The dream of the uterus

F. Gonzalez-Crussi 
Chicago, Illinois, USA

 

Front page of the book that started the debate on “the thinking uterus
Front page of the book that started the debate on “the thinking uterus” at the University of Bologna: Genial days of the dialectic of women, reduced to its true principle, etc.” Naples, 1763.

More than one-half century ago, it was my duty to examine and describe, day in and day out, the bodily parts that surgeons removed at the hospital where I worked. Surely this peculiar daily routine must have incited the flights of fancy that I took then, and which I recount now.

The uterus impressed me as evocative above all the other organs I handled. Human imagination has embroidered around it a rich mantle of legends, fables, and myths. The womb was called “the shop of nature,” since the portentous fashioning of a human being takes place inside it. Ancient Jewish Scriptures declare this a work of God. The psalmist addresses the Almighty when he says: “For it was you who formed my inward parts; you knit me together in my mother’s womb” (Psalms 139: 13). Translators of the Hebrew Scriptural passages state that the child is formed, knit, made, kneaded, intricately woven by God; the very richness of the wording used is meant to evoke the image of the Creator as craftsman molding the complex structure of the human body.1

Its design provoked boundless admiration. Strong, yet distensible muscular parieties shelter without constraining the precious being lodged inside; and the fleshy container is defended further by a tough rampart of pelvic bones. The delicate being about to be launched to the world is secure in a perfect packing-case. But a treasure-containing safe-box is best kept hidden; and here again, nature’s wisdom was evident. The Greeks named this organ hystera, from a Sanskrit root meaning “placed behind.”2 In effect, the womb lies deep in the pelvis, beneath the intestines, the better to defend its cargo from attacks or intrusions. Soranus of Ephesus said it was also called meter and delphos: the former meaning “mother,” since it is the mother of those it encloses; the latter from adelphoi, brothers or adelphai, sisters, since all the enclosed are brothers and sisters.3

Yet human judgments are mutable. What some find admirable others vilify, or the same thing is extolled one minute and denigrated the next. The emplacement of this organ, which some praised as a providential way of protecting the unborn, others interpreted as a mark of infamy. Christian moralists remarked that the womb lies between the bladder and the rectum, that is, between the repository of urine and that of feces. Why would the Creator choose such a squalid site for our first abode, if not to remind us that our conception is impure, our condition lowly, and our origin always humble, paltry, and detestable?

But of all the odd, aberrant ideas that men conceived, the uterus as a mobile, living creature is perhaps the most egregious. It is an animal, said the ancient Greeks, living within another animal. How this hallucinating nonsense ever came to be held by the foremost thinkers of classical antiquity is still unclear. Allegedly, the womb-creature was gluttonous. In women who had no children and no sexual relations, it became desiccated and grew impatient. In an empty abdomen, it had no trouble turning ’round, then threw itself avidly upon the liver, which is fluid-rich. “But in so doing it caused sudden suffocation by interfering with breathing, for the respiratory movements are largely done in the abdomen,” wrote Hippocrates in Diseases of Women. A thirsty uterus hankered after the male seed, and in its wild roaming all over the body, it could impinge upon the throat and provoke asphyxia, or even reach the head and produce convulsions.

In time, the erratic uterine beast quieted down. It stopped moving, but continued interfering with the other organs’ functions. In the 1770s, a professor at the venerable University of Bologna accused the uterus of usurping no less than the intellectual activity of the brain. Presumably in jest, he wrote a book that pretended to have “reduced the women’s ‘dialectic’ [i.e., their reasoning power] to its true principle.” (Fig. 1). This “true principle,” needless to say, was the uterus. His thesis was that every single thought in women is determined, engendered, shaped, and colored by the uterus. In sum, women think with the uterus. Although professedly a joke, the book provoked a lively polemic. A second book appeared in rebuttal of the misogynist first. The debate might have remained within the Bolognese academic milieu, but for the fact that a celebrated man entered the fray: Giacomo Casanova (1725-1798).

Woodcut of a woman with her uterus exposed Illustration of a woman with her uterus exposed Realistic drawing of the uterus
Figure 2. Evolution of the artistic representation of the female genital apparatus. Left frame: From Berengario da Carpi (XV-XVI centuries). Middle frame: From Jacob Rueff’s handbook of midwifery (XVI century). Right frame: Highly realistic engraving by Jan van Rymsdyk, for William Hunter’s Anatomy of the Gravid Uterus (late XVIII century). Explanation in the text.

 

Most people know Casanova as an adventurer of dissolute life, famous for his prowess as a seducer, which he grossly exaggerated in his 5,000-page autobiography. He was far more than that. Recently, he has become recognized as a superb portraitist of eighteenth-century European life, and a writer of considerable merit. He joined the debate of the “thinking uterus” on the feminist side, and ridiculed the arguments used to “reduce” women’s thinking to uterine physiology.

However, institutionalized misogyny would not curtail its reductionist impetus. A professor of medicine in New Haven said in a lecture: “It seemed as if the Almighty, in creating the female sex, had taken the uterus and built up a woman around it […] This organ is the greatest central pivotal organ of her existence.”4 Another medical eminence wrote: “the ancients . . . entertained very significant notions of the controlling influence of the uterus over other organs of the animal economy; and appreciated the truth in the aphorism promulgated by Van Helmont in the seventeenth century: “Propter solum uterum est mulier id quod est.5 (Only because of the womb a woman is what she is).” Every conceivable pathology, regardless of the organ system affected, originated in the uterus. Palpitations, tiredness, hemoptysis, diarrhea, vomiting, convulsions, catalepsy, chorea, and even mania could be traced ultimately to the uterus. Hysteria dominated clinical medicine and, as implied in its name, originated in the uterus.

The arts echoed the reductionist propensity. Early medical illustrations were clumsy and unrealistic; the uterus was shown in a dissected woman incongruously dancing or adopting elegant poses. Later, the uterus was represented with artistic excellence and great realism, but alone, unrelated to the person. The woman had been removed, excised, “reduced” to an organ; sometimes literally “chopped off,” as in the famous plates that illustrate William Hunter’s Anatomy of the Gravid Uterus, which some critics find insensitive in their graphic rendering of a frightful bilateral amputation. (Fig. 2).

I will now recount a dream provoked by my lab routine in those days:

I am at work describing a uterus and taking samples for histopathologic examination. Suddenly, as happens in dreams, I discover with alarm that my workbench is not in the lab, but on the proscenium of a theater stage. On the parterre and in the balconies there is a numerous audience formed of famous physicians of the past. I recognize Thomas Syndenham (1624-1689). This makes me nervous, for I know he commented insightfully on hysteria.6 I detect Soranus, sporting a chilton or Roman tunic; behind him is Jean-Marie Charcot (1825-1893), who launched hysteria into social notoriety. Also present is John Snow (1813-1858) who gave chloroform to Queen Victoria, and many other medical luminaries. They all look questioningly at me while I hold a uterus in my gloved hands. They utter no words; yet, I distinctly hear their question. It is the same that surgeons often come to ask at the lab: “What is it?” Only this time I gather they do not mean the specimen I am holding; they refer to the uterus in general. I feel exceedingly nervous, but I manage to address the audience this way:

“Revered masters, esteemed colleagues: Begging your pardon, some of you said this organ is a divine workshop; others, that it is a safe-box; others, a filthy cloaca; others, a sui-generis brain. Some among you maintained it is the sum and compendium of femininity. But I, from what little I know, can tell you this: It is neither a workshop, nor a safe-box, or a packing-case, or a sordid cloaca, or a thinking organ, or the sum and substance of womanhood. It is a uterus, gentlemen. A uterus.”

Precisely at this point, I woke up.

 

References

  1. David Albert Jones: The Soul of the Embryo: An enquiry into the status of the human embryo in the Christian tradition. London and New York. Continuum, 2004, p. 7.
  2. Mark J. Adair: “Plato’s View of the ‘Wandering Uterus’.” The Classical Journal 91, No. 2 (Dec. 1995-Jan. 1996): 153-163.
  3. Soranus: Gynecology, translated by Owsei Temkin. Baltimore. Johns Hopkins University Press.1956, page 8, note 10.
  4. Quoted in M. L. Holbrook, M.D.: Parturition Without Pain. Code of Directions for Escaping from the Primal Curse. New York., M. L. Holbrook Publisher. 1872, pp. 14-15.
  5. Gunning S. Bedford: Lecture Introductory to a Course In Obstetrics & Diseases of Women and Children. New York, Press of New York University. 1846.
  6. John M. S. Pearce: “Sydenham on Hysteria.” European Neurology (2016) 76: 175-181.

 

Image Credit

  • Figure 1: From the author’s collection
  • Figure 2, Left to right: Woodcut depicting a pregnant woman with opened uterus from Anatomia Carpi by Jacopo Beregario da Carpi. circa 1520. Via Wikimedia. / From De Conceptu et Generatione Hominis by Jacob Rueff. Via the University of Kansas Medical Center. / Illustration from William Hunter’s book “The Anatomy of the Human Gravid Uterus Exhibited in Figures” (1774). U.S. National Library of Medicine.

 


 

F. GONZALEZ-CRUSSI, MD, is a retired pathologist and a frequent contributor to Hektoen International. For his literary work, see his Wikipedia.

 

Summer 2020  |  Sections  |  Birth, Pregnancy, & Obstetrics