penile-inversion vaginoplasty in 1903

The official history of penile-inversion vaginoplasty is that Harold Gillies & Ralph Millard pioneered the use of of penile skin-flap in 1951, but that their method was not penile-inversion vaginoplasty as we later knew it.   Poul Fogh-Andersen in Copenhagen, who had operated on Christine Jorgensen, continued to innovate, and in 1956 he reported that he had successfully used a full-thickness skin graft harvested from the penile skin to line the neovagina. This was taken further by Georges Burou in Casablanca, also in 1956, who set the standard for future surgeons.   His method was quickly adopted by Jose Jesus Barbosa in Tijuana and Milton Edgerton at Johns Hopkins in Baltimore.   It was Edgerton who passed on details of Burou's method to Stanley Biber in Trinidad, Colorado.

This was the 1950s.

Let us turn back the clock to 1903.

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E.C. had been raised as a girl in New York, and identified as a woman. At age 20 she was referred by her family physician to the gynaecology professor, J. Riddle Goffe, in that she wanted to get rid of a growth between her legs. She also had a partial vagina and facial hair. Goffe examined her, and also asked her whether she wanted to be a man or a woman. She decidedly wanted the latter.

In March 1903, he operated on her at the Polyclinic Hospital (later called the Stuyvesant Polyclinic) in the presence of his class and some invited guests. He used the skin of the penis/enlarged clitoris to form the inside of the vagina. Three months later she returned and was very happy about the success of the operation.

Goffe describes the case: “The case of pseudo-hermaphroditism which I have to present is of special interest on account of the operative procedure which I instituted and performed, and which effectually eradicated all semblance of duality of sex and placed the young patient safely in the ranks of womankind, where she desired to be”. The editorial caption under the surgical photographs reads: “operation for removal of the penis and the utilization of the skin covering it for the formation of a vaginal canal”. E.C. also undertook treatment three times a week for removal of facial hair by electric depilation.  Goffe wrote up the case in the American Journal of Obstetrics and Diseases of Women and Children.

Goffe's describes the operation: "The skin adjacent to the vulva was so harsh and bristled so with hair that it was not available for filling in the lateral gaps in the mucous membrane of the vagina. The only apparent resource was to allow them to fill up by granulation, when suddenly the thought occurred to me, Why not use the skin covering the clitoris? This was soft and delicate and free from hair. It
was therefore decided upon." (p760 in Goffe, quoted p76 in Mak, 2005.  Mak comments: "As far as I know, this was the first case in which the skin of a clitoris/penis was used to construct a vagina.")

Apparently the editor of the journal altered the title of Goffe's paper to say “for removal of the penis”, despite Goffe referring to the organ as a clitoris throughout. Goffe’s comment “where she desired to be” caused controversy among surgeons and gynaecologists in that the consensus at the time was that only gonads truly define sex – a position that Goffe himself had set forth in his introduction, but to which he did not in fact adhere.

A few other doctors in the very early 20th century did as Goffe did, and considered the patients wishes in deciding what surgery to do (see Mak 2011) rather than insisting on gonadal determinism, but there does not seem to be any record of any other surgeon using the skin of the penis/clitoris until 50 years later.

• J. Roddle Goffe. “A pseudohermaphrodite, in which the female characteristics predominated: Operation for removal of the penis and the utilization of the skin covering it for formation of a vaginal canal”. American Journal of Obstetrics and Diseases of Women and Children, 48:6, 1903: 755-763.
• Geertje Mak. ‘ "So We Must Go Behind Even What the Microscope can Reveal". The Hermaphrodite’s “Self” in Medical Discourse at the Start of the Twentieth Century.’ GLQ A Journal of lesbian and Gay Studies, 1,1, January 2005: 66-7, 71-8, 80-4
• Christina Matta. “Ambiguous Bodies and Deviant Sexualities: hermaphrodites, homosexuality, and surgery in the United Sattes, 1850-1904”. Biology and Medicine, 48,1, winter 2005: 75, 80-1.
• Geertje Mak. Doubting Sex: Inscriptions, Bodies and Selves in Nineteenth-Century Hermaphrodite Case Histories. Manchester University Press, 2011: 176-82, 258-9n32.
• Elizabeth Reis,. Bodies in Doubt: An American History of Intersex.: Johns Hopkins University Press, 2012: 78-80. .

Camille Barbin (1838 – 1868) school teacher, railway clerk.

Adélaîde Herculine Barbin was born in Saint-Jean-d’Angely in Charente-Maritime. Her family usually referred to her as Alexina.  Her father died when she was young, which resulted in her being raised in an almost exclusively female and strongly religious environment.

Alexina was chosen for a charity scholarship to study at the school of an Ursaline convent. In 1856 she was sent for teacher training. Afterwards she became an assistant teacher in a girls’ school, where she had an affair with a fellow teacher, Sara.

Abdominal pain and religious guilt led Alexina to a confession with the bishop, and with her permission to break confessional silence, he sent for a doctor to examine her. The doctor found that she had a small penis and testicles inside her vagina, had never menstruated or developed breasts, and shaved facial hair.

In 1860 a tribunal heard evidence from Dr Chestnet of La Rochelle. As a result the register of Barbin’s birth was changed: the sex to male, and the name to Abel. It was deemed that Barbin had always been male. The next Sunday, Abel Barbin, dressed as a man appeared at the church of Saint-Jean between his mother and one of the town’s most respectable ladies.

This did not mean that Abel could marry Sara. The scandal was great and they were kept apart. A family connection secured for Barbin a position of clerk to a Paris railway company. Dr Chestner wrote up the case for the Annales d’hygiène publique et de médecine légale.

Abel committed suicide at the age of 30 by inhaling from his gas stove in his room in the rue de l'École-de-Médecine in Paris. The police doctor, who had been called, examined the dead man’s genitals expecting to find that he was a syphilitic - a common cause of suicide at that time - but finding something quite different. Word spread quickly, and Dr E Goujon at the Faculity of Medicine acted quickly so that the body would not be lost to science. He performed an autopsy and took careful notes, including two detailed drawings of Barbin’s genital area.

In addition Barbin had left memoirs, in which the male persona is referred at as Camille. They were given to Auguste Ambroise Tardieu who published excerpts in his Question médico-légale de l'identité, 1872.

In 1893 the German psychiatrist and novelist Oskar Panizza, wrote a fictionalized version of Alexina/Camille as Ein skandalöser Fall: Geschichten, which is obviously taken from the account in Tardieu but set in the eighteenth century.

Five years later, Armand Ernest Dubarry, a French novelist who wrote several medical pot boilers, published L'hermaphrodite, again based on Alexina/Camille.

In 1908 Neugebauer summarized Camille’s story in his immense inventory of hermaphroditism. Either by his doing, or as a printer’s error, Barbin’s name was affixed to the image of somebody else.

After that interest in Barbin dissipated until, in the late 1970s, the memoirs were discovered in the archives of le département français de l'Hygiène Publique, and were published by the controversial academic Michel Foucault.

The story was filmed in 1985 as Mystere Alexina. To the plot from the book, the filmmakers added an intrigue of being secretive about the gender of the actor who played Alexina: Philippe Vuillemin, a comic book artist, was billed as Vuillemin only.

In 2010 Sarah Leaver, who has a similar intersex condition, performed a one-woman play based on Barbin’s memoires.

• Chesnet. “Question d’identité. Vice de conformation des organes génitaux. Hypospadias. Erreur sur le sexe” . Annales d’hygiène publique et de médecine légale, 2, 14, 1860: .206-9.
• Abel Barbin. Mes souvenirs. 1863-8. Published Paris: Editions du Boucher, 2002. www.leboucher.com/pdf/herculine/xherculi.pdf.
• E. Goujon. “Étude d’un cas d’hermaphrodisme bisexual imparfait chez l’homme”. Journal de l’anatomie et de la physiologie normales et pathologiques de l’homme et des animaux, 6, 1869: 599-616. Reprinted in Foucault 1978/80.
• Auguste Ambroise Tardieu. Question médico-légale de l'identité dans ses rapport avec les vices de conformation des organes sexuels, contenant les souvenirs et impressions d'un individu dont le sexe avait été méconnu,. Paris: J.B. Baillière et Fils,1872. Contains selection from Barbin’s Souvenirs.
• Oskar Panizza. Ein skandalöser Fall: Geschichten. 1893. Translated by Sophie Wilkins and published in Foucault 1980. Reprinted: München: Martus Verlag, 1997.
• Armand Ernest Dubarry. L'hermaphrodite. Paris: Chamuel, 1898.
• Franz Ludwig von Neugebauer. Hermaphroditismus beim Menschen. Leipzig: Klinkhardt, 1908:748.
• Michel Foucault (ed) Herculine Barbin dite Alexina B. Paris: Gallimard, 1978. Translated by Richard McDougall as Herculine Barbin: being the recently discovered memoirs of a nineteenth-century French hermaphrodite. New York: Pantheon Books; Brighton: Harvester Press, 1980.
• René Féret (dir & scr). Mystere Alexina. Scr: Jean Gruault, based on the book by Herculine Barbin & Michel Foucault, with (Philippe) Vuillemin as Alexina Barbin. France 86 mins 1985.
• Alice Domurat Dreger. Hermaphrodites and the Medical Invention of Sex. Cambridge, Ma, Harvard University Press. 2000: 16-20, 23, 28-9, 51-2, 76, 239n21.
• Sarah Leaver (writer & performer). Memoirs of a Hermaphrodite, 75 mins 2010. Performed in London, Brighton, Manchester, Liverpool www.decibelpas.com/index.php?id=85.
• “Herculine Barbin: Being the Recently Discovered Memoirs of a Nineteenth-century French Hermaphrodite”.  Wikipedia, the free encyclopedia.  en.wikipedia.org/wiki/Herculine_Barbin:_Being_the_Recently_Discovered_Memoirs_of_a_Nineteenth-century_French_Hermaphrodite.

EN.WIKIPEDIA     FR.WIKIPEDIA    TRANS.ILGA

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Dr Goujon left us two detailed drawing of Barbin’s genital area, but we have no record of her face.  The drawings may be viewed in Dreger’s book.

The EN.Wikipedia article, in line with its usual practice, retrojects final gender back to birth.  “It's wikipedia policy to use the gender that the person decided upon as the pronoun throughout, not alternate them”.  However it gives not the slightest evidence that Barbin chose to be male, or even accepted the gender reassignment.  Suicide was her method of refusing to be male.  Even stranger, having imposed male pronouns, it names the article with Camille’s birth girl name: “Herculine Barbin”.

Actually the birth name was Adélaîde Herculine Barbin, so if only one first name is given, it should be Adélaîde Barbin.  However it would be better to refer to Alexina, as this is what family and friends called her.  This is one case where the film got it more right than most of the books about this person.

Likewise Abel is a name imposed.  When Alexina uses a male name for herself, she uses Camille.  I have used Camille in the name of this article in that it is the last name that Barbin used for herself.

If Barbin had been born earlier, s/he would have been determined to be a hermaphrodite, and permitted to choose a gender.  This freedom had been gradually reduced since the eighteenth century and by 1860 the church, the state and medicine in alliance took it upon themselves to determine the ‘true sex’ of a person, and compel them into it, without any consideration of the person’s feelings.

Previously to 1860, the major determinant in sexing a person had been presence or lack of a penis or vagina.  Barbin had both and should have been a hermaphrodite.  However the new fashion was that gonads determined sex.  Barbin had testes but no ovaries.  This criterion was the trump until chromosomes were discovered in the twentieth century.

As I have mentioned elsewhere, I am not a follower of Michel Foucault.  However I feel that his paragraph from page xiii is certainly worth pondering:

Alexina wrote her memoirs about that life once her new identity had been discovered and established. Her "true" and "definitive" identity. But it is clear she did not write them from the point of view of that sex which had at last been brought to light. It is not a man who is speaking, trying to recall his sensations and his life as they were at the time when he was not yet "himself." When Alexina composed her memoirs, she was not far from her suicide; for herself, she was still without a definite sex, but she was deprived of the delights she experienced in not having one, or in not entirely having the same sex as the girls among whom she lived and whom she loved and desired so much. And what she evokes in her past is the happy limbo of a non-identity, which was paradoxically protected by the life of those closed, narrow, and intimate societies where one has the strange happiness, which is at the same time obligatory and forbidden, of being acquainted with only one sex.

Franciszek Neugebauer (1856 – 1914) gynecologist

In the 1850s when gynecology was just emerging as a medical speciality, Ludwik Neugebauer was a Polish pioneer in the field. His son Franciszek decided to qualify as a gynecologist. He studied first in Warsaw and then in Dorpat (now Tartu, Finland) where he gained his medical doctorate. He further studied in Leipzig, Dresden, Berlin, Paris, London and Vienna before returning to Poland in 1887. In addition to Polish, he was also fluent in English, French and German. In 1897 he became chief of the Gynecological Department at the Evangelical Hospital in Warsaw, a position that he would hold until he died. 

He developed a reputation for his work with hermaphroditism and with inborn deformities of the spine. Patients with malformations were sent to him from all over Poland and beyond. Neugebauer himself travelled all over Europe and North America to investigate reports of such cases. He carefully documented what he found in writing, photographs and casts. He readily shared his collection with other doctors. He regularly attended meetings of medical associations in these countries and was elected to memberships of the British Gynaecological Society, the Warsaw Medical Association, the Warsaw Science Association, the New York Obstetrical Society, the Paris Academy of Medicine, the Association of Pathologists in Brussels and Belgian Royal Academy of Science. 

His writings consist mainly of observations with very little theory. He published in medical journals in Poland, Germany, France and Britain. Like most doctors of his generation he was very concerned to establish a person's 'true sex' for otherwise “disastrous consequences may follow an erroneous declaration of sex, and that not merely for the individuals immediately concerned, their families and connections, but for others besides". Consequences would include unhappiness, marriage to the same sex, divorce and even suicide. The 'true sex' of course was established by finding hidden testicles or ovaries, not by asking the person which sex they felt that they were. He was a major voice in the then emerging consensus that it is the gonads above all that determine a person's true sex. Other doctors needed to be educated to recognize the condition. In 1903 he published in the journal of the British Gynaecological Society "Hermaphroditism in the Daily Practice of Medicine: Being Information upon Hermaphroditism Indispensible to the Practitioner". He maintained that in addition to grave consequences resulting from erroneous determinations of sex, the frequency of such was that the ordinary practitioner could expect to encounter them. He advised his colleagues to go beyond prodding and poking, and search for evidence of ejaculation or amenorrhea in an apparent girl, and of menstruation in an apparent boy. He many times insisted: "pseudo-Hermaphroditism in its essence is a paradoxical incongruity between the genital glands on the one hand and the genital ducts and external genitals on the other". 

His major work is Hermaphroditismus beim Menschen, 1908, which summarizes 2000 cases of hermaphroditism across history and around the world. He had observed forty or so of the cases first hand. 

He authored 391 professional works, and was a member of 33 professional societies. He died at age 58.

• Franz Ludwig von Neugebauer. Hermaphroditismus beim Menschen. Leipzig: Klinkhardt, 1908.
  
• Krzysztof Boczkowski. "Franciszek Neugebauer (1856-1914)--Pioneer in the Study of Hermaphroditism". Polish Medical Science and History Bulletin. 9, no. 4: 155-7, 1966.
  
• Alice Domurat Dreger. Hermaphrodites and the Medical Invention of Sex. Cambridge, Ma, Harvard University Press. 2000: 49, 61-3, 75, 76, 79-80, 83, 85, 90, 96, 97-8, 117-8, 146, 223n103.
  

PL.WIKIPEDIA.

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It took 81 years before Hirschfeld’s Die Transvestiten was translated into English.  Neugebauer’s Hermaphroditismus beim Menschen is still untranslated.  While the social construction of sex has moved on and we no longer regard the gonads as the ultimate arbiter of which sex we are, his book is presumable a work of scholarship according to standards of the early 20th century and if so would be well worth reading alongside Hirschfeld and Havelock Ellis.

I have attached the category ‘sex-change doctor’ to Neugebauer in that based on a person’s gonads he told several who had been raised female, were happily so and even married as such that they were men and must switch, and vice versa.

I use the term ‘hermaphroditism’ here as that was the term used during Neugebauer’s lifetime.