In the first week of April 1867, 237 fellows of the Obstetrical Society of London crowded into a hall and stayed from eight in the morning until nearly midnight. The business involved one of their own. Isaac Baker Brown had been president of the Medical Society of London two years earlier. Seymour Haden, the Society's vice-president, opened the day by condemning the operation Baker Brown had built his reputation on, and when Baker Brown tried to answer, he was jeered. The vote to expel him came to 194 to 38.
The operation was clitoridectomy, the surgical removal of the clitoris. Baker Brown had opened his own clinic in Notting Hill, the London Surgical Home, in 1858, and in a book published in 1866 he argued that irritation of the clitoris, which in his usage meant masturbation, disordered the nervous system and led, if left alone, to epilepsy, idiocy, and insanity.
His list of warning signs was not only physical. For a single woman, he wrote, it might be a wish to escape home and become a hospital nurse; for a married one, distaste for marital intercourse was added. One of his case notes describes a woman who had been ill since her marriage five years earlier and disliked her husband's company. He performed what he called his usual operation. Another describes a husband who told him his wife would fly at him during fits of excitement. After the surgery, Baker Brown reported,
"she remained quite well, and became in every respect a good wife."
What the fellows objected to
Historians read the debate differently. One 2024 study finds the fellows stressing informed consent and a woman's right to the integrity of her own body. Another account says the fight over consent centered on husbands and fathers, and reports that Baker Brown defended himself by saying some patients had begged him to keep the operation secret from their husbands. A 1981 study argues the real offense was publicity: other doctors, on that reading, used similar operations quietly, and Baker Brown put his in print.
Nobody knows how many women had the operation. His Home treated nearly twelve hundred patients in its ten years, but that figure doesn't say how many had clitoridectomies. By one account the operation was never a staple of surgical practice, and in Britain it had largely left orthodox medicine by the end of the century.
The idea crossed the Atlantic
Five years later in Georgia, a surgeon named Robert Battey removed a woman's healthy ovaries and called the procedure normal ovariotomy. Battey held that insanity was not infrequently caused by disease of the uterus and ovaries, and the operation was soon used for epilepsy, for so-called nymphomania, and for insanity. By 1887 he had performed 215 such operations himself, and a 2020 review found 94 published cases in which it was done for neuropsychiatric symptoms. An estimate from 1906 put the total at 150,000 women; a 2024 surgeons' bulletin calls that figure unsubstantiated.
The operations reached institutions. In 1892, at the State Hospital for the Insane in Norristown, Pennsylvania, Dr. Alice Bennett, head of the women's department, sterilized six women in her care. Several members of the state's Committee on Lunacy considered the operations unethical and illegal, and the Board of Public Charities reported on them in 1893. Bennett was herself a physician, appointed at the urging of a doctor who argued that women patients should have women doctors. She resigned in 1896, in part over the criticism.
Private practice had its own version. In 1896 a Brooklyn doctor, John O. Polak, examined a 29-year-old woman whose father insisted that something drastic be done and took responsibility for it. Polak, who had warned the father that surgery might not help, removed her clitoris nearly two weeks later. The historian Sarah Rodriguez found that American physicians removed the clitoris or its hood to treat masturbation in women and girls from the nineteenth century into the mid-twentieth, and that the published medical literature was more cautious than earlier accounts assumed. No total exists. Reviews of Joel Braslow's study of California state hospitals count four or five women at Stockton who had the clitoris removed along with a lobotomy.
It was not only women
Between 1893 and 1898, F. Hoyt Pilcher, superintendent of a Kansas asylum for children and youths then labeled idiotic and imbecile, castrated 44 males and performed hysterectomies on 14 females, by one historian's count. Kansas newspapers denounced him, and the Kansas Medical Journal praised him. His stated target was masturbation, as it was for many of the operations above.
Why this follows Elizabeth Packard
In 1867, the same year London's fellows cast their ballots, Illinois passed the law Elizabeth Packard had lobbied for, guaranteeing anyone accused of insanity, wives included, a public hearing. That law was about commitment hearings. Packard's disagreement with her husband had been declared insanity after a pulse check. In Baker Brown's case notes, a wish to leave home, or distaste for a husband, was recorded as a symptom, and the cure was aimed at the body.
The operations differed from case to case, and the men who ordered or performed them did not always agree with one another. What repeated was where the trouble was said to be: in an organ. By 1941 a different operation was in fashion, and it went through the skull. The next essay goes to a Washington operating room in November of that year, where a father made the decision and his 23-year-old daughter was asked to sing a song.