Brain or Genitals?

The development of medical specialties such as gynecology, neurology, and psychiatry over the course of the nineteenth century led to turf wars in which each specialty promoted its own physiological explanation and treatment for women's diseases. Yet nymphomania remained elusive, despite attempts to classify its symptoms and to categorize its causes on sound scientific principles. Some medical specialists, such as neurologists and alienists (the earlier name for psychiatrists), looked for a physiological cause of nymphomania in cerebral lesions, changes in the brain's blood vessels, thickening of the cranial bones, or overexcited nerve fibers. They generally took issue with the "uterine theory," which argued that diseased genitals caused the malady. By doing so, they hoped to be able to diagnose, treat, and perhaps cure nymphomania, staking out their particular medical specialty's claim to expertise.

Neurologists looked to the relationship between the brain and the nervous system to explain cases of oversexed men and women. Through postmortem examinations of spinal fluid, for example, they hoped to find some evidence that might help them sustain their claim to treat these disorders. But autopsies that showed no significant alteration in the brains of those defined as nymphomaniacs critically challenged the nerve doctors' theories. Neurological research found little organic evidence linking nymphomania to the brain. Even so, for lack of alternatives, neurologists continued to recommend treating the disease with cold compresses, long periods of enforced inactivity, and other remedies directed at the brain and the nervous system.

Alienists, while identifying suppressed or disordered menstruation and similar symptoms as connected to female nervous and mental illness, also looked to the brain and the nervous system as the location of the disorder. As superintendents of newly opened mental asylums, they espoused the then modern idea that mental illness was curable. The most progressive advocated that it be dealt with by "moral treatment": maniacs and others diagnosed insane were no longer to be restrained in basements and attics, but placed in institutions and treated with a pleasant environment, simple work, and a "regular mode of living." Although uncertain of the causes of female disorders, such as hysteria, hysteromania, and nymphomania, alienists remained confident, until later in the century, that positive change could be brought about through this new, humane approach.

During the early part of the century, phrenology—at the time thought to be a serious science—took another approach to the question of sexual excess. Phrenologists believed that mental faculties could be determined by measuring the shape of the skull: an enlarged cerebellum (the part of the brain located at the back of the head, which controls muscle coordination and bodily equilibrium) indicated inordinate sexual appetite. But a particularly sensational case, mentioned in the 1840s in both the American Journal of Psychological Medicine and Mental Pathology and the British medical journal, Lancet—whose tantalizingly few details were cited throughout the nineteenth century—dramatically refuted this claim: an autopsy report on a twelve-year-old girl diagnosed as a nymphomaniac declared that she had no cerebellum. No further details were given, and we do not know why she was diagnosed with nymphomania, but without a cerebellum the girl would presumably not have been able to walk.

If some nineteenth-century doctors located women's diseases in as-yet-undiscovered lesions in the brain or in too highly strung nervous systems, gynecologists emphasized the central role played by the reproductive organs, not only in diseases of the body but in those of the mind as well. Gynecology, not yet a respected medical specialty in the first half of the nineteenth century, had to fight to establish its professional status and to counter the unseemliness of male doctors examining female genitalia. Social mores combined with female modesty to limit what a doctor could see or touch. In the early part of the century the physician generally viewed the patient fully clothed, asked probing questions, looked at her face, hands, and feet, then made a diagnosis without ever physically examining her genitals.

By midcentury, gynecologists very tentatively began to use the speculum (forerunner to today's instrument, which is inserted into the vagina) and to undertake more elaborate physical examinations, although moralists of all stripes protested this invasion of women's bodies. One critic even feared that the use of the speculum itself might so excite a woman's passions that it could cause nymphomania.

Medicine was not a monolith in the nineteenth century and doctors did not speak with one voice about women's diseases. In addition, patients and their families had treatment alternatives from which to choose: homeopathy, hypnosis, hydrotherapy (water cure), and folk remedies. Various medical specialties developed competing theories, definitions, and treatments, especially for uncertain diagnoses such as nymphomania. As we will see, women patients also influenced the concept of nymphomania by the way they described their symptoms to the physician.

In the following case, discussed by Dr. Homer Bostwick, author of A Treatise on the Nature and Treatment of Seminal Diseases, Impotency and Other Kindred Affections, in its eighth edition in 1855, we meet such a woman, who presents herself as so inflamed by passion she fears she might go crazy.

Full article:
Nymphomania
A History
By CAROL GRONEMAN
W. W. Norton & Company