Table of Contents INTRODUCTION .......................................................................................................................... 2 FOUNDATIONAL TEXTS AND THINKERS ............................................................................. 3 WOMEN IN CONTEXT ................................................................................................................ 6 SPECIFIC ISSUES ......................................................................................................................... 9 CONCLUSION.…………………………………………………………………………….....…17
Healers and Home Remedies: Women’s Health in Late Medieval Europe Many men and women in the Middle Ages took a keen interest in issues of gynaecology, if not professionally or formally, then at least on a personal level as women (individuals, mothers, wives, daughters) dealt with matters such as pregnancy, menstruation, infertility, and so on. While medical treatises provide indications of prescriptions and formalized advice, it is difficult to gauge exactly the roles which women played as community healers, midwives, wet nurses, mothers, physicians, and, more broadly, simply as home-remedy users. This project takes up these questions by asking: what roles did women play in administering gynaecological care for themselves and their communities, and how did traditional ideas about women’s health and gynaecology influence these roles? The aim of this pamphlet is to provide an overview of women’s health issues in the late Medieval West. By looking at theories of women’s medicine and popular knowledge in Western Europe, this project argues that women had a significant amount of agency over their bodies and health care practices, using a variety of home remedies to treat diverse problems.
Figure 1 A woman breastfeeds a baby in fifteenth-century Italy
FOUNDATIONAL TEXTS AND THINKERS Greek Medicine Humoral theories from antiquity were foundational to medical practices in the medieval West. Gathered in the writings of Hippocrates, Humoralism contended that the body consisted of four basic fluids: yellow bile (choler), blood (sanguine), phlegm, and black bile (melancholia). 1At its core, humoralism provided a framework for medieval individuals to think about both disease and wellness. According to these theories, equilibrium of the four humours was a precondition for good health, while unbalanced humours were reputed to cause illness and infirmity in the patient.2 Along with theorizing a system of four humors, Hippocratic medicine also proposed a theory of four temperaments, including warm, cold, dry, and moist, all of which aligned with corresponding humors. Blood, for instance, Figure 2: Hippocrates lecturing.
was associated with warmth and moisture; black bile with coldness and dryness; yellow bile with dryness and warmth; and phlegm with moist and cold. Temperaments and humours constituted a holistic view of the body,
determining an individualâ€™s characteristics, health, ability to conceive, and even gender expressions.3 First expressed by Hippocrates, these ideas were taken up and expanded upon by Galen in the Roman period. 4
Margret Berger, Hildegard of Bingen: On Natural Philosophy and Medicine (Cambridge: D.S. Brewer, 1999), 15. 2 Ibid., 16. 3 Ruth Mazo Karras, Sexuality in Medieval Europe: Doing Unto Others (New York: Routledge, 2012), 14. 4 Berger, Hildegard of Bingen, 16.
Hildegard of Bingen (1098-1179) Interweaving Greek, Roman, and Early Christian ideas about health, Hildegard of Bingen applied her own version of humoralism specifically to women, describing four different varieties based on fluid compositions. In particular, Hildegard outlined sanguine, phlegmatic, choleric, and melancholic women, using these classifications to consider questions such as why some women are fertile and others fail to conceive, why some women desire sex and others do not, and so forth. According to Hildegard, for instance, choleric and melancholic women “suffer severe blood loss at menstruation” and are susceptible to paralysis if menstruation ends earlier “than it should.” On the other hand, sanguine and phlegmatic women menstruate moderately and conceive easily.5 Along with these discussions of menstruation, in her foundational medical text, Cause et Cure, Hildegard covered topics from embryology to human sexuality, offering theoretical explanations for such issues as incontinence, infertility, bloodletting, diet, and other issues particular to women and gendered health. 6
Trotula The Trotula, a twelfth-century Italian medical treatise from Salerno, occupies an equally foundational position in the history of gynaecological medicine in Medieval
Figure 3 Trotula
Europe. Consisting of three texts on cosmetics, cures, and
Hildegard of Bingen, “Hildegard of Bingen: Medical Writings (12th C.)” in Women’s Lives in Medieval Europe, ed. Emilie Amt, trans. Margret Berger (New York: Routledge, 2010), 102. 6 Berger, Hildegard of Bingen.
diseases, the collection takes its name from Trota, a woman who authored one of the three volumes. Like Hildegard of Bingen, the authors of the Trotula considered topics such as menstrual health, infertility, birth, and other issues specific to sex and gender, but the work differs from Hildegard’s writings as it offers more prescriptive advice to readers, providing practical and novel solutions to everyday problems including issues like contraception, choosing a midwife, and caring for ulcers on the womb. The Trotula was frequently translated from the Latin into vernaculars such as German, French, English, and Dutch, and disseminated widely across Western Europe. 7
Hippocrates (460370 BC)
Galen (130-216 AD)
Arabic Translations (c. 6th-9th centuries)
Latin Translations (11th-12th centuries)
Hildegard of Bingen and Trotula (12th century)
Distaff Gospels (1480) Toward the later Middle Ages, the medical profession grew increasingly exclusive, but folkloric texts indicate that local, village people shared their own forms of medical knowledge and practical advice. Texts such as the Distaff Gospels provide a counterpoint to the medical theories provided by Hippocratic medicine, the Trotula, and Hildegard of Bingen, offering insight into folk gynecological advice from England and France in the late Medieval period. Consisting of
Joan Cadden, “Western Medicine and Natural Philosophy” in Handbook of Medieval Sexuality, ed. Vern Bullough and James Brundage (New York: Garland Publishing Inc., 2000), 54; Monica Green, Making Women’s Medicine Masculine: The Rise of Male Authority in Pre-Modern Gynaecology (Oxford: Oxford University Press, 2008), 325-344.
remedies gathered together in the fifteenth century, the Distaff Gospels collects nearly 250 guidelines about women’s health ideas in lower class communities in Picardy and Flanders.8
WOMEN IN CONTEXT Women’s Bodies, Male Doctors Hildegard of Bingen and the authors of the Trotula wrote important medical treatises on women’s health in the Middle Ages before the thirteenth century, when universities began regulating and gendering medical practice through licensing. This wave of licensing increasingly marginalized women doctors and midwives
Figure 4 A Male Physician Advises a Pregnant Woman
who often practiced locally and were excluded from the universities. 9 Essential to understanding the contexts of local healers, the shift toward masculinized professionalism illustrates a change in women’s roles as community medical practitioners. Two examples from across Western Europe illustrate this point. In 1329 Valencia, a law required that “no woman may practice medicine or give potions, under penalty of being whipped through the town; but they may care for little children and women to whom, however, they may give no potion.” The English parliament enacted similar legislations nearly a century later; in 1421, women risked “long emprisonement” for the “practise of Fisyk [medicine].”10
Garay, Kathleen Ellen and Madeleine Jeay. The Distaff Gospels. Peterview: Broadview Press, 2006. 9 Monica Green, Making Women’s Healthcare Masculine, 52. 10 As quoted by Green, Making Women’s Healthcare Masculine, 53-54.
Women Healers Despite the exclusionary nature of the medical profession, women played a variety of roles as healers in the Middle Ages, taking up positions as midwives, wet nurses, physicians, and less formal administers of home remedies. Before the fourteenth century, women in religious orders often served as health care providers, writing foundational treatises on women’s medicine.11 Many of these positions were circumscribed by social and institutional pressures. For instance, with the expansion of the universities and the regulation of the medical profession, religious women’s roles in the production and administration of medical knowledge declined. Equally, social pressures encouraged lay women to administer remedies conspicuously for fear of stigma. Healing, then, often took on the form of tradition enacted regularly and privately, by means of “diet, herbal remedies, and the sanctified word.” 12
Figure 5 Woman bleeding another woman. Shows one role of Medieval woman healers: physician
Outside of the religious order, some women worked as midwives, tending specifically to pregnancy, birth, and neonatal care in their local communities. By the fifteenth century, trends in medical licensing extended their reach to midwives, who had previously operated in unofficial networks, separate from the guilds or other similar forms of organization. Attempts to regulate the practices of midwives spoke largely to their perceived moral threat as women practitioners,
Debra Stoudt, “Medieval German Women and the Power of Healing,” in Women Healers and Physicians, ed. Elizabeth Furst (Lexington: The University of Kentucky Press), 32. 12 Ibid., 33.
often on the fringes of mainstream medical, legal, and even social practices, rather than the threat of their medicinal capabilities.13 Midwives were part of a larger network of women healers, many of whom took up positions as “physicians, surgeons, barber-surgeons, apothecaries, and […] empirical healers.” This constellation of public women practitioners existed particularly before the fourteenth century with the rise of male-gendered medical practice. 14 Finally, some women provided care in their local communities as wet nurses. The Trotula suggests that an ideal wet nurse,
Figure 6 Dittamo
Ought to be young, having a clear color, a woman who has redness mixed with white, who is not too close to her last birth nor too far removed from it either, who is not blemished, nor who has breasts that are flabby or too large, a woman who has a large and ample chest, and who is a little bit fat 15 Women could play a variety of roles as healers and health care providers in
their communities as well as in professional, regulated contexts. Records of midwives, wet nurses, and community healers are sparse, however, for two reasons. In large part, these professions and activities were carried out without regulation until the fifteenth century. Secondly, in attempting to study women’s roles as healers in the Middle Ages women often remain unnamed or unidentified with an occupation in the historical record. 16 In this way, it is likely that women who administered medicine and or worked with their husbands in medical professions have been overlooked in histories of healers and health care.
Green, Making Women’s Healthcare Masculine, 55. Ibid., 44. 15 “The Trotula: On the Conditions of Women,” from Amt, 100 trans. Monica Green 16 Monica Green, Women’s Healthcare in the Medieval West: Texts and Contexts (Aldershot: Ashgate, 2000), 329. 14
SPECIFIC ISSUES Medieval Sexuality Many of the gynaecological problems these women dealt with were closely linked to sex and sexuality. Issues of morality, reproduction, and the potential benefits of sexuality form the core of discussions about sex in the Middle Ages. Authors such as Constantine of North Africa and Albertus Magnus suggest that pleasure was built into sex to encourage individuals to procreate, despite the carnality and sinfulness of the act itself.17 Other Christian writers took up an unflinchingly moralistic view, contending that sex was necessarily sinful. Eventually the Christian view reached a compromise between reproduction and pleasure, suggesting that intercourse could be without sin so long as the possibility of conception remained.18 A second function of sexuality in the Middle Ages was closely linked to health and wellness. Much of the medical writing from this period addresses “superfluities” in the body, using a logic of expurgation to describe efforts to balance the humours and achieve good health. Medical texts posited that sex could be an important remedy akin to exercise, eating, and drinking, a remedy that would help both men and women expel extra materials and achieve bodily balance. 19
Conception (pregnancy and infertility) 17
Cadden, “Western Medicine and Natural Philosophy,” 59. Karras, Sexuality in Medieval Europe, 92. 19 Cadden, “Western Medicine and Natural Philosophy,” 59. 18
From the twelfth century on, infertility and conception became dominant subjects in medical treatises, and writers suggested that women struggling with infertility should try “baths, diets, lotions, and fumigations” in order to induce ovulation.20 Along with these methods, popular knowledge from the Distaff Gospels indicates that women took natural substances to aid in conception and increase sexual satisfaction. An anecdote in the Gospels, for example, speaks to the popularity of Artemisia, a natural substance used for a variety of gynaecological issues, particularly to increase the likelihood of conception. The Gospel reads: THE TWENTY-THIRD CHAPTER I tell you, in conclusion, as true as we are here together, that if a woman wants her husband or lover to love her passionately, she must put a walnut-tree leaf, picked just before nones on Midsummer’s night in his left shoe, and for sure, he will love her amazingly.21 The Gospels also touch on methods for conceiving specific kinds of children. For instance: THE NINETEENTH CHAPTER If a woman wants to bear small children, she must break her fast in the morning with toasted white bread dipped in wine, and without any doubt, the children she is carrying will be small. Gloss. An old woman of the company said: “I rather think that small children are conceived during the new moon more often than otherwise, because usually men lack vigour then. 22 Along with fertility issues, pregnancy raised the spectre of birthing an unhealthy baby. Parts of the Distaff Gospels indicate that women were concerned about these kinds of matters; in turn, they avoided certain foods and activities during pregnancy in hopes of delivering a healthy child: THE EIGHTH CHAPTER 20
Karras, Sexuality in Medieval Europe, 85 Distaff Gospels, 153. 22 Distaff Gospels, 171. 21
“Young women should never be given a hare’s head to eat for fear that they might think about it later, once they are married, especially while they are pregnant: in the case, for sure, their children would have split lips. Gloss. Margot des Bledz said: “That happened some time ago to one of my cousins. Because she had eaten a hare’s head when she was pregnant, her daughter was born with four lips.”23 Similarly, the Gospels alleged that pregnant women who have “cherries, strawberries, or red wine […] thrown in the face” will likely give birth to a child with birth marks. 24 By outlining the methods by which women attempted to take control of their bodies during pregnancy, these examples show that medieval women drew on a variety of traditions and systems in order to regulate and understand their bodies.
Figure 8 Hen eggs were reputed to help intercourse
Distaff Gospels, 87. Distaff Gospels, 38.
Menstruation Menstruation was closely tied to conception and fertility. Hildegard of Bingen contended that menstruation in women was the result of Eve’s association with the serpent, describing in detail the “storm” set in motion in a woman at the time of menarche. In her writings, Hildegard recognized different bodily changes associated with women during menstruation, including increased chances of conception at certain times of the cycle, as well as the possibilities of headaches and infirmity Figure 9 Hildegard of Bingen and other church writers often associated menstruation with Eve, contributing to the conception that the menses were associated with sin.
associated with the menses. 25 Social norms from the late Medieval period suggested that menstruation could be a source of threat for those wishing to conceive. The church
dictated that couples should not engage in intercourse during a woman’s cycle, and for those who did, the risks of birthing complications were viewed as especially high. 26 Despite the menses’ associations with sin, Medieval writers also understood the centrality of menstruation to conception. As such, many medical texts proposed different recipes to stimulate menstruation. Inducing menstruation was essential for women attempting to become pregnant, but it could also be read as a means of inducing an abortion or preventing a pregnancy.
Berger, Hildegard of Bingen, 81. Distaff Gospels, 41
Figure 10 Many of the remedies women used in the Late Medieval Period consisted of herbs and ingredients that could be gathered locally, such as parsley.
Contraception While some women used natural remedies in efforts to conceive, others used them to prevent pregnancies. Historian John Riddle writes that scholars typically assumed that only educated elites practiced birth control effectively, but the thirteenth-century example of a woman named Beatrice of Montaillou shows that some villagers also used natural methods to avoid
unwanted pregnancies.27 Beatrice, a woman far removed from the university context, was tried for Albigensian heresy, and in a portion of her inquisition she revealed to the courts that her lover, Pierre, a “rogue priest” and Albigensian heretic himself, had given her abortifacients in order to prevent a pregnancy after their sexual union. 28 Natural abortifacients were generally taken orally, in the form of an amulet, or as a pessary inserted vaginally.29 Beatrice’s case is a rare indication of birth control practices in a local village. While Beatrice attempted to use herbs to prevent pregnancy, some “barrier methods” existed, such as inserting sponges into the vagina or pebbles into the uterus.30 The Trotula provides an illuminating example of birth control in the Medieval period. According to the text, a woman could, take a male weasel and let its testicles be removed and let it be released alive. Let the woman carry these testicles with her in her bosom and let her tie them in goose skin or in another skin, and she will not conceive. 31 This prescription, intended for administration by medical practitioners, shows that women had agency in applying their own remedies. If a woman wished to avoid pregnancy, she could apply a number of different treatments using ingredients and materials from the village. This suggests that although physicians played important roles prescribing medical treatments, women who took up their advice did so on their own accord, applying solutions independently after receiving a prescription.
John Riddle, Eve’s Herbs: A History of Contraception and Abortion in the West (Cambridge: Harvard University Press, 1997), 23. 28 Ibid., 12. 29 Riddle, Eve’s Herbs, 23. 30 Karras, Doing Unto Others, 93. 31 “The Trotula: On the Conditions of Women,” Women’s Lives in Medieval Europe, 99
Abortion Views on abortion during the Middle Ages could at times be contradictory, but by the thirteenth century the Christian church denounced individuals who interfered with conception. 32 Although this view was largely solidified and broadly accepted by the late Middle Ages, some writers, such as John of Naples in 1315, continued to probe questions about the ethics of abortion, asking whether or not abortifacients could be administered in order to save the life of the mother.33 Despite these questioning individuals, by the mid thirteenth century, anti-abortion sentiment was widespread throughout Christendom, and England had incorporated similar legislation into Common law, declaring that abortion was equivalent to homicide. 34 Although the secular and church courts forbade abortion, local women may have continued to draw on popular knowledge and foundational traditions, using well-established herbal mixtures to induce abortion. Medical texts continued to offer advice for terminating an early pregnancy, although sometimes prescriptive literature (such as the Trotula) subtly sidesteps the issue of abortion, acknowledging instead remedies for inducing menses without reference to the potential uses of such a treatment. Likewise, traditional knowledge from antiquity and earlier centuries remained in circulation, at least among the medical community.
Riddle, Eveâ€™s Herbs, 92. Ibid., 94. 34 Ibid. 33
Rue, Artemisia, and Pennyroyal
Dittany, Squirting Cucumber, Asarum. All of these plants were believed to have abortive or contraceptive properties in them, and were used for such purposes in late Medieval Europe
CONCLUSION Although womenâ€™s health care practices saw significant transformations between the twelfth and fifteenth centuries, an abundance of folkloric and popular knowledge, as well as widely disseminated medical treatises written for women, demonstrate that many women in the Late Medieval Period drew on tradition, novel theories, or a combination of the two, in order to address gynaecological health problems, encourage conception, induce abortion, and so on. Even as medicine as an institution became increasingly masculinized and professionalized, women held remarkable agency in addressing their sexual health issues.
BIBLIOGRAPHY Berger, Margret. Hildegard of Bingen: On Natural Philosophy and Medicine: Selections from Cause et cure. Cambridge: D. S. Brewer, 1999. Garay, Kathleen Ellen and Madeleine Jeay. The Distaff Gospels. Peterborough: Broadview Press, 2006 Green, Monica. Making Women’s Medicine Masculine: The Rise of Male Authority in PreModern Gynecology. Oxford: Oxford University Press, 2008. ---. Women’s Healthcare in the Medieval West. Aldershot: Ashgate Publishing Limited, 2000. Handbook of Medieval Sexuality. Edited by Vern L. Bullough and James A. Brundage. New York: Garland Publishing, Inc. 2000. “Hildegard of Bingen: Medical Writings.” Women’s Lives in Medieval Europe. Edited by Emilie Amt. Translated by Margaret Berger.100-103 Karras, Ruth Mazo. Sexuality in Medieval Europe: Doing Unto Others. New York: Routledge, 2012. Riddle, John M. Eve’s Herbs: A History of Contraception and Abortion in the West. Cambridge: Harvard University Press, 1997. Stoudt, Debra. “Medieval German Women and the Power of Healing.” In Women Healers and Physicians. Edited by Lilian R. Furst. Lexington: University of Kentucky Press, 1997. Emilie Amt, Women’s Lives in Medieval Europe: A Sourcebook. New York: Routledge, 2010.
IMAGES Title Page Images: Alimenti, Fritto, Taccuino Sanitatis, Casanatense, https://commons.wikimedia.org/wiki/File:15alimenti,_fritto,Taccuino_Sanitatis,_Casanatense_4182..jpg Alimenti, acqua calda, Taccuino Sanitatis, Casanatense, https://commons.wikimedia.org/wiki/Category:Tacuinum_sanitatis__Casanatense_4182#/media/File:25alimenti,_acqua_calda,Taccuino_Sanitatis,_Casanatense_418.jpg Alimenti, latte, Taccuino Sanitatis, Casanatense, https://commons.wikimedia.org/wiki/File:8alimenti,_latte,_Taccuino_Sanitatis,_Casanatense_4182..jpg
f. 31v, Parsley, Tacuinum Sanitatis, M. Moleiro, http://www.moleiro.com/en/books-ofmedicine/tacuinum-sanitatis/miniatura/4fe2df5f75ee9 f. 63v, Hen Eggs, Tacuinum Sanitatis, M. Moleiro, http://www.moleiro.com/en/books-ofmedicine/tacuinum-sanitatis/miniatura/4fe2e09a00454 f.29v, Sweet Flag, Tacuinum Sanitatis, M. Moleiro, http://www.moleiro.com/en/books-ofmedicine/tacuinum-sanitatis/miniatura/4fe2df0b3f6d3 Erba Circiana, Erba filox vel herba busiles, Index of Medieval Medical Images (IMMI), http://digital2.library.ucla.edu/viewItem.do?ark=21198/zz0000zw93 Svaghi, passeggiare, Taccuino Sanitatis, Casanatense, https://commons.wikimedia.org/wiki/Category:Tacuinum_sanitatis__Casanatense_4182#/media/File:41svaghi,_passeggiare,Taccuino_Sanitatis,_Casanatense_4182..jpg Figure 1: Erba Circiana, Erba filox vel herba busiles, Index of Medieval Medical Images (IMMI), http://digital2.library.ucla.edu/viewItem.do?ark=21198/zz0000zw93 Figure 2: Authorial portrait, Hippocrates with fleur de lys, lecturing, Italy-Bologna, Index of Medieval Medical Images (IMMI), http://digital2.library.ucla.edu/viewItem.do?ark=21198/zz00010615 Figure 3: Trotula, Miscellanea medica XVIII, Wellcome Library, London, https://commons.wikimedia.org/wiki/File:Trotula_of_Salerno_Miscellanea_medica_XVIII _Early_14th_Century.jpg Figure 4: Paris, Bibliotheque Nationale, fr. 12323, folio 95v, Bibliotheque Nationale, Paris, France, The MacKinney Collection of Medieval Medical Illustrations, http://dc.lib.unc.edu/cdm/singleitem/collection/mackinney/id/3985/rec/3 Figure 5: Woman Bleeding another woman, possibly a patient, from Cambridge University Library, Li.V.ii (1846), folio 36v, The MacKinney Collection of Medieval Medical Illustrations, http://dc.lib.unc.edu/cdm/singleitem/collection/mackinney/id/3345/rec/14. Figure 6: Erba Strafisagria. Two plants called Dittamo alio, Italy, Index of Medieval Medical Images (IMMI), http://digital2.library.ucla.edu/viewItem.do?ark=21198/zz0000zxkq Figure 7: Dictamo, Italy, Index of Medieval Medical Illustrations (IMMI), http://digital2.library.ucla.edu/viewItem.do?ark=21198/zz0000zxwc Figure 8:
f. 63v, Hen Eggs, Tacuinum Sanitatis, M. Moleiro, http://www.moleiro.com/en/books-ofmedicine/tacuinum-sanitatis/miniatura/4fe2e09a00454. Figure 9: Erba Strafisagria. Two plants called Dittamo alio, Italy, Index of Medieval Medical Images (IMMI), http://digital2.library.ucla.edu/viewItem.do?ark=21198/zz0000zxkq Figure 10: Albucasis. Observations sur la nature et les propriétés de divers produits alimentaires et hygiéniques, sur des phénomènes météorologiques, sur divers actes de la vie humaine, etc, Bibliotheque Nationale de France, BNF Gallica, http://gallica.bnf.fr/ark:/12148/btv1b105380445/f46.planchecontact.r=NAL Herb Images: Top left to right bottom: Herba luccia minore. Erba ditta. Two types of Ruta silvestris, Italy, Index of Medieval Medical images, http://digital2.library.ucla.edu/viewItem.do?ark=21198/zz0000zz0d. Artemisia minor. Lapatium, Lombardy, Index of Medieval Medical Images, http://digital2.library.ucla.edu/viewItem.do?ark=21198/zz000100t5 Ebulum. Pulegium, Lombardy, Index of Medieval Medical Images, http://digital2.library.ucla.edu/viewItem.do?ark=21198/zz000102gz Aristolochia rotunda, Lombardy, Index of Medieval Medical Images, http://digital2.library.ucla.edu/viewItem.do?ark=21198/zz000104fd Dictamo, Italy, Index of Medieval Medical Images, http://digital2.library.ucla.edu/viewItem.do?ark=21198/zz0000zxwc Erba Grania Maggiore. Siler Montana, Italy, Index of Medieval Medical Images, http://digital2.library.ucla.edu/viewItem.do?ark=21198/zz000102gz Two types of Erba muscata. Two types of Baccara vel assiri idem est, 1500, Index of Medieval Medical Images, http://digital2.library.ucla.edu/viewItem.do?ark=21198/zz0000zxzd