Medicinal: The Swing from Pharmakopola to Apothecary

From Pharmakopola to Apothecary: how we used alcohol, cocaine and other drugs throughout history in the biological context

There is no real “beginning” of the use of psychoactive substances as a drug. Their use was intertwined with that of food and nutrition, satisfying many needs of hunger, thirst, refreshment as well as for the many health benefits that were imparted, even though the processes of such were not understood. In ancient times, combinations of many different substances, magic and rituals were used to sustain health and in the treatment of illnesses and conditions, drugs as we know them today played a small part overall.

The concept of “drugs” really only emerged with written history. In the oldest surviving Egyptian Medical text, the Elbers Papyrus, (1600BC), there is a description of the opium poppy,  which includes the whole plant, roots, seeds and heads, and although other texts suggest its use as an analgesic and sedative, it is not known whether the effect was attributed to its opium sap. It was used from anything from placating a crying child, to being applied by sponge to relieve pain during surgery.

The medicinal effects of wine and beer were well known to the Egyptians, and along with their use in wound dressings, for fighting fever, as a diuretic and a restorative beverage, they were commonly used as vehicles for other plant drugs.

TAIRONA COCA IMPLEMENT 1000-1550, for grinding lime to mix with coca leaves, attesting the long history of coca leaf use in South America.

In the ancient civilizations of the Americans, a huge array of psychoacitve substances were used ritually and medicinally. When the Spanish arrived in the mid 15th century, they found the indigeonous populations had great medical knowledge, their tradition having been passed down orally for thousands of years. They maintained botanical gardens for their healing plants and their markets (as in contemporary central and south America) were home to traders offering a wide range of cures and remedies. They chewed the leaves of the coca plant to relieve hunger and fatigue and to cope with the effects of altitude. Coca leaves were used to treat gastrointestinal illnesses, to ease the pain of dental caries, arthritis, headaches, sores, fractures, nosebleed, asthma, and impotence. Archaeological artifacts associated with coca processing dates as early as 7000BC suggests continuous use of the coca alcoloid (cocaine) for thousands of years, although it’s use in this form may have been restricted to ritualistic  or sacred purposes.   Alcoholic beverages were also commonly used in ancient American cultures, made from maize and roots, although the use of alcohol was predominantly for religion and feasting. It was said that “alcohol makes you feel good, but coca puts strength in your limbs”

In the classical world of Ancient Greece, the concept of “pharmaka” emerged, which intertwined the sense of “drug”, “cure” and “poison”, in much the same way as and “intoxicant” combines the concepts of altered consciousness and poisoning. Drugs were no longer a supernatural thing,  but as stated in the Corpus Hippocraticum, were “substances that act by cooling, drying, wetting, contracting and relaxing or inducing sleep”, and were categorised according to characteristics such as “purgative or “emollient”. Hippocratic healing was the natural product of this era, where patients were involved in performing their own cures, where the art of the physician encompassed a range of performance and ritual and treated not just the disease, but the patient as a whole. (r)

Opium was the favourite drug of the ancient Greeks, and it was used to treat everything from “hysteria and uterine suffocation” to “calming down any pain”. Opium was not considered as a despicable drug, and there is no mention in texts of addiction or terrible afflictions associated with its use.

Ancient Greek custom, mixing wine and water in a "krater"

Wine was a part of the diet of all Greeks, diluted with water, and it was well regarded socially and medicinally. Hippocrates used wine as a cure for fevers, convalescence and as an antiseptic and studied the effect of wine on his patient’s stool. Various types of wine were prescribed by Greek doctors for use as an analgesic, diuretic, tonic and digestive aid. Plato described wine as having been “granted by God as a potion to aid in withstanding the rigours of old age, to regain our youth, forgetting which afflicts the elder and discharging coarseness from the soul, lending him more joviality”(r)

It was alcohol that was regarded as the substance with the greatest risk for intoxication and addiction embodied in the description of wine as “a terrible stranger, capable of ruining the house that welcomed him”.

Dioscorides, writing in the first century AD, mentions wine mixed with extracts of the mandrake plant (Mandragora) as being the standard surgical anaesthetic of his day. His works remained the authority on drugs for more than 1500 years, and his descriptions were the first written understandings of the psychoactive drugs, discussed within the framework of pharmacology rather than pleasure. He grouped together plants with different narcotic effects and was the first to relate the effects of such drugs to the dose at which it was taken, rather than the innate properties of the substance.

The Roman perceptions of drug use followed on from the Greeks. The formidable daily consumption of opium by millions of Roman citizens, as in Greece, posed no social or health issues of intoxication or addiction. It’s use was indistinguishable from any other daily custom, and there is no word in Latin for  “opium addict”. It was sold in stores throughout Rome and was used to treat everything from pain, stomach fluxes, to relieve coughing, to induce sleep and relieve the agony of dying.

Romans also used wine medicinally in the same fashion as the Greeks, and were also conscious of the personal and collective problems caused by addiction. (s)

Alcohol was a major component of medicine. Wine was used as a means of extracting the active elements from medicinal plants. Indeed it has been suggested that wine mixed with opium or wormwood were offered to Jesus at his crucifixion because of its anaesthetic properties.

With the decline of the Roman Empire, the role of the “pharmakopola” or drug sellers of the classical world was taken over by the Apothecaries of medieval Europe. The Christianization of the Roman empire led to great social change and the perception of many substances that had been used medicinally for thousands of years took on a new association with paganism. Attitudes to euphoria, affliction and pain assumed a new dimension  with the changed religious teachings of Christianity. Euthanasia, seen as a noble act in Greece and Rome was condemned under Christian law, and pain was welcomed as long as it “mortified the flesh”. Pagan knowledge of drugs was considered to be contaminated by witchcraft and volumes of ancient texts on the subject were destroyed.  Charlemagne declared opium the “work of satan” and drug sellers were executed or sold as slaves, as opium , the ubiquitous painkiller of the classical world was outlawed, and the use of diabolical plants was viewed as treason to the Christian faith.

Monk drinking wine, from Medieval Illustrated Manuscript

As Europe descended into the dark ages, it encountered plagues, natural catastrophes, barbarism, localised conflict and Viking invasions. The prolonged state of disastrous affairs set the medical world back to the realms of superstition and magic as disparate populations looked again to alcohol mixed with local plant substances (mainly halluncinogenic solenaceous plants like mandrake, belladonna and henbane) to cure their ills, forming the basis for what would lead to the war against witchcraft that erupted in the 13th century. In the face of being burned at the stake for heresey, undoubtedly the safest drug of any kind in Europe during this period was alcohol. Around 1250, the technique of distillation was rediscovered,  and distilled spirits were used largely for medical purposes until the end of the Middle Ages, when people began consuming them as a beverage. By the time of the Black Death of 1347-1351, distilled alcohol had already earned its split personality as nourishing food, beneficent medicine, and harmful drug and the widespread drinking of spirits followed closely on the heels of the Europe’s bouts with plague. Though completely ineffective as a cure for plague, alcohol did make the victim who drank it at least feel more robust.

Medieval Apothaceries

No other known agent could accomplish even that much. The medieval physician’s optimism related to spirits may be attributed to this ability to alleviate pain and enhance mood, effects that must have seemed quite remarkable during a medical crisis that saw perhaps two thirds of Europe’s population culled in a single generation.

Alcohol remained the prominent (legal) medicinal psychoactive substance until at least the 15th century, and was consumed with most meals in a time when sanitation was unheard of and drinking water was by far the more deadly option.