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The women of Salerno, also referred to as the "ladies of Salerno", the "Salernitan women", and the "mulieres Salernitanae", are a group of women physicians who studied in medieval Italy, at the Schola Medica Salernitana, one of the first medical schools to allow women.

Introduction

These women not only practiced medicine, but were known to both teach and to publish medical works. Additionally, there is evidence that the study of female diseases was not their only interest, but they studied, taught, and practiced all branches of medicine, indeed multiple references attest to the vital role they played in surgical and scientific achievements. It has been possible for them to assert themselves within Salerno thanks to a climate of great tolerance that extended itself from women practitioners as well as Jews and Arabs. In addition , during most of its lifetime, Salerno was the only medical school in Europe that opened its doors to women.

Women in medieval southern Italy and Salerno

Miniature depicting the Schola Medica Salernitana

In medieval southern Italy, Salerno was, in XI century, “city of extraordinary wealth and splendor for its trade, in which it had supplanted Amalfi and Gaeta. There were cedars, almonds, coated walnuts, imperial drapes, fine gold ornaments; wine, nuts, fruit, trees and crops abounded. Beautiful palaces adorned it; attractive women and upright men lived there" ( Guglielmo di Puglia, 190). To this wealth correspond glory and fame that doctors gave to Salerno, making it the best health care centre of Medieval Italy. In this political, social and cultural background, the women kept roots to the origins, shared the deeds of men, participated in battles and exercised the medical art, as doctor or not. Intellectual openness excluded dogmas and confronted with the daily practice of dialogue and experience, with the comparison of Greek, Latin, Arab texts that were studied without prejudices or hierarchies of value. In this climate, accepting women as students and even more as teachers seemed natural and important. Indeed, the remedies used by women are appreciated and welcomed in the writings of the  Schola Medica Salernitana. Matteo Plateario (1140-1180) mentioned the women of Salerno and their remedies: in the article “Bernix” is reported a cosmetic; in the article “Cyclamen” two recipes for haemorrhoids and for splenic diseases; in the article “Calamentum” an astringent for the uterus; in the article “Papaver” a sedative; in the article “Parietaria” a remedy for abdominal pain; in the article “Terra Sigillata” a recipe to overcome hair dryness; in the article “Tetrahit” a recipe for urination disorders.

Studies and methodologies

The women of Salerno were free to talk about sexual topics without moralisms or religious conditionings, in addition, their writings were some of the firsts to talk about menstruations.

During early years of 1000s, people were already talking about fundamentals modern values as prevention and healthy eating as a base for medical treatments. More generally, mulieres salernitanae preferred treatments like aromatized baths, therapies with erbs and massages, and there is no traces in their history of prayers or other sovrannatural methods in order to treat diseases.

Generally, Trotula's and the other women writings were the first studies on female body in medicine. They gave also many suggestions on surgery and how infertility could also be attributed to men and not only to women.

Fundamental for them was the history of the patient, in order to identify the right therapy, reading their works shows that they were not only deep acquaintances of the female body, but also had a high knowledge of plants and the benefits of herbs. They were innovative in many respects, considered prevention fundamental, proposed unusual methods for the time, stressed the importance of hygiene, a balanced diet, physical activity, their advice was easy to apply, were gentle treatments, which included baths and massages, decoctions, bloodletting, a range of proposals to remove ailments and pain. They have no fear of revealing truths never told and, to solve problems never solved, speak from woman to woman in a calm and safe, their lessons speak to us with extreme naturalness of sexuality, contraception using a simple language accessible to all.

Allegations of witchcraft

About the mulieres salernitanae there were also many rumours : an example is Arnaldo da Villanova, spanish scientist, who explained that women of Salerno drank mysterious potions during gestation and for this reason women grew aberrant, accompanying the recitation of the Pater noster with a mysterious magic formula:

"Binomie lamion lamium azerai vaccina deus deus sabaoth

Benedictus qui venit in nomine Domini, hosanna in excelsis."

These rumors were born due to the fact that, although the wealth and intellectual openness of the city of Salerno, early Medieval era represented also the start of prejudice towards women and theory of feminine inferiority. From the prejudice and the discrimination of women, the label of “witches” was born. Michelet (1862) stated “that the only doctor of the people, for a thousand years, was the Witch”, meaning that people of humble condition continued to consult and trust women’s recipes and remedies.

Despite these rumors of discredit, however, their fame grew, and at the same time also that of Trotula, whose name was linked, not only in Italy but also beyond the Alps.

Components

Trota of Salerno

These women included:

• Trota of Salerno – The most famous of the women of Salerno, Trota is believed to have lived during the 11th or 12th century. She had long been believed to be "Trotula of Salerno", the author of a 3-part book about medical treatments for women, De curis mulierum ("On Treatments for Women"). However, recent discoveries indicate she was likely only the author of one third of this compendium.
• Constance Calenda (15th century) – Lectured on medicine and was eventually a professor at the University of Naples.
• Rebecca Guarna – Published works on "Fevers, De febrius" the "Urine, De Urinis" and the "Embryo, De embrione".
• Abella – Published works on "Black Bile" and "Nature of Seminal Fluid"
• Maria Incarnata
• Mercuriade – Published works on "Crises", "Pestilent Fever, De Febre Pestilenti", and "The Cure of Wounds, De Curatio"

The first to remember the women of Salerno is a historian from Salerno, Antonio Mazza, prior of the School of Medicine in the seventeenth century, who in the essay "Historiarum epitome de rebus salernitanis" writes "We have many learned women, who in many fields surpassed or equalled by ingenuity and doctrine many men and, like men, were remarkable in the field of medicine". Among the most famous women who attended the school of Salerno we find also Francesca Cenci, wife of Matteo Romano Cenci, who received a degree in medicine and surgery from Carlo D’Angiò, Duke of Calabria, in 1321. Abella, from the noble family of Castellaneta, wrote “De atrabile” and “De nature seminis humani”, of which, unfortunately, any trace has been lost. Rebecca de Guarna specialized in the study and treatment of urinary diseases and fevers. Mercuriade, surgeon, wrote many didactic essays: “Le crisi”, “La febbre da pestilenza”, “La cura delle ferite”. The most known woman of Salerno is Trotula, the first female doctor in history,  she was a Magistra of Medicine at the School of Salerno, ran a prolific clinical practice. She taught her students about three types of diseases: inherited, contagious, and self-generated , and these type of teaching was carried by all the other women. Her instruction focused on diagnosing various illnesses, using tools such as urine analysis, pulse rate, and skin tone evaluation. Her students were able to differentiate between typhoid and malaria, they could calculate fever temperatures and estimate recovery times, and they could treat complex wounds with some appreciable chances of success.

Contributions

One of the most important contributions of the women of Salerno is a textbook that was widely distributed throughout Europe. The textbook, “De Passionibus Mulierum ante in et post partum” , that witnesses the birth of obstetrics and gynecology as science, was first published around 1100 AD and then it was completely  revised by Ambrose Paré's assistants in the early 17th century. Also Paley, one of the greatest anatomist of his time, stated that many of his important anatomical and surgical considerations came directly or indirectly from the work of Salerno women. He advances that Salerno women first documents, thoughts and practices are an interesting and important part of our surgical heritage.

The work begins by outlining the characteristic nature of the female gender, which, unlike the nature of the male, hot and dry, is rather cold and humid. This, on the one hand, promotes the complementarity of the genders by supporting and restraining each other on the other, is the cause of the different pathologies: in fact, being the weakest women and lacking them the heat necessary to dissipate bad moods, their diseases are more frequent and mainly affect the reproductive organs. To defend themselves from moods, however, women have a particular purification, the menstruation, whose regularity is a source and sign of health, that is, symptom and source of disease. The first task of the doctor is then to diagnose the reasons for the interruption of the regularity or scarcity of the menstruation and to identify with the pharmacopoeia the appropriate remedies.

Lack of adequate treatments for severe pain, bleeding, and infection was the main problem in early medieval surgery. Therefore, medieval surgeons deserve the most recognition for their innovations in wound treatment and pain management. In this field, the women of Salerno play a vital role.

Perineal tears and uterine tears are common wounds often experienced by midwives, giving Trotula and her students ample opportunity to develop new techniques and remedies for wound healing. She has developed and documented various herbal and animal remedies for the prevention and care of infectious wounds. She has also developed a range of opioids for childbirth, which have also been extended to general post-operative pain.

The anatomy of the reproductive organs was known at that time only through animal anatomy and written descriptions in Islamic texts (without pictures). Salerno female physicians made an important contribution to the study of the female reproductive system because female physicians have greater access to female patients than their male colleagues. The merit of mulieres was to deepen the study of the female body, coming to theorize that infertility could also depend on men and not only women.

Bibliography

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