My long subtitle might almost function as a short definition of how medicine in general, and women’s medicine in particular, was understood, learned, practised and disseminated by medieval Jews. Western Jews participated in the medical systems that operated within their milieus, integrating the notions and praxis of the different medical traditions that circulated at the time. They acquired, and even developed, the medical knowledge available to them, and negotiated the limits of what was acceptable for them as Jews by eliminating non-permitted aspects and by contributing some elements of ‘judaization’. This paper explores succinctly the paths of transmission and reception of theories and notions of female physiology, health and disease within the Hebrew medical corpus, and analyses the influence of the Arabic and Latin traditions in this process. It examines more specifically the contribution of Arabic gynaecology to Hebrew medical literature which, as Gerrit Bos has suggested, has been often overlooked.Reference Bos1 It also explores a sphere of care – adornment and decoration of the body – largely associated with women, which appears to have been considered by Jewish authors as part of women’s healthcare, as it mostly occurs within this kind of literature.
The Hebrew corpus on women’s healthcare and its sources
Apart from two medical works that were written and circulated in Hebrew around the 10th century in southern Italy, medical literature was not produced in that language until the end of the 12th century. The last years of that century witnessed the launching of the Hebrew medical corpus, inaugurated by an impressive translation project, which initiated the process that provided learned Jews with the Hebrew version of the scientific and medical corpus available at universities at the time. Between 1197 and 1199, an unknown translator, working in Provence, rendered from Latin into Hebrew 24 theoretical and practical medical works. Three of these were gynaecological tracts.2
Recent research in the field has resulted, so far, in the identification of around 23 Hebrew texts (treatises and sections within general medical works) devoted to women’s healthcare, of which only approximately half have been either edited and/or translated into a modern language.3 On the whole, they offer remedies for women’s ailments, largely related to the reproductive cycle (diagnosis, aetiology and therapeutics of menstrual problems, displacement and suffocation of the womb, uterine tumours, contraception, abortion, pregnancy and childbirth), but also recipes for the general care of the health and beauty of the body. Neither the content nor the layout of these Hebrew texts differed in essence from those produced in the Latin tradition, as this area of Jewish medicine relied strongly on what was available in Latin and flourished under its influence. The Jewish texts in question were mostly produced in the Christian territories of the Mediterranean west, and the direct source of most of them was Latin.
However, this is not to say that the Hebrew production on women’s healthcare was exclusively based on Latin medical literature. In fact, many of the Latin works rendered into Hebrew, or utilized and/or quoted by Jewish medical writers, were themselves translations from Arabic texts. Arabic gynaecological treatises rarely circulated independently. Nevertheless, women’s conditions were treated at length within medical encyclopaedias, on account of which Arab understanding of this sphere of medicine achieved wide dissemination.4 As a result, Arab influence often reached the Hebrew medical corpus indirectly, which may have contributed to making it less conspicuous. For, even when the works on which Jewish authors relied had originally been written in Latin, most notions and theories stemmed from the Greco-Latin corpus handed down to the west by Arab medical authors and translators, and relied heavily on their adaptations and reinterpretations. This is especially noticeable regarding the unmistakable ‘Galenization’ of gynaecology, alongside general medical knowledge, and despite the paradoxical fact that it had received little attention from Galen himself. Arab medical authors had adhered enthusiastically to the coherent Galenic humoural system to explain the functioning of the body. This model explicated consistently women’s physiology and assigned menstruation a central role in the (im)balance of humours, that is, in female health and disease. The process of adaptation and development of Galenic gynaecology was initiated by Haly Abas al-Majusī (d. 982/992) in Persia and Ibn al-Jazzār (d. 1004) in North Africa, who had learned gynaecological traditions of antiquity from the re-elaborations collected in Byzantine medical encyclopaedias, and articulated a medical area that, despite limited independent circulation, had a long-lasting impact on contemporary and later Arabic, Hebrew and Latin gynaecology. Their knowledge was transmitted to the West mainly through the translations into Latin undertaken by Constantine the African at the end of the 11th century.5
But Jews did not attain this medical knowledge exclusively through Latin textual transmission, either original or translated from Arabic. They also acquired medical knowledge in the lands of Islam, where they participated in the medical system. A few of them, such as the famed Isaac Israeli and Moses Maimonides, even contributed to its development. Medical works written in Arabic by Jewish authors began to be rendered into Hebrew also from the 12th century on. Not only the texts, but the immigration of Jewish scholars to the Christian territories of the Iberian Peninsula and Provence after the arrival of the Almohads in 1146 also resulted in the dissemination of their ‘Arabic’ knowledge and science among their northern co-religionists.6
As a result of all these and other factors, the Hebrew corpus presents a mixture of traditions not always easy to classify. Apart from translations from one language or another, which frequently had undergone a previous translation process, the Hebrew corpus also includes some original independent treatises, compilations and sections on women’s healthcare within medical encyclopaedias where different notions and views, at times conflicting, on the female body and its functioning intertwine as a result of the different layers of ideas and approaches.
Caring for the beauty of the body
Around the 12th-century, a new medical tradition devoted to women’s healthcare originated in Salerno. This tradition assembled medical practices and theories elaborated by the Arabs from those originating in Greco-Roman antiquity, and traditions locally developed in southern Italy.Reference Green7 It was represented by a collection of texts devoted to women’s medicine – gynaecology and decoration of the body – attributed to the female physician and writer Trota or Trotula of Salerno. All this knowledge, widely disseminated through medieval Europe, became instrumental in the development of notions on women’s healthcare until the end of the Middle Ages. The impact of Arabic gynaecology, especially the writings of al-Majusī and Ibn al-Jazzār, is patent in the aetiology and therapeutics developed in one of the three treatises that make up the compilation: the Liber de sinthomatibus mulierum.Reference Green8 This treatise and, in all probability, another on cosmetics, De ornatu mulierum, were rendered into Hebrew by an unknown translator in 1197–1199. They have been preserved in two fragmentary versions.9
The Sefer ha-seter (Book of the Secret) has been identified as an extant fragment of the first translation of the Liber de sinthomatibus mulierum to any other language. In the prologue, the translator explains that it deals with knowledge relating to the ‘secret parts’ of women and to cosmetics. Although this second cosmetic part is missing in the only remaining copy, it seems quite possible that it was translated at the same time to form a single treatise. Ron Barkai has suggested that the ‘announced’ section on cosmetics might correspond to the translation of De ornatu mulierum, which circulated both independently and as part of the famous Salernitan compendium and was frequently copied and translated into many vernacular languages.
His suggestions have been substantiated by the recent identification of a treatise labelled She’ar yashuv (A remnant shall return, from Isaiah 10, 21). Under such an unexpected title, which in no way indicates the content, a series of recipes devoted to women’s conditions and to the care of beauty, mostly derived from both Salernitan treatises, are hidden. Apparently, around the second half of the 13th century, an unknown ‘editor’ working in Provence – referred to as Jacob by the anonymous author of the medical encyclopaedia Sefer ha-yosher, who claimed to be his brother – selected portions from both treatises – without mentioning the source – organized the excerpts adding some remedies, gave the result a title and attributed it to himself. The She’ar yashuv has been preserved in a single manuscript copy from the 15th century. It devotes a first section to women’s conditions, and a second, which occupies approximately a third of the treatise, to cosmetics. This second part is divided into five short chapters, with a few recipes each, which offer remedies and procedures largely for smoothing and whitening women’s skin, and eliminating sores, boils, stains and imperfections. Although, as is usual in medieval cosmetics literature, it does not mention sources, I have been able to identify at least five remedies from De ornatu mulierum.10
Cosmetics, understood as part of the technology that focused on intervening in the functioning of the body,11 is present in several of the Hebrew preserved texts. However, apart from the She’ar yashuv, not many Hebrew treatises that include ‘cosmetics’ as a significant part of their content have been identified to date. In my experience, these treatises often slumber in archives, hidden under titles that do not reveal their content or arouse the curiosity of historians. It must not be forgotten that, in general, historiography has shown no serious interest in what has been considered a minor genre. As a consequence, the majority of texts known to us that contain cosmetic material have been discovered by chance. In my view, a systematic search would produce better results, a search for manuscripts that contain references to women or that deal with gynaecology. Why gynaecology? Because all cosmetic material – that is, remedies and procedures whose aim is to beautify the body – identified in Hebrew to date was part of texts that deal with all kinds of gynaecological ailments and offer therapeutic treatments for the care of matters related to the incidences of women’s life cycle.
This is the case, for example, with the Sha’ar ha-nashim (Chapter on Women), a short anonymous 15th-century treatise devoted to women’s conditions, which includes a remedy to avoid the excessive growth of the breasts.Reference Caballero-Navas12 In addition, the section on ‘women’s diseases’ of the above-mentioned medical encyclopaedia Sefer ha-yosher (Book of Perfection) devotes Chapter 98 to the elimination of the disagreeable odour of sweat.13 This encyclopaedia was written in Provence during the last decades of the 13th century by an unknown but highly educated medical author, who apparently also benefited from abundant clinical experience. Neither of these texts seems to separate the attention to beauty from the preoccupation with health, and their recipes are based, as in the Arabic and Latin medical traditions, in Galenic physiology, aetiology and therapeutics.
The last item that I would like to discuss here is a unique book that offers the most complete and wide-ranging approach to the care of the female body of the Hebrew texts so far identified. It is a late 13th-century compilation, called Sefer ahavat nashim (Book of Women’s Love), divided into three sections.Reference Caballero-Navas14 The third section, devoted, in the compiler’s words, to ‘women’s matters’, is by far the longest of the three, and includes therapeutic measures and recipes on cosmetics, gynaecology and obstetrics without making any distinction between these areas. The section is organized in the traditional ‘head to toe’ order and presents a series of practical remedies for removing the hair of certain areas of the body, for the care of the hair on various parts of the body, for the eradication of parasites, for the treatment of wounds and scabs on the head, for care of the face and the preparation of cosmetics, for care of the teeth and gums, for the elimination of sweat and bad body odour, for the removal of warts, and care of and improvement of the appearance of sagging and wrinkled breasts.
A close reading of this section, and a study of various treatises and recipe books in Latin and in the vernacular (the Trotula, the Catalan Trótula, the Flos de tresor de beutat),15 show that it shares most of the basic features of medieval literature on cosmetics. One of the most important of these is its highly practical nature and its prescriptive layout. The compiler has collected a number of recipes and organized them a capite ad calcem. He does not always mention the origin or source of the recipes and, often, has recourse to empirical experience, following a criterion of effectiveness, to demonstrate the value of the measures advised. For example, using phrases such as ‘it has been tried and tested’ the compiler seeks to give authority to the content of certain recipes whose effectiveness is guaranteed by experience. Among the sources mentioned in this section of the work, those of anonymous, mainly collective, authorship occupy a prominent position. Many of these are of Arab origin: ‘the Ishmaelites’, ‘the Ishmael kings’, ‘the Land of Ishmael’, etc. On one occasion it is unequivocally female – ‘the women of the Ishmaelites’, to whom a recipe for a depilatory is attributed. Apart from the influence that individual texts may have exerted, either directly or indirectly, on particular Hebrew writings, the well-known impact of Arabic pharmacology on medieval medicine, which also affected the development of cosmetics, left important traces in Hebrew literature on women’s healthcare. The evident influence of Arabic cosmetics and perfumery is patent on the techniques and methods of preparation of the products listed in the compilation. We can read in it perfumery procedures, such as distillation and the use of alembic, whose use, inherited from the Arabs, was widespread in Christian Spain.16
In addition, it is worth noting that Arabic continued to be a means of transmission of medical knowledge for Jews as late as the 15th century, even when they lived in territories that were no longer under Islamic rule. This was the case with the Jewish communities of Castile, where some regions had been newly conquered by Christians. Recent studies have demonstrated that Jews did not limit themselves to reading and copying Arabic medical writings, but also composed original medical books in that language, which underscores the centrality of Arabic in the Jewish understanding of medicine, even in a Christian environment.17 Jewish medical authors’ skills in Arabic allowed them direct access to sections on cosmetics by Arab writers such as Ibn Sīnā, al-Zahrawī or al-Rāzī, who had devoted the fifth book of his Kitāb al-Mansūrī (Book for al-Mansūr), to cosmetics.18
To be or not to be… Jewish
After this short outline of the impact that Arabic and Latin medicine had on the Hebrew corpus on women’s healthcare, one may wonder, what makes it ‘Jewish’, then? First, there is the language. As has been mentioned, Hebrew became a vehicle for scientific transmission at the end of the 12th century. This conferred upon it a new dimension, and allowed literate Jews wider access to the knowledge circulating in their milieus. Second, there are some Jewish elements included by the authors in the texts translated, copied or produced by them. On the one hand, these elements were just part of their (Jewish) perception of the world; on the other, they were apparently intended to eliminate religious, cultural and social tensions from the text. The tension between integrating ‘foreign’ knowledge and maintaining traditions is apparent in the treatment that medical texts give to certain relevant issues that were deeply embedded in Jewish culture and regulated by Religious Law, such as menstruation.19
During the Middle Ages, Jewish life was mainly shaped by a specific collection of customs and practices that stemmed from halakhah and Tradition. Dietary and Purity Laws, as well as the customs concerning marriage and divorce, which regulated in detail many aspects of Jewish life, affected specifically women’s traditions, rituals and even daily routines. We may safely assume that daily (and less frequent) practices and concerns derived from Jewish Religious Law modelled Jewish women’s experiences. However, medical texts hardly make any distinction on that account when addressing women’s conditions, apart from occasional allusions to specific Jewish traditions such as the Purity or Dietary Laws.
Perhaps one of the most pressing issues regarding the implementation of Jewish Law in connection with the treatment of women’s conditions is menstruation. Hebrew tradition identifies menstruation with a form of ritual impurity (Lev. 15:18). Niddah is the Hebrew term that signifies the status of the ritually impure woman, whose impurity is caused by genital discharge, either menstrual blood or abnormal bleeding. Purity is recovered after immersion in the miqweh or ritual bath. The Laws of Niddah regulate women’s daily life and social behaviour,20 but during the Middle Ages they also played a main role in the understanding of women’s healthcare, since, in the Hippocratic-Galenic physiological system on which medieval medicine was based, menstruation was, as already mentioned, a central issue in the explanation of female health and disease.
From the 13th century on, menstruation became a core argument in the misogynistic debate on the inferiority of women, based on binary and highly hierarchic definitions of the human body. This discourse was not new, but the implementation of Aristotle’s writings in the university curriculum had contributed to legitimize it, as Maimonides’ writings had legitimized it within Judaism. Jewish sages seem to have adopted these negative attitudes by adding them to their own prejudices based on their views of Jewish traditions. Nevertheless, this detrimental view of menstruation was not universally accepted. The therapeutic content of many remedies collected in the Hebrew treatises on women’s healthcare – as well as on texts from the Arabic and Latin medical traditions – defines menstruation in terms of health and disease, understanding it as a way to purge the body of bad or excessive humours in order to regulate its well-functioning by re-establishing the lost balance.
Medical texts linked menstruation to fertility and maternity. Although the production of offspring is central to Jewish life, the fact that women are exempted from the divine commandment to ‘be fruitful and multiply’, introduced some permissibility regarding contraception and abortion, which was also perceptible in Arabic texts. The Jewish principle of pikuach nefesh (save a life), according to which the life of the mother prevails over the foetus, seems to be behind a procedure for difficult birth found in a 12th-century Hebrew treatise from Castile.21 The author even advises the recourse to embryotomy if the size of the foetus’ head endangers the life of the woman in labour. A similar procedure is recommended in Ibn Sīnā’s Canon (Book III, Fann XXI, maqala II, chap. 28),22 which may have been the Hebrew text’s source. Nonetheless, embryotomies were accepted by Jewish Law, as Maimonides discusses in his Mishneh Torah, Hilkot Rotseah 1,9.
Although Hebrew approaches to these important issues may have been permeated by Arabic and Christian notions of them, they were adequately addressed from a Jewish point of view. In contrast, there are many things within those very medical texts that are forbidden by Jewish Law, such as a variety of non-kosher ingredients included in remedies. Jews are a people utterly aware and concerned about foodstuffs, the ingestion of which is regulated by dietary laws that forbid some products as inappropriate for consumption. However, many remedies number among their ingredients elements that are shocking from a Jewish point of view. An example in this case is pork, the ingestion of which, as it is comes from an impure animal, is absolutely forbidden under normal circumstances. In my view, that such a substance not only regularly recurs but actually is quite common in recipe books points to the fact that health was considered a main issue by people, even if to procure it they had to renounce temporarily some of their otherwise precious precepts and overcome their scruples.23 In addition, we should not disregard the impact that cross-cultural interaction and cross-religious medical attention had in relation to adopting and adapting non-Jewish social practices. We are certain that women at childbirth were attended by female neighbours and midwives in their homes, no matter which their religion, which led to cultural contact and introduced changes in customs and traditions under the influence of the host culture.Reference Caballero-Navas24
To conclude this short outline of a subject that perhaps deserves a book, I shall return to the idea delineated in my title: Jewish literature on women’s healthcare; actually Jewish medical knowledge and practice in general, signifies the encounter and harmonization of different medieval medical traditions. The vicissitudes of medieval Jewish life, so often awkward for the Jewish population, also placed them in a privileged position to acquire science from many different routes. The result can be appreciated in the enriching processes of reception, creation and transmission of knowledge that occurred among Jewish communities in the Middle Ages. One of their very best outcomes was a precious Hebrew corpus on women’s healthcare, some of whose samples can be still admired today.
Carmen Caballero-Navas (PhD, 2000, in Hebrew Studies, Universidad de Granada), is currently an Assistant Professor at that university. She has edited a medieval Hebrew compilation on women’s healthcare (The Book of Women’s Love and the Jewish Medieval Medical Literature on Women. Sefer ahavat nashim, London, 2004), as well as other shorter medical treatises on the same subject, and has published several articles on the Hebrew textual production on women’s healthcare in the Mediterranean west during the Middle Ages, paying especial attention to women’s experiences.
