WOMEN IN MEDICINE

medica
Stele for a Roman medica (female physician) from the 2nd c. By Musée de La Cour d’Or Metz Métropole. CC BY-SA 3.0

Recognition of Roles and Focus

Image
Stele of Phanostrate. After V. Dasen, L’ars medica au féminin, Eugesta-6, 2016, figure 1. With permission of author.

In studying the role of women in medicine in antiquity, it is important to recognise that many variables play a hand in determining who took part. The matter of class and economic standing is of course ever a factor, but so too is perceptions of the body and gendered treatments. Even within the sphere of women’s involvement in medicine –and there were few women involved– methods varied greatly. This resulted in the formation of many roles within medicine that differed greatly not only on the basis of training, but in the work performed and angle at which health was approached. It is also important to recognise the existence of women performing medicine with little to no medical knowledge at all. As the position nurse didn’t exist until much later in history, physicians often made use of “slaves, or the members of a patient’s family, as assistants” (Retief, 2005, p. 167). These individuals obviously did not receive the same instruction as physicians, and  these different levels of training were worlds apart. In working to negotiate this, the 2nd century physician Soranus writes (Soranus of Ephesus, 1991, p. 5):

Now, generally speaking we call a midwife faultless if she meanly carries out her medical task; whereas we call her the best midwife if she goes further and in addition to her management she is well versed in theory. And more particularly, we call a person the best midwife if she is trained in all branches of therapy […]

(Gynaecology  1. 2)

This suggests three types of training:

  • Experiential- Women who had learned only from observing household related matters of health
  • Experiential and theoretical- Women who had also experienced simple training perhaps from a more experienced midwife or perhaps had read gynaecological treaties
  • Experiential, theoretical, and practical- Women who had been trained formally and in several areas of health beyond childbirth and women’s health.

Another way of exploring this would be in examining the lexicon. While midwives were called “Obstetrix” or “maia”, female physicians or doctors were more often called “iatrine” or “medica” (Bloomfield 1846 pp. 69, 47). These terms are helpful, but do not actually divide professions as neatly as it would today, because during this time, there were no required certifications to practice medicine on any level (Retief, 2005, p. 168). Furthermore, there are many cases such as Phanostrate where women are referred to as both midwife and physician (Lefkowitz and Fant, 2005). The use of both terms is interesting as it assumes that the training of physician does not negate the training of a midwife. It makes them separate and in keeping with this, instead of using these terms to establish a stratified hierarchy or medical education (with physician at the top and midwifery at the bottom), we will use these terms to indicate type of training. There are a lot of words that describe women who practised medicine in the ancient world and there is a lot of cross over between them, but the larger dual categorisation of women as either midwives or physician lends itself more willingly to the understanding of the purpose of each role and the implications of its separate training.

For the purposes of this article, we will combine the first two of Soranus’ groups into one as “midwives” and the other group, iatrine and medicas as “Physicians”, and we will focus primarily on the means by which medical education in general was received.

L0016719 Agnodice.
Agnodice, From Wellcome Images on Wikimedia commons CC BY 4.0

The Importance of Well Trained Women in Medicine With Regards to Women’s Health

The first means of entry into the world of women in medicine is the overwhelmingly apparent necessity of it. Medicine was a for the most part a very men only profession as the female form of the word doctor didn’t even exist in Greek until the 4th-3rd C. BCE (Retief, 2005, p. 169). The problem then arose from the tendency of male physicians to avoid physically examining a woman’s body. This had at least two factors. It may have been in order to maintain “pudicitia” or “modesty” which was a very prevalent social ideal or it may have also been the believed to be polluting qualities of the female body in the hair, ears, eyes, and moth, but also in a woman’s glance or speech (Llewellyn-Jones, 2003, p. 259). Either way, this proved a very real problem in diagnoses which were often made on only minimal descriptions of symptoms. The radically sexist medical principles observed in the earlier writings of the mid 5th to 4th C. BCE Hippocratic Corpus was founded on the principle of the male body being completely different (and better) than the female body. This supports the idea of women’s bodies being polluting. It also creates a difference in healing procedures as healing of a male body was not the same as healing for a female body. There were even believed to be dangers in treating women’s symptoms the same way as men’s which is ironically reference in the early Hippocratic Corpus (Hippocrates, 1975, p 570):

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.

(Diseases of Women 1.62.)

Some key inferences that can be made from this quote include:

  • Women are ashamed to not know what is causing them illness
  • Information of women’s bodies comes from questioning, not examination.
  • Physicians learn the diseases of men and women separately
funerary stele
Greek Attic funerary stele, By Giovanni Dall’Orto. CC BY-SA 3.0

The work of the Hippocratic Corpus also states that all issues of the woman are due to her being a woman, and the study of women’s medicine was largely structured around the uterus and the reproductive organs (Hippocrates, 1983), but this was not without reason.

The image of a Greek attic funerary stele here shows a  woman who died in childbirth saying goodbye to her husband, mother and newborn’s nurse from around 350 to 330 BCE (Irving, 2012, p. 192). The stele itself would have been expensive and it works to show the prevalence of birth related deaths even at higher social and economic levels. Early deaths of women during these times were very commonly birth related and we can use this information to conclude that women’s health was primarily focused on the uterus and birthing, because those where the illnesses that predominantly effected their lives with the most impact.

The hesitancy of women to divulge personal medical information to men in fear of embarrassment is referenced in many sources notably including Hyginus’ Fabulae (set 4th C. BCE) which depicts a woman “Agnodice” disguising herself as a man to learn medicine. The story goes that after she is taught by Herophilus, who himself was very well known for his medical writings, she used her skills as a midwife and physician in order to help the women who would rather die than accept treatment from a male physician (Grant, 1960). This again suggests that the training of a midwife was not always enough to heal a woman, and that physicians learned different things. The same idea is presented in the 428 BCE play Hippolytus when the wet nurse tries to sooth Phaedra who had become sick by saying:

If thou art sick with ills thou canst not name, there be women here to help to set thee right; but if thy trouble can to men’s ears be divulged, speak, that physicians may pronounce on it.

(Euripides, 2014, p. 43)

Although neither of these accounts are verified as having actually happened (Hippolytus being a play based on myth, and Agnodice’s story being at best anecdotal), they both speak to a very real disconnect and problem in the medical community. They also both corroborate the ideas that:

  • Women were ashamed to not know what is causing them illness.
  • Women’s health studied by male physicians comes from questions, not inspections.
  • The work of a midwife is more practice based and the work of (even a female) physician are very theory based.

If the experiences outlined here are at all indicative of everyday relations between male physicians and female patients, the existence of midwives and female physicians who were both trusted, and capable, would have been paramount in women’s health in general as they would be the ones most readily sought, and most able to make diagnoses based on all the facts. This also explains the rise in women practising in these fields and being recognised for it.

Training as a Slave and Freed-Woman

Female slaves were often trained as midwives and physicians. Funerary inscription relaying freed-women midwives become especially increased around the 1st and 2nd Century C.E., and especially in Rome. The inscriptions are mostly very short and simple often stating only the name of the deceased, the statement “freed-woman of…”, and the position of either “midwife” or “Physician”.

For example: Minucia Asste, Rome 1st/2nd Century CE:

MINVCIA
C.L.ASSTE
MEDICA

Minucia Asste, freed-woman of a Roman citizen woman, Physician

(Lefkowitz and Fant, 2005, p. 265)

A good number of similar inscriptions exist, and with some exceptions such as Secunda (1st-2nd c. CE, Rome)”midwife, slave of Statilia the elder” (French, 1986, p. 141), and Melitine (1st-2nd c. CE, Rome) “Physician, slave of Appolius” (Lefkowitz and Fant, 2005, p. 265), the majority of the inscriptions are for freed-women. The simplicity of the inscriptions themselves suggests that the status of a freed-woman midwife or physician was not high and that they likely did not have very much wealth, but the fact that the majority of the inscriptions are for freed-women suggests that either they earned enough money in theses positions to buy their freedom, or that once freed, they found the job profitable enough to want to remain in it. The number of these grave inscriptions also suggests that women in these jobs were not rare, but that little expansion from the role occured. Placing emphasis on inscriptions such as that of Poblicia Aphe from Rome in the 1st/2nd Century CE to show that women aged as young as 21 were still recognised midwives, and indicates training for these roles began young.

POBLICIA • C • L • APHE
OPSTETRIX • OSSA • TIBI
BENE QVIESCANT •
VIXIT • ANNOS • XXI

Poblicia Aphe, midwife, freed woman of a Roman citizen woman. May your bones rest peacefully. She lived 21 years.

(Lefkowitz and Fant, 2005, p. 405)

It is important to consider the limitations of these roles. Slaves were property of their masters and their education was determined by them, but that did not mean only rudimentary education was given. Women received the education that best fit what their masters wanted, and if their masters decided that having a well trained female physician would be beneficial in keeping the health of the other slaves or household, a slave would be trained accordingly (Booth). Apprenticeships were the main way slave women learned a craft outside the home because it improved their value. This idea, although existing long before, is seen in the Corpus Juris Civilis (531 CE) which states “the price of a slave midwife was is the highest for any female slave” (Scott, 1932, p. 277). The value of a slave was determined by their abilities and it was common for slaves to be considerably well trained (Irving, 2012). That having been said, slaves were not recognised in society as being on equal standing as free-born citizens, and the lack of substantial reference to slaves and freed-women recognised for their skill, beyond their profession indicates that the role may have been primarily held in partnership with their servitude and as an aspect of it.

Training as a Family Members

The training of family members in tasks and duties was not only common, but expected. This is especially true in regards to women who were often only taught by family members in simple house keeping activities. Although this training did not include more than perhaps basic tending to the sick, there is evidence suggesting that the same principle also applied in the context of women with medical family members.

Antiochis 1st C. CE

Ἀντιοχὶς Διοδότου̣ Τλωὶς μαρτυρηθεῖσα ὑπὸ τῆς Τλωέων βουλῆς καὶ τοῦ
δήμου ἐπὶ τῇ περὶ τὴν ἰατρικὴν τέχνην ἐνπειρίᾳ ἔστησεν τὸν ἀνδριάντα
ἑαυτῆς.

Antiochis, daughter of Diodotus of Tlos, awarded special recognition by the council
and the people of Tlos for her experience in the healing art, has set up this statue of
herself.

(Lefkowitz and Fant, 2005, p. 264)

We know that Antiochis’ father as a famously recognised physician (Discorides, 1934) and it can be assumed that her association with him in this context is a recognition of her education as well as of familial authority in the area. Some key conclusions that can then be made from this source include:

  • A physician father raised a physician daughter passing down education not to a son
  • Women could be recognised for the skill (healing art) beyond their title (medical position is not stated i.e. “Midwife” of “physician”)
  • Antiochis was recognised for medical achievement because she was upper class and had the money to set up a statue and inscription.
  • Antiochis took great pride in her skill and profession

Another source that suggests this is:

Aurelia Alexandria Zosime 3rd-4th C. CE

Αὐρ. [Ἀ]λ[εξ]άνδριαν
Ζ[ωσ]ίμην ἀπὸ ἐπισ[τή]μης
ἰατ[ρι]κ[ῆ]ς Αὐρ.
[Πομπω]νι[α]νὸ[ς Ἀ]σκ[λη]-
τι[άδ]ης, ὁ ἀν[ὴρ] αὐ[τ]ῆς,
καὶ
Αὐρ. [Μ]οντ[άνη]ν, τὴν
γλυκυτάτην θυγατέρα,
ὁ αὐτὸς Ἀσκληπιάδης.

Aurelius Pomponianus Asclepiades, her husband, [honoured with this monument]
Aurelia Alexandreia Zosime, in accordance with her medical knowledge; and the
same Asclepiades [honoured] also Aurelia Montane, his most sweet daughter. (Flemming, 2007, p. 260)

Sources suggest that Aurelia Alexandreia Zosime’s husband was also a doctor (James, 2012), so here we too see affluent medical men training close female relations. Another set of similarities these souses share are these: 

  • Recognition of “medical knowledge” as apposed to position
  • Wealth enough to erect a monument/ have a monument erected

If this is the case it would imply that women’s education in medicine in regards to familial relations, was largely dependent on status, wealth and connections with others highly ranked individuals in the field of medicine.

Training as a Student

The Hippocratic oath is also called the “physicians oath” and in regards to teaching male physicians, it is quite explicit. The agreement to teach not only sons, but sons of teachers is written directly into it.

hippocratic oath
Earliest surviving fragment of the Oath 275 CE From Papyrus Oxyrhynchus  on Wikimedia commons CC BY 4.0

ἡγήσεσθαι μὲν τὸν διδάξαντά με τὴν τέχνην ταύτην ἴσα γενέτῃσιν ἐμοῖς, καὶ βίου κοινώσεσθαι, καὶ χρεῶν χρηΐζοντι μετάδοσιν ποιήσεσθαι, καὶ γένος τὸ ἐξ αὐτοῦ ἀδελφοῖς ἴσον ἐπικρινεῖν ἄρρεσι, καὶ διδάξειν τὴν τέχνην ταύτην, ἢν χρηΐζωσι μανθάνειν, ἄνευ μισθοῦ καὶ συγγραφῆς, παραγγελίης τε καὶ ἀκροήσιος καὶ τῆς λοίπης ἁπάσης μαθήσιος μετάδοσιν ποιήσεσθαι υἱοῖς τε ἐμοῖς καὶ τοῖς τοῦ ἐμὲ διδάξαντος, καὶ μαθητῇσι συγγεγραμμένοις τε καὶ ὡρκισμένοις νόμῳ ἰητρικῷ, ἄλλῳ δὲ οὐδενί.

To hold my teacher in this art equal to my own parents; to make him partner in my livelihood; when he is in need of money to share mine with him; to consider his family as my own brothers, and to teach them this art, if they want to learn it, without fee or indenture; to impart precept, oral instruction, and all other instruction to my own sons, the sons of my teacher, and to indentured pupils who have taken the physician’s oath, but to nobody else.

(Lloyd, 1983, p. 94)

The oath very clearly calls for the education on men and these are the principles on which many men were brought into the Hippocratic tradition, but what about women? well, simply put, not many women were trained in the Hippocratic tradition and as far as we know, no woman every contributed to the writings in the Hippocratic corpus (Retief, 2005).

This meant that there must have been other ways for women to get medical education and one of these ways was the reading of preexisting medical treaties and textbooks. As stated before, training of medical practitioners in general was not uniform and formal certifications did not exist. This is not to say, however, that there was not a working idea of what training a midwife or physician should have. Soranus talks extensively on the requirements for a good midwife, and while this page does not deliberate on that, it is important to recognise that if there were good and competent midwives, there must also have been bad and incompetent midwives. This suggests that training was essential and although Soranus’ Gynacology (1st- 2nd C. CE) was likely written for all people weather they studied medicine or not, there are entire sections like 4.60. which describe in great detail how a midwife should go about re-orienting a child and correcting its positions to solve difficulty in birthing. These are sections that could only have been directed towards midwives and their training. Another writer Herophilus’ his work called “Maieutikon” (4th -3rd C. BCE) was explicitly for use as textbooks and the importance of women in these roles to be able to read the medical texts of the past (literate), is one of the key qualities Soranus outlines in his “What Persons Are Fit to Become Midwives”.

Mousa 2nd-1 st C BCE

Μοῦσα Ἀγαθοκλέους ἰατρείνη.
Mousa, a physician, [daughter] of Agathocles.

(retief, 2005, p. 177)

This grave inscription for Mousa in itself is not very unique. But the fact that it is accompanied by a funerary stele in which a women (presumably her) holds a scroll. This is important because it gives insight into how women were viewed in regards to education. If in the funerary context, a stele of woman is holding a scroll, it means at least enough to say that she was literate and reading and writing were very central to who she was in her life. The stele also works as an indicator of wealth suggesting that Mousa was, like Antiochis, from a decently wealthy family.

The ability to learn from others and learn from the work of others begins to requisite women who have studied in their medical professions and be trained even if they are not being trained outside the house. In this context, these works as scholarly textbooks were to service the ever growing number of midwives and female physicians may have read in order to further their skill.

This all constitutes resources women may have used to teach themselves, but references to formal training received by a women from trained physicians do exists.

firstly, we have Restituta’s inscription from the 1st C. CE, made for her teacher

Τι(βερίῳ) ∙ Κλαυδίῳ Ἀλκίμῳ ∙ ἰατρῷ Καίσαρος ∙ ἐποίησε Ῥεστιτοῦτα ∙

πάτρωνι ∙ καὶ ∙ καθηγητῇ ἀγαθῷ καὶ ἀξίῳ· ἔζη(σε) ἔτη πβʹ

For Tiberius Claudius Alcimus, physician of Caesar. Made by Restituta,

for her patron and professor, good and worthy, he lived 82 years

(Furst, 1997, p. 142)

Restituta’s connection with Tiberius Claudius Alcimus is decidedly not familial and is crucial in understanding women’s training from outsiders. Her description of him as “good” and “worth” makes it clear that although they were not related by family, the relationship between the two of them was close.

Sources

Flemming, R. (2007). Medicine and the making of Roman Women Oxford: Oxford University Press.

Euripides. (2014). Euripides’ Hippolytus. (Helleran, M., trans.). Williamsburg, VA: Focus Classical Library. (Original work published 428 BCE)

Bloomfield S. T. (1846). Lexilogus Scolasticus of A Greek and English Vocabulary, On a New and Improved Plan; Comprising All the Primatives of Any Importance; Together with Some Derivatives. London: Gilbert and Rivington printers.

Retief, F. and Cilliers P. L. (2005). The Healing Hand: The Role of Women in Ancient Medicine. Acta Theologica Supplementum 7, 165-188. 

French, V. (1986), Midwives and Maternity Care in the Roman World, Helios, New Series, 13 (2), 69-84.

Booth, A. (1979). The Schooling of Slaves in First-Century Rome. Transactions of the American Philological Association (1974-), 109, 11-19.

Hippocrates. (1983). Hippocratic Writings (2nd ed.). ( Lloyd, G., trans). London: Penguin Books. (Original work published 460 BC-377 BC)

Hippocrates. (1975). Hippocrates: “Diseases of Women 1.(Hanson, A., trans). University of Chicago Press1(2), 567-584.

Llewellyn-Jones, L. (2003). Aphrodite’s Tortoise: The Veiled Woman of Ancient Greece. Swansea: The Classical. Press of Wales.

Soranus of Ephesus. (1991). Soranus’ gynecology. (Owsei, T., Trans.). Baltimore: Johns Hopkins University Press. (Original work published 1st-2nd C. CE)

Irving, J. (2012). Restituta: The Training Of The Female Physician. Melbourne Historical Journal, 40(2), 45-57

Lefkowitz, Mary R. and Maureen B. Fant (2005), Women’s Life in Greece and Rome: A Source Book in Translation. Baltimore. MD: Johns Hopkins University Press.

Dioscorides. (1934). Materia Medica: The Greek Herbal of Dioscorides. Goodyear J.,  Theodore R. G. (eds.). Oxford: Oxford University Press.

James, S. L., and Dillon S. (2012). A Companion to Women in the Ancient World. John Wiley & Sons, Blackwell Publishing.

Furst, Lilian R. (1997), Women Healers and Physicians: Climbing a Long Hill. Lexington: University Press of Kentucky.

Grant, M. (1960). The Myths of Hyginus. Lawrence: University of Kansas Press.

Scott, A. M. (1932) The Civil Law. Cincinnati: The Central Trust Company

 


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