y Rachel P. Maines. 181 pp. Baltimore, Johns Hopkins University Press, 1999. $22. ISBN 0-8018-5941-7

In the course of preparing a scholarly documentation of needlework in the late 1800s and early 1900s, Rachel P. Maines, the author of this small and surprising book, noticed a variety of advertisements for vibrators. After graduate school, as an assistant professor at Clarkson University in Potsdam, New York, she investigated the use and meaning of vibrators, consulting such sources as the Bakken Library of Electricity in Life, in Minneapolis, which had 11 "musculo-skeletal relaxation devices" in its collection. Based on over 500 sources (documented in 24 pages of notes), this book is the fruit of a curious, serendipitous discovery of a thread in the history of medicine and sexuality. The thread is that "genital massage to orgasm by a physician or midwife was a standard treatment for hysteria, an ailment considered common in women," and there have been variations on this treatment from the Hippocratic corpus to medical practice at the beginning of the 20th century. Genital massage was performed to the point of "hysterical paroxysm." The introduction of the vibrator as a medical instrument in the late 1880s, credited to the British physician Joseph Mortimer Granville (who ironically opposed its use for treating women, especially those with a diagnosis of hysteria), offered a more efficient treatment. The diagnosis of hysteria, however protean the symptoms, was apparently both persistently and prevalently applied to women. According to one 17th-century source that Maines cites, hysteria was, after fevers, the most common diagnosis received by women. Among the symptoms of hysteria were anxiety, irritability, nervousness, erotic fantasies, heaviness in the abdomen, lower pelvic edema, vaginal lubrication, and by the latter half of the 19th century, paralytic states or syncope (fainting). The uterus was believed (first literally, then figuratively) to cause these symptoms by choking the patient because of unexpended seed resulting from sexual deprivation. Thus, single women were encouraged to marry and get relief through coitus, and celibate women, widows, or unhappily married women were encouraged to go horseback riding, use rocking chairs, or seek genital massage. Use of the vibrator decreased treatment time and was more effective than manual massage by a practitioner. The author found no evidence that physicians enjoyed providing the treatment and much evidence that they willingly passed this task on to midwives. Dr. Jean Martin Charcot Presenting a Hysterical Woman at the Hopital Salpetriere, Paris. Maines refers to the conceptual framework in Western medicine for the diagnosis and treatment of hysteria as an "androcentric model of sexuality." Specifically, coitus and only coitus defined a legitimate sexual experience. Thus, a woman's orgasm needed to occur during coitus because that was the norm for males. If her orgasm did not occur then, and we can strongly suspect, given more recent data, that it often did not, women had no reliable orgasmic release, since masturbation was considered an unhealthy sexual outlet. The author proposes that many women were orgasmically deprived because of these constraints and thus "asserted their sexuality through one of the few acceptable outlets: the symptoms of the hysteroneurasthenic disorders." The treatment -- the production of orgasm in a clinical setting -- allowed the response to be viewed as a hysterical crisis rather than as an orgasm. Orgasms occurred only during coitus, after all. As a result, many women with normal sexual responses (or a reasonable lack thereof) were thought to have a pathologic condition. This book has several provocative messages. It is not surprising that so many women have been labeled hysterics, given the breadth of the symptom list, or that physicians might have used vibrators for massage, even genital massage. More surprising are the following: the implication that although not universally used (the author notes several written objections by physicians), this particular treatment may have been rather common; the fact that clinical provision of genital stimulation to the point of hysterical paroxysm was typically not viewed as sexual; and the fact that we have heard nothing of this until now, in spite of a number of books on the history of hysteria. These points, especially the last, will make readers skeptical in spite of the considerable documentation that Maines provides. Is this book worth reading? I believe so. It is written by an outsider with respect to the medical profession, a useful position from which to see events afresh. The content and the sources cited certainly warrant further scrutiny by other scholars, especially historians and sexologists. Nevertheless, the book is reference-based, with remarkable illustrations of the medical artifacts of vibrators, other devices, and treatment tables. The material can be seen as an example of the power of a dominant group (men, in this case) to blind one to alternative truths, even about something as apparently obvious as the normal range of sexual responses. And it is important to have reminders from the history and ethics of medicine that we must continually question the factual and conceptual bases for diagnoses and treatments, especially those given disproportionately to one sex. Julia R. Heiman, Ph.D. University of Washington School of Medicine Seattle, WA 98105