MEDICAL EDUCATION FOR WOMEN
Among the rather startling surprises that have developed, as the growth of
our knowledge of medieval history, through consultation of the documents
in recent years, is constantly contradicting traditions founded on lack of
information, perhaps the greatest has been to learn that women were given
opportunities for the higher education at practically all of the Italian
universities, and that they became not only students, but professors, at
many of these institutions. No century from the twelfth down to the
nineteenth was without some distinguished women professors at Italian
universities, and in the later Middle Ages there was a particularly active
period of feminine education.
The most interesting feature of this development for us is that the
application of women to medical studies from the twelfth to the fourteenth
centuries was not only not discouraged, but was distinctly encouraged, and
we find evidence that a number of women studied and taught medicine,
wrote books on medical subjects, were consulted with regard to
medico-legal questions, and in general were looked upon as medical
colleagues in practically every sense of the word. The very first medical
school that developed in modern times, that of Salerno, which came into
European prominence in the eleventh century, was quite early in its
history opened to women students, and a number of women professors were on
its faculty.
Considering the modern idea that ours is the first time when women have
ever had any real opportunity for the higher education, and above all
professional education, it is a source of no little astonishment to find
that at Salerno not only an opportunity was afforded to women to study
medicine, but the department of women's diseases was handed over entirely
to them, and as a consequence we have a Salernitan School of Women
Physicians, some of whom wrote textbooks on the subject relating to this
speciality. De Renzi, in his "Storia della Scuola di Salerno," has brought
to light many details of the history of this phase of medical education
for women at the first important medical school that developed in modern
Europe. The best known of these medieval women physicians was Trotula, to
whom is attributed a series of books on medical subjects--though
doubtless some of these were due rather to disciples, but became
identified with the more famous master, as so often happened with medieval
books. Trotula's most important book bears two sub-titles: "Trotula's
Unique Book for the Curing of Diseases of Women, Before, During, and After
Labour," and the other sub-title, "Trotula's Wonderful Book of Experiences
(_experimentalis_) in the Diseases of Women, Before, During, and After
Labour, with Other Details Likewise Relating to Labour."
Probably the most interesting passage in her book for the modern time is
that with regard to a torn perineum and its repair, even when prolapse of
the uterus is a complication. The passage, which may be found readily in
De Renzi or in Gurlt, runs:
"Certain patients, from the severity of the labour, 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 we sew the tear between the
anus and vulva 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 almost more interesting with regard to prophylaxis of
rupture of the perineum. Trotula says: "In order to avoid the aforesaid
danger, careful provision should be made, and precautions should be taken
during labour after the following fashion: A cloth folded in somewhat
oblong shape should be placed on the anus, and 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."
There are records of other women professors of Salerno, though none of
them as famous as Trotula. A lady of the name of Mercuriade is said to
have written "On Crises in Pestilent Fever," and as she occupied herself
with surgery as well as medicine, there is also a work on "The Cure of
Wounds." 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, wrote "On Fevers," "On the Urine," and "On the
Embryo." Abella acquired a great reputation with her work "On Black Bile,"
and curiously enough on "The Nature of Seminal Fluid." From these books
it is clear that, while as professors they had charge of the department of
women's diseases, they studied all branches of medicine. There are a
number of licences preserved in the Archives of Naples in which women are
accorded the privilege of practising medicine, and apparently these
licences were without limitation as to the scope of practice. The preamble
of the licence, however, suggests the eminent suitability of women
treating women's diseases. It 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.
The story of medical education for women with the free opportunity for
practice, and above all the recognition accorded by making them professors
at the University of Salerno, will seem all the more surprising to those
who recall that the Benedictines largely influenced the foundation at
Salerno, and were important factors in its subsequent growth and
management. Ordinarily it would be presumed that monastic influence would
be distinctly against permitting women to secure such opportunities for
education, and, above all, encouraging their occupation with medical
practice. As a matter of fact, it seems indeed to have been monastic
influence which secured this special development. The Benedictines were
already habituated to the idea that women were quite capable, if given the
opportunity, of taking advantage of the highest education; and besides,
they were accustomed to see them occupied, and successfully, with the care
of the ailing. When St. Benedict established the monks of the West in
retreats, where the men of the earlier Middle Ages could secure, in the
midst of troubled times and with men in the cities utterly neglectful of
intellectual interests, a refuge from the disturbed life around them, and
an opportunity for intellectual development, his sister Scholastica
afforded similar opportunities for such women as felt that they were
called rather to the intellectual and spiritual life than to the taking up
of the burden of domestic duties and a wife's labours.
In these Benedictine convents for women, as they spread throughout
Italy--and afterwards throughout Germany, and France, and England, though
the fact is often ignored--the intellectual life was pursued as faithfully
as the spiritual. Besides, there gathered around the convent gates as
around the monasteries the farmers who worked their estates, and who found
it so good "to live under the crozier," as the rule of the Abbot or
Abbess was called, and who always suffered severely whenever, by
confiscation or war or like disturbances, the monastic lands passed into
the hands of laymen. For their own large numbers as well as for their
peasantry, and for the travellers who stayed in their guest-houses, the
nuns had to provide medical attendance; and the infirmarians of the
convents, situated as they were so often far from cities or towns,
acquired considerable medical knowledge and came to apply it with
excellent success. The traditions were gathered from many quarters, and
passed on for centuries from one house to another; and they gathered
simples and treated the ordinary ailments, and nursed the ailing into
moods of greater courage and states of mind that predisposed to recovery.
Probably the most important book on medicine that we have from the twelfth
century is written by a Benedictine Abbess, since known as St. Hildegarde.
She was born of noble parents at Boeckelheim in the county of Sponheim,
about the end of the eleventh century. She was educated at the Benedictine
cloister of Disibodenberg, and when her education was finished she entered
the house as a religious, and at the age of about fifty she became abbess.
Her writings, reputation for sanctity, and her wise rule, eminently
sympathetic as she was, 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 Rupertsburg, which English
and American travellers will doubtless recall because it is not far from
Bingen on the Rhine, made famous in the later time by Mrs. Hemans's poem.
Here she came to be a sort of centre for the intellectual life of her
period. According to traditions, some of which are dubious, she was in
active correspondence with nearly every important personage of her
generation. She was an intimate friend of St. Bernard of Clairvaux, who
was himself perhaps the most influential man of Europe in this century.
Her correspondence was enormous, and she was consulted from all sides
because her advice on difficult problems of any and every kind 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,
strange as it may seem, on medicine. The first is called "Liber Simplicis
Medicinæ," and the second "Liber Compositæ Medicinæ." These books were
written as a contribution of her views with regard to the medical
knowledge of her time, but were evidently due, partly at least, to the
Benedictine traditions of interest in medicine. Dr. Melanie Lipinska in
her "Histoire des Femmes Médicins," a thesis presented for the doctorate
in medicine at the University of Paris in 1900, which was subsequently
awarded a special prize by the French Academy, reviews Hildegarde's work
critically from the medical standpoint. She does not hesitate to declare
the Abbess Hildegarde the most important medical writer of her time.
Reuss, the editor of the works of Hildegarde as they are published in
Migne's "Patrologia," the immense French edition of all the important
works of the Fathers, Doctors, and Saints of the Church, says:
"Among all the saintly religious who have practised medicine or
written about it in the Middle Ages, the most important is without any
doubt St. Hildegarde...." With regard to her book he says: "All those
who wish to write the history of the medical and natural sciences must
read this work, in which this religious woman, evidently well grounded
in all that was known at that time in the secrets of nature, discusses
and examines carefully all the knowledge of the time." He adds: "It is
certain that St. Hildegarde knew many things that were unknown to the
physicians of her time."
Some of Hildegarde's expressions are startling enough because they
indicate discussion of, and attempts to elucidate, problems which many
people of the modern time are likely to think occurred only to the last
few generations. For instance, in talking about the stars and describing
their course through the firmament, she makes use of a comparison that
seems strangely ahead of her time. She says: "Just as the blood moves in
the veins, causing them to vibrate and pulsate, so the stars move in the
firmament, and send out sparks as it were of light, like the vibrations of
the veins." This is, of course, not an anticipation of the discovery of
the circulation of the blood, but it shows how close were men's ideas to
some such thought five centuries before Harvey's discovery. For Hildegarde
the brain was the regulator of all the vital qualities, the centre of
life. She connects the nerves in their passage from the brain and the
spinal cord through the body with manifestations of life. She has a series
of chapters with regard to psychology, normal and morbid. She talks about
frenzy, insanity, despair, dread, obsession, anger, idiocy, and innocency.
She says very strongly in one place that "when headache and migraine and
vertigo attack a patient simultaneously, they render a man foolish and
upset his reason. This makes many people think that he is possessed of a
demon, but that is not true." These are the exact words of the saint as
quoted in Mlle. Lipinska's thesis.
With this story of St. Hildegarde in mind, and the recall of other
educational developments among the Benedictine nuns, it is easy to
understand the developments that took place at Salerno, where monastic
influence was so prominent. Just as the medical, and above all the
surgical, traditions of Salerno found their way to Bologna at the
beginning of the thirteenth century, so also did the regulations regarding
standards in medical education, and with them medical education for women.
There are definite historical documents which show that women not only
studied but taught in the medical department of Bologna. The name of one
of them at least is very well known. She was Alessandra Giliani, and,
strange as it might appear, was one of the prosectors in anatomy of
Mondino, the founder of teaching by human dissection. According to the
"Cronaca Persicetana," quoted by Medici in his "History of the Anatomical
School at Bologna":
"She became most valuable to Mondino because she would cleanse most
skilfully the smallest vein, the arteries, all ramifications of the
vessels, without lacerating or dividing them, and to prepare them for
demonstration she would fill them with various coloured liquids,
which, after having been driven into the vessels, would harden without
destroying the vessels. Again, she would paint these same vessels to
their minute branches so perfectly, and colour them so naturally,
that, added to the wonderful explanations and teachings of the master,
they brought him great fame and credit."
This passage with its description, as coming from a woman, of a very early
anticipation of our most modern anatomical technique--injection,
hardening, and colouring, so as to imitate nature for the making of
anatomical preparations, for class and demonstration purposes--is all the
more interesting because the next great improvement in anatomical
teaching, the use of wax models of dissected specimens coloured to imitate
nature, came also from a woman, Madame Manzolini, also of Bologna.
Feminine instinct aroused women to use their inventive ability to do away
with the necessity for always recurring to the deterrent material of fresh
dissections, and yet securing such preparations as would make teaching not
less but more effective.
Some doubt has been thrown on certain details of the story of Alessandra
Giliani, but the memorial tablet erected at the time of her death in the
Hospital Church of Santa Maria de Mareto in Florence gives all the
important facts, and tells the story of the grief of her fiancé, who was
himself Mondino's other assistant. Like her, he died young also, when
there were high hopes of his ability, and there is more than the suspicion
that these two untimely deaths may have been due to dissecting wound
infections. She died "consumed by her labours," so that it may have been
phthisis; but he was taken by "a swift and lamentable death."
Nicaise, in the Introduction to his edition of Guy de Chauliac's "Grande
Chirurgie" (Paris, 1893), has a brief review of the history of women in
medicine, with special reference to France. He supplies practically all
the information available in very short compass, as well as the references
where more details can be obtained.
"Women continued to practise medicine in Italy for centuries, and the
names of some who attained great renown have been preserved for us.
Their works are still quoted from in the fifteenth century.
"There was none of them in France who became distinguished, but women
could practise medicine in certain towns at least on condition of
passing an examination before regularly appointed masters. An edict of
1311, at the same time that it interdicts unauthorized women from
practising surgery, recognizes their rights to practise the art if
they have undergone an examination before the regularly appointed
master surgeons of the corporation of Paris. An edict of King John,
April, 1352, contains the same expressions as the previous edict. Du
Bouley, in his 'History of the University of Paris' gives another
edict by the same king, also published in the year 1352, as a result
of the complaints of the faculties at Paris, in which there is also
question of women physicians. This responded to a petition: 'Having
heard the petition of the Dean and Masters of the Faculty of Medicine
at the University of Paris, who declare that there are very many of
both sexes, some of the women with legal title to practise and some
of them merely old pretenders to a knowledge of medicine, who come to
Paris in order to practise, be it enacted,' etc. (The edict then
proceeds to repeat the terms of previous legislation in this matter.)
"Guy de Chauliac speaks also of women who practised surgery. They
formed the fifth and last class of operators in his time. He complains
that they are accustomed to too great an extent to give over patients
suffering from all kinds of maladies to the will of Heaven, founding
their practice on the maxim, 'The Lord has given as he has pleased;
the Lord will take away when he pleases; may the name of the Lord be
blessed.'
"In the sixteenth century, according to Pasquier, the practice of
medicine by women almost entirely disappeared. The number of women
physicians becomes more and more rare in the following centuries, just
in proportion as we approach our own time. Pasquier says that we find
a certain number of them anxious for knowledge, and with a special
penchant for the study of the natural sciences and even of medicine,
but very few of them take up practice."
There seems, however, to have been not nearly so much freedom or so much
encouragement for women in medicine in France as in Italy. Indeed, in the
whole matter of education for women, medieval France has but little to
record compared to Italy's significant chapter in the history of feminine
education. One reason for this was doubtless the Hélöise-Abélard incident
early in the history of the University of Paris. This seems to have
discouraged efforts in the direction of the securing of the higher
education for women in most of the Western Universities. Oxford was a
daughter university of Paris, and Cambridge of Oxford, and they and all
the other universities of the West were more deeply influenced in their
customs and organization by Paris than by Italy, and as a consequence we
hear little of feminine education in the West generally. One result of
this has been the existence of a feeling that, since women had very few
opportunities for the higher education in Western Europe, they must have
had them nowhere else. This presumption forms the basis of not a little
misunderstanding of the Middle Ages in our time. It often takes but a
little incident to set the current of history in a very different
direction from that in which it might have gone, and this seems to have
been the case as regards the higher education for women in France and
Spain and England.