A Space of Convergence:

Hildegard of Bingen’s Multivalent Understanding of the Body

Brianna M. Marron

In this way human beings carry everything because the entire creation is within them.1

In Causes and Cures, Hildegard characterized the human being as a container within

which all of creation was held together. All of the elements that humans carried within the

physical body was a reflection of Hildegard’s own intellectual and spiritual context. Causes and

Cures is a textual space where Hildegard’s monastic spirituality and scientific knowledge

intersect. These two epistemological categories were not markedly distinct but rather existed in a

more fluid state than is sometimes understood by scholars.2 The continuity of monastic

spirituality and scientific interpretations of the natural world are apparent in Hildegard’s medical

writings and particularly manifest in her conceptualization of the human body. Several places in

Causes and Cures are indicative of Hildegard’s monastic background. While the effect of

monasticism on Hildegard’s writing is discernible, she gave equal weight to scientific

explanations. Hildegard participated in the burgeoning scientific culture of the twelfth century;

the new Latin translations of ancient texts were being rediscovered and studied. In this article, I

argue that even though Hildegard placed Causes and Cures within the context of the ancient

medical tradition, she presents an innovative theory of the body as a space of convergence of

natural philosophy and spirituality.

1Hildegard of Bingen, Causes and Cures, trans. Margret Berger, from On Natural Philosophy and Medicine:
Selections from Cause et Cure (Cambridge: D.S. Brewer, 1999), 36.
2 Caroline Walker Bynum explains the artificial nature of the monastic/scholastic distinction in The Resurrection of
the Body in Western Christianity, 200-1336 (New York: Columbia University Press, 1995), 157.

1
 I. Hildegard’s Interpretations of the Medical Body

Hildegard’s medical thought evinces her active participation in the scientific culture of

the twelfth century. Due to the proliferation of ancient texts on medicine and natural philosophy

in Latin translations, a more methodical view of the natural world began to coexist alongside

religious interpretations.3 Disibodenberg was no exception to the growing adoption of scientific

interpretations; in fact, it was within the religious environment of monasteries that scientific

scholarship really took hold. Hildegard was among the inheritors of newly available ancient texts

and, despite her claim to ignorance, was knowledgeable of their contents.4 In many places in

Causes and Cures, Hildegard reiterates accepted medical theories and methods of practice.

Hildegard adopted the humoral theory of ancient medicine as a key concept in her

medical thought. In Causes and Cures, Hildegard presents a multilayered interpretation of the

body’s significant fluids. According to Hildegard, the humors were the traditional four fluids of

blood, phlegm, bile, and melancholia which corresponded to the four qualities of hot and cold,

wet and dry, in addition to the essence or “juice” of anything, especially the medicinal juice of

plants.5 Hildegard defined the qualities of the humors as dry, wet, tepid, and foamy.6 Hildegard

3Nancy G. Siraisi, Medieval and Early Renaissance Medicine: An Introduction to Knowledge and Practice
(Chicago: The University of Chicago Press, 1990), 7-9.
4 Although it cannot be definitively known to which manuscripts Hildegard had access, it is known that
Disibodenberg had a substantial library which participated in the loaning of books between neighboring monasteries
including St. Jacob’s in Mainz, Eberbach, St. Eucharius in Trier, and Gandersheim. Peter Dronke has noted striking
similarities in language use between Hildegard’s writing and that of St. Benedict’s Rule, Augustine’ On the Psalms,
Ambrosius Autpertus’ Conflict of Virtues and Vices and several others. The medical writing to which Hildegard had
access is, however, difficult to pin down. See Victoria Sweet, Rooted in the Earth, Rooted in the Sky (New York:
Routledge, 2006), 22-23.
5For a discussion of humoral theory in Hippocratic and Galenic thought see Vivian Nutton, Ancient Medicine, 2nd
ed. (London: Routledge, 2013), 81-86, 246-7; For a discussion of Hildegard’s addition of “essence” and “juice” of
plants to the tradition four humors see Victoria Sweet, Rooted in the Earth, Rooted in the Sky (New York: Routledge,
2006), 93.
6 Victoria Sweet, Rooted in the Earth, Rooted in the Sky (New York: Routledge, 2006), 99.

2
accepted the ancient theory that the cause of disease emerged from the wrong proportion of

humors.7 For example, Hildegard wrote:

But the humors that come out of the heart, liver, lung, stomach and other organs, if
sometimes they turn into a wrongful difference or superfluity, then they become sticky,
slippery, and tepid, and if they stay inside, will cause illness.8

Hildegard made it clear that a wrong balance of humors from any organ will cause disease if no

therapy was pursued to correct the proportion. Treatment was centered on amending the wrong

proportion to restore a proper balance. Thus, Hildegard’s understanding of the humors represents

a synthesis of ancient humoral theory where the “humors were bodily fluids, a cosmological

system where the humors were the carriers of the four qualities, and a horticultural system,

where the humors were the essences of plants.”9

In the beginning of Book Two, Hildegard explains the significance of the four humors for

bodily health:

But humans could only have been made from the four humors- not from one or two or
even three- so that each may temper one another, just as the universe is made of the
four elements in harmony with one another. 10

Hildegard understood the balance of the four humors as essential for health. In addition,

Hildegard’s understanding of the humors is related to her cosmology in which the elements that

comprise the universe are reflected in the microcosm of the human body. It was through the

humors that the environment affected the body; those environmental factors included food and

7 David C. Lindberg, The Beginnings of Western Science (Chicago: The University of Chicago Press, 1992), 332-3.
8Hildegard of Bingen quoted in Victoria Sweet Rooted in the Earth, Rooted in the Sky (New York: Routledge,
2006), 102.
9 Victoria Sweet, Rooted in the Earth, Rooted in the Sky (New York: Routledge, 2006), 93.
10Hildegard of Bingen quoted in Victoria Sweet, Rooted in the Earth, Rooted in the Sky (New York: Routledge,
2006), 94.

3
drink, rest and exercise, waking and sleeping, sex, emotions, and climate. 11 The proper balance

of environmental elements insured health.

The last book of Causes and Cures further evinces Hildegard’s use of ancient medical

thought in her discussions of prognosis. Before treatment, the employment of proper prognostic

techniques are essential for effective therapy. Hildegard explains many prognostic tools that can

inform a diagnosis and treatment. For example, she wrote:

When a person is healthy and has moderately red cheeks, then it is a sign of life, since
the red color can be seen just under the skin like in an apple. For the red color under the
skin is there because the fiery breath of life is the anima, which so shows in the cheeks
because it sits securely in the body and will not leave soon. But if, when a person is
healthy his cheeks are so red that no skin can be seen under the redness, then he will die,
because the redness cannot be seen like the red of an apple; this redness shows that the
anima is about ready to leave.12

Hildegard valued the significance of examining a patient’s facial coloring to determine either

health or illness. Passages pertaining to a patients’s face and eye color are numerous in Book

Five and thus represent the value Hildegard placed on its efficacy for diagnosis and treatment. In

medieval theories of disease it was commonly believed that each person had a characteristic

complexion or temperament which was determined by the humors.13 In addition to using facial

color as a means of evaluation a persons health, Hildegard viewed the examination of urine as

another determinate of illness: “Whatever someone drinks, whether wine, beer, mead, or water,

his urine will show his health or illness.”14 Urine had been an essential component of prognostic

11
According to Galen, a patient’s whole lifestyle had to be altered to ensure recovery. See Vivian Nutton, Ancient
Medicine, 2nd ed. (London: Routledge, 2013), 246.
12Hildegard of Bingen quoted in Victoria Sweet, Rooted in the Earth, Rooted in the Sky (New York: Routledge,
2006), 129.
13 David C. Lindberg, The Beginnings of Western Science (Chicago: The University of Chicago Press, 1992), 332.
14Hildegard of Bingen quoted in Victoria Sweet, Rooted in the Earth, Rooted in the Sky (New York: Routledge,
2006), 129.

4
techniques since antiquity; she believed that urine could reveal the state of the liver.15 Ancient

medical writers and practitioners, such as Galen, examined urine for color, consistency, odor, and

clarity.16

Hildegard clearly utilized ancient medical theories and prognostic techniques. Hildegard

also emphasized the significance of taking a patient’s pulse. She explains,

When a human lies in bed sick, whatever the infirmity may be, and if the pulse in the
blood vessel of his right arm is regular and balanced, like a person who regularly and
evenly draws breath and expels it, then he will live and not die. For no matter how great
the infirmity from the ardent fevers caused by the humors may be, the soul still maintains
its regular way of breathing because it is not about to leave the body. For that reason the
pulse in the blood vessel is regular and balanced because the soul does not move the
vessel by way of leaving...Furthermore, the pulse of the blood vessel in the right arm
deserves special consideration because the signs indicating life and death are particularly
noticeable in the right arm, as the greatest power is in the right, and the right is always
active. In the left there is a numbness, so to speak, and the left is not active. In the bend of
the right arm and the bend of the right leg, that is to say under the knee, the pulse of
the blood vessel can be accurately observed because it is there that the strength of the
soul exists.17

Hildegard notes that pulse is a key indicator in whether a patient will live or die. She also makes

a connection here between pulse and the soul, anima. Pulse was so important that it determined

whether a patient’s soul would remain or leave the body. The prognostic technique of taking a

patient’s pulse developed from antiquity through the high Middle Ages.18 Because pulse could

indicate death, it was an essential tool for prognosis and diagnosis. In Causes and Cures,

15Galen was known for his careful analysis of physical changes in the body including urine, “noting any unusual
colors, turbulence or clouds in it, since they offered significant information on the weakness or failure of organs
deep in the body.” See Vivian Nutton, Ancient Medicine ( New York: Routledge, 2013), 243.
16 Ibid.
17Hildegard of Bingen, Causes and Cures, trans. Margret Berger from On Natural Philosophy and Medicine
(Cambridge: D.S. Brewer, 1999), 120.
18David C. Lindberg, The Beginnings of Western Science (Chicago: The University of Chicago Press, 1992), 337;
Vivian Nutton, Ancient Medicine, 2nd ed. (London: Routledge, 2013), 244.

5
Hildegard demonstrates a methodical and scientific approach to prognosis. She does add her own

interpretation and characteristic idiosyncrasies, however, she also placed great value on ancient

theories of prognosis.

Finally, Hildegard’s method of treatment is another area in which we can ascertain her

referencing of ancient medical thought. Again, Book Five of Causes and Cures is the main place

where Hildegard lays out therapeutic intervention techniques. Hildegard employed a variety of

therapies to restore a patient’s health. Causes and Cures deals first with the regimen of health,

that is, diet, exercise, and sleep. The regimen was first described in the Hippocratic writings.19

Examining and altering a patient’s regimen of diet and exercise was a common therapy in

antiquity.20 Hildegard considered the regimen of health to be pertinent to restoring a balance

among the four humors and qualities. She addressed digestion, excretion, hunger, thirst, sleep,

exercise, and what foods to eat during each of the seasons. 21 Hildegard’s treatment for adjusting

a patient’s regimen, or diet, was relative to their particular affliction. Examining a patient’s

regimen was essential for identifying her complexion, diagnosis, and necessary treatment. 22

Following a scrutiny of a patient’s regimen, Hildegard accounted for the need for bloodletting

every third month.23 The practice of regular bloodletting was a common treatment in antiquity

and the Middle Ages. Hildegard describes the practice like this:

19 Lindberg, 116.
20 Ibid.; Galen and Hippocrates utilized this method of therapy extensively in their respective practices.
21Hildegard of Bingen, Causes and Cures, trans. Margret Berger from On Natural Philosophy and Medicine
(Cambridge: D.S. Brewer, 1999), 85-88.
22 David C. Lindberg, The Beginnings of Western Science (Chicago: The University of Chicago Press, 1992), 333.
23 Hildegard of Bingen, Causes and Cures, trans. Margret Berger from On Natural Philosophy and Medicine
(Cambridge: D.S. Brewer, 1999), 88; Galen was a strong advocate of letting blood from the vein as a regular part of
treatment. See Vivian Nutton, Ancient Medicine, 2nd ed. (London: Routledge, 2013), 246.

6
 When a person’s blood vessels are full of blood they must be purged, by incision, of
noxious livor and digestive humor. When a blood vessel is incised the blood is shaken up
as by a sudden shock. What comes out first is blood. At the same time putrid and
digestive sanguineous matter flows out. Consequently, what flows out now has various
colors because it consists of waste matter and blood. As soon as waste matter together
with blood has been discharged, pure blood will come out. At that point the bloodletting
has to stop.24

Bloodletting was prescribed to restore the patient’s balance of humors and qualities. The

elimination of excess bodily fluids through bloodletting was viewed as an effective treatment to

correct an imbalance and maintain health. 25 Hildegard identifies the right time to bleed,

bloodletting for women, scarification, and cautery. The effectiveness of bloodletting depended on

a keen knowledge of human anatomy. According to Hildegard,

You must know that more humors flow in the cephalic vein than in the median or the
hepatic vein...If someone has a lot of flegma in his head and in his chest or if somebody
has a throbbing headache so that his hearing is considerably affected by it, one should
withdraw blood from the cephalic vein.26

Hildegard clearly had intimate knowledge of anatomy gleaned from reading ancient medical

texts. Her handle on anatomical terms added to the accuracy of Causes and Cures as a whole,

especially in the sections that deal with treatment.

Medicinal remedies comprise the majority of Hildegard’s discussion on treatment. In fact,

drug therapy was the most common treatment used in the Middle Ages. 27 A practitioner would

have been knowledgeable of the therapeutic properties of plants, minerals, and animal

24Hildegard of Bingen, Causes and Cures, trans. Margret Berger from On Natural Philosophy and Medicine
(Cambridge: D.S. Brewer, 1999), 88.
25 David C. Lindberg, The Beginnings of Western Science (Chicago: The University of Chicago Press, 1992), 333.
26Hildegard of Bingen, Causes and Cures, trans. Margret Berger from On Natural Philosophy and Medicine
(Cambridge: D.S. Brewer, 1999), 90.
27 Lindberg, 333.

7
products.28 Hildegard’s medical repertoire utilized this knowledge. She provided instructions and

recipes for many different illnesses. For madness, she said,

If someone’s brain is chilled so that he turns mad, take laurel berries and pulverize
them. Then take wheat flour, combine it with the laurel powder and mix it with
blessed-thistle water. After the patient’s head has been shaved, spread this deich [paste]
over his entire head and hold it in place with a felt cap until the inside of the head is
warmed and the patient falls asleep.29

Hildegard used medicinal remedies, extracted from local plants, and instructed a patient to apply

them directly to the location of the disease. Thus madness was localized to the brain and treated

with a therapeutic head dressing. This particular example concerning madness raises many

questions about Hildegard’s perception of mental illness. What is clear from the placement of

this passage in Causes and Cures is that Hildegard viewed madness as a physical aliment; she

does not differentiate madness from other maladies of the head such as headache or migraine.

Here is another example of the fluid nature of her medical thought. The seamlessness with which

she describes mental, physical, and spiritual illness is telling of her integrated, comprehensive

conceptualization of the body.

On hearing loss, Hildegard stated, “If a person’s hearing is disturbed through a flegma or

some other infirmity, take a small amount of white incense and produce with it a vapor over live

coals, and let this vapor ascend into the plugged ear.”30 Again, Hildegard identifies an illness, in

this case hearing loss, with a disturbance of the humors and fashions her treatment to restore a

proper humoral balance through direct treatment to the ear.

28 Lindberg, 333.
29Hildegard of Bingen, Causes and Cures, trans. Margret Berger from On Natural Philosophy and Medicine
(Cambridge: D.S. Brewer, 1999), 106.
30 Ibid, 109.

8
 Hildegard’s discussion of female illness does not not contain any ideological slant, rather,

she explains the physiological causes of various disorders relating to the female reproductive

system and prescribes treatment. On female infertility, she writes:

A woman whose uterus is too cold within and too weak to conceive offspring can, if God
wills, be aided to be fertile in the following way: take the uterus of either a lamb or a cow
that is sexually mature but still pure...Cook it with lard, other fatty meat and fat, and give
that to the woman to eat when she has or will very soon have intercourse with her
husband...The juice from the uterus of the animals mentioned above is combined with the
juice from that woman’s uterus such that it becomes somewhat fattened and strengthened
from it and, if God wills, conceives much more easily.31

Hildegard prescribes a special diet for a woman who has difficulty conceiving that involves

eating the uterus of an animal that has not reached sexual maturity. Her treatment is designed to

take place right before intercourse to better ensure the conception of a child. 32 Again, on illnesses

associated with the female body, Hildegard has a special treatment for women who suffer from a

heavy menstrual flow: “...soak a linen cloth in cold water and frequently put compresses on the

upper part of her thighs so that she becomes cooled inside...She should also cook ebech [celery]

in water and place it warm around thighs and navel.”33 Hildegard makes a correlation between

menstrual flow and warmness thus she instructs that the woman use a cold linen on her thigh and

navel to alter the temperature of the uterus.

In several places in Causes and Cures, Hildegard moves beyond ancient theories of

health and disease and offers her unique spiritual and medical interpretation of the causes of

31Hildegard of Bingen, Causes and Cures, trans. Margret Berger from On Natural Philosophy and Medicine
(Cambridge: D.S. Brewer, 1999), 111.
32The monastery at Rupertsberg provided an apt location to treat laypeople who sought medical care. Thus,
Hildegard would have prescribed this kind of remedy to be used at the patient’s home just before engaging in
intercourse.
33Hildegard of Bingen, Causes and Cures, trans. Margret Berger from On Natural Philosophy and Medicine
(Cambridge: D.S. Brewer, 1999), 113.

9
disease and recommendations for treatment. In Book Four, Hildegard prescribes a physical and

spiritual treatment for someone suffering from apparitions:

A person who is stricken with a diabolical apparition- be it day or night, be he waking or

sleeping- should take a belt of helun [elkhide] and a belt made of deerskin. Fasten them
together with four small steel pins...When attaching the pin that will be on the stomach,
say: “By the absolute power of the almighty God, I invoke you for my protection.”
When putting in the pin that will be on the back, say: “By the absolute power of the
almighty God, I consecrate you for my protection...” The person should be girded with
this belt at all times, day and night. And the diabolical apparitions will shun him and
magical words will hurt him less.34

This example displays Hildegard’s method of medical treatment and her ultimate dependence on

God for healing. Hildegard inserted this treatment for apparitions between remedies for clouding

of the eyes and forgetfulness. The intentional insertion of contra fantasiam is significant because,

as Margret Berger has posited, Hildegard most likely copied the majority of her treatments from

ancient medical texts.35 Hildegard’s inclusion of a treatment for apparitions indicates her

departure from accepted ancient medical theory. Her discussion of apparitions reveals that she

did not separate the physical from the spiritual. The value she placed on both forms of healing

was so equitable that she wove together the physical method of treatment with spiritual,

prayerful invocations. Hildegard’s treatment for apparitions poignantly demonstrates the

convergence of spirituality and natural philosophy.

The treatments Hildegard prescribes in Causes and Cures indicate her engagement with

ancient medical thought. She copied and interpreted ancient medical texts to accommodate her

concept of medicine and the body. Hildegard’s interpretations make use of both spirituality and

natural philosophy. The above section suggests, through a handful of pertinent examples, that

34Hildegard of Bingen, Causes and Cures, trans. Margret Berger from On Natural Philosophy and Medicine
(Cambridge: D.S. Brewer, 1999), 115.
35 Margret Berger, On Natural Philosophy and Medicine (Cambridge: D.S. Brewer, 1999), 152.

10
Hildegard placed Causes and Cures within the context of ancient medical literature in her

application of humoral theory, prognostic techniques, and treatment.

II. The Medieval Body

The practice of medicine in the Middle Ages provides a frame through which to view

somatic experience and embodiment of cultural, sexual, and religious values. In Hildegard’s

visionary and natural-philosophical writings she placed human beings at the center of the

universe.36 The body was a space on which cultural and religious beliefs were etched. The body

played an active role in shaping medieval culture which was ultimately connected to concepts of

health and disease. Caroline Walker Bynum has argued that medieval perceptions of the body

were not consistent with a Cartesian-like dualism of body and soul.37 Rather there existed a

continuity, a fluid concept of the self as a psychosomatic unity.The idea of person was

conceptualized as an integral entity in which physicality was bound to sensation, emotion,

reasoning, and identity. As Bynum writes, “person was not person without the body, and body

was the carrier of the expression of what we today call individuality.”38 The body was a carrier of

cultural and religious expression. Hildegard’s medical writings are evidence of not only the value

of the body but also the significance of the body for cultural expression.

The body as space is a particularly rich lens through which to view perceptions of the

medieval body. The work of linguists George Lakoff and Mark Johnson, Metaphors We Live By,

36I am referring to Hildegard’s Scivias, trans. Bruce Hozeski (Santa Fe: NM: Bear & Company, 1986) and Causes
and Cures, trans. Margret Berger from On Natural Philosophy and Medicine (Cambridge: D.S. Brewer, 1999).
37Caroline Walker Bynum, The Resurrection of the Body in Western Christianity, 200-1336 (New York: Columbia
University Press, 1995), 11; What follows is a summary of Bynum’s discussion of medieval conceptualization of the
body.
38 Ibid., 11.

11
provides a fruitful schema for analysis.39 Thoughts about the body influence and are influenced

by conceptions of space.40 As Lakoff and Johnson describe:

We are physical beings, bounded and set off from the rest of the world by the surface of
our skins, and we experience the rest of the world as outside us. Each of us is a container,
with a bounding surface and an in-out orientation. We project our own in-out orientation
onto other physical objects that are bounded by surfaces. Thus we view them as
containers with an inside and an outside. Rooms and houses are obvious containers.
Moving from room to room is moving from one container to another, that is, moving out
of one room and into another.41

The body is a container which is set off from the world by the surface of the skin but also

permeable because it contains the features of the world. This container acts as a physical locus

into which culture is imprinted on the body. Physicality, space, and culture an inherently linked.

The body as container is a recurring theme in Hildegard’s Causes and Cures and also in Scivias.

The schema of space is highly resonant for the medical body. The body in a state of

health or disease reflects cultural perceptions. Biological change manifested in the medical body

often indicates the ways in which societies respond to disease and infirmity.42 Beyond biology,

“how physical afflictions are conceptualized, what means are employed to address them, who is

designated the healer- all these are elements of culture.”43 Elements of culture heavily influence

perceptions of the healthy and diseased body. Culture permeates the body which is like a

container of social historical experience. The somatic existence of people living in the Middle

39 George Lakoff and Mark Johnson, Metaphors We Live By (Chicago: University of Chicago Press, 1980).
40Patricia A. Baker, Han Nijdam, and Karine van’t Land, eds., Medicine and Space: Body, Surroundings and
Borders in Antiquity and the Middle Ages (Leiden: Brill, 2012), 8.
41 Quoted in Patricia A. Baker, Han Nijdam, and Karine van’t Land, eds., Medicine and Space (Leiden: Brill, 2012),
9.
42Monica H. Green, Women’s Healthcare in the Medieval West: Texts and Contexts (Aldershot: Ashgate Publishing
Limited, 2000), viii.
43 Ibid., viii.

12
Ages is a significant avenue to pursue historical research concerning medieval perceptions of the

body and culture. Exploring the history of the body should take into account not only biological

factors but, more importantly, how medieval society mediated between the biological and the

social.44

The rich scholarship of the history of the body has identified the body as not only a

container but also the location of the self. 45 As noted by Bynum, the self was located in the

physical body as exhibited by sensation, emotion, reasoning, and identity.46 These ideological

manifestations of the body’s physicality tell us how culture was embodied. The relationship

between the body and culture holds meaning for the nature of somaticism and embodiment of

social values. The body is a complex structure whose various parts and functions act as a source

of symbols for other complex structures: “the social structure is reproduced in small on the

human body.”47 The projection of culture onto and into the body, a container of societal

characteristics, is applicable to Hildegard’s own perception of the healthy and diseased body.

IV. The Body in Causes and Cures

The body that emerges from Causes and Cures is a complex system that indicates the

interconnectedness of natural philosophy and spirituality. The body in Hildegard’s medical

writing was a container which was filled to the brim with the imprint of God. As we saw in

44Monica H. Green, Women’s Healthcare in the Medieval West: Texts and Contexts (Aldershot: Ashgate Publishing
Limited, 2000), ix.
45Patricia A. Baker, Han Nijdam, and Karine van’t Land, eds., Medicine and Space (Leiden: Brill, 2012); Jacques
Le Goff and Nicolas Truong, Une Histoire du Corps au Moyen Âge (Paris: Liana Levi, 2003); Sarah Kay and Miri
Rubin, eds., Framing Medieval Bodies (Manchester: Manchester University Press, 1994).
46
Caroline Walker Bynum, The Resurrection of the Body in Western Christianity, 200-1336 (New York: Columbia
University Press, 1995), 11.
47Mary Douglas quoted in Patricia A. Baker, Han Nijdam, and Karine van’t Land, eds., Medicine and Space
(Leiden: Brill, 2012), 5.

13
Chapter Two, Causes and Cures was affected by Hildegard’s religious vocation and monastic

environment. In the above sections, we have seen how Hildegard’s knowledge of ancient medical

literature shaped her own medical thought. Hildegard’s spiritual and intellectual formation was

complex as was the historical landscape in which she lived. All of these factors converge on the

physical space of the body in Causes and Cures. The body was the centerpiece of Hildegard’s

spirituality and medical writing. At the center of the universe and the pinnacle of creation the

human body stood; the body was the locus of medical theory and practice. Thus, the body

emerges from Hildegard’s writing as a focal point and as a template for her spiritual and medical

thought.

Central to Hildegard’s medical thought concerning the human body was the notion of

microcosm and macrocosm. She viewed the human body as a microcosm of God’s macrocosmic

Creation. The body was, then, a small scale copy of the macrocosmic universe. Hildegard writes,

“O human, look at the human being! For human beings hold together within themselves heaven

and earth and other things created, and are one form; and within them everything is concealed.”48

According to Hildegard, within every human being, all of creation was contained: heaven, earth,

and other divinely-ordained things. As stated at the beginning of this chapter, Hildegard wrote,

“In this way human beings carry everything because the entire creation is within them.”49 The

body was a space, a container that held together all of creation within it.

Hildegard explains that at the beginning of creation, God had already planned to become

human. God’s parenthood of the universe was like a wheel: “The rim of the wheel is fatherhood,

48Hildegard of Bingen, Causes and Cures, trans. Margret Berger from On Natural Philosophy and Medicine
(Cambridge: D.S. Brewer, 1999), 24.
49 Ibid., 36.

14
the fullness of the wheel is divinity. Everything is within it and stems from it, and there is no

creator beyond.”50 Again, this idea of space is revisited in that the outer edge of the wheel is God

and contained within the wheel was the fulness of divinity in the physical manifestation of

human beings. God created a “corporeal mass” from the breath of life and clay of the earth in

order for human beings to intensely praise and lift themselves to God.51 God also created the

firmament and the elements and “they are within the human, and the human concerns himself

with them.”52 Hence, it is clear from Book One of Causes and Cures that Hildegard viewed the

body as a container in which all of divine creation was poured.

The body that emerges from Causes and Cures is connected to the universe through the

permeable surface of the skin. A discussion of Hildegard’s cosmology is necessary in order to

understand how Hildegard perceived the permeability of the body. Hildegard’s unique

cosmology significantly affected her medical thought. She explains that all of the elements were

contained within the body:

As has been said above, the elements- namely fire, air, earth, and water- are in the human
being. They operate in him with their forces, and in all the human’s undertakings they
circle around fast, like a turning wheel. Fire, with its aforementioned five forces, is in the
human’s brain and marrow because, when the first human was transformed from clay,
fire, with a reddish glow was burning in his blood through God’s might...Air, with its four
forces, as mentioned above, is in the human’s breath and rationality. It attends to the
human being with its living breath which is in the soul, in that the soul carries the human
and is the wing of his flight when he draws air and expels it so that he can live. And the
soul is the fire that perfuses the entire body and vivifies the human being...Water with its
fifteen forces, which were named above, is in moisture and in the human’s blood. 53

50Hildegard of Bingen, Causes and Cures, trans. Margret Berger from On Natural Philosophy and Medicine
(Cambridge: D.S. Brewer, 1999), 36.
51 Ibid.
52 Ibid., 25.
53 Ibid., 35.

15
Hildegard envisioned that each of the elements contributed to one or more anatomical functions

of the human body. The elements of the universe were integrally bound to the body and essential

for health. The external elements influence the internal workings of the body. Although the skin

may function as a boundary between the body and the natural world, borders are unclear and

permeable as well. The best place to see the permeable boundaries of the body is in Hildegard’s

discussion of winds.

The winds play a crucial role in Hildegard’s understanding of the body. Her metaphorical

use of winds implied not only the external winds but also the winds that move inside the body.

The internal winds brought about physiological qualities:

Sometimes in an idle person, a hot wind arises which fills the chest, and makes that
person happy. From the chest it ascends to the brain and fills the head and all the veins
with heat; then it goes to the lungs and heart, and thence to the umbilicus in a woman and
the loins in a man.54

According to Hildegard, wind circulated in the veins to the major organs. This internal

circulating wind caused physiologic change resulting in everything from laughter to erection.

Hildegard understood the affect of the winds as highly influential on the body’s functions. She

explains quite clearly that the winds affected the internal body: “All the winds, whether naturally

or by God’s disposition, penetrate man’s body, so that by their breaths he is either strengthened

or made destitute.”55 Through the permeable pores of the skin wind could enter the body and

alter someone’s internal state. This alteration was made possible because of the connection

between the winds and the humors: “The different qualities of the winds and of the air go

54Hildegard of Bingen quoted in Victoria Sweet, Rooted in the Earth, Rooted in the Sky (New York: Routledge,
2006), 87.
55 Ibid., 90.

16
together, and they change the humors in the body, which take up the qualities of the winds.”56

The body takes up and contains the qualities of the winds. The process of physiological change

due to the influence of internal winds occurs through the anima: “This makes man somewhat

mutable in his humors; for when he takes on this changed air, and his soul [anima] transmits it to

the interior of his body, his humors are changed, and often induce sickness or health in him.”57

The anima is the medium through which the internal state of the body is changed. The humors

are influenced by the winds which then cause either disease or health. In sum, the body that

emerges from the text of Causes and Cures was permeable. It was affected by the external winds

of season and weather. The winds entered the body through its pores and openings and

influenced the internal circulating winds. Wind “was the tie that bound the unseen; it invisibly

connected the macrocosm and microcosm, the fabric of outside and inside.”58 Wind was a central

part of Hildegard’s conception of physiology. Her physiological configuration of external and

internal winds provides a unity of “God’s disposition” and the natural world.

Another significant area in which we can see Hildegard’s understanding of the body is in

her description of the physiological differences between the sexes. Her discussions of women, in

particular, are indicative of a symmetrical relationship between her spiritual and medical thought.

Hildegard devoted many sections of Causes and Cures to explanations of menstruation and

conception. She discusses Eve as a paradigm of women’s sexuality. On Eve, the origin of

conception, Hildegard wrote: “The first mother of humankind was created similar to ether. For as

ether contains all the stars so she, pure and uncorrupted, carried humankind within herself when

56Hildegard of Bingen quoted in Victoria Sweet, Rooted in the Earth, Rooted in the Sky (New York: Routledge,
2006), 90.
57 Ibid., 91; What follows is a summary of Sweet’s discussion of the winds.
58 Ibid.

17
she was told: ‘Be fruitful and multiply’ [Gen. 1:28].”59 Eve contained all of humankind within

herself. Following in suit, women too carry humankind, albeit not all of humankind, within their

bodies. Through the act of intercourse a woman draws the man’s semen in and encases it in her

womb. We can see the female body as a container of not only a child but also of the fluids of

men and the act of conception itself. After the man’s ejaculation the woman’s menstrual blood

“intermingles with semen, makes it sanguineous and turns it into flesh.”60 It is within her womb

that flesh is formed from blood and semen, “this same blood draws a vessel around it, like a little

worm preparing its dwelling out of itself.”61 Hildegard compares a woman’s womb to a vessel

inside which a child is formed. Of course, a child could not be conceived without the exchange

of proper love between the man and woman nor without God’s will. Hildegard also explains that

it was God’s will that women bear and labor children in pain thereby also justifying some of

women’s particular anatomical features that result in, namely, menstruation. Hildegard’s

discussion of women’s physiology is bound by her understanding of menstruation and

conception as anatomical and theological realities.

In addition, Hildegard assigned physical and spiritual qualities in her conceptions of the

soul, anima. Hildegard assigns to the soul an interesting nature in which she pulls it down

towards the physical but also elevates it towards God. She explains that human beings exists as,

created from the four elements, two of which are spiritual and two carnal. Namely, fire
and air are spiritual, water and earth carnal...Indeed, God made humans from the clay of
the earth so that, with the breath of the soul, they consist of aqueous, fiery and airy earth.
And so the soul moves humans through the four elements, because the figure formed
from earth is constituted with the help of God’s finger and is mixed by water, moved by

59Hildegard of Bingen quoted in Victoria Sweet, Rooted in the Earth, Rooted in the Sky (New York: Routledge,
2006), 81.
60 Ibid.
61 Ibid., 82.

18
 air and cooked by fire...The soul holds longing. Longing, however, holds will. The soul is
like fire, the body like water, and they exist together. So the human being is God’s
handiwork.62

Hildegard places the soul in both the carnal and spiritual categories. In fact, the soul is the agent

that binds the body together with the other elements, both physical and spiritual. The soul moves

the body from the earthly elements toward God. Because human beings were God’s handiwork

the soul acts as an impetus for the praise of God, however, the soul remains a part of the physical

body. The movement of the soul from physicality to spirituality is described by Hildegard in the

form of a metaphor:

When humans build a house, they give it a door, windows and a chimney so that they
can to go in and out through the door to receive the necessaries and get light through the
windows and so that, when a fire is lit, the smoke can leave through the chimney so that,
thanks to the chimney, the house will not be damaged. Thus the soul too sits in the heart
as in a house and lets thoughts in and out as through a door and looks at them as through
windows... If humans had no thoughts they would have no knowledge, and they would be
like a house that has no door, no windows and no chimney.63

The soul is like a well built house in which cognition flows in and out. The heart acts as a

structure that contains the soul yet allows thoughts to venture in and out: out toward God and in

toward the body. The heart is like a container but is not impermeable; it has windows and a

chimney that grant, or rather insist, that cognitive processes enter and exit. The heart and indeed

the whole body would be damaged and diseased if the free movement of the soul were not

exercised. In fact, all of Hildegard’s explanations of bodily processes can be imagined through

this metaphor of the house. Her prescriptions for treatment center around restoring a proper

balance of humors which includes adding and subtracting fluids from the body. Health was

62Hildegard of Bingen, Causes and Cures, trans. Margret Berger from On Natural Philosophy and Medicine
(Cambridge: D.S. Brewer, 1999), 47-8.
63 Ibid., 74.

19
dependent on the in-and-out orientation of the body’s physiology. Hildegard imagined the soul to

be housed within the body’s container and allowed to move freely between its physical locus and

its spiritual origins.

The body manifested in Causes and Cures displays Hildegard’s understanding of the

human body as a reproduction of creation. Hildegard’s concept of medicine posits an anatomy in

which blood vessels are akin to stars, the abdomen to all creatures, the head to the firmament,

and the heart to the earth; all of which reflect God’s plan for the corporeal mass. The body was a

container into which physiological, cultural, and theological characteristics were channelled. All

of these factors were ordained by God and reflected God’s influence in the world and on the

human body. Everything was held within the body, according to Hildegard-- the space into which

there existed a convergence of natural philosophy and spirituality.

Hildegard of Bingen’s Causes and Cures reveals a culture in a liminal state before the

rise of universities and distinct academic disciplines where the mutual borrowing between

medical thought and Christian spirituality was the norm. Hildegard’s medical writing reflects that

liminality and presents the body as a contextual space that contained within it the entire universe.

For Hildegard, the body was a vessel, a container, layered with the concepts of natural

philosophy and spirituality. Hildegard saw human beings as crafted in such a way that they

mirrored and contained all of creation and God’s own image. In this way, the medical body and

the spiritual body were seamlessly bound together in an integrated, psychosomatic whole.

Hildegard’s understanding of the body was an intricate system of microcosm and macrocosm,

boundaries and entry, causes and cures.

20