Cumin and dill - Arabic translation of DMM
Cumin and dill – Arabic translation of DMM (Wikipedia)

Chapter 3. 1st century AD. Dioscorides de Materia Medica

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1st Century Pedanius Dioscorides  –   born around AD 40, died around AD 90


The definitive herbal!

Dioscorides wrote the ” De Materia Medica ” , a five volume text which was the pharmacological bible for the next 16 centuries. Originally written in Greek, it was translated into Latin and Arabic and at least five other languages.

John Riddle is the modern expert on Dioscorides

The modern authority on Dioscorides is John M. Riddle with his book: “Dioscorides on Pharmacy and Medicine”.  Very little is known about Dioscorides.  We can work out roughly when he lived from Dioscorides’s quotes about other authorites in DMM and comments about DMM by other writers. It is generally assumed that he was a physician or surgeon who travelled with the Roman Legions but this is based mainly on one reference to his “soldier’s life” which is ambiguous in the original Greek and may have been mistranslated, according to Riddle. Riddle produces further evidence that the “physician with the legions” hypothesis is weak. It is however fairly sure that he travelled to many different countries and was able to study personally, plants, animals, minerals and their medicinal properties from a large geographical area.

(Side note:  It’s interesting to note that Paracelsus (see entry for Paracelsus, 16th century) was credited with inventing the use of opium as an analgesic and anaesthetic and also the use of metallic oxides as drugs but both are described in de Materia Medica.)

Does vine leaf cure leprosy?

To try to assess the effectiveness of the remedies I looked at a chapter on vine leaf in book five, “Vines and Wines” (Chapter 741) to see if his claim that is could be used for leprosy would stand up in the light of modern studies.  

The leaves and tendrils of the wine-bearing vine (pounded into small pieces and applied with polenta) lessen headaches, and the inflammation and burning of the stomach. The leaves do the same (applied by themselves) as they are cooling and astringent. Furthermore, the juice of them (taken as a drink) helps dysentery, bloodspitters, gastritis, and women that lust[anaphrodisiac]. The tendrils (steeped in water and taken as a drink) do the same things. The resin from it is like gum thickening around the stumps, and taken as a drink with wine it draws out stones [urinary, kidney] [calculi]. Rubbed on, it heals lichen [papular skin disease], parasitical skin diseases, and leprosy but you must first rub the place with saltpetre [potassium nitrate]. The liquid that sweats out from a burning green branch (smeared on with oil) removes hair, and rubbed on it takes off warts. The ashes of the branches, husks and seeds after the grapes are pressed (smeared on with vinegar and applied around the perineum), heal venereal warts and glandular fever. Applied with rosaceum [1-53],rue [3-52, 3-53, 4-98] and vinegar it is good for dislocations, viper bites, and inflammation of the spleen.”

I found this study from the University of Ljubljana in Slovenia: Phenolic Profile, Antioxidant Capacity, and Antimicrobial Activity of Leaf Extracts from Six Vitis vinifera L. Varieties Katalinic et al 2011

…The antioxidant properties determined by ferric reducing antioxidant power and 2,2-diphenyl-1-picrylhydrazyl assays, and antimicrobial activity against Stapylococcus aureus, Bacillus cereus, Campylobacter jejuni, Escherichia coli, and Salmonella Infantis were good and in correlation with the chemical composition changes of the leaf extracts. The results indicated that leaves remaining on the vine in September after the grape harvest could be especially promising as an inexpensive source of effective antioxidant/antimicrobial agents….”

Dioscorides: “…The leaves do the same (applied by themselves) as they are cooling and astringent. ..”

One of the flavonols found in vine leaves in the study is Astringin. This is a rare flavonol because apart from vines it is found only in 2 species of spruce trees. (Wikipedia). “..An astringent (sometimes called adstringent) is a chemical that shrinks or constricts body tissues…” “…In medicine, astringents cause constriction or contraction of mucous membranes and exposed tissues and are often used internally to reduce discharge of blood serum and mucous secretions…” (Wikipedia).  So we know for certain therefore that his claim that vine leaf is astringent is accurate.

Here is another study, this time from Gazi University in Turkey Biological activities of Vitis vinifera L. leaves Orhan et al 2009

…The fractions of different polarity, namely chloroform, ethylacetate, n-butanol, and remaining water fractions, were fractionated from an aqueous extract of V. vinifera leaves. The antibacterial, antifungal, antiviral, antioxidant activities, and total phenolic content of these fractions were investigated. The chloroform fraction showed a promising effect against Herpes simplex virus type-1 (HSV-1) and Parainfluenza viruses (PIV). The results indicated that all the fractions were more pronounced against gram-positive bacteria (S. aureus and E. faecalis) than against gram-negative
bacteria (E. coli and P. aeruginosa). On the other hand, the fractions showed equal antifungal activity against the genus Candida (C. albicans and C. parapsilosis)….”
….The results of the antiviral and antioxidant activities supported the utilization of V. vinifera leaves in folk medicine….”

Does the claim stand up?

Could vine leaf really cure leprosy as Dioscorides claims? First of all, would he be able to diagnose leprosy accurately and not confuse it with other skin conditions like eczema or psoriasis? Leprosy has a particular set of symptoms such as painless ulcers on the soles of the feet and loss of eyebrows. So I think that the answer is that he probably would have been able to diagnose it accurately.

He says that first you must rub on Saltpetre. What is Saltpetre?  From Britannica: “..Ordinary Saltpetre: Potassium nitrate occurs as crusts on the surface of the Earth, on walls and rocks, and in caves; and it forms in certain soils in Spain, Italy, Egypt, Iran, and India…”

Nitric oxide is generated on the skin surface by reduction of sweat nitrate Weller et al 1996

..Sweat contains nitrate in appreciable amounts, and skin commensal bacteria can synthesize nitrate reductase enzyme….. “….We propose that Nitric Oxide generation from skin is dependent on bacterial nitrate reduction to nitrite and subsequent reduction by acidification. We speculate that this has a physiologic role in the inhibition of infection by pathogenic fungi and other susceptible microorganisms and may affect cutaneous T-cell function, keratinocyte differentiation, and skin blood flow….”

Leprosy is caused by mycobacteria.

Leprosy, also known as Hansen’s disease, is a chronic infectious disease caused by Mycobacterium leprae. The disease mainly affects the skin, the peripheral nerves, mucosal surfaces of the upper respiratory tract and the eyes. Leprosy is known to occur at all ages ranging from early infancy to very old age. (WHO)

Modern treatment for leprosy (from CDC)

Hansen’s disease (Leprosy) is treated with a combination of antibiotics. Typically, 2 or 3 antibiotics are used at the same time. These are dapsone with rifampicin, and clofazimine is added for some types of the disease. This is called multidrug therapy. This strategy helps prevent the development of antibiotic resistance by the bacteria, which may otherwise occur due to length of the treatment.

Treatment usually lasts between one to two years. The illness can be cured if treatment is completed as prescribed.  (Note: the WHO claims 6 months)

Mycobacteria (Wikipedia):

…Mycobacterial infections are notoriously difficult to treat. The organisms are hardy due to their cell wall, which is neither truly Gram negative nor positive. In addition, they are naturally resistant to a number of antibiotics that disrupt cell-wall biosynthesis, such as penicillin. Due to their unique cell wall, they can survive long exposure to acids, alkalis, detergents, oxidative bursts, lysis by complement, and many antibiotics. Most mycobacteria are susceptible to the antibiotics clarithromycin and rifamycin, but antibiotic-resistant strains have emerged…”

Antibacterial action of Saltpetre and vine leaf

Could the application of saltpetre and vine leaf to the skin really have cured leprosy? Both the saltpetre and the vine leaf have antibacterial properties and both might kill the leprosy mycobacterium. The Dioscorides remedy using saltpetre to lighten freckles is still used by some people (source “curezone”) so the salpetre would probably act in some way to allow the vine leaf to penetrate the skin and heal the skin lesions by killing the mycobacteria. Perhaps the saltpetre destroys or dissolves the very resilient cell wall of the mycobacterium allowing the antibacterial fractions in the vine leaf to finish the job. Then the astringent properties of the vine leaf would tighten the skin’s pores making them more impermeable to any remaining mycobacteria.

A topical cure for early stages maybe?

I don’t think this would be an overnight cure but it’s a topical treatment rather than a systemic treatment as with modern antibiotics so in the early stages, if caught early enough before it could affect the peripheral nerves, the eyes and the nose and throat it might be fairly quick acting and effective.

Mouse droppings to restore hair?

Dioscorides mentions dozens of other remedies which are good for leprosy, many of them involving metallic oxides. The effectiveness of most of Dioscorides remedies is hard to assess without trying them out. For example, there are dozens of very colourful hair restoring recipes such as rubbing mouse droppings or charred hedgehog skin on the scalp. If only one of them worked, I’m sure it would have passed the test of time, and still be in use.

“oxymel”. Is it “honeygar”?

Another remedy I looked at was “oxymel” made from (I assume, wine) vinegar, honey, sea salt and water all boiled together. It is supposed to “expel thick fluids”, (mucous ?) “… and helps sciatica, arthritis and epilepsy.” He says it is also good an as antidote to snake bite and as a gargle for an abscessed throat. I tried to draw a parallel with the folk remedy “honeygar”, (raw honey and raw, unpasteurised cider vinegar) a folk remedy widely used today by people to ward off arthritis but it was really too much of a stretch – the two recipes are too dissimilar and also, there is no instruction in Dioscorides for dosage. I guess I will just have to make Dioscorides’ recipe and keep it for when I get bitten by a viper to see if it works.

Treatments corresponding to every modern type of drug!

These guides to remedies were many orders of magnitude more sophisticated and extensive than we might imagine, with drugs corresponding to every type of modern drug (including anti-cancer treatments, antibiotics and even contraceptive drugs – pace Riddle), but a simple reading of them would not be enough. Dioscorides for example, makes clear that a great deal of experience, skill and judgement are necessary in using his remedies. His DMM was not written for amateurs. He does not compare the effectiveness of one remedy to another for example – he just lists all the uses. One would have to be able to sort the wheat from the chaff and also master fully the preparation and administration of the remedy. Know how to identify properly the correct plant, the time to harvest the plant for when the active components were at their peak, know the correct way to prepare them etc. etc. No easy task when confronted by thousands of possible remedies with only a very sketchy description of each plant and details of where to find it, where the best examples are found, how to harvest it and use it.

John Riddle does a very thorough and scientific investigation into the mineral, animal, plant etc remedies and has had a lot of input from various different specialists. He is therefore able to give a very authoratitive account of how accurate or not Dioscorides descriptions are of medical properties of the various remedies. (Many of them still await accurate assessment – something that modern drug companies are no doubt undertaking today………. in stealth!)

Original manuscript is lost – big problem!

One of the difficulties in analyzing DMM is that the original manuscript has been lost. As with all medical manuscripts in Greek, it has come down to us through the Byzantine Greeks and then the Arabs who translated the texts into Arabic when they defeated the Byzantines. These Arabic texts were then translated into Latin in Salerno with Constantine the African (see entry: 11th century) and later on at the impressive school of translators in Toledo during the expulsion of the Moors from Spain. So in Europe, Dioscorides only emerges blinking, into the light, as it were, at the end of the dark ages with the new dawn of humanism. As Greek scholarship in Europe improved during the middle ages, earlier copies of the Greek originals were found, in various monasteries and the Vatican, still in their original Greek. This is the case for example with the rediscovery in the middle ages of manuscripts of the Classical Greek Theophrastus who predates the Romano Greek Dioscorides by 3 or 4 centuries (and is probably an important source for Dioscorides).

Did Dioscorides illustrate the original?

So Dioscorides’ DMM’s original Greek version has had to be reconstructed from these many different versions. We don’t even know for sure, for example, if Dioscorides illustrated his manuscript with drawings of the plants. Riddle thinks he almost certainly did.

So are the drawings found on later copies accurate depictions of the plants that Dioscorides is describing?

Another problem is translating 1st century Greek into English. Many of the Greek words have various different meanings, depending on context. Can we always be sure we have the correct context and thus the correct meaning?

Many translations, many copies, some additions –  how many errors?

Throughout the centuries, numerous copies were made of DMM and sometimes things have been added. For example, Riddle says that in the original, Dioscorides usually gave only one name for a given plant but that around the 5th century, sometimes up to a dozen synomyms have been added. Riddle thinks that this did not detract from the original and only made it more useful. Likewise, some of the copies have beautiful illustrations. Many copies, especially Arabic translations, have commentaries added.

The organisation of the five volumes has puzzled succeeding generations according to Riddle. In some versions, copyists have re-organized the chapters alphabetically. Riddle himself was puzzled for a long time, he tells us, but realised that in the original manuscript, the chapters are organised by affinities of their drug effects on the body thanks to Dioscorides’s acute observations. Riddle says that through the centuries, this system of organization has not been properly understood and that if it had been, the DMM would have been much more useful to those using it.

No comparative judgements about efficacy of remedies

Dioscorides did not make comparative judgments about which drug might be best for which affliction. He merely lists all the known medical uses for each drug.

Galen – the wrong turning

Only a few decades later, medical history and pharmacy would take a wrong turning and Dioscorides would have his thunder stolen by the acknowledged superb physician and charismatic showman, Galen with his own Materia Medica, with drugs listed for their effect on re-balancing the humors, according to Galen’s complicated (and hopelessly wrong) humoral and elemental theories.  Each drug is classified with degrees of cold or warm, wet or dry and is to be used according to the cold, warm, wet or dry temperament of the patient. 

Astrological dogma enforced by the state in the middle ages

In the middle ages,   further theoretical nonsense was added with each drug and each organ of the body having an astrological connection and a drug would have to have an astronomical correspondence with the organ it was supposed to treat.  This has been airbrushed out of the history of medicine but the dogma was taught in medical schools and astronomy was a central part of the curriculum.

Physicians love complicated theories.  The more labrynthine the better.

So although Dioscorides became an important authority for succeeding centuries, much of the DMM’s value was not fully appreciated for two reasons:

  1. His classification by affinities of drug action was not properly understood and later copies reorganized the DMM into alphabetical classification.
  2. Later generations took Galen to be the absolute authority and Galen interpreted many of the entries in Dioscorides to fit his own, completely erroneous humoral theory. Galen’s “corrections” of Dioscorides were taken to be accurate by succeeding generations, up to Paracelsus and further astrological nonsense was added in the middle ages.

(This chapter in my Unofficial History of Western Medicine is free.  You will need to click on the “Support Chris” button and become my subscriber on subscribestar to access other chapters. )