Lessons learned from the Greeks: The physician-patient relationship in Hippocratic Gynecology

Jenna Nickas
New Brunswick, NJ, USA

 

Sanctuary of Asclepius, Epidaurus, Greece. June 8, 2013 (photo taken by Jenna, on her 21st birthday)

The medical treatment of women in Classical Greece was a topic not overlooked by the Hippocratic tradition. Much of the Corpus addresses the health of women, especially Epidemics and Diseases of Women. Within this genre two things are certain: all patients were female and all doctors were male. Many clinical problems were addressed in the treatises, most commonly excessive or absent menstruation, barrenness, and postpartum complications.1 In the infamous case of the Daughter of Leonidas, a young woman is suffering from prolonged epistaxis, but has not been menstruating. According to Hippocratic Aphorisms 5.33: “In a woman whose menstrual periods have stopped, blood flowing out of the nostrils is a good thing.”2 Although this case at first sounds almost mythical, the Daughter of Leonidas could in fact have been suffering from vicarious menstruation, a rare condition in which extragenital organs bleed at menstruation in response to estrogen stimulation, such as bleeding from the nasal mucosa.

Hippocratic pharmacology or “recipes” for treating women included some very exotic ingredients, such as squirting cucumber, animal genitals or excrement, human urine, or even dirt.3 This was far more diverse than what was used to treat male ailments, which typically included only herbs or exotic plants. Although feces have been used for ritual or medicinal purposes in many cultures, the Greeks stand alone in that they prescribed cow and other animal dung exclusively for women.4 This “excrement therapy” is far more reminiscent of ritual magic practices than of medical remedies.

As one might imagine, the physician-patient relationship in the Hippocratic corpus is complicated by the very nature of gynecology. There is evidence of care avoidance both in the Corpus and in contemporaneous plays. In Euripides’ Hippolytus, women are featured commiserating over what they call “the helplessness of childbirth and its madness.” Phaedra falls ill in the tragedy and is told to look to her friends for help, suggesting that being sick or even unhappy is simply natural to being a woman.5 Phaedra opts to rely on the confidence of her female friends rather than asking a doctor, who undoubtedly would have been male during this era.

The hesitation of women to confide in male medical professionals reflects the Hippocratic female patient’s lack of trust and doubt that a male doctor could understand or have sympathy for her experiences. Herodotus writes about how long Queen Atossa hesitated before being treated by a physician for a lump in her breast. Female patients who felt reluctant to talk to a healer out of modesty or other uneasiness often suffered as a result. Failure to diagnose serious problems in a timely matter, or the woman’s self-treatment, often resulted in extreme side effects. This is seen especially in self-administered drugs for abortions.6

It is also important to note that the Hippocratic author is a man, writing for a primarily male audience, and there is a social consciousness that must accompany that. Vaginal examination was a particularly sensitive matter, especially as consent was not recognized as a generalizable moral concept in the fifth century BCE.

Not entirely different from medicine today, the treatment of women in ancient Greece did not affect only the patient. When treating female patients in “womanly conditions,” Hippocratic doctors were often serving many other interests, fathers, husbands, and even the polis itself.7 It is true of all Graeco-Roman medical writing that the names of female patients were almost never used. Women were instead referred to as “daughter of _____” or “wife of _____ .”8

The Hippocratic doctors often lent their medical authority to the men who traditionally directed and controlled female fertility, and they reinforced that control with their medical writings.9 Although the doctor was a woman’s advocate in that he held out hope of pregnancy to the woman who wanted a child, Hippocratic physicians were also serving the interests of the woman’s family and community. The Hippocratic physician presented reproduction as an essential ingredient for health in post-pubertal women, attributing an increased risk for many ailments to unmarried and not sexually active women, as entry to the womb was closed and could therefore cause problems. Infertility or barrenness was also seen as a defect in women.10

The complex relationship between women and the Hippocratic physician had the potential to cause harm. The author of Diseases of Women claims to have witnessed many women maltreated because doctors approached female ailments as though they were treating a man. This demonstrates a dire need for personalized healthcare for women in Classical Greece. The focus on inspiring confidence in the practitioner was far less common in the treatment of women, and many female patients in the Corpus were presented with inadequate explanations of their ailments, perhaps because the practitioner simply did not know what the cause of uniquely female ailments were.

These ancient barriers to care are unfortunately not an entirely foreign idea in modern medicine. Independent of gender and medical specialty, gynecologic treatises within the Hippocratic corpus serve as a reminder to increase comfort on both sides of the patient-physician relationship and commit to providing patient-centered care.

 

Bibliography

  1. Dean-Jones, Lesley. (1996). Women’s Bodies in Classical Greek Science. New York, NY: Oxford University Press.
  2. Euripides, Hippolytus.
  3. Flemming, Rebecca. (2000). Gender, Nature, and Authority from Celsus to Galen. New York, NY: Oxford University Press.
  4. Galen, On Prognosis.
  5. Hanson, Ann Ellis. (1992). Conception, Gestation, and the Origin of Female Nature in the Corpus Hippocraticum. Helios 19: 1, 2.
  6. Hanson, Ann Ellis. (1990). The Medical Writers’ Woman. Before Sexuality: Construction of the Erotic Experience in the Ancient Greek World. Princeton, NJ: Princeton University Press.
  7. Hippocrates, Diseases of Women I and II.
  8. Hippocrates, Epidemics.
  9. Jouanna, Jacques. (2001). Hippocrates. Baltimore, MD: Johns Hopkins University Press.
  10. King, Helen. (1998). Hippocrates’ Woman: Reading the female in Ancient Greece. London: Routledge.
  11. Nutton, Vivian. (2004). Ancient Medicine. New York, NY: Routledge.
  12. Von Staden, H. (1992). Women and Dirt. Helios 19: 1, 2. 1992.

 


 

JENNA NICKAS is a second-year medical student at Rutgers Robert Wood Johnson Medical School. She graduated from the University of Pennsylvania with a double major in Classical Studies and Biology, having pursued an independent study in ancient Greek medicine. She had the opportunity to study abroad in Crete and travels back to Greece as much as her medical school schedule allows. She is interested in pursuing a career in emergency medicine.

 

Winter 2019  |  Hektorama  |  Antiquity