‘Nonnatus dictus quod caeso defunctae matris utero prodiit’. Postmortem Caesarean Section in the Late Middle Ages and Early Modern Period

‘Nonnatus dictus quod caeso defunctae matris utero prodiit’. Postmortem Caesarean Section in... Abstract Historians call sectio in mortua the act of opening the abdomen of a woman who has died during pregnancy or in childbirth in order to extract a baby. According to recent studies, the sectio is considered to be a routine practice carried out by male surgeons from the end of the Middle Ages, particularly in Italy, where the evidence of the sectio being performed by a midwife is scanty. But was it really such a popular operation at the time, and can the figure of the midwife be seen as secondary? It is also known that the operation was qualified through aspects which went beyond the surgical sphere, such as religion, myth, and especially law. How did these fields interact? This article highlights the complexity of sectio through the interpretation of different sources spanning from the late Middle Ages to the Early Modern period. sectio in mortua, childbirth, unborn, midwife, surgeon, jurist, consilia The caesarean section only became a successful routine operation to safeguard the health of a mother and her baby in cases of obstructed labour in more developed countries around a century ago. Although it was already commended by physicians and surgeons in the late sixteenth century, its history is dominated by a series of major failures for a further three centuries.1 The historical precedent of the operation—also in etymological terms—was the act of cutting open the womb of a woman who had died in childbirth, defined, albeit inaccurately, by scholars as sectio in mortua, which had the mainly ethical goal of saving the baby’s soul through baptism.2 For an adequate understanding of the sectio in mortua, we need to focus on the synergy of different elements such as surgical practice, theological thinking and liturgical practices, jurisprudence, literature and also the myth which grew around the operation in antiquity and which continued to echo throughout the Middle Ages and the early modern period in literary and other sources.3 There has been a significant increase in the number of studies on the subject carried out in the last few years. The most recent have often noted—with particular reference to countries such as modern-day France and Italy—that the sectio became a matter of routine to baptise the baby during the late Middle Ages.4 Moreover it was noted that the sectio was not usually performed by the midwife. The situation was summarized by Rebecca Wynne Johnson in a sort of state-of-the-field survey of childbirth studies: ‘The … work of Monica Green and Katharine Park shows little evidence that midwives ever performed sectio in the more medicalized realm of southern Europe, where the responsibility already lay with male physicians or surgeons’.5 Indeed, Katharine Park connected the operation with the progressive participation of medical men in childbirth in Italian cities from the fourteenth century onwards. Above all, she highlighted the clear distinction between the roles of those assisting the woman in labour: ‘midwives delivered babies; physicians provided pre-and post-partum medical care and surgeons and barbers performed operations such as foetal incisions and embryotomy’.6 A barber cut open Isabella della Volpe postmortem to extract her foetus in 1545. Park stresses that the roles taken on by male practitioners reflected the ‘early involvement of Italian physicians, surgeons, and barbers in obstetrics and gynaecology’.7 To confirm this, she examines texts by physicians and surgeons such as Pietro d’Argellata and Jacopo Berengario da Carpi who both described their first-hand experience of performing the sectio.8 In view of these considerations, and without denying the precocious medicalisation in the field of gynaecology by physicians in some Italian cities that was comprehensively demonstrated by Monica Green,9 this paper aims to seek confirmation of the general routine nature of the operation from the late Middle Ages onwards and the exclusion of midwives. Unfortunately, the lack of evidence makes it impossible to conduct the study on a local scale, which would be preferable as there are likely to have been notable behavioural variations between different places. However, because of the aforementioned complexity and synergy of the different characteristic elements of the operation, a long-term analysis of medical and other sources will nevertheless lead to timely reflections. The article will also focus on late medieval sources that have so far received little or no consideration from historians studying the sectio in mortua, such as those of a legal nature, showing that the issue of leaving an inheritance had a significant influence on whether the operation was performed. In particular, the analysis of a lengthy consilium by the Veronese jurist Bartolomeo Cepolla (1420–75) will be integral for understanding the role and behaviour of those who witnessed the event in question—the dead woman’s husband and parents, the priest, the performer of the operation and so on—and the different ways of interpreting the state of the baby (dead or alive) for the purpose of baptism and above all for inheritance-related reasons. Historical and Mythological Origins The first references to the surgical extraction of a foetus from a dead mother’s womb, with implications involving inheritance, can be found in several passages—widely known and much discussed during the Middle Ages—of the Digest in the Corpus iuris civilis promulgated by the Emperor Justinian in 533–34.10 The practice can be dated back to imperial times, with a reference in the Lex Regia, although, as Danielle Gourevitch points out, no medical literature of the time ever mentions a concrete case of a womb being cut open.11 The literary and mythological aspect is much more complex, abounding with examples of heroic characters whose aura was enhanced by their ‘unnatural’ birth and the fact that they were ‘unborn’. Caesar is one of the most representative examples, described in one tradition—chiefly associated with Pliny’s Natural History—as having come out of his dead mother’s split (caesus) womb.12 In truth though, as Suetonius recounts in his De Vita duodecim Caesarum, we know that Caesar was already an adult when his mother died.13 Nevertheless, the legend was handed down to later generations through various sources including Isidore of Seville.14 Les Faits des Romains, a medieval novel about Caesar’s life, also played an important part in the transmission of this narrative. There are many surviving manuscripts of this anonymous vernacular work written in France between 1213 and 1214, which influenced both French and Italian literature.15 The myth of the ‘Nonnatus’ (Unborn) was also applied to the Christian context, where the best-known saint is the Spaniard Raymundus Nonnatus (‘Nonnatus dictus quod caeso defunctae matris utero prodiit’),16 whose dossiers abound with childbirth miracles. The Religious Aspect The practice of cutting open a dead mother’s abdomen to extract a baby is widely cited in texts from the late thirteenth century onwards. The operation is mentioned in passages focusing on baptism as it is justified for such purposes, inasmuch as it guarantees the salvation of the child’s soul. One such source was the influential liturgical compendium written by Guillaume Durand, Bishop of Mende, in 1285–86, which provides an allegorical reading of Church rituals. It specifies that ‘if the mother should die in childbirth, she should be cut open and the live baby should be extracted from her womb and baptised’.17 Guillaume formalised a practice that bishops advocated widely across France, as shown by a number of synod statutes drafted between the thirteenth and fourteenth centuries, probably starting with the Synodicae Constitutiones by Odo of Sully, Bishop of Paris (1196–1208).18 It is notable that the Bishop of Mende formulated his norm quite differently from the liturgist and theologian Jean Beleth († 1182), who offered the following advice on performing an incision in the mother’s womb: ‘If the woman dies in childbirth, she must not be brought into the church. The obsequies must take place outside the church and the body must then be taken to the cemetery, but the baby must be extracted from the womb and buried outside the cemetery’.19 Such a declaration justifies the sectio as an act of purifying the dead mother, the bearer of an unbaptised foetus, rather than a way of saving the baby’s soul. Considering that Beleth’s manual was one of Durand’s sources, it is legitimate to think that the Church gradually changed its attitude towards women who died in childbirth and therefore towards the ultimate aim of the sectio. This emerges from several sources addressing the subject by theologians or decretalists from the end of the twelfth century onwards.20 Evidence of the change can be found in a number of later synodal acts, such as the statute of Tournai in 1366, in which priests are encouraged not to prevent the bodies of women who died in labour from entering churches and are urged to give them a burial in consecrated ground so as ‘not to turn a painful event into a fault’.21 Although the norm about the sectio—often transcribed verbatim or with very few variations—was included in synodal acts, often written in nearby areas, it is not clear whether it was a question of emulative rewriting or of bishops reminding priests to pay attention to a generally neglected practice. Despite the edicts, it seems that the Church did not exert any real control over the operation being performed at a local level in France. Indeed, in as late as 1473 in Volx, Provence, a notarial document demonstrates that the highest local authority, the ‘baiulus’, was involved in a case of cutting open a dead woman’s womb.22 This account also indicates that the operation could not have been a routine practice at the time, at least in that area, as the civil authority needed to be contacted. With regard to the Italian peninsula, in 1559, almost a century after the events in Volx, the men in Violante Carafa’s noble family rejected outright a Capuchin friar’s pressing request to disparare, which meant performing the sectio in mortua on Violante, who had been killed by her husband on suspicion of adultery while six months pregnant.23 Conversely, 17 years later in 1576, the womb of Francesca Caetani, another noblewoman killed by her husband for the same reason while seven months pregnant, was swiftly cut open by a midwife.24 The aim was clearly to save the soul of the foetus through baptism. As Ottavia Niccoli points out, the time gap between the episodes involving Violante Carafa and Francesca Caetani was crucial in terms of the sectio in mortua becoming accepted at all levels; it was finally added to the norms of the Catholic Church by Pope Paul V in 1614.25 The increased deployment of the operation was undoubtedly influenced by the increasingly lively Church debate about baptism, the salvation of the soul, and the afterlife places—particularly the limbo of infants, reserved for unbaptised dead babies—at the Council of Florence (1439–45), which reached its apex at the Council of Trent (1545–63).26 The period provides various Italian references to the sectio in diary sources or city chronicles. For example, in the Diario di ser Tommaso di Silvestro, we read in the year 1494: ‘The wife of Passarotto died. She died in childbirth, could not deliver and bore the heir within her. As soon as she died, her belly was incised and inside was the dead heir.’27 In his 1550 Cronaca Modenese, Tommasino de’ Bianchi wrote about a fellow citizen who ‘fell in the street and died at the end of her pregnancy. Immediately her belly was cut open and the creature was discovered to be full of fractures but not dead, and it was baptised.’28 Later, in 1584, Orazio Lombardelli (from Siena) wrote: ‘my wife died with a child in her womb. He was extracted with a cut in order to take him to his baptism.’29 Despite the definite increase in the practice of the sectio in the early modern period, it does not seem to have been fully accepted or become part of normal routine even after Paul V’s intervention. Indeed, in as late as the second half of the eighteenth century, Friar Minor Diodato (or Deodato or Adeodato) of Cuneo regretted the fact that the operation tended to be avoided in his comprehensive work largely dedicated to the subject, a synthesis of religious thinking at the time that also featured quotations from medical and legal texts.30 He even included letters of excommunication sent by Italian bishops to those who had shirked the duty. He reported the episode of a woman who bravely begged the women in attendance to cut open her womb for a caesarean section while she was in labour. Her husband not only forbade the operation but also subsequently opposed a sectio in mortua after the woman had died, even though ‘the movement of the unborn child could be seen on the surface of her belly’.31 The Medical Aspect and the Performers of the Sectio in Mortua The significant aspect of Diodato’s account is that it was the midwives who were ready to cut open the woman.32 In another passage he duly specifies that they are the most suitable professionals to perform a sectio after surgeons and barbers; as we have seen, even in the late sixteenth century a midwife cut open the unfortunate Francesca Caetani. This shows that although surgeons and barbers feature as the main performers of the operation in various late medieval and early modern sources, midwives certainly cannot be excluded with regard to the period as they are still found at a much later date, when medical men and surgeons undoubtedly played a more dominant role in obstetric and gynaecological procedures. Unfortunately, many of the aforementioned sources referring to the early modern period provide no useful information about which professional figure performed the operation. With reference to the methods used to perform the sectio, the first informative sources are synodal statutes, including those from Nîmes in 125233 or Cahors and Rodéz in 1289, which stated ‘if the midwives deem the foetus to be alive, immediately after the woman’s decease a piece of wood must be put in her mouth so the foetus may breathe. Let the dead woman be cut open’.34 The need for the mother’s mouth to be open so that the foetus could ‘breathe’ was familiar in a number of cultural contexts, starting from the first medical text that refers to the sectio in mortua, namely Bernard of Gordon’s Lilium medicine (1305).35 In his 1363 treatise on surgery, Guy de Chauliac associates it with the simultaneous opening of the vagina in light of the practical experience of women assisting with childbirth: ‘… tenendo mulieri os et matricem apertam, ut volunt mulieres, aperiatur mulier’.36 The author therefore seems to be stating that physicians adopted and theoretically reworked a practice that originally belonged to the cultural knowledge of mulieres or midwives through the exchange of expertise between medical practitioners at different levels.37 It is not until Ambroise Paré (1510–90) that the worthlessness of the procedure in terms of helping the foetus to breathe was actually noted.38 Regarding the need for the mouth of the vagina (os matricis) to be open, let us see how it is cited in Lilium medicine. If we go by some printed versions of the text, Bernard does not seem to consider opening the woman’s mouth, but mentions the os matricis twice almost in succession.39 However, in a number of manuscripts one of the two references is changed from os matricis to os matris (mouth of the mother) and, given the similarity between the two terms (matris and matricis), it is reasonable to think that the printed texts may be incorrect, particularly since the later work by Guy de Chauliac mentions the need to open both orifices.40 We should note though that the text of the Sermones medicinales by the physician Falcuccius Nicolaus (†1411?), in which Bernard’s work is transcribed almost verbatim and is mentioned explicitly by the author (‘Dixit Gordo’), also features the version that mentions the os matricis twice.41 This makes it difficult to understand the correct form of Bernard’s text and whether he was really referring to opening both orifices or just the vagina. The fact is, however, that none of the physicians in question mention direct involvement in the procedure. While Bernard notes the necessary steps to guarantee the child’s breathing, Guy mentions the need to cut open the woman’s womb on the left-hand side as it does not contain the liver.42 Besides providing very little description, they both justify the operation through its supposed historical and mythological origin. Bernard simply writes that Caesar was the first to be extracted from a dead mother’s womb in this way.43 Guy, meanwhile, underlines that justification for the sectio comes from the tale of Roman deeds (‘ut in gestis legitur Romanorum’) and above all because the Lex Regia banned a woman from being buried before the extraction of the foetus (‘vetat lex regia mulierem pregnantem non humari quousque fetus exiverit’).44 These are clear references to medieval literature about Caesar and Justinian’s Digest. An analysis of medical texts between the fourteenth and sixteenth centuries shows that the sectio in mortua was not widely cited by scholarly physicians in their works. In many cases, the authors who include sections on the operation mostly just adapt the citations from Bernard or Guy, including the mythological references. The same is true for Falcuccius Nicolaus who, as mentioned above, reports Bernard’s text verbatim in his fifteenth-century Sermones medicinales, as does Alessandro Benedetti (†1512).45 Pietro d’Argellata (†1423) is more original and although he transcribes passages by Guy de Chauliac, including the myth, he seems to hint at first-hand experience, albeit with sketchy generic descriptions.46 A much more credible account is provided by Berengario da Carpi (†1550), differing significantly from the content of other medical texts. Here, the sectio is merely an addition to the main narrative about his experience of dissecting a female body, which led him to discover an abscess in the womb and an extrauterine pregnancy. He is not interested in describing how the sectio should be carried out (nor does he mention the usual mythological references), but he is the only author who provides us with a first-hand account, including a note on the baptism of the extracted foetus—a detail absent from other medical texts. Berengario writes that before incising the abdomen he was sure about ‘finding two foetuses who, if not completely alive, could be sufficiently so to be baptised’. He actually only found one foetus that he describes as ‘half-alive’ (‘inveni unum foetum semivivum’) and handed him to the women of the house to be baptised.47 Unfortunately, he does not specify the characteristic signs of being ‘half-alive’, which was deemed sufficient to receive the sacrament. It is worth noting that there are no references to the sectio in mortua by Michele Savonarola (1385–1468), a physician who not only dealt extensively with gynaecology and obstetrics in Practica maior, but also wrote a treatise in the vernacular on the women and midwives of Ferrara.48 Neither did the Florentine physician Antonio Benivieni (1443–1502), although he showed great interest in anatomy and described several cases of obstetric-gynaecological operations.49 The work deserves a special mention for a somewhat bizarre and macabre anecdote reported by the author: ‘What should appear even more incredible is that while the dead wife of a certain Francesco was being taken to her burial, unexpectedly a child slipped out of her womb and with a wail forced the procession with the coffin to come to a halt, as the organisers of the funeral had thought the boy to be dead together with his mother’.50 Such an account could easily have set the stage for a description of the sectio in mortua operation, but it is not mentioned anywhere in the work. In later years, it is interesting to note that although La comare o ricoglitrice—a work on midwives by the physician Scipio Mercurius (1540/50–1615?)—contains a substantial section on caesarean section on live mothers, an operation which was starting to be debated at the time, little is said regarding the operation on dead mothers apart from the fact that it allowed Scipio Africanus to be born.51 The somewhat meagre interest in the subject shown by the authors of texts is probably related to the fact that, as the sources reveal, it was mostly the so-called ‘low level practitioners’ (surgeons, barbers, midwives) who performed the sectio.52 I use the expression with extreme caution as although these professionals were not part of the university environment, they were steeped in orally transmitted knowledge and had to achieve extremely high levels of professionalism at a practical level. The problem is that the vast majority of the information we have about their work comes from indirect sources, such as the case of the surgeon cited by the jurist Bartolomeo Cepolla, which is discussed below. The Legal Aspect Many of the surviving late medieval sources that document cases of the sectio being performed are related to issues of inheritance. It is known, for example, that the chain of inheritance was interrupted if the child showed even the slightest sign of life upon extraction from the womb, as the mother’s property would be inherited first by the baby and then by the father (the deceased’s husband) without being returned to the woman’s family of origin. Therefore, in order to understand the sectio in mortua in the Middle Ages and antiquity, the operation needs to be contextualised in the framework of jurisprudence, especially as many fifteenth-century legal sources highlight some relevant discussions and theories, starting from the text of the Digest.53 The descriptions of specific cases in consilia are of great interest, where jurists described their first-hand experiences of being summoned, sometimes by the town authorities, to settle post-sectio disputes. Somewhat predictably, the first issue they had to resolve was to judge the state of the baby—dead or alive—immediately after its extraction from the mother’s womb. This question is addressed, for example, in a short consilium (1388–89) by the jurist Baldus de Ubaldis of Perugia (†1400), although he reached his judgement easily as the child emitted a wail before dying (‘vocem emisit et immediate decessit’): the emission of sound was always seen as a sure sign of life.54 A case of sectio is also mentioned by Baldus’s son Francesco, another jurist, in reference to the years 1390–97.55 However, just like his father, he provides no information about who performed the operation. The consilium transcribed by the jurist Bartolomeo Cepolla (or Cipolla, 1420–75) stands out for its length and structure, although it is equally significant in terms of understanding the synergy between the religious aspect (the baptism of the baby), the medical-surgical aspect (the action and role of the performer of the operation) and the legal aspect.56 The considerable number of witnesses (over ten) to the operation—many of whom were not related to the deceased woman and who were questioned by the jurist—may indicate that it was seen as an event of special importance in the community.57 At the same time, it was also in the interest of the contending parties to summon as many people as possible to support their cause. It is plausible that more people witnessed such an event when there were inheritance disputes rather than when the operation was performed solely for the purpose of baptism. Cepolla was called in as a consultant by the Podestà of Noale (Anovalis) in the Veneto region as a daughter had been extracted from the open womb of Caterina, dominus Dominicus’s dead wife, which led to a conflict over inheritance between the baby’s father and maternal grandmother. In order to settle the quarrel, the jurist had to try and understand whether the child had shown any sign of life. To this end, he listened to the testimonies of all those who had been present during the sectio and seen the baby as soon as she had been taken out of the womb. Somewhat predictably, the witnesses were grouped into two opposing sides. The first and biggest group, who maintained that the baby was stillborn, included the mother of the deceased, several women—probably those who had helped with the delivery—and the priest, who stated that the extracted baby was ‘terribly pale and this paleness was the sign of death rather than life. She also had her eyes and mouth closed. At first sight they appeared to be signs of death.’58 Other witnesses in the same group also stated that they had seen no sign of life in the baby, claiming further proof in the fact that no blood came out of a small incision made in her forehead by the surgeon, magister Fixolus.59 It is not clear whether this cut was made accidentally, perhaps during the sectio, or deliberately to ascertain whether the baby was alive. However, the absence of blood did not stop the surgeon from siding with the other group who claimed that the baby had shown signs of life. Given the importance of the surgical aspect of the sectio, one would expect Cepolla to have given more consideration to the magister’s opinion than to the views of other witnesses and to have shown interest in the operation procedure. After all, the role of surgeons as experts summoned by local authorities to settle criminal matters (by determining the relative deadliness of a wound for example) was long-established by then, particularly in Italian cities.60 In their treatises, jurists specifically recommended using the advice of healing professionals such as physicians, surgeons and midwives.61 However, generally speaking, any testimony regarding the determination of death—and the normal recognition of the related signs—could be legally valid as it was enough to appeal to common universally shared knowledge and experts did not necessarily need to be involved.62 Indeed, in Cipolla’s consilium the surgeon does not make any statement to highlight his professional experience. Furthermore, the magister is stripped of any authority and even described as a suspectus (suspect) witness, because he is found to have signed a contract only entitling him to remuneration in the event of a live baby being extracted from the mother’s womb.63 The same payment system regulated the structure of healing agreements between patients and professional healers, described in detail for the early modern period by Gianna Pomata, with medical practitioners only receiving a fee in the event of success.64 The surgeon’s reference to general movement by the baby is further questioned by Cepolla when he explains how it should not be seen as a significant detail as it may have been caused by ‘ventositate’ (wind) within the body, which can also occur after death. This statement is based, as he duly notes, on a passage from the Liber testimoniorum by the jurist Bartolo da Sassoferrato (†1357) that specifically discussed what should be deemed signs of life in an extracted foetus when witnesses offered different opinions.65 Bartolo felt that general movements should not be seen as such as they could be induced by ‘ventositatibus’; witnesses therefore needed to be more precise in their indications, for example by specifying which part of the body the baby had moved and how.66 This is precisely what the witnesses in the magister’s group did, stating that they had seen specific movements, such as in the mouth and tongue, and also mentioning that blood came out of the baby’s nostrils. However, Cepolla does not consider this a definite sign of life as it is not deemed thus by those he calls ‘philosopher experts’ (‘peritissimi philosophi’).67 The text clearly shows how signs were seen and interpreted in a completely subjective way by the various parties involved in the legal dispute. There is no discord between the two groups, however, with regard to baptism, which is seemingly administered without any discussion even though the presbiter is in the group claiming that the baby was dead. None of the witnesses notice this contradiction. It is magister Fixolus who ‘holds the baby for baptism’ (which probably means that he is the godfather), while a few lines above Cepolla specifies that ‘Friar Petrus de Pentromulo testifies that the baby was alive as it changed colour after the baptism’.68 The friar might even have baptised the baby himself, but in any case the act is not questioned by the presbiter. It is almost as if all disharmony ceased when the baby’s soul needed to be saved and all those present tacitly agreed on the evidence that the baby was alive. To this end, it is interesting to note that during a later dispute in 1620 similar to the one recounted by Cepolla, the husband of the incised woman had the baby baptised immediately after extraction, using the sacrament to prove that the baby had come out alive.69 However, when the child was then proclaimed dead after a dispute between ‘the midwife, the surgeon, the physician, and those present’ (‘la Balia, il Cerusico e il Medico e gli astanti’), the priest did not bury him in consecrated land and a ‘bitter fight’ ensued. In this case it seems that a layperson (perhaps the midwife) performed the baptism, which was not approved by the priest as he was absent when the baby was extracted. It is feasible that the priest and most of those present were sure that the baby was dead on account of the fact, specified in the document, that the woman was eight months pregnant, a period deemed to be incompatible with childbirth in a well-known astrological theory of hermetic-Arab origin.70 In general, however, we should not be surprised at the more conciliatory attitude towards evaluating signs of life in a baby for the purpose of baptism. This should be viewed in tandem with the spread of sanctuaires à répit, shrines that were active from the late Middle Ages well into the modern age where dead babies were frequently taken, sometimes even after being exhumed, to obtain momentary resurrection and enable baptism.71 The signs of life were also extremely vague in these cases, so much so that during the seventeenth century many cases of violations, also involving priests, were denounced in the inquisitorial courts.72 If we compare Cipolla’s consilium with a slightly earlier hagiographic source, the collection of miracula by Philippe de Chantemilan, which features accounts of many miracles à répit as his remains were held in a specialised sanctuary, most descriptions of the signs proving that the baby was alive tend to coincide.73 Such signs are also eagerly sought-after in the accounts of miracles by a large number of people gathered around the little body placed before the saint’s remains for this very purpose. However, on these occasions they are unquestioningly and unanimously accepted because the only aim is to confirm the miracle and proceed with the baptism of the baby. More generally, it is not unfeasible that unequivocally dead babies were also baptised even though this practice was strictly forbidden. Such testimonies sometimes managed to evade the Church’s strict control filter and were included in hagiographic texts, as was the case with one of Louis of Toulouse’s miracles that features in the dossier of his canonisation process (1308). Here, after emerging lifeless from the womb, the baby was carried into church and baptised as normal, only coming back to life after the administration of the sacrament.74 Early modern sources also suggest that the problem of extracting babies from the open womb for baptism could be solved using the conjectural words ‘I baptise you if you are alive’, meaning that the sacrament was only considered valid if the baby was not dead.75 The formula is the result of discussions about the duty to baptise all miscarried foetuses, culminating in the work of Girolamo Fiorentini, a priest from Lucca (1602–78).76 There does not seem to have been a comparable formula in the Middle Ages, only a conjectural formula for conditional baptism regarding repetition of the sacrament when it was uncertain whether it had previously been received or administered using the correct wording.77 Returning to Cepolla’s consilium, the jurist appears to show particular interest in the statement by an apothecary, who is keen to specify that the baby had shown significant signs of life by moving inside the mother until shortly before the latter’s death, as he was able to ascertain for himself by placing his hand on the woman’s abdomen.78 This leads the jurist to think that the baby could well have been alive when she was extracted, although he is even more convinced by the fact that she was in a condition where she ‘could live according to nature, because she was born at the time when the mother was supposed to give birth’.79 Basically, the mother had reached the right time to give birth; he confirms this by making explicit reference to the judgement of the physician Gentile da Foligno (‘Gentilis philosophus’). At the request of the jurist Cino da Pistoia, who consulted him on the subject of gestation and childbirth times, Gentile digressed into a detailed explanation focusing at length on the aforementioned astrological theory and the Hippocratic tradition, with special reference to the treatise on the eight-month-old foetus.80 Regarding the fact that the majority of witnesses agreed that the baby was dead, Bartolomeo writes that: ‘when questioned about the reasons for their declarations, the witnesses say that they did not notice any sign of life. This is possible. Nevertheless, others were able to see signs, though they were temporary.’81 To further endorse the verdict, he stresses that the well-known procedure of keeping the woman’s mouth open with a piece of wood was observed during the operation. The jurist does not appear to be remotely interested in asking whether the usual attempts were made by midwives to check the state of the baby with a view to a possible ‘resuscitation’, including procedures such as submerging the baby in warm water, placing salt, spices or garlic on their lips and trying to blow air into their nose or mouth (or even ears).82 As the consilium notes, it is not even a problem that the baby was extracted from her mother’s womb at least an hour after her death. Indeed, Bartolomeo observes that ‘we read about Caesar Augustus and many others who came out alive even though they were extracted from their mother’s womb several hours after her death’.83 Here too, as in medical texts, myths helped to prove that the sectio in mortua could be a successful operation. Conclusion Cepolla’s text is indubitably one of the richest sources of information on how the practice of sectio was experienced and understood in a community environment at the end of the Middle Ages. Questions of inheritance were certainly a determining factor in seeking the intervention, and this is why the texts of jurists become indispensable sources for any study of the subject. From Cepolla’s consilium we learn how discussion in a legal dispute was entirelycentred on whether the child on leaving its mother’s womb was alive or dead, and what signs could be taken as proof of life. A discussion that must have been limited, if not wholly absent, when the practice of sectio was solely for the purpose of baptism. For the jurist, contrary to what one might expect, testimony from the executor of the operation, an expert in medical matters, stood on the same plane as that of the other witnesses, or was indeed marginalised for economic reasons. This in spite of the growing importance of medical practitioners at all levels, figures called in as authorities in the various juridical cases. In evaluating the success of an intervention, the reasoning of practical medicine counted for less than that of jurisprudential theory, which in turn, as in the case of the letter to Cino from Pistoia, drew on philosophical-speculative type medical theories. This datum contrasts with the fact that it was precisely exponents of practical medicine who could claim real experience of the operation, since they were the ones who normally did it, as borne out by the sources. With a few exceptions, however, the learned physicians cite sectio peripherally and in a manner that is repetitive from one author to the next, without demonstrating any concrete involvement. Unfortunately the approach of practical medical operators is hard to fully evaluate since it emerges only sporadically and indirectly from the sources. This augments the problem of a point by point study of the practice of sectio, which should be carried out in a capillary manner on different territories. Above all, eye witness sources referring to the intervention are few, and sometimes the operators’ identities and methods are not clarified. From the sources acquired, although an increase in testimonies of sectio cases from the fifteenth to sixteenth centuries is demonstrable, it emerges that caution must prevail in speaking of the routine nature of the intervention, especially in view of episodes such as the Violante Carafa case, of the Church’s need to regulate it after the Council of Trent and, even in the eighteenth century, of the need for churchmen such as Diodato to urge both specialists and the common people towards implementation of sectio. Certainly, surgeons and barbers were increasingly called upon to perform the operation, but sources demonstrate that it is not possible to completely exclude midwives from practices in Italian cities since as early as the fifteenth to sixteenth centuries, nor to make a clear distinction of roles at the mother’s bedside. Not only does the case of Francesca Caetani contradict the assumption: the work of Diodato further demonstrates that as late as the eighteenth century midwives were active in performing sectio, and indeed considered eminently capable, albeit on a rung below the surgeons and barbers. Acknowledgements My sincerest thanks go to Professor Alessandro Pastore and Professor Mary Morse for reading the text and for their suggestions. Footnotes 1 There is evidence from the sixteenth century in the work of the French surgeon François Rousset, in 1581 (Traitté nouveau de l’Hystérotomotokie ou enfantement caesarien). See Nadia Maria Filippini, La nascita straordinaria. Tra madre e figlio la rivoluzione del taglio cesareo (sec. XVIII–XIX) (Milan: Franco Angeli, 1995). In terms of later centuries, although somewhat fictionalized, Paolo Mazzarello’s account is of undoubted interest, based on evidence from the archives of the San Matteo hospital in Pavia regarding the work of the surgeon and obstetrician Edoardo Porro and what can be described as the first successful caesarean operation to be scientifically documented in 1876, leading to innovative surgical methods. Paolo Mazzarello, E si salvò anche la madre. L’evento che rivoluzionò il parto cesareo (Turin: Bollati Boringhieri, 2015). 2 Although the expression sectio in mortua is improper as it never appears in medieval or early modern sources, I will use it in this article for convenience. 3 See Daniel Schäfer, Geburt aus dem Tod: Der Kaiserschnitt an Verstorbenen in der abendländischen Kultur (Stuttgart: Pressler, 1999); Steven Bednarski and Andrée Courtemanche, ‘“Sadly and with a Bitter Heart”: What the Caesarean Section Meant in the Middle Ages’, Florilegium, 2011, 28, 33–69. 4 Steven Bednarski and Andrée Courtemanche in order to interpret an unpublished notarian act connected to sectio in mortua wrote: ‘If, by the late fifteen century, the Church encouraged sectiones in mortua, and if surgeons performed the operation with increasing regularity, why go to the trouble of redacting a notarized act for a routine operation?’(‘Sadly and with a Bitter Heart’, 5). For the authors the sectio in mortua was a routine operation. 5 ‘Division of Labor: Gender, Power, and Later Medieval Childbirth, c. 1200–1500’, History Compass, 2016, 14, 383–96, at 385. 6 ‘The Death of Isabella Della Volpe: Four Eyewitness Accounts of a Postmortem Caesarean Section in 1545’, Bulletin of theHistoryofMedicine, 2008, 82,169–87, at 174. 7 Ibid., 174. 8 Katharine Park retraces the episode above all through documents (letters, diaries) related to upper-class women and a few medical treatises. She provides examples of the sectio in mortua such as the wife of Gaspare Nadi, a master mason from Bologna, and Francesca Pitti, wife of the Florentine banker Giovanni di Francesco Tornabuoni. A physician performed the operation in the former case in 1462, while there is no such information about the latter case in 1477. Park, ‘The Death of Isabella Della Volpe’, 169–87. 9 The progressive inclusion of sections dedicated to gynaecology and obstetrics by authors of medical texts led to the conclusion that male physicians or surgeons began to have increasing involvement in women’s issues and illnesses and mothers in labour from the fifteenth century onwards. See Monica Green, Making Women's Medicine Masculine. The Rise of Male Authority in Pre-Modern Gynaecology (Oxford: Oxford University Press, 2008). 10 E.g.: D. 11. 8. 2; D. 28. 2. 12 (Digesta Iustiniani Augusti, ed. Th. Mommsen (Berolini: Apud Weidmannos, 1870), I, 356; 821. 11 Danielle Gourevitch, ‘Chirurgie obstétricale dans le monde romain: césarienne et embryotomie’, in Véronique Dasen, ed., Naissance et petite enfance dans l'Antiquité (Fribourg: Vandenhoeck et Ruprecht, 2004), 240–45. 12 Plinius, Naturalis Historia, VII, 9, 47. Pliny tells of three characters extracted from their dead mothers’ wombs: Scipio Africanus, Caesar and the consul Manilius. 13 De Vita duodecim Caesarum libri VIII, I, XXI. 14 Isidore of Seville, Etymologiarum libri, IX, 3, 12. See note 181, p. 126 of the edition by Marc Reydellet, Étymologies (Paris: Les Belles Lettres, 1984). 15 See Catherine Crozy-Naquet, ‘Les Faits des Romains. Une fortune diverse’, Anabases, 2006, 4, 141–54. Many manuscripts were illustrated with the scene of Caesar’s birth. Renate Blumenfeld-Kosinski, Not of Woman Born. Representation of Caesarean Birth in Medieval and Renaissance Culture (Ithaca-New York: Cornell University Press, 1990). 16 ‘He was called Unborn because he came out of his dead mother’s womb, cut open’ (Acta Sanctorum, Aug., VI, 737). Unless otherwise indicated, translations are the author’s. 17 ‘si mater in partu moritur, incidatur, et infans vivus de ventre extrahatur et baptizetur’: Rationale divinorum officiorum, VI, 83, 33, ed. by A. Davril and T. M. Thibodeau, Corpus Christianorum continuatio mediaevalis, 140A (Turnhout: Brepols, 1998), 425. 18 Sacrorum conciliorum nova et amplissima collectio, ed. by Mansi, XXII, col. 681. For an excursus on the northern French synodal acts recounting the praxis of the sectio in mortua, see Kathryn A. Taglia, ‘Delivering a Christian Identity: Midwives in Northern French Synodal Legislation, c. 1200–1500’, in P. Biller and J. Ziegler, eds, Religion and Medicine in the Middle Ages (York: York Medieval Press, 2001), 77–90. 19 ‘Mulier si moriatur in partu, non debet poni in ecclesia, sed extra ecclesiam dicatur ei obsequium et postea sepeliatur in cimiterio, sed puer extrahatur de ventre eius et sepeliatur extra cimiterium’; Summa de ecclesiasticis officiis, 159, ed. by H. Douteil, Corpus Christianorum, continuatio mediaevalis, 41A (Turnhout: Brepols, 1976), 309. Author’s italics. 20 See sources mentioned by Ludwig Schmugge, ‘Im Kindbett gestorben: Ein kanonistisches Problem im Alltag des 15. Jahrhunderts’, in R. H. Hemholz, P. Mikat, J. Müller and M. Stolleis, eds, Grundlagen des Rechts. Festschrift für Peter Landau zum 65. Geburtstag (Paderborn: Schöningh, 2000), 467–76. While elaborating the norm, Guillaume Durand may have developed an interest in the sectio for practical reasons related to his role as a bishop. I am grateful to Timothy Thibodeau for his precious insights. On the taboo about the death of women in childbirth, see Maaike Van Der Lugt, ‘L’animation de l’embryon humain dans la pensée médiévale’, in L. Brisson, M.-H. Congourdeau and J.-L. Solère, eds., L’embryon: formation et animation. Antiquité grecque et latine, tradition hébraïque, chretienne et islamique (Paris: Libr. Phil. J. Vrin, 2008), 233–54, 250–2. More broadly, the appearance of a law and Church statute connected with graveyard spaces created stricter regulations for funeral practices and from the twelfth century onwards we find lists of excluded people. See Mathieu Vivans, ‘Christiana sepultura priventur. Privation de sépulture, distinction spatiale et inhumations atypiques à la lumière des pratiques funéraires (Xe–XIVe siècles)’, in I. Cartron, D. Castex, P. Georges, M. Vivas and M. Charageat, eds, De corps en corps. Traitement et devenir du cadavre (Pessac: Maison des Sciences de l’Homme d’Aquitaine, 2010), 193–214, 196. 21 ‘Si mulier mortua fuerit in partu, non negentur ei aliqua jura Christianitatis, sed in Ecclesia deferatur et in cimiterio tumuletur, nisi aliquid canonicum obstiterit; quare poenam non debemus ei convertere in culpam’; Summa Statutorum Synodalium … , ed. by J. Le Groux (Insulis: J.-B. Brovellio & c., 1726), 4. 22 The document was transcribed by Bednarski and Courtemanche, ‘Sadly and with Bitter Heart’, 53. See note 4 above. Independently of the interpretation of the sources given by the authors I maintain that the need to apply to the authority is proof of the difficulties involved in performing sectio. 23 Ottavia Niccoli, Rinascimento anticlericale. Infamia, propaganda e satira in Italia tra Quattro e Cinquecento (Rome-Bari: Laterza, 2005), 147. 24 Ibid., 154. 25 ‘Si mater praegnans mortua fuerit, fetus quamprimum caute extrahatur, ac si vivus fuerit, baptizetur: si fuerit mortuus, et baptizari non potuerit, in loco sacro sepeliri non debet’; Rituale Romanum Pauli V Pont. Max. (Paris: Apud Societatem Typographicam Librorum Officij Ecclesiast. Ex Decreto Concil. Tridentini, 1623), 11. For cases of sectio in mortua in the eighteenth–nineteenth centuries, see Paola Zocchi, ‘Nascita innaturale e parto cesareo: problemi e paure tra Sette e Ottocento’, in A. Menzione, ed., Specchio della popolazione. La percezione dei fatti e problemi demografici nel passato (Udine: Forum, 2003), 81–104; Adriano Prosperi, Dare l’anima. Storia di un infanticidio (Turin: Einaudi, 2005), note 105, p. 215. 26 On the importance of the debate about the limbo of infants during the time of the Council of Florence, see Prosperi, Dare l’anima, 175–217; Chiara Franceschini, ‘Dibattiti sul peccato originale e sul Limbo a Firenze (1439–1450)’, in A. Prosperi, ed., Salvezza delle anime disciplina dei corpi. Un seminario sulla storia del battesimo (Pisa: Edizioni della Normale, 2006), 215–54. With the decree of the Council of Florence of 4 February 1442, it was established for the first time that the ceremony of baptism should not be postponed, but should take place as soon as possible. See Silvano Cavazza, ‘La doppia morte: resurrezione e battesimo in un rito del Seicento’, Quaderni storici, 1982, 50, 551–82, at 567. English translation: ‘Double Death: resurrection and Baptism in a Seventeenth-Century Rite’, in E. Muir and G. Ruggiero, eds, History from Crime (Baltimore: The John Hopkins University Press, 1994). 27 ‘Morì la moglie di Passarotto … morì di parto, che non potette parturire, chè haviva l’arede in corpo morta; et da po’ che morì fu sparata, et fu trovata l’arede morta’; Diario di ser Tommaso di Silvestro notaro, ed. by Luigi Funi (Orvieto: Tip. Comunale di E. Tosini, undated), I, 24. Tommaso di Silvestro was the canon of Orvieto cathedral and a notary. 28 ‘… cascò in la strata et se amazò et era gravida da fare fioli e subito fu sparata e la creatura era tutta frachasata ma non era morta e fu batezata’; Cronaca modenese di Tommasino de’ Bianchi detto de’ Lancellotti, vol. X (Parma: Pietro Fiaccadori, 1878), 305. 29 ‘la mia consorte n'andò à meglior vita con un figliolino, che di lei s’hebbe co’l taglio per il battesimo …’; Orazio Lombardelli, Dell’uffizio della donna maritata (Florence: Giorgio Marescotti, 1584), 63. 30 Diodato da Cuneo, Notizie fisico-storico-morali conducenti alla salvezza De’Bambini Nonnati, Abortivi, e Projetti (Venice: Presso Niccolò Pezzana, 1760), 111–15. It is significant that Deodato dedicates several parts of the text to the sectio in mortua, showing genuine concern, as most of his interest—in keeping with other men of the Church such as Emanuele Cangiamila (Embriologia sacra)—is focused on performing the caesarean on live women, an issue that triggered much discussion at the time in medical and religious terms. 31 ‘… tuttochè si vedense dalla superficie del ventre a strepitar nel seno della defunta il nonnato Infante’: Notizie fisico-storico-morali, 97. 32 In this particular case they were prepared to perform a caesarean on the live mother. 33 For the 1252 Nîmes statutes see Les statuts synodaux du XIIIe siècle, II, Les statuts de 1230 à 1260, ed. Odette Pontal (Paris: CTHS, 1983), 281–3. 34 ‘si partum credunt vivere obstetrices apposito statim id est subito post mortem, baculo in ore mulieris, ut sic infans cito spiramen recipiat, aperiatur mulier mortu’; Statuta Synodalia Carducensis, Ruthenensis et Tutelensis ecclesiarum, in Thesaurus novus Anecdotorum, ed. by E. Marténe and U. Durand, IV (Paris, 1717), col. 686. 35 Accounts of allowing the foetus to breathe are also found in the narration of a miracle performed by Jeanne-Marie de Maillé (fifteenth century), where the saint placed a piece of wood between the dying mother’s teeth so that the foetus could still breathe (in the end, both mother and child were saved as a result of miraculous intervention). Acta Sanctorum., Mart. III, 760E. 36 Inventarium sive Chirurgia Magna, VI, 2, 7, ed. by M. R. McVaugh (Leiden, New York, Köln: Brill, 1997), 389. 37 I have reservations about Katharine Park’s suggestion that the passage represents a concession on the surgeon’s part to the women who normally assist the mother in labour, while still expressing scepticism towards the procedure (‘The Death of Isabella Della Volpe’, 173). 38 Les Oeuvres, XXIII, 38 (Paris: Chez Gabriel Buon, 1579), 885–6. Interestingly, in the work by Diodato da Cuneo the opening of the mother’s mouth is considered useless, but he recommends keeping the abdomen warm (Notizie fisico-storico-morali, 116). 39 ‘Secundo notandum, quod foetus potest vivere matre mortua existente … et potissime vivit quando os matricis manet apertum, ideo matre mortua, aliquod artificium debet fieri ut os matricis stet apertum …’; Practica Gordonii, Praxis omnibus medicine studiosis utilis consummatissimi artium et medicine … medicine lilium nuncupata …, (Venetiis: Mandato et expensis Luceantonii de Giunta, 1521), f. 89va. The same version is in the 1559 edition (Lugduni: Apud Gulielmum Rouillium), 638–9. Author’s italics. 40 On the change from os matricis to os matris, see, e.g. MS Paris, BnF, lat. 16189 (a. 1313–14), f. 116rb: ‘fetus attrahit aerem / attractum in arteriis matris et potissime vivit quando / os matricis remanet apertum et ideo matre mortua a / liquod artificium debet fieri ut os matris stet apertum’. See Renate Blumenfeld-Kosinski, Not of Woman Born. Representation of Caesarean Birth in Medieval and Renaissance Culture (Ithaca-New York: Cornell University Press, 1990), who refers to several different manuscripts with variations. 41 Falcuccius Nicolaus, Sermones medicinales septem, Sermo sextus de membris generationis (Venice: Bernardino de Tridino da Monferrato, 1491), f. 38vb. 42 ‘aperiatur mulier secundum longitudinem cum rasorio in latere sinistro’: Inventarium sive Chirurgia Magna, 389. 43 ‘ut dicitur, fuit primus Caesar extractus, ed inde ex illo habuit nomen’: Opus Lilium medicinae …, VII, 15 (ed. 1559), 639. 44 Inventarium sive Chirurgia Magna, 389. 45 Falcuccius Nicolaus, Sermones medicinales septem, f. 38v. When narrating the etiological myth, Falcuccius mentions Scipio Africanus rather than Caesar. He considers a passage by Solinus, a widely-appreciated third-century author who misinterpreted Pliny’s text and does not mention Caesar: ‘Dixit Solinus necatis matribus ortus auspicatior est sicut Scipio affricanus hic enim prior fuit qui defuncta matre exciso utero in diem venit primus romanorum cesar dictus’. See Solinus’s text: Collectanea rerum memorabilium, ed. by Th. Mommsen (Berlin: apud Weidmannos, 1895), 17. For Solinus’s passage, see comment within Robert Schilling’s edition of Pliny’s work, Histoire Naturelle, livre VII (Paris: Les Belles Lettres, 1977), 145–6. Alessandro de Benedetti, De re medica opus insigne et apprime medicinae candidatis omnibus utile, XXV, 25 (Basel: per Henricum Petri, 1549), 477. 46 Chirurgia Argelate cum Albucasi, V, 16, 6 (Venice: Luceantonij de Giunta Florentini 1520), f. 112rb: ‘Ego aliquando feci incisionem. … Et per istum modum extraxi puerum … et per hunc modum extractus fuit Julius Cesar, ut scribitur in Gesta Romanorum’. 47 ‘et ego aperui ventrem eius credens invenire duos foetus si non totaliter vivos ad minus taliter quod posset baptizari’; Commentaria cum amplissima additionibus super Anatomia Mundini (Bologna: Girolamo Benedetti, 1521), ff. 211v–212r. 48 Michele Savonarola, De regime pregnantium et noviter natorum usque ad septennium, ed. by Luigi Belloni (Milan: Società Italiana di Ostetricia e Ginecologia, 1952). In spite of the Latin title, the work is in the vernacular. See Gabriella Zuccolin, ‘Nascere in latino e in volgare. Tra la Practica Maior e il De regimine pregnantium’, in C. Crisciani and G. Zuccolin, eds, Michele Savonarola. Medicina e cultura di corte (Florence: SISMEL, 2011), 137–209. 49 Antonio Benivieni, De abditis nonnullis ac mirandis morborum et sanatiorum causis, ed. by G. Weber (Florence: Olschki, 1995). 50 Ibid., 194. 51 Scipione Mercurio, La comare o ricoglitrice, II, 28 (Venice: Appresso Gio. Battista Cioti, 1596), 76. This case also follows Solinus’s version. See note 45 above. 52 In addition to the cases cited in this article, see also the source cited by Monica Green regarding Marseille in 1331. In this case the operation involved a barber: Moving from Philology to Social History: The Circulation and Uses of Albucasis's Latin Surgery in the Middle Ages, in F. E. Glaze and B. K. Nance, eds, Between Text and Patient. The Medical Enterprise in Medieval and Early Modern Europe (Florence: SISMEL, 2011), 360–1. 53 On the legal experts involved in the discussion and the ways in which they were consulted, see Osvaldo Cavallar, ‘Septimo mense. Periti, medici e partorienti in Baldo degli Ubaldi’, in C. Frova, M. G. Nico Ottaviani and S. Zucchini, eds, VI centenario della morte di Baldo degli Ubaldi. 1400–2000 (Perugia: Università degli Studi, 2005), 365–460. 54 The text of the consilium is in the appendix to Julius Kirshner, ‘Baldus de Ubaldis on Disinheritance: Contexts, Controversies, Consilia’, Ius Commune, 2000, 27, 197–200. See also the 1390–97 consilium by the same jurist in the appendix to Cavallar, ‘Septimo mense’, 448–50. 55 Cavallar, ‘Septimo mense’, 448–50. 56 Bartolomeo Cepolla, Consilia ad diversas materias … (Venetiis: apud Bartholomaeum Rubinum, 1575), n. 50, ff. 186r–189v. 57 Zocchi, ‘Nascita innaturale e parto cesareo’, 84–6, notes that at the end of the eighteenth century in a small village in the Canton of Grisons the sectio operation still drew a large group of curious people to the woman’s house, even from neighbouring areas. 58 Bartolomeo Cepolla, Consilia, f. 186v: ‘erat illa puella vehementer pallida quando nata fuit, quae palliditas significare vero potius mortem quoddam vitam. Item quia tenebat oculos clausos, et os esset clausum … prima facie vero esse probatum dictam puellam potius natam fuisse mortuam quoddam vivam’. 59 Ibid., f. 186v: ‘nam si viva fuisset sanguis verisimiliter exivisset, ut de se patet’. 60 See Joël Chandelier and Marilyn Nicoud, ‘Entre droit et médecine: les origines de la médecine légale en Italie (XIIIe–XIVe siècles)’, in J. Chandelier and A. Robert, eds, Frontières des savoirs en Italie à l'époque des primières uniersités (XIIIe–XVe siècles) (Rome: École française de Rome, 2015), 233–93; Osvaldo Cavallar, ‘La “benefundata sapientia” dei periti: Feritori, feriti e medici nei commentari e consulti di Baldo degli Ubaldi’, Ius commune, 2000, 27, 215–81; Corinne Leveleux-Teixeira, ‘Savoir techniques et opinion commune: l’expertise dans la doctrine juridique médiévale (XIIIe–XVe siècle)’, in Experts et expertise au Moyen Âge. Consilium queritur a perito (Paris: Publications de la Sorbonne, 2012), 117–31. For the early modern period, see Alessandro Pastore, Il medico in tribunale. La perizia medica nella procedura penale d'antico regime (secoli XVI–XVIII) (Bellinzona: Casagrande, 1998). 61 See Cavallar, ‘La “benefundata sapientia” dei periti’. 62 See Leveleux-Teixeira, ‘Savoirs technique’, 121. On the topic of physical signs indicating death in the context of juridical discussion, see Cavallar, ‘Septimo mense’, 424–5. 63 Consilia, f. 186v. 64 Gianna Pomata, La promessa di guarigione. Malati e curatori di antico regime. Bologna XVI–XVII secolo (Rome-Bari: Laterza, 1994). English translation: Contracting a Cure: Patients, Healers, and the Law in Early Modern Bologna (Baltimore-London: The Johns Hopkins University Press, 1998). 65 Consilia, 187r. 66 Tractatus testimoniorum in Consilia, Quaestiones … tomus decimus (Venetiis, 1596): ‘Si testis dixit vivere, quia vidit eum moveri, non probat: nam in mortuo sepe visum est ventositates in corpore saepe motum facere. Dicat igitur testis quo motu, si tibias vel brachia extendere, vel actrahere vidit …’ Bartolo responds to the question about how to behave in the event of contrasting testimonies about whether or not the baby was alive after the delivery. See Cavallar, ‘Septimo mense’, 424–5. 67 Consilia, f. 187v: ‘Nam ex hoc arguitur, licet non necessario secundum quod a peritissimis philosophis intellexi, quod ipsa erat viva’. 68 Consilia, f. 187r. 69 Alberto Malvolti, Fucecchio e dintorni. Storie e microstorie tra Medioevo ed età Moderna (Vicopisano: Tipografia Monteserra, 2014), 82. The document comes from Memorie di Casa Galleni from Fucecchio, near Florence. The source is quoted also in Prosperi, Dare l’anima, note 105 p. 215. 70 The theory was based on the influence of the planets in each month of the gestation. The baby had a good chance of being born alive during the ninth, seventh and tenth months. No chance was given for the eighth month, dominated by the inauspicious influence of Saturn. For the philosophical origin of the astrological theory from antiquity onwards, see Charles S. F. Burnett, ‘The Planets and the Development of the Embryo’, in G. R. Dunstan, ed., The Human Embryo. Aristotle and the Arabic and European Traditions (Exeter: University of Exeter Press, 1990), 95–112. 71 See the example of an exhumation for year 1642 in a town in the Veneto region mentioned by Prosperi, Dare l’anima, 209. Adriano Prosperi refers to an extensive bibliography on this issue in French, Italian and German, in ibid., note 77 p. 205 and note 79 p. 206. 72 Cavazza, ‘La doppia morte’. 73 Vie et miracles de la bienheureuse Philippe de Chantemilan, ed. by Ulisse Chevalier (Valence: Picard 1894), 39–40; 44–5; 47; 49; 51–4; 57; 58; 62; 68; 69; 80–1; 83–6; 88. For instance, in these cases blood coming out of the nostrils was always considered a sign of life. On miracles à répit by Philippe de Chantemilan, see Pierrette Paravy, ‘Angoisse collective et miracles au seuil de la mort: résurrections et baptêmes d’enfants mort-nés en Dauphiné au XVème siècle’, in La mort au Moyen Âge (Strasbourg: Libraire Istra, 1977), 87–102. For a comparison of the ways in which the vitality of the baby was interpreted in miracles à répit and testimonies of the sectio in mortua, see A. Foscati, Venire alla luce e rinascere. Il cesareo da madre morta e il miracolo à répit nel tardo Medioevo, in A. Foscati, C. Gislon Dopfel and A. Parmeggiani, eds, Nascere. Il parto dalla tarda antichità all’età moderna (Bologna: Il Mulino, 2017), 95–114. 74 Processus Canonizationis et Legendae variae Sancti Ludovici O. F. M. Episcopi Tolosani, in Analecta Franciscana (Quaracchi-Florence: Ex Typographia Collegii S. Bonaventurae, VII, 1951), 128–9. Besides the dedicated sanctuaries, it should be noted that in saints’ dossiers miracles à répit are the most frequently considered childbirth miracles. See A. Foscati, ‘Retracing Childbirth Through Hagiographical Texts and Canonization Processes in Italy and France between the Thirteenth and Sixteenth Centuries’, in C. Gislon Dopfel, A. Foscati and C. Burnett, eds, Pregnancy and Childbirth from Late Antiquity to the Renaissance, (Turnhout: Brepols, forthcoming). 75 See Zocchi, ‘Nascita Innaturale’, 87; Diodato da Cuneo, Notizie fisico-storico-morali, 112; 211. 76 Disputatio de ministrando Baptismo humanis foetibus abortivorum … (Lugduni: apud Claudium Chancey, 1658). See Prosperi, Dare l’anima, 272–5. 77 ‘De quibus dubium est, an baptizati fuerint, baptizantur his verbis praemissis: Si baptizatus es, non te baptizo, sed si nondum baptizatus es, ego te baptizo’; Gregorii papae IX Compilationis Liber III, Titulus XLII, De Baptismo et eius effectu, chap. II, in Corpus Iuris Canonici, ed. by Aemilius Friedberg (Graz: Akademische Druck-D. Verlagsanstalt, 1959), II, col. 644. 78 Consilia, f. 187v. 79 Consilia, f. 189r. 80 Pseudo-Hippocrate, Du foetus de huit mois, edited and translated into French by R. Joly (Paris: Les Belles Lettres, 1970), 147–81. On the astrological theory, see note 70 above. Gentile da Foligno (†1348) wrote the letter-treatise (De temporibus partus or Super lege VII mense) in around 1326. See H. U. Kantorowicz, ‘Cino da Pistoia ed il primo trattato di medicina legale’, Archivio Storico Italiano, 1906, 37, 115–28. 81 Consilia, f. 187v. 82 These methods are found in the account of miracles à répit in several canonisation processes. See Foscati, ‘Retracing Childbirth’. Interestingly, hagiographic texts often reveal that there was no absolute certainty about death not even in the case of adults. Besides observations of the signs that appeared on the patient's body (pallor, rigidity, etc.), the process sometimes involved looking for further proof of death, as in the canonisation process of Clare of Montefalco, where boiling wax was poured on the patient’s face to observe whether there were any reactions. Il processo di canonizzazione di Chiara da Montefalco, ed. by Enrico Menestò (Scandicci: La nuova Italia, 1984), 319, 326. 83 Consilia, f. 188r: ‘legitur de Cesare Augusto et de multis aliis, qui de caeso ventre matris per plures ante horas defunctae vivi nati sunt’. © The Author(s) 2018. Published by Oxford University Press on behalf of the Society for the Social History of Medicine. This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/about_us/legal/notices) http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Social History of Medicine Oxford University Press

‘Nonnatus dictus quod caeso defunctae matris utero prodiit’. Postmortem Caesarean Section in the Late Middle Ages and Early Modern Period

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© The Author(s) 2018. Published by Oxford University Press on behalf of the Society for the Social History of Medicine.
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Abstract

Abstract Historians call sectio in mortua the act of opening the abdomen of a woman who has died during pregnancy or in childbirth in order to extract a baby. According to recent studies, the sectio is considered to be a routine practice carried out by male surgeons from the end of the Middle Ages, particularly in Italy, where the evidence of the sectio being performed by a midwife is scanty. But was it really such a popular operation at the time, and can the figure of the midwife be seen as secondary? It is also known that the operation was qualified through aspects which went beyond the surgical sphere, such as religion, myth, and especially law. How did these fields interact? This article highlights the complexity of sectio through the interpretation of different sources spanning from the late Middle Ages to the Early Modern period. sectio in mortua, childbirth, unborn, midwife, surgeon, jurist, consilia The caesarean section only became a successful routine operation to safeguard the health of a mother and her baby in cases of obstructed labour in more developed countries around a century ago. Although it was already commended by physicians and surgeons in the late sixteenth century, its history is dominated by a series of major failures for a further three centuries.1 The historical precedent of the operation—also in etymological terms—was the act of cutting open the womb of a woman who had died in childbirth, defined, albeit inaccurately, by scholars as sectio in mortua, which had the mainly ethical goal of saving the baby’s soul through baptism.2 For an adequate understanding of the sectio in mortua, we need to focus on the synergy of different elements such as surgical practice, theological thinking and liturgical practices, jurisprudence, literature and also the myth which grew around the operation in antiquity and which continued to echo throughout the Middle Ages and the early modern period in literary and other sources.3 There has been a significant increase in the number of studies on the subject carried out in the last few years. The most recent have often noted—with particular reference to countries such as modern-day France and Italy—that the sectio became a matter of routine to baptise the baby during the late Middle Ages.4 Moreover it was noted that the sectio was not usually performed by the midwife. The situation was summarized by Rebecca Wynne Johnson in a sort of state-of-the-field survey of childbirth studies: ‘The … work of Monica Green and Katharine Park shows little evidence that midwives ever performed sectio in the more medicalized realm of southern Europe, where the responsibility already lay with male physicians or surgeons’.5 Indeed, Katharine Park connected the operation with the progressive participation of medical men in childbirth in Italian cities from the fourteenth century onwards. Above all, she highlighted the clear distinction between the roles of those assisting the woman in labour: ‘midwives delivered babies; physicians provided pre-and post-partum medical care and surgeons and barbers performed operations such as foetal incisions and embryotomy’.6 A barber cut open Isabella della Volpe postmortem to extract her foetus in 1545. Park stresses that the roles taken on by male practitioners reflected the ‘early involvement of Italian physicians, surgeons, and barbers in obstetrics and gynaecology’.7 To confirm this, she examines texts by physicians and surgeons such as Pietro d’Argellata and Jacopo Berengario da Carpi who both described their first-hand experience of performing the sectio.8 In view of these considerations, and without denying the precocious medicalisation in the field of gynaecology by physicians in some Italian cities that was comprehensively demonstrated by Monica Green,9 this paper aims to seek confirmation of the general routine nature of the operation from the late Middle Ages onwards and the exclusion of midwives. Unfortunately, the lack of evidence makes it impossible to conduct the study on a local scale, which would be preferable as there are likely to have been notable behavioural variations between different places. However, because of the aforementioned complexity and synergy of the different characteristic elements of the operation, a long-term analysis of medical and other sources will nevertheless lead to timely reflections. The article will also focus on late medieval sources that have so far received little or no consideration from historians studying the sectio in mortua, such as those of a legal nature, showing that the issue of leaving an inheritance had a significant influence on whether the operation was performed. In particular, the analysis of a lengthy consilium by the Veronese jurist Bartolomeo Cepolla (1420–75) will be integral for understanding the role and behaviour of those who witnessed the event in question—the dead woman’s husband and parents, the priest, the performer of the operation and so on—and the different ways of interpreting the state of the baby (dead or alive) for the purpose of baptism and above all for inheritance-related reasons. Historical and Mythological Origins The first references to the surgical extraction of a foetus from a dead mother’s womb, with implications involving inheritance, can be found in several passages—widely known and much discussed during the Middle Ages—of the Digest in the Corpus iuris civilis promulgated by the Emperor Justinian in 533–34.10 The practice can be dated back to imperial times, with a reference in the Lex Regia, although, as Danielle Gourevitch points out, no medical literature of the time ever mentions a concrete case of a womb being cut open.11 The literary and mythological aspect is much more complex, abounding with examples of heroic characters whose aura was enhanced by their ‘unnatural’ birth and the fact that they were ‘unborn’. Caesar is one of the most representative examples, described in one tradition—chiefly associated with Pliny’s Natural History—as having come out of his dead mother’s split (caesus) womb.12 In truth though, as Suetonius recounts in his De Vita duodecim Caesarum, we know that Caesar was already an adult when his mother died.13 Nevertheless, the legend was handed down to later generations through various sources including Isidore of Seville.14 Les Faits des Romains, a medieval novel about Caesar’s life, also played an important part in the transmission of this narrative. There are many surviving manuscripts of this anonymous vernacular work written in France between 1213 and 1214, which influenced both French and Italian literature.15 The myth of the ‘Nonnatus’ (Unborn) was also applied to the Christian context, where the best-known saint is the Spaniard Raymundus Nonnatus (‘Nonnatus dictus quod caeso defunctae matris utero prodiit’),16 whose dossiers abound with childbirth miracles. The Religious Aspect The practice of cutting open a dead mother’s abdomen to extract a baby is widely cited in texts from the late thirteenth century onwards. The operation is mentioned in passages focusing on baptism as it is justified for such purposes, inasmuch as it guarantees the salvation of the child’s soul. One such source was the influential liturgical compendium written by Guillaume Durand, Bishop of Mende, in 1285–86, which provides an allegorical reading of Church rituals. It specifies that ‘if the mother should die in childbirth, she should be cut open and the live baby should be extracted from her womb and baptised’.17 Guillaume formalised a practice that bishops advocated widely across France, as shown by a number of synod statutes drafted between the thirteenth and fourteenth centuries, probably starting with the Synodicae Constitutiones by Odo of Sully, Bishop of Paris (1196–1208).18 It is notable that the Bishop of Mende formulated his norm quite differently from the liturgist and theologian Jean Beleth († 1182), who offered the following advice on performing an incision in the mother’s womb: ‘If the woman dies in childbirth, she must not be brought into the church. The obsequies must take place outside the church and the body must then be taken to the cemetery, but the baby must be extracted from the womb and buried outside the cemetery’.19 Such a declaration justifies the sectio as an act of purifying the dead mother, the bearer of an unbaptised foetus, rather than a way of saving the baby’s soul. Considering that Beleth’s manual was one of Durand’s sources, it is legitimate to think that the Church gradually changed its attitude towards women who died in childbirth and therefore towards the ultimate aim of the sectio. This emerges from several sources addressing the subject by theologians or decretalists from the end of the twelfth century onwards.20 Evidence of the change can be found in a number of later synodal acts, such as the statute of Tournai in 1366, in which priests are encouraged not to prevent the bodies of women who died in labour from entering churches and are urged to give them a burial in consecrated ground so as ‘not to turn a painful event into a fault’.21 Although the norm about the sectio—often transcribed verbatim or with very few variations—was included in synodal acts, often written in nearby areas, it is not clear whether it was a question of emulative rewriting or of bishops reminding priests to pay attention to a generally neglected practice. Despite the edicts, it seems that the Church did not exert any real control over the operation being performed at a local level in France. Indeed, in as late as 1473 in Volx, Provence, a notarial document demonstrates that the highest local authority, the ‘baiulus’, was involved in a case of cutting open a dead woman’s womb.22 This account also indicates that the operation could not have been a routine practice at the time, at least in that area, as the civil authority needed to be contacted. With regard to the Italian peninsula, in 1559, almost a century after the events in Volx, the men in Violante Carafa’s noble family rejected outright a Capuchin friar’s pressing request to disparare, which meant performing the sectio in mortua on Violante, who had been killed by her husband on suspicion of adultery while six months pregnant.23 Conversely, 17 years later in 1576, the womb of Francesca Caetani, another noblewoman killed by her husband for the same reason while seven months pregnant, was swiftly cut open by a midwife.24 The aim was clearly to save the soul of the foetus through baptism. As Ottavia Niccoli points out, the time gap between the episodes involving Violante Carafa and Francesca Caetani was crucial in terms of the sectio in mortua becoming accepted at all levels; it was finally added to the norms of the Catholic Church by Pope Paul V in 1614.25 The increased deployment of the operation was undoubtedly influenced by the increasingly lively Church debate about baptism, the salvation of the soul, and the afterlife places—particularly the limbo of infants, reserved for unbaptised dead babies—at the Council of Florence (1439–45), which reached its apex at the Council of Trent (1545–63).26 The period provides various Italian references to the sectio in diary sources or city chronicles. For example, in the Diario di ser Tommaso di Silvestro, we read in the year 1494: ‘The wife of Passarotto died. She died in childbirth, could not deliver and bore the heir within her. As soon as she died, her belly was incised and inside was the dead heir.’27 In his 1550 Cronaca Modenese, Tommasino de’ Bianchi wrote about a fellow citizen who ‘fell in the street and died at the end of her pregnancy. Immediately her belly was cut open and the creature was discovered to be full of fractures but not dead, and it was baptised.’28 Later, in 1584, Orazio Lombardelli (from Siena) wrote: ‘my wife died with a child in her womb. He was extracted with a cut in order to take him to his baptism.’29 Despite the definite increase in the practice of the sectio in the early modern period, it does not seem to have been fully accepted or become part of normal routine even after Paul V’s intervention. Indeed, in as late as the second half of the eighteenth century, Friar Minor Diodato (or Deodato or Adeodato) of Cuneo regretted the fact that the operation tended to be avoided in his comprehensive work largely dedicated to the subject, a synthesis of religious thinking at the time that also featured quotations from medical and legal texts.30 He even included letters of excommunication sent by Italian bishops to those who had shirked the duty. He reported the episode of a woman who bravely begged the women in attendance to cut open her womb for a caesarean section while she was in labour. Her husband not only forbade the operation but also subsequently opposed a sectio in mortua after the woman had died, even though ‘the movement of the unborn child could be seen on the surface of her belly’.31 The Medical Aspect and the Performers of the Sectio in Mortua The significant aspect of Diodato’s account is that it was the midwives who were ready to cut open the woman.32 In another passage he duly specifies that they are the most suitable professionals to perform a sectio after surgeons and barbers; as we have seen, even in the late sixteenth century a midwife cut open the unfortunate Francesca Caetani. This shows that although surgeons and barbers feature as the main performers of the operation in various late medieval and early modern sources, midwives certainly cannot be excluded with regard to the period as they are still found at a much later date, when medical men and surgeons undoubtedly played a more dominant role in obstetric and gynaecological procedures. Unfortunately, many of the aforementioned sources referring to the early modern period provide no useful information about which professional figure performed the operation. With reference to the methods used to perform the sectio, the first informative sources are synodal statutes, including those from Nîmes in 125233 or Cahors and Rodéz in 1289, which stated ‘if the midwives deem the foetus to be alive, immediately after the woman’s decease a piece of wood must be put in her mouth so the foetus may breathe. Let the dead woman be cut open’.34 The need for the mother’s mouth to be open so that the foetus could ‘breathe’ was familiar in a number of cultural contexts, starting from the first medical text that refers to the sectio in mortua, namely Bernard of Gordon’s Lilium medicine (1305).35 In his 1363 treatise on surgery, Guy de Chauliac associates it with the simultaneous opening of the vagina in light of the practical experience of women assisting with childbirth: ‘… tenendo mulieri os et matricem apertam, ut volunt mulieres, aperiatur mulier’.36 The author therefore seems to be stating that physicians adopted and theoretically reworked a practice that originally belonged to the cultural knowledge of mulieres or midwives through the exchange of expertise between medical practitioners at different levels.37 It is not until Ambroise Paré (1510–90) that the worthlessness of the procedure in terms of helping the foetus to breathe was actually noted.38 Regarding the need for the mouth of the vagina (os matricis) to be open, let us see how it is cited in Lilium medicine. If we go by some printed versions of the text, Bernard does not seem to consider opening the woman’s mouth, but mentions the os matricis twice almost in succession.39 However, in a number of manuscripts one of the two references is changed from os matricis to os matris (mouth of the mother) and, given the similarity between the two terms (matris and matricis), it is reasonable to think that the printed texts may be incorrect, particularly since the later work by Guy de Chauliac mentions the need to open both orifices.40 We should note though that the text of the Sermones medicinales by the physician Falcuccius Nicolaus (†1411?), in which Bernard’s work is transcribed almost verbatim and is mentioned explicitly by the author (‘Dixit Gordo’), also features the version that mentions the os matricis twice.41 This makes it difficult to understand the correct form of Bernard’s text and whether he was really referring to opening both orifices or just the vagina. The fact is, however, that none of the physicians in question mention direct involvement in the procedure. While Bernard notes the necessary steps to guarantee the child’s breathing, Guy mentions the need to cut open the woman’s womb on the left-hand side as it does not contain the liver.42 Besides providing very little description, they both justify the operation through its supposed historical and mythological origin. Bernard simply writes that Caesar was the first to be extracted from a dead mother’s womb in this way.43 Guy, meanwhile, underlines that justification for the sectio comes from the tale of Roman deeds (‘ut in gestis legitur Romanorum’) and above all because the Lex Regia banned a woman from being buried before the extraction of the foetus (‘vetat lex regia mulierem pregnantem non humari quousque fetus exiverit’).44 These are clear references to medieval literature about Caesar and Justinian’s Digest. An analysis of medical texts between the fourteenth and sixteenth centuries shows that the sectio in mortua was not widely cited by scholarly physicians in their works. In many cases, the authors who include sections on the operation mostly just adapt the citations from Bernard or Guy, including the mythological references. The same is true for Falcuccius Nicolaus who, as mentioned above, reports Bernard’s text verbatim in his fifteenth-century Sermones medicinales, as does Alessandro Benedetti (†1512).45 Pietro d’Argellata (†1423) is more original and although he transcribes passages by Guy de Chauliac, including the myth, he seems to hint at first-hand experience, albeit with sketchy generic descriptions.46 A much more credible account is provided by Berengario da Carpi (†1550), differing significantly from the content of other medical texts. Here, the sectio is merely an addition to the main narrative about his experience of dissecting a female body, which led him to discover an abscess in the womb and an extrauterine pregnancy. He is not interested in describing how the sectio should be carried out (nor does he mention the usual mythological references), but he is the only author who provides us with a first-hand account, including a note on the baptism of the extracted foetus—a detail absent from other medical texts. Berengario writes that before incising the abdomen he was sure about ‘finding two foetuses who, if not completely alive, could be sufficiently so to be baptised’. He actually only found one foetus that he describes as ‘half-alive’ (‘inveni unum foetum semivivum’) and handed him to the women of the house to be baptised.47 Unfortunately, he does not specify the characteristic signs of being ‘half-alive’, which was deemed sufficient to receive the sacrament. It is worth noting that there are no references to the sectio in mortua by Michele Savonarola (1385–1468), a physician who not only dealt extensively with gynaecology and obstetrics in Practica maior, but also wrote a treatise in the vernacular on the women and midwives of Ferrara.48 Neither did the Florentine physician Antonio Benivieni (1443–1502), although he showed great interest in anatomy and described several cases of obstetric-gynaecological operations.49 The work deserves a special mention for a somewhat bizarre and macabre anecdote reported by the author: ‘What should appear even more incredible is that while the dead wife of a certain Francesco was being taken to her burial, unexpectedly a child slipped out of her womb and with a wail forced the procession with the coffin to come to a halt, as the organisers of the funeral had thought the boy to be dead together with his mother’.50 Such an account could easily have set the stage for a description of the sectio in mortua operation, but it is not mentioned anywhere in the work. In later years, it is interesting to note that although La comare o ricoglitrice—a work on midwives by the physician Scipio Mercurius (1540/50–1615?)—contains a substantial section on caesarean section on live mothers, an operation which was starting to be debated at the time, little is said regarding the operation on dead mothers apart from the fact that it allowed Scipio Africanus to be born.51 The somewhat meagre interest in the subject shown by the authors of texts is probably related to the fact that, as the sources reveal, it was mostly the so-called ‘low level practitioners’ (surgeons, barbers, midwives) who performed the sectio.52 I use the expression with extreme caution as although these professionals were not part of the university environment, they were steeped in orally transmitted knowledge and had to achieve extremely high levels of professionalism at a practical level. The problem is that the vast majority of the information we have about their work comes from indirect sources, such as the case of the surgeon cited by the jurist Bartolomeo Cepolla, which is discussed below. The Legal Aspect Many of the surviving late medieval sources that document cases of the sectio being performed are related to issues of inheritance. It is known, for example, that the chain of inheritance was interrupted if the child showed even the slightest sign of life upon extraction from the womb, as the mother’s property would be inherited first by the baby and then by the father (the deceased’s husband) without being returned to the woman’s family of origin. Therefore, in order to understand the sectio in mortua in the Middle Ages and antiquity, the operation needs to be contextualised in the framework of jurisprudence, especially as many fifteenth-century legal sources highlight some relevant discussions and theories, starting from the text of the Digest.53 The descriptions of specific cases in consilia are of great interest, where jurists described their first-hand experiences of being summoned, sometimes by the town authorities, to settle post-sectio disputes. Somewhat predictably, the first issue they had to resolve was to judge the state of the baby—dead or alive—immediately after its extraction from the mother’s womb. This question is addressed, for example, in a short consilium (1388–89) by the jurist Baldus de Ubaldis of Perugia (†1400), although he reached his judgement easily as the child emitted a wail before dying (‘vocem emisit et immediate decessit’): the emission of sound was always seen as a sure sign of life.54 A case of sectio is also mentioned by Baldus’s son Francesco, another jurist, in reference to the years 1390–97.55 However, just like his father, he provides no information about who performed the operation. The consilium transcribed by the jurist Bartolomeo Cepolla (or Cipolla, 1420–75) stands out for its length and structure, although it is equally significant in terms of understanding the synergy between the religious aspect (the baptism of the baby), the medical-surgical aspect (the action and role of the performer of the operation) and the legal aspect.56 The considerable number of witnesses (over ten) to the operation—many of whom were not related to the deceased woman and who were questioned by the jurist—may indicate that it was seen as an event of special importance in the community.57 At the same time, it was also in the interest of the contending parties to summon as many people as possible to support their cause. It is plausible that more people witnessed such an event when there were inheritance disputes rather than when the operation was performed solely for the purpose of baptism. Cepolla was called in as a consultant by the Podestà of Noale (Anovalis) in the Veneto region as a daughter had been extracted from the open womb of Caterina, dominus Dominicus’s dead wife, which led to a conflict over inheritance between the baby’s father and maternal grandmother. In order to settle the quarrel, the jurist had to try and understand whether the child had shown any sign of life. To this end, he listened to the testimonies of all those who had been present during the sectio and seen the baby as soon as she had been taken out of the womb. Somewhat predictably, the witnesses were grouped into two opposing sides. The first and biggest group, who maintained that the baby was stillborn, included the mother of the deceased, several women—probably those who had helped with the delivery—and the priest, who stated that the extracted baby was ‘terribly pale and this paleness was the sign of death rather than life. She also had her eyes and mouth closed. At first sight they appeared to be signs of death.’58 Other witnesses in the same group also stated that they had seen no sign of life in the baby, claiming further proof in the fact that no blood came out of a small incision made in her forehead by the surgeon, magister Fixolus.59 It is not clear whether this cut was made accidentally, perhaps during the sectio, or deliberately to ascertain whether the baby was alive. However, the absence of blood did not stop the surgeon from siding with the other group who claimed that the baby had shown signs of life. Given the importance of the surgical aspect of the sectio, one would expect Cepolla to have given more consideration to the magister’s opinion than to the views of other witnesses and to have shown interest in the operation procedure. After all, the role of surgeons as experts summoned by local authorities to settle criminal matters (by determining the relative deadliness of a wound for example) was long-established by then, particularly in Italian cities.60 In their treatises, jurists specifically recommended using the advice of healing professionals such as physicians, surgeons and midwives.61 However, generally speaking, any testimony regarding the determination of death—and the normal recognition of the related signs—could be legally valid as it was enough to appeal to common universally shared knowledge and experts did not necessarily need to be involved.62 Indeed, in Cipolla’s consilium the surgeon does not make any statement to highlight his professional experience. Furthermore, the magister is stripped of any authority and even described as a suspectus (suspect) witness, because he is found to have signed a contract only entitling him to remuneration in the event of a live baby being extracted from the mother’s womb.63 The same payment system regulated the structure of healing agreements between patients and professional healers, described in detail for the early modern period by Gianna Pomata, with medical practitioners only receiving a fee in the event of success.64 The surgeon’s reference to general movement by the baby is further questioned by Cepolla when he explains how it should not be seen as a significant detail as it may have been caused by ‘ventositate’ (wind) within the body, which can also occur after death. This statement is based, as he duly notes, on a passage from the Liber testimoniorum by the jurist Bartolo da Sassoferrato (†1357) that specifically discussed what should be deemed signs of life in an extracted foetus when witnesses offered different opinions.65 Bartolo felt that general movements should not be seen as such as they could be induced by ‘ventositatibus’; witnesses therefore needed to be more precise in their indications, for example by specifying which part of the body the baby had moved and how.66 This is precisely what the witnesses in the magister’s group did, stating that they had seen specific movements, such as in the mouth and tongue, and also mentioning that blood came out of the baby’s nostrils. However, Cepolla does not consider this a definite sign of life as it is not deemed thus by those he calls ‘philosopher experts’ (‘peritissimi philosophi’).67 The text clearly shows how signs were seen and interpreted in a completely subjective way by the various parties involved in the legal dispute. There is no discord between the two groups, however, with regard to baptism, which is seemingly administered without any discussion even though the presbiter is in the group claiming that the baby was dead. None of the witnesses notice this contradiction. It is magister Fixolus who ‘holds the baby for baptism’ (which probably means that he is the godfather), while a few lines above Cepolla specifies that ‘Friar Petrus de Pentromulo testifies that the baby was alive as it changed colour after the baptism’.68 The friar might even have baptised the baby himself, but in any case the act is not questioned by the presbiter. It is almost as if all disharmony ceased when the baby’s soul needed to be saved and all those present tacitly agreed on the evidence that the baby was alive. To this end, it is interesting to note that during a later dispute in 1620 similar to the one recounted by Cepolla, the husband of the incised woman had the baby baptised immediately after extraction, using the sacrament to prove that the baby had come out alive.69 However, when the child was then proclaimed dead after a dispute between ‘the midwife, the surgeon, the physician, and those present’ (‘la Balia, il Cerusico e il Medico e gli astanti’), the priest did not bury him in consecrated land and a ‘bitter fight’ ensued. In this case it seems that a layperson (perhaps the midwife) performed the baptism, which was not approved by the priest as he was absent when the baby was extracted. It is feasible that the priest and most of those present were sure that the baby was dead on account of the fact, specified in the document, that the woman was eight months pregnant, a period deemed to be incompatible with childbirth in a well-known astrological theory of hermetic-Arab origin.70 In general, however, we should not be surprised at the more conciliatory attitude towards evaluating signs of life in a baby for the purpose of baptism. This should be viewed in tandem with the spread of sanctuaires à répit, shrines that were active from the late Middle Ages well into the modern age where dead babies were frequently taken, sometimes even after being exhumed, to obtain momentary resurrection and enable baptism.71 The signs of life were also extremely vague in these cases, so much so that during the seventeenth century many cases of violations, also involving priests, were denounced in the inquisitorial courts.72 If we compare Cipolla’s consilium with a slightly earlier hagiographic source, the collection of miracula by Philippe de Chantemilan, which features accounts of many miracles à répit as his remains were held in a specialised sanctuary, most descriptions of the signs proving that the baby was alive tend to coincide.73 Such signs are also eagerly sought-after in the accounts of miracles by a large number of people gathered around the little body placed before the saint’s remains for this very purpose. However, on these occasions they are unquestioningly and unanimously accepted because the only aim is to confirm the miracle and proceed with the baptism of the baby. More generally, it is not unfeasible that unequivocally dead babies were also baptised even though this practice was strictly forbidden. Such testimonies sometimes managed to evade the Church’s strict control filter and were included in hagiographic texts, as was the case with one of Louis of Toulouse’s miracles that features in the dossier of his canonisation process (1308). Here, after emerging lifeless from the womb, the baby was carried into church and baptised as normal, only coming back to life after the administration of the sacrament.74 Early modern sources also suggest that the problem of extracting babies from the open womb for baptism could be solved using the conjectural words ‘I baptise you if you are alive’, meaning that the sacrament was only considered valid if the baby was not dead.75 The formula is the result of discussions about the duty to baptise all miscarried foetuses, culminating in the work of Girolamo Fiorentini, a priest from Lucca (1602–78).76 There does not seem to have been a comparable formula in the Middle Ages, only a conjectural formula for conditional baptism regarding repetition of the sacrament when it was uncertain whether it had previously been received or administered using the correct wording.77 Returning to Cepolla’s consilium, the jurist appears to show particular interest in the statement by an apothecary, who is keen to specify that the baby had shown significant signs of life by moving inside the mother until shortly before the latter’s death, as he was able to ascertain for himself by placing his hand on the woman’s abdomen.78 This leads the jurist to think that the baby could well have been alive when she was extracted, although he is even more convinced by the fact that she was in a condition where she ‘could live according to nature, because she was born at the time when the mother was supposed to give birth’.79 Basically, the mother had reached the right time to give birth; he confirms this by making explicit reference to the judgement of the physician Gentile da Foligno (‘Gentilis philosophus’). At the request of the jurist Cino da Pistoia, who consulted him on the subject of gestation and childbirth times, Gentile digressed into a detailed explanation focusing at length on the aforementioned astrological theory and the Hippocratic tradition, with special reference to the treatise on the eight-month-old foetus.80 Regarding the fact that the majority of witnesses agreed that the baby was dead, Bartolomeo writes that: ‘when questioned about the reasons for their declarations, the witnesses say that they did not notice any sign of life. This is possible. Nevertheless, others were able to see signs, though they were temporary.’81 To further endorse the verdict, he stresses that the well-known procedure of keeping the woman’s mouth open with a piece of wood was observed during the operation. The jurist does not appear to be remotely interested in asking whether the usual attempts were made by midwives to check the state of the baby with a view to a possible ‘resuscitation’, including procedures such as submerging the baby in warm water, placing salt, spices or garlic on their lips and trying to blow air into their nose or mouth (or even ears).82 As the consilium notes, it is not even a problem that the baby was extracted from her mother’s womb at least an hour after her death. Indeed, Bartolomeo observes that ‘we read about Caesar Augustus and many others who came out alive even though they were extracted from their mother’s womb several hours after her death’.83 Here too, as in medical texts, myths helped to prove that the sectio in mortua could be a successful operation. Conclusion Cepolla’s text is indubitably one of the richest sources of information on how the practice of sectio was experienced and understood in a community environment at the end of the Middle Ages. Questions of inheritance were certainly a determining factor in seeking the intervention, and this is why the texts of jurists become indispensable sources for any study of the subject. From Cepolla’s consilium we learn how discussion in a legal dispute was entirelycentred on whether the child on leaving its mother’s womb was alive or dead, and what signs could be taken as proof of life. A discussion that must have been limited, if not wholly absent, when the practice of sectio was solely for the purpose of baptism. For the jurist, contrary to what one might expect, testimony from the executor of the operation, an expert in medical matters, stood on the same plane as that of the other witnesses, or was indeed marginalised for economic reasons. This in spite of the growing importance of medical practitioners at all levels, figures called in as authorities in the various juridical cases. In evaluating the success of an intervention, the reasoning of practical medicine counted for less than that of jurisprudential theory, which in turn, as in the case of the letter to Cino from Pistoia, drew on philosophical-speculative type medical theories. This datum contrasts with the fact that it was precisely exponents of practical medicine who could claim real experience of the operation, since they were the ones who normally did it, as borne out by the sources. With a few exceptions, however, the learned physicians cite sectio peripherally and in a manner that is repetitive from one author to the next, without demonstrating any concrete involvement. Unfortunately the approach of practical medical operators is hard to fully evaluate since it emerges only sporadically and indirectly from the sources. This augments the problem of a point by point study of the practice of sectio, which should be carried out in a capillary manner on different territories. Above all, eye witness sources referring to the intervention are few, and sometimes the operators’ identities and methods are not clarified. From the sources acquired, although an increase in testimonies of sectio cases from the fifteenth to sixteenth centuries is demonstrable, it emerges that caution must prevail in speaking of the routine nature of the intervention, especially in view of episodes such as the Violante Carafa case, of the Church’s need to regulate it after the Council of Trent and, even in the eighteenth century, of the need for churchmen such as Diodato to urge both specialists and the common people towards implementation of sectio. Certainly, surgeons and barbers were increasingly called upon to perform the operation, but sources demonstrate that it is not possible to completely exclude midwives from practices in Italian cities since as early as the fifteenth to sixteenth centuries, nor to make a clear distinction of roles at the mother’s bedside. Not only does the case of Francesca Caetani contradict the assumption: the work of Diodato further demonstrates that as late as the eighteenth century midwives were active in performing sectio, and indeed considered eminently capable, albeit on a rung below the surgeons and barbers. Acknowledgements My sincerest thanks go to Professor Alessandro Pastore and Professor Mary Morse for reading the text and for their suggestions. Footnotes 1 There is evidence from the sixteenth century in the work of the French surgeon François Rousset, in 1581 (Traitté nouveau de l’Hystérotomotokie ou enfantement caesarien). See Nadia Maria Filippini, La nascita straordinaria. Tra madre e figlio la rivoluzione del taglio cesareo (sec. XVIII–XIX) (Milan: Franco Angeli, 1995). In terms of later centuries, although somewhat fictionalized, Paolo Mazzarello’s account is of undoubted interest, based on evidence from the archives of the San Matteo hospital in Pavia regarding the work of the surgeon and obstetrician Edoardo Porro and what can be described as the first successful caesarean operation to be scientifically documented in 1876, leading to innovative surgical methods. Paolo Mazzarello, E si salvò anche la madre. L’evento che rivoluzionò il parto cesareo (Turin: Bollati Boringhieri, 2015). 2 Although the expression sectio in mortua is improper as it never appears in medieval or early modern sources, I will use it in this article for convenience. 3 See Daniel Schäfer, Geburt aus dem Tod: Der Kaiserschnitt an Verstorbenen in der abendländischen Kultur (Stuttgart: Pressler, 1999); Steven Bednarski and Andrée Courtemanche, ‘“Sadly and with a Bitter Heart”: What the Caesarean Section Meant in the Middle Ages’, Florilegium, 2011, 28, 33–69. 4 Steven Bednarski and Andrée Courtemanche in order to interpret an unpublished notarian act connected to sectio in mortua wrote: ‘If, by the late fifteen century, the Church encouraged sectiones in mortua, and if surgeons performed the operation with increasing regularity, why go to the trouble of redacting a notarized act for a routine operation?’(‘Sadly and with a Bitter Heart’, 5). For the authors the sectio in mortua was a routine operation. 5 ‘Division of Labor: Gender, Power, and Later Medieval Childbirth, c. 1200–1500’, History Compass, 2016, 14, 383–96, at 385. 6 ‘The Death of Isabella Della Volpe: Four Eyewitness Accounts of a Postmortem Caesarean Section in 1545’, Bulletin of theHistoryofMedicine, 2008, 82,169–87, at 174. 7 Ibid., 174. 8 Katharine Park retraces the episode above all through documents (letters, diaries) related to upper-class women and a few medical treatises. She provides examples of the sectio in mortua such as the wife of Gaspare Nadi, a master mason from Bologna, and Francesca Pitti, wife of the Florentine banker Giovanni di Francesco Tornabuoni. A physician performed the operation in the former case in 1462, while there is no such information about the latter case in 1477. Park, ‘The Death of Isabella Della Volpe’, 169–87. 9 The progressive inclusion of sections dedicated to gynaecology and obstetrics by authors of medical texts led to the conclusion that male physicians or surgeons began to have increasing involvement in women’s issues and illnesses and mothers in labour from the fifteenth century onwards. See Monica Green, Making Women's Medicine Masculine. The Rise of Male Authority in Pre-Modern Gynaecology (Oxford: Oxford University Press, 2008). 10 E.g.: D. 11. 8. 2; D. 28. 2. 12 (Digesta Iustiniani Augusti, ed. Th. Mommsen (Berolini: Apud Weidmannos, 1870), I, 356; 821. 11 Danielle Gourevitch, ‘Chirurgie obstétricale dans le monde romain: césarienne et embryotomie’, in Véronique Dasen, ed., Naissance et petite enfance dans l'Antiquité (Fribourg: Vandenhoeck et Ruprecht, 2004), 240–45. 12 Plinius, Naturalis Historia, VII, 9, 47. Pliny tells of three characters extracted from their dead mothers’ wombs: Scipio Africanus, Caesar and the consul Manilius. 13 De Vita duodecim Caesarum libri VIII, I, XXI. 14 Isidore of Seville, Etymologiarum libri, IX, 3, 12. See note 181, p. 126 of the edition by Marc Reydellet, Étymologies (Paris: Les Belles Lettres, 1984). 15 See Catherine Crozy-Naquet, ‘Les Faits des Romains. Une fortune diverse’, Anabases, 2006, 4, 141–54. Many manuscripts were illustrated with the scene of Caesar’s birth. Renate Blumenfeld-Kosinski, Not of Woman Born. Representation of Caesarean Birth in Medieval and Renaissance Culture (Ithaca-New York: Cornell University Press, 1990). 16 ‘He was called Unborn because he came out of his dead mother’s womb, cut open’ (Acta Sanctorum, Aug., VI, 737). Unless otherwise indicated, translations are the author’s. 17 ‘si mater in partu moritur, incidatur, et infans vivus de ventre extrahatur et baptizetur’: Rationale divinorum officiorum, VI, 83, 33, ed. by A. Davril and T. M. Thibodeau, Corpus Christianorum continuatio mediaevalis, 140A (Turnhout: Brepols, 1998), 425. 18 Sacrorum conciliorum nova et amplissima collectio, ed. by Mansi, XXII, col. 681. For an excursus on the northern French synodal acts recounting the praxis of the sectio in mortua, see Kathryn A. Taglia, ‘Delivering a Christian Identity: Midwives in Northern French Synodal Legislation, c. 1200–1500’, in P. Biller and J. Ziegler, eds, Religion and Medicine in the Middle Ages (York: York Medieval Press, 2001), 77–90. 19 ‘Mulier si moriatur in partu, non debet poni in ecclesia, sed extra ecclesiam dicatur ei obsequium et postea sepeliatur in cimiterio, sed puer extrahatur de ventre eius et sepeliatur extra cimiterium’; Summa de ecclesiasticis officiis, 159, ed. by H. Douteil, Corpus Christianorum, continuatio mediaevalis, 41A (Turnhout: Brepols, 1976), 309. Author’s italics. 20 See sources mentioned by Ludwig Schmugge, ‘Im Kindbett gestorben: Ein kanonistisches Problem im Alltag des 15. Jahrhunderts’, in R. H. Hemholz, P. Mikat, J. Müller and M. Stolleis, eds, Grundlagen des Rechts. Festschrift für Peter Landau zum 65. Geburtstag (Paderborn: Schöningh, 2000), 467–76. While elaborating the norm, Guillaume Durand may have developed an interest in the sectio for practical reasons related to his role as a bishop. I am grateful to Timothy Thibodeau for his precious insights. On the taboo about the death of women in childbirth, see Maaike Van Der Lugt, ‘L’animation de l’embryon humain dans la pensée médiévale’, in L. Brisson, M.-H. Congourdeau and J.-L. Solère, eds., L’embryon: formation et animation. Antiquité grecque et latine, tradition hébraïque, chretienne et islamique (Paris: Libr. Phil. J. Vrin, 2008), 233–54, 250–2. More broadly, the appearance of a law and Church statute connected with graveyard spaces created stricter regulations for funeral practices and from the twelfth century onwards we find lists of excluded people. See Mathieu Vivans, ‘Christiana sepultura priventur. Privation de sépulture, distinction spatiale et inhumations atypiques à la lumière des pratiques funéraires (Xe–XIVe siècles)’, in I. Cartron, D. Castex, P. Georges, M. Vivas and M. Charageat, eds, De corps en corps. Traitement et devenir du cadavre (Pessac: Maison des Sciences de l’Homme d’Aquitaine, 2010), 193–214, 196. 21 ‘Si mulier mortua fuerit in partu, non negentur ei aliqua jura Christianitatis, sed in Ecclesia deferatur et in cimiterio tumuletur, nisi aliquid canonicum obstiterit; quare poenam non debemus ei convertere in culpam’; Summa Statutorum Synodalium … , ed. by J. Le Groux (Insulis: J.-B. Brovellio & c., 1726), 4. 22 The document was transcribed by Bednarski and Courtemanche, ‘Sadly and with Bitter Heart’, 53. See note 4 above. Independently of the interpretation of the sources given by the authors I maintain that the need to apply to the authority is proof of the difficulties involved in performing sectio. 23 Ottavia Niccoli, Rinascimento anticlericale. Infamia, propaganda e satira in Italia tra Quattro e Cinquecento (Rome-Bari: Laterza, 2005), 147. 24 Ibid., 154. 25 ‘Si mater praegnans mortua fuerit, fetus quamprimum caute extrahatur, ac si vivus fuerit, baptizetur: si fuerit mortuus, et baptizari non potuerit, in loco sacro sepeliri non debet’; Rituale Romanum Pauli V Pont. Max. (Paris: Apud Societatem Typographicam Librorum Officij Ecclesiast. Ex Decreto Concil. Tridentini, 1623), 11. For cases of sectio in mortua in the eighteenth–nineteenth centuries, see Paola Zocchi, ‘Nascita innaturale e parto cesareo: problemi e paure tra Sette e Ottocento’, in A. Menzione, ed., Specchio della popolazione. La percezione dei fatti e problemi demografici nel passato (Udine: Forum, 2003), 81–104; Adriano Prosperi, Dare l’anima. Storia di un infanticidio (Turin: Einaudi, 2005), note 105, p. 215. 26 On the importance of the debate about the limbo of infants during the time of the Council of Florence, see Prosperi, Dare l’anima, 175–217; Chiara Franceschini, ‘Dibattiti sul peccato originale e sul Limbo a Firenze (1439–1450)’, in A. Prosperi, ed., Salvezza delle anime disciplina dei corpi. Un seminario sulla storia del battesimo (Pisa: Edizioni della Normale, 2006), 215–54. With the decree of the Council of Florence of 4 February 1442, it was established for the first time that the ceremony of baptism should not be postponed, but should take place as soon as possible. See Silvano Cavazza, ‘La doppia morte: resurrezione e battesimo in un rito del Seicento’, Quaderni storici, 1982, 50, 551–82, at 567. English translation: ‘Double Death: resurrection and Baptism in a Seventeenth-Century Rite’, in E. Muir and G. Ruggiero, eds, History from Crime (Baltimore: The John Hopkins University Press, 1994). 27 ‘Morì la moglie di Passarotto … morì di parto, che non potette parturire, chè haviva l’arede in corpo morta; et da po’ che morì fu sparata, et fu trovata l’arede morta’; Diario di ser Tommaso di Silvestro notaro, ed. by Luigi Funi (Orvieto: Tip. Comunale di E. Tosini, undated), I, 24. Tommaso di Silvestro was the canon of Orvieto cathedral and a notary. 28 ‘… cascò in la strata et se amazò et era gravida da fare fioli e subito fu sparata e la creatura era tutta frachasata ma non era morta e fu batezata’; Cronaca modenese di Tommasino de’ Bianchi detto de’ Lancellotti, vol. X (Parma: Pietro Fiaccadori, 1878), 305. 29 ‘la mia consorte n'andò à meglior vita con un figliolino, che di lei s’hebbe co’l taglio per il battesimo …’; Orazio Lombardelli, Dell’uffizio della donna maritata (Florence: Giorgio Marescotti, 1584), 63. 30 Diodato da Cuneo, Notizie fisico-storico-morali conducenti alla salvezza De’Bambini Nonnati, Abortivi, e Projetti (Venice: Presso Niccolò Pezzana, 1760), 111–15. It is significant that Deodato dedicates several parts of the text to the sectio in mortua, showing genuine concern, as most of his interest—in keeping with other men of the Church such as Emanuele Cangiamila (Embriologia sacra)—is focused on performing the caesarean on live women, an issue that triggered much discussion at the time in medical and religious terms. 31 ‘… tuttochè si vedense dalla superficie del ventre a strepitar nel seno della defunta il nonnato Infante’: Notizie fisico-storico-morali, 97. 32 In this particular case they were prepared to perform a caesarean on the live mother. 33 For the 1252 Nîmes statutes see Les statuts synodaux du XIIIe siècle, II, Les statuts de 1230 à 1260, ed. Odette Pontal (Paris: CTHS, 1983), 281–3. 34 ‘si partum credunt vivere obstetrices apposito statim id est subito post mortem, baculo in ore mulieris, ut sic infans cito spiramen recipiat, aperiatur mulier mortu’; Statuta Synodalia Carducensis, Ruthenensis et Tutelensis ecclesiarum, in Thesaurus novus Anecdotorum, ed. by E. Marténe and U. Durand, IV (Paris, 1717), col. 686. 35 Accounts of allowing the foetus to breathe are also found in the narration of a miracle performed by Jeanne-Marie de Maillé (fifteenth century), where the saint placed a piece of wood between the dying mother’s teeth so that the foetus could still breathe (in the end, both mother and child were saved as a result of miraculous intervention). Acta Sanctorum., Mart. III, 760E. 36 Inventarium sive Chirurgia Magna, VI, 2, 7, ed. by M. R. McVaugh (Leiden, New York, Köln: Brill, 1997), 389. 37 I have reservations about Katharine Park’s suggestion that the passage represents a concession on the surgeon’s part to the women who normally assist the mother in labour, while still expressing scepticism towards the procedure (‘The Death of Isabella Della Volpe’, 173). 38 Les Oeuvres, XXIII, 38 (Paris: Chez Gabriel Buon, 1579), 885–6. Interestingly, in the work by Diodato da Cuneo the opening of the mother’s mouth is considered useless, but he recommends keeping the abdomen warm (Notizie fisico-storico-morali, 116). 39 ‘Secundo notandum, quod foetus potest vivere matre mortua existente … et potissime vivit quando os matricis manet apertum, ideo matre mortua, aliquod artificium debet fieri ut os matricis stet apertum …’; Practica Gordonii, Praxis omnibus medicine studiosis utilis consummatissimi artium et medicine … medicine lilium nuncupata …, (Venetiis: Mandato et expensis Luceantonii de Giunta, 1521), f. 89va. The same version is in the 1559 edition (Lugduni: Apud Gulielmum Rouillium), 638–9. Author’s italics. 40 On the change from os matricis to os matris, see, e.g. MS Paris, BnF, lat. 16189 (a. 1313–14), f. 116rb: ‘fetus attrahit aerem / attractum in arteriis matris et potissime vivit quando / os matricis remanet apertum et ideo matre mortua a / liquod artificium debet fieri ut os matris stet apertum’. See Renate Blumenfeld-Kosinski, Not of Woman Born. Representation of Caesarean Birth in Medieval and Renaissance Culture (Ithaca-New York: Cornell University Press, 1990), who refers to several different manuscripts with variations. 41 Falcuccius Nicolaus, Sermones medicinales septem, Sermo sextus de membris generationis (Venice: Bernardino de Tridino da Monferrato, 1491), f. 38vb. 42 ‘aperiatur mulier secundum longitudinem cum rasorio in latere sinistro’: Inventarium sive Chirurgia Magna, 389. 43 ‘ut dicitur, fuit primus Caesar extractus, ed inde ex illo habuit nomen’: Opus Lilium medicinae …, VII, 15 (ed. 1559), 639. 44 Inventarium sive Chirurgia Magna, 389. 45 Falcuccius Nicolaus, Sermones medicinales septem, f. 38v. When narrating the etiological myth, Falcuccius mentions Scipio Africanus rather than Caesar. He considers a passage by Solinus, a widely-appreciated third-century author who misinterpreted Pliny’s text and does not mention Caesar: ‘Dixit Solinus necatis matribus ortus auspicatior est sicut Scipio affricanus hic enim prior fuit qui defuncta matre exciso utero in diem venit primus romanorum cesar dictus’. See Solinus’s text: Collectanea rerum memorabilium, ed. by Th. Mommsen (Berlin: apud Weidmannos, 1895), 17. For Solinus’s passage, see comment within Robert Schilling’s edition of Pliny’s work, Histoire Naturelle, livre VII (Paris: Les Belles Lettres, 1977), 145–6. Alessandro de Benedetti, De re medica opus insigne et apprime medicinae candidatis omnibus utile, XXV, 25 (Basel: per Henricum Petri, 1549), 477. 46 Chirurgia Argelate cum Albucasi, V, 16, 6 (Venice: Luceantonij de Giunta Florentini 1520), f. 112rb: ‘Ego aliquando feci incisionem. … Et per istum modum extraxi puerum … et per hunc modum extractus fuit Julius Cesar, ut scribitur in Gesta Romanorum’. 47 ‘et ego aperui ventrem eius credens invenire duos foetus si non totaliter vivos ad minus taliter quod posset baptizari’; Commentaria cum amplissima additionibus super Anatomia Mundini (Bologna: Girolamo Benedetti, 1521), ff. 211v–212r. 48 Michele Savonarola, De regime pregnantium et noviter natorum usque ad septennium, ed. by Luigi Belloni (Milan: Società Italiana di Ostetricia e Ginecologia, 1952). In spite of the Latin title, the work is in the vernacular. See Gabriella Zuccolin, ‘Nascere in latino e in volgare. Tra la Practica Maior e il De regimine pregnantium’, in C. Crisciani and G. Zuccolin, eds, Michele Savonarola. Medicina e cultura di corte (Florence: SISMEL, 2011), 137–209. 49 Antonio Benivieni, De abditis nonnullis ac mirandis morborum et sanatiorum causis, ed. by G. Weber (Florence: Olschki, 1995). 50 Ibid., 194. 51 Scipione Mercurio, La comare o ricoglitrice, II, 28 (Venice: Appresso Gio. Battista Cioti, 1596), 76. This case also follows Solinus’s version. See note 45 above. 52 In addition to the cases cited in this article, see also the source cited by Monica Green regarding Marseille in 1331. In this case the operation involved a barber: Moving from Philology to Social History: The Circulation and Uses of Albucasis's Latin Surgery in the Middle Ages, in F. E. Glaze and B. K. Nance, eds, Between Text and Patient. The Medical Enterprise in Medieval and Early Modern Europe (Florence: SISMEL, 2011), 360–1. 53 On the legal experts involved in the discussion and the ways in which they were consulted, see Osvaldo Cavallar, ‘Septimo mense. Periti, medici e partorienti in Baldo degli Ubaldi’, in C. Frova, M. G. Nico Ottaviani and S. Zucchini, eds, VI centenario della morte di Baldo degli Ubaldi. 1400–2000 (Perugia: Università degli Studi, 2005), 365–460. 54 The text of the consilium is in the appendix to Julius Kirshner, ‘Baldus de Ubaldis on Disinheritance: Contexts, Controversies, Consilia’, Ius Commune, 2000, 27, 197–200. See also the 1390–97 consilium by the same jurist in the appendix to Cavallar, ‘Septimo mense’, 448–50. 55 Cavallar, ‘Septimo mense’, 448–50. 56 Bartolomeo Cepolla, Consilia ad diversas materias … (Venetiis: apud Bartholomaeum Rubinum, 1575), n. 50, ff. 186r–189v. 57 Zocchi, ‘Nascita innaturale e parto cesareo’, 84–6, notes that at the end of the eighteenth century in a small village in the Canton of Grisons the sectio operation still drew a large group of curious people to the woman’s house, even from neighbouring areas. 58 Bartolomeo Cepolla, Consilia, f. 186v: ‘erat illa puella vehementer pallida quando nata fuit, quae palliditas significare vero potius mortem quoddam vitam. Item quia tenebat oculos clausos, et os esset clausum … prima facie vero esse probatum dictam puellam potius natam fuisse mortuam quoddam vivam’. 59 Ibid., f. 186v: ‘nam si viva fuisset sanguis verisimiliter exivisset, ut de se patet’. 60 See Joël Chandelier and Marilyn Nicoud, ‘Entre droit et médecine: les origines de la médecine légale en Italie (XIIIe–XIVe siècles)’, in J. Chandelier and A. Robert, eds, Frontières des savoirs en Italie à l'époque des primières uniersités (XIIIe–XVe siècles) (Rome: École française de Rome, 2015), 233–93; Osvaldo Cavallar, ‘La “benefundata sapientia” dei periti: Feritori, feriti e medici nei commentari e consulti di Baldo degli Ubaldi’, Ius commune, 2000, 27, 215–81; Corinne Leveleux-Teixeira, ‘Savoir techniques et opinion commune: l’expertise dans la doctrine juridique médiévale (XIIIe–XVe siècle)’, in Experts et expertise au Moyen Âge. Consilium queritur a perito (Paris: Publications de la Sorbonne, 2012), 117–31. For the early modern period, see Alessandro Pastore, Il medico in tribunale. La perizia medica nella procedura penale d'antico regime (secoli XVI–XVIII) (Bellinzona: Casagrande, 1998). 61 See Cavallar, ‘La “benefundata sapientia” dei periti’. 62 See Leveleux-Teixeira, ‘Savoirs technique’, 121. On the topic of physical signs indicating death in the context of juridical discussion, see Cavallar, ‘Septimo mense’, 424–5. 63 Consilia, f. 186v. 64 Gianna Pomata, La promessa di guarigione. Malati e curatori di antico regime. Bologna XVI–XVII secolo (Rome-Bari: Laterza, 1994). English translation: Contracting a Cure: Patients, Healers, and the Law in Early Modern Bologna (Baltimore-London: The Johns Hopkins University Press, 1998). 65 Consilia, 187r. 66 Tractatus testimoniorum in Consilia, Quaestiones … tomus decimus (Venetiis, 1596): ‘Si testis dixit vivere, quia vidit eum moveri, non probat: nam in mortuo sepe visum est ventositates in corpore saepe motum facere. Dicat igitur testis quo motu, si tibias vel brachia extendere, vel actrahere vidit …’ Bartolo responds to the question about how to behave in the event of contrasting testimonies about whether or not the baby was alive after the delivery. See Cavallar, ‘Septimo mense’, 424–5. 67 Consilia, f. 187v: ‘Nam ex hoc arguitur, licet non necessario secundum quod a peritissimis philosophis intellexi, quod ipsa erat viva’. 68 Consilia, f. 187r. 69 Alberto Malvolti, Fucecchio e dintorni. Storie e microstorie tra Medioevo ed età Moderna (Vicopisano: Tipografia Monteserra, 2014), 82. The document comes from Memorie di Casa Galleni from Fucecchio, near Florence. The source is quoted also in Prosperi, Dare l’anima, note 105 p. 215. 70 The theory was based on the influence of the planets in each month of the gestation. The baby had a good chance of being born alive during the ninth, seventh and tenth months. No chance was given for the eighth month, dominated by the inauspicious influence of Saturn. For the philosophical origin of the astrological theory from antiquity onwards, see Charles S. F. Burnett, ‘The Planets and the Development of the Embryo’, in G. R. Dunstan, ed., The Human Embryo. Aristotle and the Arabic and European Traditions (Exeter: University of Exeter Press, 1990), 95–112. 71 See the example of an exhumation for year 1642 in a town in the Veneto region mentioned by Prosperi, Dare l’anima, 209. Adriano Prosperi refers to an extensive bibliography on this issue in French, Italian and German, in ibid., note 77 p. 205 and note 79 p. 206. 72 Cavazza, ‘La doppia morte’. 73 Vie et miracles de la bienheureuse Philippe de Chantemilan, ed. by Ulisse Chevalier (Valence: Picard 1894), 39–40; 44–5; 47; 49; 51–4; 57; 58; 62; 68; 69; 80–1; 83–6; 88. For instance, in these cases blood coming out of the nostrils was always considered a sign of life. On miracles à répit by Philippe de Chantemilan, see Pierrette Paravy, ‘Angoisse collective et miracles au seuil de la mort: résurrections et baptêmes d’enfants mort-nés en Dauphiné au XVème siècle’, in La mort au Moyen Âge (Strasbourg: Libraire Istra, 1977), 87–102. For a comparison of the ways in which the vitality of the baby was interpreted in miracles à répit and testimonies of the sectio in mortua, see A. Foscati, Venire alla luce e rinascere. Il cesareo da madre morta e il miracolo à répit nel tardo Medioevo, in A. Foscati, C. Gislon Dopfel and A. Parmeggiani, eds, Nascere. Il parto dalla tarda antichità all’età moderna (Bologna: Il Mulino, 2017), 95–114. 74 Processus Canonizationis et Legendae variae Sancti Ludovici O. F. M. Episcopi Tolosani, in Analecta Franciscana (Quaracchi-Florence: Ex Typographia Collegii S. Bonaventurae, VII, 1951), 128–9. Besides the dedicated sanctuaries, it should be noted that in saints’ dossiers miracles à répit are the most frequently considered childbirth miracles. See A. Foscati, ‘Retracing Childbirth Through Hagiographical Texts and Canonization Processes in Italy and France between the Thirteenth and Sixteenth Centuries’, in C. Gislon Dopfel, A. Foscati and C. Burnett, eds, Pregnancy and Childbirth from Late Antiquity to the Renaissance, (Turnhout: Brepols, forthcoming). 75 See Zocchi, ‘Nascita Innaturale’, 87; Diodato da Cuneo, Notizie fisico-storico-morali, 112; 211. 76 Disputatio de ministrando Baptismo humanis foetibus abortivorum … (Lugduni: apud Claudium Chancey, 1658). See Prosperi, Dare l’anima, 272–5. 77 ‘De quibus dubium est, an baptizati fuerint, baptizantur his verbis praemissis: Si baptizatus es, non te baptizo, sed si nondum baptizatus es, ego te baptizo’; Gregorii papae IX Compilationis Liber III, Titulus XLII, De Baptismo et eius effectu, chap. II, in Corpus Iuris Canonici, ed. by Aemilius Friedberg (Graz: Akademische Druck-D. Verlagsanstalt, 1959), II, col. 644. 78 Consilia, f. 187v. 79 Consilia, f. 189r. 80 Pseudo-Hippocrate, Du foetus de huit mois, edited and translated into French by R. Joly (Paris: Les Belles Lettres, 1970), 147–81. On the astrological theory, see note 70 above. Gentile da Foligno (†1348) wrote the letter-treatise (De temporibus partus or Super lege VII mense) in around 1326. See H. U. Kantorowicz, ‘Cino da Pistoia ed il primo trattato di medicina legale’, Archivio Storico Italiano, 1906, 37, 115–28. 81 Consilia, f. 187v. 82 These methods are found in the account of miracles à répit in several canonisation processes. See Foscati, ‘Retracing Childbirth’. Interestingly, hagiographic texts often reveal that there was no absolute certainty about death not even in the case of adults. Besides observations of the signs that appeared on the patient's body (pallor, rigidity, etc.), the process sometimes involved looking for further proof of death, as in the canonisation process of Clare of Montefalco, where boiling wax was poured on the patient’s face to observe whether there were any reactions. Il processo di canonizzazione di Chiara da Montefalco, ed. by Enrico Menestò (Scandicci: La nuova Italia, 1984), 319, 326. 83 Consilia, f. 188r: ‘legitur de Cesare Augusto et de multis aliis, qui de caeso ventre matris per plures ante horas defunctae vivi nati sunt’. © The Author(s) 2018. Published by Oxford University Press on behalf of the Society for the Social History of Medicine. This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/about_us/legal/notices)

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Social History of MedicineOxford University Press

Published: Apr 18, 2018

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