the care of women professors, and the granting of licenses to women to
practise medicine, is not so surprising in the light of this tradition
among Greeks and Romans, taken up with some enthusiasm by the
Christians. We are not sure just when this development took place. The
first definite evidence with regard to it comes in the life of Trotula,
who seems to have been the head of the department. Some of her books are
well known, and often quoted from, and she contributed to a symposium on
the treatment of disease, in which there are contributions, also, from
men professors of Salerno at the time. She seems to have flourished
about the middle of the eleventh century. Ordericus Vitalis, a monk of
Utica, who wrote an ecclesiastical history, tells of one Rudolph
Malcorona, who, in 1059, came to Utica and remained there for a long
time with Father Robert, his nephew. "This Rudolph had been a student
all his life, devoting himself with great zeal to letters, and had
become famous for his visits to the schools of France and Italy, in
order to gather there the secrets of learning. As a consequence he was
well informed not only in grammar and dialectics, but also in astronomy
and in music. He also possessed such an extensive knowledge of the
natural sciences that in the town of Salerno, where, since ancient
times, the best schools of medicine had existed, there was no one to
equal him with the exception of a very wise matron."
This wise matron has been identified with Trotula, many of the details
of whose life have been brought to light by De Renzi, in his "Story of
the School of Salerno."[11] According to very old tradition, Trotula
belonged to the family of Ruggiero. This was a noble family of Salerno,
many of the members of which were distinguished in their native town at
least, but the name is not unusual in Italy, as readers of Dante and
Boccaccio are likely to know. It was, indeed, as common as our own
Rogers, of which it is the Italian equivalent.
De Renzi has made out a rather good case for the tradition that Trotula
was the wife of John Platearius I--so called because there were probably
three professors of that name. Trotula was, according to this, the
mother of the second Platearius, and the grandmother of the third, all
of them distinguished members of the faculty at Salerno.
Her reputation extended far beyond her native town, and even Italy
itself, and, in later centuries, her name was used to dignify any form
of treatment for women's diseases that was being exploited. Rutebeuf,
one of the _trouveres_, thirteenth-century French poets, has a
description of the scene in which one of the old herbalist doctors who
used to go round and collect a crowd by means of songs and music, and
then talk medicine to them--just as is done even yet in many of the
smaller towns of this country--is represented as saying to the crowd
when he wants to make them realize that he is no ordinary quacksalver,
that he is one of the disciples of the great Madame Trot of Salerno. The
old-fashioned speech runs somewhat as follows: "Charming people: I am
not one of these poor preachers, nor the poor herbalists, who carry
little boxes and sachets, and who spread out before them a carpet. I am
the disciple of a great lady, who bears the name of Madame Trot of
Salerno. And I would have you know that she is the wisest woman in all
the four quarters of the world."
Two books are attributed to Trotula; one bears the title, "De
Passionibus Mulierum," and the other has been called "Trotula Minor," or
"Summula Secundum Trotulam," and is a compendium of what she wrote. This
is probably due to some disciple, but seems to have existed almost in
her own time. Her most important work bears two sub-titles, "Trotula's
Unique Book for the Curing of Diseases of Women, Before, During, and
After Labor," and the other sub-title, "Trotula's Wonderful Book of
Experience (_experimentalis_) in the Diseases of Women, Before, During,
and After Labor, with Other Details Likewise Relating to Labor."
The book begins with a prologue on the nature of man and of woman, and
an explanation of how the author, taking pity on the sufferings of
women, came to devote herself to the study of their diseases. There are
many interesting details in the book, all the more interesting because
in many ways they anticipate modern solutions of difficult problems in
women's diseases, and the care of the mother and child before, during,
and after labor. For instance, there are a series of rules on the choice
of the nurse, and on the diet and the regime which she should follow if
the child is to be properly nourished without disturbance.
Probably the most striking passage in her book is that with regard to a
torn perineum and its repair. This passage may be found in De Renzi or
in Gurlt. It runs as follows: "Certain patients, from the severity of
the labor, run into a rupture of the genitalia. In some even the vulva
and anus become one foramen, having the same course. As a consequence,
prolapse of the uterus occurs, and it becomes indurated. In order to
relieve this condition, we apply to the uterus warm wine in which butter
has been boiled, and these fomentations are continued until the uterus
becomes soft, and then it is gently replaced. After this the tear
between the anus and vulva we sew in three or four places with silk
thread. The woman should then be placed in bed, with the feet elevated,
and must retain that position, even for eating and drinking, and all the
necessities of life, for eight or nine days. During this time, also,
there must be no bathing, and care must be taken to avoid everything
that might cause coughing, and all indigestible materials."
There is a passage, also, almost more interesting with regard to
prophylaxis of rupture of the perineum. She says, "In order to avoid the
aforesaid danger, careful provision should be made, and precautions
should be taken during labor somewhat as follows: A cloth should be
folded in somewhat oblong shape, and placed on the anus, so that, during
every effort for the expulsion of the child, that should be pressed
firmly, in order that there may not be any solution of the continuity of
tissue."
Her book contains, also, some directions for various cosmetics. How many
of these are original, however, is difficult to say. Trotula's name had
become a word to conjure with, and many a quack in the after time tried
to make capital for his remedies in this line by attributing them to
Trotula. As a consequence, many of these remedies gradually found their
way into the manuscript copies of her book, and subsequent copyists
incorporated them into the text, until it became practically impossible
to determine which were original. There are manuscripts of Trotula's
work in Florence, Vienna, and Breslau. Some of these contain chapters
not in the others, undoubtedly added by subsequent hands. In one of
these, that at Florence, from which the edition of Strasburg was printed
in 1544, and of Venice, 1547, one of the Aldine issues, there is a
mention in the last chapter of spectacles. We have no record of these
until the end of the thirteenth century, when this passage was probably
added. It was also printed at Basle, 1566, and at Leipzig as late as
1778, which would serve to show how much attention it has attracted even
in comparatively recent times.
After Trotula we have a number of women physicians of Salerno whose
names have come down to us. The best known of these bear the names
Constanza, Calendula, Abella, Mercuriade, Rebecca Guarna, who belonged
to the old Salernitan family of that name, a member of which, in the
twelfth century, was Romuald, priest, physician, and historian, Louise
Trencapilli, and others. The titles of some of their books, as those of
Mercuriade, who occupied herself with surgery as well as medicine, and
who is said to have written on "Crises," on "Pestilent Fever," on "The
Cure of Wounds," and of Abella, who acquired a great reputation with her
work on "Black Bile," and on the "Nature of Seminal Fluid," have come
down to us. Rebecca Guarna wrote on "Fevers," on the "Urine," and on the
"Embryo." The school of Salernitan women came to have a definite place
in medical literature.
While, as teachers, they had charge of the department of women's
diseases, their writings would seem to indicate that they studied all
branches of medicine. Besides, there are a number of licenses preserved
in the archives of Naples in which women are accorded the privilege of
practising medicine. Apparently these licenses were without limitation.
In many of these mention is made of the fact that it seems especially
fitting that women should be allowed to practise in women's diseases,
since they are by constitution likely to know more and to have more
sympathy with feminine ills. The formula employed as the preamble of
this license ran as follows: "Since, then, the law permits women to
exercise the profession of physicians, and since, besides, due regard
being had to purity of morals, women are better suited for the treatment
of women's diseases, after having received the oath of fidelity, we
permit, etc."
Salerno continued to enjoy a reputation for training women physicians
thoroughly, until well on in the fifteenth century, for we have the
record of Constance Calenda, the daughter of Salvator Calenda, who had
been dean of the faculty of medicine at Salerno about 1415, and
afterwards dean of the faculty at Naples. His daughter, under the
diligent instruction of her father, seems to have obtained special
honors for her medical examination. Not long after this, Salerno itself
lost all the prestige that it had. The Kings of Naples endeavored to
create a great university in their city in the thirteenth century. They
did not succeed to the extent that they hoped, but the neighboring rival
institution hurt Salerno very much, and its downfall may be traced from
this time. Gradually its reputation waned, and we have practically no
medical writer of distinction there at the end of the fourteenth
century, though the old custom of opportunities for women students of
medicine was maintained.
This custom seems also to have been transferred to Naples, and licenses
to practise were issued to woman graduates of Naples. This never
achieved anything like the reputation in this department that had been
attained at Salerno. Salerno influenced Bologna and the north Italian
universities profoundly in all branches of medicine and medical
education, particularly in surgery, as can be seen in the chapter on
"Great Surgeons of the Medieval Universities," and the practice of
allowing such women as wished to study medicine to enter the university
medical schools is exemplified in the case of Mondino's assistant in
anatomy, Alessandra Giliani, though there are also others whose names
have come down to us.
The University of Salerno had developed round a medical school. It was
the first of the universities, and, in connection with its medical
school, feminine education obtained a strong foothold. It is not
surprising, then, that with the further development of universities in
Italy, feminine education came to be the rule. This rule has maintained
itself all down the centuries in Italy, so that there has not been a
single century since the twelfth in which there have not been one or
more distinguished women teachers at the Italian universities.
University life gradually spread westward, and Paris came into existence
as an organized institution of learning after Bologna, and, doubtless,
with some of the traditions of Salerno in the minds of its founders.
Feminine education, however, did not spread to the West. This is a
little bit difficult to understand, considering the reverence that the
Teutonic peoples have always had for their women folk and the privileges
accorded them. A single unfortunate incident, that of Abelard and
Heloise, seems to have been sufficient to discourage efforts in the
direction of opportunities for feminine education in connection with the
Western universities. Perhaps, in the less sophisticated countries of
the North and West of Europe, women did not so ardently desire
educational opportunities as in Italy, for whenever they have really
wanted them, as, indeed, anything else, they have always obtained them.
In spite of the absence of formal opportunities for feminine education
in medicine at the Western universities, a certain amount of scientific
knowledge of diseases, as well as valuable practical training in the
care of the ailing, was not wanting for women outside of Italy. The
medical knowledge of the women of northern France and Germany and
England, however, though it did not receive the stamp of a formal degree
from the university and the distinction of a license to practise, was
none the less thorough and extensive. It came in connection with certain
offices in their own communities, held by members of religious orders.
Genuine information with regard to what the religious were doing during
the Middle Ages was so much obscured by the tradition of laziness and
immorality, created at the time of the so-called reformation in order
to justify the confiscation of their property by those whose one object
was to enrich themselves, that we have only come to know the reality of
their life and accomplishments in comparatively recent years. We now
know that, besides being the home of most of the book knowledge of the
earlier Middle Ages, the monasteries were the constant patrons of such
practical subjects as architecture, agriculture in all its phases,
especially irrigation, draining, and the improvement of land and crops;
of art, and even what we now know as physical science. Above all, they
preserved for us the old medical books and carried on medical traditions
of practice. The greatest surprise has been to find that this was true
not only for the monks, but also for the nuns.
One of the most important books on medicine that has come to us from the
twelfth century is that of a Benedictine abbess, since known as St.
Hildegarde, whose life was spent in the Rhineland. Her works serve to
show very well that in the convents of the tenth, eleventh, and twelfth
centuries there was much more of interest in things intellectual than we
have had any idea of until recent years, and that, indeed, one of the
important occupations of convent life was the serious study of books of
all kinds, some of them even scientific, as well as the writing of works
in all departments. The century before St. Hildegarde there is the
record of Hroswitha, who wrote a series of dramas in imitation of
Terence, that were meant to replace, for the monks and nuns of that
period, the reading of that rather too human author. Hroswitha, like
Hildegarde, was a German, and we have the record, also, of another
religious writer, abbess of the Odilian Cloister, at Hohenberg, who
wrote a book called "Hortus Deliciarum, the Garden of Delights," a book
of information on many subjects not unlike our popular encyclopedias of
the modern time, the title of which shows that the place of information
in life was considered to be the giving of pleasure. While this work
deals mainly with Biblical and theological and mystical questions, there
are many purely scientific passages and many subjects of strictly
medical interest treated.
The life of the Abbess Hildegarde is worthy of consideration, because it
illustrates the period and makes it very clear that, in spite of the
grievous misunderstanding of their life and work, so common in the
modern time, these old-time religious had most of the interests of the
modern time, and pursued them with even more than modern zeal and
success, very often. Her career illustrates very well what the
foundation of the Benedictines had done for women. When St. Benedict
founded his order for men, his sister, Scholastica, wanted to do a
similar work for women. We know that the Benedictine monks saved the old
classics for us, kept burning the light of the intellectual life, and
gave a refuge to men who wanted to devote themselves in leisure and
peace to the things of the spirit, whether of this world or the other.
We have known much less of the Benedictine nuns until now the study of
their books shows that they provided exactly the same opportunities for
women and furnished a vocation, a home, an occupation of mind, and a
satisfaction of spirit for the women who, in every generation, do not
feel themselves called to be wives and mothers, but who want to live
their lives for others rather than for themselves and their kin, seeking
such development of mind and of spirit as may come with the leisure and
peace of celibacy.
Hildegarde was born of noble parents at Boeckelheim, in the county of
Sponheim, about the end of the eleventh century (probably 1098). In her
eighth year she went for her education to the Benedictine cloister of
Disibodenberg. When her education was finished, she entered the
cloister, of which, at the age of about fifty, she became abbess. Her
writings, reputation for sanctity, and her wise saintly rule attracted
so many new members to the community that the convent became
overcrowded. Accordingly, with eighteen of her nuns, Hildegarde withdrew
to a new convent at Rupertsberg, which English and American travellers
will remember because it is not far from Bingen on the Rhine. Here she
came to be a centre of attraction for most of the world of her time. She
was in active correspondence with nearly every important man of her
generation. She was an intimate friend of Bernard of Clairvaux, who was
himself, perhaps, the most influential man in Europe in this century.
She was in correspondence with four Popes, and with the Emperors Conrad
and Frederick I, and with many distinguished archbishops, abbots, and
abbesses, and teachers and teaching bodies of various kinds. These
correspondences were usually begun by her correspondents, who consulted
her because her advice in difficult problems was considered so valuable.
In spite of all this time-taking correspondence, she found leisure to
write a series of books, most of them on mystical subjects, but two of
them on medical subjects. The first is called "Liber Simplicis
Medicinae," and the second "Liber Compositae Medicinae." These books were
written in order to provide information mainly for the nuns who had
charge of the infirmaries of the monasteries of the Benedictines. Almost
constantly someone in the large communities, which always contained aged
religious, was ailing, and then, besides, there were other calls on the
time and the skill of the sister infirmarians. There were no hotels at
that time, and no hospitals, except in the large cities. There were
always guest houses in connection with monasteries and convents, in
which travellers were permitted to pass the night, and given what they
needed to eat. There are many people who have had experiences of
monastic hospitality even in our own time. Sometimes travellers fell
ill. Not infrequently the reason for travelling was to find health in
some distant and fabulously health-giving resort, or at the hands of
some wonder-working physician. Such high hopes are nearly always set at
a distance. This of itself must have given not a little additional need
for knowledge of medicine to the infirmarians of convents and
monasteries. There were around many of the monasteries, moreover, large
estates; often they had been cleared and made valuable by the work of
preceding generations of monks, and on these estates peasants came to
live. Workingmen and workingwomen from neighboring districts came to
help at harvest time, and, after a chance meeting, were married and
settled down on a little plot of ground provided for them near the
monastery. As these communities grew up, they looked to the monasteries
and convents for aid of all kinds, and turned to them particularly in
times of illness. The need for definite instruction in medicine on the
part of a great many of the monks and nuns can be readily understood,
and it was this need that Hildegarde tried to meet in her books. The
first of her books that we have mentioned, the "Liber Simplicis
Medicinae," attracted attention rather early in the Renaissance, and was
deemed worthy of print. It was edited at the beginning of the sixteenth
century by Dr. Schott at Strasburg, under the title, "Physica S.
Hildegardis." Another manuscript of this part was found in the library
of Wolfenbuttel, in 1858, by Dr. Jessen. This gave him an interest in
Hildegarde's contributions to medicine, and, in 1859, he noted in the
library at Copenhagen a manuscript with the title "Hildegardi Curae et
Causae." On examination, he was sure that it was the "Liber Compositae
Medicinae" of the saint. The first work consists of nine books, treating
of plants, elements, trees, stones, fishes, birds, quadrupeds, reptiles,
and metals, and is printed in Migne's "Patrologia," under the title
"Subtilitatum Diversarum Naturarum Libri Novem." The second, in five
books, treats of the general diseases of created things, of the human
body and its ailments, of the causes, symptoms, and treatment of
diseases.
It would be very easy to think that these are small volumes and that
they contain very little. We are so apt to think of old-fashioned
so-called books as scarcely more than chapters, that it may be
interesting to give some idea of the contents and extent of the first of
these works. The first book on Plants has 230 chapters, the second on
the Elements has 13 chapters, the third on Trees has 36 chapters, the
fourth on various kinds of Minerals, including precious stones, has 226
chapters, the fifth on Fishes has 36 chapters, the sixth on Birds has 68
chapters, the seventh on Quadrupeds has 43 chapters, the eighth on
Reptiles has 18 chapters, the ninth on Metals has 8 chapters. Each
chapter begins with a description of the species in question, and then
defines its value for man and its therapeutic significance. Modern
scientists have not hesitated to declare that the descriptions abound in
observations worthy of a scientific inquiring spirit. We are, of course,
not absolutely sure that all the contents of the books come from
Hildegarde. Subsequent students often made notes in these manuscript
books, and then other copyists copied these into the texts.
Unfortunately we have not a number of codices to collate and correct
such errors. Most of what Hildegarde wrote comes to us in a single copy,
of none are there more than four copies, showing how near we came to
missing all knowledge of her entirely.
Dr. Melanie Lipinska, in her "Histoire des Femmes Medecins," a thesis
presented for the doctorate in medicine at the University of Paris in
1900, subsequently awarded a special prize by the French Academy,
reviews Hildegarde's work critically from the medical standpoint. She
says that the saint distinguishes a double mode of action of different
substances, one chemical, the other physical, or what we would very
probably call magnetic. She discusses all the ailments of the various
organs, the brain, the eyes, the teeth, the heart, the spleen, the
stomach, the liver. She has special chapters on redness and paleness of
the face, on asthma, on cough, on fetid breath, on bilious indigestion,
on gout. Besides, she has other chapters on nervous affections, on
icterus, on fevers, on intestinal worms, on infections due to swamp
exhalations, on dysentery, and a number of forms of pulmonary diseases.
Nearly all of our methods of diagnosis are to be found, hinted at at
least, in her book. She discusses the redness of the blood as a sign of
health, the characteristics of various excrementitious material as signs
of disease, the degrees of fever, and the changes in the pulse. Of
course, it was changes in the humors of the body that constituted the
main causes for disease in her opinion, but it is well to remind
ourselves that our frequent discussion of auto-intoxication in recent
years is a distinct return to this.