Battey's Operation

Back in the 19th century,  few medical questions were more vexing than what to do with female patients suffering from "hysteria". 

First identified in ancient times, the term hysteria stemmed from the Greek word hystera meaning "uterus" and was believed to be linked to problems involving the female reproductive system.  Symptoms of hysteria included nervousness, melancholia (depression), neurasthenia, irritability, loss of appetite or libido, and "unfeminine" behaviour such as rebellion and promiscuity.  Given that women were considered mentally inferior to men and suffering from the "curse" of menstruation, women subjected to "serious" subjects such as music and literature were felt to be especially prone to hysteria and unfit for their essential duties of reproduction and child-rearing.  By the dawn of the Victorian era, physicians had implicated an enormous range of symptoms in hysteria cases (which was considered unique to females) and some mental health experts estimated that as many as twenty-five percent of all women suffered from some form of the disease. 

Diagnosis and treatment of hysteria proved to be a financial gold mine for physicians dealing with nervous complaints.  Treatments could include "vaginal massage", (i.e., masturbation), hydrotherapy, electrical stimulation, and use of mechanical massage devices (vibrators).  Although the sexual nature of many of the treatments used seems obvious today, physicians of the time objected to any suggestion that hysteria might be linked to sexual dissatisfaction.  There was also the question of what could be done for more extreme cases, including women in lunatic asylums.  Since many of these female patients engaged in "unacceptable" practices such as masturbation and nymphomania (which was often used to justify committing them in the first place), physicians searched for a viable solution.

Which brings us to Dr. Robert Battey...

Born in Augusta, Georgia in 1828, he trained in medicine and served as a military surgeon during the U.S. Civil War.  After the war, he worked in various hospitals around Rome, Georgia and, in the course of his Images[1] medical practice, dealt with numerous female patients suffering from hysteria. On August 17, 1872, he performed what would later be referred to as Battey's operation, a.k.a.radical oophorectomy (removal of a woman's ovaries).  His patient was a long-term invalid suffering from convulsions, headaches, and other nervous symptoms apparently linked to menstruation.  Despite post-surgical complications, the woman experienced a complete remission of all nervous symptoms (in conjunction with menopause brought on by the procedure).  The rationale for the operation was straightforward enough: since hysteria and other emotional problems were associated with the menstrual cycle, wouldn't removal of a woman's ovaries cause the symptoms to be alleviated?  While oophorectomies were already being used for treating ovarian cysts, the prospect of radical surgery to deal with non-gynecological maladies seemed to usher in a new age of treatment.

Although Battey was actually not the first surgeon to carry out "Battey's operation", his outspoken advocacy of the surgical procedure ensured that it would be forever associated with his name ("Battey-izing a woman" became  recognized medical slang for the procedure).  Battey and his colleagues stressed that the emotional problems associated with menstruation stemmed from "abnormalities" in the ovaries (even relatively minor ovarian cysts could qualify) and the rush to apply this exciting new development in gynecology began.  As for the troubling question of whether women patients should be sterilized this way, Battey himself justified the operation by arguing that women who required it were probably sterile anyway.  His followers went even further by suggesting that women "disordered enough" to require the operation would probably have given birth to defective children.  Thus Battey's operation was not only medically justified, but made good eugenic sense as well.

Throughout the 1870s and 1880s, surgeons performed Battey's operation on healthy young women across much of North America and Europe.  While many of these operations were justified on solid medical grounds, a large percentage of cases dealt with women suffering from emotional problems.  As word spread concerning the potential benefits of Battey-izing, even patients came forward asking for the surgery to be done on them despite the obvious risks involved (as many as one in three women died during surgery or as a result of post-surgical complications),   European gynecologists endorsed the Battey operation (which they termed Hegar's operation due to another surgeon who had pioneered the technique) but the most enthusiastic supporters were their American colleagues.  Although the actual number of these operations will likely never be accurately known (some sources placed is as high as 105,000 operations), the popularity of the procedure in dealing with nervous and mental disorders can't be underestimated.  According to historian Edward Shorter, 51 per cent of all medical articles relating to ovarian surgery described in the 1889 edition of  the Index-Catalogue of the Surgeon-General`s Office, United States Army dealt with psychiatric disorders in women.  By 1907, this had deceased only slightly to 42 per cent.

While some European gynecologists began questioning the actual value of Battey-izing as early as 1884, the Battey-Hegar operation continued to be carried out until well into the 20th century.  Many lunatic asylums had staff gynecologists who performed the procedure on female patients, often without their consent.   By the early 1890s, most "psycho-gynecologists" viewed Battey's operation as a necessary treatment and vigorously opposed any attempt at reining in the practice.  It wasn't only ovaries that were removed either. Although not as common as Battey's operation, clitoridectomies (surgical removal of the clitoris) were also practiced on female patients (usually in asylums).   Even in the early 20th century, clitoridectomies were used in cases of compulsive masturbation although surgeons eventually became leery of the operation as more appropriate treatments became available. 

It's hard to think of a single watershed moment when Battey's operation was decisively proven to be unnecessary and dangerous for psychiatric patients.  As time passed, the surgery simply fell out of favour.  While premenstrual syndrome (PMS) is now a recognized medical condition, treatment usually focuses on pharmacological treatments and supportive counseling.  Although Battey's operation continues to be performed (rarely) in cases of ovarian cancer or related pathology, its use in dealing with "troublesome" patients seems long over. 

Still, the long reign of Battey's operation should be an uncomfortable reminder of the dangers of medical fads and "innovative" treatments that likely seemed like a good idea at the time.

           

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