The-pharmaceutical-use-of-Lapis-Lazuli-in-the-Ancient-East-Dr-Christopher-J.-Duffin-Sutton-Surrey

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PHARMACET]TICAL

HISTORIAN

British Society for the History of Pharmacy

Q House, Troon Way Business Centre, Humberstone Lane,

Thurmaston, LEICESTER LE4 9HA

Vol. 44 No. 4

December 2AI4

d

Founded 1967

The pharmaceutical use of Lapis

Lazuli in the Ancient East

Dr Christopher J. Duffin

Sutton, Surrey

Technically,lapis Iazludliis a rock, since it is made up of an association of several different minerals.l The main component is lazurite, an aluminosilicate belonging to the feldspathoid sodalite goup of minerals and possessing a somewhat varied composition. Its distinctive intense marine blue to violet blue colour (with lighter blue and green varieties also known) means that it has sometimes been confused with the copper carbonate, azurtte, especially in older literatwe. It is typically metamorphic in origin, the bulk of geological occrrrrences being related to the contact metamorphism of limestones, dolomites and evaporates. The rock has been the subject of several brief overviews.2 Historically significant deposits were located in Badakfrstan (northern Afghanistan and referred to in 13th century accounts by Marco Polo), Pamir (Russia), theAtlas Mountains (North Africa), Latium, Vesuvius and the Albano mountains (Italy). Significant quantities of the rock were probably produced in kan during the 13th and l4th centuries, according to some medieval Arabic sources. Exfraction was carried out by means of fire-setting, right into the early 19th century.3 Lapis laztili was hidrly valued in Mesopotamia and the Mediterranean region as a decorative building stone, a syrnbol of diguty, in various rifual and magical contexts, in votive offerings, as royal gifts and fributes, ffid as stones in a wide variety of items of jewellery.a It was also the base material for the production of the artists'pigment, ulframarine,s and used in the dyeing of cloth. The intense blue colour is believed to be a function of the complex chemis@ of the various oxides of sulphur in the crystal lattice.6 The objective ofthe present paper is to examine, for the first time, the historical use of lapis laztili ils a geopharmaceutical material. Further papers in this series are intended to frace the use of lapis Lazuli within the western Ernopean and Arabic medical traditions until its elimination from the materia medica ataround 1750.

Ancient Egyptians

Traded withAfEhan suppliers, probably via Turkey, lapis laztili was employed by the ancient Eglptians from predynastic times onwards for the production of beads, scarabs, amulets and other small objects, as well as a colonring agerfi.1 It seems that colours were deeply symbolic; the blue of lapis taztiliwas associated withjoy, delight and tranquilhty - it was the colour of heaven.s Used extensively in the tomb of Tutanlilramun (18th Dynasty pharaoh reigning from circa 1332-1333 BC), lapis LazvLi was used for the eyebrows, eyelids and kohl marks on the death mask of the young king whilst a lapis substitute, Egyptian Blue, was used for the decorative stripes on the nemes or headcloth of the gold maslq and also to provide the inlay on the plaited false beard. This use of the authentic lapis emphasises a connection with the eyes in Eg5lptian culture. Eg;ptian medical witings are mostly found on stelae (stone or wooden blocks) and osfraca (shards of poffery or clay tablets), os well as specialised medical papyn. Amongst the latter, the Ebers Papynrs, now held by the Universrty of Letpzig, is the most extensive. The 20mlong scroll contains 110 pages and was supposedly fourd between the legs of a mummy in the Assassif area of the Theban necropolis on the East bank of the River Nile. It is believed to date from 1534 BC, having been written during the reign ofAmenhotep I, second pharaoh of the 18th Dynasty. TWo recipes in the papyrus refer to the use of lapis lanili in treaftnents of the eye.e Recipe 378 recommends 'real'lapis lazvLi(i.e. not the Egyptian Blue synthetic glass equivalen| mixed with green and black eye paints or 'kohls' (based on malachite and galena respectively), crocodile dung and two rather obscure herbal components in a milk base. The mixfure was applied to the outside of both eyes to 'eliminate stasis of water', a condition believed to be cataracts. Recipe 390, this time to 'eliminate blood vessels in both eyes' (presumably dilated conjunctival capillaries or conjunctivitis) recommends applyurg a 'ductile dough' comprising equal parts of green and black kohls, lapis laztili, ochre and honey to the eye surfaces. A limestone osfracon at the Metropolitan Museum of Art (New YorD contains a prescription for hysteria comprising lapis LaztlJi, 'green stone' (malachite), a fumigant ('Ki-bu'), one herbal component ('Ssyt') and raisins, all mixed together in ajug ofwine.lO Hysteria was supposedly caused by internal movement of the uterus. According to Plato (circa 428-348 BC), The womb is an animal which longs to generate children. When it remains baren for a long time after puberty, it feels wroth, it goes about the body, closing the tissues for the air, stopping the respiration, putting the body into exfeme dangers.ll

The resulting characteristic and rHrcomfortrable sensation of having a mass ernbedded in the oesophagus or frachea (globus hystericus) is a psychological disorder allied to anxiety, and still little understood today.tz Assyrians

The kingdom ofAssyria (late 25thcentury-605 BC) was located in the area of present-day northern kaq. The caprtal city of the Neo-Assyrian Empire was Nineveh situated on the opposite bank of the River Tigns to present-day Mosul, and razedto the ground by besiegtrg Medes and Babylonians. Towards the end of its existence, Nineveh was home to the famous library of Ashurbanipal (685-ctrca 627 BC), the last of the NeoAssyrian sfrong kings. Excavation ofthe mound-ruins of Kouyunjik begun in 1847 by Sir Austen Henry Layard (1817-1894) yielded (in 1849) a collection of between 20,000 and 30,000 cuneiform tablets from Ashrnbanipal's library, the bulk ofwhich made their way to the British Museum. Amongst these is a rimge of medical texts, first studied by Reginald Campbell Thompson (1876-1 94l1.tt Here, lapis la li is recommended 84 Pharm Hist (Lond) 2014; 44 (4):

crushed in curd or ghee (an rHrclarified butter) as an eye ointnent in cases of ocular complaints caused by 'the Hand of Ghost'.l4

One tablet (K.4120;Fig. 1) also blames danlngofthe eyes on Hand of Ghost, and prescribes lapis Laztiliplus a mixture of other geological and herbal ingredients, finely crushed together on copper and applied continuously to the eyes iN an oinfinent in 'suet of the kidney of a black ox'. 15

Amongst the various remedies for oral complaints, one cuneiform tablet recommends the amuletic use of lapis Iaztili, hung on a thread arorlrd the neck, together with similar beads of cinnabar, iron oxide and alabaster.16 'If the hand of a ghost seizes on a man, and his ears sing', the recommended freaftnent was to crush lapis lazvli together with myrrh, powdered arsenic, 'green stone' (perhaps verdigris or malachite) and, bound together with cedar oil, use it to anoint the ear lobes as well as inserting it into the ear itself in order to effect a cure'I7 Together with another 26 stones, including magnetite, carnelian, coral and jasper, lapis laztili was recommended for 'emplacement of the intense pain of hand of ghost', and ifbound to the site ofthe pain, alleviated the synlptoms.r8 Ifpowdered lapis lazr,ili,haematite, plus a range of other stones andbotanical ingredients (many ofthe identities of which are currently obscure) were continually rubbed in a solution of oil upon the temples, neck and eye sockets of a patient whilst reciting an incantation which is franslated as 'The pointing ofthe evil finger ofmankind', disease was guaranteed to be removed.le The combination of incantation with the magicomedical employment of lapis Iazvli, (togettrer with a range of other geological and herbal ingredients) was also used in cases where a frightening affay of symptoms indicated that 'a roving ghost' afflicted the patient. The symptoms included pain in the breast, scalp and temples, roaring in the ears, numbness, shortrress of breath, depression, chills, a crushing sensation in the chest, shortrress of breath and persistent vomiting; the patient wils perceived as specifically being rHrder the Hand of Mardulq the somewhat capricious Babylonian deity who was deemed to exercise confol over humanity.2O The rather complex incantation, recited whilst holding the patient's hand (which held a representative figurine) and prosfrated before a specially consecrated potter's pit, invoked Ea, the Sumerian andAl,rkadian God of creation and father to Marduk, to exorcise the sufferer from the influence ofthe God.2l

Ancient lndian sources

The Rasaratna Samuccaya is a 13th century alchemical freatise from the late Thntric Perio4 named after the Hindu and Buddhist scriptures produced at the time. Wriffen by Yagabhatacarya, this work explains the preparation and properties of mineral drugs.22 The best quahty lapis Iaz1ili is taken to be that showing flecks of associated iron pyrites, also known as 'golden fly'. One possibly contemporaneous description of the rock recounts that 'lapis Lazuli must be regarded as genuine and auspiciom, which is without white flecks, is blackish +. K"4ltroeqH r#F'Hft{ ffi#.# Figure 1. Figure 1. Assyrian cuneiform tablet @ritish Museum K.4L20) from the library ofAshurbanipal at Nineveh (circa 620 BC), after Campbell Thompson (l923,plate 12 fi5. q. or dark blue, smooth, heavy, pwe, shining and like a peacock's neck'.23 Incorporated into the specialised eye ointnent, 'sttme ', lapis lanili was prepared by boiling in a mixture of cow's urine, lemon juice and salts prepared from various herbs for a period of six hous in a specialised earthenware pot (Daula yantra). Alternatively, the lapis lazuli could be oxidised to a red colour by a complex process involving mixing and gnnding with sulphur and lemonjuice, fashioned into ttre form of a tablet which was dried in the surl before being fired seven times in a specialised arrangement of two conjoined clay pots. This could then be used to freat ' aggravated bile', haemorrhoids, tuberculosis, jaundice, coughing and 'illnesses produced by humors of mucus and wind'. Furthermore, a paste or 'pishthi' could be made for the freafinent of dysuria, tuberculosis, jarurdice, coughs, haemorrhoids, diabetes, insomnia, restlessness and neurosis. This involved ginding the stone with apple juice for a period of 14 duyr; stirring the mixtrne for three hours per day for three successive days, allowing the mixture to settle and then pouring off the supernatant apple juice. After drying and a fifiher period of grinding, the paste was taken orally with honey, rose petal jam and murabba (a sweet jam pickle) of Indian Gooseberry (P hyll anthus emb I i c a, formerly Emb I ic a ffi cinal is) .2a Generally referred to as Rajavartah, lapis laz,ili also has the following synonyrns: Nilaima, Nrpapalah, Swarnadhdtu, Raj adrT and Avarta-manilt. In Ayurvedic medicine, it is fraditionally believed to alleviate problems in each ofthe three humours or doshas. Based heavily on the Rasaratna Samuccaya cited above, plus the 13th century Dhanwantari nighantu andthe 1 7th cenhrry Ral a nighanht,zs it is commended iN having rejuvenating, nourishing, appetirirg, digestive and aphrodisiac qualities, and employed for urinary disorders, Pharm Hist (Lond) 20la; aa @) 85 fuberculosis, haemorrhoids, anaemia, hiccough, vomiting and even alcoholism!26 Chinese and Tibetan sources Geopharmaceuticals figure strongly in Traditional Chinese Materia Medrc*7 but, possibly rather surprisingly, references to lapis laziili are quite spurse. Liu-li is taken by some authorities to refer to lapis Laz.l/ii, whilst others think that the name applies to rock crystal (qaanz).28 Those identifytng it and its synonyrns as lapis Laztili indicate that the powdered mineral, or water in which the stone was dipped, was used to cure fevers and inflammation of the eyes. One of the most venerated of the Tibetan Mahayana Buddhist pantheon is the Medicine Buddha, Bhaishajyaguru Vaiduryaprfuha, or the Healing Master of Lapis Lanili Radiance. Represented pictorially in the distinctive deep blue of lapid lanili,wearing the robes of a monk and sitting cross-legged holding a myrobalan stem in one hand he is revered as the source of the Tibetan healing arts, embodying the teaching of the Four Medical Thnfras. These tanfras are ascribed to the teaching of the Lord Buddha at the age of 72, and one ffadition holds that they were franslated into Tibetan by Vairocana during the 8th centuryAD. An alternative view is that the Tanfas were gathered together and presented by Yuthong Yonten Gonpo II (1126-1202), one of a family lineage of royal court students and practitioners of traditional Tibetan medicine. Derived from this historical base, lapis laz1ili is known by a number of synonyms in Traditional Tibetan Medicine, and esteemed for curing cases of poisoning, disorders of the lymph and leprosy. According to one text, it is even able to cure grey hatrlze Author's Address: Dr Christopher J. Duffin, Scientific Associate, Deparfinent of Earth Sciences, Palaeontology Section, The Natual History Museum, Cromwell Roa4 London SW7 5BD, UK and 146 Church Hill Road, Sutton, Surrey, SM3 8NF, England. Email:

cduffin@blueyonder. co.uk.

Endnotes and References

1. Accessory minerals usually include pyrite, calcite and Hatiyne.

2. Rosen, Lvon. Lapis Laziliin geoloEcal contexts and in ancient written sources. Studies in Mediterranean archaeolog and literature. Pocket-book 65, 1988; da Cunha, C. Le Lapis Lazuli. Monaco: Editions du Rocher,

4. Wood, J. A Personal Ir{arrative of a journqt to the Source of the River Oxus in the Years 1836-1838. London: John Murray, I84l: 265.

5. Rosen, Ref, 1; Rosen, L von. Lapis laztili in archaeological contexts. Studies in Mediterranean arcltaeolog and literature. Pocket-book 93, 1990; Searight,S. Lapis Lazuli. In Pursuit of a Celestial Stone. London: East and West Publishing Ltd,20I0.

6. The earliest recorded use is from around 500 AD in wall paintings of Cenfral Asia; Moorey, PRS. Ancient Mesopotamian Materials and Industries: The Archaeological Evidence. Winona Lake: Eisenbrauns, 1999: 85; Merrifield, MP. Medianl and Renaissance Theatises on the Arts of Painting: Original TLxts with English translations. Mineola, New York Dover Publications, 1967:340ff. Originally published in 1849; Curiosa arcana: being curious secrets, artificial and natural. In three parts. ... From the last edition in French; which contains near as much ... printedfor J. N. Printed for T King in Little Brittain, 1711: 108-109.

7. Thuson VL, Sapozhnikov AN. On the nature of lazttnte coloring. Zapiski Vserossijskogo Mineralogicheskogo Obshchestva lin Russian], 2003; 132 (s): 102-107.

8. Lucas, A & Harris, IP.. Ancient Eg,tptian Materials and Industries. 4th edn. London: Histories & Mysteries of Man IJd, 1989: 399; Herrmann, G. Lapis Laztilr: the early Phases of its Tiade. Iroq, 1968; 30 (1) :21,-57.

9. Van Benthem, H. Coloring the Ancient Eglptian World. The Ostracon. The Journal of the Eg,,ptian Study Society, 2006; 17 (1), 17 -19.

10. Ghalioungui,P. The Ebers Papyrus. A nsu English Translation, Commentaries and Glossaries. Cairo: Academy of Scientific Research and Technology, 1987: 113,116.

11. Coriat, IH. An Ancient Eglptian medical prescription for Hysteria. Annals of Medical History, 1921; 3 (1) :12-76.

12. Plato, Timaeus, quoted in Ref. 10: 15.

13. Finkenbine, R & Miele, VJ. Globus hystericus: a brief review. General Hospital Psychiatry, 2004: 26: 78-82; Klein, DF. Panic Disorder and Agoraphobia: Hypothesis Hothouse. Journal of Clinical Psychiatry, 1996;57 (strppl. 6): 2l-27.

14. Campbell Thompson, R. Assyrian Medical Tbxts "fro* the originals in the British lvIusanm. London: Oxford Universrty Press, 1923; Campbell Thompson, R. Assyrian Medical Texts. Proceedings of the Royal Society of tuIedicine, 1924; 17: l-34; Campbell Thompson, R. Assyrian Medical Texts. II. Proceedings of the Royal Society of Medicine, 1926: 19;29-78; Jasftow, M. The Medicine of the Babylonians and Assyrians. Proceedings of the Royal Society of Medicine, l9l4; 7 : 109-176.

15. Campell Thompson Ref. 13, 1926: 39:' See also Scurlock, J. Magico-medical means of treating ghostinduced illnesses in ancient Mesopotamia. Leiden : Brill, 2006:368.

16. Campbell Thompson, Ref. 13, 1926: 43; the other ingredients are 'magnetic iron ore, mineral of lead, mil'usalt, sulphate of iron, sab-stone, subu-nttrteral, balmineral, male copper, . . . tamarisk-seed, laurel-seed, seed of male C1perus, ffid arsenic'. See also Scurlock, Ref.

14:366.

16. Campbell Thompson, Ref, 13,1926:77.

17. Campbell Thompson, R. Assyrian Prescriptions for Diseases of the Ear. Journal of the Royal Asiatic Society of Great Britain and lreland, 1931; l: I-25; Scurlock, Ref. 14: 404.

18. Scurlock, J. Ref. 14:269-270,44I.

19. Scurlock, Ref. 14:337-8. 86 Pharm Hist (Lond) 2014;44 (4):

20. Oshima, T. Babylonian Prayers to Marduk. Orientalische religionen in der Antike,20ll1'7: 58.

21. Scurlock, Ref. 14: 346-347 .

22. Tripathi, ID. Rasaratna Samuchchaya of Vagbhatacharya: TTanslated with' Rasprabha' Hindi Commentary, Critical notes, and Introduction. Yaranasi : Chaukhamba Sanskrit Bhawan,2006.

23. Rajanighantu, Chapter 13, verse 216; Winder, M. Vaidurya. In Meulenbeld, GJ. and Wujastyk, D (eds). Studies on Indian Medical History. New Delhi: Motilal Banarsidass, 2001: 90. The white flecks in the description refer to associated crystals of calcite.

24. Johari, H. The healing power of gemstones in Tantra, Ayurveda, & Astrology. Rochester: Destiny Books, 1997:178-179.

25. Sharma, PV. The date of the Dhanwarfiari nighantu. Indian Journal of the History of Science, 1970; 5: 364-370; Prasad, PV. and Narayana, A. Biography of Narahari - the author of RajaNighantu. Bulletin of the Indian Institute for the History of Medicine in Hyderabad, 2007;37 (1): 1-8; note that these dates are contested Narahari is supposed to have written the Rajanighantu sometime between 1235 and 1250 according to Ramachandra Rao, SK. Encyclopaedia of Indian Medicine: historical perspective. Encyclopaedia of Indian Medicine, 1985; I : 68, but is asserted to have flourished around 1500 according to Wujastyk, D. Jambudvipa: Apples or Plums? In Burnett, C, Hogendrjk, JP, Plofker, K and Yano, M (eds). Studies in the history of the Exact Sciences in honour of David Pingree.Leiden: Brill, 2004: 288.

26. Sudarshan, SR. Encyclopaedia of Indian Medicine. Volume Five. Materia Medica - Metallic and Mineral Drugs. Bangalore: Dr V. Parameshvara Charitable Trust,2005: 37 .

27. Duffin, CJ. Lithotherapeutical research sources from antiquify to the mid-18th century. InDufftn, CJ, Moody, RTJ & Gardner-Thorpe, C. (eds.) A History of Geology and Medicine. Geological Society of London Special Publication , 37 5. (in press).

28. Smith, FP. Contributions to the Materia Medica and natural history of China. For the use of medical missionaries and native medical students. Shanghai: American Presbyterian Mission Press, Shanghai, 1891: 129; Read, BE & Pak, C. A Compendium of Minerals and Stones used in Chinese Medicine from the Pen T'Sao Kang Mu Li Shih Chen 1597 AD. The Peking Society of lr{atural History Bulletin 1928: 3 (2),24. fSouthern Materials Center reprint, 1982]; De M61y, F. Les lapidaires de l'antiquite et du moyen age. Tbme I. Les Lapidaires Chinois. Paris : Ernest Leroux, Paris, 1896: 63,258; Morgan, HT. Cltinese Symbols and Superstitions. Los Angeles: TimesMirror, 1942: 138.

29. Arya, PY. Dictionary of Tibetan Materia Medica. New Delhi: Montilal Banarsidass Publishers, 1998: r82.

'What the Dickens!' The Out-patients

pharmacy at the Middlesex Hospital,

London

Norma Gox

Wandsworth, London

In 1979 I was the staffpharmacist in charge of the outpatients deparfrnent pharmacy at the Middlesex Hospital, London. The out-patients deparfinent was in a brick building in Cleveland Sfreet. (See figure 1). It was a separate building from the main Middlesex Hospital in Mortimer Sfreet. The out-patients deparlrnent and the main Middlesex Hospital were connected by a myriad of rHrderground pinsageways that allowed the movement of people, supplies and tolleys along narrow tunnels. Figure L. The out-patients deparfinent of the Middlesex Hospital in Cleveland Sfreet.

The out-patients pharmacy w€rs underground, beneath the out-patients building in Cleveland Sfreet. Patients called in for their medicines, after seeing the consultants and registars in their clinics in the out-patients block. The pharmacy had a reception area with seating for patients to wait. The dispensary led from the reception area. There was anareawithin the dispensary for the staff to have their tea-breals and lunch. I don't recall where the toilet facilities were. I left this position at the end of 1979 and thought little of the place except for nostalgic memories with contemporaries.

I knew that the MiddlesexHospital had become part of University College Hospital NHS Trust in 1994.r The Tiust had sold the Middlesex Hospital site for housing, offices and retail outlets to fund the University College Hospital Private Finance Initiative.r The Middlesex Hospital was then demolished in 2008 after anger and outcry.2 Worse still, the new building works had been delayed and only the hospital's listed Chapel remained intact in the middle of a building site.3 In 2013 I visited the Middlesex Hospital site in Mortimer Sfreet and found building works well underway, with completion dates predicted for 2014. I walked along Cleveland Sfreet towards the Middlesex Hospital out-patients deparfrnent expecting to find demolition or building works. To my amazement the out-patients building w€rs still there. The perimeter wall wns boarded by a wooden fence and worlcnen were busy. Pharm Hist (Lond) 20Ia; aa () 87