In her 2008 study of medieval gynecology, Monica H. Green centres her focus on a set of texts from twelfth century Salerno known as The Trotula. Its authorship, as Green discusses, has been attributed to Trota of Salerno, a figure that has drawn much debate around the details of her life and the realities of her existence. The story of her life describes a female healer living in Salerno during the height of its medical school (Schola Medica Salernitana) and on the eve of the creation of the Kingdom of Sicily by Roger II in the 1130s. Whether she existed in reality or in legend, Trota’s story and medical thinking raises important questions about the multilingual and multireligious nature of Salerno as a Mediterranean city at the crossroads of Islamic, Christian, and Jewish learning during the supposed “Renaissance of the Twelfth Century.”^[1] Chiefly, what can The Trotula and the culture of Salerno tell us about cultural exchange and medical thought between Islamic and Christian physicians and natural philosophers in the Mediterranean world in the central Middle Ages? ^[2]

To do so, we must first begin with Trota herself and why her personhood has been doubted by medieval scholars since the late Middle Ages. This problem lies in the manuscript copies of The Trotula itself since only one of its now three books, De curis mulierum (On the Treatments of Women), circulated with Trota’s name attached to it in the twelfth century. By the end of the century as the text migrated outside of Southern Italy, two other related works, De ornatu mulierum (On Women’s Cosmetics) and Liber de sinthomatibus mulierum (Book on the Conditions of Women), that were not originally in circulation without an author’s name attached, were now attached to De curis mulierum in a compendium that we now call The Trotula. Due to this manuscript mix up, Trota is now credited as the author for all three works. Whether these last two texts on women’s cosmetics and their medical conditions were Trota’s or not remains unclear since we can only know for certain that her original work on the treatments of women was written and circulated from her scriptorium. Where, then, did these other works come from and why do we still think of them as part of the The Trotula?

The answer to this question remains difficult to discern since we do not have the identity of any additional writers or know where these texts originated. One working theory that Green describes in her monograph and translation of The Trotula is that the text was a combination of texts written by male physicians in Salerno under the pseudonym of Trota of Salerno. This theory suggests that Trota did not actually exist, or if she did, her texts survive through the work of male physicians working with her. The idea that Salerno could have a female healer in the twelfth century was not uncommon since in the Mediterranean world and other parts of Western Europe, women often worked as healers in their villages. The only difference between these women and male physicians was that physicians were university trained and had a medical licence. Women could not enter universities or obtain medical licences, so much of their healing work took place in their own homes or in their villages. Whether Trota existed or if her works were authored by others does not take away from the importance of The Trotula for understanding Salerno as a centre of medicine and how it served as a multicultural hub of learning for centuries. Trota, as a historical or legendary figure, is one of hundreds of examples of healers and physicians that worked in Salerno’s medical school and transformed it into a site of medical knowledge that those that wished to train as physicians would travel to from across Europe and the Mediterranean.

Map of Southern Italy and Salerno in the mid-twelfth century.

Source: Wikimedia Commons

Due in part to its location on the Tyrrhenian Sea and in close proximity to the County of Sicily and North African coasts, the Schola Medica Salernitana drew on a rich tradition of medical texts in Latin and Arabic from thinkers such as Galen, Hippocrates of Cos, Aristotle, Constantine the African, and others. The use of Arabic texts in Salerno’s medical school set it apart from other university centres in medieval Europe such as Oxford University, the University of Paris, and the University of Montpellier, since their medical training only drew on Latin language scholarship. The use of Arabic texts was thanks, in part, to the translation work of an eleventh century thinker from modern Tunisia, Constantine the African (d. circa 1098), who travelled to and lived in Salerno and nearby Monte Cassino where he translated the works of Al-Razi,  Ibn Imran, Ibn Suleiman, Ibn al-Jazzar, and many others, from their original Arabic into Latin. His translations were used as textbooks in Salerno and elsewhere for centuries to come. Constantine’s translation work and his own authored texts such as De Coitu (On Sex) brought Islamic medicine and thinking about the body to Western audiences and shaped the training of the city’s physicians. Trota, imagined or historical, drew on this tradition in The Trotula as the text is the first text written in Latin to directly engage with gynecology from the perspective of a female healer and to incorporate the perspective of Muslim women living in the city. In the twelfth century, broader Latin thinking about the body and female medicine suggested that female bodies were imperfect versions of male bodies and that as a result, female sexuality and gynecology needed to be restricted by physicians. Only women could serve female patients and understand their medical needs.

Constantine the African as he appeared in a fourteenth

century manuscript (Bodleian Library, MS. Rawl. C. 328, fol. 3r, Wikimedia Commons)

In the context of binary thinking about bodies and the confines of medical practice in Salerno, Trota’s understanding of medicine and practice on her patients existed in the context of Christian thought about the role of the physician and Islamic texts that transformed Western understanding of anatomy. In her discussion of female cosmetics, Monica Green argues that Trota’s understanding of the female anatomy and how to treat its ailments stems from Islamic thinking about herbs and their medicinal properties. Green argues that in the De ornatu mulierum “the author of Women’s Cosmetics introduces several of the remedies as being the practices of Muslim women: a depilatory used by noble Muslim women, a tried-and-true recipe for dyeing the hair black, a lead-based preparation named for its Muslim origin, a marine plant that the Muslims use to dye skins violet, and the redolent water to cleanse the genitalia.”^[3] The author of this text, whether they be Trota or a group of physicians, understood the treatment of and workings of female bodies through their multicultural perspective due to Trota’s understanding of Arabic scholarship and her interactions with Muslim patients. Considering Christian doctors farther north in cities such as Paris and Oxford understood female bodies through the medical and theological writings of men like Hippocrates of Cos, Galen, Aristotle, Peter Damian, and many others, the cultural perspective of their counterparts in Southern Italy factored in a variety of treatments to treat their patients of a variety of religious and linguistic backgrounds – Islamic, Christian, and Jewish.

What, then, should Trota’s story and the precarities of her existence tell us about the medical culture in Southern Italy in the Middle Ages? The nature of her story, her text, and the position of other thinkers such as Constantine the African should highlight to modern people that the medieval medical context was not static, nor was it reliant on a linear Christian perspective. Physicians that travelled to Salerno were trained in the context of both Latin and Arabic texts and the medical traditions of two cultures. To fully understand The Trotula and the politics surrounding Trota’s identity as a part of a Latin tradition, we must all understand her and her world as a part of the Islamic medical tradition and the thinking of physicians from around North Africa, the Near East, and Southern Italy.  

A leaf from a thirteenth century Arabic text from Baghdad

depicting a physician making honey (The Metropolitan Museum of Art. 13.152.6 Rogers Fund, 1913, Wikimedia Commons)

Title Image: A manuscript illustration of Trota of Salerno, the female physician thought to have written the Trotula in thirteenth century Salerno. Source: Wikimedia Commons

Bibliography and Further Reading:

Cotts, John D. Europe’s Long Twelfth Century: Order, Anxiety, and Adaptation, 1095-1229. Basingstoke: Palgrave Macmillan, 2013.

Ferraris, Zoë Alaina, and Victor A Ferraris. “The Women of Salerno: Contribution to the Origins of Surgery from Medieval Italy.” The Annals of Thoracic Surgery 64, no. 6 (1997):1855–1857.

Green, Monica Helen. Making Women’s Medicine Masculine the Rise of Male Authority in Pre- Modern Gynaecology. Oxford: Oxford University Press, 2008.

Green, Monica Helen. The Trotula an English Translation of the Medieval Compendium of Women’s Medicine. Philadelphia: University of Pennsylvania Press, 2002.

Jaeger, C. Stephen. “Pessimism in the Twelfth-Century ‘Renaissance.’” Speculum 78, no. 4 (2003): 1151–1183.

Lugt, Maaike van der. “The Learned Physician as a Charismatic Healer: Urso of Salerno (Flourished End of Twelfth Century) on Incantations in Medicine, Magic, and Religion.” Bulletin of the History of Medicine 87, no. 3 (2013): 307–346.

Melve, Leidulf. “‘The Revolt of the Medievalists’. Directions in Recent Research on the Twelfth-Century Renaissance.” Journal of Medieval History 32, no. 3 (2006): 231–252

Pormann, Peter E., and Emilie. Savage-Smith. Medieval Islamic Medicine. Washington, D.C: Georgetown University Press, 2007.

Ragab, Ahmed. The Medieval Islamic Hospital: Medicine, Religion, and Charity. New York: Cambridge University Press, 2015.

Skinner, Patricia. Health and Medicine in Early Medieval Southern Italy. Leiden: Brill, 1997.

Verskin, Sara. Barren Women: Religion and Medicine in the Medieval Middle East. Berlin: De Gruyter, 2020.

[1] For more recent work on the “Renaissance of the Twelfth Century” and the debate about its role in twelfth century historiography see: Melve, Leidulf. “‘The Revolt of the Medievalists’. Directions in Recent Research on the Twelfth-Century Renaissance.” Journal of Medieval History 32, no. 3 (2006): 231–252; Jaeger, C. Stephen. “Pessimism in the Twelfth-Century ‘Renaissance.’” Speculum 78, no. 4 (2003): 1151–1183; John D. Cotts, Europe’s Long Twelfth Century: Order, Anxiety, and Adaptation, 1095-1229 (Basingstoke: Palgrave Macmillan, 2013).

[2] Monica Helen Green, Making Women’s Medicine Masculine the Rise of Male Authority in Pre-Modern Gynaecology. (Oxford: Oxford University Press, 2008).

[3] Monica Helen Green, The Trotula an English Translation of the Medieval Compendium of Women’s Medicine. (Philadelphia: University of Pennsylvania Press, 2002), 47.