Making Women's Medicine Masculine: Oxpord

Making Women’s
Medicine Masculine
The Rise ofMale Authority in Pre-Modern
Gynaecology
MONICA H. GREEN
OXPORD
UNIVERSITY PRESS
Contents
This book has been printed digitally and produced in a standard specification
in order to ensure its continuing availability
Preface vii
List ofIlltistrations and Tables xvii
OXPORD
UNIVERSITY PRESS List ofAbbreviations xix
Great Clarendon Street, Oxford 0X2 6DP Introduction: Literacy, Medicine, and Gender 1
Oxford University Press is a department of the University of Oxford. 1. The Gentle Hand of a Woman? Trota and Women’s Medicine at
It furthers the University’s objeetive of exeellenee in research, scholarship,
and education by publishing worldwide in
Salerno 29
Oxford New York 2. Men’s Practice of Women’s Medicine in the Thirteenth
Auckland Cape Town Dar cs Salaam Hong Kong Karachi and Fourteenth Centuries 70
Kuala Lumpur Madrid Melbourne Mexico City Nairobi
New Delhi Shanghai Taipei Toronto 3. Bruno’s Paradox: Women and Literate Medicine 118
With offices in
Argentina Austria Brazil Chile Czech Republic France Greece 4. In a Language Women Understand: the Gender of the Vernacular 163
Guatemala Hungary Italy Japan South Korea Poland Portugal
Singapore Switzerland Thailand Turkey Ukraine Vietnam 5. Slander and the Secrets of Women 204
6. The Masculine Birth of Gynaecology 246
Oxford is a registered trade mark of Oxford University Press
in the UK and in certain other countries Conclusion: The Medieval Legacy: Medicine of, for, and by Women 288
Published in the United States Appendix 1. Medieval and Renaissance Owners of Trotula Manuscripts 325
by Oxford University Press Inc., New York Appendix 2. Printed Gynaecological and Obstetrical Texts, 1474—1600 345
© Monica H. Green 2008
References 358
The moral rights of the author have been asserted General Index 385
Database right Oxford University Press (maker) Index ofManuscripts Cited 406
Reprinted 2009
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Oxford University Press, at the address above
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ISBN 978-0-19-921149-4
XX List ofAbbreviations
Green, Women's Healthcare Monica H. Green, Women’s Healthcare in the

Medieval West: Texts and Contexts, Variorum
Collected Studies Series, CS680 (Aldershot: Ashgate,
2000)
LWL London, Wellcome Library for the History and
Understanding of Medicine
OBL Oxford, Bodleian Library Introduction: Literacy, Medicine, and Gender
In June of 1410, a female surgeon, Perretta Petone, was brought before the royal
tribunal of Paris on charges of unlicensed practice. Perretta never denied that
she practised medicine. On the contrary, she proudly claimed that she had been
trained by one of her relatives and several other practitioners in a small provincial
town and that for the past eight years she had been practising in Paris, evidently
with great success. Her patients themselves had demanded her release when she
had first been imprisoned more than a year earlier. The intent of the corporation
ofsurgeons that brought the charge, however, was to prove Perretta incompetent.
And the key to their arguments was her literacy. According to Perretta’s account,
at a formal examination of her medical knowledge (which would normally have
been performed by only three examiners) some dozen physicians and surgeons
all interrogated her together, ‘mocking her and eyeing her scornfully’. They took
the medical book she had brought with her, a collection of remedies in French,
and flipped through the pages in front of her, all the while drilling her with
questions about how she prepared her medicines. When asked directly if she
could read, Perretta said that she could. Her interrogators, however, concluded
that ‘she doesn’t know an A from a bundle of sticks’.'
While Perretta was undergoing her humiliating ordeal in the courts at the
Chatelet, there sat on the shelves of the nearby royal library at the Louvre a
copy of a Latin medical book on women’s medicine bearing the inscription
‘Trotula, mistress of women’ {Trotula domina mulierum). ‘Trotula’ was, besides
the semi-mythical Cumaean Sybil, the only female author represented among
the nearly 900 volumes that made up the French king’s collection.^ In fact, the
royal library had originally had two copies of‘Trotula’s’ work: this Latin copy
■ Geneviive Dumas, 'Les femmes et les pratiques de la santd dans le “Registre des plaidoiries du
Parlement de Paris, 1364-1427 ” ’, Canadian Bulletin ofMedical History/Bulletin canadien d’histoire
de la midecine 13 (1996), 3-27. Dumas provides an analysis and a complete transcript of this
case, though see also Laurent Garrigues, ‘Les Professions m^dicales k Paris au ddbut du XVe siicle;
Praticiens en procis au parlement’, Bibliothiquedel‘£coledes Charles 156 (1998), 317-67, for more
on the medical context.
^ Throughout this book, I shall use Trotula as a descriptive label to refer to any or all of the
three texts that were eventually subsumed into the Trotula ensemble: Conditions of Women (Liber
de sinthomatibus mulierurn). Treatmentsfor Women (De curis mulierum), and Women's Cosmetics (De
omatu mulierum). When referring to ‘Trotula’, the purported author of the whole Trotula ensemble,
I use quotation marks in order to highlight the fact that ‘she’ is a scribal phantom. See below.
2 Making Women s Medicine Masculine Introduction 3
(which was probably rather unimpressive, since it was valued at the modest price only by a few steps. For not only was she disengaged from the theoretical discourse
of six sous in 1424 when the royal library was dispersed) and a French copy of that distinguished the medical writings of her male Salernitan peers, she was
‘the lesser and the greater Trotula’ (‘le petit et le grant Trotule’). Both copies ultimately no more accepted as an equal by her fellow twelfth-century medical
had been acquired before 1373 by Charles V, who suffered from infertility in writers than was Perretta by her fellow surgeons in fifteenth-century Paris.
the early years of his marriage. Like Charles, a variety of readers in medieval The figure of‘Trotula’, a textually metastasized form of Trota, seems at first
Paris saw great utility in ‘Trotula’s’ work. At least three copies of the Latin texts glance not to be marginal at all. The Trotula, recognized now as a compendium
were owned by the college of the Sorbonne, while individual owners of Latin of three different texts of independent twelfth-century authorship, was generally
and vernacular copies ranged from university professors to medical students to understood in the Middle Ages to be a single text (or perhaps ‘a lesser and
surgeons. So renowned was ‘Trotula’, in fact, that both the Sorbonne and the a greater’ pair of texts) by the eponymous author ‘Trotula’. ‘Trotula’s’ work
Abbey of St Victor held works falsely attributed to her. Her name was also cited was incorporated into handbooks of leading medical writings, and in libraries
in non-medical contexts well into the fourteenth century as a premiere authority throughout Europe ‘her’ work stood side-by-side those of such medical and
on women’s nature.^ natural philosophical authorities as Aristotle, Avicenna, and Albertus Magnus.
The practitioner ofquestionable literacy, Perretta, and the authoress of enviable Yet in the very act of granting her a special authority within women’s medicine,
fame, ‘Trotula, mistress of women’, would seem to have little in common. Yet medieval physicians and natural philosophers also limited ‘Trotula’s’ competence
it is the object of this book to show that they represent two extremes of a absolutely within those bounds. While it is perhaps ironic, it is not paradoxical
single spectrum of the ways in which women related to literate medicine in that learned Parisian males, both medical practitioners and intellectuals more
medieval Europe: that is, marginally. It was women’s marginality vis-h-vis literate generally, could (up to a point) accept ‘Trotula’ as an authority while at the same
medical culture that would make them marginal in the process of creating written time dismiss Perretta and indeed all female practitioners in Paris. In fact, ‘Trotula’
knowledge about their own bodies and diseases. By the time the Middle Ages was herself fading into insignificance right around the time Perretta was put on
came to a close, neither female practitioners like Perretta nor female textual trial. A fifteenth-century French translator of ‘Trotula’s’ work not only simply
authorities like ‘Trotula’ were deemed to have much relevance in the world of failed to acknowledge her authorship of the text, he even misinterpreted her
medical learning or practice, not even that part of it devoted to women’s diseases. name as that of a disease.^ By the following century, nobody any longer assumed
that a woman, because she was a woman, would have any greater authority in
the field of gynaecology than a man. On the contrary, the opposite was true.
FEMALE AUTHORITY, LICENSING, AND THE POWER The eclipsing of female practitioners as well as the learned authority ‘Trotula’ is
OF BOOKS remarkable, since several centuries earlier there was little to predict this outcome.
The Latin Trotula texts, composed in southern Italy in the twelfth century, would
Perretta’s marginality is obvious: a widowed provincial woman, she is jailed, go on to circulate throughout western Europe, from Spain to Poland, from Sicily
ridiculed, and driven out of practice because she was not able readily to recite to Ireland, and in most of those areas the authoress ‘Trotula’ would have enjoyed
the elements of medical theory found in books. ‘Trotula’s’ marginality is more at least a modicum of fame. Likewise, female medical practitioners, marginal
complex, yet it is ultimately akin to Perretta’s. The textual figure of‘Trotula’ though they may have been, can be documented sporadically throughout western
grew up around a core of both lore about and the actual dicta of a historic twelfth- Europe and still played a necessary function in the delivery of healthcare to both
century woman, Trota of Salerno, a practitioner who, like Perretta, seems to women and men. But the three centuries separating the historic Trota in twelfth-
have been exceptionally skilled in the treatment of men as well as women. century Salerno from Perretta in fifteenth-century Paris witnessed extraordinary
Unlike Perretta—and indeed, unlike all but a tiny handful of other medieval shifts in the social positioning of medicine within medieval society. The early
women—Trota crossed the threshold into the realm of medical authorship.^ But twelfth centuty wm the last moment in western history when there were no legal
restrictions whatsoever on medical practice.® Just as in Antiquity, the ‘medical
marketplace’ was open to anyone who wished to lay claim to medical expertise.
^ On the circulation of the Trotula in later medieval France, see Green, ‘Traitti^’. On the
infertility of Charles and his wife, Jeanne de Bourbon, see Chapter 6 below. By the fifteenth century, some form of legal controls or regulation of medical
* On the other documentable female medical writer from the twelfth centuty, the nun Hildegard practice had been instituted in what is now Spain, France, Italy, England, and
of Bingen, see Chapter 1 below. For other written testimonia to women’s medical practices, see parts of Germany. Although by no means universal, systems of licensing created
Monica H. Green, 'Books as a Source of Medical Education for Women in the Middle Ages’,
Dynam 'u: Acta Hispanica adMedicinae Scientiarumciue Historiam Illustrandam 20 (2000), 331-69,
and Chapter 3 below. 5 See Chapter 4 below. ® See Chapter 1 below on the origins of medical licensing.
4 Making Women's Medicine Masculine Introduction 5
pockets of standardization of what constituted proper medical knowledge and disease. It was precisely this knowledge of‘hidden causes’ that the new learned
medical skill. Literacy was not a sine qua non for licensing; most local licensing physicians—who began to style themselves physicus (‘one learned in the science
panels would conduct oral examinations of prospective licensees to ascertain the of nature’) as well as medicus (‘healer’)—could claim to offer.'®
extent of their experience and their knowledge of drug lore, surgical technique, Books were the bearers and transmitters and, indeed, the symbols, of this
etc.^ Nor were any legal impediments to licensing placed before women prior knowledge. As asserted in a general law passed for the Crown of Aragon in 1359,
to the fourteenth century; while such impediments would be enacted thereafter, medical practitioners, just as much as lawyers, were defined by their books:
well into the fifteenth century we have evidence that, at least on an ad hoc basis, we decree that no lawyer in cities, towns, or other significant places may practice law nor
some women continued to practise medicine without hindrance.® Perretta herself exercise the office of judge or assessor ifhe does not have all the ordinary books ofcivil law,
would claim as much in 1410, asking why she was being singled out when there or at least the ordirutry books ofcatwn law, or has not studied them for at least five years
were so many other female practitioners in Paris ‘of whom nobody demands in a studium generale, which he must swear to have done. And we wish the same to be
anything’. required of physicians in the art of medicine, except that it is enough for them to have
There was, nevertheless, a discernible consensus that licensing was a good thing studied for only three years in a studium generale.' *
and that reasonable criteria existed to determine who were the best individuals to
As in the case of Perretta’s examination, the physical books themselves might
license. With the rise of the universities out of the cathedral schools in the later
become part of the probative process of competence. For a university-educated
twelfth century, medicine took its place as one of the learned disciplines. Precisely
practitioner, it was not at all unusual that an examination for licensing involve
because regularized education created a cohort of similarly trained practitioners,
asking the candidate to read a passage from a book and then offer an ex tempore
authorities looking for some standard against which to assess medical competence
oral commentary on it.'^
began to see university education as the ideal. What university education had
The power of this claim to a ‘philosophical’ knowledge of medicine can be
to offer was grounding in ‘the principles of medical science’ and ‘verifiable
assessed most clearly among surgeons, who did not gain a firm foothold in
experience’. With the introduction of an Arabic medical corpus into Latinate
the university hierarchy but who nevertheless repeatedly made claims similar to
Europe in the late eleventh century, physicians in Salerno (and later Bologna,
the university physicians to possess a ‘science’ of healing.'^ Although surgery
Paris, Padua, and Montpellier) could begin to claim to ground their medical
had been largely passed over as an area of medical writing in twelfth-century
beliefs and practices on a real philosophical basis.® Whereas empirics might
Salerno, a written tradition that had begun in Italy c. 1170 with the pragmatic
regularly be successful in the cures they performed, they could not explain
and descriptive Surgery of Roger Frugardi would, by the beginning of the
why their cures worked nor explain the causes or predict the outcome of a
fourteenth century, be represented by fully theorized works by the Italians
Bruno of Longobucco, William of Saliceto, Theodoric of Lucca, and Lanfranc
^ Danielle Jacquart, Le milieu midical en France du XJIe au XVe silcle: En annexe 2e supplement of Milan, and the Frenchman Henri de Mondeville. Writing in the mid
au 'Dictionnaire'dEmest Wickersheimer (Geneva: Librairie Droz, 1981), p. 84, notes that there is
currently no evidence of university instruction for at least 35% of known Christian French male thirteenth century, Bruno of Longobucco was already identifying Latin literacy
physicians between the mid 13th and the end of the 15th centuries, at least some of whom may as a minimum requirement for practice.'^ Henri de Mondeville, who laid out his
have qualified simply by private study and then submission before an examining body. The most
comprehensive colleaion of published licenses, that of Raffaele Calvanico, Fonti per la storia della
medicina e della chirurgiaper il regno di Napoli nelperiodo angioino (a. 7273—(Naples: L’Arte Jerome Bylebyl, ‘The Medical Meaning of Physica’, Osiris, 2nd set., 6 (1990), 16-41.
Tipografica, 1962), presents many cases of both men and women who are licensed despite being ' ‘ Luis Garcia-Ballester, Michael R. MeVaugh, and Agustin Rubio-Vela, Medical Licensing and
ydiota (illiterate). Learning in Fourteenth-Century Valencia, Transactions ofthe American Philosophical Society 79, pt. 6
* Evidence for formally licensed women in the 14th and 15th centuries comes from Spain, the (Philadelphia: American Philosophical Society, 1989), p. 8, emphasis added.
southern Italian Kingdom of Naples, and certain areas of France. In the early I5th century, a ‘poor See, for example, the record of the examination of Pierre Calberte, bachelor of medicine, at
bedeswoman Joan’ sought permission from Henry IV of England to practise medicine ‘without Montpellier in 1307, cited in Garcia-Ballester etal.. Medical Licensing, pp. 12-13.
hindrance or disturbance from all folk’. If her request was granted (we don’t know whether it was or * ^ University training of surgeons is documented only at Montpellier and certain northern Italian
not), it would have fiinaioned as a facto licence; see Eileen Power, ‘Some Women Practitioners universities, and even then they did not receive a lull programme of study. It should be stressed, too,
of Medicine in the Middle Ages’, Proceedings ofthe Royal Society ofMetEcine 15, no. 6 (April 1922), that university-trained physicians were always a numerical minority among the array of medical prac
20-3. See also Chapter 3 and the Conclusion below for further evidence of women’s medical titioners. Jacquart, Milieu, p. 246, for example, estimates that for Paris (a university town) between
praaices. the years 1310 and 1329 (which included theyear ofjacoba Felicie’s trial), there were 84 physicians,
’ Mark D. Jordan, ‘The Construction of a Philosophical Medicine: Exegesis and Argument 26 (at minimum) surgeons, 97 barbers, and 15 mires (empirical healers). It should remembered,
in Salernitan Teaching on the Soul’, Osiris, 2d set., 6 (1990): 42-61; and ‘Medicine as Science too, that practitioners with university associations have a higher likelihood of being identified since
in the Early Commentaries on “Johannitius”’, Traditio 43 (1987): 121-45; Danielle Jacquart, their institutional affiliations themselves generate documents chronicling their careers.
‘Aristotelian Thought in Salerno’, in A History of Twelfth-Century Philosoplty, ed. P. Dronke Susan P. Hall, ‘The Cyrurgia Magna of Brunus Longoburgensis: A Critical Edition’, DPhil
(Cambridge; Cambridge University Press, 1988), pp. 407-28. thesis, Oxford University, 1957, p. 4: ‘They [ideal surgeons] should be literate men [uiri litterati\
6 Making Women’s Medicine Masculine Introduction 7
own simultaneously empirical and theoretical training as a model for others in fourteenth century, even though authorities in Paris stilF expected surgeons to
the early fourteenth century, stressed that his Latin surgical text was intended for have a modicum of Latin.^® Literacy in at least the local vernacular languages
‘intelligent [practitioners], especially literate ones, who know at least the common could likewise be expected of apothecaries, who by 1329 in Valencia were
principles of medicine and who understand the terminology of the art’.*5 By assumed to be able to read prescriptions presented to them in the vernacular,^'
1363, the Frenchman Guy de Chauliac would list literacy as the very first of four and who, in Paris at just about the same time, were being enjoined to have both
qualifications of the good surgeon.’® While it can be questioned whether literacy a corrected copy of the pharmaceutical authority Antidotary ofNicholas and at
alone had the transformative effect on the practice of surgery that Mondeville least one literate person in the shop (preferably the master apothecary himselO
and others had hoped, literacy clearly played a major role in altering the status who could read it.^^ Indeed, the fact that so many later medieval vernacular
of surgeons and other practitioners outside the strict confines of the university, copies of surgical texts are almost hopelessly corrupt is itself an indication that
what I will call ‘peri-university’ circles. Some sixty-seven male authors of medical the value of these books lay more in the symbolic aura of learning they granted
writings in France, for example, have no known university ties and many times to their possessors than any intrinsic knowledge they could have effectively
that number owned medical books.*^ conveyed.^^
This belief in the power of books to confer, not simply collected therapeutic Ramon Roquer, the unlicensed Catalan surgeon, claimed that his prosecution
knowledge but also the principles of medical science, was not confined to Latin was motivated by other envious surgeons, and there is ample evidence that
medical literature. When Ramon Roquer, a surgeon from a small town in many cases of prosecution were instigated by fellow practitioners who stood to
Catalonia, was accused, like Perretta, of unlicensed practice in 1338, he asserted benefit by removal of their competitors from the medical marketplace. But to
that ‘he had practised the art of surgery for a long time, and, although he was cast these developments in licensing and learning as merely the manifestations
a layman and unlettered [i.e., not a cleric and not literate in Latin], he owned of self-interest on the part of university-educated practitioners would be to
good books and had good cures to his credit’.'* Ramon’s books would probably slight evidence that there was a growing general belief in the ability of learned
have been in Catalan, into which at least half a dozen different surgical texts medicine to provide desirable medical care. In monasteries and nunneries, which
had been translated by the first half of the fourteenth century.” To be sure, ever since the time of Benedict had been expected to run their own infirmaries
Latin remained the main language for composition of theoretical medical texts to care for their sick, there is widespread evidence for the employment of
through to the end of the Middle Ages. But just as in Catalonia, many parts professional practitioners from outside the community to tend to their more
of Europe witnessed an efflorescence of vernacular medical writing, often in grievously ill. These communities sometimes even signed contracts with licensed
the form of translations of Latin texts. Thus, in France, we find almost all the practitioners to ensure their attendance when needed.^^ Lay people as well, from
major surgical texts—Roger Frugardi, Bruno of Longobucco, Lanfranc, Henri the nobility to the middling urban classes, sought out the ministrations of learned
de Mondeville, and Guy de Chauliac—available in French translation by the
or at least they should learn the art from someone who knows letters; for 1 think that hardly anyone “ On French surgical texts in general, see Helen Vails, ‘Studies on Roger Frugardi’s Chirurgia',
who is completely without letters can comprehend this art’. See also Chapter 3 below. PhD dissertation. University of Toronto, 1995; and Claude de Tovar, ‘Les versions franpiises de
'5 Henri de Mondeville, Chirurgia, in Die Chirurgie des Heinrich von Mondeville (Hermondaville); la Chirurgia parva de Lanfranc de Milan. £tude de la tradition manuscrite'. Revue d'Histoire des
nach Berliner, Etfarter und Pariser codices, ed. Julius Leopold Pagel (Berlin: August Hitschwald, Textes 12-13 (1982-3), 195-262. On Parisian surgeons’ Latinity, see the intriguing observations
1892), p. II. in Genevieve Dumas, ‘Les femmes’, pp. 13—15. In 1396, the surgeons associated with the
Guy de Chauliac, Inventarium sive Chirurgia magna, ed. Michael R. McVaugh, with Margaret Confraternity of Saints Cosmas and Damian ordered that all new apprentices should be able to
S. Ogden, Studies in Ancient Medicine, vol. 14, I and II (Leiden: Brill, 1997), vol. I, p. 9. (Ail speak and write good Latin; see Cornelius O’Boyle, ‘Surgical Texts and Social Contexts; Physicians
citations from this edition will be from vol. I unless otherwise indicated.) Chauliac included a and Surgeons in Paris, c.1270 to 1430’, in Practical Medicine, pp. 156-85, at 183.
full training in medical theory and practice in his definition of literacy. The other qualifications Garda-Ballester, et aL, Medical Licensing, p. 6.
were practical experience (including watching others work), ‘ingeniousness' (by which he meant Henri Denifle (ed.), Chartularium universitatis Parisiensis (Paris: Delalain, 1891-9; repr.
a combination of quick wit, nimble hands, and good eyes), and sound morals (including clinical Brussels; Culture et Civilisation, 1964), 2: 268-9.
prudence, chastity, sobriety, and mctcy). For examples of rather astounding levels of textual corruption, see Green, ‘Traitti^’; Sylvie
Jacquart, pp. 199-205. Bazin-Tacchella, ‘Adaptations franfaises de la Chirurgia Magna de Guy de Chauliac et codification
'* Garcia Ballester et aL, Medical Licensing, p. 9 (my emphasis). du savoir chirurgical au XV' si^cle’, in Bien dire et bien aprandre: Actes du collotjue du Centre d'Btudes
” My thanks to Llufs Cifiientes for sharing with me the results of his many years of research on Midiivales et Dialectales de Lille III. 'Traduction, transposition, adaptation au Moyen Age', Lille,
Catalan scientific and medical texts (petsonal communication, 5 January 2003). Of course, Ramon 22-24septemhre 1994, t. 14 (1996), pp. 169-88; and Joris Reynaert, ‘Over medische kennis in de
may not have been referring specifically to surgical books at all but to remedy books or any number late Middeleeuwen: De Middelnederlandse vertalling van Lanfrancs Chirurgia magna', Millenium:
of other medical texts in Catalan; see Llufs Cifiientes i Comamala, La ciencia en catala a I'edat tijdschrifi voor mimiddeleeuwse Studies 13, n. 1 (1999), 21-30.
mitjana (Barcelona; Univetsitat de Barcelona, 2001). See the evidence collected in Green, ‘Books as a Source’,
practitioners and signed contracts with them to ensure their availability.^^ Jn literates’ who were increasing in number throughout this period.^® For example, a
later medieval Italy, patrician women not simply sought out learned practitioners grammar teacher and historiographer, Bonvesin de la Riva, estimated in 1288
for cases of infertility and other problems, but even willingly asked to be that there were 1500 notaries in his native Milan, a city that at the time had
autopsied by them after their death so that the causes of their disease could be no university.The rise of such notarial classes was more intense in southern
determined for the sake of their children.^® To be sure, learned practitioners Europe, though by the mid fourteenth century comparable classes of literate, and
were never numerous enough to attend to the needs of the entire medieval exclusively masculine, functionaries could be found in urban northern Europe,
populace, even in densely populated urban areas. Illiterate or only marginally the majority of whom would have had facility with Latin.3* Little is known about
literate practitioners could still be found everywhere and were often used in the training of these bureaucrats, but it is apparent that they could form their
conjunction with the services of literate healers.^^ But whereas the illiterate own local masculine cultures with shared reading habits (often in the vernacular),
empiric might have had the same chance of gaining a local reputation for such as that in which GeoflFrey Chaucer participated at the court of Richard II
excellence in healing as a book-learned practitioner at the beginning of the in England.®^ Medical reading was not necessarily high on the agenda of such
twelfth century, such possibilities for equal competition would have been socially aspiring male readers, but it figured often enough in the libraries of
quite rare by the fifteenth. Literacy is thus a key historical element in the lawyers, merchants, and gentry to constitute an important element of medical
changed landscape of medical licensing and practice in the high and later culture.® ’ On the island of Majorca, for example, some 660 medical books (most
Middle Ages. in Latin, but some also in the vernacular) have been found in the possession
It is also a key element to understanding a broader function that medical of eighty-six different individuals between the thirteenth and the mid sixteenth
literature came to perform in the later medieval period. Even as medicine was century, at least forty-nine of whom are not professional medical practitioners
becoming more and more professionalized—more concentrated, that is, in the but rather noblemen, merchants, artisans, and clerics. Aside from one Jewish
hands of practitioners who took on identities as practitioners and perhaps relied woman, none of these owners was a woman.®^
on medicine for a major part of their income—it was also developing a broader Neither the role of literacy in the processes of medical professionalization nor
lay audience for written texts on health. Some readers were simply interested in the rise of lay audiences of medical writings will come as a surprise, of course,
regimens of health, guides to regulating the six ‘non-naturals’ (environmental when seen in light of the radically changed understanding we have now of the
and behavioural factors over which one had some control, such as air, food, literacy revolution of the high Middle Ages.®® The work of Michael Clanchy
sexual activity, and so forth). These interests in health maintenance would and others has demonstrated that although medieval Europe (at least after its
often be accompanied by interest in having random recipes or short tracts on the
properties of particular herbs, such as betony or rosemary. At this level of reading,
Richard Britnell (ed.). Pragmatic Literacy, East and West: 1200—1330 (Woodbridge, Suffolk:
we find more or less comparable evidence of male and female interests.^® Other Boydell, 1997).
non-professional readers, however, had more advanced interests, branching into ^ Thomas Behrmann, ‘The Development of Pragmatic Literacy in the Lombard City Com
munes’, in Britnell, Pragmatic Literacy, pp. 25-42. Ronald G. Witt, 'In the Footsteps ofthe Ancients’:
studies of the humours and other elements of physiology, and also allied fields
The Origins ofHumanism from Lovato to Bruni, Studies in Medieval and Reformation Thought, 74
such as alchemy and astrology, which promised even more knowledge with which (Brill: Leiden, 2000), p. 91, cites modern studies showing only slightly lower numbers of notaries for
to control one’s relation to the natural world. The genesis of these audiences was Bologna and Pisa, nevertheless noting that ‘the field [of the notariate] was perennially overcrowded’.
Under Roman-canon law, women could not serve as notaries because they could not legally
likewise a function of the literacy revolution, for we can locate many readers of
serve as witnesses to testaments. On the continued use of Latin as the principal language of record
this type among the mercantile, lawyerly, and notarial classes, those ‘pragmatic throughout Europe, see Britnell, ‘Pragmatic Litetacy in Latin Christendom’, in idem. Pragmatic
Literacy, pp. 3-24.
Paul Strohm, Social Chaucer (Cambridge, MA; Harvard University Press, 1989). See also
Katharine Park, Doctors and Medicine in Early Renaissance Florence (Princeton: Princeton Witt, 'In the Footsteps’, for the roles notaries played in the development of humanism and vernacular
University Press, 1985), and ‘Medicine and Magic; The Healing Arts’, in Gender and Society in Italian literature.
Renaissance Italy, ed. Judith C. Brown and Robert C. Davis (London: Longman, 1998), pp. 129-49: I will return to this point in Chapters 4 and 5. For evidence on the circulation among male
Michael R. McVaugh, Medicine Before the Plague: Practitioners and Their Patients in the Crown of readers of the French RIgime du corps (a general regimen of health that had originally been addressed
Aragon, 1285-1345 (Cambridge: Cambridge University Press, 1993);Joseph ShzxztmWet, M/decine to a female recipient), see Gteen, ‘Possibilities’.
etjusticeen Provence midiivale: DocumentsdeManosque, 1262—1348 (Aix-en-Provence: Publications J. N. Hillgarth, Readers and Books in Majorca, 1229—1550, 2 vols. (Paris: Editions du
de rUnivetsit^ de Provence, 1989). C.N.R.S., 1991), pp. 43-44, 89-96 and 261; Hillgarth in facr suspects that medical volumes are
Katharine Park, Secrets of Women: Gender, Generation, and the Origins of Human Dissection rather underdocumented. On the Jewish woman Alegra, see Chapter 3 below.
(New York; Zone, 2006). The general trends and conclusions of this field of research have been summarized by Charles
Park, ‘Medicine and Magic’. F. Briggs, ‘Literacy, Reading, and Writing in the Medieval West’, Journal ofMedieval History 26
Comparable, that is, in type, not in extent. See Chapters 3 and 4 below. (2001), 397-420, though neither gender nor medicine receive any attention in his analysis.
Christianization) was never completely without letters, it was in the eleventh and transmission of medical knowledge nor how literacy may have played a role
twelfth centuries that Europe can be said to have become a truly literate culture. in the process of professionalization. Jole Agrimi and Chiara Crisciani, in their
This is not a matter of increasing levels of literacy (though that surely was a several studies of the creation of new medical epistemologies in the high Middle
by-product of the transition) but of new attitudes about the power of the written Ages and their effects on medical practice, have come closest to articulating
word to preserve information in a way that could first compete with and later a sense of the importance for medicine of the transition from oral to written
supersede the powers of individual and communal memory.*® Clanchy’s study forms of communication. As they note, ‘The composing of texts can be seen
centred on the impact of literacy in law and governance; literary scholars have as a fundamental turning point towards more ordered systems of studies which
focused on the rise of the vernacular languages and the transition from orality to are able to establish a new kind o(societas [association of master and students],
literacy as it affected composition and performance.*^ Most recently, a variety of one no longer based on private familiar relationship.’^’ I will argue here that not
researchers have turned to documenting the literacy of medieval women and how only did written medical texts enable the formation of these larger societates of
medieval gender roles affected women’s education and access to different kinds practitioners, but they also sometimes enabled the formation of larger ‘textual
of literature.*® None of these studies mention medicine, despite its position as communities’ (as Brian Stock would call them) of men directly associated
one of the archetypal learned professions, next to theology and law among the neither with the universities nor professional medical practice, yet who had both
higher faculties of the medieval universities. the literate skills and the intellectual desire to participate in the discourses of
Historians of medicine, for their part, have only begun to pose questions of medicine.^^
how literacy or the transition from orality to literacy shaped the content or use The present study is also informed by the ‘linguistic turn’ that has affected
of medical knowledge in the premodern period.*® Studies of medical readers and so many areas of scholarship in the last twenty years. Like many other historical
writers traditionally focused on university physicians whose literacy and Latinity disciplines, the field of the history of medicine in premodern Europe has
need never be questioned. Prosopographical studies of medical practitioners broadened considerably to include not only aspects of social history but analyses
have occasionally noted their ownership of books or, on the other extreme, of the social construction of knowledge. Historians have been faced with the
instances where practitioners are explicitly called illiterate (idiota, illiteratus)^^ realization that just as medical texts—whether they are works of general medical
Yet thus far there has been no systematic concern to document how literacy theory, specialized textbooks on particular diseases, handbooks of regimen, or
or the lack of it may have set up more or less impermeable barriers in the collections of individualized diagnoses and courses of therapy—cannot be read
without an eye to their textual and theoretical affiliations with earlier medical
Rosamond McFGtterick, The Carolingians and the Written Word (Cambridge: Cambridge traditions (whether Greek, Arabic or European), so, too, they cannot be read
University Press, 1989); and ead. (ed.), The Uses ofLiteracy in Early Mediaeval Europe (Cambridge: without an eye to aspects of rhetoric, topos, formulicity, and the other discursive
Cambridge University Press, 1990); Michael T. Clanchy, From Memory to Written Record: England
1066-1307,2nd rev. edn (Oxford; Blackwell, 1993). See also his essay ‘England in the Thirteenth traditions in which they participate. Medical texts are not objective records
Century: Power and Knowledge’, in England in the Thirteenth Century: Proceedings of the 1984 that can provide the historian with transparent witnesses to past realities, but
Harlaxton Symposium, ed. W. M. Ormrod (Woodbridge, Suffolk; Boydell Press, 1986), pp. 1-14, crafted documents meant to serve specific, historically contingent purposes. The
which explores some issues of the relation between power and knowledge; and M. B. Parkes, ‘The
Literacy of the Laity’, in Literature and Western Civilization, vol. 11; The Mediaeval World, ed. David analytical techniques honed by literary scholars are, in fact, among our most
Daiches and Anthony Thorlby (London: Aldus, 1973), pp. 555-77. important tools in excavating the shifting meanings and uses of medical texts.
For example, Franz Bauml, ‘Varieties and Consequences of Medieval Literacy and Illiteracy’,
Speculum 55 (1980), 237-65; Joyce Coleman, Public Reading and the Reading Public in late
As the editors of a recent collection on general uses of the vernacular in England
Medieval England aruL France (Cambridge: Cambridge University Press, 1996). have asserted, medieval texts ‘require to be read in quantity, in careful relation to
I survey this literature in Green, ‘Possibilities’. See also Chapter 4 below. their cultural situation and, above all, with a sense of their strategic function’.^*
Two early contributions are 1. M. Lonie, ‘Literacy and the Development of Hippocratic
Looking at medical texts in quantity is challenge enough (given that the vast
Medicine’, in Formes de pemie dam la collection Hippocratique, ed. Francois Lasserre and Philippe
Mudry (Geneva: Droz, 1983), pp. 145-61; and Gordon Miller, ‘Literacy and the Hippocratic
Art; Reading, Writing, and Epistemology in Ancient Greek Medicine’, Journal of the History
of Medicine and Allied Sciences 45 (1990), 11—40. More recently, medievalists have noted the Jole Agrimi and Chiara Crisciani, ‘The Science and Practice of Medicine in the Thirteenth
delibetate self-fashioning, both of the individual and of the craft, that the new genre of surgical Century according to Guglielmo da Saliceto, Italian Surgeon’, in Practical Medicine from Salerno to
writing permitted in the late 12th and 13th centuries. There is, moreover, now a growing and very the Black Death, ed. Luis Garda-Ballester, Roger French, Jon Arrizabalaga, and Andrew Cunningham
sophisticated literature on issues of audience and uses of medical texts as they crossed from Latin (Cambridge: Cambridge University Press, 1994), pp. 60-87.
into the vernacular. See Chapter 4 below. On this concept of‘textual communities’, see below.
E.g. Shatzmiller, Midecine etjustice', and MeVaugh, Medicine Before the Plague. MeVaugh has Jocelyn Wogan-Browne, Nicholas Watson, Andrew Taylor, and Ruth Evans (eds.). The Idea
discovered the very intriguing foct that physicians in the Crown of Aragon occasionally functioned ofthe Vernacular: An Antholo^ ofMiddle English Literary Theory, 7520 (University Park, PA;
as grammar teachers (p. 87), but how they themselves became literate is not known. Pennsylvania State University Press, 1999), p. 316.
^^ Making Women’s Medicine Masculine
Introduction
majority are still unedited), but the payofFfrom doingso, and from situating them 13
foftheeffor^^^ and specially learned medicine, came increasingly to dominate, and increasingly
to disenfranchise, those who could not enter into literate culture.
here are, of course, important distinctions within the realm of literate
dicine that must be kept in mind. Already in 1206, the French poet and
WOMEN AND LITERATE MEDICINE isteraan monk Guiot de Provins identified literacy as the key to success for
both charlatans and good, reliable physicians’: ‘Any old rascal with the gift
My primaty concern in the present study is to explore the cultural situation ûHn ^ dim-witted folk^5
thfoZhT uTr ^ 'hey moved in rhe ^ and simple was never enough. To have basic literacy
through the world of Latin medical literature and as they ‘filtered dov^’ (often knirT r Latin: to have some rudimenta^
multiple times) into many of the European vernacular languages. Precisely subt7ettf f d" u one to comprehend Z
because they were created prior to the establishment of the universities, and subtlenes of medical theory that demanded grounding in logic, grammar, and
SuS gendered feminine in two respects—being both
g y) y a female author and addressing women’s medicine—the Trotula m absorb the highly sophisticated physiological theories of university medical
pts oiler a unique opportunity to examine how textual communities were Te tho!7'''h'^ of literacy as possible would always
medi«r°“ hy whom women’s / l,"^ ” status an edge. As the university-trained
medical care was delivered. The history of the Trotulavczs played out on a terrain urgeon/physician Guy de Chauliac warned readers of his Latin surreal text,
somewhere between the high learned medicine of the universities and the wholly il physicians have not learned geometry, astronomy, dialectics, nor any other
oral practices of illiterate empirics. I call this terrain ‘literate medicine’, the realm liberal disciplme, soon leather workers, carpenters, smiths, and others will quit
thcir own crafts and become physicians’.^^
ot medical thought and practice that involves medical knowledge that has been
The higher levels of literate medicine never eclipsed or made obsolete the more
written down, knowledge that has been committed to a textual and not simply
humble forms, as is amply attested by continued traditions of more or less random
oral mode for its transmission. ‘Literate medicine’ is a much broader category collections of recipes, free of all theoretical trappings, and the continued presence
than learned medicine (for example, the formal commentaries and scholastic throughout Europe of successful, marginally literate empirical practitioners (of
disputations of the universities), which will demand competence not only with a whom Perretta had been one). Nor did Latin always trump the vernacular. As
large technical vocabulary but also with sophisticated philosophical concepts for we have already seen, however, there was clearly a sense of hierarchy, a sense
its interpretation. Literate medicine encompasses learned medicine, of course, that grew as patients themselves came to value more highly the learning of the
but it also includes written material such as recipes jotted down in the back Latinate, university-trained physician or surgeon who could claim to ground his
of a notebook or a little handbook of daily regimen. Simply by the fact of its diagnostic decisions and therapeutic practices in rigorous medical theory. For
being written down, it involves both its creators and its users in the world of certain individuals to be excluded from basic literacy, from the grammar schools
medical books. True, some of these users may not in fact have known how that taught logic and rhetoric, and from the universities that taught Aristotle,
to read, but even if they depended on others to read to them (and so did not Galen, and Avicenna, meant their exclusion from the small but increasingly
have the same intellectual independence as did full literates) these quasi-literates powerful circles of literate medical discourse, both as practitioners and as patients
participated all the same in a literate culturc.^^ In focusing on literate medicine, who might wish to choose self-treatment or select a practitioner on the basis of
therefore, I am by no means ignoring the fact that much, perhaps most medicine informed criteria. It meant, in effect, their exclusion from the mechanisms of
in medieval Europe was not literate—that many medical practitioners were power offered by literacy and literate medical culture.
probably illiterate, or that many acts of healing and therapy were probably This book is not intended as a definitive exploration of the manifold questions
performed without recourse to any texts or textual traditions of knowledge. On of how literacy and medicine interacted in the Middle Ages, yet in focusing on
the contrary, I take the illiteracy of many practitioners (especially women) very the question of how literacy, medicine, and gender interacted it is in fact able
seriously, precisely because it was against this backdrop that literate medicine.
As cited in Tony Hunt, Anglo-Norman Medicine^ 2 vols. (Cambridge: D. S. Brewer), 2: 15-

^ I adopt the term quasi-literates from BaumI, ‘Varieties’, which he defines as ‘those iUiterati
^ Guy de Chauliac, Inventarium^ p. 9, lines 26-9. Guy was quoting the Greek physician Galen
who must and do have access to literacy. .. [and who depend] on the written word for the exercise
here, making it all the more striking how readily he was able to adopt the rhetoric of ancient medical
of their socio-political function’ (p. 246).
rivalries to his own day.
to lay bare the central features of that transformation. For it is no coincidence 1329, the city of Valencia asserted unambiguously that no woman was to practise
that women—who as a group were excluded from the grammar schools that medicine in the city aside from providing care to other women or children (and
taught logic and rhetoric, from the universities that taught Aristotle, Galen, even then they were prohibited from prescribing medicinal potions). Similar
and Avicenna, and even from the notarial schools and chanceries that taught restrictions specifically on women were put into place (or at least attempted) in
bureaucrats their advanced literate skills—were also, as a group, frequently England and France by the end of the fifteenth century.’*
singled out by medical writers and legislators as particularly unsuited for medical Just seven years before the Valencian ordinance was passed, the well-known
practice. Whereas in twelfth-century Salerno male medical writers could refer to trial ofJacoba Felicie was held in Paris. Although Jacoba was accused along with
the empirical practices of Salernitan women with acknowledgement and even several other women and men of unlicensed medical practice, the prosecution of
respect, from the mid thirteenth century on denunciation of the practices of her case took on a particularly gendered focus. A principal argument used by the
women becomes a recurring topos in the writings of theoretical surgery, a field prosecution against Jacoba was that as it was forbidden for women to practise
particularly anxious to separate itself from strictly oral and empirical practices. law, so much the more should they be barred from practising medicine where
The Italian surgeon Bruno of Longobucco readily adopted the condemnation of their ignorance might result in a man’s death rather than the simple loss of his
medical practice by illiterates from one of his Arabic sources, but it was he who case in court. Yet the statute of 1271 which Jacoba allegedly violated said nothing
added the particular element of gender: ‘What ought to be judged even more that restricted women more than men from medical practice. On the contrary,
indecent and horrible [than medical practice by illiterate men] is that vile and the statute was phrased in such a way that put the female surgeon, apothecary,
presumptuous women usurp and abuse this art, women who, although they have or herbalist under the very same restrictions as her male counterpart—but
faith [in what they are doing], have neither art nor understanding.’'*^ Lanfranc also outlined the conditions under which both men and women could practice
of Milan, writing some fifty years after Bruno, still relied on the testimony legally. Jacoba Felicie claims that she knows medical theory, but nothing in
of women, since they ‘are without doubt expert in their own diseases’, along her trial record confirms that she owned books or was literate.’^ Jacoba’s trial
with his own experience and that of ‘revered medical doctors’ to confirm the is also striking because, even as Jacoba tries to separate herself from ‘illiterates
effectiveness of his pharmaceutical recommendations. He nevertheless saw them and empty-headed ignoramuses’ (ydiotas et fatuos ignaros) to whom, she agrees,
as a lesser order of practitioner who ought not be delegated responsibilities that medical practice should legitimately be forbidden, and tries to align herself with
properly belonged in the hands of surgeons.^® His fellow surgical writers Henri the theoretical medicine of the university physicians, she also wishes to claim
de Mondeville and Guy de Chauliac, both writing in the fourteenth century, that she, as a woman, has a special expertise to treat women that none of her
were even harsher, finding nothing to praise, and much to condemn, in women’s male accusers can claim. And indeed, she has a point: in what ways could the
medical practices.'*’ Early licensing laws either made no explicit mention of learned medicine of university-educated males claim to offer better knowledge or
women or phrased their stipulations in egalitarian formulae {medicus vel medica, more appropriate treatment to female patients who, according to Jacoba, prefer
chirurgicus vel chirurgica) that assumed that female practitioners not only existed to ‘reveal their secrets’ to a female practitioner than to a male? It is notable
but had the same potential to obtain licenses as did their male counterparts. By
the mid fourteenth century, all such egalitarian phrasing had disappeared.’® In
le Bel, roi de France, composie de 1306i 1320, Paris: F^lix Alcan, 1893, pp. Ixiv-v). Ellen E. Kittell
and Kurt Gueller, '“Whether Man or Woman": Gender Inclusivity in the Town Ordinances of
Medieval Douai’, Journal ofMedieval and Early Modem Studies 30 (2000), 63-100, find this same
" For the full context of this statement, see Chapter 3 below.
Lanfranc, Chirurgia magna, in Cyrurgia Guidonis de Cauliaco. et Cyrurgia Brunt, Teodorici, use of occupational dyads in mid 13th-centuty Oouai, arguing that there such usages demonstrate
Rolandi, Lanfranci, Rogerii, Bertapalie (Venice, 1519), ff. 166va-210vb, Tractattis V (the Antido- the acknowledgement of women’s participation in these fields. They also, however, find the same
tarium), preface, f 206va: ‘Nullas [medicinas] enim in eo ponemus: nisi illas quibus longo tempore disappearance of such usages by the early 15 th century.
sumus vsi: & quas a reuerendis doctoribus medicis: ac etiam mulieribus habuimus: que omnes sine ” Garcfa-Ballester, Medical Licensing, pp. 29-32; Monica H. Green, 'Women’s Medical Practice
dubio in casibus suis sunt experte’. In Tractatus I, doctrina 1, on the purpose of surgery, Lanfranc and Health Care in Medieval Europe’, in Sisters and Workers in the Middle Ages, ed. J. Bennett,
derided his fellow surgeons who, out of arrogance, let such manual tasks as scarifying, cauterizing, E. Clark, J. O’Barr, B. Vilen, and S. Westphal-Wihl (Chicago: University of Chicô Press, 1989),
and applying leeches fall to the hands of barbers and women (harheriis & mulieribus relinquantur, pp. 39-78, repr. in Green, Women's Healthcare, Essay I, at pp. 51 -4. This piece originally appeared
f. 168va). in Signs: Journal of Women in Culture and Society 14 (1989-90), 434-73.
Henri de Mondeville, Chirurgia, p. 65; and Guy de Chauliac, Inventarium, p. 1, lines 7-8. Her accusers, the physicians, likewise tie literacy to proper knowledge of medicine but they
For example, an ordinance from Paris in 1271 reads: 'idcirco firmiter inhibemus ne aliquis throw this back at Jacoba as an accusation: she is, according to them, ‘totally ignorant of the
cirurgicus seu cyrurgica, apothecarius seu apothecaria, herbarius seu herbaria per juramenta sua art of medicine and illiterate’ (totaliter est ignara artis medicine et non litterata); Denifle (ed.),
limites seu metas sui artificii clam vel palam seu qualitercunque excedere presumat. ..' (Oenifle, Chartularium, vol. 2, pp. 255-67. For a recent comprehensive analysis of this case, see Montserrat
Chartularium, 1:489), while one issued by Philip Ic Bel in 1311 refers, in French, to 'Chirurgiens Cabtd i Pairet and Fernando Salmdn Muniz, ‘Poder acaddmico versus autoridad femenina: La
et Chirurgiennes’ (Edouard Nicaise, Chirurgie de Maitre Henri de Mondeville: chirugien de Philippe Facultad de Medicina de Paris contra Jacoba Fdlicid (1322)’. Dynamic 19 (1999), 55-78.
16 Making Women s Medicine Masculine
Introduction 17
that whereas the Parisian physicians respond point by point to all of Jacoba’s
questions thus kept growing at a pace far exceeding my ability to answer them:
other claims (whether the physicians rightly have jurisdiction over the case, the
Are the original addresses of the late antique Latin texts to midwives evidence for
alleged absence of any law forbidding her practice, etc.), on the matter of treating
women s literacy in the late antique West? Or is the address to women somehow
female patients they simply dismiss her arguments as ‘worthless’ and ‘frivolous’.53
Had the physicians better assessed their own strategic strengths, they might just a I'terary conceit, a mechanism to legitimate the publication of material
that had all along been intended for men? In either case, what are men doing
have shifted the debate to who possessed the greater theoretical knowledge of
women s diseases. For on this point they, with their medical books, would surely u Tx-jjP niaterial and (b) reading it if, as has often been assumed, in
have won. the Middle Ages ‘women’s health was women’s business’? All these questions
about women’s and men’s relationship to gynaecological literature were further
As the present study will document, university physicians and other male
complicated by the fact that those few studies on medieval literacy that had
literates would have had within their medical books a not insignificant body of
been done at the time suêsted (or assumed) that women’s literacy was almost
material on female physiology and pathology. Discerning the cultural situation
universally minimal throughout the late antique and medieval periods.56
and strategic function of these writings is no easy matter, for it involves exploring
My original project surveying the development of early medieval medical
how the production and then use of knowledge on the female body was gendered.
theories on the female body had been conceived as a source analysis of the
The rather circuitous path that brought me to this analysis of literacy and the
so-ca led Trotula treatises. These twelfth-century works had intrigued me not
exclusion of women from the production of gynaecological knowledge may
simply because they were generally reputed to be the most popular medieval
help make these connections clear. In my early work, I was concerned to chart
texts of their kind, but because they constituted the first attempt to synthesize
the development of ancient theories of female physiology and disease as they
the very different and in many respects incompatible traditions of Latin and
were transmitted and transformed in early medieval Latin and Arabic medical
Arabic gynaecological thought. Yet these texts resembled their early medieval
traditions.5^ Incidental to that research, I discovered a striking difference in the
predecessors in that they, too, begged questions of their genesis and potential
textual context of early Latin and Arabic material on women’s diseases. Whereas
function as practical handbooks ofwomen’s medicine. Even if we could postulate
the Arabic material was almost entirely subsumed within the genre of the medical
literate, Latinate midwives in late antique North Africa, could we plausibly do
encyclopedia—an all-encompassing compendium of diseases usually arranged in
the same for twelfth-centuiy southern Italy? Or for the rest of medieval western
head-to-toe order, the diseases peculiar to women being placed among those of
Europe where the texts later came to circulate? If not literate midwives or other
the reproductive tract—in the late antique Latin West gynaecological material
female practitioners, were there literate laywomen who would have used such
was more ofren found in separate, specialized texts. Remarkably, the latter were
texts privately for their own healthcare? Or were the texts intended not for women
usually addressed either explicitly or implicitly to women, especially midwives
at all, but for men? In one respect especially, the Trotula made the question of
{obstetrices or medicae).^^ This divergence in genres forced me to think about both
ma e vs. female involvement with gynaecological literature acute: unique among
the reasons why material on women’s diseases might be segregated from other
all later medieval Latin gynaecological texts, they had traditionally been reputed
general aspects of medicine, and the possible implications this might have for
to be the work of a female author, ‘Trotula’.57
how we envisaged the actual practice of gynaecology and obstetrics in the period.
Not being a historian of medieval Arabic culture, I was unable to explore that
aspect of the development. Even limiting myself to the Latin tradition, however, widelJ Hornm! hT ‘“eracy 1 am referring only to the ability to read. It has been
I found the issue becoming increasingly complex. I discovered that, for the most âhinr^r r ® skills, most often learned separately. An
part, gynaecology remained a textually separate field of medicine throughout the be an t^ne^ mcchantes of putting pen to parchment or paper) need not in hself
early Middle Ages, with new compilations being made up through the twelfth tar U smee dtetation to a professional scribe was always a possibility
( t least to the upper clasps). It was more unusual for a medieval author to write out a text in
century. But whoever their original intended audiences may have been, the only women amanuensis do it, and this apparently was as true for men as for
medieval readers I could document for the late antique treatises were men. My because m most instances these amanuenses would have been male (e.g. the cases
dependence on men for access to
literate culture would, m this respect, still be a fretor.
’3 Denifle (ed.), Chartularium, vol. 2, p. 267. ouL n!onatL" Tbgynecological text associated with the name of the Egyptian
33 Monica H. Green, The Transmission of Ancient Theories of Female Physiologj' and Disease froreSier I arin " ’P^^^s (the text is almost certainly a late antique comp^tion
Through the Early Middle Ages’, PhD dissertation, Princeton University, 1983. (buTen, ■'"’“yd"'™ m some part from the Greek Cosmetics traditionally
33 Midwife was defined much more broadly in antiquity and late antiquity than it would be naL? M ^ spuriously) attributed to her. On the late antique Greek text attributed to a woman
in the later Middle Ages; in the earlier periods the midwife’s responsibilities encompassed the full named Metrodora, see Hd^ne Congourdeau, ‘“M^trodora” et son cjeuvre’, in Matadie et sociM
range of gynaecological as well as obstetrical care. See Chapters 1 and 3 and the Conclusion below. 4 ed. Evelyne Patlagean (Spoleto; Centro Italiano di Studi sull’Alto Medioevo, 1993),
pp. 3/ J6, in Its Latin translation, however, it was never attributed to a woman. See Monica
18 Making Women i Medicine Masculine Introduction 19
The modern history of the Trotula has centred around this alleged author belief holds less sway now among medieval historians, the idea that the Middle
‘Trotula’, who has been a political pawn in debates about women’s capabilities Ages were some ‘golden age’ for women’s control over their own healthcare is
and achievements in medicine ever since the sixteenth century. In 1556, the a truism among those working on modern Europe or even doing cross-cultural
first formal argument was made that the text (for it was assumed by then to be comparisons.®® If this scenario of a female monopoly on female medicine were
a single work by a single author) was written not by a woman but by a man. universally true, however, it would beg the question of why knowledge about
Debates over female authorship are nothing new, of course, and feminist scholars women’s diseases and cosmetics should be written down at all. While women,
over the last several decades have devoted considerable effort to recovering ‘lost’ as a group, might seem to be the most likely generators and users of texts
female authors and artists and to exposing the layers of obfuscation and even on women’s medicine, women, as a group, were also the least likely to have
wilful deceit that have deprived individual women of their historical legacies.^® had the kind of access to literate culture that would allow them either to
Ironically, however, the modern quest for a female author ‘Trotula’ has obscured create or to use such texts. In other words, if we are talking about information
several equally pressing questions for a feminist analysis of the Trotula texts and meant to be kept within a community of women, we need to demonstrate that
for the historical implications of all gynaecological literature. My objective here female literacy was sufficient, or that the author(s) and later copyists of these
is to turn the traditional ‘Trotula Question’ on its head, or rather, to broaden it texts believed it was sufficient, to sustain a written vector of transmission of
beyond the simple question ‘Did ‘Trotula’ exist or didn’t she? Did she write the knowledge among women. An assumption that ‘women’s health was women’s
text(s) on women’s medicine commonly attributed to her?’ to an exploration of business’, at least in so far as it concerns written knowledge, therefore demands
the historical implications of feminine vs. masculine authorship and readership. the positing of a broad community of female readers to explain the existence of
I wish to de-centre the question from its traditional emphasis on a presumedly the corpus of gynaecological literature that was in fact circulating in medieval
unique author’s sex and focus it instead on the broader interface between author Europe.
and audience, text and social context, and the gender dynamics of the actual Unfortunately, the medieval evidence in no way supports such a supposition:
practice of women’s medicine. In reframing the ‘Trotula Question’ around most written knowledge about women’s bodies is to be found in texts composed
the issue of women’s participation in the whole culture of literate medicine, by male physicians and surgeons, male physicians and surgeons (or if not for
several new questions emerge: Did any women read these works? Did these texts them, then for lay male patrons), and incorporated into volumes owned by male
function to inform women (whether lay or professional) on the causes and cures medical practitioners or other male literates. Despite the wide circulation of the
of women’s diseases? Or did they function, instead, as mechanisms by which Trotula texts throughout Europe and the frequency with which they were copied
men might learn about and establish authority over the diagnosis and treatment in Latin and translated into the vernacular, there is only scattered evidence
of women’s diseases? (and that often circumstantial) to suggest that any women owned and used
these texts. Women may have had some additional access to the texts through
oral readings, but even then it would have often been mediated by men. This,
WAS WOMEN’S HEALTH WOMEN’S BUSINESS? then, raises the question of the relationship between medical writing, medical
reading, and medical practice. How is medical knowledge about the female body
The existence of written knowledge on the treatment of women’s diseases and generated in the first place? Since, so far as I am aware, no medieval author ever
conditions raises a conundrum about the social functioning of a system of literate explicitly mused on this question, I will have to fill in this lacuna with some
medicine. As mentioned earlier, it has been widely believed that in the Middle speculation.
Ages ‘women’s health was women’s business’: women had exclusive control over First of all, I do not assume that such knowledge is grounded strictly in biology,
gynaecology and obstetrics, meaning that written texts on women’s medicine that simply because they are born women, women have an innate knowledge
must have been created by women and intended for their use.’’ Although this of female physiology and pathology. Were medical knowledge of women’s
bodies innate, there would be no need for its acquisition or transmission, either
H. Green, ‘Medieval Gynaecological Texts: A Handlist’, in Green, Women's Healthcare, Appendix,
in written form or orally, since all women would have it from birth. Far
pp. 1-36, at p. 24.
5“ On the authenticity debates surrounding Trota’s contemporaries Heloise and Hildegard of
Bingen, see most recently Bonnie Wheeler (ed.). Listening to Hehise: The Voice ofa Twelfih-Century “ In a forthcoming essay, I examine the extraordinaty influence that a small 1970 pamphlet,
Woman (New York; St Martin’s, 2000); and Barbara Newman (ed.). Voice of the Living Light; Witches, Midwives andNurses, written by the non-historians Barbara Ehrenreich and Deirdre English,
Hildegard ofBingen and Her World (Berkeley: University of California Press, 1998). has had not simply in women’s histoty but in anthropological studies of women’s health, too.
See Green, ‘Women’s Medical Practice’.
more important, I believe, is the role of experience, that is, that because they patients. In weighing men’s ability to acquire gynaecological knowledge against
live their lives as women—experiencing not only the biological processes of women’s, therefore, men are not handicapped in any absolute way. Indeed, if
menstruation, pregnancy, childbirth, lactation, and various disorders consequent literacy is a tool that men have but women lack, then men might have a real
to their anatomy and physiology, but also the social expectations of what women advantage.
should do with their bodies—women individually acquire, to greater or lesser It will be the central argument of this book that men’s advantage in liter
degrees, an experiential knowledge of the workings of the female body. To this acy—and all the intellectual stature and social authority that went with it—was
individual experience would be added collective knowledge that women gain in feet key to the regendering of gynaecological knowledge production and
over many generations and share within their sex-specific communities. This practice between the twelfth and the sixteenth centuries. In short, I am redefining
collective knowledge would remain among women, however, only to the extent the ‘Trotula Question’ as an issue about far more than female authorship. It is
that there were social pressures to keep it there. If in a society women have a about women’s participation in the whole culture of literate medicine: whether
‘separate sphere’, if there were a general cultural expectation, inculcated in both as literate or semi-literate authors, as literate or quasi-literate readers and listeners
men and women, that men should not touch the female genitalia nor should and practitioners, or, even more distantly, as recipients (as patients) of a form
women allow their ‘private parts’ to be touched or seen by men other than of medicine whose theoretical structures they did not help create and whose
their legitimate sexual partners, and if issues surrounding reproductive processes precepts they were, perhaps, never expected to understand. To use Brian Stock’s
and the organs involved in them are not to be talked about between the sexes, term, I am asking who made up the ‘textual communities’ that surrounded the
then to that extent women will be the only qualified practitioners of women’s Trotula texts and other medieval gynaecological writings, who viewed the texts
healthcare (at least in so far as it involves the genitalia) and the only generators of as their intellectual property, and who perhaps even found some elements within
such knowledge. One of the original Trotula texts. On the Conditions of Women, the texts with which to self-identify.®^ I am therefore of necessity asking whether
explicitly admitted that women, out of shame, do not wish to bare the diseases male as well as female textual communities may have surrounded these texts, how
of their ‘private parts’ to male practitioners. This would seem to imply that, they may have read them, and how, indeed, the very existence of male as well as
in medieval southern Italy at least, there were cultural dictates that kept men female readers may have affected not only the practice of but also the discourses
away from women’s bodies at the same time that they fostered an exclusively surrounding women’s medicine.
female context in which experientially acquired knowledge would be used and
disseminated.
If, however, gynaecological knowledge can be derived by other means—by,
THE PLAN OF THIS BOOK
for example, analogical reasoning from the male body or deductive reasoning
from certain a priori principles—then it is possible that even in a sexually The following chapters survey the history of gynaecological literature and the
segregated society men could generate a kind of gynaecological knowledge, too.
practice of medieval and early Renaissance women’s medicine from varying
If that knowledge can be added to knowledge gleaned from women (however it is perspectives. I begin with the gender dynamics of medical practice in Salerno and
obtained) and to the knowledge found in earlier written texts (the principal source the creation of the Trotula texts before the universities and their fixed gendered
for Conditions of Women itself), then even when males are denied immediate
hierarchies of education came into existence. The so-called ‘school’ of Salerno was
access to the female body they can accumulate gynaecological knowledge more in the late eleventh and twelfth century nothing more than an informal gathering
or less comparable to women’s. If, moreover, males can use female assistants to of masters and pupils, not a real physical or legal entity. But having moved beyond
examine female patients and administer therapeutic measures, then what might
the stage of purely empirical (and largely oral) traditions of medical practice.
have initially appeared to be crucial gender differences—men’s lack of personal
experience of female bodily functions and their limited access to the female
body—might turn out to be immaterial.®* The only remaining impediment Brian Stock, The Implications of Literacy: Written Language and Models of Interpretation in
might thus be men’s relative freedom to discuss gynaecological matters with their the Eleventh and Twelfth Centuries (Princeton; Princeton University Press, 1983), p. 522, defines
‘textual communities’ as ‘groups of people whose social activities are centred around texts, or, more
precisely, around a literate interpreter of them. The text in question need not be written down nor
the majority of auditors actually literate. The interpres may relate it verbally, as did the medieval
Anatomical dissections ofhumans do not seem to have occurred prior to the late 13th centuty, preacher.. . [T]he group’s members must associate voluntarily, their interaction must take place
and then only in Italy; prior to that, pigs were used for anatomical training in Salerno. It is possible around an agreed meaning for the text. Above all, they must make the hermeneutic leap from what
that certain knowledge was gathered from prostitutes, whose bodies were more accessible to men the text says to what they think it means; the common understanding provides the foundation for
than those of‘honourable’ women. On both these issues, see Chapter 6 below. changing thought and behavior.’
Salerno’s medical school was already engaged in the synthesis of the new, more Chapter 2 turns to the reception of the Latin Trotula in thirteenth- and
theoretical medicine coming out of the Arabic world and it was starting to create fourteenth-century Europe and to evidence for the gynaecological practice of
a style of commentaries on authoritative texts that would characterize formal male physicians and surgeons. Even though the three Salernitan gynaecological
medical education for the next several centuries. In addition to the group of texts never established a foothold in university curricula, both individually and as
Latinate male masters who wrote the texts and commentaries for which Salerno an ensemble the Trotula became the most widely circulating specialized texts on
is most famous, there was also what seems to have been a significant number of women’s diseases and cosmetic concerns in medieval Europe. For about a fifth
female healers. OneofthesewasTrota who,as John Benton first showed in 1985, of the documentable copies of the Trotula, we know one or more of the owners
was the author of a general treatise on practical medicine, the Practical Medicine through whose hands the book passed, and we can therefore be quite specific
According to Trota (Practica secundum Trotam)A^ She was also, as I will argue about the gendered uses of the texts. But for ail the rest, the lack of ownership
here, the source for the most distinctive and novel ‘hands-on’ text of women’s inscriptions raises the need for codicological analysis: that is, examination of
medicine composed in the medieval period. Treatments for Women (De curis how the book, the codex, was put together and what that says about how the
mulierum), which would later form the centrepiece of the Trotula ensemble.®"* volume as a whole might have been used. Thus, for example, I assume that a
Within the diverse group of practitioners in twelfth-century Salerno, there was no codex that situates the Trotula or other gynaecological texts amid predominantly
absolute distinction in the sex of their patients: male practitioners treated female technical surgical works will likely have been made for a surgeon; one filled
patients, females treated males.®® There was, however, a clear limit to male access with sermons for a preacher. A codex made up entirely of vernacular texts
to the female body, with the result that discussions of gynaecological matters may have been intended for someone who was either ignorant of Latin or felt
by male authors lack certain elements of hands-on knowledge. Conversely, the distinctly more comfortable reading in the local tongue. But a codex that mixes
female practitioners, although they could have intimate contact with both female Latin and the vernacular cannot be interpreted in the same way. Codicological
and male patients, were little engaged in the world of literate medicine being analysis is, admittedly, inferential in comparison to the more positivist evidence
generated by their male peers. Trota was the boundary-crosser: she has an of ownership inscriptions. But precisely because the Trotula texts survive in
access to the female body unmatched by her male peers, while as a writer she such large numbers (as do other texts on women’s medicine), it is possible to
participates in literate medicine. Yet this participation was only marginal; her reconstruct certain patterns of use. And it is these patterns of behaviour, and the
work evinces little engagement with the high theoretical medical traditions that meanings attached to them, that make up the societal norms that collectively
her learned male contemporaries were actively developing and, with but few constitute a gender system.
exceptions, they were just as oblivious to her. Thus, while at the beginning of What all these physical books show, then, together with evidence from other
the twelfth century, literate medicine was a new enough endeavour not to have medical writings and illustrations of medical encounters, is that as in Salerno,
been distinctly gendered (thus allowing a skilled female empiricist like Trota to male practitioners throughout Europe were regularly treating female patients
participate), by the end of the century it had become a thoroughly masculine for all kinds of complaints, including gynaecological problems like menstrual
enterprise. irregularities or infertility. Gynaecology (and even what we might call ‘advisory
obstetrics’) had become a fairly normative part of many male physicians’ practice,
John F. Benton, 'Trotula, Women's Problems, and the Professionalization of Medicine in the an area in which most healers wished to claim some minimal level of knowledge.
Middle Ages’, Bulletin tfBk History ofMedicine 59 (1985), 30-53. Indeed, while the Trotula is adopted in the thirteenth century, occasionally even
Benton had dismissed Treatments fir Women as just another male-authored text that sought,
exploited, as the chief authority on women’s medicine in large part because it
like the male-authored Conditions ofWomen and Women’s Cosmetics, to control women by controlling
their medical care. had no effective rival, by the fourteenth century male physicians have developed
Although a range of sexual characteristics was posited by certain medical texts circulating enough confidence to create a special area of expertise, fertility medicine, which
in or around 12th-century Salerno, the Trotula texts neither explore sexual ambiguity nor posir
grew from a topic on which a few hasty remedies might be thrown together
‘woman’ or ’man’ as problematic categories requiring definition or explanation. Sexual ambiguity
was not, of course, completely unknown. For example, a text on generation that may have been into an area of specialized thought and writing. Beyond treating disorders of
translated by Constantine the African, called De spermate (On the Seed), explained that males the breasts, surgeons laêd behind the physicians considerably in engaging
were generated on the right side of the utems, females on the left, and hermaphrodites in the
with gynaecological conditions, yet even they evince developing confidence
middle. For recognition of the phenomenon of hermaphroditism among surgeons, see Chapter 2
below. The nature of sex diflFerences was also examined at length in a series of natural-philosophical by the fourteenth century. Both physicians and surgeons are, I argue, clearly
questions that may have originated from Salerno, known as the Salernitan Questions. In the medical inhibited to a significant degree by concerns that cross-sex practice will bring
texts under discussion here, however, what constituted a ’man’ or a ’woman’ was not subject
not only shame to the female patient, but dishonour to the male practitioner.
to debate.
Nevertheless, apparently with the consent of female patients, they forge ahead.
Despite occasional denunciations of the dangers of male practice on female male readers was not. Where the vernacular traditions differ from the Latin one,
patients, a variety of evidence—both textual and iconographic—shows that it however, is that here we find an explicit contest over who should have access not
was both common and accepted. to the bodies of women but to texts on women’s medicine. A peculiar feature
Having a better sense of how far the male medical practitioner could and of a few of the later medieval vernacular gynaecological texts is that they are
could not go aids us in turning to the question of the extent of women’s prefaced either by warnings to men not to use texts on women’s medicine for ill
medical practices. Simply put, the gendered structures of society (including the intent, or by apologies to women that such texts are not intended to harm them.
still unstated prohibition against male sight or touch of the female genitalia) These warnings and apologies were not solely concerned with male practice of
demanded the continued presence of women in medical practice. As I discuss gynaecology. Rather, they reflect an awareness that some male interest in the
in Chapter 3, female medical practitioners—from specialists in surgery to texts was not therapeutic at all.
those engaged in casual practice domestically—can be documented throughout Chapter 5 traces the development in the later medieval period of a growing
thirteenth- and fourteenth-century Europe; the existence of even more women perception that the Trotula texts were not repositories of therapies for women’s
like them can be inferred precisely because gender segregation would have diseases in toto, but rather compilations of more specific information on female
demanded their existence. Yet there was an important gender differential between sexuality and fertility. Chapter 2 has, of course, already shown the activity of
these women and their male counterparts. Whereas the medical literacy of male male physicians in the field of infertility and Chapter 4 the interests of lay male
practitioners follows a general upward trajectory in this period, the same was readers in using gynaecological literature to understand and even control the
not true of female practitioners. Women’s general literacy was clearly rising in processes of generation. Chapter 5 takes this story beyond the Trotula or even
the later medieval period, to be sure, but the ‘typically feminine’ reading habits strictly medical writing into a larger genre of‘women’s secrets’. Whereas many of
of women show them turning their reading skills (which only rarely involved the other so-called secrets traditions—in alchemy, astrology, and magic—were
full competence with Latin) primarily toward liturgical and devotional reading. inherited or derived from texts of Arabic, Greek, or Hebrew origin, the genre
Medical books can only rarely be documented in women’s hands. While the of women’s secrets was almost entirely a European creation. Texts circulating
knowledge encompassed in Latin books may have been conveyed to women under the rubric The Secrets of Women took different forms, but most in some
through oral readings by literate males, there is scant evidence that the medical way addressed questions of sexuality, foetal development, birth and other issues
book came to function for women as a defining resource for medical learning in surrounding generation. The Trotula texts came to be allied with this tradition,
the same way it did for men. often being abbreviated or otherwise altered to fit the narrower interests of a
Chapter 4 turns from Latin to vernacular texts on women’s medicine. The new audience interested in generation. The female body was seen not so much
sheer number of translations of the Trotula is itself evidence of the existence of as a marvel of generative properties as a site of voracious sexual appetites and
new audiences: at least twenty-one different translations were made into Dutch, mysterious physiological processes that threatened men precisely because they
English, French, German, Hebrew, Irish, and Italian between the late twelfth were uncontrollable. The authoress ‘Trotula’ came to be seen as an authority not
and fifteenth centuries. A third of the Trotula translations are in fact addressed to on women’s diseases, but on ‘women’s secrets’, herself a contributor (according
women and even though we have no woman’s signature on any extant medieval to Chaucer) to the litany of testimonials to the ‘wickedness’ of women. Here in
copies of these texts, codicological evidence suggests that women probably did particular we see the effects of the exclusion of women from literate discussions
own and use some of them. Be that as it may, all the other translations were for of their bodies and their conditions, for the university and other all-male
either medical practitioners or lay patrons concerned to have knowledge about institutions provided men with a single sex environment in which to discuss
generation;^ in neither case was it necessary to specify the gender of the intended ‘the nature of women’ without any threat of challenge. Given the larger cultural
audiences since they were assumed to be the same groups that had read the Latin. atmosphere that existed in western Europe in the fourteenth and fifteenth
In both north and south, men not simply continued to read gynaecological centuries, it is not surprising to find that the ‘secrets of women’ carried a taint
literature, they even reappropriated some of the new texts addressed to women: of misogyny, a taint that spread to the Trotula as it, too, came to be seen
while the enfranchising of female readers was possible, the disenfranchising of as ‘secret’.
‘Secrets of women’ texts and the larger phenomenon of lay and clerical interest
“ I think we mislead ourselves by subsuming all discussions about reproduction under the single in women’s secrets had their own intense afterlife. My focus in Chapter 6,
rubric ‘sexuality’, a term unknown and perhaps inconceivable in the medieval period. Although, however, returns to the gendering of knowledge production and the practice
as I will argue, there was definitely a concern with sexual prurience in some of the warnings that
male readers use caution when reading gynaecological literature, the greater motivation for medieval
of women’s medicine at the end of the Middle Ages and just beyond. In the
readers really was the desire to understand and attempt to control the processes of generation. fifteenth century, in northern Europe as well as the south, male medical writers
Making Women s Medicine Masculine Introduction TJ
26
began to move beyond their fairly passive levels of involvement in womens since gynaecology had now been ‘birthed’ as a field in which female authority
medicine to more active, creative roles. In Italy, discussions of women s diseases played no role whatsoever.
remained, at least in their original formulation, within the confines of the The Conclusion returns to the question of how the creation of a masculine
encyclopedic Practicae, where they were perennially linked with conditions of gynaecology affected women, both as practitioners and as patients, and how those
the male genitalia. Yet the size and detail of these sections on reproduction effects have extended to the present day. Women were excluded from the insti
grew to such an extent that several began to circulate independently. More tutions and intellectual traditions of western medicine right at the moment that
important than the textual form of this material was its content; fifteenth- it was establishing its most distinctive features: the grounding of medical science
century Italian writers, both physicians and surgeons, display a nw level of on principles of natural philosophy and the standardization of that knowledge in
engagement with women’s medicine; most notably, there is now evidence that university curricula. The rise of male authority in gynaecology and emergency
the taboo against male sight and even touch of the external female genitalia obstetrics came at the price of a decline in female authority: a trade-off evidenced
has finally been breached. Midwives are still the only ones allowed to insert both in women’s increasingly circumscribed roles as medical practitioners and
their hands into the female body, but male practitioners were now equipped in the limited ways women’s medical competencies were imagined. On several
with a variety of tools that literally opened up the living female body to important levels, women had no medical Renaissance: there was a disruption
new levels of inspection. This kind of ocular inspection was not immediately of the late medieval pattern of rendering vernacular gynaecological texts for
paralleled north of the Alps, but changes in social practice and knowledge women and, with but few exceptions, the medical literature available to women
occurred there, too. In France, we find male writers confidently adopting in print was narrowed down to a handful of obstetrical texts that spoke to
the Italian texts, filling the margins of their books with notes on their own women either as midwives (within a very circumscribed and subordinate role) or
gynaecological cures and, in two remarkable cases, composing entirely novel, to laywomen in their capacity as mothers. While the increasing involvement of
specialized gynaecological texts, arrogating to the physician the responsibility at least certain classes of early modern women in literate practices led them to
to supervise the midwife even in the handling of childbirth. We also find revive a traditional genre of medical writing, the recipe collection, as an arena for
extraordinary evidence that male practitioners might contest among themselves feminine expertise, it would not be until the nineteenth and twentieth centuries
that the gendering of medical authority that had been established in the Middle
for the right to treat women’s conditions.
By the time the effects of humanism and the printing press spread to medicine, Ages would be overturned. Hence the morals of this story of the masculine
therefore, the field of women’s medicine had already been masculinized not only birth of gynaecology for women’s history more generally apply to our own time,
in its theoretical construction but in its clinical application, too. The sixteenth including the question of why ‘Trotula’ has taken on the role she has in modern
century did witness its own distinct developments, but they built on those of popular cultural understandings of women’s medical history.
the fifteenth century rather than representing a radical break. First, there was The field of gynaecology in medieval and early Renaissance Europe was a
the creation of obstetrics as its own distinct field—the province now of both territory of interplay, of contest between men and women for access to and
female midwives and male surgeons, each group having its own texts. Then, control over medical knowledge of the female body. Whatever may have been
there was the creation of gynaecology not simply as a field in which learned true of strictly oral traditions of medical practice (where there may indeed have
practitioners claimed authority, but as a field that now had a rationale for why it been an all-female world of theorizing and therapy), once we move into the realm
should be distinct from ‘men’s medicine’. The rediscovery of the original Greek of literacy, the gendering of women’s medicine instantly becomes complex. I
Hippocratic corpus of gynaecological texts in the 1520s (and their immediate argue that it was probably men who can be credited with many of the layers
translation into Latin) contributed not only to this latter development but it gave of authorship and editing of the Trotula texts, and that it was certainly men
this new field its own originary masculine source, the Father of Medicine himself, who for the most part claimed the Trotula texts as their intellectual property
Hippocrates. The medieval inheritance was almost completely wiped from the and who formed the principal textual communities surrounding the Trotula and
common consciousness of the field, with the surprising exception of the Trotula other gynaecological literature from the twelfth through the sixteenth centuries.
texts which would be ‘cleaned up’ by a humanist editor in 1544 and reprinted Certain female practitioners, like Trota in the twelfth century and Perretta in
a total of eleven times over the course of the sixteenth century. They survived, the fifteenth, may have recognized the virtues (or, for Perretta, the necessity)
however, not because they were believed to represent a woman s perspective on of engagement with literate medicine in order to establish their position within
women’s medicine, but because (due to some creative editing) they were believed the community of medical practitioners, just as certain male translators and the
to be of classical origin. The female author Trotula was herself expendable, by laywomen for whom they wrote recognized the capacity of the vernacular to put
1556, she became a male author Eros, an alteration that could readily be accepted gynaecological knowledge back into the hands ofwomen. On the whole, however.
28 Making Women s Medicine Masculine
women’s encounters with literate medicine, whether they were practitioners or

patients, were more obstructive than enabling. Only at the point of initial genesis
of the Trotula texts in twelfth-century Salerno and then again in certain of the late
medieval translations is there straightforward acknowledgement and contesting 1
of the paradox of literacy and women’s medicine.
The Gentle Hand of a Woman? Trota
and Women’s Medicine at Salerno
[T]here would seem to be no good reason for denying that a book having
such decidedly feminine touches as Trotula’s was written by a woman. It
bears the gentle hand of a woman doctor on every page.
Kate Campbell Hurd-Mead (1930)'
Kate Campbell Hurd-Mcad, an American obstetrician and ardent proponent

of the female medical authority ‘Trotula’ in the early part of the twenti
eth century, drew on rhetoric typical of her day when she argued for the
feminine authorship of the Salernitan compendium of women’s medicine.^
Women’s capacity to practise medicine and especially to treat women and
children was ‘innate’, she and many of her contemporary advocates of female
physicians believed, a biologically inherent quality of women. Modern gender
theories have rendered such essentialist beliefs in feminine character obso
lete and we can no longer assume a priori how a woman would have
practised medicine or that she would have done so with a ‘gentle hand’.
Rather, we are accustomed now to see gender roles—the behaviours, occupa
tions, dress, and self-expectations that societies deem appropriate for males or
females—as contextually specific and, therefore, historically contingent. What
‘ Kate Campbell Hurd-Mead, ‘Trotula’, his 14 (1930), 349-67, at p. 364.

^ Hurd-Mead was, of course, still working on the assumption that the whole Trotula ensemble
was the work of a single author; ironically, she was particularly persuaded of the author’s female
identity by what I have identified as the male-authored Conditions of Women. For work on Hurd-
Mead’s late nineteenth and early twentieth-century context, see Regina Markell Morantz-Sanchez,
Sympathy and Science: Women Physicians in American Medicine (New York: Oxford University
Press, 1985); Susan Wells, Out of the Dead House: Nineteenth-Century Women Physicians and the
Writing of Medicine (Madison: University of Wisconsin Press, 2001); and Montserrat Cabr4 i
Pairet, ‘Kate Campbell Hurd-Mead (1867-1941) and the Medical Women’s Struggle for History’,
Collections. The Newsletter of the Archives and Special Collections on Women in Medicine. The
Medical College of Pennsylvania, Philadelphia, PA, issue 26 (February 1993), pp. 1-4, 8. On
‘Trotula’s’ post-medieval fate, see Monica H. Green, ‘In Search of an “Authentic” Women’s
Medicine: "The Strange Fates ofTrota of Salerno and Hildegard of Bingen’, Dynamis:Acta Hispanica
ad Medicinae Scientiarumque Historiam lUustrandam 19 (1999), 25-54; and the Conclusion
below.

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Green, Women's Healthcare Monica H. Green, Women’s Healthcare in the

As cited in Tony Hunt, Anglo-Norman Medicine^ 2 vols. (Cambridge: D. S. Brewer), 2: 15-

women’s encounters with literate medicine, whether they were practitioners or

Kate Campbell Hurd-Mcad, an American obstetrician and ardent proponent

‘ Kate Campbell Hurd-Mead, ‘Trotula’, his 14 (1930), 349-67, at p. 364.

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