How To Make a Victorian Villain (or the Tale of Isaac Baker Brown) Part 2

Sally Frampton

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.”[1]

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.”[2] 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.

Extract from “The Baker Brown Fund.”The Lancet, Volume 99, Issue 2535, 30 March 1872, Page 453.

Extract from “The Baker Brown Fund.”
The Lancet, Volume 99, Issue 2535, 30 March 1872, Page 453.

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.[3] 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.”[4] 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.


[1] Isaac Baker Brown On the Curability of Certain Forms of Insanity, Epilepsy, Catalepsy and Hysteria in Females (London: Robert Hardwicke, 1866) 20-21.

[2] Moore, Harry Gage “Clitoridectomy” (The Lancet, V.87, no.2234) June 23 1866. 699.

[3] “Obituary” (The Lancet, V.101, no.2580) February 8th 1873, 222-223.

[4] Brown (1866), 79.

How To Make a Victorian Villain (or the Tale of Isaac Baker Brown) Part 1

Sally Frampton

                                                   Portrait of Isaac Baker Brown from the Medical Circular (1852)    Portrait of Isaac Baker Brown from the Medical Circular (1852).

Isaac Baker Brown is something of a legend in the history of medicine. A shorthand for the unhappy excesses of Victorian surgeons, he was the brute who mutilated vulnerable women; the clitoris cutter of West London carried away by his talent for operating; the surgeon who took his knife to those who committed the heinous act of masturbation; an embarrassment to the profession who was eventually exiled by his colleagues, had a nervous breakdown and died a broken man.

…well that’s the tabloid version anyway. And a fascinating tale it is too. But of course like so much of history, the story of Isaac Baker Brown is one easily compacted, compartmentalized and extricated from context.  It’s easier to think of Brown this way perhaps, as more monster than man, rather than consider the many factors that led to him towards performing clitoridectomy, one of the most shocking surgical experiments of the nineteenth century. This I hope to do here in a blog of two parts.

Isaac Baker Brown – The Early Years

Like all good stories Brown’s was one of twists and turns which reflected the rapid changes occurring in medical culture in the mid-nineteenth century.  His beginnings however, were inconspicuous enough. Born in 1812, the second son to a respectable farming family in Essex, he was apprenticed at a young age to a local surgeon. Brown was fairly typical of the type of young man entering surgery in the early decades of the nineteenth century, which was increasingly considered a worthy profession for middle-class men. Hospitals were slowly beginning break free from the nepotism that had previously dominated selection of staff, allowing a more meritocratic environment for young surgeons to distinguish themselves in. Judith Roy has speculated that Brown’s relatively modest background may have played a part in propelling him towards a practice in treating diseases of women, which had a reputation for being lucrative;[1] this seems plausible, but it was probably as much to do with his stint as a student at Guy’s that followed his apprenticeship, where he quickly began to make a name for himself as a young surgeon of some talent. It was here his interest in ovarian disease was formed in the buzzing atmosphere of London’s hospital wards and medical societies and where in 1830, at the tender age if eighteen, he read a paper on the topic to contemporaries. It is perhaps not surprising that an intelligent young man like Brown was drawn to this testing branch of medicine. Ovarian disease was notoriously hard to treat. Medicine seemed to be ineffective in curing or even palliating ovarian tumours, which often grew to huge sizes, and some radical thinking doctors had begun to tentatively suggest the use of major abdominal surgery to remove the disease, despite the risks of haemorrhage and post-operative disease that such a procedure entailed. The operation had been performed a number of times with success in Scotland and America and the justifiability of performing it would become one of the most controversial and debated topics in Victorian medicine. Brown’s mentor at Guy’s, James Blundell (1791-1878), was one of the most avid proponents of the operation and probably played a large part in influencing the professional choices of his young colleague.

Ironically, for someone who would go down in history for his surgical excesses, Brown’s forays into abdominal surgery were initially rather restrained. While other surgeons began to attempt the operation on patients with advanced cases of the disease, Brown held back, believing that ‘ovariotomy’, as the procedure was increasingly known, was not justifiable. Convinced that other less risky therapeutics such as mercurial tonics and pressure bandages could be adequate in treating the disease, only at the end of the 1840s did he begin to cautiously advocate opening the abdomen. His first attempt came in 1852. Sadly his results were not good; the first three of his ovariotomy patients all died. Famously his fourth case was his own sister, who did survive and went on to live a long and healthy life. It might be tempting to see his performance of such a risky operation on his sister as an early clue to his tendency to put convictions before the patient’s safety or welfare. What kind of man after all, would perform ovariotomy on his own sister after such terrible results? But I’m not sure if this would be quite accurate. Ovarian disease was a humiliating and painful condition and Baker Brown was probably cognisant that radical surgery was his sister’s only chance of survival. Given his history of surgical restraint, it seems he was no more audacious than other young ovariotomists. Bad luck? Definitely. Bad operating? Quite possibly. Rashness? Probably not. Nor should we assume that he was emotionally detached from the experience. Historians of medicine have often cited the importance of surgeons and anatomists’ dispassion;[2] certainly harbouring some emotional detachment from one’s grim and bloody work was a useful tool in protecting both professional reputation as well as one’s own sanity. But even with the bountiful advantages of anaesthesia (and indeed even after the integration of antiseptic techniques), surgery remained hugely risky. The tense and heated atmosphere of the operation made for a veritable myriad of emotions and throughout the nineteenth century surgeons performing ovariotomy were often open about the trauma they experienced in performing the operation on their vulnerable and terrified patients, writing emotion into their reports of cases and eliciting emotional responses; “in 1883, 1881 and 1882….my ovariotomies died right off as fast as I could operate upon them. It made me so sick, that I could scarcely bear to hear of a case of ovariotomy” wrote one American surgeon with remarkable candour in 1884[3]. Many of these men gave up permanently after a bad experience.

Due to his increasing success, Brown was not one of these men. By the mid-decades he one of Britain’s most well-known and successful ovariotomists. However his colleagues at St. Mary’s disliked him performing the controversial operation within its walls and in 1858 he left to form his own specialist hospital, the London Surgical Home. Not by any means the first specialist hospital for women, it was however the first in the city to have at its heart the surgical treatment of the diseases of women.  The Home employed a system where women paid only what they could afford and it enjoyed great success over the following years; most specialist hospitals relied on the patronage of the wealthy and well-known to support their work but by 1865 the Surgical Home’s list of supporters was one of the most extensive, as Earls and Bishops, Lords and Ladies queued up to put their name to Brown’s endeavours. His star was on the rise.

Part 2 of How To Make a Victorian Villain (or the Tale of Isaac Baker Brown) coming next week!

Sally Frampton is a research student at the Centre working on the history of ovarian surgery,


[1] Judith M. Roy, ‘Brown, Isaac Baker (1811–1873)’, Oxford Dictionary of National Biography, Oxford University Press, 2004 [http://www.oxforddnb.com/view/article/50268, accessed 16 Jan 2013]

[2] For instance see Lynda Payne on medical dispassion in the early modern period: With Words and Knives : Learning Medical Dispassion in Early Modern England (Aldershot: Ashgate, 2007).

[3] Essay on Desperate Surgery in its Relation to Women: The Proper Place for it; Who Should and Who Should not Attempt it. Journal of the American Medical Association, v.3, no. 12. September 20, 1884. 322.

Upcoming events at the Centre

In 2013 the Centre, in conjunction with the department of Neuroscience, Physiology and Pharmacology, will be running a series of seminars. Details below:

Prof David Armstrong, Department of Primary Care and Public Health Sciences, King’s College London.

“Origins of Behaviour”

5th February 2013

With recent advances in neuroscience the promise of a physical explanation for human behaviour seems to be getting closer.  At the same time behaviour is increasingly seen as an important factor in maintaining health and treating disease.  Throughout this engagement, however, the idea of ‘behaviour’ is very much taken-for-granted.  This presentation will therefore explore, through an examination of contemporary medical journals, how behaviour emerged as a key problem for science and health care between the 19th and 21st centuries.  It is argued that the origins of the concept/problem are relatively recent.

 

Katja Guenther, Assistant Professor, History of Science Program, Princeton University

“Reflex and Interpretation – A Genealogy of Psychoanalysis and the Neuro Disciplines” 

12 February 2013

In the medicine of mind and brain, the “neuro” and the “psy” disciplines – neurology, neurosurgery and neuroscience on the one hand, psychiatry, psychology and psychoanalysis on the other – have generally been considered as opposed in both their theory and practice. I aim to recast their relationship by focusing on Otfrid Foerster (1873-1941), a major proponent and founding figure of the neurological tradition in Germany, and Sigmund Freud (1856-1939) the father of psychoanalysis. An examination of their common engagement with sensory-motor, or reflex, physiology, as presented by the dominant neuropsychiatry in nineteenth-century Germany, allows us to think these different fields alongside each other and recognize unexpected parallels in their development, theory and practice.

 

Jesse F. Ballenger, Associate Professor, Science, Technology and Society , Penn State University

“To Conquer Confusion: The Struggle for a Coherent Framework for Dementia in Modern Medicine.”

5 March 2013

Since 1980, the massive investment of financial, institutional, and intellectual capital into research on the causes of and possible treatments for Alzheimer’s disease by both the federal government and private industry has helped to transform research on dementia from a small field with a broad agenda, to a massive multi-faceted research enterprise focused much more narrowly on pathological mechanisms. This has created unprecedented challenges in terms of managing the scale and scope of research, harmonizing clinical experience and laboratory knowledge generated in widely different contexts, negotiating the relationship between industry and academic research, diagnosing and treating multiple complex chronic conditions related to processes of aging, and using the information generated by generated by genetics and early diagnostics concerning risk factors and prodromal states in a coherent manner that meets the needs of researchers, clinicians, and patients. Understanding the transformation of the Alzheimer’s field in this period will yield great insight into what it means to research, diagnose, treat and live with chronic disease in late modernity.

 

Cornelius Borck, Institut fur Medizingeschichte und Wissenschaftsforschung, University of Luebeck

“Voodoo Correlations in Social Neuroscience: From Criticism to
Epistemological Analysis of Scientific Practice”

12 March 2013

The presentation takes the heated debate on “Voodoo correlations in
social neuroscience” as its starting point for an epistemological
analysis of functional neuroimaging. Back in 2009, the new and
flourishing field of social neuroscience faced fierce criticisms of
using flawed statistical methods that would lead to inflated
correlations. The debate left no alternative but to side with either the
critics or with the neuroscientists accusing the critics for their
insufficient understanding of complex statistics, thereby furbishing the
sequence of events to a textbook case of scientific debate on methods,
standards, and scientific authority. The call for a more robust
corroboration of experimental data, however, bypasses the
epistemological and ontological issues at stake here: Current work in
functional imaging flattens epistemological complexity, typical for the
previous paradigm of reductionist brain theories, and replaces it by an
ontological inflation of animated material objects. “Voodoo”, introduced
in the debate as a critique of curbed scientific rigor, thus turns into
a surprisingly descriptive concept, calling for further epistemological
discussions.

Seminars are open to all.

Medawar G01 Lankester Lecture Theatre, University College London. 

Map and directions:

http://www.ucl.ac.uk/find-us/

All seminars begin at 5pm.

Welcome!

Welcome to the newly-established blog of the UCL Centre for the History of Medicine. My thanks to Sally Frampton whose initiative this is. The Centre was established in 2011 and is located within the Division of Biosciences at UCL. This is an unusual, if not unique, situation for a humanities department that brings with it opportunities as well as challenges.

Through our teaching and research activities we maintain a commitment to the wider field of the history of medicine. Our focus is however upon history of neuroscience, a subject that is intrinsically interdisciplinary in nature. The study of the brain and the rest of the nervous system of course form part of the province of the life sciences and clinical medicine. But it also impinges on fields such as philosophy of mind and ethics. Moreover, increasingly bold claims are made for how advancing understanding of the neural basis of all aspects of behaviour must transform the methodological underpinnings of the social sciences and humanities. Through advertising and the media we are bombarded with gaudy images of the brain all seemingly designed to drive home the inescapable nature of our cerebral destiny. Part of the Centre’s mission is to seek an historical understanding of these developments.

Our hope is that this blog will help to disseminate our activities to a wider audience.

Stephen Jacyna, Centre Director.