THE BRITISH LIBRARY

Science blog

01 April 2015

A Medieval Medical Marvel

A medieval potion, described in a 1000 year-old manuscript kept at the British Library, has recently been shown to have 'astonishing' antibiotic properties, capable of defeating the 'superbug' MRSA. Boudewijn Dominicus looks at the science behind this 'ancientbiotic'.

Medieval medicine is often seen as a bit of an oxymoron. With practices such as bloodletting commonplace1, many would say this reputation is deserved. Indeed the word for ‘leech’, a creature synonymous with medicine of the era, is derived from the Anglo-Saxon word for physician ‘laece2.

Sloane Bloodletting
Bloodletting was a common panacea, a therapy to 'rebalance the humours'.
Image: © The British Library Board (Folio 11v, Le Regime du corps)

Although many treatments were ineffective or even harmful, careful analysis of Old English medical texts has revealed that not all of them were as backwards as we imagine. For example, there is evidence that honey was used as an antiseptic – its high sugar content and low levels of hydrogen peroxide destroying bacterial cells3.  Another example was the use of the herb marrabium vulgare (horehound) to treat coughs – horehound is still used today in some throat lozenges4. Some of these treatments required specific identification of herbs, careful preparation and appropriate administration. Such examples show that Anglo-Saxon physicians were willing to experiment, see what worked and from that, occasionally, find an effective cure – formulating simple compound drugs using a prototypical scientific method.

But now, researchers from the University of Nottingham have discovered a medieval treatment for eye infections which puts even some modern medicines to shame. The eye salve described in Bald’s Leechbook, a 9th century medical manuscript held by the British Library, was tested by a team of microbiologists at Nottingham University’s Centre for Biomolecular Sciences and was shown to kill one of today’s most notorious antibiotic-resistant bacteria: Methicillin-resistant Staphylococcus aureus (MRSA).

Bald's Leechbook Folio 12b
Bald's Leechbook was the preeminent medical text of its day.
Image: © The British Library Board (Royal 12 D xvii)

Dr Christina Lee, an Anglo-Saxon expert from the University’s School of English, translated the recipe which was made from a mixture of garlic, onions, wine, and bovine bile salts, all of which were then brewed in a brass cauldron and let sit for nine days:

“take cropleek and garlic, of both equal quantities, pound them well together, take wine and bullocks’ gall, of both equal quantities, mix with the leek, put this then into a brazen vessel, let it stand nine days in the brass vessel, wring out through a cloth and clear it well, put it into a horn, and about night time apply it with a feather to the eye.”

The microbiologists made three batches and tested them on cultures of three commonly found and hard to treat bacteria, Staphylococcus aureus, Staphylococcus epidermidis and Pseudomonas aeruginosa in both synthetic wounds and in infected wounds in mice. The results were then compared to a control treatment using the same recipe, but without the vegetable compounds. On their own the ingredients had no measureable effect, but when combined the mixture was startling effective: only about one in a thousand bacteria survived application. Vancomycin, the current antibiotic of choice against MRSA, has approximately the same level of antibacterial activity.

The scientists then diluted the eye salve, investigating its effectiveness at different concentrations and exploring its possible mechanism of action. Interestingly, they found that when the medicine was too dilute to kill Staphylococcus aureus, it interfered with bacterial cell-cell communication (quorum sensing). Quorum sensing is essential to the formation of biofilms; a means by which bacteria aggregate together to form a cell colony. Biofilms can promote bacterial antibiotic resistance by forming a dense outer film around a colony which is impervious to antimicrobials such as antibiotics and detergents. As such, many microbiologists think that blocking this behaviour could be a means of combatting antibiotic resistance. 

501430c901674f6eb596a99ad6821ca3
Colonies of bacteria, such as Pseudomonas aeruginosa (shown above), defend themselves by grouping together and secreting adhesive polymers to form a 'biofilm'.
Image: Public Domain (Janice Carr, CDC)

Bald’s remedy certainly confirms that this approach is promising. Many of the microbiologists involved were surprised by the efficacy of the treatment. Dr Freya Harrison, who led the work in the laboratory at Nottingham, commented that they were “hopeful that Bald’s eyesalve might show some antibiotic activity, because each of the ingredients has been shown by other researchers to have some effect on bacteria in the lab – copper and bile salts can kill bacteria, and the garlic family of plants make chemicals that interfere with the bacteria’s ability to damage infected tissues. But we were absolutely blown away by just how effective the combination of ingredients was.”

The next step is to investigate why the combination confers such powerful antibiotic activity; in isolation each individual ingredient has little effect. Understanding how and why these ingredients interact may inform the development of new drugs which could help us combat theevil that is antibiotic resistance’.

 

Boudewijn Dominicus

References

1http://britishlibrary.typepad.co.uk/digitisedmanuscripts/2013/10/anglo-saxon-medicine.html

2http://bjgp.org/content/bjgp/20/97/63.full.pdf

3http://europepmc.org/abstract/MED/23569748

4http://www.vikingsofmiddleengland.co.uk/surgery-medicine.html

Comments

Very good piece of work and presentation. I also heard the BBC interview and was impressed. One thing that struck me (it may be trivial) was the period of nine days that the concoction had to be left for. If I remember right, it was emphasized in the interview that this period was essential. But I wonder about that. Is it a coincidence that nine days up until that 4th century CE at least was the usual length of a week? If so, then leaving something for 9 days might be just a way of saying "leave for a week" or some such. Beyond that, might the 9 days even be an indicator that the recipe goes back to a pre-Christian, Roman source when a week was indeed 9 days?

Hi Alan. Sorry for the slow reply. Here is some more info from our manuscripts team: "You are correct that Roman calendars had weeks of 8 days, sometimes reckoned as nine days (or ‘nundium’: see https://books.google.co.uk/books?id=mcUyAQAAQBAJ&pg=PA88&dq=roman+calendar+eight+days&hl=en&sa=X&ved=0ahUKEwjQg-S28cfKAhXMchQKHdo5AdYQ6AEIMzAE#v=onepage&q=roman%20calendar%20eight%20days&f=false). However, this had been replaced by a ‘planetary’/ seven day week by the 4th century, and Jews and Christians especially observed a seven-day week. As far as I know, Anglo-Saxons also observed a seven day week: in fact, modern English names for days of the week come from the Old English names (sunnandæg, monandæg, tiwesdæg, wodnesdæg, þunresdæg, frigedæg, sæterndæg).
The week as a period of seven days is discussed by the Anglo-Saxon writer Bede in his work on The Reckoning of Time (translated here: https://books.google.co.uk/books?id=yFsw-Vaup6sC&printsec=frontcover&dq=bede+the+reckoning+of+time&hl=en&sa=X&ved=0ahUKEwjS_pjF9cfKAhUJthQKHc9YDAUQ6AEIMDAA#v=onepage&q=week&f=false p. 32), although Bede was willing to extend his definition of ‘Scriptural weeks’ to explain certain Biblical miracles. Bald’s Leechbook definitely drew on Late Antique and classical sources, however, particularly the 6th-century Greek physician Alexander of Tralles. The researchers at Nottingham may be able to offer a fuller explanation."

The comments to this entry are closed.