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Medicine and Anatomy

343. 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.[1]

(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.[2] 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[3] 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.


Notes:

1. On the medicinal use of excrement, cf. von Staden, 1989, 18-9.

2. 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.

3. I. e., wasting away or atrophy.