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Trotula the Medieval Doctor: A History of Women's Health from the Middle Ages
Early Medical Textbook for Woman's Healthcare
Trotula: A Female Physician from the 11th Century
Women’s healthcare has come a long way in the past century, and is light years from the medical treatments women bore in the Middle Ages. Prior to the advent of modern medicine, the most highly regarded work of literature on women’s healthcare was a set of writings by Trotula. Trotula of Salerno was a female physician in the 11th century, who recorded treatments for infertility, problems during childbirth, and many other ailments that plagued women in the time before modern scientific understanding.
Trotula was born a thousand years ago in Italy to a family called di Ruggiero. She taught at the University of Salerno, located on the west coast of Italy. According to church record, she died in 1097 and a two-mile long procession of mourners followed her casket to its grave. Her husband and two sons were also physicians at Salerno.
The writings actually consist of three distinct books: Treatments for Women, Women’s Cosmetics, and Diseases of Women. In truth, only Diseases of Women actually carries Trotula’s name: the other two books were written anonymously and were combined with Trotula’s work sometime in the 13th century. Modern translations of the three books are simply known as the “Trotula.”
Women’s Cosmetics is largely derived from Muslim Origin (Green, Monica: The Trotula page 113-124: University of Pennsylvania 2001). Treatments for Women is likely gathered from oral traditions handed down among the people of the Mediterranean. Trotula’s work (Diseases of Women) is derived from Trotula’s understanding of the Galenic philosophy that women are “cold” by nature and must regulate their bodies via menstruation: the book discusses this topic at length, along with childbirth and movement of the uterus. Galen was a Greek physician in the 2nd century and his medical theories were highly regarded until the advent of modern medicine.
An English Translation of the Trotula
On the Differences Between Women and Men: Beliefs of the Middle Ages
The Trotula declares that men are created as hot and dry, while women are cold and wet. Based on the writings of Galen, this was believed to be nature’s way of “balancing” the feminine and masculine qualities – the man and women find each other’s company pleasing because their mate has opposing characteristics.
In the time the Trotula was written, men were presumed to be stronger than women. The book claims:
“since women are by nature weaker than men, it is reasonable that sicknesses more often abound in them especially around the organs involved in the work of nature.”1
Menstruation was believed to be the female body’s way of ridding the body of excess moisture. Since women are weak and cold, the text asserts, women cannot endure the exertion of exercise to sweat off the moisture. It must be purged from the body in the form of menses.
1The Diseases of Women, a Translation of Passionibus Mulierum Curandorum by Elizabeth Mason-Hohl, M.D.
Treatments for Women in the Middle Ages
Women suffering from amenorrhea (lack of menstrual flow) were a particular concern for physicians in the Middle Ages. Bleeding the woman was a common treatment: a vein in the foot would be lanced and the woman bled several times until she “returned to health.” The book also states that any constipation should be treated, and the woman should be given tea made from mint and honey. Other concoctions are described, which include the use of poisonous hemlock and wormwood.
Women who had scanty flow were prescribed an infusion of carrot and willow in wine, along with various herbs (pennyroyal, wormwood, and rue, among others). Women who have scanty menses, however, were not to be bled from the foot. Strong wine and a dinner of scaly fish were far preferred as treatments for this condition.
Of course, some women had the opposite problem and bled too heavily during their monthly cycles. The favored treatment in this case was fumigation with hot smoke, because it would “comfort cold wombs.” The woman was to be given powdered deer antlers mixed with rainwater and dried nettle as a drink during the fumigation, as a way to heat up the uterus. This particular medical problem was believed to be caused by too much food and drink, which created too much blood in the woman’s body.
On the Cause of Illness
Convulsions, faintness, and a weak pulse were blamed on a condition known as “choked womb.” The belief was that a woman’s “seed” could only be brought out by fertilization and childbirth. Virgins who never married and widows were believed to have hundreds of “spoiled seeds” clogging their wombs. The spoiled seed supposedly rose into the heart, lungs, and voice box. The cure for this condition involved anointing the woman with oil, herbal medications in wine, or a powder made from fox testicles. Another medication involved the use of axle grease combined with the roots of an herb called lovage: this was not ingested, but tied over the belly button.
Abscesses in the womb were another common medical issue endured by women of the Middle Ages. The cause was ascribed to everything from excessive flatulence to bile. Bleeding was the recommended treatment: taking a pint of blood from the woman as much as twice per day was called for, if the woman could stand it.
Treatments for Infertility in the Middle Ages
Trotula believed that women could not conceive because they were either too fat or too thin. The woman’s wombs could be too soft or too wet to retain the man’s seed. She does concede that sometimes the men also had a problem with producing “seed,” and that the difficulty with conception was caused by a defect with the man’s body just as often as it was caused by a defect in the woman’s body. This seems to be a rather progressive viewpoint for that era.
A woman who had a wet womb also had a wet brain, according to the text, and the symptoms would be:
“Her eyes will be continuously tearful for since the womb is frequently tied up with the sinews it is necessary that the brain suffer with the womb. If the womb is too moist the brain is filled with water and the moisture running over to the eyes compels them to involuntarily shed tears.”1
The treatments for infertility involved many different herbs, though the dried testicles of a pig were also considered helpful.
Preventing Pregnancy the Medieval Way
The methods for contraception in Diseases of Women are all from the works of Galen. To prevent pregnancy, a woman should:
- Place the uterus of a female goat that had never borne a kid onto her skin.
- Wear a stone called Galgates around her neck.
- Castrate a weasel and wear the testicles in a sack made of goose flesh.
- Sprinkle barley on the afterbirth: the more barley she sprinkles, the longer she will remain infertile.
Beliefs about Fetal Development
The development of a child within the womb was quite mysterious to most people in the middle ages. Trotula tried to outline a path of development: after conception, Trotula believed a blood clot was formed. In the second month, the body and blood formed, and hair was produced in the third month. The cause of morning sickness was believed to be due to fetal movement in the fourth month. The child would gain his or her facial features in the fifth month, bound its sinews in the sixth month, and was strengthened in the seventh month. By the eighth month, the child became fatter and was born in the ninth month.
Miscarriage could be caused by the emotions of the mother, according to the book: excessive anger, a cough, diarrhea, or too much activity in the early part of a pregnancy could dislodge the child from the womb. Bleeding a woman was highly discouraged prior to the fourth month of pregnancy, though bleeding was considered acceptable after the fifth or six month of gestation.
Gender determination was believed to be possible by collecting a few drops of blood or milk from the woman’s right breast. If the drops of blood floated on top of a glass of water, the fetus was believed to be female. If the drops sank, the child would be a boy.
Childbirth in Medieval Times
Sneezing was forbidden in late pregnancy, to keep as much strength and spirit in the body (particularly the womb). A woman was supposed to guard herself from colds or anything which might cause her to sneeze. Aromatic poultices could be made and tied below the nose to aid in this effort.
Trotula did not know the benefits of several other traditions supplied by midwives of the time, but she included them in her book. A necklace of coral could be worn around the neck and a magnet held in the right hand – this was supposed to imbue strength to a woman in the last stages of pregnancy. A far less palatable suggestion is to have the expectant mother drink the dung of baby birds, or the white portion of eagles’ excrement.
Death in childbirth was common in the middle ages, and in this section of the book, Trotula simply states “one must have recourse in God.” A child may not fit through a woman’s hips, or may have died in utero – in this case sneezing is encouraged, to help expel the child. Trotula does advise walking for a woman with stalled labor, along with some herbal drinks to help create more forceful contractions. If the child had died in the womb, she recommends tying snakeskin around the woman like a belt, or tying a stone to her thigh to cause the fetal remains to come out.
Newborn Care in Medieval Times
The baby’s ears were of particular concern to Trotula: the child’s ears were to be pressed flat immediately after birth and frequently shaped during the newborn period. The umbilical cord length, she believed, influenced the length of the male genitalia. Honey and hot water were placed on the palate and tongue to allow the child to speak more clearly when he grew older. Swaddling was necessary, because without swaddling the child’s limbs would grow crooked. She also advised covering the infant’s eyes so that he would not be exposed to bright light.
Gentle voices were encouraged, along with showing the infant bright colors and pearls. As the child grew and was ready for solid food, Trotula advised white meat from the breast portion of a chicken or pheasant as a first food.
Wet nurses were commonly used and the proper type of wet nurse is described: she must have had a child in the recent past, and must not be anxious or eat anything sharp or acidic. She was to have a fair complexion and clean: Trotula specifically states that dirty women should be avoided.
The Limits of Knowledge in the Middle Ages
Trotula was well versed in the works of Hippocrates, Galen, and Cleopatra. She understood the medical application of various herbs in her day, and was a proponent of using various amulets and herbal concoctions to treat various ailments. She also knew that there were limits to her knowledge, and advised that one should “leave the rest to God” in certain difficult cases.
Fortunately, women’s healthcare has evolved significantly from the Middle Ages. The understanding of human physiology, microbiology, and the development of antibiotics and surgical techniques have made death in childbirth a rare event in the developed world.