Friday, February 7, 2014

A FOURTEENTH CENTURY DIETETIC: 2. Brother Leonard on diet and health

This is one of several posts exploring a dietetic written in the fourteenth century by a certain “Brother Leonard” at the monastery of St. Jacques in Liège (today in Belgium). In 2007, Geneviève Xhayet published a transcription, with notes and commentary, of this Latin work and these posts reference that transcription. 

The other posts are:
1. What is a dietetic?
Belgian (Walloon/Liègois) food in the fourteenth century
4. Brother Leonard on behavior and attitude

This post explores the work's approach to diet and

Brother Leonard does not limit his advice on health to diet; he touches on everything from mental attitude to exercise, sleep and keeping warm. But certainly the bulk of the document addresses specific foods and their effects on health. This is perfectly standard for a medieval dietetic. What is most striking in this one however is what, with a few exceptions, is not present: humoral theory.

Consider these previously quoted statements from earlier dietetics: “As for lentils... they produce bad and melancholy juices” (Galen); if the food has been well prepared, it... nourishes good humors,”they have black meat and engender melancholic humors” (Anthimus); "Chervil is warm and dry at the second degree" (Aldobrandino).

Terms like “melancholy”, “humors”, “warm”, “dry” are all taken straight from humoral theory, the idea that health results from a balance between bodily humors (bile, blood, and phlegm) and their warm or cold, moist or dry qualities. (Melancholy -  (Gk. melan chole) – literally corresponded to black bile.) This was the dominant medical theory long before Leonard's time and would remain so for centuries after. Typically, it is fundamental to early dietetics.

Leonard only rarely uses such language, as here: “For your supper, fish or fruit or similar moistening things, but do not take anything drying.” or here:The broth of goose giblets... is very hot and dry because of spices.” When he writes that broth is “dry” he is referring to the liquid's humoral character (or more specifically here that of the spices added to it). But such references are exceptional in his text.

Possible sources

The absence of humoral language is all the more striking given his probable models. Xhayet provides an overview of these, first of all in general, for the type of dietetic she describes as being based on "non-natural things": Galen's De sanitate tuenda and De alimentorum facultatibus and Johannitus (Hunain-Ibn-Ishaq)'s Eisagoge. with strong contributions from Arab dietetics, notably Isaac's Liber dietarum universalium and Liber dietarum particularium, the first book of Avicenna's Canon (fen 2, on non-naturals and fen 3 on types of regimen), Ibn Butlan's Tacuinum sanitatis and the Secret of Secrets (Secretum secretorum).

Leonard does not name his own sources – writers of dietetics often do not – but Xhayet refers to (and in 2007 had intended to publish) another of his works, the Medecina, which references several works, include Isaac's Diets, Constantine's Pantegni and Avicenna's Canon. "These works," she writes, "make up a possible substratum" of Leonard's work. Except for Arnaud de Villeneuve's regimen, however, he does not mention any other regimena santitatis. His own work then may reflect other sources.
Could not one see... in it also a reminiscence of the old dietetic calendars established by month, which had appeared since the early Middle Ages and were related to the old monastic medicine? Under the form of short notices, these calendars lay out, month by month, a series of recommendations sometimes on bleedings and baths, sometimes on the consumption of foods and specific drinks, appropriate to the moment.
Certainly there are signs that he is writing more in a monastic than a medical tradition. This might explain his lack of emphasis on humoral theory; writers of dietetic calendars only make passing mention of humors. But nor do they outline the effects of eating the wrong foods. Leonard does so regularly, moving his text closer to a standard medical text.

One indication of how deeply humoral theory permeated medical thought at the time is reflected in the monks' own practice of being bled at regular intervals. “Physicians became blinded by the philosophical dogma of the Hippocratic School, which advocated bleeding as a method of restoring harmony of the humours and hence health.” (Hart) As previously mentioned, Bede's calendar already mentioned bleeding and it remained a standard part of monastic life in the fourteenth century. Regular bleedings and the days right after them form an integral part of Leonard's calendar.

The only bodily fluid Leonard discusses with any frequency is urine. Relative to blood and bile, for instance, urine has one particularity: it leaves the body naturally. This may be one reason it was the subject of a number of medieval treatises. Leonard can be very specific about it: "If you drink beer.., it will constrict your urine and you will urinate little and your urine will be thick and your voice will not be clear, but thick, and the urine's sediment will be globular;" “Your urine from beer after sleep will be red and thick;” “If you do otherwise, you will stay as if strangled, and your urine will be left dark;” “This will appear overnight in the urine which will be thick and appear fatty on its surface and in its depths will be a lot of sediment.”

Attitudes towards foods

Many of Leonard's statements on diet are surprisingly in keeping with modern attitudes, starting with the most general one: “Be measured in dining and drinking.” He objects to salted foods: “If it is fresh, not salted, then you can safely eat it;” “Beware very salty mutton;” “Flee rancid crouzos and salted meat;” “Do not eat garlic or hard or salted cod;” “Abstain from soup which is prepared with salted meat or with the broth of salted meat;” “Do not take salted meat of cattle, pigs and their broth except mutton.” This was not a minor point in a time when salting was one of the main means of preserving foods, especially given that he also has reservations about smoking, the other major method: “Continually abstain from what tastes of salt and is dry and smoky.”

He warns against foods prepared with fat (again not a minor issue when lard was one of the most common flavorings): “Do not eat fatty vegetables [or vegetable stew];” “Never eat long vegetables in winter with frozen stems and prepared with fat. which are the worst for you. Rarely use others prepared with fat or lard, above all in the summer when it is very hot;” “Carefully avoid greens and omelets soaked in a great deal of fat;” “Avoid the broth of fatty meat.”

He offers a related warning against foods cooked in oil: “Nor even take fish fried in oil, because these are the most cloying [“thick”] to you and soaked in much oil, abominable and sticky;” “You will also avoid fish fried in oil because of its viscosity, above all its skin especially if it is drenched in oil.” Some will still find the image of the greasy skin of a fried fish off-putting today.

He warns too against rancid foods, notably butter and eggs. “Rancid butter, and perchance age in selected eggs is easily detected by the odor;” “If however it has a strong smell, eat nothing of it, but at once move it away from you;” “Better to take something fresh than rancid omelets.”

Though many eat meat rare today, it is not unusual still to warn, as does Leonard, against under-cooked meat: "Beware salted meat or red and badly cooked beef or pork with a horrible flavor;" "Also beware of hard or badly cooked or salty mutton," "Never eat half-cooked and red beef or mutton, which cannot be peacefully distributed by your stomach to other members;" “Beware of... above all half-cooked beef and mutton, because the taste is horrible and also your mouth will be dry and arid in the morning;” Not that he approves of over-cooking either: “Do not take refreshment from dry and hard, and badly cooked or burnt, oxen or cow intestines, because they are too tough and indigestible.”

Would a “dry” chicken be more dangerous because older, or just unappetizing? At any rate, this advice too could as well be given today: “Beware also chickens, if they are dry and arid”. (Note that here he uses “dry” in its common, not humoral, sense.)

His various reservations about fish that is not absolutely fresh also still make sense today: “Hard and salt fish such as herring, cod, hard, and salted gem of the sea and smoked haddock as well as old haddock with a black mouth and scallops in the same state, the old also avoid, do not eat them, particularly those that are rancid and yellow nor eat fish fried in oil, nor carp prepared with clear onions, nor loach.” 

He also warns several times against drinking a variety of wines or other drinks: “Avoid a plurality of wines,”, “If you are offered wines of various colors and substances beware of this;” “Flee a variety of drinks, both in color and substance." “good wine of one sort, and not of different colors and seasons.” Anyone who has woken with a hangover from mixing white, red and rosé (never mind bourbon and vodka) would probably still consider this good advice.

It is more surprising, however, to see him warn against ale and beer (that is, in this period, cervoise and, in his rare term, “hoppa”, a fermented grain drink with hops added), two very northern drinks: “Avoid small and strong ale and beer, unless very old or sour. But wine or water and the like, however, take as drink.” Otherwise, note that this fourteenth century reference is yet another confirmation that water was a perfectly standard drink in the Middle Ages and in fact in this case is preferred to beer and its close ancestor.

His suspicion of hard – and so older – cheese and fruit, if more surprising today, was probably not so unique in the time: "Refrain from hard cheese and many fruits;” “Nor take a great deal of cheese or fruit when supping;” “Avoid pears also raw or cooked;” “Never eat any fruit whatsoever, because you [will] feel a bitter taste in the mouth and in the throat and easily have hoarseness in the throat and constriction in the nose, you will have winds and roaring in the belly.”

It is striking that the one cheese he singles out was from a neighboring region (and one known for its dairy products): “Always avoid cheese of Flanders, dry, hard and highly salted, and similar types of cheeses at hand” (Note that in this time it was still fairly rare to identify cheeses by region, even in France, where Brie was one of the few to be so singled out.) Is the curious “at hand” (ad manum) a warning against these precisely because they are so easy to obtain?

It is more striking still that he says to “beware butter and black bread”, a pairing that seems perfectly natural today and was probably not exceptional in the time.

His warning on eating peas with their pods reflects a common-sense concern: “Nor take peas cooked with their pods, because they are not cooked.” (This would have been all the more true of peas in this era, which were white, mature field peas, not the more tender green peas, with more tender pods, most common today.) His warning to “not eat crushed broad beans unless there is vinegar” has at least one antecedent – Anthimus' sixth century warning: “Whole broad beans, well cooked, either in gravy or in oil, with seasoning or salt, are more fit than these beans crushed because they weigh on the stomach.” Strangely though Leonard specifically says to eat them broken up under certain circumstances: “Do not eat beans, peas with bacon, above all very salted or often rancid, rather use them broken up in broth and this will be with non rancid butter.” Neither Galen nor Isaac, for instance, make any such distinction.

Compare too his advice on hard-boiled eggs – “Do not eat .. hard boiled or poached eggs or cooked with shells when they are hard, especially the white, that is hard to digest” – to Anthimus: “For the hard-boiled white is completely indigestible; it causes corruption in the belly, and does not help but rather causes harm. Beware then of all egg whites made hard.”

Some of his concerns are less clear-cut. “Do not eat carp in onions or other fish prepared with onion, because they are often old or the remains of Sunday Supper.“ The problem here seems to be, not mixing fish with onions, but rather the risk of unhealthy food being disguised (a rare period echo of the modern canard that spices were used to hide the smell of rotting food).

Some are more curious. In a time when a hard shell of pastry – the pasty – was standard fare, he is not a fan of hardened baked goods: 'Leave aside crusts of tartlets and waffles;” “It is also good to avoid crusts and dry bread.” Cumin had a long and mainly favorable history in this region since the Gauls, yet Leonard writes “cumin ... is very much the contrary for you. for its taste often comes back as a belch in your mouth.” He uniformly rejects herring – by then one of the most important fast-day foods – in all its various forms: smoked, salted, broiled, even fresh.

Soups and broths are often considered healthy and in fact had gained, at the least, more visibility in the European diet at this point. But Leonard does not approve of most broth (though Xhayet translates brodium as brouet; it might also be translated as “soup”). He repeatedly warns against the broth of eels, and otherwise of that of goose giblets,.of wild boar, and of game in general. Several times he warns against “black broth”, a phrase whose meaning is obscure, though in one passage he specifically warns against the “black broth of boars”. Whatever virtues chicken soup may be thought to have today, the closest mention Leonard makes to it, of capon broth, is at best neutral: “Be careful not to eat parsley roots cooked incompletely in capon broth.” In fact the only broth he positively approves of is that of... haddock: “Boldly take however broth of haddock”. In one of his rare forays into classic humoral jargon, he even says that the broth of game will make one thirsty: “Do not drink the broth of game, because you will be thirsty for more, for it is very hot and dry.”

His most curious interdiction is of leeks. “Never eat tarts made with leeks cut up small;” “Also beware tarts, if cut leeks are in them;” “Do not eat a vegetable dish of leeks, because they come up in your mouth, the flavor like the broth, and balls of boiled leeks as well.” This is, at the least, an extreme take on classic humoral views of this food. Galen finds leeks, along with garlic and onions, bitter, but is not opposed to eating them, especially after boiling them; Anthimus actually recommends adding them to soup; In one passage, Isaac also describes them as bitter and dry, but does not condemn them; in another however he does say that they do things like cause nose bleeds and darkening of the vision and are “useless in food”; even then he recommends ways to compensate for their qualities and to use them for such things as snake bites or inciting desire. As late as the seventeenth century (when vegetables overall were still looked at with suspicion), Gontier wrote that they were “hot in the third degree, dry in the second” and had a bitter taste, but also credited them with various curative properties (curing coughs among them). Overall they were a common food, even if writers had reservations about them, and a curious one to condemn.


When it comes to the effects of different foods, Leonardo's concerns are also idiosyncratic. Anthimus, for instance, is largely concerned with digestive ailments. Chick peas, he writes, “can cause serious flatulence and bad indigestion and corruption of the stomach;” “Do not take [certain birds'] hindquarters because these weigh on the stomach;” “[Hard sausage] will not be digested, but will cause corruption of the belly.” Anthimus cites several foods as being useful for dysentery. He shows particularly concern about the kidneys: “It thickens in the kidneys and from that stones are produced;” Raw vinegar is rather harmful to the kidneys and bladder and it is not appropriate for the liver.“

Turning to Leonard's work, one finds almost none of these. Maladies, or merely discomforts, of the mouth and throat are prominent. “Your mouth will remain dry and parched, as if you had eaten dust or ashes;” “You will undoubtedly incur hoarseness, as you have experienced many times, and the loss of your voice;” “The fat of herbs mutes your voice;” “Your lips will swell up and your saliva will be like a white foam, and your throat dry, and you will not have a clear voice, but it will become thick and troubled;” “Hawking phlegm will be most aggravated in your chest and your throat.”

Even where digestion comes into play, the focus is on the mouth: “If you do otherwise, you will be heavy and your mouth will be foul and dry in the throat and it will be undigested;” “A fetid odor will be in your mouth, because it will not be digested;” “The stomach does not digest such broth well, but rather it rises up to the mouth, causing belching.”

Otherwise, simply waking up is a concern: “You may feel too heavy in the morning on getting up;” “Your mouth and throat will be dry and parched with thirst in the morning, when you get up;” “Because in the morning you will be spitting too much phlegm following the night;” “If you do this, the lighter and the more promptly you will rise in the morning;” “If you do anything else, [you will be] heavy and drowsy.”

Xhayet offers a perfectly credible reason for some of Leonard's more idiosyncratic recommendations. Might he not be addressing a specific monk, she asks. "Several details of the 'dietetic calendar' allow us to think so at any rate.” In discussing bleeding for instance he writes, "If you were one of those suffering".
The evocation of digestive troubles, of a repulsion for certain dishes... or condiments.. equally allows one to guess a clearly defined addressee....
Multiple allusions to the quality of the voice and to factors that might alter it... would lead one to identify this person as the chanter...
At the least, it is clear that Leonard's advice did not guide the monastery's kitchens; several times he makes it clear that the person he is addressing will have no control over what is served: “If dinner is in the hall, first be careful to ask what common meat must be eaten;” “If peas are set in front of you, take off any bacon floating on them;” “When you are eating in the morning in the refectory from Easter to the Exaltation of the Cross, carefully avoid greens and omelets [or, per Xhayet, crepes] soaked in a great deal of fat.”

Still, writes Xhayet, “whatever the case, most of the recommendations have a broad enough impact to have been able to benefit the whole monastic community." Whether in fact they did is a separate question.

Three facets of the calendar

It would be surprising if Leonard did not take key religious days into account, but it is difficult sometimes to work out the relationship between his health and religious concerns: “If it is very hot, abstain from hot greens and fats, above all outside the Sabbath.” Because better foods were to be reserved (as was sometimes the case) for the Sabbath? It is particularly strange to read: “Eat eggs and fish, except if it falls on a Saturday or Friday;” both were (technically) fast days and the fish at least would seem to have been appropriate to them. Other advice is closely linked to certain feast days, but couched in what appear to be concerns for health: “Sunday of the Nativity: avoid greens, flee omelets, leave eel broth, eat sops in honey, drink wine three times;” “On Rogation, the second and the third day of the week, do as for Mark the Evangelist except if you have greens, because then you can safely eat of them.”

Xhayet only touches in part on the relation between certain foods and certain holidays:
Eel brouet [or broth] (brodium) is served for the vigils of certain feasts (Assumption and All Saints), Holy Thursday, Christmas Day and during Advent. On the Sexigesima, during the second Sunday of Lent, Holy Thursday and Saturday, the menu offers carp in civet [that is, with onions] ...Herring are associated with the Quinquagesima, Ash Wednesday and for the vigils of various feasts....
A gruel (grumellum) of unspecified cereals [was] served at the dinner of Ash Wednesday and the Sundays of Advent, or oat gruel, on Good Friday... Apple beignets [were] offered on the second Sunday of Lent.
While some aspects of diet were clearly regulated by fast days, etc. it is less obvious why Leonard would advise or discourage specific foods on specific holidays. One might at least consider that specific feast days also corresponded to specific moments in the seasons and so his counsel might bear more relationship to the natural calendar than is obvious by his reference to specific saints. There is also the question of humoral theory's view of each season. Overall, the relationship here between the religious calendar and the natural seasons, as well as humoral theory, would be one worth exploring in depth, ideally by a scholar well-versed in both the Catholic calendar and medieval medical theory.



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