Hildegard of Bingen, Birth Control, and Abortion

Abstract

Hildegard of Bingen was a leading intellect in tenth-century Germany, and has since been declared a saint and a teaching authority in the Catholic church. She is an interesting figure for Catholic gynecologists, since historians have described her Physica as prescribing emmenagogues and abortions. This short piece by a Catholic obstetrician/gynecologist examines her texts, reviews the medical literature available on eight herbs she recommends, and lets Hildegard define herself with a holistic view to all of her writings. Two of the herbs she uses contain chemicals that can produce abortions at high concentrations; however, it is difficult to show whether Hildegard used such quantities. Hildegard’s words contextualize her experience of her patient care in straightforward language about menses, infants, and obedience to church teaching, suggesting she did not intentionally recommend pharmacologically spacing or terminating pregnancies.

Introduction

Hildegard of Bingen (1098-1179), declared a teaching authority of the church by Pope Benedict XVI in 2012, lived in Catholic tenth-century Germany. She was widely regarded to have mystical experiences and her writings were formative for her contemporaries (Flanagan, 1999). Her experiences relate to the culture she was surrounded by, largely containing theological imagery. During her busy life, she founded two monasteries, composed music, and carried out four public speaking tours around Germany. In her letters to popes, emperors, and holy men including Bernard of Clairveaux, she urged figures in power to avoid corruption and aid the weak. Hildegard also composed two works of contemporary medicine: Physica and Causae et Curae. Like other treatises of their time, these works are largely plant-based, anecdotal, and teleological. Even before her death in 1179, Hildegard’s hagiography was well established, and the cult of “saint” Hildegard continued informally for centuries. In the late 1900s, she was taken up as an New Age figure and an icon of feminism because of her holistic medicine and her ease in navigating male-dominated medieval Europe.

Pope Benedict XVI proclaimed Hildegard a canonical saint and a doctor of the church in 2012. The church has no issue with Hildegard’s visions, her hymns, her determination to avoid corruption, or her work to improve the lives of others by means of natural science. However, some scholarly work suggests that her Physica includes birth control or abortions. The Catholic church is widely known to oppose abortions as “gravely contrary to the moral law” (Catechism 2271), and that contraception represents a problematic “falsification of the inner truth of conjugal love, which is called upon to give itself in personal totality” (Catechism 2399). Most church teaching documents maintain that these two teachings have remained constant in the church for thousands of years. The idea that a Catholic authority such as Hildegard may have thought otherwise is important to investigate.

Prior Scholarship

John Riddle, a pharmacological historian specializing in the medieval period, discusses Hildegard’s “use of abortifacients, emmenagoges, and, possibly, contraceptives” (Riddle 1994, 116). In particular, he highlights her use of tansy:

Tansy is a well-known abortifacient in modern medicine of the type known as ecbolic. [Hildegard’s] recognition of tansy’s quality is the first known recorded use of the plant in the West (Riddle 1994, 116)

Riddle points out that Hildegard’s personality, which enabled her to engage powerful figures on a largely male-dominated stage, could give her strength to quietly resist the church on issues surrounding the “need for birth control [which] persons of compassion wanted to address. Hildegard’s writings,” he concludes, “show that they had at least some of the information” (Riddle 1994, 116-117).

Riddle is not alone. In 1995, a thorough historical collection of women healers included Hildegard, and simply states:

Hildegard avoided the topics of contraception and abortion as both were vehemently opposed by the church, but she does include recipes for ”retention of the menses,” a polite term for abortifacient (Brooke 1995, 47).

The idea that Hildegard originated natural methods of abortion continues to this day, with Hildegard most recently credited in Natural Liberty: Rediscovering Self-induced Abortion Methods, again with the first description of tansy (Sage-Femme! 2008). It is noteworthy that the description of tansy in Hildegard’s work is an emendation, and the emender used the Latin name for the herb (tenacetum), while Hildegard knew the plant by its German name, reynfan (Schleissner 1995, 151). However, this detail does not completely dismiss the question: did Hildegard recommend abortifacient herbs?

Dismissing Some Possibilities from Historical Criticism

In the part of Physica under consideration, Hildegard uses a large group of herbs in a concoction for “obstructed menses.” She advises:

Let a woman who suffers from obstructed menses take tansy, an equal weight of feverfew, and a little more mullein than either of the others. … And when she enters [the] bath, let her place these warm herbs on the bench and sit on them. … Let her do this as long as she sits in the sauna so that her skin and flesh are softened on the outside and in her womb by the humors of these herbs and so that her closed veins are opened. Then let her take bearberries, a third as much yarrow, rue a third as much as the yarrow, birthwort as much as the bearberries and yarrow, and a little more dittany. … Boil this in the best wine and mix this into the sack with the previously mentioned herbs and thus prepare claret. Let her drink this daily…until she is well (Physica 103-105).

A careful examination of more recent clinical research is necessary to interpret this. The answer is simple for several of the herbs suggested. A review of feverfew from 2000 does not list miscarriage or menstrual effects among observed adverse effects over 245 patients, and found that feverfew caused as many menstrual disorders as did placebo (Ernst et al. 2000). Mullein has been used for ulcers and pulmonary complaints, but its only arguable evidence-based use is in ear pain (Sarrell et al. 2003). Dittany has been used for hysteria and uterine hemorrhages in the past; there is no evidence on these uses.

Some of the herbs have more obscure reputations and there is not enough information to answer the question. Bearberry has been studied in urinary tract infections (Schindler et al. 2002) and hyperpigmentation (Maeda et al. 1996). There is insufficient information to determine whether the anecdotal advice that bearberries (in large quantities) are oxytocic and may induce labor. In a single animal study, yarrow was associated with decreased fetal weight and increased placental weight, but no studies have investigated further (Boswell-Ruys et al. 2003).

Although historians were very concerned about Hildegard’s use of tansy, the only study that mentions tansy as an abortifacient is a 1979 sociological narrative on North America (Conway et al. 1979). Although it goes into great depth on some herbs, its short paragraph on tansy explains that it was not used much among the population studied, and the authors did not know why.

However, some of Hildegard’s herbs, such as rue and birthwort, raise concerns in medical literature that no historian has mentioned. Rue is still used today as an abortifacient. The lyophilized hydroalcoholic extract of its above-ground parts is embryocidal after implantation and feticidal in mice (Gonçalves et al. 2005). It remains unclear what in rue is abortifacient in humans, although it may be the pilocarpine it contains. As a sympathomimetic, pilocarpine can in theory increase smooth muscle motility (uterine muscle is smooth muscle, so pilocarpine could in theory lead to uterine contractions). Late in the last century, it was described as abortifacient in humans (Bartholow 1891, 109); since that time, it has been used ophthalmically more than systematically, so there is no modern data on its effectiveness.

Birthwort contains p-coumaric acid and aristolic acid. These are abortifacient in mice with a single oral doses of 50 mg/kg and 60 mg/kg (of the methyl ester), respectively (Pakrashi et al. 1979 and 1978). A sesquiterpene isolated from the roots is abortifacient in 91.7% of pregnant mice at a single oral dose of 100 mg/kg (Pakrashi et al. 1977).

There is no information on how much of these extracts of rue or birthwort are contained in the raw or dried plant, especially in the imprecise quantities that Hildegard gives. Further, the topical application of these herbs would not likely produce this effect, and the pharmacology of first- or second-pass metabolism of the wine mixture is unknown as well. Because of this, it is premature to conclude anything about whether Hildegard’s remedy could be abortifacient, even if some of the herbs she used are abortifacient in certain quantities.

Conclusion: Letting Hildegard Answer

Hildegard’s works themselves disclose her beliefs about the ethics of abortion, most clearly in her warnings about the use of hazelwort. She writes, “[hazelwort] is very poisonous and [can] harm a person. …[I]f a pregnant woman were to eat it, either she would die or she would abort the infant with great danger to her body.” (Physica 45-46) Here, Hildegard calls a fetus an “infant” and seems to include him in the category of “persons” that hazelwort rushes to harm. Hildegard expressed no hints about her beliefs regarding contraception, which was already condemned by the contemporary Cathoic church (see John IV, Libellus Poenitentialis circa 580s) but her enthusiasm for the church dims any hopes that she was innovative on these matters.

Hildegard defended the authority of the church throughout her non-medical writings, describing it as “the tower of celestial Jerusalem,” (Letters, 12) “the garment of the word of God,” (Letters, 23) and a “dawn [for] spiritual people…so refulgent in virtue that it had a defense like a shield and protection like a breastplate for their defense” (Letters, 15r). Unlike later feminist icons, she preferred personal suffering to disobedience to church teaching (Letters 5, 15r, 23). Even as she rebuked men in the church hierarchy for not serving those in their care, she was vocal in her praise of their office and acknowledgement of her subordination. In fact, it may be said that to her the church was all about obedience. In her own biblical scholarship, she showed how obedience related to integration with the Catholic church:

Abel prefigured the priesthood; Noah, the papal office….Abel poured forth his brightness like the moon, because he revealed the time of obedience in his burnt offering; and Noah, like the sun, because he brought the edifice of obedience to perfection (Letters, 15r).

This attitude of submission grounded Hildegard, even though she provided a progressive example of the role of women in the medieval church. In brief, it is extremely unclear that Hildegard knowingly recommended certain herbs to space or terminate pregnancy. One of her herbal remedies included chemicals that are certainly abortifacient, but Hildegard herself demanded extreme docility to the authority of the church, which already proscribed contraception and abortion.

References

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Note: This was published without peer review in part to practice R Markdown.