Book Review

Rhubarb: The Wondrous Drug

N Engl J Med 1993; 328:215January 21, 1993

Article

Rhubarb: The Wondrous Drug
By Clifford M. Foust. 371 pp., illustrated. Princeton, N.J., Princeton University Press, 1992. $35. ISBN: 0-691-08747-4

One of the quotations the author effectively employs to introduce each chapter, a snippet from David Hume's Enquiry Concerning Human Understanding, states, “Nor has Rhubarb prov'd always a Purge, or Opium a Soporific to everyone who has taken these Medicines.” Foust uses this quotation to illustrate the fact that rhubarb's pharmacologic action depended in large part on the species and dosage to be administered. But this statement from Hume also captures in a broader sense what Foust's Rhubarb: The Wondrous Drug is all about, because this is more than a story about the use of rhubarb in medicine. Rather, this book explores the history of rhubarb in the context of early-modern international trade, horticulture, taxonomy, quantitative clinical testing, chemical analysis, the movement to expose food and drug adulteration, and of course the plant's incorporation into a variety of medical systems.

Purging had a special place in most medical systems from Galen to the 20th century, and rhubarb was prized as a comparatively mild but nevertheless effective cathartic. Hence the great interest in this plant. But the most efficacious species of rhubarb were indigenous to Central Asia, a fact that fueled increasing activity among public and private trading interests in Europe and Russia.

Rhubarb begins with -- and indeed devotes considerable attention to -- trade and economics, principally in the 17th and 18th centuries. For example, Foust has chapters on the state monopoly on the rhubarb trade in Russia and the role of the English East India Company. After discussing problems in the identification and cultivation of the plants, the author relates how physicians accommodated rhubarb in the 18th century. For example, we learn of some very interesting clinical tests of the purgative power of various species of rhubarb. A chapter follows on rhubarb as a case study in the movement to identify and expose food and drug adulteration. Finally, after addressing ongoing problems in the 19th-century search for the “true rhubarb” among rheum species, Foust discusses the history of some culinary uses of rhubarb.

Foust has researched his subject exhaustively; his informative endnotes and extensive bibliography make up about a third of the book. Moreover, his reliance on unpublished sources and primary publications, as well as his selection of secondary material, reflects the judgment of an experienced historian who has thought long on his subject. Still, it would have been interesting to learn more about rhubarb in the 20th century, and more discussion of the history of folk-medical uses of the plant would have enhanced the book. The treatment of rhubarb in international trade is rich in detail, but at times Foust should have sacrificed a bit of the detail for brevity's sake. Without a doubt, this book should have included some sort of atlas, given the frequency of (often obscure) place names from Europe to Asia. In all, Rhubarb: The Wondrous Drug is a work of thorough scholarship, with much to attract readers of the Journal.

John P. Swann, Ph.D.
Food and Drug Administration, Rockville, MD 20857