Wormwood: Worms And Safety

An action associated with bitters in general and wormwood in particular is that of anthelmintic. Nevertheless, experience is not uniform. Dioscorides, notably, does not document wormwood as anthelmintic. He reserves the designation for seriphon, sea wormwood ‘boiled down either by itself or with rice and consumed with honey it destroys intestinal and round worms, gently purging the bowels’, although it is bad for the stomach, he adds. It will do the same boiled with lentil gruel, and moreover fattens the sheep (Dodoens extends this to beeves, sheep and cattle) that graze on it, presumably by ridding them of worms. Santonicon acts similarly. I can find no reference from Galen to the use of wormwood for worms, only sea wormwood, as Dioscorides. There is a small debate here about Galen’s declaring sea absinthium as of the same sort and taste similar to absinthium, while Dioscorides says seriphon, sea wormwood, more approaches abrotanum than absinthium. Mattioli says it is a case of deciding who is at fault, although Parkinson holds they cannot differ so much in judgment and that the place in Dioscorides or Galen is ‘perverted by some writer’s fault’.

Pliny, however, does appear to commend wormwood for ‘worms of the belly’. He writes too of a ‘device’ to put the leaves of wormwood in figs for administration to children to avoid their bitterness. This may well also refer to a use against worms. Parkinson’s coverage of Pliny carries no such commendation. Neither Turner nor Mattioli appear to commend wormwood for worms. Dodoens carries a small reference to worms under wormwood but this is in the context of oil for ‘fleas, flyes, knats and wormes’, an extension of Dioscorides’ recommendation for repelling mosquitoes (discussed below) and unlikely to refer to worms of the belly, which he covers under the usual sea wormwood: ‘boyled by it selfe, or with rice, or with any other food or meat, and eaten with hony, slayeth both long and flat wormes, and all other kinds whatsoever, loosing the belly very gently. It is of like operation being layd to outwardly upon the belly or navel, and for this purpose it is of more strength and virtue than all the other kindes of Wormewood; but it is more hurtfull to the stomacke’. The seed too is good for all kinds of worms, he adds. Gerard does suggest wormwood for worms, an inner and an outer application. Culpeper suggests sea wormwood is to be given to children and the elderly for worms because it is weaker, but he exhorts the use of common wormwood for this purpose for those who are stronger ‘for the others will do but little good’. Bauhin, citing Mesue, mentions only dried herb of wormwood applied with cloths to overcome tinea, and that the juice with peach kernels (no longer used due to its cyanide content) kills and draws out worms from the ears and from other parts. Serapio appears to make no mention of worms. Ibn Sina has a reference to worms but it runs ‘decoction of wormwood on its own or with rice or chickpeas and drunk with honey kills worms but easily weakens the stomach’, almost word for word a repetition of Dioscorides on sea wormwood. Hence the tradition for wormwood for worms from these authors appears variable. Other tradition is firmer but whether based on erroneous interpretation of the ancients is difficult to tell. The Old English Herbarium is very clear on this matter ‘if worms are a bother around the anus, take equal amounts of absinthium (wormwood), horehound and lupine. Simmer them in sweetened water or in wine. Put it on the anus 2 or 3 times, and it will kill the worms’. It is notable that this text carries only two uses for this wormwood Artemisia absinthium, wermod, and both external (the other for bruises, see below) and reference to the firmer tradition of gastrointestinal tract use only for Pontic wormwood, although again for external use. Hildegard carries a reference only to ear worms. The Salernitan Herbal does refer to gut worms: ‘when the worms called lombrics are in the intestines the juice of absinthe with juice of betony or centaury or peach kernels can be given’.

Miller carries a reference to killing worms, as does Quincy, so its reputation as anthelmintic is current in the 18th century. Cook records its popularity in the treatment of worms: it is good for the stomach worm, he says, ‘when the stomach is languid and the abdomen tumefied and flaccid’. Ellingwood only has an entry for santonica, Levant wormseed, which rids worms and which he praises from his experience to relieve reflex irritation. Dosage appears to be crucial: two grains (130 mg), he says, caused the death of a feeble child. Cullen seems not too persuaded of sure efficacy against worms, neither of wormwood nor anthelmintic bitters in general. Skelton, however, is convinced otherwise. He says almost any strong vegetable bitter, given at bedtime and fasting with a pretty strong purgative, will expel the round worm. He recommends the powdered herb as more efficient than the infusion, although treating children is more problematic since they dislike bitters in any form. He offers a prescription: wormwood powder 1 oz, ½ oz senna powder Senna alexandrina, 2 oz common salt. Mix and take a tablespoon-ful in a teacupful of cold water night and morning. Eat nothing 3 hours before taking the medicine at night or 3 hours after taking in the morning. These doses seem excessive. In cases of children the powders alone, he says, can be made into a conserve or mixed with treacle, taken at a dose of a teaspoon or tablespoon night and morning. General health should be attended to. A further recipe for adults is 1 oz wormwood dried herb, 1 drachm ginger powder Zingiber officinalis, infuse in V/₂ pints boiling water in covered vessel, allow to cool, strain, press, add 6 oz treacle and take a teacupful at bedtime every night. This will remove Means lumbricoides, according to Skelton. Grieve records the flowers dried and powdered as a ‘most effectual vermifuge’, and the essential oil, as spirituous extract rather than that distilled in water, as a worm expeller. While Weiss acknowledges wormwood’s use for threadworms, by a tea taken internally and a retention enema of a strong decoction, he rather supports the ancient advice of Dioscorides, that wormwood is ‘not very effective against worms. Artemisia cina, Levant wormseed is the real worm remedy used against both threadworms and roundworms’. Wormwood’s reputation as anthelmintic continues today, although still with some reservations. The British Herbal Pharmacopoeia records it as an anthelmintic, with indications for nematode infestation and specific indications for infestation with Enterobius or Mcaris. Bartram suggests internal and topical applications; as a strong tea injected into the rectum by enema, or a single dose of 5-10 mL much diluted and taken on an empty stomach, repeated fortnightly. Wood, more recently, is more reserved, quoting Neil that it is useful, injected (enema) for pin worms, but is less effective for more potent parasites. Chevallier and Mills & Bone record it as an anthelmintic, although none offers a specific dosage. Barker gives a dosage of up to 2 mL for shorter periods as anthelmintic. Hoffman calls it ‘a powerful remedy against worm infestations, especially roundworm and pinworm, taken powdered in pill form’. Menzies-Trull recommends taking it on an empty stomach with syrup night and morning, with an enema on days 1 and 3. Mills (1991) records it ‘appreciably antiparasitic’. However, he notes the necessity of working with relatively toxic material, although exploiting the differential aspects of metabolism in host and parasite, and hence this should only be done with care by the experienced. We now recognize different families of helminths and use of information from what is in this case a questionable tradition needs more evaluation.