Full content for this article includes table and illustration.

Source: Nutrition Today, May-June 1992 v27 n3 p13(13).

Title: Aztec patterns and Spanish legacy. (Nutrition Past - Nutrition
Today: Prescientific Origins of Nutrition and Dietetics, part 4)
Author: Louis E. Grivetti

Subjects: Aztecs - Food and nutrition
Native Americans - Medicine
Medicine, Ancient - Nutritional aspects
Allopathy - History
Dietetics - History
Spaniards in Mexico - Food and nutrition

Electronic Collection: A12448850
RN: A12448850

Full Text COPYRIGHT 1992 Lippincott/Williams & Wilkins

For thousands of years the peninsula of Iberia in southwestern Europe was a
crossroads of competing cultures, civilizations and religions. Roman patterns
of allopathic medicine with accompanying hot-cold designations were introduced
there several centuries before the Common Era. Situated on the Mediterranean
western rim, Iberia was intellectually isolated from the Greek medical
teaching centers. This isolation changed, however, as a result of three
historical events: the Jewish diaspora after the Roman conquest of Jerusalem
in the 1st century A.D.; the domination of Christianity throughout
Mediterranean lands in the 4th century; and the rise of Islam in the Arabian
peninsula and its spread across northern Africa during the 7th century A.D.

On July 19th, in the year 711 A.D., Mushm armies massed in northwestern Africa
and invaded Iberia. One result of this African religious invasion of Europe
was an astonishing cultural transformation, a fusion of
Christian-Jewish-Muslim art and architecture, culture and language and
medical-nutritional practices. In the centuries after this invasion there
evolved in southern Iberia a unique medical system that integrated Christian,
Jewish and Muslim traditions. Three complementary systems of allopathic
medicine and "hot-cold' concepts were taught at universities and medical
schools at Cordova, Granada and elsewhere.

As Europe declined into the Dark Ages, two great geographical centers of
enlightenment and learning emerged in the Mediterranean basin: an eastern
complex that included physicians who practiced in the great eastern cities of
Antioch, Baghdad, Cairo, Constantinople, Damascus and Jerusalem, and a western
cluster of universities in Iberin. Later, a third center of medical thought
developed during the 11 th and 12th centuries on the Italian peninsula,
expressed by important contributions from the hospital at Monte-Casino. Most
influential of the Italian medical schools, however, was Salerno, near Naples,
a center of Christian, Jewish and Muslim intellectual leadership whose
publications influenced Iberian allopathy into the 16th century at the time of
the Spanish Portuguese voyages of exploration.

SALERNO AND THE REGIMEN SANITATIS

The teaching hospital at Salerno rounded in 1150 A.D. evolved as one of the
bright centers of learning in an otherwise dark European era. Contributions to
medicine, nutrition and dietetics attributed to scholars at Salerno reveal a
creative approach to allopathy and the use of food in healing. One of the
interesting texts readily available today is the Regimen Sanitatis
Salernitatum, dated to the 13th century A.D. The Regimen, originally composed
in Latin, was subsequently translated into modern European languages, and
appears even in Gaelic.(1) It has remained a popular medical text and may be
read in English either as poetry or prose, although the latter is preferred
because of latitude taken by poets who "stretched" the meaning of medical
terminology to conform to rhyming patterns.

The Regimen reveals a wealth of information on allopathic, humoral, hot-cold
medicine, especially the role of food and dietetics in Mediterranean Europe,
and highlights concepts widely practiced in Iberia on the eve of Spanish
contact with the New World:

To keepe good dyet, you should never feed

Until you finde your stomacke cleane and void Of former eaten meate, for they
do breed

Repletion, and will cause you soone be cloid,

None other rule but appetite should need,

When from your mouth a moysture cleare doth void.

All Peares and Apples, Peaches, Milke and Cheese,

Salt meates, red Deere, Hare, Beefe and Goat: all these

Are meates that breed ill bloud, and Melanacholy,

If sicke you be, to feede on them were folly. And:

Eate not your bread too stale, nor eate it hot,

A little Levend, hollow bak't and light:

Not fresh of purest graine that can be got.

The crust breeds choller both of browne and white,

Yet let it be well bak't or eate it not,

How e're your taste theren may take delight.

Porke without wine, is not so good to eate

As Sheepe with wine, it medicine is and meate

Tho Intrailes of a beast be not the best,

Yet are some intrailes better than the rest. Elsewhere:

If to an use you have your selfe betaken,

Of any dyer, make no sudden change,

A custome is not easily forsaken,

Yea though it better were, yet seemes it strange,

Long use is as a second nature taken,

With nature custome walkes in equall range.

Good dyet is a perfect way of curing:

And worthy much regard and health assuring.

A King that cannot rule him in his dyet,

Will hardly rule his Realme in peace and quiet.

Perhaps the most famous passage from the Regimen, however, is a recommendation
on medical selftreatment: "If you lack doctors, these three will serve you: a
cheerful mind, rest and a moderate diet," sometimes translated as good humor,
rest and sobriety (Harington, 1957).

THE TACUINUM SANITATIS Other medieval European documents influenced the
evolution of 16th century Iberian, Spanish medicine and dietetics. Five
illuminated medieval manuscripts survive with the collective name Tacuinum
Sanitatis (health handbook). These manuscripts, beautifully illuminated were
used throughout Mediterranean Europe from Iberia to Greece. They contain
information on self-healing and identify six factors that all so-called
educated persons should recognize and understand, if they wished to remain in
good health: 1) attributes and qualities of air, 2) proper use of food and
beverages, 3) correct principles of human activity and sleep, 4) treatments
for insomnia, 5) principles of correct elimination or retention of humors and
6) techniques to counter adverse effects of anger, fear, distress and joy.

The Tacuina originally were composed in Arabic by a Christian physician during
the 11th century A.D. By the 14th century these texts had circulated widely
throughout southern Europe and Iberia. Although the Tacuina were based on
Arabic medicine, their content can be traced historically to classical Greek
and Roman accounts originally authored by Celsus, Galen and Hippocrates
(Grivetti, 1991b). Each handbook provided healing designations for
Mediterranean foods, then defined and described their various attributes. The
texts also posed and answered questions on appropriate seasonality, food
preparation and combinations. Consumables were designated by their perceived
inherent nature, whether "hot-dry," "hot-wet," "cold-dry," or "cold-wet," and
by optimum source, defined as either fresh or preserved and by best
geographical location. Appropriate medical-dietary uses and impacts on
specific body organs were identified, defined and explained. Foods also were
evaluated, then recommended or discouraged in accord with the consumer's
occupation. Perceived dangers associated with consumption were identified and
specific counteractions listed (Arano, 1976).

The Tacuina identify more than 200 foods common to Iberia and the southern
Mediterranean; a selection is presented in Table 1. Beef, for example, was
considered "hotdry," deemed useful for persons engaged in hard labor, and veal
was perceived the optimal source of beef. Overconsumption reportedly injured
the spleen. Diseases of the spleen could be avoided, however, if beef
consumers exercised regularly after eating and bathed. Pork, in contrast to
beef, was designated "hot-wet," and reportedly nourished the body. Eating too
much pork, however, was said to harm the stomach unless it was well roasted
and eaten in combination with mustard. Pears, assigned to the "cold-&y"
category, were said to strengthen the stomach. Ripened pears were considered
optimum, but eating too many was said to provoke colic unless eaten in
combination with other undefined foods. Lettuce, in contrast, was designated
"cold-wet" with attributed properties that countered insomnia. Fresh leaves
were optimum, but would injure human eyesight unless eaten with celery (Arano,
1976).

SPANISH AND PORTUGUESE ALLOPATHY: CONNECTIONS BEYOND IBERIA

Mediterranean allopathic, "hotcold" concepts formed the core of Iberian,
Spanish medicine during the Middle Ages. These concepts, familiar to all
educated Mediterraneans, were brought to new territories wherever Italian,
Portuguese and Spanish explorers and armies landed in successive centuries.
Patterns of Mediterranean allopathy and use of food to treat disease spread
widely during Portuguese conquests in Africa and Asia. Iberian allopathy,
likewise, was transferred westward with Columbus in 1492 and diffused
throughout the Caribbean. During the next 25 years Spaniards arrived in the
New World as administrators, conquistadors, priests or teachers, and brought
with them, too, the rich medicaldietary heritage of Iberia.

AZTEC MEDICAL-FOOD SYSTEM

The earliest accounts and descriptions of the New World written between 1492
and 1612 may be found in most libraries. These accounts contain wonderful
descriptions of food, diet and medical practices and excite nutrition
historians even today. One intriguing point from the perspective of the
history of prescientific nutrition and dietetics is that the accounts in these
texts reveal that allopathic, "hot-cold"| concepts pre-existed within the
Aztec civilization of modern Mexico well before arrival of the Spanish in
1519.

Like the allopathic medical-dietary systems of other cultures, the Aztec
pattern was based upon religion and mythology. The Aztecs conceived the earth
as a plane with four cardinal directions. At the central point or balance
within the plane lay the Aztec empire. The five localities were assigned
characteristic colors and attributes: West-- white, female, house; East--red,
male, reed; Center--green, order, equilibrium-balance; North--black, death,
flint; and South--blue, life, rabbit. The Aztecs also conceived a structured
world based upon 18 sets of paired terms (Table 2). Especially prominent
within these dichotomies were designations for "hotcold," "dark-light,"
"humiditydrought" and "weakness-strength." Of the 18 terms identified by
literate Spanish conquistadores at the time of contact in 1519, six terms were
similar to those developed within Mediterranean allopathy, but 14 of the 18
paralleled the Asiatic, Chinese pattern of prescientific dietetics.(2)

A pantheon of seven Aztec deities dominated the pre-Spanish Mexican
medical-dietary system: Tzapotlatenan, creator goddess of the earth and sky,
and principal medical deity; Xipe or Totec, god of maize and human sacrifice;
Ixtilton or Tlaltecuin, god of medicine and protector of children; Centeotl or
Tonantzin, goddess of medicinal herbs and midwives; Cihuacoatl or
Macuilxochilquetzali, goddess of pregnancy; Quetzalcoatl, god of air, wind and
medicine, responsible for female sterility and wind-related diseases such as
rheumatism; and Tlaloc, god of rain, responsible for the distribution of
disease (de la Cruz, 1940, pp. 42-44).

In Aztec tradition health was perceived as "balance," illness and disease as
"imbalance." Equilibrium, however, was not easy to maintain since balance
changed seasonally and in accord with human age, gender, personality and
exposure to environmental temperature extremes. Sexual activity also
influenced "balance," as did physiological conditions of lactation,
menstruation and pregnancy. Central to the Aztec system, too, was the concept
that "balance" was effected favorably or adversely by diet.

Diseases and medical problems were assigned to one of three categories:
supernatural illnesses, which included gout, leprosy, paralysis and
rheumatism, thought to be produced by spirits of women who had died during
childbirth; magical illness, which resulted because of inappropriate human
behavior resulting in disease as a punishment from the gods; and natural
illness, defined as obvious problems that included fractures, sprains or snake
bite. In the Aztec system diseases of the first two types were transmitted
through air and distributed by wind (de la Cruz, 1940; Ortiz de Montellano,
1990; Vargas, 1984).

SPANISH VIEWS ON AZTEC MEDICINE AND DIETETICS

Troops commanded by Hernando Cortes landed on the east coast of Mexico in
1519. Within 2 years they subdued and conquered a great empire and established
the European colony of New Spain. In successive decades after conquest,
Spanish administrators rounded medical schools where European concepts of
allopathy and diet were taught for the first time on the American continent.
During the first centuries of colonization, Spanish administrators, educators,
priests and soldiers imposed European civilization upon the conquered Aztecs,
then upon the Inca, Maya and other Native Americans. This process of
"Europeanization" and conversion to Christianity was responsible for the
destruction of countless manuscripts that detailed the specifics of Aztec
medicine and dietetics. Such were the events and attitudes of religious
zealots who viewed these ancient texts as godless and without redeeming value.

Within this frenzy of cultural destruction imposed by the majority, a minority
of Spaniards sympathetic and curious about Aztec cultural traditions, medicine
and dietetics, technology and world view protected and preserved some original
Aztec documents. This body of Aztec literature, a mere fragment of works that
once existed in greater detail, may be examined today. In addition, there are
the accounts written by the early Spanish that described Aztec food and
dietary practices, their system of medicine.

Bernal Diaz del Castillo (1956) accompanied Hernando Cortes on the Spanish
invasion, overland march and conquest of Tenochtitlan (now Mexico City). In
his memoirs he described with wonder the vast array of food available in the
great open-air market in the Aztec capital. His text is the first
documentation for "fast-food" in the Americas: There were... traders who
sold.., cacao [chocolate]... There were those who sold... sweet cooked roots
... [others] sold beans and sage and other vegetables and herbs ,.. fowls,
cocks with wattles [turkeys], rabbits, hares, deer, mallards, young dogs...
let [me] also mention the [fruit sellers], and the women who sold cooked food,
dough and tripe in their own part of the market (1956, pp, 216-217),

Francisco Bravo (1570) wrote the first medical book published in the New
World, Opera Medicinalia. His text consisted of four essays: a discussion of
typhus and typhoid fever (European diseases introduced after Spanish contact);
how to bleed patients (venesection); a review of the ancient Greek,
Hippocratic doctrine of critical days and discussion of the classification and
treatment of fever; and an essay on the medical properties and allopathic
nature of sarsaparilla (Smilax officinalis), a New World plant used by the
Spanish to treat fever and syphilis, which he designated "hot-dry." Bravo also
cautioned against eating fish in Mexico, maintaining that fish in the swamps
and lakes surrounding the capital caused disease.(3) He commented, too, that
Spanish colonists living in the former Aztec capital, Tenochtitlan, were
vulnerable to disease because the surrounding mountains prevented removal of
"foul air" (Bravo, 1570; Jarcho, 1957).

Francisco Hernandez (1577) documented Aztec medical practices and noted
parallels with Mediterranean, Spanish medical systems. In his text, De
Antiquitatibus Novae Hispaniae, he wrote that dietary recommendations were not
made to ill patients and that the sick were bled in a manner similar to the
common practice of Mediterranean allopathic medicine. Hernandez documented a
wide range of useful medical plants from New Spain, but wrote that most Aztec
physicians were ignorant of basic botanical "properties," by which he meant
Mediterranean "hot-cold" designations and other useful properties defined in
documents such as the Arabic-Latin, Regimen and Tacuina (Hernandez, 1577;
Peredo, 1985).

Augustin Farfan (1592) wrote Tractado Brebe de Medicina (two editions) wherein
he identified and recommended local Aztec herbs, their properties and medical
uses. He noted that avocado seeds were ground to powder, then prepared as a
concoction to counter diarrhea, observed that chili peppers, rhubarb and
vanilla were commonly used by the Aztecs as purgatives, and that chocolate
brewed as a thermally hot beverage was a traditional laxative. He described an
Aztec method to counter colic: maize tortillas were heated, then applied
directly onto the patients' abdomen to reduce pain (Risse, 1987),

Farfan's texts are enlightening not only for their descriptions of Aztec
medical and food-related practices, but for observations on early Spanish
colonists, especially their putative idleness, lack of strenuous activity and
gluttony:

The foods eaten in Mexico are hot and humid, conforming to the humoral
complexion of the country, and hence are weak, whereas the foods of Spain are
solid and nutritious. In Spain people are healthier than in Mexico and [they]
live longer. The idleness so prevalent in Mexico is conducive to overeating
and over drinking (1579, 1st ed., p. 223).

At all hours of the day and many hours of the night [Spanish women of New
Spain] can be seen eating dainties; especially cacao is eaten and drunk...
Other women stuff themselves with chocolate which .., [is] bad for
digestion... [because] these things fatten the blood and obstruct and cover
the veins (1592, 2nd ed., p. 33).

AZTEC MEDICINE: THE BADIANUS MANUSCRIPT

Perhaps the most important source on Aztec medicine and diet known is the
Badianus Manuscript. Its author was an Aztec teacher, with a "Europeanized"
name, Martinus de la Cruz, at the College of Santa Cruz rounded by the Spanish
circa 1536 in a suburb of Mexico City. He wrote the manuscript in his native
tongue, Nahuatl, which was then translated into Latin by another Aztec teacher
with the Europeanized name, Juannes Badjanus. The manuscript presents a wealth
of information on Aztec disease concepts, religion and world view, and
outlines the healing properties of local animal, vegetal and mineral
medicines. De la Cruz recorded the Aztec tradition that diseases were
dispersed by and carried on the wind, and that in cautious human exposure to
temperature extremes of weather, especially the heat of deserts and the cold
of high mountain areas, predisposed the human body to disease. He also wrote
that lack of attention to body cleanliness, specifically bathing, contributed
to illness (De la Cruz, 1940, pp. 3-51).

Excerpts from the Badianus Manuscript reveal the Aztec view that food was
important to healing and that "hot-cold" assignments predated Spanish contact,
and provide descriptions and treatments for a range of New World diseases.
Some of these treatments are nutritional in nature:

Angina: [Grind] white earth, the many-colored little stones or pebbles...
collected from brooks [along with] flowers [of] huacalxochit(4) and
tlacoyzquixochit,(4) the juice well pressed out, which [the physician] should
then pour into the throat repeatedly (Plate 30, p. 234).

Gout: If the foot is bothered with much heat, it is to be moistened with cold
juice; if, on the other hand, the foot is extremely cold, it is to be warmed
(Plate 62, p. 267).

Headache: Eat onions in honey, [do not] sit in the sun, [do not] work, and do
not enter the baths (Plate 7, p. 209).

Indigestion: When any one is constipated because of indigestion of the
stomach, grind together... cones of cypress, laurel leaves, stalk of the herb
zacamatlalin,(4) bark of the blackberry bush, root of cherry and the ylin(4)
tree and of the herb tonatiuhyxiuh(4) .... And when ground they are to be well
cooked in acid water with honey; the juice when drunk helps marvelously to
purge the abdomen (Plate 87, p. 298).

Elsewhere in the manuscript specific attention is directed to maternal and
child health, especially problems associated with breast feeding:

To promote lactation: When the milk flows with difficulty, the herb[s]
chichilticxiuhtontl,(4)tohmiyoxihuit,(4) and a crystal are to be crushed in
octIi [fermented sap of maguey] and boiled. The potion is to be drunk
frequently ... [and]... the woman should... enter a bath, where she is to
drink another potion made of maize [and] when she comes out she is to take as
a drink the sticky water of boiled maize (Plate 111, pp. 319-320).

To promote infant sucking: If the infant ... does not wish to put his lips to
his mother's breasts, give him a drink of the sma11 herbs called teamoxtli,(4)
the sun dried liver of a quail, and some of his hair which you have cut off,
and which you should burn to ashes. [Rub] him with an ointment carefully made
from the brain of a weasel and a burned human bone, which you are to dissolve
in acid water (Plates 113 and 114, p. 322).

The Badianus Manuscript index provides commentary on approximately 100 medical
conditions. Of these, 10% are nutrition or foodintake related and include
reference to conditions of angina, constipation, dental problems (tartar
removal), dysentery, dyspepsia-indigestion, fatigue, gout, heart (overheated),
hemorrhoids and lactation difficulties. No references appear in this
manuscript that could be equated with beriberi, pellagra, rickets or scurvy,
or to medical-nutrition related conditions such as cancer, diabetes or stroke.

AZTEC MEDICINE: A 20th CENTURY PERSPECTIVE

Other texts document nutritional problems among the Aztecs, including heart
disease, kwashiorkor(5) and obesity. Ortez de Montellano (1990) wrote that
traditional Aztec diet apparently was low in saturated dietary fats, given
only modest intake of meat and the lack of dairy products before the Spanish
conquest. He suggested that such a pattern, coupled with a presumed high level
of physical activity among Aztec workers, would minimize cardiovascular
disease. Yet his review of surviving Aztec documents identified heart ailments
such as angina and "overheated heart."

Lopez Austin (1988) reviewed Aztec manuscripts and accounts by 16th century
Spanish priests and physicians practicing in Mexico. He concluded that the
Aztecs had a sophisticated medical system that predated Spanish contact. Aztec
healers used food and medicines to balance "hot-cold" relationships and to
transfer disease from one part of the body to another part where it could be
more easily cured (see quotation at the beginning of this article).

The Aztecs had a sophisticated vocabulary for obesity and locations of
specific fat deposits: cotztzotzol--soft, drooping fat and skin deposited
along the calf; eltzotzolli--flabby, fatty tissue and skin deposited across
the chest; ititzotzolli--soft, bland fat and skin in the hypogastrium region;
puchquiyot| very flabby fat widely distributed over the body; and
quechtzotzol--a flabby, double chin (Lopez Austin, 1988, p. 259).

They also had a well-recognized understanding of infant malnutrition and the
concept of kwashiorkor. The nursing child of an Aztec mother who became
pregnant was called tzipitl. Both child and fetus were perceived as
"interlaced" with the mother and former breast-fed infants, deposed by the
birth of a second child, were perceived as weak, slow to develop and
characterized by diarrhea and weight loss that precipitated emaciation and
death (Lopez Austin, 1988, pp. 268-269).

One Aztec manuscript, the Codice Vatican Latino Number 3738, depicts the
poignant result of kwashiorkor and untimely infant death. In the Aztec belief
system breastfeeding children who died were miraculously transported to the
nether-world, to a site called Chichihualcuauhco (alternative spelling
Tonacacuahtitlan or Xochatlapan), where the infants played under magical trees
that bore fruits in the shape of human breasts. There, under the protective
branches and fruits of the magical tree, the infants flourished; when hungry,
they merely tilted their tiny heads upward to receive sustenance, human milk
dripping from the magical breast fruits.

Ortiz de Montellano (1990) collected extensive Aztec references to dental
disease. Caries were thought caused by human behavior, especially incautious
exposure to sudden temperature change. Suffering patients were told to avoid
thermally warm foods and were instructed how to avoid dental decay using an
allopathic, "hot-cold' approach that stated:

Wait between consuming warm things [and between eating] have a [thermally]
cold drink; avoid chewing green maize stalks [classified as 'cold'] at night.

Given the sugary properties of maize stalk pith, ancient Aztec recommendations
logically reduced exposure to "sticky" foods and probably lowered the
incidence of dental caries.

Aztec physicians also perceived associations between drinking cold water,
eating raw vegetables and diarrhea. Gout, identified as a "cold" disease, was
thought to be caused by undue exposure to cold wind and treated by ingesting
hallucinogenic plants [not specified] or by eating tobacco leaf.

Given the meticulous research by these eminent Mexican researchers, it is
interesting that documentation is lacking in ancient Mexico for other types of
malnutrition. Katz et al. (1974) concluded, however, that rickets would not be
a concern in

Aztec society where the dietary staple of maize tortillas previously treated
with lime was coupled with human exposure to the sun. Given, too, that
traditional Aztec diet was balanced and based upon a combination of maize and
beans with complementary amino acids, the presence of pellagra also would have
been unlikely (Grivetti, 1992).

HUMAN TRAGEDY: THE EPIDEMIC ERA (1520-1581)

The conquest of Mexico by the Spanish and the blending of Old and New World
civilizations, produced an enormous legacy with both positive and negative
effects. Among the positive effects of cultural contact were dramatic medical
and dietary exchanges, whereby the foods of Africa, Asia and Europe were
introduced to the Americas. Old World foods introduced to Mexico within the
first 100 years of Spanish contact included: almond, apples, apricots,
cabbage, cattle (whether beef, milk, or dairy products), garlic, lemons,
lettuce, olives, oranges, pig (whether pork or lard), rice, sheep (including
lamb, milk, and dairy products), sugar cane and wheat.

New World contributions to Old World cuisine also were positive and included
an enormous range of foods readily adopted throughout Africa, Asia and Europe.
Among them were artichokes, avocados, kidney beans, cacao (chocolate),
cassava, chile peppers, guava, maize, papaya, peanuts, pineapples, pumpkins,
sunflower, tomatoes and turkey.

Agricultural and dietary exchanges represent the positive side of culture
contact; the mirror image, unfortunately, was terrible, unplanned and
difficult to imagine. Old and New World medicine, both rounded upon
prescientific concepts of allopathy and the signature of opposites (contraria
contraris), could not prevent or stem unintended outbreaks of communicable
disease and widespread epidemics. Specific chronicles detailing the origins,
spread and outcome of the diseases exist, but no one counted or documented the
names of the millions who died.

The first 60 years of Spanish occupation in Mexico were defined by four
epidemics characterized by medical symptoms not previously seen or experienced
in the New World. Smallpox caused the first epidemic of 1520 to 1521 and
struck during the second year after Spanish contact. Previously unknown to the
New World, it was called hueyzahuatl by Aztec physicians. Aztec medicine could
not stop its spread, and untold thousands died. The second epidemic, also
smallpox (possibly in combination with measles?) occurred 10 years later in
1531. In Aztec accounts it was known as tepiton zahuatl or "little leprosy."
The third epidemic erupted in 1545 and lasted 3 years. The cause of this
outbreak is unknown and its symptomology cannot be identified; the Aztecs
called it cocoliztli. By some estimates onethird of the pre-Spanish population
of Mexico died as a result of these first three epidemics. A fourth and last
major epidemic hammered the Native American population; it lasted for 5 years
from 1576 to 1581. This disaster was also called cocoliztli; it reportedly
killed an additional 300,000 to 400,000 Native Americans in New Spain (Risse,
1987, p. 27).

From the vantage point of 1992 such a human disaster seems impossible. The
evidence, however, is undeniable. How many people died? No one knows with
certainty. The power of words left by educated, literate ancient Aztec men and
women who lived during those times cut through time and demand our attention.
They are as poignant now as when first transcribed more than 100 years ago by
Brinton:

Zan tlaocolxochitl, tlaocolcuicatl on mania Mexico nican ha in Tlatilolco, in
yece ye oncan on neiximachoyan, ohuaya. (Only sad flowers, sad songs, are here
in Mexico, in Tlatilolco, in this place these alone are known, alas.) Zan ye
chocaya amaxtecatl aya caye chocaya tequantepehua. (He who cared for books
wept, he wept for the beginning of the destruction,) (Brinton, 1890, pp. 82-83
and 122-123).

BLENDED TRADITIONS: AZTEC AND SPANISH "HOT-COLD" IN THE 20th CENTURY

Spanish allopathic medicine and "hot-cold" were brought to the New World where
the Mediterranean pattern blended with existing Aztec and subsequent Maya,
Inca and other Native American medical practices. Ultimately, the Spanish,
Mediterranean allopathic system dominated, then later paralleled and
complemented allopathic practices introduced to the Americas by British and
French physicians. The Spanish allopathic legacy flourished within Mexico,
then extended southward throughout Central and South America. The Spanish
pattern also diffused northward into regions that encompassed the southwestern
portions of the United States of America.

This ancient Spanish legacy was spread throughout the American southwest and
California by Spanish priests, especially Jesuits and the Franciscans, and is
expressed in American-Hispanic food practices today. But while the practices
exist widely within the ethnic Hispanic population of the Americas and the
Caribbean the patterns are highly variable and cannot be reduced to simplistic
summaries.(6)

Wide variation in "hot-cold" designations is acknowledged by researchers, but
the extent of variation has troubled some authors who have concluded there is
little value in summarizing and comparing data from different Hispanic
respondents from widely separated geographical localities. Such variation,
however, should be a challenge rather than a frustration, and examination of
intercultural variation presents a valuable lesson, Just as people are not
alike and groups are dissimilar, it is logical that the expression of
traditional medicine and nutritional practices should be highly variable, Data
from nine representative publications are summarized here to demonstrate
variation and range of allopathic, 'hotcold" practices within Hispanic
cultures of the Americas.

Madsen (1955) identified a continuum of five terms for "hot-cold" used in
Mexico, a pattern also balanced by degree of food freshness: very hot (muy
caliente), hot (caliente), temperate-neutral (templado), cold (frio) and very
cold (muy .frio), set within designations of very fresh (muy fresco) and fresh
(fresco). Madsen sought explanations for "hot-cold" designations and found
that many species grown in very wet ground were classified "cold," but since
their leaves and fruits were exposed to the sun the "cold" was diluted,
whereupon such foods were designated "fresh" or "very fresh." She concluded
that food characteristics of color, spiciness and ecological habitat
influenced category assignment. Madsen also found that 'hot-cold" designations
extended beyond food to human activities and commercial medicines, Movies
screened locally were classified "cold," while Alka Seltzer, a medicine
manufactured in the United States, was designated "fresh.' She prepared
extensive food lists for "hot-cold' that formed a baseline for comparison
against Hispanic practices elsewhere in North, Central, South America and the
Caribbean.

Logan (1972, 1977) conducted work in Mexico and argued nearly 20 years ago
that Hispanic allopathy and "hot-cold" practices predated Spanish conquest. He
urged scientifically trained nutritionists and dietitians to consider
"hot-cold" food assignments, then challenged nutrition educators to implement
dietary information using an allopathic framework more easily understood by
Hispanic clients. Logan noted that Mexican farmers recovering from illness
traditionally snacked on peanuts, and he urged nutrition educators to examine
other components of traditional Hispanic medicine, and to identify common
practices that promoted sound diet, nutrition and health. He was among the
first to suggest that pellagra may not have existed in pre-Columbian Mexico
because of balanced Aztec dietary practices that blended maize and legumes.

Logan posed the tantalizing hypothesis that outbreaks of pellagra throughout
the Americas during the 19th and 20th century occurred at locations where
allopathic "hotcold" practices had been forgotten or abandoned.

Suarez (1974) worked among Native Americans in the Venezuelan Andes and
identified a classical Spanish, Mediterranean allopathic, 'hot-cold" system,
set within precontact indigenous medical practices. She identified disease
categories with specific gender assignments thought to be caused by
unsatisfied food cravings: mal de madre (diseases of mature women who
previously had conceived), maldijada (diseases of mature women who never had
conceived) and padrejon (diseases of mature men). Suarez identified other
disease categories, among them: arco (illness produced by rainbows), mal de
ojo (evil eye disorders), mal viento (sickness after exposure to draft), mojan
(witchcraft) and pasmo (sickness after exposure to cold water).

Molony (1975) examined variation and consistency in Hispanic "hot-cold"
beliefs. "Cold" designations commonly were linked with an ecological water
niche, i.e., edible plants and animals that lived in or grew near water. "Hot'
foods commonly were items associated with sunlight, or were consumables that
burned the lips or mouth, hence "hot" designations for ice and distilled
alcohol. She found that cuts of meat obtained from male animals were
sometimes, but not always, identified "hotter" than those from a female of the
same species. Molony also studied combination dishes and wrote how cooking
altered "hot-cold" designations. She reported that when foods were combined or
cooked with spices, such dishes usually were designated "hot,' while food
combinations boiled or cooked in water or other fluids usually were "cold.'

Mathews (1983) wrote that while Hispanics practiced a classical Mediterranean
"hot-cold" tradition, foods often were categorized along four additional
continuums: dangerous-safe, raw-cooked, healthyunhealthy and sexual
promotingsexual neutralizing. He noted the common extension of "hot-cold"
designations to disease potential and sexual activity: "hot" people (male or
female) supposedly suffered more "cold" illness and exhibited strong sexual
drive, whereas "cold" individuals suffered more "hot" medical conditions and
frequently failed to marry or produce children. Mathews reported how foods
were used and diets planned to neutralize or balance human conditions. "Hot"
people were encouraged to eat more beans (white varieties), cucumbers, eggs
(duck), fish-bone powder and gelatin, whereas "cold" people were prescribed
more chiles, garlic, onions and shrimp.

Mathews' most important contribution, however, was his caution against
preparing master lists of "hot-cold" foods for widespread nutritional
counseling (Table 3). The problem he identified, called "intercultural
variation" by social scientists, showed the difficulty of relying upon food
surveys and "hotcold' designations. Mathews wrote that "hot-cold" existed
widely within Hispanic culture, but designations received from residents of a
region, a village or even a single household varied widely. He documented,
furthermore, that the same respondent might provide different food assignment
categories during different times of the day and that responses were apt to
change during different seasons, even through the years.

In an attempt to examine response consistency for allopathic, "hot-cold"
category assignments, Mathews interviewed adult men and women (n= 40) in the
village of Oaxaca, Mexico, and sought information on 88 local foods. Category
consistency was met when respondents agreed 100 to 75% of the time;
inconsistency was considered less than 75% agreement (Table 4). Within the
village some foods consistently were designated "hot,' such as chilies, mescal
(distilled liquor prepared from maguey), black mole sauce (a combination of
chile and chocolate), onions, salt, chocolate and garlic. Greatest village
agreement for "cold" foods was seen with water, tejate (beverage of corn meal
and chocolate), vegetable soup, rice water, rice, estofado (green tomato
sauce) and cheese. Least agreement (i.e., strongest inconsistency) was
associated with seven common foods: camomile, coconut, cucumber, edible
grasshoppers, potatoes, raisins and tea.

The anthropologist George Foster (1984, 1985) studied the Mexican village of
Tzintzuntzan and reported that "Western" and traditional medicine existed side
by side, where concepts of magic and evil eye (mal de ojo) were followed along
with reasonable dietary practices and "hot-cold ""assignments. Foster found
extensive evidence for allopathic practices in Tzintzuntzan. He wrote that
fever was "extracted" by bathing, by cupping (bleeding) and by administration
of purgatives or compounds to induce sweating. Body chills, in contrast, are
neutralized by ingesting appropriate "hot" foods and herbal teas. Dietary
"balance" and management of "hotcold" illness were facilitated by selecting
from five distinctive beverage categories: 1) te: brews of a single herb,
either "hot' or "cold" depending upon the illness to be treated, previously
soaked or boiled in water, then drunk thermally hot, 2) cocimiento: two or
more "hot" or "cold' herbs boiled together, drunk thermally hot, but sometimes
cooled and stored before drinking, 3) horchata: seeds of melon and watermelon,
designated "cold," then ground, soaked in water, and drunk to cool the kidneys
or stomach and used to counter diarrhea or constipation, 4) care: toasted
seeds of avocado or mango, classified "hot," then ground and boiled or soaked
in hot water, and 5) agua de uso: miscellaneous herbs, usually "cold," boiled,
cooled, then drunk throughout the day as a thirst-quenching beverage.

According to Foster the allopathic, dietary system of Tzintzuntzan consisted
of the classic Mediterranean triad: hot, neutral and cold. "Cold" diseases,
among them pneumonia, sore throat, stomach ache and tonsillitis, were treated
by eating representative "hot" foods such as distilled alcoholic beverages,
avocado, beans, chocolate, coffee, garlic, honey, peanuts, pork, brown sugar,
rue, wheat tortillas and water. "Hot" diseases, among them diarrhea, smallpox,
and sunstroke, were mitigated or cured using "cold" foods such as iced
beverages, cauliflower, carrots, chicken eggs, fish, ice cream, lamb, lard,
lime, mallow, papaya, pineapple, salt, squash, turkey, vinegar and watermelon.
Examples of neutral-temperate foods at Tzintzuntzan included beer, bread,
chicken, maize and maize tortillas. Foster noted that most over-thecounter
oral medicines (e.g., aspirin) were classified "hot." In addition, his
respondents also classified foods along a 'heavy-light" continuum. So-called
"heavy" foods included eggs, most meats, milk, potatoes and rice. "Heavy"
foods were considered especially dangerous and unhealthy if eaten at morning
or evening meals, but their assignment shifted along the continuum toward
"lighter" if eaten at the midday meal.

Tedlock (1987) worked in Guatemala where he found a continuum of eight
'hot-cold" terms: fiery hot, very hot, hot, warm, lukewarm, cool, cold and
very

cold. He noted that most "warm" foods were astringent, bitter or dark-colored,
whereas "cool' consumables frequently were light-colored, Tedlock discovered
that respondents made no specific attempt to balance dietary components of a
meal along "hot-cold' lines, as would be expected in a classical Mediterranean
system, but instead formed socalled "healthy meals" that combined "warm' foods
such as black or red beans, beef, dried chili, cinnamon, cloves, coffee, duck,
garlic, ginger, yellow maize, peppermint and brown sugar, with "lukewarm"
items, identified as cheese, leafy greens, noodles, potatoes, rice, sauces
made from fresh chilies, tortillas or watercress. Tedlock wrote that
'hot-cold' assignments along the continuum were widely inconsistent from town
to town within the same geographical region, and highly variable from person
to person within the same village. Some respondents changed their minds and
offered different assignments when interviewed at different times of the same
day.

DECLINE OF ALLOPATHY: RISE OF THE GERM THEORY

Less than 150 years ago concepts of disease and illness transmission in the
United States of America were primarily allopathic and based upon the
"hot-cold' balance. The allopathic approach to medicine, however, was
challenged after the discovery of fermentation principles and publications on
anthrax by Louis Pasteur in 1877, Afterwards, the concept of "germ theory"
began to be accepted widely, and allopathy declined. While physicians were
attracted to the germ theory, the general public did not take easily to this
explanation for disease and disease transmission. Furthermore, the new
approach raised doubts and fears that since "germs were everywhere and must
cover everything," fresh or prepared foods sold in stores and open-air markets
were potentially dangerous to consumers.

Kramer (1948) documented this debate and the public doubts that followed in
the decades after Pasteur's discoveries. In a wonderful, but frequently
overlooked essay, he noted that the fledgling field of microbiology flourished
only after 1880 when scientists discovered specific organisms for diseases
such as cholera, diphtheria, pneumonia, tetanus, tuberculosis and typhoid. He
observed that by 1890 microscopes no longer were technical "oddities," but had
become standard university equipment. However, millions of people worldwide
still did not accept the germ theory, because they believed their eyes rather
than the microscopic world.

Gradually there was widespread acceptance in Western medicine of the germ
theory and disease causation, With acceptance there were two results. First,
allopathy and use of "hot-cold" concepts declined, and second, scientific
arrogance began to develop. As the Western medical model advanced, allopathy
and humoral medicine were discounted, then ignored and finally abandoned in
many parts of the world. As science progressed, allopathy retreated, lingering
in non-Western, so-called 'quaint' regions of the world, geographical areas
considered by some scientists to be less advanced.

As the gap between science and allopathy widened, many scientists lost the
fine art of communication. Some scientists cared about the health and
nutritional status of different peoples and regions of the world, and for the
medical-dietary practices of American immigrant groups. Because they were
trained in science, however, most physicians and nutritionists saw little
reason to identify and understand nonscientific approaches to health and diet
practiced by their ethnic clients. Was it not easier, and perhaps better to
treat nutritional conditions such as diabetes, diarrhea, obesity and vitamin
and mineral deficiencies using "standard diets"? Most textbooks on clinical
and dietary approaches to treatment noted that the easiest way to communicate
with clients and treat nutrition-related disorders was to assemble clients or
bring them to central localities, where lectures could be prepared and
delivered to the greatest number, with the least cost in time. Nutrition
education was easy and had entered a new age.

But a problem remained: while sound, scientific lectures were delivered and
"standard diets' distributed, communication between clients and
health-nutritional professionals declined. Clients were eager for nutrition
and dietary information, but the information they received was of limited use.
Nutrition educators, in turn, were eager to provide facts that would
facilitate treatment, but the information they provided was of limited use.
Nutrition counseling frequently became a dialogue of the deaf, where many
words were spoken and many smiles exchanged, but instead of winning and
overcoming disease and malnutrition, education was a casualty of the process.
Health and nutrition professionals frequently could not communicate scientific
principles to clients who did not believe in the germ theory and were
distrustful of science. As a result both sides have been frustrated,

A 1992 PERSPECTIVE

Allopathy flourishes throughout the United States of America in 1992 as a
medical-nutritional approach. Most Americans practiced allopathy before 1885,
some still do. It is not scientific, but it is not necessarily nonsense.
Allopathy is practiced from California to Maine; it thrives along our coasts
and exists within the heartland of America.

Throughout this four-part series we have explored the origins, distribution
and comparative aspects of allopathy, a prescientific approach to medicine,
nutrition and food practices. Part One documented that allopathy and "hotcold"
concepts originated in ancient India and were manifest in the pioneering
medical texts of Caraka, the father of medicine. Part Two examined the spread
of allopathy and "hot-cold practices westward from India into the
Mediterranean region, where they were adopted by ancient Greek and subsequent
Roman, then Christian, Jewish and Muslim Physicians. Part Three explored the
diffusion of allopathy eastward from India into China, and examined the
complexities of the Yang-Yin, "hot-cold" healing system of eastern Asia. The
present and concluding article in this series has traced the spread of
Mediterranean allopathic, "hot-cold" practices into Central America where they
blended with indigenous, preColumbian Aztec medical-dietary traditions that
existed long before the arrival of Columbus in the Caribbean and subsequent
conquest of Mexico by Hernando Cortes.

In the United States of America allopathy and scientific approaches to
medicine, nutrition and diet exist side by side. Americans are not a
homogeneous people who all believe in science. Nutrition educators, dietitians
and university professors, encounter cultural diversity and scientific
skepticism daily. During the past 500 years cultural, religious diversity has
enriched the American continents; peoples from all inhabited world regions now
live in this land along with Native Americans who were here before European
contact. Many citizens have well developed attitudes, beliefs, and practices
regarding health, diet and nutrition. Some of these practices are
scientifically sound; others are nonsense. Some allopathic principles
identified in this series are sound and complement scientific knowledge. As
dietary and nutritional counselors we face a basic challenge: how to provide
correct, informative, high-quality nutritional information to the most
clients, with the least cost in terms of money, time and effort.

The general public, however, is eager to learn and we professionals are eager
to teach. Having worked on cultural practices and food habits for more than 25
years I have experienced individuals of four types within the United States.
The first has no knowledge of allopathy or "hot-cold" concepts, although they
originate from a population that traditionally has practiced it. The second
will have a vague to excellent recollection of such medical-dietary systems,
but prefer to receive nutrition information within a scientific context. Other
individuals primarily will follow allopathy and "hot-cold" practices, then use
these concepts interchangeably with scientific medical-nutritional information
provided. The fourth type of person, a minority, seeks nutrition information
and is eager to learn, but rejects scientific explanations and the germ
theory. Such clients base their medical and dietary principles primarily upon
"hotcold" concepts; often they are the most needy, and often they are the most
challenging. How we communicate with ethnic Americans is a measure of our
educational skills and talents. It is obvious that not all Asians or all
Hispanics are the same. Too often, nutrition educators lump Asians and
Hispanics into single groups and seek common food practices that would make
counseling easier. Not all Asian-Americans eat rice; not all
Hispanic-Americans eat tacos; not all Italian-Americans eat spaghetti. One
pattern of dietary advice and nutritional counseling is not suitable to all.
Diversity remains our national strength, but with diversity comes complexity
and the need to explain scientific concepts using culturally correct examples
that are easily understood. If you agree that this is our professional
challenge, not our mutual frustration, then this series has been successful.

SELECTED REFERENCES

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Bernal Diaz del Castillo. The discovery/conquest of Mexico. 1517-1521.
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Bravo F [1570]. Opera medicinalia. London: Dawson, 1970.

Brinton DG [1890]. Ancient Nahuatl poetry, containing the Nahuatl text of
XXVII ancient mexican poems. Brinton's Library of Aboriginal American
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Carter G. Pre-Columbian chickens in America. In: Man across the sea: problems
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Clark M. Health in the Mexican-American culture. Berkeley: University of
California Press, 1959.

Currier RL. The hot-cold syndrome and symbolic balance in Mexican and
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de la Cruz M [1552]. The Badianus Manuscript (Codex Barberini, Latin 241)
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The Johns Hopkins Press, 1940.

Farfan A [1579; 1592]. Tractado breve de medicina. Madrid: Ediciones Cultura
Hispanica, 1944.

Foster GM. How to stay well in Tzintzuntzan, Soc Sci Med 1944;5:523-33.

Foster GM. How to get well in Tzintzuntzan. Soc Sci Med 1985;7:807-18.

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(1) Spread of allopathic medicine and hot-cold designations into the British
isles originated with Roman contact. A 16th century Gaelic allopathic,
hot-cold medicine text, Regimen Sanitatis, has been published by
Gillies(1911).

(2) Geographers, among them Carter (1971), Jett (1989) and Johannsen and
Parker (1989), have urged reconsideration of the traditional view that
Europeans were the first to encounter Native Americans, They argue that New
World maize existed in Asia before 1492, and they have documented the presence
of Asian chickens in he New World before the arrival of Columbus.

(3) A strong dietary prohibition towards fish remains today thoughout Indian
populations of the central valley of Mexico.

(4) English designation-equivalent uncertain.

(5) The term kwashiorkor is used by the Ga people of Ghana to designate a
disease "the-first-child-gets-when-the-second-child-is born." It was brought
into the Western medical literature by Cecile Williams(1933)

(6) Representative references to Hispanic hot-cold literature not cited in
this review may be obtained upon request from the editor.

Dr. Grivetti is Professor of Geography and Professor of Nutrition at the
University of California, Davis campus. His research focuses on human dietary
patterns, using historical and contemporary perspectives, especially among
African, Mediterranean societies and ethnic populations in the United States.
He is coauthor with W.J. Darby and P. Ghalioungui of the awardwinning book.'
Food. The Gift of Osiris New York: Academic Press, 1979).

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