Rifling through an old herbal book, Fabien Schultz, PhD, discovered a handwritten three-page recipe. Schultz, head of ethnopharmacology and zoopharmacognosy at Bernhard Nocht Institute for Tropical Medicine in Hamburg, Germany, was intrigued by the opening lines attributing the elixir to Germes, a Swedish doctor who died at age 104 after falling off a horse. As Schultz was researching the document, he found a similar recipe for a traditional remedy called Swedish Bitters. But the second recipe was attributed to a physician named Samst who, coincidentally, died at age 104 — after falling off a horse in the 17th or 18th century.

While their deaths may sound like an early modern fairy tale, both Germes and Samst could have been among the era’s roving physicians toting “secret compositions” from house to house, Schultz said. The slight differences between ingredients, ratios, and backstories likely occurred as the tincture was “further modified and embellished through the retelling in these households.”

Schultz’s team spent months immersed in Germes’ recipe before publishing their findings in the Journal of Ethnobiology and Ethnomedicine last October. His and other research groups’ efforts to contextualize and reproduce Swedish Bitters revealed sensory aspects of early modern medicine that have all but disappeared and fundamentals of patient-doctor relationships that persist.

For instance, then and now, “there’s a person who’s hurting and scared and there’s a person who thinks they can do something about it,” said Mary E. Fissell, PhD, a professor of the history of medicine at Johns Hopkins University in Baltimore, who was not involved in Schultz’s research. “People in the past weren’t twiddling their thumbs, going, ‘It’s, you know, 1000 years until antibiotics are invented. What am I going to do?’ They sought out healers who had expertise.”

Schultz and his co-authors searched for the recipe in other medical texts and explored how early modern people might have interpreted the remedy. Specialists in early modern German helped Schultz make sense of the recipe’s outdated measurement units and medical and botanical terms.

Based on the handwriting style, terminology, and linguistic conventions, Schultz dated Germes’ recipe to between 1770 and 1820. The period was a heyday for longevity elixirs formulated by “herb witches” and other wise men and women in Germany, Schultz said, but “Germes’ recipe does not rely on magic or spiritualism or witches to explain its effectiveness.”

“The efficacy seems to really have been attributed to the medicinal properties of the ingredients, which includes precise reproduction of the preparation and administration methods — or it was quackery, basically. That’s something we are investigating in the laboratory,” Schultz said.

His team has attempted to make Germes’ recipe and tested the elixir and individual ingredients for anti-inflammatory and antibiotic effects. They plan to test neurologic and neuroprotective effects and hope to finalize the research this year. Already, they’ve made “some interesting discoveries” about rhubarb and saffron, Schultz said. “As far as we know, the assays we applied haven’t been used on these plants, so we still discovered something new of very common plants.”

The Sensory Experience of Making and Taking Early Modern Medicine

Other researchers at Uppsala University in Uppsala, Sweden, attempted to make Swedish Bitters in 2016. Hjalmar Fors, PhD, an associate professor in the history of science, and Nils-Otto Ahnfelt, PhD, a retired pharmacist and researcher, reproduced Hiärnes Testamente, an elixir attributed to Urban Hiärne, a royal physician, scientist, and alchemist who lived from 1641 to 1724.

“We wanted to move from description of recipes and how things were made in texts to the actual process of making them and learning by doing,” Fors said.

Hiärne was employed by the aforementioned Samst, according to a Swedish Bitters recipe found in Health Through God’s Pharmacy, a book by Austrian herbalist Maria Treben published in 1980.

Fors and Ahnfelt made two batches of Hiärnes Testamente using different methods to grind the ingredients before combining them with alcohol to rest. The researchers were especially curious about Theriac, a Swedish Bitters component containing 66 ingredients, of which they were able to procure 52, including sea squill — a traditional remedy for heart disease lacking evidence of efficacy — and a small amount of opium.

“The most intriguing part was really to discover how fantastic it all smelled when we came into the room where we had tried to gather all the ingredients,” Ahnfelt said. The smell and flavor inspired the pair to develop a digestif made with honey and brandy, sold through Tevsjö Distillery in Hälsingland, Sweden.

Swedish Bitters may not have “any real pharmacologic effects in the modern sense,” Fors said. Researchers at Wroclaw Medical University in Wroclaw, Poland, chemically analyzed a 1630 recipe for Theriac and came to a similar conclusion in 2021. But chemical analysis doesn’t capture the sensory aspects of early modern medicine — the focus of subsequent papers by Fors and Ahnfelt in 2020 and 2022, which compared contemporary with 18th-century sensory descriptions.

The researchers enlisted trained “sensory assessors” to analyze the flavor and smell of lab-produced Theriac. Engaging with the smells, flavors, and textures of ingredients when making and taking medicine “does have very powerful effects in terms of how your body reacts to the substance,” Fors said. “That is deeply meaningful from an early modern medical perspective, but it’s not deeply meaningful from the perspective of modern pharmacology.”

Early modern medicine emphasized the body’s expulsions, Fissell said. Practitioners aimed to rebalance the body’s four humors: blood, phlegm, black bile, and yellow or red bile. The “relatively violent bodily effects” were signs that something was working, she said. “They love remedies that make you go in the bathroom, that make you throw up. Disease is a terrible foe and maybe you want something that’s fighting back, right?”

‘The Ultimate Cleanser’

Swedish pharmacies often prescribed Swedish Bitters until the mid-1960s, when the country’s National Board of Health and Welfare questioned the medical use of the nostrums. Since then, most pharmacies have phased it out, but apothecaries and health food stores have continued supplying it. Fors and Ahnfelt tracked down a 1986 pharmacy-made version from the Swedish Pharmaceutical Society and determined its chemical makeup to be similar to theirs.

While Swedish Bitters is less commonly used in Germany today, Schultz said most supermarkets sell a lemon balm-based herbal remedy called Spirit of Melissa, thought to relieve indigestion, muscular pain, and other ailments.

Merz Apothecary in Chicago sells “a ton of Swedish Bitters,” said Abdul Qaiyum, a registered pharmacist and the apothecary’s CEO and owner. When Qaiyum bought the company in 1973, customers often requested recipes from Treben’s book, including “something called Schwedenbitter.” Qaiyum started importing Swedish Bitters from a pharmacy in Austria. He eventually met Treben before her death in 1991, hosting her in the apothecary for an event with customers. Now he sells her proprietary brand.

“Swedish Bitters has herbs in it to cleanse the kidney, the liver, the gallbladder, the stomach,” Qaiyum said. “I always call it the ultimate cleanser.”

Germes’ recipe described Swedish Bitters as a panacea having numerous uses and effects ranging from sharpening the senses to killing worms to healing wounds. Regular doses also helped a few of Germes’ relatives live to be well over 100, according to Schultz’s translation. The longevity claims could be exaggerated or an early-modern instance of medicine’s inherent mysteriousness.

“If you talk to an experienced clinician, they would be the first to tell you they see things that don’t make sense, that they can’t fully explain,” Fissell said.

Scientists still don’t fully understand the medicinal effects of plants, either. Only 16% of plants thought to have therapeutic properties have been studied for biological activity. And while about 80% of people globally use traditional herbal medicines, the remedies largely lack clinical evaluation, leaving additional potential uses unknown. As resistance to antibiotics and other drugs increases, research to discover new therapeutic uses for plants is urgently needed, Schultz said.

Artificial intelligence tools that quickly analyze bioactive compounds are helping scientists identify plant candidates worth studying in the lab. Schultz’s project moves more slowly. During the pandemic, after student volunteers helped scour historic herbal books for forgotten medicinal uses of plants, they collected samples in the forest outside Hamburg for pharmacologic analysis. Schultz hopes to finalize the results of the analyses, which are separate from their tests of Swedish Bitters ingredients, by June.

“There’s a huge potential,” he said. “With the emergence of artificial intelligence, I’m pretty convinced that we are going back to nature-driven drug discovery.”

The sources in this story reported having no relevant financial conflicts of interest.

Sarah Amandolare is a freelance journalist based in New York City.