1. Women as Patients II Gynaecology, Sexuality

2.  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

3.  Created new medical specialties  Enables us to see the gendered assumptions that structured medicine

4. Rise of Gynaecology  Specialization not supported by leaders of regular medicine in 19 th century  Associated with quackery

5.  Favoured conceptualizing body as a coherent whole  Despite this, specialization did arise in the late 19 th century  Congregated around specific populations (children)

6.  Also around specific health problems (psychiatry)  Gynaecology doesn’t quite follow this patter  More of a generalist practice

7.  Had to stake out their turf anatomically  Focussed on women’s reproductive diseases  Greatly assisted by founding of specialist hospitals by physicians

8.  Moorfields Eye Hospital, 1804  Separate ward for women’s diseases at Guy’s Hospital, 1831  Hospital for Diseases of Women, Soho, 1842

9.  By 1890, 88 specialist hospitals in London  Most rapid period of growth in 1860s  Development initially resisted by leadership of regular medicine

10.  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

11.  Specialist hospitals for gynaecology gave gynaecologists an institutional presence  Hospital representation of the idea the women’s biology was their destiny

12. The Pelvic Examination  Gendered assumptions shaped the way women were examined by men  First encountered with development of chest auscultation

13.  Diagnosis by chest sounds developed by Rene Theophile Hyacinthe Laennec (1781-1826)  Reluctant to examine women using this technique

14.  Invented the stethoscope around 1816  Enabled examiner to keep distance while listening to chest & heart sounds

15.  Pelvic examination even trickier  Direct examination not possible  Examiner needed to manually examine the patient

16.  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

18.  Use of speculum also controversial  Physicians very concerned re: its use on “respectable” women

19.  Believed it was morally pernicious  Break down women’s natural restraint  Awaken their sex drive  Encourage masturbation

20.  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 19 th century

21.  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

22. Gynaecological Surgery to Treat Non-Gynaecological Problems 1. Clitoridectomy  Believed that excessive female sexuality, masturbation caused insanity

23.  Isaac Baker Brown performed clitoridectomies to solve this “problem”  Expelled from London Obstetrical Society 1867  Allegations he had coerced some of his patients

24. 2. Ovariectomy  Belief that women’s general health greatly affected by her reproductive organs  Rarely performed prior to mid 19 th century

25.  By end of 19 th 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

26.  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.”

27.  Women might lose their sex drive  Sex without capacity to procreate rendered women analogous to prostitutes

28. Hysteria  Defined today as disease that is psychogenic in origin  In Victorian times, seen as originating in the uterus

29.  Overwhelmingly a diagnosis for women  Begs question of why it was so common in the 19 th century  A response to enforced idleness?

30.  Gendered assumptions made it difficult for 19 th century physicians to see its manifestations in males?  If biological, then only women had uteruses  Biology of menstruation & reproduction fragile & easily upset

31.  Treatment also influenced by these assumptions  Initially treated with blisters, purges, bleeding  Development of specific treatments

32.  Local treatments –Manual adjustment of uterus –Application of leeches –Cauterization  Surgical treatments –Ovariectomy

33.  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

34.  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