God’s Hotel: A Doctor, a Hospital, and a Pilgrimage to the Heart of Medicine

by Victoria Sweet

  It was not a very exciting life. It was the opposite of the admitting ward. Instead of walking into the hospital not knowing what might happen, whether a patient would run off into the forest or even try to die, I was in charge of each day. My schedule was predictable: writing in the morning, research in the afternoon, walks in the evening. Now and then, I took a field trip to a Swiss library to examine some special medieval manuscript face-to-face.

  There were other differences from my life in America. At Christmastime Lausanne decorated its streets with holly and candles; in the market there was a different holiday food every week. Advent meant brunsli, and Christmas meant lebkuchen, and if I didn’t get brunsli at Advent, I wouldn’t find it the next week. It was very medieval.

  In fact, as the months went by, I began to understand that Switzerland, although modern, had not rejected premodernity as America had. Instead, the Swiss kept what they liked about the past and added the best of each period to their culture, consecutively. So when trains were invented, the Swiss took to them and put trains in everywhere, tunneling through mountains and laying tracks across peaks. But they kept their mountain paths and cobblestone streets for walking. When the automobile arrived, they took to it, too. They put in a bus system and highways, but still did not remove their trains, pave over the cobblestones, or put highways over their footpaths. They liked electric lights, installed them, and even improved on them. But they also liked darkness, and left their lakes and towns without much illumination, so that the stars were visible and the night sky not unfamiliar. Lausanne in particular liked its night watchman from the Middle Ages and still had one. At night, on the hour, I could hear his call that all was well.

  The Swiss way seemed to be melding the medieval with the modern in a kind of additive fusion, like lacquering, perhaps. Or better, like evolution, where what works survives, and what doesn’t work atrophies and disappears. This Swiss way was followed even in medicine, with the new ideas and medications of modern medicine integrated almost seamlessly into what had come before.

  So in Swiss hospitals, I discovered, massage and brandy were prescribed at night for sleep, and herbal baths still used. When a physician found homeopathy useful or even convincing, he did not therefore resign his hospital position, but mixed the two practices, medieval and modern. In the pharmacy I found medieval potions on the shelves right next to modern pills. Old dicta that America had rejected long ago—that cold weather causes colds, that vinegar applied to the temples soothes headaches—were still believed and passed on. What I was discovering with such effort about health and the body from premodern medicine in general, and from Hildegard in specific, was, in Switzerland, nothing new.

  The first thing I did in my quiet study was to take a second look at Hildegard’s Unknown Language. I’d heard a talk about it at the conference and was once again intrigued by what it was and what it could tell me about Hildegard.

  Of all her creations—her visions and illuminations, her Gregorian chants and letters—Unknown Language was the most mysterious. It was indubitably hers, because it was part of a manuscript that Hildegard put together while she was still alive. No one knew what it was supposed to be, however, because Unknown Language was simply five pages of words in some kind of language no one had ever heard of. Above each word was its translation in Latin or German. Hildegard never explained what it was for; a friend of hers had called it “the unknown language given to you by God,” which is how it got its name.

  A few scholars thought that Unknown Language preserved nonsense words that Hildegard uttered in a state of trance, like the talking in tongues of the Pythia or of certain Christian sects. But most scholars believed it was a glossary for a private language that Hildegard invented for her nuns to use when they were inside her monastery. Why, no one knew. The first time I looked at it, I wondered if it was a code masquerading as a glossary. The Middle Ages liked codes a lot, and a coded text would have been a way for Hildegard to write what she wouldn’t have dared otherwise. I’d asked a computer specialist in codes to take a look at it, and he gave Unknown Language to his students to decipher. While I was in Switzerland, I received his summary of their research: Hildegard’s Unknown Language was definitely not a code.

  So now I was going to study it as what it seemed to be, a glossary for a Hildegardian language.

  I started by counting. Unknown Language contained 1,011 words, and all of them, I noticed, were nouns. Which meant that if it was actually used as a language, it must have been with the grammar of another language—Latin or German, most likely. What nouns did Hildegard choose to translate? What order were they in?

  The very first word in Unknown Language, I saw, was aigonz—God, according to the translation above it. Then came aieganz—angel; zivienz—saint; livionz—savior; and divveliz—devil. So, reassuringly, in her Unknown Language Hildegard placed spiritual beings above everything else.

  Next came words for man, woman, and child, and words for the family—father, mother, brother, sister, son, daughter, and stepfather and stepmother, too.

  In third place—and here I was pleasantly surprised—came medical words. There were words for the blind, the lame, the leper, the heart patient, and then for the parts of the body from head to toe. What was stunning was that Hildegard had words for all the parts of the body—not just lung, heart, and liver, but vagina (fragilanz), testicles (virlaiz), and penis. In fact, she had two words for penis—creveniz and lizia. Talk about hard to square with a modest, enclosed nun! Suddenly, reading that list of words in Unknown Language was like reading a mystery story. What would come next?

  Next came words for bishop, priest, abbot, abbess—important positions in the Church. Then for building (Hildegard was building a monastery, after all). Then for workers and craftsmen: gardener, fisherman, weaver, goldsmith, silversmith. There were words for the tools of the scriptorium, where her manuscripts would have been copied—pen and parchment, ink and paints; and there were words for the days of the week, the months of the year, and the times of day.

  It was fascinating. With its words and its ordering, Hildegard’s Unknown Language supplied an inventory of Hildegard’s physical world as she saw it.

  It also solved the problem of Hildegard’s practice of medicine. Because not only were there words in Unknown Language for the humors, for the parts of the body, and for certain illnesses; there were also hundreds of words for the same medicinal plants that Hildegard recommended in her medical books. In fact, names for medicinal plants made up the largest section of the text. There was lavender (liniz), yarrow (agonzia), wormwood (karischa), marijuana (aseruz), and the opium poppy (cuz), to name just a few; and the only logical reason for Hildegard to have included so many medicinal plants in her glossary was that she did, in fact, use them.

  Unknown Language was indeed a code, I concluded, but not a code to a secret text. It was a code to Hildegard’s world. And in that world there was no contradiction between the mystical Hildegard, who needed words for God and angels, pen and parchment; and the medical Hildegard, who needed words for the humors, for the parts of the body, and for medicines. Unknown Language convinced me that it was one and the same Hildegard who wrote Scivias and Causae et Curae, who was stunned into silence by a vision of the universe, and who knew how to prepare a potion and touch a patient.

  If Hildegard did practice medicine, I asked myself next, then how did she learn what she knew? There was only one possible answer, which was that she had been the infirmarian for the women’s side of Disibodenberg.

  Now, every Benedictine monastery had a monk or nun infirmarian, whose special duty was to take care of the sick. The patients he or she took care of were more varied than I’d imagined at first because a monastery was not simply a place of worship but also a working farm. It employed many people, and the monk or nun infirmarian was responsible for all of them: for injured workers and their families when they took sick; for pilgrims and travelers; and for the monks and nuns of the monastery who became ill or old. Occ
asionally the infirmarian would be a physician who’d become a monk later in life, but most often he or she learned the healing arts as an apprentice to the senior infirmarian in the monastery.

  This must have been how Hildegard learned her medicine. She would have had the perfect opportunity because Disibodenberg, with both a men’s side and a women’s side, would have needed a nun infirmarian for the women. She probably learned her medicine from the monk infirmarian for the men. Most likely, when she moved to Bingen, she wrote her Causae et Curae as a medical text for the nun infirmarian who replaced her when she herself became abbess.

  So now I picked up Causae et Curae again, this time to study it as if I were Hildegard’s twelfth-century student infirmarian. I decided to use only the information she provided in Causae et Curae, along with whatever would have been available to such a student. I would not use medical texts that came from before the twelfth century unless her twelfth-century student could have seen them, and no texts from after the twelfth century. I would try out what I learned, too, just as a student might. I would grow some of the plants she recommended, and I would prepare some of her prescriptions. I did boil up her sage cough lozenges; and I did prepare some of her medicinal potions.

  Slowly I began to understand Hildegard’s methodus medendi—her Way of Medicine. Not that she laid it out. Yet through her descriptions of diseases, her explanations of how medicines worked, and her teachings about diagnosis, I gradually put together an idea of what she must have done with her patients. Her method was very different from mine—and surprisingly similar.

  Like me, her first and most important tool was observing her patient. She watched her patient as he walked in, sat down, and told his story. She noted how rich or poor he seemed, how clean or dirty. She looked at his color, his animation, and the brightness of his eyes; and she estimated the greenness of his viriditas.

  Then, just as I do, she began her examination of the patient with the vital signs—the signs of life: temperature, respiratory rate, and pulse. Although not in the same way as I do. Hildegard didn’t take a temperature with a thermometer, which wouldn’t be invented for seven centuries; instead, she felt her patient’s forehead, hands, and feet. I do that, too, nowadays, ever since the mercury thermometer disappeared from the hospital, to be replaced by the easy-to-use but unreliable electronic thermometer.

  Next, she attended to her patient’s respiration. But she was not getting a respiratory rate of so many breaths a minute the way I do; she was interested in something other than a number. Breath for her meant spiritus—the essence of life—and what she did was simply observe her patient breathing. Was his breath weak or strong? Fast or slow? Continuous? Or—most serious of all—discontinuous, with long spaces between each breath? Breath told her a lot about just how sick her patient was.

  Last of the vital signs, Hildegard took her patient’s pulse. But again, differently from the way I take a pulse. She was not counting the pulse for fifteen seconds and multiplying by four. That would have required a watch, also only invented seven centuries later. Rather, she was taking the pulse the way we speak of taking the pulse of a social group, by which we mean getting a sense of its emotional state—its enthusiasm, reluctance, energy. The pulse she took was the standard against which she measured the life force of her patient. It was not about heart, blood pressure, and circulation, but about the health and illness of her patient.

  Sitting quietly, holding her patient’s hand, she would first determine the temperament, since each temperament had a characteristic pulse. Her patient might be melancholic, sanguine, choleric, or phlegmatic, and was usually some combination, of the four. Because, just as DNA is made up of a combination of four basic nucleic acids, so every individual “temperament” was made up of a subtle combination of all four basic tempers, and the patient’s pulse would reveal this unique temperament. Then she would decide whether that particular pulse was “normal,” that is, “healthy,” for that particular patient.

  The rest of her exam was more focused and simpler than mine. She made sure to look at the part of the body that was bothering her patient, though not with flashlight, tongue blade, or stethoscope; instead with her eyes and her hands. Because her concept of the body was different from mine. She was not examining a body of fleshy organs linked by networks of vessels and nerves, but a body of liquid humors needing to flow freely and in the proper balance.

  Last, she examined her patient’s blood and urine. Again, not the way I examine blood and urine, sending them off to the laboratory for tests, although some of my tests are refinements of hers. What she did was, after drawing blood and getting a sample of urine, she waited for the blood and urine to layer out into their basic humors of blood, choler, phlegm, and melancholia. Then she “read” them, estimating their balance of the four humors and confirming her humoral diagnosis.

  Finally she would come up with her prescription. It would have two parts: the first would be an individualized prescription for a “regime,” and the second would be a prescription for some herbal mixture.

  Regime—from regula (rule)—meant a set of rules for living. What you ate, how much you slept, how much you exercised, how often you had sex. Regime wasn’t only for the sick, therefore; if you followed the right regime for your body, you had a good chance of staying healthy. Regime was personal, and it varied with your particular humoral makeup, the season, your age, and the climate in which you lived. Its principles were summarized by the proverb “Even without a doctor / You have three doctors at hand / Dr. Diet, Dr. Quiet, and Dr. Merryman.”

  Hildegard’s prescription for regime would, consequently, include what her patient should and should not eat and drink (that was Dr. Diet); how much exercise, sleep, and rest he should take (Dr. Quiet); and how much sex and what kind of emotions he should allow himself (Dr. Merryman). Today all that we have left of regime is the monotonous injunctions to lose weight, lower our cholesterol, sleep eight hours a day, exercise, and be cheerful. Hildegard and premodern medicine were more subtle. Nothing was bad or good but as it suited the season, the climate, and the person. So she might recommend beer to fatten up the anorexic and forbid red wine to the choleric; in spring, fresh green shoots were good; in winter, stews. For the lovesick, distraction; for the scattered and anxious, focus.

  The second part of Hildegard’s prescription would be for a medicine, usually a mixture of those plants whose names she’d been so careful to put into her Unknown Language. She would prescribe just how the medicine should be made up and how it should be taken—eaten or drunk or applied to the skin so many times a day for so many days.

  After I’d finished putting together my idea of Hildegard’s methodus medendi, what intrigued me most about it was how different it was from mine and yet how similar. The biggest difference was that her method did not use numbers. It was subjective. Almost everything I did had a number—blood pressure, pulse, and temperature; the width of the liver, the circumference of the calf, and all the measurements of blood and urine. Which made my method objective, to some extent, and reproducible by others. And yet, as different as they seemed, from a distance they wouldn’t have looked all that different. Patients came to Hildegard with symptoms—pain, coughs, rashes—just as they do to me; and just as I do, she questioned and examined them, assessed their blood and urine, and gave them a prescription.

  But did her method work?

  Some of her prescriptions probably did. Her medicines were not as concentrated as the chemicals we have today; they took longer to act and were not so certain. Yet many of today’s effective medications originated in the plants that she and other premodern practitioners prescribed. Opium, with its potent mix of morphine and codeine, was always grown in the infirmarian’s garden, and it does work well for the pain, cough, and diarrhea for which Hildegard prescribed it. Ergot from rye fungus does control blood loss and instigate labor, as she used it; and we still use extracts of vinca and mistletoe for certain cancers. Doubtless there were active hormones and potent
vitamins in the thyroid glands, bear’s testicles, and liver she had her patients take.

  There were even things to be learned from her method, I concluded, which we’d lost in our pursuit of the most reproducible tests and the strongest drugs: her patience, her skills at observation, her notions of the relationship between patient and environment—Dr. Diet, Dr. Quiet, and Dr. Merryman.

  Nevertheless, as I closed Causae et Curae for the third time, I was even more grateful for modern medicine than I’d been before, especially for its scientific method, which tests the past, rejects what is ineffective, improves on what works, and passes to the future its powerful results. Taken all together, how jealous Hildegard would have been of me and my technology! Of my amazing ways of examining the blood, of peering into the body, of what I had to heal the sick.

  The snow had started to melt in Lausanne; the days were getting longer; and one day as I was out for a walk, I passed a woman with a large thyroid. I could see it clearly, swelling at her throat, and suddenly I found myself wanting to stop her and examine it. I didn’t stop her—it was Switzerland, after all—but I did begin to think about medicine. I missed it. I wanted to see patients. And I still had a few months to go before my leave of absence was up.

  So that evening I contacted Dr. Hoefer, chief of community medicine at the University Hospital in Geneva. I explained who I was, what I was doing in Switzerland, and what I was missing. We talked for quite a while. I wouldn’t be able to practice medicine on such short notice, Dr. Hoefer told me, but he could arrange a rotation so that I could get a sense of how medicine was practiced in Switzerland. Why don’t we meet next week at his hospital in Geneva? We could have lunch, and in the meantime he would put together a schedule so that I could spend a day or two with each of his medical units.