Why blog this?

This the senior project I wrote nine years ago. It might be of interest to people studying the history of medicine, sexuality, or the eugenics movement. If you have any comments or suggestions please post. I hope to revise it at some point and would love a critique or two.

P.S.

Be aware that this project contains anatomical and sexual diagrams that are explicit.

Preface

This project started as a search for something else. I had been researching the medicalization of homosexuality in post-World War II America last summer. What I sought was psychiatric case studies; I wanted to analyze these in order to reclaim the lives of those who suffered treatment. I wanted to understand how and why people sought treatment for their “homosexuality” and what this treatment actually entailed. I was looking for a way to illuminate the mode and meanings of the medical project to “cure” same-sex desire and the wider project to eliminate the “homosexual.” Implicit in my proposed analysis was an attempt to explore how medicine regulated the ways in which all of us conceive “sexuality” in the latter half of our century. Accomplishing all of this was much more difficult than I imagined.

Cases studies that involved the treatment of homosexuality are among the most difficult medical records to find. The major reason for this is legal. Most hospitals will only release their records to physicians, certainly not to undergraduates. Psychiatric records are kept confidential under the law. Records of “homosexuals” are even more veiled in secrecy. I have been told by experts in this type of research that finding such cases would be nearly impossible even if I had access. For obvious reasons, psychiatric records are not arranged by subject. Faced with this reasonably understandable form of academic censorship, I decided that it would be better to start research of this kind when I became a physician myself.

Faced with these difficulties, I changed the direction of my research. I wanted to study a particular physician who did sexological research -- someone who was renown in medical circles but still relatively unresearched. To do this I turned to the medical history archive of the Harvard University Medical School. The archivist there directed me to the Robert L. Dickinson papers. Looking through the collection of papers, notes, and drawings I realized that I had found a wealth of material that lent itself to the type of analysis in which I was interested. My search had ended, and this project began.

Robert L. Dickinson’s work has largely gone unnoticed by scholars interested in gay, lesbian, and gender studies. Most of the focus has been on the late nineteenth-century European sexologists which came before him, men such as Richard von Krafft-Ebing or Havelock Ellis. If not focusing on the early sexologists, scholarship has been directed toward the studies of those that came after Dickinson, principally the studies of Kinsey of the 1940s and 1950s or Masters and Johnson’s work in the 1960s and 1970s. What I am suggesting here is that Dickinson had an important role in the development of sexology in America. He was the first American sexologist. For that reason alone, Dickinson’s work is important.

It is hard to speculate why Dickinson has been ignored. Two reasons for his exclusion from history come to mind: his work stayed mostly within the medical community, it did not receive the same attention in the wider culture as other medical experts. Secondly, he has not been studied because his work deals with women. Women’s issues have been understudied in gay and lesbian scholarship; the stress has been on gay studies, not lesbian studies. This is not a question I seek to resolve in this project. In some small way, I am trying to rectify this omission.

In what follows, I want to remedy the lack of scholarly interest in Dickinson by giving the first introduction to his sexological works. Underpinning my exploration of Dickinson’s life in research is a belief that the agendas of queer studies and gender studies are linked. It is impossible to conceive of sexuality without thinking of gender. Scholarship which questions the meaning of “sexuality” should necessarily focus on gender as well. Accordingly, in figuring gender we must understand the place of sexuality. We have not yet reached the point were desire is only understood based on the gender of its object. I am not sure if this time will ever occur, but until it does, it is important for feminists and those who stand against homophobia to work together. In my reading of Dickinson, I am trying to draw these connections.

Matthew DeGennaro, May 1996

Chapter 1: "Now, We See as in a Speculum, Darkly": Robert Dickinson's Program for American Gynecology

--Robert Latou Dickinson (1861-1950)




Sexual behavior is not, as is too often assumed, a superimposition of, on the one hand, desires which derive from natural instincts, and, on the other, of permissive or restrictive laws which tell us what we should or shouldn't do. Sexual behavior is more than that. 1

-- Michel Foucault


Robert Latou Dickinson (1861-1950) was a man of conviction who sought to reformulate gynecology. In this, he struggled to engage what he conceived was the origin of a fundamental problem in American society, the instability of the family The most crucial threat was the mismanagement of desire; he thought this would lead to "marital maladjustment". As a physician, Dickinson thought he could lend his gyneco-scientific eye to the study of gender and sexuality to make an objective difference. By accumulating physical, sexual, and familial histories of his mostly female patients, he sought to unlock the secrets of sexual disharmony in the marital bed. The application of his discoveries was supposed to alleviate or prevent the pains of marital strife, divorce, and social maladjustment which he linked to sexual deviance. Dickinson's work represented an attempt to extend the medical gaze to tackle what he would come to call "sociologic problems".

Dickinson was one of the most prominent medical advocates of birth control and sex research of the early twentieth century. He published from 1887 to 1951. Dickinson attempted to bring the respectability that medicine could offer to these controversial subjects. To this end, he formed the Committee on Maternal Health2 in 1923 which studied contraception, fertility, abortion, and sexuality. The case studies that served as the basis for his conclusions were drawn from his own prior gynecological practice and from new studies which the committee undertook. During the 1920s, Dickinson became increasingly supportive of Margaret Sanger's untiring efforts for the legalization of birth control. He became one of her most important advocate in the medical community and lobbied fellow physicians to support the legalization of contraception. Dickinson sought to prove that the birth control methods of his time were safe and effective. He felt that contraception was an important tool that allowed for sexual happiness and could be medically necessary in many cases.3

Contraception was one among many other issues the Committee on Maternal Health focused on. Dickinson defined the aims of the committee as "studying marriage, premarital instruction, birth control, abortion, prevention of the unfit from producing their kind, and trying to find out what the normal in sex life is."4 Under the auspices of the committee, four major works were published which reflected these research objectives, Control of Conception (1931), Human Sex Anatomy (1932), A Thousand Marriages (1933), and The Single Woman (1934).5 Control of Conception was the most widely read with the first edition going to two subsequent reprints, with a second edition published in 1938.6 Dickinson was heavily involved in the research and publication of all these books. The last large publication he worked on was the Doctor as Marriage Counselor. Dickinson died before it was ready to go to press. The research for and the dissemination of the information in these works was the primary function of the Committee on Maternal Health, and its activities represented the culmination of Dickinson's life's work.

Dickinson brought his own liberal Episcopalian views to his sex research. As James Reed, Dickinson's most significant biographer, explains "one of Dickinson's functions as a reformer was to bear Christian witness that sex was a force to be accepted and enjoyed."7 Dickinson was not a sexual revolutionary, but he was a sex reformer. Specifically, types of sex and who should enjoy them were clearly prescribed in Dickinson's texts. Erotic acts needed to be understood, described, and directed to ensure the health of the individuals involved. Mutual, monogamous heterosexual satisfaction leading to orgasm was the idealized standard by which Dickinson judged all sexual acts. All other forms of desire were seen as pathological. This scientific management of desire would allow, in Dickinson's view, for societal acceptance of specific types of sexual fulfillment that were designated as healthy.

Dickinson's perspective on sexuality was fundamentally influenced by his European sexological precursors. European medical experts were becoming increasingly concerned with sexuality and its relationship to health in the late nineteenth century. This new interest of the medical establishment was exemplified by the sexological works of men such as Havelock Ellis, Richard von Krafft-Ebing, and Magnus Hirschfeld. Sexology attempted to extend medical control over bodies and minds. Death and disease were already under medicine's nearly exclusive jurisdiction; through the discourse of sexology, sexual life became medicine's new province. A preventive medicine that could protect the moral, mental, and physical health of individuals, and ensure the proper reproduction of the race by intervening before transgression, emerged in the late nineteenth century and early twentieth century in the work of these pioneering physicians. Sexologists viewed sexual deviance in terms of disease. Their work added socially prohibited sexual acts to the medical lexicon. Medical terms like "homosexuality," "sadism," and "fetishism" emerged and were seen as disease entities with their own specific etiology. Dickinson read much of this sexological literature.8

Michel Foucault concluded that the medicoscientific codification of sexual acts through the theory and praxis of sexology has produced a fundamental change in the construction of the individual as the subject of scientific discourse. In historical periods preceding the investigations of the sexologists, sex was an act that revealed little in and of itself. Such acts did not constitute the truth of an individual, a secret that needed to be explored in order to reveal health or pathology, nonetheless men and women were ascribed particular roles in and outside of the bedroom. Sexual acts signified gender, power, and pleasure, but were not a key to understanding the fundamental nature of individuals.9

The sexological discourse and its medical implementation disrupted the traditional gender-based evaluation of sexual acts. The active/passive binarism was no longer the primary analytical tool with which to understand sexual acts and to identify personages. The concepts of heterosexuality and homosexuality were introduced into the medical nosography by sexologists. Eve Kosofsky Sedgwick sums up the implications of what emerged in this new historical formation.

New, institutionalized taxonomic discourses - medical, legal, literary, psychological - centering on homo/heterosexual definition proliferated and crystallized with exceptional rapidity in the decades around the turn of the century, decades in which so many of the other critical nodes of culture were being, if less suddenly and newly, nonetheless also definitively reshaped. Both the power relations between the genders and the relation of nationalism and imperialism, for instance, were in highly visible crisis. For this reason, and because the structuring of same-sex bonds can't, in any historical situation marked by inequality and contest between genders, fail to be a site of intensive regulation that intersects virtually every issue of power and gender.10

The construction and proliferation of sexualities, as Sedgwick insightfully viewed the late nineteenth and early twentieth centuries, impacted not only the individuals directly spoken about in these texts, but the culture as a whole. The sexological discourse had an impact beyond the bounds of a constructed sexuality. It spawned a cultural shift that changed the structure of power, gender, and subjectivity in Western Culture. These ideas became part of the cultural lexicon.

On a more minute scale, the new taxonomy defined the pathological nature of distinct personages to whom particular biological attributes were ascribed. Who they are became defined by who they experienced desire for. For example, men were only supposed to be women's lovers. If a man found pleasure in the arms of another man it was a result of some congenital defect. Socially inappropriate love was a disease for the sexologists. Not only was sexual deviance pathological, but it was a mark. When read by the trained eye, sexologists believed such markings could reveal pathology and possibly degeneration. The meaning of sex was being reduced to what could be recorded by scientific observation. What was healthy was always already defined by what was shown to be pathological.11

Richard von Krafft-Ebing (1840-1902) was the first major sexologist to get wide medical recognition. His vision of sexuality permeated most sexological thinking into the twentieth century.12 His monograph Psychopathia Sexualis, originally published in Germany in 1886, was a milestone in the study of sex. It was influential among medical experts long after it was published. He did not intend for the book to be read by the general public. The basic precept of Krafft-Ebing's sexology was that sexual proclivities were biologically based. He did not believe this was true in every case; sexual pathologies could be acquired. However, the locus of sexual desire was firmly placed in the body.13

Sexual desire during the years of sexual maturity is a physiological law. The duration of the physiological processes in the sexual organs, as well as the strength of the sexual desire manifested, vary, both in individuals and in races. Race, climate, heredity and social circumstances have a very decided influence upon it.14

Krafft-Ebing has located activity of the sexual organs and sexual desire in biology. He created a paradigmatic way of looking at sexual acts. Varying differences in sexual appetite were explained by race and heredity. Environmental or developmental factors that could lead to sexual difference were seen as secondary by Krafft-Ebing. This biological way of looking at desire led him to oppressive conclusions especially when he turned to the subject of sexual pathology. For example, Krafft-Ebing spoke of "fully developed masochism" as being "hereditarily transferred to a psychopathic individual in such a manner that it becomes transformed into a perversion."15 "Perversion" existed as a hereditary trait that led to disease. Sexual deviance was primarily seen as the result of biological degeneration throughout his work.

Krafft-Ebing tried to explain what was sexually healthy through exploring what was pathological. He cataloged perversity. Through medically defining "perversion", Krafft-Ebing created a scientific language for discussing sexual morality. His most significant contribution to sexology was transposing the discussion of sexuality from the moral, political, and economic spheres to the realm of medical science. This fundamentally changed the relationship of society to sex acts in Krafft-Ebing's discourse. Sexuality became a question of health, above and beyond morality. Krafft-Ebing's medicalized vision of sexuality laid the ground work for further sexological investigations in the late nineteenth and early twentieth centuries.16

Foucault demarcated this historical shift in the history of pleasure in terms of Scientia Sexualis. This new perspective on sexuality emerged under the auspices of a science of desire that linked confession with the empirical project in which both gender behaviors, sexual acts, and sexual personages could be medically analyzed.17 In light of this emerging sexological tradition, Dickinson saw sex as an empirical question which his society knew all too little about. Sexology was producing new data and research potentialities. It was a scientific discipline that Dickinson was determined to disseminate to American medical audiences.18

Dickinson continued the work of European sexology in the American context. Of all the medical experts on sex, it was Havelock Ellis that principally influenced Dickinson. Ellis had Dickinson's respect. Dickinson was impressed by the multifaceted approach to the study of sexuality that Ellis employed. Dickinson would combine Ellis' use of the case study with his own gynecological expertise. It was through this combination of sexology and gynecology that made Dickinson unique. Through continued sexological research and its proper application, Dickinson believed the constitutional and social future of Americans would be safeguarded. Dickinson, like Ellis, viewed sex not only as a question of health but also as the culmination of desire.19

In this formulation of the role of medicine in regard to culture, an investigation of individual bodies would lead to the understanding of the collective social body. Armed with new knowledge, social reformers of the Progressive Era through to the 1930s sought to develop more effective techniques to arrest deviance, and thereby promote societal cohesion. Moral and political problems increasingly became empirical questions as positivistic science attempted to extend its focus into what would be called the social sciences. Dickinson believed that through education most social problems could be alleviated. What stood as education for him was based in scientific observation and conjecture. Dickinson was a positivist.20

Dickinson was not alone in his faith that empirical investigation could solve nearly all problems. This positivist evaluation of science was intrinsically tied to the eugenics and sexological movements which were particularly influential in the early twentieth century.21 Dickinson was an important player in a wider social contest which was defining the nature of acceptable familial relationships, gender roles, and sexual practices.

Becoming a Gynecologist

Dickinson grew up among those who were reaping the benefits of the industrial expansion of the United States in the late nineteenth century. Born into an affluent home in Brooklyn Heights in 1861, Dickinson was brought up with traditional, New England Episcopalian values. Civic responsibility, professionalism, and the sanctity of the family were some of his foremost concerns.22 Industrial expansion and its accompanying population growth in the cities caused concern for men like Dickinson. The decline in Protestantism and the growth of Catholic and Jewish populations in the city were particularly problematic for many in his social milieu. There was much concern among protestants that this change in the distribution of population would lead to a decline in morality to the detriment of the American social order. These changes lead many Protestant churches to become involved in urban reform.23

It was a bright and prosperous time for Dickinson's family. His father was an industrialist and was well able to provide for Dickinson's education and travel. Dickinson was an accomplished swimmer, sailor, and artist. He was exposed to the polite upper-class society of Brooklyn Heights and summered at his uncle's farm in Connecticut. It was at this farm that he suffered a terrible accident which left him with a large, permanent scar because of inadequate medical attention. A carpenter had to sow his stitches because no doctor could be found. Through this experience, Dickinson recalled discovering his passion for medicine. He wanted to alleviate suffering because he himself had not received adequate medical care. 24

When he and his family returned to America from a four year sabbatical in Europe in 1877, Dickinson entered Brooklyn Polytechnic Institute. There he received a traditional liberal arts education which was equivalent to the last years of high school. After graduation he entered the Long Island College Hospital medical school instead of accepting a job in lithography. Before the sweeping changes brought about three decades later by the Flexner Report, medical schools did not require a college degree for admission. This school was a symbol of the new found prosperity of Brooklyn. Long Island College Hospital medical school modeled itself on the European university-hospital system; it was the first teaching hospital in the United States.25

Dickinson exhibited a passion for gynecology early on in his education. Dr. Alexander J. C. Skene (1837-1900) served as his mentor. Skene was a prominent Brooklyn gynecologist who won his reputation by his successful and sometimes inventive practice, but not by his research. Dickinson worked closely with him and served as an illustrator on his Treatise on Diseases of Women (1888).26 Dickinson drew upon his artistic skill often in his life and employed it to his advantage in his gynecological practice. He went on to graduate first in his class at Long Island College Hospital. He was unable to immediately get involved in research because the necessary grant possibilities did not yet exist in the American medical establishment. Like many other new medical graduates of his generation, Dickinson went into private practice. The many patients he saw in his successful practice would later serve as case material for his inquiries into the nature of sex.27

The state of American medicine was quite different when Dickinson became a gynecologist than when he began to focus exclusively on sex research in the 1920s. In the 1870s and 1880s the state licensing of medical practitioners was beginning in earnest. Doctors in many areas had to register with state medical boards in order to obtain licenses to practice. New physicians generally had to have diplomas from medical schools, although existing practitioners could still continue their careers without a degree. Although medical schools were not regulated in any particular fashion, these boards could reject applications from doctors who had diplomas from disreputable schools.28 Dickinson received his license to practice through his diploma. However, Long Island College Hospital would later be regarded as a second-rate institution. Nonetheless, Dickinson's medical education was better than average for his day.

The lax nature of medical regulation equated to wide ranging standards for becoming a medical practitioner. There was no strict control over what was taught in schools and no strong emphasis on research. The focus of medical training was on practice, not the advancement of medical knowledge. Medical schools did not have substantial endowments or state funding. Many schools were privately run for profit. This lack of funding left little money for research but this would soon change.29 Dickinson would become caught up in the movement for the reform of medicine through a new emphasis on scientific objectivity. Medicine's new focus on scientific research was in part ushered in by the Flexner report of 1910.

American medicine experienced a significant change in the early part of the twentieth century. Doctors began to slowly organize under a national body. To facilitate this, the American Medical Association was established in 1846. It was not until the twentieth century that its membership grew significantly. From 1900 to 1910, the AMA's membership increased from eight thousand to seventy thousand. According to Paul Starr, many physicians felt that their economic and professional rights were not being represented. They wanted to have a greater voice in American society through collective action. Following the organization of labor and corporatization of capital that was a hallmark of the Gilded Age, physicians wanted to organize to improve their standards of living. Doctors sought to escape from corporate exploitation through socioeconomic solidarity. Doctors in the period succeeded in improving their economic status and their social respectability.30

The American Medical Association was not just interested in the consolidation of professional authority. Reform of the medical college establishment was crucial to forming a strong, independent profession. In 1904, the AMA established a Council on Medical Education that was mandated to improve and standardize requirements to get into medical school. It also investigated the quality of medical schools. The council soon realized the situation was grave; many schools were far below the standards they sought to establish. The AMA chose not to publish these findings for fear they would violate codes of professional solidarity. However, they called upon the Carnegie Foundation for the Advancement of Teaching to do an independent survey which culminated in the publication of the Flexner Report in 1910.31

The Flexner report demonstrated the discrepancy between the progress that had been made in medical science and the backward state of medical education. The smaller schools were the hardest hit by the report. Many of them claimed to be research oriented but the Flexner report contradicted their claims. A large number of smaller medical schools which were run for profit, could not afford to invest in expanded research facilities. The impact of the report caused the closure of these schools because they could no longer produce certifiable graduates. The consolidation of medical schools was accompanied by a reduction in graduates and a standardization of medical education.32

However, the consolidation of medical schools brought about by the changing structure of the American medical establishment had a negative impact on women, minorities, and those who could not afford to pay the rising cost of a medical education. Only those with the necessarily large financial resources could pay for medical school and the new preparatory education necessary for acceptance into a medical school. Many schools, which had previously accepted women and minorities, could not afford to make the necessary changes to become more scientifically credible. Policies were adopted that discriminated against Jews, women, and African-Americans in many of the surviving schools. As a result, medicine became an increasingly elite upper class, white male dominated profession.33

Many philanthropic foundations began donating heavily to the remaining medical institutions which followed a program of research-oriented, academic medicine exemplified by the Johns Hopkins University. The AMA's support of medical education reform combined with the flow of capital to these institutions made them dominate the profession. By the 1920s, this shift in the American medical establishment focused resources on the basic science aspects of medicine such as physiology, cell biology, and anatomy. Expanded research facilities and full-time clinical research positions existed at nearly all medical schools. Patient care was no longer the primary focus of a medical education. Young doctors were trained to be both scientists and care givers. Scientific research received a new prestige which had not been seen before in American medicine which transformed the climate in which physicians practiced.34

The impact of the changes in medicine led to increased professional authority. The rise of income and status of physicians in this period was linked not only to medicine's reorganization but to the widespread cultural acceptance of this privileged role of the doctor. Paul Starr sees these changes as resulting from the, "widespread support, which they received because of complex changes overtaking the entire society, physicians were able to see social interests defined so as to conform with their own. This was the essence of their achievement."35 The medical establishment positioned itself to have a near monopoly on matters of health in America.

Eugenics and Sexuality

In this new climate of empirical investigation and medical authority, Dickinson began his research into sexuality, contraception, and women's lives. He was fundamentally influenced by the shift in medical perspective toward scientific investigation. Another concurrent influence on his investigation into the sexual life was eugenics. Eugenic theory gave him expanded criteria with which he could judge the validity of sexual acts. It offered a language in which moral issues, societal fears, and racism could be scientifically articulated. Dickinson felt these problems should be within the scope of medicine.

The first few decades of the twentieth century saw the expansion of the eugenics movement in the United States. In the pre-World War I period, new ideas of heredity and the constitutional nature of personality spread from England to America. Initially, American eugenicists joined the British organization, the Eugenics Education Society, which was established in 1907. In 1923 an organization was brought into being in the United States, the American Eugenics Society. It quickly expanded and had twenty-eight state committees. The actual numbers of members were relatively small but they had many prominent people in their ranks. Doctors, clergy, university academics, and others who held respected positions in society were attracted to the American Eugenics Society. Dickinson himself was a member of the advisory council. Professionals were attracted to the eugenics movement as they were to other social reform campaigns.36

Eugenics, in part was popular because of its ability to connect with the concerns embedded in the social purity movement. Such groups saw the unraveling of society as the result of moral decay. They wanted to return society to what they thought was a more traditional state. Social purity organizations were concerned with preserving the integrity of a bourgeois family which symbolized the purity of the past. Much of the social purity discourse dealt with the control of sexuality, particularly male sexuality and its relationship to prostitution and temperance.37 Eugenics had an added appeal to social reformers even though its views were not always in line with conservative social purity organizations. It offered a scientific way to solve social problems to which other reform programs had no recourse. Anxieties about the decline in birth rate in middle and upper-class families, the loss of morality, and the impact of waves of immigration were all addressed by eugenic theory.38

Eugenic ideas began to filter into popular culture in the second two decades of the twentieth century. Magazines and newspapers published articles expressing eugenic opinions. "Fitter Families" fairs celebrated the superiority of eugenically fit families. American culture embraced eugenics as a new brand of science that had potential to make a difference for "everyone". Eugenics was part of the general atmosphere of social reform which was sweeping America.39

The early twentieth century was marked by its emphasis on reforming society and this extended to new spheres for governmental intervention. Enlightened reform government during this time relied on the advice of scientific experts. Many of these experts drawn upon were eugenicists. New laws were drawn up using eugenic data as their basis. At the national level, laws were enacted to curtail immigration of non-whites and Southern and Eastern Europeans. Eugenic legislation was most successful at the state level. Such laws included restrictions on marriages of "drunkards," "the insane," "the mentally deficient," and persons who carried a "transmissible disease". Some state laws allowed the involuntary sterilization of "defectives" and sometimes criminals. Though this legislation was not uniform, it was surprisingly widespread.40

Increasingly, social deviants such as criminals, homosexuals, alcoholics, and "the feebleminded" were labeled as biologically degenerate "types" as a result of the new eugenic perspective. These ideas marked the poor among other groups and blamed them for their situation, instead of locating responsibility in the social stratification brought about by the mode of production. Eugenics was coextensive with the bourgeois management of the "masses" in American capitalism. The increasingly surveilled behavior of "degenerates" was understood as a product of poor breeding and inherent biological inferiority. Although environmental causes were still sought to explain why people transgressed, these reasons were secondary to hereditary factors. Transgressing laws or taboos was no longer a simple question of the morally weak giving in to vice and crime; transgression was explained, rather, as the result of proclivities inherent to the flesh. These marginalized people exemplified a supposed racial degeneration that many in the middle and upper classes feared was happening in the United States.41 (see figure 1 and 2)


-- Figure 1: "The sins of the parents are visited upon the children- syphilitic father and blind son."


-- Figure 2: Eugenic diagram describing the potential of environmental factors in male development

The eugenics movement in America advocated both positive and negative ways of improving the stock. Many argued for a scientifically directed propagation of the human race, but disagreed about its exact implementation.43 The difference between positive and negative eugenic methods was explained clearly in lay person terms in the American Eugenic Society tract, Tomorrow's Children (1935).

Negative or restrictive eugenics is the application of social measures to the problem of limiting the number of children in families where genetic principles enable us to predict an undesirable inheritance with a high degree of probability, and where environmental conditions indicate that the training will be poor. . . . Positive or constructive eugenics is the application of social measures to increasing the number of children in families where the probability of a desirable inheritance and good training is strongly indicated.44

Both forms of eugenics involved the management of reproduction through some standard of genetic fitness. A scientific language is adopted in this passage which conceals the race and class-based assumptions behind the empirically-based presumptions. Bourgeois norms were thus naturalized. Positive eugenics involved the promotion of reproduction in families who were both constitutionally and socially fit. Negative eugenics involved limiting the birth of the socially undesirable. The more radical forms of the latter ranged from involuntary sterilization, to other less invasive forms of birth control, limitation of marriages, and/or segregation of degenerate types.45

The language used to discuss those who were labeled unfit was both reductionistic and dehumanizing. In articulating the merits of positive or negative eugenics, Huntington used an analogy between human reproduction and plant propagation.

The case is like that of seeds in a garden. What we want is good seed from which to get not only good flowers and vegetables, but more good seed for next season. The only way to be sure of such seed is to have plenty of good plants and prevent poor varieties from growing with good ones.46

The garden analogy used in this passage made the "problem" of heredity seem quite simple to the reader. In order for the progress of humankind to continue, a eugenic gardener must take matters into "his" own hands. Natural selection and human evolution became the tools of social engineering for the eugenicist. The extreme measures that would have had to be undertaken would equate to mass sterilization and segregation of "undesirables". American eugenics goals were ideologically linked with racial policies that the Nazi party would implement once in power. The metaphor of the garden reduced human destiny only to the preservation and enhancement of the germ plasm. During the middle and late 1930s, the linkage of American eugenics with German fascism eventually lead to its most serious criticism and vehement cultural disavowal.47

Eugenics was intrinsically linked with race hygiene in the cultural sphere. Eugenic assumptions about who were "undesirable" were tied to racially infused, class-based biases. Members of the eugenics movement claimed the term "race hygiene" for themselves. In Tomorrow's Children, Huntington sought to answer the question why eugenics sometimes was called race hygiene. His reply was, "because it will do for the race what personal hygiene does for the individual."48 He went on to suggest that those defined by eugenic investigation as "defectives" were an insidious disease that posed a threat to America's future.49

This medicalized metaphor of the social problem of "defectives" drew upon notions of purity and cleanliness. The social body was made dirty by the presence of those constructed as less than pure. Mainline American eugenics was a program to clean the social body through the elimination of those who transgressed the mores of the polite society and could not adequately compete in the marketplace. Social misfits, physical misshapes, and those who lived in squalor were all indicted in this discourse. Their births were seen as careless mistakes by those in the eugenics movement. Eugenics promised to prevent the birth of "degenerates" so the "unfit" could not hamper the progress of bourgeois society.

The discourse of eugenics put the body at the forefront of public discourse. Within individual bodies existed the dangers of social degeneration and the promises of a new society free from deviance and disorder. This was a historical moment that allowed a gynecologist like Dickinson the discursive authority to research into subjects that were socially contested: birth control and sexuality. Taking an approach similar to what Ellis had done previously in England, Dickinson could turn to sexological research and attempt to reorient gynecology to his perspective.

“Now, we see, as in a speculum, darkly”

By 1920, Dickinson had turned fully to research. He left his gynecological practice and lived on the investments he had accumulated over the years. His large office-home in Brooklyn was exchanged for a smaller apartment in Manhattan. Dickinson had gained eminence as a surgeon but felt that the perfection of surgical techniques was not as rewarding as sex research. Although he lacked training in the basic sciences, his intellectual curiosity led him to devote the rest of his life to a more serious "study of womankind."50 Dickinson saw the female body as centrally important to the maintenance of social stability. By understanding more about this body - its pleasures, its diseases, and its supposed reproductive proclivities - he thought he could understand the root of American social problems. His focus became centered on how sociological problems related to and stemmed from women. He would instruct other gynecologists to follow in his footsteps.51

Dickinson was influenced by many important figures who spoke about women's relationship to social strife and cultural redemption. Contributing to an article about Havelock Ellis for his eightieth birthday on January 11, 1939, Dickinson showed the great admiration he had for him. Dickinson ended his essay with this sentence "The noble head of Havelock Ellis is a fitting leader in the line of the prophets of the promised land, a line which includes powerful figures like Malthus and Galton and Drysdale, Forel and Mensinga, Reuter and Hardy and Briffault , and the priestesses of the time to come Margaret Sanger and Marie Stopes and Aletta Jacobs."52 These theorists and activists represented the intellectual world that Dickinson aspired to be a part of. A world where the scientific management of heredity, reproduction, and "races" were the keys to saving a civilization that was constructed as being in serious decay, was described by these authors. Dickinson wanted to do his part to help American civilization and drew upon the ideologies of men such as Galton, Malthus, and Briffault. The "priestess of the time to come" were applying these ideologies through the birth control movement to women's bodies, but for not necessarily the same conservative end. Despite the prominence of all these figures he situated Havelock Ellis above them as their leader. Ellis' work touched upon much of these theorists' life's work.53

Ellis was the most fundamental influence on Dickinson's research into sexuality. He represented for Dickinson the culmination of a long stream of thought about sexuality and race's connection to the development of Western civilization. Feminist scholar, Margaret Jackson sees Ellis' sexological perspective as the codification of male sexual power which relied on two main themes. The first being that normal heterosexual sex is based on a power relationship which is biologically determined; masculine domination and female submission are natural and necessary to sexual satisfaction. The second assumption was that all forms of abnormal sex are extensions of the normal and even violent and dangerous forms of sex are rooted in "innocent and instinctive" impulses.54 She argues that sexology disrupted and undermined feminist challenges to male power by articulating a false ideology of sexual liberation.55 The specter of Ellis' phallogocentric sexology would haunt Dickinson's work, but without Ellis it seems impossible for Dickinson to have emerged as an American sexologist. Ellis' sexological paradigm was what Dickinson articulated in the American context. The limits of love and sex for these sexologists were unconsciously already prescribed by their observational standpoint.

Robert Dickinson had risen to the top of his profession but he had since retired from his private practice by the second decade of our century. In his inaugural address as the president of the American Gynecological Society in May 1920, Dickinson unveiled a bold new plan for American Gynecology. This address was paradigmatic of Dickinson's scientific inquiry into the lives and bodies of women. He began his address with a discussion of the state of American gynecology. The analysis and readjustment which medicine had been undergoing made Dickinson feel that it was of the utmost importance for gynecology to reorganize itself. He wanted gynecology to continue to progress and reform or he believed it would become antiquated and absorbed into other medical specialties.

Further studies into the various departments of medicine are imminent. It is for us to decide whether we shall lead or be led in such surveys. Now, we see, as in a speculum, darkly. It is for us to say how we wish to be seen in the future.56 (bold mine)

Dickinson spoke here of a lack of clarity and direction in the gynecological profession. He believed that there were reasons that made gynecology a distinct speciality. Gynecology had been quite successful with dealing with obstetric complications and the "diseases of women" in Dickinson's opinion. More importantly, he believed that gynecology's past and present ability to obtain knowledge about the pathology of women's anatomy and physiology was reason alone for gynecology's independence. Dickinson challenged his audience to continue research on a much grander scale than ever before. He wanted to both sharpen and extend the focus of gynecology.

Dickinson endeavored to reformulate the structure of the American Gynecological Society's organization and extend its scope. This was in the interest of facilitating research and promoting professional cohesion. The professional language of gynecology was to be reformed. As Dickinson explained to his audience, "a standard nomenclature should be a matter of agreement on the part of authoritative organizations.57" Gynecology must have its own distinct medical language in order to continue to be a distinct medical speciality in Dickinson's view. Through discursive systematization, gynecology would be able to progress more rapidly, operate more efficiently, and continue to possess its own exclusive forms of knowledge about women and their bodies. Dickinson did not want gynecology to lose its authority.

Since research was a necessary part of Dickinson reform program, he wanted the result of their studies to be shared between members of the American Gynecological Society. To facilitate the exchange of professional opinions, he wanted a new official journal to be established. Dickinson defined this journal as, "an example of the type of concrete and visible activity on the part of the Society."58 The journal would serve as a repository for new gynecological knowledge. More importantly, the journal would show the medical community and other professionals the necessity of a gynecological perspective, given the new findings it would contain. Like other scientific organizations, gynecology would have an academic journal.

In his address Dickinson also pointed to some new directions for gynecological research. He stressed that there were new realms for gynecology to encompass and offer assistance. Dickinson laid out a program to tackle what he called "sociologic" problems such as marital instability or preventing the birth of "degenerates". Such problems were not traditionally part of the gynecological sphere, but presumably by their connection with women's health Dickinson felt confident that other gynecologists would begin to explore them. According to Dickinson, gynecology had lacked the appropriate concern for these issues in the past.59

The Society's interest in sociologic problems, to judge from recent volumes of the Transactions, does not evince itself to the extent of half a dozen papers in a dozen years. These are of limited range, dealing chiefly with venereal diseases and prenatal care.60

The narrow focus of his contemporaries must change and there was much to uncover as Dickinson saw it. He believed that gynecology could be useful in more ways than just ensuring proper fetal growth, maternal nutrition, and protection from infection. These activities were certainly important for Dickinson; yet he saw that through proper medical intervention, at the earliest of stages, the gynecologist could be involved in the prevention of illness.

Dickinson drew upon eugenic theory to support his claim that gynecology could serve a preventive capacity. He presented a classic negative eugenic viewpoint in regard to sterilization of "diseased" women.

From among the strictly technical social problems that are in our hands, a few instances may be given. Is there a simple method of preventing propagation among women who are idiots, epileptic, hopelessly insane or incurably criminal?61

Dickinson was steering gynecology to participate in the eugenic project of stopping degeneracy. He claimed these eugenic concerns were only technical and, subsequently, were well within the reach of the intervention of medical science. The dehumanizing language he used, such as the words "technical" and "propagation", turned women who are not healthy in the eugenic sense into objects of scientific knowledge who needed to be policed by gynecologists for the greater social good. "Unfit" women were seen as without the necessary subjectivity to recognize the dangers they posed to society. His perspective was that such women needed to be taken under the care of their gynecologists to prevent social harm.

The "sociologic" problems Dickinson wanted to address were eugenic concerns that he felt the gynecological establishment was ignoring. These were areas into which he wanted gynecology to expand its jurisdiction. The most radical form of preventive medicine, sterilization, should become standard gynecological practice as Dickinson assessed the situation. Dickinson was sponsoring the genocidal elimination of those with the "potential" to be idiots, epileptics, insane or criminals by the members of his association. He assumed a constitutional basis for social deviancy. This belief in a constitutional basis for behavior positioned Dickinson to propose a means of social progress through medical management.

At the opposite pole from sterilization, with its enormous potentialities of betterment of the race, is artificial impregnation. Dublin proposes to open the abdomen after a few months of sterile married life, and Boston and Brooklyn do so without trial of this simpler means. This procedure is an excellent instance of the need of collective experimentation, since no man is likely to have a large experience.62

Dickinson was clearly charging gynecology to embrace notions of race hygiene. In the spirit of negative eugenics, sterilization was a tool he felt could be used to reduce socially unwanted pregnancies. There were other methods to improve the race as well. Artificial impregnation had much promise as a tool of implementing positive eugenics. Dickinson wanted gynecologists to direct their studies to "opening up" women's bodies to see how fertility can be improved upon. Through this experimentation on women, Dickinson thought his Society would be able to ensure the fertility of the fit, while sterilizing those who are not of the proper extraction. Dickinson believed the objective gynecological eye can purify the race through a collective medicoscientific intervention into women's reproductive organs. According to Dickinson gynecology should not only prevent degeneracy, but they must help those who were healthy and without a suspect family history to understand their obligation to reproduce.63

Presumably working together under Dickinson, American gynecologists could devise new ways of preventing the further degeneration of the race and possibly improve the stock. He promised societal progress by way of the application of eugenics through the speculum and the surgical knife. It is clear that Dickinson has combined the medical interests of gynecology with the goals of the eugenic movement. Using the new science of eugenics, he would resituate gynecology as an important and necessarily independent branch of medicine.

In order to accomplish this, Dickinson saw the need for further study. Sexuality and birth control were the two principal problems that Dickinson thought gynecologists needed to investigate.

Another of the distasteful subjects we naturally shirk is contraception. What serious study has ever been made bearing upon the harm or harmlessness of the variety of procedures, or concerning the failure or effectiveness of each? Who has or can acquire any considerable body of evidence on these matters but ourselves? What, indeed, is normal sex life? What constitutes excess or what is the penalty for repression in the married? Do we still have to hark back to Luther for an answer? It will take a few professional lifetimes of accredited histories to gather evidence to submit, but some time a start must be made.64

Dickinson believed the time was at hand for gynecologists to embrace subjects that had not been addressed previously. Gynecology must understand all aspects of the sexual life to accomplish his goals. Dickinson wanted gynecology to open the mythical bedroom door to understand the multiplicity of behaviors and normalize them to conform with some external, idealized medico-moral criteria. With this knowledge, Dickinson and the members of the Society would prescribe a proper sexual behavior that was healthy and contraception that worked. Needless pregnancy and senseless repression were solvable problems with the proper data, given the proper understanding of sexuality. Sexuality could apparently be liberated from "Luther," but only as far as what the data showed was "normal". What his form of sexual liberation entailed was left unanalyzed in his speech. Repression may be costly for Dickinson but licentiousness could be even more dangerous for him. Therefore, more study was needed in order for Dickinson and American gynecology to fully understand what fell into the contested category of a normal sex life.

By invoking Martin Luther, Dickinson was seemingly distancing himself from ideas of sexual repression. By moving away from silence concerning sexual issues, Dickinson was moving away from the still recent Victorian past. He was casting himself as a sexual pioneer in a supposedly more enlightened age.65 This had another important effect. By representing himself as allowing all sexual possibilities to come under medical scrutiny, he conjured unbiased objectivity. This apparent progressive openness towards sex was by no means the entirety of his particular medical project. The word "normal" still haunted his speech and limited the possibilities of both objectivity and liberation.

This new understanding of sexuality that Dickinson wanted to bring about was to be used for sex education as well as to inform medical praxis. He stated to his audience, "parts of sex instruction belong to us, and we may well be chief counselors in the determination of the details of the curriculum." Dickinson wanted gynecology to be an authority in matters of sex education concerning women since women were, in a sense, his province. This instruction would involve the gynecologist speaking directly to the patient and also demonstrating techniques. He used the metaphor of masturbation to make his point. Sex instruction he said, "applies to the prevention of vulvar irritation and watchfulness lest the normal degree of autoeroticism go beyond bounds ." Watchful observation was necessary to prevent pathology for Dickinson. The limits of sex would be defined by gynecological research and enforced through the gynecological consultation. Dickinson turned speaking about sex into a preventive medicine.66

Dickinson's vision of sex instruction was based in the embedded structure of power within the medical relationship. The doctor was conceived as both healer and teacher. The woman was constructed as the object of knowledge and source of pathology. Dickinson's rhetoric was indicative of a disparity in power relationships. In the service of his particular scientific perspective, Dickinson relegated women little of any real subjectivity. Women were constantly spoken about in his work but only in terms he and other specialists had already defined. Yet, women were presumably the source of knowledge that the gynecologist drew upon. Dickinson's perspective on gynecology revealed the complicated relationship between women and gynecologist.

Dickinson's articulation of eugenic theory made visible the centrality of women's bodies within that particular discourse. Women were the cause of race degeneration by their inappropriate couplings. Women were also the necessary source of racial regeneration. Therefore, the control of women was necessary for any eugenic act. Women's reproductive power was too important for eugenicists to leave unpoliced. In a sense, sexology served as a form of applied eugenics through its power to regulate sexual acts.

The connection between sexology and eugenics, which Dickinson's work exemplified, revealed sexology's inability to escape its own coercive power. Dickinson sought to liberate women from sexual unhappiness and the burdens of unwanted pregnancy. Yet, his discourse permitted only a further surveillance of their bodies and proscriptions of their pleasures. Of course, this surveillance was conceived by him as "for their own good". Yet, it only (re)presented the sexual restrictions placed on women in a scientific form. Dickinson's articulation of sexological theory did not seek to overturn the sources of power which restrict female pleasure. It, in essence, only strengthened them.

The rise of the medical industry, the spread of sexology, and the growth of eugenic ideology were all intrinsically linked in a particular historical moment. Dickinson's medical foray into sexuality was a production of the particular historical moment from which these discourses emanated. Dickinson brought sexology to American gynecology and connected the research projects of the two. His work represents the multiplication and intensification of medical discourse concerning sex. This "incitement to discourse", as Foucault would call it, leads in Dickinson's work to the pathologization of women and the redefinition of gender roles in terms of male power (knowledge) and female subservience (ignorance). Dickinson's pathologization of femininity was new in the sense that new aspects of women's lives were coming under the gynecological gaze. More than ever before, the interstices of women's sexuality were now available to the gynecologist for the purposes of research. The knowledge obtained, through both verbal confession and physical observation, would be used to regulate women's sexual activity and control their desires.

Dickinson would continue this process of obtaining knowledge about women and using it to delineate their sexuality throughout his career. He defined himself as "a gynecologist who studied the body as an exposition of the mind questioned the pelvic organs for documentary evidence of emotional experience and accumulated records about the sex life of woman in relation to health and personality."67 The body, seen as the essential source of behavior, was always connected with the mind in his work. Directing medical vision toward female genitals was an important analytical tool for Dickinson; it allowed the body to stand testament for behavior in a striking fashion. He positioned himself as a neutral observer of physical fact merely looking at the body. The dubious connection between the pelvic organs, the case history, and understanding sexuality will be explored in the next chapter.

Chapter 1: Footnotes

1 Michel Foucault, Foucault Live: Collected Interviews, 1961-1984 (New York, 1996), p. 322.
2 The Committee for Maternal Health was later renamed the National Committee for Maternal Health, for clarity I discuss it throughout this text as the former.
3 James Reed, From Private Vice to Public Virtue: The Birth Control Movement and American Society Since 1830 (New York, 1978) pp. 167-80.
4 Robert Latou Dickinson Papers, Box 4, Fd 14, Francis A. Countway Library of Medicine, Harvard University, Boston. His analysis of the research objectives of the Committee on Maternal Health was excerpted from a speech he gave to Vassar College students on March 4, 1932 entitled "Evolution vs. Revolution in Sex Mores".
5 Robert L. Dickinson, Control of Conception, 2nd Ed. (Baltimore, 1938), and Human Sex Anatomy (Baltimore, 1933); Robert L. Dickinson and Lura Beam, A Thousand Marriages: A Medical Study of Sex Adjustment (Baltimore, 1931), and The Single Woman: A Medical Study in Sex Education (Baltimore, 1934).
6 Robert Latou Dickinson Papers Box 15, Fd 63.
7 Reed, p. 148.
8 Jeffrey Weeks, Sexuality and its Discontents: Meanings, Myths, & Modern Sexualities (New York, 1985), pp. 64-79, and Robert Latou Dickinson Papers, Box 3.
9 Michel Foucault, The History of Sexuality: An Introduction, vol. 1 of The History of Sexuality, trans. Robert Hurley (New York, 1978), pp. 53-73.
10 Eve Kosofsky Sedgwick, The Epistemology of the Closet, (Berkeley, CA, 1990) pp. 2-3.
11 David F. Greenberg, The Construction of Homosexuality (Chicago, 1988), pp. 400-11. The author provides a discussion of the medicalization of sexuality and its intrinsic links to degeneracy theory, social Darwinism, the legal regulation of sexuality, and Freudanism.
12 It is important to note that Freud's development of psychoanalysis in the early twentieth century distanced many medical professionals from a strictly constitutional basis for sexuality. However, Ellis and Dickinson's sexology was essentially based in Krafft-Ebing's ideas, not Freud's. See Sigmund Freud, Three Essays on the Theory of Sexuality, Trans. James Strachey, (New York, 1905).
13 See Richard von Krafft-Ebing, Psychopathia Sexualis (New York, 1965).
14 Ibid., p. 42.
15 Ibid., p. 186.
16 Paul Robinson, Modernization of Sex (Ithaca, NY, 1989), pp. 21-27, and Krafft-Ebing, pp.61-67.
17 The History of Sexuality., pp. 53-73.
18 Dickinson, Robert L. "The Average Sex Life of American Women," Journal of the American Medical Association 85 (1925): 1113-7.
19 Robert Dickinson Papers, Box 1, Fd 38.
20 Boyer, pp. 195-204, Reed, pp. 181-93.
21 For more on this subject see Kevles,; and Paul Robinson, Modernization of Sex (Ithaca, NY, 1989), pp. 1-41.
22 Reed, pp. 147-9.
23 Paul Boyer, Urban Masses and Moral Order in America: 1820-1920 , (Cambridge, 1978) p. 133.
24 Reed, pp. 147-9.
25 Ibid., pp. 149-150. Long Island College Hospital is still graduating medical students. It is now part of the State University of New York and has been renamed the Health Science Center at Brooklyn.
26 Alexander Skene, Treatise on the Diseases of Women (New York: 1st ed., 1888, reprinted, 1889, 1890; 2nd ed., 1892, reprinted, 1893, 1895; 3rd ed., 1898).
27 Reed, pp. 151-2.
28 Paul Starr, The Social Transformation of American Medicine (New York, 1982), pp. 103-5.
29 Starr, pp. 90, 104-5.
30 Ibid., p. 110.
31 Ibid., pp. 117-8.
32 Ibid., pp. 119-23.
33 Ibid., p. 124.
34 Ibid., pp. 119-23.
35 Ibid., p. 144.
36 Daniel J. Kevles, In the Name Of Eugenics (Berkeley, CA, 1985), pp. 57-69.
37 Boyer, pp. 205-11.
38 Kevles, pp. 57-69.
39 Ibid.
40 Ibid., pp. 96-112.
41 Ibid., pp. 85-95.
42 The source of the illustrations presented is the eugenic manual concerning sexuality, see Herman H. Rubin, Eugenics and Sex Harmony (New York, 1943).
43 Kevles., p. 21.
44 Ellsworth Huntington, Tomorrow's Children: The Goal of Eugenics (New York, 1935) p. 35.
45 Ibid., pp. 38-60.
46 Ibid., p. 38.
47 Kevles, pp. 116-118, and Stefan Kühl, The Nazi Connection: Eugenics, American Racism, and German National Socialism (New York, 1994), pp. 27-36, 77-84.
48 Huntington, p. 44.
49 Ibid., p. 45.
50 Reed, p. 165.
51 Ibid., pp. 165-6.
52 Robert Latou Dickinson Papers, Box 1, Fd 38.
53 George Drysdale wrote Elements of Social Science (1854) which was an early apology for birth control. August Forel was a Swiss sexologist and psychiatrist. For more on his particular perspective on sexuality please see August Forel, The Sexual Question (New York, 1924). Edward Byron Reuter was a scientific racist interested in the impact of miscegenation. He saw the mulatto as the "key to the race problem". For more on his work refer to Edward Byron Reuter, The Mulatto in the United States (Boston, 1918). Alister Hardy was a prominent eugenicist. For more details about his perspective refer to his article, Alister Hardy, "Escape from Specialization" in Evolution as a Process, ed. Julian Huxley, Alister Hardy, and E. B. Ford (London, 1954), pp. 122-42. Also see Alister Hardy, The Living Stream (New York, 1965). Robert Briffault researched into the primitive origins of human civilization and proposed that human society was maternal in origin. He also explores the evolution of civilization from a matriarchal in form to the contemporary patriarchal situation of the 1930s. For more information refer to Robert Briffault, The Mothers (New York, 1931). Marie Stopes was an English paleobotanist turned philosopher of marriage who wrote a best selling sex advice book called Married Love (1918). She opened the first birth control clinic in England, (Reed, pp.112-13). Dr. Aletta Jacobs was Holland's first woman physician. She opened a contraceptive clinic for the poor in Amsterdam in 1882 and developed an improved spring-loaded pessary, (Reed, p. 95).
54 Margaret Jackson, "Sexual Liberation or Social Control?," Women's Studies International Forum 6 (1983): 7.
55 Ibid.
56 Robert L. Dickinson, "A Program for American Gynecology," American Journal of Obstetrics and Gynecology 1 (1920): 2.
57 Ibid., p. 3.
58 Ibid., p. 8.
59 Ibid., pp. 2-10.
60 Ibid., p. 5.
61 Ibid., p. 6.
62 Ibid.
63 Robert Dickinson, "Birth Regulation," Eugenics: a Journal of Race Betterment 2 (1929): 35-7, "Control of Conception, Present and Future," New York State Journal of Medicine 29 (1929): 596-602, "Simple Sterilization of Women by Cautery Structure at the Intra-uterine Tubal Openings, Compared with Other Methods," Surgery, Gynecology & Obstetrics 23 (1916): 203-6.
64 Ibid., p. 6.
65 For a cogent argument against this problematic reading of the modernization of sex in the early twentieth century see Michel Foucault, The History of Sexuality, pp. 17-35.
66 Ibid., p. 7.
67 Robert Latou Dickinson and Lura Beam, A Thousand Marriages: A Medical Study of Sex Adjustment (Baltimore, 1931), p. 433.

Chapter 2: Reading Genital Love: Scientific Heterosexism and Same-Sex Eroticism

And he who entertains and realizes the dream of achieving peace in equilibrium, of overcoming the pain of living and of insoluble tragic dilemmas, also reveals himself to be the master of duels in which no violence breaks out, because one of the terms has been removed. 1

-- Luce Irigaray


The medically constructed category "homosexual" was increasingly used to police, pathologize, and disrupt same-sex desire in early twentieth-century America. Previously homosexuality was seen in terms of vice and moral weakness; physicians and sexologists were seeking to change that view. Many, who believed homosexuality was a criminal act, subscribed to the idea that same-sex eroticism was an immoral choice that deserved punishment. Yet, voices in the medical community challenged the criminality of homosexual acts and wanted to intervene for the "social good" on their own terms. Within the medical discourse of toleration that emerged was a proliferation of theories of cause, etiology, and cure for homosexuality. The "homosexual" emerged in the late nineteenth century as a specified individual that could be located by the medical gaze. Doctors sought to transfer the management of sexual deviance, which was under the jurisdiction of the state, to the medical profession through advocating the decriminalization of homosexuality. Leaving the juridical sphere, homosexuality gradually became a disease to be treated or possibly eliminated by the medical profession.2

Even though American doctors began their inquiry into "sexual perversion" in the late nineteenth century, the acceptance of the medical model of homosexuality by the wider culture took time and was not without dispute.3 The medical discourse penetrated middle-class and upper-class culture first in the early twentieth century. Only later on did sexology significantly penetrate the structures of working class sexuality. Although some involved in same-sex relationships saw their lives in terms of pathological taxonomies, many did not. Others choose not to define their sexual experiences at all, they simply "did it".4 Sexological discourse was also drawn upon as a means of self-identification for those who had same-sex desires. This identification participated in the growth of the homosexual community.5 The growing pathologization of same-sex desire still functioned to suppress sexual deviance in order to promote marital sexuality.

The normativisation of sexuality relied on the construction of a distinct boundary between heterosexuality and "perversion". The term "perversion" encompassed a continuum of non-heterosexual forms of eroticism that were considered culturally deviant. Homosexuality, sadism, bestiality, masochism, and autoeroticism emerged as distinct medical entities that were all linked within the category of "perversion". Richard von Krafft-Ebing, one of the earliest sexologists, started a tradition of separately demarcating the multiplicity of deviant sexual acts while grouping them together as "morbid," as "perverse".6 The linkage of sexual acts in the polymorphous category of perversion was continued by Havelock Ellis and Robert Dickinson.

Among the perversions, homosexuality was the most discussed and investigated by the sexologists. Homosexuality was used by medical experts and later mass culture to delineate the boundaries of this norm. Homosexuals came to represent what heterosexuality was not. In this way, homosexuality defined heterosexuality.7 Robert Dickinson's research into the nature of same-sex desire had a similar effect. By investigating "abnormal sex," he could understand the limits of "normal" sexuality. Dickinson wanted to produce his own nosography of perversion. "Autoerotics" and "homosexuals" existed in his texts to warn doctors of the "damaging" effects of perversion. Dickinson wanted to convince other physicians that not only was non-heterosexual sex pathological in and of itself, but that it could also lead to further health problems.8

By understanding what was abnormal, Dickinson was finding ways to correct or prevent such perversions. Dickinson could then apply this knowledge to promoting sexual pleasure and fidelity between a man and a woman in marital union. Those who enjoyed same-sex eroticism were important for Dickinson's investigations only in so far as they could lead to new medical ways of eliminating sexual deviance. They were studied so that in the future such forms of desire could be removed from American society. A multiplicity of sexual behaviors were talked about in Dickinson's works, but inevitably only to ensure that marital sexuality would become the single most important form of sexual expression.9

Dickinson employed this new medical categorization of "perverted" individuals and sought to bring them under American medical surveillance. In the spirit of sexological research of Ellis and Krafft-Ebing, he started to explore the lives of "homosexuals" and began publishing on the topic in the 1920s. His foremost analytical tool was the case study. The case study had been used by the sexologists that came before Dickinson. In such studies the patient was given a voice, but only in terms of the observer's near absolute diagnostic authority. Dickinson drew on case material of his own gynecological practice and that which was obtained from other members of his Committee on Maternal Health and later by another group he formed the Committee for the Study of Sex Variants.10 All of these case studies were interpreted according to a medical paradigm based on scientific heterosexism. Homosexuality was never legitimated in his work; heterosexuality was always promoted.

The subject of same-sex desire was a politically charged one within the medical community during this period. Medical and sexological discussions of what constituted homosexuality denigrated same-sex desire in favor of an idealized vision of heterosexual monogamy. Homosexuality was constructed as a disease, but its cause was disputed by the sexological experts of the time. Debate oscillated around whether homosexuality was a product of heredity or whether it was an acquired through social development. The latter theory of causality dealt with issues of pathology in familial relations bringing about "maladjustment" in children or with seduction. The former theory of cause was constructed as a physical sign of degeneracy by many medical experts.11

The foremost authority on sexuality in the early twentieth-century medical discussions was Havelock Ellis. His ideas were influential on both sides of the Atlantic. American medical professionals drew on his work when they confronted "sexual pathology". Without Ellis' studies of sexuality, Dickinson's investigations would not have been possible. Ellis codified scientific heterosexism by turning his own interpretation of case studies into the basis for a wide-ranging sexological theory. Infused with eugenic fervor, Ellis wanted to scientifically manage desire to produce what he believed would be a stronger race and a (hetero)sexual utopia. He believed above all that the "marriage relationship is [sexuality's] most important social manifestation."12 The case studies presented in his multi-volume Studies in the Psychology of Sex stood testament to this view.13

Ellis' use of first-third person split narration style in his case studies allowed him the scientific license to analyze the statements of his study subjects in a fashion that would support his theory. Selected statements of the subject were surrounded by Ellis' authoritative analytical text written in the third person. The subject's first person speech was usually limited and removed from its context. This narrative style limited the possibilities of a dialogue between the research subject and the sexologist in the text. The reader could not make judgments about the subject themselves. The analysis was always already mediated by Ellis. The weight of textual authority was firmly rested on Ellis, not the study subject. The first person speech in the case studies served only to illustrate a point or as an anecdotal evidence. What the subjects actually experienced is nearly impossible to discern.14

The science of Ellis' sexology was rooted in a theory of libidinal economy. Sex was the result of the vascular congestion and decongestion that he saw accompanying sexual excitation and ending in orgasmic release. He labeled the process of congestion, the physical accumulation of desire, as tumescence. The release of desire in orgasm was labeled detumescence. Ellis employed these two concepts to understand the basis of all sexual arousal and release. It was not only this hydraulic metaphor that permeated his sexological theory; he also drew upon the dialectics of bourgeois production. Varying degrees of sexual capital led to different sexual practices; perversity was simply an improper balance deviating by degree from commonplace sexual behavior.15

Only overshadowed by Sigmund Freud, Ellis was one of the foremost sexological authorities on the subject of different-sex desire as well as same-sex desire in the English speaking world. For Ellis, the difference between the two "sexualities" was based on the inborn differential operations of tumescence and detumescence.16 As with much of his other sexological ideas, this position on homosexuality was linked with eugenic notions of heredity. He did not see homosexuals as a result of racial degeneration as had Richard von Krafft-Ebing.17 In fact, he tended to see them as biological anomalies which should be accepted by society but same-sex desire was still seen as a product of heredity.18 Regardless of this tolerant treatment of homosexuality, Ellis believed it was primarily an inborn misdirection of sexual aim. Heterosexuality was the basis by which all other forms of sexual pleasure were to be judged.19

Ellis introduced his own term for same-sex love, "sexual inversion." He located the cause of people loving someone of the same-sex as a function of gender inversion. Ellis saw it as a form of psychic hermaphroditism that was usually fixed at birth. A feminine desire was inside the homosexual male; masculine desire existed in the homosexual woman. Ellis argued that sexual inversion was beyond the "invert's" control and therefore he or she should receive social acceptance. Ellis constructed a medical apology for same-sex desire but did not take many steps to show that it was a legitimate alternative to heterosexuality.20

On the subject of female sexual inversion, Ellis believed that abstinence should be the primary treatment goal. He connected nervous disorders such as exhaustion, hysteria, and epilepsy with female same-sex desire; all were tied to an imbalance in libidinal economy.21 Ellis may have distanced himself from pathologizing homosexuality in and of itself, but he associated other pathological states with it. In this instance, he was connecting images of female hysteria with sex between women. For a successful medical treatment to be accomplished, both the sexuality and the "neurosis" of the patient needed to be discontinued. Abstinence or psychiatric intervention apparently would accomplish similar goals in Ellis' formulation of the etiology of female homosexuality; they could return the patient to a state of "health."22

In 1895, Ellis suggested in an American medical journal that women with homosexual desires should not be encouraged to marry men because of the disastrous results to themselves, their future husbands, and her necessarily neurotic offspring.23 He advised the medical reader that for such a woman, "the normal instinct is just as unnatural and vicious as homosexuality is to the normal man or woman; so that in a truly congenital case "cure" may simply mean perversion, involving the general demoralization that usually accompanies perversion."24

Although Ellis has long been known for his tolerance of homosexuality, it was only within certain bounds.25 Homosexuality, as shown in the above statement, was still defined for him as abnormal and as an example of perversion. Furthermore, it was clear to Ellis that those men or women who experienced a same-sex desire, which could not be demonstrated as congenital, should not receive the same amount of tolerance. Blame could apparently be made in these instances. How Ellis made the distinction between acquired and congenital homosexual was not demonstratively clear in his work, but it was inferred that such acquired sexual inverts could be "cured."26

For congenital female homosexuals, Ellis recommended abstinence because it would be quite difficult to normalize them to a heterosexual lifestyle. Apparently, abstinence would restore the balance in these women's sexual economies and therefore remove their neurotic symptoms. Ellis' final analysis was that "inversion will not thus be removed but it may be rendered comparatively harmless, both to the patient herself and to those who surround her."27 His remedy was the suppression of female sexuality to avoid the harm that her deviance would presumably cause. In this formulation, feminine same-sex desire was apparently dangerous and needed to be controlled by a physician for "her own good."28

Greatly indebted to Ellis' pioneering work, Dickinson undertook his own studies into the nature of homosexuality. Dickinson drew upon much of Ellis' sexological theory, but often made a conservative interpretation of it. He was more interested in deciphering pathology, than in promoting tolerance of those who were sexually marginalized. The sexological texts Dickinson produced followed a similar organizational structure to that of Ellis' own works; like Ellis, Dickinson used the case study split first/third person narrative style. Yet, he extended the scope of the case study to include items that Ellis was unable to include. Ellis did not have the same access to women's bodies that Dickinson had; Ellis was not a gynecologist. Using his gynecological expertise, Dickinson studied the anatomy and physiology of his research subjects and integrated that information into his case studies.29

Ellis believed Dickinson's work was an important extension of sexology. The combination of sexology with gynecology made Dickinson's work stand out in Ellis' mind. Ellis commented on Dickinson's work in 1931 in the Committee for Maternal Health's first major sexological study, A Thousand Marriages: A Medical Study of Sex Adjustment.

Sex is first of all a physical fact, and the relationship of sex is primarily and fundamentally a physical relationship. The report of a gynecologist... becomes, therefore, essential if we are to have an all-around picture of the sexual situation to-day. It is here that Dr. Dickinson comes before us.30

This link between soma and sexuality in Ellis' work was furthered by Dickinson. Dickinson combined a medical examination of the patient with an interview. They both felt this new approach would extend sexological knowledge. Ellis went on to point out that Dickinson was not as narrowly focused as previous gynecologists investigating these matters. Dickinson avoided being overly reductionistic, in Ellis' view, unlike other gynecologists who had "less broadly envisaged the woman's whole sexual relationship in life as a member of a civilized community."31 Dickinson was aware of social and psychological forces which could effect female sexuality. He tried to take them into account when exploring the sexual aspects of a patient's or research subject's life.

The Committee for Maternal Health and The Single Woman

Dickinson's Committee for Maternal Health was a platform from which he could begin to carry out this new type of sexological research. It became widely known as a source for sexological knowledge in America. By the late 1920s, the committee was receiving requests for information and assistance concerning sex matters from doctors, journalists, and others interested in sexuality.32 James Reed called it the American "publisher and clearinghouse" of sexological information.33 This was because of the respect Dickinson received in the medical community, the committee's birth control advocacy, and the committee's publications. Dickinson used the committee as a platform for his medical agenda.

One of the more interesting books concerning sexuality was The Single Woman. Dickinson wrote the book with Lura Beam. Using her psychology background, she helped to interpret Dickinson's case studies and formulate them into something coherent for the reader. She was put forward as a coauthor, but her role in the publication was less significant than Dickinson's role. She was sympathetic to the situations of homosexuals, but her perspective rarely came across in the book.34 Dickinson may have just wanted a woman's name attached to the book. He might have thought a woman writing about female sexuality with him would make the book more palatable to the reader. To be sure, Lura Beam's perspectives on female sexuality, whatever they were, did not receive the attention that Dickinson's ideas did.35

The Single Woman represented an attempt to understand comprehensively the sexuality of single women including such areas as autoeroticism, heterosexuality, and homosexuality. The case studies concerning homosexuals contained within this book attempted to describe the etiology of homosexuality, but failed to make definitive statement on the subject. It contained case studies of thirty-two people who experienced same-sex desire; twenty-eight of these were women. The four men described in the text were brought to Dickinson's attention by his patients who were their wives or lovers. The female patients did not come to Dickinson for treatment of homosexuality, he discovered their same-sex desires in the course of gynecological treatment. He admitted that the data he obtained was limited and that many of his patients resisted questioning about their sexual practices. Dickinson concluded that their reticence was the result of their modesty or shame.36

The tone of this work in regard to homosexuality was relatively tolerant, nonetheless it did not legitimize it. Homosexuality was seen in this study as, "a transient attempt to recreate life by love for the same sex with or without a specifically sexual consummation."37 Whether it was merely fantasized about or actually practiced, same-sex eroticism was seen as transient in the study for two reasons. Firstly, most of the subjects eventually pursued a heterosexual lifestyle according to Dickinson.38 Secondly and more importantly, homosexuality was seen as a wrongful phase, a misstep that could only imitate love. True love was believed to be only the product of a man and a woman's interaction throughout Dickinson's writings. Also, it can be discerned from this statement that not only were physical homosexual relations under scrutiny, but even desirous thoughts needed to be revealed to the physician. Therefore, all aspects of his subject's lives needed to be interrogated; the pathology of same-sex desire seemed to be all pervasive for Dickinson.

Dickinson seemed not to subscribe to ideas of sexual inversion in this study. Dickinson wrote concerning the women in the study, "no transference of feeling to maleness is recorded, the female element functions along its various levels as child, equal, and mother.39" The women were described as "feminine" but pursued an inappropriate sexual object. The three roles Dickinson ascribed to women, child, equal, and mother, were still fulfilled, but in a imitated form. For Dickinson, these roles were transitory stages in homosexual women's relationships that were linked to the different roles that women could apparently only achieve in the family and/or society. He saw these women as acting "feminine" in a pathological context.


A reversible quality of love appears and the same body lives at its chronological age and also in the childhood and the teens. This has likeness to the dream and the day dream and is the self's own wishes in animation. It is itself and had a lover; it is the child and has a mother or it is the mother and has a child. It slips back and forth from one relationship to another, making the self tall inside the life and motives of another. It serves whatever age period is concerned, engages whatever part of personality - sexual, romantic, conscientious, or familial is uppermost.40

Same-sex desire was turned into a juvenile fantasy by Dickinson. It was both dream and wish fulfillment for him. Women were represented as both child and mother simultaneously; their desires constantly changing focus, but always within the bounds of maternity, childhood, and love. Child and mother were roles that were sexually charged in Dickinson's writings; they constituted essential components of female sexuality. The bourgeois family was naturalized by Dickinson and somehow thought to exist within the woman.

Women were represented as the natural source of the family. As such, Dickinson believed the roles within the bourgeois family structure for women, wife and mother, were the source and limit of women's sexuality. Dickinson linked this to what he believed was an intrinsic feminine instinct. Women who loved women were misusing this instinct in the gynecologist's opinion. Speaking of marriage earlier on in his career he defined the "good" woman as the heterosexual woman. "The main surprise will be the straightforward naturalness with which the good woman will accept the occasion, unabashed, possessed as she is by the great primal instincts of love and maternity."41 The homosexual represented the pathological use of the "feminine" sex drive.

Seeing female sexuality only within the context of instinctive familial relationships precluded an equitable evaluation of women's lives. The feminine was constructed as purely functional and positioned as the source and result of the family.42 Dickinson was producing a history of woman; the woman-child became her lover's equal during courtship and then eventually became a fertile mother who should reproduce the cycle. Of course, homosexuality in women disrupted this cyclical vision of femininity even though it was being represented by Dickinson as being contained within it.43

This schematic picture of women's lives sets them apart from men. They were tied to natural cycles in a way that men were not; the instinctual aim of women's lives was familial love and reproduction. Dickinson was drawing upon earlier visions of women. This connection between women and nature was common in the late nineteenth century. This view was used to underpin both feminist and antifeminist debates.44 The lack of reproductive possibilities in the same-sex relationship turned homosexuals into imitations of their heterosexual counterparts in Dickinson's eyes.45 Dickinson described the structure of same-sex relationships as a hallucinatory reproduction of different-sex relationships.

An obvious likeness to family life appears in this building up of obligations and also in the myths and traditions which characterize expressions of inner life. The use of heroic and symbolic names, identification with flowers, animals, poetry, totems, and historical characters appear between two people as living fantasy, sexual in origin, expressing romantic conceptions or constructing family relationships.46

Dickinson turned same-sex love relationships into a fantastic delusion. The myth he constructed turned the love these women shared into something false. The only way they could recognize their relationships was in terms of heterosexual familial relations. Being seen as mimetic of heterosexuality, homosexuality was discounted as a unauthentic practice in this work. Therefore same-sex relationships could not draw upon the naturalized truth of different-sex eroticism. Insertive intercourse between man and woman was solely designated as natural and healthy. In the logos of Dickinson's sexology, homosexuality was excluded from the truth of the healthy body and transposed onto the psychic world of fantasy.

The male subjects in the study revealed another side of Dickinson's view of homosexuality. "The doctor's interest in this subject was kept alive by his observations on men, especially husbands of patients."47 The four cases of male homosexuality included in The Single Woman are all described as an inability of these men to have proper intercourse which ended in some form of tragedy. One of the men, described as having a "great desire for leadership among men and boys ," killed himself after his relationships with men were discovered.48 Another married man in the study, labeled as "artistic", would not have children with his wife and slept with other men in his "professional field". The couple went their separate ways in divorce. The third case involved a husband who was a "leader of men who both gave and demanded hero worship" and had an "antipathy to sexual relations."49 This man left his family and was diagnosed with "distorted homosexuality and paranoia" even though there was no evidence that he had slept with other men.50

The fourth male homosexuality case presented dealt with the issue of seduction. The subject was forced into "passive pederasty" by a group of male strangers and could no longer have intercourse with women. Dickinson discounted this man's story of being raped. He put it in quotes to suggest the fraudulence of his story, to make it seem that this man was making an excuse for his homosexuality or that he had wanted to be raped. This case was an example of the author's ability to discount the speech of the patient. Dickinson not only had the sole right to interpret the results of the interview, but the ability to call into question pieces of the patient's story. The power dynamic between the sexologist and the subject was clear. Dickinson could call into question any of the subjects' statements and claim they misspoke because of shame or fear. The doctor was deliberately placed as the sole source of truth in the text.

These cases are symptomatic of Dickinson's thinking. They are examples of how Dickinson thought homosexual relationships could be dangerous. They were problematic for him because they involved the break up of families. Desire for people of the same sex was represented as a direct transgression against the family structure resulting in tragedy for both the transgressor, the male homosexual, and the transgressed upon, the wives and children. Male homosexuality was equated with an uncontrolled and destructive sexuality; by default the lives of these men were rendered bleak and certainly pathological.51 The discussion of male homosexuality set the stage for Dickinson presentation of female same-sex eroticism in The Single Woman. The male homosexual was constructed as "unhappy," "tragic," and a liar; his life, in some senses, was seen as not worth living. This image would linger in Dickinson's discussion of female homosexuality. It would serve as a basis for his understanding of same-sex eroticism between women. Furthermore, Dickinson went into greater depth in his investigation of female homosexuality principally because he was a gynecologist. Dickinson had intimate access to women's bodies; he could not study men in the same detail.

Morphology and Meaning

The authority by which the sexologist could interpret his female subject's sexuality was nearly unbounded. Dickinson combined case history material with information obtained in gynecological examinations. The results of his investigations, as presented in the text, provided little dignity and showed no respect for these patients. Throughout the case studies, psychologized assumptions about women, understood in terms of a libidinal economic theory, were mapped onto the study subjects' bodies. In this another case, Dickinson decoded pathology in a girl's body and actively enforced the conventions of health that conveniently mirrored his vision of sexual propriety.52

During the course of treating an upper-class seventeen-year-old girl, Dickinson was shocked to uncover what he thought were sexual aberrations. He examined this girl's genitalia and found "evidence" that she was not a virgin, although she protested otherwise. The findings of his examination in case 372, the first case in the series, were described as follows.53

The vulva indicates the most extreme autoerotic or homosexual practice. The vagina has huge folds, very unusual in a young girl, and is enormous; the anterior wall is whitish, leathery but rugose. The meatus gapes. The vulva shows big glands on a flushed, shiny surface, great veins above the clitoris, old smegma and little prepuce; it immediately appears very erotic, flushing to a quick purple without mucous secretion, very thin pelvic floor, no levator action, nearly admits the hand, four fingers two joints. This is an exhausted vulva. The hymen has no nick and is insensitive. The patient has never douched, never been examined or treated by a doctor, the possible alternative causes of such enlargement of the hymen.54

The depiction of this girl's genitalia was used to demonstrate that physical signs could point to sexual deviance specifically, homosexuality and autoeroticism. It was assumed in this diagnosis that a chaste girl's genitalia would be different; the chaste girl was seen as the normal girl. The patient's genitalia was described in Dickinson's discussion to reflect her perceived sexual activity. He believed in a strong connection between psychic life and what he called the "physiology of the pelvic zone."55 Words such as "flushed," "erotic," and "exhausted" which he applied to her genitals mirrored Dickinson's attempts to construct her as sexually precocious. Drawing upon what Ellis had theorized earlier, Dickinson believed that women had a level of sexual energy that was comparable to men, but it was harder for women to express and control it. This formulation made women more prone to disease, particularly nervous disorders.56 For Dickinson, the mismanagement of her limited sexual energy was seen as leading to pathology (i.e. the exhausted vulva). Furthermore, her genitals were depicted as unclean by Dickinson's language. Phrases such "old smegma" and that "she has never douched" stressed the impurity and pathology of the study subject. She was not only represented as being precocious because of her non-heterosexual activity, but she was dirty.57

This view of her being unclean led to the connection between sexual deviance and pathology which drew on the medical mythos of contamination equaling disease58 . Since the shape of her vulva did not coincide with her story and no other medical intervention which could be alternatively read as male penetration occurred, she was rendered a liar who concealed her sexual pathology because of shame. Dickinson implied that by wasting her sexual energy engaging in autoerotic and homosexual practices, she was harming herself. The "harm" of her pleasure supposedly led her to require gynecological treatment. In Dickinson's mind, sexual misconduct was translated into sexual mismanagement. The apparent over expenditure of sexual energy was what Dickinson cited as leading to disease. 59

Dickinson constructed this girl's genitalia in a peculiar fashion. He compared her vagina, clitoris, hymen, and labia to those of other girls. Noticing the difference between them, he assumed sexual pathology. Dickinson not only constructed a definitive normal limit to the shape of her genitalia but turned them into an object of scientific inquiry. The contours of female genitalia were fetishized under Dickinson's scopaphillic gaze. Female genitals were either virginal or, as he put it, "erotic." The unbroken hymen became a prized symbol of pure girlhood and potential heterosexuality. The enlarged vagina represented pathological desires in the form of autoeroticism and homosexuality. Genital size signified erotic intensity and sexual pathology. By looking and touching the girl's vulva, Dickinson produced a narrative of her sex life which disputed her own recollection of it. Dickinson's aesthetic judgments decided the "sexual truth" which for him was written on her body.

Dickinson turned this girl's body into an object of pathos, and he went further. He wanted to punish her for her sexual improprieties. Dickinson deliberately hurt her during the gynecological procedure she came to have him complete. Dickinson did not apparently have any qualms about printing this statement in the published version of the case study. Dickinson "hurt her purposely" to teach her a lesson. Somehow his abusive act was acceptable enough to the medical community to be put into print. 60

After the painful procedure, the girl returned to Dickinson for further treatment during an engagement she secretly agreed to with a young lawyer. She asked, "Why do I have to come again?". Dickinson replied, "Because of the catarrh61 of the womb and you have that because you are doing something you deny you do?". Dickinson wrote, "no erotic behavior, but some face flushing" during this tense verbal exchange.62 Dickinson yet again connected sexual deviance and illness but this time in the form of cervicitis. He blamed this girl for her illness and the sex life he perceived she had. The symbols of his description had changed, however. The erotic vulva had now become the flushed face. Dickinson implied a transfer of shame from one part of the body to the other. For him, the shame could be read by his trained eye observing her body; she did not need to say a word.63 Dickinson commented at the end of case 372, "happily married with normal response in coitus and no nick of hymen or fourchette in labors."64 Apparently, Dickinson believed her marriage caused an improvement in the shape of her genitals. A return to heterosexual sex was equated with a return to health and somehow Dickinson saw it signified on her body.

Dickinson played three roles in this particular case study: gynecologist, sexologist, and disciplinarian. He used his socially sanctioned ability to observe the female body as a tool to disrupt its pleasures. Dickinson would not merely look, touch, or draw what he saw. He would deploy his findings into a theory that would employ education as a means to ending sexual deviance. This would necessarily promote marital sexuality. As shown in the above case study, sometimes he would not take the time to educate his patient. Dickinson could simply enforce his scientific morality by hurting her.

Much of this anatomical diagnosis was linked to Dickinson's much earlier research in female genital morphology. In his 1902 article "Hypertrophies of the Labia Minora and Their Significance," Dickinson connected the shape of the labia minora and majora with sexual activity, particularly autoeroticism. The enlarged genitals he located in these women's bodies exhibited their autoeroticism. Dickinson connected autoeroticism with pelvic diseases such as cervicitis. It was in this early work that Dickinson first attempted to read behavior into the female body.65

In the final analysis, Dickinson could not definitely demonstrate a cause or cure for homosexuality in these women. He favored a theory of bisexuality. Through development, a person would be socialized into a heterosexual lifestyle. Homosexuality was conceived as the failure of proper developmental socialization.66 These failures are linked to both the family and the individual. "The youthful life of these patients often contains early and critical brooding and adverse judgments about the parental relationship and marriage, the father relatively lacking and the mother's position unstable."67 According to Dickinson, those who later have homosexual relationships come from unhappy and unstable homes. In a sense, he believed these patients were rejecting the family structure which further complicated attempts to heterosexualize them. During critical periods the transition from bisexuality to heterosexuality was apparently not made in his research subjects. In Dickinson's estimation, this lead to a period of homosexuality in these women that ended in marriage.68

Despite the fact that he claimed to be unable to come up with a detailed curative regimen for homosexuality, Dickinson was developing a preventive remedy. The last case in the series on homosexuality, 1137, of this volume discussed a form of social manipulation which was mentioned as an example of the progress of Dickinson's theory.69 The case study explored a mother's concern for the normalcy of her daughter. The mother came to Dickinson because she was suspicious of the relationship of her daughter and a college friend. They were quite close friends, but there was no evidence of sexual relations. In response to the mother's concerns, Dickinson advised her to, "raise no questions and do nothing directly. . . have the other girl at the house weekends and with the chance to live like sisters they will become so. Meanwhile consider her daughter's chances to meet men, have rest and social life and try to make opportunity. Later when this situation is not acute, take up the question of marriage."70 Dickinson wanted the mother to conspire to normalize her daughter's sexuality. He wanted her to discretely engineer social situations which would push her daughter into a heterosexual lifestyle. Dickinson believed this would allow her daughter to enter the world of marriage and family, to lead a "normal" life.

Dickinson believed it was his position as a physician specialized in treating the "diseases of women" to regulate many aspects of his patient's lives to promote health. The case of the concerned mother and her daughter was not an aberration in his work. Dickinson favored the redirecting personality through education. He went further. Food intake, sleep, exercise, amusement, and vocation were parts of his patient's lives he wanted to regulate. He linked social and personal behaviors to health in a way that was analogous to this case. To what extent he was able to effectively supervise such diverse behaviors is difficult to answer. Regardless, Dickinson's will to do so was problematic.71

The implications of this study to his construction of homosexuality, and necessarily heterosexuality as well, were great. Heterosexuality became something that needed to be promoted and protected. Heterosexuality was paradoxically constructed as fragile even though it was designated as healthy and natural by Dickinson. He believed heterosexualization was a precarious series of developmental steps that could be disrupted at any time. This was especially true, in his opinion, for women. Dickinson wanted experts to intervene to help prevent people from straying from the heterosexual path and correct deviance if it was discovered. All that was not heterosexual was projected onto the homosexual. Yet, an important absence persisted in his understanding of homosexuality as Dickinson noted to himself in 1933, "Why does this sexual manifestation cure itself sometimes but not always?"72 He saw that sometimes women married after experiencing same-sex love, but others did not. This was a question he would try to resolve in his next major study of homosexuality. It was a question he could never completely unravel.

The Committee for the Study of Sex Variants was established by Dickinson in 1935 to further his investigation into homosexuality. He had to work outside of the Committee for Maternal Health because of opposition to further study in this area by the executive secretary, Louise Stevens Bryant. The study relied upon the help of people within the New York City's gay culture particularly a "Miss Jan Gay”73 . Gay contacted Dickinson in the hopes that he would be receptive to helping the homosexual community. They eventually collaborated and she brought him the case studies he used in the study. The gay researchers involved in the project hoped that their participation would lead to a sympathetic reading of gay life, but that did not occur. This study turned out to have a strong commitment to a medical model of homosexuality which did far more to condemn gay life than it did to improve its cultural understanding and acceptance.74 After the publication of the two-volume Sex Variants monograph, the committee, which was founded only six years prior, ceased its operations.75

Dickinson's contribution to Sex Variants took a much more clinical vision of same-sex desire which extended his work in The Single Woman. It was in Sex Variants that Dickinson articulated a more definitive interpretation of homosexuality which was rooted in physiology. Anatomical observation clearly became more important than patient interviews when compared with the studies he undertook in The Single Woman. Patient speech was even more sparse and under closer scrutiny in this collection of case studies. Most of the information he presented came accompanied by anatomical observations and diagrams which connected homosexuality with biological abnormality. These diagrams and the misrepresentation of the lives of the subjects in the case studies made them appear to be diseased and, at times, morally depraved.76

Dickinson began his appendix to Sex Variants entitled "Gynecology of Homosexuality" by noting what was new in his investigation of female sexuality. "Among the characters which render this sex-study unique, the physical examinations - general, local, roentgenographic 77 - stand out next to the impressive detail of the record."78 Dickinson's case studies combined the doctor's analysis of the patients' self-reporting of their sexual histories with a medical examination. Dickinson examined global aspects of these women's health as well as the interstices of their genitalia. He sought a correlation between same-sex desire and a multiple of factors, all of which were within the parlance of disease. What followed in the text were case studies written in the first-third person split narration style which included detailed drawings of these women's erogenous zones (see figure 1 and 2).79 This was the data he used to persuade his audience that there was a connection between abnormal genital morphology and homosexuality. He cautioned the reader to remember, "that this is the voice of a rather intelligent group defending its point of view."80 Before the study subjects were allowed to speak, Dickinson already had questioned the veracity of their stories.


--Figure 1: Comparison of homosexual vulva to norm


--Figure 2: The range of female genital size and shape

Throughout the studies he presented homosexuality as being mimetic of heterosexuality. His discussions of sexual practices between women made them seem to be necessarily fraught with complications, difficulties, and the need for phallic implements. He could not conceive of a non-phallic sexuality which could achieve any real satisfaction. He described heterosexual intercourse as "facile" and natural, but sex between women presented "anatomical difficulties." The difficulty for Dickinson was the lack of the insertion of an erect penis. This heterosexist notion deigned the legitimacy of noninsertive sexuality to be as pleasurable as
phallic penetration.81 Yet, he could not deny that these women experienced pleasure and reported that most of these women achieved orgasm with their female partners.82 He could make no clear pronouncement on this subject. In his discussion, Dickinson succeeded only in making sex between women seem problematic.(see figure 3, 4, and 5)


--Figure 3: Depiction of the "anatomical ease" of heterosexual sex


--Figure 4: Depiction of the "difficulties" of sex between women


--Figure 5: Dickinson sees that sex between women requires phallic implements


The case of Myrtle K., whom he called a "negress," revealed much about how Dickinson read behavior through the body. It was also a case that explored a supposed physical mimicry of different-sex intercourse between women. Dickinson described her genitals as being abnormally large with her "pelvis of a moderately masculine type." As with other cases in the study, the female doctor who examined her caused her genitals to become "erotic." When Dickinson examined her, this did not occur. He found this response to be a common trait among female homosexuals. However, the discussion of genital morphology was the central focus of the case study.

Dickinson wrote concerning Myrtle K., "The vulva is of a very unusual length, 11 cm; the corrugated labia minora protrude a little through the thick labia majora, spreading 3.5 cm. when laid apart, but 6.5 cm on a very slight stretch, and with the blackness of deep pigment so often found in the negro.83" The darkness of her genitals was linked with their size and erectility; conceived by Dickinson as a product of both heredity and deviant sexual practices. Dickinson had previous noted that hypertrophy of the vulva was more common in darker-skinned women than lighter-skinned.84 This allowed him to imply that women of color were more prone to sexual deviance. This case was representative of the intersection of race and sexual ideology. Homosexuality was linked with scientific discourses concerning race that were particularly prevalent during Dickinson's lifetime.85 Racial theory, with its obsessive concern with the racially "mixed" body, allowed for a way to articulate homosexuality. The language was extended to include another supposedly pathological mixing, that of femininity and masculinity.86

"My clitoris is two inches long," she claims, "and enlarged, it's three inches, and the thickness of a little finger. It's grown half an inch in the last year." She is able, she declares, to "insert the clitoris in that vagina" and produce orgasms in other women in a most desired fashion.87

This was the first text in the first person printed in the case study and it set the tone for the medical reader. This woman was viewed as dominant and therefore was masculinized. Her sexuality was represented as all pervasive; the words she spoke through Dickinson in the case study were meant only to support that "fact." He connected a perceived black sexual power with pathology. The clitoris was constructed as phallic substitute while at the same time the possibilities of insertive sex between women were called into question by Dickinson. The emotional mimetics of different-sex desire were translated into physical reality in Dickinson's presentation (see figure 6).


--Figure 6: Investigation in the possibilities of clitoral projection

Dickinson chose to excerpt this from her interview, "No man in the world could rouse me. I loathe the idea of anything going inside me, even a douche."88 This example as nearly all excerpted speech. was meant to show how pathological she was; Myrtle K. was betraying her femininity. Ellis' vision of sexual inversion lingered in this case as in the others. The masculinization of this woman continued. She was represented as psychic hermaphrodite with genitals of a virile nature. Beyond that, the fact that she denied any form of vaginal insertion made her seem "non-female" to Dickinson. Dickinson saw the female body as a sexual space that needed to be open to insertion for sexual pleasure to occur. He believed the female body should be passive. Only male sexuality was insertive in his sexual theory; female sexuality could not be. Myrtle K. denied this formulation and therefore abdicated her femininity in the eyes of the sexologist.

There was a separation being made in this case like the others in the study. Myrtle K. deviated from traditional gender roles. She was seen in direct opposition to the heterosexual woman. Her penetrative sexuality showed her "taking the male part"; this act could only be understood by Dickinson in terms of deviance and pathology. The fact of her gender made this extremely problematic for Dickinson. She did more than transgress gender boundaries; she assumed a "male" subject position in her sexual relations. She therefore came to embody sexual pathology and the disruptive effects it could have on traditional ideas of gender, power, and pleasure. Dickinson "other-ized" her to pathologize her sexual practices and deny her disruptive power. Her resistance to societal norms was read simply as a manifestation of disease; here, deviance became pathology. The anxieties caused by Myrtle K.'s difference were projected on to her as deviant affliction.89

Dickinson had devised a way to mark the "otherness" of female homosexuals. He designated their genitals as the locus of their difference. He made them recognizable, but only by experts. This allowed homosexual women to be set apart from heterosexual women. Dickinson was not alone in trying to demarcate the "homosexual" body as distinct and other. Sommerville has noted that, like the science of race, sexological discourse attempted to demarcate specific types of bodies.

Methodologies and iconographies of comparative anatomy attempted to locate discrete physiological markers of difference by which to classify and separate types of human beings. Sexologists drew upon these techniques to try to position the "homosexual" body as anatomically distinguishable from the "normal" body.90

The distinction between these two types of bodies allowed for the medical marginalization of those who enjoyed same-sex eroticism. This specification of individuals involved the projection of anxieties about female power and sexual autonomy as was clearly shown in the case of Myrtle K. Those labeled "homosexual" became living signifiers of sexual pathology in Dickinson's work. They constructed the boundaries of normal sexuality right before the eyes of the medical reader.

The findings of this study were two-fold. First, Dickinson detailed a supposedly high frequency of responsive erotic feeling during gynecological examination in most of the subjects. He claimed this was especially true when a woman gave the examination. Dickinson also demonstrated that the external genitals of these women are large and exhibited special hypertrophies of various parts linked to their nonheterosexual erotic practices. He claimed only masturbation and sex between women could cause this change in genital morphology. Dickinson was shocked to find that these sexual practices did not coincide with gynecological difficulties in his subjects. He believed that more research was needed.91 He concluded, "Thus, while no definite local findings could be classified as peculiar to homosexual practices, there are indications on examination which fully warrant inquiry concerning genital excitations and preferences by homosexual or autoerotic technique."92

Although Dickinson felt he needed to continue studying the connection between the erotic response in the examination room and homosexuality or autoeroticism, he still had made a connection, however preliminary, between large genitals and deviant sexual practices. He thought this could be useful to marital counselors or psychiatrists. He wanted such "experts" to compare "the patient's statement of her experience with the findings on inspection of the generative tract."93 There were two types of evidence for Dickinson, verbal and anatomical. The anatomical evidence obtained through the physical exam was always privileged when compared to the personal statements given by the patient. The expert's act was about ordering bodies, not uncovering lives.

This connection between genital shape and sexual activity created a new observational position for Dickinson. He could view the female body and understand its sexual history with little regard for the patient's own recounting. He created an objective way to read the female erogenous zones and discover the markings of sexual activity that was pathological and/or deviant. This constituted a new phrenology of the female body, a way to read behavior into the shape of the body.94 By looking at the body in this way, Dickinson thought its sexual past and its sexual future could both be simultaneously predicted. Using this clinical criteria, he could read sexual deviance in his patients without even exchanging a word with them. In writing sexual transgression on the body, Dickinson created a particular epistemology of female sexuality. The female subject became divorced from her body. Her body became the vessel of sexual knowledge that only the medical expert could read. She need not speak because her body spoke for her. What was seen on the body's surface could even contradict what women said about their own lives.

Dickinson wrote about homosexuality to find ways to eliminate it. The key to this elimination was recognition. He created a way to identify eroticism between women. By making morphological distinctions between "types" of women, Dickinson designated the genitals as the site of identification. The female genitalia came to represent the origin of objective sexual truth in Dickinson's work. They revealed both pathology and health. They became sex's witness. This represented an important extension of sexological theory. Dickinson translated Ellis' sexual inversion which was primarily internalized into something observable that existed at the body's surface. This allowed the female body and its sex to be connected by a reading of genitals which could apparently produce medical, psychological, and historical knowledge.

The reflection of genital morphology on to same-sex desire mirrored Dickinson's attempts to eliminate love between women. He thought his findings could be applicable to preventing homosexuality in certain cases. He wanted to deploy the knowledge he acquired to redirect desire. Dickinson sought to make sure women were normalized into a heterosexual lifestyle. Dickinson believed that marriage could prevent homosexuality. He also thought that it had the potential to preclude sexual activity between women after the wedding.95 To ensure that marriage could prevent same-sex eroticism, Dickinson thought the management of sexual pain was a critical point for medical intervention.

The complaint of pain during coitus is the typical instance of such a need. Another is the finding of an infantile vulva in woman otherwise well developed; another, muscular resistance in the athletic woman. These are well worth premarital discovery, as is shown in more than one example in this series, where timely self-stretching of the inadequate opening could have prevented the association of pain with the approach by a male. Such distress in coitus or failure to provide for orgasm, tend - once desire has been awakened - to drive desire toward a woman.96

This was a very simplistic vision of desire; the simple association of the pain of intercourse with a man would cause a woman to find a female lover. This did not take into account any other aspects of sexuality or the desire for a partner. It was either pain or pleasure. Dickinson did not notice that pain could be a part of "normal" sexuality. This reductionistic stance allowed Dickinson a simple preventive prophylactic for homosexuality. He would tell the woman to stretch her vaginal opening to more easily allow the painless penetration of a man. Painless intercourse with men would ensure the development of proper marital sexuality.

The blame for sex between women was also placed on men. Men who could not provide for orgasm in their female partner were held responsible by Dickinson. Without pleasure from heterosexual intercourse, Dickinson thought, women would necessarily turn to homosexual sex. His vision of female sexuality as flexible and to a certain extent unpredictable, stood as a rationale for medical intervention into women's lives. It also accorded sexual behavior a totalizing power to determine identity. The "nebulous" quality of female sexuality also necessitated the proper sexual training of men. Men needed to perform properly in the bedroom in order for women to enjoy marital sexuality.

Dickinson's formulation of desire and its relationship to the body made sexuality something that needed to be managed. The dissemination of medical information and the deployment of medical techniques by experts was all that could ensure the proper sexual behavior in Dickinson's work. Both men and women needed to be properly instructed by their physicians to safeguard them from deviant desires. If that did not accomplish Dickinson's normative goals, then he believed doctors should directly intervene.

The Straight Street

Dickinson constructed a physiology of homosexuality. A locus, a disease caused by deviant sexual practices, was found in female genitalia. This allowed him to uncover homosexual practices without the same need for a confessional dialogue between himself and his patient. This set him apart from his sexological precursors. Dickinson's sexological investigations were, as he stated it, "always proceeding from the body to the mind".97 Ellis and Krafft-Ebing talked about the body in a way that firmly bound it to sexuality, but did not observe the interstices of the flesh with the precision that Dickinson did. This allowed for new sexological perspectives on same-sex desire.

A new homosexual body emerged in this discourse that could be visually identified. By producing this type of knowledge, Dickinson could better see the contours of sexuality. Dickinson found pathology in genital morphology. He used this information to specify individuals as members of sexological categories. Dickinson claimed he could learn the history of a women's sex life by looking at her vulva. The shape of the vulva constituted who women were in his sexology.

The comparison of "homosexual" or "autoerotic" genitals with "heterosexual" genitals allowed for the delineation of normalcy and deviance. This aesthetic judgment was used to support his vision that heterosexual intercourse was healthy. Petite genitals signified feminine sexual purity in Dickinson's work. Dickinson's discriminatory vision was used to show that physically same-sex desire was a threat to health. Dickinson somehow saw that "misshapen" genitals belonged to pathological women. Dickinson began to see more clearly how to avoid this "threat".

Women who loved women were not studied for their own sake; they were not examined by Dickinson to be healed. The desire these women felt was explored only to eliminated. Reading genital love in this fashion reduced women who experienced same-sex eroticism to symbols of pathology. The otherness of these women permeated Dickinson's text. This difference served as a boundary between the norm and the limit. Furthermore, they existed in his work to warn the medical reader to prevent homosexuality at nearly any cost. The female homosexual became a sexual outlaw in Dickinson's work. The goal was to prevent future transgression against what Dickinson thought was sacred, marriage and maternity.

His discussion of homosexuality and how to recognize and subsequently avoid it, inevitably led to what he was trying to promote, that is, marital sexuality. He wanted to bring about the (hetero)sexual utopia Ellis dreamed of by ensuring the sexual happiness of married couple through medical intervention. Dickinson sought to sanctify bourgeois marriage through science. By his investigations into sexual pathology, he became increasingly aware of how to proscribe a normal sexuality. Dickinson would construct a role for the physician that would make him or her become increasingly central to preserving the integrity of the family. Dickinson wanted physicians to keep sex within bounds of matrimony. He wanted to save people from their unpredictable desires through sex instruction.

Chapter 2: Footnotes

1 Luce Irigaray, Marine Lover of Friedrich Nietzsche Trans. Gillian C. Gill (New York, 1991), p. 152.

2 See John D'Emilio, Sexual Politics, Sexual Communities: The Making of a Homosexual Minority in the United States, 1940-1970 (Chicago, 1983), pp. 9-22; Lillian Faderman, Odd Girls and Twilight Lovers: A History of Lesbian Life in Twentieth-Century America (New York, 1991), pp. 37-61; Michel Foucault, The History of Sexuality: An Introduction, vol. 1 of The History of Sexuality, trans. Robert Hurley (New York, 1978), pp. 77-131, David F. Greenberg, The Construction of Homosexuality (Chicago, 1988), pp. 400-11; Bert Hansen, "American Physicians' "Discovery" of Homosexuals, 1880-1900: A New Diagnosis in a Changing Society" in Framing Disease, eds. Charles E. Rosenberg and Janet Golden (New Brunswick, NJ, 1992), pp. 104-25; and Paul Robinson, Modernization of Sex, (Ithaca,1989), pp. 1-41.

3 George Chauncey, Gay New York: Gender, Urban Culture, and the Making of the Gay World, 1890-1940 (New York, 1994), p. 98.
4 Chauncey, pp. 121-7.
5 Hansen, pp. 123-5.
6 Richard von Krafft-Ebing, Psychopathia Sexualis (New York, 1965) pp. 61-7.
7 Jonathan Ned Katz, The Invention of Heterosexuality (New York, 1995), p. 112.
8 Robert Latou Dickinson Papers, Box 4.
9 Ibid., Box 11.
10 Henry L. Minton, "Community Empowerment and the Medicalization of Homosexuality: Constructing Sexual Identities in the 1930s" Journal of the History of Sexuality 6 (1996): 436.
11 Greenberg, pp. 400-11
12 Havelock Ellis in Robert Dickinson and Lura Beam, A Thousand Marriages: A Medical Study of Sex Adjustment (Baltimore, 1931), p. vii.
13 See Havelock Ellis, Studies in the Psychology of Sex , Second Edition (Philadelphia, 1931); Minton, pp. 436-7, and Paul Robinson, Modernization of Sex (Ithaca,1989), pp. 1-41.
14 Ibid.
15 Robinson, p. 15.
16 Katz, The Invention of Heterosexuality, pp. 87-88.
17 Richard von Krafft-Ebing saw homosexuality as a functional sign of degeneracy. He believed homosexuality should be decriminalized as well, but was considerably less interested in sexual freedom than Havelock Ellis. As one of the earliest sexologists, his monograph, Psychopathia Sexualis, was initially published in 1886 in Stuttgart, Germany. See Richard von Krafft-Ebing, Psychopathia Sexualis, pp. 285-297.
18 Greenberg, p. 411.
19 Robinson, pp. 1-11.
20 Ibid.
21 Jonathan Ned Katz, Gay American History: Lesbians & Gay Men in the U. S. A. (New York, 1992), p. 139.
22 Havelock Ellis, "Sexual Inversion in Women" Alienist and Neurologist (1895), segment reprinted in Katz, Gay American History , p. 139.
23 Ibid.
24 Ibid.
25 Greenberg, pp. 400-11 and Robinson, pp. 1-11
26 Havelock Ellis, Studies in the Psychology of Sex, vol. 2.
27 Ellis, "Sexual Inversion in Women".
28 Ibid.
29 Robert Latou Dickinson and Lura Beam, A Thousand Marriages: A Medical Study of Sex Adjustment (Baltimore, 1931), and The Single Woman: A Medical Study in Sex Education (Baltimore, 1934); Robert Latou Dickinson, "Doctor as Marriage Counselor", Robert Latou Dickinson Papers. Francis A. Countway Library of Medicine, Harvard University, Box 11-12.
30 Havelock Ellis, A Thousand Marriages, p. ix.
31 Ibid.
32 James Reed, From Private Vice to Public Virtue: The Birth Control Movement and American Society Since 1830 (New York, 1978), p. 184.
33 Ibid., pp. 181-4.
34 Minton, p. 438.
35 Dickinson and Beam, The Single Woman.
36 Ibid., pp. 203-4.
37 Ibid., p. 203.
38 Ibid., p. 213.
39 Ibid., p. 203.
40 Ibid., p. 211.
41 Dickinson, Robert. "Martial Maladjustment: The Business of Preventive Gynecology," Long Island Medical Journal 2 (1908): 2.
42 Dickinson and Beam, The Single Woman, pp. 211-2.
43 Ibid.
44 Ludmilla Jordanova, Sexual Visions: Images of Gender in Science and Medicine between the Eighteenth and Twentieth Centuries (Madison, WI, 1989), pp. 19-42
45 Dickinson and Beam, The Single Woman, pp. 211-2.
46 Ibid., p. 212.
47 Ibid., p. 214.
48 Ibid., p. 205.
49 Ibid.
50 Ibid., pp. 205-6.
51 This particular medical construction, the "unhappy homosexual", had its roots in the sexological work that was being disseminated in this period. It is an image that has persisted even until the present day.
52 Dickinson and Beam, The Single Woman, pp. 214-22.
53 Ibid., pp. 214-6.
54 Ibid., pp. 214-5.
55 Ibid., p. 76.
56 Ellis, Studies in the Psychology of Sex, vol. 3, pp. 189-91, 249-56.
57 Dickinson and Beam, The Single Woman, pp. 214-6.
58 Sexual deviance was linked with contamination both of the individual body and the social order during the late nineteenth century. This particular medical perspective was exemplified in discussions of venereal disease. See Allan M. Brandt, No Magic Bullet: A Social History of Venereal Disease in the United States since 1880 (New York, 1987), pp. 5-6.
59 Dickinson and Beam, The Single Woman, pp. 214-6.
60 Ibid., p. 215.
61 An inflammation of a mucous membrane that Dickinson believed was caused by "vulvar irritation" during masturbatory or homosexual sex.
62 Dickinson and Beam, The Single Woman, p. 215.
63 Ibid., pp. 214-6.
64 Ibid., p. 216.
65 Robert L. Dickinson, "Hypertrophies of the Labia Minora and Their Significance," American Gynecology 1(1902): 225-7, 248-53.
66 Dickinson and Beam, The Single Woman, p. 214.
67 Ibid., p. 203.
68 Ibid., pp. 203-22.
69 Ibid., p. 214.
70 Ibid., p. 222.
71 Ibid., pp. 422-5.
72 Robert Latou Dickinson Papers, Box 6, Fd 10.
73 A pseudonym. For more on "Miss Jan Gay" see Minton, pp. 436-42.
74 Many of the members of the Committee were the principle advocates for the medical model of homosexuality in America. Eugen Kahn, Adolph Meyer, George Henry, and Clifford Beers were major figures in American psychiatry who were interested in applying there psychiatric perspective to manage a wide range of social "problems."
75 Minton, pp. 435-58.
76 Robert L. Dickinson, "Gynecology of Homosexuality," in George W. Henry, Sex Variants: A Study of Homosexual Pattern (New York, 1948), pp. 1069-99.
77 Roentgen rays are the electromagnetic phenomenon we now call x-rays.
78 Dickinson, "Gynecology of Homosexuality," p. 1069.
79 The source for all illustrations in this chapter is the Robert Latou Dickinson Papers.

80 Dickinson, "Gynecology of Homosexuality," p. 1076.

81 Ibid., pp. 1076-7.

82 Ibid., p. 1081.

83 Ibid., p. 1097.

84 Dickinson, "Hypertrophies of the Labia Minora and Their Significance," p. 244.

85 Audrey Smedly, Race in North America (Oxford, 1993), pp. 231-52.

86 Siobhan Sommerville, "Scientific Racism and the Emergence of the Homosexual body," Journal of the History of Sexuality 5 (1994): 264-6.

87 Dickinson, "Gynecology of Homosexuality," p. 1097.

88 Ibid.

89 For further methodological considerations and historical iconographies of race and sexual deviance in relation to the construction female sexuality see Sander Gilman, Difference and Pathology: Stereotypes of Sexuality, Race, and Madness (Ithaca, NY, 1983), pp. 76-108.

90 Sommerville, p. 265.

91 Dickinson, "Gynecology of Homosexuality," pp. 1081-2.

92 Ibid., p. 1082.

93 Ibid.

94 For a discussion of how phrenology and other scientific readings of the body surface played a large part in the construction of racialized and/or criminalized bodies please see George L. Mosse, Toward the Final Solution: A History of European Racism (Madison, WI, 1978), pp. 27-30; and Stephen Jay Gould, The Mismeasure of Man (New York, 1981), pp. 92-8.

95 Dickinson, "Gynecology of Homosexuality," p. 1073.

96 Ibid., p. 1082.

97 Dickinson and Beam, A Thousand Marriages, p.435.

Chapter 3: Sex Instruction and the Sanctity of Marriage

He takes female sexuality as he sees it and accepts it as a norm. That he interprets women's sufferings, their symptoms, their dissatisfactions, in terms of their individual histories, without questioning the relationship of their "pathology" to a certain state of society, of culture. As a result, he generally ends up resubmitting women to the dominant discourse of the father, to the law of the father, while silencing their demands. 1

-- Luce Irigaray


Robert L. Dickinson believed sex education was crucial to preserving the institution of marriage in America. Throughout his works, he would point to sex instruction as a way to avoid problems in marriage and prevent "perversity." Toward the end of his life, he became more assured that the doctor had an essential role to play in preserving proper sexual relations and monogamous love. Dickinson wanted physicians to become marriage counselors. As in his inaugural address to the American Gynecological Society, Dickinson upheld that marital maladjustment was the business of a preventive gynecology.2

In order for marriage to be "saved," Dickinson believed scientific study was necessary. He looked not only to sexual deviance as a way to find the limits of normal sexuality. Studies of homosexuality, autoeroticism, and genital morphology were insufficient. Dickinson studied marital sexuality directly to generate data which would serve as the basis for his version of sex education. Dickinson acted as a marriage counselor himself through much of his medical career; as with his other studies he drew on his clinical experience.3 However, the bulk of Dickinson's knowledge came from observing what he called the pathological. He wrote, "What I teach is based, each clause of it, on the wreck of some marriage or some mind."4 Dickinson tried to find the meaning of marital harmony through the analysis of its difficulties; he found health through pathology.

Dickinson's sexological information would be carefully disseminated by medical experts according to his strategy. Dickinson wanted the doctor to take care in presenting information to his patient, especially if the patient was a woman. He wrote,"our high function as confessors and advisers to the saintly half of the race. . . is impossible without intimate speech, gentle, reverent, direct."5 He wanted marriage counselors to fill this role. They would not only present the "truths" of sexology to the couple, but intervene directly to ensure Dickinson's vision of sexual health.6

Marriage counselors would play three important roles for Dickinson: to train perspective couples to have a proper sexuality, to prevent the marriage of "degenerates," and promote fertility and fidelity in "genetically fit" couples. To accomplish these goals, Dickinson felt it was also necessary to ensure that neither partner had engaged in deviant sexual practices. He would give the woman the sexual advice she apparently needed in a fashion that would only allow her to be heterosexual. Heterosexuality was the only healthy path for women according to Dickinson.7 He thought the doctor, acting as a marriage counselor, should oversee all of these matters and could give objective advice to couples.8

The lack of basic sex knowledge in the general populace was at the root of most marital difficulties according to Dickinson. This was a problem for him primarily because he believed that marital discontent was the result of sex problems. He believed that women, much more than men, were uninformed about sex. Yet, this gave him an opening to offer his medical services to prevent marital difficulties. Dickinson wrote early on in his career that gynecology could be useful in the sexual arena. He espoused a preventive gynecology whose most powerful tool was the dissemination of knowledge.

If very many mothers subject their daughters to the shock of a first genital hemorrhage, unannounced; if there is rarely any warning concerning self-abuse; if normal curiosity, at proper times, concerning marriage and maternity is evaded; if engaged couples are not guarded; if lack of very simple knowledge on nearly every wedding night leaves blind fear to blundering ignorance; if no single cause of mental strain in married women is as widespread as sex fears and maladjustments, and if the court records show that in most divorces the initial source of friction lies in a real or fancied physical incompatibility - if some of these things are so, then the proper agency for oversight has failed of its duty.9

It was the woman that he primarily saw as the source of marital discontent. Dickinson believed he could save the bourgeois family from its ignorance with his sex education. Apparently, women lacked the knowledge that he could provide. Dickinson claimed to be able to relieve women's mental strain that were a result of "sex fears and maladjustments" through cautious conversations about sex. This ignorance was not necessarily her fault, Dickinson thought, she just needed to be made aware of the "facts" of sexuality.10 (see figure 1)11


--Figure 1: Eugenic diagram promoting sex education

Dickinson would relieve women's supposed anxieties about sexuality by telling them how to feel about their desires. Dickinson would relay the "simple" facts of the sex act. He believed he was an objective observer, a scientist. The implementation of sexological theory in this context was used to provide more than just a knowledge base. Drawing from his clinical data, Dickinson thought he had the tools to train women to perform heterosexuality. Although Dickinson thought it was better to instruct women before marriage, he would offer medical assistance after the nuptials had long since been said.

The clergyman unites man and wife. It is for [gynecologists] to help to keep them united, inasmuch as the very perfection of union cannot exist without physical harmony. 12

Dickinson positioned sexuality as the physical source of love and fidelity. For him, sexuality allowed the "very perfection of union." Incompatibilities in sexual relations were the true source of marital difficulties in Dickinson's mind. Other influences, such complaints about money, work, or children, were secondary.13 Reducing marital life to merely its sex, allowed Dickinson to make his case that gynecologists were needed to protect the family. As successful managers of female bodies, Dickinson believed, they should be especially able to preserve failing marriages. This linkage relied on the assumptions that gynecologists actually understood sexuality and that sex was primarily physiological in nature.

Dickinson positioned gynecology as the arbiter of sexual knowledge. He wanted American gynecology to be an "agency of oversight"; this panoptic perspective of the medical speciality allowed for a specialized regulation of sexuality without restrictions. Dickinson saw himself as the guardian of young couples. He wanted to ensure their unfettered assent into the heterosexual status quo. Armed with a new understanding of erotics and reproduction brought by the espousers of sexology and his own investigations, Dickinson believed he had the information to ensure the development of marital sexuality. If need be, he assured himself that he could restore the "fallen" woman to her rightful place as sacrosanct mother and wife through reeducation.14

As in his writings concerning sexual deviance, heterosexuality was precarious. Dickinson revealed a crisis of misinformation in the bedroom. A doctor's oversight was needed. Sex should not be a secret according to Dickinson. Sex needed to be understood and named by the scientific mind. By defining sexuality in such a manner, he sought to find an objective solution to marital difficulties. Dickinson's sexual knowledge became a medical technology that would inform and conform sexual praxis.15

Responding to the "New Woman"

Dickinson's concern with the wife and her sexuality was linked to two important trends in American society in the early twentieth century. Women were redefining their position in the social hierarchy. The "new woman" was being born. This reformulation of female gender roles allowed for increasing autonomy for women which was a concern for many middle-class men. The second concern was the decline in birth rates among the middle classes. This trend combined with fears about immigration, led to cultural anxiety about the future of the "Anglo-Saxon stock." These wider cultural fears were represented in Dickinson's perspective on birth control, marriage, and fertility.

The "new woman" assumed a variety of forms and meanings in the cultural lexicon of early twentieth century America. She existed in both middle-class and working-class arenas advocating for the advancement of women's legal rights and significant social change. Radical women in the period such as Emma Goldman and Elizabeth Gurley Flynn were part of the second wave of feminism.16 Standing firmly on the side of labor, they argued for the redistribution of political-economic power in America. Social, intellectual, political, economic, and sexual equality between men and women were their goals. Those involved in this feminist project sought to overturn the bourgeois order on a multiple of fronts.17

Many feminists were involved in the struggle for reproductive and sexual freedom. They argued that motherhood fundamentally was a choice but not a limiting one. Although this articulation of female autonomy was an important and radical one, it lead to some difficulties for the movement. The sexuality of women came under increased cultural scrutiny. This drew attention away from the main focus of feminists which was political, economic, and social equality for all.18

Dickinson was not particularly supportive of women publicly advocating for their own rights. He saw such political actions as a possible result of sex maladjustment. Dickinson focused on the sexuality of the "new woman".

Compensation for love impulses thwarted in marriage does not necessarily take the form of requiring physical satisfaction. To atone for spiritual loneliness, compensation magnifies the personality by extraordinary egotism and by material acquisition. Of these attempts, fear, girlish ways, gourmandism, the arts, religion, morals, culture, social and political "causes", the overassumption of family responsibility, worry and financial extravagance are indications told in about 250 cases. 19

Dickinson saw political activity and taking a stronger position in the family as the results of women not being sexually satisfied. Dickinson pathologized women who resisted traditional gender roles. Dickinson's sexually undernourished woman was hysterized; her sublimated desires became his rationale for her deviant behavior. Dickinson did not comprehend the oppression caused by the unequal status of woman, and how that sent women into action. The inequalities of gender in American society were naturalized in Dickinson's work; every resistant act a woman took was somehow a result of the misuse of her sexuality. Dickinson thought women should remain in the private sphere of the home.20 (see figure 2 and 3)


--Figure 2: Idealization of the wife and her children in the domestic sphere as the "happy family"


--Figure 3: Depiction of gender dimorphism in humans

Dickinson delegitimized feminism through an attack on women's sexuality. At least in theory, controlling sexuality gave him a way of regulating the status of women in society. He thought that the use of sex instruction would ensure the proper place of women in society as wife and mother. To implement this, Dickinson would teach the perspective couples how to sexually satisfy each other. He believed that this would prevent sublimation from occurring in women; thereby ensuring their docility.21


Feminism was not the only cultural force Dickinson was reacting to; the general decline in birth rate and the growth of immigration led to an increasing nativistic concern for the survival of the "American stock". These concerns were based both in race and class. Many members of the professional classes were concerned that birth rates among the better-educated, economically advantaged middle and upper classes were declining. Their fear was compounded by the fact that the birth rates among the working class and non-whites were not declining nearly as fast. Men like Theodore Roosevelt scolded economically advantaged women to have as many children as possible to prevent "race suicide."22 Half the growth in American population from 1900-1915, was the result of immigration. Many eugenicists wanted to stop immigration to prevent the "outbreeding of the native stock".23 Being involved in the eugenics movement, Dickinson articulated these issues by trying to make eugenics the concern of marriage counseling.

Dickinson wanted to increase the medical surveillance of sexuality in America to protect and promote marriage. His final work which was left unfinished before his death The "Doctor as Marriage Counselor" was an attempt to convince his colleagues to get more involved in the sex lives of their patients.24 Dickinson's plan was radical. It represented the culmination of his life's work. Dickinson's unfinished manuscript was his final attempt to convince American medicine to get more deeply involved in the regulation of sexuality. Dickinson published a summary of the manuscript in the Journal of the American Medical Association before his death.25

The article that appeared in the journal summarized much of the work Dickinson had been involved with throughout his life. Particularly, Dickinson wanted doctors to directly intervene to save the institution of marriage. The belief that marital unhappiness could be prevented by medical means permeated Dickinson's work.

It took twenty years in practice for me to come to the belief that marital maladjustments were mostly preventable; then as many more to earn enough to retire to devote a last twenty to a closer study of marriage counseling and its relation to general sex education and to character training.26

Recounting his clinical experience in marital sexuality, Dickinson was seeking to influence the focus of American medicine. He wanted to convince doctors that they should be especially involved in premarital consultation. Dickinson saw marital problems in the same light as he did organic disease. Dickinson believed that all forms of pathology, whether organic, social, or psychological, should be under medical scrutiny. He recognized social discontent as a disease that emanated from individual bodies.27

If the medical profession did not assume the responsibility for sexual management of its patients, Dickinson saw grave consequences for American society and for American medicine itself. Speaking polemically, he warned medicine of its responsibilities.

Any community that waits to give training that anticipates marriage until patterns are set - or well on the way toward setting - into frigidity and impotence and divorce - or in any degree toward promiscuity and homosexuality - is guilty of an unpardonable lack or courage and foresight. 28

Dickinson argued here for prevention. Frigidity, impotence, divorce, promiscuity, and homosexuality were linked in his thesis. Frigidity and impotence resulted in marital maladjustment because of the lack of sexual fulfillment. Divorce, promiscuity, and homosexuality troubled Dickinson because they involved sexual gratification outside of marriage. All of these represented in his work great threats to family stability and marital fulfillment. Dickinson warned doctors that if they did not take steps to eliminate sexual deviance they would be responsible for devastating consequences; he held the medical community responsible for familial breakups. The consequences were, of course, the gradual overturning of oppressive ideologies of sexuality and gender. Social change of this sort was very disturbing for Dickinson and other members of the medical establishment. For them, gender and family were biological issues, not social ones. Physicians like Dickinson had a stake in maintaining the sexual status quo. Seen in a essentialist perspective by medical professionals, transgressing gender boundaries was analogous to infection. Physicians felt it was their duty to return their patients to biological health.

The belief that sexual behavior was a purely technical question allowed Dickinson the freedom to simplify issues of marriage and sexuality. He saw marriage as analogous to other forms of employment, albeit, an important one. Therefore, Dickinson wanted to make sure perspective parents were suited for the job.

Examination for fitness is becoming the rule of all occupations save for the two most vital and difficult - marriage and parenthood. How to start marriage counsel as custom, how to do it well, yet rather simply, - this is the immediate problem.29

Dickinson wanted to alter the fabric of American society to allow strict medical surveillance and regulation of marriage. He wanted to make marriage counsel a cultural institution that would teach and enforce "sexual health". Dickinson wanted marriage counseling to become part of everyday life. He wanted medicine to have broad powers to implement a moral-scientific code of heterosexual hegemony. Women and men were to be taught what their proper roles in the family were so they would be ready for marriage. Along with these gender prescriptions, the grounds for parental "fitness" would be based in eugenics.

Dickinson looked to Europe as an inspiration for the marriage counseling system he wanted to implement in America. He was particularly impressed by German eugenic policies as were many others in the American eugenics movement.30 He included a great deal of material published on the subject in the manuscript. The German eugenic law which took effect on January 1, 1934, Dickinson wrote, allowed for the sterilization of nearly 400,000 people seen as "unfit to bear children". He quoted the policy in more detail.

The federal cabinet has enacted a law for the prevention of offspring with serious hereditary defects... to be regarded: insanity, hereditary epilepsy, hereditary chorea minor, hereditary blindness, hereditary deafness, severe hereditary bodily deformities. Of especial importance is the regulation that sterilization can be performed on persons who are suffering from severe alcoholism. 31

Dickinson subscribed to ideas of eugenic sterilization. He believed it was part of the responsibility of American physicians to promote social well-being. Dickinson hoped to bring to the United States a kind of reproduction management similar in spirit to the German law. His tactics were different, however. He was not interested in direct state intervention. Dickinson sought an indirect measure; he wanted the state to allow voluntary sterilization. He wanted doctors to be able to advise their patients to sterilize themselves or family members. Dickinson placed the responsibility to handle these issues firmly upon the medical community. He believed physicians could implement eugenic policies with a much subtler form of coercion.32

Marriage counseling could implement eugenic birth regulation if it were given the power by the state to certify marriage. Dickinson thought it would be more effective to stop the "unfit" from reproducing by preventing them from marrying at all. Dickinson wrote about the medical, marriage certification requirement in European states such as Sweden and Denmark. In these countries the doctor would present to the authorities a "declaration by the couple covering mental trouble, epilepsy, venereal disease, leprosy, consanguinity, previous marriage, and children born out of wedlock." 33 He wanted the marriage counselor to serve the same function in America.34

Dickinson did not believe that "marital legislation" was the answer for America at his point in time. He thought state regulation of marriage would be counter-productive to the struggle for racial purity through social hygiene. Dickinson wanted to study the situation further; he maintained that scientific inquiry should guide social policy.35

The need now is for the development of a practical clinical procedure, experience with which will give the basis for the development of a broad social policy. This responsibility weighs equally upon the individual, the social mind and the technician, in this case the physician.36

By working as marriage counselors, Dickinson believed himself and others could gather enough scientific evidence through clinical undertakings to make a strong case for the changing of social policy concerning marriage. He hoped this would eventually change American marriage customs enough to be codified into law. Dickinson was seeking to make marriage a purely scientific problem. He saw that the facts obtained from the study of marriage should be used to influence social policy.37

Dickinson's hopes for the reformation of marriage based on eugenic principles were summarized in this 1913 article.

Looking toward the time when law and custom will require the exchange of certificates of physical and mental soundness before marriage is permitted or even finally pledged, and with the character of the examination for such certificate standardized, [Dickinson] urged that the profession should get ready by formulating the type of the examination and certificate.38

Having the medical profession intimately involved in marriage was Dickinson's goal early on. He wanted doctors to certify the physical, mental, and moral fitness of perspective couples. He sought to further a medico-moral agenda based on eugenic principles. Furthermore, he wanted to make sure the couple was prepared for sexual life and advised the offering of sex instruction to perspective couples. Dickinson even devised a rudimentary marriage certification form.39

Dickinson believed the marriage counselor could offer advice about family planning to the young couple. Dickinson felt that birth control was quite necessary; "the ability to give advice on bearing all the children compatible with well-being of parents, progeny, and community calls for knowledge of the best methods of spacing births."40 Dickinson wanted continued research into new birth control methods. Dickinson also sought their greater availability and widespread use. He was critical of coitus interruptus which he thought could lead to the "limitation of male gratification" and/or prevent female orgasm. The lack of pleasure was seen to lead to marital maladjustment and "nerve strain." Dickinson was particularly enthusiastic about spring-loaded pessaries, spermicidal creams, and condoms. Whatever the method, medical professionals would be the ones to decide when contraception should be used. He did not want to give women unlimited free access to contraception control.41

Although Dickinson was a vehement public supporter of women's access to birth control, he was still concerned about contraception's effect on fertility. He saw birth control as a way to improve marital harmony and also as a means to implement negative eugenics. For Dickinson, birth control was a way of upholding the status quo, not disrupting existing power inequalities. The disturbances in power relations between men and women brought about by the feminist challenges to the status quo were a problem for Dickinson. He thought changes in familial power dynamics would upset health.

As culture develops this "independent" woman, does it develop a complementary child man or a superman? If it develops equals can it promote fertility? If the child woman is the type preferred for marriage, with which sex shall education begin and what education?42

These statements summed up Dickinson's concerns about the effects of redefining gender roles on the family structure. Since the "child woman" was seen by him as the preferred female "type" for marriage, the mature and self-reliant woman presented a problem. The independent woman was seen as a threat to the family by Dickinson even though her independence was called into question by the quotes that encircled the word. It would cause a redefinition of male gender roles in response to the rise in status of the new woman. Dickinson thought the family would create a new power equilibrium in response to the feminist challenges to it. Dickinson's "family" was always already hierarchical in structure. This change in the distribution of familial authority would entail for Dickinson either a reduction of the husband to a "child-man" who would be dominated by his wife or a "superman" whose authority over his wife would rise so that he would still be dominant. Hypervirility would somehow counter the effects of female autonomy according to Dickinson.43

As Dickinson stated above, he believed greater female autonomy could lead to a lower birthrate. He directly linked changes in the family structure to a drop in fertility. Dickinson believed some independent women were reneging on their responsibility to reproduce the "native stock". Yet, this problem could be resolved through proper sex instruction and marriage counseling according to Dickinson. He did see that birth control could lead to "race suicide." On the other hand, Dickinson viewed controlling contraception as an opportunity to implement negative eugenics especially for those who were "economically disadvantaged." The languages of racism and class warfare are intertwined in Dickinson's discourse. A tension lingered in his work between the problems and possibilities of birth control. This tension made it clear to Dickinson that medical oversight of birth control was all the more necessary.44


Dickinson thought marriage counselors needed to have a knowledge of sexology, birth control, organic disease, and eugenic theory. Besides these issues, the qualifications for becoming a marriage counselor were relatively lenient. The most important attribute of potential marriage counselors was if they had a medical background. Dickinson wanted the marriage counselor to be a physician like himself who was "clean of mind and happy in his marriage."45 Dickinson was particularly excited about the possibilities of psychiatrists, gynecologists-obsetricians, and urologists being involved in marriage counseling. Dickinson thought the combination of their expertise in psychology, genital anatomy, and general physiology would connect understandings of mind and body. This combination of medical disciplines would allow Dickinson and future marriage counselors to reduce the sexual life to something easily interpreted by physicians; that being, something that was written on body as an anatomical abnormality. As in much of Dickinson's sexological work, interpretation of the body led to technologies of sexual regulation.46

The actual practice of marriage counseling Dickinson advocated involved interviews similar to the studies he undertook throughout his sexological career. The most important technique was the interview. The marriage counselor would question the perspective couple and physically examine them. He used this to discover what he thought were sexual aberrations, for example, excessive autoeroticism, homosexuality, and sexual activity in women who were presumably virginal. Such discoveries could lead the counselor to recommend that the marriage not proceed.47

Dickinson offered some indications of what signs marriage counselors should be watchful for. The female body, as discussed in the previous chapter, was a place where Dickinson felt he could find objective sexual knowledge by reading the vulva. He used this perspective on the body and its sex as a means to make the premarital interview more efficient and effective.

Where the doctor is a stranger to his patient he does well to establish a friendly relationship before examination. Where that has been already established, the examination is done promptly, as it is likely to give direction to the questions and the instruction and thus save much time. For instance, a wide and worn hymen and free self-exposure suggest direct speech with shortened preambles, whereas, other things being equal, embarrassment and infantile genitals and a small sharp-edged opening give warning that instruction is to be approached in a somewhat gradual fashion.48

Dickinson was using his particular way of reading behavior into the body as effective medical praxis. Two basic stereotypes of femininity were constructed in this text, the sexually free woman and the virgin. The sexually free woman's genitals were described as open and freely presented to the doctor. To this woman, Dickinson, recommended frank and direct speech about sexual matters in the interview. In contrast, the virgin's genitals were childlike and closed. She apparently did not want to be examined. Dickinson advised that with the virginal woman, which he sometimes defined as imparous, the discussion of sexuality take a slower pace.49

Here as well, Dickinson connected psychology with anatomy. This medical myth-making assumed that there was two basic types of women that would come before the marriage counselor: a woman who has known sex and one who has not. A woman well aware of sexuality would somehow have larger, more open genitals for the doctor to view. As for the less sexually experienced women, she would necessarily have small genitals and be resistant to gynecological examination. Dickinson used this anatomical stereotyping to easily categorize women under his examination. He saw it as an expedient method to accomplish his medical goals.50

By doing the gynecological examination early on in the premarital interview, Dickinson thought he could bypass a lengthy dialogue between the woman and the doctor. He focused on her genitals and her willingness to show them, first. The observations Dickinson made from this examination procedure were understood to be able to tell him more than the verbal exchange. In his work, Dickinson preserved the long practiced medical ritual of opening the body; such observations were thought to lead to the medical "truth" more precisely than unverifiable speech.51

Dickinson used the scientific presumptions of his past linkage of homosexuality and genital morphology to give marriage counselors techniques to prevent same-sex eroticism.52 The prevention of same-sex love was crucial to preserving his notion of marital stability. Dickinson made sure the future marriage counselors would understand that homosexuality was pathological.

Unalterable fixation of desire and response on members of the same sex, psychologically or physically, is an important condition for the Counselor to recognize. It is his function to prevent marriage in the presence of such irremediable clash and to diagnose post-marital maladjustments of this sort in their relation to reeducation. Familiarity with any behavior or with any bodily form or genital variation met with in examination which may point to sex deviance belongs in the Counselor's armamentarium (bold mine).53

Dickinson conjured the spirit of war as he attempted to use the counselor as a tool to eliminate difference. Whether homosexuality was seen to be caused by psychological or congenital factors, Dickinson wanted potential counselors to be aware of the signs of sexual deviance. The counselor was charged to point out these dubious signs and prevent the potential marriage. If the marriage had already occurred, Dickinson thought a medical reeducation could possibly remedy sexual deviance.54

Dickinson used the pelvic exam to discover more than homosexuality. The certification of virginity came under the jurisdiction of the marriage counselor. Dickinson believed it was still an issue, even though he saw its importance on the wane.55

There is a fear of removal of evidence of virginity as well as apprehension of discovery of nonvirginity... as to the hymen after the doctor's examination, we give assurance that virginity remains, anatomically. Neither the male size index finger nor... the virgin-sized vaginal speculum expands the opening... of the virgin hymen to that size required to admit the male.56

Dickinson assured the medical reader that marriage counselors would not disturb the "anatomical virginity". There was a discomfort inherent in this text. Dickinson was trying to allay fears concerning the male doctor's intrusion into the husband's sphere; access to the woman's body was seen as the husband's right. Mary Poovey has observed a similar discomfort with the gynecologists' interaction with his female patients and the use of ether in the late nineteenth century. Gynecologists were trying to "desexualize" women by either anesthetizing them or letting them experience pain during labor. The sexuality of the doctor was rendered problematic by gynecologists' own discourse. Dickinson was still experiencing some degree of anxiety over his relationship with the female body in the first half of the twentieth century.57

By examining the "virgin hymen," Dickinson thought he could prevent future sexual difficulties. He believed that the hymen needed to be stretched to avoid pain on the wedding night. This could be done by the bride or the groom. If the hymen was too thick for stretching to make a difference, Dickinson proposed surgical methods to open the vulva. He sometimes performed such operations but only rarely.58

Beyond the pelvic examination, Dickinson wanted the marriage counselor to notice apparent psychological traits of the perspective couple. Here as well, the repression of homosexuality was central to his thinking. He believed the marriage counselor should be watchful for signs of femininity in men and masculinity in women. Dickinson argued that these "gender inversions" were signs of homosexuality or other forms of sexual deviancy. The marriage counselor should seek to prevent marital union in such cases.59

The marriage counselor functioned more than just as a disseminator of medical sex knowledge. Marriage counseling involved the direct enforcement of gender roles. If gender roles were deviated from, Dickinson wanted the marriage to be discouraged to prevent future marital maladjustment. Any disturbance in the family structure that he thought could be avoided, fell under what he called "preventive" medicine.


The examples outlined above highlight what he thought gender roles should be and the techniques Dickinson devised to ensure them. He had a clear idea of what women's roles in society should be. Dickinson stated in the foreword to the 1941 version of "Doctor as Marriage Counselor" the goals of the marriage counselor which reflected his vision of gender.

For health and happiness in homemaking, childbearing and childrearing, the doctor is called upon to define normal function, to foster sane attitudes toward sex conduct, to develop sound schedules for examination and instruction, and to aid in planning programs to prevent discontent and disruption.60

The focus was firmly on women. The woman in Dickinson's text was domesticated. He romanticized the role of the wife as the ideal member of the "saintly half of the race." Dickinson's woman was a mother, homemaker, and (hetero)sexually "awakened." This construction of femininity placed women in the domestic service of men. Female domesticity was seen as the norm; Dickinson used an idea of an innate sexual drive in women to naturalize the censored role of women. He thought women could only find pleasure in the keeping of the home, the rearing of children, and sex with their husbands. The possibilities of women finding pleasure in other ways were seen in direct opposition to their nature. Defining actions that were outside of the norm as against nature, Dickinson could justify them as the result of pathology. Women's diseases were either in the mind or the pelvis for Dickinson. He did not see that the actual difficulties women faced were inherent in the norms he was trying to uphold. From Dickinson's reductionistic perspective, an idea like that would be absurd; he could not truly see the world outside of the body.

Dickinson's biological focus failed to consider that gender was a product of a particular historical moment. Dickinson drew the majority of the justification for his work from what he saw were the physical facts of womankind. If a woman deviated from the role she was ascribed then Dickinson thought marriage counseling should reeducate her to perform her "biological" destiny. The destiny for women in Dickinson's work was marriage and pregnancy.

The reproductive possibilities of women's bodies were managed by Dickinson. Through the use of "planning," he wanted to instruct women when and if they should bear children to prevent "discontent and disruption." He wanted to ensure that marital harmony would continue under the added stress of childbirth and childrearing. Yet, marital harmony was not the only goal he was seeking to implement. The idealized wife of Dickinson's work also implemented birth control properly to protect the race. Dickinson's marriage counselor should educate the wife about eugenics. He felt it was her duty to humankind to reproduce or not according to the "hereditary traits" she and her husband carried. Dickinson advised marriage counselors to take steps to ensure this would occur.61

Education was crucial to marriage counseling. The marriage counselor would use his or her discursive authority as an expert to instruct couples on how they should live, love, and bear children. A dialogue between the counselor and the couple did not exist. The couple could either accept or reject the counselor's advice. The discussion in the premarital interview was about how the couple should emulate the bourgeois familial ideal; the validity of the family structure could never be the subject of argument. Dickinson thought this education would necessarily transform the single man and the single woman into the perfect couple.62


As we have seen in this discussion of marriage counseling and sex instruction, female sexuality was central in Dickinson's thinking. Male sexuality was also a focus but it was not as significant; it did not need to be analyzed in the same fashion because it was apparently more understood. Female sexuality represented both the problem and solution to marital difficulties. Through sexual reeducation, Dickinson believed he could manage female sexuality to ensure the heterosexual marriage. Without the scientific management of women's libidinal economy, he thought marriage could be in jeopardy.

Here, sex instruction was crucial to preserving the sanctity of marriage. Dickinson constructed a world were a crisis of misinformation was leading to the instability of marriage. He wanted to inform women of the "sexological truths" that could apparently save this heterosexual institution. Dickinson prescribed this role to the doctor and called it marriage counseling. The doctor as marriage counselor would ensure proper heterosexual adjustment through examining and instructing the bride and groom.

The primary focus of Dickinson's work was the preservation of the bourgeois family structure. In order to do this he needed to maintain women in a subservient position in the private sphere. She was deemed pathological when she transgressed the familial role she was ascribed. Whether by loving another women instead of a man or by entering the public sphere, what was central to Dickinson's understanding of women's behavior was that she transgressed her gender role as wife and mother. By not performing gender in the way Dickinson approved of she therefore was pathological.

Instead of focusing his energy on how the family could benefit from the equality of men and women, he sought to prevent egalitarian relations between the sexes. He thought the disparity in power between men and women was a product of nature, not culture. Dickinson wanted women to desire to enter the private sphere of the home; he saw it as the aim of their innate sex drive. Yet, this "aim" was something Dickinson felt needed to be controlled. He wanted marriage counselors to shape women so they would desire nothing more than marriage. Marriage counseling was a disciplinary technology designed to make women conform to the desires of the husband and enjoy doing so.

Chapter 3: Footnotes

1. Luce Irigaray, The Irigaray Reader, ed. Margaret Whitford (Cambridge, MA, 1991), p. 120.

2. See Robert L. Dickinson, “A Program for American Gynecology,” American Journal of Obstetrics and Gynecology 1 (1920): 5-7.

3. For more about his investigation of marital sexuality see, Robert Latou Dickinson and Lura Beam, A Thousand Marriages: A Medical Study of Sex Adjustment (Baltimore, 1931).

4. Robert L. Dickinson, "Martial Maladjustment: The Business of Preventive Gynecology,” Long Island Medical Journal 2 (1908): 2.

5. Ibid.

6. Robert Dickinson, “Doctor as Marriage Counselor,” Robert L. Dickinson Papers, Francis A. Countway Library, Harvard University, Box 11.

7. Dickinson, "Martial Maladjustment,” p. 1.

8. Dickinson, “Doctor as Marriage Counselor,” Robert L. Dickinson Papers, Box 11.

9. Dickinson, "Martial Maladjustment,” p. 1.

10. Ibid.

11. The source of the illustrations presented is the eugenic manual concerning sexuality, see Herman H. Rubin, Eugenics and Sex Harmony (New York, 1943).

12. Dickinson, “Marital Maladjustment,” p. 2.

13. Robert Dickinson, “Medical Analysis of a 1000 Marriages,” Journal of the American Medical Association 97 (1931): 532.

14. Dickinson, “Martial Maladjustment,” p.1-5.

15. Ibid., p. 1.

16. Emma Goldman was an influential anarcho-socialist feminist. Elizabeth Gurley Flynn was a labor organizer for the Industrial Workers of the World (IWW).

17. Lois Rudnick, “The New Woman,” in 1915, The Cultural Moment, eds. Adele Heller and Lois Rudnick (New Brunswick, NJ, 1991), pp. 69-78.

18. Ibid., p. 78.

19. “Medical Analysis of a Thousand Marriages,” p. 533.

20. Ibid.

21. Dickinson, “Doctor as Marriage Counselor,” Robert L. Dickinson Papers, Box 11.

22. Daniel J. Kevles, In the Name of Eugenics (Berkeley, CA, 1985), pp. 73-4.

23. Kevles, p. 94.

24. The manuscript went through several drafts dating from the mid-thirties to the forties. See Robert Latou Dickinson Papers, Box 12.

25. Robert L. Dickinson, “Premarital Consultation” Journal of the American Medical Association 117 (1941): 1687-92.

26. Ibid., p. 1687.

27. Ibid.

28. Ibid., p. 1691.

29. Dickinson, “Doctor as Marriage Counselor,” Robert L. Dickinson Papers, Box 11.

30. Stefan Kühl, The Nazi Connection: Eugenics, American Racism, and German National Socialism (New York, 1994): p. 48-52

31. “Doctor as Marriage Counselor” Box 11, notes taken by Dickinson on a Journal of the American Medical Association article entitled “Eugenic Sterilization,” vol. 101, p. 866, September 9, 1933.

32. Robert L. Dickinson, “Birth Regulation,” Eugenics: A Journal of Race Betterment 2 (1929): 35-7.

33. Dickinson, “Doctor as Marriage Counselor,” Robert L. Dickinson Papers, Box 11.

34. Ibid.

35. Ibid.

36. Ibid.

37. Ibid.

38. Robert L. Dickinson, “Preparation for Marriage; Instruction, Examination, Certificate” Long Island Medical Journal 7 (1913): 156.

39. Ibid., p. 156-57.

40. Robert L. Dickinson, “Conception Control,” Journal of the American Medical Association 123 (1943): 1043-4.

41. Ibid., p. 1043-46.

42. Robert Latou Dickinson and Lura Beam,The Single Woman: A Medical Study in Sex Education (Baltimore, 1934), p. 433.

43. Ibid.

44. Robert L. Dickinson, “Control of Conception,” New York State Journal of Medicine 29 (1929): 596-602.

45. Dickinson, “Marital Maladjustment,” p. 1.

46. Dickinson, “Doctor as Marriage Counselor,” Robert L. Dickinson Papers, Box 11.

47. Ibid.

48. Ibid.

49. Ibid.

50. Ibid.

51. Ibid., and Michel Foucault, Birth of the Clinic, Trans. A. M. Sheridan Smith (New York, 1975), pp. 124-46.

52. Robert L. Dickinson, “Gynecology of Homosexuality,” in George W. Henry, Sex Variants: A Study of Homosexual Pattern (New York, 1948), pp. 1069-99.

53. Dickinson, “Doctor as Marriage Counselor,” Robert L. Dickinson Papers, Box 11. This passage from the 1942 manuscript of the "Doctor as Marriage Counselor" revealed his ambivalence towards the actual cause of homosexuality. Whether drawing on constitutional ideas of Havelock Ellis or Richard von Krafft-Ebing, or the newer American psychoanalytic theory, the etiology of sexual difference was not central to the medical praxis he wanted to introduce. Dickinson found ways to identify homosexuals and attempted to eliminate same-sex desire. The actual praxis of identification and medical intervention was his primary focus. Dickinson took a pragmatic approach to the elimination of same-sex eroticism.

54. Dickinson, “Doctor as Marriage Counselor,” Robert L. Dickinson Papers, Box 11.

55. Ibid., and “Premarital Consultation,” p. 1690.

56. Dickinson, “Premarital Consultation,” p. 1690.

57. Mary Poovey, “Scenes of an Indelicate Character: The Medical ‘Treatment’ of Victorian Women,” in The Making of the Modern Body, eds. Catherine Gallagher and Thomas Laqueur (Berkeley, CA, 1987), pp. 137-56.

58. Dickinson, “Premarital Consultation,” p. 1690.

59. Dickinson, “Doctor as Marriage Counselor,” Robert L. Dickinson Papers, Box 11.

60. Ibid.

61. Ibid.

62. Ibid.

Conclusion: Alien Mirrors

Even the sharpest, the most piercing gaze will be incapable of calculating its angles of incidence, for the eye remains captive in the world of the visible and does not embrace the totality of viewpoints and their harmonious organization. 1

-- Luce Irigaray


By reading the state of medicine in the early twentieth century through the work of Robert L. Dickinson, we can see that medicine had a vested interest in the regulation of sexuality. Dickinson wanted to protect and promote the family through the management of sexuality. The marriage counselor, a physician, was to examine the young couple to make sure they were fit for marriage and parenthood. Dickinson wanted medicine to directly manage marriage and maternity. According to him, marriage counselors would decide if a potential marriage was valid on grounds of eugenics and sexual adjustment. If the couple did not live up to his standards of “marital health,” then the marriage counselor was left with two options by Dickinson. He or she would either try to correct the problem through sexual reeducation or by recommending that the wedding not proceed.

The family, in the logos of Dickinson’s science, assumed a transhistorical position. The family was constructed as biological destiny. It was seen to naturally flow from the female body. By maintaining a strong connection between the family, the natural, and the feminine, Dickinson believed that medicine had scientific grounds for the medical management of desire. The family, seen as the culmination of feminine sexual drive, was a problem that could be resolved by medical experts principally because it was rooted in the body. If medical experts did not intervene to preserve the family through the regulation of gender and sexuality, Dickinson believed the medical profession held the responsibility for the consequences of family instability, whatever those consequences could be.

The role of the marriage counselor was to facilitate the (re)discovery in women of their “natural” desire to get married and have children. What was crucial here was the performance of gender. Dickinson believed men and women had different roles in the family that stemmed from the different “natures” of men and women. Men needed to have authority the over domestic sphere. Women needed to make the home a sanctuary for her husband and children. The enforcement of strict gender roles became a medical technique in Dickinson’s work. Women were the main focus of his gender regulating discourse, but of course they had repercussions for the men as well. In the sexual sphere, Dickinson’s vision of health relied upon maintaining a patriarchical family structure.

Dickinson’s ideas about family were not new. Both Havelock Ellis and Richard von Krafft-Ebing had similar assumptions about gender and family which permeated their respective works. Nonetheless, Dickinson was able to extend the scope of sexological investigations. He examined the female body to find signs of sexual deviance. Ellis and Krafft-Ebing did not explore the female body in nearly the same detail. They did not have the same clinical access to women’s bodies that Dickinson possessed. Instead, Ellis and Krafft-Ebing focused on interviewing patients to create a case study. Dickinson’s gynecological expertise set him apart from the two great fathers of sexology. Dickinson could extend the scope of the case study to include a gynecological examination as well as patient interviews. This form of investigation allowed him to come to a startling conclusion about the visibility of sexual pathology in women.

Dickinson’s difference from other sexological writers emerged in his discussion of female same-sex desire. He found a way to identify women who love other women by observing their genitals. Dickinson was also able to categorize the sexuality of women in general by observing their genitals. By simply viewing the genitals he believed he could see if and when women had engaged in autoeroticism, homosexuality, or heterosexuality. No other sexological writer was able to do this before Dickinson and so far no one has done it since his death. Dickinson’s “discovery” was a breakthrough in the practice of sexology; diagnosis of sexual pathology in women could simply come from a gynecological examination. Looking replaced listening in Dickinson’s sexology; this was the critical difference between himself and his sexological precursors.

Dickinson wanted his mode of sexual identification to be used for a variety of purposes. Dickinson wanted to be able to easily diagnose his patients as “pathologically perverse” through a brief gynecological examination instead of a lengthy dialogue. Furthermore, he used the criteria he invented as a tool for marriage counselors. Dickinson wanted the marriage counselor to be able to do a brief examination of the vulva to see if the woman was ready for marriage. If her genitals were deemed to be large, and therefore “homosexual” or “autoerotic”, she would be disqualified for marriage by the counselor. If she exhibited genitals of “normal” size and shape, then the marriage consultation most likely would lead to marriage.

Genital morphology took on a larger significance in Dickinson’s work than simply the policing of deviant desires. Measuring the genitals’ shape, size, and erectility was the way he could translate femininity into something he could make qualitative and quantitative judgments about. Dickinson read sexuality through the vulva. Women’s bodies were supposed to reflect his idealized vision of female sexuality. Female genitals were supposed to be open, but the width of this opening varied at different stages of “female life”. The young girl’s vulva apparently was only to admit a male finger or the “virgin” speculum. Only after the wedding night, were women sanctioned to have a full, open sexuality. Dickinson’s gynecology allowed for only the husband to open the hymen and initiate his wife in the erotic arts. Yet even after marital sexuality had begun, the shape of the vulva needed to be watched to ensure there was no homosexual or severe autoerotic behavior. Regardless of its specific form, women’s sexuality was something that Dickinson sought to manage because he deemed it uncontrollable.

Throughout Dickinson’s medical career, the regulation of gender was primary, sexual difference was secondary. The fundamental issue in his work is the management of desire in order to preserve the stability of the bourgeois family structure. For him, this primarily involved a regulation of gender behavior through medical intervention. Even in the case of his studies into same-sex eroticism, the issue at hand was whether these women would perform heterosexuality. It was that women who loved women were not making a family with a man that was problematic. Thus, the family was Dickinson’s primary concern. The fact they were sleeping with women was still important but not as important as their abdication of marriage and motherhood.

Dickinson’s work is symptomatic of medical writings on gender and sexuality. In his texts, women were exploited in order to further his hegemonic vision of heterosexuality. Whether the women in these texts loved other women or men they all fell under the surveillance of Dickinson’s medical gaze. His vision turned women into objects of discovery for the scientific mind. Women were uncovered to be disciplined; they were talked about, but there was no real dialogue between the woman and the doctor. Women were alienated and alien throughout Dickinson’s work.

By figuring female sexuality as undiscovered, Dickinson positioned women’s desire outside of medical knowledge. In this sense, female sexuality was unconscious and alien. It (id) was outside the realm of the known, the apparent. It was silent and Dickinson sought to give it a voice. However, the voice he gave female sexuality was only the echo of his own. Nevertheless, Dickinson maintained that female sexuality needed to be uncovered to maintain the imbalance in the gender system; this inequality was necessary for him to maintain marital harmony and “viable” offspring. Women therefore needed to be pulled back into discourse through scientific observation in order to be understood by Dickinson. By unveiling an always already alien feminine libido, Dickinson mistakenly thought he could reach some form of truth. In his work, female sexuality could be read as a phallogocentric fantasy.

Instead of locating women in a historical and social context, Dickinson saw women through their timeless bodies. Therefore in his studies, femininity, like the family, took upon a transhistorical quality. His vision of natural femininity was eternal. Dickinson wanted women to return to their primal desire for the man and his family. There was no sense that gender was constructed in the fabric of his time. For Dickinson, gender had no past and the body was always invested with the same meanings. Therefore, any change in female gender roles would deny the body. This denial was the source of pathology in Dickinson’s writings.

Yet, Dickinson failed to find his ideal of femininity in many of the women he examined. These other women, the women that were sexually awake before marriage, presented a problem for Dickinson. Their bodies did not mirror what Dickinson wanted to see. This discovery was shocking for the doctor especially when confronted by same-sex eroticism. The “homosexual” female body reflected difference. To manage the difference he saw in women who loved women, he focused on genital morphology. The genital morphology of “homosexual” women was understood to stand outside the norm. He used his discussion of female homosexuality as a mirror that reflected a distorted image of heterosexual satisfaction. This reflection was meant to warm the medical reader to prevent homosexuality at all costs. The distortion actually existed in his presentation of female genitalia.

Here, female sexuality existed underneath what was said about it, and was always alien to what could be said about it. The elusive quality of female sexuality as it was presented in Dickinson’s work was the precise reason it needed to be managed. By examining and instructing women, Dickinson thought he could resolve the “problem” of female sexuality. Nonetheless by Dickinson’s own construction of female sexuality as “undiscovered” and “alien”, there would be always something he could not grasp. By always seeing women’s sexuality as a question, the answer would always escape him.

Dickinson’s woman was an alien mirror. She could either reflect or distort his image of femininity. Yet, she should not speak and rarely did. Her body was a reflective canvas on which Dickinson focused the light of his gaze. When he did not see what he desired, the virgin hymen, the quiet wife, then the mirror that was woman became alien. It was no longer his mirror, his reflected gaze. The impact of this experience in looking at her changed his perspective. This other woman became something else, something pathological. He needed to put this woman in the category of what was not his, the displaced and distant. But from this outside space, in another time, this alien woman would reemerge. The mirror she holds would someday reflect all that had been done to her.

Conclusion, footnotes

1. Luce Irigaray, The Speculum of the Other Woman trans. Gillian C. Gill (Ithaca, NY, 1985), p. 328.

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Journal Articles

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Lindquist, Lisa J. "Images of Alice: Gender, Deviancy, and a Love Murder In Memphis." Journal of the History of Sexuality, 6,1 (1995): 30-61.

Marks, Jonathan. "History of Eugenics." American Journal of Human Genetics, 52 (1993): 650–52.

O'Connor, Erin. "Pictures of Health: Medical Photography and the Emergence of Anorexia Nervosa." Journal of the History of Sexuality, 5,4 (1995): 535- 72.

Regardie, Francis I. "Analysis of a Homosexual." Psychiatry Quartery, 23 (1949): 548-66.

Somerville, Siobhan. "Scientific Racism and the Emergence of the Homosexual Body." Journal of the History of Sexuality, 5,2 (1994): 243––66.

Traub, Valerie. "Psychomorphology of the Clitoris." GLQ: A Journal of Lesbian and Gay Studies, 2,1-2 (1995): 81-113.

Ullman, Sharon R. "The Twentieth Century Ways: Female Impersonation and Sexual Practice in Turn-of-the-Century America." Journal of the History of Sexuality, 5,4 (1995): 573-600.

Weindling, Paul. "The Survival of Eugenics in 20th–Century Germany." American Journal of Human Genetics, 52 (1993): 643–49.



Manuscript Material


"Robert Latou Dickinson Papers." Francis A.Countway Library of Medicine, Harvard University, Boston.

Acknowledgements

I am grateful to John Fout, Peter Skiff, Diana Brown, Allan Brandt and Alice Stroup for giving me the resources to write this project. To Dick Wolfe and the rest of the staff at the Countway archive, this project could not have been possible without you. I would also like to thank John Ferguson who inspired me to do something a bit different with my education.

I am particularly grateful to Deirdre D’albertis for hearing my ideas and always giving me courage to continue.

To Jen Shykula and Darin Ikeda whose strength, love, and support allowed me to live through this. I would also like to thank Patrick Burke and Ros Stone for their insight and commentary.

I must also acknowledge the pleasant distractions of Brett, Justine, Richard, Bobby, Kathleen, and Damon.



“We’re moving, so moving, so we are a boy, so we are a girl, we’re moving, so moving, we’ll move the world.”

-- Anderson/Butler