Book summary “Unwell Women”: summary

Introduction

You likely know the frustrating experience of having your physical pain minimized, misdiagnosed, or attributed to anxiety by a medical professional. When you seek help for chronic symptoms, you step into a healthcare system built on centuries of patriarchal assumptions that view the female body as inherently defective and hysterical. Elinor Cleghorn exposes how modern Western medicine was founded on the myth that women are biologically prone to illness because of their reproductive organs. The book traces a continuous historical thread from ancient Greece to the twenty-first century, showing how physicians systematically pathologized womanhood. You will discover the origins of medical misogyny, the brutal treatments inflicted on past generations, and the ongoing struggle for credible healthcare.

• How did ancient medical theories turn the uterus into an independent creature?
• Why did nineteenth-century doctors invent surgical cures for normal emotions?
• What systemic biases still cause modern physicians to dismiss women's autoimmune and chronic pain conditions?

1. Androcentric Foundations and the Wandering Womb

Modern Western medicine was founded on patriarchal assumptions from ancient Greece that positioned the female body as an inferior version of the male body. In the third century BCE, Aristotle described the female body as the inverse of the male body with genitalia turned outside in, defining women as faulty and defective. Medicine validated social determinants by constructing the myth that women are entirely ruled by their biology and reproductive organs. In ancient Greece, girls were the property of their fathers and women of their husbands, with medicine reflecting and legitimizing this total social and physical control.

Ancient Greek and Roman medical writers conceptualized the uterus as an independent, animal-like creature that wandered the body when unfulfilled by sex or pregnancy.

Hippocratic physicians and later writers like Plato and Aretaeus believed that a dry, empty womb caused suffocation, convulsions, and hysteria by moving toward the liver or choking the throat. Prescribed treatments ranged from forced marriage and frequent pregnancy to foul-smelling herbal fumigations meant to entice the organ back. During the fourth and fifth centuries BCE, the Classical era of Hippocrates, the wandering womb and suffocation of the womb became dominant dogmas. Plato described the womb as a living creature in the middle of the third century BCE, while Aretaeus of Cappadocia proclaimed the uterus was like an animal within an animal in the second century CE.

On the island of Kos, a young girl experiencing fever and chest tightness was diagnosed by a physician as drowning in her own menstrual blood because she had not yet married, and her father was urged to marry her off immediately. Not all ancient physicians accepted the wandering womb myth. Soranus of Ephesus rejected the notion that the uterus roamed the body like an animal or that foul odors could coax it back. He practiced medicine in Rome in the first or second century, and his work was first translated into Latin in the sixth century. Soranus attributed conditions to inflammation and constriction from menstrual problems, miscarriages, or childbirth.

You can trace alternative gynecological care through these steps:

• Lay the woman down in a bright, warm room without hurting her.
• Place warm compresses on her belly.
• Gently straighten out her cramped limbs.
• Restore health through exercise and promenades, light gymnastics, baths, and anointments with oils.
• Administer pungent foods, vocal exercises, and reading aloud.

2. Mapping the Body and the Uterine Theory of Illness

Renaissance anatomists mapped female organs through the lens of inferiority while physicians blamed the uterus for all forms of female mental and physical distress.

Andreas Vesalius published De humani corporis fabrica in 1543, providing detailed illustrations of dissected organs. He depicted the vagina and uterus as a turned-inside-out penis and omitted the clitoris. Vesalius and his students secretly exhumed the body of an attractive sex worker who had been the lover of a monk. They stripped away her skin so her grieving family could not identify her stolen corpse.

Realdo Colombo in 1559 and Gabriele Fallopio in 1561 claimed discovery of the clitoris. They recognized its role in female pleasure but interpreted larger variations as pathological deformities or intersex abnormalities. Realdo Colombo described a female patient he termed an Ethiopian gypsy who possessed an enlarged clitoris nearly the size of a little finger. He pathologized her condition as a wretched deformity that prevented her from fitting standard heterosexual roles.

Physicians like Edward Jorden sought to reframe demonic possession as a natural medical disease caused by uterine disorders. He published A Briefe Discourse of a Disease Called the Suffocation of the Mother in 1603, arguing that womb suffocation resulted from an idle uterus and lack of marital sex. Edward Jorden acted as a medical witness in the trial of Elizabeth Jackson, an older woman accused of bewitching fourteen-year-old Mary Glover. He successfully diagnosed Glover with a natural uterine disease rather than demonic possession, though courts initially failed to heed his medical reasoning.

You can trace the standard treatments for this condition through these steps:

• Hold the suffering woman down by her throat and belly during a fit.
• Tie up her legs.
• Prescribe fasting, sleeping, avoiding wine, and praying all day to police her thoughts and emotions.

John Sadler published The Sicke Woman’s Private Looking-Glasse in 1636 to reveal the truth about women's uterine distempers. He argued that an empty, inactive, or unfulfilled uterus stewed up poisons and caused mental aberrations, convulsions, and hysteria. Thomas Willis revolutionized the understanding of hysteria in the 1660s by disproving the uterine origin theory. He coined the term neurology in his 1664 work Cerebri anatome, discovering that hysteric passions stemmed from nervous system malfunctions rather than a wandering womb. Thomas Willis performed an autopsy in 1667 on a noble lady who suffered convulsive passions and died after a miscarriage. He found her uterus healthy but her brain membranes distended with blood and fluid.

3. Racial Biases and Surgical Abuses in the Nineteenth Century

Nineteenth-century physicians institutionalized racist pain hierarchies and subjected women to brutal surgical experiments and vaginal examinations under the guise of medical progress.

Physicians combined class-based theories of civility and nervous sensibility with racial hierarchies. They asserted that savage or Black women did not feel pain to the same degree as civilized Western European women. These distorted beliefs justified extreme surgical experimentation without anesthesia. British surgeon Henry James Johnson reported in 1827 that American surgeon Ephraim McDowell's ovarian surgeries on Black women in Kentucky succeeded because negresses could bear cutting nearly as well as animals.

J. Marion Sims perfected a revolutionary surgical cure for vesicovaginal fistulas in the 1840s by performing dozens of brutal, unanesthetized experimental operations on enslaved Black women. Operating in a backyard hospital in Alabama, Sims bargained with slave owners to acquire enslaved women suffering from severe childbirth injuries. He subjected subjects like Anarcha, Betsey, and Lucy to repeated operations without anesthesia, driven by a desire for professional renown while leveraging racist views of their pain tolerance. Anarcha endured thirty agonizing operations using a silver wire suture before Sims successfully perfected his vesicovaginal fistula repair procedure in Montgomery, Alabama.

The introduction of chemical anesthetics like chloroform in mid-nineteenth-century childbirth sparked intense medical and moral debates before becoming a symbol of liberation for women wealthy enough to access it. Traditionalists like Charles Meigs argued that labor pain was a divine, salutary necessity that helped mothers bond with their children and that women only experienced minutes of actual pain. Conversely, innovators like James Young Simpson and anesthetist John Snow championed anesthetics, demonstrating their safety and comfort. When Queen Victoria used chloroform for the birth of her eighth child, pain-free labor gained widespread cultural acceptance. Queen Victoria used a brass vaporizer administered by Dr. John Snow to inhale chloroform for fifty-three minutes during the birth of her eighth child on April 7, 1853.

The introduction of the vaginal speculum and reflex theories of hysteria unleashed intense moral panic over female modesty and sexual autonomy.

The speculum allowed visual inspection of the cervix and uterus, replacing blind abdominal palpation and digital examinations known as the touch. Detractors argued that its use destroyed female purity and induced erotic hysteria, while proponents recognized it as essential for diagnosing uterine diseases and infertility. French regulatory laws for prostitution made the speculum an instrument of state control, creating a precedent where sex workers were forcibly examined for venereal diseases. From 1810, French laws required Paris sex workers to attend special dispensaries for vaginal and rectal checks, detaining those with suspicious ulcerations in prison-like lock hospitals until cured.

Mid-nineteenth-century medical theory posited that stimulation of the reproductive organs triggered involuntary nervous system responses, leading to hysteria and nymphomania in women. Physicians concluded that any overexcitement or touching of the female genitalia caused uncontrollable emotional and behavioral derangements. Robert Brudenell Carter argued that women were under the dominion of feelings and prescribed punishments or distracting tasks to dampen their ardor:

• wind a heavy wheel for hours
• confess secrets
• play chess
• go to bed early with a short candle
• pretend others believe she is pregnant
• practice a bit of light astronomy
• avoid reading

Victorian gynecologists performed clitoridectomies as a surgical cure for masturbation, hysteria, epilepsy, and other nervous disorders. Isaac Baker Brown founded a private clinic in Notting Hill, the London Surgical Home, where he systematically performed clitoridectomies on young women and girls before the Obstetrical Society expelled him in 1867.

Surgeons prepared patients through strict clinical routines:

• soak a handkerchief with chloroform and place it over the face
• remove the glans with a snip of scissors
• plug the wound with lint and bandage her up
• apply one grain of opium to relieve pain
• enforce recovery in complete silence with no visitors, no diverting activities, and only the blandest foods for a month

Early feminist campaigners and activists mobilized against the Contagious Diseases Acts, fighting against state-sanctioned invasive exams and the systemic punishment of women. Josephine Butler founded the Ladies National Association to lobby for its repeal, denouncing enforced exams as steel rape and declaring that women were engaged in a deadly fight for their bodies against male medical tyranny.

4. Menstruation Myths and the Rest Cure

Medical dogmas pathologized menstruation as an incapacitating illness and enforced the rest cure to force ambitious women back into domestic compliance.

Victorian medicine treated menstruation as an inherent disease and relied on unscientific theories of ovarian irritation. Physicians claimed that social life, reading, or emotional overexcitement could overstimulate the ovaries and trigger hysteria. This supposed biological vulnerability served as proof that women were unsuited for professions outside the home. In the 1845 Old Bailey trial of Martha Brixey, who murdered an infant, her physician testified that young women were prone to violent fits of passion when their constitutional functions were suspended. This testimony led to an acquittal for menstrual insanity.

Anti-feminist physicians weaponized medical theories to argue that higher education would ruin women's health. Edward Hammond Clarke claimed that intellectual labor drained the vital energy needed for reproductive organs. Edward Hammond Clarke cited 'Miss A,' who supposedly suffered from heavy periods and Saint Vitus's dance after overstudying at seminary school, using her case as a cautionary tale in his 1873 book 'Sex in Education'.

Pioneering physician Mary Putnam Jacobi disproved pseudoscientific claims about menstrual incapacity through rigorous clinical research. In 1876, Mary Putnam Jacobi expanded her clinical research to 268 women across diverse backgrounds, mapping their physiological changes before, during, and after menstruation.

Silas Weir Mitchell popularized the rest cure as a form of moral conditioning to force independent women back into domestic compliance. He prescribed absolute bed rest, a fat-heavy diet, massage, and electrotherapy while strictly forbidding any intellectual, creative, or physical activity. Charlotte Perkins Gilman was subjected to Mitchell's rest cure in 1887, after which her doctor prescribed a strictly domestic life with minimal intellectual stimulation and a permanent ban on writing or painting.

5. Militant Suffrage and the Birth Control Movement

Black women abolitionists and activists fought for universal women's rights while criticizing mainstream white suffrage leaders for ignoring racial discrimination. Prominent Black figures like Sojourner Truth, Ida B. Wells-Barnett, and Mary Church Terrell campaigned for both civil rights and women's suffrage, pointing out that white suffragists often neglected the specific needs and dangers faced by Black women. Sojourner Truth delivered her famous "Ain't I a Woman?" speech at the 1851 women's rights convention in Akron, Ohio, asserting her physical strength and intellectual capacity as proof of her equal rights.

As militant suffragists adopted direct action and hunger strikes, British authorities instituted brutal forced feeding procedures that were condemned as torture. The Women's Social and Political Union, led by Emmeline Pankhurst and her daughters, engaged in civil disobedience through deeds, not words. When imprisoned members went on artificial feeding hunger strikes, prison doctors forcibly fed them through the nose or mouth using tubes and gags. Mary Richardson endured nasal feeding thirty times by prison physician Dr. Pearson while serving a sentence in Holloway, while Mary Leigh was held down by wardresses while a tube was pushed down her throat.

To carry out artificial feeding, authorities used specific methods:

• hold the protesting prisoner down using wardresses;
• insert a rubber tube up the nose and down into the throat, or force the mouth wide open using a screwed steel gag;
• pour liquid food or milk down the tube through a funnel.

In 1903, Emmeline Pankhurst founded the WSPU, leading to a massive "Women's Sunday" rally in London's Hyde Park in 1908 where 30,000 suffragists marched. Feeding tubes were sometimes pushed to a depth of 20 inches.

Early twentieth-century childbirth in the United States was a lethal ordeal, functioning as a leading cause of death among young women due to infections, trauma, and unhygienic practices. The 1910 US census identified the puerperal state as the leading cause of death for women aged twenty to thirty-nine, surpassing accidents, cancers, and heart diseases. Protracted labors, unsterilized instruments like forceps wielded by inexpert physicians, and postpartum infections routinely left women physically devastated. The US census of 1910 showed that 45.5 percent of all deaths in women aged twenty to twenty-nine occurred either during childbirth or within six weeks afterward, while 3 to 5 percent of children died during childbirth.

The Dämmerschlaf, or twilight sleep method, used morphine and scopolamine to wipe away the memory of labor pain while allowing women to push consciously. Developed at the Frauenklinik in Freiburg by Bernhard Krönig and Karl Gauss, the technique used a psychoactive derived from nightshade plants combined with an opiate. The dose induced a clouded consciousness where external impressions slid off, and patients retained no memory of the ordeal, though the process often involved physical restraints, padded rooms, and deafened senses. In 1913, American suffragist Mary Sumner Boyd traveled to Freiburg to undergo Dämmerschlaf and later published her experience in McClure's Magazine, sparking an American craze with 1500 Dämmerschlaf births recorded at the Frauenklinik with only one maternal death.

The popularity of twilight sleep allowed male obstetricians to pathologize childbirth and seize control of delivery from midwives by making surgical and narcotic intervention routine. Prominent obstetricians like Joseph DeLee used the public demand for pain relief to argue that normal childbirth was too perilous to be left unmanaged. He instituted a routine of prophylactic forceps operation interventions involving scopolamine, ether, episiotomies, and forceps extractions. Joseph DeLee founded the Chicago Lying-In Hospital and pushed for routine surgical interventions under the argument that tokophobia, or the fear of pregnancy, had become endemic.

Obstetric management followed strict protocols:

• administer sedative scopolamine injections in the early stages of labor;
• use ether in the second stage of labor to relieve pain;
• perform an episiotomy incision in the perineum and vaginal wall;
• deliver the baby using forceps;
• remove the placenta and tightly stitch the episiotomy site.

The Comstock Laws legally suppressed birth control information in the United States, driving activists like Margaret Sanger to defy the government and distribute practical contraception methods. Enacted in 1873, the Comstock Laws prohibited the distribution of obscene literature and articles of immoral use via the postal service. Sanger responded by publishing radical newspapers like The Woman Rebel and self-help pamphlets detailing contraceptive instructions in Family Limitation to free women from the economic slavery of unwanted motherhood. In October 1916, Margaret Sanger and her sister Ethyl Byrne opened the nation's first birth control clinic on Amboy Street in Brooklyn, leading to their subsequent arrest and imprisonment. Official records noted 100,000 criminal abortions occurring annually in the United States alongside 6,000 estimated annual deaths resulting from botched abortions, and Ethyl Byrne endured 185 hours of hunger strike before being force-fed in prison.

Early birth control methods required specific tasks:

• act immediately with daily laxatives and quinine to stop the ovum from attaching if fluid entered the vagina;
• use condoms, pessaries, sponges, or douching solutions of Lysol, vinegar, salt, or cold water for contraception;
• apply special ingredient-laced pessaries to negate the male seed.

Mary Ware Dennett campaigned for the complete legalization of contraception and sex education for all social classes, opposing the medical monopoly on birth control information. Dennett founded the National Birth Control League and later the Voluntary Parenthood League to remove references to contraception from the Comstock Laws. She believed that restricting birth control advice exclusively to medical professionals was a form of class legislation that kept vital knowledge away from working-class women. In 1915, Dennett wrote The Sex Side of Life, an educational guide for her fourteen-year-old son that used proper anatomical terminology and explained the physiological realities of reproduction.

Marie Stopes popularized marital sex education and contraception in Britain to liberate women from the misery of unwanted pregnancies and unfulfilled marital relations. After a painful marriage annulment, Stopes published Married Love to demystify female sexuality and explain that sexual desire ebbed and flowed through a woman's cycle. She opened Britain's first Mother's Clinic in London to provide free contraceptive advice, including her patented Pro-Race Cap or Racial Cap, exclusively to married women. On the opening day of Stopes's Mother's Clinic in Holloway in 1921, women queued in the hundreds around the street to receive guidance from visiting midwives, and the sixth printing of Married Love reached within two weeks of publication.

Early birth control advocates frequently intertwined their campaigns with ableist and eugenicist ideologies, supporting the forced sterilization of individuals deemed genetically defective. Figures like Margaret Sanger and Marie Stopes adopted neo-Malthusian and eugenicist frameworks, arguing that limiting reproduction among the lower classes and the feeble-minded would achieve racial betterment. This led to state-sanctioned compulsory salpingectomy sterilization laws and practices targeting vulnerable women in institutions without their consent. In 1924, seventeen-year-old Carrie Buck was ordered to be sterilized at the Lynchburg Colony in Virginia, a decision upheld by the Supreme Court in the landmark case Buck v. Bell following the 1907 legalization of forced sterilization in many US states.

6. Endocrinology, Hormones, and Menstrual Management

The rise of endocrinology replaced older myths of weakness with hormonal reductionism while innovative women physicians championed non-surgical treatments.

British biologist Ernest Starling introduced the word hormone in 1905 to describe secretin after discovering how internal molecules regulate organ communication. Theorists like Marie Stopes believed that female secretions governed traits like intelligence.

Endocrinology provided new biological justifications for eugenics by linking internal secretions to racial purity.

In 1916, Eliza Burt Gamble argued that functional nervousness was a social symptom of male dominance. Gynecologist William Blair Bell asserted that internal secretions determined idealized femininity. Physicians used sheep thyroid extracts to treat myxedema, which was four times more common in women than in men. In November 1891, Robert Alex Lundie treated a fifty-four-year-old woman with sheep-thyroid extract.

Researchers transplanted ovarian tissue grafts to prove secretions governed organs. Emil Knauer removed ovaries from adult rabbits in 1896 and transplanted ovarian tissue grafts. Anne Louise McIlroy showed that ovaries maintained metabolic health. In 1898, McIlroy became the first woman to receive an MD from the University of Glasgow.

Gynecologists pathologized menopause as a deficiency disease. Harry Benjamin provided X-ray rejuvenation therapy to women. In 1922, Gertrude Atherton underwent Benjamin's therapy at age sixty-four. Pharmaceutical companies manufactured estrogen replacements. In 1941, Wyeth Pharmaceuticals launched Premarin, derived from pregnant mare urine.

Clelia Duel Mosher showed that period cramps are caused by poor breathing rather than female defect. You can apply Mosher's simple physical routine to relieve cramps:

• Loosen clothing and lie down with knees flexed.
• Apply gentle pressure to the abdomen with one hand.
• Breathe in deeply and see how high the hand can be raised by lifting abdominal muscles.
• Observe the hand lowering as exhaling and muscles contract.
• Practice this exercise ten times, morning and night, in nightclothes with a well-ventilated room, keeping movements smooth and rhythmical.

By 1896, Mosher had studied more than 3,350 cycles in over 400 women. Louisa Martindale purchased a 200,000-volt machine to treat uterine fibroids. In 1930, the Marie Curie Hospital opened in London.

7. Wartime Realities, Abortion Laws, and Postwar Control

Working-class women suffered severe chronic neglect while state authorities and medical practitioners enforced strict reproductive controls and invasive surveillance.

The Women's Health Enquiry Committee distributed questionnaires through health visitors and gathered data on the dire health and living conditions of working-class housewives. Margery Spring Rice published these findings in her 1939 book Working-Class Wives, showing that ailments like anemia, rheumatism, and gynecological disorders went completely unaddressed as women sacrificed their well-being to domestic and economic labor. Out of 4,655 maternal deaths studied over four years, 45.9 percent were avoidable. A thirty-two-year-old mother of seven in County Durham rose daily at 4:00 a.m. to weave mats for clothes and manage endless household labor while suffering from nerve inflammation, kidney damage from childhood Bright's disease, and recurring cystitis.

Under laws like the Infant Life (Preservation) Act, abortion was a criminal offense unless the mother's life was at risk. In England and Wales in 1934, 14 percent of puerperal deaths were attributed to botched operations and abortifacients. Activists like F. W. Stella Browne formed the Abortion Law Reform Association in 1936 to challenge oppressive laws that treated women's bodies as public property and denied them the right to choose. Working-class women unable to afford safe private physicians resorted to purgatives, gin, knitting needles, crochet hooks, or slippery elm bark which frequently caused life-threatening sepsis.

After a fourteen-year-old girl named Miss H was brutally raped by guardsmen, gynecologist Joan Malleson secured Aleck Bourne's agreement to perform an abortion and turn himself in to test the law. Bourne successfully argued that carrying the pregnancy to term would inflict incurable psychological and nervous damage, leading the jury to acquit him under the principle of preserving health after a 40 minutes of jury adjournment.

8. Feminist Health Movements and Modern Medical Bias

Grassroots activism revolutionized women's health literacy and forced research reforms, yet systemic dismissal of female pain and autoimmune conditions persists today.

Activists such as Barbara Seaman and members of the DC Women’s Liberation exposed suppressed data regarding the risks of oral contraceptives and hormone treatments. Alice Wolfson and other DC Women’s Liberation protesters disrupted the 1970 Senate hearings led by Senator Gaylord Nelson to demand answers regarding the health hazards of the pill. These protests led the FDA to require package inserts detailing side effects and contraindications, resulting in an 18 percent drop in the use of the pill following the congressional hearings.

Grassroots women's health groups broke down the culture of paternalistic mystification in medicine by researching and publishing accessible anatomy and healthcare manuals. Printed by the New England Free Press, the original 193-page book cost seventy-five cents in 1970, and after being renamed and reduced to thirty cents in 1971, it sold over 230,000 copies. You can apply these self-help principles directly:

• read medical books and clinical journals;
• meet with health professionals;
• distribute questionnaires to friends and peers;
• touch, explore, and learn to love your body.

Activists took illegal reproductive care into their own hands by establishing clandestine abortion networks and inventing safer, less invasive menstrual extraction devices. Heather Booth founded the underground support network The Jane Collective in Chicago in 1969, where members learned to perform surgical procedures like dilation and curettage themselves in rented apartments. Carol Downer demonstrated vaginal self-examination with a plastic speculum in Venice, California in 1971.

Medical bias routinely dismissed female pain as emotional rather than physical. Clinical psychologist Dr. Dorothea Lack's 1982 study of 188 hospital patients revealed that women had to wait three years longer than men for pain clinic referrals and were more frequently offered tranquilizers. Dr. Bernadine Healy coined Yentl syndrome in 1991 to describe how women only receive proper medical attention when acting or presenting like men.

10 Key Ideas

1. Elinor Cleghorn exposes how modern Western medicine was founded on the patriarchal myth that the female body is inherently prone to illness because of its reproductive organs and a wandering womb.
2. Renaissance anatomists and physicians mapped female organs through the lens of inferiority while blaming the uterus for all forms of female mental and physical distress.
3. Nineteenth-century physicians institutionalized racist pain hierarchies and subjected enslaved Black women like Anarcha to brutal, unanesthetized surgical experiments under the guise of medical progress.
4. Victorian medical dogmas pathologized menstruation as an incapacitating illness and enforced the rest cure to force ambitious women back into domestic compliance.
5. While Black women abolitionists fought for universal rights, militant suffragists endured brutal forced feeding by prison doctors during hunger strikes.
6. The popularity of twilight sleep allowed male obstetricians to pathologize childbirth and seize control of delivery from midwives by making surgical and narcotic intervention routine.
7. Activists like Margaret Sanger and Mary Ware Dennett defied the Comstock Laws to distribute practical contraception and fight the medical monopoly on birth control information, though some advocates intertwined their campaigns with eugenicist ideologies.
8. The rise of endocrinology replaced older myths of weakness with hormonal reductionism while innovative women physicians championed non-surgical treatments and disproved menstrual incapacity.
9. Working-class women suffered severe chronic neglect while state authorities and medical practitioners enforced strict reproductive controls, illegal abortions, and invasive surveillance.
10. Grassroots activism revolutionized women's health literacy and forced research reforms, yet systemic dismissal of female pain and autoimmune conditions as emotional rather than physical persists today.