Introduction: Throughout history, women have sought help from mystical powers to protect them from unexpected situations related to pregnancy and childbirth. The use of amulets in Anatolia, which encompasses the dynamics of products, ideas, beliefs, and civilizations, has been prevalent.

Aim: This study aims to explore the connection between amulets used in the Ancient Mediterranean region and medical practices within the context of the history of medicine, utilizing a figurine.

Method: Through a detailed examination at the Mersin Museum, a figurine depicting a woman in a crouching position with distinctive facial and bodily features was discovered. The figurine, believed to have been used as a birth-facilitating amulet necklace, was compared with information found in classical medical literature.

Findings: The figurine bears resemblance to ancient amulets utilized in the past, which aligns with women's physiology, childbirth beliefs, and facilitating positions described in ancient texts. Recent studies indicate that women continue to employ amulets as a means of protection against birth-related risks.

Discussion: The presence of amulets among archaeological remains draws attention to the enduring influence of superstitions from the past to the present, particularly in situations where the lives of both the mother and child are perceived to be at risk.

Conclusion: The historical use of amulets and talismans by women has served as a unifying practice throughout different eras. While these methods are generally regarded as harmless, the ongoing advancement of medicine from its primitive origins suggests that women's health still faces unresolved challenges.

Keywords: amulet, history of medicine, anatolia, ancient medicine, gynecology

Throughout history, although there is no disease, women have sought help from supernatural forces to protect themselves from possible bad situations, as pregnancy, birth and postpartum carry life-threatening risks for the baby and the mother. Developments in science and technology have determined medical interventions for health problems. In antiquity, when women needed help, midwives mainly carried out interventions; however, unfortunately, since the knowledge and skills of midwives are not as good as physicians, physicians have intervened in women with severe problems. Out of fear of life, women made vows and hung amulets and jewelry that they attributed meaning to their necks or carried them. Amulets and talismans, among the finds found in archaeological excavations, provide an idea about the existence of beliefs.^1,2 The association of physiological characteristics specific to the female body with nature regarding creativity and productivity has led to the identification of soil and woman. It can be argued that the use of depictions of women's fertility and sexuality in archaeological remains is due to the similarity between the ability of women to become pregnant with the seed of the man, to give birth, to feed his baby with milk, and to obtain a product from the soil with seeds.² The location, diversity, mastery and differences should be considered when examining the remnants. The figurines of women nursing their children and appearing pregnant were used in different parts of the house, such as warehouses and cellars, to bring fertility. The small, necklace-like appearance of the finds suggests that they were used as jewelry.^3,4 The use of amulets by women against all evils in matters related to their health during late antiquity suggests the influence of Greco-Roman culture. There are remnants of similar beliefs in Anatolia, the Mediterranean Islands, Europe, Asia and North Africa, and the New World.⁴ The common feature of Anatolian finds is that figurine women are fat, with large slanted eyes and beautiful noses, as pregnant, giving birth and feeding women.⁵ On the other hand, using amulets as a protector was common in antiquity when the mortality of women and infants was very high. Today, the use of amulets in situations that affect the life of the woman and the baby still exists in many cultures in the form of folk medicine and folkloric medicine.^6,7

In this context, the study endeavors to explore women's perceptions regarding childbirth and infertility, delving into their interrelation with medical practices from a perspective grounded in the history of medicine. This exploration is centered around a figurine presumed to have served as an amulet, currently housed in the collection of the Mersin Museum, located on the Mediterranean coast in Anatolia.

In this study, the following questions were sought to be answered about the material thought to have been used as an amulet by women in the past.

1. Is the material used by women to facilitate childbirth?
2. Does the position of the woman in amulet similar to the positions proposed in the history of medical gynaecology and childbirth artefacts?
3. Is there any study in the world that such amulets are used from that time until today when the material was used?
4. In the history of medicine, different studies were investigated that women used an amulet related to childbirth, and its similarity with the amulet we have were revealed.
5. In the works in the history of medicine, it was investigated whether there is an amulet or mystical suggestion written by physicians in the departments related to gynaecological diseases.
6. Current studies on traditional medicine related to childbirth in Turkey were examined.
7. In this study, which uses the method of description and in-depth analysis, the aim is to comparatively examine the works written in the history of medicine and today's researches about women's hope for help from supernatural forces in a vital event such as childbirth, and to contribute to the field.

This study was carried out jointly by Mersin Archeology Museum and Mersin University Medical History and Ethics Department between December 2021 and June 2022. After obtaining permission from the clinical research ethics committee and the Ministry of Culture, the museum's artifacts related to obstetrics and gynecology were examined. A figurine in a crouched position was identified, with a prominent face and body, which was registered with inventory number 11.21 (photo 1) and presumed to be an amulet. A figurine was depicted, thought to be used as an amulet to facilitate childbirth and/or protect mother and child or for fertility purposes. The amulet was described in the findings section. Discussion section was composed of three parts. The first part compiled information about obstetrics and gynecology in the classical medical literature. In the second part, the archeological artifacts and information we have were examined comparatively from the point of view of the history of medicine. Thirdly, the use of amulets today was mentioned.

Findings

Female statuette (amulet): This artifact, which is in the inventory records of Mersin Museum, is a pendant with inventory number 11.2.1, which could have been obtained from Mersin and its surroundings, and was brought to the museum through hard purchase. (Figures 1–3) The 1.4 cm high female figurine, depicted in a crouching position, is made of bronze. The face is highly stylized. It has a short and thick neck. The body is short. Upper body parts are poorly understood due to corrosion. The knees are bent, pulled towards the abdomen, the legs are spread apart, the feet are again stylized, and the genitals are visible. Although it may seem that she has no arms when viewed from the front, it is seen that she has her arms behind her back and her hands on her hips. It can even be mentioned that there is a third arm that helps birth. When viewed from the side, it is seen that the facial features are not clear from the profile. The ring of the pendant comes out from the back of the head and is joined to the nape of the neck.

Figure 1 Front view, woman crouching at knees, open to both sides, face in pain, woman's labia prominent.

Figure 2 Side view, ring on the back of the head suitable for use as a necklace.

Figure 3 Rear view of the female figurine, arms at the back, hands on hips, seen from behind that the woman is crouching.

The necklace has a very thick and solid ring for its small size. The pendant, which was an amulet, must have symbolized the belief in the Mother Goddess in the Anatolian tradition. Although the subject is very wide, if we go back to our work in Mersin Museum, unlike the figurines that are usually depicted with materials such as clay, bone, stone and marble, it is made of both bronze and in a relatively small size since it is a pendant. As such, we can date the work to the earliest Bronze Age. While the Mother Goddess statues found are generally depicted standing, sitting on the throne, sitting, lying, with or without children, our work shows privilege in terms of position.

Positions on obstetrics and gynecology in classical medical works

When the positions suggested in medical practices related to female physiology, diseases and childbirth in the ancient literature and the positions mentioned in traditional beliefs are compared with the position of the woman in the amulet (figurine) we have examined, there are similarities and differences.^2,4–9 Physicians who lived in the period of classical medicine, formed the basis of rational medicine, which has survived for many years by combining the knowledge they obtained with observation and experience.^3,6–10

Fertilization

In the presence of falling uterus and wandering uterus in women in Ancient Egyptian medicine; it has been stated that if conception does not occur, the uterus leaves its place in the pelvis and for the treatment of this condition, incense, herbs, beer, goat's milk, olive oil and vaginal fumigations should be used.² Soranus states that when menstruation is stopped, the position during intercourse is important for the retention of the seed, the massage can make the seed more ready to be taken in, and can help the distribution of food and the retention of the seed. In addition, it was stated by ancient physicians that the positions and body types of men were important for fertilization.^7,11 Avicenna suggested paying attention to nutrition to obtain healthy sperm in fertilization. He also linked the health of eggs and sperm to the lifestyle. He argued that stress would impair sperm quality.¹² Antiquity writers stated that the appropriate time for fertilization occurred under the influence of external factors, and they believed that the rising moon was favorable.¹¹ While talking about the characteristics midwives should have, Soranus emphasized that the midwife, who plays a role in birth, should know the prophecy, tradition, customs, and common beliefs among the people and be careful in their practices.⁷

Soranus stated that at the critical moment of coitus during the sexual act, when the man empties the seed, the woman holds her breath and slides herself down, the seed cannot enter the depth of the uterine cavity quickly, and the woman's crouching after intercourse prevented the progress of the seed. According to ancient physicians, women who want pregnancy should lie down and cross their legs immediately after intercourse. In addition, Soranus wrote that there are many signs of fertilization and that at the end of the intercourse, the conscious woman feels the excitement of trembling.⁷

According to Soranus, the room is not ready at the time of fertilization, and the woman drinks alcohol, the hour is late, the season is very cold (constricts the cervix), relaxation due to excessive heat, and the inexperience of the midwife or doctor affect the birth.⁷ The ancient physicians stated the effect of the pregnant woman's behavior on the image of the fetus. According to Hippocrates, such things appear on the child's head when a woman eats soil and coal for a long time. Galenos similarly believed that the contents of the uterus affected the appearance of the fetus. This subject has been mentioned in many ancient works.^7,8,13,14

About miscarriage

In the classical medicine period, it was thought that difficult birth, miscarriage, ulceration and delayed menstruation would cause excessive bleeding.^7,15 Bleeding due to miscarriage was considered by physicians a hazardous condition. In the treatment, the woman is placed on a hard bed in a small, dark and normal-temperature room; her feet are lifted, the legs are rested after crossing them to increase the pressure, the arms and legs are held tightly, bandaged, a soft sea sponge moistened with cold water and vinegar is applied to the hip, pubis, waist and chest, and the woman is sneezed.^7,8,15 Soranus stated that some people were affected by substances such as magnets, Asian stones, yogurt, rennet, sharp amulets or amulets, and did not prohibit their use. Some women carried amulets as keys and tried to overcome their fears. Soranus stated that the amulet does not directly affect the treatment, the patient will probably be happier, and this situation affects the patient positively.⁷ Birth is one of a woman's most complex and challenging experiences, and it is reported that ensuring the woman's comfort facilitates the birth.

Galenos stated that bleeding from the veins of the uterus can occur in a pregnant woman and that the issue of Aetius uterine hemorrhage is important, but cold application harms the woman.⁸ Ancient physicians generally suggested that the steam obtained from the decoction of blood astringent and blood-stopping plants should be applied directly to the uterine mouth or by absorbing it into a woolen cloth. Razi recommended bloodletting and vaginal fumigation with substances mixed with pomegranate flowers, bile, antimony, acacia and alum, application of cold astringents in uterine bleeding after delivery, and bandage on legs and arms. Ali Abbas suggested that uterine bleeding is caused by excess blood and to treat it with bloodletting.⁸ Avicenna said that uterine bleeding was caused by excess blood and suggested reducing the severity of bleeding from the arm, general treatment of the body during attacks, and substances such as water, vinegar, camphor, alum and bile. Ibn-i Sina used opium in some of his recipes.^8,16 It is clear that the use of plants as medicine for gynecological diseases and childbirth in the history of medicine is within certain principles and is far from mystical understanding, even if the factor is not determined following today's pharmacology understanding.¹⁷

What is written in medical works about the difficult birth

In the first century, Soranus and later physicians of classical medicine explained that difficult birth could be caused by fetus, mother or external factors.^7,8 In addition, physicians of the classical medicine period stated that it would be very difficult to give birth without bursting the membranes due to conditions such as the uterine opening not opening correctly, being completely closed, not being widened enough, uterus or orifice atony, narrow pelvis or mechanical obstacles, and paralysis in the uterus.^7–9,16,18 Soranus stated that if the pregnant woman is excessively fat, short or tall, it may be difficult to give birth because her body proportions are not normal. Avicenna stated that a woman's being young, thin, tall, fat, physically or mentally ill may cause a difficult birth. In addition, Avicenna stated that if the fetus settles outside the uterus, pregnancy is dangerous, and it can be understood by palpation in the examination that the movement in the uterus is different from what is expected.^7,16 He wrote the reasons arising from the child as being too large in size or head, congenital anomalies or location anomalies, and although the ancient physicians did not recommend it, Avicenna forced, shook and shook the woman who had difficulty giving birth.¹⁶ Soranus states that women who marry at a young age may experience difficult childbirth since the size of the uterus, fundus and orifice are not developed due to their nature, that advanced age, weakness and long-term celibacy may also affect the birth, that women who have insufficient information about childbirth cannot cooperate and delay the birth, some women are afraid because they are going to give birth for the first time. They may have difficulties because they do not know the correct position of their bodies.⁷ In addition, ancient writers argued that women's emotional states, such as fear, joy, shyness, very irritability, getting used to laziness, loving a luxurious life, loss of energy, and excessive self-indulgence, were also reasons for difficult birth.^7,8 In Hippocrates' aphorisms, there is no information other than medical practice.¹⁹ However, Hippocrates stated that a woman who does not menstruate and does not give birth would become ill.² Exercise can facilitate the delivery of the fetus. The ancient physicians believed that physicians should know the causes of a difficult birth; otherwise, they could make a big mistake. Herophilus stated that birth requires physical or vital ability. According to Hippocrates, the hip bones are separated at the first birth.^7,18 In the Müntahab-ı Şifa, written by Celalüddin Hızır bin Aliyü'l Hattab, who is known as Hacı Pasha, who is thought to have lived between the end of the 14th century and the beginning of the 15th century, In the treatment of difficult birth, it is recommended that after three or four parts of acura peels are crushed and sieved, three parts of hot water and one part of oil are added and the woman drinks. He also explained that the woman was given a magnet stone in her left hand and that she left this stone and took a coral stone and helped the boy to be born. Hacı Pasha wrote that Aristotle told the woman who had a difficult birth that she gave birth easily when a piece of flint was tied with a piece of cloth and the coriander root was tied to the woman's leg. He stated that he had also tried this and that the application worked.²⁰

There is a birth description in the Codex Vindobonensis, which contains copies of manuscripts with different illustrations from the Middle Ages. A woman in labor is pictured from the front, sitting on high ground with her legs open. Two women are standing in the back; a woman in the front is holding the expectant mother, while a fourth woman is talking to the expectant mother. The midwife puts one hand on the woman's left knee, and the other is in the form of palpation between her legs. In the picture description, “In order for the woman to give birth quickly, 11 or 13 coriander seeds are wrapped in a cloth and then crushed, held by a man or a virgin on the nape of the baby that will be born on her left leg, allowing the woman to give birth quickly.” is written. It is a drawing describing how the coriander plant is used to aid childbirth.²¹

The use of amulets by women in the era of classical medicine

Physicians of the classical medicine period stated in their works that mystical abilities did not have a place in the discussion of illness, and they produced works describing the diagnosis and treatment of diseases according to the knowledge and technological possibilities of that time.^7,8 However, women have taken refuge in mystical and magical understanding due to the excess of maternal and child deaths throughout history. Such practices, which are still alive in the form of folk medicine or folkloric medicine, continue to affect the life of the woman and baby, which is our subject.²² Apart from ancient medical texts, the existence of amulets appears in folkloric and mythological narratives. In cases where medicine does not find a cure, demons can kill the mother and child during or after pregnancy. The woman could lose her baby by miscarriage, and her life could be in danger. From Antiquity to Byzantium, amulets resembling a "uterus" were used on a small part of the body to aid pregnancy and childbirth or to protect against the evil eye. This amulet prevented the demons from killing and stealing women and children. Magical texts were also used for these demons. Uterine amulets are found in Greece and Anatolia. Women's use of magic and amulets to drive away the evil of sickness dates back to the 5th century BC.²³ In Ancient Egypt, a ubiquitous god called Bess, protecting the household and children, has been found in archaeological excavations at different times. Bess was considered a funny dwarf god, believed to bring luck and happiness to the home, protect women and children at birth, and prevent miscarriages. It was also believed that women with tattoos on their hips in Ancient Egypt would be protected against venereal diseases. It is depicted as feminine to exorcise ghosts, black magic, evil spirits and demons.²⁴ In the literature, it is stated that uterine amulets can be pendants (precious jewelry), insignia and rings using metal or precious stones. The figures on the amulets could be depicted as a woman or a monster consisting of an animal's head, arms or body. The blood-stopping property of hematite, which was used in making uterine amulets, was used. Amulets could be in the form of magical writing, small figurines or iconography, and they were made to protect women and children from demons and the evil eye.² It was thought that women's wombs were like animals that scoured the body to catch sperm. Unless the wandering uterus calms down, it does not create a suitable environment for fertilization. Diseases in women were attributed to the wandering uterus. The information related to the connection between the diseases of women and the uterus in the medical texts served the purpose of getting help from the amulets among the people. If the wandering uterus was the source of disease, the amulet made in the form of the uterus was used as a protector. Amulets have been used for many reasons, from menstrual irregularity to birth problems. Women are relieved with these amulets.² Since the position in the figurine we are examining is crouching, it can be thought of as a position that aids in emptying the uterus. Women wore talismans around their necks and placed them on their arms or vaginas. The talismans contain depictions symbolizing the womb or fertility, and gods or goddesses are depicted; they may be related to fertility, pregnancy or contraception. The figurine we examined is also likely to be used as a necklace. Evidence of the use of womb talismans in Greece and Rome assists us with the idea of the origin of the amulet we are examining.2 Although it is not clear when they were made, there is evidence that talismans and amulets are used for similar purposes today.^2,22 Written talismans were generally used by the upper classes due to the difficulty of accessing writing and knowing how to read.

Crouching position for women in medical works

According to Islamic Medicine, the woman is sitting or crouching during childbirth. In addition, this position is used by midwives to practice the treatment of women's vaginal diseases. The woman's posture is depicted similarly to a statuette in work called Cerrâhiyyet'ül-Haniyye, written in 15th-century Turkish by Şerefeddin Sabuncuoğlu. Cerrâhiyyet'ül-Hâniyye can be accepted as the first work that includes medical drawings. Sabuncuoğlu, in the chapter of his book titled “Hemorrhoids and Warts on the Vulva and the Treatment of scarlet pimples”, explained how to practice medical practice and showed how the woman's position would be (Figure 4).¹⁰ Sabuncuoğlu explained that the woman was sitting on a forked lectern, bringing her hands under her knees and pulling her legs towards her stomach, and the midwife used a tool to open her vulva, levleb or miftah-ul ferc (a tool that opens the vulva). It is shown on the female vaginal model that miftah-ul ferc, which was made exactly like it by Oya Ögenler, was used following Sabuncuoğlu's description.²⁵

Figure 4 Miniature of the female examination drawn by Ş.Sabuncuoğlu in the work titled Cerrahiye’ül Haniyye.

However, Paulus Aegineta, a 6th-century physician, explained that during the operation, the woman pulled her legs to her stomach after lying supine and holding her legs with her arms.⁸ In the work of Soranus, if there is no midwife's chair in labor, the pregnant woman is seated on a woman's lap, the assistant women stand on either side of her and prevent the woman's movement, while the midwife stands lower than the pregnant and helps the baby to come out.⁷ Hippocrates stated that in a difficult birth, the woman's head would be tied to the cot (by putting a bandage around the chest), the woman's feet would be raised with a helper, and other helpers would help the woman by raising the leg of the bed and dropping it to the floor and making the woman shake strongly.²⁶ Other ancient physicians compelled women to climb stairs and walk. As seen in medical works, it is noteworthy that ancient physicians suggested different positions while applying medical treatment to women during childbirth. The resemblance of the artifact numbered 11.2.1 in Mersin Museum to the Aztec goddess Ixcuina (Tlazolteotl) is a warning about the similarity of beliefs in different regions. Similar to the position in the figurine we examined, it was made as a woman breeding in a crouching position, the sculpture is 20.2 cm high. It was found in North America, belonging to the Aztec culture. This image is a birth posture practiced by the Ancient Mexicans.²⁷

The use of amulets today to protect the woman or the baby

Traditional medicine is rooted in history, practiced among the people, based on experience and observation, and continuing throughout the ages. In archaeological excavations, we come across many practices similar to those that have been effective for centuries and continue to exist among the people. The knowledge that traditional methods have local characteristics brings applications with similar characteristics in archaeological excavations, and the woman's body still needs protection.²² Many studies in Anatolia show that the use of amulets and similar practices continue.^22,28–31

It is thought that the plant, which is known as Kaff Maryam in Arab countries, Sanggul Fatimah in Malaysia, and Hand of Mother Fatma, Mother Eve or Virgin Mary in Anatolia, due to its dry leaves, which hides its seeds in its body and resembles a closed fist in Anatolia, facilitates the birth process. Its Latin name is Anastatica hierochuntica. (Figure 5).³¹

Figure 5 Hand of Mother Fatma plant.

It was determined that 77.9% of the women who participated in a study conducted in the Central Anatolia region in 2012 used a plant named " Hand of Mother Fatma, Coral Mother Hand" to facilitate childbirth. In a study conducted in 2019 on pregnant women who applied to a hospital outpatient clinic in Mersin, it was determined that 65% of women knew to have written amulets and read-blowing of blessing, which are among the traditional methods, and 5% use them to get pregnant (29, 22). In a study conducted in Istanbul in 2021, women were determined to know applications to get pregnant such as sitting on a  hot brick drinking onion juice, eating figs and honey, pulling the waist, putting oil and sugar cubes in the vagina, keeping the waist-belly warm, raising the feet after coitus, amulets and visiting the shrines.²⁸

In Anatolia, it is believed that a jinn called "Ummu Sübyan" prevents women from getting pregnant, and it is believed that women could never get pregnant or their pregnancies ended in miscarriage and stillbirth. Therefore, women who want to become pregnant are not left alone at home and are constantly blessed or wear blessed amulets. They eat the food or carry objects such as belts and beads on their bodies that the hodjas bless.³² Traditional methods in order for women to have a child of the gender they want, such as making vows and sacrifices, applying to teachers, having amulets and talismans written, sleeping on the right side of the woman during sexual intercourse and getting up on the right side, rolling a boy on the bride's bed, giving a boy to the woman's lap on the day of marriage, giving birth until she gives birth to a boy are applied. It is believed that those who want the sex to be male will have a male baby by intercourse 15 days after the end of the menstrual period, coinciding with the time the man wants. Women who want a baby boy say male names for forty days. The last-born girl is given names such as "Yeter, Döne, Döndü, Dursun, Songül, and Rabiye". It is believed that the last child born will be called "Eve", so that the next child will be a boy.30 In a study conducted in Mersin in 2019, a quarter of the participants stated that they used amulets for pregnancy and postpartum.³³

As a result, it has been determined that the position of the examined figurine is recommended for birth and medical practice in medical works. It is similar to the position in medical practice in Sabuncuoğlu's work.¹⁰ Although some authors claim that the use of amulets was suggested by the physicians of the classical medicine period, it can be argued that as a result of the examination, no evidence was found in the works of Hippocrates, Soranus and other later physicians that hoped for help from mystical and supernatural powers. Only the use of coriander plants is like a talisman. It is thought that some applications in the people's beliefs are similar to medical information and do not harm the user, as in the example of amulets, that will enable them to resist time. Prevention of traditional methods harmful to health has been important for public health since the earliest times.

As a result of this study, it was concluded that the amulet we had was used by women to help in childbirth. The position of the woman in Amulet was found to be similar to the positions proposed in gynaecological and childbirth artefacts in the history of medicine. However, it was determined by some physicians that this position was recommended for miscarriage and that they never recommended help from supernatural forces. It was determined that there were studies in the world and in Turkey.

Unfortunately, society still imposes social and emotional pressure on married couples to have children, and the couple's married life is affected by this situation. The use of amulets and talismans to express the desire to be a mother or protect from childbirth risks has united women from the past to the present. Although methods such as the use of amulets are considered harmless, the continuation of the evolution of medicine from the primitive stage of medicine based on instinct, experience and magic to the present suggests that women's health has insoluble problems. It is recommended that healthcare providers should be informed about the permanence of traditional methods and that such multidisciplinary studies should be increased in terms of the cultural dimension of health.

None.

The author declares no conflicts of interest.

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