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Excuse me, has your womb wandered today?

July 22, 2011

For the ancients, men and women seemed to be separate species. At times, this idea was taken quite literally: from Hesiod, who claimed that woman sprang from a separate act of creation: Pandora, with her box of woes – to Plato who, behind pretensions of equality, ranks women as the second order of creation: lesser than men, but somewhat superior to birds. For others, women were a regrettable deviation from the typical human design: Aristotle called them a “natural deformity” from the basic pattern of maleness and the medical writer Galen called them a less perfect specimen. These views were entrenched in the medical theories of the day, in which women were seen as congenitally disordered and at risk of health issues which (surprise, surprise) could only be ameliorated by getting married and having lots of babies…

‘She’s just being hysterical’ is a phrase often used to justify the dismissal of women seen to be acting irrationally. The word ‘hysterical’ stems from the Greek hystera, meaning womb. Greek medicine believed the womb to be a sentient being, capable of having desires and thirsts, and of responding to smells. In the Timaeus, Plato suggests that the gods created the human desire for sexual intercourse by making the penis and uterus sentient entities. Like animals, these could be domesticated in some situations, but might also be wild and unpredictable, driven by desires. The uterus, if unoccupied, might wander around the body. In part, this belief in the wandering uterus was underpinned by the belief that the male body formed the basic template of humanity, and that its internal layout was the default – the female body was an aberration. As such, they thought the womb had no fixed place, unlike the penis, and therefore could not be tamed in the same way. Indeed, the simplest of actions could, it seemed, dislodge it. The book On the Diseases of Women warns that an overly forceful sneeze could displace the uterus, and that if a women was to overly physically exert herself, she would dry out her womb and cause it to go wandering in search of moisture. Like a skittish animal, it had to be lured and goaded back into place, with foul smells placed near the nose, and sweet ones near the vagina. This wandering could, it was believed, cause severe health problems for affected women, with the uterus impinging on the liver or lungs and impairing their function.

Such loosening and wandering might also take place because the female body suffered from the problem of not being able to process moisture as well as the male. The socially acceptable arrangements of marriage and childbearing were considered the best cures. If a womb was not anchored by a pregnancy or kept regularly moistened by sexual intercourse, it would wander. Thus, women not in a position to regularly be having sexual intercourse and becoming pregnant – young girls, widows, etc. – are characterised in the Hippocratic corpus as at an increased risk of illness. On the Diseases of Young Women suggests that before menstruation, excess blood might overflow from the already-full uterus and accumulate in the body, putting pressure on organs and endangering the girl’s health, making her feel suffocated and suicidal. The cure is sex, which will open up her tubing. By the time of later writers, such as Soranus, menstruation is seen as a sign that the womb is ready to carry out its function, and intercourse should not be practiced until then. However, pooling blood was still seen as a problem in young women, and stories abound of teen suicide sprees caused by lack of early marriage. Menstruation and childbirth were seen as opening up the connective channels of the female body, and rendering her flesh more absorbent, so that she could better manage her excess fluid. Although children seem to have been barely differentiated on the basis of sex in medical theory, puberty was a strongly defining moment, with the physical changes of the girl into a woman manifesting the true nature of her flesh, which took on its spongy characteristics, soaking up the blood that her body produced from the food she ate, preventing her from being overwhelmed by menses. Diseases of Women describes a woman’s flesh as being like waterlogged wool. The female breasts, like her menstruation, were a manifestation of this soggy inferiority: women’s inferior flesh could sag much more than men’s, and collect more blood – as blood pooling in the breast was believed to cause madness, this was another instance where female psychological inferiority was believed to be biologically predicated. The Hippocratics believed that food was processed by the body and turned into different products that were either consumed or excreted – into the latter category fell menstrual blood and semen. The male body was seen to be better at processing what it consumed – semen was the rarefied end product, while menses were surplus, a waste product that was soaked up from the stomach through the flesh and into the womb. If there was an excess of it, it would linger in the woman’s flesh where, like an improperly wrung dish sponge, it would fester. At the mercy of the strange, passionate creature that was her uterus, the woman was not fully in control of her mental faculties, and might at any time need the restraint of her husband or the assistance of a doctor. Making all women’s ailments pathologically related to their sex allowed for a medicalization of women that entrenched their social position. While advice about sexual intercourse for women is seen as an essential element of their overall bodily health, for men, such advice often merely appears in dietetic treatises alongside information on diet and exercise – a way of maintaining balance, but not the way – and one that could most often be administered by the man himself.

While the Hippocratic corpus claims that doctors must vigilantly be aware of the different ways that illnesses will manifest in men and women, Aristotle notes a variety of physiological differences. For example, he suggests that men have more sutures in their skull because their bigger brains require more ventilation, and that men and women have a different number of teeth. Women’s lack of body hair is explained by claiming that secondary hair growth is prompted by seminal fluids, which are agitated by the heat of the body at puberty. As women’s bodies were not considered to be as hot, they could not agitate seminal fluid in the same way, and thus it pooled around the genital region, while men became hairy all over. However, he also conflates elements of the anatomy, presumably on the assumption that the male pattern was the default, leading him to make no distinction, for example, between the vagina and the urethra!

The Hippocratic corpus generally goes to great lengths to look at the difference that various conditions might make to treatment, so perhaps the differentiation of men and women is not so surprising. In fact, when they are examined, a great deal more care is taken outside of the gynaecological works to differentiate patients by age, body-type and underlying health complaints than by gender. The book Airs, Waters, Places takes it for granted that men and women have different responses to disease-causing environmental factors. However, elsewhere, we find the assumption that certain elements of disease progress identically: the book Prognosis makes this blanket statement, but also notes that fevers progressed the same in men and women – even though this might seem to run contrary to the understanding that the Greeks had of the different temperatures of the male and female body. However, overall, the difference between men and women was considered to be so significant that if they were not taken into account, women’s lives might be put at risk. In On the Diseases of Women, the writers suggests that the doctor must carefully examine each case in a woman, and not just assume that it is the same as in men, for this puts women’s lives at risk. This differentiation may seem bizarre, but even if they pathologised the female condition, they Hippocratics did bestow to medical theory the professionalization of medicine for distinctly female issues relating to conception, menstruation, and childbirth, however backward many of their opinions may now seem.

As time progressed, there were some improvements in understanding. In the Hippocratic corpus, the woman and her womb are believed to be utterly passive in the process of birth. Rather, the birth and its painful pangs were thought to be caused by the thrashings of the infant trying to get out after its food supply ran out! However, by the Roman period, in part because of the practice of dissection, the process of birth was better understood, and in the writings of the physician Galen, we find an understanding of the uterus as being active in the process of birth. Blood also begins to feature less strongly – although it is still present. Post-Hippocratic Greek medical theory was not in any way dramatically revisionist, but a patchwork built up over Hippocratic underpinnings. Medical theory advanced with social change. In Euripides’ Medea, the titular protagonist bemoans the fact that women cannot say ‘no’ to marriage. In light of Greek medical thought, we see that one reason for this was that the social role of the woman was seen as necessary to maintain her health. By the time we get to the likes of later physicians and writers like Soranus or Galen, while many of the underlying Hippocratic ideas about the female body still remain, a woman’s sexual life is no longer construed as utterly inseparable from her general well-being. By the 1stAD, women, and especially women from the higher social echelons, had a great deal more freedom in their social and romantic dealings. Family size seems to have shrunk, women were more educated and, stemming from some cult practices, some women were even enacting voluntary celibacy. Sexual moderation or non-participation, which had always been a viable option for men, was now becoming viable for women too. As women began to gain more male opportunities, medical theory seems to have adapted. This is not to say that medical theory was substantially readapted – women were still primarily considered to be “a creature of excess”, who might dry up her womb make herself irrational if she deviated too strongly from the path of wife and mother.

The appearance of sexual abstention as an option for women appears most markedly in Christianity, where early ascetics rejected sex and family life to work towards the second coming of Christ. Before the creation of more ordered structures for such virgins or widows, we find well-educated women who, thanks to recent reforms of inheritance law, commanded their own resources, refusing to lose either their freedom or resources by marrying and instead forming proto-convents with other like-minded women, endowing churches, and corresponding with some of the foremost theological minds of the day. Women who were not tied into some kind of social construct of marriage, family and childbirth did not quite make sense in the ancient world: even the Christians themselves frequently either described such individuals as being in some way rendered male – the Gnostics believed that Jesus had rendered Mary Magdalene male, and there are many stories of desert ascetics dressed as and living as men – or they struggled to fit them into acceptable conceptual categories: before convents, many dedicated virgins lived with holy men – an arrangement that their pagan neighbours often regarded with great suspicion. For several centuries, the church argued about whether virgins were even “women” at all, for the letters of the New Testament which lay down proscriptions for women do so using the word gyne which, while meaning “(adult) woman” has the sense of “wife”. Like the suicidal teens of Greek medical theory, Christian virgins were a strange intermediate category that made society in some way uncomfortable. It is perhaps unsurprising therefore that we slowly find virgins adopting the marks of married women: rings, veils, and the idea of some kind of (albeit non-sexual) spousehood. Sexual and social control were ultimately linked, and as people in the ancient world understood it, the very fabric of the female body necessitated such control.

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