Current discussions of female genital mutilation often present these procedures as something non-western, incomprehensible and alien to the traditions of “civilised” industrial societies. Since 1985 it has been illegal to perform FGM in the UK, but despite more than 100,000 thought to be at risk, only one doctor has been prosecuted – and he was found not guilty because he had been helping a woman, who had already been mutilated, to give birth.

But as Pat Caplan noted in a previous piece on The Conversation, our own modern pursuit of cosmetic genital surgery appears to go unnoticed. There is also some precedent in Victorian times, when FGM was also performed in the UK and the US, though it was certainly never a staple of surgical practice.

As medical historian Lesley Hall points out, in the 19th century “given the lack of attention paid to the clitoris in medical textbooks, probably few doctors could reliably have located it.”

Yet in 1860s London, one form of FGM – clitoridectomy, the surgical removal of the clitoris – briefly became an acceptable treatment for a wide range of conditions including “hysteria” and mental illness. It could also be used as treatment for behaviour seen as unfeminine and as a threat to marriage. These included a “distaste for marital intercourse”, “a great distaste for her husband”, violent behaviour, or even just answering back.

The man who removed the clitoris

The conditions thought to merit clitoridectomy come from the publications of Isaac Baker Brown, a respectable member of the London medical establishment. Born in 1812, he became a fellow of the College of Surgeons in 1848, and developed new operations to treat ovarian cysts and tumours. In 1858 he set up his own clinic in Notting Hill, the wonderfully-named London Surgical Home for the Reception of Gentlewomen and Females of Respectability suffering from Curable Surgical Diseases, where he could perform what he often called simply “the operation”. The archbishops of Canterbury and York supported this clinic.

In the second edition of his book, On Surgical Diseases of Women, published in 1861, Baker Brown included the condition “Hypertrophy and Irritation of the Clitoris”. What he really meant was masturbation. He believed that this “irritation”, which he also called the “peripheral excitement of the pudic nerve”, could affect a woman’s nervous system. This excitement was a possible cause of sterility. But, unlike with other causes, there was something that could be done – as Baker Brown wrote: “irritation of the clitoris and its horrible results may frequently be cured”.

And rather than what were then the standard remedies for an irritated clitoris – leeches to the labia, cold baths and a gentle diet – he proposed that the answer lay in surgery.

Clitoridectomy as cure-all

In 1866 Baker Brown took this further in another publication: On the Curability of Certain Forms of Insanity, Epilepsy, Catalepsy and Hysteria in Females. Here, he suggested that his sheer success in curing previously intractable cases proved his ideas worked.

His method, he insisted, was “humane and effectual”, a speedy answer to problems including hysteria, fits, catalepsy, “idiocy”, and mania. A woman who, according to her husband, would “fly at him, and rend his skin, like a tigress”, was quite well after the operation and “became in every respect a good wife”.

A 17-year-old girl with catalepsy, a nervous condition that causes bodies to become rigid and unresponsive to external stimuli, also recovered:

Five weeks after operation, she walked all over Westminster Abbey, whereas for quite a year and a half before treatment, she had been incapable of the slightest exertion.

One of Baker Brown’s supporters, Charles Routh, cited a success story of a young woman with idiocy who, after the surgery, was able to read her bible and obtained a position in service.

A clitoris is not a genital wart

So why did Baker Brown come up with this operation as the answer to so many perceived problems? He certainly didn’t see it as barbaric or non-Western. In support of the practice, he cited a text from the 5th century BC, associated with a great name in the history of the western medical tradition: Hippocrates the “father of medicine”. But in fact this text was about cutting out genital warts.

The downfall of the operation, and of Baker Brown himself, came when the Obstetrical Society of London debated its efficacy and its ethics. Perhaps those who recommended the standard treatments for the huge range of disorders Baker Brown claimed could be cured felt that their own livelihoods were under threat.

It wasn’t really about women and the damage that Baker Brown might be doing. A crucial issue in the society’s acrimonious debate was not the historical origin of clitoridectomy, or even its efficacy, but instead the matter of consent. Not that of the women undergoing the procedure – but of their fathers and husbands.

Baker Brown argued that he had sometimes not asked husbands because the female patient begged him to do the operation in secret. Was this an acceptable interpretation of patient confidentiality? The society thought not. Baker Brown was expelled; his clinic closed, and he was left bankrupt. He died in 1873 from “softening of the brain”. His “operation” was no longer acceptable in the UK, though in the US it continued to be performed until the mid-20th century.

Since then, of course, we rail against FGM as an uncivilised act. But it wasn’t always so.

An earlier draft of this article said that the clitoridectomy continued to be performed in the US until the 1890s. This has been revised to the mid-20th century.