The History of Healing: Farmacy (Part III)

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Guess who said these words:

“Verde que te quiero verde.” (Green how I want you green.)

Was it Francois the French farmer or Ben the Belgian banker? Answer: neither of the two. The one who said it (wrote, to be more apt) was the Spanish playwright and poet Federico Garcia Lorca (from his poem Romance Sonambulo).

If our primary mode of judgment is to appraise things by their color, then we would be perfectly validated for accusing Francois and Ben of poetry. Anyone who has tried to venture outdoors knows how green is a guiding aesthetic in agriculture. Anyone who has had the unfortunate experience of conducting bank transactions knows how green is associated with the contemptuous customs of commerce.

Green has pervaded all aspects of our lives. From food to finance. From profits to perversity. From horticulture to haughty culture. From can I make a deposit to I’m about to withdraw. The ubiquity of green stems from two important objects that are often correlated with the color: plants and money.

This concordat is not a modern menace. It goes way back to ancient history when people’s idea of power was quite simply where our feet rests. That of course, is land. Sure, there were other things that symbolized power like weapons, skulls, fur, etc., but these meant nothing if you didn’t have your own land. At best, one is but a wandering cubone looking for their dead matriarch. Land meant power because it implied domination and encouraged social collection within a defined stretch of geography. The ownership of land also meant control on what the land was for, and since food can be grown from the land, why not use it for that purpose? They did. And so agriculture was born. This was an important step in our overall development as a species: it made civilizations happen. Agriculture helped stabilize early human societies, allowing people to grow accessible resources otherwise unavailable in the harsh environments of pre-history. Ancient peoples learned to associate wealth with the successful cultivation of plants. As time went by, it became serious business since it ensured security from hunger and predation. Growing wheat in well protected acres near the safety of your community was a lot a safer than foraging for berries out in hostile savannas. Continuous accumulation of agricultural knowledge improved overall practice and produce. More food around also meant more energy, and more energy meant more capacity for activity. Entertainment was hard to come by in those days, so our early ancestors developed social practices where unspent energy were better devoted to. But when those failed to expend joules, the strong urge of reproductive instinct was a reliable and effective outlet of unused energy. Thus, populations increased and communities started to grow bigger and bigger. Mankind prospered with a full belly. Both from food and pregnancy.

Traces of this early relationship between plants and wealth still survive in the words we use today. Farmers, the ones who we usually see tending the fields, used to harvest coins instead of crops, for they used to be tax collectors. This is because the word farm comes from the Latin firma which means fixed payment or rent.  During the middle ages, where the feudal system became the dominant mode of production, peasants rented agricultural lands owned by the nobility, and the farmers were the ones collecting their dues. One of history’s most famous (and highly unfortunate) farmers was Antoine Lavoisier, father of modern chemistry. His past as a tax-collector, a farmer general, was reason enough to suspect of him counter-revolutionary sentiments, ultimately earning him a quick rendezvous with the ever so sharp Madame Guillotine. Nowadays, farmers hardly get recognition for the efforts and innovations that they may have discovered since they’re mostly seen by affluent society as crude and elementary for their supposed lack of social finesse, not to mention their constant exposure to dirt and soil sully them in the eyes of the rich. Neither do they need to have questionable pasts to have their heads cut off. Poverty does that to them on a daily basis.

Their plight is usually far from sight. Their suffering and cries for help are usually muted by their relative geographical distance away from modern commercial and residential centers. Destitute and far removed from contact, farmers of today are ageing and dying in droves, for their medical conditions are rarely addressed, simply because they’re far from modern hospitals and can hardly afford healthcare if there’s a clinic nearby.

It is a sickness that has no cure at the moment.

Cosmopolitan cities are organized in ways that make financial activities more fluid and efficient. Malls, cafés, shops, etc., are erected here and there to ensure that the movement of money happens constantly. In short, cities are designed to better facilitate the circulation of capital. Nowhere else can you shop for the trendiest sweater while sipping a takeaway latte as the latest Ed Sheeran song plays for the 3,652nd time on repeat but in cities. Activity is its lifeblood, and since cities are where most of the action takes place, hospitals and other healthcare facilities are concentrated within its borders. It is true that huge sums of capital are also invested in farmlands, but profits reaped from there are then transferred back to cities, adding to cycle of capital. Hence the division urban and rural. Songs like The Green Green Grass of Home illustrate this divide: the city hosts an alien life, inhumane, far from the innocence and simplicity that is and was enjoyed out in the country, and there’s that old oak tree that I used to play on. Foreshadowed in the song is the eventual execution of the one singing, but death signifies a return to the green, an escape from the clutches of urbanity, as they lay me ‘neath the green, green grass of home. Nostalgia is the driving message of this song, but it fails to see that the green grass of home hosts bodies whose lives were wrecked by the harsh (but often romanticized) realities of rural life. For out in the fields, in the vast stretches of the rural country, lie a long life of endless and unrewarding work. The distance that separates farms from the major commercial scene makes the development of rural areas secondary, and unfortunately, even forgotten in most cases. Ben is in a far better lot than Francois. This has led to a crisis in public health.

Hospitals need revenues to continue their operations. Farmers, being humans, also get sick and contract various diseases. Cough, they need to see a doctor, cough. Money is required for healthcare and medicines. Problem is, money is hard to come by if you’re just an ordinary farmer who has to pay land lease, chemical contracts with big companies like Monsanto, mechanical repairs, etc. The unwelcome arrival of disease takes away the little that is left of the farmer. Most of the time, they don’t have any left, which forces them to work even under the brutal brunt of blight. Life as a farmer is difficult. Who is willing to take care of them? Consequently, who will the doctors in rural areas treat if farmers can’t pay medical fees? This makes it difficult for rural hospitals to stay operational. A lot fail. Many close.The immediate result of this vicious cycle is the movement away and the absence of health practitioners in rural areas, since the “closure of a hospital limits physician income and practice opportunities and thus affects physician recruitment and retention and jeopardizes the delivery of other health services in the community” (Weisgrau, 1995).

A cruel historical irony is at play here. Historical since medicine and agriculture share a common origin. Cruel since both have been forcefully separated from one another. And ironic since it doesn’t have to be that way but it is.

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Shen Nong depicted by the painter Guo Xu (1503)

Medicine and agriculture emerged from the same seed and started life as conjoined twins. Together they blossomed and fed off of each other’s nurture. Nowhere is this best represented than in the story of the Ancient Chinese deity Shen Nong (神農), whose name means “agriculture god”. Legend has it that Shen Nong was the one who invented many of the appliances and tools still used by farmers today like the axe, hoe, plow, etc. But inventing these wasn’t enough for Shen Nong. He wanted to know more. If what we grow as food are plants, then surely, other plants might hold secrets that are beneficial for our survival. If it is plants that gave us rice, then they must have other things that are also nice. There was more to plants than just being food material. What else was out there that we didn’t know about? Wanting to find the answers himself, Shen Nong went and catalogued the various qualities of the different plants species around him. This led him to discover the medicinal properties and the not so nice qualities of various plants. Legend has it that he would ingest various plant material, leaves, roots, stems, roots, flowers, fruits, and meticulously take note of their effects. It was during one of his surveys that he happened to stumble across tea and discovered its therapeutic properties. The oldest extant Chinese herbal text is named after him: Shennong Ben Cao Jing (神農本草經) or The Classic of Herbal Medicine – though it is from the 3rd century AD (Shen Nong is said to be from the 28th century BC). Legends may not be everyone’s cup of tea, but this story is indicative of the intimate relationship shared by agriculture and medicine that was common knowledge to the ancients, as it was by daily association with plants that farmers developed an extensive knowledge of their healing potential.

But history provides a sugar of truth into this legend.

As explained in the previous essays, the Mesopotamians, Egyptians, and now the Chinese, have all developed early forms of medicine making from materials around them. What is common among the three is that they are all river civilizations: Mesopotamia, the Tigris and Euphrates; Egypt, the Nile; and China, Yangtze. Joining the river roster are the Harappans, an Indian Bronze age civilization who settled near the banks of the Indus river. For a variety of reasons, climate change being the chief culprit, the Harappans moved away from the Indus and settled near another river, the great Ganges. This was the start of the Vedic period, a time of flourishing that also gave us the Ayurveda, a set of ancient medical practices that include herbal therapy and even surgery. These examples lead one to think, “why did they stay near rivers?”

Simple. Rivers are important in agriculture.

Not only are rivers sources of food and freshwater for drinking, but rivers were/are important in irrigation, ensuring a well hydrated land, which is essential for farming. Like the annual Nile floods, rivers also bring with them silt and minerals that keep the soil healthy. Hydrated: check. Nourished: check. The crops are healthy. But plants aren’t the only recipients of good fortune thanks to the blessings of rivers; humans, too, profit in wealth and health. Rivers also acted as roads for transporting humans and produced goods. Food and culture traveled much faster than they could if both took the journey by foot. The stomach and the mind was left satisfied and floating.

So far so good. Agriculture. Rivers. The ancients. But wait. Aren’t we forgetting something? Oh yeah, the Ancient Greeks!

Yes, what about the Ancient Greeks? Aren’t they the ones who set the groundwork for modern medicine? Do they also have a major river that helped them thrive?

The most famous of the Greek rivers is, unfortunately, the River Styx. What it does is nothing of the kind that would be beneficial to agriculture. Instead of encouraging life, it escorts life away. On the other hand, it also renders life invincible, like how it made Achilles unstoppable against the forces of Troy. A field of cabbages irrigated with water from the River Styx does not sound like a good plan. On a rather whimsical note, it is quite interesting that at one point in the Trojan war, Achilles fought a river named Scamander or Xanthos. The second river in terms of prominence is the Maritsa, which is the largest river in the Balkans. But its role in the overall growth and development in Ancient Greece is minimal, making its size and and breadth rather insignificant for this discussion. Since nothing like the Nile or the Euphrates nurtured Greece’s soil, it became barren and dry, making agriculture a nightmare. With what they lacked in natural luck, they made up with raw human power. Leopold Migeotte, in The Economy of Greek Cities, estimates that 80% of the Ancient Greek population worked in agriculture; while Charles Freeman, in Egypt, Greece, and Rome: Civilizations of the Ancient Mediterranean, claims that it is even higher, saying that up to 90% of the population was involved in agriculture. Whatever the real ratio is, a truth can be surmised from these two estimates: almost all of the Ancient Greeks tilled the land. They led a lifestyle deeply embedded in plant cultivation.

Nonetheless, it would be a mistake to assume that Ancient Greece was all dry and arid.

In the absence of a major river, another body of water burst onto the scene to carry them through turbulent times. It wasn’t a river. It was bigger than that. A bit salty, as well. It was a whole sea: The Mediterranean. A vast expanse of water that served as a frantic highway for travel, trade, and cultural exchange. It was through the Mediterranean that the seeds of medicine sailed and landed on Greece. Once these seeds germinated on the hostile Greek soil, they developed a unique flavor and flower that would later bear the fruit of an intellectual tradition that lasted for centuries.

Better agricultural practices and ideas across the Mediterranean arrived in Greece at an important time in their infancy. Like milk to a hungry mouth, the Mediterranean delivered nourishment of mind to a fledgling culture in desperation. Yes, the land was dry, but intellect is a wellspring of ideas, and the Ancient Greeks weren’t short of that. Generous servings of composted knowledge from all over did well to make Greece’s soil fertile and fecund enough. The foundations of Greek agriculture was now in motion. With that came its ugly corollary, the disproportionate distribution of wealth. Soil didn’t just grow plants, it also promoted power and prestige. Owning the bits of land that were friendly to farming enabled the concentration of wealth to one side of society and away from the other.

Now that Ancient Greek agriculture was in place, the conditions were ripe for medicine to grow and flourish.

Hippocrates, the medical mastermind of Ancient Greece, finally affirms the connection between agriculture and medicine made in the story of Shen Nong. This is how he thought it came to be: in On Ancient Medicine, he states that men of olden times observed how various plant materials in their diet affected their health. From these observations, Hippocrates believed that ancient man was able to come up with the original recipe for the medical arts. (See chapter 3 of James Sands Elliott’s Outlines of Greek and Roman Medicine.) This method wouldn’t have been possible if agriculture remained in a rudimentary state.

Cultivating plants for later consumption is the main point of agriculture. That’s agreed. So, given that the Ancient Greeks were wont to think about things, it is reasonable to expect that a philosophy dealing with plants would surface immediately. That wasn’t the case. Plants were merely things for decoration, trade, industry, and eating. So it seemed. Aristotle, known in posterity as the father of biology, ironically didn’t talk a great deal about plants, and the body of work which this nomenclature rests on is his voluminous treatise The History of Animals. This is not to say that Aristotle’s designation as such is questionable; no, not at all. Charles Darwin, the man who legitimized biology as a science with his theory of evolution by natural selection, had this glowing recommendation to say about Aristotle: “Linnaeus and Cuvier have been my two gods, though in very different ways, but they were mere school-boys to old Aristotle.” (Letter to William Ogle, 1882). We credit Aristotle as such because he left an intellectual tradition that would later make natural philosophy possible, and in the long run evolve into science.

Though not the direct progenitor, Aristotle still had a hand in the early development of plant science. The person to do that was his replacement as head of the the Lyceum, a school that he founded. Aristotle himself selected him to be the new principal. It wasn’t a difficult choice. After all, they were friends and both were students of Plato in the Academy.

Tyrtamus of Eresus, later renamed as Theophrastus by Aristotle, was arguably of equal talent and intellect as his predecessor, and was the right person to helm the Lyceum. Diogenes of Laertius, whose Lives and Opinions of Eminent Philosophers remains as one of the chief sources of ancient biographies, notes that there are about 225 texts written by (or at the very least, attributed to) Theophrastus. Their breadth spans the territories of history, philosophy, comedy, rhetoric, geology, and most importantly botany. He matched Aristotle’s 10 books on animals with his monumental Historia Plantanum (also 10 books). His botanical project continued to branch, as he later released another work of 6 books, De Causis Plantarum (On the Causes of Plants). The former is concerned with cataloging the anatomic and taxonomic profile of plants that he personally observed and heard of from other sources. The latter directs its focus on the biology of plants, particularly its propagation and reproduction. The roots of botany had finally established itself on scientific grounds.

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Frontispiece of a 1644 copy of Historia Plantarum

While not at all perfect when compared to today’s standards, Theophrastus made sure that all his records complied with that of reality and in accordance to the means available to him. In the Historia, he says that “In considering the distinctive characters of plants and their nature generally one must take into account their parts, their qualities, the ways in which their life originates, and the course which it follows in each case.” No room for the supernatural was made available. Even though this work was published around the 3rd century BC, it sounds refreshingly modern.

Of course, a discussion of plants would be incomplete without talking about their medicinal properties. The 9th book of Historia is solely devoted to treat this topic. Theophrastus consulted the “rootcutters” (rhizotomoi) and drug sellers (pharmakopolai) and compiled all that he had learned from them to complete this segment. While this is the first botanical in history (at least extant), this contribution has a lot of gaps, guesses, and speculations, as Theophrastus mainly relied on secondary sources since his main interests lay elsewhere.

Thanks to the work of Theophrastus, botany was growing and growing, and one of its fruits was pharmacy. It grew ripe and was ready to fall. But it refused to barge and it remained insistently attached to botany’s branches. It needed a little budge. A quick nudge would’ve been enough. But Theophrastus left it at that and could never be bothered with the task, so someone had to step in and do the honors. It took centuries for him to arrive, but when he did, he shook the tree so hard that it remembered his name for a very long time.

His name was Dioscorides.

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A 13th century Arabic depiction of Dioscorides

Pedanius Disocorides was a first century AD Roman army medic from the small town of Anazarbus (Cilicia, Turkey). He may have lived a short life (sources say he was born around 40 AD and died circa 90 AD), but his work rendered him immortal. For a millennium, his seminal work on pharmacy remained the principal text of the field. That work being his magisterial, De Materia Medica (On Medical Material). While Theophrastus was contented with listing down medicinal plants, Dioscorides went further. In De Materia, not only does he give a list of medicinal plants but he also provides instructions on how to prepare potions and concoctions from them. His directions are precise and ordered, leaving little room for mistakes. To extract drug components from particular plant parts, he provides these specifications:

For stems, “Extract juices from plants by infusion when the stems are recently sprouted, and similarly with leaves; but to gain juices and droplike gums by tapping, take the stems and cut them while still in their prime.”

For roots, “Gather roots for laying up in storage, as well as roots for juices and root barks, when the plants are beginning to shed their leaves. The clean roots should be dried out immediately in areas free from moisture, but roots with earth or clay adhering should be washed with water.”

For flowers, ““Flowers and such parts that have a sweet smelling fragrance should be laid down in small dry boxes of limewood, but occasionally they can be wrapped serviceably in papyrus or leaves to preserve their seeds.”

The directives above show just one part of his project, which is making medicines. A huge chunk of De Materia, however, is spent talking about what to administer given a particular concern or illness.

If one has an upset stomach, Dioscorides suggests the use of chamomile since they “have heating and thinning properties”, and because of that they are used “for treatment of bowel gas and for intestinal obstructions and for jaundice, and they cleanse and cure liver complaints.”

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Papyri fragments of De Materia Medica ©The University of Michigan

A great deal of what Dioscorides writes benefits from the botanical tradition handed down through the ages by Theophrastus. However, what we see in De Materia looks less like a continuation, but more of a synthesis of two traditions, since Dioscorides also includes within his treatise the use of animals as medical ingredients. De Materia is arguably the first biological applied science text.

As food cleanliness and hygiene wasn’t that advanced in his time, a lot of diseases and discomforts were digestive in nature. Today, laxatives are given to people suffering from constipation. Dioscorides had his own version of purgatives.

One was made from a seafood delicacy: “Fresh clams are good for the bowels, but the soup made from them is best. . . This kind of soup is taken with wine.”

Hair care was also an area in want of inspiration at that time, as their concoctions failed to prevent rapid hair loss. A balding seafarer or fisherman would be relieved to know that there’s actually a way to reverse this, for Dioscorides had found a way to restore hair back to those bald spots. Why people of the sea specifically? Because the concoction required seahorses:

“A seahorse is a small sea creature, which being burned, the ash is prepared as an ointment with raw pitch, or hog’s fat, or oil of marjoram, and smeared on a bald spot brings back hair to those afflicted with alopecias.”

The work of Dioscorides would go on to shape and define a medical culture that would last even until the 20th century. De Materia became the medical textbook: not just as a drug compendium, but also as a botanical reference, even more so than Theophrastus’ Historia Plantarum. The great Italian renaissance physician Niccolò Leoniceno (1428-1524) used Dioscorides’ texts because of its paramount reputation to complete his criticism of Pliny’s Natural History. In fact, Leoniceno wasn’t alone in his veneration of Dioscorides. The greatest medical minds of the renaissance held Dioscorides in high regard. Popular personalities like the scholar Ermolao Barbaro (1454-1493) and the botanist Valerius Cordus (1515-1544) made Dioscorides a model scholar and naturalist for intellectuals to follow. But it wasn’t just the content of Dioscorides’ work that earned him that status; renaissance scholars found Dioscorides’ work to be free of any Aristotelian speculation on final causes, granting its form a modern flavour that was in vogue among the humanists (See The Science of Describing: Natural History in Renaissance Europe by Brian Ogilvie).

But modernity turned its back on Dioscorides’ modern sensibilities. The medical tradition that he had helped shape was slowly becoming an altogether different juggernaut: a beast that stomped its way far from the fields where Theophrastus and Dioscorides collected ancient knowledge. Laboratories are now the exclusive spheres of drug making, experimenting, and testing. The classroom has now become the sole venue for medical instruction (almost).

In principle, this won’t present any problems, since hospitals and institutions need all the support they can get in order to function. However, a great deal of knowledge is lost by positioning these institutions away from areas that are likely to provide important insight into the various medical problems and conundrums that we now face. The late Harvard public health and evolutionary biologist professor Richard Levins suggested that we should consider setting medical institutions in farms and forests, where diseases are most likely to originate. Think about it. How can a physician trained exclusively within the city fully know the nature of, say, contagious diseases that came outside of it Of course, textbooks and published dogma are there to help, but firsthand account and knowledge of the natural world is premium in medicine. It is but a requirement set by our biological reality as evolved organisms (here is an argument for evolutionary epidemiology). This is part of the reason why almost every year governments are caught by surprise by the sudden outbreaks of plague.

Perhaps the renaissance masters were onto something when they made Dioscorides a model. Maybe it isn’t enough that we just refer to his texts. Maybe we should also look and follow his example, his scientific conduct. If we do now, what is it that we can learn from the examples of Dioscorides (and Theophrastus)?

Get out.

Indoors is my sanctuary, and I always try my best to avoid the punishment of going outside. But as an obsessed collector of knowledge, there is no other way but to do so. All the libraries and museums of the world are positioned away from my home, to my extreme disadvantage.

Get out.

Indeed. This is a credo and an important reminder to public health officials and education reformers: Hospitals are not the sole arena for learning and classrooms only present a controlled idea of the world. It also hammers home the point that our modern economic regimes have set in place a public health crisis where hospitals aren’t designed to cure, but to act as loci for capital, where health care is bought and medicines are a commodity.

Get out.

Who knows, a doctor with years of experience with the stethoscope might hear things previously unheard of in the wild, leading to the next big biological discovery. Or the steady hands of a surgeon might come in handy in recovering fragile important samples. Or better yet, now that he’s a doctor, the French farmer Francois might find that writing prescriptions isn’t the only way medics can convey their messages. There’s also poetry.

“Healthy que te quiero healthy.”

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15th century Byzantine copy of De Materia Medica

 

(The complete bibliography for this series will be provided in the last essay.)

 

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