Role of Women in Ancient Medicine

History of medicine is closely linked to the overall history of civilization and to its social aspects in particular. The discussion of women’s place in ancient medicine is impossible without understanding the context of values, beliefs and gender roles of a particular epoch. Like in other spheres, women had to deal with discrimination, as science and healing practice was purely a business in the western world, in contrast to primitive and shamanic civilizations. Women’s position was inferior in the considered time period, no matter whether ancient Rome or Greece is considered.

The role of women was confined to a narrow circle of duties, usually inside a family, so each case of their participation in medicine as therapists was not only an exception but a revolutionary situation, which was not always readily accepted by their contemporaries. Yet, because female population could not be ignored, at least in the role of patients, progress in considering organism of a woman as a separate subject worth attention was inevitable.

Medicine of Ancient Rome and Greece

There are two points of view among scholars on the role of women in the medicine of the ancient world. Some of them believe that there were women who practiced medicine and even had patients but they were not physicians in its true sense, so they would rather reject them as equal counterparts of male physicians. On the other hand, however, there is a group of scholars who believe that only prejudice, both historical and contemporary, is on the way to accepting the fact that there were outstanding physicians among women in the ancient epoch. Apparently, it is difficult to arrive at one or another conclusion as the data about these women are scarce and scattered anyway. Women in medicine are mentioned in the texts of some historians, philosophers and medical writers of the epoch, though they provide little detail. Besides, tombstones with inscriptions work as historical evidence in favor of these women, which clearly. The current paper considers the main milestones, innovations and figures in medicine of ancient Rome and Greece, which contributed to transformation of medicine and social attitudes, and the role of women in this context.

Galen

Because Claudius Galen was a famous physician who determined the overall development of ancient Roman medicine, its history is commonly classified into pre-Galenic and post-Galenic periods. Apparently, the period when Galen practiced was a transformation between two stages of medical science. Among his achievements is research of over three hundred muscles, brain areas and spine research, classification of medicines and the general systematization of knowledge of ancient medicine. He pointed out the importance of anatomy’s knowledge for physicians and the significance of nerves for proper functioning of the organism. Because of this huge impact that created a new Galenic kind of medicine, the role of women is discussed separately in each of the periods.

In the period before Galen, medicine was balancing on a thin borderline between science and religion. Folk roots of medicine could not help playing a dominant role, which ousted a scholarly element out in many cases. Human life was largely believed to be in the hands of gods, so purely physiological approach was not always possible, as spiritual and ritual ones could be present as well. At the same time, the authors of this period attempted to sum up and synthesize the knowledge that came from different sources: folk tradition, philosophy, science. Besides, the role of Hellenic influence was still very high, so many scholars adopted the Greek approach rather than invented their own one. In any case, there was a place for women in these studies, as their health and specifics of their bodies could not be ignored.

Celsus

Celsus was one of representatives of the period who contributed to medical art. He determined his own approach, which was reasonably balanced between certainty and risk and enabled to achieve some good result. “He reclaims reason from the rationalists, basing it solely on manifest causes and forcing it into an awareness of its own inevitable fallibility, to establish a medical art which is both ‘rational’ and ‘conjectural'” (Flemming 130). Besides, in his study On Medicine, he does not only cover the historical tradition but speaks about the most appropriate philosophy, which should be applicable in practice.

Thus, he introduces the word “empirical” to determine the approach, which focuses not only on knowledge but on real-life results. The goal of the treatment for each individual patient, hence, has a higher priority than following the dogmas. Yet, he believes that the best result is achieved when method is followed properly, so that a physician can elicit the best practices, which will eventually help when practice is concerned. When describing the works of his contemporaries, he mentions medical women who were practicing at the time, “Celsus, a notable medical writer of the first century AD, tells of women physicians in Rome, recounts the activities of several women, including Margareta, an army surgeon”( A Brief History of Women in Surgery).

Pliny the Elder

Pliny the Elder was another representative of the epoch who contributed to different fields, as he was an extremely versatile personality who deals with a whole range of sciences. Medical science was not an exception, and he was among the first ones to devote special attention to women’s health, especially fertility and menopause. Based on the empirical research, he generalizes the data and gives methods and treatments for female patients of different ages. Thus, he provides an important historical evidence, which informs of the fact that menopause occurred earlier to ancient Roman women compared to our contemporaries. Thus, he gives forty years as an average age of fertility cease, though it could be longer as a matter of exception.

Besides, he focuses not only on scholarly report of the issues but also on practical solutions. Hence, he mentions fertility problems, PMS and menopause health symptoms as the major concerns that women had in terms of specifically female organism issues. He classifies two sorts of drugs that could be used to be dealt with the problems, including plants and those of animal origin.

Pliny mentions a number of herbal remedies to treat fertility-related problems, some of which may be effective. For instance, he mentions that the Druids used mistletoe to treat barren animals. Mistletoe contains estrogen and progesterone-like compounds and is used to make the Swiss menopause drug Iscador. He also mentions chasteberry, which appears to inhibit secretion of prolactin, a substance associated with PMS symptoms (Palmer).
Animal treatment, suggested by Pliny, is apparently more exotic for today’s women, as he recommends to use such items as “the ashes of deer antlers as a salve for uterine problems, wolf liver to soothe uterine pain, and embryonic rabbit meat to make menopausal women fertile again”( Palmer).

Thus, although Pliny does not contribute much to historical account of female medical women, he makes a breakthrough in terms of acknowledging them as patients, to whom both specific treatment and specific studies of their organism was necessary. Most likely, a lion share of his remedies dates back to folk medicine (mentioning Druids confirms this idea), so he used ancient manuscripts in order to provide the recipes. Pliny is mostly known as historian, and partially as experimental researcher, thus, it is possible to suggest that he was not a practicing physician but rather a medical historian. In fact, this approach of collecting, accumulating and synthesizing data of natural medicine is common for Pre-Galenic era of ancient Roman medicine. In other words, at this point medicine was still immature as a science; this is why folk and shamanic evidence was used by medical people. Remedies for women were not an exception, yet it is worth paying tribute to Pliny the elder in collecting them and speaking out openly about women as a category of patients.

Researchers point out that one of the aims that Pliny had when writing on female health is to educate men of Rome about it, “To a limited extent, therefore, Pliny was willing to draw on female traditions in compiling the medical knowledge that Roman men should possess, and both he and Celsus clearly included women as proper objects of that knowledge, to be incorporated in their encyclopedic compilations.” (Flemming). Besides, they claim that the origin of Pliny’s data was extremely versatile in terms of gender, class, ethnicity, historical epoch, etc. Because “the recommendations made are in areas about which both midwives and prostitutes might well be expected to be particularly knowledgeable”, the text were quite controversial and did not exactly were considered to be equally credible by all of the scholar’s contemporaries and further epoch’s scientists. His assumptions about reproduction and pregnancy were quite controversial, as he tries to give advice on how to distinguish a male fetus from a female one by the pregnant woman’s behavior. Besides, he makes many assumptions which have doubtful scientific credibility. “Girls are generally carried in the left side of the womb, boys in the right, and girls develop more quickly but are delivered with greater difficulty.” (Flemming)

Dioscorides

Another representative of ancient Roman physician, Dioscorides, was of Greek origin but practiced in Rome. He relied on the same medical sources as Pliny did, when he described practices, which women could use for specific issues. However, he is very cautious when stating the credibility of certain remedies. As a practicing surgeon of Nero’s army he preferred to believe in precise scientific evidence. In this respect, most of his recipes for women that he mentions in his studies are rather descriptive than recommendatory in their nature, so he put them just as remarkable information which he collected from numerous sources. These include the use of certain herbs and stones in order to treat skin problems and certain deceases.

However, this material is historically precious because it reflects real lifestyle of women, no matter whether Dioscorides approved of them or not. The approach was of the following kind, “Women undoubtedly use these things for their skin, as depilatories and perfumes, even, in the case of Thessalian women, as love potions; but whether anyone should follow their example is less obvious” (Flemming). Apparently, mentioning love potions could hardly be a scientific account of the female remedies, yet it is another illustration of how medicine was merged with folk tradition and spirituality. At the same time, Dioscorides was well aware of this fact and was really willing to change this situation in medicine, so his main aim was to distinguish rational and supernatural elements of that day’s medicine and to separate them in order to shape individual branches.

The epoch of Galen brought new perspective to women as being objects and subjects of medicine. Through his specific interest in anatomy, he created a new precise approach to determine a healthy human being, a woman in particular. Yet, Galen was known to fulfill several roles, like his predecessors, he would pay attention to collecting historical evidence and recommendations on all epochs’ remedies. As researchers point out, “Galen gives recipes from Antiochisand Cleopatra (attested elsewhere) and is our sole source for Eugerasia, Originea, Samithra, Spendusa and Xanite. Then, there are two questions to be answered. DoGalen’s sources make an identifiable difference in quoting ‘real’ vs. ‘practical’ authors (or famous vs. obscure or primary vs. secondary)?”(Parker 365). Also, there is both social and scientific realm when we ask to what extent he used male and female sources and to what extent he believed them to be credible.

The above mentioned women are a primary source, which means he thought of them as reliable evidence, meaning that information should come directly from women and their daily practice rather than from male historians. Yet, all these primary sources of evidence were incorporated in male historians and physicians’ texts, which leaves the question open about whether he believed them to be more reliable or just had no other opportunities to receive this data directly from primary sources. Researchers agree that the major reason for doing this is Galen’s desire to lean on written texts in order to trace back the historical evidence. At the same time, it is obvious that he did not ignore at all the empirical data that he got in the process of his physiological and anatomic research.

Galen, as well as his colleagues, mentions the type of women who practiced medicine in ancient Rome, “ranging from old women who continued folk medical traditions in the villages of the empire, through midwives whose expertise might be acquired in more varied ways, and whose activities might extend far beyond childbirth, to those who claimed (or had claimed for them) something still more general and prestigious, indeed that they were female physicians.” (Flemming). What is meant by this status is the fact that for various social and gender reason they could not reach the same acknowledgement as their male colleagues. This mean that they constituted a separate layer of medical people with a narrow sphere of duties, usually related to purely female health issues. This layer, thus, only emerged based on experience and intuitive knowledge of female organism these women participated in the process but in most cases did not have proper training or education.

Neither they were able to contribute to the theory or history of medicine a par with their male counterparts because they were purely practical physicians, often with folk medicine background. Yet, some historians mention that there is a chance that some female physicians could treat men as well, in the same way males often treated females. An important aspect, which unfortunately is not covered by significant descriptive evidence, is how female physicians and patients communicated with one another. However, researchers suspect that there must have been a more significant bond among them than contemporary medicine offers. In other words, all women were part of cultural female tradition, which was passed from one generation to another one and meant that a certain ritual spiritual healing could also have been a part of the treatment process alongside surgery and “heir liver” kind of remedies.

It is also remarkable that medicine reflected the status of hierarchy in ancient Roman society, no matter whether in an aristocratic or common family, a woman was inferior, including health matters. Therefore, in any case when a woman had health issues, decision had to be made by her husband instead of her. So, the researcher’s conclusion of the status of women is not reassuring. As the hierarchy of medical practice meets the hierarchy of the household, women lose out on both accounts; they lose control of their patients, and their patients lose any control of their treatment they might have had when dealing with another woman, and one likely to be of lower status than themselves. (Flemming).

Even progressive physicians like Galen had a considerable disproportion when describing cases, which involved male and female patients. It meant that male health was a priority on the one hand, and on the other hand it is obvious that the research was meant for men to be read. So, this vicious circle discriminated women and confined their status to some practical areas of reproductive folk medicine.

A lot has been said about women as patients, while information on women who were practicing physicians in ancient Rome and Greece is very scarce. Moreover, even if mentioned in the works of medical science historians or practicing physicians, they are mostly anonymous. Yet, there are a few of them whose work has been recorded, so it would be fair to mention them in order to understand what place they could take in the society in which they lived. In his

Soranus

Genecology Soranus gives a historical account about what was expected from “the best midwife”, which clearly provides an insight into the way Roman women lived in a family and in society. Among all, he writes, “We label someone ‘the best midwife’ if she is knowledgeable about theory in addition to handling actual cases, and particularly if she is trained in all branches of therapy (for some cases require special diet, some require surgery, some must be treated with drugs) and is able to prescribe hygienic rules, to observe both general and individual symptoms, and to discover from them what needs to be done. She will be calm and unruffled in crises, and able to give a clear account of the procedures she is using” (Shelton). This passage from Soranus gives an evidence of the fact that midwives were not simply women who used old methods of folk medicine, which they inherited from their ancestors.

In fact, they were a totally new subclass of women, who were both skilled and educated. The emergence of this group is not surprising taking into account the fact that pregnancy and child bearing was a realm, which could not be ignored at any stage of history. Besides, it was probably the only field where woman could have some advantage compared to male physicians just because of their gender. Even literary evidence differentiate between male and female realms in medicine, “Phaedra’s nurse in Euripides’ play Hippolytus draws a distinction between some injury that Phaedra ought to discuss with the male doctor and a more specifically female ailment for which she and the women in the chorus can offer help.” (Nutton). So midwives seemed to be a more privileged and a more educated class of medical women, if those are meant who worked with aristocratic families. It is logical that the same thrive was impossible in other fields of medicine, where males completely dominated.

Speaking about exact advantages that women could have in this case, it should be pointed out that it was not about the decency of a woman being physically attended by someone rather than a man. It is also about psychological skills in which women were believed to be superior. Thus, Soranus writes further about an ideal midwife. She will provide reassurance to her patients and will be sympathetic. She will be prudent and always sober, since she is never sure when she will be summoned to a woman in danger. She will be discreet since she will share in many secrets of life. She will not be superstitious and will not overlook a possible remedy because of a dream or an omen or a ritual or a vulgar superstition. (Shelton).

Hence, conclusion can be made, that ‘sympathetic’ and ‘secrets of life’ are key words in understanding the reasons why midwives still managed to acquire a better position in Roman medical realms compared to work as an ordinary physician or a surgeon.

Hygius

Another case, a quite controversial one, of a woman mentioned as historical example of female presence in medicine is Hagnodike, one of few names mentioned and saved from full anonymity. Hygius is a writer in ancient Rome who includes her in his studies claiming that she was the first obsterix and lived about 150 AD in Greece. This is quite peculiar and is widely debated because unlike Rome, such role was not typical for Greece. So, there is disagreement about whether Hagnodike is a historical personality, a legend or both. The idea that she might have worn male dress while being a woman speaks in favor of the fact that being a woman physician was not a typical case in her society, or maybe even a banned role. The evidence says that there were no such practitioners in Athens because women and slaves were forbidden to learn the art of medicine until Hagnodike, ‘a pupil of Herophilus’, who disguised herself as a man and, when later tried for this crime and in danger of being condemned to death, was saved by the protests of the Athenian mothers she had attended. Their husbands in the Areopagus relented, and the law was changed. (Nutton 101)

There is a historical inconsistency about Hygius’ records, as it is believed that his work had an element of fiction. Most researchers believe Plato’s evidence about the situation in ancient Greece to be more reliable. In his works, he mentions that only elderly women participated in child bearing as midwives, and only those who were mothers themselves. Thus, it looked more like a traditional medicine, which was passed from one generation of women to another. In any case, these women were only involved on a temporary basis rather than participated full-time as a separate occupation. Instead, it was just an element of female circle of activities, part of tradition. This opinion clearly contrasts with that of Soranus, who thinks that an age does not matter for a good midwife but also that her own maternity is not important other.

This means that Roman sources more eagerly demonstrate the transfer from a traditional medicine to professional one, which was also possible for a woman. To add to the above mentioned qualities of Soranus’ best midwife, it should be mentioned that he focuses on the combination of two aspects: practical skill and education, which in fact signifies that it was among the first cases in history of medicine, where requirements were not gender related. Proper practical and theoretical training was also a requirement for male physicians, so one could suggest that a faint glimpse of equality emerged. This glimpse should not be illusionary though, since it has been already mentioned, midwifery was a privileged area for Roman medical women. Based on Soranus’ text, researchers raise several historical questions. First of all, they wonder whether this role model midwife could really exist or was it just a dream of Soranus about improvement of medical service. Secondly, scholars are curious about participation of men in the same role in obstetrics.

Historians believe that there were several examples of such outstanding women, while the rest did not match the high requirements mentioned by Soranus, at least because there was no special school to educated them. There are women with their names recorded for history but they are few. The idea that historians did not tend to focus on them and leave their names for descendants, can speak of several cultural realia. First of all, it could mean that this role was considered to be mundane and not outstanding at all, secondly, they were believed to be not worth much attention because of their gender. Some names are kept rather accidentally, like the following one, “The tombstone of Valeria Berecunda proclaimed that she was the ‘first medical midwife of her precinct’ within Rome, an advertising slogan rather than an official position: others, more humble still, have left no memorial at all.” (Nutton 196).

This example demonstrates that even outstanding women who deserved such post-mortem memorial tombstone were not considered significant enough to be mentioned in historical texts. Speaking about education, it was mostly practical, and consisted in being present with other midwives during a child birth at first, with an opportunity to assist them in the future. There is no evidence that there were women who were as educated as Soranus expected them to be, because this would mean that they had to be trained professionally by outstanding male physicians and surgeons, which was almost impossible. Besides, they should have been familiar with history and philosophy, as well as the latest texts of medical authors. No reliable evidence is present to confirm this kind of versatile training for women.

There were some exceptions, though, for instance a woman who received a training from her father and husband, which was probably the only way to receive an education equivalent to that of a man, Restituta or Aurelia Alexandria Zosime, of Adada in Pisidia, who had gained her expertise from a husband or father, would have had a similar training to that of most males. The garrulous Glycon, a Pergamene doctor of the first or second century, praised his late wife Panthea because she had increased the shared glory of medicine and, though a woman, was not his inferior in the medical art. (Nutton 197).

So, to state that female medicine was confined to gynecology would be wrong, yet in order to achieve success in other realms a woman had to go beyond the scope of her social role, which took courage, persistence, and a certain masculine character. So, despite the fact that Soranus believed midwifery to be the only proper field for a woman, there were other cases, yet to find a surgeon woman was next to impossible.

In conclusion, it is worth saying that in ancient world the role of women was determined by social and cultural aspects, which were attributed to gender. While woman’s position was inferior to that of a man, this was reflected in all realms, including medicine. Family household was generally believed to be the major field of a woman’s activities, so science and medicine was not her sphere and was not generally approved. Exceptions that existed generally confirm the rule and suggest that even being involved in medicine, women could not reach the same level as male physicians. Gynecology was probably the only exception, and was a field where education and skill was expected from woman practitioners outside folk medicine, especially in case of aristocracy. At the same time, ancient medicine was an evolution of physiology and anatomy, which applied to women as well. Yet, even though prominent authors began paying more attention to female organism and health, there are considerably fewer cases described for them compared to males.