March 31, 1996

Beyond the Birthing Room

Monica Green

by Bridget Booher
A historian uncovers the role of women in medieval science and medicine, challenging the long-held assumptions about how knowledge was obtained and distributed in the Middle Ages.
Words tell us what the writer wants us to know. For historians, who routinely question an author's motivation with a skeptical eye, this poses an in- triguing challenge. What happens when one considers history's silences? How does one go about including t he lives and contributions of the non-literate members of a society? Or examine the ways knowledge is transmitted verbally or casually, apart from the formal documentation of scribes or civic records? What forgotten facts of life are buried in what's alre ady been studied? Might there be different versions of history waiting to be uncovered?

Associate professor of history Monica Green is intrigued by the possibilities. A medieval scholar who specializes in the history of women in science and medicine, Green has a research agenda that explores changing theories about women and sex differences, and the roles women have played as actual participants in science and medicine. As she challenges some long-held assumptions about the way medical knowledge was obtained and distributed in the Middle Ages (and what this says about medieval society), she has cast a much wider net than her colleagues before her. But the lack of supplemental material makes answering such questions a provocative, prickly business.

"Dealing with a paucity of sources is common for medievalists," says Green, "but it's raised to a much higher level when you're doing women's history. There are times when I just have to say, 'I don't know [what it was like], and I may never know.' It's l ike walking up to a black hole in the dark. You get to the edge and your foot slips a little bit, so you put a marker there, and you map an outline of the hole and make a guess about what was in there. It's a very inexact science. In fact, it's no science at all. It's building inference upon inference."

Green first discovered the thrill of the historical unknown while an undergraduate at Barnard College in the mid-Seventies. Women's studies programs were being established across the country, and Green was one of the early beneficiaries. For class, she re ad French writer Christine de Pisan's City of Ladies, an early fifteenth-century allegory about women carving a place for themselves apart from the misogynistic culture in which they found themselves. "I read this when I was an undergraduate and my jaw ju st dropped," she recalls. "This was written 500 years ago! It was eye-opening to realize there was all this stuff out there that I had never thought about, had never even thought to think about."

After earning both her master's and doctorate from Princeton University, Green did postdoctoral work at the University of North Carolina at Chapel Hill, and was a visiting member at the Institute for Advanced Studies in Princeton, New Jersey, after coming to Duke in 1987. From a cluttered office on the second floor of East Campus' Carr Building, Green works non-stop on various projects. There's more research to be done, several books to be completed for publication, students to advise. Although she was aw arded tenure last spring, she has not slowed down to catch her breath. There are too many questions still left to ask.

"A lot of what I've written so far has been speculative, or framed as a problem with previous scholarship," she says of her work on the medieval medical community. "Now I am getting to the point of having a body of empirical evidence, and the theoretical constructs to go with it. So, rather than argue negatively about what someone else has presumed, I can make strong assertions saying, this is the way it happened, this is the way it was."

What Green and her colleagues do know is that medieval men and women were fascinated with physical well-being. If suffering from a painful ailment, they sought treatment from any number of healers, amateur or expert. They practiced preventive regimens, su ch as not eating large meals before bed and being moderate when imbibing spirits. Diet, lifestyle, environment, and disposition were all believed to affect one's vitality. Bloodletting was routinely recommended, and herbal therapies were valued by peasant s and aristocracy alike. Patients and surgeons both looked to the stars before undertaking an operation to insure that the astronomical alignment promised an optimal outcome.

Less clear, though, is who was treating whom. Until the twelfth century, when the licensing of physicians first began, there is no reliable documentation of who was providing health care. Women in the home treated the routine ailments of daily life, banda ging a child's scrape, for example, or blending an aromatic tonic for indigestion. In the fifteenth century, records of midwives who assisted women in childbirth and treated related obstetric and gynecological conditions became abundant. But aside from a few other scattered instances, these are the only places previous scholars have acknowledged women in the history of medieval medicine.

Green contends that the lack of documentation before licensing does not prove that women weren't engaged members of the medical community. Furthermore, the long-held scholarly idea that women only treated women (and then, only for female conditions) and m en treated men is simply untrue. Central to her argument is the celebrated case of Trota, an Italian woman who lived in the late eleventh or twelfth century. At the time, Trota earned a widespread reputation as a healer and medical authority. (Chaucer mak es reference to her in his "Wife of Bath's Prologue" in The Canterbury Tales.) From the late twelfth century until the end of the Middle Ages, a collection of medical remedies titled Trotula circulated widely through Europe. Both the woman and the text ha ve been at the center of a centuries-long debate about women as medical practitioners and medical writers. Some argue that the writings in Trotula were written by Trota; others dismiss the possibility that she could have written the popular text.

"What was frustrating about the Trotula debate," says Green, "was that all scholars wanted to talk about was attribution: Did she or didn't she? No one was paying attention to the content of the text. And virtually none of the people debating this had loo ked at the Trotula manuscripts."

In the Middle Ages, written material circulated in manuscript. To make reproductions of a written document, scribes would carefully copy the material letter by letter, word by word. The person overseeing the process, an editor of sorts, might alter the au thor's words to conform to changes in language over time, or to reflect a shift in church or political ideology since the book was first penned.

"It's like that classic game, Rumor," Green says. "One person starts it but by the time it comes back around to you it's a different story. In a manuscript culture, every manuscript matters because the text is always changing. What had happened with Trotu la is that every modern scholar had gone to the Renaissance edition printed in 1544 because that was the most convenient and accessible one to look at."

The Renaissance version, however, turned out to be a combination of three different medical texts that had circulated at roughly the same time. The editor had dismantled and then reassembled the three documents and packaged the whole thing under the name Trotula. Green has spent the last six years untangling the texts to determine their origins and how they came together. While it is extremely rare in medieval studies to have an original author's document, Green has gone back to the Trotula manuscripts da ting from the late twelfth century, approximately fifty years after the texts are thought to have been composed.

The results of her investigation will be published in the forthcoming Women and Literate Medicine in Medieval Europe: Trota and the "Trotula." In the first chapter, she explores the modern debates over authorship, which she says come down to "women and th eir intellectual capacity, both posi-tive and negative." The remainder of the book is devoted to translations of the texts, and the implications of what they say.

"The first one, called 'Women's Cosmetics,' is clearly written by a man," says Green. "He starts off with this wonderful, very elegant preface saying how physicians--by which he means male physicians--must be as learned as possible in order to be acclaime d. What's at stake is reputation, not wealth. He has gone to women who were learned about cosmetics so that whenever a woman patient came to him wanting to dye the hair or take off face spots or remove hair from the skin, he would have something to offer them. So, even though it's knowledge about women, and has come from women, he is taking over it and intending circulation of this information only among other men.

"The second, called 'Conditions of Women,' is a general coverage of basic gynecological and obstetrical disorders. I think it is unquestionably written by a man, from a male perspective, for other men. He begins with a medical interpretation of Genesis, and the differences between women and men, and how women are too ashamed to talk about diseases of the private parts. And that's why, out of pity for them, he has gathered together this information. But throughout the text, there's this distancing in his language; it's al-ways a passive voice: 'Let this be applied. Let the woman be anointed. Let this be inserted.' In other words, let somebody else do it.

"The third one is called 'Treatments for Women,' and I think it absolutely, no question, comes directly out of women's medical practice. There is no textual precedent for the treatments and the vocabulary--it's not coming out of a literate, learned tradit ion. I've read all that exists of early medieval gynecological texts, and this covers a broader range of disease categories than anything I've seen. And when it talks about treating women patients, it's direct: 'We apply this. We mix this. We push the ute rus back inside when it's prolapsed.' It is constantly hands-on where all of this other stuff is hands-off. I mean, the difference between this one and the other two is radical."

These discoveries, says Green, indicate a much more integrated medical field than previously believed. Not only were women practitioners needed to treat female conditions that were too private to discuss with a man, but women like Trota were routinely han dling the needs of male and female patients alike. There is historical evidence of women working as physicians, surgeons, barber-surgeons, apothecaries, and in the broad category of lay healers.

As she reconstructs pictures of everyday medieval life using scarce material and modern research methodology, Green must avoid the seductive tendency to view her findings through a contemporary lens. Such skepticism, a required component of any scholarshi p, is particularly essential to her work. Although she brings a feminist perspective to her research, she has no patience for readers who force modern feminist interpretations on medieval women's lives. Romanticizing the way women lived, or proposing they had more authority than they did, is not only dangerous, says Green, but it also misses the point.

"Some feminists look back at the medieval period with this notion that women's health was women's business, and women had absolute control of their bodies. I say nonsense. It was a patriarchal culture where the male head of the household had tremendous co ntrol, sometimes appalling control over the women in the household. When women cared for women exclusively, it was because men didn't want other men touching the women in the family. I think there may have been, and probably was, a sense of female communi ty when the door to the child birthing room was closed and men could not enter. But once women stepped back out the door, that evaporated."

Green says that what's infinitely more interesting is the transference of knowledge across gender boundaries--how women's knowledge comes to be men's knowledge. "This is what's fascinating about the large cultural history, both the genesis of texts, like the Trotula, and then how those texts are circulated and used for hundreds of years afterward."

With the licensing of physicians in the twelfth century, women practitioners gradually found their medical activities curtailed. Midwives were licensed by church and municipal establishments concerned about moral and spiritual matters rather than medical ones. (Because midwives continued to provide obstetrical care, church officials wanted to make sure that these attendants would baptize babies destined to die, so that their souls would be saved. Similarly, midwives were called on to testify in court on a woman's virtue, whether she was a virgin or had been raped, and so on.) As Green writes in the forthcoming Women in the Middle Ages: An Encyclopedia, midwives, who were often highly respected members of their communities, came to be "regulated and circum scribed into a narrow range of practice. Empiric practitioners, on the other hand, caricatured as simple and ignorant 'old women' by physicians and clerics alike since the thirteenth century, will be pushed closer and closer toward what will ultimately se rve as the stereotype for the heretic and the witch."

Medieval history and ancient texts may seem inconsequential to contemporary audiences, but Green urges students in her classes to consider the parallels to what's happening in today's arena. "I ask them to consider how questions of medicine and science ar e dictated by who's doing the asking. Look at the revelations about NIH [National Institutes of Health] studies that completely excluded female models. These were clinical trials that only used men because the researchers said women are too complicated. T hey might be menstruating or in menopause. If more women were doing science, maybe these questions would be asked routinely, and they wouldn't seem so peculiar and so late in coming."

Copyright 1996 Duke University. All rights reserved.
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