Clitoridectomy and Medical Ethics

Journal article

By: Anonymous

Date: April 13, 1867

Source: Medical Times and Gazette (London) 1 (Saturday, April 13, 1867).

About the Author: This editorial in the Medical Times and Gazette was written by members of the publication's editorial board, and as such the author is undisclosed.

INTRODUCTION

The history of secular male circumcision in the United States traces its history to the 1850s. While members of certain religions, such as Judaism and Islam, have removed the foreskin as part of religious ceremonies, secular circumcision developed as a result of medical theories concerning masturbation, sexually transmitted disease, and mental illness.

Jonathan Hutchinson, a London physician, first connected male circumcision to lower rates of venereal disease in 1854, using poorly manipulated data. His conclusion—that venereal disease rates were lower for Jewish men vs. gentiles—led to his theory that circumcised men were less vulnerable to venereal disease.

In the 1880s and 1890s, Hutchinson published articles and lectured on the topic of routine male circumcision in infancy as a method to reduce masturbation; removal of the foreskin would reduce physical stimulation. Other researchers applied the same concept to girls and women; clitoridectomy was introduced as a cure for various female ailments, including masturbation, hysteria, overexcitement, aggression, "the whites" (yeast infections), incontinence, and more.

Dr. Isaac Baker Brown, president of the Medical Society of London, proposed a theory in 1858 on the evils of masturbation in young women, which he believed created circumstances for eight stages of progressive illness: hysteria, spinal irritation, hysterical epilepsy, cataleptic fits, epileptic fits, idiocy, mania, and death. Removal of the clitoris, Baker Brown believed, could prevent masturbation, which would prevent disease.

The operation Baker Brown initiated involved the excision of the clitoris; the wound was packed, opium administered rectally, and the patient required one month to recover. Baker Brown's operation was used in England, and by the 1860s in the United States, to cure hysteria, nymphomania, and in younger girls, rebellion or "unfeminine" aggression.

Baker Brown's stature in the medical community, as well as an increased interest in routine male circumcision, kept the topic of clitoridectomy in medical journals throughout the 1860s. However, the medical community did not unanimously adopt the procedure or the rationale behind its use.

PRIMARY SOURCE

MEDICAL TIMES AND GAZETTE.

SATURDAY, APRIL 13, 1867.

CLITORIDECTOMY AND MEDICAL ETHICS

THE operation of clitoridectomy, as performed under the conditions described in Mr. Baker Brown's writings and denounced in Dr. West's lectures, is an offence against Medical science and Medical ethics.

1. It is an offence against Medical science in the first place, that it should be described as a mere circumcision (a) Instead of taking away a loose fold of skin, it removes a rudimentary organ of exquisite sensitiveness, well supplied with blood vessels and nerves, and the operation is described by the author as occasionally attended with serious bleeding; in these respects it differs widely from circumcision.

It is a second error to assume that if a woman desired to continue filthy habits this operation would stop her. The organ removed is but one amongst many susceptible of intense excitement.(b)

In the third place, it is against all Medical science to remove such a part because "subject" (or subjected?—see note) "to unbearable irritation." Intense itching is a common malady, but this itching does not depend on local causes, and it may generally be relieved by proper measures. To cut off part of the body because it itches is monstrous.

If indeed the clitoris be diseased, that is another thing; but as clitoridectomy is practised, the part is cut off without any signs of disease in it.

It is nothing to the purpose to affirm that clitoridectomy may have been successful in postponing epileptic fits or lengthening their interval. Any positive line of treatment will do that for a time. Many young men believe for three months that they have found a specific treatment for epilepsy. An intimate friend lately thought he had found one in colchinum [autumn crocus]. Give enough of any potent drug to make the patient ill, break a leg, or cut off the clitoris, and the fits will probably be interrupted for a time.

Neither is it to the purpose to accuse Mr. Brown of having performed an operation rashly, groundlessly, and unsuccessfully. Many such operations have been performed in the best faith. Marshall Hall used to propose tracheotomy for epilepsy; a living Surgeon once performed castration for the same malady; each operation thoroughly unsuccessful, and not to be defended, save on the ground of the good faith of the proposers, and of an enthusiasm which had carried them beyond the bounds of sound discretion.

Although, then, clitoridectomy must be condemned as an offence against Medical science, if that were all, it might let pass into oblivion without further notice. It is the offence against Medical ethics which it involves, which has secured for it the reprobation of the Profession.

2. It is an ethical offence, in the first place, if the Practitioner who is consulted for any common complaint, say hysteria, or fissure of the rectum, set himself to consider whether or not the patient is guilty of immoral practices, which have nothing to do with the case before him. Thus, as we said in our last number, and as we implied in the Med. Times and Gaz. June 4, 1864, if the clitoridectoral theory and practice were established, no parent who sent a daughter to any Medical man for any complaint whatever, could be sure that she might not return tainted with filthy inquiries, or branded by filthy suspicions—a thing incompatible with the honour of the Profession, and the possibility of that unrestrained frank intercourse between Practitioner and patient that happily exists now.

As an illustration of this kind of breach of Professional honour and its consequences, we will mention a case which was shortly touched on in our first article in the number for June 4, 1864.

A young lady was brought by her friends, ten or twelve years ago, to a Surgeon practising specially on the rectum, for a fistula. He did not content himself with exploring the fistula, but ascertained that she had lost her virginity, and told her father so. The consequences were frightful, including a painful trial, and loss of honour, character, and position to the parties concerned. All this, because the Surgeon had gone out of the path of his duty, and, instead, of confining himself to the malady for which he was consulted, had gratuitously imported into it certain moral considerations with which he had nothing to do. If this were a habit with Medical men, there would be an end to the present free and honourable intercourse with their patients. We should be accused, and justly, of making prurient, or indecent, or degrading inquiries, and of bringing a knowledge of evil to minds from which it had been absent.

Affirming then, in the first place, that the very entry of thoughts of pollution into the Practitioner's mind respecting his patients is an offence of the deepest dye, this offence is aggravated by the kind of evidence which the clitoridectomist is taught to accept as proof of his patient's guilt. That evidence consists, partly, in certain physical signs detailed in Mr. Baker Brown's book—a "peculiar straight and coarse hirsute growth," a peculiar follicular secretion, and other phenomena detected by inspection, which are as frivolous as they are disgusting. It is said by credible witnesses, that at a clitoridectomical operation nose as well as eyes were called into requisition, and that a respectable Practitioner was invited to apply his nose to the parts implicated, in order to satisfy his mind, by this test, that these parts had been subjected to abnormal irritation. The thing is almost too beastly to tell of, but we want to deal with this subject once for all, and to let our readers know why clitoridectomy does not stand in the same category as any other unsuccessful operation.

But says Mr. Brown, "before commencing treatment, I have always made a point of having my diagnosis confirmed by the patient or her friends." And this brings us to what we may call the moral evidence on which the patient's guilt is assumed, the process of obtaining which is one of the most heinous offences against good sense and Professional ethics that can be conceived.

We have heard of questions put (not by Mr. Brown) to female out-patients after the following fashion:—"Do you feel any irritation in certain organs?" "Is it very bad?" "Does it induce you to rub them?" "Does the rubbing ever make you feel faint?" And if the patient answers these questions affirmatively it is said that the evidence of unnaturally excitation is regarded as complete.

Nervous young women, as it is well known, may be profoundly ignorant of the nature and drift of such questions. They delight to magnify their own sensations, they enjoy the Physician's sympathy and are sure to answer "yes" to any leading question whatever. But we say that if young women are subjected to such inquiries as these in out-patient rooms at Hospitals and Dispensaries, or by private Practitioners, the sooner the Profession speaks out the better. A Medical consultation may involve the worst contamination to the patient. We think we are justified in saying that the kind of evidence on which the guilt of the woman is assumed is itself an ethical offence.

That the performance of clitoridectomy on a woman without her knowledge and consent, as detailed by Dr. West, is an offence against Medical ethics, needs not to be said. We suspect it is amenable to the criminal law of the land.

It is an offence against Medical ethics, also, to obtain the woman's consent, nominally, while she is left in ignorance of the real scope and nature of the mutilation, and of the moral imputations which it involves. Consent to a thing whose nature is not known, is like the consent of an infant or lunatic—null and void. Equally do we repudiate, as an offence against Medical ethics, the performance of such an operation, even with the consent, nominal or real, of the patient, but without the full knowledge and consent of the persons on whom she is dependent, as wife or daughter. As the woman's character affects theirs, they have a right to decide whether a female relative should undergo this operation, with the disgrace it involves, or whether relief shall be sought from other means.

We may be pardoned for adding that not one of the supposititious cases alleged by Dr. Routh at the late meeting of the Obstetrical Society has the least bearing on or analogy with the performance of clitoridectomy without the knowledge of the patient or her friends. Dr. Routh argued that all the details of every operation cannot be described to patients. But it is not the details—it is the moral questions involved in clitoridectomy, which ought not to be kept secret. Dr. Routh argued, also, that there are cases in which a Practitioner is bound to keep a patient's secrets from her husband; but in cases before us, it is not secrets imparted by the patient, but dishonourable surmises and filthy imputations generated in the mind of the Practititioner—the nature of the mutilation and its disgrace—that are kept secret.

Thus, then, we have shown, as shortly as possible, the real position of clitoridectomy as an offence against science and morality, and the reasons why the Medical Profession, as an honourable, moral Profession, whose members have free and familial access to families, must repudiate and utterly reject it.

(a) "Let it be known, once for all, that clitoridectomy is neither more nor less than circumcision of the female; and as certainly as that no man who has been circumcised has been injured in his natural functions, so it is equally certain that no woman who has undergone the operation of excision of the clitoris has lost one particle of the natural functions of her organs. I would here protest against the cruel insinuation made against me by my accusers, that my reasons for performing the operation are because women are subjected to immoral habits; when, as I have distinctly again and again asserted, I operation because there is undue and unbearable irritation of the clitoris, and in such cases alone is the operation likely to be successful."—(Mr. Baker Brown's "Replies to the Remarks of the Council," Nos. 12 and 13.)

(b) For evidence, see Baker Brown on Curability, etc., pp. 12, 18, etc.

SIGNIFICANCE

This editorial continued a strong debate in academic and medical circles as the specialty of Gynecology emerged in western medicine in the 1850s and 1860s. This debate, during the heart of the sexually restrained Victorian Era, divided gynecologists. The idea that women could be convinced to give consent via leading questions from the practitioner was an affront to some doctors who considered women to be unable to understand the medical procedure and its effects. As this editorial notes, "Consent to a thing whose nature is not known, is like the consent of an infant or lunatic—null and void. Equally do we repudiate, as an offence against Medical ethics, the performance of such an operation, even with the consent, nominal or real, of the patient, but without the full knowledge and consent of the persons on whom she is dependent, as wife or daughter. As the woman's character affects theirs, they have a right to decide whether a female relative should undergo this operation, with the disgrace it involves, or whether relief shall be sought from other means."

The frank discussion of clitoridectomy with the father or husband of a potential candidate for clitoridectomy, as a vehicle for gaining informed consent, was controversial. Under the sexual mores of the time such a discussion would have been difficult at best. In addition, the clitoris was one of "many organs" used for masturbation; if the goal of clitoridectomy was to end masturbation, it would not succeed.

In the 1880s, American doctor John Harvey Kellogg, inventor of Corn Flakes cereal and a health and hygiene advocate, theorized that masturbation was best curbed by circumcising young infant boys and applying carbolic acid to the clitoris of young girls to prevent overexcitement of the genitals. Clitoridectomy and variations of clitoral suppression remained part of the medical literature and practice for decades after Baker Brown's first writings on the issue.

In a 1915 article by Dr. Benjamin Dawson, President of the Eclectic medical University, the clitoris and the foreskin are described as being the source of "convulsions, eczema, paralysis, constipation, tuberculosis, locomotor ataxia, rheumatism, idiocy, insanity, lust and all its consequences" in the body. Removal of the clitoris or the foreskin removes the "nerve-waste" that causes the medical and psychological conditions listed. Dawson's 1915 article revisits Baker Brown's original theory while adding new, systemic diseases and complications attributed to the sexual organs. Dawson, like Baker Brown, advocated clitoridectomy and male circumcision as remedies.

Britain outlawed female circumcision or clitoridectomy in the 1860s. Female circumcision, routinely described as "female genital mutilation" by the United Nations and non-governmental organizations that promote women's health and women's rights, continues in many sections of Africa. An estimated 130 million African women have experienced clitoridectomy or infibulation, in while the clitoris and the labia are removed and the wound stitched together, leaving a small hole for urine and menstrual blood to exit.

The practice of clitoridectomy and infibulation worldwide continues, and is part of modern western medicine in the 21st century, though in a different form than that practiced by Baker Brown. Clitoridectomy in modern, western terms involves the removal of the clitoris or the reduction of the organ when gender anomalies are present; each year 2,000 surgeries—including clitoridectomies—are performed on such children in the United States.

FURTHER RESOURCES

Books

Groneman, Carol. Nymphomania: A History. New York: W.W. Norton, 2000.

Periodicals

Dawson, Benjamin E. "Circumcision in the Female: Its Necessity and How to Perform It." American Journal of Clinical Medicine vol. 22, no. 6, June 1915.

Leonard, Lori. "We did it for pleasure only." Qualitative Inquiry vol. 6, no. 2, November 2, 2000.

Sheehan, E. "Victorian Clitoridectomy: Isaac Baker Brown and his harmless operative procedure." Medical Anthropology Newsletter vol. 12, no. 4, August 1981.

Web Sites

Amnesty International."Female Genital Mutilation—A Human Rights Information Pack." 〈http://www.amnesty.org/ailib/intcam/femgen/fgm1.htm〉 (accessed March 20, 2006).