Medicine, Ancient

The themes of gender and sex were central to medicine in the ancient Mediterranean world and, because of the subsequent influence of Greco-Roman medical ideas and practices in the medieval Christian and Muslim worlds and subsequently in Renaissance medicine, they had a far-reaching effect on constructs of gender in Western culture.

Cuneiform texts survive from the ancient Near East in which all aspects of the body are discussed, including sexuality: a Ugaritic myth describes how "By kissing, there was pregnancy, by embracing, heating" (Stol 2000, p. 6) whereas material from Egypt shows that ideas such as the mobility of the womb can be traced back before the rise of Greek civilization. The earliest medical texts from the Greek world, dating to the fifth and fourth centuries bce, are included in what is now called the Hippocratic corpus. Named for its traditional association with the historical figure Hippocrates (traditionally 460–377 bce), it was in fact written by many physicians holding different views about the nature of the body and the cause of disease; many of these views had originated in popular thought, but were systematized by the early physicians. While it would therefore be misleading to generalize about "Hippocratic medicine," some ideas are widespread; in particular, as well as various uses of the four qualities of hot, cold, wet, and dry, the belief that disease is caused by an imbalance in the fluids that make up the body, including semen and menstrual blood. This means that sex is very much within the domain of medicine, and the Hippocratic texts discuss both sex and gender in a variety of ways. For example, the writers advise men to have more intercourse in winter, because the wetness of the season means that more moisture needs to be removed from the body (Dean-Jones 1992, p. 77).

In the Hippocratic treatise On Generation/Nature of the Child, the process of sex determination in the womb is seen in terms of the polarities of strength and weakness, quantity and absence. As in the Near Eastern material, both sexes are thought to produce a "seed," with the sex of the child being decided according to the relative strength and quantity of the seminal material produced by its parents. Male and female exist on a continuum that includes in its center the intermediate categories of the manly woman, and the womanly man; instead of two genders, there are many variations. The seed is imagined to come from all over the bodies of the parents, and the child's physical characteristics are understood to result from one parent's nose seed, ear seed, and so on, dominating at the point of conception.

But this is not the only view in the Hippocratic corpus. The treatises usually known as Diseases of Women do not suggest that women produce seed: their contribution to generation rests instead with the raw material provided by the blood that they supply. These treatises single out women as a distinct category, a move reminiscent of the myth of the first woman, Pandora. According to the poet Hesiod (c. 700 bce), the gods created Pandora as an afterthought to punish the culture hero Prometheus, who had helped humanity by bringing the gift of fire. Pandora was an alternative or counter-gift to fire, and Hesiod described how women "burned up" men with their voracious appetites for both food and sex. The idea that women lack self-control and enjoy sex more than men is also found in the myth of the seer Tiresias, who experienced being both male and female, and annoyed the goddess Hera by revealing to her husband Zeus that women have ten times the pleasure men experience in sexual intercourse. However, the Hippocratic text On Generation argues that men feel more pleasure, but that of a woman is of longer duration, peaking when the male seed reaches her womb.

In Greek, Diseases of Women is Gynaikeia, a word meaning "matters concerning the mature woman"; the same word was used as one of many terms for menstruation, seen as the marker of female difference because it was evidence of the wet and spongy nature of female blood, for which the breasts, and the softer texture of the flesh more generally, acted as evidence. Gynaikeia also meant "women's diseases" and "cures for women's diseases," and the second volume of the Diseases of Women has a particular focus on remedies for the retention of menstrual blood, the movement of the womb to another part of the body, and other peculiarities of the female condition. Failure to menstruate was seen as critical because it was from menstrual blood that the fetus was formed, a process discussed in the treatise On Generation/Nature of the Child. Indeed, it is not simply intercourse that the mobile womb desires, but conception; female sexuality is seen in terms of reproduction. For a twenty-first century observer, absence of menstruation can be evidence of pregnancy, meaning that one can interpret the remedies given to "draw out" the blood as early abortion. For the ancient Greeks, such absence was worrying because it meant that conception could not take place, and the remedies were intended to flush out the blood from wherever in the body it was hiding; in addition, by traveling to various locations in the body the blood could put pressure on the organs and cause a wide range of symptoms.

Various vaginal discharges that one would regard as the evidence of sexually transmitted infections are discussed in the Diseases of Women treatises; in the absence of any theory of infection, these are interpreted as inadequately formed menstrual blood. "The whites," in particular, are seen as very difficult to treat. Instead of being considered a possible source of disease, sex is presented as therapeutic for women, with the remedy for many conditions being intercourse followed by pregnancy. As On Generation puts it, "Another point about women: if they have intercourse with men their health is better than if they do not." While sex keeps the womb open so that it can menstruate, and stimulates the bodily fluids in their movement around the body, the process of giving birth acts as a valuable purge. This contrasts with medical advice for men, who are more commonly advised to abstain from sex while recovering from a disease.

Another treatise, Places in Man, concentrates on the generic male body until its final section, where the female body is introduced with the statement that "The womb is the origin of all diseases in women." This method of treating men as normal, but adding a special section on women, is replicated in treatises such as Aphorisms, which group together medical conditions surrounding the womb and menstruation towards the end of the text.

Contemporary with some of the later writers of the Hippocratic corpus, the philosopher Aristotle (384–322 bce) put forward his own view of the female body in which women were unable to produce semen: defined by their coldness, women were unable to "concoct," or cook, their blood into semen. In generation, it was only the man's semen that could impose form on the shapeless mass of menstrual blood. Breast milk was seen as a fluid intermediate between menstrual blood and semen. Aristotle's medical views should be read alongside his political ideas; for example, he regarded women as perpetual minors.

While Aristotle and the Hippocratics did not dissect humans, instead basing their beliefs about the interior of the body on what came out of it, in third-century bce Alexandria Herophilos (330–260 bce) and Erasistratos (c. 315–240 bce) opened the body and made such discoveries as the uterine ligaments and the ovaries. However, these organs were not fully understood, and the idea that the womb could move survived because the ligaments holding it in place were thought to be particularly elastic, allowing movement around the body; this position was put forward by Aretaeus of Cappadocia in the first century ce.

Soranos of Ephesus, writing in the second century ce, followed the ancient Methodist medical sect, according to which all diseases in both sexes were caused by looseness or constriction. For him, both sexes could suffer from excessive emission of seed in the absence of sexual excitement, a condition of looseness that he called gonorrhea: literally, discharge of seed. Satyriasis, too, can affect women as well as men, causing "an irresistible desire for sexual intercourse … with no sense of shame" (Temkin 1956, p. 148). Soranos considered that the womb was made of the same basic material as any other part of the body. He did not believe that intercourse had any obvious health benefits for either men or women, so that perpetual virginity could be seen as a healthy state, and pregnancy as carrying many dangers to the woman.

The extensive oeuvre of the most famous and influential of ancient physicians, Galen (d. c. 216 bce), mentioned women many times but did not include any one text dedicated to the female body; writing only a generation later than Soranos, he regarded men and women as two versions of a single sex, with the same organs. While men's greater heat meant that their organs were pushed to the outside, women—now, following Aristotle, seen as the colder sex—retained theirs within their bodies. The penis was the analogue for the vagina. This meant that women, too, were thought to produce semen, although theirs was thinner than that of men. In addition to the health problems of retained menstrual blood, women were also thought to be in danger of seminal retention; this was the more dangerous of the two conditions, as retained semen was thought to become poisonous. In a famous passage from On the Affected Parts, Galen praised a midwife whose massage of a sick woman's thighs was enough to cause her to ejaculate her retained semen. This passage, which seemed to recommend therapeutic masturbation, was the subject of controversy in early modern medicine, and Catholic physicians such as Luis de Mercado (1525–1611), a convert from Judaism and personal physician to Philip II (r. 1556–1598) and Philip III (r. 1598–1621), condemned the practice. Other early modern medical texts instead followed Galen in recommending dietary control—in particular, restricting the consumption of meat and other blood-producing foods—in order to prevent the build-up of semen and blood in the first place.

Galen's work was simply too extensive and repetitive to be widely read. Instead, after his death what is known as "Galenism" developed; this is based on some of the more accessible works, and simplifies his theories. While the Latin West focused on those works of practical relevance, and the Greek East incorporated Galenic medicine into encyclopedic works, in the Muslim world many more texts by Galen survived, 129 being translated into from Greek into Arabic. Galen's ideas also passed into many Arabic encyclopedic works, where they were fused with those of Soranos. The belief that regular intercourse is essential to female health survived, Soranos's ideas here being eclipsed by those of the Hippocratic/Galenic tradition. Ibn al-Jazzâr's Viaticum added to Galen's account of rotted female seed or menstrual blood causing illness: the idea was that the putrefying matter gave off fumes that traveled up the body to cause symptoms such as suffocation. The idea that it was the womb itself that moved was not, however, defeated; as Monica Green (2002, p. 26) has shown, when these texts were translated from Arabic to Latin in the early Middle Ages, at least one writer in twelfth-century Salerno considered that these fumes carried the womb itself upwards, like a balloon.

"Uterine suffocation," in Greek hysterikê pnix, was a condition in which the womb caused symptoms throughout the body, usually being thought to work by the transmission of the effects through "sympathy" between organ systems. This condition did not transform into "hysteria" until the nineteenth century; before that, it is important to note that the origin of the symptoms was seen as entirely physical, coming from the womb (Greek hystera), and also that they varied according to the location to which the womb traveled. Sexual intercourse was a cure, because it would draw the womb back to its proper place. Another condition with complex roots was lovesickness, shown by Mary Wack to have originated from Constantine the African's Latin adaptation of al-Jazzâr (trans. 1124), in whose work "passionate love" was found as a disease category. However, the idea that love is a disease was also based on representations of desire in classical writers such as Sappho (c. 625–c. 570 bce) and Ovid (43 bce–17 ce).

The "one-sex" model of Galen coexisted with other models of the body through the Middle Ages. However, in the sixteenth century, when the Hippocratic corpus was translated into Latin, a revival of the Diseases of Women model—in which the female sex was entirely different from the male and required its own branch of medicine—led to an increased interest in gynecology as a specialized field of male medical practice. Diseases associated with women who were not having sufficient sexual intercourse, such as greensickness or chlorosis, became increasingly important in medicine.

see also Manliness.

BIBLIOGRAPHY

Cadden, Joan. 1993. Meanings of Sex Difference in the Middle Ages: Medicine, Science, and Culture. Cambridge, UK: Cambridge University Press.

Dean-Jones, Lesley. 1992. "The Politics of Pleasure: Female Sexual Appetite in the Hippocratic Corpus." Helios 19: 72-91.

Flemming, Rebecca. 2000. Medicine and the Making of Roman Women: Gender, Nature, and Authority from Celsus to Galen. Oxford, UK: Oxford University Press.

Green, Monica H. 2001. The Trotula: A Medieval Compendium of Women's Medicine. Philadelphia: University of Pennsylvania Press.

King, Helen. 1998. Hippocrates' Woman: Reading the Female Body in Ancient Greece. London: Routledge.

King, Helen. 2004. The Disease of Virgins: Green Sickness, Chlorosis, and the Problems of Puberty. London: Routledge.

Schleiner, Winfried. 1995. Medical Ethics in the Renaissance. Washington, DC.

Stol, Marten. 2000. Birth in Babylonia and the Bible: Its Mediterranean Setting. Groningen: Styx.

Temkin, Owsei. 1956. Soranus' Gynecology. Baltimore, MD: Johns Hopkins University Press.

Wack, Mary Frances. 1990. Lovesickness in the Middle Ages: The Viaticum and its Commentaries. Philadelphia: University of Pennsylvania Press.

                                                            Helen King