The first cosmetic treatise of history. A female point of view

Synopsis

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

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

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 name	Scientific name	11th century (Trotula)	21st century
1	Absinthe [6]	Artemisia absinthium	Bad breath – cheilitis	Insect repellent
2	Agaric [7, 8]	Amanita muscaria	Lip ointment (oedema)	Hallucinogen property
3	Agrimony [9]	Agrimonia sp.	Hair dye (blond)	Free radical scavenger
4	Alkanet [10]	Alkanna sp.	Skin depilation/hair dye	Radical scavenging activity
5	Aloe [11, 12]	Aloe sp.	Sensitive skin emollient	Topical anti-inflammatory
6	Avens	Geum sp.	Anti-fistula	Intestinal astringent
7	Barley	Hordeum vulgare	Face cream	Nutrient creams
8	Barley bread	H. vulgare	Hair loss treatments	Hair loss shampoos
9	Barley chaff	H. vulgare	Shampoo	Hair mask
10	Barley straw	H. vulgare	Shampoo	Hair mask
11	Bean	Phaseolus sp.	Skin detergent	Oily skin detergent
12	Birthwort	Aristolochia sp.	Cheilitis	Lenitive creams
13	Bistort [13]	Polygonum bistorta	Skin care oinment	Anti-ageing mask
14	Black henbane	Hyoscyamus sp.	Hair dye (black)	Hallucinogen property
15	Boxwood	Buxus sp.	Hair dye (blond)	Hair dye (blond)
16	Bran	–	Facial skin care	Skin care
17	Brazilwood	Caesalpinia sp.	Lipstick	Dyestuff
18	Broom [14]	Cytisus sp.	Scabies	Anti-oxidant activity
19	Bryony (white)	Bryonia alba	Post-scabies	Homeopathic analgesic
20	Bryony (red) [15]	B. dioica	Severe scabies	Anti-inflammatory activity
21	Burnt grapevine ash	Vinis vinifera	Hair dye (blond)	Vegetable hair dye
22	Cabbage [16]	Andira inermis	Hair care	Hair care pack – photoageing
23	Camphor	Cinnamonum camphora	Sunburn	Sunscreen
24	Centaury [17]	Erythraea centaurium	Cheilitis	Anti-ulcer agent
25	Cinnamon	Cinnamomum zeylanicum	Depilatory	Depilatory
26	Clove	Eugenia caryophyllata	Depilatory	Depilatory
27	Colocynth	Citrullus colocynthis	Capelli folti eneri	Drastic hydragogue cathartic
28	Colophony [18]	Conifers	Wax depilation	Wax depilation
29	Common flax	Linum usitatissimum L.	Hair mask	Hair mask
30	Crocus	Crocus sp.	Hair dye (blond)	Tanning generator
31	Cuckoo pint [19]	Arum sp.	Ointment	Anti-staphylococcus activity
32	Cucumber	Cucumis sp.	Depilation	Depilation gel
33	Cumin [20]	Cuminum sp.	Post-scabies ointment	Mosquito repellent
34	Date	Phoenix dactylifera	Tooth whitening	Toothpaste ingredient
35	Dragontree	Daemonorops draco	Hair dye (gold)	Ink
36	Dwarf elderberry	Sambucus sp.	Hair dye (blond)	Hair brightness
37	Eglantine	Rosa sp.	Anti-ageing	Anti-ageing
38	Elecampane	Inula sp.	Post-scabies ointment	Anti-septic
39	Elm	Ulmus sp.	Hair reinforcement	Sebo regulator agent
40	Fennel	Foeniculum sp.	Dental care	Toothpaste
41	Figwort	Scophularia sp.	Lip swelling reduction	Lipstick
42	Frankincense	Boswellia thurifera	Skin care	Striae distensae
43	Galangal	Alpinia sp.	Hair restructurant powder	Hair restructurant spray
44	Galbanum	Ferula galbaniflua	Anti-ageing ointment	Anti-ageing mask
45	Garden lovage	Levisticum sp.	Skin lightening	Skin lightening creams
46	Garden vetch	Vicia sativa	Anitiageing	Anti-ageing
47	Ginger	Zingiber sp.	Skin lightening	Skin lightening creams
48	Greater celandine [21]	Chelidonium sp.	Hair dye (gold)	Exfoliant mask
49	Gum arabic	Acacia senegal	Skin care	Cosmetic emulsifier
50	High mallow	Malva sp.	Dry skin ointment	Dry body lotion
51	Houseleek	Sempervivum sp.	Burns	Skin injuries
52	Ivy gum	Hedera helix L.	Definitive depilation	Anti-cellulitis
53	Laurel [22]	Laurus nobilis L.	Hair loss treatment	Dandruff shampoo
54	Lily [23]	Lilium sp.	After skin care	Filler-like effect
55	Liquorice [24–26]	Glycyrrhiza glabra L.	Lenitive shampoo	Lenitive shampoo
56	Madder	Rubia tinctorum L.	Hair dye (blond)	Lightning shampoo
57	Marrow	Cucurbita sp.	Bad breath	Toothpaste
58	Marshmallow	Althaea sp.	Lightning skin	Lightner milk
59	Mastic	Pistacia lentiscus L.	Revirgination	Anti-ageing
60	Meadowsweet	Spiraea sp.	Anti-fistula	Mild keratolytic
61	Moss	Bryophytes	Hair combing	Nourishing hair balsam
62	Mullein [27]	Verbascum sp.	Cheilitis	Lipstick
63	Mustard	Brassica sp.	Skin lightening	Anti-ageing
64	Myrtle berry	Myrtus sp.	Hair dye	Eyeliner
65	Nutmeg	Myristica fragrans	Lightner plaster	Lightner serum
66	Oak apple	Andricus californicus	Revirgination	Astringent
67	Oat [28]	Avena sativa	Hair dye (blond)	Children skin emollient
68	Olive oil	Olea europaea	Curly hair	Hair protection factor
69	Onion [29–31]	Allium cepa	Acne post-partum	Exfoliant peeling – scars
70	Parsley	Petroselinum	Teeth whitening	Toothpaste
71	Patience dock	Rumex patientia	Removing face’s worms	Oily skin cleanser
72	Pepper	Piper nigrum L.	Bad breath	Mouthwash
73	Pitch	Sarracenia purpurea L.	Exfoliant	Homeopathic skin care
74	Plantain	Plantago sp.	Revirgination	Insect bites
75	Pomegranate	Punica granatum L.	Revirgination	Astringent
76	Populeon	Populus sp.	Burns	Topical anti-inflammatory
77	Red squill	Urginea maritima	Acne post-partum	Anti-redness skin care
78	Reed	Arundo donax	Hair care	Topical anti-inflammatory
79	Rose	Rosaceae sp.	Skin and lip care	Skin and lip care
80	Saffron	Crocus sp.	Hair dye (gold)	Hair dye (gold)
81	Sage	Salvia sp.	Hair dye (black)	Hair dye (black)
82	Saxifrage	Saxifraga sp.	Cheilitis	Hyperseborrhea
83	Southernwood	Artemisia sp.	Damaged hair treatments	Dry hair pack
84	Sowbread	Cyclamen sp.	Cheilitis	Lipstick
85	Starch	–	Weekly worm removing	Anti-wrinkle properties
86	Sweet almond	Amygadalus sp.	Depilatory ointment	Demulcent – nutrient
87	Tragacanth	Astragalus	Skin care ointment	Sensitive skin care
88	Verbena [32, 33]	Verbena sp.	Hair protection	Hair care products
89	Vinegar [34]	Vitis vinifera	Hair scabies	Scalp psoriasis
90	Violet	Viola sp.	Burn plaster	Cold-damaged skin
91	Violet oil	Viola sp.	Anti-ageing	Anti-ageing
92	Walnut (cupule)	Juglans sp.	Skin care	Tanning generator
93	Watercress	Nasturtium sp.	Anti-ageing	Anti-ageing
94	White lupine [35]	Lupinus sp.	Hair scabies	Seborrheic eczema
95	Willow [36–39]	Salix sp.	Hair strengthening	Keratolytic hair care
96	Wine [40, 42]	Vitis vinifera	Hair strengthening	Hair strengthening

Table II.   Animal derivates

No.	Common name	11th century (Trotula)	21st century
1	Ant egg	Definitive depilation	–
2	Bear fat	Sunburn	–
3	Bee	Hair whitening	–
4	Beef marrow	Hair strengthening	–
5	Butter	Depilation eccipent	–
6	Child urine	Face abscesses	Urinotherapy?
7	Cow marrow	Skin depigmentation	–
8	Cuttlefish bone	Skin whitener	Skin whitener
9	Deer fat	Damaged skin treatments	–
10	Egg white	Skin whitening plaster	–
11	Egg yolk	Hair strengthening	–
12	Goat fat	Acne post-partum	–
13	Goat milk	Hair strengthening	–
14	Goose egg	Whitening skin	–
15	Green lizard	Hair strengthening	–
16	Hen fat	Skin whitening plaster	–
17	Ivory	Hair strengthening	–
18	Milk	Facial skin care	Facial skin care
19	Pigeon droppings	Skin whitener	–
20	Pork fat	Sunburn	–

Table III.   Mineral derivates

No.	Common name	Scientific name	11th century (Trotula)	21st century
1	Alum	Aluminium potassium sulphate	Make-up – revirgination	Skin care products
2	Armenian bole	Bolus armenus	Teeth care	Toothpaste
3	Crystal	Quartz	Damaged skin treatments	Microdermoabrasion
4	Haematite	Iron(iii) oxide	Revirgination	Eye make-up
5	Litharge	Lead oxide	Severe facial scabies	Acne
6	Meerschaum	Magnesium silicate	Congiuntivitis	Anti-ageing
7	Mercury	Mercury	Severe facial scabies	–
8	Natron	Hydrated sodium carbonate	Drying agent	Drying agent
9	Orpiment	Arsenic sulphide	Definitive depilation	–
10	Pumice	–	Teeth whitening	Skin exfoliant
11	Quicklime	Calcium oxide	Skin depigmentation	Cosmetic
12	Soda	Sodium carbonate	Teeth and skin whitening	Teeth and skin whitening
13	Sulphur	Sulphur	Bad breath	Oily skin
14	Tartar	Tartaric acid	Acne	Acne
15	Tincal	Sodium borate	Skin care ointment	Striae distensae
16	White lead	Lead carbonate	Sunburn	Anti-ageing
17	White marble	Calcium carbonate	Teeth whitening	Toothpaste

Table IV.   Miscellaneous

No.	Common name	Scientific name	11th century (Trotula)	21st century
1	Breadcrumbs	–	Hydratant treatment	–
2	French ink		Per scurire i capelli
3	Honey bee	–	Hair dye (gold)	Mild shampoo
4	Red cloth	–	Bad breath	–
5	Varnish	Turpentine	Exfoliant agent	Exfoliant agent
6	Wax		Nutrient ointment	Nutrient cream

Table V.   Beauty care habits of salernitan noble women (11th century)

Hair	Shampoo	Liquorice
	Dye (black, blond and gold)	Dragontree
	Increase length	Ivory
	Make curly/soft	Olive oil
	Perfume	Musk
	Improve growth	Agrimony
Skin	Cleaning	Rosewater
	Bath for softening	Bath
	Depilate	Orpiment
	Cleanse	Walnut
	Whiten	Eggs in vinegar
	Redden the face	Red and white bryony
	Protect from sunburn	Pork fat
Mouth	Soften lips	Honey bee
	Whiten teeth	Soda
	Redden lips	Mastic
	Against cheilitis	Rose essential oil
	Against bad breath	Marrow

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 ad–c. 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

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