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 widelyfrom 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 manysusceptible 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 ititches 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 atime.

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 evedinec 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? 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 theland.

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 agaist 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.

Editorial, Medical Times and Gazette, 13 April 1867

Comments by the Medical Historian

Clitoridectomy and medical ethics

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 informedconsent.

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 similarly asserted that masturbation in boys could be stopped by amputation of the foreskin. 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 the 1860s, and the following year he was disgraced and expelledfrom 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.

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