23 de February de 2017

Saint Hildegard von Bingen (1098-1179): “the light of her people and of her time”

Saint Hildegard von Bingen (1098-1179): “the light of her people and of her time”. International Journal of Dermatology 1999; 38(4):315-320.

Marcia Ramos-e-Silva, MD, PhD
From the Sector of Dermatology and the Post Graduation Course in Dermatology, HUCFF-UFRJ, School of Medicine, Federal University of Rio de Janeiro, Brazil. Presented at the Symposium ‘Women in Dermatology’, History of Dermatology Society Meeting, Orlando, Florida – Feb. 26 1998.

The first time I ever heard the name of Hildegard von Bingen was when I was preparing a paper about Giovan Bonomo, the discoverer of the etiology of scabies, for the 1997 History of Dermatology symposium. In the twelfth century, Hildegard had already commented about scabies. The 1998 symposium which subject was ‘Women in Dermatology’ gave me the great opportunity of researching about life in the Middle Ages and about the life and work of Hildegard von Bingen. By reading about her I learned to deeply respect her: she was one of the most fascinating and remarkable personalities of her time. I was astonished to find out how extremely creative she was, and how her creations and observations related to so many different sectors and areas of Medieval life, including Medicine, still influence modern times and are so up-to-date.

The present article is one more homage to this incredible woman, Hildegard von Bingen, in the year her nine hundred birth anniversary is being commemorated.

Women in Medicine and during the Middle Ages
The actual presence of women as doctors or surgeons and in academic medicine is very recent, although for over a thousand years of our Greco-Roman civilization women learned the healing art by doing, while men by reading about it. The actual care of the sick was largely in the hands of women;1 and still is.

The first hesitant move of women into academic medicine in western society was made in Italy during the Renaissance, a move which failed to spread. The breakthrough in modern times came as part of the industrial revolution in England and America during the first part of the 19th century.1 There have been many difficulties and struggles over the years for us to enter Medicine and the field of Dermatology, even in the early days of this century, and still now depending on the country.

Women’s actual condition varied not only from century-to-century but also from class-to-class. In the Middle Ages, the black and evil period between 500AD to 1500AD, church’s view, as broadcast by monks, clergy and friars, was that women were instruments of devil, the supreme temptresses. Men had the right, approved by the church, even to inflict corporal punishment on their women.2

In the Middle Ages, depending on the social class, women’s lot was completely different, but they were all considered chattel and inferior to men. Though considered evil and inferior, most of them, even those of the aristocratic class, were occupied with very practical affairs in which they were expert, such as spinning, weaving, making clothes, and cooking with a great variety of ingredients, spices and flavorings. They had great responsibilities in the household and with the children. Medieval wives, regardless of status, had an outstanding characteristic: a 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 husband’s absence on Crusades, at wars, or in courts.2

During medieval times women were often skilled in medicinal herbs and in first aid, but were not allowed to practice outside the home as doctors or surgeons.2 In the twelfth century, Hildegard von Bingen (Figure 1)3 was an important exception, a “first” in many fields.4 The first woman to discuss plants in relation to their properties2 and probably the first to be involved with our specialty, Dermatology, Hildegard was known as the “Sibyl of the Rhine”, and produced major works of theology and visionary writings. When few women were accorded respect, she was consulted by and advised popes, bishops, and kings. She used the curative powers of plants, animals, trees and stones, and is the first composer whose biography is known. Hildegard also founded two vibrant convents, the monastery of Ruperstberg, in 1147, and of Eibingen, in 1165,5,6 where her musical plays were performed.4 This remarkable woman was a true influence and has a guaranteed place in Modern Medicine, among many other arts.7

Hildegard von Bingen

Figure 1: Hildegard von Bingen (with permission of Christiana-Verlag).3

Hildegard’s life
There are many doubts and controversies about the life and work of Hildegard von Bingen, a German nun, famous for visions and prophecies, who made written comments about many subjects8 and several diseases, including dermatoses. She exposed her mystic visions, gave a scientific interpretation of the universe, reflected with great frankness about sexuality problems, wrote musics, and showed many other talents.4,9

Hildegard was the last of the ten children of Hildebert of Bermesheim, imperial minister, and his wife, Mechthild.4,10 It seems that hers was an old and well-connected Frankish noble family.4 She was born at the castle of Baron of Bermersheim, in 1098, in Bermersheim in the German province of Rheinessen; 6,10,11,12 and either for reasons of economy, protection; in recognition of her exceptional talent;2 or because it was customary with the tithe, which family could not account on feeding, she was dedicated to church.2

At age eight Hildegard was placed in the Benedictine Monastery of Disibodenberg (Figure 2)13, where Jutta, an anchoress and abbess of the convent, would be responsible for her religious education.2,14 Also born into a wealthy and prominent family, sister of Count of Spanheim, and by all accounts a young woman of great beauty, Jutta had her cell next to the convent. It was completely closed except for a small window from where she could follow the services, and for the door through which Hildegard and another dozen girls from noble families could enter to receive their religious education.4

Ruins of Monastery of Disibodenberg

Figure 2: Ruins of Monastery of Disibodenberg, engraving by Winkles, approximately 1830, after a drawing by C. Schlikum (with permission of Johannes Gutenberg-Universität Mainz).13

Hildegard started to have visions of luminous objects at the age three, but soon realized she was unique in this ability and hid this gift for many years.4 They became more frequent, intense and vivid as she attained maturity;2 and it is now generally agreed that she suffered from migraine, and that her visions were a result of this condition. It is a tribute to the remarkable spirit and the intellectual powers of this woman that she was able to turn a debilitating illness into the word of God, and create so much with it.4 In 1141, she wrote that God commanded her to record the visions she had been having since she was a child (Patrologia cursus completus series latina, 197, 383-386).6

Hildegard lived all but the first eight of her eighty-one years as a Benedictine nun. When Jutta died in 1136 she was her successor as prioress of the Disibodenberg cloister;14 and ended as abbess of a convent on the Rupertsberg.15 (Figure 3)10 Hildegard was an unusual mixture of administrator and visionary, pietist and radical, poet and scientist, physician, saint,15 and musician.12

Ruins of Monastery of Ruperstberg

Figure 3: Ruins of Monastery of Ruperstberg, engraving – XIX century (with permission of Internationale Gesellschaft Hildegard von Bingen).10

She received religious education of a recluse, was taught to love God above all and become a great abbess and a famous visionary, prophetess and thaumaturge.16 At the age of 42 years she began to write about her visions and prophecies, and some members of the 2nd Crusade believed she was a true prophetess of God.2 In 1147 Hildegard took eighteen of her nuns from Bingen and established a new convent in Rupertsberg, accross the Rhein from Rüdescheim, where she remained until her death in September 17, 1179.2,6,8,13 She also established a daughter house in Eibingen on the Rhein, in 1165. 5,6,17 Her relics are maintained in the new Abbey Saint Hildegard reconstructed in 1900 at Eibingen near Rüdesheim.10,17 (Figure 4)18

Abbey of Saint Hildegard, Eibingen

Figure 4: Abbey of Saint Hildegard, Eibingen – photographed by Roland Horst (with permission of Johannes Gutenberg-Universität Mainz).18

Hildegard’s work
Hildegard was a woman of extraordinarily active and independent mind. She was not only gifted with a thoroughly efficient intellect, but had great energy and considerable power. Her writings cover a wide range, revealing the most varied activities and remarkable imaginative capacity.11

In the Benedictine convent she wrote religious edification works, texts on Medicine and Natural Science, a countless number of letters, and an autobiography constituted by fragments.19 Her writings reveal a good knowledge of the Bible and of theological texts.20 In her abundant correspondence Hildegard wrote to the great of her times: saints, popes, emperors, and bishops,21 such as Saint Bernard, Pope Eugenius III, Emperor Frederick I, and Henry II of England and his wife Eleanor,4,6 always in a tone of inspired authority, and in Latin prose of masculine power, a language she knew well. Hildegard published several books of visions, such as Scivias, a dogmatic treatise, for which she claimed the collaboration of the Deity.4
The clergy were chagrined to hear about her revelations because they were highly critical of the wealth and corruption of the Church.5,15 Hildegard, in accents of eternal hope, said: “Divine justice shall have its hours… the judgments of God are about to be accomplished; the Empire and the Papacy, sunk into impiety, shall crumble way together…. But upon their ruins shall appear a new nation …. The heathen, the Jews, the worldly and the unbelieving, shall be converted together; springtime and peace shall reign over a regenerated world, and the angels will return with confidence to dwell among men.” 22

Walker-Moskop6 believes that her message has a much more universal appeal than is generally attributed to it; that her primary concerns are to describe the way to health, or harmony, and to discuss the universal continuity on which health is dependent. Her major and very complex works are traditionally divided into two separate categories: the visionary works Scivias, (Figure 5)11 Liber vitae meritorum, and Liber divinorum operum, and the medical writings Physica or Study of Nature,23 and Causae et curae (Figure 6)11 or Holistic Healing.17

Title page of Scivias

Figure 5: Title page of Scivias (with permission of Oxford University Press).11

Opening lines of Causae et curae

Figure 6: Opening lines of Causae et curae (with permission of Oxford University Press).11

Scivias, written from 1141 to 1151, in essence describes the way to harmony with God which is a necessary prerequisite for a person’s internal spiritual and, in turn, physical health. It may be described as Hildegard’s discussion of the way to health through faith.6

The mystic Abbess of Bingen wrote two major books of medical writings, Causae et curae (Holistic healing),17 after receiving “divine revelations” about the origin and treatment of many diseases; and Physica or Liber subtilitatum diversarum naturatum creaturarum,23 an encyclopaedic work, marred here and there with magic formulas, but rich in medical lore.6,15 These books are concerned primarily on how to promote health of the body.6 Hildegard’s therapy is based on natural cure; it is a system of linked components of the human being and its relationship to the world as a whole.24 Probably Hildegard’s own physical and emotional experiences were the basis for her observations. A passage written before she moved from Disibodenberg suggests this: “when (a person) is in transition giving one thing up and beginning another, the soul naturally senses this change and is disgusted … it acts as if it would leave the body, just as it does in leaving a dying body” (Causae et curae, 144, lines 27-31).6 She also wrote: “The soul loves moderation in all things. Whenever the human body lacks measure, and eat and drinks or something like that unbalances it, the powers of the soul are wounded. … So in all things let people maintain a proper balance”.17

Hildegard exposed an original system for the embryo’s sexual determination, and conceived a definite place for psychic factors, noticing there was need of affection for the psychological development of the child. She wrote: “The strength of the male seed determines the sex of the embryo, while the love of one parent to the other determines the moral qualities of the child”. She understood the feminine nature describing sexuality, pleasure and procreation, which she mentions with a coat of metaphoric poetry.9 Hildegard did not fail to express the sense of fragility of feminine nature, and revealed the great confidence in her own intellectual possibilities.21

During her tenure at the new convent, she wrote Physica (Natural Science),23 which brought her renown. This is the first book in which a woman discusses plants, trees and herbs in relation to their medicinal properties. It is the earliest book on natural history written in German and, in essence, is the foundation of botanic studies in northern Europe. Hildegard’s Physica influenced the later 16th century works of Brunfels, Fuchs and Bock, the so-called ‘German Fathers of Botany’. In addition to displaying a complete knowledge of what was then known about the natural world, Physica gives us a reliable picture of how medicine was practiced 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.2 Saint Hildegard’s medicine is still practiced in Germany and it was Dr. Gottfried Hertzka who rediscovered her medical knowledge and advice, and made them available for our age.25

Although she could read and write Latin, Hildegard could never escape the feelings of inadequacy and lack of education, because of her rudimentary education. That was why a monk of Disibodenberg called Volmar became her almost lifelong secretary at the same time as he served as her teacher. He was the one that wrote down most of her visions, 4,17 (Figure 7)25 and, for whatever reason, Hildegard 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 lessened the evil humors, and that roses leaves would clarify sight. Such things were said for more than 1000 years before and would continue to be said until the 19th century. It is not their efficacy that is in question, nor should Hildegard be censured for plagiarism. What is important about Hildegard writings is that she has given us an unretouched view into the beliefs and practices of medieval man.2

Hildegard receiving the word of God

Figure 7: Hildegard receiving the word of God, manuscript of XIII century (with permission of Bear & Co).25

Hildegard and Dermatology
Hildegard is probably the first women to write about skin diseases, and also about their therapies. In her book Causae et curae or Holistic Healing17 she mentioned leprosy (not necessarily leprosy as defined today), scabies, lice, insect bites, burns, and also describes entities that probably are erysipela, paronychia, contact allergies, rosacea, rhinophyma, and many others.

Healing through the skin also plays an important role in the Hildegardian system of treatment. Many of her remedies, even for internal diseases, operate through this organ, such as rubbings, baths, warming, sauna, cupping, etc.25 She recommended sulfur ointment during at least five days for the treatment of scabies, and stated that with this ointment “the sick person will get well unless God does not intend that he be healed”. Hildegard made the first and almost classical description of a peeling for rosacea: she used plants that promote blistering on the skin, healing rapidly afterwards. Depending on the color of an abscess, black, grayish, or whitish, she could predict its outcome; the black would threaten the patient with death; and she recommended their drainage for better evolution. In her books there are recipes for the use of various plants that are now proven antinflammatory and antibiotic agents. She had also a recipe for preventing hair loss in young men.17,24

In Hildegard’s medicine it is most important to take the responsibility for your own health. Enjoy a natural life and make proper use of your five senses. Take joy in walking, mountain-climbing, swimming, rowing, sailing, riding, fishing, taking care of animals, gardening, music and painting, etc, and believe in God, the essence of all good, creator and lord of the natural order of things.25

Maestro Christopher Page, who, in 1981, in England, directed the recording of a series of her musical works entitled “A feather on the breath of God: Sequences and Hymns by Abbess Hildegard von Bingen”, an anthology of some of her chants,12 describes her, in his notes, as “one of the most remarkable creative personalities of the Middle Ages…” and Sandra Sabatini, in her paper ‘Women, Medicine and life in the Middle Ages’, asks: “does he (Maestro Page) know about her contribution to Medicine, too?” 2

Hildegard’s life spanned the reigns of twelve popes, an equal number of antipopes, and four Holy Roman Emperors. After she died, her devotees felt that she should be venerated as a saint, and made every possible effort towards that end. Although not formally canonized by the church, Hildegard von Bingen is considered a saint in Germany, and her death’s date, September 17, is observed in several German dioceses, specially around the junction of the Nahe and Ghan Rivers.5,6,14
Referred as “prophetess”, “Secretary of God”, “Sibyl of the Rhine”, “German’s first female doctor”, “Saint”, and “the Dear Abby of the twelfth century”, Hildegard von Bingen is best described by the descriptions of her occupations: “healer”, “teacher”, “thinker, “musician”, “first published woman physician” and “respected abbess”.6,17
In the celebration of the eight hundred years of her death, in 1979, the pope John Paul II defined Hildegard von Bingen, one of the most remarkable women of the Middle Ages, as “the light of her people and of her time”.26

The author wishes to thank Thais R M Castro (Brazil) for the collaboration in all steps of the elaboration of the manuscript; Eros de Viterbo Jr. (Brazil) for the preparation of the figures; Tania Cestari (Brazil) for the review of the paper; Stephen Greenberg and the staff of the National Library of Medicine (USA), Barbara Newman (USA), Catherine Innes-Parker (Canada), Kristina Lerman (USA), Sue Wallace (UK), Roland Horst (Germany), and Providence Calderon (USA), for their help in obtaining some of the documents, figures, books and articles used in this article.

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