Imagine it is the twelfth century, and you have woken up experiencing some trouble breathing. Fortunately, you have the financial resources to hire a top-tier, exquisitely learned physician to attend you. He listens closely to your problems, and knows at once what to do. Your uterus, he tells you, has wandered up into your chest cavity and is interfering with your lungs.
Sounds reasonable, you say, but what do we do about it?
But of course, all the great authorities are in agreement, he assures you. We simply must drive the uterus back down where it belongs by coating your nose with foul-smelling substances and burning or boiling sweet-smelling ones near your vagina. The uterus, which everybody knows has a sense of smell, will be repelled by the foul-smelling compounds, and attracted to the sweet ones, and will swim back to its proper place. Case closed.
Medieval medicine is the quintessential example of just how persuasively complicated and nuanced a body of knowledge can appear while being at the same time wrong in just about all of its assumptions and conclusions. The theories of the Hippocratic authors and the humours of the Galenic tradition filtered their way through copiers and editors on two continents, evolving into ever more learned theories about how bodies should work, while steadily losing contact with how they actually did.
For male patients, the results were harrying enough, but for women the treatments they were subjected to ranged from the absurd but harmless to the positively barbarous. Women were entirely at the mercy of theoretical systems that used theological and philosophical ideas about women’s natures to form regimens for the regulation of their bodies. Because women were believed to be dominated by ‘cold’ humours, it was considered necessary for the maintenance of their health to regularly eject heat through menstruation, a process which doctors would help along by slashing the soles of women’s feet with scalpels or producing lesions around the genitals so as to ‘pull’ the body’s blood downwards, and thus towards the womb. Likewise, if a woman was menstruating too much and thus losing too much heat, pressure cups would be applied to her breasts so as to drive blood back upwards and away from the uterus.
Bled, prodded and pulled, women were less subjects in their treatment and more a battlefield of humours to be tamed by whatever means necessary so that procreation could proceed apace.
The only thing to be said of this long tradition was that it held a generally positive view of menstruation and sexual activity as normal, healthful and necessary. But otherwise, it was male-crafted theory that led practice until the late twelfth century when a woman physician by the name of Trota of Salerno took it upon herself to write not about what ought to work in the curing of women’s diseases, but about what actually did work in practice. The resulting texts on the practical aspects of women’s health would stand as the definitive works on the subject for three full centuries.
We know next to nothing about Trota’s life story other than that she probably lived in the mid-to-late twelfth century and came from the southern Italian city of Salerno. Those two mere facts however speak volumes, as twelfth-century Salerno was an epicentre of medieval medical reform. A trading post between Africa and Europe, Salerno was one of the first towns in Europe to benefit from the importation of Arabic medical texts.
Sometime around 1070, a physician named Alfanus invited Constantine the African to settle in Salerno and supported him in the translation of the cream of Arabic medical knowledge. The result was a cavalcade of returned Greek practice blended with African materia medica knowledge, culminating in his seven volume Viaticum, which would hold its position as a core medical text for centuries. In a short century’s time, the unremarkable town of Salerno was garnering a continental reputation for the quality and learnedness of its physicians. For those of a practical turn of mind, the new cures and medicines coming from Africa could be tested side by side with traditional Italian and wider European practices, providing a way to break out of the practical stalemate of the previous centuries.
Trota appears to have been of such a practical turn of mind, and there is no better place to see that at work than in the book that solidified her position at the centre of medieval medical practice: the Trotula. The first thing to know about it is that it is not a single book, but rather three books that were thrown together by a succession of well-meaning editors and reworked until it was perceived to be one text written by the great and famous Trota. In fact, however, she was only responsible for one of those books, a fact we see right away when comparing her section with the other two.
The first section, On the Conditions of Women, is a straight-up retread of the Viaticum and all its theoretical, Galenic concerns. It advises certain procedures, not because they have been observed to be effective but because they fit nicely with certain accepted intellectual tropes.
The second section, Trota’s own On Treatments for Women, has flickers of theory here and there, but is overwhelmingly a brass tacks, ‘Here’s What Seems to Work’, approach to women’s health issues. Does your sweat stink? Bilberry leaves seem to do a pretty good job clearing that up. Are you experiencing swelling of the vagina after sex? Taking a bath infused with pennyroyal and mallow seems to help. Do you live in a restrictive society where your entire hope of happiness lies in being declared a virgin when you know perfectly well you are not one? Here are a few constrictive herbs that might help trick your prospective husband into believing you are.
The Trotula exists today in some 126 different manuscripts spread over four centuries, indicating that it was one of the most widely distributed medical texts of the Middle Ages, its original Latin eventually translated into Dutch, German and French. For issues relating to gynaecology, it was simply the reference work to have. Though it was Trota’s most influential book, it was far from her most comprehensive. Practical Medicine According to Trota included seventy-one remedies covering both women’s and men’s illnesses, but it exists today in only two manuscripts, while a greater work still we know only through excerpts included in the compendium On the Treatment of Illnesses. That she, a woman physician, was included in that compendium on the strength of her medical reputation, without seemingly a second thought, speaks not only to her influence but to the greater possibility that women physicians were more prevalent in medieval times than we generally believe.
That we do not have Trota’s complete body of works, and only know of her as a living person through one anecdote in the Trotula which narrates an incident when she used her level-headed knowledge of women’s issues to save a female patient from the theoretically muddled ministrations of a male colleague, is deeply frustrating. There are hints and whispers in the historical record of other Salernitan women boasting both medical knowledge and a familiarity with the newly arrived corpus of African remedies, but Trota is the only named practitioner we have to grasp, examine and speculate solidly about.
That is frustrating, but at least we do have the full Trotula, and while I doubt anybody will be adding leeches to their face to remove redness, or inserting a laurel-oil infused piece of lint into their vagina attached to two strings that are tied around the thighs to determine whether hot or cold humours are currently dominant in their bodies, there are moments in that book that reach across the centuries – of treating cracked lips with honey, or using hyssop to treat a coughing child, which remind us of our common humanity and deep trove of historical wisdom. Trota put practice and efficacy back at the centre of the physician’s practice, a foundational step towards that grand questioning of any metaphysics masquerading as science which bloomed in the Renaissance, and flourishes still.
FURTHER READING:
Historian Monica H. Green is perhaps the real hero of this story. She not only made the Trotula widely available in English for the first time with her 2001 The Trotula: An English Translation of the Medieval Compendium of Women’s Medicine, but included in it an exhaustively researched sixty-page account of the probable authorship of the different section of the Trotula, and of the twists and turns that saw three very different books gradually merged into one. She also gives a vibrant sense of what eleventh- and twelfth-century Salerno was like intellectually and commercially. It is an absolute must-have for any Women in Science collection.
And if you want to read more tales of great women physicians, check out my History of Women in Medicine and Medical Research, available from Amazon, and Pen and Sword US and UK.
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