Suffering from a skin ulcer? French physician Bernard de Gordon would suggest an unconventional remedy: Apply a ground-up pomegranate boiled in vinegar.

Unconventional by today's standards, that is. Bernard was treating patients more than 700 years ago.

Medieval medicine is generally scoffed at by modern physicians, to the extent they give it a moment's thought. But an international group of scholars thinks that, in some cases, these early practitioners may have been on to something.

Cynthia greer / Staff Artist

Two years ago, the researchers found that one medieval remedy, said to be a cure for eye infection, did indeed kill bacteria in laboratory tests. Now Erin F. Connelly, a team member at the University of Pennsylvania, is expanding the quest to include thousands of ingredients cited in Bernard's writings, in hopes that they might be useful today.

Using statistical techniques, she is looking for combinations of herbs, fruits, and other additives that crop up again and again in the nearly 500-page Lylye of Medicynes, a Middle English translation of a medical text that Bernard wrote in 1305.

The idea is that repeated use of certain mixtures may have been the result of experimentation.

"Were these actual antibiotics being used long before the modern science of infection control?" said Connelly. "Or was this just a lucky combination of ingredients?"

It is not far-fetched to imagine that ancient medicine might yield modern treatments, as it has happened before.

Aspirin is based on a substance in the bark of the willow tree, first used in ancient Sumer and Egypt. And artemisinin, a treatment for malaria, is derived from wormwood, a plant used in long-ago Chinese remedies. Scientist Youyou Tu shared  the 2015 Nobel Prize in Medicine for that discovery.

Other modern researchers have studied the remedies of native cultures in South America and Africa. But traditional medicine from Europe has, until recently, been largely ignored, said Freya Harrison, an assistant professor of microbiology at the University of Warwick, in England.

"We thought it not as good as anybody else's," Harrison said. "That it's all placebo. It's all superstition."

wellcome library, London
Oil painting of Bernard de Gordon, whose medicinal recipes from the early 1300s are being studied at Penn and elsewhere for possible use against modern drug-resistant bacteria.

In 2014, then at the University of Nottingham, Harrison co-founded the group to study medieval remedies, along with Christina Lee, an associate professor of Viking studies in Nottingham's School of English. They dubbed it the AncientBiotics Project.

The interdisciplinary team now includes a dozen members from institutions in the United Kingdom and the United States, representing such varied fields as chemistry, pharmacology, immunology, and medieval studies.

Connelly, who joined the team while studying at Nottingham, is interdisciplinary all by herself.

She earned her undergraduate degree in biology from Calvin College, in Grand Rapids, Mich., working in a molecular oncology lab during her senior year. She also took courses in Old English, Middle English, and Latin, both out of pure interest and because she hoped to apply that expertise to the study of ancient medicine. At Nottingham, she earned a Ph.D. in medieval English, and now is in the midst of a two-year fellowship at Penn.

"The arts and sciences are often presented as diametric opposites," she said. "But I have seen the great value in incorporating experts from the arts and the sciences to yield results greater than individuals or individual disciplines acting in isolation could accomplish."

Harrison, the British microbiologist, welcomes Connelly's mix of skills.

"It's very unusual to find someone like Erin," she said. "Not only does she have the biomedical science background, and her understanding of these manuscripts, but she wants to look at them in a very quantitative, analytical way."

Based on her work so far, Connelly says at least some medieval treatments were not simply the result of haphazard mixing of ingredients.

In Bernard's Lylye of Medicynes – so named because the text unfolds like the structure of a lily plant – the French physician writes of experimenting with different ingredients, and altering treatment plans based on observation, she said.

Then again, some of it sounds a bit silly to modern ears.

To alleviate coughing fits, the book suggested that the patient "holde ofte his brethe as myche as it is possible."

That is how it was written in the Middle English version that Connelly is using, from the early 15th century, the lone copy of which is housed at Oxford's famed Bodleian Library. The original was in Latin (titled Lilium Medicinae), and was translated into Hebrew, Irish, Spanish, and French over four centuries, a mark of its widespread influence.

Connelly is entering the ingredients into a database so she can analyze the combinations and how often they appear.  She also is preparing the first modern edition of the Lylye, meaning she has transcribed and edited the text and is writing a detailed commentary. For her fellowship at Penn, funded by the Mellon Foundation and the nonprofit Council on Library and Information Resources, she also is helping to digitize medieval manuscripts at 15 Philadelphia-area institutions.

Connelly cautioned that audiences accustomed to the medicine of today should not be too quick to dismiss medieval treatments.

"Maybe for some of the things we're doing, we're going to be considered barbarians in the future,"  she said.

It is curious that Oxford's Middle English version of Bernard's volume is missing some pages that are in the original Latin, and some sections are out of order. That suggests it was a tool for working practitioners, the long-ago equivalent of today's physicians double-checking treatments or symptoms on their smartphones, she said:

"This wasn't just a display piece. Probably, people were taking bits and pieces of it out to carry with them."

The first remedy that the team studied, the one said to cure an eye infection, was written in the 10th century, long before Bernard de Gordon, in a volume called Bald's Leechbook. It calls for the practitioner to crush some garlic and a related plant, then combine them with wine and the bile of a cow. The mixture is then left to stand in a brass vessel for nine days.

british library board
A thousand-year-old recipe for treating an eye infection, from a volume called Bald's Leechbook, was found by modern-day scientists to have antimicrobial properties.

When the team found it killed staph bacteria, that opened a multitude of follow-up questions. Alcohol has antimicrobial properties, as do garlic and its relatives, though the latter are not terribly strong on their own. Did the mixture work because of the combined effects of the various ingredients?  Or was it the result of some new compound created by allowing the mixture to steep in alcohol, a potent solvent? Or both?

Then there is the question of whether the remedy can kill bacteria without harming human cells. So far, results on that score are promising, said Harrison.

The group plans similar study of ingredients from Bernard de Gordon's work. Research is underway on one recipe that the French physician praised for its ability to alleviate poor vision in the elderly, though the team's primary interest is in potential antibiotics.

It is a complex task, in part because names of some ingredients have changed, as have the names of certain diseases that Bernard described.

Still, the physician's attention to detail and compassion for his patients are clearly evident. He writes of ailments that are more prevalent among the poor, and of lower-cost treatment options when available. He observes. He experiments. He draws conclusions.

And in those respects, compared with Connelly and her colleagues, he is no less modern.

erin f. connelly
A word cloud showing the most common terms in the Middle English translation of Lylye of Medicynes, an ancient medical text by French physician Bernard de Gordon.