Herbs in History: Hawthorn


Crataegus spp.


Mysteries of a Tree

Hawthorn (Crataegus spp.) is well known, as either a single, majestic almost sovereign high tree in vast open pieces of grassland or lower hedgerows that cuts the landscape in the countryside as a jigsaw puzzle or orderly rhythm rural towns gardens and orchards. Despite this presence in the environment and its familiarity—and also its current reputation as The plant for the heart—, it entered pharmacopoeia only recently if we consider the long-term history, having been mysterious for centuries.

Hawthorn (Crataegus spp.)

Illustration 1: Hawthorn (Crataegus spp.)


The Queen of May, as Hawthorn is called, bursts in this month into a froth of small, white flowers (Illustration 1), diffusing in the warm air of the spring a fresh, delicate, spicy, and almond- or vanilla-like scent. This evanescent emanation is now captured and artfully mixed by perfumers from Chanel to Valentino in subtle creations with powerfully evocative names from “Water Woman” and “Petit Matin” to “Pour Femme”, “Blasted Bloom”, “Totally White” or, simply straightforward and more symbolically, “Paris”.
Strangely, these enchanting creations and names go together with a sinister reputation and the belief that Hawthorn flowers should not be brought into a home as they convey bad luck. There is worse: its blossom smells like bad breath, rotting fish, gangrene, and decaying bodies, and this smell is said to be that of death, of the medieval Black Death. By a strange inversion, however, this very same smell, clove-like and even musky, is also believed to be that of sex.

A Lexical Labyrinth?

Contradictions and resulting uncertainty and mysery can already be found in the current interpretations of Linnaeus’ genus name Crataegus. In current literature on the botany, therapeutic uses, and history of Crataegus, the genus name is considered to have been built with three classical Greek terms: kratos, meaning strength; akakia, which is the name of thorns; and aigos, designating goats. Whatever the analysis of its composition, the genus name is differently interpreted, meaning, for example, that Hawthorn wood is hard.
A reading of ancient historical information in the original language tells a very different story and helps to leave the lexical labyrinth created by contemporary interpretation, in addition to revealing aspects of Hawthorn history that might not be immediately perceptible.
Crataegus is an ancient, classical Latin phytonym, which is attested by Pliny (23/24-79 CE) in the Naturalis Historia (Natural History). There, it appears only once and it designates the fruit of trees (kernels), and it is used about laurel bays and hazelnuts.
Crataegus is a transcription of Greek krataigos, in which the component kratai- refers to might, strength, power. Interestingly, in ancient, classical Greek literature, this component kratai- was used in compound terms that qualified the human fate, the invincibility, implacability of destiny; the weight of the stone that Sisyphus is always trying in vain to roll up to the tip of the mountain; the scorching heat of the summer; and also—and for example—the strength of a virile handshake.
This element kratai- was also used in phytonomy, where it generated the plant name krataiogonon corresponding to present-day Persicaria maculosa Gray (syn. Polygonum persicaria L.) in the buckwheat family, now commonly named Lady's thumb, Spotted lady's thumb, Jesusplant, and Redshank.
The deep meaning of this phytonym appears nowhere better than in the treatise De materia medica by Dioscorides (1st cent. CE), where the plant is described (3.124) and credited with the following use:

... it is reported by some that drinking its seed makes a woman give birth to a boy, if, after menstruation and before intercourse, she drinks on an empty stomach, three times a day for 40 days, one triobolon (1.794 gr) of seed with two cyathoi (91.2 gr.) of water; but her man, too, must drink it similarly for the same number of days and then he must have sexual intercourse with her.

It is significant that the plant named in that way does not have any therapeutic application, but only this one. Through it, we understand that kratai- is about strength, force, and power. Applied to generation as is the case here (through the second element of the plant name, -gonos), it is about the solidity of a male descendance that will guarantee the continuity, stability, and prosperity of a family.
The same information about the generative power of krataiogonon appears in Pliny’s Natural History, where the Greek term is transcribed as crataegonon (27.62). There, this information is followed by this remark (27.63): “By crataegos or crataegon Theophrastus would have us understand the tree which in Italy is called aquifolium”. This aquifolium tree is our Ilex (Holly). Although there is a confusion on the correct interpretation of the plant referred to by Theophrastus (4th/3rd cent. BCE), we locate a full description of the plant identified by this term crataegos/on through this note of Pliny. We do find it, indeed, in Theophrastus’ Historia Plantarum (Histories of Plants), where its description reads as follows (3.15.6):

Krataigos is very abundant; some call it krataigon. It has a leaf like that of the medlar, smooth, but greater, larger, and longer, while the edge not like that of the medlar. The tree does not grow very tall or thick. Its wood is mottled, strong, yellow. It has a smooth bark like that of the medlar, in most cases a single root, deep. The fruit is round and as large as wild olive; as it ripens it turns yellow to black. In taste and flavour, it is like that of the medlar. This is why it could be considered as a wild medlar. There is only one form of it, without variations.

The comparison with Medlar unmistakably brings Hawthorn to mind, all the more because both were species of Crataegus until Medlar was moved to the genus Mespilus (M. germanica Tourn. ex L.). This comparison hints, however, at some confusion, which is no longer present in Dioscorides, De materia medica, where the two trees were described as follows:

Hawthorn (oxuakantha; 1,93). Some call it puren and others puracantha. It is a tree that closely resembles the wild pear, but it is smaller and very prickly; it bears a fruit that resembles a myrtle-berry, full, red, easily broken, full of seeds. It has a root verry cloven and deep.
Medlar (mespilon; 1,118). Medlar, the tree, which some call aronia, is thorny and similar in its leaves to that of purakantha. It bears a small round fruit, resembling an apple, which is sweet and contains three kernels, on account of which some also call it "three-kernelled".

Although the two trees are not explicitly compared, they are through the similarity of the leaf, identified, in the description of the Medlar, by one of the names of Hawthorn (purakantha). Beyond this similarity, the precise description of its fruit—specifically the structure of its kernels—, distinguished Medlar in a clear way.

Oxuakantha in manuscript New York, Pierpont Morgan Library, m 652, f. 261 recto (10th cent., Constantinople)

Illustration 2: Oxuakantha in manuscript New York, Pierpont Morgan Library, m 652, f. 261 recto (10th cent., Constantinople)

The Greek names of Hawthorn are significant: krataigos/on in Theophrastus and oxuakantha in Dioscorides, with the latter exactly meaning the sharp thorn. Or, better, the Fiery thorn, as per an English name of Hawthorn. Since both terms refer to the same plant, oxuakantha in Dioscorides, which seems more recent, provides a better understanding of the term krataigos/on in Theophrastus, which gave its name to the Crataegus genus: although kratai-certainly refers to power, solidity, and strength as we have indicated above, oxuakantha specifies that this strength is the sharpness of the typical thorns of Hawthorn. It is probably no coincidence that Medlar had a very different name in Antiquity: mespilon in Greek adapted as mespilum in Latin. Both the thorns and the names make a clear difference between Hawthorn and Medlar, even though both have a similar fruit.
The descriptive power of names is further illustrated by the term purakantha used by some to identify Hawthorn according to Dioscorides, and by Dioscorides himself in the description of the leaf of Medlar. If the second element -akantha refers to thorns, the first (pur-) was used in ancient Greek for the stone of such fruits as olives, the arils of pomegranate, or the seeds of myrtle fruit and grape. This meaning of the name purakantha as the thorny small, hard fruit has been excellently translated in visual terms in the representation of Hawthorn in a 10th-century manuscript of the Greek text of Dioscorides, De materia medica (Illustration 2).
If this fruit justified the grouping of Hawthorn and Medlar in the same genus, it also created a dilemma to Linnaeus at the moment of naming this genus. Should he have followed Theophrastus and the term krataigon/-os in the Latinized form attested by Pliny crataegus, which referred to strenght, or Dioscorides and the term purakantha used for both species, which referred to both a hard fruit and thorns? A good classicist, Linnaeus escaped the dilemma by deftly combining different elements in his Species plantarum (1.477): Crataegus as per Theophrastus for the genus for both Hawthorn and Medlar, and, for the species, oxyacantha as per Diocorides for Hawtorn and azarolus for Medlar, with the latter species name coming from medieval Latin and, beyond, from Arabic (zarur).

Few Medicines, Many Beliefs, and Renewal

Unsurprisingly, a tree with these characteristics was not abundantly used in the medicine of Antiquity. Hawthorn does not appear before Dioscorides, where it is quite succinctly treated (1.93):

Its fruit stops diarrhea and leucorrhea when drunk and eaten. Its root finely ground and plastered extracts splinters and thorns.

Astringency might account for these indications, as well as for the extraction of splinters and thorns, through a mechanical action of constriction on the skin and tissues. Astringency is a very common property in ancient medicine and its presence in Hawthorn just expanded the range of substances to be possibly used, thus allowing for substitution when necessary.
To this Dioscorides adds a popular belief, which opens onto a different interpretation of the tree:

It is said that the root [of Hawthorn] can even effect miscarriages when the abdomen is gently struck with it three times or anointed with it.

The number three announces, indeed, the century-long life of Hawthorn through the woods of beliefs. Contradictorily, however, Hawthorn was allegedly a sign of good luck in ancient Greece and a symbol of marriage in the Roman world. But these meanings might not be as contradictory as they seem if they are translated in moral terms. They then reflect the solidity with which Hawthorn was credited, together with the sharpness of an intimate bond and a focused and fully lived life.
Medieval literature, tales, and folklore, and even daily life in the countryside where low Hawthorn edges divided the properties and rhythmed the landscape, are full of stories about the powers of Hawthorn reported at length in medieval tales and literature.

Leonhart Fuchs

 Illustration 3a: Leonhart Fuchs, De historia stirpium commentarii insignes, maximis impensis et vigiliis elaborati, adiectis earundem vivis plusquam quingentis imaginibus, nunquam antea ad naturae imitationem artificiosius effectis & expressis. Basilea: In Officina Isingriniana, 1542, p. 543: Oxyacantha.

Petri Andreae Matthioli

Illustration 3b: Petri Andreae Matthioli ... Commentarii secundo aucti, in Libros Sex Pedacii Dioscoridis Anazarbei de Medica Materia ... Venetiis, Ex Officina Erasmiana, Vincentii Valgrisii, 1558, page 113: Acuta spina.

In the Renaissance, Hawthorn left the medieval fairy woods with the new herbals by Leonhart Fuchs (Illustration 3a), Dodoens and others, who just repeated the data of Pliny, Dioscorides, or Galen. Renewal came from the Italian physician Pietro Andrea Mattioli (1501-1578), who translated Dioscorides’ treatise from Greek into Italian and Latin, and also commented on it. His works were published in numerous editions from 1544 to his death and literally became botanico-medical best-sellers.

His chapter entitled Acuta spina clearly refers to Hawthorn (Illustration 3b). Acuta spina is, indeed, an exact translation of the Greek name used by Dioscorides: oxuakantha, sharp thorn. After a detailed discussion of all the other species confused with Hawthorn, Mattioli comes to the uses of Hawthorn, which are not only much more numerous than in the herbals of that time, but also very different. Interestingly, they refer to countryside practice and hint at traditional usages unknown to learned literature:

After the harvest of grape, the countrymen make a wine of the fruit, ... which is more astringent and acid than the juice of pomegranate. If it is mixed with a syrup of violet and administered with water to patients suffering of acute and pernicious fever, as ardent fever and the fever of plague, it will not only quench their thirst, but also stop bilious pestilent exhalation.
It can also be administered to patients suffering of colic, patients throwing up food and suffering of dysentery, and those who regurgitate bile.
It treats excessive menstruation.
It eliminates stomach worms, particularly if taken with wheat water, or purslane, or wormwood, with some sugar.
It is good in cases of blood in stool.
Frequent application reinforces loose teeth and gums, and it treats inflammations of the throat and the uvula in gargarism ...
It cicatrizes recent and superficial wounds, and dries old wounds.
It is beneficial to patients affected by cardiac pain due to shortness of breath or cold.
It is also usefully given against liver inflammations.
It is mixed in collyria for the eyes, and prevents tears ...

If some of these uses at least can be accounted for by the astringent action attributed to Hawthorn, others seem to result from new therapeutic explorations. One of them could be the application in the treatment of plague, which most probably resulted from the experience of the Black Death of 1347 and later, and suggests a field practice. More intriguing is the treatment of cardiac pain and the reference to shortness of breath, taken here as a cause of cardialgy instead of its symptom. This application, attributed to Paracelsus in current literature, probably came from the practice of that time rather than from a specific individual. Mattioli was indeed very keen to knowing all possible therapeutic and other uses of the plants treated in Dioscorides’ work or introduced by him on his commentary on the ancient text. He inundated Europe with letters to receive information, seeds, samples and other material. It would be no surprise if this and the other usages he reports came from one of his epistolary exchanges, be it from a famous physician or some local practitioner about whom he heard in some way. Unless he came to know these applications by direct contact with his colleagues and their patients.
Whatever its actual source, this specific usage in cases of cardiopathy was subsequently forgotten for centuries in another of the mysteries and contraditions typical of Hawthorn history, however useful and even lifesaving it might have been. But, perhaps, cardiopathy was not as frequent as it became, without requiring to preserve this usage of Hawthorn? Fortunately, however, this cardiologic usage was rediscovered in the early 20th century, giving Hawthorn the reputation of the plant of the heart par excellence.

European Medicines Agency, 5 April 2016 - EMA/HMPC/159075/2014
Committee on Herbal Medicinal Products (HMPC)
European Union herbal monograph on Crataegus spp., folium cum flore
Final (7 pages)
European Medicines Agency: Crataegi folium cum flore
“The HMPC conclusions on the use of hawthorn leaf and flower medicines for heart complaints related to nervousness, mild symptoms of mental stress and to aid sleep are based on their 'traditional use'. This means that, although there is insufficient evidence from clinical trials, the effectiveness of these herbal medicines is plausible and there is evidence that they have been used safely in this way for at least 30 years (including at least 15 years within the EU). Moreover, the intended use does not require medical supervision.
The HMPC noted a lack of clinical studies with hawthorn leaf and flower medicines. In its assessment, the HMPC also considered data from textbooks which supported a use for heart complaints related to nervousness, mental stress and to aid sleep.” https://www.ema.europa.eu/en/medicines/herbal/crataegi-folium-cum-flore
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