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Women as Patients II. Gynaecology, Sexuality. Victorian physicians pushed the idea that men and women are different beyond contemporary ideas Woman’s biology was her destiny Influenced how they diagnosed and treated female patients. Created new medical specialties

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women as patients ii

Women as Patients II

Gynaecology, Sexuality

Victorian physicians pushed the idea that men and women are different beyond contemporary ideas
  • Woman’s biology was her destiny
  • Influenced how they diagnosed and treated female patients
Created new medical specialties
  • Enables us to see the gendered assumptions that structured medicine
rise of gynaecology
Rise of Gynaecology
  • Specialization not supported by leaders of regular medicine in 19th century
  • Associated with quackery
Favoured conceptualizing body as a coherent whole
  • Despite this, specialization did arise in the late 19th century
  • Congregated around specific populations (children)
Also around specific health problems (psychiatry)
  • Gynaecology doesn’t quite follow this patter
  • More of a generalist practice
Had to stake out their turf anatomically
  • Focussed on women’s reproductive diseases
  • Greatly assisted by founding of specialist hospitals by physicians
Moorfields Eye Hospital, 1804
  • Separate ward for women’s diseases at Guy’s Hospital, 1831
  • Hospital for Diseases of Women, Soho, 1842
By 1890, 88 specialist hospitals in London
  • Most rapid period of growth in 1860s
  • Development initially resisted by leadership of regular medicine
Believed these hospitals were a strategy to capture patients by physicians operating on the margins of the profession
  • Could create a lucrative practice in these settings
Specialist hospitals for gynaecology gave gynaecologists an institutional presence
  • Hospital representation of the idea the women’s biology was their destiny
the pelvic examination
The Pelvic Examination
  • Gendered assumptions shaped the way women were examined by men
  • First encountered with development of chest auscultation
Diagnosis by chest sounds developed by Rene Theophile Hyacinthe Laennec (1781-1826)
  • Reluctant to examine women using this technique
Invented the stethoscope around 1816
  • Enabled examiner to keep distance while listening to chest & heart sounds
Pelvic examination even trickier
  • Direct examination not possible
  • Examiner needed to manually examine the patient
Many physicians believed it was inappropriate to do this
  • Others endeavoured to do it without violating social conventions
  • Eye contact to be avoided at all cost
Use of speculum also controversial
  • Physicians very concerned re: its use on “respectable” women
Believed it was morally pernicious
  • Break down women’s natural restraint
  • Awaken their sex drive
  • Encourage masturbation
Physicians claimed to have seen “respectable” middle class women “reduced . . .to the mental and moral condition of prostitutes”
  • As a result, routine use of speculum proscribed in mid 19th century
May be more fruitful to view the speculum issue as an indication of the sexual anxiety of the Victorian male
  • Development of anaesthesia (1840s) appears to have enabled more common use of speculum
gynaecological surgery to treat non gynaecological problems
Gynaecological Surgery to Treat Non-Gynaecological Problems

1. Clitoridectomy

  • Believed that excessive female sexuality, masturbation caused insanity
Isaac Baker Brown performed clitoridectomies to solve this “problem”
  • Expelled from London Obstetrical Society 1867
  • Allegations he had coerced some of his patients
2. Ovariectomy
  • Belief that women’s general health greatly affected by her reproductive organs
  • Rarely performed prior to mid 19th century
By end of 19th century, very common
  • Physicians interpreted much of women’s ill health as ovarian in origin
  • American physician Robert Battey advocated procedure for menstrual pain or irregularity
Extremely controversial
  • Those who opposed the surgery did so primarily because of concerns re: women’s sterility
  • “Few men would wed a woman deprived of her ovaries.”
Women might lose their sex drive
  • Sex without capacity to procreate rendered women analogous to prostitutes
  • Defined today as disease that is psychogenic in origin
  • In Victorian times, seen as originating in the uterus
Overwhelmingly a diagnosis for women
  • Begs question of why it was so common in the 19th century
  • A response to enforced idleness?
Gendered assumptions made it difficult for 19th century physicians to see its manifestations in males?
  • If biological, then only women had uteruses
  • Biology of menstruation & reproduction fragile & easily upset
Treatment also influenced by these assumptions
  • Initially treated with blisters, purges, bleeding
  • Development of specific treatments
Local treatments
    • Manual adjustment of uterus
    • Application of leeches
    • Cauterization
  • Surgical treatments
    • Ovariectomy
Rest cures
    • Advocated by Dr. S. Weir Mitchell
      • Fat and Blood and How to Make Them
    • Women isolated from family
    • Enforced rest
    • Forced feeding
    • Based on conviction that hysteria induced by nervous exhaustion
Some women resisted
  • Charlotte Perkins Gillman
    • “The Yellow Wallpaper”
  • Contemporary historians argue that this approach reveals physicians’ need to control and even punish female patients