Medieval gynecology

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The treatment is worse than the condition

Medieval gynecology was the practice of gynecological medicine during the 1100s-1400s AD. Other cultures at different times also practiced gynecology. For example, in 1500 B.C. Egyptians described 'womb falling'.[1] In 400 B.C. an anonymous Greek physician[2] documented his observations and treatments:

"After the patient had been tied to a ladder-like frame, she was tipped upward so that her head was toward the bottom of the frame. The frame was then moved upward and downward more or less rapidly for approximately 3 to 5 minutes. As the patient was in an inverted position, it was thought that the prolapsing organs of the genital tract would be returned to their normal position by the force of gravity and the shaking motion."[1]
Hypocrites thought he had women all figured out.

Hippocrates had his own theories regarding the cause of prolapse. He thought that recent childbirth, wet feet, 'sexual excesses', exertion, and fatigue may have contributed to the condition. Polybus, Hippocrates's son-in-law, wrote: "a prolapsed uterus was treated by using local astringent lotions, a natural sponge packed into the vagina, or placement of half a pomegranate in the vagina." In 350 A.D., another practitioner named Soranus described his treatments which stated that the pomegranate should be dipped into vinegar before insertion. Success could be enhanced if the woman was on bed rest and reduced intake of fluid and food. If the treatment was still not successful, the woman's legs were tied together for three days.[1]

In 1521, Berengario da Carpi performed the first surgical treatment for prolapse. This was to tie a rope around the prolapse, tighten it for two days until it was no longer viable and cut it off[3]. Wine, aloe, and honey were then applied to the stump.[1]

In the 1700s, a Swiss gynecologist, Peyer, published a description of a cystocele. He was able to describe and document both cystocele and uterine prolapse. In 1730, Halder associated cystocele with childbirth. During this same time, efforts began to standardize the terminology that is still familiar today. In the 1800s, the surgical advancements of anesthesia, suturing, suturing materials and acceptance of Joseph Listers's theories of antisepsis improved outcomes for women with cystocele. The first surgical techniques were practiced on female cadavers, but with no apparent success. In 1823, Geradin proposed that that an incision and resection may provide temporary relief. In 1830, the first dissection of the vagina was performed by Dieffenbach on a living woman. In 1834, Mendé proposed that dissecting and repair of the edges of the tissues could be done. In 1859, Huguier proposed the amputation of the cervix was going to solve the problem for elongation.[1]

In 1866, a method of correcting a cystocele was proposed that resembled current procedures. Sim subsequently developed another procedure that did not require the full-thickness dissection of the vaginal wall. In 1888, another method of treating anterior vaginal wall was rediscovered in an ancient Greek manuscript. Manchester combined an anterior vaginal wall repair with an amputation of the cervix and a perineorrhaphy. In 1909, White noted the high rate of recurrence of cystocele repair. At this time it was proposed that reattaching the vagina to support structures was more successful and resulted in less recurrence. This same proposal was proposed again in 1976 but further studies indicated that the recurrence rate was not better.[1]

In 1888, treatments were tried that entered the abdomen to make re-attachments. Some did not agree with this and suggested an approach through the inguinal canal. In 1898, further abdominal approaches were proposed, but were ultimately rejected. Another proposal (1903) to attach damaged sections of the vaginal wall to the upper thorax was widely regarded as a puerile joke. No further advances have been noted until 1961 when reattachment of the anterior vaginal wall to Cooper's ligament began to be used. Unfortunately, posterior vaginal wall prolapse occurred in some patients even though the anterior repair was successful.[1]

In 1955, using steel mesh and reinforced concrete to support pelvic structures came into use. In 1970, tissue from pigs began to be used to strengthen the anterior vaginal wall in surgery. Beginning in 1976, improvement in suturing began along with the surgical removal of the vagina being used to treat prolapse of the bladder. In 1991, assumptions about the detailed anatomy of the pelvic support structures began to be questioned regarding the existence of some pelvic structures and the non-existence of others. As a result, the entirety of gynecological theory was scrapped overnight. More recently, the use of stem cells and robot-assisted laparoscopic surgery are being used to treat cystocele.[1]

References[edit]

  1. 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 Lensen, E. J. M. Surgical treatment of pelvic organ prolapse: a historical review with emphasis on the anterior compartment 24 10 (2013-10-01)   en
  2. Anonysimus of Rhodes, according to some questionable sources.
  3. Matthew 5:30