Ten Drugs

How Plants, Powders, and Pills Have Shaped the History of Medicine

Abrams Books

Contents

THE JOY PLANT

YOU CAN IMAGINE an early hunter-gatherer in the Middle East looking for that next meal, roaming some new countryside, trying a taste of this or that insect, animal, or plant. Seeds, high in nutritional value, are generally worth trying. So, often, are the pods and fruits that surround them. On this particular day he or she finds a patch of waist-high plants growing in an open area, each head nodding under a heavy, fist-sized, waxy, light-green seed pod.

Worth a try. A sniff. A small bite. A grimace and a spit. The flesh of the pod is mouth-twistingly bitter, and this is a bad sign. We are wired to sense a lot of poisonous things as bitter; this is nature's way of telling us what to avoid. Bitter usually means a stomachache or worse.

So our early explorer turned away from the plants with the big seed pods. Then an hour or two later, something strange. A dreaminess. An easing of pain. A pleasant sense of well-being. A connection with the gods. This plant was holy.

IT MIGHT HAVE started that way. Or it might have started when a sharp-eyed early human noticed some animal feeding on those same seed pods and afterward acting a bit odd, also a sign from the gods that the plant had power.

We do not know how it happened, exactly, but we know something about when. The long love affair between humans and this miraculous plant started more than ten thousand years ago — before towns, before agriculture, before science, before history. By the time the first human cities on earth were rising in the valleys of the Euphrates and Tigris rivers, this holy plant's seeds were being eaten as food, its bitter sap was being used as a medicine, and its praises were being sung. During the excavation of a four-thousand-year-old palace in what is today's northwest Syria, archaeologists recently found an unusual room near the kitchens. There were eight hearths and a number of large pots, but there was no food residue. Instead, they found traces of poppy along with heliotrope, chamomile, and other herbs known to be used in medicines. Was this one of the world's first drug manufacturing sites?

The plant at the center of this ancient attention was a particular strain of poppy. The seed pods, especially the sap in their outer walls, had effects that were so powerful, so healing, that it seemed almost supernatural. A terra-cotta statuette found on Crete and dated back more than three thousand years shows a goddess with headdress adorned with pods of poppy, incised exactly as the pods are cut today to harvest the sap. "The goddess appears to be in a state of torpor induced by opium," wrote one Greek historian. "She is in ecstasy, pleasure being manifested on her face, doubtless caused by the beautiful visions aroused in her imagination by the action of the drug." Some archaeologists have proposed that the room in which this goddess was found was used by Minoans for inhaling the vapors of dried poppy sap.

The Greeks associated the plant with their gods for sleep (Hypnos), night (Nyx), and death (Thanatos), and put its image on coins, vases, jewelry, and tombstones. In myths, the goddess Demeter was said to have used poppies to soothe the pain of losing her kidnapped daughter, Persephone. The ancient poet Hesiod wrote eight centuries before Christ of a town near Corinth in Greece called Mekonê, which translates roughly as "Poppy Town," which some historians believe got its name from the extensive poppy farms that surrounded it. Homer mentions the plant in the Iliad, and in the Odyssey he tells the story of Helen making a sleeping potion, assumed by many to include poppy sap. Hippocrates mentioned poppy frequently as an ingredient in medicines. It was part of temple rituals, carved into statues, and painted on tomb walls. Dried and eaten or smoked, it was early man's strongest, most soothing medicine. Today it is among the most controversial. It is the most important drug humans have ever found.

IN A WA Y it's amazing that early humans ever discovered any natural drugs at all. Consider that 95 percent of the three-hundred-thousand-odd plant species on Earth are inedible by humans. Go out and start randomly munching the greens in your local woods, and the odds are twenty to one that you'll double over, throw up, or die. Among those few plants that are digestible, the chance of finding useful medicine is close to zero.

Yet our ancestors did it. Through trial and error, inspiration, and observation, prehistoric peoples around the world slowly found and built a store of herbal medicines. Early healers were locavores, using what grew close to home; in Northern Europe effective herbs included mandrake root (for just about anything from stomach problems to coughs to sleeping problems), black hellebore (a strong laxative), henbane (to allay pain and ease sleep), and belladonna (for sleep and eye problems). Other early drugs, like cannabis, traveled on trading routes from points south and east. Many spices eagerly sought from traders in the Middle East and Asia, such as cinnamon and pepper, were used as medicines as much as seasonings. Early healers knew not only what their local herbs were but how to use them. A Greek physician in Nero's army in the first century, Pedanius Dioscorides, summarized what was known at the time in his multi-volume De Materia Medica, one of the earliest and most important guides to drugs. In addition to listing hundreds of herbs and their effects, he described their preparation and recommended doses. Plant leaves could be dried, crushed, and added to potions brewed over slow fires; roots could be harvested, cleaned, smashed into pastes, or eaten fresh. Some could be mixed with wine, others with water. Medicines could be swallowed, drunk, inhaled, rubbed on the skin, or inserted as suppositories. Dioscorides' work guided the use of drugs in medicine for more than one thousand years.

He described the poppy, summarized its effects, and outlined its dangers: "A little of it," he wrote in De Materia Medica, "is a pain-easer, a sleep-causer, and a digester, helping coughs and abdominal cavity afflictions. Taken as a drink too often it hurts (making men lethargic) and it kills. It is helpful for aches, sprinkled on with rosaceum; and for pain in the ears dropped in them with oil of almonds, saffron, and myrrh. For inflammation of the eyes it is used with a roasted egg yolk and saffron, and for erysipela and wounds with vinegar; but for gout with women's milk and saffron. Put up with the finger as a suppository it causes sleep."

The plant and its magical juice accrued many names as it traveled from culture to culture, from the ancient Sumerian for "joy plant" to the Chinese ya pian (from which we derived the expression "having a yen" for a drug). The Greek word for juice is opion, which gives us today's word for the raw drug made from the poppy: opium.

You can't get it from just any poppy. There are twenty-eight species of poppy, members of the genus Papaver, on Earth. Most of them are showy wildf lowers that don't produce more than a trace of opium. Only two of the twenty-eight make appreciable amounts of drug, and only one of these grows easily, suffers few pests, and doesn't require much irrigation. Its scientific name is Papaver somniferum (somniferum comes from Somnus, the Roman god of sleep).

This single plant, the opium poppy, still provides the world with almost all of its natural opium.

Researchers today debate whether this particular poppy was always so opium-rich, or whether early humans cultivated and bred it specifically to boost the amount of drug. Whichever, by ten thousand years ago it was being grown in much the same way that it is today, and its medicine was being processed pretty much the same way.

Two thousand years ago, Dioscorides described how to gather the juice. It's remarkably simple: After a brief flowering, the poppy petals fall off. Within a few days the plant produces a waxy green seed pod that grows to the size of a hen's egg. Harvesters watch closely as the pod starts drying to a dull brown, and at the right moment they make a series of shallow cuts into its skin. These cuts weep the juice that contains the magic. The sap produced in the skin of the pod is where the drug is most concentrated (poppy seeds, used widely in baking and flavoring, contain very little opium).

Fresh poppy juice is watery, whitish, cloudy, and almost entirely inactive. But after exposure to the air for a few hours it turns into a brown, sticky residue that looks something like a cross between shoe polish and honey. That is when its medicinal powers are freed. It is scraped off the pod and formed into sticky little cakes, the cakes are boiled to remove impurities, and the resulting liquid is evaporated. The solid that's left, raw opium, is rolled into balls. And those dark, gummy balls changed history. Drugs before the nineteenth century were more than just bundles of herbs drying in the back rooms of witches, medicine men, and priests. They were processed and combined in ways part therapeutic, part magical — boiled into brews and elixirs, shaped into pills, mixed with everything from mummy dust and unicorn horn to powdered pearls and dried tigers' droppings, formed into elaborate concoctions for wealthy patients.

Opium was a prize ingredient. It could be dissolved in wine or blended into mixtures with other ingredients. It worked no matter how you took it — orally, nasally, rectally, smoked, drunk, or swallowed as a solid. One method might be a little faster than another, but no matter how it was delivered, it had the same range of effects, from making users sleepy and dreamy to killing their pain.

Most important — a sort of heavenly bonus — it made patients happy. It raised their spirits. It was more than a medicine; it was a doorway to pleasure. As one historian put it, "Opium was appealing because it always soothed the body while romancing the imagination. ... Psychic and physical discomfort was replaced with hope and a halcyon calm." This was a truly seductive package of effects: a respite from pain, a feeling of well-being, a sense of exhilaration, an invitation to dream. Early users and caregivers often employed the same word to describe its effects: euphoria. Opium made it possible to bear the pain of disease and injury and at the same time to deeply rest. It was a perfect tool for early physicians (as long as it was used carefully; early healers, too, knew that too much could easily ferry patients from sleep to death).

It's no wonder the use of the drug spread across time through the Middle East and the Western World, from the Sumerians to the Assyrians to the Babylonians to the Egyptians, and from Egypt to Greece, Rome, and Western Europe. The best opium in the ancient world was said to come from the area around Thebes; one Egyptian medical text records its use in some seven hundred different medicines. The armies of Alexander the Great carried it with them as they conquered their way from Greece to Egypt to India, introducing it to local populations as they went. Poppy flowers became symbols of sleep both temporary and permanent, associated with the gods of slumber, dreams, and transformation, marking the passage from life to death.

The poppy's association with death was more than poetic. As early as the third century BCE, Greek physicians were already keenly aware that opium could be as dangerous as it was euphoric, and they debated whether the value of the medicine was worth the cost to patients. The Greeks worried about overdosing patients; they also realized that once patients started using opium, it was difficult to get them to stop. They wrote the first descriptions of addiction.

But the dangers of opium seemed far outweighed by its benefits. By the time Rome ruled the world in the first and second centuries CE, opium was said to be as widely consumed as wine and was sold on Roman streets in the form of poppy cakes — unbaked, malleable sweets made of opium, sugar, eggs, honey, f lour, and fruit juice — used to lift the spirits and ease the minor aches and pains of the populace. Emperor Marcus Aurelius was said to take opium to help him sleep; the poet Ovid was also reputed to be a user.

After the Roman Empire's fall, opium found new markets thanks to Arab traders and merchants, who made the substance — lightweight, easy to transport, and worth its weight in gold for the right buyers — a standard part of caravan freight, spreading its use through India, China, and North Africa. One of the greatest of all Arab physicians, Ibn Sina (called Avicenna in the West), wrote around 1000 CE that opium is one of Allah's signal gifts for which he should be thanked every day. He very carefully described its many beneficial uses as well as its dangers, such as its ability to cause memory and reasoning problems, its constipating effects, and the dangers of overdose. Ibn Sina himself had seen a patient die from the rectal administration of too much opium. This great healer's thousand-year-old conclusion about opium sounds very much like the attitudes of today. "Physicians should be able to predict the duration and severity of pain and patient's tolerance and then weigh the risks and benefits of opium administration," he wrote, advising its use only as a last resort, and then recommending that physicians use as little as possible. It is likely that Avicenna was himself an early opium addict.

He and other Arab physicians worked it into cakes, infusions, poultices, plasters, suppositories, ointments, and liquids. Arab physicians of the Middle Ages were the world's best medicine-makers, greatly expanding the art of drug-making by developing the use of filtration, distillation, sublimation, and crystallization, all part of a practice they called "al-chemie" (thought to be derived from the word khem, for Egypt, thus, roughly, "the Egyptian science"). The basic idea of alchemy, as it became known in the West, was to work with nature's raw materials to bring them to perfection, to help natural things evolve from their rough, raw states into more refined, more pure forms — to release their pure, inner spirits (this idea is embed- ded in our language: The alchemical distillation of wines and beers released the powerful liquors we still call "spirits"). Alchemy was at the same time a method of making useful items like medicines and perfumes, an exploration of the natural world, and an almost religious pursuit of the soul in all things.

Ancient Islamic writings made it clear that while opium could do great things, it could also enslave its users. Manuscripts also include descriptions of opium addicts, with their dangerous illusions, sluggishness, laziness, and diminished mental powers. "It turns a lion into a beetle," one writer warned, "makes a proud man a coward and a healthy man sick."

European use of opium declined after the fall of Rome, then grew again as soldiers trekking home from the Crusades brought the drug back with them from the Holy Land. By the sixteenth century it was being used from Italy to England to treat everything from ague, cholera, and hysteria to gout, itches, and toothaches.

Among its boosters was one of the strangest and most fascinating figures in medical history, a Swiss alchemist and revolutionary healer with the impressive name of Philippus Aureolus Theophrastus Bombastus von Hohenheim. Today he is better known as Paracelsus. He was a one-of-a-kind medical genius, part rebel, part con man, a bit mystical, a bit mad, a larger-than-life figure who trekked from town to town across Europe with his bags of remedies and instruments, carrying a huge sword with a pommel said to hold the Elixir of Life. He would come to a town, talk to the locals, hawk his skills, heal the sick, argue heretical new theories, pick up tips from local healers, and rail against the entrenched medicine of his time. "In my time there were no doctors who could cure a toothache, never mind severe diseases," he wrote. "I sought widely the certain and experienced knowledge of the art [of medicine]. I did not seek it from only learned doctors: I also enquired of shearers, barbers, wise men and women, exorcisers, alchemists, monks, the noblemen and the humble people." He listened, he argued, he learned, and he applied the best ideas to his patients.

Along the way he penned several books, most of which were not published until after his death. These were written in a style that one historian called "very difficult to read and more difficult to understand," a mish-mosh of fantastic alchemical symbols and magical allusions, astrological references and Christian mysticism, medical recipes, divine inspirations, and philosophical ruminations. But underneath much of it lay a core of breakthrough ideas in medicine.