The Trotula A Medieval Compendium of Women's Medicine

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6244 Green / THE “TROTULA” / sheet 3 of 319

The Trotula
A Medieval Compendium
of Women’s Medicine

Edited and Translated by

Monica H. Green

PENN

University of Pennsylvania
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Philadelphia
6244 Green / THE “TROTULA” / sheet 4 of 319

Copyright ©  University of Pennsylvania Press

All rights reserved
Printed in the United States of America on acid-free paper

         

Published by
University of Pennsylvania Press
Philadelphia, Pennsylvania -

Library of Congress Cataloging-in-Publication Data

The Trotula : a medieval compendium of women’s medicine /
edited and translated by Monica H. Green.
p. cm. — (The Middle Ages series)
Includes bibliographical references and index.
ISBN --- (alk. paper)
. Gynecology—Early works to . . Obstetrics—Early works
to . . Medicine—Italy—Salerno—History. . Women—
Health and hygiene—Early works to . . Medicine, Medieval.
I. Green, Monica Helen. II. Series.
RG .T 
'.'—dc
-
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Malaika wa Kanza
Ilā bintayya al-‘azīzatayn
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Contents

List of Illustrations ix
Preface xi

Introduction 
Salerno 
Women’s Medicine 
The Fate of the Trotula 
Notes on This Edition and Translation 

Edition and Translation of the Standardized Trotula Ensemble

Liber de Sinthomatibus Mulierum/Book on the Conditions
of Women 
De Curis Mulierum/On Treatments for Women 
De Ornatu Mulierum/On Women’s Cosmetics 

Appendix: Compound Medicines Employed in the

Trotula Ensemble 

Notes 
Notes to the Latin Version 
Notes to the English Translation  

Bibliography 

Index Nominum et Locorum 

Index Verborum 
General Index 
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Illustrations

Figure . Map of southern Italy and north Africa facing page 

Figure . The city of Salerno as depicted in an eighteenth-
century engraving 
Figures  and . A case of uterine suffocation from a late
thirteenth-century English manuscript –
Figures  and . Fumigation pots and pessaries from a
fifteenth-century Dutch translation of the Trotula  – 
Figure . A   charm from a fifteenth-century
medical amulet 
Figure . A private bath for a woman; from a late twelfth-century
copy of the Salernitan Antidotarium magnum 
Figure . The development of the Trotula ensemble 
Figure . Opening page of the standardized Trotula ensemble 
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Preface

I    as in histories of medicine, readers often find a

passing reference to a mysterious person called Trotula of Salerno. ‘‘Trotula,’’
for whom no substantive historical evidence has ever been brought forth, is
said by some to have lived in the eleventh or twelfth century and is alleged
to have written the most important book on women’s medicine in medieval
Europe, On the Diseases of Women (De passionibus mulierum). She is also alleged
to have been the first female professor of medicine, teaching in the southern
Italian town of Salerno, which was at that time the most important center of
medical learning in Europe. Other sources, however, assert that ‘‘Trotula’’ did
not exist and that the work attributed to her was written by a man.
Any figure who could generate such diametrically opposed opinions
about her work and her very existence must surely be a mystery. Yet the mys-
tery of ‘‘Trotula’’ is inevitably bound up with the text ‘‘she’’ is alleged to have
written. The Trotula (for the word was originally a title, not an author’s name)
was indeed the most popular assembly of materials on women’s medicine from
the late twelfth through the fifteenth centuries.Written in Latin and so able to
circulate throughout western Europe where Latin served as the lingua franca
of the educated elites, the Trotula had also by the fifteenth century been trans-
lated into most of the western European vernacular languages, in which form
it reached an even wider audience.1
Surprisingly, for all its historical importance this work exists in no printed
form that can reliably be used by students and scholars. The Latin Trotula was
edited for publication only once, in the sixteenth century, under the title The
Unique Book of Trotula on the Treatment of the Diseases of Women Before, Dur-
ing, and After Birth,2 and the only modern translations available are based
on this same Renaissance edition.3 While these modern translations have had
some utility in keeping alive the ‘‘Trotula question,’’ they have in another sense
perpetuated the confusion, since they have passed on to new generations of
readers the historical distortions of the Renaissance edition, a work which is
in fundamental respects a humanist fabrication.
The Renaissance editor, undoubtedly with the best of intentions, added
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what was to be the last of many layers of editorial ‘‘improvements.’’ These

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xii Preface

intrusions had, over the course of the four-hundred-year life of the Trotula,
almost thoroughly obliterated all indications that this was not one text but
three. True, they were all probably of twelfth-century Salernitan origin, but
they reflected the work of at least three authors with distinct perspectives on
women’s diseases and cosmetic concerns. The first and third of these texts, On
the Conditions of Women and On Women’s Cosmetics, were anonymous. The sec-
ond, On Treatments for Women, was attributed even in the earliest manuscripts
to a Salernitan woman healer named Trota (or Trocta). Each of the texts went
through several stages of revision and each circulated independently through-
out Europe through the end of the fifteenth century, when manuscript culture
began to give way to the printed book. But the texts also had a second, parallel
fate. By the end of the twelfth century, an anonymous compiler had brought
the three texts together into a single ensemble, slightly revising the wording,
adding new material, and rearranging a few chapters. This ensemble was called
the Summa que dicitur ‘‘Trotula’’ (The Compendium Which Is Called the ‘‘Tro-
tula’’), forming the title Trotula (literally ‘‘little Trota’’ or perhaps ‘‘the abbre-
viated Trota’’) out of the name associated with the middle text, On Treatments
for Women. The appellation was perhaps intended to distinguish the ensemble
from a general, much longer medical compilation, Practical Medicine, com-
posed by the historical woman Trota. The Trotula ensemble soon became the
leading work on women’s medicine, and it continued to be the object of ma-
nipulation by subsequent medieval editors and scribes, most of whom under-
stood ‘‘Trotula’’ not as a title but as an author’s name.4
By , when the ensemble came into the hands of the Renaissance edi-
tor, Georg Kraut, generations of scribes and readers had come to believe that
they were dealing with a single text or, at most, two texts on the same subject
by a single author.5 It is, then, quite understandable that Kraut saw his task as
merely to clean up a messy, badly organized text. He rewrote certain passages,
suppressed some material and, in his most thorough editorial act, reorganized
all the chapters so as to eliminate the text’s many redundancies and inconsis-
tencies (due, we know now, to the fact that several authors were addressing the
same topics differently). There is no way that a reader of this emended printed
text could, without reference to the manuscripts, discern the presence of the
three discrete component parts. Hence when some twenty years later a debate
over the author’s gender and identity was initiated (and it has continued to the
present day), it was assumed that there was only one author involved.6
Medieval readers were coming to the Trotula texts with urgent questions
about how to treat women’s diseases or address cosmetic concerns, or per-
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haps with more speculative questions about the workings of the female body
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Preface xiii

or the processes of generation. For them, the texts were a vital fund of infor-
mation. Questions of authorship or textual development were of minimal im-
portance.7 For modern students of medical history or the history of women,
however, it is imperative to understand the processes by which the Trotula en-
semble was compiled if we are to answer such questions as: What do these
texts show us about the development of medieval medical theories concerning
the workings of the female body? What can they reveal about the impact of
the new Arabic medicine that began to infiltrate Europe in the late eleventh
century? Is there, in fact, a female author behind any of the texts and, if so,
what can she tell us about medieval women’s own views of their bodies and
the social circumstances of women’s healthcare either in Salerno or elsewhere
in Europe? Answering these questions calls for close textual analysis that pulls
apart, layer by layer, decades of accretion and alteration. Such analysis shows
us not simply that there are three core texts at the heart of the Trotula but also
that the ensemble became a magnet for bits and pieces of material from entirely
unrelated sources. We cannot, for example, attribute the neonatal procedures
described in ¶¶– to local southern Italian medical practices but must rec-
ognize them instead as the work of a ninth-century Persian physician named
Rhazes. Such analysis shows us, in other words, that the Trotula ensemble is
a patchwork of sources. There is no single author and no single text. There is,
consequently, no single (or simple) story to be told of ‘‘Trotula’’ or women’s
medicine at Salerno.
Knowledge of the multiplicity of the Trotula may resolve certain ques-
tions (about the redundancies and inconsistencies that so troubled the Renais-
sance editor Georg Kraut, for example), but it raises others. Particularly, if the
texts are so protean (a total of fifteen different versions of the independent texts
and the ensemble can be identified in the medieval manuscripts),8 how do we
choose any single version to study? Obviously, the authors of the three origi-
nal, independent works had their own unique conceptions of the content and
intended uses of their texts. On the basis of my reconstructions of these origi-
nal forms of the texts, I describe in the Introduction their more distinctive
medical theories and practices; I also summarize what is now known about
the medical practices of the women of Salerno—including, most important,
Trota. Nevertheless, the three original twelfth-century works often bore only
an oblique resemblance to the text(s) that later medieval readers would have
had in front of them. The Trotula ensemble, ragged patchwork though it is,
has a historical importance in its own right, since it was this version of the texts
that the largest proportion of medieval readers would have seen, and it was this
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assembly of theories and remedies (whatever their sources or however incon-

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xiv Preface

gruous the combination originally may have been) that would have been most
commonly understood throughout later medieval Europe as the authoritative
Salernitan teachings on women and their diseases.
One of the several versions of the ensemble was particularly stable in form
and widespread in circulation: this is what I have called the ‘‘standardized en-
semble,’’ which, with twenty-nine extant copies, ranks as the most popular ver-
sion of the Salernitan texts in any form, circulating either independently or as
a group. The standardized ensemble is a product of the mid-thirteenth cen-
tury (whether it was produced at Salerno itself I cannot say) and it reflects
the endpoint of what had been an active first century of development for the
three texts.9 Since it was also the version most closely associated with univer-
sity circles (and so the version most likely known to medieval commentators,
both medical and lay), I felt that this was the version best suited for use by mod-
ern scholars and students who are interested in medieval medical and intellec-
tual history and the history of women. I have based the present edition on the
earliest known complete copy of the standardized ensemble, an Italian manu-
script from the second half of the thirteenth century, and I have collated it in
full with eight other manuscripts coming from various parts of Europe and
dating from the later thirteenth century through the turn of the fourteenth
century.
The edition and translation presented here, then, reflect the standardized
Trotula ensemble text as it was known and used up through about . To
facilitate a historically nuanced understanding of the ensemble, I have anno-
tated the edition to highlight its major points of divergence from the three
original Salernitan texts on women’s medicine.10 The translation, like all such
endeavors, is merely an attempt to recapture a physical world and a concep-
tual world-view in many ways foreign to modern readers, especially those who
function within the western biomedical paradigm. Inevitably, many nuances—
anatomical, nosological, and botanical—can never be adequately recaptured.11
As translator, therefore, I in no sense wish to authorize the efficacy of any of
the following remedies. Many more questions remain regarding Trota and the
Trotula, but it is my hope that this first edition of these important and influen-
tial texts will offer a foundation for future debates and, in the process, enhance
our understanding of women’s healthcare in medieval Europe.

Note on Abbreviations and Pronouns

For reasons of space, when quoting in the Notes from the original Trotula trea-
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tises I refer to them by abbreviations of their Latin titles:

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Preface xv

TEM = Tractatus de egritudinibus mulierum (Treatise on the Diseases of Women, the

‘‘rough draft’’ of the LSM)
LSM = Liber de sinthomatibus mulierum (Book on the Conditions of Women)
DCM = De curis mulierum (On Treatments for Women)
DOM = De ornatu mulierum (On Women’s Cosmetics)

All quotations come from working drafts of my editions of the indepen-

dent texts. For complete descriptions of the manuscripts, please see my pub-
lished handlists.12
I have employed the same system of enumeration for component para-
graphs of all the different versions of the Trotula, whether in their original in-
dependent form or when combined into the ensemble, as laid out in my essay
‘‘The Development of the Trotula.’’ 13 Paragraphs identified with a simple arabic
numeral will refer to material that is found in the standardized ensemble (the
version of the text edited here) as well as in earlier versions. Hence, for example,
when I refer to ¶ in the first version of Conditions of Women (LSM ), this
refers to the same section on uterine suffocation, mutatis mutandis, as ¶ in
the present edition. Since many passages from the original texts were moved or
deleted during the first century of the texts’ development, however, I have also
employed subordinate alphanumerics so that readers may understand where
these now-lost sections were located. So, for example, ¶f, a detailed proce-
dure for vaginal hygiene, had appeared in early versions of Women’s Cosmetics
in the position after ¶ as found in this edition. Readers may refer to the
concordances of the Trotula texts in my above-mentioned essay for full com-
parisons of all the different versions of the texts.
Finally, my employment of pronouns should be explained. As noted ear-
lier, the gender of the author(s) of the Trotula has been a central concern in
scholarship to date and will, no doubt, be of prime interest to many readers of
the present edition precisely because gender—whether of the authors, scribes,
practitioners, or patients—is central to larger historical questions surrounding
women’s healthcare and roles in medical practice. Although it is not my objec-
tive to settle all these questions here, I have employed gendered pronouns to
indicate where I think the gender of the author (or, for that matter, the patient)
is clear and where it is not. Thus, I believe the authors of Conditions of Women
and Women’s Cosmetics to be male and so use the masculine pronoun. Treat-
ments for Women, however, represents what I believe to be a palimpsest, with
a female author’s voice overwritten by another (or others) of uncertain gen-
der.14 For that text and for other situations where there is still ambiguity or
doubt about a historical actor’s gender, I have employed the inclusive forms
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s/he, her/his, her/him.

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xvi Preface

* * *
This book had three beginnings. In , John F. Benton, of the California
Institute of Technology was asked to write a new introduction for a planned
reprint of Elizabeth Mason-Hohl’s  English translation of the Renaissance
edition of the Trotula. In checking the translation, Benton soon became aware
of many significant problems with Mason-Hohl’s work and so began a new
translation of his own (again based on the Renaissance text). He also began
a study of the manuscript tradition in order to clarify the question of author-
ship, collecting microfilms of many of the several dozen copies he had identi-
fied. In the course of that research, Benton discovered the three-text origin of
the Trotula ensemble, which immediately demolished any question of single
authorship. Equally important was his discovery in a Madrid manuscript of
a completely different text, the Practical Medicine According to Trota (Practica
secundum Trotam), which he identified as the authentic work of a Salernitan
woman healer named Trota, whose historicity could now for the first time be
established. These initial findings were published in  in an article in the
Bulletin of the History of Medicine.15 Unfortunately, at his death in  Benton
had not yet made the final revisions of his new translation and commentary
on the Renaissance Trotula.
My own involvement with the Trotula treatises began simultaneously
with Benton’s and resulted in my Ph.D. dissertation, which surveyed the his-
tory of early medieval gynecological theory up through the creation of the
Trotula in the twelfth century.16 Benton and I carried on a lively correspon-
dence about the Trotula for several years, and my postdoctoral work on the pre-
Salernitan Latin gynecological corpus complemented his study of the manu-
script tradition of the Trotula texts. Since the history of the Trotula was vitally
important for the overall history of medieval gynecological literature, I found
it necessary to see that Benton’s pioneering work did not die with him. In ,
Elspeth Benton very graciously granted me permission to take over the Tro-
tula project and make use of all the materials her late husband had collected.
It very quickly became apparent, of course, that John Benton’s own discover-
ies had made yet another translation of the Renaissance edition irrelevant, so
I decided it was time for a proper edition of the medieval texts. While I am
thus solely responsible for the form and content of the present work, it is to
John and Elspeth Benton that I owe not simply profoundest thanks but also
acknowledgment that it is because of them that the present edition came into
being at all.
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Thanks are also due to the late Robert Benson and to Rosie Meiron, John