Sunday, December 18, 2016

Women Physicians in Medieval and Ancient Times by James J. Walsh 1911

MEDIEVAL WOMEN PHYSICIANS by James J. Walsh, K.C.St.G., M.D., Ph.D., LL.D., Litt.D., Sc.D. 1911

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Very probably the most interesting chapter for us of the modern time in the history of the medical school at Salerno is to be found in the opportunities provided for the medical education of women and the surrender to them of a whole department in the medical school, that of Women's Diseases. While it is probable that Salerno did not owe its origin to the Benedictines, and it is even possible that there was some medical teaching there for all the centuries of the Middle Ages from the Greek times, for it must not be forgotten that this part of Italy was settled by Greeks, and was often called Magna Græcia, there is no doubt at all that the Benedictines exercised great influence in the counsels of the school, and that many of the teachers were Benedictines, as were also the Archbishops, who were its best patrons, and the great Pope Victor III, who did much for it. For several centuries the Benedictines represented the most potent influence at Salerno.

For most people who are not intimately familiar with monastic life, and, above all, with the story of the Benedictines, their prestige at Salerno might seem to be enough of itself to preclude all possibility of the education of women in medicine at Salerno. For those who know the Benedictines well, however, such a departure as the accordance of opportunities for women to study medicine would seem eminently in keeping with the practical wisdom of their rules and the development of their work. From the beginning the Benedictines recognized that a monastic career should be open to women as well as to men, and Benedict's sister, Scholastica, established convents for them, as her brother did the Benedictine monasteries, thus providing a vocation for women who did not feel called upon to marry. That the members of the order should recognize the advisability of affording women the opportunity to study medicine, and of handing over to them the department of women's diseases in a medical school in which they had a considerable amount of authority, seems, then, indeed, only what might have been expected of them.

We are prone in the modern time to think that our generation is the first to offer to women any facilities or opportunities for education in medicine. We are prone, however, just in the same way, to consider that a number of things that we are doing are now being done for the first time. As a matter of fact, it is extremely difficult to find any important movement or occupation that is not merely a repetition of a previous interest of mankind. The whole question of feminine education we are apt to think of as modern, forgetting that Plato insisted in his "Republic," as absolutely as any modern feminist, that women should have the same opportunities for education as men, and that at Rome, at the end of the Republic and the beginning of the Empire, the women occupied very much the same position in social life as our own at the present time. Their husbands supplied the funds, and they patronized the artists, gave receptions to the poets, lionized the musicians, and, in general, "went after culture" in a way that is a startling reminder of what we are familiar with in our own time. Just as soon as Christianity began to influence education, women were given abundant opportunities for higher education in all forms. In Ireland, the first nation completely converted to Christianity,—where, therefore, the national policy in education could be shaped by the Church without hindrance,—St. Brigid's school at Kildare was scarcely less famous than St. Patrick's at Armagh. It had several thousand students, and, to a certain extent at least, co-education existed. In Charlemagne's time, with the revival of education on the Continent, the women of the Imperial Court attended the Palace School, as well as the men. In the thirteenth century we find women professors in every branch at Italian universities. Some of them were at least assistants in anatomy. The Renaissance women were, of course, profoundly educated. In a word, we have many phases of feminine education, though with intervals of absolutely negative interest, down the centuries.

There had evidently been quite a considerable amount of opportunity, if not of actual encouragement, for women in medicine, both among the Greeks and the Romans, in the early centuries of the Christian era. Galen, for instance, quotes certain prescriptions from women physicians. One Cleopatra is said to have written a book on cosmetics. This name came afterwards to be confounded with that of Queen Cleopatra, giving new prestige to the book, but neither Galen nor Aëtius, the early Christian physician, both of whom quote from her work, speak of her as anything except a medical writer. Some monuments to women physicians from these old times have escaped the tooth of time. There was the tomb of one Basila, and also of a Thecla, both of whom are said to have been physicians. Two other names of Greek women physicians we have, Origenia and Aspasia, the former mentioned by Galen, the latter by Aëtius in his "Tetrabiblion." Daremberg, the medical historian, announced in 1851 that he had found a Greek manuscript with the title, "On Women's Diseases," written by one Metrodora, a woman physician. He promised to publish it. It was unpublished at the time of his death, but could not be found among his papers. There is a manuscript on medical subjects, bearing this name, mentioned in the catalogue of the Greek Codices of the Laurentian Library at Florence, but this is said to give no indication of the time when its author lived. We have evidence enough, however, to show that Greek women physicians were not very rare.

The Romans imitated the Greeks so faithfully—one might almost say copied them so closely—that it is not surprising to find a number of Roman women physicians. The first mention of them comes from Scribonius Largus, in the first century after Christ. Octavius Horatianus, whom most of us know better as Priscian, dedicated one of his books on medicine to a woman physician named Victoria. The dedication leaves no doubt that she was a woman in active practice, at least in women's diseases, and it is a book on this subject that Priscian dedicates to her. He mentions another woman physician, Leoparda. The word medica for a woman physician was very commonly used at Rome. Martial, whose epigrams have been a source of so much information in medical history, especially on subjects with regard to which information was scanty, mentions a medica in an epigram. Apuleius also uses the word. There are a number of inscriptions in which women physicians are mentioned. Among the Christians we find women physicians, and Theodosia, the mother of St. Procopius, the martyr, is said to have been very successful in the practice of both medicine and surgery. She is numbered among the martyrs, and occurs in the Roman Martyrology on the 29th of May. Father Bzowski, the Polish Jesuit, who compiled "Nomenclatura Sanctorum Professione Medicorum" (Rome, 1621; the book is usually catalogued under the Latin form of his name, Bzovius), has among his list of saints who were physicians by profession a woman, St. Nicerata, who lived at Constantinople in the reign of the Emperor Arcadius, and who is said to have cured St. John Chrysostom of a serious disease.

The organization of the department of women's diseases at Salerno, under the care of women professors, and the granting of licenses to women to practise medicine, is not so surprising in the light of this tradition among Greeks and Romans, taken up with some enthusiasm by the Christians. We are not sure just when this development took place. The first definite evidence with regard to it comes in the life of Trotula, who seems to have been the head of the department. Some of her books are well known, and often quoted from, and she contributed to a symposium on the treatment of disease, in which there are contributions, also, from men professors of Salerno at the time. She seems to have flourished about the middle of the eleventh century. Ordericus Vitalis, a monk of Utica, who wrote an ecclesiastical history, tells of one Rudolph Malcorona, who, in 1059, came to Utica and remained there for a long time with Father Robert, his nephew. "This Rudolph had been a student all his life, devoting himself with great zeal to letters, and had become famous for his visits to the schools of France and Italy, in order to gather there the secrets of learning. As a consequence he was well informed not only in grammar and dialectics, but also in astronomy and in music. He also possessed such an extensive knowledge of the natural sciences that in the town of Salerno, where, since ancient times, the best schools of medicine had existed, there was no one to equal him with the exception of a very wise matron."

This wise matron has been identified with Trotula, many of the details of whose life have been brought to light by De Renzi, in his "Story of the School of Salerno." According to very old tradition, Trotula belonged to the family of Ruggiero. This was a noble family of Salerno, many of the members of which were distinguished in their native town at least, but the name is not unusual in Italy, as readers of Dante and Boccaccio are likely to know. It was, indeed, as common as our own Rogers, of which it is the Italian equivalent.

De Renzi has made out a rather good case for the tradition that Trotula was the wife of John Platearius I—so called because there were probably three professors of that name. Trotula was, according to this, the mother of the second Platearius, and the grandmother of the third, all of them distinguished members of the faculty at Salerno.

Her reputation extended far beyond her native town, and even Italy itself, and, in later centuries, her name was used to dignify any form of treatment for women's diseases that was being exploited. Rutebeuf, one of the trouvères, thirteenth-century French poets, has a description of the scene in which one of the old herbalist doctors who used to go round and collect a crowd by means of songs and music, and then talk medicine to them—just as is done even yet in many of the smaller towns of this country—is represented as saying to the crowd when he wants to make them realize that he is no ordinary quacksalver, that he is one of the disciples of the great Madame Trot of Salerno. The old-fashioned speech runs somewhat as follows: "Charming people: I am not one of these poor preachers, nor the poor herbalists, who carry little boxes and sachets, and who spread out before them a carpet. I am the disciple of a great lady, who bears the name of Madame Trot of Salerno. And I would have you know that she is the wisest woman in all the four quarters of the world."

Two books are attributed to Trotula; one bears the title, "De Passionibus Mulierum," and the other has been called "Trotula Minor," or "Summula Secundum Trotulam," and is a compendium of what she wrote. This is probably due to some disciple, but seems to have existed almost in her own time. Her most important work bears two sub-titles, "Trotula's Unique Book for the Curing of Diseases of Women, Before, During, and After Labor," and the other sub-title, "Trotula's Wonderful Book of Experience (experimentalis) in the Diseases of Women, Before, During, and After Labor, with Other Details Likewise Relating to Labor."

The book begins with a prologue on the nature of man and of woman, and an explanation of how the author, taking pity on the sufferings of women, came to devote herself to the study of their diseases. There are many interesting details in the book, all the more interesting because in many ways they anticipate modern solutions of difficult problems in women's diseases, and the care of the mother and child before, during, and after labor. For instance, there are a series of rules on the choice of the nurse, and on the diet and the régime which she should follow if the child is to be properly nourished without disturbance.

Probably the most striking passage in her book is that with regard to a torn perineum and its repair. This passage may be found in De Renzi or in Gurlt. It runs as follows: "Certain patients, from the severity of the labor, run into a rupture of the genitalia. In some even the vulva and anus become one foramen, having the same course. As a consequence, prolapse of the uterus occurs, and it becomes indurated. In order to relieve this condition, we apply to the uterus warm wine in which butter has been boiled, and these fomentations are continued until the uterus becomes soft, and then it is gently replaced. After this the tear between the anus and vulva we sew in three or four places with silk thread. The woman should then be placed in bed, with the feet elevated, and must retain that position, even for eating and drinking, and all the necessities of life, for eight or nine days. During this time, also, there must be no bathing, and care must be taken to avoid everything that might cause coughing, and all indigestible materials."

There is a passage, also, almost more interesting with regard to prophylaxis of rupture of the perineum. She says, "In order to avoid the aforesaid danger, careful provision should be made, and precautions should be taken during labor somewhat as follows: A cloth should be folded in somewhat oblong shape, and placed on the anus, so that, during every effort for the expulsion of the child, that should be pressed firmly, in order that there may not be any solution of the continuity of tissue."

Her book contains, also, some directions for various cosmetics. How many of these are original, however, is difficult to say. Trotula's name had become a word to conjure with, and many a quack in the after time tried to make capital for his remedies in this line by attributing them to Trotula. As a consequence, many of these remedies gradually found their way into the manuscript copies of her book, and subsequent copyists incorporated them into the text, until it became practically impossible to determine which were original. There are manuscripts of Trotula's work in Florence, Vienna, and Breslau. Some of these contain chapters not in the others, undoubtedly added by subsequent hands. In one of these, that at Florence, from which the edition of Strasburg was printed in 1544, and of Venice, 1547, one of the Aldine issues, there is a mention in the last chapter of spectacles. We have no record of these until the end of the thirteenth century, when this passage was probably added. It was also printed at Basle, 1566, and at Leipzig as late as 1778, which would serve to show how much attention it has attracted even in comparatively recent times.

After Trotula we have a number of women physicians of Salerno whose names have come down to us. The best known of these bear the names Constanza, Calendula, Abella, Mercuriade, Rebecca Guarna, who belonged to the old Salernitan family of that name, a member of which, in the twelfth century, was Romuald, priest, physician, and historian, Louise Trencapilli, and others. The titles of some of their books, as those of Mercuriade, who occupied herself with surgery as well as medicine, and who is said to have written on "Crises," on "Pestilent Fever," on "The Cure of Wounds," and of Abella, who acquired a great reputation with her work on "Black Bile," and on the "Nature of Seminal Fluid," have come down to us. Rebecca Guarna wrote on "Fevers," on the "Urine," and on the "Embryo." The school of Salernitan women came to have a definite place in medical literature.

While, as teachers, they had charge of the department of women's diseases, their writings would seem to indicate that they studied all branches of medicine. Besides, there are a number of licenses preserved in the archives of Naples in which women are accorded the privilege of practising medicine. Apparently these licenses were without limitation. In many of these mention is made of the fact that it seems especially fitting that women should be allowed to practise in women's diseases, since they are by constitution likely to know more and to have more sympathy with feminine ills. The formula employed as the preamble of this license ran as follows: "Since, then, the law permits women to exercise the profession of physicians, and since, besides, due regard being had to purity of morals, women are better suited for the treatment of women's diseases, after having received the oath of fidelity, we permit, etc."

Salerno continued to enjoy a reputation for training women physicians thoroughly, until well on in the fifteenth century, for we have the record of Constance Calenda, the daughter of Salvator Calenda, who had been dean of the faculty of medicine at Salerno about 1415, and afterwards dean of the faculty at Naples. His daughter, under the diligent instruction of her father, seems to have obtained special honors for her medical examination. Not long after this, Salerno itself lost all the prestige that it had. The Kings of Naples endeavored to create a great university in their city in the thirteenth century. They did not succeed to the extent that they hoped, but the neighboring rival institution hurt Salerno very much, and its downfall may be traced from this time. Gradually its reputation waned, and we have practically no medical writer of distinction there at the end of the fourteenth century, though the old custom of opportunities for women students of medicine was maintained.

This custom seems also to have been transferred to Naples, and licenses to practise were issued to woman graduates of Naples. This never achieved anything like the reputation in this department that had been attained at Salerno. Salerno influenced Bologna and the north Italian universities profoundly in all branches of medicine and medical education, particularly in surgery, as can be seen in the chapter on "Great Surgeons of the Medieval Universities," and the practice of allowing such women as wished to study medicine to enter the university medical schools is exemplified in the case of Mondino's assistant in anatomy, Alessandra Giliani, though there are also others whose names have come down to us.

The University of Salerno had developed round a medical school. It was the first of the universities, and, in connection with its medical school, feminine education obtained a strong foothold. It is not surprising, then, that with the further development of universities in Italy, feminine education came to be the rule. This rule has maintained itself all down the centuries in Italy, so that there has not been a single century since the twelfth in which there have not been one or more distinguished women teachers at the Italian universities. University life gradually spread westward, and Paris came into existence as an organized institution of learning after Bologna, and, doubtless, with some of the traditions of Salerno in the minds of its founders. Feminine education, however, did not spread to the West. This is a little bit difficult to understand, considering the reverence that the Teutonic peoples have always had for their women folk and the privileges accorded them. A single unfortunate incident, that of Abélard and Héloïse, seems to have been sufficient to discourage efforts in the direction of opportunities for feminine education in connection with the Western universities. Perhaps, in the less sophisticated countries of the North and West of Europe, women did not so ardently desire educational opportunities as in Italy, for whenever they have really wanted them, as, indeed, anything else, they have always obtained them.

In spite of the absence of formal opportunities for feminine education in medicine at the Western universities, a certain amount of scientific knowledge of diseases, as well as valuable practical training in the care of the ailing, was not wanting for women outside of Italy. The medical knowledge of the women of northern France and Germany and England, however, though it did not receive the stamp of a formal degree from the university and the distinction of a license to practise, was none the less thorough and extensive. It came in connection with certain offices in their own communities, held by members of religious orders. Genuine information with regard to what the religious were doing during the Middle Ages was so much obscured by the tradition of laziness and immorality, created at the time of the so-called reformation in order to justify the confiscation of their property by those whose one object was to enrich themselves, that we have only come to know the reality of their life and accomplishments in comparatively recent years. We now know that, besides being the home of most of the book knowledge of the earlier Middle Ages, the monasteries were the constant patrons of such practical subjects as architecture, agriculture in all its phases, especially irrigation, draining, and the improvement of land and crops; of art, and even what we now know as physical science. Above all, they preserved for us the old medical books and carried on medical traditions of practice. The greatest surprise has been to find that this was true not only for the monks, but also for the nuns.

One of the most important books on medicine that has come to us from the twelfth century is that of a Benedictine abbess, since known as St. Hildegarde, whose life was spent in the Rhineland. Her works serve to show very well that in the convents of the tenth, eleventh, and twelfth centuries there was much more of interest in things intellectual than we have had any idea of until recent years, and that, indeed, one of the important occupations of convent life was the serious study of books of all kinds, some of them even scientific, as well as the writing of works in all departments. The century before St. Hildegarde there is the record of Hroswitha, who wrote a series of dramas in imitation of Terence, that were meant to replace, for the monks and nuns of that period, the reading of that rather too human author. Hroswitha, like Hildegarde, was a German, and we have the record, also, of another religious writer, abbess of the Odilian Cloister, at Hohenberg, who wrote a book called "Hortus Deliciarum, the Garden of Delights," a book of information on many subjects not unlike our popular encyclopedias of the modern time, the title of which shows that the place of information in life was considered to be the giving of pleasure. While this work deals mainly with Biblical and theological and mystical questions, there are many purely scientific passages and many subjects of strictly medical interest treated.

The life of the Abbess Hildegarde is worthy of consideration, because it illustrates the period and makes it very clear that, in spite of the grievous misunderstanding of their life and work, so common in the modern time, these old-time religious had most of the interests of the modern time, and pursued them with even more than modern zeal and success, very often. Her career illustrates very well what the foundation of the Benedictines had done for women. When St. Benedict founded his order for men, his sister, Scholastica, wanted to do a similar work for women. We know that the Benedictine monks saved the old classics for us, kept burning the light of the intellectual life, and gave a refuge to men who wanted to devote themselves in leisure and peace to the things of the spirit, whether of this world or the other. We have known much less of the Benedictine nuns until now the study of their books shows that they provided exactly the same opportunities for women and furnished a vocation, a home, an occupation of mind, and a satisfaction of spirit for the women who, in every generation, do not feel themselves called to be wives and mothers, but who want to live their lives for others rather than for themselves and their kin, seeking such development of mind and of spirit as may come with the leisure and peace of celibacy.

Hildegarde was born of noble parents at Böckelheim, in the county of Sponheim, about the end of the eleventh century (probably 1098). In her eighth year she went for her education to the Benedictine cloister of Disibodenberg. When her education was finished, she entered the cloister, of which, at the age of about fifty, she became abbess. Her writings, reputation for sanctity, and her wise saintly rule attracted so many new members to the community that the convent became overcrowded. Accordingly, with eighteen of her nuns, Hildegarde withdrew to a new convent at Rupertsberg, which English and American travellers will remember because it is not far from Bingen on the Rhine. Here she came to be a centre of attraction for most of the world of her time. She was in active correspondence with nearly every important man of her generation. She was an intimate friend of Bernard of Clairvaux, who was himself, perhaps, the most influential man in Europe in this century. She was in correspondence with four Popes, and with the Emperors Conrad and Frederick I, and with many distinguished archbishops, abbots, and abbesses, and teachers and teaching bodies of various kinds. These correspondences were usually begun by her correspondents, who consulted her because her advice in difficult problems was considered so valuable.

In spite of all this time-taking correspondence, she found leisure to write a series of books, most of them on mystical subjects, but two of them on medical subjects. The first is called "Liber Simplicis Medicinæ," and the second "Liber Compositæ Medicinæ." These books were written in order to provide information mainly for the nuns who had charge of the infirmaries of the monasteries of the Benedictines. Almost constantly someone in the large communities, which always contained aged religious, was ailing, and then, besides, there were other calls on the time and the skill of the sister infirmarians. There were no hotels at that time, and no hospitals, except in the large cities. There were always guest houses in connection with monasteries and convents, in which travellers were permitted to pass the night, and given what they needed to eat. There are many people who have had experiences of monastic hospitality even in our own time. Sometimes travellers fell ill. Not infrequently the reason for travelling was to find health in some distant and fabulously health-giving resort, or at the hands of some wonder-working physician. Such high hopes are nearly always set at a distance. This of itself must have given not a little additional need for knowledge of medicine to the infirmarians of convents and monasteries. There were around many of the monasteries, moreover, large estates; often they had been cleared and made valuable by the work of preceding generations of monks, and on these estates peasants came to live. Workingmen and workingwomen from neighboring districts came to help at harvest time, and, after a chance meeting, were married and settled down on a little plot of ground provided for them near the monastery. As these communities grew up, they looked to the monasteries and convents for aid of all kinds, and turned to them particularly in times of illness. The need for definite instruction in medicine on the part of a great many of the monks and nuns can be readily understood, and it was this need that Hildegarde tried to meet in her books. The first of her books that we have mentioned, the "Liber Simplicis Medicinæ," attracted attention rather early in the Renaissance, and was deemed worthy of print. It was edited at the beginning of the sixteenth century by Dr. Schott at Strasburg, under the title, "Physica S. Hildegardis." Another manuscript of this part was found in the library of Wolfenbuttel, in 1858, by Dr. Jessen. This gave him an interest in Hildegarde's contributions to medicine, and, in 1859, he noted in the library at Copenhagen a manuscript with the title "Hildegardi Curæ et Causæ." On examination, he was sure that it was the "Liber Compositæ Medicinæ" of the saint. The first work consists of nine books, treating of plants, elements, trees, stones, fishes, birds, quadrupeds, reptiles, and metals, and is printed in Migne's "Patrologia," under the title "Subtilitatum Diversarum Naturarum Libri Novem." The second, in five books, treats of the general diseases of created things, of the human body and its ailments, of the causes, symptoms, and treatment of diseases.

It would be very easy to think that these are small volumes and that they contain very little. We are so apt to think of old-fashioned so-called books as scarcely more than chapters, that it may be interesting to give some idea of the contents and extent of the first of these works. The first book on Plants has 230 chapters, the second on the Elements has 13 chapters, the third on Trees has 36 chapters, the fourth on various kinds of Minerals, including precious stones, has 226 chapters, the fifth on Fishes has 36 chapters, the sixth on Birds has 68 chapters, the seventh on Quadrupeds has 43 chapters, the eighth on Reptiles has 18 chapters, the ninth on Metals has 8 chapters. Each chapter begins with a description of the species in question, and then defines its value for man and its therapeutic significance. Modern scientists have not hesitated to declare that the descriptions abound in observations worthy of a scientific inquiring spirit. We are, of course, not absolutely sure that all the contents of the books come from Hildegarde. Subsequent students often made notes in these manuscript books, and then other copyists copied these into the texts. Unfortunately we have not a number of codices to collate and correct such errors. Most of what Hildegarde wrote comes to us in a single copy, of none are there more than four copies, showing how near we came to missing all knowledge of her entirely.

Dr. Melanie Lipinska, in her "Histoire des Femmes Médecins," a thesis presented for the doctorate in medicine at the University of Paris in 1900, subsequently awarded a special prize by the French Academy, reviews Hildegarde's work critically from the medical standpoint. She says that the saint distinguishes a double mode of action of different substances, one chemical, the other physical, or what we would very probably call magnetic. She discusses all the ailments of the various organs, the brain, the eyes, the teeth, the heart, the spleen, the stomach, the liver. She has special chapters on redness and paleness of the face, on asthma, on cough, on fetid breath, on bilious indigestion, on gout. Besides, she has other chapters on nervous affections, on icterus, on fevers, on intestinal worms, on infections due to swamp exhalations, on dysentery, and a number of forms of pulmonary diseases. Nearly all of our methods of diagnosis are to be found, hinted at at least, in her book. She discusses the redness of the blood as a sign of health, the characteristics of various excrementitious material as signs of disease, the degrees of fever, and the changes in the pulse. Of course, it was changes in the humors of the body that constituted the main causes for disease in her opinion, but it is well to remind ourselves that our frequent discussion of auto-intoxication in recent years is a distinct return to this.

Some of Hildegarde's anticipations of modern ideas are, indeed, surprising enough. For instance, in talking about the stars and describing their course through the firmament, she makes use of a comparison that is rather startling. She says: "Just as the blood moves in the veins which causes them to vibrate and pulsate, so the stars move in the firmament and send out sparks as it were of light like the vibrations of the veins." This is, of course, not an anticipation of the discovery of the circulation of the blood, but it shows how close were men's ideas to some such thought five centuries before Harvey's discovery. For Hildegarde the brain was the regulator of all the vital qualities, the centre of life. She connects the nerves in their passage from the brain and the spinal cord through the body with manifestations of life. She has a series of chapters with regard to psychology normal and morbid. She talks about frenzy, insanity, despair, dread, obsession, anger, idiocy, and innocency. She says very strongly in one place that "when headache and migraine and vertigo attack a patient simultaneously they render a man foolish and upset his reason. This makes many people think that he is possessed of a demon, but that is not true." These are the exact words of the saint as quoted in Mlle. Lipinska's thesis.

It is no wonder that Mlle. Lipinska thinks St. Hildegarde the most important medical writer of her time. Reuss, the editor of the edition of Hildegarde published in Migne's "Patrology," says: "Among all the saintly religious who have practised medicine or written about it in the Middle Ages, the most important is without any doubt St. Hildegarde...." With regard to her book he says: "All those who wish to write the history of the medical and natural sciences must read this work in which this religious woman, evidently well grounded in all that was known at that time in the secrets of nature, discusses and examines carefully all the knowledge of the time." He adds, "It is certain that St. Hildegarde knew many things that were unknown to the physicians of her time."

When such books were read and widely copied, it shows that there was an interest in practical and scientific medicine among women in Germany much greater than is usually thought to have existed at this time. Such writers, though geniuses, and standing above their contemporaries, usually represent the spirit of their times and make it clear that definite knowledge of things medical was considered of value. The convents and monasteries of this time are often thought of by those who know least about them as little interested in anything except their own ease and certain superstitious practices. As a matter of fact, they cared for their estates, and especially for the peasantry on them, they provided lodging and food for travellers, they took care of the ailing of their neighborhood, and, besides, occupied themselves with many phases of the intellectual life. It was a well-known tradition that country people who lived in the neighborhood of convents and monasteries, and especially those who had monks and nuns for their landlords, were much happier and were much better taken care of than the tenantry of other estates. For this a cultivation of medical knowledge was necessary in certain, at least, of the members of the religious orders, and such books as Hildegarde's are the evidence that not only the knowledge existed, but that it was collected and written down, and widely disseminated.

Nicaise, in the introduction to his edition of Guy de Chauliac's "Grande Chirurgie," reviews briefly the history of women in medicine, and concludes:

"Women continued to practise medicine in Italy for centuries, and the names of some who attained great renown have been preserved for us. Their works are still quoted from in the fifteenth century.

"There was none of them in France who became distinguished, but women could practise medicine in certain towns at least on condition of passing an examination before regularly appointed masters. An edict of 1311, at the same time that it interdicts unauthorized women from practising surgery, recognizes their right to practise the art if they have undergone an examination before the regularly appointed master surgeons of the corporation of Paris. An edict of King John, April, 1352, contains the same expressions as the previous edict. Du Bouley, in his 'History of the University of Paris,' gives another edict by the same King, also published in the year 1352, as a result of the complaints of the faculties at Paris, in which there is also question of women physicians. This responded to the petition: 'Having heard the petition of the Dean and the Masters of the Faculty of Medicine at the University of Paris, who declare that there are very many of both sexes, some of the women with legal title to practise and some of them merely old pretenders to a knowledge of medicine, who come to Paris in order to practise, be it enacted,' etc. (The edict then proceeds to repeat the terms of previous legislation in this matter.)

"Guy de Chauliac speaks also of women who practised surgery. They formed the fifth and last class of operators in his time. He complains that they are accustomed to too great an extent to give over patients suffering from all kinds of maladies to the will of Heaven, founding their practice on the maxim 'The Lord has given as he has pleased; the Lord will take away when he pleases; may the name of the Lord be blessed.'

"In the sixteenth century, according to Pasquier, the practice of medicine by women almost entirely disappeared. The number of women physicians becomes more and more rare in the following centuries just in proportion as we approach our own time. Pasquier says that we find a certain number of them anxious for knowledge and with a special penchant for the study of the natural sciences and even of medicine, but very few of them take up practice."

Just how the lack of interest in medical education for women gradually deepened, until there was almost a negative phase of it, only a few women in Italy devoting themselves to medicine, is hard to say. It is one of the mysteries of the vicissitudes of human affairs that ups and downs of interest in things practical as well as intellectual keep constantly occurring. The number of discoveries and inventions in medicine and surgery that we have neglected until they were forgotten, and then had to make again, is so well illustrated in chapters of this book, that I need only recall them here in general. It may seem a little harder to understand that so important a manifestation of interest in human affairs as the education and licensure of women physicians should not only cease, but pass entirely out of men's memory, yet such apparently was the case. It would not be hard to illustrate, as I have shown in "Cycles of Feminine Education and Influence" in "Education, How Old the New" (Fordham University Press, 1910), that corresponding ups and downs of interest may be traced in the history of feminine education of every kind. In that chapter I have discussed the possible reasons for these vicissitudes, which have no place here, but I may refer those who are interested in the subject to that treatment of it.

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