Childbirth and obstetrics in classical antiquity (here meaning the ancient Greco-Roman world) were studied by the physicians of ancient Greece and Rome. Their ideas and practices during this time endured in Western medicine for centuries and many themes are seen in modern women's health. Classical gynecology and obstetrics were originally studied and taught mainly by midwives in the ancient world, but eventually scholarly physicians of both sexes became involved as well. Obstetrics is traditionally defined as the surgical specialty dealing with the care of a woman and her offspring during pregnancy, childbirth and the puerperium (recovery). Gynecology involves the medical practices dealing with the health of women's reproductive organs (vagina, uterus, ovaries) and breasts.
Midwifery and obstetrics are different but overlap in medical practice that focuses on pregnancy and labor. Midwifery emphasizes the normality of pregnancy along with the reproductive process. Classical Antiquity saw the beginning of attempts to classify various areas of medical research, and the terms gynecology and obstetrics came into use. The Hippocratic Corpus, a large collection of treatises attributed to Hippocrates, features a number of gynecological treatises, which date to the classical period.
Women as doctors
During the era of Classical Antiquity, women practiced as doctors, but they were by far in the minority and typically confined to only gynecology and obstetrics. Aristotle was an important influence on later medical writers in Greece and eventually Europe. Similar to the writers of the Hippocratic Corpus, Aristotle concluded that women's physiology was fundamentally different from that of men primarily because women were physically weaker, and therefore more prone to symptoms caused in some way by weakness, such as the theory of humourism. This belief claimed that both men and women had several "humours" regulating their physical health, and that women had a "cooler" humour. The Hippocratic Corpus writers indicated that men were more rational than women, and that women's physiology made them susceptible to problems that would cause symptoms of irrationality. Continuing with this assumption that men were more rational, men dominated the profession of physicians, an occupation requiring rational research, and for which they believed women were not suited.
This did not stop women from becoming physicians. Philista was a popular professor of medicine who delivered lectures from behind a curtain, to prevent her beauty from distracting her students. In ancient Greece, there was also an opportunity for midwives to receive some further medical training, to become a doctor-midwife, called in the Hellenistic, Roman and Byzantine eras as iatromea (ιατρομαία).
Women doctors may have offered specializations beyond gynecology and obstetrics, but there is not enough information to know how frequently. As obstetricians and gynecologists, they appear to have been numerous. The Code of Justinian presumed women doctors to be primarily obstetricians. The first medical text known to be written by a woman is by Metrodora, Concerning the Feminine Diseases of the Womb.
During Classical Antiquity, anyone could be trained as a doctor at one of the many medical schools/hospitals, the Asclepeieon. Training involved mainly practical applications as well as forming an apprenticeship to other doctors. During the Hellenistic era, the Library of Alexandria also served as a medical school, where research and training would take place on the body of the diseased. It also appears that the children, male or female, of famous doctors, would also follow the medical profession, continuing the family tradition. For example, Pantheia, who was the wife of a physician, became one herself, a pattern also seen in the careers of Aurelia Alexandria Zosime and Auguste. Auguste received recognition as a chief doctor of her city, a title her husband also received. Metilia Donata was prominent enough to commission a large public building in Lyon. Anthiochis of Tlos, the daughter of a prominent physician, Diodotus, was recognized by the council of Tlos for her work as a doctor and had a statue of herself erected. She was also a widely discussed expert cited by Galen and others. Aspasia is quoted extensively by Aetius on gynecology.
This Greco-Roman approach differs greatly from other ancient civilizations, where women's roles as medical specialists concerning gynecology and obstetrics were apparently unquestioned. Medical schools attached to temples in ancient Egypt were numerous, including well-known medical schools for women at Heliopolis and Sais, where women are also believed to have been the professors.
Breast cancer Hippocrates was the first to use the term cancer to describe the hard lesions occasionally found in women's breasts. He reasoned that the lesions were caused by problems with the woman's uterus and menstrual cycle. Symptoms of these lesions were believed to be pain, appetite loss, bitter taste, and confusion. Hippocrates urged against surgery as a treatment for breast cancer because he considered it harmful and found that the prognosis was much better for women who did not have the lesions removed or treated. In his later work Diseases of Women, Hippocrates furthers the list of late-stage cancer symptoms by including deliria, dehydration, dry nipples, loss of sense of smell, and shallow breathing.
Galen considered breast cancer to be a result of excess black bile in the body, referencing to Hippocrates' theory of the humoral theory of diseases. He hypothesized that a women's menstrual period was a method of removing black bile from the body. This idea fit his observation that it more common for women in menopause and pre-menopause to develop breast lesions. Unlike Hippocrates, Galen encouraged surgical removal of tumors and even prescribed special diets and purgation to rid the body of excess black bile.
Infertility Aristotle formulated early tests for infertility by placing scented cloth in a woman's vagina for an extended amount of time and determining whether the aroma came out of the mouth or if the eyes or saliva was colored. This test determined whether or not the woman's semen passes were open or closed. Hippocrates formed a similar test by observing whether a scent would pass through a woman's body out of her mouth when the smell was produced between her legs while she was wrapped in a blanket. Hippocrates further tested for infertility by putting red stone in a woman's eyes and determining if it penetrated through.
Midwifery During antiquity, there was no profession equal to that of our modern day nurse. No ancient medical sources discuss any sort of trained nursing personnel assisting doctors. However, many texts mention the use of slaves or members of a doctor's family as assistants. The closest similarity to that of a nurse during antiquity was a midwife. Midwifery flourished in ancient civilizations, including Egypt, Byzantium, Mesopotamia, and the Mediterranean empires of Greece and Rome.
There were doctors within the Greco-Roman world who wrote favourably of midwifery. Herophilus wrote a manual for midwives, which advanced their status. This was followed by the work of the Greek Soranus of Ephesus (98–138 AD), who was widely translated into Latin, and Galen. Soranus was an important gynecologist and is credited with four books describing the female anatomy. He also discussed methods to deal with difficult births, such as using forceps. He also outlined a series of criteria for woman to be an eligible midwife. He wrote:
This instruction manual for midwives served as a reference text and reflects the role midwives filled in society.
Birth control and abortion
Women practiced birth control in antiquity mainly through their knowledge of plants and herbs. Their knowledge was transmitted by herders who observed sterility of their livestock when exposed to certain plants. Knowledge of birth control was also transmitted by word of mouth, mainly originating from knowledgeable midwives. Midwives knew how to identify necessary plants, how to administer them, and most importantly, when to administer them in relation to the last menstruation or coitus.
A very popular plant used for birth control by the Greeks was Silphium. It is a giant fennel-like herb which was filled with a pungent sap and offered a rich flavor. The plant was so widely used that it appeared on a Cyrenian coin as a woman touched the plant with one hand and pointed to her genitals with the other. The demand for the plant was so great that by the fourth century, it had gone extinct. It is believed that the heart shape originated from the seed of this plant as they are the same shape and the plant was associated with love, romance, and sexuality.
Although Silphium was most popular, there were many other plants and herbs used. Another plant used was pennyroyal, an abortifacient. Although toxic, pennyroyal was consumed in small dosages in tea because it contained the abortive substance pulegone. A medical document dating back to 1500 BC in Egypt includes a list of substances used as birth control. One substance involved making a paste from acacia gum, dates, fiber, honey, and other unidentified plants to create a sort of spermicide. Early physicians Galen and Dioscorides believed that women would consume willow and pomegranate kernels to prevent pregnancy as well.
Soranus of Ephesus advocated for the application of ointments made of old olive oil, honey, cedar resin, and white lead on the cervix in order block the opening to the uterus. However, Soranus believed birth control was most effective when oral contraceptives were combined with certain procedures. Soranus recommended that women should avoid having intercourse during their fertile period in their cycle, as well as avoid deep penetration. After intercourse, women were urged to squat, sneeze, and cleanse the vagina before drinking something cold. If these combined practices failed in the prevention of pregnancy, recipes including small amounts of Cyrenaic juice, diluted wine, leukoion, and white pepper were prescribed to induce abortion.
According to the Hippocratic Corpus, there were oral alternatives used to induce abortion such as chaste tree (Vitex agnus-castus), copper, and Ferula species. Plato explored the control that midwives perhaps had during this process:
Pregnancy There were many theories used to determine whether a woman was pregnant during antiquity. A popular method involved examining the vessels of her breasts. A second method involved sitting a woman on a beer and date mash covered floor and using a proportionality equation according to the number of times she vomits. Another method included inserting an onion into a woman's vagina and determining whether or not it could be smelled from her breath. Although there is little evidence as to whether or not any of these methods were confirmed medical procedures or if they were just folklore.
Labor and delivery