Circulating Now welcomes guest blogger Winston Black, PhD, from St. Francis Xavier University in Nova Scotia, Canada, to share his research on the oldest European manuscript in the National Library of Medicine’s collection, a twelfth-century medical collection from England.
Monasteries were among the most important institutions in Medieval Europe. They housed anywhere from a dozen to hundreds of monks or nuns, along with many servants and visitors. The ideal monastery was cut off from the world so the inhabitants could devote their lives entirely to God but, in practice, many monasteries served as community centers, providing religious services, education, charity, local government, guest housing, and medical and hospice care, often in a dedicated hospital or infirmary. Depending on the size and wealth of the monastery, this infirmary could range from a single room just for the monks to a complex of medical buildings including a hospital, pharmacy, baths, bloodletting services, and a separate chapel. Some of the larger monasteries ran both an internal infirmary and numerous hospitals in the surrounding community.
Historians of medicine and religion are deeply interested in monastic hospitals. We know they existed, we can still see their surviving structures or ruins, and many of their financial accounts survive. But there is often little evidence for what medical care looked like in a monastery. We are left wondering: Who did they consider sick? What treatments were available and how were they purchased or made? Were some of the monks trained as physicians? And how did they balance care of the body with care of the soul in an institution dedicated to religious devotion? One of the key difficulties in identifying medical care in medieval hospitals is that their main purpose was caring rather than curing, that is, providing shelter, food, and spiritual sustenance for those most in need, like lepers, pilgrims, orphans and widows, but only incidentally offering medical care for the sick and infirm.
The National Library of Medicine (NLM) holds a medieval manuscript that can help us answer these questions by providing a rare window onto medical care in one medieval monastery, the Abbey of Bury St Edmunds in Suffolk, England. The abbey is in ruins today, destroyed after the dissolution of the monasteries in 1539. But in its heyday in the twelfth through fifteenth centuries, Bury was among the largest and richest religious houses in England, and a renowned center for medical learning. The NLM manuscript in question, known as “E8”, is the oldest European manuscript in the Library, dating from the first half of the twelfth century. It is an unassuming volume of about nine by six inches, recently rebound in untanned leather. It contains 190 parchment folios (leaves) or 380 pages, often of a rough quality and of different sizes. Dozens of different scribes and readers have written on these pages and added notes in the margins or at the end of longer texts. The volume is described in older catalogues simply as “Recepta varia” (“Various recipes”), but that vague description obscures a wealth of history found in its worn parchment pages. Manuscript E8 almost certainly was made and used in Bury because its contents and annotations were copied from two other surviving medical manuscripts, both now in the British Library, that were used or made there in the later eleventh and early twelfth centuries.
What makes E8 special is the combination of medical and religious texts that were designed to be used together for healing body and soul. The bulk of the manuscript, its first 185 folios, is dedicated to medical diagnosis and herbal remedies. It contains some fifty different texts in numerous different hands, showing that it was consulted and enlarged throughout the twelfth century. Some texts are dedicated to medical wisdom (a commentary on the Aphorisms of Hippocrates), some to knowing how to recognize and name different medicines (an herbal glossary known as Agriocanna), and others on how to diagnose a patient’s health by analyzing their urine or pulse. Most of the texts, however, are compilations of remedies, providing ingredients and instructions for various cures. These remedies are typically described by their format and the problem they are treating: “Antidote for a migraine”, “Plaster for broken joints”, “A salve for cloudy eyes”, and so on. Every inch of free space is used, especially around the remedies, showing generations of medical students and practitioners adding cross-references or notes to other books that could be found in the monastery’s library.
After the medical texts come the final five folios which form a booklet of stories and music dedicated to the Virgin Mary, copied at the same time as the medical section and possibly bound with it from the start. These include three miracle stories about Mary and a selection of hymns and chants, with medieval musical notation, about Mary or the infant Jesus at Christmas. The hymns include Ave, Maris Stella (“Hail, Star of the Sea”), a reinterpretation of the Ave Maria prayer. Collections of miracles about Mary, known as Mariales, were first composed at several English monasteries in the twelfth century, including Bury St Edmunds. These miracles could be read out loud as part of a sermon, or for education and entertainment in the dining hall or in the infirmary.
The three miracle stories in E8 share a lesson: the holiness of the Virgin can save the soul of even the most wicked person. In these stories she does not cure sickness or death, which is a common theme in miracle stories of the Early Middle Ages. Rather, each protagonist dies in the story but is saved from damnation because of their love of Mary during life. The characters show this love in various ways, either by constantly saying the Ave Maria, praying at an altar dedicated to Mary, or gaining her forgiveness through weeping and fasting. The living companions of these sinful men assumed their souls were lost until they witnessed bodily miracles that signalled the saving presence of the Virgin: one person is found to have the words of the Ave Maria engraved on his tongue, and another is found with a white lily, the symbol of the Virgin, growing from his mouth. The compilers of the manuscript then provided the very tools that the audience would need to show devotion to Mary, and obtain her favor after they died: the words and music to hymns in her honor, and chants for special masses in her memory.
At first glance, it might not seem like the medical texts and miracle stories in this manuscript belong together. But they served a common purpose in the infirmary of a monastery like Bury St Edmunds: they taught the monk-practitioners how to examine the body for signs of health and disease, physical or spiritual. These signs could be natural, like urine and pulse, or supernatural, like the miracles described in the Mariales. Whether they lived or died, a patient in a monastic infirmary like Bury’s, could rest assured that the monks had the tools to care for their whole person, using resources like those in NLM manuscript E8.
Dr. Winston Black is a historian of medicine and religion in Medieval Europe and holds the Gatto Chair of Christian Studies at St. Francis Xavier University in Nova Scotia, Canada, and a 2023 NLM Michael E. DeBakey Fellow. He is the author of three books and dozens of articles, most recently Medicine and Healing in the Premodern West: A History in Documents(Broadview Press, 2020). He is active on Twitter @WinstonEBlack.