THIS BOOK IS an excellent polemic about the way male doctors mistreat women doctors, women health workers and women patients. Like any good polemic, it is aggressive, controversial, clear, strong and passionate.
Those qualities seem natural to Gena Corea's accumulation of horror stories. Her evidence from the 18th and 19th centuries adds a dimension that makes it easier to understand why women are angry about health care in the 20th century.
Distance in time may encourage us to snicker at Dr. William Steward of Philadelphia, for instance. He was called on in 1885 to treat a 26-year-old housewife who continued to masturbate even after he had fixed a pad of steel pins over her vulva. Steward said he had "no recourse but to deprive her of her ovaries, hoping in that way to remove her perverted instincts." The operation was successful, from his viewpoint: afterwards the patient was "willing and anxious to return to the management of her home."
The historical snicker evaporates when we read Corea's account of a 1970 report in Medical World News. It said that surgeons acknowledged they rarely hesitate to remove an ovary but hate to remove a testicle, because "No ovary is good enough to take out." Most surgeons, of course, are men.
One of Corea's most interesting historical perspectives is her chapter on Elizabeth Blackwell and Clemence Lozier. Blackwell, the first woman physician in the United States, is a heroine to most feminists. But she dissociated herself from the 19th-century feminist movement and adopted what Corea considers male values. She joined the campaign to prevent lay women from practicing midwifery, for instance, supporting the doctors' caste system.
Lozier, a contemporary of Blackwell's little known even to many of today's women's health activists, was a practicing feminist who believed in preventive medicine, unlike most doctors then or now (prevention is not where the money is). She founded a women's medical college that prospered until male professors took it over and expanded it into bankruptcy.
Corea also documents a host of medical offenses against women today, from discrimination against female medical students and the tendency to treat women's illnesses as psychogenic, to questionable practices in venereal disease control, contraception, sterilization, childbirth and drug use.
On drugs, the story of the inadequate testing of the birth control pill and the belated discovery of its damaging side effects has become widely known (thanks in part to the efforts of Morton Mintz of The Washington Post, whom Corea does not mention).
A lesser-known story that horrified me was that of diethylstilbestrol (DES), a drug used for decades to prevent miscarriage, which has caused vaginal or cervical cancer in the daughters of women who took DES while pregnant with them. (In March, a Michigan judge agreed to consider whether 153 women could sue a group of drug companies for failing to test the drug's safety. Since it was prescribed under the generic names DES, it is impossible to hold a single company responsible for a specific dose.)
Despite the well-established dangers, DES is being used without Food and Drug Administration approval (but equally without an FDA ban) as an experimental morning after contraceptive for women. The dosage is 55,000 times the amount FDA tried to ban in cattle feed in 1973.
On another level, Corea discusses the medical establishment's apparent determination to ignore a simple method of male contraception. Dr. Martha Voegeli, a woman, has been testing it since 1921, and Dr. John Rock, one of the inventors of the birth control pill, thinks his own tests of it are promising. But the establishment keeps ignoring it or putting bureaucratic obstacles in its way. The method is killing sperm with heat. Dr. Voegeli tested it in India by having a man sit in a bath of 116 degrees Fahrenheit for 45 minutes daily for three weeks. She found that this produced six months of sterility, after which normal fertility returned. Dr. Rock tried insulated underwear as well as hot baths.
I suspect one reason the medical establishment disdains this kind of temporary male sterilization is not only that it's the man who has to put his scrotum in hot water, but also because it's so simple it might erode the mystique of medicine.
Corea doesn't pay enough attention to that element, to the way doctors condescend to patients regardless of sex. She mentions women who prefer midwives who treat them as persons rather than walking uteri. Men also prefer doctors who treat them as persons rather than walking prostates. Some male patients are just as frustrated as women in their quest for information that will enable them to understand what the doctor is doing. Some women doctors play God with their patients as determinedly as male doctors do.
Nor does Corea pay enough attention to changes for the better that are taking place even as she writes. The proportion of women in medical school has doubled, according to Corea's own figures, even if 15 per cent is still proof of discrimination. Women - too few, but more than formerly - are getting part-time internships and residencies to enable them to have both children and careers. Both men and women among younger doctors are refusing to play God and treating patients as intelligent, whole persons.
Perhaps if Corea had looked more at the balancing and brigher sides, she would not have written as effective a polemic. She has written a more comprehensive book than some earlier classics of the women's health movement, and for that very reason she relies more on secondary sources and less on personal experience. The result is still devastating.