What Skeletons Can Tell Us

[source]

Yesterday we mentioned Dr. Sharon DeWitte of the University of South Carolina, who examines skeletons from the Middle Ages to determine what she can about their lifestyle. So far, her research has included over 600 skeletons from the 11th through 14th centuries. She has particularly studied skeletons from the period just before and just after the Black Death. She found something curious:

“I found that a significantly higher number of people were living to really old ages after the Black Death. Many people lived beyond the age of 50 and particularly above the age of 70,” DeWitte said. “I honestly was surprised by how dramatic the difference was in their survival. I’ve analyzed risks of mortality within the pre-and post-Black Death populations, and the preliminary results suggest lower overall risks of mortality after the Black Death.” [source]

She attributes this to a few things: those who survived the Plague were more likely to be from a segment of the population that was healthier to begin with. Also, the population loss led to a food surplus that promoted greater health. We have already noted, for instance, the Statutes of Laborers, rules that were established (again and again) post-Plague to try to keep peasants from moving to other estates. The shortage of laborers meant workers had new opportunities to seek better wages that would lead to better living conditions.

In the future, she intends to collaborate with others to look at genetic variation in humans before and after the Plague. Perhaps she can learn how the massive "die off" perhaps reduced certain genes that made humans more susceptible to Plague, leaving future generations healthier.

Autopsying the Middle Ages

When learning about people in the Middle Ages, you can only go so far with records and archaeology. Sometimes you have to go to the people themselves—and not be dissuaded by the fact that they are dead.

It is said that "dead mean tell no tales"—a phrase nowadays associated irrevocably with Disney's "Pirates of the Caribbean" ride, but probably originated by John Dryden in The Spanish Friar (1681), act IV, sc. i—but in fact we can learn a lot about dead men by examining their bones.

Someone who is learning a lot about the Middle Ages from bones is anthropologist Sharon DeWitte.* She spends her summers traveling from the University of South Carolina to London where she is able to analyze the bones from medieval English skeletons.

What can she tell from skeletons?

DeWitte says where the two halves of the pelvis meet in the front and join in the rear provide consistent signs of adult aging. For children, teeth and the fusing of certain bones are among the best indicators of age. To determine sex, she looks for a wider pelvis in women and a squared jaw and skull made rugged along the forehead and back by testosterone in men.
...
She also examines for linear enamel hypoplasia, or little horizontal grooves that form on the teeth of children whose enamel formation was interrupted by malnutrition or infectious disease. Visible to the naked eye, these defects remain through adulthood and tell DeWitte the ages of when the health disturbances would have occurred.

Tomorrow, we will look at some of the other things she can discern about medieval disease and life-spans, and the surprising conclusions she has come to about the aftermath of the Black Death.

*This post inspired by and drawn from here.

A King, a Cardinal, and a College

Sancho in a contemporary manuscript

King Sancho IV of Castile (1258 - 1295), also known as Sancho the Brave, ruled the combined Iberian kingdoms of Castile, León, and Galicia for a little over ten years. Although his father wished Sancho's older brother, Alfonso, to take the throne, Sancho managed to gain support of the nobles. There was opposition to Sancho, but he offered a change from the elitist policies of his father, which helped maintain his support. Still, he could be harsh to opposition, such as when he executed 4000 followers of an opposition party.

Unfortunately, he could even be harsh to his own supporters. One of his most loyal supporters was Lope Díaz III de Haro—who was, among other things, Sancho's brother-in-law—but Sancho killed him in 1288 during an argument in which Lope threatened Sancho.

On 20 May 1293, King Sancho IV of Castile granted a royal charter to the Archbishop of Toledo to create a university in the city of Alcalá de Henares. It was called the Studium Generale ["School of General Studies"]. The archbishop, Gonzalo Garciá Gudiel, had been born in Toledo but studied at the University of Paris and become rector at the University of Padua. Wishing to create a university in the place of his birth, he convinced Sancho to give him some land and the charter. Sancho called him chanceller mayor en todos nuestros regnos ["great chancellor in all our realms"].

In 1499, an alumnus of the Complutense University (Complutum was the Latin name for Alcalá), Cardinal Cisneros, received a papal bull from Pope Alexander IV (seen here endorsing the Sorbonne) that allowed him to purchase more land for the expansion of the university. In the 16th and 17th centuries, students from all over Europe flocked to study there, in philosophy, canon law, medicine, philology, or theology. Famous alumni included Ignatius Loyola, founder of the Jesuits.

Complutense granted a doctorate to a female student in 1785, 135 years before Oxford even accepted female students! The university grew so large that, in the 20th century, it was moved to Madrid and given more buildings to accommodate its needs.

Richard the LionHeart's Death

Richard's tomb at Fontevraud Abbey

Richard the Lionheart (1157 - 1199) died from complications after being hit by a crossbow shot by a follower of the Viscount of Limoges. But I'm getting ahead of myself...

In March of 1199, Richard besieged the town of Châlus near Limoges, because the lord of Châlus held a Roman treasure that had just been discovered by a farmer plowing his field. Richard, as overlord of the area (he was the Duke of Aquitaine, after all), demanded the treasure. His demand was refused.

On the evening of 25 or 26 March, an archer shot at Richard—who had neglected to put on his chain mail—while he stood outside the walls, driving the shaft deep into Richard's left shoulder. From this point on, things might have gone differently, but carelessness and circumstance had their way with Richard. In pulling out the crossbow bolt, the shaft broke, leaving the head inside. A surgeon removed the head, but did much additional damage to the wound, and infection set in.

Richard knew he wasn't going to live much longer. A message was sent to his mother (but not his wife), Eleanor of Aquitaine, who rushed to his side. The siege was successful while he lay incapacitated, and the archer was brought before him. Although different chroniclers identify the archer as one of four different men, all stories agree that Richard magnanimously forgave the archer, saying "Live on, and by my bounty behold the light of day,"and gave him 100 shillings and his freedom. Sadly, for the archer, Richard's followers had other ideas. Richard died on 6 April, and either Richard's captain Mercadier or Richard's sister Joan (depending on which chronicle you read) had the archer flayed alive and then hanged.

But that's not what I wanted to talk about. I really wanted to discuss what happened to Richard's body afterward, but I seem to have run out of time. We will look at that subject tomorrow.

Skincare for Women

Madonna of the Recommended,
Lippo Memmi (c.1291 - 1356)

Cosmetics were known as far back as early Egyptian culture, so it is no surprise that ways to maintain good skin were known through the Medieval Era. The materials needed for cosmetics were derived from some of the same sources as medicines—such as lily root or white lead—so much cosmetic advice came from physicians.

An example of ideal skin was the 1350 painting by Lippo Memmi, "Madonna of the Recommended." Trotula of Salerno offered recipes for fair skin. "Fair skin" was not necessarily light-colored skin, but referred to smoothness  and a lack of blemishes. A woman could be considered "fair-skinned" if she were a pale Englishwoman or an olive-complexioned Mediterranean. Frequent smallpox epidemics made fair skin a rarity.

There were several ways to treat a less-than-perfect complexion. Rubbing a saliva-coated amethyst over pimples to remove them was one method, or just hold the amethyst over a pot of boiling water and use the moisture that gathers on it.

Hildegard of Bingen (c.1098 - 1179) is known today largely for her devotional musical compositions, but as this blog has noted in the past, she also gave medical advice for, among other things, clear skin:

Pulverize ginger with twice as much galingale* and a half portion of zedoary.** Place in a tied cloth in vinegar and then in wine so it doesn't become too dark. Smear the skin where eruptions are, and he will be cured.

Rosemary, also mentioned previously in this blog, could be mixed with white wine and applied to the face as a beauty treatment. And if you wanted to get rid of freckles, the Liber de Diversis Medicinis ["Book of Diverse Medicines"] from 14th century England (found in the Lincoln Thornton Manuscript in Lincoln Cathedral) suggested the blood of a hare or bull.

I feel compelled to add the caveat: Don't try these at home!

*Galingale was a plant from the ginger family.
**Zedoary is a perennial herb native to India. Also called "white turmeric," it has largely been replaced in western cuisine by ginger.

Medieval Cannabis

Cannabis sativa from the 6th-century
De Materia Medica of Dioscorides

I was contemplating a post about Easter, which takes place this Sunday. Since Easter takes place on the date 4/20, however, and since "4/20" is a counter-culture reference for smoking marijuana, I started wondering about the use of marijuana in history, specifically (of course) in the Middle Ages.

One website tells us that:

... cannabis use was reintroduced into Europe after the Dark Ages, when the Knights Templar, founded by Hugh de Payns (“of the Pagans”) around the beginning of the twelfth century, became involved in a trade of goods and knowledge with the hashish ingesting Isma’ilis. [Source]

Another explains its uses:

In the Middle Ages cannabis was used for its psychoactive effects as well as commercially. Its use as a mind-altering drug was widespread in Egypt and seems to date from around the 13th century. In medieval Europe cannabis appears to have been employed as a folk medicine, particularly for the treatment of toothache and rheumatism, and in childbirth. [Source]

Dioscorides in his De Materia Medica [Concerning Medical Materials] describes and illustrates cannabis sativa:

Kannabis; is a plant of much use in this life for the twisting of very strong ropes, it has leaves like to the Ash, of a bad scent, long stalks, empty, a round seed, which being eaten of reduces sexual activity, but being juiced when it is green is good for the pains of the ears. [Book III]

Here we recognize the lethargy that accompanies cannabis use.

Use of the plant for its fibers seems to have been very important to the Medieval and Renaissance eras. Henry VIII decreed in 1533 that "for every sixty acres of arable land a farmer owned, a quarter acre was to be sown with hemp." (Henry wanted to make sure he had plenty of source material for the rope that was vital to a strong naval effort.) A BBC report in 2001 presented the claim that pipes dug up in the backyard of Shakespeare's Stratford home had the remains of burned cannabis seeds. The investigation was in response to a reading of Sonnet 76 which mentions "invention in a noted weed." (Note: the pipes could not be traced definitively to Shakespeare's time at that address.)

Knowledge of cannabis was certainly available to the Middle Ages, but there is no evidence that it was used in a manner similar to its contemporary recreational use.

The Invention of Acne...

A copy of his work [source]

...was a typographical error.

The word "acne" does not come from a classical language root; that is, not in the way we usually derive our modern medical terms. It was described by a Greek physician and then mis-transcribed in a later volume of his work.

Aetius of Amida was a contemporary of Theodoric the Great (454 - 526; mentioned here in connection with Grammar). He was known for the breadth of his learning; his writings show a great knowledge of those who came before him as well as personal skill. He came out of Mesopotamia and learned medicine at Alexandria, known for its medical school.

His famous work was Sixteen Books on Medicine, in which he compiles knowledge from Galen and others of whom we would otherwise have little information: the surgeons Rufus of Ephesus and Leonidas, and the obstetricians and gynecologists Soranus of Ephesus and Philumenus. He is not completely derivative, however. He includes original treatments for eyes, ears, nose and throat, as well as goiter and rabies and others. He also addresses surgical procedures such as for a fistula or tonsilitis.

Although a Christian, he was not immune to the cures that came from non-Christian sources. He relates spells and charms popular in Egypt at the time. Also, in explaining how to help a person suffering from a bone stuck in the throat, he makes the earliest reference to St. Blaise.

As for the condition in which the skin is covered with small eruptions or peaks, he used the Greek word ἀκμή ["acme"; point]. Unfortunately, a scribal error in a later copy turned this into ἀκνή ["acne"]. The popularity of his text made this the common name for the affliction, and so it remains.

Conjoined Twins

from a 1499 woodcut by Jacob Locher

Hippocrates was aware of the phenomenon of conjoined twins, and offered an explanation: the male provided too much seed for just one being and yet not enough for two.

Whatever the reason, antiquity and the Middle Ages were well acquainted with this occurrence. Not everyone would have had opportunity to see an example of conjoined twins—there's no evidence that Hippocrates himself ever saw or "treated" such a case—but some who did witness the phenomenon wrote about it. One eyewitness was Leo Diaconus, or Leo the Deacon.

Leo the Deacon was a Byzantine historian who was born about 950. After 992 he started a history of the Empire, for some reigns of which he is our only source. His writing style has been criticized, but his facts have not. He reports:

At this time male twins, who came from the region of Cappadocia, were wandering through many parts of the Roman Empire; I myself, who am writing these lines, have often seen them in Asia, a monstrous and novel wonder. For the various parts of their bodies were whole and complete, but their sides were attached from the armpit to the hip, uniting their bodies and combining them into one. And with the adjacent arms they embraced each other’s necks, and in the others carried staffs, on which they supported themselves as they walked. They were thirty years old and well developed physically, appearing youthful and vigorous. On long journeys they used to ride on a mule, sitting sideways on the saddle in the female fashion, and they had indescribably sweet and good dispositions. [Leo Diaconus]

The pair lived for several years, apparently making appearances around the Eastern Empire (perhaps earning money for some 10th century P.T.Barnum). Eventually, one twin died.

...skilled doctors separated them cleverly at the line of connection with the hope of saving the surviving one but after living three days he died also. [Theophanes Continuatus]

A history written in the 11th century has an illustrated page for the case of these conjoined twins. You can see the pictures here.

[Today's post is inspired by a recent item on medievalists.net, a blog I recommend.]

Hildegard of Bingen, MD

Hildegard of Bingen (1098 - 1179) has been discussed here before, and many know her as a nun and composer of devotional music. Her compositions have been adapted by numerous musical and spiritual groups. Among her writings, however, were also works about the natural world and medicine.

Two works in particular date to the 1150s. Physica ["Physics," or "The Physical World"] is her attempt to explain the whole world from the elements (the four: earth, air, fire, water) to all animals and plants, and even metals and stones, both ordinary and precious gems. One theme that runs through this work is the Genesis-based idea that Man has been given dominion over all the Earth. Everything on Earth has been put there by God, and therefore everything has value, and therefore Man can benefit from everything God put on Earth, from nourishment found in plants and animals to the material value of gems.

The other book was Causæ et Curæ ["Causes and Cures"]. In it, she lists 47 different diseases. Whereas in Physica she listed 200 herbs and other plants, in Causæ et Curæ she describes over 300 plants that are useful for medical use. She might not have had personal experience of all these, since she would have had access to standard texts from such as Pliny and Galen and Isidore of Seville. She wouldn't be the first or last to borrow from Pliny and the others.

She would not, however, give medicines the final say in the treatment of illness:

Hildegard gave physical events, moral truths, and spiritual experiences equal weight. Healing was both medical and miraculous, and God’s will was an important element in her remedies. “These remedies come from God and will either heal people or they must die, for God does not wish them to be healed,” she wrote. [source]

It wasn't just up to God and the herbals. She also believed in using rituals bordering on the magical as part of the healing process. She claimed betony leaves placed next to the bed would reduce bad dreams. Sadness could be countered by mandrake: mandrake she believed was made from the same earth that made Adam. If a sad man dug up a mandrake root, washed it in a fountain for 24 hours, then took it to bed, he could alleviate his depression after reciting: “God, who madest man from the dust of the earth without grief, I now place next me that earth which has never transgressed in order that my clay may feel that peace just as Thou didst create it.” [source] And marshmallow (the plant, not the sweet confection made from it) could counteract evil magic!

Hysteria

from a Latin copy of Gynæcology by Soranus of Ephesus

Hysteria describes two different states: exaggerated or uncontrollable emotion or excitement, and as a psychological disorder in which psychological stress can manifest physical symptoms. The word is derived from the Greek word for uterus, ὑστέρα [hystera]. Hysteria was once assumed to be solely a female medical problem.

It seems to have started with Hippocrates (c.460-c.370 BCE), who maintained that men and women had entirely different bodies: men's humors were hot and dry by nature, women's were wet and cold. Women also had different processes, such as menstruation. Hippocrates did not pass judgment on these differences; they merely needed to be addressed by the practitioner of medicine.

Aristotle (384-322 BCE), however, had other ideas. He postulated that processes like menstruation could be harmful to men, who should avoid women during that time. He also felt men's bodies were perfect and women's were flawed. Women were irrational and unbalanced—literally "unbalanced," because he believed that the uterus "wandered" in the body.

By the time medieval medicine came along, the authority of Aristotle made it clear: over-emotional women were suffering from being unbalanced because of their womb. Hysteria could be treated by removing the source of the unbalance, and the hysterectomy was "born." (Sorry.) Unfortunately, as summarized in this abstract:

The procedure was performed by Soranus of Ephesus 120 years after the birth of Christ, and the many reports of its use in the middle ages were nearly always for the extirpation of an inverted uterus and the patients rarely survived. [source]

The procedure wasn't considered remotely safe until antiseptic techniques began in the 19th century. Even so, it wasn't until the 20th century that diagnoses of hysteria declined, possibly because the general public came to understand that "hysteria" was too easily used as a label for anxiety.

Marshmallow

Yes, marshmallow. (Maybe Halloween has put me in mind of sweets.)

Althaea officinalia (the "marsh mallow") is a perennial that grows wild in salty marshes. Egyptians discovered that the root contained a sweet sap that could be used to sweeten cakes. The delicacy was reserved for Pharaohs.

The Greco-Roman world embraced the substance in mallows and believed it had medicinal value. The 1st century Dioscorides (cribbing from Pliny) wrote:

boiled in ... wine or chopped on its own, it works against wounds, tumors of the parotid gland[*], swellings in the glands of the neck, abcesses, inflamed breasts, inflammations of the anus, bruises, swellings, tensions of the sinews ... It works also against dysentery, blood loss and diarrhoea. [Hippocratic Recipes: Oral and Written Transmission of Pharmacological Knowledge in Fifth- and Fourth-century Greece, p.264]

Medieval Europe, willing to try anything suggested by the Classical world, discovered how sweet the mallow concoctions were and started using them as a sweet treat—with the bonus of them being healthful. An Italian cookbook of the 1400s—De Honesta Voluptuate et Valetudine [On Right Pleasure and Good Health], by Bartolomeo Platina—suggested several ways to season the substance. Medieval monks grew the mallow for its sweetness and medical properties. Herbalists turned it into treatments for sore throats and coughs, indigestion and toothache.

The marshmallow sap was used for liquids in the Middle Ages; it was 19th century French confectioners who whipped it into a solid candy by mixing it with egg whites and corn syrup. Nowadays it can be made without any recourse to the mallow plant. My personal favorite recipe is here (you would be surprised how easy it is to make, and how sticky it is to work with after it has "set"). If you would rather make it from actual marshmallow root, go here.

*The "parotid gland" is a salivary gland in the back of the mouth.

St. Anthony's Fire

Victims of ergotism by Peter Bruegel

Diagnosing medieval diseases has its difficulties. Modern research must rely on accurate recording of symptoms and knowledge of potential causes. And yet, we manage to estimate the likeliest causes of the ailments of long-gone centuries.

Geoffroy du Breuil of Vigeois was a Benedictine who recorded events from 994-1184 in his Chroniques. He mentions preparations for the First Crusade and the Cathar heresy. He also talks about an outbreak in France of an illness that caused rampant gangrene. This is believed to be a case of St. Anthony's Fire.

St. Anthony's Fire was so-called because it was most successfully treated by monks of the Order of St. Anthony. The order was founded in 1095 by Gaston of Valloire and his son, because the son had been cured from the symptoms by the relics of Saint Anthony the Great. The symptoms of St. Anthony's Fire were not only gangrene that caused limbs to fall off but also convulsions, diarrhea, psychosis, headaches, nausea, vomiting, and an uncontrollable itching feeling.

Now we equate St. Anthony's Fire with ergotism, caused by the fungus Claviceps purpurea which infects rye, barley, and other grains. Ergotism also explains a plague in 857, mentioned in the Annales Xantenses. It is also a proposed explanation for anecdotes of bewitchment found in the Middle Ages and later, including in Puritan New England.

A Pain in the Ass

(I apologize if the title—or the topic—is too crude for some.)

The poor fellow to the right (the one half showing) is suffering from an anal fistula, described thusly:

... a small channel that can develop between the end of the bowel and the skin near the anus.
... can cause bleeding and discharge when passing stools - and can be painful. ...
In some cases, an anal fistula causes persistent drainage. In other cases, where the outside of the channel opening closes, the result may be recurrent anal abscesses. The only cure for an anal fistula is surgery. [WebMD]

Nowadays it is called a "pilonidal cyst." At the very least, inconvenient; in many cases, extremely painful, especially when sitting down.

At a time when many men spent long stretches of time bouncing on horseback, these fistula-in-ano (to give it the Latin phrase) were debilitating. Fortunately, soldiers of Edward III's time had a solution in the skill of John of Gaunt's favorite physician and surgeon.

John Arderne (1307-1392) left us very little information about his early life. It seems he was a surgeon in Nottinghamshire. During the Hundred Years War, he probably traveled with the army; his writing suggests a well-traveled man with wide experience of the world as well as medical practices.

He produced the definitive work on treating this particular medical problem. His writing describes the cause and the treatment, and describes the surgical instruments needed for his procedures. He also shows knowledge of Galen & Guy de Chauliac, Avicenna, and Dioscorides.

Arderne was ahead of his time in some ways. He advised opium to dull pain during surgery, and the code of conduct proper for a physician. In the matter of fees, he was fine with charging a rich patient whatever the traffic would bear, but felt that the poor should be treated for free. He was also a great believer in cleanliness, and in not fussing with a wound once treated, but allowing the healing process to proceed untampered with.

That is not to say that he was "modern." He also subscribed to the belief that parts of the body were aligned with astrological signs, and that the time of the year could influence the efficacy of surgery on parts of the body.

Avicenna

In 1527, when the healer and alchemist Paracelsus wanted to display his contempt for tradition, he burned a book in the town square in Basle, where he had been appointed to the university by the town council. That book, allegedly, was The Canon of Medicine by Avicenna. Paracelsus had gone too far in rejecting what was still considered a fundamental work in western medicine. He was ejected from his post at the University, and from the town itself. Avicenna was too respected, even 500 years after he wrote his books.

Abū ʿAlī al-Ḥusayn ibn ʿAbd Allāh ibn Sīnā, called by the West Avicenna (c.980-1037), was mentioned here in the context of medicine. About 40 of the 240 surviving texts that he wrote (of a total of about 450!) deal with medicine. The encyclopedic Book of Healing and the Canon became standard textbooks for centuries.

The Canon assembled the best known medical knowledge to date, including Galen (129-c.200 CE) and Hippocrates (c.460-c.370 BCE) and adding a great deal of information that seems new to Avicenna. For instance:

The 'Qanun' is an immense encyclopedia of medicine. It contains some of the most illuminating thoughts pertaining to distinction of mediastinitis from pleurisy; contagious nature of phthisis*; distribution of diseases by water and soil; careful description of skin troubles; of sexual diseases and perversions; of nervous ailments. [George Sarton, Introduction to the History of Science]

Another reason why Paracelsus would want to burn Avicenna: Paracelsus was advertising his reputation as an alchemist, and believed that with salt, sulphur and mercury you should be able to produce anything. Avicenna, however, was completely opposed to the idea of alchemy, rejecting the notion that man could improve on Nature.

One could still work with Nature, however. Besides dealing with disease and injury (such as explaining how to judge how much healthy tissue could be removed during an amputation or the removal of cancerous tumors), Avicenna promoted restoring health, not just treating disease. He believed in the importance of physical exercise, of a good diet, and of a healthful environment.

Among other innovations, he lays the groundwork for modern ophthalmology, even suggesting that the optic nerves cross over each other. He laid out careful ground rules for the preparation, administration, and testing of drugs.

It has been called "one of the most significant intellectual phenomena of all times."** The Canon of Medicine is an essential part of any curriculum that studies the history of medicine.

*tuberculosis
**Swiss tuberculosis expert, Arnold Klebs

Sugar, Short & Sweet

In a few parts of the world today, children are gorging on their haul of candy from trick-or-treating last night. The makers of candy out-do themselves yearly in producing variations on sugar and chocolate and color and texture, et cetera. But there is hardly anything in children's sacks and plastic jack-o-lanterns today that does not contain sugar.

A medieval merchant weighs sugar for sale

It was soldiers of the Persian Emperor Darius who reported finding, near the Indus River in 510 BCE, reeds which produced honey without bees. Nothing was made of this discovery, but Alexander the Great in 327 BCE learned of it and spread the knowledge to the Mediterranean. By 95 CE, this substance was well-known to the point where the Periplus Maris Erythræi (Guidebook to the Red Sea) could say there is "Exported commonly ... honey of reeds which is called sakchar." Not only may this be the first recorded evidence of sugar cane, it is probably also the origin of the later term saccharine.

But let's skip a bit to the European Middle Ages. According to one scholar, the Muslim conquest of Sicily would have introduced sugar to the West:

"Practically all the distinguishing features of Sicilian husbandry were introduced by the Arabs: citrus, cotton, carob, mulberry, both the celso, or black and the white morrella-sugar cane, hemp, date palm, the list is almost endless." — The Barrier and the Bridge-Historic Sicily, Alfonso Lowe (1972)

When William II of Sicily (1155-1189) built the Benedictine Abbey of Monreale and made it the largest landowner in Sicily after the Crown, it became one of the largest manufacturers of processed sugar in Europe.

Sugar was wonderful, like honey before it. It could be used to sweeten food, make medicine more palatable, and produce new kinds of drinks. It also could add a decorative touch to food: either by adding sparkle to fruit dusted in sugar crystals, or by caramelizing to a lovely brown on cooked foods.

Still, sugar was not as common as everyone would have liked. In 1226, Henry III (1207-1272) had difficulty finding 3 whole pounds needed for a banquet. Before long, however, production and trade must have increased, because only a generation later, in 1259, Henry could have bought that pound of sugar for only 12 shillings (ginger was 18 shillings, and a pound of cumin was only 2).

To see a collection of recipes from the Middle Ages for sweets, many of which used sugar, see here.

The First Female Professor of Medicine

The medical school in Salerno had on its staff the first well-known female physician and professor of medicine. Sadly, we know nothing of her personal life, not even her dates: her existence at Salerno in the 11th or 12th centuries is inferred from the handful of texts she wrote or contributed to. Fortunately, her texts were considered important enough that they were preserved and copied, translated and distributed throughout Europe.

Trotula

Her name was Trotula (listen here for pronunciation), and we find it on several texts. The best-known is the three works collectively known as La Trotula.

• Conditions of Women—based on the Latin translation of an Arabic work, with additions of several Latin-based passages that had been around for awhile.
• Treatments for Women—"a disorganized collection of empirical cures with only a thin theoretical overlay."*
• Women's Cosmetics—a head-to-toe listing of ways to beautify all aspects of a woman's appearance, with no medicinal applications.

Although there are conditions that make no sense to modern medicine (such as a "wandering womb"), there are also techniques that we would consider very sound, such as using opium on the patient during childbirth (defying church tradition that women should suffer; see Genesis 3:16), and using silk thread to repair tears that occur in childbirth.

Some scholars have attributed these works to a man, perhaps through simple chauvinism, but also because it is believed that the frank addressing of gynecological topics would be too indelicate for a female author of the era. The author of La Trotula, however, self-identifies in the texts as a woman, and the analysis of history is always turning up surprises that challenge modern notions of medieval sensibilities. Also, in Chaucer's Canterbury Tales, the book of wicked wives read by the Wife's husband Jankyn includes the name "Trotula." However little we may know of her now, it seems she developed a reputation that preserved her name for at least a couple centuries after her prime.

*Quotation from The Trotula: An English Translation of the Medieval Compendium of Women's Medicine, by Monica Green.

The Edict of Salerno

Salerno, located on the lower "shin" of Italy's southwest coast, has been occupied continuously since pre-historic times, frequently changing hands due to the many wars in the peninsula. Despite the changing political landscape, however, at least one feature of Salerno rose to a prominence that it held for several centuries, through several political shifts.

We don't know precisely when the Schola Medica Salernitana (Medical School of Salerno) was founded, but at some point, the dispensary of a 9th century monastery became a focal point for medical study and earned the title of the first medical school in history. Because of the fame of the school, Salerno became known as the "Town of Hippocrates."

The School today.

One of its unique qualities for the time was that it not only was well-versed in the Greco-Roman traditions of Hippocrates, Galen, Dioscorides and others. Its proximity to North Africa and Sicily gave it access to Arabic learning (Sicily was under Arab control from 956 until 1072). In fact, it was the arrival in 1077 of the Tunisian Muslim merchant-turned-monk Constantinus Africanus that started a Golden Age at the school. He compiled the Liber Pantegni (Book of All Arts).  It was (as is typical for the time) largely a collection of the work of others, but it drew together Greek and Arabic medical knowledge in what is called the earliest surviving Western medical treatise [source].

Salerno produced other medical texts as well. A 12th century pair named Johannes and Matthaeus Plantearius wrote the Liber de Simplici Medicina (Book of Simple Medicine). Several books on gynecology and cosmetics were created by the most famous woman doctor of the time.

Salerno thrived, even after Holy Roman Emperor Frederick II declared the Edict of Salerno. The Modern Age would approve of the Edict: it created a legal separation between physicians and apothecaries. Physicians could no longer prescribe medicines that they themselves prepared and sold. The Edict also fixed prices to prevent overcharging the sick. Over time, this Edict was copied throughout Europe, and we have reason to be glad that similar regulations exist today.

Great Surgeon

The history of medicine includes many brave and progressive thinkers who were not willing to follow the herd or be content with what was already known. One such in the Middle Ages was Guy de Chauliac. Born about 1300, he studied at a university in Montpellier known for its expertise in medicine. After becoming a Master of Medicine and Surgery around 1325, he went to Bologna for further study. His reputation became such that he was invited to Avignon to be personal physician to Pope Clement VI, then Pope Innocent VI and Pope Urban V. The papal connection gave him access to a library that included the texts of the Greek physician Galen in their original; most of Europe knew Galen through less accurate Latin translations.

He possibly saved Clement's life during the spread of the Black Death, when he advised the pope to stay near blazing fires. Although many physicians fled Avignon at the arrival of the Plague, Chauliac stayed to study the disease and treat people. He determined that it was contagious, but couldn't figure out the method of contagion. Still, he advised bloodletting, a healthy diet, and exposure to pure air (hence the fires, which would have serendipitously served to keep fleas away). He also realized that there were two diseases involved because of different sets of symptoms: the initial Bubonic Plague, and the follow-up Pneumonic Plague which found its foothold in the weakened population and killed much more swiftly. Chauliac spoke out strongly against those who blamed the Jews for the Plague, explaining that scientifically it made no sense to consider them at fault.

Tools for withdrawing an arrow.

His value to the rest of the world and history was the writing of Chirurgia magna (Great [book of] Surgery) in 1363. Its seven volumes covered every imaginable medical topic of the day: intubation, surgery, disease, anesthesia, hernia, cataracts, ulcers, bloodletting, cauterization of wounds, and the use of special instruments (some of which he designed himself, such as an elaborate contraption for withdrawing an arrow from flesh). Chauliac drew on the past, quoting Galen (129-c.200) and Avicenna (Abu Ali al-Husayn ibn Abd Allah ibn Sina, c.980-1037). He placed great emphasis on learning anatomy, saying that "A surgeon who does not know his anatomy is like a blind man carving a log."

Chauliac was not always accurate. He believed, for instance, that pus was an important part of the healing process and should be left alone. Nevertheless, his Chirurgia became a standard text for the next three centuries, translated into several European languages. Unfortunately for future generations, anti-Islam sentiment caused many translators to leave out knowledge from Islamic scholars, resulting in a less complete and less accurate work. Still, he has been labeled the "Father of Modern Surgery," and his great work was the standard text until the 17th century.

Leechbooks

A leechbook was a collection of remedies, called so because a physician or surgeon was called a "leech." Bald's Leechbook is a very early (9th century) example.

It contains the only known plastic surgery procedure in an Anglo-Saxon text:

For hare lip, pound mastic very small, add the white of an egg, and mingle as thou dost vermilion, cut with a knife the false edges of the lip, sew fast with silk, then smear without and within with the salve, ere the silk rot. If it draw together, arrange it with the hand; anoint again soon.

We don't know if this is just theory, or if it were actually put into practice with the desired results.

Bald was not the author, and not likely a medical man. A Latin colophon at the end states:

Bald habet hunc librum Cild quem conscribere iussit
"Bald owns this book which he ordered Cild to compile."

Cild may have been someone with medical experience as well as being the organizer of the book, or he may have simply been a copyist who brought together various sources for Bald. Two doctors are mentioned in the book, Dun and Oxa, but we don't know much else about them.

The leechbook is organized into two volumes, dealing respectively with external (such as skin, teeth, or ear) and internal (such as upset stomach, jaundice, or vomiting blood) problems. The surgery is in part one. This organization is different from many other leechbooks and collections of knowledge, which often gather together every bit of lore known to the author without much regard for categorization. Another collection is a late 10th/early 11th century manuscript named Lacnunga (Anglo-Saxon for "Remedies") by its 19th century editor. It uses Anglo-Saxon and Latin to list medical knowledge, remedies (some the same as in Bald's), prayers, charms and incantations, and some Old Irish poetical prayers for health.

Both are found in the British Library. A 19th century searchable edition of Bald's can be found here.