Tag Archives: Hippocratic Corpus

A Pain in the Backside: Ancient Remedies for Haemorrhoids

By Glyn Muitjens

Although haemorrhoids are not often talked about, as many seem to consider them a source of embarrassment, they are anything but a rare condition. In fact, the Association of Coloproctology of Great Britain and Ireland suspects one in three people in Britain suffers from them sometime in life. Haemorrhoids seem to have been a common problem in Greek antiquity as well, and this inspired at least one medical author from the 5th century BCE to dedicate a treatise to them and their treatments – recipes included!

            Haemorrhoids (Greek haimorrhois, a contraction of haima, ‘blood’, and rhoia, ‘flux’) form due to prolonged pressure on the anal veins, which swell up and may in some cases lead to lumps appearing on the outside of the anus. The author of the treatise Haemorrhoids, which is part of the Hippocratic Corpus, describes their formation as follows:

Nineteenth-century representation of the excision of haemorrhoidal tumours. Source: Wellcome Images

When bile or phlegm becomes fixed in the vessels of the anus, it heats the blood in them so that, being heated, they attract blood from their nearest neighbours. As the vessels fill up, the interior of the anus becomes prominent and the heads of the vessels are raised above its surface, where they are partly abraded by the faeces passing out, and partly overcome by the blood collected inside them, and so spurt out blood, usually during defecation, but occasionally at other times as well. (Hippocrates, Haemorrhoids 1)

For this author humoral clogging, heat and the ensuing attraction of ‘like to like’ – staples of Hippocratic pathology – are to blame for the formation of haemorrhoids. Another Hippocratic claims that men from cities exposed to hot winds have heads filled with phlegm, often suffering from haemorrhoids “in the anus” (Airs Waters Places 3). The Greek word haimorrhois can be used to denote any vein that discharges blood, so some topographical precision is necessary to speak of haemorrhoids in our sense of the term.

            The Hippocratic author mentions several possible ways of treating haemorrhoids. Some of these are rather invasive: cauterization with heated irons, for example – a treatment not always welcomed with enthusiasm (“Let assistants hold the patient down by his head and arms while he is being cauterized so that he does not move – but let him shout during the cautery, for that makes the anus stick out more.” Haemorrhoids 2). The cautery wound is then covered with a plaster of boiled lentils and chickpeas for 5 or 6 days, after which an assemblage of different fabrics covered in honey is inserted in the anus and kept in place by a bandage tied around the body.

A tool to remove haemorrhoids: the Chassignae-type écraseur, London, England, 1880-1902. Source: Wellcome Images

            This final treatment points to an interesting aspect of treating haemorrhoids ‘of the anal variety’, namely that the backside is a difficult place to reach both for diagnosis – the author warns that using a device to dilate the anus for closer inspection might obscure the haemorrhoid – and for treatment, which elicits some creative responses. For example, having removed a “knobbiness” or kondulôma next to a blood vessel by hand, the author suggests to dry out the blood vessel by inserting a tube into the anus, and shove a heated iron into the tube, so as not to expose the patient to the burning directly.

            Haemorrhoids could also be removed purely with medications, for which the author provides several recipes, both for direct application and as suppositories. For example, after moistening the anus:

Grind myrrh and oak galls into a smooth paste, and add one and a half times as much burnt Egyptian alum and an equal amount of black pigment: apply this medication dry. (Haemorrhoids 8)

Recipes for this purpose were also provided by the 1st century CE pharmacological writer Dioscorides: bramble, and several kinds of frankincense when applied as a plaster could be used to treat condylomas and haemorrhoids (De Materia Medica 3.74.2; 4.37.1).

Frankincense, represented in the ‘Vienna Dioscorides’ manuscript, 512 CE

            At the end of the treatise, our Hippocratic author speaks of what he calls haemorrhoids “as pertaining to women.” The treatment is as follows:

Moisten with copious warm water in which sweet smelling substances have been boiled; grind tamarisk, burnt litharge, and oak gall, add white wine, olive oil, and goose grease, pound these all smooth, and after she has been moistened give this to be anointed. Also foment the anus after forcing it out as far as possible. (Haemorrhoids 9)

What does the author mean with “as pertaining to women”? The moistening treatment (the Greek verb used appears only a handful of times in the Corpus) is very reminiscent of those found in the Hippocratic gynaecological treatise Nature of Women, in which they pertain to the womb. Are we to imagine that these haemorrhoids are located in the uterus? The final sentence, “also foment the anus”, might be taken to point in this direction, as if the backside is not the primary concern.

            I hope to have broken some of the embarrassed silence surrounding haemorrhoids, putting them in historical perspective. Although haemorrhoids nowadays can be a nuisance, we should remember they are a common condition and rarely pose a serious threat to health. At worst, they have to be treated through minor surgery. Let’s thank the stars we’re not ancient Greeks.

All of the Greek translations, sometimes slightly adapted by me, are from Paul Potter, Hippocrates Volume VIII (Cambridge MA, London: Harvard University Press, 1995)

Sweet as Honey

By Laurence Totelin

Yesterday I read some press releases about a fascinating Welsh research project (based at my University: Cardiff University) that will screen Welsh honey for antibiotic properties.  The aim is to find the Welsh answer to Manuka honey, by driving bees to flowers with the highest antibiotic properties. This project, if successful, will no doubt have significant positive medical, ecological, and economic implications. The press release mentions the use of medicinal honey since the Middle Ages. One should never take press releases too literally, but the history of employing honey medicinally goes much further than the Middle Ages. I will focus here on the Greek and Roman periods of antiquity, but honey was used in many cultures well before the Greeks started using writing.

A coin from ancient Ephesus, representing a bee. Source: wildwinds.com
A coin from ancient Ephesus, representing a bee. Source: wildwinds.com

Honey is one of the most common ingredients in Greek and Roman pharmacopoieias. It was taken orally as well as applied to the body.  What interests me here is the great care the ancients took to differentiate between types of honey. In particular, ancient recipes frequently and consistently ask for Attic honey. For instance, the Hippocratic text Internal Affections (end of the fifth, beginning of the fourth century BCE) has the following recipe for a ‘hip-disease’:

If this [previous treatment] does not help, purge with the following remedy: crush half a kotyle of cumin; chop into pieces an entire gourd, of the small and round variety, in a mortar; sprinkle with the finest red Egyptian natron, in the amount of a quarter of a mina; roast; pound finely; put these ingredients in a pot; pour in a kotyle of oil, half a kotule of honey; a kotyle of sweet white wine, and two kotylai of juice of beet. Boil these [ingredients] until they have the right consistency; pass them through a cloth; add to them a kotyle of Attic honey, if you do not want to boil they honey together with the other ingredients. If you do not have Attic honey, use some of the best honey and heat up in the mortar. If this clyster preparation is too thick, add the same wine to the recommended thickness. Use this as a clyster. [Hippocratic Corpus, Internal Affections 51]

Several interesting things here: first, the Attic honey is not the only ‘ethnic’ ingredient in this recipe: it also contains Egyptian natron. This use of geographically-qualified ingredients is a characteristic of ancient recipes. Second, the author understands that not everyone will have access to Attic honey and suggests using the best possible honey available if that is the case. Third, the recipe recommends not to boil the honey together with the other ingredients, possibly indicating an awareness that heat destroys some of the qualities of honey.

The Hippocratic authors do not tell us what made Attic honey special, but other medical authors tell us that Attic honey (and in particular the honey of Mount Hymettus) was special because the bees fed on thyme, which was itself an important medicinal herb. Some writers produced lists of plants that produced the sweetest honey (thyme, violets, asphodel, iris), and those that should be avoided (spurge, thapsia, wormwood, wild cucumber). According to Palladius, a fifth-century CE agronomist, these plants had to be avoided because their bitter taste would prevent the creation of sweetness (1.37).

The Greeks and Romans also mention poisonous honeys. The historian Xenophon (fourth century BCE) describes the effect of a poisonous honey to be found in the land of the Colchians (East Coast of the Black Sea, modern Georgia).

And swarms of bees were numerous there, and the soldiers who ate the honeycombs all went out of their mind, vomited and suffered from diarrhoea, and none of them was able to stand up; but those who had consumed only a little appeared like those who are extremely drunk; while those who had taken a lot seemed like mad or even dying men. Thus many lied there as if there had been a defeat, and there was much despondency. But the next day nobody had died, and around the same hour as they [had taken the honey], they came back to their senses. And on the third or fourth day they got up, as if after a poisoning (pharmakoposia). [Xenophon, Anabasis 4.8.20-21].

Unfortunately, Xenophon does not tell enough about the flora of the region to make a hypothesis about the nature of the plants upon which these bees fed. Pliny the Elder also describes a poisonous honey from Heracleia Pontica (on the Black Sea, modern Turkey), this time produced from a plant called ‘the goat killer’ (Natural History 21.74). I wonder whether modern apiculturists are aware of such poisonous honeys, and whether these dangerous honeys, taken in small doses, could be used medicinally? In any case, there is much scope for honey bioprospecting, and I wish my Cardiff colleague the best of luck!

I smell a rat! Fumigation in Mesopotamian and Hippocratic recipes for women’s ailments – Part 2

By Ulrike Steinert

In this post, I will introduce Hippocratic prescriptions for fumigation from below and compare the uses of this treatment form in Mesopotamian and Hippocratic gynaecology. Some Hippocratic recipes — like the Akkadian BAM 237 discussed in Part 1 —  just list the ingredients, which have to be thrown into the fire, adding a short instruction for application. Other Greek recipes describe a procedure very similar to the Babylonian text K.8678+ (see Part 1), especially the instruction to dig a hole in the ground as a receptacle for the fumigant:

Diseases of Women (DW) 2.195, L 8.376 (Totelin 2009, 253):
Another fumigation: it is necessary to dig a hole and to roast grape stones, in the amount of two Attic choinikes; let him throw some of this ash in the hole, continuously dropping sweet-smelling wine. Seating herself around <the hole> and taking her legs apart, let her be fumigated.

A few Hippocratic recipes state that the woman should be completely covered with clothing during treatment, so that none of the fumes would escape around her. We find the same instruction in a Mesopotamian recipe (12th cent. BCE) for releasing postpartum blood and “fluids” that are “blocked” in the womb:

(If) a woman gives birth and subsequently she has intestinal trouble, her excrement? […], her intestines are blocked, her fluids and [her] blood are (b)locked [in her belly?], to make her release (it): kukru-aromatic, juniper, atā’išu-plant, ṣumlalû-aromatic, “sweet reed”, ballukku-aromatic, myrrh, ṭūru-aromatic, abukattu resin, baluḫḫu-aromatic resin, root of atā’išu-plant. These eleven drugs you mix together. You gather charcoals of ašāgu-thorn into a kirru-vessel, you throw these drugs into it, you have that woman sit down above it, you wrap her with cloth(s).(W.G. Lambert, “A Middle Assyrian Medical Text”, in: Iraq 31 (1969), 28-39 obv. 1-9)

In some Hippocratic passages we notice the desire to make the procedure more comfortable for the woman by using a chair with a hole in it placed above the fire on which she could sit during the treatment (DW 2.114, L 8.246). Several instructions warn to take care not to burn the patient (e.g. DW 1.75, L 8.164). It is probable that the Babylonian healers also used such a chair, but this is never explicitly stated, and it is likewise possible that the patient had to squat above the fumigation apparatus as shown in the illustration.

An African woman is fumigated during delivery. From: Gustave J. Witkowski, Histoire des accouchments chez toys les peubles, 1887, fig. 282. Source: http://ihm.nlm.nih.gov/images/A30263
An African woman is fumigated during delivery. From: Gustave J. Witkowski, Histoire des accouchments chez tous les peuples, 1887, fig. 282. Source: http://ihm.nlm.nih.gov/images/A30263

Both Babylonian and the Greek recipes leave us with unanswered questions. How did the Hippocratics and the Babylonian healers explain the effect of the treatment in view of the contrasting symptoms for which they applied fumigations? How was it possible that fumigation of the genitalia could at the same time stop bleeding and release fluids locked in the womb?

The Hippocratics apparently attributed a drying effect to some fumigations, since they explain in one prescription for stopping fluxes that the ingredients should be mixed only with a little vinegar, in order not to moisten the womb too much.[i]

Likewise in Akkadian, the choice of “human bone” as fumigant for bleeding (in BAM 237) can be explained on the basis of its dryness: blood is contrasted with bone as “wet” with “dry”, and at the same time entails a colour contrast. Thus, the name of the drug “human bone” could have referred to the drying effect of the substance.

On the other hand, in the Hippocratic recipes the effect of fumigations to induce bleeding is sometimes described as “expulsive” (e.g. DW 1.78, L 8.186), and DW 2.133 explains that when the womb attaches itself to the hip joint, with the result that the womb becomes twisted sideways and closed, a fomentation is able to fill the womb with air, straighten and open it. Missing similar explanations for our second Babylonian example K. 8678+, it is hard to say whether the fumigation was supposed to open the womb (remove blockages) or to irritate it.

Some of the fumigations in the Hippocratic corpus were certainly quite irritating to the nose! A common treatment in Hippocratic gynaecology when the womb had moved upward in the body was to apply fragrant, sweet-smelling substances to the vagina (by fumigation or pessary), while foul-smelling substances like animal excrements or hair had to be inhaled by the patient in order to lure the uterus back downwards.[ii] This principle does not hold for fumigations with a different therapeutic purpose. Thus, beside recipes using fragrant substances such as myrrh, ingredients as stag horn and cow dung are recommended for a fumigation to stop fluxes (DW 2.195, L 8.376), and wolf’s turds and donkey hair are burned to help conception. We have likewise encountered similar materia medica as Dreckapotheke in one Mesopotamian prescription, and in both traditions their application entails symbolic meanings. But in contrast to Hippocratic medicine, in Mesopotamia such substances were not restricted to the treatment of women.[iii]

But beware! It is known that in Mesopotamian medicine some ingredients like “dog turds” and “wolf fat” were secret names (Decknamen) for medicinal plants, and often should not be taken literally! Thus, in a plant compendium, “human bone” is a secret name for the (unidentified) plant “shepherd’s staff”, and it is possible that the scribe of BAM 237 consciously used this code to keep his knowledge secret from the uninitiated, making a fool of a 21st century interpreter… The debate about the actual use of Dreckapotheke in Mesopotamian medicine is still going on, and it could reshape our perspective on ancient medical practice!


[i] DW 2.114, L 8.246; cf. DW 2.195, L 8.376 for recipes which apply dry and astringent ingredients such as horn, roasted flour/grain, dry cypress, gallnuts and astringent dark wine.

[ii] E.g. DW 2.123, L 8.266; DW 2.127, L 8.272.

[iii] For ingredients such as excrement in Hippocratic gynaecology see e.g. von Staden 1992.

References:

L = Littré, Émile (1962) Œuvres completes d’Hippocrate. Tome Huitième, Amsterdam.

von Staden, Heinrich (1992) “Women and Dirt”, in: Helios 19, 7-30.

Totelin, Laurence (2009) Hippocratic Recipes. Oral and Written Transmission of Pharmacological Knowledge in Fifth- and Fourth-Century Greece. Leiden, Boston.

I smell a rat! Fumigation in Mesopotamian and Hippocratic recipes for women’s ailments – Part 1

By Ulrike Steinert

In my first post on the blog, I described some of the difficulties in studying Mesopotamian medical texts from 2nd and 1st millennium BCE Babylonia and Assyria. In the following two contributions, I would like to discuss similarities between Babylonian and Hippocratic recipes applying “fumigation from below” as a therapy for gynaecological disorders. In this part I will present the recipes themselves with some comments on fumigation in general. In the next post I will compare Mesopotamian and Hippocratic concepts of women’s ailments and their treatment gleaned from the fumigation recipes.

The specific treatment form of fumigation from below is so far attested only a few times within the Mesopotamian gynaecological corpus, but fumigation of the (whole body of the) patient or of specific body parts (e.g. the ears) is more commonly found as a treatment type in other areas of Mesopotamian therapy. Surprisingly, the situation is reversed in the Hippocratic texts: most attestations within the Hippocratic corpus are found in the gynaecological treatises, while fumigation is otherwise rare (Goltz 1974, 232). Here, I would like to point out some similarities and differences between the Babylonian and Hippocratic sources with regard to the therapeutic procedure itself, and with regard to the female ailments treated by fumigation from below in each tradition.

Before comparing the recipes, the term “fumigation” should be clarified. In fumigation, hot and dry vapours or smoke are led to a body part, while in the cognate procedure of “fomentation”, hot water vapours are used to lead medicinal substances to a body part (Totelin 2009, 52; Goltz 1974). The differentiation between both techniques was not very strict in Greek medicine, except in the gynaecological treatises (Goltz 1974, 235). The main difference between both procedures is the apparatus: in fomentation, a vessel containing the drugs and some water is heated over a fire and the vapours are led to a body opening through a reed, while in fumigation substances are directly thrown into the fire or onto glowing charcoals or ashes. In Mesopotamian medical texts, fumigation consists of burning aromatic substances on a fire or on charcoals (usually a brazier is used), exposing the patient (or specific body parts) to the fumes (Goltz 1974).

It may come as a surprise that in both Mesopotamian and Hippocratic gynaecology fumigation from below was applied for some identical purposes and ailments. In Hippocratic gynaecology, fumigation was used to treat infertility, with the incentive to open or soften the uterus for conception.[i] Interestingly, fumigation was regarded as a patent method both to stop fluxes and to expel retained fluids from the womb.[ii] More often however, fumigation was applied to return the womb to its correct position, if it had moved elsewhere in the body.[iii]

By contrast, the theory that the womb could move within the body and cause illness is unknown to Mesopotamian medicine. But one prescription applies fumigation from below to stop bleeding during pregnancy (naḫšātu), comparable to the Hippocratic use of fumigation for fluxes. Further, both in Hippocratic and Mesopotamian gynaecology fumigation from below was prescribed when fluids were retained or blocked in the womb. While the Hippocratic texts speak of blocked menstrual or postpartum blood (lochia), the Babylonian texts describe a similar condition called “(b)locked fluids” (lit. “water”). Because this condition is sometimes mentioned in the context of postpartum complications, it is possible that the word “fluids” here refers to the lochia, but this is far from certain, since the word “fluids” can stand for several things in different contexts, e.g. for the amniotic fluid or for vaginal discharge other than blood. Yet, Mesopotamian texts describe very similar symptoms in connection with the condition “(b)locked fluids” as the Hippocratic texts do in connection with disease conditions caused by retained menses (see Steinert 2013 for discussion). Should the Akkadian expression “(b)locked fluids” be a euphemistic term for the retained menses?

BAM 237 (VAT 8577+), a collection of gynaecological recipes from Assur. Source: Cuneiform Digital Library Initiative (http://cdli.ucla.edu/dl/ photo/P285323.jpg)
BAM 237 (VAT 8577+), a collection of gynaecological recipes from Assur. Source: Cuneiform Digital Library Initiative (http://cdli.ucla.edu/dl/photo/P285323.jpg)

One of the prescriptions for fumigation from below is contained in a Neo-Assyrian text from Assur (ca. 7th cent. BCE), devoted to treating bleeding during pregnancy:

BAM 237 i 26’-27’:
“You scatter “human bone” over charcoal, you let the woman sit down above it. If (the haemorrhage) does not stop, you repeat (it), and let her sit down (again), ditto (i.e. and it will stop).”

From a second, contemporary recipe on a Babylonian tablet found in the palace library of the Assyrian king Ashurbanipal at Nineveh, we learn a few more details about the procedure:

K. 8678+ rev. 9’-12’:
“If ditto (i.e. a woman is (b)locked regarding the fluids): you dig a hole, you make it two fingers [deep], […],
[…] you cover (it). You throw flour? into it, one tenth of a litre of ka[mūnu-spice?],
[…] solid pieces? of resin, one thirtieth of a litre of ṭūru-aromatic […],
[…] you spread on coals; you make the woman sit down above it.”

Although the text is fragmentary and presents difficulties, the procedure is quite clear and bears similarities to a few Hippocratic recipes for fumigation of the womb (presented in Part 2 of this post). The apparatus is simply a hole in the ground, which functions as a receptacle for burning charcoal and the fumigants. The woman’s pubic region is exposed to the fumes.

 


[i] E.g. Diseases of Women 1.75, L 8.164; cf. Diseases of Women 2.154, L 8.330; Sterile Women 230, L 8.438ff. describes a fomentation with a gourd for the same purpose.

[ii]DW 2.114, L 8.246; DW 2.195, L 8.376; DW 1.78, L 8.186.

[iii] For discussion see King 1998; e.g. Diseases of Women 2.123, L 8.266 movement to the head; DW 2.126, L 8.272 womb attaches itself to the hypochondria; DW 2.127, L 8.272 movement to the liver; DW 2.133, L 8.284-6 fomentations when the womb moves to the hip joint; DW 2.203, L 8.390 womb fixes itself to the loins. Sometimes, the patient is described to suffer from more than one symptom at the same time, e.g. in Diseases of Women 2.154, L 8.330 the womb is “irritated”, the menses are blocked and the woman does not conceive.

References:

Goltz, Dietlinde (1974) Studien zur altorientalischen und griechischen Heilkunde. Therapie-Arzneibereitung-Rezeptstruktur, Wiesbaden.

King, Helen (1998) Hippocrates’ Woman. Reading the Female Body in Ancient Greece, London/New York.

L = Littré, Émile (1962) Œuvres completes d’Hippocrate. Tome Huitième, Amsterdam.

Steinert, Ulrike (2013) “Fluids, rivers, and vessels: metaphors and body concepts in Mesopotamian gynaecological texts”, in: Journal des Médecines Cuneiformes 22, 1-23. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3791376/

Totelin, Laurence (2009) Hippocratic Recipes. Oral and Written Transmission of Pharmacological Knowledge in Fifth- and Fourth-Century Greece. Leiden, Boston.