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Artemisia annua
Prospects, Applications and
Therapeutic Uses
Artemisia annua
Prospects, Applications and
Therapeutic Uses
Edited by
Tariq Aftab
M. Naeem
M. Masroor A. Khan
CRC Press
Taylor & Francis Group
6000 Broken Sound Parkway NW, Suite 300
Boca Raton, FL 33487-2742
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Chapter 1
Diverse Biologies and Experiential Continuities: A Physiognomic Reading of
the Many Faces of Malaria in the Chinese Materia Medica...................................... 1
Elisabeth Hsu
Chapter 2
Artemisia annua and Grassroots Responses to Health Crises in Rural Tanzania.... 17
Caroline Meier zu Biesen
Chapter 3
Use of Artemisia annua L. in the Treatment of Diseases—An Update................... 41
M. Naeem, Tariq Aftab, Asfia Shabbir, and M. Masroor A. Khan
Chapter 4
Current Perspectives and Future Prospects in the Use of Artemisia annua for
Pharmacological and Agricultural Purposes............................................................ 57
Ebiamadon Andi Brisibe
Chapter 5
Artemisia annua and Its Bioactive Compounds as Anti-Inflammatory Agents....... 83
Bianca Ivanescu and Andreia Corciova
Chapter 6
Biosynthetic Pathway of Artemisinin..................................................................... 115
Bushra Hafeez Kiani
Chapter 7
Cultivation of Artemisia annua—The Environmental Perspective........................ 131
Karina Knudsmark Sjøholm (nee Jessing), Bjarne W. Strobel,
and Nina Cedergreen
v
vi Contents
Chapter 8
Therapeutics of Artemisia annua: Current Trends................................................. 155
Shilpi Paul
Chapter 9
Various Applications of Artemisia Annua L. (Qinghao)........................................ 183
Himanshu Misra, Mauji Ram, Ashish Bharillya, Darshana Mehta,
Bhupendra Kumar Mehta, and Dharam Chand Jain
Chapter 10
Impact of Integrated Omics Technologies for Identification of Key Genes and
Enhanced Artemisinin Production in Artemisia annua L...................................... 221
Shashi Pandey-Rai, Neha Pandey, Anjana Kumari, Deepika Tripathi,
and Sanjay Kumar Rai
Chapter 11
Engineering the Plant Cell Factory for Artemisinin Production............................ 245
Mauji Ram, Himanshu Misra, Ashish Bharillya, and Dharam Chand Jain
Chapter 12
Use of Nanocarriers to Enhance Artemisinin Activity.......................................... 271
Anna Rita Bilia
Chapter 13
In Situ Cultivation of Artemisia annua................................................................... 295
Salisu Muhammad Tahir
Chapter 14
Mode of Action of Artemisinin: An Update........................................................... 323
Athar Ali, Abdul Qadir, Mather Ali Khan, Parul Saxena, and
Malik Zainul Abdin
Index....................................................................................................................... 335
Preface
Internationally, scientists are making unstinted efforts to improve the under-
standing of malarial biology and to develop more effective malaria treatments.
Malaria remained the major scourge of mankind until the Chinese introduced arte-
misinin to the world as a remedy. The antimalarial drug artemisinin was discovered
by Tu Youyou, a Chinese scientist, who was awarded half of the 2015 Nobel Prize
in Medicine for her discovery. Since the discovery of artemisinin, treatments con-
taining artemisinin derivatives (artemisinin combination therapies, or ACTs), have
been standardized for the treatment of Plasmodium falciparum malaria worldwide.
Artemisinin is certainly one of the most promising natural products investigated
in the past couple of decades. The plant has potent therapeutic potential beyond its
antimalarial activity, including anticancer, immunosuppressive, anti-inflammatory,
antihypertensive, antioxidative, antimicrobial, antiparasitic, and antiviral activities.
However, artemisinin-derived drugs are not available to millions of the world’s poor-
est people because of the low yield (0.1%–0.5% of dry weight) of artemisinin in
naturally grown Artemisia plants. The present demand for artemisinin far outstrips
supply; therefore, researchers around the world are working toward improving the
artemisinin content of the plant by various means.
The editors’ efforts, in the form of this comprehensive volume, detail recent
updates to the applications, current research, and future prospects of Artemisia
annua. Since the intact plant contains artemisinin in very low concentrations, its
commercial extraction requires huge amounts of plant biomass to be processed.
Massive demand and low yield of artemisinin from the plant has led to exploration
of alternative means of production, including the cultivation of A. annua on scien-
tific lines. Considering the significant benefits of various properties of the plant to
human health, we present this exclusive volume entitled Artemisia annua: Prospects,
Applications and Therapeutic Uses. As per the rationale, this volume focuses on
various scientific approaches, namely, agricultural, pharmacological, and pharma-
ceutical aspects, in vitro technology, and nutrient management strategies, as well as
omics technologies for the regulation of artemisinin biosynthesis in A. annua. The
book also contains a plethora of information about various scientific approaches to
the cultivation of this medicinal plant. Also, it includes information about the plant’s
survival under conditions of environmental stress.
The book comprises 14 chapters, most of them being reviewed articles written
by experts from around the globe. We are hopeful that this volume will meet the
needs of all researchers who are working or have interest in this particular field.
Undoubtedly, this book will be helpful to research students, teachers, ethnobotanists,
oncologists, pharmacologists, herbal growers, and anyone else with an interest in
this plant of paramount importance.
We are greatly thankful to the CRC Press, Taylor & Francis Group, USA, for their
expeditious acceptance and compilation of this scientific work. Sincere thanks are
expressed to the team members of the Taylor & Francis Group for their dedication,
sincerity, and friendly cooperation in producing this volume. With great pleasure, we
vii
viii Preface
extend our sincere thanks to all the contributors for their timely response, outstand-
ing and up-to-date research contributions, support, and consistent patience.
Lastly, thanks are also due to the well-wishers, research students, and authors’
family members for their moral support, blessings, and inspiration in the compila-
tion of this book.
Tariq Aftab
M. Naeem
M. Masroor A. Khan
Aligarh Muslim University, Aligarh, India
About the Editors
Tariq Aftab received his PhD from the Department of
Botany at Aligarh Muslim University, India, and is currently
an assistant professor there. He is the recipient of the pres-
tigious Leibniz-DAAD Fellowship from Germany, Raman
Fellowship from the Government of India, and Young Scientist
Awards from the State Government of Uttar Pradesh (India)
and Government of India. He has worked as a visiting sci-
entist at IPK, Gaterleben, Germany, and in the Department
of Plant Biology at Michigan State University, United States.
He is also a member of various scientific associations in India
and abroad. He has published research articles in several peer-reviewed national
and international journals and is the lead editor of the book Artemisia annua:
Pharmacology and Biotechnology. His research interests include physiological, pro-
teomic, and molecular studies on medicinal and aromatic plants.
ix
x About the Editors
xi
xii Contributors
Bjarne W. Strobel
Københavns Universitet
Det Natur- og Biovidenskabelige Fakultet
Sektion for Miljøkemi og Fysik
Copenhagen, Denmark
Chapter 1
Elisabeth Hsu
CONTENTS
1.1 Introduction....................................................................................................... 1
1.2 Physiognomic Reading of a Recipe to Treat Intermittent Fevers
with Qing Hao...................................................................................................3
1.3 Physiognomy of Complaints for Which the Chinese Materia Medica
Literature Recommends the Application of Qing Hao...................................... 7
1.4 Summary......................................................................................................... 10
1.5 Outlook............................................................................................................ 11
References................................................................................................................. 12
Premodern Sources................................................................................................... 14
1.1 INTRODUCTION
This chapter explores whether, and how, the enormously rich and rewarding
biomedical research into the antimalarial efficacy of artemisinin, contained in
A. annua plant materials, might be useful for textual scholarship.* Admittedly,
such a project is fraught with problems, as social historians working with
pre-twentieth century medical texts are apprehensive of any attempt to iden-
tify the referential meanings of the terms translated. Malaria, for instance, is
a modern scientific nosological term for which there is no equivalent in the
1
2 ARTEMISIA ANNUA: PROSPECTS, APPLICATIONS, AND THERAPEUTIC USES
Let us start by reading the famous physician Ge Hong’s 葛洪 (284–363 CE) prescrip-
tion against “intermittent fevers” (nüe 瘧) in his Zhou hou bei ji fang 肘後備急方
(emergency prescriptions kept in one’s sleeve). Let us first ask whether he considered
these fevers malarial, which would make his prescription an herbal antimalarial, and
second, query what might make the reading of his formula (or recipe) physiognomic.
Another recipe: qing hao, one bunch, take two sheng [2 × 0.2 liters] of water for soak-
ing it, wring it out, take the juice, ingest it in its entirety (you fang: qing hao yi wo yi
shui er sheng zi, jiao qu zhi, jin fu zhi 又方 青蒿一握 以水二升漬 絞取汁 盡服之).
(Zhou hou bei ji fang, juan 3, “Zhi han re zhu nüe fang” 治寒熱諸瘧方16: 734–407)
* Writing convention in this chapter: the monosyllabic transcription refers to terms in premodern texts,
for example qing hao, but not in modern ones, where qinghao is used.
4 ARTEMISIA ANNUA: PROSPECTS, APPLICATIONS, AND THERAPEUTIC USES
science grounded in a Cartesian view of mind and body, Merleau-Ponty insisted that
the body–self formed an inextricable part of the phenomenal field through which it
moved. Accordingly, the researcher’s body is part of the lived world he or she inhabits
and aims to research. While a natural scientist, as the subject who does the research,
is expected to investigate a research object in a detached manner (even if “objectiv-
ity” may be performed in different ways; Daston and Galison, 2007), Merleau-Ponty
stressed that the body has a spatiality that is part of the spatial field around it. It cannot
be disentangled from its surroundings, just like its parts cannot be considered a [ran-
dom] “assemblage of organs juxtaposed in space.” Rather, they form a whole, and are,
in not entirely arbitrary ways, “enveloped in each other” (Merleau-Ponty, 1962, p. 98).
Merleau-Ponty thereby provided a basis for critiquing objectivist disease categories.
Accordingly, intermittent fevers are not a symptom or sign caused by the disease of
malaria, because any biomedical disease category presupposes an objective descrip-
tion of the world, and its relation to the sign is grounded in cause–effect relations
established through objective scientific study.
Following Merleau-Ponty, I suggest instead to read “intermittent fevers” as a
physiognomy of the spatial field. As already said, Merleau-Ponty emphasizes that
the body has a spatial dimension inextricably entwined with the phenomenal field
of its surroundings. This spatial field has physiognomies that arise from a practical
engagement of the self with its surroundings. Merleau-Ponty’s philosophical con-
cept, physiognomy, makes “intermittent fevers” an aspect of the spatial field with
which the body–self is practically engaged. This practical engagement arises from
the body–self experiencing perceived demands from specific configurations in the
spatial field to “do” something. The demands affect the self on multiple levels and are
responsible for prompting the body–self into action. Intermittent fevers thus become
relevant for the patient and physician as physiognomies of a spatial field demanding
a practical intervention from the body–self.
Physiognomies are perceived wholes. Merleau-Ponty points out that to a person
for whom meanings are no longer embodied in the world, the world no longer has
any physiognomy (ibid, p. 132). Much like the Gestalt psychologists emphasized that
the whole is other than the sum of its parts (a saying that is often misquoted as “the
whole is greater than the sum of its parts”), Merleau-Ponty emphasized that percep-
tion relies on an organism’s ability to perceive wholes in a single instant. The Gestalt
psychologists and the philosopher Merleau-Ponty argued against the behaviorists
of the day, against the “empiricists,” “intellectualists,” and “sensationalists,” who
all posited that sensory perception is an additive process. Merleau-Ponty spoke of
knowing “without thinking” (ibid, p. 129), and underlined immediacy in the perceiv-
ing of a whole. His concept of physiognomy is important for us here as it refers to an
“immediate practical recognisability” (Morris, 2012, p. 25), where the practical is not
merely opposed to the intellectual, but directly appeals to our practical capabilities.
As the Gestalt psychologists emphasized, the perception of the practical significance
of objects, entities, and events lies not merely in their functional characteristics, but
also in so-called “demand characters” or “appeals,” “attractions,” “exigencies,” and
“solicitations” that arise from the perceiver’s unmediated, often affective relation to
them (Koffka and Gauillaume, cited in Morris, 2012, p. 40).
Diverse Biologies and Experiential Continuities 5
mice in each cohort tested, and the juice of a certain concentration, injected twice
and thrice, respectively, at six-hour intervals into the gut of infected mice effected
95% and 96% recoveries, respectively, in each cohort (based on plasmodial density
in the blood a few days later).*
As noted elsewhere (Hsu, 2015), it was the juice obtained by pounding fresh
plant materials that contained concentrations that were highly effective in mice
infected with P. berghei and not the juice wrung out from plant materials that had
been soaked overnight, as recommended by Ge Hong. In other words, it was in fact
the virtuosity in textual interpretation of the Ming dynasty (1368–1644) physician Li
Shizhen (1518–93) that made Ge Hong’s recipe effective in our experiment:
Recipe from the Zhou hou fang: use one bunch of qing hao, two sheng [2 × 0.2 liters] of
water, pound with a pestle to a juice and ingest it (yong qing hao yi wo, shui er sheng,
dao zhi fu zhi 用青蒿一握, 水二升, 搗汁服之).
* Although sometimes characterized as such, ours was not actually an “ethno-archaeological” project
because our research was not concerned with the study of contemporary people to explain an archaeo-
logical record of the past.
† Techniques of wringing out plant materials (like a house wife wrings out washed clothes) continue to
be enacted today by healers in Africa (fieldwork observation, early 2000s) and in the Amazon (per-
sonal communication, F. Barbira-Freedman, late 2000s).
Diverse Biologies and Experiential Continuities 7
practical intervention of administering qinghao juice, such that they disappeared and
the mice recovered.
In summary, Ge Hong’s extraction technique of wringing out the whole plant,
which resulted in an emulsion of water, flavonoids, aromatic oils, and artemisinin as
contained in the leaves, in particular, is likely to have yielded artemisinin in larger
quantities than earlier techniques of preparation recorded in the Chinese materia
medica, and this is in all likelihood directly linked to the recommendation of using it
for treating acute fever episodes of intermittent fevers (Hsu, 2014). Not just artemis-
inin, but also several flavonoids, found in stems and leaves alike, have antimalarial
properties, and synergistic effects may or may not have played an additional role
(Willcox et al., 2004). Furthermore, resistance to the antimalarial, artemisinin, is
much less likely to occur in whole plant preparations (Elfawal et al., 2014).
In the Chinese materia medica literature, wherein qing hao is mostly known as cao
hao 草蒿, it is recommended for a variety of complaints other than intermittent fevers
(for a chronically ordered, comprehensive translation of these recommendations, see
Hsu, 2010). Medical historians have been quick in dismissing those as biologically
unfounded “culture‑bound syndromes,” “illnesses,” or “sicknesses.” In what follows,
we discuss the treatment recommended in the Chinese materia medica from the
first century CE to 1596 for such culture-specific notions in light of the scientifi-
cally known biological variations of malaria. If the pathology of malaria in regions
where it is endemic need not always manifest as fever bouts, its cultural perceptions
may vary accordingly. In what follows, we explore what is gained by reading these
recommendations as a response with practical significance to the solicitations of the
physiognomy of the lived experience of malaria’s diverse biologies.
The Chinese materia medica literature is a genre that consists of long lists of
materia medica identified by name and synonyms; by flavor, quality, and other prop-
erties, such as whether the materia medica in question has potency/toxicity (you/wu
du 有/無毒); by main indications; and sometimes also by “pharmaceutical” infor-
mation on how to prepare and when to administer them. The first canonical materia
medica, which is no longer extant in its original form but has been reconstructed
from multiple citations in later works, is Shennong’s Canon of Materia Medica
(Shennong ben cao jing 神農本草經), presumably compiled in the first century CE.
It has an entry on cao hao, the “herbaceous hao.”
The herbaceous hao. Its flavor is bitter, cold. It treats jie itches, jia itches,* and ugly
wounds. It kills lice and lingering heat between bones and joints. It brightens the eyes.
* jie sao jia yang 疥瘙痂痒 is an itching that can affect toes and fingers. See, for instance, jie jia 疥痂
in Ling shu 靈樞10:307, or jie chuang 疥瘡 in Zhu bing yuan hou lun 諸病源候論 50:1411.
8 ARTEMISIA ANNUA: PROSPECTS, APPLICATIONS, AND THERAPEUTIC USES
Another name is qing hao, another name is fang kui. It grows in river waste lands.*
(Shennong ben cao jing, juan 4: 341)
At a first glance, it appears as though the authors of this text were completely
unaware of the potential antimalarial use of cao hao. They primarily recommended
it for treating different kinds of itches, ugly wounds, and lice.† However, joint aches
are a common lived experience among patients in regions where malaria is endemic.
Likewise, the “lingering heat between bones and joints” in Shennong’s Canon of
Materia Medica may have alluded to this face of endemic malaria.
Shennong’s Canon of Materia Medica also recommends cao hao for “brighten-
ing the eyes” (ming mu 明目). Incidentally it is also mentioned in the Materia Medica
for Successful Dietary Therapy (Shi liao ben cao 食療本草) of 721–739 among a list
of terms indicating enhancement of one’s vitality:
They say qing hao is cold, enhances qi 氣, causes growth of head hair, can make the
body feel light, supplement the interior and prevent ageing, brighten the eyes, and halt
wind poison. (Zheng lei ben cao, juan 10:20b)
Chinese medical historians generally do not consider materia medica that can
“brighten the eyes” to be antimalarial. However, if we take into account that endemic
malaria causes anemia, which is experienced as lethargy and tiredness, we can see
why a materia medica with antimalarial effects might be considered vitality- and
longevity-enhancing.
The Materia Medica for Successful Dietary Therapy uses the raw plant, after
soaking it in urine and making it into a powder and pill. It also recommends qing
hao as a pickle, and Tao Hongjing (456–536) seems to have recommended it as an
unprocessed food supplement in his Notes to [Shennong’s] Canon of the Materia
Medica ([Shennong] Bencao jingji zhu [神農]本草經集注) around 500 CE.‡
It is everywhere, this one is today’s qing hao, people even take it mixed with fragrant
vegetables for eating it. ([Shen nong] Ben cao jing ji zhu, juan 5, p. 363)
Although a syntactic reading of the text is that the vegetables were “fragrant,”
there is little doubt that they were considered such due to the fragrance of qing hao,
which in other texts is called “fragrant hao” (xiang hao 香蒿) or even “stinking hao”
(chou hao 臭蒿). As food supplement, the presumably fresh and fragrant qing hao
may have been seen as a preventive health measure.
* ze 澤 is here rendered as “wasteland,” in accordance with Bodde ([1978]1981). This is the ecological
niche of Artemisa apiacea and Artemisia annua, rather than interpreting ze as meaning swamps and
wetlands.
† This is a recommendation much in line with the first extant text on the therapeutic use of qing hao in
a manuscript unearthed from a tomb closed in 168 BCE near Mawangdui (Harper, 1998: 272–273),
and it is one that prevailed in the materia medica literature for about one thousand years (Hsu, 2014:
table 1).
‡ Notably, these three passages do not recommend heating the plant extract, which is in line with the
modern scientific finding that heat changes the molecular structure of artemisinin to one without anti-
malarial effects (Hien and White, 1993).
Diverse Biologies and Experiential Continuities 9
Later materia medica texts recommend cao hao (a synonym of qing hao) for
treating “bone steaming” (gu zheng 骨蒸) and conditions of “exhaustion arising due
to heat/fevers” (re lao 熱). Although Chinese medical historians do not generally
consider these two terms to describe malarial conditions, with hindsight, know-
ing that qing hao can be used as antimalarial, it is possible that they sometimes
referred to malarial fevers. Furthermore, it is conceivable that the effective treat-
ment of malarial cases of gu zheng and re lao by cao hao may have led to this
recommendation.
For treating bone steaming, take one liang 兩 [41.3 g.] of urine to soak it overnight,
dry it, turn it into powder and make a pill. It entirely eliminates exhaustion arising due
to heat/fevers. (Shi liao ben cao 食療本草 of 721–739, as quoted in the Zheng lei ben
cao, juan 10:20b)
In this context, it is worth noting that a hao is also recommended for a wide
range of convulsive disorders including “daemonic qi,” “rigor mortis possession
disorder,”* and fu lian,† as in the Supplements to the Materia Medica (Ben cao shi yi
本草拾遺) of the eighth century, which recommended, in line with Ge Hong, wring-
ing out the juice from a presumably fresh plant:
Hao controls daemonic qi, rigor mortis possession disorders, fu lian, the blood qi of
women, fullness inside the abdomen and [perceptions of] intermittent cold and hot,
and chronic diarrhea. In autumn and winter, use the seeds, in spring and summer,
use the sprouts, together pound them with a pestle, wring out the juice, and ingest.
Alternatively, dry it in the sun and make it into a powder, and apply it in urine. (Zheng
lei ben cao, juan 10:20a)
Notably, cerebral malaria can also present as convulsions, but Chinese medical
historians do not associate “daemonic qi,” the “rigor mortis possession disorder,” and
fu lian with malaria. Rather, they tend to relegate these conditions into the domain of
culture-bound possession behavior or mental illness, and these have rather distinc-
tive physiognomies; for instance, when associated with pollution through contami-
nation with the dead (e.g., Li, 1999). In this case, it is possible but unlikely that qing
hao’s effectiveness against cerebral malaria motivated its recommendation. Rather,
another observation comes to mind: the component qing, in the name qing hao, has
a phonoaesthetic that alludes to lightness, transparency, and purity, and hence it may
have been used for treating conditions of pollution. Although the term qing is not
given in this quote, it likely was implied. In the highly medicalized formula litera-
ture, qing hao is the usual term, but not in the materia medica literature, where we
have cao hao in its stead.
* For zhu 注 “possession disorders,” see Chao Yuanfang 巢元方’s Zhu bing yuan hou lun諸病源候論
(Origins and Symptoms of Medical Disorders) of 610, juan 24: 690–715.
† For fu lian 伏連 lit. “to harbour and connect,” see Wang Tao’s王燾Wai tai mi yao 外台秘要 (Arcane
1.4 SUMMARY
We started with the modern bioscientific finding that qinghao, a Chinese herbal
materia medica that today is composed of A. annua whole plant materials, contains
the chemical substance artemisinin, a molecule with a peroxide bridge that has been
proven beyond reasonable doubt to be an effective antimalarial (WHO 2005, WHO
2006). Although skeptical textual scholars likely adhere to the cultural constructiv-
ist stance that renders this bioscientific finding irrelevant, we asked whether this
incisive bioscientific research might have any relevance for textual scholarship nev-
ertheless. Our aim was not to validate premodern texts through modern scientific
research, but rather to work out a method to make sense of materia medica texts and
propose a reading of them that is sound, theoretical, and rigorous.
It is hoped that this study has demonstrated that materia medica texts have rel-
evance if one accords the lived body a theoretical importance, not as an object of
study but as starting point for making sense of the world, as did Merleau-Ponty. To
overcome some obstacles causing the current impasse between naïve realism and
cultural constructivism, we proposed to work with Merleau-Ponty’s notion of “physi-
ognomy”: a physiognomic reading accords the text a practical significance and in
this way, reduces its culturally constructed arbitrariness (which can obstruct mean-
ingful cross-cultural comparison).
We still do not know how to read texts containing premodern scientific knowl-
edge. So, what is gained by reading some select materia medica excerpts in a physiog-
nomic way; that is, in a way that according to Merleau-Ponty attended their practical
significance? A physiognomic reading of the selected materia medica passages made
it possible to relate to them not merely as poetry about culturally constructed dis-
orders for which there is no biological basis, but as recommendations that have a
practical significance to individual cases. To be sure, the proposed physiognomic
reading was not applied to all passages (some passages clearly recommended qing
hao because of its wound-healing properties; others, likely, alluded to its general
purificatory powers). Rather, we asked what is learned from specific felicitous text
passages if qing hao is read as having a practical significance due to its antimalarial
properties? A physiognomic reading offers advantages on the theoretical and meth-
odological levels. It makes it possible to grant premodern physicians and scientists
the capacity to accurately assess specific physiognomies of the lived experience of
the diverse biologies of acute, recurrent, and endemic malaria, and of cerebral falci-
parum malaria, and it imbues the responses to them with equally accurate practical
significance.
The preparation methods presented here varied from using fresh qing hao as a
food supplement (to enhance vitality and longevity) to wringing out the whole plant
after soaking it in water or pounding it when fresh (for treating acute fever bouts).
The experiment with plants grown in Oxfordshire (Wright et al., 2010) was just as
much a scientific legitimation project for validating the efficaciousness of a specific
premodern recipe as it has become an explorative project here for better understand-
ing the problems that textual scholarship is confronted with.
Diverse Biologies and Experiential Continuities 11
1.5 OUTLOOK
Many retrospective biomedical diagnoses are grounded in the assumption that bio-
logical processes give rise to “diseases” that are universally the same, while “ill-
ness” is culturally specific. The prime example of such a concept of disease and
illness is what scientists eventually identified as Creutzfeldt–Jakob disease, which
the Fore people of Papua New Guinea considered a phenomenon of kuru sorcery
(Lindenbaum, 1979). In this particular case, both the Fore and the scientists referred
to people suffering from the very same morbid condition, which was very distinctive
and could not be confused with others. However, in general, local and biomedi-
cal terms rarely refer to exactly the same phenomena. Sometimes, they are entirely
unrelated, but often they overlap in respect of certain easily identifiable phenomena.
Paul Unschuld (2002) has argued that malaria has a biological reality, which
cross-culturally can be recognized in the local terminology of intermittent fevers;
that is, han re (寒熱; intermittent coldness and heat) and nüe (瘧; intermittent fevers)
in Chinese medicine. Some intermittent fevers are malarial, others not. In full aware-
ness that other culture-specific terms cannot be mapped onto “empirical reality” as
straightforwardly, Unschuld argued against an extremist cultural relativist interpre-
tation of different illness categories.
Unschuld was following the lead of medical anthropologists who adhere to the
notion that a biological substratum of disease is universal, even if the culture-specific
way in which it is expressed differs in degrees. For instance, the use of the term
somatization in psychiatry and applied medical anthropology made it possible to
conceive of depression as a universal condition, experienced in primarily somatic
ways in cultures other than those of Europe and North America (Kleinman, 1980).
However, the usefulness of the disease/illness dichotomy has been abandoned since
(also by Arthur Kleinman himself), and the concept of disease as a universal biologi-
cal substratum onto which are grafted culturally specific illnesses has proven unten-
able. Margaret Lock’s (1993) concept of “local biologies,” in particular, underlined
that women during menopause who suffered from hot flashes were not merely com-
plaining about a cultural construct (affecting their minds), but possessed locality-
specific physiologies that were bio-scientifically validated yet not universal, that is
not identical cross-culturally.
Thomas Csordas (1994), by combining Merleau-Ponty (1945) and Bourdieu
([1977]1980), took the discussion in a direction that is even more applicable to this
study. In The Sacred Self, Csordas underlined in a similar vein the complex interplay
of physiology, bodily posture, psychology, faith, rhetoric, and the socio-cultural, but
he gave the bodily processes primacy when he claimed that the body is the founda-
tion of one’s existence, even if one’s experience of it is never pre-cultural. Following
in his footsteps, I argue here that it is not only “mental” conditions, but also biologies
that can be very diverse, as in the case of what is often conceived as the “physical”
condition par excellence, the very real, and often deadly, disease malaria.
Although malaria tends to be used as a prime example of a disease with a biologi-
cally universal pathology (Unschuld, 2002), its biology can be locally specific. It can
12 ARTEMISIA ANNUA: PROSPECTS, APPLICATIONS, AND THERAPEUTIC USES
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Bodde D. [1978] 1981. Marches in the mencius and elsewhere: A lexicographic note. In Essays
on Chinese Civilisation. Princeton University Press, Princeton, 416–425.
Bourdieu [1977] 1980. Outline of a theory of practice. Translated by Nice, R. Cambridge
University Press, Cambridge.
* Nor is it a matter of race, for malaria is just as deadly to the African infant as it is flu-like for the
European missionary who has been able to build up immunity after a lifetime’s exposure to it.
† Rachel Jenkins, personal communication; and own fieldwork experience (e.g., Pemba, January 2004).
‡ Dege dege is a term used for making sense of many symptoms other than convulsions, ranging from
general irritability to complete apathy; it designates an age-specific sickness that only affects infants
and toddlers (Makemba et al., 1996).
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Unschuld P. 2002. Diseases in the Huang Di Neijing Suwen: Facts and constructs. In
A.K.L. Chan, G.K. Clancey, and H.C. Loy (eds) Historical Perspectives on East Asian
Science, Technology and Medicine. Singapore University Press, Singapore, 182–197.
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Special Issue. Canadian Bulletin of Medical History 26(1).
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dations. http://www.who.int/malaria/publications/mct_workingpaper.pdf, retrieved on
1 December 2014.
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whqlibdoc.who.int/publications/2010/9789241547925_eng.pdf?ua=1, retrieved on 1
December 2014.
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and P. Rasoanaivo (eds) Traditional Medicinal Plants and Malaria. CRC Press, Boca
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1996. Local terminology for febrile illness in Bagamoyo district, Tanzania and its
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remarkably effective for the preparation of artemisinin-rich extracts of Qing Hao with
potent antimalarial activity. Molecules 15(2): 804–812.
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vols. Renmin weisheng chubanshe, Beijing, 1977–1981.
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c. CE. Anon. References to Huangdi neijing zhangju suoyin 黃帝內經章句索, edited
by Ren Yingqiu 任應秋. Renmin weisheng chubanshe, Beijing, 1986.
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Medica). Liang, ca. 500. Tao Hongjing 陶弘景. Annotated by Shang Zhijun 尚志鈞
and Shang Yuansheng 尚元勝. Renmin weisheng chubanshe, Beijing, 1994.
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Anon. References to Shennong bencaojing jizhu 神農本草經輯注, annotated by Ma
Jixing 馬繼興. Renmin weisheng chubanshe, Beijing, 1995.
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Tao 王燾. Renmin weisheng chubanshe, Beijing, 1955.
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bei yong ben cao 重修正和經史證類備用本草. Facsimile of the 1249 edition. Renmin
weisheng chubanshe, Beijing, 1957. And to Siku yixue yeshu congshu 四庫醫學叢書,
annotated by Cao Xiaozhong 曹孝忠. Shanghai guji chubanshe, Shanghai, 1991.
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CHAPTER IX
"THE GLORY OF THE STARS"
That evening, Jack, the astronomical weather-prophet (as he
laughingly called himself) took advantage of the magnificence of the
stars, undimmed by the moon, which was still below the horizon, to
bring out his big telescope.
Eight bells had gone and the starboard watch were below until
midnight. The greater number of them, preferring the fresh night air
to that of the stuffy foc's'le, had brought their blankets up on to the
foc's'le head. Here they lay about in attitudes peculiar to sailors, and
in which only sailors could sleep.
Only one man lay at full length, flat on his back, his pipe between his
lips, as he puffed steadily, a vacant look in his open eyes as he
rested his brain as well as his body. This was Red Bill. Near him lay
the cockney, curled up like a dog and snoring tunefully, his pipe on
the deck by his cheek, where it had fallen from his mouth. A sailor
always lights his pipe to go to sleep with, and generally falls asleep
smoking. A habit which is supposed to be very dangerous to
landlubbers, but which, so far as I have heard, never caused an
accident at sea.
Paddy sat jammed between two bollards, his chin sunk upon his
chest, in a position which looked the reverse of comfortable, and yet
he was sleeping peacefully.
Up in the bows reclined Jack, with the cowboy and Curly. These last
two were taking turns to peer through the telescope, whilst Jack
discoursed upon the wonders of the heavens.
"Now, just you look at that fellow there, Broncho," said the rover,
pointing along the cowboy's line of sight. "That's the planet Saturn."
"You don't say!"
"Yes, have you got him? Now, do you see his rings?"
"Which I do for shore. Whatever be them rings, Jack, an' why does
this here Saturn trail round with 'em. I notes he's the on'y star with
them appendages."
"They're supposed to be rings of gas or vapour. It's been said that
our world once had rings like that, and that they burst and all fell
upon the earth at once, which produced the flood."
"Say, but that's kinder strange. However scientific sports onravels
them mysteries an' rounds up them facts shore has me bogged.
Mebbe Providence devastates this here Saturn with floods right now.
If them rings is rain-clouds they're bulky a whole lot, an' liable to
swamp this Saturn planet if they plays a steady game; an' if I were
an inhabitant thar I'd be hittin' quite a gait for the high spots, or
pawin' in my war-bags for the price of a birch-bark."
"Of course, you know the signs of the zodiac, Curly," went on the
amateur astronomer.
"No, not all. Spout 'em out, Jack, and show 'em to us."
"Why, don't you remember the rhyme:
The Ram, the Bull, the Heavenly Twins,
And next the Crab, the Lion shines;
The Virgin and the Scales,
The Scorpion, Archer, and He-Goat,
The Man that holds the water-pot,
And Fish with glittering tails."
"Whar's the Bull you mentions?" exclaimed the cowpuncher eagerly.
"I jest itches to throw a rope over him."
"Well, do you see that V with a big red star?"
"Red star—why, shore, I savvys that V since I were a kiddy."
"That's the head of the Bull, and that rose-red star is Aldebaran, the
eye of the Bull. That's a star you'll find useful some day, Curly, when
you're captain of a ship and want to take night sights."
"Why ever do they call him 'Aldebaran'?" asked Broncho.
"It's Arabic, meaning 'the follower,' because it follows the Pleiades."
"I know the Pleiades," said Curly, pointing aloft proudly.
"Many a night I saw the Pleiads,
Rising through the mellow shade,
Glitter like a swarm of fire-flies
Tangled in a silver braid,"
quoted Jack.
"The Pleiades," he went on, "were the seven daughters of Atlas, and
are in some mysterious way connected with the flood. The ancient
Egyptians celebrated a festival in November at the culmination of the
Pleiades, which they directly connected with the flood.
"The same thing seems to have occurred amongst the Hindoos, the
Persians, the Druids, and in the South Seas. The Japanese Feast of
Lanterns is also supposed to commemorate this event, whilst the
ancient inhabitants of Mexico had a tradition that the world had been
destroyed at the midnight culmination of the Pleiades. This is all
mysteriously borne out by the fact that Taurus, the Bull, whom you
have just looked at, shows only his head and shoulders; he is
supposed to be swimming."
"That's shore interesting as an idee," commented Broncho. "But do
you-alls regyard this here flood superstition you recounts as a likely
play?"
"It's only a theory, Broncho, with maybe nothing in it."
"Theeries is theeries, an' facts is facts. I meets a gent once way
down to Tombstone, who allows he's the bigges' full-blooded wolf in
Arizona. He's shore a tough citizen a whole lot, carries a six-gun with
the stock full o' notches an' the trigger tied back. Wall, this here
Tombstone sport, which his name is P'ison Dick (an' he's shore
p'isonous as a t'rantler) cherishes the theery, an' gives it out
premiscuous as a hoss-back opinion, that a 45-calibre bullet ain't
able to worry him none; if he accoomilates one he allows he
assimilates it into his system, an' don't take no more account tharof.
That's his theery, an' as mebbe you-alls shrewdly surmises, it bogs
down in the dust before facts—an' it's this way; he's been a-loafin'
around Tombstone mebbe hard on the hocks of a year, an' the
camp's shore full to bustin' with his goin's on; and I ain't wonderin',
for there ain't a moon goes by without Tombstone's shy a citizen an'
mebbe a greaser or two, all corpses o' this P'ison Dick's layin' out.
"Wall, it's 'bout sundown, one day in the early fall, when a stranger
comes lopin' into camp on a played-out pinto pony, which he halts up
before the 'Gold Nugget,' old Konkey Bell's saloon, an' proceeds to
dismount tharfrom like as if he's some wearied an' bone-tired. I notes
this through the door, from where I'm buckin' a faro game, an'
likewise takes in a pair o' big black eyes an' a smooth face. 'It's a
boy,' I remyarks casual to myself as I coppers my bet, an' the next
minit I sees this here black-eyed foreigner up agen the bar, a-
swallowin' a drink 'longside o' P'ison Dick. It ain't manners none to
take a drink alone that-away, an' is liable to make a gent too
conspicuous to be healthy; but seein' he's a stranger and without
many rings on his horns, it passes. P'ison Dick scowls, but says
nothin'; then poco tiempo tells the bar-keep to set 'em up again.
"The bar-keep slams down a glass before the stranger, who pushes
it away some careless, an' allows he's done finished lubricatin'.
"P'ison Dick's eyes kinder narrowed like a snake's.
"'I'm askin' you to hev' a drink, stranger,' he says, colder'n ice in hell.
"You-alls may surmise the rest of us is some taciturn, not to say
mute a whole lot, an' some foxy longhorns is already takin' cover.
"The stranger smiles kinder queer at Dick—jest a mouth twist, his
eyes lookin' a heap grim; an' he stands thar for mebbe the length of
a drink o' whisky, then snaps out in a sorter shaky screech, 'To hell
with yer drink!' an' before you can turn a kyard over, he ups an' has
the glass bruck on P'ison Dick's crimson beak.
"By this move he has Dick some disgruntled an' gains more time to
draw; then, bang! go the gatlin's a'most together, an' Dick's theery
cuts adrift from him without strainin' itself none. He's dead meat that
sudden, he don't even have time to emit a groan.
"The stranger's hit too, plumb through the lung, an' pretty soon
cashes in likewise; but, where the game comes queer is this way.
That 'ere black-eyed party whom I allowed was a boy is a woman,
an' a mighty pretty one at that, though her sperit peters out 'fore we
is able to corral any reasons for the game she plays; an' as I pulls
my freight next sun-up I never does accoomilate no knowledge
tharof. Anyway, P'ison Dick gets his medicine an' lights out that
sudden for the heavenly pastures I reckons the angels, or more likely
it's them fork-tailed miscreant collectors, is some surprised to see
him bulgin' in an' defilin' the scenery o' their sperit-ranche."
"Well," observed Jack slowly, "astronomy's a science which gives a
wide fling to the imagination, and without those theories you despise
is liable to lose a great deal of interest. But let's look at Orion, the
finest constellation in the heavens. He's the greatest hunter the
world has ever known—Nimrod, who, with his dogs, has been placed
up in the heavens to hunt the Bull.
"D'you see that reddish star? That's Betelgeuse—Arabic beyt al
agoos, 'the old man's house.' Betelgeuse is a sun like our own, but a
cooling one, and represents the left shoulder of Orion, Bellatrix,
supposed to be a lucky star for women, being the right shoulder.
Those three bright stars in a line are the hunter's belt, whilst below is
Rigel—Arabic rigl, 'a foot'—being Orion's left foot.
"That big star of a delicate green is Sirius, the blazing dog-star,
Orion's great hunting dog."
"So!" drawled Broncho with a slow smile. "Smell-dawg or tree-
dawg?"[1]
"Sirius," went on Jack, taking no notice of Broncho's facetiousness,
"is the brightest star in the heavens, though not the biggest.
Canopus, though only half as bright, is immeasurably bigger; but if it
were as near to us as Sirius I expect it would shine in the sky with as
great a brilliance as our sun.
"Now, at the least computation, Sirius is fifty billion miles off, or five
hundred and thirty-seven thousand times as far from the earth as the
sun; and since light diminishes as the square of the distance
increases, the sun, if as far off as Sirius, would give us two hundred
and eighty-eight thousand million times less light than it does now.
"The character of Sirius' spectrum shows that, surface for surface, its
brightness is far greater than the sun's, and as Sirius is some twenty
times the size of the sun, Sirius is reckoned to shine some seventy
times as bright as the sun. This is putting the calculation at its
smallest. Good authorities put Sirius at twice that distance off, and
calculate the star's brilliancy as two hundred and eighty-eight times
greater than the sun's.[7] Now, when you come to contemplate
Canopus——"
"Hold on, son! Hold your horses there!" burst out Broncho, drawing a
long breath. "Sirius is a size too large for this child. My brain's dizzy
an' wobblin' with them Sirius calc'lations o' yours, an' if you turns
your wolf loose on this Canopus star, compared to which you allows
Sirius is merely a puny picaninny, you'll shore have me that locoed
an' brain-strained, tryin' to size up them measurements o' yours, I'd
be liable to dislocate my mental tissues an' stampede away into a
lunatic complete."
"Well, you needn't worry; astronomers are beaten by Canopus."
"If you-alls aims to surprise me by that statement, you don't succeed.
I bet a stack o' blues them astronomy sharps goes locoed or beds
down in their coffins 'fore they has time to round up the tally o'
Canopus," declared the cowpuncher.
"He's so far off," continued Jack impressively, "that if they used up all
the oughts in the world, they couldn't get his distance down on
paper."
"Tell us some more about Sirius," said Curly, his eyes bulging with
Jack's stupendous statements.
"Well, there is another queer thing about Sirius. He's got a big
companion-star fussing round him, which gives such a dim light it
can only be seen by the very biggest of astronomical telescopes.
There is no reason why there should not be many invisible as well as
visible stars in the firmament. As Bessel said, 'No reason exists for
considering luminosity an essential property of stars.'
"Just imagine, then, that it is quite possible that the heavens are not
only full of those bright globes we see night after night, but besides
them a multitude of dim, ghostlike stars, unseen by us, but there all
the same, are pacing along their allotted paths like the rest."
"Are these invisible, unlighted stars allowed by scientists, Jack?"
asked Curly, in a subdued voice of awe.
"Hinted at, hinted at," returned the rover carelessly. "But I'll tell you
something more wonderful to think of than that—the systems of
double, treble, and quadruple suns. Now, our solar system is at the
bottom rung of the social ladder in the heavenly world. We just have
a plain white sun, which we revolve round with regular seasons and
fixed day and night; but take a system that revolves round a double
star, and thus has two suns, and say these suns differ in colour,—as
is often the case, for every star has a colour of its own—Sirius is a
pale green, Aldebaran rose-red, Betelgeuse orange-red, Rigel a
blue-white, Capella a pearly white, and so on.
"Suppose, then, one of these suns is red and the other blue.
Imagine, if you can, the combinations of colour that ensue, not to
mention the variations in day and night and in the seasons.
"At one time both suns will be high in the heavens at once, one
shedding rays of red, the other rays of blue; and as they set in
different corners of the horizon, two gorgeously coloured sunsets
simply overwhelm the sky with beautiful colour-effects.
"At another time, perhaps, one sun will be above the horizon for half
the round of the clock, the other taking the other half—no night
during that period, simply so many hours of red and so many hours
of blue light, and perhaps the sunrise of the one coincides with the
sunset of the other. Ye gods! What a prospect! But how much further
does a quadruple system carry us—four suns glaring down upon
one; no nights at all now (the people in those systems no doubt have
reached a stage in the evolution of the body—if, indeed, they have
bodies at all—when sleep is no longer required), just days of every
hue, of every grade of colour—pale blue days, brilliant red days,
gorgeous yellow days, violet days, green days——"
"Good night, Jack," broke in the cowpuncher softly. "I guess I'll quit.
You're one too many for me; you have me beat to a stan'still. My
head'll burst if I accoomilates any more astronomy. It takes up too
much space in my brain-cells an' don' settle down none, but jest
rampages 'round stampedin' my intellec's out into the cold, till I
wonders, has I a headpiece at all or has it blowed off like a rawcket?"
This broke up the astronomy party, and the three rolled into their
blankets; but Curly, when he was turned out at one bell, complained
of a dream in which the devil, with a face of variegated colours, had
been grinning at him through Saturn's rings, whilst the grim shades
of ghost stars pranced before him in all manner of fantastic shapes,
headed by the monstrous fiery apparition of Sirius, whose flames,
spread out in great tentacles—a twisty, creepy, crawly mass of claw-
ended arms—sought to drag the terrified dreamer out of his
blankets.
FOOTNOTES:
[7] It is now known that these figures re Sirius are much
overstated.
CHAPTER X
"STUDPOKER BOB'S MALADY"
Like most wooden ships, the Higgins had to be pumped out twice a
day, once in the morning watch and once in the second dog-watch.
A ship's pumps are worked by handle-bars on heavy flywheels, and
it is probably the finest exercise in the world for your back muscles,
especially if you have a bucko like Black Davis to watch over you
and keep you doing sixty revolutions to the minute for half an hour
without a spell.
The bosun was not such a keen muscle-developer, and in
consequence the starboard watch only averaged thirty-five to forty
revolutions a minute, and also had a spell-ho after fifteen minutes.
Notwithstanding this, Studpoker Bob, who had a horror of any sort of
form of muscle-developing, used to let his arms go round with the
brakes, and so managed that, instead of his arms pulling the brakes,
the brakes pulled his arms.
This man was fast beginning to show up in his true colours.
As Broncho observed to Jack:
"That ere kyard-sharp don't surge back on a rope suffeecient to
throw a calf. He's shore regyardful of his health that-away; yet he's
a-distributin' views in the foc's'le like as if he's the most put-upon
gent in the ship, which same views is shore fomentin' trouble."
"The man's a real waster," replied the rover. "I watched him dealing a
brace game last night against Hank, Ben, and those two tenderfoots,
Jimmy Green and Pinto. I believe he's got notes for most of the
men's paydays already, and now, as you say, he's trying in a sneaky,
underhand way to rake up trouble; but sailors always will walk blindly
into the ditch, and won't be warned."
"Which his mood is shore ornery an' he's plumb wolf by nacher; but
as you-alls sagely remyarks, them misguided shorthorns won't
believe it none, an' listens to his howlin' like he's the President of the
United States. It has me plumb wearied," and Broncho sniffed
disdainfully as he slowly filled his favourite corncob.
But matters were rapidly coming to a head. The Higgins had lost the
south-east trades, and was plunging into a heavy head sea under
topgallant-s'ls, whilst a succession of sprays turned the forward part
of the ship into a shower-bath, and ever and anon a green sea
tumbled aboard and roared aft.
The wind, a dead muzzler, was slowly increasing in strength, with an
edge to it which was a good foretaste of the "Roaring Forties."
To windward the sky had a dirty look, and untidy, threadbare storm-
clouds swept across it, whilst in the west the sun sank into a
greenish, sickly sea through a variegated mess of yellow tints.
The watch no longer went about bare-foot in thin dungarees; instead,
oilskins and sea-boots were the order of the day.
At four bells, 6 p.m., the port watch went below, and as they came
forward some of them presented a very curious appearance. Sam,
the coloured man, had supplemented his rags with odd bits of
dungaree and canvas, tied on to his body with numerous pieces of
ropeyarn; whilst Jim, the boy, swaggered along in an old blanket coat
of Jack's, which made him a good-sized overcoat.
The cockney went aft to relieve the wheel, a somewhat comical
figure in some Piccadilly masher's discarded town coat, with velvet
collar and cuffs, whilst the rest of the watch were turned out to man
the pumps.
They started briskly to work at a cry of "Shake her up, boys," from
the bosun.
Studpoker Bob, in his usual style, took special care lest he should
inadvertently put some weight on to the brakes, and was
succeeding, he thought, very well.
Jack, of course, was not the man to let the opportunity go by without
a chanty, and started off with:
"Were you never down in Mobile bay?"
The whole watch thundered in the chorus with the exception of the
gambler, who kept all his breath for his mutinous talk in the foc's'le.
As they swung the bars, deep came the note:
"John, come tell us as we haul away."
(Jack) "A-screwing cotton all the day."
(Chorus) "John, come tell us as we haul away.
Aye, aye, haul, aye!
John, come tell us as we haul away."
Then Jack went on:
"What did I see in Mobile Bay?"
(Chorus) "John, come tell us as we haul away."
(Jack) "Were the girls all fair and free and gay?"
(Chorus) "John, come tell us as we haul away.
Aye, aye, haul, aye!
John, come tell us as we haul away."
(Jack) "Oh! This I saw in Mobile Bay."
(Chorus) "So he tells us as we haul away."
(Jack) "A pretty girl a-making hay."
(Chorus) "So he tells us as we haul away.
Aye, aye, haul, aye!
So he tells us as we haul away."
So the chanty ran on gaily verse after verse, the chorus raised high
above the moaning of the wind and the groaning of the ship.
"Give us another!" was the general cry as the last verse finished, and
away went Jack again with "A-roving":