Pestilence refers to infectious disease, which may or may not be epidemic, of which the archetypal example is plague. The connection with the heart is that pestilence was considered to be carried by the air into the lungs where it would attack the heart and therefore corrupt the vital spirit. Ancient authors were aware of the infectious nature of disease, although not aware of the mechanism of infection. Later, Hildegard makes an explicit linkage between diarrhoea and food-borne infection. She describes the coldness of tormentil as effective against fevers that arise from noxious foods. She advises tormentil cooked in wine with a little honey added, strained, and drunk frequently at night on an empty stomach.
After the Black Death in the 1300s, it is hard to see that people cannot have been aware of the transmission of disease. According to Carmichael (1997) quarantine of ships where passengers were not allowed to disembark for a given period, began in 1377 in the Venetian port that is now Dubrovnik. Zuckerman (2004) gives an account of beliefs on contagion in the early 1700s when Richard Mead wrote a report for the British government on contagion and quarantine arrangements in response to the last outbreak of bubonic plague in Europe, in Marseille in 1720. Contagion was a problem for doctors, who retained some loyalty to the humoral system with its focus on the individual vulnerability of patients and places but this is probably over-represented in the texts which were written by educated people. Those with a less theoretical bent must have relied on observation and accepted that many diseases were contagious. However, it is impossible to cast one’s mind back to the world views of the past and French (2003) gives a thought-provoking account of the changes in thought associated with the observation that syphilis was spread from person to person.
Dalechamps, perhaps citing Galen, notes that tormentil is without manifest heat and has the faculties of cinquefoil to resist poisons and suppress dysentery. Bauhin describes tormentil and cinquefoils stating that they expel poisons and plague by sweating by use of a warm decoction of a handful of leaves and roots, or 1 drachm (4 g) of powdered root. He also gives pastilles, powders, electuaries and drinks as useful in dysentery. Culpeper states that juice of the herb or root of tormentil resists all poison and venom of any creature, even pestilential fevers and the plague itself, and contagious disease such as the pox, measles and ‘purples’ by expelling the venom and infection from the heart by sweating. He also includes the distilled water of the herb and roots of tormentil in his list of antidotes.
The authors describe tormentil as dry in the third degree but opinions vary on its heat. Galen describes ‘pentaphyllum’ as without manifest heat. Parkinson gives it as cold in the second degree whereas Culpeper says it is hot in the first degree. This might be because of the discrepancies in the plant or part of the plant being discussed but use of aerial parts is definitely recommended in infection and fever. Use of the leaf is recommended by Dioscorides for intermittent fevers: the leaves of four sprays for quartan fevers, three sprays for tertian fevers and one spray for the quotidian. This is repeated by Culpeper in his entry for cinquefoil. He describes Dioscorides as ‘full of whimsies’ and says that a dose of 20 grains (1300 mg) of cinquefoil in white wine or white wine vinegar will cure agues of whatever type if given on three successive occasions. Culpeper describes cinquefoil as an especial herb in all inflammation or fever, ‘whether infectious or pestilential’. Culpeper states that Andreas Vesalius (anatomist, 1512-1564) thought tormentil as good as lignum vitae Guaiacum officinale or china Smilax species in the ‘French pox’ (syphilis). This recommendation is also given by Grieve, who refers to tormentil as the English sarsaparilla.
Use in infection continues in the 18th century. Quincy states that tormentil is most noted for its binding qualities, yet is included amongst the alexipharmics particularly for ‘malignant cases attended with any flux, either of the bowels or the womb’. Hill makes the same point, and suggests a larger dose of cinquefoil for intermittent fevers. Hill describes tormentil as cordial as well as astringent and that it ‘operates by sweat’ and so is useful in any fever associated with excessive diarrhoea. Cullen (1772) considers tormentil as equivalent to cinquefoil in intermittent fevers used alongside Gentiana lutea and other bitters. Hill recommends it for loose bowels associated with measles and smallpox, and Cullen is more specific in that he uses astringents to promote suppuration and thus resolve disease.