Women and Medicine
in the Middle Ages and Renaissance
Medicine Before and around 1600
Medical care before 1600 involved a wide variety of tactics:
'holistic' lifestyle prescriptions and diets based on the theory of
humors; direct applications of various substances alone or in
combination; bloodletting, cauterization and cupping; use of holy
relics and prayers as well as other ritual/magical actions; and
prayers to saints, charity, pilgrimages and other 'acts of virtue'.
Herbs, spices, resins, stones and other substances were used in
drinks, pills, washes, baths, rubs, poultices, purges, enemas,
suppositories, pessaries, bandages, ointments and most other
conceivable forms to treat illness. A wide variety of practitioners
were also involved-- university trained physicians, literate and
illiterate 'empirics', religious, surgeons, barbers, apothecaries,
midwives, relatives of the patient and specialist healers of one
type or another.
Medicine's view of Women
Eve and Medicine (and Aristotle)
The learned schools of medicine subjected women to a double whammy
of medical contempt: not only were there church doctrines about the
inferiority of women due to Eve, but many Greek and subsequent
ancient writers, such as Aristotle, wrote misogynist texts about
women and their bodies.
In most schools of thought, women were held to be weaker, more prone
to vices, including sexual vices, humorally more cold and damp, and
generally inferior copies of the male organism. Church doctrine was
that the discomfort, pain and peril of childbearing were women's lot
because of the sins of Eve.
Because learned medicine concentrated almost exclusively on theory
and rehashing of classical texts, there was room for writings by
male monks and scholars who had no practical experience of women or
women's medicine. The most outstanding would be the 'Secretis
Mulierum' by the pseudo-Albertus Magnus, which is chock full of
horrible distortions and misinformation.
Because medieval Western Europe was a 'birth-positive' culture which
placed a high value on human reproduction, women's roles in
childbearing were very important to the culture. There was heavy
emphasis on conceiving and bearing children, and men blamed women
for any infertility. On the other hand, there was a positive side to
childbearing, as seen in traditions such as the celebratory
post-partum visits and special clothes and furnishings for the
mother in Renaissance Italy.
Menstruation was of grave concern to classical, medieval and
Renaissance medical writers and physicians. Modern anthropologists
have noted that excessive concern with menstruation is a
characteristic of many birth-positive cultures. Not only did regular
menstruation indicate fertility, but by the theory of humors,
women's excess humors and buildup of bodily wastes were flushed by
regular monthly courses. If these did not occur, the wastes would
build up and cause illness. An older woman who no longer menstruated
posed a serious safety concern since the excess humors and wastes
were thought to be able to poison men and sometimes children
and others with whom she came into contact.
Conception & Birth
Male writers often had trouble with the basic anatomy of the
gynecological parts. Though some had a very good idea of how the
parts subject to manual examination were formed, there were
arguments about the number of chambers in the uterus and other
matters of anatomy.
Though some authorities still believed that male semen was the only
engenderer of the child, most agreed that the child was equally
formed and nourished from the male semen and female menstrual fluids
that were retained during pregnancy. In general, it was considered
necessary that both the man and the woman be fully satisfied
during intercourse for conception to occur (which was good for
married women but bad for rape victims).
Fertility was a major concern. In one well recorded case, a italian
woman seeking to become pregnant was offered a multitude of advice.
Her physician offered humoral theory. Her sister found both a female
empiric who would produce a plaster to apply on the abdomen and
another specialist that would produce a blessed girdle. Her
brother-in-law suggested acts of charity and prayer.
Sources on 'Women's medicine' available to period people:
- De Secretes Mulierium, a nasty text that Christine de
Pisan condemned as 'full of lies'
- The texts making up the Trotula-- one on ob/gyn, one
on ob/gyn and cosmetics, one on cosmetics
- The Seeknesse of Women, an extract from the works of Gilbertus Anglicus
- Some of the writings of Hildegarde of Bingen, notably Physica
and Causa et Curia
Medical Treatments for women
Some historians claim that "Women's medicine is women's business".
Others provide plenty of evidence that women medical practitioners
treated men, and men treated women even in gynecology and obstetrics
(though a female intermediary would be employed for manual
Treatments (or at least home remedies) for itching, burning, vermin
and whites (yeast infection) were included in many texts. Other
types of illness, such as breast cancer and uterine cancer were
known, though treatments for them were rare and dangerous. Women who
were celibate could incur various discomforts, to be abated by
applications of warm oils to the genitalia and poultices to the
abdomen. Surgery for cancers and fistulas was not unknown, though a
dangerous procedure. Various treatments for bladder disorders were
Menstruation indicated fertility, and the concern for regular
menstruation led to a number of remedies 'to bring down women's
courses' which may or may not have been abortifacient. However, most
of the items specified as causing menstruation have little or
no abortifacient potential. Women who did not menstruate might
suffer from wandering of the uterus; a misplaced uterus could cause
pain in other parts of the body, and even cause stoppage of breath.
'Suffocation of the uterus' due to lack of menstruation was
treated in various ways, with drinks, steam-baths, and manual
manipulation. For young women, treatments for disorders of
menstruation generally included the suggestion of marriage and
Europe in the middle ages was what is referred to as a
'birth-positive' culture. That is, they valued reproduction above
other considerations. Many rules, medical treatments and
stratagems are suggested in the documents for encouraging
conception, especially conception of a healthy child, preferably a
boy. For instance, having pictures of boys and handsome men about
during pregnancy, and avoiding all distressing sights, were
recommended by physicians and writers.
While strategies to prevent conception were forbidden by the
church, by common law and by the society, it does seem that some
sort of conception regulation was practiced in some cases -- both
the Trotula and the Secrets of Women describe contraceptives.
Furthermore, population analyses suggest that births may have been
limited by choice in some way.
Pregnancy & Childbirth
Though the care of women during pregnancy does not appear to be
exclusively controlled by other women, women figured prominently
there. During the pregnancy, though, women might well consult male
physicians for a variety of advice, and university physicians and
literate male doctors had access to texts that show a variety of
obstetrical presentations. Some women (such as the queen of Jaume
II of Spain) were attended in childbed by male physicians, but
midwives or maids were employed to do any manual examination.
Many texts suggest not only health regimens for the pregnant
woman but also remedies for the various discomforts of pregnancy,
such as swollen feet and painful breasts.
The best documentation about childbirth and aftercare seems to be
provided by illustrations on wooden trays and majolica ware made
to be used by the new mother in Renaissance Italy. (Jacqueline
Musacchio describes and depicts in detail these presentations and
their social setting.)
Childbirth: Woodcut from Der Swangern Frawen und he bammen roszgarten, by
Eucharius Rösslin, 1513. (Arons, 1994)
Illustrations depict women usually giving birth in some kind of
chair, sometimes using a birthing stool that was v-shaped to
support the legs while giving space for the midwife to work;
however illustrations also suggest that x-shaped chairs and other
normal sorts of chairs were used, as well as the half lying
position and a crouching position.
Chair: Woodcut from Der Swangern
Frawen und he bammen roszgarten, by Eucharius Rösslin,
1513. (Arons, 1994):
...She should lie down on her back, but she should not lie
down completely and yet also she also should not quite be
standing, but rather it should be somewhere in the middle . . .
And in high German lands, and also in Italian lands the midwives
have special chairs for a woman's labor, and these are not high,
but carved out and hollow on the inside, as depicted here. And
these should be made so the woman can lean back on her back . .
. And if she is fat, she should not sit, rather she should
lie on her belly, and lay her forehead on the ground and pull
her knees to her belly . . . (Arons, 1994)
Anointing the belly and the vulva, especially the perineum, with
oils and unguents was practiced to help reduce tearing. (Medical
books specify instructions for repairing torn perineum with
Prolapsed uterus and hemorrhaging were common complications, as
were difficult presentations, such as buttocks-first. Retained
placentas and dead children retained in the womb were also a
concern. There are many remedies suggested for expelling the dead
child from the womb; some of these could have been used as
Intentional abortion, though illegal, was known, though the
substances and procedures doctors and priests reported as being
used were generally dangerous and/or ineffective.
By the latter part of our period, it was common for women of the
upper and upper middle classes to send their children out to
wetnurses. It's not clear from the documents why this was so
fashionable, but there is likely to be one important factor: women
who were not breastfeeding were likely to conceive sooner.
[In Russian and some Eastern orthodox church areas, the wetnurse was
a necessity, since no-one, including the child, could eat in the
presence of a postpartum woman until she had completed the 40 days
purification and been 'churched'. How this was arranged is unclear
but prominent women used wetnurses.]
As a result, some women needed help stopping their flow of milk,
while others needed to encourage it. There are a variety of
medicaments and botanicals recommended in the herbals and texts to
encourage or discourage lactation; also certain activities and diet
were said to affect lactation.
On the other hand, by the end of the period many medical and advice
texts strongly recommend that women nurse their own children instead
of resorting to wetnurses.
In addition, most herbals and other kinds of texts prescribe
remedies for 'sore breasts' without specifically mentioning
lactation: these may have been connected with lactation or the
symptoms of dysmenorrhea.
With the high level of infant mortality, women faced an uphill
battle in raising their children even to the age of 5. Infectious
diseases, injuries, and even unrecognized birth defects could
kill. In at least one case, women medical personnel were directed
to treat only women and children (Valencia). Accounts of miracles
and sometimes household accounts indicate that physicians were
consulted for children. However, there does not seem to have been
a specific discipline of pediatrics.
Place of Women in Medicine
Inside the Home-- Dr. Mom.
It is generally assumed by modern historians and by the writers of
many manuscript sources that the wife, mother, lady of the house, or
female head of the household, was responsible for first-line and in
most cases all medical treatment in the home.
While this practice is not as strongly documented in earlier
records, by the sixteenth and early seventeenth century it is
explicitly stated by authors such as Thomas Tusser (500 points of
good husbandry) and Gervase Markham (The English Housewife).
Earlier, we see writers condemning women practicing on their
families (for instance, Chaucer's story about Chanticleer, where his
wife nearly poisons him with her suggested remedies).
In farm and manorial households, the owner's wife was expected to
provide medical care not only to her own family but to servants and
dependents, including tenants and neighbors of lower status. If she
did not provide the care herself, she was responsible for seeing
that it was done. In Le Menagier de Paris (written in the
late 1300s), the husband instructs his wife to drop everything and
see to the care of any servant fallen ill. "The charities of the
Roman noblewoman Francesca Bussi dei Ponziani (St. Francesca Romana,
1384-1440) included doctoring not only the members of her wealthy
husband's large household but also neighbors, friends and strangers
in need." (Siriasi)
Most people in the middle ages appear to have had a basic
understanding of the prevailing medical theory of the day, that of
humors; and women and men would have been familiar with a variety of
treatments for illnesses and injuries. (What we would now call a
combination of first aid and folk medicine.) For bleeding,
cauterization and cupping, a specialist might be called in, as well
as for surgeon's work (such as cutting for the stone or removing
cataracts). Physicians might be consulted on a trip to the city. In
larger households, a household physician might be on salary and thus
take the place of the lady in prescribing physic (though actual care
was probably delegated to family members and/or female servants).
Margaret Paston's husband's comments on her medical knowledge
survive in the Paston letters. Queen Isolt, from the Tristam saga,
is both a sorceress and skilled physician, and ladies of the castle
who turn out to be 'skilled physicians' show up with great
regularity in the romances.
However, Monica Green has pointed out that we cannot prove that
women had access to medical, much less gynecological texts, on a
regular basis, any more than men did. They seem to have instead used
their increasing literacy toward the end of period to assemble
collections of 'receipts' in their own handwriting for various
medicaments (and cookery!)
Outside the home
The myths that all women's medical care was provided by midwives, or
that all female medical practitioners were midwives, has been widely
challenged. Green, and others, have made a strong case that small
numbers of women are documented to have occupied almost all the
ranks of medical personnel of the middle ages. Furthermore, women
were not universally restricted to treating 'women's diseases' or
Siriasi has this to say:
"Women as well as men practiced medicine and surgery; as
with their predecessors in the Roman empire, women's practice was
limited neither to obstetrical cases nor to female patients. For
example, the names of 24 women described as surgeons in Naples
between 1273 and 1410 are known, and references have been found to
15 women practitioners, most of them Jewish and none described as
midwives, in Frankfurt between 1387 and 1497...
Even in the twelfth century, however, the accomplishments of Trota
and Abbess Hildegard were highly unusual. Once university
faculties of medicine were established in the course of the
thirteenth century, women were excluded from advanced medical
education and, as a consequence, from the most prestigious and
potentially lucrative variety of practice. Furthermore, it
deserves to be emphasized that although women practitioners
existed in many different regions of Europe between the thirteenth
and the fifteenth centuries, they represent only a very small
proportion of the total number of practitioners whose names are
recorded-- according to one estimate, about 1.5 percent in France
and 1.2 percent in England. It is probably that many more women
may have engaged in midwifery and healing arts without leaving any
trace of their activities in written records; but this in turn may
imply that such women are likely to have clustered in the least
prosperous sector of medical activity, or to have been part-time
or intermittent practitioners." -- Siriasi, p. 27
Only a small number of women were treated as 'physicians' in period.
Partly this was because, after the founding of medical schools in
universities, physicians were expected to attend university schools
of medicine-- and women were generally not welcome in universities.
Dame Trota, a possibly apocryphal figure, is the most famous of the
women university physicians. It is said that she practiced at the
University of Salerno, along with a number of other female medical
scholars referred to as 'the Salernitarian Women'. A number of
writings have been attributed to Trota, specifically those gathered
together in the collections referred to as the _Trotula_.
Some historians claimed that all the texts in question were written
by men and merely attributed to Trota; however, another extant
general medical work by Trota was identified by John Benson. Monica
Green advances a compelling argument that at least one of the
Trotula texts was in fact written by a woman physician, though
perhaps not Trota herself.
Some women were licensed as doctors or medical professionals in
various states, and various writers have claimed that a few women
attended medical school in period. In cases where women healers were
licensed, the historians perceive a blurring between the status of
physicians and licensed healers. For instance, in Naples, and in
Florence, and even in Valencia (before 1329) women could be licensed
as 'medica' during certain historical periods.
The term 'empiric' was widely used by university trained physicians
to refer to non-university trained medical practitioners, especially
those who were illiterate and learned their skills by practical
Empirics could be general healers/doctors or specialists, and their
level of knowledge and ability to cure varied widely. Some of the
lower-status healers also resorted to prayers, charms and even
attempts at magic to supplement their cures.
Both men and women practiced as empirics, and as the power of the
university physicians grew, both men and women empirics were forced
out of the trade. However, because of their inability to attend
universities, as well as the prejudices of male physicians and
lawmakers, women were especially targeted by this sort of campaign.
Because surgeons and barber-surgeons were often organized into
guilds, they could hold out longer against the pressures of
licensure. Like other guilds, a number of the barber-surgeon guilds
are recorded as allowing the daughters and wives of their members to
take up membership in the guild. An example is "Katherine la
surgiene of London, daughter of Thomas the surgeon and sister of
William the Surgeon" in 1286 (Rawcliffe) Widows of members were
generally allowed to retain their husbands' status in the guild if
they so chose, at least until they remarried. The guilds of Lincoln,
Norwich, Dublin and York appear to have accepted female members
until quite late in period. Even in London, "The London Surgeon
Nicholas Bradmore held his apprentice Agnes Woodcock, in such high
regard that he left her a red belt with a silver buckle and 6s. 8d.
in his will of 1417, although she may, ironically have been one of
the last of her sex to receive formal training in the City."
The records, according to Rawcliffe, indicate that women were often
eye surgeons, because of the delicacy required for the work. Some of
the 'Women of Salerno" are considered to have been surgeons.
Diligent searches of the historical records have turned up a small
number of female apothecaries recorded in Western Europe.
Midwives, those who helped the parturient mother to give birth and
provided a limited amount of before and after care, were exclusively
women. Women in labor may not always have been attended by midwives;
sometimes accounts give no information about midwives being present
at a birth or paid for a confinement. Women might be attended by
their female relatives, friends, or servants during birth; and since
having experience given birth oneself was a major qualification for
midwives, that might make recourse to a midwife considered
The medical expertise of the midwife could vary widely. Midwives
were generally taught via practical training and/or their own
childbirths-- by 1600, in London, an apprenticeship system was in
place where younger midwives served 7 years under an older midwife.
In the upper classes, a midwife might be supervised during the
delivery by the patients' female relatives, or even, in rare cases,
by the father or a male physician-- but records and depictions
suggest that men generally did not enter the confinement room,
except in severe cases.
It was expected that in really severe cases--- such as when the
mother was dying and a cesarean operation needed to be performed to
retrieve and baptize the infant-- the midwife would refer the case
to a physician.
Midwives were not infrequently prosecuted in church courts for
providing charms either to assist the mother in childbirth or
pregnancy, or to encourage conception. Such practices made them more
vulnerable to persecution during the witch craze. However, before
1400, such practices, if overtly Christian, superstitious or
'magical' behavior were dealt with less harshly. Robin Briggs, in Witches
and Neighbors, asserts that midwives were generally not
persecuted as witches.
There were a number of hospitals set up as charitable foundations in
the Middle Ages, and they generally employed women nurses, sometimes
with the status of servants, other times as 'lay sisters'. The
immense amount of work expected of these nurses has been detailed by
several authorities, as they fed, washed, dressed, cared for the
sick, did the laundry, cooked the food, and washed, laid out, and
shrouded the dead.
Minkowski, on the nurses at the Hotel-Dieu in Paris: "Nurses arose
at 5:00 am, attended chapel prayers after ablutions, , and then
began work on the wards. Their duties included using a single
portable basin to wash the hands and faces of all patients,
dispensing liquids, comforting the sick, making beds, and serving
meals twice daily. Sisters on night duty reported at 7:00 pm. It was
their task, in an era before the bedpan, to conduct the ill to a
communal privy, for which purpose the hospital provided a cloak and
slippers for every two patients."
If the hospital had a ward for pregnant women or took in orphans,
they cared for children as well. (Though hospitals tried to send
foundlings out to wet-nurses, if such could not be found, the staff
had to feed the infants with cloths dipped in milk.) These
hospitals generally turned away those with infectious diseases and
had little in the way of strenuous treatment regimes: usually they
performed the functions of nursing home and hospice for the poor who
sought refuge there. Relatively clean surroundings and nourishing
food, as well as the occasional apothecary dose, was the standard of
Women sometimes held responsible positions in these hospitals, but
not all the time. Minkowski reports that in German hospitals, women
often held the posts of Custorin (similar to a steward), Meisterin
(head of the kitchens), and Schauerin (implementing hospital
admission policies). In orphanages, Minkowski reports, "the
Findelmutter was the healer for these children."
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- Van De Walle, Etienne, and Elisha Renne, editors. Regulating
Menstruation: Beliefs, Practices, Interpretations.
(Chicago: University of Chicago Press, 2001)
- Whaley, Leigh Ann. Women and the Practice of Medical Care
in Early Modern Europe, 1400-1800. Houndmills,
Basingstoke, Hampshire ; New York: Palgrave Macmillan, 2011.
Medieval Women.” Women in the Middle Ages: An
Encyclopedia. Santa Barbara: ABC-CLIO, 2004.
Copyright Jennifer A. Heise.
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