Sex reassignment surgery in a turkish medieval manuscript
Medieval images of intersex persons (or hermaphrodites, as they were known) are rare. This has to do with a very simple reason, as intersex persons were living most of the time a perfectly conventional life, as a man or as a woman, there was no reason they should be pictured with specific caracteristics. There might be two exceptions to that : images referring to a the so-called ‘monstrous races’ which included Hermaphrodites, for example on the famous Hereford Map, and medical treaties.
The late XIIIth century is the moment of a severe concurrence between physiologists and surgeons. In the medical tradition, there is a simple explanation of hermaphroditism based on the theory of the seven cells of the uterus (three cells for males, three for females, one for hermaphrodites). But as the new surgical science was developing, the close examination of the form of sexual organs (male and female) started to be discussed in books of surgeons, such as Lanfranc of Milan’s Chirurgia Parva. And in case a person would want or need to change his sexuals organs, operation of masectomia and emasculation could be described. In a Persian manuscript from the Bibliothèque nationale de France, showing the reference manual of surgery from Al-Zahrâwî (Turkish adaptation: Surgery of Ilkhani, Sharaf al-dîn, Cerrâh nâma) the description of the surgical instruments (surgical knife and scalpel) is followed by a technical text about incision illustrated with the example of the gynecomastia of an hermaphrodite person. The operation, described in the image as many other operations, is showing a voluntary person offering his breasts to be cut off, without the help of a assistant, as it sometimes shows.
The operation is described as not uncommon, and followed by the extraction of a tumor (fol. 89v) and hernia (fol. 93r). As many of the classical surgery operation were external, masectomia seem of be considered as the extraction of an excressence of the body. Even though specialists have shown that part of Islamic surgery was theoretical, as there are many testimonies were not always keen on going on surgery, because of the risks, we can notice of how common the practice seem to be.
In the same treaty, an operation of emasculation is described among different surgeries on penis and testicle. It is situated in another part of the treaty, along with sexual operations and childbirth. And while it is clearly shown in the images that operations of vaginal of anal imperforations were performed on children (helped by their parents during the operation), emasculation on hermaphrodite persons are only shown on adults, wearing a short beard on the image.
An image on fol. 110r shows the castration of a person, showing penis as well as testicles; the difference is visible with the image of the hermaphrodite. While these images are standardized, and meant for the purpose of knowledge, they give information about the way these kind of operations were thought if not achieved so often. They were a common part of surgery, performed on willing adults. In both cases, the image of the person is wearing a beard, that is in the Islamic world leaning towards masculinity, as it might have been the best case for an hermaphrodite person, more willingly hoping to be gendered male, with all the advantages it could provide.
Primary Sources :
Galien, De spermate, ed. in Spuri ilibri galeno ascripti, Venice 1597
Sharaf al-dîn, Cerrâh nâma, Paris, Bibliothèque nationale de France, Supplément turc 693. [Images available via the Mandragore server: http://mandragore.bnf.fr/jsp/rechercheExperte.jsp]
Secondary literature :
- Joan Cadden, Meanings of sex differences in the middle ages, Medecine Science and Culture, Cambridge University Press, 1993
- Leah DeVun, “Erecting Sex: Hermaphrodites and the Medieval Science of Surgery,” Osiris 30:1, Scientific Masculinities (2015): 17-37
- Danielle Jacquart and Claude Thomasset, Sexualité et savoir médical au Moyen âge, Puf, 198