Despite a recent surge of interest, ancient Greek medical science remains a relatively neglected area of study, for reasons which ought not to surprise anyone. Research in the field requires patience, imagination, and a higher level of philological skill than many other subjects. Many of the important texts are still untranslated or poorly edited; the bulk of the relevant material is enormous; the rewards to be had from work in the field might seem slight to classicists with a conventional literary training.
Lesley Ann Dean-Jones belongs to a growing group of classicists working in the field of Greek medicine and dedicated to developing the rich resources it offers for an understanding of ancient culture. Her focus is on female physiology and pathology, and on ancient theories about the female role in human reproduction. Her major body of evidence consists of the Hippocratic corpus and parts of Aristotle’s biology. Her argument is set in a social-historical context and shows an acute and usually critical interest in the position of women in both Greek and Roman societies. That she is writing about women’s health from a critical perspective gives her work a sharp contemporary relevance: we are still wrestling with the problems which arise when a male-dominated medical profession addresses specifically female pathologies and we still wonder whether there can or should be a distinctly female medicine.
The thematic centre of her book lies in her demonstration that menstruation (rather than other possible differentiating factors) was fundamental to Greek medical and biological conceptions of the female body. In itself, this is an argument of some consequence, and her exposition of the basic evidence in support of it takes Dean-Jones through many difficult texts. She examines an impressive array of Hippocratic texts and on the whole balances them well with the relevant Aristotelian material ( Historia Animalium, de Partibus Animalium and de Generatione Animalium). Her analysis of the primary evidence is close and usually careful, and on many points her work will have to be consulted by anyone working on this material.
In each of her three central chapters Dean-Jones opens with a brief sketch of the cultural construct of the female as found in literary sources, followed by reference to Presocratic efforts in the given domain. Thereupon she proceeds to a detailed treatment of the Hippocratic and Aristotelian material. She sensibly arranges her material in a comparative treatment of a series of subtopics, a presentation which shows the similarities and divergences between the two corpora. In light of the number of these subtopics, it might have been helpful to include them in the table of contents.
Chapter 1, on female anatomy and physiology, takes us in a developmental sequence from pubescence through to menopause, with particular focus on theories concerning menses and menstruation. Dean-Jones surveys the explanatory factors used, most notably blood-temperature and flesh consistency (49 ff., 55, 85). She also studies closely the important Hippocratic text Virg. (47 ff.) for its suggestion of the dangers of transition between the relative asexuality of childhood and the pronouncedly differentiated state of womanhood. Among the theoretical curiosities concerning menstruation which she examines is the Hippocratic belief in an extraordinarily large amount of menstrual emission (1 pint). She offers a cultural rationale for both the Hippocratics’ and Aristotle’s likening of menstrual blood to that of sacrificial animals. She also assesses the significance of Aristotle’s failure to recognize the distinct female urethra (77 ff.) in relation to his more famous claims that the female has a different skull structure and number of teeth than the male. On the whole the material is reasonably ordered, although her discussion of hysteria (the Hippocratic notion of the ‘wandering womb’)
In the course of her treatment of female pathology (ch. 2) Dean-Jones is largely tied to Hippocratic sources, which is inevitable since (as she notes 7, 18-19) the medical corpus is largely therapeutic in orientation, while the Aristotelian works concentrate on theoretical concerns. Her main project in this chapter is two-fold: first, to establish that, except in the gynaecological works, the general Hippocratic views on pathology presupposed a conception of male physiology (what she calls ‘andrology’ (112)); and second, to show that female pathology, where found, was regularly tied to reproductive physiology. She begins from a close reading of Mul. I.62, where the author argues that there should be a distinct field of medicine for the treatment of females. Dean-Jones interprets this as a sign that ‘general’ Hippocratic medicine ignores female physiology. She proceeds to consider a wide variety of texts, such as Aer., Epidemics and de Victu, for evidence of these claims. Insofar as they do refer to female pathology, she also shows us how the authors of these texts regularly turn to female reproductive physiology, particularly menstruation, as the key explanatory factor and the focal point for therapy.
Finally, in her study of the theories of reproduction (ch. 3), Dean-Jones proceeds in developmental sequence again. First, we see the raging debate on the origin of generative seed (‘one’ or ‘two seed’, i.e. from the male parent alone or from both parents?). Then we are led through theories on sex-differentiation, resemblance of offspring to parents, gestation, parturition and lactation, all treated in considerable detail. She points out that although a cultural belief in the superiority of the male underlies both Hippocratic and Aristotelian theory generally, the ‘one or two seed’ debate was fought over the theoretical problems of explaining sex-transmission, and inheritance of resemblance (160-170, 193-200). While concluding that Aristotle’s version of the one seed (male semen) theory is more theoretically successful, she points out some of the problems inherent in his insistence that no material part of the male seed remains in the conceptus, for in his view the father contributes form only and the mother contributes the matter of the conceptus through her menses (184-192). Elsewhere in this chapter Dean-Jones argues that there was a belief among the Hippocratics and Aristotle of a period between the conjunction of the parents’ reproductive contributions (‘fertilization’) and what was viewed as the point of origin of a viable human life form (‘conception’) (172-176).
This is an impressive range of material to digest and present to the non-specialist reader; but readers who are new to this material will want to be cautious in accepting Dean-Jones’ analyses at some points. Perhaps most important for readers who are not classicists (and so depend completely on the author for presentation of the primary evidence) is the question of the texts and translations on which she builds her case. For example, Dean-Jones announces that she generally relies on the Littré edition (1831-1861) for her Greek text—and it is still the only complete edition of the entire corpus of Hippocratic writings. But readers not acquainted with the current state of the Hippocratic corpus should know that for most of the works upon which she bases her discussion the Littré text has been superseded in editions of individual treatises in the Corpus Medicorum Graecorum and Budé series.
Her use of a variety of translations also is problematic at times. Issues of terminological consistency aside, confusion can arise from the fact that some of the translators she uses have based their works on texts subsequent to Littré and have in many cases added emendations of their own. To cite one instance, Dean-Jones uses Lonie’s translation of and commentary on de Genit., Nat.Puer., and Morb. IV (1981), a work which depends on the Budé text of Louis (1970) and includes many of Lonie’s own emendations. It is also uncertain which text and translation (presumably Temkin’s translation) she uses for Soranus, since neither is specified in her note on texts and translations (xii) or in the bibliography.
Dean-Jones justifies her use of existing translations as being “in the interests of objectivity”. However, in the heat of argument she occasionally violates this principle. For instance, she offers her own tendentious translation of the Hippocratic Oath (31-2) to support her contention that in the early period ‘women could receive medical training in the same scientific tradition as men’. She also translates part of Aer. 9 to argue that the non-gynecological Hippocratics were aware of the distinct female urethra, as Aristotle was not (80-81). At 159 n.37 she offers what seems to us an inferior translation of
One of the greatest strengths of this book is its awareness of social and cultural influences on science. But occasionally this kind of analysis leads her into anachronism. For example, several Hippocratic accounts of abortion are connected by Dean-Jones to the notion that human life is not counted in the conceptus until after the first seven days (172-176). She suggests (174-5) that this allowed women and co-operative doctors (or those deceived by women about the stage of gestation) to carry out abortions for some time into the early stages of pregnancy. By the terminological ploy of calling the ejected conceptus of the first seven days an ‘effluxion’ and a certain liberty on the part of doctors or mothers in the identification of the day of fertilization, Hippocratic doctors could (according to Dean-Jones) terminate the pregnancy without violating the strictures of the Hippocratic Oath on abortions.
This is an ingenious suggestion, which might serve to account for the varied terminology used for the developmental stages of the product of fertilization, and for otherwise puzzling statements about the observation of aborted fetuses. Nevertheless, the reasoning she imputes to the Hippocratics is more reminiscent of modern deliberation on the topic of abortion (which focusses on the justifiability of taking an embryonic ‘life’) than it is of any ancient practice or discussion of the topic. For example, we have no clear statement on the question of when the conceptus is or is not considered a human life form in the Hippocratics or Aristotle, probably because that sort of issue was not of great concern in a society which still practised infant exposure. Edelstein noted long ago in his discussion of the oath
Dean-Jones does not, however, discuss the ancient social context of the abortion issue
Another issue she addresses is the role of female pleasure in intercourse and its relation to conception. There is an element of anachronism, however, when she explores (159-160) the applicability of these Hippocratic and Aristotelian theories to the questions of rape and the ‘right’ to female orgasm. Although the issues are important, her discussion would be strengthened by a broader consideration of the relevant ancient attitudes and ideology. For instance, the notion that anyone, male or female, had ‘rights’ in something like the modern sense is dubious. As for the question of ancient views on rape, while Dean-Jones extrapolates the logic of these Hippocratic and Aristotelian theories into a plausible connection with rape, the fact remains that these authors do not give a stated position on the subject. Rather than commenting on the significance of this silence, she directs us to the views of Soranus (159). The reader should keep in mind that Soranus wrote about 500 years later than the other authors discussed, which might well be significant when dealing with a social issue.
A different area which the reader should treat cautiously in Dean-Jones’ discussion is her use of literary sources for representation of the social construct of women ostensibly borne out in the medical theories. In her section entitled ‘Gender Categories of Disease in Early Greek Poetry’ (111-112) we are given a depiction calculated to presage the Hippocratics’ rationalisation of female pathology. It is important to emphasize, as Dean-Jones does, the connections between medical theory and other facets of Greek culture, though in this case the generalisations she makes about the gender typing of disease in Greek myth (female gods for women, male gods for men) is too simple—the tendency is there in myth, but the tradition is more flexible than she allows. Perhaps some use of prose sources would have helped to balance the discussion of Greek social views of ‘gender and disease’. It would also have been interesting to see what Dean-Jones makes of Thucydides’ account of the plague in Athens, particularly in comparison with her close and helpful analysis of the material in the Hippocratic Epidemics.
Taking another cue from mythology (Hesiod’s and Semonides’ depiction of woman as a different race than men, 42-43), Dean-Jones argues that the Hippocratics rationalise this notion in their pathology and physiology: ‘For the Hippocratics, woman is a radically different animal from man in structure and processes’ (225), ‘a completely different creature’ (85). By contrast, she maintains, Aristotle sees both sexes as ‘members of the same species partaking in basically the same phusis‘ (59), although ‘the male is the ideal in human structure and processes’ to which the female approximates (225; also see 54, 71, 76). In general terms the Hippocratics do seem to draw the contrast more strongly at times than does Aristotle. But some tempering of Dean-Jones’ rather strong claims might be in order, and she herself on occasion quite rightly points out that complete consistency is not attainable on the Hippocratic side, considering the composite nature of the corpus (225).
Some items in which the Hippocratics show the male and female as assimilated under a common human nature are as follows. In Nat. Hom. 3 we read: “unless the things which copulated were of the same species ( homophula) and had the same generative capacities, we should not get these results”.
As for the sharp distinction she draws between the Hippocratics’ and Aristotle’s apparent assimilation of the sexes under a common nature, Dean-Jones apparently has missed a few passages in Aristotle germane to the point. In the HA he distinguishes the sexes sharply in terms of blood (consistency, volume, temperature, colour) and a wide range of secondary sex characteristics (cf. HA III.520b10-521a30, IV.538a22-b2). Moreover, Dean-Jones’ assertion that, in contrast to the Hippocratics, Aristotle ‘did not regard the human female as quite so anomalous with the female gender of other species or the other gender of the human species’ (76) is questionable in light of GA II.732a5ff, where Aristotle asserts that the higher the species the more distinct the sexes (cf. HA IX.608a21-b2, II.497b22 and Peck’s note ad loc. and Dean-Jones, 60 fn.53).
Furthermore, GA IV.775a4-b24 relates a considerable number of differences between the human sexes as opposed to those of other species, the reason being that in humans there is a wider gap of temperature between men and women. Nevertheless, on the whole, Dean-Jones well draws attention (176-184) to the fact that while Aristotle repeatedly and consciously wrestles with the problem of how to embrace the human sexes under one specific form, the Hippocratics, where they do directly consider the issue at any length at all (cf. Mul. I.62), seem to stress the differences between the sexes more.
The close relationship of ancient medicine with philosophical thought means that students of medicine must (like Galen, Sextus Empiricus, Empedocles, and others) be philosophers too. Dean-Jones is sometimes a bit uncertain about philosophical matters which lie on the periphery of her topic (such as the claim on 181 that ‘no Greek philosopher except the Sceptics thought to challenge’ the notion that ‘knowledge was of the unchanging and the real’; this is accurate for ‘real’, but Stoics and Epicureans both allowed for knowledge of changing physical objects).
In dealing with Aristotle, though, the philosophical material can be of real importance to the substance of Dean-Jones’ case, and there are points on which a clearer grasp would be desirable. One might think, for example, of her over-simplified account of Aristotle’s use of the endoxon (29); she invokes NE X.1172b36-1173a1 to show that ‘Aristotle holds that an endoxon with which all men agree is beyond challenge’, and applies this principle to biology. But endoxa are not mentioned in that chapter of the NE, and its dialectical discussion of hedonism has little bearing on Aristotle’s biological method. Some mention is made of G.E.L. Owen’s pioneering 1961 work ‘tithenai ta phainomena’ (16-19), but her knowledge of the debate since its publication is uneven. Nussbaum’s provocative extension of that work (‘Saving Aristotle’s Appearances’ (chapter 8 of The Fragility of Goodness) is neglected.
Dean-Jones is also somewhat uneven when discussing the very difficult issue of form ( eidos) in human reproduction (176-193), not least because at this point Aristotle’s biological theories interact so closely with a number of metaphysical issues, such as the principle of individuation and the relation of the species form to the individual. It is crucial that the relevance of the metaphysical principles to biology be appreciated, though on this point Dean-Jones would have benefited from a familiarity with Rist’s 1989 treatment in The Mind of Aristotle. On occasion the explanations Dean-Jones offers are opaque: the characterization of semen as an efficient cause in that it is used as tool by the agent/father (184, n.122) will not be of much help to most readers.
This kind of criticism merely shows, however, how demanding and important a task Dean-Jones has taken on. Her work lies at the intersection of such a wide range of other interests, including ancient law, social history and the role of women in Greek and Roman societies, feminist ideology (where she is by no means uncritical), and methodology in the history of science.
Such exploratory work inevitably raises more questions than it can answer and opens up issues where perhaps the only way forward is through speculation. The greatest value often emerges from the acute questions and observations Dean-Jones advances, rather than from the answers or the explanations she suggests. An example of this emerges from her perceptive consideration of the relationship between the medical men whose works we have and their female subjects and informants. Dean-Jones is sensitive as few previous writers have been to the obvious problems (both social and scientific) ancient doctors had in gathering information about specifically female physiological and medical matters. But in grappling with the question Dean-Jones is often reduced to speculative suggestions about the relationships between women and their doctors (the repeated occurrence of ‘may have’, ‘would have’, ‘might’ and ‘could have’ on 34-5 is revealing). This is a field where the best questions often lack definite answers.
This is also true when one asks, as Dean-Jones does, about the number and importance of female doctors in the classical period: the review of evidence on this question (31-33) misleadingly inflates the limited evidence we have. There are a couple of inscriptions, one just possibly from as early as the fourth century BC honouring a ‘midwife and doctor’. But Dean-Jones devotes nearly a page to an admittedly apocryphal story from Hyginus which tells us nothing about the prevalence of female medical activity. Other literary evidence is treated rather cavalierly: it is wishful thinking to use Rep. 454d2, for example, as though it were a factual account of social reality; the Hippocratic oath—itself of uncertain date—is exploited to create the possibility ‘that women could receive medical training in the same scientific tradition as men’ (see above). After this, we are driven to stray information about a certain Cleopatra in the Hellenistic period and tall tales about Aspasia generated in late antiquity. Dean-Jones concludes that ‘there is a basis for believing that women practised scientific medicine [i.e. Hippocratic medicine rather than folk medicine] in the fifth and fourth centuries B.C.’ But the ‘evidence’ for this claim is speculative at best.
Challenging work in intellectual history requires the kind of imagination we usually associate with a good detective. Since so many historians of ancient thought attend primarily to familiar questions, we ought especially to value our colleagues who, like Sherlock Holmes, notice that the dog did not bark in the night. Dean-Jones is perceptive in just this way, noticing (and proving) in her concluding chapter that Greek culture is characterized by a striking silence about menstruation. A wide range of bodily functions turn up over and over in non-medical literature, but this one does not, and perhaps the greatest single merit of her book is the demonstration that this silence is a real and important fact about Greek culture. It is a distinctly less important question whether her own explanation for this fact is finally convincing; but Dean-Jones’ detective work is being carried out in the more or less real world of historical facts, and is constrained by evidence in a way that Conan Doyle’s fictional creation was not. Hers is a new field yet, and one in which an indispensable contribution can be made just by asking the intelligent questions. And that, at least, Dean-Jones has done repeatedly. Her somewhat uneven successes in answering the questions should not detract from the importance of her accomplishment.