by Lucy Inglis
Further proof of Egypt’s full adoption of the opium poppy in the Bronze Age is offered by the Ebers Papyrus, which dates from c.1552 BC. It was discovered by notorious American tomb raider Edwin Smith, who lived in Egypt in the latter half of the nineteenth century. Smith allegedly removed the papyrus from between the legs of an unknown mummy and sold it to German egyptologist Georg Moritz Ebers, from whom it takes its name, in the winter of 1873–4. The Ebers Papyrus is most famous for its instructions to dose infants with opium: ‘Remedy to stop a crying child: Pods of poppy plant, fly dirt which is on the wall, make it into one, strain, and take it for four days, it acts at once.’45
It is, at best, a contradictory recipe, yet its cavalier administration to small children reveals the humdrum reality that opium use had already attained.
The Graeco-Roman Empires
Opium is the Latin derivation of the Greek ópion, meaning ‘poppy juice’, although poppy preparations were commonly known as mēkōnion, referring to Mekones, now Kyllene, where according to legend Demeter – the Greek mother goddess of earth and renewal – first discovered poppies.46 The opium poppy was sacred to Demeter, as it was to her Roman equivalent Ceres, and they are often depicted holding wheat in one hand and poppies in the other. Incarnations of Demeter and her daughter Persephone are all part of the ancient European mother-goddess tradition, deeply associated with health and renewal, and with life and death. In Greek mythology, the poppy was also associated with Nyx, the goddess of night, Hypnos, the god of sleep, Morpheus, the god of dreams, and Thanatos, the god of death.47
With the rise of the Greek and Roman empires, society moved to a more patriarchal, warlike model. These new societies, with their increased wealth, sophistication and urban way of life, brought about an equivalent rise in art and science. The Greek poet Homer’s works were composed sometime between 1100 and 800 BC at the beginning of the period when ancient Greece and Rome began their rise to prominence. Both his great epic poems, the Iliad and the Odyssey, include references to the poppy, although the latter is of most interest.
The Odyssey continues the story of the Iliad, after the fall of Troy, and features Helen presented with a drug, believed to be opium or possibly an opium/hashish mixture, by Polydamna of Egypt: nepenthe. Homer describes Egypt as a place where ‘the earth, the giver of grain, bears greatest store of drugs, many that are healing when mixed, and many that are baneful’. To help his friends forget the loss of Odysseus, Helen ‘cast into the wine of which they were drinking a drug, to quiet all pain and strife, and to bring forgetfulness of every evil’.48
Helen’s role as the bringer of both wine, and relief, in the form of opium, and Polydamna’s knowledge of medicines are typically feminine attributes in classical mythology: a subtle thing, passed between women. Diodorus Siculus, Greek historian, noted of nepenthe that ‘from ancient times only the women of Diospolis in Egypt were said to have found a drug against anger and grief’.49
Homeric references to the opium poppy are concerned with the need for emotional oblivion, but Greek scholars were also discovering its many medicinal properties. One of the outstanding early scholars was Hippocrates. Born c.460 BC in Cos, he is often referred to as the father of Western medicine. Around sixty medical works survive that are associated with him, although it is impossible to know for certain how many of them he actually wrote. The most famous, his Hippocratic oath, included injunctions against unskilled surgery, interfering with the ‘tender fruit’ in a mother’s womb, and bringing early death, even to those who ‘beg for it in anguish’.50 The Hippocratic oath has been reworked enough times for it to be little use as a set of rules for doctors to follow, but it established a holistic way of looking at illness and the patient, and the collected works are a fascinating look at the foundation of early medicine. Hippocrates and his followers, for instance, used questions that led to an understanding of the patient’s pain to both diagnose and monitor disease and injury, and the way that they did so was detailed and accurate. Hippocrates is also thought to be responsible for the ‘four humours’ theory of the human body: that it is made up of ‘blood, phlegm, black bile and yellow bile’.51 These humours correspond – with one extra, blood – to the three doshas in Ayurvedic medicine, one of the world’s oldest systems. When the humours or doshas are in balance, then the body will be in balance. The unfortunate downside of the humours theory is that bloodletting was the commonest method used to restore this balance, and became a mainstay of many physicians’ practices – one that would claim many thousands of lives over the coming centuries.
The Hippocratic texts show that ancient-Greek doctors knew much about what could go wrong with the body, but they often didn’t know why, and their associated pharmacology is therefore often more than a little awry. For instance, the womb was increasingly considered to be ‘an animal within an animal’, capable of determining its own actions and of ‘wandering’ within the body, although these symptoms were most likely indicative of postpartum stress or prolapse, uterine cancer or disease. Twenty-one of the twenty-five uses of opium in Hippocratic texts are gynaecological, and mainly for a wandering womb.52 While these conditions were no doubt painful and perhaps dangerous, it indicates that opium remained strongly associated with women and fertility.
However, opium was used for a variety of other conditions and especially to induce sleep. Aristotle himself wrote in his text On Sleeping, that ‘poppy, mandragora, wine, darnel, produce a heaviness in the head’.53 The number of early medical texts mentioning sleeplessness suggests insomnia is a timeless human disorder.
Another early mention of medicinal poppy use comes from Aristotle’s pupil Theophrastus. Theophrastus, author of Historia Plantarum (Enquiry into Plants) and On the Causes of Plants, is credited as the father of botany. Intriguingly, Theophrastus does not mention the opium poppy in such a way that would firmly identify it. He mentions poppy remedies, but these are not for the uses associated with opium. Instead, he discusses three types of poppy, all of which appear to be wild, including the alarmingly named ‘frothy poppy’ he recommends as a bowel purge.54 Theophrastus also mentions a rhizotomoi, or root-digger, who mixed hemlock and poppy to bring about a swift demise. The root-diggers were botanists, and an important social group in ancient Greek culture. Their knowledge of plants, and poisons in particular, was usually far superior to that of scholars. Perhaps Theophrastus was simply being cautious and adhering to the Hippocratic determination to prolong life. Or, he was avoiding the potentially awkward mention of the Keian Custom, a political hot potato at the time he was writing.
Keos, or Kea as it is now known, is an island in the Cyclades close to Attica, and by the time of Aristotle and Theophrastus had seceded from Athens. This put food supplies to the island under enormous pressure, but the population was healthy and long-lived. The Keians were a determined people, and when faced with this food shortage introduced a practical solution: upon turning sixty each citizen was to consider whether they were still of use to the state or not. If not, a small ceremony was performed, a wreath donned and a mixture of poppy latex, hemlock and wine downed from a ‘Keian Cup’, thus staying true to the Keian thinking of ‘Whoso cannot live well shall not live ill’.55 Emphasis in the accounts is upon the selfless willingness of the aged Keian to drink from the cup, with no small amount of theatre. Theophrastus was writing at a time when funerary rituals and customs were changing, partly due to the Greek desire to create laws for governing daily life and reinforcing social status.56 Accounts of the Keian suicides vary, mainly as to whether the custom was compulsory or not, but the introduction of condoned euthanasia did not sit well with Hippocratic thinking, and Aristotle too thought that suicide was unjust to society. Attitudes to old age and the place of the elderly in society were complex and varied in the ancient world, but the idea that older people had little to offer was a persistent one. The question of if there was a right time to die and, if so, when that time would be, and whether the state has any part in making that decision, was already
a thorny issue.
At the same time as Aristotle and Theophrastus were writing, and elderly Keians were allegedly holding suicide parties, the opium poppy began to appear on coins. Coinage began around the sixth century BC in what is now Turkey, and in 330 BC in Şuhut the Romans minted a coin depicting a wheat ear and a poppy head. Other coins from Şuhut depict a goddess holding wheat, poppies and flax, indicating the poppy’s status.57
The Roman coins of Şuhut coincided with the vast campaign of Alexander the Great (356–323 BC) sweeping across Asia. The Silk Roads already existed as a couple of thousand miles of caravan trading routes, although they wouldn’t start to carry large amounts of silk for another century. Alexander, another pupil of Aristotle, is often credited with introducing the opium poppy to Persia and India; what is far more likely is that with him he took supplies for his troops, then traded it and other goods during the campaign, rather than made any conscious decision regarding opium.
By the first century BC, the poppy featured on money, jewellery, in art and literature, and in homes and gardens across Europe and the Near East. The presence of the opium poppy in gardens is confirmed by the wonderful hortus conclusus, or garden room at the House of the Golden Bracelet at Pompeii. Painted across three walls is a stunning fresco that would have been open to the elements, featuring all sorts of plants, including roses, lavender and opium poppies, which were trained up a frame around the roses.58
Pliny the Elder – who, like the family of the House of the Golden Bracelet, was killed by the eruption of Vesuvius that destroyed Pompeii in AD 79 – made frequent mentions of opium in his myriad works. The majority of them are rather vague, but occasionally he focusses in detail on how to tell genuine opium from the fake product, such as trying to dissolve it, or heating it to appreciate the odour. He cites the use of opium to cure ‘bowels, snakebites, the stings of spiders, scorpions, etc.’, and also for the easing of dropsy.59 Pliny also warned against henbane, which he mentions in the same passage as the opium poppy, writing that it puts men out of their ‘right wits’, so people were still using henbane to counteract the problem of digesting opium without cramps or nausea.60 Pliny’s warnings are valid as henbane is a psychotropic, capable of inducing disturbing visions and the sensation of flying.
In contrast, the works of Pedanius Dioscorides offer a comprehensive account of the early uses of opium. A physician and botanist originating from Anatolia, Dioscorides was born around AD 40 in Anazarbus, near Tarsus, which was a seat of pharmacological studies. His five-volume De materia medica is the defining work of pharmacology of the Graeco-Roman period, and remained influential for the next 1,500 years. His purpose was clear:
Although many authors, old and new . . . have put together books on the preparation, testing and properties of drugs, I shall try to show you that my undertaking in this purpose is neither idle nor absurd, for some of my predecessors did not give a complete survey, while others took most of their information from written sources.61
Dioscorides was referring to the incestuous group of early physicians who interpreted and picked over each other’s works, rendering them all but incomprehensible. His work, however, was meticulous and wide-ranging. He did not rely only upon texts by other physicians, but also collected folklore remedies from oral traditions, one of which was that adding wormwood juice to ink would stop mice eating your manuscripts. Particularly important are his specific descriptions of medicines and complaints which make identifying the opium poppy and its applications far easier. Not for Dioscorides the vagueness of earlier authors’ descriptions of how to administer medications, but rather, ‘applied to the finger and used like a suppository, the latex induces sleep’.62 He was also aware of the difference between the horned poppy and the opium poppy, and that the horned poppy was used for the purposes of adulteration, by mixing it with gum or ‘juice of wild lettuce’ to look like opium latex.63
The stabilization of trade routes over Asia Minor and the Mediterranean – and the manner in which Dioscorides dispensed his advice – indicates that opium was readily available, and sold by herbalists who gathered together in dedicated quarters of larger towns and cities, such as off the Via Sacra in Rome, but Dioscorides drew a distinction between ‘shop-bought’ opium gum and poppies he had harvested himself. He also described in detail how to scarify the poppy head to obtain the opium latex:
after the dew-drops have become well dried [the] knife must be drawn round the crown without piercing the fruit within; then the capsules must be directly slit on the sides near the surface and opened lightly, the juice drop will come forth onto the finger sluggishly but will soon flow freely.64
Detailed instructions such as these, the myriad references throughout classical literature, and the archaeological evidence, all prove that people were becoming more aware of the way in which opium could be used, and the way it affected the body over time. Herbalists noticed that those treated with opium could develop a tolerance to the drug, and graphic warnings against overdosing began to appear, where patients would display ‘chilled extremities; their eyes do not open but are bound by their eyelids . . . and through the throat the laboured breath passes faint and chill’. Should this happen, the patient should be made to vomit and kept awake. Yet, despite all this, there was little mention of the dangers of long-term use.65
Galen of Pergamon (ad 129 to after 215) was Emperor Marcus Aurelius’ doctor, and the leading physician in Rome. Despite his blustering tones and occasionally suspect methodology, he adopted a pioneering stance on the crossroads between philosophy and medicine; between moral health and physical health. He was a keen observer of his surroundings, and subjects, and wrote extensively on his experience of dissection and vivisection.66 Galen’s On the Dissection of Living Animals has been lost, but he referred to it himself in his Anatomical Procedures, and gave demonstrations of how to effect paralysis, and performed trepanation in front of audiences.67 His subject of choice was ‘an ape’, thought now to be macaques or rhesus monkeys, which he chose for their rounded faces, as they were ‘most like humans beings’.68 Galen’s grisly work may seem like a barbaric sideline, but it is one that set the tone for medical and particularly surgical writing until the mid seventeenth century. In his rational observations of removing animals’ ribs while they are tied down to boards, their distress is not reported, even as their heart is laid bare, still beating. The potential for struggle is inferred from the levels of restraints required, rather than a description of suffering.69 This necessary separation between surgeon and subject is a pivotal moment in the history of medicine, and in the history of opiates.
Marcus Aurelius (AD 121–80) spent a decade on campaign, during which he wrote Meditations, dealing with the responsibilities of his role and the importance of duty and service. Galen dosed his star patient with detached precision. On an almost daily basis, he administered theriac (from the Greek word for treacle) to Aurelius, containing a number of different ingredients, including opium, although the ‘poppy-juice’ was removed from the compound when the emperor appeared to be ‘getting drowsy at his duties’. Without the opium, this drowsiness was replaced by insomnia.70 Theriac was a version of a ‘mithridate’ or universal antidote, allegedly created by Mithridates VI, king of Pontus, who feared poisoning to such an extent that he took a mixture of poisons each day, including opium, to make himself immune to them. Mithridate concoctions, some containing up to seventy ingredients, became almost compulsory among those in powerful positions until the Renaissance. On campaign on the Danube, Marcus Aurelius had to go without his theriac after a period of heavy use, and the nervous symptoms he displayed were those of a regular opiate user, ‘So,’ Galen noted, ‘he was obliged to have recourse again to the compound which contained poppy-juice, since this was now habitual with him.’71
The emperor is often cited as one of the earliest documented drug addicts, but addiction was a concept unknown in the ancient world. Galen’s enthusiastic endorsement of opium, and imperial associations, as well as his u
ndeniable success as a physician, meant that it became a popular and desirable medicine in Rome, bought from druggist-stalls at the market.72 The Roman appetite for both drugs and luxuries meant that most theriacs were exotic mixtures of genuine medicines and ingredients such as cinnamon and rare honeys. The spectrum of Roman life and ordinary medical knowledge is seen in the variety of people who supplied Galen with drugs or with recipes for cures. He credited those who gave him information, and some of them appear to have occupational links such as Celer the centurion with his cure for arthritis and tremors, and Paris the actor with an eye-watering recipe for hair removal, and a Bythian barber with a concoction for sciatica. Opium remedies included Flavius the boxer’s dysentery medicine, and acopon, or painkilling recipes, from Orion the hairdresser and Philoxenos the schoolmaster.73 A woman, Aquillia Secundilla, is credited with her recipe for lumbago.74
Even as Greek dreams of Troy were replaced by the bureaucratic realities of Rome, which thrived on taxation, war and trade, the Romans were feeling the curtailment of their boundaries. Hedged in by North Africa, seeing scant bounty to be had in the far north of Europe, they were instead looking east, back towards the Fertile Crescent, full of people, goods and money, all of which could be either sold or taxed. It was not a place without its perils. The Persians had proved mighty enemies, and the Arabs were deemed to be feral and dangerous. But the strategic trading stronghold of Byzantium was a prize that Rome had long eyed from afar.