Women’s Bodies and Souls: Perspectives in the Middle Ages

Brenda S Gardenour. Science, Religion, and Society: An Encyclopedia of History, Culture, and Controversy. Editor: Arri Eisen & Gary Laderman. Volume 1. Armonk, NY: M.E. Sharpe, 2006.

The history of women’s bodies is one of shifting perceptions. Theoreticians, such as Hippocrates and Aristotle, developed various systems to explain the structure and function of female anatomy. They contemplated not only the differences between male and female, but also the characteristics and functions that made the female body unique. Although not alone in their quest to understand the female body, Hippocrates and Aristotle were the most influential of their time period, and their ideas were the most persistent in the development of medieval medicine. Aristotelian logic, especially its use of categories, would influence medieval perceptions of the female body and the types of female bodies that were possible, leading to the construction of two dialectical categories: the miraculous body of the virgin, and the maleficent body of the witch. The medieval belief that body and soul were integrated meant that female biology was thought to have spiritual consequences and, reciprocally, that the state of a woman’s soul could affect the functioning and composition of her physical body.

But the theories developed by academics, who were elite members of a literate, Latinate culture, were not the only ideas about women’s bodies prevalent in the Middle Ages. Beside their theoretical approach existed another tradition, that of practical care. Midwives handbooks, for example, found wide circulation and often contained a mixture of elements, from snippets of theoretical medicine to therapeutics, practical advice, recipes, and natural magic. Women’s bodies were portrayed in realistic terms, with detailed descriptions of actual female anatomy, physiology, and the procedures needed to maintain a healthy system.

Theoretical Bodies: Ancient Greece

The first sources for the biology of women’s bodies originated in ancient Greece. Hippocrates of Cos (c. 460-370 BCE), a practicing physician, wrote extensively on the theoretical functions of the human body. The fundamental contribution of Hippocrates to ancient and medieval biology was the theory of the four humors, which were based on Empedocles’s four elements: earth, air, fire, and water. Hippocrates asserted that there were four bodily humors: phlegm, blood, black bile, and yellow bile. Each contained a pair of elemental qualities: phlegm was cold and wet, blood was hot and wet, black bile was cold and dry, yellow bile was hot and dry. According to humoral theory, food was digested in the stomach and turned into blood; from there, the body refined the blood into phlegm, yellow bile, or black bile, as necessary. Bodily health was directly related to the balance of the humors; if any one humor was retained or produced in excess, the body would manifest symptoms from which the physician could diagnose the cause of the illness.

Of the sixty works in the Hippocratic corpus, ten deal with women’s bodies and the problems specific to them. Hippocrates postulated that women and men were very different creatures, and that women had their own, unique systems that demanded specific treatments. Women were thought to be composed of a different type of tissue than men; whereas men were firm and compact, women were soft and spongy, cold and moist. Women, being spongy, not only retained their humors more easily than men but also lacked the ability to refine their blood into humors as quickly as men, and so were left with an excess that they could not process. Hippocrates asserted that this excess, in the form of blood, was retained in the spongy tissue until menstruation, when the blood would descend into a woman’s uterus and out through the vagina. For Hippocrates, menstruation was the natural cleansing process of the female body, a necessary function to maintain humoral balance. The menstrual cycle was so vital to the maintenance of women’s health that disruption of menstruation was seen as dangerous. Women who were unable to menstruate were bled by a physician once a month in order to maintain humoral balance.

Aristotle (384-322 BCE), a philosopher rather than a practitioner of medicine, believed that men and women were not as drastically different as Hippocrates would have allowed. Understanding a complete parallelism to exist between the categories of male and female, Aristotle sought to reconcile each male organ with a female organ of similar function. The male sexual organ was the penis, while the female sexual organ was the womb. Because of his desire to force men and women’s bodies to fit this symmetrical construct, Aristotle was forced to ignore or deny certain organs, such as the clitoris. Since there was no obvious parallel for the clitoris in the male, then it was simply a fold of skin, and not an organ. Furthermore, since men produced only one sexual residue, semen, women could have only a single residue, the menses. In this way, Aristotle denied the possibility that women might produce seed as men did. Women were allowed to be somewhat different, somewhat alike, but never to have more than men.

Aristotle’s perception of women as weaker, softer, and less perfect men is evident in his theories of menstruation and conception. Like Hippocrates, Aristotle believed that women could not fully digest their food and so produced an excess of blood. However, he also postulated that, because women were colder and moister, they did not produce sufficient heat to reduce the resultant blood into humors. Men were hotter and drier, and so could refine blood into muscles, sweat, and hair, thus their different appearance. Women, however, retained excess blood, which trickled slowly into the womb throughout the month, where it became corrupt. At the end of their monthly cycle, women discharged this toxic brew as menstrual blood. Aristotle also thought that because the womb collected blood throughout the month, it was closed to the reception of male seed except for the few days following menstruation, when the uterus was essentially empty. After the male seed had entered the womb, menstrual blood could be used to nourish a fetus.

Hippocrates and Aristotle had similar theories about the anatomy of the womb, which was believed to be a soft vessel, like a bladder. The fallopian tubes were often referred to as horns, or tentacles, and ancient Greek physicians believed they were mouths through which the womb sucked bodily fluids. The cervix was considered a third mouth that served as an external opening. The womb was believed to contain pockets. If sperm entered the left pocket, which was cold and moist, a female would be born. If sperm entered the right pocket, which was hot and dry, a male would be born. Although the right side of the womb was hot and dry, the womb itself was cold and moist in nature.

Ancient physicians believed that changes in the natural state of the womb might cause it to wander throughout the body. Hippocrates explained its movements as a desire for moisture: when the uterus was not lubricated with semen, it dried out, became thirsty, and traveled to other organs for relief. The condition known as hysteria was thought to result when the uterus visited the brain, which was considered one of the moistest areas in the body and thus a favorite destination for the womb. The liver and the heart were also areas that attracted the wandering womb.

The womb was thought to move through large tunnels, called phlebes, the largest of which was thought to extend from the uterus through the diaphragm and up into the nostrils. Hippocrates postulated that a woman’s fertility could be ascertained by placing garlic near the opening of her vagina; if the garlic could be smelled on her breath or through her nose, her main phlebe was unobstructed, and thus her womb was healthy and fertile. To coerce a wandering womb back into its proper place, foul-smelling substances were placed near a woman’s nostrils, while sweet-smelling substances were placed near the mouth of her vagina. The womb would be attracted to the sweeter smell and descend back toward it. To cure a prolapsed womb, the process was reversed, thus luring the womb upward. None of the ancient sources explains why the womb was thought to have a sense of smell.

Where Hippocrates advocated for a central tube linking womb and mouth, Aristotle theorized that the transference of odors between womb and mouth took place through a relay of bodily fluids. If women collected corrupt blood and potentially poisonous humors in their wombs, the vapors from these humors could travel through the phlebes or mix with the fluids of the head and lungs. Therefore, it was physiologically possible for women to excrete poisonous substances in their saliva, breath, and tears. Poisonous vapors could be emitted from the eyes with the pneuma that was necessary for sight to take place, so the “evil eye” could be truly deadly. Aristotle postulated that a menstruating woman could look into a mirror and “dim it with a bloody cloud.” Women’s bodies were not only different from men’s, but also much more dangerous, and thus powerful. The wandering womb and the passageway between womb and mouth were two of the most persistent cultural ideas about the physiology of women’s bodies, ideas that would affect medical theory and practice through the Middle Ages.

Virgin and Witch

Medical treatises circulated widely through the ancient Mediterranean. Many ultimately were housed in Alexandria, where they were used in the schools through the fourth and fifth centuries. By the eighth century, the Islamic Empire had absorbed many regions previously within the Greek orbit, including Alexandria. Under the Abbasid caliphate, medical treatises were translated into Arabic, some by Nestorian Christians in the Persian city of Jundishapur, but mostly by scholars attracted to the intellectual center at Baghdad. Physicians such as al-Razi and Ibn Sina (Avicenna) enriched the received medical tradition, and their texts, along with translations, commentaries, and original works on philosophy, especially of Aristotle, circulated throughout the Muslim world. In eleventh-century Sicily and Iberia, Western Europeans began to translate and absorb Greek and Arabic medicine and philosophy. In the developing medieval universities, these texts, especially by Aristotle, became the foundation of study. By the thirteenth century, all university students were required to study Aristotelian logic; in particular, the Dominicans espoused Aristotelian logic and the creation of opposing categories in their attempt to understand their world. Important for our discussion is the constructed category of the miraculous virgin, and the inversion of this category, the maleficent witch.

Virgin women were seen as ideal women, unaffected by physical and emotional lust for sexual intercourse. Because of this spiritual and sexual purity, the virgin body was believed to be a potential conduit for the word of God. At first, this would seem paradoxical; medical theory taught that the female body was deficient and corrupt, the female will weak, and the female mind clouded and unable to comprehend complicated matters such as theology. However, it was this very weakness that allowed Hildegarde of Bingen to claim authority for herself. An eleventh-century Benedictine nun, Hildegarde wrote treatises on medicine and mystic revelation, and she composed letters to the pope and emperor expressing her opinions. Barbara Newman has argued that Hildegarde of Bingen was able to act in such a straightforward manner because of her virginity and her perceived female weakness. The idea that her revelations were from God was taken seriously, because it was thought biologically impossible for a woman to have conceived of such complicated truths through her own intellect.

Male theologians saw virgin women’s bodies as vessels for the revelations of God; exceptional, saintly women, chosen by God, could act as spokeswomen for the almighty. The weakness of their constitutions made possible the miraculous, but the true miracle was the working out of God’s plan in the fullness of time. By the thirteenth and fourteenth centuries, however, there was a shift in the perceptions of women’s bodies as miraculous in and of themselves. Thomas Cantimpre, a Dominican intensely interested in the religious experiences of the Beguines, women who formed secular communities similar to a religious order, wrote biographies of Christina Mirabilis and Lutgard of Aywieres. In recording the stories of these exceptional women, Cantimpre did not focus on their spiritual revelations but on their miraculous bodies.

Christina Mirabilis’s transformation began with her desire for union with Christ. Her quest drove her into a state of lovesickness, a medical condition with symptoms including sleeplessness, loss of appetite, racing heart, and intermittent periods of elation and depression. Ultimately, her body began to fail, and she appeared to die. It was in this state that her spirit left the earth to travel to the world beyond the moon, beyond time, to join with Christ. Her unio mystica complete, Christina returned to her earthly body and physically came back from the dead. Christina’s union with God had reordered her spirit, which in turn had a corresponding effect on her body. Her body was no longer the chaotic body of those who live below the moon, but instead the resurrected body of the inhabitants of the heavenly Jerusalem. Just as God took the chaos of the primordial world and ordered it into creation, so too had he taken the chaos of Christina’s body and ordered it into a new one, a body with qualities very different from those of ordinary bodies. Among her new capabilities were contortions, such as rolling around like a hoop, levitation (since she was no longer tethered to the earth), and the power of healing. Christina’s body was no longer a natural body, nor was it any longer a female body, subject to humoral imbalances and menstrual cycles. As an ordinary woman, her connection with the divine would have been physically impossible. Thus, Cantimpre recreated her, defeminized her, and gave her a body of resurrected flesh that existed beyond gender.

Cantimpre portrayed Lutgard of Aywieres in a similar fashion, attempting to fit her unusual experiences into a categorical framework. Like Christina Mirabilis, Lutgard longed for union with Christ, and like Christina, she achieved her goal. After their communion of hearts, Lutgard physically shared in Christ’s suffering and felt on her own flesh the invisible marks of the stigmata. Still, this was not enough for Lutgard. One night, as she lay in bed, pleading for martyrdom, her desire became so strong that a vein burst close to her heart and she began to bleed from her side as did Christ on the Cross. She bled so much that it soaked her tunic. As she awoke, Christ appeared to her and informed her that she had died a martyr for his love. Lutgard’s effusion of blood resulted in the total defeminization of her body. When Lutgard’s vein ruptured, she was drained of her sinful blood, purged of all impurities. Just as Hippocrates had prescribed bleeding to relieve excess blood in women, so also Christ had prescribed an extreme bleeding for Lutgard. The hemorrhage that she experienced from her side was in fact to be the last menstruation of her earthly life. Since she now dwelled in a resurrected, perfect body, there was no need for her to menstruate, to cleanse her body of poisons, to regulate her humors. There was, really, no need for her to even be awoman.

Cantimpre portrayed women obsessed with their bodies, women who could only experience the divine through physical means. They waxed hysterical; their wombs seeking moisture, until Christ ultimately healed them, purging them of their humors, blood, and ultimately their woman-ness. But these weren’t real women’s bodies, nor were they real women’s experiences. In his attempt to classify these women, and to validate their visions, he resorted to categorization of their bodies. The ideal holy woman was both virgin and miraculous; to prove that the ecstatic experiences of Christina and Lutgard conformed to the ideal, and were not due to hysteria, Cantimpre recreated them to fit the category of the miraculous, resurrected, asexual body.

Just as academics created a category for exceptionally good women, so also they created a category for exceptionally bad women; the witch was an inversion of the virgin category. The witch inhabited an upside-down world that mirrored the hierarchy of the Christian church. Just as the church had at its head God, the diabolical church had the devil. The priest entered the church in pure white robes; the head sorcerer entered Satan’s synagogue walking backward and wearing black. In the diabolical church, angels were replaced by demons, the liturgy was read backward, and the kiss of peace became a kiss of the devil’s anus. The church had virgins and female saints, and the diabolical church had witches.

Just as theologians used ideas about women’s bodies to support their theories of sanctity, so too did they use their understanding of the way women’s bodies worked to explain the existence and powers of witches. Witches’ bodies were inverted versions of virginal bodies. Unlike the body of a virgin, the body of a witch had experienced sexual intercourse. Widows were seen as most likely to succumb to the wiles of the devil; although accustomed to sexual activity, they had not sought to replace their partner through marriage and were considered suspect. And because the witch embodied the worst of all female qualities, she could not control her tongue, her emotion, her mind, or her body. The witch’s physical yearning for intercourse, caused not only by her weak constitution but also because of her womb, which was searching for moisture, drove her to accept the favors of any man, even if he were a demon or the devil himself. As the virgin experienced spiritual union with God, so the witch longed for carnal union with the devil.

Where a virgin was physically pure, a witch’s body was corrupt. Unlike Christina and Lutgard, whose bodies had become perfectly ordered, the body of the witch was chaos, seething with corrupt humors. The uterus demanded moisture and sought it through sexual activity. If it was not satiated, the uterus might detach and wander through the body, causing hysteria. Unpurged seed might also become corrupt and the vapors rise to the brain, causing madness. The uterus also contained menstrual blood, considered a toxic brew of humors; these poisons traveled as gas, according to Hippocrates, and as a fluid, according to Aristotle, and could be emitted through the breath, saliva, and tears of a witch. The witch not only contained poisons in her own body but also controlled the poisons in nature. Where the virgin had forsaken the natural world and contemplated heaven, the witch had mastered the meaner elements of nature, and with the help of demons knew the secrets hidden in herbs and animals. The witch appeared to be a healer but actually caused infertility and abortions. She received communion at Easter, only to spit the wafer into the privy at home. The Virgin Mary had nurtured and cherished baby Jesus, but witches killed and sometimes consumed infants.

The characteristics of the witch were built upon beliefs about women’s bodies and the way they functioned. Academics were not interested in the anatomy and physiology of actual women, but in the ways that abstract theories about women’s bodies could be used to support artificial categories constructed for the classification of women, such as virgin and witch. Elements of folklore, popular beliefs, natural and demonic magic, natural science, and mysticism all went into the construction of the witch category; these elements, however, were arranged in such a way as to counterbalance the qualities of the virgin. Ideas about maleficent women and virgin women were present in the general culture, but the witch was not a category described by theologians. There were undoubtedly exceptional women, both good and wicked, in the medieval world, but it is unlikely that they fit into the constructs demanded by Aristotelian thinkers.

Practical Care

Theories about women’s bodies that were originally developed in ancient Greece were persistent in medieval learned culture. Humoral theory, the anatomy and appetites of the uterus, the wandering womb, the toxicity of menstrual blood, all were used by thirteenth- and fourteenth-century academics to defend the dialectical categories developed to define types of women. At various levels, these theories about women’s bodies impacted general perceptions about women, but they were not the predominant way of understanding women’s bodies and their functions. While dominant male academic culture debated and classified women’s bodies according to theory, and ascribed all manner of paradoxical qualities to women’s anatomies, a more prevalent tradition existed which treated with compassion and practical care the bodies of real women.

The practical care of women’s bodies found its source in the work of Soranus of Ephesus, a second-century CEpractitioner of methodism, a sect of medicine that focused on therapeutics, or the relaxation and constriction of tissues, instead of theory. Soranus’s treatise on women’s health, Gynecology, survived through the translation of the sixth-century encyclopediast Caelius Aurelianus. The Gynecology assessed not only the specific maintenance needs of women’s reproductive parts but also techniques for intervention when these organs malfunctioned. One section discussed normal female functions, including the physiology of the uterus, menstruation, conception, contraception, abortion, pregnancy, parturition, and delivery. A second section discussed abnormal female functions, including the retention of the menses, hysterical suffocation, wind in the uterus, bloody flux, and the ascent of the uterus. Another section treated abnormalities in labor, including the various positions of a fetus, the turning of a malpositioned fetus, removal of a dead fetus, prolapse of the womb, and the repair of a torn peritoneum. Also included in the Gynecology was advice on how to choose a wet nurse, how to care for an infant, and how to be a good midwife.

Soranus described the best midwife as trained in all branches of therapy. She was to be calm in demeanor, since she would be called on to share the many secrets of life. The midwife was to have small, soft, closely manicured hands to travel into small, delicate places. Furthermore, like Soranus himself, she was to shun superstition and look only to the disease as it presented itself and the therapies that had been proven to work. Soranus’s manual did not contain the elaborate theories of Hippocrates and Aristotle; as a methodist, he found these unnecessary in the care of women. A woman with a disease was a woman suffering, and the job of the midwife was to alleviate this suffering through therapeutics. She was to observe her patient as an individual, to learn her patient’s own unique systems and cycles, and to treat her accordingly. Soranus did not demand that all women’s bodies behave or function in exactly the same manner, nor did he separate them into constructed categories. He rejected superstitious beliefs such as a wandering, smelling womb and the toxic nature of menstrual blood. Yet he allowed for the use of talismans and other ritual objects, not because of their efficacy in physical healing, but because they might provide comfort to a woman in pain.

Soranus’s Gynecology provided medieval healers with various therapies, long proven effective in the care of women’s bodies. In Soranus, we see the basic medical procedures that would endure well into the Middle Ages, including the use of potions, salves, ointments, pessaries, purgatives, and dietary regimens, as well as the physical techniques of massage, baths, and exercise. Medieval gynecology, practiced mostly by midwives and wise women, was an amalgamation, combining elements of theoretical medicine, especially the humoral theory, superstitions about women’s bodies, practical therapeutics, and folk medicine and magic. Many of these elements can be seen to coexist in medieval gynecological handbooks, such as those attributed to Trotula of Salerno.

Trotula, an eleventh-century woman healer, stands out not only as the author of at least one treatise on gynecology but also as a literate medieval woman. She based her work on translations of Soranus, her understanding of the humoral theory, recipes that she had heard of and perhaps tried, and local traditions of healing. Handbooks for midwives circulated in Latin throughout the twelfth and thirteenth centuries. However, the majority of women healers were illiterate. While it is possible that some midwives had treatises read to them, it is most likely that midwives learned their healing therapies from other women healers. They also relied on local traditions of natural magic as well as trial and error.

With the increase in lay literacy in the fourteenth and fifteenth centuries, midwives’ handbooks were translated into the vernacular. Some handbooks were very small, meant to be carried by the midwife on her many errands about her community. Simply written, these manuals combined elements of theoretical medicine, such as the humoral theory and the wandering womb, therapies originally prescribed by Soranus and Trotula, and recipes and incantations passed down through oral tradition. The salient feature of medieval handbooks for midwives, however, was their concern for the compassionate and practical care of real women’s bodies. Each body was considered individually, with its own diseases, cycles, and needs.

Theoreticians such as Hippocrates and Aristotle developed ideas about the differences between male and female anatomies and tried to explain female physiology. Concepts such as the humoral theory and the wandering womb were persistent in both the ancient and medieval worlds. Aristotle’s system of logical categories and his arguments for the toxicity of women’s bodies affected the way some medieval academics perceived women in general, providing them with the tools to develop categories such as virgin and witch. Female anatomy and physiology had spiritual consequences, since body and soul were interconnected, and the condition of the one had a reciprocal effect on the other. Medieval theoreticians did not conceive of the body as a precise machine, but as a complex system subject to the sympathetic influence of natural elements, planets and stars, spirits and demons. Women, having been defined as the weaker sex from earliest times, were thought to be more open to these cosmic forces than men.

Theoreticians and academics sought to explain women’s bodies in terms of systems and functions, both physical and spiritual. Some of their ideas, such as hysteria and the powers of the witch, have persisted into our own day, if only as stereotypes and categories. However, these ideas about women circulated in an elite, literate milieu populated by men, many of whom had little direct experience of women’s bodies. Alongside this elite, theoretical tradition there existed a popular, practical culture of healing. Medieval midwives sought to provide compassionate care, through whatever means necessary. They were not concerned with developing a rational system of medicine, but instead combined paradoxical elements from the various traditions, using prayer alongside talismans, and salves and ointments alongside purges and incantations. Medieval midwives were not concerned with types or categories of women, but with individual women whose bodies and problems were unique.