Trota of Salerno

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Trota of Salerno

Trota of Salerno (c. 11th century)—also known as Trotula, Trocta, Trot, Troto, Trotta, Trocula, Truta, and Trutella—was most probably a female physician, obstetrician, and gynecologist who lived in eleventh-century Salerno, a city on the Italian peninsula just south of Naples. By long tradition, she is held to have written the most important and influential texts on women's medicine in medieval Europe and is also alleged to have been the first female professor in the famous school of medicine in Salerno, a town famed for its wise female healers, known simply as the mulieres Salernitane, the Salernitan women. Scholars dispute whether these women were practicing physicians or "merely" midwives and nurses.

Part of Salerno School of Medicine

Reliable biographical information on Trota is scarce—there is very little concrete proof of her existence. She lived in Salerno during the eleventh century, certainly, and was recognized during her lifetime as a remarkable physician. She may have been a member of the noble di Ruggiero family, and some scholars identify her as the wife of Johannes Platearius and mother of Matthias and Johannes the Younger, both medical authors. All four may have been members of the Salerno faculty.

In the medieval era, Salerno's position as a coastal city gave it access not only to culture and commerce but to scientific and medical knowledge from both Europe and Arabia. Even before Trota's day the city was known for the skill of its physicians, and patients came from as far away as England to be treated. Salerno's "school" of medicine was equally famous, although it was not incorporated into anything resembling a modern "university" until the thirteenth century; it, too, attracted students from all over the continent.

During this time, new—or, more properly, newly discovered—Arabic medical texts, based largely on the writings of Galen of Pergamum (A.D. 129–c. 216) began to circulate, competing with the long-established theories of Hippocrates (c. 460–c. 377 B.C.). The Salernitan medical school was the mechanism through which these teachings were incorporated with existing practices, spreading from Italy northward above the Alps and throughout Europe.

Authored Medical Texts

Trota contributed directly to at least three medical texts: Practica secundum Trotam (Practical medicine according to Trota), De egritudinum curatione (On the treatment of illnesses), and On Treatments for Women. The three texts overlap, sharing passages and remedies, proving their common authorship. Although Trota may well have been the principal contributor of these books she was almost certainly not the sole author—at least one book, De egritudinum curatione, began as a compendium. All were frequently edited, amended, and otherwise altered by medieval scribes as the works were copied over the centuries. Trota's influence, however, was monumental and her writings remained the foundation of women's medicine in Europe for four hundred years.

Practica secundum Trotam survives in only two manuscripts, and these may be abbreviated versions of what was once a longer work. The book is an assemblage of treatments for everything from toothache to hemorrhoids, with female complaints comprising many of the entries. De egritudinum curatione, as noted above, contains writings from seven Salernitan physicians, Trota included; here her contributions cover remedies for intestinal and ophthalmic disorders.

As the centuries passed and manuscripts were copied, Trota's works were often combined with others to create medical textbooks. One such compilation, which eventually came to be called De passionibus mulierum (variously translated as "The sufferings of women" or "The diseases of women"), was the gold standard of gynecology through the sixteenth century. Like most writing attributed to Trota, however, it began its life as separate texts, only one of which (On Treatments for Women) could be directly attributed to her. The first compilation appeared at the end of the twelfth century as Summa que dicitur "Trotula" (the compendium which is called the "Trotula"). Trotula literally means "little Trota," and the term may have been applied to this manuscript to distinguish it from the longer Practica secundum Trotam. Interestingly, of all Trota's works it is the Trotula that has survived best, with twenty-nine extant copies. Variant forms exist as well; by the sixteenth century the Latin Trotula had been translated into most, if not all, European languages—one English version was The Knowing of Woman's Kind in Childing. Thus Trota's knowledge was disseminated throughout Europe, influencing both doctors and midwives for centuries.

Medieval Medical Advice

Much of Trota's medical advice strikes modern readers as ludicrous. At this point in history the human body was thought to be dominated by the four elements—hot, cold, wet, dry—and the four humors—blood, red bile, yellow or black bile, and phlegm (although these receive surprisingly little mention). Any systemic imbalances or predominances were detrimental; they not only led to disease but determined its progression and cure. In Treatments for Women, quoted in Monica Green's book The Trotula: A Medieval Compendium of Women's Medicine, Trota explains the necessity of determining "which women are hot and which are cold" to allow "a succinct exposition on the treatment."

Women who are too cold, Trota claimed, must be treated with "hot" (or supposedly heat-inducing) herbs: pennyroyal, laurel, juniper, hyssop, fleabane, and others. Depending on the condition being treated, this would be done with a bath or even a pessary (tampon) inserted vaginally. Women suffering from excess heat would be given "cold" herbs, such as roses, mallows, and violets. Such treatments, Trota assures her readers in Green's book, will balance the patient's system: "they will be found cleansed from this awful excess and ready for conception."

In Treatments for Women Trota discussed many recognizable gynecological and obstetric problems: infertility, difficult births, and uterine prolapse. Others, however, have been invalidated by science. Medieval theory posited that the uterus was an untethered mass that could move inside a woman's body, and "wandering womb" was a commonly diagnosed syndrome; the patient's symptoms depended on the womb's "location." Another condition, "uterine suffocation" (whose symptoms often sound like epilepsy), was thought to be caused by a lack of sexual activity (in married or marriageable women) or a cessation of the menstrual cycle not due to pregnancy. In either case sweet-or foul-smelling substances were among the remedies used to induce the uterus to either "move" to its proper location (i.e. away from the bad smell and toward the good) or to restore its normal function.

Menstruation and its association with fertility was of supreme importance at this time, and many of the cures and medicaments recommended were intended to restore a woman's cycle. "Retention" of menses in a woman who was not pregnant was thought to poison the body, and physicians often encouraged any type of bleeding as a substitute, including bloodletting or even a nosebleed. In other instances, herbs were used to bring on menstruation.

Not all of Trota's knowledge was ineffectual, however. Her texts, which gave detailed instructions in how to handle difficult births—including breech, posterior, and other abnormal presentations—told midwives how to turn the infant while still in utero into the proper position. Trota also included sections on how to repair delivery-induced tears with silk thread, and even recommended opiates to dull the pain of labor. This recommendation was notably at odds with Church teaching of the era, which held that women were required to suffer during childbirth as part of their punishment for Eve's sin.

One of the cures described in Treatments for Women concerns Trota herself: A young woman, thought to have a ruptured intestine, was about to undergo surgery—a desperate and frequently unsuccessful option in the eleventh century. As a last resort, Trota was summoned and asked for her opinion. Her questioning led her to discount the first diagnosis, and she took the patient to her home. Further examination revealed that the young woman apparently suffered from "wind" in her uterus—yet another now-discounted medieval malady. Trota's treatment of herbal baths and poultices, however, was enough to effect a cure (much to the patient's relief).

Trota also turned her attention to more universal concerns, writing on the treatment of bladder stones, hemorrhoids, and abdominal pain, among other conditions. Treatment depended on the sex of the patient—different remedies were prescribed for men and women. In another departure from accepted medical practice, Trota also devised treatments for male infertility—an interesting speculation in an era when failure to conceive was universally considered the woman's "fault." More mundane medical concerns were also discussed, such as balms for skin that had sunburn or lesions, and salves for chapped lips.

Although the treatments prescribed in Trota's work often seem ineffectual with modern medical knowledge and hindsight, such texts reflect the daily realities of life in the Middle Ages and reveal early (albeit inaccurate) efforts to understand and treat disease. Although it would be centuries before science found causes and treatments for the diseases Trota discusses, books such as hers are windows into an earlier time, when a woman's fertility (whether real or presumed) was frequently the key to her social, financial, and physical health.

Modern Discoveries of a Wise Teacher

As time went by and copies (and compilations) of Trota's texts were disseminated, both scribes and readers began to confuse the title with the author. Within a century "Trotula" came to be known as the author, and not simply the title of the work. Modern scholars perpetuated the error, continuing to refer to her as "Trotula of Salerno," and crediting her with authorship of the entire Trotula compendium. Only in the twenty-first century would scholars, particularly Monica Green in The Trotula: A Medieval Compendium of Women's Medicine, unearth the truth about Trota, her practice, and her writings.

Like so much of her life, Trota's death remains a mystery. Some sources say she died in 1090, others cite the year 1097, and still others claim she lived into the twelfth century. Whenever she lived, Trota was a unique and formidable magistra mulier sapiens: wise woman teacher, even in Salerno, a city noted for its learned females. Her influence on medicine—particularly women's medicine—was profound and lasting.

Books

Alic, Margaret, Hypatia's Heritage: A History of Women in Science from Antiquity to the Late Nineteenth Century, The Women's Press, 1986.

Barratt, Alexandra, editor, The Knowing of Woman's Kind in Childing: A Middle English Version of Material Derived from the Trotula and Other Sources, Medieval Women: Texts and Contexts 4, Brepols Publishers n.v., 2001.

Green, Monica, The Trotula: A Medieval Compendium of Women's Medicine, University of Pennsylvania Press, 2001.

Riesman, David, The Story of Medicine in the Middle Ages, Paul B. Hoeber, Inc., 1935.