Művelődés-, Tudomány- és Orvostörténeti Kiadó
Folyóirat: 2018/16
Cím: Visual History of Childhood– Medical History Aspects

Title: Gyermekkortörténeti ikonográfia – orvostörténeti vonatkozások
Szerző(k): dr. Endrődy-Nagy, Orsolya, PhD - Eötvös Loránd Tudományegyetem, Tanító- és Óvóképző Kar, Neveléstudományi Tanszék
Rovat: A középkori medicinától a romantikus medicináig
Kötet: 2018/16
DOI: 10.17107/KH.2018.16.28-38
új fejezet, Ψ-tudomány, az emberi psziché és viselkedés, inter- és multidiszciplináris
new heading, Ψ-science, human psyche and behaviour, inter- és multidiszliplinary

Interdisciplinary research is always a challenge, especially when done in a historical perspective. Present research is born on the boundary of childhood studies and visual theories. The study aims to define trends in the attitude towards children through an in-depth examination of a well-defined period of cultural history, the decades between the first print of the 42-line Gutenberg Bible in 1455 and Luther’s declaration of his “95 Theses”, through the analysis of visuals present in works of medical history among others. A significant part of the work involves cataloguing and analysing the available documents, then, comparing these to the written works of the given period, it may modulate, reformulate the trends in the perception of children.[1]Present article aims to convey the customs relevant to medical sciences, bearing in mind the holistic approach.

[1] The research was published in “A reneszánsz gyermekképe” by Eötvös Kiadó in 2015. (Endrődy-Nagy 2015)

1.     Conceptual Framework

As previous research in the field of education studies has been essentially textual, examination of images is a legitimate expectation. The historical anthropological approach is best supported by a microhistorical and qualitative research method (Sebők2000: 8). The research encompasses the qualitative analysis of images that were created using various techniques. The images are important in what they reveal about educational/parenting situations, breaking the silence around the specific character of educational customs and child-rearing practices, as they seek to contain an educational message (Depaepe-Henkens2000: 15). In accord with Depaepe, present research explores educational messages in visual documents of the Renaissance era. Every image contains coded, complex meanings. These meanings may be understood through in-depth analyses, especially when focusing on the ones that may be relevant to childhood studies. Visual communication theorists Kress and Leuween disclose that social relations are encoded in pictures (Kress–Leuween2006). It is a popular notion that the creator and the audience have fundamentally different approaches. While the creator plays and active role, the audience’s status is passive as a receiver. Expression (articulation) and interpretation lead to a face to face interaction in respect to the social meaning, the position in space places the participants in different situations (Kress–Leuween 2006: 116). Images have the potential to provide information that cannot be coded in any other way (Nyíri2009).

1.1.  Education Studies

The study is based on childhood research, which seeks to explore the conception of childhood and the perception of children of a given period through the interpretation of certain possible narratives.

It may give new directions to early childhood research if more scientific disciplines get included in the research. Previous interdisciplinary research in education studies is primarily related to the fields of philosophy and cultural history. Closer co-operation with art historians, medical history researchers, as well as archeologists and linguists may be important for a more thorough understanding of the perception of childhood in various periods. Researchers suggesting the application of multiple perspectives for the first time (Kéri, 2014; Kereszty, 2014) have taken important steps by defining possible new research paths, thus inspiring and legitimating efforts in this direction.

1.2.  Picture Theory

According to Horányi (1982), the meaning of a picture is dependent on convention, and it is a matter of constitution what makes a picture a picture. Gadamer (1971) points out that pictures and buildings can be read, according to Thomka (1998), first we just try to decipher the letters, then we read them fluently. In “Forgotten Picture Theories” (“Elfelejtett képelméletek”), Kristóf Nyíri (2016) notes that the difficulty lies in the lack of consensus regarding cornerstones, and that people tend to forget about certain theories. In an earlier work of his (2009) Nyíri talks about the conservational function of pictures, as they are able to store information that could not be conserved in any other form. According to Kress – Leuween (2006), picture analysis helps interpreting and deciphering the coded information. In the case of Japanese visual documents, decoding the pictures is further complicated by having to consider that the reading order of Japanese texts is different from the European one. The hermeneutical process serving the deciphering and interpretation of pictures may be summarised as follows (Endrődy-Nagy, 2017):


Figure 1 A possible process of reading an image(Endrődy-Nagy, 2017)

2.     Methods

Papers on iconography in the field of education studies, as well as works with a methodology built on iconography are constantly being produced in Hungary since 2008, primarily presented by János Géczi, Katalin Kéri and the author of the present study (Géczi, 2008; Kéri, 2008; Endrődy-Nagy, 2010). Additionally, recent methodological reviews were prepared by Lajos Somogyvári and Renátó Támba. While Géczi, Kéri and Somogyvári mainly focus on photo analysis, Endrődy-Nagy and Támba works with a methodology relevant in painting (Somogyvári, 2015; Endrődy-Nagy, 2015, 2017; Támba, 2016). Methodological approaches and considerations of the present research use image analysis strategies primarily based on visual semiotics, visual anthropology and iconography. Through the combination of several methods, the presentation of the decoded information may be more detailed. The present research applies the Panofsky methodology published in 1984, requiring a thorough knowledge of art history, as well as the Bouteaud method (Bouteaud 1989) explored in the French literature, applicable for researchers with a technical background, and the Collier method (Collier, 2001) from the field of visual anthropology, which so far has only been tested in its series analysis application in photo analyses. A distinction must be made between the final conclusion regarding the images and the individual results gained through the application of various methods. Following the application of the three methods, a final conclusion might be reached knowing the social conditions, the historical and cultural background and childhood history of the period, and thus a more detailed conception of childhood may be presented.

3.     Results

Present study only focuses on those results of the research that are relevant to medical history.

3.1. Pregnancy

Although there was undoubtedly less information available on pregnancy in the given period than there is today, the imagery of medical history works is rather diverse, including images of possible fetal positions of singletons or twins. The following figures show examples of these fetal positions.

Figure 2 Difficult fetal positions, Collection of medical works, France, end of XIIIth-beginning of XIVth century, Paris, BnF, Department of Manuscripts, Latin 7056, fol. 88v.-89


Figure 1Iacobi Rueff (1554): Chirurgii Tigurini, De conceptu et generationes hominis et iis quae circa, printed by Christophorus Froschno, 37verso

Figure 2Iacobi Rueff (1554): Chirurgii Tigurini, De conceptu et generationes hominis et iis quae circa, printed by Christophorus Froschno, 4verso

According to the medical resources found on pages 22–26 of the Hebamen Buch by Albertus Magnus and in Iacobi Rueff’s Chirurgii Tigurini, doctors were probably aware of the stages of fetal development (Rueff 1554, Magnus 1581).[1]Above mentioned Chirurgii Tigurini (“Surgical Tract”) guides fellow doctors through the fetal development stages, as well as discussing the possibly arising difficulties, complete with suggestions on how to handle them. Interestingly enough, images in the two works are identical, even the birthing chairs seem to be the same. This suggests that there was little or no change in the practices or the knowledge on childbirth during the 30 years that passed between the creation of the two books. It is an interesting fact that the church has explicitly forbidden sexual relations between the husband and the pregnant wife, but encouraged women to continue working, including working on the fields. They explained the necessity of abstinence from sexuality with the possible effect it might have on the position of the fetus,and they found bathing unnecessary during the first and the last month of pregnancy, which, according to contemporary indications, might lead to premature delivery (Alexandre-Bidon and Closson 1985, 51.)

 Monks and scribes copying the illuminated manuscripts also wandered off the subject sometimes. They were human in the fullest sense, often noting down glossae drenched with deep emotions, rapture, desires and longing on the margins. Love poems, or a picture of the monk’s newborn, wrapped in swaddling bands, lying in a cradle, may be found on the margins.  Such an image can be found for example in a 15th-century medical recipe collection, on the margins of the verso of folio 7, see Figure 5 The text appearing above the image of the baby rocking in a cradle is a poem in Middle English, conveying the strong feelings of the monk, his joy, his longing for the child and its mother — it is about requited love, about the love for his child.[2]

Figure 5 Baby tightly wrapped in swaddling bands in a cradle, first half of the 15th century, Medical Recipe Collection, WMS 4, MS.5262, verso of fol. 7 Wellcome Library, London

Pollock highlights in his analysis of 16th-century diaries that there are numerous descriptions and diary entries on the tasks of a mother before giving birth, and there are notations of their happiness, as well as a certain excitement and focus on the arrival of the baby. In a holistic view, he adds that there are also examples among these descriptions of mothers giving birth to unplanned babies from unwanted pregnancies, still the writer points out on one occasion that when the mother was temporarily separated from the baby, she wept bitterly (Pollock 1983: 208–209).

Time series analyses of iconography and visual anthropology shed light on the grave dangers of giving birth, or even being pregnant in the Renaissance period. Women literally risked their lives by getting pregnant and giving birth. They risked their lives for their children. This idea was so prevalent in the analysed period, that all types of picture analysis support the thesis of the child’s life being more important than that of the mother. What leads to this conclusion?

3.2. Giving Birth

When giving birth, mothers received all the help provided by the limited knowledge of the period, but the life of the child was more important, or rather its birth and its salvation from the original sin through being baptised. The utter lack of hygienic standards at childbirth, as well as the proscription of stitching the abdomen and uterus claimed the lives of millions of mothers, but the life of the child was aided by the application of the clean baptismal water in its hygienic aspects as well as providing hope for salvation through following religious customs, beliefs and dogmas.

            The Renaissance period had limited knowledge on childbirth, having an approximate awareness of the anatomy of female organs and the process of giving birth. Usually women, midwives delivered the babies, most probably by applying pressure on the abdomen, and sitting the mothers in birthing chairs. They did not have the means to stop the bleeding. In accordance with dogmatic regulations, the husband could not touch his wife who had recently given birth. This, coincidentally, helped eliminate another source of infection. Still, it has to be mentioned that women returned to work very shortly after giving birth, just as they worked during pregnancy as well.

            Parents concerned about the future of their children turned to fortune tellers, and women constantly prayed for their unborn child.

The research presents the image of a woman and parent who lovingly cares for her children and risks her life so that the child may live, thus ensuring a chance for its salvation, the most important thing of the era. There is evidence of women giving up their lives by agreeing to the then lethal caesarean section (Szabó 1998) for the sake of their child being born and receiving salvation.

There are few representations of traditional childbirth, one of them is in the book of Harksen (Harksen 1976, 96.) – unmarked folio – the woman giving birth is standing, it is the moment when the child pops out. See Figure 6

Figure 6 Depiction of childbirth in the Wenceslas Bible, miniature, 1390–1400, Vienna, Austrian National Library, Cod. 2759, unmarked folio

Every aspect of the image suggests that it is a depiction of an ordinary woman. The mother is in a semi squatting position in front of a starry background, with hands clasped in prayer, while a woman helps picking up the child from the ground. The dress of the mother is richly pleated, and she seems to be supporting herself on something, maybe a birthing stool. Her head is carefully wrapped in a shawl. There is no sign of blood, and so it may be assumed that realistic representation of childbirth was not the aim of the artist. Still it is worth noting the semi standing position, which might have been aided by a birthing stool similar to the one on Figure 7. Interestingly, the depiction of the newborn is similar in its proportions to a real newborn, its head is covered with fetal hair, and its mouth is open, as if it was the baby’s first cry. The face of the other woman, evidently acting as a midwife, is helpful and preoccupied as she places her hand under the child. The child is looking at the mother, the mother and the midwife are looking in opposite directions, their eyelines running parallel to each other, none of them is looking at the child. Interestingly, the floor below them hints at the pattern of the swaddling bands, but there are no bandages or other tools used to stop the bleeding in the picture. On the 70th verso of the Hebamen Buch, Figure 8 shows forceps used to pull out the child from the mother’s belly in case of difficult deliveries. Birthing chairs were undoubtedly also utilised.


Figure 7 Iacobi Rueff (1554): Chirurgii Tigurini, De conceptu et generationes hominis et iis quae circa, printed by Christophorus Froschno, 21verso, Alberti Magni (1581): Hebamen Buch, 52 verso

Figure 8 Alberti Magni (1581): Hebamen Buch, 70 verso

One of the earliest books on midwifery is the 1480 Midwifery Ordinance of Württemberg, which also provides descriptions of the surgical procedures that may be performed by midwives, including postmortem caesarean sections (Szabó 1998). A note must be made on the fact that in the given period, women were almost exclusively aided by midwives when giving birth. It was only later that surgeons discovered the opportunity of gaining prestige through performing gynaecological surgeries, and as social demand also increased for their work, they gained almost exclusive authority in the context of childbirth (Szabó 1998, 143.) As works on surgery were written in Latin, midwives had little chance to read them, and so they had to rely on word of mouth, apart from ordinances such as the one mentioned above (Harksen 1974).

According to written sources, there were cases of conjoined twins in the Middle Ages; in Hungary the chronicles recorded the first case in 1554, (Métneki and Varjassy 2008, 90.), but the twins were not separated. The earliest documented European case of separated twins date back to 945, but one of them died before the surgery, and the other due to the procedure. The next documented operation happened in 1505, on 10-year-old female twins, with the same result: one of the twins died before, the other after the surgery. The first successful operation only happened in 1689. Several chronicles, incunabula (from the Brandt workshop) and engravings exist on the head-conjoined twins who were born in 1495 and operated on in 1505. (Métneki and Varjassy 2008, 78 – 79.) 

3.3. Cleanliness

Regarding the cleaning of the newborns and their connection to water, Fossier highlights that the function of bathing is twofold: first, it satisfies the need for hygiene after exiting the womb, cleaning off any pieces off tissue, placenta or blood right after the birth – references to this are found in the written sources of the period, as they mention that the father may not hold the newborn before this ritual bath; and the second ritual is baptism itself. Fossier draws attention to the fact that these two rituals intertwine in depictions of the birth of Christ (Fossier 2012: 43).

In a dogmatic sense, this cleaning is connected to baptism in its aspect of washing away of the original sin. From a thematic aspect, this might be the reason behind its frequent appearance on images. Although the shapes of bath tubs are diverse, their time series analysis shows that they were only used for the babies, and, unfortunately, the mothers did not receive a bath, which contributed to the occurrence of childbed fever and to high mortality rates, among other things. It is worth noting that depiction of women taking a bath happens exclusively in the context of brothels, explicitly making water a symbol of uncleanliness.

3.4. Breastfeeding

Babies received attention from the mothers during nursing in the Renaissance too, artists may have observed breastfeeding in everyday situations, even on the streets. The examined pictures point to the fact that in the Renaissance era mothers probably regarded this function of nourishment and protection important. It was presumably an organic part of their lives. The author of the present paper considers the theory that babies were not sent to wet nurses because they were unloved, but out of love, in a need for feeding them, and the images seem to provide evidence for this hypothesis. This kind of image is quite common in the examined picture material, they constitute a substantial amount, and so it may be assumed that it was an organic part of the scenes on the street and of everyday life.

In the Middle Ages and the Renaissance, the topic of childbirth and children’s health was normally discussed in chapters of general medicine (Shahar 2000), or, as seen from the above examples, surgical works, rather than in independent works. Shahar notes that there is no information available on the popularity of treatises and medical collections on children’s health. Nevertheless, these works mention the right way to bath a child, and that it has to be done before nursing in order to avoid vomiting, and also that it should be done several times a day (Shahar 2000: 140).

The pictures analysed above show that medieval mothers loved their children just as much as mothers do today. There is no information on the importance of nursing, or the number of women breastfeeding their children, but painters had the opportunity to observe the process. It is possible that this situation occurred even on the streets.

3.5. Sickness – mortality

As Heywood notes, according to the statistics of England one baby out of four was stillborn, and one out of five passed away under the age of one in the 1600s. French statistics are even worse: as many as 400 children out of a thousand died before reaching one year of age (Heywood 2001). The statistics were probably even more horrible in times of plague, and only started to improve in the 18th century across Europe, and so it is important to examine and draw conclusions on the way mothers viewed the frailty of their children.


Figure 9 Unity unto Death, Danse macabre, France, fin du XVe siècle, Paris, BnF, département des Manuscrits, Français 995, fol. 34 v.

Figure 10 Death and the Child: Destiny, Danse macabre, France, fin du XVe siècle, Paris, BnF, département des Manuscrits, Français 995

 Figures 9 and 10are particularly good representations of the knowledge and fears of medieval men of child mortality. On Figure 10, Death takes mother and child by hand, leading them to death, showing the way. In some places he hands over an envelop sealed with a golden coin to the mother, indicating that he is taking the infant. His arrow also points at the child. He takes the child from a room without exception. These images, as pieces of the Danse Macabre motif, express that everyone is equal in death, whether rich or poor, young or old. The use of perspective draws the attention to the hand of death in every instance, amplifying it, and the other characters are somewhat dwarfed by him. In this sense, Panofsky views perspective as a symbolic form of imagery as well (Panofsky 1984).

Shahar points out that in times of sickness people used to pray to the saints. They were reluctant to call for a doctor, as they feared surgical procedures. Doctors believed that giving medicine and bloodletting is dangerous for children, and so in many cases it would have been useless to call for the doctor anyway. Contemporary sources also suggest that doctors had difficulties diagnosing infants. According to certain sources, wealthy parents called for the doctor before praying to the saints, but he was unable to heal children except for fractures and swellings (Shahar 2000: 249–250).

Pollock’s analysis of 16th-century diaries present numerous examples for expressions of parental worries, and for descriptions of how they wish for their children to get well as soon as possible. The author of an English diary, Dee for example follows closely and notes down the condition of her sick children in detail, as well as her own feelings about the situation. All the authors of the analysed diaries mention that they are praying for their children, and that they feel sorry for them (Pollock 1983: 124–125).

The black death is known to be viewed as a punishment from God in the period. A contemporary religious pamphlet traces mortality back to fourteen distinct causes, containing moral considerations and social criticism as well. It is not surprising that people believed in the magical protective powers of sacral images in such a desperate situation (Szilárdfy 2003: 180).

The cruelty of death is depicted in numerous images of the examined period. On these pictures, death does not spare the children, indeed, sometimes it takes them right from the cradle or the arms of the mother. In many cases death is grinning, sneering, appearing in the most unexpected situations with a grotesque realism, with protruding bowels, when the child and the parents are powerless against him.

The analysed pictures tend to depict parents as being helpless about the frailty of their children. It is articulate on the pictures that love was evident, but the contents of love were different from the modern concept of it supplemented by 21st century knowledge of psychology, biology and hygiene. This also leads to the conclusion that we may not be able to judge the views on infant mortality in the Renaissance era. The frailty of children was seen as a fact of life with a fatal approach – they accepted it, but they did not resign themselves to it. They did everything for the child that they believed to aid its survival. They baptised their children, nourished them, sewed pictures of saints into their clothes for protection, and accepted that everyone is mortal. They felt that there is nothing to be done about this, and looked at the world with a certain grotesque realism. They feared for their children, but at the same time believed that God and his angels will save them. When the time has come for the child to leave the mortal realm, they had a firm conviction that the child will be given eternal life in heaven. For this reason, children were baptised at the moment of their birth, even the cheeks of stillborns were pecked and slapped until they turned rosy, giving the impression of being alive, and hence becoming baptisable.

An interesting fact from medical history is the mention of Mary’s milk as “medicine” by Pál Esterházy. At the place where she was nursing the infant Christ, a drop of her milk fell onto the ground, which turned white, and the cave was named the Milk Grotto of Betlehem. The walls of the cave were scraped, crushed into a fine powder, then dried on the sun, and after further refinement it was diluted with water and sold as medicine. Pilgrims travelling to the Holy Land brought it home in phials and sold it as a relic / holy medicine. (Szilárdfy 2003, 182 – 183.) It was noted that Louis XIV bought some of Mary’s milk in 1247 (Alexandre-Bidon and Closson 1985: 92), so there are several sources for it.

In connection with his analysis of 16th-century diaries, Pollock notes that five of his subjects lost their infant babies. Only two of the five subjects do not write about their feelings on the matter, but Pollock assumes that the authors may not have been able to express their feeling in words, as this emotional articulation is apparent in the other cases and also in diaries analysed later (Pollock 1983: 134).

4.     Discussion

The review of books on midwifery might provide interesting additions to the nursing and parenting practices of the period, as midwives were the ones in contact with ordinary people, just as health visitors are today – for example, they had access to the homes, and so the mother–child relationship and parenting practices may be studied through them. For this reason, the next step of the research will be the comparison of the depiction of children in midwifery books and in the available contemporary visual documents available of the period.


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Translation aid: Villámfordítás (Kakuszi Panna)

[1]The photograph was taken of the Rueff work, and so it is listed as recto 4 in the references, available in the Medical Library.

[2]It must be noted that scribes were not necessarily celibate, even students studying in the monastery may have become scribes, and so the image does not necessarily point to the violation of a vow of chastity.