The Asclepion
Prof. Nancy Demand, Indiana University
- Bloomington
Hippocratic Use of Drugs*
There is no book devoted solely to pharmacology
in the Hippocratic Corpus, and few of the treatises provide directions
for treatment. The books dealing with general medicine that do
discuss treatment rely generally on diet as a therapy; in those
that do specify other treatment, these seem to develop out of,
and to be used in conjunction with, dietary measures.
In fact, the author of Ancient Medicine
attributes the discovery of medicine to experiments in treating
natural products to make them more suitable for human consumption,
by "steeping, winnowing, grinding and sifting, kneading,
baking ... combining the weaker components so as to adapt all
to the constitution and power of man." (III, tr. W.H.S.Jones)
Regimen in Acute Diseases gives detailed instructions
for various forms and uses of gruel (which, despite its innocuous
sound, also has its dangers -- the doctor warns that untimely
use of gruel without first purging the patient, or use of unstrained
gruel, can be fatal) (XVI, XVII)
Hippocratic treatment was based upon the
principle that all foods have properties that react on the body.
Some cool, others heat, some are soothing, and some offer dramatic
evidence for their "effectiveness" (purges, emetics).
For example, Diseases III, 17 gives numerous recipes for
ardent fever, first advising: "...they have many effects,
some are diuretic, others laxative, others both, and others neither,
merely cooling as if some one were to pour cold water over a
vessel of boiling water, or were to move the vessel itself into
the cold air. Give different ones to different patients, for
the sweet ones do not benefit everyone, nor do the astringent
ones, nor are all patients able to drink the same things."
(tr. Paul Potter)
In most cases, drugs, when they appear,
are mingled with dietary suggestions, and it seem that the Hippocratic
doctor saw little distinction, since all have properties and
effects on the body. Thus Internal Affections 1 suggests,
"...give him for breakfast fine cereals and main dishes
of the heartiest kinds, have him drink the same wine. Also, give
him roots effective against tears: grate centaury over wine;
grate dragon arum [shavings] over wine, too, and give it. For
the cough, grate dragon arum into honey, and give this to the
patient to take." (tr. Paul Potter) In Epidemics
VII.80 a fever is said to have come down from "the drink
made from coarse barley meal, sometimes from apple and pomegranate
juice and juice from toasted lentils, cold." (tr. Wesley
Smith) In the recipe given in Internal Affections 6, only silphium
juice (because of its rarity) would probably not qualify as an
everyday nutrient: "...early in the morning let the patient
drink in the fasting state silphium juice, to the amount of a
vetch, in melicrat or in wine and honey, eat garlic and radishes,
and on top of that take dry white or dark wine unmixed with water;
let him again take these things with his meal and after it."
(tr. Paul Potter)
On the other hand, a few books are more
therapeutically oriented. For example, Diseases III prescribes
a number of non-foods as expectorants, including, "...equal
amounts of white hellebore, thapsia, and fresh squirting-cucumber
juice....Alternatively... give a cheramys each of cuckoo-pint,
dauke and stinging nettle, good pinches of mustard and rue, and
silphium joice in the amount of a bean; mix these in sweetened
vineagar and water, sieve, and give warm to the fasting patient."
(tr. Paul Potter)
- White hellebore,
one of two hellebore plants, probably unrelated: "analgesic,
anthelmintic, cathartic, emetic, errhine, expectorant, hypnotic
and sternutatory. The root is very poisonous, with a paralyzing
effect on the nervous system, and is scarcely if ever used internally."
- Thapsia, deadly carrot: diuretic, emetic and purgative; strongly rubefacient,
producing blisters and intense itching.
- Squirting-cucumber: juice is antirheumatic, cardiac, purgative; used
in treatment of oedema associated with kidney complaints, heart
problems, rheumatism, paralysis and shingles. Excessive doses
can cause gastroenteritis and even death. Abortifacient.
- Cuckoo-pint, Arum maculatum: Root and leaves edible when dried or cooked.
Medicinal uses: root is diaphoretic, expectorant, vermifuge.
- Dauke, wild carrot: "an aromatic herb that acts as a diuretic,
soothes the digestive tract and stimulates the uterus. The whole
plant is anthelmintic, carminative, deobstruent, diuretic, galactogogus,
ophthalmic, stimulant.... The root is also used to encourage
delayed menstruation. It can induce uterine contractions and
so should not be used by pregnant women."
- Stinging nettle:
"A tea made from the leaves has traditionally been used
as a tonic and blood purifier. The whole plant is antiasthmatic,
antidandruff, astringent, depurative, diuretic, galactogogue,
haemostatic, hypoglycaemic and a stimulating tonic. An infusion
of the plant is very valuable in stemming internal bleeding.
It is also used to treat anaemia, excessive menstruation, haemorrhoids,
arthritis, rheumatism and skin complaints, especially eczema.
Externally, the plant is used to treat arthritic pain, gout,
sciatica, neuralgia, haemorrhoids, hair problems, etc."
- Mustard:
"The seed is antibacterial, antifungal, appetizer, carminative,
diaphoretic, digestive, diuretic, emetic, expectorant, rubefacient
and stimulant....cathartic.... seldom used internally as a medicine.
Externally it is usually made into mustard plasters (using the
ground seed), poultices or added to the bath water."
- Rue:
"especially valued for its strengthening action on the eyes.
The plant contains flavonoids (notably rutin) that reduce capillary
fragility, which might explain the plants reputation as an eye
strengthener. Some caution is advised in its use internally,
however, since in large doses it is toxic and it can also cause
miscarriages. The whole herb is abortifacient, anthelmintic,
antidote, antispasmodic, carminative, emetic, emmenagogue, expectorant,
haemostatic, ophthalmic, rubefacient, strongly stimulant, mildly
stomachic and uterotonic."
- Silphium:
a giant fennel (Ferula), now extinct, prized in antiquity as
a condiment and cathartic.
The more pharmaceutically-oriented books
include the two major gynaecological works, Diseases of Women,
and On the Nature of Women. These include many recipes
for remedies, which may be written records of previously orally
transmitted folklore, much of it passed along by women in their
treatment of illnesses in the household, and focussed especially
on women's concerns. Control of the menses was obviously of importance,
since the Greeks saw their blockage as presenting both a mortal
threat to women and a risk to their companions (sufferers might
seek to strangle themselves or murderously attack others). Therefore
emenogogues (drugs to bring on the menses) were frequently prescribed.
Many of these could also have been used to speed a slow or inadequate
labor, or to end an unwanted pregnancy. We often cannot tell
how they were intended to be used, but many such "multi-purpose"
recipes appear in the gynaeocological works. John Riddle has
done much interesting research on the ingredients of these, many
of which -- rue, pennyroyal (one of the family of mints), pomegranate
seeds, ivy, belladonna (a member of the nightshade family) --
have properties that would have made them effective in the right
dosages (and possibly fatal otherwise).
A number of other members of the nightshade
family, which we would classify clearly as drugs, were used as
well, about half the time for their narcotic effect. Opium makes
21 appearances in the gynaecological treatises, mostly in drinks
to be used for the Wandering Womb or other uterine troubles.
Another characteristic of the gynaeocological
treatises is their use of "excrement therapy." Heinrich
von Staden has drawn attention to the fact that ninety-nine percent
of all references of the use of such materials occur in the gynaecological
works. He suggests that this constitutes an element of Hippocratic
continuity with ritual: "Here the Hippocratic healer of
the womb partially resembles those very 'purifiers' and magicians'
whom the celebrated author of On Sacred Disease excoriates."
(von Staden, 20)
In conclusion, we can say, with the author
of Affections 45, that Hippocratic therapy was, with some
notable exceptions, based on effects that were empirically determined
and in harmony with rationalized beliefs about the workings of
the body and the causes of illness: "About medications that
are drunk or applied to wounds it is worth learning from everyone;
for people do not discover these by reasoning but by chance,
and experts not more than laymen. But whatever is discovered
in medicine by reasoning, whether about foods or about medications,
you must learn from those that have discernment in the art, if
you wish to learn anything." (tr. Paul Potter)
Some useful Bibliography
Riddle, John, J.Worth Estes, and Josiah
C.Russell, "Birth Control in the Ancient World," Archaeology
47.2 (1994) 29-35.
Riddle, John, "Folk Tradition and
Folk Medicine: Recognition of Drugs in Classical Antiquity,"
in John Scarborough, ed. Folklore and Folk Medicines,
Madison, Wisconsin, 1987.
Riddle, John, Contraception and Abortion
from the Ancient World to the Renaissance. Cambridge, MA
1992.
Lewis, Walter, Medical Botany: Plants
affecting man's health. New York, 1977.
Moisan, Monica, "Les plantes narcotiques
dan le Corpus Hippocraticum," in P.Potter, G.Maloney, J.Desautels,
La maladie et les maladies dans la Corpus Hippocraticum,
Quebec, 1990, 381-91.
von Staden, Heinrich, "Women and Dirt,"
Helios 19 (1992) 7-30.
*Translations
are from the Loeb Hippocrates series.
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