Category Archives: Antiquity

How to cure a ‘headache’ in a Mesopotamian way?

Strahil V. Panayotov
(The BabMed, ERC-Project, Free University of Berlin)

In 7th century BC Nineveh, in an area located within today’s much-troubled Iraqi city of Mosul, an astonishing episode of human history occurred. Thousands of texts from all corners of the Assyrian empire were brought into the royal capital of Nineveh in order to create the first universal library in human history. The majority of the excavated tablets are now being kept in the British Museum, London.  (On these tablets, see this article and this post).

Among the texts transported to the Ashurbanipal library, there were works of literature such as the tale of Gilgamesh, written descriptions of rituals and prayers, litanies, explanatory works, and large collections of omens, or royal letters. Numerous collections of healing texts, magical and medical prescriptions, rituals and incantations also found their way into the archives of Nineveh (SAA 7, chapter 7). Among the thousands of manuscripts dealing with healing, one collection stood out. It was written down in cuneiform by highly educated scribes who carefully edited a handbook with medical prescriptions, incantations and rituals on behalf of king Assurbanipal. This handbook was arranged into distinctive series, addressing body parts in a sequential order from head to toe. Each series had its own name and chapter called simply ‘tablets’ in Akkadian. The majority of tablets in this handbook carried the same colophon (i.e. inscription at the end of a tablet with facts about its production):

Palace of Ashurbanipal, king of the world, king of the land Assyria, to whom (the gods) Nabû and Tašmētu granted understanding, (who) acquired insight (and) a high level of scribal proficiency, that skill which among the kings, my predecessor(s) no one has acquired. I (i.e. Ashurbanipal) wrote, checked, and collated tablets with medical prescriptions from head to the (toe-) nail, non-canonical material, elaborate teaching(s) (and) the advanced healing art(s) of (the gods) Ninurta and Gula, as much as exists, (and) I placed (them) within my palace for my reading/reciting. (BAK, no. 329)

The colophon illustrates that this collection aimed to include all the existing healing knowledge and to thus create an encyclopaedic handbook that would serve as a reference source for the royal palace. We might imagine that such a precious collection could have been accessed and consulted only by royal or high-profile physicians.

The first series from the handbook was called ‘If a man’s cranium contains heat (fever).’ We will look at the first prescription and incantation of the third tablet (CDLI no. P365746):

Fig. 1, K 2566 +, photo courtesy of the author with the permission of the Trustees of the British Museum.
Fig. 1, K 2566 +, photo courtesy of the author with the permission of the Trustees of the British Museum.

The third tablet begins accordingly:

If a ‘headache’ due to ghost affliction (lit. ‘Hand of a ghost’) continuously persists in a man’s body and cannot be loosened, (nor) does it cease despite bandage(s) and incantation.

The beginning of this diagnostic part gave the name of the third tablet, since in Mesopotamia the first line of a certain text was used to designate the whole text.

‘Headache’ in its broadest sense is an interpretive translation of the Sumerian term SAG.KI.DAB.BA ‘seized forehead/temple/brow’. The suffering was caused by a ghost, which originated in a diseased person (Geller 2010: 154-55 and passim). The title of this tablet suggests that if a normal treatment with bandage(s) and an incantation were not helping in such a case, one needed special therapies, preserved on the tablet. It contains extraordinary prescriptions and incantations which were specifically designed to counteract a ‘headache’ from a tough ghosts’ afflictions. In the first prescription, directly following the diagnostic part, the healer had to sacrifice a bird, and mix some of its body parts in a resin of a plant. This mixture was then magically enriched with an incantation:

You slaughter a captured goose. You take its blood, its throat, its gullet, its fat, the rind of its gizzard. You char (them) over charcoal. You mix (them) within cedar ‘blood’, and then three times recite the incantation ‘Evil Finger of Mankind’. You repeatedly anoint his head, his hands and everything that affects him and he shall get better. The ‘headache’ will be eradicated. (modified after Scurlock 2006: no. 113)

The animal substances were charred, and subsequently mixed within cedar ‘blood’. The designation cedar ‘blood’ is a metaphor of the sometimes reddish appearance of cedar resin, which flows out of the tree like blood from a body.

Everything was thoroughly mixed and an ointment was created, over which the healer had to recite this incantation:

The pointing of the evil finger of mankind, the evil rumor of the people, the bitter curse of god and goddess, the transgression of the limits of the gods – in order to continually go around safely in the presence of the(se things), to loosen their curse . . . he is the god . . . the regions, [Enki, son] of the Abzu and his son Asalluhi, [gods … : Ea] and his son Marduk, [gods … ] I … have changed …‘hand’ of ghost . . .” (Scurlock 2006: 39, no. 114a; see also p. 113, fn. 389).

Thus, the magical power of the incantation was transferred into the ointment, creating a potent cure. The healer anointed first the head, then the hands and all affected body parts until the ‘headache’ was gone.

Beside the goose’s blood and the fat, body parts and organs connected to food intake and digestion were selected. This suggests a certain symbolic significance: the suffering had to disappear, like the goose digested its food. But, the cure was not only magical. The use of cedar resin implies natural oils with a pleasant smell. It might well be that the fatty ointment had a pleasant smell, which made the patient feel better especially by massaging it into the skin. Thus, magic, massage, and aromatherapy were all part of this prescription.

Similar texts, and possibly fragments belonging to the same tablet (fig. 1), are lying still in the soil of Iraq. We can only hope that the ancient Assyrian capital Nineveh, which now lies within occupied Mosul, will not be vandalized again, and blown into the air like Nimrud.

Literature:

BAK = Hunger, H. 1968. Babylonische und assyrische Kolophone. Alter Orient und Altes Testament 2. Neukirchen-Vluyn.

SAA 7 = Fales, M. and Postgate, J. N. 1992. Imperial Administrative Records, Part I. State Archives of Assyria VII. Helsinki.

Scurlock, J. 2006. Magico-Medical Means of Treating Ghost-Induced Illnesses in Ancient Mesopotamia. Ancient Magic and Divination III. Leiden–Boston.

Geller, M. J. 2010. Ancient Babylonian Medicine. Theory and Practice. Chichester (GB)–Malden, Mass.

Further Readings:

Finkel, I. L. 2014. The Ark Before Noah. London, pp. 44-45; 60-65.

Le Journal des Médecines Cunéiformes (Link http://people.ds.cam.ac.uk/mjw65/jmc/de.html)

Scurlock, J. 2014. Sourcebook for Ancient Mesopotamian Medicine. Writings from the Ancient World 36. Atlanta, Georgia.

From the dry sands of Egypt… Greek medicine labels on papyrus

By Isabella Bonati

Amongst the many objects depicted in the “unswept floor” mosaic by Heraclitus (II cent. CE) there is a drug container (unguentarium) with a narrow, probably folded, papyrus tag suspended from its neck. This tag likely offered the identification of the content, possibly an ointment or some aromata, stored into the unguentarium. This striking mosaic provides archeological evidence of the common use of medicine labels across the ancient world. [1]

imm1-unswept-floor-mosaic
Drug container with papyrus label. Detail of the asàrotos òikos mosaic (“unswept floor”) by Heraclitus, Gregorian Profane Museum (Vatican Museums), cat. 10132.

Like the modern patient information leaflets, the practice of labeling containers was particularly useful in medical contexts. In spite of the perishability of their support, some of these labels on papyrus have been preserved by the dry sands of Egypt. One example is a strip of papyrus cut on all sides (8,5 cm x 22 cm), dating back to the first half of the III century BCE on paleographical ground (SB XIX 12074).[2]

imm2-papyrus-with-a-list-of-spices
Ptolemaic list of aromata and honey on papyrus (SB XIX 12074), Ann Arbor, Michigan University, Library P. 3243

The papyrus contains a list of five spices – cassia, cinnamon, nard, myrrh and saffron – and two specific kinds of honey – the Cretan and the Theangelic – commonly used in medical recipes. The strip was folded vertically down the center in order to obtain five panels of equal size. Then a notch was cut along the right-hand fold producing two holes. It is likely that a string was passed through the holes to suspend the folded sheet from or attach it to some other object, such the container storing the remedy obtained by the ingredients mentioned in the list, like in the mosaic image above. Thus, this papyrus seems to represent a concrete specimen of the practice illustrated in the “unswept floor” mosaic.

This particular medical label belongs to a broader context. Greek medical papyri coming from Egypt, dating from the III century BCE to the VII century CE, represent a body of evidence offering a rich and veritable picture of medical tradition over this thousand-year period.[3] Indeed, aside from literary fragments and adespota handbooks copied by professional scribes, practical medical texts constitute the largest group of surviving papyri. Thus, collections of drug recipes used by physicians and medical prescriptions written on single papyrus sheets attest to the wide variety of remedies circulating in Egypt at the time.

Among the medical papyri discovered and published so far, just a few of them – about 10 items – may be interpreted as medicine labels. These share formal and material features. Often the writing is concise and the small papyrus is expressly cut from a larger sheet of a particular thickness. According to the kind of information they contain, these labels on papyrus, parchment or ostraca may be divided in three categories: some of them carry only the name of a drug or medicine, others only the therapeutic indication introduced by pros (“against”) plus the name(s) of the disease(s) in accusative, reproducing the typical formula of the epangelia of the medical prescriptions. A third category displays both the therapeutic indication and the name of the medicinal substance, occasionally followed by the quantity. So, these last specimina have features more similar to actual recipes. A papyrus strip measuring 10,6 x 4 cm, P.Prag. III 249 (VII CE),[4] may serve as an exemplar of this category:

‘Against spreading ulcers. Of incense ounce(s)…’

imm3-p-prag-iii-249
Medicine label on papyrus (P.Prag. III 249), Prague, National Library P. Wessely, Prag. Gr. III 1204 v

In conclusion, in the everyday practice, these tags were attached to – or stored with – small containers or boxes for aromata and medicaments by the pharmacopolai, the apothecaries who were used to sell drugs and pharmaceutical products to the doctors. These inscribed labels likely identified the content of small jars or vases circulating on the trade-market: they are a surprising witness of both the medical practices and the commerce in the ancient world, as is concretely revealed by the dialogue between the archaeological and papyrological evidence survived from the telling silence of the past.

[1] The “unswept floor” mosaic asàrotos òikos is in the Gregorian Profane Museum (Vatican Museums). This detail is taken from L. Taborelli, Sulle ampullae vitreae. Spunti per l’approfondimento della loro problematica nell’ottica del rapporto tra contenitore e contenuto, ArchCl 44 (1992) 311, cf. pp. 326-7 for description and bibliography. For the entire mosaic see http://mv.vatican.va/3_EN/pages/x-Schede/MGPs/MGPs_Sala01_03.html#top.

[2] Editio princeps by A.E. Hanson, A Ptolemaic List of Aromata and Honey, TAPA 103 (1972) 161-6. For the image reproduced below see http://quod.lib.umich.edu/a/apis/x-1906.

[3] On medical papyri see, e.g., I. Andorlini, Prescription and Practice in Greek Medical Papyri from Egypt, in H. Froschauer-C.E. Römer (Hrsg.), Zwischen Magie und Wissenschaft, Ärzte und Heilkunst in den Papyri aus Ägypten. Katalog der Asstellung, Österreichische Nationalbibliothek, Wien 2007, 23-33.

[4] Editio princeps by R. Luiselli, Etichetta di sostanza medicinale (Gr. III 1204 verso), in R. Pintaudi-D. Rathbone (eds.), Papyri Graecae Wessely Pragenses (P.Prag. III), Firenze 2011, 157-8, from which the image is taken (Pl. XLVI).

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Isabella Bonati is currently completing a Post-Doctoral Fellowship in Papyrology at the Department of Letters, Arts, History and Society (L.A.S.S.) of the University of Parma, Italy, where she is involved in research activities in the ERC project DIGMEDTEXT (Online Humanities Scholarship: A Digital Medical Library based on Ancient Texts). She holds a PhD in Papyrology from the University of Parma and she received an Yggdrasil grant 2012-2013 at the University of Oslo. Her main research interests are concerned with papyrology, especially lexical studies. Other research interests include classical philology, linguistics, archaeology, history of medicine. For list of her publications go here.

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.

Controlled substances in Roman law and pharmacy?

By Molly Jones-Lewis

Let me begin with a passage from the Digest of Roman Law within the section on the Lex Cornelia on murderers and poisoners (D.48.8.3.3):

It is laid down by another decree of the senate that dealers in cosmetics[1] are liable to the penalty of this law (the Lex Cornelia on murderers and poisoners) if they recklessly hand over to anyone hemlock (cicuta), salamander, aconite, pine-worms (pituocampae), or buprestis,[2] mandragora, or, except for the purpose of purification, cantharis beetles.

This particular decree of the senate was preserved by the jurist Marcian (active c. 200 and 222 CE), but the actual decree could date from any time between 81BCE, when it was passed, and Marcian’s own day. The main test of the law was not whether or not a murder had been committed, as it is with most modern legal systems, but the intent to murder. Penalties ranged from relegation (temporary exile) to death by wild animals.

Negligence should not have exposed someone to its penalties, but there is evidence in both the legal and literary record of medical professionals who unwittingly aided in a murder being prosecuted under the Lex Cornelia. Galen, for instance, mentions one unfortunate doctor who was executed when a wicked stepmother (of course) claimed a drug was for her own use, only to have her slaves slip it into her stepson’s food.

Other examples preserved in the Digest involve gynecologists, aphrodisiacs, and abortifacients; gender bias very likely accounts for the departure from the intent-test. Add to that the demographics of medical professionals in the Roman Empire–many of them were slaves and freedmen–and the pattern becomes even more clear. Elite moral panic likely drove the legislative policy in this decree of the senate, with chilling effects. Under it, suppliers are held liable for selling commonly used pharmaceutical ingredients.

So would these highly toxic items that an ancient pharmacist would carry? Absolutely! Dioskourides, author of a first century CE pharmacy manual (and standard reference for Roman pharmacists), listed several uses for them.[3]

“Spanish Fly” continues to enjoy an unfortunate reputation as a “natural” aphrodisiac, even in this age of safer alternatives. Image credit: Nuvalife.
“Spanish Fly” continues to enjoy an unfortunate reputation as a “natural” aphrodisiac, even in this age of safer alternatives. Image credit: Nuvalife.

We begin at the end with Blister Beetles (Cantharis, buprestis, pituocampae): Here, I am grouping three similar insects, just as Dioskourides did (2.61). These insects are more popularly known as “Spanish Fly.” The oil produced by these beetles causes the skin to blister, and this made it a useful item for removing growths.

But Dioskourides does not mention its most famous application, and most dangerous–blister beetle poisoning irritates the urogenital tract, causing an erection. It was, in essence, ancient Viagra. It seems to have been responsible for quite a few accidental and embarrassing deaths, and likely accounts for the general anxiety surrounding the use of aphrodisiacs in Roman law and armchair scientists like Pliny the Elder.[4] It also shows up in some cringe-worthy gynecological recipes, and must have caused many a woman severe discomfort.

Cosmetics sellers would stock it for people with warts, women would keep it handy, and Roman legislators were concerned. It is hardly surprising that this class of insect dominates the senate’s decree.

The shape of the flower resembles the hood of a monk, hence the English common name. Image credit: Wikimedia Commons.
The shape of the flower resembles the hood of a monk, hence the English common name. Image credit: Wikimedia Commons.

Aconite, also known as monkshood, wolfsbane, and the “queen of poisons,” is best known today as Professor Snape’s go-to icebreaker question for Potions class. It is deadly–strong enough to cause numbness when it comes in contact with the skin–and that is precisely what put it on the senate’s list. Dioskourides 4.77 declares it useful for killing wolves, and nothing else, but urban sales were almost certainly aimed at eliminating human nuisances like abusive slaveowners and inconvenient husbands, at least in the minds of lawmakers.

The English name reflects the long history of identifying the somewhat anthropomorphic form of this root. Dioskourides differentiates between a “Male” and “Female” form – this one is the female variety. Image credit: http://fa13ethnobotany.providence.wikispaces.net/Mandrake.
The English name reflects the long history of identifying the somewhat anthropomorphic form of this root. Dioskourides differentiates between a “Male” and “Female” form – this one is the female variety. Image credit: http://fa13ethnobotany.providence.wikispaces.net/Mandrake.

Another alumna of Harry Potter, the mandrake is best known for its use in magic. However, it also has a strong effect as a sedative and anesthetic; it was used as such into the early 1900s. But too much could cause death, as Dioskourides warns in his lengthy list of applications (4.75). It’s hallucinogenic properties, too, combined with its sedative effects, would have made it a prime candidate for abuse and accidental death. No wonder it makes the senate’s list!

Even today, Hemlock remains infamous for its role in the death of Socrates. So why on earth would a pharmacy sell it? Dioscorides 4.78 recommends it for topical applications only, first as a cure for shingles and erysipelas, both common and painful skin conditions. He goes on to prescribe it to stop lactation, to keep youthful breasts small, and, alarmingly, to cause a boy’s testicles to shrivel. The most shocking suggestion, though, is that it be applied to the testicles to prevent nocturnal emissions – surely a recipe for disaster if the man in question failed to wash his hands carefully.

Small jars excavated in the prison in the Athenian Agora, possibly used for the executioner’s Hemlock. Author’s image, 2006.
Small jars excavated in the prison in the Athenian Agora, possibly used for the executioner’s Hemlock. Author’s image, 2006.

So we have in this list a number of items common in recipes and associated with women and medical professionals, both of whom might respond to their systemic oppression with the covert violence of poisoning. If you were to open a pharmacy in the bustling streets of the Roman empire–especially if you were a woman, freedman, or both– it would be best to think twice about why your patient is so keen to buy his cantharis in bulk.

[1] The ingredients in cosmetics and pharmacy were often similar, and likewise cosmetics were made to also have medical benefits.

[2] J. B. Rives rightly suggests (n. 22) that the word “bubrostis” is a misspelling of “buprestis.”

[3] See Lily Beck’s excellent translation and commentary for the most likely identification of the species involved. Taxonomy and nomenclature in antiquity is imprecise by modern standards; it can be difficult to link ancient names to known species.

[4] For example, Natural History 25.25: “I do not include abortifacients in my account, and not even love potions, remembering that Lucullus the most famous general perished from such a potion.”