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“To all grave and modest matrons”: Practical Midwifery and Chirurgery in De conceptu et generatione hominis (1580)
by Megan Guenther


Jacob Rueff’s De conceptu et generatione hominis, first published in 1554, occupied an intermediate space between medieval manuscripts on gynecology and 16th-century practical obstetric texts printed in vernacular languages and intended for mass markets. As such, it reflected the remnants of Renaissance society’s fascination with the medieval tradition of “women’s secrets.”1 Early medieval sources shared a common social view that women’s bodies and ailments were women’s affairs. Regardless of the sex of the authors, these texts invariably were narrated by feminine voices and were directed primarily to female audiences. Women’s bodily matters were considered secretive in a private sense. That is, when the feminine body was ailing in its general physical, cosmetic, menstrual, and reproductive functions, remedies were suggested within the confines of domestic knowledge.2 But in the late 14th and early 15th century, the notion of the “secret” started to change. New manuscripts began to concentrate specifically on women’s reproductive function, and the phrase “secrets of women” became associated primarily with gynecology. This marked a shift in focus from the female body’s general health to a focus on generation and birth. It was also accompanied by a gender shift. Women’s secrets, which had previously been sacrosanct feminine subjects, increasingly became a masculine preoccupation. 3

If previous manuscripts offered helpful remedies to soothe women’s suffering, these new works studied reproduction for theoretical gain, not practical application. Late medieval manuscripts devoted to revealing women’s secrets were intended for masculine audiences and no longer made any attempt to assume a sympathetic female voice. In fact by the 11th century medieval gynecological and obstetrical manuscripts were produced for and located in male homosocial environments–such as monasteries or universities. Instead of providing practical information to women themselves, these manuscripts reflected an increasing tendency to connect women’s secrets to the secrets of nature in a more general sense.4 By writing these manuscripts in Latin, the language of learned male readers, scholars further guaranteed a limited audience of secret sharers. In addition, as long as manuscript production and copying required specialized skills, time, and talent, only a select portion of society could afford the means to produce or collect such valuable items. And when vernacular translations of these texts started circulating throughout Europe, this secretive knowledge inevitably attracted an audience even larger than the scholarly community.

One might describe De conceptu as a contribution to the tradition of women’s secrets, but it actually occupies an intermediate position between medieval secret literature and practical early modern printed texts intended for larger audiences. Rueff’s book contributed to the explosive growth in 16th-century printed vernacular texts that broadcasted secrets of all varieties to many different readers. As a translator, Rueff transformed current scholarly theories about conception and women’s anatomy into a language and idiom familiar to his midwife and surgeon dedicatees.5 Midwives, who were banned from the university system because of their sex, turned particularly to vernacular printed texts, folk remedies, and informal apprentice relationships to acquire the information and experience necessary to practice their trade.6
Figure 1


Although Rueff addresses both midwives and surgeons in De conceptu, he also directs specific parts of the manual to each individual group. In particular, his discussion of attending to women in labor divides his readers by gender. Earliest medieval evidence suggests that social conventions surrounding privacy prevented men, even those with medical training, from touching the genitalia of unfamiliar women.7 This tradition of tactile privacy persisted into the early modern period. As a result, instead of using their hands, early modern physicians and surgeons relied on medical tools such as the speculum to prevent direct contact with women during birth. In contrast, midwives believed that the physician’s instruments caused women more pain than the skilled hand, and they regularly relied on their sense of touch to determine the infant’s placement in the mother’s womb.8

The beginning of the 1580 edition of De conceptu includes a vivid image of the traditional birthing room that reflects both women’s manual role and men’s theoretical and technological participation in childbirth (Fig. 1). In this image we see a laboring woman tightly grasping the handles of her birthing stool while two additional women support her on either side. The midwife sits on a low stool below the mother with her back to the viewer and her hands hidden beneath the mother’s skirt. While the women sit in the foreground of the image, two men stand in a recessed corner at an open window with astrological charts. Their attention is not directed towards the mother and her attendants, but towards the night sky and the planets that will determine the arriving infant’s place in the cosmological order.9

If Rueff echoed ancient and medieval images and texts throughout De conceptu, he also drew upon the most current anatomical representations of female anatomy. In his illustration of a seated female figure (Fig. 2), he directly quoted Vesalius for the anatomist’s description of the reproductive organs, yet also recalled years of traditional medieval assumptions by including representations of the human uterus adorned by horns. Rueff described these as “on the right and left side, two hornes as it were...called ligaments or binders of the Matrix with which it is bound, fastened, and basted....10 In addition, he stated mistakenly that the urinary tract meets with the vagina so that both urine and children exit the female body through the vagina. Of course, Vesalius himself made the same error. According to Book Five of Vesalius’s De humani corporis fabrica, “a small, thin portion of the vagina grows out on either side to the sides of the insertion of the neck of the bladder...Just as the vagina readily admits urine, those hanging processes prevent urine or other material from regurgitating into the neck of the bladder.”11

Figure 2
De conceptu also reflects Rueff’s close reliance on Galenic notions of gender, as explained in both Soranus and the Trotula.12 Like many 16th-century writers, Rueff believed in Galen’s theories of humoral medicine. He espoused the notion that heat determines the sex of the fetus and that conception required the intermingling of both male and female seed. Because they embraced humoral theory, Soranus, the anonymous Trotula authors, and Rueff all identified menstruation as a necessary purgative to cleanse women of excess humors that were not burned off in sweat or hair due to women’s natural cold and moist state.13 In this, all three authors embraced the Galenic notion that women were simply imperfect versions of men–that is, rather than two sexes, men and women were seen as variations of a one-sex model. Along these lines, Rueff describes the ovaries as comparable to the testicles.

By the 18th century, interest in scientific empiricism and the institutionalization of birth and reproduction signaled the beginning of the decline of the midwife’s role in society and the birth room. The two hundred years following the publication of De conceptu witnessed a long and bitter gendered fight for jurisdiction over birth. Although both midwives and their new male competitors flooded the late 17th-century print market with rivaling texts supporting both sides of the midwifery debate, by the 18th century male physicians gained the social upper-hand in the midwifery dispute and assumed a dominant authoritative position in all gynecological and obstetric matters. 14

1. According to William Eamon, the early modern secret was “packed with its ancient and medieval connotations: the association with esoteric wisdom, the domain of occult or forbidden knowledge, the artisan’s cunning, the moral injunctions to protect secrets from the ‘vulgus,’ and the political power that attended knowledge of secrets” Eamon Science and the Secrets of Nature: Books of Secrets in Medieval and Early Modern Culture (Princeton: Princeton University Press, 1994), p. 5. Continuing the medieval obsession with hidden information, early modern printers paradoxically titillated mass audiences with the lure of secretive knowledge accessible only to select audiences.
2. Monica H. Green, “From ‘Diseases of Women’ to ‘Secrets of women’: The Transformation of Gynecological Literature in the Later Middle Ages,” Journal of Medieval and Early Modern Studies 30, no. 1 (Winter 2000): 7-10.
3. Green, Ibid., pp. 5-6.
4. Green, Ibid., pp. 13-15. See also, Monica H. Green, “Women’s Medical Practice and Health Care in Medieval Europe,” Signs 14, no. 2 (Winter 1989): 457-458; and Monica H. Green, ed. and trans., The Trotula: A Medieval Compendium of Women’s Medicine (Philadelphia: University of Pennsylvania Press, 2001), 148.
5. Rueff wrote, “my labours I bequeath to all grave, modest and discreet women, as also to such as by profession, practice either Physicke or Chirurgery.” Jacob Rueff, The Expert Midwife or An Excellent and most necessary Treatise on the Generation and birth of Man (London: Printed by E.G. for S.B., 1637), A4-A5.
6. Lynne Tatlock, “Speculum Feminarum: Gendered Perspectives on Obstetrics and Gynecology in Early Modern Germany,” Signs 17, no. 4 (Summer 1992): 732.
7. Green 2001, 14; Tatlock, Ibid., 733.
8. Tatlock, Ibid., 758.
9. P.M. Dunn, “Jacob Rueff (1500-1558) of Zurich and The Expert Midwife,” Archives of Disease in Childhood, Fetal, and Neonatal Education 85 (2001): 223; Tatlock 725-757.
10. Rueff 1637, 52; For a direct comparison of the Ryff and Rueff images, see Thomas Laqueur, Making Sex: Body and Gender from the Greeks to Freud (Cambridge: Harvard University Press, 1990), 89.
11. Andreas Vesalius, De humani corporis fabrica, book V, chap. 15 “On the uterus,” Daniel Garrison, trans. (forthcoming, Thoemmes Press). For a similar quote about the placement of the “urine-pipes,” see Rueff 1637, 46. For additional discussion about the bladder and vagina positions in medieval discourse, see Joyce E. Salisbury, ed., Sex in the Middle Ages: A Book of Essays (New York: Garland Publishing, Inc., 1991), 61.
12. Falsely attributed solely to Trotula of Salerno, the Trotula was in fact a manuscript collection of medieval texts written by multiple authors (one of whom may have been Trotula herself). See Green, 2001, op. cit. Soranus was a 2nd century C.E. Greek physician from Ephesus. He was attributed with having written a text entitled Gynecology that was known in the Middle Ages through an illustrated 6th century manuscript associated with a writer named Moschion. See the Introduction to Soranus' Gynecology, trans. Owsei Temkin (Baltimore: Johns Hopkins University Press, 1956).
13. Audrey Eccles, Obstetrics and Gynaecology in Tudor and Stuart England (Kent, OH: Kent State University Press, 1982), 20-44; Green 2001, 73; Rueff 1637, 9-11. For a more detailed explanation of menstruation in medieval Europe, see Joan Cadden, Meanings of Sex Difference in the Middle Ages: Medicine, Science, and Culture, (Cambridge: Cambridge University Press, 1993), 173-176.
14. Adrian Wilson, The Making of Man—Midwifery: Childbirth in England, 1660-1770 (Cambridge: Harvard University Press, 1995), 1.

 

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