The Uterus vs. the Brain
The reign of the uterus (and ovaries) was never entirely as tranquil and secure as the doctors might have wished. There was the constant threat of subversion by sexual feelings, arising from God knows what disorders of the brain or genitals. Doctors warned that vice in any form could derange the entire woman, flesh and spirit. Nothing alarmed them more than masturbation—known at the time as self-abuse or simply “the vice”—which could lead to menstrual dysfunction, uterine disease, lesions on the genitals, tuberculosis, dementia, and general decay.
With the fervor of public health officials battling plague germs, the doctors pursued “the vice” into its dark and solitary hideouts. Parents were urged to watch their children for the first symptoms (pallor, languor, peevishness) and if necessary to strap their hands to their sides at night. Patients of both sexes were urged to “confess.” In women even amorous thoughts inspired by reading, parties, flirtations, or “hot drinks” could upset the entire physiology. Doctors acknowledged a stern duty to oppose the reading of romantic novels “as one of the greatest causes of uterine disease in young women.”62
As the century wore on, the hegemony of the uterus appeared to grow ever shakier. More and more women were rejecting the doctors’ passive, sickly model of femininity and carving out activist roles for themselves. The suffrage movement had grown to nationwide proportions and was waging highly organized campaigns state by state. More and more middle-class women were seeking college educations either in the burgeoning women’s colleges, like Smith (opened in 1875), Wellesley (1875), Bryn Mawr (1885), and Mills (1885), or in all-male institutions like Cornell, Williams, and Harvard.63 To the doctors it seemed as if a new organ had entered the scene to contest for power—the female brain. Nineteenth-century gynecology became absorbed in the combat between the brain and the uterus for dominion over the female persona. It was as if the Woman Question were being fought out on the dissecting table: on the one hand, the brain—aggressive, calculating; on the other hand, the uterus—moistly receptive, nurturing, still governed by the ancient tempo of the moon and tides.
The possibility of peaceful coexistence between the two organs was ruled out by the basic laws of physiology. Medical men saw the body as a miniature economic system, with the various parts—like classes or interest groups—competing for a limited supply of resources. Each body contained a set quantity of energy which could be directed variously from one function to another. Thus there was inevitably a tension between the different functions, or organs—one could be developed only at the expense of the others. Strangely enough, doctors saw no reason to worry about conflicts between the lungs and the spleen, or the liver and the kidneys, or other possible pairs of combatants. The central drama, in bodies male or female, was that great duel between the brain and the reproductive organs.
Needless to say, the desirable outcome of this struggle was quite different for the two sexes. Men were urged to back the brain, and to fight the debilitating effects of sexual indulgence. Since the mission of the male (the middle-class male, anyway) was to be a businessman, professor, lawyer, or gynecologist—he had to be careful to conserve all his energy for the “higher functions.” Doctors warned men not to “spend their seed” (the material essence of their energy) recklessly in marital relations, and of course not to let it dribble away in secret vice or prurient dreams. Historian Barker-Benfield suggests that the doctors’ fanatical dread of female sexuality reflected the constant, uphill struggle to preserve the male fluids for male endeavors. The “oversexed” woman was seen as a sperm-draining vampire who would leave men weak, spent, and effeminate.
In reverse but almost parallel terms, women were urged to throw their weight behind the uterus and resist the temptations of the brain. Because reproduction was woman’s grand purpose in life, doctors agreed that women had to concentrate all their energy downward toward the womb. All other activity should be slowed down or stopped during the peak periods of uterine energy demand. At puberty, girls were advised to take a great deal of bed rest in order to help focus their strength on regulating their periods—though this might take years. Too much reading or intellectual stimulation in the fragile stage of adolescence could result in permanent damage to the reproductive organs, and sickly, irritable babies.
Pregnancy was another period requiring intense mental vacuity. One theory had the brain and the pregnant uterus competing not only for energy, but for a material substance—phosphates.64 Every mental effort of the mother-to-be could deprive the unborn child of some of this vital nutrient, or would so overtax the woman’s own system that she would be driven to insanity and require “prolonged administration of phosphates.” Menopause brought no relief from the imperious demands of the uterus. Doctors described it as a “Pandora’s box of ills,” requiring, once again, a period of bovine placidity.
But it was not enough to urge women in the privacy of the office or sickroom to side with the beleaguered uterus. The brain was a powerful opponent, as the advance of the women’s movement and the growing number of educated women showed. It must have seemed to the doctors that only they had the wisdom and courage to champion the poor uterus, who was, by her nature, not so nimble and clever as her opponent. So the doctors were led, beginning in the eighteen seventies, into the ongoing public debate over female education.
Dr. Edward H. Clarke’s book Sex in Education, or a Fair Chance for the Girls was the great uterine manifesto of the nineteenth century.65 It appeared at the height of the pressure for co-education at Harvard, where Clarke was a professor, and went through seventeen editions in the space of a few years. Clarke reviewed the medical theories of female nature—the innate frailty of women, the brain-uterus competition—and concluded, with startling but unassailable logic, that higher education would cause women’s uteruses to atrophy!
Armed with Clarke’s arguments, doctors agitated vociferously against the dangers of female education. R. R. Coleman, M.D., of Birmingham, Alabama, thundered this warning:
Women beware. You are on the brink of destruction: You have hitherto been engaged in crushing your waists; now you are attempting to cultivate your mind: You have been merely dancing all night in the foul air of the ball-room; now you are beginning to spend your mornings in study. You have been incessantly stimulating your emotions with concerts and operas, with French plays, and French novels; now you are exerting your understanding to learn Greek, and solve propositions in Euclid. Beware!! Science pronounces that the woman who studies is lost.66
Dozens of medical researchers rushed in to plant the banner of science on the territory opened up by Clarke’s book. Female students, their studies showed, were pale, in delicate health, and prey to monstrous deviations from menstrual regularity. (Menstrual irregularity upset the doctor’s sensibilities as much as female sexuality. Both were evidences of spontaneous, ungovernable forces at work in the female flesh.) A 1902 study showed that 42 percent of the women admitted to insane asylums were well educated compared to only 16 percent of the men—“proving,” obviously, that higher education was driving women crazy.67 But the consummate evidence was the college woman’s dismal contribution to the birth rate. An 1895 study found that 28 percent of female college graduates married, compared to 80 percent of women in general.68 The birth rate was falling among white middle-class people in general, and most precipitously among the college educated. G. Stanley Hall, whose chapter on “Adolescent Girls and their Education” reviewed thirty years of medical arguments against female education, concluded with uncharacteristic sarcasm that the colleges were doing fine if their aim was to train “those who do not marry or if they are to educate for celibacy.” “These institutions may perhaps come to be training stations of a new-old type, the agamic or agenic [i.e., sterile] woman, be she aunt, maid—old or young—nun, schoolteacher, or bachelor woman.”69
The doctors and psychologists (for we should acknowledge Hall’s influential contribution to the debate) conceded that it was possible for a woma
n, if she were sufficiently determined, to dodge the destiny prepared for her by untold eons of evolutionary struggle, and throw in her lot with the brain. But the resulting “mental woman,” if we may so term this counterpart to the natural, “uterine woman,” could only hope to be a freak, morally and medically. “She has taken up and utilized in her own life all that was meant for her descendants,” Hall complained. “This is the very apotheosis of selfishness from the standpoint of every biological ethics.” Physically, the results were predictable: “First, she loses her mammary function.” Hall wrote,70 since lactation seemed to represent woman’s natural unselfishness.
Some medical writings suggested that the loss of the mammary function would be accompanied by an actual loss of the breasts. “In her evening gown she shows evidence of joints which had been adroitly hidden beneath tissues of soft flesh,” wrote Arabella Kenealy, M.D., of the “mental woman,” “and already her modesty has been put to the necessity of puffing and pleating, where Nature had planned the tenderest and most dainty of devices,” i.e., the breast. Doctors agreed that the brain-dominated woman would be muscular, angular, abrupt in her motions. Dr. Kenealy, who directed many of her writings as polemics against Olive Schreiner, described the new woman thus:
Where before her beauty was suggestive and elusive, now it is defined.… The haze, the elusiveness, the subtle suggestion of the face are gone.… The mechanism of movement is no longer veiled by a certain mystery of motion.… Her voice is louder, her tones are assertive. She says everything—leaves nothing to the imagination.71
Uterine woman had been indistinct, mysterious, like a veil over the harsh face of industrial society. The real horror of the brain-dominated woman was that she left man with no illusions.
Even the woman who opted for the sexless, mental life could not expect the brain to have an easy victory. The struggle between the brain, with its die-hard intellectual pretensions, and the primitive, but tenacious uterus could tear a woman apart—perhaps des-troying both organs in the process. So in the end all that awaited the brain-oriented woman was in most cases sickness, which of course is precisely what awaited her if she remained a “good,” uterine woman. S. Weir Mitchell smugly expressed to a graduating class at Radcliffe his hope “that no wreck from these shores will be drifted into my dockyard”—but, really, what hope was there?72
The medical warnings against higher education did not go unheeded. Martha Carey Thomas, president of Bryn Mawr College, confessed that as a young woman she had been “terror-struck” after reading the chapters relating to women in Hall’s Adolescence, lest she “and every other woman … were doomed to live as pathological invalids …” as a result of their education.73 Martha Carey Thomas survived her education and pursued a full and demanding career (no doubt serving to the doctors as a repulsive example of muscular, brain-dominated woman), but there were also casualties. Margaret Cleaves, M.D. of Des Moines ended by confessing the futility of her own attempts at a career. In her own description she had been a “mannish Maiden” from the start and had let her masculine ambition draw her into a medical education. But no sooner had she achieved her goal than she developed a galloping case of neurasthenia, or “sprained brain” as she diagnosed it. “It may be true,” she admitted in her book The Autobiography of a Neurasthene:
As emphasized by [S. Weir] Mitchell and others, that girls and women are unfit to bear the continued labor of mind because of the disqualifications existing in their physiological life.74
Similarly, Antoinette Brown, America’s first female minister, dropped out of the ministry after being converted to the “scientific” theory of woman’s nature.75
As the century wore on, fewer and fewer women were willing to take the doctor’s advice seriously, though. Feminists vigorously attacked the idea that women did not have the stamina for higher education, and even satirized the medical injunctions, as in this poem, “The Maiden’s Vow”:
I will avoid equations
And shun the naughty surd
I must beware the perfect square
Through it young girls have erred
And when men mention Rule of Three
Pretend I have not heard.76
The Rest Cure
The notion of the female body as the battleground of the uterus and the brain led to two possible therapeutic approaches: one was to intervene in the reproductive area—removing “diseased” organs or strengthening the uterus with bracing doses of silver nitrate, injections, cauterizations, bleedings, etc. The other approach was to go straight for the brain and attempt to force its surrender directly. The doctors could hardly use the same kind of surgical techniques on the brain as they had on the ovaries and uterus, but they discovered more subtle methods. The most important of these was the rest cure—the world-famous invention of Dr. S. Weir Mitchell.
The rest cure depended on the now-familiar techniques of twentieth-century brainwashing—total isolation and sensory deprivation. For approximately six weeks the patient was to lie on her back in a dimly lit room. She was not permitted to read. If her case was particularly severe, she was not even permitted to rise to urinate. She was to have no visitors and to see no one but a nurse and the doctor. Meanwhile, while the unwary brain presumably drifted off into a twilight state, the body would be fortified with feedings and massages. The feedings consisted of soft, bland foods and were supposed to result in a daily weight gain. The massages lasted for one hour a day, covering the entire body, and increasing in vigor as the cure wore on.
The cure became immensely popular—largely because, unlike other gynecological treatments, this one was painless. As a result of the rest cure, Philadelphia (where Mitchell practiced) was soon “the mecca for patients from all over the world.”77 Jane Addams underwent the rest cure, but it was apparently unsuccessful since it had to be followed with six more months of rest during which Addams was “literally bound to a bed” in her sister’s house.78 Charlotte Perkins Gilman underwent the cure before being discharged to “live as domestic a life as possible”—the results of which we have already recounted. But the majority of the patients seem to have come out of the cure filled, if not with health, with a sycophantic worship of Dr. Mitchell. Ex-patients and would-be patients plied him with small gifts and admiring letters, such as this one, which contrasts the writer’s continued invalidism with the virile strength of the physician:
Whilst laid by the heels in a country-house with an attack of grippe, also an invalid from gastric affection, the weary eyes of a sick woman fall upon your face in the Century [magazine] of this month—a thrill passed through me—at last I saw the true physician!79
The secret of the rest cure lay not in the soft foods, the massages, or even, ultimately, in the intellectual deprivation, but in the doctor himself. S. Weir Mitchell must be counted as one of the great pioneers, perhaps the greatest, in the development of the twentieth-century doctor–patient relationship, or more generally, the expert-woman relationship. His personal friend and colleague Sir William Osler came to represent for posterity the masculinist ideal of the healer. But it was Mitchell, blessed with an endless supply of female invalids and neurasthenics, who perfected the technique of healing by command.
Mitchell was, by his own description, a “despot” in the sickroom. Patients were to ask no questions (or, like poor Gilman, attempt to volunteer information). His manner would be gentle and sympathetic one moment, abrupt and commanding the next. Now magnify Dr. Mitchell’s authoritarianism by the conditions of the rest cure: the patient has been lying in semidarkness all day. She has not seen any other man, and no person but for the nurse, for weeks. She is weak and languid from lying still for so long. Perhaps the long massage has left her with inadmissible sensations which she hesitates to localize even in imagination. Enter Dr. Mitchell. His lack of physical stature makes no difference to a prostrate woman. He is confident, commanding, scientific. He chides the patient for her lack of progress, or predicts exactly how she will feel tomorrow, in one week, in a month.
The patient can only feel a deep gratitude for this particle of attention, this strange substitute for human companionship. She resolves that she will get better, as he has said she must, which means she will try to be a better woman, more completely centered on her reproductive functions.
It is as if Dr. Mitchell recognized that in the battle between the uterus and the brain, a third organ would have to be called into play—the phallus. The “local treatments” of earlier decades had already recognized the need for direct male penetration to set errant females straight. Nineteenth-century doctors universally expected sick (or cantankerous) women to spread their legs and admit leeches, “decoctions,” the scalpel—whatever the physician chose to insert. But these were mere adolescent pokings compared to the mature phallic healing introduced by S. Weir Mitchell. He deplored “local treatments,” foreswearing physical penetration altogether (unless you count the constant oral ingestion of soft foods). The physician, according to Mitchell, could heal by the force of his masculinity alone. This was, of course, the ultimate argument against female doctors: they could not “obtain the needed control over those of their own sex.”80 Only a male could command the total submissiveness which constituted the “cure.”
For Her Own Good: Two Centuries of the Experts Advice to Women Page 16
