Soranus’ Gynecology

This translation of Soranus’Gynaikeia, based on Johannes Ilberg’s 1927 edition of the Greek text for Corpus Medicorum Graecorum, began as a collaborative project in the mid-1930’s. Ancient historian (Temkin) and classical philologist (Edelstein) met obstetricians/gynecologists (Eastman and Guttmacher), and they completed the translation after seven years of biweekly sessions. Revisions were delayed by World War II, and the finished product was published only in 1956. Soranus’ Gynecology has been out of print for years, and its reissue by Johns Hopkins University Press is most welcome. The new volume is a photographic reprint of the 1956 edition, and although the translation has weathered well—and no doubt will serve the needs of future generations—the accompanying bibliography (pp. xix-xxii), introduction (pp. xxii-xlix), and addenda (pp. 211-44) are out of date. The original edition cannot, of course, be faulted for failing to predict subsequent generations’ interest in Soranus’Gynaikeia, sparked to some degree by the readability of this very translation. Soranus’Gynaikeia has in recent years become a familiar text to all who focus upon the women and children of the Roman empire. ¹ Nor can this translation’s popularity be faulted for fostering the impression that Soranus was first and foremost a gynecologist and obstetrician, rather than a physician of broad intellectual interests that spanned philosophy, medical history and doxography, etymology, as well as other aspects of medicine—embryology, nosological etiologies, hygiene, materia medica, chronic and acute diseases, surgery, bandaging. ² Nonetheless, it is simply unfortunate that the publisher made no effort to update some or all of the translation’s ancillae; so careful a scholar as Temkin would not have written in this same manner in 1991. At the least, a note alerting readers to the bibliography in the 1988 edition of Soranus’Gynaikeia I in the Budé Les Belles Lettres series should have been inserted on one of the blank half-pages (e.g. pp. xi, xxii, xlix, etc.). ³

I offer the following notes as bibliographical supplement in the hope they will be useful to others.

A. Introductory remarks on Soranus’ life, works, and later reputation, pp. xxiii-xxv. The jejune details about Soranus’ life, derived from two complementary biographical entries in the Suida, s.v. “Soranus,” receive some confirmation in the Gynecology. That Soranus’ adult career began with study at Alexandria, perhaps learning his anatomy there, and continued with his practice of medicine at Rome, is bolstered by the familiarity he displays not only with the dissections of the uterus Herophilus undertook in Alexandria (I 10; III 2-3), but also with specific obstetric and pediatric practices of both Alexandria (II 6) and Rome (II 44). ⁴

Kind’s list of titles for Soranus’ lost works remains standard. ⁵ Edelstein’s view that the “Life of Hippocrates,” the Vita Hippocratis carried in Hippocratic mss. with an attribution to Soranus, was erroneously ascribed to him under a mistaken impression that it was a fragment of his Lives of Physicians has gained general acceptance. ⁶

P. Burguière has called attention to Soranus’ creative use of language in accordance with highest standards of koinê idiom and to the fact that some fifty Greek words appear either only in Soranus’Gynaikeia I, or appear there for the first time. ⁷

B. Introduction, The Methodist Sect, pp. xxv-xxxii. The development of the medical sects ( haireseis) at Alexandria in the 3rd century BCE and the subsequent writing of sectarian medical history has been clarified by H. von Staden, W.D. Smith, G.E.R. Lloyd, and others. ⁸ Not only did Herophilus and Erasistratus profoundly change the medical profession by their extraordinary contributions to anatomy and physiology, but they also gathered followers around them—Herophileans and Erasistrateans—apparently on the model of the philosophical schools of Plato and Aristotle at Athens. As a group, the Herophileans of Alexandria were committed to an epistemology that explained causes of health and disease by means of deductive and inductive theories and espoused a methodology that considered logical explanation of causes integral to proper diagnosis and therapy. In opposition there appeared a group of physicians self-consciously styling themselves “Empiricists” and calling their medical method “Empiric,” since it was based, they claimed, on clinical observation, rather than theory. In the course of their arguments Empiricists coined the label “Dogmatist,” or “Rationalist,” for any physician they considered a “non-Empiric.” Dogmatists did not constitute a school in the same sense as “Empirics” or “Herophileans,” and physicians labelled “Dogmatists,” or “Rationalists,” may have shared no more than an epistemology that proclaimed the validity of causal explanations and a medical theory that appealed to proofs from anatomy, physiology, and pathology. Although the earlier sectarian quarrels are now lost, we see their results in later medical doxographies that found the rubrics “Empiricist” and “Dogmatist” schematically useful and these contrasts likewise color the history of medicine, as told by Celsus and Galen.

Like Empiricists and Herophileans, “Methodists,” or “doctors of the Method,” as they styled themselves, were also a medical sect, or school, coming to prominence in Rome early in the 1st century CE. This “Methodical” medicine was a negative reaction against both the Dogmatic and Empiricist Greek doctors practicing in the city, yet its members also shared a methodology grounded in the doctor’s ability to perceive in every patient’s illness one of three universal commonalities ( koinotêtes)—excessive constriction, excessive fluidity, or a mixture of the two—and a therapy that looked to counteract these bodily conditions. Some doctors of the Method achieved considerable notariety among the increasingly valetudinarian upper classes of Rome. Nonetheless, our knowledge of Methodism is hampered by the fact that we know at first hand only two Methodist doctors—Soranus and the much later Caelius Aurelianus (for whom, see below)—and Methodism was nearly a century old by the time of Soranus. Further, there are no adequate collections of fragments or testimonia for other Methodist doctors. Closer scrutiny of evidence continues to underscore how difficult it is to compose a detailed history of “Methodism” and to trace origins and developments in Methodist thought. ⁹ Galen’s information on Methodists and Methodism passed through his own lens of personal animosity toward contemporary Methodists, ¹⁰ such as the very successful Statilius Attalus and Julian, but his hostility was often retrojected upon their Methodist predecessors: the controversial Republican doctor Asclepiades of Bithynia, who introduced the Romans to his popular, non-invasive therapies, such as passive exercises (rocking, riding, being massaged) and a regimen of bathing, fasting, and wine-drinking. E. Rawson has argued persuasively that Asclepiades died not long before the dramatic date of Cicero’s De oratore, September, 91 BCE. ¹¹ J.T. Vallance has separated Asclepiades’ corpuscles ( anharmoi onkoi) from Epicurean atoms, because his onkoi are frangible, and Asclepiades’ pores ( poroi) from Epicurean void, because they transported fluids through the body in a manner reminiscent of Erasistratus’ explanations. Vallance further argues that the language in which Methodists discuss the pathology of their universal commonalities betrays intellectual dependence upon Asclepiades’ physiology and etiology, even if the sect claimed emancipation from previous theories. ¹² The “old Methodists,” as Caelius Aurelianus called them, remain rather shadowy figures—Themison of Laodicea, said by Pliny the Elder to be Asclepiades’auditor ( NH 29.6), and the flamboyant Thessalus of Tralles (Galen quotes from the letter he wrote to Nero to accompany the treatise he was dedicating to the emperor, MM I 2.1). ¹³

Medical studies flourished in Alexandria long after the death of Herophilus’ patron Ptolemy II Philadelphus, and the city remained the center of anatomical studies for centuries after wealth and political power shifted to Rome—for the time being the preeminent city in which Greek doctors achieved fame and fortune. ¹⁴ The Methodist sect came into being in Rome, and Methodist influence appears to have been greater in western provinces than it was in eastern provinces—where Galen’s influence soon predominated. Nonetheless, a papyrus from the Egyptian county seat of Oxyrhynchus ( P. Oxy. LII 3654), dated on the basis of its hand to the 2nd century CE, makes it clear that Methodist medicine was known in Roman Egypt. ¹⁵

C. Introduction, Soranus’ Theoretical Concepts, pp. xxx-xxxii. G.E.R. Lloyd’s overview of Soranus’ theoretical preconceptions and Soranus’ criticisms of traditional gynecological practices more clearly explicates Soranus’ intellectual baggage and his stance vis-à-vis the medical and scientific options available to him. ¹⁶ Lloyd is concerned not only to underscore Soranus’ disdain for superstitious beliefs on the grounds that religious notions should not interfere with medical requirements, but also to explicate Soranus’ cautious and critical assessments of time-honored gynecological practices. Gynecology was an area of medicine in which the overlap between popular and literate traditions was considerable, and while Soranus’Gynaikeia was medically more sophisticated than Hippocratic gynecologies, he too was frequently reworking widespread popular beliefs, grounding them in logical bases and integrating deeply-seated notions into his medical discourse. (See e.g. Gyn. II 6, where Soranus, although rejecting the popular etiology, nonetheless accepts the notion that the parturient’s girdle be loosed, “for this enhances her breathing,” and that her hair be untied, “for this effects good tonus of her head.”) Hippocratics and Soranus were both concerned to distance gynecological theory and practice from folk traditions and to draw human reproduction within the compass of established medicine. The underscoring of this similarity in stance, so central in Lloyd’s discussion, has likewise discouraged a tendency of the early 1980’s to balance Hippocratic gynecology against Soranus’ gynecology in order to discover which of the two better represented women’s views on the anatomy and physiology of their reproductive organs. ¹⁷

In the effort to make Soranus attractive to “modern readers,” Temkin misled, however, when he suggested that Soranus’ lost treatise On the seed was probably “a lengthy discussion of fertilization and embryology.” If Soranus had given voice to interesting notions about conception and gestation, Galen would perhaps have said so, either in his own On the seed or elsewhere. As it is, Galen’s testimony suggests that Soranus relied on the Hellenistic anatomist Herophilus for his anatomy and physiology of conception, since both share the mistaken notion that uterine tubes in women issue into the bladder, just as they do in men (cf. Galen, De semine II 1, IV 596-98K and Soranus, Gyn. I 12.2-3, CMG IV, 9 Ilb).

D. Introduction, Nosology and Therapy, pp. xxxii-xxxvi. A particularly useful explication of Soranus’ nosology and therapy is Y. Malinas and D. Gourevitch for Gynaikeia I 48-53 (Soranus’ treatment of digestive problems in the first months of pregnancy, pica), ¹⁸ where they underscore the fact that Soranus was choosing among traditional therapies and adapting the most congenial ones for his 3-day therapeutic cycles. They reconstruct the pathological concepts Soranus assumed, but did not express: pregnancy itself causes the malady, for it creates a surplus of blood in and around the uterus that is neither evacuated as menses nor consumed by the embryo when small; like the skin and the kidneys, the uterus evacuates through regular menstruation morbid fluids that are end-products of digestion; in early pregnancy this surplus blood, made stagnant by noxious fluids, returns to the stomach, upsetting it and its digestive functions. The universal commonality in pica is excess fluidity, indicating therapies that constrict and dry by moving surplus blood away from the stomach and toward the skin; therapies that calm the stomach by fasting on the first day, but that introduce gentle foods on the second, and add passive exercises and respiratory activities on the third. J. Scarborough examines drug lore in Soranus’ account of amenorrhea ( Gyn. III 6-16), where the commonality is excessive constriction and the 3-day cycles of therapies “relaxing.”¹⁹ Although doctors of the Method subscribed to the three, universal commonalities, Soranus’ criticisms of Methodist predecessors make it clear that although commonalities do indicate treatment, not all Methodists would have necessarily responded in the same manner. (See, e.g., Gyn. IV 39, where Soranus criticizes Thessalus for using irritating salt or natron on a prolapsed uterus before reinserting it, claiming that Thessalus here violates his own principles: the metasyncritic remedies, designed to alter a diseased organism, were to be employed during remission, rather than during the exacerbation of prolapse.) M. Frede concludes that while Thessalus may have intended a radical change in medical practice, Soranus actually offered a largely traditional medicine in Methodist guise. ²⁰

E. Introduction, Soranus’Gynecology : contents; afterlife; manuscripts, editions, and translations, pp. xxxxvi-xlix. D. Gourevitch’s account of the Gynecology in her introduction to the 1988 Budé edition of Gynecology I better places Soranus’ treatise into the context of ancient gynecology, beginning with the Hippocratics and the Midwifery of Herophilus and ending with the compendia of Aetius of Amida and Paul of Aegina. ²¹

Soranus’Gynaikeia was known in the Latin west in Latin guise. Caelius Aurelianus paraphrased: although Caelius’ Latin is preserved in a single ms., there also contaminated with another Latin version of Soranus circulating under the name of Mustio, Caelius’ Latin can on occasion be juxtaposed to Soranus’ Greek. Caelius’Gynecia sometimes omitted historical details in preference for diagnostics and therapeutics; nonetheless, his version did preserve Soranus’ ordering and a representation of Soranus’ thinking on most issues. In the case of Soranus’Acute and chronic diseases, now lost in Greek, Caelius said that he was “latinizing” Soranus’ Greek ( Cel. II 8). Caelius, however, also refered to Soranus in the 3rd person, making it likely that, while this is Soranus’ intellectual property, it is only a Latin version, a reflection of his words—not “…to all practical purposes … a translation of Soranus’ Greek original.”²²

Temkin’s description carried the reconstituting of Soranus’ Greek text from a single Paris ms. Par. Gr. 2153 (= P) through the work of Dietz, Ermerins, and Rose, to the 1927 edition by Ilberg. The new edition in the Budé series represents, like the Temkin translation, the combined efforts of philologist, ancient historian, and practicing gynecologist (see note 11), and copious reference has been made here to its introductory essays. Serious questions have been raised, however, by D. Manetti as to the philological principles on which this Greek text was based: she argues that the 15th century composite ms. P has been overvalued at the expense of direct testimony from the fuller text in the papyrus fragment of Gynaikeia III ( PSI II 117) and of the indirect tradition in Oribasius, known to us from mss. older than P and lacking corruptions that mar P’s text. ²³ Manetti considers unwise the decision to treat the Gynaikeia as a “Gebrauchstext” (and therefore to include passages systematically athetized by Ilberg as not belonging to Soranus on the grounds that they are “Soranian” and therefore have “documentary interest”), since such passages clarify only the priorities and interests of the compiler of P, rather than the text of Soranus. Her comments come at an important point for the editors, who have published only Book 1, since it is in Books 3 and 4 of the Gynaikeia in particular that P contains less generous excerpts from Soranus.

F. Addenda: Ancient Names; Materia medica, pp. 211-44. For Herophileans in the list of “Ancient Names,” see H. von Staden, Herophilus (note 8), 445-578. For Materia medica, see e.g. J.M. Riddle on plants with contraceptive and abortifacient properties , a number of which appear in Soranus I 60-63.

• [1] E.g.: 1) R. Jackson, Doctors and diseases in the Roman empire. London, 1988, especially chapter 4, juxtaposing Soranus’ text to archaeological evidence; 2) P. Garnsey, “Child rearing in Ancient Italy” (pp. 48-65 in The family in Italy, D.I. Kertzer and R.P. Saller, edd. New Haven and London, 1991), who relies on Soranus for child-rearing practices among Roman upperclasses; 3) the two studies by K. Bradley, in both of which he not only notes similarities between Soranus’ theory and ancient practice, as set out in wet-nursing contracts from Roman Egypt ( Klio 62, 1980, 321-25), or in the inscriptions from Rome mentioning the nutrix (pp. 201-229 in B. Rawson, The family in ancient Rome, London and Sydney, 1986). [2] E. Kind, cols. 1113-1130 in RE, zweite Reihe, III Bd., Stuttgart, 1927, lists some eighteen titles in addition to the Gynaikeia in 4 books and a shorter gynecological catechism in 2 books, lost in Greek, but paraphrased in Latin by Mustio (R. Radicchi, ed., La Gynaecia di Muscione: manuale per le ostetriche et le mamme del VI sec. d.C., Pisa, 1970). [3] Pp. lxxv-lxxxvi in Soranos d’Éphèse: Maladies des femmes, Livre I, Paul Burgurière, Danielle Gourevitch, Yves Malinas, Paris, 1988. Even so, such a note would not, for example, inform a student that Edelstein’s article on Methodists, cols. 358-73 in RE Supplementb. VI, Stuttgart, 1935—cited by Temkin, p. xxvii and note 13—was translated into English in the Johns Hopkins University Press collection of Edelstein’s essays, Ancient Medicine, Baltimore 1967, 173-91, reprinted in paperback in 1987. [4] See my forthcoming “Soranus: princeps methodicorum,”ANRW. [5] Add to the bibliography, J. H. Waszink, Tertulliani De anima, Amsterdam, 1947, 22*-44*, on Soranus’Peri psyches as a source for Tertullian. [6] E.g. W.D. Smith, Hippocrates: pseudepigraphic writings, 1990, p. 49 and note 2, p. 51 and note 1, p. 53 and note 3; more cautiously expressed by O. Temkin, Hippocrates in a world of pagans and Christians, Baltimore, 1991, 52-57. [7] “La langue et le style de Soranos,” pp. lix-lxv in Soranos d’Éphèse. [8] H. von Staden, “Hairesis and heresy: the case of the haireseos iatrikai,” pp. 76-100 in B.F. Meyer and E.P. Sanders, edd., Jewish and Christian self-definition III = Self-definition in the Greco-Roman world, London, 1982; and Herophilus: The art of medicine in early Alexandria, Cambridge, 1989, 58-59, 445-46. W.D. Smith, “Ancient medical historiography,”BHM 63, 1989, 73-109, esp. 98-100. G.E.R. Lloyd, The revolutions of wisdom, Berkeley, 1987, 158-71. [9] E.g. D. Gourevitch, “Le méthodisme,” pp. x-xxii in Soranos d’Éphèse (above, note 3) and “La pratique methodique,” pp. 51-81 in P. Mudry and J. Pigeaud, Les écoles médicales à Rome, Geneva, 1991; J. Pigeaud, “Les fondements du méthodisme,” pp. 7-50 in Les écoles médicales—a discussion particularly useful for its investigation of specific phrases associated with Methodism. M. Frede presents a more unified view of Methodist theory, but he does so by glossing over differences (“The Method of the so-called Methodical school of medicine,” pp. 1-23 in J. Barnes, J. Brunschwig, M. Burnyeat, and M. Scholfield, edd., Science and speculation: studies in Hellenistic theory and practice, Cambridge, 1983, and reprinted in Frede, pp. 261-78 Essays in ancient philosophy, Minneapolis, 1987). [10] V. Nutton in Galen: On prognosis, CMG V 8,1, Berlin, 1979, 224; J.T. Vallance, The lost theory of Asclepiades of Bithynia, Oxford, 1990. [11] “The life and death of Asclepiades of Bithynia,”CQ ns 32, 1982, 358-70, and Intellectual life in the late Roman Republic, London, 1985, 171-78. [12] The lost theory, esp. 131-43. [13] J. Pigeaud, “Les origines du méthodisme d’après maladies aiguès et maladies chroniques de Caelius Aurélian,” pp. 323-38 in I. Mazzini and F. Fusco, I testi di medicina latini antichi: problemi filologici et storici, Rome, 1985. For Themison, see also Rawson, Intellectual life (above, note 13) 176-77; D. Gourevitch, “Asclépiade de Bithynie dans Pline: problèmes de chronologie,”Helminta, numéro spécial, 1987, 67-1, and “Le méthodisme,” x-xxii. For Thessalus, von Staden, “Hairesis and heresy” (above, note 8), 83-85; Gourevitch, “Le méthodisme,” xx-xxii. For Thessalus’ letter, J. Hankinson, Galen: on the therapeutic method I and II, Oxford, 1991, 88-89. [14] V. Nutton, “The perils of patriotism: Pliny and Roman medicine,” pp. 30-58 in R. French and F. Greenaway, Science in the early Roman empire: Pliny the elder, his sources and influence, Ottowa, 1986. [15] For commentary on the papyrus, see Gourevitch, “Le méthodisme,” xi-xii. Cf. also the 4th century CE papyrus containing parts of Soranus’Gynaikeia III 2-3, PSI II 117, below, Section E. [16] Science, Folklore and Ideology, Cambridge, 1983, 182-200 and 168-82. Also Gourevitch, “Le traité Des maladies des femmes et la tradition gynécologique” and “Soranos et le méthodisme dans le traité Des maladies des femmes“, pp. xxx-xlvi in Soranos d’Éphèse. [17] E.g. A. Rouselle argued that information about women’s bodies in Hippocratics derived from women, while Soranus (and Rufus) were, by contrast, “manuals of fertilization written for husbands” ( Porneia, Oxford, 1988, 24-46); P. Manuli found Soranus’ views on the healthfulness of virginity more attractive, claiming that Hippocratics viewed women as merely a uterus (“Sorano e l’elogio della castità,”Memoria 3, 1982, 39-49, and “Donne mascoline, femmine sterili, vergini perpetue: la ginecologia greca tra Ippocrate e Sorano,” pp. 147-92 in Madre materia: sociologia e biologia della donna greca, S. Campese, P. Manuli, G. Sissa, edd., Turin, 1983). [18] “Les vomissements gravidiques selon Soranus,” pp. 217-29 in Mudry and Pigeaud, Les écoles médicales. [19] “The pharmacy of Methodist medicine,” pp. 203-16 in Mudry and Pigeaud, Les écoles médicales; Scarborough relies in this section on the unpublished, 1985 Cambridge dissertation of G.L. Rubenstein, The Riddle of the Methodist method: understanding a Roman medical sect. [20] “The Method of the so-called Methodical school of medicine.” [21] “Coup d’oeil sur la médecine des femmes,” pp. xxxii-xl in Soranos d’Éphèse. [22] E.g. P.H. Schrijvers, Eine medizinische Erklärung der männlichen Homosexualität aus der Antike, Amsterdam, 1985, 21-25, where he argues that Caelius strengthened Soranus’ negative view of homosexuality with rhetoric of his own; J. Pigeaud, “Pro Caelio Aureliano,”Memoires III du centre Jean Palerne (St-Étienne), 105-17; Lloyd, Science, Folklore and Ideology (above, note 18), 185-86; J. Kollesch, Vorwort to Caelius Aurelianus: Akute Krankheiten I-III, Chronische Krankheiten I-V, Teil I, G. Bendz, ed., CMG VI 1, Berlin, 1990. Also Vallance, The lost theory of Asclepiades of Bithynia, p. 5 and n. 1. [23] “Un testo fondamentale di ginecologia antica,”Hist. Phil. Life Sci. 12, 1990, 262-70. [24] “Oral contraceptives and early-term abortifacients during classical antiquity and the middle ages,”Past and Present 132, 1991, 3-32: the genus Ferula (“giant fennel”), to which both silphion and opopanax belong, pomegranate, juniper, rue, pennyroyal, squirting cucumber, Queen Anne’s lace.