Category Archives: Premodern

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.

To break or not to break (Part 2): From Cairo to Dordrecht

By Saskia Klerk, with Sietske Fransen

In the eleventh chapter of his Steen-Stuck (Treatise on the Stone, 1637), Johan van Beverwijck related a story of an encounter in Dordrecht, the Dutch city where he was town physician. A man had shown him the pieces of stone that he said had been broken by the following recipe. Van Beverwijck tried it himself, but had not found the same results. Still, he noted, the pieces of stone that the “trustworthy man” showed him, would together make up a large stone.

Broken bladder stones from Des monstres et prodiges (1573) by Ambroise Paré (c. 1510– 1590). From the Lyon edition of 1664.
Broken bladder stones from Des monstres et prodiges (1573) by Ambroise Paré (c. 1510– 1590). From the Lyon edition of 1664.

Around 1677, the compiler of Ms BPL 3606 copied this passage, leaving out Van Bever-wijck´s skeptical remark. Apparently, he found the display of broken stones, a tactic we have encountered before, to be persuasive proof of the recipe´s effectiveness.

When Sietske and I started our blog series on this Dutch recipe collection, I did not expect most of my posts to be about “stone breaking” remedies such as this one. However, they turned out to have been of particular interest to its compiler. By pursuing this interest, Sietske and I have learned quite a bit about him and his world. For example, we now suspect that he lived in or near the province of Zeeland in the south-west of the Dutch Republic. We also confirmed Sietske´s earlier observation, that the compiler especially noted down remedies that where accompanied by favorable experiences. In my last post, I showed that the compiler of BPL 3606 used Steen-Stuck´s tables of contents to find the information he was looking for.

As I continued studying the manuscript, the question of why there are so many stone-breaking remedies in it became more pressing. In an earlier post, Seth LeJacq laid out the persuasive answer that patients’ fears of surgery led them to explore alternative therapies. Master Reijmers´ story has shown us that the compiler of BPL 3606 shared these fears and desires. Perhaps, this is also key to understanding why he included not only so many recipes for stone breaking remedies in his manuscript, but also three other sections from Steen-Stuck that are not recipes.

Before the recipe, as a “Nota”, the compiler copied a short section on how the stone should be returned to the bladder if it got stuck in the bladder´s neck. In his Treatise on the Stone, Van Beverwijck suggested surgical options to actually remove the stone from the body as well. The compiler copied the most curious of these, after the recipe, as another “Nota”.

Alpinus told of this procedure in Cap. XIV of the third book of De medicina Aegyptiorum (1591) under the title "To remove stones without an incision"
Alpinus described this procedure in Cap. XIV of the third book of De medicina Aegyptiorum (1591) under the title “To remove stones without an incision”

This particular option advised sufferers to blow into the   urethra with a little pipe. Thereby extending it far enough to be able to remove a stone no larger than an olive pit. Despite his interest in the cure, the compiler omits the original source of this procedure, Van Beverwijck´s teacher in Padua, Prosper Alpinus (1553-1617) and the Egyptians amongst whom Alpinus had resided.

The inclusion of treatments such as these  further confirms the compiler´s anxiety towards actually cutting the body. Moreover, I would argue this anxiety was a factor in the transmission of this custom from faraway Egypt to this Dutch recipe collection. Alpinus explicitly mentioned the non-cutting aspect of the procedure in the title of the chapter in which he described it. Van Beverwijck repeated this aspect in Steen-Stuck, before going on to describe cutting the body to remove the stone as a last resort.

Finally, in his exploration of alternative therapies the compiler also recorded knowledge that by 1677 was outmoded to many of his contemporaries.

Section from Van Beverwijck´s, Steen-Stuck (1649) Ch. 11, pt. 4
Section from Van Beverwijck´s, Steen-Stuck (1649) Ch. 11, pt. 4
The same section copied in BPL 3606
The same section copied in BPL 3606

Van Beverwijck named several materials that possessed a stone breaking power. Some of these (such as lime zest and laurel) worked by a manifest quality and others (such as ashes of scorpio and woodlice) by a hidden property. In his note-taking, the compiler was careful to separate these into two lists.

The distinction between manifest and hidden or occult qualities was characteristic of academic Galenic medicine familiar to Van Beverwijck. It was fundamental to explaining the properties of medical materials. Was the way a material worked in the body “manifest”, that is, was it caused by the primary qualities (hot, dry, cold and moist)? Or could this “operation” not be explained from these qualities and was it therefore “hidden”? While this important distinction had come to be questioned by the 1620s, as I described elsewhere[1], Van Beverwijck included it without comment. Accordingly, when the compiler copied out this section, all that mattered to him was that the physician asserted the healing properties of these materials.

Here, the compiler´s fear of cutting the body thus resulted in a quite eclectic collection of materials, surgical techniques and a stone-breaking recipe, originating from as diverse places as Egypt and Dordrecht. Investigating his interest in alternative cures for bladder stones further, has also indicated the practical reasons behind the staying power of (parts of) Galenic medicine, despite its philosophical problems.

[1] Saskia Klerk, “The Trouble with Opium. Taste, Reason and Experience in Late Galenic Pharmacology with Special Regard to the University of Leiden (1575–1625),” Early Science and Medicine, vol. 19, issue 4 (2014): 287-316.

Paper as Commodity in Medieval Magical and Medical Practices

By Orietta Da Rold

‘He then looked and saw an amulet sewn into the tarboosh, which he took and opened’

(The Arabian Nights: Tales of 1001 Nights)

The tale of Nur al-Din and his son Hasan is a well-known tale from the Arabian Nights. It tells the story of Nur al-Din’s self-imposed exile in Basra and of the return to Egypt of his son Hasan. The involvement of magic, the disguise and the subsequent recognition of Hasan as the son of Nur al-Din are all essential elements of the story. But the amulet represents the tangible proof of Hasan’s true identity. The talisman is made with a scroll of paper, folded and stitched in a fold of material then placed in Hasan’s turban. It was given to Hasan by his father just before he died. A token of recognition which unlocks a knotted mystery; a powerful meaningful object which represents the climax of the narrative, because it enables the identification of the male protagonist and the continuation of the story to a happy conclusion.[1] In the Arabian Nights, the writing of words on paper regularly carries symbolic, almost sacred connotations, announcing in a loud and clear voice that paper as a commodity is an integral part of understanding social and cultural custom in fiction and perhaps in real life too.

It is now accepted that Arabian Nights, first mentioned in a ninth-century manuscript fragment, is a compilation of stories which has evolved and extended over the centuries;[2] it is tantalising to suggest that this process of augmentation also absorbed local practices and technologies. Paper arrived in the Arab world well before its introduction to the West and started to be used as a commodity from the eighth century.[3] The amulet on paper is a witness to knowledge and healing in a society fully accustomed to paper. This use in popular lore is indicative of the adoption, acceptance and full participation of a new technology in society (see also the ‘One Million Pagoda’ in Japan). Similar evidence can be traced in the use of paper in charms, amulets, medical or culinary recipes in Western literature and culture from the late medieval period. This evidence, however, is seldom studied or indeed catalogued, although more work has been undertaken on post medieval medical practices.

One fascinating example is Oxford, Bodleian Library, Laud Misc. MS 553. The volume is a fifteenth-century collection of medical recipes and texts including one charm which claimed to cure all manner of fevers. In this instance, the maker is instructed to write this phrase: ‘for to destruye alle maner of feueres wryt þes ix wordes in pauper’ on a piece of paper.[4] Here, the very act of inscribing these 9 words on paper activate their magical and healing power.

The practice of using paper in medical knowledge and treatments is also seen in another medical treatise translated into English in the fourteenth century. Oxford, Bodleian Library, Ashmole MS 1396 and London, British Library, Additional MS 12056 contain a version  of Lanfrank’s Science of Cirurgie. Paper is here used in a number of different ways. In a recipe to whiten teeth, paper was folded and used as a plaster to apply a mixture of flour, sal ana and honey.[5] In another recipe, burnt paper ashes was used, alongside borax, to staunch blood after phlebotomy.[6]

Cambridge, Trinity College, MS O. 1.13, fol. 194v, to be published with the following credits: ‘By permission of the Master and Fellows of Trinity College, Cambridge’. Photo taken by author.
Cambridge, Trinity College, MS O. 1.13, fol. 194v. By permission of the Master and Fellows of Trinity College, Cambridge. Photo taken by author.

In a final example in Cambridge, Trinity College, MS O. 1.13 (fol. 194v), a recipe dating to the late fifteenth-century uses brown paper as a kind of bandage to heal the wound of the head.[7] In all these examples the different proprieties of paper are put to use in different ways for esthetical and healing purposes.

In contrast to Mediterranean countries, England only experienced the importation of paper at the beginning of the fourteenth century. However, as soon as it became available it was adopted in diverse ways. As we recover the significance of the paper revolution in the West and in different geographical locales, in this case England, we often focus on the impact that it had on book production, record keeping and manuscript transmission. We frequently forget that the great success that paper enjoys as technology and craft is in direct proportion to its multiple uses to fulfill different needs and, as such, demands more attention.

The examples I have included above explain that paper started to be employed in traditional medical practices as an alternative to textiles to attend to injuries. This is what I call the ‘textile’ economy in medical customs, which largely employed linen cloth and wool to medicate and wrap wounds, but also to make potions.

Cambridge St John’s College, MS B. 15, fol. 11v. By permission of the Master and Fellows of St John’s College, Cambridge.
Cambridge St John’s College, MS B. 15, fol. 11v. By permission of the Master and Fellows of St John’s College, Cambridge.

Cambridge, St John’s College, MS B.15 is another collection of medical recipes, in which a recipe advises to cure pain and the inflation of nerves with black wool (fol. 11v). The recipes says ‘Tak blak wolle as it growth between þe schepe legges’ and carries on advising how to wash it in in warm water to make a concoction derived from the water to cure nerves.

This phenomenon should not be surprising because in fourteenth- and fifteenth-century England, grocers, spice dealers and haberdashers sold paper to meet a wide range of practical needs outside the book trade. For example, in the 1360s the household of King John II of France purchased paper from a certain Berthëlemi Mine, a spice dealer in London to wrap up jam (Paris, Bibliothèque Nationale de France, MS FR 11205).

It should not, therefore, be surprising that paper as a technological innovation contributed to both literary as well as medical texts. Both served specific purposed in society and both contributed to popular lore with the determination of improving life; in the case of the Arabian Nights, actually prolonging life itself.

 

Orietta Da Rold is a University Lecture in The Faculty of English and a Fellow of St John’s College at the University of Cambridge. She has worked for many years on the impact of paper in late medieval England. Da Rold is the Director of the Mapping Paper project and is currently working on a monograph seeking to explore the impact that paper had in the pre-printing world by considering how paper enabled the mobility of knowledge and dissemination of learning by enriching literary, cultural and technological practices.

[1] On this practice, see Don C. Skemer, Binding Words: Textual Amulets in the Middle Ages, Magic in History (University Park, Pa.: Pennsylvania State University Press, 2006)

[2] R. Irwin, The Arabian Nights: A Companion (London: Penguin, 1995)

[3] J. Bloom, Paper before Print: The History and Impact of Paper in the Islamic World (New Haven: Yale University Press, 2001).

[4] S. J. Ogilvie-Thomson, Index of Middle English Prose, Handlist XVI, Manuscripts in the Laudian Collection Bodleian Library, Oxford (Cambridge: D.S. Brewer, 2000), p. 69, item 41. I should like to thank Lea T. Olsan for drawing my attention to this reference.

[5] ‘If a mannes teeþ ben blac, in þis maner þou schalt make hem whit / farinam ordei, sal ana, & leie hem in hony, & make þerof past & folde it in paper or in lynnen clooþ’; Robert von Fleischhacker, ed., Lanfrank’s “Science of Cirurgie“, E.E.T.S., O.S. (London, 1894), p. 265.

[6] ‘þan sette þervpon a ventuse for to drawe þerto blood. & þan anoynte þe same place wiþ blood, & þan sette þervpon þe watir leche. & whanne he is ful & þou wolt do him awei, blowe vpon þe place baurac, ouþer askis maad of paper’; Robert von Fleischhacker, ed., Lanfrank’s “Science of Cirurgie“, E.E.T.S., O.S. (London, 1894), p. 305.

[7] ‘ffor the sowndinge in the hedd: take ij sheetes of browne paper’. Cambridge, Trinity College, MS O. 1.13, fol. 194v.

Human Milk as Medicine in Imperial China: Practice or Fantasy?

By He Bian

What does milk have in common with blood? According to Kou Zongshi (fl. 1110-1117), author of Bencao yanyi (Extended Interpretations on Materia Medica), they are basically the same vital fluid produced by the female body at two critical moments in a woman’s life. While the first menstrual period signifies the maturation of reproductive power, motherhood is the consummation of that power–miraculously causing the vital fluid to flow upward as milk. After nursing ends, the flow of milk again reverses back to blood, as evident from the return of the menses.

“Human milk.” Anon. Buyi Leigong paozhi bianlan (n.p, 1591), Book 8.
“Human milk.” Anon. Buyi Leigong paozhi bianlan (n.p, 1591), Book 8.

For centuries, Kou’s comment was repeatedly quoted as the dominant theory over lactation in the realm of learned medicine. It also coincides with parallel attempts to speculate on the metaphysical foundation of sex differences in women, and the consolidation of women’s medicine (fuke) and pediatrics (erke) as medical specialties.[1]

However, Kou’s original aim was to make sense of medical recipes. In particular, he was trying to figure out why do so many recipes for eye medicine use human milk to mix up powdered mineral drugs: a practice that has parallels in different cultural contexts. Since blood is essential for the five senses to function and human milk is essentially blood, Kou reasoned, this makes it an excellent medicine for eye diseases. Another recipe that may have been on his mind is the recommendation to drink “three portions of human milk” to help with obstructed menses. It makes sense if they were considered of the same origin. Like cures like.

Let’s pause here to consider what this means. Working with Chinese materia medica texts often means untangling different strands of thought, modes of compilation and miscellaneous quotations. The entry on each substance (e.g. human milk, renru or ruzhi) often begins with a learned survey of previous literature, including passages from classical literature and histories, and ends with a large (and often unwieldy) body of recipes. The problem is that the prescribed uses of the substances in the first part do not always sit well with the recipes, which are messy, opaque, and often outright strange.

In fact, Kou Zongshi’s work could be understood as a scholar-physician’s attempt to impose order and coherence on the unruly recipes, which were becoming increasingly available in print. [2] The incongruities and tension between theory and recipes, however, allows us to follow the intricate dance between empiricism and rationalism in such texts: when did authors equate recipes with real-life experiences, and when did they treat them as exemplars of theory and formulaic principles? When did book culture begin to shape the ways in which medicines were prepared, consumed, and invented?

Back to Kou Zongshi’s ingenious, if somewhat contrived, speculation over the nature of lactation. It did not seem to have caught much attention immediately. The twelfth and thirteenth centuries witnessed a growing suspicion among medical experts to discipline and curb wet nurses’ sway over childcare, and pediatric treatises abound with warnings against drunken, naughty wet nurses whose milk turns unwholesome to the infant.[3] Again, the female body’s power to nourish but also intoxicate with her transformed milk resonates with similar discourses discussed elsewhere on this blog; notably, alcoholic drinks were seen to be a bad thing that excites her passions, in contrast to ancient Roman recommendations.

In addition, the conquest of Mongols brought about increased consumption of cow and goat’s milk.[4] A leading physician active in the fourteenth century advised consuming those over human milk, which is easily “tainted with poisonous passions.” It looks like the arrival of more abundant dairy products would transform the existing pharmacopeia once and for all.

But not so simple. By the sixteenth century in China, human milk had become a “super food” of sorts, especially among elite families. Kou Zongshi’s dusty theory became a dominant trope, fanning the imagination of the female body as a machine of alchemical wonders, and her milk a sort of elixir that revitalizes the frail and depleted bodies. In the sixteenth-century encyclopedia Systematic Materia Medica (Bencao gangmu), Li Shizhen, the erudite naturalist and capable physician, criticized the excessive fetishizing of human milk. The prudent Li nevertheless included twelve “new recipes” that involve human milk as medicine. Li’s encyclopedia was first printed in 1596; soon after the turn of the century, dietary manuals began to teach people how to prepare dried milk powder at home, after collecting fresh milk from “strong women who just gave birth to boys”. Presumably, women sold their milk not as wet nurses, but directly to pharmacists (as depicted in the picture above).

So did people in imperial China consume human milk as medicine? Quite likely. But was it ubiquitous? Probably not. Recipes can be practical and fantastic, and theorists can explain and inspire. What matters is that human milk as medicine gradually came to be taken out of the context of nursing and acquired a more abstract quality as commodity.

[1] Charlotte Furth, A Flourishing Yin: Gender in China’s Medical History: 960–1665 (Berkeley, CA: University of California Press, 1999).

[2] Asaf Goldschmidt, The Evolution of Chinese Medicine: Song Dynasty, 960-1200 (London ; New York: Routledge, 2009).

[3] Ping-Chen Hsiung, “To Nurse the Young: Breastfeeding and Infant Feeding in Late Imperial China,” Journal of Family History, 20, 3 (1995), pp. 217-38.

[4] Paul D. Buell, E.N. Anderson, and Charles Perry, A Soup for the Qan : Chinese Dietary Medicine of the Mongol Era as Seen in Hu Sihui’s Yinshan Zhengyao, 2nd Rev. and Expanded ed. (Leiden, The Netherlands: Brill, 2010).