Feminae: Medieval Women and Gender Index

In this picture a woman cares for a leper. She wears white (dress and headpiece) with a dark gray cloak. Medical care in the Middle Ages was often associated with religious communities. While she indeed may be a nun—the Augustinian hospitaller sisters wore white garments under their cloaks, and Poor Clares wore gray—her hair is long and uncovered beneath her headdress. She might instead be a laywoman committed to religion without formal vows involving a cloistered life. A mulier religiosa like this included beguines and Franciscan tertiaries.

Here, the woman hands her patient a fish. Giving food to the hungry and drink to the thirsty were two of the biblical acts of mercy. The patient sits in bed and has red spots evenly spaced across his upper body. This is a standard representation of leprosy in medieval art. The illness was mentioned frequently in both the Old and New Testaments, in accounts which addressed disease, sin, social rejection, mercy, concern, and healing. Medieval responses tended to share the same complicated set of ideas. It is to be noted, however, that Salmon identified the disease as syphilis in her book published in 2022.

The image is an historiated letter D in DIXI for the initial word in Psalm 38 (Vulgate and Douay-Rheims) in which David regrets the brevity of life but puts his hope in God. An excerpt from Matthew 25:40, "Quod uni ex minimis fecistis" (What you did for the least of these, you did for me) is inscribed within the scene, itself set within the circle of the letter.The painter uses mainly five colors: a bright red; a pink for accents; light, vivid blue; a bluish-gray; and a yellow-gold tone for the background and part of the border. The figures' skin is a different color, emphasizing the woman's health in contrast to her patient.

The letter D is formed with four creatures biting each other. The two smaller animals on the left have their tails intertwined, forming the left, vertical side of the letter. Depictions of hybrid animals appear in many illuminated manuscripts. The two smaller creatures each swallow the tail of a larger, fish-like animal; the larger red animal bites the head of the gray one. Fish held particular significance: Jonah's encounter with a big fish had parallels to Christ's death and resurrection, the Gospels mentioned “fishers of men,” and early Christians adopted the fish symbol as an anagram for Christ (IXTHYS: Iesous Xristos Theou Yios Soter). In addition, fish and eggs were a staple of the medieval diet, particularly on fast days and other days of restraint (e.g. Lent); very ill patients, while occasionally exempt from certain religious dietary restrictions, still ate fish regularly as part of their diet.

This image comes from a psalter created in the Benedictine Abbey in Engelberg, Switzerland, in the last quarter of the thirteenth century. Other pages in the psalter use the same colors; besides historiated initials, the psalter contains zodiac signs. Secular imagery was used regularly enough that some religious leaders voiced open objection. This manuscript may have been made for use in a Dominican women's monastery.

In the sixth century, Saint Benedict of Nursia founded a monastery in Italy and established a written Rule governing monastic life that spread throughout Europe. In particular, part of the Benedictine Rule called for regular reading of the entire psalter—all one hundred fifty psalms—within the week. This requirement drives the liturgical divisions and order of psalms common to psalters. In addition, Benedict's desire for all—religious or lay communities—to chant the psalter promoted the popularity of psalters among the laity as well as the vocationally religious. The books' small size made them portable.

Although leprosy affected a minority of individuals during the Middle Ages, it figured prominently in sermons and literature, which revealed a dramatic tension in how the disease was viewed. Leprosy itself was associated with sin, including promiscuity—many believed it to be a sexually transmitted disease—but lepers themselves were thought to have been specially selected by God for salvation due to their earthly suffering. Their physical condition was often associated with Christ's suffering on the cross, and preacher Jacques de Vitry equated lepers with the laity most valued by God: the poor, pilgrims, mourners, and crusaders. The Third Lateran Council, while assuming the separation of lepers from the broader community, made provisions for their religious needs and repeatedly emphasized their continued membership in the broader Christian community. It seems that lepers still had regular ties to healthy family and friends and even continued to own land. Hospitals for lepers, although located outside city walls, were not far from the archbishop's palace and major churches.

To care for the sick, special hospitals, known as leprosaria, were founded, particularly during a wave of charitable donations and building during the thirteenth century. Care was complicated. Contemporaries knew that leprosy could not be cured by medical intervention and focused on alleviating suffering and saving souls. Leprosaria were generally located outside city walls, possibly in response to the Levitical injunction to put lepers "outside the camp" due to the contagious nature of the disease. In addition, medieval people understood that the body's gradual deterioration from leprosy required long-term attention. Caregivers ensured that the sick ate carefully balanced diets, with some institutions specifically choosing softer foods (eggs, fresh bread) to accommodate the sick who had suffered so much physical, sensory, and nerve damage they could not eat solid foods. The leprosaria residents had to exercise and bathe frequently. Clothing was supplied and washed (separate from the clothing of the healthy). The nurses also performed the requisite bloodletting and dressed patients' sores, providing needed care. In addition, in order to nourish the souls of the afflicted, leprosaria followed the basic monastic model and lived according to the monastic rule, regulating day time hours for prayer to benefit the soul.

Medical caregivers did include secular physicians later in the medieval era, but the primary caretakers were from religious communities. Nuns from orders geared towards care (Augustinian hospitaller sisters, Cistercians, Poor Clares), female beguines and male beghards, and Franciscan tertiaries all provided care. Some tertiaries were married couples; others were social elites who either chose not to take vows or were sometimes actively discouraged by religious leaders from doing so. Instead they were often urged to use their power and their wealth to maintain peace and stability and to aid the poor and the Church, rather than renounce it all through separation from the world and a vow of poverty.

In particular, beguines performed all the major forms of medical care, from nursing and midwifery to giving medicines and regulating diet, as well as prayer and meditation. Many beguines worked in monastic hospitals or in beguinages which included hospitals. Medical knowledge, born from experience, was transmitted within the community. Ritchey posits that some knowledge was written and passed via texts that religious women carried with them at all times including psalters.

This image, from folio 38v from the Wellcome Apocalypse manuscript depicts two married women in conversation, as indicated by their raised hand gestures and remarks about their husbands. One woman is seated and naked, with loose hair, while her interlocutor is standing and dressed in the clothing of a wealthier and older woman. The banderoles they hold highlight the conversation: " I have often been distressed, sister" (seated woman)
" I too have often been distressed" (standing woman) - Evans, p. 161 The manuscript text accompanying the illustration provides more detail about the women's problems with miscarriages: "I have often been distressed, sister, by the size and length
of my husband's male member when, banging against the
smallness and narrowness of my vulva, the cervix, tired out,
forced the foetus to slip out before time."
"I too have often been distressed because I am unable to
carry a conceived child; I said that the blame for this is my
husband's, as if he has not provided the proper seed. Yet the
problem is rather that of my moist womb and of its coldness
destroying the semen." - Evans, p. 175

While the seated woman calls the standing woman sister (soror) their relationship is not clear. The seated woman bears a mark in front of or on top of her stomach that could be understood to be a depiction of a vulva. In recent analyses, the mark has been variously recognized as a conversation between two women on gynecological topics, with the mark described as an incision, a marker of pregnancy, a womb, or a cesarean section, or not mentioned at all. Identification of the mark as a vulva comes partially from the mark's resemblance to another vulva depicted on the manuscript's Disease Woman illustration (folio 38r) . Comparisons to a womb and cesarean section also refer to depictions of these subjects found on other folios of the manuscript.

The image is found on folio 38v of the Wellcome Apocalypse (MS.49). Produced in Germany circa 1420, the manuscript is written in Latin and German. Multiple sections comprise the manuscript, which opens with the Apocalypse of St. John, followed by a medical text, and a miscellaneous section. Although the sections of the manuscript were intended to be bound in the same manuscript, images in the medical section and a following segment on Ars moriendi appear to have been produced by a different artist than the illustrations found in the Apocalypse of St. John. Within the medical section, four distinct sections divide the text. The first two sections contain illustrations of the body, and describe medical treatment. The fourth section contains a diagram of the Moon, followed by depictions of the four Regions of the World and the Four Elements. The illustration taken from folio 38v, in the medical section of the manuscript, is classified as part of the third group that depicts gynecological imagery, women, fetuses, and the Signs of Death. This illustration directly follows a portrayal of a cesarean section; the mark posited to be a vulva significantly does not have the same shape or bloody color as the cesarean section depicted above it on the page. It is likely that the medical instruction and images contained within the manuscript were prepared for a cleric, who may have shared the manuscript and the information and images it contains with women providing medical care, particularly midwives.

In medieval Europe, men were generally prohibited from viewing women's genitalia, a restriction that extended to texts that visually and textually addressed women's bodies. Throughout the Middle Ages, those present at births typically included only women, permitted to view naked women. From the thirteenth century, following antique Roman practices, female practitioners gained specific duties, including a responsibility to examine women suspected of being pregnant and verifying other women's virginity, to maintain male distance from women's genitalia. This group of medical women included midwives and women referred to as matrons, whom legal authorities and civic officials sometimes held as more trustworthy than midwives. After 1400, although some elite women were cared for by newly professionalized male doctors, the majority of births continued to be facilitated and attended by women. The representation of what may be a vulva in the Wellcome Apocalypse may be seen as representative of the trend of obscuring women's bodies to the male gaze. At the same time, representing a vulva indicates some willingness to expose men, who would have encountered the text, to women's genitalia in a gynecological context.

Midwives, or female medical practitioners more broadly, did not have unrestricted access to texts or the information contained within manuscripts like MS.49. Midwives traditionally circulated information through informal networks of practitioners; texts were most often owned and used by male practitioners. Women working to provide care could generally access the material contained in manuscripts, only with the mediation of men who owned and read these texts. Despite increasing texts regarding childbirth and women's medicine by the end of the Middle Ages, little is known about literacy rates and reading practices among women involved in medicine. Further, as medicine became professionalized in Europe at the end of the Middle Ages, women lost expertise as knowledge became formalized, with medical texts and university training providing an avenue to enshrine medical knowledge as a masculine domain.

In this wall painting, Marianos, the bishop of the city of Faras (known in late antiquity and the Middles Ages as Pachoras), stands beside the Virgin Mary and the Christ child. Marianos is the central figure in the scene, holding a large Gospel book with a jeweled cross on its cover. The Virgin places her hand on the bishop's shoulder indicating the protection she provides for him. The infant Christ holds a book in one hand and, turning toward Marianos, gives a benediction. Little remains of the figure of the adult Christ standing on the other side of Marianos, though his hand in a protective gesture is partially visible on the bishop's shoulder and his feet remain above an elaborately decorated cross. The holy figures' heads are marked in specific ways: the adult Christ has a cruciform halo, the infant Christ a cross without a halo and Mary a halo with a red rim. Scholars believe that this and other paintings of bishops were added to the cathedral's walls near the beginning of their episcopates to ensure immediate divine blessings as well as ongoing intercessory prayers even after the bishops had died.

Surviving inscriptions in Greek identify the two figures and encourage the prayers of viewers:
      To the left of the composition: With God, † and Abba Marianou, Bishop of Pachoras, orthodox and most pious, (may he live) many years! Amen
      Above the bishop's head: † Abba Marianou, Bishop of Pachoras, orthodox and most pious, (may he live) many years!
      To the right: Son of Abba Ioannou, Bishop of Pachoras
      Beside and above the Virgin's head: † Holy Mary, Mother of Christ

The cathedral in the city of Faras was an important repository of centuries of medieval Nubian art and history. As the seat of a bishop, Faras Cathedral, first built in the 630s, was repeatedly renovated. Bishop Petros in the tenth century redid the roofing to create central domes and side room barrel vaults. He and his successors carried out an extensive visual program. New paintings and decorative motifs were placed atop earlier scenes of saints or angels with bishops, kings and queens. Done over a limestone whitewash, the murals contained paints sourced from around the Nile region, such as Egyptian blue, carbon black, red ochre, hematite, yellow ochre, and limonite. The city of Faras was first documented by American and British university expeditions at the beginning of the 20th century, but archaeologists' attention was focused on antiquity. When plans for the Aswan Dam threatened Faras and the larger region in 1961, international teams responded to the emergency by surveying and documenting historical treasures. A Polish team excavated Faras Cathedral, discovered the wall paintings and saved 120 works from the waters of Lake Nubia which would shortly inundate the region. Half of the paintings were relocated to the National Museum in Khartoum and half to the National Museum in Warsaw. Subsequent study of these paintings has recognized the artistry and complex iconography of an evolving medieval Nubian visual tradition across 700 years which built in part on Egyptian and Byzantine precedents.

Faras was likely the seat of the rulers of Nobadia, a late antique kingdom in Nubia, now considered a part of modern-day southern Egypt and northern Sudan. In the 6th century the Nubian kingdoms converted to Byzantine Christianity, and Nobadia was annexed by Makuria, another Nubian kingdom, in the 7th century. The practice of creating murals of saints and bishops, as well as scenes from the Bible, on the walls of churches provides information both about aesthetics and religious belief. While subjects are treated repeatedly over time, different phases in depiction can be distinguished. The portrait of Marianos falls in the classical period of Nubian painting, characterized by bright colors, attention to decorative details and individualized treatment of faces. The bishop is wearing ecclesiastical garments and vestments which reflect his office, including the omophorion, a stole draped around his neck and hanging to the floor. These items are decorated with intricate designs and small bells. Both the bishop and the Virgin are holding an enchirion (in Greek “what is in the hand”), a ceremonial napkin associated with figures of high rank.

The Christ Child and Bishop Marianos (and likely the adult Christ as well) are in possession of books of religious teachings. At the same time, Marianos gestures toward the book he holds, indicating a focus on teaching. The cathedral was a place of learning. This is evidenced not only by the iconography in the murals but also by school texts inscribed on the walls. They include Coptic alphabets, Greek words, numbers and exercises in writing signatures which all were likely used as learning tools in classes. Due to colonization, pillaging, and environmental change in the area, this history can very easily be lost to time. The preservation of the murals and discussion of the cathedral and religious practices allow us to keep alive the rich cultural history of the African medieval kingdoms.

To the left of the composition: With God, † and Abba Marianou, Bishop of Pachoras, orthodox and most pious, (may he live) many years! Amen
Above the bishop's head: † Abba Marianou, Bishop of Pachoras, orthodox and most pious, (may he live) many years!
To the right: Son of Abba Ioannou, Bishop of Pachoras
Beside and above the Virgin's head: † Holy Mary, Mother of Christ
See Greek texts and Greek transcriptions along with the translations above in Jakobielski, Pachoras Faras, page 309.