The Medical Role of Women: Women as Patients and Practitioners

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The Medical Role of Women: Women as Patients and Practitioners

Overview

Throughout history more than half of the people involved in health care and healing have been women. More than half of the patients have also been women. Historically, the disproportionate fame and recognition given to male practitioners is largely due to the fact that surviving manuscripts from earlier times were written by men, and because women generally were not accepted into medical schools. Women have long practiced medicine, but dealt primarily with childbirth and conditions of the female reproductive system—women took care of women.

During the Renaissance, the period of intellectual and cultural revival that marks the end of the Middle Ages in the fifteenth and sixteenth centuries, women had a freer life, but living conditions were still poor and life was cheap. The use of herbs and potions for healing led to associations between healing and witchcraft, in some cases resulting in unjust trials and the execution of alleged sorcerers—many of whom were women.

The sixteenth century brought about the beginning of a new era in geography, religion, the arts, and science. The Renaissance in medicine began in 1543 when Andreas Vesalius (1514-1564) published his anatomy works. Several unsung women also participated in the medical renaissance.

However, as the medical profession became more regulated, women did not fare as well. By the end of the 1600s the role of women had not improved and ultimately gave way to complete male dominance in obstetrical care in the next centuries.

Background

For many centuries women had significant roles as physicians. For example, in the Egyptian medical schools at Helipolis and Sais, the golden-haired Agamede was skilled in medicine and herbal lore. Philistra (318-372 b.c.) lectured so well that pupils flocked to her. She was also so attractive she had to lecture from behind a curtain. Women physicians were numerous during Roman times. Roman records attest to gynecological work done by both obstetrices, or midwives, and medicae, female doctors. According to Tacitus, the practice of medicine was common among the German barbarians.

During medieval times the scholars of both genders kept learning alive in the Christian monasteries. Many herbal and diagnostic skills were continued. The best known nun was Hildegard von Bingen (1098-1179), who wrote two medical manuscripts on plant, animal, and mineral medicines and on physiology and the nature of disease. Her remedies were partly herbal and partly spiritual or magical.

In the eleventh century there emerged at Salerno treatises attributed to Trotula. She gained a great reputation as a physician and obstetrician and wrote on many topics. One manuscript reports that Trotula was so loved that at her funeral in 1099 her procession was two miles long. Some scholars argue that the woman Trotula did not do the writing. Regardless of who wrote it, many of the remedies and procedures were practiced for centuries. The books, which had to be first hand-copied, appeared in print in the fifteenth century.

Much of the obstetric care was given by midwives who passed down herbal remedies via oral tradition. The herbals became closely related to spiritual and magic, and consequently led to the presumption of witchcraft and sorcery. From the fifteenth century the Catholic Church was active in the persecution of witches, many of whom were women who were herbalists and healers. In 1486 The Hammer of Witches was the black bible of this movement and led to the death of thousands of innocent people. The last witch was supposedly burned in Germany in 1775.

Impact

To understand the status of women, one must look at the traditions passed down by Galen (c. 130-c. 200), Soranus, and others. Women were thought to be inferior models of men. Men were strong and muscular; women were weak and flabby. Physiologically, they were viewed as the same except the uterus was an inverted version of the male penis. Women were considered leaky vessels compared to men. Menstruation, tears, and producing milk ostensibly proved this. Although women were generally considered to be inferior mortals, some girls of the upper classes were educated like the men by tutors.

Medicine in general in the fifteenth century reflected the times—terrible. Personal hygiene was unknown and plagues and war were rampant. For example, during the plague of 1478 one-third of the population of Europe died. In 1484 Pope Sixtus IV (1471-1484) issued an edict proclaiming that only university graduates could practice medicine. These laws were continuously broken because there was such a need.

Medical schools were generally unpopular, and it was only in Italy that women were admitted to the university. Beatrix Galindo (1473-1535) was educated in Italy and went on to be professor of Latin, philosophy, and medicine at the University of Salamanca in Spain. At that time professors taught several subjects that were part of the liberal arts curriculum, which included medicine, though it was not medical training as we think of today.

The Medicis of Florence were great collectors of books and their researchers found copies of Galen, Aristotle (384-322 b.c.), and Hippocrates (460?-377? b.c.) in Greek. They hired Cassandra Fidelis, a scholar known for her knowledge of medicine, to translate. She wrote a book on the natural sciences and treatment of diseases in 1484.

Italy's famous medical families and the university women were crucial in Italy's acceptance and advancement of medicine.

The fifteenth century also witnessed the widespread belief in witchcraft for the first time. The public was convinced that a large number of women conspired with the devil to injure others. Many of these innocent women were tortured into confessions, then publicly killed. With the ban against women physicians and the witchcraft mania, many women were reluctant to even become midwives. If the baby or mother died, the midwife or doctor might be blamed.

The education of midwives was passed on via oral tradition, but toward the end of the fifteenth century certain midwives began to demand books in their vernacular languages. The earliest treatise for midwives, Das Frauen Buchlein (The little book for wives) was printed in 1500. In 1513 Eucharius Roesslin (1490?-1526), a city physician at Frankfurt-am-Main, published A Rose Garden for Pregnant Women and Midwives. In 1545 Thomas Raynalde published The Byrth of Mankynd. This book included an illustration of "The Woman's Stool" and adult-like figures of fetuses floating in an inverted light-bulb shaped uterus. In general, the state of obstetrics was stunted by superstition and quackery. However, this century has been dubbed as the end of the Middle Ages.

The sixteenth century was the beginning of the new era of freethinking and the Renaissance. The great age of discovery of Christopher Columbus (1451-1506) and the Cabots opened geography and astronomy, art, music, and drama. The renaissance of medicine began in 1543 with the publication of the anatomical text De Humani Corporis Fabrica by Vesalius.

In France the position of medical women was worse than ever, but women could attend births, nurse charity patients, and care for their own families. The most noted French obstetrician of the sixteenth century was Louise Bourgeois, friend and pupil of Ambroise Paré (1510-1590), the famous French surgeon. Born in 1563, Bourgeois, like most women of her age, married young. She had three children and was widowed. Deciding that lace-making was not enough to provide for her family, she begged to be taught medicine. Acquiring great skill, she published books on midwifery in 1608 and 1653.

By the end of the century Bourgeois had formed an association to make rules for the protection of midwives and to elevate midwifery in general. The association sought to have their practitioners attend dissections of female bodies at medical schools to learn about anatomy.

The most famous medical woman in Switzerland was Marie Colinet of Bern, who was married to the renowned surgeon Geronimo Fabricius (1537-1619). He taught his wife surgery and admitted that she was a better surgeon than he was. He praised her skill as a bonesetter and told of a case where she wired the ribs of an injured man then placed an effective dressing containing oil of roses. She also performed obstetrical operations and was skilled in cesarean sections.

Medical books of the sixteenth century give insight into the conditions of the times. Roesslin's Rose Garden had many later editions with woodcuts that illustrate the care of mother and child. Caspar Wolff also printed Trotula's work. The books of this period indicate that gynecology was becoming a medical specialty.

Since the sixteenth century was a transitional period of thought, there were extreme and puzzling contradictions. Medicine, however, was not changed as much as other fields because it was still closely tied to religion. Astrology held tight, but people were beginning to realize the suffering of the plague could not be helped with heavenly bodies. Education was spreading slowly among women, and the Catholic church no longer ruled in Protestant countries.

Medicine in the seventeenth century advanced slowly. While the work of Bourgeois and others had spread some hope in a small part of the world, the practice of obstetrics in Europe and the American colonies went back to medieval practices before Trotula. Doctors performed vaginal examinations with unclean hands and broke the bag of waters with their long dirty fingernails. The rate of puerperal fever ran high among both rich and poor. There also emerged a new problem for women healers—aggressive witchcraft persecution.

It was unfair that medical women, denied a university education, except in Italy, should be blamed for their lack of success. Men were frequently called by midwives for help. Francois Mauriceau (1637-1709) delivered charity patients at Hotel Dieu as well as noblewomen. In 1668 he wrote and illustrated a book for midwives that was used for 150 years, until it was replaced by Madame Boivin's book in the nineteenth century.

Slowly men began to emerge as professional leaders. The Chamberlen family of male midwives developed a type of short obstetrical forceps for the delivery of babies, an instrument they kept secret for four generations. Obstetrics and gynecology eventually became a male-dominated profession, and remained so until the twentieth century.

EVELYN B. KELLY