[Monica] So, the story thus far: We’d worked out a syllabus, planned a quick and immersive introduction for the students into both medieval medical history and codicology (the study of medieval books as physical objects), and dropped our overly ambitious plan to work with TWO unstudied and unpublished texts on royal fertility. We would stick with our original plan: just focus on the Pomum aureum, Pierre André’s Golden Apple, the treatise on fertility and childbirth he had composed for Gaston IV of Foix in the year 1444. 

Theresa started off the course by herself, the first time she had ever taught either medical history or codicology!

[Theresa] This course posed some unique pedagogical challenges. First off, I had never before co-taught a class. The first hurdle was paying for it, which turned out to the be the easy part of this course. I had a modest budget to fund the course, thanks to an endowed chair from Seattle University. The real challenges came from how to design a course for undergraduates with some Latin, a course or two in the history of medieval Europe, and absolutely no experience with archival manuscripts. As I briefly noted in an earlier post (Royal Mothers, Part II: Down the Rabbit Hole We Went), the structure of the first half of the course—the overview of the history of medicine and reading Monica’s edition of The Trotula (2001)—was made easier because I had materials used in the NEH seminar. The hard part, the part that made me lose sleep, was actually teaching the materials.

From time to time, we all teach out of our depth, so you can sympathize that while teaching this course I felt like a student cramming for an exam. I knew a fair bit about modern medicine from undergraduate classes in human biology, chemistry, microbiology, and genetics, but had never had a formal course in the history of medicine. Like most medievalists, I’d read around a bit, but focused mostly on gender and sexuality, books such as The Trotula (2001), Joan Cadden’s The Meaning of Sex Differences in the Middle Ages (1995), Ruth Mazo Karras’s ‪Sexuality In Medieval Europe: ‪Doing Unto Others (2005). The closest I came to seriously studying the history of medicine was reading Roy Porter’s The Greatest Benefit to Mankind: A Medical History of Humanity from Antiquity to the Present (1997). But my work on a childless queen, María of Castile, queen of the Crown of Aragon (d. 1458), led me to pose questions that only a study of the history of medicine could answer. I wondered if childlessness was due to infertility, but I wasn’t even sure what infertility is. Is it a disease? A malady? A syndrome? A temporary or permanent condition?

This led me to a conversation with Monica in 2008 which, of course, led to more conversations, and all this conversation led me to the NEH Seminar at the Wellcome Library in London in the summer of 2012. This was the first time I rigorously studied the history of medicine. This gave me the necessary background and depth to teach Aristotelian, Galenic, and Hippocratic foundations of medieval medicine. But I felt, like most of us do when we teach new material, seriously over my head. Monica was a great guide who provided plenty of teaching materials that made it possible to do more that provide a “once-over-lightly” lesson plan. I was able to use many of the works we read that summer in the syllabus and that gave me what I needed (see the syllabus, in the Essential Reading tab on the left).

But I still felt like a student. I have a classroom policy that rewards students for what I call “Stump the Professor Questions” in order to create a safe place to pepper me with questions. Well, let me tell you, I was stumped often. Our unanswered questions were sent as emails to Monica, who sent long, detailed responses and conversed with us on Skype. In this way, she was part of the class, even as she prepared for the hectic end of the term at Arizona State and all the hubbub of grading and graduation.

I felt a lot more comfortable with teaching codicology thanks to coursework in graduate school at Fordham University on paleography and codicology. Ray Clemens and Timothy Graham’s book, an excellent resource for advanced undergraduate students, led the way. Students gobbled up this book like candy. They had never before seriously thought about how books, medieval or modern, were made. This book, read alongside Monica’s side-by-side Latin text and English translation of the Trotula, gave students a deep appreciation for how knowledge is created and transmitted.

[Monica]: This is where technology proved to be a valuable friend. And it proved to be a great pedagogical aid, too, because a lot of our initial discussion of the Pomum aureum centered around the production of the physical book that we were examining via a digital reproduction of a microfilm photo. Conscious of how advanced our own technology was, we continually asked: How did medieval manuscript books get made? And what could we learn about this particular book by considering such questions as format, quality of the scribal hand, and codicological structure?

[Theresa]: This was vital material so that when we read the Trotula, they had many cogent questions about the translations and the way Monica decided what parts of the ensemble of texts went where in the finished edition. The students were not so much troubled by the arrangement of the ensemble as they were by some of the translations. For example, they struggled with the Latin word aborsus. As 21st-century readers, they automatically assumed “elective abortion” and “Roe v. Wade,” and all the current bitter political battles over abortion. But aborsus is a tricky word with a range of nuances and meanings that changed over the course of the Middle Ages. They learned one of the most valuable lessons anyone can learn when she or he studies the past: Check your a priori assumptions and your political leaning at the door. Do not presume that a word is static in meaning or usage. Do not let political inclination or religious beliefs get in the way of understanding what at word meant to a physician in Toulouse in 1444. Then, when we got to tackling the actual transcription and translation of the Pomum aureum, they realized just how hard it is to edit a text, that the nuance of a word like aborsus demands a careful analysis of context, a knowledge of more than just a single text but a myriad of texts on medicine, sexuality, and fertility. They realized that they needed to know how legal scholars used the term, so we directed them to Wolfgang Müller’s The Criminalization of Abortion in the West: Its Origins in Medieval Law (2012). The students in this class will never be able to pick up an edited text again without recalling the arduous work and scholarly expertise required to get that book into press.

By the middle of the term, Skype had worked well, up to a point. It got us all in the same classroom at the same time, which was, as anyone who uses Skype can tell you, both a blessing and a curse. Yes, we were all slogging through the material, transcribing the same passage at the same time, which was brilliant. And then, the connection would drop. Or the micro-second delay in the conversation caused the conversation to overlap. But we all got the hang of it and made it work to our advantage.

[Monica]: I joined the class in earnest (via Skype) once we got going on Pierre André’s text. One of the first conclusions we came to was that this particular copy of the Pomum aureum (the only copy that still exists, so far as we know) was almost certainly NOT the presentation copy given to its dedicatee, Gaston IV of Foix. How did we know? Well, first of all, the book wasn’t “pretty.” Later in the course, I would show the students several online “archives” of medieval manuscripts made for royal patrons. Called Europeana regia, this amazing project reassembles digitally the libraries of some of Europe’s great royal houses:  the Carolingians, Charles V of France and his family, and the Library of the Aragonese Kings of Naples. This last library was being assembled at the very time Pierre André was attempting to assist Gaston IV and his wife, Leonor of Navarre, in their reproductive needs.  A properly “royal” book should look something like this one, a copy of the famous Baths of Pozzuoli written by Petrus de Ebolo at the turn of the thirteenth century.

Valencia, Universitat de València, Biblioteca Històrica BH Ms. 838, f. 4r (detail)

This particular copy was made near the end of the fifteenth century for Alfonso II, Duke of Calabria. Deluxe copies of books of regimen—how to live a healthy life, eat right, take proper exercise, and so forth—were often owned by nobility. This image shows women bathing in one of the Pozzuoli baths, many of which were recommended to treat fertility problems.

By contrast, the copy of Pierre André’s work on fertility and childbirth that we were working with had none of these sumptuous qualities. Yes, the text was complete: divided into a section on Theory and one on Practice, each half was then divided into four chapters. There was a lavish opening passage praising the dedicatee, Gaston, and an equally overwrought conclusion. But it was an UGLY manuscript. Some use of majuscule characters to flag the beginning of new chapters, but otherwise no elegance whatsoever. Lines were uneven, words irregularly abbreviated. Rather than this being a copy for a noble patron (the one who paid the bills!), we concluded that this must be a later copy, made most likely for and maybe even by another physician, who wanted not only Pierre’s work on fertility, but also his treatise on plague and the several other texts in the volume on surgery and other technical matters of medicine. 

It was likely the haste with which this copy was made that caused the omission of the fetal images that were supposed to have been included.  After all, Pierre himself flagged their importance for understanding what the midwife should know during birth:

It ought to be noted that the fetus naturally presents looking at the ground (though some say that females emerge on their backs). First, the head emerges and then the neck, then the shoulders, and the arms ought to be extended along the sides.  But birth can happen unnaturally in various ways, 15 specifically, as can be seen readily in the following pictures. The reason why the face is turned toward the ground in a natural birth is because in its fundus the field of nature (or womb) has this shape, and at the hour of birth [the fetus] turns and commonly faces the ground just as before it had faced its navel, as can be seen in the present picture.

André then added further: 

How and in what ways the woman can give birth, and what the midwife ought to do is made apparent in the following pictures which lay it out openly.

It seems, then, that André, wishing to make his text truly remarkable with these images, went beyond the Muscian tradition of just showing fetal malpresentations. Were this the presentation copy, therefore, we would have expected an artistic investment similar to, if not surpassing, that found in another fifteenth-century manuscript that incorporated the fetal images, this surgical scroll now in Stockholm: 

Stockholm, Kungliga Biblioteket, MS X.118, ca. 1425–35 (England): the eighth fetal figure from Muscio, showing a footling presentation

By the end of our discussion of the manuscript’s format, we weren’t even sure that Pierre André had followed through on his plan to give this text to Gaston. What was becoming obvious to us was that we needed to know the POLITICAL CONTEXT of this text, not just its internal structure or its medical theory. Something about the timing seemed wrong. The text was clearly dated at the end: “Given [at Foix?] the sixth of October, 1444.” But Gaston and Leonor’s first child (also named Gaston) was, according to current research by Elena Woodacre, born in either 1443 or 1444. Was Leonor already pregnant when Pierre drafted his work? Had she already produced the requisite male heir? If she had, what was prompting this intense effort by Pierre?

What we needed was a political historian . . .

[Theresa]: Whew! I was on much more comfortable ground on the political history of Spain in the fifteenth century. At first I thought that Gaston commissioned the text because he was concerned about having a male heir to succeed him. The kingdom of Navarre did not prohibit women from inheriting and ruling in their own right and the presence of ruling queens was perceived by neighboring rulers as a weakness, particularly for the ambitious Trastámara clan. Leonor’s mother, Queen Blanca I, had no surviving children from her first marriage, and the idea of marrying a queen-regnant was irresistible to Juan, infante (prince) of the Crown of Aragon. He married her in 1419 and together they had four children, including a son, but he shoved both his wife and son aside and ruled in Blanca’s name. Leonor’s sister, Blanca II, married King Enrique IV of Castile in 1440, but after thirteen years of marriage without children, Enrique secured an annulment of the marriage. The marriage may never have been consummated; Blanca was sent home where her father imprisoned her. Enrique had a daughter from a second marriage, but it was alleged that the king was not her father. In the resulting struggle for the throne, Enrique’s step-sister Isabel of Castile (1451–1504) fought against him in a civil war to secure her inheritance and rule Castile.

It seems that the dynastic worries may have been less about producing children and more about protecting princesses from predatory lords from neighboring realms. The marriage of Gaston of Foix and Leonor of Navarre in 1434, when he was 12 and she was 8, was intended to strengthen links to the French county against Spain. Two years later, his father died, Gaston inherited the county, and eight years later, in 1443 or 1444 Leonor gave birth to their first son (although the sources are unclear; some scholars argue that a sister was born before him). They went on to have nine more children, so Gaston’s concerns for children seem, in retrospect, to have been groundless. But his concern for a son to ward off his grasping Trastámara relatives may be why André devoted a section in his treatise to how to conceive a male child. The answer to why Gaston wanted this text may simply be that his family was very interested in medicine and owned a number of medical treatises.

By midterm, then, we had made good progress. Students were improving their command of medieval medical Latin, could converse skillfully about codicology and paleography, and were showing good historical instincts in their initial take on the text of the Pomum aureum. When Monica arrived in person, I thought that our dependence on the technology would end, but I was wrong.