Endometriosis: A Hysterical History

Endometriosis: A Hysterical History

It's anything but funny.
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Leeches: so common a tool in medical history that for part of the 1800's, France was importing about 33 million leeches annually. With so many to keep track of, one journal advised doctors to count their leeches before and after a bloodletting for gynecological conditions — because a leech lost in a woman's uterus would cause not only extreme physical pain but also undue mental stress.

Yes, you read that correctly. Internal bloodletting. Leeches up the vagina. Aren't you glad to live in the 21st century?

By now, modern medicine understands that endometriosis is an extremely painful gynecological condition where cells from the endometrium — that is, the innermost layer of the uterus — show up elsewhere in the body. These growths of endometrial cells, also called ectopic lesions, cause infertility in affected women as well as inflammation and scar tissue wherever they grow. That scar tissue can turn into adhesions, sticking abdominal organs together (ow). This condition affects about one in ten women, which means a conservative estimate would be over 15 million people suffering from endometriosis in the United States alone. The only sure diagnosis is through laparoscopic surgery (inserting a camera to get a clear view of the lesions), and the only current treatment of the root cause (the lesions) is through surgery (deep tissue excision or total hysterectomy, which doesn't always help). Symptoms can be treated with painkillers and hormone therapy, but that's the same broad treatment for most gynecological conditions. Even with so many women affected, progress in understanding this disease has been slow.

A basic description of endometriosis was first given around the fifth century B.C.

The writers of the Hippocratic Corpus, of the fourth and fifth centuries B.C., narrowed down the symptoms of a gynecological disease to four main factors: pain, infertility, menstrual dysfunction and temporary relief with pregnancy. Although there was some suggestion that social class may influence the condition (that it was somehow only a condition of the upper class), these four symptoms would form a common thread connecting various seemingly distinct conditions with various names that wouldn't be connected in the medical field for thousands of years. Though we now refer to the condition as endometriosis, its most popular name for centuries was "suffocation of the womb" first coined by the Greek philosopher Plato (375 B.C.). According to him, this suffocation occurs because a uterus left too long without pregnancy starts to wander around the young woman's body, hungry for motherhood. If it wanders too far, the tubes get tangled and it is unable to breathe. Women so afflicted in ancient Greece would be treated with succession, the practice of tying the patient upside down on a ladder and shaking them until the womb returns to its proper location. The best prevention method they could come up with was to have girls get married and pregnant as soon as possible after puberty so as to satisfy this hungry and animalistic organ. This method of thinking about gynecological conditions likely contributed to the culture of early marriage for women throughout history and is actually still used in some parts of the world.

After about 500 years of descriptions of extreme pelvic pain causing convulsive fits, persistent infertility, organ adhesions and ligaments infiltrated with endometrial tissue, in the second century A.D., Galen of Pergamon concluded that on one hand, suffocation of the womb might be caused by menstrual blood flowing backwards and becoming anchored in the wrong organs (a theory still used today, called retrograde menstruation theory), and on the other hand, the condition is also likely psychological in nature because young widows simply must go mad after "their loss of sexual fulfillment."

Given centuries of medical research on this kind of pain... Meh, it's all in her head.

This was the first time that gynepathology was authoritatively linked with psychology (though the Hippocratic Corpus also vaguely suggested a link), and it was far from the last. From this seed of thought, the idea that women in chronic, invisible pain are just crazy would persist for millennia. Women would be labeled hysterical, blamed for their conditions, locked in madhouses that civilians visited for entertainment, and treated with shock therapy.

But that's up to the 19th century — let's not get ahead of ourselves. We wouldn't want to miss witchcraft and demonic possession, right?

She's a witch, and she's a witch, and she's a witch...

During the Middle Ages — or the Dark Ages of Europe — the supernatural found its way into the scientific scene. Whether a convulsive fit of pain was blamed on the woman herself being possessed, who was then exorcised, or was blamed on the neighbor across the street, who was then sent to the pillory or executed on charges of witchcraft, women got the worst of this new companionship between the mystic and the medical. Despite new observations on the anatomy of suffocation of the womb, such as an association with ulcers, treatments developed during the Middle Ages included those such as "shouting therapy" and other painful or torturous prescriptions with the idea that a malady like invisible pelvic pain is caused somehow by the woman's bad behavior, so the treatment must be karmic in response. We have to look elsewhere in the world for a bit of level-headedness. For example, it was Avicenna, the Persian polymath, who finally determined that pain was solely biologic and had zero medical benefits. Yet, with no cause of the chronic pelvic pain in sight, ideas of demons and magic as a cause of suffocation of the womb persisted through the Middle Ages and into the Renaissance. Occasionally, a physician would be called in as a witness during witchcraft trials, and it's known that Dutch physician Johannes Weyer and English physician Edward Jorden defended the women accused of witchcraft, insisting that the allegedly supernatural symptoms were in fact entirely natural conditions of the uterus.

The women were found guilty.

Women like them were found to be witches while, at the same time, physicians searched for a medically treatable cause of their ailment. There were two paths of research happening in parallel — some physicians, such as Thomas Sydenham, began to flesh out theories of a psychological cause of "hysteria," while others, like William Harvey and Johannes Vesling, looked to autopsies for a physical source of suffocation of the womb. Both of these paths would develop into the 20th century, and it appears that the treatment a woman got depended on whether she was recommended to a physician or a psychologist for her symptoms.

Physicians and psychologists gave wildly different treatments, but both would appear to have hundreds of years of research backing up their conclusions.

Women diagnosed with hysteria were held in the worst of mental institutions, including the infamous St. Bethlehem Hospital (commonly known as Bedlam), where they were physically restrained with chains and straitjackets. In France, many were held at Salpêtrière outside of Paris. The "hystero-epileptic" ward was entirely comprised of young women, the vast majority complaining of ovarian pain, yet even when the famous French psychiatrist Jean-Martin Charcot visited and made note of this common thread that should have pointed to a gynapathological condition, he concluded that the condition was psychiatric in nature. There was no reason, it seemed, to stop sending these "hysterical" women to the worst of prisons: mental institutions of the 19th century.

Meanwhile, physical signs of endometriosis were noticed most clearly in 1852 by Edward Tilt and in 1858 by Armand Trousseau, who identified the lesions on a macroscopic scale, and named the disease "catamenial hematoceles." It was finally in 1860 that Karl von Rokitansky discovered microscopic signs of endometriosis. Looking at strange tissue growths and uterine polyps, he noticed striking similarities between the growths and the characteristics of endometrial tissue, specifically the presence of glands that should only be present on the tissue inside of the uterus. These findings would be confirmed (or re-discovered) in 1921 by John Sampson, who would then coin the term "endometriosis" in 1927. Importantly, in 1887, Franz Wickel was the first to realize that it was women with very small endometriotic lesions who were most likely to be diagnosed with hysteria and sent to mental institutions, as the lesions were virtually undetectable.

20th century progress (mostly).

In the 1900's, a woman with pelvic pain but no clear cause could still be referred to psychiatrists, but progress in treatment and public awareness was rapidly increasing. Hysterectomy and specific nodule removal surgeries became more advanced with the introduction of non-video laparoscopy in the 1940's. In the 1950's, pelvic exams, previously considered a vulgar suggestion in the United States, became a common procedure with the rising awareness of cervical cancer and the introduction of the Pap smear. It was also in the 1950's that, with the vision of Margaret Sanger, the funding of Katharine McCormick, and the science of George Pinkus that the hormonal contraceptive pill was first introduced, and women with endometriosis were some of its earliest recipients. Unfortunately, the pill at that time used such high doses of estrogen that its side effects included cancers. Research didn't always move forward, though. In 1949, an investigator brought back theories from ancient Greece when he asked, "Is endometriosis principally a disease of the higher social and economic levels of society?"

Video-assisted laparoscopy was developed in the 1970's, and over time the cameras became smaller and the surgeries more precise. While surgical precision and awareness of rampant misdiagnosis have increased in the last few decades, there is still much confusion over the best treatment options for endometriosis. With only laparoscopy as a diagnostic, there is an average of seven years between the onset of symptoms and a diagnosis of the condition. Treatments now include full hysterectomy, deep tissue excision and hormone treatments — none of which tend to work on the first try. This leads women to get multiple surgeries in attempts to treat their chronic pain. Even as recently as 1995, reports have shown that over 50 percent of women complaining of chronic pelvic pain were told there was no "organic" basis for their complaints, thus leaving them forever untreated, or labeling them mentally unstable, or they're even recommended pregnancy as a treatment — the same archaic conclusion as thousands of years ago.

After thousands of years of ambiguity and belittling, it's clear that more information is needed about endometriosis.

Frustratingly, some recent researchers purport to quantify the relative attractiveness of women with endometriosis, or characterize personality traits of women with pelvic pain.

However, many researchers are taking steps in useful, foundational research, working out the molecular markers of the condition, some of which might be treatable with prescription drugs or be useful as a diagnostic red flag as an alternative to laparoscopy.

Cover Image Credit: Medarus

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22 Girl Names Your Random College Roommate Will Have, And The Type Of Roommate They Are

Will she be your BFF?
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Every roommate situation in college is going to be different.

All you can do is hope and pray that they'll just leave you alone for the most part. A lot of the time, you can get a hint about what kind of roommate they'll be just knowing their first name.

1. Hailey

Her dad pays her rent. She can't cook. Litters the kitchen with take out boxes from the local vegan joint.

2. Beth

Totally wants you to go to SoulCycle with her at 6 a.m. on a Saturday. Room is littered with leggings and sneakers.

3. Michelle

Comes home at 3 a.m. after a night of heavy drinking. Loudly makes some sort of frozen meal. Sleeps through her noon alarm.

4. Victoria

Probably has dark hair and an acoustic guitar. Keeps pretty much to herself. Does homework in the living room at obscure hours.

5. Madison

Was on the dance team in high school and has not stopped telling you about how great it was. Does work out videos on the TV in the living room.

6. Kim

Brings her boyfriend over every night of the week. Brings different boys home on the weekends.

7. Megan

Actively avoids cleaning the bathroom. Leaves her dishes in the sink. You haven't seen her shower in four days.

8. Erica

Normal. Quiet. Wants to be a high school English teacher.

9. Erika

Wild. Emotionally distraught always. Is always hosting the pre-game. Never comes home with all of the clothes she left wearing.

10. Sarah

"Definitely should have got into Harvard, but I ended up here instead." Too into trying to get a 4.0 to pay attention to you.

11. Julia

Studies music performance. Screams expletives at her keyboard. Cannot play the trumpet, but still tries really hard.

12. Hannah

So tall she almost hits her head on the doorways. Plays basketball. Raps to old Kanye in the shower.

13. Jenny

Should not be allowed to go out. Goes out every weekend anyway. Throws up in your bathtub and doesn't always address it in the morning.

14. Heather

Stressing about her internship. Is currently failing all of her classes. Will somehow still get a 3.5 GPA this semester.

15. Grace

You never see her, only the hairballs she leaves all around your place.

16. Emma

Only has guy friends because "it's easier." Guy friends who leave empty beer cans out after every sporting event on TV.

17. Caitlyn

Has a 4.0 as a biology major. Is going to med school. Sterilizes her room, the bathroom and the kitchen sink every four hours.

18. Sam

Always has a paper about feminism to write. Rosie the Riveter poster in her room.

19. Alex

Is probably dating her boss. Has straight Ds in all her classes.

20. Taylor

Is somehow always home when you're home. You know nothing about her other than where she's from.

21. Alyssa

Trying to become the next big YouTuber. Has lighting equipment all over the place. You constantly hear the phrase, "Hey guys, welcome to my channel!" She squealed because yesterday she hit 25 subscribers.

22. Jesse

Is probably plotting your murder. Lurks around like a cat.

Cover Image Credit: Morgan Yates//YouTube

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Breaking, Raking, Shaking

A news-wire covering breaking news, financial news, and interesting stories too.
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School's out for summer, but not forever. Let's get caught up on some stories I found really fascinating this week.

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The use of live ammunition and force is being called into question as to whether or not that was the best course of action for the protest. I have a feeling this will continue to develop in the future weeks. Rupert Colville, spokesperson for the U.N. High Commissioner for Human Rights condemned the "appalling, and deadly violence".

Social Security Secrets: Some information on SS.

Although I'm quite far from being anywhere near retirement age I found this article on some basic information about Social Security to be very fascinating. This article covers topics like when you can receive your full benefit depending on the year you were born, what spousal benefits can tell you about your experience, and other curious odds and ends most people don't know about Social Security.

A new think-tank suggests combining Medicare and the ACA: a revolutionary idea on Healthcare?

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Department of State lifts hiring freeze: A change in the air for foreign policy?

New Secretary of State, and former CIA director Mike Pompeo has lifted the hiring freeze at the State Department of the United States. This is a shift from the former policies of former Sec. of State Rex Tillerson. This shift may be a sign that the United States is making a change in how it approaches foreign policy, or it could signify Pompeo gaining favor with the President.


Supreme Court strikes down law banning gambling on Sports

The New Jersey law prohibiting gambling on sports has been struck down by the highest court in the United States. This could open up gambling on sports more throughout the nation, and will help increase growth in a burgeoning industry.

Africa's Free Trade Future: A story in the works

African nations have started signing a new free trade agreement in Africa aiming to eliminate 90% of tariffs within the continent for commercial trade.Talks started in 2015 to establish what the nations are attempting to call the "African Continental Free Trade Area". If successful in the negotiations, the continent could see its GDP grow to $3 Trillion making it one of the larger economies in the world, comparative to Germany.

In other news...

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This is pretty neat! Who says Electric cars don't have torque?

Tenacious D announce tour, and new album

Ever since the pick of destiny, many of our lives have felt the impact of Tenacious D. Their music serenades the heart, and solidifies the soul. With the recent announcement of a new tour, and a new album it's hard to contain the joy resonating from myself. With it being their first album in six years, i'm sure there are plenty of others prepared for the LP later this year.

Cover Image Credit: diggertomsen from flickr

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