May Day, the present-day name for the Celtic religious festival of Beltaine, when people lit bonfires and honoured the god Bel. He was a god of life and death, and the festival was seen as purification or a fresh start: the end of spring and the beginning of summer.

In many local villages, dancing round the phallic maypole reminds us that this was originally a time to celebrate fertility as well as a great fire festival. In the17th-century, the Puritans banned all May Day celebrations because of the sexual licence involved.

I suppose that the plant with which I associate the month most readily is Hawthorn, often commonly called May or Mayblossom since it blooms at this time of year.  Some believe that the flowers still bear the smell of the Great Plague of London [1665-1666], probably because their perfume hints of rotting flesh. Attracted by the odour, the flowers are mostly fertilized by carrion insects which lay their eggs and hatch out their larvae in decaying animal matter.

At the time of the Great Plague fear of foul smells reached a peak in London.  Danger was perceived to be everywhere.  All the inhabitants were assaulted and contaminated by the stench of unburied bodies; pedestrians attempted to avoid the miasmas from infected buildings by keeping to the middle of the street; pestilential vapours were caught in the fur and hair of animals; the deadly breath of the sick was carried by the servants who shopped and ran errands for bourgeois households; the air teemed with the effluvia of plague victims and of those who were infected although apparently healthy, but all that while carrying death with them into all companies which they come into [Daniel Defoe (1660-1731), A Journal of the Plague Year].

Defoe reported that at religious services during the plague, the whole church was like a smelling-bottle. Perfumes, aromatics, pungent substances, and a variety of other drugs and herbs, salts, and spirits were all blended together to produce tonic and protective aromas. However, one whiff of mustiness, an odour identified with the plague, was enough to empty the premises: Once, on a public day...in Aldgate Church, in a pew full of people, on a sudden one fancied she smelt an ill smell.  Immediately she fancies the plague was in the pew, whispers her notion or suspicion to the next, then rises and goes out of the pew.  It immediately took with the next, and so to them all; and every one of them, and of the two or three adjoining pews, got up and went out of church, nobody knowing what it was offended them, or from whom.

Heart tonic?
The Hawthorn is called botanically Crataegus oxyacantha from the Greek kratos, meaning hardness (of the wood), oxus (sharp), and akantha (a thorn). Christ’s crown of thorns was reputedly made of hawthorn. 

Capable of living to a considerable age, the tree grows in hedgerows, copses and fields throughout the British Isles and in all temperate regions of the northern hemisphere.  It possesses a single seed-vessel to each blossom, producing a separate fruit, which when ripe is a brilliant red. The flowering tops are harvested in late spring and the berries in late summer to early autumn.

Hawthorn was traditionally used in Europe for kidney and bladder stones, and as a diuretic.  The 16th- and 18th-century herbals of Gerard, Culpeper and K’Eogh all list these uses, and Culpeper praised it as no less effective for dropsy [congestive heart failure].  American pioneers also used the plant for heart problems, and the 19th-century Eclectics prescribed it for angina.

Modern herbals echo this advice, and most agree with David Hoffmann’s Holistic Herbal: Hawthorn is one of the best tonic remedies for the heart....It may be used safely in long-term treatment for heart weakness or failure....palpitations....angina pectoris....and high blood pressure.
 
However, although hawthorn is considered safe and may be effective in the treatment of angina, congestive heart failure, and cardiac arrhythmias, these are serious, potentially life-threatening conditions requiring professional medical care. Therefore consult your doctor if you wish to use hawthorn as part of your overall treatment plan, and children and pregnant and nursing women should not use it at all.

Hawthorn is characterised by its phenolic constituents, in particular the flavonoid components (rutin, quercetin, etc.) to which many of the pharmacological properties associated with the plant have been attributed.  These constituents relax and dilate the arteries, especially the coronary arteries.  This increases the flow of blood to the heart muscles and reduces the symptoms of angina. 

Although pharmacological actions documented in both human and animal studies support the traditional actions of hawthorn as “food for the heart”, and include cardioactive, hypotensive and coronary vasodilator [Hobbs C., Foster S. Hawthorn - a literature review. HerbalGram 1990; No. 22: 19-33], further clinical trials are probably required to establish its true worth in treating cardiovascular disorders.

Boning up on Kigelia.
A game that I play frequently with myself is trying to anticipate which plant I will be asked about next.  To assist me, I scour the Trade press in search of new product launches.  A likely source of inspiration was a review of the recent Natural Products Europe Exhibition....Other products on show include A.E. Hobb’s Zambesia Botanica - a range of shampoos and creams made using the fruit of the Kigelia africana tree....I had barely scanned the words before the phone rang....What can you tell me about Kigelia?!

Kigelia africana (Lam.) Benth., commonly known as Sausage Tree, occurs in the northern and north-eastern parts of South Africa and is widely distributed further north in tropical Africa.  A large, rounded tree with a thick trunk and smooth grey bark, its branches have seven to eleven large leaflets of which the terminal one is usually bigger than the others.  The very large, hibiscus-like, maroon flowers are borne on pendulous stalks. The flowers are very attractive but have an unpleasant smell.  They are followed by enormous greyish-brown, sausage-shaped fruits of up to a metre in length, which contain a fibrous pulp with numerous seeds embedded in them.

Both the fruit and the bark are used medicinally [Hutchings, A. 1996. Zulu Medicinal Plants]. The dried fruit is powdered and used as a dressing for ulcers, sores, syphilis and is also applied locally for rheumatism [Coates Palgrave, K. 1977. Trees of Southern Africa]. Decoctions of the bark are used for dysentery [Von Koenen, E. 1996. Heil-, Gift- u Essbare Pflanzen in Namibia].  In addition to the external use, decoctions of of the fruit and bark may also be taken orally or as an enema for stomach ailments in children [Hutchings, A. Ibid.]. The fruit is reported to be purgative [Watt, J.M. & Breyer-Brandwijk, M.G. 1962. The Medicinal and Poisonous Plants of Southern and Eastern Africa. 2nd Edition.].

The roots and bark have the napthoquinone lapachol and the dihydroisocoumarin kigelin as major compounds.  Several other compounds, including kigelinone, pinnatal, isopinnatal, stigmasterol and b-sitosterol have been isolated from the bark, but the beneficial effect of external use may be due to the dihydroisocoumarins and their glycosides. Antimicrobial activity has been demonstrated, using watery extracts of the bark.  It is likely that kigelin and related compounds (the suggested active ingredients) are also present in the bark [Akunyili, D.N. et al. 1991. Antimicrobial activities of the stem bark of Kigelia africana. J. Ethnopharmacol., 35: 173-178]. 

Claims have been made that it is beneficial against some forms of skin cancer, and fruit extracts are becoming popular nowadays as ingredients of cosmetics and skin lotions. Quinones and coumarins are likely to be responsible for the antimicrobial and skin-healing properties [Ben Erik van Wyk & Nigel Gericke. 2000. People’s Plants: A Guide to Useful Plants of Southern Africa].

I remember well my first introduction to Kigelia Cream.  It must be five or six years ago now when the postman, with arm outstetched and fingers barely gripped, dropped an oozing tub upon my desk. Badly bandaged in layers of sticky tape, with colourful stamps upon every surface, I viewed it with suspicion.  Several minutes later, and with my desk spread liberally with chocolate-like goo, I prised open the lid: a cocoa-coloured, junket-like mixture lurked beneath a surface of oily water.  Ugh!  Sizzling Sausage Tree!....Africa’s Natural Secret!....

I have to admit that I never tried it.
A story waiting to be told.
I was passed your details by BBC’s Check Up programme. They thought that you may be interested in my story about the treatment of my 85-year-old mother’s pressure sore (bone exposed), which was completely healed with Organic Manuka Honey. I asked one of the community nurses who visits weekly what she thought of the healing. She was dismissive to the point of hostile.  I have tried to interest various professional nursing journals in the information but they too deem it ‘unsuitable’for their publications, e-mailed Sue Owen. 

Of course I was interested, but also a little surprised because.....

The therapeutic potential of uncontaminated, pure honey is grossly underutilized.  It is widely available in most communities and although the mechanism of action of several of its properties remains obscure and needs further investigation, the time has now come for conventional medicine to lift the blinds off the “traditional remedy” and give it its due recognition - Zumala, A., and A. Lulat. “Honey - a Remedy Rediscovered”. Journal of the Royal Society of Medicine 82 (1989): 384-85.

In fact, honey, sugar, and plant preparations containing high proportions of sugar appear so often in the materia medica of the past that it surprises me that honey’s efficacy is ever doubted.  By the mid-1970s scattered medical reports from around the world were beginning to suggest wide-ranging uses for sugar pastes and honey. In 1966, for example, a nurse at Frenchay Hospital in Bristol, reported that two men suffering from bedsores and infected amputations resistant to standard treatments were successfully healed using honey.   

The mechanism by which sugars, either in pure form or in honey, exert their antibiotic effects is incompletely understood.  On the one hand, sugar appears to stimulate phagocytosis, the process by which white blood cells ingest and destroy germs. On the other hand, they also appear to protect tissues from infection in the same way that they preserve jellies and jams from fungi and bacteria.

Interestingly, honey is a more effective antifungal and antibacterial agent than is sugar, suggesting that honey contains additional antimicrobial ingredients. Some of these have been identified. Most honeys contain relatively high levels of hydrogen peroxide. The higher the hydrogen peroxide content, the more effective it is in killing germs. Also many honeys have significant amounts of vitamins and a wide range of minerals, including iron, copper, sodium, manganese, calcium, phosphorous, potassium, and magnesium: all are essential for the activation and repair of body cells. These substances probably add to honey’s wound-healing effects.

However it should be noted that most commercially available sugar is not sterile and contains calcium chloride, flour, or other materials to prevent caking.  Moreover, some honeys have been reported to have low levels of the bacteria that cause botulism or other toxins that can be harmful to infants and people with pre-existing medical problems. Thus most medical professionals do not recommend home use of commercially available sugars and honeys.

The very possibility that sugar and honey can be used at home without medical supervision may explain not only the survival of this therapy as folk medicine but also the strong medical resistance it has met with in some quarters.

Sue’s story........
My mother, 85-year-old Dorothy, has multiple sclerosis the effects of which have caused a gradual loss of movement and now she can only use one arm independently and has some limited neck movement.  Living at home with a care package, her mental ability, sight and hearing are good.  She is slightly built and her skin is extremely thin.

About two years ago a discoloured pressure area at the base of the spine in the soft tissue of the buttock began to cause concern and community nurses began to use various types of protective ‘skin’on the area but in due course the area did break down.

Over the subsequent months Dorothy remained in bed and nurses began to treat the area with a variety of products but the wound became deeper.  A ‘ripple’ type mattress was put on the bed but the wound remained open, about 1½inches across and at times the bone was visible.

Because Dorothy cannot move herself and carers only visit four times daily the nurses felt Dorothy should go into a nursing home where she could be moved every two hours throughout the day and night.  However the nursing home was actually unable to provide staff with the time and the skill to achieve this plan and Dorothy returned home after a few weeks with the wound unchanged.  Some weeks later the nurses insisted that this should be tried again and Dorothy returned to the home.  It quickly became evident that this would not be effective and she returned home again.

I live 360 miles away from home by my eldest brother lives close by and since his retirement has taken a very active part in caring for Mum. He heard, from a retired midwife, about the healing properties of Manuka honey and decided that after two years there was nothing to lose by trying it.

The nurses were extremely disapproving and would have nothing to do with the treatment. In October 2002 my brother began to fill the wound, which was as bad as it had ever been, showing bone and almost 2 inches across, with Manuka honey. He placed a piece of gauze over the top and held it in place with a proprietary skin-like adhesive.  He intended to leave each dressing for up to three days but, because of the position, it sometimes had to be changed daily. He would check it each day and leave it if undisturbed.

There was no other change to Dorothy’s routine.  She remained in her favoured position, which was not good for healing but was good for her comfort and sense of security, which had to be balanced against her feelings when placed on her sides.

I had seen the wound when I visited in October.  In December I visited again and the wound was granulating and the open area at the top was smaller.  In February I returned and the wound was completely healed with the skin intact.  There was still considerable discolouration and scar tissue and my brother, again on the advice of the midwife, was beginning to treat the area with neem oil [an interesting choice] to try to reduce scar tissue and help the area become more supple.

I was sceptical about this treatment, not because I do not accept alternative methods, on the contrary, but because of Mum’s age and condition and knowing she would always wish to remain in the position which caused the wound in the first place.

As Martin, a natural healer in the poor Mexican village of Ajoya, comments.....Every day one has to learn by trying different methods of how to cure the people more actively.  You can learn things in hospitals, schools, everywhere, but the best school is practice.....[Singer, P. “Bioethics Where There Are Not Bioethicists.” Video. Southfield, Michigan: Traditional Healing Productions, 1993].   

Vision of the future?
How often am I asked what an oil smells like?  Too often, and invariably I am unable to describe it. Nevertheless help may be on the way. Smellivision is the new product in the sights of Hewlett-Packard.

According to New Scientist, the company has filed a patent on a camera that can create photographs with scents matching the pictures.

There could be two ways of linking smells with a photograph, the company believes. The more expensive version requires a miniature gas chromatography probe that could capture a distinctive whiff of the air when the photograph is taken. A cheaper version will hold a library of scent pictures, such as fruit or a wet dog, for the photographer to choose from.

Both versions recreate smell using an adapted inkjet printer, which deposits a mix of basic scents on the paper. Where’s Mung?  I turn on the bath tap....

Ulterior motive!
Few cannot have read about severe acute respiratory syndrome (Sars), now thought to be a severe form of pneumonia, and wondered about possible deterrents.

According to South Korea’s Rural Development Agency, Kimchi, the fiery pickled cabbage dish at the heart of South Korean cuisine, could provide some resistance.  Kimchi, strips of cabbage soaked in garlic and red pepper, is served as a side dish with almost every Korean meal, including breakfast.

The agency said the large amount of garlic in kimchi might explain why none of the country’s 48 million people had yet succumbed to Sars. I don’t think it is just a coincidence that a country with a food culture like Korea’s is free of Sars, said Hong Jong-woon, a researcher at the agency.

True, garlic (Allium sativum L.) has long been recognised for its medicinal qualities, reducing people’s chances of developing cancer and heart disease and increasing resistance to viruses but, as George Slama, WHO representative in Seoul, points out, there are hundreds of different substances in garlic and many of them are good for health but it is impossible to prove a link with Sars.

During the Choson Dynasty (1392-1910), the period when Korea’s culinary culture was refined, kimchi and its variations amounted to roughly 80 kinds of dishes. In ancient times, kimchi was made of greens pickled in salt, or in a salt and alcohol mixture.  Sliced-radish kimchi pickled in brine then became popular and, soon after its introduction to Korea around 1500, chilli (Capsicum spp.) was added to make kimchi. During the latter part of the period, powdered chilli together with chotkal (fish or shellfish paste) were the favoured ingredients in the mix. No mention, however, of garlic but, today, many firms are mass-producing kimchi.

Is it any surprise therefore to discover that Mr. Hong’s agency has an interest in promoting South Korea’s garlic industry, the world’s second-largest garlic producer after China!

Meanwhile Taiwan’s China Post newspasper last week published a list of recipes designed to combat Sars, with salmon’s head among the recommended ingredients.  Who owns John West?

Testing Tea Tree.
And what about Tea Tree? enquired my new podiatrist. My old one, a former research chemist, knew too well about Melaleuca alternifolia and had been quite a devotee. This young lady, however, knew little of its worth and requested research back-up.  Quickly spying the fresh degrees from Salford neatly arranged upon the wall, I realised that I couldn’t just hack it.

To be honest I had not read of any foot-related research since the 1970s [Walker, M. 1972. Clinical Investigation of Australian Melaleuca alternifolia oil for a variety of common foot problems. Current Podiatry April 7-15], and I didn’t think that would appear too current to a 20-something-year-old.  Anyhow she performed a most excellent job on my feet, and I resolved to come up with something a little more recent.

Fortunately some researchers at Royal Prince Alfred Hospital in Camperdown, New South Wales, have been looking recently at the treatment of tinea pedis with Tea Tree. Tinea pedis, is that chronic fungal infection of the feet, principally the areas between the toes, marked by intense itching, scaling, maceration and cracking of the skin: athlete’s foot to you and me. 

They have conducted a randomized, controlled, double-blinded study to determine the efficacy and safety of 25% and 50% Tea Tree oil in the treatment of interdigital tinea pedis.
One hundred and fifty-eight patients with tinea pedis clinically and microscopy suggestive of a dermatophyte infection were randomized to receive either placebo, 25% or 50% tea tree oil solution. Patients applied the solution twice daily to affected areas for four weeks and were reviewed after two and four weeks of treatment.

There was a marked clinical response seen in 68% of the 50% tea tree oil group and 72% of the 25% tea tree oil group, compared to 39% in the placebo group. Mycological (fungal) cure was assessed by culture scrapings taken at baseline and after four weeks treatment. The mycological cure rate was 64% in the 50% tea tree oil group, compared to 31% in the placebo group. Four (3.8%) patients applying tea tree oil developed moderate to severe dermatitis that improved quickly on stopping the study medication [Satchell, A. et al. Treatment of interdigital tinea pedis with 25% and 50% tea tree oil solution: a randomized, placebo-controlled, blinded study. Australasian Journal of Dermatology (2002) 43 (3), 175-178].

Meanwhile, in the Department of Dermatology at Flinders Medical Centre, South Australia, other researchers have been undertaking the first study to show experimentally that tea tree oil can reduce histamine-induced skin inflammation.

Twenty-seven volunteers were injected intradermally in each forearm (study and control assigned on an alternating basis) with histamine diphosphate (5mg in 50ml).  Flare and weal diameters and double skin thickness were measured every ten minutes for one hour to calculate flare area and weal volume. At 20 minutes, 25ml of 100% tea tree oil was applied topically to the forearm of 21 volunteers. For six volunteers, 25ml paraffin oil was applied instead of tea tree oil.

The results? Application of liquid paraffin had no significant effect on histamine-induced weal and flare.  There was also no difference in mean flare area between control arms and those on which tea tree was applied. However, mean weal volume significantly decreased after tea tree oil application [Koh, K.J. et al. Tea tree oil reduces histamine-induced skin inflammation. British Journal of Dermatology (2002) 147 (6), 1212-1217].

Another boost for Sacaca.
Last month I wrote about a possible alternative for Rosewood: Sacaca (Croton cajucara Benth.). I mentioned also that the bark and leaves of Sacaca are widely used in Amazonian folk medicine for, amongst other things, the treatment of a wide range of gastrointestinal symptoms. Infusions of C. cajucara bark contain dehydrocrotonin (DHC), the furan diterpene, and an essential oil, a rich mixture of sesquiterpenes. Although the antiulcerogenic activity of the essential oil has been studied in different gastric ulcer models, its mechanism remains unclear.

Recently researchers at Universidade Estadual Paulista, Botucatu, Brazil, examined the ability of this essential oil to increase PGE2 release from mucus cells, as well as its effect on the amount of gastric mucus and on the healing of acetic acid-induced gastric ulcers.

The essential oil (100mg/kg body wt., p.o.) significantly increased PGE2 production by glandular cells (by 102% compared to control) and the amount of Alcian blue binding to the gastric mucus. In chronic gastric ulcers, a single daily oral dose of essential oil (100mg/kg body weight) for 14 consecutive days accelerated ulcer healing to an extent similar to that seen with an equal dose of cimetidine [Tagamet].

Thus, the protective and healing actions of the essential oil from C. cajucara bark on gastric lesions resulted mainly from an increase in PGE2 release and gastric mucus formation which would protect the gastric mucosa [Hiruma-Lima, C.A. et al. Effect of essential oil obtained from Croton cajucara Benth. on gastric ulcer healing and protective factors of the gastric mucosa. Phytomedicine (2002) 9 (6), 523-529].
      
Off to Africa!
Blackflies (Simulium spp.) are some of the most tenacious biting flies in Africa and are the bane of those who live near the fast-flowing rivers where these insects breed. The ultimate outcome of a blackfly bite can be very serious because the insect transmits onchocerciasis. 

This debiltating disease, which occurs in Latin America and Yemen as well as Africa, is caused by nematode worms (Onchocerca volvulus) that form nodules under the skin after entering a human via the infective bite of the female fly. These adult worms produce tiny offspring - microfilariae - that move around the body causing intense itching. When they enter the eye they can cause blindness, hence the disease’s common name “river blindness”.     

Any ideas for repellents? e-mailed a lady about to board a plane for Bouaké, Côte d’Ivoire. Good heavens, she’s left it a bit late!  Nevertheless I got scrambling....

Fortunately researchers at the Centre of Medical and Veterinary Entomology in Bouaké have been doing the research for me. They have been investigating the efficiency of vegetal oils of Coconut (Cocos nucifera L.), Palm Kernel (Elaeis guineensis Jacq.) and Gobi (Carapa procera DC.).

Gobi is a new one to me, but I do recollect that another member of the genus - C. guianensis Aublet - is the source of Andiroba oil, which is considered in Brazil to be not only good for the treatment of arthritis and throat infections but also an insect repellent. I believe also that it was used formerly to shrink heads!

A member of the same family - Meliaceae - as Neem (Azadirachta indica A. Juss.), I discover that C. procera contains a filaricide, carapolide A, which has been suggested for the treatment of onchocerciasis [Titanji, V.P. et al. Novel Onchocerca volvulus filaricides from Carapa procera. Acta Leiden (1990) 59: 1-2, 377-82].  It all begins to make some sense.

Still, back to the study.  Coconut, palm kernel and gobi formulations (lotions and creams) were applied on the legs of volunteers in the savanna zone (Niakaramandougou) and forest zone (Soubré) in Côte d’Ivoire; one person without repellent [pity him!] was used as control.

The number of blackfly bites was observed during two sessions, from 0700 to 1200 and from 1500 to 1600. The results showed that the least efficient repellent (gobi) ensured nonetheless a reduction of 90% of the number of bites that an individual would have received if he was not protected by the repellent [It would be interesting to know how many this is!].  The use of either cream or lotion made no significant difference to the number of bites received [Sylla, M. et al. Effect of individual attraction on the efficiency of vegetal oils against Simulium damnosum s.l. bites. Parasite (2002) 9 (4), 357-361].

Nonetheless I think that I would stick to Coconut or Palm Kernel because I have now read of a case in Senegal where a new-born baby was severely burned by the application of Carapa procera to her skin [Seignot, P. et al. A deep skin burn caused by the local application of a traditional oily ointment of Senegal (Carapa procera). Med. Trop. (1991) 51: 1, 91-2].

Finally......
Oil and water do mix, according to Australian research chemist Ric Pashley, who removed all of the gas dissolved in water and found that he could make oil mix with it quite happily, forming a cloudy emulsion.  Even when gas was reintroduced into the water after the emulsion had formed, the oil continued to mix. However his results, reported in the New Scientist, have yet to be repeated by other chemists.
 

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