Worcester Cathedral Library is fortunate to possess a fine collection of twelfth and thirteenth century medical manuscripts, comprising a wide selection of the most important authorities of that time. They are all in Latin, the language of serious discourse. While this may seem a tiresome hindrance to modern eyes, it actually represented a huge step forward for medical understanding in the kingdoms of western Christianity because it brought to them for the first time the writings of both ancient Greeks and contemporary Arabic scholars
One manuscript in particular may be considered as an introduction to this important subject. It is catalogued as Q. 40 and is an edition of a text that enjoyed widespread popularity from its beginnings in about 1050 until well into the sixteenth century – the Passionarius of Gariopontus. The Latin title may be translated as ‘A Compendium of Illnesses.’
The pages of a manuscript are usually called folios, and each folio has two sides, a front and a back. The left-hand page is the back or reverse of folio twelve and the right is the front of folio thirteen. The original parchment has been damaged by water but carefully restored and bound onto new sheets of paper. The two small white patches are holes in the parchment. But all the original features of the manuscript are well preserved and make an interesting and colourful display. The picture shows how a manuscript can be both elegant and impressive through its lettering alone, without the need for elaborate further illustration.
The prominent capital T is in gold with an intricate floral array, and it is there to begin the first word of a new chapter of the manuscript On Diseases of the Lungs. That word is Tusicula or Little Cough. The paragraph begins with the common-sense observation that A dry little cough can come to anyone! This opening matches what Gariopontus says in his rubricated heading Incipit Prologus – the Preface begins, on the opposite page: in primis de tussicula dicam which means at first I will speak of little coughs.
Paragraphs within the various chapters are introduced by alternate red and blue capitals, at once simple and elegant in design. The last nine lines of folio twelve and the first fifteen lines of folio thirteen provide a summary of what is to come. And it is easy to see that the main text has been supplemented with tiny notes written in the margins and sometimes in between the lines.
The Passionarius is a sort of medical anthology, based mainly on a Latin translation of the writings of Galen, the second-century Greek physician, surgeon and philosopher. Galen’s works were a major influence on medical practice for more than 1,300 years after his death. But Gariopontus’ work includes much more than this. He created an organised practical manual from Galen and a number of other writers, all arranged in a logical and useful manner. Diseases and their treatments were set out for each part of the body, starting at the head and working downwards. They are arranged into seven books and each book is divided into chapters:
Book i, On diseases of the head, brain and nerves, 21 chapters
Book ii, Diseases of the lungs and thoracic viscera, 38 chapters
Book iii, Diseases of the abdominal and pelvic viscera, 60 chapters
Book iv, Diseases of the muscles and articulations, 24 chapters
Book v, Diseases of the skin and other eruptive diseases, 31 chapters
Book vi, On Fevers, 44 chapters
Book vii, On Fevers (continued), 20 chapters
The work ends with two books on Fevers, illnesses that may be said to affect the whole body at the same time. All these features show a well-organised and useful work containing 107 folios.
This clear and logical approach made the Passionarius so useful that more than sixty separate manuscript versions are still in existence, found in libraries all over Europe. Three printed versions appeared early in the sixteenth-century, proof that the work was still considered both useful and saleable. After this time, the work of Gariopontus was largely neglected by both doctors and scholars, and it is only recently that his importance has been recognised.
Gariopontus lived and worked in the southern Italian town of Salerno, not far from Naples and Pompeii. Contemporary references indicate that he was a priest at the Cathedral of Saint Matthew and a respected scholar and teacher at the Schola Medica Salernitana, the Salerno Medical School, said to have been the world’s first such institution. Evidence suggests that Gariopontus was alive in the first half of the eleventh century.
Salerno is a coastal town and port about twenty five kilometres south of Naples. About the year 1000 it was a Lombard principality bordered in the south by states still ruled by the Greek speaking Byzantine Empire, and facing Sicily which was still under the rule of Muslim Arabs. Thus Salerno was an important centre of trade and learning with links to the Catholic north of Italy, the Muslim empire of North Africa and the still flourishing eastern part of the Roman Empire based in Constantinople.
The manuscript itself offers clues to an origin somewhere in southern Europe, perhaps in Salerno itself! It is thought to have been copied sometime between 1100 and 1150, not so many years after it was first written by Gariopontus. Suggestions for a place of origin, based on the style of the script used, include Italy, Spain and southern France. The parchment used has been prepared in the Italian manner which usually means that the hair side and the flesh side have different textures. Bishop Mauger, physician to King Richard the Lionheart came to Worcester in about 1200. Could it be that he brought the manuscript here himself?
The small annotations are written in a very different style of script. Its elaborate loops and joins are part of a style developed for quicker and more efficient writing for business and administrative use. The examples in this manuscript are thought to be from the thirteenth century and to be in an Anglicana or English style which suggests that the notes were made after the manuscript had come to England. They may be notes added by students attending lectures or by practising physicians offering further practical hints.
In the recent blog about Dr Thomas Willis, mention was made of Worcester’s excellent medical museums, details of which can be seen at https.//medicalmuseum.org.uk/