S2E1: Wandering Wombs: Greco-Roman Gynecology and Women’s Health

With Dr. Rebecca Flemming

In this episode, we sit down with Professor Rebecca Flemming  and talk about ancient gynecology, wandering wombs, and what agency, if any, women had over the healing of their bodies.

How did classical medical writers describe a woman’s anatomy and its inner workings? And how did those beliefs influence the treatments they prescribed? You’ll learn the gynecological ideas of people like Aristotle, Galen, and Soranus.

“[Galen’s] natural world is this kind of normative, ordered hierarchical world.”

— Dr. Rebecca Flemming

BIO

Professor Rebecca Flemming is the  A.G. Leventis Chair in Ancient Greek Scientific and Technological Thought at the University of Exeter and is Director of the Wellcome Centre for Cultures and Environments of Health (WCCEH). Rebecca researches pandemics and disease; gender, bodies, and sexuality; and reproduction and society in the classical world. She has written Medicine and the Making of Roman Women, and co-edited two volumes: Reproduction: Antiquity to the Present Day (with Nick Hopwood and Lauren Kassell) and Medicine and Markets in the Graeco-Roman World and Beyond (with Laurence M. V. Totelin). She has also appeared in a BBC4 documentary on the Justinianic plague. She earned her MA and PhD in the History Department of Kings College London. A forthcoming monograph examines medicine and empire in the Roman World.

• Transcript

  [Opening Music]

  Emily Chesley: Welcome to Women Who Went Before, a gynocentric quest into the ancient world! I’m Emily Chesley!

  Rebekah Haigh: And I’m Rebekah Haigh!

  Emily: scholars, friends, and your hosts.

  [music ends]

  Emily: In today’s episode, “Wandering Wombs: Greco-Roman Gynecology and Women’s Health,” we talk with Dr. Rebecca Flemming about the wild animal living inside every woman, how a Roman gladiator doctor influenced twenty-first century American politics, and why an ancient woman might need a clay breast.

  [Music]

  Rebekah H: A healthy woman was a procreating woman—she was having sex and getting pregnant. Such was the general idea held by Greek and Roman medical authors. Not reproducing could make a woman ill, and so a common treatment for many gendered maladies was more sex and more children (Diseases of Young Girls).[1] The Latin satirist Juvenal once suggested you could tell the difference between a man’s wife and his mistress by observing their stomachs during a sea voyage. The sexually neglected wife will get seasick, but his mistress will keep a strong stomach because sex with her lover imbues her body with strength.[2] So, if you don’t want to vomit crossing the Aegean, try some preventative sex!

  Emily: Gynecology, the treatment of diseases specific to women, has been around for millennia. Some of the oldest known gynecological texts, such as the Kahun Gynecological papyrus from Egypt or Mesopotamian medical tablets, date two to three thousand years before the start of the Common Era![3]In beginning our season on ancient women’s bodies, we start with the complex, sometimes bizarre, sphere of women’s health in Greece and Rome. How did Classical medical writers describe a woman’s anatomy and its inner workings, and how did those beliefs influence the treatments they prescribed?

  Rebekah H: Besides the ever-present Aristotle and Plato, three corpora were particularly influential in the Classical medical tradition. The Hippocratic Corpus is a collection of around sixty Greek medical texts written around 420 to 350 BCE. While they were attributed to the famous physician Hippocrates (from whom we get the Hippocratic Oath), the actual authors of these texts remain unknown. Whoever they were, these medical philosophers sought to find “natural” causes for illnesses rather than divine or religious reasons for sickness. And they usually pointed to an imbalance of the four humors, namely yellow and black bile, phlegm, and blood (Nature of Man 4).[4]

  Several hundred years later, after the Romans had come to power, Soranus of Ephesus (98–138 CE) specialized in obstetrics and gynecology. He wrote over twenty medical treatises, and his work on Gynecology was popular in the late antique west and was translated into Latin in the sixth century.[5]

  But perhaps the most influential medical author was the physician Galen of Pergamum who lived ca. 129 to 215 CE. Galen studied medicine and philosophy throughout the eastern Mediterranean. He worked as a gladiator doctor in Asia Minor and was eventually named imperial physician by emperor Marcus Aurelius. He learned about physiology and anatomy by performing animal dissections.[6] Galen’s more than 120 treatises were incredibly influential, and were translated from Greek into Syriac, Arabic, and Latin in the sixth through eleventh centuries.[7]

  Emily: These different writers read and learned from each other’s works, but thought about the body in slightly different ways and proposed varying treatments. For example, Soranus contradicted the majority medical establishment by arguing that child-bearing drained a woman’s health. Rather than pregnancy resolving any health concerns, as the Hippocratic authors had taught, Soranus believed that doctors should take greater care for pregnant women.[8]

  Rebekah H: Classical physicians recognized that men and women had different reproductive organs like animals, and that seemed the primary difference between the two sexes, biologically speaking. So as men looked for the causes of men’s and women’s illnesses, they often ascribed them to differences in their biological bodies, especially the womb. In fact, the Hippocratic treatise On the Places in Manblames the uterus as the cause of all female diseases.[9]

  Emily: The Greek word for uterus is hystera (ὑστέρα), from which we get the word hysteria. For some ancient Egyptians and Greeks hysteria was not a psychological disorder, as it would become in Early Modern Europe, but the label was a catch-all diagnosis for women’s problems because it was a disorder of the unique female organ: the womb. Some Greeks believed that the womb, wandering from its assigned place, caused hysteria. As Plato describes the womb, it is a “creature,” and whenever its desire for childbearing is thwarted, the womb is vexed and roams throughout the body provoking “all kinds of maladies…until the desire and love of the two sexes unite them.”[10] Speaking of the creature, in the second century CE, Aretaeus of Cappadocia called the womb an “animal within an animal,” and Soranus dubbed it a “wild animal” (thērion).[11] We know these ideas of a roving womb found their way into popular thought as well because of depictions on healing amulets from around the Mediterranean. A magical amulet dating to the turn of the millennium is inscribed with a spell to prevent the womb of a woman named Ipsa from leaving its place.[12] To their credit, Soranus and Galen were skeptical of a womb fully wandering about the body on its own. After all, the medical dissections that had started coming into vogue suggested the womb was held in place by ligaments.[13] But these physicians still believed wombs caused bodily ills. Galen taught that if blood and semen got “trapped” in this jug, the womb could get poisoned (Galen, On the Affected Parts, 6.5). Not too different from that troubling modern trope that women on their periods go a bit crazy.[14]

  Rebekah: So what did this roving “wild animal” look like? In the Hippocratic Corpus, a woman’s womb was imagined as a hollow container that tapered to its opening like a wineskin or a jar for oil (OnDiseases of Women 1.33 and 1.61).[15] Soranus thought the womb was shaped like an upside-down jug. When its “neck” flexed, the womb was lifted upward or to the side, causing a whole host of ills. The idea of a womb as a jug wasn’t new; it appears in Etruscan iconography. It lasted for a while, too. Similar images appear in an illuminated Latin manuscript of Soranus’ Gynecology created in the ninth century CE.[16]

  Emily: Other Mediterranean cultures used similar metaphors for women’s corporality. The rabbis sometimes described a woman’s body as continually fluid-filled. The Mishnah pictures her body as containing three rooms: “a chamber, a vestibule, and an attic” (Mishnah Niddah 2:5).[17] Blood from the “chamber,” or the womb, could flow into one of the other rooms and cause impurity—something the rabbis worried a lot about.[18] One opinion from the Babylonian Talmud likens the womb to a bottle made of skin that ties at the neck, revealing an implicit anxiety over the womb’s potential to leak or open at inopportune times.[19]

  Ancient authors (men) focused on regulating the flow of fluids into the right cavities at the right times. Whether through herbal remedies, votive offerings, purity laws, and of course sex, the opening and closing of women’s bodies could be properly managed. Or so they tried, at any rate.

  Rebekah H: As we mentioned last season, Aristotle held that the female body was a deformed or unformed male body.[20] In a similar vein, Galen taught that women were failed men, men who did not fully develop and stayed colder, wetter. Because of their chilly, moist bodies, female genitalia were unable to pop out like male ones.[21] These writers frequently analyzed female anatomy in relation to the male anatomy, the “standard” or “original,” and compared the female reproductive system to male genitalia.[22]

  Emily: Now, don’t start patting yourself on the back for our “more enlightened” scientific knowledge of today, how much further we’ve advanced beyond writers like Aristotle and Galen. Plenty of misconceptions about women’s bodies linger in popular conceptions around the world—some with direct links to these Greek and Roman medical authors.

  During his campaign for the US Senate in 2012, former Missouri congressman Todd Akin asserted that rape rarely leads to pregnancy because women’s bodies biologically prevent it.[23] In his words, “If it’s legitimate rape, the female body has ways to try to shut the whole thing down.”[24] This was part of Akin’s justification for antiabortion legislation. He’s not the first or last person to make this claim, either. A thirteenth-century text of English common law argued, “without a woman's consent she could not conceive” (Fleta II 1.33, trans. Richardson and Sayles).[25] This idea was echoed in Samuel Farr’s Elements of Medical Jurisprudence, which stated that a woman could not conceive without lust or pleasure so she was unlikely to become pregnant from rape.[26] To be clear, there is no scientific merit to this idea. But you can trace continuities from Akin’s 2012 comment down through English law to Galen.[27]

  Rebekah H: Galen didn’t say that without pleasure a woman couldn’t conceive. But he did write about pleasure accompanying sex and procreation.[28] He believed that when it came to procreation, women had “seed” (semen) too. Galen taught that seed from both a man and a woman mixes together in the womb to spark a child.[29] The woman’s semen, along with blood and other humors, increased her pleasure, making her more eager for sex. Physiologically, it also expanded “the neck of the uteri” during sex so that the couple’s semen could enter her womb.[30] For all his scientific ideas that would get totally overturned, we can give him a hat tip for thinking women’s pleasure mattered and not connecting it to rape. Galen for congress!

  Emily: A different set of evidence for how women sought bodily healing, beyond the evidence from male-authored textbooks, comes from temple sites. In the Classical world, people did not make much distinction between professional medicine practiced by those like Galen and popular healing methods that relied on the gods.[31] People also sought healing at temples and healing sanctuaries, like those of Asclepius. Galen lived and practiced medicine in Pergamum, where there was a famous healing shrine of Asclepius, the god of healing whose symbol, the snake, remains a modern symbol of medicine. (It’s even on the flag of the World Health Organization.)

  If the gods provided healing after being petitioned, people expressed gratitude by leaving anatomical clay models of their restored body parts.[32] Some of these votive offerings included models of vulvas, uteri, and breasts allowing us another glimpse into women’s sickness and their bodies.[33] The glimpse is partial, though, because there’s no way of knowing why any given anatomical model was left by a particular woman. A breast might symbolize the successful nursing of a child, the healing of breast cancer, or some other successful petition.[34] These material objects aside, the Classical medical textbooks are our best look into what Greeks and Romans believed about women’s bodies.

  Rebekah H: An expert on classical physicians and their complex gynecological ideas, our first guest of the season is Professor Rebecca Flemming. She is the inaugural A.G. Leventis Chair in Ancient Greek Scientific and Technological Thought at the University of Exeter. After earning her MA and PhD in the History Department of Kings College London, she held positions at the Wellcome Trust Centre for the History of Medicine, Kings College London, and the University of Cambridge. Her research interests include pandemics and disease; gender, bodies, and sexuality; and reproduction and society in the classical world. She has published extensively, including Medicine and the Making of Roman Women (2000), and two co-edited volumes: Reproduction: Antiquity to the Present Day (with Nick Hopwood and Lauren Kassell, 2018) and Medicine and Markets in the Graeco-Roman World and Beyond (with Laurence M. V. Totelin, 2020). Keep an eye out for her forthcoming monograph on medicine and empire in the Roman World! We are honored to welcome her to the podcast!

  [Podcast theme music plays]

  Emily: Anyone who has read the stories of the book of Genesis has encountered several moments in which God is said to “open” or “close” the wombs of biblical matriarchs. As you write, this conception of the female body was fairly common across the Mediterranean world. So if we're talking with ancient medical writers in Greek or Roman antiquity, what is a woman? How did they conceive of the anatomy of the female body?

  Rebecca Flemming: In all sorts of ways. A woman could be many different things, and there's kind of a bit of a spectrum approach in various contexts, and different authors may be emphasizing differences or similarities in what they're writing. But I would sort of summarize, I think, by saying that you could have three definitional themes or approaches to thinking a bit harder about what is a woman. 

  The first of those would be that a woman is defined in some sense by a particularity of her whole body. Maybe one of the famous examples of that is in the Hippocratic text—and these are a set of texts that are authored, probably anonymously originally, in the late 5th, early 4th centuries BCE in the Greek world, and then get attached to the famous name of Hippocrates the father, legendary father, of Greek medicine and sort of circulate under his name—but they're all sort of in conversation with each other in various ways. So I shall talk about Hippocratic texts and Hippocrates somewhat loosely. But there's a famous Hippocratic texts, Diseases of Women I, which says that women's flesh is more porous and softer than men's. And in general talks about women as somewhat fluid. Or Galen, so famous medical writer in the 2nd century CE. He talks about women as overall colder than men, as does the philosopher Aristotle. So that's one way of thinking about it. 

  Another way would be to think about women's reproductive role and to define her through her reproductive role in some sense. So to go back to Aristotle, he says women reproduce or generate within themselves, inside themselves, whereas men generate outside themselves, sort of from themselves. Coming back to the inside-outside distinction, Galen talks about women and men having roughly the same set of generative organs, but the man's are on the outside and the woman’s have been sort of somehow turned inside. So again, this idea of interiority. 

  And then I think the third one would be a kind of very frank, explicit kind of hierarchy. So the women are the worst version, and the men are the better version. Aristotle talks about women as a mutilated or in some sense imperfect man. Galen picks up on that theme as well, talks about women as a imperfect man.

  And there is also a sense in which these themes can overlap with each other. For Galen, who's really keen on everything linking up and all kind of being systematic, he links up the kind of idea of women as imperfect and cold—so their imperfection is all about them being colder than men—but it also is about their reproductive role because it's really useful. So he says, there has to be a female too–-bit reluctant, but there has to be a female too–-because when thinking about generation and having children, then the idea is that women's coldness and her kind of imperfection means that she builds up matter. So she has kind of excess material from what she eats and what she drinks, which normally she menstruates. But then if she becomes pregnant, it goes into feeding and nourishing the fetus.

  And Galen says the fetus needs the food and either going to grapple quite violently and seize the food from the woman, or the woman can produce an excess, which it can use in a much more kind of collaborative, well not really very collaborative, but a sort of slightly collaborative fashion. And that's the one, that's the model we've gone for.

  And so for Galen, they were all the same. Women are colder, they're imperfect, and they are got a particular reproductive role. But it all kind of fits together nicely to produce what we want, which is the continuation of humanity in some way.

  Emily: It strikes me that all three of these kind of views of women are in relation to the men—whether or not it's the hierarchy strictly speaking, you know, colder, spongier, wetter. Those are still comparative, right?

  Rebecca F: Yes, I think that's one of the really striking points about this, that they are all comparative and they are all inferior. So there are some Hippocratic writers who say that actually women are hotter because they've got more blood. But that's still worse! If women are colder, it's worse. If they're hotter, it's worse. Their kind of messages are quite clear. 

  And they do really struggle. So at various points, medical writers try and define what it is to be a man in a more sort of virtuous sense. It's courageous. It's strong. It's these sorts of things. And they really struggle to put any positive adjectives on what it is to be a woman. They, as you say, they can think that they’re weaker or spongier or whatever, but they really find it very hard to think of women in and of themselves. And obviously these are all male authors coming from a reasonably shared background of various kinds.

  Rebekah H: Was there any sense that physiological conceptions of a woman's body related to, let's say, psychological or the way that a woman was thought to behave?

  Rebecca F: There's a general idea in the ancient medical texts, which is also shared in philosophical texts. There's a text, a treatise by Galen, the qualities and powers of the soul follow the qualities and powers of the body. So there is a general view that your body will in some sense shape your soul, and you can adapt your kind of regimen and exercise and eat and drink to try and change [chuckle]what's going on in your brain, make you cleverer or whatever. And there's also a clear sense that if you have a kind of disease in the body, that might affect your kind of psychology, but also vice versa. So one of the causes of various bodily infirmities can be that you've had a shock, a kind of psychological shock, which then has physical repercussions. So there's generally a sort of assumption that body and soul are all kind of operating as part of a holistic system, or at least a joined up system. 

  That then leads to certain sorts of characteristics or certain sorts of moral qualities. 

  It's particularly complicated by the fact that some of the medical authors will also make the argument the other way round [chuckles]. So Galen at one point says that animals get the body that their soul requires. So if you're a fierce lion, you get a kind of claws and lots of muscles. And if you're a kind of scared rabbit, you get the body that means you can run really fast. And things like that. So they're prepared to do it the other way round.  

  But also, there's always a possible intervention. You can always affect it. Part of what medicine is about is saying, “okay, if you do this, you can improve your health, both psychologically and physically.” So things are very rarely kind of absolute. There's always a sense in which you can alter and change. 

  Rebekah H: Well, let's talk some more about some of those visible ailments that a woman might have. From Plato in the 5th and 4th centuries BCE, through the Hippocratic writers, even into the Byzantine period, when it came to women's ailments the womb was the culprit for many of their ills. Some believed if the womb got detached, it could float about a woman's body and cause all sorts of ailments.

  Plato put it, “the wombs (mêtrai) and the so-called uteruses (husterai) in women— …[have] in them a living animal (zôion) desirous of childbearing (epithumêtikon paidopoiias), whenever it is fruitless for a long time beyond its due season, being distressed it carries on with difficulty and by wandering (planômenon) in every direction throughout the body, by fencing off (apophratton) the passages of breath, and by not allowing (the body) to catch its breath (anapnein), it throws it (the body) into the extremes of helplessness and provokes all other kinds of diseases” (Timaeus (91b–e).[35] Some serious problems there!

  Why does the womb become the locus for so many seemingly unrelated illnesses? And what could be done to fix them?

  Rebecca F: On the one hand, I think the womb is a sort of focus of attention in the female body because it is both something that can be thought of as quite distinctive. So another way of thinking about the female body is it's kind of like a male body but it's got a womb, or it's got whatever. So you can sort of think of it as quite distinctive in that way. 

  But it's also really quite special, because it has this key role in reproduction and generation. And a number of different authors kind of sing the praises of the womb in terms of its amazing ability to be able to expand at the right time and then to sort of open up at the right time and to close at the right time and then to shrink back down. So it's really quite an amazing, amazing organ. 

  Then there's a kind of Hippocratic throwaway line about, “if she's ill, look to the womb,” which also reflects not just a sort of special organ but also that women are there to produce children pretty much. And therefore sort of female health and reproductive health are kind of mixed up together. So if a woman is reproducing, pregnant, conceiving, she's probably healthy. And vice versa, if she's not doing that, she's probably unhealthy. So you can see how you get this focus on that particular part of the body. 

  So what can go wrong with the womb? Some of the things that can go wrong with the womb are what can go wrong with the whole body. So it can be inflamed. It can be too hot, it can be too fluid, it can get hard. And there's a general idea about the sort of linkage of different parts of the body together. There's some particular connections between the womb and the breasts, but pretty much all of the parts of the body are sort of joined up, and therefore if you've got an imbalance, if you've got inflammation, and things are too hot in one area, it's quite likely that that will spread across the body in various different— or affect the balance of the body much more widely. 

  So there is this, on the one hand special, on the other hand, it's quite like another organ and has the same sorts of conditions. 

  I guess the one that might stand out against that is the one that you're referring to, which Plato talks about. So this idea of the wandering room or the hysterica pnix, the uterine suffocation. The Platonic version is that it sort of has its own kind of mind of its own, and medical authors would tend to think of a bit more mechanic equal model whereby it sort of dries out in some sense, not enough heterosexual sex, or is not been stabilized sufficiently by childbearing so it sort of sets off in search of moisture. Or sort of moves up the body and then impacts on the diaphragm, stops people breathing, and then the women sort of keel over and look as if they're almost dead. Barely breathing, barely pulse. 

  So on the one hand, that looks quite distinctive, and there's a medical author from the kind of early Roman Empire called Aretaeus the Cappadocian who talks about this and says very particularly that this is a disease that's particular to women. Men don't have uterine suffocation because they don't have wombs.

  On the other hand, the context in which he's saying that, or one of the contexts in which he's saying that, is that he is also wanting to make an argument that women don't suffer from a disease called satyriasis, which is named after satyrs and is about permanent and uncomfortable erection. And you might think, oh, well, women shouldn't suffer from satyriasis because they don't have the requisite part, which is what Aretaeus says, a bit like men not having wombs. But there are medical authors who do think women suffer from satyriasis. Soranus, another medical author of the Roman Imperial period, says women can suffer from satyriasis. 

  So, I guess the thing to say is there are some trends which put women's bodies and men's bodies in a much more kind of generic situation. And there are the counter trends which want to say something specific about men's and women's body.

  Emily: Yeah. And this idea of the womb’s being able to wander for whatever reason, is there something comparable— Is this an idea that any organ can wander, such that you know the male liver could also wander? Or is this an idea specifically oriented to the womb?

  Rebecca F: That's a good question. And so far as we can tell, this seems to be very specific to the womb. And there are authors— So in the kind of early 3rd century BCE there was a kind of a moment at which, due to state support, doctors could systematically dissect and vivisect the human body within the kind of context of the Ptolemaic capital in Alexandria. Herophilus and Erasistratus seem to have done that. At which point we kind of got quite a detailed map of the anatomy, the structure of the body. How it all worked was a little bit less clear, but they were pretty detailed in terms of the map. 

  After that, they did notice that the womb was attached by various ligaments and all sorts of things. So somebody like Galen says the womb can't actually move, but it can twist and kind of contort. And in particular, the kind of severity of uterine suffocation comes from a contortion caused by a buildup of corrupt seed in the womb. So there's a very particular reason why it's so powerful in that kind of context. And he would be somebody who would say that no organ can actually move.   

  Rebekah H: In one gynecological treatise that Emily and I were looking at, it talks about some of the symptoms of the womb wandering as a woman grinding her teeth, suffocating, as her eyes becoming chilled (Diseases of Women 2.201). So this idea that some of these symptoms seem very silly, and so does the cause of this disease, this wandering womb. But I wonder, is there a sense that some of these descriptions of diseases that a woman has, or anyone in antiquity has, can map on to identifiable diseases that we know something about today?

  Rebecca F: Another very good question and which we're kind of debating– We [chuckles]– Ongoing debate about how to engage with ancient descriptions of diseases which are, come from their own world, their own particular way of understanding the body. So some of the things that make sense to them, if you're kind of in this world of thinking about imbalances and the body interacting with the environment and so on—then what you look for in the way the bodies change is particular. They're thinking about external indicators as ways of thinking about what's going on inside the body. But also just what they're interested in and the kind of descriptions they provide.

  So what do you do with those sorts of descriptions? Can they map onto modern diseases? And now also, we know that diseases change quite a lot. We are all very aware that you can get new diseases. The viruses, the bacteria can evolve really fast. The way they interact with the hosts can change. So it's a kind of historically variable domain more broadly.

  And there are some diseases where I think people fit with modern descriptions reasonably good. So for example, the disease that's described—sometimes called “the sacred disease,” which involves quite serious fits—people are reasonably happy that that includes epilepsy. It might include other diseases or other conditions that include fits, but it probably does include epilepsy. There's kind of a reasonably good match. Other diseases it’s really difficult to tell. 

  And then you also have these diseases which make it even more complicated, particularly when we're talking about women and we're talking about wombs. There's so much kind of ideology and suppositions and assumptions invested in these descriptions that it becomes even more difficult to kind of work out what's going on. 

  So there's been various different sort of ideas about this. If we think of it as simply becoming almost comatose, then there are various different possibilities as to what might cause that.

  There are those who've also suggested that the history of these hysterical conditions—as in hysterical, “from the womb”—is that it's part of the way that women's sensibilities are constructed, are sort of over-sensible in some ways, and therefore prone to fainting, taking to their beds [laughs], and so on. Which is a kind of response to female oppression, if you like. The response to kind of, particularly in a certain sort of Victorian middle-class context, where you really have very little role. [chuckles] What exactly you're meant to do is very unclear, and therefore taking to your bed seems aligned with that in various senses. 

  So there are different kind of possibilities in terms of the interpretation of this. Could it be a sort of response to external conditions? Could it be about anxiety and pressure? Could it be that, as you say, maybe the authors of these texts want to give us something really exciting, so they kind of exaggerate; somebody just keeling over maybe isn't interesting enough. So I think there's lots of different things going on, and it's quite hard to work out exactly. But certainly this was a disease that medical authors gave quite a lot of attention to. 

  Emily: So thinking a bit about treatment, a recent study by the University of Chicago and UC Berkeley found that many women today have been overmedicated because medicines are typically tested on a quote-unquote “standard” male body, and then dosages are based on their physiology.[36] And similarly, somewhat, in the ancient world, many ailments could be treated identically across patients. You know, a woman who had issues with her breast or a man who had foot problems could both bring clay models of those body parts as votive offerings to a god and seek healing. And we've excavated and found a lot of these clay votive offerings.

  But were there points at which treatments diverged? Did Greek and Roman doctors have the same treatments for men and women? (And you know, of course, Greek and Roman civilizations were different from each other, but there was a fair bit of continuity in their medical practices that we're assuming in this conversation.)

  Rebecca F: So again, I mean, I think this is a sort of really interesting question because as we've said, there is this male paradigm really dominant in ancient medical thinking. On the other hand, there's also a very strong idea about individualistic approaches to medicine that everybody's bodies are slightly different and that both how you can tell somebody is ill, the way that they will manifest dropsy or whatever it is as opposed to the next individual will manifest it, is slightly different. You need to know what every individual is like when they're healthy as well, and then you need to adjust the treatment to every kind of individual. And you can see that this is already going to be only good for people who are seeing a small number of patients [laughs] and who have a lot of time to talk to them and so on. 

  Going back to the tensions that I was thinking about earlier, there is the author of Diseases of Women I,the Hippocratic treatise, says very decisively that what some physicians get wrong, so what a number of other authors and other physicians get wrong is that they treat women and men exactly the same. And that in fact, the diseases of women are different from the diseases of men. And he also blames the way that those physicians get things wrong because they don't talk to the women enough. And the women are kind of a bit problematic as patients because they tend to be quite ignorant and quite “inexperienced,” by which he means that you don't really know your body properly until you go through, until you menstruate, you become pregnant, and so on. And until you kind of know all of that, you're not really able to read what's health and what's illness within your own body. 

  But there's a counter kind of tradition, if you like. There's Soranus, this author who does write a gynecology. So Gynecology suggests that women's bodies are different, women's diseases are different, women's treatments are different and distinctive. But Soranus says, “Are there any diseases that are particular to women?” and he says “no.” [laughs] On the kind of big scale, on the important scale, men and women have the same diseases. There are some differences of detail, but they're the same, and therefore the treatments are going to be pretty much the same. 

  And Galen would certainly agree with that, that diseases are by and large generic. It might be in the breasts rather than in a foot, but basically what's happening to them is, comes under the same headings, and how you would treat them in terms of reversing those processes comes under the same headings. So that would suggest that there’s similarity of treatment, except in the detail. 

  But there is a sense in which they think that women have generally softer bodies. So you use slightly weaker, slightly more gentle drugs. Some of the cures would be… So you start with changing people's regimen, people's lifestyle. You start with alterations of diet and exercise and things like that. And clearly what the sort of exercise that women could be expected to do, and the sort of exercise that men would be expected to do and their sort of lifestyles, were somewhat different, sort of social factors that go through that difference of detail.

  And certainly Galen talks about his interactions with patients, and he interacts with his female patients and his male patients quite differently. So for example, there’s a treatise that he writes about his first arrival in Rome and how he developed his reputation and showed everybody that he was a brilliant doctor. And he has various case studies, one of which is with a philosopher Eudemus. And he has a very philosophical discussion with Eudemus about how he should understand his disease and how he should behave. And then he has a case with the wife of Boethius, one of his senatorial patrons, and she really doesn't get much of a look at [chuckles]. She gets told what to do. [All chuckle ruefully] So there clearly are differences in terms of the kind of social interactions as well, but with the Hippocratic exception there is generally a sort of treating people roughly the same and adjusting pretty much as you would on an individual basis.

  Emily: And just a quick follow-up question. This is a season on women's bodies, not women's work, but you've written an article about female medical authors and medical practitioners.[37]So should we be assuming that all of these doctors we’re talking about were men?

  Rebecca F: No, no, we shouldn't. There are definitely female physicians in the Roman world, and probably to some extent the classical Greek world as well. And there are also female medical practitioners of other sorts. So particularly midwives, for example. And midwives would be quite a, certainly in the Roman period is quite a skilled profession that Soranus tells us requires training and that you should be literate and have some ideas about theory as well as practice. And we have inscriptions from the Roman world of people who describe themselves as midwives, obstetrix or maia, so who clearly are quite committed to that role. 

  And then we do have a number of female physicians, some of whom appear in inscriptions, and some of whom get mentioned in medical texts as well. We hear about them authoring individual recipes, so particular remedies. We're very uncertain about whether or not they authored any treatises. They certainly weren't at the level of Galen or Aretaeus of Cappadocia or whatever. We do have some treatises that have women's names attached to them, but they tend to be names like Cleopatra. Now, obviously who's pretending, you don't know!

  There certainly are indications that women shared knowledge about their bodies amongst themselves and presumably did also share knowledge about cures and therapies and stuff as well. The problem is getting at that. 

  Rebekah H: Yeah, that's really interesting. And also one of the themes of our first season was the difficulties of recovering women at all from the past.

  Rebecca F: I mean we don't have very much patient perspective stuff from the medical texts themselves. But we have even less from a sort of female perspective. Did women have any choices about their doctors? So, when Galen treats Boethius's wife, he's already in contact with Boethius. And Boethius's wife becomes sick. She's been treated by her usual midwives who attend on her and Galen has quite a lot of respect for. But whatever they're doing doesn’t seem to be working. And Boethius then sort of panics a bit and starts to put the call out for other doctors to become involved. And we don't have any sense that Boethius’s wife has any choice. She has her own female medical attendants, but once it's got beyond them, seems to be that it's out of her hands.

  Rebekah H: Well that's a really nice pivot to talk about what agency women had, if any, when it came to their bodies. In a papyrus document dated to 8 BCE, a woman agreed to return her dowry and surrender any claim on her former husband's estate.[38] In return, she is permitted to expose her child and get remarried. On the other side of things, the Latin satirist Juvenal attacks those wealthy women who foster such exposed children because they are reluctant or perhaps unable to bear children of their own (Juvenal, Satires 6.592–609). So what options did women have to control their reproduction, be it enhance their fertility or restrict it?

  Rebecca F: Yeah. So again, two important points there that you raise, one of which is about—“fertility control” may be quite a strong term–but different interventions to both promote and limit fertility. And I think it's really important that we talk about both of those. And then the second question is who gets [chuckles ruefully] to exercise what control it is. Is it women control of their own bodies, or kind of male actors of various sorts?

  In the scholarship, there's been a bit of a focus on contraception and moves to try and limit fertility. But actually one of the things that's come out more recently, is historically the most important thing that pretty much every family is focused on (men, women, everybody) is having healthy children and being able to continue the family name. Cog in the communal enterprise. Even if you don't have very much property. (If you do have property, then as you were alluding to with our papyruses and so on, it's a bit more kind of complicated.) But even if you don't have property, this idea about continuity, but also the kind of way that the family is an economic unit and needs to flourish in various ways.

  We do have quite a lot of concentration on how to have healthy children. Having healthy children and keeping those children healthy may also require limitations at various points. So it may require that you don't give birth until the woman is old enough and her body is mature enough for that to be successful. Spacing of births is important for the woman's health and her prospects of producing more children, but also helps the children that are born. Stopping at a certain point is also really important in terms of trying to have a flourishing family. 

  So we do have a number of different points of intervention, or suggestions about interventions. Soranus talks about when is the best time to have sex if you want to have children, and that you should do it when you're, everybody's healthy and nobody's drunk, and everybody's sort of in the right frame of mind, and so on. And so you can do that, or you can do the opposite if you want to have less chance of conceiving. 

  And there are also pharmacological interventions both to promote fertility and to curtail it. In the Diseases of Women there's a remedy which involves honey, myrrh, tamarisk seeds, some resin, some goose grease. And you kind of join it all together and put it in wool, and use it as a pessary to promote fertility, presumably just before sex. You could switch up some of those materials, and it would have a kind of contraceptive effect as well. 

  And Soranus brings us round to the question about agency, because he says that there's been a bit of a debate about all of this, should there be abortions at all. And he says yes. He wants to reassure his male readership—or at least his male possible people who will be paying him lots of money to look after the health of their women— that you don't do it to conceal adultery. That's absolutely not right. And you also don't do it for reasons of vanity, for the woman to protect her beauty in some sense. But there are lots of good medical reasons. So if the womb’s too small, that there are problems with the health of the woman, all sorts of things that—then you can do interventions to help those outcomes. 

  And he is very clear that he is looking essentially to the man. [chuckles] They're the kind of controlling figure in all of this. That it’s what they want that is most important. And he says very clearly that basically, reproducing is bad for women's health but they've got to do it 

  They do suggest that women are talking to each other. And they do those lists of different sorts of remedies. Sometimes they suggest that they're being used by the women themselves. And clearly, once the knowledge is out there the women can try and use it themselves. 

  So, I think we're left a little bit uncertain. We know that certainly men had got clear interests in this and did exert, did attempt to pursue their own interests. But there is space for female agency as well. And it's more to do with that we can see space and opportunity than we can definitely see it happening. But space and opportunity is often all we've got.

  Emily: So we've talked about the womb as various parts of female anatomy. We're, let's talk a bit about the clitoris because it's a bit different in ancient understandings of what it was. In our world, the clitoris is associated with pleasure, but to certain Roman men it was something potentially dangerous. Writers like Rufus and Soranus document the ostensibly Egyptian practice of surgically removing the quote-unquote “excess” part of a woman's clitoris, which is truly terrifying to think about.[39] (If this sounds like a kind of female genital mutilation, that's because it was.[40]) But what was the problem this Roman “surgery,” in air quotes, was trying to correct?

  Rebecca F: Yeah. So I guess I should say at the beginning that in a sense there's been various claims to discovery of the clitoris, which is that the Greeks and Romans describing the external female anatomy did include the clitoris. And indeed, I think did think of it as about sexual pleasure. Galen also thought that it was about protecting the entrance to the vagina from cold and drafts. But I think there is a sense in which they recognized that it did, was the sort of site of pleasure. That in its of itself might be problematic if you like. 

  And we have medical authors that talk about the ways that what they would call an overly enlarged, excessive clitoris can cause kind of excessive sexuality. And in particular, they are thinking that it generates desire and an erection and takes you into the realm of male sexual behavior in various ways. 

  So they come up with a surgical sort of response to this excess. So they would say that there were some traditions, the Egyptian tradition the one they often talk about, where they claim that pretty much all women just before they're married will have some kind of surgery on the clitoris to minimize it in some way. They are looking at clitorises that are too large, but whatever “too large” means, who's judging. They don't really. [Rebekah H laughs.] They don't talk about how that might be decided. There's no suggestion—coming back to female agency—that the women themselves are saying that this is too large. So it does seem very much a kind of control of female sexuality and the possibility of kind of sexual transgressions.  

  Rebekah H: Well I've been reading a lot about pain theory recently, so I'm thinking of the inverse—so pleasure being a distinctly embodied experience. So you can imagine a world where men can talk about their own pleasure. How do they think about women and their pleasure? Or is this, again, just purely this ideological, subjective topic?

  Rebecca F: So interestingly, they do have some discussion of this. And obviously there were kind of ancient debates about, did men or women have more desire and more sexual pleasure and so on.

  But in another Hippocratic treatise On Generation, which is, kind of goes through the whole theory of generation from the production of seed through sexual intercourse through conception and pregnancy, and so on— That text does have a theory about sexual pleasure as linked to two things. One is a kind of rubbing, a kind of physical rubbing of the genital areas, but also to do with the production and the ejaculation of seed. And in that one the model is that the female experiences sexual pleasure during heterosexual intercourse on account of the man. And that her pleasure may be greater, but more short-lived. It's a bit like once he ejaculates, she's kind of been rubbed, it's generating pleasure. It's a bit like a sort of fire that's slowly building and then he pours water on it and it kind of is a big [Rebecca F. makes an explosion sound] pleasurable. [Rebekah H. laughs] And then it kind of ends. 

  So there were various other discussions a bit about female pleasure. And somebody like Galen would say that, they’ve got the genital organs in both men and women. And what the creator did is make them both, the use of them really pleasurable. And that will mean that there will be enough sex and enough for the continuation of the human beings. It doesn't really matter exactly where the pleasure is going, but there's enough pleasure. And people will have enough heterosexual sex and will have babies, that's all good. So there's a bit of thinking about it, but it's less on their mind than issues to do with male desire and male pleasure. 

  Although, I mean, they do also simply assume that men desire, kind of full stop. You don't have to explain. So one of the things that female seed does is increase sexual desire. You don't really need to explain for men why they get into it.

  Rebekah H: So the last topic we wanted to talk about is your work on the naturalization of sexual difference, studying how beliefs in women's otherness or unfitness became grounded in ideas of their inherent nature. As we've seen during this conversation, some of their explanations for disease are wrapped in sexually differentiated patterns for disease and cure, relying on the natural difference they see inherent between men and women.

  For example, Galen contrasts his virtuous father with his mother, whom he describes as “so very prone to anger that sometimes she bit her handmaids; she constantly shrieked at my father and fought with him, more than Xanthippe did with Socrates” (Aff. Dig. 8. 1). In another story, Galen is called to examine the wife of Justus, who is hostile and unable to sleep. He diagnoses her with lovesickness, a problem of the soul and not the body. Through some strategic checking of her pulse, he is even able to identify the object of her affections (Praen 6 1–2)! So can you describe this process of naturalizing sexual difference that you observe in the classical writers? How does this pattern of framing and control of the body reverberate in later centuries or even today?

  Rebecca F: Yeah. So, it's quite interesting that, on the one hand, how people have understood sexual difference has clearly varied quite a lot, changes quite a lot over history. But there are also elements of continuity. And to go back right to the beginning where we were saying that however you construct the female body, whether you think it's hotter or colder or whatever, than the man, it's always worse.

  And one of the things that has changed as well is how do you understand, how do you explain, and then how do you anchor, how do you ground, those ideas about difference of role and/or particularly hierarchies and inequalities? What sort of explanation and what kind of justification are offered in different sorts of contexts? And those do change, and they in fact they're kind of still changing. They're kind of on the move as we speak. 

  And the sort of idea about naturalization is also quite interesting because it can work in different sorts of ways. On the one hand, in the post-Enlightenment period it was very much about bodies as brute objects, if you like. As kind of hard matter which you then ground inequalities or certain sorts of social role in those bodies, and therefore make them— You know, that's just the way the world is. Or that's the way that the atoms have kind of got themselves together. And there's nothing you can do about it. That's just unchangeable.

  And there's various sort of particular arguments that come up in the nineteenth century about women's sort of fragile bodies—that if they learn Latin, it will mean that their wombs are ruined and they can't have babies. So there are kind of arguments that are like that, and that's one form of nature.  

  But in a sense in the ancient world, nature is a bit more of a kind of holistic and sort of normative concept. It's kind of important that everything aligns so that everybody's got the appropriate bodies. But whether the bodies come first, or the soul comes first, or your kind of ideas about hierarchy and the natural order comes first, is kind of more flexible. 

  And certainly somebody like Aristotle has got a very clear idea about nature in which he thinks that hierarchy is itself natural. That it is part of the nature of the cosmos, that there be better and worse. And it's pretty obvious [chuckles wryly] who's going to be on which side of that kind of equation! 

  And in a way, Galen would also agree with that. He has a kind of idea about a creative nature figure who themselves sort of makes various decisions about what's going to be best, and has some very clear ideas about what counts as best. So when we said women, you can— One way of thinking about the female anatomy is, it's the male anatomy put inside. For Galen he would then say, “and that's obviously the worst position.” And you think why? [laughs] Because actually maybe having it all on the outside is a really bad idea because it makes you more vulnerable, could be damaged. Having inside is much safer, looks more integrated. But that's just not… His natural world is this kind of normative, ordered hierarchical world.

  So I think one of the interesting things then, thinking about how these ideas go through history, is that some of these ideas about how hard you have to argue to justify things, and what are strong moves to make and what are weak moves to make, have changed and continue to evolve. The kind of arguments that people make now are not quite the same as they made even ten years ago. [Emily murmurs assent]

  One of the things that looking at history does is show you the variety, and show you that different sorts of arguments have different kind of strengths. And that if you dislodge one set of arguments that doesn't necessarily mean you've won, because they might all come round and reformulate themselves and reconfigure to meet certain other epistemic and rhetorical goals – she says cheerfully. 

  [podcast music interludes]

  Emily: “My body, my choice.” In recent years, we’ve heard this phrase invoked by progressives and conservatives alike in political and medical debates over abortion rights and Covid precautionary measures.[41] Even as debaters disagree over the range of possible choices that a woman might be allowed to make within a given scenario, it is generally assumed we all know what her body is. But as we’ve seen in today’s episode, what a woman’s body was understood to be has varied quite a bit throughout history. Even within the Greco-Roman medical tradition, several frameworks coexisted, and sometimes they were self-contradictory.

  Rebekah H: It’s important at the start of our journey together studying ancient women’s bodies, to acknowledge that the “body” itself can morph. One’s physical body grows and changes—hair turns gray, internal organs are displaced during pregnancy, menopause changes hormones with physical effects. And ideas about what the body, and specifically a woman’s body, is and how it behaves differ across cultures and evolve across time.

  Emily: Physicians’ ideas about the female body may have changed over time, but were those changes driven by anatomical and physiological observation or by culturally sexist philosophy?  Rebecca Flemming points out that what ultimately separates a Roman physician’s treatment of men and women is not a disease, like the wandering womb, or even its cure, but rather that the female patient is never the center of the story. Her body is an object on which the male doctor performs knowledge for his colleagues and the men who control the woman’s body—her father, her brother or her husband. Within Classical medical writers, women represent the minority of medical cases.[42]

  Rebekah H: Perhaps the biggest point of medical continuity from Greco-Roman antiquity to today is the tendency for men’s bodies to be the default in medical research and practice. Remember how Galen and Aristotle saw the female of the species as the deformed or incomplete male body? The male was the standard, the benchmark. The female existed in relation to it. Despite our many medical marvels since their day, overwhelmingly medicine still operates with a male-centric bias, as Maya Dusenbery and Caroline Criado Perez have recently shown.[43] Medical trials are calculated on male test subjects, with doses simply presumed to work the same way in women. For years, women’s heart attacks were often undiagnosed because physicians and average citizens did not commonly realize that heart attacks present differently in women: less of a weight upon the chest and more an ache in the shoulders and jaw, shortness of breath, nausea, and arm pain. Doctors and scientists today don’t write off women as deformed men, thankfully, but they still operate (sometimes quite literally!) with a male-centric scope. Despite all the advances of modern medicine, women today, like those in the past, can still suffer the effects of a medical tradition that treats women as just male bodies with a womb.

  Emily: Although the medical theories of female physicians and healers from Greece and Rome did not get preserved and transmitted like the works of male medical writers, we know they were working.[44]A gravestone from the mid-fourth century BCE names a woman Phanostratē as a “midwife and doctor” (IG II2 6873, NM 993). A statue of that same doctor was dedicated to Asklepios (IG II3 700).[45] Like women today, ancient women must have equally known and monitored their bodies: watching their breasts for suspicious lumps and tracking their menstrual cycles down to the day.[46]

  Rebekah: We’ll never know how Roman women’s health might have been different if physicians hadn’t considered them deformed men. But what we can do is in our world make sure that women are not treated like medical afterthoughts—but the centers of their own story. And while it’s difficult to recover the bodies of ancient women, we’re trying to do just that: putting them at the center of our story.

  [podcast theme music plays over the outro]

  Rebekah: If you enjoyed our show, please rate and review us on Apple Podcasts, Spotify, Audible, or wherever you get your podcasts. Check out our website, womenwhowentbefore.com, or find us on Twitter @womenbefore.

  This podcast is written and produced and edited by us, Emily Chesley and Rebekah Haigh. Our music is composed and produced by Moses Sun.

  This podcast is sponsored by the Center for Culture, Society and Religion, the Program in Judaic Studies, the Stanley J. Seeger Center for Hellenic Studies, and the Committee for the Study of Late Antiquity, all at Princeton University.

  Emily: Thanks for listening to Women Who Went Before. And don’t forget:

  Both: Women were there!

  [1] Rebecca Flemming summarizes: “But womb and procreation are also essential to female health more broadly. A healthy woman is a generative woman and vice versa: nonparticipation in the reproductive processes of marriage, marital intercourse and pregnancy may well make a woman ill (the Hippocratic treatise Diseases of Young Girls is the most blatant in this respect), and the cure may lie in doing these things, particularly becoming pregnant (see Hanson, 1990). That the uterus itself is the cause of many ailments is a related idea and, indeed, On Places in Man claims that wombs are the cause of all female diseases” (“Wombs for the gods,” in Bodies of Evidence:  Ancient Anatomical Votives Past, Present and Future, ed. Jane Draycott [London: Routledge, 2017], 127–128). C.f., Soranus’s contradictory view, analyzed in Rebecca Flemming, “Fertility control in ancient Rome,” Women’s History Review 30, no. 6 (2021), 898. See also Galen, On the Affected Parts 6.5.

  [2]  Quae moechum sequitur, stomacho valet. Illa maritum  / convomit (Juvenal, Satire 6.100–1). Discussed by Claude-Emanuelle Centlivres Challet, “Say it with fluids: What the body exudes and maintains when Juvenal’s couple relationships go awry,” in Bodily Fluids in Antiquity, eds. Mark Bradley, Victoria Leonard, and Laurence Totelin (London: Routledge, 2021), 138.

  [3] Ulrike Steinert, “Concepts of the Female Body in Mesopotamian Gynecological Texts,” in The Comparable Body: Analogy and Metaphor in Ancient Mesopotamian, Egyptian, and Greco-Roman Medicine, ed. John Z. Wee, Studies in Ancient Medicine 49 (Leiden: Brill, 2018), 275–357.

  [4] Walton O. Schalick III, “Hippocrates (428–347 bce),” in Encyclopedia of Disability, vol. 5, ed. Gary  L. Albrecht (Thousand Oaks, CA: Sage Publications, 2006), 852–852.

  [5]  Ali Çağlar Turgut and Recep Kutlubay, “Soranus of Ephesus (98–138 AD) and his contributions on human embryology, paediatrics and obstetric knowledge,” Child's Nervous System (2023), cover editorial, np; Rebecca Flemming, “gynecology,” in The Oxford Dictionary of Late Antiquity, online edition (Oxford: Oxford University Press, 2018), np.

  [6] Ian Johnston, “Galen and His System of Medicine,” in The Oxford Handbook of Science and Medicine in the Classical World, eds. Paul T. Keyser and John Scarborough (New York: Oxford University Press, 2018), 765–768; Christian Brockmann, “„Groß war der Name Galens”. Die Selbstdarstellung eines Arztes in seinen wissenschaftlichen Werken,” Medizinhistorisches Journal 44, no. 2 (2009), 110–113.

  [7] Johnston, “Galen and His System of Medicine,” 774–776. Brockmann puts the estimate at more than 150 treatises (“„Groß war der Name Galens,” 113).

  [8] Flemming, “Fertility control in ancient Rome,” 898.

  [9] “The uterus is the cause of all these diseases; for however it changes from its normal position—whether it moves forward, or whether it withdraws—it produces diseases” (Hippocrates of Cos, On the Places in Man 47). In Hippocrates, Places in Man. Glands. Fleshes. Prorrhetic 1-2. Physician. Use of Liquids. Ulcers. Haemorrhoids and Fistulas, ed. and trans. Paul Potter, Loeb Classical Library 482 (Cambridge: Harvard University Press, 1995), pp. 93–95.

  [10] Plato, Timaeus, 90c–91d, in Plato, Timaeus. Critias. Cleitophon. Menexenus. Epistles, trans. R. G. Bury, Loeb Classical Library 234 (Cambridge: Harvard University Press, 1929), 249–251.

  [11] Aretaeus of Cappadocia, On the Causes and Symptoms of Acute Diseases 2.11.1; Soranus, Gynecology 3.29.

  [12] The thin gold sheet dates to the first century BCE or CE and is inscribed in Greek, “I adjure you, womb of Ipsa, whom Ipsa bore, in order that you never abandon your place, in the name of the lord god, the living, the unconquerable: remain in the spot of Ipsa, whom Ipsa bore.” Translated and analyzed by Christopher A. Faraone, “Magical and Medical Approaches to the Wandering Womb in the Ancient Greek World,” Classical Antiquity 30, no. 1 (2011), 19.

  [13] Faraone, “Magical and Medical Approaches,” 6. While Jean MacIntosh Turfa suggests that postmortem Cesarean sections may have provided some information of what the womb looked like (Divining the Etruscan World: The Brontoscopic Calendar and Religious Practice [Cambridge: Cambridge University Press, 2012], 170), Rebecca Flemming thinks they would have only provided a general sense of the uterus’ carrying capacity and would not have supplied new information (“Wombs for the Gods,” 125). For a study of how Greco-Roman physicians learned about human anatomy and how that knowledge was shared, see Claire Bubb, Dissection In Classical Antiquity: A Social and Medical History (Cambridge: Cambridge University Press, 2022).

  [14] Or the idea that women get more emotional leading up to menstruation – which, incidentally, scientist Sally King has disproved. Sally King, “Premenstrual Syndrome (PMS) and the Myth of the Irrational Female,” in The Palgrave Handbook of Critical Menstruation Studies, ed. Chris Bobel et. al. (Palgrave Macmillan, 2020), 287–302.

  [15] “If no flux appears, but the uterus fails to release the menses even though it is swollen by the diseases above, the woman’s belly becomes large, she feels a weight in it like a woman who is pregnant, and a fetus seems to be moving there because the uterus is full of water and the water is moving, since it undulates from time to time like it would in a wineskin” (Hippocrates, On Diseases of Women, ed. and trans. Paul Potter, Loeb Classical Library 538 [Cambridge: Harvard University Press, 2018], 1.61, p. 129). For the womb as an “oil flask” (Hippocrates, On Diseases of Women, 1.33), see Flemming, “Wombs for the gods,” 126–127.

  [16] Bibliothèque Royale de Belgique MS 3701–15.

  [17] As Shai Secunda puts it, “The Mishnah also hints at a second, key feature of female corporality shared with other writings in antiquity, namely, that of a fluid female body, where blood constantly flows between bodily chambers.” The Talmud’s Red Fence: ​​Menstrual Impurity and Difference in Babylonian Judaism and its Sasanian context (Oxford: Oxford University Press, 2020), 30.

  [18] “The sages had a metaphor for the woman: [She possesses] a chamber, a vestibule, and an attic. Blood of the chamber is impure; If it is found in the vestibule, a situation of doubt [regarding its origins] is [treated as] impure, for the assumption is that it is from the womb” (m. Nidah 2:5 in MS Kaufmann, trans. Secunda, The Talmud’s Red Fence, 29).

  [19] “It is the way of flesh and blood that when someone places an object in a tied skin bottle with its mouth turned upwards it is still doubtful whether or not it is secure; yet the Holy One blessed is He fashions an embryo in a woman’s innards, which is open and the mouth faces downwards and yet it is secure” (b. Nidah 31b, trans. Secunda, Talmud’s Red Fence, 30n12). Leviticus Rabbah 14:2 sees the womb as a prison from which the fetus must be freed. For the body as a “skin bottle,” see also b. Shabbat 152a.

  [20]  “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” Aristotle, Generation of Animals, trans. A. L. Peck, Loeb Classical Library 366 (Cambridge: Harvard University Press, 1942), 2.3.737A24–38.

  [21] Tara Mulder, “Flabby Flesh and Fetal Formation,” in Bodily Fluids in Antiquity, 151. Galen, On Seed 2.5.56–78, and On the Usefulness of the Parts 14.6.

  [22] Rebecca Flemming, “The Classical Clitoris: Part I,”  EuGeStA 12 (2022), 212.

  [23] Charles Jaco, “Jaco Report: Full Interview with Todd Akin,” The Jaco Report on FOX 2, August 19, 2012, updated August 20, 2012, accessed October 13, 2024, https://fox2now.com/news/jaco-report/the-jaco-report-august-19-2012/; and Charlotte Alter, “Todd Akin Still Doesn’t Get What’s Wrong With Saying ‘Legitimate Rape’,” Time, July 17, 2014, accessed October 13, 2024, https://time.com/3001785/todd-akin-legitimate-rape-msnbc-child-of-rape/.

  [24] Charlotte Alter, “Todd Akin Still Doesn’t Get What’s Wrong.”

  [25] Fleta, ed. and trans. H.G. Richardson and G.O. Sayles, Selden Society Publications, vol. 72 (London 1953), volume II, Book 1, chapter 33, p. 89, quoted in Elise Bennett Histed, “Mediaeval Rape: A Conceivable Defence?” The Cambridge Law Journal 63, no. 3 (2004): 744.

  [26]  Samuel Farr, Elements of Medical Jurisprudence (London 1788), pp. 42–43, quoted in Histed, “Mediaeval Rape,” 767. 

  [27] Histed traces a plausible route for how ideas from the Hippocratic Corpus and Galen were transmitted through medieval philosophy and legal texts into thirteenth-century England (“Mediaeval Rape,” 745–754).

  [28] For further reading on the possible role of pleasure in procreation in the Mediterranean world see Laura Quick, “Bitenosh’s Orgasm, Galen’s Two Seeds and Conception Theory in the Hebrew Bible,” Dead Sea Discoveries 28, 1 (2021): 38–63; Rebecca Flemming, “Galen’s Generations of Seeds,” in Reproduction: Antiquity to the Present Day, eds. Nick Hopwood, Rebecca Flemming, and Lauren Kassell (2018), 100–102; and Flemming, “The Classical Clitoris: Part I,” 209–210 and 209n17. 

  [29] Galen, On Seed 1.2 and 1.7, and On the Usefulness of the Parts 14.7 and 14.11. See also Rebecca Flemming’s discussion of seed, pleasure, and reproduction in “One-seed, two-seed, three-seed? Reassessing the fluid economy of ancient generation” in Bodily Fluids in Antiquityeds. M. Bradley, V. Leonard, & L. Totelin (Routledge, 2021), 160.

  [30] Galen, On the Usefulness of the Parts 14.11, trans. Margaret Tallmadge May in Galen, On the Usefulness of the Parts of the Body,vol. 2 (Cornell University Press, 1968), 643.

  [31] Steven Oberhelman, “Anatomical Votive Reliefs as Evidence for Specialization at Healing Sanctuaries in the Ancient Mediterranean World,” Athens Journal of Health 1, no. 1 (2014): 48.

  [32] Rebecca Flemming, “Wombs for the gods,” 114.

  [33] Frankfurter talks about how votive offerings continued into Christian Egypt with temple cults replaced by saints shrines. David Frankfurter, “Female Figurines in Early Christian Egypt: Reconstructing Lost Practices and Meanings,” Material Religion 11, no. 2 (2015): 190–223.

  [34] On the complexity of interpreting votive offerings and how local beliefs about a god or goddess’ power influenced the votive offerings found in their sanctuaries, particularly in the case of Heraia, see Jens D. Baumbach, “‘Speak, votives, …’. Dedicatory practice in sanctuaries of Hera,” in Le donateur, l’offrande et la déesse: Systèmes votifs dans les sanctuaires de déesses du monde grec, ed. Clarisse Prêtre with the collaboration of Stéphanie Huysecom-Haxhi (Liège: Centre International d’Étude de la Religion Grecque Antique, 2009), 203–223.

  [35] Translated by Farone, ““Magical and Medical Approaches,” 3.

  [36] Irving Zucker and Brian J Prendergast, “Sex differences in pharmacokinetics predict adverse drug reactions in women,” Biology of Sex Differences 11, no. 32 (2020), 14 pages; and University of California – Berkeley, "Lack of females in drug dose trials leads to overmedicated women," ScienceDaily, accessed October 15, 2024, https://www.sciencedaily.com/releases/2020/08/200812161318.htm. “The common practice of prescribing equal drug doses to women and men neglects sex differences in pharmacokinetics and dimorphisms in body weight, risks overmedication of women, and contributes to female-biased adverse drug reactions” (Zucker and Prendergast, p. 1 of 14).

  [37] Rebecca Flemming, “Women, Writing And Medicine In The Classical World,” The Classical Quarterly 57, no. 1 (2007): 257–279.

  [38] 58 BGU 1V.1104; Jane Rowlandson, Women and Society in Greek and Roman Egypt: A Sourcebook (Cambridge: Cambridge University Press, 1998), no. 129.

  [39] Flemming, “The Classical Clitoris: Part I.”

  [40] “Female genital mutilation,” the World Health Organization, fact sheet, February 5, 2024. Accessed October 15, 2024.https://www.who.int/news-room/fact-sheets/detail/female-genital-mutilation

  [41] Melissa N. Montoya and Eve C. Feinberg, “My body, whose choice?” Fertil Steril 1117, no. 3 (2022): 485–486; and “‘My body, my choice’: Anger over US Supreme Court abortion ruling,” Al Jazeera, 25 June 2022, https://www.aljazeera.com/news/2022/6/25/my-body-my-choice-anger-over-us-supreme-court-abortion-ruling.

  [42] Rebecca Flemming, Medicine and the Making of Roman Women: Gender, Nature, and Authority from Celsus to Galen (Oxford: Oxford University Press, 2000), 360

  [43] Maya Dusenberry, Doing Harm: The Truth About How Bad Medicine and Lazy Science Leave Women Dismissed, Misdiagnosed, and Sick (2018); and Caroline Criado Perez, Invisible Women: Data Bias in a World Designed for Men (2019).

  [44] “Women Healers: Midwives, Physicians, and Folk Healers,”  in The Empire’s Physician: Prosperity, Plague, & Healing in Ancient Rome, online exhibition curated by Claire Bubb, Clare Fitzgerald, and Alexander Jones, and written by Rachel Herschman, presented by The Institute for the Study of the Ancient World (ISAW), 2021, accessed October 13, 2024, https://exploregalen.com/project/women-healers; Caroline L. Herzenberg, Susan V. Meschel, and James A. Altena, “​​Women scientists and physicians of antiquity and the Middle Ages,” Journal of Chemical Education 68 no. 2 (1991), 101–103; and Ioannis D. Gkegkes, Christos Iavazzo, Thalia A. Sardi, and Matthew E. Falagas, "Women Physicians in Byzantium," World Journal of Surgery 41 no. 3 (2017), 893–895.

  [45] References on Phanostratē from Katherine Backler, “Who’s your tent-buddy? The social worlds of Athenian women,” Program in the Ancient World lunch talk, Princeton University, April 5, 2024.

  [46] One of the oldest known calendars in the world is the Ishango bone: ca. 20,000–22,000 years old, it is marked with a series of notches. Various theories have been proposed about the bone, from a lunar calendar to a counting stick in base 6–10 to an arithmetic game (See Dirk Huylebrouck, Africa and Mathematics [Cham: Springer Nature Switzerland, 2019], 141–176 for an up-to-date summary of research). One proposal from Claudia Zaslavsky was that the bone was produced by an ancient woman tracking her monthly cycle, since she saw 28 lines on the bone. For further reading on different cultural practices around menstrual tracking see Olivia Campbell, “How Period Tracking Birthed the Calendar: Women as the first mathematicians, the first agriculturists,” Beyond Curie, December 2, 2021, accessed October 13, 2024, https://oliviacampbell.substack.com/p/how-period-tracking-birthed-the-calendar. Some Burundian women traditionally tracked their pregnancies by tying knots in strings (Huylebrouck, Africa and Mathematics, 79–81).

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Cover Image:

The doctor Soranus’ treatise Gynecology was one of the most popular medical texts, even into late antiquity and the medieval period. It was copied and translated widely. The images in this ninth-century Latin manuscript show how he viewed the womb as a sack or leather bottle with a flexible neck.

Image Credit: Fetal positions in the womb. Illustration accompanying Soranus’ Gynecology. 9th century CE. Brussels, Bibliothèque Royale, ms. 3701-15, fol. 28r. Image from Wikimedia Commons.

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Votive Womb

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Votive Pregnant Woman

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Manuscript of Soranus

Women Who Went Before is written, produced, and edited by Rebekah Haigh and Emily Chesley. The music is composed and produced by Moses Sun.

Sponsored by the Center for Culture, Society, and Religion, the Program in Judaic Studies, the Stanley J. Seeger Center for Hellenic Studies. at Princeton University

Views expressed on the podcast are solely those of the individuals, and do not represent Princeton University.