Case Reports
Case 1. A 55-year-old man who had completed 11 years of education reported using turpentine during the year preceding the survey to rid himself of "seed ticks." The man purchased turpentine at a local drug store and, based on the advice of a friend, poured approximately 4 oz of turpentine onto a sponge and applied the sponge over all surfaces of his body below the neck. He then bathed in a tub of hot water and had onset of a severe burning sensation. To alleviate the burning, he soaked in a tub of cold water. The man subsequently developed blistering on all body surfaces to which he had applied turpentine. He also reported having used aloe as a topical remedy during the preceding year and reported previous use of briar root, castor, garlic, lemon, and sassafras.
Case 2. A 46-year-old woman who had completed 7 years of education reported using castor oil routinely as a laxative and to treat "colds." She purchased castor oil at a discount department store, kept it readily available in her home, and had used castor oil and acetaminophen to treat a cold in her 18-month-old grandchild. She fed the child 1 teaspoon of castor oil mixed with one half of a baby bottle of orange juice. The symptoms resolved. She also reported using aloe, asafetida, catnip, garlic, lemon, and turpentine as remedies during the preceding year and recalled previous use of briar root, chinaberry, corn shucks, and pine as remedies.
Survey
A 2% random cluster sample of households (n=11,671) was selected from detailed transportation maps for two geographic areas in rural central Mississippi (1990 rural central Mississippi population: 33,992). Of the 223 occupied households contacted, one or more adults (persons aged greater than or equal to 18 years) in 210 (94%) households participated; 251 adults were included in the survey. The survey collected information on demographic, socioeconomic, and health variables; medicinal use and knowledge of 25 specific plants or plant derived substances*; and diseases or symptoms treated with these plants. The 25 plants were selected based on ethnobotanical research conducted in this geographic area. In addition, respondents were asked about their knowledge or use of any other plant-derived remedies to treat specific diseases or symptoms.
Of the 251 respondents, 178 (71% [95% confidence interval (CI)=65%- 77%]) reported using at least one plant-derived remedy during the year preceding the survey. The prevalence of reported use varied among age groups and was significantly higher among persons aged 45-64 years (81% [95% CI=72%-90%]) than among those aged 18-44 years (75% [95% CI=65%-85%]) and among those aged greater than or equal to 65 years (62% [95% CI=53%- 71%]) (p less than 0.05). Of respondents who had used plants during the preceding year, 31% (95% CI=25%-37%) had used one plant-derived remedy; 20% (95% CI=15%-25%), two; and 20% (95% CI=15%-25%), three or more.
The most frequently used (i.e., used by at least 10% of respondents)
plant-derived remedies during the preceding year were lemon (47% [95% CI=41%-53%]), aloe (27% [95% CI=22%-32%]), castor oil (14% [95% CI=10%-8%]), turpentine (12% [95% CI=8%-16%]), tobacco (12% [95% CI=8%-16%]), and garlic (10% [95% CI=6%-14%]). Other plants used for self-treatment included poke and sassafras.
The most common self-reported reasons for using plant-derived remedies during the preceding year included treatment of diseases or symptoms**associated with the respiratory system (43% [95% CI=38% 48%]), the s in (20% [95% CI=16%-24%), insect bites or parasite infestations (11% [95% CI=8%-14%]), the cardiovascular system (9% [95% CI=6%-12%]), and the gastrointestinal system (6% [95% CI=4% 8%]).
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* Aloe vera, asafetida, briar root/blackberry, castor/castor oil, catnip, chinaberry, corn shucks/corn silks, dock/yellow dock, garlic, American ginseng, Jimson weed, lemon, life everlasting/rabbit tobacco/rabbit grass, mayapple/bitter apple, milkweed, mistletoe, nutmeg, oak, peach/peach seed/peach pit, pine/pinetop, poke/poke salad, sassafras, sage/horsemint, tobacco, and turpentine.
** The reported diseases or symptoms treated with plant-derived remedies were categorized by organ system. For the respiratory system, the diseases or symptoms reported included "colds," sore throat, and cough; for the skin, rashes and burns; for the cardiovascular system, hypertension and diabetes; and for the gastrointestinal system, "stomach aches," constipation, and diarrhea.
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Editorial Note: In this survey of adults residing in rural areas of Mississippi, nearly three fourths of respondents reported having use plant-derived remedies during the preceding year. These data also indicate that plant-derived remedy use was widely distributed among all age groups and was not limited only to older persons in the population. In comparison,in a previous study of herbal remedy use among a national sample of U.S. residents, only 3% of respondents indicated that they had used such remedies during the preceding year (7). The substantially higher use reported in the population surveyed in Mississippi may reflect methodological differences in the two studies. Specifically, the definition of plant-derived remedies used in this report was more inclusive than the definition of herbal remedies used in the national survey. In addition, higher use in the population surveyed in Mississippi may be associated with socioeconomic and cultural influences in this population. For example, in rural central Mississippi, only 51% of persons aged greater than or equal to 25 years had a high school diploma or higher education compared with 64% for the state (8). Although utilization rates of the health-care system in the survey area are similar to national rates, self-treatment is an important adjunct to receiving formal care in this area (9).
Some plant-derived remedies reported in rural central Mississippi (e.g., poke and sassafras) contain pharmacologically active and potentially toxic compounds (2). For example, both turpentine and castor oil can produce adverse effects if used inappropriately. Use of externally applied turpentine oil for treatment of parasites has been reported previously (6). Although turpentine oil is a nontoxic and effective counterirritant when applied to a small area of the skin, cutaneous application of larger amounts has been associated with vesicular eruptions, urticaria, and vomiting (10). Castor oil is a stimulant laxative that may cause thorough evacuation of the bowels within 2-6 hours of ingestion (10); the strong purgative action of castor oil also can cause dehydration and electrolyte imbalance, and long-term use may reduce the absorption of nutrients. Because the stimulant effects of castor oil may cause uterine contraction, some authorities have recommended that it not be used during pregnancy; use also is not recommended in infants and young children (11).
The survey findings in this report document the popularity of self treatment with plant-derived therapies among persons in rural central Mississippi. Increased interest by health agencies in plant-derived therapies is reflected through the efforts of both the National Institutes of Health (which established the Office of Alternative Medicine) and the Food and Drug Administration (which has issued regulations addressing health claims for foods and dietary supplements). The survey findings also underscore the need for physicians, pharmacists, and other health-care providers to consider thepossibility of plant-derived self-treatments among their patients and to actively elicit this information when taking a clinical history. In addition, health-care providers should be aware of potential drug interactions, toxicity, and adverse re- actions as well as possible treatment benefits that may be associated with plant-derived therapies.
References
1. Marini-Bettolo GB. Present aspects of the use of plants in traditional medicine. J Ethnopharmacol 1980;2:183-8.
2. Croom EM Jr. Herbal medicine among the Lumbee Indians. In: Kirkland J, Mathews HF, Sullivan CW III, Baldwin K, eds. Herbal and magical medicine. Durham, North Carolina: Duke University Press, 1992:137-69.
3. Croom EM Jr. Documenting and evaluating herbal remedies. Economic Botany 1983;37:13-27.
4. McCaleb RS. Regulation of dietary supplements: hearing before the Subcommittee on Health and the Environment of the Committee on Energy and Commerce, House of Representatives. Washington, DC: 103rd US Congress, House of Representatives, 1993; series no. 103-57.
5. Morton JF. Folk remedies of the low country. Miami: Seeman, 1974.
6. Bolyard JC. Medicinal plants and home remedies of Appalachia. Springfield, Illinois: CC Thomas, 1981.
7. Eisenberg DM, Kessler RC, Foster C, Norlock FE, Calkins DR, Delbanco TL. Unconventional medicine in the United States: prevalence, costs, and patterns of use. N Engl J Med 1993; 328:245-52.
8. Bureau of the Census. 1990 Census of the population and housing: summary social, economic, and housing characteristics--Mississippi. Washington, DC: US Department of Commerce, Bureau of the Census, 1992; publication no. CPH-5-26.
9. Banahan BF III, Frate DA. Use of home remedies and OTC products among rural residents at high risk for development of coronary heart disease. San Diego: American Pharmaceutical Association, March 1992.
10. American Pharmaceutical Association. Handbook of nonprescription drugs. 10th ed. Washington, DC: American Pharmaceutical Association, 1993.
11. Brunton LL. Agents affecting gastrointestinal water flux and motility, digestants, and bile acids. In: Gilman AG, Rall TW, Nies AS, Taylor P, eds. The pharmacological basis of therapeutics. 8th ed. New York: Pergamon Press, 1990:914-32.
(Reported by: DA Frate, PhD, EM Croom, Jr, PhD, JB Frate, JP Juergens, PhD, Research Institute of Pharmaceutical Sciences, School of Pharmacy, The Univ of Mississippi, University; EF Meydrech, PhD, Dept of Preventive Medicine, The Univ of Mississippi Medical Center, Jackson. Health Studies Br, Div of Environmental Hazards and Health Effects, National Center for Environmental Health, CDC)