14.09.35, Van Arsdall and Graham, eds., Herbs and Healers

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Kurt M. Boughan

The Medieval Review 14.09.35

Van Arsdall, Anne and Timothy Graham. Herbs and Healers from the Ancient Mediterranean through the Medieval West: Essays in Honor of John M. Riddle. Medicine in the Medieval Mediterranean, 4. Burlington, VT: Ashgate, 2012. Pp. xv, 377. ISBN: 9781409400387 (hardback).

Reviewed by:
Kurt M. Boughan
The Citadel

This volume is a festschrift for the eminent historian of medieval medicine John M. Riddle. It especially honors Riddle's innovative and pioneering studies of herbal medicine in the pre-modern West.

Riddle's studies, in accord with the great continuities of plant lore, extend well beyond the Middle Ages, both back to antiquity, and forward to the advent of modern scientific medicine. It is fitting, then, that the volume's eleven essays include two concerning the classical Mediterranean world and one on the nineteenth century. John Scarborough surveys the fragmentary documentation of three physicians in the entourage of Cleopatra. The documentation for two of them, Philotas of Amphissa and Dioscorides "Phacas," offers some vivid details of pharmacological practice in the milieu of a ruler who was herself an expert in the lore of drugs and poisons. Alain Touwaide offers an finely-detailed analysis--and one that is extremely difficult to follow without some familiarity with classical Greek pharmaceutical names--of the Pseudo-Galenic De succedaneis, a list of drug substitutions and presumed model for a genre of pharmaceutical literature identified in the Latin West by the title Quid pro quo Touwaide concludes that the patterns of substitution in the list indicate that its original purpose was to adapt canonical Greek pharmaceutical texts, which had been developed in the largely rural and agricultural world of the polis, to the conditions of life and medical practice in a great city of the Roman Empire, most likely Rome or Alexandria.

John Crellin is the modernist contributor. He investigates differing opinions by nineteenth-century British physicians regarding the efficacy of iron, myrrh, and pennyroyal as emmenagogues and abortifacients. Crellin's prompt for this investigation is account in Riddle's Eve's Herbs: A History of Contraception and Abortion in the West (1997) of an 1871 British abortion trial that turned on the question of these substances' pharmaceutical properties. That contemporary medical opinion was divided on this question, and that trial witnesses indeed denied that preparations of these substances could cause abortion, Riddle takes as emblematic of a general "forgetfulness" by nineteenth-century doctors of a long history that knew otherwise. Crellin's concern is why physicians' opinions differed. The answer, he argues, is therapeutic uncertainty. Physicians were aware of the traditional use and lore of iron, myrrh, and pennyroyal as emmenagogues with abortifacient potential, but observed widely varying results in their application. The inconsistency of outcomes, in the context of an emerging modern paradigms of medical science, accounts for physicians' doubt or denial of the properties attested of these substances and others by history and folklore.

Karen Reeds's essay on the history of Saint John's Wort (Hypericum perforata) represents the early modern period. It also most closely represents Riddle's conviction that the plant lore of the past can and should assist the pharmacognosy of the present. Reeds investigates the merit of common claims, made during the popular mania for hypericum in the United States of the 1990s, of the historical use of the herb as an antidepressant.

Any such claims, it seems, especially for any time before the seventeenth century, are weak at best, despite that hypericum was well-known to Dioscorides and other ancient Western writers on materia medica. Proceeding on the assumption that the pre-modern notion of melancholia is continuous with the modern concept of depression--a dubious assumption, to be sure, but one that does not seem to affect her results significantly--Reeds examines the remarks on hypericum in the KreĆ¼ter Buoch (1546), the great vernacular Renaissance herbal of Hieronymus Bock (Hieronymus Tragus, 1498-1554). In this work Bock joined Galenism and German folklore. Neither tradition, at least as Bock represents them, would comfort the herb's modern enthusiasts. The former tells in no way of its use in treating melancholy. The latter holds it to put demons to flight, and while this suggests a connection with dejection or mental disorder, the herb is supposed to do so apotropaically; i.e., not by ingestion, nor even by contact, but by its mere presence. Reeds also examines remarks on hypericum by Bock's contemporary and fellow German Paracelsus, who famously rejected Galenism for a magica scientia of his own devising. Paracelsus did recommend hypericum against phantasmata, or disordered and troubling mental images. However, given Paracelsus's emphatic rejection of Galenic humoralism, it is unclear whether this disease of the soul is at all comparable to the Galenists' melancholia. Even if it is, Paracelsus, like the German folk tradition, understood hypericum to work by proximity, not by ingestion; he recommended, for instance, carrying it under one's hat, or placing it over a window.

The earliest anticipation that Reeds finds of the present use of St. John's Wort against depression is a work of 1630 by the Italian protestant physician Angelo Sala (1576-1637). Sala, who saw no fundamental incompatibility between Galenism and Paracelsianism, and drew upon both, recommended an hypericum-based drink to treat melancholy. Reeds strains to suggest lines of future research that might yet yield a stronger historical case for Saint John's Wort as an antidepressant. Despite these suggestions--and indeed despite Riddle's conviction that pre-modern Western plant lore has much to teach modern pharmacology--the overwhelming impression left by Reeds's study is that, when it comes to one herb, we are highly unlikely ever to find a true match of past wisdom with present hopes.

For medievalists, greater interest and utility will be found in the essays on medieval medical learning and culture by Florence Eliza Glaze, Faith Wallis, Winston Black, and Linda Ehrsam Voigts.

Glaze considers sets of late eleventh- and twelfth-century Salernitan masters' glosses of "Greek technical terminology, medicinal preparations, and materia medica" (66) added to the Passionarius of Gariopontus of Salerno. The Passionarius is the earliest known Salernitan text, composed c. 1035 out of an ensemble of Greek medical texts already rendered into Latin in late antiquity. The number of known copies from the period 1050-1225--at least 45--indicates that it was one of the most popular medical books of that "long twelfth century"; and if manuscript glosses are traces of classroom instruction, as Glaze holds, then this work was widely used for teaching. This is despite that it seems never to have belonged to the set of core medical textbooks that became known later as the Articella. This is also much to the surprise of historians of medicine who have assumed the Passionarius to have been eclipsed by more sophisticated and theoretical texts translated from Arabic in the decades around 1100.

Glaze discovers that the Salernitan Passionarius glosses are highly consistent across manuscripts, and fall into two broad categories: the "nosological," meaning those that explain Greek disease names, and the "pharmacological," meaning those that explain the ingredients of compound medicines. The terms of both kinds of glosses closely match those used in later texts; thus they mark the development of a common disciplinary language, one that connected Gariopontus coherently with other authoritative texts. Indeed they mark Gariopontus as the origin for much of that common tongue. Glaze shows in two lengthy tables that the terms of the Passionarius and the glosses added to it are repeated, often verbatim, in later works, including the Alphita, the great medical and botanical glossary of the late twelfth century.

Wallis's essay introduces an accompanying edition of a twelfth-century pharmacological text. The text is a hitherto unnoticed commentary on the Liber graduum, the work on pharmacological degrees ascribed to Constantine the African because of its incorporation in the Constantinian Pantegni Practica. Evidence of the commentary's authorship is not conclusive, but supports the hypothesis that the author is Bartholomaeus of Salerno. Wallis explains that the Liber graduum itself is significant as the locus of the first encounter of medieval Western pharmacy, which had continued in the resolutely empirical mode of its classical antecedent, with the Galenic theory of complexions and degrees. That theory is presented in the work's prologue, its body being a catalogue of medical simples adapted from the Adminiculum of al-Gazzar. Wallis's commentary is one of at least three twelfth-century written responses to the prologue's many "logical paradoxes and problems;" it is, however, the only one of them that is a true commentary, that is, a lemma-by-lemma analysis. Wallis explains the different approaches of all three texts. She also detects in the manuscripts of her commentary a drive to establish the Liber graduum as part of the Articella. In every one, she observes, the commentary is set among Bartholomaeus' Articella commentaries. Clearly, then, "someone writing in the second half of the twelfth century wanted to present the Liber graduum as a companion to the other texts in the Articella anthology" (121). That there was thus a push to incorporate pharmacy into the Articella, Wallis adds, is not at all improbable. The anthology, while already canonical, was still evolving, and had not yet become a decided "vehicle of medical theory" (122-123). The push failed, however, and so left the Liber graduum--as Wallis's essay's title dubs it--"the ghost in the Articella."

As in Wallis's essay, Constantine's Liber graduum is central to Black's, but this time as a source of drug lore in northern European medical verse of the long twelfth century. Black surveys how poet-physicians, including Macer Floridus, Henry of Huntingdon, and anonymous authors, adapted in their verse herbals material from Constantine's catalogue of simples. His focus is on poems that take more than a line or two from Constantine; accordingly, he translates in full and examines in detail seven such poems: two by Macer, two by Henry, and three anonymous. These he selects from fifty that his research so far has verified, and that he briefly catalogs in an appendix. Black's examination of the seven makes plain that "verse herbals were not simply mnemonic repositories of ancient pharmacological knowledge," (157) but in effect "independent medical treatises with their own view and presentation medicinal ingredients, their qualities, and applications" (156). Black's poet-physicians modify Constantine, and not just to fit the meter; they make revisions, rearrangements, expansions, and omissions that significantly alter the sense of the material, sometimes obscuring and distorting it, sometimes increasing its clarity and utility. In the case of one poem by Henry on the fruit and bark of the cassia tree, they even render penetrating virtual commentary on their source by the artful blending of two separate entries from it. Black shows, then, that scholars can no longer ignore verse herbals on the assumption that they are prose herbals' less serious, less legitimate kin.

For the true lighter side of medieval herbal lore, there is Voigts, who shows that in fourteenth- and fifteenth-century England, satirical treatments of herbal medicine and its practitioners made for entertainment, both for popular and elite audiences. The case is made by brief critical examination of three texts, all of which have modern editions. The first two texts were intended for popular audiences. A mock epistle from the West Midlands, c. 1465-1470, manifestly "makes sport of the expertise and truth claims of a rural healer" (217). The second text is a comic scene inserted into Play of The Sacrament, the late fifteenth-century miracle drama and exemplar of that perennial medieval anti-Semitic trope, host-desecration. The scene itself stars a drunkard and itinerant physician, Master Brandyche of Brabant, and his sardonic servant, Colle. Before Brandyche arrives, Colle relates to the audience his master's mock-worthy personal and professional foibles; afterwards he reads aloud his master's banns. Herbs are mentioned at Brandyche's arrival, where the physician boasts of quelling a female patient's pain with a drink of scammony, oxymel, lettuce, sage, and pimpernel. Voigts explains that these substances were prescribed for a wide variety of ailments, and together would have at the least made a strong laxative. Knowing this, the irony of Colle's reply--"Then she ys full saue" (221)--becomes clear. Voigts repeats her view, substantiated in a previous study in which she compares the banns read by Colle to the legitimate banns of an actual East Anglian itinerant physician, that the scene as a whole is a prime example of medieval estates satire.

Voigts's third text is Chaucer's comic beast fable, the "Nun's Priest's Tale," specifically the passage where Pertelot, beloved hen of the rooster Chauntecleer, argues to her mate that his terrible dream of a fox--a dream that will prove as prophetic as he believes--is merely the result of a humoral imbalance, and instructs him to ingest as remedy several sorts of herbs from the henyard. Voigts sets the hen's medical discourse in the context of other, non-satirical references to therapeutic herbs and spices in the Canterbury Tales. From these, it appears that Chaucer's elite London audience was quite familiar the use and lore of therapeutic herbs and spices, including exotic, expensive ones. Viewed together with the mock epistle and the miracle play, they also make clear that whatever previous scholarship has made of the specific content of Pertelot's remarks, they were meant above all to entertain.

In sum, the essays collected in Herbs and Healers, with their range and exhibition of first-rate technical skill in the analysis of source texts, honor Riddle well. The editors close the volume with a list of all of Riddle's publications from 1964 to 2010.

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Kurt M. Boughan

The Citadel