As you and everybody in the world with an Internet connection now knows, Angelina Jolie had her fallopian tubes and uterus removed as part of an ongoing series of preventative surgeries for cancer. But one thing that’s gone pretty much unsaid in the media coverage of her brave act is that it’s pretty amazing in the first place that this surgery is 1) possible and 2) safe. We take it completely for granted that a woman in the Western world can now safely have bits of her reproductive system taken out and be not only alive and pain-free, but walking around and writing NYT op-eds a few days later. While there's still a long way to go, the state of gynecological health sure has come a long way.
To say “it hasn't always been this good” is an exaggeration of epic proportions. For most of human history, women in sticky gynecological situations didn’t have surgery, anesthetic, or even surgeons who knew what the hell their insides looked like. Until a few centuries ago, nobody wanted to cut open a woman at all, and every mysterious ailment in a lady’s reproductive areas was treated from the outside, which went about as well as you'd expect. We, as well as Jolie, are a lucky bunch.
If you want to appreciate just how far we’ve come, take a journey with me through five landmark moments in the grisly, reptilian history of women’s gynecological surgery.
Ancient Egyptians: The First Gynecological Diagnosis
The oldest mention in history of dealing with problems in a woman's reproductive system using medicine goes to the Ebers Papyrus of the Ancient Egyptians (1800 BC) — or rather, went to it, as the German destroyed it in World War II. Fortunately, we still have a translation of the text; but it doesn't look as if the Egyptians can take the crown for the first people to try and conduct a reproductive surgery. Far from it.
If the papyrus is correct, the Egyptians were pretty loath to cut into any tumors or cancers that weren't on the surface (they also did something terrifying called "treating it with fire"). Awareness, in this case, didn't mean doing anything about it. Sorry, Egyptian ladies.
Anicent Greece: "Plug And Hook" The Uterus?!
The Greeks had a lot of very involved and confusing theories about the female genitalia and reproductive system — including the charming theory, by the highly-respected Greek physician Hippocrates, that women's wombs "wandered" around the body like slimy animals, causing problems by bumping into things and getting stuck. (Apparently you could lure it around the body using "fragrant smells".)
Despite being plagued by this kind of lunacy, the Greeks were also the first to report surgery on women's reproductive systems; specifically by Soranus (approx. 100AD), Ancient Greece's great authority on gynaecology (he wrote four books about it). Soranus didn't seem to be very successful — he deplored the fact that hemorrhage of the uterus couldn't be fixed "by pressure of the fingers, insertion of hooks, plugging with pledgets [wads of gauze]", and thought that infected uteruses could be fixed by being tied up in a "bright warm room" and being injected with olive oil down below. But hey, it was a start.
(And at least he's doing better than a disciple of his, the Roman Oribasius, who thought ailments of the reproductive system could be fixed if you shouted at the patient or made her sneeze.)
The Renaissance: Leeches And Knives
While grisly, the Renaissance started to make things a little better for women's surgery. For one, Leonardo Da Vinci did some very detailed sketches of female pelvic anatomy of the first time, and others followed suit, including the first anatomical sketch of the uterine canal by Barthomeleo Eustachio. This meant that people actually understood where things were — even if they were unwilling to cut into them.
Ambroise Pare (1510-1590) was part of the new wave. A French surgeon (and barber, as they all were back then) who served four kings, he was also a pioneering surgeon, and included in his insights were women's reproductive systems. He was a great obstetrician, which was as far as most doctors were willing to go (if they didn't let midwives do all the work) — but he also tried a bunch of other operations, including applying leeches to the cervix's surface and treating cervical lesions with mixtures of pomegranate juice and leeks. And, most notably for us, he recommended amputating a cervix if it was diseased (though we now don't think he ever did).
1809: First Ovarian Tumor Removed (Without Killing Anyone)
American doctor Ephraim McDowell (1770-1830) is claimed as "the father of ovariotomy," and rightly so — but not because he was the first to attempt it. He was just the first to remove a tumor on an ovary without outright killing the attached patient.
It was a hell of an operation: the tumor he removed in 1809 weighed a whopping 22.5 pounds and would definitely have killed its owner (previous doctors had thought she was pregnant). Even crazier? It was done entirely without anesthetic.
Unfortunately, the discovery that ovaries could be operated on and even removed without complications — a process known as an oophorectomy (what Jolie had) — led to a rage for them in the 19th century. Doctors removed ovaries willy-nilly as a cure for "menstrual madness," hysteria, nymphomania, masturbation and basically anything else. Hurrah!
1813: The First Hysterectomy
The poor Conrad Lagenbeck of Gottingen, Germany, was a pioneering surgeon who managed to remove a uterus successfully for the first time in 1813 — and then discovered that nobody believed him. None of his medical contemporaries thought anybody could have done such a complex operation without killing the patient. To make things worse, his (apparently grumpy and unhelpful) assistant died, and the uterus itself was lost, meaning that the medical fraternity just had Lagenbeck's word for it. They didn't take it.
It took 28 years, until the patient's death and subsequent autopsy revealed that she did not in fact have a uterus, for anybody to believe him. Since then, we've gone on in leaps and bounds — helped by the fact that people now think it's actually possible for women to survive without their reproductive parts. Always good for surgery.