The Medieval Review 09.10.26

Green, Monica H. Making Women's Medicine Masculine: The Rise of Male Authority in Pre-Modern Gynaecology. Oxford, UK: Oxford University Press, 2008. Pp. 409. $120 978-0-19-921146-4. .

Reviewed by:

Sally Crawford
Oxford University

Women's bodies have been, and still are, a battleground for control: a central place for testing and demonstrating rights, taboos, and restrictions. Knowledge, the right to know things, is also a matter of control, restriction, taboo, and access. The relationship between knowledge of medicine, anatomy, writing, and knowledge of women's bodies, has always been--and still is--complex, gendered and multi-layered. It is the history of this complex, gendered relationship, and the ultimate victory of men in the fight for authority over knowledge of women's bodies from the twelfth to the sixteenth century, that Monica Green tackles in this volume.

It might seem apparent that women should have greater knowledge of their own bodies than men, and that women should be acceded authority over men in women's healthcare. Social mores might also inhibit masculine access to knowledge about women's bodies: the fact that the organs most specifically involved in women's key physiological functions were also the sex organs "posed no small problem for the cross-sex practice of women's medicine" (p. xi). One solution, exemplified by the work of the twelfth-century female practitioner, Trota of Salerno, was for women to write about women's medicine for other women. Unfortunately, as Monica Green demonstrates, vanishingly small numbers of books on women's medicine can be shown to have been owned by women, and, from the twelfth century onwards, women's authority in knowledge of their own bodies was increasingly challenged and marginalized as "authority" was defined through texts. Access to written knowledge was more readily available to literate men than women, and the rise of universities ensured significant exclusion of women from any professional authority in the field of medicine. However, even if written knowledge of women's bodies was available to men, how did they practice medicine on women they were prevented, by social taboo, from seeing or touching in the flesh?

One option was for a (male) doctor to give instruction to an unlearned woman when it came to treating or touching the body. By careful analysis of the fate of Trota's text and reputation, Monica Green offers a convincing argument to show that even copies that were originally intended for a female audience were regularly rewritten for users who no longer actively participated in treatments ("apply this to the women"), but who gave instructions, as men, to a third (female) party ("let this be applied").

Even when men had knowledge of women's disease, however, this knowledge did not necessarily benefit either the woman or medicine. Where women's private parts were matters of intense taboo, even to be ill brought shame. The problem was exacerbated by the attitude of some masculine readers to this "secret" knowledge--like a schoolboy's volume of Lady Chatterley's Lover, Monica demonstrates, through a volume of "women's medicine" now at Winchester College, unpleasantly annotated by several fourteenth and fifteenth century readers, that books on women's medicine would happily fall open through frequent use at the most "titillating" pages (on conception and contraception), while the rest went unread and unconsulted. Furthermore, the use to which texts about women's medicine were put might not even have had care of women as their primary motive: lay male interest in gynaecology was in part sponsored by the growing concerns of landed gentry and nobility to ensure successful provision of sons to inherit their estates. Monica Green offers a depressing story of how consistently knowledge of women's bodies was perverted, and texts which were written with the intention of helping women were recontextualized by misogyny. A constant theme in the history of women's medicine, and one which is still current, is women's reluctance, through shame or embarrassment, to reveal their own ill-health.

All this is amply demonstrated as Green painstakingly tracks the development of the text called the Trotula in its various disguises, copies and influences across Europe. Country by country, period by period, she explores ownership, transmission, translation, and contextualization of the Trotula, as "women's medicine" becomes "women's secrets"--male readers are using these books to ensure that they have knowledge which will prevent women from deceiving them or controlling their own bodies; the texts have become a way for men to know about contraception and conception, to avoid being tricked by women. Tracking the minutia of the changes to the texts, Monica Green encapsulates the intimate relationship between the written word, masculine authority, and the exclusion of women in medieval society. By the time Chaucer was writing, his Wife of Bath was able to note with frustration that Trotula was just another text with which to oppress women.

As part of her text, Monica Green does refer to the various treatments offered to women for their diseases--heroic excisions, exercises, and potions have been administered to women over the centuries in the hopes of improving their health--but medicine itself--whether treatments worked, whether improvements were made in women's experience of medicine, whether a particular group of doctors offered more effective interventions, and the development of techniques which led to the modern practice of gynaecology--are not the subject of this study. For a reader without a medical qualification, it is occasionally distracting to be told of some intervention without being given any hint as to whether the intervention was effective. But, as Monica Green makes absolutely clear, this is not a study of medicine, but of how medicine and knowledge of women was gendered in theory and practice.

It might be thought that much of the story of women's medicine would be told through the activities and access to knowledge of midwives, but midwives are not the focus of this research, and appear only in parentheses. They, or women like them, are the ones who appear to carry out the instructions of the male doctor, touching and investigating the woman's body, until, in the fifteenth century, texts indicate consistent direct access for male doctor's to female bodies: the authority of male medical knowledge and professional status now transcended any social taboos. Green justifies her relative lack of detailed discussion about the knowledge of midwives by pointing out that it was not until the sixteenth century that there is good evidence that midwifery was treated as a profession in which training was required. Prior to that, midwives might be "elected", or their performance of care for sick or pregnant women was seen as "natural", rather than medical--women who intervened were "caring", while men were perceived as "curing". The sources indicate that when women blatantly transgressed the line between "care" and "cure", or if they challenged the medical authority of males, they were likely to find themselves in trouble. Green cites ample evidence to show that midwives were viewed (by male writers, at least) as ignorant and unqualified, and what is more, she argues, they never organized themselves into any professional group.

There may be a slight danger here of marginalizing the knowledge of midwives because the standard by which they are being judged as agents are male-gendered standards. The presence of women helping at pregnancies is attested by numerous illustrations, there must have been many women who had experiential knowledge of complications in childbirth and pregnancy, and many women gave birth without the aid of male supervision. Was their knowledge only gained by experience, or did women transmit information between themselves? Even if their knowledge was not written down, this does not mean that women did not claim and recognize special authority and knowledge, and indeed, the occasional cases that surface of a woman defending her right to practice (women's) medicine argue for a much wider practice of medicine by women which was neither recognized nor recorded by men, but, as such, cannot be accessed by historians.

As Green rightly points out, however, the existence of midwives in the middle ages, even if not as an organized professional group, is indicative of strong gendering of women's health care: obstectric practice was the purview of those who took care of uncomplicated births (women), while what was effectively gynaecology, though not articulated as a separate medical discipline during the medieval period, belonged to the field of male medical authority.

The story of the ways in which authority for women's medicine was claimed by men, in spite of much rearguard action by women in every century, is compelling. Green's breadth and depth of knowledge is deeply impressive, and her own authority in the field of the history of women's medicine is unquestionable. This is an outstanding achievement of scholarship, both in terms of the history of medicine, and as a major contribution to feminist literature.