DoubleTake Magazine
Winter 1997

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."
     "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.