Unwell Women

1. Wandering Wombs
 
On the Greek island of Kos many centuries ago, a girl was taken ill. At first, she felt strangely weak, her chest heavy and tight. Soon she began to shiver with fever; pain gripped her heart; terrifying hallucinations swarmed her mind. She was found wandering the streets, so consumed by heat and hurt that she wanted to end her life. Throwing herself down a well or hanging from a tree by a noose would have been pleasant compared with the torment that wracked her body and mind. Her father called for the physician-a man trained in the arts of healing. The physician had seen this illness before in girls who had started to menstruate but hadn't yet married. As they developed into puberty, their plentiful female blood had been used up by growing. Once they had grown into women, all that extra blood accumulated in their wombs, ready to spill out every month. All physicians knew that this was how the female body stayed healthy. This girl was drowning in her own blood. It had no way to flow out, so it had traveled from her womb back through her veins, inflaming her heart and poisoning her senses. The physician urged the girl's father to marry her off without delay. Intercourse would open her body so that her blood would flow out, and pregnancy would make her healthy.
 
In another home on the island, an older married woman was seized by a violent convulsion. Her eyes rolled back, she ground her teeth, and saliva foamed in her mouth. Her skin was deathly cold; her abdomen wrenched with pain. Her husband called for the physician. This malady often befell women of her age who had stopped having sex and bearing children. He watched the woman writhe and sob and noted that her skin was clammy. The woman's womb, empty and dry because it wasn't being filled, had crept toward her liver in search of moisture. From there it had blocked her diaphragm and robbed her of breath. The woman was being suffocated by her own womb. Soon, the physician hoped, phlegm would flow from her head to moisten her womb and weigh it down. The physician listened to the woman's belly for the gurgling sounds of the womb returning to its rightful place. If it lingered too long near her liver, she would choke to death. If only she had been having sex regularly, she might have been spared this misery.
 
Women like this haunt The Hippocratic Corpus, a collection of medical discourse attributed to Hippocrates of Kos, the Greek physician known as the father of medicine, from the Classical era-the fourth and fifth centuries BCE. As a teacher and physician, Hippocrates revolutionized medicine. He debunked centuries-old superstitions that diseases were punishments doled out by vengeful gods. He taught that ill health arose from imbalances in the body, and he invented the patient case study, writing careful notes about the symptoms and course of a person's illness and prescribing herbal recipes as treatments. He vowed to treat all illness, in all people, to the best of his ability and to never abuse the body of any man or woman. Whether his patient was freeborn or enslaved, he promised to do no harm: Hippocrates's oath became the cornerstone of patient ethics, and it is still sworn by medical graduates today.
 
Hippocrates emphasized how women's bodies and illnesses needed to be dealt with very differently from those of men. He stressed how important it was for physicians to "learn correctly from a patient the origin of her disease" by questioning her "immediately and in detail about the cause." Many women, he remarked, suffered and died because physicians proceeded to treat their diseases like "diseases in men." But even though he acknowledged that the diseases of women required special and specific approaches to healing, Hippocrates was not exactly championing women's right to body autonomy and informed medical choice. The Hippocratic Corpus was written at a time when most women had few, if any, civil or human rights. In the patriarchal social order of ancient Greece, girls were the property of their fathers, and women of their husbands. They had no ownership over land, property, money, or even their own bodies. They were seen as weaker, slower, smaller versions of the male human ideal, deficient and defective precisely because of their difference to men. But in their difference, women possessed the most useful and mysterious organ of all: the uterus. Since women's sole purpose was thought to be to bear and raise children, their health was entirely defined by the uterus. Medical ideas reflected and legitimized society's control over the female body and its precious procreative power. Right at the very beginnings of Western medical history, in writings that would become the foundations of scientific medical discourse and practice, unwell women emerged as a mass of pathological wombs.
 
The Hippocratic Corpus was based on the teachings of Hippocrates, but it was actually written down by different physicians who followed him. In treatises like Diseases of Women, Nature of Women, and Diseases of Young Girls, Hippocratic physicians described many different symptoms that afflicted women, from puberty and the beginnings of menstruation to conception, pregnancy, and menopause. The idea that all women's diseases were related to their reproductive functions seems, today, like the worst kind of misogynistic conspiracy. But in ancient Greece, where women's entire social existence was defined by their uteruses, it made perfect sense that the disorders and dysfunctions of their bodies and minds would be too. And the Hippocratics didn't have much else to go on. Human dissection was prohibited, so they had no knowledge about where organs were precisely located, how blood circulated, or how respiration occurred. They didn't know about cells, hormones, or neurons. Their understanding of female physiology decreed that women's bodies were overly wet because they had too much blood. They came to this conclusion because women menstruate.
 
Physicians could interpret what was making a woman ill only through what they could see and feel. Limited knowledge and prevailing social attitudes led to a concoction of theories about the influence of the uterus on every aspect of women's health. Sometimes it was diseased; other times it caused diseases in different parts of the body, including the mind. It was both a channel and a vessel, and a woman was kept healthy if it was either releasing moisture or being filled with it. The cure for Hippocratic uterine pathologies, from the madness of suppressed menstruation to the horrors of womb suffocation, was as much social as it was medical: marriage, ideally by the age of fourteen, regular sex with one's husband-who was usually around the age of thirty-and multiple pregnancies. "I assert that a woman who has not borne children becomes ill from her menses more seriously and sooner than one who has borne children," wrote the author of the first tract of Diseases of Women. For the uterus would always start causing mischief if it was stifled by virginity, dried up for wont of male "seed," or not weighed down with child.
 
Women in ancient Greece were no more in control of their uteruses than they were any other aspect of their lives. The womb hungered for intercourse and pregnancy in a way that was always beyond the control of the woman it resided within. To govern women's biological destiny, physicians pushed the message the womb wants what the womb wants. From Hippocratic diagnoses such as "suffocation of the womb" came the idea that an unfulfilled, unemployed uterus could move out of place, wreaking havoc on the organs it reached, including the heart and liver, and causing a startling array of symptoms. Convulsions that resembled epileptic fits. Delirious visions. Loss of breath. Pain and paralysis.
 
Just after The Hippocratic Corpus was laid down, around the middle of the third century BCE, Plato, the great philosopher of Athens, described the womb as a living creature that became "vexed and aggrieved" if its desires for childbearing were not met. In his famous dialogue Timaeus, about the world, the universe, and everything in it, Plato conflated women's biological purpose with their apparently untamable sexual impulses, creating a mythology of a womb that wandered "throughout the body," blocking "the channels of the breath," bringing the sufferer to "extreme stress," and causing "all manner of disorders."
 
Around the second century CE, Aretaeus, from the Roman province Cappadocia, took Hippocratic teachings on "womb suffocation" further by proclaiming that the uterus was like "an animal within an animal." Its capacity to move "hither and thither" and its responsiveness to sweet and fetid smells meant Aretaeus decided it had appetites and inclinations all of its own. Herbal fumigations were often used as remedies to entice displaced uteruses back to their rightful place. An animalistic womb was erratic, its movements sudden and violent. It could float up and down and "incline to this side and that, like a log of wood." If a womb wandered enough to compress a woman's intestines or choke her throat, she lost all her strength, her knees collapsed, her head ached and swam with vertigo, and the veins in her nose pulsed with pain. If her womb was actually choking her, her pulse might weaken, and she could lose her speech and breath. In extreme cases, she suffered "a very sudden and incredible death" in which she didn't actually look dead but somehow remarkably brighter than she did when she was alive.
 
Medical writers of ancient Greece and Rome held many different views on the wandering womb. But the uterus, as the dominant force behind so many illnesses, diseases, and symptoms of women, was woven into them all. Women were under the dominion of male authority, and medical discourse legitimized this by making women's bodies subordinate to the whims of the very organ that defined their social purpose. Whether these physicians believed the womb literally wandered or just imagined it did, the idea that all women with uteruses were susceptible to becoming unwell because their bodies were hell-bent on making babies persisted for centuries.
 
As human civilization lumbered into the Middle Ages, the womb wandered with it. The decline of the Roman Empire plunged Europe into the Dark Ages. With the rise of Christian theology and mythology across the Western world from the first century CE, interpreted and spread through the gospel of Saint Paul, new punitive beliefs about women and their bodies ushered forth. The ancient Greeks had blamed all the sickness of the world on Pandora, the mythological first woman, who was too weak to resist opening the forbidden jar of evils that her husband, Epimetheus, was taking care of. Christianity spun a different story about women and their bodies being responsible for all the sin in the world. The book of Genesis decreed that Eve, the original woman, imperfect and incomplete from the get-go-and an afterthought spawned from Adam's rib-ruined everything because of her desirous and disobedient ways. Medical writings that survived the fall of Rome were closely sanctioned by the Church, so those very men who proselytized that women were universally deviant were also the ones in charge of teaching texts that claimed the female body was inferior, defective, and always governed by the whims of the womb.
 
Latin translations of ancient books on the diseases of women, housed in monastery libraries, taught male physicians-medici-about the influence of the uterus on women's illnesses. For most women of the common classes in the early Middle Ages, medical care was provided by female healers or midwives within their communities, who tended ailments and provided remedies along with delivering babies. But when a woman did see a medici, her symptoms were generally blamed on the "manifold and diverse" forces of the womb. Thankfully, some of the sources on women's diseases at least tried to offer a less dramatic view. One of the most popular volumes at the time was Gynecology, an exhaustive text attributed to Soranus of Ephesus, a Greek physician practicing in Rome around the first or second century, and first translated into Latin in the sixth century. Part practical guidebook for midwives, part treatise on the many and various disorders of the uterus, Gynecology derived from Soranus's more balanced, holistic view of human health. He didn't subscribe to the notion that women's biological differences meant they were naturally inferior and defective creatures, and he departed from the Hippocratic idea that women needed an entirely separate branch of medicine. This meant he didn't promote menstruation, sex, and pregnancy as catchall cures for women's diseases, although he did believe that a proper understanding of gynecological complaints was crucial when caring for women.
 
Illness, for Soranus, was a universal human condition caused by different states of relaxation and constriction within the organs and systems of the human body. He found the notion of the wandering womb fairly implausible: "For the uterus does not issue forth like an animal from a lair." Attributing such impulses to the womb was, in his teaching, an impediment to women's healing. He found the ancients' belief that the uterus would return to its rightful place if a woman inhaled "bad odors"-including cedar resin, burned hair and wool, extinguished lamp wicks, charred deer horns, and squashed bedbugs-faintly ridiculous. And he held a dim view of the ancient Greek philosopher Xenophon, who, around the time of Hippocrates, suggested banging metal plates together and making a huge racket so the uterus would flee back in fright. Diseases like "womb suffocation" were caused by the uterus being constricted with inflammation from menstrual problems, difficulties in childbirth, miscarriages, and menopause. This could cause intense sympathetic pain in the abdomen, fevers, weakness in the limbs, and "convulsive contractions" that "seized the senses." But it didn't drive a woman into a fit of apoplectic mania resembling epilepsy, as the Hippocratics claimed. In fact, Soranus thought that the whole fumigation business actually caused many of the symptoms associated with womb suffocation, like torpor, and that remedies including "forcing air by means of the smith's bellows into the vagina" damaged rather than healed "the inflamed parts." His suggested treatments were altogether more sensible. He recommended laying the woman down in a bright, warm room "without hurting her," placing warm compresses on her belly, and gently straightening out her cramped limbs. If the "paroxysm" continued, he didn't send her off for a roll around the marital bed. He encouraged restoring her health through exercise and "promenades," light gymnastics, baths, anointments with oils, various "pungent" foods, vocal exercises, and reading aloud.

Medieval Christian moral laws forbade medici from physicallyexamining any woman. The female body was shrouded in secrecy and shame, and not only to the eyes and hands of male physicians. Women themselves wouldn't have dared reveal intimate details to men about what was going on in their own bodies. Some medical writers of the time echoed these sentiments, including one who referred to women's gynecological complaints as "her disgrace." In the foundational Hippocratic writings in Diseases of Women, the shame felt by women patients, especially those who were young and lacking in experience, was identified as a barrier to their receiving accurate care and treatment. Although the Hippocratic authors advised physicians to ask women about the cause of their illnesses, they also believed that their sense of shame-coupled with their ignorance about medical matters-meant they should not necessarily be trusted as reliable narrators of what was happening in their own bodies. The "diseases of women . . . are dangerous . . . and difficult to understand because of the fact that women are the ones who share these sicknesses . . . For women are ashamed to tell even if they know, and they suppose it is a disgrace, because of their inexperience and lack of knowledge." Without the kind of intense questions that only the authoritative male physician could ask, a young woman's disease might well become incurable. But if she was older and had a decent amount of experience with "diseases that come from the menses," then her own testimony might be taken more seriously. But ultimately, even when medical men were forbidden to touch women's bodies, it was male-authored knowledge that determined how they might be healed.