At this point it is useful to mark an important transition of relevance to this podcast. In the first two episodes we discussed the concept of a “drug” and the challenges posed by using a modern-day medical understanding in the context of historical practice. We therefore adopted a “middle-ground” view that sought to be sensitive to the context in which various substances were used as curative agents in history. Whilst they might now be known to be ineffective, the iterative nature of growth in medical understanding demands an honest mention of such substances so that a fuller appreciation of developments in medicine can be attained. Moreover, we have several examples of substances used as medicines today that do not meet the strict definition of a drug. Some commercial, over-the-counter products and all homeopathic substances fall into this category.
Against this backdrop, a discussion by Winston Black in 2012 provides useful insights into changes in drug therapy in the latter part of the Middle Ages and moving onto the Renaissance. Black observes that the word ‘drug’ was not used until the very end of the Middle Ages to refer to medicine. He also provides the following insight:
Medieval pharmacy until the twelfth century was based on ‘simples’, single ingredients (herbs, spices, stones, animal parts) whose properties could be learned through apprenticeship or, for the literate, from ancient and early medieval herbals, like the seventh-century Alphabet of Galen. Recipes survive which call for multiple ingredients, but most cures were dependent on these simples, usually from local plants, well known and easily obtained.
What was new after ca. 1100 was the notion that a natural substance could be, and in fact should be, identified, collected, studied, modified, measured, and administered by professionals trained in the art of medicine or, later, pharmacy. The ingredients of drugs were still found in nature, like the old materia medica, but patients, physicians, and pharmacists came to expect these natural substances to be unlocked, and their secrets to be compounded, inhaled, applied, or injected for the purposes of healing or intoxication. This change in attitude can be seen in antidotaries, pharmaceutical texts providing recipes for compound medicines like theriac, which became popular after 1100, overshadowing though not replacing simple herbals in the Later Middle Ages. There is some scope for belief that contact with Islamic societies during the crusades (1095 – 1291) was a factor in these developments. And so, as we move from the end of the Medieval Period into the Renaissance, we see the embryonic stages of the development of scientific medical and pharmaceutical practice in the western world.