Beginnings of Renal Pharmacology

Am J Nephrol 1994;14:391-398

Sandra Sabatini
Women, Medicine and Life in the
Departments of Physiology and Internal
Medicine. Texas Tech University Health
Sciences Center, Lubbock, Tex., USA
Middle A ges (500-1500 AD)

Key Words Abstract

Women's status The status of women in the Middle Ages was ambiguous, because although
Middle Ages they had great responsibility and expertise in practical affairs they were
Hildegarde von Bingen viewed as chattel and inferior to men. They were skilled in cookery, often of
History of pharmacology highly spiced dishes using a variety of ingredients and flavorings, and they
Pharmacy and magic were taught the use of medicinal herbs. They were often skilled in simple first
aid, though they were not allowed to practise outside the home. An important
exception to this was Hildegarde von Bingen, whose Physica brought her great
renown. In it she became the first woman to discuss plants in relation to their
medicinal properties. For most people in the Middle Ages, treatment revolved
around herbs and diet, together with faith and holy relics and the use of (for­
bidden) pagan incantation and ritual. Astrology was often a necessary adjunct
to treatment. In Salerno, however, medicine had been practised from classical
times, and medical training could last for 7 years or more. One of the greatest
medieval medical texts is the Tacuinum Sanitatis, which describes in detail
the 6 essentials for the preservation of man’s health. Several vegetables and
herbs are mentioned in connection with the kidneys, the picking and prepara­
tion of which are imbued with magic.

Introduction
‘There are waste places in the earth which fill one with
terror...’ [1], So wrote Sir William Osier in 1913 of the
land we call ‘Europe’. When desolation takes over the
flourishing of man’s mind and hand, a chill runs to the
heart and one trembles with a sense of human instability.
This is the way the Middle Ages began:
‘Following the glory' that was Greece and the grand era that was
Rome, a frigid chill came upon the civilized world, in which the light
of learning burned low. flickering almost to extinction’ [1],
How did the gifts of these two great civilizations vir­
tually vanish, and what was life and medicine like in this
black and evil period from 500 AD to 1500 AD?
To address the first question, scholars believe that
these civilizations were decimated primarily for 3 reasons
[2], First, virtually all the important cities were destroyed
in the 400s when the ‘barbarians’ invaded southern Eu­
rope (table 1). As people fell, so did the writings and pic­
tures of the times. Secondly, Christianity preached death,
judgment, heaven and hell, and it was thought that only a
few could ‘save’ the many. Thirdly, illness and the plague
of the 6th century destroyed much of the Roman world.
The Mausoleum of Hadrian shows an angel with a drawn
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Sandra Sabatini, PhD, MD © 1994 S. Karger AG. Basel

Department of Physiology
Vanderbilt University Library

Texas Tech University

Health Sciences Center
Lubbock, TX 79430 (USA)
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 Table 1. A few events of the Middle Ages (500-1500 AD)
Year (AD) Military and political
476 The fall of Rome
581 Monte Cassino destroyed
768-814 Charlemagne
1020-1053 Normans conquer southern Italy
1095-1099 1st Crusade
1204 4th Crusade (Constantinople captured)
1323-1328 Flanders social revolt
1400 Erasmus (1465-1536)
1500 The Renaissance
Data from Ref. 4, pp. 214-221.
sword unsheathed as victory over the plague. Catastroph­
ic illness continued intermittently throughout the Middle
Ages, culminating with the Black Death in 1348 (table 1).
Life and medicine in the Middle Ages, the subject of
this paper, will examine the everyday life of women and
doctors and shall show how the two were inextricably
linked to the health and well-being of the populace. Some
of the ‘therapies’ that affected the kidneys are also dis­
cussed before briefly reviewing the role of magic in medi­
cine, because even though it was illegal, it pervaded the
practice of medicine.
Women in the Middle Ages
Women in the Middle Ages found themselves perpet­
ually oscillating between a ‘pit and a pedestal’. The
Church’s view, as broadcast by monks, clergy and friars,
was that women were instruments of the devil (the
supreme temptresses) and as such, must necessarily both
be evil and inferior to man. Women’s actual condition
varied not only from century to century, but also from
class to class. The well-born woman’s lot differed from
that of the rich merchant’s wife, and even more from that
of the serfs wife. Regardless, most men agreed that all
392 Sabatini
Scientific and medical Other
Death of Anthimus, Theodoric’s Greek Lombards invade Italy
physician (526)
Rhazes. Persian physician (850) Romanesque architecture
Hildegardc von Bingen (1098) Normans conquer England ( 1066)
Paper made in Spain (1150) Gothic architecture
Gold coins minted in Italy (1252) Thomas Beckct murdered (1170)
Magna Carta (1215)
Dante bom (1265)
Marco Polo in China (1271-1292)
Black Death (1348) Chaucer (about 1340-1400)
The 100 Years War ( 1337-1453)
Henry the Navigator Turks capture Constantinople (1453)
Printing from metal reaches Italy (1465) The Italian language
The Medici in Florence
women were inferior beings. This gave men the right to
inflict corporal punishment on ‘their women’ [2, 3], A
Dominican declared in the 13th century:
‘A man may chastise his wife and beat her for correction, for she
is of his household, therefore the lord may chastise his own’ [4].
Canon law stated:
‘It is plain that wives should be subject to their husbands and
should be servants’ [4],
Even the kindly and affectionate Goodman of Paris in
the 14th century, told his wife:
'... to watch the behavior of a dog who always has his heart and his
eye upon his master, because even were his master to beat him. the
dog follows wagging his tail’ [4],
One statute states:
‘All inhabitants of Villefranche have the right to beat their wives,
provided they do not kill them’ [4].
Perhaps it was in the sphere of marriage that women’s
lot was the hardest, and it was worse for those in the low­
est positions [3], Marriages were not a matter of choice.
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but were arranged by parents, guardians, overlords - even
the Church. The overriding consideration was financial
gain or territorial aggrandizement. The Church’s attitude
towards divorce did not make a woman’s lot enviable.
According to Canon law. a marriage once made was
unbreakable. The furthest the Church would go was to
declare a marriage ‘null and void’. A satirical poem from
the time of Edward II tells us [4]:
'If a man have a wife.
And he love her not.
Bring her to the consistory court.
There truth should be wrought.
Bring two false witnesses with him.
And himself the third.
And he shall be separated.
As far as he would bide from his wife;
He shall be backed up full well
To lead a disreputable life.’
Some men, after spending their wives fortunes, de­
serted them, delighting in the game of searching for a
‘handsomer and wealthier’ mate.
Despite the sombre plight of women in the Middle
Ages, however, there were happy marriages. Writings and
romantic poems are documented in the late Middle Ages,
the most famous of which was The Romance o f the Rose
[2, 3], An idealistic view of women began to grow in the
12th century because of the adoration given to the Virgin
Mary. Aristocratic women poets began to appear as trou­
badours in southern France. All wrote in praise of their
lovers or on the escapades of King Arthur and Charle­
magne.
Most women, however, even of the aristocratic class,
were occupied with very practical affairs. An outstanding
characteristic of medieval wives, regardless of status, was
their capacity to deal not only with the management of
their households - a matter complicated enough in itself -
but also with the running of the estate during their hus­
bands’ absences on Crusades, at wars, or in courts. A
woman was hostess in the lord’s absence, meeting guests
as they arrived onto the property. The woman of the castle
trained her young children as well as those older girls sent
from neighboring castles and great houses. These children
were expected to behave demurely, be courteous, be
silent, be modest, and when walking, not to ‘trot or run’.
When sitting a young woman must have her hands folded
with her eyes modestly turned down [3, 4], How times
change, but how they still remain the same!
Spinning, weaving and the making of clothes were
skills possessed by almost all women in the Middle Ages.
In matters of household management, women excelled.
As women supervised the servants they needed a knowl­
edge of every household task. As cooks they were experts.
Records show that food was extraordinarily spicy and it
was cooked in tremendous quantities [3, 4], Medieval
dishes were strongly seasoned with pepper, cloves, garlic,
cinnamon, vinegar and wine, virtually all medicinal in
some fashion. Ale was often used for cooking fish, and
saffron was favored for coloring. One ancient recipe
shows that: ‘One hundred eggs are to be beaten into eight
pints of milk’, to which was added mint, sage, marjoram,
fennel, parsley, beets, spinach, lettuce and powdered gin­
ger [4], Such a mixture of flavors must have been over­
powering in smell and cholesterol, the latter earning the
wrath of the American Heart Association today. Many
birds not usually eaten today were often served in ban­
quets - swans, cranes, herons and peacocks. Meat, poultry
and fish were eaten in quantity, all heavily salted for pres­
ervation.
Women were also taught the use of medicinal herbs
and became skilled in simple first aid, though they were
not allowed to practise outside the home as doctors or sur­
geons. An exception to this was Hildegarde von Bingen,
who is discussed later.
Doctors in the Middle Ages
The great schools of medicine were virtually decimated
by the year 500 AD. A few monks kept medical and other
knowledge alive during the centuries of barbarism. This
care for the ailing was at first directed mainly towards the
monks themselves, and then towards the lay brethren
working within the monasteries. Nobles and kings had
their own physicians, but almost all were clerics. The
masses, by and large, had to depend on their womenfolk
or on ‘quacks and women pretenders’. This was particu­
larly true in Europe, except in southern Italy where the
Salerno School of Medicine flourished [4, 5].
Most treatments revolved around the use of herbs and
adherence to diets, but numerous stories of miraculous
cures by the Virgin Mother are found. Alongside this
widespread belief in the healing power of the Christian
faith was the use of pagan incantation and practices, high­
ly tinged with sorcery. These were strictly forbidden by
the Church, but under the sign of the cross or diluted by
an admixture of Christian names and phrases, pagan
practices persisted. Herb gatherers, busily plucking flow­
ers or digging roots, under the influence of an appropriate
planet, would be heard to mutter:
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 ‘Holy Goddess. Earth, Parent of Nature, the Great M other...
come to me with thy healing powers and grant favorable issues to
whatever I shall make from these herbs and plants. I beseech thee
that thy gifts shall make those who take them, whole’ [6].
Astrology was regarded as a necessary adjunct to the
practice of medicine throughout the Middle Ages, even by
the most scientifically minded. For example, there were
lucky and unlucky days for blood-letting. One of the first
inquiries a doctor made was to ask the patient his star
sign, as certain remedies were associated with certain
planets. Even then, it was essential to drink the medicine
only when the moon was in a favorable position [6].
Urinalysis was a favored method for the diagnosis of
disease. In the 9th century Notker, a monk from St. Gall,
performed unbelievable wonders of healing by this meth­
od [4], When the Duke of Bavaria became his patient, the
Duke substituted the urine of a pregnant woman for his
own, in order to test Notker. After the doctor’s analysis of
the matula, the monk turned to the Duke and said: ‘God
is about to perform a miracle. Within 30 days the Duke
will give birth to a child’! Needless to say, Notker was
appointed as ducal physician. Many tables and graphs
were drawn up during the Middle Ages showing the signif­
icance of the color of urine for the diagnosis of disease. A
fairly common sight was a servant carrying a urine flask
through the street to be examined by a physician.
Not all medicine, however, was practised in this way.
In Italy, trained laymen continued to practise medicine
from classical times. Salerno, on its beautiful and shel­
tered bay, had long been a health resort, and by the 9th
century was a flourishing medical center [4], By the 11th
century the Salerno School of Medicine had developed
into one of the earliest and most important foundations
of scientific and technical knowledge of the Middle Ages
in Europe. There, 3 years of study in the liberal arts was
followed by 4 years of medical study before a student
could qualify as a physician. If the student intended to
practise surgery, an additional 1 year of anatomy was
compulsory.
One of the most famous teachers in Salerno was Con-
stantinus Africanus, who was bom in Carthage early in
the 11th century [7, 8], Africanus knew Arabic but not
Greek, and thus he took to Salerno Arabic books and a
thorough knowledge of Arabic medicine [4], Duke Robert
of Salerno invited Africanus to become his physician, and
he spent most of his time translating medical works from
Arabic into Latin. The works included those of Hippo­
crates, Galen and Celsus as well as the writings of the
Arabic physician, Avicenna. A popular book containing
394 Sabatini
certain maxims for health was composed at Salerno and
the following has been translated [3]:
‘If you would health and vigor keep.
Shun care and anger ere you sleep.
All heavy fare and wine disdain.
From noon-day slumber, too, refrain.
Each day to walk awhile you should
For this will work you naught but good.
The urgent calls of Nature heed.
These rules obey and you will find.
Long life is yours and tranquil mind.’
One of the most widely used Salernitan rules for health
remains applicable today [4]:
‘Use three physicians still - first Dr. Quiet
Next Dr. Merryman and third Dr. Diet.’
A vivid picture of the 11th century doctor can be
gained from reading the Instructions for the Physician
Himself from Salerno [4], The physician is described on
his way with a messenger who has summoned him to visit
a patient. The physician is told to question the servant
closely as to the exact nature and circumstances of his
master’s illness:
‘Then, if not able to make a positive diagnosis after examining the
patient’s pulse and urine, he will at least excite astonishment for his
accurate knowledge of the symptoms of the disease, and so win his
confidence. The fingers should also be kept on the pulse, until at least
the hundredth beat, to judge its character. Those standing around
will be all the more impressed by the delay. On entering the house,
the physician should not appear too haughty, but greet with kindly
demeanor those present. Then, after seating himself by the sick man,
he should accept the drink offered and proceed to put the patient at
his ease before examining him.’
The Instructions also advised that the physician should
have well-shaped nails, and that his hands should be:
‘cleansed from all blackness and filth’. The doctor was fur­
ther advised to learn proverbs pertaining to his craft in
comforting patients, for if a doctor could tell good tales
which made his patient laugh, he would: ‘... induce a light
heart to the sick man’ [4]. These insights speak of the impor­
tance of the medical history and of having a ‘good bedside
manner’. It is also clearly one of the first revelations of the
importance of cleanliness in the practice of medicine.
Tacuinum Sanitatis
Perhaps one of the greatest medical texts in the Middle
Ages is the Tacuinum Sanitatis. This collection was first
discovered in 1875, though it appears that much had been
written by the end of the 12th century. The term tacuinum
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 Table 2. Food and herbs beneficial to the kidney

From the garden Use in the Middle Ages1 Composition2 (g/100 g or % (water))
water sodium potassium calcium phosphorus fiber

Watermelons, Stimulate urine output 96 2 410 29 21 1.7

cucumbers Cause ‘pain in the loins’
Onions, leeks Enhance urine output 89 1 130 32 44 0.8
Stimulate sex and libido
Pignola (pine nuts) Stimulate the kidneys and the bladder 3 0.3 420 74 324 2.2
Enhance libido
Beans (fava) Stimulate urine output 12 1 1.300 163 437 4.9
Fennel Stimulates urine output
Enhances vision
Sugar ‘Good’ for the kidneys and bladder () 0 0 0 0 0
Stimulates thirst
Figs ‘Clean the kidneys’ 21 34 780 162 116 1.4
Turnips Decrease swelling 91 37 230 40 34 1.1
Increase sperm

1 From The Medieval Health Handbook (Tacuinum Sanitalis) [9],

2 From Geigy Scientific Tables [10],

is derived from the Arabic taqwim. meaning tables, and is
a series of beautifully colored drawings complemented
with a text on medicine and health. The manuscript was
originally in Arabic, but precisely when it was translated
into Latin has not been established with certainty [9],
Much of the information concerning this work revolves
around the Arabian physician, Ibn Botlan, who lived in
Egypt in 1047. Botlan occupied himself with theologic
questions and wrote many works on medicine and health.
It appears that a Latin translation must have been avail­
able by the year 1266, as an inscription in the Marciano
Library in Venice reads [9]:
‘Here begins the book of the Tacuinum, translated from Arabic
into Latin at the court of the illustrious King Manfred, lover of
science.’
This inscription indicates both when and where the
translation was done. Manfred was King of Sicily from
1254 to 1266 AD and his court was in Palermo. While it is
not known whether this represents the first translation,
the text was widely distributed throughout Europe by the
14th and 15th centuries. The work was a summary of
everything needed to live a healthy life. The following is
taken from the preface [9]:
‘The Tacuinum Sanitalis is about the six things that are necessary
for every man in the preservation of his health, about their correct
uses and effects. The first is the treatment of air which concerns the
heart. The second is the right use of foods and drinks. The third is the
correct use of movement and rest. The fourth is the problem of prohi­
bition of the body from sleep, or excessive wakefulness. The fifth is
the correct use of elimination and retention of humors. The sixth is
regulating of the person by moderating joy, anger, fear and distress.
The secret of the preservation of health, in fact, will be in the proper
balance of all these elements, since it is the disturbance of this bal­
ance that causes illnesses which the glorious and most exalted God
permits. Listed under these six classifications are many useful vari­
eties whose nature, God willing, we shall explain. We shall speak,
furthermore, about the choices suitable to each person owing to his
constitution and age, and shall include all these elements in the sim­
ple form of tables because the discussion of the sages and the discor­
dances in many different books may bore the reader. Men, in fact,
desire from science nothing else but the benefits, not the arguments
but the definitions. Accordingly, our intention in this book is to
shorten long-winded discourses and synthesize the various ideas. Our
intention also, however, is not to neglect the advice of the ancients.’
Table 2 lists some of the vegetables and herbs consid­
ered in the Tacuinum to be beneficial to the kidneys.
Watermelons and cucumbers were thought to be particu­
larly important in that they: ‘cool hot fevers and purify the
urine’. Also of value were turnips, particularly long and
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 Table 3. Food and herbs harmful to the kidney
Adverse effects1
‘Old’ cheeses Cause kidney stones
Sweet pomegranates Cause swelling
(Stimulates libido)
Sorghum (melega) Causes swelling
(Good for peasants and swine)
Capers Decrease urine output
Decrease sperm
Dill ‘Harmful’ to the kidney
Causes nausea
1 From The Medieval Health Handbook (Tacuinum Sanitatis) [9].
2 From Geigy Scientific Tables [10].
dark ones, as they: ‘increase sperm and make the body less
subject to swelling'. Pine nuts (pignola): ‘stimulate the
bladder, the kidneys, and the libido’. Onions and leeks:
‘stimulate urination, influence coitus, and mixed with
honey clear up catarrh of the chest’. Leeks were thought to
be of particular value for individuals in cold climates dur­
ing the winter. Listed with these foods are their mineral
and fiber contents [10]. No clear pattern emerges, but
most have high water and potassium contents and a low
sodium content. These foods also contain substantial
fiber, and today are recommended by the National Can­
cer Institute to: ‘aid digestion and decrease cancer’! The
‘beneficial’ foods also have strikingly parallel effects on
urine and sexual intercourse!
Table 3 lists some food and herbs cited in the Tacit i-
num as harmful to the kidney. ‘Old’ cheese causes kidney
stones, and an analysis of the mineral content of cheese
reveals a high calcium and phosphorus content. Except
for its high potassium content, most people would agree
that it should be restricted to ‘swine’!
In the midst of this compendium, the issue o f‘magic’ is
encountered. Most of the information does not reflect
explicitly on the relationship between medicine and magic,
nor does it indicate which of the cures are ‘occult’ as
opposed to ‘pharmacologic’ [6], Doubtless, most experts of
the day would have argued that the curative power of their
remedies was bom out by the ‘scientific’ experience.
Magic is encountered in several different areas. First,
the preparation of drugs and herbs often involved the
observance of taboos. This was thought important for
396 Sabatini
Composition2 (g/100 g or % (water))
water sodium potassium calcium phosphorus
38 400 100 440 570
24 43 1.238 273 16
maintaining the ‘purity’ of the healing substance or for
enhancing the power of the healer. For example, ashes
from burnt ravens were effective against gout and epilep­
sy, but only if the birds were taken live from their nest,
carried without touching the ground, and burned in a new
pot! Also, herbs and foods had to be picked both barefoot
and in silence, and the gatherer should abstain from sex­
ual contact before collecting these herbs or foods. A herb
should be dug from the ground without using an iron
implement.
Secondly, the choice of healing ingredients was some­
times dictated by the symbolic considerations of per­
ceived magic. Thus, animals known for their strength,
speed or ferocity were preferred over gentler beasts. A bull
or ram was considered more important as regards healing
powers than was the female counterpart of the species.
Thirdly, even apart from the rise of a systematic form
of astrology, medical procedures often involved explicit
or implicit attention to the effects of heavenly bodies. Cer­
tain plants and herbs were thought to cure lunacy if they
were wrapped in a red cloth and tied around the patient’s
head, particularly if the: ‘appropriate astrologic sign was
present and the moon was waxing’.
Finally, a specialized language rapidly developed
which only the healers understood. Many new words
appeared, often garbled and uninterpretable - not unlike
the medical jargon that has developed in the 20th century.
Thus, while the use of herbs and potions was both magic
and medicine, the medieval practitioner and his patient
could not separate one from the other.
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 Hildegarde von Bingen
As discussed earlier, women were taught the use of
medicinal herbs and became skilled in simple first aid,
but they were not allowed to practise outside the home as
doctors or surgeons. The medieval illustration of Tobit,
lying blind and ill on his couch, while his wife Anna pre­
pared medicine for him, mirrors many contemporary
scenes [4], Anna is seen reading her book of medical
recipes and numerous copies still remaining testify to
their popularity.
One particularly important woman of the Middle Ages
was Hildegarde von Bingen [11], Hildegarde was born in
1098 in the little German town of Bockelheim near
Mainz. She was the daughter of a knight and for reasons of
economy, protection, or recognition of exceptional talent
was placed in a Benedictine convent at the age of 8 years.
From early childhood, Hildegarde was subject to visions
which became more frequent, intense and vivid as she
attained maturity. At the age of 42 years she began to
write about her visions, and some members of the 2nd
Crusade believed she was a true prophetess of God. In
1148 Hildegarde took 18 of her nuns from Bingen and
established a new convent, where she remained until her
death in 1179.
In addition to her gifts as a mystic, she was said to have
a reputation for learning. During her tenure at the new
convent, she wrote the Physica (Natural Science), which
brought her renown. This is the first book in which a
woman discusses plants, trees and herbs in relation to
their medicinal properties [11], It is the earliest book on
natural history written in German and, in essence, is the
foundation of botanic studies in northern Europe. Hilde-
garde’s Physica influenced the later 16th century works of
Brunfels. Fuchs and Bock, the so-called ‘German Fathers
of Botany’.
At first glance this may seem a strange vocation for a
cloistered nun, but it was an outgrowth of her duties in the
convent. Almost all medicine in the Middle Ages had pro­
found religious overtones. In the 12th century, particu­
larly north of the Alps and far from Salerno, the practice
of medicine was largely in the hands of the clergy. These
clergy treated not only monks and nuns but also those lay­
men who worked their land; this later extended to the vil­
lagers and nearby parishes; it finally encompassed wayfar­
ers whom the Christian faith exhorted its faithful to treat
with charity and mercy. It is thus easy to understand how
Hildegarde absorbed so much medical knowledge.
Hildegarde’s Physica. in addition to displaying a com­
plete knowledge of what was then known about the natu­
ral world, gives us a reliable picture of how medicine was
practised by the clergy. She included recipes handed down
by generations of her predecessors. She wrote her own
observations on diseases and cures and of the various folk
remedies of the day. In the course of gathering such infor­
mation, she came on plant names that were not easily
translated into Latin, a language that she knew intimately.
Faced with this difficulty, the very practical and teutonic
Hildegarde simply kept the original name. In her work are
the first recorded uses of such names as hymelsluszel
(heaven’s keys, for the primrose) and storkschnaubel (a
species of geranium).
Hildegarde wrote clearly that peas were considered
inferior to beans as food (beans were thought useful as a
diuretic (table 2). They are very high in potassium, low in
sodium, rich in phosphorus, and very high in fiber. For
whatever reason, she knew that beans were an almost
complete food source. She also documented in elaborate
detail (perhaps during one of her ‘visions’) that cannabis
relieved headache, nutmeg purified the senses and les­
sened the evil humors, and that rose leaves would clarify
sight. Such things had been said for more than 1000 years
before and would continue to be said until the 19th centu­
ry. It is not their efficacy that is in question, nor should
Hildegarde be censured for plagiarism. What is important
is that she has given us an unretouched view into the
beliefs and practices of medieval man.
Hildegarde also provided some drawings in the Physi­
ca. In one, a physician is seen holding the famous ‘urine
cup' (matnla) in order to determine whether the patient
should be bled or not and from which site. Later, other
artists sketched interpretations of her writings. This re­
markable woman was also a composer. In 1981, hyperion
(England) recorded a series of her works entitled ‘A feath­
er on the breath of God: Sequences and Hymns by Abbess
Hildegarde of Bingen '(Gothic Voices directed by Christo­
pher Page). In his notes, Maestro Page describes her as ‘...
one of the most remarkable creative personal ites of the
Middle Ages...’. Does he know about her contributions to
medicine, too?
Conclusions
While medicine in the Middle Ages was very primitive
by modern standards, it was quite complex as regards
rituals and taboos. The Tacuinam Sanitatis provides
insight as to those foods and herbs deemed important for
all aspects of life, concentrating on many aspects of thera­
py for the kidneys. Yet it is a limited treatise, considering
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the restrictions imposed by the Church and the undercur­ Acknowledgements
rents of magic and astrology. The hopelessness and de­
This work was supported in part by grants from the National
spair of the populace, particularly women, that pervaded Institutes of Health, numbers R0I-DK.-36119 and R01-DK.-36199.
this era can be clearly sensed. Were it not for the survival The author would like to thank Ms. Liz Lund for typographic assis­
of the Salerno School of Medicine and the ‘common tance.
sense’ that survived in southern Italy, what might have
resulted and how much longer the world might have
waited for the Renaissance are matters for speculation.

References
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