The Development of Medical Botany and Pharmacology During the Middle Ages

Overview

Once early humans developed the ability to reason, they began to experiment with various plants and herbs. Through the process of trial and error, early humans discovered which plants might be used as a food source, which could be used to flavor food or drink, which caused sickness or death, and which had medicinal value. Over time, nearly every type of herb and plant was classified into one of these categories. Pharmacy at that time was not a scientific discipline; rather, it was a mixture of medicine, superstition, and magic.

However, such primitive study of the medicinal value of plants and herbs established the roots of the modern branch of medicine called pharmacology. Traditionally, the field of pharmacology relies heavily on the subdiscipline of medical botany, the scientific study of the medicinal value of plant life. The vast majority of chemical compounds that have physiological actions in the human body derive from plants. Humans have used these types of remedies to alleviate common discomforts such as colds, allergies, and constipation. Interestingly enough, most of the present-day laxatives were used in similar fashion by societies during antiquity. While pain remedies such as aspirin would not be isolated for thousands of years, it was known that willow bark would help relieve pain. We now know that willow bark contains a substance that is similar to salicylic acid, the main active ingredient of aspirin.

It should not be assumed, however, that humans at that time had an understanding of the pharmacological actions of plants and their subsequent actions within humans. Drugs were administered with little concern for the patient, often with incantations, charms, and other paraphernalia that were believed to be necessary for action. As previously mentioned, drugs made from plants and other products were only a small portion of the cure. Many times, the administration of a specific compound was not based on reason, but misconceptions and superstitions. While these may have had some effect as placebos, they were often ineffective, or, even worse, the treatments were more dangerous than the condition that was being treated. Pharmacology as science really did not begin until the late nineteenth century. As a result, attempts were made to systematically describe the field of medical botany so that it could become more useful and reliable.

The ancient Greeks were the most successful in describing the medicinal value of plants. Theophrastus (c. 372-c. 287 b.c.) was the first scientific botanist who described and classified many different types of plants. Later, Dioscorides (40-90) applied this knowledge and described nearly a thousand different pharmacological treatments, with the vast majority of those using plant-based ingredients. He is often known as the first herbalist and is often referred to as the "father of pharmacology." This body of knowledge was expanded upon during the Middle Ages, with new remedies being described and formulated with increasing frequency.

Background

Despite the available body of knowledge in medical botany and pharmacology, it was quite common for a person to die during the Middle Ages from a contracted disease, especially if it was caught during a major epidemic. Over one million people died from the Black Death (bubonic plague) in England alone, and millions of others died throughout Europe. Certainly deficiencies in medical technology and practice played a major role in the low survival rates, but most people who were sick during those times would have fared better if they were able to visit a physician. While wealthy individuals could afford proper medical care if they were stricken ill, less well off individuals were often priced out of the market. A single visit to the doctor during that time would cost a laborer an entire month's pay. In order to bridge this service gap, apothecaries and "wise women" served the local populations in the capacity of the physician. In fact, in most cities the majority of the populous was served by apothecaries rather than trained physicians.

Apothecaries and "wise women" were individuals who made and dispensed medicines. Most of these people also made diagnoses and treated diseases as well. Nearly every town had at least one apothecary shop that sold medicines for many types of ailments. The drugs that were dispensed were either filled prescriptions according to a physician's direction, or a concoction of their own devising. These remedies were assembled using a wide variety of ingredients, which consisted mainly of herbs and flowers. Apothecaries also relied heavily on animal organs and tissues to make their potions, salves, and ointments. Most apothecaries learned their trade as an apprentice mixing medicines, so there was little formal education. They spent a large amount of their time mixing and dispensing plant and herbal derivatives as drugs. Some apothecaries sold their remedies while traveling from town to town, never staying too long in one place. This type of setup was a prime target for abuse and many charlatans practiced this way. Because of this type of practice and their lack of medical training, there was an attempt to make all apothecaries practice their trade while licensed. This was largely unsuccessful as many simply ignored the law. Over time, the influence and importance of apothecaries waned.

Christian monks were another important component of medieval pharmacy, as religion was tightly entwined with medicine at the time. It was common for a monk to know how to mix herbs and drugs, but put his faith in the healing power of God. However, it was a nun named Hildegard von Bingen (1098-1179) who made some of the most important contributions to pharmacology at this time. Hildegard was a practical medical practitioner who trained nurses and studied medical botany. She made use of over 100 medicinal plants grown in her own garden, gathered from the surrounding area, or imported for that specific purpose. She also published two important pharmacological works, which were compilations of current knowledge along with her own reflections and improvements. She even advocated many modern practices, such as the importance of a good diet and exercise.

The field of pharmacy took a significant step in the early fifteenth century when the Italian physician Saladin di Ascoli wrote the first European guide for pharmacists. In his work, he outlined the duties and obligations of a pharmacist and warned against the misuse of drugs. He also advocated following the orders of the physician literally, without changing any of the ingredients of the prescription. This was the first step in establishing pharmacy as a reliable and useful profession.

Impact

It is obvious that modern day medical practice and pharmacology have their roots, at least in part, in the Middle Ages. The application of plant and herbal medicines grew tremendously during that time. These drugs became an important component of treatment just as they are today. The wealth of medieval knowledge on this subject is much more than one would think, despite the general lack of systematic scientific inquiry. Perhaps no other person had as significant impact as Saladin di Ascoli. To a large degree, he made pharmacology a legitimate science and made the pharmacist a trusted and viable professional by his insistence upon reform. The use of drugs was a controversial subject at that time, and by encouraging legitimate use of these materials, pharmacy became a respected and useful science.

People like Hildegard von Bingen also had a significant impact on modern pharmacy and medical botany in two major ways. First, they kept alive the body of knowledge about medicinal plants in their everyday work, and some carefully recorded their uses. Second, their natural curiosity led them to greatly expand upon this knowledge through their own research and experimentation. Although many of these developments were somewhat hampered by superstition and myth, they nevertheless made significant strides in the field on medical botany. This quest for knowledge in the area of herbs and plants is continued in modern society. Each year there are about 4,000 newly described chemical compounds reported by scientists. Of those, about 75% are derived from plant life. All of these compounds have the potential for becoming a useful drug. One of these compounds, for example, might even hold the cure for cancer. This quest for knowledge is a direct result of the work in medical botany done hundreds of years ago. In fact, this has led to a new title for an old profession, bioprospecting. Bioprospecting involves searching for new sources of drugs and chemical compounds from living organisms (primarily plants).

Another important development is the increased use of physician assistants and nurse practitioners. These medical professionals can be likened to modern apothecaries, as they provide similar services. With increased medical costs, it seems ideal to provide inexpensive medical services through people who have medical training, but are not full-fledged doctors. These licensed medical professionals have significant schooling and training. They are well qualified to treat a variety of ailments and represent a cost effective alternative to a standard physician.

While much of our knowledge and practice of medicine has changed significantly since medieval times, the field of pharmacology has its roots in the Middle Ages. Medieval contributions to this body of knowledge proved to be important steps in the development of our modern knowledge and practice of pharmacology and medical botany.

JAMES J. HOFFMANN