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Medical Discourse and the Denial of Incest in the

United States, 18901940
Lynn Sacco
This article examines medical discourses from 1890 to 1940, when physicians and reformers uncovered, and then dissembled, evidence that
white, middle- and upper-class American men were sexually abusing
their daughters. Doctors had long recognized that children could acquire
gonorrhea, but they believed that infections were confined primarily to
poor and working-class girls who had been sexually assaulted. In the
1890s, doctors began to incorporate new technologies into the diagnostic process and they were shocked to discover that gonorrhea infection
was so common among girls that they feared it was epidemic. Doctors
claimed that concurrent infections in fathers and daughters from respectable white families were particularly vexing. Although they could
neither explain nor prove how else these girls became infected, doctors
refused to consider the possibility of incest. Persistently ignoring the
obvious, health care workers and reformers revised their views about
the susceptibility of girls to infection, not incest. By 1940, medical textbooks relied on untested speculation to declare that most girls acquired
gonorrhea from nonsexual contacts with other females or contaminated
objects: their mothers, other girls, or toilet seats. Scientific advances,
ironically, obscured rather than illuminated the source of girls infection.

n 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 dispensarys female patients infected with a venereal disease, a term
for sexually transmitted diseases that included gonorrhea and syphilis.1
The task of identifying the source of gonorrhea infections in girls, who
comprised 10 percent of the gynecology clinics patients, quickly frustrated
Lovell. Although she believed that adults acquired gonorrhea only from
sexual contacts, Lovell considered girls susceptible to infection from innumerable mundane interactions: Was it an accidental infection from a
dirty toilet seat, or an infection, as accidentally incurred in the daily exigencies of life in a crowded household where the mother or father or perhaps an older sister had the disease? Or was it one of the rare cases of
rape . . . ? 2
Lovells bewilderment was not unusual, but part of a dramatic shift
in medical views about the etiology of gonorrhea infections in girls that
occurred in the first half of the twentieth century. Nineteenth-century doc 2002 I NDIANA UNIVERSITY PRESS , VOL. 14 N O. 3 (A UTUMN )




tors had expressed few doubts that gonorrhea was a sexually transmitted
disease in children. Most of the children they diagnosed with the disease
were poor and working-class girls who claimed to have been sexually assaulted, sometimes by their fathers. Gonorrhea was important evidence
that corroborated both a girls accusation and the identity of her assailant,
whom doctors also examined for infection.3 But in the 1890s, when new
technologies significantly improved doctors ability to detect the disease,
they were startled to discover that it was not limited to this relatively small
pool of girls. Rather, so many girls from all classesmost of whom were
between the ages of five and nine and who did not claim to have been
assaultedtested positive for gonorrhea that doctors feared it was epidemic.
Doctors realized that incest was the most likely source of infection,
and tracing the source of infection by the traditional method of considering sexual contacts might have revealed the occurrence of incest throughout American society. But this is not what occurred. Using medical
discourses from this period, this article argues that doctors, nurses, social
workers, public health officials, and reformers mislabeled or even ignored
the evidence of incest that they themselves had discovered. Physicians
who believed that only foreign, primitive, or ignorant men abused
their daughters assumed that incest was contained within African American, immigrant, poor, and working-class families. When the incidence of
gonorrhea among the daughters of white middle- and upper-class men
suggested otherwise, health care professionals revised their views on gonorrhea, not incest.
Nearly everyone who wrote about gonorrhea infections in girls between 1890 and 1940 rejected out of hand the possibility of incest, even
though they could not agreeor provehow else girls acquired the disease. One result was that incest was not documented except as a rare occurrence, confined to socially marginalized groups. 4 Incest would not be
discovered until the 1970s and 1980s, when mental health professionals
who had been influenced by second-wave feminism suggested a different
In her groundbreaking 1981 book Father-Daughter Incest, feminist psychiatrist Judith Lewis Herman reconceptualized incest from a personal
pathology to a mainstream gender issue: Female children are regularly
subjected to sexual assaults by adult males who are part of their intimate
social world. . . . Any serious investigation of the emotional and sexual
lives of women leads eventually to the discovery of the incest secret. 5
Herman was one of a growing number of mental health professionals who
challenged the psychoanalytic orthodoxy that had narrowly construed
Sigmund Freuds theories and dismissed incest narratives as statements




of fantasy rather than fact.6 However, Hermans assertion could only be

accurate if incest permeated American society as a static facet of gender
relations. Indeed, when, in the late 1980s and early 1990s, American women
from all socioeconomic groups disclosed histories of father-daughter incest, their accusations raised questions about the racial and economic
alterity of male sexuality that spun into a fiery debate over the incidence
of incest in the United States. These debates became polarized within psychoanalytic discourses and the questions they raised remain unanswered.7
In their books on domestic violence published in the late 1980s, historians Linda Gordon and Elizabeth Pleck identified incest as a gender
issue and provided historical evidence of its occurrence over long chronological periods. 8 But unlike other personal problems that second- wave
feminists identified as gender issues, the topic of incest has received little
attention from historians.9 This disinterest is surprising in light of the contentiousness of the recent debates, including among feminists.10 Moreover,
some critics attempted to discredit incest accusations by arguing that they
were inspired by feminism but unsupported by science, as though the
two are mutually exclusive. They argued that science was an objective
and therefore superior system of knowledge. 11 Tracing shifts in the etiology of gonorrhea in girls suggests otherwise.

Definitions and Incidence

This article will be limited to father-daughter incest, defined here as
any type of sexual contact between an adult male and his female child or
stepchild. Although recent studies have estimated that as many as 54 percent of American women were sexually assaulted as children, little data
exists 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 largest
category of victims and that most had been assaulted in their own homes
by an adult male who was a family member or acquaintance.13 No studies
have shown that the incidence of incest differs by race or class, and data
on ethnicity is inconclusive.14
Incest is sometimes reported by doctors who have diagnosed a gonorrhea infection in a child. The Centers for Disease Control and Prevention define gonorrhea as a sexually transmitted disease (STD), and the
second most frequently reported communicable disease in the United
States. 15 When parents and siblings of a girl infected with vaginal gonorrhea agree to be tested, the results are positive in half of the cases.16 However, like human immunodeficiency virus (HIV), Neisseria gonorrhoeae (N.
gonorrhoeae), the bacteria that cause gonorrhea, dry too quickly for it to




spread by casual or nonsexual contact.17 A newborn may acquire gonorrhea from its mother but these infections affect the babys eyes or joints,
and not its genitals. 18 It was not until 1998 that the American Academy of
Pediatrics emphasized that gonorrhea in a child is diagnostic of abuse
with very rare exception, and it warned physicians that a conclusion
that the transmission was . . . nonsexual in nature is unacceptable. 19
Contemporary physicians report more than 50,000 infections in children each year, and experts agree that, Among all STDs diagnosed in
children evaluated for suspected abuse, gonorrhea is the single most common diagnosis.20 Child sexual abuse usually consists of rubbing, fondling,
and oral contact, activities that may not leave any lasting genital marks or
injuries. Because N. gonorrhoeae cause a local infection at the point where
they enter . . . the body, gonorrhea may also be the only physical evidence
of abuse. 21 Boys and girls suffer from infections in the rectum or throat,
but the vast majority of children diagnosed with an STD are prepubescent
girls with vaginal gonorrhea, also called vulvovaginitis or gonococcal
vaginitis. 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 gonorrhea
rested entirely on the physicians clinical observations and his willingness to render an opinion that he could not verify and which entailed
legal consequences. There was no laboratory test to assist doctors in determining whether a vaginal discharge was a symptom of gonorrhea or
another type of disease, such as pinworms or leucorrhea, a catch-all
phrase for vaginal infections. Recognizing that their diagnostic abilities
were crude and imprecise, doctors weighed the heavy penalties for child
rapewhich included lengthy imprisonment and even executionagainst
their assumption that most accusations were false. 23
Late nineteenth-century scientific and technological advances dramatically improved doctors ability to diagnose gonorrhea in girls, but not their
willingness to do so. After German dermatologist Albert Neisser identified
N. gonorrhoeae in 1879, doctors could confirm a diagnosis by examining a
culture or smear from a vaginal discharge under a microscope. 24 If the
slide revealed N. gonorrhoeae, the patient had gonorrhea. Doctors initially
viewed bacteriological testing as a godsend that provided them with diagnostic certainty.25 However, as they incorporated testing into the diagnostic process, doctors also examined vaginal discharges from girls who
did not claim to have been assaulted. These patients included girls from
respectable white families, and doctors were shocked to realize that they
were infected with gonorrhea.26 At the 1901 meeting of the American Medi-




cal Association (AMA), Chicago physician J.C. Cook articulated the conundrum these cases presented to doctors. He declared that when it came
to families of educated and refined people, It is trying to our credulity
to find a 4-year-old daughter and a 25-year old father having gonorrhea at
the same time with no other source of infection to the daughter other than
the father.27
Early-twentieth-century physicians were aware that incest occurred
but they expected it only in homes they associated with primitivism and
degeneracy.28 In 1886, Brooklyn physician Jerome Walker, who examined
abused children for the Society for the Prevention of Cruelty to Children,
admonished his colleagues that he had learned from experience that certain motives, conditions, and statements about child sexual abuse are at
variance with ones ordinary conception of such things.29 Among the factors that surprised Walker was that, Apparently respectable men, as well
as ordinary disreputable characters outrage children; that even fathers,
step-fathers, and brothers will do it.30 But doctors ignored Walkers warnings and during a period of intense nativism focused exclusively on cases
that occurred among the poor and working classes, especially immigrants
and people of color. 31
For instance, in 1908, Dr. W. Travis Gibb, medical examiner for the New
York Society for the Prevention of Cruelty to Children (NYSPCC), attributed incest to immigrants whom he claimed did not value children as
highly 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 man
afflicted with an obstinate venereal disease have intercourse with a virgin,
the latter will develop the disease and he will be cured. 32 Nineteenthcentury European physicians claimed to have encountered this superstitious cure in Germany, Ireland, and Italy, and Richard von Krafft-Ebing
mentioned it in Psychopathia Sexualis, his influential compendia of psychosexual perversions.33 In 1909, Dr. Flora Pollack, attending physician at
the Johns Hopkins Gynecological Dispensary, cited Krafft-Ebing and reported that, This superstition is so deeply rooted in the belief of men that
were you to ask ten police officers, cab drivers, hucksters, etc. of the truth
of it I think eight would affirm it as a fact, and all would know of its
existence. 34 Although Pollack left open the possibility that people from
all classes believed in the superstition, most doctors did not, and references to the superstition and foreign beliefs and practices persisted in
the medical literature as an explanation for child sexual assault and incest
through the 1930s. 35
Doctors who viewed incest as a racially or culturally based behavior




considered it a measure of difference and a definable border between the

civilized and the savage, the native-born, white American and the immigrant. Their unwillingness to acknowledge incest among the white
middle and upper classes was so strong that they refused to consider the
possibility even when an infected father admitted that he and his daughter slept in the same bed. For instance, in 1900, Dr. Herman B. Sheffield,
who treated infected girls at New York Citys Metropolitan Hospital and
Dispensary for Women and Children, and whose patients rarely exhibited obvious genital injuries, eagerly dismissed indecent violence as
very rare indeed. 36 He proposed that girls became infected accidentally from contacts with objects that mediated the transmission of bacteria from parent to child. Little girls sleeping with their parents or elder
brothers suffering from gonorrhea may contract the disease through coming in contact with the soiled bedclothes, cotton-pads, or rags which are
being used for cleansing purposes.37
Sheffield drew from his experience in institutional settings. Nineteenthcentury doctors had occasionally detected vaginal discharges among girls
in orphanages and hospitals, which they had identified as leucorrhea and
attributed to poor hygiene. 38 When early-twentieth-century doctors began to examine these discharges bacteriologically, they discovered that
entire wards of girls were infected with gonorrhea, not leucorrhea. 39 But
doctors continued to attribute the infections to uncleanliness. In an era
when hospitals had little money to spend on supplies, nurses commonly
used the same instruments, such as thermometers and wash rags, for each
child, and any number of infections spread in this manner. To curtail ward
epidemics, hospitals instituted new procedures, such as requiring that
each girl receive her own supplies, including bedpans and catheters. When
these measures failed, hospitals began to test every girl who sought admission, and by 1905, most refused to admit any girl found to be infected
except for life-threatening emergencies.40
However, as the number of infections acquired outside of institutional
settings continued to rise, doctors became alarmed at both the extent and
consequences of the disease. By 1903, Dr. Reuel B. Kimball, attending physician at the New York City Babies Hospital, called gonorrhea one of the
most dangerous microorganisms, and doctors at the Johns Hopkins Hospital warned that its complications included death.41 Yet even as they grew
to appreciate the seriousness of the disease, for which no effective cure
had yet been discovered, doctors avoided discussing incest. In December
1905, New York physician W.D. Trenwith reported to the Section in Pediatrics of the New York Academy of Medicine that he did not believe that
any of the girls he treated, most of whom were between the ages of four
and six, had been assaulted, even though their fathers were also infected.42




Trenwith claimed that after making inquiries of the most searching character, that indirect infection by the fathershared bed linen and wash
ragswas responsible for 75 percent of the cases. He blamed other girls
their playmates and siblingsfor the rest.43

Social Hygiene and Innocent Infection

As doctors muddied the etiology of gonorrhea in girls, social hygiene, a public health campaign developed to provide reliable medical
information about sexually transmitted diseases became so successful that
by the late 1930s, the U.S. Surgeon General had incorporated its tenets
into national policy. 44 Social hygiene was an ambitious social reform and
medical program that early-twentieth-century physicians, health officials,
and reformers believed would eradicate venereal disease from American
society. A shared belief that venereal disease posed a serious threat to
American society drew together a diverse coalition of prominent reformers and philanthropists, including John D. Rockefeller, Jr. and Jane Addams.
They wanted to raise awareness that gonorrhea was a sexually transmitted disease and to encourage people to be tested and treated. To do so,
social hygienists reframed venereal disease from a moral problem to a
social and medical issue.45
Social hygienists challenged the assumption that adults acquired venereal disease only from immoral or extramarital sexual relations. The
views of New York City physician Prince A. Morrow, a European-trained
expert on venereal disease, deeply influenced the shape of twentiethcentury social hygiene.46 In 1904, Morrow estimated that 75 percent of
American men had been infected with gonorrhea, and he blamed them
not prostitutesfor the spread of infection. 47 Morrow claimed that most
of his female patients were respectable white women who were married
to men who have presented a fair exterior of regular and correct living
often the men of good business and social position, and he blamed these
men for bringing the disease into their homes.48
Yet even though he complained that family epidemics were frequent, Morrow did not believe that fathers infected their daughters in the
same way that they infected their wives. Beginning in 1885, he declared
that, The existence of a purulent discharge from the vulva of children
has often led to the unjust accusation and punishment of innocent persons for attempted violation. 49 After the turn of the twentieth century,
bacteriological analysis minimized the chance that a man would be wrongly 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




facility with which children are disposed to accuse and lie.50 He claimed
instead that, We now recognize that gonorrhoea in children is vastly more
often due to accidental mediate transmission than to attempted intercourse. 51 However, the medical literature contained mostly anecdotal
speculation and no research studies, and it did not support his unequivocal declaration. As Dr. J. Clifton Edgar, an NYSPCC medical examiner and
the author of a chapter on child sexual assaults complained at an AMA
session on vulvovaginitis that same year, nothing of value had ever been
published on the subject.52
An emphasis on innocent infection was a defining facet of twentiethcentury social hygiene and an effective rhetorical maneuver that reduced
the social stigma of venereal disease. As a result, significantly more men,
women, and children were tested and treated. But no one expected so
many of these patients to be girls. Dr. L. Emmett Holt, professor of diseases of children at Columbia University Medical School, author of an
authoritative textbook on childhood diseases, and attending physician at
the Babies Hospital, warned that physicians were not only detecting gonorrhea more frequently, but that its actual incidence among girls from all
classes was increasing. He claimed that at least five or six of the 125 girls
the hospital screened each month were infected, and that on a single summer day in 1904, five girls applying to the hospital for admission had tested
positive for the disease.53 That same year, a Chicago pathologist declared
gonorrhea among girls epidemic.54 During the winter of 19111912, the
childrens ward at the Cook County Hospitalwhich Jane Addams called
the most piteous . . . of all childrens wardsplaced girls three to a bed
and turned away many more. 55 In just one month, September 1926, the
Vanderbilt Clinic on Manhattans Upper West Side, the citys major provider of outpatient treatment for infected girls, saw 213 new cases. 56 In
1927, the American Journal of Diseases of Children ranked gonorrhea as the
second most common childrens contagious diseasesecond to measles
and outnumbering smallpox and scarlet fever.57 By the early 1930s, the
Massachusetts Department of Health announced that girls accounted for
10 percent of reported female gonorrhea infections, a figure that Washington D.C. matched for 1929. 58 Yet, doctors and reformers did so little to
investigate the cause of such widespread infection that in 1927, the New
York City Department of Health called vulvovaginitis the most neglected
and poorly managed condition seen in medical practice.59
Doctors, public health officials, and reformers recognized that gonorrhea in girls was a costly problem, but their refusal to acknowledge incest sabotaged their efforts to effectively address prevention. Even
Progressive-era women reformers, who were eager to demonstrate the evils
of male sexual license and to protect girls from male predators, passed on




the opportunity to use the incidence of gonorrhea infection to expose male

sexual misbehavior. 60 Because they were committed to promoting the
nuclear family as a corrective to social chaos, concerns about the viability
of the family may have discouraged them from identifying its more sinister features. 61
Instead, many doctors believed that gonorrhea was endemic among
African Americans, immigrants, and the working classes, and they simply added gonorrhea to the list of diseases they blamed domestic servants
for carrying into fashionable schools and the homes of luxury.62 When
the presence of a diseased servant could still not account for all of the
cases, experienced practitioners simply lamented that, one is occasionally utterly unable to trace the source of infection in a child surrounded by
every protection and comfort money can procure.63
Sanitation activists filled in the gap. The early twentieth century was
an era of heightened medical and public attention to cleanliness, including bathrooms and toilets, thought to be the source of a variety of diseases.64 Reformers who regarded improved sanitation as a remedy for many
social problems readily included epidemics of gonorrhea in girls among
the problems they could solve. Although sanitary reforms included coercive measures aimed at Americanizing poor and immigrant families,
cleaning up cities and educating the public about germs had markedly
reduced disease and mortality.65 Yet as applied to gonorrhea in girls, the
focus on sanitation was tragically misguided.

Mothers Hands and Dangerous Things: Sanitation Reform

Sanitation reformers and public health activists, who wanted to improve social conditions by keeping America clean, had long held mothers
responsible for keeping their families free of all kinds of disease. 66 In her
histories of sanitary reforms, Nancy Tomes has shown how late nineteenthcentury reformers designated mothers responsible for protecting their
familys health by keeping their homes clean.67 Whereas an 1887 sanitary
tract 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 the
water-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 pioneer Dr. Alice Hamilton published an influential article on gonorrhea in
girls that conceptualized it as a sanitary problem, she contextualized it
within a well-known reform movement with a record of accomplishment
(and in which she had established her reputation).69 Hamilton scoffed at
the popular view that girls acquired gonorrhea only from sexual con-




tact, joining those who charged that such old-fashioned thinking had contributed to retard the clearing-up of this subject. 70 She argued that it was
wrong to assume that girls infections were necessarily venerealsexually transmittedand claimed that the disease spread because of the close
contact in modern city life.71 In a second paper read at the 1910 National Conference on Charities and Corrections, Hamilton set out the modern view that, The child victims of gonorrhea usually have been infected
by their mothers. She argued that dangerous things transmit infection
when soiled with gonorrhea discharge, namely nurses or mothers fingers,
towels, wash-cloths, sponges, bath-tubs and the seats of closets, by which
she meant toilet seats. 72 Such contacts were so numerous that she concluded, other members of the family are responsible for a small number
of cases, and sexual violence for only an insignificant minority.73
Doctors knew that nonsexual transmission of N. gonorrhoeae was improbable because the bacteria die quickly in the open air. However, they
guessed that the genital lining of prepubertal girls was so thin that the
bacteria could penetrate it on casual contact. 74 Therefore, doctors, social
hygienists, and sanitary reformers began to demand sanitary improvements that would reduce opportunities for exposure to virulent bacteria.
In the 1910s, Dr. Clara Seippel was Chicagos Assistant City Physician, attending physician at the Cook County Hospital childrens venereal disease ward,
and President of the Frances Juvenile Home Association, which operated
a residential facility for infected girls where Seippel was also attending
physician. As city physician, she had examined scores of girls for evidence
of assault, and the numbers of men who assaulted children, including their
own, troubled her. Still, she told a meeting of the Chicago Medical and
Social Hygiene societies that they had a civic duty to protect hundreds of
children 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 surroundings predispose to its transference, thereby shifting responsibility
for infection from fathers to mothers, and further widening the rift between sexual contact and infection. 76 When a girl became ill with the disease, health care providers and social workers excoriated her mother for
poor housekeeping and did not waste time investigating the possibility of
incest.77 In the burgeoning literature on the topic, only Dr. Flora Pollack
dismissed sanitation theories as a very useful shield for a guilty individual that make it extremely difficult to protect children. 78 In 1909,
Pollack estimated that at least 1000 girls were infected in Baltimore each
year, and she visited police stations and met with community groups to
try to improve criminal prosecutions of men who assaulted girls. However, even Pollack conceded that it was difficult to believe that the inhab-




itants of Baltimore included enough perverts to have caused so many

infections. 79
Doctors who treated infected girls insisted that few, if any, of their
patients had been assaulted, even though they could not identify any other
cause of infection. In 1913, Dr. Edith Rogers Spaulding, attending physician on the vulvovaginitis ward at the Childrens Hospital in Boston, admitted that she had been unable to determine the source of infection in
thirty of her fifty-six cases. 80 Not discovered was the largest category
under sources of infection; twenty-six cases were classed as history of
discharge in one of parents, by which she meant accidental infection
from poor sanitation; sixteen patients had a history of a recent hospital
stay; and three were ascribed to history of contact, meaning sex play
with other children.81 Yet Spaulding refused to conclude that any of her
patients (most of whom were under five years of age) had been raped. To
prevent the spread of infection, Spaulding demanded that school nurses
ensure that infected girls did not use the school toilet.
Since the mid-nineteenth century, doctors had occasionally speculated
that chamber pots or toilet seats could be a source of girls infections. 82
Now the sanitation and social hygiene movements seized upon the toilet
as key. They claimed that toilets located in public places such as schools
(where no family member could be implicated) were particularly dangerous. In 1912, Seippel warned that, A drop of gonorrheal pus on the toilet
seat in a public school can start [an] epidemic, even though no school
epidemic had been documented in the American medical literature, nor
had any case of individual infection been traced to a school toilet.83 Nonetheless, the need to improve the rundown and dirty conditions of schools,
particularly the lavatories, was an issue with which doctors and reformers were already familiar and engaged.84
From the 1910s to the 1940s, doctors endorsed the toilet seat as the
primary source of girls infections, a theory that again displaced the source
of danger to girls, this time to other girls. For instance, in 1914, Dr. Frederick
J. Taussig, a nationally known gynecologist and member of the Executive
Committee of the St. Louis Society for Social Hygiene, argued that The
most frequent source of infection is from child to child, and the most common manner of its transmission is through the school lavatory.85 Taussig
supported his supposition with imagination rather than research data: Lavatories . . . are as a rule so high that the smaller children in using them are
forced to have their genitals and clothing rub over a considerable portion
of the seat. The greater the number of persons using the same lavatory, the
less interval of time is apt to elapse between its use, and hence the greater
likelihood of carrying infection. The lavatories in tenements, playgrounds,
and public schools are consequently a source of considerable danger.86




Taussig brushed aside the possibility that any of his patients had been
raped because only a few were from the ignorant, foreign-born population where he assumed incest occurred. Nor could he imagine that the
infection arose in the home environment, as his patients came from both
squalid homes and the fashionable parts of town.87 To prevent the spread
of infection, Taussig recommended lowering toilets, U-shaped toilet seats,
paper seat covers, and lavatory attendants who could detect discharges
and ensure that girls used the seat covers.88
However, early-twentieth-century school boards lacked the funds to
keep lavatories clean, let alone remodel them. But in response to warnings that infected girls posed a real menace to other children, school
boards and municipalities around the countryfrom New York City in
1916 to Los Angeles in 1937enacted policies suspending them from
school, even though the federal Childrens Bureau found such measures
to be ineffectual. 89 Dr. Nels A. Nelson, the Assistant Director of the Division of Communicable Diseases of the Massachusetts Department of Public Health, even included the topic in his Christmas Eve 1930 radio
address. 90 Nelson was against excluding girls and he assured parents that
there was no proof that any girl had been infected at school. The issue was
still unsettled in 1935, when Nelson had became the top public health
official in Massachusetts in the area of venereal disease. Although he decried the misunderstanding and resultant confusion, almost to the point
of hysteria, over gonorrhea and syphilis in the public schools, to allay
parents fears, he recommended that girls be suspended until the discharge
cleared up, about six to eight weeks.91

It Is Less Embarrassing To Accuse A Toilet Seat

Parents may have become hysterical because the vague information
provided by public health departments and social hygiene organizations
confused them. For instance, a New York City Health Department pamphlet printed on pink paper and circulated in English and Italian in the
1930s entitled, Important Information: Special Instructions for Vaginitis
Cases, warned mothers only that, Your child is suffering from a contagious (catching) disease. You must be careful to prevent its spread to others. . . . Care in this cause means CLEANLINESS.92 In a public education
pamphlet that Nelson wrote for the Massachusetts Society for Social Hygiene in 1936, he conceded that nobody knows how children become
infected from nonsexual contacts. 93 Nor could he describe the process in a
1938 public health textbook: How the gonococcus finds its way to the
childs 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 1920s
and 1930s had neither the time nor the resources to investigate the sources
of patients infections.95 Moreover, health care workers whose primary
interest was to increase the number of people receiving treatment avoided
questions that might have discouraged parents from permitting their
daughters to be treated. 96 However, doctors circumvented the issue in research studies as well. When a prestigious three-year clinical study at a
specially constructed vaginitis clinic at New York Citys BellevueYorkville Health Demonstration set out to identify the definitive source of
girls infections, investigators pressured mothers to be tested but omitted
fathers from their protocols. In 1933, the projects investigators admitted
in their lengthy final report that they could not determine whether either
uncleanliness or rape had been the source of infection in any of the 322
cases studied. 97 They concluded that, the exact manner of transference of
the infectious material from the ill to the well is unknown.98
Even so, practitioners continued to insist that nonsexual contacts
caused infection, even though doing so had not improved their ability to
trace contacts. By 1937, doctors Reuel A. Benson and Arthur Steer, attending physicians at the busy vaginitis ward at New York Citys Metropolitan Hospital, still could not identify the source of infection for one-half of
their 195 patients. 99 Yet, they dismissed rape as an infrequent cause of
infection, even as they admitted that patient histories provided by a girls
parents could not be verified when things such as toilets seats, linen and
bathing water were accused. 100 As Nelson commented in 1938, It is less
embarrassing to accuse a toilet seat than to seek for sexual sources or to
request the examination of other members of the family.101
However much doctors relied upon the notion of nonsexual infection, no research study before 1940 attempted to test the possibility. The
first do so was the New York Vaginitis Research Project of the Gonococcus
Research Committee, which was organized by the New York City Department of Health, and funded by the U.S. Public Health Service and private
foundations. By measuring factors such as the length of time N. gonorrhoeae
remain virulent on a toilet seat, it was able to discredit the notion of casual
infection. 102 However, the committee did not explain how else girls acquired the disease from an infected parent. Although the study attributed
infections transmitted between children to sex play, it only said of parent-child transmission that, The relationship between the child and the
infected adult has to be quite intimate.103
That same year the eleventh edition of Holts Diseases of Infancy and
Childhood, the most prestigious pediatrics textbook of the twentieth century, repeated Alice Hamiltons speculation as fact: Gonococcus vaginitis in children is not to be regarded as a venereal disease. An insignificantly




small proportion of the cases are acquired by sex contact. 104 Holts instructed physicians that, In schools and other public places [vulvovaginitis] may be spread by toilet seats . . . The young child may have slept in the
same bed with an infected mother or sister; the infection may have occurred through baths, towels, clothing, toilets, etc.105 To prevent the spread
of infection, Holts suggested that doctors quarantine infected girls by isolating them within their homes where they would not be a menace to
others. Fortunately for girls, shortly thereafter, penicillin became available as an instant cure for gonorrhea. 106 Now that they no longer posed
a risk of spreading a lingering infection to others, medical interest in girls
infections evaporated and researchers and clinicians moved on to more
pressing subjects. 107

Despite profound changes at the end of the twentieth century in talking about sex in general and about incest in particular, the incidence with
which incest occurs remains in doubt. Contemporary womens incest narratives arose amid events that were as disturbing as they were puzzling:
the mass criminal prosecutions of daycare workers for sexual abuse; the
imprisonment of fathers for incest and other crimes based on their daughters childhood memories; and the commercialization of a grassroots recovery movement that turned self-help into big business. The media and
partisans in the debates often conflated these events and flattened the complicated issues they raised about memory, subjectivity, and power to an
artificial contest between irrational feminism and reliable science. This
paper demonstrates that evidence of the widespread occurrence of incest
exists, but that professionals have used authoritative discourses to conceal it.
The discovery of seemingly rampant sexually transmitted disease
among girls in the early twentieth century raised a compelling threat to
the status quo, which health care professionals and reformers diffused by
using their scientific authority to manipulate the evidence. Late nineteenthcentury scientific advances substantially improved doctors ability to diagnose gonorrhea by detecting the presence of N. gonorrhoeae , a specific
infectious agent. But the more attention professionalsfrom a strikingly
diverse range of doctors, nurses, social workers, social hygienists, and reformerspaid to the disease, the more they obscured the source of infection. Scientific advances paradoxically fomented confusion rather than
clarity. When the medical evidence before them conflicted with key ideologies about masculinity, class status, and citizenship, health care professionals and reformers did not hesitate to substitute speculation for




empirical data. They reframed infection from a medico-legal issue to a

facet of sanitation reform, thereby placing the blame for infection first on
bed linens, then on mothers, other girls, and, in desperation, even on toilet seats. This discursive move exonerated fathers from responsibility by
rendering the issue of whether or not they had raped or sexually assaulted
their daughters irrelevant.
The ways in which professionals revised the etiology of gonorrhea in
girls supports the feminist argument that the production of knowledge is
never value neutral, but always arises from historically specific social relations. 108 Scientific advancesidealized as positivistic, objective, and
reliable sources of knowledgeresulted in the discovery of widespread
evidence of incest in the early twentieth century. But as Sandra Harding
notes in her critique of scientific methods, [A]ny body of systematic
knowledge is always internally linked to a distinctive body of systematic
ignorance. 109 Had the sexual misbehavior of fathers not been obvious all
along, no concerted effort to disguise it would have been necessary. It was
only after second-wave feminismderided as a subjective, politicized,
and ideological approach to knowledgeoffered a new critical perspective from which to evaluate family relations and allegations of sexual assault that fathers sexual abuse of their daughters was finally recognized
as incest.
The author thanks Lois W. Banner, Steven J. Ross, Carole Shammas, Beverly J.
Schwartzberg, David Bello, Jeanette Barbieri, Ivan Noah Uldall, Leila J. Rupp and
the anonymous readers for the Journal of Womens History, Patricia Cline Cohen,
the UC-Santa Barbara Womens Studies Program, and the UC Presidents Postdoctoral Fellowship Program.
Bertha C. Lovell, Some Problems in Social Hygiene in a Clinic for Womens
Diseases, Journal of Social Hygiene 2, no. 4 (1916): 50116, quotation on 501.

Ibid., 505.

Jerome Walker, Reports, with Comments, of Twenty-One Cases of Indecent Assault and Rape Upon Children, Parts 1 and 2, Archives of Pediatrics 3 (May
1886): 269; (June 1886): 32141; Alfred S. Taylor, Medical Jurisprudence, ed. R.
Egglesfield Griffith (Philadelphia: Lean & Blanchard, 1845), 45860; 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 in
London, 1st American ed. (Philadelphia: Cary and Lea, 1832), 163; Thomas Percival,
Medical Ethics: Or, A Code of Institutes and Precepts Adapted to the Professional Conduct of Physicians and Surgeons (Manchester: Printed by S. Russell, 1803), 10203,




In his influential study begun in the 1940s, sociologist S. Kirson Weinberg
argued that less than one in a million men commit incest. S. Kirson Weinberg,
Incest Behavior (New York: Citadel Press, 1955), 39.
Judith Lewis Herman with Lisa Hirschman, Father-Daughter Incest (Cambridge, Mass.: Harvard University Press, 1981), 7.

See, for example, Jeffrey Moussaief Masson, The Assault on Truth: Freuds
Suppression of the Seduction Theory (New York: Farrar, Straus, and Giroux, 1984);
Herman and Hirschmann, Father-Daughter Incest, 911; Florence Rush, The Best
Kept Secret: Sexual Abuse of Children (Englewood Cliffs, N.J.: Prentice-Hall, 1980);
and Elizabeth Hanfin Pleck, Domestic Tyranny: The Making of Social Policy Against
Family Violence from Colonial Times to the Present (New York: Oxford University
Press, 1987), 15057.

See Diana E.H. Russell, introduction to The Secret Trauma: Incest in the Lives
of Girls and Women, rev. ed. (New York: Basic Books, 1999); Elizabeth Wilson, Not
In This House: Incest, Denial, and Doubt in the White Middle-Class Family, Yale
Journal of Criticism 8, vol. 1 (spring 1995): 3558; Frederick C. Crews, The Memory
Wars: Freuds Legacy in Dispute (New York: New York Review of Books, 1995); and
Richard Ofshe and Ethan Watters, Making Monsters: False Memory, Psychotherapy,
and Sexual Hysteria (New York: Scribner, 1994).
Linda Gordon, Heroes of Their Own Lives: The Politics and History of Family
Violence, Boston 18801960 (New York: Penguin Press, 1988); and Pleck, Domestic

See Lisa Duggan, From Instincts to Politics: Writing the History of Sexuality in the U.S., Journal of Sex Research 27 (February 1990): 95110, esp. 10809. In
addition to essays by Gordon and Pleck, historical studies of incest include Irene
Quenzler Brown and Richard D. Brown, Tales From the Vault, Common-Place 1
(September 2000). Available Online: <http://www.> 3 September 2000; and Peter Bardaglio, An Outrage upon Nature: Incest and the
Law in the Nineteenth Century South, in In Joy and In Sorrow: Women, Family, and
Marriage in the Victorian South, 18301900, ed. Carol Bleser (New York: Oxford
University Press, 1991), 3251, esp. 44. Historians documenting incest in the context of other topics include Cornelia Hughes Dayton, Women Before the Bar: Gender, Law, and Society in Connecticut, 16391789 (Chapel Hill: University of North
Carolina Press, 1995); Mary E. Odem, Delinquent Daughters: Protecting and Policing
Adolescent Female Sexuality in the United States, 18851920 (Chapel Hill: University
of North Carolina Press, 1995); and Kathleen Ruth Parker, Law, Culture, and
Sexual Censure: Sex Crime Prosecution in a Midwest County Circuit Court, 1850
1950 (Ph.D. diss., Michigan State University, 1993).

See Janice Haaken, Pillar of Salt: Gender, Memory, and the Perils of Looking
Back (New Brunswick, N.J.: Rutgers University Press, 1998); Carol Tavris, Beware 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 February
1994, 3; and Linda Alcoff and Laura Gray, Survivor Discourse: Transgression or
Recuperation? Signs 18 (winter 1993): 26080.

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





1 and 2, New York Review of Books, 1 December 1994, 4958; and Elizabeth Loftus
and Katherine Ketcham, The Myth of Repressed Memory: False Memories and Allegations of Sexual Abuse (New York: St. Martins Press, 1994).
U.S. Dept. of Health and Human Services, National Center on Child Abuse
and Neglect, Child Maltreatment 1995: Reports From the States to the National Child
Abuse and Neglect Data System (Washington, DC: U.S. Government Printing Office,
1997); and David Finkelhor, How Widespread Is Child Sexual Abuse? Children
Today 13 (July-August 1984): 1821.
U.S. Dept. of Justice, Bureau of Justice Statistics, Sexual Assault of Young
Children as Reported to Law Enforcement: Victim, Incident, and Offender Characteristics (July 2000), 1. Available Online: <
sayclre.htm> 26 September 2000.
Pat Gilmartin, Rape, Incest, and Child Sexual Abuse: Consequences and Recovery (New York: Garland Publishing, Inc., 1994), 47; David Finkelhor and Larry
Barron, High-Risk Children, in A Sourcebook on Child Sexual Abuse, ed. David
Finkelhor (Beverly Hills, Calif.: Sage Publications, 1986), 6088, esp. 6771; and
Stefanie Doyle Peters, Gail Elizabeth Wyatt, and David Finkelhor, Prevalence,
in Sourcebook on Child Sexual Abuse, 1559, esp. 2730.
Division of STD Prevention, Sexually Transmitted Disease Surveillance 1998
Supplement: Gonococcal Isolate Surveillance Project (GISP) Annual Report1998 (Dept.
of Health and Human Services, Public Health Service. Atlanta: Centers for Disease 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.
Fact_Sheets/FactsGonorrhea.htm>15 September 2000.
Deborah Stewart, Sexually Transmitted Disease, in Evaluation of the Sexually Abused Child: A Medical Textbook and Photographic Atlas, ed. Astrid Heger and
S. Jean Emans (New York: Oxford University Press, 1992) 14569, esp. 145, 150.
Child abuse specialist Dr. Suzanne M. Sgroi speculates that some parents refuse
or delay testing because a private physician who will not report the infection is
treating them, suggesting that the coincidence of infection may be higher. Suzanne
M. Sgroi, Pediatric Gonorrhea Beyond Infancy, Pediatrics Annals 8 (May 1979):
7387, esp. 83.

Stewart, Sexually Transmitted Disease, 150.


Adaora A. Adimora, Holli Hamilton, King K. Holmes, and P. Frederick
Sparling, eds., Sexually Transmitted Diseases: Companion Handbook, 2d. ed. (New
York: McGraw-Hill, Inc., 1994), 35254, 380.
American Academy of Pediatrics, Statement, Pediatrics 101 (1998): 134
35; see also Suzanne M. Sgroi, Kids With Clap: Gonorrhea as an Indicator of
Child Sexual Assault, Victimology 2 (1977): 25167, esp. 25863.

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




3d. ed., ed. King K. Holmes, P. Frederick Sparling, Per-Anders Mrdh, Stanley M.
Lemon, Walter E. Stamm, Peter Piot, and Judith N. Wasserheit (New York: McGrawHill Companies, Inc, 1999), 114553.
Sgroi, Kids With Clap, 252; Astrid H. Heger, Evaluation of Sexual
Assault in the Emergency Department, Topics in Emergency Medicine 21 (June 1999):
4657, esp. 5152; American Academy of Pediatrics, Committee on Child Abuse
and Neglect, Guidelines for the Evaluation of Sexual Abuse of Children, Pediatrics 87 (February 1991): 25457, esp. 25657.
Adimora, Sexually Transmitted Diseases, 354; Pamela F. Farrington, Pediatric Vulvo-Vaginitis, Clinical Obstetrics and Gynecology 40 (March 1997): 13540,
esp. 138; Gutman, Gonococcal Diseases in Children, 1149; and Robert M. Siegel,
Charles J. Schubert, Patricia A. Myers, and Robert A. Shapiro, The Prevalence of
Sexually Transmitted Diseases in Children and Adolescents Evaluated for Sexual
Abuse in Cincinnati: Rational for Limited STD Testing in Prepubertal Girls, Pediatrics 96 (December 1995): 109094.

See, for example, Walker, Twenty-One Cases, Part 1, 27073, Part 2,

33233, 33941; Francis Wharton and Moreton Still, A Treatise on Medical Jurisprudence (Philadelphia: Kay and Brother, 1855), 32635; Taylor, Medical Jurisprudence, 460; Burke Ryan, On the Communicability of Gonorrhoea, in Reference to
Medical Jurisprudence, London Medical Gazette 47 (1851): 74445, esp. 744; and
Theodoric Romeyn Beck, Elements of Medical Jurisprudence, ed. John Darwall, 3rd
ed. (London: Longman, Rees, Orme, Brown, and Green, 1829), 5456.

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

See, for example, John Lovett Morse, Five Cases of Gonorrhoeae in Little
Girls, Archives of Pediatrics 11 (1894): 59698, esp. 598; and Isaac A. Abt, Gonorrhea in Children, Journal of the American Medical Association 31 (17 December 1898):

See, for example, Flora Pollack, A Report of the Womens Venereal Department of the Johns Hopkins Hospital Dispensary, Maryland Medical Journal 49
(August 1906): 289; L. Emmett Holt, Gonococcus Infections in Children, With
Especial Reference to Their Prevalence in Institutions and Means of Prevention,
New York Medical Journal and Philadelphia Medical Journal 81 (18 March 1905): 521
27, 58993, esp. 59091; Sara Welt-Kakels, Vulvovaginitis in Little Girls: A Clinical Study of 190 Cases, Part 1, New York Medical Journal and Philadelphia Medical
Journal 80 (8 October 1904): 69893, esp. 689; and Joseph Louis Baer, Epidemic
Gonorrheal Vulvo-Vaginitis in Young Girls, Journal of Infectious Diseases 1 (19
March 1904): 313.
J.C. Cook, Comment, in Abraham L. Wolbarst, Gonorrhea in Boys,
JAMA 33 (28 September 1901): 82730, esp. 830.

Wharton and Still, A Treatise on Medical Jurisprudence , 32728.


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





Ibid., 33031.


See, for example, E. D. Barringer, Gonorrheal Vulvo-Vaginitis in Children, in Diseases of the Genito-Urinary Organs, ed. Edward L. Keyes, Jr. (New York:
D. Appleton and Company, 1910), 12227; Pollack, A Report, 290; Gurney
Williams, Rape in Children and in Young Girls: Based on the Personal Investigation of Several Hundred Cases of Rape and of Over Fourteen Thousand Vaginal
Examinations, Parts 1 and 2, International Clinics , 23rd ser., 2 (1913): vol. 2, 24567,
esp. 245; vol. 3, 24567, esp. 25253; W. Travis Gibb, Indecent Assault Upon Children, in A System of Legal Medicine, ed. Allan McLane Hamilton and Lawrence
Godkin (New York: E.B. Treat, 1894), 64957, esp. 65556; and J. Clifton Edgar and
J.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 Company, 1894), 41590, esp. 461.

W. Travis Gibb, Criminal Aspect of Venereal Diseases in Children: Based
Upon the Personal Examination of Over 900 Children, the Alleged Victims of Rape,
Sodomy, Indecent Assault, Etc., Transactions of the American Society of Sanitary and
Moral Prophylaxis 2 (1908): 2534, esp. 30.
Richard von Krafft-Ebing, Psychopathic Sexualis: With Especial Reference to
the Antipathic Sexual Instinct, A Medico-Forensic Study, 12 th ed., trans. F.J. Rebman
(New York: Medical Art Agency, 1906), 561; Giuseppe Pitr, Sicilian Folk Medicine ,
trans. Phyllis H. Williams (Lawrence, Kans.: Coronado Press, 1971), 302, originally published as Medicina Popolare Siciliana (Carlo Clausen, Torino Clausen, 1896);
William R. Wilde, Medico-Legal Observations Upon the Case of Amos Greenwood, Tried at the Liverpool Assizes, December, 1857, for the Wilful [sic] Murder
of Mary Johnson, and Sentenced to Penal Servitude for Life, Dublin Quarterly
Journal of Medical Science (February 1859): 5187, esp. 61; Wharton and Still, A
Treatise on Medical Jurisprudence, 32728 (citing Johann Ludwig Caspar, Pract.
Hadbuch der Gerichtlichen Medicin [Practical Handbook of Forensic Medicine], vol.
3 [Berlin, 1857], 103).
Flora Pollack, The Acquired Venereal Infections in Children, Johns Hopkins Hospital Bulletin 20 (May 1909): 14249, esp. 143. Pollack referred to the 1906
translation of Krafft-Ebing, which states that, in Europe an idea is still prevalent
that intercourse with children heals venereal disease. 561.
Nels A. Nelson and Gladys L. Crain, Syphilis, Gonorrhea and the Public
Health (New York: Macmillan Co., 1938), 141, 143; Phyllis H. Williams, Southern
Italian Folkways in Europe and America: A Handbook for Social Workers, Visiting Nurses,
School Teachers, and Physicians (New Haven, Conn.: Yale University Press, 1938),
16768; Havelock Ellis, Studies in the Psychology of Sex, vol. 4 of Sex in Relation to Society (1906; reprint, New York: Random House, 1936), 337; Stephen A. Yesko, Gonorrheal Vulvovaginitis in the Young: History, Prevalence, Treatment and Case Reports,
American Journal of Diseases of Children 33 (April 1927): 63046, esp. 636; and John
Lovett Morse, Clinical Pediatrics (Philadelphia: W.B. Saunders Company, 1926), 667.
Herman B. Sheffield, Vulvovaginitis in Children, New York Medical Journal 76 (4 August 1900): 18992, esp. 19091.

Ibid., 191.





W.M. Leszynsky, Leucorrhoea as the Cause of a Recent Epidemic of Purulent Opthalmia in one of our City Charitable Institutions, New York Medical
Journal 43 (27 March 1886): 35235; and I.E. Atkinson, Report of Six Cases of
Contagious Vulvitis in Children, American Journal of Medical Science (April 1878):
A.C. Cotton, An Epidemic of Vulvovaginitis Among Children, Archives
of Pediatrics 22 (February 1905): 10615; Henry Koplik, Prophylactic Measures To
Prevent the Spread of Vulvovaginitis in Hospital Services, Archives of Pediatrics
10 (1903): 73541; and Herman B. Sheffield, Contribution to the Study of Infectious Vulvo-Vaginitis in Children, with Remarks Upon Purulent Opthalmia, and
a Report of Sixty-Five Cases, American Medico-Surgical Bulletin 9 (30 May 1896):

Holt, Gonococcus Infections in Children, 52325.


Reuel B. Kimball, Gonorrhoea in Infants, With a Report of Eight Cases

of Pyaemia, New York Medical Record 64 (14 November 1903): 76166; and Guy L.
Hunner and Norman MacL. Harris, Acute General Gonorrheal Peritonitis, Bulletin of the Johns Hopkins Hospital 13 (June 1902): 12130, 127.

W.D. Trenwith, Gonococcus Vaginitis in Little Girls, New York Medical
Journal 83 (3 February 1906): 24042.

Ibid., 241.


Brandt, No Magic Bullet , 12026, 13557.


Ibid., 3740; John C. Burnham, The Progressive Era Revolution in American Attitudes Toward Sex, Journal of American History 59 (March 1973): 885908,
esp. 89092; and Roster of officers and directors, 191357 (ca. 1957), Box 18, folder
7, 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 as
ASHA). See also William Snow, The American Social Hygiene Association: Some
Notes on the Historical Background, Development and Future Opportunities of
the National Voluntary Organization for Social Hygiene in the United States,
(New York: ASHA, June 1946); pamphlet, Box 1, folder 1; Minutes, American Vigilance Association, 17 February 1913; and pamphlet, Box 2, folder 6, in ASHA.

Brandt, No Magic Bullet, 1417, 2326; and Burnham, The Progressive
Era Revolution in American Attitudes Toward Sex, 892902.

Prince A. Morrow, Social Diseases and Marriage: Social Prophylaxis (Philadelphia: Lea Brothers and Co., 1904), 25; Richard C. Cabot, Observations Regarding the Relative Frequency of the Different Diseases Prevalent in Boston and
Its Vicinity, Boston Medical and Surgical Journal 165 (3 August 1911): 15570; and
Prince A. Morrow, The Frequency of Venereal Diseases: A Reply to Dr. Cabot,
Boston Medical and Surgical Journal 165 (5 October 1911): 52025. Estimates varied
widely because no laws before 1911 required doctors to report gonorrhea infections. See Brandt, No Magic Bullet , 1213, 4243.




Morrow, Social Diseases and Marriage, 23.


Prince A. Morrow, Woods Pocket Manuals, Venereal Memoranda: A Manual
for the Student and Practitioner (New York: William Wood and Co., 1885), 15.

Morrow, Social Diseases and Marriage, 117


Ibid., 118.


J. Clifton Edgar, Comment, in Holt, Gonococcus Infections, 592.


Holt, Gonococcus Infections, 525, 591.


Baer, Epidemic Vulvo-Vaginitis, 313.


Clara P. Seippel, Venereal Diseases in Children, Illinois Medical Journal
22 (July 1912): 5056, esp. 52; and Jane Addams, A New Conscience and an Ancient
Evil (New York: Macmillan Co., 1912), 184.

Kathleen Wehrbein, A Survey of the Incidence, Distribution and Facilities For

Treatment 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.

Yesko, Gonorrheal Vulvovaginitis, 633.


N.A. Nelson, Gonorrhea Vulvovaginitis: A Statement of the Problem,

New England Journal of Medicine 207 (21 July 1932): 13540, esp. 136; Walter Clarke,
Summary of a Social Hygiene Survey, Journal of Social Hygiene 27 (February 1931):
6594, esp. 78.

New York City Department of Health, Clinic Does Research on Vaginitis, Journal of Social Hygiene 15 (June 1929): 36870, esp. 369.

See, for example, Chicago Society of Social Hygiene, For the Protection of
Wives and Children from Venereal Contamination (Chicago: Chicago Society of Social
Hygiene, 1907); and Lavinia L. Dock, Hygiene and Morality: A Manual for Nurses
and Others, Giving an Outline of the Medical, Social, and Legal Aspects of the Venereal
Diseases (New York: G.P. Putnams Sons, 1910), 14849.

Jane Addams, The Spirit of Youth and the City Streets (Urbana: University
of Illinois Press, 1972), 33, 3447. See also Anna Garlin Spencer, Womans Share in
Social Culture (New York: Mitchell Kennerley, 1912), 25474; and William L. ONeill,
Divorce in the Progressive Era, in The American Family in Social-Historical Perspective, ed. Michael Gordon (New York: St. Martins Press, 1973), 25166.

Barringer, Gonorrheal Vulvo-Vaginitis, 122; Wolbarst, Gonorrhea in

Boys, 828; and Charles ODonovan, Gonorrhoea in Children: A Frequent Occurrence Amongst the Negroes of Baltimore, Archives of Pediatrics 16 (1899): 25
26. See also Brandt, No Magic Bullet , 2021.

Seippel, Venereal Diseases, 52.


Nancy Tomes, The Gospel of Germs: Men, Women, and the Microbe in American Life (Cambridge: Harvard University Press, 1998), 8487, 15766, and Nancy




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), 596611, esp. 603. See also Edith
Abbott, The Tenements of Chicago, 19081935 (Chicago: University of Chicago Press,
1936), 20522, 21113; Tenement House Committee, Committee on Housing, COS,
Housing Reform in New York City: Report of the Tenement House Committee of the COS
of the City of New York, 1911, 1912, 1913 (New York: M.B. Brown, 1914), 2, 3233;
and New York Association for Improving the Condition of the Poor, Department
of Social Welfare, and Bureau of Public Health and Hygiene, Comfort Stations in
New York City: A Social Sanitary and Economic Survey, publication no. 80 (New York:
AICP, ca. 1910).
See Tomes, Gospel of Germ, 18595; Suellen Hoy, Chasing Dirt: The American Pursuit of Cleanliness (New York: Oxford University Press, 1995), 87121; and
Alan M. Kraut, Silent Travelers: Germs, Genes, and the Immigrant Menace, (New
York: Basic Books, 1994).

Hoy, Chasing Dirt, 98117; Tomes, Gospel of Germs, 6567, 13554, 17585.


Nancy Tomes, The Private Side of Public Health: Sanitary Science, Domestic Hygiene, and the Germ Theory, 18701900, Bulletin of the History of Medicine 64 (winter 1990): 50939, esp. 52835.

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


See Alice Hamilton, Exploring the Dangerous Trades: The Autobiography of
Alice Hamilton, M.D. (Boston: Little, Brown and Co., 1943), 99100; and Barbara
Sicherman, Alice Hamilton: A Life in Letters (Cambridge, Mass.: Harvard University Press, 1984), 145, 14446.
Alice Hamilton, Gonorrheal Vulvo-Vaginitis in Children: With Special
Reference to an Epidemic Occurring in Scarlet-Fever Wards, Journal of Infectious
Diseases 5 (March 1908): 13357, esp. 134. See also Holt, Gonococcus Infections,
521; and Welt-Kakels, Vulvovaginitis, 740.

Hamilton, Vulvo-Vaginitis in Children, 142.


Alice Hamilton, Venereal Diseases in Institutions for Women and Girls,
Proceedings of the National Conference of Charities and Corrections 37 (1910): 5356,
esp. 54.

Ibid., 54.


Ibid., 5455; and J. Clifton Edgar, Gonococcus Infection as a Cause of

Blindness, Vulvovaginitis and Arthritis, JAMA 49 (3 August 1907): 41114, esp.

Seippel, Venereal Diseases, 51.


Barringer, Gonorrheal Vulvo-Vaginitis, 122.


Edith M. Baker, Social Case Work in Hospital and Clinic, Journal of Social Hygiene 13 (November 1927): 47791, esp. 490.




Pollack, Acquired Venereal Infections, 147.


Ibid., 143.


Edith Rogers Spaulding, Vulvovaginitis in Children, American Journal
of Diseases of Children 5 (March 1913): 24867, esp. 253; see also B. Wallace Hamilton,
Gonococcus Vulvovaginitis in Children: With Results of Vaccine Treatment in
Out-Patients, JAMA 54 (9 April 1910): 119698.

Spaulding, Vulvovaginitis in Children, 253.


Morrow, Social Diseases, 116; Edgar and Johnston, Rape, 465; John Morris, Gonorrhoeae in Women, Virginia Medical Monthly 5 (1878): 37380, esp. 375;
and Ryan, On the Communicability of Gonorrhoea, 745.

Seippel, Venereal Diseases, 52.


Hoy, Chasing Dirt, 12628; John Duffy, A History of Public Health in New
York City, 18661966, vol. 2 (New York: Russell Sage Foundation, 1974), 21718;
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 from
Modern Hospital 6 (March 1916); and [New York City] Board of Education, Sanitary Conditions in Lavatories, School Health News 1 (December 1915): 8.
Frederick J. Taussig, The Prevention and Treatment of Vulvovaginitis in
Children, American Journal of Medical Sciences 148 (October 1914): 48090, esp. 483.

Ibid., 483.


Ibid., 490.


Ibid., 48384.


George Stevens, Public Health Aspects of Gonorrhea in the Female, bulletin

no. 20 (Los Angeles: Board of Health Commissioners, March 1937), 4; Clarke, Summary of a Social Hygiene Survey, 78; [New York City] Bureau of Public Health
Education, Department of Health, Routine Procedure in Guarding the Schools
Against Syphilis and Gonorrhoea, School Health News 7 (February 1921): 12, esp.
2; Venereal Disease, School Health News 2 (April 1916): 6; Ella Oppenheimer and
Ray H. Everett, School Exclusions for Gonorrheal Infections in Washington, D.C.,
American Journal of Public Health 24 (May 1934): 52931. See also Paul R. Stalnaker,
Gonococcal Vulvovaginitis Before Puberty, Texas State Journal of Medicine 29
(October 1933): 395400; N.A. Nelson, Gonorrhea Vulvovaginitis: A Statement of
the Problem. New England Journal of Medicine 207 (21 July 1932): 13540; and S.H.
Rubin, The Point of View of the School Physician, New England Journal of Medicine 207 (21 July 1932): 142.

N.A. Nelson, Some Diseases We Dont Talk AboutAnd Why Not: The
Prevalence of Gonorrhea and Syphilis, Commonhealth 20 (April-May-June 1933):
5758, esp. 58 (text of radio broadcast, WBZ, 24 December 1930); see also N.A.
Nelson, Gonorrhea and Syphilis: A Description of the Two Diseases, Commonhealth 20 (April-May-June 1933): 5962 (text of radio broadcast, WEEI, 12 August




N.A. Nelson, Gonorrhea and Syphilis in the Public Schools, Commonhealth 22 (April-May-June 1935): 11819.
New York City Health Department, Instructions to Parents Regarding Vaginitis, Official Project #6597-415, Treatment of Social Diseases (New York: Works
Progress Administration for the City of New York, 1937); Department of Health,
City of New York, Important Information: Special Instructions for Vaginitis Cases (New
York: Department of Health, 1929).
Nels A. Nelson, Gonorrhea (Boston: Massachusetts Society for Social
Hygiene, 1936), 4.

Nelson and Crain, Public Health , 14243.


New York Tuberculosis and Health Association, Inc., Social Hygiene Committee, Survey of Female Gonorrhea Clinics in New York City (New York: New York
Tuberculosis and Health Association, Inc., 1936), 4; and American Social Hygiene
Association, Survey of New York City Infections and Hospitals, (1935): 9394,
124, unpublished typescript, Box 101, folder 3, ASHA.

Edna Pearson Wagner, Social Aspects of Gonorrhea Vaginitis as Shown

By a Study of Fifty Cases of the Childrens Bureau in New Orleans (M.A.thesis,
Tulane University, 1940), 73, 44; and Baker, Social Case Work, 47980.

See, 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 York
City, Hospital Social Service Magazine , Supp. 1 (March 1933): 198, esp 67, 75. See
also, Duffy, Public Health , 32325; C-E.A. Winslow and Savel Zimand, Health Under the El: The Story of the Bellevue-Yorkville Health Demonstration in Mid-Town
New York (New York: Harper and Brothers Publishers, 1937), 150, 151; Pamphlet,
The Bellevue-Yorkville Health Demonstration, (November 1929), Box 62, folder
3718 [19261930], Community Service Society (formerly Charity Organization
Society of New York) Papers, Rare Book and Manuscript Library, Butler Library,
Columbia University. New York, NY; and Vulvo-vaginitis Clinic in the BellevueYorkville Health Center, Journal of Social Hygiene 13 (November 1927) 49899,
esp. 499.

Brunet, Report, 6.


Reuel A. Benson and Arthur Steer, Vaginitis in Children: A Review of
the Literature, American Journal of Diseases of Children 53 (March 1937): 80624,
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 of
Diseases of Children 54 (September 1937): 45995.

Benson and Steer, Vaginitis in Children, 810, 822.


Nelson and Crain, Public Health , 144.

Alfred Cohn, Arthur Steer, and Eleanor L. Adler, Further Observations

on Gonococcal Vulvovaginitis, Transactions of the American Neisserian Medical Society, 6 th annual session (New York, 1011 June 1940), 2441; and Gonococcal




Vaginitis: A Preliminary Report on One Years Work, Venereal Disease Information

21 (July 1940): 20820, esp. 211, 219.

Cohn, Further Observations, 25.

L. Emmett Holt, Jr. and Rustin McIntosh, eds., Holts Diseases of Infancy
and Childhood: A Textbook for the Use of Students and Practitioners, 11 th ed. (New
York: 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.

Holt and McIntosh, eds., Holts Diseases of Infancy and Childhood, 821.

See John Parascandola, The Introduction of Antibiotics into Therapeutics, in Sickness and Health in America: Readings in the History of Medicine and Public
Health, ed. Judith Walzer Leavitt and Ronald L. Numbers, 3rd ed., rev. (Madison:
University of Wisconsin Press, 1997), 10212.
Excitement over antibiotics and an overall decline in STD infection in
the United States from 1946 to 1958, convinced many physicians that STDs had
become an insignificant medical and public health problem. Tomes, Gospel of Germs,
25354; and Duffy, Public Health , 58687.
Sandra Harding, Comment on Walbys Against Epistemological
Chasms: The Science Question in Feminism Revisited: Can Democratic Values
and Interests Every Play a Rationally Justifiable Role in the Evaluation of Scientific
Work? Signs 26 (winter 2001): 51125, esp. 51921; see also Sandra Harding, Whose
Science? Whose Knowledge?: Thinking From Womens Lives (Ithaca: Cornell University Press, 1991), 14449; and Patricia Hill Collins, Black Feminist Thought: Knowledge, Consciousness, and the Politics of Empowerment (New York: Routledge, 1991),

Harding, Comment on Walbys Against Epistemological Chasms 516.

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