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 in many middle and upper-class life-styles of the 18th and 19th centuries also 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 extoll the virtures 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 1930's, 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.

Specifically, the authors are: 10 = James Alleyne's A New English Dispensatory (1733), 11 = R. James' Pharmacopeia Universalis (1745), 12 = Andrew Duncan's revision of Dr. Lewis' famous Edingurgh New Dispensatory (1791), 13 = William Cullen's A Treatise of the Materia Medica (1802), 14 = James Thatcher's The American New Dispensatory (1813), 15 = Jonathan Pereira's The Elements of Materia Medica and Therapeutics (1843), 16 = Samuel Potter's Handbook of Materia Medica (1890), 17 = A.A. Stevens' A Textbook of Therapuetics (1924) and 18 = Torald Sollmann's A Manual of Pharmacology (1936). 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.

Remedy Description of Uses [13] [14] [15] [16] [17] [18] [19] [20] [21]

Asafoetida (Ferula assa-foetida L.)--hysteria and other X X X X X X X X X nervous complaints

Bromine (sodium bromide, etc.)--sedative to the nervous X X X system; antispasmodic; "...greatly overused..."

Camphor (Cinnamomum camphora [L.] Presl)--given in X X X X X X X X nervous affections, to excite the vis vitae, antispasmodic, procure sleep, nervous headaches

Clary Sage (Salvia sclarea L.)--recommended in X X hysteric disorders

Conium maculatum L.--anodyne taken internally (leaf X X X X X X powder, up to 2 ounces); antispasmodic

Feverfew (Tanacetum parthenium [L.] Schultz-Bip.)-- X X hysterical disorders

Galbanum (Ferula galbaniflua Boiss. & Buhse.)-- X X X X X X esteemed in hysterical complaints

Hops (Humulus lupulus L.)--induces sleep; mania X X X X

Black Hellebore (Hyoscyamus niger L.) --"...has been given X X X X X with advantage in a variety of nervous affections, mania, melancholia, epilepsy, hysteria, etc. anodyne. Like opium, its influence is diminished by [habitual use]

Iron (martial flowers, called Ens veneris)--for X X X X hysterical and hypochondriacal states

Lavandula angustifolia Miller--recommended in vertigos, X X X X palsies, tremors, suppression of menses.., all disorders of the head, nerves and uterus

Opium (Papaver somniferum L.)--most prescribed; X X X X x "...mitigating pain, inducing sleep.."; hysteria, hypochondriasis

Pennyroyal (Mentha pulegium L.)--hysterical cases X X X X

St. John's wort (Hypericum perforatum L.)--"..extolled X X in hysterical and maniacal disorders.."; melancholy

Valerian (Valeriana officinalis L.) "...one of the principal X X X X X X X X X anti-spasmodics..for nervous and hysterical affections.."

Wood soot--used in hysteric and other nervous cases, X sometimes in conjunction with asafoetida, galbanum

Zinc (flowers of zinc)--epilepsy and X X antispasmodic

As can be quickly seen from table 1, the six most prescribed medicines over the 200-year period were asafoetida, camphor, conium, 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, 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]

Lavendar 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 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]