Conflicting Heterosexualities: Hermaphroditism and the Emergence of Surgery around 1900

Historians who have studied hermaphroditism generally agree that heteronormativity was directive in how medicine dealt with people whose sex was doubted around 1900.¹ But what was the heterosexuality that was normative? This article describes the fierce national and international debates about precisely this issue that emerged between physicians around the turn of the twentieth century. The sudden urgency of the issue was directly related to a rapid and fundamental shift in surgical clinical practice in Europe and the United States. In 1890 two simultaneous medical innovations, effective antiseptic measures and the introduction of anesthesia, quickly changed surgery from a life-threatening experience to a commonly applied technique.² The rise of surgery produced an exponential increase in its use in cases of hermaphroditism, both for diagnosis and for treatment. This led to all kinds of new problems concerning the clinical treatment of people of doubtful sex.³

In this article, I will use clinical case histories of hermaphroditism from around 1900 to unravel the many different ways in which heterosexuality (or fear of homosexuality) was enacted in this debate. For instance, a couple that had been deemed heterosexual because one of them looked like a man and the other like a woman in their quotidian appearance might in another context be deemed homosexual because doctors proved that the woman had testicles in her abdomen. Such differences show that heterosexuality is not a single, clearly defined thing or norm but is rather very much divided in and of itself. I will end this essay on a more theoretical note, arguing that skepticism about heteronormativity’s unity and stability is more useful than criticizing it as a grid of “intelligibility” that makes certain lives “unlivable.”⁴

A Surgical Turn

In 1908 the internationally acknowledged expert on hermaphroditism, Franz Ludwig von Neugebauer, published a collection of more than eleven hundred case histories from around the world concerning people with a doubtful sex—people who at the time were referred to as (pseudo)hermaphrodites.⁵ This volume summarized cases from an enormous range of countries from antiquity to his own time. Neugebauer, who was Polish and maintained contact with gynecologists worldwide, published this volume in German, but he had already published large overviews in both English and French. Using this collection as a starting point for my research, I retraced as much as possible the original sources for the cases in the languages that I read (German, English, French, and Dutch) concerning living hermaphrodites from the late eighteenth century on. This led to the creation of my own database of just over three hundred cases. German and French cases are probably overrepresented in my database, but it nonetheless provides a good international overview, especially around 1900, when Neugebauer was actively collecting international material.⁶

Neugebauer’s work of collecting, comparing, and counting cases of doubtful sex was an important technique at a time when there were no specialized clinics for the treatment of what we today call “intersex.” The case histories of his time create the impression that most of the gynecologists involved encountered only one or maybe two cases of doubtful sex in their entire careers. Although they might have heard of other cases, for most of them the situation must have been surprising and new. Neugebauer’s collection of cases helped gynecologists compare their own findings and decisions to those of their colleagues. As other historians before me have noticed, the scattered nature of cases lends a strongly idiosyncratic character to how cases of doubtful sex were dealt with. Every case was very different. It is virtually impossible to discern different schools of thought in the material or to relate the individual characteristics of a certain doctor to his way of treating hermaphrodites. After all, most doctors only treated one. Nevertheless, certain implicit structures behind the clinical treatment of hermaphrodites can be discerned, and despite the idiosyncrasies, remarkable international similarities emerged around 1900 as clinicians incorporated surgery into their diagnosis and treatment.

The statistical overviews of the large collection of cases that Neugebauer investigated in his various publications...