Published online by Cambridge University Press: 29 July 2016
Some twenty years ago, when few major books of Galen were available in modern English, one of his lesser writings, the treatise Περὶ μαρασμοῦ was published in translation. Even while this translation was in press, Pearl Kibre unearthed in the Vatican Library a text De marasmode secundum sententiam Galieni, which was composed by Bernard of Gordon at Montpellier in the early 1300s and is the only systematic discussion of marasmus in the medical literature for some fifteen centuries after Galen. By further coincidence, these two texts made their appearance just as several historians of science and of medicine were drawing attention to the ancient and medieval interpretations of life as the interaction between ‘innate heat' and ‘radical moisture'—precisely the paradigms in which the concept of marasmus was rooted. In 1974, in a seminal article on the Humidum radicale in thirteenth-century medicine, Michael McVaugh offered a first assessment of Bernard's discussion. His positive appraisal suggested that the text was worth editing and analyzing on its own terms, an enterprise that became more feasible with the recognition of additional manuscripts, references, and implications. A critical and annotated edition is presented here, together with an effort to collate Bernard's treatment of marasmus with his other works, with the teachings of his colleagues, and with the Galenic tradition.
1 Theoharides, Theoharis C., ‘Galen on Marasmus,’ Journal of the History of Medicine and Allied Sciences 26 (1971) 369–90. This translation is based on the Greek version in Opera omnia Galeni (ed. Kühn, C. G.; Leipzig 1821–1833) 7.666–704.Google ScholarPubMed
2 Vatican MS Palatine lat. 1234, fols, 135va–139vb; see the edition below. The treatise is introduced in general terms in my monograph Doctor Bernard de Gordon: Professor and Practitioner (Toronto 1980) 77–84.Google Scholar
3 The trail was blazed by Everett Mendelsohn, Heat and Life: The Development of the Theory of Animal Heat (Cambridge, Mass. 1964), particularly 1–26; followed by Hall, Thomas S., ‘Life, Death and the Radical Moisture,’ Clio Medica 6 1971) 3–23; and Niebyl, Peter H., ‘Old Age, Fever, and the Lamp Metaphor,’ Journal of the History of Medicine 26 (1971) 351–68. A recent and indispensable synopsis of citations is offered by Durling, Richard J., ‘The Innate Heat in Galen,’ Medizinhistorisches Journal 23 (1988) 210–12.Google Scholar
4 Michael McVaugh, ‘The Humidum radicale in Thirteenth-Century Medicine,’ Traditio 30 (1974) 259–83. The assessment was recently restated in a broader perspective by McVaugh, ‘The Nature and Limits of Medical Certitude at Early Fourteenth-Century Montpellier,’ Osiris, 2d. ser. 6 (1990) 82–83. I am most grateful to Dr. McVaugh for his encouragement and inspiration without which the present article and edition would have remained a mere project. with an effort to collate Bernard's treatment of marasmus with his other works, with the teachings of his colleagues, and with the Galenic tradition.Google Scholar
5 Pagel, Julius, ‘Über den Theriak nach ein bisher ungedruckten Schrift des Bernhard von Gordon,’ Pharmaceutische Post 27 (1894) 205.Google Scholar
6 Émile Littré, “Bernard de Gordon, Médecin,” Histoire littéraire de la France 25 (1869) 321–37. Robert von Töply, “Die chronologische Reihenfolge der Schriften des Bernard Gordon,” Mitteilungen zur Geschichte der Medizin und der Naturwissenschaften 6 (1907) 94–95. Sudhoff, Karl, ‘Zur Schriftstellerei Bernhards von Gordon und deren zeitlicher Folge: Eine Handschriftenstudie,’ Archiv für Geschichte der Medizin 10 (1917) 162–88. George Sarton, Introduction to the History of Science III (Washington, D. C. 1948) 873–76.Google Scholar
7 Erfurt MS Amplon. F 236 contains, in addition to Galen's work on marasmus (see n. 13 below), seven writings by Bernard with a colophon by Amplonius (fol. 115vb), ‘Nota preter istos libros adhuc quosdam alios composuit videlicet Lilium et librum de conservatione sanitatis quos alibi habeo.’Google Scholar
8 Questio disputata and Capitulum de confectione ducente ad insenescibilitatem, Erfurt MS Amplon. Q 227, fols. 208r–209v, in the midst of Gordonian treatises. These two chapters have no bearing on marasmus per se, and therefore they are largely ignored in my discussion.Google Scholar
9 McVaugh, ‘Humidum radicale’ (n. 4 above) 282.Google Scholar
10 Siraisi, Nancy, Taddeo Alderotti and His Pupils (Princeton 1981) 107 n. 30.Google Scholar
11 In particular, Gabriele Zerbi, Gerentocomia (Rome 1489) fol. 10r and passim. This incunabulum is examined, together with other early works, in my article ‘The Care of Health in Old Age: The Development of Gerocomy in the Renaissance,’ in Aging in the Renaissance (ed. Adele Seeff and Ed Ansello; Dover, Del. forthcoming).Google Scholar
12 McVaugh, ‘Humidum radicale’ (n. 4 above) 272 n. 31, suggests that the versions ‘should probably be called two recensions of a single translation.’ For further references, see ibid. nn. 32–34.Google Scholar
13 Hence Bernard did not write ‘too early to have used Niccolò's translation,’ as Lynn Thorndike believed in ‘Translations of Works of Galen from the Greek by Niccolò da Reggio (c. 1308–1345),’ Byzantina Metabyzantina 1 (1946) 226 n. 20. I have transcribed Niccolò's translation from MSS Paris BN Lat. 6865, fols. 121rb–124ra and Erfurt Amplon. F 236, fols, 16r–17r (cf. n. 7 above, and, for the latter MS, n. 29 below). Initially, I thought I had found an amazingly early citation of Niccolò's version in a work dedicated to Philip the Fair in 1300, Arnald of Villanova's Parabole medicacionis: Doctrina IV, Regula 8: ‘Membrum quod substantialiter exiccatur velut in senio (sanie) contabescit atque destruitur (destituitur) naturali caliditate. Tale membrum contabescit naturali calore, id est destituitur a naturali calore ita quod naturalis calor ammodo non potest tale membrum reducere ad humiditatem, et hoc satis declarat Galienus in suo libro de marasmo ubi ipse probat quod marasmus senii est impossibilis restaurationis sed potest prolongari.’ Opera (Lyon 1504), fol. 106rb. But only the first sentence occurs in the MSS (I checked Paris BN Lat. 6971 and 17847, and Wiesbaden 56), and the rest is a later commentary; moreover, the citation seems drawn from more indirect sources. I have not yet been able to consult the recent edition of the Medicationis parabole by Paniagua, Juan A. in Arnaldi de Villanova Opera medica omnia VI 1 (Barcelona 1990).Google Scholar
14 Libri de differentiis febrium a Galeno … tres translationes … digressionibus scientificis Thadei, Dyni et Thome de Garbo illustrate … (Pavia 1519) fol. 42rb: in Dino's characterization of one kind of consumption as ‘marasmus et tabes cum talis sit corruptio viventis corporis ex siccitate,’ it is most likely that ‘talis’ should read ‘tabes.’Google Scholar
15 As De tabe, according to Siraisi, Taddeo Alderotti (n. 10 above).Google Scholar
16 Fols. 128ra–130ra. Seven Latin versions are listed, but only one of them is dated earlier than the fifteenth century (and attributed to Niccolò) by Durling, Richard J., in ‘A Chronological Census of Renaissance Editions and Translations of Galen,’ Journal of the Warburg and Courtauld Institutes 24 (1961) 230–305.Google Scholar
17 Anglicus, Gilbertus, Compendium medicine in MS Bruges 469, fols. 40v–41r.Google Scholar
18 Bernard of Gordon, De marasmode, lines 182–185 and 372–375 in the critical edition which follows (line numbers hereafter refer to this edition). Joannes Damascenus (Serapion Jr. or Jachja ben Sarabi, ca. 879–930), Therapeutice methodi (Basel 1543), 28. De differentiis febrium in Galieni Opera (Venice 1490), fol. 440ra. References hereafter to Galenic works are to this 1490 edition unless indicated.Google Scholar
19 In this rather important passage Galen explained that what ‘men commonly call old age is the dry and cold constitution of the body resulting from many years of life. But sometimes it seems also from febrile disease, and we call it age from disease, as I have said in my book On Marasmus. For marasmus is such a condition which occurs not only in animals but also in plants. And in my first book on this subject, I have written about the inevitable origin of old age. And from that, and from what I have said in my book On Constitutions, and further from my book on marasmus, anyone might become easily more advanced in the gerontological portion of the art.’ Green, Robert M., A Translation of Galen's Hygiene (Springfield, Ill. 1951) 218. See De sanitate tuenda in Kühn, Opera omnia Galieni (n. 1 above) 6.334. The passage is missing in the Regimen sanitatis 5.10 in Galieni Opera (n. 18 above) fol. 378; I have not yet been able to determine whether the text in this incunabulum is less complete than in the manuscripts, and whether it represents the translation by Burgundio of Pisa (who Latinized the entire work) or, possibly, by Niccolò da Reggio (who Latinized only Book V).Google Scholar
20 ‘Monstratum autem est in libro de marasmo id est tabe … quod non est possible solidarum particularum siccitatem finaliter sanare.’ De ingenio sanitatis 10.10 in Galieni Opera (n. 18 above) fol. 419rb. Cf. Kühn, Opera omnia Galieni, (n. 1 above) 10.727.Google Scholar
21 McVaugh, ‘Humidum radicale’ (n. 4 above) 260–65, surveys the change, and aptly observes (261 n. 5) that the ‘different language could only have heightened the terminological difficulties.’Google Scholar
22 De differentiis febrium 1.8 and 9 in the translation by Burgundio of Pisa, Galieni Opera (n. 18 above) fols. 439v–440v; chapters 10–11 in Kühn, Opera omnia Galieni (n. 1 above) 7.313–315.Google Scholar
23 Theoharides, ‘Galen on Marasmus,’ (n. 1 above) 370.Google Scholar
24 Although it was not explicitly included in the ‘nuevo Galeno,’ it can be associated with the writings that made up this wave according to Luis García Ballester and Enrique Sánchez Salor in the introduction to Arnald's Commentum supra tractatum Galieni de malicia complexionis diverse (Barcelona 1985), 15–37.Google Scholar
25 Arnald cited De differentiis febrium in his later Speculum and commentary on Galen's De morbo et accidenti but not at the more pertinent occasions in his commentary on De malicia complexionis diverse (1295). The manuscript of De differentiis was listed in the inventory of his library: ibid. 25.Google Scholar
26 Cartulaire de l'Université de Montpellier I (Montpellier 1890), documents 25 (1309) and 68 (1340).Google Scholar
27 In Doctor Bernard de Gordon (n. 2 above) 83, I suggested inaccurately that Bernard was referring to ‘a formal commentary’ rather than to a single quodlibet.Google Scholar
28 Lines 406–407 and 427.Google Scholar
29 Erfurt MS Amplon. F 236 (cf. nn. 7 and 13 above), fols. 16r–17r. This text appears to be part of an early fourteenth-century pecia of Italian provenance that is bound between a fascicle of early fifteenth-century folios in the hand of Amplonius and a medical miscellany written at Montpellier in 1360–1361.Google Scholar
30 Lines 1–2 and 541. Bernard applied the same characterization, indicating a treatment much freer than a commentary, to his Tractatus de tyriaca secundum intentionem Averrois et aliorum, ed. Pagel, ‘Über den Theriak’ (n. 5 above).Google Scholar
31 Even for these items the correspondence is far from verbatim, as may be seen in a comparison between Bernard's citation (lines 313–320) and Galen's anecdote—whose implications warrant quoting a substantial excerpt—of a certain philosopher who ‘scripsit librum monstrans qualiter est insenescibilem aliquem permanere omnino. Edidit quidem igitur librum adhuc quadragenis existens; protensus autem fuit usque ad octaginta annos et erat ita macilentus et siccus ut conveniret in eo ypocratica series [sic] ex pronostico: nasus acutus oculi concavi tympora concisa aures frigide et contracte et lobi earum inversi et cutis que circa frontem sicca et circumtensa et arida ens. Quare igitur deridebatur talis apparens qui alios homines temptavit docere qualiter utique quis insenescibilis permaneat. Secundam edicionem fecit de mirabili insenescencia; ita enim ipsam nominabat per conscripcionem demonstrans quoniam non omnis homo insenescibilis permanere potest…. Et promittebat ydoneorum ad hoc puerorum mox a principio ipse procuracionem habens immortalia ipsorum facere corpora, et erat irredarguibilis eius promissio: ante enim quam viri fierent infantes quos accipiebat debebat ipse mori….’ De marasmo, trans. Niccolò da Reggio, in Paris MS BN lat. 6865, fol. 121va.Google Scholar
32 This identical incipit effectively hid Bernard's treatise from manuscript cataloguers who listed the text as by Galen.Google Scholar
33 For example, Aristotle, De iuventute et senectute 478B26; cf. pseudo-Aristotle, Problemata 871B16.Google Scholar
34 A systematic examination of marcor and its cognates in classical usage, along the lines of a recent study of tabes (see n. 52 below), would be valuable. For now, suffice it to sample some instances from The Oxford Latin Dictionary (Oxford 1982): ‘annis corpus iam marcet,’ Lucretius; ‘marcent luxuria vino et epulis,’ Livy; ‘marcor, et inexpugnabilis dormiendi necessitas,’ Celsus; ‘somno aut libidinosis vigiliis marcidus,’ Pliny.Google Scholar
35 ‘Quoniam autem viventis corporis diximus esse corrupcionem marasmum, sunt autem tria genera viventium: animalia et plante et semina et preter hec et fructus; horum utique erit passio marasmus interpretanti proprie,’ De marasmo in Paris MS BN lat. 6865, fol. 121rb. See also ‘Marasmus is such a condition which occurs not only in animals but also in plants’ (n. 19 above).Google Scholar
36 ‘Secundum metaforam autem iam et alias corrupciones quecumque fiunt propter siccitatem marasmum nominant, unde et in ignem inferunt hoc nomen et magis adhuc longius transferentes ad omnia que paulatim corrumpuntur.’ De marasmo fol. 121rb.Google Scholar
37 Lines 188–190.Google Scholar
38 Lines 201–203; this figurative sense had indeed been captured in a poetic line by the first-century physician Celsus, ‘if the soul is languid (marcet animus) and the body torpid.’Google Scholar
39 Constantinus in libro de febribus ostendit quod talis desiccacio habet provenire tribus modis: primo modo per desiccacionem frigidam a calore ut videmus in arboribus et plantis in estate …; alio modo ex privacione humiditatis sicut contingit in yeme non pluviosa cum deberent attrahere nutrimentum et non subministratur eis: non frondescunt sed arescunt; tercio modo fit defectus ex mutacione nutrimenti in malas qualitates ut quando humiditas mutatur in acetosam sulphuram unde attrahit eam arbor ad sui nutrimentum et hoc contingit in corpore humano quod ex defectu subministracionis naturalis humiditatis fit defectio in corporibus senum.’ Gilbertus Anglicus, Compendium medicine in Bruges MS 469, fol. 40va. I have not been able to determine whether the analogy originated with Constantine or, in fact, with Isaac Judeus whose work on fevers he translated.Google Scholar
40 Gentilis de Fulgineo, Introductorium practicae de febribus (Venice 1560) fol. 191v.Google Scholar
41 A third species of hectic fever is called ‘consumptio marcor et ptisis’; see McVaugh, ‘Humidum radicale’ (n. 4 above) 261 n. 5.Google Scholar
42 Line 194.Google Scholar
43 For example, see p. 271 and n. 74 below.Google Scholar
44 It was under the title De marcore that Galen's Περὶ μαρασμοῦ was translated by Hermannus Cruserius (Paris 1533) and entered the Opera edition by Kühn (n. 1 above). The term ‘marasmus,’ however, prevailed in five other sixteenth-century translations (as well as in the modern medical vocabulary); see Durling, ‘Chronological Census’ (n. 16 above) 259, 280, 287.Google Scholar
45 Still more confusion could be introduced by other variants; for example, macescere means ‘to grow lean’ as well as ‘to waste away’; macerare means ‘to soak, steep,’ and ‘to soften by soaking’ (for corpses on which anatomy was studied) as well as ‘to weaken, exhaust, wear down,’ See the lines from Plautus in n. 52 below.Google Scholar
46 ‘Experimento videmus corpora in estate matrescere [sic, lege macrescere] in yeme vero pinguescere…. In estate corpora maxime macrescere et extenuari … matrefaccio [sic] consequitur resolucionem …,’ in Vatican MS Pal. lat. 1203, fols. 31r, 35v, and 37v.Google Scholar
47 Line 196, see nn. 46 above and 49 below.Google Scholar
48 E.g., Andrew Jaffe, ‘Africa's Disastrous Drought,’ Newsweek August 5, 1974, p. 58.Google Scholar
49 The aphorism states, ‘Febricitantibus … non minuere corpus aut contabescere malum est magis eo quod secundum rationem fit….’ Galen comments, ‘… Quod autem diceret “contabescere” non est accipiendum absolute sicut significat hoc verbum quod abusive est positum pro macrescere, bene autem addidit “magis eo quod secundum rationem fit.” Si enim plus quam oportet corpus permaneat vel marcescat [sic, lege macrescat] malum…. (Tempus anni, regio, etc.) citius et magis faciunt tabescere [inter lineas additur vel macrescere] corpus…. Sicut enim macrescit corpus ita virtus minuitur … et hoc est quod ego dixi esse causam maciei decrepitorum,’ in the translation by Constantine the African, in Vatican MS Pal. lat. 1103, fol. 22rb.Google Scholar
50 ‘Faciunt maciem rationabilem scilicet fortitudo febris et longitudo eius, etas, complexio aeris … vigilia, tristitia, abstinentia…. Sed quando nulla causarum presente que facit rationabilem maciem, corpus macrescit, talis macies est preter rationem, et demonstrat defectum virtutis.’ Taddeo Alderotti, Expositiones in arduum Aphorismorum Ipocratis volumen (Venice 1527) fol. 53rb.Google Scholar
51 Preferred forms are συντήκειν, as in Aphorisms 1.14 and 2.28, and σύντηξις, as in Epidemics 3.13.19; τηκόμενοι, rarer, occurs in Epidemics 1.2.32. φθίσις in Aphorisms 3.10, 13, 22, 29; 5.12, 14 and 64; τò φθινώδες and τὰ φθινώδεα in Epidemics 1.2.14–35 and 3.13.19–3.14.1.Google Scholar
52 An excellent recent study, with focus on classical Latin, is by Armelle Debru, ‘Consomption et corruption: l'origine et le sens de tabes.’ in Mémoires VIII: Etudes de médecine romaine of the Centre Jean Palerne (ed. Guy Sabbah; Saint-Étienne 1988) 19–31. The linguistic palette and potential for confusion are vividly illustrated in Debru's quotation and exegesis (pp. 19–20) of Plautus Captivi 135–137. ‘tuo maerore maceror / macesco, consenesco et tabesco miser / Ossa atque pellis sum miser macritudine’ (emphasis added).Google Scholar
53 Thus, , De ingenio sanitatis in Galieni Opera fol. 419rb; and De differentiis febrium, ibid. fol. 439vb. It is worth noting that the second species of hectic fever ‘Grecis μαρασμός Latinis tabes, sive marcor appellatur’ and the third ‘omnino μαρασμώδυς, hoc est, tabida existit,’ in one version of Damascenus, Therapeutice methodi ‘partim Albano Torino Vitodurano paraphraste, partim Gerardo Iatro Cremonensi metaphraste’ (Basel 1543), 28.Google Scholar
54 If Bernard knew Peter of Abano's translation, it would be strange that he did not adopt its key words such as ‘tabescere’ and ‘tabidus’ for which he used ‘tabefieri’ (lines 193 and 270), ‘tabefacti’ (lines 224 and 229), and ‘tabefactio’ (line 284).Google Scholar
55 Debru, ‘Consomption’ (n. 52 above) 28.Google Scholar
56 Lines 350–351.Google Scholar
57 Thus, ‘consumption (τò φθινώδες) was the worst of the diseases that occurred…. Patients quickly wasted away (τηκόμενοι) and grew worse…,’ Epidemics 1.13, trans. Jones, W. H. S., Hippocrates I (Loeb Classical Library, Cambridge, Mass. 1962) 149–51. In addition σύντηξις had a dual succession in Latin: by equivalents such as tabes and contabescere, and by transliterations, namely, syntexis and syntecticus; four loci in Pliny Historia naturalis 22 and 28 may be added to the citations from Caelius Aurelianus and Areteaus in Debru, ‘Consomption’ (n. 52 above) 28. See Bernard of Gordon's ‘sintetica,’ line 244, and ‘sinthetici,’ line 347.Google Scholar
58 The theoretical and practical treatment of phthisis, even just in the fourteenth century, merits its own examination; one representative excerpt (in combination with nn. 59–65 below) may at least adumbrate the range of the concept. The author of a Capitulum de ptisi (possibly Nicolaus Bertruccius) inserts the following ‘Canon’: ‘Ptisis Grece est consumpcio Latine, quapropter omnis consumpcio corpori nostro superveniens potest ptisis nuncupari. Propter quod sciendum quod ptisis large sumpta est dupliciter, naturalis et non naturalis. Naturalis est illa que accidit senibus et defectus ex etate; innaturalis est duplex, ut dicit Ysach in libro suo de febribus, quia quedam est cum febre quedam sine febre. Illa autem que est sine febre est duplex: quedam namque fit a causa calida, ut quando aliqui fumi adusti exspirant ad cor et consumunt humiditates capsule cordis …; quedam vero est a calida [sic, lege causa] frigida, ut patet in ethica senectutis…. Que autem est cum febre est duplex: quedam fit incipiendo …; alia vero consequendo egritudines alias, et hoc dupliciter quia vel consequitur febrem … vel consequitur pleuresim vel peripleumoniam vel aliam aliquam decem causarum …,’ in Vienna MS 5486, fol. 129r–v. The inclusive sense of ptisis seems to be especially characteristic in translations from Arabic: cf. McVaugh, ‘Humidum radicale’ (n. 4 above) 260–63, 271.Google Scholar
59 Compendium medicine (n. 17 above), fol. 40va.Google Scholar
60 ‘Ptisis potest sumi dupliciter scilicet pro simplici consumptione sine ulcere pulmonis … alio vero modo sumitur pro consumptione facta ex ulcere pulmonis.’ Taddeo Alderotti, Expositiones (n. 50 above) 3.17, fol. 80rb. ‘Ptisis accipitur uno modo pro sola consumpcione corporis … alio modo pro consumpcione corporis propter ulceracionem pulmonis.’ Berengar de Thumba, Questiones supra Aphorismos in MS Basel D.I.11, fol. 175ra. Compare the definition in the Codicillus, a lexicon attributed to Bernard of Gordon: ‘Thisis generaliter nichil aliud est quam consumpcio corporis, et ita quilibet consumptus potest dici thisicus. Hoc autem aut habet accidentaliter aut naturaliter…. Vel cum ulcere pulmonis, et ista proprie est thisis, cuius hec est descripcio: Ptisis est commutacio augmentacionis in diminucionem cum ulcere pulmonis …,’ in Oxford MS St. John Coll. 197, fol. 166r.Google Scholar
61 ‘Ptisis est ulcus pulmonis cum consumpcione tocius corporis,’ incipit of Lilium medicine 4.5, a chapter whose similarities and differences with the Capitulum cited above (n. 58) are quite intriguing.Google Scholar
62 Line 242.Google Scholar
63 For example, Arnald refers to ‘ptisi de siccitate’ in his commentary on Galen's De malicia complexionis diverse (n. 24 above), 197, but he synonymizes ‘ulcus in pulmone sive ptisim’ in his translation of Galen's De interioribus (ibid. 324, ed. Richard Durling).Google Scholar
64 Celsus, For, see Debru, ‘Consomption’ (n. 52 above) 26; Damascenus, Therapeutice methodi 4.27 (n. 18 above) 249.Google Scholar
65 ‘Ptisike is consumpcyon and wastyng of kinde humours of the bodie. Euerich that hath tisike hath etike,’ De proprietatibus rerum 7.31 (London 1495) 234.Google Scholar
66 EETS 139 (repr. London 1969) 43.Google Scholar
67 The nouns themselves, consumptio and corruptio, were very rare; and (in a few expressions by Cicero, Ovid, and Livy) the cognate verbs alluded to ‘terminal wasting’ and ‘spoiling,’ respectively, in general terms rather than as biological processes.Google Scholar
68 ‘Utrum calor naturalis consumat humidum radicale…. De racione calidi est consumere et desiccare … per se consumit humidum radicale per cuius consumpcionem calidum naturale conservatur.’ Questiones supra Johannitium in Basel MS D.I.11, fol. 192ra.Google Scholar
69 ‘Queritur utrum aliqua sit mors morienti [naturalis] … calidi naturalis extinctio multipliciter potest contingi: primo a contrario ipsum extinguendo per simplicem alteracionem frigidum generando corrumpat caliditatem; … quandoque autem fit per humidi exsiccacionem sive resolucionem.’ Dubia seu questiones medice [on Avicenna] in Vat. Pal. lat. 1133, fol. 151rb.Google Scholar
70 Lines 186–187.Google Scholar
71 Marasmus as the second kind of hectic fever ‘congelat et arefacit’; the nature of the third kind is to ‘extinguere et confringere sive dissolvere.’ Damascenus, Therapeutice methodi (n. 18 above) 28.Google Scholar
72 ‘Humido multum terrestrificato extinguitur calor … [cum] ipsum humidum non poterit calidum naturale convenienter sustentare, unde incipit calidum naturale diminui quia cum adhuc non cessat humidum resolvere adhuc procedit ulterius humidi siccitatem augendo, et mensura caloris diminuitur unde tandem in tantum minoratur calidum quod non est amplius sufficiens ad operaciones vite et per consequens tunc deficit vita et advenit mors.’ Dubia (n. 69 above), fol. 151vb.Google Scholar
73 Compare Aristotle's statement that ‘the source of life is lost … when the heat with which it is bound up is no longer tempered by cooling, for, as I have often remarked, it is consumed by itself,’ in On Youth, Old Age 479A8–10, trans. Ross, G. R. T. in The Complete Works of Aristotle (Princeton 1984) 760.Google Scholar
74 ‘Utrum calidum naturale possit corrumpi a seipso …. Dico quod ignis sive calidi videmus duas corruptiones: unam que est a seipso scilicet marcedinem, aliam que fit a contrario scilicet exsiccationem…. manifeste apparet quod ignis consumit ceram candele donec marcessit et corrumpitur, et ita corrumpit se consumendo materiam requisitam ad eius salvationem.’ Montpellier Questiones in Erfurt MS Amplon. F 290, fol. 115va.Google Scholar
75 See Mendelsohn, , Heat and Life (n. 3 above) 11–12 and 18–19.Google Scholar
76 On Youth … 479A19 (n. 73 above) 761.Google Scholar
77 ‘Deinde deinceps [flamme] iam nutrimento deficiente hoc marasmantur et extinguuntur …. Hic sermo proserpatur [sic] ab omnibus paulominus iunioribus medicis et philosophis, non ens verum me demum iudice….’ De marasmo fol. 121vb.Google Scholar
78 Lines 448–449.Google Scholar
79 Even though Bernard adopts the priority of warmth in principle (lines 296–299) and pays passing attention to ‘corruption’ and such analogues as ‘alteration’ or ‘confraction’ (lines 177–180, 183–185, 189, 327–335, 340 and 359), his explanations are thoroughly dominated by the notions of moisture and consumption (lines 177–181, 187, 199–200, 204–207, 211, 231–232, 238, 256–257, 262–265, 270, 282–284, 333–334, 344–345, 358, 359–360, 408–411, 430–433, and 444).Google Scholar
80 ‘Utrum vita per medicinam possit prolongari …. Sicud de admixtione aque modice admixte vino que cum in vino convertitur aliqualiter alterat et si continuo admisceatur vinum corrumpet.’ Bernard Angrarra, Questiones super Aphorismos in Erfurt MS Amplon. F 290, fol. 40r. ‘Utrum febris plus noceat corpori sua siccitate quam caliditate…. Dicendum quod humidum radicale non est primum principium vite sed calidum naturale.’ Ibid. fol. 47v.Google Scholar
81 Thus, Berengar de Thumba in 1332, particularly on the question ‘utrum etas possit esse causa morborum.’ Questiones super Aphorismos in Basel MS D.I.11, fol. 175vb. Further, in an anonymous discussion, at Montpellier in 1334, of the question ‘utrum calor naturalis agat in humidum radicale ipsum consumendo.’ Questiones supra tertiam fen primi Canonis in Basel MS D.I.11, fol. 189vb. Another Montpellier author determines ‘utrum maior calor naturalis sit in puero vel in iuvene’ by postulating that ‘calor naturalis est duplex scilicet fluens et radicalis. Fluens est triplex … et de isto triplici caliditate non querit questio…. Alter est calor qui vocatur radicalis, sicut ille qui est in osse nervis et venis et membris solidis, et de illo querit questio.’ Questiones supra Iohannitium in Basel MS D.I.11, fol. 191v.Google Scholar
82 ‘Utrum calor naturalis consumat humidum radicale…. [De corruptione, sicut] patet de aqua calida mixta cum frigida, eodem modo de calido et humido radicali….’ Questiones supra Iohannitium fol. 192r.Google Scholar
83 Isidore of Seville, Origines 4.7.27.Google Scholar
84 For example, the name atrices for a non-swelling kind of hemorrhoids is attributed to the following etymology: ‘dicuntur quasi atrofices ab atrofia quod in arabico [sic!] sonat defectus nutrimenti, ut in ethica, quia atrices deficiunt in humore replente.’ Arbor egritudinum (ascribed to Bernard of Gordon) in Vatican MS Pal. lat. 1083, fol. 317r.Google Scholar
85 Atrophy is not mentioned in the most logical contexts, such as the description of terminal wasting when ‘brachia indurata fuerunt propter temporis longitudinem desiccantem.’ Dubia (n. 69 above), fol. 151vb. Galen indicated that ‘totum quidem corpus marasmari scimus: non autem est consuetum secundum unamquamque particulam inferri hoc nomen [viz. marasmus].’ De marasmo fol. 121rb.Google Scholar
86 Coxe, By J.E. (Philadelphia 1846), cited by Theoharides, ‘Galen on Marasmus’ (n. 1 above) 370.Google Scholar
87 One kind of phthisis which ‘consequitur febrem’ is the most common, ‘nam ut plurimum omnis febris putrida quando prolongatur tendit ad ethicam et arefactionem quia membra radicalia inflammantur propter diuturnam inflammationem spirituum et humorum.’ Capitulum de ptisi (n. 58 above) fol. 129v.Google Scholar
88 ‘Utrum terminus naturalis vite per beneficium medicine possit prolongari…. Non omni cause termini accidentalis possumus obviare per beneficium medicine sicut percussioni [vel] morsui reptilium, sed quibusdam scilicet putrefactioni humorum et cite consumptioni humidi radicalis.’ Questiones supra tertiam fen … (n. 81 above) fol. 190ra.Google Scholar
89 See Huard, Pierre and Grmek, Mirko D., Mille ans de chirurgie en Occident: Ve–XVe siècles (Paris 1966) 42–44, 66.Google Scholar
90 In contrast with hair becoming white from disease, ‘the greyness of hair which is due to age results from weakness and deficiency of heat…. its own proper heat is unable to concoct the moisture and so it is decayed by the heat in the environing air. All decay [σήψις, putrefactio] is caused by heat—not the innate heat.’ Further, ‘greyness comes about by some sort of decay, and is not, as some think, a withering,’ Aristotle, Generation of Animals 784A30–B8 and 785A25, trans. Platt, A. in Complete Works (n. 73 above) 1212–13.Google Scholar
91 ‘Sanies et thabes in hoc differunt quod sanies vivorum thabes mortuorum,’ anonymous and acephalous chapter on skin diseases, in Vienna MS 5154, fol. 32v.Google Scholar
92 Lines 436–442.Google Scholar
93 Lines 327–340, 345–346, and 354–364 (cf. n. 79 above). Compare Aristotle's equation regarding natural death from a cause which ‘is internal, and involved from the beginning in the constitution of the organ…. In the case of plants the name given to this is withering, in animals old age.’ On Youth … 478B25–28 (n. 73 above) 760.Google Scholar
94 Lines 369–373.Google Scholar
95 ‘Indeed, we may rightly call disease an acquired old age, old age a natural disease; at any rate, some diseases produce the same effects as old age.’ Generation of Animals 784B32–34 (n. 90 above) 1212.Google Scholar
96 ‘Et problematis occasio fit sophistis hiis quidem quod egritudo est senium, hiis vero quod sanitas … et hiis quidem quod secundum naturam aliis autem preter naturam …. De hiis talibus denique ambiguitatibus alterius est distinguere temporis.’ Galen, De marasmo fol. 122rb Google Scholar
97 Lines 354–362.Google Scholar
98 The following causes in lines 218–247 also occur in Lilium medicine 1.9, ‘De febre ethica’: carcer, fames (‘abstinencia’), labor, ira, tristicia, causon, effimera, ulcera pulmonis (‘ptisis’), discrasia (‘vicia’) cordis et epatis, apostemata.Google Scholar
99 Lines 236–238.Google Scholar
100 This assertion occurs in the ‘clarification’ of Bernard's chapter; earlier he justified omitting his usual section on prognosis: ‘signa autem bona et mala non oportet hic apponere, alibi a nobis posita sunt.’ Lilium medicine 1.3 in Paris MS BN lat. 16189, fols. 4v–5r.Google Scholar
101 ‘Ethica que venit propter causonem … facilis cognicionis est quoniam ypocondria et venter videntur tangere dorsum, et totum corpus est aridum et siccum.’ Liber pronosticorum 1.6 “De febrium differencia et pronosticacione in eisdem,” in Paris MS BN lat. 16189, fol. 174rb.Google Scholar
102 Lines 239–240.Google Scholar
103 Lines 218–225.Google Scholar
104 Compare ‘sicut videmus in Judeis cum suspenduntur per pedes, nichilominus tamen cibus attrahitur ad stomachum.’ Lilium medicine 5.2 in Paris MS BN lat. 16189, fol. 76ra.Google Scholar
105 ‘Oculos concavos immoderate considerabis, ut in gurgitibus quibusdam viventes: ex perditione omnis eorum humide substantie et ossium in quibus nate sunt palpebre apparent eminentie.’ Galen, De differentiis febrium 1.9 (Burgundio translation) in Galieni Opera (n. 18 above) fol. 224ra. Compare ‘oculos … quasi in fovea quadam conditos’ of the Renaissance Latin version, and ‘ὀφθαλμοὺς … καθάπερ ἐν βόθροις τισὶν ἐγκειμένους’ of the Greek in Kühn, Opera omnia Galieni (n. 1 above) 7.315. A parallel locus in Damascenus: ‘Tertia species hecticae signis admodum manifestis depraehenditur: oculi immodice concavi veluti quibusdam quasi scrobibus reconditi atque in imum, exhausta omni ipsorum humiditate, submersi videntur, sordes ac lemae in ipsis aridae apparent, palpebrae prae gravitate ceu somnolentae identidem convenit, supercilia sursum elevantur.’ Therapeutice methodi (n. 53 above) 29.Google Scholar
106 See Larenaudie, M. J., ‘Les famines en Languedoc aux XIVe et XVe siècles,’ Annales du Midi 64 (1952); Lucas, Henry, ‘The Great European Famine of 1315, 1316, 1317,’ Speculum 5 (1930) 343–77; and Stouff, L., Ravitaillement et alimentation en Provence aux XIVe et XVe siècles (Paris 1970).Google Scholar
107 For example, ‘simplex marasmus in cibationibus videtur fieri eorum qui secundum propositum perseverant [viz. desiccari] et quicumque famescunt inopia cibariorum.’ De marasmo fol. 121rb; see also fol. 122va.Google Scholar
108 ‘Utrum primi senes facillime tolerent ieiunium …. [Nota quod] nocumenta potissime consequentia toleranciam ieiunii sunt tria scilicet tristicia sequens ex fame, humidi resolucio membrorum humorum et adhuc spirituum inflammacio et ex consequenti spirituum resolucio, et attractio humorum pravorum ad stomachum.’ Questiones in Vatican MC Pal. lat. 1203, fol. 23r. Also ibid. fols. 27r and 31r–38r (see n. 46 above). ‘Utrum etas humida facilius feret ieiunium quam alie etates…. Intelligendum per tollerare ieiunium id est non facile incurrere famem et nociva contingentia ex fame….’ Berengar de Thumba, Questiones supra Aphorismos (n. 60 above) fol. 162va.Google Scholar
109 Lines 226–232.Google Scholar
110 ‘Quando advenit toti [corpori] mala complexio, aut sicca aut humida, transit in naturam equalis, sicut in ptisi de siccitate manifestum est, in yposarcha de humiditate…. Docent periti medici circa curam male complexionis sicce in ptisi et humide in yposarcha.’ Commentum … de malicia complexionis diverse (n. 24 above) 197 and 199.Google Scholar
111 Lines 272–274.Google Scholar
112 ‘Cum deficit disseminacio causatur macies, et si deficiat unio causatur ydrops, et si assimilacio lepra.’ Lilium medicine 6.5 fol. 98ra.Google Scholar
113 With some reservation, I associate ‘anorexia’—as distinguished from ‘hunger’ and ‘fasting’ (‘fames’ and ‘ieiunium’ in nn. 107–108 above)—with the term abstinentia. For example, ‘mors preter naturam indifferenter in qualibet etate potest contingere, ut si quis moriretur propter abstinenciam a cibo.’ Dubia (n. 69 above) fol. 151vb. Fourteenth-century texts have not yielded any references as clear as that, ‘concerning the phthisical affections,’ to patients who ‘quickly wasted away and grew worse, being throughout averse to all food,’ in the Hippocratic Epidemics 1.13 (n. 57 above) 151.Google Scholar
114 Lines 232–235.Google Scholar
115 A strange classical precedent of ‘l'anorexie amoureuse’ and ensuing tabes cupidinis—of cattle—is cited by Debru, ‘Consomption’ (n. 52 above) 26.Google Scholar
116 Arnald of Villanova mentioned ‘exsiccatio’ and described how the lovesick lost their ‘appetitum comedendi’ with the result that ‘macerantur corporis membra.’ De amore heroico ed. Michael McVaugh (Barcelona 1985) 51–52. For Bona Fortuna see Mary Wack, Lovesickness in the Middle Ages (Philadelphia 1990) 257, 279.Google Scholar
117 Lines 404–405, 425–426, and 395, 420–422.Google Scholar
118 ‘In tertia autem specie [febris ethice] … urina est sicut oleum, et si cadat super lapidem sonat rauce. Signum autem ethice senectutis est … urina tenuis et remissa.’ Lilium medicine 1.9, fol. 9ra. ‘Ptisis est consumptio…. In quibus urina oleagina….’ Anon. lexicon in Vienna MS 5300, fol. 18v.Google Scholar
119 ‘Accidit in senectute corporibus corrugatio et contractio ad modum carte exposite igni.’ Libellus de humido radicali in Paris MS BN lat. 17847, fol. 95va.Google Scholar
120 Lines 245–246.Google Scholar
121 Lines 230–231 and 349–350.Google Scholar
122 This supposition is suggested by an admittedly tangential instance concerning ‘simia.’ In consumption from a warm cause but without fever, ‘consumunt humiditates capsule cordis prout accidit illi simee de qua loquitur Galienus Ve de interioribus,’ Capitulum de ptisi (n. 58 above) fol. 129r. However, this is just the opposite of what Galen reported on his pet monkey—whose predicament warrants a full quote in the context of marasmus: ‘Quamdam enim simiam habui cuius corpus semper consumebatur et desiccabatur. Eam enim eo quod impeditus eram anothomizare priusquam moriretur minime potui. Sed postquam mortua est inquirens omnia membra eius sana inveni: in capsula tamen cordis crossitiem extra naturam humoribus plenam reperii sicut sunt humores quos in vesica invenimus….” De interioribus 5.2 in Galieni Opera (n. 18 above) fol. 348rb (emphasis added).Google Scholar
123 Semeiology is largely ignored in Galen's essay on marasmus, but the description of the eyes and other signs is developed in his work on distinguishing fevers.Google Scholar
124 See n. 105 above. It was rightly noted around 1300 that ‘primum signum quod ponit [Galienus] est sumptum a concavitate oculorum, cuius causam notam ipsemet assignat.’ Libri de differentiis febrium … (n. 14 above) fol. 45rb.Google Scholar
125 Lines 276, 315, and 436.Google Scholar
126 ‘Quando autem ungues incurvantur tunc [tertia species ethice] est in statu, quando autem capilli cadunt iam vicinatur morti, et si venerit fluxus ventris iam est proximus.’ Bernard of Gordon, Lilium medicine 1.9, fol. 9ra. ‘Nota signa quae ponit Avicenna de facie Hippocratica, curvitas unguium et elongatio, casus pilorum sunt supra mortem significativa,’ Gentilis de Fulgineo, Introductorium (n. 40 above) fol. 193r–v. Also in patients with advanced consumption ‘oculi concavantur, ungues constringuntur, pili decidunt.’ Anon. lexicon (n. 118 above) fol. 18v.Google Scholar
127 Hippocrates, , Prognostics 2. With only one element missing (the last phrase which describes the color of the face), the profile is cited verbatim as ‘ypocratica series’ in Galen's De marasmo; see n. 31 above.Google Scholar
128 Lines 276–278. Compare the observation of Gentile that in hectic fever ‘si inflentur tibiae et fluxus ventris supervenerit non diu vivere potest, ideo loquendo et comedendo moriuntur,’ Introductorium (n. 40 above) fol. 193v. ‘Cavendus est medicus in cura ptisicorum et ethicorum quia moriendo loquuntur et loquendo moriuntur.’ Capitulum de ptisi (n. 58 above) fol. 130r. Advanced phthisics ‘loquendo moriuntur.’ Anon. lexicon (n. 118 above) fol. 18v. In fact, the frequent occurrence of this phrase suggests an origin in some authoritative text, which I have not yet identified.Google Scholar
129 Lines 279–280.Google Scholar
130 See n. 126 above.Google Scholar
131 Aphorisms 5.12 and 14.Google Scholar
132 Twentieth-century experience, not only with consumption but also with famine, continues to demonstrate that the threshold of mortality is reached with the loss of 35 to 40 per cent of normal body weight.Google Scholar
133 The remedies in lines 483–488 are more diverse and arranged far more systematically than in the corresponding part of Galen's Περὶ μαρασμοῦ, where bathing is emphasized.Google Scholar
134 Lines 483–488.Google Scholar
135 For drying bodies ‘melius nullum lacte esse videtur’ according to Galen, De marasmo fol. 123vb, with stronger recommendations in several of his other works. Bernard of Gordon cited particularly Galen's De ingenio sanitatis, Books 5, 7 and 10, when he prescribed milk as part of the treatment of hectic fever and of consumption in his Lilium medicine 1.9 and 4.5.Google Scholar
136 ‘Lac citissime corrumpitur sicut et semen, et si timemus corrupcionem lactis in stomacho, bulliatur….’ Lilium medicine fol. 9ra; see also ibid. fol. 66rb.Google Scholar
137 ‘Maxime [valet lac] si quis id sustineat sugere imponens ori muliebrem mamillam, quemadmodum Eurifon et Prodicus in ptisacionibus [sic] dignificant.’ Galen, De marasmo fol. 123vb. ‘Praestat sane ipsum [lac asininum] ex ipsis statim mammis sugere.’ Damascenus, Therapeutice methodi 2.12 (n. 18 above) 30. ‘Modus autem sumendi sit ab ubere, et si non est possibile habeatur scutella abluta … bulliatur ad ignem … aut proiiciantur in lacte lapides fluviales candentes aut ferrum candens.’ Bernard of Gordon, Lilium medicine fol. 66ra–b. ‘Proiciantur in eo lapides igniti vel calips ignitus … licet autem lac muliebre sit conforme corpori nostro, tamen propter abhominationem ipsum postponatur.’ Capitulum de ptisi (n. 58 above) fol. 122v.Google Scholar
138 Thus, compare lines 481–482 with the advice for hectic fever that ‘lac quod magis competit est lac mulieris, postea asine, deinde caprarum, postea vaccarum.’ Lilium medicine fol. 9ra; the same sequence occurs in Bernard's Liber pronosticorum 1.6 (see n. 139 below). Cow milk is omitted by Bernard, for consumption (in the Lilium) as well as for marasmus; by Galen, in De marasmo as well as in De ingenio and Regimen sanitatis; by Damascenus; in the Capitulum de ptisi (n. 58 above); and so on.Google Scholar
139 ‘Super omnia valet lac quoniam de facili per membra disseminatur et mittitur et assimilatur, et maxime valet lac mulieris et plus etiam iuvenis bene complexionate, deinde asine lac, deinde caprarum, deinde vaccarum. Lac autem mulieris est temperatum, asine subtile, vaccarum grossum, caprarum mediocre.’ Paris MS BN lat. 16189 fol. 174va. This formulation, whether it is Bernard's own or not, is more specific than Galen's assessment, at least in the Latin version, ‘Melius est cum usuri sumus lacte: quandoque esse id caprinum quandoque asininum: tenuius enim est et serosius lac asininum: moderatum vero crossitie est caprinum. Quare hoc quidem nutriendum est magis si eo opus est, asininum vero minus fallax omnino … et maxime si de sale et melle assumpserit.’ Regimen sanitatis 5 in Galieni opera (n. 18 above) fol. 378ra.Google Scholar
140 For example, ‘non accipiat … in eadem mensa lac et vinum quia disponunt ad lepram.’ Lilium medicine 5.8, fol. 82ra.Google Scholar
141 Galen recommends the addition of some honey to (ass's) milk and then, paradoxically, warns that honey should be avoided for hectic fever, in De ingenio sanitatis 10.11 in Galieni opera (n. 18 above) fol. 422vb Google Scholar
142 Lines 492–496.Google Scholar
143 Lines 534–540 closely resemble the lines which frame the recipe for a universal antidote in the final chapter of Bernard's work on theriac: ‘Capitulum sextum de medicamine alciori quod excedit tiriacam et omnem perspicacitatem luminis naturalis …. Istud autem electuarium … valet et in passione cuiuscumque membri; et valet summe contra venenum et contra omnem passionem cuius causa ignoratur; et mirifice prodest senibus, et contra omnem aeris corrupcionem…. Et est de invencione nostra. Benedictus igitur qui terminavit et menti aride tribuit roritatem amen.’ Vatican MS Pal. lat. 1083, fol. 326v.Google Scholar
144 It may be noted that the phrase ‘et eciam aliquo modo supra naturam’ in lines 498–499 is omitted in two manuscripts.Google Scholar
145 Bernard, who is evidently far less interested in this material principle than in qualitative constructs, also ignores Galen's important methodological declaration that ‘Senii vero marasmum impossibile est utique alicui solvere, adiuvare vero ut ad plurimum extendatur possibile, et girocomica id est senum educativa nominata pars medicine hoc ipsum est intentionem habens…. Si vero nullus est sufficiens neque epar humidius se ipso facere neque cor sed necessarium in procedenti tempore sicciora fieri seipsis non viscera solum sed et arterias et venas, prohibere quidem senectutem impossibile est, detinere vero festinantiam eius possibile.’ De marasmo fol. 122rb.Google Scholar
146 Lines 539 and 313–320; see n. 31 above.Google Scholar
147 Bernard's explanation of this inevitability (lines 302–313) is rather terse, in contrast not only with Galen's statements but also with many fourteenth-century texts, such as those cited earlier (notes 69, 72, 80 and 88) and a synopsis of the debate ‘Utrum mors possit retardari’ in the Questiones of an anonymous physician in Wiesbaden MS 56, fol. 334r–v.Google Scholar
148 Such antidotes, possibly including some species of ‘amaranth’ (ἀμάραντος) or mythical fadeless flower, await a separate study. Their objectives included, in varying proportions, the dream of extended youth, the pursuit of prolongevity, and the acceptance of aging.Google Scholar
149 This is underscored by the opening phrase, ‘Vita brevis,’ in the margin above the text ‘Utrum vita per medicinam possit prolongari’ in Bernard Angrarra, Questiones super Aphorismos (n. 80 above) fol. 40ra.Google Scholar
150 Temkin, Owsei, Galenism: Rise and Decline of a Medical Philosophy (Ithaca, N.Y. 1973) xii.Google Scholar
151 A stimulating example of broader inquiry is Jørgen Benedictow, Ole, ‘Breast-Feeding and Sexual Abstinence in Early Medieval Europe and the Importance of Protein-Calorie Malnutrition (Kwashiorkor and Marasmus),’ Scandinavian Journal of History 13 (1988) 167–206.Google Scholar
152 I hope to investigate further what happened to the term ‘marasmus’ and to the notion of withering during the Renaissance. The narrower application to children is not only suggested in references by authors such as Girolamo Cardano but also evident in the Milanese archives, which Ann Carmichael is now examining systematically (personal communication); cf. Ann Carmichael, ‘The Health Status of Florentines in the Fifteenth Century,’ Life and Death in Fifteenth-Century Florence (ed. Marcel Tetel et al.; Durham, NC 1989), 28–45.Google Scholar
153 Milton, John, Paradise Lost 11.485–487.Google Scholar