history of medicine for the poor

In Rome in the first and second centuries, wealthy persons consumed expensive medicine.  Mithridates VI, King of Pontus (120-63 BGC), developed an antidote to protect himself against poisoning.  This medicine, which came to be known as Mithridatium, was compounded from 41 ingredients.  Roman Emperor Nero’s physician Andromachos the Elder added viper flesh, more opium, and other ingredients to Mithridatium to create a general-purpose medicine known as Theriac.  Theriac, like Mithridatium, required rare and expensive ingredients and elaborate preparation:

Four vipers cut down small were placed in a solution of sal ammoniac, about one gallon, to which were added nine specified herbs and Attic wine, together with five fresh squills also cut down small. … At the final stage the prescribed quantities of 55 herbs previously prepared by various processes, along with the prescribed quantity of squill and viper flesh powder (48 drachmas), were added to hedychium, long pepper and poppy juice (all at 24 drachmas); eight herbs including cinnamon and opobalsam (all at 12 drachmas); 18 herbs including myrrh, black and white pepper and turpentine resin (at 6 drachmas); 22 others and then Lemnian earth and roasted copper (at 4 drachmas each); bitumen and castoreum (the secretion of {the testes of a} beaver); 150 drachmas of honey and 80 drachmas of vetch meal. The concoction took some 40 days to prepare, after which the process of maturation began. Twelve years was considered by Galen the proper period to keep it before use.[1]

In late twelfth-century Damascus, an eminent scholar — the Christian Metropolitan bishop’s son, who was the physician to Saladin — observed:

Originally, theriac consisted only of laurel seeds and honey and its development into a complicated and most beneficial medicine was due not to divine revelation and inspiration, but to logical thinking by keen intellects over long periods.[2]

Theriac became a fashionable, highly demanded medicine among wealthy Romans, wealthy persons throughout Islamic lands, and wealthy persons in Europe through to the eighteenth century.[3]

Medicines for the poor were a counterpoint to medicines like Mithridatium and Theriac.  Galen wrote On Remedies Easy to Prepare, On Drugs Which Are Easy to Find, and Medicine for the Poor, all of which may be the same work described slightly differently, or perhaps a spurious, but early work.[4]  Asaph’s Book of Medicine, a Hebrew text dating to the tenth century or earlier, includes a section entitled “The Book of Medicaments for the Poor.” It begins thus:

Asaph spoke of all the diseases of the body, from the head to the feet and indicated how to cure them.  I shall now tell you of the primary drugs for the poor people, in order to enable anybody to get free medicaments against any disease and in any place.  Asaph the Physician required his disciples to take an oath and not to take fees from poor people, but to cure them free of charge, as a present.[5]

With a similar concern for access to medicine, the influential Persian physician al-Rāzī (865-925 GC) composed:

A book for those who cannot reach a doctor, aiming to define the various maladies; here he discourses at length, mentioning one malady after the other, and how each can be treated by common drugs; this book is known as “The Medical Book of the Poor.”[6]

A prominent physician in early thirteenth-century Egypt reformulated Theriac to make it widely accessible:

After spending a long time preparing the theriac al-Farūq — as it was difficult to obtain the proper ingredients from distant countries — he prepared a less complicated theriac. The components of which are to be found everywhere. In preparing it, his intention was not to ingratiate himself with the sovereign or to gain money or worldly fame, but to find favor with God by aiding all His creatures and showing mercy to all. So he freely dispensed it to the sick, bringing relief to the paralyzed and straightening crooked hands on the spot: it produced additional natural warmth in the sinews, strengthened them and dissolved the phlegm contained in them. The patients at once felt relief, and colic pains subsided immediately after evacuation.[7]

Books of medicine for the poor were popular throughout second-millennium Arabic and European literature.[8]

Medicine prior to the twentieth century on balance probably harmed patients more than helped them.[9]  Nonetheless, medicine for the poor shows the enduring importance of concern for the poor.

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Notes:

[1] Griffin (2004) pp. 317-8.

[2] HP p. 13; comment of Shaikh Muwaffaq al-Dīn As`ad ibn Elyas ibn al-Maṭrān, who wrote a book entitled The Garden of Physicians and the Meadow of the Intelligent.  In twelfth-century Andalusia, Ibn Marwān ibn Abū al-`Alā ibn Zuhr sought acclaim for development of Theriac in the opposite direction:

He dedicated to `Abd al-Mu`min his book on theriac, the components of which he reduced from seventy to ten and then to seven, the seven-drug composition being known as “Theriac antula.”

HP. p. 657.

[3] Totelin (2004) pp. 10-14, Nutton (1985) pp. 140-2.  Theriac was produced in Venice in the twelfth century and widely exported.  It became known in England as Venetian treacle, or just treacle.  Padua, Milan, Genoa, Bologna, Constantinople, Cairo and London all subsequently participated in Theriac production and exportation.  Theriac continued to be listed in German and French pharmacopoeia through nearly the end of the nineteenth century.  Griffin (2004) p. 318, 324.

[4] The Galenic Corpus includes under therapeutics, Of remedies of easy preparation (On Remedies Easy to Prepare) De Remediis Paratu Facilibus Libellus (Rem.).    Ibn Abi Usaibia recorded as Galenic works:

  •  “On Drugs Which Are Easy to Find,” i. e., drugs available everywhere; two chapters.
  • “The Treatment of Diseases,” known also as “Medicine for the Poor,” in two chapters.

See HP pp. 186, 192.  Bos (1998) p. 368 reports Vivian Nutton’s judgment that the Galenic text referenced in Arabic as K. Ilaj al-masakin wa-tibb al-fuqara (On the treatment of the destitute and the healing of the poor) is spurious.  Id. notes that Galen seems to have been interested in serving the poor.

[5] Trans. Muntner & Rosner (1971) pp. 118-9 (para. 126).  Bos (1998) p. 367 has a rather different translation of part of this section, but with the same general sense.  Ibn al-Jazzar of Qayrawan’s Medicine for the Poor and Destitute, a tenth-century Arabic text from North Africa, similarly proceeds from head to feet.  That’s a general characteristic of medieval medical books for the poor.  Bos (1998) pp. 366, 375.  Here’s some analysis of Asaph’s Oath.

[6] HP p. 546.

[7] HP pp. 753-4, describing Rashīd al-Dīn Abū Hulaiqa (b. 1194).  Al-Farūq was known as the “great theriac.”  HP p. 693.  The theriac al-Farūq was prepared for the son of “King Marī” (Baldwin IV, son of King Amalric I) in twelfth-century Christian-ruled Jerusalem.  HP p. 744.

[8] Bos (1998) provides many examples.  See also the National Library of Medicine’s description of a manuscript of Ibn al-Jazzar’s Medicine for the Poor and Destitute.

[9] The first serious criticism of Mithridatium and Theriac’s efficacy was Willaim Heberden’s pamphlet, Antitherica, Essay on Mithridatium and Theriac, published in 1745.  Heberden declared the “injudiciousness, the ostentation and wantonness of this heap of drugs.”  Using crowd imagery inconsistent with these medicines’ royal origins, Heberden described these medicines as “a dissonant crowd collected from many countries, mighty in appearance, but in reality, an ineffective multitude that only hinder one another.”  Quoted from Griffin (2004) p. 323.

References:

Bos, Gerrit. 1998. “Ibn Al-Jazzār on Medicine for the Poor and Destitute”. Journal of the American Oriental Society. 118 (3) pp. 365-375.

Griffin, J. P. 2004. “Venetian treacle and the foundation of medicines regulation“. British Journal of Clinical Pharmacology. 58 (3): 317-325. DOI:10.1111/j.1365-2125.2004.02147.x

HP: Ibn Abi Usaybi’ah, Ahmad ibn al-Qasim. English translation of History of Physicians (4 v.) Translated by Lothar Kopf. 1971. Located in: Modern Manuscripts Collection, History of Medicine Division, National Library of Medicine, Bethesda, MD; MS C 294Online transcription.

Nutton Vivian. 1985. “The drug trade in antiquity”. Journal of the Royal Society of Medicine. 78 (2): 138-45.

Totelin, Laurence M. V. 2000. “Mithradates’ Antidote—A Pharmacological Ghost”. Early Science and Medicine. 9: 1–19.

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