Hysterectomies: 2000 Years of Care & Coercion

Summary

Betwixt The Sheets: The History of Sex, Scandal & Society

Episode: Hysterectomies: 2000 Years of Care & Coercion
Release Date: April 8, 2025
Host/Author: Kate Lister
Guest: Eleanor Cleghorn, Author of Unwell Woman

---

In this compelling episode of Betwixt the Sheets: The History of Sex, Scandal & Society, host Kate Lister teams up with historian Eleanor Cleghorn to explore the intricate and often troubling history of hysterectomies. Spanning over two millennia, their conversation delves into the medical, societal, and ethical dimensions of this pivotal surgical procedure.

1. Introduction to Hysterectomy

Kate Lister kicks off the episode with a candid introduction, preparing listeners for a deep dive into the history of the hysterectomy. She sets the tone by highlighting the procedure's gruesome aspects and its profound impact on women's lives.

"Today is actually a bit of a spicy one. We are looking at the history of the Hysterectomy." — Kate Lister [02:01]

2. Early Records: Ancient Rome

Eleanor Cleghorn takes listeners back to ancient Rome, where one of the earliest references to hysterectomy is found. She discusses Seronis, a Greek physician who practiced in Rome, detailing the rudimentary and perilous nature of early surgeries.

"A physician practicing in ancient Rome was not going through the abdominal route and making a lovely clean incision. Let's call him an opportunistic hysterectomy performer." — Eleanor Cleghorn [14:22]

3. The 17th Century Case: Faith Raworth

The conversation shifts to the 17th century, highlighting the extraordinary and desperate case of Faith Raworth. Cleghorn recounts how Faith performed a self-administered hysterectomy in her garden to alleviate her suffering, showcasing the extreme measures women took in the absence of effective medical care.

"She shoves it back in there and it keeps falling out again... she simply had it, lies down, draws it forward, so pulls out and lops it off." — Eleanor Cleghorn [23:35]

4. 19th Century Developments: Rise of Gynecology

Moving into the 19th century, Cleghorn explains how hysterectomy became more common with the advent of gynecology as a specialized field. However, the procedure was fraught with high mortality rates, often due to infections and lack of anesthesia.

"Before the introduction of antiseptics and carbolic spray, hysterectomies carried a 7 in 10 mortality rate." — Eleanor Cleghorn [27:50]

5. Eugenics Movement and Forced Sterilizations

A significant portion of the episode examines the dark period of the eugenics movement, where hysterectomies were used as tools for forced sterilization. Cleghorn discusses how marginalized women, particularly Black, Native, and Indigenous women, were subjected to non-consensual surgeries under the guise of medical necessity.

"There were state-sponsored sterilization programs... targeting black, native and indigenous women." — Eleanor Cleghorn [37:29]

6. Modern Perspectives: Access and Autonomy

In contemporary times, the episode addresses ongoing challenges women face in accessing hysterectomies. Cleghorn highlights issues such as long waiting lists, economic barriers, and the paternalistic attitudes of medical professionals that continue to impede women's autonomy over their reproductive health.

"Women who really want electively HRT are finding that there are barriers and obstacles to having that." — Eleanor Cleghorn [44:29]

7. Gender Affirming Care: Hysterectomy in Trans Healthcare

The discussion extends to the role of hysterectomy in gender-affirming care for transgender men. Cleghorn emphasizes the importance of the procedure for autonomy and identity affirmation while noting the significant barriers in accessing such care.

"The WHO recommends hysterectomy in terms of gender affirming care... access to that kind of care is incredibly difficult." — Eleanor Cleghorn [49:19]

8. Ethical Considerations and Conclusion

Wrapping up, the hosts underscore the critical need for informed consent and respect for women's choices regarding their bodies. Kate Lister reflects on the enduring societal narratives that diminish women's autonomy, urging for greater recognition and support for women's reproductive rights.

"Women are still primarily seen as reproductive material... we are always seeing that we as women have to put ourselves second to that hypothetical husband, that hypothetical child." — Kate Lister [44:54]

---

Notable Quotes:

• "A hysterectomy is a surgical procedure to remove the uterus or womb." — Eleanor Cleghorn [06:34]

• "She kept shoving it back in there and it keeps falling out again... she simply had it, lies down, draws it forward, so pulls out and lops it off." — Eleanor Cleghorn [23:35]

• "There were state-sponsored sterilization programs... targeting black, native and indigenous women." — Eleanor Cleghorn [37:29]

• "Women who really want electively HRT are finding that there are barriers and obstacles to having that." — Eleanor Cleghorn [44:29]

• "The WHO recommends hysterectomy in terms of gender affirming care... access to that kind of care is incredibly difficult." — Eleanor Cleghorn [49:19]

• "Women are still primarily seen as reproductive material... we are always seeing that we as women have to put ourselves second to that hypothetical husband, that hypothetical child." — Kate Lister [44:54]

---

Final Thoughts:

This episode of Betwixt the Sheets offers a profound and often unsettling exploration of the hysterectomy's place in medical history and its lasting impact on women's lives. Through meticulous research and candid discussion, Kate Lister and Eleanor Cleghorn illuminate the intersection of medicine, gender, and societal control, urging listeners to reflect on the progress made and the challenges that remain in ensuring women's autonomy over their bodies.

---

Transcript

[Kate Lister]

Hi, I'm your host Kate Lister. If you would like Betwixt the sheets ad free and get early access. Sign up to History Hit with a History Hit subscription. You can also watch hundreds of original documentaries with top history presenters and enjoy a new release every single week. Sign up now by visiting historyhit.com subscribe.

[Thrive Market]

Worried about what ingredients are hiding in your groceries? Let us take the guesswork out. We're Thrive Market, the online grocery store with the highest quality standards in the industry. We restrict 1000 plus ingredients so you can trust that you'll only find the best high quality, organic and sustainable brands all free of the junk. With savings up to 30% off and fast carbon neutral shipping, you get top trusted groceries at your door and you can stop worrying about what your kids get their hands on. Start [e-mail] podcast for 30% off your first order and a free gift.

[Sleep Number]

They say opposites attract. That's why the Sleep Number Smart bed is the best bed for couples. You can each choose what's right for you whenever you like. You like a bed that feels firm but they want soft. Sleep Number does that. You want to sleep cooler while they like to feel warm. Sleep Number does that too. Why choose a Sleep Number Smart bed so you can choose your ideal comfort on either side. Sleep Number Smart beds start at $999. Price is higher in Alaska and Hawaii exclusively at a Sleep Number store near you. C store or sleepnumber.com for details.

[Paige]

Hey, this is Paige from Giggly Squad and this episode is brought to you by Nordstrom. Nordstrom is here to help you dress in a way that feels totally you with the best spring styles from Boho dresses and matching sets to must have bags and sneakers. Discover thousands of items from lots of your favorite brands like Mango Reformation, Veronica Beard and Farm Rio. It's easy too with free shipping and returns in store order pickup and more. Shop today in stores [e-mail].

[Kate Lister]

Hello my lovely betwixters. It's me, Kate Lister. How the hell are you doing? Well, I'm fine. Thank you very very much for asking and I'm so glad that you're here. Thank you for dropping by. Once again you are listening to Betwixt the Sheets. But before you can keep listening, I do have to tell you that this is an adult podcast spoken by adults to other adults about adult things in an adulty way covering a range of adult subjects. And you should be an adult too. Today is actually a bit of a spicy one. We are looking at the history of the Hysterectomy. So we are going to be covering very gruesome medical procedures like it's out there guys, it really is. There will be discussion about life changing illnesses, fertility and just about everything that you can imagine that is going to go with this particularly gruesome history. But if you're game, then I am game. Let's crack on. You are joining me in the kitchen of Dr. Ephraim McDowell. In 1809 in the small American frontier town of danville in Kentucky. Dr. McDowell, although he's called a doctor, his medical credentials are slightly dubious, is about to operate on 44 year old Jane Todd Crawford. Nothing particularly unusual about that. Although the operation will be performed without anesthesia and without anesthetic. But what is significant here is this will be the first successful ovaryctomy performed through the abdomen where the patient lives. Poor old Jane Crawford has to endure a 25 minute operation on Dr. McDowell's kitchen table where a 22 pound tumor is removed from her ovaries. Fucking yikes. Up until this point, anybody who had been attempting this particular operation through an abdominal incision, the result would almost always be the death of the patient. But as we're going to learn today, there had been many who were willing to give it a go and other ways of removing the womb and the ovaries. Oh, I told you it's going to be a spicy one. Right on with the show. What do you look for? A man.

[Eleanor Cleghorn]

Oh, money.

[Paige]

Of course.

[Kate Lister]

You're supposed to rise when an adult speaks to you. I make perfect copies of whatever my boss needs by just turning a knob and pushing a button. Yes, social courtesy does make a difference.

[Eleanor Cleghorn]

Goodness, my beautiful dime.

[Kate Lister]

Goodness has nothing to do with it, dearie. Hello and welcome back to Betwixt the Sheets, the history of sex scandal in society with me, Kate Lister. The hysterectomy is one of the most commonly performed surgeries today. And we wanted to find out more about the history of this operation. Who was the first person to undergo it? We know that Mrs. Crawford was the first person to survive an abdominal hysterectomy in 1809. But the history of this procedure goes back to the ancient world. And who better to ask about this than Eleanor Clegorn, the fabulous author of Unwell Woman. That we're all going to be unwell after this one. Deep breaths everybody. Let's do it. Hello and welcome back to Betwixt the Sheets. It's only Elida Clegon. How are you doing?

[Eleanor Cleghorn]

I am thrilled to be here. Thank you so much. For having me back. What a treat.

[Kate Lister]

Well, we had so much fun the last time you were on and people absolutely loved that episode. So we were definitely, definitely going to have you back. And what a topic to have you back for the history of the hysterectomy.

[Eleanor Cleghorn]

I know, I know, a huge topic. A topic that cuts across the politics of women's bodies, of reproductive medicine, of male dominated surgery. I mean, it really is a vast and fascinating and at times horrifying subject.

[Kate Lister]

Yeah, we should say that I will have issued a fair dues warning right at the top of the show, but I think we should just repeat it again that if anyone's listening and is eating a lasagne or something, just, just turn this one off because it's going to get gruesome, isn't it?

[Eleanor Cleghorn]

It might may well get gruesome. Yeah.

[Kate Lister]

As a complete starter question then, page one. What is a hysterectomy?

[Eleanor Cleghorn]

Well, a hysterectomy is a surgical procedure to remove the uterus or womb. And there are sort of three main types of hysterectomy. There is the total hysterectomy, which is I think the most common form of the procedure, and that removes the uterus and the cervix. The subtotal hysterectomy, or supracervical hysterectomy, as it's sometimes called, just removes the uterus, leaving the cervix in place. And the third type is the radical hysterectomy, which removes the uterus, the cervix, the ovaries and often surrounding tissue, sometimes parts of the vagina as well. So that is a radical operation that is would usually be performed when there are, say, cancers of the reproductive organs. And a surgeon needs to get really good margins to remove that malignant tissue in those tumors. So that's the most extreme form. Hysterectomies are also performed in different ways. So there's the vaginal hysterectomy, where the womb is removed through a cut at the top of the vagina.

[Kate Lister]

Didn't know that.

[Eleanor Cleghorn]

This actually, believe it or not, is less invasive than the traditional route, which is an incision in the abdomen, the abdominal hysterectomy, where the organs are then removed. Since the 80s when the technology was developed and into the 1990s when it was being practiced more often there's also laparoscopic surgery where tiny incisions are made and cameras go in. And that's another minimally invasive way. And as we look towards the future, of course there's robot technology. Robotic arms that go in really precisely.

[Kate Lister]

Robot giving you a hysterectomy. Wow.

[Eleanor Cleghorn]

Indeed, yeah. Robot hysterectomies may well be in our future, Kate. Who knows? So it's a complex, it's major surgery, it's performed in different ways and it's also performed for many different reasons, but principally to treat disorders and diseases associated with the female reproductive organs. So that could include uterine fibroids, which are benign, as in non cancerous masses of muscle and tissue. Can also be performed, as I mentioned before, as a treatment for different cancers also associated with the reproductive system. It can be performed postpartum if women have suffered injuries or bleeds or to the uterus and it needs to be removed. So that's important as well with prolapses. Prolapse has been suffered and there aren't other treatment options available. That's another reason. And of course it's also used for gender affirming care. Gender affirming surgery.

[Kate Lister]

My mum had a hysterectomy and she had. Because she had bad pms. And when I say bad, I mean like debilitating. That was in like the early 2000s. Ish. Oh, hello mum, by the way. Sorry, I'm giving out your medical history on the podcast, but I've often wondered if they would do that now because no matter how they do it, it's a big deal, isn't it? A hysterectomy is a big deal, whether it's vaginal or robotic or whatever it is. It's a big surgery.

[Eleanor Cleghorn]

Yeah, it's a major surgery and it has implications for your sort of long term health going forward because it's a long recovery. It can also cause symptoms depending on what kind of hysterectomy you have. So say you also have your ovaries removed as well. That is going to impact. Well, it's going to stop the production of estrogen from the ovaries. So people who have hysterectomy that includes removal of the ovaries, O theory otomie or oophorectomy as that's called, will stop producing estrogen from the ovaries. So that brings you into what's called a surgical menopause. So that's an immediate menopause. There are also other complications associated with just having the uterus removed and that can impact your hormones as well because of the way that the blood supply to the ovaries can be affected. And there are of course post operative risks, there are long recovery time, but it's really interesting that you bring up your mum having this procedure after suffering from debilitating menstrual pain or pain related to menstrual cycle, because that is another major indicator for a hysterectomy. And that's when someone has really, really been through it with pelvic pain, with pain related to periods, even with pain related to diseases like endometriosis. Sometimes this is. The hysterectomy is the solution because you just want to get rid of the source of that pain. But that is something that. Now we read more about how it's difficult for people who are suffering pain and being in pain to get these elective hysterectomies. So I'm sure we'll come on to this as well, the way that choice and consent comes into this operation. But, yeah, that is another. Another major indicator for having a hysterectomy is having been through debilitating pain.

[Kate Lister]

It's reasonably safe now, but it's 2025 at the time of recording and we've potentially got robots who are going to be doing this surgery. I'm going to take a punt and guess it hasn't always been safe, not by a long shot. And I'm also. I'm wondering, what are the first records of this procedure and why on earth would they be carrying it out throughout history? Because they wouldn't have known about things like endometriosis.

[Eleanor Cleghorn]

Yeah.

[Kate Lister]

So what. Tell me some of the earliest records, what was going on?

[Eleanor Cleghorn]

So one of the earliest sort of recorded discussions of hysterectomy appears in this book called Gynecology by a Greek physician called Seronis, who practiced in Rome, in ancient Rome in the first second centuries bce. And he wrote this book, he was really interested in obstetrics. He's treated a lot of daughters and wives of the elite families of Rome. So he was very keen on making sure that women were performing their social duty, having the babies. But at the same time, he really understood that menstruating, getting pregnant, carrying a baby to term, delivering a baby, were not, as he put it, healthful for women. So he was really aware of the fact that this uterus, this womb, was a sort of contentious organ. It could cause a lot of harm as well as, you know, provide the Roman populace with the babies it needed. So he talks about a hysterectomy being performed because of prolapse. So the patient's uterus are kind of fallen down into her vaginal canal. So he talks about how you can try all these different treatments. This Is Okay. So if. If your patient, say postpartum, or she's an older woman and she's experienced a prolapse, you can try all these treatments. So you can try fumigations, and you can try sprinkling the offending protruding bit of organ with salt and seeing if it kind of shrinks back up. You can apply tonics of astringent wine. If you've tried all these things, if you've done all this and it still won't go back and remain in place, you can either cut off part of the diseased protruding organ, or you can cut the whole organ away.

[Kate Lister]

So he'd be talking about that, like, through the vagina then, wouldn't it?

[Eleanor Cleghorn]

Yes. Yeah.

[Kate Lister]

Right. Okay.

[Eleanor Cleghorn]

Yeah. So to clarify, a physician practicing in ancient Rome was not going through the abdominal route and making a lovely clean incision. Let's call him an opportunistic hysterectomy performer. The organ had fallen down. And in order to sort of deal with that, if it couldn't be, I'm just going to say it, push back up in it would then essentially excise it, cut it off, and then sort of stitch it up. Now, the patient that Sarenus talks about in this gynecology book, I'm assuming, did not survive this operation.

[Kate Lister]

It doesn't sound like something that. I mean, blood loss, infection, sepsis.

[Eleanor Cleghorn]

Absolutely. I mean, the potential for death either during the procedure or immediately after was just extremely likely. I mean, he's. He's kind of talking about this as a case, but he also maintains that previous physicist physicians to him have performed this when women have survived, because he is of the opinion that there is some use for wombless women and wombless creatures.

[Kate Lister]

Thanks, Serenus.

[Eleanor Cleghorn]

Mm. He contends that if you don't have a uterus bothering you with all its menses and all its pain causing, then you can be stronger. And he uses the example of female pigs who've had hysterectomies.

[Kate Lister]

See, I was with him. I was with him there for a moment, and now. Now he's lost me again.

[Eleanor Cleghorn]

So, strange account of an early hysterectomy, but suffice it to say, there it is in the early literature.

[Kate Lister]

What's interesting about that is right from the ancient Greeks, I don't know where they got the idea from, but they seem to have come up with it is this idea of the wandering womb that they have that you have written about it. And it's basically this idea that all ill health in women can be located to the womb that whatever it is, if your nose is blocked, if your head hurts, if you've got a rash on your arm, it's all. The womb has done something. And this idea that it moves around the body, which for a while I thought was like an Internet joke, but that's actually what they thought when, like you get those odd historical myths. I was like, no, that was just. They really did think that.

[Eleanor Cleghorn]

Yeah, they did.

[Kate Lister]

Like the idea of cutting out a womb must have had particular significance for them.

[Eleanor Cleghorn]

Yeah. I think this is where the sort of tension or paradox or kind of frustration around hysterectomy kind of begins. Because on the one hand, yes, all of these kind of pathological ideas about women being controlled by this unruly organ that, you know, sits there in the pelvis, but if it isn't doing its job, if it's not busy, you know, conceiving or being pregnant, then it's going to start wandering around the body causing all manner of illnesses and diseases. So on the one hand it's this really sort of pathological organ, sort of beset with troubles and tragedies, but on the other hand, it's the organ that gives a woman her social value. It's the organ that in terms of our kind of patriarchal history, defines what a woman is, it defines her use. So I think what we find as we look through the history is this real tension between seeing this organ as the seat of so many problems regarding women's health, but also this kind of further to preserve it. Because without it, what even is a woman anymore? From a medical point of view, from a patriarchal medical point of view. So there's always this tension. So while there's a sort of fervor to solve problems by getting rid of the unruly organ, there's also a kind of fear and conservatism around it as well. And these two impulses kind of sit side by side as we kind of move forward into the 19th and 20th century when hysterectomies became, if not routine surgeries, then part of a surgical repertoire.

[Kate Lister]

I'll be back with Eleanor after this short break.

[Thrive Market]

Worried about what ingredients are hiding in your groceries? Let us take the guesswork out. We're thrive market the online grocery store with the highest quality standards in the industry. We restrict 1,000 plus ingredients, so you can trust that you'll only find the best high quality, organic and sustainable brands all free of the junk. With savings up to 30% off and fast carbon neutral shipping. You get top trusted groceries at your door and you can stop worrying about what your kids get their hands on. Start [e-mail] podcast for 30% off your first order and a free gift.

[Sleep Number]

They say opposites attract. That's why the Sleep Number Smart Bed is the best bed for couples. You can each choose what's right for you whenever you like. You like a bed that feels firm, but they want soft. Sleep Number does that. You want to sleep cooler while they like to feel warm. Sleep Number does that too. Why choose a Sleep Number Smart bed so you can choose your ideal comfort on either side. Sleep Number Smart beds start at $999. Price is higher in Alaska and Hawaii. Exclusively at a Sleep Number store near you. See store or sleepnumber.com for details.

[Paige]

Hey, this is Paige from Giggly Squad, and this episode is brought to you by Nordstrom. Nordstrom is here to help you dress in a way that feels totally you, with the best spring styles, from boho dresses and matching sets to must have bags and sneakers. Discover thousands of items from lots of your favorite brands like Mango Reformation, Veronica Beard and Farm Rio. It's easy, too, with free shipping and returns in store order pickup and more. Shop today in stores [e-mail] the last.

[Eleanor Cleghorn]

Thing you want to hear when you need your auto insurance most is a robot with countless irrelevant menu options. Which is why with USAA Auto insurance, you'll get great service that is easy and reliable, all at the touch of a button. Get a quote today.

[Kate Lister]

Restrictions apply. Is most of the records that we have then of what would be called a hysterectomy in really ancient medicine? Is that because of. Probably because of prolapse?

[Eleanor Cleghorn]

Yeah. I mean, the ones that I've read about because of prolapse. I think there are kind of occasional mentions as we move forward, but it's very rare to read about hysterectomy as we would understand it in the, say, medieval and early modern medical literature, simply because a procedure like that would have been a death sentence.

[Kate Lister]

It absolutely would have been, wouldn't it?

[Eleanor Cleghorn]

So the case of prolapse is interesting because that's when the organ, the offending organ, becomes visible and the possibility of removing it arises because it's kind of right there. It's like, what do we do with. It's a bit like cutting off, you know, the gangrenous leg or it's right there. It's sort of visible to see.

[Kate Lister]

So, all right, so we've got ancient doctors and they were coming up with mad stuff anyway about wombs and theories and all of this stuff, and one of the weirdest things about medical history throughout most of it is that they believed very much in the great hits, the great hits of medical theory that is all the Greeks. And it just didn't change for thousands of years. They all thought the same thing, they practiced the same stuff. So this idea of wandering wombs hangs on for a while, but when do we start to get sort of more detailed descriptions of what we would recognize as a hysterectomy today?

[Eleanor Cleghorn]

So one of the first and most kind of astounding, just kind of following on a little bit from the prolapse situation. One of the first and most kind of astounding descriptions of a hysterectomy that we've got in the medical literature appears in the 17th century in a collection of case studies by a rural doctor and also man midwife. So man who delivered babies in Derby and his name was Percival Willoughby and he was a friend of William Harvey, discovered circulation, you know, it was kind of a big deal. And he wrote up his case studies of women that he saw on the beat, you know, and he describes a woman, her name is Faith Raworth. And she was quaking about big heavy sacks of coal. And as she was lifting these sacks of coal, she felt it go. She heard the snap and the uterus falls out. And so she keeps shoving it back in there and it keeps falling out again. And after a while she just has enough. She's like, enough of this. So she goes out and she's much wearied and afflicted. Percival Willoughby writes by this. And off she goes into the garden. She just simply had it, lies down, draws it forward, so pulls out and lops it off.

[Kate Lister]

Holy mother of fuck.

[Eleanor Cleghorn]

Just performs autosurgery on herself. Performs her own hysterectomy in her garden.

[Kate Lister]

Hell face.

[Eleanor Cleghorn]

She bled copiously after this. She had just had it.

[Kate Lister]

She had had desperation of that.

[Eleanor Cleghorn]

She did not want this anymore.

[Kate Lister]

Do you think it's real?

[Eleanor Cleghorn]

I think so, yeah. I think that's the real story he talks about. So this Dr. Percival Willoughby treated her shortly after. She lost a whole load of blood. She was fainting, presumed dead. She was revived, he sewed up. So he treated the wound. He sewed her up with silk thread as best he could. But what had happened is that in her self performed hysterectomy, she'd actually injured part of her bladder as well. So she did survive for what he says, several years. Don't know what that actually means, but she had a terrible time for the rest of her life because she was. She was incontinent, and she sadly passed away without this ever being cured.

[Kate Lister]

God, the desperation of that.

[Eleanor Cleghorn]

Yeah, the desperation of it. And the. And it's all there, you know, her having to do this hard work. She's working. She's carrying sacks of coal. She's, you know, been described in literature as a peasant woman. You know, she's. She's trying to make do, trying to get by. And she has this problem for which there is really no cure.

[Kate Lister]

Then I can't believe that she survived that. That's incredible.

[Eleanor Cleghorn]

Yeah, she survived, but, I mean, what her quality of life was like, I really don't know because she was just constantly. Her bladder couldn't function. So this is one of the more kind of extreme and astonishing cases that appears in the literature. Thankfully, I don't have any accounts of horrifying auto surgery to regale you with, but we can all think about poor faith.

[Kate Lister]

I'm gonna do my pelvic floor exercises for the remainder of this interview, Eleanor, and advise everybody else to do the same, please. Holy shit. That's a crazy case. But at this point, are hysterectomies being performed as routine by medical professionals?

[Eleanor Cleghorn]

Not in the 17th century? So when we see hysterectomies becoming part of the kind of surgical. Of the repertoire of surgery is really in the 19th century, when gynecology becomes a specialism that male doctors are very, very interested in, and that male doctors are beginning to really monopolize. And something we probably talked about when I was here before is that, you know, the female reproductive system, with all its unruly attributes, all its vagaries, all its strangenesses, was kind of fertile territory upon which to perfect different kinds of procedures. And there were certain gynecologists in the US and in the UK who are very keen on surgery, on gynecological surgery. So it's really in the 19th century that we see hysterectomy become more common, and it's most commonly indicated for fibroids and for different cancers. What's really interesting, I think, about hysterectomy, you were mentioning earlier about the kind of Internet myths, because hysterectomy, the word hysterectomy and the word hysteria are linked together through the ancient Greek word hystera, which means womb. I think it's a real common belief that hysterectomy was this cure that male physicians were forcing upon women who were hysterical, and that whipping out a uterus was kind of common 19th century. Sort of Victorian practice for when a woman was, you know, uppity or, you know, refusing to do what a man said. I think to a certain extent this is more true with ovariotomy, which is just the removal of the ovaries, because hysterectomy in the 19th century, before the introduction of antiseptics and carbolic spray and safe surgeries, carried a 7 in 10 mortality rate.

[Kate Lister]

Oh, okay. Wow. And of course there wouldn't have been anesthetic, would there? Until. When did that start to come in?

[Eleanor Cleghorn]

No. So that's after the kind of end of late 19th century, chloroformin ether becoming more commonly used. But even after the introduction of some of those anesthetics, the hysterectomies were still performed, sometimes without anaesthetic.

[Kate Lister]

Why?

[Eleanor Cleghorn]

So the post operative complications were incredibly risky. Principally, people died of infection because where the cervical stump, they would use a kind of ligature so that it could drain. This is really not breakfast talk, is it? So that could.

[Kate Lister]

No, it's not, but keep going, Eleanor. We're down the rabbit hole now.

[Eleanor Cleghorn]

We are, we are. We can't get out. We're here. So the pus could drain. But of course, you know, this is the age of infection and not understanding how infection happens. So that was a huge complication of these surgeries and a huge reason why people lost their lives. Once physicians understood that if you cauterize the stump, which I think was popularized by a gynecologist called Thomas Keith, who was a Victorian Scottish gynecologist, and he figured out if you actually cauterize that wound, then there's less chance of post operative fevers, what we now know as infections, and that reduced the mortality rate. But it remained an incredibly risky operation and one that as far as I can see, was relatively conservatively performed. That said, I have found references to hysterectomy being recommended for women who were confined to lunatic asylums, principally with mania. And there was a very strange chap called Maurice Buck, Robert Maurice Buck, who was very, very interested in kind of cosmic consciousness. And he was also psychiatrist.

[Kate Lister]

This is exactly the kind of person you want to be your gynecologist. Brilliant, right? Okay.

[Eleanor Cleghorn]

You want a cosmic bro with a crazy beard to come along and whip it out for you. Morris Buck was a Canadian psychiatrist in the late 19th century, and he was the head of an asylum in Ontario, Canada, and in London, Ontario. And he reported in 1898 on a series of gynecological surgeries he'd done on just over 100 women at this asylum. And of those, 16 were hysterectomies, so mostly total, some of which tipped the ovaries as well. And he thought that a record of four recoveries was really good.

[Kate Lister]

How that, that's the worst bit is when you find these medical quacks that the way they're writing about it is they're so proud of what they've been doing.

[Eleanor Cleghorn]

Yes.

[Kate Lister]

And they say things like, oh, I've operated on 200 women. Why have you been doing that, you maniac? And they're so like, oh God, you're not gonna believe this thing that I've done. And only four people died.

[Eleanor Cleghorn]

The vain, glorious kind of delight. And this is one of the things I always found really horrifying when I was writing. Some of the more difficult material in Unwell Women was that gynecological surgeons in the 19th century are often so convinced of their own rightness of their mission and convinced of not only of their genius, but of their kind of ability to cure and help. When you look at the facts and figures, what you're seeing is kind of unimaginable suffering, much of it non consensual, much of it none involving any kind of informed consent. And of course, what is also pretty horrifying about performing these surgeries on women in 1890 who are in a lunatic asylum is that they wouldn't necessarily have had any idea what was happening to them. And they certainly wouldn't have given what we now would call informed consent.

[Kate Lister]

And you often see the medical ranks closing around it. I can't remember the exact details, but I read of a case, it was in America, it was in a lunatic asylum, and some poor girl had had both of her ovaries cut out by a doctor and she had died a few days later and the nursing staff had tried to get her parents in because she was calling out for them and it wasn't allowed. And basically they tried to go to the press and be like, this is, he did this and he shouldn't have done it, and da, da. And then they all closed ranks. The nurses were described as drunks, the woman was described as a hysteric who wouldn't have survived anyway. And the guy was allowed to carry on doing more of these operations.

[Eleanor Cleghorn]

That's the thing. I mean, they're saying that she wouldn't have survived anyway. You see this a lot like she wouldn't have survived anyway. This was the last resort. We were doing everything we could to say that this, you do read a lot, is that if a woman doesn't survive or she has terrible symptoms or she really suffers because of an operation deemed necessary by a male doctor that you know, it was somehow her own fault for not surviving, somehow her own fault for not recuperating.

[Kate Lister]

I'll be back with Eleanor after this short break.

[Thrive Market]

Worried about what ingredients are hiding in your groceries? Let us take the guesswork out. We're Thrive Market, the online grocery store with the highest quality standards in the industry. We restrict 1000 plus ingredients so you can trust that you'll only find the best high quality, organic and sustainable brands all free of the junk with savings up to 30% off and fast carbon neutral shipping. You get top trusted groceries at your door and you can stop worrying about what your kids get their hands on. Start [e-mail] podcast for 30% off your first order and a free gift.

[Sleep Number]

They say opposites attract. That's why the Sleep Number Smart bed is the best bed for couples. You can each choose what's right for you whenever you like. You like a bed that feels firm but they want soft. Sleep Number does that you want to sleep cooler while they like to feel warm. Sleep Number does that too. Why choose a Sleep Number Smart bed so you can choose your ideal comfort on either side. Sleep Number Smart beds start at $999. Price is higher in Alaska and Hawaii. Exclusively at a Sleep Number store near you see store or sleepnumber.com for details.

[Kate Lister]

What you start to get in the 19th century, and maybe it was in the 18th century as well, I'm not sure is this idea that you can control behavior, women's behavior by operating on them. And it's not a new idea that's you wandering womb ideas right back to the Greeks that it's everything that women do is because of their reproductive system. So you get this idea that if we take a bit out or if we do something to it, then we will be able to correct behavior that we don't like. From what I've seen, it's not very common actually, as you were saying. But taking out the ovaries or cutting out the clitoris was seems to have been more common than a hysterectomy.

[Eleanor Cleghorn]

I think it was because again, the mortality rate. Yeah, of course, yes, ovary otomie was still incredibly risky, but it carried a far lesser risk than full hysterectomy. And because the ovaries were kind of freighted with this sense that they were these kind of glandular centers of what made a woman a woman. So almost imagine that if her childbearing potential is there in her uterus. Her personality, her propensity for madness, her propensity for feminine mania is kind of contained in the sort of glands, right? And so there was a lot of Talk in the 19th century about things like ovariitis and ovarian stimulation and, and how, you know, the ovaries become excited and kind of radiate their discont all around the female body. So it's a very similar narrative to that of the wandering womb in ancient Greece, is that these mischievous little ovaries full of naughty femininity, you know, if you whip them out. But again, of course, coming back to the sort of central paradox of it all, is that it would again be difficult to become pregnant. So whichever way you're kind of taking Robin Peter K. Paul in the minds of these gynecologists, you know, what's more important? Allowing a woman who is deemed by the patriarchal medical establishment to go off and procreate if she's, you know, seen as being degenerate or deranged or over sexualized. Or is it better to remove her ability to become pregnant and have children?

[Kate Lister]

Which leads us very nicely to the subject of eugenics, which was obviously going to get itself stuck in here some way. So you've got, eventually, I think that this, I. Well, at least I hope so. At least my GP's never recommended it. The idea that if you cut bits of the reproductive system out that you'll be in better mental health, that kind of falls away. But this actually, you know, I think you can still see echoes of that, to be completely honest, up to this very day. But it's replaced again, but with this idea of control, because a hysterectomy, the complete removal of reproductive capacity, that goes straight to the heart of the early birth control movement, doesn't it?

[Eleanor Cleghorn]

It really does. And the eugenics movement, the idea that you could alter the childbearing body in order to achieve ambitions for population control, for state based population control. And it began in the early 20th century and sterilization orders. So this means that the state or an institution has permission essentially to remove somebody's ability to have children, both men and women, if they are deemed, you know, not useful to the increase of the further population. So this could include people who were deemed to have hereditary mental illnesses. This could include people who had disabilities, mental and physical disabilities. And it also overwhelmingly included black native and indigenous people and people who were socially and economically insecure. So the idea that the state, especially in the United States, could Conduct kind of state sponsored, federally sponsored sterilization programs in which doctors in institutions, so hospitals in prisons, in so called lunatic asylums could perform different kinds of surgeries to remove the reproductive ability of mostly women. But often too happen between sort of 1920s, going right up until the 19, late 1970s, 80s, and also, you know, continuing into our far more recent history as well. And around the civil rights movements and 60s and 70s, there were campaigns to end sterilization abuse in the United States and also to inform communities who are marginalized by the dominant culture. So we're talking about black women, women on welfare, native and indigenous women forced to live on reservations who were being sort of either coerced into having a hysterectomy or a tubal ligation, which is like having the tubes, fallopian tubes cut, being coerced into doing this in return for land, in return for health care, in return for welfare benefits, or they were going to hospital for what they thought was one kind of procedure. Say they had a fibroid, say they had intense menstrual pain and they were kind of told that this had to happen. You know, this is what you needed to happen was to have, say a hysterectomy in order for your long term health and then realizing what had happened and understanding that it hadn't been consensual. So on the one hand you have the sort of white dominated medical establishment in the early 20th century being very pearl clutching about the idea of removing a woman's womb if she was still of childbearing age. But then you have a sort of fervor to perfect this surgery and sort of perform this surgery on the bodies of women who you don't deem to be valuable in a reproductive sense. So it's really, really horrifying. And thankfully there is so much documentation so we can really learn about this history and extent of it. But there were orders that tried to be passed before the second world War in this country about eugenic sterilization. I mean, the eugenics board in this country, as you know, was, it was huge.

[Kate Lister]

So popular as well.

[Eleanor Cleghorn]

Yeah, really popular and popular kind of across the political spectrum. You see some very, very left wing, radical people immersed in radical politics who are really in favor of various different forms of eugenics.

[Kate Lister]

It's very disappointing in it when you, when you find them, you're like, oh, Virginia Woolf.

[Eleanor Cleghorn]

No, no, know, I know, like please not need, like immigrant, like these people, these kind of radicals and anarchists. And then you read that like, yes, eugenics. But I Mean, eugenics was a huge concept, a huge idea that kind of really did traverse the political spectrum and was seen as kind of a solution for perfecting this future of sort of strength and intellect and, you know, the. The best form of future generations. And of course, it had its most extreme abuses in Nazi Germany in. Where also hysterectomies were horrifyingly and harrowingly performed on women in the name of medical experimentation in some of the camps, which is another awful history that is there to be read about. Terrible thing. But I think important to. Really important to confront.

[Kate Lister]

It is really important to confront. And it becomes incredibly complex because by the time you get to the 1960s, there's a campaign for birth control for women to be able to control their own bodies and to have access to these things, but also running at the same time, parallel to that is a whole other community of women going, stop giving us forced birth control. Like, at the same time as white women were campaigning to have full access to the pill. I read recently that the pill itself was being forcibly administered to poor black children by the state government. And it's a really weird, like, oh, my God, like, the experiences going on here are so vastly different.

[Eleanor Cleghorn]

They are so vastly different. It's like contraceptive technologies. Our ability for people who can get pregnant to control our fertility is so incredibly important in terms of our autonomy, our rights. But at the same time, it's something that has been horrifically abused. And I think if we're looking at a kind of feminist history of things, two things can be true at once. We can appreciate things like the pill as being incredibly important for our liberation, a cornerstone of our liberation. And we can also appreciate that in order for us as white women to have access to these technologies, there is a history of suffering behind that. And we know also that, you know, the pill was unethically tested on many women in Puerto Rico. And Puerto Rico being, you know, the site of some of the most extensive sterilization abuses in the kind of mid century. What the hysterectomy is kind of. Hysterectomy is a brilliant thing for thinking around all of these tensions and all of these paradoxes and sort of examining the history of the hysterectomy really brings out, you know, these kind of stories. It's a perfect kind of telling tool, I think, for thinking about exactly what we mean when we talk about the history of reproductive medicine, because it just crosses over all of these sort of ethical questions.

[Kate Lister]

It really does. And it's still very complex to this day. And there's lots of different experiences within it. Like there's, you know, on one hand there's a very aggressive campaign that, you know, no, there should never be abortions and, you know, the pill's terrible and page and all this stuff. And then at the same time there are people trying to get access to full hysterectomies and they find that they can't get that.

[Eleanor Cleghorn]

Yes. So I was reading that in the early 2000s there was all these studies done to say that many, like a majority of hysterectomies being performed in the US and in the UK were medically unnecessary. And that women who, say, have fibroids or say, were suffering with, you know, extreme, extreme menstrual related pain or had diseases like endometriosis were being offered hysterectomy, like get it all out because it was more economically viable for things like medical insurance in the States and over here for NHS costs. So there was a lot of talk about hysterectomies being really overperformed. I think now we're in a situation where women who really want electively so a choosing tavist distract me say, like your mum, who suffered with, you know, that debilitating pain, are finding that there are barriers and obstacles to having that. Firstly in this country, because our, at present, our gynecological procedure waiting lists are astronomical. You know, we're really at a crisis point in terms of women being able to access gynecological care, treatment and surgery at the moment. And more and more women are having to turn to private healthcare in order to have hysterectomy. But more than resources, we're also still stuck with ideology. Right? So you read very often about women who are electing to have hysterectomy, who are fully informed about the benefits and the possible risks of this surgery, know this is what they want. Being discouraged or denied or refused a procedure because they are still capable of having children. And there was a case recently, I think, that was brought to the Senate in the us where a young woman who'd suffered from the most terrible menstrual related pain and mental health issues was told by her doctor, think of your future husband, think of your future children. So even now, I think, especially in the States, but also here as well, women are still primarily seen before you hit perimenopause and menopause as reproductive material. You know, we're always seeing that we as women have to put ourselves second to that hypothetical husband, that hypothetical child, and women who are happily child free or for whom you would rather not have the ability to biologically have a child than suffer. And, you know, quite honestly, when a woman says, you know, I understand, this is what I want, but always this cajoling, always this paternalistic kind of idea that you don't know what's best to you because primarily what you want is babies. So I think always this. And this is, I think, what links the ongoing campaign for full and accessible reproductive health care and abortion with something like collective hysterectomy. So it all comes down to what our society and our culture deems a woman's body is for a vessel for having babies.

[Kate Lister]

And it doesn't matter how much pain you're in, because, like, it can. When my mum had a hysterectomy, they just put her on hrt. After that, she was bouncing off the wall. She was having a marvelous time. Like, she couldn't believe that she had to wait this long for it, but she'd just been left like that for, for years and years and years. And I've got other friends that, that have endometriosis and they have been told that they're too young to have a hysterectomy and it just basically means that they have to be in pain most of the time.

[Eleanor Cleghorn]

I mean, the default condition, women have been told for centuries that the default condition, our default condition for existing in this female body is to be in pain. That that is our lot. You know, it's what God said to Eve in the Bible. It's what we were all cursed. It is our lot. And I think what we find in our culture and in medicine, but also in religious culture too, is that having babies is our reward for being in pain all the time. You know, yes, yes, we have to suffer the pain and the bleeding and the horror of existing in our bodies, but then we get the joy of the babies. And this is a payoff that, you know, we understand is complete bullshit. But it's still astounding to me that this narrative exists. It still exists. Think of your future husband.

[Kate Lister]

Think of your imaginary husband who's not here yet. How does this fit in with something like gender affirming care and surgery? Because that must be a very complex one. If, like, if there are women going, give me a hysterectomy, I'm in pain. And they go, no, no, no, but you might need it. You might want to use that like somebody who wants a hysterectomy because of gender dysphoria and they are trans, man. How does it fit in with that. What's the state of play with something like that?

[Eleanor Cleghorn]

Yeah, well, the who, the World Health Organization, recommends hysterectomy in terms of gender affirming care and recognizes it as a really important part of gender affirming care. And again, of course, incredibly difficult to actually access this level of gender affirming care, especially on something like the nhs. It's quite interesting actually, because the first case of a hysterectomy being performed for gender affirming care was in 1917.

[Kate Lister]

Wow.

[Eleanor Cleghorn]

With a man called Alan L. Hart, who was an American scientist who went to Stanford and was working as a laboratory assistant working on X rays, on using X rays to treat tuberculosis. And they went through a hysterectomy to live as their preferred identity as a man. But, you know, were found out to have been born, you know, identified as female at birth and were kind of sat from that position. Alan, you know, went on to be a really important figure in the history of tuberculosis. But yeah, I mean, it is incredibly important and again, just shows that the applications of hysterectomy are so sort of all encompassing in terms of identity and in terms of who one is. But yet again, access to that kind of care is incredibly difficult. And as we're seeing in the States at the moment, with, you know, the really, really worrying kind of prejudices and discrimination against trans people, non binary people, you know, access to that kind of care would become even more scarce. So again, incredibly important to understand that in terms of how we think about hysterectomy, what is most important is that people who can have it and who want to have it are given all the information, are given access to that kind of care and are able to make their own decisions for their own bodies and for their own long term health.

[Kate Lister]

Absolutely. Elna, you have been wonderful to talk to. Thank you so, so much for coming back to talk to us. You've been horrifying but fascinating. And if people want to know more about you and your work, where can they find you?

[Eleanor Cleghorn]

They can find me. At the moment I'm mainly on the Instagram. I'm Eleanor Cleorn over there. I'm also on the Blue sky place at the same handle. So yeah, come and say hi and thank you so, so much for having me. Kate, as ever, complete joy to talk to you.

[Kate Lister]

It was an absolute pleasure, thank you for listening and thank you so much to Eleanor for joining me. And if you like what you heard, get therapy. Nobody should have liked that, but it was an important listen, I think. So if you thought that it was an important listen. Don't forget to like, review and follow along wherever it is that you get your podcasts. If you'd like us to explore a subject, or maybe you just wanted to say hello, then you can email us@betwixt historyhit.com this month on the podcast. Don't miss our deep dive into the boys of history and an episode about one of my most favorite people from history, Nell Gwynn. That's right, Mama Nell, as I like to call her. This podcast was edited by Tom Delaghi and produced by Sophie G. The senior producer was Charlotte Long. Join me again betwixt the Sheets the History of Sex, Scandal and Society, a podcast by History hit. This podcast contains music from Epidemic Sound.

[Sleep Number]

They say opposites attract. That's why the Sleep Number Smart Bed is the best bed for couples. You can each choose what's right for you whenever you like. You like a bed that feels firm, but they want soft. Sleep Number does that. You want to sleep cooler while they like to feel warm. Sleep Number does that too. Why choose a Sleep Number Smart bed so you can choose your ideal comfort on either side. Sleep Number Smart beds start at $999. Price is higher in Alaska and Hawaii. Exclusively at a Sleep Number store near you. See store or sleepnumber.com for details.

[Paige]

Hey, this is Paige from Giggly Squad and this episode is brought to you by Nordstrom. Nordstrom is here to help you dress in a way that feels totally you, with the best spring styles, from boho dresses and matching sets to must have bags and sneakers. Discover thousands of items from lots of your favorite brands like Mango Reformation, Veronica Beard and Farm Rio. It's easy too, with free shipping and returns in store order, pickup and more. Shop today in stores [e-mail].