The Art Is Long: On the Sacred Disease and the Scientific Tradition 9004121528, 9789004121522

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THE ART IS LONG

STUDIES IN ANCIENT MEDICINE EDITED BY

JOHN SCARBOROUGH PHILIP J. VAN DER EIJK ANN HANSON NANCY SIRAISI

VOLUME 25

THE ART IS LONG On the Sacred Disease and the Scientific Tradition BY

JULIE LASKARIS

BRILL

LEIDEN· BOSTON· KOLN 2002

Cover Illustration : Pomegranate (Punica Granatum), by Leo La.skaris This book is printed on acid-free paper.

Library of Congress Cataloging-in-Publication Data Laskaris,Julie. The art is long : on the sacred disease and the scientific tradition / by Julie Laskaris. p. cm. - (Studies in ancient medicine, ISSN 0925-1421 ; v. 25) Includes bibliographical references and index. ISBN 9004121528 (hard cover) I. Hippocrates. De morbo sacro. I. Title. II. Series. Rl26.H6 M825 610-dc21

2002

2002020862

Die Deutsche Bibliothek - CIP-Einheitsaufnahme Laskaris,Julie: The art is long : on the sacred disease and the scientific tradition/ by Julie Laskaris. - Leiden ; Boston ; Koln : Brill, 2002 (Studies in ancient medicine ; Vol. 25) ISBN 90-04-12152-8

ISSN 0925-1421 ISBN 90 04 12152 8 © Copyright 2002 1!J Koninklfjke Brill .Nv, Leiden, The Netherlands All rights reserved. No part ef this publication may be reproduced, translated, stored in a retrieval .rystem, or transmitted in any farm or 1!J any means, electronic, mechanical, photocopying, recording or otherwise, without prior written permission from the publisher. Authorization to photocopy items far internal or personal use is granted 1!J Brill provided that the appropriate fies are paid directly to The Copyright Clearance Center, 222 Rosewood Drive, Suite 910 Danvers MA 01923, USA. Fees are subject to change. PRINTED IN THE NETHERLANDS

To my father, Leo Laskaris, whose art is beautiful.

CONTENTS Acknowledgements ....... ............ ............ ....... ... ........ ................. ....

1x

Introduction ...... ... ................. .................................... ...... ............ Science, Magic, Rationality, Empiricism-A Proposal ........ Science, Magic, Rationality, Empiricism-Modern Scholarship on Ancient Medicine ........................ .... ........ Sources and Methodology .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .... .. .. .. .. .. .. .. .. .. ..

29

Chapter One: The Art is Long .................. ............ ...... .. .......... Early Healers ...... ............... ........ ... .. .......... ............ ...... .. .......... Transmission of Medical Knowledge .................................... Healing and Religion .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. ..

32 33 44 49

Chapter Two: On the Sacred Disease-Summary; History and Reception .. .. .. .. .. ... .. ... ... .. .. .. .. .. .. .. .... .. .. .. .. .. ..... .. .. .... ... .. .. ... Summary of the Text ............................................................ Early Reception of the Text ................................................ Modern Reception of the Text .... .. .. .. .... .. .. .... .. .. .. .. .. .. .. .. .. .. ..

54 54 59 62

Chapter Three: On the Sacred Disease-A Sophistic Protreptic Speech .................................................................... The Definition of T echne and the Scientific Problem Set ........................................................................................ The Defense of Secular Medicine's Technicity Sophistic Protreptic Speeches .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .... .. .. Characteristics of Protreptic Speeches .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. First-person verbs ............................................................ Epangelma ... .. .. ..... .. .. .. .. ... ... ... .. .... .. .. .. .. .. .. .. .. .. .. .. .. ... .... ... . The Relativity of Goods .. .... ............ .... ........................ .......... The Divine is Contrary to Nature .................................. The Divine is in Accordance with Nature ...................... The Divine is Both Contrary to Nature and is in Accordance with Nature .............. ...... ...... .. .. .... .............. The Attack on Magico-Religious Medicine's Technicity .... Modus Tollens Arguments ....................................................

1

6 15

73 75 78 83 84 84 85 93 94 95 96 97 108

Vlll

CONTENTS

Sophistic Problemata and the T echnai .. ... .. .......... ....... ... .. ... Disease and the Divine-Adding to the Problem Set ........

110 113

Chapter Four: Getting Their Goat .......................................... Etymologies .............................................................................. The Disease Called Sacred .................................... ............ Diaphragm and Ears .......................................................... Everyday Experiences ..................... ........ ............................... Conventional Religious Ritual ... ........................... ............ Headaches and Numbness ................................................ Storing Wine .. ... ....... ..... ... ..... ... .... ......... ... .... .. ... ................. Physiological Description ... ... ... .. ... ... ...... ... .... .... .. ... ..... ... ......... Health and the Climate .................................................... Divine Punishment .......... ............ .......................................... The Brain and Bile vs. Phlegm .. ..... .... ... ...... ... ........ .. .. ..... Fear ...................................................................................... Hereditary Curses vs. Archetai kata genos ...... ... ........ .... ..... Pollution vs. Contact ... .. ...... .. ...... ...... .... ... ...... ... ..... .. ..... .....

125 126 126 127 129 129 129 13 l 132 135 140 14 l 143 146 149

Conclusion ...... .. ... ....... .... ... .... ...... .. .......... ...... ......... ... ..... ... .........

156

Bibliography ...... .. ... ... ....... .. ...... .. .. .. ...... .... .. ..... ..... .. .... ..... ... .... ..... General Index .... ...................................................... .................. Index Locorum

159 16 7 172

ACKNOWLEDGMENTS This book grew out of the dissertation I wrote under the direction of David Blank at the University of California, Los Angeles and with the unflagging support of him and of my other committee members, Sarah Morris and Brian Copenhaver. I shall always be grateful for their many helpful suggestions, careful reading, and endless patience, and for the warmth and camaraderie of the students and faculty of the Classics Department at UCLA. Later work was done not in Los Angeles, however, but at the University of Richmond in Virginia, and it could not have been accomplished without the warm encouragement and support of my colleagues in the Department of Classical Studies, Dean Simpson, Walter Stevenson, and Stuart Wheeler, or without the firm but gentle hand of our administrative assistant, Stella Jones. Owing to the generosity and excellent resources of the Center for Hellenic Studies in Washington, D.C., a good portion of the revisions to this manuscript were completed during the Summer of 2000 in that idyllic setting, then under the direction of Deborah Boedeker and Kurt Raaflaub and of Summer Directors David and Mary Depew. While many others have aided and abetted this project, very special thanks are owed to Ann Hanson, who has been generous with her time, invaluable insights and suggestions from the first stages, and was an astute reader of an earlier draft. Philip van der Eijk offered a critique of a later version that improved it greatly. Walt Stevenson saved me from several errors and oversights, and Caroline Mowbray, on loan from Smith College, provided careful and intelligent copy-editing. Brill's readers and editorial staff, particularly Michie! Klein Swormink and Tanja Cowall, are owed special gratitude for their diligence and patience. Stimulating conversations with my good friend and colleague, Penny Reynolds, in the Department of Biology, have given rise to many ideas-and have also prevented many errors from seeing the light of day. I am fortunate to have a family who cheerfully tolerates my preoccupation with things far removed in space and time and who offered every imaginable help and support during the course of this project.

INTRODUCTION llepi iepij~ vovaov (On the Sacred Disease), an anonymous, fifth-century

BC medical treatise included in the Hippocratic Corpus, is a bitter

polemic against the magicians, purifying and begging priests, and charlatans' who had long treated "the disease called sacred" (tf\c; i.epfjc; voucrou KaAf:oµEvTJc;). 2 The treatise has often been interpreted as having easily banished from medicine magical and religious elements, and as having done so with the aim of providing it with the rational premise upon which modern biochemical medicine rests, or as having represented scientific medicine in the ancient world, or as having aided medicine's progress in becoming scientific. 3 But such interpretations are anachronistic; positivist; and beg the questions of how science and rational premises are defined, what relationship they bear to each other, and whether modern medicine can indeed be considered entirely scientific or to function solely on a rational basis. More importantly, such interpretations overlook the true motivation

µayot, Ka.0a.pta.i, i I find difficult Kudlien's construction of a kind of continuum of degree of rationalism, on which 'Coan,' 'Cnidian,' and 'primitive' medicines are placed in descending order; ( 1968) passim. My objection to the notion of relative degrees of rationalism in this context I shall discuss below; since Lonie's important article (1978), there is the additional difficulty of treating 'Coan' and 'Cnidian' as meaningful terms, as already discussed. 93 Lloyd (1986 ( 1983)) 132- 135.

INTRODUCTION

29

logy, but speculates that what 'rationalist framework' secular practitioners did have depended upon former practices as much as upon empirical evidence. 94 He considers secular practitioners to have been rigorously rationalistic in their pharmacology, but does not think that the absence from the Corpus of the rituals and superstitions that were attached to some medicinal plants is the evidence for that rationalism, since both the superstitions and the rationalistic explanations of secular doctors had primarily a rhetorical purpose: to reassure the patient of the efficacy of the treatment. 95 At any rate, neither method, he suggests, was able to account for the observed effects of those drugs that probably did work, and the force of tradition may explain secular medicine's continued use of the ones that we are fairly sure did not. 96 However much common conceptual and procedural ground fifthcentury secular and magico-religious practitioners may have shared, and however similar their results, On the Sacred Disease shows that the same impulse to sharply differentiate 'scientific' and 'magical,' so prevalent in later centuries, can be seen already in the fifth century. I shall argue, in fact, in Chapter 3 that it is precisely because of this common ground that the author is compelled to launch his polemic against magico-religious healers, and that the differentiation he seeks to make was rhetorically based, and probably motivated by financial or other non-intellectual considerations rather than by fundamental conceptual differences with his opponents. My analysis of On the Sacred Disease will also take into account certain rhetorical and philological features that support this view, particularly the treatise's polemical and persuasive elements.

Sources and Methodology The scholarship on ancient medicine has generally been text-oriented, and rather selective at that. If any sources are considered that are outside of the Corpus itself, or the botanical or philosophical texts, it is nearly exclusively Homer and Hesiod who are cited. Virtually

94 95 96

Lloyd (1986 ( 1983)) 132-135. Lloyd (1986 (1983)) 132-135. Lloyd ( 1986 ( 1983)) 132.

30

INTRODUCTION

absent from the literature are references to the Linear B tablets, archaic lyric poetry, and archaeological evidence. In order to get a clear picture of the traditions upon which secular medicine could draw, of the circumstances under which it came into contact with them, and of the various sorts of medical practitioner with whom it interacted, I shall devote Chapter l to presenting some of the information we have regarding medicine and its practitioners from the Bronze Age through the Archaic. In the earlier periods, my sources will, of course, be restricted to archaeological remains, and to a few fragments from the Linear B tablets. In addition to this more tangible evidence for the existence of medical specialists and therapies, and the transmission of medical knowledge prior to the fifth century, I shall investigate certain ideas deeply embedded in the culture concerning such things as how the body functions, what accounts for changes in its functioning, and how the sexes differ. Each member of a society is thoroughly imbued with such concepts and, in a traditional ancient society, these notions were not likely to have been called into question. Views about the body's physiology have, of course, a direct impact on the conception of health and disease and, therefore, on what constitutes acceptable therapy. Furthermore, since many traditional healing practices made use of religion and magic, an analysis of the relationship between traditional and secular medicine should take into account the Greeks' deep conservatism in these matters-especially in religion, where accretion and syncretism, not fundamental upheaval, were the norm. Secular healers will have been vulnerable to such cultural influences, and literary texts can reveal to us what some of these influences were. In Chapter 3, I shall examine On the Sacred Disease as a sophistic protreptic speech, and will consider certain of its features as rhetorical ploys aimed at attracting a clientele and students. These features include the author's promise to explain the cause and cure of the sacred disease, his recounting of his opponents' explanations of these same things together with his refutation of them, and his denigration of his opponents' level of knowledge and of the financial considerations that, according to him, are their true motivation for practicing medicine. For the fifth century, and the position of secular medicine vis-a-vis other forms of medicine-the focus of Chapter 4-I shall use On the Sacred Disease as the basis for an argument that secular healers were

INfRODUCTJON

31

sometimes forced by the pressures of competition to offer the public credible alternatives to traditional, often deeply-rooted, explanations of disease and physiological processes. In this case, the author had to find an explanation for the sacred disease acceptable to the public's religious sensibilities, and to prove that he, though not functioning in a religious capacity, was capable of treating it. The explanations, observations, and beliefs of the magical and religious healers, together with their social standing and the sacred status of the disease, forced the author of this treatise to sharpen and refine his own account of the disease, and the ways in which he argued for it. In conclusion, I intend to show that the venerability of traditional medical concepts and practices; their occasional efficacy, real and perceived; and their close ties with religion and magic, made them forces with which secular practitioners had to contend intellectually and economically. They also, however, provided secular healers with therapies and explanatory models that could be adopted, perhaps in a rationalized form. A reading of On the Sacred Disease sensitive to the context in which its author and other secular healers functioned, and to its persuasive and polemical aspects, can provide very clear evidence for both the competitive and conservative forces that shaped medical theories and practices in the last third of the fifth century.

CHAPTER ONE

THE ART IS LONG Medicine in Greece was well-established as a field of expertise long before the classical period, the era from which our earliest medical treatises come. The evidence for the existence of highly-skilled and highly-valued healers goes back to the Bronze Age, 1 and it is likely that, as it had in other regions, medical expertise had developed in Greece already in the Neolithic. Given the general tendency towards conservatism in conceptions of health, disease, and physiology,2 and the close connection such conceptions usually have with religion and magic, it will be my contention that the magico-religious healers named by On the Sacred Disease, and others whose medical ideas and practices were enmeshed in magic and religion, were seen by their contemporaries as representatives of valuable and venerable traditions. The advantage such healers gained in claiming special knowledge in divine matters 3 together with the occasional efficacy (or

See Arnott (1996) for a survey of disease and medicine in Bronze Age Greece. People will often cling to old concepts about health and disease, even when they are willing to try new therapies; this has been observed by Janet Reid, an anthropologist who studies the confrontation in Australian Aboriginal culture between traditional and modern medicine: Studies the world over have shown that people are conservative in their medical beliefs but flexible in their therapeutic choices. Beliefs about illness are much less readily abandoned than indigenous treatments. People of all societies, including the industrial West, are skilful in reconciling new medical knowledge with their own ideas or simply ignoring logical inconsistencies .... Ultimately the overthrow of cherished beliefs is probably less a matter of critical reflection than it is of radical change in the social and economic structures of a society; (1983) 153. It should be borne in mind that the therapies Reid refers to are probably in most cases demonstrably more effective than the ones they are replacing, whereas innovative therapies in the ancient world were probably not, and therefore were probably not as readily accepted. See Hanson on the conservatism that prevails in pharmacological texts, (1985), 28 with n. 9; the same apparently holds true for ancient Chinese therapies, Johns (1990) 20. 3 The Oefyssry lists four types of wandering demiourgoi (17.383-385), including 'seer or healer of ills' (µav'ttV fi irrri\pa K:aK:rov), a passage that Burkert cites as evidence for the close connection between, and sometimes identity of, seer and healer for the Geometric period and later; (1992) 41-87. Empedocles claims to walk among 1

2

THE ART IS LONG

33

presumed efficacy) of their therapies, constrained secular healers to respond to these traditions, either by adopting them and perhaps offering new explanations for them, or by rejecting them and inventing acceptable alternatives. In either case, these older traditions will have shaped the development of secular medicine in practical, theoretical, and rhetorical terms functioning, in effect, as a problem set for it to inherit, and thus playing a key role in lodging it in the intellectual tradition of science. It will be fundamental to my analysis of On the Sacred Disease that such traditions will not have been easily vanquished, as has been the view of many scholars who have hailed the text for its vehement categorical attack on magic and religion in medicine (see Introduction). I shall argue, on the contrary, that the author took on powerful opponents when he attacked magicoreligious healers, that he was constrained to make a detailed and thorough case against them, and that there is no evidence that he succeeded. Therefore, to establish a context for the arguments and polemical rhetoric of On the Sacred Disease, this chapter will present a limited survey of the evidence for the status of medical knowledge in early Greece, and for its acquisition, preservation, and transmission.

Early Healers Our earliest textual evidence for the existence of medical specialists in Greece is Linear B tablet Pr Eq 146, a land tenure tablet from Pylos. It documents the granting of a unit of land to a healer, using the same agent-noun as is found in texts from Homeric epic on. 4 While this document is later than the textual evidence from Egypt people 'as a god, mortal no longer,' (8di~ aµ~poto~, ou1een 8vrrc6~) dispensing prophecies and the 'healing word' for every illness (102(112), 4 Wright) (cf. Introduction, note 12); on Empedocles as a shamanic figure, and on shamanism in early Greek ·philosophy and medicine more generally, see Kingsley ( 1995). According to On the Sa.cred Disease, the magico-religious healers link their piety with their knowledge: "they make themselves out to be exceedingly pious and to know more" (I. 10, 1tpocmotfovtm mp66pa 8rnaE~EE~ dvm 1ea1 1tAkov tt Ei6evm (see Roselli ad Joe.) and cf. 1.20, 27). Galen remarks that patients being treated at Pergamon 'by the god' are likelier to believe in the efficacy of a certain cure (not drinking for fifteen days), than they are when doctors advise the same thing (T 40 I, Edelstein ( 1998 (1945)) = Commentary on Epidemics VI, iv, Section IV, 8). ~ i-ja-te, nominative singular = iatTJp, Chadwick (1958) 116-117, (s.v. i-ja-te); Ventris and Chadwick (1973 2), 547; Palmer (1963), 422. Cf. e.g., ll. 2.732, Od. 17.384, Pi. P. 3.65.

34

CHAPTER ONE

and the Near East, and considerably later than the non-textual evidence for all of these regions, 5 it is highly useful for demonstrating that the services of Mycenaean doctors were seen as valuable by the members of their society. The land tenure tablets show, as M. I. Finley has pointed out, that land was granted to people with a wide range of statuses and occupations which, together with the fact that rental payments are not mentioned, suggests to him that the land was granted in exchange for services or products rendered. 6 Thus it would appear that it was seen as worthwhile to secure the services of a Bronze Age healer by strengthening his ties to the community. 7 A Bronze Age burial in Nauplia (1450-1400 BC) 8 confirms this view. According to Protonotariou-Deilaki, the eleven doctor's tools found there-mortars and pestles, bronze pincers and blades, and a scissors-like tool for examining dental cavities-are of astonishingly high quality and are quite similar to those found in the Asclepieia of classical times, and even to those used by doctors until rather recently. 9 The fact that the buried man's relatives chose to identify him with the tools of his trade, and that the tools themselves are finely-made, indicate that medicine was a recognized craft in the 5 On the earliest evidence for medicine in Egypt and the Near East, see Breasted (1906), Vol I, 111-113; Breasted (1930); Jonckheere (1945) 29; Giiterbock (1962) 110-111; Oppenheim (1962) 101; Burde (1974); Parpola (1983); Powell (1993) 57; Avalos (1995) 218-219; Kinnier Wilson (1996) 137. On the relationship of Greek to Babylonian and Egyptian medicine, see Goltz (1974). 6 (1982 (1953)), 208-210. 7 Letters documenting the sending of Egyptian and Babylonian doctors and diviners to Hatti or Ugarit may support this interpretation; Burkert (1992) 42-43; Zaccagnini ( 1983) 250-255. Some of the letters make it clear that the healers were to be lent on a temporary basis, although there were clearly violations; Zaccagnini (1983) 250-254; he refers to 652/f+; NBC 3934; 401/c; KUB 3 66, 3 67, 3 71; EA 49: 22-26; KBo I 10+ rev. 34-41, 42-48; (1987) 59-60. For example, Zaccagnini calls attention to a letter in which the Hatti king, Hattusili, is apparently obliged to explain why two Babylonian doctors and a diviner, sent to Hatti during his brother's reign, had never been returned; Hattusili does not know the fate of the diviner, he says, but states that one doctor has died, after having been well cared for and showered with luxurious gifts, while the other has married into his own family and has been given a house; ( 1983) 253-254. These doctors had obviously been pressured to remain in Hatti, more or less voluntarily; Zaccagnini thinks that they were detained, and then given valuable gifts, such as a chariot, horses, silver, and even a wife, in order to increase their sense of attachment to Hatti; ( 1983) 254. The endowment of property in the one case bears a striking similarity to the allotment of land to the Pylos doctor mentioned above, and the intention would seem to be the same in both instances: to retain the services of a valuable craftsman. 8 Protonotariou-Deilaki ( 1973) 92 with plates. 9 Protonotariou-Deilaki (1973) 92.

THE ART IS LONG

35

Bronze Age and that it was held in some esteem. The similarity in the form of these instruments to later tools suggests similar purposes and methods, which in turn indicates continuity in the transmission of skills. 10 Transmission of skill is obvious in the case of the earliest form of surgery known, trepanation, the evidence for which begins in the Neolithic, extends to the present, and comes from every corner of the world. 11 Trepanation is intended to remove a piece of the skull by scraping, gouging, boring and sawing, sawing alone, and drilling (properly, trephination). 12 There are thousands of examples of trepanation from the ancient world, many of them from central and northern Europe, where the operation was perhaps most active during the Neolithic, but has been performed continuously ever since. 13 Trepanation may have been done to relieve pressure on the brain or to remove bone fragments in the case of injury; 14 many of the examples of trepanation occur on skulls that had suffered injury, and texts from historical periods (e.g., Epid. 5, 215 L) recommend it in such situations. 15 In fact, doctors today sometimes perform trepanation in the very circumstances recommended for it in the Corpus. 16 It is not impossible, though it cannot be proved, that among those on whom trepanation was performed were victims of depression fractures who were suffering post-traumatic seizures. Such seizures occur fairly frequently as the result of depression fractures, 17 and they would be indistinguishable from the convulsions described in our text (e.g. l.33-38, 6, 7, IO; see Chapter 4 for discussion of the symptoms in greater detail). Furthermore, seizures that arise from damage to the temporal lobes may lead to uncontrolled outbursts of anger or fear, 10 On continuity of types of surgical instruments from the Roman Empire and the Early Byzantine Period through the Middle and Late Byzantine Periods, see Bliquez ( 1999), who suggests in one instance the possible survival for more than a millennium of a particular instrument: a scalpel with a handle in the form of Heracles' head, 296-297. 11 Roberts and Manchester (1995 2) 91; Johns (1990) 274, who notes that there is evidence of skilled bone-setting, too, in the early Neolithic. 12 Roberts and Manchester (1995 2) 93. 13 Roberts and Manchester ( 1995 2) 91, who note that the relatively high figures for Europe may be a reflection of the superior quality and greater extent of archaeological investigation and skeletal analysis there. 14 Roberts and Manchester ( 1995 2) 91-94. 15 Roberts and Manchester ( 1995 2) 94. 16 Roberts and Manchester (1995 2) 94. 17 Little and Papadopoulos (1998) 389, 396-397.

36

CHAPTER ONE

or involuntary speech or action 18-all symptoms described in On the Sacred Disease ( l.38, 15.3-8). Trepanation requires a great deal of skill since death is very likely to result if the membranes surrounding the brain or the major blood vessels within the skull are punctured, or if bleeding and infection after the operation cannot be controlled. 19 Since the archaeological record shows that there are signs of healing on many trepanned areas, even on prehistoric skulls, it seems that patients often survived the procedure. 20 Trepanation was performed in Greece, sometimes with great skill, in Bronze Age Karata~, Asine, Lema, and Mycenae;21 in Early Geometric Argos (900-850 BC); 22 and, as mentioned above, in the classical period, as attested by the Corpus (Epid. 5, 215 L). 23 Hinting at a continuous transmission of this skill, Grmek comments that Bronze Age "professional surgeons had already mastered the technical side of this operation ... ; they were on the path that led ultimately to the Hippocratic codification." 24 It is worth noting in this regard that the five types of trepanation are not evenly distributed geographically: the scraping method was used more frequently in Europe, for instance, while the South Americans favored sawing. 25 This fact underscores what is already obvious from other physical evidence: that the level of skill needed to perform trepanation successfully required specialized expertise and training. If formal instruction had been absent, one would expect to find a more random distribution of the methods employed as well as evidence of higher mortality rates. Knowledge of botanical pharmaceuticals was also transmitted in Greece and elsewhere long before the time of our texts. In fact, the Little and Papadopoulos (1998) 389, 396-397. Roberts and Manchester (1995 2) 91. 20 Roberts and Manchester (1995 2) 93, who report that where these data have actually been gathered, the survival rate is 50 percent or higher. And of course some deaths may have resulted from the injuries that will often have prompted the trepanation and not from the procedure itself. 21 Mylonas (1957) 138; Angel (1966) 256; (1971) 44, 93, 105, and Plate XXII; (1976), 385; (1982), Fasc. I 109, 111; Grmek (1989 (1983)) 63-65; Krug (1984) 13. 22 Grmek (1989 ( 1983)) 65; Charles ( 1958) 310. 23 Dastugue (1959); Krug (1984) 13. Pliny reports that three Greek writers advocate the medicinal use of skulls-evidently post-mortem trepanation-for certain conditions: the first recommends that water be drunk from the skull of a man who had been killed but not cremated; the second favors 'bones from the head' (ex capite ossa) for a variety of complaints-criminals' bones for some ills, those of a friend or guest for others; the third advises making pills (catapotia) out of a human skull for the treatment of rabies (NH 28. 7). 24 Grmek (1989 (1983)) 64. 25 Roberts and Manchester (1995 2) 93. 18

19

THE ART IS LONG

37

ability to differentiate potential sources of food from toxins and to make safe medicinal use of potentially toxic plants has been an aspect of human survival from the earliest times, 26 and may underlie the concern in our texts to understand what distinguishes food from drug (Loe. 45). The safe and successful medicinal use of potentially toxic plants requires sophisticated and specialized knowledge and skill: the practitioner must know not only proper dosages, but be aware that potency will vary in accordance with location, weather, the point in the plant's growth cycle at which it is harvested, which part of the plant is being used, and other natural variables, some of which have come to the attention of phytochemists and chemical ecologists only recently. 27 Ethnobotanist Timothy Johns has proposed that knowledge of medicinal plants rose dramatically in the Neolithic, though may have had a long period of prior development. 28 Indeed, given that chimpanzees and baboons appear to select and carefully use certain plant leaves to self-medicate, 29 it is hard to imagine that early man could not have done so, as well. In any event, living conditions in the Neolithic will have both dictated and permitted a dramatic increase in knowledge of medicinal plants since it was precisely because they lived in settled communities that Neolithic peoples had worse sanitary conditions than did their Palaeolithic predecessors, and their closer and more constant association with domesticated animals increased their exposure to parasites and diseases; these problems grew increasingly more severe along with urbanization and the spread of agriculture. 30 In addition, Neolithic peoples were no longer consuming

26 Johns (1990) 267-269, who notes that toxins and medicines 'are two sides of the same coin.' Plato's Republic states that one turns to the 'more manly' doctor when drugs are required; if regimen alone is used, an inferior doctor is sufficient: iatpov OE !to'\J µ11 OEOµevou; µEv oc.oµacn q>apµaKWV, a'A}J1. oia(-rn e0e'A.6vtwv \J7t(l1(01JElV, Kat q,au'A.otepov E~apµaKEUElV oen, foµEv Otl avOpElOttpou OE! tOU iatpou, 459c3-6. We think, I suppose, that a doctor, even a rather inferior one, is sufficient for bodies in no need of drugs, but willing to comply with a regimen; but whenever it is necessary to give drugs, too, we know that there is need of a doctor who is rather bold (lit. 'more manly'). 27 Johns ( 1990) 268. 28 ( 1990) 259. 29 Johns ( 1990) 255-25 7. 30 Johns (1990) 259, 261, 263, 285-285. See Dobson and Carper on population density as a crucial factor in the support of infectious disease pathogens ( 1996); I owe this reference to my colleague, Dr. Peter Smallwood, Department of Biology.

38

CHAPTER ONE

as a regular part of their diet small quantities of wild plant leaves with their potent prophylactic allelochemicals as their Palaeolithic ancestors had done, but ate larger amounts of pharmaceutically weaker (and thus less bitter and more palatable) domesticated plants. 31 Rather than derive prophylactic benefits from the wild leaves, Neolithic peoples began to use the leaves therapeutically, as part of medical practice. 32 Another major dietary change in the Neolithic, the increase in the ingestion of animal protein owing to the availability of domesticated animals, may have permitted the expansion of the pharmacopia, since with the added protein people were vigorous enough to tolerate more potent plant toxins. 33 Thus, the domestication of animals, while it resulted in an increase in people's exposure to parasites and disease, also permitted the more extensive use of medicinal roots and barks, which generally have a greater concentration than do leaves of those chemicals that are at once the most active pharmacologically and potentially the most toxic. 34 Herbalists virtually always rely upon taste and odor to distinguish medicinal from edible plants, and tend to classify plants on that basis, employing such terms as 'bitter,' 'sweet,' and 'sour. ' 35 Bitterness is an especially important quality for the herbalist to note since it is likely to indicate that a plant contains alkaloids with which it defends itself against insect predators, and which can cause some of the strongest reactions in the human body. 36 As ethnobotanist Mark Plotkin observes: Alkaloids ... provide everything from the kick in our morning coffee (caffeine) to the addictive compounds in our most dangerous drugs (cocaine, heroin, and nicotine), the toxic principles in some of the

Johns ( 1990) 259. Johns (1990) 286-287. 33 Johns (1990) 259. 3' Johns ( 1990) 259, 286-287. Roots, barks, and leaves are not the only suppliers of botanical pharmaceuticals, of course. Fungi are the source of most of our antibiotics; Plotkin (1993) 96-97; a rare piece of direct evidence suggests that Neolithic peoples may have exploited fungi for their therapeutic properties: the discovery in the Otztal Alps in 1991 of the naturally mummified body of a Late Neolithic man who had been carrying dried birch fungus (Piptoporus betulinus) on a strip of fur. Birch fungus contains the antibiotic, polyporic acid C., which is active against some mycobacteria, including the tuberculosis agent; the common consensus among researchers is that the fungus was being used medicinally; Spindler (1994) 115-116. 35 Johns ( 1990) 272. 36 Plotkin (1993) 6. 31

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THE ART IS LONG

39

deadliest poisons (strychnine and batrachotoxin), the analgesic effects in our most potent painkillers (codeine and morphine), and the mental pyrotechnics in some of the most powerful hallucinogens (mescaline and psilocybin). . . . The concept of 'bitters'-just about any concoction that contained bitter-tasting plants and was said to have healing properties-is found in medicinal systems from ancient Israel to the colonial East Indies to modern Amazonia. 37 The importance of bitterness as a criterion is increased if the potent roots and bark are being used medicinally. In fact, because they are so frequently toxic, the presence of roots and bark in a society's pharmacopia may be sufficient evidence in and of itself for assuming the presence of highly-skilled herbalists. Early Greek sources variously reflect several of the issues raised above: the toxin-medicine ambiguity, bitterness as an important criterion in identifying drugs, the medicinal use of potent roots and barks, the need for trained specialists, and the involvement of magic and religion in medicine. The Linear B tablets provide us with our earliest evidence for the existence of 'drug' as a distinct concept and, possibly, for the transmission of pharmaceutical knowledge. Richard Janka has interpreted Pylos tablet Un l 3 l 4 as recording the bringing of two types of ebiska, domeios and prawos, to someone as a pamako (YtTJprov 'l>YlTJPOC, Kat (l7t() trov VO(JTJprov VO