Category Archives: Minerals

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.

 

 

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.

Consumers of the Exotic: summary of a workshop in Cambridge, April 5-6, 2017

By Emma Spary and Justin Rivest

By Reede tot Drakestein, Hendrik van,1637?-1691 [Public domain], via Wikimedia Commons
The project “Selling the Exotic in Paris and Versailles, 1670-1730”, running in the Faculty of History at the University of Cambridge, and funded by Leverhulme Research Grant 2014-289, held its planned workshop in April this year. Its theme, “Consumers of the Exotic: European commerce and the consumption of exotic materia medica, 1670-1730”, brought together a group of international scholars working on these questions in a broad variety of European contexts.

Our goal at the workshop was to produce a comparative picture of the ways in which exotic plant materials were processed, bought and consumed in Europe. Why did European consumers buy—and more significantly ingest—exotic plant materials? What did exoticism mean to them? While recent work has focused on colonial bioprospecting and the appropriation of indigenous knowledge, our aim was to investigate demand within Europe itself, exploring divergences and similarities across contexts. The choice of a restricted timespan—the decades around 1700—provided a baseline for comparison of drug production, sales and consumption in different cultures. Alexandra Cook (University of Hong Kong) kicked off the programme with a study of a proprietary drug, Garcin’s “Maduran pills”, sold around Europe in the early eighteenth century by an entrepreneur whose Protestant faith led to a complex intellectual and commercial itinerary. Cook argued that exotic ingredients were not necessarily a selling point for eighteenth-century patients. Harun Küçük (University of Pennsylvania) provoked us to think about the complexity of defining the exotic, and the importance of a multi-perspectival view of the history of drugs: Ottoman healers associated New World exotica like cinchona bark and ipecacuanha root with French medicine, since these substances often reached them via French commercial and intellectual networks. Continuing the global theme, Samir Boumediene explored the place of drugs in the missionary activities of the Society of Jesus. The decades around 1700 represented a decline in the relative importance of Jesuits in the global drug trade, as new players came to disrupt their initial privileged position.

Šebestián Kroupa (University of Cambridge) offered a counterpoint to the workshop’s focus on European consumption by exploring the supply of European drugs to transplanted European populations—Manila in the Philippines. European drugs were in fact imported in large volumes to this “exotic” locale; little attention was paid to the pursuit of plant substances that might be commodified in the metropole, an exception being the Saint Ignatius bean. Victoria Pickering explored the diverse trajectories, contacts, and exchanges that were necessary to assemble the massive collection of exotic plant substances of Sir Hans Sloane.

Moving to early modern Russia, Clare Griffin suggested that its unique geographical connections—in the form of a land route between Europe and the Far East—led commentators to represent distant substances and peoples as subject to incorporation into the Empire, rather than “exotic” in the sense of “foreign”, as the case of rhubarb showed. Paula De Vos concluded the first day with an account of Palacios’ prominent 1706 pharmacopoeia. Early modern Western pharmacy was indebted, for its materia medica, to the Indo-Mediterranean world rather than the continent of Europe. The slow appropriation of new drugs spread outwards from this Indo-Mediterranean core to the Silk Roads, the Indian Ocean, and eventually the Atlantic world.

On day 2, Laia Portet explored the architecture of exoticism in printed French materia medica. Where familiar European plants tended to be classified alphabetically, unfamiliar exotics were classified by parts (roots, barks, leaves) since this was the form in which they entered the European marketplace. Emma Spary used a case history of an exotic aromatic, cinnamon, to point up the disjuncture between textual, material and empirical knowledge of drugs, a conundrum for medical experts, market regulators and individual consumers. Hjalmar Fors provocatively suggested that for early modern Europeans, “the exotic” primarily evoked traded material goods, including spices and drugs, rather than foreign peoples or distant geographies. Lack of knowledge about the places of origin of drugs was critical to a substance remaining “exotic” in European eyes.

Justin Rivest spoke of the encounter between political power, the emerging state and the large-scale administration of drugs in France, looking at how personal trialling of drugs by successive ministers of war led to a centrally administered programme of dispensing exotic drugs like tobacco, quinquina and ipecacuanha to French troops. In a very different take on the end-user, Wouter Klein introduced us to the uses of print culture as a research tool for relating newspaper advertising and ships’ cargoes of drugs in the Dutch republic after 1700.

Several common themes emerged from the papers. It seemed that “colonial bioprospecting” had its limits as a way of understanding European engagement with non-European materia medica. Most substances discussed did not reach Europe thanks to state intervention, but rather were trafficked by a heterogenous set of actors: missionaries, trading company officials, entrepreneurial merchants and court physicians. Many papers also showed that “exoticism” was not necessarily inherently desirable. A drug’s value was established through consensus-building over time. Furthermore, “exoticism” was a relative, context-specific category, subject to change, not solely a feature of geographic origin, or of a core-periphery relation between European metropoles and their colonies. The papers demonstrated that exoticism was also, perhaps largely, a product of degrees of familiarity and unfamiliarity, which varied widely across different European contexts. In sum, rather than being inherently valuable objects of appropriation, exotic drugs were socially constructed goods.

Bright Red, Dark Red: Coral’s Color-Coded Virtues

By Jennifer Park

I have long wanted to explore the fascination with coral as an ingredient in the history of science and medicine. Laurence Totelin wonderfully began her post on the use of coral in an ancient amulet by placing coral “centre stage,” noting its curious and complex categorization as animal, plant, or stone, and bringing attention to the other posts in which the red ingredient has cropped up. In tandem with these fascinating mentions of coral, I have been struck for years by a remarkable image in the medieval French Livre des simples médecines which depicts coral on an apothecary’s shelf in a beautiful, vibrant red.

Livre des simples médecines, Paris, Bibliothèque Nationale, MS n.a. fr. 6593, fol. 12322.

In this post, I’d like to focus on coral’s red color, a key indicator of the ingredient’s effectiveness, and its naturally occurring virtues as explained in early modern texts. In his medical treatise, translated into English as Paracelsus his Dispensatory and Chirurgery (London,1656), the physician Paracelsus provides an entire treatise on “the Vertues and Preparations of CORALS.” From the start, Paracelsus’s examination focuses on the color of red coral, determining two main kinds: a “dark red colour, or toward a purple colour,” and “a bright, shining red colour” (39). It is the quality of the redness of coral, Paracelsus insists, that indicates its virtue and effectiveness.

Coral that has the “clear, bright, shining red colour”—and additionally which is “full of boughs, and no where broken”—is “full of power and vertue” (40). This virtue is lessened if the coral has “clefts” or is missing parts. Paracelsus uses this to begin his analysis of color differences in coral, and how those color differences indicate the use value of the coral in a number of different remedies.

Paracelsus’s starting premise is that the corals that have the bright red color are “pleasant and delectable,” while the “dark red” or purple are “not pleasant to the eye” (40). Correspondingly, Paracelsus advises that if you carry coral with you, one should “chuse and love the bright Coral,” but “beware…the dull, dark Coral” (40). This leads to Paracelsus’s emphasis of the role of color in distinct affective differences in coral. “As joy differs from sorrow, and laughing from weeping” he outlines, “so these two sorts of Corals differ the one from the other” (40). Therefore, a “sick or weak man, who would have his heart merry and joyfull” would “increase his disease and sadnesse of heart” were he to carry with him the darker colored coral (40-41).

In addition to the affective differences in brightly or darkly colored red coral, the redness of the coral, according to Paracelsus, serves to address one’s susceptibility to various mental, psychosomatic, and spiritual concerns. For example, bright red coral is “good to quicken Phansie, or imaginative faculty” (41), which helps to aid the “studie of Secrets, of Arts and Sciences, and new Inventions” without tiring the mind (41). This is because bright red coral prevents the mind from being infected by “the Divel,” or with “impurity, wickedness or vanity” (41); the dark red coral, however, “doth the contrary” (41).

Bright red coral also protects against “Phantasms, or nocturnal spirits” as well as “vain visions, or vain sights, call’d Spectra” (41). Phantasms and nocturnal spirits were believed to be both good and bad, related to nightmares. Though not of much use to humans, these phantasms were cumbersome in that they could trouble one’s thoughts. Bright red coral provides a remedy, as these phantasms “fly from these bright Corals as a dog from a staff,” although one must beware of the darker colored corals which, in contrast, attract these nocturnal spirits (42). Spectra, on the other hand, are ghosts, or as Paracelsus describes, the “Starry bodies of dead men” (42). These ghosts “cannot endure to be where the bright Coral is,” and thus bright red coral can be used as protection from them. In contrast, however, “dark coloured Coral allures” the ghosts (42).

It is perhaps due to the influence of bright red and dark red coral on both psychosomatic and supernatural afflictions, the spirits and ghosts that can plague early modern minds, that it also gains the reputation of aiding with melancholy. Melancholy, according to Paracelsus, is “a disease which makes a man sad whether he will or not; that he grows weary of every thing, and becoms dull: and by his diverse thoughts and speculations makes him grieve and weep” (43). Bright red coral is able to drive melancholy away, whereas the dark red coral increases melancholy.

Indeed, the early modern description of these virtues of a coral’s redness fits with the ways in which we ascribe affective significance to colors. The vibrancy of red coral thus contributes to its use in recipes that draw upon its redness, not only for its affective influence but also for its sympathetic properties, like the blood staunching remedies of antiquity that Laurence Totelin brings to light and the eighteenth-century bloodstone that Marieke Hendrikksen examines. As Paracelsus himself exclaims, “the mysteries and secrets of Corals are wonderfull” (51)!