Brady Lonergan
Farmington, Connecticut, United States

Literary and material evidence includes medical treatises ostensibly written by female physicians and references to female medical writers’ pharmaceutical contributions as early as the late classical period (fifth century BCE) in the Greco-Roman world.¹

The second century CE physician Galen cites remedies attributed to Spendousa, Aquilia Secundilla, and Antiochis.² The first or second century CE Gynaecia, Pessaria, and Cosmetics are attributed to Cleopatra, or potentially a woman named Theodote, who may have been the physician of a Ptolemaic Cleopatra and Arsinoe. On the Diseases and Cures of Women, which has been dated anywhere from the first to sixth centuries CE, is attributed to Metrodora.³ However, given the later tradition of Cleopatra VII as a scientist and scholar, and the Greek translation of the name Metrodora as “gift of the womb,” some suggest that both names are merely pseudonyms.³

While Flemming suggests that only five percent of physician inscriptions from the ancient world relate to women, there are several worth mentioning.² Many of these inscriptions come in the form of funerary stelae, and two notable examples include those of Mousa and Naevia Clara from the first to third centuries CE. The former is depicted holding a scroll, a motif commonly used in contemporary inscriptions of male physicians, and the latter is described as both a physician and scholar. An earlier example from the first century BCE is the inscription of Antiochis, wherein she was recognized by the people of Tlos for her medical contributions and expertise.² Some have even suggested that this may be the same Antiochis who was referenced in Galen’s work, to whom Heracleides dedicated a text on pharmacology, and who was the daughter of the famous physician Diodotus.²

Linguistic evidence also suggests different medical roles for women during this era. Parker highlights the distinct terms for midwives and female physicians in both Greek (maia vs. iatrina) and Latin (obstetrix vs. medica). Although these physicians appear to have primarily engaged female patients in obstetrical and gynecologic care, separate roles within related fields seem to have existed much like they do today.

Women continued to play important roles in health and medicine later under the Eastern Roman Empire. While the earliest known example of a female physician in the medieval West dates to the eleventh or twelfth century CE, the majority date to the thirteenth through fifteenth centuries.⁴ The medical establishment was dominated by men, and medical literature was produced by men for a male readership.⁵ In contrast, both textual and material evidence substantiates the existence of female physicians throughout the Byzantine period in the East. Material evidence includes five inscriptions of women distinctly identified as physicians,¹ and several textual sources shed light on women’s contributions to the practice of medicine in the Eastern Roman Empire.

Male writers cited female medical experts, including the fifth to sixth century CE physician Aetius of Amida, who referenced remedies attributed to Aspasia in his treatise on gynecology.¹ Women’s roles as medical doctors also became codified into law under the Emperor Justinian. Specifically, his Codex Justinianus affirmed female physicians’ right to seek payment for services and held women to the same medicolegal standards as their male peers.⁶

Another detailed textual source about women in Byzantine healthcare comes from the Pantokrator Typikon, the policies and procedures for the Pantokrator Monastery and its associated hospital, which were built in the early part of the twelfth century CE by Emperor John II Komnenos. The fifty-bed hospital had five wards, one of which was a women’s ward staffed by two male physicians, one female physician, and several female ancillary staff.⁷ While these female physicians and other medical personnel appear to have been tasked primarily with addressing obstetrical and gynecological needs, Talbot suggests they also likely managed general medical issues.⁸ The hospital personnel worked in shifts; during the day, there were two male doctors, one female physician, four female medical assistants, two auxiliary female assistants and two female orderlies. At night, a female medical assistant would oversee the service alone.⁹ The Typikon outlines the following with regard to pay for the physicians:

The other four [physicians] after them should receive six and a half similar nomismata each, for their food a third of a nomisma each, and thirty-six modioi of grain each… The female doctor should receive three similar nomismata including her food allowance, and twenty-six modioi of grain.⁷

The text also outlines the pay scale for other staff:

The sixteen certified assistants and the four female assistants should each receive two and a half of the new preferred nomismata of the day, for their food a sixth of a nomisma each, and twenty-four modioi of grain each. The eight auxiliary assistants and female assistants should receive two similar nomismata each, for their food a twelfth of a nomisma each, and twenty modioi of grain each… [and] eight orderlies together with the three female orderlies should receive four similar nomismata each, for their food a quarter of a nomisma each, thirty modioi of grain each, and for their monthly allowance each of them should receive four similar trachea nomismata every month.⁷

Female medical assistants and orderlies received the same pay as their male counterparts. Female doctors received roughly half the salary of their male colleagues. Miller suggests that a possible explanation: if women physicians were on call and only worked as needed, they would likely see their own private patients outside the hospital, which could make sense in the context of the relative gender equality of other staff salaries.⁹ To put it in perspective, all physicians at the hospital were paid below the estimated minimum wage of the time and likely chose to pursue hospital appointments for the associated prestige, which in turn could augment the appeal of their private practices.¹⁰

There is no evidence for formal medical education for women during this time. Parker suggests that women likely followed the same intrafamilial apprenticeship pathway as some of their male counterparts. Antiochis of Tlos is one example, as she was the daughter and possible student of Diodotus.¹ Naevia Clara may also have followed a similar pathway, as her funerary stele describes her husband as a physician.

While female physicians were certainly in the minority and possibly relegated primarily to obstetrical and gynecological matters, evidence suggests that the Byzantine medical establishment was more inclusive of women in the medical professions as compared to the medieval, early modern, and modern West.

References

1. Parker, HT. “Women Doctors in Greece, Rome, and the Byzantine Empire.” Women Healers and Physicians: Climbing a Long Hill, ed. Lilian Furst. Lexington: The University Press of Kentucky (1997): 131-150. 
2. Flemming, R. “Women, Writing and Medicine in the Classical World.” The Classical Quarterly, 57.1 (2007): 257–279.
3. Totelin, L. “The Third Way: Galen, Pseudo-Galen, Metrodora, Cleopatra and the Gynaecological Pharmacology of Byzantium.” Collecting Recipes: Byzantine and Jewish Pharmacology in Dialogue, edited by Lennart Lehmhaus and Matteo Martelli, Berlin, Boston: De Gruyter (2017): 103–122.
4. Green, M. “Women’s Medical Practice and Health Care in Medieval Europe.” Signs, 14.2 (1989): 434–473.
5. Benton, JF. “Trotula, Women’s Problems, and the Professionalization of Medicine in the Middle Ages.” Bulletin of the History of Medicine, 59.1 (1985): 30–53.
6. Gkegkes ID, Iavazzo C, Sardi TA, Falagas ME. “Women Physicians in Byzantium.” World J Surg, 41.3 (2017): 892–895.
7. Thomas, JP and Hero, AC, eds. Byzantine Monastic Foundation Documents: A Complete Translation of the Surviving Founders’ Typika and Testaments. 28. Pantokrator: Typikon of Emperor John II Komnenos for the Monastery of Christ Pantokrator in Constantinople, transl. Robert Jordan. Washington, D.C.: Dumbarton Oaks (2000): 725–781.
8. Talbot, A-M. Women and Religious Life in Byzantium. Aldershot: Ashgate, 2001.
9. Miller, TS. The Birth of the Hospital in the Byzantine Empire. Baltimore: The Johns Hopkins University Press, 1997.
10. Miller TS. “Byzantine Hospitals.” Symposium on Byzantine Medicine, ed. John Scarborough. Dumbarton Oaks Papers 38 (1984): 53–63.