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Des sources du savoir aux médicaments du futur

Jacques Fleurentin
Jean-Marie Pelt
Guy Mazars

1. Origine des pharmacopées traditionnelles

Pharmacopoeias of the Ancient Near-East

Guy Mazars


The oldest documents in the world relating to pharmacology are those inherited from the Civilisations of the Ancient Near-East, Egypt and especially Mesopotamia. These documents not only provide lists of remedies, but also valuable information about the preparation of these remedies and the way of using them. According to a widespread opinion, these pharmacopoeias in outline, like all those of Antiquity, have most probably been set up empirically. As the need to find food led men to tasting the plants they found in their environment, they realised that stomach ache disappeared when they chewed specific plants, others offered relief from fatigue or pain, still others caused death. Consequently, they came to identify and transmit over generations the majority of medicinal plants and poisons. But this interpretation does not shed any light on the selection procedure applying to the plants in relation to specific purposes. The examination of the textual resources discovered by the archaeologists shows that the plants were already perceived in relation to cultural references, with systems to match them with other items in the cultural setting influencing the decisions made.

Texte intégral

1The Fourth European Conference on Ethnopharmacology focussed on the questions relating to the origins of the pharmacopoeias, the way they were set up transmitted. Thanks to the research carried out by specialists in prehistory, in particular in paleopathology, we now have valuable information about which diseases affected our ancestors and even about a range of the remedies they used in those times. Results suggest that prehistoric men already had rather good knowledge of their environment.

2However, research has not supplied yet so much information about the way the substances used were identified as potential remedies or the conditions in which the pharmacopoeias contemporary with the oldest written documents brought to light by archaeologists have been developed and set up. The studies carried out by the historians, philologists, and specialists in Antiquity show that, from the very beginning of historical time, therapists prescribed many remedies whose formula were transmitted over ages. On the basis of their composition, we also understand that many of these drugs had indeed efficacy when used as they were manufactured with natural substances whose effect on our body has been evidenced in the mean time.

Medical documents of the Ancient Middle East

3The oldest documents in the world relating to pharmacology date back to the Ancient Near East Antique, Egypt and, in particular Mesopotamia. We have information about the amount of knowledge and the kind of medical practices these civilizations had from various sources, in particular specialized literature.

4Very few Egyptian medical texts have been preserved, mostly because of the fragility of the medium used by the scribes. The texts were drafted in hieratic writing and copied on sheets of papyrus (Cyperus papyrus L). Hieratic is a cursive script composed of simplified hieroglyphs used for the texts written on the flexible material or pieces of pottery (ostraca) used for drafts. Among the most significant papyri preserved, we can mention the Edwin-Smith papyrus and the Ebers papyrus. The former one was discovered in Thebes in 1862; it dates back to the end of the 12th dynasty (about 1 780 B.C.) and could be a duplicate of a treatise written at the time of the Old Empire (between 2800 and 2400 B.C.). It mostly deals with surgery (Breasted, 1930). The latter document was bought by the German Egyptologist Georg Ebers in 1873; it dates back to the beginning of the 18th dynasty (c. 1580 B.C.). and is also probably just a duplicate of older documents. When it was discovered, it had the form of a band of over 20 meters in length and 30 centimetres in width, comprising 108 written pages. It is a kind of medical encyclopaedia divided in 877 paragraphs containing several hundreds of remedies against all kinds of affections (Bryan, 1930). These two treatises have been published and translated and submitted to extensive investigation (Bardinet, 1995; Breasted, 1930; Bryan, 1930; Grapow, 1954-1962; Leca, 1971).

5The Hearst papyrus is another text from the 18th dynasty interesting for the study of the Egyptian pharmacopoeia; it is a collection of 260 medical recipes. It is probably somewhat more recent than the Ebers papyrus as it offers a copy of 96 of its recipes (Leca, 1971, 30). The Berlin papyrus no. 3038, presumably dating back to the 19th dynasty (1320-1200 B. C.) also offers recipes for remedies (Leca, 1971, 31). Among the other manuscripts that have been preserved, we can mention the Chester Beatty papyrus, a fragmentary document of unknown origin containing some prescriptions (Jonckheere, 1947).

6The documentation from Mesopotamia is much more extensive as it was preserved in good condition on clay tablets offering better protection against the damage of time. Hundreds of Sumerian and Akkadian tablets were discovered by archaeologists; they supply a wealth of information on medical knowledge in those ancient times. The texts are written in cuneiform script; they were inscribed between the third and the first millennium before Christ. The examination of these documents shows that doctors already existed in Mesopotamia in the third millennium B. C., and they had an extensive knowledge of the curative powers of many plants and substances of origins mineral and animal (Biggs, 1990). The assyrio- logists classify this documents into three categories: lists and repertories, forms and collections of therapeutic regulations (Herreo, 1984, 16-22). All these documents provide, not only lists of remedies, but also valuable information about the preparation of these remedies and the way they could be used. But they do not provide any systematic presentation of medical knowledge. They are rather a kind of memoranda which "could be used for teaching and training purposes on the basis on daily practice and the comments given orally by the Master" (Herrero, 1984, 16). Many of them have been published (Köcher, 1963-1980).

7A Sumerian text dating back to the 22nd century B. C. supplies an information of great interest on the process applied to manufacture various simples and compounds. The ingredients and the mode of preparation are mentioned for each of these drugs, with details on the various operations to be carried out (desiccation, purification, extraction, cooking, filtering, etc). However, this collection of recipes does not contain any indication concerning the affections targeted by the various preparations. In addition, all the ingredients have not been identified. Nevertheless, those which have been identified testify to the great interest of Sumerians for the odoriferous principles contained in plants. We also have some Akkadian texts on perfumes and bilingual glossaries with the terms used in Sumerian and Akkadian as names for these plants. In these documents, the plants are sorted in various categories, not according to their morphology, but rather according to their use, in particular medical.

8The medical texts are not the only sources available. Some interesting information is found in literary and legal texts on doctors and their practice. We have also letters written by Mesopotamian doctors giving information about the medical trade. The Royal Archives in Mari (on River Euphrates) hold numerous documents of this kind.

9Most of them date back to the time of Zimrilim, the last king of Mari who reigned from 1775 to 1760 B. C. (Herreo, 1984, 13-15). The archaeological excavations carried out in Egypt have also brought to light correspondences on papyrus and ostraca, steles and other monuments with inscriptions supplementing the medical literature. Containers still holding some content that could be submitted to chemical analysis help scientists to establish which material was used for beauty care or therapeutic purposes (Leca, 1971, 38-41 ).

Between magic and empiricism

10Many people, in particular in scientific circles, are still convinced that medicine developed in several stages, from magic to empiricism, until modern medicine emerged. Jean Bernard, for example, writes that "Four periods can be identified in the history of medicine. First there was magic. Human destiny belongs to the gods and the diseases belong to destiny. The second period is inaugurated by Hippocrates (5th century B. C.) and introduces the observation of symptoms. It endures up to the 19th century. Medicine is ineffective. There is no great difference between the capacity, or rather the absence of capacity, of doctors at the time of Hippocrates, and the capacity, or rather the absence of capacity, of doctors of the beginning of the 19th century. The third period is very short: it covers the six glorious years from 1859 to 1865, with Charles Darwin, Claude Bernard, Louis Pasteur, Gregor Mendel. These six years have changed the fate of man more deeply than all the wars and battles cluttering history books of history ever did. They offered to mankind vaccination, the emergence of modern surgery and obstetrics. However, paradoxically, they had for a long time but little influence on the ways and fashions to cure diseases. The fourth period, the therapeutic one, began in 1936 with the discovery of sulfamides... But this kind medicine, at long last somewhat effective, was still rather empirical. And now, at the end of the 20th century, the fifth period - the rational one - has just started. 20th-century medicine will be quite different from the medicine of ancient times as it will be strictly governed by rigour" (Bernard, 1996, 7-8).

11It is about a a little simplistic vision of the history of medicine. Actually, historians and philologists specialists in civilizations of Antiquity know for a long time that empiricism and the magic coexisted as of the most moved back times. They continue to still coexist today. Like extremely precisely the assyriologist Jean Bottéro writes it: perhaps "Nowadays, to see, on a side the persistence of the religious feeling and belief in a supernatural world, whatever it is, and other, in very an other direction, the success of deliberately irrational, if not absurd and inept methods curative, one will think that, in the content, the things did not change so much since the Babylon antique..." (Bottero, 1992, 224).

12In fact, as René Labat mentioned in 1966, the medical treatment of illness in ancient Mesopotamia, far from depending only on magic, relied on two perfectly distinct methods: that of the exorcist (âsipu) and that of the doctor proper (asu) (Labat, 1966, 90). Some documents make it also clear that "the asu prevails over the asipu and the magician never intervenes if the doctor fails, whereas the latter can intervene if his colleague has done so" (Herrero, 1984, 23).

13The letters written by doctors or relating to doctors, not only provide information about their travels or their private life, but are also invaluable documents on their notion of their own science and the nature of the treatment which provide to their patients. Medicine is always presented as a purely objective and human science. The documents, on the one hand, refer to a clinical examination of the patient, and on the other hand, to the use of bandages, cataplasms, lotions, ointments, potions and massages. Nowhere is any mention of the use of magic or any reference to the divine to be found (Labat, 1966, 90).

14These letters, according to Labat, are also of great value as "due to long period of time they cover, they shed light on a problem which could hardly be elucidated on the sole basis of the professional texts. It has been widely assumed that magic was the most ancient form of medicine and rational concepts appeared only gradually, at a rather late time. Now the oldest letters show that, as early as early Babylonian time, natural medicine existed with a spirit and methods of its own, independently of magic" (Labat, 1966, 91).

Testified knowledge

15Many of our medicinal plants were already known to Egyptians and Mesopotamians. Moreover, we owe a large part of our knowledge to the Arabs and the Greek who had received them from the people of the Ancient Middle East, as is confirmed by phytonymy. In this respect, Wallis Budge points out the contribution of the assyriologist Campbell Thompson who showed that many plant names derived from Sumerian via Arabic and Greek: asa foetida, colocynth, carob, cumin, myrrh, mandrake, sesame, cypress, lupine... (Budge, 1978, 43).

16Among the vegetable species or parts of plants mentioned in the papyruses, we find in particular acacia (Acacia nilotica Del.), aloe (Aloe vera L.), asa foetida (Assa foetida Regel), bryony (Bryonia dioica Jacq.), carob tree (Ceratonia siliqua L.), celery (Celery graveolens L.), hemp (Cannabis sativa L.), colocynth (Citrullus colocynthis Schrad.), coriander (Coriandrum sativum L.), cumin (Cumimum cyminum L.), the date palm tree (Phoenix dactylifera L.), ebony (Dyospyros ebenum Koenig), frank incense (Boswellia carterii Birdw.), fennel (Anethum foeniculum L.), the fig tree (Ficus carica L.), juniper (Juniperus phoenica L.), ammoniac gum (Dorema ammoniacum Don.), pomgranate (Punica granatum L.), hellebore (Helleborus sp.), ground rush (Juncus sp.), hyosciamus (Hyoscyamus niger L.), lotus (Nymphea lotus L.), melilot (Melilotus officinalis L.), melon (Cucumis melon L.), myrrh (Commiphora myrrha Engl.), onion (Allium cepa L.) (watermelon (Citrullus vulgaris Schrad.), the pine tree (Pinus pinea L.), potamogeton (Potamogeton lucens L.), the castoroil plant (Ricinus communis L.), reed (Arundo donax L.), nut grass (Cyperus esculentus L.), styrax (Liquidambar orientals Mill.), sycamore (Acer pseudoplatanus L.), terebinth (Pistacia terebinthus L.), vine (Vitis vinifera L.).

17In the chapter in the Ebers Papyrus devoted to the diseases affecting the eyes, for example, acacia (Acacia nilotica Del.) appears in a recipe meant to cure eyelid inflammation (Ebers no. 415) and also in a recipe to cure trachoma (Ebers no. 383). The therapeutic activity has been attributed to the active ingredients contained in acacia leaves and endowing them with disinfectant, astringent and anti-haemorragic properties. Aloe (Aloe vera L.) appears in the first recipe too. The thickened leaf juice contains anthracene derivatives, the main one being aloine (Paris and Moyse, 1981, 57), and traces of essential oils. The doctors of Ancient Egypt incorporated it into eye lotions against blepharitis and sties (Ebers no. 355, 423).

18The Mesopotamian tablets testify to the use of several hundreds of plants or vegetable substances. Over one thousand names of medicinal plants have been recorded. However, as many of these names are just synonyms, the number of species actually used in medicine is probably close to 300, of which many have not been identified yet. They are used as ingredients in more or less complex drug recipes, in various forms: powder, potion, lotion, ointment, balm, pill, suppository... Manufacturing them required much handling and several operations which can classified in four categories: the operations prior to cooking, the cooking operations proper, the operations for cooling, the operations common to the three preceding tasks (Herrero, 1984, 61-86).

19The lists in the first set of tablets are written in two columns. One column contains the names of the plants. The other one provides various information about these plants: synonyms, denominations in other languages (which proves that contacts and exchanges were common), and sometimes a short description and comments about curative powers (Herrero, 1984, 16).

20The repertories that have come down to us provide even more information for a better knowledge of Mesopotamians. They are like medical abridged guides with information organised in three columns. The first column is a list of the names of plants. Sometimes, there is also some information about the part of the plant and the species to be used (e.g. murru sha shadi, "mountain myrrh". Next to these details, the document also offers information concerning the methods for the gathering (eg. ashâgi sha ina nasâhika shamshu the îmur "ashâgu root that the sun should not see when you tear off"). The second column is a list of the diseases for which these plants can be used as remedies. The last column specifies briefly the form of preparation and the mode of administration corresponding to the various remedies. Instructions are given by verbs either in the infinitive ("to crush, to mix, to dry...") or in the future tense and the thou form ("thou wilt extract its juice..."). There is sometimes an indication of the excipient (honey, milk, vegetable oil), the form for administration (potion, suppository), the dosage, the contraindications... (Herrero, 1984, 17-18).

21The forms that have come down to us have probably been used as memoranda for the practitioners. They are lists of substances drawn from the three natural kingdoms, with the names of the diseases for which they can be prescribed (Herrero, 1984, 20-21).

22The third set of documents is most valuable, due to the number of texts and the variety and interest of the knowledge contained. They have the form of collections of therapeutic prescriptions distributed in most cases in three main categories. The first part is a list of the symptoms displayed by the patient with, in some cases, the diagnosis corresponding to these symptoms. The second part suggests a treatment, identifying the ingredients to be used, the way to prepare them to prepare a remedy and the mode of administration for this remedy. The third part - which is always very short - is devoted to the prognosis (Herrero, 1984, 21-22).

23The existence of these repertories and these collections, the wealth of information, its compactness and accuracy, proves that Mesopotamians enjoyed a great sense of observation and were keen to classify.

Origin, development and transmission of knowledge

24The oldest tablets and pharmacopoeia that they expose are so specific and detailed that they seem to be in the line of a long tradition (Labat, 1966, 91). The Ebers Papyrus refers indeed to former writings (Ebers no. 856a). Medical traditions might have developed a long time before the invention of writing and be transmitted orally from generation to generation before being recorded in written form.

25How was knowledge built up and transmitted? All the documents of Antiquity addressing the issue of the origins of medical knowledge give the same answer: this knowledge is a gift of the gods who revealed it to mankind in various ways, directly or via more or less legendary characters, demigods and prophets, in dreams or in a trance. The interpretation of dreams has indeed played a major role with Babylonians as a way to acquire knowledge.

26Thus, the Egyptian texts touching upon the origin of medicine make it clear that knowledge was revealed and then offered to men by the gods. The medical handbooks are supposed to have been passed on to men by Thot, the doctor and magician of the gods, a god that the Greeks later equated with Hermes. At the beginning of a section in the Ebers papyrus, we can read that it was found under the feet of god Anubis and taken to a Pharaoh of the 1st dynasty.

27In Mesopotamia too, medicine was regarded as a gift of the gods. The medical school in Nippur, for example, claimed patronage of the goddess Gula: "some masters claimed that their dogmas has been transmitted to them orally by wise men, the holders of secrets more ancient than the Flood" (Sendrail, 1980, 22). Among the divinities having a medical role, the sun-god Shamash is also prominent.

28The historians of pharmacy have made another assumption. According to a very common opinion, these draft pharmacopoeias, just like all those in Ancient times, have been set up in an empirical way. As men were driven by the need to find food, they tasted the plants found in their environment and they realised that stomach ache stopped when they chewed specific plants while other plants offered relief from tiredness or pain and others could be lethal. This might have been the way a majority of medicinal plants were selected and poisons identified and this knowledge was passed on across generations.

29However, such an explanation does not shed light on the effective process for a selection of plants for specific purposes. A close examination of the texts discovered by the archaeologists shows that the plants were already evaluated according to cultural standards and systems of correspondences with other cultural factors, which might have influenced the selection process. Mesopotamians reasoned by analogy, sometimes by induction and deduction. Various clues indicate that the Mesopotamians and the Egyptians carried out experiments on prisoners or slaves. Other peoples did that too. In India, a Buddhist text reports on therapeutic testing carried out at the time of King Ashoka (264-227 B. C.) (Mitra, 1974, 57-59).

30There is little doubt that people had come to observe and notice the behaviour of sick animals. Various documents dating back to Antiquity refer to that. The example of the shepherd Melampus has been frequently cited; according to Theophrastus (327-287 B. C.) Melampus had discovered the purgative properties of hellebore after observing the effect it had on his goats. Much older Sanskrit texts report about several animals that know about the plants having curative power (Mazars, 1994, 433). But the Mesopotamians might have been first to develop an interest in the manners of wild or domestic animals. We have extensive evidence of that. René Labat says that the kings of Ashur and Nineveh "went to great lengths to create vast zoological gardens in the gardens of their palace. The soothsayers endeavoured to study with great care the manners of wild and domestic animals to derive predictions from them" (Labat, 1966, 89). As Marguerite Rutten put it (1960), they were undoubtedly "researchers": Their "sacred science" held in it self all the seeds of knowledge and, after spreading in the Greek world, it opened the way for the discoveries of modern Times (Rutten, 1960, 125).

31Finally, the Egyptians and Mesopotamians might have received a part of their knowledge from the peoples with whom they had been in contact. We have evidence of the borrowings with the presence of exotic plants in the pharmacopoeias. Mésopotamia had connections with the Indian sub-continent at the time of the so-called "Indus Valley" civilisation (Kühne, 1976, 99-103; Francke-Vogt, 1995, 340). The vestiges of this civilization (Mackay, 1936; Wheeler, 1953; Piggott, 1962) testify to the existence of a civilization in India that had attained such a high degree of development as early as the third millennium before our era that we have good reasons to think that medicine was well advanced there too (Mazars, 1991, 2). The cities in the Indus valley are known to have maintained commercial ties with Mésopotamia as is proven by the discoveries made in Ur, Susah or Kish in the strata corresponding to the third millennium before Christ, with seals (Gadd, 1932) and other objects originating from the Indus area, a region known under the name of Meluhha in the Mesopotamian tablets (Gelb, 1970; Heimpel, 1993). This trade might have been the medium for an exchange between the two civilisations, if not for scientific concepts or theories, then at least for practical knowledge and medical recipes.


32In way of conclusion, what do written sources tell us relating to the pharmacopoeias in the Ancient Middle East?

33First, the texts that have come down to us are among the oldest writings produced by human beings. But they are not the first ever "pharmacopoeias" as they explicitly refer to even older documents. They represent the final stage of an ancient tradition that had been transmitted orally across several generations. They testify to a knowledge that was already well established and might have merged even before the first writings were created. This knowledge might have been elaborated in the course of centuries after the beginning of the settling process in the Middle East and be enriched when in contact with other peoples.

34These texts, in particular those from Mesopotamia, are "scholarly" treatises, remarkable by their rational character, the scientific rigour that pervades them and which the specialists have observed. Unfortunately, this vast literature, for various reasons, has not been the subject of thorough investigation yet.

35We have much information about what the Arabs and the Greeks owe to the Egyptians and the Mesopotamians concerning science (Levey, 1973, 1-10), but we are much scantier knowledge about the scientific exchanges between the Ancient Middle East and other civilizations, between the third and the second millennium before our era. There is indeed extensive documentation, but it is not so easy to have access to it. It is practically non-existent for the peoples without writing system. Consequently, it would be probably be very profitable, for example, to investigate for traces of Egyptian influences in the African traditional pharmacopoeias.

36Our understanding of the knowledge accumulated by the civilizations of the Ancient Middle East Antique is still far from satisfactory. We may hope to bridge part of the gap if we accept to re-examine existing documentation, try to have a better understanding of these texts and engage in new comparative studies.



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