Whether we’re anxious about a potential illness or expecting a baby, being cared for by a professional who’s empathetic and inspires our confidence is a comfort. My experience with women healthcare practitioners has been positive. There’s a built-in understanding when I explain how I’m feeling. They’ve never invalidated my concerns.
Women practitioners have treated me as a whole person, not a jumble of body parts.
As a historical fiction author who’s interested in women’s lives, I’m always thinking of the past. This leads me to wonder about the care and understanding that women did—or didn’t receive—from male physicians before the prevalence of licensed female doctors.
I recently read Lisa See’s historical fiction, Lady Tan’s Circle of Women, a story inspired by Tan Yunxian (1461–1554). Tan was one of a few women physicians during China’s Ming Dynasty and the first to publish a medical book. Women doctors and authors faced credibility issues. In the prologue, Tan wrote, “I beg readers’ indulgence and ask that they do not laugh at me.”
In the novel, I was struck by an account of a male doctor caring for a pregnant patient. Male doctors weren’t allowed to touch female patients, nor could married women be treated in the absence of their husbands. With the doctor seated on one side of a screen and the woman on the other, her husband acted as a go-between, posing the doctor’s questions to his wife and then repeating her answers to the doctor.
What quality of treatment did women receive under that kind of restriction?
With the 17th-century introduction of forceps aiding in difficult births, male doctors took over delivering babies in hospitals. Being attended by a male doctor became a status symbol for pregnant women, and the popularity of midwifery and home deliveries fell out of practice.
William Smellie (1697–1763), obstetrician and author of A Treatise on the Theory and Practice of Midwifery, is credited with developing and promoting the proper use of forceps. He wrote that fetuses were “passive” and that women were too weak to give birth without physicians’ assistance. A woman was capable of “squeez[ing] her Uterus,” but once the cervix had dilated, she’d be “unable to continue this effort for any length of time, from the violence of the pain it occasions, and the strength of the muscles being thereby exhausted and impaired.” At this point, the male physician would assume control.
A fine bit of mansplaining. My heart breaks for what women have medically been subjected to. More to come about Smellie’s ethics.
Misconceptions about women’s bodies throughout history were the topic of conversation when author Helen King discussed her book Immaculate Forms: A History of the Female Body in Four Parts with podcast host Ann Foster of Vulgar History. “Ancient Greek medicine was used up to pretty well the 19th century as a basis for what the body is about,” says Helen. “Modernity is quite recent. The same sorts of beliefs that, for example, a woman’s body only has a finite amount of blood in it, and if you use up your blood by thinking, using your brain, you haven’t got enough left to make babies out of.”
Since ancient Greek times, doctors have believed that the womb migrated to different locations within the body—hence the term wandering womb. In the 1600s, the wandering womb was synonymous with hysteria. (Insert female rage here!) The term uterus wasn’t uttered publicly but instead was referred to as the mother.
Curiosity about the wandering womb led me to a medical book in my antique collection. I checked The Practical Home Physician Illustrated, published in 1884, written by a collection of male doctors from both the United States and London, England. No wombs were wandering here, but I did find mention of displacement of the womb caused by stretching during the process of pregnancy and giving birth. Doctors also blamed the weight of clothing “suspended at the hips” and “the pressure of a tight corset.”
What great irony! Women endured skirts and crinolines weighing up to 15 pounds and tightly laced corsets in the name of pleasing the male gaze.
Another condition, referred to as falling of the womb and known today as a prolapsed uterus, was attributed by doctors to age, “improprieties of dress,” and “inflammation of the womb consequent upon imprudence during menstruation.”
Impropriety? Imprudence? Those words are loaded with blame.
Surgery was a rare treatment option in the 19th century because the risks to women’s lives outweighed any temporary benefit an operation might offer. Instead, to achieve the “replacement of the womb to its natural position,” women were advised to remove the weight of clothing from their hips and to alleviate pressure on their stomachs. Even so, it was recommended that the patient wear corsets suspended from their shoulders. (See the health corset in the above diagram.) These measures, doctors said, would block anything internal from prohibiting the womb’s return to its proper position.
The Practical Home Physician Illustrated also advised that if these strategies were not helpful, a “local mechanical means” might be acquired in order to do the job. They recommended the use of a pessary, refined versions of which are still in use today. Wikipedia describes a pessary as a prosthetic device inserted into the vagina for structural and pharmaceutical purposes.
The earliest mention of pessary usage dates back to a third-century papyrus fragment that documents part of the Hippocratic Oath attributed to Hippocrates (460–370 BC). Women have suffered through pessaries made of materials like gold, silver, waxed cork, and porcelain. Before Charles Goodyear (yes, of Goodyear Tires!) patented his durable and flexible rubber in the mid-19th century, pessaries were also made of wood, leather, or glass. Oh dear!
The doctors who authored this book wrote, “the [pessary] may give considerable pain and discomfort.” I would imagine so!
In 1860, gynecologist Hugh Hodge recommended that pessaries should be made of “incorruptible material, maintain the normal uterine position, allow for natural movement, be worn without pain, and not excite leucorrhea or menorrhagia.”
An ever-increasing number of pessary designs flooded the marketplace. Fortunes were made by gynecologists who inserted pessaries and those who removed them.
New Hampshire State Medical Society President W. D. Buck made this tongue-in-cheek comment at a conference:
“The Transactions of the National Medical Association for 1864 has figured one hundred and twenty-three different kinds of pessaries, embracing every variety, from a simple plug to a patent threshing machine, which can only be worn with the largest hoops. They look like the drawings of turbine water-wheels, or a leaf from a work on entomology. Pessaries, I suppose, are sometimes useful, but there are more than there is any necessity for. I do think that this filling the vagina with such traps, making a Chinese toy-shop of it, is outrageous.”
Oh yes! An interesting side note about William Smellie, mentioned earlier in this piece. Smellie’s competitors questioned how he had access to so many deceased bodies for medical research. His fear of being tried in court and possibly executed drove him to suspend his work for years. Even as recently as 2010, it’s been suggested that Smellie procured the murders of several pregnant women and used their bodies for dissection and experimentation to further his career.
Sources:
https://vulgarhistory.com/2025/01/22/the-tits-out-history-of-womens-bodies-with-helen-king/
https://pmc.ncbi.nlm.nih.gov/articles/PMC3236436/
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