198Chapter 11
protein in youth. The average height of an adult male
was probably not much above five feet, though this dif-
fered widely by class and region.
Disease and Demography
Inadequate nutrition continued to affect population
rates in several ways. The number of live births is deter-
mined in large part by the rate of conception and by
maternal nutrition, both of which are directly related to
diet. A third factor, obstetrical technique, is also impor-
tant but changed little until the revolutionary develop-
ments of the nineteenth and twentieth centuries.
Rates of conception in a given population are de-
termined in part by the total number of childbearing
years available to a woman. Malnutrition, obstetrical
accidents, and epidemic disease shortened life ex-
pectancy and reduced the childbearing years dramati-
cally. They were also reduced by a far higher age of
first menstruation than is now common. Though mar-
riages were sometimes contracted at an early age, espe-
cially among the upper classes, medieval women are
thought to have reached puberty at an average age of
seventeen as opposed to today’s average of 12.4. Nutri-
tion is usually blamed for the difference. Inadequate nu-
trition can also prevent ovulation in mature women,
which probably reduced conception rates even further.
After conception, poor maternal diet led to a high
rate of stillbirths and complications during pregnancy. If
a child were brought to term it then faced the hazards
of childbirth. Babies were normally delivered at home in
unsanitary conditions. The midwives who delivered ba-
bies were often experienced, but they knew nothing of
sterilization and lacked the most elementary equipment
(see illustration 11.1). Forceps, for example, were not
invented until the middle of the eighteenth century.
Though Trotula, a woman physician, taught at the
University of Salerno in the thirteenth century and pub-
lished a treatise on obstetrics, most medieval physicians
were men and knew no more than a competent midwife.
They were, in any case, available only to the rich.
Infants who survived the obstetrical techniques of
the day then faced the possibility that their mothers
would be unable to nurse. Malnutrition interferes with
lactation as does the stress of poverty, exposure to war,
and other forms of physical and mental insecurity. The
problem could be solved by turning the child over to a
wet nurse, but this was not always a satisfactory solution.
The wet nurse was normally another woman in the vil-
lage who had milk to spare because she had recently lost
her own baby. She had to be paid—a serious problem
for a poor woman—and did not always care for the child
as she might have cared for her own. Babies put out for
nursing had a higher mortality rate than those who re-
mained at home. Either way, the children of poorly
nourished mothers were often weak and susceptible to
disease. The birthrate was therefore by modern stan-
dards low and the rate of infant mortality high. Valid sta-
tistics are unavailable for medieval times, but deaths
presumably ranged from 30 to 70 percent in the first two
years of life, depending upon such variables as current
food supply and the presence or absence of epidemics.
In hard times, personal decisions hindered popula-
tion growth as well. Those whose own survival was in
doubt abstained from sex, used the primitive means of
contraception then available (notably coitus interruptus),
or, when all else failed, resorted to infanticide. Abor-
tion, though not unknown, was extremely dangerous,
and most women preferred to carry a child to term
even if they could not afford to keep it. Infanticide mayIllustration 11.1
Midwives at Work.Midwives, or perhaps a midwife assisted
by relatives, are trying to hasten a birth by shaking the mother
up and down. Such obstetric techniques ensured a high rate of
mortality for infants and mothers alike.