John M. Riddle, Contraception and Abortion from the Ancient World to the Renaissance. Cambridge, MA: Harvard University Press, 1992. Pp. x + 245. ISBN 0-674-16875-5.
Reviewed by Paul T. Keyser, University of Alberta.
A seminal and unique work of great importance. Riddle has studied Dioskorides in a recent monograph, and now focusses on one aspect of his drug lore, already broached in a valuable article, "Oral Contraceptives and Early-term Abortifacients during Classical Antiquity and the Middle Ages," Past and Present no. 132 (August 1991) 3-32. A frequent problem in attempting to understand ancient medicine is the precise nature of the condition described: e.g. the Athenian plague. Studies of conception and its prevention have the advantage that diagnosis ('pregnant') is proven by birth. Riddle is firmly historicist -- the procedures described are taken as such and not as metaphors, symbols or signs (vii-viii). After all, pre-modern women had as much or more interest as moderns in effective contraceptives and abortion.
Riddle asks was it possible for pre-modern people to regulate fertility by other than abortion, infanticide, or abstinence (1-16)? He rightly concludes that evidence (literary and archaeological) shows little recourse to such methods and a birth rate too low to explain unless achieved by the use of contraceptives. Restraint, delayed marriage, coitus interruptus, non-fertile intercourse, rhythm, surgical abortion, infanticide: it is clear that none was the method of choice. The point is crucial and elsewhere thoughtlessly neglected. The best recent survey of any other part of ancient medicine, R. Jackson, Doctors and Diseases in the Roman Empire (1988) devotes only two shallow pages (109-111) to the whole topic and is hesitant to credit the use or efficacy of any contraceptives. Similarly two otherwise excellent books concerned in part with ancient population growth quickly dismiss any possibility with even less discussion: J. Diamond, The Third Chimpanzee (1992) 189-90 and M. N. Cohen, Health and the Rise of Civilization (1989) 103, 129.
Riddle then discusses at length the abundant but neglected evidence in Dioskorides and Soranos (16-56) for herbal (oral) contraceptives (ATO/KIA) and abortifacients (FQO/RIA). These chapters ought to be required reading for those who believe that the conceptual world of Greek medicine is wholly alien to and disjoint from ours. First, laws and precepts from Plato to Talmud show that ancient people believed that oral contraceptives worked to reduce fertility (16-20), and they distinguished contraception from abortion (20-24). Riddle evaluates the prescriptions of Soranos 1.61-3 by reference to numerous modern pharmacologic studies which show that nearly every plant claimed as contraceptive by Soranos and which has been tested, in fact works. For example, Soranos (and others) advise pomegranate rind, which when fed to guinea pigs prevents pregnancy (25-6). SI/LFION is prescribed, now usually thought extinct, but ferujol (extracted from another ferula species, asafetida, which the ancients thought an inferior substitute) is "nearly 100% successful in preventing pregnancy up to three days after coitus at a low dose of 0.6 mg/kg in adult female rats" (28). A third herb is rue (PH/GANON) now used to induce abortion in horses, in humans in Latin America, and in rats (where it also prevents implantation) in the lab (28-9). Modern tests validate such of Dioskorides' prescriptions as have been tested as well. The point is important: ancient doctors knew about working oral-route contraceptives -- and knew they knew.
Riddle next asks how widespread were the knowledge and agents (57-65)? Literary references and modern folklore parallels show they were wide-spread indeed. E.g., the seeds of Queen Anne's Lace (wild carrot) were prescribed post-coitally by Diosk. 3.72 and Scr. Larg. 121, and are still used in the Western part of Riddle's home state, North Carolina, and in India, for the purpose -- a practice validated by modern bioassays (58-9). Jokes in Aristophanes Pax 706-12 and Lys. 87-9 turn on audience recognition that penny-royal (BLH/XWN) was an effective contraceptive -- and it is (53-4, 59).
In order to establish the continuity of the tradition of knowledge and practice, Riddle returns to Egyptian papyri (66-72). Already the Kahun papyrus of ca. 1850 B.C. contains contraceptive pessaries, of doubtful efficacy, but the recipe of the Ebers papyrus of ca. 1550 B.C., linen soaked with honey steeped in acacia spikes (cp. the modern sponge and diaphragm) was probably effective (69-70), and Soranos describes similar devices (25-6, 30). At least one oral contraceptive is prescribed in the Berlin papyrus, ca. 1300 B.C. (72-3), of uncertain efficacy. I am surprised that there is no information from the very potion-oriented Mesopotamian medicine: R. Campbell Thompson, The Assyrian Herbal (London 1924). As Riddle notes, his "study has a conspicuous omission," China and India (154): the texts are very difficult of access (the Indian "herbal", Charaka Samhita, so far as I know, is available in English only in a privately-published, unindexed version by A. Ch. Kaviratna: Calcutta 1897-1912).
From Hippokrates to Galen, Greek medical writings contain a variety of contraceptive prescriptions, whose known ingredients when tested show anti-fertility effects (74-86). Such knowledge was acquired in the same way that we have learned over centuries and millennia which plants are edible, cure headache or heart trouble, etc. (87). Observations of low fertility in animals by herders allowed further discoveries (88). In the Late Roman Empire and Early Middle Ages the tradition survived, albeit weakened, in standard medical texts (89-107). The difficulty was the Roman Church's well-known opposition to abortion and contraception: yet in Macer's influential XI-A.D. herbal, pennyroyal is still given as a birth control herb (108-117). Arabic medicine showed no such inhibition, and is replete with contraceptive herbs, some ancient, some new (127-34). Riddle brings his survey down to the Renaissance (135-57) and investigates what happened thereafter: physicians banished the long-preserved herbalists' knowledge to the realm of superstition (159-60). Furthermore, much of this knowledge was probably originally resident in the oral female culture of herbalists and midwives, who were marginalised by the professionalisation of medicine in the XVIIII A.D. (155-7). The increasing tendency to criminalise abortion and even contraception contributed (158-9, 161-3).
In addition to showing the efficacy, prevalence, and continuity of knowledge and use of oral herbal contraceptives and abortifacients, Riddle discusses the attitudes of the ancients, pagan, Christian, and Jewish, toward abortion and the status of the fetus (7-10, 17-24, 62-4, 109-112). Although Riddle treats the famous prohibition of abortive pessaries in the Hippokratic Oath (7-10) and cites Edelstein's magisterial study, he does not note that Edelstein argues cogently that the oath derives from IIII-B.C. neo-pythagoreans (see Edelstein Ancient Medicine 18-20). Riddle and Edelstein come otherwise to the same conclusion, that from Hippokrates and Plato through Aristotle to Augustine and Gregory of Nyssa all Greek and Roman (and Jewish) writers more or less agreed that aborting an unformed fetus incurred no impurity or guilt (20-24). The lone exceptions are Musonius Rufus and Basil of Caesarea, apparently.
Riddle however misses three documents relevant to abortion of great importance and influence, which hamartia he shares with many scholars (not Edelstein): none have ever yet been done into any modern language. The latest is the earliest extant anti-abortion pamphlet, which circulated for centuries in perhaps the most influential corpus of ancient medicine, and collects arguments against abortion still standard. An animal sit id quod in utero est, formerly ascribed to Galen (19.158-81 Kühn), is clearly a late III-A.D. neo-pythagorean or neo-platonic work (by Iamblichos?). [Galen] makes use of the same polar dichotomy which inflames the modern debate, and argues since the embryo has all the parts which make a living being, uses its organs in the womb, and when born already knows how to eat, etc., it must therefore be a living being and hence laws should and do exist to protect it. The earlier PRO\S *GAU=RON PERI\ TOU= PW=S E)MYUXOU=TAI TA\ E)/MBRUA of Porphyry -- see K. Kalbfleisch, Abh. Akad. Wiss. Berlin: Philol.-Hist. Kl. (1895) -- was one of [Galen]'s sources but is more complex and aporetic. Galen's own views, in de Fet. Form. (4.652-702 K.), are, he claims, based on anatomy (652.1-9, 664.9-13, 676.7-9.1, etc.) and he concludes the embryo has liver, heart, and brain from an early date (663.2-17), formed properly in that order (672.7-4.5). It is Galen's teleologic God who forms the fetus, not FU/SIS, the soul itself, or anything else (687.5-8.15), but he hesitates to declare when a fetus has a rational human soul (665.3-6.3, 685.1-14, 701.7-2.4).
There are copious notes (171-210) and an extensive and valuable bibliography (211-35). Although Riddle's focus is herbal, he might have noted W. Krenkel, "Hyperthermia in Ancient Rome," Arethusa 8 (1975) 381-6: the hot Roman baths reduced sperm production, and Hippokrates may have known that heating the testicles caused temporary sterility. With reference to abortion, add Diethard Nickel Untersuchungen zur Embryologie Galens (Berlin 1989), W. Krenkel, "Der Abortus in der Antike," WZRost 20 (1971) 443-52, and idem, "Familienplanung und Familienpolitik in der Antike," WJA 4 (1978) 197-203.
Although it is no longer common to study classics offering blood to ghosts, here at least the ghosts (esp. of Dioskorides and Soranos) seem to have blood for us. Society has moved beyond the ancients in most areas of science, and fancies it has in politics, but it seems that the Renaissance and Enlightenment missed A)TO/KIA. Riddle repairs that lack. In a world of fifty myriads of myriads of people, curtailing growth would alleviate most of our most crucial problems. According to the Cypria (fr. 1) Zeus ordained the Trojan War because the Earth groaned with too many people. Whether or not Riddle's book influences modern medicine (as I hope), it should influence our views of ancient social and medical history. The ancients did seek, find, and use effective herbal oral contraceptives and abortifacients, and probably did so extensively. That matters for our understanding of ancient ethics, demography, science, and women.