Trota, the medic of Salerno
Folk remedies are as old as humankind, as old as speculation on how our bodies and minds function, stay healthy, fail and heal. At times, concentrations of expertise and interest in medicine and philosophy have propelled the study and treatment of human diseases onto a new plane.
In eleventh- and twelfth-century Italy, specifically in the city of Salerno, southeast of Naples, such a concentration produced a famous medical treatise called Trotula. Trota, the local woman’s name from whom the Latin title derives, was a celebrated practitioner of medicine.Salerno was a magnificent city, founded by incoming Lombards from the north in the eighth century, taken and expanded by Normans in the eleventh: a melange of Christian, Jew and Muslim and of Latin, Greek, Hebrew and Arabic learning; rich in produce, architecture and intellect. Like Cordoba, it enjoyed access to the riches of Europe, Africa and Arabia: precious herbs and spices; the bounteous wheat harvests of Sicily; the words of the ancients. Its many bath houses were fed by aqueducts from the surrounding hills. Of its nine monasteries, three were convents for women. In the late eleventh century its archbishop, Alfanus, claimed that in his youth
Salerno then flourished to such an extent in the art of medicine that no illness was able to settle there.
We know nothing of the life of Trota herself except for the texts that bear her name: Practica secundum Trotam (Practical Medicine According to Trota)§ and Trotula, of which the central third, seemingly dictated to a scribe, contains De curis mulierum (On Treatments for Women), now directly ascribed to Trota. Two much better-known writers of the twelfth century, Orderic Vitalis and Marie de France, tell the story of a Norman or French visitor to Salerno who found a woman there ‘very learned in medicine’.
Trota’s medicine was free of much of the philosophical and moral dead weight informing many other classical treatises, which pictured diseases as functions of character or of fundamental human types after the second-century Greek physician Galen’s theory of humours.
Her treatments were largely empirical, the practices of what we would nowadays call frontline medics: women who visited, consulted and treated women – and sometimes men, too. The majority of the city’s physicians were male, and there is a strong sense that they were reluctant to confront many of the more intimate ailments so commonly suffered by women: that is to say, infertility and obstetric, gynaecological and urogenital conditions. Trota’s work addresses all these; it also includes advice on skin conditions, the whitening of teeth and anti-ageing creams – some of them containing toxic substances like lead, which is deleterious in the long term, if effective in the short term.Despite her freedom from the encumbrance of classical theory, Trota believed that women conformed to one of two essential physiological types, which guided treatment on the basis of contraries – that is to say, by correcting perceived imbalances…
In order that we might make a concise summary of the treatment of women, it ought to be noted that certain women are hot, while some are cold. In order to determine which, one should perform this test…7
The test in question involved the insertion of a cloth, anointed in certain oils and herbs, into the vagina and observation of the results. To that extent, it might be called diagnostic; but it’s not something to try at home. More practical – and Treatments for Women is nothing if not practical – is this advice ‘On those giving birth with difficulty’:
We should prepare a bath and we put [the woman] in it, and after she leaves [the bath] let there be a fumigation of spikenard [an essential oil derived from the highly aromatic Nardostachys jatamansi] and similar aromatic substances. For strengthening and for opening [the birth canal], let there be sternutatives…8
Sternutatives – in this case, an extract of the plant white hellebore (Veratrum album) – are substances that induce sneezing. Now, as it happens – and the clinical evidence comes from the effects of white hellebore used in the early twentieth century as a sneezing powder – this plant’s root contains a toxin that, in large doses, paralyses the nervous system with potentially fatal consequences.
The idea of sneezing and then having the muscles relaxed sounds alarmingly risky, if possibly effective, in easing the physiological pain of birth.Straightforward, uncomplicated delivery is not covered in the treatise. Monica Green, the scholar who has produced the definitive text and analysis of the Trotula manuscripts, argues that this is an indication of her audience’s – that is, female medics’ – familiarity with midwifery. Trota reserves her advice for interventions in what she calls the ‘dangerous things’ that happen when women give birth – perineal tearing, for example: to be sewn up with silk thread and smeared with pitch. There is, then, an empirical understanding here of the danger of infection.
Only once are Trota’s readers offered clinical, if anecdotal, evidence of her personal success. It concerns the case of a woman suffering pain, as if from a uterine rupture
Whence it happened that Trota was called in as a master of this operation when a certain young woman was about to be operated on for a windiness# of this kind as if she suffered from rupture, and she was thoroughly astonished. Therefore, she made her come to her own house so that in secret she might determine the cause of the disease. Whereupon, she recognised that the pain was not from rupture or inflation of the womb but from windiness. And so she saw to it that there be made for her a bath in which marsh-mallow [Althaea officinalis] and pellitory-of-the-wall [Parietaria officinalis] were cooked, and she put her into it. And she massaged her limbs frequently and smoothly, softening them, and for a long time she made her remain in the bath. And after her exit, she made for her a plaster of the juice of wild radish and barley flour, and she applied to her the whole thing somewhat warm in order to consume the windiness. And again she made her sit in the above-mentioned bath, and thus she remained cured.9
It is striking, in this unique passage, that Trota’s skills were not confined to diagnosis and treatment. There is a substantial element of nursing care – not to mention humanity and compassion – in the account. Trota’s career cannot have been unique: it must stand for the thousands of women who, unacknowledged by history, practised midwifery and nursing care in all cultures.∫