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Is it true that Victorian doctors used to masturbate neurotic female patients to orgasm and used special new inventions (e.g., vibrators) to do so? If so, does this have any connection with Freud’s theories on female sexuality? —Rob King, via e-mail

Just a few tweaks: 1. the women were diagnosed as hysteric, not neurotic; 2. vibrators were used but, contrary to rumor, that wasn’t their original purpose; and 3. Freud helped end, not start, the practice. But, mainly, you’ve got it: The medical profession long treated such patients by fiddling with their genitalia—a subject receiving its most thorough examination in Rachel Maines’s The Technology of Orgasm (1998).

The always-nebulous concept of hysteria was known to the ancients; its original symptom was difficulty breathing, which as of 1900 BC was attributed by Egyptians to the uterus’s straying toward the lungs and throat. One early treatment (persisting into the Middle Ages) involved smearing foul substances near the nose and sweet ones near the crotch to goad and lure the errant organ back into place. Such beliefs influenced writings attributed to Hippocrates circa 400 BC, who concluded marriage and sex were the best cures but also advocated sneezing.

Several centuries later, medical pioneer Galen also blamed the uterus for hysteria but denied its upward mobility. He believed female “sperm” (probably female ejaculate, as discussed here before) was released during sex; its accumulation via abstinence could produce toxic vapors, resulting in hysterical symptoms, namely shortness of breath and convulsions. (This idea, incidentally, gave rise to the notion of “the vapors,” scourge of Victorian gentlewomen and Southern belles, though, by then, doctors no longer believed actual vapors were causative.) For unmarried patients Galen prescribed “digital manipulation” by a midwife to the point of “twitching,” “pleasure” and the release of “abundant sperm”—i.e., to orgasm. Over ensuing generations, influential pagan, Christian and Muslim physicians continued to recommend such treatment, with midwives continuing to do the gruntwork. Under Christianity, the practice was controversial, but some doctors persisted, considering Catholic objections mere superstition.

By the mid-1800s, symptoms of hysteria included inability to reach orgasm through vaginal intercourse and sexual fantasies accompanied by vaginal lubrication and an urge to masturbate. In short, normal female sexuality had been classified as pathological, and doctors stood ready to battle the epidemic. French physician Pierre Briquet popularized la titillation du clitoris as treatment for hysterics.

If this all sounds wildly sketchy, consider alternative hysteria treatments, ancient and subsequent. Some operated on the first-do-no-harm model (cod liver oil, radishes), some on the let’s-get-you-high model (alcohol, cannabis, opium, cocaine). But others were less benign: dosing with arsenic, rubbing the genitals with dung, applying leeches to the cervix, injecting milk (likely unpasteurized) into the uterus, and cauterizing the clitoris. Suddenly, letting a health professional get to third base doesn’t sound so bad.

Also, there’s no evidence that prurience drove M.D.s’ advocacy of manual massage—on the contrary, they eagerly farmed out the task to subordinates. Or turned to technology. Water jets were used this way 150 years ago; following the development of windup and steam-powered massage devices intended for sore muscles, arthritis and so on, Joseph Mortimer Granville invented the modern electromechanical vibrator in the early 1880s. Presumably many customers used vibrators for the muscle massage touted in the ads, but surely not all. Greater public acknowledgment of women’s sexuality made it too clear what female users might be up to and, as of the 1930s, mainstream publications had stopped advertising them.

By then, the medical treatment was faltering. Though poorly explained nervous disorders (see neurasthenia) had been the rage among upper-class Victorians, styles changed in the new century. It was Freud’s influence in particular that ended medical masturbation. He administered it early on but found it ineffective—as Maines puts it, “the man who, notoriously, did not know what women wanted was less than successful as a gynecological masseur.” Freud later concluded only talk therapy could resolve underlying issues; there, too, his efforts weren’t entirely satisfying.

Hysteria has since been all but defined out of existence. Those who once would have been labeled hysterical might now be described as having conversion disorder, or just a healthy libido. Meanwhile, in a culture that’s more sex-positive but body-fat-negative, eating disorders have in some senses taken hysteria’s place—hardly a real improvement.