medieval diet during pregnancy

Articles

Medieval Women's Guides to Food during Pregnancy: Origins, Texts, and Traditions*

MELITTA WEISS-AMER

Abstract. The dietary guidelines contained in medieval Arabic, Latin, and vernacular pregnancy-regimens are analyzed and their origins explored. In their emphasis on eating disorders such as morning-sickness and pica, the texts are shown to follow more closely Greek, Roman, and Byzantine sources than the conservative pregnancy-regimens of Hindu medicine, although medieval Arabic compilers were familiar with both the Eastern and Western tradition. A shift in audience from professional and male to lay and female is observed when the Latin pregnancy-regimens of school medicine are translated into the vernacular and later printed either separately or in conjunction with books on midwifery and gynecology. R6sum6. Ce texte analyse les origines et la nature des directives dietetiques contenues dans les regimes alimentaires pour femmes enceintes, b i t s en langues arabe, latine ou vernaculaires. En insistant sur les d6ordres nutrition- nels comme la ccmaladie du matin* et le pica, ces textes montrent qu'ils s'ins- pirent davantage de sources grecques, romaines ou byzantines, que des regimes similaires proposes par la mkdecine hiidoue - quoique les compila- teurs arabes connussent aussi bien la tradition orientale que celle de ltOccident. Un glissement de l'ecoute, qui passe de l'homme professionnel A celle de la femme, plus concernhe par les questions pratiques, est observe lorsque les regimes de l'ecole latine de medecine sont traduits en langues vernaculaires, et lorsque, plus tard, ils sont imprimes sbparement ou A l'interieur des livres d'obstbtrique ou de gyn6cologie.

In the twentieth century prenatal care has evolved into a specialized field of medicine for which entire clinics are set aside, equipped with

Melitta Weiss-Amer, Department of Modern Languages and Literatures and Department of History of Medicine, University of Western Ontario, London, Ontario N6A 3K7.

CBMH/BCHM / Volume 10: 1993 / p. 5-23

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the latest in monitoring technology. In her book The Captured Womb, Ann Oakley follows this development, which has gradually turned pregnancy into a "pathological" state closely supervised by the medical profession.' Although the author denies that prenatal care in the modern sense of the word existed in earlier centuries, she concedes that "some idea of taking care of pregnant women has. . . been built into most societies' ways of managing childbirth throughout his t~ry."~ What exactly this idea was with respect to the nutrition of the pregnant woman is the subject of this article.

Realizing that the food eaten during pregnancy affects both the mother and the child, and therefore not just the present but also future generations, medical writers over thousands of years have felt the need to address the issue in some form or other.3 In the Middle Ages such information was usually contained in the pregnancy-regimens of school medicine, which were conservative in nature and which dealt with top- ics in addition to food, such as air, exercise and rest, sleep and waking, repletion and excretion, and the passions and emotions of the pregnant woman. Although Western school medicine was firmly rooted in the Greek tradition, the pregnancy-regimen as a genre of medical literature is non-existent in the works of Hippocrates and Galen. It is only with Byzantine authors such as Oribasius, Aetius of Amida, and Paul of Aegina that we find the beginnings of this type of literature. However, with the exception of Aetius, these writers still show a strong orientation towards pathology, focusing on disorders and their correction rather than on conservation and hygiene, a slant which is characteristic of Greek medicine as a whole. A system of prenatal care which stressed conservation and hygiene can be found in Ancient Hindu medicine, and like its medieval Arabic and European counterparts, Sanskrit pregnancy-regimens prescribed a comprehensive lifestyle for the pregnant woman, ranging from the air she breathed and the food she ate to the

I right amount of exercise and sleep as well as attention to her emotional well-being.

With regard to the nutrition of the pregnant woman, three major themes emerge in the examined Hindu and Graeco-Roman sources: morning sickness, pica, and the diet for optimal fetal development. But not all of them were considered of equal importance in the respective cultures. When the Arabs made the conservative pregnancy-regimen an integral part of the medical discourse, they had access to both the Hindu and Graeco-Roman tradition. This raises the question of what role, if any, Sanskrit literature played in shaping the medieval Arabic concept of nutrition during pregnancy, which was later adopted by Eu- ropean school medicine and lived on in Latin and the vernacular well into the early modern period.

Medieval Women's Guides to Food during Pregnancy

HINPU, GREEK, AND ROMAN SOURCES

In Hindu medicine Rasa, the digestive product of the mother's food, is listed as one of the five factors responsible for procreation, together with mother, father, soul, and wholesomeness.4 With such a prominent position being ascribed to food, it is not surprising that early Sanskrit compilations of medicine such as the Ayurveda of Caraka and SuSruta provide ample information on the correct nutrition of the pregnant woman. SuSruta warns of "dry, stale and dirty food as well as that prepared overnight," and recommends food that is "amply sweet, palat- able (Hridya), well-cooked, prepared with appetising drugs and abounding in fluid s~bstances."~ Before and during pregnancy a woman is to avoid certain foodstuffs and eating habits which, according to Caraka, can result in impairment of pregnancy, abortion, or an offspring suffering from diseases. They include the intake of sharp and hot food, too much or too little food, and the addiction to "wine, in- guana [sic] flesh, pork, fish, sweet, sour, pungent, bitter, and astringent foodstuffs, as well a ~ s a l t . " ~

Both texts then provide a sophisticated diet-plan which is to be ad- justed according to the month(s) of pregnancy. SuSruta's regimen, for instance, contains the following guidelines: Special regimen during the period of Gestation: During the first three months of pregnancy an enciente [sic] should partake of food abounding in sweet, cool and fluid articles. Several medical authorities recommend a food made of Shashtika rice with milk, to be given to her spe- cially in the jhird month of gestation, with curd in the fourth, with milk in the fifth and with clarified butter in the sixth month of pregnancy. Food largely composed of milk and butter, as well as relishing (Hridya) food with the soup of the flesh of jhngalti (wild) animals should be given to her in the fourth, food with milk and clarified butter in the fifth, adequate quantity of clarified butter prepared with (the decoction of) Svadamshtrl, or gruel (Yavlgu) in the sixth;

I and clarified butter prepared with (the decoction of) the Prithak-parnylcli group in adequate quantities in the seventh month of gestation. These help the foetal development.. . . Henceforth up to the time of delivery the enciente should have liquid food (Yavlgu) made up of emollient substances (fats) and soup of the flesh of Jlngala animals (deer, etc.). If treated on these lines the enciente remains healthy and strong, and parturition becomes easy and unat- tended with evils.'

These minute dietary rules have no counterpart in Greek medicine. Heinrich Fasbender,who in the nineteenth century studied the material on obstetrics and gynecology contained in the Corpus Hippocrati- cum, and compared it with that in Hindu medicine, came to the conclusion that while there are common traits, Sanskrit literature was much more detailed in some areas, especially dietetics of pregnancy and de- l i v e r ~ . ~ As to the latter, the Ayurveda of SuSruta has, for instance, gone

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down in history as one of the earliest testimonies for a Caesarean op- eration performed on a dead woman, a procedure not mentioned in the Corpus Hippocrat ic~m.~ More recently, Jean Filliozat in his book on the origins of Indian medicine and its Greek parallels, has argued that in particular the Hippocratic texts Diseases of Women and Nature of Woman were strongly influenced by Indian medicine, and that the Persians may have acted as mediators in the transfer of knowledge prior to the expedition of Alexander.lo

Hippocrates, in commenting on the diseases of pregnant women, re- peatedly mentions mistakes in nutrition as a factor which can cause abortions. Pregnant women suffering from anorexia or fainting, or con- suming too much or too little food are in danger of aborting, and so are women who in the early stages of their pregnancy eat and drink acrid and bitter things they are not used to, or substances which upset their stomach.ll

In his description of the symptoms of pregnancy, Hippocrates mentions cravings for strange foods and a reduced intake of food due to loss of appetite and nausea.12 When the cravings of the mother are for things which are not normally used as foodstuffs, and when such desires are met, this can have detrimental consequences for the child, as the author explains in the Book on Superfetation: "Si une femme enceinte a envie de manger de la terre ou des charbons, et en mange, l'enfant qui est mis au monde porte sur la tete LIII signe provenant de ces ~ h o s e s . " ~ ~ The Hippocratic text most often quoted in medieval Arabic and Latin compendia of medicine is the collection of Aphorisms, of which Book V is devoted to human reproduction. But unlike the Ayuroeda with its abundance of material on prenatal care, or the above-mentioned works of the Corpus Hippocraticum with their occasional dietetic references, it contains virtually no information regarding the diet and lifestyle of the pregnant woman.14

l Galen, the most prolific writer of the Graeco-Roman period, likewise ascribes a relatively minor role to the conservative aspects of pregnancy. This is not surprising, given that, as Joseph Needham has pointed out, only 7 percent of Galen's works deal with human reproduction, compared with 37 percent in Aristotle or 31 percent in Al- bertus Magnus.15 Although Ursula Weisser raises doubts as to the ac- curacy of such a statistic, it nevertheless can be seen as an indication that pregnancy was an area Galen was not particularly interested in.16 A phenomenon he does describe in detail, however, is an eating disorder common in many pregnant women, which he calls citta. This desire usually occurs in women abounding in an exceedingly bad humor and in pregnant women, and it is called citta. This desire makes them crave

Medieval Women's Guides to Food during Pregnancy 9

sour, very bitter, and sometimes acrid things, or on occasion even Cimolean earth, shells, extinguished coals, or certain strange foods.''

According to Galen, this stage is followed by vomiting and nausea in the fourth month. In his etiology of citta the author is strongly indebted to Hippocrates and in addition may have drawn from Aristotle's Gen- eration of Animals, especially in his explanation of the causes for the disorder, as the following quotations from Galen and Aristotle, respec- tively, illustrate: For in the first two months the fetus attracts to itself too little blood, because it is still small, since at that time what is contained in the uterus is not yet called fetus, but that which has been conceived. As it gets bigger, however, and uses more food, and consumes not just the best of what is in the veins, as I have said earlier, but needs a variety of things, it also consumes blood of lesser quality together with the rest.

. . . and most women are troubled in this way rather more at the beginning, just after they have conceived, because although the fetation is able to prevent the evacuation, yet as it is so small it does not at first use up any amount of the residue; afterwards, when it does take up some of it, it relieves the trouble.lB

When Pliny wrote his Natural History in the first century AD, he included a section on pregnancy, abortion, and delivery in Book VII. In his description of the signs of pregnancy he, in keeping with his Greek forerunners, puts strong emphasis on women's eating disorders. "On the tenth day from conception pains in the head, giddiness and dim sight, distaste for food, and vomiting are symptoms of the formation of the embryo."19 And although he does not give a detailed account of the right diet during pregnancy, he does provide an example of the bad effects mistakes in nutrition can have on the progeny: "mothers eating food that is too salty bear children lacking nails."20

Pregnant women's cravings for thirfgs not normally associated with l food continued to capture the imagination of the male medical commu-

nity during the Graeco-Roman period as well. In the second century AD Soranus of Ephesus was the first to deal with female physiology and human reproduction separately. In his Gynacia he devotes seven questions to cittosis, and gives the following definition of the disorder which he calls cissa:

37. What is cissa? The craving for unusual food which occurs in pregnant women at a certain time together with an unstable stomach, an abundance of humors, and nausea.21

He maintains that cissa normally starts in the second month of pregnancy and in some cases may last almost until delivery. Among the

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remedies he mentions are the occasional day of fasting or, if this is not possible, many small meals preceded by water and followed by wine, as well as dry and astringent foods.22

Soranus's work, parts of which have come down to us only in the fifth: and sixth-century translations of Caelius Aurelianus and Mos- chi0n,2~ does not yet contain a conservative list of foodstuffs for optimal fetal development of the type found in Hindu, Arabic, or Euro- pean pregnancy-regimens.

The first comprehensive set of guidelines for prenatal care was put together by Oribasius in the fourth century AD. In Book V, Chapter 1, of his Synopsis, he describes the disorders common in pregnant women and provides the appropriate regimen to correct the various afflic- t i o n ~ . ~ ~ Not surprisingly, all of them are eating disorders: overeating, frequent vomiting, increased secretion of saliva, heartburn, and nausea. Against vomiting and over-eating he recommends walks, foods that are not too bitter and not too sweet, fragrant white wines (especially when they are five years old), drinking in moderation, a medicinal potion to be taken before and after the meal, as well as a cataplasm to be applied externally on the cardia. Heartburn is cured by drinking small sips of warm water, by taking leisurely walks, and by putting soft wool on the abdomen. Work and more or less extended trips are also a means to restore the pregnant woman's appetite. Nausea is cured by eating a variety of savory foods and dry starch. The latter is especially beneficial to women who have a craving for earth. Large women who suffer from nausea should on occasion eat acrid things, particularly mustard. The regimen ends with various cures for oedematose feet.

Aetius of Amida, a sixth-century Byzantine compiler, provides an extended version of Oribasius's regimen in Book XVI of the Tetrabiblon which deals with gynecology and obstetric^.^^ Chapter 10, entitled

l "Concerning the Morbid Appetite (Pica) of the Pregnant Woman, Ac- ' cording to Galen," begins with an etymology of the disorder which, Aetius maintains, gets its name (pica) from the noisy bird, the magpie. On the other hand, others feel that the name is derived from the ivy plant which is called citta by the Greeks. It is so called because the ivy is wont to attach itself to any nearby plant. So women suffering from the pica crave various foods which are either sensuous or di~agreeable.~~

While Aetius's association of the ailment with the plant ivy was not taken up by later authors, the association with the magpie has survived in medical textbooks from ancient Byzantium until the modem era. Ac- cording to Paul of Aegina, a seventh-century Byzantine writer who copied Oribasius's regimen almost verbatim, pica was named after a


bird for two possible reasons: the bird's variety of colors, or its prone- ness to the same afflictionaZ7 Francis Adams identifies the bird as the jay (Corvus glandarius), whereas Julius Berendes suggests the German translation Holzheher (Garrulus glandarius), and points to the North American blue jay (Cyanocitta cristata) which has citta as part of its name. However, since all three terms cissa, citta, and pica appear in the scientific names of birds of the genus Cowidae, a precise identification of the animal in question is very diff i~ult .~~ Modern medical dictionar- ies generally agree that it is the magpie after which the disorder was

Following his etymology of pica, Aetius gives an explanation of its causes and symptoms in which he shows familiarity with a tradition that can be traced back to Galen, Aristotle, and hippo crate^.^^ Aetius's subsequent regimen, though similar to that of Oribasius, is much more detailed when it comes to the foods that are recommended and those that are harmful to women suffering from pica: They should abstain from sweet foods eaten with bread; they should drink old, tawny, fragrant wine which is a little tart. The fluid ifitake should be moderate so that the food may not remain undigested in the stomach. It is advisable to serve before the meal preserved olives with soft bread; also five to seven bitter almonds, or coarse barley meal kneaded with the juice of Cretan pomegranates, or endive, or marsh grown asparagus or lettuce. And also poultry which is not too fat nor too strong. Also it is advisable to give pig's feet, snout and stomach, and freshly caught fish. After meals, one should give raisins, pomegranates and pears. All these are to be given in a moderate quantity; and those who have an aversion to eating must be enticed by a delightful variety of foods. Those who desire to eat sand should be given nothing but freshly baked bread.31

Aetius then lists a number of drugs, ointments, and poultices which help control pica. In cases of severe affliction he recommends that the woman "be allowed to eat pickled fish and radishes in sour honey [vin-

I egar sweetened with honey]."32 The section on oedematose feet, which formed the end of Oribasius's regimen, is a separate chapter in Aetius. It is followed by the first genuine conservative pregnancy-regimen in Greek, which is also the first attributed to a woman: "On the Manage- ment of the Pregnant Woman, According to A~pasia."~~

It is not clear who this Aspasia was that is credited with more than 10 chapters in Aetius's book.34 Over the centuries historians of medicine have tried to identify her as a beautiful Phoenician, mistress of the Kings of Persia, Cyrus the younger and Artaxerxes, as Aspasia of Miletus of Pericles fame, as a derivation of the name Aspasios, or the title of a lost text on diseases of women.35 All these hypotheses have been refuted by Walther Schonfeld on the grounds that to this day nothing is known of Aspasia beyond the references in A e t i ~ s . ~ ~

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The pregnancy-regimen begins with a caveat against mental disturb- ances and overactivity, acrid foods and foods which predispose to flatulence, vigorous enemas, too much or too little food or drink, as well as loss of blood. Recommended are "moderate amounts of food which are suitable to the stomach, trips in a sedan chair, short walks, gentle mas- sage, and wool spinning."37 At about the eighth month of pregnancy the amounts of food and exercise are to be reduced, and constipation is to be corrected by such foods as "juice of ptisan, cooked sorrel, mallow and lettuce." In the ninth month frequent baths are recommended.

With the possible exception of Aspasia's regimen, all representatives of the Hindu and Greek medical tradition examined above are male discourses dealing with an intrinsically female experience, namely that of pregnancy. When it comes to women's diet, however, the emphasis is different in the texts of ancient India and Europe.

The Ayurveda of Caraka and SuSruta ascribes eminent importance to the right food during each phase of a woman's pregnancy-and even as much as a week before cohabitation, if a son of excellent qualities is desired.38 Considering that weakness, timidity, lack of wisdom, igno- rance, unsteadiness, heaviness of lower limbs, intolerance, slackness, and softness are among the characteristics determining the female sex?9 it is understandable that the chapter on procreation in the Caraka Samhita with its focus on excellent progeny, deals with procreating male children only.40 If there is any doubt as to the sex of the fetus in the early stages of the pregnancy, a special therapy, purizsavana, is ad- ministered to the woman in order to guarantee a male child. Mistakes in nutrition are mentioned briefly in Hindu medicine together with their disastrous effects on the health of the progeny.41 As to the symptoms indicative of pregnancy, they do include such eating disorders as "excessive salivation, loss of appetite, vomiting, anorexia, liking for taking sour things, and liking for all types of food-both wholesome

I and unwholesome," but these are not elaborated on in the pregnancy- regimen.42

In Hellenic medicine, on the other hand, the connection between the diet of the mother and the quality of the progeny is less pronounced. The focus in the Greek texts is clearly on eating disorders and corrective nutrition. In particular it is morning sickness and women's crav- i n g ~ for strange things which are discussed at great length in the literature, thus illustrating once again the strong orientation of Greek medicine towards pathology.

MEDIEVAL ARABIC AND EUROPEAN PREGNANCY-REGIMENS

As noted, Hindu and Greek medicine show a number of common traits. While the question as to precisely how and when the exchange of


medical knowledge between ancient India and Greece took place is still far from being resolved, it is a fact that the two systems came together during the Arabist period. According to Manfred Ullmann, the Arabs in the early Middle Ages had access to translations of Hindu works of medicine in addition to the extensive translations from Greek and S y r i a ~ . ~ ~ His study of the Arabic medical literature makes clear that ba- sically all the classical works of Ayurveda belonging to the Brihat Trayee (greater triad), i.e., Caraka-Samhitn, Sus'ruta-Samhitif, and Asfangahrdaya- Samhita, were known to the Arabs, and were quoted by such renowed physicians as Rhazes and A~icenna.4~ In an appendix to his book Para- dise of Wisdom, the Arabic writer Aba l-Hasan 'Ali ibn Sahl Rabban at-Tabari gives a summary of Hindu medicine based on translations of the works by "Caraka, SuSruta Vagbhata (Astangahrdaya) und Madhavakara (Nidt i~~a) ."~~ As Ursula Weisser points out, this appendix also includes information on the Hindu theory of human reproduc- t i ~ n . ~ ~

While Arabic medicine throughout the Middle Ages was essentially Hippocratic and Galenic in nature, it is conceivable that familiarity with the Hindu system led to a shift in emphasis from pathology to preventive medicine, and the development of "new" genres of texts such as the conservative regimens for pregnancy, childbirth, and child- rearing.

When Arabist writers, above all Johannitius, Haly Abbas, Rhazes, and Avicenna put Greek medicine into a theoretical framework for which they used as ordering principles Galen's sex res non naturales (namely air, food and drink, exercise and rest, sleep and waking, repletion and excretion, and the passions and emotions), they created a type of literature which gained enormous popularity among the Arabs, and which in medieval Europe came to be known as Regimen ~anitatis.4~ In dealing not only with healthy adults but with all stages of a person's

I life, Arabic Regimen-literature brought pregnancy, childhood, old age, and convalescence, regarded as the neutral state between sickness and health, into the realm of preventive medicine. Given the availability of Hindu medical literature, it is possible that Arabic compilers in their search for material on the ideal lifestyle of the pregnant woman, turned to the conservative regimens of the Ayurveda which contained ample information on virtually all the non-naturals. An analysis of the Arabic pregnancy-regimens will show whether actual dietary guidelines were adopted from Hindu medicine.

Around 900 AD Rhazes was one of the first Arabic writers to include a pregnancy-regimen in his regimen-cycle of the Liber de medicina ad Al- man~orem.~~ Although in the incunabulum used for this analysis the regimen is entitled "De regimine infantis et pregnantis," it deals only


with ,the pregnant woman, and puts strong emphasis on nutrition. Rhazes begins with a caveat against all foodstuffs that are acrid and bitter, such as capers, lupines, and unripe olives, and foodstuffs which provoke urine and menstruation, such as chick-peas, green beans, and especially rue. He recommends delicate foods that generate good humors, suppress nausea, and strengthen the cardia, such as the meat of chicken, partridge, and kid. The pregnant woman is advised to drink good, fragrant and slightly diluted wine in small quantities. To fight nausea and ~lguaa?~ the syrup of sour and styptic foods is to be taken. Furthermore, food should be eaten many times during the day, and not just in one big meal. Lost appetite can be restored by eating acrid things in small quantities, such as onions, mustard, and the like. To chew mastic and white incense also helps, as does eating quinces and pomegranates, sour apples, and limes. Concluding his remarks on nutrition, Rhazes again warns of bad foods and the mixing of bad and diverse foods in the stomach.

In the pregnancy-regimen Rhazes hence deals with three aspects of the woman's nutrition: foods to be avoided, recommended foods, and cures for nausea and lost appetite. The author provide? concrete information on the foodstuffs in question, which many of his' Greek forerunners did not do, but stops short of offering a complete diet-plan for the individual months of pregnancy of the type found in Caraka and SuSruta.

One of the most influential books for medieval Arabic and European medicine alike, surpassed only by Avicenna's Canon medicinae, is the Liber pantegni written by Haly Abbas in the tenth century.50 His pregnancy-regimen is embedded in a "Regimen omnium etatum," which in turn is part of the "Regimentum sanitatis partic~lare."~~ In an introduction to the regimen, Haly Abbas lists retention of the menses, nausea, vomiting, saliva, pain in the cardia, and cittosis as the signs of preg-

I nancy. In the manuscript consulted for this analysis, women's cravings are described as the desire for "bad things" such as eels. Since eels were a common foodstuff in medieval kitchens, we must assume that the scribe, not familiar with the etiology of citta, substituted argilla (clay) with anguilla (eel). As remedies Haly Abbas recommends the syrup of pomegranates, nutmeg, and aloe, and the smell of fragrant substances. The food and drink to be consumed during pregnancy include chicken and kid with the vinegar of wild grapes, and fragrant, slightly diluted wine. Meals should be eaten two to three times a day in modest quantity. Haly Abbas, too, warns of foods which are sour, bitter, diuretic, and provoke menstruation, such as black chick-peas, green beans, rue, fenugreek, and celery. The author then discusses a variety of remedies for constipation, flatulence, bad cravings, and


other complications, and concludes the regimen with recipes for induc- ing labor.

There are without doubt strong similarities between the regimens of Rhazes and Haly Abbas, and yet in the Liber pantegni greater emphasis seems to be put on corrective nutrition. This tendency is even more pronounced in Avicenna's Canon. A pregnancy-regimen of the type found in Rhazes and Haly Abbas is included in the Canon in Liber 3, Fen XXI, Tractatus 2, where it is part of Avicenna's treatment of sexual- ity, male and female reproductive organs, and their diseases.52 Com- pared to his predecessors, Avicenna provides substantially more information and focuses more clearly on the eating disorders common during pregnancy.

In the regimen entitled "De regimine vniuersali pregnantis" his dis- cussion of the various aspects of nutrition begins with a reference to the bread a pregnant woman should eat, followed by the foodstuffs that are bad for her, many of which were encountered earlier in Rhazes and Haly Abbas: acrid and bitter foods, such as capers and unripe olives, and those provoking menstruation, such as green beans, chick- peas, and sesame. Avicenna then turns to the day of conception and lists two beverages which, according to Hippocrates, enhance fertility: "savic in aqua,"53 and fragrant, fine, old wine. In the second month of pregnancy the woman is advised by Avicenna to eat raisins, sweet quinces, pears, and things which whet her appetite, as well as apples and pomegranate^.^" The regimen concludes with recipes for electuaries, of which the electuarium de margaritis (pearl electuary) became enormously popular in Medieval Europe, where it found its way into many compilations of medicine.55

Avicenna apparently deemed the appetite of the pregnant woman so important that after a comparatively brief regimen for the wetnurse, "De regimine enixe," he returns to the subject once more and devotes

l an entire chapter, "De appetitu pregnantis," to corrective nutrition. In it he provides information on ways to restore lost appetite, to rectify appetitus malus (cittosis?), and to reduce a woman's appetite. He also gives a recipe for an electuary against flatulence, and various remedies against vomiting.

In the Arabic pregnancy-regimens "food and d r ink is without doubt the most prominent of the non-naturals. More detailed information is now included on recommended foodstuffs than was contained in the Greek sources, and yet none of the regimens provides a diet-plan comparable to those found in Hindu medicine. With eating disorders and corrective nutrition still being discussed extensively in the texts, Arabic dietetics of pregnancy seems to be indebted more to the West- ern than the Eastern tradition.

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In general, European pregnancy-regimens followed the models of Rhazes and Avicenna, with the occasional insertion of passages from Hippocrates' Aphorisms. One of the earliest European regimens origi- nated in Salerno, and is included in the treatise De passionibus mulierum, which circulated in Europe under the name of T r ~ t u l a . ~ ~

Trotula introduces her regimen with a warning not to mention any- thing in front of a pregnant woman which she cannot have, since un- fulfilled desires may lead to abortion. She is quick to point out, however, that her statement does not apply to the strange cravings pregnant women often experience. Instead of advocating that these desires be met, she provides a recipe for rectifying the disorder: "Quod si ap- peteret argillam, uel cretam, uel carbones, dentur ei fabae coctae cum zuccharo" ("If she craves clay, or chalk, or coal, she should be given ' cooked beans with sugar"). When the woman approaches labor, the author recommends light, digestible foods. After other foodstuffs she should eat poultry, quinces, and pomegranates, which is consistent with the information found in Rhazes and Avicenna (see above). The regimen concludes with remedies against flatulence.

In the twelfth century Salerno was superseded by Montpellier and Paris, which quickly became the new centers of medical learning. Con- sequently Avicenna's Canon emerged as the undisputed work of reference, and with it a strong emphasis on the eating disorders of pregnant women can be observed in the regimens compiled in France. The following are three examples from the thirteenth and fourteenth centuries:

Bernard de Gordon's Lilium medicinae, recognized as the first medical text of medieval Europe to mention Caesarean birth,"7 contains a pregnancy-regimen. In his nutritional guidelines the author focuses on the pregnant woman who has enormous appetite. According to Bernard, she should eat roasted, fried, asd fragrant foods, and conclude her

I meals with cooked pears, pomegranates, roasted hazel-nuts, roasted chestnuts, or roasted chick-peas.58 The compiler appears to have sup- plemented the information he found in Avicenna's regimen on corrective nutrition, that roasting is useful for reducing a woman's appetite, with concrete examples.

In his Regimen sanitatis Magninus Mediolanensis, a contemporary of Bernard, follows perhaps most closely Avicenna's Canon.59 Practically all the advice he gives in the chapter "De regimine pregnantis" is derived from Avicenna's general pregnancy-regimen and the regimen on the appetite of the pregnant woman.

One of the earliest examples in French is part of Aldebrandino de Siena's thirteenth-century compilation Le rigime du corps.60 Aldebran- din0 introduces the section "Comment le [sic] femme se doit garder


quant ele est en~ainte" with the quote from Pliny's Natural History, in which the Roman author warns that too much salt in the diet of the mother results in babies being born without nails. The thrust of the regimen is based on Avicenna and Rhazes. Hence, foodstuffs believed to provoke urine and menstruation are to be avoided; tender meats of young animals and poultry, on the other hand, are recommended together with slightly diluted wine. To whet a woman's appetite, pears, pomegranates, and sour apples are listed. This is followed by the recipe for an electuary which is said to comfort the stomach and the rest of the body, and which constitutes the French translation of Avicenna's electuarium de margaritis.

By the end of the thirteenth century, Rhazes' Liber and Avicenna's Canon had also become the standard textbooks at Italian universities, as the pregnancy-regimen in Book I of Guilielmus de Saliceto's Summa conservationis et curationis illustrate^.^^ Guilielmus, who was trained in Bologna and wrote the regimen sometime after 1275,62 also makes extensive use of Hippocrates' Aphorisms in addition to Rhazes and Avi- cenna. Like many authors before him, Guilielmus differentiates be-

- tween the nutrition of pregnant women who enjoy a healthy appetite, and those who experience eating disorders such as cittosis. Appetitus mendosus is the term he uses to describe the cravings for coal and clay.63

In 1493 a German translation of Guilielmus' text was made by the physician Bartholomaus Scherrenmiiller at the request of Graf Eberhard im Bart and his wife Barbara who had problems conceiving an heir. But Scherrenmiiller's translation of a pregnancy-regimen was by no means the first. The shift from Latin to German had in fact begun over 150 years earlier with a brief regimen included in Ortolf voq Baierland's A r ~ n e i b u c h . ~ ~ h it the author follows by and large the Ara- bist tradition and warns of bitter foodstuffs while recommending wholesome food which generates good blood, such as the meat of

l chicken, partridge, and kid. Not surprisingly, Ortolf, too, favors wine over all other beverages.

The advent of the plague in the mid-fourteenth century made the survival of mankind a concern for everyone and triggered a massive wave of translations into the vernacular. In addition to physicians, the clergy now became increasingly involved in translating texts such as the regimen-literature of medieval school medicine, thus making ac- cessible to the literate what was once the prerogative of the latinate.65 One of the most popular German pregnancy-regimens was composed ill 1429 by a cleric from Freiburg by the name of Heinrich La~fenberg .~~ The author is clearly familiar with European school medicine, and does not hesitate to exploit it for the propaganda purposes of the church. He achieves this primarily by stripping the medical discourse of all ele-


ments which run counter to church doctrine, and declaring the "cen- sored" version the will of God.67 In nutritional matters he advises the pregnant woman to eat food in moderation without going hungry or thirsty. A caveat against coarse, tough food such as beef, pork and smoked meat, beans, lentils, barley, raw fruit, and fish caught in ponds, is followed by the recommendation to eat veal, kid, chicken, partridge, small birds, venison, and soft-boiled egges. Diarrhea, constipation, and medicinal potions with the exception of a mild laxative are to be avoided.@ The parturient woman is to be given hot milk or and the woman who has just given birth, light food from hens and chickens, and light white wine.70

The shift from Latin to the vernacular also brought about a change in audience from professional and male to lay and primarily female. And with it came a shift from corrective nutrition with its sometimes com- plex medical recipes to the standard nutrition of the pregnant woman. Laufenberg, for instance, provides only simple remedies requiring readily available ingredients which can be prepared by the pregnant woman or her entourage. For more serious disorders the author suggests that the woman consult a doctor, and buy her electuaries in an ap~thecary.~~

The trend towards expanding on the regular foodstuffs and their effects on the woman becomes especially evident in an Italian regimen written by a contemporary of Laufenberg, the physician Michele Sa- vonarola. Chapter 2 of his treatise Ad mulieres ferrarienses de regimine pregnantium et noviter natomm usque ad septennium begins with a conservative regimen which discusses all six non-naturals, but puts the strongest emphasis on food and drink." In using Avicenna and Galen as hissmain sources on nutrition in general, and pregnancy in particular, Savonarola evaluates foodstuffs of all the traditional food-groups found in medieval school medicine with regard to their positive and

I negative effects on the pregnant woman: the meats of four- and two- legged animals, fish, other sea-food, fruits, roots, seeds, grains, herbs, citrus fruits, milk and dairy products, oil and fat, sweeteners, spices, wine, and other beverages. Following the treatment of the non-naturals, Savonarola turns to the question of appetite and, like Avicenna, gives a detailed account of the various eating disorders common during pregnancy, as well as their re me die^.'^

Savonarola's treatise, written in Italian and dedicates to the women of Ferrara, is the culmination point in the development of the pregnancy-regimen. Never before and never after, it seems, was there so much attention paid to all aspects of pregnancy, and especially to nutrition. In the sixteenth century German regimens, for example, were mostly reworkings of Laufenberg's text, printed separately or in con-


junction with the new literature for widwives and authors such as Eu- charius Rosslin and Jacob R~eff. '~

CONCLUSION

When in the early medieval period Arabic physicians created the genre of the pregnancy-regimen based on Galen's six non-naturals, and con- sequently made pregtancy a part of preventive medicine, they had access to the predominantly male medical discourses of Ancient India and Greece. While on the question of food Hindu medicine stressed the excellence of a male progeny through the right diet of the mother, Greek physicians, who until the Byzantine Period did not organize their information regarding pregnancy in special regimens, seemed more concerned with phenomena such as morning-sickness and cittosis and their cures. In their nutritional guidelines Arabic regimens were found to follow more closely the Western than the Eastern sources. A typical Arabic regimen would provide a list of recommended foods, of foods to be avoided, and remedies for eating disorders. European school medicine generally followed the Arabic model and continued to discuss pregnancy in the context of preventive medicine. Numerous Latin regimens were compiled in the West, and were geared towards a professional male audience. The advent of the plague led to an increase in translations into the vernacular, and the fusion of the male medical with the male clerical discourse when churchmen such as Heinrich Laufenberg acted as translators and "editors" of medieval school medicine. As women became more and more the target group for these vernacular versions, pregnancy-regimens were taken out of the context of preventive medicine and e;entually integrated in books dealing mainly with human reproduction and women's health.

I NOTES

* I would like to acknowledge anonymous readers for their comments on this article and the Social Sciences and Humanities Research Council of Canada for financial support.

1 Ann Oakley, The Captured Womb: A History of Medical Care of Pregnant Women (Oxford and New York: Basil Blackwell, 19M).

2 Oakley, The Captured Womb, p. 11. 3 Obstetrical and gynecological sources from the earliest Egyptian papyri to the twen-

tieth century can be found in Heinrich Fasbender, Geschichte der Geburtshlilfe (Jena: Gustav Fischer, 1906); and Harvey Graham, Eternal Eve (Altrincham: Heinemann, 1950). See also Theodore Cianfrani, A Short History of Obstetrics and Gynecology (Springfield, 111.: C. C. Thomas, 1960). For information on the medieval and early modem period see Paul Diepgen, Frau und Frauenheilkunde in der Kultur des Mit- telalters (Stuttgart: Georg Thieme, 1963); and Audrey Eccles, Obstetrics and Gynecology in Tudor and Stuart England (London: Croom Helm, 1982); for obstetrics and gynecol-


ogy i n art see Harold Speert, Iconographia Gyniatrica: A Pictorial Histoy of Gynecology and Obstetrics (Philadelphia: F. A. Davis, 1973). Ram Karan Sharma and Vaidya Bhagwan Dash, eds. and trans., AgniveSa's Caraka Samhitd: Text with English Translation & Critical Exposition Based on Cakrdpani Datta's Ayurveda Dipikd, Chowkhamba Sanskrit Studies, Vol. 94 (Varanasi: Chowkhamba Press, 1977), p. 367; the work is "a compendium made b y Charaka (2nd century AD) from an earlier work o f Agnivera, based upon the lectures o f his master Atreya (6th century BC)"; see Fielding H. Garrison, An Introduction to the Histoy of Medicine, 4th ed. (Philadelphia and London: Saunders, 1929), p. 70. Kaviraj Kunjalal Bhishagratna, ed. and trans., An English Translation of the Sushruta Samhita Based on Original Sanskrit Text, Vol. 2, Chowkhamba Sanskrit Studies, Vol. 30 (Varanasi: Chowkhantba Press, 1963), p. 216f.; the text was written i n the f i f th century according to Garrison, History of Medicine, p. 70. It is not clear what the translator o f Susruta means b y "appetising drugs"; the passage reads "Such food is t o be given as she wants, but it must be soft, thin, sweet, oleaginous, and what promotes the internal heat" i n Thomas Alexander Wise, commentay-on the Hindu system of Medicine: An Ex- position of Ancient Hindu Medicine as Embodied in Sanskrit Literature (London 1860; Am- sterdam: APA-Oriental Press, reprint, 1981), p. 415. Sharma and Dash, Caraka Samhitd, p. 475f. Bhishagratna, Sushruta Samhita, p. 217f. Heinrich Fasbender, Entwicklungslehre, Geburtshiilfe und Gyniikologie in den Hippokra- tischen Schrifen (Stuttgart: Ferdinand Enke, 1897), p. 44. Fasbender, Entwicklungslehre, Geburtshiilfe und Gyndkologie, p. 57; and Renate Blumen- feld-Kosinski, Not of Woman Born: Representations of Caesarean Birth in Medieval and Renassiance Culture (Ithaca: Cornell University Press, 1990), p. 22f.; according to Blumenfeld-Kosinski Caesareans on living women are a more recent phenomenon, presumably starting i n early Jewish culture. i Jean Filliozat, The Classical Doctrine of Indian Medicine: Its Origins and Its Greek Parallels, translated b y Dev Raj Chanana (Delhi: Munshiram Manoharlal, 1964), esp. p. 255; the Hippocratic treatises i n question are "De la Nature de la Femme," Vol. 7 , p. 312-430, and "Des Maladies des Femmes," Vol. 8, p. 10-462, o f Emile Littre, ed. and trans., Oeuvres Compl8tes dlHippocrate, 10 vols. (Paris: J . B. Bailliere, 1839-61). "Des Maladies des Femmes." v. 67.69. "Elle a des envies d'aliments &ranges; m&me peu de nourriture cause des dbgoGts et des nausbes" b e e "Des Maladies des Femmes." v. 79). "De la ~u~er f k ta t i on , " i n Littrb, ed., ~ippocrate) 61. s, '~. 487. Inge Miiller-Rohlfsen, ed., Die Lateinische Ravennatische Llbersetzung der Hippokra- tischen Aphorismen (Hamburg: Hartmut Liidke, 1980), p. 150-53. Joseph Needham, A History of Embryology, 2nd ed., rev. wi th the assistance o f A. Hughes (Cambridge: Cambridge University Press, 1959), p. 86. Ursula Weisser, Zeugung, Vererbung und prdnatale Entwicklung in der Medizin des ara- bisch-islamischen Mittelalters (Erlangen: Hannelore Liiling, 1983), p. 40f. "De symptomatum causis lib. I," Chap. 7 , Paragraph 1 i n C. G. Kiihn, ed., Galenus: Opera Omnia (= Medicorum Graecorum Opera quae exstant, Vol. 1-20), Vol. 7 (Leipzig 1821-33; Hildesheim: Olms, reprint, 1964-65), p. 133; the English translations are m y own, unless otherwise indicated, and are based on Kiihn's Latin translation. "De symptomatum causis lib. I," p. 133; and Aristotle, Generation of Animals, translated b y A. L. Peck (Cambridge: Harvard University Press and London: William Heinemann, 1963, Book IV, Chapter 6, v. 463. Pliny, Natural ~ i s t o r y : With an ~&l i sh franslation in Ten Volumes, translated b y Harris Rackham, Vol. 7 [London: William Heinemann and Cambr id~e : Harvard Universitv Press, 1963), ~ o o k VII, Chapter 6, p. 533. " Pliny, Natural Histoy, p. 535. Valetin Rose, ed., Sorani Gynaeciorum Vetus Translatio Latina (Leipzig: Teubner, 1882), p. 15.


22 Rose, Sorani Translatw, p. 16. 23 Caelius Aurelianus, Gynaecia: Fragments of a Latin Version of Soranus' Gynaeciafrom a

Thirteenth-Cektu y Manuscript, edited by Miriam and Israel Drabkin (Baltimore: Johns Hopkins University Press, 1951); and Moschion, La Gynaecia di Mtlscione, edited and translated by Rino Radicchi (Pisa: Editrice Giardini, 1970).

24 Charles Victor Daremberg and Uko Cats Bussemaker, eds., and trans., Oeuvres d'Ori- base, 6 vols. (Paris: Impr. nationale, 1851-76), Vol. 5, Book I, p. 196-98.

25 James V. Ricci, trans., Aetios of Amida: The Gynecology and Obstetrics of the VIth Centuy A.D. (Philadelphia and Toronto: Blakiston, 1950).

26 Ricci, Aetws of Amida, p. 20-22. 27 Julius Berendes, trans., "Des Paulos von Aegina Abriss der gesammten Medizin in

sieben Biichern," Janus, 1 (1908): 7. 28 Francis Adams, trans., The Seven Books of Paulus Aegineta, Vol. 1 (London: syden&m

Society, 1844), p. 3; Berendes, "Paulos von Aegina," p. 7. Compare, for instance, Mag- pie (Pica pica), Steller's Jay (Cyanocitta stelleri), Green Magpie (Cissa chinensis), listed under "Crows" in Christopher M. Perrins and Alek L. A. Middleton, The Encyclopedia ' of Birds (New York: Facts on File Publications, l98S), p. 442-47.

29 Dictionnaire des Sciences Mtdicales, Vol. 42 (Paris: C. L. F. Panckoucke, 1820), p. 347: "Pica [ . . . ] pie (parce que cet oiseau avale souvent des mati&res terreuses ou pier- reuses, etc.); Stedman's Medical Dictiona y, 22nd ed. (Baltimore: Wikliams & Wilkins, 1972), p. 971; and Cyril Williarh H. Havard, Black's Medical Dictionay, 36th ed. (Lon- don: A. &C. Black, 1990), p. 532.

30 "All of these symptoms develop especially because of an excess of bloody humor which is customarilv exmlied via the vessels of the uterus at each monthlv period; this bloody humor &hit& is suppressed by the pressure of the foetus, rises ipward and attacks the stomach, particularlv sensitive (at this time). For this reason (to satisfy this depraved humor) th'ese womei crave various and odd foods, some salty, som;? acrid; some crave for ordinary sand, oyster shells and ashes. Often thismorbid condi-

. tion may last up to the fourth month. In the beginning only a moderate amount of blood carries nourishment to the foetus; subsequently, as the foetus develops, it draws more nourishment. Thus as more of the bad humor is removed (from the blood stream) by virtue of repeated vomiting spells, and by carrying more to the uterus to nourish the foetus, the above mentioned symptoms cease" (Ricci, Aetios of Amida, p. 21; compare with Galen and Aristotle, supra, note 18.

31 Ricci, Aetws ofdmida, p. 21. 32 Ricci, Aetios of Amida, p. 21. 33 Ricci, Aetws of Amida, p. 22f. 34 Thirty-eight chapters are assigned to specific authors by Aetios: ten to Aspasia, nine

to Soranos, six to Philumenos, five to Archigenes, two to Leonides, two to Philagrios, one to Galen, and one to Aesclepiades. The contents of one chapter was abstracted from Archigenes and Leonides, and the contents of another from Rufus and Aspasia (see Ricci, Aetws of Amida, p. 173).

35 See Ricci, Aetws of Amida, p. 12, note 37. 36 Walther Schbnfeld, Frauen in der abendlrYndischen Heilkunde: Vom klassischen Altertum

bis zum Ausgang des 19. Jahrhunderts (Stuttgart: Ferdinand Enke, 1947), p. 43f. 37 Ricci, Aetws of Amida, p. 22. 38 "If she desires to have a son with a massive body, white complexioned with the

strength like that of a lion, with vigour, purity and strong mind, then from the first day of her purificatory bath [after the menstruation] she should be given manhta [thin gruel] prepared with white barley by boiling it with the milk of a white cow having a white calf and mixing it with ghee and honey in a silver or bronze vessel to drink every morning and evening continuously for one week. In t k morning she should take food preparation made of sali rice or barley along with curd, honey, ghee or milk" (Sharma and Dash, Caraka SatphiZd, p. 466f).

39 Sharma and Dash, Caraka Sumhit#, p. 394.

MELITTA WEISSAMER

40 Sharma and Dash, Caraka Samhitd, p. 471-73. 41 Sharma and Dash, Caraka Samhitd, p. 476. 42 Cf. Sharma and Dash, Caraka Samhita, p. 396. 43 Manfred Ullmann, DieMedizin im Islam (Leiden and Cologne: E. J. Brill, 1970), p. 103. 44 Ullmann, Medizin im Islam, p. 104f.; as to the classification of the Hindu works,

see K. R. Srikanta Murthy, trans., SWgadhar-Samhitd ( A Treatise on iiyurveda) by Sdrngadhara (Varanasi and Delhi: Chaukhambha Orientalia, 1984), p. 1.

45 Ullmann, Medizin im Islam, p. 122. 46 Weisser, Zeugung, Vererbung und prdnatale Entwicklung, p. 16. 47 Wolfram Schmitt, "Theorie der Gesundheit und 'Regimen sanitatis' im Mittelalter"

(Habilitationsschrift Heidelberg 1973). 48 See Garrison, His toy of Medicine, p. 120; the edition used is Muhammad Rhazes, Liber

ad Almansorem (Venice: Bonetus Locatellus for Octavianus Scotus, 1497), fol. 2ra-60vb, and the pregnancy-regimen is on fol. 21rb.

49 Perhaps the latinized form of the Arabic word for citta? 50 See Garrison, Histo y of Medicine, p. 120; I use the pregnancy-regimen of the Liber pan-

tegni in Cod. M. p. med. f. 3, Universitatsbibliothek Wtirzburg, fol. 74va-vb (late thirteenth century).

51 As to the structure of the Regimen sanitatis in the Liber pantegni, see Schmitt, "Theorie der Gesundheit," p. 88-95.

52 The edition used is Avicenna, Liber Canonis (Venice 1507; Hildesheim: O h s , reprint, 1966); the pregnancy-regimens are on fol. 365vb-366rb.

53 A kind of wheat decoction, also mentioned in Ibn Butlan's Tacuinum sanitatis ("sau- ich, id est pultes tritici"), see Franz Unterkircher, ed. and trans., Das Hausbuch der Cer- ruti: Nach der Handschrift der Osterreichischen Nationalbibliothek (Dortmund: Harenberg Kommunikation, 1979), p. 84.

54 "Et sint in secundis mensis earum passe [sic] et cydonia dulcia et pira et excitanta ap- petitum et mala mum [sic] et granata muza [sic]" (Avicenna, Liber Canonis, fol. 366ra); a French rendition of this Avicenna-passage lists "poires, et puns de gemate, et puns aigres" (see Louis Landouzy and Roger Pepin, eds., Aldebrant [MaBre Aldebrandin de Siennel. Le Rtgime du Corps [Paris: Librairie Ancienne Honore Champion, 1911; Geneva: Slatkine, reprint, 19781, p. 72).

55 It appears as diamargariton in Thornas de Cantimpre, cf. Christ. Ferckel, Die Gyniikolo- gie des Thomas von Brabant (Munich: C. Kuhn, 1912), p. 21,32; according to Ferckel (p. 74) it was used "als Emmenagogum und zur Stlrkung der Gebarenden resp. WBcherin. Plat[earius] empfiehlt Perlen mit Rosenzucker geg. Schwachezusttinde; den starkenden Einfluss schreibt er der constringierenden Wirkung der Perlen zu."

56 According to John F. Benton, only the Practica secundum Trotam is genuine Trota (see his "Trotula, Women's Problems, and the Professionalization of Medicine in the I Middle Ages," Bulletin of the History of Medicine, 59 [1985]: 30-53). The edition used is Trotvla, "De Mulierum Passionibus, ante, in, & post partum, cum reliquis partim item inseruientibus Liber experimentalis mirificus," in Experimentarivs medicinz (Ar- gent: Ioannis Schottus, 1544), p. 437; the pregnancy-regimen is on p. 13. Since the real author/compiler of the regimen is unknown, I will refer to him/her as Trotula.

57 Blumenfeld-Kosinski, Caesarean Birth, p. 31-34; the edition used is Lilium medicinae a Bernardo Gordonio Professore olim rnontispessulano Ordinatio praeclarissimo (Frankfvrti: Petrvs Uffenbachius, 1617), p. 798-803.

58 Lilium medicinae, p. 802. 59 The edition used is Maynus Mayneriis, Regimen sanitatis (Lyon: Franqois Fradin,

1505), fol. lr-71r; the pregnancy-regimen is on fol. 23-v. 60 Landouzy and Pepin, Rtgime du Corps, p. 71-73. 61 "Capitulum primum primi libri, in quo determinabitur de consewatione sanitatis a

die conceptionis usque ad ultimum vite senij" of Saliceto's Svmma is edited in Wol- fram Schmitt, "Bartholomaus Scherrenmiillers Gesundheitsregimen (1493) fur Graf Eberhard im Bart" (diss. Heidelberg 1970), p. 105-46.


62 Schmitt, "Theorie des Gesundheit," p. 26. 63 Schmitt, "Scherrenmullers Gesundheitsregimen," p. 106. 64 Chapter 19 ("De muliere qui est gravida") in James Follan, Das Anneibuch Ortolfs von

Baierland nach der iiltesten Handschrift (14. fit) Stadtarchiv K6ln W4'24' (Stuttgart: Wissenschaftliche Verlagsgesellschaft m.b.H., 1963), p. 88f. Documents revealed that Ortolf von Baierland lived in Wiirzburg before 1339 (see Giinter Kallinich and Karin Figala, " 'Ortolf von Baierland': Ein Beweis seiner Existenz," Sudhoffs Archiv, 51 [1967]: 184-87).

65 In England especially, Dominican friars acted as translators of Latin medical literature (see Faye Marie Getz, "Charity, Translation, and the Language of Medical Leam- ing in Medieval England," Bulletin of the History of Medicine, 64 [1990]: 1-17).

66 Heinz H. Menge, Das "Regimen" Heinrich Laufenbergs: Textologische Untersuchung und Edition (GBppingen: Kurnmerle, 1976), p. 361-70.

67 Melitta Weiss-Amer, "Dietetics of Pregnancy: A Fifteenth-Century Perspective," Fifleenth-Century Studies, 19 (1992): 301-18.

68 Menge, "Regimen" Heinrich Laufenbergs, p. 366f. 69 Menge, "Regimen" Heinrich Laufenbergs, p. 368. 70 Menge, "Regimen" Heinrich Laufenbergs, p. 370. 71 Menge, "Regimen" Heinrich Laufenbergs, p. 368f. 72 Michele Savonarola, Ad mulieresferrarienses de regimine pregnantium et noviter natorum

usque ad septennium, edited by Luigi Belloni (Milan: Societa Italiana di Ostetricia e Ginecologia, 1952), p. 65-87.

73 Savonarola, Ad mulieres ferrarienses, p. 88-100. 74 At least 23 editions of the Laufenberg-regimen appeared between 1508 and 1700 in

German and Dutch (see Menge, "Regimen" Heinrich Laufenbergs, p. 10f.).