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Doctors in Fiction Lessons from Literature


Here comes our earliest doctor – Vesuvia Adelia Rachel Ortese Aguilar – a 12th-century graduate of the Schola Medica Salernitana, the first known medieval medical school, located in the southern Italian town of Salerno in the Kingdom of Sicily. When we fi rst encountered Adelia, as she is familiarly known in the novel, we thought the author was engaged in some apocryphal feminist joke.

 After all, in 12th-century Europe the proper place for a woman was in the home or the nunnery, and women who tried to cure people were sometimes accused of witchcraft. So how dare Franklin come up with an accomplished and sophisticated female medical doctor in 1171, when the opportunities for women to practice medicine did not exist in the Western world until the 19th century?

DOCTORS IN FICTION

Of course we were wrong. Ariana Franklin is a medieval scholar, journalist and experienced researcher who, under her real name, Diana Norman, has written 13 respected historical novels, one of which, Fitzempress’ Law, was cited by the BBC Radio Bookshelf as the best example of an historical novel for 1980. She is married to the fi lm critic and broadcaster Barry Norman and lives with him and their two daughters in Hertfordshire.2 Mistress of the Art of Death won the CWA Ellis Peters Historical Award in 2007.3 Salerno was a special place in the Middle Ages, where freedom of speech, religious practice and literacy were considered a Sicilian’s birthright.

It was a cosmopolitan city peopled by Muslims, Byzantines, Normans, Greeks and Jews. No wonder, then, that along with beautiful Romanesque architecture and true multiculturalism, an advanced medical school appeared. At this school, the works of notable early Greek physicians were taught, among them Hippocrates, known as the father of the medical profession and creator of the Hippocratic oath that set standards of medical ethics still guiding today’s physicians; Galen, the great 1st-century physician and surgeon; and Dioscurides, whose De Materia Medica of the same time was an important compilation of the medical uses of plants. In fact the Salerno school, founded in a 9th-century monastery, hit its golden age between the 10th and 13th centuries, just in time to welcome the fictional Adelia.

But there are real life examples of early female doctors. Trotula di Ruggiero, born in 1090, was another physician at the Salerno Medical School and the author of Passionibus Mulierum (The Diseases of Woman).4 Even earlier in antiquity women practiced midwifery and healing. For example, in 400 BC Greece, Hippocrates was instructing them in gynecology and obstetrics at his school in Asia Minor. Of course, all was not smooth sailing even in enlightened Greece.

Athenian lawmakers learned that women were performing abortions and banned them from practicing medicine, imposing the death penalty for violators. Losing their female doctors and feeling uncomfortable taking their intimate health problems to male physicians, Greek women’s mortality rate rose. In 300 BC a woman named Agnodice had to disguise herself as a man in order to study medicine at the great Alexandria University and continued wearing male garb after returning to Athens, where she set up a practice treating women.

Her male colleagues, jealous of her success, charged her with corrupting women patients. When she revealed that she was a woman, she faced death. But the Athenian women saved her, going to the judges en masse, calling for her acquittal, which would allow her to continue practicing.5 Although some believe Agnodice to be a mythical character, all this makes Adelia’s novelistic career somewhat more believable

THE STORY

Adelia, an orphan raised by an atheist Jewish doctor, is a medical student but not an unusual one, as women students and teachers were regularly admitted to the Salerno Medical School. She has mastered the art of death, which today we call forensic medicine, making her, historically, the earliest fictional female coroner likely to turn up in any novel. She is calmly looking forward to a life of teaching, research and solving crimes in her home city when history intervenes.

A series of terrible child murders in the English town of Cambridge has been blamed on the local Jews, who seek protection from King Henry II and are hiding in Cambridge Castle. Loath to sacrifi ce the income from taxes paid by prosperous Jewish merchants, Henry wishes to shield them from harm and appeals to his fellow royal and cousin, the King of Sicily, to send his best master of this frightful new science to help find the real killer(s), which should exonerate the Jews.

But in backward England a woman doctor is unheard of and any female openly engaging in curative measures might be labeled a witch. Therefore, Adelia must travel with two companions, Mansur, a Muslim, who is really her bodyguard, and Simon of Naples, a clever and quick-witted Jew chosen to establish the innocence of his English co-religionists. Their combined detective work forms the essence of the story.

Adelia’s medical knowledge  

As the three Sicilians travel towards Cambridge with a group of English pilgrims, Adelia’s medical competence is quickly tested. Prior Geoffrey of St. Augustine’s canonry of Barnwell is suffering great pain from urinary retention and is unable to walk. When his attendants, asking to borrow the cart in which the odd-looking threesome are traveling, discover inadvertently that one of them is a doctor and assume, of course, that it is Simon, they bring the overweight and suffering prior to him for help.

 Hiding the cart in the woods so that no one can view the procedure, Adelia, guarded by Mansur and helped by Simon, uses a sturdy reed plucked from a nearby stream as a medieval catheter to successfully relieve the blockage in the prior’s urethra, even though she has never before done the procedure, having only heard of it from her stepfather. Her knowledge of male anatomy is clear when she warns her partially recovered patient the next day that the retention could happen again.

“Men have a gland that is accessory to the male generative organs. It surrounds
the neck of the bladder and the commencement of the urethra. In your case
I believe it to be enlarged. Yesterday it pressed so hard that the bladder could
not function.”


DOCTORS IN FICTION

She offers to show him how to use the reed if needed, which he eschews, and advises him to eat less and exercise. (It seems this staple of medical advice has been given out by physicians for centuries.) The benefi t of this encounter, however, is clear; Adelia and company have acquired a powerful protector in Prior Geoffrey.

Once in Cambridge, the prior arranges for Adelia to examine the remains of the murdered children so that she can determine how they were killed. This she does secretly, although she is watched by Sir Rowley Picot, King Henry’s tax collector and ex-Crusader, whom she quickly puts to work helping her. Prior Geoffrey also arranges for the Sicilians to live in one of the cottages abandoned by the Jews. He even supplies a local servant, the wily woman Gylthia and her grandson, Ulf, who are valuable in explaining local customs and personalities.

No sooner do they move in than the locals assume that Mansur, wearing a traditional kaffiyeh, is the doctor, Arab medicine being well regarded even here, and immediately start asking for help for their various ills. Thus a new medical practice is born and serves as an excellent cover while Adelia and Simon continue their investigation of the child murders.

Adelia remains involved in treating the locals, quietly imparting her knowledge to the fake doctor Mansur. The remedies and procedures she uses include an eyewash of weak, strained agrimony on the infected and inflamed eyes of an old, nearly blind woman; amputating the gangrenous foot of a young man, using a cloth soaked in opium as an anesthetic, then stitching the edge of the wound and bandaging it. Meanwhile Dr. Mansur, now puffed up with his new importance, prescribes sugar for a child with a cough. Furious at this useless advice, Adelia substitutes an inhalation of essence of pine, which she maintains should help the youngster if his lungs are not too badly damaged.

Not all of her efforts are successful, because these patients come to the
“foreign doctor” too late, so that the child with the cough develops pneumonia
and a man with the ague dies, as does a new mother who hemorrhaged after
delivery.

Perhaps Adelia’s greatest medical accomplishment is saving Sir Rowley Picot from death after a brawl, during which a cleaver in his groin struck an artery, causing a major bleed. Putting her fi st in the wound to plug off the site of hemorrhage then closing the wound on the proverbial kitchen table with thread and needle from the sheriff’s wife’s sewing kit may stretch the reader’s credulity somewhat, particularly as Adelia is not sure during the procedure if she extracted all the pieces of his tunic from the wound, which would inevitably have caused infection and death from gangrene.

Why was Sir Rowley brawling? We cannot reveal the cause except to say he was behaving heroically and that we must bear with the author, as Sir Rowley needs to survive to play a pivotal role in the denouement of this story and in solving its central crime. To say more would ruin the ending for the reader.




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