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; 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; 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. 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,
 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]
 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).
 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.