Trotula (c. 1040s–1097)

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Trotula (c. 1040s–1097)

Professor of medicine at the University of Salerno, Italy, who wrote several works on medicine, including a text on obstetrics and gynecology that was used in Europe for at least six centuries. Name variations: Troctula; Trotta; Dame Trot; Trotula Platearius. Pronunciation: TROH-too-lah. Born probably shortly before 1050, in Salerno; died in 1097; said to have been married to Giovanni Plateario (a fellow physician);

children: said to have had two sons who became noted doctors.

Selected works:

De mulierum passionibus or De passionibus mulierum (On the diseases of women); De ornatu mulierum (On beautifying women); De passionibus mulierum ante, in et post partum (On the diseases of women before, during, and after birth).

The idea that the education of women in the Middle Ages was abysmal is so universally accepted that the realization that some women not only received university instruction, but also acted as university professors, comes as a surprise. Yet the University of Salerno (on the west coast of the Italian peninsula, south of Naples), one of the oldest universities in Europe, had several women on its medical faculty in the Middle Ages. One such was Trotula, who specialized in obstetrics and gynecology. Said Trotula:

Since … women are by nature weaker than men it is reasonable that sicknesses more often abound in them especially around the organs involved in the work of nature. Since these organs happen to be in a retired location, women on account of modesty and the fragility and delicacy of the state of these parts dare not reveal the difficulties of their sicknesses to a male doctor. Wherefore I, pitying their misfortunes and at the instigation of a certain matron, began to study carefully the sicknesses which most frequently trouble the female sex.

The University of Salerno, recognized as the leading institution of its kind in 12th-century Europe, was opened in the 9th century near the famous Benedictine abbey of Monte Cassino, founded by St. Benedict three centuries earlier. This order was interested in the medical arts, and it is possible that the university's medical school owed its creation, at least in part, to the need for the monastery to have trained physicians nearby. The entire area, in fact, was steeped in learning. The region had been conquered at various times by the Greeks and the Arabs, two cultures noted for their expertise in the sciences (including medicine), and, at the beginning of the 11th century, the Normans had conquered Sicily and much of the nearby peninsula, including Salerno, bringing yet another perspective and body of knowledge to the area.

Italy was a seat of learning for Europe, and, contrary to modern assumptions, women were accepted at nearly all southern European universities in this era. Though some areas of study were closed to them (they could not, for example, prepare for the priesthood), female students were given training in medicine alongside male students. Salerno, aside from having women in the same classes with men, developed the Salernitan School for Women Physicians specifically for women to pursue medical studies. Many of the instructors were also female.

Indeed, women were needed as healers for several reasons. Of course, most midwives were female, and their expertise was useful to physicians attempting to treat women during pregnancy and in childbirth, but women also tended to have more experience in tending the sick, recognizing symptoms, and using herbal remedies for ailments. These abilities comprised what might be called the "folk" aspect of medicine. Surgical techniques were, in large part, learned from the Arabs. The scientific area of medieval medicine was derived mainly from Greek medical practice and required its students to know Latin and to have a grounding in alchemy and philosophy as well. One of the major tenets of this philosophy held that the human body was ruled by the balance or imbalance of the four humors: bile, black bile (or choler), spleen, and blood. These humors had qualities of heat and cold, dryness and moisture, associated with them. Health was achieved when the balance proper for each person was stuck through diet, herbal treatment, and other remedies.

The study of these humors and other "scientific" aspects of medicine was not for the uneducated. Attendance at a university was mandatory for those wishing to prescribe treatment for the ill; the punishment for the medieval equivalent of "practicing medicine without a license" was to be burned at the stake. That women were admitted to schools of medicine is evidenced not only by the names of women as faculty (the University of Bologna, for example, shows one Allessandra Giliani , the teacher of a physician known as Mondino, who was the first to teach anatomy through dissection), but also by laws defining what was and was not proper training for a physician. A French edict of 1311 forbade "unauthorized women" to practice surgery, recognizing their equal right to practice if they had been examined by a board of surgeons appointed by the city of Paris.

Some modern critics have assumed that women physicians specialized only in midwifery, but in fact women could specialize in any of a number of fields. One of Trotula's female colleagues, known as Abella , specialized in bodily fluids. Her two books, On Black Bile and The Nature of Seminal Fluid, show that women at Salerno were not trained exclusively in female health. Mercuriade of Salerno , another of the Salernitan School, wrote treatises entitled On Crises in Pestilent Fever and The Cure of Wounds, and Rebecca Guarna was the author of On Fevers, On the Urine, and On the Embryo. (The works of all these authors except Trotula's have been lost.)

Trotula's treatments reflect the best knowledge of her time period, and much of it appears strange to modern readers. Women were supposed to be composed mainly of cold and moist humors, and men of hot and dry humors (the opposition of these characteristics was assumed to draw them together, in an attempt to achieve a kind of equilibrium). A lack of balance in these humors could cause any number of ailments whose cure was to be effected by redressing the balance. Different herbs, minerals, and parts of animals (e.g., hooves or bones) also had different characteristics of moist and dry, hot and cold, and they could be used to offset an excess or lack of one of the humors. These ingredients were ingested in any number of ways: drunk in a tea, rubbed into the skin in an ointment, eaten, worn on the skin in a bag, inserted as a pessary or a suppository, or inhaled in smoke. In fact, some ailments of the uterus were to be treated by having the patient squat over a smoke made of certain herbs, having first taken the precaution to "anoint her vulva inside with cold ointments lest she be irritated."

Ingredients of some of the medications Trotula prescribed are familiar: carrots, eggs, clover, laurel, ginger, pennyroyal; some have qualities that are recognized as medications today: willow (related to the ingredient in aspirin), mint, sal ammoniac. Others have fallen into disfavor in the intervening centuries: weasel's testicles worn next to the skin (making sure that the weasel stayed alive through its surgery), eagle dung drunk in water, stag's horn mixed with ashes of a nettle, the womb of a virgin goat carried on the skin (to prevent conception).

Giliani, Allessandra (1307–1326)

Italian who pioneered anatomical dissection. Name variations: Alessandra. Born in 1307; died in 1326.

It is likely that most of these "cures" derived from folk medicine, with infusions from the learning of the other cultures that held sway in Southern Europe. But where Trotula really left her mark was in her discussion of surgery. In speaking of childbirth, she emphasizes the importance of preventing tears to the perineum, instructing the attendant to press on the area with a folded-up linen cloth during delivery. If the perineum should tear nonetheless, Trotula provides detailed and precise instructions as to how to stitch up the area. This is the first written example of a perineorrhaphy in medical literature, and the technique described is not much different from modern practice.

I could find no one [in Salerno] practiced in medical arts but a certain very learned noblewoman.
—Rudolfus Malacorona

Given her specialty in obstetrics and gynecology, many of Trotula's treatments have to do with childbirth. Knowing that this was an extremely risky time for a woman, she writes, "In the first place and above all things when there is difficulty in childbirth one must have recourse to God. Descending then to lower means," and she briskly proceeds with more practical advice. She describes complications of labor and delivery, with instructions as to what intervention should be preformed, while admitting that in some cases, there is no treatment. A breech delivery is handled in much the same way as today; the midwife is to lubricate her "small and gentle hand" and attempt to turn the fetus. She also supplies several means of preventing conception, being careful to emphasize that they are to be used only by women who have fear of death in case of childbirth. There are no prescriptions for abortion in the text. Cures of light and heavy menstrual flow, choice of a wet-nurse, and ulcers of the womb are topics specific to women that she covered. She dealt as well with problems of conception, recognizing that it is often a problem with the man's reproductive system that causes difficulties.

Other of her writings concern more general health care (prevention of lice, sweetening of the breath, curing toothache), and recipes for cosmetics are included. Face powder, for example, is based upon a lead compound and is intended to be left on the skin for eight days. There are treatments for wrinkles, excessive paleness, and freckles.

Trotula's fame was such that when she died in 1097, her funeral train was said to have extended more than three kilometers. Her most important text, On the diseases of women, enjoyed great success in Europe and was translated into Irish, French, German, Old and Middle English, Flemish, and Catalan. An English version of 1545 enjoyed great popularity. Her name became a byword for a wise woman, especially a healer, and the "Dame Trot" encountered in several English nursery rhymes probably derives from Trotula.

It is perhaps due to the great success of the text and the obvious amount of learning evidenced in it that some scholars have refused to believe that it was written by a woman. Despite her declaration that she took up the practice of gynecology and obstetrics because women "dare not reveal the difficulties of their sicknesses to a male doctor," despite her feminine name, and despite the clear evidence of women doctors in southern Europe in her day, some scholars doubt the existence of a female physician and medical professor named Trotula, declaring that her books were written by a man (postulated to be named Trottus or Troctus). Ignoring the fact that the medical advice presented in the books was state of the art for the 11th century, and contradicting his praise of the surgical techniques described, Isaac Harvey Flack said in his Eternal Eve that the " Trotula were not very good books…. They covered all aspects of woman's life, ranging in rather Peeping Tom fashion from patchouli to parturition, and that they should have been wished on to a non-existent woman professor is not surprising." Other scholars, while not so condescending in tone, have also expressed doubts that a woman could have produced the works. James V. Ricci speculated in his The Genealogy of Gynecology that "Trotula" was probably a freedman of the Empress Julia, yet his text also lists five other Salernitan women physicians without mentioning any doubts as to their existence.

Elizabeth Mason-Hohl, who translated De passionibus mulierum in 1940, always argued for the case of her subject's actual existence. More recently, the debate seems to have cooled, and Trotula can once again take her place as an important figure in the history of Western medicine.