1.2.1 Greco-Roman and Medieval Medicine

In describing the relevance of maternal impressions in Greco-Roman and Latin medieval medicine, it is important to highlight three major aspects. First is the wider experience of the pre-modern body as a permeable and porous entity, living in a state of constant apprehension of the external environment on its physiological balance. Second is the physical power of imagination. Before the modern split between body and mind, a fully materialistic view prevailed in pre-modern medicine where the soul and human temperament were seen as mostly determined by the physical impact of changes in diet, climate, or through the effects of planets’ movement. This deep communication between imagination and bodily changes may seem superstitious or only metaphorical in the post-Enlightenment mindset, which neatly separates inwardness and external objects, but it was literal and effective well into early modernity [Reference Kirmayer3]. Scholastic philosophers, for instance, shared the notion that mental images could impress real forms into matter. Al-Kindi (ninth century CE), one of the fathers of Islamic philosophy known in the Latin West for his On Rays (De Radiis) and a translator of Aristotle, held the view that any spiritual substance can induce true forms in the body just through imagination [Reference Zambelli4, Reference al-Kindi5]. This widespread understanding of the relationship between matter and mind offers a context to appreciate the impact and ubiquity of the doctrine of maternal impression or the belief that a mother’s imagination could imprint both physical and mental characteristics on an unborn child.

Third is the gendering of biological knowledge, at different degrees, in both medical and philosophical views of reproduction. Physiologically, in Greco-Roman and later medieval medicine, it was widely assumed that women were of a softer, more permeable, and less stable nature, more liquid and transparent than men, and hence easily subject to passion [6]. This perceived greater impressionability of the female body finds its validation earlier in Hippocratic texts, where women are considered spongier, ‘with a capacity to absorb fluid which makes it directly analogous to wool or sheepskin’ [6]. These and other tropes were instrumental in consolidating the image of women as more subject to passions and less shielded ‘against corrupting ingestions’ [Reference Kukla1]. These ingestions included the power of imagination and the susceptibility to several social influences that we would now call shocks or traumas. As we can read in the most influential treatise in female medicine in antiquity, Soranus’ Gynecology (c.125 CE):

A treatise attributed to Galen [Reference Leigh7] enlists the perceived ability of an expectant mother to imprint her child as one of the many ‘wonderful works of nature’. The Aristotelian view is even more radically gendered. Whereas the Hippocratic and Galenic tradition sees both men and women as contributing to semen for procreation, for the most influential philosophers of antiquity until early modernity, women contribute only bare matter to the male semen that will inform and shape the female menses. Medieval medicine and natural philosophy would rework these tropes with a few variations. Women being not just less hot but also of a more watery constitution than men, Albert the Great and Thomas Aquinas thought that they would behave as any moist object would: that is, they would receive impressions more ‘easily but retain them poorly’ [Reference Aquinas8]. In a moralising rendering of this trope, Albert the Great instead made the claim that the mud-like impressionability of women could explain why ‘women are more inconstant and fickle than men’ [Reference Albertus9]. Their moister constitution made women more easily subject, for instance, to the effects of lunar tides. Throughout the European Middle Ages and into early modern Europe, maternal impression was debated as one of the key environmental influences to explain the specific characteristics of the child, particularly birth defects or the resemblance (or lack of) to the father [Reference Temkin10, Reference Tucker11]. The emphasis remained on the negative, and the avoidance of scary sights or stressful emotions was largely advised in the medical literature as a way to counteract the power of a porous womb.

1.2.2 Early Modern European Debates 1500–1700

Maternal impression, and particularly one racialised version of it possibly based on the Hippocratic ‘On the Nature of Children’ [Reference Doniger and Spinner12], became widespread in the Renaissance and early modern Europe (see [Reference Paré13]). In the medical-teratological work of Ambroise Paré (Des monstres et prodiges, 1573), Hippocrates was said to have saved a white princess from the accusation of adultery when she mothered a child ‘black as a Moor’. The father of medicine pronounced that a portrait of a Moor in the princess’s bedroom was to blame for the case of dissimilarity in generation. (For the racialised aspect of maternal imagination, see [Reference Doniger and Spinner12].) Besides Paré’s teratology, a belief in maternal impression was shared by a large number of European intellectuals and doctors of this period from Ficino to Montaigne and Gassendi [Reference Hirai, Manning and Klestinec14]. Paracelsus claimed that ‘the woman is the artist and the child the canvas on which to raise the work’ (cited in [Reference Pagel15]); Montaigne claimed that ‘we know by experience that women transmit marks of their fancies to the bodies of the children they carry in the womb’ (cited in [Reference Huet16]).

The seventeenth century saw a progressive collapse of the fluid body of humoralism in favour of an organic understanding of physiology and the fading of teleological explanations replaced by emerging mechanistic science. Maternal impression, however, still found a place in debates on reproduction and heredity. Rather than just being confined to teratological abnormalities, the power of imagination was integrated as another mechanism for explaining resemblance among generations [Reference Smith17]. For this reason, the alleged power of maternal impression was often resisted and criticised by scholars who highlighted instead the stability of natural processes and their relative impermeability to the direct effect of accidents or emotions [Reference De Renzi, Mueller-Wille and Rheinberger18].

Although scientific debates became more cautious in connecting abnormalities to maternal misconceptions, seventeenth- and eighteenth-century medical and midwifery texts, both technical and popular, continued to offer harsh prescriptions to control pregnant women. Unknowingly building on old humoralist tropes of maternal permeability, they taught women that their wombs were sensitive to the external world ‘as our senses are’ and that ‘whatsoever moves the faculties of the mother souls may do like in the child’ [Reference Sharp19]. John Maubray, in his influential treatise The Female Physician (1724), also claimed that when the soul is ‘elevated and inflamed with a fervent Imagination, it may not only affect its proper Body, but also that of Another’. Therefore, pregnant women were encouraged to ‘suppress all Anger, Passion, and other Perturbations of Mind, and avoid entertaining too serious or melancholic Thoughts; since all such tend to impress a Depravity of Nature upon the Infant’s Mind, and Deformity on its Body’ (1724 cited in [Reference Shildrick20]).

1.3.1 Pre-eugenic Thinking in the Biblical and Talmudic Tradition

Moving to the East Mediterranean and what is today the Middle East, we can see how tropes around maternal impression often took a different form within debates on paternal and maternal power to shape heredity. In the Jewish tradition, for instance, what emerges more vividly is the possibility to control and optimise reproduction through impressions, particularly at the time of conception rather than during the whole pregnancy. The Torah offers a clear and oft-cited example. Jacob, the grandson of Abraham, uses something akin to maternal impressions to generate spotted sheep. Genesis (Reference Furth30, Reference Richardson37–Reference Kamata39) says:

While Midrashic disputes or Talmudic commentaries refer to this episode to exonerate white mothers having a black child or vice versa [Reference Kueny22–Reference Preuss24], in later rabbinic commentaries (14th CE) the passage in Genesis is taken as a platform to suggest a positive possibility of control of heredity among humans:

An interesting albeit anecdotal variation to this quasi-eugenic theme (in the sense of better birth) can be found in a story about the famous Rabbi Yohanan (first century) who apparently justified to other rabbis his frequent attendance of Roman public bathhouses by claiming that ‘the sight of his physical beauty’ would cause women who ‘washed before intimacies with their husbands … to conceive handsome children’ [Reference Barilan26]. The focus on preventing negative effects, instead, is highlighted by a story in the Talmud of the anxious precaution of a rabbi who only made love to his wife in darkness, so that at the moment of copulation he would not set his eyes on another woman ‘begetting sons who are as bastards’ (cited in [Reference Doniger and Spinner12]). At least in this case, it is the man and not the woman the possible channel through which impressions or emotions may shape a child’s nature.

Finally, Moses Maimonides’ work (1135–1204) also emphasises the potential usage of maternal impression to achieve a good or better birth. In his medical aphorisms on Greco-Roman medicine, he writes [Reference Leigh7]:

1.3.2 Muslim Medical Views in the Middle Ages

Medical views in Islam are influenced by four parallel and somehow competing if not conflicting sources and traditions: the Greco (Unani)-Islamic tradition (Avicenna, Al-Razi, etc.); Aristotle’s highly influential view of generation and reproduction as determined mostly or only by the power of the male semen to control a recalcitrant maternal matter; Prophetic medicine (medical sayings attributed to Muhammad, which were later turned to a whole discipline); and ‘spiritual’ saintly healing. References to maternal impression are, however, somehow more contained. Key medical sources from the tenth and eleventh centuries – Al-Qurtubi, al-Rāzī, and Ibn Sina – are more worried about possible miscarriages caused by frightening emotions in women (or undue movement) than maternal impression or influence on the child morphology as such (see, for instance, [Reference Kruk28]). Two peculiar aspects of Islamic culture may have deflected the medical view on impressions. One is that the Islamic ban on portraits and statues at home limits the number of eccentric sights (mostly outdoor sights such as animals) (see [Reference Amster and Amster29]) that could influence a woman [Reference Kueny22]. The diminished impact of images is balanced by a stronger emphasis on smell. According to Ibn Sina, women could abort due to particular smells such as an extinguished candle. And if the smell of some peculiar food generated a craving that was not satisfied immediately, this would lead to a proverbial birthmark (in the shape of the food) or crossed eyes, a punitive sign that not enough attention has been paid to a mother’s desire. As commentators noticed, a penalty applied to all tenants of a building if a maternal craving caused by smelling food was not satisfied, illuminating the attention and care that should be reserved for pregnant women under Islamic rules [Reference Kruk28].

The second peculiarity of Islamic commentaries is their emphasis on a less permeable view of heredity that somehow ‘resembles’ a contemporary understanding. Indeed, Islamic medieval commentators developed a specific understanding of heredity that sidelined the direct power of impression and instead highlighted how ‘traits from distant relatives may skip generations and then suddenly appear in subsequent offspring’ [Reference Kueny22].

This is important to highlight to avoid a too-deterministic view of direct maternal effects as a ubiquitous monolith in pre-modern traditions. Besides medical advice such as the work of the Persian physician Ali ibn Sahl Rabban al-Tabari (d. 870) in his Firdaws al-Hikma (Paradise of Wisdom), similar notions can be found in the saying of the prophet Muhammad who explicitly advised fathers not to disown sons who look nothing like them because children frequently receive hereditary traits (naj‘a ‘irq) from distant ancestors, just as red camels oftentimes produce ashy-coloured offspring that resemble prior relatives [Reference Kueny22]. This is less to attribute to the Prophet a Mendelian view of heredity and more to highlight sociological pressures to avoid a too-easy dismissal of paternal responsibility from men and hence the risk of disintegration of the family [Reference Kueny22].

This is not to say that in medieval Islamic medicine there is no emphasis on and hence anxiety about direct environmental influences on the act of procreation and accordingly the quality of birth. Tenth-century embryological debates (Arıb ibn Sad (d. 980), in his Kita¯b khalq al-janı¯n (Creation of the Embryo)) are ripe with precautions about the presence of certain winds during coitus that may produce lazier or more delicate children, the importance of maternal and paternal mood at the moment of procreation (a happy soul strengthens the body, and a stronger body gives rise to more robust sperm), or avoiding intercourse with women who had refrained from sex for a long time [Reference Kueny22]. Both Islamic and Jewish medical traditions present different interpretations of maternal impressions developing out of their specific religious contexts. A shared similarity is the importance placed on the various senses at the time of conception to optimise reproduction, and a framing within legal-theological debates, while references to licit and illicit sexual intercourse and a patriarchal anxiety to control female desire are in continuity with the Greco-Roman experience.

1.4.1 Garbh Sanskar: Ayurvedic Education in the Womb

The concept of fetal education in Ayurveda is often evoked by the tragic hero Abhimanyu from the Indian classic the Mahabharata. In this epic, Abhimanyu learns how to enter an impenetrable city while within his mother’s womb [Reference Smith33]. Hindu myths express ideas about maternal impressions during conception or even prior to conception (see [Reference Doniger and Spinner12]). In Ayurvedic medicine, Garbh Sanskar, commonly translated as ‘education in the womb’, prescribes a regime for both men and women to conceive and birth a healthy child. Garbh Sanskar interestingly has cited the preconception period as a key component to producing healthy children and advises a variety of purification procedures and timings to ensure good-quality progeny. The focus is not solely on women, and men are included in the procedures and are thought to play an important role in conception.

The classical text, the Charaka Samhita explains how at conception the embryo is created by three factors: the mother, the father, and ‘the self’ or ‘life’. All three components are said to influence different organs and dispositions of the child [Reference Wujastyk34]. Here, maternal and paternal health both play an important role before conception, and men are required to undertake actions to produce good-quality semen. Semen, in classical Ayurvedic medicine, is viewed as the ‘highest essence’ generated by the body [Reference Wujastyk34]. Invoking an agricultural metaphor, the Caraka Samihita describes the need to prepare for pregnancy: ‘As seed (of a plant) does not sprout if affected by improper time, water, worms, insects and fire, so is the defective semen of man’ [Reference Samhita35]. For women, menstrual blood plays a similar, but not equivalent, role to semen and is a generative fluid that unites with semen at conception [Reference Wujastyk34]. After the time of conception, the focus shifts to the mother and her actions, behaviours, and nutrition.

1.4.2 Taijiao and Taikyō: Fetal Education in Chinese and Japanese Medicine

Classical Chinese medicine incorporates the cosmology of Yin and Yang. Yin is representative of qualities such as ‘darkness, cold, moisture … the moon, the night and the feminine’. Yang is representative of the qualities of ‘brightness, the sun, fire, warmth, activity and the masculine principle’. Yin and Yang were seen to regulate the bodily qi (fundamental energy) and any changes in the body [Reference Furth30]. In medieval China, the concept of fetal education reflected a particular interconnection between the womb and external stimuli. The sex of the child, for instance, was thought to be malleable during this indeterminate time, and the responsibility for the outcome rested upon the mother’s conduct [Reference Furth30]. For instance, in Song Dynasty texts, such as the Fu Ren Da Quan Liang Fang (A Great Complete Collection of Fine Formulas for Women) (1237 CE), the mother’s actions are described as impacting the attractiveness or intelligence of the child:

Taijiao or ‘fetal education’ (literally tai [fetus] and jiao [to instruct]) has roots in the classical text the Senior Dai’s Book of Rites (Da Dai Liji) and was later expanded upon by Liu Xiang (ca. 80–7 BCE), a Han Dynasty Confucian scholar, who claimed that the integrity of kings rested on the morality of their mothers [Reference Richardson37]. It has been part of Chinese gynaecology for centuries and returned periodically to prominence at certain historical junctures of Chinese stories, such as the early Republican era from the 1910s. Often, the specific nature of training in the womb reflected the importance of moral transformation within Confucianism and the wider belief that the outside environment could influence the developing fetus. Here, the fetus is responsive to stimuli provided by the mother through her senses, behaviour, emotions, and environment. Taboos, such as not eating or looking at rabbits (which would result in the child developing a harelip), reflect the belief in the ability of the fetus to absorb outside stimuli and incorporate them physically into their own developing body [Reference Richardson37].

The influence of the environment on the child is expanded in Japanese fetal education or Taikyō to include both parents and the wider society. Taikyō was introduced to Japan from China in the tenth century and, like Chinese medicine, was strongly influenced by Confucian ideas [Reference Yoshino38, Reference Kamata39]. In Japanese, Taikyō translates to ‘womb teaching’ and could be interpreted as teaching the pregnant woman or the fetus within the womb. Originally, the belief was that if a pregnant woman behaved appropriately, she would birth a man of great virtue [Reference Yoshino38]. Other texts such as the Onna chōhōki or The Record of Women’s Great Treasures, written by Namura Jōhaku in seventeenth-century Japan, show the progression of these beliefs and give an insight into ideas of pregnancy during the Edo period. Namura’s recommendations on Taikyō included wrapping the belly, prescribing types of food, and producing an ideal environment to bring about an uneventful birth and the health of the child [Reference Tanimura and Chart40].