MFCM016: The %22Sick%22 Women of the Upper Classes.pdf

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IXth MFC annual meet back-ground literature
The ”8ick” Women of the Upper Classes

Barbara Ehrenreich
and
Deirdre English

The affluent woman of the late nineteenth century normally
spent a hushed and peaceful life indoors, sewing, sketching,
reading romances, planning menus, and super ising servants and
children. Her clothes, a sort of portable prison of tight
corsets and long skirts , prevented activity any more vigorous
than a Sunday stroll, Society agreed that she was frail and
sickly. Her
delicate nervous system had to be shielded as
]
carefully as her body, for the slightest shock could send her
reeling off to bed. Elizabeth Barrett Browning, for example,.
although she was an extraordinarily productive woman, spent six
years in bed following her brother’s death in a sailboat accident.
But not even the most sheltered woman lived in a vacuum..
Just outside the suffocating world of the parlor and the boudoir
lay a world of industrial•horror. This was. the period of America’s
industrial revolution, a revolution based on the ruthless exploita­
tion of working people. Women, and children as young as six,
worked fourteen-hour days in factories and sweatshops for sub­
subsistence wages. Labour struggles were violent, bordering, at
times, on civil wars. For businessmen, too, survival was a bitter
struggle : you squeezed what you could out of the workers, screwed
the competition, and the devil take the hindmost. Fortunes were
made and destroyed overnight, and with them rode the fates of
thousands of smaller businessmen.
The genteel lady of leisure was not just an anomaly in an
otherwise dog-eat-dog world. She was as much a product of that
world as her husband or his employees. It was the wealth extracted
in that harsh outside world that enabled a man to afford a totally
leisured wife. She was the social ornament tb^b proved a man’s
success: her idleness,.her delicary, her childlike ignorance of
“reality” gave a man the "class” that money alone could not pro­
vide. And it was the very harshness of the outside world that
led men to see the home as a refuge - ”a sacred place, a vestal
temple,” a ’’tent pitch’d in a world not right,” presided over by a
gentle, ethereal wife. Among the affluent classes, the worlds of
men and women drifted farther and farther apart, with divergent
standards of decorum, .of health, of morality itself.
There were exceptional women in the upper classes - women
who rebelled against the life of enforced leisure, the limitations
on meaningful work - and it is these exceptional women who usually
are.remembered in history books. Many became women’s rights
activists or social reformers. A brave few struggled to make
their way in the professions. And toward the end of the nineteenth
century a growing number were demanding, and getting, college
educations. But the majority of upper- and upper-middle-class
women had little chance to make independent lives for themselves;
tney were financially at the mercy of husbands or fathers. They
nc.d to accept their roles - outwardly at least - and remain duti­
fully housebound, white-gloved, and ornamental. Of course, only
a- small minority of urban women could afford a life of total
leisure, but a great many more women in the middle class aspired
to it and did their best to live like ’’ladies.”

The Cult of Female Invalidism

The boredom and confinement of affluent women fostered a
morbid cult of hypochondria - ’'female invalidism” - that began

2

in the mid-nineteenth century and did not completely fade until
the late 1910s. Sickness pervaded upper- and upper-middle-class
female culture, Health spas and female specialists sprang up
everywhere and became part of the regular circuit of fashionable
women. And in the 1350s a steady stream of popular home readers
by doctors appeared, -all on the subject of female health. Litera­
ture aimed at female readers lingered on the romantic pathos of
illness and death; popular women’s magazines featured such stories
as "The Grave of My Friend” and "Song of Dying."’ Paleness and
lassitude (along with filmy white gowns) came into vogue. It was
acceptable, even fashionable, to retire to bed with "sick headaches,"
"nerves," and a host of other mysterious ailments.

In response, feminist writers and female doctors expressed
their dismay at the chronic invalidism of affluent women. Dr.
Mary Putnam Jacobi, an outstanding woman doctor of the late
nineteenth century, wrote in 1395 •
It is considered natural and almost laudable to break
down under all conceivable varieties of strain - a winter
dissipation, a houseful of servants, a quarrel with a
female friend, not to speak of more legitimate reasons.
...Women who expect to go to bed every menstrual period
expect to collapse if by chance they find themselves on
their feet for a few hours during such a crisis.
Constantly considering their nerves, urged to consider
them by well-intentioned but short-sighted advisors,
they pretty soon become nothing but a bundle of nerves.

Charlotte Perkins Gilman, the feminist writer and economist,
concluded bitterly that American men "have bred a race of women
weak enough to be handed about like invalids; or mentally weak
enough to pretend they are - and to like it."
It is impossible, to tell, in retrospect, how sick uppermiddle-class women really were. Life expectancies for women wore
slightly higher than for men though the difference was nowhere
near as great as it is today.
It is true, however, that women - all women •- faced certain
risks that men did not share, or share to the .same degree. First
were the risks associated with childbearing, which were all the
greater in an age of primitive obstetrical technique when little
was known about the importance of prenatal nutrition.. In 1915
(the first year for which national figures are available) 61
women died for every 10,000 live babies born, compared to- 2 for
every 10,000 today, and the maternal mortality rates were doubt­
less higher in the nineteenth century. Without adequate, and
usually without any, means of contraception, a married woman
could expect to face the risk of childbirth repeatedly through
her fertile years. After each childbirth a woman might suffer
any number of gynecological complications, such as a prolapsed
(slipped) uterus or irreparable pelvic tear, which would stay
with her for the rest of her life.
Another special risk to women came with tuberculosis, the
"white plague." In the mid-nineteenth century, TB raged at
epidemic proportions, and it continued to be a major threat until
well into the twentieth century. Everyone was affected, but
women, especially young women, were particularly vulnerable,
often dying at rates twice as high as those of men of their age
group. For every hundred women aged twenty in 1365, more than
five would bo dead from TB by the age of thirty, and more than
eight would be dead by the age of fifty. (It is now believed
that hormonal change's associated with puberty and childbearing
accounted for the greater vulnerability of young women to TB.)

3
The dangers of childbearing, and of TB, must have shadowed
women’s lives in a way that we no longer know. But these dangers
cannot explain the cultural phenomenon of ’’female invalidism”
which, unlike TB and maternal mortality, was confined to women
of a particular social class. The most important legitimization
of this fashion came not from the actual dangers faced by women
but from the medical profession.
The medical view of women’s health not only acknowledged
the specific risks associated with reproductivity; it went much
farther: it identified all female functions as inherently sick.
Puberty was seen as a ’’crisis,” throwing the entire female organism
into turmoil. Menstruation - or the lack of it - was regarded as
pathological throughout a woman’s life. Dr. W.C. Taylor, in his
.book A Physician’s Counsels to Woman in Health and Disease (1371),
gave a-warning typical of those found in popular health books
of the time :

We cannot too emphatically urge the importance of regarding
these monthly returns as periods of ill health, as days
when the ordinary occupations are to be suspended or
modified... Long walks, dancing, shopping, riding and
parties should be avoided at this time of month invariably
and under all circumstances. ...Another reason why every
woman should look upon herself as an invalid once a
month, is that the monthly flow aggravates any existing
affection of the womb and readily rekindles the expiring
flames of disease.

Similarly, a pregnant woman was ’’indisposed, ” and doctors
campaigned against the practice of midwifery on the grounds that
pregnancy was a disease and demanded the care of a doctor.
Menopause was the final, incurable ill, the ’’death of the woman
in the woman.”
Women’s greater susceptibility to TB was seen as proof of
the inherent defectiveness of female physiology. Dr. Azell Ames
wrote in 1375' ”It being beyond doubt that consumption...is
itself produced by the failure of the (menstrual) function in
the forming girls... one has been the parent of the other with
interchangeable priority.” Actually, as we know today, it is
true that consumption may result in suspension of the menses. But
at that time consumption was blamed on woman’s nature and on her
reproductive system. When men were consumptive, doctors sought
some environmental factor, such as overexposure, to explain the
disease. But in popular imagery, consumption was always effemi­
nate : novels of the time usually featured as male consumptives
only such ”effete” types as poets, artists, and other men
'■’incompetent ” for serious masculine pursuits.
The association of TB with innate feminine weakness was
strengthened by the fact that TB is accompanied by an erratic
emotional pattern in which a person may behave sometimes freneti­
cally, sometimes morbidly. The behaviour characteristic for the
disease suited - and perhaps helped to create - the prevailing
standards of female beauty. Ths female consumptive did not lose
her feminine identity, she embodied it: the bright eyes, translu­
cent skin, and red lips were only an extreme of traditional female
beauty. A romantic myth rose up around the figure of the female
consumptive and was reflected in portraiture and literature; for
example, in the sweet and tragic character of Beth, in Little
Women. Not
I’
only were women seen as sickly - sickness was seen as
feminine.
The doctors’ view of women as innately sick did not, of
course, make them sick, or delicate, or idle. But it did provide
a powerful rationale against allowing women to act in any other

4
way.
way. Medical arguments were used to explain why women should bc%
barred from medical school (they would faint in anatomy lectures),
from higher education altogether, and from voting. For example,
a Massachusetts legislator proclaimed: ’’Grant suffrage to women,
and you will have to build insane asylums in every country, and.
establish a divorce court in every town. Women are too nervous
and hysterical to enter into politics.” Medical arguments seemed
to take the malice out of sexual oppression: when you prevented a
•■'omen from doi^ anything active or interesting, you were only
doing this for her own good.
The DoctorsT strake in Women’s Illness

The myth of female frailty, and the very real cult of female
hypochondria that seemed to support the myth, played directly to
the financial interests of the medical profession. In the late
nineteenth and early twentieth centuries, the '’regular” AMA
doctors (members of the American Medical Association - the
intellectual ancestors of today’s doctors) still had no legal
monopoly over medical practice and no legal control over the
number of people who called themselves ’’doctors.” Competition
from lay healers of both sexes, and from what the AMA saw as an
excess of formally trained male physicians, had the doctors run­
ning scared. A good part of the competition was female: women
lay healers and midwives dominated the urban ghettos and the
countryside in many areas; suffragists were beating on the doors
of the medical schools.
For the doctors, the myth of female frailty .thus served two
purposes. It helped them to disqualify women as healers, and, of
course, it made women highly qualified as patients. In 1900
there were 173 doctors engaged in primary patient care per 100,000
population, compared to 50 per 100,000 today. So, it was in the
interest of doctors to cultivate the illnesses of their patients
with frequent home visits and drawn-out ’’treatments.” A few
dozen well-heeled lady customers were all that a doctor needed
for a successful urban practice. Women - at least, women whose
husbands could pay the bills - became a natural ’’client caste”
to the developing medical profession.

In many ways, the upper-middle-class woman was the ideal
patient: her illnesses -• and her husband’s bank account - seemed
almost inexhaustible. Furthermore, she was usually submissive
and obedient to the ’’doctor’s orders.” The famous Philadelphia
doctor S. Weir Mitchell expressed his profession’s deep apprecia­
tion of the female invalid in 1S8S:
With all her weakness, her unstable emotionality, her
tendency to morally warp when long nervously ill, she
is then far easier to deal with, far more amenable to
reason, far more sure to be comfortable as a patient,
than the man who is relatively in a like position.
The reasons for this are too obvious to delay me here,
and physicians accustomed to deal with both sexes as
sick people will be apt to justify my position.

In Mitchell’s mind women were not only easier to relate to, but
sickness was the very key to femininity:nThe man who does not
know sick women docs not know women.”

Some women were quick to place at least some of the blame
for female invalidism on the doctors’ interests. Dr. Elizabeth
Garrett Anderson, an American woman doctor, argued that the
extent of female invalidism was much exaggerated by male doctors
and that women’s natural functions were not really all that
debilitating. In the working classes, she observed, work went
on during menstruation ’’without intermission, and, as a rule,

5
without ill effects.” (Of course, working-class women could not
have afforded the costly medical attention required for female
invalidism.) Mary Livermore, a women’s suffrage worker, spoke
• Tainst ’’the monstrous assumption that woman is a natural in­
valid,” and denounced "the unclean army of ’gynecologists’ who
seem desirous to convince women that they possess but one set of
organs -and that these are always diseased.” And Dr. Mary
Putnam Jacobi put the matter most forcefully when she wrote in
1395, ”1 think, finally, it is in the increased attention paid to
w?and especially in their new function as lucrative patients,
scarcely imagined a hundred years ago, that we find explanation
for much of the ill-health among women, freshly discovered today.”

The “Scientific” Explanation of Female Frailty

As a businessman, the doctor had a direct interest in a
social role for women that encouraged them to be sick; as a doctor,
he had an obligation to find the causes 'of female complaints. The
result was that as a ’’scientist,” he ended up proposing medical
theories that were actually justifications of women’s social role.

This was easy enough to do at the time: no one had.a very
clear idea of human physiology. American medical education, even
at the best schools, put few constraints on the doctors’ imagina­
tions, offering only a scant introduction to what was known of
physiology and anatomy and no training in rigorous scientific
method. So doctors had considerable intellectual license to de­
vise whatever theories seemed socially appropriate.
Generally, they traced female disorders either to women’s in­
herent “defectiveness” or to any sort of activity beyond the
mildest “feminine” pursuits - especially sexual, athletic, and
mental activity. Thus promiscuity, dancing in hot rooms, and
subjection to an overly romantic husband were given as the origins
of illness, along with too much reading, too much seriousness
or ambition, and worrying.
The underlying medical- theory of women’s weakness rested on
what doctors considered the most basic physiological law: “con­
servation of energy/" According to the first postulate of this
theory, each human body contained a set quantity of energy that
was directed variously from one organ or function to another.
This meant that you could develop one organ or ability only at
the expense of others, drawing energy away from the parts not
being developed. In particular, the sexual organs competed with
the other organs for the body’s fixed supply of vital energy.
The second postulate of this theory - that reproductivity was
central to a woman’s biological life - made this competition
highly unequal, with the reproductive organs in almost total
command of the whole woman.
The implications of the “conservation of energy” theory
for male and female roles are important. Let’s consider them.

Curiously, from a scientific perspective, men didn’t
jeopardize their reproductivity by engaging in intellectual
pursuits. On the contrary, since the mission of upper- and
upper-middle-class men was to be doers, not breeders, they had to
be careful not to let sex drain energy away from their “higher
functions.” Doctors warned men not to ’’spend their seed”
(i.e., the essence of their energy) recklessly, but to conserve
themselves for the ’’civilizing endeavors” they were embarked
upon. College youths were jealously segregated from women except on rare sexual sprees in town - and virginity was often
prized in men as well as women. Delibitated sperm would result
from too much “indulgence,” and this in turn could produce
“runts,” feeble infants,- and girls.

6
On the other hand, because reproduction was woman’s grand
purpose in life, doctors agreed that women ought to concentrate
their physical energy internally, towards the womb. All other
'Ctivity should be slowed down or stopped during the peak periods
of -sexual energy use. At the onset of menstruation, women were
told to take a great deal of bed rest in order to help focus their
strength on regulating their periods- - though this might take
years. The more time a pregnant woman spent lying down quietly,
the better. At menopause, women were often put to bed again.

•Doctors and educators were quick to draw the obvious conclu­
sion that, for women, higher education could be physically
dangerous. Too much development of the brain, they counseled,
would atrophy the uterus. Reproductive development was totally
antagonistic to mental development. In a work entitled Concern­
ing the Physiological end Intellectual Weakness of Women, the
German scientist P. Moebius .wrote :
If we wish woman to fulfill the task of motherhood
fully she cannot possess a masculine brain. If the
feminine abilities were developed to the same degree
as those of the male, her maternal organs would suffer
and we should have before us a repulsive and useless
hybrid.
In.the United States this thesis was set forth most cogently by
Dr. Edward Clarke of Harvard College. He warned, in his influential
book Sex in Education (1373), that higher education was already
destroying the reproductive abilities of American women.

Even if a woman should choose to devote herself to intellec­
tual or other "unwomanly" pursuits, she could hardly hope to escape
in domination of her uterus and ovaries. In The Diseases of
Woman (1349) , Dr. F. Hollick wrote: "The Uterus, it must.be
remembered, is ths controlling organ in the female body, being
the most excitable of all, and so intimately connected, by the
rectifications of its numerous nerves, with every other part." To
other medical theorists, it was the ovaries that occupied center
stage-. This passage, written in 1370 by Dr. W.W. Bliss, is, if
somewhat overwroughtj nonetheless typical:
Accepting, then, these views of the gigantic power and
influence of the ovaries over the whole animal economy
of woman, - that they are the most powerful agents in
all the commotions of her system; that on them rest her
intellectual standing in society, her physical perfec­
tion, and all that lends beauty to those fine and
delicate contours which are constant objects of admira­
tion, all that is great, noble and beautiful, all that
is voluptuous, tender, and endearing, that her fidelity,
her devotedness, her perpetual vigilance, forecast,
and all those qualities of mind and disposition which
inspire respect and love and fit.her as the safest
counsellor and friend of man, spring from the .ovaries,
- what must be their influence and power over the
great vocation of woman and the august purposes of her
existence when these organs have become compromised
through disease I Can the record of woman’s mission
on earth be otherwise than filled with tales of sorrow,
sufferings, and manifold infirmities, all through the
influence of these important organs?
This was not mere textbook rhetoric. In their actual
medical practices, doctors found uterine and ovarian "disorders”
behind almost every female complaint, from headaches to sore
throats and indigestion. Curvature of the spine, bad posture,or pains anywhere in the lower half of the body could be the

3
f:r it by stroking the breasts or the clitoris. But under the
stern disapproval, there always lurked the age-old fear of and
fascination :<ith woman’s "insatiable lust" that, once awakened,
might be totally uncontrollable. In 1853, when he was only
twenty-five years old, the British physician Robert Brudenell
Carter wrote (in a work entitled On the Pathology and Treatment
of Hysteria) :

No one who has realized the amount of moral evil wrought
in girls.. owhoso prurient desires have been increased
by Indian hump and partially gratified by medical
manipulations, can deny that remedy is worse than disease.
I have...seen young unmarried women, of the middle
class of society, reduced by the constant use of the
speculum to the mental and moral condition of prostitutes;
seeking to give themselves the same indulgence by the
practice of solitary vice; and asking every medical
practitioner... to institute an examination of the
s exua1 organ s.

(Did Dr. Carter’s patients actually smoke "Indian hemp" or beg
for internal examinations? Unfortunately, we have no other au­
thority on the subject than Dr. Carter himself.)
Medical Treatments
Uninformed by anything that we would recognize today as a
scientific description of the way human bodies work, the actual
practice of medicine at. the turn of the century was largely a
matter of guesswork., consisting mainly of ancient remedies and
occasional daring experiments. Not until 1912, according to one
medical estimate, did the average patient, seeking help from the
average American doctor, have more than a fifty-fifty chance of
benefiting from the encounter. In fact, the average patient ran
a significant risk of actually getting worse as a result: bleeding,
violent purges, heavy doses of mercury-based drugs, and even
opium were standard "therapeutic approaches throughout the nine­
teenth century, for male as well as female patients. Even well
into the twentieth century, there was little that we would recog­
nize as modern medical technology. Surgery was still a highly
risky enterprise; there were no antibiotics or other "wonder
drugs”; and little was understood, medically, of the relationship
between nutrition and health or of the role of hormones in
regulating physiological processes.
Every patient suffered, from this kind of hit-or-miss treat­
ment, but some of the treatments applied to women now seem parti­
cularly useless and bizarre. For example, a doctor confronted
with what he believed was an inflammation of the reproductive
organs might try to "draw away" the inflammation by creating what
he thought were counter-irrigations - blisters or sores on the
groin or the thighs. The common medical practice of bleeding
by means of leeches also took on some very peculiar forms in the
hands of gynecologists. Dr. F. Hollick, speaking of methods of
curing amenorrhea (chronic lack of menstrual periods),commented:
"Some authors speak very highly of the good effects of leeches,
applied bo the external lips(of the genitals), a few days before
the period is expected." Leeches on the breasts might prove
effective too, he observed, because of the deop sympathy between
the sexual organs. In some cases leeches were even applied to the
cervix despite the danger of their occasional loss in the uterus.
(So far as we know, no doctor ever considered perpetrating simi­
lar medical insults to the male organs.)

Such methods could be dismissed as well intenbiened, if
somewhat prurient, experimentation in any age of deep medical
ignorance. But there were other "treatments" that were far more

7
result of "displacement” of the womb, and one doctor ingeniously
explained how constipation results from the pressure of the uterus
on the rectum. Dr. M.S. Dirix wrote in 1S69 •
Thus, women are treated for diseases of the stomach,
liver, kidneys, heart, lungs, etc.; yet, in most
instances, these diseases will be found, on due
investigation, to be, in reality, no diseases at all,
but merely the sympathetic reactions or the symptoms of
one dis..:se; r.amely, a disease of the womb.

The Psychology of the Ovary
If the uterus and ovaries could dominate woman’s entire body,
it was only a short step to the ovarian takeover of woman’s entire
personality. The basic idea, in the nineteenth century, was that
female psychology functioned merely as an extension of female
reproductivity, and that woman’s nature was determined solely by
her reproductive functions. The typical medical view was that
'•The ovaries.. .give to woman all her characteristics of body
and mind...” And Dr. Bliss remarked, somewhat spitefully, "The
influence of the ovaries over the mind is displayed in woman’s
artfulness and dissimulation.” According to this "psychology
of the ovary,” all woman’s "natural” characteristics were directed
from the ovaries, and any abnormalities - from irritability to
insanity - could be attributed to some ovarian disease. As
one doctor wrote, "All the various and manifold derangements of
the reproductive system, peculiar to females, add to the causes of
insanity.” Conversely, actual physical reproductive problems and
diseases, including cancer, could be traced to bad habits and
attitudes.
Masturbation was seen as a particularly vicious character
defect that led to physical damage, and although this was believed
to be true for both men and women, doctors seemed more alarmed
by female masturbation. "They warned that "The Vice” could lead
to menstrual dysfunction, uterine disease, and lesions on the
genitals, Masturbation was one form of "hypersexuality, " which
w?s said to lead to consumption; in turn, consumption might
result in hypersexuality. The association between "hypersexuality”
and TB was easily "demonstrated" by pointing to the high rates of
TB among prostitutes. All this fueled the notion that "sexual
disorders” led to disease, and conversely, that disease lay
behind women’s sexual desires.

The medical model of female nature, embodied in the "psy­
chology of the ovary,” drew a rigid distinction between reproduc­
tivity and sexuality. Women were urged by the health books and
the doctors to indulge in deep preoccupation with themselves as
"The Sex”; they were to devote themselves to developing their
reproductive powers, their maternal instincts, their "femininity."
Yet they were told that they had no "natural” sexual feelings
whatsoever. They were believed to be completely governed by
their ovaries and uteruses, but bo be repelled by the sex act
itself. In fact, sexual feelings were seen as unwomanly, patho­
logical, and possibly detrimental to the supreme function of
reproduction. (Men, on the other hand, were believed to have
sexual feelings, and many doctors went so far as to condone
prostitution on the grounds that the lust of upper-middle-class
males should have some outlet other than their delicate wives.)
The doctors themselves never seemed entirely convinced, of
this view of female nature. While they denied the existence of
female sexuality as vigorously as any other men of their times,
they were always on the lookout for it. Medically, this vigilance
was justified by the idea that female sexuality could only be
pathological. So it was only natural for some doctors to test

9
sinister - those aimed at altering female behavior. The least
physically destructive of these was based, simply, on isolation
and uninterrupted rest. This was used to treat a host of problems
diagnosed as "nervous disorders."
Passivity was the main prescription, along with warm baths,
cool baths, abstinence from animal foods and spices, and indulgence
in milk and puddings, cereals, and "mild sub-acid fruits."
Women were to have a nurse - not a relative - to care for them,
to receive no visitors, and as Dr. Dirix wrote, "all sources of
mental excitement should be perseveringly guarded against."
Charlotte Perkins Gilman was prescribed this type of treatment
by Dr. S. Weir Mitchell, who advised her to put away all her pens
and books, Gilman later described the experience in the story
"The Yellow Wallpaper," in which the heroine, a would-be writer,
is ordered by her physician-husband to "rest":

So I take phosphates or phosphites - whichever it is,
and tonics and journeys, and air, and exercise, and am
absolutely forbidden to "work" until I am well again.
Personally, I disagree with their ideas.
Personally, I believe that congenial work, with
excitement and change, would do me good.
But what is one to do?
I did write for a while - in spite of them; but it does
exhaust me a good deal - having to be so sly about it...
or else meet with heavy opposition.

Slowly Gilman? s heroine begins to lose her grip ("It is getting to
be a great effort for me to think straight. Just/fchis nervous weakness, I. suppose.") and finally she frees herself from her prison
- into madness, crawling in endless circles about her room, muttering about the wallpaper.
But it was the field of gynecological surgery that provided
the most brutally direct medical treatments of female "personality
disorders." And the surgical approach to female psychological
problems had what was considered a solid theoretical basis in the
theory of the "psychology of the ovary." After all, if a woman 1 s
entire personality was dominated by her reproductive organs,
then gynecological surgery was the most 1 gical approach to any
female psychological problem. Beginning in the late 1860s, doc­
tors began to act on this principle.

At least one of their treatments probably was effective :
surgical removal of the clitoris as a cure for sexual arousal.
a medical book of this period stated: "Unnatural growth of the
clitoris...is likely to lead to immorality as well as to serious
disease... amputation may be necessary." Although many doctors
frowned on the practice of removing the clitoris, they tended
to agree that this might be necessary in cases of "nymphomania."
(The last clitorectomy we know of in the United States was per­
formed twenty-five years ago on a child of five, as a cure for
masturbation.)
More widely practiced was the surgical removal of the ova­
ries - ovariotomy, or "female castration." Thousands of those
operations were performed from 1360 to 1890. In his article "The
Spermatic Economy," Ben Barker-Benfield describes the invention
of the "normal ovariotomy," or removal of ovaries for nonevarian
conditions - in 1872 by Dr. Robert Battey of Rome, Georgia.

10
Among the,indie- tions were a troublesomeness, eating
like a ploughman, masturbation, attempted suicide,
erotic tendencies, persecution mania, simple "cussedness,"
: nd dysmenorrhea. Most apparent in the enormous
variety of symptoms doctors took to indicate castration
was a strong current of sexual appetitiveness, on the
,p~rt of women.

Patients were often brought in by their husbands, who complained
o' their unruly ’?./• ~vior. When returned to their husbands,
castrated,”" they were "tractable, orderly,
"castrated,
orderly industrious and
cleanly,” according to Dr. Battey. (Today ovariotomy, accompanying a hysterectomy, for example, is not known 'to have these
by. One can only wonder what, if any,
effects on the personality,
personality changes Dr. Battey7s patients really-went through.)
Whatever the effects, some doctors claimed to have removed from
fifteen hundred to two thousand ovaries; in Barker-Benfield’s
words, they ‘’handed them around at medical society meetings on
plates like trophies."

We could go on cataloging the ludicrous, theories, the lurid
cures, but the point should be clear: late nineteenth-century
medical treatment of women made very little sense as medicine,
but it was undoubtedly effective at keeping certain women - those
who could afford to be patients - in their place. As we have seen,
surgery was often performed with the explicit goal of "taming” a
high-strung woman, and whether or not the surgery itself was
effective, the very threat of surgery was probably enough to bring
many women into line. Prescribed bed rest was obviously little
more than a kind of benign imprisonment - and the prescriptions
prohibiting intellectual activity speak for themselves I
But these are just the extreme "cures." The. great majority
of upper-middle-class women were never subjected to gynecological,
surgery or long-term bed rest, yet they too were victims of the
prevailing assumptions about women’s "weakness" and the necessity
of frequent medical attention. The more the doctors "treated,”
the more they lured women into seeing themselves as sick. The
entire mystique of female sickness - the house calls, the-tonics
and medicines, the health spas - served, above all, to keep a
great many women busy at the task of doing nothing. Even among
middle-class women who could not afford constant medical atten­
tion and who did not have the leisure for full-time invalidism,
the myth of female frailty took its toll, with cheap (and often
dangerous) patent medicines taking the place of high-priced
professional "cures."
One very important effect of all this was a great increase
in the upper-middle-class woman’s dependence on men. To be sure,
the leisured lady of the "better” classes was already financially
dependent on her husband. But the cult of invalidism made her
seem dependent for her very physical survival on both her doctor
and her husband. She might bo tired of being a kept woman, she
might yearn for a life of meaning and activity, but if she was
convinced that she was seriously sick or in danger of becoming
so, would she dare to break away? How could she even survive on
her own, without the expensive medical core paid for by her
husband? Ultimately, she might even become convinced that her
restlessness was itself "sick” - just further proof of her need
for a confined, inactive life, and if she did overcome the
paralysing assumption of women’s innate sickness and begin to
act in unconventional ways, a doctor could always be found to
prescribe a return to what was considered normal.

In fact, the medical attention directed at these women
amounted to what may have been a very effective surveillance
system. Doctors were in a position to detect the first signs of

11

rebelliousness, and to interpret them as symptoms of a ’’disease”
which had to be ’’cured. ”
Subverting the Sick Role

It would be a mistake to assume that women were merely the
passive victims of a medical reign of terror, In some ways, they
were able to turn the sick role to their own advantage, especially
as a form of birth control. For the ’’well-breed” woman to whom
sex really was repugnant, and yet a ’’duty,” or for any woman who
wanted to avoid pregnancy, '’feeling sick” was a way out - and
there were few others. Contraceptive methods were virtually un­
available; abortion was risky and illegal. It would never haveentered a respectable doctor’s head to advise a lady on contracep­
tion (if he had any advice to offer, which is unlikely), or to
offer to perform an abortion (at least according to AMa propaganda).
In fact, doctors devoted considerable energy to ’’proving” that
contraception and abortion were inherently unhealthy, and capable
of causing such diseases as cancer. (This was before the pilll)
But a doctor could help a woman by supporting her claims to be too
sick for sex: he could recommend abstinence. So who knows how
many of this period’s drooping consumptives and listless invalids
were actually well women, feigning illness to escape intercourse
and pregnancy?
If some women resorted to sickness as a means of birth - and
sex - control, others undoubtedly used it to gain attention and a
limited measure of power within their families. Today, everybody
is familiar with the (sexist) myth of the mother-in-law whose
symptoms conveniently strike during family crises. In the
nineteenth century, women developed, in epidemic numbers, an
entire syndrome which even doctors sometimes interpreted as a
power grab rather than a genuine illness, The new disease was
hysteria, which n many ways epitomized the cult of female invalidism. It affected upper- and upper-middle-class women almost exclusively; it had no discernible organic basis; and it was
totally resistant to medical treatment, For those reasons alone,
it is worth considering in some detail.

A contemporary doctor described the hysterical fit this way:

The patient...loses the ordinary expression of counten­
ance, which is replaced by a vacant stare; becomes
agitated; falls if before standing; throws her limbs
about convulsively; twists the body into all kinds of
violent contortions; beats her chest; sometimes tears
her hair; and attempts to bite herself and others;
and, though a delicate woman, evinces a muscular
strength which often requires four or five persons
to restrain her effectually.
Hysteria appeared, not only as fits and fainting, but in every
other form: hysterical loss of voice, loss of appetite, hysteri­
cal coughing or sneezing, and, of course, hysterical screaming,
laughing, and crying. The disease spread wildly, yet almost
exclusively in a select clientele of urban middle- and upper­
middle-class white women between the ages of fifteen and fortyfive .

Doctors became obsessed with this "most confusing,
mysterious and rebellious of diseases.” In some ways, it was
the ideal disease for the doctors: it was never fatal, and it
required an almost endless amount of medical attention. But
it was not an ideal disease from the point of view of the
husband and family of the afflicted woman. Gentle invalidism
had been one thing; violent fits were quite another. So
hysteria put the doctors on the spot. It was essential to

12
1 .ir professional self-esteem either to find an organic basis
:r the disease, and cure it, or to expose it as a clever charade.

There was plenty of evidence for the latter point of view.
•vith mounting suspicion, the medical literature began to observe
th^t hysterics never had fits when alone, and only when there was
something soft to fall on. Ono doctor accused them of pinning
th' ir hair in such a w.^v that it would fall luxuriantly when they
fainted. Thu hysterical “typo" .began to be characterized as a
"'putty tyrant” with a "taste for power” over her husband, servants,
end children, and, if possible, her doctor.
In historian Carroll Smith-Rosenberg7s interpretation, the
doctor’s accusations had some truth 'to them: the hysterical fit,
for many ’/omen, must have been the.only acceptable outburst - of
ragv,, of despair, or simply of energy - possible. But
ra~^,
D_ as
— ay form
2
of revolt it was very limited. No matter how many women might
adopt it, it remained completely individualized: hysterics don’t
unite and fight. As a power play, throwing a fit might give a
brief psychological advantage over a husband or a doctor, but
ultimately it played into the hands of the doctors by confirming
their notion of women as irrational, unpredictable, and diseased.

On the whole, however, doctors did continue to insist that
hysteria was a real disease - a disease of the uterus, in fact.
(Hysteria comes from the Greek word for uterus.) They remained
unshaken in their conviction that their own house calls and high
physician’s fees were absolutely necessary; yet at the same time,
in their treatment and in their writing, doctors assumed an increas­
ingly angry and threatening attitude. One doctor wrote, "It will
sometimes be advisable to speak in a decided tone, in the pres­
ence of the patient, of the necessity of shaving the head, or of
giving her a cold shower bath, should she not be soon relieved."
He then gave a “scientific" rationalization for this treatment by
saying, “The sedative influence of fear may allay, as I have known
it to do, the excitement of the nervous centers.”
Carroll Smith-Rosenberg writes that doctors recommended
suffocating hysterical women until their fits stopped, beating
them across the face and body with wet towels, and embarrassing
them in front ©f family and’friends. She quotes,Dr. F.C. Skey:
"Ridicule to a woman of sensitive mind, is a powerful weapon
...but there is not an emotion equal to fear and the threat of
personal chastisement... They will listen to.the voice of au­
thority." The more women became hysterical, the more doctors
became punitive toward the disease; and at the same time, they
began to see the disease everywhere themselves until they were
diagnosing every independent act by a woman, especially a women’s
rights action, as "hysterical."

With hysteria, the cult of female invalidism was carried
to its logical conclusion. Society had assigned affluent women
to'a life of confinement and inactivity, and medicine had justi­
fied this assignment by describing women as innately sick. In
the epidemic of hysteria, women were both accepting their inherent
"sickness” and finding a way to rebel against an intolerable social
role. Sickness, having become a way of life, became a way of
rebellion, and medical treatment, which had always had strong
overtones of coercion, revealed itself as frankly and brutally
repressive.
But hysteria is more than a bizarre twist of medical history.
The nineteenth-century epidemic of hysteria had lasting significance
because it ushered in a totally new "scientific" approach to the
medical management of women.

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