Tag Archives: Caleb Prus

A Cure for Cardiacle: Making and Tasting a Medieval Remedy for Heart Ache

By Caleb Prus

Grief often feels as physical as it does emotional—like a weight on the chest, a flutter of the heart, or a tightening in the throat. The distinction between these physical and emotional symptoms is largely a product of modern medicine; in the premodern world, those boundaries were far blurrier. In The Canterbury Tales (c.1390), Chaucer’s Physician tells a story so tragic that the Host cries out, “I almost have caught a cardiacle”—a heart pain brought on by pity and sorrow—and begs for a drink of ale before he collapses from grief. But what exactly was a “cardiacle,” and how might a medieval ale have helped? As both a medical student and a scholar of medieval medicine, I set out to answer these questions, by recreating a centuries-old recipe—and tasting for myself how people in the Middle Ages tried to ease heartache.  

The Death of Fébus (d. 1391). Chronicles of Froissart, London, BL, Harley 4379 (c.1470-1475), f. 126. Public Domain.

The cardiacle feared by Chaucer’s Host was a broad diagnosis for heart-related distress. It referred to chest pain, palpitations, and fainting spells—what we might now call angina, arrhythmia, syncope, or even a heart attack. But for medieval people, living centuries before the discovery of circulation, the heart wasn’t a pump. It was the seat of feeling, emotion, and spirit. A sudden wave of grief, or an excess of melancholy (black bile) could literally make the heart sick. This is why the Host panics after the Physician’s Tale: he fears that sorrow itself might give him a cardiacle. And while this diagnosis is rooted in humoral theory, this link between emotion and cardiac dysfunction is supported by modern medicine. Today, we recognize conditions like Takotsubo Cardiomyopathy, commonly known as “broken heart syndrome,” in which acute emotional stress can lead to temporary heart failure.

Given its literary and medical prominence, I was intrigued when I came across a remedy for cardiacle in a Middle English medical manuscript. The recipe was simple, direct, and surprisingly easy to recreate:

For the cardiacle

Take gallynggale, gyngeuer and licoris, with fynel; seth and make to poudre, and drynke with stale ale.

The remedy is, essentially, a spiced ale—something Chaucer would have readily recognized. In The Miller’s Tale, he writes that the barber-surgeon Absolon woos his beloved with “spiced ale,” and in the Tale of Sir Thopas, Chaucer lists licorice, zedoary, cloves, and nutmeg as flavorings “to putte in ale / wheither it be moyste or stale.” This recipe for cardiacle is a variation on this familiar tradition, blending licorice, ginger, galangal, and fennel into a warming, aromatic drink.

Ingredients used to recreate the remedy for cardiacle.

The ingredients were surprisingly easy to source. The instruction to “seeth” the herbs likely referred not to boiling but to drying and dehydrating them, preparing them to be ground into powder with a mortar and pestle. At my local spice shop, I found dried fennel seeds, ginger pieces, and licorice root, all ready for grinding. For the galangal, which I bought fresh-frozen from an Asian grocery store, I dehydrated slices at 250°F for several hours until they were brittle enough to crush. 

Finding the right ale proved more challenging. Medieval ale was quite different from today’s beer: unhopped, malty, and slightly sweet, often brewed with a mix of herbs or bittering agents in a style now referred to as gruit. It was also regularly consumed while it was still fermenting or allowed to settle into “stale” ale, as the recipe directs. Without the means to brew my own gruit, I settled on Samual Smith’s Nut Brown Ale, a low-hop British ale with a mellow maltiness and smooth body—about as close to a medieval ale as I could get off the shelf.

On brew day, I laid out my ingredients and began grinding them by hand with a mortar and pestle. Following the proportions implied by the recipe, I used equal parts of each herb, about half a teaspoon per ingredient, mixed into one cup of gently warmed ale. The resulting drink smelled strongly of fennel and licorice. Its taste was intense: sweet, earthy, and medicinal, with a lingering licorice bitterness on the tongue. Hoping to make the potion more palatable, I reduced the quantities to just a pinch of each spice for the second batch. Even then, the licorice dominated, its sweetness overwhelming the other flavors. The drink was also course and gritty. Since the recipe offered no instruction to strain it, I left the powder in the cup, which resulted in heavy sediment that clung to the teeth. 

Warmed ale after the addition of ground spices.

In the end, the potion was challenging to drink—a sensory shock to a modern palate more accustomed to hoppy beers than to bitter, spiced tonics. Its flavor was unmistakably medicinal and sweet, dominated by the taste of fennel and licorice. Yet I suspect the experience would have been quite different for a medieval drinker. The unhopped, malty base of a traditional ale would likely have complemented the sharper notes of the spices. And while modern drinkers tend to associate black licorice with cough syrup or candy, that connotation may not have existed in the medieval period. To medieval tastes, this kind of spiced ale may have been not only palatable but genuinely comforting.  

As The Canterbury Tales continues, the pilgrims stop at an alehouse, allowing the Host to finally get the draught of ale he so desperately craves. The Physician and his potions are nowhere to be found in this scene—but perhaps that’s the point. The physical and emotional dimensions of cardiacle were deeply intertwined, and so too was its cure: a warming drink, shared among fellow travelers, to soothe the heart in both body and spirit. In the end, Chaucer’s Host wasn’t simply asking for ale; he was reaching for spice, for solace, and for the ritual comfort of drinking in good company.


Caleb Prus is a 4th-year MD candidate at the University of Rochester School of Medicine. He holds a MSt in English (650-1550) from the University of Oxford and a BA in English Literature and Chemistry from the University of Rochester. His Master’s dissertation studied the use of Middle English bloodletting texts by John Tyryngham, a fifteenth-century Londoner. He has presented his research at the Leeds International Medieval Congress, the Kalamazoo International Congress on Medieval Studies, the American Association for the History of Medicine Annual Meeting, and the Corner Society for the History of Medicine.

 

On Medical Manuscripts in Reynolds’ Reading Practice

By: Caleb Prus

Euricius Cordus (1486-1535), Fur die newe, hievor vnerhorte und erschrocklich todtliche Kranckheyt und schnellen todt, die English schweyee-sucht geant (Strassbourg: 1529). Image courtesy of the Wellcome Collection.
Euricius Cordus (1486-1535), Fur die newe, hievor vnerhorte und erschrocklich todtliche Kranckheyt und schnellen todt, die English schweyee-sucht geant (Strassbourg: 1529). Image courtesy of the Wellcome Collection.

In 1485, during London’s first epidemic of the sweating sickness, the physician Thomas Forestier complained to Henry VII about certain “false leeches” healers deceiving the public through “writing of the kind[s] of powders and of medicines.” These “unexpert men” were not university-educated physicians like Forestier but ordinary tradespeople “carpenters and mill keepers”who boldly posted their medical writings on the city’s gates and church doors. How did people like carpenters and mill keepers, once excluded from specialized knowledge, come to participate in the exchange of written medical information alongside elite physicians? And why was Forestier so alarmed that the writings of common tradespeople had become more persuasive to some Londoners than those endorsed by esteemed medical authorities?

Melissa Reynolds’ Reading Practice: The Pursuit of Natural Knowledge from Manuscript to Print answers these questions by tracing the cultural and historical development of what she calls the “practical manuscript.” Of the impressive 182 medieval manuscripts surveyed in her study, most contain some form of medical recipe, treatise, or charm that would have been available to the literate public. Their broad appeal is evident in the diverse array of manuscript ownersfrom priests like Peter Cantele, to prominent families such as the Pastons and Tyrynghams, to amateur surgeons like Nicholas Neesbett. These books were prized not only for the knowledge they contained but also for their material, social, and intellectual value. As Reynold notes, “acquiring and possessing knowledge was often more important than organizing or analyzing that knowledge” (34). In a time of crisis, simply owning a practical manuscript, regardless of whether it was authored by a carpenter, a mill keeper, or a learned physician, might have provided Londoners with a sense of security.

Reynolds ultimately uncovers the significant role of practical manuscripts in shaping premodern medicine. One of the most compelling aspects of Reading Practice is her exploration of the shift from reliance on established textual authority to a culture of experimentation. In the fifteenth century, compilers of practical manuscripts showed great deference to authority, often without much concern for verifying authenticity. However, as the century progressed, readers like Nicholas Neesbett began to claim their own authority by incorporating experiential knowledge. They were willing to experiment—adding a word to a charm or modifying an ingredient in a recipe—in order to better meet their practical needs. This transition not only reflects a pragmatic approach to medicine but also marks an important step towards the empirical methods that would later define early modern science and medicine. It was this everyday medical writing of the “non elite,” that helped to make “the hard-won but fleeting knowledge of experience durable.” (95).

Medical recipes and charms for horses, First quarter of the 15th century, MS Dd.4.44, Cambridge University Library.
Medical recipes and charms for horses, First quarter of the 15th century, MS Dd.4.44, Cambridge University Library. You can link through to the whole source by clicking here.

Importantly, these manuscripts did not vanish with the rise of the printing press. Reading Practice tracks the afterlife of these texts well into the sixteenth and early-seventeenth century, highlighting their continued circulation among a variety of owners. Collectors like Henry Dyngley and Thomas Dib—whose surviving libraries are only now being reconstructed—demonstrate that these manuscripts retained their value long after their original production. They were cherished by royal astrologers like John Dee and Simon Foreman, by royal surgeons like Sir John Ayliff and John Gerard, by barber-surgeons like John Smerthwaite and William Gale, and by tradesmen like William Thorowgood and John Young. This remarkable survival mirrors the journey of many medical texts themselves as they transitioned from manuscript to print. As Reynolds argues, the medical content of practical books changed very little between 1400-1600. It wasn’t until the 1550s, when printers began to publish new works that evoked experiential authority, that the landscape of medical knowledge began to trend toward newer methods of empiricism.

In the aftermath of the COVID-19 pandemic, Reading Practice could not be more relevant to modern readers. Reynolds reminds us that in the premodern era “English people were largely on their own to work out what they believed, what they valued” (201). The explosion of written medical knowledge in practical manuscripts, accelerated by the advent of print culture, made navigating this flood of information more daunting. Today, as we sift through health advice in increasingly unmoderated online spaces, we find ourselves in a similar predicament. Just as early Londoners turned to church doors in search of medical wisdom, we now rely on our screens to guide us through the sprawling digital marketplace of information. And just as Thomas Forestier once felt powerlessness in a “free-for-all” market of medical texts, today’s physicians struggle to maintain an authoritative voice in the deluge of online data. 

Caleb Prus is a 3rd-year MD candidate at the University of Rochester School of Medicine. He holds a MSt in English (650-1550) from the University of Oxford and a BA in English Literature and Chemistry from the University of Rochester. His Master’s dissertation, supervised by Dan Wakelin, studied the use of Middle English bloodletting texts by John Tyryngham, a fifteenth-century Londoner. He has presented his research at the Leeds International Medieval Congress, the Kalamazoo International Congress on Medieval Studies, the American Association for the History of Medicine Annual Meeting, and the Corner Society for the History of Medicine.