What, if anything, can the history of surgery tell us about menstruation? And why is this a question worth asking? Scholars of the menstrual cycle have recently been galvanized by a series of international conferences, new publications, and mainstream media attention [1]. In all of this, the surgeons are usually missing. As part of a wider project that explores the visual history of menstruation, we visited the archives and specimen collection at the Surgeons’ Hall Museum in Edinburgh to review the collection for visual and historical data in our search to track menstruation in the twentieth-century. Below, we discuss our findings and argue that the history of surgery might provide a different angle on menstruation.
Women’s History
The Surgeons’ Hall Museum is largely devoid of blood, due to the difficulty of preserving it. Blood is rinsed out of specimens during preparation, as it would otherwise cause potential discoloration of the preservative fluid (although some can be present in the tissue itself).[2] Searching for menstrual history here therefore feels quite paradoxical, as most uteri on display are never actually in visible stages of the menstrual cycle. This absence mirrors the overall absence of visual menstrual blood in culture in general, and so is nevertheless symbolically relevant.
The uteri we visited were donated by surgeons when their careers were active, and given to the college for training purposes to assist future surgeons. Situated between the active Surgeons’ College and the café, the collection provides unique insight into Scotland’s pioneering place in medical history. The historical exhibition traces a series of Scottish men and (some) women, and their adventures into the human body. The narrative is one of opening and shutting the body, anesthetizing and helping it, cutting and altering it. The body remains ‘it’ and, overall, there is little space for human histories here. Gender and other identity markers take a backseat, as historians of surgery have written about elsewhere.[3] Women surgeons, allowed into the Royal Edinburgh College in 1920, are, in contrast, relegated to the ‘women’s history’ corner.
Watercolour uteri
In the archives, a search through possible sources that might include women’s health or the menstrual cycle, leave us with a small pile of written and visual materials. William Hunter’s Gravid Uteri arrives as a first edition, collected by the founder of the British College of Obstetricians and Gynaecologists, and president of the Royal College of Surgeons 1929-31, Haig Ferguson. An important figure in the field, Ferguson was also the Queen’s physician, author of Combined Textbook on Obstetrics and Gynocology, and a painter of watercolour uteri. One painting shows the bicornuate uterus of a young woman who died during surgery, when she suffered a rupture four months into her first pregnancy. Using pinks, peaches and purples, Ferguson depicts the uterus suspended at the center of the canvas – careful to convey delicate tonal change and glistens of light in his copy.
As historians interested in visual culture, we were struck by the visual nature of the surgeons’ writing as well. Detailed sensory descriptions mention shapes, movement, and smells, exemplified by an account of menstrual blood in A Treatise on Obstetrics by Dr A Charpentier from 1889: “mucous discharges predominate, the fluid is slimy, with a penetrating door; it is more or less coloured, either a light or dark red…”
Overall, these are three-dimensional descriptions designed to provide a sensory and holistic overview of the body to a distant reader. The focus on the sensory continues throughout the archive collection, despite changing methods of illustration, from microscopic details to print, hand drawings to photocopies, and metric overviews. Nonetheless, this visualisation of the body through meticulous scientific records binds the sensory to the scientific.
In the written material, menstruation appears as a signifier of womanhood within an overall worldview that is traditional and Christian. It is decidedly something that happens ‘to’ ‘the women’, and not part of the body. Throughout, the focus is on menarche and menopause, the beginning and end of menstruation, but not the bulk of the menstrual cycle between these events.
The inclusion of morality and worries about virginity seems to have clouded scientific thinking as well. Surgeons discuss if menstruation and ovulation could be linked, but give equal attention to ‘issues’ of reproduction and race. The woman and the cycle is presented in varying language, sometimes echoing the findings in Emily Martin’s seminal work on medical textbooks and their presentation of sperm as active and ovum as passive, but elsewhere women’s reproductive systems are granted agency.[4] “The great capability of the ciliary movement principally, as well as the fact that among the lower animals an ovum lying free in the abdominal cavity is brought from a considerable distance to the tube by this force alone, speaks positively for the probability that this arrangement plays an important, if not the most important part also in the human species.” [5]
In contrast, the woman is acted upon by the process of menstruation, yet the bleeding phase is described as a passive event.
Uteri on display
The real public draw of the Surgeons’ Hall, however, is its collection of ‘pickled’ (our term) body parts. The historic collection of pathology specimens include a neat division of surgery through a focus on the eleven fields of surgery recognised by the college. The body is dissected into ear, penis, womb, brain, bone, infection, teeth, toes, and fingers… Any body part lost or removed in surgery is ‘pickled’ into glass jars and presented on white wooden shelves, including some uteri.
The display shows a collection of material in a collection that raises many ethical questions: what is considered inoffensive, for example. Yellowed jars of bones, penises and eyes twinkle in the clean, white, purpose-built rooms. Meanwhile, obstetrics and gynaecology is awkwardly placed alongside a large poster of two foetuses in the womb, tying women to childrearing. On the shelf, we can see a ‘normal uterus’, a uterus with an Inter-Uterine Device inserted, as well as some uteruses that are ‘sick’. Although reasons for why the uteri were removed from the body may vary, the long and extensive history of hysterectomy may well provide answers as it was a normal surgical procedure until very recently, utilised for menstrual cramps, menopause, or pain, as well as a non-reversible contraceptive.
The behind-the-scenes area that we were lucky to visit with Surgeons’ Hall curators houses more uteri, including those with endometritis – inflammation of the inner lining of the uterus, most commonly caused by infection after childbirth. These show the physical reality of the condition. The black colouring on one specimen is indicative of necrosis – severe and fatal cell damage, whereas further indications of endometritis is seen in the thickness of the uterine wall and the granularity of the tissue. Any suggestion that ‘women’s troubles’ is psychological only, is easily dismissed here.
Beyond inflammation, we also find the figure of the foetus – a politicised and complicated topic for any medical collection, as Parry Manon’s research on museums featuring such items reveal. Ever since the first photographs of foetuses by Lennart Nilsson were published in A Child is Born, they have been utilised by pro-life, pro-choice, and other groups for political aims, a situation any museum would understandably prefer to steer clear of.[6] Although the collection shows that maternal death and abortion are indeed common realities in the past as in the present, the public display can only hint at this.
Concluding thoughts
The Surgeons’ Hall Museum and collections reflect, reinforce, and provide solutions to menstrual stigma. The books held in the archives reflect historical attitudes about menstruation and reproductive health, as well as the general surgical disinterest in the cycle.[7] Yet, these resources provide exciting and rare evidence for menstrual scholars. The materials omitted reveal historical changes, and highlight the dependence on hysterectomy within surgery. Likewise, endometritis, abortion, menopause and menarche are all visualised in a unique, realistic way. This is a clinical iconography that was created to showcase facts, largely devoid of history. The role of the historian or art historian is to contextualise this data, and The Surgeons’ Hall provides a fantastic opportunity to do so.
Alexandra Stephenson completed a foundation in Art and Design at Oxford Brookes University in 2016, and is currently studying for an undergraduate degree in Art History at the University of St Andrews. She is the co-founder of Capture Collective in St Andrews.
Dr Camilla Mørk Røstvik is Leverhulme Early Career Fellow in the School of Art History at the University of St Andrews working on the visual history of menstruation. She is on Twitter @CRostvik
Notes:
[1] Abigail Jones covers the recent growth in media and activism in ‘The Fight to End Period Shaming is Going Mainstream’, Newsweek (20 April 2016). The Society for Menstrual Cycle Research biennale conference in 2019 featured several panels on recent media attention. In the UK, Europe, Africa, North America and South America menstrual equity policies are being advocated for by activists and, patchily, implemented by policy makers. New publications include Sharra Vostral, Toxic Shock: A Social History (New York: New York University Press, 2018), Chris Bobel, The Managed Body (Palgrave, 2018), and the forthcoming Palgrave Handbook of Critical Menstrual Studies (Palgrave, 2020) edited by Bobel et al.
[2] Information provided by Cat Irving, Human Remains Conservator at Surgeons’ Hall Museum.
[3] On the nineteenth-and early twentieth-century, see Ornella Moscucci, The Science of Woman (Cambridge: Cambridge University Press, 1990) and Gender and Cancer in England 1860-1948 (Palgrave Macmillan, 2018); Claire Brock, British Women Surgeons and their Patients, 1860-1918 (Cambridge: Cambridge University Press, 2017), Sally Frampton, Belly-Rippers, Surgical Innovation and the Ovariotomy Controversy (Palgrave Macmillan, 2018); Barron Lerner, Breast Cancer Wars (Oxford: Oxford University Press, 2001).The Wellcome Trust funded Surgery and Emotions project at Roehampton University is exploring the emotional history of surgery, whereas Thomas Schlich (ed.) recently published Palgrave Handbook of the History of Surgery (Palgrave, 2018) provides a broader context.
[4] Emily Martin, ’The Egg and the Sperm: How Science Has Constructed a Romance Based on Stereotypical Male-Female Roles’, Signs Vol. 16, No. 3 (1991), pp. 485-501.
[5] P. Müller, ’The Transmigration of the Ovum’ in Encyclopedia of Obstetrics and Gynecology XI. Sterility: Developmental Anomalies of the Uterus (1889), p 23.
[6] Lennart Nilsson, A Child is Born, first published 1965.
[7] Agnes Arnold-Foster argues that sexism is still alive in surgery more broadly, see ‘Sexism in Surgery – Little has Changed’, The BMJ Opinion (24 January 2019): https://blogs.bmj.com/bmj/2019/01/24/agnes-arnold-forster-sexism-in-surgery-little-has-changed/ (accessed 18 September 2019).
