The Latin of Trotula is taken from the 1586 edition, the third edition of the work q. v. supra, which was lent me by Dr. Charles Singer. I am indebted to Dr. Percy Kirkpatrick for the loan of the 1547 edition, which is divided into sections and paragraphs, while the third runs on consecutively. The Irish—which, as suggested above may have been translated from a Latin MS., indeed must have been if the date (1352) is correct—is also divided into sections and paragraphs. A consideration of the section on Gynaecology and its author, more especially the name of Trotula, brings one back over a thousand years in the history of medicine to the famous medical school of Salerno, the earliest university and medical school of the middle ages, which alone kept the lamp of science burning in the so-called dark ages. Salerno, a coast town in southern Italy, was one of a chain of centres in which Benedictine monasticism and learning flourished during the centuries following the death of St. Benedict of Nursia (about 445–550 A.D.). Cassiodorus (490–585), a Roman official, described as the last of the ancients and the first of the mediaevals, spent the second half of his long life of ninety five years collecting and writing books in a monastery which he established at Squillace under Benedictine rule. To him is thus partly due the preservation of the classics and whatever learning survived his turbulent age. The Benedictine monks developed a peculiar sort of Latin script called Beneventan, from Benevento, the place of its origin. A large amount of medical matter was written in it, and in spite of ceaseless wars and raids, fourteen volumes of medical writings in Beneventan script have survived. Naturally they are not original, being copies, not always accurate, of older works, and derived from versions of Hippocrates and other early medical writers.

Salerno had a rich and varied history. The earliest extant works from the school date from about A.D. 1000, but as Salerno was not much inferior in learning and books to the more famous Benedictine settlements at Monte Cassino and Benevento, it must have been producing medical works for hundreds of years before that. The university or school had very old statutes which served as a pattern to later schools. It had the privilege of granting degrees and a licence to practise medicine, a privilege conferred by the Emperor Frederick II about 1225. The patron of the school was St. Matthew and the motto of its seal was Civitas Hippocratica. There are three well-defined periods in the history of the medical school, the first ending in the middle of the eleventh century; the second beginning with the writings of Constantine the African, Orientis et Occidentis Doctor, a monk of Monte Cassino who died in 1087, and lasting till the thirteenth century; the third period, one of gradual decay, began when the Emperor Frederick III founded the University of Naples close by, and ended ingloriously at the beginning of the nineteenth century when Napoleon caused the school to be closed.

The best known book produced in Salerno is the which furnished material for the medical folklore of Europe for hundreds of years. The school of Salerno attached much importance to diet and herbs, while Anglo-Saxon medicine concerned itself mainly with drugs. A great deal of Salernitan teaching on the subject is to be found in the , which, however, had a great influence on English medicine in its later development. It is a long piece of verse and was translated into English by Sir John Harrington in the 17th centuryHarrington, .. It contained the famous couplet Si tibi deficiant medici, medici tibi fiant Haec tria, mens laeta, requies, moderata diaeta, which has been translated by Harrington:— Use three physicians still, first Doctor Quiet, Next Doctor Merryman, and Doctor Dyet, and by some unknown translator more racily:— Joy, Temperance and Repose Slam the door on the doctor's nose.

One of the most romantic features of the far from dull history of Salerno is the tradition of the ladies of Salerno around whom much controversy has raged. It was claimed by some that Salerno alone among mediaeval institutions admitted Jews and women to its teaching. Others hold that the ladies were simply midwives and nurses, who may indeed have been connected with the school but not as students. Trotula was believed to be a lady of Salerno who had written books, was a Dozent of the university, and lived about 1050. While some authorities consider her an historical personage, another school regard her as a myth, whose very name arose from a misunderstanding—Trotula being merely the works of Trottus, who is known to have been a doctor at Salerno. They associate her with Dame Trot of nursery fame and refuse to believe that such a person ever existed. Dr. Charles Singer and Mrs. Singer, in a pamphlet entitled , claim a different origin for the Trotula work, and believe it to have been a compilation from much older sources. The search for authentic details about Trotula continues among scholars. The famous Salernitan MS., the Breslau codex, containing thirty-five works of medicine, does not mention her. On the other hand, George L. Hamilton in , Vol. IV, 1906, is convinced of her existence and thinks her popularity due to the nature of her work. He adds:— Her work is an important source of the twelfth century , and of the of the thirteenth century.

That modern scholars have not lost interest in Salernitan medicine, more especially in the Trotula controversy, is shown by a dissertation submitted, by Dr. Hermann Rudolf Spitzner, for his Doctor's degree in Surgery and Medicine at the University of Leipzig. published in 1921. Dr. Spitzner quotes from many authorities and various editions of Trotula and examines in detail the theories and methods in the Trotula book. His conclusions are that it is undoubtedly true that in the heyday of the Salernitan School, in the middle of the eleventh century, from which our Gynaecological writing comes, there was a famous midwife called Trotula in Salerno.

Another authority, Dr. Paul Diepgen, writes of Trotula as follows:— Entsprechende Angaben finden sich sowohl bei arabischen, wie bei abendländischen Autoren, z. B. in der einer Frau, der Salernitanerin Trotula (XI. Jahrhundert?) zugeschriebenen geburtshilflichen Schrift des XIII. Jahrhunderts. Sie empfiehlt auch wieder eine primitive Art des seit Soranos in Vergessenheit geratenen Dammschutzes and erwähnt zum erstenmal den kompletten Dammriss and seine Vereinigung durch die Naht.Paul Diepgen, Geschichte der Medizin. II Mittelalter. Berlin and Leipzig, 1914.

Finally, Dr. Max Neuburger, Professor of Medical History in the University of Vienna, one of the highest authorities on the subject, accepts Trotula as a real person, a scholarly woman, Sapiens Matrona of the family of Ruggiero, and presumably wife of John Platearius I. Neither does he doubt the existence of the Salernitan ladies and names among them Abella, author of and ; Mercuriade, author of , , Rebecca Guarna, Constanza Calenda and others.Cf. Dr. Karl Sudhoff, .

The one outstanding feature of Trotula's work that may still be of interest to modern doctors is her description of the practical precautions to be taken in cases of dystochia. In Chapter 20, Trotula describes the operation of perinaeorrhaphy for complete tear of the perinaeum with prolapse of the uterus. There are someDe infinituno esg (ex) partu .i. don mi-amh[an]tur tegmas dona mnaibh deis leinim do breith, oir as minic tic sin o misduaim (&ersir;) na man fritholta &ersir; o imurcraidh uaingis, co ndein enruathar acu, innus co ndoirteann an maclac isin slighi sin; da reir sin dleaghtur an slighi sin a fuaighail aturra. Et da roibh an macluc amuigh dleagur fin deaghbalaid do bruith &ersir; im do leagad ir, &ersir; sin do coimelt don macluc no co ngabha bogadh cuigi &ersir; cuirter co min asdeach &ersir; 'na diaigh sin cuirter .iii. gremanna no .iiii. do snaithi thsida ann san inadh ana mbriseann &ersir; cuir a coimhlinadh dedach lín ma bandacht, &ersir; coimilter pic leaghtha don fuaigheal, oir tairrngidh sin an maclucc ana inadh fein &ersir; foiridh he; &ersir; gab compoiri &ersir; compoiri medonach &ersir; den pudar dibh &ersir; do chaneal ar an pic sin, &ersir; bid a cosa &ersir; a leas nias airdi na ceand, &ersir; sechnadh gach uili obair &ersir; t-shaethar co ceand .uiii. la no a .ix.; &ersir; na caitead acht becan bigh &ersir; denadh obair nadurdha ann sein, &ersir; sechnadh fotragadh risin fead sin mona faicear co fetfadh si a fulang, &ersir; seachnadh gach uili biadh nemdilegthach ghaethmar &ersir; seachnadh na neithe toghghairmes cosachtach &ersir; sraedach doibh, &ersir; gidh edh ni dligeadh na neithe so do denamh doibh an trath bid re nighibh, oir coimegnighi sin iad cum an leinim do breith. E. p. 105., she says, in whom the vagina and anus form one orifice, a single canal, with prolapse of the uterus, which in consequence becomes hard and hypertrophied. The uterus must be replaced first, and this is done gently after it is softened by fomentations with melted butter. The tear between the anus and vagina is then closed by three or four silk stitches. The vagina is plugged with tow, a dressing of liquid pitch is applied, which on account of its smell makes the uterus withdraw. The parts are then powdered with lungwort and cumin. The patient is put to bed with her feet raised, and there, eating, defecating and performing all her usual functions, she must stay for eight or nine days or longer till she is able to take a bath. She must avoid anything which would make her cough or which would be indigestible. Great care must be taken during parturition to prevent the occurence of a tear. An oval plug of tow should be placed in the anus, so that during any effort of expelling the child there may be no tear. This is the first mention in medical texts of alleviating the sufferings of women, though indeed here the writer is under obligation to Soranus of Ephesus, the most advanced of early gynaecologists. Soranus of Ephesus, of the second century A. D., a follower of the Methodist School of Asclepiades, is the leading authority on obstetrics, gynaecology and paediatrics of antiquity. The influence of Soranus made itself felt through the middle ages and even into modern times. After him there were no real additions to obstetrics before the time of Paré, some fifteen hundred years later. Among the medical works surviving in Beneventan script is a Latin abbreviation of Soranus on childbirth. The influences of Constantine the African and Galen are also shown in the work of Trotula.

There were four editions of the : in 1490, 1502, 1517, and 1595. The first three were alike, but the fourth, the Augsburg edition of Philip Schopff, differs from the others; v. supra. Schopff made a good many changes, omitted passages which he thought foolish and superstitious, and thus spoilt the character of the book for modern readers.

Of the parallel Latin passages, the first piece (printed infra p. 55–63) is taken from the fourth edition, the second (printed p. 65–73) from the Venice edition of 1502.

I am indebted to the Librarian of University College, London, for the loan of the 1502 edition which was placed at my disposal in the Royal Irish Academy, Dublin; and to Dr. Percy Kirkpatrick for the loan of the first volume of the 1595 edition, which does not contain the piece on Scabies. This, however, I found in the 1502 edition.

John of Gaddesden, a contemporary of Chaucer, was court physician at the court of Edward II. His was regarded as a standard medical text-book in the later middle ages. It was never, as far as is known, translated into English until recently (in part only) v. supra. He inherited the Montpellier tradition of medicine from two of his predecessors, Bernard of Gordon and Gilbert the Englishman. In connection with the section on Gynaecology, it is of interest to note the following from Freind's :The | History | of | Physick: | from the time of | Galen | to the beginning of the | Sixteenth Century; | Chiefly with regard to | Practice. | In a discourse | written to | Doctor Mead | by J. Freind, M. D. | Part II | London | Printed for J. Walthoe, over against the Royal Exchange in Cornhill MDCCXXVI. Above all he ^{John of Gaddesden} understood the sweets of being concern'd in the eases of pregnant Women; he recommends toasted rhubarb to them. He knew very well, that there was a peculiar dialect to be us'd in these circumstances; and therefore we find him very waggish in these points, and sometimes not only familiar but wanton, not to say luscious. He talks much of Midwifery; whether he actually perform'd the operation, he does not directly say; but I should guess, by his grasping at everything, that so notable a branch of business could not escape him. At least he seems to have studied all the methods, and with great variety, to promote Conception: and there's no doubt, but he was much sought after for his Secrets in this way. They who would have a taste of his Talents, may consult the Author himself, and his learned Comments and Receits concerning the detestable Practice of Provocatives. It was from Montpellier, the other great centre of medical learning in the middle ages, that John, as stated above, inherited his medical tradition. Montpellier was first under the influence of the civilization of the Arabs, and afterwards, from 1204, of Aragon. It was only reunited with France in 1492. It benefited by the presence of Jews, among them doctors learned in Arabian medicine, who had great influence and continued to flourish under the Popes at the neighbouring Avignon. It was the centre of the most enlightened region in France during the middle ages. The University enjoyed the favour of the Popes. From the twelfth century its medical school had a great reputation. In the beginning there was no Faculty. Instruction was given in the particular school (écoles particulières), which formed a sort of loose association under a common rule. The charter of the University was confirmed in 1239 by a legate of Pope Gregory IX, and in 1258 by Pope Alexander IV. It gave power to confer three diplomas or degrees, baccalaureus, licentiatus and magister. The course for the degree of bachelor of medicine lasted three and a half years, and the other courses were in proportion.

In 1289 the right to confer the degree of master was restricted to one school, which also gave official instruction, while the other associated schools might continue to give instruction but not degrees.

The oldest document of the University is a Bull of Clement V, of the 5th September 1309, which prescribed the books of Galen and Avicenna for degree, also those of Rhazes, Constantine, Isaac and Hippocrates.

For many years there was no provision for anatomy or surgery. In 1376, permission was obtained from the Duke Louis of Anjou to operate on criminals, but dissection was actually done much sooner at Montpellier than at Paris.

Guy de Chauliac (14th century) studied surgery at Montpellier while working for his degree in medicine. With the departure of the Popes from Avignon, the University stopped the practice of surgery. It was only in 1597 that instruction in surgery was recommenced and a chair established. Lectures had been given earlier in the subject to the barbers, who however did not understand Latin, the only language allowed at the University. Gradually the barbers began to perform other operations besides cutting hair and shaving, and by the 15th century the barbers of Montpellier found it undignified to extract teeth.

Montpellier, like Salerno, was largely frequented by monks, who were however forbidden to stay for long periods at the University.

To the following who helped in many ways in the preparation and production of this volume my best thanks are due: Dr. Charles Singer; Dr. Percy Kirkpatrick; Rev. Paul Grosjean, S. J.; Miss Roisin Walsh; Dr. Madeleine Dempsey and Miss Margaret Dobbs; also Miss Eleanor Knott, for reading the proofs. I wish also to express my indebtedness to the librarian, Trinity College, Library for placing at my disposal in the Royal Irish Academy the manuscript E.4.1. which contains a large portion of the text. My thanks are also due to the printers for their excellent and painstaking work.