Monday, 24 February 2014

The Accidental Surgeon

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The Accidental Surgeon
by Dr Louise Chambers

When I first began compiling an archive regarding the emergence of ‘gender reassignment surgery’, I never imagined that my research would take me back as far as the 1830s.

According to Elizabeth Reis (2009: 45-6), one of the first descriptions of genital surgery occurs in notes made by one Dr John C. Warren, a surgeon at Harvard and one of the founders of the Massachusetts General Hospital in Boston. Warren’s patient, a 23 year-old woman, appeared to have ‘no vagina’, although she did have ‘normal breasts’ and a clitoris. Warren made an incision at the front of the woman’s rectum and created a vaginal opening ‘three inches deep’ which, after ‘days of profuse bleeding, fever and pain’ (and a period of dilation), seemed to remain open after the wound had healed (ibid., 46).

Reis argued that the main motivation for this kind of intervention was to ensure that the person concerned had ‘normal’ and natural (ie. heterosexual) sexual relations. Consequently, many of the early reports on genital surgery tended to appear in marriage manuals, as well as the usual journals on medical science.

This point is echoed by writers like Alice Dreger (1998) and Suzanne Kessler (1998), who argue that the sudden ‘appearance’ of, and moral panic around, the ‘hermaphrodite’ was as much to do with fears about same sex relations as it was to do with ensuring individuals had a happy, (re)productive life.

So what does this all have to do with trans people? Well, it is my belief that the emergence of surgical interventions as a means of ‘curing’ what became known as ‘Gender Identity Disorder’ or ‘Gender Dysphoria’ occurred at the juxtaposition of three nineteenth century ‘discoveries’: the hermaphrodite, the invert and the concept of psychical hermaphroditism. I would like to examine each of these in turn.

The Hermaphrodite
The Nymph Salmacis & Hermaphroditus by François-
Joseph Navez, 1829; Museum of Fine Arts, Ghent
For those readers not so well versed in Greek mythology, a short interlude…

According to Ovid (Metamorphoses Book IV) Hermaphroditus was the son of the gods Hermes and Aphrodite and, when he was 15, he found himself wandering near a pool wherein lived a nymph by the name of Salmacis. Now, being the son of Aphrodite, Hermaphroditus was of course very beautiful and, after stripping off his clothes and diving into the pool, Salmacis fell in love with him. Unfortunately her affections were not returned and, as she clung to his body, Salmacis prayed they could be joined as one. The gods heard her prayers and joined them together – literally:
Her prayers find propitious Deities, for the mingled bodies of the two are united, and one human shape is put upon them…So, when their bodies meet together in the firm embrace, they are no more two, and their form is twofold, so that they can neither be styled woman nor boy; they seem to be neither and both. (Ovid, Metamorphoses, IV. 376-391)

Now, strictly speaking, this account suggests that an hermaphrodite is both male and female and has both sets of reproductive organs: this is certainly the definition commonly used today. Nonetheless, the Victorian physicians and surgeons seemed to conveniently ignore that idea and broadened the category to include pretty much anyone who presented genital or gonadal differences that would be classified as ‘ambiguous’ or ‘atypical’ in the determination of an individual’s sex (and, by extension, their sexual orientation). There is a paradox here, however: despite the hermaphrodite sobriquet, most physicians insisted that the individuals who presented with ‘atypical genitalia’ were not part man and part woman. As Dr JW Long (1896: 243) commented:
"the peculiarities which make them appear mixed, are only deformities… they always, with scarce an exception, belong to either one sex or the other."

Dreger (1998: 153-4) suggests that this paradox was resolved through the virtual elimination of the ‘true’ hermaphrodite – a move which may have been partly due to the fear that the possibility of sexual dimorphism among humans fed the continuing paranoia about legitimising same sex couples. This may also explain the emergence of the categories of male and female pseudohermaphroditism – a category to which we will return later in this essay.

Whilst Reis lists a number of early accounts of surgical interventions in the first half of the 19th century, the philosopher and historian Michel Foucault (1980: ix) argued that matters really came to a head (accompanied by the ensuing moral panic) in 1860, following the publication of an autobiography by one Herculine Barbin:
The years from around 1860 to 1870 were precisely one of those periods when investigations of sexual identity were carried out with the most intensity, in an attempt not only to establish the true sex of the hermaphrodites but also to identify, classify and characterise the different types of perversions.

Barbin’s story was first published in 1860. Barbin was sexed as a female on her birth in 1838 but, when examined by a doctor at the age of 22 after complaining of severe pains in her groin, the examining doctor reported that Herculine had a larger than average clitoris and – crucially for the times that Dreger (1998) has described as ‘The Age of the Gonads’ – testicles in a ‘divided scrotum’. She also had a vagina, but neither this, nor her clitoris, prevented the examining doctor from declaring, on finding her ‘testes’:
These are the real proofs of sex. We can now conclude and say: Alexina is a man, hermaphroditic, no doubt, but with an obvious predominance of masculine sexual characteristics.

It’s worth noting that Alexina/Herculine made no secret of her desire for other women – in fact her memoir celebrated the fact that, once declared a ‘man’, she would be able to marry her lover, Sara. Unfortunately, things did not work out that way and, eventually, Herculine took her own life, shortly after completing her memoirs.

Alice Dreger (1998) argued that the late 19th century witnessed a veritable explosion of human hermaphrodites – a phenomenon that might be partly to do with Barbin’s revelations, but may also be accounted for in the rise of the medical and gynaecological sciences in the second half of the 18th century and the simple fact that, post-Barbin, physicians were on the ‘look out’ for other instances of ‘hermaphroditism’. It was clear that, during this period, people with ‘atypical’ or reproductive systems were always already constituted as a ‘problem’. Dreger (1998: 34) noted that the French anatomist, Isidore Geoffroy Saint- Hilaire (1805-1861) created a new field which he called teratology (the biological study of malformations and ‘monstrosities’) and hermaphrodites were included in that field:
by the early 19th century, hermaphroditism was understood by scientists and medical men as a phenomenon to be fully explained by the natural sciences, one existing within the realm of natural law.

When reading through the different accounts of surgical interventions, the main motivation for the surgery seems to be the production of a person with heteronormative desires. As Reis (2009: 56) observed:
"To uncover the history of intersex is to expose the consequences of pervasive attitudes toward permissible and impermissible sexuality… Physicians uncritically accepted and acted on their own heterosexual norms, often elevating marriage as a goal to parents considering surgery for their children." P.56

This conflation of hermaphroditism and homosexuality was only possible, I would argue, due to the way in which a slightly obscure theory of same sex desire, proposed by one Karl Heinrich Ulrich, was transformed by the Viennese psychiatrist, Richard von Krafft-Ebing, into what became known as a theory of sexual inversion.

anima muliebris in corpore virili inclusa
(a feminine ‘essence’ incorporated in a male body) (1)
I don’t have time to discuss Ulrichs’ life in detail here (2), but would sketch out a couple of important points. Ulrichs was open about his love for other men and, when the opportunity came to challenge §143 of the Prussian criminal code (which criminalised sex between men), Ulrichs realised that the committee considering a change to the law would require any challenge to be supported by scientific proof. For Ulrichs, the existence of sexual dimorphism offered that proof. The classification of hermaphroditism as a ‘naturally-occurring’ phenomenon was a significant factor in the development of Ulrichs’ theories of sexuality and the next logical move was to hypothesise a shift from a wholly physical form of hermaphroditism, to a model of hermaphroditism where one aspect of the sexed body is material and the other is immaterial. Effectively, Ulrichs posited the existence of a ‘third sex’, the Uranier, (3) which was naturally dimorphic and thus could be thought of as a “uranian hermaphrodite”. In 1863, Ulrichs wrote and published two pamphlets: Inclusa, which set out Ulrichs’ theory of dimorphism, and Vindex, where Ulrichs set out empirical evidence for his theory. Inclusa began with a poem in Latin:
Sunt mihi barba maris, artus, corpusque virile;
His inclusa quidem: sed sum maneoque puella.
(Have I a masculine beard and manly limbs and body;
Yes, confined by these: but I am and remain a woman.)

Now, Ulrichs’ efforts to change the Criminal Code failed, but his ideas were to have unexpected effects. By constituting homoerotic desire as a pseudo-hermaphroditic condition, Inclusa attracted the attention of the psychiatric community, and there is evidence of the emergence of a narrative of gender difference that incorporated disease, morbidity, abnormal pathology and inversion. Perhaps the most significant development in the emergence of a narrative of pathology is the relationship that developed between Ulrichs and Viennese psychiatrist, Richard von Krafft-Ebing. Vindicta included lengthy quotes from an article written by Krafft-Ebing in 1864. A grateful Krafft-Ebing responded in a letter to Ulrichs dated 19 January 1879:
I have given my full attention to the phenomenon, which at that time was just as puzzling to me as it was interesting; and it was the knowledge of your writings alone, which gave rise to my research in this highly important field and to the setting down of my experiences in the essay with which you are acquainted in the Archiv für Psychiatrie. (Critische Pfeile, 92; my emphasis)

The psychiatrist Krafft-Ebing transformed Ulrichs’ Romantic, mythological theory of dimorphism into a more prosaic, Cartesian model of neurological dysfunction. In Psychopathia Sexualis, the now-famous catalogue of sexual ‘dysfunction’ published in 1886, Krafft-Ebing argued that same sex desire could be explained through the concept of neurological inversion: sexual desire, originating from the mind, had somehow become disassociated from the corpus, so that muliebris in corpore virili inclusa concept was mistranslated and misinterpreted as ‘a female mind in a male body’ and this epithet was then applied to any and all individuals who came to Krafft-Ebing’s offices, presenting various aspects of ‘effeminacy’ or sexual desire for other men. The opposite version of the epithet (‘a male mind in a female body’) would be applied to ‘masculine’ women, or women expressing desire for other women. Krafft- Ebing (1892: 187) concluded that an individual’s sexual development can result in an inversion (4) of ‘the sexual instinct’:
notwithstanding a normal anatomical and physiological state of these [genital] organs, a sexual instinct may be developed which is the exact opposite of that characteristic of the sex to which the individual belongs.

Richard von Krafft-Ebbing
Krafft-Ebing (ibid., 222-3) went on to produce a continuum of sexual inversion, including the concept of psychical hermaphroditism, a concept which, I would argue, created even more confusion in an already confusing field. Alice Dreger (1998: 128-9) seems to agree. By the beginning of the 20th century, Dreger argues that the work of sexologists like Krafft- Ebing, Magnus Hirschfeld and Havelock Ellis had become conflated with theorists of hermaphroditism, and cites an example of a 1911 presentation by Magnan & Pozzi to the Academy of Medicine in Paris. The case of a feminine hermaphrodite, with ‘homosexual desires’ was accompanied by the conclusion that these desires, were “a matter of the brain of a man in the body of a woman”, ie. “a complete inversion of the genital sense”.

Dreger argued that many sexologists began to imagine that all cases of inversion were actually forms of hermaphroditism. No surprise, then, I would argue, that people began to imagine that surgical interventions, thought as necessary for the normalisation and ‘well-being’ of hermaphrodites, may also be appropriate for dealing with inversion. This is particularly true in cases where homosexuality is ‘suspected’.

An example is reported by one Dr J Riddle Goffe in 1903 (5): E.C. was a pseudo-hermaphrodite and, save for a small vaginal opening, had a beard, bushy eyebrows, no breasts or menstruation and a clitoris, 3 inches long and 3 and a half inches at its circumference. Goffe decided the clitoris should be removed and the vaginal opening enlarged, partly because: "She… has been attracted by boys." The doctor concluded:
"the sooner… the anatomical features [can be] made to harmonize with the psychic the better it is for that individual and for society."

The confusion was exacerbated in 1917 when Richard Goldschmidt, a biomedical researcher, began using the concept of intersexuality to refer to a range of gender ‘ambiguities’ that were previously categorised as ‘hermaphroditic’. For a while this term was also used to refer to homosexuals and inverts. It is therefore no surprise, when we examine the surgical records at the beginning of the twentieth century, that the same individuals may be described as ‘hermaphrodite’, ‘intersexual’, ‘pseudohermaphrodite’, ‘invert’ and/or ‘psychical hermaphrodite’. All of which makes it difficult, if not impossible to claim that so-and-so person is the ‘first example’ of ‘gender reassignment surgery’. There is, I would argue, no absolute moment that we could point to and say, “This is when physicians and psychiatrists decided that surgery was the correct means of disciplining (ie normalising) the body of the transsexual.” I think this point should be emphasised because I don’t think there was ever a point when psychiatrists, surgeons and physicians decided that surgery and hormone therapy were the appropriate treatment for conditions such as inversion or psychical hermaphroditism. Instead, I want to suggest that the impetus for corporeal transformation came largely from the individuals themselves and that part of the reason for this was the development of new medical technologies, such as plastic surgery and endocrinology.

The Appliance of Science
At the risk of oversimplifying matters, I would argue that three co-incidences or conditions made possible the use of surgery as a ‘cure’ for what would become known as ‘transsexuality’. I have already discussed two of these conditions: firstly, the conflation of inversion with hermaphroditism and pseudohermaphroditism, producing the notion of mind/body dissociation; secondly, the confusion around terminology, which meant individuals (and their physicians) might identify their conditions as psychical hermaphrodites or pseudo-hermaphrodites, seeking surgery as a means of resolving their ‘condition’. The third element is the development of medical technologies, as plastic surgery, vaginoplasty and phalloplasty became more sophisticated, and the field of endocrinology emerged at the beginning of the 20th century.

Bernice Hausman (1995: 28-9) claimed that Ernest Henry Starling is credited with introducing the term, ‘hormone’ in 1905; endocrinologists then began to use hormone treatments for intersex people and these developments led to a confrontation with psychoanalytic formulations of ‘sexual deviance’. In Glands Regulating Personality, Louis Berman (1921: 21) wrote: “The future belongs to the biochemist.” Rather grand claims were made about the effects of artificially-produced oestrogen. For example, Herman Rubin (1933: 222) asserted:
It is the perfect functioning of [the sex] that gives to the woman her charm of femininity, her rounded contours and soft curves, her pitch of voice, the comparative absence of hair upon the face, neck and breast.

The first decades of the 20th century were also a time of rapid improvements in asepsis and antisepsis in operating theatres, better surgical dressings, advances in anaesthesiology, and the use of sulfa drugs and antibiotics. During the Great War, two surgeons, working independently, developed the ‘tubed pedicle flap’, used in phalloplasty. The Russian Vladamir Filatov devised the Filatov Pedicle, whilst Harold Gillies developed a similar form of ‘flap’ surgery at the Queen’s Hospital in Sidcup, Kent. We’ll come back to Harold Gillies later.

Portrait of Lili Elbe by Gerda Wegener
A number of individuals have been claimed as the ‘first’ transsexuals to experience gender reassignment surgery. There are two problems with this claim: firstly the term, transsexuality, although coined by Magnus Hirschfeld in 1923 as seelischer Transsexualismus [psychic transsexualism] (6), was not in general use until the early 1950s. Secondly, a close inspection of cases such as those of Karl Baer, Dr Alan Hart and the celebrated model, Lili Elbe, reveal that these individuals had been diagnosed with intersex conditions and the use of surgery and, in Lili Elbe’s case, hormone treatment, would therefore have been established practice. It is clear from his autobiography, for example, that Karl Baer (née Martha Baer) was born with an intersex condition. Although brought up as a girl, Baer describes how ‘secondary’ sexual characteristics (a deep bass voice and a beard) appeared during puberty, and he failed to develop breasts or menstruate. Whilst living in Berlin, after graduating from university, Baer finally went to see a doctor who told him: “You are as much a man as I!” (N.O. Body, 1907/2006 Memoir of A Man’s Maiden Years, p.99). Baer successfully petitioned the German authorities for a change of sex and, under the care of Magnus Hirschfeld, had genital surgery in 1906. The exact nature of Baer’s intersex condition was never revealed.

Surgeons continued to perform operations on individuals diagnosed with intersex conditions throughout this period of taxonomic confusion, and continued to have their work represented and misreported – particularly in the Press. For example, Lennox Broster became Head Surgeon at Charing Cross Hospital, London, and pioneered hormonal therapy and surgery for intersex patients, especially those with adreno-genital syndrome (now known as congenital adrenal hyperplasia) in the 1930s and 1940s. However, the News of the World reported that Broster was conducting ‘sex change’ operations – an accusation that was strenuously denied. One patient who became notorious was the former Olympic javelin and shot-put champion, Mary Edith Weston, who changed her name to Mark Weston in 1935 and spent some time under the care of Broster during that year. It was Weston’s so-called ‘sex change’ that was partially responsible for the introduction of ‘sex-testing’ after the Berlin Olympics in 1936. However, the News of the World report had rather unexpected consequences: many individuals seeking a change to their physical appearance, who were referred to in the UK during this period as ‘transvestites’, turned up at Charing Cross Hospital in the hope that Broster would be able to help them. In the event, it would be another surgeon at Charing Cross, JB Randell, who would take on the mantel of gender reassignment surgery but that, as they say, is a story for another day.

The Accidental Surgeon(s)
During the first half of the 20th century, a number of surgeons were plying their trade in practices that were loosely connected to issues relating to sex and sexuality. Some were gynaecologists; some performed illegal abortions; some were former military doctors pioneering early forms of plastic and ‘cosmetic’ surgery; some were surgeons working with people diagnosed with intersex conditions and some, like the German surgeon, Ludwig Levy- Lenz (1889- 1966), who worked with Magnus Hirschfeld in the Institut für Sexualwissenschaft, took a more formal role in the performance of gender realignment surgery.

However, with the possible exception of Levy-Lenz, who practised in Berlin and later (after escaping the Nazis) relocating to Egypt, most of the names I have found in my research seemed to come to gender surgery by accident - usually because they had been approached by individuals searching for someone who would change the appearance of their bodies. In fact Hausman (1995: 110) goes so far as to argue that the impetus for a material change to the body (rather than a change of ‘mind’) came from trans people themselves, rather than from physicians and psychiatrists:
Demanding sex change is…part of what construes the subject as transsexual: it is the mechanism through which transsexuals come to identify themselves under the sign of transsexualism and construct themselves as its subjects. Because of this, we can trace transsexuals’ agency through their doctors’ discourses, as the demand for sex change was instantiated as the primary symptom (and sign) of the transsexual.

Support for this argument might be found in the experiences of two of the best known ‘accidental’ surgeons: Dr Georges Burou and Sir Harold Gillies.

Dr Georges Burou
Georges Burou was the son of a French teacher in Algeria. After obtaining a medical degree, Burou trained as a gynaecologist and, after the war ended, he opened the Clinic du Parc at 13 rue Lapébie in Casablanca. There is some controversy surrounding Burou’s early practice, with some commentators claiming he had to leave Algiers because he was prepared to carry out abortions on request. He consequently decamped to Casablanca where, after .WW2, the French authorities no longer had jurisdiction. Now, there were a number of nightclubs in the town and, in 1956, Burou was approached by Jenny, an electrician who wanted to change her gender identity. She had already approached and been rejected by a number of other gynaecologists in France. It’s still not clear why Burou agreed to perform the surgery: unlike Harold Gillies, Burou had no previous experience of performing surgery to alter a person’s genitalia. Burou told the story to Paris Match in 1974:
I started this specialty almost by accident, because a pretty woman came to see me. In reality, he was a man, I only realised afterwards, a sound engineer in Casablanca, 23 years old, dressed as a woman… with a lovely chest he had obtained through hormone injections… He told me about his problem and the deep conviction that his boy's body was a tragic accident of nature and irremediable … The operation lasted three hours. The patient remained a month in the clinic, convalescing. She was satisfied beyond all expectation. I had made a real woman.” (7)

Of course, intersex and cosmetic surgery had produced various methods that Burou was able to draw upon, including the work of Levy- Lenz and Harold Gillies, and Burou developed a technique to create a vagina using a live graft taken from the penile skin. Burou’s second client was a carpenter, also working in the nightclubs, but it was the third operation that, arguably, made him famous. Jacques Charles Dufresnoy was born in Paris, and worked as a singer and performer, firstly in Chez Madam Arthur and later (as Jacqueline- Charlotte Dufresnoy) in Le Carrousel de Paris, a nightclub whose cabaret included drag and cross-dressing. After appearing in a red dress festooned with black polka dots, Dufresnoy was given the
nickname ‘Coccinelle’ (‘ladybird’) and she continued to use this name in the nightclubs where she performed. In her autobiography, Coccinelle reported that it was the electrician Jenny who told her about Burou’s surgical skills and, in 1958, Coccinelle flew to Casablanca to have the surgery herself. She was later followed by Marie-Pierre Pruvot (‘Bambi’) and Toni April (aka April Ashley) in 1960. Both Marie-Pierre and Toni April had met Coccinelle whilst working at Le Carrousel. In 1973, Dr Burou gave his first formal public presentation on his innovative surgical technique at a major conference held at the Stanford University Medical School. By that time he had performed over 3000 male to female operations.
"I do not transform men into women. I transform male genitals into genitals that have a feminine aspect. All the rest is in the patient's head."

Other notable patients included the British writer, Jan Morris and the sociologist Carol Riddell, both of whom attended the clinic in 1972.

Sir Harold Gillies
Roberta Cowell was born Robert Marshall Cowell in April 1918. She was both a racing driver and a decorated RAF pilot and, according to her autobiography, discovered her unconscious mind was ‘predominantly female’, after she had consulted a psychoanalyst, following a bout of depression (Cowell, 1954: 71). Cowell went to see a ‘famous sexologist’ who ‘gave it as his considered opinion that my body showed quite prominent feminine characteristics’ (ibid.: 74). The doctor explained to Cowell that some people developed feminine characteristics later in their lives as a result of ‘glandular problems’ (ie. problems relating to hormones) and recommended further consultations with various gynaecologists, endocrinologists and anatomists. The outcome of all this consultation was Cowell’s conclusion that she had an intersex condition of some kind:
By now I had accepted the fact that nature had originally intended me to be female, but for the purpose of some grim joke I had been supplied with male organs.” (ibid.: 79)

Roberta now had a choice to make: she could remain a man, which wasn’t really an option because “I had an instinctive dislike of the male body” (ibid.) or she could change from male to female. She began her hormone treatment a few weeks later.

Two years after beginning hormone treatment, in 1952, Cowell felt she was ready for surgery. Harold Gillies had already carried out a number of surgical interventions for people with the condition known as ‘hypospadias’ (8), but what is less clear is whether Gillies had ever carried out genital surgery on anyone other than people with intersex conditions. Pagan Kennedy, in a rather sensationalist biography of Michael Dillon, entitled The First Man-Made Man, claims that Roberta Cowell was ‘desperate’ for surgery. After reading a little-known medical text written by Michael (formerly Laura) Dillon (9), Cowell apparently arranged to meet the author in a London restaurant. Kennedy (2007: 89) claimed Dillon ‘confessed his deepest secrets to her’, which is odd, because Cowell had already read Dillon’s book on hormones. However, it was Dillon who introduced Roberta Cowell to Harold Gillies. Dillon had fallen in love with Roberta Cowell and she appeared to reciprocate his feelings. What is less well known (and certainly not in Cowell’s autobiography) is that she allowed Dillon (who was a medical student) to perform an orchiectomy on her, to enable them to eventually marry. An extract from a document discovered recently by Kennedy, seems to confirm this claim:
I, R.C. have, of my own free will asked and persuaded L.M.D., who I’m aware is an unqualified man, a 5th year medical student, to perform an orchiectomy on me…” (Kennedy, 2007: 91)

The document was thought to have been written in 1950 or 1951 and may explain the ‘feminising’ changes that Cowell describes in her autobiography. It might also explain why, in Cowell’s case, the surgical narrative was constructed in relation to an intersex condition, rather than as ‘sex change’ surgery (ibid.: 101):
[Gillies] told me that the operation for congenital absence of vagina was completed [and] perhaps a tidying up operation would be needed at some future date.” (my emphasis)

Facial surgery followed: ‘giving me a new upper lip, reshaping my mouth, and giving me a new and smaller nose’ (ibid.: 103) and the ‘tidying-up’ surgery followed soon afterwards. As far as I have been able to ascertain, Gillies only carried out one instance of male to female reassignment surgery, and this appears to have been largely due to the fact that Gillies supposed Cowell had an intersex condition – certainly that was how her gynaecologist, Dr George Dusseau, perceived her condition; this enabled her to legally change her sex in May, 1951 and obtain a new birth certificate. As far as Gillies was concerned, the surgery was literally cosmetic, because it confirmed what Dusseau had already observed: “she is undoubtedly a woman.” (10)

Whose body? Whose surgery?
The question of whether Roberta Cowell (or other people like Jenny the electrician, or Coccinelle) had an intersex condition seems to be secondary. The primary point, I would argue, is that they were actively seeking a surgical, rather than a psychological, solution to resolve their desire to live in a particular gender. Of course, this position was partially made possible through the development of hormone therapies and the amazing work of surgeons like Sir Harold Gillies and Dr Georges Burou. However, it also suggests a very strong desire for a corporeal investment in the gender to which a person feels they belong – so strong in Roberta Cowell’s case, that she would undergo a very primitive and presumably very painful orchiectomy in order to convince doctors that she had an intersex condition. Perhaps Karl Heinrich Ulrichs, with his claim that his ‘essence’, his ‘breath of life’ was eternally feminine, was right all along?

  • Berman, Louis (1921) The Glands Regulating Personality. J. J. Little & Ives Company.
  • Body, N.O. (1907, 2006) Memoirs of a Man’s Maiden Years. University of Pennsylvania Press.
  • Cowell, Roberta (1954) Roberta Cowell’s Story: An Autobiography. William Heinemann Ltd.
  • Dreger, Alice Domurat (1998) Hermaphrodites and the Medical Invention of Sex. Harvard University Press.
  • Fausto-Sterling, Anne (2000). Sexing the Body: Gender Politics and the Construction of Sexuality. New York: Basic Books
  • Foucault, Michel (1980) Herculine Barbin: Being the Recently Discovered Memoirs of a Nineteenth Century French Hermaphrodite. (trans. Richard McDougall). Random House.
  • Goldschmidt, Richard (1917) ‘Intersexuality and the Endocrine Aspect of Sex’. Endocrinology (Philadelphia),1, 433-456.
  • von Krafft-Ebing, Richard (1892) Psychopathia Sexualis. FA Davis & Co.
  • Hausman, Bernice (1995) Changing Sex: transsexualism, technology and the idea of gender. Durham & London: Duke University Press.
  • Kennedy, Pagan (2007) The First Man-Made Man. Bloomsbury.
  • Long, JW (1896) 'Hermaphroditism So- Called, with an Illustrative Case’. International Journal of Surgery, 9, no.8, (August), 243-44.
  • Reis, Elizabeth (2009) Bodies in Doubt. The Johns Hopkins University Press
  • Rubin, Herman (1933) Eugenics and Sex Harmony. Elliott Publishing Company

1. This is my translation and decidedly not the translation preferred by the psychiatric community, who read it as ‘a female mind in a male body’. In fact, it is animus that refers to mind and intellect; anima refers to ‘the breath of life’ or ‘that which gives life’ – I believe Ulrichs was arguing that his very essence, his very life source, was feminine (and thus the source of his desires), even as his body was sexed as male.
2. There is an excellent biography available by Hubert Kennedy (2002) for those who are interested. I also outline the story in ‘Science, the Law & Homosexuality (pt 1): 1854 and all that’ in our 2013 LGBTQ History Magazine. (P.4,
3. And we’re back to Greek mythology again – the idea of the Uranian being based on an imagined conversation about the conception and birth of Uranus, that takes place in Plato’s Symposium.
4. Hirschfeld (2000: 59) later argued that one reason for the use of inversion was to distinguish this condition as a pathology (perversion) rather than a vice (perversity).
5. J Riddle Goffe , 'A Pseudohermaphrodite' American Journal of Obstetrics and Diseases of Women & Children 48 (December 1903): 755-763
6. Pfäfflin, Friedemann et al (2001) ‘Editorial to Special Issue on David O. Cauldwell (1897-1959)’. The International Journal of Transgenderism. Volume 5, Number 2, April – June.
7. Slate Afrique (2012) ‘Casablanca, la Mecque mythique des transsexuels’ (accessed 08/01/2014)
8. Hypospadias is an abnormality of the urethra and penis that is present at birth and causes problems with both urination and erections. The main problem is that the urethra opens on the underside of the penis instead of at the end of the penis. The opening can be anywhere from just below the normal position (mild) to as far back as the base of the scrotum (severe). Hypospadias affects 1 in 300 ‘male’ births and boys are sometimes raised as girls if the genitals fail to ‘properly function’ as male genitalia (see, for example, Fausto-Sterling, 2000). Corrections are often made through surgery
9. This is probably Michael Dillon’s Self: A Study in Endocrinology and Ethics, published by Butterworth- Heinemann in 1946.
10. Quoted in Cowell (1954: 96)

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