Byzantine herbs and drugs
a) the magical and dangerous mandrake
Mandragora or Mandrake
During their extended and fruitful existence, is obvious to believe the Byzantine Empire had herbalists and physicians that not just adopted (copied), but adapted and discovered numerous drugs and preparations for the treatment of pain and other illnesses, including those containing the somehow mystical, and highly toxic, mandragora root.
The earliest surviving illustrated surgical codex was made for the Byzantine physician Niketas about 900 CE
If you were to search the word “mandrake” or “mandragora” in my Pharmacology text when I was studying for my Pharmaceutical degree, you would not find it. It had long been out of Pharmacopoeias and Pharmacology textbooks. Goodman & Gilman’s 6th Edition of “The Pharmacological Basis for Therapeutics” did not mention it at all; though we did heavily study Atropine, Scopolamine, Homatropine and other related Antimuscarinic drugs, generally referred to as belladonna alkaloids. The Mandragora or European Mandrake (Mandragora officinarum) plant is a member of the Solanaceae family that includes Atropa belladonna (nightshade), Datura stramonium (Jamestown or Jimson weed), and other shrubs. The interesting alkaloids they contained have played important roles in history and medicine. Indeed, the mandrake plant was believed to have magical powers. We must remember though all these alkaloids are psychoactive, highly toxic, often lethal substances.
The Mandragora plant has been used since Greco-Roman times, and it’s even mentioned in the Bible. Hippocrates noted that a small dose would relieve anxiety and the deepest depression. If drunk its hypnotic properties allowed amputation or cauterisation. It was also used as an aphrodisiac and cure for sterility. Today we know that it contains the psychoactive alkaloids hiosciamine, scopolamine and madragorine (a powerful narcotic and hypnotic, chemically identical to atropine). However, long before its active principles had been identified, it had been used to produce both therapeutic (the mandragora wine was probably the first anaesthetic used in surgery), and obscure and poisoning effects, especially during the European Middle Ages. Both the root and its method of picking were associated with superstition and mysterious popular legends (due to its spindle-shaped root which is often forked beneath, and is therefore compared, in shape, to the human figure). Mandrake root, was supposed to utter a dreadful shriek when pulled from the ground and whoever heard the shriek died. To collect it, a dog was tied to the plant and tempted with meat. Indeed Shakespeare makes use of its properties in many of his plays.
“Give me to drink mandragora…
That I might sleep out this great gap of time
My Antony is away.” (Shakespeare’s Antony and Cleopatra, I.v).
“Shrieks like mandrakes’ torn out of the earth.”
(Shakespeare’s Romeo and Juliet, IV.iii)
Byzantine herbalists and physicians surely came to know analgesic, sedative and anaesthetic preparations containing mandrake. However, as we know so little about this magnificent people, we need to wait for scholars to go through medical-historical Byzantine texts to confirm the extent of the aforementioned affirmation. As Prof John Scarborough from the University of Wisconsin so clearly states it: “Byzantine medicine: a millennium of medical history, very poorly known by comparison with ‘classical’ Arabic or Greco-Roman medicine”. Moreover, in his Byzantine Medicine & Pharmacy course information of Spring 2008, he tells students: “Even today, some 25 years after I composed the “Introduction” to the 1984 Dumbarton Oaks Papers, the ‘state of research’ remains much the same, with basic texts and sources unedited, given eras of Byzantine medicine still unexplored, and too few qualified philologists, physicians, and historians have devoted efforts to understanding the medical history of the Byzantine Empire.
Folio 90v Naples Dioscorides – c. VII century
In what could be called the precursor of modern pharmacopeia, the Greek herbal De Materia Medica by Pedanius Dioscorides of Anazarba in Cilicia, the author describes the mandragora in detail, and explains how wine made from mandragora can induce anaesthesia – in the sense of an absence of sensation – in people about to undergo surgery or a cauterization of their wounds.
“… [sleeping potions such as opium or mandragora are applied] to such [people] as shall be cut, or cauterised … For they do not apprehend the pain because they are overborn [overcome] with dead sleep …. But used too m much they make men speechless.” Pedanius Dioscorides
Dioscorides receiving mandrake from Euresis (discovery).
This seminal book written in the first century AD was faithfully studied, copied and quoted for another fifteen hundred years, mainly by Byzantine scribes. One of its more famous copies known as the Vienna Dioscorides can be found in the Austrian National Library; and mandrake is present in two paintings of the frontispiece of this illustrated manuscript completed in 512 CE (also known as the Aniciae Julianae Codex). More than 600 plants and 1000 drugs were described in this ancient pharmacopeia, which remained the standard medical text until the 17th century.
More recent studies described evidence on pain relief and sedation for surgical and medical purposes traced in literary medical treatises from the Roman and Byzantine times (2nd century BC to 7th AD). Roman and Byzantine scientists, such as Dioscorides Pedanios, Gaius Plinius Secundus, Galen, Orivasios from Pergamum, Themistios, Aetios of Amida, Ioannes Damascenos and others, referred to Mandragora officinarum, Hyoscyamos niger and Atropa belladonna as the most important herbs, besides the opium poppy, to be used for producing pain relief and sedation.
Many other drugs and herbs were extensively used by Byzantine physicians, contributing in this way to the preservation and deepening of ancient pharmacological knowledge.
References
– Goodman & Gilman’s “The Pharmacological Basis for Therapeutics”, 6th Edition.
– Rätsch C., Encyclopedia of Psychoactive Plants, Park Street Press, 2005, pg. 796-7.
– Ioanna A. Ramoutsaki, Helen Askitopoulou, and Eleni Konsolaki, Pain relief and sedation in Roman Byzantine texts: Mandragoras officinarum, Hyoscyamos niger and Atropa belladonna,International Congress Series, Volume 1242, 2002, pg. 43-50.
b) The Poison Aconite or Wolfsbane
Monkshood – Aconitum napellus, Wolfsbane – Aconitum lycoctonum; and other species
Aconite is a powerful plant, used in the past as a medicinal herb, a poison and in potions for incantations. It belongs to the Aconitum genus of flowering plant belonging to the buttercup family (Ranunculaceae).
There are over 250 species of Aconitum. The most common plant in this genus, Aconitum napellus (the common Monkshood) was considered to be of therapeutic and of toxicological importance. These herbaceous perennial plants are chiefly natives of the mountainous parts of the northern hemisphere, growing in moisture retentive but well draining soils on mountain meadows.
Some species of Aconite were well known to the ancients as deadly poisons. It was said to be the invention of Hecate from the foam of Cerberus, and it was a species of Aconite that entered into the poison which the old men of the island of Ceos were condemned to drink when they became infirm and no longer of use to the State. Aconite is also supposed to have been the poison that formed the cup which Medea prepared for Theseus. The Greeks hailed it as the Queen of Poisons, and until the 20th century, it was the deadliest toxin known to man.
The leaves and root yield its active ingredient, a potent alkaloid called Aconitine, which was frequently used to poison the tips of hunting darts or javelins. Until its toxic properties were discovered, tincture or liniment of aconite was used to relieve sciatica, neuralgia and rheumatism, for the heat-production and mild anaesthetic properties of the potion gave comfort to many an aching joint. However, its popularity took a plunge when it was discovered that the mere rubbing of preparations on skin produced symptoms like poisoning by ingestion, and thereafter was sought primarily by those who had more sinister uses for the plant. Already the author Nicander of Colophon (fl 130 BC) advised of aconite toxicity.
The poison works by targeting the cardiovascular and central nervous system, and gastrointestinal tract. All the species contain the active poison Aconitine, which exists in all parts of the plant, but especially in the root. The poison takes effect quickly. At one time, Aconite was a homeopathic remedy used in western medicine. Today, Aconite use in medicine has been discontinued in favour of safer medications.
Ancient knowledge of Aconite usage
The Greeks called Aconite lykotonon, meaning wolf slaying (Wolfsbane); this plant earned the name because it was rubbed on the arrows used when hunting wolves. Several species of Aconitum have been used as arrow poisons. Soldiers would dump aconite down wells in order to poison an enemy’s water supply.
Monkshood originated from the spittle of the beast Kerberos was dripped on the ground and this lead to the sprouting of Monkshood.
The art of poisoning was carefully cultivated in Rome, and became a flourishing industry since the early Emperors. Our knowledge of poisons available during Roman times is derived from the writings of Dioscorides, Scribonius Largus, Nicander, Pliny the Elder, and Galen. Poisons were of vegetable, animal and mineral origin. Vegetable poisons were best known and most frequently used. They included plants with belladonna alkaloids, e.g. henbane, datura, deadly nightshade and mandrake; aconite from monk’s hood; hemlock, hellebore, colchicum (from autumn crocus), yew extract and opium.
Galen understood the very deleterious qualities of botanical poisons, some cultivated for nefarious use, and others combined with beneficial drugs to engender stimulant effects (aconite, hyoscyamus, mushrooms, hemlock, mandrake, this last common in Roman times as a reliable anaesthetic). Galen commanded the technical details, best recorded in Greek by Dioscorides of Anazarbus, of animal, botanical, and mineral pharmacology.
An illustration of the species “Akoniton napellus”, folio 67V
In De Materia Medica (“The Materials of Medicine”), Dioscorides describes two different plants, the first Akoniton lycoctonum, which was used to kill panthers, wolves, and other wild beasts, and as an anodyne (pain reliever) in eye medications. In the next chapter, he describes “the other aconitum,” Aconitum napellus (monkshood), which also is toxic. Aconitum napellus is so named, says Theophrastus, because the tuberous root of the plant was thought to resemble a small turnip (napus) and “in this root resides its deadly property” (the alkaloid Aconitine). He goes on to say that, depending upon how it is compounded, the effect of the poison can be immediate or fatal in several months or even a year or two, the longer the time, the more painful the death. In general, it was deadly to any four-footed animal and “kills them the same day if the root or leaf is put on the genitals”.
Byzantine usage of Aconite as a poison
Of the 88 emperors who reigned from 324 to 1453— from Constantine I to Constantine XI— 29 died violent deaths, including several poisonings. Evidence for the use of aconitum as a poison in the Byzantine period can be found in the case of Emperor John I Tzimisces (ruled 969—976), who appears to have been poisoned by a disgruntled eunuch. He died suddenly in 976 on his return from his second campaign against the Abbasids, and was buried in the Church of Christ Chalkites, which he had rebuilt. Several sources state that the imperial chamberlain Basil Lekapenos poisoned the emperor to prevent him from stripping Lekapenos of his ill-gotten lands and riches.
John I Tzimisces entering Constantinople in Triumph with the Preslav Icon
Nowadays, Aconite’s natural habitat comprises the lower mountain slopes of the north portion of the Eastern Hemisphere; from the Himalayas through Europe to Great Britain. The Via Egnatia, one of the most important roads in the Byzantine Empire, built during the Roman Empire, to facilitate the communication between Rome and Constantinople, and connecting Durrеs to Lychnidos (Ohrid), Thessalonica (Thessaloniki), Adrianople (Edirne) and Constantinople (Istanbul), is known to be the spiritual and cultural axis, first for the spreading of Orthodox Christianity in South East Europe, and later on the spread of monkshood.
References
• “Poisons, Poisoning, and Poisoners in Ancient Rome”, Francois P. Retief & Louise Cilliers
• “Drugs for an Emperor”, John Scarborough
• “Medicine in the Crusades: warfare, wounds, and the medieval surgeon”, Piers D. Mitchell
• Cultural Corridors of South East Europe
All figures were borrowed from public domains in the Internet.
Laura Diaz-Arnesto
Montevideo – Uruguay
Laura is a pharmacologist and has offered this piece to give us an opportunity to develop some understanding of an aspect of Byzantine medicine.
by Laura Diaz-Arnesto
WE THE ECOUMENISTS exontes zilon FOR AN OECOUMENIC POLIS 
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