Aspasia and Cleopatra Metrodora: Female pioneers of Medicine in the Christian Roman Empire

In this article we present selected parts of the very interesting paper “Aspasia and Cleopatra Metrodora, Two Majestic Female Physician – Surgeons in the Early Byzantine Era“, by Tsoucalas Gregory and Sgantzos Markos.

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Women in ancient Greece were confined socially, dedicated to house keeping, without having access to higher education. Although for some have been ordered an exception, and they were permitted to study philosophy and medicine, the great majority of the female population was, as educated figures, mainly doomed to oblivion. For the ancient Greeks medicine was a divine science derived from the gods, thus women and slaves were not allowed to perform it.

(…) it was the Roman emperor Julius Caesar (100 BC to 44 BC) who ordered that all women who were educated as physicians could gain citizenship and relieved them from all taxes. Women of noble origin had an easier access to education, creating a new status quo.

Women left their stigma as physicians, midwives, surgeons, druggists, herb collectors (Greek: ριζοτόμος), nurses, therapists and wet nurses for the newborns (Greek: τροφός, τιτθή). Among them stood two exceptional female figures, Aspasia (ca 4th century AD) and Cleopatra Metrodora (ca 7th century AD, or 2nd century AD), as excellent examples of influential physicians who managed to overcome the sex barrier and make important contributions on the medico-philosophical knowledge of their time.

Aspasia’s pioneering work and prolific writings influenced all major figures of the Byzantine medicine, like the eminent physician and surgeon Aetius of Amida (6th century AD, died in 575 AD), and the innovator of surgery Paul of Aegina (ca 625 AD
to 690 AD) [8-11]. Her admirable knowledge and techniques in the field or the innovative surgical procedures were thoroughly mentioned by Aetius, who considered her as a medical genius and at least equivalent to the best male surgeons of her time.

Aspasia gained fame as a midwife and gynecologist, founding the origins of the obstetrical practice, both regarding the early techniques of induced abortions and the surgical management of the early failure of pregnancy. She seems to have tried to impress her pregnant patients with the necessity of being extremely careful in order to avoid abortion (…)

(…) Even surgery, at least gynaecological surgery, may not have been impossible for a woman to practice. Aspasia discussed venesection and surgery for haemorrhoids of the uterus, external edematous tutors of the labia, and for varicose hernia of the labia. She had performed a variety of surgical operations introducing her own innovative surgical techniques.

(…) Aspasia gave an early description of a surgical excision of hemorrhoids, a method used until almost recently. Even though today this procedure is associated with significant post operative pain and long recovery, it is noteworthy that she had suggested an urgent operation for what it could be understood as a prolapsed, thrombosed, potentially ruptured hemorrhoid, a medical condition which remains until nowadays an acute indication for a patient to be operated.

Among the fragments of her saved treatises a surgical treatment for varicoceles, was mentioned. Aspasia followed a careful ligation and dissection of the vessels, one-by-one inside the local plexus (…)

(…) A second innovation introduced by Aspasia, was the operation with which she had surgically treated the cases of hydrocele (…) Aspasia’s technique resembles today’s
typical hydrocelectomy, during which the tunica vaginalis is to be excised, the fluid drained, and the edges of the tunica sutured to prevent the re-accumulation of fluids, a still much acceptable option in the modern surgery.

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Cleopatra Metrodora (Metra in Greek: μήτρα: uterus, or mother doron in Greek: δώρο: gift), was an illustrious Greek surgeon, probably of Egyptian origin, who lived around the 7th century AD (…) As an extremely capable gynecologist, midwife and surgeon, Metrodora wrote a great number of medical treatises, among which stood the “On the uterus, abdomen and kidneys”. Her masterpiece was constructed in such a way,
as to describe in details all women diseases, in a similar pattern to a modern textbook.

(…) there is a parchment manuscript of 263 pages inside the “Laurentian Library” in Florence, Italy, dated back to the 12th century. A work divided into 108 chapters, attributed to the skillful Cleopatra Metrodora. She was a highly educated woman physician, who dared to write her scientific views in order to express her freedom of thinking and stood among the best, when women’s rights were in status nascendi. All these, present evident of her major inclination towards research and ongoing love for science.

Cleopatra Metrodora, as an experienced gynecologist described a plethora of natural methods for determining the fetus’ sex. In cases of a difficult labor, she recommended for the “hysteric” pregnant to be spread with almond oil. She suggested therapies for the treatment of menorrhagia and metrorrhagia, of the hysteric shock, and advised to “apply potato porridge mixed with goose fat in a form of pessos” (pessary, something like a tampon, a small soluble block that is inserted into the vagina to treat locally an infection or as a contraceptive). She was able to determine possible sexual abuse, mastering a method on how to diagnose virginity. She defined the way to diagnose and treat female sterility by administering herbal and chemical drugs, and also provided instructions for breastfeeding and breast milk production. She had, sometimes, followed Alexander of Tralles’ treatment methods and used the herbal substances mentioned by Hippocrates (ca 460 BC to 370 BC) and Theophrastus of Eresos (ca 371 BC to 287 BC). She had used intravaginal and intraureteral rowels to cure local infections, while she was able to perform embryotomias of the dead embryos to save the pregnant. She was also considered able to cure obesity, diseases of the kidney and stomach.

Metrodora as a surgeon, she was among the few to perform cosmetic operations, such as aesthetic breast and face reconstruction, and re-suturing of the vaginal hymen to create a sense of a new virginity for the abused, or sinful “unlucky” women. In an effort to cure the most fatal of diseases, malignant ulcer, or scirrhous, or as named today cancer, she suggested surgical treatment for both the breast and the uterine cancer (…) those innovative surgical operations, were all procedures ahead of her era.

(…) Aspasia’s work presented great similarities to Soranus, having a great interest in palliative patient-centered care, while Metrodora’s was thoroughly Hippocratic in her understanding about diseases and treatment efforts, having a pioneering way
of operating.

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Research-Selection for NovoScriptorium: Anastasius Philoponus

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