Celsus’ attention to diseases of women was jejune and scattered throughout Books 2-4, with a short section in his seventh book on gynecological surgery, including the procedure for removing a dead fetus from the mother’s womb (Med. 7.28-9). His gynecological material was drawn for the most part from the fifth book of ‘‘Aphorisms,’’ an extensive gnomic treatise in the Hippocratic Corpus that remained popular throughout antiquity and beyond, but there is no indication Celsus ever consulted the larger gynecological works of the Corpus, such as ‘‘Diseases of Women,’’ with its elaborate discussion of dystocia and excision of the dead fetus (Morb. mul. 1.68-70). In the next century Soranus and Galen also drew considerable gynecological material from ‘‘Aphorisms 5’’ (A. E. Hanson 2004a: 281-2). Nonetheless, both amply demonstrated that the join between childbearing and women’s health that characterized Hippocratic gynecology had been severed, at least in medical theory. Male health in the Hippocratic Corpus largely involved an esthetic balancing of the food and drink ingested against what was expended in exercise as sweat or evacuated as urine and feces. In the case of women, however, the refrain ‘‘If she becomes pregnant, she will be healthy’’ was oft repeated in the gynecological treatises (e. g. Hippoc. Morb. mul. 2.137), and ‘‘old virgins and widows too young in their widowhood’’ were declared particularly prone to illnesses (A. E. Hanson 2000: 149-50; cf. Hanson and Flemming: 1998). Quotations from Herophilus’ now lost treatises suggest that he was an important figure in the assimilation of men’s and women’s bodies, whether one looked to his employment of the same nomenclature for male and female generative parts that underscored similarity, not difference, or his judgment that the uterus was made of the same stuff as the rest of the body (Fragments 105-109 and 193 von Staden). The Hellenistic anatomists demystified the uterus Hippocratics had medicated and rendered old-fashioned their etiology for ‘‘hysterical suffocation’’ (hysterike pnix), the disease caused by the wandering of the uterus around the woman’s body, wreaking havoc and preventing her from breathing (e. g. Hippoc. Morb. mul. 2.12353; H. King 1998: 205-46). Hellenistic anatomists’ ability to isolate and see the ligaments that held the uterus in place did not mean that this disease of the womb disappeared or lost its prevalence among those women not so sexually active as they should be. Rather, Soranus thought hysterical suffocation was caused by tensions on uterine ligaments resulting from miscarriage and long widowhood (Gyn. 3.26-9), and Galen attributed suffocation to retention of generating seed and menses, followed by their subsequent putrefaction (Loc. affect. 6.5). Perhaps more significant, Galen thought those men who retained seed in excess might also exhibit hysteric symptoms, albeit less frequently than women (Diff. resp. 3.10). The notion that the uterus roamed the woman’s body kept its hold on the popular imagination, as uterine amulets, magic charms, and its reappearance in the Gynaecia of Mustio, another late antique translator of Soranus from North Africa, demonstrated (Gen. 2.4.26).
Soranus readily dismissed Hippocratic confidence in the salubriousness of pregnancy, maintaining rather that perpetual virginity was healthful for men and women, while repeated childbirth was exhausting (Gyn. 1.30-3; 42); his evidence came not only from female animals who were more healthy and sleek once their sexual organs were removed, but also from Rome’s Vestal virgins who were less susceptible to disease, because they renounced sexual intercourse and were kept active and thin by their perpetual service to the gods. Soranus viewed menstruation as harmful, albeit a necessary antecedent to pregnancy, and considered amenorrhea as natural in the young, the menopausal, and female athletes, for the latter expended their bodily fluids in strenuous activities, thus leaving no surplus to be evacuated (Gyn. 1.23-9). Soranus’ views were nonetheless juxtaposed to instructions on promoting healthful pregnancies and successful birthing. At the same time, Soranus also marked the fact that male and female pathologies and physiologies were drawing closer together by noting that diseases previously thought to afflict only men, such as gonorrhea (in the ancient sense, a continuous flow of seed) and satyriasis (continuous erection of the penis, or engorgement of the clitoris), might afflict women as well (Gyn. 3.28; 45-6). Galen endorsed the Aristotelian position that the female body possessed less innate heat than the male body. He was nevertheless able to construct a gendered thought-experiment comparing pulses, which were, in turn, determined by interior body heat, and he came to the conclusion that the pulse of a particular woman under a specific set of circumstances could beat more strongly than the pulse of a particular man:
Have the man dwell in Pontus, but the woman in Egypt; he should pass the day indoors and idle, eating cold and luxurious food. By contrast have the woman spend her days out of doors, exercising strenuously and maintaining a modest intake of hot foods. This woman’s pulse is surely greater than that man’s. [Cans. puls. 3.2)
Medicine at Rome was deliberately distancing itself from the gender asymmetry that had characterized the medicine of fifth-century Greece and the Hippocratic Corpus. Roman therapeutics, however, remained conservative in gynecological practice, retaining the many old recipes, sometimes enhanced by exotic ingredients from faraway places, as well as introducing new therapies and procedures. Providing cures for infertility and amenorrhea, preventing miscarriage, and medicating all manner of uterine complaints remained a high priority. Both wet and dry fumigations that delivered vapors directly into the uterus continued to be popular and would be for a millennium to come. Cato had prescribed as a gynecological cure-all boiling the urine from a cabbage eater in a pan and sending the fumes through a reed into the woman’s uterus, as she sat above on a chair with a pierced seat, her garments enveloping her lest the fumes escape {Agr. 107.11). Similar methods for fumigations punctuated the gynecological treatises of the Hippocratic Corpus, for the application of odoriferous vapors was often a therapy of choice for drawing a traveling uterus back to its proper position in the body. Old fashioned as the procedure seems, so sophisticated a woman as the empress Agrippina the Younger {15-59 ce ) gave herself fumigations, once she recovered from her misadventure in the collapsible boat her son Nero had had built in order to kill her and her swift swim to shore, and after she applied medicaments to her bruises {Tac. Ann. 14.6). Agrippina would no doubt have employed more exotic ingredients in her fumigations than Cato’s cabbage urine.
Archeologists have unearthed uterine amulets, usually made of hematite, from the length and breadth of the Roman Empire, from Britain to Syria; common features of the amulets included a stylized image of the uterus as a rounded globe with a foreshortened vagina, closed at the mouth by a lock; an ouroboros {snake eating its tail) usually encircled the image; and the name Ororiouth was carved somewhere on its surface. The lock facilitated the closing of the uterus when menses were to be retained during gestation for nourishing the fetus, while its opening permitted the uterus’ contents to be expelled - an infant, or monthly accumulation of menses {A. E. Hanson 1995). A specialized sub-type of uterine amulet was carved on red, orange, or yellow gemstones {red jasper, yellow jasper, carnelian). These were ‘‘quick-birth-ers’’ {okytokia), and women employed them over the course of two millennia, from the time of the Hippocratic Corpus until the sixteenth century {A. E. Hanson 2004b). A ‘‘quick-birther’’ from the Taubman collection at the University of Michigan was probably carved in the third century ce and, in common with late antique and medieval examples, it summoned the fetus to stride into this world with its words ‘‘Onto your little feet’’ {epipodia, Bonner 1950: 274, no. 134) {Figure 25.2). Both pagan and christian versions of the ‘‘quick-birthers’’ addressed the fetus directly, instructing it to come out, for by the time of birth a fetus was thought sufficiently sentient to respond to commands. Although it lacked sense and feeling at conception, the fetus gradually acquired these characteristics in utero, and this gradualist view of embryonic and fetal development was widespread among medical professionals, as well as the general populace. The messages of the quick-birthers shared in this assumption. The writers of the Hippocratic Corpus had been unaware of uterine contractions and attributed the pains of labor to the movements of the baby, as it punched and jabbed its way down and out in the effort to be born {e. g. Hippoc. Nat. puer. 30; A. E. Hanson 1999b). Galen knew all about uterine contractions, describing in elaborate detail the ability of the uterus to retain its contents through a retentive faculty and its ability to deliver the baby through an expulsive faculty, yet he continued to endorse the Hippocratic view that the fetus of term initiated birth when it recognized that its food supply in utero was inadequate. In a restlessness born of hunger the fetus broke the membranes that surrounded it in the womb, thus causing birth to take place {Nat. fac. 3.3-12).
Infancy and childhood had begun to attract serious attention from both philosophers and medical writers in the Roman republic, and by the time of the empire rules proliferated as to how responsible adults should best prepare children for the later life that hopefully awaited them. The second book of Soranus’ Gynecology discussed neonates and small children up to their being weaned, probably at age two or three, and the time a pedagogue or other child minders took charge of them. Galen supplied fulsome information on pediatric theory and practices that Greek doctors were purveying at Rome in the first book of his Hygiene and at various points in his Habits, another treatise preserved only in Arabic (Sanit. 1; Mor.). Contracts for the hire of wet nurses from the Roman province of Egypt exhibited some of the same concerns about the care of infants and young children, thus tempering, to some extent, the notion that Soranus or Galen wrote about babies and small children only from books and the perspective of the elite (Masciadri and Montevecchi 1984; A. E. Hanson 2003). Roman babies were swaddled for months after birth, and Soranus provided elaborate instructions for massaging and swaddling, for female neonates were to be bound more tightly in the breast, but loosely in the hips, since this promoted the shape attractive for women (Gyn. 2.14-16). He was also preoccupied with the damaging effects premature standing and walking had on the legs of small children, lashing out at Roman mothers who failed to devote sufficient attention to child rearing, as Greek women did, but
Figure 25.2 An okytokia, or ‘‘quick birth’’ amulet, beseeching the gods for a birth in which the child appeared feet first (C. Bonner, Studies in Magical Amulets, Chiefly Graeco-Egyptian, Ann Arbor, 1955, n. 134. Photo courtesy of the A. Alfred Taubman Medical Library, University of Michigan)
Figure 25.2 (Cont’d)
Allowed little children to stand and walk before they were physically ready. As a result, the child’s legs became distorted, bowing outward, as the weight of its body rested on the still pliant limbs, and the ground of Rome, solid and hard because paved with stones, did not give way (Gyn. 2.43-4). Soranus advised clothing that supported the child’s back, whenever the baby tried to sit up, and a chair with wheels, when it first tried to walk. He claimed that Romans attributed the bowing of small children’s legs to the cold waters flowing beneath the city, an explanation that faulted no one, although he had heard stories attributing the cause to the fact that Roman women had intercourse too frequently, and did so when drunk. Galen boasted of having diagnosed what ailed a crying baby when its nurse was at a loss as to how to quiet her charge; his inspection of the baby’s bed revealed its clothes and linens were dirty, and after ordering the nurse to bathe the baby and provide clean garments, the baby stopped crying (Sanit. 1.8.30-2). Galen saw three - and four-year olds as separating into two groups - those amenable to discipline, who loved praise for its own sake, and those who resisted out of naughtiness:
[W]e sometimes see one of them hurt by a playmate, and... we see some of them take pity on him and help him, and others laugh at him, gloat over him, and sometimes join in and take part in hurting him. We also see some children rescue others from difficulties, and others push playmates into dangerous places, poke their eyes out or choke them. Some are reluctant to give away anything they have in their hands, some are envious, others are not. (Mor.)
Galen deemed vigorous exercises appropriate for older children who attended school and were learning sports, such as riding on horseback, but by then frequent bathing was no longer salubrious (Sanit. 1.8.5-6).
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