08 Jun Gynaecological Knowledge in Translation: Interview with Micaela Brembilla and Larisa Ficulle Santini
This spring, we have had the honor of hosting Larisa Ficulle Santini from the Austrian Academy of Sciences as a Retracing Connections guest researcher at Uppsala University. Larisa has been looking into translational aspects of her ongoing project “Fertility Control in Byzantium: Women’s Reproductive Agency in the Eastern Roman Empire”. She has had a chance to collaborate with the UU recent doctoral graduate in Latin, Micaela Brembilla. We have also co-organized a seminar with the Uppsala University Centre for Medical Humanities, where Larisa’s and Micaela’s work has been commented by contemporary medical and phytopharmacological researchers and practitioners, Matts Olovsson and Sonny Larsson. Ingela Nilsson has asked Larisa and Micaela to introduce the connections between their topics and their relevance for today’s audiences.
I. N: You both work on texts that are in some sense medical, even if they sometimes transfer knowledge that is not scientific in the traditional sense. Do you think that texts like these were transmitted and translated in ways that are different from narrative texts of antiquity and the Middle Ages? If so, in what way?
M. B: I think that the practical and technical manuals of Late Antiquity have a particular transmission history due to their didactical nature. I can bring as an example the text I know best, Mustio’s Gynaecia, which is a practical handbook for the education of sixth century North African midwives. The most educational sections – like those on delivery featuring explicative drawings – on the one hand present a variety of additional material from one manuscript to the other, as if people using it wanted to complete the information with their own knowledge. On the other hand, they have often been separated from the Gynaecia, and integrated in other gynaecological texts during the Middle Ages, with no reference whatsoever to the author Mustio. Even though this is not what usually happens with the transmission of more prestigious authors – or, at least, this is what we believe – I think that transmission and use of narrative cores and themes is not that different from what we see in this type of texts.
L. F. S: Micaela is certainly right in emphasising the didactical and practical scope of these texts as the element to take into account in their transmission and translation. Another case in point is that of the Byzantine/eastern Roman physician Paul of Aegina (seventh century). Paul’s Pragmateia, a medical compendium written in Greek, contained several sections on gynaecology and obstetrics and enjoyed considerable success in both Syriac and Arabic medical traditions (especially from the nineth century onwards.) His gynaecological and obstetrical expertise was especially praised – up to the point that he was known in Arabic as “Paul the obstetrician”. What emerges from the translation process is far from being a literal translation, as we would say now, but more an adaptation. Certain sections are translated, others omitted, new information integrated. In other words, medical texts, in light of their practical nature, would be considered as more porous and prone to be integrated and modified, sometimes with other sources, sometimes with first-hand knowledge, within the translation process, depending on what the person who was translating would consider right, relevant, worthy of being transmitted, and what not. For those who are interested, the place to start for the fascinating subject of the Oriental tradition of Paul of Aegina is P. E. Pormann’s monograph (The Oriental Tradition of Paul of Aegina’s Pragmateia, Leiden–Boston 2004).
I. N: The division between (male) medicine and (female) practice seems to be present both in the past and the present. Why is that? What could one do to change it?
L. F. S: For me, this is above all a question of authoritative knowledge, a concept developed by the anthropologist of birth and reproduction Brigitte Jordan and that is helping me a lot thinking about my own work. By this I mean: who holds the knowledge that counts socially and institutionally – not necessarily as the most accurate or correct, but the one that is recognised as legitimate. In patriarchal societies, men have historically held more authority than women, and in that sense, the issue is not simply a division between “male medicine” and “female practice”, but between different kinds of knowledge and unequal access to authority. In the past, this was of course closely tied to education. Literacy and advanced study were largely reserved for men, especially elite men, while women were mostly excluded from formal scholarly training. Today, at least in much of the Western world, the situation has changed significantly, and women are present in medicine in ways that would have been unimaginable in antiquity. Yet we face another problem: for a long time, the body that medicine studied and treated as the norm was overwhelmingly male – more specifically, male, white and able-bodied. This is one of the reasons why gender medicine has become so important. It reminds us that what counts as medical knowledge is never neutral.
M. B: I am not sure that the point is to eliminate such division. I think that the problem is that this division, in the past but also when it is detected in our times, is often rigid and judged qualitatively by society, with male, scientific and standardised knowledge recognised as more important and valid than the female, practical and oral one.
The concept of authoritative knowledge underlined by Larisa helps us address the question from a more refined angle than just the dichotomy of male and female. What these medical manuals do, in their process of defining the fundamental expertise for their contemporary midwives, is to crystallise the knowledge that they considered correct, raising themselves and their text as the authorities in the field. The process is very explicit in those passages where Mustio, in the Gynaecia for example, openly refuses and condemns other popular practices, saying that we don’t do this anymore, and presenting his own treatment and interpretation as the correct one. Among these practices, one can also identify things that women were doing, and that are now disregarded as old, ignorant and superstitious.
I. N: What does it mean to be a midwife? Are there similarities between the historical situations you study and the way we see the profession today?
M. B: I don’t think I am knowledgeable enough to answer this question from a contemporary perspective. What I would like to underline is that it is clear from Antiquity and beyond that the role of midwives is a unique and special one. They are present at one of the most traumatic experiences of life, both for the mother and the baby, and they engage with life and death. The process of childbirth is ultimately transcendental and therefore midwives’ role in it remains mysterious. Brigitte Jordan, the anthropologist already mentioned by Larisa, analyses the dichotomy “modern obstetrics vs traditional obstetrics”, i.e. a scientific and hospitalised approach vs a traditional and home-based one; she argues how this dichotomy is present in various degrees in our societies, and how does it affect the perception of childbirth and delivery.
Western civilisation has the tendency to consider traditional obstetrics as something obsolete in need to be integrated and ultimately surpassed. In a way, we can say that we see the same tendency in action in the special environment of 6th century Africa Romana, as we witness the attempt of male physicians to standardise and normalise the scientific knowledge of midwifery and gynaecology. In doing so, they for sure want to give better access to education to contemporary midwives, but they also contribute in distancing these women, and themselves, from the traditional practices transmitted outside the scientific literature.
L. F. S: I am not a midwife myself – I guess it would be better to ask them directly! My impression is that what it means to be a midwife depends very much on where one is a midwife. For example, when it comes to childbirth, we know that it can be organised in very different ways, depending especially on how medicalised birth is. Even within Europe today, the role of the midwife varies considerably. In some contexts, the birthing person depends primarily on an obstetrician; in others – especially where home-births are a common practice – the midwife is the central figure.
As a historian working on reproduction and fertility in Byzantium, I have the impression that the history of midwifery in Byzantium is still largely unwritten. We have a handful of studies, and many relevant sources still remain to be identified and analysed. For the moment, the most striking similarity I can see between past and present concerns the midwife’s position in relation to the male physician. I am thinking above all to the work of Aetius of Amida. In Book 16 of his medical compendium, when midwives appear, they are the ones who engage directly with the woman’s body through internal manual interventions. The male physician, by contrast, more often observes, diagnoses, and interprets. He is also the one associated with surgical procedures, whereas the midwife is usually not. I find this distinction – and its echoes in some contemporary situations – particularly revealing. It suggests not only a division of labour, but also a division in the access to the female body.
At the same time, sources such as Byzantine prayer books, the euchologia, show that the midwife remained present at important moments in the lives of both mother and child even after birth: for example, at naming rituals or the churching of the infant. It is also striking that the midwife, like the woman who has given birth, can appear as the recipient of prayers of purification after childbirth. By virtue of her close involvement in birth, she too was considered to have crossed a threshold that required ritual reintegration. That closeness matters. I imagine that something comparable may still be found in contexts where childbirth is less heavily medicalised and where midwives continue to play a central role.
I. N: Last but not least: why should we study these issues and their traditions?
L. F. S: This is perhaps the hardest question: the risk of giving an obvious or banal answer is around the corner. Rather than trying to offer a universal response, I can only give a personal one. As someone with a womb, working on the history of reproduction has felt like a call – perhaps even a responsibility, though a welcome one. For centuries, the history that was written and studied was overwhelmingly the history of elite men: kings, wars, political institutions. Later, social history broadened that perspective, and feminist scholarship pushed us to ask different questions and to look at different experiences. The history of reproduction – and also of non-reproduction – is part of that shift.
Even though most of our surviving sources were written by men, studying these materials allows us to come closer to the realities of historical women: women who struggled with infertility, women who became pregnant, who died in childbirth. Women who tried not to conceive or sought to terminate a pregnancy; women who lived with menstrual pain or irregularity. In other words, people whose lives were profoundly shaped by the presence of a uterus and by the biological and social meanings attached to it. For me, trying to recover these histories means recognising how deeply questions of reproduction have shaped human lives across time, even in periods when the room for agency, choice, and control was, generally speaking, more limited than it is today.
M. B: I would like to try and answer this question from a more specific point of view. Why should we study the issue of male and female division of knowledge? Traditional obstetrics, to adopt Jordan’s terminology, does not seem to be in relationship anymore with modern obstetrics, but our society seems to still apply a qualitative judgement to the dichotomy “male doctor vs female midwife”, even if midwives in our Western civilisation have access to high level education at universities and do not usually practice traditional obstetrics.
It is fundamental to try to understand the history and the origin of the bias towards female knowledge, and towards knowledgeable females, in order to approach it and fight it in our society. However, It is difficult to trace female agency and presence in such a male dominated area as ancient medicine. The traditional structure of these disciplines was shaped by male physicians mostly writing and talking to other males, and the analysis of sources can give us very little results if one is looking for female traces. Gynaecology and midwifery, however, for their very nature, may offer little cracks in the male facade of medicine, and give us the opportunity to detect also the female side of this discipline.
Micaela Brembilla graduated in Latin Linguistics at Università Statale di Milano in 2020, under the supervision of Paola Francesca Moretti. She defended her PhD thesis, entitled Prolegomena to a New Critical Edition of Mustio’s Gynaecia at Uppsala University in December 2025. She is currently working on the production of the critical edition, while deepening her research on female participation in Late Antique medical environment, women’s medical education and midwives’ folkloric and practical knowledge.
Larisa Ficulle Santini is a postdoctoral researcher at the Austrian Academy of Sciences and Principal Investigator of the FWF-ESPRIT Project “Fertility Control in Byzantium: Women’s Reproductive Agency in the Eastern Roman Empire”.