Key words : Kidney disease, Kidney remedies, Medieval medicine

Hildegard von Bingen (Hildegardis Bingensis, ie, Saint Hildegard), also known as Sibyl of the Rhine (AD 1098-1179), was a Rhineland Benedictine abbess of the 12th century who was a writer, musician, counselor, and a gifted healer,^1,2

Hildegard was born and lived in the municipality of Bermersheim in Rheinhessen, a hilly wine-producing region in western Germany. She was the tenth child of a wealthy and devout family. At the age of 8 years, Hildegard was given into care of an anchoress and noblewoman, Jutta von Spanheim (1091-1136), whose hermitage was attached to the Benedictine monastery of Disibodenberg. This monastery was founded during the 7th century by an Irish monk, Saint Disibod.

Taught and raised by Jutta von Spanheim, Hildegard learned to read and write. Furthermore, Hildegard had been able to study many holy texts in Latin. In 1106, at the age of 15 years, Hildegard took her vows as a nun and received the veil from Bishop Otto of Bamberg. By that time, the anchorhold had expanded to become a convent, and Jutta became its mother superior. Hildegard had been recognized for her diligence and dedication in the convent, and Jutta chose her as successor. In 1136, after the death of Jutta, the 38-year-old Hildegard von Bingen was appointed abbess.

With a multifaceted personality (writer, poet, componist, linguist, theologian, preacher, spiritual counselor, and healer), Hildegard outshines many scholars from her period and perhaps from any period.

Hildegard was special for another reason, namely, her visions, which she had experienced from childhood.³ Although she truly believed her visions were of divine origin, she had concealed these from fear of condemnation for heresy. However, one powerful vision at the age of 42 years compelled Hildegard to start writing. She heard, “speak and write […] as one who hears and understands the words of a teacher and explains them in his own way.” Her life changed, and she felt as if she had been “weighed down by a scourge of God.”^4,5

Hildegard’s exploration of mysticism was documented in her major visionary work Scivias (Sci vias Domini, ie, know the ways of the Lord), in which she depicts each of 26 visions with 39 beautiful miniature illustrations and respective elaborative text. Pope Eugenius III received a draft of Scivias, read part of it at a synod in Trier (winter of 1147-1148), and authorized Hildegard to continue writing.⁶

After this papal endorsement, the abbess, recognized as a person who hears, understands, and explains the words of God, became established as counselor (and sometimes critic) to popes, emperors, kings, queens, bishops, and the common people, all of whom sought her advice and prayers.

As Hildegard’s fame expanded, so did the prominence of Disibodenberg. Many girls and women came to study and live under Hildegard. The women’s quarters in the monastery soon became overcrowded, at which time (AD 1150), against the will of the abbot, Hildegard disembarked with her loyal followers (18-20 nuns), to establish a new convent at Rupertsberg, a day’s journey from Disibodenberg, near Bingen on the Rhine. Construction of Rupertsberg abbey was financed and overseen by Hildegard herself. Fifteen years later (AD 1165) she founded another nearby community at Eibingen.

Ergography

Having completed Scivias in 1151, Hildegard wrote 2 additional visional works completed by 1173: Liber Vitae Meritorum (ie, Book of Life’s Merits), a work on theology, and Liber Divinorum Operum (ie, Book of Divine Works), a work concerning world creation, the human place in the cosmos, and the end of time the Final Judgment. After Scivias was completed, Hildegard turned to her medical work, which is collected in 2 books completed from AD 1152 until 1163: Physica and Causae et Curae. Physica is a collection of 9 volumes with an inventory of plants, trees, elements, stones, animals, and metals, describing their natural therapeutic properties. Causae et Curae is a work of pathophysiology and clinical practice.

In Rupertsberg, Hildegard composed 70 religious songs and works of liturgical music, which were performed in both vibrant convents she had founded in Rhineland. Presently, in modern times, her musical works continue to be performed and recorded. Here, too, she transcended the usual constraints imposed upon women in the medieval era.. Even Heloise a contemporary most prominent woman scholar (the French abbess, Héloise du Paraclete) did not dear to compose music for her convent but asked Abelard (a male musician) to do it for her.

Hildegard’s minor works are letters, poems, biographies of Disibod and Rupert, and commen-taries on the Gospels, the Athanasian Creed, and the Benedictine Rule, as well as a theatrical play. She invented a unique language and alphabet for use by her nuns.

The aim of the study presented here was to identify all nephrology-oriented natural remedies in Physica and to analyze the characteristics of these remedies, to compare these in content and illustrative style versus the remedies described in De Materia Medica by Dioscorides Pedanios Anazarbeus (AD 1st century), as described in (1) the Vienna and Neapolis Greek manuscript copies,⁷ (2) the 1907 modern edition by Max Wellmann,⁸ and (3) the English translations published in 1934 by Robert Gunther⁹ and in 2000 by Osbaldeston and Wood.¹⁰

Materials and Methods

We searched Hildegard’s work Physica, which is a collection of 9 volumes with an inventory of plants, trees, elements, stones, animals, and metals, describing their natural therapeutic properties, in order to identify any nephrology-related remedies or prescriptions for kidney ailments.

For this purpose we used a translation of Physica from the Latin into English by Priscilla Throop,¹¹ which is a translation of an 1882 edition of Physica (volume 197 of the Patrologia Latina) published by C. Daremberg and F. A. Reuss.¹² This edition includes the text from a manuscript of the 15th century, now kept in the National Library in Paris (Codex 6952), with additions (in brackets) of missing passages in comparison to the first publication in 1533 by Johann Schott.¹³

The texts were digitized from the original, and thereafter a search for nephrology-oriented remedies was performed digitally. As nephrology-oriented remedies, we considered all elements that were prescribed or were ingredients of prescriptions with kidney-related pharmacological action (diuretic) or indication (eg, dysuria, nephritis, kidney stones or sand, dropsy).¹⁴ All the entries in brackets were used for the digital search and also finally for a personal review of the text by the authors.

Results

We studied all 293 plants in Physica (230 herbaceous plants and 63 trees). Among all plants in this treatise (n = 293), there were 15 (5.1%) of nephrological interest (11 herbaceous plants and 4 trees) (Table 1).

The nephrological treatment indications described in Physica included dysuria, nephritic pain, and lithiasis in 13 of 15 (87%) and dropsy (edema) in 2 of 15 (13.3%), which is comparable with 9.5% in the nephrological recipes described in De Materia Medica.

Only some of the natural ingredients mentioned in Physica were also found with similar indication in the ancient text of Dioscorides (9 of 15). Many of these, however similar, were not intended for ingestion but rather for dermal application. In comparison with De Materia Medica, the Physica contains no introductory descriptions of plants or other natural ingredients and no illustrations to give readers a real picture of the entries.

Discussion

Drugs of nephrological interest cover about 5% of the total number of remedies described in Physica by Hildegard. The comparison of Physica to the ancient text of Dioscorides, on the one hand, indicates differences in the form of writing, ie, lack of illustrations and the healing practices applied, especially the higher frequency of external (dermal) applications of remedies, versus the ancient text. These differences might be due to the healing practices applied by the clergy for many centuries and to some special personal experiences of Hildegard.¹⁵

On the other hand, the comparison of the 2 authors’ works reveals some similarities between the ancient and medieval medical texts with respect to the frequency and importance of prescriptions for dropsy as well as dysuria, kidney pain, and stones, respectively. This might either be associated with a real similarity in disease epidemiology in ancient times versus the monastic practices of the medieval era^14,16 or reflect a mere resemblance in the available remedies and the forms of practicing medicine between the 2 periods.

The distinction between the “medical” and “visionary” in Hildegard’s medical works is not as clear-cut as we might like to think. Her medical and physiological ideas in Liber Divinorum Operum Simplicis Hominis (ie, Book of Divine Works) and her medical works were all inspired by her visions, which she believed were direct transmissions from the Divine.

Nevertheless, Hildegard was a multifaceted scholar and, above all, a gifted healer. Hildegard had absorbed all of her teacher’s knowledge, but not Jutta’s asceticism. Hildegard believed in moderation and regarded the human body with fascination rather than suspicion, and her practice of medicine and her skill to heal were based absolutely on her own knowledge, whether of visionary origin or not, and not on miraculous effects.^17,18 Her healing ability outshined her many other substantial talents, and all ranks of people visited her for healing, exorcism, and counsel.¹⁹

During medieval times (AD 500-1500), women were often skilled in medicinal herbs and in first aid; however, they were not allowed to practice outside the home as doctors or surgeons.²⁰ Contrary to western Europe, in Byzantium times, women were officially allowed to practice the medical profession, mainly in specialties as midwifery and gynecology, but also many other medical services to women, and were also appointed in hospitals in women’s wards.²¹ In this respect Hildegard was exceptional, offering her services in public to anyone who asked. Altogether, Hildegard von Bingen was a distinguished person and one of the most remarkable women of the medieval era.

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