Category Archives: Alisha Rankin

Anecdotes and Antidotes

By Alisha Rankin

How did early modern individuals test and try their recipes and cures? This question is at the heart of the special issue of the Bulletin of the History of Medicine, “Testing Drugs and Trying Cures in Medieval and Early Modern Europe,” in which I participated as both a co-editor and an author. My article, “On Anecdote and Antidotes: Poison Trials in Early Modern Europe,” examines the ways in which early modern practitioners tested a specific kind of cure: antidotes to poison. It contains some information I discussed in earlier posts on this blog – here and here – but adds many details and thoughts about testing in general. Most cures, I argue, tended to be tested in the course of regular clinical experience. A patient got sick; a practitioner tried a particular remedy, observed the results, and frequently shared anecdotes of success or failure. The scale of this kind of testing could be small or large, but in most cases it involved patients who were already sick.

Poison antidotes were a little different, because practitioners could actually create the condition of illness by giving poison to a test subject. In 1563, for example, the royal surgeon to Holy Roman Emperor Ferdinand I, Claudius Richardus, wrote a letter describing the marvellous virtues of bezoar stone. As avid Harry Potter readers will know, bezoar was an animal byproduct prized as a poison antidote and cure-all. Richardus recounted a series of marvellously successful tests he had conducted on bezoar at the Emperor’s behest. In two of them, patients received bezoar in the midst of a serious illness – the usual practice. In the other two, bezoar was tested in contrived trials on condemned criminals.[1]

Bezoar stones from the imperial Kunstkammer, Kunsthistorisches Museum Vienna. Photo by Alisha Rankin.

This second kind of test – which I call a poison trial – has a long history dating back to antiquity. Many ancient kings, most famously Mithridates VI of Pontos (135-63 BCE), used condemned criminals to test poison antidotes, from which he developed his famous antidote and cure-all, mithridatium. The Greco-Roman physician Galen reportedly tested theriac, a derivative of mithridatium, on roosters, and versions of this test appeared in the writings of several Arabic physicians, including Avicenna’s highly influential Canon of Medicine.[2] Medieval physicians repeated the description of Galen’s test as well. However, poison trials tended to be described as theoretical tests that one could conduct rather than as anecdotes about tests that had actually taken place, and they were mainly suggested as a means to test whether a batch of theriac was inferior, fraudulent, or old – not whether theriac actually worked. From the time of Galen, moreover, poison trials were conducted exclusively on animals, not humans. The dominant argument for the efficacy of these drugs remained anecdotal reports of their use on sick patients.

In the Renaissance, poison trials expanded significantly, as did their role in medical communication. From the 1520s, powerful rulers began to revive the gruesome tradition of using condemned criminals to test a variety of poison antidotes – not just theriac. In addition, these tests were reported and circulated as anecdotes rather than being described as theoretical suggestions. The first known example comes from Rome in August 1524, when Pope Clement VII directed his medical personnel to test an antidote oil created by the surgeon Gregorio Caravita. He granted the medics two Corsican criminals who had been condemned to death by beheading. Both prisoners were given a strong dose of the deadly herb wolfsbane (aconitum napellus). Caravita then anointed one prisoner with the oil. The other, a “savage spirit,” was given no antidote. The first man survived; the other died in much agony.

Testimonium de verissima ac admirabili virtute olei compositi contra pestem & omnia venena (Rome, 1524), BNF.

A second successful test was conducted on a Mantuan prisoner given arsenic. Soon thereafter, the medical personnel published a public service pamphlet describing these trials in detail.[3]

A shorter version of this anecdote also appeared in the famous herbal published by Italian physician Pietro Andrea Mattioli in 1544 (with a Latin version in 1554). Mattioli’s influence helped spread poison trials around Europe. From 1561-67, a number of contrived trials on condemned criminals took place under powerful princes, including Emperor Ferdinand I, King Charles IX of France, and Duke Cosimo II de’Medici. Significantly, royal physicians and surgeons spearheaded these poison trials, and they communicated the results in anecdotes that appeared both in private documents and printed books. Claudius Richardus’s bezoar trials were part of a series of such events.

These anecdotes demonstrated careful thought in how the trials were devised and conducted. They described the trials in in excruciating detail, including the number of times a prisoner had vomited and defecated as well as the hour at which these events had occurred. In some cases, physicians attempted to created conditions that would lead to a useful outcome. Richardus’s letter described how food was withheld from a prisoner before the test, “so that one could be more certain of the trial.” This step came in response to a previous case in which the physicians had trouble getting the poison to work. Finally, physicians took care in reporting and circulating their reports about the trials, clearly imbuing them with significance. A series of poison trials on dogs conducted in 1580 by a German prince circulated in both manuscript and print as a detailed Observatio, a report intended to be shared.

Poison trials represented only a miniscule part of drug testing in early modern Europe. Indeed, anecdotes about drugs used successfully on sick people helped drive the interest in new drugs from around the globe, as described in this post by R.A. Kashanipour. Nevertheless, the anecdotes about antidotes demonstrated significant developments in both testing practices and medical communication. To find out more, read my article!

 

[1] Richardus’s letter, to Archbishop Nicholas Olahus, was later published in Latin and German. Thomas Jordan, Pestis phaenomena (Frankfurt, 1576), 621–630; Johann Wittich, Bericht von der wunderbaren bezoardischen Steinen (Leipzig, 1592), 21.

[2] Galen’s poison trial appeared in the treatise On Theriac to Piso, which may be spurious. However, scholars in the Islamic world and Europe assumed it was authentic. See Robert Leigh, On Theriac to Piso, Attributed to Galen: A Critical Edition with Translation and Commentary (Leiden: Brill, 2016).

[3] The pamphlet was signed by the physician Paolo Giovio, the apothecary Tomasso Bigliotti, and the senator Pietro Borghese. Testimonium de verissima ac admirabili virtute olei compositi contra pestem & omnia venena (Rome, 1524).

Testing Drugs and Trying Cures

By Elaine Leong and Alisha Rankin

Miniature (no. 37.181) from 15th century manuscript in Dresden: Galen, and assistant with a pestle and mortar, and a scribe in an apothecary’s shop. © Wellcome Images

As readers of this blog well know, early modern Europe was aflood with recipes and drugs. One central question has long preoccupied many of us –  just how did our historical actors assess, test and try out recipes, drugs and materia medica? A few summers ago, a group of historians of science and medicine gathered to discuss just this question. This month, we present our ideas and findings in a special issue of the Bulletin of the History of Medicine. To celebrate the launch of the special issue, several authors of the volume will share their work on The Recipes Project. Tuesday’s post revisited Ashley Buchanan and Tillmann Taape‘s report on the original 2014 conference. Over the next few weeks, we’ll learn more about the research of Erik Heinrichs, Valentina Pugliano, Alisha Rankin and Justin Rivest. Finally, Tillmann Taape, who just completed his PhD at the University Cambridge (congrats!) also adds his voice to the series by reflecting on how theme of drug testing features in his doctoral dissertation.

To get us started on our month of ‘Testing Drugs and Trying Cures’, we wanted to say a few words as the organizers and editors of the project. First, you might ask, what do we mean by ‘Testing Drugs and Trying Cures’? Over the course of the project, we found that it was useful to view ‘testing drugs’ and ‘trying cures’ as two overlapping but distinct phenomena.

As the essays in the special issue show, physicians and apothecaries developed clear rules and practices for testing drugs as materials – from sensory analysis of materia medica to chemical analysis of substances like mineral waters or alchemical medicines. This kind of ‘testing drugs’ largely focused on gaining knowledge on the substances’ medicinal properties and played a particularly significant role in the discovery and adoption of materia medica from the New World and in assessing and establishing authenticity of exotic and/or expensive medicaments.

Paolo Antonio Barbieri, The Spice Shop, 1637. Image from Wikimedia.

‘Trying cures’, on the other hand, describes the widespread practice of trying remedies and other kinds of cures on human bodies. If ‘testing drugs’ was mainly conducted by learned physicians and apothecaries, ‘trying cures’ was performed by a broad range of healers. Within the home, women and men applied and observed the effects of remedies on family and household members. Likewise, physicians and other practitioners prescribed diets, medicines and other cures to their patients, again observing and recording the effects. Ample evidence of this kind of ‘trying cures’ survive in a range historical sources from the use of ‘probatum est’ to expressions of personal experience, customisation and rejection of recipes in household recipe collections (for more on this, see posts here and here).

For us, these two categories ‘testing drugs and ‘trying cures’ serve as helpful heuristic tools to untangle the assessment practices used by early modern practitioners. We see the two categories not as separate boxes but rather as overlapping and often intertwined practices. Many healers merged testing and trying by using patient tests to determine a substance’s properties or to refine methodologies in both drug production and application. These themes of testing and trying occupied a central place in the making of medical knowledge across a vast chronological span and broad geographical regions and social contexts. The essays in the special issue examine these crucial knowledge practices in Europe c. 1300-1800 (go here for a table of contents).

Several main themes emerged from this collaborative project. First, medicine was always an experiential art and the essays in the special issue demonstrate clear continuities between the learned physicians’ uses of experience/experiment in the Middle Ages and early modern experimental interests. Learned medicine made deliberate use of experience from a very early date and pharmacy was an area where the gathering of experiential knowledge was particularly pronounced. The senses – touch, taste, smell, sight and hearing – played vital roles in determining the properties of drugs and their effects on the human body.

Concurrently, as many essays in the volume demonstrate, structured drug testing had a long history. Medieval physicians developed meticulous rules for drug testing, as Michael McVaugh’s essay shows, although they left no record of actual medical trials. This focus on establishing protocols for drug testing continues throughout the medieval and early modern period, with significant expansion in scale and scope. By the eighteenth century, the testing of mineral spa waters (in Michael Bycroft’s essay) or proprietary drugs (in Justin Rivest’s essay) became large-scale undertakings situated in learned academies and hospitals.

When taken together, the essays in the ‘Testing Drugs and Trying Cures’ special issue collectively argue that ‘experimental thinking’ played a crucial role in learned assessments of medicine and drugs throughout the Middle Ages and early modern period. From the time of Galen, drug testing was structured and evidence-based with an aim to produce transferable results. For us, this fascinating and multifaceted story of premodern drug testing enriches and extends current histories of experimentation and we hope that our explorations into topic will inspire others to join us too!

Further Reading and Acknowledgements:

This post is a very condensed version of Elaine Leong and Alisha Rankin’s ‘Testing Drugs and Trying Cures: Experiment and Medicine in Medieval and Early Modern Europe’, Bulletin of the History of Medicine, 91 (2017), 157-182. The full version of the article is available here. The entire special issue is available here.

The ‘Testing Drugs and Trying Cures’ project was funded by the Max Planck Society as part of the Minerva Research Group’s ‘Reading and Writing Nature in Early Modern Europe’.  We also extend our grateful thanks to all the participants of the 2014 workshop, the editors of the BHM and the anonymous reviewers of the articles in this special issue.

Writing Early Modern Medicine for Medical Readers

Poison trials on dogs conducted by Landgrave Wilhelm IV of Hesse-Kassel in 1580. Universitätsbibliothek Heidelberg, Cod. Pal. germ. 177
Poison trials on dogs conducted by Landgrave Wilhelm IV of Hesse-Kassel in 1580. Universitätsbibliothek Heidelberg, Cod. Pal. germ. 177

By Alisha Rankin

Years ago, in a recipe collection belonging to Countess Elisabeth of the Palatinate (1552-90), I found a fascinating entry: a copy of an official document that described trials of a poison antidote on dogs, which I described in a post on this blog. My interest in that document has expanded into an entire book project on poison trials. Because these trials feel vaguely like an antecedent to modern clinical trials (with many twists and turns along the way), I’ve found that this project has provided an exciting opportunity to introduce early modern medicine to a medical audience. Last month Justin Rivest and I had the privilege of publishing a short piece, “Medicine, Monopoly, and the Pre-Modern State: Early Clinical Trials,” in the New England Journal of Medicine. Just a few days later, I published a blog post titled “Poison Trials on Condemned Criminals under Pope Clement VII: A Medical and Moral Testimonial” for the Sperimento blog, run by the Medici Archive Project. The juxtaposition of these two pieces, of similar length and on similar topics but in two very different venues, led me to reflect on writing history for non-experts, and on how different it is to write for doctors than for historians. Because the Recipes Project blog intends to reach a wide audience, I thought it might be interesting to jot down some thoughts on the experience here.

Testimonium de verissima ac admirabili virtute olei compositi contra pestem & omnia venena (Rome, 1524), BNF.
Testimonium de verissima ac admirabili virtute olei compositi contra pestem & omnia venena (Rome, 1524), BNF.

Writing the Sperimento piece felt very familiar. The blog is intended to introduce a specific document in early modern Italian science and/or medicine, so I picked a Latin pamphlet published in 1524 on the authority of Pope Clement VII. The pamphlet described three poison trials conducted on condemned criminals and was intended to show the wondrous workings of an antidote oil created by a surgeon named Gregorio Caravita. I reflected on the religious and moral undertones of the document, and I included several footnotes with the original Latin. It was a pretty typical blog piece – fun to work on and quite helpful to write, as it forced me to sit down and meticulously make my way through the pamphlet. (I had hoped to find a recipe for the oil at the end of the pamphlet, but sadly the recipe remained Caravita’s secret – although Jo Wheeler included a later Medici version in his book.)

The NEJM piece, on the other hand, was far harder. We had to plan the article out very carefully. The word limit was officially 1,200 (although they happily ended up being a little flexible!), and it needed a lot of framing on each end. Justin is an expert in seventeenth- and eighteenth-century France, and I was highlighting work from sixteenth-century Germany. That left each of us just a couple of short paragraphs to present our case from our own research and to tie everything together. This is apparently the first time the NEJM has published a piece on early modern medicine, so we tried our best to make it fit into categories that medical readers would find familiar. That meant keeping modern medicine as the standard against which we compared our historical case. It also – helpfully – forced Justin and me to come up with a coherent narrative over a long period of time.

The hardest part – for me at least – was the footnotes. The journal allowed only five references, which was very hard for two historians with two completely different sets of research that drew on archives as well as printed sources. Justin and I worked and worked to get it down to the requisite number and felt pretty good about the result. Then the peer reviews came back – and the editor clarified that five references meant individual references, not footnotes. Because some of our footnotes contained multiple sources, we had to cut out an additional six references. Uff. We simply had to give up on documenting everything, and I learned how uncomfortable that made me. Would historians think that the article was shoddily researched? Maybe, but I kept reminding myself that historians were not the main audience, an important distinction when I had to choose between my archive and an important English-language journal article. Were I writing for historians, I almost certainly would have picked the archive, to show all the great (hard!) research I’d done. In this case, I went with the article, on the theory that an interested reader could follow up with it more easily.

The fun part of writing for the NEJM was thinking about how to make early modern medicine seem something other than “wrong.” We went for the basic takeaway point that trials (even in a very, very early form) have been used to assess drugs for a really long time. I also did a short podcast with the journal, to expand on certain points. I didn’t have the questions in advance, and I couldn’t help but cringe a bit when the interviewer straightforwardly referred to our historical actors as “scientists” and “researchers,” but in some ways that was validating, as it suggested he was treating our subject with respect.

A truly interesting coda was what happened afterwards. Both the NEJM article and the Sperimento post made the rounds on social media. Interestingly, the latter appears to have been of more interest to early modernists, at least judging by the re-tweets I saw on my Twitter feed (perhaps those footnotes mattered after all!). The NEJM piece, in contrast, really did reach physicians. While we did not receive any major press attention, Tweets came literally from all over the world. Looking at this metrics map of where the article was read was really fascinating:

NEJM page views

I hadn’t quite thought about how far-reaching a top medical journal is – that short essay may well be the most widely read thing I ever write. Most gratifyingly, I received a lovely e-mail from a former student – now a doctor – who was delighted to see his old professor pop up in an unexpected place. But overall, the consensus from Twitter appeared to be “Wow! I had no idea that people were testing drugs that early!” In some ways, that is exactly why we do public history – to make people look at the past a little bit differently and, hopefully, to put modern trends in context. Being forced out of your comfort zone (footnotes!) also makes you think carefully about what message you really want to share. And of course readers of this blog will not be surprised to learn that recipes can lead you to all sorts of unexpected places!

Recipes and Experiment: A Poison Trial on Dogs

By Alisha Rankin

To what extent did early modern individuals experiment with their recipes and cures? I puzzle over this question quite a bit in my research, as I see fleeting evidence of experimentation in letters and other documents, but it is always hard to pin them down. Every once in awhile, however, I find an entry in a recipe collection that shows without a doubt that ample experimentation was going on.

And so it is with this fascinating entry bound into recipe collection belonging to the Princely Palatine Library in Heidelberg (Biblioteca Palatina), compiled by Countess Elizabeth of the Palatinate-Lautern (1552-85). The document is an account of a trial conducted in the city of Kassel by the ruling Prince, Wilhelm IV of Hesse-Kassel (1532-92). Wilhelm was known for his scientific endeavors, especially his interest in astronomy, but this document shows that he had medical interests as well.

Codex palatinum germanicum 177
University of Heidelberg Library, Codex palatinum germanicum 177

The text begins by explaining that, on St. Jacob’s Day [July 25], 1580, the landgrave had “tried” a poison antidote, terra sigillata, on dogs. It continues on to detail eight different tests of the antidote: in pairs, two dogs were given a poison, and only one received the terra sigillata. The details of the effects on each poor dog are carefully recorded, numbered 1 through 8. Interestingly, the recipe is half in German, half in Latin: in each case, the description of the dog and what poison he was given was recorded in German, with the outcome in Latin. The entire document has the feel of a rather formal report. Because the antidote appeared successful – all of the dogs who took it survived, while the ones who did not eat it died – it represented a testament to a potentially potent cure for poison. Clearly, the court in Kassel found the results significant enough to share; an even more detailed version appears in print.

Now, there are many fascinating aspects to this document, and it plays a starring role in my book-in-progress on evaluating poison antidotes. In this post, however, I’d like to focus on its place in the recipe collection of Countess Elisabeth. Like many noblewomen, Elisabeth was active in making medicines, at least according to physician Jacob Theodor Tabernaemontanus, who dedicated a book to her in 1577. Several of the recipe collections in the Bibliotheca Palatina can be traced back to her, as the fabulous digitization project led by Karin Zimmerman has shown. She loved to write her name in the margins to mark recipes she felt were proven. This particular collection is a mishmash of loose recipes and other medical documents that were bound together when the library’s holdings were captured and taken to Rome during the Thirty Years’ War. We do not know whether Elisabeth would have chosen to bind these particular papers together, but they seem to have been stored together. Many entries involve people who were close to Elisabeth, including a recipe attributed to her father, Elector August of Saxony (1526-86); a recipe for “the aquafetta,” which refers to the aqua vitae for which her mother, Electress Anna (1532-85), became famous; and one entry in the hand of her close confidant, Countess Anna of Hohenlohe. Marginalia by Wilhelm Rascalon, a court physician who worked closely with Elisabeth, appear in several recipes. A good number of entries also contain Elisabeth’s own edits and/or her name scrawled in the margins, as can be seen in the recipe below.

A page of recipes against stroke. Cod. pal. germ 177.
A page of recipes against stroke. Cod. pal. germ 177.

We can’t make too much of the fact that Elisabeth seems to have kept the dog trial record among these recipes; we have no idea whether she even read it, as she would have had trouble with the Latin bits. However, the evidence suggests that she found the results significant, as one would expect given the craze for poison antidotes in courtly circles. For various reasons, poison represented a special case: both particularly easy to test and particularly useful given the panacea qualities of many antidotes. It is not surprising that a princess interested in recording proven cures would be intrigued. And the circulation of the trial report suggests that the Kassel court expected to have eager readers.

In the end, the antidote did not help Countess Elisabeth: ten years later, she died after (purportedly) being poisoned by her estranged husband, Count Johann Kasimir. But I think her possession of Landgrave Wilhelm’s dog trial report does provide direct evidence of that the oft-stated claim of probatum est in regards to cures was sometimes taken very seriously!

Editorial: To find out more about the Heidelberg University Library and the Bibliotheca Palatina, watch out for the March edition of the First Monday Library Chat when we’ll be talking to Karin Zimmermann, Deputy Head of Manuscripts and Early Printed books.

Interested in experimentation and drug trials? Visit the webpage of the ‘Testing Drugs and Trying Cures in the Pre-modern World’ working group at the Max Planck Institute for the History of Science.

Want to learn more about women, medicine and recipes in early modern Germany? Check out Alisha’s book Panaceia’s Daughters. Noblewomen as Healers in Early Modern Germany.