The Romans had developed some helpful concepts regarding child- birth and gynecological care, but these beliefs were not destined to be part of medieval health care. Though Soranus of Ephesus (a Roman from the second century c.e.) wrote knowledgeably about
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The Middle Ages
MedievAl undersTAnding
of WoMen’s heAlTh
The people of the Middle Ages had many misconceptions about women and health that were part of the mythology that surrounded the female of the species. No male physician ever had direct contact with a female patient, so it was easy for the lore to grow. For example, they believed that women were constitutionally weaker and more prone to illnesses than men. As in earlier times, medieval practitioners attributed many female illnesses to a “wandering uterus” and the “cure” was to have a woman inhale noxious fumes in order to get the uterus back into the proper position. They realized that the menstrual blood must in some way provide nourishment for new life, so in that regard it was seen as a vital part of fertility. But men- struation was also viewed as a sign of weakness, and during the menstrual period women were considered unstable.
Medieval understanding of conception, referred to as “generation,” was a composite of teachings from the Bible, Aristotle, the Greek physician Soranus, and Galen. Theo- ries on conception were seriously misguided. A few people believed that only the man’s semen was necessary for con- ception to occur. However, if the couple failed to produce offspring, women were solely to blame. Baby boys were pre- ferred, and medical texts and manuals often offered sugges- tions as to how to increase the likelihood of giving birth to a male. Some of the recommendations on this topic included avoiding distressing sights during pregnancy. The church forbade birth control, but social scientists who have analyzed population figures feel as though many citizens used some method of birth control or the population figures would be higher. This finding is validated by the fact that vari- ous methods of contraception are described in two books, the Trotula and The Secrets of Women, so there was informa- tion available at this time on how to prevent pregnancy.
Women Practitioners and . . . Women’s health 77
turn an infant in the womb in order to facilitate a safer birth, these theories were forgotten during the Middle Ages.
Other than Hildegard’s books (see page 79, “Hildegard of Bingen (1098–1179): Respected Healer”), there were very few books about medical treatment of women. Peter of Spain (who was to become Pope John XXI) wrote The Treasury of the Poor, and it contained more than 100 prescriptions for aphrodisiacs, fertility, and con- traceptives. Otherwise, women generally had to turn to folk rem- edies for cures for anything from yeast or urinary infections to headaches and chest congestion. A few texts noted remedies for discomforts specifically suffered during pregnancy such as swol- len feet or painful breasts.
Whether Trotula was a pen name for a male doctor or actu- ally a university-trained female physician as originally claimed, Trotula wrote a health manual that was not particularly helpful. Though the author correctly indicated that the placenta needs to be expelled after birth, the methods the book recommends to do so are nothing short of bizarre. Among them were these: burning the bones of salted fish, horses’ hooves, or the dung of a cat or lamb so that the smoke “fumigates the woman from below.”
Childbirth was very dangerous; both mother and baby were at risk. Hemorrhaging, a prolapsed uterus, and a retained placenta were all very serious complications of childbirth. There were few effective solutions. If a woman died in childbirth, then a surgeon or male physician was summoned to attempt to save the baby by performing a cesarean section on the deceased mother. They did not yet have the medical knowledge to permit a woman to survive a cesarean, so it was only undertaken when the mother died.
Women generally gave birth in a “confinement room” using a birthing chair, which was designed with a V-opening so that mid- wives could easily check on how the birth was proceeding. The chair would have been a positive invention, since it put women in a more or less upright position, encouraging gravity to help the birth along. If no birthing chair was available then a woman probably crouched or was propped up. Oils were applied to reduce tearing, and stitches were used to repair the area if the vaginal opening ripped. Midwives, neighbors, friends, or maids oversaw
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childbirth. Men were not per- mitted to attend to women in labor, though male physi- cians were sometimes con- sulted if there were difficult circumstances.
After a successful birth, family and friends customar- ily held a special postpartum celebration and provided the mother with new clothing to wear. Well-to-do women were given herbal remedies that successfully suppressed lacta- tion, and their infants were given to wet nurses to be fed and cared for.
The risks to children during childhood were almost as great as the risks to mothers during childbirth. Birth defects, infectious diseases, and injuries during birth as well as during toddlerhood were common, and children frequently died.
MidWiveS
Even after the 14th century when university training became important within the medical profession and women started being edged out, women were still valued for their work as midwives. Like most medical practices of the time, midwifery alternated from the practical (helping the woman give birth) to the super- stitious. Among the superstitions was the belief that the mother would have an easier labor if the midwife opened the doors and drawers and cabinets of the household, took out the stoppers of every bottle, jar, and jug, and removed all the hairpins from the future mother’s hair.
While few texts on gynecology were to be found during the Mid- dle Ages, one that survived from Roman times noted the qualities
The birthing chair permitted a woman to remain upright while giving birth and thereby would permit gravity to ease the process slightly.