Technologies of Knowledge: Pharmacology, Botany, and Medical Recipes
Abstract and Keywords
This article presents an overview of the main questions in the history of Greek and Roman pharmacology and botany. It presents the actors in the transmission of pharmacological and botanical knowledge in antiquity and discusses how they established their authority through claims to expertise and effective treatments. It shows that much of that transmission occurred orally, and that attitudes toward the written word in general, and recipes in particular, were ambivalent. Next the article examines the question of efficacy from a cross-cultural and anthropological point of view. It notes that the notion of efficacy is culturally bound and asks whether it is possible to use ancient texts for bioprospecting, that is, to find “new” remedies. It calls for more collaborative studies involving historians, scientific archaeologists, and (ethno)-pharmacists.
Pharmacology and botany today are two distinct scientific fields, but in antiquity they were intimately linked. One of the most important botanical texts of antiquity, Theophrastus’s Enquiry into Plants (fourth century BCE), includes much information about pharmacologically active plants and the people who sold them, the pharmakopōlai (the drug sellers; see below) (Amigues 1988–2006, 2010). Conversely, one of the most important pharmacological texts of antiquity, Dioscorides’s Materia Medica (first century CE; see Figures 1 and 3), a five-book catalog of pharmacologically active natural substances, also contains some excellent botanical information (Wellmann 1906–1914; Riddle 1985; Beck 2005). It therefore makes sense to examine botany and pharmacology together in this article.
The student of ancient pharmacology and botany is spoiled for choice. Written sources are abundant and very often understudied. In addition to the already mentioned texts of Theophrastus and Dioscorides, one can add several treatises of the Hippocratic Corpus (fifth and fourth centuries BCE), in particular the gynecological ones, which contain a large number of recipes (Totelin 2009a; Nutton 2013; Craik 2014); books 12 to 37 of Pliny’s Natural History (French and Greenaway 1986; Beagon 1992); the large pharmacological output of Galen (see below); the writings of the Roman agronomists Cato, Virgil, Varro, Columella, and Palladius (Diederich 2007); the medical encyclopedias composed by the Byzantine authors Oribasius (fourth century CE), Aetius and Alexander of Tralles (both sixth century CE), and Paul of Aegina (seventh century CE) (Scarborough 1984); as well as many other shorter texts, some of which make an appearance below. Through these preserved works, we hear of many more that have been lost through the vicissitudes of manuscript transcription. Thus, Galen often quotes, among many other works, recipes from Asclepiades the Pharmacist’s External Ailments (first century CE) and Crito’s Cosmetics (second century CE), two works that have now disappeared (Fabricius 1972, 190–199; Scarborough 1985).
In addition to these literary sources, we have at our disposal numerous pharmacological and some botanical papyri, often lists of recipes, dating to the third century BCE onward, some of which are illustrated (see Figure 5). Among these, we could mention the “Michigan Medical Codex” (P.Mich. 758 = P.Mich.inv. 21), a fourth-century CE compilation of recipes, annotated by its owner, who added his own selection of remedies (Youtie 1996). Also noteworthy is the “Johnson papyrus” (P.Johnson + P.Ant 3.214 = MP3 2095), which consists of the remains of a papyrus codex leaf, bearing colourful plant illustrations on either side (Fausti 1998, 43–58, 2004; Leith 2006).
Archaeological sources, for their part, include pharmacological stamps (see Figure 2); remedy boxes, bottles, and cans (Marganne 2006; Evershed et al. 2004); funerary monuments to people involved in the medical professions (Korpela 1995; Samama 2003); remains of ancient plants (pollen, seeds, cavities left by the roots of trees) (Day 2013); mosaics or paintings representing plants, such as the paintings decorating the garden room in the “Villa of Livia” at Prima Porta near Rome (Settis 2008); coins with plants on the obverse (Baumann 2000); and so forth.
The student of ancient pharmacology and botany can also hope for regular new discoveries. Manuscripts rarely opened for centuries can reveal “new” texts. This was the case with MS Vlatadon 14, which revealed Galen’s “lost” text Avoiding Distress, which contains some information on recipes and pharmacological substances (Boudon-Millot 2007; Singer et al. 2013). A text neglected for centuries can also show itself to be fascinating, as in the case of On the Virtue of Centaury, a short text only known through a Latin translation (from the Greek). Vivian Nutton argues that this text was written by the Methodist Themison and therefore constitutes a very rare example of a fully preserved Methodist text (Nutton 2010, 2014). Archaeological excavations can bring to light extraordinary finds. For instance, excavations in 2003 in London revealed a second-century tin canister, still filled with a cosmetic cream, whose chemical composition researchers were able to study (see below).
However, even without these exciting discoveries, there is much work to be done—work that will occupy researchers for generations. For instance, almost none of the Galenic pharmacological texts are translated into modern languages (among the exceptions we can count Properties of Foodstuffs, Powell 2003; and Theriac to Piso, Leigh 2013). Further, for many of these treatises the most recent edition remains that by Kühn in the nineteenth century (1821–1833). In that edition, Galen’s pharmacological works occupy some three thousand pages. Indeed, Galen wrote a treatise in eleven books, Mixing and Powers of Simple Drugs, on single ingredients used medicinally; a treatise in ten books, Composition of Medicines According to Places, a list of compound remedies listed in “head-to-toe” order; a treatise in seven books, Composition of Medicines According to Types, a list of compound remedies classified according to their form or type; a treatise in two books, Antidotes, on those panaceas supposed to treat all matters of ailments besides poisoning; a treatise in three books, Properties of Foodstuffs, a catalog of foods and their medicinal benefits; and various other short treatises, the authenticity of which is sometimes debated (see Debru 1997 and Vogt 2009 for an introduction to Galen’s pharmacology).
Studying ancient pharmacological and botanical sources is hard work—it is probably best to state this from the outset. The texts are for the most part extremely technical, often taking the form of lists, and as already stated, they are often not translated into English or any other modern language. Disciplinary boundaries rarely facilitate collaboration between ancient historians and philologists, on the one hand, and scientific archaeologists, chemists, botanists, and pharmacists, on the other. However, collaborative interdisciplinary studies must become more frequent, as it is clear that very few people can acquire all the skills needed to fully understand the evidence. In other words, very few people can, like French scholar Suzanne Amigues, master the philological skills that enabled her to re-edit Theophrastus’s Enquiry into Plants, as well as the botanical skills that allowed her to offer plausible plant identifications (Amigues 1988–2006, 2010, 2012). Collaborations may not always be easy, but they are the way forward.
In the remainder of this article I approach the current debates in the history of ancient botany and pharmacology from two very different points of view. In the second section I take a traditional approach in the history of science and examine who the actors in the fields of ancient botany and pharmacology were. This leads to the questions of expertise—how it was established in antiquity—and transmission of knowledge. In particular, I discuss the interplay between the oral and the written word in that transmission. In the third section I approach the material from the viewpoint of a modern onlooker and ask the seemingly naïve question, “Did these remedies work?” This leads to a discussion of how definitions of diseases and efficacy are culturally bound.
The Actors of Ancient Botany and Pharmacology
Our main sources for the history of ancient botany and pharmacology are texts written by ancient philosophers (e.g., Theophrastus), physicians (e.g., Galen), encyclopedists (e.g., Pliny the Elder), and agronomists (e.g., Columella). These elite authors, however, were by no means the only experts in their fields. Through their writings, we hear of numerous authorities. (I choose the word “authority” rather than “author” for reasons that will soon become clear.) Ancient botanical and pharmacological texts preserve the names of hundreds (perhaps thousands) of such sources. They raise the question of what constituted expertise and authority in ancient botany and pharmacology. Was authority tied to social status, gender, or literacy levels? Or did authority reside in the perceived quality of actors’ knowledge?
From a social point of view, authorities mentioned in ancient pharmacological and botanical texts came from all echelons of ancient society, from the market peddler to the wealthy king, ruling over extensive territories. Knowledge of natural substances was very widespread in antiquity. Vivian Nutton (1992) used the words “medical market place” to describe the variety of “actors” in the field of ancient medicine, and in an earlier article provided the following list of some ancient drug inventors or traders mentioned by Galen:
I offer a litany of the names of some authors or providers of drugs listed by Galen, men (and a woman) of all classes and religions, who secured a sort of immortality by their invention of a healing remedy: Achillas the eye-coucher; Antonius the drugdealer; Apollonius the pharmacist; Aquillia Secundilla and her recipe against lumbago; Axius, doctor in the British fleet, with his eye ointment; Celer the centurion; Cletius Abascantus of Lyons; Diogas the trainer; Euschemus the eunuch; Flavius the boxer; Orion the groom; Pharnaces the Persian rootcutter; Philoxenus the schoolmaster; Protas of Egyptian Pelusium; Publius of Pozzuoli; and Simmias the crowd-puller. That is the ancient drug trade in kaleidoscope.
(Nutton 1985, 145)
This list calls for several comments, which introduce us to many important issues central to an understanding of ancient pharmacology and botany. First, many of these people are identified by their “professional” occupations as well as by their personal names. Nutton of course selected his list for maximum effect, but the variety of occupations named in ancient pharmacological and botanical texts is nevertheless staggering. Some of these occupations are clearly medical or pharmacological in outlook and at times point to a high level of specialization in ancient medicine: eye coucher, drug seller, pharmacist, military doctor, and root cutter. Other occupations have no particular link with medicine, although it is possible to see how an athletic trainer or a boxer might have developed good remedies against bruises and wounds. As for the crowd pullers, they may have been market sellers who used impressive techniques to attract crowds, such as simulating a snake bite before consuming an antidote (see Boudon-Millot 2003 and McNamara 2003 for various quacks and charlatans active on the medical market). It is not easy to determine the social status of these people only from their occupation. For instance, it would be wrong to assume that root cutters were all of low status, as there is at least one significant exception: Crateuas the root cutter. This authority was a correspondent of King Mithradates VI of Pontus and author of an illustrated treatise on plants entitled Rhizotomikon (Root-cutting), which was an important source for Dioscorides (Scarborough 2006).
A second point to make about Nutton’s list is that several authorities are identified by their ethnicity: they come from Lyons (modern France), Pozzuoli (near Naples, Italy), and Egyptian Pelusium (east of the Nile’s Delta). In addition, one of these authorities traveled to Britain with the Roman army. The growth of the Roman Empire, which was at its apogee at the time of Galen, undoubtedly facilitated travel and transmission of knowledge. However, several centuries before Galen, the pharmacological market was very much a global one. Theophrastus mentions a drug seller who called himself “the Indian” (Enquiry into Plants 9.18). That “Indian” may never have set foot in India, but he nevertheless understood that there were strong connections between India and pharmacological substances.
Together with people traveled plants and recipes, and this too is reflected in our ancient sources. The earliest medicinal recipes preserved in Greek, those of the Hippocratic Corpus, include numerous exotic ingredients, such as myrrh, frankincense, and cinnamon (scholars debate the identity of ancient kinnamōmon, but for the sake of simplicity I refer to it as “cinnamon”; see De Romanis 1996; Marganne 1996). These people told fantastic stories about the plants they brought, which authors wrote down while expressing their doubts about them. For instance, several different stories circulated about cinnamon: it grew in ravines full of deadly snakes (Theophrastus, Enquiry into Plants 9.5.2); great birds made their nests out of cinnamon twigs on inaccessibly high cliffs (Herodotus, Histories 3.111) or high trees (Aristotle, History of Animals 8.13, 616a7–13), and one had to find and attack those birds to collect cinnamon. Pliny the Elder was most probably correct when he dismissed all these stories as inventions by merchants who wanted to sell their produce at the highest price (Natural History 12.85).
Fantastic stories—quite naturally—attract attention. It is also undeniable that scholars feel the pull of exoticism and luxury, even when they work in a postcolonial framework. As a result, entire books have been written on the trade of products such as cinnamon and Indian ingredients (Miller 1969; Raschke 1978; De Romanis 1996; Dalby 2000), while more local aspects of pharmacological and botanical trade remain understudied. Most natural substances used in the ancient world were not exotic, expensive, and luxurious, but must have been produced or gathered locally. In the case of plants, Pliny tells us that he observed numerous medicinal herbs in the garden of a certain Antonius Castor, a famous pharmacologist of the first century CE (Natural History 25.9). Other substances had to be traded over some distance, but did not travel for months. These “mid-distance” products are sometimes identified by their alleged place of production, in the same way that people in the ancient world were identified with their place of origin: perfume from Commagene, wine from Lesbos, earth from Samos, silphium from Cyrene, and so forth (Totelin 2016). It is important not to neglect these less global aspects of the ancient pharmacological trade. It is also worth noting the fragility and small-scale nature of the global trade in natural substances in the ancient world. Thus Galen tells us that in order to prepare antidotes, he used imperial cinnamon stocks kept in storehouses. The emperor Commodus, however, sold off the cinnamon most recently acquired, leaving Galen to use the stocks purchased under the reign of Trajan and Hadrian (Antidotes 1.13, 14.64–65 Kühn). That cinnamon had lost some of its power, but Galen had no choice but to use it. This anecdote shows that Galen did not have access to large stocks of cinnamon, and that these were highly dependent on the whims of a particular emperor.
A third comment to make in relation to Nutton’s list of people involved in the drug business is a very simple observation: all these authorities have a personal name. Because their names are recorded, many of these authorities have found their way into modern encyclopedias and prosopographical studies, even though we actually know very little about them (see, e.g., Pauly et al. 1894–1980; Fabricius 1972; Keyser and Irby-Massie 2008). Not all ancient pharmacological and botanical authorities were afforded the honor of having their names recorded, however. Indeed, the Hippocratic authors do not name a single one of their sources, whether they agreed or disagreed with them. But even authors who acknowledged their sources did not always identify them by their personal names. Some authorities, like the Indian mentioned above, were identified by their ethnicity. Alternatively—and more commonly—they were identified by their professional occupation. For instance, Galen explains how “a certain doctor in Mysia, in Hellespont, an expert in drugs” used bull’s dung on patients affected with dropsy (Mixing and Powers of Simple Drugs 10.23, 12.300–301 Kühn). While that doctor is anonymous, he is still acknowledged as an expert and afforded a certain level of individuality. Many other authorities were simply “lumped together” in an anonymous professional group. For instance, Dioscorides mentions on several occasions the myrepsoi, the perfumers, in relation to strong-smelling plants (Materia Medica 1.20.1, 1.109.4, 3.4.3, 3.130.1, 4.23.2). The information attributed to the perfumers is quite technical; it is therefore likely that Dioscorides met with them to gather knowledge. However, he did not allow them to be remembered as individuals. Other professional groups named in ancient botanical and pharmacological texts include, among many others, gardeners, farmers, merchants, wreath makers, and sponge divers (see Hardy and Totelin 2016, ch. 2 for a much longer list).
Fourth, Nutton’s list includes one woman: Aquillia Secundilla (Flemming 2007; Parker 2012). Women in the Greek and Roman world were active in the fields of pharmacology and botany from an early period. The earliest preserved Greek texts, the Iliad and the Odyssey, present women such as Helen or Circe harnessing the powers of plants, often to negative effect. Throughout antiquity authors associated women with magical uses of plants (Luck 2006). That is of course true of mythical women such as Helen, Circe, and Medea, but it is also the case for real women. For instance, Dioscorides noted that Thessalian women made love potions with vetch and roots of orchid (Materia Medica 3.126.2 and 4.131), and the Greek magical papyri include a recipe attributed to a Syrian woman from Gadara against any inflammation (PGM 20.4–12, Betz 1992, 258). Plato, for his part, perceived the powers of midwives as hovering between healing and magic, in a famous passage of the Theaetetus (149d).
There is no doubt that women were involved in treating other women for ailments relating to their reproductive life (see Figure 3). Scholars therefore often assume that the high number of gynecological recipes included in the Hippocratic Corpus reflects the knowledge of midwives as well as women who prepared their own remedies at home (see, e.g., Rousselle 1980; Riddle 1992, 81–82; Hanson 1991, 1992). I follow Helen King in arguing that the situation is more complicated; it is unhelpful to categorize knowledge as “female” or “male,” and one must acknowledge the deep impact of writing on the formulation of knowledge (see below) (King 1998, ch. 7). In any case, the Hippocratic authors never mention from whom they obtained their recipes and knowledge of pharmacological substances.
In later antiquity, the names of women are often recorded in relation to gynecological recipes and cosmetic recipes—two fields that have female connotations. Thus, the name of Metrodora is attached to a short treatise (perhaps dating to the sixth century CE) dealing mostly with gynecological ailments and cosmetics (Kousis 1945; Congourdeau 1993; Parker 1997). The name “Metrodora” may be a pseudonym masking a male author, but it remains interesting to observe that women’s authority was recognized, albeit in an ambivalent manner, in some medical and paramedical fields.
A final point to make in relation to the authorities in Nutton’s list is that not all were literate. It is difficult, however, to determine exactly who was literate and who was not. The only person about whom we can make some safe assumptions is Philoxenus the Schoolmaster, as his title indicates he mastered the written language (grammatikos literally means “the person of letters”). Literacy was not widespread in the ancient world, but its distribution did not necessarily follow social hierarchies (Harris 1989; Thomas 1992). That is, a merchant (relatively low on the social scale) may have had some basic command of reading and writing. If people could not write, they transmitted their knowledge orally until someone managed to get hold of it and write it down. Pliny the Elder notes that many plants and their properties are unknown because only “illiterate (litterarumque ignari) folk people” know about them (Natural History 25.16). Pliny’s claim is of course dismissive and overstated; nevertheless, it is clear that authors of ancient pharmacological and botanical treatises carried out “ethnographic” work to gather knowledge. Theophrastus, for instance, collected plant knowledge from people in Macedonia, Arcadia, Thessaly, Boeotia, and the region around Mount Ida of Troad (Hardy and Totelin 2016, ch. 2). King Mithradates too allegedly carried out ethnographic work. Thanks to his amazing gift for languages (he apparently knew between twenty-two and twenty-five languages), he was able to collect information on natural substances and their properties from all his subjects and record it in writing (in Greek). These writings were then translated into Latin, thus making, according to Pliny, a great contribution to the Roman state (Pliny, Natural History 7.88, 25.5–7; Gellius, Attic Nights 17.17).
When faced with such a variety of “authorities,” how did people in need of pharmacologically active plants or other substances choose to whom to turn? We unfortunately have very little information to answer that question from the point of view of the patient/client. However, we may assume that the client’s choice would have been influenced by his or her wealth, social status, locality, and literacy level. A peasant in a remote locality would have had considerably less choice than a relatively wealthy town dweller living in Rome. But in cities like Rome, in order to make a living, these authorities had to establish their expertise in one way or another. This may have involved performing exceptional feats, like the drug seller Thrasyas, whom Theophrastus describes ingesting large amounts of hellebore publicly to show he had become immune to its powers (Enquiry into Plants 9.17.1).
Establishing one’s expertise may have also involved writing books, but ancient authors themselves (i.e., people who wrote) considered the written word to be somewhat inadequate in a medical or botanical context. Classical philosophers famously expressed the dangers of relying too much on the written word in such a context. Plato in the Phaedrus (268c) stressed that nobody can become a physician by reading remedies in a book; Aristotle argued that nobody could learn medicine from books—books are only useful to those who are already experienced (tois empeirois), not to the ignorant (tois anepistēmosin) (Nicomachean Ethics 10.9, 1181b2–6); and Socrates in Xenophon’s Memorabilia (4.2.10) mocked Euthydemus for attempting to become a physician through reading. The issue these philosophers had was not with writing qua writing, but with its inability to replace expertise: experience cannot come from books alone.
One could question whether the views of philosophers were representative of the views of actual botanical and pharmacological practitioners. I suggest they were, as ancient authors in these fields regularly criticized bookish knowledge. For instance, Dioscorides opens his Materia Medica with a claim to superior expertise, not merely based on reading other authors’ works (historia), but on observation (autopsia) and questioning of people native to the regions he visited (Materia Medica pref. 1, 5). To Dioscorides, real knowledge of pharmacologically active substances could only result from handling them. In the case of plants, this meant observing them at all stages of their growth and in every season (Materia Medica pref. 7–8; Scarborough and Nutton 1982). Dioscorides, however, did not always live up to his high standards, and he made mistakes, indicating that even he could not be familiar with all pharmacological ingredients. Thus, he wrote of the Lemnian earth (see Figure 4), a common ingredient in antidotes, that it was “brought up from a certain underground cave and mixed with goat’s blood” (Materia Medica 5.97.1). Galen tells us that he wanted to find out whether that claim was trustworthy and decided to visit Lemnos. Eventually he reached the hill from which the earth was extracted and witnessed the accompanying rituals performed by the priestess of Artemis. Galen asked the assembly when goat’s blood would be added to the earth. His query was met with laughter from “people who were well educated in all matters of local folklore and other matters”; there was no blood involved in the preparation of Lemnian earth. One of the people in attendance presented Galen with an old book about the uses of the ingredient, a book on which Galen based his own practice (Mixing and Powers of Simple Drugs 9.2, 12.173–174 Kühn). Galen’s account, while perhaps embellished, perfectly shows the interplay between oral enquiry and the reading of books in the second century CE.
Elsewhere, Galen stresses the importance of training and personal observation in the preparation of compound remedies. It is possible to learn new remedies from books, but this will require pre-knowledge of the requisite ingredients and their properties (see, e.g., Antidotes 1.2, 14.6–7 Kühn, in relation to theriac). Galen, like other medical authors, often indicates that he has tried and tested a compound remedy, thus demonstrating that his knowledge was not merely bookish (Fabricius 1972, 36–37, 174–179; van der Eijk 1997a). “Efficacy phrases,” such as expertum est (“this has been tried”) or probatum est (“this has been tested”), are common in medieval manuscripts, where they can be found either in the margins or in the main body of the text (Jones 1998).
Ancient pharmacological authors were ambivalent toward writing in part because of the vicissitudes of manuscript text transmission. Unique manuscript copies could get destroyed, as indeed happened to Galen himself (Avoiding Distress 12–13). Copyists could introduce mistakes: errors in quantities (especially when numerals were used instead of writing quantities in full letters), omission of ingredients, and inadvertent substitution of an ingredient for another. Excellent knowledge of ingredients would help the reader to discern these mistakes, as would consulting various manuscript copies of the same work. Galen regularly indicates that he has found divergences in the composition of a recipe from one manuscript to another (Totelin 2009b). It should be noted, however, that very few people in antiquity would have been able to access several versions of the same text as Galen did.
In order to avoid misinterpretation of recipes, Galen also recommended writing them in verse. In addition to being more difficult to corrupt, verse recipes were easier to remember—a bonus for the student of ancient pharmacology (von Staden 1998; Vogt 2005). Several verse recipes have indeed survived from antiquity. Some are preserved in the writings of Galen (e.g., the poems by Damocrates and Andromachus the Elder; Houston 1992; Luccioni 2003); others have been preserved independently, as is the case with Nicander’s Theriaka and Alexipharmaka (second century BCE; Jacques 2002–2007) or Serenus Sammonicus’s pharmacological poem (second century CE; Pépin 1950; Champlin 1981). Scholars are starting to pay more attention to these poems, from the point of view of both content and form, but much work remains to be done.
While authors like Galen and Dioscorides criticized bookish knowledge and recommended using the written word in conjunction with practice and oral enquiry, they lived in a society that had been literate for over half a millennium. The case was very different in the fifth and fourth centuries BCE, when the Hippocratic authors were active. They were very much pioneers in their use of the written word (Lonie 1983; Dean-Jones 2003; Lloyd 2003a), writing down knowledge that had until then been transmitted only orally. Scholars have attempted to uncover formal traces of orality in these early medical texts and in particular in recipes. For instance, recipes that take on the “if … then” format are interpreted as the writing down of oral words (Andò 2000, 25). In looking for “signs of orality,” historians are following in the steps of Homeric scholars who, working in the tradition of Albert Lord (1960) and Milman Parry (1971), have interpreted the recurring formulae in the Homeric poems as traces of oral composition and transmission (see Foley 1985 for an overview). I argue, however, that finding such signs of orality in ancient recipes is a vain exercise. I follow the anthropologist Jack Goody (1977), who has questioned the very existence of “recipes” in oral traditions (see also Goltz 1974, 304–305).
In my opinion, Greek and Roman pharmacological recipes and descriptions of plants are not the exact reflection of an oral tradition; writing down knowledge of plants and other natural substances transforms it deeply. Writing imposes a “mold” on knowledge, one that facilitates reading but may leave out pieces of information (van der Eijk 1997b). Thus, for instance, a written description of a plant must remain short to be effective and will therefore focus on salient points. However, the choice of what constitutes a “salient point” is culturally bound; people in different periods and different contexts may choose to dwell on different aspects. This explains why ancient descriptions of plants often seem completely useless to modern readers (see Hardy and Totelin 2016, ch. 4 for discussion). As for ancient recipes, they are short formulae, which usually follow a strict format: title; indication (what the recipe is for); ingredients; method of preparation; and modes of applications (Fabricius 1972, 24–30; Marganne 2004, 78–80; see Figure 5). The method of preparation is often the shortest part of the recipe; ancient recipes rarely spell out the techniques and apparatus involved in preparing remedies. The knowledge of methods and apparatus would have been transmitted orally and constitutes what sociologists of science call tacit knowledge: knowledge that is not made explicit (Collins 2010).
To sum up, knowledge of plants and other pharmacologically active substances was widespread in the ancient world. Experts or authorities could come from all strata of ancient societies; they could be male or female, literate or illiterate. Those who could establish the efficacy of their remedies would be deemed experts in their field. This, however, is much more easily said than done: How did one prove that a remedy worked? I now turn to this question of efficacy and the issues it raises for historians and scientists looking for new remedies in ancient texts.
Did It Work?
As a historian of pharmacy and botany, the question I am asked most often is undoubtedly, “Did these remedies work?” This is a legitimate question, but one that ancient historians feel particularly uncomfortable answering. This is because of two main, related issues: the identification of ingredients and the fact that efficacy is culturally bound and particularly difficult to pinpoint.
Let us start with the issue of identifying substances named in ancient texts (Touwaide 1993, 1997; Reveal 1996). The nomenclature of natural substances (animal, vegetable, and mineral) in the ancient world was not stable—far from it. The issue is more keenly felt in the case of plants listed in ancient pharmacological and botanical texts; it is generally possible to determine the genus of the plant discussed, but not always its species. Indeed, various names could refer to the same plant. This is best illustrated by the numerous plant synonyms listed in the manuscripts of Dioscorides’s Materia Medica. These synonyms lists include names in various languages or dialects (Greek, Latin, Egyptian, Cappadocian), as well as names used by authorities, real or mythical, such as Zoroaster and Pythagoras. Conversely, the same Latin or Greek name could be given to plants that we would consider to be different species. For instance, Dioscorides lists three plants named panakes, identified by Lily Beck as Opoponax hispidus Griseb., Ferula nodosa L., and Helianthum ovatum Dunal (Beck 2005, 202–203). Finally, pseudonyms could serve to hide the identity of natural substances in magical contexts, as illustrated by a magical papyrus that lists pseudonyms for plants as well as other natural substances (PGM 12.401–44, Betz 1992, 167–169).
The identifications of some plants named in ancient texts have become causescélèbres. That is certainly the case for silphium, a Cyrenaic plant that could not grow in Greece, which was used in numerous remedies, as well as in cooking. It was so important to the economy of Cyrene that it figured on most of its coins for centuries. Silphium became the victim of its own success and apparently had become almost extinct by the first century CE. Scholars for centuries have attempted to identify silphium and to determine whether the plant is truly extinct by carrying out explorations in what is now Libya. Their results have ranged from the frankly absurd (Vercoutre identified silphium with a palm tree, 1913) to the much more reasonable assumption that silphium must be of the same genus as Ferula asafoetida H.Karst (see Amigues 2004 for discussion). Another cause célèbre would be the identification of cucurbits named in ancient texts. The issue of identifying various gourds and colocynths has an impact, among other things, on our understanding of the title of Seneca’s Apocolyncotosis of the Emperor Claudius. Was Claudius transformed into a gourd, a colocynth, or a pumpkin? Some argue that it cannot be a pumpkin (Cucurbita pepo L.), which they consider to be a New World plant. Others suggest that the pumpkin spread from two parts of the world: tropical Asia and North America (Dalby 2003, 162; Amigues 2012, 192).
If we cannot identify the plants and other ingredients listed in ancient botanical and pharmacological texts, how can we ever hope to determine whether their remedies worked? Added to this is the fact that some plant species may have evolved since antiquity. This is not a serious issue for plants that grow in the wild (like silphium), but it can be for cultivated plants (like cucurbits), which are transformed through selection and other horticultural methods.
While the issue of identification is real, one can work around it, for instance by investigating the properties of several plants in the same genus. The issue of efficacy, on the other hand, is much more complex. Nowadays, to be deemed efficacious, a remedy must first be tested in a laboratory. It will then be tested on humans in double-blind trials. This means that the people on whom the remedy is tested are divided into at least two groups. One group will be given the new remedy; the other will be given a placebo, a pharmacologically inactive substance. The new remedy will be deemed efficacious if there is a marked difference in outcomes between the two groups. Some ancient remedies would pass these tests and be deemed efficacious according to modern standards. This would, for instance, be the case for remedies including opium poppy and described as reducing pain (e.g., in a headache), because morphine (the active compound in opium poppy) is a strong analgesic (Scarborough 1995). It would, however, be unethical to test such an ancient remedy on living beings, as morphine is now known to be highly addictive.
In addition to ethical issues, one has to take account of the placebo effect, that is, the fact that people may respond to a substance that is supposed to have no real biochemical effect. In other words, people may start feeling better when taking a sugar pill (Harrington 1999). The very act of taking something—anything—may lead people to feel better, display the symptoms usually associated with taking a strong drug (side effects), and even heal. Healing is not merely dependent on the taking of substances, but also on the accompanying rituals. In that context, it is important to note that Greek and Roman medicine is very rich in rituals such as cleansing (von Staden 1992; Laskaris 1999; Lloyd 2003b, ch. 3).
Further, each natural substance in the ancient world can be considered as a matrix of meaning: ritual and other symbolic connotations were attached to it. For instance, myrtle in a gynecological preparation may have evoked the goddess Aphrodite, to whom myrtle was often offered. The ingredient deer horn, for its part, may have called to mind the sexual potency of the deer, as well as the goddess Artemis, to whom the animal was consecrated. These connotations contributed to the perceived efficacy of a drug in the ancient world. That is not to say, however, that the drug is necessarily inert from a biochemical point of view. Helen King is right to state that “myth and folklore may be poor guides to efficacy” (1985, 151), but it does not follow that all substances mentioned in myths and folktales are inefficacious from a modern point of view. In the question of efficacy, biology and sociology are thoroughly intermingled (van der Geest et al. 1996).
The next question we must ask ourselves is about expectations. When the ancients prescribed a remedy against, say, tetanus (a disease that was difficult to treat before the advent of antibiotics), what exactly did they expect? As medical anthropologist Nina Etkin very nicely puts it, “efficacy might mean a number of things, ranging from full symptom remission to some physical sign (e.g., fever, salivation, emesis, etc.) which is interpreted as a requisite proximate effect that indicates that the curing/healing process is under way” (1988, 302; see also Demand 1999). The ancients may not have expected the same outcome from their remedies that we do. In the case of tetanus, they may have deemed a small reduction in pain a successful outcome.
One has to ask, however, whether ancient diseases were the same as ours. Both ancient and modern tetanus are characterized by painful contractions of the muscles. However, the Hippocratic authors discerned three different types of tetanus, all with different etiologies (Internal Affections 52–54), whereas modern medicine has one tetanus, whose cause is a bacterium discovered in the late nineteenth century. In the case of other diseases, it is not possible to find an exact equivalence between ancient and modern. For instance, the ancient “disease of virgins” is not an exact equivalent to anorexia nervosa, even though there is some overlap between the two illnesses (King 2004). Attempts at retrospective diagnosis—that is, trying to find what modern diseases hide behind ancient descriptions—are often futile. This is because the Greeks and Romans conceived of the body, and hence health and disease, in an entirely different way than we do. They defined health as a state of balance (usually of humors, sometimes four in number; Nutton 2005) and disease as a disturbance in that state of balance. In that system, purging—through diarrhea, vomiting, or bloodletting—had a very significant role to play, as it enabled the balance to be re-established. For instance, when a woman had not evacuated her menstrual blood in a timely fashion, she was at risk of serious ailments; an emenagogue pessary such as that with cantharid (the blistering beetle) would allow the superfluous blood to be evacuated, thus restoring balance. Today, we would consider such a remedy, as well as other purging preparations, dangerous.
By modern standards, ancient pharmacology offers a mixture of effective, absurd, and frankly dangerous remedies. Historians must examine all these aspects in a nonjudgmental manner; they cannot “brush under the carpet” unsavory (in modern eyes) remedies, but have to study ancient medicine on its own terms. Studies that attempt to show that ancient medicine was effective by modern standards open themselves to harsh criticism. Thus, when John Riddle (1992 and 1997) gathered together modern pharmacological studies to show that the Greeks and Romans had effective methods of birth control, the flaws in his methodology were severely criticized by Helen King (1998, ch. 7). Historians should study ancient botany and pharmacology in their social context, taking into account all the ritual and symbolic connotations attached to natural substances.
But does this exclude the possibility of using ancient texts for bioprospecting, for finding “new” remedies? Famously, 2015 Nobel Prize winner Youyou Tu came to discover the compound artemisinin (originally extracted from Artemisia annua L., sweet wormwood) through reading ancient Chinese medical texts, dating back to the third or fourth centuries CE (Tu 2011). That discovery of artemisinin led to great advances in the treatment of malaria, a disease that remains one of the biggest killers in the world. Also in 2015, an interdisciplinary team at the University of Nottingham constituted of historians and microbiologists discovered that a remedy from Bald’s Leechbook (tenth century CE) was very effective at killing MRSA (Rayner 2015). Historians may have objections to such research in addition to those outlined above; most prominently they may object to the patenting of “old” remedies. However, by joining collaborative teams constituted mostly of scientists, or at least by not dismissing those teams’ interests and concerns, historians may be able to voice their concerns in a more effective manner than by addressing a homogeneous audience. In this task, blogging and other modes of digital publishing have a very important role to play.
Another possible way for historians and scientists to work together is to carry out more chemical analyses of archeological remains. For instance, in 1996 a series of dolia (containers) were found in the so-called Villa Vesuvio, near Pompeii. All dolia had thick organic deposits at their bottom, but the deposit in dolium 2 was different in composition (Ciaraldi 2000). That container had held peaches (Prunus persica (L.) Batsch) and walnuts (Juglans regia L.), but also a complex compound of plant and animal substances, many of which were—or still are—thought to have medicinal qualities. Archeologists also found at the Villa a small cooker of a type that is associated at other sites with medical activities, the production of dyes, or the production of soap. The combination of the cooker and remains of mixed natural substances in dolium 2 led archeologists to interpret Villa Vesuvio as a site of medical preparations. Marina Ciaraldi suggested that the drug prepared there might have been an antidote, like the Mithridatic antidote or theriac. She concluded with a plea for more such analyses:
Despite much of the evidence suggesting an interpretation of the plant and animal remains as residues of drug preparation, still this cannot be considered as a definitive conclusion. One problem is the scarcity of archaebotanical studies in Italy and particularly in southern Italy. The absence of suitable potential comparisons, especially of waterlogged assemblages, makes the interpretation more difficult.
(Ciaraldi 2000, 97)
We cannot do anything to remedy the rarity of organic remains that lend themselves to chemical analysis, although new methods may mean that an increasing number of samples become candidates for analysis. On the other hand, the scarcity of archeobotanical studies on Mediterranean sites could be addressed, but this would require concerted efforts on the part of “traditional” archeologists to call upon—and budget for—the services of scientific archeologists.
I also want to mention the discovery of a Roman tin canister still filled with cream in a London excavation in 2003 (see Figure 6). The chemical analyses carried out on the remains of the cream revealed that it contained an animal fat and tin (Evershed et al. 2004). Interestingly, tin is not listed very often as an ingredient in pharmacological or cosmetic preparations; there is not even an entry on tin in Dioscorides’s Materia Medica. On the other hand, Galen does mention tin recipients for several remedies (e.g., remedy for the ear at Composition of Medicines According to Places 3.1, 12.631 Kühn).
As more analyses of this type are carried out, it will become easier for historians and archeologists to evaluate the gap between written recipes and actual preparations in the ancient world. This in turn will give us a better understanding of the role of tacit knowledge and oral transmission in antiquity.
It is difficult for one scholar to develop both the skills of a historian and/or philologist as well as those of a scientist. Specialization is unavoidable. Yet in order fully to understand ancient botany, pharmacology, and medical recipes, it is necessary to approach the material from both humanities/social sciences and sciences points of view. To edit and translate ancient pharmacological and botanical texts, scholars need to acquire a basic knowledge of biology and biological nomenclature. That is a lot to ask when years of training are already required to acquire the language and philological skills necessary to edit and/or translate ancient texts. Nevertheless, there are many ancient botanical and pharmacological sources that await fuller study, editions, and translations. This is a field in which new and significant discoveries are a reality rather than a dream.
Historians and classicists may work alone when studying the social context in which pharmacological and botanical knowledge was created, transmitted, and acknowledged as authoritative. However, they will always reach a point where they need to address the issue of efficacy. Ancient experts established their authority through remedies that were deemed efficacious. The historian who tries to avoid the question “Did it work?” will be met with disappointment from their audience. Even stating that efficacy is culturally bound requires a basic understanding of the scientific notions of placebo, nocebo, and double-blind trials.
I advocate collaborative studies wherever possible. The multiauthor model of publication is already common among scientific archeologists and should be adopted more often when studying ancient pharmacology and botany. (Ethno-)pharmacists and botanists should be consulted by historians, and historians should be consulted by scientific archeologists and ethnopharmacists. In order to do so, scholars across disciplinary boundaries will have to show willingness to listen to each other and understand different methodologies.
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