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WOMEN AND MEDICINE

12 May

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

WOMEN AND MEDICINE

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.

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