Apart from a few exceptional women who achieved recognition for their mastery of the medical literature either in convents or the University of Salerno, women were generally excluded from formal medical education and thus from the legal and lucrative professional practice of the art. Nevertheless, it is possible to ﬁnd women practitioners among all the ranks of the medieval medical community—physicians, surgeons, barber-surgeons, apothecaries, leeches, and assorted empirics. As in the modern university or corporation, their distribution would tend to include much larger numbers at the bottom of the hierarchy than at the top. Although medieval practitioners battled ﬁercely for control over the paid practice of medicine, there is little doubt that much of the routine, unpaid care of the sick took place in the home and was carried out by women.
With a few rare exceptions, women as practitioners and patients
were largely invisible in Western histories of medicine. Although women presumably suffered from most of the diseases and disasters that afﬂicted men, ‘‘women’s complaints’’ were generally discussed only in terms of pregnancy, childbirth, lactation, and menstrual disorders. Women practitioners were assumed to be midwives, nurses, or elderly
‘‘wise women.’’ Since the 1970s, historians specializing in women’s stud- ies, gender studies, and social history have helped to correct this picture and enrich our knowledge of medical practice and medical care during the Middle Ages. In addition to retrieving the work and lives of excep- tional and accomplished women who, nevertheless, became ‘‘lost’’ to history, scholars have become aware of the ways in which surviving documents and conventional methodologies have biased our view of history in terms of gender. Rather than study only the world of the
Medieval depiction of an operation on the liver.
‘‘elites’’ of the medical profession, historians have looked more broadly at the world of health-care practitioners and gender issues related to health and disease.
Just as women practitioners were not restricted to the role of
midwife, women patients did not restrict their choice of medical advi- sor to members of their own sex, even if their ‘‘complaint’’ involved sensitive issues, such as fertility. Literacy was quite low during this period, but some women owned and used books, including medical
texts. Historians have achieved insights into women’s grasp of written medical information by studying the ownership of speciﬁc books.
Most of the ordinary women practitioners left no trace in the his-
torical records, but studies of the life and work of Hildegard of Bingen (1098–1179) provide a vivid portrait of one of the twelfth century’s most remarkable writers on cosmological and medical questions. Widely known and respected as a writer, composer, and healer during her life- time, she was soon all but forgotten, except in her native Germany. St. Hildegard has been called a mystic, a visionary, and a prophet, but her writings suggest practical experience and boundless curiosity about the wonders of nature. A revival of interest in St. Hildegard during the twentieth century brought her to the attention of scholars, feminists, musicians, poets, herbalists, and homeopathic practitioners.
As the tenth child of a noble family, Hildegard was offered to God as a tithe and entered a life of religious seclusion at the age of eight years. She took her monastic vows in her teens and was chosen abbess of her Benedictine convent in 1136. At about 15 years of age, Hildegard, who had been having visions since childhood, began receiving reve- lations about the nature of the cosmos and humankind. The visions were explained to her in Latin by a voice from heaven. In 1141, a divine call commanded her to record and explain her visions. When she began writing, Hildegard thought that she was the ﬁrst woman to embark on such a mission. After a papal inquiry into the nature of her revelations, Hildegard became a veritable celebrity and was ofﬁcially encouraged to continue her work. Popes, kings, and scholars sought her advice. At the age of sixty years, Hildegard focused her energies on the need for monastic and clerical reform.
Hildegard’s Physica, The Book of Simple Medicine, or Nine Books
on the Subtleties of Different Kinds of Creatures, is probably the ﬁrst book by a female author to discuss the elements and the therapeutic virtues of plants, animals, and metals. It was also the ﬁrst book on natural history composed in Germany. The text includes much traditional medical lore concerning the medical uses or toxic properties of many herbs, trees, mammals, reptiles, ﬁshes, birds, minerals, gems, and metals. Hildegard’s other major work, the Book of Compound Medicine, or Causes and Cures, discusses the nature, forms, causes, and treatment of disease, human physiology and sexuality, astrology, and so forth. Interestingly, the two books on medicine made no claims to divine inspiration.
Relying primarily on traditional humoral theory, Hildegard usually
suggested treatments based on the principle of opposites. Foods, drugs, and precious stones were prescribed to prevent and cure disease. For example, sapphire was recommended for the eyes and as an antiaphrodi- siac, which made it an appropriate gem to have in a convent or monas- tery. Remedies calling for parts from exotic animals, such as unicorn liver and lion heart, were recommended for dreaded diseases like leprosy.
In exploring mental as well as physical diseases, Hildegard discussed frenzy, insanity, obsession, and idiocy. According to Hildegard, even the most bizarre mental states could have natural causes. Thus, people might think a man was possessed by a demon when the real problem might be a simultaneous attack of headache, migraine, and vertigo. Hildegard probably had a special interest in these disorders. Indeed, modern medical detectives have diagnosed her visions as classical exam- ples of migraine.
Most of the women healers who practiced medicine and midwifery
during the Middle Ages left no traces of their activities in the written records. Certainly, coming to the attention of the authorities and directly competing with licensed practitioners was dangerous for those forced to live at the margins of society. Thus, although few women were able to attain the learning and inﬂuence reached by St. Hildegard in her safely cloistered position, many other medieval women served as nurses, herbalists, and healers in hospitals and inﬁrmaries in Europe and the Holy Land. For example, St. Walpurga (d. 779) was an English princess who studied medicine and founded a convent in Germany. She was often depicted holding a ﬂask of urine in one hand and bandages in the other.
One of the most popular medieval works on women’s medicine, a
text generally known as the Trotula, is attributed to a woman who might have been a member of a remarkable group of women medical practi- tioners associated directly or indirectly with Salernitan medical culture during the eleventh and twelfth centuries. There is some evidence that women were allowed to study and teach medicine at some Italian univer- sities from the twelfth to the fourteenth centuries. At the University of Salerno, the subject of ‘‘women’s diseases’’ fell within the province of women professors. According to some sources, Trotula (also known as Trocta or Trotta) taught, wrote, and practiced medicine during the twelfth century. Nevertheless, Trotula and other medieval medical women have often been dismissed as myths. Indeed, until confronted by recent scholar- ship on medieval women, many people were more likely to believe in uni- corns and alien abductions than the existence of female healers, female medical writers, female professors, or even female readers. Since the
1990s, however, scholars have found evidence that literacy in medieval Europe, including female literacy, was more prevalent than previously assumed. However, the oral transmission of knowledge was still important even with increasing literacy, especially for therapeutic knowledge and techniques. Some scholars assumed that a male physician wrote the text based on the work of a Salernitan female healer and then named the resulting treatise the Trotula, in her honor. Perhaps, the putative male author thought of these writings as ‘‘women’s secrets’’ which should be attributed to a female writer, rather than a signiﬁcant medical treatise.
At least in part, the confusion about Trotula as a medical writer illustrates the general problem of establishing the authorship of medie- val manuscripts. Many manuscripts were copies that did not name the original author. When printed editions of texts were produced in the ﬁfteenth and sixteenth centuries, assumptions were made about the authors, often without sufﬁcient evidence. If recent scholarship con- cerning the Trotula tradition has not solved the riddle of the text and its author, it has thrown some light on the transmission and corruption of the earlier versions of the manuscripts. Apparently, three different twelfth-century Salernitan manuscripts on women’s medicine became fused and evolved into a treatise known as the Trotula. Trotula may have written one or more of the original manuscripts, but her name was probably attached to other texts, just as other works were erroneously attributed to Hippocrates or Galen. During the sixteenth century, the manuscripts that now comprise the Trotula were edited, rearranged, and printed, thus establishing the ﬁnal text and serving as the source of several vernacular translations.
The Trotula includes discussions of gynecology, obstetrics, the dis- eases of women, and cosmetics. In addition to more serious aspects of women’s medicine, the text includes recipes for perfuming hair, clothes, and breath, cosmetics to whiten the face, hands, and teeth, creams to remove the blemishes that occur after childbirth, preparations that color and thicken the hair, unguents, and stain removers for linens. Recipes for depilatories are accompanied by a very sensible preliminary test that is performed on a feather to make sure the mixture will not burn the skin. The text provides advice about feminine hygiene, menstrual prob- lems, infertility, pessaries for widows and nuns, methods of restoring virginity, drugs to regulate the menses, emmenagogues, and so forth. Trotula seems to have strongly believed that menstruation was crucial to women’s health. If that is true, then many recipes that were said to
‘‘bring on the menses’’ may have been prescribed to promote regular menstrual periods, although the same phrase might have been a euphemism for abortifacients. The text discussed the proper regimen for pregnant women, signs of pregnancy, difﬁcult births, removal of the afterbirth, postpartum care, lactation, and breast problems. The dis- cussion of the care and feeding of infants included advice on choosing a wet nurse, remedies for impetigo, infantile worms, vomiting, swelling of the throat, whooping cough, and pain.
Medieval ideas about women’s health and physiology were appar-
ently inﬂuenced by the Salernitan medical texts that were later printed as the Trotula. Perhaps, the lasting impact of the Trotula correlates well with recent ﬁndings that the Trotula manuscripts were almost invariable owned and used by male practitioners. Historians have suggested that this pattern of ownership indicates that during the Middle Ages, male physicians were already attempting to expand the range of their services
to include gynecology. Indeed, some historians believe that essentially all of the medieval gynecological literature was written by men for the use of male practitioners. These ﬁndings have challenged previous assumptions that during the Middle Ages, women would only consult female healers about issues such as menstruation, fertility, pregnancy, and childbirth. Women were likely to consult midwives for ‘‘female complaints’’ as well as for childbirth, but determining the scope of medie- val midwifery practice is difﬁcult because midwives were not organized into guilds or other formal associations. For the most part, regulations pertaining to midwifery did not appear until the ﬁfteenth century and licensing rules generally dealt with moral character rather than medical skills.
In contrast to common assumptions about female medical practi-
tioners in medieval Europe, recent scholarship suggests that women practiced general medicine and surgery as well as midwifery. For exam- ple, in some parts of France, women could practice medicine or surgery if they passed an examination. However, as medical faculties and pro- fessional organizations gained prestige and power, laws governing medical practice became increasingly restrictive throughout Europe. Unlicensed practitioners were prosecuted, ﬁned, or excommunicated for disregarding these laws. Many of those who cared for the sick remain nameless, except when they became targets of the battle waged by physicians for control of the medical marketplace. As indicated by the case of Jacoba (or Jacque´line) Felicie in Paris in 1322, the lack of a formal education did not necessarily mean a lack of skill and experience.
The Dean and Faculty of Medicine of the University of Paris charged Jacoba with illegally visiting the sick, examining their pulse, urine, bodies, and limbs, prescribing drugs, collecting fees, and, worse yet, curing her patients. Not only did Jacoba feel competent to practice medicine, but also she thought herself capable of pleading her own case. Patients called to testify praised her skill; some noted that she had cured them after regular physicians had failed. Jacoba argued that the intent of the law was to forbid the practice of medicine by ignorant and incom- petent quacks. She argued that, because she was both knowledgeable and skillful, the law did not apply to her. Moreover, natural modesty about the ‘‘secret nature’’ of female diseases created a need for women practitioners.
The Dean and Faculty of Medicine who prosecuted Jacoba did
not deny her skill, but they argued that medicine was a science trans- mitted by texts, not a craft to be learned empirically. Actually, the larger goal of the Parisian faculty of medicine was to control the medical practice of surgeons, barbers, and empirics, whether male or female. Thus, trials of unlicensed practitioners provide glimpses into the lives of otherwise invisible practitioners and the relationship between
marginal practitioners and the elite medical community. In response to the case against Jacoba, the Court agreed with the interpretation of the statutes put forth by the Faculty of Medicine. Nevertheless, modern ideas about professionalization and the legal status of medical practi- tioners are very different from those that prevailed during the Middle Ages. Indeed, throughout history, most medical practitioners, whether male or female, were unlicensed and only a tiny minority had university degrees. Competition among many different kinds of medical practi- tioners was, however, already a factor in the medieval medical market- place—physicians, surgeons, apothecaries, and empirics.
Medieval documents pertaining to women practitioners are rare, but historians have found a few examples of women who specialized in the treatment of gout and eye disorders and a woman physician who held the title ‘‘master’’ (magistra). Between the thirteenth and the ﬁfteenth centuries, some women were granted licenses to practice medi- cine or surgery, although sometimes their practice was speciﬁcally limited to female patients, or conditions that affected the breasts and reproductive organs. For example, a fourteenth-century Spanish law prohibited women from practicing medicine or prescribing drugs, but the law made an exception for the care for women and children. In the absence of formal educational criteria for most occupations, medi- eval women and men may have worked at different full- or part-time occupations during the course of their lives. Thus, various aspects of healing, including midwifery, herbalism, nursing, and surgery, might have been practiced informally and intermittently. Those who enjoyed some success in such ventures might well be considered healers by fam- ily, friends, and neighbors, despite the lack of any speciﬁc training or formal licensing. Women were likely to be active participants in the work performed by their father or husband, because there was little or no separation between household and workshop, or caring for family members and supervising apprentices. Very few women appeared in the rolls of medieval guilds, but it is likely that many of the women who asked for permission to practice medicine or surgery when their hus- bands or fathers died had already been performing the tasks associated with those occupations.
Licensed women doctors essentially vanished by the sixteenth century, but hordes of quacks were busily peddling herbs, amulets, and charms. This army of marginal practitioners included barber- surgeons, herbalists, nurses, and midwives. As the medical profession assumed more power and prestige, the position of women healers became ever more precarious. Whatever the relative merits of scholars, priests, physicians, midwives, and empirics might have been, probably the best physicians of the Middle Ages were those recommended in the popular health handbook known as the Regimen of Salerno: doctors Quiet, Rest, Diet, and Merryman. Unfortunately, these doctors were
unlikely to be on the staff of the typical hospital or to make housecalls at the hovels of the poor.