Battey’s Operation and Medical Violence as “Life-Saving Medicine”
Battey’s Operation and Medical Violence as “Life-Saving Medicine”
Fashionable treatments rise and fall, at great expense to desperate patients
NOTE: I have changed the title “Medical Violence as ‘Life-Saving Medicine’” to “Battey’s Operation and Medical Violence as ‘Life-Saving Medicine’” to situate Battey’s operation as one example among historical examples of medical violence as “life-saving medicine.”
I hold it to be the highest duty of our profession to preserve life. No physician has the moral right to say to his patient, ‘It is better to die than to live.’ No part of the human body ought be invested with such dignity and value that it may not properly be sacrificed, if need be, for the welfare of the whole.
- Robert Battey, “Extirpation of the Functionally Active Ovaries for the Remedy of Otherwise Incurable Diseases,” 1876, in Transactions of the American Gynecological Society, vol. 11
When I resigned myself to the operation I believed and hoped that it would end my life. I am now relieved of the old pain, and am better in every way than I have been for ten years, […] and I can not express what I feel for my noble, untiring, and skillful physician. I feel that I owe more than my life to him, for I fear I would have been insane with the suffering there was no respite from until I fell into his kind hands.
- Ms. S., a twenty-four-year-old woman, in Joseph Taber Johnson, “Four Cases of Oöphorectomy [sic], with Remarks,” 1885, in Transactions of the American Gynecological Society, vol. 102
Many insane, epileptic, and hystero-epileptic women, who have been thus mutilated, have subsequently found their way into hospitals for the insane, and are heard of no more. This is also the case in many instances where insanity has resulted from this operation, which is by no means an unusual occurrence. Those whose duty it is to care for the insane in institutions are familiar with these ultimate failures, whose last condition is worse than the first.
- “Removal of the Ovaries as a Therapeutic Measure in Public Institutions for the Insane,” JAMA 20, no. 5, February 4, 18933
“For the Welfare of the Whole”?
Male doctors performed unnecessary surgeries to remove the otherwise healthy ovaries of thousands of women during the late nineteenth century, presumably to save lives. Known as Battey’s operation, the bilateral oophorectomy, also called the ovariotomy, became a popular treatment for various forms of physical discomfort, including for abdominal pain, and forms of mental distress exhibited by female patients. In his 1979 paper in the Bulletin of the History of Medicine, Lawrence D. Longo gives a detailed account of the rise and fall of Battey’s operation using selected historical documents from the late 1800s through the early 1900s.4 Robert Battey pioneered what he termed the “normal ovariotomy,” confusingly named, “to establish at once the ‘change of life’ for the effectual remedy of certain otherwise incurable maladies.”5 The point was to alleviate women’s symptoms of physical or mental distress through an unnecessary mutilation of their sexual organs, namely triggering early menopause, by surgical intervention removing normal ovaries.
Battey’s operation marked an early instance of sexual surgery used for the purpose of behavior modification through medical bodily mutilation.6 Medical professionals believed it to be “life-saving medicine,” purportedly improving women’s health and wellbeing. This intervention was mainly a treatment for middle- and upper-class women.7 “If her sick condition derived from postindustrial worklessness, it also depended on it for cure,” G.J. Barker-Benfield writes. “The greatest amount of sexual surgery was performed on the nonworking female dependents of men economically ‘well situated in life.’”8 Sexual surgery of this kind resembled Chinese footbinding inflicted more severely on the woman of relative wealth, presumed not to need movement of her own, not even labor.
Lacking money, lower-class women were less likely to be subjected to Battey’s operation, spared this one torture, though vulnerable to other forms of nineteenth-century medical violence. Enslaved Black women and largely poor female Irish immigrants, for instance, became subjects for J. Marion Sims, seen as the “father of gynecology,” recognized as having founded modern surgical gynecology. For Battey’s operation, however, the ideal patient was the most wholly dependent woman whose suffering could most profit the enterprising surgeon. Barker-Benfield’s The Horrors of the Half-Known Life, in 1976, elaborated on this class status, adding, “In some respects, the workless woman was tailor-made for the therapy dealing with the disorder caused by her tailor-making for therapy.”9 One is not born, but rather tailor-made, for therapy.
On average, women undergoing Battey’s operation were thirty years old, with some of the documented cases being as young as their early twenties seeking the surgery.10 Though once relatively widespread, we do not find young women diagnosed with such diseases as “oöphoromania” today and, for “treatment,” subjected to “oöphorectomy”—or “normal ovariotomy.” Drawing on Longo’s account, Thomas Szasz notes that the rising popularity of Battey’s operation was due to it being a purported cure for “mythological (nonexistent) diseases”—like “pelvic neurosis,” “oophoromania,” and “ovarian epilepsy.”11 Looking at the documented cases, there was distress, as the female patients expressed it, but removing the ovaries was not a cure-all. Although Battey framed the operation in terms of it being a “last resort,” Longo notes that “many of the procedure’s advocates, if not Battey himself, tended to regard it as a panacea.”12 While providing useful context, Longo sidesteps further discussion of the harmfulness of this practice and its political implications for the social control of women by the male-dominated profession of gynecology.
Still, Longo’s account underscores how medicine can become captivates by cures later found to be harmful to patients, even those who believe themselves cured. Ultimately, he observes, “Battey’s operation serves as an example of changing fashions in the practice of clinical medicine”—and, he adds, “illustrates the Achilles’ heel of medicine: its too frequent and ready espousal of untested procedures or unproved theories.”13 Longo notes the operation not only worked in further developing “abdominal surgery in general, and pelvic surgery in particular,” but also furthering knowledge of “the concept of the relation of ovarian function to menstruation.”14 However, these advancements in scientific knowledge for medicine need to be read in the context of medical violence done to thousands of women in the process. Battey writing that no body part should be dignified and valued beyond necessary sacrifice becomes complicated by that sacrifice having been unnecessary.15 Rather than working “for the welfare of the whole,” as Battey idealized the intervention “to preserve life,” sexual surgery under such conditions opposes the principle of “First, do no harm.”
“She Recovered Perfectly”—Until She Died by Suicide
Reading the historical documents on Battey’s operation, we find a relative enthusiasm for the intervention and its purported success with patients convert into skepticism and, soon after, transition into condemnation and regret. A point that should be underscored is that the diagnostic criteria and indication for treatment were so ill-defined that application itself remained questionable from one case to the next. In 1884, a piece titled “Marriage as a Substitute for Battey’s Operation” appeared in The Physicians’ and Surgeons’ Investigator, illustrating nonsensical indications for treatment.16
At a meeting for the Obstetrical Society in New York, Dr. Paul F. Munde began with a report on the case of a widow, aged thirty-seven. For almost a year, he reported, the woman “had suffered intensely from neuralgic pains in the pelvic region, extending down the right thigh, and from hysterical symptoms.” “Neuralgic pains” would broadly encompass nerve pain, physical in nature, here relatively specified to a region but still general. Even broader, “hysterical symptoms” would be interpreted by degrees of mental distress, which, presumed specific in terms of diagnosis, tells little of the patient’s actual conditions. It should not be understated how broadly such terms could be applied in clinical medical practice.
Watching and waiting, relatively more so than certain other doctors, Munde kept the woman under observation for two months, hoping that increased amounts of opium would relieve her pain. “There was no history of pelvic cellulitis,” he reported, “and the only pathological condition discovered was what was supposed to be inflammatory thickening of the broad ligaments.”17 Again, we have somewhat of a broad indication for treatment with Battey’s operation, especially considering it would involve the removal of the woman’s otherwise healthy ovaries. Six years prior, a Dresden surgeon had amputated her cervix over the supposed “enlargement of the womb,” which purportedly led to two years of relief from similar conditions described above.18 Quite likely, however, the amputation of the woman’s cervix worsened her conditions over time, with her only believing this previous surgery functioned successfully when it worked against her. The report continues:
Battey’s operation with removal of the tubes seemed to offer the only prospect of relief, but the exact condition being obscure, he was loth to resort to so grave an operation, but finally yielded to the patient’s wishes and removed both ovaries with their tubes. She recovered perfectly from the operation, the pain before complained of ceased, all narcotics were discontinued, and a happy result seemed to have been attained. Soon after, however, the former neuralgic and hysterical symptoms returned, worse, if anything, than before, and about three months after the operation the woman suicided.19
Unnecessary sexual surgery appeared as if a “last resort,” here in response to prior sexual surgery, also seemingly unnecessary. Both operations worked to the detriment of the female patient’s health and wellbeing, worsening her physical and mental conditions and contributing to her death by suicide. Reports of “positive” outcomes, as reported in the journals, usually far outnumbered the negative, including the incidence of suicides, left relatively undocumented. That The Physicians’ and Surgeons’ Investigator reported a suicide connected to Battey’s operation was an exceptional occurrence. Having surveyed much available historical documentation, though missing the article referenced here, Longo notes that “undoubtedly many cases went unreported.”20 “Positive” results seemed assumed, even if there was little to no proof. Patient suicide following Battey’s operation does not appear discussed by Barker-Benfield, Longo, and Szasz in their analyses.
First Comes Misdiagnosis, Then Comes Marriage
Another case involved a widow, her age unmentioned but presumably around the same age as the prior case dead by suicide after undergoing the procedure. This one expressed having experienced “two or three attacks of pelvic cellulitis,” especially painful menstruation, and “pelvic organs [that] were extremely sensitive.”21 At a glance, the symptoms, as listed, appear relatively more severe than the previous case, though this woman retained her cervix. The reader would presume the patient to undergo Battey’s operation for similar reasons, like the first; however, it did not happen. Instead, according to the report:
To make a long story short he diagnosed the case as one of pyo-or hydro-salpingitis, and as a last resort advised an operation. She said if her sufferings continued, she would not hesitate, for with them life was a burden. Soon after she went to Europe, and on the steamer met a gentleman whom she married soon after her return. From that time all pain disappeared, and so far as she knew, or the doctor could ascertain, she was as well as any woman, and there was now absolutely nothing to indicate disease of the pelvic organs. Undoubtedly the case was one—not at all uncommon among widows—of reflex irritation consequent upon ungratified sexual appetite.22
A type of pelvic inflammatory disease (PID), salpingitis is inflammation of the fallopian tubes, usually caused by a bacterial infection or a sexually transmitted disease (STD) like chlamydia or gonorrhea.23 For the time, medical professionals considered the removal of the ovaries a possible cure for PID. However, contemporary medicine extremely contrasts the surgical intervention that nineteenth-century gynecologists saw as necessary. According to the Oxford Textbook of Obstetrics and Gynaecology, published in 2020, “Based on an understanding of the polymicrobial aetiology, PID should be treated with antibiotics covering a broad spectrum of pathogens.”24 Such medicine would treat an infection, such as chlamydia and gonorrhea, aiming to cover the further possibility of an upper genital tract infection.
Setting aside the fact that Battey’s operation would be especially unnecessary in a case of PID, the woman met a man on the voyage to Europe, they married after coming back to America, and, somehow, marriage cured her painful conditions. Apparently, even more interestingly, nothing indicated the diseased conditions previously diagnosed and documented above. The Physicians’ and Surgeons’ Investigator reported that the woman’s pain was “reflex irritation” due to “ungratified sexual appetite,” presumably gratified by marriage and, upon satisfaction, requiring no surgical intervention. A far likelier explanation, however, would be that, despite no antibiotics, the prior inflammation subsided, as she healed on her own—or the diagnosis of salpingitis was a misdiagnosis. The report concluded, “Dr. Munde thought the fact that one case recovered after marriage was proof that the indication for the operation did not exist.”25 With at least one woman subjected to “life-saving medicine” dead by suicide and the other healed on her own, the doctor took note.
Further analyses will discuss (1) the business of Battey’s operation, (2) patients convinced to consent, and (3) how the operation spread by confirmation of friends, relatives, and doctors.
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Robert Battey, “Extirpation of the Functionally Active Ovaries for the Remedy of Otherwise Incurable Diseases” (1876), in Transactions of the American Gynecological Society, vol. 1 (Cambridge: Riverside Press, 1877), 112-113.
Ms. S., quoted in Joseph Taber Johnson, “Four Cases of Oöphorectomy [sic], with Remarks” (1885), in Transactions of the American Gynecological Society, vol. 10 (New York: D. Appleton and Company, 1886), 123.
“Removal of the Ovaries as a Therapeutic Measure in Public Institutions for the Insane,” JAMA 20, no. 5 (February 4, 1893): 135.
Lawrence D. Longo, “The Rise and Fall of Battey’s Operation: A Fashion in Surgery,” Bulletin of the History of Medicine 53, no. 2 (Summer 1979): 244-267.
Robert Battey, “Normal Ovariotomy—Case,” Atlanta Medical and Surgical Journal 10, no. 6 (September 1872): 321. See also Longo, 249.
On sexual surgery, see G.J. Barker-Benfield, “Sexual Surgery in Late-Nineteenth-Century America,” International Journal of Health Services 5, no. 2 (1975): 279-298. See also Barker-Benfield, “Sexual Surgery,” chap. 11, in The Horrors of the Half-Known Life: Male Attitudes Toward Women and Sexuality in Nineteenth-Century America (New York: Routledge, 1976/2000), 113-124.
Longo, 256.
Barker-Benfield, “Sexual Surgery in Late-Nineteenth-Century America,” 289.
Barker-Benfield, The Horrors of the Half-Known Life, 120.
Longo, 244.
Thomas Szasz, Sex by Prescription: The Startling Truth About Today’s Sex Therapy (Syracuse, NY: Syracuse University Press, 1980/1990), 78.
Longo, 249.
Longo, 266.
Longo, 266.
Battey, “Extirpation of the Functionally Active Ovaries for the Remedy of Otherwise Incurable Diseases,” 112-113.
“Marriage as a Substitute for Battey’s Operation,” The Physicians’ and Surgeons’ Investigator 5, no. 2 (February 15, 1884): 44-46.
“Marriage,” 44.
“Marriage,” 44-45.
“Marriage,” 45.
Longo, 257.
“Marriage,” 45.
“Marriage,” 45.
Sabaratnam Arulkumaran, William Ledger, Lynette Denny, and Stergios Doumouchtsis, Oxford Textbook of Obstetrics and Gynaecology (Oxford: Oxford University Press, 2020), 537-540.
Arulkumaran et al., 543.
“Marriage,” 46.