3 Doubtful Medicine

Doubtful Sex: The Fate of the Hermaphrodite in Victorian Medicine
Author(s): Alice Domurat Dreger

Source: Victorian Studies, Vol. 38, No. 3 (Spring, 1995), pp. 335-370
Published by: Indiana University Press
Stable URL: http://www.jstor.org/stable/3828713
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Doubtful Sex:
The Fate of the Hermaphrodite
in Victorian Medicine
ALICE DOMURAT DREGER
O n Wednesday, 25 April 1888, at a regularly scheduled meeting

of the British Gynaecological Society, the esteemed gynecolo-
gist Dr. Fancourt Barnes, physician to the Chelsea Hospital for
Women, the British Lying-in Hospital, and the Royal Maternity Charity,
announced that he had "in the next room a living specimen of a
hermaphrodite" (fig. 1). Barnes added that he used the term hermaph-
rodite "on general principles, because it is the case of an individual who
has been brought up to the age of nineteen as belonging to the female
sex, when it is perfectly clear that he was a male" (205). Or was it
perfectly clear?
Although a few colleagues-among them the well-known gynecol-
ogist Lawson Tait, surgeon to the Birmingham and Midland Hospital for
Women, a man (like Barnes) well versed in hermaphroditism-supported
Barnes's diagnosis, several Society members in attendance were not so
sure. Pressed by the latter to defend his claim, Barnes explained that
[h]is own reasons for believing the person to be a male were, (1) the appearance
of the head, (2) the timbre of the voice, (3) the non-development of the breasts, (4)
the undoubted existence of a well-formed prepuce and glans penis, (5) the im-
perfectly formed urethra running down from the tip of the glands [sic] and passing
into the bladder, (6) the utter absence of anything like a uterus or ovaries, and (7)
the appearance of the perineum. The thighs were covered with masculine hairs....
Lastly, the patient never had the menstrual molimina. (212)
These seemed to Barnes significant and sufficient symptoms ofmalehood.

But if Barnes thought his diagnosis (that the patient was "undoubtedly a
man" [206]) would be uncontroversial, he was sorely mistaken.
Criticism and controversy began with a question from Dr. Charles
Henry Felix Routh, Consulting Physician to the Samaritan Free Hospital
and founding member of the British Gynaecological Society (hereafter
SPRING 1995
336 ALICE DOMURAT DREGER
Fig. 1. Barnes's "living subject" and the hand of an unknown medical man
from Barnes (original fig. 2), courtesy of the Ruth Lilly Medical Library, In
sity School of Medicine, Indianapolis.
VICTORIAN STUDIES
DOUBTFUL SEX 337
BGS). Routh asked whether the rectal examination conducte

had been sufficient, specifically whether it was enough to have
a digital exam, or if, rather, Barnes should have tried to "pass
hand into her rectum" to search for evidence of a uterus. Furt
Routh objected, "Even supposing there were no uterus, the mer
no argument against its being a woman." This might simply be
of a woman deprived of that organ. Routh was unconvinc
offered the additional evidence for manhood that two or three y
there had appeared a moustache and beard, but Routh protested
had absolutely no weight. ManyJewesses had quite a large quan
beard and moustache." Beards and moustaches, like absent uteri
unheard of in women (208). In Routh's eyes these were not sure
As consulting physician to the Chelsea Hospital for Wom
James Aveling had to agree with Dr. Routh on the matter of fac
he himself "had often seen it in women just as well marked." A
noted of Bares's subject that "[t]he face was feminine, [and]
was decidedly that of a woman, the pomum Adami not being a
nent" (208). He recommended putting the patient under an
and performing a bimanual examination "per rectum and t
abdomen" (210). He wanted, if at all possible, evidence of ovarie
Without that, perhaps Barnes had been too quick to conclud
For his part, Dr. G. Granville Bantock, surgeon to the Sa
Free Hospital, concurred that "[t]hey all knew how unsafe facia
teristics were as a guide, the dress making such a very great d
Nonetheless he found the case "clear as daylight." To him the c
lay well below the face: 'The appearance of the sexual organ
a penis, and the remainder of the urethra was to his mind, inco
evidence in favor of its being a male" (210). Still this reason
persuade everyone present. After all, deceptive genitalia we
problem in doubtful sex; it hardly seemed that in ambiguou
offending organs should stand as trustworthy witnesses to true
Fellows now argued about how much weight ought to be giv
signs, or to pubic hair and menstruation, or lack thereof, to th
the skull, to balding patterns. Dr. Routh pondered aloud the qu
whether a woman without a uterus and ovaries would still be a woman.
And, piling doubt upon doubt, Dr. Bantock paused to criticize Dr. Aveling's
handling of a similar case some years prior, with the result that a sub-debate
erupted between Bantock and Aveling over what should have been the
proper diagnosis in that case.
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Finally, in an effort to bring to a close this fractious exch

the London physician Dr. Heywood Smith "suggested that the
should divide on the question of sex" (212). Divide the men did
to decide what they had seen and felt, incapable of agreeing
nature of sex and its proper diagnosis. The 25 April 1888 me
the BGS had begun with Barnes's claim of alleviation of doub
instance of "doubtful sex." However, by the time the gatherin
not only had uncertainty about that subject's sex been reinst
doubt had metastasized, spreading in turn to the efficacy of
techniques, the aptitudes of particular colleagues, the surety o
symptoms of sex, and indeed the very nature of sex itself. Wh
one a male or a female? Sex was doubtful.
This article is about the doubt that surrounded hermaphro-

dites, and the efforts by late-Victorian medical men to tame that doubt.
It is the story of an unrelenting struggle on the part of physicians and
surgeons to keep men and women distinct, theoretically and practically,
even while case after case of hermaphroditism threatened that pro-
gramme. The 1888 BGS presentation and discussion of a hermaphro-
ditic subject did not form an isolated incident in the Victorian period.
Similar sorts of exchanges took place among a wide range of Victorian
medical men as they gathered around sexually ambiguous bodies.'
Brought to the ready attention of fascinated medical men, "doubtful"
subjects offered all kinds of confusing combinations of anatomies, phys-
iologies, and behaviors. Some men menstruated; a few women had
verifiably "erectile organs" of notable size; some people even came with
breasts, a penis, a vagina, and a beard-all at once.
Victorian "hermaphrodites" (as people with sexually ambigu-
ous bodies were generally called) forced medical practitioners like
Barnes and his Fellows to raise presumably-settled questions about
what made one a male or a female, and along with those questions
there also surfaced latent disagreement and doubt about the nature
of males and females. AsJudith Butler noted in Gender Trouble, a critical
analysis of the relationships of sex, gender, desire, and identity, any
body which does not clearly fit into stereotypical categories of sex
necessarily raises questions about the integrity, nature, and limits of
those categories:
VICTORIAN STUDIES
DOUBTFUL SEX 339
The presuppositions that we make about sexed bodies, about them being o
the other, about the meanings that are said to inhere in them or to follow from
sexed in such a way are suddenly and significantly upset by those examples th
to comply with the categories that naturalize and stabilize that field of bodies
within the terms of cultural conventions. (110)
Hermaphrodites were the ultimate disrupters of presuppositions

men and women. As such, hermaphrodites were also effective di
ers of comfort.
In a "Note on Hermaphrodites" in the 1896 volume of his Archives

of Surgery, Jonathan Hutchinson lamented, "So much of what is repulsive
attaches to our ideas of the condition of an hermaphrodite that we expe-
rience a reluctance even to use the word" (64). Truly the whole business
was quite disconcerting. What was one to do with a person who seemed to
be neither or both male and female? Furthermore, what was one to do
with the Woman Question if one could not exactly say what a woman was?
How could one distinguish "normal" from "homosexual" relations if one
could not clearly divide all the parties into males and females? And if
human hermaphroditism were possible, and not all that rare, what did this
say about the supposedly profound and natural differences between men
and women? Hermaphroditism was a sticky problem, one demanding keen
attention, particularly in the late nineteenth century when, just as her-
maphrodites threatened to crash "natural" sex borders, feminists and
homosexuals threatened to storm social sex borders. The problem of
doubtful sex held important ramifications beyond the life of the individual
doubtful patient. British medical practitioners agreed with their French
colleagues who, in writing on the enigmatic problem of human hermaph-
roditism, declared that "the possession of a [single] sex is a necessity of
our social order, for hermaphrodites as well as for normal subjects" (Tuff-
ier and Lapointe 256; my translation). Everyone, including every doubtful
person, had to have one permanent, "true" sex.
In human culture, a body is never a body unto itself. Anthro-
pologist Mary Douglas noted in her study of bodily pollution and taboo:
The body is a model which can stand for any bounded system. Its boundaries can
represent any boundaries which are threatened or precarious. The functions of its
different parts and their relation afford a source of symbols for other complex
structures. (115)
In its transgression of anatomical sex boundaries, the Victorian her-

maphroditic body inevitably became a site for the negotiation and
SPRING 1995
fortification of social sex boundaries. Responding to the threat

hermaphrodite, medical men did all they could to control and c
doubtful sex at the local and global levels. As this article demons
medical men tried in practice to resolve each case of doubtful se
a diagnosis of either "true" male or "true" female sex; meanwhi
their theory, they reconfigured the category of "true hermaphrod
in order to reduce the possibility of its existence in humans.
Much recent scholarship has been devoted to documenting
Victorian medical and scientific construction of sex and gender, esp
of women and femininity.2 My review of late Victorian medical lite
on hermaphrodites supports in part the findings of these studies in t
similarly demonstrates rampant sexing by medical men of various b
parts, behaviors, and desires. However, close analysis of the literatu
hermaphroditism also reveals that there was not a single, unified m
opinion about which traits were essentially or significantly male or f
The sexes were constructed in many different (sometimes conflicting
in hermaphrodite theory and in medical practice, as medical men st
gled to come up with a system of sex difference thatwould hold. Ulti
it was not only the hermaphrodite's body that lay ensconced in ambig
but medical and scientific concepts of the male and the female a
Still, however mixed and multifaceted sex was shown able to be, how
overt and extreme the disagreements about the nature of sex, m
men never ceased to assume that in the final analysis there were sti
and only two distinct, "true" human sexes. And, as the end of the c
neared, it became certain that any given body could and would o
entitled to one.
In 1903, the BGS received and published in itsJournal a lengthy

communication from one of its founding members. The piece was
entitled, "Hermaphrodism in the Daily Practice of Medicine; Being
Information Upon Hermaphrodism Indispensable to the Practitioner."3
The author, Franz von Neugebauer, then Director of the Gynecological
Section of the Evangelical Hospital of Warsaw, took very seriously his
international mission of documenting, publicizing, explaining, and al-
leviating cases of ambiguous sex. By the turn of the century this multi-
lingual Polish gynecologist held the unofficial title of premier world
VICTORIAN STUDIES
DOUBTFUL SEX 341
authority on hermaphroditism, having by then collected a

some 930 accounts of human hermaphrodites. Thirty-eight
subjects had been examined by him first-hand.
A principal aim of Neugebauer's BGS communication
impress upon his British colleagues "the grave conseque
erroneous determination of sex, and the frequency of suc
in ordinary practice" (226). Perhaps British practitioners n
admonished that "[t]he number of cases in which the
confronted by pseudohermaphrodism is much larger than i
supposed" (246). Nonetheless, even if they had to be pu
about the frequency of mistaken sex, they hardly needed
of the tremendous gravity of it. They knew very well from th
record the "importance of making early discovery of suc
order to save the miserable consequences, unhappiness, divo
even suicides, which may follow if they are not recognise
allowed to proceed in error" (Croom 102). Neugebauer'
mounting collections of marriages between persons discov
medically the "same" sex had made frighteningly clear the
of the "responsibility which is incurred by a doctor when
definite opinion in cases of doubtful sex" (Croom 102). Th
GynaecologicalJournal readers who faced doubtful patients of
accordingly would have appreciated this latest assembla
histories and tips from their expert associate.
Throughout the nineteenth century, hermaphrodite
supposed to come in two basic varieties: "spurious" and "t
gebauer and nearly all his colleagues (including those at the
meeting) usually assumed that patients of doubtful sex wer
spurious hermaphroditism; that is, ambiguous subjects wer
to be individuals in whom a single "true [male or female] se
or rendered dubious by the existence of malformations" (
490). This diagnostic supposition was due largely to collecti
experience-autopsies of doubtful people typically revealed
nal sex organs common to only one sex-and partly to pra
no one knew quite what to do with or tell a living patient w
a man or a woman exclusively. In any case, only those peopl
clearly shown "truly" to have organs essential to males an
could be considered true hermaphrodites. Therefore, un
otherwise, doubtful people were assumed to be merely sp
SPRING 1995
maphrodites, and the goal of sex diagnosis was simply to find th

"true" sex.
Sometimes a quick peek in the trousers or under the skirts

seemed sufficient to reveal a case of patently mistaken sex. In a good
number of cases the genitalia were not really ambiguous at all, but just
had been a little odd (and therefore mislabeled) at birth. Neugebauer
comforted his professional readers with the knowledge that "[i]n the
majority of [ambiguous] cases the true sex, even when indeterminate
at birth, declares itself spontaneously at puberty" (242). Socially and
psychologically resolution of these cases could be rather problematic,
but medically it was a cinch.
Secrecy about or unfamiliarity with genital anatomy sometimes
allowed sex-identification mistakes to remain unnoticed even long after
pubescent sexual blooms burst forth. For instance, J. Halliday Croom,
M.D., was presented with "two supposed girls, aged 19 and 21," brought
by their mother '"ith simply the history that they were both quite well
but that they had never menstruated." Croom noted that these two had
"masculine features," flat and hairy chests, "loud and harsh" voices, and
that "the elder had a budding moustache" (102). With what he thought
a stunning preponderance of masculinity, Croom had little trouble
diagnosing the problem, one which the mother had apparently not
suspected: the "sisters" were "really" malformed brothers. "Each had a
representative of the penis, about 1 inch long," and "no vaginal orifice
could be found." Moreover, "it was made out that each labium con-
tained what was evidently a small testicle" (103).
Few medical men shown the evidence Croom described would
have disagreed with his diagnosis, though many may well have won-
dered how it was "such a mistake could arise with the organs so obvious
as they were in this case." Croom chalked up the persistence of the
mistake to the fact that the two siblings "as children were brought up
abroad, in [the] charge of coloured nurses" who either did not realize,
or did not mention, that something was amiss (104).4 A relatively simple
error had been committed and allowed to continue until the messy
(presumably necessary) resolution was enacted:
Many formalities had to be gone through; questions with regard to their father's
will had to be adjusted, and new names had to be given to the young men, who
donned men's attire, left this country, and are now pursuing useful avocations in
the far East. (104)
VICTORIAN STUDIES
DOUBTFUL SEX 343
A rather unusual brand of British export, to be sure! As

concisely shows, sex diagnosis, no matter how simple, was n
merely intellectual exercise.
Lawson Tait had declared in 1879 that, in cases of hermaphr
ism, "the glandular element must always be considered as the chief
of sex" (124), and in fact it routinely was. Practitioners unanimousl
that if conclusive evidence of the nature of the gonads (as either ov
testicles) could be found, the question of true sex was solved. Thu
Frederick Willcocks, M.D., examined a child named Rebecca bro
the Evelina Hospital for Sick Children in April of 1884, he det
that her gonads '"were obviously testes, and the diagnosis was acco
made that the child was a mal-formed male" (310). Conversely, St.
Hospital Museum's specimen number LL 99, from a premature fet
"reckoned female in sex, since the generative glands consist[ed
well-developed ovaries" (Shattock 196). As one participant in
discussion remarked, whenever diagnosing doubtful sex, investiga
ferred to be able "to say definitely ... [that] they had found o
testes" (Edis in Barnes 212). Thus practitioners burdened with
children often waited to render definitive opinions, as they '
forward to the period of puberty" with the hope "that all doubt [
then be set at rest" (Lindsay 164). Specifically they hoped for som
and definitive sign of the nature of the gonads, such as the chara
descent of testicles.
Still, testes and especially ovaries often did not present them-
selves in an obvious way. Several techniques were available to the medical
investigator who sought concealed organs. At the BGS meeting rectal
examinations were the procedures of choice for literally feeling out or-
gans contained in the abdomen. Practitioners also combined rectal ex-
aminations with bladder catheterization or vaginal examinations; the idea
here was to determine tactilely if and what sort of organs (ovaries, testes,
uterus, prostate) might be hidden in the abdominal cavity. Bimanual
examinations (one hand reaching in the rectum or vagina, one pushing
externally on the abdomen) sometimes provided similar information.
The examiner often administered general anaesthetic before these inva-
sive examinations in order to lessen the pain caused the patient's body
or modesty (see Aveling to Barnes above, and Croom 102).
Failure to find particular organs, such as ovaries or testicles,
was sometimes taken as evidence that the organ did not exist, as when
SPRING 1995
;II
, 'I' I ,, /
I
I .
#I
CI,_
'//'
-
,'/
\9^.
Fig. 2. Sketch of the genitals of Lizzie, aged four, showing the ambi
Reproduced from Lindsay, original fig. 1.
Barnes concluded his patient did not have ovaries b

not locate them. But many were wary of such reason
as was C. E. Underhill when he admonished the Obst
Edinburgh in 1876, "In the living woman absence of
with certainty be recognised." Underhill was specif
that practitioners "avoid confounding these cases [f
apparent uteri] with male hermaphrodites" who hav
organs and formation of the female along with m
scended] testicles" (908). Furthermore, even if a prac
an organ, how could he be sure it was what it seeme
the nature of hermaphroditism. Neugebauer warned
ovary has often been taken for a testicle, or a testi
descent for an ovary" (250). The possibility of comb
VICTORIAN STUDIES
DOUBTFUL SEX 345
ceiving" organs made the matter still more confusing. For i

underdevelopment of the penis combined with undescended
and the development of a more or less rudimentary vagina simulates the

of a vulva; hypertrophy of the clitoris simulates hypospadias [a type of de
of a penis; labial ectopia [displacement] of the ovaries, the testicles; adh
the labia majora, the scrotum; non-adherent labia, a divided scrotum. (2
Navigation of this sea of doubt was no job for the hasty. The sexe
look and feel remarkably similar even to the experienced med
No wonder then thatJohn Lindsay, a Glasgow surgeon
tioned that "to found an opinion on the external appearance
would be in the highest degree unscientific" (163). Lindsay pe
faced an especially difficult situation, a triple dose of doubtf
three young siblings. For several years the parents had succ
hidden the ambiguity of Robert, Jessie, and Lizzie (respectiv
seven, six, and four) until Lindsay, called in to attend the family
a bout of measles, discovered the situation (fig. 2). Lindsay th
could discern what sex the children were, namely male, and yet h
only too well that "[t]he instances in which the post-mortem diss
such cases has falsified the ante-mortem diagnosis are numerous e
and striking enough to make one doubt whether during life an
as to the sex can be given with any assurances at all" (163). Exp
surgery was generally out of the question given that it was si
risky, and besides, it would not necessarily be helpful; biopsies w
performed on hermaphrodites in Britain until the 1910s, and
macroscopic visual inspection would not necessarily reveal th
of the tissue contained in the gland (and therefore the nature of the
gland, and by implication the sex).
Yet both Fancourt Barnes-who readily admitted "the difficulty
of deciding these cases without a post-mortem examination" (206)-and
John Lindsay-who confessed that "the whole story of sexual malforma-
tions make[s] one venture on a diagnosis with much diffidence" (164)-
felt it absolutely necessary to provide "strong opinions" of their patients'
sex, even at the risk of being "unscientific." Barnes, Lindsay, and many
other medical men so confronted with ambiguous sex figured that if,
stifled by their doubts, they let a potentially mistaken sex go without at
least expressing their well-informed opinion, they might allow what was
called an "error of sex" to continue, ultimately engendering wrongful
occupations, scandalous unions, and broken lives. How then did they
SPRING 1995
propose to figure the sex? By doing what the BGS tried to do for B
"living specimen": by "sum[ming] up the whole of the evidence," eva
ing and calculating the symptoms of sex until the "preponderan
evidence" weighed in favor of one (Edis in Barnes 211-12).
III
When John Lindsay made his report of Robert, Jessie, and

Lizzie to the Obstetrical and Gynecological Society of Glasgow in Jan-
uary 1893, he reminded his audience that persons of doubtful sex "are
frequently of an indifferent cast, or show a mingling of the characters
proper to the sexes separately." Lindsay was forced to conclude there-
fore that, in practice, "the classification of those who are sexually ab-
normal turns on the estimation of probabilities" (164). The Glasgow
surgeon meant this partly in a literal sense, that a practitioner ought to
know that statistics indicated that an ambiguous patient was much more
likely to be truly male (have testicles) than female (have ovaries).5 But
Lindsay's "estimation of probabilities" also referred to the general belief
among physicians and surgeons that sex might be estimated by calcu-
lating the many possible signs of true sex.
For instance, one might, through various procedures, manage
to elicit symptoms characteristic of testicles or ovaries from apparent
sex glands. Thus when a forty-two-year-old widow was admitted into Bird
Ward of Middlesex Hospital "on account of a painful swelling in the
left groin," the attending surgeon, Andrew Clark, suspected the swelling
was really a recently-descended testicle because he managed to rouse
classically testicular behavior from the swelling: "There was no impulse
on coughing, it was dull on percussion, very tender to the touch, and
not reducible into the abdominal cavity" (Clark 718, 719; see also
Martin 36; Phillips 160). Neugebauer advised surgeons and physicians
in similar situations to search for clues literally emitted by the testicles,
that is, for semen, because "error of sex in a male hypospadiac [spurious
hermaphrodite] brought up as a girl reveal[ed] itself comparatively
frequently by seminal ejaculations" (255). Nocturnal emissions and
ejaculation during intercourse also hinted malehood (see Cameron
350), conclusively so if the fluid expelled contained spermatozoa.
Certain extra-genital traits might also indicate the likely sex of
the gonads. The voice, for instance, seemed literally to bespeak the sex
(see Green 130; Maude 429). Recall that Barnes listed as one point of
VICTORIAN STUDIES
DOUBTFUL SEX 347
evidence for maleness the timbre of his subject's voice. A loud

or deep-toned voice seemed incongruous in a woman (Cro
Barnes and Barnes 531). Similarly hair appeared to emerge in
kind, and degree according to sex. Women were supposed natu
have had more hair on top and less the rest of the way dow
mistaken sex of some anatomically-masked males was exposed
short hair which stubbornly refused to grow past the shoulders.6
suspected his supposedly-female subject was a man in part bec
thighs were covered with "masculine hairs" (212), and bec
pubic hair crept in "unfeminine" ways past the mons veneris a
the navel (205; see also Croom 102).
Yet, as was the case in the BGS discussion, practitioners
to rely on these "estimations of probabilities" often disagreed whi
could be trusted as reliable symptoms of true sex. A simple ex
a contested sign is the cremaster reflex, a spontaneous and sud
vation of the testicle induced by certain stimuli like cold or
anticipated stroke on the inner thigh. Many practitioners thou
elicitation of a cremaster-like reflex from a genital swelling meant
it was a testicle, but not everyone "believed the cremasteric reflex
an absolute proof of the existence of a testicle" (Buchanan 217)
want of it to be proof of no testicle (Neugebauer 246). As this
suggests, and the BGS meeting richly illustrated, diagnosis of a "t
often depended on the eye, the hand, and the mind of the beholde
if medical men did not explicitly acknowledge this fact
For example, in matters of spurious hermaphroditism p
tioners often relied on the menses as the female diagnostic c
part to semen. Yet menstruation constituted a very tricky sy
For his part, Neugebauer was greatly distressed that his colleag
not often enough consider mistaken sex as the explanation fo
tent amenorrhoea (absence of menstruation) in supposed wom
reminded BGS colleagues that
the practitioner, whenever he is confronted with a case of absolute amen

should always remember the possibility of such a mistake [of sex]. Und
circumstances to omit an examination of the genital organs out of consider
the timid modesty of a young girl, may be a matter of great regret. (252)
Amenorrhoea was the condition that "more frequently than any o

led to the discovery of an error of sex" (252), but as Neugebaue
it was not by any means a sure sign of mistaken sex. It could just
SPRING 1995
signal a genuine woman beset by imperforation of the vagina or c

ital absence of the uterus-or, for that matter, pregnancy!
To complicate matters, it was not clear what symptoms
count as menstruation. Some but not all practitioners were w
take as signs of menstruation (in the absence of vaginal b
periodic pains and swelling, and "vicarious" bleeding through n
inal orifices like the nose. Consequently, although his sub
never had monthly bleeding, Sir Hector Clare Cameron, Prof
Clinical Surgery at the University of Glasgow, grew suspiciou
sex of a young man burdened monthly by excruciating atta
abdominal pain. They had started when the patient was thirte
of age (he was now twenty-seven), came monthly, and lasted
three days. Furthermore, "during each attack of pain the bre
came full and enlarged, and were so very tender that he coul
tolerate the weight of the bedclothes upon them" (349). This c
smacked of menstruation to Sir Hector, and sure enough, upo
ating he discovered an ovary, the removal of which ended t
plaints. Symptoms such as periodic pain, swelling, and extra
bleeding were lumped under the rubric of "menstrual molim
auxiliary signs of the body's attempt to menstruate, i.e., au
symptoms of femalehood. Like Sir Hector, many medical men
require genital bleeding for menstruation (see Barnes 206, 2
derhill 907, 912; Worrall 107).
In short, some practitioners did not view periodic genital ble
as a necessary sign of menstruation, and therefore femalehoo
while, some did not consider periodic genital bleeding a sufficient
femalehood. The reason was simple enough: "real" men sometim
struated. Experts were at a complete loss to explain why it was th
sionally menstruation occurred in male spurious hermaphrod
womanish-looking "true males" complete with testicles and no ova
the Middlesex Hospital widow (Clark 718; see also Neugebauer
Certainly some of this could be chalked up to trickery, as in the
case of Catherine Hohmann in Germany (later married as
Hohmann in America), who was suspected of smearing herself wit
to feign menstruation. Hohmann and other hermaphrodites were
monitored by medical men, doubtful of their menstrual veracity, a
titioners were warned by an expert German colleague of "the great
these individuals have to deceive any medical man" (Ahfeld qtd. in
464n).7 In some cases, the patient's word was as doubted as the sex
VICTORIAN STUDIES
DOUBTFUL SEX 349
Nonetheless, all trickery aside, some otherwise undoubte

appeared genuinely to menstruate (Moscucci 178-80). "A. B."
wife consulted the medical doctor William Rushton Parker because
they had both noticed that he had periodical red monthly discharges, usually lasting
about three days, and staining his shirts and sheets, [and so] they began to note the
dates on which this began, and ticked off the following days: April 24th, May 22nd,
June 19th,July 21st, August 14th, September 10th, October 9th, November 1st. (272)
The wife especially found the whole situation quite disconcerting, and
she wanted to know of Parker "whether he [A. B.] was a man, or a
woman, or both, or neither." The doctor guessed A. B. was "at least not
a complete man," but was at a loss to give any more definite diagnosis.
Like amenorrhea in women, menstruation in men was by no means
considered a normal condition, but neither was it considered an incon-
ceivable one. It was not at all clear a person needed ovaries and a uterus
to menstruate (see Stonham 226). Consequently Parker could not be
sure what A. B.'s bleeding meant. The nature and meaning of menstru-
ation was murky enough that many medical men would have agreed
with Dr. Bantock's frustrated remark in the 1888 BGS discussion: "Men-
struation again was hardly reliable" (210).

The breasts, too, were "hardly reliable" as indicators of true
sex. Certainly most (if not all) late Victorian medical men maintained
definite ideas about what made a breast feminine. "Feminine" breasts
were those that were full, rounded, "with large nipples surrounded by
a dark areola." They "gave to one's hands grasping them the distinct
feeling of mammary glands, and not merely that of masses of fat"
(Cameron 349).8 The problem with using breasts for sex determination,
however, was that men occasionally possessed these "feminine" breasts.
In fact, the condition was documented often enough that it earned its
own name, gynecomastia (or gynecomazia), defined in the late nine-
teenth century as the coincidence in a man of "feminine" breasts and
shrunken, absent, or misplaced testicles. This condition constituted one
of the many "masks" to true sex in male spurious hermaphrodites, but
it also was known to afflict pubescent boys, fat men, and male inebriates
and idiots. Sizable rounded breasts, however widely considered a fem-
inine trait, still made an untrustworthy marker of sex, as they could
indicate several pathologies other than true womanhood.
Part of what made doubtful sex so confusing was that it seemed
that the nature of many potentially-diagnostic characteristics could be
SPRING 1995
traced to non-sexual attributes. So, for instance, pubescence and obe

could bring about feminine breasts in a male. Race constituted an
factor that could mitigate the nature of the breasts (Schiebinge
and other signs that were otherwise typically considered simply sex
termined. In the BGS discussion, Routh's objection to Barnes's re
on facial hair as a sex symptom indicated that Routh thoughtJewish
enough to make facial hair grow on women. ("ManyJewesses had
a large quantity of both beard and moustache" [208].) Likewise w
of some Asian and African races were supposed commonly to po
hypertrophied clitorides and other "masculine" genitalia.9 Onanis
also alleged capable of making any woman's clitoris hypertrop
penis-like dimensions (Pozzi 454). Meanwhile, those familiar with
tic asylums testified that "It is not uncommon to find hirsute [
females amongst the insane," even an occasional woman with as "per
a beard and moustache" as an unshaven "real" man (Hills 130).
Age and premature aging were also construed to be signifi
mitigating factors in otherwise "sexed" traits. Infancy in males
times hid their telling organs, such that they appeared feminin
old age often incited in women "a manly appearance." One a
related that he had
had occasion to observe numerous examples of this in old women who have been
long in prison, or in a lunatic asylum; in these the female breasts quite disappear, a
beard is developed on the lips and chin, and they acquire a rough and manly voice,
so that when lying in bed covered up to the chest, they may very readily be mistaken
for a man. (Casper 253)
Race, age, sexual practices, insanity-all these and more could deter-
mine traits otherwise supposed simply "sexed." Various kinds of educa-
tion, climactic conditions, and occupation might make a man womanly
or a woman manly (Moscucci 184-85). Clearly there was more to sex
than sex. Heywood Smith had suggested the BGS "divide on the ques-
tion of sex," but it seemed sometimes as if sex itself was forever dividing.
Some sex traits did manage to remain almost entirely sex-dis-
tinctive, no matter what the extenuating circumstances. For instance,
the pelvis escaped from the sea of sexual doubt relatively unscathed.
Most medical men maintained the existence of "striking differences in
the shape and size of the pelvis in the two sexes" (Ogston 162, original
emphasis). In a dramatic demonstration of how firm this belief in
profound pelvic sex difference could be, John Phillips, staff physician
VICTORIAN STUDIES
DOUBTFUL SEX 351
at the British Lying-in Hospital and the Chelsea Hospital fo

measured the pelvic bones of an ambiguous baby in an
determine its sex (Phillips 162). Phillips's methodology was
diagnosing a baby, but not for resolving doubtful sex in adults
reporters often employed pelvic measurement to reach and
dence their conclusions (see Turner 1884).
Indeed, the entire skeleton seemed to stand as a litera
work that stayed sexually secure, no matter what the we
ambiguity hung upon it (see Edis in Barnes 212). In a lectu
medico-legal aspects of doubtful sex at the University of
Francis Ogston, M.D. and Professor of Medical Logic and M
prudence, enumerated in vivid detail the structural contra
man and woman. He focused his lengthy sex-difference obse
the maxim: "the female is usually not so tall as the male, and t
figure makes an approach to the ova1 not witnessed in the
masculine form" (161). So the doubtful body's proportions
would betray its sex. Men's limbs and appendages were assu
naturally more "stout and strong" (Maude 429), and "large
veyed a "masculine appearance" (Clarke 718). The "rounded
the female form" (Croom 102) was supposed made possi
woman's peculiar bone shape and fatty padding. The curve
pressed her knees together, and the prominent size and s
throat revealed what some thought that absolutely foundat
of malehood-the conspicuous Adam's apple (Aveling in B
Casper 253).
Sexuality was also seen as a strongly sexed trait (see Dreger,
"Hermaphrodites in Love"). The assumption that "true" males, i.e.,
people with testicles-even those with mistaken identity-would natu-
rally desire females, and "true" females, i.e., people with ovaries, would
naturally desire males, pervaded Victorian medical literature on doubt-
ful sex. The wife of A. B., the menstruating man, grew suspicious of her
husband's sex not only because he seemed to menstruate, but also
because he showed oddly little interest in her, even when she "did her
best to stimulate him." What kind of man could this fellow be? Certainly
not enough of one for Mrs. A. B. as, "doubtless cowed by his wife's
dissatisfaction, [A. B.] readily consented to a separation and allowed
her half his income" (Parker 272).
It came as no surprise (and was perhaps even satisfying) to J
Halliday Croom when one of the two supposed sisters, medically a male,
SPRING 1995
"confessed to feelings of sexual excitement when sleeping with

cousins" (104). Surely a sign he had diagnosed the "true ma
correctly! Jonathan Hutchinson articulated the belief that the o
tion of desire was sexed when he remarked in his "Note on Her
rodites," that "roughly speaking, and in a general way" the "s
organs of [each] sex are inseparably connected with its mor
emotional characteristics" (65).1? In fact Hutchinson hinted that
for the "wrong" sex might indicate an underlying "organic pecul
(66). The anatomy-desire link was supposed to be ubiquitous en
that medical practitioners faced by doubtful patients commonly fig
the "sex" of the subject's desires into the final diagnosis.
Male sexuality was thought naturally frightfully insidious, and
possibility (and occasional incidence) of masked males placed am
unsuspecting females caused medical men terrific anxiety. In fac
pernicious character of male sexuality constituted a major reaso
raising doubtful children as males; if a masked male were raised
females, his sexuality was bound to erupt, forcing him to behave "li
wolf in a sheepfold" (Neugebauer 245). Accordingly Lawson Tai
structed practitioners faced with thoroughly doubtful children:
If... no genital orifice can be discovered, let the patient be considered as a

for if brought up amongst males but little harm can come to him. If, howeve
individual were brought up amongst girls who turned out to be a semi-com
male, no end of mischief might accrue, as is amply proved in the case of Mad
Mugnoz, the nun of Ubeda, who suffered death for rape. (22)
Tait's warning was positively clinical compared to Neugebauer's

sition of the worst-case scenario. The latter described in lurid detail "the
supposed young girl of 16," really a masked man, "her sexual instincts
aroused by reading romances; sharing the dormitory of her fellow
pupils, she watches every night and morning these maidens at their
toilet, and without any restriction has opportunities of learning to
admire the bodily charms of persons of the opposite sex." These cir-
cumstances naturally served to "awake[n] in him, however innocent
hitherto in regard to sexual matters, desires that might easily lead him
to abuse the situation, in a way which might be followed by conse-
quences even more serious perhaps for the companions sacrificed to
his masculine desire than for himself' (244-45). (Note that the pro-
noun switches to the masculine precisely when desire for females is
VICTORIAN STUDIES
DOUBTFUL SEX 353
awakened.) At least when it came to male sexuality, it seemed

would find its way out, no matter how thick the veneer of abnor
IV
What then to do upon the revelation of mistaken sex? In late

1884 or early 1885, George Buchanan, a Glasgow surgeon, took it upon
himself to act on the maxim that male organs meant male desire when
he was presented with a nine-year-old girl named Christina. Initially "Dr.
Buchanan had some doubt as to the nature of the case, conceiving it
possible that it might be a hernial sac containing an ovary on each side,
or possibly a testicle in a patient, otherwise with the external parts of a
female." A cut of his knife showed it to be a case of the latter, and
Buchanan decided to excise Christina's testicles, "as it would [have
been] a singularly unfortunate thing for a person with all the outward
appearance of a female to develop into a man as to internal organs and
feelings" (214). A short time later, Buchanan presented the case history,
Christina, and her testicles to the local Medico-Chirurgical Society, and
was gratified to hear his colleagues assent to "the propriety of the
operation" (215).
Christina's case history did not form an isolated incident (con-
trary to Thomas Laqueur's claim that, while ovariotomies were not
uncommon, testicles were "sacrosanct" surgically-speaking [177]). Re-
call the widow who came to Middlesex Hospital and complained to
the surgeon Andrew Clark of a painful swelling in the groin. Clark
thoroughly examined the widow, and suspected testicles even before
operating. When he opened the patient's labia he found his diagnosis
vindicated. There was "no doubt about the nature of the organs" he
subsequently removed. They were testicles. Still, in the end Clark "did
not think it necessary or even fair to inform [the patient] of what we
had discovered, and when she left the hospital she believed, as far as
I am aware, that she had been suffering from an ordinary rupture
which had been cured" (719). The widow came a woman, and Clark
let her leave a woman, even if, like Christina, in a way and for a time
she had been medically male by virtue of two testicles.
G. R. Green of Ripon decided in favor of advising his patient
that she possessed two testicles. Twenty-four-year-old A. H. had come to
the surgeon in January 1897 to obtain his opinion as to why she never
SPRING 1995
Fig. 3. Photograph of A. H., "To show

Feminine Type." Reproduced from
Green (original fig. 1), courtesy of the
History of Medicine Division of the Na-
tional Library of Medicine, Bethesda.
Fig. 4. Photograph of the genitals of A.

H., "Showing Penis, Groove, and Ure-
thral Orifice." Reproduced from Green
(original fig. 3), courtesy of the History
of Medicine Division of the National
Library of Medicine, Bethesda.
VICTORIAN STUDIES
DOUBTFUL SEX 355
menstruated. Imagine her surprise at his answer! She looked very m

like a woman (figs. 3 and 4), she was employed as a woman, an
thought of herself as a woman. Inevitably,
[t]he question now arose as to what should be done, and as the patient in min
habit is more a woman than a man, and it is illegal for him to remain as h
female attire, he expressed a desire to have the testicles removed and con
woman. (132)
Green shared A. H.'s opinion that this was "the best solution o
difficulty," and accordingly he performed a double castration a
Ripon Cottage Hospital. A. H. then, in Green's words, "continu
woman" (my emphasis), that is, "He [sic?] made a good recover
having been unsexed, has now returned to domestic service as a
maid." Clearly A. H., though perhaps medically neutered, w
entirely "unsexed," for she went on to live as she had before,
woman, to wear the clothes and fulfill the occupation of a wom
be "in mind and habit... a woman" (132). Similarly, in terms of
identity, life did not change much for Sir Hector's patient (th
afflicted with menstrual molimina) after removal of his ovary,
that he no longer had to suffer periodic debilitating pain. He cam
left Sir Hector's practice as "a young man . . . an engineer by
(347), married to "a good-looking young woman," one "evidently
solicitous" about her husband (351)."
Paradoxically, the medical treatment of young Christina and
cohorts actually illustrates that gonads were not the only sex traits
counted, no matter what men of the profession claimed. Certain
gonads were terribly important, to Buchanan and several other surg
important enough to warrant prompt removal of testicles from a p
with "all the outward appearance of a female" (Buchanan 214). Bu
is the point: outward appearances mattered, at least as much a
gonads. For example, in the case of Christina, if the nature of the g
had been all that counted toward sex, Buchanan would have sim
declared Christina a boy and done what he could to have the pub
personal identity amended, as Croom did in the case of the very ma
line male "sisters." Yet, whatever medically her "true" sex, her outw
femininity and her personal and social sexual identity were extraord
ily significant. Indeed, every encounter between a hermaphrodit
medical man demonstrates this point, for whatever the degree of at
tion focused on the gonads, much heed was also paid to other
SPRING 1995
Fig. 5. The preoperative genitalia of Sarah Jane, aged two years and
Reproduced from Lloyd, courtesy of the History of Medicine Division of
Library of Medicine, Bethesda.
traits-not only as indicators but also occasionally as deter

ultimate sex. Thus in 1888 when a Birmingham surgeon wa
with two-year-old SarahJane and her sizable penis or clitori
could not be sure if the child was gonadally male or female
carefully considering the case in all its bearings, social as well
ical, [the surgeon] accepted the mother's suggestion, and am
member close to the pubes, and the child made a rapid reco
being brought up as a female" (Lloyd 103). SarahJane may s
testicles, but she was allowed to leave a girl.
As was true for the status of so many other supposed
traits, despite medical rhetoric, the status of the gonads w
or fixed. It seems that, when revealed, the sex glands count
cient signs of sex in most doubtful cases, and yet they wer
considered necessary signs. Sex diagnosis was often conduc
them. (Barnes, for instance, diagnosed his patient male tho
not found testicles.) And while the surgeons Green, Clark
chanan struggled to remind themselves their patients were "re
VICTORIAN STUDIES
DOUBTFUL SEX 357
by virtue of testicles, they seem to have in practice treated the

spoken of them as if they had always been female.12 Perhaps in sur
minds the removal of incongruous organs served to reinforce t
that seemed the true one, even if true sex allegedly depended sp
ally on the nature of the gonads. If gonads had been the only trait
really counted to sex, then the sex of all hermaphrodites would
been declared simply equal to the sex of the gonads, and men
breasts, girls with large erectile organs, people with the "wrong
shapes, sorts of hair, chests, voices, and desires would not have
the trouble they did. While gonads held important agency (diag
cally and physiologically) in the realm of sex, many other traits ret
deep-if enormously contested-sexuality.
It is especially remarkable, then, that in the midst of all
swarming doubt and sexual slippage illustrated above, medical men-e
those intimately familiar with hermaphroditism-managed to ma
the unflagging belief that there were two well-delineated sexes. Par
cally, the whole medical approach to hermaphroditism continued
imbued profoundly with the assumption that there existed two dist
sexes, and that, accordingly, each body ought to be naturally (or som
surgically) limited to one. One body, one sex: this was the magn
around which the rhetorical, conceptual, and physical treatment of
maphroditism hovered. Medical practitioners strived to make a
parts conform, conceptually and occasionally surgically, to a sing
Undoubtedly physicians and surgeons resorted to the conceptual
tionism of equating gonads with sex in part because gonads were
tively stable trait. In the great majority of people, they matched the o
signs of sex; furthermore, even hermaphrodites tended to have only
kind of gonad, and rarely were these organs missing entirely. Finally
gonads did radically contradict the outward signs (as they did in Ch
and company) then.their relatively simple removal meant a quick co
mation to one-body-one-sex.
Extraordinary as it seems, medical practitioners rarely ab
doned the idea that, no matter how many traits contradictory
gonads existed in a body, there was still only one sex in that bod
language chosen for "spurious" traits (traits that did not reflect the
"true" sex) indicated their status as deceptive interlopers. Howev
thentic it appeared, periodic bleeding in a "true" man constitute
"pseudo-menses." The annoying erectile organ removed from a f
a veterinarian was designated by him an "erratic penis" (Macgill
SPRING 1995
582). Similarly, medical men typically labeled hermaphrodit

not according to that genitalia's nature, but according to th
the gonads thought to be contained inside. Thus folds of skin t
for all the world like labia-and in a true woman would be "labia"-were
instead identified as "an incomplete scrotum" because they contained

testicles (see Corby 712; Croom 103; Maude 432). An erectile organ tha
on a boy would surely have been a penis, on a girl was instead brande
a "hypertrophied clitoris." No matter how blurry the organs became
medical men strove to keep them organized into the two sex camps.
What then of true hermaphrodites, those beings who by defini-

tion were truly male and female? With this pervasive devotion to th
one-body-one-sex rule, a devotion that seems to have grown more pas
sionate with every empirical challenge, it is hardly any wonder that by th
turn of the century, true hermaphrodites for the most part ceased to be
I do not mean the incidence of the particular anomaly changed. Nor d
I mean that true hermaphrodites were killed off, though some practition
ers may not have been sorry to see all hermaphrodites go that genera
route.13 Rather, what I mean is that medical and scientific authoritie
revised the criteria for true hermaphroditism such that it became almost
impossible at the fin de sigcle for any body to satisfy the experts' criteria
By contrast, throughout the early- and mid-Victorian period, a
relatively wide range of sexually-ambiguous bodies fit the medical def
inition of true hermaphroditism. Most British medical men from 184
to the 1880s subscribed to Sir James Young Simpson's classification
system, presented in the 1839 volume of Todd's Cyclopaedia of Anatomy
and Physiology. Simpson divided hermaphroditism into two orders:
Spurious and True; the spurious comprehending such malformations of the genital
organs of one sex as make these organs approximate in appearance and form to those
of the opposite sexual type; and the order, again of true hermaphroditism including
under it all cases in which there is an actual mixture or blending together, upon the
same individual, of more or fewer of both the male and female organs. (684)
The criteria for "true" hermaphroditism, as laid out by Simpson and

generally adopted, were fairly broad. Beings with many different com-
binations of "male" and "female" parts counted as true hermaphrodite
medically. Some so-classified true hermaphrodites had both of wha
VICTORIAN STUDIES
DOUBTFUL SEX 359
appeared to their investigators to be ovaries and testes, how

pendent and/or microscopic verification of the gonads' n
generally not required for the claim to stand. Accordingly,
true hermaphrodites possessing both ovaries and testicles
unchallenged through the early decades.
Additionally, and of particular importance for our p
under Simpson's classification scheme, true hermaphrodite
required to possess both types of gonads. A person provided wi
and a uterus (but no ovaries) could qualify as a true herm
(Rawdon 47; Simpson 1835, 703). Indeed Simpson and other
as a true hermaphrodite the Italian Maria Arsano although
absolutely none of the typically "female" organs internally (fig
posthumously-famed hermaphrodite passed an 80-year life
only to have her exclusively male internal organs discovered by
at an autopsy. Arsano was externally female and internally
in the early Victorian period, this was enough to make he
hermaphroditic. In other words, Arsano was a "true herm
although-or rather because-internally she was thoroughly
Until the mid-1880s, many established practitioners c
to employ Simpson's fairly liberal definition of true hermaphr
For instance, in 1885 Buchanan considered little Christina a
maphrodite although he did not think she had any ovarie
her testicles. In the same year, Fancourt Barnes and his fat
provided in their obstetrical textbook a fairly vague, Sim
description of what made a case one of true hermaphroditi
it was one "in which some of the sexual organs of both sexe
one individual" (531). But increasingly through the 1870s,
especially the '90s, more and more medical men grew impa
definitions of true hermaphroditism that paid mind to any
other than the establishment of both ovarian and testicular tissue.
Lawson Tait was an early lobbyist for the stricter taxonomy. In h

Diseases of Women, published in 1879, Tait argued that "it is not a phil-
osophical proceeding to say that both sexes are represented unless bo
a testicle and an ovary are present" (124). This new criterion gaine
steadily in popularity (see Cunningham 460), and increasingly autho
went further by demanding and providing microscopic evidence th
organs were what was claimed.
The definitive statement on the new criteria for true hermaph-
roditism came in 1896 in the form of a lengthy article published in the
SPRING 1995
Fig. 6. An anatomical sketch of Maria Arsano. Simpson classified Arsano

maphrodite, specifically "transverse hermaphroditism with the external sex
female type" and internal sex organs of the masculine type (703). The letter
pubic hair covering mons veneris; b, labia majora; c, clitoris; e, urethral ori
opening; g, testicles; h, vas deferens; n, ureters; o, urinary bladder; k, 4 m, s, t
Reproduced from Simpson, courtesy of the Ruth Lilly Medical Library, India
School of Medicine, Indianapolis.
VICTORIAN STUDIES
DOUBTFUL SEX 361
Transactions of the Obstetrical Society of London and authored by

Blacker, Obstetric Physician to University College Hospital, an
P. Lawrence, Curator of the Museum at University College. I
article, Blacker and Lawrence detailed a new taxonomy for t
maphroditism according to which "the utmost importance is t
upon the presence or absence of the genital glands themselves
establish their presence we must insist upon the necessity of
scopical examination" of the gland tissue (266) (See fig. 7). W
new criteria did not eliminate the possibility of true hermaph
in humans-in fact Blacker and Lawrence were "convinced . . . that
true hermaphroditism can occur and has occurred in man" (307

themselves offered an original case of it-the tougher prerequisite
radically reduce the number of true human hermaphrodites. Bla
and Lawrence initiated in their article what became a sweeping h
ical clean-up by reviewing previously legitimate cases of true herm
roditism. Nearly every case in which microscopic analysis was n
performed on the alleged ovaries and testes suffered eliminatio
their hands. Indeed, Blacker and Lawrence were stunned to discover
"upon what extremely slight foundations the diagnosis of true hermaph-
roditism was at one time based" (286).
After 1896, nearly every documenter of hermaphroditism ad-
hered to the new criteria, and it now became, in the fashion of Blacker
and Lawrence, a popular endeavor of those writing of sexually ambig-
uous subjects to review cases in the medical record.'5 Authors had done
this in the earlier part of the century too, but then it was to compare
their own cases to prior ones like them for diagnostic and illustrative
purposes. Now they reviewed past accounts in order to reclassify the
conditions, to move great numbers of previously true hermaphrodites
into the category of the spurious (see Hirst and Piersol 82; Primrose
70). Ironically, even Blacker and Lawrence's own case (a case they had
defended in their 1896 diatribe as one of only three confirmed in-
stances of true hermaphroditism) fell victim within a few years to the
re-assessment blitz (Ballantyne 491).
In short, the new criteria had three major outcomes. First,
medical history was revised, as nearly all previous cases were eliminated
from the already-dwindling ranks of true hermaphrodites for failure to
meet or evidence the new criteria. Second, far fewer new cases met the
criteria for true hermaphroditism and so almost all hermaphrodites
were now considered spurious, no matter how confused their traits (or
SPRING 1995
Fig. 8.
Fig. 6.
Fig. 7. Photograph of the histological sections provided by Blacker and Lawre

evidence their case of true hermaphroditism. The subject was a premature fetus stil
at eight and a half months. Blacker and Lawrence classified this as a case of
unilateral hermaphroditism," that is, hermaphroditism in which the sex organ of on
is an ovary or a testis, and that of the other side is both ovarian and testicular. B
and Lawrence claimed their subject's left gland (shown here in two sections) w
"ovotestis." The top section shows the "ovarian portion," and the bottom the "tes
portion." The letters indicate: c, cell nests; f, Graafian follicle; s, stroma; i, interstitia
t, seminal tubule. Reproduced from Blacker and Lawrence (original plate X, figs.
6), courtesy of the Ruth Lilly Medical Library, Indiana University School of Med
Indianapolis.
VICTORIAN STUDIES
DOUBTFUL SEX 363
their doctors). Third, given the limitations of medicine at the time

given that biopsies were not performed), the only possible tru
maphrodite was a dead and dissected hermaphrodite-or at b
castrated one. As if to weaken the true hermaphrodites even m
Jonathan Hutchinson declared in 1896 his conviction that, even
a truly sexually-mixed being did exist, rather than being doubly po
it was thoroughly impotent:
whenever this [true hermaphroditism] is the case, the organs are never dev
in perfection. The testes do not secrete semen, or the ovaries do not attain
functional activity, and thus the being who is in a sense bisexed is in another
unsexed, and never attains the full development of either. (65)
Small in number, dead, impotent, castrated-what a sorry lot th

hermaphrodites had become. And what a strange look true herm
roditism now had. No longer was the condition pictured in fac
even genitalia, like those seen in figures one through six. Now
hermaphroditism was depicted as in figure seven-as tissue sam
No doubt the conceptual shift to this strict, reductionistic de
nition of true hermaphroditism had much to do with contemp
developments in corollary medical sciences. German pathologists shi
medical attention to histology, and Blacker and Lawrence were
influenced by German pathologists (especially Edwin Klebs) who
a concern for tissue-based analysis and diagnosis. But why this d
to make ovarian and testicular tissue the sole markers of femalehood
and malehood? It could not have been purely a concern for reproductiv
capabilities, for even subjects anatomically incapable of impregnatin
woman were considered true males because they had testicular tiss
and even subjects anatomically incapable of being impregnated we
considered true females because they had ovarian tissue.
Perhaps then it was the physiological role of the gonads wit
respect to secondary sexual characteristics that made them seem so
important to sex? The subject period of this analysis saw the rise
internal secretion theories and the study of the ductless glands (w
would several decades later become endocrinology). C. E. Brown-Sequ
and other scientists widely publicized their findings with regard to the
systemic effects of testicular and ovarian extract injections, and dozens
investigators had observed the changes in sexual characters that to
place after removal of the gonads (Borell 1-10). But the first over
reference to internal secretions as the logic for the strict true-hermap
SPRING 1995
roditism criteria came only in 1905, nearly ten years after the g
acceptance of the new criteria (Lawrence 24).16 Moreover, true herm
roditism seemed to defy the very core of internal secretion theory
spurious hermaphrodites with testicles (and no ovaries) displayed en
female secondary-sexual characteristics, and vice versa. So attemptin
base the criteria on physiological aspects of the glands would onl
confused the issue.
What is so striking, then, is the strict yet somewhat arbitrary

character of the new, reductionistic definition of sex in the context of
true hermaphroditism. Medical men might well have stuck to a broader
(or for that matter, stricter) definition of true hermaphroditism.'7 Yet
this was the definition that seemed to ring true, and (probably not
coincidentally) one which made true hermaphrodites small in number
and eminently manageable.
In trying to understand the revision of true hermaphroditism
as a concept, it certainly would be a mistake to neglect the inevitable
importance of the concurrent rise of social challenges to sex borders.
For brevity's sake, let me suggest that, for instance, it cannot be a
coincidence that at the same time Michel Foucault and other historians
find the emergence of the homosexual, I find the virtual extinction of

the true hermaphrodite. And surely the hermaphrodite experts must
have known of feminism as something more than the anatomical pa-
thology for which they used the term ("the arrest of development of
the male towards the age of puberty, which gives to it somewhat the
attributes of the female" [Power and Sedgwick, "Feminism"]). For a
medical man to admit a doubtful subject to true hermaphroditism
would have been potentially to add to the threat of social sex confusion.
What on earth would one have made of the Woman Question if i
became patently clear that a good number of women were really or also
men, and vice versa? Perhaps this helps explain the theoretical single
mindedness in matters of true hermaphroditism among men who, in
hermaphrodite practice, frequently disagreed about what made a pa-
tient male or female. The fervor with which old cases of true hermaph-
roditism were dug up and decimated is extraordinary, as is the firm
insistence that theoretically one knew exactly what a true hermaphro-
dite was (or was not) when simultaneously in actual practice it was
phenomenally difficult to say what made a man and what a woman.
How doubtful sex was. It could be altered or blurred by so
many circumstances, by race, sexual practices, aging, by particular cli
VICTORIAN STUDIES
DOUBTFUL SEX 365
mates, occupations, and mental states. It could be profoundly

enough that it might be almost impossible to diagnose in the
even so masked that it might go forever "mistaken" unless a
autopsy revealed an "error of sex" and by consequence a new "
Indeed, it was not even clear what sex was-what traits, fluids
were necessary or sufficient for femalehood or malehood, wha
with an ovary was, what a woman who had her testicles remo
came. Yet the doubtful sex literature of the late Victorian p
fraught with this paradoxical fact: the more confusing and ab
cases of doubtful sex became, the more certain and constrictive
hermaphroditism (true double sex) grew. If practitioners coul
keep their heads above the sex doubt that walked into their h
and offices, at least conceptually sex in the realm of true herm
ditism seemed safely confined and certain. In the late 1890s a
twentieth century, the confident, reverberating declarations by m
men about the nature of true hermaphroditism, and by implicatio
nature of sex, amidst all the blooming sexual confusion they witn
was like the frantic painting of a house falling down. Medica
triumphantly re-constructed and constricted the true hermap
even while-perhaps because-they witnessed the malignancy o
Sex fractured, moved, blurred, slipped again, absorbed and e
organs and traits and behaviors and certainty from its grasp. Yet
end, sex, so exquisitely doubtful, was never really doubted.
NOTES
Funding for this project has been generously provided by Indiana Unive
by the Woodrow Wilson Foundation in the form of a Charlotte Newcombe
Fellowship. I am grateful to Jeanne Peterson, Ann Carmichael, Fred Chu
members of the Victorian Research Group of Indiana University for their assi
this project. Thanks also to Aron Sousa for help with my anatomy.
1 For instance, in November of 1875, a case of doubtful sex in a livin
was presented before the Medical Society of London by a practitioner who s
Society's advice. Those present could not agree on the likely sex, and they a
committee to look deeper into the matter (de Gorrequer 25-27). Sometimes
did emerge. A "child was considered a female by the meeting" of the South
Branch (East Kent District) of the British Medical Association, and "[a] ver
and interesting discussion followed" (Hart, "Communications" 1119). Coll
gathered outside the domain of formal medical societies (see Buchanan 2
131) and consulted relative experts like Lawson Tait (Tait 22n).
SPRING 1995
2 See Fee; Laqueur ch. 5; Moscucci; Russett.

3 By the last third of the century, almost all medical and scientific
preferred the term "hermaphroditism" to "hermaphrodism." (Neugebauer was a
exception.) The two words were used interchangeably but the longer preferr
it preserved the entire root ("hermaphrodite").
4 Compared to their continental analogues, British subjects of mistaken s
typically to have gone longer without suspicion of error (Dreger, "Doubtful Sex
This was probably due mostly to what the editors of the British MedicalJourna
lambasted as "the complete ignorance regarding the sexual organs and the sexual
which is permitted, and, indeed, sedulously fostered, by the ordinary education w
and girls receive in this country." The BMJ editors were "convinced that this se
'conspiracy of silence,' has gone too far, and that it is productive of serious evi
"Sexual Ignorance" 303). While this editorial on "Sexual Ignorance" and su
responses did not specifically enumerate mistaken sex as one of those "serious ev
might have if their authors had consulted Lawson Tait's 1879 treatise, Diseases of W
it Tait specifically listed feminine ignorance in sexual matters as one reason why
children should be raised male:
By the time a male arrives at the age of marriage, he will have learnt,
from the education which all men go through soon after puberty, whether or
not he has marital capacity; and if he finds that he has not, he will not attempt
to enter married life. But the majority of women enter the married state with
but a very hazy notion of what its functions are, a misfortune to which a large
proportion of their special diseases may be attributed. If a malformed male,
therefore, should be brought up as a woman, he may enter, and in very many
instances actually has entered, the state of marriage, utterly unaware of his
misfortune. (21)
Neugebauer claimed in his 1903 BGJarticle that '"awson Tait advised that it [the child of doubtful
sex] should be treated as a girl on the ground that it is far easier to protect a child from the
disagreeable results of a genital malformation in the social position of a girl than in that of a boy"
(244), but I have not found recorded any such recommendation by Tait. (See below for additional
advice from Tait on raising doubtful children.)
5 Arthur Maude of Westerham used this statistical reasoning when he argued
that although "[t]he rule in doubtful cases used to be to have the child brought up as
a female, on the ground that concealment of abnormality was easier for a girl than a
boy," in fact "this rule is a bad one in face of the unexplained fact of the far greater
excess of masculine pseudo-hermaphrodites over female" (431). Maude also suggested
it was better to raise doubtful children as males because of "the greater social difficulties
which, at a marriageable age, will await the male in petticoats than the female in
trousers" (431; see also Clark 718; Hirst and Piersol 80; and Turner 1884). On statistics
regarding hermaphrodites, see Dreger, "Doubtful Sex," ch. 1.
6 See Croom 102 and Maude 429. Interestingly, by contrast, French male
spurious hermaphrodites often brandished glorious heads of hair (see Dreger,
"Doubtful Sex," ch. 6).
VICTORIAN STUDIES
DOUBTFUL SEX 367
7 Some hermaphrodites, including Catherine Hohmann, made money b

themselves to medical men and other curious parties. The more profoundly m
appeared, the more they could earn, so Hohmann and others had a good reaso
signs. Gottlieb Gottlich, born Marie Rosine Gottlich in Saxony in 1798, made
(financially speaking) in the 1830s by exhibiting himself at many of the me
Europe. Gottlich was not suspected of deception, but he did decline corrective su
it would at once deprive him of his present easy and profitable mode o
(Handyside 318).
8 See also Clarke 718. For the flat nature of the masculine chest, see
Croom 102; Maude 429.
9 See, for instance, Phillips 162-63: "enlargement of the clitoris was, and doubtless
now is, very common among Asiatic and African races, especially in Arabia; indeed,
Albucasis describes the necessary operation for its removal, thus preventing obstruction to
coition and libidinous practices." (For race as a mitigating factor in sex traits, see Gilman,
"Black Bodies"; see Gilman, "Jewish Body," and Efron for the history of medical and
scientific theories about the unique anatomy ofJews.)
10 Of course, when they spoke of such things as "moral and emotional characteristics,"
medical authors usually had in mind a complex of traits rich in many things besides what we
call sexuality. Practitioners figured sex might reveal itself in a whole variety of "tastes" and
"penchants" (see Barnes 205; Maude 429; Targett 276), though unfortunately these were not
generally articulated in the record beyond a reference to such things as a "feminine
disposition" or a "masculine penchant." It is clear that modesty was often equated with
femininity, and boldness with masculinity. Pauline S., for example, was reportedly "anything
but shy and reserved; the character was decidedly masculine" (Targett 274). Compare
Neugebauer's account of another case: "And the patient, formerly timid and shamefaced as
a girl, at the latter period [seven years later] betrayed all the aplomb and assurance of a man,
and appeared naked and not ashamed before a company of medical men" (235).
1 Perhaps the sex situation made sense in Sir Hector's mind, because he thought
a testicle remained in the patient, in which case Sir Hector had literally excised the doubt
(in this case an errant ovary), and not the male sex.
12 Clark for instance apologized that throughout his report "I have called the
patient 'she,' though as far as we were aware she [again 'she'] had none of the essential
generative organs of the female" (719). In his history of A. H.'s case Green used the
feminine pronoun for his patient until he reported his findings; at that point he switched
to the masculine pronoun.
13 John Phillips, Physician to the British Lying-in Hospital and Senior Assistant
Physician at the Chelsea Hospital for Women, uncovered a whopping four cases of
spurious hermaphroditism in one family, and remarked with relief "[t]hat, fortunately
for the community, the survival of these creatures is not the rule, as they gradually waste
and die of inanition a short time after birth" (Phillips 167). Phillips's claim aside, I have
not found any evidence that this was in fact the rule.
14 Even Robert Knox, who degraded Simpson's work because of philosophical
disagreements, nonetheless concurred that the useful definition of true hermaphroditism
was simply "the existence of male and female organs in the same individual . . . these
organs [being] more or less perfect" (450).
SPRING 1995
15 A small minority continued (perhaps in ignorance of the standardiz

revisions) to use "true hermaphroditism" in the older sense (see Turner 1884).
16 Lawrence also explained why both kinds of tissue, rather than both o
were required: "mere fractions appear to exert an influence hardly inferior to that
whole gland" (24).
17 The German anatomist Ahfeld, for instance, defined the true hermaphr
as "an individual with functionally active glands of both sexes, provided with exc
ducts," i.e., one potentially able to impregnate him/herself (Hirst and Piersol 7
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Doubtful Sex: The Fate of the Hermaphrodite in Victorian Medicine

Author(s): Alice Domurat Dreger

ALICE DOMURAT DREGER

O n Wednesday, 25 April 1888, at a regularly scheduled meeting

These seemed to Barnes significant and sufficient symptoms ofmalehood.

BGS). Routh asked whether the rectal examination conducte

Finally, in an effort to bring to a close this fractious exch

This article is about the doubt that surrounded hermaphro-

Hermaphrodites were the ultimate disrupters of presuppositions

In a "Note on Hermaphrodites" in the 1896 volume of his Archives

In its transgression of anatomical sex boundaries, the Victorian her-

fortification of social sex boundaries. Responding to the threat

In 1903, the BGS received and published in itsJournal a lengthy

authority on hermaphroditism, having by then collected a

maphrodites, and the goal of sex diagnosis was simply to find th

Sometimes a quick peek in the trousers or under the skirts

A rather unusual brand of British export, to be sure! As

Barnes concluded his patient did not have ovaries b

ceiving" organs made the matter still more confusing. For i

and the development of a more or less rudimentary vagina simulates the

When John Lindsay made his report of Robert, Jessie, and

evidence for maleness the timbre of his subject's voice. A loud

the practitioner, whenever he is confronted with a case of absolute amen

Amenorrhoea was the condition that "more frequently than any o

signal a genuine woman beset by imperforation of the vagina or c

Nonetheless, all trickery aside, some otherwise undoubte

struation again was hardly reliable" (210).

traced to non-sexual attributes. So, for instance, pubescence and obe

at the British Lying-in Hospital and the Chelsea Hospital fo

"confessed to feelings of sexual excitement when sleeping with

If... no genital orifice can be discovered, let the patient be considered as a

Tait's warning was positively clinical compared to Neugebauer's

awakened.) At least when it came to male sexuality, it seemed

What then to do upon the revelation of mistaken sex? In late

Fig. 3. Photograph of A. H., "To show

Fig. 4. Photograph of the genitals of A.

Library of Medicine, Bethesda.

menstruated. Imagine her surprise at his answer! She looked very m

traits-not only as indicators but also occasionally as deter

by virtue of testicles, they seem to have in practice treated the

582). Similarly, medical men typically labeled hermaphrodit

instead identified as "an incomplete scrotum" because they contained

What then of true hermaphrodites, those beings who by defini-

The criteria for "true" hermaphroditism, as laid out by Simpson and

appeared to their investigators to be ovaries and testes, how

Lawson Tait was an early lobbyist for the stricter taxonomy. In h

Fig. 6. An anatomical sketch of Maria Arsano. Simpson classified Arsano

Transactions of the Obstetrical Society of London and authored by

true hermaphroditism can occur and has occurred in man" (307

Fig. 7. Photograph of the histological sections provided by Blacker and Lawre

their doctors). Third, given the limitations of medicine at the time

Small in number, dead, impotent, castrated-what a sorry lot th

What is so striking, then, is the strict yet somewhat arbitrary

find the emergence of the homosexual, I find the virtual extinction of

mates, occupations, and mental states. It could be profoundly

2 See Fee; Laqueur ch. 5; Moscucci; Russett.

7 Some hermaphrodites, including Catherine Hohmann, made money b

15 A small minority continued (perhaps in ignorance of the standardiz

Ballantyne,J. W. "Hermaphroditism." Encyclopaedia Medica. Ed. Charles Watson. Edi

Borell, Merriley. "Organotherapy and the Emergence of Reproductive Endocrinology."

Cameron, Sir Hector Clare. "Notes on a Case of Hermaphrodism." British Gynaecological

Dreger, Alice Domurat. "Hermaphrodites in Love: The Truth of the Gonad

. ed. "Communications; South-Eastern Branch: East Kent District." British Medical