Ancientbiotics: Medieval Medicines for Modern Infections

By Erin Connelly

In 2015, Youyou Tu jointly won the Nobel Prize in Physiology or Medicine for the development of a new therapy (Artemisinin) to treat Malaria, a disease which has been on the rise since the 1960s. Significantly, the antimalarial component was successfully extracted from the plant Artemisia annua only after consulting the instructions found in the ‘ancient literature’ of traditional herbal medicine.

As the drugs (chloroquine or quinine) used to combat the malarial parasite have experienced decreased efficacy, such is the case with a wide range of conventional antimicrobials. In fact, major pharmaceutical companies and government agencies have identified antimicrobial resistance as one of the most pressing concerns for global health. The World Health Organization (WHO) stated in September 2016 that antimicrobial resistance is ‘an increasingly serious threat to global public health that requires action across all government sectors and society.’

In response to this threat to global health, the Ancientbiotics team was formed. Originally based at the University of Nottingham, the team is an interdisciplinary group from the Arts and Sciences comprised of microbiologists, medievalists, parasitologists, wound specialists, and pharmacists, who are united by the belief that novel avenues of antibiotic discovery are crucial, along with the shared conviction that the past can inform the future. At the same time that Youyou Tu was awarded the Nobel Prize for her work with malaria, the Ancientbiotics team was investigating a tenth-century Anglo-Saxon remedy for eye infection, known as Bald’s eyesalve. The full paper is available here.

Recipe for an eyesalve from Bald’s Leechbook, England (Winchester?), mid-10th century, Royal MS 12 D XVII, f. 12v. Image and caption credit: British Library
Recipe for an eyesalve from Bald’s Leechbook, England (Winchester?), mid-10th century, Royal MS 12 D XVII, f. 12v. Image and caption credit: British Library

The 1,000-year old recipe has been shown to effectively kill a range of microbes, including, but not limited to, Methicillin-resistant Staphylococcus aureus (MRSA), Klebsiella pneumoniae, Escherichia coli (E. coli), and leishmania. All of these species are causes of chronic, opportunistic, drug-resistant, or difficult to treat infections. While each ingredient in the eyesalve demonstrates some antimicrobial activity on its own, what is remarkable is that only in the combination of ingredients, exactly as specified by the medieval instructions, do we see the synergistic, potent antimicrobial effect in clinically realistic infection models.

An interview on Radiolab with Freya Harrison and Christina Lee is available to explain the full story of Bald’s eyesalve.

Clusters of Methicillin-resistant Staphylococcus aureus (MRSA) Image Credit: Annie Cavanagh, Wellcome Images https://creativecommons.org/licenses/by-nc-nd/4.0/
Clusters of Methicillin-resistant Staphylococcus aureus (MRSA) Image Credit: Annie Cavanagh, Wellcome Images
https://creativecommons.org/licenses/by-nc-nd/4.0/

The Ancientbiotics project also extends to medical texts of the later medieval period. The Lylye of Medicynes (Lylye) is one such text that offers a diverse range of recipes, including many promising treatments for infectious disease. The Lylye is the only extant Middle English translation of Bernard of Gordon’s Lilium medicinae; it exists in one fifteenth-century manuscript (Oxford Bodleian Library MS. Ashmole 1505). The Lylye is most notable for its pharmaceutical content. There are nearly 6000 individual ingredients in the text; 3500 of those ingredients are contained in 360 specific recipes, which represent over 110 disease states (many of which include symptoms of infection). One of the eye recipes is currently being tested at the University of Nottingham and research is ongoing to identify those ingredients which interact with the same antimicrobial synergy found in Bald’s eyesalve.

Lylye of Medicynes, Oxford Bodleian Library MS. Ashmole 1505 Image Credit: Erin Connelly
Lylye of Medicynes, Oxford Bodleian Library MS. Ashmole 1505 Image Credit: Erin Connelly

I am also working on the first published edition of the whole text of the Lylye in order to allow accessibility for increased scholarship. A forthcoming paper (2017) in the proceedings from the 8th Annual Disease, Disability, and Medicine in Medieval Europe conference (‘Treating Infected Wounds in the Middle English Translation of Bernard of Gordon’s Lilium medicinae’) conveys in greater detail the potential of this text to be mined for antimicrobial recipes.

You may read a little bit more about the Lylye of Medicynes in these short blog posts from 2014: ‘ȝif it be a pore man . . .’: Healthcare for the Rich and Poor in the Lylye of Medicynes and ‘þe best mylke is womman milke’: Does Breastmilk Heal?

As a truly interdisciplinary effort between the Arts and Sciences, the Ancientbiotics project has opened new and significant pathways to antimicrobial drug discovery, but it has also challenged the popular categorization of the medieval period as a ‘Dark Age,’ and the centuries-long pattern of dismissing medieval medical texts as ‘unenlightened’ by reason and scientific discovery. In a paradigm-shifting manner, the efficacy of medieval medicines against modern infections instead shows that medieval practitioners were operating within a lengthy tradition of observation and experimentation with recipes that may inspire present day research.

A 17th-Century Italian’s Encounter with Uzbek Plov

By Scott Levi

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A mountain of pumpkins at the Alayskii Market in Tashkent

The Venetian doctor Niccolao Manucci lived in India for some fifty-five years, nearly his entire adult life. Working in a variety of capacities on behalf of his Mughal hosts, in the middle of the seventeenth century he found himself at the court of emperor Aurangzeb, who in 1658 ascended the throne in place of his father, Shah Jahan.

Twelve years earlier, Shah Jahan had placed Aurangzeb at the head of an army charged with marching across the Hindu Kush and retaking the Mughals’ ancestral homeland in Central Asia. The Mughal occupation of Balkh, near the banks of the Amu Darya, ended in failure and a disastrous retreat. Now, with Aurangzeb on the throne, the Uzbek ruler of Balkh, Subhan Quli Khan, dispatched an embassy to the new emperor in the hope that the two powers could once again enjoy peaceful relations.

India’s hot climate disagreed with the Uzbek nobles, and when one of the ambassadors fell sick Manucci himself was charged with caring for him and seeing to his recovery. This provided Manucci with the opportunity to become personally acquainted with the Central Asian visitors, and, much to his dismay, even share meals with them. His experience is instructive in how Mughal customs had changed over the century and a half since the dynastic founder, Babur (1483–1530), had made his way to India in the wake of the Uzbek invasion of the Timurid capital of Samarqand.*

It was disgusting to see how these Uzbak nobles ate, smearing their hands, lips, and faces with grease while eating, they having neither forks nor spoons…Mahomedans are accustomed after eating to wash their hands with pea-flour to remove grease, and most carefully clean their moustaches. But the Uzbak nobles do not stand on such ceremony. When they have done eating, they lick their fingers, so as not to lose a grain of rice; they rub one hand against the other to warm the fat, and then pass both hands over face, moustaches, and beard. He is most lovely who is the most greasy… The conversation hardly gets beyond talk of fat, with complaints that in the Mogul territory they cannot get anything fat to eat, and that the pulāos are deficient in butter.

Plov is an exceptionally hearty Central Asian variant of what is widely known in Turkish, Persian and Indian cuisine as a pilaf or pulao. In essence, each is a dish of seasoned rice, often cooked in a stock, and generally including a combination of spices, vegetables and proteins designed to make the dish a rich and tasty centerpiece to a meal. Even within their respective regions, each is differentiated in terms of cooking techniques and they exhibit endless local variations in the customary combination of vegetables, nuts, fruits and meats (if any). One may find garlic, onions and carrots alongside raisins and chickpeas, while other variations may favor lentils, peas, almonds, pistachios, barberries and even pomegranate seeds. Instead of lamb, one may also find chicken, beef and even variants calling for fish or horsemeat.

Fat-tailed sheep in Khoqand, Ferghana Valley
Fat-tailed sheep in Khoqand, Ferghana Valley

Dumba is the single ingredient that most distinguishes Central Asian plov. Dumba is the fat tail of the region’s highly valued fat-tailed sheep. Rendering it to provide the grease for cooking adds calories and equips Uzbek plov with a distinctive and deeply satisfying flavor. Historically, Central Asian nomads lived much of their lives out of doors and found animal fat to be an effective salve for protecting one’s skin from the damaging effects of the sun and wind. In traditional Uzbek cooking, the rice in a bowl of plov should appear to glisten. If it fails to do so, adjust the recipe by adding additional lamb fat (or vegetable oil) in the early stages of cooking.

Fresh dumba at the Chorsu Market in Tashkent
Fresh dumba at the Chorsu Market in Tashkent

Manucci was clearly put off by the table manners and comportment of the Uzbek envoys. But his account also illustrates the importance that culture and environment play in how culinary traditions develop and change. The more “refined” Mughlai pulao suited Indian tastes, relying on ghee instead of animal fat and emphasizing the use of spices. But to the Uzbeks this was considerably less satisfying than plov: the quintessential Uzbek dish that incorporated ingredients and cooking techniques perfectly suited to their steppe heritage, and is still loved throughout Central Asia today.

*Niccolao Manucci, Storia do Mogor, or Mogul India, 1653–1708, 4 vols, tr. By W. Irvine, London: John Murray, 1907–8, II, pp. 40–41.

Lamb Plov

½ c. sunflower or corn oil

1½ lb lamb meat, trimmed and cut into ½-inch cubes (reserve fat)

6 carrots cut into matchstick-sized strips

2 large yellow onions, thinly sliced

1 t. paprika

¼ t. ground turmeric

2 t. cumin seeds, toasted and crushed

Salt

Pepper

½ c. water

3 c. rice, rinsed till clear (traditionally made with short grain rice, though basmati works well)

1 whole head of garlic, roasted with outer stem removed

6 c. boiling water

Place a large cast-iron Dutch oven or similar vessel over medium-high heat. Render lamb fat until the liquid coats the pot and begins to smoke. While vegetable oil is healthier, you can achieve a more authentic-tasting result by increasing the amount of fat rendered at this stage. Remove the (now crispy) fat solids and set aside. (Note: in Central Asia, this lamb crackling is called the jizza. It is salted and enjoyed as a delicacy.)

Add oil and return to temperature.

Add cubed meat and brown on all sides, stirring frequently, for 8-10 minutes. When browned, remove meat with slotted spoon and set aside.

Add the sliced onions and cook till browned, about 10 minutes. Return meat to the pot.

Add carrot slices on top of meat and onions. Add paprika, turmeric, cumin, salt and pepper. If so desired, add garlic cloves, chickpeas, barberries, raisins, or other items.

Add ½ c. water and stir well. Bring to a boil and reduce heat to simmer for 2 minutes, adding more water if necessary. Flatten the top of the meat mixture with a spatula.

Pour the rice over the meat mixture and flatten the top of the rice. Slowly add the boiling water, taking care not to let the rice mix with the meat mixture.

Let boil uncovered for 15 minutes. When rice begins to thicken, poke several holes in the plov with the handle of a wood spoon to permit steam from the bottom to rise evenly.

Reduce heat to very low and cover tightly. Let cook for approximately 25 minutes. Remove from heat and let stand, covered, for 5 minutes.

Dish rice onto large platter and spoon the meat and vegetables on top. Garnish with roasted garlic.

Serves 6

___________________________________________________________________________

Scott Levi is Associate Professor of Central Asian history at Ohio State University.  He is author of The Indian Diaspora in Central Asia and its Trade, 1550–1900 (Leiden: E.J. Brill, 2002) and Caravans: Indian Merchants on the Silk Road (Gurgaon: Penguin, 2015).  He is currently a residential fellow at the Institut d’Études Avancées de Nantes, France, where he aims to complete two new research monographs: The Early Modern Silk Road: Integration and Crisis in Eighteenth-Century Central Asia, and Central Asia in the Global Age: The Rise and Fall of Khoqand, 1709–1876.

To Make a Fine Apple Pye

By Sarah Peters Kernan

Forget cold weather and the first frosts of winter; I am already thinking about my spring garden! For years I have been yearning for space to plant a large vegetable garden and fruit trees. Now I can finally begin seriously planning such an endeavor since I recently moved into a new home with a large yard. Despite the approaching winter, I am constantly daydreaming about apples, beets, carrots, and tomatoes. The apple trees, in particular, have piqued my curiosity. There are hundreds of heirloom varietals, many of which will flourish in my planting zone. More than the standard fruits available at local markets, these heirloom ones attract me. I thought that I would use this opportunity to try growing some varietals that may have been available in late medieval or early modern England so that I can not only cook my many favorite modern apple dishes and preserves, but also prepare apple recipes from my research with period-appropriate fruit.

The art of grafting and cultivating fruit trees was acknowledged and recorded in Antiquity. Many treatises on the topic exist from the Middle Ages, such as those by Nicholas Bollard and Godfrey’s translation of a fourth-century work by Palladius. Similarly, early modern cookbooks and books of household management, like Charles Estienne’s L’agriculture et maison rustique (1564) and its English translation Maison Rustique, or the countrie farme (1600), devote sections to the topic. In late medieval and early modern England, apples were an accessible fruit for peasants and commoners. Each autumn apples ripened on trees that flourished across the English countryside. And despite the popularity of the apple, recipes rarely distinguished specific types of apples to use; in most instances, the selection of fruit was left to local availability and personal preference.

Elizabeth Blackwell, "The apple tree or pearmain," 1739, Science, Industry and Business Library: General Collection , The New York Public Library. Source: The New York Public Library
Elizabeth Blackwell, “The apple tree or pearmain,” 1739, Science, Industry and Business Library: General Collection , The New York Public Library. Source: The New York Public Library

Recipes sometimes distinguish between apples, pippins, pearmains, codlings, and others, but none of these terms refer to specific varietals. These terms do, however, tend to highlight certain flavor, texture, or keeping characteristics. Pippins, for example, are typically sweeter apples. Codlings refer to harder apples not intended to be eaten raw. Sometimes this hardness is a feature of the varietal, while other times this term refers to unripe apples. This lack of specificity in recipes is not to say that we have no record of medieval or early modern varietals. Medieval legal, religious, and household records, for example, describe specific apples.[1] It is the recipes that remain vague.

Nicolaes Maes, “Young Woman Peeling Apples,” ca. 1655, The Metropolitan Museum of Art, Bequest of Benjamin Altman, 1913, http://www.metmuseum.org/art/collection/search/436934. Source: Metropolitan Museum of Art
Nicolaes Maes, “Young Woman Peeling Apples,” ca. 1655, The Metropolitan Museum of Art, Bequest of Benjamin Altman, 1913, http://www.metmuseum.org/art/collection/search/436934.
Source: Metropolitan Museum of Art

Most early modern recipes similarly exclude mention of apple varieties. However, a very rare instance of a recipe identifying a specific varietal occurs in a recipe book in the New York Public Library, Whitney Cookery Collection MS 2. This recipe book belonging to Lady Anne Percy in the mid-seventeenth century contains instructions for a perfume which requires the “skinn of an apple called Camveza.”[2] It is notable that this recipe is for a non-edible luxury item containing expensive ingredients such as ambergris and civet. Camuesa was a Spanish apple varietal, and while it eventually came to refer more generally to pippins, the recipe seems to refer to the more luxurious and specific fruit. The majority of recipes do not specify a variety, though details are sometimes noted. In Mrs. Murrey’s Jelly of Pippins recipe in Lady Percy’s book, the reader is instructed to “take the best white pippins.”[3] Another recipe designates the best time of year to preserve green, or unripened, pippins is “about bartholme tide,” or late August. [4] Since pippins, like apples in general, ripen at varying points throughout the late summer and fall, the date in this recipe is probably specific to Mrs. Murrey’s source of pippins. Earlier recipes for apple fritters, tarts, and sauce (applemoys) appearing in manuscripts prior to 1500 exclude any mention of varietals, or even the adjectives which color early modern apple recipes.

Limited, if any, descriptions of apple varieties appear in other texts concerned with details of fruit like gardening treatises or herbals prior to the seventeenth century. Even the aforementioned Maison Rustique, a detailed manual for growing and grafting all sorts of fruits, mentions only a few varieties, like the globe apple, apple of paradise, and choke apple. However, a concern with growing consistent, identifiable, and enhanced fruit developed throughout Europe during the sixteenth century, so that by the early 1600s, elite gardens likely contained multiple varietals of fruits. This is reflected in contemporary texts: herbalists and botanists listed and described a wealth of varietals (like the sixty apple varieties in John Parkinson’s Paradisi in sole paradisus terrestris) and the occasional recipe from an elite household with access to many varietals, like the Percys, actually specified types to incorporate in recipes.[5] Named varietals at this time seem to point toward social status, though the many other recipes which indicate descriptions of texture, firmness, or size, reflect a more general concern with taste.

This apple ambiguity is ultimately a good thing, both for a cook trying to replicate a historic recipe and me, in planning a small, historically-oriented home orchard. For one, the lack of specificity does encourage the modern cook, like the original cooks, to use the apples we have on hand and are pleasing to our taste. Second, while many apple varietals are available today, only a handful available in the United States can be traced back several centuries. One American heirloom fruit tree vendor boasts twelve varietals dated before 1700; this includes fruits originally cultivated in England, France, Switzerland, Denmark, two American colonies, and one more vaguely attributed to “Europe.” It is difficult, if not impossible, to recreate any kind of “authentic” apple experience. While I may not be able to recapture any specific ingredients from historic recipes, I am excited to cultivate some new-to-me varietals in my own garden and experience some flavors from many centuries ago.

In case anyone still has apples in storage from a fall orchard picking, or you just want to plan ahead for next year’s crop, I leave you with a recipe from Lady Morton’s 1693 recipe book. [6]

To Make a Fine Apple Pye

Take 19 or 20 large codlings or pippings. Coddle them very soft over a slow fire. When enough squeeze them through a cullender. Put to it six eggs, half the whites beaten and strain’d, 6 ounces of butter melted, half a pound of fine sugar, the juice & rind but small of 2 lemons, one ounce and half of banded orange peele, half an ounce of banded lemon peel. Cut small, mix all these together, & put in a little orange flower water to your tast. Bake it in puft paste in a dish.

 

 

[1] Christopher M. Woolgar, The Culture of Food in England 1200–1500 (Yale University Press, 2016), 106–7.

[2] New York, New York Public Library, Whitney MS 2, 85.

[3] Whitney MS 2, 23.

[4] Whitney MS 2, 39.

[5] John Parkinson, Paradisi in sole paradisus terrestris (London: Humfrey Lownes and Robert Young, 1629), 587–8.

[6] New York, New York Public Library, Whitney MS 4, 150.

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MOOCing about with Ancient Recipes

A while ago, Professor Helen King (Open University) offered Dr Patty Baker (University of Kent) and me the opportunity to be involved in an exciting project: a MOOC (Massive Online Open Course) on the topic of Health and Wellbeing in the Ancient World. We had previously worked together on a pedagogical project (an article on the difficulty of teaching sensitive topics such as the history of abortion), and were prepared for a new collaborative challenge.

Several months down the line, the MOOC is in the final stages of writing. We chose to organise our material in the ‘head-to-toe’ order, which is the structure so often adopted in Greek and Roman medical texts. We cover a huge variety of themes and topics, in what we hope will be an original and informative introduction to ancient medicine.

I was particularly keen to introduce as many recipes as possible into the MOOC material. We did so both in written sections and in video ones. For the film sections, I chose to recreate two ancient recipes: that of a collyrium (an eye remedy) found in Galen’s pharmacological writings and an oxygarum (a recipe supposed to aid digestion) found in Apicius‘ cookery collection.

Filming in the stacks of the National Roman Legion Museum at Caerleon
Filming in the storerooms of the National Roman Legion Museum at Caerleon

The wonderful National Roman Legion Museum at Caerleon (South Wales) was kind enough to host the filming. They provided us with authentic looking Roman pots to put all the ingredients in, as well as a costume – complete with winged-phallus amulet – for me to wear. I believe being in costume greatly helped me feel slightly less nervous.

For nervous, I certainly was. This was only my second experience of filming: the first had taken place a couple of days before, at the Wellcome Library, where we filmed a piece on manuscript herbals. I had not quite realised that filming a cookery piece usually involves several cameras, as multiple takes are not possible (because ingredients are expensive). I therefore had to pretend to be natural in front of the producer (Lizzy Jones) and three cameramen. Let’s just say that I can’t see an alternative career for me as a TV chef…

We started with the collyrium:

White collyrium, for a persistent flow of tears and other afflictions; it is called ‘delicate’: calamine, 16 drachms; white lead, 8 drachms; starch, 4 drachms; gum, 4 drachms; tragacanth gum, 4 drachms; opium, 2 drachms. Take up with rain water. Use with egg. Galen, Compositions of Medicines according to Places 4.8, 12.757 Kühn

Of course, I could use neither white lead nor opium, which are dangerous substances. I substituted the former with zinc, and the latter with a white powder.

Wondering what comes first: the remedy or the egg
Wondering what comes first: the remedy or the egg

As someone who has experience recreating ancient recipes, I knew exactly what to expect: the ingredients mixed together with water would take on a consistency similar to a very thick shaving foam. But, while photos can illustrate this point, they can’t do so as powerfully as a film.

Like so many ancient eye-remedy recipes, this one omits to state that the preparation has to be left to dry, a process which I discovered takes at least 24 hours… Fortunately, I had tried this at home a few days before the filming! Once the preparation is dried, it can be crumbled, and a small amount is then applied to the eye. But to what part of the eye, and how exactly? I knew that the part of the egg to use is the white (I can now add ‘can separate an egg in a highly stressful situation’ to my CV), but I did not know whether to dip my finger in the crumbled remedy first and the egg second, or vice versa. Helen King and I had a quick chat, and decided that the egg came first!

The second recipe I recreated is named after its main ingredient, garum, the famous Roman sauce made with fermented fish. A purist would have prepared some garum in advance, but I simply went to the supermarket to buy some Nam Pla, also known as Thai fish sauce:

Another oxygarum, for digestion: 1 ounce each of pepper, parsley, caraway, lovage; mix with honey. When done add garum and vinegar. Apicius, De re coquinaria 1.37

Feeling a bit like a rabbit in the headlights
Feeling a bit like a rabbit in the headlights

Preparing that recipe was very simple. Instead of using an ounce (a relatively large amount), I used a spoonful of each ingredient. I confidently announced to the camera that Roman medicine was ‘all about proportions’ merrily throwing spoonfuls of ingredients into a mortar. I failed to notice that I had been rather heavy handed with the pepper.

Of course, the crew insisted that I should try some of my wonderful aid to digestion. I obliged – the things that one does! The preparation tasted surprisingly sweet, until – that is – the pepper kicked in. I am sure my face pulling will be much appreciated by the MOOC learners!

I was left with a fishy, fiery taste in the mouth for several hours. Perhaps the Romans were wired differently from me, but I suffered from heartburn for the entire afternoon.

Health and Wellbeing in the Ancient World, a Future Learn MOOC, will start on February 6th, 2017. You can read Helen’s thoughts on writing a MOOC here.

Food, Magic, Art, Science, and Medicine