Treatment has been provided in West Africa by the native 'doctors' (ifas, juju men and herbalists). The juju man is believed to be able to get the support of the gods (through magic and tribal rituals) for the numerous problems affecting his applicants. He not only treats diseases, which the people consider to be an adversity imposed upon them by outside forces they do not comprehend, but is also required to be a rainmaker or to perform rites to ensure good crops, prosperity, etc., or to help in calamities caused by offended dead relatives or evil spirits (Oliver-Bever, 1983). Therefore his aims, being so closely related to mystic practices, are often more concerned with the spirit than with the body. It seems that early civilizations felt the importance of a psychosomatic approach to illness long before this received attention in modern medicine!
A great quantity and variety of 'medicines' based on plants, or parts thereof (Oliver, 1960), are given by the different herbalists throughout West Africa. Often they are sold in the markets to people in search of cures and a great number are 'assured' to heal almost every disease under the sun: others have a definite use. Of course, this materia medica is by no means limited to plants, and frequently in 'strong medicines' components like the heart of chicken, animal remains, human saliva and even flesh and blood are part of the preparation. Generally, the drugs are made up in the shape of small rissoles or balls of mastic, but liquid potions, ointments or powder can also be found and even enemas or fumigations are used in a local fashion.
The knowledge of the properties of the drug plants shown by some local juju men may either have been passed on to them by their elders or be based on experience. Frequently, neither the 'doctor' nor the patient attributes the action to the plant itself, a situation reminiscent of a similar attitude in Europe in the Middle Ages. Indeed, disease in old Anglo-Saxon times was attributed to 'possession by devils' or to 'flying venom' or to 'the loathed things that rove through the land' (Rohde, 1922). To counteract these evils, religious rites, together with herbs and charms of traditional value, were employed not only for man but also for his cattle (Rohde, 1922) (religion was the outward sign of man's appeasement of forces that he did not understand). Also, it was superstitiously believed that when a plant was pulled out of the ground it uttered shrieks and caused death or at least insanity to the gatherer if he heard them (Lloyd, 1921). Shakespeare refers to this belief in Romeo and Juliet when he writes (Act 4, Scene 2): 'shrieks like mandrakes torn out of earth, that living mortals, hearing them, run mad...'. The problem of gathering the root, therefore, was overcome by tying a dog to the plant while the gatherer stopped his ears lest he should hear anything.
The if a may say that he has discovered a plant possessing a spirit stronger than the disease spirit, and he and his patients believe that the power of this spirit, or the soul of the medicine, is not manifested before the healer has spoken some magic words or has chanted an incantation over the plant. Before doing so the if a himself may appeal for advice to gods or worship idols which in Yoruba country (Western Nigeria) are often small carved figures of a man or woman and sometimes also of animals. The patients in turn should not only take or apply the medicine but also appeal to and make offerings to communal and household gods, which may also be carved statues or other objects blessed by the local priests in ceremonies that generally last for days. In a school in Badagry (Nigeria, near the frontier with Dahomey) there were in a dark corner places of sacrifice consisting of cones of clay with an irregular shiny surface. They were streaked in white, turquoise, yellow and brown by the numerous offerings that had been made, and had the odd piece of eggshell and feather glued to them. Trees can also be idols, for example the iroko tree, Chlorophora excelsa, which is regarded as a sacred tree by the Ibos (Eastern Nigeria) and is credited for 'furnishing souls for the newborn'. Sacrifices are made to this tree and offerings are often found at its base. The household gods (Ikenja) are always carved from iroko-wood and pieces of its bark are added to many medicines to increase their action.
Another rare but interesting tree used by thejuju men is Okoubaka aubrevillei. The bark is used by the Binis (Eastern Nigeria) to drive away evil from a house or to inflict a curse upon an enemy. The bark, according to Hardie (1963), may be removed but never at sunset or sunrise when it 'spits poison' (the foliage then exudes a dark poisonous liquid). Before removal of the bark, however, the spirit of the tree must be propitiated by the offering of gifts. These usually consist of portions of kola nut, white yam, coco yam and plantain, two cowrie shells, a piece of white drill cloth and a quantity of chalk. With these it is possible to approach an Okuobisi (its local name) after having stripped off all clothes at a safe distance. The gifts are laid at the foot of the tree and at the same time the spirit is begged for whatever help may be required. A small piece of bark can now be removed with the aid of a wooden batten (under no circumstances may a machete or metal implement be used) after which it is advisable to run away quickly 'out of sight' and to re-dress. The reason for this is that the spirit of the tree may not have been sufficiently appeased by the gifts and if it pursues the applicant it will fail to recognize him fully clothed.
An Ibibio in trouble may say to the iroko: 'Oh tree! you who are a strong man and to whom heavy things are light, I am only a small weak creature, and my worry is so big that I cannot carry it, will you, who are strong, take it from me? It would be a straw to you.' And he will sacrifice to the tree and leave in peace, convinced that his burden will be taken from him.
Formerly, plants were used not only for healing but also for killing. Arrow poisons were prepared by rubbing certain seeds between two stones until they formed a paste to which was added saliva and the juice of different toxic plants. A vesicant latex, for example from Euphorbia spp., was often used as this damaged the skin, thus facilitating penetration and absorption. Often the remains of animals were also added for magic purposes. Another method consisted of extracting the active constituent, generally with water or palm wine, and concentrating the extract until it formed a paste. If the poison was part of the latex of a plant then the latex might be dried out until it had the right consistency.
In trials by ordeal, a man suspected of evil influence or action was forced with much ceremony to swallow a dose of poison. If he survived, this was the wish of the tribal gods and he was considered innocent; if he died this was evidence of guilt. A classical example is the trial of Lander in Badagry in 1827. Fortunately, Lander, who had been given a decoction of a portion of bark from Erythrophleum guineense (Sassy bark), which contains erythrophleine, a strong heart poison, was wise enough to take a violent emetic immediately afterwards and so survived.
Apart from the local juju men, who treat the more complicated and resistant cases, the more common ailments are treated by villagers, generally elderly women, with knowledge of the local plants. The reasons for the local selection of drug plants is varied. In a number of cases prescriptions are based on the observation of what happened to animals and men who had eaten certain plants accidentally. In other cases it was noticed that the plants produced, for example, a local irritation of the skin but at the same time relieved a pain or cleared up a sore on persons who touched them, and so local inhabitants used such plants in this way.
Other uses are just empirical, for example those based on the 'Law of Signatures'. This is an old belief which says that nature has provided a plant for every disease and has indicated by an obvious sign for which disease or which part of the body each drug plant is to be used. Thus the shape of a plant or of one of its components may suggest a cure. This belief existed in many parts of the world, including Europe in the Middle Ages. The classical example was a walnut, which having the shape of a brain, should thus be used for diseases affecting the brain. Grier (1937) cites other examples: 'Plants with red flowers were to be used in blood disorders and those with yellow flowers, also turmeric, in jaundice. Saxifrages, which grow on rocks and break them up, would be useful for stones in the bladder, a belief in the Middle Ages in England (Grier, 1937). Euphrasia was to be given in eye diseases, because a black spot in the flower resembles the pupil of the eye.' Similar beliefs are prevalent in primitive West African medicine and have been documented by many authors. . . . plants with white latex are used to increase milk production; those with big swollen fruits to favour fertility (Githens, 1949): Commelina, with its bright blue flowers like eyes, for ophthalmic treatment (Dalziel, 1937, p. 465): Eryngium foetidum, a plant with a powerful odour, is supposed to bring a person to his senses; the stems of Palisota hirsuta, with joints which are swollen and bend like a knee, are used for sprained knees; and the bark of Pentaclethra macrophylla, a tree which never grows straight but always has a hump in the trunk, is part of a preparation applied to the hump of a hunchback. The leaves of Ficus exasperata (sandpaper leaves) are cooked with salt fish and eaten with the idea that these scratchy leaves will scrape out whatever is causing the trouble (Harley, 1941).
On similar lines it is believed that 'the administration of owl's feathers makes the disease fly silently away' (Githens, 1949, p. 2). In the Caineroons, for the treatment of migraine, a spider's web spun on the grass is found, and grass, web and all are mixed with white clay and rubbed on the patient's head. As the spider runs away on its web, so will the headache run away (Talbot, 1926). Also, abuse exists like everywhere else, and Gerarde's comment on the use of henbane seeds to cure toothache (Woodward, 1931) is reminiscent of practices used in West Africa by some unconscientious healers. He writes: 'The seed is used by Mountibank toothdrawers which run about the country, to cause worms come forth of the teeth, by burning in a chafing dish or coles, the party holding his mouth over the fume thereof; but some crafty companions to gain money convey small lute-strings into the water, persuading the patients that those small creepers came out of his mouth and other parts which he intended to ease.'
Even in those parts of the world where different populations communicated, often through Greek or Latin texts, and where drugs were received by overland or sea routes from China, India and the Far East (Gunther, 1934), it took from ancient times until the eighteenth century before the causes and treatment of illness began to be understood. The folklore of young isolated communities, still based on a scheme similar to that of Anglo-Saxon medicine in the Middle Ages, is therefore not surprising but it is rapidly disappearing with the development of communications and education.
Practical therapeutic indications and mechanisms of action of the drugs
A distinction should be made between the practical use of a drug and the way in which it acts. The therapeutic effects of a number of plants are the result of their action on the nervous system.
First brief mention should be made of the mode of action of the drugs on the nervous system. Their activity may be the result of:
(a) stimulant or depressant effects on the central nervous system, activity being exerted at various levels from the higher centres to peripheral nerve terminals;
(b) modulating effects on autonomic nervous system activity.
The therapeutically useful effects are those that are selectively induced at important sites mainly by substances which simulate (mimic) neurotransmitters or interact with them or their receptors.
Plants acting on the cardiovascular system (Chapter 2) mainly produce their effects through the autonomic nervous system (ANS). Autonomically innervated structures are regulated at a subconscious level by nerve fibres from the sympathetic and parasympathetic divisions. The influence of each division varies with each tissue, i.e. sympathetic activity augments the heartbeat but inhibits the tone of intestinal and bronchiolar muscles. Constituents which stimulate the release of the neurotransmitter (noradrenaline) will increase the adrenergic effects but drugs which antagonize its activity give prominence to the cholinergic division and an exaggeration of the cholinergic effects (Fig. 1.1).
The cardiovascular plants have been grouped into:
(a) cardiotonics, which are mainly used for their positive inotropic effects, produce reinforcement of the contractibility of the heart;
(b) cardiac depressants, which are mainly used for their positive or negative chronotropic effects, regulate the rhythm in tachycardia and fibrillation;
(c) vascular agents, the action on the blood pressure being treated here as well as their action on vascular solidity, the permeability of capillaries and blood coagulation and formation.
The ANS intervenes in many different functions of the organism. I have given the descriptions of the plants under their principal effect, which is likely to control the practical demand, rather than by their mode of action. Drugs affecting bronchial, intestinal or uterine motility are described under their stimulating or antispasmodic effect on the smooth muscles.
In Chapter 3 (The nervous system) I discuss mainly those plants used in mental treatment, including sedatives, hypnotics, tranquillizers, anticonvulsants and hallucinogens having a stimulating or depressant action on the central nervous system (CNS) or the ANS. Analgesics, antipyretics, anaesthetics and antispasmodics are also included in this chapter.
The mechanism of action of the drugs acting via the nervous system is believed to be based on their interference with the action of chemical substances such as acetylcholine and the catecholamines, the chemical mediators of nervous transmission. This interference may occur through affinity of the plant constituents for specific receptors, which can be cholinesterase, adenylcyclase or other enzymes or
Fig. 1.1. Action and sites of action on the ANS.
SYMPATHETIC DIVISION acts on peripheral adrenergic nerve endings a and ji receptor sites)
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