From The New England Journal of MedicineThe condition of hermaphroditism has been recognized since antiquity. The term derives from the Greek legend of the joining of Hermaphroditos and the nymph Salmacis into a single form that was neither male nor female, but both. Culturally, men and women are distinct, yet their sexual structures arise from common bipotential precursors. This fact explains how intersexuality can result from aberrations in the sexual-differentiation pathway.
In Hermaphrodites and the Medical Invention of Sex, Alice Domurat Dreger chronicles the medical diagnosis and treatment of hermaphroditism from the perspective of both the subject and the medical community during the late 19th and early 20th centuries. She traces the advancement of medical technology and its effects on the classification of persons with intersexual disorders. The book covers the period during which sexual identity was being questioned in both scientific and medical theory and the ideas of sex, sexuality, and gender had not yet become distinct from one another.
During this time, one's "true sex" was felt to be based solely on the presence of a testis or an ovary. The number of people recognized with hermaphroditism was increasing, in part because of improved access to gynecologic care and more reporting of medical findings in the literature. This increase led to the need for criteria to define maleness and femaleness in order to keep the two sexes distinct. Also during this time, physicians emerged as the authorities in determining sex and anatomical identity. To show the effect of cultural differences in the management of intersexual disorders, Dreger has chosen to study hermaphrodites in Britain and France.
Dreger uses case histories of people with intersexual conditions and describes the responses of their physicians to illustrate why definitions of true sex were thought to be necessary. She explores the social, economic, and political ramifications of having a "mistaken" sex. In her book, the term "hermaphrodite" is used loosely to describe someone with ambiguous genitalia or someone whose external genitalia do not correspond with the internal gonads; she does not necessarily use it to imply true hermaphroditism (the presence of both testicular and ovarian tissue).
An epilogue has been added to the book to cover the treatment of intersexual conditions today and to show how history influences present-day management. Unfortunately, Dreger's description of present-day management is not up to date. Over the past few years, the voice of people with intersexual conditions has grown louder through autobiographies and the formation of support groups. Dreger has included in the epilogue the histories of people with intersexual conditions who were dissatisfied with their care.
Dreger believes that the current management of intersexual disorders remains very paternalistic. She states:||Doctors typically make decisions about sex assignment with little genuine discussion with the parents. Parents who will not consent to recommendations are subject to pressure, and even those parents who do agree to the surgeries performed do not realize that they are, by implication, consenting to the doctor's right to choose the sex of their child on the basis of a particular anatomically demanding psychosocial theory of gender identity.
She concludes with a plea for "an honest conversation" between physicians and parents. Currently, though, physicians do openly discuss with parents everything that is known about intersexual conditions. However, there is still much that is unknown about the cause of such conditions, and thus it sometimes becomes difficult to predict the future of an affected child. Decisions regarding sex assignment are made by parents with the consultation and support of their child's physicians and are individualized to each situation.
Overall, this engaging, well-written book will benefit scholars and lay readers interested in the history of sex, sexuality, gender, and medicine. The book traces the evolution of what makes a person male or female and shows how the answer has changed depending on when the question was asked and where it was asked. Dreger has succeeded in compelling the reader to ask the same question.
Reviewed by Patricia Y. Fechner, M.D. --This text refers to the Hardcover edition.
Review
In her study of the medical response to human hermaphrodites, Alice Dreger draws on over 300 scientific and medical commentaries in France and Britain, of which over half the cases reported occurred between 1860 and 1915...As Dreger observes, there was no single opinion among doctors or the public at large about which traits were essentially male or female, or even what they might signify. In Britain, female facial hair was likely to be associated with insanity, while in France it was more likely to be seen as a mark of remarkable strength. Other interesting differences emerge...Hermaphrodites and the Medical Invention of Sex is richly researched, detailed and fascinating.
--Angelique Richardson (Times Literary Supplement )
This is a well-researched, sober history of a problem that Alice Dreger shows has directly affected more people than we might think and which shapes the sense of sexual identity of us all...Avoiding preachy judgementalism, Dreger shows how deeply ingrained are our assumptions about gender normality (sexual anatomy is destiny) and on how flimsy a basis they have been grounded. The book offers us all a lesson in self-awareness.
--Roy Porter (Nature )
Alice Dreger ascribes the growing visibility of the hermaphrodite to Victorian anxieties about gender-blurring social phenomena, including homosexuality and feminism, as well as to improvements in medical science. During the Victorian era, Dreger argues, a greater number of women gained access to gynecological care, and as a result, infant anatomy came under more professional scrutiny; medical journals of the period, widely accessible for the first time, publicized anomalous cases. Scientific knowledge of embryological development began turning the one-time monster or marvel into, in the words of the turn-of-the-century French doctor Xavier Delore, 'a scientific matter and a degraded organism.'
--Emily Nussbaum (Lingua Franca )
Dreger...has found a rich mine in the clinical case histories of hermaphroditism, which outline the physicians' complex struggle to find a foolproof way of fitting individuals into a binary sexual scheme.
--Laurence A. Marschall (The Sciences )
This engaging, well-written book will benefit scholars and lay readers interested in the history of sex, sexuality, gender, and medicine. The book traces the evolution of what makes a person male or female and shows how the answer has changed depending on when the question was asked and where it was asked. Dreger has succeeded in compelling the reader to ask the same question.
--Patricia Y. Fechner (New England Journal of Medicine )
The historic records of [hermaphrodites]...are carefully documented by this meticulous author and merit study...To read this book is to become aware of the tremendous complexity of human sexuality and gender identity--beyond genitals, hormones, enzymes, and even chromosomes and genes. Behavior, feelings, and values blend with intellect and how each individual is sexually drawn to each other.
--Domeena C. Renshaw, MD (Journal of the American Medical Association (JAMA) )
Most people have heard the term 'hermaphrodite,' but aren't quite sure what it means. [This book serves] as an introduction to that topic, bringing the voices of intersex people...into dialogue with...experts. Dreger also includes many fascinating historical photographs. Her stories of detective doctors presiding over 'doubtful-sex gatherings' show how 'again and again, consultations with fellow medical men almost invariably, rather than clearing up confusion, resulted instead in deeper and broader doubt...Medical men often discovered that too many diagnosers spoiled the certainty'...What makes [this book] important and provocative also makes [it] a little dangerous because [it] is so ahead of [its] time.
--Leonore Tiefer (Women's Review of Books )
This is a very strange and a very good book, tackling an important topic with humanity, and in a readable style. This is a subject where biology, psychology and medical authority conflict, and where prudery, ignorance and dogmatism drive people to suicide. Dreger deals with the history of definitions of man or woman by myth and by medicine, and provides case histories, together with photographs of the problematic genitalia...As biologists, we should treasure variation--if you doubt that for human sexuality, read this book.
--Jack Cohen (Biologist )
Through a collection of dramatic and moving medical case histories from the late 19th and early 20th centuries, Dreger argues that the medical profession increasingly claimed the knowledge and authority to determine 'true' gender and to effectuate such determination by surgical means...[This] is a wonderful example that historical writing is not merely about revisiting the past, but reshaping the future. This book will prove fascinating and moving reading for those concerned with the ways in which biomedical knowledge is deployed in the service of the cultural regulation of gender and sexuality.
--Vernon Rosario (Harvard Gay and Lesbian Review )
[A] perceptive, erudite and superbly-written book...Concentrating on late-nineteenth- and early twentieth-century Britain and France, Dreger analyses how defining and 'managing' hermaphroditism were crucial to the destabilization as well as a simultaneous--and only seemingly paradoxical--reinforcement of the sexual division of humanity into male and female. In a surprisingly well-integrated epilogue of the book, she establishes that present-day treatment of hermaphrodites in America, in spite of phenomenal advancements in surgical technologies and theoretical understanding of sexual physiology, continues to be guided by ideas about the nature and meaning of sex that would not have seemed unfamiliar to fin-de-siècle doctors.
--Chandak Sengoopta (Medical History )
In her compelling, highly engaging and carefully researched book, Dreger charts the individual stories of many hermaphrodites--often with accompanying photographs...[It is] vital reading for feminists in that [it] offers detailed illustrations of scientific and medical complicity with social norms of 'sex' and 'gender', and raises important questions about how cultures enforce ideas about 'normal' bodily conditions and behaviours.
--Celia Kitzinger (Feminism & Psychology )
Dregerhas produced a well-written, lucid and sensitive account of the medical treatment of hermaphrodites from the latter half of the nineteenth century through to the present day...Dreger's description of the way modern doctors persist in assuming that they, and not the individual concerned or society, have the right to define an individual's sex are particularly illuminating. This book will be immensely interesting to historians working in this area and anyone concerned with intersexuality.
--Helen Blackman (Social History of Medicine )
In her book, Alice Dreger sets out to convince the reader that the history of hermaphrodites, or people of ambiguous sex, is an important and interesting topic, and she more than accomplishes her goal. Not only does she deliver, but she does so with grace, ease, and compassion. This is a marvelous book, an unexpected surprise which is as readable and engaging as it is informative...Within pages of opening the book, I was enthralled.
--H. Hughes Evans (Journal of the History of Medicine )
Traces the history of the biomedical treatment of hermaphrodites during what Dreger calls the "Age of Gonads."...She offers the reader a complex and lucid account of the process by which hermaphrodites moved from a public space (some as performers in traveling circuses and shows) to a private space where all hermaphrodite identities became increasingly shaped and defined by physicians who gained in power and prestige by intervening in the lives of these individuals...Dreger makes a convincing argument for a new approach to individuals born with ambiguous genitalia.
--Heather Harris (Journal of the History of Biology )
Dreger has identified an important and suggestive topic, not only in the history of medicine, but for cultural history more generally. Hermaphrodites were, after all, only among the most striking members of the parade of anomalies that engaged the attention of both specialists and the general public at the turn of the century. Any liminal creature was apt to trigger anxieties about the defense of social as well as natural boundaries, and any breach of the barriers that divided the sexes was particularly unnerving.
--Harriet Ritvo, Massachusetts Institute of Technology
The casual browser who picks up this book and thinks that hermaphrodism has nothing to do with her or him is mistaken. Dreger illuminates the process by which medicine appropriated to itself the authority first to interpret and then to 'fix' sex difference. This is a specific example of a widespread but largely invisible phenomenon, in which cultural agendas are disguised as scientific authority. The medical abuse of individuals born with atypical sex anatomy in fact serves everyone who holds the unscientific belief that the world is divided neatly into two clearly distinguished sexes. Dregerhas written a book that should interest not only medical historians, professionals concerned with intersexuality, and intersexuals themselves, but everyone who thinks she knows her sex.
--Cheryl Chase, Director Intersex Society of North America
In Hermaphrodites and the Medical Invention of Sex, Alice Dreger illuminates life stories that had been recast, subsumed, and ultimately 'disappeared' by the medical profession...Dreger's book is clearly written and easy to read. Fascinating, entertaining, disturbing, and thought-provoking all at once, it makes one ask, 'what is the difference between a male and a female?' and even more unsettling, 'why does it matter so much in our society.' (Synapse: University of California San Francisco Weekly )
This fascinating book consists of numerous case studies on hermaphrodites (intersexes) and their abusive treatment by the medical and scientific community during the late 19th century and early 20th centuries in Britain and France... Dreger believes that by studying the cultural history and climate that prevailed relating to intersexuality at the turn of the last century, we may be better able to understand the concept of gender, sex, and sexuality. There are interesting sections on famous hermaphrodites and hermaphrodites in love.
--H.S. Pitkow (Choice )
This history is important to our understanding of how the categories of "male" and "female" have come to be understood in the medical community. This history is also relevant to the current questioning of modern intersex medicine…Overall, this book is well written and considers important influences of history on the treatment of hermaphrodites that have been previously ignored.
--Amy B Wisniewski, Ph.D. (The Journal of Nervous and Mental Disease )
In Hermaphrodites and the Medical Invention of Sex, Alice Domurat Dreger looks at the debates concerning intersexed peole which circulated in the medical communities of France and Britain in the late 19th and early 20th centuries. In so doing, Dreger has also offered insight into our own fin-de-siècle quandaries about the limits of usefulness of the concepts of sex and gender as categorizations of human beings...Overall, Hermaphrodites and the Medical Invention of Sex is an excellent book.
--Holly Devor (Journal of Sex Research )
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