Rebecca Guarna and the Practice of Medicine

 Rebecca Guarna, doctor, fl. 1200 (1 April)

Like Trota before her and Costanza Calenda after, Rebecca Guaarna is one of the renowned mulieres Salernitanae ("women of Salerno") who were trained in medicine in that Italian city during the Middle Ages. 

Detail from a manuscript 
illustration of a female healer,
14th century
(MS 544, Miscellanea Medica XVIII,
from Wellcome Collection, London)

A reference to this long tradition was made by Antonio Mazza, prior of the Collegium Medicorum of Salerno, who wrote the earliest history of the institution. In Urbis Salernitanae Historia et Antiquitates (1681), Mazza noted that there had been "many erudite women" who trained at the school, women who "in many fields surpassed or equaled in ingenuity and doctrine not a few men and, like men, were remarkable in the field of medicine." Among the women he names is Rebecca Guarna.

In his multi-volume history of the the Scuola Medica Salernita, historian Salvatore de Renzi notes that, while much about Rebecca Guarna is "unknown" (her dates of birth and death, for example), she belonged a noble and noteworthy family whose members include Archbishop Romualdo Guarna, who had himself studied medicine at Salerno. (Romualdo Guarna died on 1 April 1182, so I've used the date of his death as the occasion to write about Rebecca.) 

Citing Mazza, Renzi lists the medical treatises which Rebecca Guarna is said to have written: De febris (On Fevers), De urinis (On Urines), and De embrione (On Embryos).

In addition to Mazza's reference to Rebecca Guarna and to Renzi's documentary research, she is mentioned by scholars who have written about the history of medicine, and in particular about the history of women in medicine, but there are, unfortunately, no further details. They span the decades: Henry Ebenezer Handerson's The School of Salernum: An Historical Sketch of Medieval Medicine (1883), James J. Walsh's Old Time Makers of Medicine (1911), Melina Lipinska's Les Femmes et le progrès des sciences médicales (1930), Muriel Joy Hughes's Women Healers in Medieval Life and Literature (1943), Kate Campbell Hurd-Meade's A History of Women in Medicine, from the Earliest Times to the Beginning of the Nineteenth Century (1973), and Leigh Whaley's Women and the Practice of Medical Care in Early Modern Europe, 1400-1800 (2011)

I have been unbelievably excited to discover that there is a street in Salerno named in honor of Rebecca Guarna, the Via Rebecca Guarna. I am including a picture of the street, even though it's from an article with a headline about the "urban degradation" in Salerno! Sure, trees are falling, but THERE IS A STREET NAMED FOR REBECCA GUARNA!!

(Evidently the urban blight seen in Via Rebecca Guarna is a thing, because there are a couple of earlier articles, like this one, with photos of trash everywhere, but I'm still happy.)

Here it is, if you're ever in the area:

Let's Revive Childbed Fever! Back to the Future, Part 21

Yay! We're Reviving Childbed Fever! Back to the Future, Part 21

So, among all the other great news lately, there's this: in the two years since Texas banned abortion, rates of deadly sepsis, leading to maternal mortality, have skyrocketed.

Before the twentieth century, "childbed fever" (or "puerperal fever") was the name given to the septic infection that led to many women's deaths: "Before the advent of antiseptic practices—and, later, antibiotics to treat sepsis when it occurred—puerperal fever was almost always fatal. In the 18th and 19th centuries, there were between six and nine cases for every 1,000 deliveries, resulting in a death toll during that span of as much as half a million in England alone. Puerperal fever was far and away the most common cause of maternal mortality and was second only to tuberculosis among all causes of death for women of childbearing age."

Eugène Devéria,

La Mort de Jane Seymour,

Reine d'Angleterre (1847),

Musée de Valence

But now, in one more example of "back to the future," childbed fever is back!

As reported by ProPublica's Lizzie Presser, Andrea Suozzo, Sophie Chou, and Kavitha Surana, "Pregnancy became far more dangerous in Texas after the state banned abortion in 2021."

In their analysis of the life-threatening complications faced by pregnant women in Texas, the researchers focused first on rates of sepsis--infection--for women who were hospitalized after losing a pregnancy in the second trimester. 

Medical treatment is readily available for women in these circumstances: 

The standard of care for miscarrying patients in the second trimester is to offer to empty the uterus, according to leading medical organizations, which can lower the risk of contracting an infection and developing sepsis. If a patient’s water breaks or her cervix opens, that risk rises with every passing hour.

Sepsis can lead to permanent kidney failure, brain damage and dangerous blood clotting. Nationally, it is one of the leading causes of deaths in hospitals.

But in Texas, this medical treatment is now unavailable--doctors and hospitals are unable (or unwilling) to treat women for fear that their treatments will be regarded as an illegal abortion.

And so women are dying. The figures provided by the researchers are stark: In 2021, before the Texas abortion ban took full effect, "67 patients who lost a pregnancy in the second trimester were diagnosed with sepsis--as in the previous years, they accounted for about 3% of the hospitalizations."

But, those numbers have changed dramatically: "In 2022, that number jumped to 90. The following year, it climbed to 99."

Wait. There's more.

ProPublica zoomed out beyond the second trimester to look at deaths of all women hospitalized in Texas while pregnant or up to six weeks postpartum. Deaths peaked amid the COVID-19 pandemic, and most patients who died then were diagnosed with the virus. But looking at the two years before the pandemic, 2018 and 2019, and the two most recent years of data, 2022 and 2023, there is a clear shift:

In the two earlier years, there were 79 maternal hospital deaths.

In the two most recent, there were 120.

This is where we are now--a return not to the twentieth century or even to the nineteenth, but back to the eighteenth century and even earlier. While women have always died of childbed fever--it was recognized by the ancient Greek physician, Hippocrates--the number of cases of childbed fever grew after male physicians began to take over childbirth and delivery from midwives and, in particular, when childbirth moved from home to "lying-in" hospitals in the early modern period. As one example, an "epidemic" of childbirth fever was recorded in 1646 at the Hôtel-Dieu in Paris. (Laura Helmuth's "The Disturbing, Shameful History of Childbirth Deaths" is an excellent place to start reading if you're interested.)

So, you know, who needs all that modern medical treatment. Stuff like up-to-date obstetric care, sanitary practices, and antibiotics. Let's just go with bullshit and misogyny--what's the big deal if a few women die along the way, right?

I've written many entries in this blog noting women who died from childbed fever. Because of the popularity of the Tudors, I'll include a few names here. Jane Seymour, Henry VIII's third wife, is one of the more famous women who died of childbed fever--within two weeks of giving birth to the son that Henry VIII had so longed for, Jane Semour died. Henry VIII's mother, Elizabeth of York, also died of childbed fever, as did the woman who had been his sixth wife (but managed to survive him). Katherine Parr died after giving birth to a daughter, whose father, Thomas Seymour, was Jane Seymour's brother. 

The tomb of Katherine Parr,
St. Mary's Chapel,
Sudeley Castle

I don't usually link to Wikipedia pages--not because I don't value the resource a great deal (I donate regularly, and I suggest you do too) but because it's easily accessible to all. But I am going to link here to the list of notable women who died during childbirth or from complications to childbirth--it's an eye-opener. 

But even as I link you to “notable” women, every woman who suffers a terrible, unnecessary complication is notable to us—a beloved daughter, wife, partner, sister, friend, neighbor, even perhaps a mother already. She is a singular human being. 

Update, 7 May 2025: More data from Kavitha Surana, Lizzie Presser, and Andrea Suozzo at ProPublica:

As ProPublica reported earlier this year, the statewide rate of sepsis—a life-threatening reaction to infection—shot up more than 50% for women hospitalized when they lost a second-trimester pregnancy.

A new analysis zooms in: In the region surrounding Dallas-Fort Worth, it rose 29%. In the Houston area, it surged 63%. . . . 

This marks the first analysis in the wake of abortion bans that connects disparities in hospital policies to patient outcomes. It shows that when a state law is unclear and punitive, how an institution interprets it can make all the difference for patients.

Yet the public has no way to know which hospitals or doctors will offer options during miscarriages. Hospitals in states where abortion is banned have been largely unwilling to disclose their protocols for handling common complications. When ProPublica asked, most in Texas declined to say.

ProPublica’s Texas reporting is based on interviews with 22 doctors in both the Houston and Dallas-Fort Worth metro areas who had insight into policies at 10 institutions covering more than 75% of the births and pregnancy-loss hospitalizations in those areas.

The findings come as evidence of the fatal consequences of abortion bans continue to mount, with a new report just last month showing that the risk of maternal mortality is nearly twice as high for women living in states that ban abortion. 

As devastating as this article is, I cannot recommend it enough.

Update, 13 July 2025: More from ProPublica in the ongoing crisis in Texas for women: "A 'Striking' Trend: After Texas Banned Abortion, More Women Nearly Bled to Death During Miscarriage."

And beyond the effects of the Dobbs decision, women's health care--in particular maternity and childbirth treatment--will suffer as a result of the reduction in Medicare funding, as Jessica Grose makes clear in her New York Times op-ed, "Pregnancy Is Going to be Even More Dangerous in America."

The figures are dire:

Medicaid covers over 40 percent of births in the United States, and an even higher percentage in rural areas. According to an analysis from the National Partnership for Women & Families, a nonprofit advocacy organization, “144 rural hospitals across the country with labor and delivery units are at risk of closure or severe service cutbacks” based on the Medicaid cuts outlined in the bill. That’s in addition to the over 100 rural labor and delivery units that have closed or plan to close since 2020. . . . 

Cuts to Medicaid will have an impact on women across the country regardless of which community they live in. City maternity wards have also been closing, because labor, delivery and infant care are expensive. “Urban hospitals had the highest number of labor and delivery unit closures--299--between 2010 and 2022,” my newsroom colleague Sarah Kliff wrote in December.

A really "beautiful" bill, huh? 

Here's a revealing graph from a 2024 report in The Commonwealth Fund:

Back to the Future, Part 20: "Maternity Care Deserts"

March of Dimes Report: "Nowhere to Go: Maternity Care Deserts Across the US," Back to the Future, Part 20

I've been writing these "Back to the Future" reports since January 2017--for more than seven years years now, women have faced increasingly dire conditions in the U. S. So bad that I added a second series, "When Women Became No Longer Equal." (To view all the posts in these two series, click on the labels, below.) Let's hope that conditions improve after the coming presidential election.

You can download the entire
report by clicking here.

All that being said, the recent March of Dimes report on maternity care offers up more bad news for reproductive health. According to "Nowhere to Go," the reality of "maternity care" is that for many women in the U.S.--more than 2.3 million women, to be accurate--there is no "maternity care" at all. These women live in so-called maternity care deserts, where there is "not a single birthing facility or obstetric clinician." Some 1,104 counties--35% of U.S. counties--are maternity care desserts (p. 3). In addition, over 3 million women live in counties with "limited" access to obstetrical care, hospitals, or birth centers. 

From the report's "Key Findings" (p. 5):

• Living in a maternity care desert is associated with a 13% increased risk of preterm birth;
• Over half of counties in the US do not have a hospital that provides obstetric care; 
• Nearly 70% of birth centers are located within just 10 states. 

And, dangerously, "Fertility rates in rural counties and maternity care deserts are higher than urban and full access counties and are decreasing at a slower pace." 

It should be no surprise that women living in maternity care deserts also receive "inadequate" pre-natal care (page 11).

Much more information and analysis is included in the report, which you can download by clicking here.

From "Nowhere to Go," click here

Costanza Calenda, a Fifteenth-Century Medical Practitioner

Costanza Calenda, One of the Renowned mulieres Salernitanae (practicing medicine in 1422)

In her extended history of women and the practice of medicine, Leigh Whaley notes that during the Middle Ages, "Most commonly, women practising medicine were the daughters of doctors or surgeons, and they were instructed by their fathers of a male relative." Only in exceptional circumstances--if she were living in exactly the right place or at just the right time--could a woman receive any kind of formal medical education.

Manuscript illustration of 
a female healer, 14th century
(MS 544, Miscellanea Medica XVIII,
from Wellcome Collection, London)

Costanza Calenda was such a fortunate woman, one of the renowned mulieres Salernitanae ("women of Salerno") who were known to have been trained in medicine in that Italian city during the Middle Ages. 

A reference to this tradition was made by Antonio Mazza, prior of the Collegium Medicorum of Salerno, who wrote the earliest history of the institution. In Urbis Salernitanae Historia et Antiquitates (1681), Mazza noted that there had been "many erudite women" who trained at the school, women who "in many fields surpassed or equaled in ingenuity and doctrine not a few men and, like men, were remarkable in the field of medicine." 

Among those women was the "noble" and "erudite" Costanza Calenda," whom he describes as having a doctoral degree ("Laurea etiam Doctoralis Constantia Calenda")

In the early fifteenth century, Costanza Calenda was "diligently instructed in medicine" by her father, Salvatore Calenda di Salerno. In his multi-volume history of the the Scuola Medica Salernita, historian Salvatore de Renzi claims that Calenda's father was "called illustrious for his doctrine and for his expert practice" in medicine. With such a reputation, he was lured to Naples in 1415, becoming a professor at the collegio medico di Napoli, and by 1423 he was prior (or head) of the college. (There seems to be some scholarly dispute about whether he maintained an official position in Salerno as well as in Naples--it's an interesting debate, but not our focus here.) 

Salvatore Calenda also became the personal physician of Queen Joanna II of Naples. (Since I have no firm dates for the life of Costanza Calenda, I am posting about her today, 2 February, the anniversary of Joanna II's death in 1435). Salvatore Calenda was still head of the medical college in Naples as late as 1430. 

In receiving her training from a member of her family, Costanza Calenda is thus like most of the women known to have practiced medicine in the Middle Ages or in Early Modern Europe. But she seems also have have had more formal instruction, an opportunity that was afforded only a very few women

Citing Mazza's earlier work, Renzi claims that Costanza Calenda proved so knowledgeable that she earned a medical degree. In Renzi's own examination of contemporary historical documents, he cites two sources identifying Costanza Calenda and her activities: the first, a document from 1423 that refers to her as a doctor of medicine; the second is from 1426, but aside from noting that it refers to Costanza, Renzi includes nothing more about the document's contents.* 

Detail from 
MS 544, Miscellanea Medica XVIII,
from Wellcome Collection, London

In 1423, Costanza also received royal assent to marry Baldassarre di Santo Mango, lord of Santo Mango, a permission necessary to ensure  her dowry. There is no further documentation of any kind about the life and career of Costanza Calenda after the reference to her marriage, but I find this theory, from Henry Ebenezer Handerson (The School of Salernum: An Historical Sketch of Medieval Medicine, 1893) absolutely hilarious: "The silence of history on her subsequent career suggests the pleasing reflection that possibly she may have proved as excellent a wife as she had been brilliant in the rôle of a student of medicine." Poor Handerson! I know he is a man of his time, so I understand his daydream about Costanza Calenda becoming a good little wife, but I don't know what tickles me most--the implications of his use of the word "rôle" to describe Calenda as a medical practitioner or his uncertainty that she might settle down after marriage, signaled by his wonderful phrase "possibly she may have"!!!

Notably, Salvatore de Renzi doesn't focus on Costanza as a wife, nor even as a daughter. Instead, he provides details about Costanza Calenda in her own separate biographical entry, not including her in her father's entry, which immediately precedes it. 

*Renzi lists his documents by number, followed by the year. The two documents Renzi had access to in the nineteenth century were destroyed during World War II, but a modern copy of one of them survives. The modern copy confirms Costanza Calenda's practice but does not say she had the title of "doctor of medicine."

In "Trotula and the Ladies of Salerno: A Contribution to the Knowledge of the Transition between Ancient and Medieval Physick" (Proceedings of the Royal Medical Society, 1940), H. P. Bayon claimed that Costanza  "lectured on medicine ex cathedra some time during the reign of Giovanna I of Anjou (1326-82) in the University of Naples." But there is no citation, and he confuses Joanna I of Naples (Giovanna of Anjou) with Joanna II, so I'm not sure about the reliability of this! 

Clarice de Rothomago, Accused of Illegally Practicing Medicine in Fourteenth-Century Paris

Clarice de Rothomago (Rouen), medical practitioner (case against her begins 17 January 1312)

In her extended history of women and the practice of medicine, Leigh Whaley notes that during the Middle Ages, "Most commonly, women practising medicine were the daughters of doctors or surgeons, and they were instructed by their fathers of a male relative." Only in exceptional circumstances--if she were living in the right place or at the right time--could a woman receive any kind of formal medical education. 

Manuscript illustration of 
a female healer, 14th century
(MS 544, Miscellanea Medica XVIII,
from Wellcome Collection, London)

If a woman did receive less formal instruction by a family member, she could present a letter "attesting" to her medical knowledge to authorities, be examined by experienced "physicians and surgeons," and receive a license. 

Such was the situation in Paris, for example, where the medical faculty of the University of Paris was eager to limit and regulate those who could practice medicine and equally intent on prosecuting those who were practicing illegally.

In the early fourteenth century, the medical faculty claimed a right to "prosecute unlicensed practitioners" based on "a regulation issued by the bishop's court at Paris" some two centuries earlier--although, as historian Pearl Kibre points out, "no text of such a pronouncement seems to have been found. There is also no apparent evidence that an organized faculty of medicine was functioning in Paris before 1200." Maybe this claim was meant as "a mere figure of speech," she says. Right. 

Nevertheless, based on this shaky reference to the existence of an ancient statute, the medical faculty pursued its goal of regulating the practice of medicine. To that end, "An edict of 1311, at the same time that it interdicts unauthorized women from practising surgery, recognizes their right to practise the art if they have undergone an examination before the regularly appointed master surgeons of the corporation of Paris." 

In addition to setting medical standards and to controling the licensing of medical practitioners, this law also granted medical faculty of the university the right to prosecute those who practiced without a medical license. 

And it is practicing medicine without a license that drew attention to Clarice de Rothomogo in 1312. She was charged with "the illegal practice of medicine." (According to Whaley, the "University of Paris was very active in prosecuting illicit medical practitioners.")

According to surviving records, Clarice received her training from her husband, Peter Faverel, who was himself described as as empeiricus, or an "empiric," that is, a medical practitioner without formal instruction or licensing. Hers was among the earliest cases prosecuted by the faculty of medicine at the university--"armed with laws of its own making," the medical faculty proceeded in their efforts to secure "enforcement."

Clarice de Rothomago's case took place over the course of several months, from 17 January 1312 until 15 June. Somehow learning of her activities, the dean of the medical faculty ordered her arrest. Her case was brought before the bishop's court--an ecclesiastical court (faculty and students of the University of Paris were clergy, infractions subject to ecclesiastical rather than civil law). She was sentenced to  excommunication.

Clarice de Rothomago appealed her sentence, but that did not serve her well--her appeal was denied, and it earned her husband, Peter Faverel a sentence of excommunication as well. The sentence further ordered that both Clarice and her husband were to be "denounced in all churches." Anyone who continued to associate with them was to receive the same treatment, excommunication.

But, as Pearl Kibre concludes, "The effectiveness of this ban of excommunication and oral denunciation, applied against Clarice and her husband, as a means of frightening off other unlicensed persons from medical practice, appears to have been slight." 

Among the women in Paris who were punished for the illegal practice of medicine after Clarice were Perronelle l'erbière, in 1319, Jeanne Clarisse, in 1322, and her servant, Agnès Avesot, who seems to have been Jeanne Clarisse's apprentice. Muriel Joy Hughes suggests that a woman charged with the illegal practice of medicine in Paris in 1331 may have been Clarice de Rothomago's daughter. She is described as "filia Clarisse qui moratur ultra pontes, que est totaliter laica" ("the daughter of Clarice who lives beyond the bridges and who is entirely secular"). And, of course one of the most well-known cases that followed Clarice's is that of Jacoba Félicie de Almania, which occurred just a decade later . . . 

Detail from 
MS 544, Miscellanea Medica XVIII,
from Wellcome Collection, London

Further ordinances about illegal medical practitioners were drawn up by the medical faculty in 1322, and a series of appeals was sent directly by the faculty of the school of medicine to the pope, "humbly  beseech[ing]" his assistance in their efforts--appeals were made in 1325, 1330, 1340, 1347, and 1350. (In 1340, Pope Clement VII threatened not only the illegal practicioners with excommunication, but their patients as well!)

 

I've linked above to some excellent resources for women medical practitioners in the fourteenth century. They span the decades: Muriel Joy Hughes's Women Healers in Medieval Life and Literature (1943), Pear Kibre's "The Faculty of Medicine at Paris, Charlatanism, and Unlicensed Medical Practices in the Later Middle Ages" in Bulletin of the History of Medicine (1953), Kate Campbell Hurd-Meade's A History of Women in Medicine, from the Earliest Times to the Beginning of the Nineteenth Century (1973), and Leigh Whaley's Women and the Practice of Medical Care in Early Modern Europe, 1400-1800 (2011) Enjoy!

Jacoba Félicie de Almania, Fourteenth-Century Parisian Doctor

Jacoba Félicie, a Medieval Medical Practitioner (verdict issued 22 November 1322)

On 11 August 1322, Jacoba Félicie was cited for illegally practicing medicine by an official of the Bishop of Paris and the proctor of the dean of the medical faculty at the University of Paris.*

The proceedings took place over the course of the next few months, the records of her case preserved in the Cartulary of the University of Paris: "Witnesses were brought . . . in the inquisition made at the instance of the masters in medicine at Paris against Jacoba Félicie and others practicing the art of medicine and surgery in Paris and the suburbs without the knowledge and authority of the said masters, to the end that they may be punished, and that the practice be forbidden them. . . ."

Manuscript illustration of 
a female healer, 14th century
(MS 544, Miscellanea Medica XVIII,
from Wellcome Collection, London)

Among those providing evidence for the prosecution of Jacoba Félicie was John of Padua, a physician and one-time surgeon to King Philip IV of France. He claimed that "penalties and prohibitions" against those practicing medicine illegally had existed for more than sixty years. 

According to his testimony, Jacoba Félicie was "ignorant of the art of medicine," not having been "approved as competent in those things which she presumed to treat." He also asserted that she was "not lettered," presumably unable to read or write.

Evidence presented by the prosecution said that Félicie had "visited many sick persons afflicted with grave illness," diagnosed them, promised to make them well again, "visited them often," and prescribed various medications for them. She charged them money for her services. And she did all this despite the fact that "she has not been approved in any official studium at Paris or elsewhere. . . ."

A number of witnesses, both men and women, offered testimony on her behalf. One man who was questioned about her said that he had been "suffering from a certain sickness in his head and ears," and that Félicie had shown him "great care" and cured him. 

Another of the witnesses, one who had been treated by many "masters in medicine," consulted Jacoba Félicie, who treated him with such "great care" that he was "completely restored to health." She hadn't made any "contract" with him about her services--instead, he "paid as he wished when he got well."

When questioned, a female witness said that she had been "seized" by a terrible fever and sought help from "many physicians." But she became so "weighed down" with her illness that "the said physicians gave her up for dead." But Félicie had cured her "of the said illness."

In Félicie's defense, her counsel also noted there were many practicing medicine on a daily basis in Paris who did not have licenses--and that the "law" being used against her had no validity, being merely a "mandate" that had been asserted but never a legally established statute. 

To the prosecution's argument that "penalties of fines and excommunication" had been levied against "ignorant and illicit" medical practioners for more than sixty years, Jacoba Félicie defended herself. She said that the law was old, that sixty years was long before she was born (according to the record, "she is young, thirty years or thereabouts"), and thus all the "ignorant women" and "inexperienced fools" the law had been aimed at were long dead. She was not one of them. 

Detail,
MS 544, Miscellanea Medica XVIII,
from Wellcome Collection, London)

Moreover, her defense added, it was surely better for a woman to examine and care for female patients than a male doctor--and surely it was also better for a woman to to examine and care for a male patient who "dare not reveal" all the details of his illness to a male doctor. It was altogether a "lesser evil" to allow a woman to "exercise the office of practice" than it was to let sick patients die. 

In the end, however, the case was decided without any examination of Jacoba's expertise and experience but for an altogether different reason, one that had been argued by John of Padua: since a woman couldn't practice law, couldn't even provide evidence in a criminal case, it was obvious that she couldn't practice medicine either. This argument by analogy seems to have been what determined the case.

According to the final verdict against her, issued 22 November 1322: "Her plea that she cured many sick persons whom the aforesaid master could not cure ought not to stand, and is frivolous, since it is certain that a man approved in the aforesaid art could cure better than any woman."

And so, despite the witnesses in her defense and Jacoba Félicie's own arguments, she was found guilty, fined heavily, and threatened with excommunication if she continued to practice medicine. 

This is all we know of Jacoba Félicie--if she was about thirty years old at the time of her trial, she would have been born in the last decade of the thirteenth-century, but where is unknown. Nor is there information in the surviving documents where she might have gained her medical experience. She was never tested about her knowledge during the proceedings--nor was she ever given the chance to prove whether she was "not lettered."

Nor is it known whether she gave up practicing medicine, remaining in Paris, or moved on. 

I've linked above to the two most substantial articles about Jacoba Félicie, Pearl Kibre's "The Faculty of Medicine at Paris, Charlatanism, and Unlicensed Medical Practices in the Later Middle Ages" (1953) and Monica Green's "Getting to the Source: The Case of Jacoba Felicie . . . "  (2006). Both are excellent--Kibre's covers other cases and provides the cases made by prosecution and defense, Green’s focusing on the arguments made in Felicie’sdefense.  

You may also enjoy W. L. Minkowski's "Women Healers of the Middle Ages: Selected Aspects of Their History" (1992) for a brief overview of women as medical practitioners.

*Three other women were charged (as were two men) and condemned for practicing medicine: Johanna, identified as convert, Margarita de Ypra, identified as a surgeon, and Belota, identified as a Jew. All three women received the same penalty as Jacoba Félicie. 

One Year after Dobbs . . .

When Women Became No Longer Human, Part 13: Women's Lives (and Deaths) One Year After Dobbs (24 June 2023)

As if maternal mortality rates in the United States weren't bad enough before Dobbs, a new study by the Kaiser Family Foundation (now KFF), "National Survey of OBGYNs’ Experiences After Dobbs," provides necessary data about the effect of the 2022 forced birth decision and its impact on medical professionals who specialize in women's healthcare.

You can access the full report by clicking here.

Meanwhile, here are the highlights (lowlights?):

Key Findings

ABORTION ACCESS AND CONSTRAINTS ON CARE SINCE DOBBS

• Since the Dobbs decision, half of OBGYNs practicing in states where abortion is banned say they have had patients in their practice who were unable to obtain an abortion they sought. This is the case for one in four (24%) office-based OBGYNs nationally.
• Nationally, one in five office-based OBGYNs (20%) report they have personally felt constraints on their ability to provide care for miscarriages and other pregnancy-related medical emergencies [emphasis added] since the Dobbs decision. In states where abortion is banned, this share rises to four in ten OBGYNs (40%).
• Four in ten OBGYNs nationally (44%), and six in ten practicing in states where abortion is banned or where there are gestational limits, say their decision-making autonomy has become worse since the Dobbs ruling. Over a third of OBGYNs nationally (36%), and half practicing in states where abortion is banned (55%) or where there are gestational limits (47%), say their ability to practice within the standard of care has become worse.
• Most OBGYNs (68%) say the ruling has worsened their ability to manage pregnancy-related emergencies [emphasis added]. Large shares also believe that the Dobbs decision has worsened pregnancy-related mortality (64%) [emphasis added], racial and ethnic inequities in maternal health (70%) and the ability to attract new OBGYNs to the field (55%).

ABORTION POLICIES AND CONCERN ABOUT LEGAL RISK

• Two-thirds of OBGYNs nationally (68%) say they understand the circumstances under which abortion is legal in the state they practice very well. However, among OBGYNs in states where abortion is restricted by gestational limits the share is lower (45%) compared to those practicing in states where abortion is available under most circumstances (79%) or banned (68%).
• Over four in ten (42%) OBGYNs report that they are very or somewhat concerned about their own legal risk when making decisions about patient care and the necessity of abortion. This rises to more than half of OBGYNs practicing in states with gestational limits (59%) and abortion bans (61%).
• Eight in ten OBGYNs approve of a recent policy change from the FDA that allows certified pharmacies to dispense medication abortion pills.

ABORTION SERVICES

• Nearly one in five (18%) officed-based OBGYNs nationally say that they are providing abortion services after the Dobbs About three in ten OBGYNs (29%) practicing in states where abortion is available under most circumstances offer abortion care, compared to just 10% in states with gestational restrictions. There were already large differences between states prior to the Supreme Court’s ruling. Many of the states that have abortion restrictions today had these or similar restrictions in place prior to the Dobbs decision.
• Nationally, 14% of OBGYNs say they provide in-person medication abortions, but only 5% say they provide telehealth medication abortions.
• In states where abortion is banned, essentially no OBGYNs offer abortions, except under very limited circumstances. Additionally, nearly half (48%) of OBGYNs in these states only offer information, such as online resources, to help patients seek out abortion services on their own, but 30% do not even offer their patients referrals to another clinician or any information about abortion.

CONTRACEPTION

• More than half (55%) of OBGYNs nationally say they have seen an increase in the share of patients seeking some form of contraception since the Dobbs ruling, particularly sterilization (43%) and IUDs and implants (47%).
• Nearly all OBGYNs offer their patients some form of contraceptive care, but only 29% make all methods of contraception available to their patients, including all three methods of emergency contraception (copper intrauterine device (IUD), ulipristal acetate/Ella, and levonorgestrel/Plan B).
• Only one-third of OBGYNs (34%) prescribe or provide all three methods of emergency contraception and one in seven (15%) do not provide any methods of emergency contraception to their patients. A quarter of OBGYNS (25%) only prescribe or provide Plan B, which is available over the counter.
• Availability of care via telehealth expanded greatly after the onset of the COVID-19 pandemic. Today, almost seven in ten OBGYNs (69%) nationally say they provide at least some care via telehealth.

From "A National Survey of OBGYNs' Experiences
after Dobbs" (p. 15)

This is our brave new world.

Update, 29 June 2023: Here's a great link to Grace Haley's "A Year Without Roe: In the Data," posted at Jessica Valenti's Abortion, Every Day.

The data and research that's come out over these last few weeks paint a stark picture of our first year without Roe. We wanted to share with you what people’s lives have looked like by pulling out a few statistics to pay particular attention to. There are three main themes encapsulated by these reports: documenting the harm done by abortion bans, the shifting public view on abortion, and accounting for what the future will look like in the post-Roe world.

Update, 12 September 2023: For ways to address the problem of maternal mortality, see Mara Gay's NYT opinion piece, "America Already Knows How to Make Childbirth Safer" (click here).

More Bad News on Maternal Mortality (Back to the Future, Part 18)

The  "U.S. Maternal Mortality Crisis" (The Commonwealth Fund Report, 14 December 2022), Back to the Future, Part 18 

A few days ago, the Commonwealth Fund published a new report on the status of maternal mortality in the United States. Dated 1 December 2022, the comparative study, authored by Munira Z. Gunja, Evan D. Gumas, and Reginald D. Williams II, had a shocking, but not surprising, title: "The U.S. Maternal Mortality Crisis Continues to Worsen: An International Comparison." 

I say "shocking" for obvious reasons. I say "not surprising," because maternal mortality rates in the U.S. have long been exceedingly bad. As Gunja, Gumas, and Williams note, "The maternal mortality rate in the United States has for many years exceeded that of other high-income countries. Data from the Organisation for Economic Co-operation and Development and the Centers for Disease Control and Prevention show rates worsening around the world in recent years, as well as a widening gap between the U.S. and its peer nations."* 

Despite the urgency of the findings, I put off writing about the report--it was too depressing. But, today, the Commonwealth Fund has issued an even more urgent report, "The U.S. Maternal Health Divide: The Limited Maternal Health Services and Worse Outcomes of States Proposing New Abortion Restrictions."**

Together, these two publications present a devastating healthcare reality for women in the United States. 

Just one chart from the Commonwealth's "U.S. Maternal Mortality Crisis" is eye-opening: 

And, as the authors of the study note, "Data show that the maternal mortality rate in the United States — more than three times the rate in most other high-income countries — is getting worse, and the rate for Black women is nearly three times higher than for white women."

As for the "health divide" for women living in the U.S.? It will surprise no one that maternal (and infant) health is far worse in states where abortion has been made illegal or so seriously restricted that it may as well be illegal: "Compared to states where abortion is accessible, states that have banned, are planning to ban, or have otherwise restricted abortion have fewer maternity care providers; more maternity care 'deserts'; higher rates of maternal mortality and infant death, especially among women of color; higher overall death rates for women of reproductive age; and greater racial inequities across their health care systems."

Moreover, "Making abortion illegal makes pregnancy and childbirth more dangerous; it also threatens the health and lives of all women of reproductive age."

Because of course it does. So much for the "we value every single precious life" forced-birth crowd. What a load of crap.

*For data, see this CDC report on maternal mortality rates in 2021. And for earlier discussions of maternal and infant mortality rates in the United States in this blog, click "Global Gender Report" in the labels, below.

**The Commonwealth Fund report is authored by Eugene Declercq, Ruby Barnard-Mayers, and Laurie Zephyrin, Kay Johnson

Update: Here's more on maternal health, if you can stand it, from Axios.

Update, 16 December 2022: And still more, from the Washington Post, "Can Politics Kill You?" No mystery--the answer to that question is yes. The majority of the piece is about the way COVID has taken a heavy toll on Republicans and conservatives, but there's this:

With abortion services no longer legal nationwide, university researchers have estimated that maternal deaths could increase by up to 25 to 30 percent, worsening the nation’s maternal mortality and morbidity crisis. Americans live shorter lives than people in peer nations, in part because it is the worst place among high-income countries to give birth.

Update, 17 December 2022: And even more, from the Texas Tribune's Eleanor Klibanoff, "Why Are Pregnancy and Childbirth Killing So Many Black Women in Texas?" (click here). Here's just a bit:

A decade ago, when Texas first formed the Maternal Mortality and Morbidity Review Committee, Black women were twice as likely as white women, and four times as likely as Hispanic women, to die from pregnancy and childbirth.

Those disparities haven’t improved, according to the committee’s latest report, published Thursday.

In 2020, pregnant Black women were twice as likely to experience critical health issues like hemorrhage, preeclampsia and sepsis. While complications from obstetric hemorrhage declined overall in Texas in recent years, Black women saw an increase of nearly 10%.

Update, 19 March 2023: In a piece titled "US Maternal Death Rate Rose Sharply in 2021 . . . and Experts Worry the Problem Is Getting Worse, CNN reports on the new data just released by the National Center for Health Statistics (see the link in *, above). According to the CDC's Center for Health Statistics, "The number of women who died of maternal causes in the United States rose to 1,205 in 2021. . . . That’s a sharp increase from years earlier: 658 in 2018, 754 in 2019 and 861 in 2020." Check out the report--the graphs will stun you.

And CNN refers to the Commonwealth Fund's report (discussed above), published at the end of 2022: "The US has the highest maternal death rate of any developed nation."

Are we all ready for those "We're Number One" bullshit cheers we here so often? All that "greatest country in the world" claptrap? Yeah, I thought so . . . 

Update, 19 July 2023: Here is Veronica Gillispie-Bell's heartbreaking New York Times op-ed, "More Mothers Are Dying. It Doesn't Have to Be This Way." Gillispie-Bell links to the 3 July "Trends in State-Level Maternal Mortality by Racial and Ethnic Group in the United States" (JAMA 330, no. 1 [2023]: 52-61; for the online abstract, click here.)

Update, 12 September 2023: For ways to address the problem of maternal mortality, see Mara Gay's NYT opinion piece, "America Already Knows How to Make Childbirth Safer" (click here).

Sarah Stone, the "Complete Midwife"

 Sarah Stone, midwife (letter dated 25 December 1736)

The daughter of a midwife and the mother of a midwife, Sarah Stone was an English woman who practiced midwifery, as she writes, for "five and thirty year," from about the year 1703 until at least 1737.  

Sarah Stone, title page,
A Complete Practice
of Midwifery (1737)

Almost all that is known about Stone comes from what we can find in her book, A Complete Practice of Midwifery, which was published in 1737. The work seems to represent a culmination of Stone's life's work--intended as a practical guide for midwives, it seems to have been completed just as she was was ending her career. 

According to the title page of the book, Stone is living in London with her husband at the time the book appeared: the author of the work is identified on the title page as "Sarah Stone, of Piccadilly." A few pages later, at the end of her preface, she adds that she has been writing "from my house in Piccadilly, over-against the Right Hon[orable] the Earl of Burlington's."

Also included in her preface are details of where she has lived and practiced during her career as a midwife--she began her work in Somersetshire, in Bridgewater and in Taunton, where women's difficult and taxing work in "woolen manufactory" has "been the occasion" of many of the obstetrical difficulties they face. Stone has also practiced in Bristol, where, according to her preface, it has become "quite a fashion" for having a "Man-Midwife," a practice Stone altogether opposes.

Throughout her preface, Stone emphasizes men's lack of preparation for the profession of midwifery. A young man who has taken a course of anatomy as part of his apprenticeship to a barber-surgeon "immediately sets up for a man-midwife," she scoffs--as if "dissecting the dead" has prepared them for caring for living mothers and babies. 

For her part, Stone does not think it "amiss" to have "seen dissections and read anatomy," as she herself has done, but a midwife's training is, and must be, more rigorous. She notes that she had been "instructed in midwifery" by her mother and had served an apprenticeship (assisting as her "deputy") for "six full years." 

Following her preface, Stone includes a letter written to her husband (referred to only as "Mr. Stone") by "Dr. Allen of Bridgewater," dated 25 December 1736. This letter confirms details about Stone's career, beginning with the doctor's admission that when the couple had "removed from Bristol" and moved to London, he had fears about whether they could succeed there. "You know the only objection I had to your leaving Bristol for London," he writes, "was my fear how you would be able to get an acquaintance in London at your time of life." But, given their "knowledge and skill" in their professions and their "honesty, industry, and care" in their business, he seems convinced that the pair will "surmount" any difficulties they face.

The doctor praises Sarah Stone--according to the account of her career in his letter, she "began her practice" in Bridgewater with "great applause and success." Though she was "then very young," she had been "taught her skill by the famous Mrs. Holmes her mother, the best midwife that I ever knew." Allen adds further that, from Bridgewater, where Sarah Stone had started her practice, she had extended her practice into Taunton, where she "enlarged her experience," before moving on, as noted, to Bristol, which "perfected and fitted her for the Metropolis, London."

Following these introductory materials, Stone turns to her guide. This is no textbook for beginners--rather, A Complete Practice is a series of "observations," that is, more than forty-three case studies through which she illustrates her approach to challenging obstetrical problems.* From her narrative accounts of difficult births, we can fill in a few more details about Sarah Stone's life and practice. 

As Stone introduces each case, she notes where the birth that is the subject of each "observation" occurred: a farm in Huntspill (Bridgewater), for example, or the home of a gentlewoman living on Vine Street in Bristol. The range of locations shows how far a single midwife traveled as she was summoned at all hours by women in need. 

On rare occasion, a glimpse into her personal life emerges: she is called to attend a farmer's wife in Bromfield, noting that it is just three months after the death of her own mother, who had trained her in midwifery and with whom she practiced--the farmer's woman had been in labor for four days, but the woman's friends had persuaded her, at first, not to call on Sarah Stone because they thought she was still too young to oversee a birth on her own. 

In one of the last cases she describes, Stone includes a reference to her daughter, and this allows us to date her daughter's own practice to about the year 1726. According to the account she provides, Stone is faced with a woman in labor who is hemorrhaging. The midwife describes her successful treatment of this poor woman, who "flooded prodigiously." In describing how to treat this condition, Stone notes that her daughter, too, will be able to further spread this information for "the benefit of my sisters in the profession": "having a daughter that has practiced the same art these ten years, with as good a success as myself, I shall leave it in her power to make it known." (Presumably, Stone's published guide will also help in disseminating her successful treatment!)

After the publication of her guide for midwives, Stone disappears from the historical record. 

The most detailed study of Sarah Stone remains Isobel Grundy's "Sarah Stone: Englightenment Midwife," in Roy Porter's Medicine in the Englightenment (1995).

Still, with Stone's Complete Practice of Midwifery easily accessible online, you can read about her life and work in her own words for yourself.

*The title page of Stone's Complete Practice indicates that the contents present "upwards of forty cases." Most references to Stone's Complete Practice claim to be more precise and provide the same information--that there are 42 case studies in Stone's manual, perhaps repeating Grundy's reference to "42 observations" (p. 132). 

Yet there are 43 numbered observations in Stone's book--43 in the numbered list of contents and 43 in the text. And not every observation presents just one case study--Observations VII, XXI, and XXV, for instance, include two cases each, while the final observation, XLIII, has an interesting structure, moving from Stone's own case to a similar case several years earlier, in which a midwife had been blamed for the death of the mother, several man-midwives blaming that midwife for the loss of her patient. Stone then analyzes what went wrong with that earlier case and offers her own suggestions for how the death of the mother might have been prevented. 

Edith Cavell: "No Hatred Or Bitterness"

Edith Cavell, British Nurse (executed 12 October 1915

Edith Cavell was a British nurse arrested in Brussels and tried by a German military court during the First World War. She was charged with having aided Allied soldiers escape from Belgium, convicted, and executed by firing squad on 12 October 1915.

I first learned about the life of Edith Cavell when I was a girl. I read a lot of biographies, then as now, and I don't remember much about the book I read or when I read it (unlike my very distinct memory of having read about the sad end of Jane Grey, the "nine days" queen of England). 

I am wondering, now, if I might have stumbled on Iris Vinton's The Story of Edith Cavell, a biography of Cavell written for children and published in 1959. The timing is certainly right--but, then again, I read widely beyond the shelves of children's books, and so who knows what I read, other than it had to be a book published before 1962 or so. 

(By the time I was in fifth grade, I considered myself an expert on the marital misadventures of Henry VIII and his six wives, so I know I was reading "adult" biographies. Also, that's the kind of insufferable child I was.)

Born on 4 December 1865, Edith Cavell began her life much as the central figure of a novel by Jane Austen, or maybe one of the Brontës. She was the eldest daughter of a provincial vicar who had fallen in love with and then married his housekeeper's daughter.

In the Norfolk village of Swardeston, the Reverend Frederick Cavell first occupied a Georgian farmhouse and then a vicarage built next to the the Church of St Mary the Virgin in 1865, the year of Edith's birth. (Although he was a "poor parson," the reverend had the church built at his own expense, and it "nearly ruined him.")

His eldest daughter, Edith, was educated first at home, then briefly at the Norwich High School, and finally, between 1881 and 1884, at a series of boarding schools, Edith eventually trained as a "pupil teacher" at Laurel Court (Peterborough), the last of the establishments she attended.

She took a series of posts as a governess, but while she was at Laurel Court, she had learned French well enough to be recommended for a post in Brussels in 1890.

For five years, from 1890 until 1895, she was a governess for the François family. In addition to improving her French and managing the lives of the family's four children, she also focused on developing her sketching, drawing, and painting. 

In 1895, Cavell returned to England to nurse her father, who was suffering from a serious illness. Once he had recovered, she was determined to become a nurse. In April 1896, she began training at the London Hospital (now the Royal London Hospital).

She served as a nurse during an outbreak of typhoid fever in Maidstone the next year, and by 1898 was working as a private nurse. By 1899 she took up the post as a night superintendent at St. Pancras Hospital, a Poor Law institution. By 1903, she had transferred to the workhouse infirmary at Shoreditch, where she became assistant matron in 1903.

She continued her career with a transfer to the Manchester and Salford Sick Poor and Private Nursing Institution, where she became a temporary matron. But by 1907 she was again in Brussels, where she had been offered a permanent position in the newly established L'École Belge d'Infirmières Diplômées, known more simply as the "Clinique," serving as head of the institution,  which was dedicated to the training of nurses. 

Edith Cavell with some of her
nurses-in-training,
Brussels, Belgium

Cavell was still working in Brussels in August 1914, though she was actually visiting her widowed mother in Norfolk when she heard the German declaration of war--she returned to the city immediately, arriving by 4 August, the day the Germans invaded neutral Belgium.

With soldiers of all nationalities in the city, the Brussels clinic was established as a Red Cross hospital, dedicated to treating all wounded, regardless of their national origins. After the fall of Brussels (21-22 August) the Germans took over the clinic for their own soldiers, sending home some sixty British nurses, though Cavell and her assistant, Elizabeth Wilkins, remained in the city.

By autumn, Brussels was completely isolated--and Cavell found herself faced by a moral dilemma. As a "protected" Red Cross nurse, she was supposed to remain neutral. But as a human being, she felt compelled to aid the British and Allied soldiers and civilians who found their way to her, seeking shelter and assistance. 

And so she offered her assistance. She helped wounded British and French soldiers escape to The Netherlands, and she sheltered Belgian and French civilians, especially those of military age, until they could be provided with false identification papers and guided to safety. 

Within a year, by August 1915, Cavell and the clinic had fallen under suspicion--and then she was betrayed by a French collaborator, George Gaston Quien. In exchange for his own safety, he had disguised himself as an Allied soldier, sought aid at the clinic, and received it.

Cavell and some thirty-five men and women associated with the clinic were arrested on 5 August 1915 and held in the St. Gilles prison. Over the next ten weeks, she was interrogated on three separate occasions--8, 18, and 22 August. Presented by signed depositions that, she was told, fully outlined the activities of those at the clinic (the documents were written in German and only described to her in French), she freely and fully admitted to her own role in protecting men and helping them escape.

According to Cavell's own deposition, she had helped some 60 British and French soldiers to safety and had sheltered a hundred Belgian and French citizens of military age escape. Her two-day trial before a military tribunal began on 7 October; along with those who had been arrested with her, she was charged with "conducting soldiers to the enemy," helping them return to their home countries so that they could rejoin the fighting.

While she admitted helping men escape Brussels, Cavell was clear in her own testimony that her aid had been limited and that her goal had not been to help men return to battle. In response to the charge, she clarified her role: "My preoccupation has not been to aid the enemy but to help the men who applied to me to reach the frontier. Once across the frontier they were free."

An international effort was being made on her behalf, with appeals for clemency being made by Hugh S. Gibson, the first secretary of the U. S. legation in Brussels; by Rodrigo de Saavedra and Vinent, the marquis de Villalobar, the Spanish ambassador; and by Maurits Van Vollenhoven, the Dutch ambassador, Maurits Van Vollenhoven. 

The British government could do nothing to save her, or at least thought it could not help her. Sir Horace Rowland, the top official of the Foreign Office, wrote, "I am afraid that it is likely to go hard with Miss Cavell," adding that in the matter the British were "powerless."

Another member of the Foreign office agreed: "I am afraid that Miss Cavell will get a heavy sentence. There seems nothing to do." The sentiment was shared by Lord Robert Cecil. The Under Secretary for Foreign Affairs believed that British help would hurt Cavell rather than help her: "Any representation by us, will do her more harm than good. (For The Guardian's analysis of "How British Diplomats Failed Cavell," click here.)

Cavell and five others were sentenced on 11 October, and although appeals were made on their behalf, there was to be no reprieve. Cavell herself, when informed of her impending execution, was calm:

The Edith Cavell memorial,
Westminster, London

I have no fear or shrinking. I have seen death so often that it is not strange or fearful to me. This time of rest has been a great mercy. Everyone here has been very kind. This I would say standing as I do in view of God and eternity, I realise that patriotism is not enough. I must have no hatred or bitterness towards anyone.

Cavell was executed by firing squad early on the morning on 12 October. She recorded her own death in her diary: "Died at 07h on 12th October 1915."

Although she herself wished to be remembered as a simple person who did her duty, Cavell and her "martyrdom" were quickly seized on by Allied propagandists, her death serving as a recruiting tool for the military. 

She was buried hurriedly in a field next to the St. Gilles prison. Her body was exhumed after the war and returned to England. In 1919, following a memorial at Westminster abbey, she was interred in Norwich Cathedral. 

After the war, too, she was posthumously awarded the Cross of the Order of Leopold by Albert I, king of he Belgians, the government itself awarding her the Croix Civique. In France, she was recognized with the Légion d'Honneur.

A 2016 memorial service, dedicating the new grave of
Edith Cavell, begun in 2015 on the centenary
of her death

The best place to start your further reading is the website dedicated to her, which you can access by clicking here. In addition to a thorough biographical introduction, there you will find discussions of newly recovered documentary evidence as well as further links and reading. 

You might also enjoy the website of the Belgian Edith Cavell Commemoration Group, created for the occasion of the centenary of Cavell's death. You can also read about one of the more enduring monuments to Cavell, the Edith Cavell Clinic, which began operation in 1915.