Green - Making Womens Medicine Masculine

MAKING WOMENS MEDICINE MASCULINE

The Rise of Male Authority in Pre-Modern
Gynaecology

MONICA H. GREEN

Great Clarendon Street, Oxford OX2 6DP

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Monica H. Green 2008

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In 1449, an Italian humanist named Francisco Filelfo wrote excitedly to Filippo Pelliccione, a physician in Milan, asking him, indeed begging him, to be allowed to borrow a very ancient book in Pellicciones possession. According to Filelfos letter, the book contained the medical writings of Celsus, Soranus, Apuleius, and even certain women. For both these Renaissance seekers of antiquities, female authorities on womens medicine were an intriguing curiosity. As antiquities, however, they were also a thing of the past.

At exactly the same time the non-physicians Filelfo and Leland were engaging in their antiquarian quests, the field of gynaecology was exploding into a fully fledged subdiscipline of medicine. By the end of the sixteenth century, it would be represented not only by dozens of newly published books, including a massive 1097-page oversized compendium, The Books of Gynaecology of 1597 (by then in its third edition), but by university lectures, a published list of authorities in the field, and even its own insider controversies. Although there is no evidence that any sixteenth-century physicians or surgeons confined their practice to womens diseases or took on specialist identities as gynaecologists, gynaecology had reclaimed from the ancients both its name (gynaikeia, from the Greek for womens matters) and its rationale for why it should exist as a specialized field. But now, unlike Antiquity, there was no longer any association between the branch of medicine that topically addressed women and female Neither Schenck nor any sixteenth-century gynaecological writer would acknowledge a medieval or modern woman as his peer.

This sixteenth-century transformation of gynaecology is the end of my story, not its beginning. For I shall argue in this book that the traditions of medical knowledge and practice represented by The Books of Gynaecologya collection of twenty-eight treatises, all of which, with but one exception, were composed (or allegedly composed) by male authorswere in fact a long time in formation. The sixteenth-century gynaecological writers effected a nearly total evisceration of their field, rejecting or simply ignoring the opinions and teachings of medical writers from the previous half millennium. But even if they could not admit it, they had inherited from them something more important: they had inherited the social structures as well as the intellectual traditions that allowed men to be authorities in the field of womens medicine. Gynaecology as a specialist field of medical knowledge had indeed been born, but it was a masculine birtha birth without female involvement, either as maternal principle or assisting midwife.

This transformation in the shifting authorities of women vs. men in the field of womens medicine is all the more remarkable in that what had served as the leading text throughout most of Europe from the late twelfth well into the fourteenth century (and in certain areas, into the sixteenth) was credited to a female author, Trotula of Salerno. Modern researches have shown that Trotula was originally the title of a compendium on womens medicine, not its author, though significant parts of the work do indeed derive from a historic twelfth-century female author, Trota (or Trocta) of Salerno. The other parts of the work were male-authored, yet Trotas existence and that of other female practitioners in Salerno made the metamorphosis from the title Trotula to the authoress Trotula believable. At least through the fourteenth century many male intellectuals assumed it to be natural that knowledge on womens bodies should

Yet both Trota and the author-figure Trotula were anomalies. As this book will show, neither in twelfth-century Salerno nor at any point thereafter did male practitioners, as a group, not engage in gynaecological care at some level. Certain individual male practitioners, to be sure, may have refused to treat female patients, either out of a sense of ignorance of womens bodies or a belief that intimate contact with a woman would somehow negatively affect them. And many female practitioners existed who took up that slack; at least one even publicly challenged men to keep out of womens affairs. But there is far too much evidencetextual, iconographic, and anecdotalto argue that men were completely uninvolved with womens healthcare, including conditions of the reproductive organs. This same evidence also shows that women, however much they continued to attend to the medical concerns of themselves or other women, did not have anything like a monopoly over the production of knowledge on or care of the female body. In fact, as this book will demonstrate, male involvement with womens medicine, both medical (control of diet and use of drugs to affect internal conditions) and surgical (the treatment of disorders on or near the surface of the body), increased substantially between the twelfth and sixteenth centuries. Far from being a modern transformation, the masculinization of womens medicine is instead a fundamental feature of western medicine down to its medieval roots.

These are large claims and, to understand them, a crucial distinction must be made, for on this hangs my story. Although obstetrics and gynaecology are not everywhere as tightly linked as they now are in the contemporary United States (and even here they are being uncoupled due to concerns over obstetrical malpractice insurance), modern western medicine has tended to keep them closely associated so that for most observers obstetrics and gynaecology (OB/GYN) are inherently one. And that they are, in so far as both fields necessarily take the organs and physiological functions unique to the female body as their particular concern. This ontological linking of OB/GYN was true of ancient Greek and Roman cultures, and may have been true of other historical societies as well. Yet a linkage of obstetrics and gynaecology based on shared anatomical focus need not necessarily dictate that they remained linked in the intellectual frameworks of learned medicine, nor that the social structures of medicine necessarily assigned practice in the two fields to a single group of healers. I will argue here that the gendering of gynaecology took a different path than that of obstetrics, with the result that by the end of the Middle Ages, the two fields were in practice distinct: while care of uncomplicated births remained in the hands of women, gynaecological care (as well as certain aspects of emergency obstetrical care) had passed into the hands of men.