Medical Discourse and the Denial of Incest in the United ...

Sanitized for Your Protection: Medical Discourse and the Denialof Incest in the United States, 1890–1940

Sacco, Lynn.

Journal of Women's History, Volume 14, Number 3, Autumn 2002,pp. 80-104 (Article)

Published by The Johns Hopkins University PressDOI: 10.1353/jowh.2002.0074

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JOURNAL OF WOMEN’S HISTORY80 AUTUMN

© 2002 I NDIANA UNIVERSITY PRESS, VOL. 14 NO. 3 (AUTUMN)

SANITIZED FOR YOUR PROTECTION

Medical Discourse and the Denial of Incest in theUnited States, 1890–1940

Lynn Sacco

This article examines medical discourses from 1890 to 1940, when phy-sicians and reformers uncovered, and then dissembled, evidence thatwhite, middle- and upper-class American men were sexually abusingtheir daughters. Doctors had long recognized that children could acquiregonorrhea, but they believed that infections were confined primarily topoor and working-class girls who had been sexually assaulted. In the1890s, doctors began to incorporate new technologies into the diagnos-tic process and they were shocked to discover that gonorrhea infectionwas so common among girls that they feared it was epidemic. Doctorsclaimed that concurrent infections in fathers and daughters from “re-spectable” white families were particularly vexing. Although they couldneither explain nor prove how else these girls became infected, doctorsrefused to consider the possibility of incest. Persistently ignoring theobvious, health care workers and reformers revised their views aboutthe susceptibility of girls to infection, not incest. By 1940, medical text-books relied on untested speculation to declare that most girls acquiredgonorrhea from nonsexual contacts with other females or contaminatedobjects: their mothers, other girls, or toilet seats. “Scientific advances,”ironically, obscured rather than illuminated the source of girls’ infection.

In the fall of 1913, the Boston Dispensary and Massachusetts Society for Sex Education hired social worker Bertha C. Lovell to do case work with

the dispensary’s female patients infected with a “venereal disease,” a termfor sexually transmitted diseases that included gonorrhea and syphilis.1

The task of identifying the source of gonorrhea infections in girls, whocomprised 10 percent of the gynecology clinic’s patients, quickly frustratedLovell. Although she believed that adults acquired gonorrhea only fromsexual contacts, Lovell considered girls susceptible to infection from in-numerable mundane interactions: “Was it an accidental infection from adirty toilet seat, or an infection, as accidentally incurred in the daily exi-gencies of life in a crowded household where the mother or father or per-haps an older sister had the disease? Or was it one of the rare cases ofrape . . . ?”2

Lovell’s bewilderment was not unusual, but part of a dramatic shiftin medical views about the etiology of gonorrhea infections in girls thatoccurred in the first half of the twentieth century. Nineteenth-century doc-

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tors had expressed few doubts that gonorrhea was a sexually transmitteddisease in children. Most of the children they diagnosed with the diseasewere poor and working-class girls who claimed to have been sexually as-saulted, sometimes by their fathers. Gonorrhea was important evidencethat corroborated both a girl’s accusation and the identity of her assailant,whom doctors also examined for infection.3 But in the 1890s, when newtechnologies significantly improved doctors’ ability to detect the disease,they were startled to discover that it was not limited to this relatively smallpool of girls. Rather, so many girls from all classes—most of whom werebetween the ages of five and nine and who did not claim to have beenassaulted—tested positive for gonorrhea that doctors feared it was epi-demic.

Doctors realized that incest was the most likely source of infection,and tracing the source of infection by the traditional method of consider-ing sexual contacts might have revealed the occurrence of incest through-out American society. But this is not what occurred. Using medicaldiscourses from this period, this article argues that doctors, nurses, socialworkers, public health officials, and reformers mislabeled or even ignoredthe evidence of incest that they themselves had discovered. Physicianswho believed that only “foreign,” “primitive,” or “ignorant” men abusedtheir daughters assumed that incest was contained within African Ameri-can, immigrant, poor, and working-class families. When the incidence ofgonorrhea among the daughters of white middle- and upper-class mensuggested otherwise, health care professionals revised their views on gon-orrhea, not incest.

Nearly everyone who wrote about gonorrhea infections in girls be-tween 1890 and 1940 rejected out of hand the possibility of incest, eventhough they could not agree—or prove—how else girls acquired the dis-ease. One result was that incest was not documented except as a rare oc-currence, confined to socially marginalized groups.4 Incest would not be“discovered” until the 1970s and 1980s, when mental health professionalswho had been influenced by second-wave feminism suggested a differentview.

In her groundbreaking 1981 book Father-Daughter Incest, feminist psy-chiatrist Judith Lewis Herman reconceptualized incest from a personalpathology to a mainstream gender issue: “Female children are regularlysubjected to sexual assaults by adult males who are part of their intimatesocial world. . . . Any serious investigation of the emotional and sexuallives of women leads eventually to the discovery of the incest secret.”5

Herman was one of a growing number of mental health professionals whochallenged the psychoanalytic orthodoxy that had narrowly construedSigmund Freud’s theories and dismissed incest narratives as statements


of fantasy rather than fact.6 However, Herman’s assertion could only beaccurate if incest permeated American society as a static facet of genderrelations. Indeed, when, in the late 1980s and early 1990s, American womenfrom all socioeconomic groups disclosed histories of father-daughter in-cest, their accusations raised questions about the racial and economicalterity of male sexuality that spun into a fiery debate over the incidenceof incest in the United States. These debates became polarized within psy-choanalytic discourses and the questions they raised remain unanswered.7

In their books on domestic violence published in the late 1980s, his-torians Linda Gordon and Elizabeth Pleck identified incest as a genderissue and provided historical evidence of its occurrence over long chrono-logical periods.8 But unlike other “personal problems” that second- wavefeminists identified as gender issues, the topic of incest has received littleattention from historians.9 This disinterest is surprising in light of the con-tentiousness of the recent debates, including among feminists.10 Moreover,some critics attempted to discredit incest accusations by arguing that theywere inspired by feminism but unsupported by science, as though thetwo are mutually exclusive. They argued that “science” was an objectiveand therefore superior system of knowledge.11 Tracing shifts in the etiol-ogy of gonorrhea in girls suggests otherwise.

Definitions and Incidence

This article will be limited to father-daughter incest, defined here asany type of sexual contact between an adult male and his female child orstepchild. Although recent studies have estimated that as many as 54 per-cent of American women were sexually assaulted as children, little dataexists with which to measure the incidence of incest.12 Yet when the U.S.Justice Department analyzed all reports of sexual assault made in the 1990s,it found that girls under the age of twelve comprised the single largestcategory of victims and that most had been assaulted in their own homesby an adult male who was a family member or acquaintance.13 No studieshave shown that the incidence of incest differs by race or class, and dataon ethnicity is inconclusive.14

Incest is sometimes reported by doctors who have diagnosed a gon-orrhea infection in a child. The Centers for Disease Control and Preven-tion define gonorrhea as a sexually transmitted disease (STD), and “thesecond most frequently reported communicable disease in the UnitedStates.”15 When parents and siblings of a girl infected with vaginal gonor-rhea agree to be tested, the results are positive in half of the cases.16 How-ever, like human immunodeficiency virus (HIV), Neisseria gonorrhoeae (N.gonorrhoeae), the bacteria that cause gonorrhea, dry too quickly for it to

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spread by casual or nonsexual contact.17 A newborn may acquire gonor-rhea from its mother but these infections affect the baby’s eyes or joints,and not its genitals.18 It was not until 1998 that the American Academy ofPediatrics emphasized that gonorrhea “in a child is diagnostic of abusewith very rare exception,” and it warned physicians that “a conclusionthat the transmission was . . . nonsexual in nature is unacceptable.”19

Contemporary physicians report more than 50,000 infections in chil-dren each year, and experts agree that, “Among all STDs diagnosed inchildren evaluated for suspected abuse, gonorrhea is the single most com-mon diagnosis.”20 Child sexual abuse usually consists of rubbing, fondling,and oral contact, activities that may not leave any lasting genital marks orinjuries. Because N. gonorrhoeae cause a local infection at the point “wherethey enter . . . the body,” gonorrhea may also be the only physical evidenceof abuse. 21 Boys and girls suffer from infections in the rectum or throat,but the vast majority of children diagnosed with an STD are prepubescentgirls with vaginal gonorrhea, also called “vulvovaginitis” or “gonococcalvaginitis.” Its major symptom is a pus-like discharge.22

Turn-of-the-Century Advances and Reappraisals

In the pre-bacterial era before the 1890s, a diagnosis of gonorrhearested entirely on the physician’s clinical observations and his willing-ness to render an opinion that he could not verify and which entailedlegal consequences. There was no laboratory test to assist doctors in de-termining whether a vaginal discharge was a symptom of gonorrhea oranother type of disease, such as pinworms or “leucorrhea,” a catch-allphrase for vaginal infections. Recognizing that their diagnostic abilitieswere crude and imprecise, doctors weighed the heavy penalties for childrape—which included lengthy imprisonment and even execution—againsttheir assumption that most accusations were false.23

Late nineteenth-century scientific and technological advances dramat-ically improved doctors’ ability to diagnose gonorrhea in girls, but not theirwillingness to do so. After German dermatologist Albert Neisser identifiedN. gonorrhoeae in 1879, doctors could confirm a diagnosis by examining aculture or smear from a vaginal discharge under a microscope.24 If theslide revealed N. gonorrhoeae, the patient had gonorrhea. Doctors initiallyviewed bacteriological testing as a godsend that provided them with di-agnostic certainty.25 However, as they incorporated testing into the diag-nostic process, doctors also examined vaginal discharges from girls whodid not claim to have been assaulted. These patients included girls from“respectable” white families, and doctors were shocked to realize that theywere infected with gonorrhea.26 At the 1901 meeting of the American Medi-


cal Association (AMA), Chicago physician J.C. Cook articulated the co-nundrum these cases presented to doctors. He declared that when it cameto families of “educated and refined people,” “It is trying to our credulityto find a 4-year-old daughter and a 25-year old father having gonorrhea atthe same time with no other source of infection to the daughter other thanthe father.”27

Early-twentieth-century physicians were aware that incest occurredbut they expected it only in homes they associated with primitivism anddegeneracy.28 In 1886, Brooklyn physician Jerome Walker, who examinedabused children for the Society for the Prevention of Cruelty to Children,admonished his colleagues that he had learned from experience that “cer-tain motives, conditions, and statements” about child sexual abuse “are atvariance with one’s ordinary conception of such things.”29 Among the fac-tors that surprised Walker was that, “Apparently respectable men, as wellas ordinary disreputable characters outrage children; that even fathers,step-fathers, and brothers will do it.”30 But doctors ignored Walker’s warn-ings and during a period of intense nativism focused exclusively on casesthat occurred among the poor and working classes, especially immigrantsand people of color.31

For instance, in 1908, Dr. W. Travis Gibb, medical examiner for the NewYork Society for the Prevention of Cruelty to Children (NYSPCC), attrib-uted incest to immigrants whom he claimed did not value children ashighly as did “native-born” white Americans. Although he admitted that,“these crimes occur among the well-to-do,” he claimed that most men“among certain classes, especially ignorant Italians, Chinese, and Negroes,”assault their daughters because they supposedly believed “that, if a manafflicted with an obstinate venereal disease have intercourse with a virgin,the latter will develop the disease and he will be cured.”32 Nineteenth-century European physicians claimed to have encountered this “supersti-tious cure” in Germany, Ireland, and Italy, and Richard von Krafft-Ebingmentioned it in Psychopathia Sexualis, his influential compendia of “psycho-sexual perversions.”33 In 1909, Dr. Flora Pollack, attending physician atthe Johns Hopkins Gynecological Dispensary, cited Krafft-Ebing and re-ported that, “This superstition is so deeply rooted in the belief of men thatwere you to ask ten police officers, cab drivers, hucksters, etc. of the truthof it I think eight would affirm it as a ‘fact,’ and all would know of itsexistence.”34 Although Pollack left open the possibility that people fromall classes believed in the superstition, most doctors did not, and refer-ences to the superstition and “foreign beliefs and practices” persisted inthe medical literature as an explanation for child sexual assault and incestthrough the 1930s.35

Doctors who viewed incest as a racially or culturally based behavior

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considered it a measure of difference and a definable border between the“civilized” and the “savage,” the native-born, white American and the im-migrant. Their unwillingness to acknowledge incest among the whitemiddle and upper classes was so strong that they refused to consider thepossibility even when an infected father admitted that he and his daugh-ter slept in the same bed. For instance, in 1900, Dr. Herman B. Sheffield,who treated infected girls at New York City’s Metropolitan Hospital andDispensary for Women and Children, and whose patients rarely exhib-ited obvious genital injuries, eagerly dismissed “indecent violence” as“very rare indeed.”36 He proposed that girls became infected “acciden-tally” from contacts with objects that “mediated” the transmission of bac-teria from parent to child. “Little girls sleeping with their parents or elderbrothers suffering from gonorrhea may contract the disease through com-ing in contact with the soiled bedclothes, cotton-pads, or rags which arebeing used for cleansing purposes.”37

Sheffield drew from his experience in institutional settings. Nineteenth-century doctors had occasionally detected vaginal discharges among girlsin orphanages and hospitals, which they had identified as leucorrhea andattributed to poor hygiene.38 When early-twentieth-century doctors be-gan to examine these discharges bacteriologically, they discovered thatentire wards of girls were infected with gonorrhea, not leucorrhea.39 Butdoctors continued to attribute the infections to uncleanliness. In an erawhen hospitals had little money to spend on supplies, nurses commonlyused the same instruments, such as thermometers and wash rags, for eachchild, and any number of infections spread in this manner. To curtail “wardepidemics,” hospitals instituted new procedures, such as requiring thateach girl receive her own supplies, including bedpans and catheters. Whenthese measures failed, hospitals began to test every girl who sought ad-mission, and by 1905, most refused to admit any girl found to be infectedexcept for life-threatening emergencies.40

However, as the number of infections acquired outside of institutionalsettings continued to rise, doctors became alarmed at both the extent andconsequences of the disease. By 1903, Dr. Reuel B. Kimball, attending phy-sician at the New York City Babies’ Hospital, called gonorrhea “one of themost dangerous microorganisms,” and doctors at the Johns Hopkins Hos-pital warned that its complications included death.41 Yet even as they grewto appreciate the seriousness of the disease, for which no effective curehad yet been discovered, doctors avoided discussing incest. In December1905, New York physician W.D. Trenwith reported to the Section in Pedi-atrics of the New York Academy of Medicine that he did not believe thatany of the girls he treated, most of whom were between the ages of fourand six, had been assaulted, even though their fathers were also infected.42


Trenwith claimed that after making inquiries of “the most searching char-acter,” that “indirect infection by the father”—shared bed linen and washrags—was responsible for 75 percent of the cases. He blamed other girls—their playmates and siblings—for the rest.43

Social Hygiene and “Innocent” Infection

As doctors muddied the etiology of gonorrhea in girls, “social hy-giene,” a public health campaign developed to provide “reliable” medicalinformation about sexually transmitted diseases became so successful thatby the late 1930s, the U.S. Surgeon General had incorporated its tenetsinto national policy.44 Social hygiene was an ambitious social reform andmedical program that early-twentieth-century physicians, health officials,and reformers believed would eradicate venereal disease from Americansociety. A shared belief that venereal disease posed a serious threat toAmerican society drew together a diverse coalition of prominent reform-ers and philanthropists, including John D. Rockefeller, Jr. and Jane Addams.They wanted to raise awareness that gonorrhea was a sexually transmit-ted disease and to encourage people to be tested and treated. To do so,social hygienists reframed venereal disease from a moral problem to asocial and medical issue.45

Social hygienists challenged the assumption that adults acquired ve-nereal disease only from “immoral” or extramarital sexual relations. Theviews of New York City physician Prince A. Morrow, a European-trainedexpert on venereal disease, deeply influenced the shape of twentieth-century social hygiene.46 In 1904, Morrow estimated that 75 percent ofAmerican men had been infected with gonorrhea, and he blamed them—not prostitutes—for the spread of infection.47 Morrow claimed that mostof his female patients were respectable white women who were marriedto “men who have presented a fair exterior of regular and correct living—often the men of good business and social position,” and he blamed thesemen for bringing the disease into their homes.48

Yet even though he complained that “family epidemics” were fre-quent, Morrow did not believe that fathers infected their daughters in thesame way that they infected their wives. Beginning in 1885, he declaredthat, “The existence of a purulent discharge from the vulva of childrenhas often led to the unjust accusation and punishment of innocent per-sons for attempted violation.”49 After the turn of the twentieth century,bacteriological analysis minimized the chance that a man would be wrong-ly convicted because a physician had mistaken leucorrhea for gonorrhea.Still, when he published his influential Social Diseases and Marriage in 1904,Morrow repeated his pre-bacterial era warning, adding, “One knows the

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facility with which children are disposed to accuse and lie.”50 He claimedinstead that, “We now recognize that gonorrhoea in children is vastly moreoften due to accidental mediate transmission than to attempted inter-course.”51 However, the medical literature contained mostly anecdotalspeculation and no research studies, and it did not support his unequivo-cal declaration. As Dr. J. Clifton Edgar, an NYSPCC medical examiner andthe author of a chapter on child sexual assaults complained at an AMAsession on vulvovaginitis that same year, “nothing of value had ever beenpublished on the subject.”52

An emphasis on “innocent” infection was a defining facet of twentieth-century social hygiene and an effective rhetorical maneuver that reducedthe social stigma of venereal disease. As a result, significantly more men,women, and children were tested and treated. But no one expected somany of these patients to be girls. Dr. L. Emmett Holt, professor of dis-eases of children at Columbia University Medical School, author of anauthoritative textbook on childhood diseases, and attending physician atthe Babies’ Hospital, warned that physicians were not only detecting gon-orrhea more frequently, but that its actual incidence among girls from allclasses was increasing. He claimed that at least five or six of the 125 girlsthe hospital screened each month were infected, and that on a single sum-mer day in 1904, five girls applying to the hospital for admission had testedpositive for the disease.53 That same year, a Chicago pathologist declaredgonorrhea among girls epidemic.54 During the winter of 1911–1912, thechildren’s ward at the Cook County Hospital—which Jane Addams calledthe “most piteous . . . of all children’s wards”—placed girls three to a bedand turned away many more.55 In just one month, September 1926, theVanderbilt Clinic on Manhattan’s Upper West Side, the city’s major pro-vider of outpatient treatment for infected girls, saw 213 new cases.56 In1927, the American Journal of Diseases of Children ranked gonorrhea as thesecond most common children’s contagious disease—“second to measlesand outnumbering smallpox and scarlet fever.”57 By the early 1930s, theMassachusetts Department of Health announced that girls accounted for10 percent of reported female gonorrhea infections, a figure that Washing-ton D.C. matched for 1929.58 Yet, doctors and reformers did so little toinvestigate the cause of such widespread infection that in 1927, the NewYork City Department of Health called vulvovaginitis “the most neglectedand poorly managed condition seen in medical practice.”59

Doctors, public health officials, and reformers recognized that gon-orrhea in girls was a costly problem, but their refusal to acknowledge in-cest sabotaged their efforts to effectively address prevention. EvenProgressive-era women reformers, who were eager to demonstrate the evilsof male sexual license and to protect girls from male predators, passed on


the opportunity to use the incidence of gonorrhea infection to expose malesexual misbehavior.60 Because they were committed to promoting thenuclear family as a corrective to social chaos, concerns about the viabilityof the family may have discouraged them from identifying its more sinis-ter features.61

Instead, many doctors believed that gonorrhea was endemic amongAfrican Americans, immigrants, and the working classes, and they sim-ply added gonorrhea to the list of diseases they blamed domestic servantsfor carrying into “fashionable schools” and the “homes of luxury.”62 Whenthe presence of a diseased servant could still not account for all of thecases, experienced practitioners simply lamented that, “one is occasion-ally utterly unable to trace the source of infection in a child surrounded byevery protection and comfort money can procure.”63

Sanitation activists filled in the gap. The early twentieth century wasan era of heightened medical and public attention to cleanliness, includ-ing bathrooms and toilets, thought to be the source of a variety of dis-eases.64 Reformers who regarded improved sanitation as a remedy for manysocial problems readily included epidemics of gonorrhea in girls amongthe problems they could solve. Although sanitary reforms included coer-cive measures aimed at “Americanizing” poor and immigrant families,cleaning up cities and educating the public about germs had markedlyreduced disease and mortality.65 Yet as applied to gonorrhea in girls, thefocus on sanitation was tragically misguided.

“Mothers’ Hands and Dangerous Things”: Sanitation Reform

Sanitation reformers and public health activists, who wanted to im-prove social conditions by keeping America clean, had long held mothersresponsible for keeping their families free of all kinds of disease.66 In herhistories of sanitary reforms, Nancy Tomes has shown how late nineteenth-century reformers designated mothers responsible for protecting theirfamily’s health by keeping their homes clean.67 Whereas an 1887 sanitarytract urged a woman who had “lost a child, a husband, or other relative to[disease]” to “consider whether the source of trouble may not be in thewater-closet,” by the 1910s, home economists pressed mothers to become“active agents in the pursuit of the safe toilet.”68

Therefore, in 1908, when Hull House resident and public health pio-neer Dr. Alice Hamilton published an influential article on gonorrhea ingirls that conceptualized it as a sanitary problem, she contextualized itwithin a well-known reform movement with a record of accomplishment(and in which she had established her reputation).69 Hamilton scoffed atthe “popular” view that girls acquired gonorrhea only from sexual con-

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tact, joining those who charged that such old-fashioned thinking had “con-tributed to retard the clearing-up of this subject.”70 She argued that it waswrong to assume that girls’ infections were necessarily “venereal”—sexu-ally transmitted—and claimed that the disease spread because of the “closecontact” in “modern city life.”71 In a second paper read at the 1910 Na-tional Conference on Charities and Corrections, Hamilton set out the “mod-ern” view that, “The child victims of gonorrhea usually have been infectedby their mothers.” She argued that “dangerous things” transmit infectionwhen soiled with gonorrhea discharge, namely “nurses or mother’s fingers,towels, wash-cloths, sponges, bath-tubs and the seats of closets,” by whichshe meant toilet seats.72 Such contacts were so numerous that she con-cluded, “other members of the family are responsible for a small numberof cases, and sexual violence for only an insignificant minority.”73

Doctors knew that nonsexual transmission of N. gonorrhoeae was im-probable because the bacteria die quickly in the open air. However, theyguessed that the genital lining of prepubertal girls was so thin that thebacteria could penetrate it on casual contact.74 Therefore, doctors, socialhygienists, and sanitary reformers began to demand sanitary improve-ments that would reduce opportunities for exposure to virulent bacteria.In the 1910s, Dr. Clara Seippel was Chicago’s Assistant City Physician, attend-ing physician at the Cook County Hospital children’s venereal disease ward,and President of the Frances Juvenile Home Association, which operateda residential facility for infected girls where Seippel was also attendingphysician. As city physician, she had examined scores of girls for evidenceof assault, and the numbers of men who assaulted children, including theirown, troubled her. Still, she told a meeting of the Chicago Medical andSocial Hygiene societies that they had a civic duty to protect “hundreds ofchildren exposed to infection” by raising “standards of hygiene.”75

Ignoring those cases that occurred in spacious and well-kept homes,doctors and reformers insisted that “overcrowding and unhygienic sur-roundings predispose to its transference,” thereby shifting responsibilityfor infection from fathers to mothers, and further widening the rift be-tween sexual contact and infection.76 When a girl became ill with the dis-ease, health care providers and social workers excoriated her mother forpoor housekeeping and did not waste time investigating the possibility ofincest.77 In the burgeoning literature on the topic, only Dr. Flora Pollackdismissed sanitation theories as “a very useful shield for a guilty indi-vidual” that “make it extremely difficult to protect children.”78 In 1909,Pollack estimated that at least 1000 girls were infected in Baltimore eachyear, and she visited police stations and met with community groups totry to improve criminal prosecutions of men who assaulted girls. How-ever, even Pollack conceded that it was difficult to believe that the inhab-


itants of Baltimore included enough “perverts” to have caused so manyinfections.79

Doctors who treated infected girls insisted that few, if any, of theirpatients had been assaulted, even though they could not identify any othercause of infection. In 1913, Dr. Edith Rogers Spaulding, attending physi-cian on the vulvovaginitis ward at the Children’s Hospital in Boston, ad-mitted that she had been unable to determine the source of infection inthirty of her fifty-six cases.80 “Not discovered” was the largest categoryunder “sources of infection”; twenty-six cases were classed as “history ofdischarge in one of parents,” by which she meant “accidental” infectionfrom poor sanitation; sixteen patients had a history of a recent hospitalstay; and three were ascribed to “history of contact,” meaning sex playwith other children.81 Yet Spaulding refused to conclude that any of herpatients (most of whom were under five years of age) had been raped. Toprevent the spread of infection, Spaulding demanded that school nursesensure that infected girls did not use the school toilet.

Since the mid-nineteenth century, doctors had occasionally speculatedthat chamber pots or toilet seats could be a source of girls’ infections.82

Now the sanitation and social hygiene movements seized upon the toiletas key. They claimed that toilets located in public places such as schools(where no family member could be implicated) were particularly danger-ous. In 1912, Seippel warned that, “A drop of gonorrheal pus on the toiletseat in a public school can start [an] epidemic,” even though no “schoolepidemic” had been documented in the American medical literature, norhad any case of individual infection been traced to a school toilet.83 None-theless, the need to improve the rundown and dirty conditions of schools,particularly the lavatories, was an issue with which doctors and reform-ers were already familiar and engaged.84

From the 1910s to the 1940s, doctors endorsed the toilet seat as theprimary source of girls’ infections, a theory that again displaced the sourceof danger to girls, this time to other girls. For instance, in 1914, Dr. FrederickJ. Taussig, a nationally known gynecologist and member of the ExecutiveCommittee of the St. Louis Society for Social Hygiene, argued that “Themost frequent source of infection is from child to child, and the most com-mon manner of its transmission is through the school lavatory.”85 Taussigsupported his supposition with imagination rather than research data: “Lava-tories . . . are as a rule so high that the smaller children in using them areforced to have their genitals and clothing rub over a considerable portionof the seat. The greater the number of persons using the same lavatory, theless interval of time is apt to elapse between its use, and hence the greaterlikelihood of carrying infection. The lavatories in tenements, playgrounds,and public schools are consequently a source of considerable danger.”86

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Taussig brushed aside the possibility that any of his patients had beenraped because only a few were from “the ignorant, foreign-born popula-tion” where he assumed incest occurred. Nor could he imagine that theinfection arose in the home environment, as his patients came from bothsqualid homes and the “fashionable parts of town.”87 To prevent the spreadof infection, Taussig recommended lowering toilets, U-shaped toilet seats,paper seat covers, and lavatory attendants who could detect dischargesand ensure that girls used the seat covers.88

However, early-twentieth-century school boards lacked the funds tokeep lavatories clean, let alone remodel them. But in response to warn-ings that infected girls posed “a real menace” to other children, schoolboards and municipalities around the country—from New York City in1916 to Los Angeles in 1937—enacted policies suspending them fromschool, even though the federal Children’s Bureau found such measuresto be ineffectual.89 Dr. Nels A. Nelson, the Assistant Director of the Divi-sion of Communicable Diseases of the Massachusetts Department of Pub-lic Health, even included the topic in his Christmas Eve 1930 radioaddress.90 Nelson was against excluding girls and he assured parents thatthere was no proof that any girl had been infected at school. The issue wasstill unsettled in 1935, when Nelson had became the top public healthofficial in Massachusetts in the area of venereal disease. Although he de-cried the “misunderstanding and resultant confusion, almost to the pointof hysteria, over gonorrhea and syphilis in the public schools,” to allayparents’ fears, he recommended that girls be suspended until the dischargecleared up, about six to eight weeks.91

“It Is Less Embarrassing To Accuse A Toilet Seat”

Parents may have become hysterical because the vague informationprovided by public health departments and social hygiene organizationsconfused them. For instance, a New York City Health Department pam-phlet printed on pink paper and circulated in English and Italian in the1930s entitled, “Important Information: Special Instructions for VaginitisCases,” warned mothers only that, “Your child is suffering from a conta-gious (catching) disease. You must be careful to prevent its spread to oth-ers. . . . Care in this cause means CLEANLINESS.”92 In a public educationpamphlet that Nelson wrote for the Massachusetts Society for Social Hy-giene in 1936, he conceded that “nobody knows” how children becomeinfected from nonsexual contacts.93 Nor could he describe the process in a1938 public health textbook: “How the gonococcus finds its way to thechild’s vulva, if not by direct sexual contact, has never been determined.”94

One reason that doctors had so little information was because they


asked few questions. Poorly funded and disorganized clinics in the 1920sand 1930s had neither the time nor the resources to investigate the sourcesof patients’ infections.95 Moreover, health care workers whose primaryinterest was to increase the number of people receiving treatment avoidedquestions that might have discouraged parents from permitting theirdaughters to be treated.96 However, doctors circumvented the issue in re-search studies as well. When a prestigious three-year clinical study at aspecially constructed “vaginitis clinic” at New York City’s Bellevue-Yorkville Health Demonstration set out to identify the definitive source ofgirls’ infections, investigators pressured mothers to be tested but omittedfathers from their protocols. In 1933, the project’s investigators admittedin their lengthy final report that they could not determine whether eitheruncleanliness or rape had been the source of infection in any of the 322cases studied.97 They concluded that, “the exact manner of transference ofthe infectious material from the ill to the well is unknown.”98

Even so, practitioners continued to insist that nonsexual contactscaused infection, even though doing so had not improved their ability totrace contacts. By 1937, doctors Reuel A. Benson and Arthur Steer, attend-ing physicians at the busy vaginitis ward at New York City’s Metropoli-tan Hospital, still could not identify the source of infection for one-half oftheir 195 patients.99 Yet, they dismissed rape as an “infrequent” cause ofinfection, even as they admitted that patient histories provided by a girl’sparents could not be verified when “things such as toilets seats, linen andbathing water were accused.” 100 As Nelson commented in 1938, “It is lessembarrassing to accuse a toilet seat than to seek for sexual sources or torequest the examination of other members of the family.”101

However much doctors relied upon the notion of nonsexual infec-tion, no research study before 1940 attempted to test the possibility. Thefirst do so was the New York Vaginitis Research Project of the GonococcusResearch Committee, which was organized by the New York City Depart-ment of Health, and funded by the U.S. Public Health Service and privatefoundations. By measuring factors such as the length of time N. gonorrhoeaeremain virulent on a toilet seat, it was able to discredit the notion of casualinfection.102 However, the committee did not explain how else girls ac-quired the disease from an infected parent. Although the study attributedinfections transmitted between children to “sex play,” it only said of par-ent-child transmission that, “The relationship between the child and theinfected adult has to be quite intimate.”103

That same year the eleventh edition of Holt’s Diseases of Infancy andChildhood, the most prestigious pediatrics textbook of the twentieth cen-tury, repeated Alice Hamilton’s speculation as fact: “Gonococcus vagini-tis in children is not to be regarded as a venereal disease. An insignificantly

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small proportion of the cases are acquired by sex contact.”104 Holt’s in-structed physicians that, “In schools and other public places [vulvovagini-tis] may be spread by toilet seats . . . The young child may have slept in thesame bed with an infected mother or sister; the infection may have oc-curred through baths, towels, clothing, toilets, etc.”105 To prevent the spreadof infection, Holt’s suggested that doctors quarantine infected girls by iso-lating them within their homes where they would not be a “menace” toothers. Fortunately for girls, shortly thereafter, penicillin became avail-able as an “instant cure” for gonorrhea.106 Now that they no longer poseda risk of spreading a lingering infection to others, medical interest in girls’infections evaporated and researchers and clinicians moved on to morepressing subjects.107

Conclusion

Despite profound changes at the end of the twentieth century in talk-ing about sex in general and about incest in particular, the incidence withwhich incest occurs remains in doubt. Contemporary women’s incest nar-ratives arose amid events that were as disturbing as they were puzzling:the mass criminal prosecutions of daycare workers for sexual abuse; theimprisonment of fathers for incest and other crimes based on their daugh-ters’ childhood memories; and the commercialization of a grassroots re-covery movement that turned self-help into big business. The media andpartisans in the debates often conflated these events and flattened the com-plicated issues they raised about memory, subjectivity, and power to anartificial contest between “irrational” feminism and “reliable” science. Thispaper demonstrates that evidence of the widespread occurrence of incestexists, but that professionals have used authoritative discourses to con-ceal it.

The discovery of seemingly rampant sexually transmitted diseaseamong girls in the early twentieth century raised a compelling threat tothe status quo, which health care professionals and reformers diffused byusing their scientific authority to manipulate the evidence. Late nineteenth-century scientific advances substantially improved doctors’ ability to di-agnose gonorrhea by detecting the presence of N. gonorrhoeae , a specificinfectious agent. But the more attention professionals—from a strikinglydiverse range of doctors, nurses, social workers, social hygienists, and re-formers—paid to the disease, the more they obscured the source of infec-tion. Scientific advances paradoxically fomented confusion rather thanclarity. When the medical evidence before them conflicted with key ide-ologies about masculinity, class status, and citizenship, health care pro-fessionals and reformers did not hesitate to substitute speculation for


empirical data. They reframed infection from a medico-legal issue to afacet of sanitation reform, thereby placing the blame for infection first onbed linens, then on mothers, other girls, and, in desperation, even on toi-let seats. This discursive move exonerated fathers from responsibility byrendering the issue of whether or not they had raped or sexually assaultedtheir daughters irrelevant.

The ways in which professionals revised the etiology of gonorrhea ingirls supports the feminist argument that the production of knowledge isnever value neutral, but always arises from historically specific social re-lations.108 “Scientific advances”—idealized as positivistic, objective, andreliable sources of knowledge—resulted in the discovery of widespreadevidence of incest in the early twentieth century. But as Sandra Hardingnotes in her critique of scientific methods, “[A]ny body of systematicknowledge is always internally linked to a distinctive body of systematicignorance.”109 Had the sexual misbehavior of fathers not been obvious allalong, no concerted effort to disguise it would have been necessary. It wasonly after second-wave feminism—derided as a subjective, politicized,and ideological approach to knowledge—offered a new critical perspec-tive from which to evaluate family relations and allegations of sexual as-sault that fathers’ sexual abuse of their daughters was finally recognizedas incest.

NOTES

The author thanks Lois W. Banner, Steven J. Ross, Carole Shammas, Beverly J.Schwartzberg, David Bello, Jeanette Barbieri, Ivan Noah Uldall, Leila J. Rupp andthe anonymous readers for the Journal of Women’s History, Patricia Cline Cohen,the UC-Santa Barbara Women’s Studies Program, and the UC President’s Post-doctoral Fellowship Program.

1Bertha C. Lovell, “Some Problems in Social Hygiene in a Clinic for Women’sDiseases,” Journal of Social Hygiene 2, no. 4 (1916): 501–16, quotation on 501.

2Ibid., 505.

3Jerome Walker, “Reports, with Comments, of Twenty-One Cases of Inde-cent Assault and Rape Upon Children,” Parts 1 and 2, Archives of Pediatrics 3 (May1886): 269; (June 1886): 321–41; Alfred S. Taylor, Medical Jurisprudence, ed. R.Egglesfield Griffith (Philadelphia: Lean & Blanchard, 1845), 458–60; Michael Ryan,A Manual of Medical Jurisprudence, Compiled from the Best Medical and Legal Works:Being an Analysis of a Course of Lectures on Forensic Medicine, Annually Delivered inLondon, 1st American ed. (Philadelphia: Cary and Lea, 1832), 163; Thomas Percival,Medical Ethics: Or, A Code of Institutes and Precepts Adapted to the Professional Con-duct of Physicians and Surgeons (Manchester: Printed by S. Russell, 1803), 102–03,231–34.

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4In his influential study begun in the 1940s, sociologist S. Kirson Weinbergargued that less than one in a million men commit incest. S. Kirson Weinberg,Incest Behavior (New York: Citadel Press, 1955), 39.

5Judith Lewis Herman with Lisa Hirschman, Father-Daughter Incest (Cam-bridge, Mass.: Harvard University Press, 1981), 7.

6See, for example, Jeffrey Moussaief Masson, The Assault on Truth: Freud’sSuppression of the Seduction Theory (New York: Farrar, Straus, and Giroux, 1984);Herman and Hirschmann, Father-Daughter Incest, 9–11; Florence Rush, The BestKept Secret: Sexual Abuse of Children (Englewood Cliffs, N.J.: Prentice-Hall, 1980);and Elizabeth Hanfin Pleck, Domestic Tyranny: The Making of Social Policy AgainstFamily Violence from Colonial Times to the Present (New York: Oxford UniversityPress, 1987), 150–57.

7See Diana E.H. Russell, introduction to The Secret Trauma: Incest in the Livesof Girls and Women, rev. ed. (New York: Basic Books, 1999); Elizabeth Wilson, “NotIn This House: Incest, Denial, and Doubt in the White Middle-Class Family,” YaleJournal of Criticism 8, vol. 1 (spring 1995): 35–58; Frederick C. Crews, The MemoryWars: Freud’s Legacy in Dispute (New York: New York Review of Books, 1995); andRichard Ofshe and Ethan Watters, Making Monsters: False Memory, Psychotherapy,and Sexual Hysteria (New York: Scribner, 1994).

8Linda Gordon, Heroes of Their Own Lives: The Politics and History of FamilyViolence, Boston 1880–1960 (New York: Penguin Press, 1988); and Pleck, DomesticTyranny.

9See Lisa Duggan, “From Instincts to Politics: Writing the History of Sexu-ality in the U.S.,” Journal of Sex Research 27 (February 1990): 95–110, esp. 108–09. Inaddition to essays by Gordon and Pleck, historical studies of incest include IreneQuenzler Brown and Richard D. Brown, “Tales From the Vault,” Common-Place 1(September 2000). Available Online: <http://www. common-place.org> 3 Sep-tember 2000; and Peter Bardaglio, “‘An Outrage upon Nature’: Incest and theLaw in the Nineteenth Century South,” in In Joy and In Sorrow: Women, Family, andMarriage in the Victorian South, 1830–1900, ed. Carol Bleser (New York: OxfordUniversity Press, 1991), 32–51, esp. 44. Historians documenting incest in the con-text of other topics include Cornelia Hughes Dayton, Women Before the Bar: Gen-der, Law, and Society in Connecticut, 1639–1789 (Chapel Hill: University of NorthCarolina Press, 1995); Mary E. Odem, Delinquent Daughters: Protecting and PolicingAdolescent Female Sexuality in the United States, 1885–1920 (Chapel Hill: Universityof North Carolina Press, 1995); and Kathleen Ruth Parker, “Law, Culture, andSexual Censure: Sex Crime Prosecution in a Midwest County Circuit Court, 1850–1950” (Ph.D. diss., Michigan State University, 1993).

10See Janice Haaken, Pillar of Salt: Gender, Memory, and the Perils of LookingBack (New Brunswick, N.J.: Rutgers University Press, 1998); Carol Tavris, “Be-ware the Incest Survivor Machine,” New York Times Book Review, 3 January 1994, 1;Judith Herman, “Letters to the Editor,” New York Times Book Review , 14 February1994, 3; and Linda Alcoff and Laura Gray, “Survivor Discourse: Transgression orRecuperation?” Signs 18 (winter 1993): 260–80.

11See, for example, Frederick Crews, “The Revenge of the Repressed,” Parts


1 and 2, New York Review of Books, 1 December 1994, 49–58; and Elizabeth Loftusand Katherine Ketcham, The Myth of Repressed Memory: False Memories and Allega-tions of Sexual Abuse (New York: St. Martin’s Press, 1994).

12U.S. Dept. of Health and Human Services, National Center on Child Abuseand Neglect, Child Maltreatment 1995: Reports From the States to the National ChildAbuse and Neglect Data System (Washington, DC: U.S. Government Printing Office,1997); and David Finkelhor, “How Widespread Is Child Sexual Abuse?” ChildrenToday 13 (July-August 1984): 18–21.

13U.S. Dept. of Justice, Bureau of Justice Statistics, Sexual Assault of YoungChildren as Reported to Law Enforcement: Victim, Incident, and Offender Characteris-tics (July 2000), 1. Available Online: <http://www.ojp.usdoj.gov/bjs/abstract/sayclre.htm> 26 September 2000.

14Pat Gilmartin, Rape, Incest, and Child Sexual Abuse: Consequences and Re-covery (New York: Garland Publishing, Inc., 1994), 47; David Finkelhor and LarryBarron, “High-Risk Children,” in A Sourcebook on Child Sexual Abuse, ed. DavidFinkelhor (Beverly Hills, Calif.: Sage Publications, 1986), 60–88, esp. 67–71; andStefanie Doyle Peters, Gail Elizabeth Wyatt, and David Finkelhor, “Prevalence,”in Sourcebook on Child Sexual Abuse, 15–59, esp. 27–30.

15Division of STD Prevention, Sexually Transmitted Disease Surveillance 1998Supplement: Gonococcal Isolate Surveillance Project (GISP) Annual Report—1998 (Dept.of Health and Human Services, Public Health Service. Atlanta: Centers for Dis-ease Control and Prevention, November 1999), 1; National Center for HIV, STD,and TB Prevention, Division of Sexually Transmitted Diseases, CDC, Gonorrhea(September 2000). Available Online: <http://www. cdc.gov/nchstp/dstd/Fact_Sheets/FactsGonorrhea.htm>15 September 2000.

16Deborah Stewart, “Sexually Transmitted Disease,” in Evaluation of the Sexu-ally Abused Child: A Medical Textbook and Photographic Atlas, ed. Astrid Heger andS. Jean Emans (New York: Oxford University Press, 1992) 145–69, esp. 145, 150.Child abuse specialist Dr. Suzanne M. Sgroi speculates that some parents refuseor delay testing because a private physician who will not report the infection istreating them, suggesting that the coincidence of infection may be higher. SuzanneM. Sgroi, “Pediatric Gonorrhea Beyond Infancy,” Pediatrics Annals 8 (May 1979):73–87, esp. 83.

17Stewart, “Sexually Transmitted Disease,” 150.

18Adaora A. Adimora, Holli Hamilton, King K. Holmes, and P. FrederickSparling, eds., Sexually Transmitted Diseases: Companion Handbook, 2d. ed. (NewYork: McGraw-Hill, Inc., 1994), 352–54, 380.

19American Academy of Pediatrics, “Statement,” Pediatrics 101 (1998): 134–35; see also Suzanne M. Sgroi, “‘Kids With Clap’: Gonorrhea as an Indicator ofChild Sexual Assault,” Victimology 2 (1977): 251–67, esp. 258–63.

20Adimora, Sexually Transmitted Diseases, 354, 356, 378; and Laura T. Gutman,“Gonococcal Diseases in Infants and Children,” in Sexually Transmitted Diseases,

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3d. ed., ed. King K. Holmes, P. Frederick Sparling, Per-Anders Mårdh, Stanley M.Lemon, Walter E. Stamm, Peter Piot, and Judith N. Wasserheit (New York: McGraw-Hill Companies, Inc, 1999), 1145–53.

21Sgroi, “‘Kids With Clap,’” 252; Astrid H. Heger, “Evaluation of SexualAssault in the Emergency Department,” Topics in Emergency Medicine 21 (June 1999):46–57, esp. 51–52; American Academy of Pediatrics, Committee on Child Abuseand Neglect, “Guidelines for the Evaluation of Sexual Abuse of Children,” Pediat-rics 87 (February 1991): 254–57, esp. 256–57.

22Adimora, Sexually Transmitted Diseases, 354; Pamela F. Farrington, “Pedi-atric Vulvo-Vaginitis,” Clinical Obstetrics and Gynecology 40 (March 1997): 135–40,esp. 138; Gutman, “Gonococcal Diseases in Children,” 1149; and Robert M. Siegel,Charles J. Schubert, Patricia A. Myers, and Robert A. Shapiro, “The Prevalence ofSexually Transmitted Diseases in Children and Adolescents Evaluated for SexualAbuse in Cincinnati: Rational for Limited STD Testing in Prepubertal Girls,” Pedi-atrics 96 (December 1995): 1090–94.

23See, for example, Walker, “Twenty-One Cases,” Part 1, 270–73, Part 2,332–33, 339–41; Francis Wharton and Moreton Stillé, A Treatise on Medical Juris-prudence (Philadelphia: Kay and Brother, 1855), 326–35; Taylor, Medical Jurispru-dence, 460; Burke Ryan, “On the Communicability of Gonorrhoea, in Reference toMedical Jurisprudence,” London Medical Gazette 47 (1851): 744–45, esp. 744; andTheodoric Romeyn Beck, Elements of Medical Jurisprudence, ed. John Darwall, 3rd

ed. (London: Longman, Rees, Orme, Brown, and Green, 1829), 54–56.

24Allan M. Brandt, No Magic Bullet: A Social History of Venereal Disease in theUnited States Since 1880 (New York: Oxford University Press, 1987), 10.

25See, for example, John Lovett Morse, “Five Cases of Gonorrhoeae in LittleGirls,” Archives of Pediatrics 11 (1894): 596–98, esp. 598; and Isaac A. Abt, “Gonor-rhea in Children,” Journal of the American Medical Association 31 (17 December 1898):289–94.

26See, for example, Flora Pollack, “A Report of the Women’s Venereal De-partment of the Johns Hopkins Hospital Dispensary,” Maryland Medical Journal 49(August 1906): 289; L. Emmett Holt, “Gonococcus Infections in Children, WithEspecial Reference to Their Prevalence in Institutions and Means of Prevention,”New York Medical Journal and Philadelphia Medical Journal 81 (18 March 1905): 521–27, 589–93, esp. 590–91; Sara Welt-Kakels, “Vulvovaginitis in Little Girls: A Clini-cal Study of 190 Cases,” Part 1, New York Medical Journal and Philadelphia MedicalJournal 80 (8 October 1904): 698–93, esp. 689; and Joseph Louis Baer, “EpidemicGonorrheal Vulvo-Vaginitis in Young Girls,” Journal of Infectious Diseases 1 (19March 1904): 313.

27J.C. Cook, “Comment,” in Abraham L. Wolbarst, “Gonorrhea in Boys,”JAMA 33 (28 September 1901): 827–30, esp. 830.

28Wharton and Stillé, A Treatise on Medical Jurisprudence , 327–28.

29Walker, “Reports of Twenty-One Cases,” Part 2, 330.


30Ibid., 330–31.

31See, for example, E. D. Barringer, “Gonorrheal Vulvo-Vaginitis in Chil-dren,” in Diseases of the Genito-Urinary Organs, ed. Edward L. Keyes, Jr. (New York:D. Appleton and Company, 1910), 122–27; Pollack, “A Report,” 290; GurneyWilliams, “Rape in Children and in Young Girls: Based on the Personal Investiga-tion of Several Hundred Cases of Rape and of Over Fourteen Thousand VaginalExaminations,” Parts 1 and 2, International Clinics , 23rd ser., 2 (1913): vol. 2, 245–67,esp. 245; vol. 3, 245–67, esp. 252–53; W. Travis Gibb, “Indecent Assault Upon Chil-dren,” in A System of Legal Medicine, ed. Allan McLane Hamilton and LawrenceGodkin (New York: E.B. Treat, 1894), 649–57, esp. 655–56; and J. Clifton Edgar andJ.C. Johnston, “Rape,” in Medical Jurisprudence: Forensic Medicine and Toxicology,vol. 2 ed. R.A. Witthaus and Tracy C. Becker (New York: William Wood and Com-pany, 1894), 415–90, esp. 461.

32W. Travis Gibb, “Criminal Aspect of Venereal Diseases in Children: BasedUpon the Personal Examination of Over 900 Children, the Alleged Victims of Rape,Sodomy, Indecent Assault, Etc.,” Transactions of the American Society of Sanitary andMoral Prophylaxis 2 (1908): 25–34, esp. 30.

33Richard von Krafft-Ebing, Psychopathic Sexualis: With Especial Reference tothe Antipathic Sexual Instinct, A Medico-Forensic Study, 12th ed., trans. F.J. Rebman(New York: Medical Art Agency, 1906), 561; Giuseppe Pitrè, Sicilian Folk Medicine ,trans. Phyllis H. Williams (Lawrence, Kans.: Coronado Press, 1971), 302, origi-nally published as Medicina Popolare Siciliana (Carlo Clausen, Torino Clausen, 1896);William R. Wilde, “Medico-Legal Observations Upon the Case of Amos Green-wood, Tried at the Liverpool Assizes, December, 1857, for the Wilful [sic] Murderof Mary Johnson, and Sentenced to Penal Servitude for Life,” Dublin QuarterlyJournal of Medical Science (February 1859): 51–87, esp. 61; Wharton and Stillé, ATreatise on Medical Jurisprudence, 327–28 (citing Johann Ludwig Caspar, Pract.Hadbuch der Gerichtlichen Medicin [Practical Handbook of Forensic Medicine], vol.3 [Berlin, 1857], 103).

34Flora Pollack, “The Acquired Venereal Infections in Children,” Johns Hop-kins Hospital Bulletin 20 (May 1909): 142–49, esp. 143. Pollack referred to the 1906translation of Krafft-Ebing, which states that, “in Europe an idea is still prevalentthat intercourse with children heals venereal disease.” 561.

35Nels A. Nelson and Gladys L. Crain, Syphilis, Gonorrhea and the PublicHealth (New York: Macmillan Co., 1938), 141, 143; Phyllis H. Williams, SouthernItalian Folkways in Europe and America: A Handbook for Social Workers, Visiting Nurses,School Teachers, and Physicians (New Haven, Conn.: Yale University Press, 1938),167–68; Havelock Ellis, Studies in the Psychology of Sex, vol. 4 of Sex in Relation to Soci-ety (1906; reprint, New York: Random House, 1936), 337; Stephen A. Yesko, “Gonor-rheal Vulvovaginitis in the Young: History, Prevalence, Treatment and Case Reports,”American Journal of Diseases of Children 33 (April 1927): 630–46, esp. 636; and JohnLovett Morse, Clinical Pediatrics (Philadelphia: W.B. Saunders Company, 1926), 667.

36Herman B. Sheffield, “Vulvovaginitis in Children,” New York Medical Jour-nal 76 (4 August 1900): 189–92, esp. 190–91.

37Ibid., 191.

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38W.M. Leszynsky, “Leucorrhoea as the Cause of a Recent Epidemic of Pu-rulent Opthalmia in one of our City Charitable Institutions,” New York MedicalJournal 43 (27 March 1886): 352–35; and I.E. Atkinson, “Report of Six Cases ofContagious Vulvitis in Children,” American Journal of Medical Science (April 1878):444–46.

39A.C. Cotton, “An Epidemic of Vulvovaginitis Among Children,” Archivesof Pediatrics 22 (February 1905): 106–15; Henry Koplik, “Prophylactic Measures ToPrevent the Spread of Vulvovaginitis in Hospital Services,” Archives of Pediatrics10 (1903): 735–41; and Herman B. Sheffield, “Contribution to the Study of Infec-tious Vulvo-Vaginitis in Children, with Remarks Upon Purulent Opthalmia, anda Report of Sixty-Five Cases,” American Medico-Surgical Bulletin 9 (30 May 1896):726–31.

40Holt, “Gonococcus Infections in Children,” 523–25.

41Reuel B. Kimball, “Gonorrhoea in Infants, With a Report of Eight Casesof Pyaemia,” New York Medical Record 64 (14 November 1903): 761–66; and Guy L.Hunner and Norman MacL. Harris, “Acute General Gonorrheal Peritonitis,” Bul-letin of the Johns Hopkins Hospital 13 (June 1902): 121–30, 127.

42W.D. Trenwith, “Gonococcus Vaginitis in Little Girls,” New York MedicalJournal 83 (3 February 1906): 240–42.

43Ibid., 241.

44Brandt, No Magic Bullet , 120–26, 135–57.

45Ibid., 37–40; John C. Burnham, “The Progressive Era Revolution in Ameri-can Attitudes Toward Sex,” Journal of American History 59 (March 1973): 885–908,esp. 890–92; and Roster of officers and directors, 1913–57 (ca. 1957), Box 18, folder7, New York Social Hygiene Society, Inc., formerly the ASSMP, Box 125, folder 18,American Social Health Association Collection, Social Welfare History Archives,Walter Library, University of Minnesota, Minneapolis, MN (hereafter cited asASHA). See also William Snow, “The American Social Hygiene Association: SomeNotes on the Historical Background, Development and Future Opportunities ofthe National Voluntary Organization for Social Hygiene in the United States,”(New York: ASHA, June 1946); pamphlet, Box 1, folder 1; Minutes, American Vigi-lance Association, 17 February 1913; and pamphlet, Box 2, folder 6, in ASHA.

46Brandt, No Magic Bullet, 14–17, 23–26; and Burnham, “The ProgressiveEra Revolution in American Attitudes Toward Sex,” 892–902.

47Prince A. Morrow, Social Diseases and Marriage: Social Prophylaxis (Phila-delphia: Lea Brothers and Co., 1904), 25; Richard C. Cabot, “Observations Re-garding the Relative Frequency of the Different Diseases Prevalent in Boston andIts Vicinity,” Boston Medical and Surgical Journal 165 (3 August 1911): 155–70; andPrince A. Morrow, “The Frequency of Venereal Diseases: A Reply to Dr. Cabot,”Boston Medical and Surgical Journal 165 (5 October 1911): 520–25. Estimates variedwidely because no laws before 1911 required doctors to report gonorrhea infec-tions. See Brandt, No Magic Bullet , 12–13, 42–43.


48Morrow, Social Diseases and Marriage, 23.

49Prince A. Morrow, Wood’s Pocket Manuals, Venereal Memoranda: A Manualfor the Student and Practitioner (New York: William Wood and Co., 1885), 15.

50Morrow, Social Diseases and Marriage, 117

51Ibid., 118.

52J. Clifton Edgar, “Comment,” in Holt, “Gonococcus Infections,” 592.

53Holt, “Gonococcus Infections,” 525, 591.

54Baer, “Epidemic Vulvo-Vaginitis,” 313.

55Clara P. Seippel, “Venereal Diseases in Children,” Illinois Medical Journal22 (July 1912): 50–56, esp. 52; and Jane Addams, A New Conscience and an AncientEvil (New York: Macmillan Co., 1912), 184.

56Kathleen Wehrbein, A Survey of the Incidence, Distribution and Facilities ForTreatment of Vulvo-Vaginitis in New York City, With Concomitant Sociological Data:Report of the Committee on Vaginitis (New York: E.B. Treat and Co., 1927), 250.

57Yesko, “Gonorrheal Vulvovaginitis,” 633.

58N.A. Nelson, “Gonorrhea Vulvovaginitis: A Statement of the Problem,”New England Journal of Medicine 207 (21 July 1932): 135–40, esp. 136; Walter Clarke,“Summary of a Social Hygiene Survey,” Journal of Social Hygiene 27 (February 1931):65–94, esp. 78.

59New York City Department of Health, “Clinic Does Research on Vagini-tis,” Journal of Social Hygiene 15 (June 1929): 368–70, esp. 369.

60See, for example, Chicago Society of Social Hygiene, For the Protection ofWives and Children from Venereal Contamination (Chicago: Chicago Society of SocialHygiene, 1907); and Lavinia L. Dock, Hygiene and Morality: A Manual for Nursesand Others, Giving an Outline of the Medical, Social, and Legal Aspects of the VenerealDiseases (New York: G.P. Putnam’s Sons, 1910), 148–49.

61Jane Addams, The Spirit of Youth and the City Streets (Urbana: Universityof Illinois Press, 1972), 33, 34–47. See also Anna Garlin Spencer, Woman’s Share inSocial Culture (New York: Mitchell Kennerley, 1912), 254–74; and William L. O’Neill,“Divorce in the Progressive Era,” in The American Family in Social-Historical Per-spective, ed. Michael Gordon (New York: St. Martin’s Press, 1973), 251–66.

62Barringer, “Gonorrheal Vulvo-Vaginitis,” 122; Wolbarst, “Gonorrhea inBoys,” 828; and Charles O’Donovan, “Gonorrhoea in Children: A Frequent Oc-currence Amongst the Negroes of Baltimore,” Archives of Pediatrics 16 (1899): 25–26. See also Brandt, No Magic Bullet , 20–21.

63Seippel, “Venereal Diseases,” 52.

64Nancy Tomes, The Gospel of Germs: Men, Women, and the Microbe in Ameri-can Life (Cambridge: Harvard University Press, 1998), 84–87, 157–66, and Nancy

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Tomes, “Spreading the Germ Theory: Sanitary Science and Home Economics, 1880–1930,” in Women and Health in America: Historical Readings, ed. Judith Walzer Leavitt(Madison: University of Wisconsin Press, 1999), 596–611, esp. 603. See also EdithAbbott, The Tenements of Chicago, 1908–1935 (Chicago: University of Chicago Press,1936), 205–22, 211–13; Tenement House Committee, Committee on Housing, COS,Housing Reform in New York City: Report of the Tenement House Committee of the COSof the City of New York, 1911, 1912, 1913 (New York: M.B. Brown, 1914), 2, 32–33;and New York Association for Improving the Condition of the Poor, Departmentof Social Welfare, and Bureau of Public Health and Hygiene, Comfort Stations inNew York City: A Social Sanitary and Economic Survey, publication no. 80 (New York:AICP, ca. 1910).

65See Tomes, Gospel of Germ, 185–95; Suellen Hoy, Chasing Dirt: The Ameri-can Pursuit of Cleanliness (New York: Oxford University Press, 1995), 87–121; andAlan M. Kraut, Silent Travelers: Germs, Genes, and the “Immigrant Menace,” (NewYork: Basic Books, 1994).

66Hoy, Chasing Dirt , 98–117; Tomes, Gospel of Germs , 65–67, 135–54, 175–85.

67Nancy Tomes, “The Private Side of Public Health: Sanitary Science, Do-mestic Hygiene, and the Germ Theory, 1870–1900,” Bulletin of the History of Medi-cine 64 (winter 1990): 509–39, esp. 528–35.

68Tomes, Gospel of Germs, 85; Tomes, “Spreading the Germ Theory,” 603.

69See Alice Hamilton, Exploring the Dangerous Trades: The Autobiography ofAlice Hamilton, M.D. (Boston: Little, Brown and Co., 1943), 99–100; and BarbaraSicherman, Alice Hamilton: A Life in Letters (Cambridge, Mass.: Harvard Univer-sity Press, 1984), 145, 144–46.

70Alice Hamilton, “Gonorrheal Vulvo-Vaginitis in Children: With SpecialReference to an Epidemic Occurring in Scarlet-Fever Wards,” Journal of InfectiousDiseases 5 (March 1908): 133–57, esp. 134. See also Holt, “Gonococcus Infections,”521; and Welt-Kakels, “Vulvovaginitis,” 740.

71Hamilton, “Vulvo-Vaginitis in Children,” 142.

72Alice Hamilton, “Venereal Diseases in Institutions for Women and Girls,”Proceedings of the National Conference of Charities and Corrections 37 (1910): 53–56,esp. 54.

73Ibid., 54.

74Ibid., 54–55; and J. Clifton Edgar, “Gonococcus Infection as a Cause ofBlindness, Vulvovaginitis and Arthritis,” JAMA 49 (3 August 1907): 411–14, esp.413–14.


76Barringer, “Gonorrheal Vulvo-Vaginitis,” 122.

77Edith M. Baker, “Social Case Work in Hospital and Clinic,” Journal of So-cial Hygiene 13 (November 1927): 477–91, esp. 490.


78Pollack, “Acquired Venereal Infections,” 147.

79Ibid., 143.

80Edith Rogers Spaulding, “Vulvovaginitis in Children,” American Journalof Diseases of Children 5 (March 1913): 248–67, esp. 253; see also B. Wallace Hamilton,“Gonococcus Vulvovaginitis in Children: With Results of Vaccine Treatment inOut-Patients,” JAMA 54 (9 April 1910): 1196–98.

81Spaulding, “Vulvovaginitis in Children”, 253.

82Morrow, Social Diseases, 116; Edgar and Johnston, “Rape,” 465; John Mor-ris, “Gonorrhoeae in Women,” Virginia Medical Monthly 5 (1878): 373–80, esp. 375;and Ryan, “On the Communicability of Gonorrhoea,” 745.


84Hoy, Chasing Dirt, 126–28; John Duffy, A History of Public Health in NewYork City, 1866–1966, vol. 2 (New York: Russell Sage Foundation, 1974), 217–18;J.H. Berkowitz, Sanitary School Surveys as a Health Protective Measure (New York:New York Assn. For Improving the Condition of the Poor, 1916), reprinted fromModern Hospital 6 (March 1916); and [New York City] Board of Education, “Sani-tary Conditions in Lavatories,” School Health News 1 (December 1915): 8.

85Frederick J. Taussig, “The Prevention and Treatment of Vulvovaginitis inChildren,” American Journal of Medical Sciences 148 (October 1914): 480–90, esp. 483.

86Ibid., 483.

87Ibid., 490.

88Ibid., 483–84.

89George Stevens, Public Health Aspects of Gonorrhea in the Female, bulletinno. 20 (Los Angeles: Board of Health Commissioners, March 1937), 4; Clarke, “Sum-mary of a Social Hygiene Survey,” 78; [New York City] Bureau of Public HealthEducation, Department of Health, “Routine Procedure in Guarding the SchoolsAgainst Syphilis and Gonorrhoea,” School Health News 7 (February 1921): 1–2, esp.2; “Venereal Disease,” School Health News 2 (April 1916): 6; Ella Oppenheimer andRay H. Everett, “School Exclusions for Gonorrheal Infections in Washington, D.C.,”American Journal of Public Health 24 (May 1934): 529–31. See also Paul R. Stalnaker,“Gonococcal Vulvovaginitis Before Puberty,” Texas State Journal of Medicine 29(October 1933): 395–400; N.A. Nelson, “Gonorrhea Vulvovaginitis: A Statement ofthe Problem.” New England Journal of Medicine 207 (21 July 1932): 135–40; and S.H.Rubin, “The Point of View of the School Physician,” New England Journal of Medi-cine 207 (21 July 1932): 142.

90N.A. Nelson, “Some Diseases We Don’t Talk About—And Why Not: ThePrevalence of Gonorrhea and Syphilis,” Commonhealth 20 (April-May-June 1933):57–58, esp. 58 (text of radio broadcast, WBZ, 24 December 1930); see also N.A.Nelson, “Gonorrhea and Syphilis: A Description of the Two Diseases,” Common-health 20 (April-May-June 1933): 59–62 (text of radio broadcast, WEEI, 12 August1932).

LYNN SACCO2002 103

91N.A. Nelson, “Gonorrhea and Syphilis in the Public Schools,” Common-health 22 (April-May-June 1935): 118–19.

92New York City Health Department, Instructions to Parents Regarding Vagini-tis, Official Project #65–97-415, “Treatment of Social Diseases” (New York: WorksProgress Administration for the City of New York, 1937); Department of Health,City of New York, Important Information: Special Instructions for Vaginitis Cases (NewYork: Department of Health, 1929).

93Nels A. Nelson, “Gonorrhea” (Boston: Massachusetts Society for SocialHygiene, 1936), 4.

94Nelson and Crain, Public Health , 142–43.

95New York Tuberculosis and Health Association, Inc., Social Hygiene Com-mittee, Survey of Female Gonorrhea Clinics in New York City (New York: New YorkTuberculosis and Health Association, Inc., 1936), 4; and American Social HygieneAssociation, “Survey of New York City Infections and Hospitals,” (1935): 93–94,124, unpublished typescript, Box 101, folder 3, ASHA.

96Edna Pearson Wagner, “Social Aspects of Gonorrhea Vaginitis as ShownBy a Study of Fifty Cases of the Children’s Bureau in New Orleans” (M.A.thesis,Tulane University, 1940), 73, 44; and Baker, “Social Case Work,” 479–80.

97See, for example, Walter M. Brunet, Dora M. Tolle, Sara Alicia Scudder,and Anne Ruth Medcalf, “Cervico-Vaginitis of Gonococcal Origin in Children:Report of a Project of the Bellevue-Yorkville Health Demonstration of New YorkCity,” Hospital Social Service Magazine , Supp. 1 (March 1933): 1–98, esp 6–7, 75. Seealso, Duffy, Public Health , 323–25; C-E.A. Winslow and Savel Zimand, Health Un-der the “El”: The Story of the Bellevue-Yorkville Health Demonstration in Mid-TownNew York (New York: Harper and Brothers Publishers, 1937), 150, 151; Pamphlet,“The Bellevue-Yorkville Health Demonstration,” (November 1929), Box 62, folder371–8 [1926–1930], Community Service Society (formerly Charity OrganizationSociety of New York) Papers, Rare Book and Manuscript Library, Butler Library,Columbia University. New York, NY; and “Vulvo-vaginitis Clinic in the Bellevue-Yorkville Health Center,” Journal of Social Hygiene 13 (November 1927) 498–99,esp. 499.

98Brunet, “Report,” 6.

99Reuel A. Benson and Arthur Steer, “Vaginitis in Children: A Review ofthe Literature,” American Journal of Diseases of Children 53 (March 1937): 806–24,esp. 811; see also J.L. Reichert, I.M. Epstein, Ruth Jung, and Charlotte A. Colwell,“Infection of the Lower Part of the Genital Tract in Girls,” American Journal ofDiseases of Children 54 (September 1937): 459–95.

100Benson and Steer, “Vaginitis in Children,” 810, 822.

101Nelson and Crain, Public Health , 144.

102Alfred Cohn, Arthur Steer, and Eleanor L. Adler, “Further Observationson Gonococcal Vulvovaginitis,” Transactions of the American Neisserian Medical So-ciety, 6th annual session (New York, 10–11 June 1940), 24–41; and “Gonococcal


Vaginitis: A Preliminary Report on One Year’s Work,” Venereal Disease Information21 (July 1940): 208–20, esp. 211, 219.

103Cohn, “Further Observations,” 25.

104L. Emmett Holt, Jr. and Rustin McIntosh, eds., Holt’s Diseases of Infancyand Childhood: A Textbook for the Use of Students and Practitioners, 11 th ed. (NewYork: D. Appleton-Century Company, 1940), 821; see also Lawrence R. Wharton,Gynecology: With a Section on Female Urology (Philadelphia: W.B. Saunders Co.,1943), 368.

105Holt and McIntosh, eds., Holt’s Diseases of Infancy and Childhood, 821.

106See John Parascandola, “The Introduction of Antibiotics into Therapeu-tics,” in Sickness and Health in America: Readings in the History of Medicine and PublicHealth, ed. Judith Walzer Leavitt and Ronald L. Numbers, 3rd ed., rev. (Madison:University of Wisconsin Press, 1997), 102–12.

107Excitement over antibiotics and an overall decline in STD infection inthe United States from 1946 to 1958, convinced many physicians that STDs hadbecome an insignificant medical and public health problem. Tomes, Gospel of Germs,253–54; and Duffy, Public Health , 586–87.

108Sandra Harding, “Comment on Walby’s ‘Against EpistemologicalChasms: The Science Question in Feminism Revisited’: Can Democratic Valuesand Interests Every Play a Rationally Justifiable Role in the Evaluation of ScientificWork?” Signs 26 (winter 2001): 511–25, esp. 519–21; see also Sandra Harding, WhoseScience? Whose Knowledge?: Thinking From Women’s Lives (Ithaca: Cornell Univer-sity Press, 1991), 144–49; and Patricia Hill Collins, Black Feminist Thought: Knowl-edge, Consciousness, and the Politics of Empowerment (New York: Routledge, 1991),233–37.

109Harding, “Comment on Walby’s ‘Against Epistemological Chasms’” 516.

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