Vaginal pessaries were commonly used in ancient Greece. These were wool tampons soaked in a variety of substances, including: opium poppies, bitter almond oil, boiled honey, sea onion, ox marrow, goose fat, rose oil, thapsia root, myrtle, coriander, cumin, marjoram, bacchar (an aromatic root), perfumes, emetics, or other substances.5 The following is a typical account of the use of a therapeutic pessary:
The wife of Epicrates, who lay sick near the statue of the city founder, when near her delivery was seized with severe rigor without, it was said, becoming warm and the same symptoms occurred the following day. On the third day, she gave birth to a daughter and the delivery was in every respect normal. On the second day after the delivery, she was seized with acute fever, pain at the stomach and in the genitals. A pessary relieved these symptoms. . . ,6
Pessaries appear to have been a second-line treatment in that they were known to have the risk of abrading or lacerating the vagina and thereby causing infections. For example, "If the uterus is not affected by [vapor baths, mild drugs, diet therapy], one must purge it by means of non-biting drugs administered as pessaries. But always administer vapor baths before the purgatives."7 The Oath's "destructive pessary" is believed to be one that induced an abortion.
Abortion was legal in ancient Greece. Greek medical texts described many women after spontaneous and induced abortions.8 The ancient accounts often did not distinguish between induced and spontaneous abortions (miscarriages).9 Sometimes the woman did not tell the physician how the abortion came to be.
For example: "Simus' wife had an abortion on the thirtieth day, [whether] from drinking something, or spontaneously."10 In the following discussion from Diseases in Women, the physician described abortion as a secret practice that took place among women. He notes that secrecy makes it difficult to determine whether a subsequent inflammation of the uterus is caused by the trauma of miscarrying a large fetus, or by a harsh pessary, or by both.
Suppose after an abortion a woman receives a serious lesion or that she causes ulcerations in her uterus with harsh pessaries (such as women produce in treating themselves and others), and her fetus is destroyed and the women herself is not cleansed, but her uterus becomes very inflamed and closes. . . .n
The treatises discuss how to try to treat a potential miscarriage 12 but do not describe any attempt to medically reverse an abortion that a woman had elec-tively and deliberately induced. On the Diseases of Women gives detailed instructions on how to dismember a dead fetus that is retained in the uterus.13 The overall picture that emerges seems to be one where physicians were practicing in a culture where abortion was not infrequent but where it was largely performed within a women's culture.
The risks of abortion to a woman's health were recognized and feared. One physician noted, "Abortions are more dangerous than births because it is impossible for an embryo to be aborted by medicine or by a potion or by food or by pessaries or in any way at all without applying force, and force is a painful thing. The risk here is that the womb will become lacerated or inflamed and this is dangerous."14 As a result, a physician noted, women were damaging themselves with abortion "all the time."15 It is reasonable to hypothesize that orally administered potions or destructive vaginal pessaries were actually abortive adjuvants that were intended to kill the fetus or weaken its attachment to the uterine wall. Such adjuvants would have been followed by a forceful procedure (possibly uterine kneading or the insertion of sticks or plants into the uterus) to complete the abortion. Such forceful methods are widely practiced in developing countries today. Given that pessaries were a second-line therapy because of their risks of causing infection, the specific ban on using destructive pessaries as an abortive adjuvant may reflect a clinical insight that the combined use of a foreign body in the vagina with uterine force or instrumentation unacceptably increased the feared and often-lethal infections. It seems plausible that a physician would have been held responsible for a death that was proximate in bodily location and time to the use of a destructive pessary.16 This may explain why the passage only refers to abortion by a "destructive pessary" when oral abortifacents were known and described in medical works.17
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