Hildegard of Bingen

Hildegard of Bingen was a twelfth-century Benedictine abbess whose medical and natural-philosophical writings make her one of the most remarkable figures of the medieval period. Working from her convents on the Rhine, she produced an encyclopaedic body of work covering plants, animals, minerals, disease, and the natural world, all framed within a theology of creation that treated the study of nature as an act of devotion. She corresponded with popes, emperors, and theologians as an equal, and her medical observations — on migraine, nervous disorders, and the relationship between brain and body — show a clinical attentiveness unusual for any writer of her century, let alone one working outside the university system that would soon exclude women from formal medical education entirely.

Life and Position

Hildegard’s teacher Jutta died at forty-four worn out by her austerities, while Hildegard, though of fragile health, prized the classic Benedictine virtue of moderation and lived to be eighty-one. (Barbara Newman, 1998) She oversaw monastic women for forty-three years, ruling at the end some eighty nuns at two foundations. (Barbara Newman, 1998)

She was not a marginal figure. Hurd-Mead records that she corresponded with Bernard of Clairvaux, Pope Eugenius III, Frederick Barbarossa, Henry II of England, Philip of France, and Eleanor of Aquitaine, among many lesser nobles and prelates. (Hurd-Mead, 1938) It was Bernard of Clairvaux who brought her writings to the attention of the Pope. (Hurd-Mead, 1938) The decisive moment of ecclesiastical recognition came at the Synod of Trier (November 1147 – February 1148), when Pope Eugenius III, guided by Bernard, appointed a commission to visit Hildegard at Disibodenberg and secure a manuscript of the still-unfinished Scivias; the pope himself had portions read aloud before the assembled prelates and then sent her a letter commanding her to continue recording her visions — the first formal authentication of her prophetic authority. (Barbara Newman, 1998) When her correspondence is fully edited it will number 390 letters — a volume matched by few other individuals of the period outside official archives. (Barbara Newman, 1998) The letters reveal a practical pastoral physician as well as a prophet: moderation in physical regimen — food and drink — is a recurrent theme in her counsel to correspondents. She taught that moderate nourishment encourages happy and gentle habits, while excess festers in vice; immoderate abstinence, on the other hand, wastes the body and produces ill temper, for “unsuitable abstinence produces wrath, not peace.”(Barbara Newman, 1998)

Her prophetic self-presentation had a structural advantage that extended beyond its theological content. By insisting that her words were delivered under divine compulsion, she possessed what Kerby-Fulton calls a “politically foolproof” defense mechanism: she could address the most powerful lay and clerical leaders of her day while being protected by the claim of divine instrumentality. (Barbara Newman, 1998) Hildegard functioned simultaneously as a prophetic voice and reformist figure within twelfth-century ecclesiastical politics, deploying apocalyptic discourse to address contemporary institutional failures. (Newman, 2020) This prophetic authority extended to direct public action: she preached four public sermons, including one to the clergy of Trier in 1160, exercising an authority that went well beyond what was expected of an enclosed abbess. (Newman, 2020) This prophetic authority was not merely rhetorical but worked within a specific intellectual tradition. Hildegard belongs to a school of twelfth-century monastic theology known as German Symbolism (der deutsche Symbolismus), which included Rupert of Deutz, Gerhoh of Reichersberg, Anselm of Havelberg, and Otto of Freising, and which read symbolic correspondences between the Old and New Testaments as revealing patterns that could be extended into contemporary and future history. (Barbara Newman, 1998) Within this tradition Hildegard became, in Kerby-Fulton’s assessment, the first internationally known spiritual meliorist — the most high-profile northern European to challenge the Augustinian view that no spiritual renewal would occur between Christ’s ministry and the coming of Antichrist — comparable in scope of influence only to Joachim of Fiore. (Barbara Newman, 1998) Her apocalyptic framework included self-placement: she called her own era the tempus muliebre, the time of effeminate weakness, which she dated to the end of Henry IV’s reign — a period of corruption that preceded the eschatological renewal she expected. (Barbara Newman, 1998) After her death, a monk named Gebeno of Eberbach compiled the key apocalyptic passages from her visionary works and correspondence into a digest known as the Mirror of Future Times (1220); this small compilation achieved far wider circulation than the voluminous originals it summarized. (Barbara Newman, 1998)

This matters for understanding her medical work, because Hildegard’s intellectual position was exceptional in ways that would become impossible within a few generations. Siraisi notes that even in the twelfth century, the accomplishments of Trota of Salerno and Abbess Hildegard were highly unusual. (Siraisi, 1990) Once university faculties of medicine were established in the course of the thirteenth century, women were excluded from advanced medical education and, as a consequence, from the most prestigious and potentially lucrative variety of practice. (Siraisi, 1990) Hildegard’s medical writings belong to the last moment before that door closed.

Women practiced medicine across medieval Europe — Siraisi records that twenty-four women described as surgeons are known in Naples between 1273 and 1410, and fifteen women practitioners in Frankfurt between 1387 and 1497 — but they represent only about 1.5 percent of practitioners whose names survive in France and 1.2 percent in England. (Siraisi, 1990)

Medical Writings

Hildegard’s principal medical works are the Liber Simplicus Medicinae (also known as the Physica) and the Causae et Curae (also called Liber Compositae Medicinae). Tobyn, Denham, and Whitelegg record that she worked on the Liber Simplicus Medicinae from 1151 to 1158, and that it comprises nine books on plants, metals, animals, reptiles, diet, stones, and humours, written from a deep faith in the value of the parts of God’s creation. (tobyn11-ch01-009) Hurd-Mead describes the work as covering 230 plants, 60 trees, minerals, metals, precious stones, fishes, birds, quadrupeds, reptiles, and the metals. (Hurd-Mead, 1938) Hildegard herself may have originally conceived the two surviving texts as a single work: in the preface to her Liber vite meritorum (1158) she mentions completing a book she called Subtilitates diversarum naturarum creaturarum (Subtleties of the Different Natures of Creatures), and it is possible that the Physica and Causae et Curae as they survive represent the transmitted remnants of that original single compilation. (Barbara Newman, 1998)

She was, for the whole medieval period, the first scientific writer to discuss sexuality and gynecology from a female perspective. (Barbara Newman, 1998) Hildegard of Bingen and Trota of Salerno are the only two verified female medical writers in the entire medieval period; no other community of religious women has been documented as owning medical literature until at least the thirteenth century. (Barbara Newman, 1998)

[GAP: Description of the work as a medical encyclopaedia organized around the natural world, with theological framing that created things possess healing value because God made them so.] [GAP: Claim that Hildegard’s concept of viriditas operated at the intersection of theology, natural philosophy, and medicine.] In her writings on knowledge and learning, she described the Holy Spirit as infusing human minds with greenness: “the Holy Spirit fills it with the greenness of its knowledge, whence the human learns and grasps whatever it wishes to learn.” (Newman, 2020) In her medical works, Hildegard used viriditas as a central concept of health. (Hurd-Mead, 1938) [GAP: Claim that viriditas designated the animating force in living things, with its absence causing disease and death.] [GAP: Claim that the concept was not borrowed from existing medical sources but synthesized from Benedictine theology and humoral medicine, expressing conviction that created things have healing value due to divine power.]

Hildegard’s cosmological vision extended to an explicit macrocosm-microcosm doctrine: the human body mirrors the cosmos, with the firmament likened to the head, the sun and moon to the eyes, and each element of the natural world assigned its anatomical counterpart. (Newman, 2020) The full anatomical mapping runs as follows: the firmament is like the head of man; the sun, moon, and stars are like his eyes; the air like his sense of hearing; the winds like his sense of smell; the dew like his sense of taste; the sides of the world like his arms and sense of touch; the earth like his heart. (Barbara Newman, 1998) This doctrine of correspondences articulated in the Causae et Curae underpinned her “interrelated fours”: the four elements (fire, air, water, earth), four seasons, four humors, four zones of the earth, and four major winds were understood as inherently interconnected — from fire the body has heat, from air breath, from water blood, from earth flesh. (Barbara Newman, 1998) Medicine practiced within this framework was not merely pragmatic but philosophically coherent: Glaze argues that Hildegard’s effort to dignify medical practice as the means by which humanity ameliorates the bodily consequences of the Fall, much as theology ameliorates its spiritual consequences, has no known precedent in monastic medical literature. (Barbara Newman, 1998)

What distinguished Hildegard from other monastic compilers was her compositional method. Where other medical writers of late antiquity through the eleventh century allowed textual authorities to dominate and produced patchwork compilations, Hildegard allowed her own overriding visio of the universe and the natural creation to determine the content of her medical writings, using her sources as raw material she reconceptualized rather than reproduced. (Barbara Newman, 1998) Among the sources she drew on was the treatise De semine, from which she took ideas about semen as the foam of the blood and about the conversion of blood to breast milk in women, and the anatomical-embryological work of Vindician (fl. 400) — assimilating these theories to her own viewpoint rather than allowing them to dictate her presentation. (Barbara Newman, 1998)

Humoral Theory and Theology of Disease

Hildegard’s humoral system diverged from the standard Galenic framework she inherited. While accepting that four humors governed bodily health, she described them through an original hierarchical scheme: dominant humors (flegmata) and subordinate, potentially obstreperous humors (livores), in parallel with her general cosmological principle that higher powers govern lower ones. Health required the dominant flegmata to maintain ascendancy over the livores; disease arose when the subordinate humors prevailed. (Newman, 2020)

Behind this framework lay a theology of disease rooted in the Fall. Before Adam’s transgression, Hildegard argued, human flesh would have been “whole and without dark humor”; sin transformed the blood of humanity into “the poison of semen,” making flesh “ulcerated and permeable” to illness. (Newman, 2020) The flegmata themselves arose from a “smoky moisture” generated by humanity’s corrupted condition.

This theological reading does not inspire Hildegard to offer a spiritually simplistic, orthodox course of action; instead, her response is “confidently materialistic and naturalistic.” (Newman, 2020) Hildegard privileged the practice of medicine as the primary response to illness rather than prayer, penance, or reliance on Christus medicus. (Newman, 2020)

The Physica enacts this conviction in nine books, cataloguing the medicinal properties of plants, elements, trees, stones, fish, birds, quadrupeds, reptiles, and metals. (Newman, 2020) Her pharmacopoeia combined two pre-existing traditions: the Dynamidia tradition characterizing medicines by their hot, cold, dry, or moist powers (extended by Constantine the African’s De gradibus), and the Physiologus tradition characterizing animals. (Newman, 2020) The Causae et Curae is structured across six books in a temporal-cosmological sequence: creation of the universe, the nature of the human being, a head-to-foot account of diseases across nearly three hundred chapters, cures, prognostics, and a lunar horoscope. (Barbara Newman, 1998) Newman describes the sequence more fully: the work begins with the creation of the universe, moves to the creation and fall of humanity, then outlines diseases head-to-foot in “almost three hundred chapters,” followed by cures in books 3–4, prognostics in book 5, and a lunar horoscope in book 6.(Newman, 2020)

Hildegard was the first verified female medical author of the entire medieval period, with only Trota of Salerno as a contemporary parallel. (Newman, 2020)

Hildegard also applied her humoral cosmology directly in her work as abbess, classifying the personalities of her nuns into four types: the “hard” type (sharp, preoccupied with self, aloof from others); the “airy” type (inconstant, fearful, constantly self-reproaching); the “windy” type (foolish, resistant to wise counsel); and the “ardent” type (zealous for worldly things, unable to find peace). (Barbara Newman, 1998) This was not mere character description but a governance framework: she understood herself as cultivating the viriditas and virtue of her nuns as a gardener cultivates herbs, with moderation as the governing principle. (Barbara Newman, 1998) The connection between bodily state and spiritual capacity was direct and physiologically grounded: despair damages the body by depriving the person of all greenness. (Barbara Newman, 1998)

Hildegard’s Causae et curae also presents a physiological account of female desire that stands in a different but parallel relationship to the male-oriented Viaticum commentary tradition on lovesickness. Where the scholastic physicians debating amor hereos centered their discussion on the male patient, Hildegard described the physiological basis of women’s desire in terms of heat and humor. Wack, in her study of lovesickness in the Middle Ages, identifies Hildegard’s account as representing a theological-natural-philosophical tradition that read excessive female desire as physiologically constitutive rather than merely sinful — a frame distinct from but intersecting with the medical tradition on love (Wack, Mary Frances, 1990). In the scholastic debate on women’s sexual pleasure, this physiological framing of desire informed arguments about the “extensive” pleasure attributed to women — their dual satisfaction from both emitting and receiving seed — which the Viaticum’s Pantegni source had introduced into the Latin tradition. Wack cites Hildegard’s Causae et curae in her reconstruction of the context in which love melancholy was understood, noting that it offered a natural-philosophical framework for women’s desires that the academic physicians barely engaged with directly (Wack, Mary Frances, 1990).

Clinical Observations

Hildegard argued that mental illness was not demonic possession. (James J. Walsh, 1920) As Walsh notes, she states that “when headache and migraine and vertigo attack a patient simultaneously, they render a man foolish and upset his reason. This makes many people think that he is possessed of a demon, but that is not true.” (James J. Walsh, 1920)

Hurd-Mead notes that she described migraine, paralysis, deafness, vertigo, insanity, and various nervous disorders with clinical precision, and that her own personal experience with ill health gave her a deep sympathy for patients and insight unusual for her century. (Hurd-Mead, 1938) Hildegard was explicit about the relationship between her visions and bodily suffering: “I have never fallen prey to ecstasy in the visions, but I see them wide awake, day and night. And I am constantly fettered by sickness, and often in the grip of pain so intense that it threatens to kill me.” (Barbara Newman, 1998)

This self-testimony has attracted modern interpretive attention. Charles Singer, a historian of science, proposed that the classical migraine aura — producing scintillating scotomata perceived as shimmering lights and “fortification figures” resembling crenellated walls and turrets — could account for many of the visual phenomena Hildegard described. (Barbara Newman, 1998) The art historian Madeline Caviness has extended this argument by observing that the Scivias manuscript illuminations contain precisely the visual features associated with migraine aura: irregular jagged-edged forms spreading over the visual field, stars behaving like phosphenes, and crenellated fortification spectra at odd angles — features most plausibly attributed to Hildegard’s firsthand experience. (Barbara Newman, 1998) Caviness argues further that Hildegard herself was the primary designer of the Scivias and Book of Divine Works illuminations, not merely a supervisor, having sketched her visual auras on wax tablets at the time of occurrence and subsequently working them into pictorial compositions. (Barbara Newman, 1998)

Hurd-Mead also claims that Hildegard described the circulation of the blood in her Causae et Curae, anticipating Harvey by four centuries. (hm38-ch04-002) This claim should be treated with caution. The passage cited — that blood flows through the veins and arteries even as rivers flow through the earth, and the movement is continuous — uses metaphorical language that falls well short of Harvey’s experimental demonstration of a closed circulatory system. What the passage does show is an awareness of blood as a moving fluid with a continuous course, which is noteworthy but not the same thing as a theory of circulation.

Intellectual Context: Monastic Medicine Before the Universities

The revival of formal medicine in the West took place around 1100, emerging first at Salerno. (Porter, 1997) Constantine the African’s translations of Arabic medical texts into Latin provided the means whereby Latin Christendom first gained access to the tradition of Hippocratic learning rationalized by Galen and digested by the Arabs. (Porter, 1997) The Articella texts were wholly Galenic: a proper doctor could thenceforth be defined as a man who knew his Galen. (Porter, 1997)

The physical infrastructure for this medical tradition was built into the Benedictine Rule from its composition before the middle of the sixth century, which explicitly required the construction of a monastic infirmary as a separate installation for the care of sick community members. (Barbara Newman, 1998) An early ninth-century elaboration of this ideal — the Plan of St. Gall — proposed a comprehensive medical complex within the monastery: a physician’s residence with pharmacy, a dedicated bloodletting building, a separate kitchen and bathhouse for the sick, a medicinal herb garden, and a full infirmary with chapel. (Barbara Newman, 1998) Though the Plan was never built in this form, it reflects the scale of ambition. Hildegard’s infirmary at Rupertsberg would have been equipped with beds, medicinal bath tubs, an armarium pigmentorum (medicine cupboard), mortars for grinding drugs, and phlebotomes for bloodletting. (Barbara Newman, 1998) Before Constantine the African’s translations, monastic scriptoria functioned as the primary transmitters of classical medical literature; over 145 volumes of medical texts survive from the ninth through eleventh centuries, copying primarily Hippocratic material and reduced Galenic theory through Latin encyclopedias. (Barbara Newman, 1998)

Constantine the African (d. before 1098/1099), working as a Benedictine monk at Monte Cassino, transformed this tradition by translating Arabic and Galenic medical texts — particularly the Pantegni, Viaticum, and Isagoge — into Latin; these translations then spread northward through Benedictine communities across Europe, introducing a new emphasis on the causes of disease rather than simply listing remedies. (Barbara Newman, 1998) Hildegard drew directly and extensively on Constantine’s Pantegni in structuring her accounts of abdominal organs, hernia, and reproductive disorders, following the Pantegni’s basic topical arrangement and using some of its exact verbal forms — making her the only medieval author prior to the late twelfth century to present a similar analysis of hernia outside of Constantine himself. (Newman, 2020) (Newman, 2020)

But Hildegard’s work does not belong to the new university tradition that was rising in her lifetime. It belongs to the older monastic stream. Her knowledge came through direct observation, convent tradition, and local practice rather than through the Articella curriculum. Tobyn and colleagues note that her work indirectly influenced German household management books for centuries (Tobyn Denham Whitelegg, 2011), suggesting a line of transmission running through vernacular domestic medicine rather than through the Latin university system. In the fourteenth and fifteenth centuries, the Physica found new audiences among vernacular readers and university-educated German physicians alike (Newman, 2020) — being incorporated into named compilations such as the Speyerer Krauterbuch (an alphabetized herbal) and the Cookbook and Medical Book of Master Eberhard, while university professors at Heidelberg excerpted her medical recipes. (Barbara Newman, 1998)

The church was at the same time beginning to restrict monastic involvement in medicine. Starting with the Second Lateran Council in 1139, a series of decrees forbade monks from pursuing medical studies outside the monastery or practicing medicine for profit; Pope Alexander III softened this in 1163 to merely prohibit departure from the monastery for study, saying nothing negative about medical practice within it. (Barbara Newman, 1998) This regulatory climate helps explain an otherwise puzzling feature of Hildegard’s medical corpus: her medical writings are entirely absent from the Riesenkodex, the large compendium begun in the final years of her life or shortly after her death that preserved all her other writings, and there is no evidence that she circulated them to her network of correspondents as she did her visionary works. (Barbara Newman, 1998) One episode illuminates the prudence of her reticence: the abbot Faritius of Abingdon was earlier in the twelfth century rejected as a candidate for archbishop of Canterbury explicitly on the grounds that he had practiced medicine and treated female patients — suggesting Hildegard had sound political reasons not to publicize the practical applications of her medical writings. (Barbara Newman, 1998)

Scholarly opinion about the authenticity and status of Hildegard’s medical works has itself been contested. Charles Singer in 1917 rejected both the Physica and the Causae et Curae as inauthentic works unworthy of Hildegard’s “virile intellect”; this opinion has since been refuted through careful comparative analysis, and Glaze argues that the doubts arose more from assumptions about female medical authorship and ignorance of early medieval medical literature than from substantive evidence. (Barbara Newman, 1998) The Renaissance humanist Johannes Trithemius (1462–1516), visiting the Rupertsberg from his nearby abbey of Sponheim, judged the medical writings so perceptive they must have been supernaturally inspired — a reaction that Glaze reads as reflecting his own era’s assumption that medical literature was the jealously guarded prerogative of university-educated, publicly licensed male physicians. (Barbara Newman, 1998) Glaze also raises the possibility that the Physica and Causae et Curae as preserved in the earliest manuscripts were unfinished drafts at the time of Hildegard’s death — still partly on wax tablets or loosely bound parchment — which would account both for their omission from the Riesenkodex and for the duplication of material between them. (Barbara Newman, 1998)

This is what makes Hildegard difficult to place in standard histories. She was neither a university physician nor a folk healer. She was a monastic intellectual with the resources and authority to produce encyclopaedic natural-philosophical works, writing at the last moment when that position was available to a woman. The university system that arose after her would not have admitted her.

Music and Theology

Hildegard was not only the most prolific composer of monophonic chants known to us from the twelfth century but from the entire Middle Ages, surpassing in the sheer size and security of attribution even ninth-century rivals such as Notker of St. Gall. (Barbara Newman, 1998) Her musical output falls into two large bodies: the Symphonia armonie celestium revelationum (Symphony of the Harmony of Celestial Revelations), comprising forty-three antiphons, eighteen great responsories, three hymns, seven sequences, one Alleluia, one Kyrie, and four devotional songs; and the Ordo virtutum (Play of the Virtues), a full-length music drama containing over eighty songs. (Barbara Newman, 1998) She is the only composer from the entire medieval period whose works include an ensemble of liturgical chants, related art works planned by the composer, a full-length music drama, and a theological text explaining the significance of the songs for spiritual life. (Barbara Newman, 1998)

Music occupied a distinct theological position in Hildegard’s thought. Singing was not an embellishment on religious life but constitutive of it: “the body is the vestment of the spirit, which has a living voice,” so it is proper for the body in harmony with the soul to use its voice to sing praises to God — making communal song an incarnational act, central to the creative regeneration of life within the monastic community. (Barbara Newman, 1998) In the formal schema of her theology, words symbolize the body, jubilant music indicates the spirit, celestial harmony shows the Divinity, and the words show the Humanity of the Son of God; text and music were thus inseparable. (Barbara Newman, 1998) The concept of viriditas ran directly through her music as well: the responsory “O nobilissima viriditas” (O most noble greenness) is among the most characteristic examples, its opening word spanning a long melisma — her great responsories generally exceed by far the ornamental norms of later medieval office repertories. (Barbara Newman, 1998)

Contemporaries registered her songs as novel to the point of strangeness, calling them nova et inaudita — “novel and unheard-of.” (Barbara Newman, 1998) A canonization witness named Hedwig of Alzey recalled seeing Hildegard “shining with light” not only on her sickbed but also when she walked through the cloister singing the sequence “O virga ac diadema” at the Holy Spirit’s prompting — suggesting that contemporaries perceived her music as itself luminous. (Barbara Newman, 1998)

Theological Position

Hildegard’s theological method contrasted markedly with that of her most celebrated contemporaries. Where Anselm of Canterbury took for granted reason’s capacity to engage static philosophical concepts — being, substance, accident — and Abelard worked within philosophical abstractions, Hildegard developed her thought from organic concepts: “life” and “greenness” (viriditas). She reasoned from nature rather than from philosophy. (Barbara Newman, 1998) God was, in her vision, not an omnipotent being above creation but “the fiery life of the universe” — “All these things live in their essence, and are not found in death, since I am life.” (Barbara Newman, 1998) The relationship of soul to body was like sap to a tree, the intellect being the viridity of the branches and leaves. (Barbara Newman, 1998) This organic-vitalist theology underpinned both her natural philosophy and her medicine: physical disturbance was invariably a sign of deeper imbalance in the soul, and the key to both physical and spiritual health lay in the moderation of the humors so that none dominated another — a connection between traditional humoral theory and wider cosmology that was, in Mews’s assessment, most unusual among her contemporaries. (Barbara Newman, 1998)

See Also

• monastic-medicine
• medieval-medicine
• trota-of-salerno
• constantine-the-african
• viriditas
• women-in-medicine
• humoral-theory
• galenic-medicine

Sources

• Newman, B. (ed.) (2020). Hildegard of Bingen. Berkeley: University of California Press. (source_id: newman-hildegard-of-bingen-2020)
• Newman, B. (ed.) (1998). Voice of the Living Light: Hildegard of Bingen and Her World. Berkeley: University of California Press. (source_id: newman-ed-voice-of-living-1998)
• tobyn-et-al-western-herbal-tradition-2011
• hurd-mead-historywomen-1938
• walsh-medieval-medicine-1920
• siraisi-medievalmedicine-1990
• ackerknecht-shorthistory-1955
• porter-greatestbenefit-1997
• rawcliffe-medievalengland-1997
• francia-stobart-criticalapproaches-2014
• saad-said-greco-arab-islamic-herbal-2011
• Wack, M.F. (1990). Lovesickness in the Middle Ages: The Viaticum and Its Commentaries. Philadelphia: University of Pennsylvania Press. [Source ID: wack-lovesicknessmiddleages-1990]