From the Canon to the Renaissance: The Changing Place of Therapeutic Touch

Introduction

In the first part of this series, we followed the practice of therapeutic rubbing through the classical world, where it formed part of a much broader approach to preserving health. For physicians such as Hippocrates and Galen, friction, anointing, exercise, bathing, diet and rest were closely connected. Touch was not yet a distinct therapy, but one element within a carefully regulated way of living.

As the political world of antiquity changed, this knowledge did not simply disappear. It travelled. Medical texts moved between Greek, Arabic and Latin-speaking cultures, copied and reinterpreted by successive generations of scholars. At the same time, practical knowledge continued beyond the written record—in homes, bathhouses, monastic infirmaries, childbirth rooms and the hands of surgeons and other healers.

There was no medieval profession corresponding directly to the modern massage therapist. Practices that we might now place under the broad heading of massage were described instead as rubbing, friction, anointing, stretching or manipulation. Their history is therefore not one of uninterrupted progress towards modern soft-tissue therapy. It is a story of touch repeatedly finding a place within changing ideas about the body, illness and recovery.

Avicenna (Ibn Sīnā, 980–1037): Friction as Part of a Healthy Life

At the beginning of the eleventh century, the Persian physician and philosopher Ibn Sīnā—known in Latin Europe as Avicenna—undertook the formidable task of bringing centuries of medical knowledge into a single organised system. The result was the Canon of Medicine, completed in approximately 1025.

Drawing heavily upon Greek medicine, particularly the writings of Galen, Avicenna combined inherited knowledge with the scholarship and clinical experience of the medieval Islamic world. The Canon would eventually become one of the most influential medical works ever written, studied across the Islamic world and later within European universities.

In its first book, devoted partly to the preservation of health, Avicenna discussed friction in considerable detail. He distinguished hard friction, which was thought to brace or strengthen the body, from gentle friction, which relaxed it. Prolonged or repeated rubbing was believed to reduce bodily bulk, while more moderate treatment was associated with maintaining or building the body. He also differentiated rough rubbing with a cloth from gentler treatment performed with the hands (Çetkin, Bahşi and Orhan, 2019).

Friction also surrounded exercise. Preparatory rubbing began gently and became progressively more vigorous, awakening the body’s innate heat and preparing it for movement. Restorative rubbing followed exercise—or began as exertion drew to an end—and was usually performed with oil. Pressure and pace gradually became lighter as bodily tension subsided. Stretching might follow, after which the treated area could be covered with a cloth.

These practices belonged to a humoral understanding of medicine. The body was thought to depend upon the balance and movement of its constituent humours, qualities and innate heat. Friction helped to open the pores and disperse superfluous substances believed to accumulate through exertion. Gentle and restorative rubbing could promote relaxation, but it remained part of a much wider regimen involving diet, bathing, exercise, sleep, ageing and the environment.

Avicenna’s particular achievement was to organise these inherited practices into a coherent system. In the Canon, therapeutic touch was neither an isolated remedy nor a simple luxury. It formed part of a sophisticated programme for preparing the body, recovering from exertion and preserving health throughout life.

Constantine the African (d. before 1098/99): Knowledge Crosses the Mediterranean

While Avicenna was transforming medical thought in the East, another chapter in the history of medicine was beginning in southern Italy.

During the later eleventh century, Constantine the African arrived from North Africa and eventually entered the Benedictine monastery of Monte Cassino. He brought with him Arabic medical works that were largely unavailable in the Latin West and began translating and adapting them for a new audience.

His most influential undertaking was the Pantegni, a Latin adaptation derived principally from the Complete Book of the Medical Art by the tenth-century Persian physician ʿAlī ibn al-ʿAbbās al-Majūsī, known to Latin readers as Haly Abbas. The Pantegni offered Latin Europe one of its first comprehensive medical textbooks, covering both medical theory and practical treatment (Burnett and Jacquart, 1994; Kaltio, 2023).

Movement, friction and bathing appeared within a wider regimen concerned with food, sleep, environment and the preservation of bodily balance. The history of the text also illustrates how unevenly knowledge could travel. Parts of its practical section circulated in incomplete or reconstructed forms, while later copyists supplied missing material from other sources.

Medieval medicine was not transmitted through a perfectly preserved chain of authoritative books. It survived through translation, adaptation, abbreviation and sometimes creative reconstruction. Constantine’s importance lies in that process of transmission. His work helped carry an extensive body of Greek and Arabic medical learning into the schools, libraries and emerging universities of Latin Europe.

The Medieval West: The Persistence of Hands-on Care

It is sometimes suggested that massage disappeared during the Middle Ages because the Church regarded illness principally as a spiritual matter. Medieval healthcare was considerably more complex.

Prayer, confession, relics and pilgrimage could coexist with medicines, dietary regulation, bathing, surgery and physical care. Monasteries maintained infirmaries and medicinal gardens, while treatment was also provided by physicians, surgeons, apothecaries, midwives, household healers and members of the patient’s family. Religious and practical responses to illness were not necessarily viewed as contradictory.

Manual treatment rarely appeared as an independent discipline. Rubbing might help an ointment penetrate or spread across the skin. Manipulation belonged to the treatment of fractures and dislocations. Bathing could be followed by friction and anointing, while much everyday comforting and therapeutic touch remained within domestic care and consequently left little written trace.

The apparent absence of specialised massage manuals therefore does not demonstrate that therapeutic touch had vanished. Instead, it reflects the categories through which medieval people understood and recorded healthcare. Touch survived as one component of medicine, surgery, bathing, nursing and household treatment rather than as a separate profession.

Hildegard of Bingen (1098–1179): Remedies for Body and Soul

Within the religious world itself, Hildegard of Bingen offers a vivid example of the relationship between spiritual and physical medicine.

Hildegard was an abbess, visionary, composer and writer whose works explored theology, nature and the causes of illness. The texts conventionally known as Physica and Causae et Curae describe the medicinal properties of plants, animals, minerals and other natural substances, alongside broader reflections on the human body and its place within creation.

Her medicine drew upon humoral ideas, monastic learning, observation and a distinctive theological vision. Health involved order within the body, but it also reflected harmony between the individual, the natural world and divine creation. As Victoria Sweet (1999) observes, Hildegard frequently presented healing as the restoration of conditions in which the body’s own vitality could re-emerge.

Rubbing appears within her remedies, usually as a means of applying medicinal preparations. In one example, rose and sage were combined with fat to produce an ointment that could be rubbed onto an area affected by cramp or paralysis. Elsewhere, herbal oils and ointments were applied to painful or diseased parts of the body (Hildegard, trans. Throop, 1998).

Hildegard did not present these practices as a formally organised system of massage. Nevertheless, her writing demonstrates that close attention to the physical body could coexist with a profoundly Christian understanding of nature, health and the soul. The body was not simply an obstacle to spiritual life; it was part of the created world and therefore deserving of informed care.

Trota and the Trotula: Women’s Medicine and Many Hands

From Hildegard’s Rhineland monastery, the story returns to southern Italy and the culturally diverse medical world of Salerno.

For centuries, a group of influential medieval texts on women’s health was attributed to a female physician called Trotula. Modern scholarship has revealed a more complicated history. Trota of Salerno was a genuine female medical practitioner, but the Trotula was not a single book written entirely by her. It is an ensemble of three twelfth-century works—the Conditions of Women, the Treatments for Women and Women’s Cosmetics—which originated separately and were later brought together.

Only the Treatments for Women is closely associated with Trota, and even this work appears to preserve material gathered from several hands. Her reputation was nevertheless strong enough for later readers to attach her name to the entire collection (Green, 2001; 2002).

The Trotula offers a rare view of women’s healthcare in which learned medicine, domestic practice and the experience of women caring for other women intersected. Rubbing and anointing appear in a range of treatments. One remedy recommends moderate rubbing of the hands and feet with laurel oil. Rose oil and vinegar were applied to swollen feet during pregnancy, while bathing, anointing and vigorous rubbing could form part of the physical assistance provided during a difficult labour.

Other treatments combined manual care with fomentations, ointments, fumigation and bandaging. Touch did not stand alone; it belonged to a wider therapeutic setting in which heat, medicinal substances, positioning, bodily assistance and close observation worked together.

These texts also remind us how much care was delivered through relationships that formal medical histories have often overlooked. The hands involved may have belonged to midwives, attendants, household healers, relatives or other women whose knowledge was practical and orally transmitted. Their identities may be lost, but traces of their work remain within the written remedies.

Guy de Chauliac (c. 1300–1368): The Skilled Hand of the Surgeon

By the fourteenth century, hands-on treatment occupied a firmly established place within surgery.

Guy de Chauliac was a university-trained physician and cleric who studied at Montpellier and Bologna before serving the papal court at Avignon. He lived through the Black Death and described his own experience of the disease, but his enduring reputation rests upon the Chirurgia Magna, or Great Surgery, completed in 1363.

The work assembled Greek, Arabic and Latin surgical learning alongside Guy’s own experience. It examined wounds, ulcers, swellings, fractures, dislocations and numerous other conditions, becoming one of the most widely used surgical texts in Europe (Watters, 2013).

Within this surgical system, touch was indispensable. Examination began with the hands: feeling the injured area, assessing displacement and determining how the structures of the body had changed. Fractures and dislocations required extension, manipulation, reduction, positioning and bandaging. Oils, ointments and compresses could accompany these interventions, particularly in the treatment of painful injuries and swelling.

Guy’s relevance to the history of massage lies within this broader field of manual medicine. His work shows how touch operated simultaneously as a diagnostic tool and a means of treatment. Long before massage became a separate discipline, the trained hand was already central to the understanding and management of physical injury.

The Renaissance: A New Visibility for Old Practices

The Renaissance did not bring therapeutic touch back from extinction. Instead, it changed the ways in which medical knowledge was recovered, examined and circulated.

Humanist scholars searched for Greek and Roman manuscripts, compared different versions of ancient texts and produced new translations. The development of printing allowed medical works to reach far larger audiences, while anatomical investigation encouraged closer attention to the physical structures of the body. Old practices became newly visible within this changing intellectual world.

One of the most important figures in Renaissance surgery was Ambroise Paré. Born around 1510, Paré entered medicine through the practical world of French barber-surgery rather than the university. His work on military campaigns exposed him to gunshot wounds, amputations, fractures and dislocations on a daunting scale.

Experience encouraged him to question some of the most aggressive treatments of his day. He famously abandoned the routine use of boiling oil for gunshot wounds after his supply ran out, later observing that patients treated with a gentler dressing suffered less pain. Although the episode was not directly concerned with massage, it reflected a principle that would characterise much of his work: inherited authority had to be tested against observation.

Paré’s contribution to manual treatment is clearest in his management of fractures and dislocations. Drawing upon Hippocrates, Galen, Avicenna and earlier surgical writers, he described careful extension of the limb, restoration of the displaced joint, secure bandaging and appropriate positioning (Markatos et al., 2018).

These procedures were not massage in the modern sense, but they placed controlled, purposeful touch at the heart of treatment. Paré’s combination of inherited knowledge, practical experience and close observation helped make skilled manual intervention a defining feature of Renaissance surgery.

Girolamo Mercuriale (1530–1606): Recovering the Medicine of Exercise

Another important Renaissance figure was the Italian physician and humanist Girolamo Mercuriale, also known as Hieronymus Mercurialis.

While studying ancient manuscripts in Rome, Mercuriale became fascinated by Greek and Roman ideas about exercise, bathing and bodily training. His research culminated in De arte gymnastica, first published in 1569. Richly illustrated in its later editions, the work examined ancient gymnastics not simply as athletic competition, but as a branch of medicine concerned with preserving health and treating illness.

Mercuriale considered how physical activity should be adapted to a person’s age, health, strength and circumstances. He distinguished between different forms and intensities of exercise and explored how movement could be incorporated into a regulated way of life. Rubbing, anointing, bathing and recovery belonged to this same bodily regimen (McIntosh, 1984; Mercuriale, 2008).

De arte gymnastica became a landmark in the development of medical gymnastics. Mercuriale was reconstructing ancient practices, but he also adapted them to the medical and intellectual concerns of his own century. Through the medium of print, he made the relationship between exercise, bodily preparation and recovery visible to a new European audience.

There is an appealing symmetry here. In Avicenna’s Canon, written more than five centuries earlier, friction had accompanied exercise within a humoral system of health preservation. In Mercuriale’s Renaissance study, exercise, bathing and rubbing were once again brought together—this time through humanist scholarship, anatomical curiosity and the expanding world of printed medicine.

Conclusion

The history of therapeutic touch during the medieval and Renaissance periods is not a story of disappearance followed by rediscovery. It is a story of survival, movement and adaptation.

Across these centuries, a varied family of manual practices endured: rubbing with the hand or cloth, applying oils and ointments, preparing the body for exercise, easing it afterwards, stretching limbs, manipulating joints and incorporating touch into everyday care. These practices crossed languages, religions and professional boundaries. They appeared in Arabic medical encyclopaedias, Latin translations, monastic remedies, women’s medicine, surgical texts and Renaissance studies of exercise.

The explanations surrounding them changed. Avicenna described friction through innate heat, pores and the dispersal of superfluous substances. Constantine helped carry this wider medical tradition into Latin Europe. Hildegard placed the material body within the order of divine creation, while the Trotula preserved glimpses of the practical knowledge shared among women. Guy de Chauliac and Ambroise Paré embedded manual skill within surgery, and Mercuriale returned exercise, bathing and bodily preparation to the centre of scholarly discussion.

By the end of the Renaissance, therapeutic touch had not yet become a distinct or standardised profession. That transformation would depend upon new understandings of anatomy and physiology, changing attitudes towards exercise and rehabilitation, and the eventual development of recognisable systems of physical and manual therapy.

William Harvey’s account of the circulation of the blood, published in 1628, would help to change how the internal body was understood. That discovery, together with the scientific, industrial and medical transformations that followed, belongs to the next chapter in the history of healing touch.

References

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Watters, D.A.K. (2013) ‘Guy de Chauliac: Pre-eminent surgeon of the Middle Ages’, ANZ Journal of Surgery, 83(10), pp. 730–734.