ANZ J. Surg.

2005;

75

: 340–346

COWLISHAW SYMPOSIUM

Cowlishaw Symposium

MEDICAL REMEDIES: FROM THE OLD TO THE NEW

P

HILIP

S

HARP

Department of Surgery, Prince of Wales Hospital, Sydney, New South Wales, Australia

Key words: Aztec, botany, herbals, history, Renaissance.

INTRODUCTION

Until the rise of the pharmaceutical industry in the late 19th cen-tury, most medical remedies came from plants. This informationwas contained in books called herbals. I would like you to con-template how and why these books developed – from the time ofthe Greeks to the Renaissance.

Let me set the scene. For more than a thousand years medicalteaching was didactic. The late 14th century and the 15th centurysaw changes in medical learning with Latin and vernacular textswritten for both academic and lay audiences. This literaturereflected a growing market for medical learning among physi-cians and their princely patrons, and, with the spread of printing,the middle class.

It mirrored an increasing orientation on the part of medicalresearchers and compilers towards the peculiarities of medicalpractice: the symptoms of a particular disease; the therapeuticproperties of a particular plant, animal or mineral substance.Coupled with this was a growing emphasis on the direct observa-tion and description of everything.

1

This general orientation towards the particular was given newimpetus in the late 15th century and the 16th century by the worksof a number of medical scholars who aligned themselves with theprogramme of classical revival in more literary and philosophicaldisciplines by Italian humanists such as Petrarch and Boccaccio.The members of this movement, led by Niccolò Leoniceno(1428–1524), a physician of Ferrara, whose booklet titled

DePlinii et Aliorum in Medicina Erroribus

(

On the Errors of Plinyand Other Authors in Medicine

) in 1492 provoked a virulentpolemic,

2

insisted on the direct study of ancient medical texts intheir original languages. Their work produced a flood of new edi-tions and Latin translations of the most important Greek writers,such as the pharmacological work of Dioscorides.

The 16th century European author Pierro Andrea Matthioli(born Siena 1501, died Trent 1577; a.k.a. Pierro Andrea Mattioli)(Fig. 1) studied Dioscorides seriously. In his book Commentarii

In Sex Libros Pedacii Dioscorides

(Fig. 2) published in 1544,Matthioli sets out to identify the plants described by Dioscorides.I have used the 1560 edition,

3

held in the Cowlishaw collection,as the basis for my talk.

Coincidently, the Aztec Badianus Codex,

Libellis de Medicin-alibus Indorum Herbis

, written in 1552, echoed the changes inbotany that had occurred in Renaissance Europe. It is the first

herbal and the first medical text known to be written in the NewWorld. How did this happen?

THEOPHRASTUS

The first ancient author to be mentioned as a botanist is Theo-phrastus (371–286

BCE

), a student of Aristotle (384–322

BCE

) andPlato (429–347

BCE

). He wrote in the

Historia Plantarium

that

P. Sharp

FRACS, FACBS.

Correspondence: Philip Sharp, Department of Surgery, Prince of WalesHospital, Sydney, New South Wales, Australia. Email: pasharp@bigpond.net.au

Accepted for publication 23 December 2004.

Fig. 1.

Pietro Andrea Matthioli (1500–1577).

MEDICAL REMEDIES: FROM THE OLD TO THE NEW 341

the essence of plants is contained in their parts, the parts togethermake up the whole, and the differential characters of the partsmanifest the complete form. He classified plants into four classes:tree, shrub, under-shrub and herb. He also distinguished betweenflowering and non-flowering plants, identified types of sexualand non-sexual reproduction, had a basic understanding of grossanatomy and recognized fruit. He described about 500 differentplants.

4

Unfortunately some of the original writings have been lost.The geographer Strabo (64/63

BCE

–23

CE

), writing in the time ofAugustus (31

BCE

–14

CE

), gives an account of Aristotle’s library:

Aristotle gave his library to Theophrastus, to whom he also leftthe school; he was the first we know of to have collected booksand he taught the kings of Egypt the arrangement of a library: andTheophrastus gave it to Neleus; and he carrying it away to Scepsisgave it to his descendants, laymen who kept the books shut up andnot carefully stored; and when they saw the eagerness of theAttalid kings, who controlled their city, in seeking books forthe equipping of the library of Pergamum, they hid them in theground in some sort of trench; but then after a long time those in

the family sold the books of Aristotle and Theophrastus, damagedby damp and moths, to Apellicon of Teos for much money; butApellicon was a bibliophile rather than a philosopher; and there-fore, desiring a correction of the eaten-through parts, he trans-ferred the writing into new copies, not restoring it well, and putout the books full of errors.

5

Alexander the Great (356–323

BCE

) sent Theophrastus plantmaterial obtained during his conquests of Asia. After the Age ofAlexander, new biological specimens and data seldom came toEurope until the 12th century leading to a serious standstill inbotanical knowledge for 15 centuries.

DIOSCORIDES

Dioscorides (ca 40–90

CE

), a botanist and a pharmacologist, livedat the end of the 1st century

CE

, and served as a physician in theRoman army under Nero. In about 60

CE

he wrote a treatize onsome 500 plants in Greek

Περι

�

λης ιατρικης

(

Peri HylesIatrikes

), better known in the Latin version

De Materia Medica.

6

De Materia Medica

was notable for arranging the materialbased on its activity as opposed to alphabetical order or arrange-ment by morphology. The work did not discuss theoreticalmodels of causes of disease, particularly ignoring the theory ofhumors. Dioscorides based what he wrote on his personal experi-ences as a physician and upon those of other practitioners herespected, in particular Hippocrates and Theophrastus. His plantdescriptions are often too short to distinguish one species fromanother, but importance is clearly given to the medicinal use ofplants. The result was an empirical, practical manual that becameadopted as a central medical reference for over 1600 years. Acopy of

De Materia Medica

‘ensured the owner of a successfulcareer in medicine or pharmacy’.

7

The contents of his originalwritings are uncertain but five books are accepted as beingauthentic.

In the 6th century, copies of old manuscripts of Dioscorides’text were used in the

Codex Julianae Aniciae

made for Juliana,daughter of the West Roman Emperor Anicius. Here the plants,probably for the first time, are in alphabetical order presumablydue to the intervention of sixth century ‘editors’. It containsabout 400 illustrations of plants, whose beauty was only rarelyequalled by herbals in later centuries. It was first printed in1478 and has been preserved in Vienna in the Imperial Librarysince 1516.

6

Dioscorides was the absolute authority on plants up to theMiddle Ages. Renaissance botanists cited his work. His workwas translated into Arabic, Syriac, Persian and Latin. Before theadvent of printing, all copies had to be prepared by hand leadingto inevitable mistakes. Often his work was misinterpreted.

PIERRO ANDREA MATTHIOLI

Matthioli’s

Commentary

on Dioscorides is one of the great booksof the Renaissance. It had a major influence on medicine andbotany around Europe. In its importance in its subject, it can becompared with Vesalius’

Fabrica

in anatomy and Fracastoro’sideas on contagious diseases. How and why did Matthioli and hisbook come to occupy a position of pre-eminence?

8

The answer must take chronology into account. The bookchanged as it went through various editions and translations andMatthioli’s career and circumstances changed. The doctor at

Fig. 2.

Page from Matthioli’s

Commentarii

, Cowlishaw collectionRACS.

342 SHARP

Trento and Gorizia in the 1530s and 1540s was not the inter-national figure he became in the 1550s. The provincial physicianhad become imperial physician to Archduke Ferdinand in Pragueand court physician to Pope Leo X. In 1540 when he was prepar-ing his first edition of the

Discorsi

, Matthioli was far from beingthe authoritative, even the manipulative figure of the 1560s. Thepan European network of correspondents developed by Matthioli,with the help of the ubiquitous imperial postal service, was verydifferent from the local contacts he had first used. It was hisbook’s success that gave him this position of eminence.

In 1544 protection against plagiarism was obtained only fromVenice and the Pope. Ten years later this had extended beyondthe Alps with the approval of the King of France and the greatestpatron of all, the Holy Roman Emperor.

Matthioli’s success was not due to the quality of his book’sillustrations. These first appeared in the 1554 Latin edition morethan 20 years after Brunfel’s

Herbarum Vivae Eicones

had shownhow the printing press could transform the study of plants. Thefirst illustrated edition of Dioscorides was the 1543 Frankfurtedition, supervised by the noted plagiarist Walter (Wilhelm) Ryff(two of his books are in the Cowlishaw collection).

Most of the Renaissance commentaries on Dioscorides werephilological enterprises, not the result of university lectures.Matthioli’s work has the text printed in bold Roman type withhis commentary beneath in a smaller italic font. It is a flowingpiece of prose in elegant Italian. It reads like a true

discorso

rather than an academic tome. In place of a set formula for theorganization of each section, as in Ryff’s 1543 commentary,Matthioli uses literary and rhetorical variation to convey thesame information in a way that entices the reader to continuefurther. Matthioli breaks new ground in publishing his work foran Italian audience in Italian, one that was not entirely at homewith Latin.

In later editions indexes have been transformed into a guide tomedicine: alongside the list of contents, of weights and measures,and of plates, there are detailed indexes giving references todrugs and their usages. One gives the parts of the body for whichthey are appropriate, another the type of disease, another drugsthat can be used as emetics, another those useful as beauty aids.Together these lists allow the book to be easily consulted if onestarts from a medical problem and not from one of botanical orzoological identification.

Matthioli’s scholarship gave him credibility among hispeers from his own botanical expertise and his academic learn-ing. His botanical memories include a joke about Etruscanpeasants who have foolishly attempted to remove the skinfrom asses who have fallen into a stupor from eating hemlock.They have been frightened when the animals suddenly wokeup and bellowed.

These memories serve three purposes. They establish Matthi-oli’s credentials as a practical observer; they provide witnesses orthe means of authenticating his statements; and they keep hisreader’s interest.

It is the second type of scholarship, Matthioli’s own academiclearning, that gives us the clue to the success of the 1544

Dis-corsi

. There is a striking balance between necessary explanationand superfluous information. He cites classical authorities verba-tim and briefly. His comments are to the point and relate tomodern Italy. If birds and plants are no longer found, or theirdescription is imprecise, they are curtly dismissed. He does notmake a fetish out of nomenclature. He is able to summarizecomplex issues clearly giving a precise and balanced explanation.

In short Matthioli is a commentator of genius. With later editionsthere is expansion and correction of his own errors; the commen-tary is illustrated; and is now becoming a major collection of thefinding of others, especially the research of the Pisan botanistLuca Ghini (1490–1556). It becomes a work of Europeancollaboration – very different from an exposition of an ancienttext. The transformation is complete by Matthioli’s death. Hisbook has become an authoritative, comprehensive, experiential,learned, and beautifully illustrated account of all that was knownabout materia medica.

OUTSIDE EUROPE

Outside Europe the situation was different. We learn fromaccounts from European travellers like Marco Polo (1254–1324)at the end of the 13th century, that garden culture was veryimportant in the Eastern world. Whereas European gardens wereutilitarian, Muslim gardens were based on symbolism, religiousand cultural perceptions. Dioscorides’ text was translated intoArabic in the 9th century providing a basis for Arabic scholars.Plants for medicinal use were collected in the East and brought tothe Iberian Peninsula by Arab traders.

About a century later the missionary Odorico De Pordenone(1265–1331) went to Sri Lanka, Malabar, Java, Sumatra, Borneo,Tibet and China. For a long time the new plants remained merecuriosities in an unchanging and all too stable world.

It was not until the sea explorations undertaken by Henry theNavigator from Portugal, in 1415, that journeys around the worldbegan to be fruitful for botany as a science. The rediscovery ofnavigational instruments such as the compass that the Chinesehad been using since about the 7th or 8th century, made it pos-sible to travel further and more accurately.

At the end of the 15th century Columbus had reached theAmericas and the coasts of Africa and India were charted. In theearly 16th century, the West Indies, the whole American conti-nent, Malacca, the East Indies and China had been visited. Japanwas reached in 1542. By 1550 the outline of the world wasknown with the exception of Australasia. ‘The existence of aworld flora had become a fact to be recognized

.

’

4

The fruits collected on the sea journeys were sent to Italybecause of the wealth and political influence Italian bankers andmerchants exercised in Europe.

The plants from the New World certainly had a great impact onItalian gardens. Italy had become the leading country in Europeas far as culture and science were concerned. Early medicalinstruction had shifted towards elementary studies of the humanbody through anatomy. There was a similar shift in botanytowards observation and dissection of living plants rather than thestudy of plants through books.

The first real change in more than 1000 years of herbal manu-script production occurred in 1530 with Otto von Brunfel’s

Herbarum Vivae Eicones

; not because of the descriptions of theplants but due to the revolutionary drawings. Perhaps he had beeninfluenced by Albrecht Dürer, who in 1503 had painted hisfamous

Das Grosse Rasenstück

in which plants were depicted inan astonishing ecological setting They were wholly unlike previ-ous herbal drawings, which were quite abstract, often incorrectand usually rather arbitrary illustrations of plants described forthe sake of their products. Thus art preceded science. Brunfeldemanded that his plants be drawn from life. The woodcuts wereproduced in a natural way and the plants can be identified withcertainty.

MEDICAL REMEDIES: FROM THE OLD TO THE NEW 343

BOTANICAL GARDENS

The first Renaissance Botanical gardens were in Italy in Padua

9

(Fig. 3) (after the urgent request of the medical school (LuigiAnguillara (ca 1512–1570) was the first prefect 1546–1561) ) andin Pisa (through Luca Ghini) around 1545. These gardens werethe cluster point of the latest development in various disciplines.Research, education, art, architecture and garden design – thepoint where culture and nature meet – were merged in the newRenaissance world view.

The herbarium exercised a major influence on the developmentof botany as a science. In about 1540 Luca Ghini conservedplants by drying them under pressure. Now a plant could beobserved in herbaria for an indefinite time, and more importantly,could be compared with specimens from different areas, with anemphasis on the medicinal properties of plants or their parts.

My friend Robyn Stacey’s photography has inspired me. In herphotograph (Fig. 4) of rare books from Leiden (Rembrandt’shome town) are the four volumes of

The Rauwolf Herbarium

(Leonhart Rauwolf 1535–1596). The 4th and largest volume(centre foreground) is the earliest example of a collection ofplants from a country outside Europe. The book with the ties maybe the oldest Herbarium extant –

En Tibi Perpeturis RidentumGloribus Hortum

(As look here a garden in which the flowerssmile upon you forever). It was made in Ferrara, Italy ca1542–44.

Whilst Dioscorides’ manuscript had become famous through-out Europe as a result of Matthioli’s commentaries, the work ofan obscure Aztec from the other side of the world independentlymirrored these changes.

Badianus manuscript

libellus de medicinalibus indorum herbis

(Fig. 5)

In 1552 the first herbal from the Americas

10

was produced 60 yearsafter Columbus arrived in the New World and 31 years after theconquest of Cortez had led to the fall of Technochitlan (1521) (nowMexico City). It was written in the native Aztec language, Nahuàtl,by Martin de la Cruz, an Aztec physician at the Santa Cruz Collegeof Tlaltelolo, Mexico, who had learned the value of medicinalplants from the old men of his race. It was translated into Latin byJuan Badiano, an Indian from Xochimilco.

The manuscript remained in obscurity for over 350 years.Don Francisco de Mendoza, son of the first Viceroy of New

Spain intended the volume to recommend the Indians of theCollege to his ‘Holy Caesarian Catholic Royal Majesty’ – Charles Vof Spain.

The manuscript was sent to the Spanish Court and placed inthe Royal Library. It passed to Diego de Contarila y Sanabria, theRoyal Apothecary, whose name is seen on the manuscript’s firstpage.

At the end of the 17th century, it came into the possession ofCardinal Francesco Barberini (1597–1679), a nephew of PopeUrban VII (Fig. 6) and founder of the Barberini Library in 1679.

Fig. 3.

Padua’s Botanical Garden.

Fig. 4.

Leidenmaster 1

, copyright Robyn Stacey.

Fig. 5.

Badianus Codex.

344 SHARP

He was one of the 10 judges at Galileo’s trial (and one of thethree judges who did not sign Galileo’s sentence). In 1902,the Barberini Library became part of the Vatican ApostolicLibrary. This Codex survives as the only authentic descriptions ofthe plant materials used as medicaments by the natives at the timeof their conquest.

In 1929 Charles Upson Clark and Lind Thorndike discoveredit in the Vatican Library. They realized its significance and toldother scholars.

Clark spoke to William H. Welch at Johns Hopkins Universityin 1931. Welch was eager to publish the manuscript as a facsimilewith translations and commentaries. This was done simultane-ously, but independently, by William Gates and Emily WalcottEmmart of Johns Hopkins University.

The most important English language version on the Codexwas by Emmart with 118 colour plates. It was published in1940. The introductory text includes a description of the manu-script, its historical background, explanation of its Aztec glyphsymbols, illustrations and colour treatment, materia medica andAztec herbal gardens. It is an invaluable contribution to thehistory of medicine. One hundred plants and trees are depictedin brightly coloured illustrations. The first Spanish translationwas in 1955.

The text is organized by disease, presented in a head-to-toeorder, rather than by alphabetical plant name, as in most Euro-pean illustrated herbals. There are 13 chapters which deal withdifferent groups of afflictions. The first chapter, for example, pro-vides remedies relating to the head: boils, mange coming out ofthe hair, or a broken skull. Other chapters deal with leprosy, heartpain, venereal diseases, ‘tubercles of the breast’ and with moremundane ailments such as ‘fetid breath’, ‘odours of the armpits’and ‘rumbling of the abdomen’. The final chapter is ominouslytitled ‘Of Certain Signs of One Who Is Going To Die’.

Conspicuously absent are most of the hallucinogenic plantssuch as the sacred cactus peyotl and the mushroom teonanacatl.

Above each illustration (Fig. 7) is the Aztec name of the plantwritten in crimson ink. Beneath the plant illustration is the nameof the disease or condition for which the plant serves as atreatment – this Latin heading is also in crimson. The Latin textdescribing the use of the plant is found below in brown ink.

The Codex presents an orderly and systematic description ofnative medical remedies, with illustrations as an aid to identifica-tion. It frequently provides pharmaceutical procedures for thepreparation of the medicaments; most of which are simple forcommon ailments. Some are extremely elaborate and appearintended for ceremonial purposes.

Fig. 6.

Pope Urban VII.

Fig. 7.

Glaucoma – Badianus Codex.

Fig. 8.

The Peoples Demand for Better Health

, Diego Rivera, 1953.

MEDICAL REMEDIES: FROM THE OLD TO THE NEW 345

A captivating part of the text deals with ‘Trees and flowers forthe fatigue of those administering the government and holdingpublic office’. The barks, fruits, leaves, flowers and herbs (withstems) used in the prescription were to be ‘gathered in the earlymorning before the wind arises . . . Indeed these medicamentsbestow the bodily strength of a gladiator, drive weariness faraway and, finally drive out fear and fortify the human heart

.

’

11

A significant aspect of this Codex is that Aztec knowledge ofmedicinal plants and their pharmacy was imparted without beingtainted by Spanish traditions and interpretations. The nativeauthor of this text, de la Cruz, gave classes at the university. It ispossible that the Codex is a transcription and translation of thoseclasses taught to the Indians by Indians. The text is constructedlike a medieval

practica

, manuals for medical instruction inEurope. Also, the text is more like a medical text than an herbal(in the sense of Dioscorides’ model); most medieval herbals list

plants alphabetically by plant name with their various uses. Incontrast, the Aztec Codex is organized by disease.

12

The People’s Demand for Better Health

,

13

(Fig. 8) an 860square foot fresco by the great Diego Rivera is in a quiet lobby inthe Centro Medico de La Raza, a complex of modern hospitals inthe heart of Mexico City. On the left side of the painting, Riveradepicts health technology of the 1950s – transfusions, vaccina-tions, X-rays, hospital births and radiation therapy. To the righthe showed the practices of the Aztecs. A midwife brings forth aninfant; other healers administer massage, herbal poultices, dentalcare, medicinal steam baths, and enemas. Trepanation is alsoillustrated.

At the centre of the mural, copying an image from the early16th century Codex Borbonicus, Rivera painted Tlalzolteotl, theAztec goddess of cleansing and fertility. Below her the artist haspaid homage to the Badianus Codex, by reproducing the majorityof its illustrations (Fig. 9).

Dr Carlos Viesen, professor of history and medicine at theNational Anatomous University of Mexico and the leadingMexican authority on the manuscript, says 90% of the plantsdepicted in the manuscript are still used by

curanderos

in Mexicotoday.

10

After Pope John Paul II visited Mexico in 1990, the Codex,after an absence of more than 400 years, was returned to its right-ful home – Mexico.

CONCLUSION

The 16th century witnessed the shaping of a new world. Man wasnow able to look, observe, write, study, publish, correspond andpursue a course of thought independently of what others hadseen, written and thought. From a Eurocentric point of view, adeep change had taken place and it had begun and developed inItaly, before spreading rapidly to the rest of the world. In theAztec world, the study of medicinal plants had also occurred,independently of European influence.

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The Peoples Demand for Better Health

, detail showingBadianus Codex.

346 SHARP

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