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By Anne StobartIn a series of posts I have explored how we can know whether herbs might have really worked. It seems quite a while since the first post where I raised some historiographical questions (Part 1). In this eighth and last post of the series I want to conclude with (a) an overview of whether the herbs in a selected recipe might have had some efficacy and (b) a protocol for how historical researchers can approach the question of 'Did the herbs work?'.Did the herbs work in this recipe?The recipe I originally picked to consider is the 'water for affter Throwes' (Part 2) which was much copied in a privately held seventeenth-century household recipe collection in South Devon (see Figure 1). A 'throw' is a 'violent spasm or pang', while 'throwes' refers to 'labour-pangs' (Oxford English Dictionary). Thus the 'after throwes' may have meant pains related to the expulsion of the placenta through uterine contraction, a normal part of childbirth (usually within 15–30 minutes of giving birth), or may have been related to more general pains in the hours following birth.[caption id="attachment_3800" align="alignleft" width="300"] Figure 1. A water for affter Throwes (Lord and Lady Clifford recipe collection, 1689, in private archive, South Devon).[/caption]So back to my original question about this particular recipe, as to whether the herbs would have had any effect? This recipe for the 'after throws' contained five plants (hyssop, wild mint, groundsel, pennyroyal and balm). The historical indications (Part 3) for most of these plants are based on warming qualities, and longstanding use of several of the plants in women's conditions including promoting the 'courses' (menstruation) and in childbirth-related contexts.Based on today's knowledge of constituents and their effects, this combination of herbs provides for a number of possible actions including both stimulant and anti-spasmodic effects on the uterus. The aromatic distilled herbal constituents would include terpenes to provide both antispasmodic relief (from the pains of afterbirth) and uterine stimulation (to help ensure that the contents of the womb are expelled after childbirth). Thus, this combination of herbs might not have a single effect but provides for several relevant and, at first sight, apparently opposite actions (antispasmodic and stimulant). However, it is likely that stimulating more effective uterine expulsion could help to reduce pains after birth, so the overall effect would be the intended one. Such herbal combinations, with a diverse range of therapeutic effects, appear often both in modern and historical contexts.So the herbs in this recipe could have been effective. However, this effect would depend on the dose given. One version of this recipe indicates that it was made to be given as a drink ('giue a gill of this water milke warme with some sugar, in it to the patient before sleepe after deliuery being laid in bed first', Figure 1). Some therapeutic effect is possible since a 'gill' is a quarter of a pint (around 150 ml) though it is not feasible to gauge this accurately.How to approach the question 'Did the herbs work?': A draft protocol for considering herbal efficacy[caption id="attachment_3805" align="alignright" width="300"] Figure 2. [Herbal medicines in a variety of containers] Tacuini sanitatis Elluchasem Elimithar medici de Baldath, de sex rebus non naturalibus, Joannem Schottum, 1531, p. 111. Courtesy of the National Library of Medicine.[/caption]I have argued that further understanding of  the way in which particular herbs might work can be assisted by use of good quality herbal monographs (Part 4) which identify constituents and herbal actions (Part 5 and Part 6). Additional considerations are the many ways in which a recipe might be prepared (Part 7) and dosage (this post, Part 8). My posts have dipped into a few examples - so much more could be said!Overall, the protocol which I have followed involves the following steps:(1) Clarify the recipe purpose and identify the recipe ingredients (including species and parts of plants)(2) Identify sources for contemporary indications for the plants (for example based on printed herbals or medical advice books)(3) Locate reliable modern sources on the plant constituents and actions (such as a referenced monograph)(4) Consider the extraction processes and form of preparation, possible interaction of herbs, and the dosage (if known)(5) Summarise the contemporary understanding of the plants alongside their potential efficacy according to best scientific evidence.An assessment of (3) and (4), evaluating the herbal constituents and actions as well as the form of preparation, could be assisted by linking up with a clinical herbal practitioner. I hope that such partnerships can be further developed so that we are more able to understand potential efficacy. Of course, even if we understand today that the medicinal herbs might have been efficacious, this does not provide evidence that the recipe was used!ConclusionI started out on this series of posts to think through how we can use today's knowledge about plants in interpreting the past. It bothered me that much information on herbs is so readily repeated without adequate referencing of sources. I hope that I have made some useful suggestions in these posts about how to find and use reliable sources. I would welcome queries and the thoughts of others on the 'Working of Herbs'.