—Book review by James R. Marsh
I am reading a fascinating book by Lynn Sacco, an assistant professor of history at the University of Tennessee, Knoxville, entitled Unspeakable: Father-Daughter Incest in American History.
Unspeakable is an excellent book which explains how cultural mores and political needs distorted attitudes toward and medical knowledge of patriarchal sexual abuse at a time when the nation was committed to the familial power of white fathers and the idealized white family.
For much of the nineteenth century, father-daughter incest was understood to take place among all classes and legal and extra-legal attempts to deal with it tended to be swift and severe. But public understanding changed markedly during the Progressive Era, when accusations of incest began to be directed exclusively toward immigrants, blacks, and the lower socioeconomic classes. Focusing on early twentieth-century reform movements, Sacco argues that middle- and upper-class white males, too, molested female children in their households, even as official records of their acts declined dramatically.
One of the most interesting chapters in Unspeakable discusses the revolution in medicine in the early 20th century when doctors were first able to diagnose gonorrhea vulvovaginitis. Guess what they discovered?
When physicians began to use the new technology, however, they were shocked to discover that gonorrhea vulvovaginitis was widespread among American girls.…But though condemning child prostitution among the working class was one thing, explaining how girls from good families had become infected with a sexually transmitted disease was another. On the cusp of moving from the margins to the center of American health care, doctors used their professional authority, if not their medical skills, to twist the etiology of girls’ infections into existing narratives that fit more seamlessly with what doctors believed than with what they had discovered. In the process, doctors attributed fewer infections in girls to sexual assault.
 
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Over the next ten years, doctors diagnosed gonorrhea vulvovaginitis so often that by 1904 an epidemiologist writing in the Journal of Infectious Diseases declared it an “epidemic” among girls. In 1909, Dr. Flora Pollack, who treated girls at the Johns Hopkins Hospital Dispensary, estimated that at least a thousand girls in Baltimore became newly infected each year, and she visited police stations and met with community groups to press for more aggressive prosecution of their assailants.
 
By 1927, the American Journal of Diseases of Children ranked gonorrhea vulvovaginitis the second most common contagious disease, after measles, among children. In 1903 Dr. Reuel B. Kimball, an attending physician at the Babies’ Hospital, charged that “the medical world at large” had not realized “the extent to which gonorrhoeae occurs in children.” He accused medical journals—which published many more articles on gonorrhea ophathalmia in infants (a condition that affects the eyes and can cause blindness) than on genital infections in girls—of having contributed to the impression that gonorrhea vulvovaginitis was an insignificant problem. Kimball claimed that of the 600 children admitted to the public wards of the Babies’ Hospital in 1902, only 1 became infected with gonorrhea ophthalmia, compared with 69 with gonorrhea vulvovaginitis. The following year, Dr. Sara Welt-Kakels, who treated patients at the Children’s Department of the Mount Sinai Hospital Dispensary in New York City, called gonorrhea the most pernicious and tenacious infection of early childhood.
 
Doctors knew that the disease had spread “even in children living under the best surroundings,” but they avoided the more perplexing question of how girls who neither had been hospitalized nor reported a history of sexual contact had become infected. Dr. L. Emmett Holt, attending physician at the Babies’ Hospital, for one, rejected the possibility of incest and was angered by what he perceived as the lay public’s reluctance to discard the popular view that gonorrhea was sexually transmitted to the girls. He believed that linking infection with sexual contact unfairly burdened “innocent” girls with a diagnosis that stigmatized them as sexually precocious and immoral. Hold advocated instead what he believed to be a modern and efficient solution, changing the name of the disease to disassociate it from any “venereal origins.
In terms of child pornography, it is not possible to provide an exact number of people trading child pornography across the world. UNICEF and the United Nations have provided some estimates. UNICEF estimates that there are more than four million websites featuring sexually exploited minors. Further, the number of child pornography websites is growing: 480,000 sites were identified in 2004 compared to 261,653 in 2001. More than 200 new images are circulated daily, and UNICEF estimates that the production and distribution of child pornographic images generates in between 3 and 20 billion dollars a year.
The United Nations released a report in July 2009 asserting that there are approximately 750,000 sexual predators using the Internet to try to make contact with children for the purpose of sexually exploiting them.
Sacco’s book is available here from The Johns Hopkins University Press or online at Barnes & Noble and Amazon.com