Editorial, Medical Times and Gazette, 13 April 1867

Background

Although this is one of the most hypocritical documents in British medical history, its is also one of the most useful for illuminating the origins and nature of the double standard on male and female genital mutilation which persists to this day in English speaking countries. While it seeks to quarantine "mere circumcision" from real mutilation, it nonetheless makes a cogent and powerful case against any form of genital alteration which is performed without informed consent.

The editorial was a response to the disgrace of Isaac Baker Brown, a prominent gynaecologist and dextrous surgeon who had made a name for himself as an authority on the female genitals, and the advocate of a procedure intended (guaranteed!) to cure many obscure nervous diseases – clitoridectomy. Brown claimed that conditions such as hysteria, epilepsy and catalepsy, as well as the masturbation which gave rise to them, could be prevented by the excision of the clitoris, and he insisted that he was merely following the lead of surgeons such as Jonathan Hutchinson, who had similarly asserted that masturbation in boys could be stopped by amputation of the foreskin. We should particularly note Brown's insistence 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.

In his genius for self-promotion, as well as in his conviction that he had found the magic bullet for the most intractable diseases of his age, he might be regarded as the Roger Short of the mid-nineteenth century. During the early 1860s Brown enjoyed considerable celebrity, but his methods came under attack in 1866, and the following year he was disgraced and expelled from the Obstetrical Society.

In this editorial the Medical Times and Gazette explains why clitoridectomy is both scientifically unsound as medical therapy and a violation of medical ethics in terms which are still relevant today. Although it tries to quarantine male circumcision from female genital mutilation in a manner all too familiar to us, its reasoning here is feeble and the discrimination fails. The foreskin is also "an organ of exquisite sensitiveness, well supplied with blood vessels and nerves"; like clitoridectomy, circumcision is also an operation "occasionally attended with serious bleeding".*  On the principle stated here – that sensitive organs, well supplied with blood vessels and nerves should not be excised without the informed consent of their owner – the editorial may be read as an attack on both clitoridectomy and circumcision, and a clear statement of why each procedure is an offence against both medical science and medical ethics.

*  Indeed, while there are numerous reports in nineteenth century medical journals of deaths and complications from circumcision, similar reports on clitoridectomy are very hard to find, suggesting that the latter was in fact the safer operation.

Further reading:

J.B. Fleming, "Clitoridectomy: The disastrous downfall of Isaac Baker Brown FRCS (1867)", Journal of Obstetrics and Gynaecology of the British Empire, Vol. 67, 1960, pp. 1017-34

Ornella Moscucci, "Clitoridectomy, circumcision and the politics of sexual pleasure in mid-Victorian Britain", in Andrew H. Miller and James Eli Adams (eds), Sexualities in Victorian Britain, Bloomington, Indiana University Press, 1996

Robert T. Morris, "Is evolution trying to do away with the clitoris?", Transactions of the American Association of Obstetricians and Gynaecologists, Vol. 5, 1892, pp. 288-30

CIRP ethics and human rights pages

Margaret Somerville, "Altering baby boys' bodies: The ethics of infant male circumcision"

Clitoridectomy and Medical Ethics

Medical Times and Gazette
Saturday, April 13, 1867

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. (Note 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. (Note 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 for epilepsy. An intimate friend lately thought he  had found one in colchinum. 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 an 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 s 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.

Note 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.)

Note B:  For evidence, see Baker Brown on Curability, etc., pp.  12, 18, etc.**

Notes

* "Friends" means close relatives.
** Isaac Baker Brown, On the curability of certain forms of insanity, epilepsy, catalepsy and hysteria in females (London 1866)