Sugaring the Pill

A doctor's guide to living the good life gave its medieval readers something to chew on.

The best sugar of all is white and clean. It is good for purifying the body, and is beneficial for the chest, kidneys and bladder. Its few faults - sugar makes one thirsty and irascible - can be neutralized with the help of sour pomegranates.

Educated Arabs of the 11th century read this information in a book that today would undoubtedly be titled "Guide to the Good Life." It was written by a physician from Baghdad named Ibn Butlan. The Arabic name of the book is Taqwim al-Sihha (Tablet of Health). The author was baptized into Christianity at a young age, but he absorbed his medical wisdom from the world of Islam. His travels took him to Mosul and Diyarbakir, among other places, and he spent time with the greatest physicians of his age in Egypt. In the end, he retired to a monastery in Antioch and died in the year 1068.

Ibn Butlan's famous book was presented to the reader in the form of tables and divided by subject: Plants, animals, emotions and weather conditions. Next to each of these concepts the author explains their effects - good and bad - on human health.

The West waited a long time for a patron who would devote his money to translating this literary-scientific work (which relies considerably on sources from the ancient period) from Arabic to Latin. This finally happened in the middle of the 13th century, in the court of King Manfred, in Palermo, Sicily.

Around 1900, unique manuscripts on the subject of health were found in several libraries in Europe. The manuscripts all had the same title in Latin: Tacuinum Sanitatis Medicina. One such work was found in 1895 in the Austrian imperial collection in Vienna. Soon afterwards, a similar work was found in the French National Library in Paris, and in 1905 a third manuscript was located in Rome. Two additional manuscripts, found in Rouen, France and Liege, Belgium, belong to this group.

These five manuscripts are a Western adaptation of Ibn Butlan's book, variations of the original work that were prepared in the late Middle Ages and included most of the texts from the physician's book. Unlike the Arabic original, the written words are accompanied by illustrations, from the peak of the late Gothic period in Italy. The five manuscripts were created during a very short time (in the course of two decades from the end of the 14th century through the beginning of the 15th century) and in a particular geographic region, which today comprises northern Italy. The Latin name of these works incorporates something from the Arab heritage that was absorbed in the West. Tacuinum is a transliteration of the Arabic word taqwim (table), distorted a bit with an accepted Latin ending. (In Italian, the concept is preserved in the word for notebook: taccuino.)

In the past, researchers tended to look for the sources of the visual influences on these Latin manuscripts only in Western art because the original work was not accompanied by illustrations. In his book on Tacuinum Sanitatis, the art historian Luisa Cogliati Arano suggests looking for additional sources of inspiration: in Arab scientific and botanical manuscripts, which were illustrated throughout the Middle Ages; in the gardens of residents of what is today southern Spain, where spices still sprout as if taken straight from the Tacuinum Sanitatis; and in restaurants in Italy, where some of the food appearing in the writings illustrated 600 years ago is still being cooked.

The Tacuinum Sanitatis dealt with a complete world of subjects, or at least attempted to present the readers with information that touched upon all possible aspects of their lives, from managing the household to matters of health. The manuscript that is now in Rouen opens with a quotation: "From the words of the doctor - The Tacuinum Sanitatis deals with six things necessary for preserving any person's health ... The first - the behavior of the air, which affects the heart; the second - the proper use of food and drink; the third - correct application of movement and rest; the fourth - the problem of depriving the body of sleep (heightened wakefulness); the fifth - the proper use (reduction or preservation) of body fluids; the sixth - maintaining moderation, between happiness, anger, fear and tension in a person's life."

A similar introduction appears in the manuscripts in Rome and Vienna. It is missing from those in Paris and Liege. In these two manuscripts, the introduction is replaced by a list of the 16 greatest physicians of the ancient world.

Arano regards the health books as part of a semi-secular category intended for the libraries of the affluent people of the period that prospered in parallel to religious writing. She argues that the illustrators and transcribers created manuscripts at various artistic levels. The areas of influence on these works were also not uniform, ranging between the Po Valley and Tuscany, to France and Bohemia.

The manuscript at Liege opens with a portrait of the work's author. In the following sheets there is a fig tree, with a young person in its branches, picking fruits, grapes, peaches, plums, pears and sweet and sour pomegranates. Slowly, architectural structures begin to appear in the illustrations. There are also more human figures as the pages progress. Thus, the reader advances from a rural to an urban environment, from the dominant presence of nature (with its plants and animals) to a world in which the human being stands in the center. Later, various foods are shown. The bean, according to the text, helps one urinate. Barley soup is beneficial in its positive influence on body fluids; black bread is liable to cause itching and irritation.

In sheet 40v, ricotta cheese appears. As far as it is known, this is the earliest visual description of this cheese. The textual description explains that the clear benefits of ricotta are, of course, nutrition and fattening. For people of the Middle Ages, its disadvantage was its liability to cause stomach aches.

The manuscript includes an abundance of cooked food, some of which can be recognized by name. There are also many kinds of meat, including rabbit and camel meat, which appear one after another. The Middle East was never closer to Europe.

Sheet 66v describes anger. In Christian thought, this is one of the sins punishable by death. Here it is characterized simply as "boiling of the blood in the heart." And this even has some benefits - in bringing back color to the cheeks. The disadvantages of anger can be handled with relative ease. Philosophy, the author claims, has been proven to be an effective antidote to anger.

Sheet 75v describes bathing as an action that is appropriate for every soul. Later in the book the author also describes "rooms and their air" as good for healthy people and harmful to those who tend to faint.

The manuscript in Paris is different in style. In many of its sheets, the figures of a woman and a knight appear; these are missing from the four other manuscripts. The entry on sexual relations explains it as "a connecting of the couple for the purpose of creating a seed." The author also warned that this activity is dangerous for anyone with cold and dry breath.

In the Rouen manuscript, sheet 29v describes the danger in eating acorns, though a boar appears in the illustration eating them with pleasure. For women, they are liable to stop the monthly period. Roasting acorns and dipping them in sugar will prevent this problem.

In the Rome manuscript, cloths of various materials are presented. Wool, the author claims in utmost seriousness, protects the body from cold and preserves warmth. Its disadvantage: It leads to an itching of the skin.

The manuscript now stored in the national library in Vienna includes 206 miniatures, each of which takes up a complete page. It was apparently created in Verona by two major illustrators. Aside from plants and animals, and various food and medicines, there appears in sheet 92 a salesman carefully weighing the white sugar in his store. In those days, everyone knew that "sugar is good for people of all temperaments, all ages, in every season and every region."