Medical illustrations in medieval manuscripts / by Loren MacKinney.

  • MacKinney, Loren C. (Loren Carey), 1891-1963
Date:
1965
    23. a pharmacist dispenses syrup for coughs (In a North-Italian manuscript of about the year 1400: Rome, Casana- tense Library, MS 4182, folio 183. Elluchasem Elimithar, Theatrum sanitatis.) Here is an apothecary shop independent of a physician's or surgeon's office or clinic. During the late Middle Ages pharmacy, like surgery, was organized and regulated as a separate medical profession. Apothecary shops, somewhat after the fashion of modern drug stores, sold a variety of products : spices, sugar and other comestibles. The present miniature depicts a type of shop often pictured in late manuscripts : an open-front structure with a street counter, and shelves stocked with jars and flasks of various kinds. More noteworthy are the scales held by the pharma cist, and the customer about to drink his purchase, a syrup, at the counter. Above the miniature is the caption indicating the medicine, vinegar syrup [siropus aceto sus). Below is a brief description that reads as follows: By nature it is hot and frigid; it is better to cook it moderately in a clean dish. Its uses: it cuts through, renders tenuous, cleanses and opens ailments of coitus (? aperti nocumentum choytu), cough and dysentery. It eliminates ailments [if taken] with julep. Medieval writers were confused over the term acetosus, which was used for the herb acetosa, also for acetic substances in general. Avicenna (Canon, V, 1, 6), in his De siropis acetosis, discussed a variety of acetic syrups based on sugar of honey. In a separate treatise, De siropo acetosa, he distinguished these syrups from those made of the herb acetosa. This miniature text concerns the herbal syrup which Avicenna described as useful for coughs, coition (?) and ailments of the spleen and stomach. The miniature (like fig. 21) has been popular with modern historians of phar macy. The description for the frontispiece of Stubbs and Bligh's Sixty Centuries of Health and Physic (thirteenth-century Venetian apothecary shop) should be corrected to Lombardy (probably Verona ) about 1400, from a manuscript entitled Theatrum sanitatis. Incidentally, folio 4v of the manuscript, inscribed Johaninus de Grassis designavit, suggests the authorship. 24. a pharmacist or physician rolling pills (In a manuscript from fourteenth-century Italy: Rome, Vatican, Urb. Lat. MS 241, folio 400. Avicenna, Canon, V (antidotary), i.9.)
    Among the non-liquids compounded by medieval physicians or their assistants, or (in the later centuries) by pharmacists, were the following: eye-washes ( collyria), dusting powders ( sympasmata), poultices ( malagma ), salves and rolls of paste (cata- plasmata), plasters (emplastro), emollients [panaces ), suppositories ( pessaria, pessula), linaments ( illinimenta ) and various kinds and sizes of pills ( catapotia, pilluli, pillulae, trocisci). All of these seem to have been formed by hand, sometimes with the aid of a hand implement, such as the spatula, and a mixing tile. The early use of such implements in Roman times and the Middle Ages has been pointed out by George Griffenhagen in 'Tools of the Apothecary,' Jo urnal of American Pharmaceutical Association, 1956, 17, 810-813. Medieval miniatures, notably those of Cosmas and Damian, frequently reveal spatulas along with other pharmaceutical implements. Our miniature exempli fies the simpler method of pill-making by rolling between the hands and placing on a flat surface to dry and harden. In the text that follows the picture, ' Concerning Concoctions and Pills,' each of the twenty-eight items contains a description of the uses of the pill, the dosage, the amounts of the various ingredients and sketchy instructions concerning mixing, cooking, reducing to the proper consistency and 'shaping.' In a few cases the pills were made 'like a chick pea' or 'peppercorn' and 'dried in the shade.' Two of the prescriptions instructed 'him who makes the pills' to anoint his hands with 'odoriferous oil of balsam,' or 'sweet almond oil.' The most detailed of all the instructions reads as follows: . . . vehemently macerate [the ingredients] until they can be made into little pills like peppercorns; then dry them in the shade.
    V. MEDICATION: EXTERNAL AND INTERNAL Those who have been accustomed to dismiss medieval medicine as merely prayer and incantations along with loathsome potions and superstitions performances by charlatan medicine-men should examine a few medical miniatures and consider the variety of prescriptions pictured in medieval hand books. They would find that medicines were constandy used, applied either inter nally or externally according to principles then considered rational. External applica tion might involve merely herbal, mineral or animal simples or compounds in the form of salves, ointments, fomentations, medicated bandages, pills, tablets and the like. Medicines for internal ailments were usually compounds, in liquid form, taken internally. They were the ancestors of modern 'patent medicines.' Prominent among them were antidotes for general ailments or poisons, notably the famous antidotum Mithridatum, comprising thirty-six ingredients taken in honey and wine. It was named after a famous royal experimenter with drugs, who lived in Asia Minor in the second century B.C. Other prescriptions were named after their place of origin or their reputed inventors (e.g., 'galens'), but there also were drugs simply labelled as antidotes, confections, potions, 'holy' medicine (hiera), 'sélec tives' ( electuaria ), theriacs or treacles ( tyriaca, a mithridatum improved by Nero's physician, Andromachus), cathartics, vinegar-honey and water-honey compounds (oxymel, hydromel), gargles (gargarismo), oils, syrups and pills or tablets. Critical modern scholars, noting that most of these prescriptions were classical in nomen clature, have sometimes suggested that the prescriptions were merely copied from ancient manuscripts and never actually used by medieval physicians. This is dis proved by the writings of medieval laymen and physicians. As early as the sixth century, Bishop Gregory of Tours wrote in laudatory terms (suggestive of modern pharmaceutical 'commercials') concerning one of his favourite drugs; he called it 'an infallible theriac,' 'an ineffable pigment,' 'a praiseworthy antidote,' 'a celestial purgative,' 'a super ointment.' Three centuries later Archbishop Rabanus Maurus of Mainz warned against excessive use of pigmenta et antidota. Early in the eleventh century, Bishop Fulbert of Chartres wrote as follows to an ailing fellow-bishop:
    I have not compounded ointment since I became bishop, but what I have from a physic ian's gift I give you even though I deprive myself. To another bishop he sent 'three galen potions and an equal number of diatesseron theriacae ' along with some 'wild nard' that the bishop had asked for. But Fulbert suggested 'oxymel and radishes . . . [or] laxative pills' as safer purgatives than the wild-nard emetic, and ended by offering 'other items almost ninety in number' if needed. Later, he had his assistant send 'hiera potion' to a friend, with detailed instructions on administering it and on convalescent diet. 1 References such as these indicate everyday use of various drugs even during the early Middle Ages, not to mention ample evidences from the later centuries. In comparison, magical and religious ritualism is rare in medieval medical works, and even in the chronicles and biographical descriptions of physicians in action. The practitioners seem to have been trained professionals, usually clerics but not always so, clad in long formal robes with distinctively medical head-dress. Assistants, usually hatless, wore short robes. It is apparent that physicians ( medici ) and surgeons ( chirur gici ) were of relatively high rank and were treated accordingly. Charlatans and folk- healers existed and treated the common people but did not dominate the profession. 25. a patient taking a cough drop (In a manuscript from fourteenth-century Italy: Vatican, Urb. Lat. MS 241, folio 389V. Avicenna, Canon, V (antidotary), i .5.) Medieval physicians sometimes gave specific instructions as to how pills and other medicines were to be taken. Often they are pictured wagging a forefinger at the patient while emphasizing some point or other in the prescription. Our illustration of a patient taking a cough drop shows the method prescribed in the accompanying text, as follows : Hold it in your mouth and let it trickle bit by bit as far as the lung; do not push it suddenly into the stomach, but prolong the time [of its passage] from stomach to lung {ex stomacho ad pulmonem!). 1 See Loren MacKinney, Early Medieval Medicine, pp. 63, 135 iE, for the texts, and details con cerning the passages from Gregory and Fulbert. On pp. 116 ff., are similar passages from Gerbert of Rheims and Richer concerning antidotum philoanthropum for the stone ; also concerning the use of antidotum and teriaca by a clerical physician and a 'Salernitan' in efforts to out-poison one another.
    If this text is an accurate translation of Avicenna's original Arabic text, his idea of the passage of a cough drop, to stomach and then to lung, was curiously inaccurate. 26. ointment of pig dung and herb scelerata for scrofula (In a manuscript from the thirteenth century: Vienna, NB, MS 93, folio 21V. Pseudo-Apuleius, Herbarium, VIII, 2.) In this miniature the illustrator displayed a mischievous sense of humour, rather rare in medical manuscripts. Next to the patient, whose body is covered with scrofulous sores, the compounding of the pig dung and herbal ointment is shown by picturing a pig defecating while jumping over the mixing bowl. Obviously the short-cut in the process, the pig cooperating with the pharmacist, was entirely imaginary. The physician is depicted more formally, holding a jar of medicine while giving in structions to the patient. The descriptive text reads as follows : For scrofulous tumours and boils : [use] the herb scelerata macerated and kneaded with pig dung; apply to the scrofulous tumours and boils, and within a few hours it will dissipate them and the pus will disappear. The herb under consideration ( scelerata ) is not the one pictured in the lower half of the page (which is botracion statice), but appears on the preceding page. Many of the pages of this and other Herbarium manuscripts have the same confusing arrangement, the herb pictured on a different page from the description of its medical use. A somewhat similar illustration of a pig defecating (but not in the bowl) occurs in the scelerata section of another manuscript of Pseudo-Apuleius (thirteenth-century Florence, Laurentian, MS 73 :i6, folio 41); there is the same confusing arrangement of the pictures of the herbs. These two manuscripts indicate the popularity of the Pseudo-Apuleius handbook, and the late-medieval additions therein by Western illustrators. Originally the manuscript was copied from a Greek source, as can be seen in the classical garb of the various figures and from the Greek herbal synonyms in the descriptive texts. However, during the late Middle Ages, illustrators embellished the herbal illustrations with human-interest figures such as the pig. In the Vienna manuscript (as will be seen often below) marginal sketches were added to illustrate portions of the description originally unillu- strated.