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Keywords:

  • Hippocratica Civitas;
  • medical school of Salerno;
  • medieval cosmetics;
  • Schola Medica Salernitana;
  • Trotula de Ruggiero

Synopsis

  1. Top of page
  2. SynopsisRésumé
  3. Introduction
  4. Results and discussion
  5. Acknowledgement
  6. References

The Schola Medica Salernitana was an early medieval medical school in the south Italian city of Salerno and the most important native source of medical knowledge in Europe at the time. The school achieved its splendour between the 10th and 13th centuries, during the final decades of Longobard kingdom. In the school, women were involved as both teachers and students for medical learning. Among these women, there was Trotula de Ruggiero (11th century), a teacher whose main interest was to alleviate suffering of women. She was the author of many medical works, the most notable being De Passionibus Mulierum Curandarum (about women’s diseases), also known as Trotula Major. Another important work she wrote was De Ornatu Mulierum (about women’s cosmetics), also known as Trotula Minor, in which she teaches women to conserve and improve their beauty and treat skin diseases through a series of precepts, advices and natural remedies. She gives lessons about make-up, suggests the way to be unwrinkled, remove puffiness from face and eyes, remove unwanted hair from the body, lighten the skin, hide blemishes and freckles, wash teeth and take away bad breath, dying hair, wax, treat lips and gums chaps.

Résumé

‘La ‘‘Schola Medica Salernitana”était une des premières école de médecine dans la ville de Salerne, au sud de l'ltalie et la plus importante source des connaissances médicales en Europe au Moyen Age. L’école atteint sa splendeur entre le 10ème et le 13ème siècle, pendant les dernières décennies du royaume des Longobardes. Dans l’école, les femmes étaient impliqués à la fois comme des enseignants et des élèves. Parmi ces femmes, il y avait Trotula de Ruggiero (11 ème siècle), une enseignante qui avait comme intérêt principale de soulager la souffrance des femmes. Elle était l'auteur de nombreux volumes médicaux, entre lequels les plus remarquables étaient De Passionibus Mulierum Curandarum (sur les maladies des femmes), aussi connu sous le nom de Trotula Major. Un autre important livre du même auteur était De Ornatu Mulierum (sur la cosmétiques des femmes), aussi connu comme Trotula Minor, dans lequel elle enseigne à les femmes à conserver et à améliorer leur beauté et à traiter les maladies de la peau grâce à une séries des préceptes, conseils et remèdes naturels. Elle donnait des loçons sur le maquillage, suggéraient la façon pour n’être pas froissé, pour l'elimination de la boursouflure, du visage et des yeux, et des poils indésirables du corps; decrivaient la methode pour eclairer la peau, pour dissimuler les imperfections et les lentilles, pour nettoyer les dents et enlever le mauvaise haleine, pour la coloration des cheveux pour s'occuper des lèvres et des gencives.’


Introduction

  1. Top of page
  2. SynopsisRésumé
  3. Introduction
  4. Results and discussion
  5. Acknowledgement
  6. References

A legend tells that the foundation of the medical school of Salerno starts with the occasional encounter among four masters: the Jewish Helinus, the Greek Pontus, the Arab Adela and the Latin Salernus.

Indeed, the School kept the Greek–Latin cultural tradition going, merging it harmoniously with the Arab and Jewish culture. The meeting of different cultures led to a medical learning arising from the synthesis and the comparison of different experiences [1].

Because of geographical and other favourable conditions, many of these cultural contributions synergized to form the Medical School at Salerno around 900 ad.

In the 11th century through the impulse given by Alfano I (died in 1085), Archbishop of Salerno and Constantine the African, Salerno won the title of ‘Town of Hippocrates’ (Hippocratica Civitas or Hippocratica Urbs). People from all over the world flocked to the ‘Schola Salerni’, both the sick, in the hope of recovering, and the student, to learn the art of medicine. Its fame crossed borders, as proved by the Salernitan manuscripts kept in many European libraries, and by historical witnesses.

Interestingly here we had, on a hillock on the seaboard of the town, the most ancient European botanical garden, The Gardens of Minerva, from which it was possible to plant every kind of herb able to treat most of the illnesses known at that time.

Somewhat unusual was that female physicians played a part in the advances that came from this school [2, 3]. Among the contributions associated with the school of Salerno were textbooks of anatomy, insistence on certification and training for physicians, application of investigative thinking and deduction that led to important advances such as the use of healing by secondary intention, the first textbook about aesthetics medicine, and the first recorded female medical school faculty member named Trotula de Ruggiero. The woman physician of Salerno contributed to a textbook that gained wide acceptance and distribution throughout Europe [4, 5]. The treatise, called De Passionibus Mulierium Curandarum (about women’s deseases), was first published c. 1100 ad and was a prominent text until a significant revision by Ambrose Paré’s assistant in the early 1600s. Paré was the pre-eminent anatomist of his time, and many of his important anatomic and surgical considerations were directly and indirectly derived from the work of the woman of Salerno. Unlike many other works of the period, her cures rarely include prayers, incantations, astrology or other forms of blatant superstition. She was married to a doctor named John Platearius. They had two sons, Matteo and John, who also became distinguished doctors. During her life, Trotula was referred to as Magistra Mulier Sapiens (The wise woman teacher) and afterwards her works were largely widespread: scholars assessed that more than 100 manuscript versions were widespread over Western Europe which is a demonstration that they were habitually used in the local medical schools. Her reputation was very good in the middle ages, as much as her name was quoted also in ‘The Canterbury Tales’ by Geoffrey Chaucer! (1388–1400).

In the first mid-19th century, it was even minted a very valuable bronze medal in her honour. Trotula’s other book, De Ornatu Mulierum (about women’s cosmetics), was commonly known as Trotula Minor.

This last work is passed in a collection of several manuscripts attributed to the women physicians of Salerno, and it is a treatise that teaches women to conserve and improve their beauty and treat skin diseases through a series of precepts, advices and natural remedies.

During the exposition, the authors often quote the mulieres salernitanae to be taken as an authoritative model. She gives lessons about make-up, suggests the way to be unwrinkled, remove puffiness of face and eyes, remove unwanted hair from the body, lighten the skin, hide blemishes and freckles, wash teeth and take away bad breath, dying hairs, wax, treat lips and gums chaps. Therefore, she provided indications to formulate and use ointment and medicative herbs for the face and the hair and she dispensed advices about improving health through vapour baths and massages. This was not a giddy aspect in her texts: on the contrary, according to what Trotula women’s beauty has to do with philosophy of the nature, her medical art was inspired to: beauty is the sign of a healthy body and harmony with the universe.

Results and discussion

  1. Top of page
  2. SynopsisRésumé
  3. Introduction
  4. Results and discussion
  5. Acknowledgement
  6. References

In our present study, we want to analyse several aspects of the treatise from a scientific point of view underlining the therapeutic effectiveness of several interesting ingredients and formulas as mentioned in the text.

In this work, 96 plants and derivates are reported (Table I), 20 animal preparations and derivates (Table II), 17 minerals (Table III) and six mixed preparations (Table IV) as ingredients for 63 formulas that permit to obtain so much preparations for beauty and/or medicinal aims. Many of this ingredients mentioned here are not safe for a modern use (agaric, blackenbane and mercury). Beauty care habits of mulieres salernitanae are reported too (Table V).

Table I.   Officinal plants and their derivates
No.Common nameScientific name11th century (Trotula)21st century
 1Absinthe [6]Artemisia absinthium Bad breath – cheilitisInsect repellent
 2Agaric [7, 8]Amanita muscariaLip ointment (oedema)Hallucinogen property
 3Agrimony [9]Agrimonia sp.Hair dye (blond)Free radical scavenger
 4Alkanet [10]Alkanna sp.Skin depilation/hair dyeRadical scavenging activity
 5Aloe [11, 12]Aloe sp.Sensitive skin emollientTopical anti-inflammatory
 6AvensGeum sp.Anti-fistulaIntestinal astringent
 7BarleyHordeum vulgareFace creamNutrient creams
 8Barley breadH. vulgareHair loss treatmentsHair loss shampoos
 9Barley chaffH. vulgareShampooHair mask
10Barley strawH. vulgareShampooHair mask
11BeanPhaseolus sp.Skin detergentOily skin detergent
12BirthwortAristolochia sp.CheilitisLenitive creams
13Bistort [13]Polygonum bistortaSkin care oinmentAnti-ageing mask
14Black henbaneHyoscyamus sp.Hair dye (black)Hallucinogen property
15BoxwoodBuxus sp.Hair dye (blond)Hair dye (blond)
16BranFacial skin careSkin care
17BrazilwoodCaesalpinia sp.LipstickDyestuff
18Broom [14]Cytisus sp.ScabiesAnti-oxidant activity
19Bryony (white)Bryonia albaPost-scabiesHomeopathic analgesic
20Bryony (red) [15]B. dioicaSevere scabiesAnti-inflammatory activity
21Burnt grapevine ashVinis viniferaHair dye (blond)Vegetable hair dye
22Cabbage [16]Andira inermisHair careHair care pack – photoageing
23CamphorCinnamonum camphoraSunburnSunscreen
24Centaury [17]Erythraea centauriumCheilitisAnti-ulcer agent
25CinnamonCinnamomum zeylanicumDepilatoryDepilatory
26CloveEugenia caryophyllataDepilatoryDepilatory
27ColocynthCitrullus colocynthisCapelli folti eneriDrastic hydragogue cathartic
28Colophony [18]ConifersWax depilationWax depilation
29Common flaxLinum usitatissimum L.Hair maskHair mask
30CrocusCrocus sp.Hair dye (blond)Tanning generator
31Cuckoo pint [19]Arum sp.OintmentAnti-staphylococcus activity
32CucumberCucumis sp.DepilationDepilation gel
33Cumin [20]Cuminum sp.Post-scabies ointmentMosquito repellent
34DatePhoenix dactyliferaTooth whiteningToothpaste ingredient
35DragontreeDaemonorops dracoHair dye (gold)Ink
36Dwarf elderberrySambucus sp.Hair dye (blond)Hair brightness
37EglantineRosa sp.Anti-ageingAnti-ageing
38ElecampaneInula sp.Post-scabies ointmentAnti-septic
39ElmUlmus sp.Hair reinforcementSebo regulator agent
40FennelFoeniculum sp.Dental careToothpaste
41FigwortScophularia sp.Lip swelling reductionLipstick
42FrankincenseBoswellia thuriferaSkin careStriae distensae
43GalangalAlpinia sp.Hair restructurant powderHair restructurant spray
44GalbanumFerula galbanifluaAnti-ageing ointmentAnti-ageing mask
45Garden lovageLevisticum sp.Skin lighteningSkin lightening creams
46Garden vetchVicia sativaAnitiageingAnti-ageing
47GingerZingiber sp.Skin lighteningSkin lightening creams
48Greater celandine [21]Chelidonium sp.Hair dye (gold)Exfoliant mask
49Gum arabicAcacia senegalSkin careCosmetic emulsifier
50High mallowMalva sp.Dry skin ointmentDry body lotion
51HouseleekSempervivum sp.BurnsSkin injuries
52Ivy gumHedera helix L.Definitive depilationAnti-cellulitis
53Laurel [22]Laurus nobilis L.Hair loss treatmentDandruff shampoo
54Lily [23]Lilium sp.After skin careFiller-like effect
55Liquorice [24–26]Glycyrrhiza glabra L.Lenitive shampooLenitive shampoo
56MadderRubia tinctorum L.Hair dye (blond)Lightning shampoo
57MarrowCucurbita sp.Bad breathToothpaste
58MarshmallowAlthaea sp.Lightning skinLightner milk
59MasticPistacia lentiscus L.RevirginationAnti-ageing
60MeadowsweetSpiraea sp.Anti-fistulaMild keratolytic
61MossBryophytesHair combingNourishing hair balsam
62Mullein [27]Verbascum sp.CheilitisLipstick
63MustardBrassica sp.Skin lighteningAnti-ageing
64Myrtle berryMyrtus sp.Hair dyeEyeliner
65NutmegMyristica fragransLightner plasterLightner serum
66Oak appleAndricus californicusRevirginationAstringent
67Oat [28]Avena sativaHair dye (blond)Children skin emollient
68Olive oilOlea europaeaCurly hairHair protection factor
69Onion [29–31]Allium cepaAcne post-partumExfoliant peeling – scars
70ParsleyPetroselinumTeeth whiteningToothpaste
71Patience dockRumex patientiaRemoving face’s wormsOily skin cleanser
72PepperPiper nigrum L.Bad breathMouthwash
73PitchSarracenia purpurea L.ExfoliantHomeopathic skin care
74PlantainPlantago sp.RevirginationInsect bites
75PomegranatePunica granatum L.RevirginationAstringent
76PopuleonPopulus sp.BurnsTopical anti-inflammatory
77Red squillUrginea maritimaAcne post-partumAnti-redness skin care
78ReedArundo donaxHair careTopical anti-inflammatory
79RoseRosaceae sp.Skin and lip careSkin and lip care
80SaffronCrocus sp.Hair dye (gold)Hair dye (gold)
81SageSalvia sp.Hair dye (black)Hair dye (black)
82SaxifrageSaxifraga sp.CheilitisHyperseborrhea
83SouthernwoodArtemisia sp.Damaged hair treatmentsDry hair pack
84SowbreadCyclamen sp.CheilitisLipstick
85StarchWeekly worm removingAnti-wrinkle properties
86Sweet almondAmygadalus sp.Depilatory ointmentDemulcent – nutrient
87TragacanthAstragalusSkin care ointmentSensitive skin care
88Verbena [32, 33]Verbena sp.Hair protectionHair care products
89Vinegar [34]Vitis viniferaHair scabiesScalp psoriasis
90VioletViola sp.Burn plasterCold-damaged skin
91Violet oilViola sp.Anti-ageingAnti-ageing
92Walnut (cupule)Juglans sp.Skin careTanning generator
93WatercressNasturtium sp.Anti-ageingAnti-ageing
94White lupine [35]Lupinus sp.Hair scabiesSeborrheic eczema
95Willow [36–39]Salix sp.Hair strengtheningKeratolytic hair care
96Wine [40, 42]Vitis viniferaHair strengtheningHair strengthening
Table II.   Animal derivates
No.Common name11th century (Trotula)21st century
 1Ant eggDefinitive depilation
 2Bear fatSunburn
 3BeeHair whitening
 4Beef marrowHair strengthening
 5ButterDepilation eccipent
 6Child urineFace abscessesUrinotherapy?
 7Cow marrowSkin depigmentation
 8Cuttlefish boneSkin whitenerSkin whitener
 9Deer fatDamaged skin treatments
10Egg whiteSkin whitening plaster
11Egg yolkHair strengthening
12Goat fatAcne post-partum
13Goat milkHair strengthening
14Goose eggWhitening skin
15Green lizardHair strengthening
16Hen fatSkin whitening plaster
17IvoryHair strengthening
18MilkFacial skin careFacial skin care
19Pigeon droppingsSkin whitener
20Pork fatSunburn
Table III.   Mineral derivates
No.Common nameScientific name11th century (Trotula)21st century
 1AlumAluminium potassium sulphateMake-up – revirginationSkin care products
 2Armenian boleBolus armenusTeeth careToothpaste
 3CrystalQuartzDamaged skin treatmentsMicrodermoabrasion
 4HaematiteIron(iii) oxideRevirginationEye make-up
 5LithargeLead oxideSevere facial scabiesAcne
 6MeerschaumMagnesium silicateCongiuntivitisAnti-ageing
 7MercuryMercurySevere facial scabies
 8NatronHydrated sodium carbonateDrying agentDrying agent
 9OrpimentArsenic sulphideDefinitive depilation
10PumiceTeeth whiteningSkin exfoliant
11QuicklimeCalcium oxideSkin depigmentationCosmetic
12SodaSodium carbonateTeeth and skin whiteningTeeth and skin whitening
13SulphurSulphurBad breathOily skin
14TartarTartaric acidAcneAcne
15TincalSodium borateSkin care ointmentStriae distensae
16White leadLead carbonateSunburnAnti-ageing
17White marbleCalcium carbonateTeeth whiteningToothpaste
Table IV.   Miscellaneous
No.Common nameScientific name11th century (Trotula)21st century
1BreadcrumbsHydratant treatment
2French ink Per scurire i capelli 
3Honey beeHair dye (gold)Mild shampoo
4Red clothBad breath
5VarnishTurpentineExfoliant agentExfoliant agent
6Wax Nutrient ointmentNutrient cream
Table V.   Beauty care habits of salernitan noble women (11th century)
HairShampooLiquorice
Dye (black, blond and gold)Dragontree
Increase lengthIvory
Make curly/softOlive oil
PerfumeMusk
Improve growthAgrimony
SkinCleaningRosewater
Bath for softeningBath
DepilateOrpiment
CleanseWalnut
WhitenEggs in vinegar
Redden the faceRed and white bryony
Protect from sunburnPork fat
MouthSoften lipsHoney bee
Whiten teethSoda
Redden lipsMastic
Against cheilitisRose essential oil
Against bad breathMarrow

This is the earliest aesthetic textbook carried out by a woman physician for other women and applicants. We know that Ovide, Publius Ovidius Naso, a Roman poet (43 bc–17 ad) wrote a treatise about cosmetology, Medicamina faciei foeminarum, also known as ‘The Art of Beauty’, (100 lines surviving. Published c. 5 bc), but, so as described, he was just a poet and his target was just poetry and not teaching or popularize science. Pliny the Elder wrote Naturalis Historia, Pedanius Dioscorides (c. 40 adc. 90 ad), an ancient Greek physician, pharmacologist and botanist who practised in Rome at the times of Nero, wrote Materia Medica and Hildegard von Bingen (1098–1179), a German artist, author, counsellor, dramatist, linguist, naturalist, philosopher, physician, poet, political consultant, prophet, visionary and a composer of music, wrote Physica, but the cosmetic subject was not ever the main one, but just mentioned together with several other ones, such as medicine, natural sciences, philosophy and theology, and above all, they were not written with the aim of teaching and popularize cosmetology to the women. The many cosmetic formulas under the name of Trotula attest to the existence of an important medieval cosmetic. The second half of the treatise includes chapters that contain cosmetic recipes and specifies ingredients and quantities, procedures for preparation, manner of application and the results to be expected. Here, for example, we report a Trotula’s formula that explains how to emphasize the colour of cheeks: ‘take root of red and white bryony, clean it, and chop it finely and dry it. Afterward, powder it and mix it with rose water, and with cotton or a very fine linen cloth, we anoint the face and it will induce redness. For the woman having a naturally white complexion, we make a red colour if she lacks redness, so that with a kind of fake or cloaked whiteness a red colour will appear as if it was natural’. To obtain blonde hair, Trotula proposed a dye gotten with bark of elder, flowers of broom, saffron and yolk of egg; or an ointment with bees burned in a pot and mixed with oil and milk of goat. To lengthen hair and dye them of black, she recommended a gotten ointment making to boil in oil the head and the tail of a green lizard. For the make-up of face and lips, a mixture of honey, cucumber and rose water was boiled up to consume its half. The make-up was put on the lips rubbing the bark of roots of walnut-tree and passing them above an artificial colour gotten by white of egg and parsley, finally dust of alum. To light the face, Trotula recommended a wax ointment and oil.

Most of these officinal plants and also the other ones used by the School members for their experimental preparation were at the beginning just spontaneous in the area, and then, in the 14th century, they used the first botanical garden of history, the Garden of Minerva, carried out by the Salernitan physician, Matteo Silvatico. We know from historical sources that in this garden about 300 species of plants were cultivated to prepare medication known in those days. Some of them were imported by other country just for the aims of the School. Some of them are of Middle-East origin. Others are of American origin, thus confirming that the Trotula’s paper has been rewritten in more recent periods, with the addition of more recent remedies (the manuscript we considered is dated XIII and was found in Madrid) [4]. Another explanation is the misinterpretation of some plant name. In fact, it is difficult to understand if the common name used in those days and reported in the treatise identifies the same plant known nowadays under that name.

The medieval cosmetics were very greasier (ointments) than the actual ones, because they were prepared with animal fats. This allowed the active principle to stay for a lot of time to contact with the skin. The modern cosmetics are manufactured in watery emulsions instead (cream, milk and serum) to offer to the woman a best compliance.

Nevertheless, most of plant derivates reported are still used in modern cosmetics. On the other hand, it is difficult to identify all the skin diseases, because of the different nomenclature of the time and to the use of medieval Latin language. In medieval times, scabies was the name given to many skin diseases including eczema, psoriasis, acne and smallpox. Good results obtained on the scalp with vinegar, let to think for a seborrheric eczema or a psoriasis rather than the described severe scabies. So, it is also difficult to evaluate the supposed efficacy of remedies.

All the itchy pathologies of the face (acne, eczema, psoriasis, tinea and impetigo) were attributed to the presence of sub-dermal worms and they were generically denominated scabies. Trotula describes in her treatise a primordial facial ‘scrub’. In fact, she advised to use an exfoliant detergent prepared with bread crumb to smooth the skin face. When she mentions the facial sub-dermal worms ‘that sometimes provoke the hair loss’, she probably alludes to the seborrhoea that shows it to the face with acne and to the scalp with androgenetic alopecia. Some of them are clear, such as the use of physical devices for depilation (gum Arabic, mastic from Lentiscus), mercury for infestation and honey as moisturizing. It is interesting that nowadays, in the 21st century, we still use cosmetics based on a lot of active principles just mentioned in the medieval treatise (Tables I and III), while many animal products are not used anymore today (Table II).

Trotula keeps her interest not only in skin disturbances, but also in ocular and oral affections. Bad breath, teeth whitening and affections of the lips are reported. Whitening of teeth can be achieved with mechanical devices such as marble. A kind of ancient peeling is prescribed (probably for acne after pregnancy) by using the irritant effect of onion. Anti-acne effect is, due to its content in alliina and mixtures, similar to the sulphur [43]. Onion also possesses an anti-ageing effect because it contains water (90%), proteins (1.5%) and vitamins, including B1, B2 and C, along with potassium. Polysaccharides along with peptides, flavonoids and essential oil are also present in onion. Prostaglandins also have been identified in onion (anti-inflammatory effect). The help of Trotula to women is also in other fields: the use of astringent agents and red dyes is recommended to be thought a virgin woman.

From a historical point of view, the paper by Trotula is also very important for the study of aesthetic tendencies during high Middle-Age, and also of woman’s social condition. It is very impressive to discover from this text how many aesthetic troubles, nowadays, are the same ones (hair growth, baldness, dying hair, melasma and wrinkles). On the other hand, other conditions, such as cellulitis, are not reported, probably because there was a different model of woman’s beauty. Moreover, most of the people think that the golden standard of female beauty in Middle-Age was the Norman girl with fairy hair and blue eyes: indeed in the work by Trotula are reported methods for the darkening of hair and some Arabian aesthetic methods, thus confirming the importance of Schola Medica Salernitana as the collector of medical tradition of Mediterranean area.

Acknowledgement

  1. Top of page
  2. SynopsisRésumé
  3. Introduction
  4. Results and discussion
  5. Acknowledgement
  6. References

This study was supported by the Associazione Educazione e Ricerca Medica Salernitana, ERMES.

References

  1. Top of page
  2. SynopsisRésumé
  3. Introduction
  4. Results and discussion
  5. Acknowledgement
  6. References