Aphorisms or academic education?

Ms. 679 of the Utrecht University Library looks to be well-used. Frequent use has deposited dirt on its pages, scribbles in the margins are abundant and some of its folios have been folded and torn. In the Middle Ages, books were objects of heavy use and sometimes, a manuscript’s use left noticeable traces. Ms. 679 functioned primarily as a work reference and seems to have passed through many hands. Who, exactly, consulted this medical manuscript so intensively?

Wall tile wisdom

The Aphorismi by Hippocrates is the main text in this manuscript. Hippocrates is considered to be one of the founders of medieval and modern medicine. Upon entering their professions, physicians everywhere still swear a professional oath that is inspired by the Hippocratic Oath. In doing so, they promise to practice medicine dutifully and conscientiously. The modern oath only vaguely resembles the one written by Hippocrates, who in 400 BCE had his students swear by Apollo, Asclepius, Hygieia and Panacea. However, the underlying concept of ethical and moral responsibility remains central to the physicians’ professional oath.

Hippocrates’ relevance to medieval and modern medicine is also demonstrated by his implementation of a scientifically founded practice of medicine based on empiricism (Huizenga 2003, 331). This means that frequent observations result in a sort of general knowledge of medicine and the human body. The Aphorismi is a collection of this general knowledge, and presents itself somewhat as an encyclopedia of aphorisms – the kind of texts which Dutch people put on wall tiles at home. Some aphorisms, for instance, include “spontaneous lethargy indicates illness” (Aphorismi 2:5), “in acute illnesses, cold of the extremities (of the body) is bad” (7:1) and “violent treatments are best for violent illnesses”(1:6). These universal truths were used and applied frequently in the Middle Ages, which might explain why Ms. 679 looks a bit worse for wear.

An academic education

Ms. 679 contains two additional texts: De Regimine Acutorum, also by Hippocrates, and Galen’s Ars Parva. In the thirteenth and fourteenth centuries, these texts frequently occur together in works of reference, which were used both by medics and students. From the twelfth and thirteenth centuries onward, the Aphorismi and Ars Parva were part of the medical curriculum taught at the university of Salerno. These texts were translated from the Greek into Arabic, and afterwards in Latin.


During this time, a number of texts began to form a kind of canon in the medical curriculum. Later, in the fifteenth and sixteenth centuries, these texts were regularly printed under the collective header Ars Medica, or Articella. Of these, the essential works that gained general recognition in the twelfth and thirteenth centuries are the following:

  • Johannitius, Isagoge
  • Hippocrates, Aphorismi
  • Hippocrates, Prognosticon
  • Theophilus, De Urinis
  • Philaretus, De Pulsibus
  • Galenus, Ars Parva

Some time during the thirteenth or fourteenth century, De Regimine Acutorum joined this collection of basic medical texts to form the quintessential Articella. Even outside of Salerno, these texts were generally considered as a good foundation for the prospective medic. They were part of the oldest known Parisian curriculum, and students in Bologna took exams on the Aphorismi and Ars Parva (Baader 1969, 22-23).

The evolution of the corpus that would become known as the Articella took a considerable amount of time. It might be worth investigating how the creation of Ms. 679 was influenced by this process. Where was the manuscript written and used, and why were these three texts specifically bound together? These are matters that offer grounds for additional research.


It seems obvious that Ms. 679 was intended as a work of reference, perhaps even as a textbook. The texts were copied with an accompanying commentary. Each section of the original text was discussed and commentated upon extensively. An easy to spot distinction between the original text and the commentary was made, as the words of the original texts were written in the space of two lines, and the commentary in the space of one. Additionally, initials that alternated between red and blue were used to distinguish between paragraphs and lines. The beginning of each chapter was indicated with a larger, decorated initial. Those found in the Aphorismi were even illuminated with gold-leaf. All signs point to a visual presentation of the manuscript that was optimized for a user that needed to quickly find what he was looking for.

Use of the manuscript

Moreover, the margins contain some user’s notes. At first glance they seem rather neat, unlike your stereotypical illegible doctor’s scribbles. As modern students mark their textbooks with highlighters, users of medieval manuscripts followed the fashion of drawing manicula, little hands with pointing fingers that literally pointed out important passages. At times, the manicula were supported the word ‘nota’: pay attention!

It’s striking that the manicula occur far more often at the beginning of the texts in Ms. 679. The first pages also appear far more dirt-stained than those that follow. One could imagine the user of the manuscript began an enthusiastic study of the text, but lost interest or motivation somewhere along the way. Apparently, that’s common for students throughout history…

Further reading

  • Baader, G., ‘Handschrift und Inkunabel in der Überlieferung der medizinischen Literatur’, in: E. Schmauderer (ed.), Buch und Wissenschaft: Beispiele aus der Geschichte der Medizin, Naturwissenschaft und Technik (Düsseldorf, 1969), p. 15-48.
  • Boyle C., The art of medicine: medical teaching at the University of Paris, 1250-1400 (Leiden, 1998).
  • Huizenga, E., Tussen autoriteit en empirie: de Middelnederlandse chirurgieën in de veertiende en vijftiende eeuw in hun maatschappelijke context (Hilversum, 2003).
  • MacKinney, L.C., ‘Medical education in the Middle Ages’, in: Cahiers d’Histoire Mondiale 2 (1955), p. 835-861.
  • Talbot, C.H., ‘Medical education in the Middle Ages’, in: C.D. O’Malley (ed.), The history of medical education : an international symposium held February 5-9, 1968 (Berkeley, 1970), p. 73-88.





    ca. 1300-1310
    Linda Brakenhoff, April 2017
    fol 2r., manicula
    fol 3r., notes in the margin
    fol 5v., initial
    fol. 30r, littera duplex
    Probetur sursum, fol. 65 v.

    Hippocrates, Aphorismi (with commentary by Galen); Hippocrates, Regimen Acutorum (with commentary by Galen); Galen, Ars Parva (with commentary by ʿAlī Ibn Riḍwān, in the translation by Gerard of Cremona). Utrecht, University Library, Ms. 679 (5 C 2)

    • France?, ca. 1300-1310.
    • Parchment, 160 fol., 285 x 197 mm.
    • Gothic textualis and hybrida in 2 columns, c. 60 lines.
    • Marginalia and manicula in various hands.
    • Initials decorated with goldleaf (f. 2v, 5v, 15v, 21v, 26v) and littera duplex (f. 30r, 39r). Pen decorations (f. 30r, 39r, 74r).
    • Post-medieval cover, paper flyleaves.
    • Chapter of St. Mary in Utrecht, transferred in 1811 to the University Library.