Betwixt The Sheets: The History of Sex, Scandal & Society - Hysterectomies: 2000 Years of Care & Coercion

Episode Date: April 8, 2025

Today, it is one of the most commonly performed surgeries. But when was the hysterectomy, the removal of the uterus, first performed? How has this procedure interacted with ideas such as femininity and eugenics? And WHY would a very brave woman perform this surgery on herself?Kate is joined Betwixt the Sheets with returning guest, Dr Elinor Cleghorn. Elinor is the author of 'Unwell Women: A Journey Through Medicine and Myth in a Man-Made World'.This episode was edited by Tom Delargy and produced by Sophie Gee. The senior producer was Charlotte Long.If you'd like to get in touch with the show you can contact us at [e-mail] up to History Hit for hundreds of hours of original documentaries, with a new release every week and ad-free podcasts. Sign up at https://www.historyhit.com/subscribe.  You can take part in our listener survey here.All music from Epidemic Sounds.Betwixt the Sheets: History of Sex, Scandal & Society is a History Hit podcast. Hosted on Acast. See acast.com/privacy for more information.

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Sign up to join me in locations around the world and explore the past. Just visit historyhit.com forward slash subscribe. 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 your 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. overrectomy 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 tumour 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? Oh, money, of course. You're supposed to rise when an adult speaks to you. I make perfect copies of whatever my boss needs by just turning it up. Good, good. Yes, social courtesy does make a difference.

Goodness, my beautiful time. Goodness has nothing to do with it, Terry. But 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 Cleggon, the fabulous author of Unwell Woman. I think we're all going to be unwell after this one. Deep breaths, everybody. Let's do it. And welcome back to Betwixt the Sheets. It's only Eleanor Cleggon.

How are you doing? I am thrilled to be here. Thank you so much for having me back. What a treat. Well, we had so much fun the last time you're 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. 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. Yeah, we should say that. I will have issued a fair do's 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 the lasagna or something, just turn this one off because it's going to get gruesome, isn't it? It may well get gruesome, yeah. As a complete starter question then, page one, what is a hysterectomy? 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 suproservical 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 part of the vagina as well. So that is a radical operation that 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 tumours. So that's the most extreme form. Histerectomy is 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. Didn't know that. This actually, believe it or not, is less invasive than the traditional root, 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 you know another minimally invasive way and as we look towards the future of course there's robot technology robotic arms that go in really precisely robot giving you a hysterectomy wow 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. It 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 are other treatment options available. That's some other reason. And of course, it's also used for gender affirming care, gender affirming surgery. 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 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 ovaryotomy or ophorectomy, 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, you know, 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 sore, of that pain. But that is something that now we read more about how it's difficult for people who are suffering pain, being in pain, to get these elective hysterectomy. 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 major indicator for having a hysterectomy is having been through debilitating pain.

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. So 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. No. Yeah. So tell me some of the earliest record. What was going on? So one of the earliest sort of recorded discussions of hysterectomy appears in this book called gynecology. by a Greek physician called Soronis, who practiced in Rome, in ancient Rome, in the first, second

centuries BC. 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 a 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. So it's okay. So 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 a stringent 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 disease protruding organ or you can cut the whole organ away. So you'd be talking about that like through the vagina then, wouldn't it? Yes, yeah.

Right, okay. 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, he would then essentially excise it, cut it off, and then sort of stitch it up.

Now, the patient that Saurinus talks about in this gynecology book, I'm assuming did not survive this operation. It doesn't sound like something that, I mean, blood loss, infection, sepsis. Absolutely. I mean, the potential for death, either during the procedure or immediately after, was just extremely likely. I mean, he's kind of talking about this as a case. But he also maintains that previous 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. Thanks, Serenis. He contends that if you don't have a uterus bothering you with all its mencies and all its pain causing, then you can be stronger. And he uses the example of female pigs who've had hysterectomies. See, I was with him. I was with him there for a moment. And now he's lost me again.

So strange account of an early hysterectomy. But suffice it to say, there it is in the early literature. 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 all, while I thought was like an internet joke, but that's actually what they thought. You know, like when you get those odd historical myths. I was like, no, they did. They really did think that. So like the idea of cutting out a womb must have had particular significance for them. 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 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. point of view. So there's always this tension. So while there's a sort of further 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. I'll be back with Eleanor after this short break. Is most of the records that we have then of what would be called a hysterectomy in really ancient medicine? Is that probably because of prolapse? Yeah. I mean, the ones that I've read about are 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. It absolutely would have been, wouldn't it? 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.

So, all right, so we've got ancient doctors and they will. 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, i.e. 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? So one of the first of 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 was Faith Rayworth 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, personal Willoughby writes, by this.

And off she goes into the garden, she just simply had it, lies down, draws it forth, so pulls it out and lops it off. Holy mother of fuck. Just performs auto surgery on herself, performs her own hysterectomy. in her garden. She bled copiously after this. She had just had it. She had the desperation of that.

She did not want this anymore. Do you think it's real? I think so, yeah. I think that's a real story. He talks about so this doctor, 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. I don't know what that actually means.

But she had a terrible time for the rest of her life because she was incontinent and she sadly passed away without this ever being cured. God, the desperation of that. Yeah, the desperation of it. 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 trying to make do, trying to get by. And she has this problem for which there is really no cure then. I can't believe that she survived that. That's incredible. Yeah, she survived. But I mean, what her quality of life was like, I really don't know, because she was just constantly, her blood 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. I'm going to do my pelvic floor exercises for the remainder of this interview, Ellen. That's advice. And advice.

everybody else to do the same, please. Holy shit. That's a crazy case. But at this point, are hysterectomy being performed as routine by medical professionals? Not in the 17th century. So when we see hysterectomy's 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 doctor are very, very interested in and that male doctors are beginning to really monopolise. 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 gynaecological surgery. So it's really in the 19th century that we see hysterectomy become more common and is 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 and linked together through the ancient Greek word hysteria, 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 seven in ten mortality rate. Oh, okay, wow.

And of course there wouldn't have been anaesthetic, would there, until when did that start to come in? 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 hysterectumists were still performed sometimes without anesthetic. Why? 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 it could drain away. But keep going, Eleanor. We're down the rabbit all now. We are. We can't get out. We're here.

So the past 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 quarterized the stump, which I think was popularized by a gynecology called Thomas Keith, who was a Victorian Scottish gynecologist, and he figured out if you actually quarterise that wound, then there's less chance of post-operative fevers, what we now know is 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 chat called Maurice Buck

Robert Maurice Buck who was very very interested in kind of cosmic consciousness and he was also psychiatr This is exactly the kind of person you want to be a gynaecologist brilliant, right, okay. You want a cosmic bro

with a crazy 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, 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 took the ovaries as well. and he thought that a record of four recoveries was really good.

Fucking hell. That's the worst bit is when you find these medical quacks, the way they're writing about it is they're so proud of what they've been doing. Yes. 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 don't believe this thing that I've done

and only four people died. Fuck. 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 gynaecological 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 nonconcernable. much of it not involving any kind of informed consent. And of course, what is also pretty horrifying about performing these surgeries on women in 1890 who were 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.

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, he did this and he didn't have done it and did it. 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. That's the thing. I mean, the 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 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. I'll be back with Elner after this short break. 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 seems to have been more common than a hysterectomy. I think it was because, again, the mortality rate. Yeah, of course, yes. Ovariety 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 centres 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 this sort of glands, right?

And so there was a lot of talk in the 19th century about things like ovarietis and ovarian stimulation and how, you know, the ovaries become excited and kind of radiate their discontents 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 to Paypool in the minds of these gynaecologists, 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 a degenerate or deranged or over-sexualized or is it better to remove her ability to become pregnant and have children. 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? It really does. And the eugenics movement, the idea that you could alter the child-bearing 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 some. body'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 month to happen between sort of 1920s going right up until the 19th, 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 tube or legation, which is like having the tubes, fallopian tubes cup, 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 further 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 eugenics sterilisation. I mean, the eugenics board in this country, as you know, was huge. It was so popular as well. 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 favour of various different forms of eugenics. It's very disappointing, isn't it, when you find him? You're like, oh, Virginia Wolf, no. No, I know. You're like, please, not. And you, like, emigate, like, these people, these kind of radicals and anarchists, and then you read, 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 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 really important to confront. It is really important to confront. And it becomes incredible. 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. 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 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, on 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. And 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. 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,

at 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 hate, 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. 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 the women who say have fibroids or say were suffering with, you know, extreme menstrual-related pain or had diseases like endometriosis were being offered hysterectomy, 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 hysterecting as being really overperformed. I think now we're in a situation where women who really want electively, so choosing to have a hysterectomy, say like your mum who suffered with, you know, that debilitating pain, a finding that there are barriers and obstacles to having that. Firstly, in the, this country because at present our gynaecological procedure waiting lists are astronomical. You know, we're really a crisis point in terms of women being able to access gynaecological 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, and know this is what they want, being discouraged or denied or refuse 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 had 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 seen that we as women have to put ourselves second to that hypothetical husband, that hypothetical child. And for women who are happily child-free or for who,

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, that 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 and it doesn't matter how much pain you're in because when my mum had a hysterectomy they just put her on HRT after that

she was bouncing off the fucking walls she was having a marvel this time like she couldn't believe that she had to wait this long for it, but she'd just been left like that for years and years and years. And I've got other friends that have endometriosis and they've 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. I mean, the default condition, women have been told four 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 with. 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, 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. 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 there are women going, give me a hysterectomy, I'm in pain. And they're going, no, no, no, but you might need it. You might want to use that. But somebody who wants a hysterectomy because of gender dysphoria and a trans man, How does it fit in without? What's the state of play or something like that? Well, the WHO, the World Health Organization, you know, recommends histotomy in terms of gender affirming care and recognises it as an 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 of the first case of, a hysterectomy being performed for gender affirming care was in 1917. Wow. 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. were found out to have been born, you know, identified as female at birth and were kind of

sat from their 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 will 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 giving, 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. Absolutely. Eleanor, you have been wonderful to talk to. Thank you 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? They can find me at the moment. I'm mainly on the Instagram.

I'm at Eleanor Kledkorn 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, a complete joy to talk to you. 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 at betwixt at historyhit.com. This month on the podcast, don't miss our deep dive into the fuckboys of history and an episode about one of my most favourite people from history.

Nell Gwynne. That's right, Mama Nell, as I like to call her. This podcast was edited by Tom Delagie 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.