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Received: 26 September 2018    Revised: 18 October 2018    Accepted: 23 October 2018

DOI: 10.1111/jocd.12882

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Trotula de Ruggiero: The Magistra mulier sapiens and her

medical dermatology treatises

Maurizio Bifulco MD1  | Domenico D. De Falco MLS2 | Rita P. Aquino PharmD3  |

4
Simona Pisanti PhD

1
Department of Molecular Medicine and
Medical Biotechnologies, University of Summary
Naples "Federico II", Naples, Italy Trotula de Ruggiero is supposed to be one of the first female physician of the history,
2
Beni Culturali, Biblioteca Statale di
or at least the first who practiced, taught, and wrote medical texts inside the illustri‐
Montevergine, Avellino, Italy
3
Department of Pharmacy, University of
ous medieval Medical School of Salerno around the XI‐XII centuries. Here we retrace
Salerno, Salerno, Italy the steps of her fascinating history from historical cues to legendary anecdotes,
4
Department of Medicine, Surgery through the analysis of the medical texts which were ascribed to her in the Middle
and Dentistry 'Scuola Medica
Salernitana', University of Salerno, Salerno, Ages and that were very popular around Europe for several centuries, prevalently
Italy dealing with all the aspects of women's medical problems, with a focus on dermatol‐
Correspondence ogy, cosmetic science, and obstetrics/gynecology.
Maurizio Bifulco, Department of Molecular
Medicine and Medical Biotechnologies,
University of Naples "Federico II", Naples,
Italy.
Email: maubiful@unina.it
and
Simona Pisanti, Department of Medicine,
Surgery and Dentistry 'Scuola Medica
Salernitana', University of Salerno, Baronissi,
Italy.
Email: spisanti@unisa.it

Trotula de Ruggiero is considered one of the first female physicians
in the history of medicine and among the most notable personalities
of the worldwide known medieval Medical School of Salerno, known
as Magistra Mulier Sapiens.
Her role and her reputation in the Middle Ages went far beyond
the boundaries of Salerno and Italy itself and were so important
that her theoretical manuscripts were diffused in all European uni‐
versities and laid the foundations for modern medicine (Figure 1).
However, it is a very hard issue to retrace Trotula history and estab‐
lish without any doubt if she really was a renowned and esteemed
healer or if her existence was only a legend. Indeed, the fate of such
fascinating character suffered ups and downs through the centu‐
ries.1,2 She was recognized and praised by her contemporaries as
sapiens matrona, but several centuries later some scholars doubted
about her real existence or even believed that the name Trotula
masked a male identity. Despite such unsolved questions, the scien‐
tific and cultural interest toward Trotula's medical essays increased
through the years. No historical personality named Trotula has
been reported to date. On the other hand, Trota, also in its varia‐
tions Trocta or Trotta, was a very common name in the southern area
of Italy during the medieval times; indeed, it regularly appears into
documents and parchments of that epoch. Among the women bear‐
ing the name Trocta, it is well documented that there was a female
physician, who wrote several medical texts, that was then named
with the diminutive Trotula, as we still today know and call her. It
actually seems likely that the name Trotula would concern not the
author, but the medical essays themselves, that were written inside
the Medical School of Salerno around the XII century and that were
ascribed to her. Trocta or Trotula was indeed born in Salerno, inside
the noble de Ruggiero family, as testified by the finding of her name
in the records of the Salerno's church of that time. Her activity was
recorded around 1050. She married another illustrious physician
of the Medical School of Salerno, Giovanni Plateario the Old, and
was mother of two sons, both physicians and magistri (professors)

J Cosmet Dermatol. 2019;1–4. © 2019 Wiley Periodicals, Inc. |  1

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2       BIFULCO et al.
F I G U R E 1   Pen and wash drawing London, presumably
representing Trotula. Wellcome Library, MS 544 (Miscellanea
medica XVIII), early 14th century (France), p. 65 (detail)
of the School, named Giovanni the Young and Matteo, renowned as
Magistri Platearii. She was an authority in the medical field for her
contemporaries that called her sapiens matrona (wise Lady) or san‐
atrix Salernitana (physician from Salerno), but the historical informa‐
tion about her life is insufficient and not adequately confirmed by
historical reliable sources, covered in an aura of a legend. Indeed,
it was reported that she was one of the most beautiful women of
that epoch and that in 1097, at the time of her death, there was a
funeral procession longer than 3 km along the streets of Salerno. It
is difficult to state that Trotula was the first woman professor of the
Medical School of Salerno. But there are sure historical data about
the role of the women inside the School not only as physicians but
also as authors of medical texts and teachers.3 Indeed, Constanza
Calenda of Salerno lectured on medicine ex cathedra in the XIV
century at the University of Naples.4 Trotula reputation extended
far beyond Salerno and Italy boundaries and numerous are the
references to Trotula in the medieval times. Indeed, she was even
cited by Geoffrey Chaucher in The Canterbury Tales written in the
XIV century, in the Wife of Bath's Prologue (“He had a book that he
read night and day for his amusement… This book also contained
Tertullian, Chrysippus, Trotula, and Heloise, an abbess who once
lived near Paris…”). In his day, the Canterbury library collection
had several manuscripts ascribed to Trotula, so it is very likely that
Chaucher knew her books or at least name, but maybe he underesti‐
mated her importance in the medicine field.5 The English chronicler
Orderic Vitalis (1075‐1142) in his work the “Historia Ecclesiastica,”
tells about the journey to Salerno in 1059 of Rodolfo Malacorona,
a noble Norman who studied medicine in France before becoming
monk, that met an erudite nobilis matrona (noble Lady), the only one
able to face him in medicine debate. Scholars identified Trotula in
this knowledgeable woman.6 Moreover, in an essay found in 1837
in Wroclaw (Poland), “De aegritudinem curatione” dated back to the
XII‐XIII century, about the different types of fever and the treat‐
ments for various pathologies, the medical opinion of seven phy‐
sicians belonging to the Medical School of Salerno were reported:
Giovanni Plateario, Cofone, Petronio, Afflacio, Bartolomeo, Ferrario,
and Trotula. At the end of the XIII century in the Dict de l’Herberie of
the trouvèr Rutebeuf, a medical charlatan tells his audience that he
has been sent there by “ma dame Trote de Salerne, la plus sage dame
qui soitenz quatre partie dou monde” (madame Trote of Salerno, the
wisest woman in the whole world). Trotula was doctor of both men
and women and dealt with all the branches of medicine, as it can be
inferred by historical documents and her written production, that
was mainly focused on gynecology, obstetrics, dermatology, and pre‐
ventive medicine. Her manuscripts form a body of medical precepts
almost entirely practical, accompanied by an accurate description
of the recipes to treat the ailment. Trotula follows the physiological
and etiological humoral theory of Greco‐Roman origin, with a deep
influence of the incoming Arabic medicine, as we can see from the
use of typical Arabic ingredients. Her innovation is particularly in
the approach to women medicine, as gynecological conditions are
treated in a very practical way, with medical objectivity, without any
shyness, or moral prejudice. Trotula essays were very useful to the
education of male physicians, whose contribution to gynecology
and obstetrics innovation at that time was minimal, as they never di‐
rectly observed or touched female urogenital apparatus. Moreover,
she gave a substantial contribution to dermatology and cosmetic
science. Her treatises contain very detailed cosmetic recipes that
specify ingredients, quantities, procedures for preparation, manner
of application, and expected results. Many of the ingredients used
by Trotula have indeed a cosmetic‐dermatologic relevance and are
still used today (Table 1).7
In the XIII‐XV centuries, that are the period of Trotula highest
celebrity, according to the traditional classification, she was con‐
sidered the author of at least two medical essays: De passionibus
mulierum ante, in et post‐partum, or Trotula maior (according to the
medieval custom to call a manuscript with the name of the author,
like Rolandina was the work of the surgeon Rolando) dealing with
female diseases, and De ornatu mulierum or Trotula minor, a cosmetic
and dermatologic formulary.7 But the situation is more complicated
because three different main texts are included under these names:
the Liber de sinthomatibus mulierum (Trotula maior), the De curis mu‐
lierum, and the De ornatu mulierum (often put together as Trotula
minor). These essays are included in about one hundred manuscripts
scattered in historical libraries around Europe, dated back to the
XIII‐XIV centuries referred to Trotula, and translated in Irish, French,
English, German, Flemish, Catalan, and in Latin verses, that testify
the importance of such medical texts in Middle Age Europe. From
1544, the manuscripts progressively lose importance because of the
appearance of the first print editions in Strasbourg by the physician
BIFULCO et al. |
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TA B L E 1   Ingredients used in Trotula's recipes for an error in manuscript deciphering by the typesetters, as exhaus‐
tively explained by Campbell.8 Another hypothesis is based on the
Name Dermatologic and cosmetic effect
De aegritudinem curatione annotated with the abbreviation “trot” or
Agrimonia Anti‐inflammatory, healing
“tt,” misinterpreted and referred to the male Trottus, whose exis‐
Almond Moisturizing tence, however, is not documented anywhere.
Almond milk Wetting A further confirmation comes from a Spanish manuscript stored
Aloe Soothing, moisturizing at the Complutense University of Madrid, that closes with De ornatu
Althea Healing mulierum defined by the cataloger as Trotula minor and indexed in‐
Alum Deodorant, astringent side the manuscript itself as Practica secundum Trotam. The discovery
Bistort Antiaging of such manuscript, dated at the beginning of the XIII century and

Cabbage Antioxidant copied by a French or English amanuensis, confirms the real exis‐
tence in Salerno around the XI‐XII centuries of a sapient female phy‐
Common mallow Antiaging, anti‐inflammatory
sician named Trotula (from Trota) who wrote a treatise of medicine
Cucumber Soothing
practice.9
Cumin Antiseptic, Microcirculation
improvement
Even if there are still many doubts about the attribution to
Trotula of the texts commonly ascribed to her, they were at least
Dane wort Draining
inspired by her in the XIII century, at the climax of her fame around
Egg white Nourishing
Europe that led to the reinforcement of her legendary figure.10
Egg yolk Nourishing
A philological study carried out by the scholar Monica Green
Eglantyne Vit. C supplement
analyzes the three texts written inside the Medical School of
Filipendula Anti‐inflammatory
Salerno and ascribed to Trotula in several medieval catalogues
Ginger Microcirculation improver from private English and French libraries. According to sev‐
Honey Moisturizing eral scholars (George Hamilton, Paul Meyer, Hermann Sptizner,
Horse‐heal Antiseptic, soothing Dorothea Singer, Lynn Thorndike, Pearl Kribe) there were about
Houseleeks Anti‐inflammatory, astringent 60 manuscripts copied by Latin texts and six medieval translation
Laurel Soothing in English and French.11,12 Paradoxically the history of the origi‐
Liquorise Anti‐inflammatory nal texts has been confused by the first press edition in 1544 by

Myrtle Microcirculation improver George Kraut, that proposed the manuscripts in an imperfect and
difficultly retraceable way. Indeed, different press editions of the
Nipplewort Microcirculation improver
same manuscript contain discordant texts or otherwise the same
Nut Tanning
text is attributed, according to the edition, to a different author.
Oat Nourishing
The reconstruction of the origin of such manuscripts is further
Olive oil Emollient, Vit. E supplement
prevented by the lack of an in‐depth study of the original Latin
Pomegranate Antioxidant
texts. According to Benton, the three texts usually ascribed to
Ribwort plantain Cellulite Trotula at the origin circulated independently one form the other
Rose Soothing until the XIII century when they were assembled in a very inac‐
Rose oil Soothing curate way. Green collected and analyzed 122 Latin manuscripts,
Rose water Soothing identifying 15 different editing of Trotula texts. According to her
Saffron crocus Antioxidant massive philological study, it is unlikely that the three texts were
Sage Deodorant, firming written by the same author, and in particular she claims that De
Vervain Hormonal regulator ornatu mulierum is from a different author, never cited, as the man‐

Wheat Vit. E supplement

White lupin Anti‐inflammatory
George Kraut, who introduced the Trotula's texts inside the mis‐
cellaneous book Experimentarius medicinae. Most manuscripts re‐
port the authorship of Trotula by inference from the content. Up to
the fourth press editions of Trotula's essays (made in 1544, 1547,
1554, and 1555), any doubts about her existence or gender were
expressed. It was only in the Wolff press edition in Basel in 1566 that
her book was ascribed to Eros Juliae, a Greek‐Latin male physician
that was freed slave of Julia (Emperor Augustus daughter), maybe
uscript is in all its versions anonymous. All the manuscripts were
in their older versions anonymous and then started to circulate
under the illustrious name of Trotula, only occasionally identified
as the author. Even if the thesis of Monica Green questions the
attribution of such texts to Trotula, she confirms the existence in‐
side the Medical School of Salerno of a female physician named
Trotula, who was held in high esteem by her contemporaries and
even in the following centuries. The anecdote of Trotula who pre‐
vented the surgery for a young girl suffering from uterus affliction
(ventositas matricis) is reported also by Green as a proof of the real
existence of Trotula, so esteemed for her medical knowledge to
allow her to disagree with the diagnoses made by male colleagues.
 |
4       BIFULCO et al.
Many manuscript versions of De passionibus report this clear ref‐
erence to “Trotula that was called as an expert consultant” (...unde
communite Trotula appellata (vocata) fuit, quasi magistra operis).13 It
is highly likely, according to Green, that the attribution of all the
texts to Trotula was an a posteriori acknowledgment to her fame.
In conclusion, the history of the manuscripts ascribed to
Trotula suffers the same fate of the history of her life. Even if fur‐
ther studies will be conducted on these manuscripts, adopting new
research strategies and rigorous approaches, it is very difficult
that they will lead to substantial and outstanding new discover‐
ies able to dissolve our doubts about Trotula legendary figure and
clarify if she really wrote, dictated, or inspired the original texts
from where such manuscripts have been copied. Undoubtedly, the
history of the single Trotula's manuscripts must be examined in
the entirety of what we know as Trotula ensemble, as defined by
Green. It is a very difficult issue, if not even impossible, to make a
textual comparison of the hundreds of copies of manuscripts as‐
cribed to Trotula, that differ considerably in format, text, wording,
and contents. However, it is very unlikely that the different texts
were the result of conscious plagiarism attempts. The history of
Trotula's manuscripts is indeed emblematic of the intrinsic prob‐
lems of knowledge transmission in written form in the medieval
epoch, due to the objective limits of the instruments and methods
available at the time. It was a common habit that an amanuensis, in
the work of copying a manuscript or a translator making a transla‐
tion of it, took the freedom to change or omit parts of the original
text, add new parts expressing his thought, or just making mis‐
takes in the transcription. Even in these cases, these documents,
such Trotula's manuscripts, cannot be regarded as false, because
they are still an essential proof of the scientific, literary, and artis‐
tic production of the medieval epoch.
All the manuscripts spread around several European libraries,
along with the references to Trotula in the literature and print‐
ings, concur to suggest that the treatises known under the name of
Trotula were widely recognized as a guide in gynecology and ob‐
stetrics for several centuries and as the first treatises dealing with
cosmetic from a medical point of view. Whoever may have been
the author of such text, the treatises are of great medical value
for that time, because they treated fundamental medical issues in
a very practical and modern way, instructing in particular about
the treatment of gynecological and obstetric conditions (eg, the
support of the perineum in childbirth, the suture of lacerations,
abortion) through the unique and unprecedented perspective of
a woman.
ORCID
Maurizio Bifulco  https://orcid.org/0000-0002-1771-4531
Rita P. Aquino  https://orcid.org/0000-0002-9754-4244 
Simona Pisanti  https://orcid.org/0000-0003-1383-7929
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How to cite this article: Bifulco M, De Falco DD, Aquino RP,
Pisanti S. Trotula de Ruggiero: The Magistra mulier sapiens
and her medical dermatology treatises. J Cosmet Dermatol.
2019;00:1–4. https://doi.org/10.1111/jocd.12882