The changing understanding of normal and disordered underlying the descriptions of the reproductive function can also be traced in the changing perception of the uterus as the central organ of the reproductive system and female body. In the early texts the uterus is seen as a vulnerable organ in the body reflecting the woman’s general appearance and health. Its liablity to disorder signifies women’s general state of vulnerablity. The displacement of the uterus affects the whole physique. One case is described as
rendered weak, depressed; she had the uterine physiognomy, in which dejection of mind is so evident in the drawn face and hopeless expression.
(Balls Headley,!879:382)
The female body is seen as a system of circulatory functions with the uterus at the centre. In another text the physiology of the female body is also built around the uterus so that the whole female body is seen as naturally vulnerable to disorder. Jakin’s ’The Mechanical Treatment of Displacement of the Uterus’ (1890) gives a detailed description of the position and function of the uterus in the female body. Here the clinical gaze is on the anomalies of the female body’s structure:
let us consider the uterus as placed in the middle line of the pelvis between the bladder and the rectum, as fixed anteriorly by ligaments ... These uterine ligaments are ... always more or less tense, in fact they act as suspensory ligaments to the uterus, yet yielding with every movement of the body ... let the suspensory ligaments of the uterus lose their tone ... out comes the uterus ... [T]he force of an ordinary respiration is equal to a force of 2001b pressure ... a force equivalent to 1001b 16 times a minute for life ... [W]e can form some idea of the tendency of the uterus to become displaced.
(Jakins,1890:137)
In this clinical description the natural physiological pressure renders the uterus, and therefore the whole body, liable to disorder.
In later texts the focus shifts from the detailed descriptions of the pathology of the uterus and mechanical treatments to a discussion of the general cause of uterine displacement and illhealth of woman. In these texts a more complex picture of the workings of the reproductive system emerges. The behaviour of woman, her general health and the effects of the environment are seen as factors in determining the stability of the uterus.
In O’Sullivan’s ’The Proclivity of Civilized Woman to Uterine Displacement’ (1894) the frequency of uterine displacements signifies the disorder of the civilised environment for women. Because the uterus is a floating body ’where every breath, every movement, every position of the individual, every degree of fulness of the bladder and the rectum influences its position’ fashionable corsets and heavy skirts cause ill health. (O’Sullivan, 1894:9) Tight lacing, tight clothing causing constipation and excessive muscular exertion produce displacement. In these fashionable practices ’we find in full and unrestricted operation the many agencies which are most potent in the production of the anatomical and structural alteration of the womb’. (O’Sullivan, 1894:11) Nature’s price is that civilised women’s reproductive function,
will assuredly become imperfect, her viscerae displaced, her abdominal and thoracic muscles wasted ... She lays the ground work of chronic invalidism. She unfits herself for the responsibilities and congenial occupations of a wife.
(O’Sullivan,1894:11)
O’Sullivan argues that treatment should not be,
impaling the unfortunate uterus on a stem or hoisting it on pessaries [but] to grasp the true principle for the relief of various displacements, by seeking the sources whence those troubles spring, and by an honest unflinching advocacy of Nature’s laws ... [T]he sacred duty of every woman who hopes to become a mother is to preserve all her organs in their normal state.
(O’Sullivan,1894:16-23)
The normal state of the female body is one of readiness for reproduction, signalled by a well placed uterus. The tendency of civilised woman to displaced uteri signifies a general degeneracy of the modem female body.
In Rothwell Adam’s text ’Observations on Pathology and Surgery of Retro-displacements of the Uterus’ (1903) the argument is that both women’s physiology and the conditions of the environment are responsible for displacements of the uterus. He bases his study not ’purely on observation’ but on the study of three sets of factors - civilisation, anatomy and general
pathological conditions.
Women are naturally physiologically liable to internal disorder. It is ’taken as beyond dispute’ that the ’erect position assumed by the normal female is responsible primarily for the mal-positions that occur’. (Rothwell Adam,1903:157) In the anatomical descriptions of the uterus the focus is on the natural liability of the uterus to become displaced. The normal state of the uterus leaves it vulnerable to disorder:
[i]f the general shape of the uterus be likened to an inverted cone, with its chief attachment to the apex, the marvel will be that this top-heavy organ is not more freqently displaced.
(Rothwell Adam,1903:158)
The two most important anatomical features which stand out in marked relief as bearing on the maintenance of a stable equilibrium of the uterus are -
1. The erect attitude assumed by the human female, and 2. The free moblity of the normally situated uterus
(Rothwell Adam, 1903:164)
The fundus, colon and bladder all assist in ’forcing down the uterus’. The pressure placed on the ligaments during pregnancy and labour produce a ’general hypertrophy’ and ’retrograde changes’. The uterus itself ’occupies the anomalous position of being the only organ of any size in the body that has no large vessels entering its stmcture, and yet richly endowed with a large supply of blood’. (Rothwell Adam, 1903:167) This leads to engorgement and congestion. The pelvic floor also exhibits ’ incompetency’. (Rothwell Adam, 1903: 168) This description suggests that in the equation of the norm and disordered the uterus is structurally closer to disorder.
In Rothwell Adam’s description of the general pathological factors the reproductive function tips the balance of the body towards disorder. Puberty, puerperium and pregnancy produce states of weakness, fragility, anaemia and tears to the uterine structure. (Rothwell Adam, 1903:169) The female body’s reproductive capacity is seen as leaving woman structurally vulnerable to physical illhealth and unable to perform her social function.
In these texts there is a shift in the understanding of the norm and the disordered. In the early texts the uterus is isolated as the determining organ in the female body which dictates female behaviour and appearance. In the later texts the external environment and internal structure produce a structurally vulnerable female body centred on the uterus. The disorder associated with the uterus is transferred on to the workings of the whole reproductive system.
The gynaecological gaze constitutes the female body as a delicately balanced reproductive mechanism- All women experience the activity of the reproductive cycle from puberty to
menopause and are therefore potential medical subjects. The logic underlying the gaze’s constitution of the female body is that it is centred on organs which undergo dramatic changes monthly and greater ones (potentially) yearly.