The Technology of Orgasm: "Hysteria," the Vibrator, and Women's Sexual Satisfaction (9 page)

One of the few medical writers in whose works the voice of a woman is heard on this subject, at least at second hand, is Franz Josef Gall (1758–1828), whom Havelock Ellis described as “a genius in isolation.” A patient of his, a young widow, had been experiencing hysterical fits. Gall says that “the crisis never fails to terminate with a discharge that occurs with thrills of pleasure, and in a veritable ecstasy, after which she is free from attacks for a while.”
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At the same period, Philippe Pinel asserted that hysteria and nymphomania were caused by sexual frustration or masturbation, and that physicians should direct their efforts to bringing on the “évacuation sexuelle,” as described by Gall.

It is at this point in our chronology, the beginning of the nineteenth century, that the nosological and etiological framework of hysteria becomes both confused and confusing. I warned earlier that the causal logic of my sources, if we may so dignify their reasoning, would become difficult to understand. The paradigm of hysteria as a disease, to use the terminology of Thomas Kuhn, had reached the point where it did not readily explain either the empirical data or the variations in them. The paradigm fragmented into three related disorders, of which one, chlorosis or “greensickness,” had been known well before the nineteenth century, mainly to practitioners of what we now call “folk medicine.”
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The symptoms and etiologies of these three disorders overlapped substantially and were thought to be closely related. Ellis remarked in the early twentieth century that “as Luzet has said, hysteria and chlorosis are sisters.” Physicians could not agree, however, whether sexual deprivation or overindulgence caused any of the disorders, and whether masturbation was a cause or a symptom of any of them. The debate was considerably muddled by the vague and poorly defined characters of all three ailments, a situation graphically illustrated in an anecdote from Jan Goldstein, who quotes “the psychiatrist Charles Lasègue, who pronounced hysteria ‘the wastepaper basket of medicine where one throws otherwise unemployed
symptoms.’”
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I shall have more to say of this when I turn to the influence of Charcot and the Salpêtrière. Some physicians questioned the propriety of vulvular massage; Thomas Stretch Dowse in 1903 quoted the nineteenth-century author Douglas Graham, who said that “massage of the pelvic organs should be intrusted to those alone who have ‘clean hands and a pure heart.’”
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Chlorosis or greensickness had a venerable tradition by this time as a disorder of young women, variously interpreted by modern historians as anemia, anorexia nervosa, or some combination of the two.
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Folk traditions and some medical thought from the sixteenth century through the nineteenth attributed chlorosis to sexual deprivation in virgins—as Thomas Laycock put it in 1840, “excited love, [and] ungratified desire.”
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Mary Gove Nichols, of water cure fame, thought chlorosis was an effect of “solitary vice.”
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Its symptoms were protean, including everything from lassitude and nausea to sexual fantasy. Whatever the origins of the disease, its treatment was almost identical to treatments for hysteria, except that hydropathic physicians usually added iron to the patient’s diet in the form of “chalybeate waters.”

Neurasthenia was an invention of the second half of the nineteenth century, and those who believed in its existence considered it a new disease caused by the stresses of modern life. The diagnosis was popularized by George Beard, who published an influential work on neurasthenia in 1884.
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As with hysteria and chlorosis, the interpretation of its supposed symptoms in women included many elements consistent with the normal functioning of female sexuality under social conditions that interpreted it as pathological. The plethora of possible etiologies was matched only by the bewildering array of symptoms. Haller says that “weeping, irritability, depression, mental and physical weariness, morbid fears, forgetfulness, palpitations of the heart, headaches, writing cramps, mental confusion, fear of impending insanity, and constant worry were the most noted symptoms.” But almost anything could be a symptom of neurasthenia, including yawning, itching, stomach upsets, ticklishness, insomnia, and muscle spasms.
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Daniel Brinton even went so far as to suggest that childbearing could cause neurasthenia, apparently making the Balboan discovery that caring for small children can cause sleeplessness and “mental and physical weariness.”
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By the end of the nineteenth century neurasthenia was frequently classed with hysteria and chlorosis under the
generic term “hysteroneurasthenic disorders.” Although marriage was rarely recommended as a treatment for neurasthenia, many of the other treatments were the same as those for hysteria and chlorosis, including massage. Neurasthenia was sometimes defined as “a slight hysterical tendency.”
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Men could also be neurasthenic; overwork, masturbation, and sexual excess were thought to be predetermining factors in males.
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Ernest Jones asserted in 1918 that in neurasthenic women, “persistence of clitoris masturbation is one of the most important agents leading to (sexual) anaesthesia because it means fixation on the infantile, male form of sexuality.”
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Throughout the nineteenth century, medical professionals struggled to bring scientific reasoning to the study of the hysteroneurasthenic disorders, with somewhat mixed success. R. J. Culverwell, for example, asserted in his 1844
Porneiopathology
that although “continence in females” is thought “to be the brightest ornament a woman possesses,” its effects are pathological, as “is truly attested by the miseries of hysteria, and other nervous derangements, that pervade the junior and elderly maiden branches of every family, and constitute so formidable an enemy to domestic felicity.”
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Robert Brudenell Carter, in
On the Pathology and Treatment of Hysteria
(1853), asserted that any repressed emotion could lead to hysteria, but the one most likely to cause trouble was sexual passion. Charles Delucena Meigs asked in the third (1854) edition of his widely read
Woman: Her Diseases and Remedies
, “What is her erotic state? what the Protean manifestations of that Life-force developed by a reproductive irritation which you call Hysteria?”
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Something of a liberal on the question of hysteria in the mid-nineteenth century, Meigs believed that men could be hysterical as well, and that their attacks were accompanied by erections.
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James Manby Gully, a hydropathic physician whose love life later achieved a somewhat unwelcome notoriety, wrote in his heyday of the efficacy of hydriatic massage in hysteria and “nervous headache,” which he considered curable by the douche therapy illustrated in
chapter 1
: “The douche is a very necessary part of the treatment; and, played well on the loins, tends powerfully to facilitate the uterine functions.” Few women who have experienced water under pressure “played well on the loins” would be inclined to argue with him.
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In 1909 Curran Pope wrote that “imperfect or unsatisfactory intercourse” could cause not only
hysteria but amenorrhea (failure of the menses) and dysmenorrhea (painful menstruation). For these ailments, he recommended douche therapy to the “inner surface of the thighs.” He stresses the point with his fellow physicians that they will have little difficulty persuading women to accept hydriatic massage, noting that “Douches are, as a rule, more agreeable to the majority of individuals than the other forms of hydriatic procedure … It sets the tissues in a vibration impossible to describe; experienced, it is never forgotten.”
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The French physician Pierre Briquet (1796–1881) did not mince words about the sexual etiology of hysteria: he was quite certain it was caused by sexual frustration, including “les mauvais traitements” by husbands. Briquet claimed to have treated 430 hysterics by 1859, only the middle of his long career, and he asserted that a quarter of all women suffered from this disorder. He cites Galen and Forestus on the utility of “la titillation du clitoris” for producing the desired “évacuation” and describes the medical controversy surrounding this type of treatment. He goes on to remark that hysterics typically do not reach orgasm during intercourse and that “nymphomanie” or chronic arousal may be one of the sequelae.
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Somewhat paradoxically, he claims that prostitutes, who do not, as he points out, reach sexual climax in intercourse with customers, become hysterical from masturbation, and that many consider early marriage a prophylaxis for hysteria.
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Briquet is one of the few physicians who, like Highmore, seem to understand what is going on in both the diagnosis and the treatment of hysteria, and he is unabashed about his own therapeutic role. For this he was criticized by at least one of his colleagues, as we shall see.

Wilhelm Griesinger (1817–68), a well-known American physician of the second half of the nineteenth century, noted that “nymphomaniacal excitement” was a symptom of hysteria. He observed that many cases of hysteria were relieved by “local treatment” such as massage when all other therapeutic strategies failed. A true penetrationist of the old school, he thinks that hysteria cannot be caused by sexual frustration because of “its great frequency amongst married women—the frequent injurious influence of marriage, pregnancy and childbirth, and the frequency of the affection amongst prostitutes.”
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Briquet seems to have a much clearer understanding of the affliction in question; Griesinger cannot imagine that intercourse and penetration could fail to be satisfying.

Russell Thacher Trail, another American, who was associated mainly with the hydropathic school, wrote in 1873 that women, including but not of course limited to hysterics, were an economic godsend to the profession of medicine, claiming that “more than three fourths of all the practice of the profession are devoted to the treatment of diseases peculiar to women” and that of the annual estimated aggregate income of United States physicians of more than $200 million, “three-fourths of this sum—one hundred and fifty millions—our physicians must thank frail woman for.”
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If the normal functioning of female sexuality was defined as a disease, women must have seemed frail indeed. During the decade in which Trail wrote these lines, the proceeds of treating women would have equaled just under half of the entire federal budget. In the nineteenth century, the supposed pathology of women’s sexuality was extended to nearly every aspect of her physiology. Ann Wood, in a discussion of an 1855 work by Catherine Beecher, remarks on Beecher’s apparent belief that women of her time were sick “because they were women. Most of the ailments that she records—pelvic disorders, sick headaches, general nervousness—were regarded as symptoms of ‘female complaints,’ nervous disorders thought to be linked with the malfunctioning of the feminine sexual organs.”
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Albert Hayes, writing of hysteria, chlorosis, and nymphomania in 1869, was one of many medical authors of his day who regarded the female reproductive tract as a veritable swamp, rife with pathogenic miasmas. “The strength of the reproductive force” in women, he argues, “irradiates every part of the frame … when disordered by whatsoever cause, it becomes capable of carrying confusion into every department, where it may rave and rage in its caprice and fury.”
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C. Bigelow, writing in 1875, said, in a discussion of women patients dissatisfied with their marital sex lives, that “almost every physician of large practice has a circle of ‘everlasting patients,’ whom he visits and prescribes for once a week, on the average, for years.” He considered that though husbands’ overindulgence in intercourse was wearying to women, withdrawal (coitus interruptus) was the most frequent cause of hysteria, with its attendant congestion of the female genitalia. He cites the vaginal lubrication associated with hysteria as evidence for this hypothesis.
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The French physician Auguste Tripier observed in 1883
that the convulsive crisis of hysteria “est de même quelquefois de la crise vénérienne” (is sometimes the same as the orgasm).
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He had earlier identified some of these “quelquefois” as the therapeutic remedies applied by his colleague Pierre Briquet:

Some among you will remember a treatment for hysteria everybody was talking about twenty-five or thirty years ago: I am talking about vulvular massage, recognized in ancient times and put back into practice by Briquet, who was ready to give it up after a brief trial; but he says nothing about it in his book except in connection with his predecessors and as a kind of historical footnote. Leaving aside paraphrases, I would like to point out to you that for a while Briquet was treating hysteria with masturbation, practiced more or less systematically by his interns. Now Briquet was a serious professional, a man of mature judgment, and it would not be right to take lightly a verdict which cannot fail either to make him a laughingstock or to put him in a difficult and absurd position …