Drugs and Medicines in the Roman World

The doctor stepped softly out of the sickroom, where Licinius was breathing his last. Rattling, rasping, wheezing, gasping for air, the senator had accepted death and requested that his friend and physician, the medicus Marcus Junius Asclepiades, leave the opos lozenges next to the bedside. Caecina son, Publics Licinius Caecina, was last to leave the room, misty with the rich stench of smoking libanotos. Soon there was the faint tinkle of the lozenges dropping to the bottom of a glass cup, followed by a crackle as the lozenges snapped and melted over a flame; and then the mellow gurgle of wine poured into the cup escorting the hiss of cooling. Silence. A quick gulp. Marcus Junius Asciepiades whispered, “He will sleep, now. A death of gentle descent, freeing him from his unbearable body, a death by the earliest glimpse of Apollo’s chariot in the dawn.”

Licinius’ wife of three decades had suggested that they burn the far less expensive glechon in the sickroom, but the medicos noted that this medicamentum was useful in the birthing chambers specifically. It was not appropriate for the production of reverential aromas in the resting place of the gravely ill. Julia had reflected a moment and remembered: “Indeed, yes, the attending obstetrix did use glechon when Publius was given to us. So much blood, nicely staunched by the smoke from the glechon.” Marcus Junius Asciepiades quietly wept. “Summon the undertakers and the mourners: we will shortly need them.”

The scene here depicted is part of social and medical history in the Roman Empire. Publius Licinius Caecina is a real historical figure, recorded as the son of a a senator who had committed suicide in Roman Spain a genaration before Pliny the Elder set down his Natural History. (Pliny dedicated his 37-book compendium to Titus the Emperor in AD 77.) A brief account of the suicides in Natural History, XX, 199.

Medicamenta (“drugs,” “remedies,” sometimes “poisons,” “cosmetics,” or “dyes”) were prominent in the lives of the Romans. The best physicians were well schooled in pharmaceutical lore, with an armamentarium of drugs (Fig. 2) derived generally from botanicals, but often from animals and minerals. The quasi-fictional scene of the elder Licinius’ suicide includes an attending physician, usually called a medicus in Latin or a iatros in Greek. Here Marcus Junius Asclepiades is marked as a friend of a dying man. ( Many medicus styled themselves with the cogomen Asclepiades, presumably to be identified with Asclepius,the ancient god of medicine.) Good physicians frequently were clients of powerful families in the Roman Empire, sometimes with both families an physicians interlocked over several generations. Marcus the medicus probably had learned his art as an apprentice to an experienced physicaln. Or perhaps he gained some valued years attached as a medicus to one of legions which had conquered Britain after AD 43.

Julia’s recollection of her obstetrix (“midwife”) also reflects the ordinary assumed knowledge of drugs by these experienced woman. Midwives were recognized as professionals in their own right, particularly in terms of knowledge of drugs, medicinesm and poisons. Roman jurisconsults were certain of this special expertise, and one reads in the Digest that obstetrices were the “experts” to certify or deny a pregnancy. Such women were also skilled in administrating fertility drugs (Digest XXV, 4.4 and XLVIII, 8.3.3).

Three drugs are conspicuous in the death scene of Licinius: opos, libanotos, and glechon. Each of the three was widely known, with libanotos (the famous frankincense) nor­mally reserved for the wealthy due to its cost. Opos is the very common latex of the opium poppy (Fig. 1), easily obtained in any market square in the towns and cities of the Roman empire. Opos was frequently employed by Romans who wished a painless death, espe­cially when an illness was deemed incurable. Glechon (or blechon) is the cosmopolitan pennyroyal, known since early Greek times as a contraceptive (made into a tea) for women. It was also a preferred herb for burning in the birthing chambers due to its sweetish odor, so one learns from the Gynecology of Soraniis of Ephesus (flour- ished ca. AD 117). Not only did the medicus know the useful properties of these three drugs, but so did Licinius’ wife and Licinius himself.

These glimpses of a common knowledge of drugstuffs among the Romans suggest several aspects of ancient life very much at variance from modern, city-based living in the West. Almost everyone, from the most noble to the lowest levels of society, was in some way intimately connected with the land. Wealth almost always was measured in land and its agricultural produc­tion, whether for a known market in cash crops, or in terms of what a given plot of land might produce for subsistence.

Nearly everyone knew plants of many varieties from earliest child­hood. Most knew the numerous teas brewed from “weeds” (usually un­named) gathered by the roadsides or in fallow fields quickly accessed from all but the very largest urban centers. Almost everyone knew something about the finest vegetables and fruits, the best grains employed for the high­est grades of breads. Anyone who had any pretense to high culture knew by definition the best wines and the grapes from which these vintages were fermented. Roman wine-fanciers could easily identify locale and year with a precision perhaps unmatched even today. Good cheeses (and poor ones) were known by their distinctive tastes and aromas, and high-quality olive oil was treasured for its clarity (for cooking) and for its lubricant properties. Oil seeds and their marvelously varied oils—sesame, linseed (flax), poppy (totally free of any narcotic properties), and many others—were known by consistency and clarity, especially by the talented cooks who were members of all Roman households claiming any sort of status.

Cosmetics, including the famous henna or cam­phire (Fig. 3), were always available in a daily-fresh supply. Henna was an item treasured by Roman women who used the finery ground green powder to color their fingernails, toenails, and hair a fashionable reddish-brown. Drugs, foods, and cosmetics were intermeshed in Roman perceptions, much as we think of spices as drugs while also using them to enhance the flavors of foods, or as we think of fragrant emollients as useful in both perfumes and moisturizing creams for the skin.

Botanicals

The first surviving herbal in Greek is that by Theophrastus of Eresus (ca. 370-288/5 BO, the most brilliant of Aristotle’s students. Theophrastus put down his Inquiry into Plants about 300 BC, and Book IX of this important tract on botanical morphology is devoted to medicinals. The ultimate sources for practical data were the ever-present rbizotomoi (“rootcutters”) and phar­makopolai (sing. pharmakopoles: “drug seller” or “apothe­cary”), who provided Theophrastus with much informa­tion on what parts of what plants were useful as drugs (pharmaka, sing. pharmakon). Of the 500 or so plants that can be identified in Theophrastus with some assurance, about 70 are medicinals, a fraction of the drugs known and derived from plants and animals in Greek antiquity. Poisons are here as well, including the infamous hemlock quaffed by Socrates at the behest of the Athenians in 399 BC. Not surprisingly, Athenians knew exactly how hem­lock was to be prepared, and the democracy had a Committee of Eleven elected to supervise executions for capital crimes. The Committee of Eleven directed the preparation of this poison, and everyone was presumed to know the process and its results.

Citizens of Attica, the large polis that boasted Athens as its fortified urban and cultural center, also knew well the plants of contraceptive use. Aristophanes (ca. 457-385 BC) could assume easy comprehension of jokes and puns on blechon/glechon in his uproarious and earthy comedies Peace (421 BC) and Lysistrata (pro­duced in 411 BC). The commonplace and conventional pennyroyal tea was, after all, indispensable for prosti­tutes of all levels to stay in business. Call girls could also have employed the garden-variety rue (Fig. 4), a decoc­tion of its leaves giving control over menstruals, as well as providing early abortions as necessary. Tragedies, too, had their botanicals. Sophocles’ (ca. 496-406 BC) lost play The Rootcutters had a vivid scene in which Medea in a frenzy dances naked in the moonlight after imbibing the juice of the so-called deadly carrot (Thapsia garganica L.). This plant was another of the widespread wild species known to all who maintained small or large plots anywhere among the poles of Greece.

The Athenian agora, much as would be true for marketplaces in later Hellenistic and Roman times, fea­tured stalls designated for the sale of particular vegeta­bles, always fresh, always “the best.” One reads of spe­cialized vendors who hawked various kinds of olive oils, the oils of seeds, fruits, and pharmaka that included sage, several types of mint (e.g., spearmint (Fig. 5), horsemint, Bergamot mint, woolly mint, and pennyroyal), mallows (especially the high mallow, used for mucilage, as an expectorant, and a decoction of the flowers as an excellent gargle and mouthwash; Fig. 6), and often exotics brought from somewhere in the “East.” Generally one could find black pepper (Piper nigrum L.), depending on trade and sailing conditions to and from India and points further east. (The red peppers (Capsicum spp.) were unknown in European or Asiatic diets or pharmacopeia until the discovery of the New World.)

Greek and Roman diets were quite healthy and highly flavored: some of the favored additives were garum (fermented fish entrails), pepper from India, cin­namon, and cassia. Local spices known from Mycenaean times (ca. 2500 to ca. 1000 BC) included saffron (Fig. 7), cumin, and a number of others. The Linear B tablets from Mycenaean Pylos (dated to ca. 1200 BC) suggest a thriving perfume industry, so that from earliest times pharmaceuticals were important in the culinary arts, perfumery, and medicinals.

Animal Products

Pharmaka also incorporated animal products: honey, beeswax, the ill-famed solution made from blister beetles (usually Lytta spp., still around as “Spanish fly”), fats, marrows, milks, crushed cockroaches, concoctions of boiled snakes, and even the rennets procured from the stomachs of seals, goats, oxen, and other animals. Honey is an excellent ingredient for wound dressings. Its high pH (3.9 on average) enabled Greek and Roman physi­cians to apply fats, oils, and honey in bandages on wounds and injuries, effectively “drying” them out and killing many bacteria in the process. Beeswax was another item of commerce, and any owner of a set of hives knew the flowers whence his bees gained their nectar and con­structed their combs. Not only could physicians use bees­wax as the finest of foundations for their poultices and plasters—wax is easily melted and applied, and adheres harmlessly to the wound—but these “aerates” (cera is Latin for “wax”) could be sold in bulk for making sealants of many kinds, from jar-stoppers to the seals attached to let­ters. Wax tablets took the place of portable chalk boards in the primary schools of classical antiquity; writing in wax is quickly smoothed out and the “erased” tablet reusable indefinitely. Wax and honey aficionados could tell a particular kind by locale, each having its own unique consistency and taste. (Poison honeys were also known.)

The use of blister beetles in aphrodisiacs and poisons was common enough in the Greco-Roman world to engender a large literature. The odd hexameter poems by Nicander of Colophon (fl.ca. 130 Bc), Theriaca and Alexipharmaca, detail characteristics of presumably poisonous animals, as well as poisons derived from plants and minerals, along with antidotes. Kantharis (the solution made from two species of blister beetles) is prominent, and Nicander and his sources suggest a number of anti­dotes, with one actually being ben­eficial (a quick and massive dosage of chalk, quite similar to our kaolin).

Many fats are listed by Dioscorides in his brilliantly conceived Material Medica of ca. AD 70. Here are the fats of bears, goats, and lions, and the more easily obtained fats and greases from sheep (lanolin or “wool grease” is recognized), ducks, geese, and other animals. Marrows are likewise listed, as are milks and bloods of many species of reptiles, birds, and mammals, including humans.

Dioscorides and the Materia Medica

Dioscorides of Anazarbus is one of the great figures in the history of medicine and pharmacy, and his Materia Medica became the text on drugs of all kinds. Galen of Pergamon, the polymathic philosopher and physician (AD 129—after 210), quotes and gives Dioscorides enormous respect, while ignoring the Anazarbans pre­scient “drug affinity” system, that is, what drugs did when administered to patients for particular ailments. Dioscorides’ methodologies demanded that a physician be a field botanist, knowing plants in all of their stages of growth, knowing the best ways in which to gather herbs and their specific preparation techniques, and observing the detailed actions of these drugs when given for treatments to alleviate illnesses.

Dioscorides had little patience for the “vain prating” of philosophers as they attempted explanations for pharmacy actions. But he does employ the venerat­ed concepts of the Four Elements (the Aristotelian Fire, Earth, Air, and Water) and the Four Qualities (the Hot, the Wet, the Cold, and the Dry) to propound how compounds drugs could be mixed and how simples could work against diseases characterized by any one of the Qualities. There is no trace of the famous Hippocratic­Galenic humoral pathology, which speaks of disease as an excess (Greek plethora: sometimes a “fullness” or “satiety”) of one of the Four Humors (Blood, Phlegm, Yellow Bile, and Black Bile), but many physicians in the Roman Empire did assume a set of humors as explana­tion of health and disease. (Krasis was the state of perfect “balancing” among the Four Humors, dyskrasia the “imbalance” of disease.)

Painstaking observation distinguishes Dioscorides’ drug lore, and many details in the Materia Medica are replicated by Galen and other Roman authors on medi­cine. Although Dioscorides loathed alphabetical lists of drugs and plants, this is exactly what happened to his collection of data in the Materia Medica. Galen chose to rearrange the ordering of the 600-odd pharmaceutical substances, and alphabetical tabulations of Dioscorides’ drugs were in circulation (in Greek) at the latest by the middle of the 4th century.

Crateuas, physician to Mithridates VI of Pontus (ca. 120-63 BC), produced an illustrated herbal, but Pliny the Elder (Natural History, XXV, 8) complained about its badly mauled images, perhaps indicative of the difficulty in depicting colored plants in the usual rolls of papyrus. Once the form of the “book” shifted from the papyrus roll to the flat sheets of the codex after AD 350 or so, illuminations of all kinds could be incorporated in the recopied texts. One of the earliest surviving of these illustrated manuscripts is the Codex Anicia Juliana, dated to AD 512 (Fig. 8). This is the most luxurious of Byzantine scientific manuscripts: it contains 498 minia­tures, mostly of the plants in Dioscorides’ Materia Medica arranged alphabetically (see Figs. 1, 6, 8, 9). The Codex (listed as Greek medical MS No. 1 in the National Library in Vienna) also has illuminations accompanying prose-summaries of Nicander’s Theriaca and Alexipharmaca. The plants-as-drugs pictured are occa­sionally masterpieces of painting and occasionally sim­ply dreadful. Among the folios that provide rather good depictions is folio 221v, labeled MHO HMEPOC KHNAIOC, the opium poppy (see Fig. 1), about which Dioscorides writes: a common property among the poppies is cooling . . . the leaves and capsules are decocted (viz. “boiled down”) in water and applied as fomenta­tions to induce sleep; and the decoction is drunk for insomnia, and the capsules triturated (viz. “pounded finely”) and mixed with a poultice of hulled barley and made into plasters are fitting for inflamed boils and cases of erysipelas. One should make them into lozenges—pounding them in a mortar while they are still green—and drying obstructions and for jaundice, and they cieanse and cure liver complaints. And decocted, these are used in fomentations as treatments for the bladder. But more useful for those who suffer from stones are those colored purple; the white-flowered and gold-flowered kinds are more diuretic. They are also curative for ulcers of the eye (viz. lachrymal fistulas) being laid on as plasters, and chewed they cure thrush in children. (Materia Medica, III, 137.2 [ed. Hellmann, II, p. 146])

In his Preface to the Materia Medica (ed. Hellmann, I, pp. 1-5), Dioscorides offers a clipped synopsis of why his compendium of pharmacal lore improves markedly on the efforts of his predecessors. He also admon­ishes anyone reading his account to constantly augment the mass of details by “extending . . . the range of prepa­rations and mixtures and . . . trials on patients, for the knowledge of each individual drug has a great deal to contribute” (Preface, 3 [ed. Hellmann, I, p. 2]). The Preface presents the most precise and inclusive summary of drug preparation and storage that we have from classical antiquity, and modern pharmacists can appreciate the specifics: Extract juices from plants by infusion [or decoc­tion] when the stems are recently sprouted, and similarly with leaves; but to gain juices and drop-like gums by tapping, take the stems and cut them while still in their prime. Gather roots for laying up in storage, as well as roots for juices and root barks, when the plants are beginning to shed their leaves. The ciean roots should be dried out imme­diately in areas free from moisture, but roots with earth or clay adhering should be washed with water. Flowers and such parts that have a sweet smelling fragrance should be laid down in small dry boxes of lime-wood, but occasionally they can be wrapped serviceably in papyrus or leaves to preserve their seeds. As for moist drugs, any container made from silver, glass, or horn will be suitable. An earthenware vessel is well adapted provided it is not too thin, and, among wooden con­tainers, those of boxwood. Copper vessels will be suitable for moist eye-drugs and for drugs prepared with vinegar, raw pitch or juniper oil. But stow animal fats and mar­rows in tin containers. (Preface, 9 [ed. Hellmann, I, pp. 4-5])

The drug booths in Roman fora featured a large variety of concoctions, compounds, and simples used in culinary recipes, medications, and cosmetics. The substances incorporated many land and sea creatures, as well as plants. Typical are the following from Dioscorides’ Materia Medical: A sea horse is a small sea creature, which being burned, the ash is prepared as an ointment with raw pitch, or hog’s fat, or oil of marjoram, and smeared on a bald spot brings back hair to those afflicted with alopecia. (Materia Medica, II, 3 [ed. Hellmann, I, p. 122])

Reduced to ash (viz. “calcined”), a purple shellfish has a dessicant property for detersive cleaning of teeth, for checking fleshy overgrowths, and for cleaning out sores and causing them to scar over. And trumpet shells calcined have the same proper­ties as the purple shellfish, but the trumpet shells are more caustic; and if one fills them with salt and cal­cines them in an unfired earthenware pot, they are beneficial as a tooth powder, as well as for burns, being used as an ointment smeared on. But the drug should be allowed to become dry and hardened like a potsherd: for the burn having scarred over, the ointment falls off spontaneously. (Materia Medica, 4 [ed. Hellmann, I, pp. 122-23])

Fresh clams are good for the bowels, but the soup made from them is best. Pickled, reduced to ash, pounded smooth with Greek juniper oil and dropped on plucked eyelids, the eyelashes will not grow back again. And the soup made from the small rectangular bivalves and from other cockle-like shellfish move the bowels (viz. act as laxatives), being boiled with a little water. And this kind of soup is taken with wine. (Materia Medica, II, 6 [ed. Hellmann, I, p. 123])

Triturated with myrrh and frankincense and applied as a plaster, the flesh of these snails close up wounds, particularly the wounds in and about the tendons; and triturated with vinegar, they stop bleeding from the nostrils. And the living animal gulped down (especially the Libyan snail) alleviates stomach pains. Pounded whole with its shell and a small portion drunk with wine mixed with myrrh, the snail cures pains of the bowels and the bladder. And the land snail also glues hairs together: one inserts a needle down into the snail’s flesh and attaches or fastens the hair with the gummy matter brought out on the point of the needle. (Materia Medica, II, 9. 3 [ed. Hellmann, I, p. 125])

Dioscorides and other medical and pharmaceu­tical sources reveal a tumbling series of details on plants, animals, spices, oils, wines, vinegars, and minerals—clear indications of deep and venerated expertise neces­sarily shared by shoppers in the agora and forum. Drug fraud was expectedly common, and Dioscorides fre­quently adds instructions for detection of fakes from the “real stuff,” as in the case of the latex of the opium poppy (Materia Mediae, IVY, 64.5-6 [ed. Wellmann, II, p. 220]). A modern scholar can identify a number of snails, sea creatures and shellfish, insects, plants, and minerals, so ciear are the descriptives in both their drug actions and morphologies in what we would term natural histo­ry. Equally interesting is how Dioscorides indicates par­ticulars of fashion in his own century. One can but won­der about eyelash removal as a statement of an attractive appearance (although this treatment could reflect a long-term therapy for infected eyelashes: pluck the lash­es, prevent them from growing back, and the affliction is cured).

The Marketplace

Frankincense and myrrh are frequently pre­scribed in the writings of Dioscorides, Galen, and Pliny the Elder, and in many other medical texts from the Roman Empire. This indicates that the two “Arabian spices” were ordinarily available, if somewhat expensive, much as was the very costly saffron, which was almost always a local product. Saffron is gained from the styles of the flowers of Crocus sativus L. (see Fig. 7), and it takes 100,000 flowers to produce 1 kilogram.

Drug markets and spice markets in the Roman Empire generally mirrored “going prices” for valued condiments. Pliny the Elder tells us that Arabian myrrh fetched 16^½ denarii for a Roman pound, and that the best grade of frankincense cost 6 denarii for a pound (Pliny, Natural History, XII, 70, 65); however, there is no mention of saffron. Yet when the famous Price Edict was promulgated by Diocietian in AD 301, saffron’s fixed price was 2000 denarii for a Roman pound, a price reflective of the rampant inflation characteristic of 3rd century economics. As costly as saffron became, one can presume krokos remained available to forum shoppers for many centuries, since saffron is listed as part of a quince jam recipe prescribed by Alexander of Tralles in the last part of the 6th century.

In spite of official attempts, sporadic at best, to regulate prices and products in the Roman Empire, most people bartered and bargained in the forum or agora as had generations before them. Even the great warehouses (the horrea) had limited impact, although the Horrea Piperataria in Rome (established under Dotnitian [AD 81-96]) functioned to store “exotic drugs and peppers [and] the convenient retailing of them in one place where adequate control would be exercised” (Rickman 1971:106). Since the great majority of settle­ments in the Roman Empire were small country towns, most markets flourished far from official sanctions, and Dioscorides’ recommendations for on-the-spot testing of drugs and spices remained pertinent.

One easily pictures the rhizotomist’s booth in the marketplace, stuffed with limewood boxes, various containers of boxwood, and copper vessels running over with the always-in-demand collyria (“eye-salves”) or giv­ing forth the pungencies of pine resin, the sharp odors of juniper oil, or the ordinary tartness of vinegar. The pharmakopoles would have his array of glass flasks filled with semi-fluids to be examined (one rolled the sub­stance between thumb and forefinger to test consisten­cy) or smelled once stoppers were removed (Figs. 10, 11). These semi-pasty ointments were also stored in the hollow horns of diverse bovines; the rootcutter and drug seller would have most preparations in horns, the cheap­est containers. Silver canisters (perhaps in the form of the well-known Pyxis) would be set toward the back of the stall to hold the expensive drugstuffs, perhaps ready-made myrrh in oil, or frankincense melted down’ bye the vendor for the day’s sales. And there would be many brightly colored flower petals scattered along the rude shelving on each side of the stall, each type of flower wrapped in Egyptian papyrus or some carefully arranged selection of local leaves. Anyone entering the booth would be met by a melange of aromas, a potpourri of scents that cantillated the medley of drugstuffs, spices, cosmetics, and medicines.