Harnessing Heat in Greco-Roman and Islamicate Medicine

By Aileen R Das

Associated and sometimes identified with the life-giving (or vital) principle, heat occupied a central place in ancient Greek, and subsequently Roman and medieval Islamicate, theories about the human body and its care. The medical literature surviving from classical Greece shows that early doctors’ understanding of human physiology was greatly informed by philosophical speculations about the basic constituents of the world. Heraclitus of Ephesus (fl. 500 BCE) appears to be the first natural philosopher to give fire a primary role in the cosmos; according to him, everything originates from fire, which undergoes various changes to become the materials that we see around us. His now fragmentary writings do not discuss medical or biological themes, but later ‘Pre-Socratics’ – a modern term that describes Heraclitus and other thinkers before or roughly contemporary with Socrates – such as Empedocles (495–435 BCE) did explain how this element affected the body. Both a physician and a philosopher, Empedocles of Akragas is the progenitor of the four element theory, according to which earth, water, fire, and air are the building blocks of the universe, and he asserted that heat was responsible for sexual differentiation. In his philosophical poem On Nature, Empedocles remarks, ‘For in its warmer part the womb brings forth males, and that is why men are dark, more manly, and shaggy’ (fr. 67).

The authors of the Hippocratic corpus developed several of their therapies in light of the notion that an innate heat sustains essential processes in the body such as growth and digestion. The intensity of this heat supposedly varied not only according to sex – with men being warmer than women – but also from person to person. Thus, when deciding on a course of treatment, the doctor had to make sure that they did not excessively increase or reduce the natural heat of their patients. Dietary regimens were the mainstay of Hippocratic therapeutics, for doctors working in this tradition assigned to food a range of properties (cooling, warming, drying, and moistening, to name just a few) that could influence the condition of the body. For example, the Hippocratic treatise Regimen II recommends that the herb coriander, which is described as being ‘hot and astringent’, be eaten to combat heartburn and to induce sleep.

None of the Hippocratic writers offer an overarching theory of the powers of nutriment and other natural substances. Rather, centuries later the physician Galen (d. c. 217 CE) of Pergamum, who drew on the Hippocratics, their philosophical precursors, and earlier pharmacological writers, formulated a system that ranked the properties of plants, minerals, and animal products. The dividing line between what counted as a drug as opposed to a food was blurry in the ancient (as well as medieval) world, so Galen elaborates his theory in both his dietetic and pharmacological works. On the Powers and Mixtures of Simple Drugs, which lists several hundred one-ingredient drugs, offers the most comprehensive account; it relates that all substances possess a mixture of active (hot or cold) or passive qualities (wet or dry) in four varying degrees of intensity, with the first degree being weak and the fourth strongest. For example, in the entry on the chaste-tree (vitex agnus-castus), Galen reports that the leaves and seeds of this Mediterranean plant is warm and dry to the third degree. By learning the properties and strengths of a range of materia medica, the doctor can select the appropriate remedy that will match their patient’s imbalance. Regarding the power of the chaste-tree, Galen recommends that the seeds be used to dissolve wind in the stomach and to relieve uterine pain, but he cautions that they are so warming that they can cause a headache. Thus, to avoid this affect, he advises that they be ingested with sweetmeats or other dessert items.

While Galen’s theory of the potency of natural substances was extremely influential throughout antiquity and the middle ages, later medical thinkers looked to redress his failure to explain how a doctor (or pharmacist) calculates the right proportion of ingredients in a multi-ingredient (that is ‘compound’) drug to achieve the desired potency. The Muslim philosopher Abū Yaʿqūb ibn Ishāq al-Kindī (c. 801–66), who was not a doctor himself but had sponsored the Arabic translations of Greek medical works, developed a complex arithmetical theory to quantify the strength of a drug that contained varying degrees of warmth, for instance. According to it, a substance’s intensity increases with an increase in degree according to the double ratio. Thus, if one takes a ‘temperate’ drug that has equal parts of warmth and coldness and doubles the parts of warmth, the drug will be hot in the first degree; if the parts of warmth are quadrupled, then the drug is hot in the second degree and so on. With these proportions in mind, the practitioner can weigh out the simple ingredients of the compound drug to obtain the intended strength. Al-Kindī’s solution to the gap in Galen’s pharmacology was popular not only among medieval Islamicate but also European doctors, who read it through a 12th-century Latin translation.

Removing Arrowheads in Antiquity and the Middle Ages

By Aileen Das

For a doctor is a man worth many others

cutting out arrows and applying soothing remedies.

– Homer, Iliad XI.514–15

Warfare was a reality for most ancient Romans and Greeks. Free men were often recruited to serve in the army either at home or abroad to further the expansion of their city or empire’s sovereign territory. Arrows were frequently used in pre-modern combat because of the relative ease of their manufacture; they could be cheaply produced from material ready at hand, such as bone, glass, wood, bronze, and iron. For those attending the wounded on or off the battlefield, it was important to know how to extract arrows and treat their wounds. Homer emphasizes the value of this area of medical knowledge when he exclaims that a doctor who possesses the skills to “cut out arrows” and “apply soothing remedies” is highly prized (Iliad XI.514–15).

While medical texts from antiquity offer detailed surgical instructions for extracting arrows from patients,some non-medical authors advocate the use of pharmaceuticals to remove these weapons. For example, in the Natural Histories (8.41), Pliny the Elder (AD 23–79) remarks that the perennial dittany is useful for extracting arrowheads, because it causes the point to fall out when placed on the wound. He adds that dittany’s power was first discovered by hunters, who observed that arrows became dislodged from wounded stags who grazed on this plant.

Cretan Dittany (Origanum dictamnus) Image Credit: Wellcome Library, London
Cretan Dittany (Origanum dictamnus). Image Credit: Wellcome Library, London.

The engineer Philo of Byzantium (c. 280–220 BC) recommends the application of honey and cerate–wax mixed with oil, lard, and sometimes other medicinal ingredients–to treat arrow wounds (Mechanical Syntax V.96.15–19). These substances are styptics, having the ability to staunch blood flow and bind flesh. Moreover, honey is recognized today as having anti-bacterial properties, and thus would have helped prevent infection in arrow wounds.

Medical treatises from the medieval Islamicate world contain a range of recipes for extracting arrows. Largely based on ancient Greek medical sources, these treaties were rendered into Arabic by translators working in Baghdad from the eighth to tenth centuries.

But authors often included information derived from non-Greek sources or from their own experience. In his manual Book for al-Manṣūr (VII.25), the Persian doctor Abū Bakr al-Rāzī (d. c. 925, known as Rhazes in Latin), who treated patients in hospitals in Ray, Iran and Baghdad, mentions several ‘extractive drugs’ (adwiya jādhiba) that possess the power to draw out thorns and arrowheads from flesh. Each drug is made of a honey base and compounded respectively with ammoniac salt, narcissus bulb, and reed root. None of these recipes appear in surviving Greek sources, so al-Rāzī may have added them on his own authority.

Certainly, al-Rāzī had some experience of dealing with arrow wounds, for in the Book of Experiences, a record of around 900 cases that al-Rāzī personally treated or supervised, a student describes al-Rāzī’s ecounter with a male patient wounded in the thigh by an arrow.[1] In this case, al-Rāzī does not attempt to extract the arrow from the man’s body, but recommends a drying diet to alleviate his pain. It is possible that al-Rāzī never actually employed in practice the extractive drugs listed in Book for al-Manṣūr, but instead copied these recipes from either a lost Greek or contemporary Arabic source.

Compared to other Arabic medical writers, Ibn Sīna (or Avicenna, 980–1037) provides the most complex list of extractive drug recipes for removing arrows in his influential medical encyclopedia the Canon of Medicine. Born in what is now Uzbekistan, Ibn Sīnā studied medicine as a young man and served as a courtier to several local rulers. Ibn Sīnā relates several extractive drug recipes that are prepared from plant and animal materials (IV.4.2.10). Like al-Rāzī, Ibn Sīnā highlights the extractive powers of reed root and narcissus bulb, but he does not instruct the reader to mix these plant products with honey. Rather, the former should be crushed on the wound and the latter, added to a plaster of gillyflower and birthroot.

Bulb of Narcissus species (Daffodil)  Credit: Royal Botanic Gardens Kew. Wellcome Images
Bulb of Narcissus species (Daffodil). Image Credit: Royal Botanic Gardens Kew, Wellcome Images.

Ibn Sīnā also advises the use of skinned frogs, which supposedly has the power to uproot teeth. And so, when placed on arrow wounds, it will draw out even the most adherent points. Ibn Sīnā includes the recipes as a supplement to his surgical instructions, but does not disclose whether he tried any of them in his own practice. As in antiquity, surgery remained the most reliable, if risky, method of getting the point.

[1] Al-Rāzī, Kitāb al-Taǧārib: maʿa dirāsa fī manhaǧ al-baḥṯ al-ʿilmī ʿinda al-Rāzī, Ḫālid Aḥmad Ḥarbī (ed), (Alexandria 2006), 294.