The Nature and Deconstruction of Cause et Cure:
The seemingly complex nature of the language and allegorical mode surrounding Cause et Cure is such that a literal interpretation does not do the work justice. Hildegard marks the text with symbols and conventions characteristic of medieval literature and establishes a hierarchy of thought governed by three relationships: God and Lucifer, man and woman, God and man. Cause et Cure is prefaced with a sermon on the creation of the world, as well as an explanation of the relationship between earth, nature, and man. Hildegard describes the storm:
“When intense warmth and fiery heat are in the ether, sometimes this ardor causes a sudden bubbling up and a dangerous overflowing of the waters, sending them down to the earth. And such storms, by God’s judgment, occur very often as a result of the humans past or more recent wrongdoings or to announce future dangers like wars, famine, or sudden death.”
The ecclesiastical healthcare community felt that if a patient could not be healed, and death occurred, that it was part of God’s will, and the failure of the treatment was not questioned. Many of her remedies discussed in Cause et Cure were a prophecy, seen as divine work and not a man-made creation such that the materials required to aid the sick and dieing were recommended by God.
Hildegard outlines the relationship between the earthly elements and bodily humors which is the basis for her medical theories. The text contains a number of sections incorporating ideas of humoral physiology and pathology with discussions of embryology, human sexuality, sleep, dreams and waking, disorders and diseases, menstruation, conception and pregnancy, health regimen, bloodletting, nutritional disorders, and treatments, as well as diagnostic and prognostic signs.
Disorders and Treatments: Excerpts from Hildegard’s Cause et Cure
Condition:
Madness and Insanity:
When the aforementioned afflictions occur all at once (migraine, headache and vertigo) so that they rage simultaneously in a man’s head, overpower him completely, and drive him to insanity just as when a ship shaken by storms burst into pieces. In Hildegard’s time, many people erroneously assumed that such an afflicted person was possessed by a demon.
Rage, Madness and Epilepsy:
Due to their complexional disposition, some people quite frequently break out in a rage. Often the rage in them will cause tremendous overflowing of the blood. As a result of this overflowing, some kind of vapor affects the afflicted individuals’ brains, turns them insane, and reduces their consciousness as well. Once such people become enraged and feel aggravated by day-to day worries, the Devil sees this and frightens them with breath of his suggestion. Exhausted, the soul in these people succumbs and withdraws. The person faints, falls down, and remains in this state of unconsciousness until the soul, having regained its powers, surges again. Those who suffer from this misfortune are exhausted and often have angry expressions and violent movements.
Treatment:
If someone turns mad because their brain is chilled, one of Hildegard’s remedies involves pulverizing laurel berries and mixing the berries with wheat flour and blessed-thistle water. After the patient’s head has been shaved, this deich is spread over his entire head and held in place with a felt cap until the inside of the head is warmed and the patient falls asleep. This brings warmth to the brain and the process is repeated until the patient regains his senses.
Rationale:
In order to make a clear diagnosis more information regarding the individual patient would be necessary. For instance, Hildegard does not specify the age of the patient, nor does she mention the nutritional status or the dominant symptoms of the patient. If the patient were older, many of the symptoms would be similar to those associated with neurodegenerative diseases such as Alzheimer’s and Parkinson’s. Alzheimer’s disease is characterized by symptoms of behavioral dementia such as memory loss, disorientation, impaired judgment, significant changes in mood, and problems with abstract thinking. Parkinson’s, on the other hand, is more debilitating and characterized by excessive tremors, rigidity of limbs and trunk, slowness of movement, and poor balance and coordination.
The underlying cause of the disorders has not yet been confirmed but is thought to be associated with increasing levels of oxidative stress that occur in the brain tissue over a number of years. The oxidative stress essentially deteriorates nerve cell function, and the damage cannot be reversed. Growing evidence also suggests that the presence of protein aggregations, beta-amyloid plaques or Hirano bodies, in the brains of patients with Alzheimer’s and Parkinson’s, could be linked to the neurodegeneration. Although scientists do not know whether or not the presence of these slow-forming protein aggregations are deleterious to the cell, they are currently in the process of investigating the composition, formation, and role of Hirano bodies in such neurodegenerative diseases such as Alzheimer’s and Parkinson’s.
Dr. Marcus Fechhiemer and Dr. Ruth Furukawa, researchers at the University of Georgia, are currently studying the role of the Hirano body in the progression of Alzheimer’s and Parkinson’s by investigating the formation and mechanism of this protein in a number of cell models. They feel that the Hirano body might be a defense mechanism of the cell in response to oxidative stress and aging. They have also identified the main protein to be actin, and the rest possibly transcription factors, growth regulators, and other proteins. Dr. Fechheimer and his team are also investigating the role of the Hirano body in apoptosis or programmed cell death. Dr. Rich Davis found that when the gene that makes Hirano bodies is introduced and turned on in certain cell cultures, the cells do not form the Hirano body and the cells die, which would suggest that the aggregation is helpful to the cell. The role of this mysterious protein aggregate, found primarily in the brain tissue of patients who have suffered some type of neurodegenerative disease, is still under much investigation, and scientists all over the world are trying to find a definitive link.
Another area for possible investigation would be the role of a certain class of heat shock proteins in the induction of Hirano body formation and degradation as well as their role in the development of Alzheimer’s and Parkinson’s. Heat shock proteins (HSPs) are present in the nucleus of the cell and are highly associated with the cellular DNA. HSPs are responsible for regulating the expression of certain genes and are normally induced by the presence of extra-cellular components such as heavy metals, UV light, sodium arsenate, and ethanol.
A recent article published by researchers at the University of North Texas Science Center in April of 2003 suggests that the heat shock protein (HSP 60) was found to be very sensitive to oxidative stress in tissue derived from patients suffering from Alzheimer’s, but the protein was not as sensitive in individuals with normal tissue. The researchers found the presence of highly oxidized protein aggregations identified as the beta-amyloid plaques (Hirano bodies), and they concluded that their presence has deleterious effects on the cell by inducing apoptosis. This theory is a little different from the theory previously mentioned of Dr. Fechheimer’s in that the Hirano body is a defense mechanism by the cell and may or may not induce apoptosis. The hallmark of the researchers' project was to identify the proteins in nerve cells that are most susceptible to oxidative stress-- a process that can significantly alter protein function and utility in the cell. HSP 60 is a mitochondrial chaperon protein, and over-expression is responsible for inhibiting the apoptotic response. Oxidation of this essential protein would be deleterious to the cell and is the immediate cause of programmed cell death.
Interestingly enough, Hildegard proposed treating patients suffering from “madness” with a deich consisting of pulverized laurel berries and blessed thistle as previously described. A recent series of experiments conducted by researchers at the Kyoto Pharmaceutical University in Kyoto, Japan provide evidence that Laurus nobilis, more commonly known as bay leaf or laurel extract was found to contain seven sesquiterpene lactones responsible for inhibiting nitric oxide production, a form of oxidative stress, in mice macrophages. More specifically, two of the most potent lactones, costunolids and dehydrocostus lactone, inhibited nitric oxide synthase (iNOS) induction that is in accordance with the induction of an important heat shock protein (HSP 72) which acts as the gatekeeper for the nuclear factor-KB activation. As mentioned above, in the presence of certain inducers the heat shock proteins are activated and play a central role in cell function by regulating the expression of certain proteins in the presence of certain environmental factors, thus allowing the cell to adapt more readily to changing extra-cellular conditions. The function of the sesquiterpene lactones was demonstrated in this study, and this function the facilitation of HSP 72 function by binding to certain SH groups, essential for protein structure and function, and by protecting the HSP from certain forms of oxidative stress such as nitric oxide. The lactones responsible for HSP 72 protection are constunolide, dehydrocostus lactone, mokko lactone, watsonol, eremanthine, zaluzanin, magnolialide, santamarine, and spirafolide. Other lactones isolated from the essential oil of the laurus nobilis that are also thought to aid in cytoprotection from oxidative stress are alpha-eudesmol, beta-eudesmol, lamda-eudesmol, alpha- dictyopterol, germacra-4(15),5,10(14)-trien-1beta-ol, spathulenol, oplopanone and alpha-methylene-lamda-butyrolactone.
Future investigative research could elucidate the protective functions of these aforementioned lactones and the role of other heat shock proteins in the cell. Such information of the chemical mechanism of these key compounds could possibly provide direction for the development of new Alzheimer’s and Parkinson’s treatments.
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