The role of the doctor and the possible medicalisation of fertility in the Hippocratic Corpus

Rebecca Fallas, Visiting Research Fellow, Classical Studies (Open University) and History and Philosophy of Science (University of Leeds).

This blog post is based on one aspect of the paper ‘Infertility, blame and the doctor-patient relationship in the Hippocratic Corpus’ which I presented at the symposium.

In my research on infertility in ancient Greece one of the questions that has always interested me is when did a doctor become involved in the fertility of a couple? Did a couple only visit a physician when they were struggling to conceive or before any fertility problem was suspected? These questions also intersect with issues surrounding the medicalisation of not just infertility but fertility itself.

The focus of my work is on the Hippocratic corpus which is a collection of treatises from several different anonymous authors mostly dating from the 5th and 4th centuries BC. The corpus covers a whole range of diseases and conditions, including their causes and treatments as well as offering us theoretical discussions on how the body was believed to work. Issues surrounding fertility can be found in many of the treatises in the corpus; however, it is in the third book of the text Diseases of Women, which is devoted to matters of fertility problems, that the most detailed discussions of the causes and treatments of infertility can be found.

When we examine the discussion on infertility in the Hippocratic texts we find several reasons why a couple who are attempting to conceive may approach a physician.

Visiting a doctor for fertility problems and testing

The first reason for a couple in antiquity consulting a doctor with regard to their fertility is perhaps the most obvious, the doctor becomes involved by treating diseases associated with infertility. There are numerous causes of infertility outlined by the Hippocratic writers. These include problems with the uterus – including ulcers, prolapses, problems with the mouth of the uterus, too much or too little menstruation to name just a few.

The couple may also visit a doctor to undergo fertility testing. One such test is described in the text Aphorisms where the author suggests:

If a woman does not conceive, and you wish to know if she will conceive, cover her round with wraps and burn perfumes underneath. If the smell seems to pass through the body to the mouth and nostrils, be assured that the woman is not [infertile]…

Aphorisms.5.59.4; trans. Jones, 1931, p. 175

Here perfumes are placed under the woman’s genitals and seeing if the smell passes through to her mouth. If it does then all her passageways must be clear and this would indicate the woman should be fertile.

Fertility regimens

In the examples above there is a suggestion that the couple is struggling to conceive. However, there are examples of advice for couples without any suggestion of fertility problems. This is particularly the case in the fertility regimens outlined by the Hippocratic authors. These following guidelines are given for a couple to follow should they wish to conceive a child:

When you know a woman is in the right condition to approach her husband, let her be in the fasting state, and let him be sober, bathed in cold water, and well-nourished on a small amount of appropriate foods.

If the woman knows that she has taken up the seed, let her not again approach her husband at first, but keep herself quiet; she will know this if her husband  says he has ejaculated, but she herself is dry…

            Diseases of Women 3.220; trans. Potter, 2012, p. 351

Regimens such as these appear to be offering general advice to couples wishing to conceive rather than targeting couples who are struggling to do so.

Sex determination of a child

In addition to outlining regimens for fertility, the ancient medical writers describe how a couple may attempt to predetermine the sex of their child through regimen. In the Hippocratic text Regimen, the author offers both theoretical and practical advice stating:

Males and females would be formed, so far as possible, in the following manner. Females, inclining more to water, grow from foods, drinks and pursuits that are cold, moist and gentle. Males, inclining to fire, grow from foods and regimen that are dry and warm. So if a man would beget a girl, he must use a regimen inclining to water. If he wants a boy, he must live according to a regimen inclining to fire. And not only the man must do this, but also the woman.

Regimen 1.27 ; trans. Jones, 1931, p. 265

The advice given here fits into the wider views given in the Hippocratic texts that men are generally hot and dry, whilst women are inclined to be moist and colder in nature. It is also noticeable that the regimen given for the production of the male child, one which is hot and dry, is the same advice given for regimens to generally increase the fertility of a couple.

Medicalisation of fertility?

We would perhaps expect couples to approach a doctor if they were struggling to conceive and infertility was certainly considered an issue which the Hippocratic authors felt worthy of much discussion. However, fertility regimens especially those associated with determining the sex of a child points towards an early attempt to medicalise fertility itself.

There is further evidence of a potential medicalisation of fertility in the Hippocratic texts. In book 3 of Diseases of Women (3.213), after describing the causes and treatments for infertility, the author states that as these are so numerous it is not surprising that there are women who fail to conceive. This statement suggests, then, that infertility was thought to be a relatively frequent occurrence in Hippocratic medicine.

Similarly, in the first book of Diseases of Women (1.25) the author describes many causes of miscarriages then like in the case of infertility suggests that women should not be surprised if they have a miscarriage. In fact, he goes on, it requires careful attention and much skill to carry a child to full term.

In both examples given, the emphasis is on how difficult it is not only to get pregnant but to carry that child to full term. The underlying argument behind the statement ‘it requires careful attention and much skill to carry a child to full term’ and ‘there is no need to be surprised that there are often women who fail to give birth’ could well be that fertility is not something to be left to chance but requiring medical intervention

The fact that doctors are either getting involved, or at least wanting to get involved, in a couple’s fertility before fertility issues have necessarily become an issue suggests some idea of prevention rather than necessary cure. It may even suggest an early medicalisation of not just fertility issues but fertility itself.

References:

Jones, W. H. S. (1931) Hippocrates Vol.4. Nature of Man, Regimen in Health, Humours, Aphorisms, Regimen 1-3, Dreams, Heracleitus: On the Universe, Loeb Classical Library, Cambridge, MA, Harvard University Press.

Potter, P. (2012) Hippocrates Vol.10. Generation, Nature of the Child, Diseases IV, Nature of Women, Barrenness, Loeb Classical Library, Cambridge, MA, Harvard University Press.