Category Archives: Medieval

Sugar versus honey in Byzantine recipes

By Petros Bouras-Vallianatos

The Byzantine Empire, with its capital in Constantinople (now Istanbul), then a mainly Greek-speaking region, constituted a natural crossroads between East and West for more than a millennium (AD 324–1453). Its history is an indispensable part of the medieval period in both Europe and the Middle East. In the field of medicine, for example, we can attest to widespread interactions with the Islamic tradition.

The most dynamic part of Byzantine therapeutics was pharmacology. We are privileged to have several surviving pharmacological manuals, especially dating from the later period, i.e. from the twelfth to the fifteenth centuries, which provide us with a unique testimony to Byzantine composite drugs. Here I have selected the example of sugar-based potions, as it offers an excellent case-study that helps us to better understand the way Byzantine recipes were developed through a process of both practical experimentation and influence from outside.

Before the introduction of sugar, people relied on honey to make medical potions sweet. Greek and early Byzantine medical authors referred to honey-based drugs such as oinomeli (a mixture of honey with wine), hydromeli (a mixture of honey with water) or oxymeli (a mixture of honey with vinegar). For example, Paul of Aegina (fl. first half of the seventh century) recommends the following recipe for those suffering from calculi:

One ounce[1] each of saxifrage, betony, dog’s-tooth grass, maidenhair fern, spikenard, carpesium, hazelwort, and eryngo; one half ounce each of Macedonian parsley and seed of rue; two ounces each of green fennel, iris, baked squill, and periwinkle; three ounces of bark of the root of capper; two ounces of water-parsnip; and two sextarii[2] each of water, vinegar, and honey.[3]

Meanwhile, the cultivation of sugarcane gradually spread throughout the Islamic East from the seventh/eighth century onwards. Sugar was used as a simple drug, for stomach ailments and the relief of pain in, for example, the chest and kidneys. However, it also became popular as an excipient in liquid pharmaceutical dosage forms, used as a sweetener and preservative, initially supplementing and gradually replacing the use of honey for pharmacological purposes in the Islamic world. Sugar is of higher purity than honey, thus a smaller quantity has a stronger preservative action; it is also less susceptible to changes of temperature and ensures greater homogeneity into the final product. Among the most commonly used potions in Islamic medicine are the so-called julep (julāb) and syrup (sharāb), both of which consisted of sugar and one or more kinds of fruit juices or extracts of flowers.

Figure 1. Medieval, cone-shaped earthenware devices for the refining of sugar from Cyprus. Courtesy of Bank of Cyprus Cultural Foundation.
Figure 1. Medieval, cone-shaped earthenware devices for the refining of sugar from Cyprus. Courtesy of Bank of Cyprus Cultural Foundation.

By the eleventh century sugarcane cultivation was thriving in Syria and Palestine, eventually reaching the large Mediterranean islands of Cyprus and Sicily. Western merchants, such as the Genoese and the Venetians, played an important role in the distribution of this commodity throughout the Mediterranean, including Byzantium. For example, sugar is mentioned among the main supplies for the newly established Byzantine hospital (xenon) of the Pantokrator Monastery in Constantinople in the early twelfth century, but it was not until the late thirteenth century that sugar became widely available in the Byzantine world.

At the same time, we can observe the transfer of medical knowledge to Byzantium through translations of Arabic and Persian works into Greek. The earliest text of this kind, which preserves a large number of references relating to the various kinds of sugar-based potions, is the Greek translation of Ibn-Jazzār’s (fl. tenth century) Ephodia tou Apodēmountos (Zād al-musāfir wa qūṭ al-ḥāḍir/Provisions for the Traveller and Nourishment for the Sedentary), which must have been translated in the late eleventh/early twelfth century by scholars working in Southern Italy. By the early fourteenth century recipes for sugar-based potions had become very common in Byzantine manuals. The Constantinopolitan medical author and practising physician John Zacharias Aktouarios (ca. 1275–ca. 1330) provides an extensive list consisting of about thirty recipes, and he often explicitly acknowledges that he was introducing a new recipe. For example, he gives the following recipe for a julep for heart palpitations:

One hexagion[4] of the three sandalwoods; three hexagia of violet; two hexagia of basil seed; two hexagia of rose; five hexagia each of bugloss and ox-eye flowers; two hexagia of aloeswood; one hexagion of ambergris; two hexagia of saffron; three hexagia each of dried flower-buds from the clove-tree and nutmeg; one hexagion each of cinnamon, anise, caraway, and fennel seed; five grains of musk; one hexagion of poppy seed; three ounces of the juice of sweet apples; one ounce of rosewater; five ounces of distilled endive water; one ounce each of the roots of fennel, wild celery, and chicory; three hexagia each of marjoram, chamomile, and wormwood; and three ounces of sugar.[5]

Figure 2. A julep recipe added in the lower margin of a fifteenth-century medical manuscript, MS.MSL.52, f. 143v. Courtesy of the Wellcome Library, London.
Figure 2. A julep recipe added in the lower margin of a fifteenth-century medical manuscript, MS.MSL.52, f. 143v. Courtesy of the Wellcome Library, London.

In this recipe, in addition to sugar, we can also see ingredients from Asia and the Far East, such as musk, amber, and sandalwood, which became common in European pharmacology, especially during the thirteenth and fourteenth centuries after the Mongols’ conquests in Eurasia that led to the Pax Mongolica and the resulting improvements in trading conditions. To sum up, the fact that Byzantine physicians were aware of the usefulness and effectiveness of these sugar-based potions and made extensive use of them is at odds with the established view that Byzantine society was not very open to outside influence. Nowadays sugar is omnipresent and often replaced by sugar substitutes for the sake of diabetics and the diet-conscious; but once it was a novelty and highly desirable!

[1] One ounce is equal to 27.288 g.

[2] One sextarius is equal to 54.58 g.

[3] Ed. J. L. Heiberg. Paulus Aegineta, vol. 2 (Leipzig-Berlin: Teubner, 1924), 309, 1-6.

[4] One hexagion is equal to 5.166 g.

[5] Vindobonensis med. gr. 17 (first half 15th c.), f. 118r, lines 4-11.

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Petros Bouras-Vallianatos studied pharmacy, ancient and Byzantine history, before completing his PhD on the late Byzantine medical author John Zacharias Aktouarios; a revised version of his doctoral thesis is to be published soon. He is Wellcome Trust Research Fellow in Medical Humanities in the Department of History at King’s College London, where he is working on a three-year project entitled ‘Experiment and Exchange: Byzantine Pharmacology between East and West (ca. 1150-ca.1450)’. He has published several articles on Byzantine and early Renaissance medicine and pharmacology, the reception of the classical medical tradition in the Middle Ages, and palaeography, including the first descriptive catalogue of the Greek manuscripts at the Wellcome Library in London. He is also co-editing the Brill’s Companion to the Reception of Galen.

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).

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.

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

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

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

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By Ashley Buchanan and Tillman Taape

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

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

705px-ScuolaMedicaMiniatura
A miniature depicting the Schola Medica Salernitana from a copy of Avicenna’s Canons.  From Wikimedia Commons.

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

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

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

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

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

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

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

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

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

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

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

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

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

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