Isaac Baker Brown and the Clitoridectomy Operation
It was around the time of Brown’s break with the world of general hospitals that he began to be heavily influenced by ideas of nervous physiology, particularly those of Charles Brown-Séquard (1817-1894). Hysteria had long been associated with the female generative organs but Brown now started to suspect that irritation of peripheral nerves in that area was the specific cause of such afflictions. It was from this theoretical basis he took the controversial step of asserting that excitement of these nerves through masturbation could trigger mental disturbances of all kinds in women – not just hysteria, but epilepsy and mania too – and that extirpation of the clitoris in chronic masturbators was a potential means of cure. Here Brown, perhaps keen to claim credit for what he felt was a significant and novel surgical innovation, quickly put idea into practice with the verve he would become famous for. His account of his first clitoridectomy, on a 26 year old dressmaker form Yorkshire makes for uneasy reading. In keeping with Victorian etiquette Baker Brown’s language was rather veiled when it came to the matter of masturbation – he often avoided the word itself although in other cases referenced “excitation of the pudic nerve”, the meaning of which would have been clear enough to fellow doctors. In this first case however Baker Brown only rather cryptically mentioned that “her physiognomy at once told me the nature of the case” before noting her rather vague symptoms of weight loss, irregular menstruation and melancholia. Disconcertingly, what singled her out for his surgical experiment appeared to be timing rather than the specifics of the case, Brown writing that she was “the first case that came under my notice after I had satisfied myself of the correctness of my views on the subject.”
While it was known that Brown had been performing clitoridectomy since the early 1860s it was only with the publication of his monograph On the Curability of Certain Forms of Insanity, Epilepsy, Catalepsy and Hysteria in Females (1866) that the extent of his practice was revealed. Aside from the dubiousness of Brown’s claims that a permanent cure could be achieved this way, for many of his surgical colleagues it was the flagrant attempt to use surgery to treat nervous conditions which irked. The professional standing of medicine remained shaky and the boundaries of what it was appropriate for different types of doctor to do had an increasing influence over mid-century medicine; Brown’s expansion of surgery into the realm of mental disease did not sit well with this. Still more objected to the assumption that masturbation was occurring with frequency among women and some even challenged Brown to consider whether such actions would be acceptable if the patient was a man; “we have scarcely more right to remove a woman’s clitoris than we have to deprive a man of his penis” noted one opponent.” As criticism mounted the Council of the influential Obstetrical Society took the unusual step of proposing the expulsion of Brown. The ensuing debate, which was published in The Lancet on April 6th 1867, makes for fascinating reading as Society members packed in to the crowded hall to cast their vote. It seems likely however, that the die was cast before Brown even walked into the room, for his supporters were few and far between by this point. Brown was barely given a chance to speak and jeers broke out whenever he attempted to do so. He was expelled with 194 votes for and 38 against.
The expulsion effectively ended Brown’s career, with the Surgical Home folding soon after. By the end of the following year Brown was registered bankrupt, a wretched example of how quickly financial fortune could turn in medicine and the peculiar risks of specialising in diseases of women. An appeal in the medical press in the early 1870s for financial support for the destitute and by now critically ill Brown – reports hint at a nervous breakdown of some kind – attracted big medical names such as William Withey Gull and James Paget. But it was too little too late and Brown died 3 February 1873, his death attributed to apoplexy and a softening of the brain. Soon after his son and assistant, also once known as Isaac Baker Brown, changed his name to Lennox Browne in attempt to disassociate himself from his father, a final sadness to the story. Brown’s apparent excommunication from the profession seems to have extended into surgeons’ own personal archives. It was not uncommon for Victorians to request sensitive parts of their correspondence to be destroyed once they died and hence not that surprising that there is no collection of Baker Brown’s papers. But I have always found it striking that in my years of research into Victorian surgery I have never once stumbled upon any letter to or from him. He was, perhaps, a bad dream that London surgeons wanted to forget.
What then can we learn from the story of Isaac Baker Brown? Firstly of course, that it’s a story that involved many people; not least the dozens of women who were operated on in circumstances of dubious consent, robbed of a fundamental part of their sexuality and all for a treatment that few believed worked. One disturbing example leapt out at me when reading Brown’s cases; a 57 year old woman who came under his care in 1861 suffering from “homicidal mania”. The woman was subject to the usual treatment at the Surgical Home; however on completing the operation the woman did not exhibit the usual expected compliance. Rather Brown reported that “she complained to my son that I had unsexed her. He answered that nothing of the sort had been done, but that the operation had prevented her from making herself ill.” This one case speaks volumes, not only of the arrogance that had come to dominate Brown’s practice, but of the quiet resistance of the nameless patient.
But Isaac Baker Brown also tells us something about the way we do history and how controversial medical practices become easy emblems in a broader narrative of Victorian social mores. Brown is a quick and easy Victorian villain; one only has to Google him to see how many times he features in a paragraph or two in any number of works on the history of gender or madness. He earned this place with extreme treatments practised upon vulnerable women which were almost as controversial in his own time as they are now. But it’s important to remember too that he was the product of other contexts as well; not least a professional culture where specialist institutions and procedures had increasing social and economic value and where improvements in surgery meant that the self-identity of surgeons was fundamentally changing. Isaac Baker Brown was just a man after all, made of flesh and blood, whose convictions and talents became overpowered by arrogance. And perhaps that is the saddest thing of all.
 Isaac Baker Brown On the Curability of Certain Forms of Insanity, Epilepsy, Catalepsy and Hysteria in Females (London: Robert Hardwicke, 1866) 20-21.
 Moore, Harry Gage “Clitoridectomy” (The Lancet, V.87, no.2234) June 23 1866. 699.
 “Obituary” (The Lancet, V.101, no.2580) February 8th 1873, 222-223.
 Brown (1866), 79.