Valerian and Other Anti-Hysterics in European and American Medicine (1733–1936)

Throughout the history of western medicine, valerian (Valeriana officinalis L.) has been one of the best-known herbal remedies of all time. Since the 1600s it has been known as one of the greatest sedative and restorative remedies for the nervous system. Today throughout Europe, North America, Australia, and New Zealand it is still used for the same purpose.

Hysteria Cures

(in 18th, 19th and 20th Century Medicine)

From the 18th century up to the present, nervous disorders that were poorly understood and more or less lumped under the heading hysteria or hypochondriasis gradually became more differentiated into separate disease entities. These types of disorders, usually considered a result of an overly-excitable nervous system, were treated by a group of drugs—either of vegetable or mineral origin, known as “antispasmodics” or “anti-hysterics.” In 1928, McGuigan wrote that antispasmodics or antihysterics were one and the same, saying about this class of drugs:

“Antispasmodics are remedies that control or modify minor grades of motor excitation. As a class, antispasmodics are useful chiefly in hysteria and allied conditions.”

He continues that this class of nervous disorders is nebulous and exhibits many diverse symptoms, but it can be summarized by saying that “Hysteria represents failure to utilize energy in socially successful ways.” Today, the term “hysteria” is much more defined and is considered one class of neurotic disorder—giving recognition to its true psychogenic origin. The Merck Manual(24th ed.) says that because hysteria as a disease is more than 2,000 years old, “its limits as a disorder have become blurred by a variety of definitions.” Thus today, it is difficult to say exactly what psychological conditions were treated with the help of valerian, asafoetida and other “antispasmodics” and anti-hysterics—except that they probably fall into the general modern categories of hysterical neurosis, somatization disorder, and hypochondriacal neurosis.[1]

Diazepam, or Valium, was introduced in 1964. It subsequently became one of the most prescribed drugs of all time for mitigation of anxiety, tension, relaxation of muscle spasm, as a general sedative, for nausea and vomiting of psychogenic origin, and for lessening of the symptoms of the acute agitation that may come during withdrawal from alcohol.[2] While Valium is rather new, anxiety, tension, and the other nervous disorders for which valium has been commonly prescribed are certainly not. What was used in the days before it was available—say 200 years ago, in 1790?

First of all, is it possible to draw parallels between the two eras and the remedies used to treat the common nervous disorder known in the 18th, 19th, and early 20th centuries as hysteria? If one reviews the medical literature during this 200 year time period, many parallels can be seen between the common use of valium today and that of valerian and other official drugs of the 18th century (and 19th and early 20th century) said to have similar actions. Interestingly, it is a common misconception that valium is somehow chemically derived from valerian. Then, as today, it is possible that common factors such as stress and inactivity were strong contributing factors in hysteria.[4] [5] During the 18th, 19th, and early 20th centuries, hysteria was commonly thought to occur especially in people who were of a generally weak hereditary constitution. Contributing factors were mental overwork, an overly active imagination that is not restrained, fear, constant worry, too much stimulus, too luxurious a style of living, too “relaxed” a system, too much sleep, lying abed too late in the morning, excessive use of stimulants such as coffee, tea, the use of tobacco, etc.[7] One might imagine that many of these same conditions are still likely causes of many forms of “nervous complaints today.

The sedentary life-styles of today (both work and leisure) may also be a strong contributing factor—just as many middle and upper-class life-styles of the 18th and 19th centuries were thought to contribute dramatically to nervous disorders. In fact, two of the best-known popular works on health and herbs of the last 200 years (both written by medical doctors), Buchan’s Domestic Medicine and Gunn’s Family Physician, strongly recommend exercise as indispensable for curing all manner of diseases of the nervous system, especially hysteria and hypochondria.[8] Today, many popular books on health extol the virtues of exercise.[10]

Despite the differences in technological advancement between then and today, it can be easily seen that many of the basic forces that act on the nervous system are still the same, giving rise to the same nervous problems now as then—possibly under different names.

In the 18th century until the 1930s, drugs of direct herbal or mineral origin were commonly used to cure disease and alleviate their symptoms, as synthetic drugs were not yet developed. Some of these remedies have been consistently used for a period of 3,000 years or more for the same ailments, such as senna to open the bowels.[12]

With the current renewed regard for herbal medicine and natural remedies derived from plants, it is of interest to review the most famous, or “celebrated” as they said in the 18th century, of the official remedies for these nervous problems, especially hysteria, hypochondriasis, and mania—diseases of nervous excitability—and see how many stood up to the “test of time.” The information in table 1 is compiled from dispensatories, pharmacopeias, and materia medicas from a period of 200 years—1733 until 1936. It must be mentioned that all of the works selected are written by the best-known and respected medical doctors of their day, principally for the use of doctors in practice.

Table 1

In the chart, an “x” was placed under the work corresponding to a given drug when it was not only mentioned by the author, but the author found it personally effective or recommended it for hysteria, mania, or hypochondriasis. [13, 14, 15, 16, 17, 18, 19, 20, 21]

Remedy	Description of Use	a	b	c	d	e	f	g	h	i
Asafoetida (Ferula assa-foetida L.)	hysteria and other nervous complaints	x	x	x	x	x	x	x	x	x
Bromine (sodium bromide, etc.)	sedative to the nervous system; antispasmodic; “…greatly overused…”							x	x	x
Camphor (Cinnamomum camphora [L.] Presl)	given in nervous affections, to excite the vis vitae, antispasmodic, procure sleep, nervous headaches	x	x	x	x	x	x	x	x
Clary Sage (Salvia sclarea L.)	recommended in hysteric disorders	x		x
Feverfew (Tanacetum parthenium [L.] Schultz-Bip.)	hysterical disorders	x		x
Galbanum (Ferula galbaniflua Boiss. & Buhse.)	esteemed in hysterical complaints	x	x	x		x	x	x
Hops (Humulus lupulus L.)	induces sleep; mania	x	x		x		x
Black Hellebore (Hyoscyamus niger L.)	“…has been given with advantage in a variety of nervous affections, mania, melancholia, epilepsy, hysteria, etc. anodyne. Like opium, its influence is diminished by [habitual use]		x	x	x	x	x
Iron (martial flowers, called Ens veneris)	for hysterical and hypochondriacal states		x	x		x	x
Lavandula angustifolia Miller	recommended in vertigos, palsies, tremors, suppression of menses.., all disorders of the head, nerves and uterus	x	x	x			x
Opium (Papaver somniferum L.)	most prescribed; “…mitigating pain, inducing sleep..”; hysteria, hypochondriasis			x	x	x	x	x
Pennyroyal (Mentha pulegium L.)	hysterical cases			x	x	x	x
St. John’s wort (Hypericum perforatum L.)	“..extolled in hysterical and maniacal disorders..”; melancholy	x		x
Valerian (Valeriana officinalis L.)	“…one of the principal anti-spasmodics..for nervous and hysterical affections..”	x	x	x	x	x	x	x	x	x
Wood soot	used in hysteric and other nervous cases, sometimes in conjunction with asafoetida, galbanum			x
Zinc (flowers of zinc)	epilepsy and antispasmodic			x		x
Remedy	Description of Use	a	b	c	d	e	f	g	h	i

Specifically, the authors are:

1. James Alleyne’s A New English Dispensatory (1733)
2. R. James’ Pharmacopeia Universalis (1745)
3. Andrew Duncan’s revision of Dr. Lewis’ famous Edingurgh New Dispensatory (1791)
4. William Cullen’s A Treatise of the Materia Medica (1802)
5. James Thatcher’s The American New Dispensatory (1813)
6. Jonathan Pereira’s The Elements of Materia Medica and Therapeutics (1843)
7. Samuel Potter’s Handbook of Materia Medica (1890)
8. A.A. Stevens’ A Textbook of Therapuetics (1924)
9. Torald Sollmann’s A Manual of Pharmacology (1936)

As can be quickly seen from table 1, the most prescribed medicines over the 200-year period were asafoetida, camphor, galbanum, opium, and valerian. The other remedies were recommended at one time or another, but were considered only marginal by most authors. For instance, zinc was mostly considered too toxic by many of the doctors and of too little activity in nervous complaints. Wood soot was popular in continental Europe in the early 1700s and even later but was fairly obscure—it was, however, official in early editions of the London Pharmacopeia.[22, 23] St. John’s wort has been recommended since ancient times for nervous complaints, but was also primarily a continental remedy, not as popular in England and early American medicine.[24] Pennyroyal was mentioned by a number of authors and has always been associated with female menstrual imbalances, and secondarily for nervous disorders—but it was generally considered too weak to be of any real benefit in hysteria. Opium was, of course, one of the most important drugs of the entire era—but it was more prescribed for sleeplessness and anxiety due to organic pain and to alleviate other kinds of pain. The dangers of over-prescribing it were well-known even in the early 1700s.[25] Lavender was used in several forms, including the essential oil for headache. It was considered a specific for hysteria and was popular during the late 1700s and early 1800s, but then fell out of favor as being too weak.[26] Iron was considered a specific for hysteria and as a general strengthening tonic for many years, but eventually became known as a blood-building tonic to counteract anemia, much as today.[27] Black Hellebore was considered a valuable remedy for hysteria, but later fell out of favor as being too unpredictable and toxic. Much the same can be said of Conium (poison hemlock—the dried leaf was very uneven in potency, and some authors recounted stories of people who nearly died because a prior dose was so weak and a subsequent one too strong.[28] Hops was used in pillows on the continent to bring sleep in hysterical conditions and as a tea for a period of time for the same. It was considered a mild remedy.[29] Galbanum is closely related to Asafoetida and was used in similar ways—as an anti-spasmodic and digestive strengthener in cases of hysteria and hypochondriasis. It was considered inferior in activity to asafoetida.[30] Feverfew has been considered a good menstrual remedy since antiquity and is mentioned especially in English works, where it is still popular today.[31] Clary sage was mentioned in early English materia medicas but, being considered too weak and uncertain, it quickly fell out of favor. Camphor, the solid oil from the tree, Cinammomum camphora, was always controversial as a remedy for the nervous system. Some authorities said that it was stimulating and some sedative.[32] It was generally considered effective for hysteria throughout the period, but finally began to lose favor in the 1900s, as by then bromides, the hypnotic, chloral hydrate, and the barbiturates were among the most prescribed for these conditions.[33]

Obviously, the two most-prescribed remedies for hysteria and related complaints were asafoetida and valerian. They never lost favor throughout the period of over 200 years, and were still recommended 1n 1936 by Sollmann, but declined in popularity (in the United States, but not as much in Europe) in the 1940s,[35] valerian being dropped from the National Formulary in 1950.[36,37]

Valerian

As has been previously stated, valerian was one of the most commonly used of the above remedies of herbal origin for nervous disorders—and it most certainly is today. In addition, of all the herbal remedies reviewed here it is the one that is most supported by modern research as a mild central nervous system sedative. Thus the next part of this paper will focus on this plant, starting with a short history of its use down through ancient times, and especially since the late 1600s when it began to be used particularly for its effect on the nervous system, and later, as it became the “drug of choice” for hysteria and what was known as “the vapors.”

Because of the unevenness in quality of valerian drugs, there has been some controversy over the centuries about how effective it is as a curative agent, especially for nervous conditions such as epilepsy, hysteria, nervousness, and sleeplessness, but modern research has identified several active compounds and shown them to be active on the Central Nervous System.[38]

Botany

Common or garden valerian is a member of the family Valerianaceae Batsch., an evolutionarily advanced family of 10 genera characterized by mainly opposite, whorled or basal exstipulate leaves, an inferior 3-carpellate ovary with a persistent calyx (at times forming pappus) and sympetalous, irregular tubular corollas. Stamens are 1-4.

Valerian is placed in the genus Valeriana L., comprising 200 species worldwide [39,40]. Other closely related genera include Valerianella Miller, Centranthus DC, and Nardostachys DC, all of which are commonly grown for medicine or as ornamental subjects.[41]

Although many species of Valeriana have been used for medicine through the centuries in a number of countries worldwide, the most commonly used species is Valeriana officinalis L.

Etiology

The name valerian or Valeriana was not mentioned by Hippocrates, Theophrastus, Pliny, or Dioscorides, the major Greek authors from 500 B.C. until 100 A.D whose writings survive. Valerian first appeared in the literature sometime around the 9th or 10th century, but it is not certain whether the word originated from an earlier time in Greece, during the Roman Empire or later from Anglo-Saxon medicine or Arabian medicine (9th-12th centuries). Pickering (1879) mentions that the Greeks call V. tuberosa “valeriane“—a species mentioned by Pliny and Dioscorides. As early as 1515 Valeriana was repeatedly said to be synonymous with fu or phu—a plant described by Sibthorp and now accepted as V. dioscorides.[42]

Valeriana is mentioned in an Anglo-Saxon leechbook (a medicinal recipe book) from the 11th century.[46] The word Valeriana is from Latin and is thought to derive from either valere, to be in health or valeo, to be strong, because of either the strong odor or the powerful healing properties ascribed to it by the ancients. Some attest that it was named after Valerius, who may have first used it in medicine.[47,48]

Of the other two names for valerianaceous plants known from ancient times, nard and phu—the first may be derived from the Sanskrit nalada, meaning “odorant”, giving rise to the Hebrew nerd.[49] The Phu or fu of the ancients is usually considered to be a word of disgust over the strong smell of various valerian root drugs, especially when long-dried. This smell is likened to well-seasoned dirty socks or an uncleaned gym locker after summer vacation.

Many names were popularly used in European countries for valerian throughout the middle ages, up to the present. In English, one sees theriacaria, amantilla, herba benedicta, and setwell. The latter name was used by the common people, but said to more properly be applied to zedory.[50] The German name is baldrian, the French, valeriane. In Northern and Central Europe, most of the common names derive from “Vandel’s Root”, the meaning of which is unknown.

History Of Use

Hippocrates, the great physician and nature-healer (460-370 B.C.) used a kind of valerian as medicine.[51] Theophrastus of Eresos, the best-known ancient naturalist and student of Aristotle (370-286 B.C.) mentions V. dioscorides: “which has a smell like spikenard” as being used for perfume.[52] The spikenard of the ancients is another member of the Valerian family, Nardostachys jatamansi and will be covered later.

Dioscorides, a physician in Nero’s army and the originator of the Materia Medica (54-68 A.D.) mentions several members of the valerian family—Indian, Syrian, Celtic and mountain Nard (Nardostachys jatamansi or Valeriana hardwickii, Patrinia scabiosaefolia, Valeriana celtica and Valeriana tuberosa) and “phou” (also called phu or fu), which is considered to be Valeriana dioscoridis and not V. officinalis as some past authors have stated.[53]

Although in modern times, valerian is best-known as a nervine, sedative, anti-hysteric, and sleep-aid, the ancients favored it for numerous other uses. Dioscorides recommends the various nards for conditions that herbalists would use bitter and aromatic roots today—digestive problems, such as flatulence, nausea, stagnant liver (morbus hepaticus) and as a urinary tract remedy. Energetically, he categorizes the nards as warming and drying, giving the tastes as bitter, astringent, and sweet. These plants were also recommended as an emmenagogue, for vaginal yeast infections (“ye whites”), as an anti-perspirant (“it is profitable to take away the smell of ye sweat”), as an antidote to poisons and for the making of potions and warming ointments.[54]

After Galen, the Greek authors were copied and recopied for over 1200 years. Dioscorides especially was considered the ultimate authority on materia medica as late as the 19th century. Although these centuries were considered mostly stagnant from a medical perspective, and the “golden age of herbalism” commenced only in the early 1500s, there were at least two major concentrations of medical and pharmaceutical knowledge, the Arabian school (8th-13th century) and the school of Salerno (1050-1220).

It is evident from many of the old texts that valerian was highly recommended during this period of history. It was known to the leeches as an important medicine in their “wort-craft.” Its use appears to be transmitted from the Arabian school to the school of Salerno by Constantinus Africanus. From there, it appears in most herbals, pharmacopeias, materia medicas and dispensatories up to the present—a universally-known and popular herb throughout the ages, not only in western medicine, but in Indian and Chinese Medicine as well.

The early 1500s until the mid-1600s was the “golden age of herbalism.” Authors of great herbals such as Matthiolus, Dodoens, Turner, Gerard, and Parkinson rarely recommended valerian for nervous diseases—but rather as an emmenagogue, carminative, for coughs and asthma, and as a diuretic.[55]

It wasn’t until the time of Columna (1567-1650) that valerian became renowned as a capital remedy in nervous disorders, as the Italian botanist used the remedy (after consulting Dioscorides) for his epilepsy and it cured him;[56] although later it is said that he suffered a relapse. It wasn’t until 50 years later that valerian was again taken up by the medical profession for nervous disorders, but many testimonials and recommendations by practitioners led to its being firmly established as a primary nerve remedy.[57]

Valerian was conspicuous in many “official” drug books from the late 1600s until well into the 20th century. A good reference point for “official” works of plant drugs is the first London Pharmacopeia, “Pharmacopoeia Londinensis,” of 1618, which was the first of the “official”, or nationally-mandated drug books in Great Britain, continuing also with the Edinburgh Dispensatory, then later the British Pharmacopoeia. This early work was a direct model for the first U.S. Pharmacopeia and was influenced itself by works from the 16th century, such as the Augsburg Pharmacopoeia and the Dispensatory of Valerus Cordus (1546). The project was first talked about in 1585, and was written entirely in Latin, later translated into English by the infamous Nicolas Culpeper. Culpeper felt that the authors of the “College of Physicians” who wrote it were being too secretive and desired to make the formulas and other information on herbal use available to the masses. His herbal was probably the most popular of all time and is still going through new editions today.

The Pharmacopoeia contains many herbal simples and preparations, but also over 162 drugs from animals, animal parts and excretia (such as saliva, sweat and urine)—similar to drugs included in the materia medica of Traditional Chinese Medicine. Ironically, these official works were used mainly by the “regular” physicians of the day—doctors who followed the traditions of Dioscorides and Galen. The “quacks” of the day were the followers of Paracelsus who used mineral salts, such as lead and arsenic compounds—the forerunners of synthetic medicine.

Table 2

The following table condenses many of the early uses and indications for valerian in official works from 1618 until

Year	Work Preparations	Indications & Notes
1618	London infusion, tinc.,	None given (Indian Pharmacop. ammoniated tinc. and Celtic Nard also listed); valerian official from 1618-1948
1820	U.S. tinc.,	ammoniated Official from 1820-1936 [58] Pharmacopeia tincture
1830	U.S. tinc.,	ammoniated Antispasmodic, tonic,Pharmacopeia tincture emmenagogue; dose 1 to 4 GM
1888	National fluid extract,	Official from 1888-1946 [59] Formulary ammoniated tincture

The major preparation of the British Pharmacopeia is Tinctura Valerianae Ammoniata, which contains valerian, oil of nutmeg, oil of lemon, and ammonia. Grieve says of it: “it is an extremely nauseous and offensive preparation.” A distilled water and syrup of valerian are official in the French Codex, and various valerianates are commonly used in Europe as antispasmodics. They are made by reacting synthetic valerenic acid with various bases (as of zinc).

Valerian was also official in the Pharmacopeias of many other countries world-wide. For instance, in 1967 it was still official in the Pharmacopeias of Austria, Belgium, Brazil, Chile, Czechoslovakia, France, German, Hungary, Yugoslavia, The Netherlands, Poland, Portugal, Romania, Russia, Spain, and Switzerland. In India, V. wallichii DC. was official, in Japan, V. officinalis var. latifolia.[60]

Although valerian is not official in the U.S. today, it is probably the most common herbal remedy recommended by herbalists, naturopathic doctors, and chiropractors for mild forms of insomnia and tension. In Europe hundreds of preparations are sold in drug stores, markets, and apothecaries. As herbal medicine is becoming more widespread in the U.S., there is every indication that it will continue to prosper as a mild sedative herb to be recommended where stronger drugs are not advisable or necessary.

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7. Buchan, op cit.
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22. Pereira, op cit.
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25. Pereira, op cit.
26. ibid.
27. Sollmann, op cit.
28. Pereira, op cit.
29. Potter, op cit.
30. Pereira, op cit.
31. Hobbs, C. 1989. Feverfew—A Literature Review. HerbalGram 20: 26-35.
32. ibid.
33. McGuigan, H.A. 1928. A Text-book of Phrmacology and Therapeutics. Philadelphia 7 London: W.B. Saunders Co.
34. Martinet, A. 1926. Clinical Therapeutics. Phildelphia: F.A. Davis Co.
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36. American Pharmaceutical Association. 1946. The National Formulary, 8th ed. Washington: American Pharmaceutical Association.
37. American Pharmaceutical Association. 1950. The National Formulary. Washington: American Pharmaceutical Association.
38. Hobbs, C. 1989. Valerian—A Literature Review. HerbalGram 21: 19-35.
39. Bailey, L.H. & E.Z. Bailey. 1976. Hortus Third. Revised by the Staff of the L.H. Bailey Hortorium, Cornell. New York: Macmillan Publishing Co.
40. Hickey, M. & C.J. King. 1981. 100 Families of Flowering Plants. New York: Cambridge University Press.
41. Rendle, A.B. 1963. The Classification of Flowering Plants, 2 vols. Cambridge: Cambridge University Press.
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44. Pickering, C. 1879. Chronological History of Plants. Boston: Little, Brown & Co.
45. Thompson, A.T. 1830. The London Dispensatory, 5th ed. London: Longman, Rees, Orme, Brown, and Green.
46. Flückiger, F.A. and D. Hanbury. 1879, op cit.
47. Paxton
48. Jaeger, E.C. 1972. A Source-Book of Biological Names and Terms, 3rd ed. Springfield, Illinois: Charles C. Thomas.
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52. Hort, A.F. (tr.). 1948. Theophrastus. Enquiry into Plants, 2 vols. Cambridge: Harvard University Press.
53. Gunther, op cit.
54. Ibid.
55. Hobbs, HerbalGram 21, op cit.
56. Woodville, W. 1790. Medical Botany, 3 vols. London: James Phillips (for the author).
57. Ibid.
58. United States Pharmacopoeial Convention. 1936. The Pharmacopoeia of the United States of America. Easton, PA: Mack Printing Company.
59. American Pharmaceutical Association. 1950. The National Formulary, 9th ed. Washington: American Pharmaceutical Association.
60. Todd, R.G., ed. 1967. Extra Pharmacopoeia—Martindale, 25th ed. London: The Pharmaceutical Press.