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 pleasura