Hektoen International

A Journal of Medical Humanities

The midwives of San Gimignano, 1336

Mary A. Osborne
Chicago, Illinois, United States


Before the story line for Alchemy’s Daughter flew into my imagination, the idea of writing historical fiction had not occurred to me. I had penned a number of short stories, often inspired by my experiences as a home care nurse, and two semiautobiographical novels that no publisher wanted. As I was struggling to find my “voice,” I became fascinated with the mystical subject of alchemy—the medieval science of turning lead into gold. Before long I wrote a scene about a young midwife who lived in medieval Italy, worked with herbs, and discovered a book filled with alchemical secrets. As I envisioned the life of this character, The Alchemy Series took root in my imagination. A springtime trip to Florence and a visit to the Certaldo home of Giovanni Boccaccio—the medieval author of The Decameron—brought the heroine of Alchemy’s Daughter fully alive for me. In Boccaccio’s walled Italian village, the story sprung from the ancient cobbled streets and into my listening ears.

An excerpt from Alchemy’s Daughter

Upon returning to the hilltop cottage beyond the village wall, Santina was commanded to explain everything that happened, from start to finish, at Dianora’s house.

“There was more than the usual bloody show,” Santina began, thinking to withhold nothing from the older midwife. She described how she had given the shepherd’s purse to stop the bleeding, broken the bag of waters, and moved Dianora from the birthing chair to the floor when she understood the baby was a footling breech. Tearfully, she told of the expectant woman’s suffering and the recurring bleeding that convinced her to send for help at last. When all had been told, Santina waited fearfully to hear what the mistress would say.

A sharp scolding would have been easier to accept than Trotula’s show of disappointment. “You might have known to call for help at once,” Trotula said finally. “You waited too long. And to try to deliver a breech on your own?”

“We delivered several breech babies easily enough before.”

San Gimignano, Italy

“Not a footling breech. Furthermore, she was bleeding when you arrived. That’s when you ought to have sent for me,” Trotula said. “These skills take years to acquire, Santina. You’re still an apprentice, and you will be one for some time. Pazienza. You must have patience.”

“What should I have done differently? Is it my fault the baby died?”

Trotula, sipping her nettle tea before the hearth, did not answer at once. “I’m not sure you did anything wrong at all, Santina,” she finally admitted. “Sometimes it can’t be helped.”

Although Santina understood this to be true, she wanted to believe that with her care, every mother and baby in San Gimignano would be safe. She had become a midwife to bring forth life, to acquire skills to alleviate suffering, to be like Asclepius, who cheated Hades out of dead souls by healing his patients so well that they would not die. But she was not Asclepius. She had encountered the limits of her very human hands.

That night she dreamt of vermilion red blood, wet, sticky, and flowing over Dianora. Then the figure was no longer Dianora, but her mama. Lined up in a row on the floor of the room were ten or twelve dead babies—she had not arrived in time to save them. She saw that her brother, Pietro, was among them. She was on her knees, washing the babies and wrapping them in clean, dry clothes. Dianora stood over her, accusingly, with dark, sunken, unforgiving eyes. Santina ran fleeing from the room of her dream.


The following morning she awoke to the sound of Trotula’s clattering at the stone sink. Santina washed and dressed but had little appetite for the warm bread sitting on the table. Her thoughts were of her painful failure, the baby’s death.

Stirring the cauldron over the hob, Trotula observed Santina. “You cannot blame yourself every time a life is lost,” she said. “There will always be mothers and babies who die despite our best efforts. You must accept this. You must also know when to ask for help.”

Santina was well aware of her mistake. She also knew that mothers and babies died even under Trotula’s watch. Her own mother was among Trotula’s losses. “Mama couldn’t be saved,” she remembered.

Santina had pressed Trotula about the events of that day on more than one occasion, but Trotula response always drifted to vagueness. “It couldn’t have been easy for you.”

“No. It was not,” Trotula admitted.

“What went wrong?” Santina asked. “Why couldn’t you save my mother and Pietro?”

The look of sadness on Trotula’s face almost made Santina wish she hadn’t asked. “Your mama started losing blood, just like Dianora. The baby’s shoulder was caught under your mama’s bone and I couldn’t free him,” she said. “A caesarean operation might have been done, but Master Traverseri was afraid of it—he’d never seen one. And he would’ve called the barber surgeon before he let me near her. Your Papa had faith in the doctor’s opinion. Master Traverseri tried himself to yank Pietro out. His efforts only made your Mama suffer worse,” she said, studying Santina’s response. “Then it was too late. Your Mama bled to death, and Pietro never breathed.”

Santina could still envision Mama lying in her bed, pale and unmoving after Master Traverseri and Trotula left the room that night so many years ago. Papa never spoke of what happened. Now she wondered if Papa had put his confidence in the wrong person. What if Trotula could have saved Mama?

While Papa would not easily admit he made a mistake in calling for Master Traverseri, it was now clear to Santina that Trotula might have saved Mama if the doctor had not interfered. “Have you cut through a womb before?” she asked.

“Old Ninetta taught me. Sometimes you have to take a baby that way. But only when the mother is gone. When the mother’s death is certain, than you can do the surgery. The problem is, the baby’s chance of surviving isn’t good by that time,” she explained. Under her breath she added, “In a rare case it’s done earlier.”

“Have you ever seen both mother and baby survive it?” Santina asked, astonished.

“Enough questions,” Trotula said, impatiently.

Santina had already heard what she wanted to know. If Trotula had been allowed to exercise her skills, two lives might have been saved.

“They might have lived,” Santina said, struggling to keep her voice even. “It was Master Traverseri’s fault. He wouldn’t let you do the operation.”

“No, that’s not what I said,” Trotula chided her. “You can’t second guess what might have been done after the fact. Master Traverseri gave the advice he thought best. He wanted to help your mama. Believe me. He took the loss very hard.”

Santina was not satisfied. It was apparent that Mama’s death was the result of something more than bad luck. “Why did Papa listen to Master Traverseri instead of you, Trotula? You could have saved them.”

Trotula was unyielding as she went about setting Santina straight. “I want you to understand one thing: It’s never been my responsibility to decide who lives and who dies. It will never be your responsibility either. That’s entirely up to God,” she insisted. “Anyone who imagines otherwise thinks too much of herself. You and I are not the ones who bring about the cures, Santina.”

The young midwife tried to bite her tongue, but she could not entirely agree. She believed they could, in fact, save lives. There had been a number of instances when Trotula had surely altered the course of fate. “But you have brought about cures. Like when you healed Carravagio’s leg. And the twins might not have lived if you weren’t there to deliver them.”

“There are miracles all right,” Trotula replied. “I’ve seen a few of them. But they don’t come from anything we do,” she said. “Don’t confuse your actions with the power of God.” Trotula stood before the stained glass window that scattered a rainbow of colors across the room. “This window was made by a man who is long dead now. It’s not the glass that makes the light dance like jewels. It’s the sun,” she explained. “You and I are the windows. We are not the sun.”

Rising from the table, Trotula announced her plan to visit her friend, Sister Anna, at the convent. Left alone, Santina was still not convinced by Trotula’s argument. With her own eyes she had witnessed the power of Trotula’s medicine. The midwife worked with brews and poultices the way a sculptor worked with the chisel. As the slip of the chisel cracked the marble, so would an error in judgment hurt the patient. Santina could not shake the notion that Mama might be alive if Master Traverseri had not interfered.

During the days that followed, Santina kept wondering how it was possible to cut a baby from a womb. Not on a dead woman, on a live one. If she could master this skill, then scarcely a mother or baby would be lost under her watch.

“Will you tell me how it’s done, Trotula?” Santina dared to ask one day.

“Perhaps in time.”

“What if it has to be done to save the mother?”

“The procedure poses great risk. Both mother and baby are likely to die,” Trotula reminded her. “We can only do it when the mother’s death is certain, Santina.”

Yet Trotula had once admitted that such operations had been done on live patients as well as dead ones. Santina wanted to push Trotula further on the subject but did not dare. Instead, she secretly read Trotula’s Islamic textbook, the illustrated work by Abu al-Qasim al-Zahrawi, translated into Latin. With rapt attention she read of many wondrous procedures, unknown surgical instruments, powerful anesthetics, and the precautions in cleanliness that must be taken.

She pored over Trotula’s treasured copy of Galen’s Opera Omnia, trying to understand the hidden mysteries of the female form. When she felt she had a grasp of what she had read, she dared to broach the subject with Trotula once again.

“Abu al-Qasim says that both the mother and child have a better chance of surviving if the surgeon doesn’t wait too long. I know it’s a dangerous procedure, Trotula. But it’s a matter of how and when it’s done. Will you teach me?”

Trotula did not bother to look up from the slim volume of Dante she was reading by torchlight. “If the time comes, Santina. It can’t be planned.”

Santina suspected her mentor was developing a degree of complacency in her old age. This aspect of Trotula could very well prevent Santina from learning everything she needed to learn—in particular, the surgery that might have saved Mama and Pietro.

After Trotula retired to her room for the evening, Santina pounded flax seeds with a mortar and pestle at the worktable. She extracted the oil all the while considering the possibility of finding a barber surgeon who could teach her what she wanted to know. Midwifery, like medicine, was a science, with techniques to be learned and followed. The secrets of nature and the ways of God were being revealed more and more each day through wondrous human inventions. She knew that the learned men from the University in Salerno were able to perform a great number of astonishing procedures. She had heard of a doctor in Florence who could remove cataracts with a silver needle and mend a battle-torn face with a graft of skin from the arm. For every ailment, there was a solution.

With so much scientific knowledge to be had, it seemed unreasonable that she could give a woman dying in childbirth nothing more than herbs and a prayer. Santina continued to pound the flax seeds. Later, she would mix them with mullein, coltsfoot, and licorice for the little girl with the persistent cough. She did not hear Trotula’s footsteps moving closer to the kitchen.

“Didn’t you hear me?” demanded Trotula, looking none too pleased.

“I’m sorry, Trotula, but I thought to finish this for tomorrow,” Santina answered, though she was not really sorry at all.

“For heaven’s sake, Santina, the noise could wake the dead. This is no time to be making remedies. Now get to bed,” the midwife said, allowing no further comment.

It was Trotula’s house and it always would be Trotula’s house, Santina realized with no minor annoyance. She was the apprentice and Trotula was mistress, just as Papa was master back home. She strained the flax seed oil through a piece of linen and considered her station in life. This was the place where Trotula preferred to keep her. Very well. If Trotula would have her remain in ignorance, then Santina would find another way to learn how to cut through a womb.

MARY A. OSBORNE, BSN, RN, is an author and registered nurse living in Chicago. She is an RN Care Manager with the eldercare company SeniorBridge. Her Renaissance historical, Nonna’s Book of Mysteries, has won numerous festival awards, a ForeWord Reviews Book of the Year Award, and a nomination from the American Library Association. To learn more about her novel, Alchemy’s Daughter, The Alchemy Series, and her Off the Grid Authors and Artists blog, visit www.maryaosborne.com.

Highlighted in Frontispiece Volume 4, Issue 4 – Fall 2012

Fall 2012



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