All posts by Elaine Leong

Storytelling and Practical Skills in Medical Recipes

By Ying Zhang

What constituted a medical recipe in late imperial China? Literati physicians often touted the efficacy of a medical formula by contending that it conforms to traditional order of the emperor and his officials. They might also praise the suitability of the drug combination for treating that individual body’s ills. (See discussion on drug knowledge in China elsewhere on this blog). While texts by literati physicians have attracted most scholarly attention, they might not contain some of the most widely circulated and used medical recipes in everyday settings. People in late imperial China had access to a wide range of vernacular texts to find a recipe for self-treatment. During this period, we see the circulation of many practice-oriented recipes through vernacular literature as well as personal networks. These sources included daily-use encyclopedias, almanacs, meritorious books, and fiction. These recipes functioned as a practical instruction for domestic use and a textual form that articulated practical health care knowledge through literary narratives. They highlighted the techniques of making medicine as an essential part of a medical recipe that non-expert could follow in their own homes.

The first page of the “Recipe from a bare-foot immortal for pills made with fish maw to help insemination.” Image credit: Berlin State Library.

One fascinating example which I’d like to bring to you today is the “Recipe from a bare-foot immortal for pills made with fish maw to help insemination,” which was collected and recorded in A Convenient Survey of Medical Recipes (Yifang bianlan), a manuscript written by a person with the sobriquet Gaoyangshi in the nineteenth century. This recipe presents a story at its beginning, which starts with the encounter in a certain famous mountain between an immortal and a sixty-one-year old men with the surname Zhou from Yunnan who has one wife and nine concubines but has been unable to conceive a child:

…[Zhou] talked about his family [with the immortal], saying that he does not have any children and asking for a good recipe. Moved by his sincerity, the immortal gave him a recipe. The medicine [made according to the recipe] has a character that is clearing but not cooling, warming but not heating. If men take it, [it] could strengthen the muscles and bones, invigorate the vitality, replenish the marrow, nourish the yin, and reinforce the primordial. If women take it, it could regulate the menstrual period, replenish the Blood, prevent miscarriage, regulate the qi, benefit the yin, and ease fertilization. Zhou bowed and received it [meaning the recipe] (bai er shou zhi), and refined and mixed [the medicine] according to the recipe (yi fang xiuhe)…

Following the story, the recipe lists the individual drugs required and, after each drug, it provides instructions on how to process it. For the chuan fuzi (Aconitum carmichalii Debx, Chinese aconite) from Sichuan, for instance, one needs to select the following:

Two pieces with each weighing four liang and five qian, cut off their sprouts and cut each of them into four pieces, soak them with raw gancao (Glycyrrhiza uralensis, Licorice) water for seven days, change the water every morning, and then cover them with half jin of wet flour, heat until cooked over a slow charcoal fire, cut them into pieces, and then heat to dry.

At the end of its drug list, the recipe summarizes, “to cook and make the listed drugs according to the [described] methods” (yi shang zhu yao ru fa paozhi). The word “paozhi” here refers to processing the drugs according to the methods listed under each drug. The recipe then continues with instructions on how to grind the drugs into powders and mix the powders into pills, and also explains the way to take the medicine.

It is interesting to note that the story at the beginning of the recipe uses the word “yi fang xiuhe,” a more general term referring to all of the work from processing individual drugs to mixing them together into pills. It suggests that the recipe worked well exactly because Mr. Zhou made the pills following all the technical details required by the recipe as a way of self-cultivation and demonstrated his piety in the making process. It was Mr. Zhou, not any physician or pharmacy, made the pills. The narrative episodes not only validated the efficacy by stating the mythical origin of the recipe, but also affirmed the efficacy by stating that this Mr. Zhou then had seven sons after taking the pills and lived to ninety-seven years old. They thereby presented the production of medicine as a personal endeavor that anyone could pursue. While the recipe exhibited a world of practical skills to handle medical substances and required utensils, the story advertised these specialized skills of drug processing as everyday household knowledge. The story also functioned to attract collectors through literary embellishment. This was especially desirable when recipes traveled out of medical contexts and became collectable artifacts in the context of literati sociability, connoisseurship, and moral practice. Recipes garnished with literary creation and moral teaching in this context usually encouraged its collectors to distribute it to more people to accumulate merit. Thus, when we exam the circulation and use of recipes out of medical context, we could find storytelling an essential part of medical recipes intended for household use.

Ying Zhang received her Ph.D. degree from Johns Hopkins University in 2017. Her dissertation titled “Household Healing: Rituals, Recipes, and Morals in Late Imperial China” investigates China’s rich tradition of household healing practices and reinterprets these practices in relation to religion, gender roles, and morality from the seventeenth to the early twentieth century. Drawing on a wide range of texts people used in their daily healing practices and texts about household healing, this research contributes to a deeper understanding of the heterogeneous health-related practices beyond the domain of learned medicine. It demonstrates the various ways in which the home served as a central site of healing technology in late imperial China. Through the study of the circulation of health related texts, it also sheds new light on the circulation of information in the context of literati sociability, philanthropic activities, and religious commitment in late imperial China. She can be reached at yzhang82@jhu.edu.

Water to Drink: Fit Only for Invalids and Chickens?

By David Gentilcore 

Jean-Baptiste Labat, Voyages du P. Labat de l’ordre des FF. Precheurs, en Espagne et en Italie (Paris: Jean-Baptiste Delespine, 1730) © Bibliothèque nationale de France

When the French Dominican Jean-Baptiste Labat was captured by the Spanish in the 1690s, and offered water to drink aboard ship, he informed the chaplain that ‘only invalids and chickens drink water in my country’ (Labat 1722). Perhaps this comes as no surprise. If people in past times drank plenty of wine and beer, historians generally assume, this was because the water was risky and potentially unhealthy, perhaps even fatal. But that is to project our own modern conception of water – for example, as a disease-carrying agent – into the pre-modern past. Labat’s aversion to water as a beverage, as expressed in this anecdote (and as the teller of the stories he always gets the best lines!), was due not so much to concerns about its poor quality as to biases inherited from classical culture. As a drink of the lower classes (and animals), water was often described in unflattering terms, especially when compared to what was considered the beverage par excellence – wine (Squatriti 1998). And indeed, in his account, wine is exactly what Labat goes on to request.

However, if we look at actual practices, water returns to the fore. Not only does Labat then proceed, very laboriously, to temper his wine with water, as was the usual way of drinking wine in much of pre-modern Europe; his very successful published mixtures of travelogue, memoir and natural history positively abound with references to water. Every place he visits, Labat describes the nature of the fresh-water supply, and the varied techniques used to harvest, store and access it. In Labat’s eyes a town without its own reliable supply, like Cadiz, is one that would not be able to survive a siege. He is impressed by the technology of water, in particular aqueducts, but even more by water as display. This is evident in his detailed and enthusiastic descriptions of the ornamental fountains present in many Italian towns and cities. And he gets so carried away by his instructions on how to construct a rainwater cistern, the fruit of his own experience overseeing the establishment of a Dominican monastery in the French Antilles, that he repeats them in at least two separate works (Labat 1728; Labat 1730).

 

The Tivoli waterfall, as Père Labat might have seen it (not to be confused with Niagara Falls).

Even limiting ourselves to his account of Spain and Italy (Labat 1730: in eight four-hundred-page volumes!), Labat’s knowledge and curiosity regarding water and its uses is amply evident. How the clean, clear and pure water of Tivoli’s waterfall, which he compares to Niagara Falls no less, becomes full of silt and mud when it rains, making it unhealthy, or how the bouillantes (boiling) waters of a spring on the outskirts of Viterbo remind him of the spring of that name in Guadeloupe (French Antilles). Siena’s ‘magnificent’ fountain in the main square (the Fonte Gaia) provides a ‘prodigious quantity of very good water’, whilst the numerous fountains of Rome are both delightful and necessary, since the water from the River Tiber ‘is good for nothing’. He notes the high number of itinerant water-sellers in Naples, despite the public fountains on every street, and how in Spain they are registered and taxed, like all other shopkeepers and pedlars. He praises the ‘light’ waters of Bologna and the ‘admirable’ waters of Naples, in tune with the eighteenth-century Hippocratic revival of the importance of ‘airs, waters and places’ in the pursuit of health. He describes various healing springs and the different diseases they are good for, whilst noting that local doctors were rarely much in favour, since ‘nothing disconcerts doctors more than natural remedies’. He remarks on the priest so afraid of water that he wouldn’t even wash his hands, or the doctor who quickly realised that the best remedy for disease was fresh water to drink, rest, a change of air and, most of all, plenty of patience.

We know from a wide range of other sources that communities went to great lengths to procure clean water, from elaborate public works, like aqueducts, conduits and fountains, to the construction of public and domestic rainwater cisterns, to the everyday presence of water-sellers in larger towns. If I gave drinking water rather short shrift in my recent study of food, diet and health (Gentilcore 2016), it at least means that I can now devote a research project entirely to the ‘water cultures’ of early modern Europe and the Mediterranean. It is already evident from work in progress that doctors went from being circumspect in their advice regarding drinking water, during the Renaissance, to great enthusiasts for table water as a ‘universal cure’, effective both in preventing and treating disease, during the eighteenth century.

Whatever his own personal drinking preferences might have been, the widely travelled Père Labat turns out to be a connoisseur of waters. Although his enthusiasm occasionally gets the better of him – the water-sellers of Naples were actually a necessity in a city perennially short of fresh water – Labat provides a generally reliable and entertaining introduction to the importance of water and its provision throughout the early modern world.

David Gentilcore is Professor of Early Modern History at the University of Leicester. His research interests lie in the medical, dietary, social and cultural history of early- and late-modern Italy. He is the author of seven books and his most recent monograph is Food and Health in Early Modern Europe. Diet, Medicine and Society, 1450-1800 (Bloomsbury, 2015). Our blog readers interested in the history of food might also be interested in David’s books on the potato and the tomato in Italy.

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Jean-Baptiste Labat, Nouveau voyage aux Isles de l’Amérique (Paris: Pierre-François Giffart, 1722), 6 vols. A heavily abridged translation by John Eaden was published as The memoirs of Père Labat, 1693-1705 (London: Frank Cass, 1970 [first ed. 1931])

Jean-Baptiste Labat, Nouvelle relation de l’Afrique occidentale (Paris: Guillaume Cavelier: 1728), 5 vols.

Jean-Baptiste Labat, Voyages du P. Labat de l’ordre des FF. Precheurs, en Espagne et en Italie (Paris: Jean-Baptiste Delespine, 1730), 8 vols.

Paolo Squatriti, Water and society in early medieval Italy (Cambridge: Cambridge University Press, 1998)

David Gentilcore, Food and health in early modern Europe (London: Bloomsbury, 2016)

 

The Live Chicken Treatment for Buboes: Trying a Plague Cure in Medieval and Early Modern Europe

By Erik Heinrichs 

Titlepage of Philippus Culmacher’s plague treatise, Leipzig: circa 1495
Credit: Wellcome Library, London.

While researching German plague treatises I became fascinated by one odd treatment for buboes that appeared again and again, despite sounding so far-fetched. One sixteenth-century version calls for plucking the feathers from around the single hole in a chicken’s backside, then placing it on a person’s bubo. The instructions say to hold the chicken on the bubo until it dies, when it must be replaced with a new chicken, similarly plucked. I soon dubbed this the “live chicken treatment for buboes” and after years of casual encounters I began to track the recipe more systematically. As strange as it sounds, versions of this “live chicken treatment” were fairly common in plague writing, beginning with the Black Death and lasting, amazingly, into the eighteenth century. Tracing the long history of this recipe led me to explore questions such as: Where might this come from? Why chickens? Why might healers think that this was a good idea? Did anyone actually try this or is this all theoretical? As a historian, I was also interested in change over time within the recipe. Here I found much to explore, as I followed the recipe’s twists and turns over a seven-hundred year period, roughly 1000 to 1700.

The “live chicken treatment” turns out to have a long history, indeed. Its origins seem to lie in Avicenna’s Canon of Medicine, although it may be older than that. Chickens and chicken broth were a common source of medicine in early times, probably because chickens were such ubiquitous and useful animals since antiquity. Not only did Avicenna praise chicken broth for its general benefits for the body, but he also recommended placing a cut chicken on a poisonous bite or sting in order to fight poisons. In later centuries European physicians turned to Avicenna’s advice when they faced the mysterious and devastating epidemics of the fourteenth century. As Europeans emphasized the poisonous nature of the plagues around them, older treatments for poisons drew new attention. The first mention of using a chicken rump to draw poisons out of a bubo appeared in the very first plague treatise of 1348, coming in response to the so-called Black Death. Here the Catalan author Jacme d’Agramont seems to have introduced a novel and lasting adaptation of Avicenna’s recipe, although the “cut chicken” version persisted in plague treatises for centuries to come.

Most interesting for the history of trying and testing cures are the many variations of the “cut chicken” and “chicken rump” versions of the treatment, as well as physicians’ comments about how effective they are. Especially after 1400, physicians seem to be thinking about this recipe quite often as they seek practical treatments for the plagues of the time. Physicians were preoccupied with altering the recipe in order to reason out the nature of the mysterious poisons underlying the plague. Some add substances to the process, such as salt placed on top of the chicken as it is placed on the bubo. During the fifteenth century, a number of German physicians began to explain the treatment’s workings in a strikingly physical way—that the chicken breathes through its backside and thus pulls the bubo’s poisons into itself. This change led to the suggestion to hold the chicken’s beak shut during the treatment in order to force the chicken to breathe from below. My article (accessible here) show how all aspects of the treatment changed over time as physicians engaged with the recipe, including the quantity of chickens used, the amount of time required, and even the type of animal in question. This work demonstrates the importance of the recipe itself as a platform for thought, experimentation, and communication among physicians.

Perhaps a surprise to modern readers, many physicians praised their version of the “live chicken treatment,” describing it as effective and desirable. Such comments multiply after the introduction of print, which encouraged the production of plague treatises, some fitted with fetching cover illustrations for the marketplace (see image below of Philippus Culmacher’s treatise of circa 1495). In German-speaking lands especially, sixteenth-century physicians used their printed plague treatises to promote their own services and expertise at a local level.[1] This brought about a change in the genre whereby physicians seem more eager to discuss their own experiences with effective recipes in order to appeal to the practical interests of a broad audience. Amidst this change comes evidence that some German physicians witnessed first-hand the successful use of the “live chicken treatment.” Another interesting change during the sixteenth century is the increased attention to the bodily warmth of the chicken as the treatment’s active healing force. These emergent views provide a tantalizing link to modern medicine, since moist heat remains one of the treatments for buboes today. For more information, please read my article.

Erik Heinrichs is an associate professor of history at Winona State University (Minnesota). His interests are the history of medicine and religion in the late medieval and early modern periods. His book Plague, Print, and the Reformation: The German Reform of Healing, 1473-1573 will be published by Routledge this November.

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[1] For a survey of German plague treatises from the first century of print, see: Erik A. Heinrichs, Plague, Print, and the Reformation: The German Reform of Healing, 1473-1573 (London: Routledge, 2017).

True but not Tested: Experimentation in the Apothecary’s Shop

By Valentina Pugliano

Testing and standardization are firmly entrenched in the pharmacological imagination of western biomedicine and its public. Before a new drug can be put on the market, the U.S. Food and Drug Administration demands five rounds of trials. Approximately 70% of new ‘recipes’ fails to pass the first round. Similarly, the European Medicines Agency maintains a database of adverse drug reactions (EudraVigilance) which, growing of one million entries yearly, is used to monitor all pharmaceuticals on sale across the European Economic Area. Meanwhile, the media seizes upon the perils of untested cures as if on morality tales, policing the boundaries of modern science from potential intrusion from the miraculous and the charlatanesque.

Yet, can the same be said of premodern drug manufacturing? Was a drug’s efficacy established by testing? And what did ‘testing’ recipes even mean in the sixteenth and seventeenth centuries? When these questions were suggested at Elaine Leong and Alisha Rankin’s Testing Drugs, Trying Cures Workshop in 2013, I began to look for answers among those early modern medical practitioners who most closely resemble the pharmaceutical industry of our times, combining the manufacturing of a Glaxo Smith-Kline and AstraZeneca with the retailing of Boots and Walgreens: apothecaries. [1]

Pharmacy shop, Tacuinum sanitatis, 16th century (BNF, MS Latin 9333, fol. 51v).

While not corporate giants, apothecaries thrived in every large hamlet and town of Italy, reaching spectacular numbers in metropolises like Rome, Naples, and Venice. Unlike free-lance alchemists and empirics, they belonged to the city’s official infrastructure of healthcare: they worked from a licensed shop, trained through formal apprenticeship and, like physicians and surgeons, belonged to a professional association or arte. This ‘trade brotherhood’ gave them bargaining powers but also subjected them to standardization rules and quality controls. As disgruntled masters testify from the archives, in severe cases of infraction the apothecary could see the remedies he had belaboured on for weeks thrown into the gutter or burnt to ashes.

So what did it mean to have ‘correct’ remedies that passed the test of shop inspections and satisfied “God and the public good”? As a historian of artisan knowledge I have learnt that infractions, those occasions when things go (deliberately) wrong, sometimes provide the best clue to understanding which methods of doing things were considered orthodox in the crafts. Apothecaries loved to speak of the abuses supposedly perpetrated by their colleagues. In Florence, for example, they conned customers by mixing expensive guaiac wood with the bark of mulberry trees. In Mantua and Padua, those with a fever and a bad stomach better beware the Lenitive Electuary, regularly adulterated with black sugar (instead of its fine white variety) and counterfeit tamarinds (mimicked by a paste made of old cassia and badly preserved dates ).[2]

Tamarinds

These complaints were not the only ones to be voiced, but they are telling. They are not motivated by protestations from patients, who are remarkably absent from the writings of early modern apothecaries. Nor are they driven by doubts about the method employed to make the remedy from a set of instructions. While household experimenters and professors of secrets were always seeking new formulas and ways to stabilise them, the corpus of remedies sold in sixteenth-century Italian pharmacies was fairly stable, and so were their recipes.

What these criticisms suggested, rather, was that medicinal ingredients possessed a purity, and that this purity had been tainted. The rogue apothecary had played around with the ‘honesty’ of simples, diluting their strength or altogether replacing the ‘sincere originals’ prescribed in the recipe with fraudulent alternatives (often from the kitchen pantry).

With this concern for authenticity in mind, I returned to the apothecaries’ writings, and especially to two bestselling pharmacopoeias, Girolamo Calestani of Parma’s Observations on the Antidotes and Medicaments Most Used in Italy (1562), and Giorgio Melichio of Venice’s Warnings on the Compound Remedies in Use in Pharmacy (1575). Leafing through these texts, I made a curious discovery. Repeatedly, key plant and mineral ingredients in their recipes were referred to according to their reputed truth or falsity: e.g. “true cinnamon”, “true rhaponticum”, “false stibium”, “false balsam”. Repeatedly, apothecaries stressed the importance of sourcing these authentic materials, while their absence was said to ruin the preparation.

Even the use of substitutes began to be criticised. The practice of substituting one ingredient with another possessing similar qualities (quid pro quo), usually a local simple for an exotic import difficult to acquire, had been necessary since antiquity. Yet, the changing attitude to substitutions in the sixteenth century is summarised well by the Neapolitan physician Bartolomeo Maranta: “Substitutes are an abuse.” Never more so than for Theriac, the most celebrated antidote of Italian pharmacy and the toughest to prepare with over sixty ingredients. A Theriac with substitutes instead of true ingredients, Maranta declared, “will be itself in a certain way sick”.[4]

How should we interpret such appeal to the truthfulness of ingredients? At a superficial level, we can understand the apothecary wanting to reassure the public of the genuineness of his wares. After all, practitioners of pharmacy were often portrayed as profiteers and cheats. But, as I argue in my article “Pharmacy, Testing and the Language of Truth in Renaissance Italy,” something else had changed between the medieval period and the 1540s, when this terminology of trues and falses appears: Greek and Roman books on materia medica were reintroduced into western Europe. It is well known that the reappearance of Dioscorides’s On Medicinal Plants, Theophrastus’s On Plants and Pliny’s revised Natural History created as many problems as it solved for those who wished to implement their teachings. Many of the Mediterranean and Levantine simples described in them remained entirely unavailable during the sixteenth century, while many others were plagued by problems of identification and nomenclature.

My sense is that this ‘Language of Truth’ was an intervention into this state of affairs. It helped the apothecaries get a grip on which was which among rare ingredients, and reflected their aspiration, shared with many contemporaries, of restoring the wisdom of the ancients. It also showed the increasing influence on pharmacy of the contemporary botanical renaissance and the ethos of naturalists who, for the first time, put nature in the foreground, liberating flowers, trees, animals and rocks from the need to be useful.

Crucially, authenticity came to replace experimentation. As ingredients acquired more importance in the apothecary’s mind, the efficacy of the recipe began to be pegged to their presence and quality. Providing the remedy contained the true, correct ingredients its efficacy and fitness for human consumption would be guaranteed, with no need to involve test subjects or pursue the feedback of patients and colleagues. How much this ‘testing by truth’ differed from modern-day trials becomes clear when we turn to the contemporary idiom of the pharmaceutical industry: it is as if the apothecaries’ R&D stopped at the preclinical stage.

 

Notes:

[1] V. Pugliano, “Pharmacy, Testing and the Language of Truth”, Bulletin of the History of Medicine 92/2 (2017): 233-273. See also the other articles in the same issue of BHM.

[2] Ricettario Fiorentino dell’Arte dei Medici e Spetiali di Firenze (Florence, 1574), pp. 45, 74; Giovanni Antonio Lodetto, Dialogo degl’inganni d’alcuni malvagi speciali (Padua, 1572), pp. 21-22.

[3] Giorgio Melichio, Avvertimenti nelle compositioni per uso della spetiaria (Venice, 1601), pp. 27-28.

[4] Bartolomeo Maranta, Della Theriaca et Mithridato libri due (Naples, 1572), p. 33.