Doctor's Review: Medicine on the Move

August 20, 2017
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Medicine woman

Introducing the very first female physician... at the very first medical school

Nineteenth-century ladies Emily Stowe of Canada, Elizabeth Blackwell of the United States, and Elizabeth Garrett Anderson of Great Britain had more than their pretty petticoats in common: each would become the first female to graduate from medical school and practise medicine in her respective country. Quite a feat, by all accounts.

 Indeed, the Victorian era was not a kind place for women who wanted to be doctors. They were derided, mocked and banned from classrooms. Male physicians well into the 20th century debated the myriad problems associated with lady doctors: was the issue a moral one, hinging on the conundrums posed by patient nudity and the unsuitable subject matter presented in classrooms, or was it more of a mental one, simply stemming from the fairer sex's lack of intelligence? Up against ideas like these, Stowe, Blackwell and Anderson had to fight tooth and well-manicured nail for the simple right to practise alongside their male counterparts.

But nearly a millennia before these fine society ladies were trading med-school war stories over tea and crumpets, one amazing woman was blazing a trail toward equality. A woman who -- if not for the sharp mind and winsome ways which earned her the respect of her patients and male colleagues alike -- would almost certainly have been condemned as a witch. Trotula was her name and illuminating the Dark Ages was her game.

MEDIEVAL MEDICAL MARVEL

Trotula de Ruggiero, also known as Trotula of Salerno, was born sometime around 1090, into a wealthy family. When she was a young woman, the high Middle Ages were in full swing -- urbanization was sweeping across Europe and the Crusades were all the rage, while new trade routes and increasing literacy revived interest in ancient Greek philosophy, art and science. New universities were sprouting up everywhere, replacing those fuddy-duddy monasteries as the main purveyors of education.

In Italy, where much of the intellectual action was going on at the time, Salerno was the place to see and be seen. And thanks to the brand-new medical school there -- which rose up from the ashes of a Benedictine monastic dispensary dating back to the late 700s -- it was also the hub of the 11th-century medical universe, at least as far as Europe was concerned.

The Scuola Medica Salernitana -- which many scholars believe holds the distinction of being the first medical school of the Western world -- was certainly the most prestigious centre of education during the 10th through the early 13th centuries, attracting many great scholars and physicians. It was also the first academic institution to offer degrees and boasted a very inclusive approach to medicine, fusing the three main known scientific traditions -- European (based on the classical Greek and Roman knowledge), Islamic and Jewish.

But perhaps its most progressive feature was that unlike other schools at the time, women were permitted to study there and even teach.

Not many student records exist and the number of women enrolled or who received degrees is not known. But young Trotula certainly stood out from her unknown female contemporaries. Eventually, she became a professor at the school as well, in recognition of her many contributions to medicine.

MEDIC OR MYTH?

It isn't known whether or not she faced discrimination or unpleasantness due to her gender, but one certainly can imagine. Strangely, several modern scholars have imposed a sort of posthumous discrimination upon her; indeed, some doubt that the figure of Trotula was in fact a woman, or whether she even existed at all, relegating her to mythical status, despite much evidence to the contrary. Though Trotula subscribed to the contemporary medical, social and religious ideologies of 12th-century Italy, she was noteworthy as a physician in that she chose obstetrics as her field of study, making a discipline out of women's health where none existed before.

At the time, the mysteries and practices of childbirth were zealously lorded over by midwives and not considered much of a medical specialty at all. Trotula, however, was fascinated by the workings of the female body and birth in particular. In devoting herself to women and their particular medical needs, she was arguably the first gynecologist. She is known for having written two important works, the more famous of which is Passionibus Mulierum Curandorum, ("The Diseases of Women").

The text, also known as the Trotula Major, is a 63-chapter compendium of medical information relevant to the treatment of women, covering everything from anatomy and sex to menstruation and childbirth, and she wrote it in order to educate her male colleagues. The tome was in wide use for centuries and so Trotula was undeniably a powerful influence on European medicine for many years after her death. Her other known work, De Aegritudinum Curatione (The Trotula Minor) covered more general information about the practice of medicine.

THE CURSE OF EVE

When it came to the business of having babies, Trotula was way out there. Not only did she assert that men, as well as women, could be responsible for infertility issues -- a radical notion at the time -- but she also believed that women had the right to pain relief in childbirth. To this end, she experimented with opiates and soporifics and countless herbs. She advocated a long, relaxed recovery from both illness and childbirth, was reported to have performed a successful Caesarian section, offered techniques for breech deliveries and could stitch up a perineum in a jiffy.

In general, she was all about preventative medicine as the key for promoting good health for women. In many ways, she was like the Oprah of her day, famous near and far for advocating low stress, regular physical activity and a sensible eating plan. She was also a fan of massage, scented oils and a good long soak in the tub. In his Canterbury Tales, Chaucer even referenced her with great respect as "Dame Trot."

Though her patients were doubtless quite grateful, and many of her colleagues at least tolerant of her approach to medicine, perhaps recognizing the need to address the particular needs of women within the field of medicine, the Church was not so sure. The problem? Trotula's ways were in direct opposition to one of the most basic religious tenets of the time: the Curse of Eve.

It was taken for granted (and still is by many) that women were supposed to suffer in childbirth and, frankly, life in general for Eve's sin in the Garden of Eden. Still, she managed to walk the line on that one, claiming instead it was because of women's perpetually fallen and disease-prone state that they were actually in need of more medical care than men, not less.

As a professor at the School of Salerno, Trotula taught her students a slow and measured approach to interacting with their patients. She believed in asking many questions about not only what was ailing them, but also about their lifestyle and problems in general. In this way, she asserted, the patient and attentive doctor would gain an improved understanding of the patient's physical state, and could therefore treat the problem more readily. Though Trotula was free to teach at Salerno and practise in Italy during her lifetime, it was not to last. By the mid-16th century, women were once again banned from the building and pretty much all other educational settings until the 19th century.

CONTEXTUALIZED CONTRIBUTION

Though it's easy to look back on Trotula and snicker with 21st-century hindsight, delighting in the irony of a groundbreaking female physician in medieval times using her power to tout a rehashed version of those misogynistic Galenic and Christian notions that had held sway for so long, her contribution -- indeed, her very existence in the canon of medical literature from this period -- is a testament to her charisma, intelligence and prescience.

One wonders if Tortula was simply playing the game, knowing full well that her male contemporaries would have been quick to pull the tapestry out from under her feet if she dared rock the boat. Perhaps she whispered different truths than the Church's in her patients' ears. Or perhaps she simply believed in the weaker state of women. In any case, she was a revolutionary woman in that she held the power of all known medical knowledge in her own hands during an era when women were believed to be responsible for the sins of all mankind.

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