Hysterectomies: 2000 Years of Care & Coercion
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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 you're 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 ovorectomy performed through the abdomen where the patient lives. Put

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 in 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 and pushing the button. Yes, social courtesy does make a difference. Goodness, what beautiful dance. Goodness has nothing to do with it, does it?

and 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 Clegg-On, 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. Hello, and welcome back to Betwixt the Sheets. It's only Eleanor Clegg-On. 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 were 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 huge.

a vast and fascinating and at times horrifying subject. Yeah, we should say that. I will have issued a fair dues 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 a 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 supracervical 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 parts 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. Hysterectomies are 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 route, 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 another minimally invasive way. And as we look towards the future, of course, there's robot technology, robotic arms that go in really precisely. A 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 aren't other treatment options available. That's another reason. And of course, it's also used for gender affirming care, gender affirming surgery. My mum had a hysterectomy because she had bad PMS. And when I say bad, I mean like debilitating. Yes.

That was in like the early 2000s. 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 none

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 oestrogen from the ovaries. So people who have

that includes removal of the ovaries, ovariotomy or oophorectomy 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 debilitating menstrual pain or pain related to menstrual cycle, because that is another thing.

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 you know related to diseases like endometriosis

sometimes this is the hysterectomy is the solution because you just want to get rid of the source of that pain. But that is something that now we read more about how it's difficult for people who are suffering pain and being in pain to get these elective hysterectomies. So I'm sure we'll come on to this as well, the way that choice and consent come

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. And 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 or...

Yeah. So tell me some of the earliest records. 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 Serranus, who practiced in Rome, in ancient Rome, in the first, second centuries BCE. 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 the

this uterus, this womb was a sort of contentious organ. It could cause a lot of harm as well as 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 had kind of fallen down

into her vaginal canal. So he talks about how you can try all these different treatments. He says, 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 astringent wine. If you've tried all these things, if you've done all this and it's still...

won't go back and remain in place. You can either cut off part of the diseased 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 root 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, push back up in, he would then essentially excise it, cut it off, and then sort of stitch it up. Now, the patient that Sorenus talks about in this gynecology episode,

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

But he also maintains that previous physicians to him have performed this when women have survived because he is of the opinion that

that there is some use for wombless women and wombless creatures. Thanks, Serenus. He contends that if you don't have a uterus bothering you with all its menses 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. 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 a while I thought was like an internet joke, but that's actually what they thought. Yeah.

You know when you get those odd historical myths? I was like, no, they really did think that. 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, you know, 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 of view? So there's always this tension. So while there's a sort of further to preserve,

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 elna after this short break

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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 world.

I mean, 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. It's right there. It's sort of visible to see. So, all right. So we've got ancient doctors and they were 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

more detailed descriptions of what we would recognise as a hysterectomy today? So one of the first and most astounding, just following on a little bit from the prolapse situation, one of the first and most 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 a

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 Raworth.

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, Percival Willoughby writes, by this antithesis.

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. Shitting hell, Faith. She bled copiously after this.

She had just had it. She had had enough. The desperation of that. She did not want this anymore. Do you think it's real? I think so, yeah. I think that's the 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 womb,

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...

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 bladder 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, Eleanor. And advise everybody else to do the same, please. Holy shit.

That's a crazy case. But at this point, are hysterectomies being performed as routine by medical professionals? Not in the 17th century. So when we see...

hysterectomy is 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 doctors are very very interested in and that male doctors are beginning to really monopolize and some

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, you know, in the US and in the UK who are very keen on surgery and

gynecological 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, and you were mentioning earlier about the kind of internet myths, because hysterectomy, the word hysterectomy and the word hysteria are linked together through the ancient Greek word hysterectomy.

Hystera, 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 ovaryotomy, which is just the removal of the ovaries because

Because hysterectomy in the 19th century, before the introduction of antiseptics and carbolic spray and safe surgeries, carried a 7 in 10 mortality rate. 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. Chloroform and ether becoming more commonly used. But even after the introduction of some of those anaesthetics,

hysterectomies were still performed sometimes without anaesthetic.

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? No, it's not. But keep going, Eleanor. We're down the rabbit hole now. We are. We are. We can't get out. We're here. So the pus 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 cauterise the stump, which I think was popularised by a gynaecologist called Thomas Keith, who was a Victorian Scottish gynaecologist, and he figured out if you actually cauterise that wound, then there's less chance of post-operative

fevers, what we now know as 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 that

references to hysterectomy being recommended for women who were confined to lunatic asylums principally with mania and there was a very strange chap called Maurice Buck Robert Maurice Buck who was very very interested in kind of cosmic consciousness and he was also a psychiatrist this is exactly the kind of person you want to be a gynecologist brilliant right okay you want a cosmic bro with a

crazy beard to come along and whip it out for you. Maurice 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

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're not going to believe this thing that I've done and only four people died. Fuck. The vainglorious 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 gynecological surgeons in the 19th century are often so convinced of their own rightness, of their mission,

and convinced of that, 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 non-consensual, much of it involving any kind of informed consent. And of course, what is also pretty horrifying about performance

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 shouldn't have done 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, they're 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 to save her. 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 it was somehow her own fault for not surviving, somehow her own fault for not recuperating. I'll be back with Eleanor after this short break.

I don't know about you, but the number one thing I look forward to when I return from traveling is a good night's sleep in my own bed. That has never been more true than it is now that I have a Sleep Number smart bed. I get so sore after traveling on planes, but after literally one night in my Sleep Number smart bed, my body feels restored, rested, and relaxed.

The fact that my bed actually listens to my body and adjusts to my needs to keep me sleeping soundly all the way through the night is worth it alone. Not to mention my husband and I never need to argue over firmness because we can each dial in our own sleep number setting. Why choose a Sleep Number Smart Bed? So you can choose your ideal comfort on either side. And now, for a limited time, Sleep Number Smart Beds start at $849.

Price is higher in Alaska and Hawaii. Exclusively at a Sleep Number store near you. See store or sleepnumber.com for details. Worried about what ingredients are hiding in your groceries? Let us take the guesswork out. We're Thrive Market, the online grocery store with the highest quality standards in the industry. We restrict 1,000 plus ingredients, so you can trust that you'll only find the best high-quality organic and sustainable brands, all free of the junk.

With savings up to 30% off and fast carbon neutral shipping, you get top trusted groceries at your door and you can stop worrying about what your kids get their hands on. Start shopping at thrivemarket.com slash podcast for 30% off your first order and a free gift. 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 consumption.

women's behaviour by operating on them. And it's not a new idea. That's your 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 behaviour 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. Yeah.

I think it was because, again, the mortality rate. Yeah, of course. Ovariotomy 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 centers 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 glance, right? And so there was a lot of talk in the 19th century about things like ovaritis and ovarian stimulation and how, you know, the ovaries become excited and kind of radiate their discontents all around.

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 the

Robin Peter to pay Paul in the minds of these gynecologists, 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 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, 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 idea

Actually, I think you can still see echoes of that, to be completely honest, up to this very day. But it's replaced again 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 childbearing body in order to achieve ambitions for population control, for state-based population control, began in the early 20th century and sterilization orders. So this means that the state or an institution has permission

permission essentially to remove somebody's ability

to have children, both men and women, if they are deemed 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 patients

mostly women, but often one too, happened between sort of 1920s going right up until the late 1970s, 80s, and also, you know, continuing into our far more recent history as well. And around the civil rights movements in the 60s and 70s, there were campaigns to end sterilization abuse in the United States and also to inform women

who are marginalised 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 tubal ligation, which is like having the tubes, fallopian tubes cut, being coerced into doing this in return for land, in return for healthcare, 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 fervor 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 the extent of it. But there were orders that tried to be passed before the Second World War in this country about eugenic sterilization. I mean, the eugenics board in this country, as you know, was

It 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. Exactly.

Very disappointing, isn't it? When you find him, you're like, oh, Virginia Woolf, no! No, I know. You're like, please, no. And you'd like, these people, these kind of radicals and anarchists, and then you read that, like, yes, eugenics. But, I mean, eugenics was a huge...

a huge idea that 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 the best form of future generations. And of course, it had its most extreme abuses in Nazi Germany, where also hysterectomies were horrifyingly and harrowingly performed there.

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 incredibly 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. Like 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 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

A 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. On one hand, there's a very aggressive campaign that there should never be abortions and the pill's terrible and 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 extreme fibroids

related pain or had diseases like endometriosis were being offered hysterectomy, like 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 hysterectomies being really overperformed. I

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 that debilitating pain, are finding that there are barriers and obstacles to having that. Firstly, in this country, because at present our gynecological procedure waiting lists are astronomical, we're really at a crisis point in terms of women being able to access gynecological care at

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 elect him 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 refused the 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 as

before you hit perimenopause and menopause as reproductive material, you know, we're always seeing 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 whom, you know,

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 for you because primarily what you want is babies. So I think always this. And this is, I think, what links us.

the ongoing campaign for full and accessible reproductive healthcare and abortion with something like collective hysterectomy. So it all comes down to what our society and our culture

that 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 her hysterectomy, they just put her on HRT after that. She was bouncing off the fucking walls. She was having a marvellous time. She couldn't believe that she had to wait this long for it, but she'd just been left like that for...

For years and years and years. And I've got other friends that have endometriosis and they have 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 for centuries that the default condition is

And 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 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 it

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 go, 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 they are a trans man...

How does it fit in with that? What's the state of play or something like that? Well, the WHO, the World Health Organization, recommends hysterectomy in terms of gender-affirming care and recognizes it as an important part of gender-affirming care. And again, of course, incredibly difficult to actually access this information.

of gender-affirming care, especially on something like the NHS. It's quite interesting, actually, because 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 researcher

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, but were found out to have been born, identified as female at birth and were kind of sat from their position. Alan 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 given 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. Elna, you have been wonderful to talk to. Thank you so much for coming back to talk to us. You've been wonderful.

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 Clegg-Korn 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, 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 Gwynn. That's right, Mama Nell, as I like to call her. This podcast was edited by Tom DeLarge and produced by Sophie Gee. The senior producer was Charlotte Long. Join me again between the sheets, the history of sex scandal and society, a podcast by History Hit. This podcast contains music from Epidemic Sound.

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