Procedures Of The 19th And 20th Centuries

Methods to control female sexuality included relatively pain-free interventions such as hydrotherapy, dietary prescriptions, and educational exhortations. However, the use of inventive restraints of various kinds flourished during this period as a preferred method of controlling women's bodies (48). For instance, the Moody Girdle of Chastity of the mid-19th century is exemplary. It "... consisted of a cushion made out of rubber or some other soft material and suitably covered with silk, linen, or soft leather. This cushion or pad formed the base into which was fixed a kind of grating and this part of the apparatus rested upon the vulva, the pad being large enough to press upon the mons veneris ..." (43).

Dietary measures, hydrotherapy, educational exhortations, and even physical restraints seemed too slow in their effects on stopping masturbation. Surgery was a much quicker procedure and was often described as affording immediate relief and preventing the further development of illnesses and deterioration of patients (77).

The onset of surgical genital procedures can be attributed to the medical work of Dr. Marion Sims, the "father of gynecology" and the "architect of the vagina." By the mid-19th century, the traditional art of obstetrics expanded to include the new science of gynecology (36). Procedures that explored the interior of female anatomy were the brainchild of Dr. Sims in the United States. It was he who invented the vaginal speculum and systematized the use of uterine sound and curette, and cervical dilators. Around this time, the first specialized medical journal in the United States was devoted to obstetrics. Descriptions of ovariotomies, hysterectomies, and the repair of vesicovaginal fistulas conducted under the most primitive conditions were featured routinely in its pages. Dr. Sims performed surgery to repair vesicovaginal fistulas and applied his techniques, without the use of anesthesia, first on slave women in Alabama. Later, during the mid-19th century, he exported these techniques to upper-class women in New York.

While Dr. Sims was engaged in his surgical experiments in the United States, Dr. Isaac Baker Brown introduced clitoridectomies in England as a cure for epilepsy, syphilis, insomnia, unhappy marriages, and even insanity. He was the president of the Medical Society of London and considered an authority on the nervous diseases of women. As a consequence, his work on scissoring the clitoris became the model for this surgical intervention. Dr. Brown believed that all feminine weaknesses could be cured by the excision of the clitoris. According to him, the peripheral excitement of the pubic nerve, which ends in the clitoris, led to disease that could be divided into eight progressive stages of degeneration: hysteria, spinal irritation, hysterical epilepsy, cataleptic fits, epileptic fits, idiocy, mania, and death. Hence, restlessness, loss of appetite, back pain, and distaste for marital intercourse were considered signs that demanded clitoridectomy (78-80). In cases in which he avoided excising the clitoris, he would damage the vulva and the clitoris by applying caustic substances to cause painful sores.

It is interesting to note that by the 1860s, the work of Dr. Brown was castigated by the medical community in England and he was removed from his position in the obstetrical society. In England, the practice of clitoridectomies declined rapidly in the face of the vociferous criticism that centered on its brutality. Nevertheless, Dr. Brown's inventiveness found a fertile home in the United States. The evangelical impulse that gained ground quickly gave his techniques a moral legitimacy. What was then viewed with disfavor in England became the procedure of choice for the moral correction of women and girls in the United States.

By the 1880s, with the increasing association of masturbation and insanity, female castration or oophorectomy became widespread (81). This procedure was the 1882 invention of Dr. Robert Batty of Georgia and was called normal ovariotomy (73,82). The vogue of female castration received encouragement under the eugenic movement and lasted well into the 1940s. Indeed, the eugenic movement inspired not only castration but also the rampant use of sterilization as a cure for insanity and general debility (13,83).

The prevalence of genital surgeries as a legitimate medical procedure can be gauged by the establishment of the Chicago-based Orificial Surgery Society in the late 1880s (43,65). During its uninterrupted and popular run until the 1920s, the Society, which was composed of prominent medical experts, oversaw the regular publication of a professional journal and textbooks. The Society was anchored by the belief that the lower orifices were responsible for moral, religious, and emotional well-being. For example, as a disorder in the sphincters could cause nervous irritation, the Society recommended dilation, amputation, and related operations on women and men. Between approximately 1850 and 1950, the United States was the site for a sustained rash of surgical procedures perfomed on the genitalia of men, women, and children (60,84). Whereas the last recorded castration was performed in 1946, the last medically justified clitoridectomy occurred in Kentucky in 1953 in a 12-year-old girl (58). The call for developing new and better, improved techniques still was voiced in the late 1950s (85). In retrospect, it can be seen that the advent and flourishing of genital surgeries for over a century was a complex response to the masturbation scare.

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