The Greatest Benefit to Mankind. Roy Porter

certain Trotula, said to be a female member of the medical school of Salerno during the twelfth century; but ‘Trotula’, anglicized as ‘Dame Trot’, was more likely a male writing in drag. Texts called The English Trotula long circulated, containing advice on conception, pregnancy and childbirth and motherhood (nursing mothers should avoid highly salted or spiced food).

      A few female healers were accepted into the Florentine practitioners’ guild, and English records show women called ‘leech’ or ‘medica’; at St Leonard’s Hospital, York, a Sister Ann was described in 1276 as a medica. But women were excluded in the later Middle Ages, marginalized by professional conflicts and guild restrictive practices. In 1421, the English physician Gilbert Kymer and his cronies petitioned Parliament to ban women from practising. The limitation of medical and surgical practice to those who had received a university training or were enrolled in a guild tended to confine women to nursing, midwifery and home physic.

      Control of midwifery became more common from the fifteenth century. The Papal Bull of 1484 denouncing witchcraft drew attention to alleged attacks by sorceresses on virility and fertility; in their viciously misogynistic Malleus maleficarum (1486) [Hammer of Witches], the Dominicans Henricus Institoris (Heinrich Kramer, fl. 1470–1501) and Jacob Sprenger (fl. 1468–94) accused midwives of murdering babies in the womb, roasting them at sabbaths or offering them to the Devil. There is little evidence, however, that female healers were charged with witchcraft.

      Medieval authors on sex and childbirth (or ‘generation’ as the subject was known) drew on a variety of traditions: Aristotle, Galen, Soranus and the Bible. The standard view was that men and women shared a common physiology, but in perfect and flawed versions. Female generative organs were like those of men, but inverted and inferior – the vagina was an inverted penis which had never fully developed. Thus, the female form was a faulty version of the male, weaker, because menstruation and tearfulness displayed a watery, oozing physicality; female flesh was moister and flabbier, men were more muscular. A woman’s body was deficient in the vital heat which allowed the male to refine into semen the surplus blood which women shed in menstruation; likewise, women produced milk instead of semen. Women were leaky vessels (menstruating, crying, lactating), and menstruation was polluting.

      De secretis mulierum [On Women’s Secrets] spelt out the harmful effects of menstruation:

      women are so full of venom in their time of menstruation that they poison animals by their glance; they infect children in the cradle; they spot the cleanest mirror; and whenever men have sexual intercourse with them, they are made leprous and sometimes cancerous.

      The womb was an unstable organ, making women less balanced than men. Social consequences followed from these physiological teachings. According to the instigator of the Reformation, Martin Luther (1483–1546),

      Men have broad and large chests, and small narrow hips, and more understanding than women, who have but small and narrow breasts, and broad hips, to the end they should remain at home, sit still, keep house, and bear and bring up children.

      Controversies flared among doctors, philosophers and theologians over the gendering and engendering of the body. The roles of the male and female in fecundation were disputed, as Aristotle’s distinction between superior male ‘form’ and inferior female ‘matter’ (seed and seedbed), clashed with the Galenic theory of the confluence of male and female semen to make a baby. Such niceties could have weighty implications: how, for example, had the Virgin Mary conceived Christ – was it from menstrual blood, or was such blood a waste product? Contrasting explanations could also be given regarding the means and the moment of the soul’s entering the foetus.

      In the later Middle Ages, medical and Christian views cross-fertilized at many points as the body assumed heightened significance in the humanistic theology of the times. While some, like the early Church Fathers, still viewed it as the prison of the spirit, new emphasis came to be placed on the soul’s incarnation in the flesh, the doctrine of immanentism. In the consecration of the host in the eucharist, the bread was transubstantiated into Christ’s body, turning miraculously to flesh. There was similar stress on bodily resurrection at the Last Judgment. In Catholic rituals, a saint’s power was associated with relics of the body: a hallowed bone, tooth or toenail protecting against evil; hence the booming relics business.

      BODIES

      Theological concerns loomed large in readings of the body, yet medicine too was concerned with the implications of the theory of embodiment and the soul. Scholastic medicine subscribed to the Chain of Being or Scale of Nature, with man as the midpoint between angels and brutes, distinguished from the beasts by possession of a rational soul. One consequence of this doctrine was that, considered in a purely physical light, the human body could be described in the same terms as that of a pig or a monkey. Belief in such a continuum of creation explains why the earliest medieval anatomies, conducted at Salerno and Bologna, could be performed on animals: the human soul was unique, so similarities between human and animal cadavers were not theologically worrying.

      The first recorded public human dissection was conducted in Bologna around 1315 by Mondino de’ Luzzi (c. 1270–1326). Born into a medical family, Mondino graduated at Bologna, and rose to a chair of medicine there. His fame rests on his Anatomia mundini (c. 1316), which became the standard text on the subject. Built on personal experience of human dissection, the Anatomia was a brief, practical guide, treating the parts of the body in the order in which they would be handled in dissection, beginning with the abdominal cavity, the most perishable part. Relying on Galen and the Arabs, the Anatomia perpetuated old errors derived from animal dissections, such as the five-lobed liver and the three-ventricled heart. Mondino’s achievement derived from his intuition that the developing university-based education of his day required an introductory anatomy manual. The first printed version appeared in 1478, followed by at least forty editions – a clear recognition of how central anatomy was becoming to medical expertise.

      Hitherto anatomy had played little part in medical education; it had no place in the Articella or the medical school of Salerno, though pigs had been dissected there. But from Mondino’s time learned physicians began to enunciate the view that medicine should be anatomy-based. Thereafter academic physicians gloried in public displays of human dissection and anatomy theatres were built. Dissection was justified largely in terms of natural philosophy and piety (the body demonstrated the wisdom of the Creator); the surgical benefits were rarely mentioned – clear evidence of the professional function of physicians’ anatomical knowledge.

      Various factors contributed to the rise of human anatomy, among them Galen’s prestige (after all Galen had prided himself upon his dissecting abilities). Tampering with human remains was far from unknown in medieval Christendom. The wish to bring dead crusaders back from the Holy Land for burial had led to the custom of boiling up bodies to leave only the bones, and to the preservation of the heart of the deceased. Though this practice was condemned by Boniface VIII in 1300, the papal ban proved ineffective. From around 1250, autopsies also became regular in Italian, French and German towns, with surgeons called in to investigate homicide and establish cause of death. The step from a coroner’s postmortem to dissection was small.

      Public dissection was spectacle, instruction and edification all in one. The corpse would be that of an executed criminal, presupposing municipal cooperation. It was sometimes staged in a church, usually in winter, since cold slowed putrefaction. Mondino’s order of dissection of the three main bodily cavities – first the lower abdomen, then the thorax and the skull – was designed with decay in mind. In illustrations of dissections, a physician resplendent in academic robes sits on a throne, intoning from a Galenic anatomical text, while a surgeon slits the cadaver with his knife, and a teaching assistant points out notable features. Whether or not dissections were actually conducted in this way, what is conveyed is the ritual of the performance: religious, civic, and university authorities agreed that the occasion must be accorded due gravity.

      Book-driven anatomy – a demonstration of what was already known, within the explanatory framework of learned medicine – served many purposes, providing guidance to the student, who would not have been able to see much for