Some medieval medical books had unusual advice to help improve men’s fertility. Credit: University of Exeter

Men could be held responsible for the failure to produce children as far back as medieval times, a new study of medical and religious texts has shown.

The analysis of popular medical and religious books by the University of Exeter shows that from the 13th century, widely-circulated medical texts recognised the possibility of male infertility, including sterility and 'unsuitable seed'.

A urine test to determine if a husband or a wife was to blame for the absence of children in a marriage was even devised, and medical recipes drawn up as a treatment for men.

It has been widely assumed that women in medieval England were blamed for childlessness and religious discourse about infertility focused on women. If men were deemed responsible for the failure of a couple to produce children, this was in cases of sexual dysfunction where it was obvious the man was unable to have intercourse.

But Dr Catherine Rider, a historian at the University of Exeter, found doctors of the period recognised that sexually-active men might not be able to conceive a child, and evidence that medieval medics were aware of this when treating childless couples.

Dr Rider found evidence that in 13th-15th century England male infertility was viewed as a possibility, not only among those who had studied medicine at a university and could read Latin but among less-educated sections of society reading texts in English.

Learned discussion of male reproductive disorders by medical writers filtered down into a wider audience including medical practitioners. Dr Rider found texts written in the vernacular contained references to male sterility as a possible cause of a woman failing to conceive.

Learned Latin texts were translated, adapted and added to, even influencing English recipe collections which included remedies for childlessness.

For example a 12th century gynaecological treatise entitled the Trotula, by an anonymous author, was circulated widely and translated into English and French. It states that "conception is impeded as much by the fault of the man as by the fault of the women". This widely read book on women's medicine went on to describe male reproductive disorders as being about less visible forms of "sterility" as well as problems relating to erections and emission of sperm.

It quotes an earlier work: 'whether this comes about from a defect of the spirit impelling the seed, or from a defect of spermatic humidity, or from a defect of heat. If from a defect of heat, he will not desire intercourse…if it happens from defect of the spirits he will have no desire and he will not be able to have an erection….if it is because of a defect of the seed, when they have intercourse they emit little or no semen." Meanwhile men with excessively cold and dry testicles had seed that was 'useless for generation. (Translation by Monica Green).

The Trotula also includes a test to see if the 'defect' lay in the man or the woman, which had also appeared in earlier medieval texts. Both should urinate into a pot of bran and the pots should be left for nine or ten days. If worms appeared in one of the pots than he or she was the infertile partner.

The same idea was also found in other medical works. John of Mirfield, a cleric associated with St Bartholomew's Hospital in London in the late 14th century warned in a medical treatise: '"It should be noted that when sterility happens between married people, the males are accused by many people of not having suitable seed".

Some medieval medical books had unusual advice to help improve men's fertility. The Liber de Diversis Medicinis (Book of Diverse Medicines), a collection of medical recipes from the 15th century, said: "If a man wishes that a woman will conceive a child soon take catmint and boil it with wine until it is reduced to a third of its original volume, and give it to him to drink on an empty stomach for three days."

Another book of recipes, now in the Wellcome Library in London, said to stop sterility a person should "Take a pig's testicles, dry and grind them, and give them to drink with wine for three days". It is not clear if the man or woman was supposed to drink the potion.

Such remedies date from 15th century texts, however Dr Rider has found evidence that earlier books recommended the same treatments.

The University of Exeter historian has uncovered a much wider concept of male infertility than was generally recognised by medieval marriage law, which allowed marriages to be annulled on grounds of sexual impotence but not infertility. She did find evidence of men being accused of 'impotence' in church courts but ideas about male reproductive disorders went beyond this.

Dr Rider said: "Although medical texts tended to devote most space to female infertility, male infertility was nonetheless regularly discussed as a possible cause of childlessness in academic texts and by educated medieval medical practitioners, and this information may have been used on occasion when treating childless couples. These books show people had accepted long ago that male reproductive disorders were not just about problems that occurred during sex. We can't fully understand what attitudes were like towards male infertility in the Middle Ages because we have so few records which describe the experiences of people who had reproductive disorders. It is hard to know whether men or women were more likely to seek treatment for infertility in practice. Most of our evidence comes from doctors who discussed what might happen and how to treat these problems."

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