Category Archives: Series: Women’s Health

Human Milk as Medicine in Imperial China: Practice or Fantasy?

By He Bian

What does milk have in common with blood? According to Kou Zongshi (fl. 1110-1117), author of Bencao yanyi (Extended Interpretations on Materia Medica), they are basically the same vital fluid produced by the female body at two critical moments in a woman’s life. While the first menstrual period signifies the maturation of reproductive power, motherhood is the consummation of that power–miraculously causing the vital fluid to flow upward as milk. After nursing ends, the flow of milk again reverses back to blood, as evident from the return of the menses.

“Human milk.” Anon. Buyi Leigong paozhi bianlan (n.p, 1591), Book 8.
“Human milk.” Anon. Buyi Leigong paozhi bianlan (n.p, 1591), Book 8.

For centuries, Kou’s comment was repeatedly quoted as the dominant theory over lactation in the realm of learned medicine. It also coincides with parallel attempts to speculate on the metaphysical foundation of sex differences in women, and the consolidation of women’s medicine (fuke) and pediatrics (erke) as medical specialties.[1]

However, Kou’s original aim was to make sense of medical recipes. In particular, he was trying to figure out why do so many recipes for eye medicine use human milk to mix up powdered mineral drugs: a practice that has parallels in different cultural contexts. Since blood is essential for the five senses to function and human milk is essentially blood, Kou reasoned, this makes it an excellent medicine for eye diseases. Another recipe that may have been on his mind is the recommendation to drink “three portions of human milk” to help with obstructed menses. It makes sense if they were considered of the same origin. Like cures like.

Let’s pause here to consider what this means. Working with Chinese materia medica texts often means untangling different strands of thought, modes of compilation and miscellaneous quotations. The entry on each substance (e.g. human milk, renru or ruzhi) often begins with a learned survey of previous literature, including passages from classical literature and histories, and ends with a large (and often unwieldy) body of recipes. The problem is that the prescribed uses of the substances in the first part do not always sit well with the recipes, which are messy, opaque, and often outright strange.

In fact, Kou Zongshi’s work could be understood as a scholar-physician’s attempt to impose order and coherence on the unruly recipes, which were becoming increasingly available in print. [2] The incongruities and tension between theory and recipes, however, allows us to follow the intricate dance between empiricism and rationalism in such texts: when did authors equate recipes with real-life experiences, and when did they treat them as exemplars of theory and formulaic principles? When did book culture begin to shape the ways in which medicines were prepared, consumed, and invented?

Back to Kou Zongshi’s ingenious, if somewhat contrived, speculation over the nature of lactation. It did not seem to have caught much attention immediately. The twelfth and thirteenth centuries witnessed a growing suspicion among medical experts to discipline and curb wet nurses’ sway over childcare, and pediatric treatises abound with warnings against drunken, naughty wet nurses whose milk turns unwholesome to the infant.[3] Again, the female body’s power to nourish but also intoxicate with her transformed milk resonates with similar discourses discussed elsewhere on this blog; notably, alcoholic drinks were seen to be a bad thing that excites her passions, in contrast to ancient Roman recommendations.

In addition, the conquest of Mongols brought about increased consumption of cow and goat’s milk.[4] A leading physician active in the fourteenth century advised consuming those over human milk, which is easily “tainted with poisonous passions.” It looks like the arrival of more abundant dairy products would transform the existing pharmacopeia once and for all.

But not so simple. By the sixteenth century in China, human milk had become a “super food” of sorts, especially among elite families. Kou Zongshi’s dusty theory became a dominant trope, fanning the imagination of the female body as a machine of alchemical wonders, and her milk a sort of elixir that revitalizes the frail and depleted bodies. In the sixteenth-century encyclopedia Systematic Materia Medica (Bencao gangmu), Li Shizhen, the erudite naturalist and capable physician, criticized the excessive fetishizing of human milk. The prudent Li nevertheless included twelve “new recipes” that involve human milk as medicine. Li’s encyclopedia was first printed in 1596; soon after the turn of the century, dietary manuals began to teach people how to prepare dried milk powder at home, after collecting fresh milk from “strong women who just gave birth to boys”. Presumably, women sold their milk not as wet nurses, but directly to pharmacists (as depicted in the picture above).

So did people in imperial China consume human milk as medicine? Quite likely. But was it ubiquitous? Probably not. Recipes can be practical and fantastic, and theorists can explain and inspire. What matters is that human milk as medicine gradually came to be taken out of the context of nursing and acquired a more abstract quality as commodity.

[1] Charlotte Furth, A Flourishing Yin: Gender in China’s Medical History: 960–1665 (Berkeley, CA: University of California Press, 1999).

[2] Asaf Goldschmidt, The Evolution of Chinese Medicine: Song Dynasty, 960-1200 (London ; New York: Routledge, 2009).

[3] Ping-Chen Hsiung, “To Nurse the Young: Breastfeeding and Infant Feeding in Late Imperial China,” Journal of Family History, 20, 3 (1995), pp. 217-38.

[4] Paul D. Buell, E.N. Anderson, and Charles Perry, A Soup for the Qan : Chinese Dietary Medicine of the Mongol Era as Seen in Hu Sihui’s Yinshan Zhengyao, 2nd Rev. and Expanded ed. (Leiden, The Netherlands: Brill, 2010).

Women’s Health in the South Slavic Orthodox Tradition

By Adelina-Angusheva-Tihanov and Margaret Dimitrova

Visit to the witch from the Main Church of Rila Monastery, 1844. Photograph by Adelina Angusheva-Tihanov
Visit to the witch from the Main Church of Rila Monastery, 1844.
Photograph by Stavri Tserovski

This intriguing fresco was painted on the walls of the Rila Monastery, Bulgaria, in 1844. If you look closely at the bottom left-hand corner of this fresco, you might spot a demon urinating in a woman’s potion as she hands it to a sick man. Here, viewers of this fresco are encouraged to connect the activities of female healers with demons and evil spirits. This negative depiction of female healers was a common sight on the walls of nineteenth-century Bulgarian religious institutions, and continued a centuries-long struggle between the Church and local healers. The Church demonised female healers, but regularly concerned itself with the health issues of one group that was more likely to rely upon the powers of these practitioners –women. Indeed, religious texts of various periods deal with health and sickness. Religious healing has been discussed on The Recipes Project before.  Medieval South Slavic religious manuscripts commonly contain a range of texts relating to health: curative prayers; medical recipes; healing practices; short medical treatises; prognostications for an illness; and prophylactic instructions (such as dietary texts). In this post, we would like to share some common recipes, incantations and prayers addressing women’s health issues.

Detail from Fresco Photograph by Adelina Angusheva-Tihanov
Detail from Fresco
Photograph by Adelina Angusheva-Tihanov

The Hodoş Miscellany (Hodoshki Sbornik), so called because of its association with the Hodoş monastery now in Romania, is one of the richest sources for fifteenth century South Slavic remedies. This collection contains a range of recipes, including several concerning women. One such recipe is for conception. For this, it recommends administering morning baths from a dried rabbit’s womb or placenta (lozhe) filled with water during the woman’s menstruation. Interestingly, this recipe bears close resemblance to another remedy for conception presented by Dioscorides. According to Dioscorides, rabbit’s rennet mixed with butter should be used for purging baths during menstruation to cause pregnancy. In the remedy from Hodoş the replacement of the ‘rennet’ (stored in the stomach) with a ‘womb’, perhaps stems from a belief in the sympathetic magical influence of the rabbit’s fecundity. Interestingly, versions of this remedy continued to circulate in South Slavic folk tradition well into the twentieth century. For instance, in the 1980s, Margaret Dimitrova interviewed an old woman from the village of Brestnitsa in the Lovech region who continued to use pessaries made with rabbit fat as a fertility remedy.

South-eastern_Europe_1340(1)
Map of the Balkans, c. 1340 from Wiki Commons

Aside from providing fertility aids, the Hodoş miscellany also offers readers medicines to ease the pains of childbirth. We would like to bring three of these to your attention. The first remedy advises users to place a wreath of Euforbia officinarum on the head of the woman in labour. The other two offer brief magical rituals accompanied by powerful Biblical formulae. One instructs the user to write the short biblical quote “Open you, Gate of heaven” on a piece of paper and place it on the woman’s back. The second advises the reader to have a well-watered sponge in his or her left hand, and with their right hand inscribe on the top of the door: ‘Tear it down to its foundations!’ [Psalms 136:7]. The use of the door here as a locus in performing the conjuration might be a symbolic gesture associated with transition. The biblical quotation here took on multiple functions. ‘Tear it down to its foundations!’ is also used in prayers against swelling and water retention in men and horses. The meaning of the Biblical text was quite literally understood. The implication was of liberation, rather than destruction. In all cases it was applied because of the similarity in the expected results, regardless of the nature of the pains. Evidence suggests the use of this kind of remedies was widespread in the Balkans.

A Medieval Bulgarian Bible from Wiki Commons
A Medieval Bulgarian Bible
from Wiki Commons

The sources presented here from South Slavic literate culture inevitably show the role of medieval monasteries and parish churches in the transmission of healing practices. Indeed, the role of the – male-dominated – Church might help explain the spread of some of these recipes across South Eastern Europe: religious institutions formed a network of literate centres, exchanging texts and ideas. Those institutions preserved and employed ancient medical knowledge, healing practices and biblical texts to support women in the moment of pain and need. Unlike them, however, the female practitioners (as the one in the fresco), who helped medieval women throughout the lifecycle—be they midwives, local witches, or wise and older members of the family—have left behind no sources of their own.


Adelina Angusheva-Tihanov is a Research Fellow at the University of Manchester, working on magic, medicine, and religion in Medieval South Slavic Manuscripts. To find out more about women’s health in the Medieval South Slavic context, see Angusheva-Tihanov, A. “Ancient Medical Knowledge of the Woman’s Body in the Medieval Slavic Context: The Case of the Prague Manuscript IXF10.” Wiener Slavistisches Jahrbuch Vol. 51,(2005) : 139-152.

Margaret Dimitrova is a Professor at Sofia University “St. Kliment Ohridski”, working on Medieval and Early Modern South Slavonic manuscripts. Margaret has published on medieval Slavonic translations of biblical texts and prayers.

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.

References:

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.

References:

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.