Tag Archives: infertility

I smell a rat! Fumigation in Mesopotamian and Hippocratic recipes for women’s ailments – Part 2

By Ulrike Steinert

In this post, I will introduce Hippocratic prescriptions for fumigation from below and compare the uses of this treatment form in Mesopotamian and Hippocratic gynaecology. Some Hippocratic recipes — like the Akkadian BAM 237 discussed in Part 1 —  just list the ingredients, which have to be thrown into the fire, adding a short instruction for application. Other Greek recipes describe a procedure very similar to the Babylonian text K.8678+ (see Part 1), especially the instruction to dig a hole in the ground as a receptacle for the fumigant:

Diseases of Women (DW) 2.195, L 8.376 (Totelin 2009, 253):
Another fumigation: it is necessary to dig a hole and to roast grape stones, in the amount of two Attic choinikes; let him throw some of this ash in the hole, continuously dropping sweet-smelling wine. Seating herself around <the hole> and taking her legs apart, let her be fumigated.

A few Hippocratic recipes state that the woman should be completely covered with clothing during treatment, so that none of the fumes would escape around her. We find the same instruction in a Mesopotamian recipe (12th cent. BCE) for releasing postpartum blood and “fluids” that are “blocked” in the womb:

(If) a woman gives birth and subsequently she has intestinal trouble, her excrement? […], her intestines are blocked, her fluids and [her] blood are (b)locked [in her belly?], to make her release (it): kukru-aromatic, juniper, atā’išu-plant, ṣumlalû-aromatic, “sweet reed”, ballukku-aromatic, myrrh, ṭūru-aromatic, abukattu resin, baluḫḫu-aromatic resin, root of atā’išu-plant. These eleven drugs you mix together. You gather charcoals of ašāgu-thorn into a kirru-vessel, you throw these drugs into it, you have that woman sit down above it, you wrap her with cloth(s).(W.G. Lambert, “A Middle Assyrian Medical Text”, in: Iraq 31 (1969), 28-39 obv. 1-9)

In some Hippocratic passages we notice the desire to make the procedure more comfortable for the woman by using a chair with a hole in it placed above the fire on which she could sit during the treatment (DW 2.114, L 8.246). Several instructions warn to take care not to burn the patient (e.g. DW 1.75, L 8.164). It is probable that the Babylonian healers also used such a chair, but this is never explicitly stated, and it is likewise possible that the patient had to squat above the fumigation apparatus as shown in the illustration.

An African woman is fumigated during delivery. From: Gustave J. Witkowski, Histoire des accouchments chez toys les peubles, 1887, fig. 282. Source: http://ihm.nlm.nih.gov/images/A30263
An African woman is fumigated during delivery. From: Gustave J. Witkowski, Histoire des accouchments chez tous les peuples, 1887, fig. 282. Source: http://ihm.nlm.nih.gov/images/A30263

Both Babylonian and the Greek recipes leave us with unanswered questions. How did the Hippocratics and the Babylonian healers explain the effect of the treatment in view of the contrasting symptoms for which they applied fumigations? How was it possible that fumigation of the genitalia could at the same time stop bleeding and release fluids locked in the womb?

The Hippocratics apparently attributed a drying effect to some fumigations, since they explain in one prescription for stopping fluxes that the ingredients should be mixed only with a little vinegar, in order not to moisten the womb too much.[i]

Likewise in Akkadian, the choice of “human bone” as fumigant for bleeding (in BAM 237) can be explained on the basis of its dryness: blood is contrasted with bone as “wet” with “dry”, and at the same time entails a colour contrast. Thus, the name of the drug “human bone” could have referred to the drying effect of the substance.

On the other hand, in the Hippocratic recipes the effect of fumigations to induce bleeding is sometimes described as “expulsive” (e.g. DW 1.78, L 8.186), and DW 2.133 explains that when the womb attaches itself to the hip joint, with the result that the womb becomes twisted sideways and closed, a fomentation is able to fill the womb with air, straighten and open it. Missing similar explanations for our second Babylonian example K. 8678+, it is hard to say whether the fumigation was supposed to open the womb (remove blockages) or to irritate it.

Some of the fumigations in the Hippocratic corpus were certainly quite irritating to the nose! A common treatment in Hippocratic gynaecology when the womb had moved upward in the body was to apply fragrant, sweet-smelling substances to the vagina (by fumigation or pessary), while foul-smelling substances like animal excrements or hair had to be inhaled by the patient in order to lure the uterus back downwards.[ii] This principle does not hold for fumigations with a different therapeutic purpose. Thus, beside recipes using fragrant substances such as myrrh, ingredients as stag horn and cow dung are recommended for a fumigation to stop fluxes (DW 2.195, L 8.376), and wolf’s turds and donkey hair are burned to help conception. We have likewise encountered similar materia medica as Dreckapotheke in one Mesopotamian prescription, and in both traditions their application entails symbolic meanings. But in contrast to Hippocratic medicine, in Mesopotamia such substances were not restricted to the treatment of women.[iii]

But beware! It is known that in Mesopotamian medicine some ingredients like “dog turds” and “wolf fat” were secret names (Decknamen) for medicinal plants, and often should not be taken literally! Thus, in a plant compendium, “human bone” is a secret name for the (unidentified) plant “shepherd’s staff”, and it is possible that the scribe of BAM 237 consciously used this code to keep his knowledge secret from the uninitiated, making a fool of a 21st century interpreter… The debate about the actual use of Dreckapotheke in Mesopotamian medicine is still going on, and it could reshape our perspective on ancient medical practice!

[i] DW 2.114, L 8.246; cf. DW 2.195, L 8.376 for recipes which apply dry and astringent ingredients such as horn, roasted flour/grain, dry cypress, gallnuts and astringent dark wine.

[ii] E.g. DW 2.123, L 8.266; DW 2.127, L 8.272.

[iii] For ingredients such as excrement in Hippocratic gynaecology see e.g. von Staden 1992.


L = Littré, Émile (1962) Œuvres completes d’Hippocrate. Tome Huitième, Amsterdam.

von Staden, Heinrich (1992) “Women and Dirt”, in: Helios 19, 7-30.

Totelin, Laurence (2009) Hippocratic Recipes. Oral and Written Transmission of Pharmacological Knowledge in Fifth- and Fourth-Century Greece. Leiden, Boston.

I smell a rat! Fumigation in Mesopotamian and Hippocratic recipes for women’s ailments – Part 1

By Ulrike Steinert

In my first post on the blog, I described some of the difficulties in studying Mesopotamian medical texts from 2nd and 1st millennium BCE Babylonia and Assyria. In the following two contributions, I would like to discuss similarities between Babylonian and Hippocratic recipes applying “fumigation from below” as a therapy for gynaecological disorders. In this part I will present the recipes themselves with some comments on fumigation in general. In the next post I will compare Mesopotamian and Hippocratic concepts of women’s ailments and their treatment gleaned from the fumigation recipes.

The specific treatment form of fumigation from below is so far attested only a few times within the Mesopotamian gynaecological corpus, but fumigation of the (whole body of the) patient or of specific body parts (e.g. the ears) is more commonly found as a treatment type in other areas of Mesopotamian therapy. Surprisingly, the situation is reversed in the Hippocratic texts: most attestations within the Hippocratic corpus are found in the gynaecological treatises, while fumigation is otherwise rare (Goltz 1974, 232). Here, I would like to point out some similarities and differences between the Babylonian and Hippocratic sources with regard to the therapeutic procedure itself, and with regard to the female ailments treated by fumigation from below in each tradition.

Before comparing the recipes, the term “fumigation” should be clarified. In fumigation, hot and dry vapours or smoke are led to a body part, while in the cognate procedure of “fomentation”, hot water vapours are used to lead medicinal substances to a body part (Totelin 2009, 52; Goltz 1974). The differentiation between both techniques was not very strict in Greek medicine, except in the gynaecological treatises (Goltz 1974, 235). The main difference between both procedures is the apparatus: in fomentation, a vessel containing the drugs and some water is heated over a fire and the vapours are led to a body opening through a reed, while in fumigation substances are directly thrown into the fire or onto glowing charcoals or ashes. In Mesopotamian medical texts, fumigation consists of burning aromatic substances on a fire or on charcoals (usually a brazier is used), exposing the patient (or specific body parts) to the fumes (Goltz 1974).

It may come as a surprise that in both Mesopotamian and Hippocratic gynaecology fumigation from below was applied for some identical purposes and ailments. In Hippocratic gynaecology, fumigation was used to treat infertility, with the incentive to open or soften the uterus for conception.[i] Interestingly, fumigation was regarded as a patent method both to stop fluxes and to expel retained fluids from the womb.[ii] More often however, fumigation was applied to return the womb to its correct position, if it had moved elsewhere in the body.[iii]

By contrast, the theory that the womb could move within the body and cause illness is unknown to Mesopotamian medicine. But one prescription applies fumigation from below to stop bleeding during pregnancy (naḫšātu), comparable to the Hippocratic use of fumigation for fluxes. Further, both in Hippocratic and Mesopotamian gynaecology fumigation from below was prescribed when fluids were retained or blocked in the womb. While the Hippocratic texts speak of blocked menstrual or postpartum blood (lochia), the Babylonian texts describe a similar condition called “(b)locked fluids” (lit. “water”). Because this condition is sometimes mentioned in the context of postpartum complications, it is possible that the word “fluids” here refers to the lochia, but this is far from certain, since the word “fluids” can stand for several things in different contexts, e.g. for the amniotic fluid or for vaginal discharge other than blood. Yet, Mesopotamian texts describe very similar symptoms in connection with the condition “(b)locked fluids” as the Hippocratic texts do in connection with disease conditions caused by retained menses (see Steinert 2013 for discussion). Should the Akkadian expression “(b)locked fluids” be a euphemistic term for the retained menses?

BAM 237 (VAT 8577+), a collection of gynaecological recipes from Assur. Source: Cuneiform Digital Library Initiative (http://cdli.ucla.edu/dl/ photo/P285323.jpg)
BAM 237 (VAT 8577+), a collection of gynaecological recipes from Assur. Source: Cuneiform Digital Library Initiative (http://cdli.ucla.edu/dl/photo/P285323.jpg)

One of the prescriptions for fumigation from below is contained in a Neo-Assyrian text from Assur (ca. 7th cent. BCE), devoted to treating bleeding during pregnancy:

BAM 237 i 26’-27’:
“You scatter “human bone” over charcoal, you let the woman sit down above it. If (the haemorrhage) does not stop, you repeat (it), and let her sit down (again), ditto (i.e. and it will stop).”

From a second, contemporary recipe on a Babylonian tablet found in the palace library of the Assyrian king Ashurbanipal at Nineveh, we learn a few more details about the procedure:

K. 8678+ rev. 9’-12’:
“If ditto (i.e. a woman is (b)locked regarding the fluids): you dig a hole, you make it two fingers [deep], […],
[…] you cover (it). You throw flour? into it, one tenth of a litre of ka[mūnu-spice?],
[…] solid pieces? of resin, one thirtieth of a litre of ṭūru-aromatic […],
[…] you spread on coals; you make the woman sit down above it.”

Although the text is fragmentary and presents difficulties, the procedure is quite clear and bears similarities to a few Hippocratic recipes for fumigation of the womb (presented in Part 2 of this post). The apparatus is simply a hole in the ground, which functions as a receptacle for burning charcoal and the fumigants. The woman’s pubic region is exposed to the fumes.


[i] E.g. Diseases of Women 1.75, L 8.164; cf. Diseases of Women 2.154, L 8.330; Sterile Women 230, L 8.438ff. describes a fomentation with a gourd for the same purpose.

[ii]DW 2.114, L 8.246; DW 2.195, L 8.376; DW 1.78, L 8.186.

[iii] For discussion see King 1998; e.g. Diseases of Women 2.123, L 8.266 movement to the head; DW 2.126, L 8.272 womb attaches itself to the hypochondria; DW 2.127, L 8.272 movement to the liver; DW 2.133, L 8.284-6 fomentations when the womb moves to the hip joint; DW 2.203, L 8.390 womb fixes itself to the loins. Sometimes, the patient is described to suffer from more than one symptom at the same time, e.g. in Diseases of Women 2.154, L 8.330 the womb is “irritated”, the menses are blocked and the woman does not conceive.


Goltz, Dietlinde (1974) Studien zur altorientalischen und griechischen Heilkunde. Therapie-Arzneibereitung-Rezeptstruktur, Wiesbaden.

King, Helen (1998) Hippocrates’ Woman. Reading the Female Body in Ancient Greece, London/New York.

L = Littré, Émile (1962) Œuvres completes d’Hippocrate. Tome Huitième, Amsterdam.

Steinert, Ulrike (2013) “Fluids, rivers, and vessels: metaphors and body concepts in Mesopotamian gynaecological texts”, in: Journal des Médecines Cuneiformes 22, 1-23. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3791376/

Totelin, Laurence (2009) Hippocratic Recipes. Oral and Written Transmission of Pharmacological Knowledge in Fifth- and Fourth-Century Greece. Leiden, Boston.

Following a Recipe through Different Manuscripts

By Catherine Rider

Recently I’ve been looking through medieval recipe collections for remedies and tests relating to infertility, the subject of my new research project.  At first I was looking for any remedies, from the fairly mundane (mares’ milk) to the ones that look more exotic, at least to modern eyes (numerous animal testicles and a few charms) but recently I’ve taken a more targeted approach, comparing the different manuscripts of a single recipe collection to see if the infertility recipes change as the collections were copied.  I’m hoping that these changes will tell me something about the priorities of the various different copyists and owners of the manuscripts, and so shed light on how infertility remedies may have been used in practice – or at least, how the scribes who were paid to copy collections of recipes thought they might be used.  Monica Green has taken a similar approach to manuscripts of gynaecological texts in her book Making Women’s Medicine Masculine.[1]

I started this when I noticed that a few collections included recipes which assumed the man would take a role in seeking or administering a cure for infertility.  For example one recipe to aid conception in the Liber de Diversis Medicinis (Book of Diverse Medicines), an English recipe collection published by Margaret Ogden from a fifteenth-century manuscript, opens with the heading ‘If a man will that a woman conceive a child soon.’[2]  This interested me because it’s often assumed that in the Middle Ages infertility was seen as a female condition and women therefore bore much of the responsibility for seeking treatment, and yet here we have the suggestion that a man might take the initiative in seeking a remedy.  I wondered how typical it was.  One way to find out was to look at the other manuscripts and see if they kept the same heading, or substituted a different one.

The Liber de Diversis Medicinis was a good collection to start with because it was quite widely copied: the volume of the Manual of the Writings in Middle English dedicated to scientific and medical texts listed sixteen manuscripts, and several were in London or Cambridge and so fairly easily accessible for me.  I spent some time in the British Library and a couple of Cambridge college libraries, checking their copies against Ogden’s edition; I still need to get to Oxford, Durham and Manchester for the rest.  Many of them look a bit like this – a 15th-century recipe book in the Wellcome Library:

L0000832 Receipts for cataract and teeth whitening
15h-century leechbook. Image credit: Wellcome Library, London

The first thing I noticed was the sheer amount of difference between manuscripts.  Scholars have often noted that medieval recipe collections display significant variations between manuscripts and in the case of the Liber de Diversis Medicinis the differences were very large. One fifteenth-century manuscript in the British Library (Egerton MS 833) omitted a large section of the collection, including the infertility recipes – although this may have been because pages had been lost from the manuscript, or from the exemplar copied by the scribe, rather than because the scribe had decided not to copy them.  Another British Library manuscript (Royal MS 17.A.VIII) included only a few remedies for each ailment, rather than the much greater number of possibilities recorded in the manuscript used by Ogden.  Moreover, the infertility remedies it gave were very different, as were the headings used to introduce them.  Gone was the recipe for a man who wanted a woman to conceive soon, and instead there was a heading which encompassed both sexes: ‘To do a man gete child and a woman bere child.’[3]

Another manuscript again (British Library MS Sloane 962) included a recipe for conception in Latin alongside the English ones.  Switching between languages is not unusual in medieval recipe manuscripts but it still tells us something about the scribe and the person who owned it – both had at least a basic knowledge of Latin, the language of university medicine, which suggests this manuscript is more likely to have been aimed at a male medical practitioner than an interested amateur.

So far, though, I haven’t found another manuscript which includes Ogden’s heading, aimed at a man who wants a woman to conceive, so perhaps the idea that a man might take the initiative was unusual after all.

I’m still thinking about what all this means and how significant these variations are.  In some cases variations may be the result of missing pages in a manuscript, or simple miscopying.  Even when they are not, it is difficult to tell how far scribes were consciously making these changes in order to adapt the text to the needs of a new reader – one who could read Latin, for example, or one who imagined that men would come seeking help to make their wives conceive.  However, in most cases these manuscripts do show us scribes who did not copy blindly, but rather were familiar enough with recipes to change things in ways that made sense to them.   By tracking these variations I’m hoping to uncover as many medieval attitudes to infertility and its treatment as possible.

[1] Monica Green, Making Women’s Medicine Masculine (Oxford: Oxford University Press, 2008).

[2] The Liber de Diversis Medicinis in the Thornton Manuscript (MS Lincoln Cathedral A.5.2)¸ ed. Margaret Sinclair Ogden, Early English Texts Society original series 207 (London: Oxford University Press, 1938), p. 56.

[3] London, British Library MS Royal 17.A.VIII, f. 63v.

Garlic and fertility testing in the Greek world

By Laurence Totelin

In my last blog post, I discussed some ancient gender tests. This month, I turn to Greek fertility tests. In the Greek world, women only entered full womanhood upon conception and delivery of a child, preferably a boy. Infertility seriously damaged a woman’s status in her community. It is therefore no wonder that one of the treatises of the Hippocratic Corpus (a collection of some sixty texts written in the fifth and fourth centuries BCE) was devoted to the issue of barrenness: On Sterile Women. This tract includes a few fertility tests, aimed at predicting whether a woman will become pregnant or not.

Representation of garlic in the famous 'Vienna Dioscorides' manuscript (512 CE)
Representation of garlic in the famous ‘Vienna Dioscorides’ manuscript (512 CE)

Tests by means of which you will know whether a woman will be pregnant. If you want to know whether a woman will be pregnant: give to drink butter [or a plant called boutyron] and the milk of a woman who has borne a male child, whilst she is fasting. If she vomits, she will be pregnant; if not, she will not.

Another: Let her wrap some oil of bitter almonds in wool and apply as a pessary. Check in the morning whether she smells of it through the mouth; if she smells, she will be pregnant, if not, she will not.

Another test for the same purpose: apply pessaries that are not particularly strong. If she has pains in the joints, suffers from clattering teeth, dizziness, and yawning, there is more hope that she will pregnant than if she who does not suffer from any of these afflictions.

Another: Having washed and peeled a head of garlic, apply it to the womb, and see the next day whether she smells of it through the mouth; if she smells, she will be pregnant, if not, she will not.

If you want to know whether a woman will be pregnant, let here drink finely pounded anise in water, then let her sleep. If she itches around the navel, she will be pregnant; if not, she will not. [On Sterile Women 214]

Every single one of these tests would deserve a long explanation, especially since possible Egyptian parallels exist for some of these recipes. Here, however, I will focus on the second and fourth tests, the almond oil and garlic tests. Both rest upon the assumption that women have a sort of tube (a hodos) that runs through their bodies, with two openings: the mouth of the face and the mouth of the womb (=the vagina). In a healthy woman, whose tube was not obstructed, a smell could travel easily from the lower to the upper mouth – hence the use of such smell test.

The smells used here were not chosen at random. Perfumes, such as that of bitter almond, were associated with Aphrodite, love making and marriage ceremonies. Garlic too was associted with sexuality and fertility, although the links are not particularly easy to interpret. In Aristophanes’ comedy, The Women at the Thesmophoria (a festival in honour of Demeter), women use garlic to conceal the smell of wine after a night of drinking and sex with their lovers (v. 495). Garlic masks the smells associated with sex and pleasure. Similarly, according to the historian Philochorus (third century BCE), at the festival of the Skirophoria (a festival in honour of Athena and Demeter), ‘women ate garlic in order to abstain from sex, so that they would not smell of perfume’ (FGRH 328 F 89). Thus, Philochorus presents garlic as an-aphrodisiac, a clear opposite to those perfumes used in sexual foreplay.

The sceptic will no doubt say that garlic was chosen simply because it is a strong smelling, ‘windy’ plant, whose scent would travel easily through the body. Yet, there seems to be something that links it to women and sex in the ancient world. An admittedly much later document, a sacred law from the sanctuary of the healing god Men at Sounion in Attica (IG II2 1365) informs men that they should cleanse if they have been in contact with garlic, pigs and women — a rather puzzling combination unless you know that ‘piggy’ was Greek slang for the vulva.