Category Archives: Galen

Tales from the Archives: Testing Drugs and Trying Cures Workshop Summary

In September 2016, The Recipes Project celebrated its fourth birthday. We now have over 500 posts in our archives and over 120 pages for readers to sift through. That’s a lot of material! (And thank you so much to our contributors for sharing such a wealth of knowledge on recipes.) But with so much material on the site, it’s easy for earlier pieces to be forgotten. So, the editors have decided that, every now and then, we’ll pull something out of the archives to share with our readers anew.

Over the next few weeks, The Recipes Project will feature a selection of case studies from the current issue of the Bulletin of the History of Medicine on “‘Testing Drugs and Trying Cures”. This special issue grew out of a 2014 workshop held at Max Planck Institute for the History of Science in Berlin. We were very lucky to have two then graduate students Ashley Buchanan and Tillman Taape, join us for and grateful that they took the time to pen the post below. It seems fitting to begin this month on testing drugs and trying cures with a revisit to their post. Elaine (editor).

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By Ashley Buchanan and Tillman Taape

What did it mean to test a drug or try a cure in the early modern world? This was the central question for a group of scholars who gathered for a workshop at Max Planck Institute for the History of Science in Berlin, Germany.  Since recipes emerged as one of the key themes throughout the workshop, and because the conference’s location in Berlin made it difficult for scholars outside of Europe to attend, we thought we might share a brief summary of the “Testing Drugs and Trying Cures” papers, in the hopes that we could bring the workshop’s key ideas and discussions to a larger audience.  What emerged from an exhilarating two days of discussion and debate was the conclusion that historians of science and medicine should not privilege experiment and experimentation as fixed categories, but should understand the multiple ways in which physicians, apothecaries, artisans, institutions, and individuals in the early modern world tested, tried, investigated, experienced, modified, observed, and measured medicinal remedies and materiae medicae.

As written forms of medical and pharmaceutical knowledge and practice, recipes played an important part in the testing of drugs and cures, and our discussion raised larger questions surrounding the nature and purpose of an early modern recipe.

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A miniature depicting the Schola Medica Salernitana from a copy of Avicenna’s Canons.  From Wikimedia Commons.

Michael McVaugh’s paper opened the discussion by exploring how medieval physicians went about testing drugs. Learned doctors in the Middle Ages might appear helplessly hidebound, and inclined to follow ancient authorities over experimentation. In contrast, McVaugh showed how a group of Montpellier physicians in the fourteenth century established something of an experimental program. Medieval physicians, however, were not testing to find a cure, but to determine the quality, strength, and effectiveness of a drug as it pertained to a particular person’s complexion. McVaugh underscored an important difference in the purpose of medieval drug testing. Physicians tested not for universal effectiveness, but to determine the quality of a drug – was it hot, cold, moist, or dry.

Duclos-title-page
Title page of the Academy’s Observations sur les eaux minérales (1675). From http://cures.hypotheses.org/the-workshop/programme-2/bycroft-michael

Although it became clear in our roundtable discussion that we should be wary of labeling such practices as obvious precursors to the experimental philosophies of the Scientific Revolution, many of the papers showed that the importance of specific tests resonated throughout the early modern period. Evan Ragland’s paper, for example, traced the use of the phrase periculum facere (‘to make a trial’) in physicians’ writings on medicine, anatomy and chemistry. Similarly, Michael Bycroft showed that French physicians and chemical experts of the Académie des Sciences became increasingly interested in the exact composition of mineral waters. Contrived tests such as color indicators or the analysis of residues after evaporation increasingly became the touchstone of proper inquiry.

McVaugh, Ragland, and Bycroft’s papers all underscored the need to understand the specific nature and purpose of testing in each historical context. Continuing to emphasize the importance of historical context, Francesco Paulo de Ceglia’s paper showed just how different the purpose of testing could be in the context of seventeenth century blood miracles in the Kingdom of Naples. Catholics tested the liquefaction of the blood of their patron saint to explore the limits of nature. By discovering nature’s limits, you could then determine what was truly miraculous. Protestants, on the other hand, tested various materials and recipes to recreate the liquefaction of blood to cast doubt on the alleged miracle.

san-gennaro
Reliquary containing a glass ampoule of San Gennaro’s blood. From La Repubblica.

In the context of testing, drugs and cures are often under scrutiny in the form of recipes detailing their production and administration. While recipes emerged from many of the papers as very important forms of knowledge, it proved virtually impossible to define exactly what a recipe was. Recipes can be very short or very detailed, ranging from a mere list of ingredients to careful step-by-step instructions. If there is one thing recipes have in common, it is the need for testing, trying, modifying and adapting to different conditions. While constructing an all-encompassing definition of a recipe proved futile, all agreed that it was fruitful to understand recipes as an important genre in early modern science and medicine.

apotheke_enhausen_l
From http://www.gn.geschichte.uni-muenchen.de/aktuelles/archiv_2011/archiv_2013/science_and_medicine/index.html

For her investigation on the testing practices of Venetian apothecaries, Valentina Pugliano emphasized the difference between experiment and experience. Venetian apothecaries were less concerned with testing drugs (in a traditional sense) than they were with the experience or truthfulness of their ingredients. Testing by inspection, smell and taste was also important in this pharmaceutical context, to ensure that the ingredients were what the merchant had promised them to be, and not a cheap substitute with inferior properties. For Pugliano’s apothecaries, the important issue that required testing was the authenticity of the ingredients rather than the efficacy of the finished product; after all, most preparations had proved their worth since antiquity. Like McVaugh, Pugliano questioned traditional “Baconian” understandings of what it meant to experiment and test and argued for more nuanced notions of testing and trying, which included observing, measuring, evaluating, and experiencing.

Image_Samir
Title page of Johannes Christophorus Homann’s Dissertatio inauguralis medica de medicinae cum geosophia nexu quam auspice deo prpitio (Hala Madgeburica, Hendelius, 1725). From http://cures.hypotheses.org/the-workshop/programme-2/boumediene-samir

With early modern Europeans’ increasing forays into the New World, however, more and more materiae medicae were found which were absent from ancient medical writings. Pliny and Dioscorides were silent on such substances as guaiacum wood, Peruvian bark or New World balsam, so their medicinal properties had to be newly investigated. Antonio Barrera-Osorio and Samir Boumediene’s papers added America, or the New World, into the discussion. Both emphasized the role of new drugs and materia medica in the rise of European experimental practices. New drugs and new medicinal recipes required new ways of testing.

Antonio Barrera-Osorio’s paper argued for an empirical culture in the Spanish empire, which was well suited to respond to these challenges. He showed how his protagonists gathered information about New World remedies from natives or travellers and experimented with ways of preparing them. Some of these drugs and recipes were deemed so important for the economy and health of the empire that the Spanish crown ordered tests in hospitals all over Castile. Samir Boumediene’s paper elaborated on the issue of making workable recipes for newly discovered drugs. Once more, taste and smell were important assays, but drugs such as guaiacum and Peruvian bark were also tested on a larger scale. Dispensing them to the poor inmates of charitable hospitals (as happened in France and Germany) helped to determine their effect, and to establish recipes, which indicated how to adjust the treatment in individual cases.

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Andreas Cleyer, Specimen Medicinae Sinicae (Frankfurt, 1682). From http://cures.hypotheses.org/the-workshop/programme-2/hanson-marta-and-pomata-gianna

Gianna Pomata and Marta Hanson’s paper showed how recipes also functioned as vehicles of knowledge between different cultures. Recipes, as either formula or prescription, were both found in European and Chinese medical cultures. According to Pomata and Hanson, it was the familiar genre of the recipe that facilitated the transmission of Chinese pharmacology to Europe in the second half of the seventeenth century. Similarly, Carla Nappi argued that the Manchu medicinal recipes of the Qing court were spaces of encounter and medical translation in the early modern world. Pomata, Hanson, and Nappi demonstrated how the recipe served as the common ground between European and Chinese medicine and made the translation of Chinese pulse medicine and the transmission of Chinese materia medica possible in the seventeenth and eighteenth centuries.

Although recipes are difficult to characterize as a genre, it is clear that they are fascinating objects of historical study. More often than not, they are fluid rather than fixed forms of knowledge, requiring adaptation at every turn. They bring together ingredients, practices and often practitioners from all over the world, and themselves have a tendency to aggregate into larger collections. As written manifestations of gestures and processes, they play an important part in testing, assessing and modifying drugs and cures.

Burnt Toast, Medicine and Identity in (Early Modern?) England

by Giovanni Pozzetti

Last Monday the Food Standards Agency (FSA) in the UK launched the ‘go for gold’ campaign to promote awareness in the kitchen when cooking foods at high temperatures. Results of a study conducted on mice showed how foods with a high content of acrylamide can be related to cancer. Acrylamide is a chemical that is generated in foods exposed for long time at high temperatures. However, acrylamide is also responsible for turning foods from their original colour to different shades of gold, brown, dark-brown and black. Hence the title of the FSA campaign – ‘go for gold’. The more overcooked a food is, the highest its acrylamide content. Two of the major ingredients at risk are bread and potatoes, mostly because they are particularly tasty when very well roasted, and because acrylamide is heavily present in starchy foods. Given the love that Brits have for these ingredients, the news was not well welcomed by the British public (see the comment section of this article).

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Toast and margarine. Credit: Wikimedia Commons

Medical anxieties of overcooking bread, or food in general, were very common in the pre-modern period as well. Today’s ‘go for gold’ campaign attempts to establish a rule for cooking that is based on shadowy visual indications rather than on specific and replicable instructions, and this is not something new. In fact, what ‘gold’ means is quite blurry and remains very much open to interpretation. Surprisingly, the FSA did not provide any visual guide to follow in order to reach the healthiest cooking point. Acrylamide develops in foods heated to temperatures above 120 C°; however, these kinds of temperatures are not as easy to monitor at home as in professional kitchens. This week’s furor over burnt toast and the FSA’s attitude in offering medical advice to laymen has particularly interested me. As an early modern historian working on how medical knowledge and food consumption crossed paths in the household (England and Italy, 1500-1650), I engage a lot with health regimens and cookery books.

Health regimens were supposed to be manuals of good health for non-specialists and were written in vernacular. The authors wrote instructions that noticeably recall FSA’s ‘go for gold’. For example, in the Castel of Helth (1534), a best seller published at least 14 times between 1534 and 1610, Sir Thomas Elyot (1490? – 1546), diplomat and scholar, offered instructions to make the most ‘wholesome bread’. The dough had to rise sufficiently and it had to be ‘moderately baked’.[1] Clearly, Elyot knew nothing about acrylamide. He was much more worried about the humoral imbalance that either overcooked or undercooked bread brought to the body. Overcooked bread brought hotness, and would have dried up the body. Conversely, eating undercooked bread made the complexion of the person lean towards a cold and moist humoral (im)balance.

Sir Thomas Elyot by Holbein the Younger. Credit: Wikimedia Commons.
Sir Thomas Elyot by Holbein the Younger. Credit: Wikimedia Commons.

The Galenic and Hippocratic corpus of medical knowledge, based on the humoral theory, was the pillar on which early modern medicine was based upon. The body was in good health when the four humors (blood, phlegm, choler and melancholy) were balanced, defining so the four complexions of the body (sanguine, phlegmatic, choleric and melancholic respectively). The humors were constantly altered by food, where each ingredient was either cold or hot, and dry or moist. A different science from today altogether, but science nonetheless. Elyot and other early modern authors wrote different things for different reasons but their attitude towards cooking times and procedures is the same adopted by the FSA to engage with a public that knows more of bread and potatoes than medicine.

The ‘go for gold’ campaign made the news – it was even discussed  on Good Morning Britain and the NHS has endorsed the advice. The campaign has also triggered a powerful and intense public reaction. Many didn’t like it. On the website of The Telegraph newspaper, the comment section quickly filled up with bitter reactions and sceptical criticisms. Some questioned the scientific findings while others protested against conducting experiments on animals to reach a human-related conclusion. However, one of the most common arguments was that this scientific recommendation, along with this kind of scientific research, should not be taken too seriously because nothing bad ever came out of well roasted potatoes and dark-brown toasts. People felt offended – for lack of a better word – because someone told them to avoid a food and a specific cooking procedure that for Brits are vital and deeply embedded in their modern food traditions. However, both health regimens from the sixteenth century, which carried a tradition much older than them, and today’s medical advice on food share this dependence on the cook’s interpretation and, more important, personal will. Perhaps, the vagueness embedded in the need to simplify the scientific notion is the reason behind its rejection in the first place. It’s much easier to go for a dark brown, tasty and deliciously over-toasted slice of bread, and accepting the damage that this choice brings, rather than having to work out the perfectly healthy cooking point and leaving so taste and traditions behind.

[1] Thomas Elyot Sir, The Castel of Helth (London: Thomas Berthelet, 1539), fol. D5r.

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Giovanni Pozzetti is a PhD candidate at the University of Leeds (UK). His research looks at the reception and assimilation of Galenic medicine in the early modern household between Italy and England.

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.

The coral and the seal: an ancient amulet against all ills

By Laurence Totelin

In a recent post, Sietske Fransen and Saskia Klerk introduced a seventeenth-century recipe whose main ingredient was red coral. That ingredient has made several other apparitions in The Recipes Project posts (see here, here, and here). Perhaps it is time it took centre stage. For coral is not any ingredient. We know it to be an animal (a marine invertebrate), but it is only in the eighteenth century that it was finally classified as such. Beforehand, it was generally considered to be a plant, albeit a very peculiar one, as it transformed into stone when in contact with the air. In Greek, coral was at times called ‘lithodendron’, literally, the stone-plant. As such, it was usually included in Lapidaries, treatises devoted to stones and their healing or magical properties. Thus, the Orphic Lapidary describes it as follows:

Perseus with the head of Medusa on a Roman fresco at Stabiae. Credit: Amadalvarez, Wikimedia
Perseus with the head of Medusa on a Roman fresco at Stabiae. Photo: Amadalvarez, Wikimedia

For it first grows as a green grass, but not on the ground,
Which, as we all know, gives solid food to plants, but in the sea,
The sterile sea, where are born the seaweeds and the light mosses.
Orphic Lapidary 517-519

According to a legend recounted by the poet Ovid (first century CE), coral was born of the blood of Medusa’s severed head, which the hero Perseus had placed on seaweeds. The plants, as they absorbed the monster’s blood, became harder and redder. Sea Nymphs then sowed the seeds of the newly-created coral into the sea (Ovid, Metamorphoses 4.740-753).

Perseus and Andromeda, by Giorgio Vasari (c. 1570). Credit: Wikipedia
Perseus and Andromeda, by Giorgio Vasari (c. 1570. Source: Wikipedia

Since it had been born from blood, coral was believed to have good blood staunching properties; Dioscorides (first century CE) wrote in his Materia Medica that ‘it cicatrizes; it treats quite effectively blood spitting’ (5.121). Galen (second century CE) preserves several recipes against blood loss that include the exotic coral, including one attributed to Philadelphus the Great (in reference to one of the kings of Ptolemaic Egypt):

Another remedy of Philadelphus the Great for those who spit blood: two obols of coral, four obols of Samian clay, two kyathoi of juice of knot-grass; give two draughts in total. (Galen, Composition of Medicines according to Places 7.4, 13.80 Kühn)

Unsurprisingly, the other main ingredient in this recipe, the earth from Samos, was also red. In fact, Discorides believed that it was that colour because the inhabitants of Samos mixed it with the blood of a goat (Materia Medica 5.153) – a fact that Galen knew to be false.

Coral had several other properties beside its blood staunching ones. Thus, it is recommended as an ingredient in the following teeth-whitening preparation:

V0022008ETL A coral. Etching. Credit: Wellcome Library, London. Wellcome Images images@wellcome.ac.uk http://wellcomeimages.org A coral. Etching. 1793 Published: 1 November 1793 Copyrighted work available under Creative Commons Attribution only licence CC BY 4.0 http://creativecommons.org/licenses/by/4.0/
Coral, etching by F.P. Nodder (1793. Credit: Wellcome Images

Very good remedy to whiten the teeth: red coral, pumice stone, stones of dates, bones of cuttle-fish, and burnt salts; crush and use. (pseudo-Galen, Remedies easily Procured 2.8.14, 14.432 Kühn)

This powder may (or may not) have whitened the teeth, but I am not certain it would have been a good breath-freshener – a bit too fishy for my own liking.

My favourite coral recipe, however, comes from the Cyranides, a collection of magical material in Greek. It suggests using coral wrapped in the skin of a seal as an amulet:

The seal is a quadruped sea-animal. Its skin, whenever it is placed in a house or in a ship, or carried by someone, ensures no ill occurs to whoever carries it.  For it turns away thunderbolts, hurricanes, hailstones, dangers, winds, witchery, spirits, pirates, night visitations, wild beasts, creeping animals, and phantoms. You must use it as an amulet on its own or with the coral stone.  (Cyranides 4.67)

The combination of the seal skin and coral is important here: both ingredients are born from the sea, and are difficult to classify. The seal resembles a fish but is a quadruped; the coral looks like a plant but is a stone. In antiquity, liminal objects – those that fall into two categories, or in neither – were often seen as powerfully magical.