Meanings of Sex Difference in the Middle Ages: Medicines, Science, and Culture (review)

While Joan Cadden’s book has become an essential and often-cited text for those who study gender, medicine, and science in the Middle Ages, it is also valuable for those who are interested in the history of sexuality and sex difference. In particular, this thoroughly researched and amply documented book studies areas neglected in accounts of the development of modern notions of sex difference. In the influential Making Sex: Body and Gender from the Greeks to Freud (Cambridge, Mass.: Harvard University Press, 1990) Thomas Laqueur analyzes the radical discontinuity in ideas about sex difference between the modern world and earlier ages: in the eighteenth century a one-sex paradigm, where male and female are homologous and different in degree, was replaced by a two-sex system, where male and female are oppositional and different in kind. In tracing this shift, Laqueur understands the Middle Ages as a conduit for ancient knowledge—a view that oversimplifies the complexity and variability of medieval medicine and also neglects important and unique Arabic contributions to Western science. This oversimplification of the Middle Ages is of concern not only to medievalists: many medieval medical texts circulated well into the eighteenth century.

Cadden’s study makes a valuable contribution by enriching our understanding of the history of sex difference. While she acknowledges that some of her material does fall into the one-sex model, sex difference in the Middle Ages cannot be defined with reference to one ancient authority, neither Galen nor Aristotle, nor even to medieval medicine. The topic is a complex one for two reasons. First, medieval medicine was not a uniform and fixed discourse, but variable and eclectic in its texts and practices; second, it was only one part of a wide sphere of discourses and practices that defined sex difference. The first part of Cadden’s study deals with the variability of medieval medicine by examining the complexity and even contradiction of approaches to sex difference in a chronological analysis of medical texts in three stages: ancient sources, early exemplary texts, and later university developments. The second part examines the larger cultural context by taking a thematic approach to definitions of masculinity and femininity and to the problems of sterility and abstinence.

The first part of the study begins with the ancient heritage of medicine and natural philosophy. In chapter 1, the variability in the approaches to sex difference in the writings of Hippocrates, Aristotle, Soranus, and Galen reveals the multiplicity of ancient ideas available to the Middle Ages, which meant that medieval thinkers were not constrained by any one way of understanding sex difference. While the main issues were drawn from ancient sources, the interest and focus were not necessarily the same. The question of pleasure, for example, which became a point of interest for medieval writers, was not examined extensively in ancient sources. After studying the ancient tradition, this chapter discusses the two stages of transmission of ancient ideas: in the first stage, from the fourth to the sixth century, medical texts were often brief, easily referenced, and eclectic in their mix of ideas; in the second stage, from the late eleventh to the thirteenth century, they were characterized by an impulse to increase knowledge and to integrate newly acquired ideas. Arabic medicine is central in the second stage not only for transmitting ancient works, but for contributing its own adaptations and innovations.

The next two chapters trace the variety of ways that this complex medical tradition was adapted and shaped in the Middle Ages. In chapter 2, Cadden focuses on three very different texts to show how the transmission of new ideas in the late eleventh century began to change approaches to sex difference before the rise of university medicine. Constantine the African’s On Coitus, Hildegard of Bingen’s Book of Compound Medicine, and an excerpt from William of Conches’s On the Philosophy of the World all...