Peter Feibleman
Natural Causes
In 1916 a clitoridectomy was performed on my mother, at age
five, to stop her from masturbating. The surgery was done at the request of her mother,
not in Africa but in a fashionable area of Manhattan where she was born, at the office of
a distinguished gynecologist whose fees were consonant with his fame; I first found about
it in 1944 when I was fourteen, from my father, who explained it to me in detail as the
reason for her wanting a divorce. Teenagers are more curious than considerate, and I went
straight to my mother to find out if it was true. I remember that day better than most
days because it was the first time I’d ever seen my mother cry. She confirmed the
mutilation, denied that it was the reason for the divorce, and added that we would not
discuss the matter again.
At the time I believed her case was unique – that my mother
had been singled out by some mysterious fate and mangled in an unthinkable way. But I was
wrong, her case was far from unique, and a few years later in a fumbling effort to
confront my own fear about the subject, I began to seek the truth from medical men of my
grandmother’s vintage. One of them, a second-generation gynecologist then in his
eighties, explained that the sexual mutilation of American women had been a lucrative
industry in the United States from 1867 until at least 1927, and possibly much later
– a thriving business few people spoke about afterward. In describing it, he told me
more than I wanted to know at the time, and within a decade I’d mostly succeeded in
putting the whole thing out of my mind.
Yet now – over forty years after I first found out –
people who express such tender outrage at the practice of clitoridectomy in Africa still
reject out of hand the mere suggestion that the custom was once popular in our own
country. At a party some time ago, when the dinner guests began referring to the
"barbaric" quality of clitoridectomy in Islamic cultures, I asked whether they
used the same term to describe gynecological practices in nineteenth century America, but
nobody at the table knew what I was talking about, and having dismissed it, they drifted
back to their talk of Muslims. The next day, fed up with listening to them, I decided to
be armed for the next argument on the subject and went to the public library, sure that
all the facts must, by then, be available to anyone. But the results were disappointing;
the American Medical Association, founded in 1847, had no female members till 1915, and a
quick look at its reports didn’t reveal very much. What is obsolete or has become
disreputable in medical practice tends to be omitted from history, and doctors congregate
to record their successes, not their mistakes.
Once more I forgot about it until something happened that had more effect on me than a
casual conversation at a dinner party.
The first Sunday after Christmas of that year, my mother made a
serious attempt at suicide – her second in a decade – one that would have
succeeded, as would the first, save for Louise George, a woman who worked for her as a
personal maid and housekeeper since I was born. Louise came to work in the morning as
usual and found a sealed letter addressed to her in my mother’s handwriting, propped
up on the dining room table; she panicked, ignored the instructions in the letter, and
called the doorman, who phoned an ambulance. Nearly dead, my mother was rushed to New York
Hospital, where the detoxification was slow because of the number of pills she had
swallowed (sixty milligrams of Phenobarbital, more than the requisite lethal dosage), but
within two weeks she’d been brought back to consciousness, examined by a faintly
slaphappy psychiatrist who told her that suicide was an indication of low self-esteem, and
sent home.
About a month after that, she called asked if I could come for
dinner and spend some time talking. I accepted and "I think that would be just
lovely," she said – but something about the way she said it bothered me. The
phrase itself didn’t sound like my mother – not under these circumstances –
it was too demure and fake-formal for her. She was a product of upper class New York, not
genteel, never a woman given to euphemisms, and there was a curious tone in her voice now
that smacked of performance.
Her apartment was on Sutton Place in Manhattan, and I took the
elevator up and walked back to the service entrance, thinking about it. People who love
each other sometimes fall into the habit of speaking at one level while passing silent
messages back and forth at another, and what my mother didn’t say often contained
more information than what she did. Officially, her reason for the first suicide attempt
had been cancer – this time it was emphysema – but in our private language other
reasons had been hinted at both times – not as clearly as they usually were in that
language, but there all the same, and I’d heard them the way you sometimes hear
things in dreams.
Louise answered my ring and stepped aside, examining me with the
curious look that came, I thought, from her blood: a blend of Cherokee, Jewish, and
African. It started just behind her pupils, a pinpoint of gold that increased gradually
till it became a tiny motionless beam – a light I’d been conscious of ever since
she came up with us from New Orleans – and it seemed so much older now than her
Seventy-six years on Earth that it made her look twenty years younger.
"How is she?" I asked.
Louise turned her head with deliberate slowness and looked at me
with a flat expressionless stare.
"You’ve seen her worse," she said.
I found her sitting on the sofa, eyes locked in space. Her face
was pale, pearly gray in color, with a nacreous sheen I didn’t like, and her
breathing was shallow from the emphysema, an extension of the asthma she’d had as a
child.
"Hi, darling," she said "You already know the
reason I wanted to see you tonight, don’t you?"
The question came so abruptly that my throat closed and I
couldn’t answer: Outside on the street a listless drizzle had stopped, and the car
horns were beginning to take on an angry complaining sound, like the blatting of so many
sheep.
My mother got up and arranged some books on a shelf while I
watched her, frowning. Then she turned around slowly and met my stare head-on.
"All-right… I am going to do it again," she said, as if that had been the
expected topic of conversation rather than one we’d been avoiding for weeks.
"Will you help me?"
"Sure," I said too fast.
She opened her mouth and said my name once, gently. Then she
breathed again, and the blood came back to her skin like a slow blush. Above the deep rose
velvet of her houserobe, her face blossomed in a soft oval shape, pierced by two large,
black, outraged eyes. At seventy-four she was still a beautiful woman, and the ravaged
look around the eyes somehow sharpened what had been there before.
For the next hour and a half she talked sporadically about a great many things, declaring
at last that there was nothing for her to look forward to now but what she called "a
slow death by drowning."
"Drowning?"
"That’s how you die from emphysema," she said,
"you can’t exhale. Like the asthma, only more so. I knew someone once with
terminal emphysema – toward the end, she had to go on her hands and knees to get to
the bathroom with an oxygen mask. I’d rather do it my way."
"Are you in pain?"
"Hell no, emphysema’s not painful, I thought you knew.
Bronchial spasms are frightening, but they don’t hurt… Besides, I can handle
physical pain, I always could."
"I know."
"Emotional pain is sometimes worse than…" She
broke off and raised her head and leveled her eyes at me in a way I didn’t remember
her ever doing before.
"Emotional pain from what?" I asked.
A few seconds before she said: "It started when I was
five."
I kept silent.
"I’d swore I’d never talk about it again, but now
that,…" she shrugged, "if you want me to now, I will."
"I want you to," I said
There was a heavier silence, and my mother got up and turned
toward a window overlooking the lit-up city. She appeared almost translucent against the
drilling lamplight, some of it shining through her, some of it reflected off the rose. For
a second her face looked the way I remembered when she was young. Then she started
speaking, her voice humming inside her like a tuning fork, in dense undulation, rationing
the words for the amount of air they cost…
"I don’t remember any physical hurt, but I recall
standing in a strange doctor’s office. I didn’t know why I was there. One of the
doctor’s assistant’s took me into a separate room. … My parents stayed
behind and chatted with the doctor. I remember wondering why they didn’t come with
me." She stopped to breathe. "It wasn’t considered much more than a male
circumcision. The assistant picked me up and sat me on a table… He stood behind me
where I couldn’t see him. I was afraid, but I tried not to let it show. I think it
probably did a little, because he joked with me for a while, trying to get me to relax.
Then he pulled me backward and held a gauze soaked in ether over my nose and mouth. When I
woke up it was over, and the smell was sickening – it made me vomit. I think what he
did probably hurt afterward, but I was an angry child and I wouldn’t cry."
She was wheezing, and she stopped again and took a thin spray can
of Epinephrine from her pocket and squirted it down her throat. "Your Aunt Edna and I
shared the same bedroom – I was five, Edna three – I remember lying in bed that
night… Fraulein, our governess, wrapped some cotton around an orange stick… Then
she soaked the cotton in iodine, separated my legs, and put the iodine on the raw
incision. I don’t remember any pain then, either… All I remember is Edna asking
why I was screaming so loud, and Fraulein saying, "Dorothy’s been a dirty
girl,’…"
She was silent for another little while before going on. "It
was a couple of weeks later that I got my first asthma attack. … The bronchial spasms
we severe enough that we moved from our house in New York to Scarsdale for six
months… The air was supposed to be cleaner there. And I was supposed to have changed.
They thought they’d broken me, but they were wrong… I found ways around them.
The next time they caught me doing it, my bed was exchanged for a bed with bars on the
side…. They tied my wrists and ankles to the bars at night with leather straps….
They put a metal brace between my knees and I slept that way. But I still found ways
around them, don’t you worry…."
Her face had taken on a crafty young expression, the look of a
stubborn child. "One morning they noticed that my face was flushed, and my Mother
guessed that I’d been trying to do it again. I was told to pack a suitcase and go
downstairs. She’d telephone to an insane asylum, she said, and an ambulance was being
sent… I was to sit and wait in the foyer till it arrived. I wasn’t at all scared
then because I knew my father would come and rescue me and sat on a window seat facing the
driveway…. I remember the maple tree outside the bay window… I remember that
tree very well. I sat there all day. But it wasn’t till dark that I knew my father
wasn’t going to come… I never forgave him for that…" She took some
time off to breathe again. "Around midnight, Mother came and got me. She said
she’d change her mind about the asylum this time, but wouldn’t again if I gave
her cause…."
The voice wavered, faltered, ceased. She stood with her lips
still moving, and then swiveled very slowly to the right until she saw me. For an instant
she seemed surprised to find me there; then confusion blended with recognition, and the
rose reflected on her skin turned back to gray. Her body continued to rotate in perfect
diminution, as it might have if she were a doll winding down on a music box, till she was
facing the sofa again. Then it stopped. Then it stopped. "You know the rest,"
she said.
"Not all of it."
"Some other time perhaps."
She stood still for a count of three. Then softly, as if in
answer to a question no one else could hear: "No, why should I? It’ll be done
with soon… I don’t mind…."
I was about to ask whom she was talking to, but I stopped myself.
She wasn’t looking at me anymore. She was looking past me.
I followed her gaze back over my left shoulder to where a long
unlikely shadow fell from under and archway into the living room across the carpet in
stark tremulous silence, like the shadow of an oak. I followed the shadow back, then up,
until I came to the pinpoint of gold in the eyes. I didn’t know how long Louise had
been standing there. It didn’t seem to matter. My mother had been speaking to her
shadow not to her.
I have no idea how long it was that nobody spoke while the night
outside solidified, thick and hard as tar, sealing the three of us into a cold collusive
stillness, frozen with light. Then Louise opened her mouth and the stillness shattered.
"Dinner is served," she said.
It was to take her a little over six weeks to get the pills
she needed – she’d taken all she had on the last attempt – and during those
weeks I met with her almost daily. The rest of the time I worked with two research
assistants I’d hired, collecting the bulk of the information I needed from the vast
number of medical journals and private papers published last century, now kept in medical
libraries across the states, their facts detailed, well documented, and indisputable. The
first few days were strange. I didn’t want my mother to die, but I’d given my
word to help and backing out wasn’t an option, since I’d rather have faced a
firing squad than the look on her face if I disappointed in something. If I was going to
fail, it had to be in the act, not the thinking, and in order to act I needed all the
facts I could get.
What we found was this:
By the mid 1800s, most American gynecologists (limited at the
time to males) came to believe that the first logical step toward controlling erratic
female behavior was to remove certain sexual organs. The procedures known as oophorectomy
(removal of the ovaries) and clitoridectomy (removal of the clitoris) were urgent matters,
as was their subsequent cover-up, a conspiracy of silence in which women participated for
reasons of shame. Toward the end of the nineteenth century, oophorectomy was more
prevalent than the other procedure, but both were deemed proper antidotes to masturbation
and to other common "illnesses" found in American women.
The reasons for this drastic surgery were complex, but clearly
related to the industrial revolution’s new market economy, when it suddenly became
clear that a woman could operate a machine as well as a man – making the sexes for
the first time equal in strength, and producing a new social order; working class woman
could work but middle and upper class woman were dubbed "ladies," and placed on
a high pedestal high enough to assure them a chaste atmosphere of chilling Victorian
purity. These newly citified "ladies" were permitted to do nothing they’d
done in country life – they weren’t even allowed to be healers and midwives
anymore, since medicine, now seen as a remunerative commodity, was swept into the market
along with everything else, and the market belonged to men. A new species of male medical
"experts" arose, gynecologists who were as aggressive and invasive in their
healing methods as midwives had been gentle and noninvasive in theirs. That took care of
the so-called woman problem.
But there were other problems in America, where the leveling
force of democracy in a wilderness area had led to an almost total disintegration of class
stability: generational family craftsmanship, as it existed in Europe, was almost unknown
here, and heredity didn’t count. Money was men’s chief identity in this strange
new land.
The nineteenth century’s obsession with the evils of masturbation
has been well chronicled in many countries, but nowhere did it take on quite the meaning
it had in America, where the best speaker on the subject was the Reverend John Todd, a
prolific writer from western Massachusetts whose little book, The Student’s Manual,
published in 1835, compared the spending of semen with the spending of money in a
situation where it was wasted. The analogy of sperm to money was popular among men who
believed that money was identity, and "spent" became a dirty word, not because
it implied loss of cash but because it meant orgasm. Todd declared that a masturbator
would find "vipers" feeding on his blood – his "ship of being"
would develop wormholes – his reservoir of semen emptied for life. By 1854 The
Students Manual was in its twenty-fourth edition, and it sold over a hundred thousand
copies overseas. Todd himself became so famous that Melville, who lived nearby in
Pittsfield from 1850 to 1863, based his satire, The Lightning-Rod Man, on the Reverend
Todd’s character and teaching. The sanctity of male semen was not a new idea, but it
surfaced now with a vengeance: in 1848 the superintendent of the lunatic asylum in
Worchester, Massachusetts, declared that 32 percent of people admitted to the hospital had
gone insane because of masturbation, and people found warnings against it in newspapers,
fliers, street posters – wherever they looked. A man who persisted in
"self-abuse" was said to be lost, but a woman who did so was worse because,
apart from her own downfall, she was, in her potentially seismic sexual appetite, a threat
to all men.
It was in this atmosphere that the new medical experts searched
for clues to a curious epidemic of "neurasthenic" disorders that had begun to
appear in the newly idle, languishing ladies of the upper classes who were, by now,
everybody’s romantic ideal. Femininity was synonymous with fragility – the
ancient belief that woman’s normal state was sickness had come back into fashion
– and men prided themselves on their wives’ ethereal qualities. Wives and
daughters of the rich were fed drops of arsenic or nitrate or silver to increase their
delicate pallor. (It was excessive use of nitrate of silver that caused my grandmothers
skin to appear ashen, for which she had special face powder, gray mixed with a little
pink, made for her at Elizabeth Arden’s.) A well-dressed nineteenth century
lady’s corset exerted an average of twenty-one pounds on her internal organs, and
extremes of eighty-eight pounds had been measured, resulting now and then in the uterus
being forced through the vagina. More often, tight lacing produced fainting fits,
considered further evidence of women’s daintiness.
Brief outbursts of emotion soon turned into longer fits of
hysteria that cropped up in cities all over the country. The word hysteria comes from a
Greek word meaning womb – as the word taboo comes from a Polynesian word meaning
menstruation – and physicians unable to determine the cause of the new epidemic soon
found that all theories led to the same place. In 1848 a distinguished gynecologists named
Charles Meigs warned his students to beware of the female reproductive system, which had a
"strange" influence "not one the body alone, but on the heart, the mind,
and the very soul of the woman." There was talk of "dangerously unappeasable
irritations of the clitoris," and Dr. Augustus K. Gardner, an eminent gynecologist
who was Reverend Todd’s most ardent disciple, wrote that "hysteria… is
unquestionably the result, in my opinion, of uterine irritation, be it produced as it
may… It is a complaint intimately allied to the sexual organs of females."
Historian Ann Douglas Wood describes the harrowing treatments
that were used in America to diagnose and cure such problems: "a manual
investigation" was followed by "leeching," then by "injections"
and "cauterization" of the womb. A professor name Dewees and a well-known
English gynecologist named Bennett both advised placing leeches inside is a woman, on the
vulva or "neck of the uterus" – and Bennett cautioned doctors to
"count the leeches" as they became satiated and dropped off. Otherwise, he said,
you might "lose" some of them, since he himself had known plucky little leeches
to creep up into the cervical cavity of the uterus. "I think," Dr. Bennett
wrote, "I have scarcely ever seen more acute pain than that experienced by several of
my patients under these circumstances."
It should be remembered that no anesthetic was used at the time,
short of a little opium or alcohol. The cauterization recommended by Dewees and Bennett
involved the application of nitrate of silver inside the uterus (for mild female
complaints), hydrate of potassa (for more severe complaints,) or "actual
cautery," applied in the same place with a "white-hot iron" instrument.
In 1858 Dr. Isaac Baker Brown, an eminent British gynecologist,
began to treat hysteria by reviving the ancient practice of clitoridectomy, which had long
ago fallen into disuse. Dr. Brown opened a clinic for woman, which was used largely for
this purpose, and in 1865 he was elected president of the Medical Society of London –
a prestigious institution that still exists. Ultimately he was discredited, though his
dismissal had more to do with his self-promotion than with his surgery, and he left
England and came to America still insisting that his use of clitoridectomy was
"dictated by the loftiest and most moral considerations."
Dr. Browns operation caught on in the United States, gaining and
losing medical popularity through the 1860s, and continuing, on and off, through the
1950s. The 1936 edition of Holt’s Disease of Infancy and Childhood held that it was
"not adverse to circumcision in girls or cauterization of the clitoris," and
even doctors who spoke out against the operation admitted that it was "useful"
in cases of nymphomania. Among the many-recorded instances of clitoridectomy in America is
one that took place in 1948, performed on a girl of five, my mother’s age, for the
same reason.
Once discredited, the practice became a subject of significant
embarrassment to the medical establishment, and it is interesting to note that current
American reference books on gynecology make no mention of clitoridectomy between the late
nineteenth century and first half of the twentieth centuries, despite irrefutable proof in
the countless medical journals of that time published here and in England. Apart from
these journals, the overall rise and fall of clitoridectomy has been charted by historian
Ann Dally through the articles listed in the index of the surgeon general of the United
States. In its first series (1882) "clitoris" takes up a whole page; in the
second series, less. Again in the third series (1892) it covers a whole page, and drops
again in the fourth (1938), where the reference is mainly to "savage tribes." In
the sixth series (1961) "clitoris" does not appear at all.
The practice of oophorectomy, or "female castration,"
was more widespread in the late nineteenth century, having been performed first by Dr.
Robert Battey of Rome, Georgia, as a cure for unrelated systems, in 1872 – a time
when there were large influxes of immigrants. Many Americans were fearful that
"inferior races" were taking over the country, and the same Dr. Gardner began to
advise white Anglo-Saxon parents to reproduce on stock-breeding and stock-raising
principles, American women, he wrote, had to be "restored" to virtue, so that
they might preserve "the blood of strong races in our veins," and "repulse
the [foreign] invaders," whom he had already defined as "dirty" and
"effete." Gardner was the Nazi of American gynecology, and one of the most
respected doctors in the country; his motives in encouraging oophorectomy were obvious.
To Dr. Battey’s and Dr. Gardner’s reasons other
physicians added their own, until the procedures became a popular medical fad.
Even more drastic surgery followed as the procedure of
oophorectomy was enlarged to include extirpation of the fallopian tubes and hysterectomy.
By 1906 it was estimated that there was at least one castrated woman for every one of the
150,000 doctors in the United States; some doctors boasted of performing many such
procedures, and it has been reported that ovaries were passed around at medical meetings
almost as trophies.
In 1896 Dr. David Gilliam asked that the practice of female
castration be increased, lauding it beneficial effects by comparing woman to animals:
"Why do we alter our colts and calves? Not that we expect to abate strength or
endurance, nor yet to render them less intelligent: but that we may make them tractable
and trustworthy, that we may convert them into faithful, well-disposed servants."
Bulls and men, he added were naturally belligerent and should remain so.
In 1906 Dr. Ely Van de Warker, one of the increasing number of
doctors who criticized the widespread practice of female castration, reported that the
most insidious effect of all had taken place – women themselves had become collusive.
"So constantly have [the ovaries] been held up before her as the one evil spot in her
anatomy that she has grown to look with suspicion on her own organs." Women, he
wrote, were pleading with physicians for surgery, "fully convinced that all their
grief emanates from the pelvis… this idea fostered by their friends." In the
end, American women were going to gynecologists as freely as they would soon go to
psychoanalysts when Freud came along, curing hysteria with his new school of psychology,
central to which was his theory of penis envy.
It was during my own late teens that Freudian buzzwords became
cocktail chitchat from coast to coast, and people said that a woman who suffered from
penis envy wished to steal a mans genitalia and take it for her own. Such a woman was
referred to as an aggressive, "castrating woman."
The phrase "castrating woman" caught on in America like
a great advertising gimmick. It became the most famous phrase of its kind in the twentieth
century, defining a quality that was, men said, the worst; and millions of them said it.
Men who came tumbling off the analysts couch – men who were failures – men who
doubted there masculinity – all blamed it on the same thing: "castrating
women."
And castrated women? They had been forgotten, as women
with clitoridectomies had been forgotten. The mutilated women had ceased to exist in most
people’s mind, including my own – all but one.
During the six weeks of talks with my mother, I learned the
details of things that I had only known in a general way. Her childhood asthma subsided
when she married at seventeen and moved to New Orleans with my father; by the time she was
thirty-nine, she had been divorced, remarried to a much older man, and had a hysterectomy
for what turned out to be a benign tumor: the surgeon suggested that he take out "the
whole kit and caboodle" in case of "possible complications later on," but
she insisted that he leave her ovaries intact. There were no complications after the
surgery but shortly afterward her asthma returned, and with it the bronchial spasms.
When she was in her fifties, my mother was worried by a soft lump
in her right breast that had been there for many years; her internist said it was a result
of estrogen therapy she’d been given earlier for her hysterectomy, and told her not
to be concerned unless there was some change. The day she discovered that it had turned
from a soft lump to a hard lump, she knew it was cancer and decided to do nothing about
it, on the theory that enough sexual mutilation was enough and she preferred not to go on.
She expected that the cancer would back up into her bone and kill her; instead it went the
other way, becoming discolored and so large that that she was forced to go see a doctor,
who ordered a room at Lennox Hill Hospital, called a surgeon, and told her to go home and
pack a bag. It was that same night that she made her first suicide attempt, and after
being forcibly revived, she was told that she needed an immediate radical mastectomy. She
refused, agreeing at last to a lumpectomy; this was followed by X-ray treatment and
chemotherapy for ten tough years that included, at various times, two episodes of
baldness, a broken hip, and a broken arm (both caused by lack of balance, a side effect of
her treatments), along with three more surgical procedures, before the cancer went into
remission. But by then the asthma had progressed to emphysema, and the prognosis was very
bad. That was when she made the most recent attempt.
On February 28, six weeks after she asked for my help, my mother
made a third attempt. This time she did not fail. Due to the extent of the damage caused
by her emphysema, the doctor I called in afterward made only a cursory examination and
said that an autopsy was unnecessary. The certificate he signed reads "Death by
Natural Causes."
I can’t say now that my mother’s early mutilation led
to her suicide, because I don’t know that; it triggered her asthma, and led to a fear
of disfigurement that made her choose death to treatment in the beginning. But I do know
this; it wounded her, wounded her body, wounded her spirit. She was a beautiful woman who
had no belief in herself as a woman, and that lack of belief affected most of her life.
Since her death, I’ve come to believe that the medical
practices begun in the nineteenth century continue to affect twentieth-century women in
myriad ways. Hysterectomy is the second most frequently performed major surgery in the
United States (after cesarean sections), with almost six hundred thousand cases annually,
many of them unnecessary, along with more than a few questionable mastectomies. Ignorance
about the female reproductive system remains appalling: the 1975 edition of Columbia
Encyclopedia says that removal of the ovaries may result in the loss of periods.
As late as 1990, in the Motion Picture Academy’s rating system, a filmed that showed
a man kissing a woman's bare breast for reasons of love was given an X rating, while a
film that showed a man cutting off a woman’s breast for reasons of hate was only
giving an R rating. The old shoot-‘em-up movies about men are rivaled – today
– by cut-‘em-up movies about women, and ticket sales are increasing.
My mother died saying she hadn’t done the best she could
with her life. She said a lot of things in those last six weeks, but at the end she said,
"I wish I’d had more courage."
That was the one that got me. |