The Meeting of Three Worlds

Returning to western Europe, most of Galenic medicine had been lost with the decline, from the late fourth century onward, in knowledge of the Greek language.^[267] Soranus dominated gynecology in general; his writings, perceived as shorter and more practical than those of Galen, were preserved in abridged Latin versions that reinstated the womb movement he had so vehemently rejected. Hippocratic medicine fared worse, although Aphorisms continued to circulate after its translation into Latin in the sixth century; the Ravenna translations also included some of the sections of Diseases of Women describing womb movement. Some Galenic treatises, too, were translated at Ravenna; however, whereas 129 works of Galen were translated into Arabic, only 4 existed in Latin before the eleventh century. One of these was the practical work On the Method of Healing, to Glaucon but, as has been discussed above, this can be read as a further reinstatement of the wandering womb. The third volume of Paul of Aegina's encyclopedia, which includes his largely Ga-lenic description of hysterike pnix plus details of scent therapy, was translated into Latin, but probably only in the tenth century.^[268]

The emphasis in the West lay firmly on the instructional and practical aspects of ancient medicine; thus the traditional therapies for hysterical suffocation were transmitted when discussions of its causation were not. The category of suffocation of the womb appears in several anonymous collections of texts from the eighth to the twelfth centuries. I have already mentioned Leningrad Lat. F.v.VI.3, a Latin manuscript dating from the eighth or ninth century which contains several short texts on gynecology, all of which show some resemblances to the second book of the Hippocratic Diseases of Women .^[269] Of these, De causis feminarum gives practical advice on what to do "si vulva suffocantur" (if the womb is suffocated), giving the Greek name for the condition as "styrecersis": is this a garbled form of hysterike pnix or hysterika ? The patient should be given burned and pulverized stag's horn in wine or, if she has a fever, in hot water.^[270] Another text in this collection, the De muliebria causa , claims that "uribasius"—Oribasius, the only authority named in these texts—recommends one drachma of agaric for suffocation of the womb.^[271] This is repeated in a section of the following text, the Liber de muliebria , which later gives a more complex recipe for suffocation of the womb, in which the patient is choked at the neck, so that it is turned back to the chest.^[272]

It was in the eleventh and twelfth centuries that Galenic treatises were returned to the West, through the translations from Arabic into Latin made by Constantine the African in the late eleventh century at Salerno and Monte Cassino; a few Galenic treatises were translated directly from Greek into Latin in the twelfth and thirteenth centuries, and these translations are usually of higher quality.^[273] The effect of Constantine on the history of medicine cannot, however, be overemphasized; his arrival in Italy with a cargo of books of Arabic medicine, which he translated into Latin at Monte Cassino, transformed the "theoretical impoverishment" into which medical knowledge in the West had fallen. For our purposes here, what is most significant is that his translations included Galen's commentary on the Hippocratic Aphorisms , and works of al-Majusi and Ibn al-Jazzar.^[274] Constantine translated much of the Kamil of al-Majusi as the Liber Pantegni ; this work was translated again in the early twelfth century by Stephen of Pisa as the Liber Regius and was printed in 1492 and 1523. The Kitab Zad al-Musafir of Ibn al-Jazzar was translated in an abbreviated form as the Viaticum , while Constantine's Expositio Aforismi is a translation from the Arabic of Galen's commentary on the Hippo-cratic Aphorisms .^[275]

What effect do these texts have on the hysteria tradition in the West? We have already seen the wide range of variations that can occur on the theme of womb movement. In the Hippocratic texts a dry, hot, and light womb rises in search of moisture; Soranus believes that the anchoring membranes prevent any movement, while for Aretaeus, although the womb moves it is pulled back by its membranes, thus affecting the higher parts of the body only through sympathy. In Galen the problem is a womb filled with retained seed or menses, rotting to produce coldness. In Arabic medicine a Hippocratic mobile womb becomes a mobile womb with Galenic contents, and vapors as well as sympathy explain its effects on the higher parts. In the Latin West the focus on Soranus had been combined with acceptance of womb movement; while some extracts from Hippocratic gynecology circulated, Galenic theory was lost until the eleventh century.

The return of Galenic medicine from the Arabic world led to yet another variation on this theme of womb movement and its mechanisms. It was in the twelfth century at Salerno in southern Italy that the texts of the Hippocratic corpus, Soranus, and Galen finally came together after their varied travels through the Latin West, the Greek East, and the Islamic world.^[276] The result was not a critical comparison of these traditions, but instead the decline of Soranus and the rise of the Galenic medical system of humoral balance and imbalance. One of the "masters"

of the school of Salerno in the twelfth century was Johannes Platearius. In his description of suffocation of the womb, in the late twelfth-century encyclopedia and textbook De aegritudinum curatione , he combined Galen and Paul of Aegina with Ibn al-Jazzar's claim that the symptoms were caused by vapors rising from the corrupt seed, menses, or other retained humor. However, Platearius went a step farther than this, suggesting that it was not the vapors, but the womb filled with vapors, that rose in the body to put pressure on the organs of breathing.

Green has argued that, since the Latin translations of al-Majusi's Kamil omitted the later section in which he describes scent therapy in terms of the womb as an animal annoyed by foul smells and seeking pleasant scents, this particular merger of the mobile womb with Galenic theory may come, not from Islamic medicine, but from the survival of the idea in popular thought in the West.^[277] Other features of Platearius's description are more familiar, showing the overall dominance of the Galenic material found in the newly available Arabic sources; he recommends the Galenic tests of the woolen thread at the nose of the patient, or a glass flask full of water placed on her chest, and among his suggested cures one finds sneezing provoked with castoreum or pepper, and the use of foul scents at the nose and sweet scents at the vulva. However, here too Green points out that non-Galenic ideas surface; although Galen never specifically advised marriage as a cure, Platearius recommends it if the cause is retained seed. Again, al-Majusi did explicitly prescribe sexual intercourse as a cure; but, again, this was omitted from the Latin translation of his work.^[278] It seems that the survival of Hippocratic theories—the wandering womb from Diseases of Women and the therapeutic value of intercourse from sections of that treatise and from Diseases of Young Girls —should not be underestimated.

Another writer associated with Salerno in the twelfth century is the female physician Trota, whose name is associated with a number of treatises of this period which are found in nearly a hundred manuscripts from the thirteenth to fifteenth centuries.^[279] Suffocation of the womb is mentioned in both the more empirical Ut de curis , which refers to it occurring in young girls with epilepsy, and the more theoretical and Ga-lenic Cum auctor .^[280] The Cum auctor version owes much to Ibn al-Jazzar, although it does not specify conclusively whether suffocation results from vapors, or the womb itself, rising up inside the body. Scent therapy is recommended, and the story of the woman who lay as if dead but was known to be alive through the presence of the innate heat, is transmitted through the Cum auctor ; as in Ibn al-Jazzar, Galen becomes its hero.^[281]

The influence of Galenic theory grew with the translation of other

important Arabic texts into Latin; in particular, Ibn Sina's Qanun . The work of Soranus became "virtually obsolete by the thirteenth century";^[282] the gynecological works of the Hippocratic corpus languished in the wings until the sixteenth century. However, one Hippocratic text remained in the center stage: the Aphorisms , including the section on gy-necology with the text with which this chapter began, the alleged origin for the label/diagnosis hysteria , 5.35: "In a woman suffering from hysterika , or having a difficult labor, a sneeze is a good thing."

Aphorisms circulated in both the Latin West and the Arabic world; in the latter, from before A.D . 800, it was coupled with the commentary of Galen, In Hippocratis Aphorismi . This commentary, probably written in A.D . 175, was restored to the West when Constantinus Africanus translated it from Arabic into Latin in the eleventh century. In terms of its printed editions in the Renaissance, it was the third most popular Ga-lenic treatise after Ars medica and De differentiis febrium .^[283] The central position of the Aphorisms from the eleventh century onward results not only from its perennial popularity as a series of practical tips,^[284] but also from its inclusion in the Articella , a group of medical writings "used for centuries at Salerno and elsewhere as a textbook for introductory courses in medicine."^[285] The central text of the group is Hunain ibn Ishaq's Isagoge , in Constantine's translation from the Arabic; in addition to the Aphorisms , the nucleus also contains Galen's Tegni (the Ars parva ), the Hippocratic Prognostics , Theophilus on urines, and Philaretus on pulses.

I have argued that the opening words of Aphorisms 5.35 can best be translated "In a woman suffering from hysterika ," where hysterika means disorders of the womb. But this translation depends on reading the text without the Galenic commentary that instead pushes for a very specific translation, hysterike pnix . By looking at changes in the Latin translation of this aphorism, it is possible not only to trace its gradual incorporation into the hysteria tradition, but also to provide a test case for the period in which the humanists began to carry out philological work on the Galenic and Hippocratic texts. When were these texts read as the object of serious study? It is the brief Aphorisms , not the lengthy Galenic commentary, which occupied a central place in the medical curricula of the Renaissance. Despite its impressive printing history, I would argue that Galen's commentary was little read before the sixteenth century.

The earliest Latin translations of Aphorisms , found in manuscripts dating from the eighth to the twelfth centuries A.D ., can be traced back to fifth/sixth-century Ravenna.^[286] Such Latin translations are very literal, the writers apparently having an equally weak grasp of both Greek and

medicine. The translation reads "Mulieri de matrice laboranti aut diffi-culter generanti, sternutatio superveniens, optimum" (In a woman troubled by the womb or giving birth with difficulty, a sneeze coming on unexpectedly is best).^[287] At this period, then, the aphorism was not associated with hysteria or suffocation of the womb.

The Articella uses a different Latin translation of the Aphorisms , possibly produced in the eleventh century, and linked to the name of Con-stantinus Africanus. It is not known whether this was made from a Greek manuscript of Aphorisms , or by merely extracting the aphorisms from a copy of Galen's commentary. Whatever its source, it gives for 5.35, "Mulieri que a matrice molestat aut difficulter generanti: ster-nutatio superveniens bonum." It thus differs little from the Ravenna translation; a sneeze becomes "good" instead of "the best thing," and the womb continues to "distress" or "trouble" the woman. Fifteenth-century printed editions of the Articella retain slight variations on this translation, which remains the most commonly used well into the sixteenth century.^[288] Some editions give two translations, setting this so-called versio antiqua beside the traductio nova of Theodorus Gaza. The new translation runs, "Mulieri quam vitia uteri infestant, aut que diffi-culter parit, si sternutamentum supervenit, bono est." The opening words, "In a woman in whom disorders attack the womb," again keep this aphorism within a very general gynecological context. Another variation in printed editions of the Articella is to print both translations together with a rearrangement of the Aphorisms by the part of the body discussed, on a capite ad calcem lines; thus the edition of 1519 gives this aphorism under "Concerning sneezing" and "Concerning the female generative organs."^[289]

A further development in the printed versions of the Articella is that, where the manuscript versions gave only the Hippocratic text of the Aphorisms , the printed editions from 1476 give Galen's commentary beside it. Galen is thus "given a privileged status compared with other commentators."^[290] However, an important question remains: Did anyone read the lengthy commentary, which sets it firmly in the context of hysterike pnix , as opposed to uterine disorders in general? Galen considers that apnoia , or absence of breath, is more accurate than "suffocation," seeing a spontaneous sneeze both as a "sign" (semeion ) that the patient has revived, and as a "cause" (aition ) of recovery, since in itself it revives the patient.^[291] However, despite Galen's conclusion that hysterika is equivalent to hysterike pnix , the connection with the translation of the Hippo-cratic aphorism is not made. Neither the terminology of suffocation nor that of hysteria appears in the Latin of the Aphorisms ; instead, the woman

is said to be "troubled by the womb" or to have "disorders attack the womb." Reading the long discussion of the meaning of hysterika in Galen's commentary should lead to a change in the translation of the aphorism, away from this general terminology and toward that of hysterical suffocation, but no such change is made at this time.

It is in the fifteenth century that the first signs of close study of Galen's commentary and its implications for the translation of the aphorism appear, in the work of Ugo Benzi (1376-1439). Benzi wrote commentaries on the Canon of Avicenna, the Tegni of Galen, and the Hippocratic Aphorisms , omitting books 3 and 7; this last was probably first published in 1413 or 1414 while he was lecturing on medicine in Parma, but it was later revised. Like his contemporaries, of course, he still based his translations not on the Greek, but on "the medieval Latin versions from the Arabic." Although he follows the versio antiqua translation, he improves the Latin, discusses the views of Galen and Avicenna on uterine suffocation—in particular, on whether it is the womb or merely vapors that rise up the body—and also glosses the aphorism as follows: "Sternutatio superveniens mulieri suffocationem matricis patienti aut difficulter pari-enti est bonum" (A sneeze spontaneously occurring in a woman suffering from suffocation of the womb or a difficult labor is a good thing).^[292]

The translation of Theodorus Gaza is used by Lorenzo Laurenziani (ca. 1450-1502),^[293] while Niccolò Leoniceno (1428-1524) gives both this and the verso antiqua beside his own translation, which begins with another variation on the theme of general uterine disorders, "Mulieri qua uterinis molestant."^[294]

The connection between text and commentary is made conclusively only in the 1540s, when the Aphorisms are first the object of detailed philological interest. The availability of printed Greek and Latin editions of the Galenic and Hippocratic works from the 1520s onward had no immediate impact but, after twenty years, comparison of the text both with the Greek manuscripts of Aphorisms and with Galen's commentaries is made, and the aphorism becomes explicitly "hysterical."

Antonio Brasavola's annotated edition of the Aphorisms and its Ga-lenic commentary was printed in 1541 at Basel. It discusses not only Galen's commentary but also the use of hysterika in Marcellus's commentary on Dioscorides, Philotheus, and Paul of Aegina. Brasavola (1500-1555) reasserts the identity of hysterika as hysterikg pnix , but still he does not take the step of adjusting the translation of Aphorisms 5.35, instead giving a variation on Leoniceno's translation, which reads: "Mulieri, quae uterinis molestatur, aut difficulter parit, superveniens sternutatio, bonum."^[295]

The earliest translation I have found in which the terminology of the suffocation of the womb is directly applied to Aphorisms 5.35 is that of Leonhart Fuchs (1501-1566). Printed in 1545, this gives "Mulieri quae ab uteri strangulationibus infestatur, aut quae difficulter partum edit, sternutamentum superveniens, bonum." Here, for the first time, the translation itself becomes "hysterical"; "in a woman who is attacked by uterine suffocation," a translation justified by Fuchs on the grounds that Galen and Philotheus explain that hysterika equals suffocation here. He goes on to demonstrate that the basis of his translation is the comparison of Greek manuscripts, discussing whether a word in Galen's text should read lunga or pniga .^[296]

The edition of Guillaume Plancy (1514-ca. 1568) takes the process a stage further. In this publication of 1552 the Latin reads "Mulieri hys-tericae, aut difficulter parienti, sternutamentum superveniens, bonum." A note justifies the translation by a reference to Galen's On the Affected Parts 6.5.^[297] The connection has been made, not only between aphorism and commentary, but between the Galen of the commentary and the Galen of On the Affected Parts .

Once the aphorism has reentered the hysteria tradition, it is—with a few exceptions—there to stay. Claude Champier (fl. 1556) also mentions "vulvae strangulatus," while Jacques Houllier (ca. 1510-1562) follows Plancy's translation.^[298] In keeping with his general interest in a return to the Greek classics in order to end error in medicine, Houllier also recalls Hippocratic ideas, giving a further type of suffocation due to a dry womb seeking moisture, for which a sneeze is less beneficial than baths.^[299]

Thus, once the aphorism is read—rather than merely printed—in the context of Galen's commentary, it ceases to be understood as a reference to disorders of the womb in general, and comes to be absorbed into the hysteria tradition, that set of connected texts repeated by successive commentators on suffocation of the womb.

Glancing at its fortunes in vernacular editions, the English translation of the Aphorisms of 1610 by "S. H." gives "Sneezing hapning to a woman grieved with suffocation of the wombe, or having a painfull and difficult deliverance is good."^[300] This is also found in a seventeenth-century manuscript in the British Library, Sloane 2811.^[301] A commonplace book of the seventeenth century includes a Latin translation of the Aphorisms , giving "Mulieri hysterica, aut difficulter parienti sternutamentium su-perveniens bonum"—a variant of Plancy—and an English translation, reading "Sneezing happening to a woman seized with suffocation of the womb: or that hath a difficult deliverance: is good."^[302] The comment on

this aphorism is that sneezing shakes off noxious humors and restores the natural heat that was almost extinguished. In the same book appears a work entitled "Select Aphorisms concerning the operation of medica-ments according to the place." This contains a section (pp. 121^v -122^r ) on "Hystericalls" which describes how the womb is drawn to aromatics and repelled by their contraries. It discusses how this mechanism works, and roundly rejects the belief of "some sotts" that the womb possesses "the sense of smelling." Even in the seventeenth century scent therapy is defended, but this does not mean that the womb is regarded as an animal.

If the old discussion of the implications of scent therapy for the status of the womb as, in the words of Aretaeus, "a living thing inside another living thing" is still itself alive and well in the seventeenth century, has the hysteria tradition made any progress over the two thousand or so years of its existence? I would argue that some change has, by this time, occurred. The tendency before the sixteenth century was toward an accumulation of descriptions, explanations, and remedies. Some features—such as scent therapy at both ends of the body, the use of an extinguished lamp wick to rouse a patient, and the application of aromatic oils to the sexual organs—went back to Hippocratic medicine, as transmitted by Galen. Others, although derived from the Hippocratics, were transformed by Galen's reinterpretation; for example, Hippocratic pnix concerns a hot womb seeking moisture to douse its fire, yet after Galen it becomes "obstruction of respiration," and the womb is seen as being filled with cold and corrupt substances rather than being hot and light. Other features remained in the tradition despite all that could be said to condemn them, most notably, the wandering womb, in coexistence with apparently contradictory features such as anchoring membranes.