Sex and gender: the Hippocratic case of Phaethousa and her beard

DOI : 10.54563/eugesta.957

Résumé

The paper investigates the implications, for a ‘one-sex’ model of the body, of the Hippocratic case history in which a woman ceases to menstruate and then grows a beard after her husband leaves. This story challenges a model of sexual difference based solely on the gonads, drawing attention to other visible or audible markers, and to the hierarchical relationships between them. The long history of reception of this story, telling it in a variety of contexts ranging from ‘sex change’ stories to lovesickness to accounts of prolapse, and setting it beside other stories from outside the ancient medical tradition, shows both its flexibility and the importance of having a Hippocratic seal of authority. Two gendered Greek terms in the story, οἰκουρός (oikouros) and ἐπίτοκος (epitokos), emphasise Phaethousa’s femininity and demonstrate that, far from being intermediate between two sexes, she remains female throughout her illness.

Plan

Texte

In thinking about the categories of sex and gender in the ancient world, a story I find particularly “bonne à penser”, in the classic phrasing of Claude Lévi-Strauss, is the Hippocratic case of Phaethousa, who grows a beard after ceasing to menstruate when her husband leaves1. This appears as the final section in the sixth book of the seven-volume collection of case histories, Epidemics, and probably dates to the mid-fourth century BC (Epidemics 6.8.32). After publishing a preliminary investigation set within the context of ancient Greek and Roman ideas about the gendering of the beard, I have examined this story – its genre, its content and its extensive reception – at length in my book The One-Sex Body on Trial: The Ancient and Early Modern Evidence, where my focus was on reading it alongside the story of Agnodice, “the first midwife”, and where I used both sources to challenge Thomas Laqueur’s much-repeated argument for a historical shift from a “one-sex” to a “two-sex” model of the body2.

Laqueur argued that it was sex, rather than gender, that was socially constructed, and that the need to see men and women as different in terms of their “political, economic, and cultural lives” – something he dates to the eighteenth century – meant that biological hooks were needed on which to hang such claims3. In this period, he claims, the focus shifted from seeing men and women as sharing sexual organs, located externally or internally according to the “heat” of the individual, to regarding them as being completely different. No longer could there be a straightforward list of analogies between penis and vagina, testicle and ovary, scrotum and womb, and so on. While I find his dating unconvincing, and the model of a simple watershed or, as Laqueur calls it, an “interpretive chasm”4, far too simple, like many other scholars I agree that any distinction between “sex” as biological, “gender” as cultural is unhelpful. Culture clearly affects what counts as biology, and there can be no biology without culture. Our experience of our bodies both generates, and is mediated through, the categories of biology/science.

One of the problems identified with Laqueur’s model is that it focuses on the genital organs yet, historically, these have not been the only ways of deciding on an individual’s sex. Certainly, in the modern period, sexual identities could be tied to the tissues of the gonads – the testes and ovaries – with sex determined post-mortem by discovering such tissue; indeed, Alice Domurat Dreger labelled the second half of the nineteenth century “the age of gonads”5. The gonads are not visible without cutting into the body, and a feature of the modern period was that, due to different ways of accessing the body, decisions about allocating individuals to one or other sex no longer needed to be based exclusively on what is visible. This meant that an even wider range of parts of the body could be regarded as indicators of sex; for example, blood. While debates about whether menstrual blood was “real blood” or not went back to the Renaissance, the development of different ways of testing the blood from the nineteenth century onward led to the establishment of quantitative differences between the blood of men and that of women6. Some were interpreted as evidence for women’s inferiority and, by the 1920s, aspects of women’s blood were being used to support their different role in society at that time. In England, the 1923 Report of the Board of Education used the lower haemoglobin level in the blood of girls as an argument against equality of access to education; in fact this is a biological difference between the sexes, women having 14 % less haemoglobin than men. Women also have less calcium in their blood than men – a 10-15 % lower level – but men’s level was defined as “normal”, and women’s as “deficient”, and it was thought that this explained why women were more “excitable” than men7. So here there are “biological facts” about sex difference, but they cannot remain neutral; instead, the biological differences are read through the prism of cultural assumptions about what men and women should be doing. This again demonstrates that the relationship between male sex and “masculinity”, and female sex and “femininity”, is never a straightforward one8. However, as far as I know, being found to have a low haemoglobin level and a low calcium level never led to a “man” being redefined as a “woman”.

For most of western history, however, decisions about sex were made on the basis of visible features, and these were not exclusively genital. Instead, they were parts that could be manipulated, disguised or enhanced by the individual – for example, through clothing or cosmetics – in ways that blood and gonads could not. A question asked in the classical and early modern worlds concerned whether an individual could change sex spontaneously. In the early modern period, the story of Phaethousa was used to argue both that women could become men (a “one-sex” position, in which the “same” organs changed their location) and that they could not (a more “two-sex” approach, focused on the differences between sexed bodies). Her beard could be read as a sign of such a change occurring, but while some of the other features of her story could be read as supporting this, others were seen as pointing in a different direction. A further complication was that an apparent sex change could be seen not as “change”, but as a revelation of the previously-hidden “true sex”. Phaethousa also raises the question of how society classifies those people whose organs do not convey a single clear message, and the possibility of a person who has the organs associated with one sex choosing to adopt a gendered identity associated with the other sex. In all such discussions, part of Phaethousa’s appeal lay in her origin in a Hippocratic case history; unlike such figures as the mythical seer Teiresias, who was both male and female although in succession, this meant that she appeared to her readers as “science”9.

In this paper, I am focusing on Phaethousa because looking at a single story and its changing interpretations over the course of early modern and modern medical history enables us to see far more clearly the cultural moves by which sex or gender are constructed, and I shall be approaching this story primarily through its reception. It was read and discussed across Europe before, during and after the period in which, according to Laqueur’s model, the “one-sex” body was supposed to dominate. Later interpretations of Phaethousa and her beard illustrate clearly the very different ways in which the story could be read, according to the expectations of its readers. In the words of Julia Haig Gaisser, the classical texts “are pliable and sticky artifacts gripped, molded, and stamped with new meanings by every generation of readers, and they come to us irreversibly altered by their experience”10. Over her long history of being discussed, Phaethousa offers us opportunities to study the shifting location of sex; firstly, through considering what makes “a woman”, and secondly, by analysing her story’s contribution to the question of whether sex can change. However, as I shall argue in the final section of this paper, the later interpretations do not address all the gendered implications of the specific language applied to Phaethousa; in particular, her description by the Hippocratic writer as οἰκουρός and ἐπίτοκος. Thus, in the pattern familiar from classical reception theory, studying the receptions sends us back to the source text with our agenda refreshed.

Phaethousa: the Hippocratic story

Here is the story of Phaethousa, as it appears in modern texts of the Hippocratic Epidemics. It mentions a range of body parts and, as I shall show shortly, some of its readers have found even more markers of sex in it than I think can be supported by the Greek text:

In Abdera, Phaethousa the wife of Pytheas, who kept at home (οἰκουρός), having borne children in the preceding time (ἐπίτοκος ἐοῦσα τοῦ ἔμπροσθεν χρόνου), when her husband was exiled11 stopped menstruating for a long time. Afterwards pains and reddening in the joints. When that happened her body was masculinized (τό τε σῶμα ἠνδρώθη) and grew hairy all over, she grew a beard, her voice became harsh, and though we did everything we could to bring forth menses (τὰ γυναικεῖα) they did not come, but she died after surviving (βιώσασα) a short time. The same thing happened to Nanno, Gorgippus’ wife, in Thasos. All the physicians I met thought that there was one hope of feminizing her, if normal menstruation (τὰ κατὰ φύσιν) occurred. But in her case (ταύτῃ), too, it was not possible, though we did everything, but she died quickly (Epidemics 6.8.32)12.

Even at the end of this story, the feminine forms βιώσασα and ταύτῃ clarify that Phaethousa and Nanno are still considered to be women; so, significantly in terms of how its subsequent readers have read this, in its original form this was not a sex change story, but instead an account of the illness and death of two patients.

The appearance of this story in the Hippocratic corpus raises a number of assumptions about its status, and it is perhaps not as “first-hand” as a cursory reading would suggest. In contrast to many other case histories from the Epidemics, there is nothing in the text to indicate the experience of the writer as an individual; no first-person singular wording, no verbs suggesting sensory contact with the patient, and no reporting of the patient’s words, at least directly. Instead, there is one first-person plural reference: “we did everything to bring forth menses”. The “we” in turn picks up what is an unusual reference to “all the other physicians I met/talked to”13; it seemed to them that the only hope of restoring a woman’s identity as a gynê, a wife/woman (the Greek word means both), is to restore normal menstruation. While this could suggest a number of physi-cians at the bedside, it is also possible that the story was an exceptional one that was widely discussed; perhaps Phaethousa and Nanno had been seen by different physicians, with the writer himself having seen neither woman. The inclusion of both women suggests that, although exceptional, this situation could arise again and any physician should be prepared for it.

Hermaphrodites and prolapse

While in this story Phaethousa and Nanno clearly remain women, despite beards, deep voices and plentiful body hair, in later readings these masculine features could lead to Phaethousa being regarded as a man, as someone on the way to becoming a man, or as someone between the categories of “man” and “woman”. Some of the subsequent users of her story suggested that she had even more indicators of masculinity than these: taking up the comment that “her body was masculinised”, they read this to suggest that a penis emerged from inside her body. This is not necessarily the correct interpretation; the sixteenth-century medical humanist Hieronymus Mercurialis, a brilliant and shrewd reader of ancient medical texts who held chairs of medicine at Padua, Bologna and Pisa, linked the verb employed here to other examples of its use in the Hippocratic treatise On Joints, and concluded that it meant only that her body became stronger and more mature14. I myself would read “her body was masculinised” alongside the comments on the gendered texture of flesh in another Hippocratic passage, the opening section of Diseases of Women (1.1), to imply a change in the overall texture of Phaethousa’s body, from wet and spongy (= female) to firm and dry (= male)15. But even if we took this phrase to mean the appearance late in life of something that looks like a penis, would this make Phaethousa a man, or a hermaphrodite?

Historically, medicine has tried to categorise hermaphrodites out of existence16. In 1839, James Young Simpson – who wrote a long entry on “Hermaphroditism” for The Cyclopaedia of Anatomy and Physiology – argued that true hermaphrodites were very rare, many so-called hermaphrodites really being women, with the confusion arising from the presence of an enlarged clitoris or a prolapsed womb17. While he regarded these features as accounting for apparent hermaphrodites in general, earlier medical writers had specifically named Phaethousa and Nanno in discussions of this kind. Sixteenth- and seventeenth-century writers, also resisting the possibility of true hermaphrodites, had explicitly attributed Phaethousa’s condition to prolapse; for example, Jacques Ferrand quoted the sixteenth-century medical writer Luis Mercado, who regarded the condition of Phaethousa and Nanno as due to “the protrusion or descent of the matrix [i.e. the womb] that bore a certain resemblance to the male member” 18. Despite appearances, then, medical authors denied that Phaethousa was a true hermaphrodite.

In the surgeon Jacques Guillemeau’s Child-Birth or, the Happy Deliverie of Woman, published in 1609 in French and 1612 in English, the chapter on prolapse appeared in the section on what can happen after childbirth, which suggests that an early modern reader would also think about Phaethousa’s previous confinements here; the text describes her as “having borne children in the preceding time”. This could be seen as putting her at greater risk of this condition. When Guillemeau listed the “internal causes” of prolapse in general, he included the desire of a woman to have sex, long-standing menstrual suppression, and having intercourse too soon after childbirth, while the lochia were still flowing 19. At least the first two of these could have been imagined to apply to Phaethousa. Some commentators in this period saw her as overwhelmed with desire for her absent husband; Jacques Ferrand, for example, proposed that the cause of the transformation was “passionate love” because she “loved her husband dearly, but was not able to enjoy him due to his long absence” 20. In the original Hippocratic text, she was the victim of menstrual suppression causing blood to be diverted from the womb to other parts of her body. This condition too could be seen as causing prolapse. For example, in Guillemeau’s Child-Birth, the relevant explanation was “...the long suppression of the naturall courses, which sometimes makes a woman grow Viril, or mankind [sic], as Hippocrates witnesses of Phaëtusa, wife of Pitheus, who became like a man, with a beard, and a man’s voice”21. Becoming “like a man” is not, however, the same as becoming a man, and here Guillemeau is denying that any real sex change occurred. For these early modern readers, Phaethousa may have experienced a prolapse, which could be misunderstood as the emergence of a male organ.

Alternative classical settings

While medical writers in the early modern period looking for explanations for what happened to Phaethousa found support for their proposed diagnoses in other aspects of the story, such as her previous childbearing or her desire for her absent husband, there were other contexts available to them in which to read Phaethousa. Another approach would align her with ancient sex change stories, especially those from the first century BC writer Diodorus Siculus22. These involve the unexpected emergence of what are identified not as enlarged clitorides or prolapsed wombs, but very explicitly as male organs. The book in which these stories featured is now lost, but sections – including these stories – survive in the Bibliotheca of Photius, the ninth-century patriarch of Constantinople. The Bibliotheca was probably composed in 845 AD, and summarises the 279 books Photius had read23. These stories survive today because of Photius’ love of accounts of marvels, provided that he thought they were true; he had what Treadgold characterises as a “substantial, and practically professional” knowledge of medicine, and his reading included the medical works of, among others, Dioscorides, Galen, Alexander of Tralles, Paul of Aegina and Oribasius24. Photius regarded stories of “men born with the physical characteristics of women” as “trustworthy”; his wording here suggests that he saw this not as real change, but rather the emergence of the male “true sex” later in life25. In addition to reading all of Diodorus Siculus, Photius was familiar with the Book of Marvels of Phlegon of Tralles, an older contemporary of Galen26. This included further stories of hermaphrodites and sex change. Here, some were clearly flagged as myth (for example, Teiresias and Kainis), but others were presented as reality, supported by precise dating based on the names of the magistrates of the year: the Athenian archon or the Roman consuls. Similar “real” stories from Pliny the Elder’s Natural History were known to the Renaissance medical writers and were often set alongside that of Phaethousa.

The nature of the text means that there must be some doubt as to whether the ancient sex change stories we now have are simple summaries of Diodorus, or have subsequently been altered by Photius, based on his other reading. We cannot be certain that either man knew the Hippocratic writings but there are some interesting connections which suggest to me that Phaethousa had been read by at least one of them, and thus may have had an input into the mythical tradition. Diodorus gives the story of Heraïs; she had been married to “a man named Samiades27. He, after living in wedlock with his wife for the space of a year, went off on a long journey”. The absent husband is, as we have seen, also a feature of Phaethousa’s story, although if we assume that her children were by Pytheas, then she had been married for a longer time than Heraïs. A tumour appeared at the base of Heraïs’ abdomen, and the area continued to swell, with high fevers occurring. This is an interesting feature, as it suggests that her body was “hotter” than normal for a woman, thus further assimilating her to the male, and recalling the reddening of Phaethousa’s joints. For Phaethousa this is described as a painful transition; pain is also a significant feature of one of Phlegon’s stories, one identified as real rather than mythical and dated to 45 AD, which concerns a young unmarried girl aged thirteen. She had severe pain as she was about to leave the house for her wedding, and remained in pain for three days, the doctors being unable to find out what was causing this. On the fourth day her pains became stronger and suddenly “male parts” burst out “and the girl became a man”28.

In the case of Heraïs, her physicians thought that this condition could be an ulcer at the mouth of the womb, and applied remedies to reduce the inflammation. However, “on the seventh day, the surface of the tumour burst, and projecting from her groin there appeared a male genital organ with testicles attached”. In contrast to Phlegon on the thirteen-year-old girl, or Pliny who insisted in his Natural History that he himself had in Africa seen a woman who became a man on the day of her marriage29, Diodorus distances himself from this story – “it is said”; “a strange and altogether incredible infirmity” – and the story itself contains distancing devices; when the maleness bursts out of Heraïs’s body, this event happens when only “her mother and two maidservants” are present, not the physicians who are treating her. When her husband returns, she refuses to have sexual intercourse with him and he takes the matter to court. At the point where the court decides in favour of her husband, Heraïs is forced to reveal her bodily condition: “Screwing up her courage she unloosened the dress that disguised her, displayed her masculinity to them all, and burst out in bitter protest that anyone should require her as a man to cohabit with a man”. Finally, her new sex is accepted, and she joins the cavalry.

While there are interesting parallels between the stories of Phaethousa and Heraïs, and indeed with some other “sex change” stories, this does not mean that we should read Phaethousa in these terms. Hieronymus Mercurialis is again helpful here as a reader of ancient Greek texts. Despite the stories of such events in Diodorus Siculus, Phlegon and Pliny, he consistently denied that sex change was possible. In 1588, discussing Phaethousa, he stated that “nobody of sound mind would have said that these women truly become men”30 and in his 1597 Pisae Praelectiones he stated that sex change is “nonsense”31 and insisted that Hippocrates did not say that a woman could become a man, only that she could take on the “form” of a man32. Even in the sixteenth century, alongside readings that assimilated Phaethousa to sex change stories, Mercurialis resisted these as misleading.

The hierarchy of bodily signs

So which signs should we take as significant in deciding on sex? In the story of Heraïs, there is a clear change from female to male, and the decisive organs are the genitalia. While, as we have seen, stories like this could lead later writers to find a penis in Phaethousa’s story too, what features as the most striking aspect of Phaethousa’s condition is not the external genitalia, but the beard. It is the most obviously accessible sign that something is wrong, in contrast to the external genitalia, which Heraïs only reveals when there are no other options remaining to her. In his discussions of various cases of supposed hermaphrodites, Simpson regarded a whole range of organs as relevant to determining sex; in addition to testicles and ovaries, he considered the clitoris, uterus, penis, urethra and bladder. But he ranked the beard as an important physical sign, even though for him (in the early days of the “age of gonads”) the ovaries were most significant of all; if a beard was accompanied by even one ovary, then he believed the patient must be female33. Not only the body, but also the behaviour, would be taken as evidence; this included features which we would see as concerning “gender” more than “sex”, such as the individual’s “character and appearance”. However, again, in the nineteenth century they would be trumped by an ovary.

Simpson was an antiquarian as well as a physician. For the various historical cases his researches unearthed, there was of course no longer the possibility of an autopsy to search for that hidden, and decisive, ovary. In discussing such cases, one factor that he regarded as particularly significant was menstruation, as a clue to a concealed uterus, but even this was not always seen as definitive; the beard, too, played an important role. Indeed, when he judged the true sex of Maria Nonzia, born in 1694 and twice married as a woman, the statement made about her in the records that “the visage was bearded” carried more weight for him than the comment that “the mammae were as fully developed as in the adult woman”, or even than the alleged presence of the menses. In this case he dismissed the reports of menstruation entirely, asserting that Maria only claimed that she menstruated, because she “was necessarily greatly interested in maintaining the reputed female character”34. While for a contemporary case menstruation could be witnessed, this was not possible with a historical case.

The case of Maria Arsano of Naples, who lived as a woman until her death at the age of 80 in the 1830s or 1840s, is very different35. Here, autopsy had been possible and, while all external organs had appeared female, after death she was revealed to be entirely male inside. She there-fore did not menstruate, but nevertheless she married; and, Simpson noted, “from being constantly employed in domestic occupation, the mental character was feminine”36. This suggests a mismatch between organs and “character”, with feminine behaviour not being a reliable guide to sex; gender and sex certainly did not coincide neatly here. In assigning sex, Simpson also placed little weight on the sexual desires of the individual, unless these happened to conform to his view of the balance of the organs; so Marie Madeline Lefort, exhibited in Paris in 1814 at the age of 16, “considered herself a female, and preferred the society of men”, but more important for Simpson were the facts that she had menstruated from the age of eight, and that she had no testicles. These points “can leave no doubt as to the nature of her sex”37.

What do Simpson’s discussions of past cases say to that of Phaethousa? She evidently considered herself a woman; she menstruated, she married, she gave birth. Her breasts do not feature in the story; this is an interesting omission. In the Hippocratic text, the cause of her condition is menstrual suppression; in contrast to Maria Nonzia, her previous menstruation could not be dismissed as a mere claim, because she had in fact given birth, which would not be possible in ancient medical understandings of generation unless there was enough menstrual blood present to form the child38. While some early modern writers had regarded her as a case of sex change39, for Simpson Phaethousa was not someone who became a man, nor a hermaphrodite, nor a normal woman, but something else: a “virago”. He noted that

Women, both young and aged, with this tendency to the male character, are repeatedly alluded to by the Roman authors under the name of viragines, and Hippocrates has left us the description of two well-marked instances40.

Simpson regarded the virago as a woman past child-bearing, whose ovaries were no longer functioning, so that the body became more masculine; he added that “frequently the mind exhibits a more determined and masculine cast”41. But there is nothing in the Greek text to suggest that Phaethousa is at menopause. In this volume of the Epidemics, the physician is specifically reminded to consider what is appropriate to the patient’s age: “Of an age with one’s age, or earlier or later than is proper for the age... Or earlier or later than appropriate”. Among the items to consider are “excess or defective growth of hair, thickness, toughness, diminution”42. In this context, Phaethousa’s absence of menstruation is evidently seen as inappropriate to her age, as is her growth of facial and body hair.

Discussing Simpson’s essay, a contributor to the Boston Medical and Surgical Journal in 1859 explicitly linked the virago to contemporary campaigners for women’s rights, stating that

these viragines, as the Romans styled them, with hair on the face, harsh tones and coarse expressions, graceless forms, and love for the dress and pursuits of man, are seen in modern times attempting to carry out various unpopular reformatory movements43.

On both sides of the Atlantic, this was a period in which unease about women’s rights existed alongside a complementary fascination with the “bearded lady”. For example, one such individual, Julia Pastrana, was first exhibited in London in 1857; as Rebecca Stern has shown, she was also embalmed and displayed after her death, allowing audiences to gaze at her without any of the potential embarrassment felt at being in her living presence44. Stern has listed the many parallels between Pastrana and the character Marian Halcombe in Wilkie Collins’ Woman in White, which was serialised in 1859-60. For example, we are told that Halcombe’s “complexion was almost swarthy, and the dark down on her upper lip was almost a moustache”, and that while she had a “perfectly shaped figure” the viewer is “almost repelled by the masculine form and masculine look of the features in which the perfectly shaped figure ended”45.

“Bearded ladies” – and even the terminology of “ladies” rather than “women” suggests this – were often displayed in circuses, freak shows and on cartes-de-visite very much as normative women, elegantly dressed, sometimes with a low neckline drawing attention to the bust, and were seen doing needlework or engaged in other feminine occupations, or even presented with their children46. Their dignity and their other signifiers of femininity provided an even more striking contrast with their beards. Sometimes they were shown in wedding dresses, a move that recalls ancient and Renaissance stories of the wedding day as the time when a sex change often happened47. In this tradition, in Figure 1, Delina Rossa is seated next to a flower arrangement, her lace neckline and necklace drawing attention to her bust.
 

Figure 1: Delina Rossa

Figure 1: Delina Rossa

http://www.sideshowworld.com/81-SSPAlbumcover/Beard/BL-35.jpg

 

Yet outside this emotionally-charged nineteenth-century context, Phaethousa, far from being some physically repulsive proto-feminist, was an ordinary wife who “kept at home” and had children. To concentrate exclusively on her beard, or even to label her as a “bearded lady”, unhelpfully brings in a set of assumptions that had no place in ancient Greece. The Boston Medical and Surgical Journal contributor went on to assert that

it is ordinarily not the faithful mother and loving wife, but the childless and the lonely, who thus willingly or necessarily unsex themselves; it seems to be a question between the fruitful vine and the barren tree48.

In this dichotomy, in the Hippocratic Epidemics Phaethousa is most definitely presented as the “fruitful vine”, and it is this side of her that I will discuss in the next section.

Phaethousa as woman

Phaethousa is characterised by two gendered terms which, as I suggested in the introduction to this paper, have not yet been given the attention they merit: οἰκουρός and ἐπίτοκος. While the first of these words could simply mean that she kept watch over the house, and so could be translated as “the housekeeper”, I think that we should take it in a rather different sense; as further evidence of the entirely unexpected nature of what happens to her, and thus of her previously impeccable femininity49. Wesley Smith translates as “who kept at home”, while Brooke Holmes prefers “who kept to the house”50. Phaethousa is thus what I would translate as “a good stay-at-home wife” before her husband leaves and her beard grows.

The word connects her once again to Diodorus’ Heraïs who, at least after her transformation, “continued to conduct herself as οἰκουρός and as one subject to a husband”. In the 1814 translation by George Booth, s/he “managed the affairs of the house as usual” while for the 1933 Loeb Francis R. Walton translated as “conduct herself as a homebody”51. A man beneath her clothes, Heraïs not only continues to dress as a woman, but to act like a normal woman; in fact, perhaps, to over-act. Is she adopting the οἰκουρός model in order to make her behaviour seem more “womanly” and thus to draw attention away from the terrible secret which her clothing conceals? If this interpretation is correct, then the Hippocratic writer is drawing attention to Phaethousa’s extremely feminine behaviour before her problems began – and thus warning his readers that this can happen to even the most womanly of women. While Heraïs is posing as “a good stay-at-home wife”, Phaethousa is the real thing.

Phaethousa’s femininity is also underlined by the choice of words used to describe her menstruation, a powerful marker of being a woman. It is noteworthy that in this passage her menstruation is described not with the most common term of “monthlies”, τά καταμήνια, which would put the focus on regularity, but as τὰ γυναικεῖα – “women’s things” – and later as τὰ κατὰ φύσιν, the “natural things”52. In the Hippocratic treatises, menstruation results both from women’s softer and more absorbent flesh, which soaks up more fluid from their diet, but also from their lack of activity, which prevents this fluid being used up53. This is part of a wider opposition between men as mobile, active, and functioning outside the oikos: and women as immobile, passive, properly placed inside the oikos54. Because menstruation allows women to restore their balance of fluids, even though their spongy flesh made them unable to maintain that balance for very long, it identifies a woman as a woman.

This brings me to what I see as another key term in the story: ἐπίτοκος. The phrase in which this appears is today normally taken to mean simply that she had previously given birth. For example, in the most commonly available English version of Phaethousa’s case story, that of Wesley Smith, the phrase is translated as “having borne children in the preceding time”. This echoes the mid-nineteenth century French translation of Emile Littré, “avait eu des enfants auparavant”55. But, as I have argued elsewhere, the Greek ἐπίτοκος is stronger than simply “having children”56. One piece of evidence for this comes from a section of Galen’s commentary on Epidemics 6 which today survives only in Arabic, and in which he describes Phaethousa not as Everywoman, but as an example of the “woman who bears many children” who “gives birth continually”. For such a woman, her health could become entirely dependent on this pattern of regularly giving birth. For Galen, Phaethousa is evidence that “when women lose their husbands, this causes them to suffer great damage, especially when they used to get pregnant before”57. When prevented from following her normal pattern, the very womanly woman, “who is pregnant and gives birth continually”, is at very high risk of death. Flemming links this view to Galen’s comments in On the Affected Parts where he singles out women who have previously menstruated and had babies “well” (Greek καλῶς), and who have been used to sex with men, as most likely to suffer from suffocation of the womb58.

While Galen was writing perhaps 500 years after the case of Phaethousa was composed, he was a highly knowledgeable reader of the Greek of this period, whose longest work was not a medical treatise, but a dictionary of Attic Greek. He would have understood that the sense of the prefix ἐπι- can be one of accumulation, so that ἐπίτοκια and ἐπίτοκος can also mean “compound interest”. The words are rare in the Hippocratic corpus, but in the Hippocratic text Superfetation 17, a woman who is ἐπίτοκος is likely to suffer a stillbirth, a non-viable birth, or a premature birth if her body swells up. Littré translates ἐπίτοκος here as “près d’accoucher”, near to giving birth, and Paul Potter follows this, with “a woman approaching childbirth”59. This translation is based on context yet, as one of the options that follows is premature birth, the condition being described evidently does not only strike “near” to full term, and there is nothing here to prevent us from translating ἐπίτοκος here too as “who is always pregnant”60.

Taken with οἰκουρός, this suggests that Phaethousa is a particularly womanly, particularly fertile woman – in terms of the traditional gender/sex divide, we could see her as both socially feminine and biologically womanly. The first sentence of her story could then be rendered:

In Abdera, Phaethousa the wife of Pytheas, a stay-at-home wife, having been highly fertile in the preceding time, because her husband was exiled/fled, stopped menstruating for a long time.

Phaethousa thus combines clear signs of being a woman – in particular, the capacity to menstruate and to bear children – with her markers of masculinity.

Conclusion

Phaethousa of Abdera and her counterpart Nanno have been an enduring source of fascination for generations of medical historians looking for a Hippocratic origin for a range of conditions; menopausal hair growth, sex change, or hermaphroditism. The story helps us to think about the different parts of the body that contribute to sexual identity, and about the overlap between sex and gender. While early modern and subsequent readers interpreted Phaethousa through the lenses of sex change, hermaphroditism or the virago, and set her alongside other stories of sex located in myth or in history, another version of her body can be read in Galen’s linguistically-informed understanding of her as running a risk to which only a few women are exposed; those who are excessively feminine and highly prolific. Such women cannot become men, as they clearly have functioning wombs.

In an era when the outside was normally decisive proof of sex, in the case of Phaethousa what is crucial to her identity is, unusually, not what is visible outside, but what remains unseen inside, revealed to us only in the language of the text: her womb, never mentioned here, but evidenced by her normal menstruation which is both womanly – τὰ γυναικεῖα – and natural – τὰ κατὰ φύσιν, as well as by her previously prolific childbearing as a woman who is ἐπίτοκος; and her behaviour, as someone wholly feminine, οἰκουρός. In the heart of a world claimed by Laqueur as “one-sex”, she stands out as an example of the way in which the Hippocratic writers instead mix biology and culture, and regard sexual difference, rather than fluidity, as key.

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Notes

1 My thanks to those at the conference "Sexe et genre. Questions de dénomination", and to the anonymous readers of this paper, from whose suggestions I have gained considerable benefit. Retour au texte

2 King 2008; King 2013a; Laqueur 1990. Retour au texte

3 Laqueur 1990: 5-6. Retour au texte

4 Laqueur 1990: 1. Retour au texte

5 Dreger 1998: 200, taken up by Fausto-Sterling 2000: 37-8. Retour au texte

6 On Renaissance discussions of this issue, see King 2007: 56-7; on eighteenth-century discussions, King 2004: 109. Retour au texte

7 For an outline see Dyhouse 1981: 132-3; see further Bartels 1982. Retour au texte

8 I could just as easily have used the “scare quotes” around “sex”, “male” and “female” here. Retour au texte

9 On Teiresias see Brisson 2002: 116-30. Retour au texte

10 Gaisser 2002: 387. Retour au texte

11 Or “fled”; the Greek is φυγόντος. This is a causal genitive; it was because her husband fled/was exiled that the problem began. Retour au texte

12 [Hippocrates] Epidemics 6.8.32; the translation of Wesley Smith, Loeb VII, pp. 289-91. Retour au texte

13 The verb used is “to meet” or “to talk with” (here, the aorist singular, ἐνέτυχον). There is a further plural reference to “doing everything” in an attempt to cure Nanno. Retour au texte

14 On Joints 58 and 60. Mercurialis 1585: 378 ... non cum mutationem sexus, sed corporis ad robur et virilitatis profectum indicare intendit. Retour au texte

15 Diseases of Women 1.1 (ed. Littré 8.10-14); see King 1998: 28-9. Retour au texte

16 Fausto-Sterling 2000: 37-8. Retour au texte

17 Simpson 1839. I am summarising here the arguments set out in more detail in King 2007: 175-83. Retour au texte

18 Ferrand 1623; ed. and tr. Beecher and Ciavolella 1990: 230-1; Mercado 1587. Retour au texte

19 Guillemeau 1609: 423-4; 1612: 238. Retour au texte

20 Ferrand 1623; Beecher and Ciavolella1990: 230. Retour au texte

21 Guillemeau 1609: 423-4; 1612: 238. Retour au texte

22 Green 2006: 4 notes that these stories have been “studiously avoided by most modern scholars”. Retour au texte

23 Treadgold 1980: vii, 4, 5, 36; Botteri 1992: 28-32. The stories of sex change feature in codex 244, which Treadgold argues were “probably copied by Photius’ secretary from reading notes taken before the Bibliotheca was compiled”; Cod. 244: 377a line 29-379a line 33; Treadgold 1980: 184. See also Wirth 2008: 9-10. Retour au texte

24 Treadgold 1980: 103. Retour au texte

25 Garland 1995: 130. On the concept of the “true sex”, see Foucault 1978 and 1980; for a reassessment, challenging the notion that the “true sex” is the “true self”, see Mak 2012. Retour au texte

26 Treadgold 1980: 100-101. Retour au texte

27 Diodorus Siculus, 32.10.3. Retour au texte

28 Phlegon, 4.6 (ed. Stramaglia 2011: 31-2). Retour au texte

29 Pliny, Natural History, 7.36; ... ipse in Africa vidi... Retour au texte

30 Mercurialis 1588: 180; discussion, p. 182; ... non tamen vere eas fieri viros quisquam mentis compos dixerit. Retour au texte

31 Mercurialis 1597: 29, Sed nugae sunt... Retour au texte

32 ... non dicit Hippocrates mulierem illam factam esse virum ... viri effigiem habuit... Retour au texte

33 Simpson 1839: 689. Retour au texte

34 Simpson 1839: 695. If Maria did indeed have a “menstrual” discharge, Simpson insists that it should have been analyzed to discover if it was really menstrual fluid, or rather “pure blood”. On ignoring patients’ claims as exaggerations, see also Dreger 1998: 90-1. Retour au texte

35 Ricci 1842-43; I have not been able to see this account, cited by Simpson 1839: 703-4, for myself. Retour au texte

36 Simpson 1839: 703-4. Retour au texte

37 Simpson 1839: 688-9. Retour au texte

38 See King 2007: 57 for early modern discussions of the possibility that a woman could have only enough blood to make the child, with no surplus to leave her body as menstruation. Retour au texte

39 See King 2013a: 97 on sixteenth-century readers who suggested that Phaethousa did successfully change sex. Retour au texte

40 Simpson 1839: 716. Retour au texte

41 Simpson 1839: 716. Retour au texte

42 Epidemics 6.8.11; Loeb VII, p. 283. Retour au texte

43 S.K 1859: 417. Retour au texte

44 Stern 2008: 214-5. Retour au texte

45 Stern 2008: 226-7. Retour au texte

46 Durbach 2010: 105; “Madame Clofullia” was shown with her child. Retour au texte

47 Smit 2008: 298, Figure 12.3, where the subject poses in her wedding dress and holds the viewer’s gaze in what Smit 2008: 294 calls “a collaborative aesthetic”. Retour au texte

48 S.K. 1859: 418. Retour au texte

49 Manetti and Roselli 1982: 194-5 have her as ‘la massaia (housekeeper) di Pitea’. Retour au texte

50 Holmes 2012: 14. Retour au texte

51 Booth 1814: 539. Retour au texte

52 Smith’s choice of translations in Loeb VII, pp. 289-91, is interesting here; for τὰ κατὰ φύσιν he gives “normal menstruation” while for τὰ γυναικεῖα he simply gives “menses”. While the logic of his choice is clear – what the unspecified treatments aim to produce is indeed “normal menstruation” – I think that there is more significance in τὰ γυναικεῖα than he acknowledges. Retour au texte

53 King 1998: 29-30. Retour au texte

54 Vernant 1963. Retour au texte

55 Loeb VII, p. 289; Littré 5. 357. Retour au texte

56 King 2013b. Retour au texte

57 Tr. Peter Pormann (personal communication). Retour au texte

58 Flemming 2000: 334; Galen, On the Affected Parts 6.5 (Kühn VIII, 417). Retour au texte

59 Potter, Loeb IX, p. 329. Retour au texte

60 I have discussed this at more length in King 2013b. Retour au texte

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Helen King, « Sex and gender: the Hippocratic case of Phaethousa and her beard », Eugesta [En ligne], 3 | 2013, mis en ligne le 01 janvier 2013, consulté le 20 mai 2024. URL : http://www.peren-revues.fr/eugesta/957

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Helen King

The Open University, UK
helen.king@open.ac.uk

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