Doctor's Review: Medicine on the Move

October 19, 2017
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Mad with menopause

The way we look at The Change has certainly, well, changed

In 1692, 16 women falsely accused of witchcraft were either executed or died while imprisoned in Salem, Massachusetts. At least 13 of them were menopausal. Today we see this infamous incident of mass hysteria as a seminal moment in women’s history, although to be fair, “seminal” may not be the right choice of words. No matter how one chooses to describe what happened during this dark chapter in American history, it’s undeniably significant that those targeted were women past childbearing age, a group perceived as powerful, threatening and altogether ungodly.

Gender politics aside, menopause has somewhat of a strange place in the story of medicine, despite it being a big part of the cycle of life. Prior to the last couple of centuries, not much thought had been given to the slew of physiological and psychological changes that accompany the female ageing process. Perhaps it was because life expectancy was shorter; after all, so many women died in childbirth, and the various plagues and diseases floating around meant that in some eras, making it to menopause was like hitting the jackpot!

More likely, though, was the fact that nobody gave the medical aspects of ageing much thought. Aside from the storied fountain of youth, what defense could there possibly be against the onslaught of old age? Only the wealthy and the philosophical could afford to sit around contemplating their own mortality. For the average Medieval Joe, there were fields to sow, serfdoms to defend, work to be done! The tide turned in the 19th century, when life expectancy increased somewhat in the Western world as did the accompanying onslaught of medical conditions.

It’s not that nobody knew about menopause – Aristotle himself noted that women couldn’t get pregnant after around age 50 and Hippocrates associated this with breast cancer – it’s just that nobody cared. Here and there, a physician attempted to apply logic to the situation. Most notably, perhaps, was the well-known English physician Thomas Sydenham (1624-1689).

Sydenham – who revived Hippocratic values like detailed observation, careful case histories and the blessings of opium – was keen to point out that women were prone to “hysterick fits” between the ages of 45 and 50. It stood to reason, therefore, that restoring the menses in these hapless souls might be the solution. He advocated a hearty regimen of blood-letting as a cure. Many of his middle-aged female patients likely dreamed of turning the scalpel on the gouty old man himself.

De la ménépausie

One 19th-century French physician spearheaded a new interest in the subject. Charles Pierre Louis De Gardanne studied at great length the symptoms experienced by women as they aged. He coined the term itself in 1821, in the first-ever article on the subject: De la ménépausie, ou de l’âge critique des femmes (“Menopause: The Critical Age of Women”). It was to be a banner year for granny-bashing.

Although De Gardanne may have been the first to give menopause some serious medical attention, it is also to him that we can attribute the first negative attitude towards this most natural of biological processes. He blamed an incredible slew of physical and emotional symptoms on the cessation of menstruation.

In 1845, De Gardanne’s countryman C. F. Menville de Ponsan took up the cause and devoted an entire book to menopause, which he liked to call “the death of the womb.” In his defense, he was somewhat of a romantic when it came to menopause: “When the vital forces cease to conspire over the uterus, they will increase those of the spirit… . The critical age passed, women have the hope of a longer life than men, and their thought acquires more precision, understanding and vivacity.”

Nineteenth-century cures were mainly held over from earlier times – purgatives, bleeding and enemas fell into the category of “vicarious menstruations.” The forward-thinking London gynecologist Samuel Ashwell’s (1798-1857) treatments might have been standard, but his attitude was anything but. In his Practical Treatise on the Diseases Peculiar to Women (1844), he suggested abstinence from alcohol, exercise and vegetarianism, although he did not see menopause as a disease:

“It has become too general an opinion that the decline of this function [menstruation] must be attended by illness; but this is surely an error, for there are healthy women who pass over this time without any inconvenience and many whose indisposition is both transient and slight.”

Deleterious douches

Sadly, Ashwell’s influence was limited. It wasn’t long before the Victorian mind-set twisted menopause into a mental illness to be cured. Women couldn’t catch a break: it seems that having a working womb gave you hysteria, while not having one pretty much did the same thing. The doctors in England began prescribing deadly-sounding douches containing a cocktail of acetate of lead, morphine and chloroform.

In the North American land of opportunity, the growing perception on a woman’s change of life as a disease to be cured meant a boon for snake-oil salesmen. Industrious quacks jumped on the menopause bandwagon and touted all manner of miraculous cures for hot flashes, insomnia and night sweats.

Surgery was option too, it seemed. In 1809, Kentucky physician Ephraim McDowell (1771-1830) performed the first successful ovariotomy in 1809, removing a 10.2-kilogram tumour from a woman believed by her previous physician to be 11 months pregnant. He performed several similar surgeries over the next decade or so, eventually publishing his work in 1817.

News of his successful ovariotomies travelled back to Britain, where Scottish surgeon and laudanum addict John Lizars (1787-1860) saw new potential in the surgery. He reasoned that if a woman’s ovaries – the wellspring of her goodness and virtue, according to Victorian mores – weren’t in working order, it seriously compromised her mental and physical integrity. The solution? Remove them! Lizars performed 200 ovariotomies between 1825 and 1854, killing 89 women in the process.

Sounds abominable, of course. Yet as gruesome as the ovariotomy may seem today – remember that surgical anesthesia wasn’t commonplace until the mid-1800s – the menopausal madam faced a far worse option, thanks to the megalomaniacal medical mind of one Dr Isaac Baker Brown (1811-1873).

Baker Brown, an English gynecologist and surgeon, enjoyed an illustrious career until he decided to take the ovariotomy a few inches south and began experimenting with clitorodectomies as a cure for menopause and that old stand-by, hysteria. In 1866, he published his results, claiming that clitoris removal was successful even in treating epilepsy (caused by masturbation) upwards of 70 percent of the time.

Soon it was revealed that Baker Brown was performing these surgeries without his patients’ consent. This was too much even for the cadre of clitoris-fearing old fogies at the Obstetrical Society of London, and Baker Brown was summarily dismissed.

Lawson locks ’em up

The 1870s saw a trend toward the institutionalization of menopausal women behaving badly. The popular obstetrician and general champion of women’s health Lawson Tait (1845-1899) felt that menopause-induced hysteria and general non-compliance -- especially if the woman in question liked to enjoy a glass of wine on occasion -- were good enough reason to put her away for a spell. He prescribed violent purgatives and random commitment to the asylum as prophelatic measures to be taken against the threat of menopausal “dementia.” One of Tait’s most accepted ideas was his belief that Jack the Ripper was actually a woman, and a midwife to boot.

Where institutions and surgery failed, surely pharmacology would succeed! The late 19th-century menopausal scene was flooded with medicinal treatments for hot flashes, moodiness, vaginal dryness and the like. Some treatments for menopause, often referred to as “climacteric insanity” – like opium, wine and cannabis – promised a good time, if not a complete remission. Others big sellers in the late-Victorian pharmacopeia were powdered ovaries and testicles -- of what or whom, we can never know for sure, though some labels boasted powerful pig parts.

The 20th century would hold many breakthroughs in the understanding of menopause and its treatment. Estrogen was isolated at St. Louis University in 1929 by Nobel-Prize winning biochemist Edward Doisy (1893-1986). German-Israeli gynecologist Bernhard Zondek (1891-1966) not only developed the first pregnancy test in 1928, but also discovered water-soluble estrogen in the urine of pregnant mares in 1930.

The war against cold sweats heated up and an entire industry was born in hormone-replacement therapy. While medicine may never be able to technically turn back the clock for women experiencing menopause, it certainly can make things a little easier as the next generation of drugs is poised to offer better, safer treatment than ever before.

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