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Even though it is known that hysterectomy has a profound effect that would render women more "tractable, orderly, industri- 25 physiological and psychological impact on a woman's life, why ous and cleanly". has it become the most popular non-obstetric procedure per- Given all those centuries of misinformation about the female formed on women? In order to understand this anomaly, it is body, it is small wonder that so many of today's doctors continue essential to understand the historical roots of medical science and to view the uterus as a troublesome, disposable organ. An extract gynaecology in particular. from a 1987 public information booklet on hysterectomy, pro- The Greeks invented the word hysterikos to explain "suffering duced by the Royal Australian College of Obstetricians and caused by the uterus" (hystera = womb), which they believed Gynaecologists, reassuringly states: included just about any physical or psychological malady imagin- "Women who have had an hysterectomy are delighted with the able. Hippocrates himself asked the question, "What is woman?", result. No longer do they have to plan their lives around their and answered it in just one word: "Disease." heavy or painful periods. No longer being anaemic, they gain By the 17th century, Christianity had embraced the notion that fresh energy and life is fuller and happier than it may have been whatever was 'wrong' with women—and this encompassed such for years."* non-medical 'problems' as sinfulness, sexuality and emotional- ism—was due to the reproductive organs they carried within ©THE HIGH COST OF A GYNAECOLOGIST them. Two centuries later, when modern medicine was in its It would be naive to think that the popularity of hysterectomies unscientific infancy, physicians fixed on the uterus as the source wasn't in some way related to the financial rewards for gynaecolo- of just about every complaint a woman might voice. gists. For example, Australian obstetricians and gynaecologists The 'science’ of gynaecology ‘blossomed’ in the mid-Victorian perform a great deal of surgery and earn higher incomes than era when attitudes to women were, at their most bizarre, a curious physicians, surgeons or medical practitioners. In 1991-92 the mixture of contempt and idealism. Women were thought of as overall average annual income for full-time obstetricians and pale, delicate flowers who wilted easily and required great care, gynaecologists was A$320,000 p.a., with at least 25 per cent of even in small matters—and preferably under medical supervision. them earning more than $550,000 annually from private patients It was also around this time that women were 'proven' to be alone. Added to this is income derived from sessional work pub- intellectually inferior to men. lic patients—often between $100,000 According to the popular 1 9th-centu- and $200,000 p.a.”” ry physician and medical philoso- In the US, gynaecologists, hospitals pher, Charles Meigs, women's heads It would be naive to think that and drug companies make more than were almost too small for intellect US$4 billion a year from the hys- but just big enough for love.” The the popularity of hysterectomies terectomy and castration business. prevailing theory cautioned women wasn't in some way related to In 1994, Dr West wrote of attend- against developing their intellect . . ing a seminar on medical economics: since it would cause the uterus to the financial rewards for "The topic was how to care for atrophy! 'Scientific studies’ pub- i women in order to maximise our fee. lished in the 1860s demonstrated that gynaecologists. The experts who led the discussion while blacks had smaller brains than reminded us that gynaecologists make whites, women had even smaller the most money by doing surgery and brains than black men! that the highest fee we can generate Gynaecology's early ignoble beginnings can be attributed to comes from hysterectomy. With that in mind, we were urged to James Marion Sims, who became widely known as the "father of ‘cultivate’ our patients carefully. Initially, care would require gynaecology". In the 1840s, Sims practised in the southern US advice on contraception. Then, in the normal course of events, we state of Alabama and began to experiment on Negro slaves. would supervise their pregnancies and deliver their babies. Once According to Sheila Kitzinger, "This man was able legally to take a patient had completed her family, we were advised to plant the possession of black women's bodies and perform surgery on them _idea that she might some day need a hysterectomy. The culmina- at will. He actually bought some of the subjects for his experi- tion of our years of care would be the hysterectomy. With proper ments. One woman endured thirty sessions of surgery without planning, our advisers suggested, each year of practice would pro- anaesthesia before Sims was satisfied with the job he had done. duce a lucrative 'crop' of women ripe for hysterectomy."* Sims became a hero for generations of obstetrician gynaecologists who followed him, many dreaming of worldwide fame." SAFER ALTERNATIVES TO HYSTERECTOMY The concept of the uterus as a ‘dominant organ’ controlling The removal of so many uteruses and ovaries would be more women's behaviour has obsessed gynaecologists for more than a understandable if there were no alternatives available to deal with century. They considered that conditions such as hysterical the problems for which the operation is performed. Fortunately mania, nymphomania, depression and even the "uncontrollable there are. In fact, it is stunning how often dietary, nutritional and urge to waltz" could be cured simply by removing the cause: the emotional/spiritual approaches can heal many of the problems. In uterus. This left the woman passive, happy and relieved of "the — many cases there are alternative procedures that, while far less cause of menstruation". drastic, are just as successful: In the years that followed the introduction of anaesthesia, a Fibroids: Fibroids are the primary reason why women in their woman was likely to find herself on the operating table for just 30s and 40s are recommended hysterectomies, and they occur in about anything her husband, father or doctor might decide was some 30 to 50 per cent of women. Fibroids are benign, non-can- wrong with her: overeating, painful menstruation, attempted sui- cerous lumps of the muscular wall of the uterus, composed of cide and, most particularly, masturbation, erotic tendencies or smooth muscle and connective tissue. They are rarely solitary promiscuity. The doctors of the day were convinced—and man- and never life-threatening, although at times they can become aged to persuade their patients—that hysterectomy had a calming uncomfortable and problematic. Most, however, cause no prob- effect that would render women more "tractable, orderly, industri- ous and cleanly". Given all those centuries of misinformation about the female body, it is small wonder that so many of today's doctors continue to view the uterus as a troublesome, disposable organ. An extract from a 1987 public information booklet on hysterectomy, pro- duced by the Royal Australian College of Obstetricians and Gynaecologists, reassuringly states: "Women who have had an hysterectomy are delighted with the result. No longer do they have to plan their lives around their heavy or painful periods. No longer being anaemic, they gain fresh energy and life is fuller and happier than it may have been for years."* SAFER ALTERNATIVES TO HYSTERECTOMY The removal of so many uteruses and ovaries would be more understandable if there were no alternatives available to deal with the problems for which the operation is performed. Fortunately there are. In fact, it is stunning how often dietary, nutritional and emotional/spiritual approaches can heal many of the problems. In many cases there are alternative procedures that, while far less drastic, are just as successful: Fibroids: Fibroids are the primary reason why women in their 30s and 40s are recommended hysterectomies, and they occur in some 30 to 50 per cent of women. Fibroids are benign, non-can- cerous lumps of the muscular wall of the uterus, composed of smooth muscle and connective tissue. They are rarely solitary and never life-threatening, although at times they can become uncomfortable and problematic. Most, however, cause no prob- NEXUS - 33 It would be naive to think that the financial rewards for gynaecologists. OCTOBER - NOVEMBER 1997