Unspeakable: Father–Daughter Incest in American History (review)

The last sentence of Lynn Sacco's book, Unspeakable, is a telling comment on the seven chapters that have come before: "It is a difficult story to believe." Her exposition on the medical discourses concerning gonorrhea is a difficult story to absorb, given the horrific silences that characterized medical discussion of the topic and the implications for girls whose experiences of violence were denied or dismissed. Indeed, despite the subtitle, "father–daughter incest," this book actually deals with a somewhat broader experience of sexual assault and violence against girls.

Sacco begins with a fascinating question: why was incest discussed (and condemned) as a beastly crime in earlier nineteenth-century newspapers and courtrooms only to be ignored, with the number of cases declining, in the early twentieth century? This question leads her to concentrate far more on medical discourses than their use as a forensic tool in the courtroom, though medical "discourse" is defined quite broadly. Her answer may initially appear to be a narrow medical one: "[A] seemingly minor footnote in medical history—an abrupt turn-of-the-century reversal in medical views about the etiology of gonococcal vulvovaginitis… is key to understanding what changed" (p. 3). However, her analysis is far from narrow. Unspeakable has an impressive chronological reach from the mid-nineteenth century to the mid-twentieth century; this allows Sacco to chart changes in medical discourse over time, and these are carefully situated in their changing historical, intellectual, and social contexts. She draws on a wide range of sources, including surveys of newspapers, court cases, medical discourse in many forms, and the records of both sexual reform organizations and clinics. Her argument that "doctors who wrote about the etiology of girls' infections reflected the social rather than the scientific concerns of the period" (p. 88) will not be surprising to historians of medicine; however, her detailed genealogy of medical and social work thought and practices offers a thorough, incisive, and important analysis of how the social came to trump the scientific.

In the nineteenth century the lack of a decisive scientific test for the bacteria characterizing gonorrhea hampered proceedings against those charged with incest, but by the 1890s medical breakthroughs offered doctors the ability to diagnose gonorrhea. Yet once it was more easily diagnosed, it became clear that many girls, including those from white and middle-class families, carried the bacteria. Instead of drawing the conclusion that violence against girls was rampant in all sectors of society, medical researchers, practitioners, and social reformers alike explored other explanations for the origins of the infection. In the process, certain key medical-legal cases were reiterated repeatedly despite their tenuous logic, and scientific studies were framed by questions that simply left out the possibility that sexual assault lay behind girls' infection. Assumptions about gonorrhea did shift over time. During the Progressive period reformers' obsession with overcrowded tenements and sanitation resulted in attempts to clean up public toilets where the germ was assumed to be spread, but by the 1920s the concern with "environmental causes" was replaced by a focus on "treating sick individuals" (p. 147), with negligent mothers often cited as the culprit for the spread of the bacteria. Medical discourses also claimed that "superstitious" (p. 109) beliefs, such as the "virginity cure" (infecting young girls as a cure for the carrier of gonorrhea), became rampant because of the immigration of non-Anglo, lower class immigrants. Interestingly, female professionals—with some exceptions—propagated these same ideas, even though many were supposedly concerned with violence against women and children.

One continuity over time was the inability to "see" violence against girls as the cause of the spread of gonorrhea, in large part because of the clouding "ideologies of nation, class and race" (p. 107). I would have liked Sacco to be more expansive in her conclusion, explaining these tenacious ideological continuities, by engaging with feminist theories that explore patriarchy, class, and race as structures...