Gender in Early Modern Medicine
The presence of ancient texts is clearly evident in early modern medicine. Classical medical tradition had been central to Western medical learning, but from the later decades of the fifteenth century, the philological study, editing and translation of Greek medical texts made fuller knowledge of ancient medicine available to a wider audience. In particular, the Latin translation by Marcus Fabius Calvus (d. 1527) of the Hippocratic Corpus, published in 1525, generated a new interest in Hippocrates (c. 460-c. 370 bce).5 The Hippocratic Corpus is a heterogeneous collection of around 60 medical texts, the majority dating from the fifth and fourth centuries BCE, and traditionally ascribed to Hippocrates. These writings cover a wide range of topics, including women’s diseases, reproduction, and infertility. Both in Latin translation and in the original Greek language, these editions were an important stimulus to the establishment of Hippocrates as an authority on women’s diseases and to the remarkable increase in published books on this subject between the sixteenth and seventeenth centuries.
Early modern treatises about women’s diseases have aroused some interest in recent decades. Notably, they have been exploited to offer key arguments against Thomas Laqueur’s thesis that the idea of incommensurable anatomical difference between the sexes was an eighteenth-century invention. Laqueur argued that before this time, the ‘one-sex model’ held sway. His ‘one-sex model’ theory is based on the Galenic notion that the female body was identical to the male’s, but turned inside out, so whereas the sexual organs were identical in both sexes, the male’s were located on the exterior of the body, and the female’s were internally contained. As such, the scrotum was considered the equivalent of the uterus, the testes of the ovaries, the penis of the cervix and vagina, and so forth. Laqueur therefore asserts that in this model ‘the boundaries between male and female are of degree and not of kind’.6 Scholarly revisions of Laqueur’s thesis, which draw heavily upon Hippocratic gynaecology, prove that there was, in fact, a conception of the female body as fundamentally different.7 The text that Laqueur cites as evidence - Galen’s The usefulness of the parts, 14.6 - is not, as we shall see, the strongest basis for a whole theory of sexual differentiation. In addition, as Laqueur’s critics have demonstrated, this notion had long coexisted with a ‘two-sex model’. The idea of two sexes with very different physical forms was, as Helen King rightly asserts, already present in the Hippocratic gynaecological texts.8
This ‘two-sex model’ is further reflected in humoral theory. Ancient medicine was firmly based on the idea of balance: between four humours (phlegm, blood, bile, and black bile), or the four qualities of hot and cold, moist and dry. It was believed that an imbalance of these factors produced an unusual state of body and mind, and so caused disease. In its natural state, the Hippocratic female body was considered to be hot, moist, and spongy, whereas the male was cold, dry, and firm. In the Hippocratic Corpus, the opposite traits ascribed to the sexes were used as a rudimentary system for explaining different pathologies and different reactions to the same disease, and justified separate treatment regimes for men and women.
While humoral theory was never a systematic or entirely uniform theory in ancient times, throughout late antiquity and the Middle Ages, authors like Galen’s followers and others developed it into a more or less cohesive method of diagnosis. By Castro’s times, the uneven proportion of the qualities was called intemperatura or intemperamentum. This could mean either an overwhelming abundance or a deficiency of one of the qualities (hot/cold/ dry/moist), or a combination of two (hot and dry, hot and moist, cold and dry, cold and moist). This imbalance was supposed to have physical and psychological consequences. For instance, hot (calida) women were thought to be more active and eager for sex than cold ones. Cold and moist women were largely uninterested in sex, and produced a thin, watery, and infertile semen that engendered female children. This is in fact an Aristotelian concept: the idea that, in a scale that ranges from the male (located at the top) to a monster (at the bottom), to beget a female is to fall short of perfection.
Assertion of difference between the sexes is seen in the Hippocratic treatise Diseases of Women, where the author criticizes doctors for treating women with serious diseases as if they were men:
Apa 8s Kai oi ipTpoi apapTavoooiv, о8к атрекею^ nuv0avopevoi rpv npopaoiv rqiq vovoou, akk’ aq та av8piKa vooppara irapevov Kai nokkaq si8ov 8iep0appevai; p8p ояо TOiomiBv na0ppaTfflv. Akka %pp avepirnav avriKa атрекею^ то amov 8iapspei yap p ipoiq яоккф Tfflv yovaiKpitov vooppaTiav Kai Tfflv av8prafflv. (Diseases of Women, 1.62)
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.9
What the text asserts is difference, not similarity. Likewise, in the Hippocratic text Places in Men, the womb was classified as ‘the cause of all diseases’ in women. No similar claim, to my knowledge, was ever made about the male genitals, and certainly not about the scrotum. Female pathologies were understood to be caused by organs and physiological processes that were absent in men. In Hippocratic gynaecology, menstrual regularity was considered a prerequisite for women’s wellbeing. This also had no equivalent in men. In short, not only can we detect a manifest difference between the two sexes in these medical writings; we might consider them as opposites.
It was, to be fair, very challenging to analyse the interior reproductive structures of the female body with the scarce technical means that Greek and Roman physicians had at their disposal. It was therefore very common to describe the inner processes of the body using comparisons and metaphors.
As explored further in Laurence Totelin’s chapter in this volume, the development of the embryo was likened to the growth of a plant (Nature of the Child, 22), while a foetus presenting abnormally was compared to an olive pit, stuck inside a small mouthed oil-flask (Diseases of Women, 1.33). Many of the inner physiological processes were the object of theoretical speculation, so it was also common for medicine and philosophy to overlap. Galen’s own theories about reproduction were much indebted to the Aristotelian tradition, and its belief, supported by theological, philosophical and medical arguments, in the inferiority of women (that women were colder than men, and as such unable to concoct blood into semen).
The study of medical theory and practice during the Renaissance, strongly influenced by the rediscovery of ancient texts, helps us to understand the dynamics of a trend toward sexual dimorphism that was inherited from the past, and not invented in the eighteenth century, as Laqueur proposed. According to Patricia Simons, Galen’s supposed ‘one-sex model’ was never ‘a complex theory of sexual oneness’.10 Moreover, his treatise De usu partium, where the female reproductive organs were said to be equivalent to the male’s, the difference being merely the position, had a very limited circulation in the West before the fifteenth century.11 Indeed, because Galen never wrote a comprehensive treatise on gynaecology, his influence on the subject was limited.
In the West, Soranus of Ephesus’ (fl. 98-138) Gynaikeia put forward arguably the most influential set of ideas relating to women’s diseases.12 Soranus was a physician of Greek origin who lived in Rome in the beginning of the second century. In writing his gynaecological treatise he had in mind an audience of midwives, who knew the Greek language and seem to have been highly skilled, both in practice and theory. Soranus himself owed much to Herophilus of Alexandria (330/320-260/250 bce), especially in the assertion that women’s bodies functioned in the same way that men’s did, the only differences residing in processes that were exclusive to women like conception, pregnancy, parturition, and breastfeeding. Soranus wrote:
Kai <НрофАо; sv тф Маквт1кф> ppoirqv poTspav sktov apTov toi; akkoi; pspsoi nsnA,e%0ai Kai ряб tov apTov Suvapsov SioiKsio0ai Kai та; aPTa; napaKsipsva; s%eiv pka; Kai ряб tov apTov amov vooonoisio0ai [... ]• opSsv opv i'Siov яа0о; yuvaiKov nkpv top Kupoai Kai тор тб крр0?У sK0ps^ai Kai anoTSKsiv Kai тб yaka nsnavai Kai та svavTia toptoi;. (Gynaikeia, 3.3)
Herophilus, moreover, in his ‘Midwifery’ says that the uterus is woven from the same stuff as the other parts, and it is regulated by the same forces, and it has available the same substances, and that it suffers disease from the same causes [... ]. Consequently, there is no condition in women peculiarly their own except conception, pregnancy, parturition, lactation, and conditions antagonistic to these.
It should be noted that Soranus’ treatise was not known in the West in its original Greek form until the rediscovery in the nineteenth century of the only extant manuscript. It was instead known through translations, adaptations, and excerpts that figured in later texts, such as those of Oribasius of Pergamum (c. 325-400), Aetius of Amida (fl. 530) and Paul of Aegina (fl. 630). Latin translations proved the most important vehicle for Soranus’ theories, especially one by an unknown author whose name is variously given as Mustio, Muscio or Moschion. These Latin versions were more accessible and purged much of the theoretical and etymological material in Soranus’ original. They transmitted a brief, clear, and practical account of Soranus’ book, rearranged in a question- and-answer format. Mustio’s popular Genecia (Latin equivalent for Gynaikeia) circulated in Europe for centuries. It was included in the Gynaeciorum libri, an extensive Latin compendium of ancient and contemporary texts about gynaecology, first published in 1566.13 This compendium was very important in the configuration of gynaecology as a valid field of medicine, consolidating the perspective, derived from the ancients, that this area was not under women’s exclusive control.
In early modern writings about women’s diseases and female nature, ancient texts which described women as essentially different or inferior to men were also re-evaluated in the light of new discoveries, such as the identification of the clitoris, the ovaries and fallopian tubes (already known in antiquity, but misunderstood), and the practice of caesarean section. Although these discoveries may seem to us innocuous or irrelevant, they arguably challenged a whole set of cultural, social, religious, and legal ideas relating to motherhood, embryology, female sexuality, and pleasure, and even the concept of the soul. Therefore, these treatises were not only about female pathologies and conditions. They embraced topics including medicine, religion, philosophy, and law.