|by John M. Riddle. 1997. 341, pages ISBN: 0674270266|
A few years ago, when obscure herbs and botanical remedies were just beginning to reappear in American stores, my wife and I developed a taste for pennyroyal tea. Our food co-op sold herbs in bulk, from glass canisters and funky smelling barrels, so Jennifer and I had no recipes to follow. We knew only that the pennyroyal plant was a member of the mint family, and that when we steeped its pale-blue flowers in hot water they gave off a heady, amber-colored essence. The tea had a flavor of mint that was not quite peppermint, with a certain melancholy sweetness about it like chamomile, and for a while we drank it nearly every day.
It happens that, around the same period, Jennifer became pregnant for the first time. In retrospect, there were signs of trouble from the beginning -- her hormone levels weren't rising as they should, and she seemed to be losing some color -- but we managed to shrug them off in the excitement. There were names to choose, birthing classes to schedule, and our doctor didn't seem overly concerned.
Then one night, I woke up to find Jennifer clutching herself and crying, and within an hour the pregnancy was over.
A miscarriage is a peculiar sort of tragedy: a reversal of fortune so sudden and absolute it feels like a judgment, a guilty secret. But miscarriages are also extremely common -- a third of all first pregnancies end in them -- and many of our friends, we suddenly discovered, had had to endure more than one. Like them, we learned to credit our loss, however halfheartedly, to the body's vigilance, to think of it as a test run, a tune-up.
About a year later, though, something happened to change my mind. I was sitting in our living room, listening to a song by the rock group Nirvana, when the singer's keening carried a few words above the noise:
Sit and dunk pennyroyal tea
Distill the life that's inside of me
Sit and dunk pennyroyal tea
I'm anemic royalty.
It was a kind of sinister nursery rhyme, innocent on its surface but appalling once decoded. Pennyroyal, we came to learn, is an abortifacient, an old friend to "luckless girls in need," as the Nebraskan novelist Mari Sandoz once wrote. Too much of it can damage the liver and cause convulsions, coma or even death. A little less can end a pregnancy.
A thousand, two thousand, even three thousand years ago, Jennifer and I would have known that. Any midwife in ancient Athens could have told us about the penny-royal in her garden. And we would have laughed, during a comedy by Aristophanes, to hear Hermes advise the hero to "add a dose of pennyroyal" to keep his mistress out of trouble. Had we lived in Persia at the time of the Islamic empire, Jennifer might have taken pennyroyal as a contraceptive, along with pomegranate pulp, willow leaf, and colocynth. And in 18th-century London, her copy of The Experienced Midwife would have explained that pennyroyal "hastens the menses" -- an old euphemism for abortion.
But we live in an impoverished age for herbal lore, when pennyroyal and pomegranate have given way to the pill, and midwives to physicians. Herbs are considered mostly harmless -- good for cooking and the occasional sore throat. Even their extracts, sold as nutritional supplements in drugstores, carry labels that barely hint at their uses. Modem medicine, it seems, has finished off what parish priests, grand inquisitors, and temperance leagues began: it has made people forget the drugs in their own backyards. Not so long ago herbs were a woman's secret weapon, a magic bullet against reproductive demands at home and at church. Now they're a secret affliction -- a curse courted by accident, encrypted by a song.
The irony is that contraceptives have never been more badly needed. In spite of dramatic advances in reproductive science, more than half of all pregnancies in the United States are unintended, and a quarter end in abortions. Contraceptives are safer and more effective than ever, but they can also be expensive, troublesome, and prone to side effects. For years, family-planning specialists have promised more convenient alternatives: vaccines, "morning after" pills, painless implants, and male contraceptives. But when new drugs do materialize -- such as the abortion pill RU 486, or mifepristone -- they become ensnared in lawsuits, drug regulations, and religious protests.
Along the way, vital information gets lost. Only 36 percent of adult Americans, according to a recent poll, know that a dose of birth-control pills can prevent pregnancy even three days after sex.
In Eve's Herbs John M. Riddle shows just how much more has been forgotten. A historian at North Carolina State University in Raleigh, Riddle works his way from Egyptian papyrus to papal bull, medieval antidotarium to Victorian nostrum, tracing the slow erasure of herbal lore in the West across three millennia. Riddle aims, above all, to reveal the hidden history of abortion -- to prove that women practiced it as a matter of course long before Jane Roe. But his work makes an even more telling political point, albeit indirectly: the same forces that once repressed pennyroyal and other herbs are keeping new contraceptives off the market today.
When historians mourn the lost wonders of the ancient world they tend to mean the Colossus of Rhodes or the Hanging Gardens of Babylon, the Pharos of Alexandria or the Mausoleum of Halicarnassus. To that list, Riddle might add one seemingly unremarkable candidate: a species of giant fennel known as silphium to the Romans, that once grew in North Africa. In the seventh century B.C., a band of Greek settlers from Thera founded the city of Cyrene, in what is now Libya. "What they found," Riddle writes, "must have made them question the oracle's advice to go there." The landscape was parched, the people unfriendly and Greece dishearteningly distant. But Cyrene, it turned out, had a single asset -- silphium -- that was enough to make the colony rich.
As a condiment or cough syrup, silphium was already pretty good. But as a contraceptive it had no equal. According to the second century Greek physician Soranus, the juice from a chickpea-size portion, taken once a month, was enough to do the trick. To the delight of the Cyrenians, and the everlasting dismay of everyone else, the plant grew exclusively in North Africa, along a 30-mile strip near the city. When it failed to transplant to Syria and Greece, prices rose quickly, as did harvests. By the beginning of the first century A.D., silphium was more costly than silver by weight. Three centuries after that it was extinct.
Silphium was the aristocrat's contraceptive -- the classical equivalent of lambskin condoms. But contraceptives of any kind were beyond the ken of common folk, or so most historians have held. Peasants hardly knew the connection between sex and pregnancy, the reasoning goes, much less which plants might inhibit conception. To counter such arguments. Riddle presents a chart of the declining birthrate in ancient Greece -- from 5.0 births per female in 2000 B.C. to 3.3 in 120 A.D. "How did they do it?" he asks. Infanticide, some historians answer But then why are women's skeletons from ancient sites scarred by so few childbirths? Chastity, one might venture. But sexual restraint, as Riddle writes, "was not a quality about which the ancients could boast or lament."
The best answer seems to be the obvious one: the common folk were not as ignorant as they seemed. For centuries farmers must have noted how plants could affect their pregnant livestock -- according to some estimates nearly a third of all miscarriages among animals are caused by plants. Mothers and midwives must then have passed on the information and refined it in what Riddle calls, with a touch of melodrama, a "chain of learning...forged by vocal cords."
By the time of the Greeks the seeds of herbal lore first cultivated in Egypt had grown into a pharmacopoeia. Socrates, in one of Plato's dialogues, tells a student that "midwives, by means of drugs and incantations, are able to arouse the pangs of labor and, if they wish...cause miscarriages." (Socrates would have known: his mother was a midwife.) Some of those drugs are disconcertingly familiar. Celery, dates, and figs made the lineup, next to suspicious characters such as motherwort and birthwort. And although death carrot and black cohosh sound like known felons, it is surprising to see parsley, sage. rosemary, and thyme among their ranks. The ancient sources are far from infallible, of course. "If a woman takes a frog and spits into its open mouth three times," one early physician recommended, "she will not conceive for a year." But modem pharmacological studies back up the ancient witnesses more often than not. One study found, for instance, that a diet of figs and fig leav es can reduce mouse litters by more than half. (No wonder Pacific islanders were still using figs as contraceptives as recently as the 1970s.)
At certain dosages, other plants seem even more effective: aloe, artemisia, corn mint and Queen Anne's lace consistently prevent or end pregnancy in rats, and birthwort, pomegranate and squirting cucumber can be just as potent.
Sixty-five years ago German chemists discovered that date palms contain compounds identical to female sex hormones, ushering in a new era of plant studies. Since then herbal contraceptives have been found to work in numerous ways. Corn mint keeps an embryo from implanting; seeds from the chaste tree, one of the rare male contraceptives mentioned in ancient texts, disrupt sperm production. Abortifacients, predictably, work by more brutal means: rue, for instance, poisons the body until it gives up on the fetus.
All things considered, ancient Greece was a kind of golden age for family planning -- even more so than for art and philosophy. Antifertility herbs were well known and widely used and though there were some strictures against abortion (the Hippocratic oath may or may not have forbidden it, depending on the translation), contraception was never regulated. But then, century by century, statute by statute, the screws tightened. Among the Romans, contraception was tolerated, but prescribing an abortifacient could get you exiled -- to the mines if you were poor, or to an island if you were rich. By the early Middle Ages priests were asking women in confession, "Have you drunk any maleficium so that you could not have children?" If the answer was yes, the sinner had to do penance for 40 days -- a slap on the wrist by later standards.
In the scriptural debates and witch-hunts that would follow one can see prefigured, as if in an allegorical painting, the Supreme Court decisions and clinic shootings of today. In Italy during the late Middle Ages members of a fertility sect known as I Benandanti, or the do-gooders, would stage symbolic duels in forest clearings with local witches, who probably practiced birth control and abortion. For weapons, the Benandanti wielded stalks of fennel, which was thought to prevent abortions, whereas the witches had stalks of sorghum, which contains an abortifacient alkaloid. Exchange the plants for placards and you have a modern-day abortion fracas, pitched outside a family-planning center.
Both groups were eventually rooted out by the Inquisition, which had no tolerance for fertility cults of any stripe. But the true tragic figures of the period were the midwives and "wise women." For centuries they had preserved recipes for contraceptives and abortifacients, tending to women and filling in where physicians were ignorant. Now they were caught in a pincer movement. On one side was the Roman Catholic Church, declaring ever more strictly in favor of procreation and fetal rights, until even sperm were suspected of having souls. On the other side was the medical establishment, which grew less tolerant as it grew more professional.
By the 14th century, Riddle writes, physicians, surgeons, apothecaries, and even barbers had to be licensed to practice. University degrees were a prerequisite, but women were not allowed to earn them and so were effectively shut out of medical practice. Wise women, once honored members of their communities, became vulgares or illiterati mulieres, their healing arts dismissed as mere folklore or, increasingly, witchcraft. Physicians had never learned much gynecology; now, with the church's help, they demonized what they did not know. "Midwives were the victims of a vicious syllogism," Riddle writes. "To know the secrets was to be a witch: it was necessary to know the secrets to be a midwife; therefore, a midwife is a witch." Or, as one church dictum put it: "If a woman dare to cure without having studied, she is a witch and must die."
The people took the church at its word: of the half-million witches burned at the stake in western Europe between 1450 and 1700, more than a third, in some areas, were midwives, and nearly all were women. King James I of England best conveyed the prevailing philosophy: "The more women, the more witches."
The result, in gynecological terms alone, was a disaster. The midwives' simple prescriptions, most of which could be filled in any herb garden, were gradually replaced by complicated concoctions with exotic ingredients -- the precursors of today's patented drugs. One 16th-century "menstrual regulator" contained more than 25 ingredients. "It is such a mess," a commentator later wrote, "I verily think the labour and cost of it put in an equal balance would outweigh the benefit."
A medieval woman could still step into an apothecary and buy a decent contraceptive. "What she lacked," Riddle says, were the "precise, careful, and expert directions midwives had once offered. And what of the women who never made it to an apothecary? Chances were they fell prey to the fabulous fictions in which medieval minds seemed to specialize. "Let a woman eat a bee and she shall never conceive," recommended one 14th-century book. Others put more stock in sapphire jewelry, rabbit stomachs, or mule uteruses as contraceptives; vulture feces, donkey dung, or the "oil of philosophers" as abortifacients. Physicians and prelates, so intent on dispelling superstition, effectively conjured it up instead.
It was to be more than 500 years before medicine replaced what it had helped destroy. As late as the 19th century, Riddle writes, physicians "were less aware of what women were doing, and women were themselves less knowledgeable, than their forebears thousands of years before." In 1877, for instance, a contraceptive guide called Fruits of Philosophy: the Private Companion of Young Married People, caused an uproar -- one judge called it "a...dirty, filthy book" and proceeded to fine its publisher. Yet any woman could have gotten more and better information at her local library from works by Hippocrates.
Thank goodness those days are over, one is tempted to say after reading Riddle's book. And in ways both tearful and encouraging, this is the true heyday of family planning. Nearly 40 years after the pill was invented, investigators are still perfecting ways to deliver hormones to the body, even as breakthroughs in biochemistry are pointing to entire new categories of contraceptives. In the spring of 1996, after a 20-year search, molecular biologists identified the protein (or proteins) that sperm cells use to bind with eggs. (In fact, three separate teams identified three distinct proteins -- which one is the real McCoy remains to be seen.) In addition, investigators have found ways to immobilize sperm; to "blind" them to the presence of an egg, and to induce men to produce antibodies that shut down sperm production. Every new approach, in theory, could give birth to a revolutionary new drug.
"It's really Wild West out there," says Elof D. B. Johansson, a vice president of the Population Council in New York City and director of its Center for Biomedical Research. "Basic research has come up with so many possible leads, and all of them are being tested." Testosterone injections for men -- painful, but effective -- have been shown to prevent conception, and other such contraceptives are in the works. The Population Council alone has two in early clinical trials: a vaccine and a synthetic steroid, both of which have proved effective in male rats. Investigators in India, meanwhile, are preparing to test a vaccine for women in a massive human trial -- the final step before the vaccine can be sold to the public.
Yet for all the commotion on the frontier next contraceptives are likely to remain a distant murmur. Even their greatest boosters tend to sound like physicists discussing the future of fusion power: with any luck, they say, the new vaccines may be around "in the first third of the 21st century." Although the world population will double in the next half century, and although some 228 million women lack effective contraceptives, birth control remains a risky business economically, culturally, and politically. The Middle Ages, in some ways, are still with us.
In the past two decades, eight out of 12 major pharmaceutical companies have stopped developing new contraceptives. The science is there, it seems, but the numbers are not. Developing a new contraceptive and getting it approved can cost as much as $500 million -- and then the real costs kick in. Contraceptives are powerful drugs, prone to side effects. Given that they are also designed for healthy users, who are likely to notice such side effects, they are natural targets for lawsuits. Copper intrauterine devices (IUDs) and the Norplant system, two long-term contraceptives, have both been crippled by litigation, though none of the charges has stuck. "We can find no scientific or medical basis for these litigations," Johansson says, "But they're enormously costly and they drive sales down to the bottom -- it's a double whammy." The same mixture of fear and perfectionism once suppressed herbal contraceptives when no better alternatives existed.
True, abortionists are no longer burned at the stake, but religious protests can still kill a new drug. It has been nearly 10 years, for instance, since the abortion drug RU 486 was approved in France. In that time French women have come to prefer it over surgical abortions two-to-one, and more than 200,000 women have used it safely. Yet RU 486 still cannot be sold in the United States. President Clinton originally scheduled the drug for fast-track approval, but protests from Christian and pro-life groups soon stalled the process. Last year the drug seemed ready for release at last. Then its Hungarian manufacturer, Gideon Richter, pulled out suddenly, consigning RU 486 to limbo once again.
The worst knock against the new drugs, ironically, is that they are too convenient. Pro-life groups object to RU 486 mainly because it makes having an abortion too easy. And female vaccines have drawn the ire both of women's groups and Catholics (no small feat) precisely because they promise to be cheap and effective. Longterm vaccines would be so easy to administer, both groups say, that governments might well foist them on unsuspecting women. In the Philippines three years ago, Catholic activists accused health authorities of slipping contraceptive vaccines into tetanus shots. The charges proved groundless, but not before they had kept thousands of women from getting the shots.
And so it goes, each new drug stumbling over a different set of trip wires. In 1990 and again in 1996, committees at the Institute of Medicine in Washington, D.C., suggested some ways to clear the path. The federal government could protect the makers of contraceptives against excessive liability as it does the makers of vaccines. Or a central agency could purchase and distribute contraceptives in bulk. Or insurers could cover contraceptive costs, recognizing that unintended pregnancies cost far more in the long term. But political will is lacking. The countries most likely to pay for new contraceptives are looking for ways to raise their fertility rates, not lower them. Singapore, for instance, has an entire bureaucracy devoted to matchmaking, and France rewards large families with government stipends. Population control is fine and good, such policies imply, as long as it's practiced somewhere else.
No wonder some women are turning back to herbs. In the past five years, as food and drug regulations have loosened, herb sales in the United States have doubled. Disenchanted with modern medicine, people have begun taking echinacea to fend off colds, ginkgo to sharpen memory, and any number of herbs to prevent pregnancy. More and more, a trip to a health-food store or vitamin shop can feel like a visit to a medieval apothecary. Jars of odd-colored powders and tinctures line the shelves, their labels promising vaguely to "promote well-being," their contents largely unregulated.
There is a certain bittersweet quality to the sight of all those ancient remedies, reemerging after centuries underground. But nostalgia can be dangerous where contraceptives are concerned. Unscrupulous manufacturers aside, herbs are unpredictable by nature. Depending on where and how they are grown, what part of the plant is used and how they are processed, herbs can have a host of different effects. Standardized herbal extracts dodge some of those uncertainties, but dosages remain largely guesswork. Two years ago, when Consumer Reports tested 10 ginseng products, one contained virtually no ginseng at all; the concentrations in the others varied by 1,000 percent. Medieval customers, at least, had midwives and apothecaries to guide them. But today's pharmacists know little if anything about herbs.
In the epilogue to Eve's Herbs, Riddle describes a dinner party he once attended in the Appalachian Mountains of North Carolina. He was telling a public health nurse named Mary about his research, he says, when she mentioned that some of her clients were taking an herbal contraceptive. Intrigued, Riddle asked her what part of the plant they were eating and whether they took it before or after sex.
"Told that the seed was ingested after intercourse, I guessed that they were taking Queen Anne's lace, about a tablespoon. It was then Mary's turn to be surprised, and she asked how I knew.
Ignoring her question for a moment, I told her, "Thank you, you have just provided me with my only source since the 17th century for its use!"
More than anything, that story shows just how tenuous most herbal lore has become. Riddle is a tireless scholar and an engaging writer, and as his story moves along in chronological order, it begins to read like an official history. But at heart Eve's Herbs is just the opposite: a gathering of nervous confessions and forbidden secrets, committed to paper as proof of a hidden tradition. Like a covey of quail flushed from tall grass, these anguished facts burst from the page with startling life. But they will go back into hiding just as quickly -- back to their old haunts in wives' tales and herbal manuals, midwives' formulas and nursery rhymes.
In the end, maybe that's where they should stay. Medicinal herbs have their uses, but nowadays contraception and abortion needn't be among them. If any one theme runs most plainly through Riddle's history, it is the sheer physical danger family planning once entailed. Even in modern times more than one woman has died from taking too much pennyroyal oil or colocynth powder -- an abortifacient favored by the Egyptians -- and past fatalities must have been much higher. Eve's herbs worked better than physicians were long willing to admit, better than anything science had to offer for thousands of years. But it will be a sad coda to Riddle's tale if many more women begin to use them, just when they should need them least.
Burkhard Bilger is deputy editor of The Sciences.
Article copyright American Botanical Council.
By Burkhard Bilger