On the Nose

Eric Lis

Dr. Eric Lis is a physician, gamer, and author of the Skirmisher Publishing LLC sourcebook, Insults & Injuries.

There's more than one way to skin a proverbial cat, and there's more than one way  to deliver drugs into the body. While pills and potions have always been the most common and popular way of administering both medications and illicit substances, physicians and pharmacologists have been using every single one of the body's openings for thousands of years. Let's look at two of the easily-forgotten orifices: the eyes and the nose.

In the past couple of years, a team of Iranian researchers have published a few papers on some lesser-known aspects of Persian medicine, and I've recently had the pleasure of reading two of these: Ophthalmic dosage forms in medieval Persia and Nasal drug delivery in traditional Persian medicine. The same team has published extensively on how Persian healers historically approached such problems as headache, stroke, tremor, and cardiovascular disease; I won't go into any of that here, but the interested reader can easily look up the authors' earlier papers. The two papers I focus on here deal specifically with a topic that we don't often think of, which is different ways of getting medications (or illicit drugs) into the body. When most people think of medications, they think first of pills and second of injections. I'm guilty of this too, in part because the medications that I regularly prescribe are pretty much exclusively taken by mouth or by intramuscular injection. Lots of other routes of administration exist, though: intravenous, topical, subcutaneous, rectal, vaginal, and as these two papers remind us, ocular and nasal.

Before reading these papers, it had never occurred to me that ancient physicians would have used the ocular route to administer drugs, but thinking about it, that was a bit of a silly oversight on my part. After all, if there's one thing I've learned from studying the history of medicine for the last four years, it's that healers throughout history made most of their discoveries by trying every ridiculous thing they could imagine and keeping track of what seemed to work. As the authors of the first paper point out, eye diseases were common in Persia long before the Roman empire rose to prominence, so it should actually be more surprising to us if healers had never experimented with putting all sorts of substances into their patients' eyes in hopes of bringing about a cure. In this paper, they looked specifically at Persian texts from as far back as the 9th century, which is exactly the right time period for when most medieval fantasy is set.

As far as ocularly-administered drugs go, medieval physicians appear to have divided the into much the same categories that we do today: drops, powders (not very popular in the modern era due to how unpleasant it is to pour dust into your eyes), and washes. The articles also discusses how kohl was used therapeutically; people applied it around their eyes, like makeup, to achieve a therapeutic effect, and the eyes would therefore be exposed to small, repeated doses of the drug as the eyelids moved throughout the day. All manner of ingredients were used in eye medicines, including gold and ruby dusts, ground seashells, and various animal extracts, all of which, the texts warn, must be ground to the finest possible sizes to prevent injuring the eye with large particulates. Healers noted that such powders were better tolerated if burned before administration, or washed with various alcohols; effectively, they were treated with antibacterial chemicals before applying to the eye, which really did make them safer. The authors draw a conclusion of which I'm a bit skeptical, though. They note that since these eye treatments were listed again and again for many years in different texts, they must have been non-toxic and even beneficial. I have a hard time taking that at face value, remembering how a lot of very harmful medical treatments have been with us for centuries simply because nobody ever properly tested whether they did more good than harm, and I have a hard time imagining that pouring ground up gemstone dust into your eyes is curative of anything except good vision. Still, odds are good that some of these ancient treatments had genuine positive effects that we might be jealous of.

Nasal drugs, by all rights, should be more prevalent than ocular drugs. It's much less painful to put a chemical or powder in your nose than your eyes, after all, which one would imagine makes it easier to experiment, and the nose is an obvious target for physicians experimenting with cures for respiratory diseases. The authors note that nasal medications are listed, not only in Persian medicine, but in the Ayurveda, Unani, and other texts. They again looked at texts dating back as far as the 9th century, and found records of powders for insufflation, liquid drops, and inhaled vapors. The most common form of nasal drugs was the inhalation of a burned herb, which, as any smoker knows, can be a powerful way to get a drug into your system. Similarly, vapours were often made by extracting or dissolving a drug into water or another solvent and then boiling the resulting potion, much like today's aromatherapy. Nasal drops often took the form of plant extracts dissolved in water, milk, or vinegar, and might have been water- or oil-based depending on the problem that the healer was trying to address. The authors list a number of ancient drugs, meant to treat such diverse problems as nosebleed, headache, vertigo, epilepsy, insomnia, and facial paralysis, in addition to several drugs simply identified as "brain and heart tonic." From a modern perspective, it seems likely that most of these drugs didn't work very well -- it's difficult to imagine an inhaled drug doing much to treat epilepsy given what a terrible job many of modern drugs do, for example -- but it's entirely possible that inhaled steroid could have been an effective treatment for asthma, and burning pleasant incense probably did alleviate headache and improve sleep.

The most useful lesson we can learn from these papers is, as we've seen before, ancient healers were endlessly creative. Medieval medicine often included all sorts of weird stuff that most people today might never think of, which gives the storyteller endless room to invent strange cures to be popular in their own campaign settings. If there's the slightest chance that inhaling smearing ground platinum mixed in honey will cure blindness, someone, somewhere is going to test it out, and then if an illness improves, whether because of or in spite of the treatment, someone is probably going to write it down and immortalize it. In this way, both profound truths and horrible mistakes can get passed down to later generations as something akin to gospel and can shape the way entire cultures approach healing.