Menstrual Madness and Ovary Removal in the 19th Century
CW: This piece contains discussions of surgical removal of reproductive organs, breaches of medical consent, and experimentation on enslaved women and women in asylums.
In 2018, following years of protests and petitions to city officials, a statue of John Marion Sims was removed from Central Park in New York City. Hailed as the “father of modern gynecology” and a genius innovator for his technique to repair vesicovaginal fistulas, he infamously experimented on enslaved women without consent or anesthetic in the 1840s. Sims and his experiments represent a trend in radical and medically unjustifiable gynecological procedures that emerged in the mid-19th century. Another such procedure, the normal ovariotomy, exemplified a crucial moment in the masculinization of gynecology, where men sought to have control over cis women’s bodies.
Infamously performed on those unable to consent, the normal ovariotomy is the removal of non-diseased ovaries. The procedure effectively sterilized women and embodied a eugenic disregard towards institutionalized, enslaved, or marginalized women who underwent the procedure. Through such means, doctors deemed who was and was not fit to reproduce. The lack of medical justification for the procedure was rooted in gendered constructions of “women’s illnesses” as signs of “female fragility” and biological weakness. The existence of such a surgery, despite the lack of medical necessity and documented success, shows how misogynistic, eugenic thought informed gynecological practices as the field became incredibly masculinized in the 19th century.
The original ovariotomy procedure, designed to remove diseased ovaries, ovarian cysts, and tumors, was first performed in 1809 by Ephraim McDowell in Kentucky, before anesthesia was widely used. Before it became popular throughout the Victorian era, this surgery in itself was radical and controversial in a number of ways. It was novel in its incision of the abdomen to perform pelvic surgery, yet it was also described as akin to “homicide” by surgeons such as Robert Liston, Professor of Surgery at the University College London. Soon after the ovariotomy was established within popular gynecological practice, prominent surgeons across Europe and the U.S., such as Alfred Hegar, Lawson Tait, and Robert Battey, began to experiment with the removal of “normal” ovaries to presumably cure other illnesses that were not strictly gynecological.
“The existence of such a surgery, despite the lack of medical necessity and documented success, shows how misogynistic, eugenic thought informed gynecological practices as the field became incredibly masculinized in the 19th century.”
In 1872, Robert Battey, a distinguished Confederate surgeon, performed the first normal ovariotomy on a 30-year-old woman, diagnosed with endometriosis and amenorrhea seven years earlier. Both ovaries removed were described as “grossly normal.” The patient not only survived but her condition improved, prompting Battey to publish his premature success. Within a few years of this publication, the procedure was performed by an increasing number of other surgeons as a treatment for general nervous symptoms, such as hysteria.
Battey outlined only four conditions he deemed appropriate for the surgery to the American Gynecological Society in 1877: when an absence of a uterus endangered life; irreparable damage to the uterine cavity or vaginal canal; epilepsy caused by uterine or ovarian disease; and cases of physical and mental suffering associated with the menstrual cycle. Yet surgeons, including Battey, would perform these surgeries on women who had none of these diagnoses.
Initially, Battey claimed that healthy ovaries were removed to effect an artificial menopause in order to treat conditions he claimed were “otherwise incurable.” However, Battey would later insist that all the ovaries he removed were “distinctly abnormal,” despite the procedure’s name and there being no evidence to support this. This was, perhaps, due to the mounting criticism of the unnecessary nature and increasing misuse of the procedure. Sims himself even pushed Battey to refer to the procedure as ‘Battey’s operation’ instead.
It has been estimated that as many as 105,000 women worldwide underwent the procedure in the 19th century, with a mortality rate of 10-25 percent. And Battey, the pioneer of the procedure that killed thousands of women, co-founded the American Gynecological Society in 1876.
Since at least the late Renaissance, menstruation and insanity had become intricately linked in Western medicine, and Battey, working within this tradition, claimed that insanity was “not infrequently caused by uterine and ovarian disease.” The normal ovariotomy, then, became a medically legitimate procedure to “relieve” women of their madness and to prevent them from passing it on to offspring.
During the 18th and 19th century, male physicians increasingly took over gynecological and obstetric roles previously occupied by female midwives and healers. And in the process of masculinizing reproductive health, they solidified gendered assumptions and eugenic conceptions of female weakness of the mind and body, attributing the “irritable uterus” to mental illness, hysteria, and erratic behavior in women. Contemporary physicians such as Edward Tilt, writing in England in 1851, went as far as to argue that menstruation should be actively prevented for as long as possible as it was so disruptive to female brains.
Even opposition to normal ovariectomies was grounded in a supposed connection between women’s mental and reproductive health. Resistance to the surgery was largely concerned with women’s inability to reproduce. German physician Alfred Hegar and British physicians E. H Trenholme and J. H. Aveling described the procedure as akin to “castration,” “unsexing,” or “spaying.”
In 1885, physician Thaddeus A. Reamy condemned the reckless nature of the surgery, arguing that a “sinless ovary…should not be needlessly sacrificed.” His concern with the sacrifice of a “sinless ovary,” rather than the unnecessary potential sacrifice of a woman’s life, was particularly disturbing as it highlights the demeaning and biopolitical ways women’s reproductive abilities were prioritized in arguments for and against the surgery. Philosopher Michel Foucault defined biopolitics as the ways modern society controls the individual through reproduction, rooted in heteronormative and eugenic bids to control women’s reproductive agency.
The risk and dire results on which surgeons gambled their patients’ lives were clear, yet the normal ovariotomy continually found support from gynecologists prominent in the trend of radical and experimental surgeries, including John Marion Sims. Sims published an account of Battey’s operation in 1877: Of seven patients, one died, two became worse, and one operation was brought to a halt half-way through. In spite of these abysmal results, Sims proclaimed the procedure a successful addition to gynecological practice, reflecting his complete disregard for the lives of women in his quest to “champion” a novel surgical practice.
Battey only recorded two deaths in the 94 cases he published, but these are very likely biased figures, as many of his cases were never published. Indeed, other surgeons such as George Engelmann recorded the procedure mortality rate as being closer to 30-33 percent, yet bafflingly still promoted its use, “however great the dangers.” William Goodell, a professor at the University of Pennsylvania who promoted the normal ovariotomy for all cases of insanity argued that even if the patient died “the surgeon can console himself with the thought that he has brought about a sterility in a woman who might otherwise have given birth to an insane progeny.”
By the 1880s, the radical surgery movement within gynecology was getting out of control. The increasing abuse and overuse of the normal ovariotomy for any symptom of insanity even began to be condemned by Battey himself. The use of the procedure in U.S asylums and hospitals was particularly disturbing. In the State Hospital for the Insane in Norristown, Pa., the procedure was performed frequently without patient consent until 1893 when the Committee on Lunacy of the Pennsylvania State Board for Public Charities condemned it as “illegal…experimental [in] character…brutal and inhuman, and not excusable on any reasonable ground.”
“The risk and dire results on which surgeons gambled their patients’ lives were clear, yet the normal ovariotomy continually found support from gynecologists prominent in the trend of radical and experimental surgeries…”
In the 1890s, George Rohé from Maryland examined 35 women of 200 patients, and he recommended the surgery in patients with a variety of mental illnesses, such as hysterical mania and puerperal mania (now associated with modern postpartum depression), who were clearly unable to consent to the procedure. Rohé later claimed a prominent attorney advised him that insane patients “having lucid intervals could give valid consent to any operation during said interval” to justify his recommendations.
These scandals in particular, along with persistent opposition from institutions including the Medical Board for the Women’s Hospital in New York, were instrumental in the downfall and eventual disgrace of the surgery.
Battey died in 1895, marking the beginning of a period of surgical conservatism after decades of radical experimentation and backlash in Western gynecology. The normal ovariotomy is just one of the novel and brutal treatments that sought to treat “women’s illnesses” and prevent their reproduction. The lack of consent and evidence of efficacy of these “treatments” among surgeons was not coincidental but indicative of the mass, eugenic attitude held towards institutionalized, enslaved, or “disobedient” women in this period.
The normal ovariotomy blended gendered and eugenic assumptions about women's fragile mentality and who was or was not allowed to reproduce. That even the opposition to the surgery was rooted in a belief that a woman’s purpose was only to reproduce and raise children shows how deeply gynecological practices were entrenched in misogynistic and eugenic thought. The male physicians who trialled these unnecessary surgical interventions gave little thought to women as human beings, treating women as nothing more than objects to be sliced and experimented upon in their path to alleged gynecological “progress” in medicine.
Further Reading
Sally Frampton, Belly-Rippers, Surgical Innovation and the Ovariotomy Controversy (Oxford: Palgrave Macmillan, 2018).
Ruth A. Miller, The Limits of Bodily Integrity: Abortion, Adultery and Rape Legislation in Comparative perspective (Routledge: Ashgate Publishing, 2008).
Regina Morantz-Sanchez, Conduct Unbecoming of a Woman: Medicine on Trial in Turn-of-the-Century Brooklyn (Oxford: Oxford University Press, 1999).
Image credit: Image of an abdominal ovariotomy from Pathology and treatment of diseases of women, 1912, by August Eduard Martin and Philipp Jacob (Internet Archive via Flickr’s The Commons)
