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
