Medical Knowledge

Medical knowledge in the early medieval period

Understanding of the human body and the treatment of illness in the Middle Ages derived from the works of classical authors as well as contemporary scholars. Taylor McCall examines popular medical texts and their circulation before 1200.

How did early medieval people treat illnesses and injuries? In general, medical texts from the period of 700–1200 are relatively rare. Most remedies for curing ailments were probably not written down, but passed orally from person to person and family to family. Many people were illiterate and would have had little use for medical books, which were often concerned with theoretical ideas about medicine rather than providing practical cures. Still, there are some surviving manuscripts that shed light on the medieval understanding of why people got sick, and what could be done to make them better. 

Early medieval medicine

In general, early medieval medical texts were based on the writings of the ancient medical authorities, especially Hippocrates (b. c. 460, d. c. 375 BC) and Galen of Pergamum (b. 129, d. c. 216). Treatises attributed to Hippocrates date to the 5th and 4th centuries BC, and modern scholars have concluded ‘he’ was not a single person, but rather a group of physicians writing under the same name. The Hippocratic authors explained that the body was made up of four liquids known as the humours: black bile, yellow bile, blood and phlegm. Each person had his own particular humoural makeup, and illness was thought to occur when the humours were unbalanced. Healing meant restoring balance through a variety of methods, such as alteration of diet, drawing blood from certain areas of the body, or making herbal remedies. The Greek physician Galen is the only other medical author to gain the same level of prominence as the mythical Hippocrates. Galen served as physician to the son of a Roman emperor, and in addition to his extensive writings on illness and disease, was renowned for his anatomical and surgical experiments.

Texts attributed to Hippocrates and Galen formed the backbone of early medieval medicine. After the fall of the Roman Empire in 476, the seat of power moved from Rome to Constantinople. Europe, previously united by the infrastructure and security provided by the Empire, fractured into small kingdoms and city-states, mostly disconnected from each other. Although many works by Galen and Hippocrates were lost following the fall of the Empire, some were translated into Latin, and together they gradually evolved into a standard set of medical texts beginning in the 6th century. Few original medical works by Western authors were written during this period; instead, monasteries tried to compile and preserve existing writings. 

Herbals and the properties of plants

Among the most popular medical texts to survive from this post-Rome period are those containing plant-based remedies, known collectively as herbals. Herbals describe the properties of various plants and their uses, particularly medicinal ones. The most famous herbal author was the Greek physician Dioscorides (b. c. 40, d. 90), who was active in the 1st century. Dioscorides’s work became known in Europe as the Herbarium, the word for ‘herbal’ in Latin. Another popular herbal text in the early Middle Ages was an adaptation of the Herbarium attributed to an otherwise unknown late Antique author called Pseudo-Apuleius. Pseudo-Apuleius’s herbal was often combined with other treatises, including remedies that could be drawn from animals, to form what is known today as the Pseudo-Apuleius Complex. 

Dioscorides, Liber de virtutibus herbarium

Latin 12995, f. 4r

An early translation of the Herbarium of Dioscorides (BnF, Latin 12995, f. 4r)

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Herbal texts circulated in relatively high numbers in both France and England during the early Middle Ages, a testament to their importance in medical practice. One of the earliest translations of Dioscorides’s five-book Herbarium (now BnF, Latin 12995), Dioschoridis liber de virtutibus herbarum (Dioscorides’s Book on the Properties of Plants), dates to the first half of the 9th century. This manuscript is one of only three surviving complete Latin translations of this work produced before the 11th century. It was created as part of the ‘Carolingian Renaissance’, a surge in the production of texts in the Carolingian empire as a result of the emperor Charlemagne’s (r. 768–814) efforts to establish his courts as places of learning. The Dioscorides was probably produced in the monastery of Saint-Martin in Tours, a place closely associated with the Carolingian Renaissance. Written in a clear and even Caroline miniscule, a simple script popular in the court of Charlemagne, the manuscript contains no illustrations or decoration beyond a single ornamented initial at the start. 

The Old English Herbal

In contrast to this unadorned Latin herbal is its magnificent Old English cousin, dating to a few hundred years later: now British Library, Cotton MS Vitellius C III, made in England in the first quarter of the 11th century. The manuscript is the only Old English version of the herbal that is illustrated. It features many stylised and vibrant images of flora and fauna, sometimes several images on a single page. These images, however, are not meant to be accurately observed, naturalistic representations of plants and wildlife. Rather, they serve as engaging visual markers for readers, to assist them in remembering the specific attributes of each plant.

Old English Illustrated Herbal

Cotton MS Vitellius C III, f. 27r

Colourful illustrations of flora and fauna are embedded throughout the text of the Old English Herbal (British Library, Cotton MS Vitellius C III, f. 27r)

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England produced the largest group of vernacular medical writings before the 12th century. The Old English Herbal was probably translated from the Latin original by English Benedictine monks, who would have had access to Continental Latin texts through their monastic connections in the late 10th or early 11th century. It was probably translated into the vernacular because Latin was not accessible to all those attempting to consult the text. In addition to this manuscript, there are only three other known herbals in Old English, while there exist dozens of Latin copies. 

An example of a Continental medical text that was not translated into Old English upon reaching England is now British Library, Sloane MS 1621, a composite manuscript made up of several different medical texts. Copied in Bury St Edmunds in the fourth quarter of the 11th century, this manuscript includes the Antidotarium (Book of Antidotes) and various medical recipes, combined with a few prayers and texts on music. Like the Paris Herbarium, the Antidotarium is not illustrated. 

Antidotarium and medical recipes

Sloane MS 1621, f. 17r

A text page from the Antidotarium (Book of Antidotes) (British Library Sloane MS 1621, f. 17r)

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Public Domain in most countries other than the UK.

The most common medical illustrations dating to before 1200 were those of plants associated with the herbal tradition. The Old English Herbal is among the most lavishly illustrated texts of any genre, attesting to its significance, but it is important to note that most early medical texts would have been plainly written, often as compilations of diverse texts written by different scribes. Why were certain early medical manuscripts illustrated and others not? This is a complicated question, but we can surmise from existing manuscripts that some illustrations circulated alongside a few particular texts that benefitted from pictorial supplements, like herbals. Those consulting an illustrated herbal might be able to remember the properties of a particular plant based on the image in the manuscript. 

Cautery procedures illustrated

In addition to herbals, one of the few types of medical illustrations were those of cautery procedures. Cautery was the practice of applying hot irons to the skin in certain places to create ulcers from which diseased fluids could be drained—sounds like fun, right? Cautery points were also applied to draw specific humours from one place in the body to another. First mentioned by Hippocrates, cautery texts described the exact positions on the body where a doctor was meant to apply the irons, at what time of the month, and for what purpose. Certainly not something you would see a doctor of today prescribing; imagine the pain! 

Illustrated account on cautery points and medical recipes

Sloane MS 2839, f. 1v

A surgeon heating cautery irons and a naked man with cautery points (British Library, Sloane MS 2839, f. 1v)

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Another compilation of medical treatises (now British Library, Sloane MS 2839), shows us how cautery was practiced through large and clear drawings. Possibly produced in England in approximately 1100, the cautery images and text are combined with other theoretical medical writings that were common in both France and England at the time. The cautery section is on the first several pages of the manuscript. Several nude male patients are decorated with black dots, indicating where the irons ought to be applied for the specific ailment described in the captions above the figures. A practitioner is drawn twice; on the first page, he removes a cautery iron, shown heating up in a stoked fire (ouch!), and later, he approaches a patient holding an iron and a bowl. The bowl was perhaps to catch the fluids once drained from the burn. Ouch again! 

Circulation of medical texts

Medieval medicine changed forever in the 12th century, when previously lost texts started to filter into Western Europe from the Middle East, where they had been translated and, in many cases, added by Islamic physicians. This opening up of trade and ideas between East and West was a direct result of the First Crusade by European Christians to reconquer Jerusalem from Muslim rule between 1095 and 1099. The subsequent influx of both objects and ideas into Europe has been called the ‘twelfth-century Renaissance’, a period of social, economic, and political transformations. The earliest evidence of new medical works as a result of this exchange is found in the translations of a monk called Constantine the African (d. before 1098) of the Benedictine abbey of Monte Cassino in Southern Italy. Constantine appears to have brought medical texts to southern Italy from his native northern Africa, where he translated them from Arabic into Latin. Constantine’s translations were taught in the nearby medical community of Salerno and gradually began to circulate throughout Europe.

Constantine the African, De Melancholia

Burney MS 216, f. 94r

Opening page of De Melancholia (On Melancholy) by Constantine the African (British Library, Burney MS 216, f. 94r)

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Public Domain in most countries other than the UK.

As with pre-12th century texts, the majority of these new treatises were not illustrated. Many texts were bound together into single reference volumes. A translation of Constantine the African’s work was inserted into a wide assortment of other texts in an English compilation, now British Library, Burney MS 216, produced in the third quarter of the 12th century. Unusually, we know exactly where this manuscript was made: the Augustinian priory of the Holy Trinity or Christ Church, Kirkham, Yorkshire, founded c. 1122. The brief text by Constantine the African is De Melancholia (On Melancholy), included amongst a variety of popular historical and philosophical texts. 

This manuscript serves as an indication of how widespread Constantine’s translations were across Europe less than a hundred years after his death, and also acts as an example of how many books of the period were arranged: compilations of various topics, and largely unillustrated. An example of a typical medical compilation from this period was produced in the first half of the 12th century in southern England (now British Library, Royal MS 12 E XX). It includes two commentaries on Hippocrates, several texts attributed to Galen, an anonymous text on diet, and several medical charms and recipes. The majority of the texts are written in Latin, but there are a few things written in Old English, too.

English collection of medical treatises

Royal MS 12 E XX, f. 33r

Opening page to Galen, De arte curativa ad Glauconem (Therapeutics to Glaucon) (British Library, Royal MS 12 E XX, f. 33r)

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Public Domain in most countries other than the UK.

The manuscripts discussed here—herbals, cautery texts, and assorted compilations—are a small sample of the medical books circulating in the early Middle Ages. Whether decorated or plain, illustrated or simple, each reveal something about the way medieval people thought of their bodies and their health. They also serve as important reminders that people have always done whatever they could to keep loved ones and strangers alike from illnesses and injuries.

  • Taylor McCall
  • Dr Taylor McCall received her Ph.D. in History of Art from the University of Cambridge in 2017. Her work focuses on the material culture of medieval medicine, specifically the role of anatomical diagrams as epistemological tools. Her research has recently been supported by a postdoctoral fellowship with the Paul Mellon Centre for Studies in British Art. She has served as a Teaching Fellow at University College London, the American Doctoral Volunteer in Ancient, Medieval, and Early Modern Manuscripts at the British Library, and most recently worked at the Walters Art Museum in Baltimore, Maryland.