism and theory, and between popular and scientific knowledge?
Most considerations of the origins of knowledge about medicinal plants tend to stress the importance of instinct, psychological needs, and empirical observation working together over long periods of time. Pertinent to this are observations on the use of plants by sick animals (a source of information Bass still believes to be very valuable) and the use of sensory properties, as discussed below. Perhaps, too, man's employment of many medicinal plants for a variety of nonmedical uses has been important, for the consequent familiarity aided in learning and spreading information about medicinal properties. Nowadays, many herbalists believe that they have an almost intuitive sense of whether or not a plant is "medical."
A fascinating question about medicinal plants is why, out of the thousands that have been introduced, has only a core group of a few hundred been used within any given culture? Perhaps 200 or so plants formed the basis of the ancient materia medica; 68 made up the core of three late medieval herbals; the 680 simples included in the May edition of the celebrated 1618 London Pharmacopoeia are generally considered more representative of everyday practice than the 1,190 in the December issue of the same year; and about 600 medicinal plants were known or used in the United States in the 1830s. A recent survey of herbal medicines currently sold in Britain indicates that the 5,500 or so products available are derived from about 550 plants.
Undoubtedly many factors contribute to the introduction of drugs, their popularity, and the length of time they remain in general use. Many botanical remedies were seemingly overenthusiastically introduced. Aside from entrepreneurship, this fervor sometimes rested on empirical grounds and sometimes on theoretical considerations, although the latter two factors are often so closely intertwined that it is commonly difficult to discern which contributes most to the acceptance or rejection of a new medicine or of a new use for an existing one.
Empiricism—observations and information gathered supposedly without theoretical presuppositions—is conspicuous in all areas of medicine. The discussion of self-treatment in chapter 4 illustrates the willingness of laypersons to try out new remedies, an attitude that seems almost timeless. Laypeople have not been alone in empirically trying out recipes new to them. Countless physicians, conspicuously from the late seventeenth century onward, have stressed that the "best" medical practice rests on experience, not theory. Disputes have long been waged over the relative values of theory ("Dr. Reason," or rational medicine) and empiricism ("Dr. Tradition," or clinical experience), but even some who felt intellectually uncomfortable with empiricism have argued that, "though pregnant with evils," empirical approaches have provided many "benefits to the science of medicine." Empiricism has frequently been valued on the basis that the data collected was in accord with nature, especially if it was garnered from perceptive native peoples, a viewpoint still commonplace today.
The empirical thrust—the constant search for new remedies so conspicuous in the history of medicine—is prominent in many current herbal practices. Bass, for instance, is always ready to try out a new remedy, as reflected in periodic enthusiasms. In 1981, on the advice of a Cherokee Indian, he started to use goldenrod regularly in one of his medicines for rheumatism, and in 1983 he employed wild yam for rheumatism on the basis of a newspaper article. Many of his visitors are likewise eclectic, some—even in Bass's mind—to the point of gullibility when they use certain herbs such as Solomon's seal in a "magical" way.
Empiricism in therapy relies a great deal on personal testimony that a medicine has worked. Since the late eighteenth century, and especially in recent decades, the misinterpretations that can arise from a single or relatively few instances of usage with favorable outcome have been emphasized by physicians, but commonly this has made little impression on laypeople. The notion of rigorous scientific thought is difficult for many to grasp; it seems only natural to link two closely related events as cause and effect, rather than wonder whether or not a coincidence exists. This is often seen in Bass's practice.
Although empiricism and a readiness to extrapolate from one or a few positive therapeutic experiences is central to Bass's thinking, he continually draws upon theoretical concepts. In fact, when the "rampant empiricism"—as it is often called—in medicine at any time is examined closely, it is often seen to be sustained by theoretical or cultural notions. As some of the monographs in volume 2 make clear, the apparently inexplicable reputation of various plant remedies may rest more on theoretical than on empirical grounds. It is clear, too, that shifts in theories can occur without altering therapeutic practice, which sometimes suggests fundamental confidence in empiricism, sometimes excessive faith, and sometimes an inertia to change.
There is no doubt that theory has played a considerable role in the enlargement of the materia medica over time within both domestic and professional medicine; indeed, it has often been the case that some new remedies that were found empirically or introduced through an erroneous concept became established only if they were theoretically acceptable to many physicians.
One of the most pervasive concepts of all time, and still current today, is the humoral theory. Established in classical times, it has unquestionably shaped not only the choice of medicines but also just how they were employed for particular ailments. Early humoral theory postulated that every living body was composed of four basic qualities or principles: hot, cold, moist, and dry. By a combination of these, in pairs, four humors were formed: blood (moist and hot), black bile (dry and cold), yellow bile (dry and hot), and phlegm (moist and cold). Ill health and disease were thought to rest on a lack of equilibrium of the humors, an idea which provided the basis for the employment of numerous medicaments believed to act either by possessing opposite qualities or by removing humors via, for example, urine or sweat. By the Middle Ages quantification of drug action based on degrees of qualities led to sophisticated compounded medicinal preparations with many ingredients. After the seventeenth century specific references to such drug qualities as "hot," "dry," "cold," and "moist" tended to disappear from Western scientific medicine. Even so, many ideas, certainly the notions of hot and cold, persisted and can be found today in traditional medicine in many parts of the world, including Appalachia.
Central to the humoral theory—and to most approaches to therapy over time—is the constant comparison of one treatment with another. Conclusions drawn from analogy always have been a key feature of medical and scientific thinking. At times these conclusions have been accepted at face value rather than serving as sources of scientific and medical hypotheses, as has generally been the case since the eighteenth century.
One persistent example of the employment of analogy is the doctrine of signatures. Pervasive by the sixteenth century, this doctrine explained that the "inner virtues" of a plant (or animal) stand out if the "signature," or outer appearance, is observed carefully. Some signatures are easy to discern: the yellow color of saffron suggests usefulness for jaundice, and the brainlike surface of a walnut indicates its value for head ailments. It is not easy to say how influential the doctrine actually has been. It certainly did not excite the curiosity of mankind, as is sometimes said, especially after it disappeared from regular medicine during the eighteenth century, yet the doctrine is still pervasive. Viewed in either the context that God left a signature on remedies, or the context of what is called sympathetic magic ("like cures like"), examples of its use today are easy to find both in published herbals and in oral testimony ("wild ginger is good for the heart, since it looks like one"). Bass employs the concept more to suggest possible new uses (yellow plants can be tried for jaundice) than to rationalize existing practices.
The fully developed doctrine of signatures embraced various levels of complexity, including astrological explanations. The stars, for instance, were said to represent way stations, a sort of "halfway house," which aided virtues and powers from the ineffable, spiritual, divine being entering into material objects on Earth. In consequence, close relationships were postulated between various healing powers and the motions and activities of the stars.
Although astrology plays a negligible part in Bass's thinking, he and many visitors—especially those who see unity in nature—keep an open mind about its role in herbal medicine. After all, astrology still has a pervasive influence in nonmedical facets of life (even if not openly admitted) such as knowledge and use of the signs for planting and sowing. Furthermore, the astrology widely disseminated by Culpeper's famed herbal (for example, that herbs under Venus cure, by sympathy, infirmities under Jupiter), which is known to Bass, is still commonplace in many recently published herbals.
For similar reasons associated with cultural influences, nonnatural (magical) explanations probably influence Bass's practice more than is immediately apparent. Bass's visitors were often reluctant—at least initially—to discuss magical beliefs, not so much because they run counter to modern medicine, but more because many are considered "old-fashioned" and have overtones of being antireligious. Yet it became clear that magical associations, obvious with such plants as black snakeroot, Solomon's seal, and five-finger grass, are pervasive. Nonnatural folk beliefs remain in people's systems; even if belief is muted, some feel—especially if "granny knew them and she lived to a ripe old age"—that it is prudent to use them, thus contributing to persistent usage.
Another long-standing concept conspicuous in Bass's thinking—more so than the doctrine of signatures—is the employment of sensory properties to determine medicinal uses. This is considered below as part of the discussion of plants naturalized in North America and used by Mr. Bass.
NATURALIZED REMEDIES: CONSTANCY AND CHANGE
Bass is well aware that many of the plants he knows have a history extending "back to the Bible" (especially "biblical hyssop") or were brought over by colonists or immigrants. In one sense, numerous naturalized remedies have the special pedigree of exotic drugs (like the Chinese rhubarb he knows), a term generally used for plants from the "East and faraway places." There is no doubt that colonial physicians relied mainly on cultivated or naturalized (i.e., introduced) plants and imported remedies (sometimes of plants already naturalized), and used only a few plants indigenous to North America. The rich eighteenth-century records, such as the letters written between 1710 and 1717 by London merchant Joseph Cruttendon to customers in the New World, reveal an abundant trade in many drugs and preparations—clearly subject to seasonal problems of supply and consequent high prices—that remained popular until the late nineteenth century; others faded from general usage in consequence of revisions of the materia medica in the eighteenth century (for example, salt of vipers, surfeit water, and spirit of cockle purge).
Around six hundred crude drugs and prepared medicines were generally available to eighteenth-century colonial physicians. Of the principal imported medicines of that time, Bass knows or uses only a few, such as anise, asafetida, calamus, camphor, peppermint, turpentine, and storax, as well as three New World plants well established early in European medicine: sarsaparilla, sassafras, and Virginia snakeroot. During the eighteenth century, naturalized remedies already in domestic practice in the Colonies crept into regular colonial medicine rather than being imported. Of these, Bass uses apple, beech, bramble (blackberry and raspberry), catnip, clover, comfrey, dandelion, elder, ground-ivy, hyssop, mullein, oak, wild carrot, and willow. Bass knows but does not use other items employed in colonial times like calomel, cinchona bark, cinnamon, lavender water, paregoric (a preparation of opium), saffron, and sulfur.
Illustrating both late colonial reliance on European remedies and a sense of change is a serialized herbal in Christopher Sauer's Pennsylvania German almanacs published from 1762 to 1778. Two hundred and sixty-six plants, essentially selected from Theodor Zwinger's Theatrum Botanicum, were described. Sauer, who recognized the needs of Pennsylvania readers, did not slavishly copy Zwinger. Although he rarely cited indigenous American drugs—a few were mentioned, like Indian turnip, in the belief that they were essentially the same as European plants—Sauer recognized the availability of naturalized plants. He also indicated that some exotics could be obtained at local apothecaries' shops. It has been suggested that Sauer's selection of plants (only 19 percent of 1,418 in Zwinger's Theatrum) reflected those especially helpful for the diseases facing the Pennsylvanians.
Other German almanac publishers—Heinrich Miller (1769–77) and Bailey (1778–89)—also included herbs. Nine plants were recorded by all three publishers, suggesting that considerable importance was attached to them. These plants (some of which are considered in the monographs in volume 2) are celery, elderberry, elecampane, fennel, greater celendine, mallow, parsley, rue, and spoonwort. In fact, these were not viewed as important medicines in a first-aid sense. They were simply alternative choices to medicines widely used in the eighteenth century. Representative of major categories popular at the time are: aloes (purgative), antimony (diaphoretic), calomel (for biliary problems), cinchona bark (a tonic and for fevers), hartshorn drops (stimulant), ipecacuanha (emetic), jalap (purgative), opium (analgesic and for diarrhea), senna (purgative), tarter emetic (emetic and purgative), and valerian (for nerves).
Many of the monographs in volume 2 illustrate the long history of naturalized plants, the changing concepts behind their use, and the waxing and waning of their popularity. Many uses listed for such "hot and dry" plants as calamus, catnip, and wild carrot were described as "deobstruent"; for instance, diuretic, emmenagogue, carminative, and for removal of humors. During the eighteenth century, many medical uses, physiologically efficacious or otherwise, of countless "hot" plants were scrutinized and reevaluated as part of a general revision of therapy motivated by a sense of professional responsibility on the part of many physicians. Some plants fell by the wayside, some disappeared from the prescriptions of doctors but remained domestic remedies, and others persisted in regular medicine, generally with a reduced range of recommended uses and made into a smaller range of medicinal preparations.
The revision movement embraced a rhetoric of criticism of all "old" practices, changing fashions (for example, fading interest in distilled waters), and "scientific" attitudes (or at least a basis of experience). Critical-minded and influential William Cullen (1775) said that since calamus—to give one example—is not remarkable for aromatic and bitter virtues "it has been, of late, neglected." Such attitudes led another influential author, William Lewis (1791), to write: "This root is generally looked upon as a carminative and stomachic medicine, and as such is sometimes made use of in practice.... It was formerly an ingredient in the mithridate and theriaca of the London pharmacopoeia; and in the aromatic and stomachic tinctures, and compound arum powder of the Edinburgh Pharmacopoeia; but it is now rejected from these, and it does not at present enter any official preparation."
Excerpted from Trying to Give Ease by John K. Crellin, Jane Philpott. Copyright © 1989 Duke University Press. Excerpted by permission of Duke University Press.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.