Victoria Sweet enters the crowded field of scholarship on Hildegard of Bingen with the intention of examining Hildegard's medical writings to reveal their "significance for interpreting the rest of her work, and its utility for the history of medicine" (39). More broadly, Sweet aims to examine Hildegard's theoretical system of elements, humors and qualities in order to understand its explanatory power and determine the extent to which this system might have been influenced by practical observation and the ways in which it "could have been used by a real medical practitioner responsible for real patients" (5). In order to answer these questions, Sweet proposes using an "anthropological approach" to understand pre-modern medicine from the point of view of an individual practitioner. Sweet argues that Hildegard of Bingen is an excellent candidate to reveal the relationship between theory and experience in medical practice, precisely because she was a practitioner who wrote a practical manual of medicine, not an academic physician whose writings would be aimed more at advertising his theoretical knowledge than at reflecting his actual practice.
After the introduction, the book is divided into five chapters and a conclusion. The first two chapters provide a brief biography for Hildegard, identify her medical writings and, in particular, argue that Hildegard wrote the manuscript, Causes and Cures. The next three chapters examine Causes and Cures in detail, and explore, respectively, the treatment of elements, humors and the concept of viriditas in the text. Sweet provides an appendix in which she considers "the only surviving manuscript of Disibodenberg's library" in order to see what it can reveal about life at Hildegard's monastery. The Notes and Bibliography that follow comprise roughly half of the entire volume and reflect the wide range of materials Sweet has consulted to develop her argument. They also contain Sweet's own transcriptions of passages from the manuscripts she cites.
Chapter one, "A Wonder-Working Woman," lays out what is known of Hildegard's biography and places her within the context of the monastery of Disibodenberg and the new women's monastery she helped found at Rupertsberg. Sweet works through the hagiographical accounts of Hildegard's life to disentangle the formulaic elements common to the Lives of female saints. Her goal here is to establish that far from being the "untrained," "unexposed," and "invalid" women she was portrayed as in the hagiographies, Hildegard was well-read, carried on correspondence with monks, bishops and even members of the secular world, and was healthy enough to travel and even work in the monastery garden. Sweet builds on this portrait of Hildegard in the last part of chapter two, "Gardener of the Body." Here she argues, albeit tentatively, that Hildegard trained and practiced as an infirmaria, or more specifically as a pigmentarius (meaning pharmacist, spicer, or herbalist), who would have been charged with caring for the medicinal herb garden and curing the sick in the monastic infirmary at Disibodenberg. Sweet suggests that Hildegard's medical training was likely based on a blend of theoretical Latin sources and empirical folk tradition. Furthermore, Sweet argues that Hildegard's experiences in the garden and as a practitioner informed her understanding of the theoretical Latin sources as well as the content of her own medical writings.
The first part of chapter two, however, examines the manuscript titled Hildegardis bingensis causae et curae (Hildegard of Bingen's Causes and Cures) which exists in a single copy from the mid- thirteenth century. It is composed of five books: Book One reviews cosmology and the elements, Book Two discusses human physiology and the effects of the environment on the body, Books Three and Four give recipes for a variety of diseases arranged capite ad calcem, and Book Five provides advice on prognosis. As Sweet indicates, scholarship has been divided over whether or not Hildegard actually wrote the Causes and Cures. Most recently Laurence Moulinier, in her critical edition of the Causes and Cures, has argued that Books One and Two reflect Hildegardian influence, but were written by a later follower, that Books Three and Four were composed of excerpts and rearrangements of material from Hildegard's Physica, and that Book Five is an unrelated addition.[1] Sweet, by contrast, argues that the Causes and Cures was written by Hildegard and speculates that she wrote Books Three and Four first, as practical texts for the infirmarius at Rupertsberg, and then wrote the other books later to provide a theoretical medical background. Sweet's efforts to counter the arguments of Moulinier and others who do not recognize Hildegard's authorship are not entirely convincing and she ends by noting that "For the purpose of this inquiry-to use as a practical manual from a particular time and place-whether Hildegard composed Causes and Cures precisely as we have it today is not critical. However, after working with the text for many years, I believe that Hildegard did write the text pretty much as we have it" (47). Yet, clearly, Hildegard's authorship is important to Sweet's argument because she wishes to read the Causes and Cures within the context of Hildegard's other works and her life at Disibodenberg and Rupertsberg. Furthermore, Sweet wishes to use the Causes and Cures as evidence of Hildegard's medical practice which, she argues, will be important for understanding some of the metaphors and images in Hildegard's theological writings.
The strength of Sweet's book lies in her analysis of the Causes and Cures itself, the worldview it represents, and its relation to other, mostly contemporary, sources on medicine and cosmology. Chapter three, "Wind, Land, Rain, SunThe Elements," begins the analysis by focusing on Book One of the Causes and Cures which covers cosmology and, Sweet asserts, is structured to highlight the four elements and their importance for medical practice. Sweet chooses to focus on the explanation of the element "air" as an example of how Hildegard understood the relationship between the elements and human bodies. She notes that most often in the Causes and Cures, "air" is treated as "wind." Furthermore, "wind" has three different meanings in the text, referring to the major directional winds that indicate the seasons, the local winds that emphasize local weather and the circulating winds inside the human body. The cardinal winds are defined in the text as being linked to opposed qualities (for example, the east wind moistens, the west wind dries) and seasons. However, Sweet finds that the pattern connecting the particular seasons and weathers to the cardinal winds in the Causes and Cures is not the same as in other texts that discuss the winds, like Isidore's Etymologies. She argues that the difference reflects the importance of Hildegard's empirical observation in constructing her system where the winds serve "not only as signifiers for the effect of the seasons on the body, but also for the effects of local weather" (86). Finally, Sweet examines the metaphors in the Causes and Cures for a circulating wind within the body and links this with passages from Hildegard's Liber divinorum operum that suggest the notion that winds enter the human body and affect the humors to induce illness or health.
In chapter four, "A Fluid ConceptThe Humors," Sweet turns to Book Two of the Causes and Cures. This is the longest Book, comprising more than half the total text. Although it covers a range of subjects, including sex, conception, reproduction, constitutional diseases, and treatment, Sweet identifies an underlying, unifying structure in the focus on the good and bad fluids in the body and especially the concept of "humors." The humors, as presented in the Causes and Cures, are not the ones we typically find in texts of theoretical medicine. Rather, the four humors of the body are identified as siccum (dryness), humidum (wetness), spuma (foam), and tepidum (warmth). Sweet notes that spuma was a term used to denote anything typically cold and wet in the body which suggests that these "humors" lined up more closely with what are typically referred to in medical texts as the four qualities (hot, cold, wet and dry). In addition to the explicitly identified humors, the text also refers to the traditional four humors found in ancient medicine (blood, phlegm, yellow bile and melancholy). Sweet is clear that the traditional humors, although described as having qualities, were not identical to the explicitly identified humors and she suggests that the "explicit humors of spuma, tepidum, humidum, and siccum may have belonged to a more theoretical and abstract understanding of the body, while her implicit humors, which corresponded to the four traditional humors of the bodily fluids, were actual physiologic liquids" (102). Furthermore, Sweet finds that the Causes and Cures uses the term "humor" more generally to mean liquid, juice, and especially sap. She argues that it was this notion that humor could mean any liquid, but especially sap, that linked the three definitions in the Causes and Cures. So, the text describes seasonal (qualitative) influences on body humors and plant humors (sap) and makes it clear that the plant humors (with their own qualities) influenced body humors when ingested. In order to explain this idiosyncratic treatment of humors, Sweet employs her "quasi-anthropological approach" by imagining what texts on medical theory might have been available to Hildegard or one of her students. "The question then becomes: What textual background would such a person have had access to for understanding the humors of Causes and Cures? . . .Once this canon has been determined, it can be used to put together the 'commonly-held understanding of the humors' against which to measure Hildegard" (107-108). Sweet follows with a survey of the medical texts with information on humoral theory available prior to 1150 (i.e. before most Galenic texts were available in the Latin West). Based on her survey, she argues that all of the meanings of "humor" found in the Causes and Cures could be found in the available texts, although no single text clearly explained the entire system and they were often contradictory (in terms of the number of humors, etc.). Therefore, Hildegard, as the author of the Causes and Cures, could have put together her own understanding of the humors from available sources, but Sweet ends by suggesting that it was her work as pigmentarius that would have allowed her to draw on these disparate texts to create her own system that explained the cyclical, seasonal influences on humors in plants and bodies as well as the influence of plant humors (saps) on bodies by means of their qualities and essences. Hence, Sweet's analysis in this chapter provides a useful example of the ways in which empirical observations might have influenced the interpretation of authoritative, theoretical medical texts.
Chapter five, "The Green Humor," turns to examine the concept of viriditas in Hildegard's writings. Sweet begins by surveying the references to viriditas in her texts and notice that it occurs rarely in Books Three, Four, and Five of Causes and Cures, but with greater frequency in Books One and Two. Furthermore, Sweet examines Hildegard's dated texts (the Scivias, the Liber vitae meritorum, the Epistolarium and the Liber divinorum operum) and plots the frequency of references to viriditas in them as well to show that the concept appears with progressively increasing frequency in her later works. At this point, Sweet warns off anyone who might use these findings as evidence that Hildegard did not write Causes and Cures, asserting that "the literary style of Books Three, Four, and Five is unmistakably Hildegardian," (131) but this will likely not settle all doubts as to the manuscript's authorship. Nonetheless, based on these observations, Sweet hypothesizes that Books Three, Four, and Five of Causes and Cures represent Hildegard's earliest writings, and that Hildegard's concept of viriditas originated in her experience as pigmentarius which is reflected in these practical works. Sweet, therefore, counters previous scholars who argued that Hildegard's use of viriditas metaphors came from her spiritual thought. Rather, she suggests that in order to understand Hildegard's metaphorical use of viriditas in her later works, we first need to understand her literal use of the term in her earliest medical work. When she examines the use of viriditas in Causes and Cures, Sweet finds that, aside from a single metaphorical use (245-6, footnote 45), it refers to a substance, and concludes that "[b]ehind its use as metaphor was not a powergreening power or Life Spirit-but a substance, a liquid in earth and in plants that was part of the observed horticultural cycle" (139). As in previous chapters, Sweet turns to existing sources to try to identify where Hildegard may have found this concept of viriditas. She reads passages concerning viriditas in writings of the Church Fathers and in ancient botanical texts and finds a general concept of plant physiology which she summarizes: "Plants draw humor out of the earth into their stems through their roots; from the roots it is pulled up into the branches, leaves, and fruits by the heat of the sun. As this is taking place, humor is 'digested' by heat from the sun and dries out. At the same time, it is moistened by the water of rain and irrigation." Finally, the digested earth-humor becomes viriditas (146). Ultimately, Sweet concludes that Causes and Cures differs from its predecessors by describing viriditas not only as a substance found in plants, but also as one that could be found in the body. Indeed, the text provides a sequence of transference: "Earth nourishes viriditas; viriditas nourishes fruit, and fruit nourishes animals" (152). The end result of this transfer, Sweet asserts, was viriditas, described as an actual substance, "a kind of fifth humor" found in bodies, and thus connecting "plants with body and gardening with medicine" (154).
Sweet makes a good case for the ways in which the premodern medical model was influenced by empirical observation. She concludes that the worldview presented in Causes and Cures worked "because it provided a verifiable picture of the premodern universe," grounded in the experiences and observations of its author. "What we have learned from Hildegard as our model practitioner is that the premodern system was rooted in an experience of sky, constellations, and seasons, of weather as brought by directional winds, the consequent rise and fall of saps and humors, and the transmission of their qualities to the tastes and medicinal effects of plants" (165). On the whole, Sweet's book considers how the idiosyncratic theories presented in Causes and Cures reflect the author's reliance on experience to help make sense of the often differing materials found in the available texts of the time. Consequently, she provides a valuable example of the interaction between experience and theory in a pre-scholastic medical text.
NOTES
[1] Laurence Moulinier, ed. Hildegardis Bingensis Cause et Cure. Vol. 1. Berlin: Rarissima mediaevalia, 2003.