Ancient Physiological Works
Selections
The female role in generation. Athens, 4th cent. B.C.
(Aristotle, On the Generation of Animals, 716a5-23, 727a2-30, 727b31-33,
728b l8-31, 765b8-20, 766al7-30, 783b26-784al2.
Tr. A.L. Peck, LCL. G)
Aristotle's explanation of the process of conception is deduced from external secretions: male semen has primary generative importance, female semen (i.e. menstrual fluid, which also sustains the developing embryo) purely nutritive value.
Male and female defined
As far as animals are concerned, we must describe their generation just as we find the theme requires for each several kind as we go along, linking our account on to what has already been said. As we mentioned, we may safely set down as the chief principles of generation the male [factor] and the female [factor]; the male as possessing the principle of movement and of generation, the female as possessing that of matter. One is most likely to be convinced of this by considering how the semen is formed and whence it comes; for although the things that are formed in the course of Nature no doubt take their rise out of semen, we must not fail to notice how the semen itself is formed from the male and the female, since it is because this part is secreted from the male and the female, and because its secretion takes place in them and out of them, that the male and the female are the principles of generation. By a 'male' animal we mean one which generates in another, by 'female' one which generates in itself. This is why in cosmology too they speak of the nature of the earth as something female and call it 'mother', while they give to the heaven and the sun and anything else of that kind the title of 'generator', and 'father'.
Now male and female differ in respect of their logos in that the power or faculty possessed by the one differs from that possessed by the other; but they differ also to bodily sense, in respect of certain physical parts. They differ in their logos, because the male is that which has the power to generate in another (as was stated above), while the female is that which can generate in itself, i.e. it is that out of which the generated offspring, which is present in the generator, comes into being ...[1]
Comparison of male and female anatomy. Pergamum, 2nd cent. A.D.
(Galen, On the Usefulness of the Parts of the Body 14.6-7, exc. Tr. M.T. May. G)
Galen, born and educated in Pergamum, the great Hellenistic seat of learning in Asia Minor, was philosopher, physician, and eclectic dogmatist. He began his career as a gladiators' doctor, but eventually became physician to the Emperor Marcus Aurelius. His pathology was speculative and based on the doctrine that health depended on the balance of the four humours (black bile, yellow bile, blood and phlegm). His reliance on philosophical premise and astrological prognostication has little connection with modern scientific technique. Some of his anatomical conclusions are based on inaccurate comparisons between animals, which he dissected, and humans, whom he did not. But he made significant contributions to diagnosis and prognosis.[2]
The female is less perfect than the male for one, principal reason because she is colder, for if among animals the warm one is the more active, a colder animal would be less perfect than a warmer. A second reason is one that appears in dissecting ...
All the parts, then, that men have, women have too, the difference between them lying in only one thing, which must be kept in mind throughout the discussion, namely, that in women the parts are within [the body], whereas in men they are outside, in the region called the perineum.[3] Consider first whichever ones you please, turn outward the woman's, turn inward, so to speak and fold double the man's, and you will find them the same in both in every respect. Then think first, please, of the man's turned in and extending inward between the rectum and the bladder.
If this should happen, the scrotum would necessarily take the place of the uteri, with the testes lying outside, next to it on either side; the penis of the male would become the neck of the cavity that had been formed; and the skin at the end of the penis, now called the prepuce, would become the female pudendum [the vagina] itself. Think too, please of the converse, the uterus turned outward and projecting. Would not the testes [the ovaries] then necessarily be inside it? Would it not contain them like a scrotum? Would not the neck [the cervix], hitherto concealed inside the perineum but now pendent, be made into the male member? And would not the female pudendum, being a skinlike growth upon this neck, be changed into the part called the prepuce? It is also clear that in consequence the position of the arteries, veins, and spermatic vessels [the ductus deferentes and Fallopian tubes] would be changed too. In fact, you could not find a single male part left over that had not simply changed its position; for the parts that are inside in woman are outside in man. You can see something like this in the eyes of the mole, which have vitreous and crystalline humours and the tunics that surround these and grow out from the meninges, as I have said, and they have these just as much as animals do that make use of their eyes. The mole's eyes, however, do not open, nor do they project but are left there imperfect and remain like the eyes of other animals when these are still in the uterus ...
So too the woman is less perfect than the man in respect to the generative parts. For the parts were formed within her when she was still a foetus, but could not because of the defect in the heat emerge and project on the outside, and this, though making the animal itself that was being formed less perfect than one that is complete in all respects, provided no small advantage for the race; for there needs must be a female. Indeed, you ought not to think that our creator would purposely make half the whole race imperfect and, as it were, mutilated, unless there was to be some great advantage in such a mutilation.
Let me tell what this is. The foetus needs abundant material both when it is first constituted and for the entire period of growth that follows. Hence it is obliged to do one of two things; it must either snatch nutriment away from the mother herself or take nutriment that is left over. Snatching it away would be to injure the generant, and taking left over nutriment would be impossible if the female were perfectly warm; for if she were, she would easily disperse and evaporate it. Accordingly, it was better for the female to be made enough colder so that she cannot disperse all the nutriment which she concocts and elaborates ... This is the reason why the female was made cold, and the immediate consequence of this is the imperfection of the parts, which cannot emerge on the outside on account of the defect in the heat, another very great advantage for the continuance of the race. For, remaining within, that which would have become the scrotum if it had emerged on the outside was made into the substance of the uteri, an instrument fitted to receive and retain the semen and to nourish and perfect the foetus.
Forthwith, of course, the female must have smaller, less perfect testes, and the semen generated in them must be scantier, colder, and wetter (for these things too follow of necessity from the deficient heat). Certainly such semen would be incapable of generating an animal, and, since it too has not been made in vain, I shall explain in the course of my discussion what its use is: The testes of the male are as much larger as he is the warmer animal. The semen generated in them, having received the peak of concoction, becomes the efficient principle of the animal. Thus, from one principle devised by the creator in his wisdom, that principle in accordance with which the female has been made less perfect than the male, have stemmed all these things useful for the generation of the animal: that the parts of the female cannot escape to the outside; that she accumulates an excess of useful nutriment and has imperfect semen and a hollow instrument to receive the perfect semen; that since everything in the male is the opposite [of what it is in the female], the male member has been elongated to be most suitable for coitus and the excretion of semen; and that his semen itself has been made thick, abundant, and warm ...
It is clear that the left testis in the male and the left uterus in the female receive blood still uncleansed, full of residues, watery and serous, and so it happens that the temperaments of the instruments themselves that receive [the blood] become different. For just as pure blood is warmer than blood full of residues, so too the instruments on the right side, nourished with pure blood, become warmer than those on the left ... Moreover, if this has been demonstrated and it has been granted that the male is warmer than the female, it is no longer at all unreasonable to say that the parts on the right produce males and those on the left, females. In fact, that is what Hippocrates meant when he said, 'At puberty, whichever testis appears on the outside, the right, a male, the left, a female.'[4] That is to say, when the generative parts first swell out and the voice becomes rougher and deeper-for this is what puberty is-Hippocrates bids us observe which of the parts is the stronger; for of course, those that swell out first and have a greater growth are the stronger.
Women's illnesses. Cos, 4th cent. B.C. (Hippocrates, Diseases of Women 1.1, 2, 6, 7, 21, 25, 33, 62 exc.=VIII.12-22, 30-4, 60-2, 64-8, 78, 126 Littré. Tr. A. Hanson. G)
Problems with the female sexual organs were thought to affect the woman's organism as a whole. It was believed that normal conditions could be restored in the first instance by sexual intercourse and pregnancy, and then (if that were not possible) by manipulation of the affected areas and the insertion into the vagina of medicinal pessaries or fumigations. intended to expel accumulated blood or fluid and/or restore a displaced uterus to its proper position. Along with a wide range of vegetable substances, doctors employed strong drugs like Spanish fly and substances that they did not use with such frequency on their male patients, such as animal dung and urine.[5]
(1) The following concerns women's diseases. I say that a woman who has never given birth suffers more intensely and more readily from menstruation than a woman who has given birth to a child. For whenever a woman does give birth, her small vessels become more easy-flowing for menstruation (because the birth process stretches the vessels and so makes menstruation easier.) ...
I say that a woman's flesh is more sponge-like and softer than a man's: since this is so, the woman's body draws moisture both with more speed and in greater quantity from the belly than does the body of a man ...
And when the body of a woman-whose flesh is soft-happens to be full of blood and if that blood does not go off from her body, pain occurs, whenever her flesh is full and becomes heated. A woman has warmer blood and therefore she is warmer than a man. If the existing surplus of blood should go off, no pain results from the blood. Because a man has more solid flesh than a woman, he is never so totally overfilled with blood that pain results if some of his blood does not exit each month. He draws whatever quantity of blood is needed for his body's nourishment; since his body is not soft, it does not become overstrained nor is it heated up by fullness, as in the case of a woman. The fact that a man works harder than a woman contributes greatly to this; for hard work draws off some of the fluid.
(2) Whenever in a woman who has never given birth the menses are suppressed and cannot find a way out, illness results. This happens if the mouth of the womb is closed or if some part of her vagina is prolapsed. For if one of these things happens, the menses will not be able to find a way out until the womb returns to a healthy state. This disease occurs more frequently in women who have a womb narrow at the mouth or who have a cervix which lies far away from the vagina. For if either of these conditions exists and if the woman in question does not have intercourse and if her belly is more emptied than usual from some suffering, the womb is displaced.[6] The womb is not damp of its own accord (as, for example, in the case of a woman who does not have coitus) and there is empty space for the womb (as, for example, when the belly is more empty than usual) so that the womb is displaced when the woman is drier and emptier than normal.
There are also occasions when, after the womb is displaced, the mouth happens to be turned too far, such as in a case where the cervix lies far away from the vagina. But if her womb is damp from coitus and her belly is not empty, her womb is not easily displaced.
The following things also happen. For some women, when two months' menses are accumulated in quantity in the womb, they move off into the lungs whenever they are prevented from exiting. The woman suffers all the symptoms which have been mentioned in the discussion of phthisis[7] and she cannot survive.
(6) If a woman is healthy, her blood flows like that from a sacrificial animal and it speedily coagulates. Those women who habitually menstruate for longer than four days and whose menses flow in great abundance, are delicate and their embryos are delicate and waste away. But those women whose menstruation is less than three days or is meagre, are robust, with a healthy complexion and a masculine appearance; yet they are not concerned about bearing children nor do they become pregnant.
(7) If suffocation occurs suddenly, it will happen especially to women who do not have intercourse and to older women rather than to young ones, for their wombs are lighter. It usually occurs because of the following: when a woman is empty and works harder than in her previous experience, her womb, becoming heated from the hard work, turns because it is empty and light. There is, in fact, empty space for it to turn in because the belly is empty. Now when the womb turns, it hits the liver and they go together and strike against the abdomen-for the womb rushes and goes upward towards the moisture, because it has been dried out by hard work, and the liver is, after all, moist. When the womb hits the liver, it produces sudden suffocation as it occupies the breathing passage around the belly.
Sometimes, at the same time the womb begins to go towards the liver, phlegm flows down from the head to the abdomen (that is, when the woman is experiencing the suffocation) and sometimes, simultaneously with the flow of phlegm, the womb goes away from the liver to its normal place and the suffocation ceases. The womb goes back, then, when it has taken on moisture and has become heavy ... Sometimes, if a woman is empty and she overworks, her womb turns and falls towards the neck of her bladder and produces strangury-but no other malady seizes her. When such a woman is treated, she speedily becomes healthy; sometimes recovery is even spontaneous.
In some women the womb falls towards the lower back or towards the hips because of hard work or lack of food, and produces pain.
Diseases of pregnant women
(21) Now I shall discuss the diseases of pregnant women. Some women conceive a child easily, but are not able to carry it full term; the children are lost through miscarriage in the third or fourth month-even though the woman has suffered no physical injury nor eaten the wrong kind of food. In such women the cause of the circumstances mentioned is especially when the womb releases matter which would make the embryo grow. The woman's bowels become upset: weakness, high fever, and lack of appetite affect them during the time in which they are aborting their children. The following is also a cause, namely if the womb is smooth-either naturally or due to the presence of lacerations in the womb. Now if the womb is smooth, sometimes the membranes which envelop the child are detached from the womb when the child begins to move-because these membranes are less a part of the womb than they ought to be, due to the fact that the womb is smooth. Anyone would know all these details if he would carefully ask about them. Insofar as the smoothness of the womb is concerned, let another woman touch the womb when it is empty, for the smoothness is not immediately distinguishable. If the menses flow in these women, they come copiously. Occasionally some of these women carry their embryos to full term, and when such women are cared for, they have hope of a normal birth.
(25) I say that if menses flow each month for a woman who is two or three months pregnant or more, she is necessarily thin and weak. Occasionally a fever grips her during the days until the menses flow. When the menstrual blood flows, she becomes pale, yet very little flows out. Her womb has come to gape open more than it ought to and it releases matter which would make the embryo grow. Blood comes down from all the body when a woman is pregnant and gradually enters the womb, encircling that which is inside it; the blood makes it grow. But if the womb gapes open more than it should, it releases the blood each month just as it has been accustomed to do in the past, and that which is in the womb becomes thin and weak. When such a woman is cared for, the embryo also is better and the woman herself is healthy. If she is not cared for, she loses her child and, in addition, she runs the risk of having a long-lasting disease ...
There are also many other dangers by which embryos are aborted; if, for example, a pregnant woman is sick and weak, and if she picks up a burden with all her bodily strength, or if she is beaten, or leaps into the air, or goes without food, or has a fainting spell, or takes too much or too little nourishment, or becomes frightened and scared, or shouts violently. Nurture is a cause of miscarriage, and so is an excessive drink. Wombs by themselves also have natural dispositions by which miscarriage can occur: wombs that are flatulent, for example, or tightly packed, loose, over large, over small, and other types which are similar.
If a pregnant woman feels distressed in her belly or in her lower back, one must fear lest the embryo bring on a miscarriage, since the membranes which surround it have been broken.
There are also women who lose their children if they eat or drink something pungent or something bitter contrary to their usual habits-if the child is in an early stage of its development. For whenever something happens to a child contrary to its usual habits, it will die when it is little, especially if the mother drinks or eats the kind of thing that strongly upsets her stomach when the child is in an early stage of development. For the womb perceives when a diarrhoetic flux comes down from the belly.
(33) If in the case of a pregnant woman the time for birth is already past, if labour pains are present, and if for a long time the woman has been unable to bring forth the child without injury to herself, usually the child is coming in lateral or breech position-yet it is better for it to come out head-first. The pain involved is of the following sort: as if, for example, someone would throw an olive pit into a small-mouthed oil flask, the pit is not naturally suited to be taken out when it is turned on its side. In this way, then, the birth of the embryo laterally presented is also a very painful experience for the woman; it just doesn't go out. The pains are even more difficult if the embryo proceeds feet-first; many times the women die, or the children, or even both. A major cause of the embryo not going out easily is if it is dead, or paralysed, or if there are two of them.
62. All these diseases, then, happen more frequently to women who have not borne a child; yet they also happen to those who have. These diseases are dangerous, as has been said, and for the most part they are both acute and serious, and difficult to understand because of the fact that women are the ones who share these sicknesses. Sometimes women do not know what sickness they have, until they have experienced the diseases which come from menses and they become older. Then both necessity and time teach them the cause of their sicknesses. Sometimes diseases become incurable for women who do not learn why they are sick before the doctor has been correctly taught by the sick woman why she is sick. For women are ashamed to tell even of their inexperience and lack of knowledge. At the same time the doctors also make mistakes by not learning the apparent cause through accurate questioning, but they proceed to heal as though they were dealing with men's diseases. I have already seen many women die from just this kind of suffering. But at the outset one must ask accurate questions about the cause. For the healing of the diseases of women differs greatly from the healing of men's diseases.
Displacement of the womb (Hippocrates, Places in Human Anatomy 47=V 344-6 Littré. G)
As for what are called women's diseases: the womb is responsible for all such diseases. For the womb, when it is displaced from its natural position, whether forward or back, causes diseases. When the neck of the womb has been moved back and does not bring its opening towards or touch the lips of the vagina, the problem is minor. But if the womb falls forward and brings its opening towards the lips, it first of all causes pain when it makes contact, and then because the womb is cut off and obstructed by the contact of its neck with the lips of the vagina, there is no so-called menstrual flow. This flow if retained causes swelling and pain. If the womb descends and is diverted so that it approaches the groin, it causes pain. If it ascends and diverted and cut off, it causes illness through its compression. When a woman is ill because of this problem, she has pains in her thighs and her head. When the womb is distended and swollen, there is no flow, and it becomes filled up. When it is filled, it touches the thighs. When the womb is filled with moisture and distended, there is no flow, and it causes pain in both the thighs and the groin, something like balls roll through the stomach, and cause pain in the head, first in one part, and then in all of it, as the disease develops.
The treatment is as follows: if the womb has only moved forward and it is possible to apply ointment, use any foul-smelling ointment you choose, either cedar or myssoton, or some other heavy and ill-scented substance, and fumigate, but do not use a vapour-bath, and do not give food or a diuretic liquid during this time, or wash her in hot water. If the womb has turned upwards and is not obstructed, use sweet-smelling pessaries that are also inflammatory. These are myrrh, or perfume, or some other aromatic and inflammatory substance. Use these in pessaries, and from below apply fumigations with wine vapour, and wash with hot water, and use diuretics. It is clear that the womb is turned upwards and is not obstructed, because there is a flow.
If the womb is obstructed, then there is no so-called menstrual flow. This disease must be treated first with a vapour-bath; put wild figs into the wine, and heat it and put a gourd around the mouth of the vessel in which the wine is heated. Then do as follows: cut the gourd through the middle and hollow it out, and cut off a bit of its top, as if you were making a nozzle for a bellows, so that the vapour can go through its channel and reach the womb. Wash with hot water, and use pessaries made of inflammatory drugs. The following inflammatory drugs bring on menstruation: cow dung, beef bile, myrrh, alum, galbanum, and anything similar; use as much of these as possible. Evacuate from below by laxative drugs that do not cause vomiting, diluted, so that it does not become a purgative by being too strong. Use pessaries as follows, if you want them to be strong. Use half-cooked honey, and add some of the substances prescribed to bring on menstruation; after you have added them, make the pessaries like pellets used for the anus, but make them long and thin. Make the woman lie down, and elevate the feet of the bed towards her feet, insert the pessary, and apply heat either on a chamber-pot or on some other vessel, so that the pessary melts. If you want to make the pessary less strong, wrap it in linen. And if the womb is filled with fluid, with its mouth swollen, so that amenorrhoea results, heal it by bringing on menstruation with medicinal pessaries, using both inflammatory pessaries as described, as in the case of the preceding amenorrhoea. If there is an excessive flow, do not use hot water or any other kind, nor diuretics or laxative foods. Raise the foot of the bed higher, so that the inclination of the bed does not encourage the flow, and use astringent pessaries. The flow, if her period comes directly, is bloody, if it diminishes, it contains pus. Young women bleed more, and the so-called menstrual periods of older women contain more mucous.
Hysterical suffocation. (Hippocrates, Diseases of Women 2.126, 123= VIII 271-3, 266 Littré. G)
(126) When the womb remains in the upper abdomen, the suffocation is similar to that caused by the purgative hellebore, with stiff breathing and sharp pains in the heart. Some women spit up acid saliva, and their mouths are full of fluid, and their legs become cold. In such cases, if the womb does not leave the upper abdomen directly, the women lose their voices, and their head and tongue are overcome by drowsiness. If you find such women unable to speak and with their teeth chattering, insert a pessary of wool, twisting it round the shaft of a feather in order to get it in as far as possible-dip it either in white Egyptian perfume or myrtle or bacchar or marjoram. Use a spatula to apply black medicine (the kind you use for the head) to her nostrils. If this is not available, wipe the inside of her nostrils with silphium, or insert a feather that you have dipped in vinegar, or induce sneezing. If her mouth is closed tight and she is unable to speak, make her drink castoreum in wine. Dip your finger in seal oil and wipe inside her nostrils. Insert a wool pessary, until the womb returns, and remove it when the symptoms disappear. But if, when you take the pessary out, the womb returns to the upper abdomen, insert the pessary as you did before, and apply beneath her nostrils fumigations of ground-up goat or deer horn, to which you have added hot ashes, so that they make as much smoke as possible, and have her inhale the vapour up through her nose as long as she can stand it. It is best to use a fumigation of seal oil: put the coals in a pot and wrap the woman up-except for her head. So that as much vapour as possible is emitted, drip a little fat on it, and have her inhale the vapour. She should keep her mouth shut. This is the procedure if the womb has fallen upward out of place ...
(123) When the womb moves towards her head and suffocation occurs in that region, the woman's head becomes heavy, though there are different symptoms in some cases. One symptom: the woman says the veins in her nose hurt her and beneath her eyes, and she becomes sleepy, and when this condition is alleviated, she foams at the mouth.
You should wash her thoroughly with hot water, and if she does not respond, with cold, from her head on down, using cool water in which you have previously boiled laurel and myrtle. Rub her head with rose perfume, and use sweet-scented fumigations beneath her vagina, but foul-scented ones at her nose. She should eat cabbage, and drink cabbage juice.
Notes:
1. Cf. Apollo's argument in Aeschylus, Eumenides 658-61, which helps win the case for Orestes: 'She who is called the child's mother is not its begetter, but the nurse of the newly sown conception. The begetter is the male, and she as a stranger for a stranger preserves the offspring, if no god blights its birth' (tr. H. Lloyd-Jones).
2. See number 352, and Scarborough 1977. Cf. Jackson 1988, 86-111.
3. This notion may go back to the third-century B.C. doctor Herophilus of Alexandria, Galen On Seed 2.1= F 61 (von Staden 1989).
5. On the medicinal use of excrement, cf. von Staden, 1989, 18-9.
6. Womb here translates the plural in Greek. Since human dissection was not practised, doctors inferred that the human uterus was similar to the bicornuate uterus of domestic animals. See A. Guttmacher's note in Ellinger 1952, 113-7.
7. I. e., wasting away or atrophy.