Trotula's funeral procession from Salerno

Monastic medicine.

But to understand the story of Trotula, we need to delve into the mysteries of the world and medicine of the early Middle Ages: it was at the beginning of the 6th century when everything had been razed to the ground by barbarians from the east, when buildings, civilization and culture no longer existed, that Benedict of Nursia appeared.[1] In his life and in his rule, he embodied the revolutionary concept of charity, and affirmed the principle of original conduct towards those who suffer or are ill[2] a principle hitherto unknown in a Roman world that regarded compassion as a weakness. He set up a monastery on Monte Cassino, the embryo of a monastic order that was to fertilize the whole of Europe (the Benedictines), and also... a hospital: "Everything must yield to the care we are obliged to take of the sick, and we must believe that it is truly Jesus Christ whom we are serving in their person. It was around this time that the hospital was born in the Western world, formalized by the Council of Orleans in 549 under the name domus dei[3]. So, whether in monasteries or in fledgling hospitals, whether wearing cassock or coule, care for the sick was essentially provided by clerics. For historians, this period of the early Middle Ages is therefore defined as that of "monastic" medicine, as the common people could only consult clerics for their ailments.

Over the following centuries, Western Europe regained some stability thanks to the omnipotence of the Church and the feudal system it fostered. But the world of knowledge remained confined to the convents, whereas it exploded across the Mediterranean into all strata of society.

One exception: the secular medical school of Salerno.

So it was that in Salerno, like a mushroom after a rainy night, a medical school sprang up, founded in 802 by four mythical masters: a Jew, a Greek, an Arab and a Latin, each teaching in his own language. This legendary birth contains a symbolic truth, with Salerno asserting itself as a political, commercial and cultural crossroads, receiving currents from the Mediterranean (Byzantine, Jewish and Arab worlds) while at the same time undergoing influences from Northern Europe (presence of the Lombards, arrival of the Normans). As the first medical school in the Western world, Salerno foreshadowed the future faculties that would not appear until 1137 (Montpellier). Students from all over Europe were already flocking to this free, secular city, which they dubbed "civitos hippocratica", where both surgery and medicine were practiced.

It was in these places, whose excellence was quickly recognized, that Trotula's beauty and talent were to express themselves. The daughter of a wealthy family, she married a doctor, Jean Platearius, who taught at the Salerno School. Yet, like all women of her time, she was subject to the traditions of the Lombards who ruled the region. A woman was under the guardianship of a man, first her father, then her husband; when widowed, she passed under the guardianship of her son, if he was an adult, or of another male relative. When she marries, she brings her dowry and receives a quarter of her husband's land, but she can only use his property with his permission. A woman's life depends on her seductive powers and her ability to bear children, unless she chooses religious life. Trotula wanted to help the women of her time, whose condition she judged unsatisfactory and precarious, and all her life, given the context, she would work in the service of femininity.

Since ancient Rome, girls could become doctors with the consent of their fathers or husbands. We don't know the relationship between Trotula and Jean Platearius, but we can assume that the latter was liberal, as his membership of the School of Salerno suggests, allowing her to study medicine there and then practice. This is not a first; other girls worked, studied and nursed in Salerno, and many others would follow the same path. To complete (and finish) what we know of our heroine's personal life, we can add that Trotula and Jean had two sons (Matthieu and Jean the younger) who became renowned surgeons. The rest is anyone's guess.

For Trotula is above all a work of art, a new way of looking at the women of her time. Her passion was to take action to limit the fragility of women in medieval society. Maternal and infant mortality during childbirth was terrifying. We only know the results for the royal families, where at least 50% of deaths are deplored, which suggests appalling figures for serfs and villains. For women, the ordeal is equally terrible, with hemorrhagic risks, puerperal infections and mechanical complications during expulsion. Dystocic presentations are often a death sentence for mother and child, as Caesarean sections are not yet widely practiced. As for gynecological diseases, they are of no interest to men, and the field is completely untouched.


The arrival of the African.


Educate yourself first! Trotula benefited from the books gathered at Salerno, which at the time constituted a treasure trove. She devoured Hippocrates, who devoted over 100 chapters to women's diseases and pregnancy; Aristotle's work was commented on every day in front of the students, giving rise to famous discussions. And then the monk Constantine arrived in Salerno, soon to be known as "the African" because of his world travels. He speaks every language, his knowledge is infinite, and he sets to work translating the great Arab physicians. Although he lives in the monastery of Monte Cassino, founded centuries ago by the great Abbot Benedict, he sometimes leaves the scriptorium to go to Salerno to meet up with his fellow teachers there. Trotula, the most inquisitive of them all, asks him about his experiences:

- Yes, girls are often doctors among the infidels. They are considered equal to boys and take the same exams as them. Yes, their hospitals are open to all patients, regardless of social class. Yes, they know how to make medicines and dose them precisely. Yes, their surgeons are skilled in cataract surgery. Yes, they also know the great Greek physician Galen, who synthesized all the medical knowledge of his time...

Trotula tortures the doctor-monk she admires so much, trying to extract all his knowledge from him. She knows that he has become the light of Salerno, and that through him, the School's reputation will spread around the world.

Women are already flocking to Trotula. They confide in her and talk to her for hours. Who could they confide in in this feudal world where their words are not even listened to? They want to be cured of their women's illnesses, to be told why some of them can't conceive, why their skin is losing its youthful glow... and so many other things they've never dared tell their husbands or confessors. Trotula's calm and beauty reassure them, and her calm voice answers all their questions without ever avoiding or ignoring them. The young woman also teaches medicine, while officiating in the nearby dispensary where opulent Lombard nobles, returning Crusaders and even foreigners passing through the town are treated.

And Trotula, defying the reticence of the literati, also tried her hand at writing and decided to compile all her[4]experiences by writing large treatises such as "De passionibus mulierum curandarum", which takes up and completes all Hippocrates' observations, mainly describing the physiological phenomena of menstruation and pregnancy. She shows that her Latin is perfect and can rival many others. Constantine, who liked her, encouraged her and congratulated her on her work. He introduced her to the work of Galen, who wrote extensively on menstrual disorders and the aftermath of childbirth. Other works followed, including "Traitement des femmes malades avant et après l'accouchement" (Treatment of sick women before and after childbirth), making up an extremely complete and well-documented bibliography. By way of introduction, she explains her purpose: "Since women are by nature weaker than men, they are consequently more prone to illness, especially in the parts devoted to the work of nature; and since these parts are in secret places, women, out of modesty and frailty of condition, dare not reveal to a doctor the anguish caused by these illnesses. This is why, moved by their misfortunes and at the instigation of a certain matron, I began to examine with attention these illnesses which very often strike the female sex."

Constantine the African admired this woman for her ability to write medical treatises, as well as for her determination and certainty in surgical procedures. First his pupil, he now considers her a master. It is he who describes her performing a Caesarean section to save a child's life, and in the words of the doctor-monk we hear admiration and respect. When a perineum explodes during childbirth, Trotula repairs it to avoid any residual pain or risk of fistula. As for medical treatments, she recommends pills, herbal teas and ointments in which medicinal plants, revealed to her by Constantine through the writings of Galen, play a key role.

For women.

Yet Trotula goes further than medicine. She also took on the aesthetic concerns of the women who consulted her. She wrote "De ornato mulierum", which can be translated as: how to make women beautiful. In it, she lists the make-up that gives skin its radiance, the ointments that protect it from the sun's rays, and all the delicacies that our ancestors adorned themselves with, giving us as much information on their little secrets as on what was fashionable in the 11th century. In her books, as in her life as a doctor, Trotula addresses all aspects of femininity, including psychological, aesthetic and sexual concerns. By asserting that women should not suffer in childbirth, and by not hesitating to give women opiates, she rebelled against the biblical principle that "Thou shalt give birth in pain". She didn't hesitate to assert that a couple's sterility could also come from the man, whereas at the time, it was always attributed to the woman. She was also interested in the sexual act, and sought to treat her patients' pain and repulsion.

Trotula was the feminist of the Middle Ages; she disturbed the men of her time, and would undoubtedly have been censured had she not benefited from the prestigious School of Salerno, a place of exception and tolerance, open to all discussions. The title "sapientissima" even suggests that, for a time at least, she was in charge of the School's destiny.

Her work remained popular and widely taught until the 16th century. Yet gradually, and until recently, the reaction of her eternal detractors used all kinds of arguments to diminish her merit, to the point of trying to make her forgotten [5]: "She was never a doctor but a matron who could never write a line... She was not alone and many others contributed to her work... It was not she who wrote her books, never could a woman have done so... A woman could not have had the temperament to wield surgical instruments... Or to conclude: Trotula is a legend, she never existed. "

Yes, today we can affirm that Trotula did exist. She lived in the 11th century, was a great physician, the first feminist of the Middle Ages, and undoubtedly the most beautiful woman of her time, as attested by the long, weeping procession that followed her remains along the roads of Salerno on that sad day in 1097...


[1] Saint Benedict.

[2] Vie et règle du patriarche Saint Benoit, p 59, Librairie Catholique, Clermont-Ferrand, 1848.

[3] Which of course became the "Hôtels-Dieu".

[4] The care of women's illnesses

[5] In 1985, John Benton considered that not only had Trotula never existed, but that there was no female author of gynecological texts from this period. Conversely, some have argued that these writings may have been attributed to a woman, to give them greater authority and authenticity, or simply to deflect the accusation of having ignored the taboo of observing female organs for centuries. American Monica Green began translating and publishing these texts in 1996. Since the 2000s, Trotula has been considered to have really existed, and the attribution of her works to men merely expresses the authors' antifeminism.