Abstract
The anatomic and medical knowledge of people throughout history is unexpectedly evident in some of the poems and texts written by intellectuals of the time. This article attempts to understand the conception of laryngology in the Middle Ages by analyzing the Divine Comedy, written by the Italian poet Dante Alighieri (1265-1321) at the beginning of the 14th century. In the text, Dante mentions the throat several times. He recognizes that the larynx has the dual functions of allowing respiration (dead souls recognize that the poet is alive through movement of his throat when breathing) and speech (souls with their throat cut cannot speak). However, Dante does not seem to know of the existence of vocal cords, thinking that it is the tongue that allows for word formation. In general, Dante’s poem indicates that the anatomy and function of the throat were known during the medieval period, although this knowledge was not precise.
The history of medicine is generally based on the study of medical authors and their works. 1 Information regarding the medical knowledge and practices of the Middle Ages does not only come from strictly medicine-related texts. In fact, it was common at the time for intellectuals to receive education not just in literature, history, or philosophy but also in more technical and scientific fields, including the medical field. Thus, it is sometimes possible to find accurate anatomic and pathologic descriptions in poems and other nonmedical texts.
This is the case of the Italian poet Dante Alighieri (1265-1321), whose 700th anniversary of death occurred in 2021. With his literary works, Dante shaped the Italian language as well as European medieval literature as a whole, influencing his contemporary authors and those of subsequent generations. His masterpiece La Divina Commedia (the Divine Comedy), describes the allegoric and didactic travel of Dante himself through the realms of Inferno (Hell), Purgatorio (Purgatory), and Paradiso (Heaven) to find Beatrice, the woman he loves, as well as salvation for his own soul. Written at the beginning of the 14th century, the poem is composed of 100 cantos, in which Dante, accompanied by the Latin poet Virgil, views and speaks with damned souls, including classical characters, politicians, literates, philosophers and even saints.
It is not commonly known that Dante was also instructed in the scientific and medical knowledge of the time, heavily influenced by classical authors such as Hippocrates and Galen, 2 whose texts all intellectuals were required to study. In 14th-century Florence, only physicians could wear red clothes similar to the ones in which Dante is often depicted. Dante often traveled to Padua and Bologna during his youth to attend lectures held at the cities’ universities; as such, the probability that he gained some medicine-related knowledge while at these universities is high. 3 In addition, Dante was a member of the Florentine Guild of Physicians and Apothecaries (Ars Medicorum et Spetiariorum). 2 One can find proof of Dante’s medical interests in many of his literary works, a number of which contain detailed descriptions of several organs and their functions as well as descriptions of pathologies and medications.4-6 For example, neurologic diseases, such as epileptic seizures and narcolepsy, 7 as well as the thyroid goiter 8 are mentioned in his works, but it is also possible to find descriptions related to laryngology.
Dante and Laryngology
According to Dante’s view of anatomy, the main organ devoted to phonation is the tongue. Through many of his descriptions, it is possible to see how this belief was rooted in Dante’s culture and education. For example, in Inferno Canto XXV 133, when Dante witnesses the metamorphosis of the thieves’ souls, he describes the tongue of one thief as being “apt for speech.” 9 Something similar can be seen in Inferno Canto XXVI 89, when Dante is in the Eighth Bolgia in front of 2 famous fraudulent counselors: Ulysses and Diomedes. When he hears the flame in which the 2 souls are imprisoned, he compares it to a tongue: “Moving as if it were the tongue that spake / It uttered forth a voice.” 9
However, in Dante’s descriptions of Hell, it is also possible to see how important the souls’ throats are described to be. In Inferno Canto XXIII, Dante meets the shadows of the hypocrites, who wear golden clothes made of lead. Here, 2 damned souls recognize Dante by the movement of his throat: “He by the action of his throat [gola] seems living; / And if they dead are, by what privilege / Go they uncovered by the heavy stole?” 9 Dante’s respiration, seen from afar through the motion of his larynx and not of his nostrils, reveals that he is still alive and that he is not yet covered by “the heavy stole” of death.
With this in mind, it is possible to argue that Dante believed that the tongue is in charge of phonation, while the throat is devoted to respiration. However, there is another description in the Divine Comedy that could cause one to rethink this assumption. In Inferno Canto XXVIII, Dante meets in the Ninth Bolgia the sowers of discord and scandal and the creators of schism within the papacy, who are damned to be slashed by a devil with a sword and who, depending on their sin, are shown to have different mutilations ( Figure 1 ). Here, Dante meets Curio, the Roman soldier who convinced Caesar to cross the Rubicon river, eventually causing the civil war between Pompey and Caesar. Curio has his throat cut, and he cannot speak: “O how bewildered unto me appeared, / With tongue asunder in his windpipe slit [strozza], / Curio, who in speaking was so bold!” 9 In this case, the larynx is recognized as being fundamental not only for breathing but also for speaking. Previously, Dante had defined the throat of another soul, Pier da Medicina, as a pipe (canna). 2 The definition highlights the fact that Dante likely knew the anatomy of the larynx very well, as Pier, who has only a hole in his throat, can speak whereas Curio cannot. Dante almost certainly did not know about the existence of the vocal cords, but one can infer from his work that he knew about the importance of the throat in phonation. In addition, he wrote about the tongue being related to phonation in a metaphoric sense, as seen in Inferno Canto XXVI, when Dante wants to talk to Ulysses and Diomedes, and Virgil tells him to “take heed that thy tongue restrain itself.” 9
Dante and Virgil meet Pier da Medicina and Curio. Illustration by Gustave Doré.
Conclusion
It is evident that medieval poems, even if unrelated to medicine, can provide information about the anatomic and medical knowledge of the time in which they were written. One great example is the work of Dante Alighieri, whose masterpiece the Divine Comedy contains many anatomic, physiologic, and pathologic references, among which are some related to laryngology. The throat and particularly the larynx are given great importance in the Divine Comedy, in which the words are mentioned several times. Dante attributes 2 major functions to this system: respiration and speech. In the Divine Comedy, Dante’s character is easily distinguished from the dead souls because of the movement of his larynx, described as a pipe, which allows him to breathe and be alive. He believes that it is air passing through the throat and then over the tongue that produces phonation. The fact that the ability to articulate words is attributed to the tongue implies that the existence of vocal cords was unknown at the time. Additionally, mutilations to the souls’ throats are implied to prevent them from speaking.
In conclusion, Dante’s work seems to provide precious information about knowledge of the anatomy and physiology of the larynx in the Middle Ages. The descriptions in the Divine Comedy gain more value when one considers Dante’s medical training during his academic education. It should be noted that human dissections were performed in the last decades of the 13th century in northern and central Italy, 10 so it should come as no surprise that Dante may have attended a necroscopy. Modern historians of laryngology should not underestimate the value of information that could be gathered from nonmedical works, including poetry and other literary texts.
