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Home , Pope Joan, Pope John VIII, Pope John XI, Theodora (senatrix)

00’21.972X/93/7601-ooO3$03.00/0 Journal of Clinical Endocrinology and Metabolism Vol. 76, No. 1 Copyright 0 1993 by The Endocrine Society Printed in U.S.A.

PRESIDENT’S ADDRESS Joan: A Recognizable Syndrome*

MARIA I. NEW AND ELIZABETH S. KITZINGER Department of Pediatrics, The New York Hospital-Cornell Medical Center, New York, New York 10021

My report was stimulated by a Christmas gift from my in French monasteries during the 15th century (Fig. 1). friend and colleague Patrizia Borelli: a book called La Papessa There are various accounts of how died: some Giovanna: Roma e Papato Tra Storia e Leggenda? (Pope Joan: authors have her torn limb from limb by the angry crowd; and the Papacy between Truth and Legend) by Cesare others say she was dragged by horses through the streets of D’Onofrio. Because there was great controversy about the Rome. (1304-1376), evidently thinking of the pla- existence of a female pope during the and my gues of Revelation (2), added that after her death it rained scientific interest has been directed at understanding the blood for 3 days and nights and locusts with six wings and genetic and hormonal basis for infants born with ambiguous powerful teeth appeared in France. Obviously, the idea of a genitalia, I began to search for a biological basis for the woman pope was anathema. existence of a pope who was elected as a male but unmasked What is the basis for these fantastic stories? To answer this as a female, as the legend goes. question, it helps to have some idea of the historical frame- The story of the female pope first appeared in a manuscript work (Fig. 2). In 800, on Christmas Day, was by Jean de Mailly in about 1250 A.D. During the late crowned by Pope Leo III in thanks for Middle Ages and dozens of people wrote about his help in staving off the who periodically at- this scandalous woman, many of them Franciscan and Do- tacked Rome and for defending him from enemies among minican or Protestants, and their stories were widely the Roman nobility, who had physically attacked him. But believed (1). The most popular version, which was a best after Charlemagne’s death in 814, the papacy fell increas- seller all over Europe for hundreds of years after its publi- ingly under the sway of the impious and powerful Roman cation circa 1265, was that which appeared in friar Martin nobility (3, 4). The existence of this corruption is central to Polanus’ Chronicon Pontificum et lmperutum (2): understanding the birth of the legend. Joan’s papacy was After Leo, John Anglicus, born at , was pope for 2 years, 7 placed by Martin Polanus and most of her other chroniclers months, and 4 days, and died in Rome, after which there was a in the years 855-857, between Leo IV (847-855?) and vacancy in the papacy of 1 month. It is claimed that this John was a Benedict III (?855-858) (Jean de Mailly and some others put woman, who as a girl had been led to Athens dressed in the clothes her around 1100). But all of these accounts of Joan were of a man by a certain lover of hers. There she became proficient in a diversity of branches of knowledge, until she had no equal, and written long after she was said to have lived-in most cases afterwards in Rome, she taught the liberal arts and had great masters 400 years after! The existence of a female pope is not men- among her students and audience. A high opinion of her life and tioned in any private letters or official communications or learning arose in the city, and she was the choice of all for pope. histories at the time(s) of the alleged papacy (which, inter- While pope, however, she became pregnant by her companion. estingly, was the period during which the Cyrillic alphabet Through ignorance of the exact time when the birth was expected, she was delivered of a child while in procession from St. ’s to was developed by St. Cyril and sometimes used in papal the Lateran, in a narrow lane between the Coloseum and St. Clem- correspondence). So why did the story appear? ent’s church. After her death, it is said that she was buried in that The Franciscan and Dominican mendicant orders were same place. The Lord Pope always turns aside from the street and it founded around 1200 in reaction to the corruption and is believed by many that this is done because of abhorrence of the event. Nor is she placed on the list of the holy pontiffs, both because wealth of the Church. (The plight of the may of her female sex and on account of the foulness of the matter. bring to mind Umberto Eco’s The Name of the Rose, which is set during this same time.) But at this time, Pope Innocent The Italian humanist Boccaccio, who relished the tale and III was struggling to reassert a righteous authority and was included it in his De Claris Mulieribus (published circa 1350), not inclined to let his clerics find their own path. Dominican was the first to give John Anglicus (Pope John VIII) a wom- and Franciscan may well have invented the scandal- an’s name (Giliberta). His book was magnificently illustrated ous story in their fight for independence. Received November 1, 1992. The direct inspiration for the tale may have been the Address all correspondence and requests for reprints to: Maria I. New, women of the powerful Theophylact family: matriarch Theo- M.D., Department of Pediatrics, Room N-236, The New York Hospital- dora had purchased the papacy for her lover, who became Cornell Medical Center, 525 East 68th Street, New York, New York Pope John X (914-928). Pope John X was then imprisoned 10021. * The Presidential Lecture at the 74th Annual Meeting of The Endo- by ’s daughter so that her own son, whose crine Society, San Antonio, Texas, June 24-27, 1992. father was an even earlier pope (Sergius III), could become

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FIG. 1. A and B, Illustrations of the Joan legend from two editions of Boccaccio’s , France, painted circa 1400.

Pope John XI (931-935) after she had arranged the murders these written by Protestants, who had their own reasonsfor of two intervening popes (2). keeping the scandal alive. Another avenue for this legend might have been the Is there any solid evidence that Pope Joan ever lived? Christian literary tradition of the female in male dis- There are three curious facts to weigh. The first is this: In the guise, which derives from the early legend of St. Pelagia the nave of the Cathedral of Siena is a seriesof bustsrepresenting Penitent. Examples of such stories are those of St. Eugenia, each of the legitimate popes. The head of Johannes VIII, an authentic Third century Roman martyr about whose life Femina de An&a, was placed between those of Leo IV and few facts are known, and the apocryphal Marina, Benedict III until 1600, when Pope Clement VIII ordered it Theodora, Margaret Reparata, Euphrosyne, Apollinara, and removed and, it is said, it was subsequently recycled as the Anastasia Patricia. Saint Hildegund, whose life is well doc- head of Pope Zacchary (2). Was this a cover-up? umented, appearsto have really lived the myth: she hid in a Second, there is the famous porphyry chair, in Italy called monastery in male disguise until her death in 1188, when “La Sedia Gestatoria.” This is a red marble chair, now in the she was discovered to be a woman (2). Because the Old Vatican museum (Fig. 3). Another, identical chair was stolen Testament forbade transvestism as an “abomination,” this by Napoleon and reputedly put in the . These chairs was a scandalouscourse to pursue, one which later was used have a perforated seat, and it is known that both of them to incriminate Joan of Arc, who was accused of refusing to were used in the ceremonies of installation of the popes take off men’s clothing to hear (5). between 1099 (Paschal1II) and 1513 (Leo X) (2). It is rumored Whatever the first source of the Pope Joan legend, the that these chairs were used to ascertain the gender of popes- turmoil within the Church continued for centuries. At one elect as a direct result of the scandal of a real Pope Joan (6, point, the Popes even fled to Avignon to avoid “” 7). The “junior cleric present” purportedly palpated the gen- who challenged their authority in Rome; this is the period itals of the papal candidate through the hole in the bottom known as the “Avignon captivity” (1306-1367). Martin Lu- of the chair, and, if he found what he expected, shouted in ther and the Protestant Reformation occurs around 1571, a loud voice, “Testiculos habet et bene pendentes (He has when a whole new spate of accounts of Pope Joan appeared, testicles, well hung).” To which all the others replied, “Habe

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MIDDLE AGES -1 pi&l-j I I

Pope Joan? (John VIII) 8S44S7?

Pope Joan? (Anastasius) I 2 mar. in SSS?

Jean de Mailly, Stephen of Bourbon (Dominicans) write first stories of

ioo 900 1000 1100 1200 1300 1400 1500 1600 1 I I I I Charlemagne crowned Holy Roman Emperor by Pope Leo III in thanks for protection from Lombards. On death of Charlemagne in 814, papacy weakened at mercy of corrupt Roman nobility. FIG. 2. Timeline. ova noster papa (Our father is virile).” (7) “Then they proceed A Woman Pope (as History doth tell)/In High Procession once in [ed] joyfully to the consecration of the pope-elect” (2)’ Labour fell/And was delivered of a Bastard Son/Whence Rome some call the Whore of Babylon. The third piece of “evidence” used to assert the truth of the legend is the detour in the route that the popes followed It has been used as feminist propaganda, as a basis of in their processions between their home in The Lateran romantic fiction and drama, both tragedy and comedy, and Palace and St. Peter’s This route includes both the Colos- in card games such as “Pope Joanfland “Tarot,” which has a seum and the Basilicaof St. Clement, a beautiful church built card, , first identified with Pope Joan in on the site of a third century Mithraic temple.’ Around the the famous deck made for the Visconti-Sforza family by time that the legend of Joan was spread by Martin Polanus’ Bonifacio Bembo in the 1400s (Fig. 4). book, formal papal processionsbegan to turn off the direct My -in-law is one of the chief librarians of the road between St. Clement’s and the ,purportedly Library of Congress and when I was preparing this lecture, I to avoid the place where Joan gave birth. At a spot where asked him to send me every he had on Pope Joan. I was the detour begins there is a little chapel on the street, which, amazed to find that there are hundreds of publications about although it is officially called the Chapel of the , is Pope Joan (Figs. 5 and 6). Many are written by historians popularly referred to, as I discovered walking there this sorting through the evidence about the legend, but the story spring, as the Chapel of La Papessa. has a life of its own. In the 20th century alone at least six The story of Pope Joan is undoubtedly a legend. It is very novels and plays have been published about her. One of hard to believe that this fantastic event could have occurred them, by Emmanuel Royidis, is a classic of contemporary in the Ninth century without a contemporary written record. Greek literature which was translated into English by the Yet despite the unlikelihood of its truth, this tale has contin- great novelist Lawrence Durrell, who called it “a masterpiece ued to be retold and even believed up to the present day. It of irreverence.” The Greek Orthodox Church banned the has been the vehicle for ribald mockery and for serious book and excommunicated Royidis. A play about Pope Joan accusation of the church (8): with the theme “It’s what other people think that makes sin” was written by one of Harvard’s greatest art historians, A. ’ Charles W. Lloyd (7) comments, “Such a procedure could at least Kingsley Porter. Michael Anderson (director of “Around the have assured avoidance of the election of another Papess Joan, and in World in 80 Days,” “Logan’s Run,” and “The Shoes of the Rabelais’ time no one was ignorant of the common saying: ‘Testiculos Fisherman”) made the movie “Pope Joan” starring Liv Ull- qui non habet/Papa esse non potest.‘” * There is an interesting connection with the Pope Joan legend here mann. Anderson twists the chronology so that he can have (2): A stone inscribed with the phrase ‘Petre, Pater Patrum, Papisse Charlemagne impregnate the pope after she crowns him Prodito Partum (0 Peter, Father of Fathers, Betray the childbearing of Holy Roman Emperor. Caryll Churchill included Pope Joan the female pope)” is said to have marked the spot of Joan’s death. ‘rater as one of the five women characters of her successfulplay Patrum” was the title given to the highest of the Mithraic priests. The Mithraic religion, a Persian cult of the sun, rivalled Christianity in its “Top Girls,” produced in New York in 1982 by the late Joseph popularity in Rome around the Second and Third centuries. PaPP.

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FIG. 3. A. One of the red nornhvrv chairs with perforated seat. B, The palpation of the pope-elect’s genitals (illustration from John Wolfius’ Lectionem Memorabilium et R&oE$itarum Centeiarii XVI, 1671).

If Pope Joan was a legend,3 why as a civilization have we since he was having cyclical menstrual periods. not lost interest in her after all these centuries? Why do many The endocrinological basis of the legend could be that people persist in thinking that her story could have been Pope Joan had a recognizable syndrome: classical 21-hy- true? droxylase deficiency. From a medical perspective the story The fact is, on a biological basis, it might have been. I of Joan would be that Pope John VIII was a female pseudo- have known a man who if he had lived in the Ninth century hermaphrodite who had a homosexual liaison, got pregnant, could have been Pope Joan. He became my patient because and delivered a child. one day a nurse, who was his wife, came to me and said, Pondering this scenario led me to investigate what was “Dr. New, I think my husband has congenital adrenal hy- known about sexual differentiation in Joan’s time. Medical perplasia and is a female pseudohermaphrodite.” They’d sciencein the Middle Ages derived primarily from the theo- been married for 10 yr. Why did she think this? She said, ries and observations of Aristotle and Hippocrates and their “Becausehe bleeds from his penis every month.” The patient A Second century heirs and interpreters Galen and Soranus. proved, in fact, to be a female with 21-hydroxylase deficiency The foundation of medieval science was Hippocrates’ con- who had lived all his life as a male. He had had many female struct of four elements (earth, air, water, and fire) whose lovers before he married. His wife was entirely satisfied with interaction underlay all physical phenomena (Fig. 7). Galen their sexual relationship. But he was bleeding monthly. Pre- interpreted the Greek legacy teleologically, within the context sumably, he was having menstrual periods, though he had of Christian belief. Becausethe authority of the ancients was never been treated. And I suppose it would be possible to sopowerful, it was difficult for medieval scientiststo progress think that this patient could be reproductive as a woman, in their understanding of physiology. However, by the 11th century there was some admixture of the Western legacy 3For those who are troubled by the bust in Siena and the detour from Via San Giovanna, I recommend Rosemary and Darrell Pardoe’s with Arabic and Jewish medicine (9). book listed in the References (2), which provides plausible explanations. The medieval view of the differences between men and

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#potdip. XVII L Itk3altt fie / xvie fit et84 b&t bdt vnbma4ts p pcifeltfgmcub ibrcn mw cfm I bcn flc fpriht in jrtm bcrgcnl34 #igcvnb bin tin ZWgin. [A ITI 27 FIG. 5. Title page of Dietrich von Schernberg’s Ein S&en Spiel uon Frau Jutten (15651. In this Faustian storv, Joan is sent to earth as an agent of the devil, ‘but is rescued by the Virgin Mary. purgation of menstruation, a woman was dangerous to her- self and others. Hence the association of older, menopausal women with witches: they could kill an infant in its cradle, FIG. 4. The High Priestess card from the 18th century Tarot de etc. This fear of women’s physiology has survived into our Marseilles. The Tarot deck is used for a variety of card games and for own day. Folk wisdom still has it that menstruating women fortune telling; its origin is unknown. can spoil pickles, bread, meat, or houseplants by a touch or women was quite different from ours: Men were thought to a glance (11). The medieval custom of “churching,” decon- be more perfect by nature: hotter and dryer, and therefore tamination by a priest at the door of the Church of a woman better metabolizers. Their beards, chest hair, and more mas- who has given birth, was still practiced in parts of Europe sive musculature were the end products of their exuberant (11, 12), and, I have heard anecdotally, in America, in the metabolism. Women, on the other hand, were metabolically first half of the 20th century. Orthodox Jewish law requires imperfect because they were essentially too cold. They that a woman take a ritual bath, called a mikvah, after each needed menstruation to eliminate unmetabolized fluid, un- menstrual period. lessit was shunted via the “quilin vein” (Hippocrates) to the Medieval doctors had some very odd ideas about the breasts, where it became milk, or to the uterus, where it uterus. Plato had described the uterus as “like a wild beast nourished the fetus. of the forest” and believed it would wander around the body Unused, menstrual blood was a kind of poisonous by- “vexed and aggrieved” if deprived of the function of child- product of female metabolism. According to Vincent of Beau- bearing (13). In the Middle Ages there was a treatment called vais (lo), who wrote in 1478, menstrual blood could prevent “suffumigation” which involved putting sweet- or foul-smell- cerealsfrom sprouting, cause grapesto sour, kill herbs, make ing substancesat the nose or vagina to lure the uterus back trees lose their fruit, rust iron, turn bronze black, give dogs to its proper place (13). There were two popular views of rabies, and dissolve glue made of bitumen that was imper- uterine anatomy which had been formulated on the basis of vious to iron4 A child conceived during a mother’s period dissectionsof animals (monkeys, bears, and pigs), since for might be born with leprosy or measles. But without the many centuries the Church forbade human dissection. After Galen, some thought the uterus had two chambers,a warmer 4 Aristotle’s assertion that a menstruating woman’s glance will dull a one on the right, near the vena cava, where male fetuses mirror (Dreams, c. 350 B.C.) led to an association of menstruating women with the mythological basilisk, a serpent born of a rooster’s egg whose gestated, and a colder one on the left for female fetuses. glance and touch were poisonous. Also called the cockatrice, it could Fascination with numerology had led some others to see only be killed by its own reflection (10). seven chambers in the uterus: three on the right for males,

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P-P- --f+--- unp bit fh mi4 kin Iitbce Finb. FIG. 6. Medieval German song about Joan: she prays to the Virgin _ _ Mary to bless her with a child although she is a sinner.

North

water COLDNESS Winter MOISTURE FIG. 8. The tenth figure of the treatise of Guy of Vigevano, showing a Phlegm woman whose womb has seven compartments. Phlegmatic

hypotheses (1O).5 Earth Element Air West Autumn SC!aSOtl Spring East The authority on medieval and Renaissancegynecology is Black bile HUmOUr Blood Trotula (“Dame Trot” of nursery rhymes and Chaucer’s Can- Melancholic Temperament Sanguine terbury Tales) (14, 15). Trotula was a midwife of the great early medical school at , which in the 11th century Fire emerged as the crucible in which Greek, Roman, Jewish, and DRYNESS Summer HEAT Arabic medicine were mixed. The manuscripts Trotula major Yellow bile Choleric and Trotula minor were enormously popular treatises on women’s health and cosmetology, written around the year South 1150. The author’s observations on menstruation, concep- FIG. 7. The interaction of the four primary qualities, a concept derived from the school of Hippocrates (from Jacquart, D. and C. Thomasset (10); reproduced with permission). ’ A fascinating observation that might be a good subject for further medical historical research: Aristotle (In: Barnes, J., ed. The History of Animals, Complete Works. Princeton, 1984, p. 914) and at least one of his three on the left for females, and one in the middle, amaz- medieval heirs, R. Ishmael, in The Niddah III. 7 (see Ehrman, A. Zvi, ed. The Talmud, Berakhoth, Jersusalem, El-’ Am-Hoza’ a Leor Israel, 1982, ingly, specifically for hermaphrodites (Fig. 8) (9). What de- p. 1079), comment that it takes about 40 days for a male and 80 days termined the fetus’ sex was hotly debated, whether it might for a female fetus to maintain recognizable form; this is uncannily close be the side of the body that the male sperm originated from to the number of days by which testicular and ovarian tissue differen- before it acted on inert female matter, or the heat of the tiate, which is, of course, something that the ancients could never have seen. R. Ishmael cited experiments by Cleopatra on her pregnant hand- uterus, or the result of a contest between female and male maidens as his evidence (Needham, J., A History of Embryology, ed 2, “seed” of opposing qualities and strengths, to mention several Cambridge University Press, 1959, p. 66).

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FIG. 9. A, Hermaphroditus lifting his skirt in a holy ritual gesture. Statue in the National Museum, Stockholm. B, A copy of one of several statues of Her- maphroditus believed to be by Polycles the Elder (early Fourth century B.C.). The towel on the god’s head may be a reference to the nuptial bath.

FIG. 10. !f& Birth of Aphrodite by San- dro Botticelli (Uffizi Museum, Florence).

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FIG. 12. Maddalena Ventura by Jose de Ribera, 1631 (painting in Toledo, Spain).

FIG. 11. Hermaphroditic figure from the Dogon tribe (from the Menil Ambrose Pare put it (17). Hermaphrodites were integrated Collection, Houston. Reproduced with permission). quite forthrightly into the social fabric. By the end of the 17th century, French and English laws existed which required tion, and obstetrics are acute, aswell as graceful6 - so much hermaphrodites “to chuse the sexe which they will use, and so that she was held up as the prototype of the female in which they will remaine and live, judging them to death physician by two presidents of the American Medical Wom- if they be found to have departed from the sexe they made en’s Association and has a place setting in Judy Chicago’s choice of” (17). Hebrew law had always made special pro- feminist artwork “The Dinner Party” (16). But it turns out vision for hermaphrodites (18). that, as a writer, Trotula, like Pope Joan, may well have been This was in marked contrast to the fate of hermaphrodites an imposter. It has been said that “she” was a male physician in classical Greece and Rome, where they were put out to who took the famous and beloved 11th century midwife’s die on hillsides (5). But despite an abhorrence for real her- name in order to gain credibility, since in those times women maphrodites, the Greeks were fascinated by the idea of were treated almost exclusively by other women (16). hermaphroditism, as it seemsall cultures are, including our In the scientific schema of the Middle Ages and Renais- own. sance, hermaphroditism was understood as a lack of resolu- The Greeks had a god called Hermaphroditus, who was tion in the “forming faculty,” as the eminent barber-surgeon the patron of sexual union (Fig. 9). The image of this minor deity, with a woman‘s breasts and a penis, was painted on 6 “Nature herself on account of this deficiency of heat has assigned the walls of many private homes. He is first written about in for them a certain specific purgation, namely, the menses, commonly Theophrastus’ (382-287 B.C.) “Characters” (19). Herma- called flowers. For just as the trees do not produce fruit without flowers, so women without menses are deprived of the function of conception.” phroditus was the child of Hermes and Aphrodite, the god- From The Diseases of Women, by Trotula of Salerno, translated by dessof love, who was herself conceived of the sea and her Elizabeth Mason-Hoyl, Los Angeles, The Ward Richie Press, 1940. castrated father Chronos’s testicles (her name means “foam”)

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FIG. 13. MichaelJackson (courtesy of Sony Music).

(Fig. lo).’ According to classical scholar Marie Delcourt, Hermaphroditus’ bisexuality was a holy symbol of fertility (5). In connection with her analysis of the worship of Her- maphroditus, Delcourt describesmany astonishing rituals in FIG. 14. Liv Ullmannas Pope Joan in MichaelAnderson’s film (with ancient Greece that have transvestism as their core, and she thanks to Ms. Ullmann). associatesthe Greeks’ fascination with bisexuality with a yearning for immortality. gist, discovered in 1946 living in a Stone Age culture on the As for real hermaphrodites, Herodotus (450 B.C.) had Bandiagara Escarpment. This sculpture probably represents suggestedthat a tribe of ambisexual Scythian “Enarees” was (20, 21) a first-generation human being according to the created by Aphrodite aspunishment for ransacking her most Dogons’ religious beliefs.* In the Hindu religion, there is an ancient temple (5). Hippocrates, however, thought the Ena- androgynous representation of Siva and Parvati, called Ar- reesmust have been feminized by excessivehorseback riding dhanarisvara, “lord who is half-woman.” Ardhanarisvara’s (19). body is asymmetrical: generally, his left side has a female In 7 A.D. the poet Ovid wrote a myth in his Mefa- breast, long hair, and a swelling hip, and his right half has a morphosesabout Hermaphroditus, a story which as far as we penis with one testicle, short hair, male breast, and slim hip know is entirely his invention but which has popularly (22). supplanted the Greek version of the origin of Hermaphrod- Some cultures have favored hermaphroditism in their itus’ ambisexuality (17): A nymph, Salmacis,fell in love with priests, as well. In The Golden Bough Frazier describeseffem- handsome Hermaphroditus, whom she saw bathing in a inate sorcerers or priests among the Sea Dyaks of Borneo, pool, and prayed to be united with him forever. the Bugis of South Celebes, the Patagonians of South Amer- Ceremonial hermaphroditic figures appear in non-Western ica, and the Aleutians and many Indian tribes of North cultures, as well. The Menil Collection in Houston has an extraordinary African figure (Fig. 11) with prominent penis * Sucha conceptalso exists in our ownculture (17). Rabbis and priests and jutting breasts, which comes from the Dogon tribe, an have arguedfrom the text “Man and womanhe createdthem” that Adam was a hermaphrodite.And Platowrote in “The Symposium”(c. isolated people whom Marcel Griaule, a French anthropolo- 375 B.C.), “In the first placethe sexeswere originallythree in number, not asthey are now; therewas man, woman, and the union of the two, 7Aphrodite herself was sometimes represented in a sexuallyambig- having a namecorresponding to this doublenature; they oncehad a uousfashion: there was a cult of a beardedAphrodite in Cyprus,and realexistence, but it is now lost, and the nameonly is preservedas a in Romanart shemay be portrayedas bald (5). term of reproach.”

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America, and he lists transvestite rituals in many other References societies (23). Recently, the biological basis for intersex in the 1. Cross FL, ed. 1974 The Oxford dictionary of the Christian Church. shamans of a primitive people in Papua, New Guinea has Oxford: Oxford University Press; 740. been described. An enzyme defect in 5a-reductase explains 2. Pardoe R, Pardoe D. 1988 The female pope: the mystery of Pope the ambiguous genitalia (24). Joan. Wellingborough, England: Crucible; 112. In later European art and literature there are many signs 3. Strayer JR, ed. 1989 Dictionary of the Middle Ages. New York: of a fascination with hermaphroditism. For instance, there is Scribners; 346. this extraordinary painting by Jose de Ribera, commissioned 4. von Ranke L. 1966 Fowler E, trans: The history of the popes, New for King Philip IV of Spain in 1631 (Fig. 12). It is a portrait York: Ungar. of Maddalena Ventura of ,’ mother of seven, who 5. Delcourt M. 1961 Nicholson J, trans. Hermaphrodite: myths and grew a luxuriant beard at age 37 and is shown nursing her rites of the bisexual figure in classical antiquity. London: Studio Books; 110. last child when she was 52. She could be a patient with 6. Haemerlien F. 1490 De nobilitate et rusticitate dialogus. nonclassical 21-hydroxylase deficiency. In Sexuality in West- 7. Lloyd CW. 1964 Human reproduction and sexual function. Phila- ern Art Edward Lucie-Smith reproduced an illustration of delphia: Lea & Febiger; 449-450. “The Land of the Hermaphrodites” taken from a famous 8. Cooke A. 1610 Pope Joane. A dialogue between a Protestant and a autobiographical 17th century travel book (25). In the center Papist. London. of Andrea Mantegna’s beautiful painting, “Pallas Expelling 9. Siraisi NG. 1990 Medieval and early medicine. Chi- the Vices from the Garden of Virtue” (1499-1502), recently cago: University of Chicago Press. exhibited in New York, is a hermaphroditic monkey, wearing 10. Jacquart D, Thomasset C. 1988 Sexuality and medicine in the the motto “Immortal hatred, fraud, and malice” on its sleeve. Middle Ages. Adamson M, trans. Princeton: Princeton University Hermaphrodites have been featured in circuses and tabloids Press. 11. Shorter E. 1982 A history of women’s bodies. New York: Basic in the Western world for centuries (17, 26). Books; 287-289. Interest in gender ambiguity has grown in 20th century 12. Carter J, Duriez T. 1986 With child: birth through the ages. America. The psychoendocrinologist John Money and others Edinburgh: Mainstream; 15-17. have made important observations about the roles of pre- 13. Green M. 1985 Transmission of ancient theories of female physi- and postnatal sex hormones on gender identity (27-33). ology and disease throughout the (Dissertation). Gender is a focus of controversy at the modern Olympic Princeton: Princeton University Press. games. This began with a furor in 1932 when medalist Stella 14. Hughes MJ. 1968 Women healers in medieval life and literature. Walsh was discovered to have a male chromosome and Freeport, NY: Books for Libraries; 101-109. ambiguous genitalia. In the 1990s some athletes need con- 15. Barkai R. 1988 A medieval Hebrew treatise on obstetrics. Med Hist. sultations with endocrinologists before they register for a 33:96-119. 16. Benton J. 1985 Trotula, women’s problems, and the professionali- meet (34). Frank deception has been documented only once, zation of medicine in the Middle Ages. Bull His Med 59:30-53. in Berlin in 1936, when Hermann Ratjen, a man, entered the 17. Young HH. 1937 Genital abnormalities, hermaphroditism, and re- women’s high jump for Nazi Germany - and lost (34). lated adrenal diseases. Baltimore: Williams & Wilkins; I-22. In the sphere of modern culture, the play “M. Butterfly,” 18. Macht DL 1911 Embryology and obstetrics in Ancient Hebrew an interpretation of a true story about a 20-yr love affair literature. 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Baltimore: Johns Hopkins. Medical College in the preparation of this lecture. 29. Money J, Devore H, Norman BF. 1986 Gender identity and gender transposition: longitudinal outcome study of 32 male hermaphrod- 9 Naples, coincidentally, was the home of De Crecchio, the anatomist ites assigned as girls. J Sex Marital Therap. 12:165-181. who in 1865 gave us the first clinical description of a female pseudo- 30. Money J, Norman BF. 1987 Gender identity and gender transpo- hermaphrodite with enlarged adrenal glands. sition: Longitudinal outcome study of 32 male hermaphrodites

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assigned as males. J Sex Marital Therap. 13(2):75-92. 33. Hofman MA, Swaab DF. 1991 Sexual dimorphism of the human 31. Reinisch JM, Rosenblum LA, Sanders SA, eds. 1986 Masculinity/ brain: myth and reality. Exp Clin Endocrinol. 98:161-170. femininity: concepts and definitions. New York: Oxford. 34. Grady D. 1992 Sex test of champions. Discover. 13:78-82. 32. Dorner G, Docke F, Gotz F, Rohde W, Stahl F, Tobnjes R. 1987 35. Queenan J. 1992 Hermaphrodites in love. The New York Times Sexual differentiation of gonadotropin secretion, sexual orientation, Book Review, May 31;16. and gender role behavior. J Steroid Biochem. 27:1081-1087. 36. Schrieber MHM. 1990 Madonna nudes 1979. Berlin: Taschen.

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