Category Archives: Premodern

Living in Seasons: Mulberry Wine, or the Moral Perils of Recipes in Times of Austerity

By He Bian

April and May on the US east coast = temperature swings = confusing and sickly weather. This year especially reminds me of the sobering admonition from the ancient Chinese classic of medicine, <The Yellow Emperor’s Inner Canon>: “when there is damage from cold in winter, one suffers from warm diseases in spring (Dong shang yu han, chun bi bing wen)” (see Marta Hanson’s insightful book on this subject). Seasonality is well known as a central preoccupation in the Chinese medical tradition: the cosmic resonance of the body and the larger world according to the quadruple division of the solar year – the cyclic fluctuation of temperature, directionality of wind, and the loci of corporal vulnerability that furnished essential cues for a master practitioner of medicine.

But if etiology in Chinese medicine is classically understood as seasonal, surely the therapeutics should also follow a seasonal rhythm? To my surprise, a search for pre-modern monographs that contain the keyword “four seasons” (sishi) yielded few results. In addition, they tend to focus on agriculture (which of course also follows a seasonal rhythm) or popular festivities around the year. I decide to take a closer look at the latest text that featured “four seasons” in its title – a title attributed to Qu You (1341-1427), Si shi yi ji (Auspicious and Inauspicious Deeds in Four Seasons). I thought this text might teach me something about how a learned scholar approached the notion of seasonality in the early fifteenth century, and how that might align or depart from the canonical medical model of seasonality.

The book consists of twelve chapters, each describing the dos and don’ts for a specific month. I flipped to the chapter on the fourth month (which corresponded roughly to this present moment in Western calendar). I learned, to my surprise and delight, a ton of practical advice with specific recipes: how to properly dry and insulate book and painting cases before the advent of rainy season; “use eels that have been sun-dried, burn them inside the house to thwart the thirst of mosquitoes” (seems appropriate for New Jersey habitat); “wrap your battle gears along with Sichuanese peppers (huajiao) or powder of Daphne flowers (yuanhua) to prevent worm damage… wrap windshield collars and earmuffs and store them in a vat, tightly seal it up, so as the fur will not fall off.” After the first full moon this month, one “should drink mulberry wine” to prevent “wind heat” illnesses (see Shigehisa Kuriyama’s discussion of wind in classical Chinese and Greek medicines). The recipe goes as follows:

Use Mulberries, get its juice of three dou (1 dou ~ 18 liter). White Honey four ounces (liang); Butter (suyou) one ounce; raw ginger juice two ounces.

Bring mulberry juice to a boil in a pot, and reduce its volume to three sheng (1 sheng = 1/10 dou), and then add honey, butter, and ginger juice. Add three drachm (qian) of salt and keep boiling till the texture is thick.

Store in porcelain utensils. Each time, take a small cup with wine. This effectively cures various wind-induced illnesses.

Not only does this sound completely delicious and doable to me, I also realize how recipes like this are in fact completely grounded in the seasonal rhythm of biological life (I just saw a friend posting the harvest of fresh mulberries in her backyard in China).

In sum, what Qu You did in this book was to cull from a wide range of medical and non-medical sources (a rough count yielded over 60 different titles) for hints and tips on how to live according to the seasons. Some of his references were archaic almanacs that offered divinations on the most auspicious dates to travel, have sex, trim your nails, or remove grey hair, as well as dates one should abstain from such activities. Some were quasi-ethnographic accounts of “customs” (fengsu) in ancient cities that still lend to a viable reading as practical guides to festivities. Still others draw from esoteric Daoist literature on the preservation of vital essence (I have blogged on a related topic here), a decision on Qu You’s part that raised many eyebrows both during his lifetime as well as centuries later.

A Daoist talisman in Qu You, Si shi yi ji (1920 reprint of an 1836 edition).

We must remember that Qu lived through the Ming dynasty’s founder, Hongwu emperor’s reign (1368-1398) – a period known for its austere message of moral purity and simplicity. His fourth son, who usurped the throne shortly after Hongwu’s death to become the Yongle emperor (r. 1404-1424), was not exactly friend of the letters either. Those were not easy times for a literary aficionado with keen interests in morally dubious subjects, and yet Qu You continued to compose and comment on poetry, wrote short stories featuring ghosts and women, and collected esoteric recipes. He even managed to publish those works, prefacing them with loud self-defense of his moral stature. Qu eventually got into trouble, endured decades of exile in the north, and yet again outlived the Yongle emperor, who threw many a undisciplined scholars like him into jail, by three years.

Perhaps the seasonal recipes did work well for him after all?

‘Thus it prevails against its time’: distillation and cycles of nature in early modern pharmacy

By Tillmann Taape

In past centuries, devoid of freezers and heated greenhouses, the seasons affected medicines as well as foodstuffs. In addition to pickled vegetables and stored grain, early modern people worried about their provisions of healing plants and animal substances. These, too, had their season: many herbs were considered most powerful when picked in May, and ‘May dew’ collected from fragrant meadows at this time of year was said to have many healing properties. In his Destillierbücher (distillation manuals), published in the early sixteenth century, the Strasbourg surgeon-apothecary Hieronymus Brunschwig addresses the challenges which arise in pharmacy from nature’s cyclical changes. He explains that most preparations of fresh medicinal herbs are ‘unkeepable’. For example, ‘if you pound herbs, roots or other substances and squeeze the juice from it, then it becomes unpleasant, does not last, […] and soon putrid corruption ensues’.[1] Even with dried materia medica and compound drugs, their medicinal virtues faded over time.

Brunschwig knew this all too well from personal experience. As an apothecary running his own shop near the fish market, maintaining a stock of efficacious remedies was his chief responsibility and expertise. The issue of pharmaceutical provisioning was taken very seriously by Strasbourg’s magistrates. Twice a year, they would send round a committee of medical experts to all apothecary shops, to ensure that no perished goods were stocked, and to throw away any that had gone off.

An apothecary pounding medicines. Brunschwig, Liber de arte distillandi de compositis (Strasbourg, 1512), fol. 6v. © Wellcome Library, London

Brunschwig’s understanding of the material world was shaped by his experience as a pharmacist and shopkeeper, but also by the cosmology and medical theory of his day. While the heavenly spheres were characterised by material perfection and changelessness, all matter on earth was made up of the four elements (air, water,fire, earth) and subject to their constant permutations. They were doomed to endless cycles of generation, change, and decay. Material stability was only possible where the elements were in perfect balance, ‘as you can see in May when it is neither too dry nor too humid, neither too warm nor too cold’.[2]

Brunschwig’s seasonal simile is revealing: a perfect balance of elements is just as rare and fleeting as those precious few balmy weeks in May. As well as pointing to the instability of all earthly matter, the language of seasons and their cold, hot, dry or moist qualities was associated with early modern ideas about the stages of human life. Youth, health, reproduction, decline and death were analogous with the annual cycle of flourishing and decay in nature – a relationship which is richly illustrated in a set of anonymous seventeenth-century engravings (see here for an interactive digital reproduction). The idea of changing seasons was emblematic of an early modern view of the material world which was characterised by instability. Human bodies fluctuated with the shifting balance of their humours, and the very substances which could be used to cure the resulting ailments were themselves fleeting and, in Brunschwig’s words, ‘unkeepable’.

Faced with such difficulties, Brunschwig and others turned to a branch of knowledge with a longstanding commitment to imitating and manipulating natural processes underlying the transformations of matter: alchemy. In particular, Brunschwig describes distillation as a powerful artisanal technique to ‘keep the unkeepable’.[3] Distillation was the art of separation, and in the case of medicinal simples, Brunschwig claimed, their ‘soul’ or healing virtue could be separated from their ‘body’, that is to say the material dross made up of the problematic four elements. Thus liberated, the healing ‘spirit’ of a plant in the form of a distilled water could be bottled and neatly stored on Brunschwig’s alphabetically ordered shelf, where they would keep well beyond their harvest season, for up to three years. Later Destillierbücher echo the idea that one can ‘keep these waters over the year’ as a major selling point of distilled remedies.[4]

While distillation in theory had the power to produce pure and incorruptible ‘quintessences’, this was far too laborious for everyday pharmaceutical practice. Brunschwig wrote for an audience of ‘common men’ as well as artisan colleagues, and most of the distilled remedies he discusses are much more pedestrian. They still have some of the elemental qualities of the original herb, and are ultimately perishable. Compared to ‘unkeepable’ plant juice, however, their decay is slower and more predictable. Brunschwig confidently charts the decline and change in a water’s healing powers over the years, and even gives instructions for ‘recharging’ them. A water can be saved by infusing it with fresh herbs and distilling it once more – thus, Brunschwig reassures his readers, a distilled remedy can ‘prevail against its time’ for another year.[5]

In the early modern world of matter, the seasons symbolised cycles of change and decay which spelled trouble for healers and makers of medicines. In some of the earliest vernacular works on pharmacy, Brunschwig describes distillation as a powerful tool for defying the material corruption of seasonal changes.

[1] Brunschwig, Liber de arte distillandi de simplicibus… (Strasbourg, 1500), sig. C1v.

[2] Brunschwig, Liber der arte distulandi simplicia… (Strasbourg, 1509), fol. 36v.

[3] Brunschwig, Liber de arte distillandi de simplicibus… (Strasbourg, 1500), sig. C1v.

[4] Eucharius Röslin, Kreutterbuoch von allem Erdtgewaechs… (Frankfurt, 1533), title page verso.

[5] Brunschwig, Liber der arte distulandi simplicia… (Strasbourg, 1509), fol. 18v.

 

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.