Europe and the Mediterranean Near East

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Europe differs from the other regions under discussion, in that there the historical knowledge about medicinal plants is rarely a popular tradition or based on knowledge handed down from one generation to the next. Instead herbal traditions form part of mainstream pharmaceutical traditions and relatively well-researched botanical medicines are often available. Most of this information is now transmitted via the mass media, especially through popular books about herbal medicines and in countries such as Switzerland, Italy, France and Germany. Other countries, like the United Kingdom, consider many herbal medical products to be a form of alternative and complementary medicine. However, in both cases medicinal plants have become a commodity.

The Mediterranean and Near East region has been characterized by mutual influences among popular medical practices and schools of medicine. The oldest written information in the European-Arabic traditions originates from the Sumerians and Akkadians of Mesopotamia, and another region for which we have documents that have survived through the millennia is Egypt. There are many problems in translating ancient texts. Because medicinal plants are precious and used in small quantities, they are rarely found in the archaeological record. Translation of ancient names therefore relies on internal evidence—for example, descriptions of the plant concerned—and on philological techniques. Many plant names from ancient Mesopotamia and Egypt are of uncertain meaning or cannot be translated at all. The Egyptians documented their knowledge, including medico-pharmaceutical knowledge, on papyruses (e.g., the Papyrus Eber), using paper made from the sedge Cyperus papyrus.

Greek medicine has been the focus of pharmaceutical historical research for many decades. The Greek scholar Pedanius Dioscorides from Anarzabos (first century ad) is considered to be the father of (Western) pharmacy. The doctrine presented in his works governed pharmaceutical and medical practice for more than 1,500 years and has heavily influenced European pharmacy. He was an excellent pharmacognosist and described more than six hundred medicinal plants. A number of Greek and Roman scholars were influential in developing other fields of health care practice and the natural sciences, including the following:

• The Greek medical doctor Hippocrates (ca. 460 to 375 bc) who heavily influenced European medical traditions and was the first of a series (of otherwise largely unknown) authors which produced the so-called Corpus Hippocraticum (a collection of works on medical practice).

• The Graeco-Roman medical doctor Claudius Galen (Galenus) [130 to 201 (?) ad] who summarized the complex body of Graeco-Roman pharmacy and medicine and whose name survives in the pharmaceutical field of "galenics" or pharmaceutical technology.

• Pliny the Elder [23 or 24 ad to 79 ad (killed at Pompeii while observing the eruption of Vesuvius)], who was the first to give a "cosmography" (a detailed account) on natural history, which included cosmology, mineralogy, botany, zoology, and medicinal products derived from plants and animals.

After the conquest of the southern parts of the Roman Empire by Arab troops, the Greek medical texts were translated into Arabic and adapted to the needs of the Arabs. Many of the Greek texts survived only in Arab transcripts. Ibn Sina or Avicenna from Afshana (980-1037) wrote the monumental treatise Canon of Medicine (Qanún fi'l tibb; ca. 1020), which was heavily influenced by Galen and which in turn influenced the scholastic traditions, especially of southern Europe. This five-volume book remained the most influential work in the fields of medicine and pharmacy for more than 500 years (together with direct interpretations of Dioscorides' work). While many Arab scholars worked in Eastern Arabia, the Arab-dominated parts of Spain became a second center of classical Arab medicine. An important early example is the "Umdat at-tabib" (The medical references) by the "Unknown Sevillan botanist." Thanks to the tolerant policies of the Arab regimes, many of the most influential representatives of Arab scholarly traditions, such as Maimoides (1135-1204) and Averroes (1126-1198), were Jews.

In the Christian parts of Europe the texts of the classic Greeks and Romans were copied and annotated during the Middle Ages, especially in the versions that had been passed on by the Arabs. The Italian monastery of Monte Cassino is one of the earliest examples of such a tradition, and others developed around the monasteries of Chartres (France) and St. Gall (Switzerland). A common element of the monasteries was a medicinal plant garden, which was simulateneously used for growing medicinal (and aromatic) herbs required for treating patients and for teaching the knowledge about medicinal plants to the younger generation. The species included in these gardens were common to practically all monasteries, and many of the species are still important medicinal plants of today.

Of particular interest in this context is another text, the Capitulare de villis of Charles the Great (Charlemagne, 747-814), who ordered that medicinal and other plants were to be grown in the King's gardens and in the monasteries. He specifically listed twenty-four species of medicinal plants. Walahfried Strabo (808 or 809 to 849), abbot of the monastery of Reichenau (Lake Constance), deserves mention because of his Liber de cultura hortum (book on the growing of plants), the first textbook on (medical) botany, and the Hortulus, a Latin poem on the medical plants grown in the district (Vogellehner 1987). This poem is not only famous not only because of its poetry, but also because of its vivid and excellent descriptions of the appearance and virtues of medicinal plants.

The climax of the medieval medico-botanical literature was reached in the 11th century with De viribus herbarum [On the virtues of herbs] of "Macer Floridus," a Latin poem written in approximately ad 1070 and attributed to Odo of Meung. In this educational poem, 65 medicinal plants and spices are described. Another frequently cited source was Physica, Causae et curae by the Benedictine nun, early mystic, and abbess Hildegard of Bingen (1098-1179). She described the medical benefits of plants and included many remedies popularly used during the 12th century. On the one hand, it is an early botanical work, and on the other hand her writings focus on prophetic and mystical topics. The botanical works of both scholars are only available in later copies and in prints. Unfortunately these copies only give a rather distorted idea of the original documents and are heavily reinterpreted texts.

For over 1,500 years the classical and most influential medical book in Europe had been Dioscorides' five-volume De materia medica (published ca. 50-70 ad). Until the Europeans' (reinvention of printing in the mid-15th century, these texts were handwritten codices that were almost exclusively used by the clergy and scholars in monasteries. Information about medicinal plants in Europe became much more widely available following the writing of the early herbals which rapidly became very popular and which made information about medicinal plants accessible in the languages of the lay people. Important authors of herbals published during the 16th century include Otto Brunfels, Eucharius Rosslin/Adam Lonitzer, Leonhard Fuchs (German), Nicolás Monardes (Spanish), William Turner, John Gerard (English), Pietro A. Mattioli (Latin/Italian), Garcia ab Horto (Orto) (Portuguese), and Antoine Constantin (French). The early texts were still strongly influenced by Graeco-Roman concepts, but other influences from many sources became increasingly important during the 16th century. The herbals rapidly became available in the various European languages and many of the later authors copied, translated and reinterpreted the earlier books or manuscripts.

The use of medicinal plants has always been an important part of all medical systems, including those in Europe during the various historical periods. Little is known about the popular traditions of Medieval and early modern Europe, since these were generally not written down. Our knowledge starts with the availability of written (printed) records on medicinal plant use by common people (see the previous discussion). As pointed out by Barbara Griggs (1981) a woman in the 17th century was a "superwoman," capable of administering "any wholesome receipts or medicines for the good of the family's health." A typical example of such a remedy is foxglove (Digitalis purpurea), reportedly used by an English housewife to treat dropsy and then used more systematically by the physician William Withering (1741-1799). He transformed British herbalism from knowledge simply passed by word of mouth into a science used by medical doctors (see Digitalis purpurea, following).

In the 17th and 18th centuries, knowledge about plant-derived drugs expanded, but the attempts to "distillate" the active ingredients from plants were unsuccessful. The main developments during these centuries consisted of detailed observations on the clinical usefulness of the medicinal products recorded in previous centuries or of those brought over from non-European countries. The next main shift in emphasis came in the early 19th century when it became clear that the pharmaceutical usefulness of plants was due to specific molecules, which could be isolated and characterized. This led to the development of a field of research now called natural-product biology or—in the specific case of plants—phytochemistry. Pure chemical entities were isolated and their structure determined. Some of these were then developed into medicines or were chemically modified and then used as medicines. In the second half of the 20th century, micro-organisms became another important source of biologically active molecules and many of these have been developed into medicines. However, the following brief accounts are exclusively on plants that have been of considerable pharmaceutical importance in Europe during the last centuries.

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    When was the climax of medicobotanical literature reached?
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