Drugs Before the Age of Science

Question 1

lecture 1 outcomes

Answer 1

Critically describe current sources of knowledge about medicine in the prescience era.
* Describe the scientific method.
* Describe humoral theory.
* Describe how and when Western medicine made the transition from guesswork to science

Question 2

What do we really know about prehistoric medicine and pharmacology?

Answer 2

Almost nothing! Isn’t it wonderful?
* Almost no forms of modern-day ‘traditional medicine’ can be authoritatively linked to prehistoric practice
Dig therapures al developed their own healing methods, includin
* These ways of healing were based on widely-differing beliefs and practices

Question 3

Where’s the evidence?

Answer 3

Sources for information about ancient medicine include:
* Cave paintings
* Physical human remains e.g. skeletons, skulls, bog bodies
Some fragmentary items which may be tools

Answer 4

Cave paintings can be interpreted in any way you wish …
Interpretations of this image include:
Shaman figure
indigenous healer
evidence of prehistoric use of psychedelic drugs
* Alien (I’m not kidding)

Question 5

Bones

Answer 5

7000 year old skull with hole bored in it - found in Sudan. Believed to be trepanation (medicinal skull drilling) but there is no evidence to suggest why this was done, or whether it was done pre- or post-mortem.

Question 6

Tollund Man

Answer 6

New analysis of stomach contents of bog body ‘Tollund Man’
* 12 to 24 hours before his death, he ate a hearty meal!
* It was cooked in a clay pot
* Porridge containing barley and flax; maybe also fish
* Weed seeds - pale persicaria (Persicaria lapathifolia)
* Tollund Man was infested with parasites - stomach contained proteins and eggs from intestinal worms, probably from contaminated food or water

Question 6

Ötzi

Answer 6

• Age: Ötzi’s thigh-bone = likely age of 45.
• Height: In life, 1.60 m tall (mummy size 1.54m)
• Weight: In life, around 5okg. Very wiry and strong.
• Hair: dark, medium-long hair and worn loose.
• Traces of arsenic = Ötzi was sometimes present where metal ores were being smelted.
• Nails: horizontal grooves, or Beau’s lines, were observed on the
  fingernail = great physical stress.
• Parasites and pathogens: Two human fleas were found in Ötzi’s clothing.
• Oldest evidence of Lyme Disease in Ötzi’s DNA.
  The eggs of whipworm, an irritating intestinal parasite, were found in his digestive tract.

Question 6

What evidence do we have for prehistoric medicinal drug
use?

Answer 6

We have no conclusive physical evidence of prehistoric drug use as we would recognise it.
* Plant remains found in prehistoric teeth and stomachs may have been food, rather than drugs.
* Pollen traces in a setting may not be indicative of medicinal plant
use.
* We can guess if we find local medicinal plants in a particular area, but these may be recently introduced.
* Why assume medicine? Why not beauty, religion, commerce, politics?
* There is a huge amount of “may’ and ‘could’ and “possibly” in written research around these areas.

Question 6

Is recorded history better?

Answer 6

If we want to carry out reliable comparisons with modern scientific medicine, we must go to recorded history.
* Early recorded history is very fragmented - entire millennia are missing in some cases.
* Recorded history may only apply to the literate/noble class of that society.
* Only the broadest generalisations are possible about early civilisations and medical practice.

Question 7

Did ancient medicine use the scientific method?

Answer 7

• No.
• Ancient recorded medical practices shows signs of observation (sometimes), of measurement (sometimes), of practical skills (sometimes), and of technology (sometimes).
• None of these by themselves is the scientific method.

Question 8

What is the scientific method?

Answer 8

The ‘scientific method’ consists of
* organised efforts
* to come up with explanations of nature,
always modifying and correcting these
* through systematic observations

Question 9

How it works

Answer 9

Question 9

Method versus random stuff

Answer 9

• This is because modern thinking often confuses ‘science’ with things like technology and equipment.
• Ancient communities often had quite sophisticated technology and equipment at their disposal, and they certainly practised observation.
• However, you can have a fully equipped laboratory and still not be using the scientific method.
• You can be out in an open field and be using the scientific method to test something.

Question 10

Hippocrates, the father of medicine?

Answer 10

Hippocrates of Cos (c.406-370 BC?) is referred to as ‘the father of modern medicine’.
* This is not true.
* We know almost nothing of Hippocrates’ life from actual historical sources.
* Plato mentions him in passing in two dialogues.
* We don’t know who wrote the Corpus Hippocraticum (the
Hippocratic Corpus - the body of work attributed to ‘Hippocrates’).

Question 10

Strengths of the scientific method

Answer 10

• It allows discovery to proceed in an organised way.
• It eliminates a lot of repetition.
  *It encourages us to change or revise explanations - or questions, or hypotheses - in the face of the evidence.
• It provides a clear audit trail.
• The results should be communicable and replicable.
• All these things combine to speed up innovation and make it safer.

Question 11

What did the Hippocratic approach really do?

Answer 11

The Hippocratic approach DID systematise the description of disease duration (short-term, long-term).
* The Hippocratic approach DID systematise some elements of basic clinical observation.
* The Hippocratic approach DID NOT use the scientific method to develop hypotheses about illnesses and test different remedies objectively.
* The Hippocratic approach may have held back the development of scientific medicine.

Question 12

This is what held it back photo

Answer 12

Question 12

This is what held it back

Answer 12

’ The word ‘humor’ comes from the Greek word Xupós, or chymos,
which means ‘sap’.
* Prominent in the Hippocratic Corpus.
* Thaiching the four ele ments of earch, al, fire and water that made up
the universe.
*Humors were caused by imbalance and excess in the four bodi
* Humoral theory was the single most enduring idea in Western medicine from the time of the ancient Greeks onwards

Question 13

Humoral theory’s legacy

Answer 13

Humoral theory dominated Western medicine for centuries.
It was almost unbudgeable as a way of thinking about the human body, health and illness.
It probably originated in observations that were misplaced.
It was not tested using the scientific method.
Doctors themselves supported and promoted this theory.
Those who questioned it and used observation-based methods to experiment on their patients were called
‘empirics’ and ‘quacks’ and were denounced.

Question 14

Goodbye, humoral theory!

Answer 14

• These new ways of thinking broke the centuries-old grip of humoral theory on Western medicine.
• Humoral theory literally didn’t measure up.
• New causes were found for diseases and illnesses.
• These were measurable and followed particular patterns and durations.
• They responded to particular drugs and treatments consistently pretty much every time.

Question 14

The world of humoral theory

Answer 14

• Ancient Greeks
• Ayurvedic medicine - five elements: air, fire, water, earth, ether/space
• Traditional Chinese medicine - five elements: wood, fire, earth, metal, water
• Roman medicine
• Classical Islamic medicine
• Medieval European medicine
• Renaissance medicine
• Eighteenth century European medicine

Question 15

Un-scientific medical thinking photo

Answer 15

Question 16

What do you need to do this better?

Answer 16

• An Industrial Revolution!
• 18th century onwards: use of microscope, improved timing devices, grinders, distillation equipment, moulds.
• Isolate elements = artificial compounds now possible.
• Standardise doses.
• Mass-produce remedies = cheaper.
• Advertise and market products - wider audience.
• Better communication between researchers.
• Industrial processes also created new drugs by accident.
• ….. all of which is the beginning of ‘Big Pharma’!

Question 16

So when DID medicine become scientific?

Answer 16

• What we now recognise as ‘science’ dates from no earlier than around the early Middle Ages - 12005 CE.

Question 16

How the scientific method got involved in medicine and pharmacology

Answer 16

Eighteenth century European philosophy:
Rationalism: The idea that we acquire knowledge through the use of reason, rather than from received ideas.
Inductivism: The idea that we can observe nature and then develop laws based on observation which can be tested and confirmed.
Empiricism: The idea that descriptions of things based on observation and experience indicate that a particular phenomenon is testable.

Question 17

lectrue objectives

Answer 17

• Describe how historians try to reconstruct ancient drug use.
• Describe common natural drug sources.
• Know the names of key drug innovators and their important texts.
• Provide arguments for and against the reconstruction of ancient medicines.

Question 18

How do we measure the
‘success’ of a
drug?

Answer 18

• We can measure the reduction in deaths caused by a particular disease.
• We can measure the closure of hospitals such as TB facilities or mental hospitals.
• But these measures don’t capture all the effects of a drug on a society:
• For example, mental hospital closures only tell us that mental hospitals closed.
  former patiles improved or uality of life of the
• It’s almost impossible to measure the effects of ancient drugs on populations because of confounding factors.

Question 19

How do we know what ancient drugs were used, and why?

Answer 19

• Modern anthropology has identified traditional practices in some cultures.
• BUT we can’t authoritatively link that to ancient civilisations.
• Finding evidence that particular groups ritually bathed, or tattooed, or ingested clays, tells us very little about their ideas about medicine and health.
• We know they HAD ideas about health and illness.
• But unless they:
• wrote them down, and
• this has survived, and
• we can understand them clearly,
• we don’t really know what those ideas were.

Question 19

Is it medicine? And if so, what sort?

Answer 19

• Pliny and Dioscorides both describe how zinc compounds (calamine) used to treat eyes and skin complaints.
• The Latin calamina = calamine, a mix of smithsonite and zinc silicate => calamine lotion today.

Question 19

The Pozzino shipwreck cargo - ‘medicine chest’

Answer 19

• Pozzino shipwreck (Tuscany) - nearly 2000 years old.
• Discovered in 1974; excavated 1989-90.
• Doctor’s chest, including numerous wooden and tin vials; some medical instruments as well.
• X-rays of sealed container = five tablets, each about 4cm wide by 1cm thick.
• Samples => zinc 75% - smithsonite (zinc carbonate) and hydrozincite (zinc hydroxycarbonate).
  Also contained small amounts of animal and vegetal lipids, beeswax, pine resin, pollen grains and starch grains.

Question 19

Is it medicine? If so, what sort?

Answer 19

Were these tablets collyria? (tablets which could be dissolved into an eye salve)
Collyria are usually stamped and shaped slightly differently?
There is pine resin in the tablets - was it there to prevent microbial degradation?
Was the pine resin an active ingredient instead?
We have more questions than answers!

Question 19

Bald’s Leechbook recipe

Answer 19

• Scientists recreated a gth Century Anglo-Saxon remedy using onion, garlic and part of a cow’s stomach.
• This successfully and repeatedly killed methicillin-resistant staphylococcus aureus (MRSA).
  Equal amounts of garlic and another allium (onion or leek), finely chopped and crushed in a mortar for two minutes.
• Add 25ml (0.87 fl oz) of English wine - taken from a historic vineyard near Glastonbury.
• Dissolve ox gall (bovine salts) in distilled water, add and then keep chilled for nine days at 4C.

Question 20

Weights and measures

Answer 20

• If we want to test ancient drug formulas, we need to understand their weights and measures.
  Unfortunately, these have varied considerably over time.
  Roman system persisted into Europe.
  Lots of local variations on these for centuries.
  In 1864, UK legislation standardised the ‘apothecaries’ weights’ minims, scruples, grains, dra(ch)ms, ounces and pounds.
  1963: metric system introduced to the British Pharmacopoeia.
  1965: Australian pharmaceutical industry.
  1971: United States pharmaceutical industry.
  Micrograms (ug), milligrams (mg), grams (g), kilograms (kg) - millilitres, litres

Question 20

Following the recipe!

Answer 20

• The recipe only worked against MRSA when it was followed exactly:
• You needed the right combination of ingredients
• The right preparatory method
• The right waiting time
• Changing any of these reduced its efficacy against staphylococcus.

Question 21

What do we really know about ancient use of medicinal drugs?

Answer 21

• It’s a bit of a mixed bag - lots of guesswork.
• Easy to credit a culture with ‘advanced’ knowledge of medicine through chance use of particular drugs.
• Do you need to know how something works to use it effectively?
• YES!
• Don’t try ancient drug recipes at home - quantities unreliable, potencies unknown, often highly toxic ingredients!