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4 Cutting the Gordian Knot: Gonads, Marriage, and Surgery in the 1920s and 1930s
- Johns Hopkins University Press
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82 chapter four Cutting the Gordian Knot Gonads, Marriage, and Surgery in the 1920s and 1930s It is usual for the general public to think that a doctor can settle this question [the determination of sex] without difficulty. Experience, however, has shown that there can be few more tangled Gordian knots presented for unravelment than this same question of the determination of sex in certain doubtful cases . . . Even when such cases come to autopsy it is extremely difficult to decide whether the sexual organs found are ovaries or testicles, and, of course, on these organs depends the essential distinction of sex. As the epigraph from 1898 suggests, there were no easy ways for patients and their families to determine the “essential distinction of sex,” though most doctors remained convinced that the presence of either ovaries or testes would provide the answer. By the first half of the twentieth century, doctors were able to assess the gonads by taking tissue samples and examining them under the microscope, and so a person’s sex could presumably be ascertained while he or she was still alive. Sometimes , though, a person’s visible genitalia contradicted the biopsy. Then doctors faced important decisions. They held information both recondite and, by their criteria, determinative, and so they faced ethical and moral dilemmas. Should they surgically alter external genitals to match internal gonads? Should they encourage patients to change their lifelong sexual personas? Should they even disclose what they found? This chapter explores how doctors answered those questions as they confronted patients whose mixed nature challenged both medical ethics and surgical skills. In $ Cutting the Gordian Knot 83 the 1920s and 1930s, as surgical techniques grew more sophisticated, surgeons increasingly thought they could “make” men and women. Weighing the trials and failures of earlier surgery against their own presumptions of competence and their own concepts of socially acceptable bodily integrity, they ultimately justified genital surgery by social, rather than purely medical, goals. The Gonadal Standard In the 1920s a woman came to Dr. Leon L. Solomon of Louisville, Kentucky , seeking an abortion. He refused to perform an abortion but agreed to do a physical examination. What he encountered in the examination room stunned him: “Upon entering the room, to my amazement there stood, nude, a veritable wolf in sheep’s clothing, with all of the outward habiliments of a man. I felt that a hoax was being played on me and am free to admit, I did not know whether I was angry, frightened or embarrassed . Gazing first into a woman’s face, then at a large male organ of procreation was sufficient to produce a queer sensation.”1 Was this person male or female? Her pregnancy implied womanhood, but the large phallus suggested otherwise. Dr. Solomon admitted uncertainty as to whether his patient should rightly be called a woman or a man. Perhaps because of this ambiguity, he resorted to the kind of descriptors long used to label people with atypical genitalia; he called her a “strange creature,” an “unfortunate creature,” a “queer individual,” and “a strange fellow,” highlighting the mixed nature of her body. Like most women, she had no beard on her face, but she had heavier hair on her arms and legs than other females. Her voice was “usually soft and mellow,” but at times it was “more masculine than feminine .” Her hands were large, implying masculinity, but her hips were “distinctly feminine”; her lower legs were “not distinctly feminine, but her feet were small.” Consistent with her pregnant status, her breasts expressed milk, a further indication of womanhood, even though she also had a penis. The doctor thought she had testes as well, but he was unable to positively establish this because she would not let him palpate them. “Manipulation of these two bodies is resented,” he reported, “on account of sensitiveness.” He found a vagina and assumed she had ovaries because of the pregnancy. Dr. Solomon published an account of his examination [18.206.12.31] Project MUSE (2024-03-28 10:02 GMT) 84 bodies in doubt of this patient entitled, “Hermaphroditism: Report of a Case of Apparently True Hermaphroditism with Photographs of the ‘Woman.’” The title suggested that Dr. Solomon believed his patient to be a “true hermaphrodite ,” which he defined as a person “who possesses male and female sex organs, described in the literature as Double-sexed or Complex Hermaphrodism.”2 After she left Solomon’s office, the woman ended the unwanted pregnancy on her own, using a...