The Technology of Orgasm "Hysteria," the Vibrator, and Women's Sexual Satisfaction --------------------------------------------------------------------------------
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When these symptoms indicate, we think it necessary to ask a midwife to assist, so that she can massage the genitalia with one finger inside, using oil of lilies, musk root, crocus, or [something] similar. And in this way the afflicted woman can be aroused to the paroxysm. This kind of stimulation with the finger is recommended by Galen and Avicenna, among others, most especially for widows, those who live chaste lives, and female religious, as Gradus [Ferrari da Gradi] proposes; it is less often recommended for very young women, public women, or married women, for whom it is a better remedy to engage in intercourse with their spouses. As Forestus suggests here, in the Western medical tradition genital massage to orgasm by a physician or midwife was a standard treatment for hysteria, an ailment considered common and chronic in women. Descriptions of this treatment appear in the Hippocratic corpus, the works of Celsus in the first century A.D., those of Aretaeus, Soranus, and Galen in the second century, that of Äetius and Moschion in the sixth century, the anonymous eighth- or ninth-century work Liber de Muliebria, the writings of Rhazes and Avicenna in the following century, of Ferrari da Gradi in the fifteenth century, of Paracelsus and Paré in the sixteenth, of Burton, Claudini, Harvey, Highmore, Rodrigues de Castro, Zacuto, and Horst in the seventeenth, of Mandeville, Boerhaave, and Cullen in the eighteenth, and in the works of numerous nineteenth-century authors including Pinel, Gall, Tripier, and Briquet. Given the ubiquity of these descriptions in the medical literature, it is surprising that the character and purpose of these massage treatments for hysteria and related disorders have received little attention from historians. The authors listed above, and others in the history of Western medicine, describe a medical treatment for a complaint that is no longer defined as a disease but that from at the least the fourth century B.C. until the American Psychiatric Association dropped the term in 1952, was known mainly as hysteria. This purported disease and its sister ailments displayed a symptomatology consistent with the normal functioning of female sexuality, for which relief, not surprisingly, was obtained through orgasm, either through intercourse in the marriage bed or by means of massage on the physician's table. I shall place this disease paradigm in the context of androcentric definitions of sexuality, which explain both why such treatments were socially and ethically permissible for doctors and why women required them. Androcentric views of sexuality, and their implications for women and for the physicians who treated them, shaped the development not only of the concept of female sexual pathologies but also of the instruments designed to cope with them. Technology tells us much about the social construction of the tasks and roles it is designed to implement. Although massage instrumentation has had many medical uses in history, I am concerned here only with its role in the treatment of a certain class of"women's complaints." The vibrator and its predecessors in the history of medical massage technologies are the means by which I shall examine three themes: androcentric definitions of sexuality and the construction of ideal female sexuality to fit them; the reduction of female sexual behavior outside the androcentric standard to disease paradigms requiring treatment; and the means by which physicians legitimated and justified the clinical production of orgasm in women as a treatment for these disorders. In evaluating these technologies, the perspective of gender is significant: for example, men typically react to figure 1 by wincing, and women laugh. Clearly, where technologies impinge on the body, especially its sexual organs, the sex of the body matters. When the vibrator emerged as an electromechanical medical instrument at the end of the nineteenth century, it evolved from previous massage technologies in response to demand from physicians for more rapid and efficient physical therapies, particularly for hysteria. Massage to orgasm of female patients was a staple of medical practice among some (but certainly not all) Western physicians from the time of Hippocrates until the 1920s, and mechanizing this task significantly increased the number of patients a doctor could treat in a working day. Doctors were a male elite with control of their working lives and instrumentation, and efficiency gains in the medical production of orgasm for payment could increase income. Physicians had both the means and the motivation to mechanize. The demand for treatment had two sources: the proscription on female masturbation as unchaste and possibly unhealthful, and the failure of androcentrically defined sexuality to produce orgasm regularly in most women. Thus the symptoms defined until 1952 as hysteria, as well as some of those associated with chlorosis and neurasthenia, may have been at least in large part the normal functioning of women's sexuality in a patriarchal social context that did not recognize its essential difference from male sexuality, with its traditional emphasis on coitus. The historically androcentric and pro-natal model of healthy, "normal" heterosexuality is penetration of the vagina by the penis to male orgasm. It has been clinically noted in many periods that this behavioral framework fails to consistently produce orgasm in more than half of the female population. Because the androcentric model of sexuality was thought necessary to the pro-natal and patriarchal institution of marriage and had been defended and justified by leaders of the Western medical establishment in all centuries at least since the time of Hippocrates, marriage did not always "cure" the "disease" represented by the ordinary and uncomfortably persistent functioning of women's sexuality outside the dominant sexual paradigm. This relegated the task of relieving the symptoms of female arousal to medical treatment, which defined female orgasm under clinical conditions as the crisis of an illness, the "hysterical paroxysm." In effect, doctors inherited the task of producing orgasm in women because it was a job nobody else wanted. There is no evidence that male physicians enjoyed providing pelvic massage treatments. On the contrary, this male elite sought every opportunity to substitute other devices for their fingers, such as the attentions of a husband, the hands of a midwife, or the business end of some tireless and impersonal mechanism. This last, the capital-labor substitution option, reduced the time it took physicians to produce results from up to an hour to about ten minutes. Like many husbands, doctors were reluctant to inconvenience themselves in performing what was, after all, a routine chore. The job required skill and attention; Nathaniel Highmore noted in 1660 that it was difficult to learn to produce orgasm by vulvular massage. He said that the technique "is not unlike that game of boys in which they try to rub their stomachs with one hand and pat their heads with the other." At the same time, hysterical women represented a large and lucrative market for physicians. These patients neither recovered nor died of their condition but continued to require regular treatment. Russell Thacher Trall and John Butler, in the late nineteenth century, estimated that as many as three-quarters of the female population were "out of health," and that this group constituted America's single largest market for therapeutic services. Furthermore, orgasmic treatment could have done few patients any harm, whether they were sick or well, thus contrasting favorably with such "heroic" nineteenth-century therapies as clitoridectomy to prevent masturbation. It is certainly not necessary to perceive the recipients of orgasmic therapy as victims: some of them almost certainly must have known what was really going on.
Historically, women have been discouraged from masturbating on the grounds that this practice would impair their health, and most men before this century (even to this day, some would argue) have not understood that penetration alone is sexually satisfying to only a minority of women. Even those husbands and lovers who may have known did not always want to take the trouble to provide the additional stimulation necessary to produce female orgasm. Medical authorities as recently as the 1970s assured men that a woman who did not reach orgasm during heterosexual coitus was flawed or suffering from some physical or psychological impairment. The fault must surely be hers, since it was literally unimaginable that any flaw could be discovered in the penetration hypothesis. If the penis did not represent the ultimate weapon in sexual warfare, claims to male superiority would rest entirely on the statistically greater potential of the male biceps and deltoid muscles, which did not in themselves seem equal to the task of sustaining patriarchy in Western civilization. Female orgasm and the means of producing it were and are anomalous from a biological as well as a political and philosophical point of view. Its lack of correlation with fertility and conception remains counterintuitive even—perhaps especially—in an age of greater scientific understanding of human reproduction. The biological function of the female orgasm is controversial. In both the recent and the distant past, it seemed only reasonable to assume a priori that men and women would be sexually gratified by the same act of penetration to male orgasm that made conception possible. That stimulation of the external genitalia in women should be necessary in most cases remains unexplained. As a historian, I would not presume to speculate on the physiological and evolutionary questions raised by this issue. I look forward with interest to the results of current inquiries by evolutionary biologists, reproductive physiologists, and physical anthropologists. The question of female orgasm in history is deeply clouded by the androcentricity of existing sources. Medical authors, for example, have addressed female orgasm mainly from a prescriptive viewpoint; popular writers only occasionally mention it at all. Before the middle of this century, even in literature, references to female orgasm are conspicuous by their absence, even from works purportedly built around sexual subject matter. In the development of Western medical thought on the subject of sexuality, it has been thought both reasonable and necessary to the social support of the male ego either that female orgasm be treated as a by-product of male orgasm or that its existence or significance be denied entirely. Historically, both strategies have been used, but there has also been a persistent undercurrent of recognition that the androcentric model of sexuality does not adequately represent the experience of women. Confusing the medical discussions of these issues, as Thomas Laqueur has pointed out, is the failure of the Western tradition until the eighteenth century to develop a complete and meaningful vocabulary of female anatomy. The vulva, labia, and clitoris were not consistently distinguished from the vagina, nor the vagina from the uterus. Thus it is difficult, in reading the premodern literature of gynecology, to decipher treatment descriptions in which the female genitalia are undifferentiated. Female sexuality is often referred to in masculine terms, such as the references to the secretions of the Bartholin glands as "semen" or "seed." Thomas Laqueur says that physicians writing of anatomy "saw no need to develop a precise vocabulary of genital anatomy because if the female body was a less hot, less perfect, and hence less patent version of the canonical body, the distinct organic, much less genital, landmarks mattered far less than the metaphysical hierarchies they illustrated."
Part of my argument here rests on the vague and sexually focused character of hysteria as defined by ancient, medieval, Renaissance, and modern medical authorities before Sigmund Freud. Many of its classic symptoms are those of chronic arousal: anxiety, sleeplessness, irritability, nervousness, erotic fantasy, sensations of heaviness in the abdomen, lower pelvic edema, and vaginal lubrication. The paralytic states described by Freud and a few others are rarely mentioned by physicians before the late nineteenth century. During the syncope some hysterics were observed to experience, as Franz Josef Gall pointed out in the second decade of the nineteenth century and A.F.A. King some seventy years later, the subject's apparent loss of consciousness was associated with flushing of the skin, "voluptuous sensations," and embarrassment and confusion after recovery from a very brief loss of control—usually less than a minute. That hysterics did not become incontinent during their "spells" as epileptics did, and apparently felt much better afterward, led some physicians to suspect their patients of malingering. Doctors pointed out that epileptics often injured themselves when they fell, but that hysterics rarely did so. I do not mean that all women diagnosed as hysterical were cases of sexual (or rather orgasmic) deprivation; some were no doubt afflicted with other mental or physical ailments whose symptoms overlapped significantly with the hysterical disease paradigm. Joan Brumberg has pointed out, for example, that in the nineteenth century many physicians believed that anorexia in young girls was a hysterical disorder. But the sheer number of hysterics before the middle of this century, and their virtual disappearance from history thereafter, suggests it is perceptions of the pathological character of these women's behavior that have altered, not the behavior itself. The partial or complete loss of consciousness—or more properly, of reactivity to outside stimuli—was variously interpreted and described over time. Aretaeus, like Plato, believed that the inflamed and disconnected uterus was suffocating or choking the patient, a theme dwelt on at considerable length in late classical, medieval, and Renaissance medical writings. The uterus, engorged with unexpended "seed" (semen in Latin), was thought to be in revolt against sexual deprivation. The cure, consistent with the humoral theory popularized by Galen, was to coax the organ back into its normal position in the pelvis and to cause the expulsion of the excess fluids. When the patient was single, a widow, unhappily married, or a nun, the cure was effected by vigorous horseback exercise, by movement of the pelvis in a swing, rocking chair, or carriage, or by massage of the vulva by a physician or midwife, as described by Forestus in the paragraph quoted above. Single women of marriageable age who experienced hysterical symptoms were usually urged to marry and, as Ambroise Paré expressed it in the sixteenth century, "bee strongly encountered by their husbands." Masturbation by the patient herself was not recommended as a treatment for hysteria until the early twentieth century, and then only rarely. If hysteria was for the most part no more than the normal functioning of female sexuality, the inducement of the crisis of the disease, called the "hysterical paroxysm," would in fact have provided the kind of temporary relief physicians described. Only a handful of the medical authorities who advocated female genital massage as a treatment for hysteria, however, acknowledged that the crisis so produced was an orgasm. In the nineteenth century, as noted by Peter Gay and others, the received wisdom that women required sexual gratification for health came into conflict with newer ideas regarding the intrinsic purity of womanhood. A not uncommon resolution of the conflict of medical philosophies over women's sexuality was the compromise position that women ardently desired maternity, not orgasm. This pro-natal hypothesis not only preserved the illusion of women's spiritual superiority while explaining their observed sexual behavior but also reinforced the ethic of coitus in the female-supine position as a divinely ordained norm. As Gay rightly points out, this proposition also protected the male ego and the androcentric model of sexuality. Freudian interpretations after 1900 presupposed sexual drives in women, placing these in a new kind of androcentric moralism, that of psychopathology, that was to persist into our own time. In the new paradigm, hysteria was caused not by sexual deprivation but by childhood experiences, and it could be manifested in propensities to masturbation and to "frigidity" in the context of penetration. These two "symptoms" were also evidence, in the Freudian view, of female sexual development arrested at a juvenile level. The mystique of penetration thus could remain unchallenged even as the theoretical ground shifted under the medical and sexual issues. Real women, according to Freudian theory as well as earlier authorities, experienced mature sexual gratification as a result of vaginal penetration to male orgasm and accepted no substitutes for the "real thing." The role of the clitoris in arousal to orgasm was systematically misunderstood by many physicians, since its function contradicted the androcentric principle that only an erect penis could provide sexual satisfaction to a healthy, normal adult female. That this principle relegated the experience of two-thirds to three-quarters of the female population to a pathological condition was not perceived as a problem. This androcentric focus, in fact, in many cases effectively camouflaged the sexual character of medical massage treatments. Since no penetration was involved, believers in the hypothesis that only penetration was sexually gratifying to women could argue that nothing sexual could be occurring when their patients experienced the hysterical paroxysm during treatment. Even the nineteenth-century physicians who excoriated the speculum for its allegedly stimulating effects and questioned internal manual massage saw nothing immoral or unethical in external massage of the vulva and clitoris with a jet of water or with mechanical or electromechanical apparatus. Freudian and later interpretations of hysteria and masturbation helped undermine this camouflage, and when the vibrator, used in physicians' offices since the 1880s, began to appear in erotic films in the 1920s, the illusion of a clinical process distinct from sexuality and orgasm could not be sustained. In the evidence I present here on the histories of sexuality and medical massage in hysteria, it is important to stress that the voices of women are seldom heard. It is a rare person of either sex who sees fit to leave a record even of his or her most orthodox procreative marital sexuality, let alone of experiences with masturbation. In most historical times and places in Western culture, a woman's keeping such a record would have been unspeakably shocking and unchaste; its discovery might have subjected her to severe social sanctions. Even historians of male heterosexuality struggle with the lack of primary material; what remains may be fragmentary, or revised by embarrassed heirs or publishers. Historians must rely on largely prescriptive androcentric and pro-natal medical sources for much of our information on humanity's most intimate activities, because we have nothing else. Nearly all my sources relate to members of the middle to upper classes of white women in Europe and the United States, and it would be presumptuous to generalize from them to other cultures, classes, or races.
Mechanized treatments for hysteria offered a number of benefits to users of the technology—doctors, patients, and patients' husbands. Not only did the clinical production of the "hysterical paroxysm" provide a palliative for female complaints and make patients feel better, at least temporarily, it resolved the dissonance of reality with the androcentric sexual model. And since mechanical and electromechanical devices could produce multiple orgasms in women in a relatively short period, innovations in the instrumentation of massage permitted women a richer exploration of their physiological powers. Although manual, hydriatic, and steam-powered mechanical massage offered some of these advantages, the electromechanical vibrator was less fatiguing and required less skill than manual massage, was less capital intensive than either hydriatic or steam-powered technologies, and was more reliable, portable, and decentralizing than any previous physical therapy for hysteria. Within fifteen years of the introduction of the first Weiss model in the late 1880s, more than a dozen manufacturers were producing both battery-powered vibrators and models operated with line electricity. Some physicians even had vibratory "operating theaters" (see fig. 7). Although manufacturers and users of massage technologies have called the instruments by a variety of names, here I use a relatively consistent nomenclature designed to emphasize the differences among various types of massage apparatus. First, a true vibrator is a mechanical or electromechanical device imparting a rapid and rhythmic pressure through a contoured working surface, which is generally mounted at a right angle to the handle. The applicators usually take the form of a set of interchangeable rubber vibratodes contoured to the anatomical surfaces they are intended to address. Vibrating dildos, a variant of the vibrator, are usually straight-shafted and are designed for vaginal or anal insertion. A massager, as the term is used here, is a device with flat or dished working surfaces designed mainly for manipulating the skeletal muscles. All of these are distinct from the electrodes used in electrotherapy, which imparted a mild electrical shock to the tissues they were applied to and thus are technologically related to the vibrator only in a collateral way. As we have seen, manual massage of the vulva as a treatment for hysteria or "suffocation of the mother" is continually attested in Western medicine from antiquity through the Middle Ages, Renaissance, and Reformation and well into the modern era. I have already quoted Forestus's 1653 description of the basic manual technique, which seems to have varied little over time except in the types of lubricating oils. Medical descriptions of this procedure were more or less explicit in their instructions to doctors, according to the temperament of the author. A few, like Forestus and his contemporary Abraham Zacuto (1575—1642), expressed reservations about the propriety of massaging the female genitalia and proposed delegating the job to a midwife. The main difficulties for physicians, however, were the skills required to properly locate the intensity of massage for each patient and the stamina to sustain the treatment long enough to produce results. Technological solutions to both problems seem to have been attempted fairly early in the form of hydrotherapeutic approaches and crude instruments like rocking chairs, swings, and vehicles that bounced the patient rhythmically on her pelvis. We know very little about the ancient use of hydrotherapy in hysteria. Baths, however, particularly those built over hot springs, have a long history of association with sensuality and sexuality. Saint Jerome (340?—420), for example, admonished women, especially young women, to avoid bathing, since it "stirred up passions better left alone." Female masturbation in this context typically requires that the water be in motion, preferably under some kind of pressure or gravitational force, so still bathing of the type depicted in medieval scenes of "stews" (see fig. 8, in chapter 4) would probably not have been effective. Roman bath configurations usually included piped water that could have been used in this way, but evidence is lacking. It is probable that many women in history independently discovered that water in motion had a stimulating effect, but these discoveries are unlikely to be documented except in the form of the vague prohibitions on sensual indulgence in the bath by medical and religious writers. By the late eighteenth century, specialized hydrotherapeutic appliances had been developed for female disorders and were in use in some European and British spas. There are few detailed descriptions or illustrations of these devices. Tobias Smollett remarked in 1752 on the number of hydriatic devices at Bath that were specially designed for women. Women represented a majority of the market for hydriatic massage in Britain from at least Smollett's time. Many spas had special "female departments," and at least in America, women were often the owners, co-owners, or resident physicians of hydriatic establishments. The "social lion" of water cure establishments was the douche, or high-pressure shower, which was widely used in women's disorders as a local stimulant to the pelvic region (fig. 1). Henri Scoutetten, a French physician writing in 1843, described the popularity of the cold-water douche with his female patients as follows: The first impression produced by the jet of water is painful, but soon the effect of the pressure [percussion], the reaction of the organism to the cold, which causes the skin to flush, and the reestablishment of equilibrium all create for many persons so agreeable a sensation that it is necessary to take precautions that they [elles] do not go beyond the prescribed time, which is usually four or five minutes. After the douche, the patient dries herself off, refastens her corset, and returns with a brisk step to her room. The chief drawbacks of hydriatic massage for physicians, other than its apparently excessive allure for patients, were its capital intensiveness and its centralizing character: the equipment was expensive and required a semipermanent installation with a source of water, preferably heated. Although some American manufacturers made efforts to popularize hydrotherapeutic equipment for clinics and even affluent private homes, the apparatus was prohibitively expensive and could not easily be retrofitted to existing plumbing. Patient and doctor thus had to travel to hydrotherapeutic treatment sites, where transportation, spa fees, lodging, and meals restricted the market to the upper middle class and above. Spas also represented the market for many early efforts to mechanize massage. Most had manual physical therapy equipment, such as muscle beaters, in their clinical arsenals, and when Gustaf Zander's (1835—1920) "Swedish Movement" machinery became available in the mid-nineteenth century, prosperous hydriatic establishments added this technology as well. A clockwork "percuteur," essentially a wind-up vibrator, was also available to both spas and physicians before 1870 (see fig. 18, chapter 4). The percuteur, however, was underpowered for massage purposes and had a distressing tendency to run down before treatment was complete. Roller-type devices were sold in the popular market (fig. 2) that combined massage with electrotherapy; these were sold to both sexes and were touted as especially effective for renewing sexual vigor in men. In 1869 and 1872 an American physician, George Taylor, patented steam-powered massage and vibratory apparatus, some of it designed for female disorders. His principal markets were spas and physicians with a sufficiently large physical therapy practice to justify the expense of a large, heavy, and cumbersome instrument. Taylor warns physicians that treatment of female pelvic complaints with the "Manipulator" should be supervised to prevent overindulgence. One of his devices (fig. 3) featured a padded table with a cutout for the lower abdomen, in which a vibrating sphere, driven by a steam engine, massaged the pelvic area. Swedish efforts to produce a mechanical massage device on the principles of Zander's movement machinery produced results by the late 1870s, but the first electromechanical vibrator to be internationally marketed to physicians was the British model built by Weiss. Designed by the physician Joseph Mortimer Granville, the device patented in the early 1880s was battery powered and, like the modern version, equipped with several interchangeable vibratodes. Mortimer Granville, however, was firmly opposed to the use of his device for treating women, especially hysterics, and advised its application only to the male skeletal muscles. Few physicians in the United States or elsewhere seem to have shared his compunction on this point, except for those who noted with concern that the devices induced uterine contractions in pregnant women. By 1900 a wide range of vibratory apparatus was available to physicians, from low-priced foot-powered models to the Cadillac of vibrators, the Chattanooga (fig. 4), which cost $200 plus freight charges in 1904. Monell reported in 1902 that more than a dozen medical vibratory devices were available for examination at the Paris Exposition of 1900. Mary L. H. Arnold Snow, writing for a readership of physicians in 1904, discusses in some detail about twice this number, including musical vibromassage, counterweighted types, tissue oscillators, vibratory forks, hand or foot-powered massage devices, simple concussors and muscle beaters, vibratiles (vibrating wire apparatus), combination cautery and pneumatic equipment with vibratory massage attachments, and vibrators powered by air pressure, water turbines, gas engines, batteries, and street current through lamp-socket plugs. These models, starting at $15 and ranging to the top of the line mentioned above, delivered vibrations to the patient at rates of one to seven thousand pulses per minute. Some were floor-standing machines on rollers, some were portable, and others could be suspended from the ceiling of the clinic like impact wrenches in a modern garage (fig. 5). Articles and textbooks on vibratory massage technique at the turn of this century praised the machine's versatility for treating nearly all diseases in both sexes and its savings in the physician's time and labor, especially in gynecological massage. By 1905 convenient portable models were available, with impressive arrays of vibratodes, permitting use on house calls (fig. 6). In the first two decades of this century, the vibrator began to be marketed as a home appliance through advertising in such periodicals as Needlecraft, Home Needlework Journal, Modern Women, Hearst's, McClure's, Woman's Home Companion, and Modern Priscilla. The device was marketed mainly to women as a health and relaxation aid, in ambiguous phrases such as "all the pleasures of youth . . . will throb within you." When marketed to men, vibrators were recommended as gifts for women that would benefit the male givers by restoring bright eyes and pink cheeks to their female consorts. A variety of models were available at all price ranges and with various types of power, including electricity, foot pedal, and water. An especially versatile vibrator line was illustrated in the Sears, Roebuck and Company Electrical Goods catalog for 1918. Here an advertisement headed "Aids That Every Woman Appreciates" shows a vibrator attachment for a home motor that also drove attachments for churning, mixing, beating, grinding, buffing, and operating a fan (see fig. 24, chapter 4). The social camouflage of the vibrator as a home and professional medical instrument seems to have remained more or less intact until the end of the 1920s, when the true vibrator (but not massagers or electrotherapeutic devices) gradually disappeared both from doctors' offices and from the respectable household press. This may have been the result of greater understanding of women's sexuality by physicians, the appearance of vibrators in stag films in the twenties, or both. Electrical trade journals of the period did not mention vibrators or report statistics on their sale as they did for other medical appliances. When the vibrator reemerged during the 1960s, it was no longer a medical instrument; it had been democratized to consumers to such an extent that by the seventies it was openly marketed as a sex aid. Its efficacy in producing orgasm in women became an explicit selling point in the consumer market. The women's movement completed what had begun with the introduction of the electromechanical vibrator into the home: it put into the hands of women themselves the job nobody else wanted. (C) 1999 The Johns Hopkins University Press All rights reserved. ISBN:
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