The Orificial Surgery Society and orthodox medicine

A symptom of the late Victorian vogue for surgical solutions to health problems was the Chicago-based Orificial  Surgery Society, which was active from the late 1880s until the early 1920s and published a number of textbooks by prominent members (all with MDs), and the Journal of Orificial Surgery from 1892 to 1901. Its particular obsession was the influence of the lower orifices on the nervous system, meaning that it targeted the foreskin (in both males and females) and the rectum as the focal points for disease generation and control. Any tightness or other disorder in these sphincters caused nervous irritation, and the cure was forcible dilation or amputation.

The society was particularly insistent on the need for circumcision, in both males and females, and was concerned that, while its health advantages for boys was well understood by the medical profession, there was less appreciation of its value for girls. As one textbook advised:

No matter what a person was suffering from, if he or she went to an orificial physician , the diagnosis was always the same: tight sphincters requiring dilation (in the case of the rectum) and dilation or amputation in the case of the clitoral or penile prepuce. Edward Wallerstein notes the following treatments, as detailed in the journal  [2]:

Dr Cora Smith Eaton circumcised two women to treat headaches.

Dr M.K. Kreider circumcised a boy to cure spinal curvature.

Dr C.B. Walls treated "hip joint disease" by circumcision, and commented that Jews rarely suffered from this problem. he added that "60 per cent of the insane are so because of some abnormal condition of their sexual organs".

Dr T.E. Costain recommended circumcision as a treatment for hydrocephaly.

Alex Comfort further reports that, like many of those who think they have discovered the master-key to one of the major problems of the day, [3] the orificial surgeons brought a fair load of evangelical zeal to their mission. Claiming that by genital and rectal operations "the body shall be released from every fetter that binds and the spirit directed Godward", they urged clergymen to direct their languishing charges to submit to circumcision and related procedures.  [4]

The temptation is to regard the orificialists as eccentrics or just plain loopy, but the fact is that they were largely orthodox by the standards of their day, and there was very little to distinguish either their theory or their practice from mainstream Anglo-American medicine. As Wallerstein remarks, "The essence of much American medical thinking from 1870 to 1920 was that surgery was a quick solution and/or preventive for a host of physical and emotional problems". [5] The impact of the foreskin on the nervous system was drawn from standard nerve force theory and the demonstration by Lewis Sayre that a tight or adherent foreskin could cause epilepsy, convulsions, paralysis of the limbs and other problems which could be cured by circumcision; P.C. Remondino had claimed to restore madmen to sanity by circumcision; and all authorities of the period agreed that phimosis in infancy or childhood was a serious threat to health.

Only in its advocacy of operations on the female genitals did the orificialists go out somewhat on a limb, and even here they were following a surgical theory that had been in fashion the generation before. The authoritative Boston Medical and Surgical Journal (now known as the New England Journal of Medicine)  regularly published articles like "Seminal weakness: Castration" (Vol. 29, 1843), "Insanity cured by excision of the external organs of generation" (Vol. 32, 1845), "Surgical treatment of hopeless cases of masturbation and nocturnal emissions" (Vol. 109, 1883), and "Excision of the clitoris as a cure for masturbation" (Vol. 66, 1862).  But while spermatorrhoea as a disease and clitoridectomy as a treatment fell out of favour as the twentieth century advanced, circumcision of boys elicited one new justification after another. It should be noted that the orificialists rarely practised clitoridectromy; their focus was flaps, not knobs.

Even their distinctly kinky obsession with the rectum (loosening those tight anal sphincters) does not seem all that way out when it is remembered that the champion of universal circumcision as a sanitary measure, Abraham Wolbarst, was the proud inventor of a kind of electric dildo, to be inserted into the anus with a view to massaging the prostate. [6]

It is perhaps a sign of how embarrassing the American medical establishment still finds the orificial surgery episode that no history of this movement has been published, nor even any substantial journal articles. The only item which turns up in the vast Pro-Quest database is a scrappy note by Ira Rutkow, who completely ignores the strongest feature of the movement (its advocacy and practice of male circumcision) and states that it focused on "the treatment of chronic disease processes through surgical operations on the rectum, vagina, cervix, urethra, nares, mouth, etc." It would be truer to say that it was obsessed with the foreskin and rectum (parts of the body that were exciting to play with and easy to do things to) and had a good deal less interest in these other organs. Rutkow seems to be a victim of the strange amnesia about the male body which seems to affect so many Americans; do they think that normal boys these days are born without foreskins?

The articles on this site provide both the genuine orificial flavour and an indication of how close the society was to the medical mainstream.

N. Bergman, Report of a few cases of circumcision

T. Scott McFarland, Circumcision of girls

J.H. Beaty, Some peripheral irritations common in young boys

NOTES

1.  B.E. Dawson, Orificial surgery: Its philosophy, application and technique (Newark: The Physician's Drug News Co, 1912), p. 402

2. Edward Wallerstein, Circumcision: An American health fallacy (New York, Springer, 1980). pp. 38-9

3.  Such as Jonathan Hutchinson's crusade for universal circumcision as the solution to the syphilis problem; William Chidley's crusade for "natural coitus" as the royal road to health and happiness; Roger Short's crusade for universal circumcision as a solution to the African AIDS crisis; Brian Morris's crusade for universal neonatal male circumcision as a preventive of nearly every health problem known to man. Aah, the fragrance of snake oil!

4.  Alex Comfort, The anxiety makers: Some curious preoccupations of the medical profession (London: Nelson, 1967), p. 105

5.  Wallerstein, p. 39

6. Abraham Wolbarst, "Universal circumcision as a sanitary measure", Journal of the American Medical Association, Vol. 62, 1914, pp. 92-7; Abraham Wolbarst, "Method of applying vibratory massage to the prostate: Preliminary report", Journal of the American Medical Association, Vol. 91, 3 November 1928, p. 1371

Ira M. Rutkow, the moment of Orificial Surgery

THE MOST INFLUENTIAL of the late 19th century American unorthodox medical sects was the homeopathic movement. It grew out of the experimental pharmacologic studies of German physician Samuel Hahnemann (1755-1843) and within a few decades had won over numerous converts, primarily in urban middle and upper classes. Among the more interesting yet bizarre clinical schemes to emerge from the practice of homeopathy was orificial surgery. This philosophy, the treatment of chronic disease processes through surgical operations on the rectum, vagina, cervix, urethra, nares, mouth, etc, evolved from the personal practice beliefs of Edwin Hartley Pratt (1849-1930), an Illinois homeopathic general practitioner.

Pratt obtained his medical degree from Chicago's Hahnemann Medical College in 1873. For the first 10 years of his career, he was engaged in general practice and saw patients in Cook County Hospital or his own private clinic. Pratt's theories about orificial surgery had been undergoing maturation since the early 1880s, but their first formal presentation to the medical profession did not occur until 1886. Pratt gave a lecture on the orificial philosophy that was published in The Medical Era, a trade publication managed by 2 homeopathic pharmacists. As he stated:

A vigorous sympathetic nervous system means health and long life. What surgical interest have we in this fact? It can be told in just one sentence. The weakness and the power of the sympathetic nerve lies at the orifices of the body. Surgery must keep these orifices properly smoothed and dilated.

Pratt rarely saw an orifice that was not in need of a surgeon's scalpel. In this surgical manner, problems such as constipation, dysmenorrhea, eczema, insanity, insomnia, tuberculosis, and vomiting could be treated.

Like any savvy promoter, Pratt authored a lengthy monograph on orificial surgery (1887). The work was a tremendous success in that it provided his new branch of surgery with both direction and content. A year later, Pratt and his acolytes organized the American Association of Orificial Surgeons. As Pratt's proselytizing met with increasingly receptive audiences, he began to design and sell surgical instruments intended strictly for orificial operations. By 1891, and becoming independently wealthy, Pratt began construction of his own private hospital known as the Lincoln Park Sanitarium in Chicago. With growing numbers of practitioners of orificial surgery nationwide, the necessity for its own specialty journal became paramount. In mid 1892 the Journal of Orificial Surgery commenced publication with Pratt as its editor-in-chief.

The orificial philosophy attracted a large following whose advocates were, in every sense of the word, surgeons. Their technical skills allowed Pratt's followers to perform many formidable operations, including hysterectomy, repair of complicated cervical and perineal lacerations, and radical hemorrhoidectomy. Although it is an impossible task to estimate how many Americans were victims of this unorthodox surgical philosophy, they must have numbered in the tens of thousands. The allure of orificial surgery was, for 2 to 3 decades, quite strong and paralleled the achievements in overall homeopathy. However, this appeal would decline just as rapidly as did homeopathic therapeutics. In 1901, the Journal of Orificial Surgery abruptly ceased publication with little explanation. Annual meetings of the American Association of Orificial Surgeons continued through World War I, but the end was in sight for the aging population of orificial surgeons. By the 1920s, orificial surgery had become little more than a vague memory in the minds of most American health care professionals.

Ira M. Rutkow MD, MPH, DrPH, "Orificial Surgery", Archives of Surgery, Vol. 136, Sept. 2001, p. 1088