IUD or not IUD? Did the Hippocratics invent the first intrauterine device?

by Rebecca Fallas and Helen King

We’ve just come to the end of the second run of the Health and Wellbeing in the Ancient World MOOC. One area explored on the course is the use of votive offerings in the ancient world and, within this, learners are asked to go online and find examples of votives; wombs are a popular choice here, and we also explore womb votives directly later in the course.

On both runs of the MOOC so far, there has been some discussion about the meaning of the small stones found in some votives traditionally identified from their shape as wombs (for more on Helen’s thoughts on this, see here). What has happened is that a learner, trying to think about what such stones may mean, mentions the claim that for centuries nomadic tribes have inserted stones into the uteri of camels to prevent conception. This is already an intriguing concept in itself, but what we found even more interesting is that, when you do an online search for this topic, you find articles which not only discuss camel uteri but also claim that it was the Hippocratics (or even, oh dear, ‘Hippocrates’ – to whom, of course, none of the ancient Greek medical treatises can be attributed!) who were the first to use intrauterine devices as a form of contraceptive.  One of the top results that appears from such a search is currently a 2013 Huffington Post article, ‘Intrauterine Bling: 2,000 Years of IUDs, From Camel Contraceptives to Body Mod’, which states that ‘The ancient Greek father of medicine, Hippocrates, is credited with first suggesting small objects in the human uterus to prevent pregnancy’.

There are many similar hits. For anyone familiar with the Hippocratic texts their first reaction (as ours was!) is likely to be ‘Have I missed some key part of the Hippocratic Corpus where ancient medicine was 2000 years ahead of its time on the topic of contraceptives??’ Spoiler alert – you haven’t.

What is an IUD?

There are several versions of IUDs which began to appear in the early twentieth century. Today’s IUD is a small T-shaped device made up of plastic and copper and inserted into the uterus. The copper affects the make-up of the fluids in the womb and stops sperm surviving in the womb and fallopian tubes so that conception doesn’t occur. If all is well the device can be left for five or ten years and can be removed at any time should the woman wish; fertility is almost immediately restored.

So where do these claims for Hippocratic IUDs come from?

Tracing the source

Through a bit of detective work we can start tracing this claim back and see how it has developed over time.

The Huffington Post article links to a 2009 article by a medical student, Megan Evans: ‘A desire to control: contraception throughout the ages’, in the student-run, peer-reviewed journal Historia Medicinae https://docs.google.com/a/huffingtonpost.com/viewer?a=v&pid=sites&srcid=bWVkaWNpbmFlLm9yZ3xoaXN0b3JpYS1tZWRpY2luYWV8Z3g6MjA5ODJiZTA0YjRmODFlMQ. Like so many articles on the history of medicine by medical practitioners, it is essentially a catalogue which relies on secondary materials. Peer review doesn’t seem to involve asking any historians for their verdict.

Evans states:

Around 400 B.C., writers from the Hippocrates school discussed a contraceptive similar to the intrauterine device (IUD) of today. This particular apparatus was a hollow tube filled with mutton-fat that was inserted in a woman’s womb to keep the cervix open and to prevent pregnancy.

Great! So now we have a description of the ‘device’ used. However, no source is given to tell us where we can find this in the Hippocratic Corpus. And Evans is by no means the only scholar to suggest this; similar claims are widespread, and all seem to link to this mutton-fat filled tube. It’s all over the internet, usually as evidence of the Otherness of the ancients; for example here.

Evans cites only John Camp’s 1973 book Magic, Myth and Medicine, which gives no more information on the alleged Hippocratic origin (you can find the passage used by Evans, which is also the source of the various online variants, on p.38).

The ‘Hippocratic’ source

Further searching clarifies that everyone has been copying one book, published back in 1901. This is William McKay, The History of Ancient Gynaecology. On pages 45-47, McKay describes a treatment to soften and open the cervix. It involves using greased pine-wood in various sizes to act as a dilator (you’ll be relieved to know that there’s a warning about splinters). One wooden rod is inserted into the woman, then removed and replaced by a larger one. This continues until the final probe, the thickness of the index finger and hollow in the middle, which is inserted once the woman is dilated to the required amount; this tube is filled with mutton fat. The passage quoted is from the Hippocratic text Diseases of Women Book 2, Section 133.

Hooray! finally we have a source!

However, this is by no means an IUD. As James Ricci confirmed back in 1949, in his book The Development of Gynaecological Surgery and Instruments (p. 13) this treatment comprises a set of dilators followed by the administration of a softening agent. Neither the dilators nor the final probe are left in the uterus once the treatment has ended and, on closer inspection of the text, we see that this remedy – far from being about contraception – is taken from a much longer passage for what the Hippocratic author describes as a very serious problem which could lead to death.

The passage begins by explaining a disease which occurs when the uterus moves towards the hip (the uterus moving around in the abdomen is an idea repeated many times in these texts). If it isn’t shifted back into position quickly the author describes how it ‘contracts and becomes hard’ and menstruation can’t happen. This combination of the womb moving upwards and becoming full of menstrual blood causes pressure on the woman’s chest and the breasts swell. The author describes how inexperienced women believe themselves to be pregnant as they have similar symptoms to those who are seven or eight months pregnant, including milk production. However, when the time comes to give birth nothing happens and these symptoms disappear. The uterus further contracts as does its ‘mouth’, and further symptoms develop including loss of appetite and weight loss, shallow breathing and loss of the sense of smell. If the woman gets to this point she will die from the disease.

However, after this rather depressing start there is good news; if caught early so that menstruation is restored, the woman can be cured. The rest of the passage gives a very detailed set of treatments and regimens to be followed. First, fumigation is performed for five or six days followed by the probes as described in the supposed IUD section. If these are not successful then fumigation is done again followed by other pessaries before the wooden probes are attempted again. This cycle is repeated with different ingredients for both fumigation and pessaries until the probes can be successfully introduced. Once the wooden probes are deemed a success the women is given a detailed regimen to follow until she successfully menstruates.

This treatment is pretty much as far away from any type of contraceptive device as you could imagine and this is emphasised in the second to last line in the passage which states that, for women who are still only losing a small amount of blood after this treatment, then pregnancy will help them recover fully.

Claims about what ‘Hippocrates’ said are found everywhere online, whether that’s Hippocrates on the virtues of watercress or on cures for baldness, but this example shows not only how incorrect claims are repeated but also how they are developed over time; from a misreading of the Hippocratic recipe to open the cervix, to an misrepresentation of this source as a contraceptive, and through to a ‘factoid’ about ‘Hippocrates’ creating the first IUD.  These claims are not just repeated in popular online articles but also in scholarly journals and, like the claim that Trotula provided a remedy for vaginismus they provide an excellent example of scholarly ‘Chinese whispers’ and demonstrate very clearly the importance of going back to the original source. Be warned!