LESLEY DEAN-JONES
The medical texts of Greece and Rome span the period from the mid-fifth century B.C.E. to the last years of late antiquity, though some periods are better represented than others. Like the rest of Greco-Roman literature, these writings were overwhelmingly male-authored.1 Unlike the majority of ancient literature, however, the gynecological material within the medical corpora would be derived from and aimed at a female audience. Of course, women’s experience would be refracted through authors and practitioners who were male, but if the latter were to maintain a clientele of any size, they would have to work with images with which women themselves concurred. Thus, if only to a limited extent, the gynecological treatises of antiquity give us some access to women’s perception of themselves.
Moreover, where individual women are mentioned in the medical texts, we catch a glimpse of events and circumstances of the daily life of women from all classes of society. In the Classical period a doctor was called in to attend the niece of a certain Temenes:
The niece of Temenes was asthmatic. The hypochondria seemed strained tight after a time. And if she had an infant, I do not know.
(Epidemics IV. 26; trans. Lesley Dean-Jones, from Littré 1962: 5:170)
Note that even when the patient died (as in this case) the physician avoided using her name and referred to her by her relationship to a man (see also Chapter 3, “Silenced Women”). This comment is interesting in that while the author thought it possible that the woman (probably a young unmarried girl as she is not referred to as somebody’s wife) could have given birth, he forbore to ask, though this information would surely have been relevant to his treatment of the case. He apparently believed that a family might want to conceal the fact that a woman had borne a child, rather than selling her into slavery (see Chapter 3) and tried to work within a delicate situation.
Another incidental remark made by an author challenges the notion that, except for a few clearly defined occasions (see Chapters 1 and 3) unmarried girls were kept secluded until marriage at a young age.
The beautiful maiden daughter of Nerios, twenty years of age, was struck on the front of the head with the flat of the hand by a young female friend while they were playing.2 Upon this she became blind and breathless, and when she got home she immediately developed a fever, her head ached and she was red around the face.
(Epidemics V 50; trans. Lesley Dean-Jones, from Littré 1962: 5:236)
Ancient medical texts, therefore, can be a rich source for women’s social history. The gynecological texts cover pathology, therapy, embryology, and obstetrics. For the purposes of this excursus, however, I will focus on the development of anatomical and physiological theory, suggesting how, in different periods, the dominant medical image of women reflected contemporary conceptions of female nature and women’s role in society. This will bind the excursus together as a coherent unity since most of Herophilus’s extant fragments concerning women are anatomical in nature, and he forms an essential bridge between the medical writings of the Greek and the Roman periods.
The Hippocratic Corpus is the name given to a collection of sixty to seventy medical treatises (many more would have been available in antiquity) written by several anonymous doctors from different parts of the Greek world in the fifth and fourth centuries B.C.E. Because of this diversity of authorship, the corpus does not display any unanimity of doctrine, but in theories concerning women a dominant model can be identified. Eleven of the treatises are specifically gynecological, but women are also mentioned in the general works of the corpus, and in the seven books of the Epidemics (a collection of case histories) one-third of the patients discussed are female.
During the Classical period the artistically ideal proportions for the female body were markedly masculine (see Chapter 2; cf. Fig. 3.26). The medical opinion of the time, however, suggests that it was just as difficult for ordinary women of the period to meet these ideal proportions as it is for average women today to mimic the supposed ideal of feminine beauty. One ancient doctor describes the difference between male and female flesh thus:
I say that a woman’s flesh is more porous and softer than a man's: since this is so, the woman's body draws moisture both with more speed and in greater quantity from the belly than does the body of a man. For if anyone should set clean wool and a piece of cloth which is clean, thickly-woven, and equal in weight to the wool, over water or on top of a damp place for two days and nights, when he takes them off and weighs them, he will discover that the wool is much heavier than the cloth. The reason this happens is that water in a wide-mouthed jar always escapes in an upward direction. Now the wool, on the one hand, because it is both porous and soft, receives more of the escaping water, while the cloth, because it is solid and thickly-woven, will be filled up, although it does not take on much of the escaping water. It is in this way, then, that a woman, because she is more porous, draws more moisture and draws it with greater speed from her belly to her body than does a man.
(Hippocrates: Diseases of Women 1.1; Hanson 1975 572)
Another Hippocratic author describes a type of flesh similar to that of a woman’s body in the glands of a man:
The nature of glands is spongy, and they are porous and fat, and there is no flesh like it in the rest of the body, nor anything else similar in the body, but they are of loose texture and have numerous veins. If you were to cut through one, it would bleed profusely. In appearance they are white and like phlegm, to the touch they are like wool. And if you knead a gland with your fingers and apply considerable force, it gives out an oily liquid and breaks into many pieces and is completely destroyed.
(Glands 1; trans. Lesley Dean-Jones, from Joly 1978: 13:114)
Whereas a man has flesh of this weak nature only in a few appropriate parts of his body, where it serves the specific function of absorbing excess moisture, a woman’s whole physical being is constituted from such flesh. Those surface body parts thought to exhibit this glandular nature in men (that is, the breasts), are further pronounced in women:
The glands on the chest are called breasts and they fill out in those who produce milk, but not in those who do not produce milk. Women do produce milk and men do not. In women the nature of these glands is extremely porous, just like the rest of the body, and the nourishment which they draw to themselves they convert to milk … In men the denseness and compactness of the body contribute greatly to these glands not becoming large. For the male is firm and like close-woven cloth both to the sight and to the touch. But the female is porous and loose and like wool to the sight and touch, with the result that as a porous and soft thing she does not give up moisture, while the male does not absorb any, being compact and hard; moreover, labor strengthens his body so that he does not have anything from which he might take any excess fluid. This account demonstrates that of necessity both the chest and the breasts and the rest of a woman’s body are loose and soft both on account of her inactivity and on account of what has been said. With men the opposite is the case.
(Glands 16; trans. Lesley Dean-Jones, from Joly 1978: 13:121–22)
The author did not believe the excessive porosity of a woman’s body was due to nature alone (although, since it was a part of nature, it could never be completely eradicated), but also to the supposedly inactive lifestyle pursued by women. This point of view is shared by another Hippocratic author:
The males of all species are warmer and drier, and the females moister and colder, for the following reasons: originally each sex was born in such things and grows thereby, while after birth males use a more rigorous regimen, so that they are well warmed and dried, but females use a regimen that is moister and less strenuous, besides purging the heat out of their bodies every month.
(Regimen 1.34; Jones 1979–84: 4:281)
Generally, then, contrary to the pictorial representations of women in the Classical period, the medical texts of the period describe a female body that is rounder, plumper, and softer than a male’s. An exceptionally active woman (and many women would have had a more active life-style than that assumed by the medical texts; see Chapter 2, “The Education of Spartan Women;” Chapter 3, “Women’s Work Outside the Home” and Figure 3.23) might minimize the amount of moisture her body soaked up, but it would still soak up some because of the nature of her flesh. The moisture that resulted from nourishment and that was used to build and maintain the body was blood. Consequently, women were thought to be constantly absorbing blood into their flesh. The blood was stored in the numerous passages of a woman’s flesh until it was evacuated once a month as menstrual fluid. If a women conceived, the menstrual fluid was not evacuated but was drawn on steadily for nourishment by the developing fetus. The fetus itself was constituted when male and female seed intermingled in the woman’s womb. A woman was thought to ejaculate semen directly into her womb when she reached orgasm during sexual intercourse, but despite the numerous therapies in the Hippocratic gynecology for causing women to conceive, there is no indication of how to bring about female orgasm other than the simple act of intercourse. One author advised:
The best time [for conception] is when the menstrual flow has stopped. It is especially during these days that one should see if [a woman] is able to conceive, for they are most successful [for fertility]. If she does not conceive straight away, and everything else is well with her, nothing stops her from going to her husband on other days, for the habit will excite her desire and cause her passages to open. If the ejaculate from the man runs together directly with that from the woman, she will conceive.
(On Diseases of Women 1.17; trans. Lesley Dean-Jones from Littré 1962: 8:56)
Thus, even in a context that demanded female seed, the Hippocratics realized that the time of the month was more significant for conception. As the month progressed, the woman’s passages would become congested with menstrual blood, making it difficult for the seed to be drawn together and ejaculated into the womb.
Greek men generally considered themselves more rational than women and this theory supplied them with anatomical “proof” that by their nature women were predisposed to irrationality. Within the body the passages to the breasts were particularly important in explanations of madness.
There is a thick vein in each breast. These contain the greatest portion of intelligence.… In one who is about to go mad the following is a warning indication: blood collects in the breasts.
(Epidemics II. vi. 19 and 32; trans. Lesley Dean-Jones, Littré 1962:
5:136 and 138)
Since women would always be susceptible to an accumulation of blood in their breasts, this could be taken to account for the supposedly erratic behavior of women, much as culturally stereotyped female behavior today is attributed by some to female hormones.
In a healthy woman, the blood was evacuated from the body once a month through the womb, which actively drew the blood to itself through the passages that led to it and discharged it through the vagina. This process caused most women considerable discomfort, if not actual pain, especially if the passages of the body were still narrow due to the fact that they had not been broken down by the copious lochial flow that takes place after giving birth. However, it was even worse for a woman if menstruation did not take place, for then the menses could flow out of her womb back through her body via the passages and accumulate in various sites, causing a variety of illnesses. Often the accumulation of menstrual blood manifested itself not in a physical illness but in aberrant behavior. Virgins whose cervix had not yet been opened by the warmth, friction, and moisture of sexual intercourse were apt to try to hang themselves and jump down wells because of the blood that accumulated around their hearts. This reflects the cultural association of female puberty with both marriage and death. Further evidence of the power of menstrual blood to affect the mind is shown in the case histories of two women suffering similar symptoms. Both suffered some mental derangement, as evidenced by rambling and the uttering of obscenities—a feature of some female rituals (see Chapter 3, “Civic Religion”). One woman is cured when menstruation takes place; the other never menstruates and dies.
In Thasos a woman of gloomy temperament, after a grief with reason for it, without taking to bed, lost sleep and appetite and suffered thirst and nausea. She lived near the place of Pylades on the plain.
First day. As night began there were fears, much rambling, depression and slight feverishness. Early in the morning frequent convulsions; whenever these frequent convulsions intermitted, she wandered and uttered obscenities; many pains, severe and continuous.
Second day. Same symptoms; no sleep; fever more acute.
Third day. The convulsions ceased, but were succeeded by coma and oppression, followed in turn by wakefulness. She would jump up; could not restrain herself; wandered a great deal; fever acute; on this night a copious, hot sweating all over; no fever; slept, was perfectly rational, and had a crisis.3 About the third day urine black and thin, with particles mostly round floating in it, which did not settle. Near the crisis copious menstruation.
In Thasos the wife of Delearces, who lay sick on the plain, was seized after a grief with an acute fever with shivering. From the beginning she would wrap herself up, and throughout, without speaking a word, she would fumble, pluck, scratch, pick hairs, weep and then laugh, but she did not sleep; though stimulated the bowels passed nothing. She drank a little when the attendants suggested it. Urine thin and scanty; fever slight to the touch; coldness of the extremities. .
Ninth day. Much wandering followed by return to reason; silent.
Fourteenth day. Respiration rare and large with long intervals, becoming afterwards short.
Seventeenth day. Bowels under a stimulus passed disordered matters, then her very drink passed unchanged; nothing coagulated. The patient noticed nothing; the skin tense and dry.
Twentieth day. Much rambling followed by recovery of reason; speechless; respiration short.
Twenty-first day. Death.
The respiration of this patient throughout was rare and large; took no notice of anything; she constantly wrapped herself up; either much rambling or silence throughout.
(Epidemics III.17, cases 11 and 15; Jones 1979–84: 1:277, 283–85)
In Hippocratic theory the physical differences between men and women accounted for women’s physical and mental inferiority to men. However, that women menstruated meant that they had a self-regulating purging mechanism which prevented them falling as seriously ill or being afflicted with life-threatening diseases as readily as men. To this extent the Hippocratics viewed menstruation as a good thing for all women, and in fact may have tried to emulate it by venesection and other forms of purging in men.
Though many women fell ill, they were fewer than the men and less frequently died. But the great majority had difficult childbirth and after giving birth they would fall ill and these especially died, as did the daughter of Telebulus on the sixth day after delivery. Now menstruation appeared during the fevers in most cases, and with many maidens it occurred then for the first time. Some bled from the nose.4 Sometimes both epistaxis and menstruation appeared together; for example, the maiden daughter of Daitharses had her first menstruation during fever and also a violent discharge from the nose. I know of no woman who died if any of these symptoms showed themselves properly, but all to my knowledge had abortions if they chanced to fall ill when with child.
(Epidemics 1.16; Jones 1979–84: 1:171)
Another aspect of female anatomy that was seen as a threat to female health and a cause of erratic behavior was her womb. The Hippocratics believed that if a woman’s womb became too dry and light because she was not having enough intercourse, the womb could be attracted to the moister organs of her body—her liver, heart, brain, diaphragm, or bladder. If it settled on any of the first four of these a woman could become voiceless, lose consciousness, or exhibit any of those symptoms we designate by the word “hysteria.”5
If suffocation occurs suddenly, it will happen especially to women who do not have intercourse and to older women rather than to young ones, for their wombs are lighter. It usually occurs because of the following: when a woman is empty and works harder than in her previous experience, her womb, becoming heated from the hard work, turns because it is empty and light. There is, in fact, empty space for it to turn in because the belly is empty. Now when the womb turns, it hits the liver and they go together and strike against the abdomen—for the womb rushes and goes upward towards the moisture, because it has been dried out by hard work, and the liver is, after all, moist. When the womb hits the liver, it produces sudden suffocation as it occupies the breathing passages around the belly.
Sometimes, at the same time the womb begins to go toward the liver, phlegm flows down from the head to the abdomen (that is, when the woman is experiencing the suffocation) and sometimes, simultaneously with the flow of phlegm, the womb goes away from the liver to its normal place and the suffocation ceases. The womb goes back, then, when it has taken on moisture and has become heavy.… Sometimes, if a woman is empty and she overworks, her womb turns and falls toward the neck of her bladder and produces strangury—but no other malady seizes her. When such a woman is treated she speedily becomes healthy; sometimes recovery is even spontaneous.
In some women the womb falls towards the lower back or towards the hips because of hard work or lack of food, and produces pain.
(Hippocrates: Diseases of Women 1.7; Hanson 1975: 576)
If the womb did not return to its proper place spontaneously there were various measures a doctor could follow to draw it back. One of the most common was to use sweet and foul-smelling substances at either end of a woman—sweet to entice the womb in the direction it should go, foul to drive it from the place where it had lodged.
Whenever the womb falls against the hypochondria, it causes suffocation. When in this case the crisis of the disease occurs, hot and bitter vomiting seizes the patient, and though she gets better for a short time, then piercing pain seizes her head and throat. Apply fomentations, if the suffocation is in the upper part of the body. Under the nose burn foul-smelling substances gradually, for if they are burned en masse the womb is displaced to the lower parts of the body and trouble follows. Burn sweet-smelling substances below the woman. And give her castor and fleabane to drink. When the womb is drawn down the body, fumigate the woman from beneath with putrid substances and burn sweet-smelling substances under her nose.
(On Diseases of Women 11.125; trans. Lesley Dean-Jones
from Littré 1962: 8:268)
There were other more mechanical means of treating a womb that had become displaced (such as bandaging a woman tightly beneath her breasts and applying pressure to the offending organ if it moved up the body, or hanging a woman upside-down on a ladder if it prolapsed) but the apparent favor in which odor-therapies were held suggests that the womb itself was thought to be endowed with some sense of smell. Accordingly, the Hippocratics conceived of the female reproductive organ as an entity within a woman that had a consciousness of its own beyond her control.
The philosopher Aristotle (384–322 B.C.E.) was a contemporary of some of the later Hippocratics and disputed their understanding of the female body. He was not a doctor, but took a particular interest in natural history. As a result, he was less concerned with pathology than were the Hippocratics and used his researches (including dissections) on other animals for comparative purposes and to supplement his knowledge of the human body. His theories and observations pertaining to the female body are recorded primarily in his major biological treatises.
Aristotle differed from the Hippocratics in seeing a closer resemblance between the bodies of men and women. He believed the difference between the two sexes lay simply in the amount of heat in their bodies. The hotter a body was the more it could “concoct” the food it ate into blood, and the easier it could convert this blood into flesh, hair, nails, etc., and perfect its form. Aristotle believed that the male was demonstrably more perfect than the female in almost all species.
As a general rule, in red-blooded animals furnished with feet and not oviparous, the male is larger and longer-lived than the female.… Furthermore, in all animals the upper and front parts are better, stronger and more thoroughly equipped in the male than in the female, whereas in the female those parts are the better that may be termed hinder-parts or underparts. And this statement is applicable to man and to all vivipara that have feet. Again, the female is less muscular and less compactly jointed, and more thin and delicate in the hair—that is, where hair is found; and where there is no hair, less strongly furnished in some analogous substance. And the female is more moist of flesh, and more knock-kneed, and the shin-bones are thinner; and the feet are more arched and hollow in such animals as are furnished with feet. And with regard to voice, the female in all animals that are vocal has a thinner and sharper voice than the male; except, by the way, with kine, for the lowing and bellowing of the cow has a deeper note than that of the bull. With regard to organs of defence and offence, such as teeth, tusks, horns, spurs, and the like, these in some species the male possesses and the female does not; as, for instance, the hind has no horns and where the cock-bird has a spur the hen is entirely destitute of the organ; and in like manner the sow is devoid of tusks. In other species such organs are found in both sexes, but are more perfectly developed in the male; as, for instance, the horn of the bull is more powerful than the horn of the cow.
(History of Animals 538a22–24 and 538bl–25; Thompson 1984: 1:851)
Aristotle believed male upper-body strength is relevant because it mirrors the disposition of the natural order of the universe in which more honorable objects are placed above and before those things less worthy of honor. Of the two sexes, then, the male was the more perfect representative of any species and as such was also the hotter.
As a more perfect animal would use up most of its nourishment in building a bigger, stronger, better equipped body, it would have less left over to be further concocted into seminal residue. Its greater amount of heat working on this smaller amount of material could produce a very potent hot fluid, so hot that it was capable of passing on the form of the animal into a new individual. This ability to pass on its form to another is what made an animal “complete.” In humans a man was complete when he could concoct white hot semen. A woman’s cooler body could only concoct blood into menstrual fluid, which remained bloody in appearance, though it was capable of carrying more of the human soul than ordinary blood.6 Because of her incapacity to fully concoct blood to the point it could carry the soul of a new individual, Aristotle termed woman a “deformed man.”
Just as it sometimes happens that deformed offspring are produced by deformed parents, and sometimes not, so the offspring produced by a female are sometimes female, sometimes not, but male. The reason is that the female is as it were a deformed male.
(Generation of Animals 737a25–28; Peck 1979: 175)
Aristotle did not mean that women were deformed because of their physical appearance. The aspect in which they were “deformed” (vital heat) had far-reaching effects because it was the very principle of generation. It was because of this “deformity” that women were weaker; their weakness was not, in itself, their deformity.
The most important physical result of a woman’s lesser heat and her inability to concoct her seminal residue was the menstrual flow. Unlike the Hippocratics, Aristotle did not think menstruation was beneficial for all women. For some women it could seriously weaken the body.
After puberty some lads who were thin before grow stout and healthy, and the converse also happens; and the same is equally true of girls. For when in boy or girl the body is loaded with superfluous matter, then, when such superfluities are got rid of in the spermatic or menstrual discharge, their bodies improve in health and condition owing to the removal of what had acted as an impediment to health and proper nutrition; but in such as are of opposite habit their bodies become emaciated and out of health, for then the spermatic discharge in the one case and the menstrual flow in the other take place at the cost of natural healthy conditions.
(History of Animals 581b26–582a5; Thompson 1984: 911)
In fact, Aristotle viewed menstruation as a distressing time for all women.
With those in whom the ailment [that is, menstruation] lasts but a little while, two days or three, recovery is easy; but where the duration is longer, the ailment is more troublesome. For women are ailing during these days; and sometimes the discharge is sudden and sometimes gradual, but in all cases alike there is bodily distress until the attack be over.
(History of Animals 582b5–9; Thompson 1984: 912)
Moreover, Aristotle thought that the human female was smaller and weaker than the human male to a degree not observable in other animals because in women a comparatively larger amount of their nourishment was directed to their seminal residue than to building their own bodies. Here Aristotle is confusing menstruation and the estrus discharge of other mammals, which is much smaller in volume.
The discharge is wont to be more abundant in women than in the females of any other animals … in such animals the females are sometimes larger than the males.
(History of Animals 582b29–33; Thompson 1984: 913)
The lack of vital heat meant that a woman could not exhibit the perfect human form in the intellectual arena either. She could not perfect the supremely human faculty of deliberation, and so she remained naturally subject to men as ruled to ruler (see Chapter 3, “Ancient Critical Reactions to Women’s Roles in Classical Athens”). Elsewhere Aristotle lists traits that are typical of male and female.
In all cases, excepting those of the bear and leopard, the female is less spirited than the male; in regard to the two exceptional cases, the superiority in courage rests with the female. With all other animals the female is softer in disposition, is more mischievous, less simple, more impulsive, and more attentive to the nurture of the young; the male, on the other hand, is more spirited, more savage, more simple and less cunning. The traces of these characters are more or less visible everywhere, but they are especially visible where character is more developed, and most of all in man.
The fact is, the nature of man is the most rounded off and complete and consequently in man the qualities above referred to are found most clearly. Hence woman is more compassionate than man, more easily moved to tears, at the same time is more jealous, more querulous, more apt to scold and to strike. She is, furthermore, more prone to despondency and less hopeful than the man, more void of shame, more false of speech, more deceptive, and of more retentive memory. She is also more wakeful, more shrinking, more difficult to rouse to action and requires a smaller quantity of nutriment.
As was previously stated, the male is more courageous than the female, and more sympathetic in the way of standing by to help. Even in the case of cephalopods, when the cuttlefish is struck with the trident the male stands by to help the female; but when the male is struck the female runs away.
(History of Animals 608a32–bl9; Thompson 1984: 773–75)
Thus, not only did the lack of heat cause women to be weaker and less intelligent than men, but it also resulted in those negative personality traits associated with women since the Archaic period.
A body that was going to be able to concoct semen developed testicles, spermatic passages, and a penis. A body that would only be able to concoct blood into menstrual fluid developed a womb and a vagina.
Now male and female differ in respect of their logos, in that the power or faculty possessed by the one differs from that possessed by the other; but they differ also to bodily sense, in respect of certain physical parts. They differ in their logos, because the male is that which has the power to generate in another (as was stated above), while the female is that which can generate in itself, i.e., it is that out of which the generated offspring, which is present in the generator, comes into being. Very well, then: they are distinguished in respect of their faculty, and this entails a certain function. Now for the exercise of every function instruments are needed, and the instruments for physical faculties are the parts of the body. Hence it is necessary that, for the purpose of copulation and procreation, certain parts should exist, parts that are different from each other, in respect of which the male will differ from the female; for although male and female are indeed used as epithets of the whole animal, it is not male or female in respect of the whole of itself, but only in respect of a particular faculty and a particular part—just as it is “seeing” and “walking” in respect of certain parts—and this part is one which is evident to the senses. Now in the female this special part is what is called the uterus, and in the male the regions about the testes and the penis.
(Generation of Animals 716al8–34; Peck 1979: 11–13)
Although uterus and penis were different organs fulfilling different functions, the complementary nature of their roles led to a certain similarity of formation.
The uterus is always double without exception, just as in males there are always two testes without exception.… Now in males the seminal passages must have a fixed position and not stray about, and the same is true of the uterus in females.
(Generation of Animals 716b32–33 and 720al2–14; Peck 1979: 17 and 41)
Obviously, here Aristotle is challenging the Hippocratic conception of a mobile womb. The belief that the womb was “double” (that is, contained two compartments) was generally accepted throughout antiquity and was often cited to explain the occurrence of twins. This image may have developed from some rudimentary knowledge of the Fallopian tubes (particularly as the compartments are often referred to as “horns”), but neither Aristotle nor any author before Herophilus describes the Fallopian tubes per se. It is possible, however, that Aristotle observed ovaries in pigs.
The ovaries of sows are excised with the view of quenching in them sexual appetites and of stimulating fatness. The sow has first to be kept two days without food, and, after being hung up by the hind legs, it is operated on; they cut the lower belly, about the place where the boars have their testicles, for it is there that the ovary grows, adhering to the two divisions of the womb; they cut off a little piece and stitch up the incision. Female camels are mutilated when they are wanted for war purposes, and are mutilated to prevent their being got with young.
(History of Animals 632a21–28; Thompson 1984: 982)
The result of removing the ovaries might lead one to expect that Aristotle would develop a theory of some parallelism between the function of these female organs and the male testicles, but in Aristotle’s philosophy this was impossible. The testicles were involved in the production of semen, which by definition women were incapable of producing. The fact that the Greek word translated as “ovaries” is a singular term (kapria) indicates that, if it indeed designates the ovaries, their duality was not considered significant; that is, they were not generally looked upon as analogous to testicles, which were often designated by the term “twins” (didymi).
So, while Aristotle acknowledged that female bodies were much more similar to men’s than the Hippocratics had allowed, the point at which male and female diverged—vital heat—had far-reaching consequences in the female that justified women’s physical and intellectual subordination to men.
Herophilus lived and worked at Alexandria at the end of the fourth and the beginning of the third century B.C.E. Unlike any of his predecessors, or successors until the late thirteenth century C.E., Herophilus was able to dissect the human body. We know from various testimony that he was particularly interested in gynecological matters, but we do not have the same extensive works for him as we do for the Hippocratics and Aristotle. What has survived is chiefly fragmented quotations on specific contentious issues in antiquity, and most of those dealing with women are anatomical in nature.
Although, as a physician, he considered himself to be following in the tradition of Hippocrates, where the difference between male and female was concerned he accepted Aristotle’s theory that the significant fact was that males possessed greater heat. Even the womb, the definitively female organ, was formed from the same materials as the rest of the human body and was subject to the same principles of health and disease.
And in his Midwifery Herophilus says that the uterus is woven from the same thing as the other parts, is regulated by the same faculties, has the same material substances at hand, and is caused to be diseased by the same things, such as excessive quantity, thickness, and disharmony in similars. Accordingly, says Herophilus, there is no affection peculiar to women, except conceiving, nourishing what has been conceived, giving birth, “ripening” the milk, and the opposites of these.
(Soranus, Gynecology III.3; von Staden 1989: 365)
Moreover, like Aristotle, he observed a certain parallelism between the male and female reproductive tract. The parallelism he noted, however, far exceeds anything described by Aristotle.
In females the two “testicles” [that is, ovaries] are attached to each of the two shoulders of the uterus, one on the right, the other on the left, not both in a single scrotum but each of the two separate, enclosed in a thin membranous skin. They are small and rather flat, like glands, sinewy at their surrounding covering, but easily damageable in their flesh, just like the testicles of males. In mares they are also quite sizeable. And they are attached to the uterus with no small number of membranes and with a vein and an artery implanted from the uterus into these “testicles.” You see, the attachment is from the vein and the artery that go to each of the two “testicles,” a vein from the vein and an artery from the artery.
The spermatic duct [that is, Fallopian tube] from each “testicle” is not very apparent, but it is attached to the uterus from the outside, one duct from the right, the other from the left. Like the seminal duct of the male, its anterior part is also convoluted, and almost all the rest up to its end looks varicose. And the spermatic duct from each “testicle” grows into the fleshy part of the neck of the bladder, just like the male duct, being thin and winding in its anterior part where it touches the hipbones. Here [at the neck of the bladder] it also terminates, like the pudendum penetrating to the interior from either side.
(Galen, On the Seed II. 1; von Staden 1989: 185–86)
Herophilus thus recognized organs in the female analogous to testicles in the male, and that there were ducts leading from these organs. But although he describes the ducts as being attached to the uterus, they empty out (as do the male ducts, which discharge their seed into the penis for ejaculation) into the neck of the bladder, whence the female seed will be voided from the body. Following a theory articulated by Apollo in Aeschylus’ Eumenides (see Chapter 4) and established as the medical norm by Aristotle, Herophilus believed that a woman’s only contribution to reproduction was the menstrual fluid, so female seed was unnecessary for conception; it therefore had to be diverted past the uterus. Unfortunately, we do not know what function, if any, Herophilus believed female seed fulfilled.
Herophilus’s view on menstruation was also much closer to Aristotle’s than to the Hippocratics’. In fact, whereas the Hippocratics believed the onset of menstruation was invariably a cure for any disease a woman was suffering, Herophilus believed it could make a woman susceptible to falling ill.
Herophilus, however, says that at certain times and for certain women, menstruation is harmful. Some women, he says, are actually in a state of unimpeded health when they are not menstruating, whereas the opposite often happens while they are menstruating: they become paler and thinner and contract the beginnings of diseases. At other times, however, and in certain cases, menstruation is beneficial, so that women who previously were wan and emaciated, later, after menstruation, have good colour and are well nourished.
(Soranus, Gynecology 1.29; von Staden 1989: 374)
By the Hellenistic period, then, the bodies of women were considered far more analogous to the bodies of men than they had been in the Classical period, which may have bolstered the increased autonomy many women enjoyed in affairs that had traditionally been reserved for men (see Chapter 5, “Women in Public”). But this assimilation of the interior space of the two sexes contrasts sharply with the development in the artistic representation of the female, which in the Hellenistic period began to diverge from the masculinized proportions of the Classical era (see Chapter 5, Figs. 5.16 and 5.17).
Herophilus was extremely influential on succeeding generations of physicians, particularly in descriptions and understandings of the female reproductive system. He had written a practical manual for midwives (incidentally indicating that he expected at least some of them to be able to read and that he viewed them as colleagues rather than as rivals7) and in this he was followed by the Greek doctor Soranus, who lived at Rome at the beginning of the second century C.E. The confidence Soranus placed in midwives is shown in his discussion of what makes the best midwives.
It is necessary to tell what makes the best midwives, so that on the one hand the best may recognize themselves, and on the other hand beginners may look upon them as models, and the public in time of need may know whom to summon. Now generally speaking we call a midwife faultless if she merely carries out her medical task; whereas we call her the best midwife if she goes further and in addition to her management of cases is well versed in theory. And more particularly, we call a person the best midwife if she is trained in all branches of therapy (for some cases must be treated by diet, others by surgery, while still others must be cured by drugs); if she is moreover able to prescribe hygienic regulations for her patients, to observe the general and the individual features of the case, and from this to find out what is expedient, not from the causes or from the repeated observations of what usually occurs or something of the kind.… And it is not absolutely essential for her to have borne children, as some people contend, in order that she may sympathize with the mother because of her experience of pain; for (to have sympathy) is (not) more characteristic of a person who has given birth to a child.
(Gynecology 1.4; Temkin 1956: 6)
Soranus, therefore, seems to imagine midwives performing much the same service as a doctor would, with some education in theory and with the same capacity for intelligent observation and decision making.
Soranus himself had never dissected a human body (and is, indeed, rather dismissive of the benefits to be gained from it), but he follows Herophilus’s description of the disposition of the ovaries, uterus and “spermatic ducts.” However, he goes a little further in likening the cervix and vagina to the penis and the prepuce, again, basing his description on analogy with the male.
Furthermore, the “testicles” are attached to the outside of the uterus, near its isthmus, one on each side. They are of loose texture, and like glands are covered by a particular membrane. Their shape is not longish as in the males; rather they are slightly flattened, rounded and a little broadened at the base. The spermatic duct runs from the uterus through each “testicle” and extending along the sides of the uterus as far as the bladder, is implanted in its neck. Therefore, the female seed seems not to be drawn upon in generation since it is excreted externally.… [The vagina] is a sinewy membrane, almost as round as the intestine, comparatively wide inside, comparatively narrow at the external end; and it is in the vagina that intercourse takes place. The inner part of the vagina grows around the neck of the uterus like the prepuce in males around the glans.
(Gynecology 1.12 and 16; Temkin 1956: 11–12, 14)
Although, like Herophilus, Soranus does not believe the female semen ever enters the womb and contributes to conception, he does give us an explanation of the significance of women becoming excited during intercourse and releasing their fluid.
Just as without appetite it is impossible for the seed to be discharged by the male, in the same manner, without appetite it cannot be conceived by the female. And as food swallowed without appetite and some aversion is not well received and fails in its subsequent digestion, neither can the seed be taken up or, if grasped, be carried through pregnancy, unless urge and appetite for intercourse have been present. For even if some women who were forced to have intercourse have conceived, one may say with reference to them that in any event the emotion of sexual appetite existed in them too, but was obscured by mental resolve….
As movement of the whole body is wont to provoke sweating, whereas lack of motion holds it back and prevents it, and as the performance of the vocal function stimulates to an increased excretion the saliva which by nature accompanies the passage of the breath—in the same way, during intercourse the associated movement around the female genitals relaxes the whole body. And for this reason it also relaxes the uterus.
(Gynecology 1.37 and 31; Temkin 1956: 36, 28)
As far as a material contribution to conception was concerned, however, Soranus concurred in the theory of Aristotle and Herophilus that the only thing a woman contributed was her menstrual fluid. Indeed, he advises prospective bridegrooms to inquire into a woman’s menstrual flow, among other things, before marrying her.
Since women usually are married for the sake of children and succession, and not for mere enjoyment, and since it is utterly absurd to make inquiries about the excellence of their lineage and the abundance of their means but to leave unexamined whether they can conceive or not, and whether they are fit for childbearing or not, it is only right for us to give an account of the matter in question. One must judge the majority from the ages of 15 to 40 to be fit for conception, if they are not mannish, compact and oversturdy, or too flabby and very moist.… Furthermore they seem fit if their uteri are neither very moist or dry, not too lax or constricted, and if they have their catharsis regularly, not through some moisture or ichors of various kinds, but through blood and of this neither too much, nor, on the other hand, extremely little. Also those in whom the orifice of the uterus is comparatively far forward and lies in a straight line.
(Gynecology 1.34; Temkin 1956: 32)
It is difficult to imagine many bridegrooms seeking such information from the family of a young girl. Presumably, in cases where he did, an independent expert, probably a midwife, would have to be engaged to examine the woman.
Soranus did not believe menstruation served any useful purpose beyond procreation. In this he went beyond Herophilus who had thought it beneficial for some women.
In regard to health menstruation is harmful to all, although it affects delicate persons more, whereas its harmfulness is entirely hidden in those who possess a resistant body. Now, we observe that the majority of those not menstruating are rather robust, like mannish and sterile women. And the fact that they do not menstruate any more does not affect the health of women past their prime, nay on the contrary, the drawing off of blood makes the majority more delicate. Besides, virgins not yet menstruating would necessarily be less healthy; if, on the other hand, they enjoy perfect health, menstruation, consequently, does not contribute to their health, but is useful for childbearing only; for conception does not take place without menstruation.
(Gynecology 1.29; Temkin 1956: 26–27)
It is interesting to note that in some sense Soranus considers sterile women to be healthier than those who can bear children. He admits that if menses are impeded they cause disease, but he claims it is the impediment that has to be treated. Simply bringing on the menses will not cure a woman, nor keep her healthy. He does not, however, go so far as some other “persons of distinction” who contended that menstruation is purely pathological, resulting from an ulcerated uterus.
Menstruation does not occur because the uterus is ulcerated, rather it occurs through diapedesis and profuse perspiration, in the same manner in which the gums too, when rubbed, emit blood without ulceration and as in fractures without wounds we find the bandages bathed in blood when the dressing is changed.
(Gynecology 1.28; Temkin 1956: 25)
The lessening of the importance of menstruation in defining what it was to be a woman, to the point where some thought it was the pathological product of an ulcerated womb, may go some way to explaining the increased awe and disgust in which menstruation seems to be held in the Roman period. A person could now be a healthy woman without menstruating (though she might be sterile). In some ways this could make the regular monthly appearance of blood seem inexplicable and frightening. Pliny, a nonmedical encyclopedist of the first century C.E., says there is nothing more remarkable than the periodic bleeding of women, and he lists among its attributes the capability of withering plants, stopping hail, killing caterpillars, removing bitumen, dimming mirrors, blunting knives, souring wine, drying up seeds, and driving dogs mad. His description of the effects of menstrual blood was used by the Inquisition during the Renaissance to identify witches.
Like Herophilus, Soranus does not indicate that he believed woman shared any particular behavioral characteristics because they shared anatomy, and although he believes they share “conditions” that can be termed gynecological, these are restricted to their reproductive tract. In other aspects their bodies are just like men’s.
Now we say that there exist natural conditions in women peculiarly their own (as conception, parturition, and lactation if one wishes to call these functions conditions), whereas conditions contrary to nature are not generically different but only in a specific and particular way. For in regard to generic differences, the female has her illness in common with the male, she suffers from constriction or from flux, either acutely or chronically, and she is subject to the same seasonal differences, to gradations of disease, to lack of strength, and to the different foreign bodies, sores, and injuries. Only as far as particulars and specific variations are concerned does the female show conditions peculiarly her own, i.e. a different character of symptoms. Therefore she is subject to treatment generically the same.
(Gynecology 111.5; Temkin 1956: 132)
Soranus believed all the illnesses in the body resulted from some part of the body being in either a constricted or a lax state. In therapy what was constricted had to be relaxed, what was lax had to be tightened. Relocation of the womb was not a possible source of disease. However, Soranus did believe that the womb was particularly susceptible to constriction, and he recognized the female disease “hysterical suffocation,” connecting it with what were perceived as abnormalities in a woman’s life.
Hysterical suffocation has been named after both the affected organ and one symptom, viz. suffocation. But its connotation is: obstructed respiration together with aphonia and a seizure of the senses caused by some condition of the uterus. In most cases the disease is preceded by recurrent miscarriages, premature birth, long widowhood, retention of menses and the end of ordinary childbearing or inflation of the uterus.… The hysterical disease, on account of the aphonia and seizure of the senses, is related to epilepsy, apoplexy, catalepsy, lethargy and the aphonia caused by worms.… The majority of the ancients and almost all followers of other sects have made use of ill-smelling odors (such as burnt hair, extinguished lamp wicks, charred deer’s horn, burnt wool, burnt flock, skins and rags, castoreum with which they anoint the nose and ears, pitch, cedar resin, bitumen, squashed bed bugs, and all substances which are supposed to have an oppressive smell) in the opinion that the uterus flees from evil smells. Wherefore they have also fumigated with fragrant substances from below, and have approved of suppositories of spikenard (and) storax, so that the uterus fleeing the first mentioned odors, but pursuing the last-mentioned might move from the upper to the lower parts.… We, however, censure all these men who start by hurting the inflamed parts and cause torpor by the effluvia of ill-smelling substances. For the uterus does not issue forth like a wild animal from the lair, delighted by fragrant odors and fleeing bad odors; rather it is drawn together because of the stricture caused by the inflammation.
(Gynecology III.26 and 29; Temkin 1956: 149, 152, 153)
Like Soranus and Galen, Aretaeus the Cappadocian, as his epithet suggests, was born in the eastern Empire, and like the two more famous physicians, Aretaeus probably made his name at Rome. We are not sure when he lived, but neither does he mention Galen (which due to Galen’s enormous authority any medical writer coming after him was almost obligated to do) nor does Galen mention him, though he mentions by name virtually every earlier medical writer with whose theories he disagrees. It is generally assumed, therefore, that the two were close contemporaries and as such did not refer to each other’s work in what seems to have been a convention of the time. This would place Aretaeus in the second century C.E. Aretaeus’s extant works focus on specific acute and chronic diseases and the corresponding therapies. In discussing “hysterical suffocation,” Aretaeus goes further than any previous medical writer in animating the womb.
In the middle of the flanks of women lies the womb, a female viscus, closely resembling an animal; for it is moved of itself hither and thither in the flanks, also upwards in a direct line to below the cartilage of the thorax, and also obliquely to the right or to the left, either to the liver or spleen; and it likewise is subject to prolapsus downwards, and, in a word, it is altogether erratic. It delights, also, in fragrant smells, and advances towards them; and it has an aversion to fetid smells, and flees from them; and, on the whole, the womb is like an animal within an animal.… The affection occurs in young women, but not in old. For in those in whom the age, mode of life, and understanding is more mobile, the uterus also is of a wandering nature; but in those more advanced in life, the age, mode of living, understanding, and the uterus are of a steady character. Wherefore this suffocation from the womb accompanies females alone.
The uterus in women has membranes extended on both sides at the flanks, and also is subject to the affections of an animal in smelling; for it follows after fragrant things as if for pleasure, and flees from fetid and disagreeable things as if for dislike. If, therefore, anything annoy it from above, it protrudes even beyond the genital organs. But if any of these things be applied to the os, it retreats backwards and upwards. Sometimes it will go to this side or that—to the spleen and liver, while the membranes yield to the distention and contraction like the sails of a ship.
(On the Causes and Symptoms of Acute Diseases 11.11 and Therapeutics of
Acute Diseases 11.10; Adams 1972: 285–87 and 449)
Here we can see how ingrained was the belief that female anatomy caused stereotypical irrational female behavior in that a physician who accepted the anatomical discovery of the membranes holding the womb in place still blamed the willful movements of that organ for producing erratic behavior in women.
The most authoritative individual medical author in antiquity, and into the Renaissance, was Galen, a native of Pergamum who was active in Rome from the mid- to the late second century C.E. He was an extremely prolific writer, but he did not concern himself particularly with gynecological matters, perhaps because he believed that male and female bodies could be viewed as the same for all but reproductive purposes. He went even further than Soranus in assimilating male and female genitalia.
The female is less perfect than the male for one, principal reason—because she is colder; for if among animals the warm one is the more active, a colder animal would be less perfect than a warmer. A second reason is one that appears in dissecting …
All the parts, then, that men have, women have too, the difference between them lying in only one thing, namely, that in women the parts are within [the body] whereas in men they are outside, in the region called the perineum. Consider first whichever ones you please, turn outward the woman’s, turn inward, so to speak, and fold double the man’s, and you will find them the same in both in every respect. Then think first, please, of the man’s turned in and extending inward between the rectum and the bladder. If this should happen, the scrotum would necessarily take the place of the uteri, with the testes lying outside, next to it on either side; the penis of the male would become the neck of the cavity that had been formed; and the skin at the end of the penis, now called the prepuce, would become the female pudendum [vagina] itself. Think, too, please, of the converse, the uterus turned outward and projecting. Would not the “testicles” then necessarily be inside it? Would it not contain them like a scrotum? Would not the neck [the cervix], hitherto concealed inside the perineum but now pendent, be made into the male member? And would not the female pudendum, being a skinlike growth upon this neck, be changed into the part called the prepuce? It is also clear that in consequence the position of the arteries, veins, and spermatic vessels would be changed too. In fact, you could not find a single male part left over that had not simply changed its position; for the parts that are inside in woman are outside in man. You can see something like this in the eyes of the mole, which have vitreous and crystalline humors and the tunics that surround these and grow out from the meninges, as I have said, and they have these just as much as animals do that make use of their eyes. The mole’s eyes, however, do not open, nor do they project but are left there imperfect and remain like the eyes of other animals when these are still in the uterus.
(On the Usefulness of the Parts of the Body XIV.6; May 1968: 628–29)
It is clear from the analogy to the mole’s eyes that Galen did not mean that the female genitalia were the male’s “inside out.” The scrotum and the penis had been translated upwards—hence the need to add the injunction to “fold double” the male’s to produce the female organs. The reason women’s genitalia remained inside their bodies was that they did not have sufficient heat to “perfect” them, that is, cause them to project from her body. In a sense, however, this lack of perfection was a piece of perfect planning on the part of nature, for it was only the position of the uterus that permitted human reproduction.
In the female [Nature] has located the uterus below the stomach, because she found that this place is best for sexual intercourse, for receiving the semen, and also for the growth of the fetus and its birth when it has been perfected. For you would not find any place in the whole body of the animal more suitable for any of these uses I have mentioned; it is best for coitus because it is far removed from the instruments of the face, most opportune for the growth of the fetus because it can be very greatly distended without pain, and most useful for birth because the fetus will emerge more easily if its exit is directed downward and is near the legs.
(On the Usefulness of the Parts of the Body XIV.3; May 1968: 622)
Near the beginning and the end of his career Galen wrote treatises on the anatomy of the uterus. He tells us that his earlier effort (which we no longer have, though the later treatise may be a reworked version) was written for midwives, showing that he, like Herophilus and Soranus, expected midwives to be educated, literate, and concerned with more than simply pragmatic knowledge about the female body. In describing the positioning of the womb within the body of the woman, Galen makes clear that he believes the relocation of the womb to any other part of the body is impossible. In fact, his description reads almost as if he is trying to hold a very slippery customer prisoner.
The uterus is fused with some [structures], attached to others, suspended from others; some entwine it, some support it; it is fused with the neck of the bladder and rectum at the vagina, as well as with the “testicles” and the spermatic ducts, but it may be said to be attached to the other parts of the bladder and the rectum, to be attached to and suspended from the sacred bone, but suspended only from the spinal marrow and lumbar muscles; both suspended from, fused with, and entwined with nerves; suspended from, fused with, interwoven, and entwined with arteries and veins.
(On the Anatomy of the Uterus 4; Goss 1962: 79)
This description may have been a direct challenge to the mobility attributed to the womb by Aretaeus. However, although Galen had imprisoned the womb so tightly, he still believed women were susceptible to exhibiting “hysterical” symptoms and still blamed it on a deprivation of intercourse, which lack adversely affected a woman’s reproductive system.
It is generally agreed upon that this disease [that is, “hysterical suffocation”] mostly affects widows, and particularly those who have previously menstruated regularly, had been pregnant and were eager to have intercourse, but were now deprived of all this. Is there a more likely conclusion from these facts than that in these patients the retention of menstrual flow or of semen causes the so-called uterine condition, by which some women become apnoic, suffocated or spastic? And possibly, this affliction is made worse by the retention of semen…
It became evident to me that a badly composed semen has a greater power to inflict damage to the whole body than does menstrual discharge. Consequently, a widow could have her monthly flow but retention of troublesome and damaging semen can still occur.
(On the Affected Parts V.5; Seigel 1976: 184–85)
Galen compared the retained semen in a woman’s body to spider venom and the saliva of a rabid dog.
Apart from the fact that he considered women imperfect because of their lesser heat, evidenced by their internal reproductive organs, Galen says little about the difference between male and female natures. That he did consider such a natural difference existed, however, is shown by a passage explaining the teleology of body hair.
The hair of the beard not only protects the cheeks but also serves to ornament them; for a man seems more stately, especially as he grows older, if he has everywhere a good covering of hair.… On the other hand, for woman, the rest of whose body is always soft and hairless like a child’s, the bareness of the face would not be inappropriate, and besides, this animal does not have an august character as the male has and so does not need an august form. For I have already shown many times, indeed throughout the work, that Nature makes for the body a form appropriate to the character of the soul. And the female sex does not need any special covering as protection against the cold, since for the most part women stay within doors, yet they do need long hair on their heads both for protection and ornament, and this need they share with men.
(On the Usefulness of the Parts of the Body XI.14; May 1968: 530–31)
Thus, while Galen did not blame the female reproductive parts for causing women to behave erratically, he believed women were naturally inferior, less “august” than men, citing as evidence internal reproductive organs and lack of facial hair. Here biology, while not explaining particular character traits, was used to validate the socially superior role of men. In a sense, this would make it more difficult for women to challenge their social position vis-à-vis men, for while many women could point out that they were no more cowardly, erratic, deceitful, etc., than the average man, they could not produce a beard or penis—signs that were needed to prove they had achieved the “perfect” human nature.
The female body was understood increasingly in the same terms as the male body in the medical writings of antiquity, which may have correlated with women’s playing an increasingly more diverse social role; however, it also meant that the archetypical female function of menstruation lost its positive connotations of a natural purge and developed aspects of the Judeo-Christian “curse.” Moreover, while fewer specific aspects of “female” behavior were attributed to biology, the concept that women were generally less perfect than men because of their lesser heat became axiomatic and was supported by citing anatomical facts that indisputably separated most men and women.
1. From later antiquity we have treatises by Cleopatra and Metrodora, and Aetius of Amida quotes chapters on gynecological matters from a work by a certain Aspasia. Other female medical authorities are referred to by Galen and Pliny.
2. See Figure 5.6 for young girls at vigorous play.
3. “Crisis” was the term given by the Hippocratics to the point in the disease when the diseased material in the body had separated off and was ready to be evacuated. If this was achieved the crisis was complete and the patient recovered. Otherwise the diseased material was reabsorbed and the patient relapsed till the next crisis. If no crisis occurred or none was ever successful, the patient died.
4. Epistaxis (bleeding from the nose) was considered almost as good a sign of recovery as menstruation because the menstrual blood could travel through the passages of a woman’s body either downward or upward to be evacuated.
5. This word derives from the Greek word for womb, but it was not a word used by the Hippocratics. Where the womb moved to was significant in treating the disease, and when a generalizing term was used it was usually pnix or “suffocation”.
6. Aristotle argued against the Hippocratics that no animal could produce two seminal residues.
7. This may have contributed to the association of the apocryphal story of Hagnodice studying with Herophilus (see Chapter 5, “Education and Professions”).
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