Conference Report: Traditions of Materia Medica: 300BCE–1300CE

By Sean Coughlin

On 16–18 June 2021, members of the research group A03 at the DFG-funded SFB 980 ‘Episteme in Motion’ and the Institute of Classical Philology, Humboldt-Universität in Berlin (Sean Coughlin, Christine Salazar, Lisa Sherbakova, Kristiane Hasselmann, Philip van der Eijk) held a conference called Traditions of Materia Medica: 300 BCE–1300CE. Over the three days, 25 speakers and over 50 guests from around the world met remotely to share research on the history of theoretical pharmacology in the immediate vicinity of Galen of Pergamum.

One goal for the conference was practical: to bring each other up to speed on what we’ve been doing since the start of the pandemic. Another was programmatic: to test the hypothesis that Galen’s writings on pharmacology constitute a key moment in the history of theoretical pharmacology, one that brought about an acceleration of pharmacological research and reflection. Speakers explored the hypothesis from the perspective of history of medicine, philosophy and science, Egyptology, philology, botany, chemistry and lexicography, focusing on Galen’s sources, his own work, and the work of those who followed him.

Image courtesy of Sean Coughlin

Galen’s Immediate Predecessors (3rd c. BCE – 2nd c. CE)

Among studies of Galen’s immediate predecessors, we heard from edition and translation projects that are bringing Galen’s pharmacological antecedents more clearly into view. David Leith (Exeter), working on the fragments of Asclepiades of Bithynia, presented part of his work into the pharmacology of Asclepiades and his school, many of whom, like Julius Bassus and Niger, were authorities for Dioscorides and Galen. Irene Calà (LMU Munich), critically editing books 10 and 14 of Aetius of Amida’s Medical Books, presented recently identified fragments of recipes from the Herophileans, Andreas of Carystus and Apollonius Mys. Costanza de Martino (Humboldt) discussed the structure and sources of Philumenus’ On Poisonous Animals and Their Remedies, part of her project producing a new edition, translation and study of this work. And Amber Jacob (NYU) presented her project editing 1st–2nd c. CE demotic medical papyri from the Tebtunis temple library, which represent some of the few surviving sources for Egyptian medicine of the period and the intercultural exchange of Greek and Egyptian pharmacology.

Galen of Pergamum (mid-2nd – early 3rd c. CE)

We also had presentations from edition and translation projects of Galen’s pharmacological works. Caroline Petit (Warwick) introduced methodological questions raised by her work on “Rethinking Ancient Pharmacology” and her edition of Galen’s treatise On Simple Drugs (Simples), which draws on Greek, Syriac, Arabic and Latin traditions. Caterina Manco (Paul Valéry – Montpellier) presented a study of Galen as reader of Dioscorides based on her forthcoming edition, translation and study of the botanical books of Galen’s Simples, books 6–8. And John Wilkins (Exeter) presented a comparative study of the ‘theoretical books’ (books 1–5) of Galen’s Simples, which he is translating for the Cambridge Galen Series, and their implementation in the ‘catalogue books’ (books 6–11).

Work on the history and philosophy of pharmacology was presented by P. N. Singer (Einstein Centre Chronoi), who discussed his work on epistemological and metaphysical issues raised by Galen’s notions of ‘changes through the whole substance’ and ‘tests’ of drugs. Simone Mucci (Warwick) presented on the relationship between imperial head-physicians (ἀρχιατροί) and antidotes in the Hellenistic and Imperial periods via Galen’s On Antidotes. And Krzysztof Jagusiak and Konrad Tadajczyk (Łódź) compared sitz-baths (ἐγκάθισμα) remedies in Galen’s work on Compound Drugs According to Kinds and in the pseudo-Galenica.

There were also two fascinating diachronic studies. Laurence Totelin (Cardiff) explored the nature, subject and variety of works called Euporista (“easily procured substances”) from their origins in Apollonius Mys via Galen to Theodorus Priscianus (4th c. CE). And Alessia Guardasole (CNRS – Sorbonne Université), who is working on an edition of Galen’s Compound Drugs According to Places, demonstrated how recipes change over time using the example of the diacodyon (διὰ κωδυῶν, “prepared with poppies”), from Galen to Theophanes Chrysobalantes (10th c. CE)

Galen’s Descendants (3rd – 13th c. CE)

Among scholars working on pharmacology after Galen, Petros Bouras-Vallianatos (Edinburgh) presented his work contextualizing ingredients from Asia in Galen, Late Antique and Byzantine medical works, exploring the reception of Arabic pharmacological lore into Greek and Latin sources. Anne Grons (Philipps-Universität Marburg) presented work on the systematization of ingredients in medical recipes preserved in Coptic pharmacological texts from the 4th–11th c. CE.

Matteo Martelli (Bologna) explored dry medicines, dyes, and alchemical xeria via the etymology of the term elixir, beginning with Arabic and Latin traditions and taking us back to their antecedents in Greco-Egyptian alchemy. Maciej Kokoszko (Łódź) looked at recipes for sweet sauces from Anthimus’ On the Observance of Foods and their pharmacological roots. Zofia Rzeźnicka(Łódź) proposed a theoretical basis for the ingredients of several recipes for peelings and scrubs in Aetius of Amida. And Lucia Raggetti (Bologna) discussed the creative weaving of ancient pharmacological, medical, and philosophical works (Hermes, Galen, Dioscorides, Aristotle) with technical and artisanal knowledge in Malmuk, Cairo of the 7th H/13th CE in the work of Kaylak Qabǧāqī.

Experimental, Lexicographical and Botanical Approaches

We also heard from several groups taking broadly empirical approaches to the history of pharmacology. On the chemical and biochemical side, Manuela Marai (Warwick) presented her work comparing the activity of drug combinations found in Galenic recipes to that of the individual components. Effie Photos-Jones (Glasgow) presented surprising results from the experimental work of her Wellcome Trust-funded group, “Greco-Roman Antimicrobial Minerals,” on the chemical and biological activity of Greco-Roman mineral preparations (lithargyros, psimythion, molybdos). Members of the ERC-project Alchemeast at Bologna, Matteo Martelli and Lucia Raggetti, included their work on replications of ancient alchemical recipes. And Sean Coughlin(Humboldt, Czech Academy of Sciences) introduced a new interdisciplinary research group funded by the Czech Science Foundation, “Alchemies of Scent,” that will replicate the methods of Greco-Egyptian perfumery using analytical chemistry and Greco-Egyptian literary and archaeological sources.

On the botanical and lexicographical side, Maximilian Haars (Philipps-Universität Marburg) gave an overview of his new DFG-funded project producing an encyclopedia of all medicinal plants and herbal drugs in the Galenic corpus—approximately 1,500 entries. And Barbara Zipser (Royal Holloway University London) and Andreas Lardos (Zurich) presented a new interdisciplinary methodology from their project “Plants and minerals in Byzantine popular pharmacy: a new multidisciplinary approach” for the identification of medicinal plants that can provide a more solid and replicable starting point for pharmacological screening.

Hopefully, this brief overview conveys some sense of the variety of research projects exploring Galenic pharmacology and its immediate predecessors and descendants. For those interested, abstracts for the talks are available here.

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 0,5472 ltr.

[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.

*****

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.