Medieval Medicine Sample: Trotula Edition

Z came into the studio today to talk with me about medieval medicine.

And this time, primarily obstetrics and gynecology.

We're talking about labor, we're talking about when things go wrong, and we're talking about the absolutely wild theories that the medieval doctors had about why things happen the way they do.

And I thought you'd enjoy it, so here's a small sample.

But what happens there is just this ends up being sort of the text that kind of rides this line between being a text and therefore something historians can actually look at.

There's some vague references, but not a lot to

sort of the humoral approach.

It's mostly just practical applications.

So it gives us this insight to this kind of like

hidden folk craft that's happening among women.

And that gives us kind of the best we got into what's going on with women and women's health.

But it's also strange, and you have to understand that it's strange because this woman's writing it in Salerno, which is a very strange medical place because it's the height of this turn.

She's treating a kind of a strange population that wouldn't have looked a whole lot like the population that's happening in northern France or England, which is our concern.

However, that text ends up up there really fast.

So they are using it.

They are referencing it.

So

yeah, just know that this is how this is going down.

Another thing

to understand with this is the place of women as physicians.

It's not just women as patients in childbirth, but women as physicians and as

people who treat other people.

We kind of have to understand that obliquely through various weird records and references in other texts.

But it seems clear in the 11th century, in the 12th century, that women were acting as physicians.

Like full-on studying your humors, looking at at your pee, that kind of physician?

Yes.

And in some cases they were going to Salerno and studying.

It's unclear what kind of restrictions they may have faced, if any.

I assume there were some because these were religious houses that were fairly misogynistic in some cases.

However, we do have women referenced as Salernitan women.

So with the understanding of that as someone who, a woman who went down to Salerno, study and comes back up as a practitioner in that rationalized medicine.

Wow.

We also know that nuns, just like the monks, were running medical sensors.

So in England, it looks like this.

There was an abbey in Werral or Werwoll.

Okay.

Apologize for everyone who lives there.

Not exactly sure how you're pronouncing it.

But there, there were a bunch of nuns who were running a

basically hospital out of their abbey.

And the abbess there, Euphemia, was known as a medical woman.

And she actually

had a new wing built in that abbey according to the cutting-edge standards of hygiene at the time, where things, certain things were kept separate.

So, the surgery was kept separate from other treatment areas.

Hospitals is going to be its own topic not soon, but as we move forward,

and we'll get there.

But just know that

they were also running kind of forwards time, a state-of-the-art medical area, and it was run by a woman.

What was the rationalization for, I mean, I'm all for separating, but what was the rationalization for being like, we shouldn't be doing the surgery in the waiting room?

I've not really had that conversation because I've not dug into it.

It gets complicated.

And this part was built in 1257, so we're already jumping ahead.

Okay.

Hospitals will be its own topic

for that reason.

We also have a record in York around this time

at St.

Leonard's.

One sister named Anne is listed in the records as medica, Latin.

medical physician.

And that seems to be her official title and her official job on top of being a nun.

We also know that the famous Hildegard of Bingen was known for her medical knowledge and was respected for her ability to heal, and not just in the like extreme mystical sense, because she's famous for that too.

We'll get into that as we move on to some of the more medieval magic that I'm going to do next.

But she was a respected medical mind in the rational sense as well.

And so there was this place of women practitioners, and not just in the folk craft, there were women practitioners all along this sort of spectrum of from folk to this new rationalization thing happening.

We also have some lists of women who are listed as surgeons, like licensed surgeons when licensing comes around in another 80 years from now.

Wow.

Also practicing.

And that was like we had like a couple dozen in one city at one point.

So it wasn't necessarily a rare thing either.

Would that be easier to get into because surgery was typically seen as like lesser?

Maybe, but it, I, I saw no indication in the records that this was how that was going down.

And it may be that that's just because we don't have the fine-grained detail of how or why.

There is a change, and I think a lot of people are kind of anticipate women have a lesser role in medicine because of the change that happens a couple of hundred years from where we are.

And in the 1300s and 1400s, there's another like level of professionalization that happens in medicine.

And physicians in particular start learning at certain schools that then turn into a guild.

And that's when they really start officially shoving out women from medical practice and in many cases, legally banning women from practicing medicine,

often with the only exception being some level of midwife position.

But even then later, those are kicked out as well.

Is this because largely, like, if you're doing midwifery, you're not having to go to these guilds and become a registered member of the guild.

So like that's a direct threat to their business plan?

It seemed like, yeah, it's a, they, the arguments they make, we'll get there, we'll go through this when we get there.

But what happens to women physicians is there's this clear move against non-guild practitioners, and that includes men physicians who aren't doing this.

But women are a really easy target because misogyny is on the upswing during that region in a big way.

So it's very easy to clear out women.

And then later it actually becomes part of the witch trials.

And that's like the final nail in the coffin for midwifery.

But we'll get there when we get there.

Just know that kind of our often we think of that era when we think of medieval women practitioners, but we're too early for that.

And there seems to be quite a few women practitioners.

And they were practicing on men.

And that's in addition to what we also see in lay writing, which is women who are not considered physicians, but are just considered holders of medical knowledge, because it was very normal for that to pass down through households from woman to woman.

And they knew pharmacology quite well.

They knew basic treatments quite well.

They just weren't going down to Slurno necessarily to get the anatomy classes.

But some people thought

things were pretty up in the air whether or not they'd get treatments better from which or the other.

So that's the state of women's physicians.

Cool.

It's a thing here.

And a lot of women gained respect and professions in medicine at this point.

And Trota looks like she was part of the tradition, and she manages to get down in a way that survives her treatments.

And then it's picked up kind of everywhere.

What is interesting is that the text obviously has pieces added to it later,

but the treatments don't seem to change a whole lot.

The treatments in other texts on non-childbearing and non-women's issues, they evolve, they change, they seem to be actively worked on, whereas women's treatments don't.

There's a stagnation there.

There's a lack of

innovation improvement.

And that's probably about where women were sitting in society.

That was less important.

It's also probably because the folk tradition was so robust that there was still this, that's probably a sign of there's a genuine break between the rationalized medicine and what was happening in a normal bedroom where babies were actually being born.

Yeah, were the treatments in Section 2 actually effective?

They were clearly effective enough to be written down.

I think there's no effect.

If no one was surviving some of these treatments, they wouldn't be written down.

But I think what the historians are trying to point out is that there are treatments that clearly evolve over time in other sections of medicine.

And so they get better.

But these things are not so good in this that there was no room to improve.

So

I guess that was my question because you were like, well, and maybe the folk traditions were just better and they didn't need to be improved.

But my understanding of the Trotula is that it was flawed.

We don't follow it anymore.

Yeah.

So I was like,

the folk traditions couldn't have been that great.

No, I, and here's the big kicker is there is still something, a big thing that is missing even from the Trotula, which is actually a normally progressed pregnancy and childbirth.

No one has written that down.

Not really.

Because it appears to just remain in the folk tradition that you are just attended by, if you're giving birth, you're just attended by your female relatives and a midwife or midwives.

And that's still considered not even what Trota was doing.

She's not writing about attending births, which is fascinating.

So it's what we've got here is a troubleshooting guide, not a treatise on birth.

Yes, yeah.

And there it seems to be.

So it's gone sideways on you.

Here's what we need to do next.

Pretty much, yeah.

So this is like where the best text we've got is these marginal cases where people are coming to someone with a problem that's elevated above normal situations.

Right.

And so, the best we get are what are the treatments for that.

And then, around how they talk about it, what it's telling us is like a little bit about how they viewed women's bodies and women's health.

Do we have any document that describes the horses, or are we just in a pure zebra affair here?

I wouldn't say, and this is the, this is, there's a, what you're talking about is kind of a current medical phrase of when you hear hooves, think of a horse and not a zebra, which is talking about like if you're coughing, you probably have a cold and not like lung cancer type of thing.

Yeah, you're if you're, if you're in house MD, it's lupus.

In this case, they don't have a tradition that could describe either of these things.

It's already a bit weird.

What you have is

they seem to approach pregnancy and childbirth as something that the body is going to do regardless.

And these, the things that are written down here are for when you've got a problem before or after.

That's the body not quite doing what it's meant to do.

Okay.

There is one quick reference to the humoral condition of women by Troda, and that's just the recognition of them being like cold and moist.

But she mentions that you can also, women can also suffer from the condition of being hot and dry and says there can be different treatments for both.

That's as far as she gets into the humoral thing.

So it's not as applied.

Yeah, no, I wasn't thinking necessarily the humoral thing.

I was thinking more along the lines of like,

we've had a kid.

I was present for the labor.

That's like, that's not a minor thing that's going on there.

That is a serious medical event.

And even if it's going well, it's still a very serious medical event that needs to be dealt with properly.

But there's absolutely, if I'm understanding you right, there's no like, okay, so at a baseline here you're gonna want to do the following uh there's not even like the uh the old 50s movie trope the we need some hot towels in here nothing like that not written down I think part of what that is is is they're they are dealing with a different culture here whereas right now we consider anything dealing with the body as a the realm of the medical and you we're we're always encouraged to go to a doctor and hand our bodies over to the doctor and our health over to the doctor whenever possible if it's body related is doing something weird is it doing something at all Go see your doctor.

That's our current culture.

And there was a time when childbirth got scooped into that.

We are pre- that time in the 11th century.

They don't see it as a medical event.

It's a life event.

It's a body process.

So it's not ending up in medical texts because they're dealing with diseases.

Right.

And discomfort.

It looked very uncomfortable.

I would say there would definitely be some discomfort there.

It's extremely intense, but you think of it like this way.

If you're a medieval woman, you would be attending births as a regular part of your life.

You're learning how to attend to your family members

when they're giving birth all the time.

So whatever practices that you have during that, whatever knowledge, and I'm sure there was a lot.

I don't think, I can't imagine these people were ignorant about various ways to like, say, turn the baby if the baby's not in the right position or help someone whose labor's like starting to get long, that kind of thing.

There probably was a lot of knowledge, but it's just not in these places where it's getting written down in Latin.

It's passively passed down, and that kind of thing.

Yeah,

that makes sense.

They had a different culture around children, it would have been much more present and in the home and constant, right?

And we do this with death as well, where death happens now outside the home.

Sometimes people often leave for the hospital weeks and months before they actually pass.

And

so we're also uncomfortable and

unaware of that process as well.

Whereas there was a lot of human history where death happened in the home and you would like understand and recognize that process as it moves along as well.

So I would think about it this way is that this is an in-home daily occurrence, much more normal part of the process.

It's not being hidden away in hospitals.

What's interesting about Trotula is that we capture, and honestly, we capture a fairly little bit of one woman who just happened to be in the place where everyone was writing everything down, and she managed to find a scribe to write her stuff down.

And even as it appears to be an English scribe, which might have been a sign that it was kind of a side gig, like as like a weird project.

Like it wasn't the top physician Salerno who was telling Troda to come in and give everyone a seminar.

So the vernacular that he's using, is he like...

Latin and then vernacular on top of it, like use Latin herb and then describe the English herb?

I think it was kind of something like that.

Okay, so it wasn't like he was just jumping in and out, and she was busy speaking in Latin, and he's like, I'm not writing that down.

That's got 12 syllables.

I didn't go that deep into it myself, but it was, it's been written about by most historians who've touched this document that the original seems to have these otherwise inexplicable bits of English in it, unless you would have a native English speaker, because there was no reason for someone writing a text in Latin to be doing that.

Cool.

So before we get into more specific treatments, I just want to take a minute to say, because we already talked about they see women in this, the humoral condition is like colder, moister.

They also,

in this time, this comes from other writings as well, not just the Tortulla, is that they see the woman's body as weaker and less efficient than a man's.

And that explains menstruation.

So they see menstruation, a lot of things that the womb does, as a way for the woman's body to balance her humors because I don't think it's as effective as a man's and in general the medieval mind sees the woman's body as just sort of a defective man's body they don't see it as its own system with its own purposes that works well they always have to explain it in a way that's compared to the man's body in a deficient way But that view of what the purpose of menstruation is has a lot to do with what the treatments around it are.

Okay.

So menstruation they see as

a necessary purgative for to balance humors.

And they also see the womb as this problematic thing that can kind of move

like around the body.

They're sure that the womb moves.

It's unclear that Troda herself believes this, but medieval people were absolutely convinced.

Like how far move.

Like it was an obsession in the medieval mind as far as we can tell.

And this seems to exist in Europe for a long time, going back to the Greeks, in fact, that the womb can crawl up a woman's trunk and get stuck in her throat.

Okay.

Hang on.

So, when I was a kid,

I lived near a river for a while, and occasionally, because I was just a teenager and stupid, we would take polar dips where me and my friends would jump in.

Like, it sucks the air right out of you.

But I swear to God, I could feel pressure at the back of my throat as well.

Like, like it could.

You were saying you were sure you're nuts and jumps into your mouth.

Oh, yeah.

Oh, it's like you're just swallowing them back down.

It's so freaking cold.

I assume part of it, they call this womb suffocation.

And there are so much of the medieval mind that is sure this is a thing.

It's definitely a thing, and it's definitely a thing to be worried about.

Womb suffocation.

Womb suffocation.

People don't talk about this anymore.

They sure don't.

The Greeks also were writing about this.

They were sure it's happening.

And it seems like the medieval mind might have picked it back up from old Greek texts and then convinced themselves it was a thing again.

It's unclear.

But there's this idea that the womb kind of wanders about and causes problems.

So a lot of the way that they're treating women's bodies and issues and health is about keeping the womb in its place.

And from there, it gets wild.

We've got cures involving stinky stuff.

We've got some cures that I think Gwyneth Paltrow would really enjoy.

It just gets kind of wild from here on out.

And and some of it is just downright magical, like actual spells.

It's a lot of fun, and if this sounds fun to you, you can sign up for membership over at thebritishhistorypodcast.com.

Thanks for listening.