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Making Modern Migraine Medieval: Men of Science, Hildegard of Bingen and the Life of a Retrospective Diagnosis

  • Katherine Foxhall (a1)

Charles Singer’s retrospective diagnosis of Hildegard of Bingen as a migraine sufferer, first made in 1913, has become commonly accepted. This article uses Hildegard as a case study to shift our focus from a polarised debate about the merits or otherwise of retrospective diagnosis, to examine instead what happens when diagnoses take on lives of their own. It argues that simply championing or rejecting retrospective diagnosis is not enough; that we need instead to appreciate how, at the moment of creation, a diagnosis reflects the significance of particular medical signs and theories in historical context and how, when and why such diagnoses can come to do meaningful work when subsequently mobilised as scientific ‘fact’. This article first traces the emergence of a new formulation of migraine in the nineteenth century, then shows how this context enabled Singer to retrospectively diagnose Hildegard’s migraine and finally examines some of the ways in which this idea has gained popular and academic currency in the second half of the twentieth century. The case of Hildegard’s migraine reminds us of the need to historicise scientific evidence just as rigorously as we historicise our other material and it exposes the cumulative methodological problems that can occur when historians use science, and scientists use history on a casual basis.

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1. Charles Singer, ‘The scientific views and visions of Saint Hildegard (1098–1180)’ in C. Singer (ed.), Studies in the History and Method of Science(Oxford: Clarendon Press, 1917), 1–55: 51–5. Note that Singer was mistaken in his dates; Hildegard actually died in 1179.

2. For general works in English on Hildegard, see eg. Barbara Newman (ed.), Voice of the Living Light: Hildegard of Bingen and Her World(Berkeley, CA: University of California Press, 1998), 3–29; Sabina Flanagan, Hildegard of Bingen: A Visionary Life, 2nd edn (London and NY: Routledge, 1998); Charles Burnett and Peter Dronke (eds), Hildegard of Bingen: The Context of Her Thought and Art (Warburg Institute Colloquia, 4) (London: Warburg Institute, 1988).

3. For an excellent critique of interdisciplinary ‘borrowing’ see Constantina Papoulias and Felicity Callard, ‘Biology’s Gift: Interrogating the Turn to Affect’, Body and Society, 16, 1 (2010), 29–56.

4. Cunningham, Andrew, ‘Identifying Disease in the Past: Cutting the Gordian Knot’, Asclepio, 54, 1 (2002), 1334: 17.

5. Laura J. McGough, ‘Syphilis in History: A Response to Two Articles’, Clinical Infectious Diseases, 41 (2005), 573–4; Roger Cooter, ‘The Life of a Disease?’, The Lancet, 375 (2010), 111–12.

6. For a review essay on disease ‘biographies’ see Anne Hardy, ‘A New Chapter in Medical History’, Journal of Interdisciplinary History, 39, 3 (2009), 349–59; Christopher Hamlin, Cholera: the Biography(Oxford: Oxford University Press, 2009); Sander L. Gilman, Obesity: The Biography (Oxford, Oxford University Press, 2010). Gilman has been an outspoken critic of retrospective diagnosis; see his review of Richard Schain, The Legend of Nietzsche’s Syphilis (Greenwood Press, 2001) in Isis, 93, 4 (2002), 733–4.

7. On the relationship between paleopathology and retrospective diagnosis see K.-H. Leven, “At times these ancient facts seem to lie before me like a patient on a hospital bed’ – Retrospective diagnosis and ancient medical history’ in Herman F.J. Horstmanshoff, Marten Stol and C.R. Van Tilburg (eds), Magic and Rationality in Ancient Near Eastern and Graeco-Roman Medicine(Leiden: Brill, 2004), 369–86.

8. Bruno Latour, ‘On the partial existence of existing and nonexisting objects’, in Lorraine Daston (ed.), Biographies of Scientific Objects(Chicago, IL and London: University of Chicago Press, 2000), 247–69.

9. Lester K. Little, ‘Plague Historians in Lab Coats’, Past and Present, 213 (2011), 267–90; Vivien Nutton (ed.), Pestilential Complexities: Understanding Medieval Plague, Medical History Supplement No. 27 (London: University College London, 2008); Samuel K. Cohn, Jr, ‘The Black Death: End of a Paradigm’, American Historical Review, 107, 3 (2002), 703–38.

10. Monica Green, ‘The value of historical perspective’, in Ted Schrecker (ed.), The Ashgate Research Companion to the Globalization of Health(Farnham: Ashgate, 2012), 17–38: 24.

11. Caroline Walker Bynum, Holy Feast and Holy Fast: The Significance of Food to Medieval Women(Berkeley, CA, Los Angeles, CA and London: University of California Press, 1987), 194–218. In particular, Bynum was responding to Rudolph Bell’s Holy Anorexia (Chicago, IL: Chicago University Press, 1985), in which he identified ‘a historically significant group of women [who] exhibited an anorexic behaviour pattern in response to the patriarchal structures in which they were trapped’ (ix), and hoped to persuade physicians and psychologists to re-evaluate some aspects of modern approaches to the disease.

12. Lorch, M., ‘Language and Memory Disorder in the Case of Jonathan Swift: Considerations on Retrospective Diagnosis’, Brain, 129 (2006), 31273137.

13. It is particularly significant that the idea of Hildegard’s migraine spread before the ‘whirligig of the web’. See Angelique Richardson, ‘Thomas Hardy: Neither Boring nor Syphilitic’, Critical Quarterly, 50, 1–2 (2008), 234–9.

14. For recent discussions on the question of Hildegard’s authorship of Causae et Curae see Victoria Sweet, Rooted in the Earth, Rooted in the Sky: Hildegard of Bingen and Premodern Medicine, Studies in Medieval History and Culture, 19 (New York and London: Routledge, 2006), 35–49; Laurence Moulinier (ed.), Hildegardis Bingensis Cause et Cure, vol. 1 (Berlin: Rarissima Mediaevalia, 2003).

15. Translation from Latin in Priscilla Throop, Hildegard of Bingen Causes and Cures, 2nd edn (Charlotte Vermont: Medieval MS, 2008), 74–5, 135.

16. ‘Recette contre la migraine’ in Ernest Wickersheimer, ‘Textes Médicaux Chartrains Des IXe, Xe et Xie Siècles’ in E. Ashworth Underwood (ed.) Science, Medicine and History: Essays on the Evolution of Scientific Thought and Medical Practice Written in Honour of Charles Singer(London, New York & Toronto: Oxford University Press, 1953), 164–76. With thanks to Professor Anne Duggan for assistance in Latin translation.

17. John Pughe (trans.) and John Williams Ab Ithel, The Physicians of Myddvai(Llandovery: Longman & Co, 1861), 339.

18. ‘The life of holy Hildegard’, Book II: V & VIIII, in Anna Silvas (trans. & ed.), Jutta and Hildegard: The Biographical Sources(University Park, PA: Pennsylvania State University Press, 1999), 163, 169.

19. Charles Singer, ‘Autobiographical preface’ to From Magic to Science(New York: Dover, 1958), 8; Geoffrey Cantor, ‘Presidential Address Charles Singer and the Early Years of the British Society for the History of Science’, British Journal of the History of Science, 30 (1997), 5–23.

20. Charles Ryell to Charles Singer, Wellcome Library, Singer Correspondence, PP/CJS/A.15 Correspondence R, 3 March 1911; Fielding H. Garrison to Charles Singer, WL Singer Correspondence, PP/CJS/A.7 Correspondence G, 6 October 1913.

21. Silvas, op. cit.(note 18), 159.

22. For overviews of Hildegard’s life and work see Peter Dronke, ‘Hildegard of Bingen’, in Women Writers of the Middle Ages(Cambridge and New York: Cambridge University Press, 1984), 144–201: 145; Barbara Newman, “‘Sybil of the Rhine”: Hildegard’s life and times’ in Voice of the Living Light: Hildegard of Bingen and her World (Berkeley, CA: University of California Press, 1998), 3–29; Sabina Flanagan, Hildegard of Bingen: A Visionary Life, 2nd edn (London and New York: Routledge, 1998); Kathryn Kerby-Fulton, ‘Hildegard of Bingen’, in Alastair Minnis and Rosalynn Voaden (eds), Medieval Holy Women in the Christian Tradition c. 1100–1500 (Turnhout: Brepols, 2010), 343–69.

23. Newman, ibid., 8–10.

24. One recent report suggests that three per cent of all Germany’s inhabitants express trust in ‘Hildegard Medicine’, a practice the authors warn is the highly commercialised product of two physicians (Gottfried Hertzka and Wighard Strehlow) and based on ‘poorly defined overpriced preparations’. See O. Micke and J. Hubner, ‘Traditional European Medicine – After All, is Hildegard von Bingen really right?’, European Journal of Integrative Medicine, 1 (2009), 226; Vision Dir. Margarethe von Trotta (2009).

25. Newman, op. cit.(note 22), 1.

26. Monica Green, ‘In Search of an “Authentic” Women’s Medicine: The Strange Fates of Trota of Salerno and Hildegard of Bingen’, Dynamis, 19 (1999), 25–54: 51; Florence Eliza Glaze, ‘Medical writer’, in Newman, op. cit.(note 22), 125–48.

27. Sweet, op. cite.(note 14), 6.

28. Mélanie Lepinska, Histoire des Femmes Médecins depuis l’Antiquité jusqu’a nos jours(Paris: Librairie C. Jacques & Companie, 1900), 133.

29. Singer, op. cit.(note 19), viii.

30. Arnold Klebs to Singer 29 July 1913, WL PP/CJS.A.10 Correspondence K. It is likely that Klebs is referring to photographs that Louis Baillet lent Singer, as Singer credited in the Hildegard chapter.

31. ‘St Hildegard’, Proceedings of the Royal Society of Medicine(History of Medicine Section), vii (1913), 1–2; ‘Medical Societies’, Transactions of the Royal Society of Medicine: Section of History of Medicine (1913), 1540.

32. Singer, op. cit.(note 19), ix.

33. Singer, op. cit.(note 1), 52–3. Singer quoted from Jacques-Paul Migne (ed.), Patrologia Latina, vol. 197 (Paris: Migne, 1855).

34. John Herschel, ‘On sensorial vision’, in Familiar Lectures on Scientific Subjects(New York and London: George Routledge and Sons, 1872), 400–18: 408–9. Herschel also made records in his diary eg. ‘a most superb and perfect Turkshead pattern (…) as sharp as if drawn with compasses’ in entry for 18 August 1855, Royal Society of London MS 584.

35. Sir David Brewster, ‘On Hemiopsy, or Half-Vision’, The London, Edinburgh and Dublin Philosophical Magazine and Journal of Science, XXIX, 4 (1865), 503–7; G. B. Airy ‘On hemiopsy’, The London, Edinburgh, and Dublin Philosophical Magazine and Journal of Science, 30 (1865), 19–21.

36. Elizabeth Green Musselman, Nervous Conditions: Science and the Body Politic in Early Industrial Britain(Albany: State University of New York, 2006), see especially Chapter 4, ‘Mental governance and hemiopsy’, 101–45.

37. Hubert Airy, ‘On a distinct form of transient hemiopsia’, Philosophical Transactions of the Royal Society, 160 (1870), 247–64: 255, 264.

38. Apart from his admission of headache, Airy made one passing reference in a footnote to a mention of visual aura in Fothergill’s 1778 ‘Remarks on Sick Headach’, which had been ‘very lately’ drawn to his attention; Airy, ibid., 254.

39. Edward Liveing, On Megrim, Sick-Headache and Some Allied Disorders(J. & A. Churchill: London, 1873).

40. Peter Wallwork Latham, On Nervous or Sick-Headache, its Varieties and Treatment(Cambridge: Deighton, Bell and Co; London: Bell and Daldy, 1873), 16. For a study of Latham and Liveing, see Mark Weatherall, ‘The Migraine Theories of Liveing and Latham: A Reappraisal’ Brain, 135, 8 (2012), 2560–8.

41. Latham, ibid., 2; Liveing, op. cit.(note 39), 25–7.

42. See for instance, P.J. Murphy, ‘On Headache and Its Varieties’, The Lancet, 63, 1590 (1854), 182–3.

43. See for example, Alex W. Stirling, ‘On Certain Subjective Visual Sensations’, Journal of the American Medical Association, 27, 23 (1896), 1181–4; Alexander Wallace, ‘On Migraine’, The Lancet, 141, 3620 (1893), 79–81; W. Pemberton Peake, ‘A Few Observations on the Pathology and Treatment of Migraine’, The Lancet, 136, 3500 (1890), 666.

44. M.J. Eadie, ‘Hubert Airy, Contemporary Men of Science and the Migraine Aura’, Journal of the Royal College of Physicians of Edinburgh, 39, 3 (2009), 263–7: 267.

45. Gowers, William, ‘Subjective Visual Sensations’, Transactions of the Ophthalmological Society of the United Kingdom, 15 (1895), 138, 25.

46. Lorraine Daston and Peter Galison, Objectivity(Zone Books: New York, 2010), 19–20.

47. Jean-Martin Charcot, Clinical Lectures on Diseases of the Nervous System [1882–5], trans. Thomas Savill [1889], 62–8.

48. Amanda Power, ‘A Mirror for Every Age: The Reputation of Roger Bacon’, English Historical Review, 121, 492 (2006), 657–92, 676–7; Andrew Cunningham has also critiqued recent attempts to create ‘saint-scientists’ in ‘Science and Religion in the Thirteenth Century Revisited: The Making of St Francis the Proto-Ecologist. Part 1: Creature not Nature’, Studies in History and Philosophy of Science, 31, 4 (2000), 613–43.

49. Singer, ‘The Development of the Doctrine of Contagium Vivium, 1500–1750’ (London: privately printed, August 1913), 12. WL MS PP/CJS B.1: Writings by Charles Singer, 1905–14.

50. Anna K. Mayer, ‘When Things don’t Talk: Knowledge and Belief in the Inter-War Humanism of Charles Singer’, British Journal for the History of Science, 38, 3 (2005), 325–47: 326–7.

51. Singer, op. cit.(note 1), 30–2.

52. Charles Singer, ‘Allegorical Representation of the Synagogue in a Twelfth Century Illuminated Manuscript of Hildegard of Bingen’, The Jewish Quarterly Review, New Series 5, 8 (1915), 267–88: 269, n. 8; Singer, op. cit.(note 1), 12–13. For recent discussions about Hildegard’s authorship of the medical texts known as Physica and Causae et Curae see Green, op. cit. (note 26), 45; Faith Wallis (ed.), Medieval Medicine: A Reader (Toronto, ON: University of Toronto Press, 2010), 357–8.

53. Charles Singer, ‘Science’, in F.J.C. Hearnshaw, Mediaeval Contributions to Modern Civilization(London, 1921), 106–48: 111; Charles Singer, ‘What is Science?’, British Medical Journal, 1 (1921), 954.

54. Singer, op. cit.(note 19), xii–xiii.

55. Elliott, R.F., ‘Migraine and Mysticism’, Postgraduate Medical Journal, 8, 86 (1932), 449459.

56. Macdonald Critchley and Fergus R. Ferguson, ‘Migraine’, The Lancet, 1 (1933), 182–5, and The Lancet, 1 (1933), 123–5.

57. ‘Dr Sacks on Migraine’, (accessed 14 May 2013).

58. Oliver Sacks, Migraine: Understanding the Common Disorder(London: Pan Books, 1985), 106–8. All references to Migraine hereafter are to this edition unless otherwise stated.

59. Sacks, ibid., 55.

60. Eadie, M.J., ‘The Pathogenesis of Migraine – 17th to Early 20th Century Understandings’, Journal of Clinical Neuroscience, 12, 4 (2005), 383388.

61. Sacks, op. cit.(note 58), 192.

62. Peter J. Goadsby, ‘The Vascular Theory of Migraine – A Great Story Wrecked by the Facts’, Brain, 132, 1 (2009), 6–7; for a response to Goadsby that is little short of furious see Elliott Shevel, ‘The Extracranial Vascular Theory of Migraine: an Artificial Controversy’, Journal of Neurological Transmission, 118 (2011), 525–30.

63. See eg. Oliver Sacks, Migraine(Berkeley, CA: University of California Press, 1985, 1986 & 1993).

64. Subtitles to Migraineinclude Evolution of a Common Disorder(1970–73); Understanding a Common Disorder (1985–87). By the 1990s, the subtitle had been dropped in favour of ‘Revised and Expanded’.

65. Oliver Sacks, Migraine(Berkeley, CA: University of California Press, 1993), xv.

66. Sally Shuttleworth, The Mind of the Child: Child Development in Literature, Science and Medicine, 1840–1900(Oxford: Oxford University Press, 2010), 22.

67. Esther Cohen, The Modulated Scream: Pain in Late Medieval Culture(Chicago, IL and London: University of Chicago Press, 2010), 118; Joseph L. Baird and Radd K. Ehrman, Hildegard of Bingen to Christian, Archbishop Of Mainz, 1179, in The Letters of Hildegard of Bingen, vol. 1 (Oxford: Oxford University Press, 1994), 80–2.

68. Barbara Newman, ‘Hildegard of Bingen: Visions and Validation’, Church History, 54, 2 (1985), 163–75: 167.

69. Sabina Flanagan, Hildegard of Bingen, 1098–1179: A Visionary Life, 2nd edn (London and New York: Routledge, 1998), 191–202: 200.

70. Barbara Newman, ‘Three-part invention: the Vita S. Hildegardis and mystical hagiography’, in Charles Burnett (ed.), Hildegard of Bingen: The Context of her Thought and Art(London: The Warburg Institute, 1998), 189–210: 197–8.

71. This argument is explored most fully in Madeline Caviness, ‘Gender symbolism and text image relationships: Hildegard of Bingen’s Scivias’, in Madeline Caviness (ed.), Art in the Medieval West and its Audience(Aldershot: Ashgate, 2001), 71–108. Previously, some authors had simply assumed Hildegard’s role. See eg. Matthew Fox, Illuminations of Hildegard of Bingen (Rochester: Bear & Co: 1985).

72. Madeline Caviness, ‘Hildegard as designer of illustrations’, in Charles Burnett and Peter Dronke (eds), Hildegard of Bingen: The Context of Her Thought and Art(London: Warburg Institute, 1998), 29–62: 33.

73. Madeline Caviness, ‘Artist: “To See, Hear, and Know All at Once”’, in Newman (ed.), Voice of the Living Light,110–124: 110, 113; Lieselotte E. Saurma-Jeltsch, Die Miniaturen im “Liber Scivias” der Hildegard von Bingen: Die Wucht der Vision und die Ordnung der Bilder(Wiesbaden: Dr Ludwig Reichert, 1998); Keiko Suzuki, Bildgewordene Visionen oder Visionserzaihlungen (Bern: Peter Lang, 1998). For Caviness’ critique of these two works see Madeline H. Caviness, ‘Hildegard of Bingen: Some Recent Books’, Speculum, 77, 1 (2002), 113–120: 119.

74. Vivian Nutton has warned of the need to ‘take the utmost care not to proceed along a path that is ultimately circular’. ‘Introduction’ to V. Nutton (ed.), Pestilential Complexities: Understanding Medieval Plague(London: The Wellcome Centre Trust for the History of Medicine, 2008), 11, 16.

75. Compare Singer, ‘Scientific Views and Visions [1917]’, 7 with Singer, ‘Scientific Views and Visions [1928]’, 205. In 1913, the Royal Society of Medicine Meeting report used the phrase ‘almost certainly prepared under Hildegard’s personal supervision’, although it is unclear whether these are Singer’s words.

76. Charles Singer, ‘Preface’ to From Magic to Science: Essays on the Scientific Twilight(London: Ernest Benn, 1928), xii. In the 1928 version, Singer had also removed the highly criticised sections from the article in which he rejected Hildegard’s authorship of the medical manuscript Causes and Cures. Singer’s reservations about the quality of Causae et Curae in comparison with her other works are understandable; debates about manuscript authenticity and the authorship of Causae et Curae (whether, for example, it was Hildegard’s work, but a rough draft) continues to be debated. However, while not integral to his discussion about migraine which refers only to Scivias, Singer’s removal of the discussion about Causae et Curae further removed of any sense of doubt in the piece, allowing historians who have only consulted the 1928 or 1958 versions of his article to forget that debates about manuscript authenticity were as contested in Singer’s time as they are today.

77. Walker Bynum, Caroline, Fragmentation and Redemption: Essays on Gender and the Human Body in Medieaval Religion (New York: Zone, 1991), 17.

78. See eg. G.D. Schott, ‘Exploring the Visual Hallucinations of Migraine Aura: The Tacit Contribution of Illustration’, Brain, 130 (2007), 1690–703: 1694.

79. Ferrari, M.D. and Haan, J., ‘Migraine Aura, Illusory Vertical Splitting, and Picasso’, Cephalalgia, 20, 8 (2000), 686.

80. Haan, Joost and Ferrari, Michel D., ‘‘Picasso’s Migraine: Illusory Cubist Splitting or Illusion?’’, Cephalalgia, 31, 9 (2011), 10571060.

81. Levy, Andrew, A Brain Wider than the Sky: A Migraine Diary (New York: Simon and Schuster, 2009), 104.

I thank the Wellcome Trust, whose generous postdoctoral fellowship (grant no. WT091650MA) has funded the research project of which this article is a part. I am extremely grateful to the anonymous reviewer for Medical History whose thoughtful and critical engagement with this article greatly assisted in its revision, and to Ludmilla Jordanova, Keren Hammerschlag and participants in the CHSTM research seminar at the University of Manchester who commented on earlier versions.

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