Ancient Greece

The vine then spread north to Greece. By about 2000 bc Dionysus became the Greek god of wine. The Greeks adopted wine as part of their daily nutritional needs along with bread and meat, believing it strengthened them as is amply described throughout Homer's Odyssey and Iliad, where wine was not only the medicine most frequently mentioned but characters such as Achilles and Ulysses recognized its ability to sustain the body. Normally, as a medicinal remedy, wine had been prescribed diluted three to five times by water. The Greek physicians were the first to prescribe wine undiluted and it was one of their main medicines.

Hippocrates (450-370 bc) was one of the leading physicians of the ancient world. He lived on the island of Kos and is recognized as the father of modern Western medicine because he was the first to say that illness was due not to the wrath of the gods but to poor nutrition or disease. Hippocrates believed in assisting the forces of nature to restore harmony in the body and thus promote recovery by using dietary treatments along with fresh air and exercise. This he called his Regimen. Hippocrates believed that if there was any deficiency in either food or exercise then the body would fall sick. A nourishing pottage called kykeon was made of barley with wine and milk as a nutrient (Phillips 1973, p. 77).

He used wine extensively as a wound dressing, as a nourishing dietary beverage, as a cooling agent for fevers, as a purgative and as a diuretic. He made distinctions among the various types of wine, described their different effects, directed their uses for specific conditions and advised when they should be diluted with water. In addition, he stated when wine should be avoided. In his essay on wounds, Hippocrates said: 'No wound should be moistened with anything except wine, unless the wound is in a joint' (Burke 1984, p. 193). He taught that the wound should be thoroughly cleansed with wine, that all the blood should be removed and a clean piece of linen soaked in wine should be applied directly to the wound before bandaging. Alternatively, a sponge soaked in wine and kept moist with wine from a vessel above the sponge could be applied to the wound. This was good medicine as infection was one of the greatest causes of death in the ancient world and the polyphenols and alcohol in wine are potent antiseptics. Old blood left in a wound is also a good culture medium for bacteria and thus a source of further infection. So, instead of poking around inside a wound that had not been washed with wine, and with unclean hands, as ancient physicians did, 'Hippocratic physicians, by contrast, used surgical probes which had been disinfected with wine or vinegar' (von Staden 1989, p. 15) in a wound also disinfected with wine.

Regarding the therapeutic uses of wine, Hippocrates noted that the yeast and unaltered sugar of new wines were irritants to the gastrointestinal tract; white, thin and acid wines are the more diuretic; wines rich in tannin are antidiarrhoeic. These observations are described well in the following passage from Lucia (1963).

The therapeutics of Hippocrates were based on rational observations of the responses of patients to treatment, and on strict hygienic rules. He made no extravagant claims for wine, but incorporated it into the regimen for almost all acute and chronic diseases, and especially during the period of convalescence. Although he advised against its use in illnesses involving the central nervous system, particularly in meningitis, he suggested that even in this disorder, if fever were absent, enough wine should be added to the water to ensure an adequate intake and exchange of fluid. By varying the proportion of water, he tempered the dose of wine to the requirements of the illness and the needs of the patient.

Hippocrates described water as 'cooling and moist,' and wine he characterized as 'hot and dry' and containing 'something purgative from its original substance'. Dark and harsh wines, however, were said to be 'more dry', and to '. . . pass well neither by stool nor by urine, nor by spittle. They dry by reason of their heat, consuming the moisture out of the body'. The latter constitutes the earliest recorded observation of the biophysiological effects of wines with an excessive tannin content — an agent that retards the motility and mobility of the bowel, decreases the production of urine, and suppresses the flow of salivary and other glandular secretions. Of other wines used therapeutically, he observed: 'Soft dark wines are moister; they are flatulent and pass better by stool. The sweet dark wines are moister and weaker; they cause flatulence because they produce moisture. Harsh white wines heat without drying, and they pass better by urine than by stool. New wines pass by stool better than other wines because they are nearer the must, and more nourishing; of wines of the same age, those with bouquet pass better by stool than those without, because they are riper, and the thicker wines better than the thin. Thin wines pass better by urine. White wines and thin sweet wines pass better by urine than by stool; they cool, attenuate and moisten the body, but make the blood weak, increasing in the body that which is opposed to the blood. Must causes wine, disturbs the bowels and empties them. It causes wind because it heats; it empties the body because it purges; it disturbs by fermenting in the bowels and passing by stool. Acid wines cool, moisten and attenuate; they cool and attenuate by emptying the body of its moisture; they moisten from the water that enters with the wine. Vinegar (sour wine) is refreshing, because it dissolves and consumes the moisture in the body; it is binding rather than laxative because it affords no nourishment and is sharp.'

This passage epitomizes the logic of a mastermind in its observations of human physiology and of the chemical changes upon which physiological reactions are dependent. The yeast and unaltered sugar of new wines are irritants to the gastrointestinal tract; white, thin and acid wines are the more diuretic; wines rich in tannin are antidiarrhoeic. Thus, in terse phrases, the mechanisms for acceleration and retardation of bowel movement and urinary flow and for hydration and dehydration of the body in relation to the ingestion of grape extractives, acids, tannin and alcohol were established for the ensuing centuries.

Hippocrates also had the following to say about wine as a medicine: 'Wine is fit for Man in a wonderful way provided that it is taken with good sense by the sick as well as the healthy' (Norrie 2000, p. 14) in accordance with the circumstances of each individual person.

The following are other writings about the use of wine as a medicine by Hippocrates.

Infants should be bathed for long periods in warm water and given their wine diluted and not at all cold. The wine should be of a kind which is least likely to cause distension of the stomach and wind. This should be done to prevent occurrence of convulsions and to make the children grow and get good complexions.

The main points in favour of. . . white strong wine ... It passes more easily to the bladder than the other kind and is diuretic and purgative, it is always beneficial in acute diseases . . . These are good points to note about the beneficial and harmful properties of wine; they are unknown to my predecessors.

His jaws are fixed, and he is unable to open his mouth . . . Grind wormwood (Artemisia absinthium), bay leaves, or henbane seed with frankincense; soak this in white wine, and pour it into a new pot; add an amount of oil equal to the wine, warm and anoint the patient's body copiously with the warm fluid, and also his head . . . Also give him a very sweet white wine to drink in large quantities.

For an obstinate ulcer, sweet wine and a lot of patience should be enough (Skovenborg 1990, p. 9). Wine removes the sensation of hunger (Coar 1822, p. 27). Pains of the eyes are cured by wine, by the bath, by formentation, by bleeding, or by purging (Coar 1822, p. 173). In pains of the eyes, after having administered pure wine, and free ablution with warm water, a vein must be opened (Coar 1822, p. 211). Anxiety, yawning and rigor are removed by drinking equal parts of wine and water (Coar 1822, p. 217). If the wound is in a good state but the adjacent parts are inflamed, a cataplasm, composed of the flower of lentils boiled in wine, will be found serviceable; but if you want to close and heal, you must employ the leaves of the blackberry bush, nasturtium, park leaves or allum, macerated in wine or vinegar.

For the wounds of the head and ears, whether recent or old, Hippocrates recommended unripe grapes, myrrh and honey, with a small proportion of nitre, and a still smaller one of flower of brass, boiled together in wine, for at least three days (Riollay 1783, pp. 58 —9). During the whole course of the disorder, it is useful to give honey and water, and now and then wine (Riollay 1783, p. 135).

Sweet red wine is more powerful than the white for promoting expectoration (Riollay 1783, p. 136). White (wine) is best for exciting a flow of urine: this diuretic quality renders it very serviceable in acute complaints (Riollay 1783, p. 136).

When a violent headache or a delirium supervenes, wine must be entirely laid aside, and water substituted in its place; or, at most, a watery sort of white wine: observing to give some water after it (Riollay 1783, p. 136).

Hippocrates was also one of the first of the ancient physicians to attribute feelings of joy, sadness, grief and sorrow to the brain. Prior to then the heart was considered the house of the soul and mind, while the ancient Egyptians thought one's personality lived in the liver. Mental illness was seen as a possession by evil spirits, whereas Hippocrates saw mental illness as a physical disease that would respond to his physical treatments. Aristotle also believed mental illness was physical, but resulting from an excess of black life', and advocated that the melancholia be treated with wine, aphrodisiacs and music (Horsley 1998, p. 15) — surely a combination that would work even today. The great Greek philosophers Socrates, Plato and Aristotle, contemporaries of Hippocrates, were all great oenophiles.

After Hippocrates, the father of Greek medicine, came many more physicians. Theophrastus of Eresus (372—287 bc) described many medicinal plants that were mixed with wine (Burke 1984, p. 192). He was a pupil of Aristotle and wrote many books including Inquiry into Plants, comprising nine books, and Growth of Plants, comprising six books. He had a great knowledge of plants that could be used as medicines with wine.

Mnesitheus (320—290 bc) was a famous Hippocratic physician practising in Athens who wrote a treatise called Diet and Drink in which he claimed: In medicine it is most beneficial; it can be mixed with liquid drugs and it brings aid to the wounded . . . While dark wine is most favourable to bodily growth, white wine is thinnest and most diuretic; yellow wine is dry, and better adapted to digesting foods'. (Lucia 1963, p. 12). Thus he observed that red wines contained more vitamins 2200 years before Morgan reported on vitamins in wine in 1939.

Athanaeus (ad 170 —230), a Greco-Egyptian physician from Naucratis, wrote about the use of wine as a medicine: in medicine it is most beneficial; it can be mixed with soluble drugs and it brings aid to the wounded' (Skovenborg 1990, p. 4). He also commented on wine from Mareo, noting its diuretic effect: it is white and pleasant, fragrant, easily assimilated, thin, does not go to the head and is a diuretic' (Skovenborg 1990, p. 8). Athanaeus also quoted the original writings, which no longer exist, of Diocles of carystus (c. 375 bc) and his pupil Prascagoras, both of whom wrote about the therapeutic uses of wine.

Between 300 bc and 50 bc the centre of Greek medicine moved to Alexandria where Erasistratus (300 —260 bc) founded a school for progressive physicians known as the Erasistrateans who favoured therapies involving mild laxatives, barley-water and wine in small doses. In the first century bc, followers of Erasistratus founded the medical school at Smyrna to advance his work. Hikesios led this group and wrote a treatise on the preparation of wine called De Conditura Vini which advised the use of wine as a medicine. Apollonius of Citium (c. 81—58 bc) was a contemporary of Hikesios who also wrote a treatise on wine as a medicine. cleophantus was another famous Alexandrian physician who tried to simplify treatments and taught the use of wine and cold water in therapy, especially in dealing with fevers such as malaria, to reduce the fever and to sedate the patient.

The Greeks also developed their theriacs and alexipharmics — antidote medicines using wine as part of the therapeutic agent. The term theriaca comes from therian, a wild beast which later became a venomous serpent; thus, theriaca was about the symptoms and treatment of venomous bites and animal stings. Alexipharmaca is from the Greek alexein meaning to ward off; thus alexipharmaca was about antidotes to poisons in food and drink. Both terms were first used by Nicander (190-130 bc), a poet and physician.

The next great advocate of these antidote medicines was King Mithradates the Great (132 - 63 bc). Mithradates developed his 'true medicines' (Burke 1984, p. 194), or mithradatium - antidotes and prophylactic medicines - on an empirical basis by giving guinea-pigs and human prisoners a certain poison or bite and seeing which of his medicines worked and which didn't, much to the disadvantage of the subject being tested, but such was the absolute power of being king. These mithradatium were later used by Roman pharmacies, Arab physicians, doctors in Medieval Europe as a cure for plague, and by English doctors as a cure-all well into the eighteenth century.

The Hippocratic physicians broadened the art and science of therapeutics and championed the use of wine as a medicine. They ushered in the Greco-Roman period of medicine where wine became the most important therapeutic agent of the time.

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