5.12.2017

MENSTRUATION AND FERTILITY IN EARLY MODERN ENGLAND


The female generative organs were a mysterious entity in the early modern period. Menstruation and in particular the qualities of menstrual blood were discussed and debated across the period. Medical writers explained that menstrual blood could be either a plethora of innocuous blood released from the body, or a dangerous and toxic excrement which threatened to poison the female body. The role of menstrual blood in the generative process was also disputed and considered across the period. For physicians and medical authors who subscribed to the two seed model, women’s menstrual blood provided the nutrition given to the baby during gestation. Conversely for those who followed the one seed model of generation menstrual blood was the women’s contribution to the forming fetus; it was shaped and invigorated by the male semen at the point of conception to create the new life. Consequently, whether a nutritious superfluity or the woman’s contribution to conception, menstrual blood was a key component in the reproductive process.

Susan Klepp has remarked of eighteenth-century America that medical, and other, sources fail to link emmenagogues to infertility45.However, Joan Cadden has suggested that for medical men in the Middle Ages ‘Menstrual retention [was] the most prominently featured cause of sterility among women’, with John of Gaddesden actually placing it ‘first in his list of ten intrinsic causes’.46 Similarly during the early modern period general medical texts and midwifery manuals often expressed the concern that an irregular menstrual cycle could prevent a woman from conceiving a child. Mary Fissell has adequately demonstrated that Raynalde’s midwifery text of 1545 viewed menstrual blood as a pure nourishing substance that was essential for conception.47 Likewise Jakob Rueff stated in 1554 that the state of a woman’s menstrual flow affected the health of her entire body. He wrote ‘so that her body be of a sound and healthfull constitution, [it] ought naturally to be Purged and cleansed from this superfluous matter every moneth.’48 He further lamented that ‘every woman deprived of these Flowers, I say, of this purging in her due season by the course of Nature, can neither conceive, nor ingender, being like unto an unfruitful and barren man, destitute and deprived of the same vertue, and faculty of ingendering.’49 It is clear from Rueff’s statement that irregular menstruation was not simply detrimental to fertility but entirely destructive of the womb’s ability to bear children. This sentiment was echoed by the Padua professor Alessandro Massaria in 1657.50 He wrote of the dangers to a woman’s body if her monthly purgation was suppressed, stating that ‘if there be a perpetual suppression of the Terms, then it plainly shows such a Woman to be absolutely barren.’51 Again, Massaria emphasised that the effects of not experiencing proper menstruation were severe: it could mean the total loss of a woman’s reproductive capacity. He also explained that this disorder could be intimately linked with the humoral constitution, as Rueff also implied, as the deficiency could be caused by obstructions, excessive fatness or leanness or coldness of the womb which made the woman dull, drowsy, and slowed her pulse.52 It might, therefore, be expected that remedies which served to alter the humoral state of the body, such as heating aphrodisiacs, would be employed to readdress the constitutional balance.

Across the period medical writers continued to examine the role of menstruation in the generative process. The understanding reported in these texts shows little deviation or progression and underscores the consistency of the humoral medical model. Indeed, as Helen King has shown, although new theories of menstruation were considered in the seventeenth century, the traditional Galenic view of menstrual blood was retained in British medicine into the eighteenth century.53 In the late seventeenth century Jane Sharp addressed her readers’ concerns about what hindered conception. As a part of her advice she wrote that ‘let such as desire to have children, look to it that their courses come down orderly, and be well coloured, for then there is no fear but such women will be easie to conceive.’54 By explaining the role of menstruation in this way Sharp may have encouraged her readers to provoke the courses themselves. This text explicitly states that the woman must make certain that her ‘courses come down orderly’, overtly encouraging active measures to reinstate the proper menstrual cycle.

The centrality of proper menstruation to the fertile body was also expounded throughout the eighteenth century. In 1737, Henry Bracken, physician, surgeon, and man-midwife of Lancaster, wrote that a total suppression of the menses barred all pregnancy.55 Similarly, the contemporary edition of the Ladies Physical Directory listed a deficiency of the monthly terms as the primary cause of barrenness, explaining that ‘then the natural sparkling Briskness of the Blood and Juices is wanting, the lively desirous Faculty is spoiled, neither is the womb fit to receive the spirituous … Masculine Semen, that Conception might follow.56 For these authors a deficiency of the menses was detrimental to the generative ability of the body in terms of supporting coition, sexual pleasure and conception. Moreover, the descriptions provided in their works would have supplied their readers with a context in which the provocation of absent menstruation would have been entirely understood within the framework of treatments for barrenness. The explanations that readers would have been confronted with also emphasised the role of the humoral constitution in the correction of this problem, particularly the dangers of a cold body, and the link to increased sexual desire and pleasure. Thus, it is conceivable that the authors of the texts seen here would have advocated the use of aphrodisiac substances to invigorate the body with heat and pleasure alongside substances that would encourage a natural flow of blood. Within this framework it is also clear that many women would have viewed remedies to provoke menstruation as falling entirely within the realms of sexual health practice, rather than simply as a way to remove an unwanted pregnancy.

Provoking Menstruation to Ensure Fertility

As Van de Walle and Renne, briefly mentioned, in addition simply to noting the importance of regular monthly purgation medical writers of the early modern period recommended recipes that could be used to purge the body of this retained blood and revive a natural and timely cycle. These recipes could include substances which ‘have a dark reputation as abortifacients’.57 While it is clear that these remedies could be easily utilised for the purposes of removing a blockage or an obstruction, in the form of a newly forming fetus, it is also apparent that they were designed to serve a beneficial purpose. As Laurence Totelin has demonstrated in the Hippocratic Corpus ‘purges were often conceived as the first step towards conception.’58 In the sixteenth century Jakob Rueff explained as a part of his ‘generall Precepts serving for the curing of the barrenness’ that:

"let women observe and consider the complexion and state of the Matrix, and let them warily marke their Termes, lest in the time when they issue forth, or when they are cleared from them, they use an inconvenient diet, but rather they use most especially things which are knowne to have an expulsive vertue and force to expel out of the body: such as are parsley, Stone-parsley, Fennel, the herbe which the Germans call commonly Pimpinella, with the like herbes and roots of the same nature and quality."59

Not only did Rueff recommend purgation of the female body, he explicitly related these expulsive herbs to the promotion of fecundity. Similarly, in the seventeenth century Alessandro Massaria proposed the use of the remedy Hiera Piera, which purged excrements from the body, to restore obstructed menstruation.60 He also listed several stronger purgative medicines which could be utilised should initial treatments prove unsuccessful.61 This, perhaps, suggests that stronger remedies were more likely to be viewed by both contemporary readers and historians as abortifacients but were not necessarily produced only for this operation; they could still be used for medicinal, beneficial, sexual health purposes.

These purging remedies which cleansed the womb of corrupt humours continued to be advocated across the period, into the eighteenth century. John Marten also acknowledged that strong purgative medicines could be required in the cure of this disorder. Notably the purge he recommended used a particularly powerful and dangerous aphrodisiac cantharides to excite the body. This example thus implies that these two types of substance shared common virtues, a conclusion which will be further explored below. In the treatise, Marten wrote that to cure this disorder ‘universal Remedies which evacuate upwards or downwards, must be first given’ after which he listed several purging medicines.62 He followed this with the caution that:

"‘some Cases have been so inveterate, as that for the better forcing and opening of these obstructed Passages, we have been forc’d to have recourse to Cantharides, both inwardly and outwardly apply’d; for such a Distemper, unless in time remov’d utterly spoils Procreation, and much impedes Copulation."63

Here the remedy is designed solely with the promotion of generative health in mind. Although cantharides could conceivably have been used to purge a fetus from the body, Marten does not invoke the familiar warnings offered to pregnant women across the period by medical writers discussing potentially abortifacient substances. Although his recommendation could carry the implicit connotation of being abortive, his purges were explicitly understood and described solely within the framework of curing barrenness.

Purges designed to stimulate the monthly courses and restore the fertility of the womb were also discussed and recorded by female manuscript writers. These domestic collections move beyond the realms of medical theory to indicate medical practice. Receipt books descended from the medieval books of secrets which included medical, alchemical and trade recipes.64 The practice of keeping these books was ‘profoundly influenced by the humanist reading and writing practices of the Renaissance … which emphasized the importance of collecting, organizing, and generating specialized knowledge in commonplace books structured thematically by topic.’65 Receipt books were also experimental in nature; it was assumed that women would produce these remedies, using their own knowledge, refining them until they were satisfied with the overall efficacy of the remedy.66 Many remedies were also listed with comments upon their use such as probatum est (it is proven), or notes about particular cases in which they had worked. Although these texts do not give much detail, in terms of strength or quantity of ingredients, they effectively demonstrate the practical use and understanding of purges and other sexual health medications.

As with the published examples examined above it is clear that these could have been adopted for a more sinister use. It is also likely, because they were recorded in domestic receipt books, that they could have been accessed without the necessity of visiting a doctor or apothecary. Hence, they could have been used to remove a pregnancy without threatening the lady’s virtue. However, to view them exclusively within this context is to undermine the importance of generative health and fertility to early modern women. Several examples highlight the link between provoking the terms and encouraging conception. One of the most descriptive was recorded by Lady Ayscough in her 1692 manuscript. The documented recipe was supposed ‘To cleanse the Reines’, thereby conforming to the stereotypical abortifacient virtues – the removal of obstructions or impurities in the womb.67 It contained parsley as its primary ingredient, which was known to provoke the terms. Consequently it can be assumed that this was one of its aims.68 Nevertheless, the title given to this remedy also indicates that purging was not viewed as a detrimental or damaging course of action; it was cleansing and as such would leave the womb in a purer, more fertile state. The recipe was very complex, preventing it from being a suitable quick fix for an unwanted pregnancy. Moreover, in addition to the parsley it contained numerous provokers of lust, a trend that will be examined more thoroughly in due course, including arch angel flowers, hazel nuts, and the ‘pythe’ of an oxe back; this suggests that it was indeed supposed to cleanse and then invigorate the womb bringing it to a more pleasurable and fertile state.69 Lady Ayscough’s final statement about the remedy further emphasises its place as a part of sexual health practice. She wrote that the remedy was ‘Prob[atum est]: by Mrs Hone who being 4 years without issue being married conceived with Child upon ye taking thereof.’70 Another similar example was recorded in the receipt book of the Boyle family. One family member recorded ‘A Course of Physick much tried and approved to purge the womb of superfluous humours and to promote Conception in Barren Women’. This included many herbs noted for their ability to provoke the terms including pennyroyal, madder, calamint and savin. Yet it is once again clear that provoking the terms was thought to be beneficial to the generative faculty of the womb.71 Thus, it would seem from the evidence presented in both printed medical works and manuscript collections, that provoking the terms was viewed as a form of cleansing purge which purified the womb and made it apt for conception.

The way in which these recipes were recorded leaves them open to interpretation. It was rare for women to include specific directions for creating remedies in these works, particularly the quantities of herbs needed. Thus, it has been plausible for historians to interpret the compounds as being heavily dominated by the expulsive faculties of the emmenagogue ingredients. Nevertheless, as Elaine Hobby has shown, the quantities of herbs used in recipes were left to the discretion of the woman making the recipe.72 Catherine Field has also explained that these documents were highly experiential. Women were expected to understand the quantities needed through a working system of testing; arriving at their own conclusions through trial and error.73 By utilising these remedies in their own practice it was expected that most women would have an intimate knowledge of the plants required and the amounts in which they were effective. As a result there was no need to record these trivial details. This means that from a historiographical perspective both interpretations are equally valid. Women at the time would have been able to interpret these recipes in the way that suited their circumstances; those needing an abortion could do so by including a more potent amount of emmenagogues. However, those seeking to cleanse and purge the womb to make it apt for conception could do so by balancing out the strength of potential abortifacients with the stimulating properties of provokers of venery.

Notes:
45 Klepp in Van de Walle and Renne (eds) 2001, p. 23.
46 Cadden 1993, p. 250.
47 Fissell 2004, pp. 32-33.
48 Rueff 1637, p. 11.
49 Ibid.
50 Information on Massaria, Thorndike 1941, p. 368.
51 Massaria 1657, p. 20.
52 Ibid.
53 King 2004, p. 72.
54 Sharp 1671, p. 180.
55 Bracken 1737, p. 28. Information on Henry Bracken from The Oxford Dictionary of National Biography, http://www.oxforddnb.com, accessed 26.11.09.
56 Anon. 1739, p. 48. In 1770 John Ball also noted that a stopping of the menses was problematic for conception; Ball 1770, p. 70.
57 Van de Walle and Renne 2001, p. xxi.
58 Totelin 2009, p. 217.
59 Rueff 1637, p. 49.
60 Massaria 1657, p. 21.
61 Massaria 1657, pp. 24-5, 28-31.
62 Marten 1709, p. 109.
63 Ibid.
64 Field in Dowd and Eckerle (eds) 2007, p.50.
65 Field in Dowd and Eckerle (eds) 2007, p.51.
66 Field in Dowd and Eckerle (eds) 2007, pp. 56-7.
67 Wellcome Library (hereafter WL), MS1026, M.S.1026, Lady Asycough: Receipts of Physcik and Chirurgery, p. 104.
68 Ibid. Information on the virtues of parsley from Culpeper 1653, p. 201.
69 WL, M.S.1026, p.104. The Oxford English Dictionary Online suggests that ‘pythe’ referred to the spongy interior of organs or the substance occupying the spinal cord. In this case it may have been that the substance from the spinal cord was utilised, in keeping with the common medical theory that semen was produced in the brain and travelled to the testicles through the spinal column. This would suggest that the doctrine of signatures was employed here to pass on the potency of the ox to the woman consuming the decoction. The Oxford English Dictionary Online, www.dictionary.oed.com, accessed on 09/09/09.
70 WL, M.S.1026, p.104.
71 WL, M.S. 1340, Boyle Family Collection of 712 receipts with some cookery receipts, fol. 35v. Another example is recorded in the book of Mary Doggett whose plaster for the back ‘being laid to ye belly of a woman it causeth her Terms and makes her apt to conceive.’ Again the provoking of menstruation was portrayed as the first step towards promoting the conception of a child. London British Library, M.S. Additional 27466, Mary Doggett Book of Receipts, 1684, fol. 39v.
72 Hobby 1988, p. 167.
73 Field in Dowd and Eckerle (eds) 2007, pp. 56–7.

By Jennifer Evans in "Social History of Medicine", February, 2012, vol.25, issue 1, Oxford Uniersity, UK, excerpts pp.2-19. Adapted and illustrated to be posted by Leopoldo Costa

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