SOURCE: “The Medicines of Medieval and Renaissance Europe as a Source of Medicines for Today,” in Prospecting for Drugs in Ancient and Medieval European Texts: A Scientific Approach, edited by Bart K. Holland, Amsterdam: Harwood Academic Publishers, 1996, pp. 19-37.

[In the essay below, Van Arsdall provides an overview of medical knowledge from the Middle Ages to the Renaissance, arguing that the historical texts represent the sum of what was known about disease and the body at the time.]

INTRODUCTION

This chapter outlines the practice of medicine and the use of medicinal remedies from the early Middle Ages through the Renaissance in Western Europe, from approximately a.d. 450 to 1600. It begins with a very brief historical overview, in a section aimed at orienting the reader to more than a thousand years of human history. Medical training during these two periods is summarized, and a short section is included on the major theories about the causes of disease, because they necessarily affected the remedies used in healing. A discussion of medieval and Renaissance medicines as contained in their texts makes up the bulk of the chapter. This was a time when the leaves, roots, and seeds of plants made up the primary medicaments; animal substances, minerals, and spices were often added to the plant materials. The remedies used during the Middle Ages and the Renaissance were essentially the same, but no systematic study has been made of if and how they worked. The chapter ends with major sources consulted.

The text is written from the point of view that the medical and associated pharmaceutical texts during these periods represent honest attempts of healers, professional and folk-trained alike, to alleviate suffering and to cure ailments using medicinal plants and other natural ingredients, which were the only pharmaceuticals available to them. That there were medical charlatans in all ages is a matter of record, but that is a digression from the principal topic, which aims to be an objective summary of the history of medicine and preparations used in healing during these early centuries in the West.

Until very recently, early medicine has often been treated as preposterous, as a practice that defies the understanding of rational human beings, as something no modern person could possibly take seriously. This chapter is based on the observation that, on the contrary, the historical record shows early medicine developed from rational ideas based on the understanding at that time of how the human body functions and how disease begins. Rather than being dismissed as idle curiosities, medieval and Renaissance medical texts could be considered as untapped sources for research into new pharmaceuticals based on overlooked or forgotten plants and minerals. The bulk of medical writings from the Middle Ages and Renaissance exists and is available for study, though not always in a convenient form for modern readers.

HISTORICAL OVERVIEW: THE MIDDLE AGES AND THE RENAISSANCE

Historical periods are defined by people who live after them using various criteria, such as significant changes in a language or changes in cultural and social systems. Thus, what differentiates the Middle Ages from the Roman Period and in turn from the Renaissance may never be agreed upon. The date to begin the Middle Ages and terminate the Roman Empire is a matter of scholarly conjecture; however, the Roman Empire was certainly disintegrating by the fourth century of the Christian Era. This early medieval period, which lasted from about a.d. 450 until 1100, saw not only the establishment of nations but of the Christian church as a dominant force, politically and philosophically, in the West.

During the Middle Ages, the foundations of Western nations and societies as we know them, together with their distinctive languages, were established. The Middle Ages are often termed an “age of faith” because of the supremacy of the Roman Catholic church in all areas of life. There was relative social stability after about 1100, a middle class gradually developed, and towns and universities grew. Beginning in Italy quite early, by a.d. 1300, and radiating throughout the West was the Renaissance, an age built on faith in God but intently interested in man and his capabilities. The Renaissance revived an outlook held by the ancient Greeks that brought the concerns of man from heaven to earth, but with a strong Christian, that is Roman Catholic Christian, basis. This included a greater interest in the human body both from artists and medical personnel, which was important to the development of anatomy and physiology.

However, pharmaceuticals did not change radically from the time of the Roman Empire throughout the Middle Ages and the Renaissance until at least the seventeenth century. The works of the Roman physician Galen, who died in a.d. 200, remained the authority on all aspects of medicine, pharmacy, and surgery for all of these years and were basic to medical training as well. His explanation of the way the human body worked and his methods of treatment seemed adequate for centuries, and as a consequence, no others were sought. Plants, minerals, and animal matter made up the bulk of remedies, and no challenges to the ancient prescriptive medicines began until there were also challenges to ancient theories of anatomy and physiology, and to concepts of how Nature works, in the sixteenth century.

MEDICAL TRAINING

As the Roman Empire began to crumble, so did its systems—political, educational, and economic. The formal training of physicians that existed in the Empire ceased. Native curers and midwives, whose knowledge is generally passed on orally, remained the principal source of comfort and aid for the sick throughout Western Europe. A unique Anglo-Saxon text thought to be from this unsettled period, but unquestionably reflecting widespread native practices perhaps typical for most of Europe at the time, is the Leechbook, translated into Victorian English in the nineteenth century by English clergyman T.O. Cockayne. (This work is discussed in the section on medical texts below.) It contains herbal remedies, magic spells, incantations—a unique mirror of how the common person dealt with pain and healing without trained physicians at this time and most certainly well into later periods.

For the centuries when the Christian church was evolving on the ruins of Rome and within the nascent Germanic kingdoms, roughly a.d. 450 until at least 1000, the relationship of medicine and the physician to Christian doctrine was not clearly established. If Greece and Rome had celebrated the human body, the Church preferred care of the soul and promoted disregard for the things of the world, which included the body. In fact, the role of the Church and the power of God in curing were matters of debate among the early Church Fathers. Complicating this situation was the fact that the monasteries were the only places where texts from the past were stored, copied, at times translated, and transmitted, and that included the medical lore of the Greeks and Romans, particularly of Galen. Not all the classical writings survived, and those that did were not always complete. Collections from several classical sources were made in the monasteries, and alterations and omissions were inevitable.

Asceticism was a strong factor in the early centuries of the Church and did much to restrain a quest for a better life on earth, which included improved health care. But eventually Christian monasteries became known as refuges for the sick, and healing was seen as part of the Christian community's mission. The Benedictine Order promoted this tradition beginning as early as the mid-500s; monasteries were created in England, France, and Germany along the lines of Montecassion in Italy, where a hospital and extensive library were integrated into monastic life. Libraries where books could be studied, copied, and taken to new locations, and gardens where medicinal plants were grown helped transmit formal medical knowledge. In addition to their spiritual mission, the monks and nuns assumed responsibilities for much of their neighbors' medical care.

At the same time, during the long demise of the Roman Empire, many Greek and Latin manuscripts on medicine and other scientific topics were taken to Arabic countries, where they were copied and not only saved, but studied and commented upon extensively. Arabic medicine flourished during the years when Christian Europe was forming itself, and scientific and medical knowledge was cultivated and promoted not only in Arab countries such as Egypt and Syria, but also in Arabic Spain. Many of these Greek and Latin works used in Arabic countries did not reappear again in northern Europe until the Renaissance.

Ecclesiastics and folk healers conducted what could be viewed as apprenticeship systems of medical training in the monasteries and villages of Europe well into the eleventh and twelfth centuries, passing on a loosely connected body of medical knowledge based largely on observation, inherited texts, and received wisdom. But eventually, the first non-ecclesiastical medical school in the West grew up in Salerno, Italy, on the foundations of an eighth-century Benedictine hospital. Tradition has it that its founders were a Christian, a Jew, and an Arab; in reality, the school did encompass learning from these three traditions and was particularly unique for its liberal attitude toward admitting students—women were among its teachers and graduates.

Salerno was the most famous center of medical training in the West, the only center devoted to medicine, during the twelfth and thirteenth centuries. Its importance grew as Church councils began to ban monasteries from serving as hospitals and places of medical training, then to prohibit secular (non-monastic) ecclesiastics from practicing medicine. The course of study at Salerno was five years long, followed by a one-year residency with an experienced physician, and culminated with the awarding of a license to practice. Coupled with its medical training, Salerno became increasingly noted for its collection of manuscripts on medicine garnered from around the world.

The establishment and rise of universities in the West date from this same period, from roughly a.d. 1200 forward. Very early, medical training was usually a separate school of the university, as at Montpellier, or was under the school of philosophy. The importance of Salerno as a center of medical training declined in the thirteenth century, as Montepellier and Paris, then Oxford and Bologna became important medical schools within universities at these cities. The official view was that medicine was a science to be taught and learned through texts, and was not an empirical craft, such as surgery. In fact, surgery was not part of medical training for many years, but was left to those who were willing to set bones, pull teeth, lance boils, and minister to wounds suffered on the battlefield. Surgery and childbirth, which did not involve complex diagnoses based on theory, were not a matter to concern licensed physicians. Consequently, a separate surgical literature grew up, much of it lamenting the separation of surgery from medicine and anatomy. Moreover, physicians were exclusively male when licensing was done by universities, because women were not admitted to them.

During the fourteenth- and fifteenth-century Renaissance, more complete versions of classical literary, scientific, and medical texts were sought out in every corner of the world, and when found, they were edited, copied, and often translated into the vernaculars of Europe. Medical schools avidly studied texts by Galen, the second century medical doctor in Rome who remained the supreme medical authority throughout all these periods. There was also a greater interest in anatomy during the Renaissance, prompted by a general cultural interest in the human form and the world of nature. The increased anatomical knowledge gained by Renaissance physicians provoked questions about Galen's teachings. So did clinical observations during surgery. However in general, anatomy was studied merely to better understand required medical texts, not to draw independent conclusions. Dissections were performed to a limited extent during the Middle Ages and Renaissance, but with the same aim—to understand authoritative writings about physiology and anatomy.

A radical and decisive challenge to the supremacy of Galen's authority in anatomy was made by Andreas Vesalius in the mid-1500s. Working in Padua, Italy, Vesalius heatedly and publicly challenged many of Galen's teachings on anatomy for the first time since they had been advanced during the late Roman Empire. Although his questions provoked a change in the study of anatomy in Europe, and underscored the necessity for dissections, Galen's physiology remained the cornerstone of Western medicine. Surgery, likewise, continued its separate, and subservient, way from medicine during the Renaissance. At about the same time, the alchemist Paracelsus suggested that the human body was in reality a chemical laboratory and that medicines could create a chemical change.

The scientific revolution that began in the sixteenth century and drastically altered human understanding of nature and the universe affected medicine as well. Although the beginning of modern medicine is generally agreed to be somewhat later, the breakdown of Galen's supremacy in medical theory and practice began here, in the very late Renaissance and early Enlightenment. Innovative scientists such as Newton, Copernicus, and Galileo generated change in all of scientific thought, including medicine.

However, pharmaceuticals did not change radically from the time of Galen to the seventeenth century. As they were in anatomy and surgery, Galen's writings on drug mixtures were basic to medical training for centuries. Plants, minerals, and animal matter made up the bulk of remedies; they were prescribed either separately, or more often, combined and mixed in wine or honey or other liquid to make them palatable. Salves were made of plants and other materials using wax or fat as a binder. Soothing or cleansing baths and teas, tranquilizers, anesthetics for surgery, cosmetic formulas, cures for constipation and diarrhea, and aphrodisiacs were all part of the medieval and Renaissance medicine chest, reflecting the fact that human concerns have not changed drastically in many, many years. Serious challenges to the ancient prescriptive medicines based on natural elements began at about the same time as challenges to ancient theories of anatomy and physiology, in the sixteenth century, with the chemical theories of alchemists, which in later years matured into chemistry and microbiology.

PATHOLOGY: CONCEPTS OF CAUSES OF DISEASE

Two traditions are found in medical writings from the Middle Ages concerning pathology. One reflects the pre-Christian, even pre-Roman, native northern European folk beliefs about the cause of a person's illness. The other reflects learned medical wisdom and stems from collections of writings copied and passed down from ancient Greek and Roman medical texts. Information about native healing and healers is almost exclusively found as notes in the margins of other writings, as bits of folklore in stories and legends, and as spells and charms incorporated into various tales. On the other hand, collections of classical medical texts were carefully copied and recopied beginning very early in the Middle Ages in monasteries and were shared with fellow monks, part of whose duties was treating the sick. These collections were originally in Latin; many were then translated into the vernaculars of Europe.

Native wisdom blamed the onset of an illness to some natural cause, like getting too cold or having a headache, or, failing an obvious natural explanation, was attributed to something supernatural. A demon or other evil spirit was thought to have projected a stone, a worm, or something else into the body, or it was believed something had been taken out, such as one's soul. Native treatment throughout the world was based on medicinal plants; diseases thought to be due to demons were cured by restoring the soul to its proper habitat in the body, extracting the demon using incantations, or making a hole in the skull to let the demon/disease escape. Those familiar with folk medicine everywhere know that both herbal cures and incantations of various kinds have never died out.

Inherited from ancient Greece, refined and expanded in Rome, taken north by the Roman legions and their physicians, and subsequently by Christian monks to all of Europe was the widespread belief that four humors control the body. The humors were thought to correspond to the four basic elements of the universe, earth, air, fire, and water, expressed in the human body (and in all living things) as dryness, cold, heat and moisture. The humors are blood, phlegm, yellow bile, and black bile, originating in, respectively, the heart, the brain, the liver, and the spleen and stomach. Humors were also seen this way: blood as hot and moist, phlegm as cold and moist, yellow bile as hot and dry, and black bile as cold and dry. Human personality traits were believed to originate in the humors as well: sanguine, phlegmatic, bilious, and melancholic personalities are still understood as types.

Pathology dictated for hundreds of years, and far beyond the period covered here, that when these humors are in balance, a person is healthy. Illness was understood to be caused by an excess or isolation of one of the humors. Complicating the workings of the humors was the weather—one humor was believed to dominate the body during a season corresponding to its primary properties and thus to effect an imbalance within the body. Astrology, too, figured into the physician's diagnosis of a patient's state of health, because the planets and stars were for many centuries believed to affect the humors.

This medical system based on humors was inherited from Greek Hippocrates and refined and condified by the physician Galen in Rome before a.d. 200; his extensive writings assume a natural cause for all disease. They rule out demons. Galen's texts in one form or another, with the theory of the humors as the cause for disease, were the foundation of medicine throughout the Middle Ages, the Renaissance, and the scientific revolution of the 1600s. In Galen's writings is a complex system of physiology based on the theory of the four humors. Galen concluded that vital functions are controlled by the soul, which governs vegetative, animal, and rational processes in the body. He wrote at length about how the vital fluids interact with internal organs, how food is used by the body and the excess converted to waste. Integral to his system of physiology is a philosophy of living a healthy life to keep a healthy body. His aim was to put medicine on a firm scientific basis, advancing diagnosis from guesses to a process. This system—or variants of it—constituted the theoretical background for physicians in the Middle Ages and Renaissance. A physician's diagnosis began with an examination of the patient and a lengthy consideration of the reasons why the humors were not in balance. When the concept of humoral excess is understood, the purgings and bloodletting that have become for many a hallmark of medieval and Renaissance treatment make more sense as efforts to restore balance in the body's humors.

The physician's task was thus a complicated one, involving a diagnosis based on the patient's state, an analysis of the probable cause for the humoral imbalance, and considerations of outside influences affecting the humors, such as the weather, the time of month, and many other factors.

The influence of Paracelsus in the mid-1500s marks the very beginning of modern pharmaceuticals based on (bio)chemistry. Paracelsus rejected the time-honored concept derived from Hippocrates and Galen that the human body is controlled by the humors; instead, he saw it as a system of chemical reactions. He also loudly denounced the separation of medicine and surgery, saying they had to be one and had to include study of anatomy and bodily chemistry. But the theory of humors lasted many years after Paracelsus, and only began to fall in the face of observations made on cadavers in laboratory dissections coupled with clinical observations, and improved diagnoses due to better instruments used to examine the ill. In a related matter, mechanisms for the spread of disease did not receive serious attention until the advent of Fracastro's theory of germs in the mid-1500s, corroborated only 100 years later by Bonomo, when the Renaissance had already given way to the Enlightenment.

Thus, in spite of advances made in other fields of medicine such as surgery and anatomy, the ancient theory of humors as the underlying controller of human health held sway during and long after the historical periods considered here. Microbiology and scientific investigations into the causes of disease belong almost exclusively to a late period of medical history.

MEDIEVAL AND RENAISSANCE PHARMACEUTICALS

BIAS IN MODERN ASSESSMENTS OF ANCIENT REMEDIES

Written records from the centuries covered in this chapter show that human beings suffered from largely the same complaints they do today—and that rest, change in diet, improvement in lifestyle, and mild simple medicines often produced cures. Disease and trauma, complications in childbirth, and conditions requiring surgery were more serious matters, but again, cures were made using simple medicinal preparations in combination with treatment, some of it remarkably effective considering the tools used. Epidemics such as the Black Plague in the Middle Ages and the rampant and sudden spread of syphilis in the Renaissance posed much more serious and challenging problems for the medical community, and attempts to alleviate pain and avert death resemble the way modern medicine is dealing with AIDS.

The body of medical and pharmaceutical writings from this period is very large. However an attitude often expressed in modern literature on the subject, even in histories of medicine, is that they are mindless copies of older writings or they are quaint and meaningless. S.G.B. Stubbs and E.W. Bligh write on page 86 of Sixty Centuries of Health and Physik (New York: P.B. Hoeber, 1931), in a chapter on the early Middle Ages titled “A Thousand Years of Darkness,”

We have chosen to attempt a brief note on the medieval background rather than to present strings of names of tedious writers and lengthy specimens of the futilities of medieval recipe books. It is obvious that if this attempt be a fair representation nothing in the way of medical science as we understand it could exist. In fact it did not—in Europe.

The often-cited Leechdoms, Wortcunning, and Starcraft of Early England is a work printed in three volumes between 1864 and 1865 that was reprinted in facsimile in 1965. The editor, compiler, and translator was the Rev. Oswald Cockayne, and the work consists of three Anglo-Saxon medical manuscripts, which Cockayne translated into the English of his day. A service this clergyman also provided for his readers was to put into Latin almost all references to women's bodies and their functions, so that readers limited to modern languages can only guess at what the Latin is referring to. The work is generally cited not for its value, but as an example of the absurdity of the medicine of the time; part of it contains magical incantations, which remained in folk medicine, but were not part of the university tradition based on texts inherited from Greece and Rome. In fact, the more colorful folk cures and incantations are the major parts of Cockayne that have been translated into modern English; they make up part of J.H.G. Grattan and Charles Singer's Anglo-Saxon Magic and Medicine in a chapter that begins with the query (page 92), “Surveying the mass of folly and credulity that makes up A.S. leechdoms, it may be asked: Is there any rational element here?” Their answer is, of course, “very little.”

This twentieth-century judgment on the Anglo-Saxon manuscripts making up the Leechdoms does not take into consideration the fact that during the Middle Ages, all manuscripts were tedious and expensive to prepare. Everything was written by hand with a hand-made pen on a hand-made material such as vellum. It makes sense to assume that the texts were important to the copier or at least to the requester of the copy. The written record instead suggests, if merely by its sheer volume, that these remedies were used to heal and were passed on with the intent of producing beneficial results.

In the Renaissance, the printing press was a new creation, and bookmaking spread rapidly. People wanted books and bought them in great numbers even though they were expensive. It is interesting that medical texts, especially those on personal hygiene, were among the most sought after. That the same texts tended to be copied, or compiled into other texts, and these issued with commentaries over the years should suggest that many of the medical remedies in them helped, even worked. Yet little if any comparative work has been done to ascertain the remedies that persist from Greece to Rome to the Middle Ages, the Renaissance and into the early modern period.

For example, one drug formula for theriaca, also called theriac, or Venice treacle, is a good example of what moderns disdain in ancient medicines—but what was in it and why it was popular for centuries, until as late as the nineteenth century, is not understood. Treacle is a medicinal compound first used in Rome as a remedy against poison, then for centuries as a preventive and cure-all. Numerous recipes for it exist: about 70 drugs were pulverized and reduced with honey to an electuary, a medicated paste prepared with honey or other sweet substance and taken by rubbing on the teeth or gums. Compounding and use of treacle from Rome into the Renaissance and beyond has been documented. Whether any or all recipes for treacle are bogus has not been established—except in non-scientific literature, where the recipes are cited as examples of the absurdity of older formulas. However, no one appears to have studied whether there is any scientific basis at all for the very long life that treacle enjoyed.

To be complete, the complicated theory and practice of bloodletting should be mentioned here at least in passing. This form of treatment was an important part of medical theory, training, and practice from before the time of Galen until as late as the 1920s. It was practiced routinely and unquestioningly in every country and in every age in the West as soon as academic medicine dominated. When studied in connection with the then prevalent theory of humors as controlling physiology, a theory briefly discussed above, bloodletting can be understood to be a rational approach at the time to restoring balance to the body's internal fluids and thus to restoring health and alleviating pain.

CHALLENGES TO MODERN RESEARCH ON ANCIENT PHARMACEUTICALS

Many literary works from the Middle Ages and the Renaissance contain references to the medicines and to medical practices of their time, but literary scholars tend to pay only cursory attention to them and then only half seriously. For example, Walter Clyde Curry, in Chaucer and the Medieval Sciences writes on page xi about this famous medieval writer and about medieval science and medicine … “that he (Chaucer) should have been impressed to the point of taking seriously—at least for artistic purposes—these monstrosities of error, now seems almost unbelievable. Yet such appears to be the case.”

In addition, medical texts are not usually part of medieval and Renaissance studies, which overwhelmingly prefer literature and art; yet literary scholars are usually the only people with the language skills to read manuscripts in languages no longer spoken. Moreover, historians tend to deal with broader topics than the intricacies of comparing and assessing medical remedies that are hundreds of years old.

A large part of the seemingly formidable challenge in addressing these writings from the past is the language factor: many remain in Latin, Anglo-Saxon or other old forms of the Western languages (not to mention Arabic texts) and those that have been translated vary in quality. By quality is meant the exactness of the translation and the clarity of the English or other modern language into which the work is translated. Many were last translated in the sixteenth or seventeenth centuries and have only been reprinted in that form; thus a major challenge in revisiting these ancient texts is the language barrier and inexact translations. One remedy is to make up-to-date and accurate translations; another is for more people to learn how to read older languages.

When and if texts are available, a fruitful approach may be to read them as physicians of those eras would, not seeking recipes for drugs to use in specific complaints, but using their contents, generally lists of plants, as ingredients to use in making healing drugs, lists that physicians of those remote ages would have studied and then used to create on-the-spot and detailed prescriptions that the apothecary would mix. More information than what is in the text might not have been necessary, for the physician probably knew his medicinal ingredients well. Linda Voigts, a medieval and Renaissance scholar, used such an approach in an article cited at the end of the chapter titled “A drynke that men callen dwale to make a man to slepe whyle men kerven him: A surgical Anesthetic from Late Medieval England.” Voigts and her colleagues have examined a number of Renaissance manuscripts looking for evidence that surgical anesthetics were used, also what was in them. The article evaluates the ingredients listed, and gives references for related sources on the topic. Such clear-eyed research is beginning to appear in the literature, but is new and at present is not widespread.

Health, Disease and Healing in Medieval Culture, the book in which Voigts' article appears, has articles by other scholars who offer evaluations of medieval medicine in an objective and positive light. So does M.L. Cameron, a former professor of biology at Dalhousie, in Anglo-Saxon Medicine, whose intent in writing the book is expressed on page ix of his Preface: “The present book is an attempt to explain the rational basis of Anglo-Saxon medicine in the light of modern physiology and pharmacology.” Cameron looks at portions of the Leechbook (mentioned above) through an experimental scientist's eyes, and he puts the remedies he considers in the historical context of the time. Cameron's general evaluation of medieval and Renaissance medicines is stated on his page 118: “These medicines certainly did not have the marvelous efficacy of modern antibiotics and chemotherapeutic drugs, but they do seem to have been just as good as anything available up to the end of the nineteenth century, and to have been applied with much the same appreciation of their therapeutic values.”

John Riddle, the author of the chapter in this book on Greek and Roman medicine, objectively reassesses medieval and Renaissance medicine in his Contraception and Abortion from the Ancient World to the Renaissance, and in his other writings. But these works do not yet tip the scale against the prevailing bias, which says there is not much more than folly in the old medical texts.

THE MAKE-UP OF MEDIEVAL AND RENAISSANCE MEDICAL TEXTS

Well-organized libraries and sources of reference today make it possible to look up very specific information under established categories. This is not the case for medieval works on medicine and pharmacy, where the two areas were really one. Pharmacists, or apothecaries as they were called, were under the supervision of physicians, and guilds of pharmacists were established in the early Middle Ages throughout Europe. The only function of an apothecary, controlled by city or royal statute in many instances, was to fill the written or verbal prescription of the physician, who very often made his examinations in the pharmacy, where he could immediately deliver his instructions to the pharmacist.

The university-trained doctor did not perform any of the labor involved in treating patients. Treatment was left to the pharmacist, who mixed the drugs and ointments under his specific directions, or to the surgeon, who was not usually trained in the university, or to the midwife. The doctor did examine urine, a primary way to make diagnoses, and examined patients. In sum, the physician's primary role was to evaluate a patient's condition based on physical observation and in consideration of any other factors, and to prescribe drugs or treatment, based on his own experience and knowledge of the medical literature. (This generalization omits the health care provided and recorded in monasteries. Remedies continued to be made by monastery-trained monks and nuns, but this was a separate area of healers.)

As a consequence, to find out what was prescribed for various conditions, it is necessary to read carefully the texts physicians used. Very few, if any, quantities or proportions are given for the plants, minerals, animal substances and other ingredients listed in medieval and Renaissance texts, a fact that is often noted in modern writings, saying the old medical texts are imprecise. Yet, if a physician had an apothecary at hand to mix the ingredients as he prescribed them for each individual patient in the proportions he requested, written quantities would not have been needed. Such texts instead imply a thorough knowledge of the healing properties of those plants and other items that are simply listed in the texts as being recommended for certain conditions. The apothecary knew the ingredients, too, and there is evidence that just as today, people went to the apothecary for help without going through a physician—and this was at times serious enough that it was forbidden by law. It is also interesting that in the Middle Ages and Renaissance, laws were passed to keep physicians and pharmacists from collaborating financially, for obvious reasons.

In the Renaissance, medical texts meant for home use became popular because printed books were widely available; this was the great age of illustrated books called “herbals” and of books on personal hygiene, spurred by interest in study of the human body. Herbals are home-care medical books that list medicinal plants alphabetically and include uses for each plant and sometimes growing conditions and instructions for cultivating and harvesting the plants. Many were profusely and beautifully illustrated. However, physicians and apothecaries continued to control officially sanctioned prescriptions and drugs. Beginning early in the Middle Ages and increasing as the spice trade increased, pharmacists and physicians added exotic ingredients to the plants and simple remedies of earlier ages. The apothecaries controlled storehouses of substances used in medicine, and trading in them was lucrative. Records from the Renaissance show a love of compounding more and more materials together for drugs and cosmetics.

The change from pharmaceuticals based largely on plants and mixtures of animal, plant, and mineral ingredients to those based on chemical compounds took hundreds of years after Paracelsus and his followers in the sixteenth century, and its history is beyond the scope of this chapter; suffice it to say that the older remedies remained part of the physician's stock of knowledge until at least the late 1800s, when bloodletting was still being prescribed together with herbal and simple chemical mixtures.

Throughout the medieval and Renaissance periods, the texts based on herbal remedies follow a pattern. Usually they first list the name of the plant, then tell what it is good for, and generally with what to combine it and/or how to make the preparation. Sometimes its appearance, habitat, root pattern, the best time to harvest it, and other information is included. The following examples are typical of what is to be found in these medical/pharmaceutical texts and are translated fairly literally from the original.

Bramble or blackberry. … For menstruation take the tender berries of this plant, and let there be three times seven of them, steep them in three parts of water, give this to drink for three days, while fasting, and refresh the drink every day. (My translation from the Anglo-Saxon original as found in H.J. De Vriend, The Old English Herbarium and Medicine De Quadrupedibus.)

Sea Holly. … To induce urination, take the same plant, which we call eringium, pounded, give it in wine as a drink, not only does it induce urination, but also the menses, and it induces the insides (to move) and relaxes swellings, and also with sickness of the liver … (My translation from the Anglo-Saxon original as found in Cockayne, Leechdoms, Wortcunning, and Starcraft of Early England.)

Auencia (Geum urbanum) is an herb called wood avens. This herb's leaves are like a rabbit's foot and it has a yellow flower like tormentil. The virtue of this herb, if it is dried and made into powder and is put into a little warm water or into a little ale or wine and given to the sick person to drink, for a person who has fever, it will help him. Also it helps someone who has cuts or cankers or such sores if it is drunk.

Endiwe (Lactuca virosa) is an herb that is called endive or horse thistle. This herb has leaves like thow thistle. This herb has thorns in its ridges and it has a yellow flower and a little white seed. The virtue of this herb is that the juice mixed with hot water and drunk heals blockage of the spleen and the liver. Also this herb is good to heal jaundice and quotidian fever and abscesses that feel hot. Also this herb soothes great heat in the liver and stomach. This herb is cold and moist. (My translations from the Middle English original as found in Gösta Brodin. Agnus Castus, A Middle English Herbal, reconstructed from various manuscripts.) The trick, of course, is to be able to identify with any accuracy the plants and minerals in these recipes.

Much the same format is to be found in books about medicinal plants, called herbals, which were so popular and so beautifully illustrated in the Renaissance; modern editions abound, many of them illustrated. For example, modern editions are widely available of Nicholas Culpeper's The Complete Herbal, which was originally printed in 1649 and follows the time-honored tradition of listings by plant with its uses. Such a format continues up until the modern era. For example, Mayne's Dispensatory and Formulary published in Philadelphia in 1848 begins with uses for antimonii et potassae tartras, tartarized antimony. A scientific evaluation of most of the information that is in these medieval and Renaissance texts has yet to be made in order to determine how specific medicines changed from those in the writings of Dioscorides and Galen, since many hands copied their works, mixed them with other texts, and added information gleaned from personal observation and practice.

OVERVIEW OF MEDIEVAL AND RENAISSANCE MEDICAL/PHARMACEUTICAL TEXTS

Although the texts used as the major sources for remedies during both the Middle Ages and Renaissance were written by Greek and Roman authors, not as much was available to the medieval physician as to his Renaissance counterpart. During the fall of Rome and the early centuries of the Middle Ages, passing on and copying of texts was extremely difficult because of unsettling conditions throughout Europe, which certainly did not promote widespread and systematic saving and studying of texts. When more peaceful times existed in the West and particularly with the establishment and spread of universities, the quest for more complete texts by Roman and Greek writers began in earnest. So it happened that during the Renaissance, Roman medical writings became popular that had been totally unknown for hundreds of years. However, the writings of two men who lived in Rome, Dioscorides and Galen, dominated the medical writings in the middle and late Middle Ages and the Renaissance.

Dioscorides, who died in a.d. 80, was a Greek physician in Nero's army who wrote De materia medica, The Materials of Medicine, which is known as a text based on plant remedies, though it includes use of mineral and animal substances. His writings established a pattern for most later medical texts. Dioscorides studied plants everywhere he went, and he traveled widely with the Roman army. He began a tradition that would continue in herbal literature of mentioning not only what the plant was good for, but where it grew, how it grew, and how it could be identified.¹

Galen, who died in a.d. 200, had as his patron the Roman Emperor Marcus Aurelius. His writings were undisputed as an authority on medical matters throughout the Middle Ages and the Renaissance. Galen had a detailed theory of physiology; much of his treatment was based on a complicated system of bloodletting, prescribed because of humoral imbalance and as a way of ridding the body of waste materials. Galen is well known for his drug preparations, including simple medicines and mixtures using exotic ingredients, such as clays and earths from many locations around the world. His writings were incorporated into many, many collections of medical texts, usually in part.²

After Dioscorides and Galen, no clear path leads through the medical literature of the Middle Ages and the Renaissance. No objective criteria and neat categories exist for evaluating and cataloging texts. Many were compilations of older writings, and custom did not demand that writers cite source or sources. In general, the medicines used in the Middle Ages and the Renaissance were the same and were based on natural ingredients, the bulk of them medicinal plants. Medieval and Renaissance medical texts tend to indicate that pharmaceutical remedies that were established in Rome were transmitted through the monasteries and universities, and that ingredients were added to basic recipes by later compilers. No determination has yet been made of all the original plants and their uses, nor has a comparison been attempted with later recipes and plants mentioned from other climates, nor have many evaluations been made of the plants' chemical properties and interactions. Writings on anatomy and surgery became more frequent in the later Middle Ages and blossomed in the Renaissance, affecting medicine and medical practices somewhat. A more scientific study of botany in the Renaissance promoted wonderful illustrations of plants in the popular books on medicinal plants, but medicines did not change because of them. Even the chemical drugs advocated by Paracelsus and his followers entered medical prescriptions slowly.

The bulk of medical and pharmaceutical writings from the Middle Ages through the Renaissance has not been lost, but exists and is available for study. Much of it is even in printed form, albeit often an extremely old fashioned one and not usually in an easily understood modern idiom. Interested readers may find such writings by consulting bibliographies in the history of medicine and pharmacy, and especially through the examination of such works as Schleissner's Manuscript Sources of Medieval Medicine. The summary which follows is meant to suggest the wealth and diversity of the medical texts that exist, a wealth that is largely unexplored in any depth by modern studies. Most histories of medicine and pharmacy mention the names of these medieval and Renaissance medical writers and the titles of their texts; few moderns actually read and study the texts to verify what is in them. Scholars with the language skills to read them generally study literature; medical professionals tend not to know languages no longer spoken.

MONASTIC MEDICINE

For the early Middle Ages, and even well into the period when university-trained physicians, licensed apothecaries, and more-or-less official surgeons made up the roster of official health care providers, monasteries continued to provide care for the sick. Writings from monasteries in Latin and older forms of European languages reflect medical and pharmaceutical learning well into the high Middle Ages throughout Europe. Many have never been translated into a modern idiom.

Famous throughout Western Europe were the medical writings of Isidore, Bishop of Seville, who died in a.d. 636. Isidore was a theologian who wrote in an effort to bring Christian and pagan writings together in a form that conformed to Christian morals and faith. This early bishop saw medicine as the second philosophy, which cured the body, just as the first philosophy cured the soul. Isidore said that a physician had to know literature, grammar, and rhetoric to understand and explain texts and study causes and cures for diseases in the light of reason. He wrote his medical texts in the form of a dialogue, a popular method used in teaching. His was the authoritative text for monastic medicine for many years.³

Much practical medical lore, especially about women, is found in the writings of Hildegard of Bingen, who died in a.d. 1179. Hildegard was a Benedictine abbess who began writing at age of 43 and became well-known for her sane advice and explanations. Among her many writings are the Physica: The Book of Simple Medicine,⁴ in which the abbess discusses the therapeutic virtues of plants, animals, and metals, and the Book of Compound Medicine or Causes and Cures.⁵

The work mentioned above that was translated by Cockayne belongs to this monastic medical tradition. It was published with the title Leechdoms, Wortcunning and Starcraft of Early England⁶ in the mid-1860s and was translated from the original Anglo-Saxon. The work is a compilation of native Anglo-Saxon magic and medicine and translations of several Latin medical texts. The manuscripts from which it is taken date to around the time of the Norman conquest of England in a.d. 1066 and are the first medical texts in the vernacular in northern Europe.

Information about medicine, medical practices, medical remedies, and medicinal plants is to be found in writings by medieval monastic authors on a variety of topics. If they were assembled and carefully compared, it might be possible to find out what constituted similar or differing medical approaches and remedies in monasteries of various parts of Europe. For example, in Anglo-Saxon England, the Venerable Bede, a Bishop of Wearmouth who died in a.d. 735 included medicine as part of his many treatises.⁷ Records exist of hortuli, books containing descriptions of those plants most frequently cultivated in the gardens of the monasteries from which medicines were prepared, such as the Commentarium medicinale by Benedetto Crespo, Archbishop of Milan, in the eighth century.⁸

The key to whether and how the Greek and Roman tradition in medicine and its remedies might have changed in the monasteries of Western Europe because of climate, folk medicine, experience, or other causes is probably in those unexplored monastery-based texts, along with many other facts about the life of people then.

WRITINGS USED IN MEDICAL SCHOOLS

The University at Salerno in Italy had the first non-monastic school devoted to medicine in the West. Although a number of texts can be traced to this famous medical school, mention is made here of only some of the better known. However, none has received careful study from the point of view of a systematic study of its contents. Interest tends to be largely in verifying sources and establishing authorship.

The Antidotarium Nicolai Praepositi is a formulary stemming from Salerno that became the model and source for pharmaceutical compilations for hundred of years following. The Regimen sanitatis Salernitanum, Regimen of Salerno, was an extremely famous text from the Middle Ages through the Renaissance; three hundred manuscript and printed versions of the work have been identified, and it was translated into many languages. It was written at the end of the eleventh century, and was imitated by writers at the medical schools of Montpellier and Paris. Reflecting the medical philosophy of the Italian medical school, the work stresses dietary regulations and simple drugs. The last known translation into English was made in the early seventeenth century. Most information about the work is to be found in secondary sources about the school of Salerno.⁹

Likewise, the book of instruction for physicians at Salerno still exists, but only in Latin. Titled De aegritiudinum curatione, it describes the treatment of diseases from the crown of head down, and then lists the teachings of the teachers of Salerno, one of whom was a woman named Trota, or Trotula.¹⁰ Rhazes (d. 925),¹¹ Avicenna (d. 1037),¹² later Averroes (d. 1198)¹³ and Maimonides (d. 1204)¹⁴ are some of the more famous medieval physicians representing the important Arabic tradition in medicine; medicines and therapeutics are in their writings that were very quickly incorporated into the medicine of the West. The medical schools that soon formed at universities in the West promoted a need for compilations of medical and pharmaceutical knowledge. Some of the better known and widely circulated include Arnold of Villanova's commentary on the Regimen sanitatis in the mid-1200s at Montpellier,¹⁵ Albertus Magnus, the teacher of St Thomas, and his Summa naturalium;¹⁶ and Gilbertus Anglicus's Rosa anglicana or Compendium medicinae.¹⁷

Interesting to pharmaceutical lore, although writings on surgery were separate from medical texts, is an indication that substances were used that produced sleepfulness during an operation. A narcotic such as opium or mandrake was dried and stored, then soaked in hot water; a sponge was used to soak up the water, then it was given to a surgical patient, who was told to breathe deeply through the sponge until he fell asleep.

POPULAR MEDICAL TEXTS OF THE RENAISSANCE

Celsus was a medical writer who was rediscovered in the Renaissance, though he was a Roman who died in a.d. 37. His De re medicina, a work dealing with hygiene, was discovered in a.d. 1426 and was one of first medical texts to be printed.¹⁸ The interest in his and other such books reflects a popular quest for advice on hygiene, an interest reflected in the widespread audience for herbals, books on medicinal plants. The first medical text in French, for example, is called Le Regime du Corps by Master Aldobrandino of Siena.¹⁹ It deals with hygiene and dates from the late thirteenth century. Commentaries on classical medical texts and literature aimed at the laity on personal health made up the bulk of new writings in the field of medicine and pharmacy, but the materials used in remedies did not change appreciably from those of the very early Middle Ages.

Medico-botanical literature developed rapidly in the Renaissance; in many ways it joined art and science, with scientific writings often being illustrated by intricate drawings. Many modern readers are familiar with Renaissance herbals, but they probably do not realize that the nucleus of their information originated in compilations made in medieval monasteries. Toward the end of the fifteenth century, these books were printed for the scientific botanical community and for the laity to use in employing medicinal plants. The roster of printed Renaissance medical works contains many names familiar to the Middle Ages. For example, the Herbarium of Pseudo-Apuleius of the fifth century a.d. was one of the first books of medical plants to be printed, in a.d. 1481, with illustrations.²⁰ The Antidotarium of Salerno was still widely used and translated.²¹ It is important to note that the pharmaceuticals of his fifteenth-century work were the same as those used centuries before him. The Gart der Gesundheit of 1485 had an enormous influence on English books on medical plants, but it too draws upon the plant lore of past centuries.²² At this point, the development of herbal/botanical texts enters the history of botany and really leaves the realm of pharmacy. Much of what is interesting, and unknown, about medieval and Renaissance medicines remains untapped in texts that are no longer used in treatment and seldom seriously studied.

Notes

1. See for example, Dioscorides, De materia medica, edited by Max Wellmann, 3 vols., Berlin: Weidmann, 1958; or The Greek Herbal of Dioscorides: Englished by John Goodyear A.D. 1655, edited by R.T. Gunther, New York: Hafner, 1959.

2. See for example, Galen, Claudii Galeni Opera omnia, edited by K.G. Kuhn, 22 vols., Hildesheim: Olms, 1821-33, reprinted 1964-65; Galen's System of Physiology and Medicine, translated by R.E. Siegel, Basel: Karger, 1968.

3. See for example, Isidore of Seville, the Medical Writings, edited and translated by W.D. Sharpe, Philadelphia: American Philosophical Society, 1964.

4. Hildegard [of Bingen], Liber simplicis medicinae [= Physica], edited by C. Daremberg. In Opera Omnia, edited by F.A. Reuss, Patrologia Latina 197, vols. 739-1038, 1853.

5. Hildegard [of Bingen], Causae et curae, edited by Paul Kaiser, Leipzig: Teubner, 1903; see also K.C. Hurd-Mead, A History of Women in Medicine, Haddam, Conn: Haddam Press, 1938 for a bibliography and discussion of these and other works.

6. See DeVriend and Cockayne, cited at the end of the chapter.

7. See for example Bede, Ecclesiastical History of the English People, edited and translated by B. Colgrave and R.A.B. Mynors, Oxford: n.p., 1969.

8. Benedetto Crespo, Commentarium medicinale, edited by Angelo Mai, n.p., 1833 from a manuscript in the Vatican Library.

9. For these works and others from Salerno, see Collectio Salernitana, edited by S. DeRenzi, 5 vols., Naples: n.p., 1852-1856. See also J.M. Riddle, Contraception and Abortion from the Ancient World to the Renaissance about the legacy of Salerno and for bibliographic information.

10. Scholars have long attributed some works to Trotula whose authorship is now being questioned. Please see John F. Benton, “Trotula, Women's Problems, and the Professionalism of Medicine,” Bulletin of the History of Medicine 59, no. 1, Spring 1985 and Monica Green, “Women's Medical Practice and Health Care in Medieval Europe,” in Sisters and Workers in the Middle Ages, edited by Bennett, Clark, O'Barr, Vilen, and Westphal-Wihl, Chicago: University of Chicago Press, 1989.

11. Rhazes [or Al-Razi]. Modern editions exist only in Arabic. See, for example, his Treatise on Smallpox and Measles, London: Sydenham Society, 1847.

12. Avicenna [or Ibn Sina], Canon of Medicine, translated by R.C. Gruner, London: n.p., 1930.

13. Averroes, Colliget libri VII, in vol. 10 of Opera of Aristotle and Averroes, Venice: n.p., 1562; Medical Manuscripts of Averroes at El-Escorial, Springfield, VA: Al-Ahram Center for Scientific Translations, 1986.

14. Maimonides, Glossary of Drug Names, translated by Fred Rosner, Philadelphia: American Philosophical Association, 1979; and Maimonides, Medical Writings, translated by Fred Rosner, Haifa: Maimonides Research Institute, 1984.

15. Arnaldi de Villanova opera medica omnia, edited by L.G. Ballester, J.A. Paniagua, M.R. McVaugh. Granada-Barcelona: n.p., 1975.

16. Albertus Magnus, Opera omnia, edited by Auguste Borgnet, Aschendorff: Monastery, 1982; also Women's Secrets: a translation of Pseudo-Albertus Magnus's De secretis mulierum, with commentaries. Albany, N.Y.: State University of New York Press, 1992.

17. Gilbertus Anglicus, Compendium medicinae (also known as Lilium or Rosa anglicana), Lyon: n.p., 1510; F.M. Getz, Healing and Society in Medieval England, A Middle English Translation of the Pharmaceutical Writings of Gilbertus Anglicus, Madison: University of Wisconsin Press, 1991.

18. Celsus, De medicina, edited by W.G. Spenser, 3 vols., Cambridge: Harvard University Press, 1938.

19. Aldobrandino of Siena, manuscripts in the Bibliotheque National and Bibliotheque de L'Arsenal.

20. See for example the facsimile edition of this illustrated Latin manuscript, F.W.T. Hunger, The Herbal of Pseudo-Apuleius, Leiden: Brill, 1935.

21. For the bibliography of this work, please see Collectio Salernitana, edited by S. DeRenzi, 5 vols., Naples: n.p., 1852-1856. It is often attributed to Nicholas of Salerno, whose “Antidotarium” was first printed in 1471 at Venice.

22. For bibliography and history of this work, see A.C. Klebs, Catalog of Early Herbals, Lugano, 1925 and “Incunabula scientifica et medica,” Osiris, IV, 1937.

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