Using Votives to Visualize Reproductive Anatomy in Antiquity

Shrine to Madonna del Perpetuo Soccorso
in Largo Preneste (Roma) - Photo taken in
2007 by K. Killgrove.
A few blocks from my apartment in Rome was a shrine to the Madonna del Perpetuo Soccorso (Lady of Perpetual Help) in Largo Preneste.  Every day in the summer of 2007, I walked or rode by it on my way to study the skeletons of the ancient Romans.  This is not the home of the original Byzantine icon of the same name - although that does reside in Rome - but rather a roadside shrine, located at a busy intersection near a major public transportation stop in the outskirts of the city.

The shrine to Our Lady of Perpetual Help includes flowers, candles, and dozens of plaques - mostly made out of marble - giving thanks for prayers that have been answered.  Some are simple: Grazie, thanks.  Some are spelled out: Per grazia/e ricevuta/e, For the blessing(s) received.  And some just employ the shorthand: PGR.  Many include a date and a name as well.

Every time I passed this shrine, I was struck by the pathos of one plaque in particular.  It reads PER GRAZIA / RICEVUTA / : SABINA / ROMA, 1972 and is unique to this shrine because it includes a drawing of a stomach:

Detail of the shrine.
Photo by K. Killgrove, 2007.
This tradition of dedicating a body part to a divine figure, however, is not unique to Roman Catholicism.  In fact, the practice may date back quite a long time in Italy and in other parts of the world.  In the Greek world, so-called Asklepions dedicated to the god of healing have produced treasure troves of anatomical offerings from people desperate to be cured of their bodily afflictions.  And there are more than one hundred similar sanctuaries in Italy, just in the area from Etruria to Campania, dating to the 4th-1st centuries BC (Turfa 1994).  These Etruscan and early Roman objects are generally terracotta and are often mold-made, meaning the creation of anatomical votives was a steady business, but others were more crudely fashioned, probably by the individuals themselves.  Offerings of various forms have been found, from swaddled babies to limbs to internal organs.

There's rather a large literature on votives in the Etruscan and Roman worlds, but researchers continue to question the purpose of anatomical votives, to try to suss out the ancient understanding of anatomy through identification of body parts, and to retro-diagnose the population based on the form and abundance of anatomical votives at healing centers (e.g., Cruse 2004).

This week on the blog of the Wellcome Collection, Catherine Walker writes about an object that has been identified as a Roman clay-backed uterus (dating to around 200BC-200AD).  Specifically, she notes:
This observational understanding of medicine provides an interesting perspective when looking at the votives we have in the gallery. The knowledge of what was going on inside the body was limited, so what couldn’t be observed would have been assumed. If we take the votive uterus pictured above as an example, we can see that there was little knowledge of what the organ actually looked like. Autopsies would not have been carried out at this time; there are isolated cases in third-century BCE Alexandria, but these are not the norm. The form of this votive is based on assumptions and what observation could have been made. They would have been aware of the function of the organ and could have observed childbirth, so we see that this understanding has been incorporated into the votive as the wavy lines represent contractions.
The question remains, though, should we assume a lack of knowledge on the part of the ancients, or should we question our assumption about what body part this represents?  Either way, we can arrive at different interpretations of this object.

If the Etruscans and Romans really had no understanding of internal anatomy, can we safely say that this depicts what we know to be the uterus?  That is, in modern anatomical knowledge, we understand the uterus and the vagina to be separate parts of a woman's reproductive anatomy.  The vaginal walls are somewhat ribbed and the vagina terminates in an opening - is our assignment of the anatomical votive above to a uterus simply our assumption that reproduction was the most important gynecological problem for ancient women?

And yet the Etruscans and Romans knew a great deal about childbirth (and depicted it in ceramics), even if their understanding of the internal workings of the female reproductive system was shaky.  Pretty much every woman - and probably lots of men - would have seen or attended a birth and would have been familiar with the delivery of the placenta.  Could this votive object represent the placenta, which can be rather veiny and bag-like?  Or perhaps it's a conflation of the uterus, placenta, and vagina?  In a time before modern medicine and birth control, many women (and female domesticated animals) may have seen their own uterus if they suffered from uterine prolapse, which can look similar to the votive above (I'll let you google-image search that on your own, though).

Even among experts, the assignment of votives to specific parts of the human anatomy is problematic.  In her review of the publication of the votives from Punta della Vipera, Jean Turfa (2004) writes that:
One model type, G11 (83-84, pl. 33,a) has often been identified as a bladder, but it closely resembles models found at Rome and Veii that must represent testicles; the Vipera version does have a different base or backdrop, however. Although they appear extremely stylized, sometimes described as cones or phallic markers, C.'s category G12 are, as she notes (84, pl. 33,b), intended to represent human hearts. 
One category remains problematical to all of us, C.'s G10 (82-84), identified as intestines. I now am convinced that this low-relief, oval model with undulating contours and central, teardrop-shaped organ, is in fact a deflated uterus, perhaps depicted as if just emptied of its fetus and still contracting back to normal shape. As C. notes, I originally identified the type as intestines, based on an example in the British Museum, but later amended the classification. The extra organ could be a vestigial uterus as on "normal" uterus models, or it could be a bladder or other appendage. Some examples seem to show the cervix (pl. 32, e); while the path of the intestines rendered on polyvisceral plaques can be traced, the folds on these smaller plaques are simply decorative and symmetrical.
So even experts disagree about whether something represents a bladder or testicles, whether a votive is a penis or a stylized heart, and whether an object is a uterus or intestines.  That's a lot of disagreement on pairs of organs that really look nothing alike.  Many of these articles on anatomical votives want their explanation both ways: the Etruscans/Romans didn't understand anatomy, so they depicted what they thought it was; we are reaching for the closest analogy to our modern understanding of anatomy, with the assumption that these votives are supposed to be anatomically correct.  The circular reasoning employed is a bit confusing and diminishes the attempt to understand ancient medicine and anatomy.

Figure 1 from Baggieri 1998.
The most convincing bit of evidence for assuming this anatomical votive is a uterus, though, comes from the Etruscan site of Vulci (Cruse 2004).  More than 400 anatomical votives of what appear to be wombs were found - all similarly shaped, but some with an opening and some with a closed end.  Intriguingly, these models were x-rayed, and in nearly all of them, a small clay sphere around 1cm in diameter was found.  These objects have been interpreted as intra-uterine life, connecting the votive wombs with the problems of miscarriage and infertility (Baggieri 1998).

The Vulci votives are quite different looking than the Wellcome Collection example above, but they're also much earlier in date.  With such a lengthy tradition of anatomical votives, it is possible that the slightly more natural-looking wombs of the Etruscans evolved into the more stylized, flattened womb when the votives were mass-produced in Roman times. (It's always possible that they're bladders, though, and that the spheres are, more literally, bladder stones. I'm not sure if this possibility has been investigated.)

It's easy to assume that there is an unbroken tradition in the meaning and practice of anatomical votive dedication - from the 7th century BC Etruscan wombs to the 1st century AD Roman uterus to Sabina's stomach in 20th century Rome - but it's important to question this assumption in light of the growing body of information on health, disease, and ritual in ancient Italy.  I hope the June conference at the British School at Rome will yield some new information about anatomical votives in the ancient world.


Baggieri, G. (1998). Etruscan wombs. The Lancet, 352 (9130) DOI: 10.1016/S0140-6736(05)60686-1.

Cruse, A. (2004).  Roman Medicine.  Tempus.

Turfa, J.M.  (1994).  Anatomical votives and Italian medical traditions.  In: Murlo and the Etruscans, edited by R.D. DePuma and J.P. Small.  University of Wisconsin Press.

Turfa, J.M.  (2004).  Review of A. Comella's Il santuario di Punta della Vipera.  Bryn Mawr Classical Review 2004.06.44.

Yeomans, S.K.  (2008).  Medicine in the ancient world.  Biblical Archaeology Review e-feature. This post was chosen as an Editor's Selection for


Gloria H. said…
The modern tradition is very common in Greek Orthodox churches, where metal votive plaques depicting limbs, eyes, bouncing babies, etc. are often hung in the sanctuary. As you say, ancient Greek Asklepieia (esp. at Epidauros and Corinth) have also yielded molded votive body parts. One observation I would offer is that the body parts are (all?) perfectly healthy; that is, the votives are offerings in thanksgiving for maladies perceived to have been healed and display no deformity/illness (or at least evidence of such has been lost). In light of this, interpretation of bladder with gall stones seems incongruous--with the Greek tradition, in any case. As for the "deflated uterus" suggestion, again it would seem an unusual thank-offering for a successful pregnancy and delivery. One might expect a representation of a baby to be more appropriate iconographic choice--as we see in the modern tradition--but who knows? Interesting post!
Gloria - Thanks for the comment! You're right, I can't think of having seen any disfigured votives either. But that doesn't preclude a usage in prayer for healing: that is, the "normal" votive could be a wish for what the person wants his/her body part to look like. Also, disfigured votives wouldn't fit in with the mass-marketed types we see in ancient Italy.

All of these votives are incredibly interesting - I only recall seeing a few in passing in my many years taking classes in Greek and Roman art and archaeology - but the female reproductive organs are most intriguing (at least to me) since they're at the same time (and at different times) hidden from view and very obvious.

I want to read up more on anatomical votives, but I suspect there are thousands of pages on the topic... :)
I think you can find similar charms attached to Latin American rosaries or left at pilgrimage sites. They have a specific name for them but I can't recall it.

As for shape, I'm sure they would have seen the shapes of organs in butchered animals. They would have known that humans had similar internal organs from bad sword wounds that slice open the abdomen. As for the uterus, I image they would have done emergency C-section to save a baby (probably killing the mother, if she was still alive).
Michelle - I think you're right that comparative anatomy would have told them a lot. I'd think the Romans could link anything a female cow/sheep/pig suffered (e.g., prolapsed uterus) or had in her body to female humans.

Your point about caesarian sections is good too. The term dates back to around the 8th century BC, when the Lex Caesarea was passed by the second king of Rome, Numa. A pregnant woman wasn't allowed to be buried, so the law required the child to be cut out of its mother if she died (or was about to die) in childbirth. But it doesn't seem that mothers survived C-sections until a millennium later.

Actually, that makes me think... if the Lex Caesarea was really followed in all cases, we shouldn't ever find a female skeleton with a fetal skeleton in the pelvis. Now I'm gonna have to check to see what the bioarch data in the Empire says about that...
Jane Draycott said…
There was a case of a woman in Roman Britain who was buried with three unborn/newborn babies. If I remember correctly, one of the babies was buried next to the woman, while the other two were still inside her. It was covered on History Cold Case on BBC 2.

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