Orificial Surgery Was a Gruesome 19th-Century Sham Medicine

The Muncie Surf Sanatorium stood three stories high on the northern shores of Muncie Island, a few miles from Fire Island, New York. Run by married doctors Edward and Elizabeth (Libbie) Muncie, it was a grand, hotel-like building with a billowing American flag on its roof and a multilevel entrance with a path that led straight down to the water. It had a single turret, topped like a witch’s hat. Nearby, a 270-foot well provided “drinking water of the purest quality” for its patients. It was to this facility that a woman of 24 came, in July 1898, in search of a cure for her neurasthenia, a condition characterized by lassitude and weariness—and sometimes known as “Americanitis.”

Miss E.—how she is identified in the doctors’ account—suffered from lower back pain, general weariness, and a “persistently irritated” clitoris, which apparently hampered her ability to “pursue evangelical work.” To cure this suite of symptoms, a doctor from the sanatorium (probably Libbie, who had studied gynecology and published papers on “Psychic and Physical Causes for Sexual Immorality” and “What Every Mother’s Son Should Know”) opened up Miss E.’s legs—and looked into her soul.

We don’t know from the records what Miss E.’s face looked like, what color her eyes were, or even whether she was tall or short. Recorded in extravagant, baffling detail, however, are the “healthful” hue of her sexual organs, the size of her clitoral hood, and the various qualities of her hymen. From these things alone, a Dr. Muncie—we can’t be sure which—surmised Miss E.’s powers of observation, her leadership potential, even her determination and sensitivity. “This woman could be a Jeanne d’Arc,” the doctor wrote. “At the same time, she could be a seamstress … head a seminary of learning, or give lessons in a most successful manner to a single pupil.” We often hear that the eyes are the window to the soul. The Muncies believed that such a thing was located much farther down.

The Muncies were just two of hundreds of “orificial surgeons” who practiced in the United States between the 1880s and the 1920s. This branch of homeopathy believed that by performing surgeries on the orifices—the mouth, nostrils, ears, anus, and genitals—virtually every condition known to man (and woman) could be cured. During these four decades, tens of thousands of orificial surgeries were done by so-called doctors throughout California, Oregon, Arizona, and Utah, and across swathes of the Midwest.

Within two years of its 1888 launch, there were 94 members in the American Association of Orificial Surgeons. They came together regularly to discuss internecine quibbles, ranging from the use of cocaine as a surgical tool to whether correct dilation of a rectum might help keep someone warm, someone who had hitherto needed to wear “flannels” in September. (They concluded that it would.) Within a few years, their members numbered close to 300, with their annual meetings at Chicago’s ritziest hotels, or at the swish Muncie Surf Sanatorium.

The movement had begun in Chicago, nearly 850 miles west from where the Munices practiced. Dr. Edwin Hartley Pratt was a great bearded bear of a man, six foot tall and 250 pounds, described in a short 1894 biography as cheerful and hopeful, with his mother’s “indomitable energy, courage, and perseverance.” He was also a persuasive salesman and orator. As a young man, he hopped from seminary to Wheaton College to the University of Chicago, before being valedictorian of the class of 1873 at Hahnemann Medical College, a homeopathic institution where his father taught. Soon after graduating, he become its professor of anatomy.

Over time, Pratt’s interest in surgery grew, and he took a position on the surgical staff of Cook County Hospital. With the scalpel in his hand and the siren song of homeopathy echoing in his ears, Pratt began to develop his own original branch of homeopathy: Orificial Surgery, or Orificial Philosophy, as he sometimes called it. In 1887, he published a lengthy monograph on the subject that would, for a time, make him successful, famous, and rich.

First developed in Germany in the late 18th century, homeopathy has encompassed myriad medical misconceptions, most of which spring from the curious assumption that “like cures like”—that you might, for instance, treat mania with a tiny dose of something that ordinarily causes it. Despite being pure bunk, homeopathy enjoyed a boom in popularity and credibility in the United States from around the 1870s (and again in recent decades). Desperate patients were seduced by its optimism, and its celebrity endorsements from the literati: Louisa May Alcott, Ralph Waldo Emerson, Nathaniel Hawthorne, and many others. In the minds of the general public, who often understood neither homeopathy nor traditional medicine, believing in one over the other seemed an almost arbitrary decision. In 1873, American Observer magazine declared that these two schools differed “in name, rather than in fact, and in most important respects there is little real difference between the practice of an accomplished regular physician and that of the intelligent homeopathist.” Homeopathy promised a break from tradition, cures for the incurable, and transformative results for even congenital conditions.

While its conclusions are utterly bonkers, the premises that underlay orificial surgery begin at least somewhere in the region of medical science. To be in good health, Pratt reasoned, one needed normal circulation. Because the sympathetic nervous system helps determine blood flow, it must be important to good health. So far, so good. But then the evidence-based logic begins to break down. Pratt believed that disease occurs when the circulatory system is fatigued, leading to blood “stagnation.” Observing, correctly, that there are a lot of sympathetic nerves around some of the body’s orifices, in particular the sexual organs and rectum, he reasoned that by nipping and tucking these areas to keep them “properly smoothed and dilated,” poor circulation and thus disease could be kept at bay. And so, writes Ira M. Rutkow in Seeking the Cure: A History of Medicine in America, “when this giant man with the thinning hair and Vandyke beard went to work, no mouth, penis, rectum, or vagina was safe from a manipulation or scraping.” This is true—but the mouth was of far less interest to Pratt and his colleagues than their other targets.

Accounts of these surgeries are nauseating. Labia and scrotums were amputated with seeming abandon, hemorrhoids snipped, rectums slit, foreskins and urethras dilated. The surgery documentation is unilaterally positive—as you’d expect from a man trying to hawk his own homegrown medical philosophy—but it’s unlikely they had any positive impact. Miss E. was apparently subjected to a grotesque combination of below-the-belt cutting and packing. But recovery from this mutilation, the Muncies reported, bar a little nausea and a slight temperature, was “rapid and uneventful.” Her neurasthenia was allegedly cured.

Among orificial surgeons, circumcision was cited as a spectacular panacea, curing two women of their headaches and a young boy of his spinal curvature. It was touted, too, as a cure for “unnatural behaviors”—from masturbation to rape. (Other doctors, reading the account of Miss E., have suggested that her “ailments” are consistent with the effects of persistent, and apparently distracting, self-abuse.) Other non-homeopathic doctors of the period, including John Kellogg, shared these views, though it’s hard to know whether they originated with the tenets of orificial surgery or not. Pratt’s belief that every male in the United States ought to be circumcised seems to have been a pervasive one: By the 1950s this would be the norm, with circumcision rates peaking at around 90 percent of all baby boys.

There were other elements to Pratt’s philosophy—stranger, even, than the belief that you can cure eczema with an adjustment to the foreskin. Pratt believed in a practice he called “tissue reading.” In the same way that you can read the Earth’s history from its geological layers, so too, he thought, could you decipher a person’s character from her “tissue.” And it should be clear by now which tissue most interested him. From a pale mouth, he said, you could read “cowardice and discouragement and despair, and the consequent hunger and starvation typified by anemia of the organs they serve.” A particularly tight orifice—he doesn’t specify which—was a clear sign of “prodigal expenditure of nerve force in sustaining undue muscular tension.” This bears some resemblance to particular Freudian psychosexual theories mooted just a few decades later.

In this way, Pratt writes, what is good or bad, generous or stingy, honorable and upright or disgraceful and scandalous, trustworthy and substantial or apprehensive and cowardly— “the continuous antithesis in the entire list of human qualities and characteristics”—could be accurately read by an “expert observer” in the “pelvic organs.” Vagina and penis phrenology was real, once, and from it, one could divine everything there was to know about a patient.

The majority of medical practitioners pooh-poohed Pratt and his movement entirely. Across the Atlantic, the British Medical Journal wrote teasingly in 1893 about how orificial surgeons had, like certain philosophers “who strive to solve the riddle of the universe by a persevering contemplation of their own navels,” concluded that the rectum was the source of all humanity. “It is therefore with a feeling of satisfied prophetic instinct,” they wrote, “that we learn that this retiring region has at last had surgical greatness thrust upon it.” They were still writing about it in 1923, this time with less humor, and calling it “the latest development among the quack cults of America [which] has already attained a notoriety there.” An 1899 Atlanta Journal-Record of Medicine’s editorial was still more scathing. The most valuable thing a “surgeon” might be able to glean from a reading of the vagina, they wrote, was an appraisal of “the patient’s ability to pay.”

There don’t seem to be detailed accounts of how much people forked out for their orificial surgeries, but Pratt was flush. He held classes at $700 a pop (in today’s money) for aspiring orificial surgeons, and designed and sold his own line of surgical instruments. By 1891, as his personal fortune ballooned, he built his own private hospital, the Lincoln Park Sanatorium. The following year, he became editor-in-chief of the Journal of Orificial Surgery. “With continued success,” Rutkow writes, “Pratt’s confidence in his theories increased and he began to see himself as a prophet.”

Pratt grew famous and influential, and his position at Cook County Hospital lent his movement legitimacy—at the time, even many hospitals made little distinction between traditional medical graduates and those from homeopathic institutions such as Hahnemann. In 1893, at the Columbia World’s Fair, Pratt explained how his patients had lost faith in traditional medicine, and were eventually cured by the many wonders of orificial surgery. In his writings, he called for traditional doctors to join him—”to snap the bands of prejudice that have bound him, break loose from the thraldom of tradition, dispel his fear of so-called authority, cultivate his reason and observation, and stimulate his self-reliance.” Only by doing so, he wrote, would they be able to truly treat the sick.

But as with many medicine-adjacent fads, the time of orificial surgery began to pass. Pratt’s miracle cures proved neither curative nor miraculous, and as homeopaths sought wider acceptance (membership in the American Medical Association began in 1902), they eagerly decried Pratt’s movement. Referrals to his hospital began to decline, along with the rolls of the American Association of Orificial Surgeons.

Pratt’s professional collapse was accompanied by personal tragedy. He lost his wife and both children (it is not known how), and soon after, in 1901, was forced to close his private sanatorium. The Journal folded soon after, and the Chicago Homeopathic Medical College, where he taught, closed its doors. Bankruptcy seemed inevitable. He died, after years of illness, in 1930, at the age of 80. For its final two decades, orificial surgery limped on without him, its support drying up as practitioners retired, closed up, or moved on to more orthodox practices.

The Muncie Surf Sanatorium, for its part, remained open until 1914. The Muncies removed “orificial surgery” from their list of offerings, and continued to practice in Brooklyn. Soon after the facility closed, the island was sold to developers who planned to fill it with summer bungalows. Instead, Muncie Island itself went the way of orificial surgery, vanishing nearly without trace. In 1933, the island was razed to create a shipping channel, disappearing from maps just as orificial surgery vanished from the medical horizon.