There is a disease which affects young girls, particularly around the onset of menstruation. It is known colloquially as ‘the horrors’, and its symptoms are evident. The disease makes adolescent girls violently aggressive, and commands them ‘to leap around, to fall down into wells and to hang themselves’ – to ‘take on a desire for death, as if it were a good thing’. Although, as with so many female complaints, the mind is affected as the disease progresses, the primary cause is physiological and connected to the bodily changes of puberty. ‘When the blood is flowing all the more copiously, because of nourishment and the increase in bodily size, and when the blood still has no means of egress, the blood leaps up from this surplus to the diaphragm.’ The cure: ‘my advice to young girls who suffer this is to have sexual intercourse with a man as soon as possible.’ Best of all, is to follow this with pregnancy and childbirth (where the blood really flows).
This description and analysis of adolescent illness comes from ‘On the Diseases of Virgins’, a short prefatory text transmitted under the name of Hippocrates in the large collection of writings known as the Hippocratic Corpus, and probably datable to the Classical era – that is, roughly contemporary with Sophocles’ Antigone, to take but one unmarried girl who leaps around, becomes violently aggressive and hangs herself. ‘On the Diseases of Virgins’ has become something of a test-case for the burgeoning field of ancient medicine. What view of the (female) body does this treatise promote? What does it tell us about the intellectual and social significance of medical theory, especially where the regulated care of women is concerned?
The female body seems to be imaged in the Hippocratic texts as a large central jar or tube, with mouths at either end, and a series of lesser, interconnected tubes or ‘ways’. The language of medicine still reflects this connection between face and vagina with terms like ‘cervix’, ‘the neck’, and ‘labia’, ‘the lips’, for the ‘lower mouth’. This direct passageway between lower and upper orifices provides the physiological explanation of tests for female fertility which suggest, for example, that you take a piece of garlic, insert it into a woman’s vagina at night, and if her breath smells in the morning she is capable of conceiving. For the tubes must be open if conception is to be trouble-free. The same assumption, the doctors carefully note, would explain why a woman’s voice becomes deeper after she first has sex. The flesh that covers this infrastructure is moist, porous, spongy and cold (unlike the male’s firm, hard, dry, warm body), and menstrual blood is the most telling sign of the female body’s inability fully to concoct its ingredients, just as the production of semen in the male is the sign of man’s greater ability to concoct (in all senses, one might add). The more blood that can be removed from this spongy mass, the healthier the woman. The young girl’s menstrual flow needs encouragement by unblocking the tube’s opening – hence sexual penetration and subsequent childbirth will cure the problem of what modern society would recognise as the norm of menstruation. As Helen King remarks drily: ‘In Hippocratic terms, most Western women today are very sick indeed.’
The construction of the female body of medical science starts here, then, and it would be hard to overestimate the influence of this authoritative model as it develops through Galen and Soranus in the Roman Empire, and through Christian attempts to purge the body’s softness and dampness with fasts and desert life, towards post-Enlightenment European science. It was Galen, after all, who still provided the textbooks against which Harvey wrote his revolutionary account of – precisely – the circulation of the blood. What is more, Hippocratic gynaecology, as King shows with some wonderful and terrifying examples, was still very much part of medical theory and practice in the 19th century. Fleetwood Campbell’s textbook of 1850, On the Diseases of Women, describes the phenomenon of ‘vicarious menstruation’ from the nose, eyes, gums, lungs, toes and so forth. Isaac Baker Brown – whom King gaily calls her ‘favourite example’ – was expelled from the Obstetrical Society of London in a cause célèbre because of his repeated practice of clitoridectomy, an operation used by him to cure ailments as varied as urinary incontinence and hysteria. Brown was no crank, but a former president of the Medical Society of London. His book had been well reviewed by the Church Times and his clinic had as its patrons the Archbishops of York and Canterbury. He not only cited Hippocratic theory in his defence, but also offered his casebook of women who had been seeking divorce (which, King notes, was ‘an action so outrageous that it was a clear sign of mental illness’ – though it is not clear quite whose gloss that is), but, after the operation, had ‘returned home to their husbands’. Indeed, with chilling blandness, Brown cites one woman who, after clitoridectomy, ‘became in every respect a good wife’. Nor can the influence of Hippocratic gynaecology be limited to the 19th century. Historians of psychoanalysis have explored the deep roots of the Victorian diseases of chlorosis and hysteria in this tradition of diagnosis and treatment, and how Freud, whose heirs we are, must be understood in and against this contemporary way of thinking. Hippocratic gynaecology is a foundational moment in a long history, nicely summed up by King in the words of Seymour Hayden in the British Medical Journal of 1867: ‘we, being men, have our patients, who are women, at our mercy.’
It has been easy for scholars to recognise a somewhat dodgy ideological interference on the part of doctors in the constitution of empirical medical facts. When the theorist of ‘On the Diseases of Virgins’ suggests that ‘the horrors’ begin because the blood has no means of egress after menstruation starts, it is hard for a modern reader not to respond with a mixture of bafflement and laughter – until the social implications of such a theory are calculated. Since the cure for this and other female complaints is the validation of marriage and motherhood – to become ‘in every respect a good wife’ – the culturally normative role of medicine seems clear. Modern worries about the precise connotations of a ‘bedside manner’ or of psychoanalytic ‘countertransference’ thus have a long history. Martial, the first-century Roman poet, wrote a delightfully malicious epigram about the need to call the doctor for a frustrated woman so that she can ‘get the treatment’; therapeutic intercourse was recommended by Latin and Middle English treatises; and, as Rachel Maines has shown (with pictures), the vibrator was invented to help Victorian doctors bring women to orgasm more quickly as part of a treatment for hysteria. This invention, it must be remembered, came only a few years after the Archbishop of Canterbury’s public support for Brown’s clitoridectomy clinic. Therapy for women easily becomes implicated not merely with social restriction but also with lasciviousness, humour and prurience – a full range of social policing and transgression – in what is all too often a history of patients (in the words of the BMJ) at the mercy of men’s ideological and physiological power.
Although the ideals of objective scientific method are most demonstrably creaky where women’s bodies and sexuality are concerned, this has not stopped many historians from giving teleological or even triumphalist accounts. Each recognition of a previous generation’s ideological mistreatment can be described as a false move transcended on the path to modern knowledge. After all, would even the most ardent cultural relativist not baulk at portraying ancient and modern medical intervention as equivalent in therapeutic value? So, at one level, ancient contraceptive pharmacology has been ‘retested’, to show that under the right circumstances some elements of its prescriptions could indeed have a contraceptive effect. At another level, the proclamations of ancient theorists about the requirements of rigorous method, empirical precision and a duty of care are taken as the first fundamental steps in medical science. Doctors are still asked to abide by the Hippocratic oath.
One of the difficulties of writing the history of medicine and of women’s medicine in particular is how to reconcile two different requirements: first, to produce a nuanced picture of the social and intellectual position of medical practice in a particular culture; second, to construct a history of change, but one which does not discard unwanted errors as mere hesitations on the march towards (our) truth. Helen King achieves this balance with remarkable dexterity and also with some elegance of style. Her history never lapses into gratuitous prurience (aligned, as it were, with the exhibition of curiosities); nor into a pious solemnity which fails to admit the wackiness of some of her material. This is a fine contribution which is interesting whether approached from a localised interest in the history of science or from a broader concern with gender and social change.
What is most impressive, however, is the illumination that comes from interlacing modern and ancient evidence. On the one hand, King offers a detailed investigation of the writings and cultural context of the Hippocratic doctors and theorists; on the other, she explores the way this collection of material has been read and reread by later medical writers, with different gestures of idealisation and redefinition, appropriation and misrecognition. As she demonstrates with considerable panache, the relation of generations of modern scientists to the inheritance of the past ‘is rarely even a true dialogue’. New vocabularies and new questions are broached, as the scientific project progresses, but at one level ‘the message remains the same: women are sick, and men write their bodies.’ So the Victorian understanding of chlorosis, the ‘green sickness’, must be seen both within the framework of contemporary physiology or theories of treatment and also as the construction of a disease out of a scries of purloined elements from past medicine in a line that goes all the way back to Sappho’s paradigmatic description of ‘love-sickness’. The diagnosis of chlorosis is at the same time a culturally specific invention, and an old, old story.
King’s book is successful particularly because it works out this double perspective in such intelligent detail while maintaining a firm sense of the broad picture of social change. Her discussions of contraceptive pharmacology and of hysteria are especially sharp at the expense of other, less theoretically sophisticated or technically informed scholars, and her sense of how science develops in constant interaction with the normative systems of gender and family politics veins her argument with a wit and good sense that only rarely miss their target. This book, more tellingly than many such, calls us to rethink our perceptions of the body and gender and reveals the need for a continuing historical understanding of the rhetoric of family values and medical intervention. Such a cool gaze could well be turned on the contemporary obsessions with menstruation, psychological disorder, children’s sexuality and so forth. King makes her account of women’s bodies at men’s medical mercy more than sobering, enraging or titillating, and in her hands the history of ancient medicine turns out to be integral to the construction of the modern person.