Infertility: Tracing the History of a Transformative Term 9780271078212

Citation preview

INFERTILITY

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RSA STR THE RSA SERIES IN TRANSDISCIPLINARY RHETORIC

Edited by Michael Bernard-Donals (University of Wisconsin) and Leah Ceccarelli (University of Washington) Editorial Board: Diane Davis, The University of Texas at Austin Cara Finnegan, University of Illinois at Urbana-Champaign Debra Hawhee, The Pennsylvania State University John Lynch, University of Cincinnati Steven Mailloux, Loyola Marymount University Kendall Phillips, Syracuse University Thomas Rickert, Purdue University The RSA Series in Transdisciplinary Rhetoric is a collaboration with the Rhetoric Society of America to publish innovative and rigorously argued scholarship on the tremendous disciplinary breadth of rhetoric. Books in the series take a variety of approaches, including theoretical, historical, interpretive, critical, or ethnographic, and will examine rhetorical action in a way that appeals, first, to scholars in communication studies and English or writing, and, second, to at least one other discipline or subject area. Other titles in this series: Nathan Stormer, Sign of Pathology: U.S. Medical Rhetoric on Abortion, 1800s–1960s Mark Longaker, Rhetorical Style and Bourgeois Virtue: Capitalism and Civil Society in the British Enlightenment

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Robin E. Jensen

INFERTILITY Tracing the History of a Transformative Term

the pennsylvania state university press university park, pennsylvania

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Library of Congress Cataloging-in-Publication Data Names: Jensen, Robin E., 1979– , author. Title: Infertility : tracing the history of a transformative term / Robin E. Jensen. Other titles: RSA series in transdisciplinary rhetoric. Description: University Park, Pennsylvania : The Pennsylvania State University Press, [2016] | Series: The RSA series in transdisciplinary rhetoric | Includes bibliographical references and index. Summary: “Analyzes how infertility has been defined in and across technical, mainstream, and lay communities, and how different, emergent conceptualizations of infertility have had implications for individuals and the societies in which they live”—Provided by publisher. Identifiers: LCCN 2016021316 | ISBN 9780271076195 (cloth : alk. paper) | ISBN 9780271076201 (pbk. : alk. paper) Subjects: LCSH: Infertility, Female. | Infertility, Female— Social aspects. | Medicalization. | Rhetoric. Classification: LCC RG201 .J46 2016 | DDC 618.1/78—dc23 LC record available at https://lccn.loc.gov/2016021316 Copyright © 2016 The Pennsylvania State University All rights reserved Printed in the United States of America Published by The Pennsylvania State University Press, University Park, PA 16802–1003 The Pennsylvania State University Press is a member of the Association of American University Presses. It is the policy of The Pennsylvania State University Press to use acid-free paper. Publications on uncoated stock satisfy the minimum requirements of American National Standard for Information Sciences—Permanence of Paper for Printed Library Material, ansi z39.48–1992. This book is printed on paper that contains 30 postconsumer waste.

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For my loves: Jake, Jor, and Dane

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Contents

List of Illustrations | ix Acknowledgments | xi

Introduction | 1 1

From Barren to Sterile: The Evolution of a Mixed Metaphor | 17

2

Vital Forces Conserved: Narrating Energy Conservation and Human Reproduction at the Turn of the Century | 38

3

Improving upon Nature: The Rise of Reproductive Endocrinology and Chemical Theories of Fertility | 71

4 Psychogenic Infertility: The Unconscious Defense Against Motherhood | 97 5

Fertility in Clinical Time: The Integration of Scientific Specialties as Infertility Studies | 130 Conclusion | 153

Notes

| 171

References | 189 Index | 211

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Illustrations

1

Illustration of a woman who had focused her attention on the image of a “Black-moor” and conceived and birthed an “Ethiopian” 27

2

J. Marion Sims’s illustration of an isolated, “normally” positioned cervix, contrasted with line drawings depicting different degrees of “deviant” positioning 31

3

A diagram designed to aid surgeons in positioning women on the examination table 33

4

Dr. Samuel Meaker’s graph of varying biochemical “degrees” of human “fertility” and “sterility” 87

5

Dr. Carl Javert’s representation of “abortion neurosis” 123

6

The frontispiece for Dr. Maxwell Roland’s 1968 text Management of the Infertile Couple, captioned “Neuroendocrine Regulation of the Ovarian Cycle” 136

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Acknowledgments

Writing a book is, if nothing else, a lesson in the generosity of others. As I think back over the process of envisioning and crafting this particular book, I am taken aback by the wholehearted support and expert guidance that so many individuals and institutions offered me along the way. I first began to think about the rhetorical construction of infertility in a focused, scholarly way while working on an interview project with Jennifer J. (not L.) Bute. Without Jen’s willingness to collaborate with me and share her own ongoing research concerning health communication and infertility, this book would never have seen the light of day. I am now, and will remain, in her great debt. Other individuals who made vital contributions to this project at its inception—and thus over the long haul—include Abigail Selzer King, who served as a stalwart research assistant and accompanied me to several faraway archival repositories when I was too pregnant and directionally challenged to go by myself; Erin Doss and Melissa Carrion, who also worked with me as research assistants and provided not only great insight into the issues at hand but also innumerable smiles and other kindnesses; and Kendra Boileau, editor extraordinaire, who carefully read my work as it developed over time and provided me with the sort of honest feedback and consistent encouragement necessary for intellectual growth. As the ideas presented in the following pages came into clearer focus, a number of amazing scholars facilitated the refinement of my thinking and writing. Through her work, Celeste Condit offered me a model for the type of scholarship I want to produce and, through her public and interpersonal interactions, a model for the kind of engaged, giving person that I want to be. Similarly, Angela Ray has long stopped me in my tracks with her dedication to precise, developed rhetorical narratives generated from uncompromised archival research. Her unwavering compassion and encouragement for a fledgling, starryeyed scholar still strikes me as astonishing. And Cara Finnegan, first my adviser in graduate school and now my mentor in all things professorial, has long provided me with the most intelligent and inspiring of audiences, whether she is physically present or riding around in my subconscious doling out counterarguments, masterful writing tips, and good old-fashioned grit.

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acknowledgments

I am also grateful to several particularly charitable scholars who provided me with venues to present my work or brainstorm about my work-in-progress. Jenell Johnson at the University of Wisconsin–Madison and Kristina Horn Sheeler at Indiana University–Purdue University Indianapolis invited me to discuss this project with their outstanding graduate students, opportunities that impressed on me the continued vibrancy of the field and the importance of excellent graduate instruction. Kelly Ritter and Spencer Schaffner at the University of Illinois invited me to speak in the Center for Writing Studies’ Colloquium Series. Conversations and questions generated during that visit from Kelly, Spencer, David Cisneros, Cara Finnegan, Melissa Littlefield, John Murphy, and others offered welcome guidance as I revised this manuscript for publication. Participants in the 2014 Park City Rhetoric Writing Retreat—Joshua Trey Barnett, Maegan Parker Brooks, Brian Cozen, Danielle Endres, Stephanie Gomez, José Ángel Maldonado, Megan McFarlane, Michael Middleton, Nicholas Paliewicz, Penchan Phoborisut, Cindy Koenig Richards, Julie Snyder-Yuly, Masha Sukovic, and Sara Vanderhaagen—listened carefully to my delineation of parts of this project and created a supportive environment in which to refine its contributions. The support that I have received from the University of Utah’s Department of Communication and College of Humanities has been, and remains, second to none. Whether it is helping me to hash out the theoretical implications of my scholarly trajectory or create a tongue-in-cheek promotional music video, my colleagues have my back and a place in my heart (to use multiple bodily metaphors). Special thanks to Kevin Coe, Kevin DeLuca, Danielle Endres, Rob Gehl, Marouf Hasian, Jesse Houf, Michael Middleton, Kent Ono, Penchan Phoborisut, Helga Shugart, and Ye Sun. I received invaluable financial and scholarly support for this book via an Enhancing Research in the Humanities and the Arts Grant from the College of Liberal Arts at Purdue University; a University Research Committee Faculty Fellowship from the University of Utah; a Virgil D. Aldrich Faculty Fellowship from the Obert C. and Grace A. Tanner Humanities Center at the University of Utah; and the Karl R. Wallace Memorial Award from the National Communication Association. These opportunities afforded me the time and resources to follow my research where it led, wading through and immersing myself within countless primary and secondary sources and, ultimately, composing an account of reproductive health and infertility that reflects such immersion. I acknowledge, with appreciation, permission to use revised versions of earlier publications. More specifically, I am thankful for the exceptional editorial assistance of Jim Jasinski, former editor of Rhetoric Society Quarterly, who pub-

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lished an earlier rendering of part of chapter 1 (44, no. 5 [2014]), and Barbara Biesecker, editor of the Quarterly Journal of Speech, who published an earlier rendering of part of chapter 3 (101, no. 2 [2015]). I am indebted to the staff at the Arthur and Elizabeth Schlesinger Library on the History of Women in America at the Radcliffe Institute for Advanced Study; the Francis A. Countway Library of Medicine at Harvard University; and the American Philosophical Society Library in Philadelphia. Their attention to preserving and facilitating the use of historical documents—especially documents featured in the Family Planning Oral History Project Papers, the Mary Steichen Calderone Papers, the John Rock Papers, and the George Washington Corner Papers—made this project possible. There can be no doubt that this book benefited dramatically from the feedback of Leah Ceccarelli and Michael Bernard-Donals, editors for the Rhetoric Society of America’s Series in Transdisciplinary Rhetoric, as well as from the careful readings of expert reviewers John Lynch and Amy Koerber. At Pennsylvania State University Press, I was incredibly lucky to work not only with Kendra Boileau but also with Alex Vose. I am thankful to Susan Silver, who, in copyediting this manuscript, taught me more than a few things about clarity and grace. Over the years my family has been supportive of my research in countless ways, asking questions, expressing interest and enthusiasm, caring for newborns and toddlers, and sending treats. Thanks are due, notably, to Rosemary Bender, Ginger Grey, Diana Jensen, Gretchen Jensen, Judd Jensen, and Sally Lynam. I would also like to thank my grandmother, the late Janis Frank, and my fatherin-law, the late Bob Jensen, both of whom were there when this book was being written and expressed so much unmitigated faith in me that I couldn’t help but believe that I would do this book justice. This project was bookended by the pregnancies and births of my two children, Jor Xavier and Dane Robert. I thank them not only for their brilliant smiles and intoxicating cuddles but also for the role they played in facilitating my embodied appreciation for some of the matters at hand. Finally, I cannot possibly make clear how important my partner, Jakob Jensen, is to me and everything that I do. For this book he prepared images for publication, offered a second pair of critical eyes and a listening ear, nudged me to take more risks, and believed in me from start to finish. He is an amazing scholar, an unbelievable parent to our children, and the person who makes me laugh harder than anyone else. My journey and this book are better because of him.

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Introduction

The 2010 Nobel Prize in Physiology or Medicine was awarded to English physiologist Robert G. Edwards for his work developing in vitro fertilization (IVF) technologies with his colleague Patrick Steptoe. The award not only recognized Edwards’s career achievements but also highlighted the significance of IVF to both modern-day medicine and twenty-first-century society. Edwards won the award thirty-two years after the first baby conceived via IVF was born. Today, the baby (now woman and mother in her own right), Louise Brown, has become nothing short of an icon in an era in which conception, pregnancy, childbirth, and neonatal care are increasingly facilitated by elaborate medical technologies. As rhetorician Celeste M. Condit explains, IVF “serves as an excellent marker for the new phase of human reproduction in which we now live.” Since Edwards and Steptoe’s scientific contribution and Louise’s birth, approximately five million babies have been conceived through IVF, and more than 140,000 IVF procedures are performed each year in the United States alone (about 20 percent of IVF procedures eventually result in a live birth). A far cry from the overview of conception in most biology textbooks, IVF requires that reproductive specialists manipulate a woman’s hormones to collect eggs from her body, then combine the collected eggs with sperm outside of her body, and finally transfer the resultant embryo(s) into her uterus postconception. Ideally, the embryo then implants in the uterine lining and begins to develop into a fetus. In no small sense, then, IVF requires that potential parents position scientists, endocrinologists, and physicians as central players in the realization of their fertility. The emergence of IVF, as well as similar, increasingly complex treatments such as intracytoplasmic sperm injection, gamete intrafallopian transfer, ovum donation, gestational surrogacy, and mitochondrial replacement, is situated in relationship to a number of previous scientific developments and discourses that have functioned in various iterations to medicalize infertility. Sociologist

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Peter Conrad defines medicalization as the process by which scientific and medical expertise becomes valued over experiential knowledge and is used to categorize aspects of social life in terms of disease or abnormality. For example, scholars have examined the ways in which childbirth was medicalized in the nineteenth century. They have isolated a variety of interconnected political, cultural, and rhetorical mechanisms that functioned to supplant assumptions about birth as a normal part of the life cycle—best overseen by female relations and midwives in the home—with the contention that birth is an occasion for medical complications, best positioned under the purview of physicians working in closely monitored hospitals. This shift has been attributed, in large part, to the rhetoric of professional organizations such as the American Medical Association and members’ efforts to create a steady market for their expertise. In this book I demonstrate that what has been known in turn as “barrenness,” “sterility,” and, most recently, “infertility” or “involuntary childlessness” went through a corresponding transformation throughout the course of the twentieth century, though one that transpired in the midst of—and in response to—not one but multiple, diverse scientific narratives. I offer a detailed analysis of the complex processes by which infertility was (and is) medicalized and, in so doing, illustrate that medicalization is anything but a straightforward, deterministic process. Rather, medicalization emerges and unfolds according to dynamic rhetorical, material, and sociocultural encounters, incorporating pockets of what rhetorician Jenny Edbauer describes as discursive “cooptations” or points of resistance and often forming into interrelated but topologically divergent layers—what Conrad terms “degrees”—instead of one static, all-encompassing product. In the case at hand, I find that, although appeals aligning with that of medicalization can be traced back as far as the seventeenth century and garnered some following in the mid-nineteenth century, the medicalization process did not acquire significant traction until the 1930s, when rhetoric circulating from and around the new field of reproductive endocrinology defined sterile bodies as chemically activated machines in need of technical intervention. Rhetoric about “psychogenic infertility” at midcentury created the infrastructure for an additional layer of medicalization, as adherents of Freudian psychoanalysis incorporated women’s minds—as well as their chemical bodies—within the human (i.e., machine) in need of treatment. Most recently, the emergence of the integrated field of infertility studies in the 1960s and 1970s—and the concomitant shift toward comprehensive infertility research and treatment centers—articulated

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yet another layer of medicalization in that supporting discourse positioned the infertile mind-body, with all its potential causes and abnormalities, under the ongoing gaze of diverse, cooperating scientific experts employing an emergent transdisciplinary rhetoric. On its face this theory of medicalization as layered may seem to suggest a transparent, unidirectional portrayal of that process; however, the narrative offered in this book works to demarcate the medicalization of infertility—and the medicalization process in general—in terms of a range of disparate, sometimes clashing, rhetorical interactions that, in and through time, coagulate into overlapping zones of reiterative meaning. Medicalization is revealed herein to be always in process and therefore never what Conrad has described as “total.” On the whole, Infertility: Tracing the History of a Transformative Term is dedicated to answering one very basic question: what is human infertility? I approach this inquiry by exploring infertility not as a scientific or Platonic Truth writ large but as it has been constructed rhetorically through diverse arguments, appeals, and narratives over time and at particular historical moments. To this end, I offer something of what rhetorician Judy Z. Segal describes as a “kairology” of infertility via the “study of historical moments as rhetorical opportunities,” opportunities “subject to the vagaries,” disjunctures, and fissures of situations. More specifically, I consider how infertility has been defined in and across technical, mainstream, and lay communities; how these spheres of argumentation have shaped and transformed one another; and how different, emergent conceptualizations of infertility have had implications for individuals and the societies in which they live. My findings are drawn from analyses of unique primary sources originating in scientific laboratories, infertility clinics, doctor-patient correspondence, public lecture halls, and scientific and popular media coverage. They reveal that predominant explanations for infertility have surfaced in correspondence with seemingly competing scientific narratives related to social evolutionary theory, biochemistry, psychoanalysis, and reproductive medicine. My findings also demonstrate that, throughout the past century in particular, popular explanations for women’s reproductive health have incorporated and fluctuated between those that highlight individual women’s agency in establishing fertility and those that frame medical intervention as determinant. This interpretation of events reveals that—while there have been times when medicalization has functioned to limit, to some extent, the amount of moralizing and blame associated with infertility—many other historical instances soundly refute the idea that medicalization necessarily suppresses the practice of linking “illness”

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to moral failings. Thus, the subsequent account illustrates how moralizing often persists despite medicalization and thereby situates subjects as both responsible for their health and yet inherently incapable of meeting that responsibility on their own. Correspondingly, the case studies presented here provide some evidence that, when mechanical and organic metaphors are mixed together to describe infertility, medicalization may be especially likely to take on a moralizing component. What this account also offers, in a broader sense, is a study of rhetoric in, through, over, and according to time. Beyond attending to the role that kairotic appeals played in the installation of an emerging transdisciplinary rhetoric about infertility in the second half of the twentieth century, this book also considers the percolation of rhetoric about infertility over and through time, what philosopher Michel Serres describes as the unavoidable “repetition” or “echoes” of what has long been conceptualized as chronologically past topoi. I cite Serres’s comparative theory of time not (only) because he employs stories of Aphrodite—the Greek goddess of love, fertility, and procreation—to reason through his philosophy but (also) because he depicts history as “folded, wadded up,” or “twisted” rather than laid flat at fixed distances. He offers the following metaphor by way of theoretical explanation: “If you take a handkerchief and spread it out in order to iron it, you can see in it certain fixed distances and proximities. If you sketch a circle in one area, you can mark out nearby points and measure far-off distances. Then take the same handkerchief and crumple it, by putting it in your pocket. Two distant points suddenly are close, even superimposed. If, further, you tear it in certain places, two points that were close can become very distant.” Theorized in this “topological” sense, arguments, appeals, and narratives that are chronologically disconnected often reveal themselves to be interconnected in some sense in that they circulate not just horizontally but also “vertically” and “unexpectedly.” What this percolation model means for the study of rhetorical history (as well as, in this case, the emergence of a transdisciplinary rhetoric) is that the process of invention—what rhetorician Thomas M. Conley defines as the “modes of discovering arguments”—is always mixed with some degree of what Serres labels “redundancy” in that “we are archaic in three-fourths of our actions. Few people and even fewer thoughts are completely congruent with the date of their times.” For instance, although the idea that adoption spurs pregnancy in the involuntarily childless has, since the mid-twentieth century, been recognized as an antiquated myth, the so-called miracle of adoption has continued to emerge as an

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argumentative commonplace in both technical and mainstream media constructions of infertility even into the twenty-first century. In this case, traces or forms of past rhetorical constructions of infertility have percolated into contemporary rhetoric to help construct infertility today. The rhetorical history delineated here, then, attends to this conjecture that old ideas and arguments do not disappear when their chronological time (as measured, for instance, by widespread scientific acceptance) has passed but, instead, percolate at subsequent, often seemingly disconnected moments to combine and contend with newer arguments, appeals, and narratives. This topological framework does not do away with context but, to the contrary, privileges the specific circumstances of any one moment while also highlighting the repetitive forms that appear across such circumstances. Serres insists that “history is not born of provinces, but of circumstances,” and philosopher Kevin Clayton explains of Serres’s framework: “we experience the same selforganization and the same emergent social forms as different social groups across both different geographical spaces and different chronological times have done, not because there exists some Platonic Form of which there are copies, but because energy and information flows taking the paths of least resistance have found these forms to be the most stable, given the conditions of the prevailing milieu.” From this perspective, the study of historical conceptualizations of infertility becomes less about explicating the ways in which rhetoric used to construct infertility and more about how those constructions of the chronological past, those forms, are “wadded up” in constructions of infertility in the recent past and present. Rhetorician Amy Koerber contends of health rhetoric generally and the discourses surrounding contemporary infant-feeding practices specifically that “as new rhetorical commonplaces” come into being, chronologically older commonplaces are never entirely “replaced” because they intractably “ling[er].” More specifically, in the words of rhetorician Jenell Johnson, history from this standpoint “also relishes the synchronic view, pausing to dart sideways and slantways, in order to examine the interplay of particular texts and contexts in sometimes microscopic detail.” Following Koerber’s and Johnson’s complementary conceptualizations, this project works to convey a rhetorical history that repeatedly complicates the idea that the discursive past is made up of a diachronic succession of strategies, each superseding the other. However, as Johnson’s “also” intimates, this topological—or what she calls motion-oriented—approach does not propose that the temporal flow of rhetoric across and among argumentative spheres is without impact or does not function

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coherently or cumulatively. Unlike Serres’s argument, which suggests that history functions only in terms of percolation rather than in terms of flow or circulation—with the flow of chronological time offering only an abstract chain of reasoning for making sense of the incongruent “noise” that is time—the analysis that plays out here demonstrates that history is part and parcel of a broader rhetorical ecology as complex in its content as it is in its form, percolating and circulating, repeating and flowing in differing combinations in and through time. Even Serres seems to concede that it is only in attending to the flow of historical ideas in and across time that the existence of repetitive forms can be identified and the extensive diversity of rhetorical movement within an ecology can be delineated. Thus, while this inquiry speaks in an overarching sense to how historical constructions of infertility have percolated or jumped into the twenty-first century and other chronologically disjointed moments, the individual chapters themselves contextualize the circumstances of those percolations by tracing the rhetorical circulation of constructions of infertility within distinct, but still interrelated, chronological periods. This approach to the study of rhetorical history conceptualizes rhetoric and corresponding constructions of time and relationality as always moving, interactive, and transformative, an orientation especially beneficial in contexts of emerging and established transdisciplinarity, where individual fields of expertise necessarily and explicitly commingle. Regardless of the specific historical mechanisms at play, though, understanding how and why individuals define infertility in particular ways at certain moments is important for a number of reasons, not least of which is that such definitions often correlate with beliefs, attitudes, and even behaviors. Long before the twentieth century, women’s lack of success in bearing children was attributed to immorality, sexual perversion, strenuous intellectual work, and so-called masculine professional aspirations. These attributions encouraged childless married women in particular to devote themselves to endless prayer, undergo painful sessions of bloodletting and surgery without anesthesia, forgo education and professional opportunities, and, whenever possible, avoid work outside the home. In the twentieth and twenty-first centuries, rhetoric about infertility is more inextricably intertwined with talk about technology, medicine, and science than it has been in centuries past, but it plays no less a role in shaping individuals’ daily lives. In fact, it has been argued that, with increased scientific information about reproductive health, women who are deemed “infertile” face nothing less than a technological mandate to alter their behavior—sometimes endlessly—to

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achieve pregnancy and parenthood. This mandate is coupled with the “powerful cultural norm” of parenthood, as childbirth and motherhood are seen as a “vital component in the social definition of womanhood.” As a result, infertility clinics, products, and services have become a thriving international “baby business” into which billions of dollars are devoted each year. The Western, individualist belief that any goal is attainable with enough effort encourages those with fertility problems to continue devoting their capital to the baby business until they conceive and give birth to a healthy infant. Yet infertility treatments are frequently not covered by health insurance and thus can be limited to the extremely wealthy or those willing to devote all their resources to conceiving a child. In addition, single individuals and those who identify as lesbian, gay, bisexual, transgender, or queer, regardless of financial resources, may find themselves denied access to treatments because some insurance and health-practice policies require that applicants be heterosexual and married. Beyond financial woes, women for whom conception and pregnancy prove elusive are at a higher risk for suffering from depression, as well as from sexually transmitted infections (because they are more likely to forgo safe sex practices). They also experience higher rates of divorce, which may be exacerbated by the social stigmatization targeted at childless couples. Reproductive health promotions such as the American Society for Reproductive Medicine’s ongoing “Protect Your Fertility!” campaign encourage even those women who are not actively trying to conceive or who have no evidence that their reproductive abilities are, or will be, unsound to alter their behaviors to protect themselves from fertility problems. These alterations might simply involve taking a daily multivitamin or obtaining a yearly gynecological examination. But they could also involve becoming pregnant before one is financially or professionally secure or doing so without having the support of a long-term partner. They may involve seeking out expensive or medically inadvisable treatments when, given enough time, such treatments would prove unnecessary. Or they may involve an unwillingness to consider a future that does not feature motherhood as a centripetal force. All these scenarios play out differently according to an individual’s race, class, religion, sexuality, age, and nationality because rhetoric about infertility tends to foster “stratified reproduction,” in which members of some demographic groups are encouraged to reproduce and others are not. In this respect, so-called hyperfertility among individuals identified as minority or low-income is characterized as existing at the opposite end of the infertility-reproduction continuum and as

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posing a threat to society even greater than that posed by infertility among middle- to upper-class, heterosexual Caucasian women. The rhetorical history delineated here builds off of anthropologist Khiara M. Bridges’s argument that pregnancy and its aftermath are a “racially salient event,” animated by ideas about racial formation and inheritance. Indeed, technical and mainstream rhetoric about human reproduction has consistently constructed “infertility” as an “Anglo-Saxon” or “White,” middle- to upper-class woman’s condition, despite the fact that minority and low-income women have long suffered the highest rates of involuntary childlessness. In many cases, the communication of myths about, for instance, minority women’s excess sexuality and reproductive ease have precluded the idea that such women could be infertile, just as appeals to “race suicide” in the early twentieth century and the “population explosion” in the 1970s have been employed to make concerns about low-income, minority women’s reproductive health appear moot. Because infertility has—with very few exceptions—been constructed as a female condition, this analysis is closely tied to the study of gender, reproductive biology, and the social construction of womanhood. Although men and male bodies play a central role in the process of conception, the female body and its ability to conceive and carry a child to term have remained the primary focus of medical and societal discussions about barrenness, sterility, and infertility. Several important findings by reproductive endocrinologists emerging in the midtwentieth century threatened to shift some of the focus on the infertile female body toward the male. I explore how these findings were discussed in scientific and mainstream media coverage, how they were translated into rhetoric about “infertile couples” rather than “infertile women,” and how the language of “infertile couples” was subsumed by appeals to Freudian psychosexual development in the female specifically. In this respect, the following analysis illustrates how infertility as a subject position has repeatedly been enlisted to resist more inclusive definitions, a process that has depended heavily on scientific and pseudoscientific warrants. From a rhetorical and rhetoric-of-science perspective, this book is a study in invention and science as the frequent site of and contributor to such invention. Like rhetorician John Angus Campbell, I find that “diverse facts, images, and lines of argument” associated with specific scientific fields repeatedly function as topoi or jumping-off points for the construction of both disciplinary shifts and definitional changes as employed by broader publics. The chapters in this book demonstrate that prevalent definitions for involuntary childlessness have

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generally adhered closely to the arguments, appeals, and narratives associated with prominent philosophical and scientific fields of study. This is not to imply that science has dictated those definitions but, rather, that scientific and medical rhetoric has provided a number of warrants that science journalists, biomedical public relations writers, mainstream media reporters, and lay citizens have enlisted in various forms to make sense of infertility. The emergence of ideas in these cases has repeatedly defied a clearly top-down, or “deficit,” model of public understanding and suggests, instead, their development as coherent with the shifts, circulation, and percolation of a much more complex rhetorical ecology. Sometimes, for instance, scientific reports formally introducing an argument circulated almost simultaneously with corresponding mainstream media articles that made use of the very language and appeals just introduced. At other points, scientific refutations have not been widely reported by mainstream media outlets, and the general vocabulary of infertility has continued on, largely uninterrupted, as if a scientific refutation did not occur. In still other cases, patients have informed clinicians about their perceptions of infertility; those perceptions have then been communicated among experts and reported in scientific articles and, in this way, become encapsulated within experts’ prevailing theoretical understandings of infertility. Further complicating the process of accounting for the flow and percolation of ideas about infertility from one sphere of argumentation to another has been the increased tendency among scientists and clinicians in the twentieth century to speak directly to and with lay publics. This practice functions within what rhetorician John Lyne describes as a “symbiotic third culture” that involves the establishment of a “scientific ethos while also engaging in the dialect of a literate ‘common sense,’ ” a task that generally requires the communication of different content—delivered in different ways—from that of traditional technical rhetoric. The public rhetoric of technical experts (i.e., third-culture rhetoric) has been identified, recently, as undertheorized and in need of scholarly attention, and it therefore functions as a focal point in the project at hand. All this is to say, ultimately, that scientific conversations about social evolution, chemistry, psychoanalysis, and reproductive medicine encountered and were transformed in conjunction with a number of other shifting variables to define infertility in specific, persuasive ways at any given moment. To be sure, much scholarship has been dedicated to demonstrating that scientific practice is neither insulated nor entirely unique from other, less technical rhetorical activity. For instance, philosopher Donna Haraway argues that

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science is, first and foremost, a historically situated storytelling practice, a claim that has since been taken up widely by those studying the rhetoric of science. This delineation of science and its logics as narrative in orientation works against theories bent on highlighting the differences between, for instance, literal and figurative rhetoric, as well as those championing the supposed “transparency” of certain types of technical discourse and appeals. It is grounded in the “undifferentiated textuality thesis,” which, as rhetorician James Jasinski explains, contends that “all linguistic and discursive practices—scientific reports, poems, newspaper articles, political speeches, philosophical treatises, legal contracts, corporate ‘advertorials,’ radical manifestos, advice columns, and so on”— are inherently rhetorical in that they offer “restrictive” representations of the social world. The present work emerges from this perspective that, no matter the stylistic means or purposes, all rhetoric constitutes the world by naming it in one way rather than another. In this sense, scientific and medical rhetoric functions as what sociologist Alex Preda terms “knowledge-producing social sites,” which trade in symbolic force through more or less narrative structures. These structures, however, are anything but static, and thus a growing body of scholarship has focused on tracing and thereby assessing the means through which science narratives in particular circulate, shift, transform, and are refuted. This book contributes to that conversation, finding that, although the overarching scientific narratives that emerged to help constitute infertility sometimes traded explicitly in competing arguments and ideologies, in some cases newer scientific narratives gained widespread traction not by competing with or explicitly refuting the status quo but by arguing that the newer narrative’s tenets were simply extensions of what previous narratives had proposed. For instance, theories of psychogenic infertility at midcentury generated support by demonstrating, repeatedly, how newer psychoanalytic narratives aligned with and built from the chemical theories of reproductive endocrinologists. In this situation, the newer narrative was actually grounded in very different assumptions about infertility’s causes and cures, but the strategy of narrative extension functioned to disarm potential critics by upholding the facade that nothing new had been introduced. In this regard, I find that the construction of infertility in and over time tends to be as much about how scientific narratives have competed with one another for widespread acceptance as about how they have built from, linked with, and distorted or transformed one another. Of course, the ways in which scientific and medical narratives are constituted depend not just on the discursive negotiations of technical experts but also on

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the rhetorical efforts and imaginings of popular and lay publics. Public vocabularies, what Condit defines as the “acceptable words, myths, and characterizations used for warranting social behavior in a community,” are part of the “distributed ecological spread” that functions to shape and otherwise transform scientific and medical narratives. As Johnson explains, mainstream media representations of scientific and medical topics, no matter how technically inaccurate or “wrong,” offer resources for constituting and making sense of culturally relevant subjects. Rhetorician Elizabeth C. Britt demonstrates that the same can also be said of interpersonal or vernacular accounts of such subject matter. Assessing what infertility has been, is, and will be depends on an analysis of the interplay among technical, mainstream, and lay iterations of infertility. The account at hand, therefore, attends to the mutually constitutive relationships among technical representations of science and medicine in history, popularpress media coverage, and what social psychologist Wolfgang Wagner terms “vernacular science knowledge” or the “widely distributed form of popular understanding of science.” To identify and explicate these relationships, I draw largely from a critical rhetoric orientation, which involves the identification of fragments of discourse, such as sections of speeches, interviews, and newspaper articles, and then the use of those fragments to build arguments about how rhetoric constructs and shapes communities’ values, beliefs, and behaviors. Critical rhetoric rejects the notion that texts are stable entities that individuals encounter uniformly from beginning to end. Instead, this approach works from the assumption that discursive fragments interact with one another to create meaning. Thus, rather than analyzing a single speech, book, or self-contained manifesto, the critical rhetorician considers multiple speeches, books, and other artifacts as representative of, and providing clues about, the larger rhetorical ecology in which those fragments circulate. The goal for critical rhetoricians (and rhetorical scholars in general) is not to put forth objective, generalizable findings, for, as rhetorician Angela G. Ray explains, rhetoric is, by definition, “an art of the particular.” Rather, their aim and mine is to present a compilation of interrelated, pertinent discursive fragments and delineate emergent knowledge claims detailing how meaning seems to be created therein. The knowledge claims in this book are designed to offer a rhetorical history of infertility that highlights the processes of addressing publics through discourse. The emphasis in this case, then, is less on how individual rhetors may have intended to use rhetoric to persuade audiences—although that issue plays

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a role as well—and more on the formation of arguments, appeals, and narratives within a rhetorical ecology that includes diverse and competing variables related not just to rhetoric but also to material, social, cultural, and legal spheres. Attending to this broader, fluctuating constitutive landscape illustrates how rhetoric evolves as it “mov[es] across” and percolates up from that topography, revealing itself not as a singular, static endeavor but as an ongoing transformative “public(s) creation.” To delineate rhetoric as a public creation requires the critic to identify and assess not just relevant discursive fragments themselves but also, and even more important, the relationships between and among those fragments. In this specific case, that approach plays out in terms of the identification of historical discussions of infertility in books, speeches, media accounts, professional papers, and letters, and then the analysis of those fragments in terms of their “encounters,” as Edbauer calls it, with one another. I explore, for instance, whether and how these sources explicitly cited one another, whether they used similar or contrasting arguments, and whether their narrative structures feature similar or contrasting appeals. This process is designed to highlight the co-construction of not only infertility but also sex, gender, race, and health more generally. As one might expect, a number of key discursive fragments under analysis in this project are extensively visual in nature. Understanding the relationship between these fragments and those more textually based—while also recognizing, as rhetorician Cara A. Finnegan argues, that all rhetoric can and should be considered through the lens of visuality—requires attention to medicine’s robust visual history. Over the past few decades, scholars from a range of disciplines have made important interventions into the study of reproductive health, specifically, by focusing on the role of microscopic and fetal imaging. Anthropologist Janelle S. Taylor, for instance, explores how the fetal sonogram—or, more precisely, the fetal sonographer—personifies, fetishizes, and commodifies the fetus, often representing race, class, sex, and gender in ways that promote potentially harmful political agendas. Twentieth-century audiences were given—for the first time—the opportunity to see, through a range of what sociologists Bruno Latour and Steve Woolgar would term “inscription devices,” such as X-ray machines, extraction apparatuses, and culdoscopes, depictions of reproductive organs and the processes of conception and gestation. However, as anthropologist Rayna Rapp points out, much of this imagery was (and is) all but impossible to decipher without the guidance of professionals. In this respect, many visual representations of (in)fertility came

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to have meaning primarily through the initial filter of experts. Thus, I analyze not only the infertility-related images that circulated in scientific journals and popular-press articles during the twentieth century but also the manner in which audiences were instructed to interpret them and thereby “see” infertility. More specifically, I identify how experts narrated images of (in)fertility—both among themselves and with lay publics—and argue that those narrations played a central role in constructing infertility. Correspondingly, I consider how associated representations were framed for mainstream audiences by the popular press. Under rhetorician David Zarefsky’s helpful schema of different “senses” of rhetorical history projects, this book would likely best be categorized as the “study of historical events from a rhetorical perspective” in that the focus is on delineating infertility in history through rhetoric. Where Zarefsky lays out this sense as one that explores how “messages are created and used by people to influence and relate to one another,” the project at hand is as interested in the messages themselves as in the encounters, interconnections, co-optations, and transformations that such messages undergo. The subsequent chapters therefore highlight these interests and come together to form an extended study of rhetoric, science, medicine, health, and argumentation as moving, relational, affective, and circulating yet, in many ways, folded up. The chronology featured in these chapters offers not a statement on the linearity of history but, rather, what Serres would label a chain of reason for articulating both the circulation of rhetoric in specific eras and the many points of discursive percolation and fissure that happen across time, the former of which is the major focus of the book’s conclusion in that it adopts Serres’s comparative methodology to analyze chronologically disconnected examples from the earlier chapters. Chapter 1 explores the metaphorical predecessors of the term “(in)fertility” and thereby builds an infrastructure for the book’s subsequent analysis of these metaphors as they were repeated and employed in various ways at chronologically disconnected points throughout the twentieth century. Drawing primarily from three influential texts spanning the mid-seventeenth to the midnineteenth centuries, I analyze the shifts in focal metaphors (i.e., from barren to sterile), as well as associated clustering metaphors (i.e., fruit, machinery), to trace how these metaphors supported the moralization and/or medicalization of involuntary childlessness. My findings shed light on how individual women were discursively situated—through the evolution and mixing of specific metaphorical vehicles—as responsible (or not) for their reproductive abilities and

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output. I demonstrate that a nineteenth-century shift in reproductive metaphors to the realm of the inorganic was accompanied by a reduction in fear appeals and personal responsibility rhetoric. In the early twentieth century, as metaphors of sterility were mixed with metaphors of organic growth, involuntary childlessness was increasingly framed as both a product of female volition and as resultant of the female body’s mechanical failure. Chapter 2 analyzes the arguments upholding the major model of reproductive health at the turn into the twentieth century: energy conservation. Drawing from social evolutionary theory, individuals such as physician and Harvard professor Edward H. Clarke publicized a narrative of energy conservation and human reproduction asserting that the preservation of women’s “vital forces” (i.e., their fertility) depended on their ability and willingness to abstain from higher education and professional employment. In contrast to narratives emerging from earlier epochs of gynecological study, I find that Clarke’s narrative drew from both organic and mechanistic metaphors to frame Anglo-Saxon women as responsible for their childlessness, either because they had renounced motherhood entirely to pursue their own (selfish) interests or because they failed to properly conserve their energy during their fragile adolescent years and thus never acquired the physical ability to reproduce. Furthermore, I extend historian Sue Zschoche’s work by exploring how and why public arguments about women’s reproductive health continued to offer a reconstituted narrative of energy conservation well into the twentieth century. In chapter 3 I interpret early scientific, mainstream, and lay rhetoric engaging reproductive endocrinology and infertility to elucidate what I theorize as an initial layer of infertility’s medicalization. More specifically, I analyze the chemical vocabulary of human reproduction that came to fruition in the 1930s and 1940s. I find that, as appeals to vital energy and moral physiology were supplanted or joined with discussions of internal chemistry and medical intervention, fertility was reenvisioned as a derivative of chemical interactions that could be synthesized and had the potential to mirror and even improve on nature. The chapter as a whole demonstrates how chemical rhetoric was appropriated to reenvision sex, gender, and reproductive health in light of appeals to biochemical variability, artificiality, and technical expertise, and it also generates evidence to support the argument that appeals to medicalization often do not align with the elimination of appeals to morality and moralizing. Chapter 4 focuses on the formation of what I posit as an additional, though intricately interrelated, layer of infertility’s medicalization through post–World

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War II appropriations of Freudian psychoanalysis in medical and mainstream media. I argue that advocates framed these appropriations as extending, rather than refuting, ongoing chemical theories of infertility. At this point, interest in “psychogenic infertility”—the idea that women who could not conceive were emotionally or mentally stunted—combined with propaganda campaigns that stigmatized childless women for their supposedly purposeful infertility. This analysis functions, first, to outline the alarmist rhetoric that fostered a virtual mandate for white, middle- to upper-class women in particular to reproduce and engage in traditionally feminine activities; second, to highlight the rhetorical strategies used to build from and thereby complicate chemical narratives of reproductive health; and, third, to delineate what I term a “hermeneutics of the reproductive female,” featured in much midcentury clinical rhetoric, that instructed practitioners to interpret infertile women’s minds and bodies for signs of psychosexual dysfunction. Chapter 5 explores the coming together, in the 1960s and 1970s, of multiple scientific disciplines under the rubric of a larger field of infertility studies and thus the emergence of a transdisciplinary rhetoric of infertility. I argue that this process contributed yet another layer of medicalizing discourse to the evolving characterization of involuntary childlessness. This chapter demonstrates that appeals to time—or, more specifically, appeals to clinical tracking, managing, and otherwise intervening in reproductive timing—served as the rhetorical common denominator for this transdisciplinary effort. I find that to be “fertile” in the second half of the twentieth century was to be functioning within scientific and clinical time, while to be “infertile” was to be out of time, often in more than one sense. I trace this definitional metaphor to the emergence of the biological clock trope in the 1980s and its continued employment in the twentyfirst century, and I consider the implications of this discursive temporal regime for constructions of sex, gender, and women’s reproductive health in general. Finally, the concluding chapter demonstrates that mainstream explanations for women’s reproductive health have involved the percolation, circulation, and blending of historically distinct arguments related to (a) individual women’s agency in preventing infertility and (b) the framing of medical intervention as determinant. This chapter situates contemporary rhetoric about infertility in relationship to this historical percolation in which women are blamed for their inability to bear children and objectified as bodies that require the intercession of technical experts to be restored to normalcy. Therein, I draw from and compare findings from proceeding chapters to reiterate a layered—though never

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“total” or complete—model of medicalization and to further demarcate the relationship between the flow of temporally connected rhetoric and the percolation of chronologically disconnected arguments in the formation of what, in this specific case, became a transdisciplinary rhetoric. In closing, Infertility: Tracing the History of a Transformative Term inquires into rhetorical constructions of infertility, the ways in which rhetoric flows and percolates in history, and the processes by which seemingly technical rhetoric from diverse fields relates to and interacts with other fields, argumentative spheres, and broader rhetorical ecologies. The latter inquiry is especially telling in this case, as the study of infertility transformed, in the 1960s and 1970s, from a disciplinary-specific endeavor to a transdisciplinary project. This breakdown in disciplinary boundaries required that scholars, clinicians, and “patients” alike develop rhetorical norms and patterns that worked across and beyond expertise. In this instance, those patterns played themselves out in terms of appeals to clinical timing. What becomes clear in examining the rhetorical history of infertility presented here is both the malleability of disciplinary interaction and the ways in which rhetoric is forever constituted anew out of the percolation, circulation, and transformation of what has come before.

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1 From Barren to Sterile | The Evolution of a Mixed Metaphor

Metaphors are figures of speech in which a word or phrase (i.e., the vehicle) is used to communicate an idea or subject (i.e., the tenor) to which it does not apply literally. Although it has long been recognized that the interaction between vehicle and tenor creates a meaning distinct from that of the original terms, only recently have scholars begun theorizing about situations in which two or more different vehicles are used to reference the same tenor. For instance, early twentieth-century medical experts routinely described married women without children as “fruitless” and “in need of repair,” “barren” and “broken,” thereby framing women’s inability to bear children through the conflicting lenses of the natural organic world and the world of machines. Rhetorician Leah Ceccarelli contends that these “mixed metaphors” are constructive subjects of rhetorical analysis, particularly in terms of the complex interactions among the distinct vehicles at play therein. In this chapter I analyze early historical discourses about “(in)fertility”— which constitutes both a metaphor in and of itself and a tenor that has been explained in terms of mixed metaphorical discourses of the past (e.g., reproductive bodies as fruit bearing and as mechanical)—and demonstrate that the interaction of a mixed metaphor’s distinct vehicles is dependent on those vehicles’ historical uses. Indeed, philosopher Richard Rorty argues that vehicles for individual tenors shift and change over time, moving into the realm of the literal and the metaphorically “dead” (or what anthropologist Emily Martin theorizes as “sleeping”) when they become commonplace or when they no longer meet the communicative needs of a community. As metaphorical vehicles for a given tenor shift, they not only offer competing perspectives but also, in some cases, coalesce and form entirely unique mixed metaphors composed of metaphors of old. In this respect, understanding the mixed metaphors clustering around “(in)fertility” depends on the rhetorical delineation of individual vehicles’

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historical and ongoing uses, as well as the conditions of those vehicles’ evolution, repetition, and combination. In the context of contemporary women’s reproductive health, the term “(in) fertility” is as ubiquitous as it is fraught with seemingly endless uses and connotations. But it was not until 1868 that the obstetrician James Matthews Duncan first used the word “fertile” to reference women who gave birth (or had the potential to give birth) to numerous children. According to Duncan, the more children a woman was capable of having, the more “fertile” or “fecund” she was. By the end of the twentieth century, Duncan’s metaphor had moved into the realm of the literal, as physicians and laypersons alike routinely enlisted the term “fertile” to describe women with many offspring (or the potential for many offspring), just as they enlisted the term “infertile” to describe married women who remained childless (or who bore few children). Today the term “fertility” endures as the most common denotation for women’s reproductive capacity. Even scholars who explore delineations of women’s reproductive ability among people in non-English-speaking regions across India, Africa, and the Middle East deem “(in)fertility” the most fitting translation for the ideas communicated therein. The enduring, widespread nature of Duncan’s metaphor raises questions about its emergence, as well as the terms that preceded and clustered around it. Extensive discourse about women’s reproductive problems and capabilities can be traced back as far as the writings of ancient Egyptians, Hebrews, and preHippocratic Greeks. Over the past few centuries, the terms “barren” and then “sterile” have functioned as metaphorical predecessors to “infertile,” serving—at certain historical moments—as common denotations for women’s inability to become pregnant or bear healthy children. They have also, at times, percolated into chronologically disconnected moments throughout the twentieth and twenty-first centuries and thereby produced rhetorical co-optations and fissures in an era’s rhetoric on reproduction, a point that becomes clear in the larger history of such discourse. On the whole, then, this chapter is dedicated to contextualizing contemporary rhetoric about infertility by examining preceding shifts in reproductive metaphors for infertility and building an infrastructure for the book’s ongoing analysis of these terms as they were repeated over time. Throughout the analysis I explore the facilitating role that these metaphors played in moralizing and medicalizing involuntary childlessness and thereby positioning individual women as more or less at fault for their lack of children, particularly as specific metaphorical vehicles evolved and eventually came to mix

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together. Nineteenth-century rhetoric referred to “sterile” female bodies as machines in need of repair by a surgeon and, in this way, constituted women as somewhat outside the realm of culpability for their childlessness. This rhetoric, in contrast to earlier rhetoric that referred to women as “barren” and therefore unbalanced, unnatural, or not right with God, offered them few opportunities for self-help but much in the way of surgical hope (despite the relatively bleak success rates of surgical interventions at the time). Sterile bodies could be fixed by medical intervention, but barren bodies were a sign of one’s moral failings and required individual women to behave in prescribed ways and pray for God’s blessings. In this respect, I argue that the nineteenth-century shift in reproductive metaphors to the inorganic was accompanied by a decline in fear appeals, as well as rhetoric deeming individual women personally responsible. Subsequently, in the early twentieth century, as metaphors of sterility and mechanics shifted back to and mixed with metaphors of organic growth via Duncan’s fertility metaphor, involuntary childlessness was increasingly framed as what medical historian Margarete J. Sandelowski labels a “failure of [female] volition” and as resultant of the female body’s mechanical failure. This concluding case illustrates how a seemingly medicalizing discourse can take on a decidedly moralizing function, particularly when facilitated by the employment of organic and inorganic—or mixed—metaphorical appeals. Positioned at the center of this chapter’s analysis are three primary texts that have been widely recognized as culturally influential and as representative of larger trends for explaining female reproduction. Nicholas Culpeper’s A Directory for Midwives; or, A Guide for Women, in Their Conception, Bearing, and Suckling Their Children was widely circulated throughout the lay populations of England and the American colonies and was ultimately reprinted seventeen times after it was first released in 1651. Aristotle’s Master-Piece; or, The Secrets of Generation Displayed in All the Parts Thereof was anonymously published in 1684, reprinted more than a hundred times, and, according to the medical historian Mary Fissell, “became the best-selling guide to pregnancy and childbirth in the eighteenth century.” And Clinical Notes on Uterine Surgery: With Special Reference to the Management of the Sterile Condition, published in 1867 by the notorious “father of gynecology” J. Marion Sims, was mandatory reading for would-be and practicing gynecologists well into the twentieth century. These texts were aimed at midwives, lay women, and surgeons, respectively. The earlier two texts targeted lay readers (midwives were considered lay audiences because they were apprenticed rather than educated formally), while the later text targeted

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medical professionals. This shift in intended audience supports historians Margaret Marsh and Wanda Ronner’s theory that infertility was first deemed a treatable, medical disorder in the nineteenth century. As reproductive agency was repositioned into the hands of medical associations and their members, texts about reproduction began catering to those audiences. In this way, these texts illustrate a trend in many other discourses from their respective periods that featured similar appeals but were not as widely disseminated or renowned. My analysis traces how metaphors were used and how they evolved in these widely circulated texts. I analyze “imagetexts”—“composite, synthetic works (or concepts) that combine image and text”—from the two works that featured illustrations: Aristotle’s Master-Piece and Clinical Notes on Uterine Surgery. Recent scholarship demonstrates that imagetexts can and do “cultivate productive metaphorical (and thus rhetorical) invention,” just as textually based metaphors encourage individuals to envision the tenor in question as the vehicle. To be sure, imagetexts are frequently metaphorical, and, as such, their analysis contributes another dimension to the study of metaphors as mixed. On the whole, my analysis of these three aforementioned texts identifies the key metaphors for married women’s childlessness evident therein, as well as the corresponding terms that “clustered” around those metaphors and constitute the underlying perspectives framing the tenor at hand. In this way, I am able to demarcate the metaphorical evolution of involuntary childlessness from “barren” to “sterile” to “infertile,” a task that involves examining how each new figure corresponded with specific rhetorical appeals and promoted distinct perceptions of married women’s childlessness. I conclude the chapter with a consideration of late nineteenth and early twentieth-century mixed metaphors for infertility in light of the historical uses and implications of their individual vehicles.

Barren: Metaphors of Soil, Seed, and Fruit In the largely agrarian communities populating seventeenth- and eighteenthcentury Europe and the American colonies, only families with many healthy children could successfully shoulder their livelihood’s unending demands. The biblical injunction to “be fruitful and multiply” was more than a religious ideal in this context. Daily life revolved around the rhythms of planting seeds, harvesting crops, and tending animals, all of which depended on the continued

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growth of the family and surrounding community. Thus, metaphorical descriptions of childbearing women as rich “soil,” fostering sustained growth and prosperity, would have corresponded with communities’ overarching interests and values. Likewise, descriptions of involuntarily childless women as “barren,” unable to produce or nourish the next generation, would have played into widespread anxieties about communities’ longevity and survival. When coupled with the era’s high infant and child mortality rates, concerns about women’s inability to conceive or bear children were among the most pressing. In the majority of cases, seventeenth- and eighteenth-century women— rather than men—were considered the principal facilitators of generative success, because their bodies were held up as the locus of reproduction. In this context, so-called barren women were routinely characterized as personally at fault for their inability to metaphorically flower or bear fruit. In an effort to become pregnant and thereby redeem themselves as valuable members of the community, they were encouraged to engage in diet- and exercise-related selftreatments, visit midwives who would offer herbal remedies, and pray. Nicholas Culpeper’s 1651 guidebook A Directory for Midwives; or, A Guide for Women, in Their Conception, Bearing, and Suckling Their Children, communicated these directives, although it did not include the religious appeals to prayer evident in other texts of the time, such as Aristotle’s Master-Piece. Culpeper, an English apothecary and renowned medical writer, promoted Enlightenment ideals related to equality and reason. He professed vehemently against religious tyranny, the English monarchy, and the Royal College of Physicians, framing Directory for Midwives as an informational guide for all classes of women that would allow them to cure their own generation-related ills. Culpeper hoped the book would help women to circumvent the oversight of religious, royal, and medical authorities and develop into what Fissell labels “vernacular healers.” He structured the short, pocket-sized text in a question-answer format that was informal and invited readers to reference desired information quickly. In its discussion of topics such as anatomy, conception (or lack thereof ), miscarriage, and labor, Directory for Midwives featured the term “barren” as a focal metaphor for women’s childlessness within marriage, as well as associated metaphorical lenses for generation (e.g., “seed,” “fruitful,” “nourish”). These metaphors were introduced in the context of semence theory, which can be traced back to Hippocratic writings and holds that pregnancy results from the successful combination of male and female “seed.” Culpeper articulated conception as the result “of fruitful seed spent by a man, and mixed with a woman’s seed to

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perfection, for the making of a child by the retentive and altering faculty of the womb.” The woman, according to Culpeper, must orgasm to “retain” the mixed seeds in her womb. The woman’s blood must be healthy so that it can nourish the seeds, and the womb must maintain a climate conducive to the seeds’ transformation and growth. In this respect, the woman’s role in reproduction is not only that of contributor of seeds but also that of the pregnancy’s “soil” (i.e., the mother’s womb) and “nourishment” (i.e., the mother’s blood). Thus, Culpeper reasoned that “barrenness is often from a fault in the women [rather] than the men”; for “the men there is nothing required but fruitful seed spent into a fruitful womb. But women, besides the meeting of their own seed, must receive, retain, and nourish the man’s; and afford matter to the forming of the child in which diverse accidents happen, and any of these will cause barrenness.” From this perspective, so much of the organic process of conception and childbearing is the woman’s responsibility that she alone must also be responsible for seeking out ways to rectify her childlessness. This specific argumentative topos concerning women’s complex reproductive functioning would echo repeatedly at chronologically distinct moments in the years to come. Culpeper’s text offered barren women a variety of possible cures, many of which he likely discussed with his own wife, who long struggled to bear healthy children. These cures depended heavily on an ideal of balance and bodily equilibrium, derived from Galen’s humoral theory. Readers were instructed to ensure that their wombs were neither too hot, moist, cold, or dry, as such imbalances would almost surely result in one’s inability to conceive, carry, and birth fit offspring. Culpeper painstakingly delineated all the different scenarios that might result if different types of bodily imbalance were to ensue, noting, for instance, that “heat of the womb is necessary for conception; but if it be too much, it nourisheth not the seed of the man, but disperseth its heat, and hinders the conception.” He explained to his readers that, just as a plant requires warmth from the sun to grow, so does a potential or fledgling pregnancy require just the right amount of heat from the womb. But too much heat would end the pregnancy just as it would harm the plant. And just as the frozen grounds of winter bear little plant life, Culpeper argued that “cold and moist [wombs] are hard to conceive [in],” while a “cold and dry womb is commonly barren.” According to Culpeper, an emerging pregnancy is just as sensitive to upset as is a crop of corn or a berry-yielding bush. Thus, he concluded that the female body’s environment and treatment must be monitored closely to ensure fruition.

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Culpeper coupled his complex, nebulous map of all the possible reasons that a woman might fail to “flower” (i.e., menstruate) or bear “fruit” (i.e., conceive) with a corresponding record of concrete recommendations that individual women could follow to try to overcome their barrenness. Although he framed barrenness as largely the fault of individual women, he also framed most women as capable of altering their behaviors and circumstances to address their generation-oriented troubles. For one, they could enlist a midwife to concoct one of the many herbal recipes that Culpeper scattered throughout the text— searching, perhaps endlessly, for just the right balance of succory, endives, violets, or water lilies to, for instance, cool their overheated wombs; these plantbased cures bore metaphorical witness to the organic nature of the problem at hand. Correspondingly, women were instructed to eat a diet that would “resist evil humors” and included “good juice” and not “salt, sharp, and sour things.” If this approach was unsuccessful, they might increase their efforts to achieve bodily equilibrium by avoiding excessive sex, exercise, hard travel, the use of sharp pessaries, dancing, crying, or even coughing, for these activities would certainly keep the womb from retaining the “seed.” And all women, regardless of their specific health conditions, were encouraged to avoid such “external causes” of barrenness “as eating the heart of a Deer, or if she wear Jet about her, or if Harts-tongue be hanged about her bed; if she walk over the terms of another, or tread up on them unawares, or anoint with them, or put the juice of Mints into her womb.” Here and elsewhere, Culpeper’s metaphors of “barren soil” and “fruitless seed” were used to cultivate the belief that individual women—situated in this case as farmers—had the ability to monitor every detail of their environments, emotions, and behaviors until their bodies, at long last, sprouted. Culpeper’s message of constant vigilance was echoed in Aristotle’s MasterPiece; or, The Secrets of Generation Displayed in All the Parts Thereof, as was the focal metaphor “barren” and associated clustering metaphors of “fruit,” “nourishment,” and “sprouted seeds.” Described by contemporary scholars as primarily a religiously ordained “sex manual,” the anonymous, widely circulated manuscript devoted a significant amount of text to the topic of barrenness, its causes, and its cures. The text’s authors—most likely seventeenth-century English medical writers hoping to capitalize on the credibility of Aristotle’s existing publications on generation—justified their work by explaining that God ordained sex between married couples and demonstrated approval by blessing them with offspring. The major difference between Aristotle’s Master-Piece and Directory for Midwives was the former’s appeal to divine authority. While Directory for

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Midwives included several indirect appeals about the importance of a woman’s soul or spirit to her generative success, Aristotle’s Master-Piece argued explicitly that those who were out of God’s favor would never reproduce. Early in the text, the authors explained that “when a young Couple are married, they naturally desire Children, and therefore use those means that Nature has appointed to that end. But notwithstanding their endeavors, they must know that the success of all depends on a Blessing of the Lord; and Children are a Blessing of the Lord.” Just as God’s “Holy Spirit” drew from the “Abundance of his Goodness” to impregnate the “Vast Abyss,” Aristotle’s Master-Piece argued that “no Fruits nor Pleasures, no Creature that hath Breath had Being in the place this lower World possesses” until God so deemed it. Yet rather than claiming that childless women could do nothing beyond praying for God to grant them offspring, the authors of Aristotle’s Master-Piece laid out many of the same cures for childlessness set out in Culpeper’s work and, in so doing, employed extensive fruit- and soil-oriented metaphors. The overarching message seemed to be that, while God would ultimately bless one with children or not (and it was of the utmost importance for individuals to act morally and pray for that blessing), it was still necessary for women to make sure that their bodies were appropriately prepared if they were to be so blessed. For instance, the authors agreed that “since Diet may and will alter the evil state of the Body to a better, it is necessary that such as are subject to Barrenness should eat such Meats only as tend to render them fruitful; and among such things as are inducing and stirring up thereto are all Meats of good Juice that nourish well and make the Body lively and full of Sap.” Readers were led to believe that, if they consumed appropriate, difficult-to-procure foods, their bodies would be rid of evil and also flow and drip with the nutrients necessary for pregnancy. This directive was guided by humoral theory. Unlike Culpepper, however, the authors of Aristotle’s Master-Piece framed bodily equilibrium as a necessary— but not sufficient—prerequisite for conception. A woman might attain balance by, for instance, avoiding “hot Air, soft lying, hot Meats and Spice,” but this would cure her barrenness only if she was also in God’s favor. Once a woman became pregnant, the authors argued, she must not assume that she would necessarily birth a healthy child without due diligence. Throughout the text they provided extensive, metaphorically rich descriptions of how she should protect her pregnancy from termination, noting, in one case, that she ought to avoid the “Act of Copulation” for the first four months following conception because it “moves and shakes the Womb, and consequently the Fruit therein causes the courses to descend.” This depiction of someone jarring, say, an

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apple tree and causing unripened, inedible fruit to cascade to the ground was surely enough to stick in the mind’s eye of many newly pregnant women and ultimately stifle their affections. Similarly, the text also encouraged women to protect their growing bodies from the weather’s harsh elements, as one might do when tending a garden. In fact, they were literally instructed “to choose a Temperate Air, not infected with Fogs, airing from Marshes, Ditches, Ponds, Lakes, or Rivers, and not to go abroad in too hot, nor too cold Weather, nor when the South wind blows strong; for that Wind above all others, disturbs and disorders Women with Child, oftentimes causing Abortion.” Aristotle’s Master-Piece instructed women repeatedly in how to cultivate conception and a healthy pregnancy, implying that they had the self-efficacy and tools to help them achieve success. But the text also implied that those who were unsuccessful had somehow failed themselves and God, and they bore responsibility for their childlessness. That the directives offered were all but impossible to follow (e.g., avoid all south-blowing winds while with child, not to mention fogs and overly hot or cold weather) must have left many readers feeling anxious, guilty, and probably unworthy of what they understood as God’s blessing. What would have likely fostered even more uneasiness among readers of Aristotle’s Master-Piece was that the text extended the metaphors of barren soil, seed, and fruit to include the potential for the production of abnormal or unripened fruit. The belief that childlessness, miscarriage, and children born with deformities were products of the devil was so common at this time that many women accused of witchcraft were brought to trial, at least in part, because they were childless or had few healthy offspring. Arguments about the lurking evils of the womb in particular abounded and functioned as a synecdoche for the maternal body’s potential to be transformed from a productive, creative force into the source of all things monstrous. In Aristotle’s Master-Piece, women who were pregnant or hoping to conceive were warned against confronting any “monstrous sight” because it could easily transfer via her imagination into her womb and imprint itself on her unborn child. Drawing from the then pervasive theory of maternal impressions, the authors explained that “some Children again are born with flat Noses, wry Mouths, great blubber Lips, and ill-shaped Bodies, and most ascribe the reason to the conceit of the Mother, who has busied her Eyes and Mind upon some ill-shaped or distorted Creatures.” From this perspective, women whose thoughts became rooted in images deemed horrific, lusty, or otherwise unnatural would impress those images directly onto their progeny and, essentially, ruin them before they could be born. This sort of appeal to women’s capacity for birthing monsters upheld the “dominant view of subjectivity” by

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encouraging women who had not yet conceived or given birth to shield their eyes and minds from anything that might be perceived as untoward. Beyond disciplining women before the conception or birth of their children, appeals to the monstrous maternal were also enlisted as argumentative strategies to discredit individual women after they had given birth. For example, Aristotle’s Master-Piece featured an imagetext of a naked woman covered in hair, standing and followed closely by a dark-skinned, nondescript child (see figure 1). The illustration’s caption read, “The Effigies of a Maid all Hairy, and an Infant that was Born Black, by the Imagination of their Parents.” The accompanying text—a vital element of the imagetext as a whole—dealt not with the parents, as the caption suggested, but instead with the mother specifically, who “at the time of Conception” beheld the “Picture of a Black-moor” and subsequently “conceived and brought forth an Ethiopian.” The child, whose illustration served as a “visible image of its mother’s desire,” offered immediate proof of her guilt, guilt related not even to her sexual activity necessarily but to her private sexual longings. The child’s portrayal as a dark-skinned Ethiopian played into the racist reasoning that philosopher Rosi Braidotti finds at the core of teratology (i.e., the scientific study of monsters during the European Renaissance). What Braidotti deems the “racialization of the monstrous body” functioned both to conflate racial and geographical diversity with otherness and to argue that blackness and monstrosity were evidence of maternal sin. In this depiction, the mother’s body—like her child’s—was directly marked by sin. Her nakedness functioned to connect her with nature and what philosopher Julia Kristeva terms the “abject.” Her mass of body hair played into the trope of the “hairy virgin,” who was said to have been born from a mother who had, herself, “gazed too intently” on an illustration of Saint John wearing animal skins. In this way, the imagetext suggested that the sins of not one but two generations of mothers were to blame for the monstrous birth on display, a claim that added credence to the authors’ warning that “nothing is more powerful than the Imagination of the Mother,” as well as the admonition that all women iron themselves against the devil’s impending appropriation of their wombs and the fruit that might grow therein. In this respect, Aristotle’s Master-Piece took Culpeper’s message in Directory for Midwives one step further by positioning so-called barren women as lacking not only in terms of bodily health and equilibrium but also in terms of mental and spiritual fitness. The metaphorical lens driving these texts precipitated the belief that successful childbearing depended almost entirely on the relentless caution of individual women.

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1 | Illustration of a woman who had focused her attention on the image of a “Black-moor” and conceived and birthed an “Ethiopian,” featured in Aristotle’s Master-Piece (1684; repr., London: W. B., 1694), 39.

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Sterile: Metaphors of Machinery By the early nineteenth century a growing number of texts had traded the term “barren” for the term “sterile” and, correspondingly, traded reproductive metaphors related to soil, seed, and fruit for metaphors related to machinery. In the early days of its use in the context of human reproductive function, the term “sterile” seems to have been used as little more than a synonym for the term “barren” and thus generally associated with many of the organic metaphors that clustered around that term. Unlike “barren,” however, “sterile” and “sterility” were at first employed primarily in the medical realm. Within that realm, “sterile” quickly transitioned from its early organic associations to denote something of mechanical origin, particularly in light of the emergence of bacteriology in the mid-nineteenth century and, correspondingly, the growing use of “sterile” as a denotation for the safety and health afforded by the eradication of microorganisms. As Sandelowski explains, the language of sterility brought with it the implication that there was some underlying “mechanical” problem with the body, that the body itself must be considered as outside the realm of biological contaminants and as in need of technical-mechanical diagnosis and repair. Rhetoric from this time about human “generation” was inundated with references to “re-production,” a metaphor that functioned to frame conception and birth as elements of a manufacturing process. This machine-oriented metaphor aligned with the values of increasingly industrialized societies in Europe and the United States. Although agrarian-derived philosophies continued to offer constructive points of resistance, support for supply-and-demand economics, the separation of church and state, and scientific empiricism was growing. In this context, everything from social bodies to modes of mass communication was—at some point—contemplated as machines composed of individual, interconnected parts. In the realm of medicine in particular, the body-asmachine metaphor spoke to Cartesian iatromechanic philosophy, positing that the body and its parts subscribe to the tenets of mechanics. Although seriously challenged by the eighteenth-century theory of vitalism (i.e., the philosophy— examined extensively in chapter 2—that living organisms are constitutively different from nonliving organisms), many medical schools and associations of the eighteenth and nineteenth centuries ultimately came to champion the argument that the body is best understood as a machine, a contention that some argue is also a central tenet of contemporary biomedical models of medicine. By the second half of the nineteenth century, the development of “mechanical

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aids” such as the stethoscope and the speculum had contributed further to the circulation of discourses characterizing the human body itself—and the female body in particular—as a quantifiable, mechanical structure. Scholars have marked the shift in terminology from “barren” to “sterile” as a sign of fertility’s initial immersion within the realm of medical diagnosis, and much rhetoric from this period provides evidence for this claim. For instance, the term “sterile” was first used to refer to involuntary childlessness by Dr. James Walker in his 1797 monograph An Inquiry into the Causes of Sterility in Both Sexes, with Its Method of Cure. Walker employed the old terminology to introduce the new, noting that “Physicians should be induced to a diligent investigation of the causes of Barrenness; for upon inquiry it appears that many causes of Sterility are not without remedy.” He went on to brief his physician readers about sterility’s causes, signs, and cures and, thereby, prepare them to treat the childless, married woman’s body as a medical challenge in need of their professional oversight. Walker’s goal was to position treatment for sterility outside the realm of midwives, lay healers, and even childless women themselves, and over time the term “sterile”—when applied both to a state of cleanliness and to reproductive function—became synonymous with medical treatments and facilities. Dr. J. Marion Sims, author of the 1867 text Clinical Notes on Uterine Surgery: With Special Reference to the Management of the Sterile Condition, had a similar goal. Sims initially gained notoriety for his attempts to cure women of vesicovaginal fistula, a condition in which the septum that separates the bladder from the vagina is destroyed, usually as a result of prolonged labor. Those stricken with this ailment experience a constant, involuntary stream of urine—and sometimes feces—and eventual putrefaction of the vaginal cavity, which is accompanied by a fetid odor. Sims was convinced that he could surgically reconstruct the vaginal wall, thereby ending the suffering of numerous childbearing women. In the mid-nineteenth century he began testing his theories and surgical techniques on slave women in the southern United States. Congress had deemed overseas slave trading illegal in 1807, a decision that catalyzed reproductive engineering or “breeding” among existing slaves to ensure new generations of forced labor. In this context, Sims had little trouble finding slave owners who would offer afflicted slave women with the hope that Sims’s experimental methods would enable them to rejoin the workforce and maybe even produce more children. The ethics of Sims’s recruitment and data-collection methods have since been widely criticized, not only because he operated on those who could not give their consent to treatment but also because he operated as many as

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thirty times on individual women and, when treating slave women, never used anesthesia. Sims’s conceptualization of female patients as objective commodities on which to test his scientific hypotheses was something that he carried with him into his later gynecological work and writings. In 1853 Sims moved to New York and drew from the knowledge that he had obtained while experimenting on slave women to address the reproductive concerns of Anglo-Saxon women from a range of different social classes. By that time he had developed the Sims speculum to better observe women’s interior bodies, an accomplishment that situated him among the growing number of medical professionals dedicated to enlisting technologies to visualize and enumerate the body’s internal happenings. Sims used the evidence garnered from his speculum-guided examinations to conclude that most female reproductive problems were structural and required surgical intervention. In the years that followed, Sims opened the Woman’s Hospital of the State of New York and became even more convinced that a surgeon’s knife could solve almost any reproductive trouble a woman might encounter, including sterility. In Clinical Notes on Uterine Surgery, he delineated this perspective, metaphorically positioning women’s body parts as machines that, if broken down (i.e., diagnosed with amenorrhea or sterility), required the expertise of a mechanic (i.e., surgeon) to be restored to working order. Sims’s text characterized individual women as possessing very little agency related to the curing or prevention of involuntary childlessness and therefore as relatively disconnected from a sterility diagnosis. One could argue, though, that in the midst of his machineoriented, objectifying (and therefore undeniably problematic) discourse, Sims’s articulation of sterility may have offered Anglo-Saxon women in particular some degree of respite from the guilt, anxiety, and fear (i.e., the moralizing) that accompanied many discussions of the “barren” in years past (even if, as Marsh and Ronner have noted, Sims’s “cures” were of questionable validity). This interpretation would have been true, however, only to the degree that individual women were not also positioned as responsible for obtaining such treatment. In this case, such positioning would have been unlikely given the early and experimental nature of Sims’s clinical trajectory. While Directory for Midwives and Aristotle’s Master-Piece focused on helping readers to achieve bodily equilibrium, often from herbal, noninvasive remedies, Clinical Notes on Uterine Surgery focused on providing surgeons with the information that they would need to intervene in the “abnormal” (i.e., deviant) body and remove anything deemed extraneous or obstructive. Solving the problem of

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sterility, according to Sims, was “by means almost purely surgical” and might involve “attacking” an “offending organ” or forcing open an obstructed cervix. Absent from this almost four-hundred-page document were appeals to the natural, the balanced, or the noninvasive. Instead, the text focused on three primary ideas: the identification of “normal” reproductive body parts (often in isolation of the body as a whole), the standardization of medical knowledge for the surgical profession, and the demarcation of directives concerning how one might best alter the sterile body to achieve normalcy. Sims began the text by categorizing sterility according to several different “classes” and, later, noting that the “sterile, unimpregnated uterus” was the opposite of a “normal” uterus. He went on to define a “normal type” of cervix as rounded and truncated, and he featured an imagetext of a cross-sectioned, isolated cervix in the normal shape—complete with line drawings denoting different degrees of deviant positioning, which would, according to Sims, ultimately require surgical intervention (see figure 2). Out of context, a reader might never guess what this basic, undetailed “diagram” was intended to depict, as it included no sign of a woman’s body. In this respect, it was one of many nineteenth-century medical illustrations that functioned to “take women out of the picture, especially in the matter of generation and reproduction.” The illustration’s focus demonstrated that Sims’s concern was not on the body (woman) as a whole but rather on achieving the standard look and function of individual body parts (e.g., the

2 | J. Marion Sims’s illustration of an isolated, “normally” positioned cervix, contrasted with line drawings depicting different degrees of “deviant” positioning, featured in Clinical Notes on Uterine Surgery (New York: Wood, 1867), 214.

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cervix), all in the service of reproduction. In this respect, the body-as-machine metaphor and the mind-body dualism that is one of its underlying assumptions focused Sims’s treatments and writings not on patients’ subjective experiences or even their behaviors but on the apparent normalcy of their cervixes. Sims himself was quite explicit about his view of reproductive bodies and their functions as “mechanical.” He noted, for instance, that “the act of copulation is purely mechanical. It is only necessary to get the semen into the proper place at the proper time. It makes no difference whether the copulative act be performed with great vigour and intense erethism, or whether it be done feebly, quickly, and unsatisfactorily.” He then concluded that “provided the semen be deposited at the mouth of the womb, everything else being as we would have it.” Therein, Sims depicted the male body as an active “depositor” and the female body as merely a receptive loading area, the womb’s “mouth,” so called not to highlight the organic nature of the cervix but rather to mirror descriptions of, for instance, the “mouth” of a threshing machine or the “eye” of a camera. By delineating the mechanical nature of conception as a whole, he worked to debunk long-standing arguments concerning the necessity to conception of variables such as female orgasm, appropriate maternal images, and humoral balance. As long as all the body parts and substances were functioning and appropriately timed and positioned, Sims maintained, a pregnancy “would have it.” Conception, according to Sims, was no more complicated than, for instance, the process of achieving railroad locomotion, and, therefore, he wholeheartedly accepted the “charge of mechanical views.” Although Sims mentioned both male and female bodies in his discussion of conception, he focused most extensively on the mechanics of the female body— perhaps because he framed the male as a more active, agentic (i.e., nonmechanical) participant in the reproductive process. For instance, at one point in the text he provided instructions delineating how female patients should be positioned during certain types of pelvic examinations. He demanded that “the patient . . . be taught to maintain unflinchingly this position; she must not pitch forwards and make the pelvian angle obtuse.” The accompanying figure was not, as one might expect, of a woman bent awkwardly into some kind of painful, triangular pose, but of a simple line drawing illustrating a ninety-degree angle (see figure 3). Sims labeled each line with a lower-case letter and supplied the following explanation: “The knees are to be separated eight or ten inches; the thighs are to be at about right angles with the table; thus the plane of the table (ab), the axis of the thighs (ac), and that of the body (cb), would form a right-angled triangle,

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of which the thighs and table would make the right angle, and the body the hypothenuse.” This “schematic body,” as art historian James Elkins would label it, functioned as a “way of pushing the body to some distance, purging its objectionable stuffing or whittling away at its bulky skeleton until nothing but twigs remain.” Sims demanded that the woman’s thighs be as inert and precise as the “plane of the table,” their positioning dictated not by the feelings or abilities of their owner but by the surgeon’s need to view and access specific body parts. He assured his readers that “with my speculum everything is brought so plainly into view that there is no possibility of making a mistake.” Therein, not only did he highlight his dedication to what philosopher Michel Foucault terms the “medical gaze” and what sociologist Peter Conrad labels “medical surveillance,” he also drew from the corresponding assumption that the use of specific tools or “instruments,” when applied to specific body parts, would ultimately result in a standard outcome. Each element of this equation—be it a woman’s thigh, a speculum, or a tabletop arranged at an exact angle—was portrayed as an object in the service of mechanical repair. The overarching portrayal of sterility and its causes and cures in Clinical Notes on Uterine Surgery implied that women’s bodies—and women themselves—were a compilation of objective parts. This perspective furthered the idea that women lacked the agency to prevent, cause, or cure their own reproductive problems. While barren women of earlier centuries were charged with

3 | A diagram designed to aid surgeons in positioning women on the examination table, featured in Clinical Notes on Uterine Surgery, 14.

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everything from harboring impure thoughts to consuming the wrong types of food to cavorting with the devil, Sims framed sterile women as largely blameless for their condition and simply in need of a surgical tune-up. His text laid out no self-treatments, remedies, or prayers that doctors might instruct their patients to follow, and neither did it suggest fear appeals that might frighten sterile women into behaving in prescribed ways. The “cure” for sterility, according to Sims, had to do with the expert techniques of the surgeon, observing, cutting, removing, opening, expanding, and excising patients’ bodies to achieve normalcy and function. Sims’s rhetoric indicated that it would be illogical to make women feel accountable for their inability to bear children because they had no control over the mechanical success of human reproduction. One of the striking downsides of this framework was that the subjective, embodied pain that women might endure through these procedures was deemed of little to no consequence, most notably in scenarios where the women in question were neither paying customers nor afforded the agency to deny consent for treatment. In this respect, Sims’s rhetoric of sterility traded messages concerning women’s responsibility and accountability for objectifying messages that may have induced some women’s peace of mind while forcing others to endure unimaginable pain. The medicalization process in this specific case did, in fact, seem to reduce the moralizing effect of related rhetoric, though this may have been possible only because the clinical trajectory in question was not yet available to the public at large.

Mixing Metaphors Just one year after Sims published Clinical Notes on Uterine Surgery, Duncan used the word “fertility” in the context of women’s reproductive capacity. The inverse of Duncan’s term—“infertility”—did not make its way into mainstream discourse until the twentieth century, and the term “sterility” continued to make regular appearances, particularly in the context of medical rhetoric. Yet the introduction of “fertility” into the ongoing conversation about reproduction forecast new conceptual and metaphorical lenses for procreation, childbearing, and womanhood. Rather than fostering unique metaphorical descriptions, however, metaphors of the sterile or (in)fertile female body employed during the late nineteenth and early twentieth centuries tended to involve mixing metaphors from the past. References to women’s bodies as fruitful and as mechanical, for example, offered

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a seemingly incongruous illustration of the topic at hand, especially when previous metaphorical descriptions of fruit and then machinery invited such contrasting conclusions about women’s role in their reproductive output or ability. In many ways, this mixed metaphor was symptomatic of a widespread return to naturalistic, religiously oriented views about health that were developed in the context of scientific reasoning. As mid-nineteenth-century birthrates fell dramatically among Anglo-Saxon Protestants in Europe and the United States, religious, political, and medical leaders alike became dedicated to reversing the trend. Their appeals concerning women’s health and behaviors tended to interweave argumentative warrants from different spheres of discourse. Discussions of sterility in the medical sphere, for instance, became increasingly likely to form “scientistic idioms” by incorporating appeals to the moral and the social. An “alliance” between scientific empiricism and religious revelation was brokered under the supposition that the inorganic machinery of science can reveal truths hidden in the natural, organic world and that scientific methods can be, in this way, aligned with the divinely inspired certainties of nature. In contrast to Sims’s strictly mechanical and technical portrayals of sterility, then, later rhetoric about sterility tended to build from this moral physiology by portraying married, childless women as culpable for somehow defying their nature. As Sandelowski explains, “biologic dysfunctions in the involuntary domain” were framed as the “results of actions in the voluntary domain,” particularly for women. Women’s body parts were still likely to be equated with machinery, but women themselves were increasingly framed as agentic and therefore capable of acting in ways that would protect or destroy that machinery. With increased understanding of the relationship between untreated or latent gonorrhea and involuntary childlessness, for instance, women with blocked fallopian tubes or pelvic inflammation (i.e., failed machinery) were depicted as promiscuous, impious, or, at the very least, naive regarding their husbands’ adultery. Similarly, involuntarily childless women with a history of abortion or contraceptive use were blamed for thwarting nature or God and thereby destroying their reproductive machinery. And women who dedicated themselves to educational and professional pursuits were, according to social hygienists such as Dr. Edward H. Clarke, diverting blood flow from their reproductive organs to their brains and putting themselves at risk for sterility, as well as many other health problems. In Clarke’s infamous 1873 tract Sex in Education; or, A Fair Chance for the Girls, he employed an organic metaphor to explain what he framed as a rational,

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medical fact—that women and men should not be similarly educated because their physical “organization” was so vastly different. He argued that “the gardener may plant, if he choose, the lily and the rose, the oak and the vine, within the same enclosure; let the same soil nourish them, the same air visit them, and the same sunshine warm and cheer them.” Clarke held that—due to their physiological differences—one of the plants in this scenario would thrive, while the other, likely, would not. He concluded, at one point, that the “identical education of the two sexes is a crime before God and humanity, that physiology protests against, and that experience weeps over.” Clarke conjured a biblical understanding of women as naturally fruit bearing to make the mechanical argument that the “reproductive apparatus—the engine within an engine” depended on a concentrated, unobstructed supply of blood. Clarke’s general idea—that individuals had a set amount of energy (or blood) and that women in particular could devote that energy to reproduction or to other pursuits—eventually came to be known as “energy conservation” in the late nineteenth century, a philosophical discourse that drew many adherents and that I turn to more specifically in the next chapter. Theoretically, the practice of reasoning across different spheres of argumentation (à la Clarke) has been shown to be persuasive and instructive in some scenarios, just as mixing multiple metaphorical vehicles to describe a single idea (i.e., tenor) can function, according to Ceccarelli, to “convey the richness of a complex subject matter better than does a single simplified image.” But Ceccarelli also finds that the use of two mixed vehicles can weaken and constrain them both in certain circumstances, which may be a particular risk in cases where the tenor is especially abstract (e.g., involuntary childlessness) and the vehicles in question (e.g., fruit and machinery) have historically been enlisted toward such distinct ends (e.g., blaming women for their childlessness versus situating women as without reproductive agency). In the case at hand, it seems that mixing past metaphors resulted in a corresponding amalgamation of their entailments. These entailments left involuntarily childless women of the early twentieth century in the unfortunate position of being constituted both as bearing responsibility and as lacking the means to take responsibility, both morally culpable and medically excluded. In this respect, the specific, uncontextualized vehicles themselves and the terms clustering around them may have played a smaller role in shaping the resultant mixed metaphor than did the ways in which those vehicles had been enlisted toward the same tenor in distinct discourses of the past. If both vehicles had, for instance, supported complementary

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visions of women’s role in their reproductive health, even if those vehicles seemed disjointed or contradictory on the surface, the resultant mixed metaphor may have offered not a double bind but a discursive tool for the interpretation of experiences. Heading into the twentieth century, as discussions of sterility were joined to and replaced with discussions of (in)fertility, mixtures of organic metaphors with the inorganic formed something of an unstable foundation on which to articulate women’s reproductive ability. The mixing of perceptual lenses from centuries past—lenses with divergent assumptions about blame and responsibility, morality and science—foretold an era in which articulating infertility involved a complicated, fraught balance of divergent appeals, as well as one in which the meaning of infertility was constantly reinvented according to the circulation and percolation of scientific findings, medical technologies, media depictions, and lay discourses.

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2 Vital Forces Conserved | Narrating Energy Conservation and Human Reproduction at the Turn of the Century

In 1903 the New York physician I. N. Love added his whimsical yet esteemed moniker to the growing list of health professionals denouncing the “J. Marion Sims epoch” of invasive gynecology. Love declared that the profession was no longer “mad” with a dedication to “gynecological tinkering, womb prodding and probing.” The following year the renowned psychologist G. Stanley Hall explained, “Specialists are beginning to realize that they must broaden their view from the pathology of [a woman’s] organs .  .  . to the entire problem of regimen, and know at least as much about woman as about her pelvic diseases.” Indeed, early twentieth-century gynecologists were far less likely than their predecessors to view the female reproductive system as an exclusively mechanical structure. Scientific theories classifying women’s sterility as a systematic problem—one that had as much to do with a woman’s daily choices and behaviors as with the state of her body’s individual parts—filled the pages of turn-ofthe-century medical journals. Corresponding appeals to what Hall termed “regimen” hearkened back to, and percolated from, seventeenth- and eighteenthcentury arguments concerning the specific practices that women themselves needed to adopt to protect their childbearing abilities. Accompanying this shift in gynecological theory was an analogous shift in dominant public vocabularies concerning women’s reproductive health. Although metaphors of sterility remained evident in medical and popular rhetoric, they were slowly but steadily joined by metaphors of fertility. References to fertility functioned to refocus attention on procreation as a natural, organic process, rather than as a purely mechanical one, and to thereby resituate women’s bodies as reproductive soil that required appropriate tending to bear healthy fruit. The assumption underlying this reasoning was that individual women had the agency and the duty to behave in ways that would protect their ability to bring forth offspring.

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This early twentieth-century metaphorical framing of women’s reproductive agency was informed by scientific theories of social evolution that pervaded Europe and the United States throughout the second half of the nineteenthcentury. In his 1873 tract Sex in Education; or, A Fair Chance for the Girls, for instance, Harvard professor Edward H. Clarke turned to the writings of social evolutionist Herbert Spencer to address growing concerns about falling birthrates among Protestant Anglo-Saxons. Spencer, who preceded Charles Darwin in his use of the phrase “survival of the fittest,” theorized that all living beings possess a set amount of energy with which to live and interact in the world. As humans advanced and evolved into civilized beings, he argued, they devoted increasing amounts of energy to their cognitive maintenance and growth. Spencer maintained that this process put Anglo-Saxon women—those he and other social evolutionists deemed the furthest removed from “brutes”—at risk for reaching a state of “over-civilization” as they directed energy toward mental development that was considered indispensable to the maintenance of their generative faculties. Thus, Spencer reasoned that Anglo-Saxon women were increasingly evolving beyond the point of reproductive fitness at which they could ensure the survival of the human (and Anglo-Saxon) race. Drawing from Spencer’s scientific paradigm, Clarke publicized a narrative of energy conservation and human reproduction that explicitly called for women to forgo traditional higher education and professional careers to protect what came to be known as their vital forces. This call positioned women as one with nature and at odds with rationality and scientific progress, an argument that drew from what philosopher Susan Griffin labels the “logic of civilized man.” Moreover, in contrast to narratives emerging from the Sims tradition of gynecological intervention, Clarke’s narrative characterized Anglo-Saxon women as at fault for their lack of children, either because they had rejected maternity in favor of other personal or professional pursuits or because they had squandered their vital energy during puberty and menstruation and thus never developed the capability to generate offspring. Scholars of history and gender have argued that the circulation of this particular explanation for women’s reproductive ills largely ground to a halt following the publication of logic-oriented refutations and scientific data in the late nineteenth century. In this chapter I complicate and refute this contention by, first, outlining the logics and figures of Spencer’s brand of social evolutionary theory, thereby establishing the scientific foundation and vocabulary later reappropriated by Clarke. Second, I analyze Clarke’s late nineteenth-century public

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narrative of energy conservation and human reproduction to illustrate how he and his medical supporters employed Spencer’s social evolutionary vocabulary to create the illusion of scientific credibility for what was, essentially, a colloquial cautionary tale with a gendered moral framework. Third, I identify and delineate subsequent late nineteenth-century refutations based on logic- and scienceoriented narratives. I find that such refutations fostered (rather than thwarted) the narrative’s continued circulation in the early twentieth century because they failed to disprove—and in some cases adopted—the narrative’s language and underlying moral framework and because the narrative’s claims reinforced corresponding metaphorical shifts and discursive appeals related to infertility, nature, and moral physiology. Finally, I analyze early twentieth-century primary sources including scientific journal articles and mainstream media coverage wherein public arguments about women’s reproductive health continued to draw from and offer a reconstituted narrative of energy conservation well into the twentieth century. In this regard, I build from historian Sue Zschoche’s scholarship by demonstrating that Clarke’s original narrative or “schematic,” as Zschoche refers to it, was central to early twentieth-century rhetoric about women’s reproductive health and that this narrative was repeatedly enlisted in this context to tie involuntary childlessness not to medical abnormalities but to individual women’s “immoral” separation from nature. As these sources reveal, the discursive forces driving this narrative were far more prevalent and thus powerful in the early years of the new century than was even acknowledged by early twentieth-century women’s rights advocates.

Spencer’s Social Evolutionary Theory as Narrative Foundation Recent scholarship in the communication of science and medicine maintains that all scientific theories are embedded within narratives about how the world operates. This perspective is grounded in the idea that narratives are “symbolic actions—words and/or deeds—that have sequence and meaning for those who live, create, or interpret them.” Narratives perform a sense-making function in that they help the individuals who draw from them to cope with, predict, and otherwise negotiate their material and social environments. Philosopher Donna Haraway argues that narratives in general and scientific narratives in particular are driven by metaphors, which “may be mathematical or they may be culinary; in any case, they structure scientific vision.” She goes on to argue that science is,

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above all else, a historically contextualized story-telling practice, a claim that has also been championed by those studying the rhetoric of science, medicine, and technology. Throughout her career, Haraway has identified the narratives or fictions—as well as corresponding metaphors—that animate specific scientific fields, not in an attempt to dismiss those fictions but rather to explicate how science is articulated and thereby constituted. In this chapter I follow a similar trajectory, as I link the metaphorical foundations and public vocabularies delineated in the last chapter with late nineteenth-century reproductive science and the storytelling in which that science was embedded. More important, I demonstrate that these science fictions—believed to be disproven and discarded in the late nineteenth century—circulated in amended forms well into the twentieth century, wherein they functioned as persuasive argumentative topoi grounding ideas and behaviors related to women’s reproductive health. In this respect, this chapter not only provides an account of the discursive shifts and argumentative warrants put forth via rhetoric about infertility at the turn into the twentieth century but also offers insight into how and why specific scientific narratives might survive beyond their technically circumscribed uses and justifications. Logics and Figures of Spencer’s Emerging Paradigm The telling of the late nineteenth-century narrative of energy conservation and human reproduction was grounded, above all else, in theories of social evolution furthered by Herbert Spencer. I maintain that the arguments, metaphors, and narrative logic enlisted by Spencer and other social evolutionists were ultimately reappropriated, first by Clarke and then by late nineteenth-century health professionals, to promote a colloquial cautionary tale about sterility driven by a gendered moral framework. Thus, the following pages’ focus on the scientific delineations of nineteenth-century social evolutionary theory provides essential narrative background for ascertaining the prevalent uses and meanings of childlessness among married women at the turn of the century. Appeals to the Transformative Potential of Organic Matter

That the narrative of energy conservation and human reproduction would garner considerable persuasive force concerning issues of social morality is not necessarily something that one might predict from the technical, scientific theorizing that served as its inspiration. In his early work, Spencer—a largely self-educated English natural philosopher—laid out his belief in the natural evolution of all

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matter from states of insecure homogeneity to increasingly stable heterogeneity, an assumption philosopher Jean-François Lyotard identifies as a fixture of modern Western thought. Spencer maintained that organic bodies, like all forms of matter, are fixed energy systems that must be managed and coordinated according to changing environmental conditions and social factors. As bodies naturally progress and evolve, their energy is reorganized and reallocated to support increasingly specialized, interdependent tasks, the most advanced of which Spencer held to be highly cognitive and scientific in nature. He devoted much of his celebrated 1864 work The Principles of Biology to the systematic task of explaining and justifying this evolutionary process. Spencer categorized matter and organisms on a corresponding hierarchy of evolution, which he presented using the rhetorical figure “incrementum,” wherein a series of items is ordered in a patterned trajectory. Ranked lowest on this hierarchy was inorganic matter such as a “watch or a steam-engine,” objects that lacked what Spencer referred to as vital forces. Unlike J. Marion Sims, who incessantly equated the human body (particularly the female human body) with machines, Spencer focused on highlighting what he argued were the vast differences between the vital and the lifeless, maintaining that “vital change is substantially unlike non-vital change” because nonvital matter lacks the organic energy and force that drives evolutionary progress. In this respect, the major tenets underlying Spencer’s evolutionary theory aligned well with emerging gynecological theories conceptualizing the human body as entirely unlike the workings of an inanimate machine. Spencer’s work, as a whole, was infused with appeals dichotomizing the inanimate and the animate. He tended toward contrasting dark, concrete descriptions of the “dead,” monotonous (i.e., mechanical) world with romantic, figurative depictions of the natural, organic world. In this way, he enlisted both form and representational content in highlighting what he argued was the inordinate potential and inherent beauty of the living. He wrote with almost perceptible awe of the transformations that surged from all things vital, proclaiming, for instance, that “the tree that puts out leaves when the spring brings a change of temperature, the flower which opens and closes with the rising and setting of the sun, the plant that droops when the soil is dry, and re-erects itself when watered, are considered alive because of these induced changes.” This excerpt is representative of his writings in general in that it communicates not just an admiration for organic matter’s ability to transform but also because it hints at Spencer’s belief in the centripetal role that physical energy plays in driving organisms toward ever greater complexity.

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Spencer’s evolutionary thesis was derived from the first law of thermodynamics and posited that energy or force can be neither created nor destroyed, although it can change shape and form. His reasoning on this front stemmed in part from the writings of seventeenth-century German mathematician Gottfried Wilhelm Leibniz, whose conceptualization of vis viva, or living force, referred to the kinetic energy derived from a body in motion. This conceptualization reverberated in both Spencer’s reverence for the vital world and his energetic teleology (although the energy in Leibniz’s equation was not necessarily vital in the sense that interested Spencer). Living force, then, or what Spencer came to refer to as a physical “persistence of force” (i.e., conservation of energy), was ingrained within his philosophy of the evolutionary drive to balance oppositional dynamics and establish equilibrium. Energy as Metaphor

Spencer’s literal explications of empirical energy facilitated his delineation of a theory of the energetic economy of style and composition, as well as his use—in his own composition—of energy and its synonyms as metaphors for the progressive drives of individuals and societies. Because his larger philosophical program involved the application of universal scientific laws to the study of topics ranging from psychology to ethics, it makes sense that Spencer drew from the language and principles of biology, chemistry, and physics to describe, for instance, how individuals evolve into increasingly interdependent beings within larger societies. In First Principles he explained that societies are governed by a balance of internal and external “energies,” and, like individual organisms driven toward the path of least resistance, they move in the direction with the “readiest escape from [destructive] forces.” Therein, Spencer equated social collectives with individual organisms and characterized collectives as driven by the management of various internal and external forces that are not necessarily physical but that nonetheless shape interaction and cooperation. This “logic of energy metaphors,” as sociologist Andrew M. McKinnon labels it, highlights the energy, force, power, resistance, and currents that Spencer argued constitute evolutionary potential, as well as the necessary conservation and administration of said vital energies. These metaphorical appeals hinged on Spencer’s differentiation between vital and inanimate energy and his understanding of vital energy as inherently superior because of its capacity for transformative growth. When Spencer referred to the “forces” of evolution, then, he implied that he was concerned primarily with life-infused, life-sustaining, and, ultimately, life-producing

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energy. In this respect, Spencer’s later decision to theorize about human reproduction (which he did in his 1873 essay “Psychology of the Sexes”) cohered logically with his earlier work, as did the eventual reappropriation of his theories into technical and mainstream rhetoric about childlessness among Anglo-Saxon women. The Scientific Circulation and Extension of Spencer’s Initial Paradigm In the years directly following the release of his early publications, Spencer’s energetic rhetorical appeals and logics were adopted more broadly. A range of philosophers joined him in theorizing about the hierarchy of evolutionary progress and thereby contributed to the rhetorical foundation of what would eventually emerge as the narrative of energy conservation and human reproduction. Their public communication highlighted the scientific nature of Spencer’s original theories while also extending those theories in ways that spoke to increasingly applied (and moral) applications for individuals and societies. Mental Energy and Race

Edward Livingston Youmans, an American chemist and physicist who demonstrated his devotion to Spencer’s ideas by founding Popular Science Monthly as a vehicle for their circulation, deemed “the doctrine of the conservation of energy and the mutual convertibility of the various forces” a “fundamental truth of science.” In a speech he delivered before the London College of Preceptors, Youmans drew from this doctrine to theorize about the workings of the human brain. Therein, he rejected Cartesian mind-body dualisms and argued that both mind and body draw from the same well of energy and are therefore interdependent. The brain, Youmans explained, consists of energetic nerves powered by the circulation of blood and the body’s nutritive system. He reasoned that, because the brain is a “part of the living system,” it is “subject to [the corporeal body’s] laws, and our understanding of [the brain’s] action becomes dependent upon the progress of physiological knowledge.” By factoring the brain’s needs into an organism’s overall energy allowance and framing the brain as constituted by energetic receptors, Youmans joined Spencer not only in adopting the appeals and logic of energetic metaphors but also in cautioning individuals against overtaxing the mind. Although Youmans argued that higher-order cognitive functioning was a sign of the most advanced form of evolution, he also held that failure to offset mental energy expenditure with energy intake results in the

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exhaustion and breakdown of the system as a whole. Youmans warned that, from a state of energy deficiency, “further attainments can only be made at the expense of the decay and loss of old ones.” In subsequent rhetoric, Youmans’s claim concerning the “decay and loss” of some attainments would be cited as the explanation for many married women’s childlessness. Medical doctors and mainstream reporters alike would deem women’s reproductive organs as more or less decayed, the result of their overarching body systems struggling to rectify energetic debt. These arguments were bolstered by Youmans’s and other social evolutionists’ claims that, even before attaining a state of depletion, an organism’s inability to produce new energy means that it will inevitably evolve beyond the point at which all the physical faculties needed for raw survival can be maintained. In an 1873 article published in the North American Review titled “The Progress from Brute to Man,” U.S. historian and philosopher John Fiske communicated this reasoning by explaining that as humans progress into increasingly civilized beings “those simple indirect adjustments which would seem to involve the use of the cerebellum chiefly” are counteracted by the loss of “certain powers possessed by savages and lower animals.” Fiske, like Spencer and Youmans before him, reasoned that the potential to progress “is by no means shared alike by all races of men. Of the numerous races historically known to us, it has been manifested in a marked degree only by two,—the Aryan and Semitic,” later adding that “the two great races of Middle Africa, the Negros and Kaffirs, have shown” little by way of evolution because “throughout long ages they have made no appreciable progress.” Fiske held that these so-called less civilized or “brute” races, which he claimed also included aboriginal Australians, Latin Americans, and Indians, among others, retained their physical prowess over time because they naturally endured no cognitive growth and thus required little to no additional energy. By contrast, those Youmans referred to as Anglo-Saxons or civilized Europeans were said to gradually trade faculties related to physical acumen for the development of cognitive complexity. In his North American Review article, Fiske offered the following comparison to illustrate this racial scheme and the supposed consequences of differential energy requirements: It is said that the Bushman can see as far with the naked eye as a European can see with a field-glass; and certain wild and domestic birds and mammals, as the falcon, the vulture, and perhaps the greyhound, have still

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longer vision. Among the different classes of civilized men, those who by living on the fruits of brain-work done in-doors, are most widely differentiated from primeval men, have as a general rule the shortest vision. And the rapid increase of in-door life, which is one of the marked symptoms of modern civilization, tends not only to make myopia more frequent but also to diminish the average range of vision in persons who are not myopic. Fiske went on to explain that advanced hearing and smell are also examples of faculties frequently lost to those most evolved (and therefore most engaged in chiefly cognitive tasks) as said individuals are less likely to make use of those faculties in the realm of modern civilization. In this way, he followed Spencer in extending social evolutionary theory to incorporate Lamarckian use-inheritance theory (which posits that faculties are acquired or contracted through use or disuse and that these adaptations can be passed on to future generations). Although he represented civilized individuals as lacking in terms of their ability to survive in uncivilized conditions, Fiske joined Youmans in arguing that civilized individuals’ ability to form and function within a modern society was the most obvious sign of their advanced evolution. Fiske reasoned that the establishment and maintenance of civilized societies depends on the development of highly cognitive faculties that result in the ability to establish interdependence among diverse individuals, specialization, and scientific knowledge, which encourages foresight and delayed gratification. At the same time, however, social evolutionary theory warned that the development of these laudable cognitive faculties put Anglo-Saxons at particular risk for reaching a state of energy depletion and exhaustion. Fiske explained that excessive “brainwork,” as he labeled it, taxed the cerebrum and the nervous system as a whole toward “inordinate anxiety.” Evolution, it seemed, could go awry quickly if those at the top of the progressive ladder misallocated their energetic resources. In this respect, nineteenth-century theories of social evolution not only advocated for the differentiation of the vital from the inanimate, as well as for a progressive and hierarchical understanding of organisms, plants, animals, brutes, and the civilized; they also depicted advanced evolution as a precarious balance of energies that hardly ensured the generation—and thus survival—of those deemed most evolved. Sex, Survival, and Human Reproduction

In the context of human reproduction generally and (in)fertility specifically, neither Spencer’s nor Darwin’s conceptualization of the tenet “survival of the

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fittest” encompassed the idea that the most evolved individuals would naturally survive and prosper. Instead, historian Daniel J. Kelves explains that “fitness meant the ability to survive and multiply in a given environment, and the fit in that sense included precisely the lower-order types” that had not reached the highest stages of evolution, which was defined by the ability to engage in complex cognitive brain work. In this line of reasoning, the most evolved individuals’ survival is not assured because they have progressed beyond the realms of physical subsistence in which the tenet is theorized to hold true. Thus, when birthrates began plummeting among married Anglo-Saxons in Europe and the United States during the mid-nineteenth century, social evolutionists could provide no guarantee that this trend did not signal the end of what they considered a higher-order race. In fact, many social evolutionists—including Spencer— implied that just such a dramatic end could be in sight. In 1873 Spencer published an article that laid out how his synthetic philosophy might be applied to issues of higher-order human reproduction and what he saw as the corresponding differences between males and females. Youmans’s new periodical Popular Science Monthly offered an ideal vehicle for the distribution of Spencer’s “Psychology of the Sexes,” as the journal was designed to convey vanguard scientific theories to both experts and educated lay readers. In “Psychology of the Sexes” Spencer explicated two arguments that he had laid out implicitly in his earlier work and that ultimately came to form the organizing suppositions of the emerging narrative of energy conservation and human reproduction. The first such argument posited that men and women are dissimilar both physically and mentally. Spencer reasoned that “just as certainly as [men and women] have physical differences which are related to the respective parts they play in the maintenance of the race, so certainly have they psychical differences, similarly related to their respective shares in the rearing and protection of offspring.” Drawing from the increasingly accepted postulate that the mind and body are interconnected, Spencer theorized that biological differences in reproductive faculties align with psychological variances, which position childbearing women as inclined toward “love of the helpless,” concrete thinking, and a desire to please. Men, on the other hand (particularly those who are highly evolved), tend toward a psychological proclivity for freedom, critical thinking, and abstract reasoning, which allows them to provide for their families and establish civilized social structures. Years later these appeals concerning sex and inherent physical-psychological difference, as well as the moral order that such appeals imply, would percolate into the mid-twentieth century with the rise of Freudian psychoanalysis.

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Spencer’s second major argument—which will also seem familiar to students of midcentury psychoanalytic theory—offered an evolutionary explanation for his first and drew heavily from the energetic metaphors and logic evidenced throughout his writings. He held that the physical and mental differences between the sexes are a direct result of the energy that each sex can safely devote to cognitive progress. Women, Spencer reasoned, are forced into a “somewhat earlier arrest of individual evolution,” as the development and maintenance of their reproductive faculties depletes the amount of energy that they can dedicate to growth and progress. He pointed to women’s smaller physique, earlier maturation, and the lesser quantity of carbonic acid that they exhale as evidence of this “arrest,” in addition to their aforementioned cognitive differences. In Spencer’s appraisal, women stop progressing or developing at a cognitive level “while there is yet a considerable margin of nutrition: otherwise there could be no offspring.” He explained that the surplus energy derived from this equation is economized by the laws of nature to support the life-giving process of bearing children. Furthermore, he reasoned that those women who “unduly tax the physique” through study and participation within “higher culture” trade continued advances in their cognitive development for the arrest of their reproductive faculties. In these cases women become less differentiated from men in both their physical and mental characteristics and are therefore less able to conceive, support, birth, and care for offspring. As the “self-preserving power” is “inversely proportionate to the race-preserving power,” Spencer concluded that women who fail to arrest their evolution and therefore continue developing into a state of increasing cognitive complexity ensure their own individual growth and survival but sacrifice the survival of their “race.” This conclusion provided an unyielding argumentative warrant for later claims about Anglo-Saxon women’s duty to the race and the selfish (i.e., “self-preserving”) nature of their attempts to compete with men in the realms of education and the professions. Indeed, historian Joan N. Burstyn attributes the diffusion of social evolutionary tenets in late nineteenth-century theories of reproduction not only to declining Anglo-Saxon birthrates but also to women’s growing acceptance and increasing success in institutions of higher education. Burstyn argues that as women in England and the United States demonstrated that they could compete on an intellectual level with men, established doctors and other professionals began to worry about the competition they might face from a generation of emergent female scholars. They responded to this threat by beginning an “open discussion of how women’s reproductive organs worked and what danger to

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them might ensue from prolonged and intensive mental work.” The central assertion in these conversations aligned with Spencer’s aforementioned supposition, holding that, although women could potentially compete with men in the spheres of education and the professions, their energetic resources limited their ability to partake in these pursuits and in the pursuit of reproduction and maternity. Although Spencer established a persuasive philosophical framework that he applied to many diverse topics, including women’s reproductive health, the broad nature of his professional oeuvre indicates that he was not exceptionally committed to the implications of his findings as they related to women’s health and gender politics. He used the terms “sterility” and “fertility” almost exclusively in the context of plant and animal life, and he generally avoided prescribing sex-specific changes in social behaviors that might alter ongoing patterns of interactivity. And while Spencer was an opponent of including women in traditional institutions of higher education (in part, it can be assumed, because of what he theorized as women’s biological proclivity for evolutionary arrest), he was also opposed to all formal education regardless of a potential student’s sex. Thus, although Spencer’s influence is clear throughout the late nineteenthcentury narrative of energy conservation and human reproduction, it would be a mistake to consider Spencer himself a primary advocate of this particular iteration of his evolutionary theory.

Clarke’s Moral Cautionary Tale: The Emergence of the Late Nineteenth-Century Narrative of Energy Conservation By contrast, Dr. Edward H. Clarke (a practicing physician and professor at Harvard Medical College) is widely recognized as the first to delineate publicly what I term the late nineteenth-century narrative of energy conservation and human reproduction. His 1873 monograph Sex in Education played a significant role in propagating the narrative, not only in the nineteenth century but also well into the twentieth. Originally delivered as a speech before the New England Woman’s Club of Boston in 1872, Clarke’s contentions were widely debated in technical and lay media, cited by almost every scholar who subsequently commented on the state of women’s reproductive health; countered directly by suffragist Julia Ward Howe and Drs. Elizabeth Garrett Anderson and Mary Putnam Jacobi, among many others; and reprinted well over seventeen times. In

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these ways, its appeals, logics, and examples provided a near-ubiquitous model for ensuing rhetoric about women’s reproductive health in general and AngloSaxon women’s involuntary childlessness in particular. A close analysis of this model reveals Spencer’s influence therein in terms of content and style and thus an attempt to frame the narrative as a whole as a scientifically valid endeavor; a series of mixed metaphors implying oppositional (and transitional) worldviews; and a rhetoric of women’s pseudoagency that both implicated individual AngloSaxon women as the (failed) guardians of future generations and purported their victimization within a society that had become disconnected from the laws of nature. Establishing the Illusion of Scientific Methods and Credibility Sex in Education referenced Spencer’s words and ideas explicitly at only several points in the almost two-hundred-page manuscript—perhaps because Spencer’s work had, at that point, become “paradigmatic” and thus citing him repeatedly would have been deemed “gauche and naïve,” particularly among experts. Nonetheless, Spencer’s narrative influence in Clarke’s work is evident throughout the text. Like Spencer, Clarke drew from the rhetoric of scientific rationality to frame his conclusions, noting, for instance, that his findings were supported by “clinical observation,” as well as by the laws of nature. Yet Clarke’s tome differed from Spencer’s works in that he employed scientific language primarily as a framing device, which signaled credibility and a connection to the social evolutionary paradigm. While the texts that made up Spencer’s synthetic philosophy were unrelentingly technical and dense, Sex in Education drew from only a few technical phrases (e.g., experimentation, methods, clinical observation) that functioned as cues or ideographs signaling Clarke’s commitment to scientific rationality. These terms offered validation and justification for what was, essentially, a colloquial cautionary tale. Clarke’s tale reenvisioned complicated principles of social evolutionary science in terms of relatively easy-to-follow tenets, descriptions, and anecdotes related to so-called civilized women’s potential for reproductive insolvency. This reenvisioning catered to lay audiences and introduced them to a moral framework that prescribed and warranted sex-differentiated behaviors through the facade of scientific methodology. For example, Clarke often traded discussion of “physiology” for the less technical “organization,” and he was apt to confer

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the logic of energy conservation in the context of individual, emotionally compelling clinical cases. In the book’s third section, titled “Chiefly Clinical,” Clarke engaged in an analysis of “Miss A,” who had continued with her high school studies throughout menstruation and, in this way, “made her brain and muscles work actively and diverted blood and force to them when her organization demanded active work, with blood and force for evolution in another region.” While, at first, Clarke reported that Miss A “got on nicely,” eventually “the strength of the loins, that even Solomon put in as a part of his ideal woman, changed to weakness.” This biblical citation signaled Clarke’s inclination for coupling scientific appeals with the laws of religion and morality, a rhetorical process that involved drawing explicitly from what rhetorician Davi Johnson identifies as the religious mythology lurking in even the staunchest of materialist evolutionary narratives. In the end, Clarke reported that his patient’s refusal to withdraw from mental work during menstruation (particularly during the early years of puberty, when her “organization” was still being established) resulted in a state of ongoing nervousness and unrelenting childlessness. This type of personalized, clinical anecdote eventually became something of an emotional mainstay in late nineteenth-century medical accounts of married women’s childlessness. Both Drs. George Wythe Cook and John Thorburn, for instance, wrote academic journal articles and delivered lectures that featured vivid descriptions of Anglo-Saxon women’s thwarted maternal endeavors, brought on by their inability or unwillingness to avoid cognitive work during menstruation. After proffering one such anecdotal overview, Cook concluded that “with a stimulated brain and a weakened body, what, if any, progeny is to be expected from her, to say nothing of the misery she is laying up for herself?” Thorburn presented a similar conclusion by arguing that women exposed to “exceptional culture” are “those most likely to add to the production of children of high-class brain power,” just as they are also at the highest risk for evolving beyond the “ranks of motherhood.” In this case, Thorburn iterated Spencer’s Lamarckian belief in useinheritance, while also laying out the seemingly precarious predicament facing highly evolved women as they attempted to balance the cognitive (and heritable) progress associated with exceptional culture with the reproductive energy requirements that linked them to women of so-called barbaric persuasions. On the whole, these tales and their conclusions—particularly when linked to Spencer’s theory—functioned to personalize what was portrayed as the harrowing consequences of overtaxing the female system through unremitted study.

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Mixing Metaphors and Positing Nature as Corrective The most extreme of such consequences, according to Clarke, was the diagnosis of what he referred to as “sterility.” Unlike Sims, who employed the term “sterility” only in combination with mechanical metaphors for the female body, Clarke employed a mixture of mechanical and organic metaphors delineating women’s reproductive faculties. In this way, his rhetoric evidenced a vocabulary and a culture in transition, wherein the delineated causes of women’s childlessness were anything but clear-cut and the solutions put forth were more likely to implicate individual women and the societies in which they lived than were those identified by Sims-era gynecologists. Clarke’s mixed metaphors offered vivid yet conflicting illustrations of the topic at hand, juxtaposing references to a woman’s prospects for “bear[ing] little fruit” with discussions of the female reproductive system in terms of an “extensive mechanism within the organism,— a house within a house, an engine within an engine.” Clarke’s repeated portrayal of a woman’s mind-body as an overarching, domesticated (e.g., “house”) engine, driven by internal “reproductive machinery,” corresponded in some ways with the experiences and apprehensions of an increasingly industrial age. It also signaled Clarke’s interest in emerging concerns that Anglo-Saxon women were reaching a state of “over-civilization” (and therefore becoming increasingly uninterested in sex and unable to reproduce) due to their unending mental strain and participation in the public spheres of industrial life—a concern that would be taken up in a more concentrated sense by other medical professionals such as the now infamous neurologist George Miller Beard. That Clarke was inclined to mix these mechanical, industrial metaphors with organic metaphors depicting flowers, seeds, floods, and tides suggests that he saw a return to nature and its “scientific” laws as a compelling corrective to industrialization’s harms. In an attempt to conflate the laws of science with religious ordinance, Clarke personified his corrective—Nature—as a teleological force with the power to set an individual’s energetic makeup and requirements. Nature, according to Clarke, was imbued with an overarching authority that directed and worked on everything and everyone, though in a diversity of ways aligning with its laws. Thus, “a girl upon whom Nature, for a limited period and for a definite purpose, imposes so great a physiological task [as the construction and maintenance of her reproductive faculties], will not have as much power left for the tasks of the school, as the boy of whom Nature requires less at the corresponding epoch.” Both the girl and the boy are directed by Nature, Clarke explained, but Nature

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imposes on the girl a greater physical burden, one that ultimately thwarts her ability to maintain both her health and an uninterrupted scholastic program. Mirroring the language of Old Testament appeals to divine retribution, Clarke characterized Nature as angry and vengeful, warning that “Nature punishes disobedience” by leaving the reproductive faculties “germinal,—undeveloped” so that they seem “to have been aborted,” and girls grow up to find themselves “sterile.” In this case and others, Clarke extended Spencer’s scientific philosophy and energetic logic to incorporate a moral imperative that women follow the strictures of a higher order (explicated throughout the text as aligned with “Levitical law” and the “physiology of Moses”) when provisioning their vital forces. Appeals to a morality delineated by Nature’s directives were also taken up by subsequent capitulations of Clarke’s narrative. Some of these iterations, like an article featured in the Lancet on October 9, 1886, imitated Clarke’s strategic personification, holding that “Nature must and will interpose” when its dictates are ignored. This anonymous article backed up its moral-order claims by drawing from Spencer’s scientific rhetoric, referring to the female as “undoubtedly, from a developmental point of view, an animal in which the evolutionary process has been arrested.” Similarly, in his article “Sex in Mind and in Education” published in the influential British literary journal the Fortnightly Review in 1874, Dr. Henry Maudsley warned that “when Nature spends in one direction, she must economise in another direction.” Maudsley not only personified nature à la Clarke and mimicked Spencer’s economic analogies but also folded tenets of moral physiology into his writings and thereby further linked his scientific claims to a social code of morals and ethics. He argued, for instance, that women’s “physical nature” provides overwhelming proof of their “foreordained work as mothers and nurses of children,” as well as of their need for a “special sphere of development and activity determined by the performance of [their reproductive] functions.” Their bodies alone, Maudsley maintained, reveal women as designated by Nature for the demands of caring for the young and acting as man’s “helpmate.” As rhetorician Nathan Stormer explains, the nineteenth century was inundated with this type of moral physiological reasoning in which the physiological science of the body was interpreted as code for the revelation of “divine, natural, and social law.” These appeals framed empirical science as a tool for unveiling truths that the Almighty had concealed within nature. Maudsley wisely drew from this public vocabulary, conflating what was seen as scientific (the body’s physiological materiality) with what he construed as

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Nature’s dictate (the individual’s role within society) to bolster the narrative of energy conservation’s regulatory appeal. Other iterations of Clarke’s narrative adopted the same spirit of appeals to a scientifically grounded moral imperative, but without personifying nature explicitly. In 1884 Thorburn cited Clarke’s monograph directly and cautioned the students in his introductory obstetric medicine seminar that “there is no scholastic or academic pitch-fork which can expel nature or render the disregard of its laws innocuous.” He explained that those women who took to pitching nature’s decrees aside would find themselves the victims of nature’s revenge from weakness, uterine disease, hysteria, and sterility. Indeed, as an 1897 newspaper advertisement claimed, “thousands of women lead childless, loveless lives because .  .  . they neglect the most delicate and important parts of woman’s organism.” These individuals, it seemed, had failed to follow the demands (and morality) of their unique organization and thus were left with only the hope of—in this case—Dr. Pierce’s Favorite Prescription to return them to nature’s path. Even more seriously, according to Thorburn, through their failed attention to nature they emerged as propagators of the “thorough deterioration of a race which, with all its faults, has hitherto played a predominant part in the history and civilization of the world.” Anglo- Saxon Women as Failed Racial Guardians and Victims of a Corrupt Society The late nineteenth-century narrative of energy conservation and human reproduction—whether communicated by Clarke, his medical supporters, or product ads—included frequent appeals to what Spencer theorized as the diverse evolutionary potential among races, as well as to the hierarchies of race, ethnicity, and nation of origin that Spencer and other social evolutionists, including Youmans and Fiske, accordingly set out. But unlike Spencer’s relatively removed, descriptive statements emerging from social evolutionary science, Clarke’s narrative included a number of fear appeals related to the importance of upholding what he argued was the most evolved of races via reproduction. For instance, Clarke argued that if educational training failed to incorporate rest for female students during menstruation, “then the sterilizing influence of such a training, acting with tenfold more force upon the female than upon the male, will go on, and the race will be propagated from its inferior classes.” In this case, Clarke referenced the human race in general and then delineated individual racial cat-

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egories therein, the bulk of which he deemed both inferior and prolific. At another point, he drew from an organic metaphor equating the proliferation of humanity with a stream that he warned would “flow into the future” on the backs of the “Celtic rather than American: it will come from collieries, and not from the peerage.” Clarke, like Spencer, conflated nation of origin, race, and ethnicity with economic class and reasoned that female “operatives” working anywhere from the coal mines to the urban shops were far less likely than female Anglo-Saxon students and professionals to develop reproductive difficulties because their work was less cognitively taxing. His narrative logic indicated that, although Anglo-Saxon women had to be protected from the kinds of work that advanced civilization introduced to them, women representing lesser evolved races and ethnicities did not require such protection because, first, they had a surplus of energy despite the hard physical labor they often endured, and, second, their generation was less valuable to the evolution of humanity. In time other energy-conservation advocates would extend Clarke’s portrayals of Anglo-Saxon women as superior to and therefore physically and energetically unique from other women. In one representative case, Dr. J. T. Clegg reasoned in the Texas Health Journal that “the higher on the scale of human development the woman ascends the greater is her liability to [reproductive] afflictions.” Because Anglo-Saxon women were believed to be more cognitively advanced, Clegg reasoned that their physical strength and ability to bear pain was equivalently abridged. In this respect, he iterated what historian Diane Price Herndl identifies as accepted nineteenth-century medical opinion that those representing certain races, ethnicities, and nations of origin (most notably Africans) have more forgiving—and therefore less pain-inducing—physiology than do others (most notably Western Europeans and Anglo-Saxon North Americans). Clegg explained, for instance, that “the half savage negro possesses strong muscular development; the pelvis is capacious; the head of the [newborn] child is not, by long intellectual heredity enlarged, consequently the pelvic floor is not injured [during childbirth] and regains its tone and power of support in a short while”; by contrast, he concluded, “To be a civilized woman is too often to be a sufferer.” Beyond these appeals to race-based medical philosophy, this reasoning also paired Spencer’s adherence to Lamarckian use-inheritance with the threat of overcivilization induced by modern society and industrialization. On one hand, narrative adherents spoke with condescension of women representing less evolved races, those believed incapable of building or even living within modern civilization but who also endured less physical pain and reproduced at or beyond

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the level required to ensure their racial and ethnic survival. On the other hand, narrative adherents also shamed Anglo-Saxon women for their divergence from other races and ethnicities of women as they perpetuated a “feeble race, not of women only, but of men as well.” In this way, Anglo-Saxon women were constituted as capable of improving the race because of their modern civility and heredity and as capable of diminishing or eliminating the race because they had become so ensconced within the unnatural stresses and opportunities of modern—particularly urban—life. In deeming their wombs the “cradle of the race,” the narrative featured extensive reminders that these chosen women were as much agents of modern civilization’s future via their (un)healthy reproductive systems as they were products of societal progress. This widespread emphasis on Anglo-Saxon reproductive health led not only Clegg but also other late nineteenth-century scholars and medical professionals to contextualize and thereby devise treatments for individual energy deficiency in terms of broader societal conditions. For example, Dr. George Miller Beard garnered an international reputation during this time for his writings on what he termed “neurasthenia,” or nervous exhaustion, and the development of a rest cure. Beard joined Clegg and other physicians in theorizing that the “dark races” were less sensitive to nervous excitation and thus could tolerate more pain than could others, and he used this reasoning to focus his work on curing “the feeble, the sensitive, and the highly and finely organized” (i.e., middle- to upper-class Anglo-Saxon women), who, he argued, were at much higher risk for developing nervous exhaustion and corollaries such as sterility. He published a medical treatise on the subject in 1880, but it was his 1881 follow-up manuscript boasting a “popular character” that laid out clearly the narrative reasoning grounding his medical practices. Therein, Beard upheld modern civilization itself as the chief source of contemporary women’s health and reproductive problems. He reasoned, “Much of the exhaustion connected with civilization is the direct product of the forethought and foreworry that makes civilization possible.” Beard went on to explain that Americans in particular were at risk for such exhaustion, as the country was advancing more rapidly in terms of scientific and technological progress than its most sensitive residents (i.e., highly evolved females) could endure. Thus, as historian Charles E. Rosenberg explains, while Beard venerated America as the superior modern civilization, he also indicted its residents, particularly its female residents, for falling prey to the “pathologies of progress.” Native-born American women’s childlessness was held up, in this context, as an indication of modern society’s corruption through its rapid displacement

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from nature. Beard encouraged his readers to “consider the large number of childless households, the many families that have but two or three children, or but one, and with them contrast the families that prevailed at the beginning of this century,” as well as with the “higher and lower orders in this respect.” The whole of this discrepancy could not, according to Beard, be attributed to excessive prudence or “want of it.” Instead, in the context of rapid societal progress, he reasoned that higher-order women’s energetic reserves were employed well beyond what they could spare, and the result was an inability to economize in the direction of bearing children. The best cure for such depletion, according to Beard, was extended bed rest, a conclusion that was also upheld that same year by Dr. Horatio Bigelow, who explained that “the rest must be perfect, not partial,” in that “she should go to bed, and the nurse should be charged to allow her to make no movement of herself.” This treatment plan inevitably overrode the constitutive agency evident in previous appeals that encouraged women to protect their own health by shunning traditional education and competition. Only by relinquishing to others their every movement and thought, it was argued, would energy-depleted, overcivilized women have any chance of restoration to the world of nature and generation.

Late Nineteenth-Century Narrative Refutations via Appeals to Logic and Science Although these claims about treatment (and fault) garnered widespread attention and support, the narrative of energy conservation and human reproduction—or at least its conclusion about women’s educational and professional limitations—was not without its vocal late nineteenth-century critics. Throughout the last quarter of the century, prominent public refutations and scientific studies worked to contest the seemingly scientific logic embedded within the fiction, albeit—as I argue—without significant or long-term success, given their failure to effectively dispute the underlying moral framework at the narrative’s core. Refutation Through Linear Argumentation In May 1874 Dr. Elizabeth Garrett Anderson—the first woman to pass England’s medical qualifying exams—published a contentious reply to Dr. Maudsley’s

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Fortnightly Review article in the same publication. Therein, she situated herself and her thesis firmly in the realm of scientific reasoning and linear argumentation by translating Maudsley’s iteration of the narrative of energy conservation and human reproduction into independent premises and contesting each premise by appealing to logical principles. Anderson set out her agenda in an orderly fashion, proposing, “We have here two distinct assertions to weigh and verify,” the first being “that the physiological functions started in girls between the ages of fourteen and sixteen are likely to be interfered with or interrupted by pursing the same course of study as boys, and by being subjected to the same examinations,” and the second being “that even when these functions are in good working order and the woman has arrived at maturity, the facts of her organization interfere periodically to such an extent with steady and serious labour of mind or body that she can never hope to compete successfully with men in any career requiring sustained energy.” Notably absent from Anderson’s account is any personification of nature or emotive appeals mimicking those of Maudsley, who, for instance, referred to uninterrupted study among adolescent girls as driven by a lurking “enemy.” Throughout her article Anderson seemed never to waver from the notion that logical reasoning was not only a necessary but also a sufficient tool for overthrowing the education-related conclusions furthered by the narrative of energy conservation and human reproduction. On the whole, Anderson argued that there was simply insufficient evidence for the assertions guiding Maudsley’s appeals. She not only laid out her own reasoning and substantiation on this front but also enjoined her readers to “examine the evidence for themselves.” Her overarching case was grounded in the claim that, given the questions at hand, it was a “non sequitur” whether or not males and females are inherently dissimilar. In this way, Anderson avoided having to tackle larger questions about human physiology and whether or not fixed energy was its driving force. She contended that what mattered instead was whether what had been deemed boys’ educational methods interfered with girls’ development and functions. Anderson drew from her medical and educational background to propose that pubescent boys, like pubescent girls, also have additional energy requirements, though perhaps for different reasons. She noted that English schools in particular had accounted for these needs by, for example, altering their examination schedules and providing for additional physical activity throughout the school day. The only extra stress that girls endured over boys in the schools, according to Anderson, resulted from the hostility they encountered from those arguing that they should not receive such

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training. In this respect, she suggested that disproving Maudsley’s narrative suppositions would eventually function to eliminate this source of stress and position young women on approximately equal energetic footing with young men—leaving them safe to engage in uninterrupted educational training. Moreover, Anderson refuted the claim that cognitive endeavors pursued during menstruation were the cause of women’s nervous exhaustion and accompanying ills by arguing that the majority of nervous women had neither extensive educational backgrounds nor professional careers. She drew from the “testimony of many independent witnesses,” as well as from her own “observation,” to uphold the idea that the harms “complained of are seen to a much greater extent among the fashionable and the idle,” later adding that a lack of mental stimulation and adherence to stylish yet restrictive clothing was far more likely to lead to physiological trouble than was anything else. In an edited volume that ultimately became the “most widely quoted” refutation of Clarke’s work, suffragist Julia Ward Howe made similar claims about the many alternative variables—including restrictive clothing—that were likely the cause of women’s ill health and sterility. Although it has been argued that Howe was more invested in furthering the “romantic ideal of womanhood” than she was in advancing logic and scientific reasoning, she—like Anderson—nonetheless attempted to denounce Clarke’s appeals as the stuff of groundless fantasy by appealing to the logic of linear argumentation. She portrayed Clarke’s claims as no more than a “fable out of which [Clarke drew] the moral that women must not go to college with men.” Furthermore, she decried Clarke’s “impartiality of science” and supposed misuse of facts, and, on these bases, she deemed his conclusions about women’s limitations undeniably “objectionable.” Refutation Through Quantitative Data While Anderson and Howe enlisted a linear argumentation style, coupled with a scientific vernacular, to frame their logic- and demystification-oriented refutations, Dr. Mary Putnam Jacobi’s refutations were more genuinely grounded in scientific methodology and analysis. Jacobi’s essay-cum-book The Question of Rest for Women During Menstruation won the 1876 Harvard University Boylston Prize and subsequently garnered a great deal of renown. Therein, she drew from surveys that she conducted with 268 unidentified women, as well as from smaller laboratory experiments and secondary experimental data. She mirrored closely the strictures of formal scientific reporting, writing in the passive voice,

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framing the research as a legitimate contribution to knowledge production, delineating hypotheses and research questions, referencing study participants in the abstract, and communicating evidence through a series of no less than fortyeight separate statistical tables. She appealed almost exclusively to her statistical findings rather than to the clinical anecdotes, moral arguments, or “outright advocacy” evident in Clarke’s work, to disprove the idea that otherwise healthy women who engage in cognitive enterprises during puberty or menstruation put themselves at risk for health problems such as sterility. More specifically, Jacobi drew from the results of her study to argue that girls and women who attended the most extensive schooling and who did so into their twenties were less likely than their peers to experience menstrual pain and other reproductive problems. In direct contrast to Clarke’s contentions, Jacobi used her findings to characterize menstruation as an involuntary process that removes what she theorized to be extraneous nutrition from the female body rather than as a process that requires attention and thereby leaches energy from the system as a whole. Her “theory of menstruation” was grounded in the idea that women’s bodies are constantly—rather than periodically—contributing to their reproductive system’s energy requirements and therefore that menstruation is “not a succession of temporary revolutions of that organism’s resources.” This reasoning led Jacobi to conclude that women do not require additional rest during menstruation (at least no more than what comparable men and boys also require) and that a lack of such rest in otherwise healthy women does not cause nervous exhaustion or sterility. Her argument, in this case, was based not on refuting the theory of energy conservation writ large but rather on reconsidering how, exactly, energy configures itself throughout the female reproductive cycle. At other points in her report, however, Jacobi came a bit closer to questioning the logic of energy conservation in general. For instance, she drew from her quantitative findings to attribute sterility among married women to poor family health history or, more often, “local diseases of the uterus or ovaries,” contending that there was insufficient evidence to ascertain causes for the latter. On this point, she mirrored not only the appeals to empiricism evident in the writings of Dr. J. Marion Sims but also Sims’s contention that sterility is, more often than not, a mechanical problem with a straightforward mechanical-surgical solution. Jacobi appealed to existing surgical data to contend that a diseased uterus or ovary could generally be “restored to health by a technical operation,” noting that such a correction might involve, for example, the removal of conges-

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tion from the cervix or the fallopian tubes. As in Sims’s writings, Jacobi’s reasoning on this front functioned to constitute surgeons, rather than individual women, as the primary agents of women’s reproductive health. Yet, unlike Sims, Jacobi chose to forgo mechanistic metaphors for the female body in favor of organic similes related to the biological processes of plants and animals, as well as—in one case—a reference to women as “fertile.” That these nature-based figures (accented by James Matthews Duncan’s freshly coined metaphor) were combined with representations of the body as a machine evidenced and corresponded with the transitioning rhetorical and cultural landscape in which Jacobi attempted to disarm the narrative of energy conservation’s implications. Language conflating the female body with nature (and fertility) rather than with a machine (and sterility)—even in the context of scientific experimentation— differentiated this rhetorical moment from that of just a decade earlier, just as it also obscured Jacobi’s more explicit refutations of the narrative of energy conservation and human reproduction’s underlying logic. Refutation Through Scientific Data and Appeals to Moral Physiology Further evidence for this rhetorical differentiation emerged in a widely publicized report issued by the American Association of University Women (AAUW) in 1885. In 1883 the association hired Carroll Wright (chief of the Massachusetts Bureau of the Statistics of Labor) to assess the health conditions of its nearly 1,300 members, all of whom were female college graduates. Ultimately, 705 members responded to Wright’s forty-question survey, and the resulting statistics were cited by the report’s author and the association’s chair, Annie G. Howes (not to be confused with suffragist Julia Ward Howe), in an effort to refute the narrative of energy conservation’s chief claims concerning education and reproduction. Howes mirrored Jacobi’s appeals to scientific methodology, language, and analysis, referencing the AAUW’s dedication to science as confirmation of the “general truthfulness of the answers obtained.” She explained that the report was designed to replace conjectures about what might happen in a given situation with empirical knowledge about what did happen. To this end, Howes offered table after table of statistical findings, contending that they “plainly indicate results and need but little explanation.” From there, she delineated the basic conclusion that “the female graduates of our colleges and universities do not seem to show, as the result of their college studies and duties, any marked difference in general health from the average health

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likely to be reported by an equal number of women engaged in other kinds of work, or, in fact, of women generally without regard to occupation followed.” In fact, Howes’s findings were considerably more complex than her concluding remarks suggested, but they nonetheless offered compelling empirical evidence that women who had engaged in ongoing educational training during their pubescent and young adult years did not seem to be more likely to suffer from nervousness, reproductive problems, or a lack of maternal instinct. Less than 1 percent of surveyed women reported having abstained from mental exercise during menstruation, and yet over 80 percent of the sample as a whole reported being in “good” or “excellent” overall health. Although Howes found that respondents were less likely to be married than were other women of their age in the general population, once they married she found that they were also less likely than their peers to get divorced and just as likely to become pregnant and ultimately bear and raise healthy children. She allayed “fears so often expressed for the welfare of the children of the ‘future mothers of America’ ” by explaining that of the 196 married respondents, 130 were mothers and the “exceptional record of good health among [their] children and their low death rate are strong evidences that the powers of motherhood have not suffered from college work.” In light of the study’s extensive scientific framing and goals, it is notable that Howes’s report repeatedly drew from the rhetoric and assumptions featured in the very narrative it set out to disprove. Surrounding the report’s tables and statistical descriptions was not only an energetic logic but also a personified (and easily incensed) Nature, as well as reasoning that aligned with the more exclusionary foundations of social evolutionary theory. Howes contended, for instance, that an education offered women a “better knowledge of physiology and of the relentless vengeance of thwarted Nature.” Later she noted that participants in the sample were, on the whole, American-born and descended from Puritan stock, thereby assuring readers that participants were among the nation’s most evolved and civilized. In a broad sense, these appeals demonstrate that Howes and the AAUW did not set out to refute the narrative of energy conservation’s underlying logic but rather just the narrative’s conclusion that women must remove themselves from mental pursuits for at least onefourth of their reproductive lives. Howes’s easy adoption of several of the narrative’s key features may have helped facilitate the narrative’s continued use, even among medical professionals, in the years to come. That technical and lay discussions of women’s sterility were increasingly likely to feature the metaphor

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“fertility,” at the end of the century, demonstrated that appeals to nature (even appeals that lacked scientific backing) were discursively supported and had the potential to endure. Ultimately, despite their attempts to take on the narrative of energy conservation and human reproduction at the level of linear argumentation and the presentation of scientific data, it could be argued that late nineteenth-century narrative refutations did as much to further the narrative as they did to thwart it, especially in cases such as that of the AAUW’s, wherein refutations were communicated using the same language and appeals put forth by the narrative proper. Even when such language was not employed—as was the case for Anderson, Howe, and Jacobi—that these accounts worked to disprove the narrative’s implications for women’s education rather than the narrative’s underlying moral framework (however girded it was in the illusion of scientific rationality) did little to upset the narrative foundation on which those conclusions were upheld. Thus, the early twentieth century saw not so much a break from the narrative of energy conservation and human reproduction as it did the narrative’s evolution and revitalized advocacy for the idea that Anglo-Saxon girls and women must reject industrialization and professionalization and return to Nature to become and remain fertile.

A Reconstituted Narrative of Energy Conservation at the Turn of the Century In both medical journals and lay publications of the early twentieth century, a reconstituted narrative of energy conservation and human reproduction found a broad audience. If anything, this version of the narrative even more staunchly upheld the contention that individual women cause involuntary childlessness by self-interestedly ignoring the dictates of moral physiology. The twentiethcentury narrative responded to its late nineteenth-century critics and set itself apart from its earlier iteration by, for one, appealing to scientific norms explicitly and, for another, dichotomizing the natural from the artificial in the context of married women’s childlessness specifically (rather than in terms of women’s reproductive health more generally), all the while accounting for emerging societal concerns such as the consequences of contraceptive use, abortion, and untreated or latent gonorrhea. Metaphors of fertility and infertility appeared at least as often as did metaphors of sterility in these twentieth-century accounts

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and functioned as additional rhetorical support for the idea that women’s reproductive abilities are natural or organic and thus exist in contrast to scientific progress and rationality. Appeals to Traditional Scientific Inquiry Although twentieth-century proponents of the narrative of energy conservation did not necessarily cite earlier narrative refutations, they nonetheless answered such refutations’ calls by working to translate their conclusions into a more traditional scientific program of study. This response took one of three forms in that it involved an appeal directly to Spencer’s writings, a repudiation of Malthusian theory, or a categorization of specific types of married women’s childlessness. Early twentieth-century narrative proponents tended to draw explicitly and extensively from the narrative’s philosophical roots via Spencer’s scientific oeuvre. Unlike individuals such as Clarke and Maudsley, who borrowed more tacitly from Spencer’s rhetoric and reasoning and rarely cited him directly, individuals such as Drs. Caleb Williams Saleeby and Granville Stanley Hall situated Spencer and his social evolutionary theory as central to their narrative appeals. In a 1909 New York Times article, Saleeby—an obstetrician and chief propagandist for the Eugenics Education Society in Britain—held up his countryman’s Principles of Biology as the “greatest contribution yet made to philosophic biology” and referenced “Spencer’s law” as justification for the claim that “infertility in women” is often “due to mental labor carried to excess.” Similarly, in his renowned 1904 text Adolescence, Hall—founder of the American Journal of Psychology and the first president of the American Psychological Association—grounded his ideas about female “periodicity” and its corresponding depletion of energy in Spencer’s scientific claims. Hall labeled himself an “evolutionist,” cited Spencer’s findings on topics ranging from regimentation to temperance, and then offered Spencer’s life story as justification for his claims about appropriate adolescent education. Beyond explicit appeals to Spencer’s scientific philosophy, narrative advocates of the early twentieth century separated themselves from those of the nineteenth century (and responded to calls that they communicate within the norms of science) by discussing (and rejecting) Thomas Robert Malthus’s writings on overpopulation. Beginning in the late eighteenth century, Malthus, a British cleric, began publicizing his theory that population growth would eventually exceed the agricultural resources needed to sustain it, leading to wide-

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spread misery, vice, and death. To avoid this end, he advocated that individuals limit reproduction through late marriages and celibacy, a directive that both framed small families as desirable and functioned to constitute the “Malthusian couple” as an object of governmental oversight. In the early twentieth century, individuals such as Saleeby—along with Dr. James McKeen Cattell—argued that the narrative of energy conservation disproved Malthus’s population theory and that the narrative therefore had a place within the annals of scientific knowledge production. Saleeby, in particular, confronted Malthusian critiques directly (rather than eliding them, as was generally the case among Clarke, Maudsley, and their contemporaries). He argued that there was no real risk of overpopulation because the laws of energy conservation protected against it by ensuring that, the more one evolved, the less energy one possessed for reproduction. Saleeby paired Spencer’s hierarchical, energetic logic with Clarke’s affinity for personification to argue that “in the development of higher—that is to say, more specialized, more individualized—organic types, Nature is working, and has been working for ages, toward the elimination of the brutal elements in the struggle for existence.” Although he encouraged Anglo-Saxon women to avoid being driven by higher education to “the point at which motherhood is compromised,” he also framed their reduced reproductive potential as a form of natural, divinely proscribed protection against the bitter end Malthus foresaw. At this point, Saleeby’s direct refutation of Malthusian theory was not unusual. What was unusual was his unwillingness to equate falling birthrates with the evils of civilization and moral decline. Saleeby’s was one of a very limited number of turnof-the-century voices arguing that “people who regard a falling birth rate as in itself, and obviously, a sign of racial degeneration or immorality, or approaching weakness or failure of any kind, can have no substantial additions to their knowledge of the subject.” Dr. James McKeen Cattell, by contrast, was one of many at the time who held that “notable progress has yielded sinister byproducts,” such as a falling birthrate; yet he nevertheless joined with Saleeby in advocating for the narrative of energy conservation and human reproduction by designating Malthus a “false prophet.” In a 1909 Popular Science Monthly article, Cattell—a psychology professor and renowned science journal editor—not only critiqued Malthus’s conclusions but also bolstered the narrative of energy conservation and human reproduction itself by arguing that in “Malthusian days” the fact that “intellectual development inhibits the reproductive function” was frequently “urged as a

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beneficent plan of nature.” Women, according to Cattell, had actually been encouraged by Malthusian adherents to engage in intellectual pursuits precisely because such pursuits were believed to reduce their ability to bear children. In this respect, Cattell upheld the complicated proposition that the narrative of energy conservation and human reproduction proved Malthusian theory wrong and was nonetheless championed by Malthusian adherents’ reasoning. Early twentieth-century narrative advocates further highlighted their scientific contribution and distinguished their narrative iteration from that of predecessors by working to categorize different types of involuntary childlessness, for, as rhetorician Martha Solomon notes, scientific approaches to analysis are driven by the belief that making distinctions within and among categories of phenomena is of the utmost importance. Both nineteenth-century narrative advocates and opponents tended to group sterility in with other potential health problems such as menstrual pain, anemia, and nervous exhaustion. By the twentieth century, however, the emerging field of eugenics and portents of “race suicide” had conspired to make sterility-cum-infertility among Anglo-Saxon women one of the narrative’s primary foci. As early as 1901 president of the American Gynecological Association Dr. George Engelmann published “The Increasing Sterility of American Women” in the Journal of the American Medical Association. Therein he argued that modern life, particularly “over-pressure in schools,” was a causal factor in the unprecedented rates of what he referred to, in turn, as “sterility,” a lack of “fertility” or “fecundity,” and “barrenness.” After presenting a review of statistical accounts of sterility at the time—a review that has since been disproven in relation to several of its key points—Engelmann took up the scientific project of identifying and categorizing different varieties of the condition in question. He defined general sterility as a condition in which a woman is married for at least three years without giving birth to a full-term infant. From there, he offered increasingly specific definitions of distinct types of sterility, including “absolute sterility,” wherein a woman never becomes pregnant at all; “relative sterility,” wherein a woman miscarries before giving birth; and “artificial” or “self-inflicted sterility,” wherein a woman has a history of contraceptive use or abortion and, even thereafter, is unable to bear children. Engelmann also mentioned, but did not define, “male sterility” as a condition that “has been too much ignored, and is far more prevalent than is generally accepted.” His dedication to the rhetorical act of naming both foreshadowed the condition’s eventual widespread medicalization and designated a select few cases as

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treatable illnesses and many others as primarily the product of the immoral rejection of nature and thus as less likely to be resolved by medical treatment. Upholding Moral Physiology over Artificiality Despite his large following, Engelmann did not lack for critics, some of whom seemed far more concerned with the potential harms of contraception, abortion, and philandering husbands than they did with cognitive taxation during menstruation. Following the publication of Engelmann’s article, the Journal of the American Medical Association printed a number of responses to the piece. A few respondents explicitly rejected Engelmann’s claims about schooling and energy depletion and thereby contradicted the narrative of energy conservation outright. Dr. E. D. Ferguson argued against the idea that “schools of learning” had “made [women] sterile,” and Dr. M. F. Porter seconded this view by contending that “it is not because these girls have graduated from Vassar that they are sterile.” The majority of respondents, though, discussed Engelmann’s energy conservation claims not at all or in passing—thereby appearing to concede to their accuracy— and focused instead on the so-called moral causes of infertility. Categorizing abortion and the use of “condums” as the “abuse of the physiological law of creation,” respondents drew from the logic of moral physiology to give voice to increasingly successful movements dedicated to criminalizing abortion and censoring sex-related materials and discourses. Respondents also took Engelmann’s citation of male sterility in a slightly different direction by contending that “men contaminate their wives and make them sterile” in the wake of infidelity-induced (and latent) gonorrhea. In contrast to late nineteenthcentury discussions of sterility, this recognition that men (and their moral failings) were sometimes the cause of a woman’s inability to bear children was evident in a host of early twentieth-century discussions of reproductive health— although men were still rarely framed as potentially infertile in their own right. Ultimately, these mounting concerns related to the relationship between gonorrhea and reproductive problems, as well as to the purposeful thwarting of reproduction, played out in terms of a recalibrated narrative focus. Not only did the twentieth-century narrative concentrate more exclusively on sterilitycum-infertility than did the nineteenth-century narrative, but it was also even more focused than the earlier narrative on the idea of infertility as a moral issue that could be deciphered through nature. Early twentieth-century attempts to delineate moral actions in this context were enveloped within the language of

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artificiality. In a 1901 Journal of the American Medical Association article, for instance, Dr. Henry P. Newman spoke of the “vital interests that [a female] represents” as in contrast to modern civilization’s “artificial standards,” which rob women of the “natural privileges” of maternity and motherhood. Newman went on to suggest that a natural woman avoids (perhaps subconsciously) the “ambitions of the study room” in her quest to evade the unnatural and the “lack of fertility” that is its consequence. Newman’s use of “artificial,” in this case, encouraged readers to group women’s uninterrupted studying with other “artificial” practices such as contraceptive use and abortion. Earlier narrators may have positioned girls and women who studied through menstruation as at least partially the victims of a society working against their health, but Newman targeted girls and women as the major perpetrators of their own infertile conditions, perhaps projecting the anger he used to condemn other so- called artificial, immoral practices onto women’s intellectual pursuits. Similarly, Engelmann’s coining of the phrase “artificial sterility,” which he argued was due to “artificial controllable causes,” seemed to refer not only to contraception and abortion but also to “over-pressure in schools.” Women, according to Engelmann, were naturally ingrained with a morality that led them to shun what was artificial to them—schooling during menstruation, contraception, and abortion, as well as divorce and the donning of tight garments. Those who failed to eschew such activities were, by definition, artificial and therefore at fault for their inability to bear children in the way of the natural “true womanly woman.” The natural woman of whom Engelmann and others spoke was routinely romanticized in these accounts in ways that situated women as an exotic species to be appreciated, gazed on, and described from a distance. Hall, perhaps the most guilty of such appeals, argued that a return to the morality of nature was in order to protect the “normal woman in her prime,” who—directly after menstruation—“actually though unconsciously, if entirely healthful, .  .  . is more attractive to man; and as the wave of this great cosmic pulse which makes her life on a slope pass, her voice, her eye, complexion, circulation, and her very dreams are more brilliant. She feels her womanhood and glories in it like a goddess.” Hall’s woman-is-cosmos metaphor functioned, first, to situate his representation of woman as one with nature—perhaps as the personification of nature—and, second, as evidence of the divine teleology from which he was drawing. He concluded that, given her proper place within the rhythms of the natural world, woman “is less in need of supplementing her own individual

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limitations by the study of the alien lessons of the schools.” Schooling, in this account, depleted the woman of energy because it was at odds with, “alien to,” her nature. Hall positioned his subject as defined by her natural “periodicity” and therefore as morally suspect for any actions that removed her from that natural state. The studying woman—just like the woman who used contraception or aborted a pregnancy—separated herself from Nature, an action that could only result in what gynecologist R. S. Hill termed “abnormal manifestations.” Hall’s romantic—yet normalizing and increasingly medicalized—accounts of what Engelmann labeled the “true womanly woman” mirrored appeals central to the growing eugenics movement. Eugenic advocates spoke aggressively against the women’s rights movement, and their numbers included vocal energyconservation theorists. Hall, for instance, went so far as to blame the “feminists”—then a pejorative term for women’s rights advocates—for failing to encourage girls to focus on “establishing normal periodicity” during puberty and arguing that women should be treated equally to men even when they are “depleted” for “four or five days a month for some thirty years.” His targeted blame, in this case, evidences the early twentieth-century narrative’s tendency toward censuring individual women for their own lack of children. Such appeals no doubt packed a particularly persuasive punch in a society whose leaders and news media decried deliberate childlessness as worthy of the utmost contempt and held up the Anglo-Saxon mother of many children as reverent, dutiful, and worthy of veneration. An English report from this time on the declining national birthrate made clear that Anglo-Saxon women’s failure to reproduce—whatever the cause—was “not eugenic, but dysgenic.” Any action that was believed to keep superior women from reproducing, not the least of which involved the trading of cognitive growth for reproductive establishment and maintenance, was framed as a crime against humanity. These sorts of appeals to motherhood and uninterrupted childbearing enlisted the narrative of energy conservation and human reproduction in the propagation of eugenic ideology and the discouragement of what Hall described as the expansion of “woman’s sphere.” On the whole, this chapter has been devoted to outlining the logics and figures of the late nineteenth-century narrative of energy conservation and human reproduction in an effort to demonstrate how and why the narrative persisted into the twentieth century. In a broad sense, the rhetoric considered—which represents a variety of targeted audiences, publication outlets, and authors— suggests that a reconstituted narrative continued to circulate in highly visible

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technical and lay publications, first, because key scientific attempts at refutation failed to disprove its central logic or employed morality-oriented appeals and language that aligned with that logic, and, second, because early twentiethcentury narrative advocates shrouded the narrative’s claims in the scientific agenda set up by late nineteenth-century narrative refutations. The expectations of scientific rhetoric served as a foundation from which narrative advocates dichotomized the natural, fertile woman from the artificial, infertile woman, even when scientific methods had been used to disprove the conclusions that the broader narrative upheld. The illustration put forth of married, childless women as not only unnatural but also (therefore) at fault for their childlessness—whether from energetic depletion, contraceptive use, previous abortions, or philandering husbands—made the idea of involuntary childlessness (i.e., unprovoked, unagentic childlessness) almost moot. To be an Anglo-Saxon woman without children, at this time, was to be, at worst, the subject of contempt and seen as the source of national decline and, at best, the target of extreme pity. By contrast, to be a woman representing a supposedly inferior race without children was to be ignored entirely in both medical and lay rhetoric, as social evolutionary theory and its corollary, eugenic theory, deemed the subject position a practical impossibility. What finally slowed the circulation (but not the percolation) of the narrative of energy conservation and human reproduction was the emergence of reproductive endocrinology and the field’s support for chemical theories of reproduction in the 1930s and 1940s. While the energy conservation narrative framed the body as a fixed energy system, overseen solely by nerve fibers and created in the image of Nature, the scientific field of endocrinology was catalyzed by the recognition that chemical secretions from internal organs are responsible for inducing a number of different physiological responses. That reproduction seemed to be dependent on a specific type of these secretions, and that these “hormones” could be introduced into the body via external, artificial sources to stimulate (or suppress) fertility, facilitated the rise of an alternative public vocabulary delineating fertility through the lens of chemistry and artificiality.

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3 Improving upon Nature | The Rise of Reproductive Endocrinology and Chemical Theories of Fertility

In 1889 an aging French American physician contacted the Société de Biologie of Paris to report on the results of an experiment in which he injected himself with the crushed testicles of guinea pigs and dogs. In his report CharlesÉdouard Brown-Séquard claimed to have experienced an impressive list of rejuvenating effects from his investigation, and he put forth the hypothesis that a number of diverse illnesses could be treated successfully by the subcutaneous injection of testicular extracts. At the time, Brown-Séquard was almost unanimously written off as nothing more than a misguided alchemist, chasing eternal life well beyond the bounds of reason and scientific norms. Deeming him a “pentacle,” a symbol with historical ties to magical evocation, the British Medical Journal reported that Brown-Séquard’s statement recalled the “wild imaginings of mediaeval philosophers in search of an elixir vitae.” Despite the many scientific contributions for which Brown-Séquard was recognized in the years leading up to his infamous experiment, his report to the Société made him the joke of scientific and medical communities worldwide for the remaining four years of his life. After his death, however, Brown-Séquard’s seemingly eccentric ideas began to reveal themselves as nothing less than prescient in light of the finding that the endocrine system (rather than the nervous system alone) controls human physiological processing. Today, although he is still framed as something of a scientific outsider in many reviews of his work, Brown-Séquard is also celebrated as the “father of modern experimental endocrinology” and the “originator of hormone replacement therapy.” Even more important for the purposes at hand, Brown-Séquard must also be recognized for catalyzing—however “unforeseen and undesigned”—the transgressive fissure that allowed for a major reshaping of the diction of infertility in the early to mid-twentieth century. Although his experiment was originally devised in light of the narrative of energy conservation (he hypothesized that testicular extracts would repair a

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nervous system depleted by age and excessive sexual activity), the experiment ultimately produced some of the first and most widely publicized evidence for what would emerge as a new chemical theory of human reproduction. In this respect, his self-experimentation set in motion a discursive transition in which chemical arguments and metaphors, rather than appeals to nervous energy, came to constitute the foundation of (in)fertility rhetoric and, ultimately, facilitate infertility’s long-term medicalization. Although the initial medicalization of infertility could be located in the rhetoric of J. Marion Sims in the midnineteenth century, I find that it was not until the 1930s and 1940s—and the emergence of a public vocabulary of chemistry—that both technical and lay publics had the rhetorical tools to consistently constitute infertility as a medical condition. Indeed, U.S. infertility researcher Maxwell Roland made the astute observation in the late 1960s that “the physician has assumed an important position in the prevention and correction of infertility only during the last three or four decades [with] the growth of reproductive endocrinology.” In this chapter I develop and extend Roland’s claim about the medicalization process. More specifically, I demonstrate that, after Brown-Séquard’s experiment, several emerging forces related to the so-called chemical revolution and the rise of reproductive endocrinology cumulated in the 1930s and 1940s to contest the narrative of energy conservation and situate chemical language and appeals as central to reproductive rhetoric. After tracing these discursive forces as they circulated, percolated, and transformed over time, I draw from early scientific and mainstream books and articles discussing reproductive endocrinology, as well as from corresponding infertility-related press coverage, to explicate the vocabulary and arguments evident in this emergent, alternative narrative of human reproduction. I argue that, as theories of nervous energy were displaced by appeals to internal chemistry and medical intervention, (in)fertility was reconstituted as a product of chemical interactions that could be manufactured synthetically in ways that vanquished the limitations of the natural world. From this perspective, nature was not something to be emulated but rather something to be remedied and perfected. In tracing the rhetorical ecology of this period, I find that this chemical rhetoric played out in terms of a public vocabulary that furthered three key tenets of reproductive health: that fertility must be understood in terms of the biochemical variability of heterosexual couples; that scientific progress will inevitably lead to the realization of a state of artificial fertility that exceeds what is possible through nature alone; and that the establishment of fertility requires the guidance of technical experts. All

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three tenets supported the initial medicalization of (in)fertility, but, because they were the evolving products of a complex, at times resistive, rhetorical ecology, their analysis provides an account of the medicalization process that is neither unidirectional nor predetermined. On the whole, then, this chapter speaks to the ways in which the arguments, assumptions, and appeals of modern chemistry were enlisted in the 1930s and 1940s to create a rhetorical foundation for the medicalization of (in)fertility in the years that followed.

The Chemical Revolution and Its Language Rhetorician Walter R. Fisher theorizes that the explanatory narratives that help individuals and societies make sense of reality are made up of “good reasons,” which are evaluated according to discursive forces related to “matters of history, biography, culture, and character.” As these variables shift and change over time, so too do perceptions of what makes a reason—and thus a narrative— acceptable or not. In the context of twentieth-century infertility rhetoric, the shift from the “good reasons” of energy conservation at the beginning of the century to that of reproductive endocrinology in the 1930s and 1940s was facilitated, in large part, by the growing popularity of chemistry. Modern chemistry’s unique “shared rhetorical culture” had been infiltrating scientific, public, and vernacular landscapes as far back as the late seventeenth and eighteenth centuries. In this respect, an overview of that culture as it was constructed in and over time illuminates what ultimately made a chemical theory of reproduction persuasive in the 1930s and 1940s. Modern Chemistry’s Beginnings: Elements and Atoms Outside the Human Body The publication of Robert Boyle’s The Sceptical Chymist in 1661 is often cited as the instigator of the field of modern chemistry. Therein, Boyle, a British natural philosopher, put forth a theory of corpuscularism, a predecessor to the theory of atomism, holding that physical matter is composed of moving, infinitesimal corpuscles rather than, for instance, the four basic Aristotelian elements. Boyle positioned himself as at odds with alchemists, who, since the time of the ancient Greeks, had worked to transmute base metals into gold and, later, to develop tonics for curing diseases and extending life. This dichotomy separating the study of chemistry from that of alchemy is one that endured for centuries, even

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though, as historian Maurice P. Crosland explains, alchemists’ means—“solution, sublimation, distillation, calcination”—were identical to those of the modern chemist, and key argumentative topoi and rhetorical figures from the world of alchemy were taken up via the language of chemistry, such as the use of sex- and gender-oriented metaphors. From this perspective, when Brown-Séquard’s experiment was discounted as the work of an alchemist in the late nineteenth century, the medical community was drawing from a long-established strategy of disassociating what it deemed unbelievable and magical from the practices of rational scientists. Before the widespread recognition and development of biochemistry in the early twentieth century, the idea that the human body might be governed by chemical reactions was repeatedly characterized as fanciful and devised purely for commercial gain. Numerous scholars have upheld the idea that a “chemical revolution” unfolded between the publication of The Sceptical Chymist in 1661 and the technical discussion surrounding Brown-Séquard’s report in 1889, a revolution that focused extensively on everything but the chemical reactions discharged from within human bodies. Chemists during this period promoted theories delineating the compound nature of many substances long believed to be simple, the exploration of affinities and repulsions between diverse substances, and the publication of a systematic and therefore sustainable chemical language—all what rhetoricians Kenneth S. Zagacki and William Keith would label “radical proposals” in that they forced the reappraisal of seemingly fundamental premises. Although Serres’s theory of history as repetitive rightly contends that the refutation or rejection of historical premises is never as complete or absolute as talk of revolutions and paradigm shifts implies, there can be little doubt that these specific chemically oriented conclusions were championed widely throughout this period and constituted, in large part, by ongoing technical debates concerning the appropriate terminology for chemical elements. These debates intensified during the second half of the eighteenth century with the identification of hundreds of new substances, substances that were named haphazardly and without an overarching scheme of categorization. Official reform came in 1787 with the publication of a methodical chemical nomenclature, which drew from Enlightenment ideals to justify its designation that a compound’s title should reflect the materials of its empirical composition. Also underway at this time was the “conceptual assimilation” of oxygen and the publication of an oxygen theory of combustion, which is generally attributed to the work of French chemist Antoine Lavoisier. Science philosopher Thomas

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Kuhn has argued that the growing acceptance of an oxygen theory in the late eighteenth century inspired a paradigmatic shift away from the phlogiston theory, which contended that a gas called phlogiston is released from flammable elements during combustion. More recently, scholars have asserted that the phlogiston theory was “of marginal importance, at most” in eighteenth-century Europe and that the theory was not at odds with Lavoisier’s findings, as has long been reported. But regardless of what—specifically—the oxygen theory supplanted or coalesced with, there remains considerable evidence that its promotion played a role in altering the landscape and language of chemical study. By 1789 Lavoisier had published the first catalog of modern chemical elements and thereby initiated what philosopher John G. McEvoy labels a larger “socialization and professionalization of chemical knowledge,” as well as support for the contention that the elements intimated more than mere metaphysical ideas but, instead, operational substances that could be isolated and categorized. Talk of elements as operational, rather than metaphysical, only increased with the circulation of what came to be known as the atomic thesis, beginning in 1803. Drawing from Lavoisier’s catalog of elements, John Dalton—an English chemist and elementary school teacher—is generally identified as the first to propose that all elements are composed of individual, indivisible atoms and that atoms from the same element are of the same weight. He reasoned by methods of transduction that when different types of atoms from distinct elements combine, they form compounds, and that chemical reactions occur when different atoms rearrange themselves through synthesis or separation. Dalton’s discussion and operationalization of atomic weight not only made quantitative chemical evaluations possible but also paved the way for scholars such as Russian chemist Dmitri Mendeleyev to organize the elements according to increasing atomic weight and periodic law in 1869. Mendeleyev’s periodic table (which is today deemed “one of the most powerful icons in science”) offered a visual representation of modern chemistry’s emerging, empirical language and solidified the production of what philosopher Michel Foucault would label its “science of order.” Modern Chemistry Goes Public By the mid-nineteenth century, modern chemistry’s mode of ordering knowledge was becoming increasingly evident, even outside the scholarly discipline, a phenomenon that would have been necessary given that shifts in scientific paradigms have been shown to hinge on the “changing beliefs of a community.”

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Chemical societies—both professional and amateur—were emerging across Europe, and individual chemists worked to publicize their field. German chemist Justus Liebig, for instance, penned a number of widely disseminated books and articles that touted the benefits of chemical knowledge for individuals and societies. He employed simple anecdotes and analogies gleaned from agriculture and other accessible topics to explain chemical materials and processes, and he attended to the often overlooked task of advertising scientific findings to diverse and even unspecialized audiences. His “interdisciplinary inspirational works of science,” as rhetorician Leah Ceccarelli would label them, played a role in sanctioning the study of academic chemistry, “stimulat[ing] the growth of community between different scientific disciplines,” and igniting public chemical education. Such works also played a role in the widespread circulation of appeals to the “chemistry of everyday life” through turn-of-the-century popular-press books, novels, educational brochures, museum exhibitions, public lecture series, and more. Inspired initially by the conviction that members of an educated public must be conversant in chemistry as they must be in politics, history, and philosophy, these texts were distinguishable as much for their titles (almost all of them featured the words “chemistry,” “everyday life,” “everyone,” or “all laypeople”) as for their equivocation of chemistry with progress. Their popularity among diverse audiences—which corresponded with rising literacy rates among working-class and rural populations and with the circulation of mainstream media messages situating scientific knowledge as within the purview of lay citizenry—ensured that many ideas and terms originating in the chemical sciences were slowly becoming ingrained within the larger fabric of social life and, correspondingly, that laypeople were developing their own vernacular theories of chemical knowledge and reasoning. Indeed, historian Katherine Pandora explains that the “creation of scientific knowledge” is “played out over a shared terrain where the mixing and overlapping and interfering of different forms of thought and actions from within the vernacular contribute to its character and shape.” It was in this manner that fragments of chemical nomenclature were molded by and drawn into the well of “vernacular science knowledge.” Much popular chemical talk at this time, whether mediated or interpersonal, ultimately garnered increased play in light of the corresponding emergence of the commercial chemical industry. Scientific findings related to the synthesis of materials ignited the manufacturing and sale of a wide range of synthetic products. Throughout nineteenth-century Europe and the United States, industrial

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chemists (aka chemical engineers and industrial researchers) set their sights on developing and producing glass, soap, paper, fertilizer, dye, and more. Railways and steamships offered new, efficient methods for product distribution and helped to sustain tremendous industrial development. By the turn into the twentieth century, the chemical industry had become one of the major sources of employment for untrained workers in urban centers, and technologies of (and discourses surrounding) agriculture, transportation, and international conflict had been altered completely by its products and implementations. Twentiethcentury professional organizations such as the American Chemical Society were behind a range of public education programs designed, according to a 1929 Science article, “to make chemistry understood by those outside it and to give that newness of vision and awakening of interest which come from a knowledge of what chemistry is doing and may do for us.” Organic Chemistry Beyond chemistry’s ready application in industry and the “public discourse of scientists themselves,” chemistry’s rise as a renowned, progressive science in the mid-nineteenth century had much to do with the growing recognition of its role within the realm of the organic. Liebig, for instance, joined scientists trained largely as physicians and pharmacists in exploring the “chemistry of living things.” Empirical studies published as early as 1828 demonstrated that organic compounds could be derived from inorganic matter, a finding that was corroborated midcentury by the transcriptions of increasingly powerful microscopy. This postulate worked against theories of vitalism, which aligned with the narrative of energy conservation, by upholding the conclusion that living matter is not entirely unlike inorganic matter, particularly in its dictation via internal chemical reactions. In 1858 the theory of chemical structure elucidated the chemical organization of organic matter by demonstrating that carbon atoms (the common denominator for all living substances) have an affinity for one another and bond together by trading valences. This exposition of organic materials as organized according to complex chemical bonds, in combination with the recognition that organisms are composed of cells, functioned not only to help justify the study of organic chemistry but also to encourage scientists to further investigate the chemistry of biological processes. By the mid- to late nineteenth century, German scientists and doctors in particular had begun practicing chemical physiology, which focused primarily

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on the extracellular processes related to digestion and bodily fluids, but it was not until 1903—just a few years after Brown-Séquard’s experiment—that the German chemist Carl Neuber coined the term “biochemistry,” and the study of the chemical materials and processes within living cells became an internationally recognized endeavor. Biochemist Juda Hirsch Quastel contends that, over the first decade of the twentieth century, biochemists came to the conclusion that “the living cell is characterized by a complex of chemical reactions, each of which is capable of investigation by rigorous chemical or physiochemical methods.” Their focused use of these methods, which they presented in terms of the “problem-solving topos of methodological relevance,” convinced many in the early years of the new century that internal chemical activity drives and regulates numerous bodily processes, including reproduction. This tenet—and the concatenation of processes and forces on which it was upheld—induced a shift in both scientific and lay understandings of human health. At the dawn of the twentieth century, it had become clear to scientists in particular that human bodies, both individually and in terms of their reproduction, are governed by chemistry.

Exploration into the Chemistry of Life Early twentieth-century biochemical insight was informed by corresponding rhetorics of endocrinology. Studies of the endocrine system offered evidence about what, exactly, initiated and coordinated the body’s many internal chemical reactions. The first endocrinologists—among whom Brown-Séquard must be included—identified “internal secretions” as substances emitted from endocrine glands that functioned as catalysts driving biochemical interactions. By 1905 British physiologist Ernest Henry Starling had introduced the term “hormone” to refer to a specific type of internal secretion that acts as a “chemical messenger” through the blood. Although it could be argued that the term “messenger” implies a passive response to a hierarchical command, Starling and those who adopted his language evoked the body-as-communication-network metaphor in a considerably less top-down fashion, framing communication as active, affective, and intentional rather than as a rote exchange of orders. In 1907, for instance, Starling’s colleague Edward Schäfer deemed these so-called hormonal messengers “actors” because he saw them as responsible for igniting and then actively regulating the reproductive work of the ovaries and the tes-

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ticles. This hormonal theory of reproduction contrasted with—while also building from—existing nervous theories in which the nerves alone (and the energy sustaining them) were believed to be solely responsible for stimulating reproduction. The idea that the nerves work only in combination with chemical hormones to facilitate reproduction garnered increasing, even exponential, scientific support from 1926 to 1940, a period that saw the “rise of reproductive endocrinology.” The Rise of Reproductive Endocrinology Following the publication of Schäfer’s provocative hypothesis, researchers commenced designing empirical studies to explicate the potential connections between hormones and human reproduction. At issue for this early class of reproductive endocrinologists was not only what factors supported fertility proper but also what factors were involved in its suppression, whether intended or involuntary. By 1910 they had garnered enough evidence on the topic that the vast majority of scientists and medical practitioners had accepted the idea of the existence of testicular and ovarian hormones and their function as chemical catalysts and bodily regulators. This shift in scientific thinking, coupled with evolving postwar beliefs about the essential and invigorating—rather than superfluous and draining—role that sex played within the context of heterosexual marriage, cultivated growing support for the continued study of the sex hormones’ part in human reproduction. In the United States, for instance, the Committee for Research in Problems of Sex was founded in 1921 under the National Research Council to support the international “scientific study of sex as a biological phenomenon.” The committee’s first funded projects included those exploring the effects of castration on the release of sex hormones in mammals and the role hormones play in the estrous cycles of guinea pigs and rats. In 1923 the Committee on Maternal Health (later the Maternal Research Council) was formed to support research related to issues of fertility, namely endocrinology studies exploring the potential use of hormonal contraception within marriage. Other projects related to reproductive endocrinology or “sex-gland endocrinology,” as it was often labeled, obtained financial support through social- and health-conscious academic institutions and philanthropic foundations. And still other reproductive endocrinology projects obtained support from the pharmaceutical industry, as the market potential for commercial hormone preparations came into focus.

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With this complex of sponsorship in place, the subsequent two decades witnessed a host of what have been called groundbreaking scientific “discoveries.” Reproductive endocrinologists in cooperation with gynecologists, physiologists, and biochemists delineated the hormonal patterns driving human menstruation and ovulation, a process that depended significantly on the isolation, crystallization, and eventual synthesis of hormones known today as estrogen and progesterone. Such work was facilitated by the emergence of a range of material “inscription devises” that functioned to communicate “traces” of biochemical matter and construct “analogs” for scientific and clinical use. Over the following years researchers also isolated and synthesized what is known today as testosterone, a feat delayed to some extent by a general lack of access to male-specific biological materials for study. In light of this, research historian Thomas Laqueur designates the 1920s and 1930s as the point at which “the power of science to predict and effect successful mating in humans and animals was considerably enhanced.” Hormones and Sex Specificity This period was also the site of a major change in scientific thinking about hormones’ sex specificity. Early delineations of hormonal activity upheld the idea that the uterus alone produces so- called female hormones and the testicles alone produce so-called male hormones. Female and male hormones, as well as the gonads that seemed to create them, were therefore conceptualized as “agents of masculinity and femininity.” Building from this dichotomous understanding of biochemistry and sex, Walter Heape, a British biologist and embryologist, published Sex Antagonism in 1913. Therein, he laid out a theory of the antagonistic nature of male and female hormones and extended this biochemical argument to justify the separation of the sexes in various social and political contexts. Historian Nelly Oudshoorn finds that this argument and its cultural corollary was taken up in a range of medical and popular writings at the time, many of which employed battle metaphors to illustrate, for instance, that “the chemical war between the male and the female hormones is, as it were, a chemical miniature of the well-known eternal war between men and women.” Subsequent proponents of Heape’s antagonism theory took this contention that the sexes are biochemical (and therefore social) opposites a step further by hypothesizing that the existence of so-called heterosexual hormones (i.e., female hormones in the male body or male hormones in the

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female body) is a sign of disease or “dysfunction” related to homosexuality or latent hermaphroditism. Empirical findings published in the 1930s, however, called into question theories delineating an antagonistic relationship between sex hormones. Some of the most publicized of these findings identified, for instance, stallion urine as a highly concentrated source of “female” hormones, hormonal activity as linked to physiological processes beyond those of secondary sexual characteristics and reproduction, and the adrenal glands as additional sites of hormone production. All bodies, it seemed, produced the so-called female and male hormones, and, furthermore, biochemical examination of such hormones revealed them to be constitutively similar. Although hormones continued to be widely termed “female” and “male” for years to come, a range of endocrine-oriented theories came to the fore in the 1930s and 1940s that conceptualized such hormones as cooperative or feedback-oriented, rather than as antagonistic, and thus as what communication scholar Thomas J. Darwin describes as “intelligent” actors in the body’s metaphorical “integrated communication network.” As a result, sociologist Celia Roberts explains that sexual differences were increasingly deemed— at least in technical circles—“a matter of relative quantities of particular chemicals, rather than absolute essences. A model of continuum between male and female, along which individuals could be placed as more or less feminine or masculine, became dominant.” In the subsequent analysis of primary texts from the 1930s and 1940s, I find that this spectrum-oriented understanding of sex and gender extended in some key ways to constructions of (in)fertility. Like sex, fertility (or lack thereof ) was characterized during this era as the result of a balance of different chemicals not only in female bodies but also in male bodies, as well as in pairings of the two.

Infertility Rhetoric in the 1930s and 1940s Post–World War I infertility rhetoric was increasingly likely to further or otherwise draw from chemical explanations for reproductive health. More specifically, scientific publications and correspondence, as well as mainstream books and articles, tended to frame (in)fertility as a process catalyzed and regulated by internal chemistry; as existent on a continuum of biochemical variability according to individual women, men, and pairings of the two; and as potentially synthetically derived by technical experts capable of improving on nature. All three

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of these themes furthered the process of medicalization, though the ways in which they emerged across broader social fields of discourse countered an entirely top-down, deterministic delineation of (in)fertility. Chemical Agents As one might expect, scientists’ and clinicians’ technical rhetoric provides the earliest evidence of public attempts to frame human reproduction as stimulated by internal chemicals. Following in Starling’s wake in particular (who selected the term “hormones” based on its Greek root, “‘hormao,’ which means ‘to put into quick motion, to excite or arouse’”), researchers such as the U.S. physiologist George Washington Corner published reports of empirical findings that highlighted the “endocrine action” driving processes such as ovulation and conception. Corner, best known today for his research on the relationship between the ovarian corpus luteum and the production of progesterone, offered support for a hormonal theory of menstruation. In 1927 he summarized a corollary of this theory in the Journal of the American Medical Association, maintaining that “ovulation is a periodic function occurring regularly at about the middle of the interval between two menstrual hemorrhages.” Before World War I, very little was known about the menstrual cycle, and what was known was eventually revealed to be startlingly wrong. Early advocates of the rhythm method of contraception, for example, outlined the safe period for sexual activity as exactly at the point at which pregnancy is now known to be most likely to occur—approximately ten to fourteen days following menstruation. By the late 1920s, however, Corner and contemporaries such as the U.S. physiologist Edgar Allen were demonstrating by animal experimentation that ovulation and menstruation do not occur simultaneously, as had been previously believed, and that ovulation— and thus conception—occurs in the middle of the month rather than at the end. Their findings relied largely on investigations in which rhesus monkeys—mammals believed to be analogous in some key ways with humans—were, as Corner bluntly put it, “killed” at different points in their menstrual cycles so that researchers could examine variables including the state of the ovarian corpus luteum (if ruptured, this was believed to provide evidence that progesterone had been released), an ovulated egg (which was the result of progesterone release), and endometrial changes. These experiments led Corner to the supposition that chemical hormones discharged from internal glands such as the

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corpus luteum were the “action” behind the physiology not only of menstruation but also of conception, pregnancy, and birth. Other scientists and clinicians, including the U.S. gynecologist Robert T. Frank, became similarly convinced of this idea and mirrored Corner’s language by characterizing hormones as the central agents of reproduction. In his 1929 clinical tract The Female Sex Hormone, Frank posited that “throughout puberty the ovaries exert a continuous but low level stimulus upon the female genital tract.” In this sentence, the “ovaries” serve as a metonym for their product, the “female sex hormone,” a rhetorical maneuver that conflates this specific hormone with the female body proper and reinscribes long-held beliefs about the female body as determined and controlled by the ovaries. The ovaries’ and hormones’ role as stimulant for menstruation and the development of secondary sex characteristics served as the focus of not only this particular claim but also the book in its entirety. Indeed, Frank devoted a large portion of the volume to “chemistry” and, more specifically, to the chemical makeup of the so-called female sex hormone. He justified his detailed review of the hormone’s possible elements, valences, and overarching structures through assumptions that, first, hormonal actions are dependent on their chemical constitutions, and, second, human reproduction as a whole is therefore dependent on internal chemistry. Rhetoric of Chemical Agents in the Mainstream Media

By the 1930s mainstream versions of these technical assumptions were surfacing in popular-press coverage. From 1933 to 1934, for example, the New York Times featured a series of articles on the “hormones,” which journalist William L. Laurence defined as “chemical substances” that are in “control” of a variety of bodily activities as they are carried through the blood and serve as “messengers of our bodies.” In his summary of recent meetings of the British Association for the Advancement of Science and the American Chemical Society, Laurence attempted to provide an overview of various endocrine glands and their functions, briefly considering the “reproductive glands.” A year later he focused more exclusively on the hormones believed to be responsible for reproduction, maintaining that most “infertility” could be “traced directly to improper functioning of some of the glands of internal secretion.” Laurence’s claim was grounded in the idea that a body lacking in specific internal chemical agents is an infertile body and, therefore, that chemistry’s “complicated molecules” are a—if not the—determinant of fertility.

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In ensuing years it would become more difficult to decipher if or how this language of chemical agency was conveyed by scientific and clinical rhetoric to mainstream media coverage. The circulation of rhetoric featuring chemical reproductive actors seemed to be driven neither entirely from the top nor the bottom but rather from a central well of knowledge claims and vocabularies made available by an evolving rhetorical ecology. For instance, as Corner was giving speeches on “ovarian therapy” before professional organizations such as the New York State Medical Board in 1934—speeches riddled with descriptions of hormones as “produc[ing] certain changes in the uterus which render it suitable for pregnancy” and helping to “prepare the mammary gland for lactation”— the Associated Press ran an article featured throughout a wide range of North American newspapers, reporting that “a few drops of hormone extracts,” taken daily, are an effective “cure” for infertility. And soon after U.S. gynecologist and infertility specialist Samuel Meaker published his book Human Sterility, wherein he cited endocrine disorders (i.e., hormonal complications) as the major source of human infertility, Laurence went so far as to characterize hormones in the New York Times as responsible for “producing fertility,” and Howard W. Blakeslee, writing for the Associated Press, represented the “activity” evident in “male sex hormones” as indicative of fertility. Some of this permeability between technical and public spheres of rhetoric was buttressed by scientific experts’ attempts to author popular medical articles and books on (in)fertility and thereby speak directly with lay publics about reproductive endocrinology. For example, the high-profile physician and longtime editor of the Journal of the American Medical Association Morris Fishbein authored a popular “Family Doctor” newspaper column, wherein he summarized “research on the glands” and highlighted how scientific findings were being used to produce synthetic hormones that could be injected into the body and thereby boost fertility. Similarly, Corner authored several popular books grounded in his professional expertise, books that he argued were for the “benefit of a general audience.” These works included Ourselves Unborn: An Embryologist’s Essay on Man and The Hormones in Human Reproduction, the former of which was upheld by critics as an “exceedingly readable book, presenting a highly technical subject in a nontechnical fashion, and conveying a message which is of value to all who live to run the race of life.” Corner’s “charm,” as his reviewers put it, along with his talent for employing simple metaphors in the service of public science education—at one point, for instance, he equated the endometrium with “a quick lunch counter, with a supply of raw foods in the rear (in the blood

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stream), a row of cooks and waiters (the gland cells) and a line of customers (the cells of the embryo)”—made for an entertaining, if not also informative, read. His emphasis in these books on the “subtle and potent chemistry” by which the “critical journey from conception to birth” is incurred provided a clear picture of (in)fertility as chemically derivative. Citing Energy Conservation

Yet, in the midst of this discourse emphasizing reproduction as primarily chemical, elements of the narrative of energy conservation nonetheless made subtle and even explicit appearances, in part because nervous energy was not so much dismissed by chemical theories as deemed supplemental to biochemical processes. These appearances functioned, in some cases, to introduce the idea of (in)fertility as chemically derived through the lens of more familiar language, a process that philosopher Richard Rorty theorizes as necessary for the widespread adoption of unique metaphorical frames and alternative explanatory models. In a 1931 Scribner’s Magazine article titled “The Control of Human Sterility,” for instance, James A. Tobey—a PhD in public health and director of the American Institute of Baking—upheld the idea that proper nutrition plays a key role in minimizing cases of human sterility. Tobey cited Herbert Spencer’s work, thereby nodding at the narrative of energy conservation, to argue that diet influences (in)fertility, but he also claimed that modern “laboratories of the biochemists” provided the best proof that the cellular metabolism of vitamins and minerals are central to the “power to beget living offspring.” Although Tobey discussed hormones not at all in this article, his piece nevertheless functioned as a transitional discourse in which readers were eased into new ways of thinking about energy and reproduction. He seems to have focused on nutrition not only because it was his personal expertise but also because it overlapped across the narrative of energy conservation and chemical theories of fertility. As the article progressed, Tobey adopted the language of the latter—focusing on vitamins (rather than, for instance, nerves) as “vital sparks” to reproduction—to highlight the importance of the “chemical composition” of food. In this manner, Tobey’s article featured the language of cellular metabolism and linked that language to the establishment of fertility, thereby grounding subsequent rhetoric concerning the cellular metabolism of hormones in reproductive processes. Similarly, an Associated Press article published in 1934 also alluded to the narrative of energy conservation by noting that a lack of “entire bodily energy” hindered individuals’ reproductive capacity. Unlike the Tobey piece, however,

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this article focused explicitly on hormones as agentic and framed an increase in hormonal production and activity as the best cure for said lack of energy. Thus, readers familiar with the narrative of energy conservation, which linked low energy to infertility, were introduced in a gradual way to the possibility that internal chemicals, rather than (or along with) nervous weakness, might be responsible for energetic depletion. By contrast, in a minority of cases from this era, appeals to the narrative of energy conservation were upheld without also providing an obvious link to chemical explanations for infertility. Writing for Parents magazine in 1934, journalist Helena Huntington Smith argued, for example, that “there is an unmistakable connection between the stress of modern living and sterility. The woman of today, who tries to expand her energies to include a great many other things besides home and children, is under a nervous strain unknown to her grandmother.” Smith went on to express particular concern for the business or professional woman who lacked the “vital energy” to conceive or carry a child to term. Although Smith offered other, sometimes even contradictory, statements about the causes of infertility throughout the rest of her article, this specific claim aligned clearly with the reasoning put forth in Clarke’s Sex in Education. Women, according to Smith, must devote themselves completely to home and family or risk depleting the stores of energy that make reproduction possible. Even clinical experts such as Meaker were not immune from reasoning in this way, as his 1934 book Human Sterility spoke to the dangers of “overcivilization” and cited Spencer and Darwin to remind women of their evolutionary limits. As untimely as these sorts of appeals may seem to contemporary readers, they are ultimately to be expected if, as philosopher Michel Serres theorizes, time and history exist not on a linear path but rather on a path that is “folded, wadded up.” From this perspective, the narrative of energy conservation has always and will always echo in one form or another, although the prominence it enjoyed during the late nineteenth and early twentieth century has yet to be repeated. As time is folded up into itself, resources and language placed chronologically in the past emerge as elements of the present and future. The Biochemical Continuum of Attraction: The Sterile Marriage Beyond the contention that chemical agents control reproduction, the most consistent message across technical and popular-press infertility rhetoric from the 1930s and 1940s was that fertility exists on a continuum from low-to-high

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for individual women, individual men, and pairings of the two. In contrast with the majority of framings for fertility at the turn of the century, framings that conceptualized fertility as a state that women either possess or not, both technical and popular-press characterizations from this period argued that women and men possess varying and dynamic gradations of fertility. In Human Sterility, Meaker discussed an individual’s “reproductive capacity” in light of their “relative clinical sterility,” noting that “perfect” fertility is medically defined and not necessarily a phenomenon that occurs in nature. He reasoned that a number of different factors, including endocrine fluctuations and abnormalities, play a role in limiting fertility—more or less—in any given individual case. To emphasize the point, he provided a graphic imagetext featuring differing calibers of “clinical fertility” and “clinical sterility” and explained that fertility “occurs in many grades or degrees, varying widely in different cases and fluctuating within narrower limits in the same case at different times” (see figure 4). Meaker’s “clinical” qualification situated all cases of (in)fertility—regardless of degree or manifestation—firmly within the realm of medical jurisdiction and implied that couples who failed to achieve the “threshold of conception” were medically, and therefore socially, aberrant. Toward these ends, by the 1940s Meaker, along with his colleagues Charles H. Lawrence and Samuel N. Vose, was still referencing an individual’s “degree” of fertility in research publications, a phrase that historians Margaret Marsh and Wanda Ronner maintain as a defining feature of rhetoric about infertility from this era.

4 | Dr. Samuel Meaker’s graph of varying biochemical “degrees” of human “fertility” and “sterility,” featured in his clinical manual Human Sterility (Baltimore: Williams and Wilkins, 1934), 6. Image reprinted with permission from Wolters Kluwer.

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Drawing from this rhetoric of degrees, Meaker joined a growing chorus of scientists and clinicians dedicated to championing the idea that men are as likely as women, or at least almost as likely, to exhibit a low degree of fertility. A minority of men, of course, had long been recognized as potentially sterile— particularly those unable to ejaculate—and these cases still received a certain amount of attention within infertility rhetoric of the 1930s and 1940s, but a growing number of appeals from this time constituted all men as more or less “fertile.” Perhaps the most vocal proponent of this message was Dr. Sophia Kleegman, a clinical professor of gynecology at New York University College of Medicine. In a speech she gave before the Women’s Medical Society of New York State in 1938, she not only used the term “fertility” to describe men but she also operationalized “male fertility” in terms of microscopic analysis of the sperm, which, she argued, is “a most important index of a man’s fertility.” Drawing from recent research by microbiologist Gerard Moench, she provided an illustration of fifty differently shaped spermatozoa, beginning with one defined as “normal” and progressing through various divergences, each related to an incrementally lower degree of fertility. Kleegman’s analysis in this case and others is notable not only because it contributed to an increasingly medicalized account of male infertility—turning the traditional male, scientific gaze of the microscope on men’s bodies and cells— but also because Kleegman spoke candidly about the many harms to women’s bodies that had been incurred simply because the “onus of barrenness has been placed upon the female.” Drawing from the terminology of the past— “barrenness”—Kleegman critiqued ongoing practices as outdated. She argued that “no surgery on the woman should be done for the relief of sterility, unless the husband’s sperms, when examined according to new technique [sic] outlined, are within fertile limits,” limits, she argued, that could often be achieved given the appropriate endocrine treatment. Although Kleegman’s calls for male infertility testing and treatment were not uniformly adopted by clinicians or the involuntarily childless, the attention that she and others, such as New York physician Dr. Asta J. Wittner, paid to “male responsibility” in cases of infertility functioned to transfer some interest from individual women to heterosexual couples. More specifically, the “sterile marriage” emerged at this point as a recurrent theme that highlighted the role that the couple itself played in the conception and bearing of healthy children. A Newsweek article from 1934 made early use of this trope, reasoning, “When one parent is of low fertility and the other of high fertility, children generally result

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normally. But in cases of low fertility of both parents or complete sterility of one, artificial insemination is necessary.” This piece is notable not only because it was one of the first popular-press articles to publicize the possibility of artificial insemination (a process expedited by reproductive endocrinology research) but also because it conceptualized fertility as partnered. Bearing children, in this light, is the result of a complex equation in which the unique chemical balance of individual mates combines to catalyze, ideally, “normal” reproduction. In her 1934 Parents magazine article, Smith reiterated this point by arguing that “the responsibility for a sterile marriage seldom attaches wholly to the husband, or wholly to the wife,” before adding that “in most cases, it is the combination rather than one individual that is at fault. A woman of slightly lowered fertility, married to a highly fertile partner, will have no difficulty in conceiving, but if her husband’s fertility is also below par a sterile marriage will result.” This message that the “fault” for infertility was shared by the couple as a whole had circulated widely enough by the 1940s that it was not unusual for Corner to receive letters from involuntarily childless individuals—usually women—who claimed that both they and their husbands “had been checked by our physicians.” By the 1950s Corner was receiving letters from men that included not only their wives’ but also their own detailed medical histories. One letter, sent from India, evidenced experience with the sperm-analysis procedures that Kleegman championed. This individual reported having a “testicular biopsy to ascertain whether there are sperms in the testicles at least. It was found that there are many live and active sperms in the testicles but they could not come forward due to absence of Vas duct on both sides.” Hoping for a referral from Corner for treatment, he ended his letter with the injunction that “we are, sir, waiting for an early reply from you.” For this man, the problem of infertility was one that he and his wife had been convinced to approach proactively through medical treatment and as a couple. It is no coincidence that these couple- and range-oriented conceptualizations of fertility emerged at around the same time as scientists were finding sex hormones to be neither sex-specific nor necessarily antagonistic. Just as evidence surfaced that both sexes expressed degrees of femininity and masculinity according to their unique chemical compositions, so too did the rhetoric of infertility start to consider men and women as expressing degrees of fertility conferred by chemical constitution. In some cases, rhetoric explicitly combined references to the former with appeals to the latter. Thereby, doctors and researchers indicated that arguments about fertility as a range expressed in and across both sexes were

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extensions of research on hormones that posited a separation of sex from secondary sex characteristics and gender expression. In his “Family Doctor” series, Fishbein argued that “men of a feminine type” benefit from testosterone injections in terms of “general increased masculinity,” which he suggested includes an increase in fertility. Alterations in one’s hormonal substance, according to Fishbein, are responsible for corresponding alterations in proportion of masculinity and femininity and the ability to procure offspring. This proposition also surfaced in Corner’s The Hormones in Human Reproduction, wherein he explained that hormones stimulate degrees of masculinity, femininity, and fertility but play no role in the determination of an individual’s sex. “If the ovaries fail to develop or are removed in childhood,” he noted, “and the ovarian hormones are thus unavailable, the girl still becomes a woman—infertile, of course, usually somewhat immature or boyish, but still physically a woman, not a male or a neutral individual. For this reason the term ‘female sex hormone’ has been generally abandoned and the safer name, estrogenic hormone, used instead.” This particular quotation hinted at the emerging psychoanalytic literature and its tendency to deem women “immature” who failed to follow traditional sociocultural patterns, as well as the protective role that technical rhetoric (i.e., “estrogenic hormone” as the “safer name”) might play in separating issues of medical jurisdiction from public and social debate. Although Corner tried to ring the death knell for rhetoric designating sex hormones “male” or “female,” such rhetoric nonetheless remained dominant for years to come. By contrast, appeals such as Corner’s that drew from the idea that a balance of internal, shifting chemistry is responsible for one’s placement on a continuum of masculinity, femininity, and— by extension—fertility circulated widely. And as fertility was construed not only as existent on a continuum of hormonal balance but also as a characteristic of marriages or pairings, public vocabularies surrounding fertility seemed almost naturally to incorporate powerful figurative appeals denoting a “chemistry” between mates. By the middle of the eighteenth century, the writings of Robert Boyle, John Dalton, Sir Isaac Newton, and others had made it clear that chemistry is a relational science. Individual, distinct atoms attract or repel one another and, in this way, create chemical reactions that form new molecular substances. Biochemical inquiries of the early twentieth century demonstrated that these reactions occur within the body as catalysts for reproductive processes, the successful fulfillment of which depends, ideally, on love and affection between a man and a woman.

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With this picture coming into focus through diverse technical rhetoric, it did not take long for popular-press coverage of fertility to integrate metaphors of physical chemistry into explications of the fertile marriage and its opposite, the sterile marriage. In her 1939 Pictorial Review article titled “Why Don’t We Have a Baby?,” journalist Maxine Davis argued that, for some “sterile couples,” “there is just some strange chemical hostility, scientifically inexplicable. Often these couples separate, marry again, and live to rear husky bouncing youngsters.” This appeal aligned not only with those of the early twentieth century’s “human chemistry” movement, whose advocates reduced humans to their atomic structures and argued that human relationships are a result of the interaction of those structures, but also with a vital literary tradition beginning with Johann Wolfgang von Goethe’s 1809 novel Elective Affinities, wherein chemical attraction was employed as a metaphor for romantic relationships. The imagetext featured in the Pictorial Review piece illustrated a well-heeled man looking up, expectantly, at a perplexed, lab coat–donning doctor. Far across from the man, on the opposite page, stood a forlorn woman, holding a purse to her body and gazing away, down at the floor. This couple, despite focused effort and the resources that come with wealth and community standing, was childless. The doctor could not explain it, but their combination nonetheless yielded a sterile marriage because, as readers were invited to see for themselves in the illustration, they lacked the necessary bond that comes with attraction for each other. Each partner’s individual, chemical makeup, including their degrees of masculinity, femininity, and fertility, was incompatible with the other’s makeup. Here, the chemical rhetoric of science was co-opted to explain those cases of infertility for which science could not account. Nature’s Failure, Chemistry’s Cure: Upholding the Artificial But if rhetoric about infertility in the 1930s and 1940s is to be believed, it was the rare situation for which science of the time could not account. Assumptions therein about the abilities of scientific researchers to alleviate or altogether cure infertility reflected chemical discourse in general, which philosopher Jesper Sjöström argues “is based on the modernistic discourse, i.e., the idea that science generates constant progress and improvements for modern society.” To be sure, infertility rhetoric from this time enlisted seemingly unending appeals to this assumption that science is inherently progressive. Scientific advances, according to these entreaties, could lead only to more and better treatment.

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Even slightly before the 1930s, Meaker published a popular-press article titled “Two Million American Homes Childless,” in which he assured readers that effective treatment for involuntary childlessness was on the way. He reasoned, “the science of medicine is making constant progress in various fields, and during the last fourteen years light has been thrown on the problem of sterility. Today, doctors understand the causes of this condition better than ever before. Consequently they are able to treat their patients with greater success and bring happiness to many childless homes.” Subsequent articles communicated just as enthusiastically about scientific gains and included explicit discussions of the chemistry of reproduction. For example, a Canada Press article that circulated widely throughout North America in 1932 deemed the “isolation of a sex hormone in pure form” to be a “great advance in the chemistry of life.” Appeals such as this one to the “chemistry of life” implied that scientific findings would be enlisted within broader society for its betterment. This particular article concluded by drawing attention to the assumption that scientific investigation is ongoing and by identifying the social end to which such investigation would be devoted: “It is understood that the next problem of science is to accumulate this hormone in its pure form in sufficient quantities to make it accessible to physicians in treating illnesses peculiar to women.” Given the supposed rate of scientific growth and discovery, even scientists such as Corner concluded that, in the near future, the “childless wife” would “call and not in vain for the help that science can bring.” Indeed, writings and speeches by Corner and others framed ever more successful infertility treatment as an inevitability, something that would result as scientists garnered more empirical knowledge, which would then be enlisted by practitioners to cure infertility “patients.” In a 1933 New York Times article, for instance, Laurence explained that ongoing research had led to new treatments, in which an injection of hormones corrects a “vital deficiency in the patient.” Similarly, at the end of 1939, Dr. Fishbein concluded an article with a toast to the future, the future’s as-yet-unknown scientific findings, and the notion that such findings would be taken up by clinicians to treat infertility and other health conditions. “No doubt,” he expounded, “1940 will see new hormones isolated from the pituitary gland.” Scientific progress, according to Fishbein, was not only inevitable but also worthy of celebration, as it signaled the making of families that, in the course of nature, were not forthcoming. To this way of thinking, nature was not something to be imitated but rather something to be remedied and enhanced. In contrast with early twentieth-

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century energy conservation and moral physiology appeals, infertility rhetoric from the 1930s and 1940s repeatedly characterized nature as deficient, uncooperative, and failed. Often this representation accompanied discussions about the artificial synthesis of hormones and the potential gains such synthetics might contribute to the natural body. For instance, writing for the Lethbridge Herald in 1936, journalist Howard Blakeslee justified the “chemical ‘synthesis’ ” of “artificial male sex hormone” by explaining that “natural sources” simply had not yielded enough of the hormone for adequate scientific study and clinical application. Organic bodies—human and animal—were lacking, Blakeslee argued, so science was enlisted to take up the slack. And science excelled at this task by delivering something far better than what existed naturally: “more active hormones” or “super-hormones” capable, one might assume, of igniting fertility in even the most hopeless of cases or inducing the state of “perfect” or “absolute fertility” that Meaker argued likely did not exist in nature. Similarly, in The Hormones in Human Reproduction, Corner explained that “in some of our experiences, in which a large dose [of hormonal extract] was used, we even improved upon nature by producing more extensive progestational proliferation than normally occurs.” He added that “some failure of Nature’s process” was both alleviated and transcended by this scientific intervention. A 1942 report from the Fertility and Endocrine Clinics of the Harvard-affiliated Brookline Free Hospital for Women contended, correspondingly, that “the day of meek submission to the whims of so-called ‘Nature’ in reproduction is past.” That both this report and Corner personified nature in the fashion of energy-conservation proponents, but then also highlighted nature’s capacity for failure, seemed to function as something of a discursive dethroning of both the natural world and the religious dictates thereby derived. In its place, the artificial was taken up as a value term rather than as a pejorative, a signifier for the possibility of making all things better through chemistry. And what was to be made better in this context was the natural, infertile body, a process that—as this rhetoric made clear—required the oversight of a technical expert. The 1930s saw a rise in infertility specialists, some of whom founded clinics devoted entirely to the treatment of sterile couples. Such developments encouraged journalists such as Gladys Denny Schultz to instruct her Better Homes and Gardens readers to “consult a doctor” and “faithfully and gladly submit to the whole rigamarole, if they must.” This “rigamarole” generally included endocrine therapies designed to spark and oversee reproductive processes, as well as attempts to clear fallopian tubes blocked by inflammation, venereal diseases, or botched abortion attempts—a process that might also

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involve the prescription of “glandular medications.” Such therapies were portrayed in a number of popular-press articles as easy and corrective. An Associated Press article from 1934 noted that the American College of Surgeons had reported that the “cure of 50 per cent. of childlessness among 100 married couples” was found in the “easy method of taking daily a few drops of hormone extracts.” Other articles communicated even more confidence in these “chemical substances which have ended sterility in men and women,” reiterating—as Laurence did in a 1937 New York Times article—that these “potent biological preparations” had to be administered under the strict oversight of specialists. In one case, it was imparted that the “doctor injected hormones three times a week for a month,” ordered appropriate rest and nutritional supplementation, and thereby transformed a childless couple into parents. Although the changes in diet and lifestyle were important to this transformation, the change that truly acted as a trigger, according to this article, was the one that could be induced only by a trained professional. On the whole, then, this rhetoric represented fertility as a medically induced state in which the natural, infertile body is corrected to achieve a state of normalcy, often only at the goading of synthetically prepared, extrapotent chemicals.

Chemical Fertility and Responsibility Infertility rhetoric of the 1930s and 1940s emerged in the midst of an increasingly chemical society, one in which different strains of academic chemistry gained followings, industrial chemistry flourished, and the language of chemical affinities, elements, and molecules permeated even mainstream communication outlets. Embedded within chemical theories of infertility were echoes of seemingly outdated discourses, including the narrative of energy conservation, as well as distinct but topically related discourses considering, for instance, blocked fallopian tubes, which U.S. gynecologist I. C. Rubin developed techniques for assessing and clearing in the first decades of the twentieth century. In the case of the former, these appeals functioned as transitional statements easing audiences into newer, chemical explanations and percolations of tropes from years prior and, in the case of the latter, as alternative explanations for infertility surfacing from differently focused scientific trajectories. On the whole, though, what scientists, clinicians, health journalists, and popular-press writers kept coming back to at this time was chemistry. The body’s internal chemicals, its hormones, were widely recognized as the vital sparks of reproduction, and, in this way, they

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assumed the role that the nervous system had retained throughout the second half of the nineteenth century and the first decades of the twentieth. As the years progressed and the development of synthetic hormones became a reality, some of the agency ascribed to internal chemicals themselves was transferred in these discourses to scientists and clinical specialists, those with the power to develop “super-hormones” and employ them in their infertility cures. A speech given to the Worcester District Medical Society in 1946 by the famed infertility specialist John Rock elucidates this shift. Rock explained that “to induce ovulation, we would like very much to have the hormones of the anterior pituitary at our hands which would stimulate follicular growth and rupture of at least one follicle.” In this framing, the doctor’s hands are agents of fertility. They administer the hormones and therefore “induce” the follicular growth necessary for release of the egg and subsequent conception. These hands are also, then, responsible for fertility even more so than are the hormones prescribed or the individuals treated. Although references to individuals as responsible for or “at fault” in cases of involuntary childlessness were all but ubiquitous in these discourses, particularly in mainstream media accounts, the fault was generally divided among female and male partners and therefore was less focused than it had been in, for instance, Edward Clarke’s accounts of childlessness. As the idea of fertility was increasingly ascribed to male bodies, those bodies were constituted as key variables in the equations that resulted in couples’ infertility. And, more often than not, fault was represented as something that existed beyond the control of the individuals or couples in question. Schultz, for example, went so far as to advise her Better Homes and Gardens readers that the “first thing is to get rid of any feeling that either fertility or sterility is cause for pride or shame. It’s a part of the constitution with which each of us is born, and we differ in this as in other respects.” Schultz’s emphasis on the innate nature of individuals’ differing degrees of fertility is reminiscent, in some ways, of J. Marion Sims’s nineteenthcentury mechanistic treatments of the sterile body. What separated Schultz from Sims, however, was that Schultz—like many of her contemporaries— medicalized both female and male bodies and iterated the era’s account of fertility as existent on a continuum from low to high. Sims, by contrast, focused solely on women and approached fertility as an all-or-nothing characteristic. For both Schultz and Sims, though, the solution was medical intervention, be that intervention surgical or chemical. For all the references to individual fault and responsibility, infertility rhetoric of the 1930s and 1940s delineated fertility as largely outside the bounds of individual couples’ agency. The main instruction

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that readers could take from this and other articles was to seek out medical treatment and to “submit” to whatever that treatment turned out to be. In this respect, though, to take advantage of such treatment was framed as something of a moral imperative in and of itself. Couples learned that, while they were not necessarily responsible for understanding or overseeing their own cures, they were responsible for seeking out, respecting, and abiding by technical expertise and direction. To refuse to submit to medicine was—in this context—an almost unspeakable evil, especially for women, who, it could be argued, were almost always the implied primary audience for such communication, despite frequent discussion of the “sterile marriage” or “couple.” This analysis thus offers compelling counterevidence for the argument that appeals to medicalization tend to alleviate or altogether eliminate appeals to moralizing, even in cases where explicit discussion of initial causes or responsibilities point away from individual “patients.” No matter their degree of saturation with moral imperatives, though, there is no denying that medicalized treatments championed by 1930s and 1940s infertility rhetoric were distinct from those put forth in preceding decades in that they were not designed to mirror nature’s dictates but rather to correct and surpass them. The promise of progressive science positioned artificiality as superior to the natural world in many cases. While some couples experienced fertility naturally, this rhetoric implied that others simply needed something a little better than nature—something synthetic—to reproduce. As rhetorician Amy Koerber explains in her analysis of medical appeals in favor of infant formula over breast milk at around this same time, “rather than assuming human milk was the norm and that any artificial substance would probably fall short,” much medical rhetoric left open “the possibility that an artificial substance might” function at a higher level than nature. Similarly, in 1930s and 1940s infertility rhetoric, nature was repeatedly identified as lacking and the realm of the artificial was characterized as foreshadowing the way things really should be. In this context, appeals to nature’s morality and inherent truth garnered significantly less play. Correspondingly, messages characterizing infertility as a sign of societal disintegration or individual corruption became far less prevalent than they had been in the energy-conservation discourses of earlier decades. It would not be long, however, before Freudian psychoanalytic reasoning and language (so much of which aligned with and percolated from earlier moral physiology tropes) was brought to bear on infertility rhetoric, and this tendency to value the artificial over the natural was called into question.

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4 Psychogenic Infertility | The Unconscious Defense Against Motherhood

The integration of psychoanalytic theory into diverse academic and professional disciplines during the mid-twentieth century has been well documented, as has its function as a resource for rhetorical invention among mainstream and lay publics. Disciplines committed to the study of human infertility from this era (e.g., gynecology, obstetrics, reproductive endocrinology) offered no exception to the rule. Scientific experts and lay journalists were increasingly likely, starting as early as the late 1930s, to consider women’s reproductive health as a product of their psychosexual development. Theories of psychogenic infertility— inspired in large part by the work of Polish psychoanalyst Helene Deutsch— ascribed involuntary childlessness to women’s faulty or otherwise abnormal mental processes. Deutsch, a Freudian protégé who emigrated to the United States in 1935 and helped to lead the U.S. psychoanalytic movement, distinguished herself from her mentor by focusing attention not on men’s psychology but on women’s, and the “natural” mother-child relationship in particular. For this reason, she has been designated one of the founding “mothers of psychoanalysis” in that she strove to alter the field’s initial focus on the phallus to account for what she believed to be the “maternal determinants” and femalespecific characteristics of individual psychology. Deutsch initially set the stage for her professional interest in what she called “psychogenic sterility” in a speech she delivered on April 21, 1924, before the International Psychoanalytic Congress in Salzburg, a speech that, according to historian Paul Roazen, “immediately became a classic paper in psychoanalysis, and would be cited widely for the next sixty years.” Therein, she asserted that one “has become a woman” only after having experienced pregnancy and motherhood, events that she deemed the apotheosis of women’s psychosexual development. Using this framework as a guide, she concluded in her subsequent research that those women unable to conceive or carry a healthy child to term

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are prevented from so doing by “disturbing psychic factors” resulting from their emotional immaturity, regression, or abnormality. Deutsch argued that, in many cases, these abnormal psychological factors functioned to disturb the chemical balance required for conception and pregnancy and thereby acted as defenses against motherhood for those too neurotic to nurture a child. By midcentury, psychogenic factors—as well as appropriations of Deutsch’s arguments about the connections between biochemistry and “natural” or “normal” psychosexual development—were routinely listed in academic journal articles and mainstream media coverage as legitimate explanations for infertility. In this chapter I argue that midcentury psychoanalytic interpretations of women’s health and fertility took hold and developed—largely without direct refutation from those prescribing to chemical theories of infertility—because proponents mirrored the reasoning exemplified by Deutsch. That is, they framed psychoanalytic explanations for infertility not as a departure from chemical theories but rather as a narrative extension. Psychoanalytic proponents repeatedly linked biochemical and even physiological or constitutional infertility to unconscious desires resulting from dysfunctional psychosexual development. Correspondingly, they cited a number of key argumentative commonplaces from established chemical theories related to scientific progress, the technical expert, and medicalization and then used those commonplaces to introduce new psychoanalytically informed ideas. As medical writer Randi Hutter Epstein explains, medical professionals were poised to respond favorably to these strategies because they consistently found themselves encountering cases of “unexplained” or “functional” infertility wherein no physiological reasons for their patients’ reproductive troubles could be identified. In psychoanalytic explanations for infertility, then, they saw the prospect of providing every involuntarily childless patient with a medical diagnosis and cure. And because this explanation was framed as a simple extension of the chemical theories to which they already subscribed, they were more likely to overlook the divergent conclusions that psychoanalytic theory brought to bear on infertility rhetoric. For instance, while chemical theories of infertility of the 1930s and early 1940s emphasized the role that women, men, and pairings of the two played in achieving fertility, psychoanalytic theories of the 1940s and 1950s functioned much like earlier theories—such as the narrative of energy conservation—to position women alone as the central agents of infertility. And while chemical theories offered synthetic correctives to a natural world riddled with deficiencies, psychoanalytic theories turned to nature—again, mirroring and repeating elements of the nar-

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rative of energy conservation—as a guide for psychosexual and therefore reproductive health, all while defining “nature” in a specific and decidedly heteronormative fashion. Beyond illustrating how Deutsch and her supporters enlisted narrative extension to champion theories of psychogenic infertility, the rhetoric analyzed in this chapter—which includes psychoanalytic reports, medical practitioners’ academic and clinical communication, and mainstream infertility-related news coverage—also reveals itself as situated within and constituting a complex additional layer of medicalization. This emerging dimension of medicalization positioned individual women as unconsciously responsible for their own reproductive outcomes and, correspondingly, as subjects requiring and deserving of unqualified, potentially endless physical and psychological interrogation. I find that, in the process of extending chemical theories of infertility to incorporate psychoanalytic reasoning, scientists and medical professionals worked, also, to extend the reach of established medical disciplines so that practitioners— whether psychoanalytically trained or not—could draw from psychoanalytic insight in their assessment and treatment of patients. To this end, much clinical rhetoric from this time articulated what I call a “hermeneutics of the reproductive female” that instructed practitioners in the interpretation of not only women’s bodies and behaviors but also their speech, interpersonal relationships, life choices, and dreams as evidence for (or against) their psychosexual health and thus their fertility. In a number of cases, these articulations involved the application of psychoanalytic diagnoses to errant body parts, which resulted in discussions of, for instance, “hostile cervical mucus” and “irritable uteri” or, conversely, the idea that the supposed shortcomings of individual body parts were telling of corresponding psychological deficiencies. What this hermeneutics of the reproductive female meant for involuntarily childless women was that they were constituted as not just abnormal and unnatural but also as suspicious and deceitful. In this diagnostic framework the real causes of women’s chemical deficiencies and physiological abnormalities were said to be lurking deep within their unconscious minds. Infertility patients themselves were repeatedly framed in these discourses as the major obstacle to their own successful diagnosis and treatment as they subconsciously defended against attempts to bring about normalization. Thus, whereas chemical theories of infertility required that involuntarily childless women put their bodies wholeheartedly in the service of technical experts, psychoanalytic theories of infertility extended this medicalization process by requiring that such women

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also hand over the inner recesses of their minds. Only in complying with this moral imperative to surrender body and mind to medicine, then, were involuntarily childless women led to believe that they could bear their own biological children and become, as a result, mature women. In this respect, the emergence, circulation, and evolution of mother-centric psychoanalytic theory set the stage for positioning involuntarily childless women as, if not physically, then mentally, sexually, and socially deviant.

From Freud to Deutsch and the Advent of Mother-Centric Psychoanalysis To contextualize how midcentury rhetoric framed theories of psychogenic infertility as extensions of chemical theories of reproduction, the subsequent sections provide, first, an overview of the Freudian psychoanalytic vocabulary from which Deutsch eventually drew to develop her mother-centric theories and, second, a delineation of the mother-centric turn in psychoanalysis itself and the corresponding emergence of theories of psychogenic sterility and infertility. The Freudian Psychoanalytic Vocabulary Just two decades after initiating the psychoanalytic movement, Sigmund Freud had already published a historical account of its early trajectory, thereby revealing the extent to which he believed that his “creation” had import. Published in German in 1914 and translated into English in 1917, The History of the Psychoanalytic Movement provided an overview of what Freud saw as the key tenets and terms of psychoanalysis that would eventually circulate and evolve far beyond his famous Viennese couch and be enlisted to explain a range of issues, including women’s reproductive health. Therein, Freud contended that psychoanalysis, which encompasses theories and clinical methods that inquire into the sources of mental disorder, is grounded in the assumption that “neuroses originate in the sexual life.” The sexual life was foundational for Freud, as he subscribed to what historian Roy Schafer labels a “teleological view of the propagation of the species,” wherein—in Freud’s account—a personified “Nature” guides individuals first and foremost toward heterosexual coitus and procreation. The psychically disturbed, Freud argued, have “repressed” painful memories, instincts, and desires within the “unconscious” mind, often in an attempt to reach a “compromise” between the drive for pleasure (which involves

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so-called libidinal-directed instincts) and the drive for self-preservation (which involves so-called ego-directed instincts). The best way to resolve their mental disorders, Freud concluded, is to identify and interpret “inner conflicts” through the analysis of dreams, free association of thought, and analytic “transference.” The Oedipus Complex

Beyond summarizing the early tenets of psychoanalytic theory, Freud devoted the bulk of his historical account to tracing specific pockets of movement support and resistance. He rightly characterized much resistance as emerging in response to his theories of infantile sexuality and childhood sexual development, wherein he introduced the “Oedipus Complex” as a necessary stage of human growth that directs the first sexual impulses toward one’s parents, “the son being drawn towards his mother and the daughter towards her father.” In boys, Freud argued that resolution of this “phallic” stage of development, a stage preceded by the “oral” and “anal” phases of “pregenital organization,” is brought about by the threat of castration—usually from the father. This threat forces boys to direct their sexual instincts toward a new “object-choice”—other females—and to eventually establish “the normal sexual life of the adult, in which the pursuit of pleasure comes under the sway of the reproductive function.” In girls, however, Freud contended that there could be no clear resolution as they are led to believe—upon seeing a male’s genitals—that they have already been castrated and thus are inferior to males. Freud reasoned that girls on a “normal” developmental path eventually learn to transfer their love for their fathers to that of other males and to identify with, rather than exert aggression toward, their mothers, whom they recognize as also inferior. This process, he submitted, depends on a shift in the erotogenic zone from the “masculine” clitoris to the “feminine” vagina. After interacting closely with Helene Deutsch in the 1920s and reading her work-in-progress, Freud amended his original notion that girls are first attracted to their fathers. In an essay on female sexuality published in 1931, Freud argued that in the “pre-Oedipal stage” girls are initially attracted to their mothers but that girls come to reject their mothers with hostility, generally because they blame them for their lack of a penis or harbor an impression that they were weaned from the breast prematurely. Following this break, girls replace their mothers with their fathers as objects of sexual love. Freud reasoned that, because girls never experience the threat of castration, they cannot fully escape the Oedipus complex (and consequently develop a substandard sense of justice

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and principled reasoning). Instead, they transfer their wish to bear a baby by their fathers—a baby to assuage their envy for the penis—to their husbands and are thereby driven to enact the “normal sexual life of the adult.” By contrast, Freud theorized that girls who fail to make the leap from love-of-mother to love-of-father develop neuroses such as the “masculinity complex,” which involves the “phantasy of being a man” and which blocks the “normal” flow of libidinal energy. Psychic Energy, Sublimation, and the Id

A logic of energy flow and guidance makes up the core of Freudian theory. Similar to the narrative of energy conservation of the late nineteenth and early twentieth centuries, which proposed an economy of fixed physical and mental energy, Freud theorized an economy of psychic, largely unconscious energy. Philosopher Paul Ricoeur identifies the reasoning behind what Freud labels the “psychic apparatus” as grounded in a loose interpretation of the laws of physics related to inertia and thermodynamics. More specifically, he and others have situated Freud’s “principle of constancy” as a modification of the theory that energy within a closed system both is constant and tends toward equal distribution to contend that systems (e.g., psyches) work to keep the quantity of energetic tension low and stable. Freud labeled the energy at play within the psyche “libido” and separated it entirely from the metabolic system, thereby distinguishing this energetic system—to a certain extent—from that proposed by energy conservationists of years prior. The libido, according to Freud, is a quantitative variable force derived from the sex instinct that is “invariably and necessarily of a masculine nature, whether it occurs in men or in women.” More specifically, he characterized libido as the dynamic pushing humans toward pleasure, and he argued that the survival of individuals and societies depends on its effective distribution between the innate drive for self-preservation and the drive for love-objects. The achievement of this distribution, according to Freud, depends on one’s ability to guide libidinal forces in appropriate directions. For instance, in Three Essays on the Theory of Sexuality (1905), he explained that, for neurotics, “the libido behaves like a stream whose main bed has been blocked. It proceeds to fill up collateral channels which may hitherto have been empty.” Freud used this naturalistic metaphor to argue that, when psychosexual development progresses in ways that he defined as abnormal or unnatural, the instinctual drives toward pleasure and the avoidance of pain are repressed or subverted, and the energy

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that would normally “flow” into the reproductive function is forced into counterproductive avenues and modes of expression. In some situations, Freud held, erotic energy can be “sublimated” in positive ways, as is the case when libido is transformed into professional or artistic achievements. But barring successful sublimation, a process not without its own risks, Freud insisted that the avoidance of mental disturbances depends on the early development of a psychosexual infrastructure that will direct libido toward heterosexual, reproductive ends. Freud provided an outline of this infrastructure in The Ego and the Id. First published in 1923, this work divided the psyche into three entities: the id (which encompasses the instincts and passions), the ego (which encompasses reason and common sense), and the superego (which encompasses the moral consciousness that develops at the successful resolution of the Oedipus complex). Freud argued that considerable psychic energy is expended when the ego or the superego steers the id’s instinctual drives, adding that this expenditure is as exhausting as it is necessary to the health of the individual. He offered a metaphor hearkening back to Plato’s famed charioteer allegory to illustrate his vision of psychic energy as best “driven” in specific directions and transformed to productive ends, noting that the ego, in relationship with the id, “is like a man on horseback, who has to hold in check the superior strength of the horse; with this difference, that the rider tries to do so with his own strength while the ego uses borrowed forces.” The ego, according to Freud, functions as a conduit for the energy emerging from the id and works to employ a portion of that very energy to productively direct it. He went on to extend the analogy by explaining, “a rider, if he is not to be parted from his horse, is obliged to guide it where it wants to go; so in the same way the ego is in the habit of transforming the id’s will into action as if it were its own.” Therein, Freud indicated that the energy of libidinal instincts is best harnessed rather than left to its own devices or tamed completely, for directed libido he characterized as necessary and ultimately responsible for the creation and maintenance of civilizations. Nature Versus Civilization

Throughout his writings Freud characterized libido as an expression of instinct, and instinct as a product of human nature and the natural world. In Civilization and Its Discontents (1930), for instance, he situated nature as in opposition to civilization, reasoning that “the word ‘civilization’ describes the whole sum of the achievements and the regulations which distinguish our lives from those of our animal ancestors and which serve two purposes—namely to protect men against

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nature and to adjust their mutual relations.” For Freud, civilized societies restrict individuals’ natural instincts, especially those related to sexuality and aggression, and reroute or sublimate those instincts toward the building and maintenance of an organized community. He contended that civilization is something of a necessary evil in that it generally prolongs life, but it does so by restricting individuals’ greatest source of happiness, the satisfaction of instinctual drives. In this way, Freud argued, civilization puts individuals at risk for developing neuroses because it requires their detachment from nature through the repression of libidinal energy. As “civilization is built up upon a renunciation of instinct,” he explained, “what we call civilization is largely responsible for our misery,” as “we should be much happier if we gave it up and returned to primitive conditions.” In contrast to nineteenth-century social evolutionists, who reasoned that the progression of organic life toward the formation of advanced civilization is nature’s telos, Freudian theory positions civilization as contradictory to nature and therefore as anything but the “road to perfection pre-ordained for man.” So-called primitive man contributed less to cultural endeavors and the development of science than did the “civilized,” but, Freud contended, in retaining the freedom to follow instinctual drives, he was in many ways better off than his civilized counterpart. Drawing from this idea that civilization depends on the sublimation of nature, Freud traced mental disorders to societal restrictions that repress natural instincts to the point at which they reemerge as dysfunctional symptoms—both mental and physical. He conceptualized this process as dependent on the energetic “compensation” necessary for civilization’s construction, maintaining that civilization obeys the “laws of economic necessity, since a large amount of the psychical energy which it uses for its own purposes has to be withdrawn from sexuality.” Accordingly, he asserted that mental dysfunction necessarily results when there is no effort to “compensate” for instinctual renunciation. “Neurotic symptoms are,” he argued, essentially “substitutive satisfactions for unfulfilled sexual wishes.” In this respect, Freudian theory contends that civilization— advanced or otherwise—is the source of human dysfunction (rather than the ideal of human evolution), as it is built on the repression and sublimation of sexual energy and therefore of nature. Freud concluded that the solution for such dysfunction is for individuals to identify and come to terms with their instincts within the milieu of civilization’s counterintuitive demands. This process, which he theorized as transpiring in the context of psychoanalytic therapy,

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involves the resolution of psychic tensions that have kept libidinal energy from flowing toward what he saw as the normal “reproductive function.” The Mother-Centric Turn: Deutsch’s Emerging Psychoanalytic Vocabulary This normal reproductive function, in Freud’s view, is driven by masculine energy and men’s inherently aggressive sexuality. Women, according to Freud, are largely the recipients of this initiative, although libido manifests in them as well. He argued that women are more intimately connected to nature than are men in that they are less proficient at sublimating their instincts and contributing to society, a situation that often finds them adopting a “hostile attitude towards” both men and the “claims of civilization.” In this way, Freud reasoned, women are more vulnerable than are men to psychological disturbances. For one, he contended that women are incapable of fully resolving the Oedipus complex and thereby developing an “inexorable” superego, and, for another, they are in possession of fewer avenues for sublimating their instincts in the service of civilization. From penis envy to a general overarching hostility directed at civilization, women, in Freud’s estimation, often find themselves unable to come to terms—unconscious or otherwise—with their instincts, particularly in the context of societal dictates. Extending Freud’s Narrative into Maternity

Of course it was not until Freud’s later years, following his interactions with Helene Deutsch and other rising psychoanalysts, that he directed his attentions toward women’s psychosexual development at all. Even Freudian advocates have characterized the bulk of his work as “essentially male” in focus, while his many critics have reported considerable “masculine arrogance” therein. Ultimately, the eventual female-targeted, “mother-centered” turn in psychoanalysis has been attributed not to Freud but to Deutsch, Karen Horney, Anna Freud, and Melanie Klein. Of all these up-and-coming psychoanalysts, including Freud’s youngest daughter, Anna, Deutsch has been characterized as the theorist whose life’s work came to align most seamlessly with that of Freud’s, Deutsch serving as the “clay” to Freud’s “potter,” according to a 1930 New York Herald Tribune article. Indeed, rather than furthering a revisionist or post-Freudian approach and critiquing the phallocentric nature of Freud’s oeuvre, Deutsch worked largely within the confines of her mentor’s theoretical infrastructure, building from

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Freudian tenets concerning the fundamental differences between the sexes in ways that upheld his legacy. As Roazen explains, Deutsch “always camouflaged her modifications of Freud in the most tactful language possible.” In this respect, Deutsch’s writings provide yet another example from this period of narrative extension. She employed Freudian theory as a foundation for introducing nuanced psychoanalytic claims. For instance, at certain points in her work she cited Freud and then contended simply that the “following can be added,” while at other points she deemed newly introduced theoretical constructs to be a “complementary application of Freud’s assumption.” Deutsch’s dedication to narrative extension functioned, at first, to provide momentum for her midcentury research career. In the 1960s and 1970s, however, it provoked an onslaught of critique from liberal and radical feminists whose identities were grounded in the rejection of Freudian theory. Although Deutsch is best known today for her two-volume work The Psychology of Women, published in 1944 and 1945, her work began circulating widely in psychoanalytic circles as early as the 1920s, when she became the first president and director of the Vienna Psychoanalytic Training Institute. Her initial book, Psychoanalysis of the Sexual Functions of Women, was printed in 1925 by Freud’s Viennese publishing house. In what turned out to be the first psychoanalytic monograph committed solely to women’s psychology, Deutsch contended that the study of women’s psychological functions must focus on the “generative processes” because “these form the center point of the mental life of the sexually mature woman.” Unlike men, for whom, she argued, the “sexual function” is satisfied through sexual release of the “germ plasm” during heterosexual coitus, Deutsch contended that, for women, this function remains unsatisfied by coitus alone. Rather, she maintained that it is not until women conceive, birth, and then mother offspring that sexual satisfaction and maturity are finally achieved. In this line of reasoning, childless women remain forever sexually underdeveloped, unfulfilled, and prone to psychological and physical dysfunction. Subsequent public arguments extended this logic in ways that both personified women’s reproductive body parts and framed women as reproductive beings first and foremost, concluding, in one case, that “if a uterus doesn’t make babies, it makes fibroids.” Deutsch ultimately distinguished herself from Freud by dedicating her career to explicating this psychosexual process in women. In building from Freud’s claim that sexual maturity in females depends on their acceptance of the vagina rather than the clitoris as their sole erogenous

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zone, Deutsch grounded her theories in what Schafer characterizes as Freud’s “evolutionary value system.” This system assumes that “individual human beings are destined to be links in the chain of survival” and that “nature has its procreative plan,” which depends on “genital sexuality” as the “natural order of things.” In light of this reproduction-oriented telos, Deutsch reasoned that the “female ego-ideal” can be nothing other than “idealized maternity.” What she saw as women’s natural, inherent drive to reproduce led Deutsch to determine that women experience pleasure in coitus only because it represents the “beginning of reproductive activity.” She extended this argument to contend that the act of giving birth represents, for women, the “acme of sexual pleasure,” a conclusion that generated more than a little criticism in the years following its publication. Deutsch’s earliest and most profound deviation from Freudian theory was— and is—routinely overlooked, largely because she framed the contribution so as to minimize its variation and thereby uphold her work as an extension of Freudian philosophy. Yet her discussion of what she termed “feminine libido” in Psychoanalysis of the Sexual Functions of Women departed considerably from Freud’s conceptualization of libido as inherently “masculine” regardless of its host’s sex. Although Deutsch avoided belaboring the point, she suggested that women are driven by a libidinal energy entirely unique to their sex, while men are driven by a separate, masculine libido. That neither Freud nor his devotees drew much attention to this discrepancy likely had to do with how seamlessly Deutsch constituted feminine libido out of Freud’s existing theory of psychosexual development. For example, she inferred that feminine libido is born of the “narcissistic wound” that girls suffer upon concluding that they have already been castrated, a punishment that they deduce has likely been enacted for clitoral (i.e., masculine) masturbation. Through the renunciation of this act of infantile, masculine sexuality—and with it the clitoris for the vagina—Deutsch held that young women adopt a “passive-feminine stance,” wherein they are driven to accept the heterosexual overtures of male suitors and begin their psychosexual ascendance to maturity through motherhood. This passive, “receptive” representation of what Deutsch labeled, in turn, the “feminine,” “female,” and “maternal libido” existed in contrast to—rather than at the cost of—Freud’s masculine, active consideration of libido. Feminine libido as Deutsch constructed it offered a juxtaposition that highlighted, rather than negated, the phallus as actively directing not only individual acts of reproduction but also that of civilization as a whole. Nowhere did Deutsch’s theory deny Freud’s claim “that the accomplishment of the aim of biology has been entrusted to the

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aggressiveness of men and has been made to some extent independent of women’s consent.” Psychosexual Development and Psychogenic Sterility

It was from this philosophical context, wherein women were said to be biologically and therefore psychosexually passive, that Deutsch introduced the idea of “psychogenic sterility.” The establishment of this concept depended on her contention that bearing a child is the only possible compensation women have for their biological inferiority, the only thing that can heal them “completely for all [their] narcissistic wounds.” In psychogenic sterility—a concept that Deutsch failed to define explicitly in her early works—she argued that a woman has often retained a degree of unconscious guilt for the clitoral masturbation that precipitated supposed castration. In this case, the child that would ultimately serve to make up for her deficiencies is what she comes to renounce “in a kind of renewed castration. She believes she must give up hope of a child as she once gave up hope of a penis.” In blocking the mechanisms necessary for reproduction, this subconscious guilt also blocks what Deutsch and Freud theorized as women’s only effective outlet for sublimating libidinal energy: childbearing and childrearing. As Deutsch explained, “among women all the libido that in men is withdrawn from sexuality and directed to the outside world remains centered on the sexual function.” This framework ultimately positioned those experiencing psychogenic sterility as unstable and unbalanced to begin with and, as time went on, increasingly ripe for the manifestation of further neuroses and dysfunction. Deutsch based the conclusions in her first book on observations she made in her analytic practice and on self-analysis, a process that she identified as the source of the psychoanalyst’s “practical education.” Although she was careful to mask observations of her own “psychical life” so that they appeared to be that of her analytic patients, her correspondence and autobiographical writings reveal the extent to which the bulk of her arguments concerning psychogenic sterility in particular emerged from her own experiences. She had multiple miscarriages both before and after the birth of her only child, Martin, in 1917, with one particularly devastating loss occurring at eight months into her pregnancy. In time Deutsch came to attribute her inability to carry those pregnancies to term to her own faulty psychosexual development. More specifically, she contended that she never bonded with her hostile and abusive mother, and for this reason she identified too closely with her father, developed an unforgiving “masculinity

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complex,” and struggled to accept the feminine role essential to women’s sexual maturity. Deutsch drew from this interpretation of her experience to conclude that, during pregnancy, women revisit and even embody their original relationship with their own mothers. In her case, she reasoned that the intense hostility she felt toward her mother ignited what she characterized as an “expulsion trend,” wherein her body rejected the fetus she was carrying, just as her own mother had once rejected her. Upon further reflection, Deutsch came to believe that the birth of her son was made possible only by her temporary identification with a pregnant friend’s “loving” mother, through whom she was able to get a sense of the “mother-daughter” harmony lacking in her own previous maternal interactions. Deutsch explicated this latter conclusion under the guise of a patient she called “Mrs. Smith” in the second volume of The Psychology of Women (1945). This volume, a nearly five-hundred-page tome devoted solely to the role that mothers and motherhood play in women’s psychosexual development, was taken up extensively by scholars and medical practitioners alike. French philosopher Simone de Beauvoir, for instance, quoted repeatedly and at great length from its case studies and largely upheld its findings in The Second Sex (1949). Even those who questioned the “scientific validity of the observations,” such as the revisionist American psychoanalyst Clara Thompson, grudgingly deemed the book “worth reading for it contains much of importance about women.” This volume gave Deutsch the opportunity to elaborate considerably on her initial writings discussing psychogenic sterility. She offered her first explicit definition of the condition as a whole, explaining that “when we refer to psychologic difficulties of conception [and pregnancy], we mean that the given woman’s inability to become a mother has psychic causes that have disturbed some part of the physiologic process.” There and elsewhere, she implied that all cases of infertility in women, even those that involve detectable physiological or hormonal causes, are psychogenic in nature in that they are products of blocked “psychic energies.” Whereas most rhetoric on the psychic causes of infertility at the time focused on “functional” (i.e., unexplained) or chemically induced infertility, Deutsch included even physiologically and “mechanically” based infertility in her conceptualization, musing that “the entire internal-secretory physiologic process that prepares for fecundation is probably a psychosomatic unit in all its phases”; “is constantly influenced by both the psychic and the organic life”; and—when upset—often manifests as a “physiologic problem.” She went on to ascribe

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infertility, in some cases, to an unconscious fear of childbirth—garnered perhaps from witnessing one’s mother suffer through a difficult pregnancy and labor—that might manifest in, for instance, a “vigorous ‘anti-motherly’ orgasm” that dispels the semen, general “frigidity,” or hormonal imbalance. In this way, Deutsch’s work delineated the era’s most all-encompassing interpretation of psychogenic infertility, what historian Frank van Balen labels the “full psychogenic model.” Although this interpretation was rarely communicated without at least some degree of hedging by the mainstream media (even Deutsch herself felt compelled to qualify her claim with a “probably”), it nonetheless provided sufficient grounds for the development and circulation of a range of diverse arguments linking any and all reproductive problems in women to psychological illness and instability. That Deutsch overtly connected her psychogenic theories about infertility to psychosomatic medicine was no accident. Born of psychoanalytic attempts to integrate “the ‘mind’ into the realm of scientific medicine” in the early twentieth century, psychosomatic medicine was grounded in the assumption that somatic conditions are connected to and commonly resultant of psychological processes. This assumption generated a deluge of scientific consideration and public interest during and directly after World War II. Among the field’s most celebrated practitioners and proponents were Dr. Felix Deutsch—Helene’s husband and an internal medicine specialist who became the first professor of psychosomatic medicine in 1936—and Dr. Helen Flanders Dunbar—one of Helene’s former analytic patients. In 1935 Dunbar published a sweeping overview of early psychosomatic research and, in this way and others, helped to inaugurate the field as an organized movement. Dunbar in particular worked to blur the lines between psychosomatic medicine and psychoanalytic studies of women’s reproductive processes by publishing research on psychogenic infertility in her own right. She, along with U.S. gynecologist Raymond Squier, advocated for the development and practice of “psychosomatic obstetrics,” which—as they presented it—would involve the integration of psychoanalytic diagnosis and treatment into existing obstetrical methods. These arguments corresponded closely with those put forth by the now well-known Menninger family, an American physician and his sons who, in 1919, founded what would emerge as a prominent psychiatric clinic, sanatorium, and training and research facility dedicated to a psychoanalytic approach to human health. By midcentury the Bulletin of the Menninger Clinic, which published staff research papers, had become one of the world’s most widely read psychiatric publications.

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Just as Deutsch’s conceptualization of psychogenic infertility gained discursive traction from its easy alignment with Dunbar, the Menninger family, and other proponents of psychosomatic medical inquiry, it also gained traction from a postwar world intent on nation building and repopulation. Women, many of whom had taken on factory and agricultural jobs during the war, were encouraged to return home at war’s end to start families and ensure that war veterans still had a place in the workforce. While a number of minority and workingclass women had worked outside the home before the war and continued to do so thereafter, a traditionalist, pro-natal ideology descended on large sections of postwar Europe and the United States, an ideology that elicited considerable praise for homemaking and motherhood and supported an unprecedented baby boom. Women without children, whether by choice or not, were repeatedly framed as ideologically suspect. It required only a very small conceptual (and narrative) leap for one to deduce in this milieu that childless women must also be suspect psychologically.

Psychogenic Infertility in Midcentury Rhetoric Renowned philosophers Jürgen Habermas, Michel Foucault, and Paul Ricoeur all argue that the rise of Freudian psychoanalysis marked a decisive break in the history of scientific study and philosophical inquiry, although they make their arguments in characteristically distinctive ways and for different reasons. In the case at hand, however, I maintain that Freudian interpretations of women’s reproductive health took hold not because they necessarily disproved or broke away from earlier accounts but rather because they were situated as extensions of established and ongoing narratives of human infertility. As rhetorician Walter R. Fisher might put it, midcentury rhetoric concerning psychogenic infertility repeatedly illuminated the “coherence of the discourse” with chemical theories of infertility and thereby seemed to uphold the prevailing “narrative rationality” of the era. Extending the Chemical Narrative Appeals to narrative coherence were especially convincing in this situation because Freud had, even from the very earliest days of his psychoanalytic inquiry, endeavored to reconcile his findings with that of biochemistry. In Three

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Essays on the Theory of Sexuality (1905), for instance, he illustrated a great deal of familiarity with scholarship on sex-gland grafting and what he described as “powerful substances which have been found to be present in the thyroid gland,” substances that would be officially labeled “hormones” that same year. Later Freud argued that sexual processes, “which determine in the organism the formation and utilization of sexual libido,” are, at their core, “of a chemical nature,” although he did not articulate how, exactly, biochemical forces interact with or otherwise relate to psychic forces. In time some biochemical and physiological scientists would come to acknowledge and even uphold this link. For instance, the famed U.S. physiologist George Washington Corner anticipated in a 1953 European speaking tour that the “new psychiatry of Freud and his followers” would contribute valuable insight to reproductive knowledge. By midcentury, it seemed, Freudian psychoanalysts had convinced even some leading scientific empiricists that psychology—a decidedly unobservable realm—plays a role in endocrinology and physiology. Beyond the connections Freud delineated between biochemical agents and psychology, acceptance of Freud’s work by members of established scientific circles may have also been owed to its alignment with other twentieth-century findings in reproductive endocrinology. As early as the 1920s, reproductive endocrinologists began reporting that hormones—which had been conceptualized as sex-specific—are actually produced in all bodies regardless of sex and that, accordingly, masculinity and femininity are not communicated in absolutes but in degrees. Freud grounded his psychosexual model of development in the idea that all people are inherently bisexual and that only in the process of coming to terms with the Oedipus complex do they become driven toward heterosexual reproduction, a process that does not necessarily do away with the manifestation of masculine-aggressive qualities in women and feminine-passive qualities in men. On this front, Freudian psychoanalytic theory seemed to cohere with biochemical notions of male and female sexual and gender identities, particularly in terms of their existence on a continuum of masculinity and femininity. Deutsch too upheld a bisexuality model of psychosexual development and framed biochemistry as an important element of that development. In her first book she discussed the “activity of the ductless glands” during puberty, as well as the potentially “inhibitory influence of sex hormones” in general. In her subsequent scholarship she enlisted reproductive endocrinology’s central metaphor by describing hormones as “chemical messengers,” and noting, reflexively, that

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“this term is often used” among scientists. Deutsch more concretely connected her psychoanalytic considerations to biochemistry than did Freud by explicitly mapping out what she described as the relationship between these “messengers” and “psychic factors.” She contended that “this complicated messenger service is highly organized, with a central station, branches, interactions, and separate functions. . . . Determination of the spot in the route of the messenger service in which a psychogenic disturbance may be taking place is usually a physiologic problem.” In this extension of the messenger metaphor, Deutsch argued that psychological dysfunction—which she framed as the result of faulty psychosexual development—acts to disrupt the path along which hormones travel to deliver messages, a disruption that often creates somatic disturbances. Thus, what might appear to be a straightforward problem of constitution (e.g., a tilted womb, a blocked fallopian tube) is actually—in this line of reasoning—the manifestation of faulty psychic forces that have deterred chemical processes. Deutsch’s attempt to map out a direct connection from the psyche to the endocrine system to physiology served, ultimately, as a warrant for the many midcentury discourses that considered women’s reproductive ailments through the lens of psychological disorder. As the following analysis reveals, this warrant itself— contextualized within what had become a public vocabulary of psychoanalytic reasoning—was featured both explicitly and implicitly in a wide range of discourses from midcentury, especially as they furthered assertions related to infertility and adoption, a hermeneutics of the reproductive female, and nature as restorative and heteronormative. The Miracle of Adoption Ideas about infertility as potentially psychogenic were initially circulated to lay publics via the argument that, in historians Margaret Marsh and Wanda Ronner’s words, “adoption promoted fertility.” As early as the mid-1930s, parentingoriented media in particular began describing a scenario in which “a childless couple, who have tried every treatment and given up hope of ever having a baby of their own, will finally adopt one—only to find, a few months or a year later, that they are having one themselves!” This 1934 Parents article characterized situations like the one it laid out as “familiar to every gynecologist,” and later media deemed it a situation that “every one [sic] knows” and as simply “too real to be regarded as a coincidence.” In an apparent effort to trigger a sense of “narrative fidelity” among readers—a belief that the stories presented “ring true

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with the stories they know to be true in their lives”—magazine and newspaper articles regularly featured personalized, emotionally fraught tales of involuntarily childless couples made biological parents following the adoption of a child. So “often” and “commonly cited” were these stories, it was argued, there could hardly be any doubt of their veracity. More than a mere “fairytale” or “folklore,” popular-press articles insisted that “doctors” had deemed the adoption-conception scenario a “scientific fact.” Even organizations such as the Planned Parenthood Federation of America cited Deutsch and her theories to argue that this “ ‘miracle’ of adoption” is due to the resolution of “psychic conflicts” and, more specifically, “the result of factors operating together against the inhibition and disturbance of the hormonal process.” Rather than bypass biochemical explanations for infertility, the organization’s pamphlet—published in 1950—upheld the idea that psychological dysfunction induces chemical upset and thereby causes reproductive problems. The “miracle” of adoption, according to this pseudoscientific framing, unfolds because the act of adopting a child somehow crafts order out of disorder, which catalyzes health and functionality in the reproductive body proper. Arousing the Maternal Instinct

Although both technical and lay rhetoric concerning psychogenic infertility often mentioned the problems facing “couples” (and thereby employed language upheld by chemical theories of infertility), they ultimately explained the mechanisms through which adoption was said to resolve infertility in terms of women’s psychology. For instance, in a 1952 keynote address before the American Society for the Study of Sterility, U.S. psychoanalyst Therese Benedek maintained that “adoption often brings about a ‘miracle’; the woman, after she has overcome her anxieties regarding a child by practical experience, may become fertile.” Popularpress coverage offered corresponding but less precise descriptions about how adoption offers women in particular the “sunlight of a new happiness,” which relieves their “mental tension” and thus induces endocrine and physiological “normal[cy].” A child in the house was said to arouse a “maternal instinct” that activated the “ductless glands and restoration of the normal balance in cases of earlier unbalance.” A 1947 American Mercury article argued that an adopted child helped to “slacken” a woman’s nervous tension and, with it, the “contraceptive” effect that such tension yielded—a claim that decisively overlooked the fact that many women continued to have children in spite of significant emotional strain. While some discussion occurred concerning the importance of “compatibility” between partners in the establishment of fertility (once again mirror-

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ing the language of chemical theories), these discourses clearly upheld the idea that the miracle of adoption unfolds via the creation or restoration of the maternal instinct in would-be mothers. References to the rousing of a corresponding paternal instinct were not to be found, as more than one academic article contended that male psychology did “not appear to be significant” in cases of infertility. As the authors of the 1947 popular-press book Modern Woman: The Lost Sex explained, men lack women’s “complicated reproductive system” and the “more elaborate nervous system” linked to an “infinitely complex psychology revolving about the reproductive function,” an argumentative trope percolating from both seventeenth-century texts such as Aristotle’s Master-Piece and, more recently, from early twentieth-century appeals to the narrative of energy conservation and human reproduction. From a psychological perspective, Modern Woman’s authors concluded that women “cannot be regarded as any more similar to men than a spiral is to a straight line.” So while not necessarily effective for curing “sterile” or “sub-fertile” men, adoption for “sterile” or “infertile” women was framed in these discourses as a most effective way to achieve a state of normalcy. “Normals,” as British psychologist Erich Wittkower labeled them, had either developed in accordance with Freudian theories of psychosexual health or overcome—via performances of traditional gender roles—their flawed development and associated psychic blocks. A 1947 Hygeia article, for instance, discussed a case in which a woman was said to conceive (and thereby demonstrate her normalcy) following her decision to adopt because the adoption justified her resolution to “give up her job” and, with it, the “mannish” expectations it exacted. These expectations, it was argued, had created an “unconscious conflict” that robbed her of her femininity. Similarly, Benedek suggested that because infertility is, for women, a “somatic defense against the stresses of pregnancy and motherhood,” adoption allows them to experience the rigors of motherhood, realize their until-then dormant nurturing capacity, and free themselves of the unconscious need to keep their bodies from reproducing. This framing of motherhood as what historian Rebecca Jo Plant labels an “allencompassing identity” repeatedly played itself out in terms of appeals to biological essentialism and the explicit rejection of “women’s rights.” Adoption and Alternatives as a Gateway into Complex Psychoanalytic Reasoning

Although adoption was discussed most frequently, some discourses also named alternative normalcy instigators, thereby arguing that the adoption of a child

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was not in and of itself necessary for overcoming psychological disturbances. Instead, these sources argued that any number of actions would suffice as long as they catalyzed or unblocked the maternal instinct. For instance, a 1948 Derby Evening Telegraph article cited a Kensington doctor who suggested that a “woman could borrow a baby for a time instead of having to go through the legal business of adoption,” before then also notifying readers that “there is no legal process by which you can borrow or hire a baby.” Less extreme substitutions were discussed in several academic journal articles from 1951, wherein it was proposed that successful infertility treatment might involve taking a vacation— which would invoke an “attitude” of relaxation and realign a disordered psyche into a state of normalcy—or simply accepting that an “infertility problem is insoluble,” which would also invoke a degree of mental relaxation and subsequent physical reproductive health. In some cases, claims about these relaxation-inducing strategies, or about the miracle of adoption itself, were employed as a gateway into—or evidence for— more complex arguments linking infertility to psychological problems. As famed U.S. obstetrician and gynecologist Sophia Kleegman and journalist Mildred Gilman explained in a 1947 Parents article, “The coming of children of their own to couples who have given up hope and adopted children is one of the best examples of how emotional factors influence fertility.” Relatively straightforward and seemingly in alignment with a variety of personal experiences, these examples were enlisted to ameliorate the intricate and potentially unfamiliar conceptual leaps required of more psychoanalytically dense reasoning. Deutsch used this approach in the second volume of The Psychology of Women, explaining that some women who had developed into seemingly normal, “motherly” types do not conceive until after they adopt because they are concerned that their husbands will not be dedicated fathers and breadwinners. These concerns are brought to bear through women’s own unconscious influencing of their “ability to conceive.” In time the adoption proves that the opposite is true—that their husbands excel at these traditional roles—and the psychic forces blocking conception are released. Deutsch’s explanation contended that, even when women appear or claim to be psychosexually normal, they may nevertheless harbor faulty beliefs that manifest in neuroses and, ultimately, reproductive dysfunction. This idea that women cannot be trusted cut across midcentury discourses of psychogenic infertility. It is a theme predicated on extending the medicalization of infertility from women’s bodies to their minds and that ultimately functioned to

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justify the delineation of what I refer to as a hermeneutics of the reproductive female. A Hermeneutics of the Reproductive Female Mid-twentieth-century medical journals were all but inundated with articles designed to convince proponents of so-called somatic medicine such as gynecologists and obstetricians that they should incorporate psychoanalytic tools into their practices. These appeals positioned psychoanalysis as a legitimate, scientific endeavor or, in Deutsch’s words, as one of “two sciences” that “march separately and strike together.” They also functioned to extend the reach and realm of medical practitioners’ expertise and thus extend the process of the medicalization of infertility to include the realms of physiology, endocrinology, and female psychology. Crossing Disciplinary Vocabularies

It could be argued that this process was formally initiated by a 1944 address delivered before the American Society for Research in Psychosomatic Problems and subsequently published in Psychosomatic Medicine. Therein, Squier and Dunbar argued for the practice of “psychosomatic obstetrics,” contending that “obstetricians should cultivate the psychosomatic approach to their work, and furthermore should seek instruction from and collaboration with those who are already proficient in that technique.” This speech functioned as what Ceccarelli labels a “conceptual chiasmus,” wherein “unusual linguistic choices force readers from one discipline to think about an issue in terms more appropriate to their counterparts in another discipline, and vice versa.” Squier and Dunbar discussed psychosomatic medicine through the lens of obstetrics in particular, marrying concerns about women’s “frigidity,” “introject[ion],” and “infantile fixation[s]” with discussion of “clinical phenomena (such as nausea and vomiting, and [in] some instances bleeding).” They thereby made the process of “crossing” fields in an interdisciplinary sense “conceivable to readers from both fields.” By the next decade conceptual chiasmi crossing the vocabulary of psychoanalysis with that of gynecology and obstetrics were being enlisted in decidedly more conventional—and further-reaching—research outlets. For instance, after employing tropes related to penis envy and clitoral orgasm to decipher common reproductive maladies, a 1950 Journal of the American Medical Association article

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authored by U.S. gynecologists William S. Kroger and S. Charles Freed argued that all gynecologists should be trained in—or at least have “knowledge of ”— psychopathology, particularly because of the widespread dearth of practicing psychoanalysts and the extensive costs associated with psychoanalytic treatment. Four years later Kroger published an article in Obstetrics and Gynecology wherein he reasoned that, because “the female generative tract is extremely susceptible to the physiologic expression of hidden conflicts,” gynecologists and obstetricians must consider not just women’s physical complaints but also “to what extent this woman accepts herself as a woman.” He went on to provide his clinical readers with a list of similarly psychoanalytically informed questions related to the potential “psychic forces” and “deeper meanings” driving women’s gynecological ills. A 1951 Fertility and Sterility article offered an even more aggressive account of these considerations by arguing that not just gynecologists but all medical professionals dealing with issues of women’s reproductive health should make use of psychoanalytic methods, even if they boasted no psychoanalytic training. The authors, U.S. gynecologists Earle M. Marsh and Albert M. Vollmer, reasoned that the “general physician is a far better psychotherapist than he thinks.” Marsh and Vollmer’s underlying argument was that any medically educated man is capable of interpreting the psychological health of any female patient and should not be reticent to so do, especially when issues of conception, pregnancy, and maternity—those directly tied to patients’ psychology— are at hand. Psychoanalytic Instruction for Clinicians

As in-depth psychoanalytic training would have been untenable for the majority of practicing physicians and specialists, midcentury scholarly rhetoric advocating for clinicians’ use of psychoanalytic methods often laid out psychoanalytic diagnostic techniques and tools for readers to learn from and employ directly in their clinical practices. In this way, this rhetoric functioned not only to bring together diverse disciplines via a crossing of their vocabularies but also to instruct the psychoanalytically untrained in interpreting and diagnosing women’s psychological states. Sample questionnaires and “psychiatric interview” protocols offered clinicians apparatuses for tapping into women’s psyches through discussion of their “moods, wishes, fears and hates,” as well as their motives, fantasies, and dreams. Authors justified their decision to facilitate this type of informal psychoanalytic instruction by noting that Freud himself was a proponent of so-called lay analysts and by playing into the Freudian psy-

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choanalytic tradition of framing women as less straightforward than men and consequently more in need of external evaluation. Women’s weaker superegos, according to Freud, cultivated “conventional secretiveness and insincerity,” a conjecture that William C. Menninger built from to argue that women’s “conscious professions” may have nothing to do with their actual attitudes, wishes, or intentions. By way of illustration, Menninger noted that “many [women] have unconscious aversion to pregnancy but express conscious desires based on illogical, immature or even irrational considerations.” In this sense, what Ricoeur identifies as a Freudian “hermeneutics of suspicion”—wherein truth is said to lurk in the unconscious and one endeavors to “decipher its expressions,” reveal those expressions’ true meanings, and, in this way, “free psychic energy for adaptation and better integration”—was not only enlisted but also amplified in the context of midcentury women’s reproductive health. Women were deemed especially suspicious in terms of, first, their supposed disconnection from their own unconscious motives and, second, their psychodevelopmental drive to veil from others even those motives of which they were conscious. Beyond providing sample questionnaires and interview protocols, midcentury medical rhetoric about infertility attempted to further verse medical clinicians in psychoanalytic methods by explaining how they might go about identifying and interpreting the expressions of women’s dysfunctional psychology. This hermeneutics of the reproductive female was articulated largely through characterizations of the female reproductive system in terms of psychological traits, and the linking of that characterization to corresponding psychological disorders. For instance, the portrayal of female reproductive body parts as “hostile,” “irritable,” or otherwise “cold” emerged repeatedly in midcentury discussions of infertility. The uterus, in particular, was frequently discussed in this way, likely because such appeals aligned with the deep-seated tradition of enlisting the womb as a metonym for woman as a whole. One of the most glaring examples of this appeal was featured in British gynecologist John Stallworthy’s 1947 Biennial Scholarship Lecture for the Royal College of Obstetricians and Gynecologists, an abridged version of which was published the following year in the British Journal of Obstetrics and Gynecology. Stallworthy described cases of both “uterine irritability” and “extreme uterine irritability,” wherein the uterus engages in “spastic” activity, expelling its contents and either preventing conception or ending pregnancy. His characterization of the uterus as “extremely irritable” was grounded as much in empirical evidence as it was in his argument that “the female genital tract is the most ‘hysterical’ portion of a

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woman’s anatomy” in that it is guided not just by hormones but also by women’s nerves and emotions. Thus, he reasoned, a woman’s permanent emotional state of irritability may in fact be an expression of unconscious truth that manifests as an irritable uterus and resulting infertility. When the “mental conflict” of irritability is eased, he reported,“normal function” in the uterus is also restored. Similarly, in his 1957 clinical text Spontaneous and Habitual Abortion, U.S. obstetrician Carl Javert maintained that the “hypertonic, irritable, painful uterus” is often calmed through heavy sedation. As the patient’s mind relaxes, temporarily relieving her of her dysfunctional fears and apprehensions concerning pregnancy and motherhood, her “irritable” uterus follows suit. And even when the irritability and hostility in question is focused not on the uterus but on, say, the pelvis, Marsh and Vollmer found that, as a woman’s psychological neuroses diminish through psychoanalytic diagnosis and intervention, “physiologic tensions steadily diminish until the pelvis is converted from a sterile battleground on which hostility and hope have been at cross purposes with each other into a life-giving bed of fertility.” The restoration of psychosexual normalcy (i.e., feminine passivity and receptivity) transforms the somatic body into a correspondingly pleasant, receptive “bed” of generation. Mainstream media of the 1950s began to pick up on the connections being drawn in the scholarly literature between psychological states and the errant reproductive female body, ultimately delineating those connections in the most explicit of ways. For instance, in a 1953 Coronet article titled “Sterility Can Be a State of Mind,” journalist Vera G. Kinsler reported that, “in high-strung women, doctors discovered, the tubes are sometimes tightly shut, apparently because of nervous tension” and “in exceptionally nervous women the lining of the uterus, which should be soft and relaxed, may be so taut that it offers no anchorage on which the baby-to-be can start growth.” Journalist Margaret Albrecht, writing for Parents in 1957, connected not just physiological problems such as “spasms of the Fallopian tubes” to women’s “hidden anxieties and fears” but also biochemical issues such as “upse[t] glandular balance.” Solving these difficulties might be, according to Kinsler, as easy as bowing out of the workforce or taking a leave of absence, particularly when “dietary and sex-hygiene advice, salpingograms, surgery, hormonal treatments and all such have established no reason why the couple cannot have children.” Kinsler assumed, in this article, that involuntarily childless women would be more than willing and able to give up their jobs for the sake of promoting their fertility. Those women unwilling to make this sac-

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rifice were, on that account alone, diagnosed in the medical literature as psychosexually immature, masculine, or otherwise psychically blocked. Indeed, as early as 1939 Karl A. Menninger reported in the Journal of Nervous and Mental Disease that a “rejection of femininity” is evidenced by the subconscious wish “to deny and discard the uterus as a badge of femaleness,” and often the conscious adoption of masculine behaviors and endeavors is associated with the presentation of an “infantile uterus.” Following analysis, psychological “reorganization,” and behavioral change, Menninger found that the structure of previously infertile women’s bodies matured and thus became capable of conception, pregnancy, and motherhood. Likewise, British gynecologists Erich Wittkower and A. T. M. Wilson reported in a 1940 British Medical Journal article that “boisterous tomboys”—“aggressive masculine children, ashamed and resentful of their femininity”—were more likely to experience dysmenorrhea and frigidity (i.e., the absence of vaginal orgasm) in later life. Their ongoing refusal to accept their femininity and embrace the passive actions and roles associated with femininity left them blocked emotionally and physiologically dysfunctional. In many cases, they found, “sterility patients” “display as a main characteristic a selfcentredness and lack of warmth in their social and personal relations, clearly seen in a sexual frigidity of which their abnormal reaction to coitus forms an impressive index.” In this way, it was posited that if infertile women would simply adjust to their heteronormatively prescribed roles by surrendering the hostility they directed at men, they would correct psychologically and physically and thereby become fertile. The idea that medical practitioners and specialists should be on the lookout for personality traits such as self-centeredness and lack of warmth was central to this report, as was the implication that they use the identification of such traits as justification for a diagnosis of psychosexual dysfunction. Psychosexual Diagnoses in Pregnancy

In light of growing support for the developing field of prenatal psychology, these sorts of psychosexual diagnoses were often modeled and emphasized in the context of pregnancy. As historian Ziv Eisenberg explains, European psychoanalysts such as Sándor Ferenczi and Wilhelm Stekel began arguing in the 1920s that the development of vomiting and food cravings in pregnancy is a manifestation of women’s masculinity complexes or repressed sexual desires. As Deutsch put this contention in a 1948 keynote address on the psychological

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problems of early infancy, “the fact that some women experience the usual pregnancy symptoms while others have unusual ones is due to the varying dispositional elements brought from the past into the reality situation.” Deutsch argued that vomiting and cravings in pregnancy are medically suspicious conditions in that they tend to be expressions of psychoanalytic dysfunction. She framed these symptoms as explicit signs requiring psychoanalytic interpretation and indexing women’s deeper, hidden psychic blocks. This argument characterizing vomiting and cravings in pregnancy as primarily psychological—rather than physiological or biochemical—was communicated extensively in midcentury medical publications, wherein its logic was extended to include miscarriage, too, as a psychologically derived condition. In a 1942 issue of the Lancet, founder of the London Psychoanalytical Society Ernest Jones upheld the idea that “much of the vomiting of pregnancy” is of “psychological origin in the unconscious effort to expel the foreign, and therefore bad, object.” He then added that “repeated miscarriage is also often related to the same tendency.” The “abortion habit,” as it was recurrently labeled, was linked to the “personality of the patient” as “jealous,” “envious,” “malicious,” or “resent[ful].” In his 1954 Obstetrics and Gynecology article, Kroger continued the practice of characterizing parts of the female reproductive body as in possession of psychological traits, arguing that the “uteri of habitual aborters are hypersensitive to emotional stimuli.” The framing of abortion as a “habit” in this context is predicated on the assumption that those who miscarry more than once are somehow blocked emotionally from altering ongoing ways of thinking and being that are responsible for this bodily response. In a 1956 Obstetrics and Gynecology article, the U.S. psychiatrist Edward C. Mann joined Kroger in referring to the “habitual aborter.” Mann cited research concerning the “incompetent internal cervical os” and, more generally, “cervical incompetency” as a “physiologic expression of [psychological] conflict,” conflict that often had to do with a woman’s “unevenness and incompleteness of her feminine development.” Mann contended that “incomplete” and therefore “incompetent” women are likely to have “incompetent” cervixes that facilitate repeated miscarriage and ultimately reveal them as the psychodevelopmental deviants that they truly are. In an apparent attempt to formalize and further medicalize the discussion of “habitual aborters,” Javert explicated a condition that he termed “repeated abortion neurosis.” Instigated by a woman’s “fear of the pregnancy and of the baby,” the afflicted are mostly “physically normal but psychically disturbed.” Spontaneous and Habitual Abortion depicted the emotional experience of “abortion neu-

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rosis” with a visual metaphor in which a large, menacing cartoon octopus (the neurosis) entangled a woman’s naked—though nondescript—body in its tentacles (see figure 5). Similar octopi had been featured in a variety of maps and other political materials during World War II to symbolize the type of evil that lurks and consumes everything in its way. The woman in this cartoon seemed to be in the middle of pushing away from and struggling against the malevolent creature, only to find that her body had become more intricately entangled within its sneaky limbs and ever-tightening grasp. Set against the octopus’s large, dark corpus and the provocative reach of its arms between her legs, over her stomach, and around her neck, the woman’s exposed, curvaceous figure communicated both vulnerability and generative potential, while the look of fear and distress on her face signaled a correspondingly distressed reproductive system. Javert explained that the pictured woman had found herself in this predicament as a result of her “immature, petulant” psychological state. Her escape, he contended, depended on the assistance of an analyst who would give her the “attention” she craved and guide her to verbalize the psychological conflicts restraining her from the physical-chemical task of carrying a healthy pregnancy to term. The patronizing manner in which Javert wrote about and illustrated this condition suggested that he blamed women, at least to some degree, for its manifestation, yet he had little to no faith in their ability to liberate themselves from its clutches. Almost across the board, technical and mainstream rhetoric at midcentury upheld the idea that the mind-body entanglement of psychogenic infertility could be resolved only through the attentions and guidance of a psychoanalyst or a psychoanalytically inclined doctor. Javert, so prone to metaphorical illustration,

5 | Dr. Carl Javert’s representation of “abortion neurosis,” with the octopus symbolizing the woman’s psychological dysfunction and the tight, intricate hold that such dysfunction has over her reproductive body. Featured in his clinical text Spontaneous and Habitual Abortion (New York: McGraw-Hill, 1957), 354. Image © McGraw-Hill Education.

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concluded that the doctor in this case “serves as a lighthouse, showing the way, as it were, as in a harbor.” He and his medical contemporaries argued that the “lighthouse” itself was made up of training in both the hermeneutics of the reproductive female and the psychoanalytic tradition of exposing the “discontents” of civilization. In this respect, and as the following section illustrates, midcentury discourses of psychogenic infertility echoed early twentieth-century appeals to the narrative of energy conservation and moral physiology, even as they attempted to link with biochemical, arguably mechanistic narratives of human reproduction. Nature as Restorative Although midcentury claims about the psychogenic nature of infertility were repeatedly represented as mere extensions of chemical theories of reproduction, the rhetoric constituting infertility as psychogenic actually supported very different conclusions about what women in particular should do about their reproductive concerns. Chemical theories of human reproduction from the 1930s and early 1940s were situated within a rhetoric of artificiality wherein biochemical manipulations of bodily products and processes were upheld as progressive and restorative. Infertile couples were encouraged to seek the help of a medical specialist and make use of the recent gains of science and technology to attain fertility. By contrast, rhetoric framing infertility as psychogenic in nature encouraged women, and women alone, to reject the constructs and patterns of “civilized” society. As in chemically oriented narratives, such rhetoric instructed women to turn to a medical “expert” to help them alleviate their ills. But, in this case, the expert was to guide them away from the technological hustle and bustle that supposedly forced women to repress their biological instincts. Mirroring Freud’s portrayal of civilization as inherently repressive, Karl Menninger maintained in his 1939 Journal of Nervous and Mental Disease article that “civilization robs our normal sexuality” in that it demands that individuals control and sublimate their procreative instincts. This thievery, achieved through the “artificial impediments of civilization,” as U.S. gynecology professor Willard Cooke put it, results in psychological disorder, particularly for women who were believed to have fewer outlets for the sublimation of libidinal energy. A Return to the Primitive

What women needed to do to become fertile, then, was return to what Cooke described in his 1945 presidential address before the American Association of

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Obstetricians, Gynecologists, and Abdominal Surgeons as a “biologically natural life of reproduction and maternity,” wherein reproduction is the focus of their lives and they are able to “give in to this urge [to reproduce] naturally and without awareness.” Women were to follow their body’s “natural,” biological instructions and stop thinking about the consequences of so doing. Ideally, this would involve their removal from all “competition” with men—both educationally and professionally—as “she is not, in sober reality, temperamentally suited to this sort of rough and tumble competition, and it damages her,” according to Ferdinand Lundberg and Marynia F. Farnham, “particularly in her own feelings.” Women may, of course, make use of the products of civilization such as hormonal therapies, but such therapies were considered restorative only if women also gave up the “panic-stricken striving after position and prestige” of the modern world. What women required, Karl Menninger explained in a 1943 Bulletin of the Menninger Clinic report, was to become more “primitive,” which he defined as more in touch with their drive to reproduce and therefore as more “natural.” This appeal played itself out in a number of sources through the delineation of racial arguments concerning human reproduction, racial arguments that closely echoed those so frequently voiced at the turn of the century. Just as Edward H. Clarke argued in the late nineteenth century that women representing lesser evolved races and ethnicities are less likely to experience reproductive difficulties, so too did midcentury medical rhetoric on psychogenic infertility argue that “Negros” and “Orientals,” among others, are less likely to face difficulty or pain in the processes of conception, pregnancy, labor, and maternity. Cooke, for one, contended that “Negros rarely” experience “psychoneuroses,” as did William Menninger, who reported that vomiting in pregnancy “practically never appears in Southern negros.” Kroger, too, spoke to this effect, maintaining that “nausea and vomiting of pregnancy are seldom seen in the stoic Oriental. Yet, when these same races become westernized, or acculturated, these conditions appear.” This last clause implied that lack of access to civilization—rather than race in and of itself—was likely behind said reproductive ease. Although these sources were less likely than their turn-of-the-century predecessors to evoke appeals to evolution in the traditional sense, they were just as likely to conclude that women who reject the unnatural calls of civilization to study, work outside the home, and engage in other similarly “masculine” pursuits experience less maternal suffering and fewer fertility-related complications. Those women who never had the opportunity to engage in these “civilized” pursuits and who thus experienced effortless,

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mindless fertility were offered as proof that, as a 1946 Newsweek article reported, “books and babies don’t mix.” Neo-moral Physiology

These arguments about the “natural” (i.e., unthinking, instinctually guided) reproductive female were situated within what might be termed a neo–moral physiology, “neo” in that religion was not invoked (Freud having written off religion as a neurotic obsession inciting unnecessary guilt) and “moral physiology” in that biological reproduction was nonetheless framed as the telos for all legitimate, meaningful human action. Women’s actions, in this context, were to be judged according to how closely they seemed to support and align with reproduction. As in the narrative of energy conservation upheld at the turn of the century, midcentury rhetoric espousing psychogenic infertility argued that women’s energy—physical and psychic—must be solely focused on, and allowed to “flow” to, procreation or risk dysfunction. All their energy, in this sense, needed to be dedicated both physically and mentally to the tasks of ovulation, conception, and pregnancy, tasks that parents were encouraged to impress on even their very young daughters as paramount. In several cases, the modeling and encouragement of so-called normal sex attitudes (e.g., girls as passive, receptive, motherly) was framed as effective “prophylaxis” against later “psychosexual disorders” and associated infertility. These appeals reveal, in retrospect, that what was framed as “natural” and biological by psychogenic infertility advocates was, by and large, an expression of what was argued to be “normal.” As journalist Nevitt Sanford explained in a 1957 Ladies’ Home Journal article, “psychology and psychiatry have contributed their share to the notion that the best way for a girl to show that she is healthy, wholesome, mature, well adjusted and the like is to get married and have children.” That Sanford’s critique of this practice was uncharacteristic of rhetoric at the time makes it no less exacting or accurate. Her commentary did the important work of exposing the extreme pressure put on midcentury girls and women to prove their mental health through performances of what was characterized as “nature” but was actually socially prescribed, traditional gender roles. Similarities between the central arguments featured in psychogenic infertility rhetoric and the narrative of energy conservation were supported, in some key respects, by corresponding similarities in language. For example, discourses of psychogenic infertility repeatedly characterized women in terms of their “arrested” development, whether that arrest had to do with emotional, psycho-

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sexual, or maternal function. The narrative of energy conservation, in its time, also made extensive use of this term, theorizing that women are “arrested” in their evolutionary development because they must devote excess energy to reproductive processes. Although midcentury rhetoric devoted to psychogenic infertility did not uphold the evolutionary conclusions put forth by the narrative of energy conservation, particularly those framing civilized society as the epitome of human progress, it did uphold the idea that women are inherently lesser than men as a result of their biology. By enlisting the language of “arrested” development, then, these appeals furthered a characterization of women as inferior. Likewise, organic metaphors of fruit, seed, and soil were, after a period of general disuse, regularly employed throughout these midcentury texts to construct women as fertile or, alternatively, as barren. Jones, for instance, wrote of a woman’s “unconscious ideas of hatred, guilt or fear concerning the fruit of her womb,” while others paired references to “unfruitful” women or couples with discussions of women’s psychology, noting, in one case, that “the best gardens, obviously, have the best caretakers.” This reference to “caretakers” was a metaphorical allusion to psychoanalytically inclined doctors and specialists, although women too were encouraged to “care” for their “gardens” by following the dictates of psychoanalytic guidance. That these organic metaphors were employed within a range of discussions concerning biochemistry and hormonal influence seemed to do very little to weaken the appeals to “nature,” as defined by Freudian psychoanalysis, at their core. Instead, use of this language of yore functioned to help marry the conclusions of reproductive endocrinology with those of psychoanalysis and, essentially, extend the medicalization of infertility from women’s bodies to incorporate, also, their psychology. Moreover, the mechanistic accounts of infertility that tended to accompany chemical theories of reproduction evolved and amalgamated with these increasingly organic accounts of women as more or less “natural” to uphold a discourse of medicalization that framed the infertile as inherently—although perhaps not consciously—immoral.

Infertile Body, Infertile Mind To say that the mid-twentieth century was a trying time for women facing reproductive problems would be an understatement. Discourses of psychogenic infertility from the 1940s and 1950s framed earlier chemical explanations for

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infertility—explanations that medicalized all bodies, regardless of sex—within an overarching context of women’s psychological dysfunction. Medical practitioners, scholars, and lay audiences alike were encouraged via the public vocabulary of psychoanalysis to consider even physiological or biochemical infertility as a product of women’s mental problems. Their reproductive bodies were characterized as mere representations of their minds, as signs that psychoanalytically inclined medical professionals could interpret to diagnose the true cause of infertility, whether that cause be a woman’s underlying hostility, immaturity, or general unwillingness to accept her femininity. This type of characterization of the female reproductive body as directly linked to her psychology in particular, and vice versa, supported an overt explication of a hermeneutics of the reproductive female, wherein the “incompetence” or “irritability” of a woman proper is ascribed, also, to her uterus or her fallopian tubes. Anthropologist Emily Martin identifies the discursive tendency to frame women’s body parts and products as reproductively passive and explicates the potential harms of such rhetorical patterns. The analysis featured in this chapter extends Martin’s work by tracing this conflation of female reproductive parts with passivity and negative psychological attributes to the widespread circulation of psychoanalytic rhetoric in the mid-twentieth century. Of course, as historian Lana Thompson contends, arguments delineating women’s psychology, intelligence, and other traits through the lens of their reproductive body parts (the uterus in particular) can be traced as far back as the ancient Greeks. In this respect and others, the specific discursive phenomenon at play in this chapter must be deciphered as an amalgamation of both rhetorical circulation across technical, mainstream, and lay spheres of discourse within the context of the mid-twentieth century and the percolation of rhetorical topoi echoing chronologically distinct moments of the past. Psychological characterizations of infertility at this point, then, garnered persuasive force both by responding to immediate exigencies of the day (e.g., somatic medicine’s reputation as comprehensive in its explanatory power), as well as by incorporating inventive resources of distinct but related rhetorics of yore. Although there is no denying that psychological characterizations of infertility remained in circulation in the years that followed, rhetoric from the late 1950s and 1960s included some indications that the tight grip of psychoanalysis on theories of infertility was relaxing. In a number of cases, references to the “miracle of adoption” were traded for discussions of the “adoption myth,” as different empirical studies reported that pregnancy among the involuntarily child-

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less was no more likely to occur following adoption. Throughout the 1960s such findings were publicized in speeches, reports, and newsletters attributed to emerging infertility clinics and renowned medical centers. A meta-analysis of research on psychogenic infertility published by U.S. gynecologists Robert Noyes and Eleanor Chapnick in 1964 spoke to Deutsch’s great influence in the field before adding that her claims had not been replicated by controlled studies and therefore lacked empirical support. The authors concluded that there existed “no evidence that specific psychologic factors can affect fertility.” Around this same time, articles and newspaper accounts began discussing men’s psychology as a potential contributing factor to the problem of infertility. For example, a 1957 Fertility and Sterility article provided an overview of a case in which a husband’s “unconscious fears” and “dependent feelings” kept him from ejaculating and impregnating his wife, and a 1958 Kingston Gleaner article suggested that “both the wife and the husband may require some psychotherapeutic work.” Psychoanalysis still played a central role in these portrayals, but the authors’ willingness to look beyond women’s psychological deviance as the major source of infertility demonstrated, at the very least, a shift in focus among discourses constructing infertility. And, indeed, a rhetorical shift on this front was—and long had been—in the works. Early success with in vitro fertilization was quickly becoming the topic organizing the vast majority of discourses dedicated to infertility throughout the second half of the twentieth century, just as it was propelling droves of involuntarily childless women to the growing number of infertility clinics being established in urban centers. Women’s psychology and associated claims iterating a neo-moral physiology continued to make regular appearances in these discussions, but these topics emerged as just one of many medically recognized variables that came together in a precisely timed manner to constitute women, and women alone, as fertile or not.

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5 Fertility in Clinical Time | The Integration of Scientific Specialties as Infertility Studies

Premier U.S. “fertility doctor” John Rock established the Rock Reproductive Clinic after he retired in 1956 as director of the Fertility and Endocrine Clinic at the Harvard-affiliated Free Hospital for Women. Rock’s decision to open a new clinic that was not based in one particular field of scientific study but rather incorporated the methods and expertise of multiple fields was representative of a larger change in rhetoric about (in)fertility that came to the fore in the 1960s and 1970s. A 1963 promotional brochure hailed the Rock Reproductive Clinic for assembling the “entire field of human fertility and sex relations” in the service of “helping the over-fertile as well as the infertile couple.” That the Rock Clinic and others like it brought together diverse areas of expertise to offer an integrated approach to research and treatment functioned, necessarily, to break down barriers among distinct fields and reveal their synergies. Rock’s work and the work of his contemporaries seemed to coalesce around a single idea—time—or, more specifically, clinical efforts to track, manage, and otherwise intervene in reproductive timing. This focus can be traced both to pervasive twentieth-century values related to industrial, economic, and cultural efficiency and to the development of a number of technologies that had—by the 1950s and 1960s—made it possible for experts to assess when ovulation (i.e., release of an egg) occurs in any one individual and therefore when, exactly, conception is possible. From endometrial dating to basal body temperature charting to culdoscopic imaging, the employment of these methods to “establish the fact [and timing] of your ovulation”—as a 1950 Ladies’ Home Journal article put it—was increasingly characterized both within clinics and without as central to the identification of (in)fertility. To be “fertile” in the second half of the twentieth century, it seemed, was to be ovulating and otherwise functioning within scientific and clinical time, and to be “infertile” was to be out of time, often in more than one sense. Widespread approval and legalization of the birth control

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pill in the 1960s made it possible—arguably for the first time—for women to put off having children until it was physiologically “too late” for them to conceive. In this respect, it was not enough to have a predictable and therefore measurable menstrual and ovulation cycle or even to submit to a reproductive clinic’s timing-related tests, treatments, and schedules. To be fertile, one also had to be situated at the right moment in the life cycle. In many ways, this discursive process functioned to translate the lived, embodied experience of biological rhythms—what philosopher Julia Kristeva theorizes as “women’s time”—into the scientific application of timing onto female bodies. Given this attention to the female body’s rhythms and phases, one might correctly deduce that to be infertile in the 1960s and 1970s was also to be decidedly female, despite the fact that some smaller “clinics” within larger infertility centers were devoted specifically to “husbands” and a growing number of scientific techniques were enlisted to examine (and, if necessary, bypass) the production, health, and viability of spermatozoa. As the subsequent analysis reveals, the vast majority of reproduction-oriented rhetoric from these decades characterized male body parts and products as mere extensions of the infertile female; their configuration within scientific time was repeatedly attributed to and associated with female, rather than male, reproductive processes. This finding aligns both with scholarship contending that women’s experiences have been the subject of medicalization to a far greater extent than have men’s historically and with research demonstrating that “regimes of time”—as rhetorician Leslie A. Hahner labels them—have long been employed to discipline and pathologize female bodies. This chapter sets itself apart from those preceding it because it follows not how rhetoric informed by a single scientific discipline defined infertility in a specific era but rather how transdisciplinary rhetoric associated with multiple fields of scientific study and clinical care coalesced over time (often chronologically, but sometimes “vertically” and “unexpectedly”) to define infertility across scientific, medical, and popular contexts. Drawing from a range of documents from different infertility clinics, professional correspondence, scientific reports, and mainstream media coverage, I contend that the process of scientific narrative extension that played out in the 1940s and 1950s to link the field of reproductive endocrinology to psychoanalysis continued and even intensified in the decades that followed to uphold an overarching, integrated field of infertility studies. Psychoanalysis was characterized by these discourses as just one of many diverse scientific areas of expertise that cohered with the principles of

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reproductive endocrinology and its chemical theory of human fertility. Beyond psychoanalysis and psychology, the fields of urology, cytology, and genetics, as well as the usual cast of disciplinary characters—gynecology, obstetrics, and physiology—were each argued to contribute distinct but nonetheless corresponding support for the demarcation of (in)fertility as existent within, and a product of, clinical timing. Argumentative warrants related to efficiency, opportunity, and urgency—what rhetorical scholars refer to as appeals to kairos, or “timeliness”—both held this integrated, medicalized account of infertility together and supported an emergent “doctrine of prevention” that deflected concerns about male- or couple-oriented responsibility onto individual women. I demonstrate that these warrants—instigated in many cases by rhetoric about ongoing scientific research efforts of the early to mid-twentieth century— formed a discursive foundation for the emergence of the popular “biological clock” trope in the 1980s. This trope was and is based as much on appeals to chronos (i.e., “the uniform time of the cosmic system”) as on appeals to kairos and has continued to evolve, percolate, and generate significant symbolic capital well into the twenty-first century. Correspondingly, and in a somewhat broader sense, this chapter illuminates the rhetorical formation of yet another interrelated layer of the medicalization of infertility. This layer amalgamated with the previous two to situate the female mind-body firmly within the disciplinary apparatuses of an emerging, supposedly comprehensive clinical field of investigation and to characterize individual women’s failure to position themselves within that field for evaluation and treatment as a form of moral insolvency. In this case, then, the continued formation of additional layers of medicalization depended on and facilitated a rhetoric that was more—not less—morally infused.

Kairotic Appeals in Twentieth-Century Rhetorics of (In)Fertility Although I argue that it was not until the 1960s and 1970s that (in)fertility came to be widely understood in accordance with clinical time, scientific work supporting this description had been surfacing and repeating itself for many years prior. The rise of reproductive endocrinology in the late 1920s and 1930s brought with it key findings related to the periodic nature of ovulation and its timing in the middle—as opposed to the end—of the menstrual cycle. These early timing-oriented observations invited a plethora of other temporal questions,

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questions that mid-twentieth-century scientists and clinicians, including John Rock, dedicated themselves to answering. Historians Margaret Marsh and Wanda Ronner explain, for instance, that clinicians in the 1930s could merely “estimate the time of ovulation in advance. They had no data to help them determine for what period a newly released egg might be fertilizable. They did not know how long it took for the fertilized egg to travel to the uterus, attach itself to the uterine lining, and develop its amniotic sac.” Ultimately, what Rock and others argued it would take to answer these queries was not the tools and scientific background of a single field’s experts—not the hormonal assays and treatments of reproductive endocrinologists alone—but the cooperation of experts from multiple and diverse fields of medical jurisdiction. Kairotic appeals to efficiency, opportunity, and urgency both facilitated this cooperation and directed how results of such work were characterized in technical and mainstream outlets. Integrating the Fields: Appeals to Efficiency The initial call for an integrated field of (in)fertility studies and treatment has been attributed to U.S. gynecologist and infertility specialist Samuel Meaker. In his 1934 clinical text Human Sterility, Meaker demarcated the many diverse, often interconnected causes of sterility and argued for the organization of “sterility clinics,” wherein “the complete investigation of cases of sterility is greatly facilitated by the formation of a group of interested workers, who develop a systematic plan of action and become experienced in carrying out all of its details. Such an arrangement not only guarantees completeness, but also assures the maximum of coordination.” Among these “workers,” Meaker included “a urologist, a gynaecologist, an internist, an endocrinologist, and a clinical pathologist,” noting that “special consultants outside of the regular group” should also be employed as needed. He argued that a synchronized, overarching “program of investigation” overseen by these specialists would ensure that no cause went undetected and that both doctors and patients experienced the most streamlined system of treatment possible. Subsequent calls focused as much on coordinating diverse scientific research efforts as they did on clinical application. Rock was at the vanguard in these cases, driven by his penchant for collaborative research and his own reluctance to select a single specialty area—during his medical training he completed four different residencies, in surgery, gynecology, urology, and obstetrics. As director of the Fertility and Endocrine Clinic of the Free Hospital for Women, Rock

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seemed to adjoin at least one new specialist, “clinic,” or integration-oriented project to the roster every year. For instance, the Fertility and Endocrine Clinic’s 1948 annual report announced the establishment of a new Saturday morning Male Fertility Clinic, overseen by urologist Fletcher Colby, and emphasized the time-saving benefits of being “able to study and treat [men with azo- or oligospermia] in our own clinic, thus making for a more unified and efficient overall treatment of the couple” (though the males in question were not considered patients in their own right but merely “husbands of our clinic patients”). The 1949 report discussed the recent addition of Dr. Frederick Hanson, a clinic fellow studying infertility through the lens of psychoanalytic methods, and the 1950 report highlighted efforts to develop an increasingly “efficient” clinic by developing a “coding system” for patients that would “express the nature of our complicated problems, our diverse methods of attack and our results.” These appeals to efficiency—which literary theorist Kenneth Burke characterizes as attempts at “perfecting the means of control,” generally at the expense of lay deliberation and aesthetic concerns—constituted infertility treatment as an overarching machine in and of itself, a machine designed to code and, ideally, cure the human mechanism of infertility once and for all. From urology to psychoanalysis, Rock situated mid-twentieth-century questions of infertility and temporality within an organized system of investigation that drew from the breadth of, and cooperation among, diverse scientific repertoires. The 1950s proper witnessed Rock’s and Meaker’s reasoning taken up on a larger scale. Several high-profile scientific groups and conferences were devoted not to the work of one specific field but, instead, to the scientific study of infertility writ large. Speakers presenting at the 1951 annual conference of the American Society for the Study of Sterility, for instance, included experts in anatomy, biology, endocrinology, genetics, gynecology, obstetrics, pathology, physiology, surgery, and urology. Conference panels were delineated not according to disciplinary boundaries but to broader topics, and they showcased individuals from different areas who approached named themes by employing diverse but interconnected lenses. For instance, the opening panel on “Ovulation and Conception” included presentations devoted not just to the production of the hormone human pituitary gonadotrophin but also to surgical approaches to fallopian tube observation, the physiology of basal body temperature patterns, endometrial preparation for implantation, and blood group incompatibilities between husbands and wives. All these talks, with the possible exception of the last, would have been couched in the rhetoric of time and timing. By 1953 the

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International Fertility Society had formed to further broaden this inclusive approach to infertility studies by bringing together scientific and clinical experts from around the world. As integrated infertility clinics began arising in the 1960s, such as the Rock Reproductive Clinic, the Victoria Hospital Infertility Clinic of Ontario, and the New York Fertility Research Foundation, technical and even mainstream media coverage included a number of references to a “new field” focused on “promoting fertility” that incorporated diverse scientific areas of study and practice. Maxwell Roland, clinical professor of obstetrics and gynecology and director of the Fertility Research Foundation, announced in a 1968 clinical tract devoted to the “management of the infertile couple” that “it appears unquestionable that infertility treatment will become—deservedly—a major medical disciple” in and of itself. Such a discipline, according to Roland, would necessarily involve “the efforts of an integrated group of specialists—psychiatrist, endocrinologist, internist, pathologist, urologist and gynecologist,” all of whom, working together, would be “more efficient” in finding causes and cures than any one expert toiling alone in the recesses of a single knowledge pool. The frontispiece to Roland’s book featured an illustrative diagram connecting, through arrows, distinct parts (and functions) of a woman’s mind-body in a mechanistic, reproductive feedback loop (see figure 6). Arrows pointing from the brain’s “neural signals” to the hypothalamus to a strand of DNA, for example, communicated that the study of just one of these processes through the lens of a single discipline would shed inadequate light on the “infertile couple” as a whole. Roland’s decision to highlight the “ovarian cycle” in this introductory imagetext revealed both his attention to timing and his location of “fertility” as within the female mind-body (despite the book’s reference to the “infertile couple”). A Time-Life book, authored by journalist Ernest Havemann and published in 1967, also invoked the necessity of a “new branch of medicine,” wherein “infertility specialists” not only represented diverse fields of study but, in some cases, boasted expertise that traversed traditional disciplinary boundaries; their unique and inclusive training was said to ensure the quickest and most effective assessment of even the most complex cases of involuntarily childlessness. By the time the Federation of Fertility Societies began overseeing World Congresses on infertility studies in the early 1970s, the training of a “new breed of doctors” and researchers—educated in and able to draw connections among diverse fields—was the subject of considerable discussion. Correspondingly,

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6 | The frontispiece for Dr. Maxwell Roland’s 1968 text Management of the Infertile Couple, captioned “Neuroendocrine Regulation of the Ovarian Cycle.” Image courtesy of Charles C. Thomas, Publisher, Ltd., Springfield, Ill.

one of the major initial goals of the Rock Reproductive Clinic—according to a 1960 promotional pamphlet—was “to teach other doctors” how to “identify and rectify, if possible, any disorder in [individuals’] reproductive physiology.” A 1963 clinic brochure explained that pedagogical efforts in the clinic occurred at multiple, interconnected levels. First, interdisciplinary training happened organically in laboratory and examination room, as specialists in different areas joined forces and inevitably traded expertise. Second, comprehensive “instruction in reproductive function and dysfunction” was given explicitly “to successive graduate research fellows, medical students, and house officers.” A photograph

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of a gray-haired, bespectacled Rock in concentrated conversation with freshfaced, light-skinned male medical students offered an illustration of this process, just as it also linked the clinic’s work with the increasingly embedded tradition of entrusting and training white men in the oversight of female reproductive bodies. Third, the clinic put forth a number of lectures and seminars targeting “various lay and medical groups,” efforts designed no doubt to educate broader audiences about the clinic’s comprehensive approach. But no matter who, exactly, these pedagogical initiatives targeted, the brochure made it clear that they were all—in one way or another—held together by a dedication to the efficient study and use of time and, more broadly, a rhetoric of time and reproductive timing. This emphasis provided common discursive ground for the variety of individuals brought together under the provinces of the integrated field of infertility studies, and it acted as an ongoing warrant for the idea that not just psychoanalysis but also a diversity of other scientific fields cohered with chemical narratives of human infertility. Time-Oriented Research and Language: Appeals to Opportunity The temporal appeals that, I argue, upheld the integrated field of infertility studies in the 1960s and 1970s were the product of what rhetorician John Lyne would identify as a cumulative, collective scientific research program. This evolving work was bent on explicating the many assorted and interconnected processes believed to support human reproduction. The discussions that emerged from these technical investigations repeatedly upheld clinical timing as a tool for accessing the realization of fertility through very specific, opportune moments. Invitations to seize such moments (or to be wary of them) have been theorized as fundamental to persuasive kairotic entreaties, as have individuals’ “bodily capacities”—in rhetorician Debra Hawhee’s words—for sensing and taking advantage of opportunities as they play out in the moment. Although individual women’s lived “bodily capacities” for deciphering their fertile opportunities were repeatedly overlooked in these technical discussions, clinical experts’ capacities to identify or create such moments for women through developing scientific technologies were central. Endometrial Dating and Irregularity

Following early attempts to identify when in the menstrual cycle ovulation occurs, Rock began collaborating with U.S. surgeon Marshall K. Bartlett to

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develop a diagnostic technique they called “endometrial dating.” This technique involved taking a small biopsy of a woman’s endometrial lining to deduce—via microscopic examination—which hormonal agents seemed to be at work and approximately at what point in the “cycle” of menstruation and ovulation was the biopsied individual. Rock and Bartlett explained that their “interest in the factors of female fertility ha[d] led [them] to a study of the endometrium,” reasoning that “upon the cyclic changes in this tissue is written the story of the patient’s menstruation.” The story that Rock and Bartlett ultimately deciphered from their work, which involved the analysis of nine hundred unique endometrial biopsies, had them characterizing “normal menstruation” and thus “female fertility” in terms of a detailed timeline involving “uterine bleeding in cycles not shorter than twenty-four days nor longer than thirty-one days, lasting at least two days and at most seven days and requiring at least two napkins for at least two days.” More specifically, their biopsies revealed that “the follicle [preovulatory] phase is variable within extremely wide limits but that at least 75 per cent of women between the ages of 25 and 40 have a corpus luteum [postovulatory] phase of from twelve to sixteen days.” They categorized those who fell outside this detailed timeline as representative of various degrees of dysfunction, according to the amount and consistency of their deviance or “irregularity.” These arguments aligned with what rhetorician Barry Brummett labels the “mechtech machine aesethics” of the twentieth century, which valued rhythmic predictability leading to production over variation, even (or especially) in the realm of reproduction. To be deemed “irregular” was, in this context, suggestive of not just dysfunction generally but also a lack of fertility (i.e., production) specifically. Paperwork attributed to the “so-called ‘Rhythm’ department” of Rock’s Fertility and Endocrine Clinic implied as much. Established in 1936, just as Rock and Bartlett were becoming more confident in their results concerning the “normal” menstrual and ovarian cycle, the department was charged with advising women on the “rhythm method” for either avoiding or promoting conception by timing intercourse to correspond with specific phases (i.e., opportunities) of menstrual patterns. An informational handout for “rhythm clinic patients” distributed in the late 1950s warned that “menstrual cycles must be regular, within certain limits, for the rhythm system to be applicable.” The time limits set out therein were even more precisely defined than they had been in earlier documents, as they accounted, also, for the apparent temporal limitations of male reproductive

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bodies. The handout reported that an egg is released from “a woman’s ovary every 4 to 5 weeks. This occurs about 14 days before her next menstrual period. This egg is capable of being fertilized for a period of only 12 hours. The sperm or male seeds that are contained in the husband’s semen have a maximum life of 2 days.” Although those looking to promote conception in the rhythm department were understood to be comparatively less fertile than those looking to prevent conception, the clinic’s rhetoric distinguished both groups of women as exhibiting some degree of regularity and thus fertility. By contrast, women who exhibited irregularity in or across their menstrual cycles were informed that they could not be helped by the simple and efficient “calendar marking” methods of the fertile, though the handout did mention that, in some such cases, “it may be possible to apply rhythm by the use of temperature charts.” “Rhythm,” in this context, was not so much something to be experienced in female bodies as it was a scientific tool that experts could employ to map bodies onto fertile opportunities. Basal Body Temperature Charts and Bodily Abstraction

Indeed, the charting of basal body temperature (BBT) had been found, by this time, to be one of the simplest approaches for tracking ovulation and, correspondingly, “apply[ing] rhythm” to achieve fertility. In the early 1940s British researcher Mary Barton and her husband, Austrian biologist Bertold P. Wiesner, confirmed that there is a significant rise in BBT following ovulation. While overseeing the Royal Free Hospital of London’s Fertility Clinic (and, coincidentally, administering hundreds of the first artificial insemination-by-donor [AID] procedures), they collected months of daily BBT readings from several hundred women and concluded that “fecund women” exhibit a “regular,” “diphasic temperature cycle” with a “relatively high temperature” following ovulation and the corpus luteum’s progesterone release. “Variations” from or “exceptions” to this timeline occurred in otherwise “fecund” women only as a result of “illness, operations, anticipation of pregnancy and change of climate or occupation.” Other deviations in and across cycles were considered evidence of “infecund[ity].” Barton and Wiesner’s report, which began circulating subsequent to the publication of several corresponding German studies, helped to catalyze the technique’s widespread clinical adoption. It did not take long, then, before BBT charting was also receiving detailed attention in even mainstream media articles, some of which encouraged women

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themselves to begin timing and tracking their own menstrual cycles and then to offer the results to medical professionals for analysis. A 1950 issue of the “Tell Me Doctor” series, written by Dr. Henry B. Safford for the Ladies’ Home Journal, provided an overview of BBT charting in the context of a hypothetical medical consultation. In the article a woman hoping to become pregnant was instructed by her doctor on how she could “each morning, before arising, carefully take your temperature, rectally, for a full five minutes” and then “record it on [a hospital temperature chart] by means of a dot and connect the successive dots with a line to form a temperature chart or graph.” With each dot representing a day, her doctor explained that she was to look for a drop in temperature, followed by a “rise of four to six tenths of a degree,” to identify when ovulation had occurred and then—it can be assumed—time future intercourse so that it corresponded with that timing, though that last bit of instruction was not included. The article’s protagonist offered Ladies’ Home Journal readers a model of dedicated patient compliance as she responded to the instructions—rectal thermometer and all—with the exclamation, “I think that’s wonderful.” Readers accompanied the protagonist in her journey toward the realization that fertility timing has not to do with embodied sensation—as Kristeva would have it—but rather with the application to their bodies of external, invasive measurement. By 1960 mainstream news coverage was characterizing the taking of a “basal temperature record” as one method for identifying the “period of maximum fertility.” In a London Observer article from that year, medical correspondent Dr. Abraham Marcus drew from a recent issue of the Journal of the American Medical Association to contend that the “important thing in conception” is the “timing of the tryst between the sperm and the egg.” Marcus’s reference to the “tryst” functioned as a percolation of mainstream romantic metaphors employed in the 1930s and 1940s in light of chemical explanations for infertility. But despite the romance this reference implied figuratively, such coverage included little to no mention of the subjective bodies wherein sperm and egg originated and came to be joined. Rather, mainstream accounts related to the tracking of BBT over time facilitated the characterization of fertility proper as a regular but nonetheless fleeting opportunity existent in abstract, scientific time. Fertility was upheld in these cases as a “kind of time—time as timing” that “attends to degrees of propitiousness.” The correct (i.e., scientific) timing was said to divulge, in the words of rhetorician Carolyn Miller, “kairotic ‘windows of opportunity.’ ” These apertures were characterized as external guides toward conception and pregnancy, especially for those long “denied a child.”

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Visualizing Reproductive Timing via a Pedagogy of Sight

Further support for the representation of fertility as kairotic emerged from interdisciplinary research investigating the earliest stages of human fetal development. From 1938 to 1950 Rock and U.S. pathologist Arthur Hertig collected recently fertilized ova to assess the amount of time that passed between ovulation and fertilization, as well as the timing of different developmental stages thereafter. The ova, gathered from the excised reproductive tracts of women who had been identified as in need of a hysterectomy, were analyzed under a microscope, photographed, and placed on a continuum from youngest to oldest. The project’s first publication, titled “The Human Ova of the Previllous Stage, Having an Ovulation Age of About Eleven and Twelve Days, Respectively,” employed scientific timing as the major analytic framework. Results, for instance, were reported in subsections devoted to “The Younger Ovum” and “The Older Ovum.” A subsequent article also featured time-oriented, analytic subsections such as “The Probable Time of Ovulation as Evidenced by Embryo Age and Endometrial Histology” and “The Time of Nidation” (i.e., implantation). These published reports included acknowledgment sections thanking gynecologists, obstetricians, embryologists, pathologists, and imaging technicians for their assistance and, in this way, left readers with little doubt that this was a multidisciplinary research endeavor. The degree to which experts in medical imaging technology, in particular, aided this and corresponding research trajectories was made clear through the publications’ inclusion of multiple “plates” featuring microscopic accounts of differently aged ova. In one case, for example, a “9.5-day human ova” was upheld and said to be “implanted within the surface of twenty-six-day secretory endometrium,” while, in another, the authors offered a “high-power view of the chorionic cavity of the younger specimen, to show the character of the primitive extraembryonic mesoblast and the exocoelomic (Heuser’s) membrane derived from it.” These “high-power” imagetexts were presented as visual characterizations of the exact moments at which different reproductive processes were positioned to unfold. In this way, they provided readers with what rhetorician Jordynn Jack terms a “pedagogy of sight” in that they instructed them in both “what to see” (i.e., microscopic cellular division) and “how to see it” (i.e., as opportunities for reproductive success in time). Through this technical rhetoric, midcentury scientists and researchers became increasingly versed in the practice of discussing and visualizing fertility through the lenses of timing and specific, scientifically delineated moments.

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Years after this particular project concluded, Hertig further characterized mid-twentieth-century infertility research and treatment as dependent on what could be made “visible” through the skillful use of emergent clinical and laboratory instruments. These instruments were designed to reveal evidence of “normal” reproductive timing via minute differences among the “stages” involved with egg release, fertilization, implantation, and embryonic development. The development of the “Decker culdoscope” in the 1940s, for instance, provided clinicians with the ability to see the “uterus, tubes, and ovaries” through an endoscopic tube inserted through the vagina. The Fertility and Endocrine Clinic’s midcentury annual reports repeatedly touted the benefits of this method for “inspection of the pelvic contents,” just as it touted the clinic’s employment of other visualization technologies, ranging from X-rays to “fluorescent lighting.” Such appeals positioned infertility studies firmly within the clinical “world of constant visibility,” wherein, as philosopher Michel Foucault explains, “medical rationality plunges into the marvelous destiny of perception, offering the grain of things as the first face of truth, with their colors, their spots, their hardness, their adherence.” The clinical eye, in these accounts, was guided to identify fertility via visual signs of time and to employ so-called artificial means to somehow construct those signs (and opportunities) when they did not appear on their own. Artificial Insemination, In Vitro Fertilization, and Concerns About Created, “Artificial” Opportunities

Artificial insemination (AI)—the injection of sperm directly into the female reproductive tract—was in clinical use as early as the late eighteenth century; however, it was not until scientists determined human ovulation’s timing as situated in the middle of the menstrual cycle that the procedure began to yield consistent, clinical results. Publications out of Germany and the United States in the early 1940s reported achievement on this front and framed the issue of procedural timing as critical. For instance, Dr. William H. Cary explained in a 1940 issue of the Journal of the American Medical Association that he had “chosen the eleventh to the fifteenth day of the cycle for insemination, depending, when possible, on predominant habits as noted in the past menstrual calendar. Earlier days have been selected for patients with habitually short cycles.” He also noted that he aimed to time the introduction of the “semen specimen” so that it was no more than an hour old. These timing-oriented efforts, Cary reasoned, had been key in helping him to oversee twelve pregnancies among thirty-five couples long

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deemed infertile. Subsequent accounts of AI continued this practice of emphasizing the importance of timeliness in its effectiveness, in one case reminding fellow scientists that the “functional viability of the unfertilized egg is measured by hours, not days” and, in another, that the “purpose of scheduling artificial insemination is to be able to choose the time of insemination in such a way that active sperm are present in the wife’s fallopian tubes throughout the entire period during which fertilization is theoretically possible.” In view of these reported successes, a number of technical and mainstream books and articles began circulating that explicated potential legal, ethical, and religious conundrums associated with AI, particularly in cases that employed “donor” semen (i.e., “heterologous artificial insemination” or “artificial insemination by donor” [AID]) rather than that of a “husband” (i.e., “artificial insemination by husband” [AIH]). Throughout these texts women were consistently constituted as the site and source of infertility, even when the diagnosed cause of their “pregnancy failure” was inactive or otherwise faulty semen. Medical interventions that involved injecting concentrated doses of the “husband’s” most active sperm into a woman’s cervix, mixing the husband’s sperm with donor sperm, or bypassing the husband’s sperm entirely via donor sperm were routinely discussed in terms of making “infertile” women “fertile” through the application of timing-oriented techniques. In these cases the rhetorical frame of clinical timing deflected the discussion’s focus from men to women. The widespread circulation of these sorts of deflective appeals inspired an influx of correspondence about AI from lay readers to the offices of individuals such as Dr. Mary Steichen Calderone, medical director of Planned Parenthood Federation of America. Calderone generally responded to these letters by alluding to the “mechanics” of reproductive timing and timeliness and directing correspondents interested in AIH to one of a growing number of Planned Parenthood facilities staffed with infertility specialists. Those letter writers interested in AID she advised to enlist the help of a private practice facility, as AID was not offered through Planned Parenthood. Although the knowledge of ovulation timing, on which these procedures’ successes seemed to rest, did not differ according to semen source, Calderone and many of her contemporaries argued that AID was inherently more “artificial” than was AIH and thus to be avoided if at all possible. By midcentury the days of unbridled enthusiasm for the miracle of “synthetic” hormones and the like had been cut short—to a certain extent—by the circulation of psychoanalytic appeals to “natural” development and dystopian portrayals of reproductive technologies à la Aldous Huxley’s

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Brave New World. As much as science, the medical expert, and the clinic were continually characterized as masters of fertility throughout the mid-twentieth century, a growing skepticism about scientific utopianism in general contributed consistent discursive resistance to the idea that scientific interventions are inherently progressive. To be sure, Miller argues, appeals to kairos such as the ones at hand, which transpire in the context of technological intervention, tend to involve an unresolvable tension between the potential for risks associated with technology gone awry and the potential for gains associated with technological advancement. This tension surrounding fertility and the use of artificial means for its induction only intensified when Rock and his assistant Miriam Menkin reported the first successful in vitro (i.e., outside the body) fertilization attempts in 1944, an achievement that they constituted as largely kairotic in nature. In the years leading up to their breakthrough, annual reports from the Fertility and Endocrine Clinic laid out a number of experimental alterations related to timing. In 1942, for instance, the report recounted “varying the time interval of pre-insemination culture in serum between 8 and 16 hours” and exposing ova to spermatozoa “within 2 hours after collection of the latter.” The 1944 report announced that “our efforts of seven years” had been successful, “realized in the fertilization and cleavage of four eggs recovered from ovaries.” Menkin later attributed the experiment’s success to a longer contact time between ova and sperm, noting that that particular day she had been exhausted and “so I just sat there, watching this remarkable sight, . . . which never fails to fascinate me—the human egg, with a mass of spermatozoa on its surface. .  .  . So great is the force of their combined efforts that the egg is made to rotate around and around.” Before she knew it, an hour had passed rather than the usual twenty minutes, a timing mistake that proved fortuitous when the ova divided into “two equal, spheroid blastomeres” and thereby signaled early embryonic development. These accounts characterized fertilization and thus fertility in general as, above all else, the result of an opportunity in time. That Menkin realized this opportunity at all only because of her own embodied temporal experience—her exhaustion was the result of “having been kept awake two nights running by a teething baby”—received minimal attention in medical and lay coverage of the event. In the midst of the excitement concerning this initial IVF success, Rock was among the first to recognize that a significant amount of research (and time) was still needed before it would be possible to see IVF through to pregnancy and the birth of a healthy child. The 1946 Fertility and Endocrine Clinic’s report

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noted that “much remains to be learned about how to cultivate human eggs artificially” and then called for additional funding to move the project forward. In the years (and reports) that followed, funding would be upheld as an increasingly central concern for Rock and his contemporaries, particularly as governmental agencies in the United States and Europe began pulling their funding from IVF research in the 1970s at the insistence of pro-life advocates and those otherwise concerned about the harms of “artificial” reproductive technologies. Ultimately, over forty years would pass before British researchers Robert G. Edwards and Patrick Steptoe finally managed to oversee the first child born via IVF. The rhetoric about infertility leading up to their achievement—born of the emerging integrated field of infertility studies and the transdisciplinary rhetoric of diverse, collaborative research trajectories—featured a public vocabulary that included appeals not only to efficiency and opportunity but also to urgency by invoking the threat of being “too late.” Infertile and Out of Time: Appeals to Urgency In the decades leading up to the birth of the first so-called test-tube baby in 1978, appeals to urgency became the defining feature of infertility rhetoric. To be fertile, at this discursive juncture, was to be a woman who hastened toward apertures of opportunity in scientifically deciphered time. The stage for this message was set via news coverage that repeatedly characterized IVF research as a high-intensity, international race. A 1970 Ladies’ Home Journal article by journalist David R. Zimmerman asked readers, “Who will succeed in implanting the first test-tube baby—and when? The Steptoe-Edwards team generally is conceded to be in the lead.” Zimmerman’s questions followed a detailed overview of reproductive timing and “microscopic new beginnings,” wherein he concluded that “fertilization thus is a critically timed series of events that involve all of a woman’s reproductive organs.” His account associated infertility with women, rather than men or couples, and introduced several interconnected layers of kairotic appeal that spoke to fleeting opportunities opening up in time at both meta- (i.e., scientific study) and micro- (i.e., the ovulation cycle) levels. Similarly, journalist David Rorvik, writing for Look magazine in 1971, wondered who would succeed first in the “new era [that] has dawned,” thereby enlisting a “kairotic periodization” designed to justify widespread—and quick—change. This race metaphor functioned as a distinguishing backdrop for infertility rhetoric of the 1960s and 1970s, the content of which tended to revolve around

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the supposed urgency of clinical treatment and the temporary nature of fertility in a woman’s cyclical and chronological life cycles. The Urgency of Clinical Treatment

Mainstream discussions of infertility in the 1960s and 1970s often focused on the idea that the female mind-body is so meticulously and densely driven by timing that it demands immediate expert attention, particularly in cases where a desired pregnancy is not forthcoming. This argument about the complex and therefore unique nature of women’s reproductive physiology was a percolation of arguments put forth by Nicholas Culpeper in the seventeenth century, as well as by advocates of the early twentieth century’s narrative of energy conservation and human reproduction. In his Time-Life book of 1967, Havemann contended that “the female reproductive system is much more complicated than the male” because “it must respond with a fine sense of timing to all the delicate glandular adjustments and readjustments of the menstrual cycle. Therefore it is subject to a much wider range of defects and difficulties.” Dr. Elizabeth B. Connell— director of the International Institute for the Study of Human Reproduction— offered a similar account in a 1972 Redbook article, explaining that “all the components of [the female reproductive] system are like the delicately balanced and intricate pieces of a complicated machine, and all must function properly and in the right order for ovulation and pregnancy to occur.” She went on to demarcate a variety of possible medical treatments for “nonovulation” specifically and infertility generally, directing her readers to seek out treatment in this “whole new era” of the “field of infertility.” This temporal reasoning situated women as on the clock both because the era in which they lived offered them previously unavailable reproductive treatments and because their unique physiological mechanics depended on complex timing that could so easily go awry. Mainstream media coverage encouraged those most at risk for going awry— those with “irregular” menstrual cycles—to seek out infertility treatment as soon as possible. Famed U.S. sex researchers Dr. William Masters and Virginia Johnson wrote an advice column for Redbook in 1975, wherein they instructed a woman whose “periods are completely irregular—21 days one time, 45 days the next, frequently skipping one, two or even three calendar months” to “consult her doctor whenever she and her husband decide that pregnancy is in order for them, rather than spending a year first in trial-and-error attempts.” Given that this sort of timing was so clearly off the scientifically delineated mark, Masters and Johnson encouraged women to seek expert treatment perhaps even before

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they began trying to get pregnant. Being out of time, they reasoned, was a sign that a woman was either not ovulating or not ovulating very often. She thus needed to be “made fertile” through the introduction of, for instance, “hormonal extracts which stimulate the pituitary gland, and so produce eggs which can then be fertilized,” as journalist Ann Shearer suggested in a 1968 Guardian article. This type of medical intervention, it was argued, would reposition her within the rhythms of medically recognized normalcy and thereby instigate fertility. This argument about the urgency of infertility treatment was conveyed via vivid narrative accounts of clinical experiences. In her 1973 Good Housekeeping article “The Babies They’d Always Wanted,” journalist Jean Libman Block depended inordinately on words and phrases that conveyed speed. Block contrasted accounts of women’s lengthy, failed attempts to get pregnant without the help of clinical oversight with accounts of prompt, sometimes almost instantaneously successful attempts garnered under a clinic’s care. After noting that one woman and her husband had tried futilely to have a baby for three long years, Block reported that, upon visiting the New York Fertility Research Foundation, the woman “conceived so fast that by spring it was evident to all the carriage pushers in her building that she was soon to join their ranks.” Another long infertile women “immediately started treatment” after her problem was “pinpointed” at a clinic. She became pregnant and then the mother of a healthy baby directly thereafter. When she was ready for another baby there was “no waiting around,” as she “rushed” back to the clinic, “immediately” began her original course of treatment, and was “due this summer.” Likewise, Rorvik’s Good Housekeeping article of 1970 discussed “a revolutionary and simple diagnostic technique known as ‘culdoscopy’ ” that permitted “doctors to look inside the pelvis, examine and even take motion pictures of the ovaries, uterus and Fallopian tubes in a matter of minutes.” Rorvik went on to emphasize the idea that infertility clinics “performed [diagnostic tests] not over a period of months but immediately.” In these accounts, infertility clinics were said to offer involuntarily childless women prompt results because they had both the diversity of cooperating specialists and the technology for tracking and intervening in women’s otherwise faulty reproductive timing. If the infertile hastened to a clinics’ doors, these articles contended that they would be positioned for prompt treatment and, in most cases, pregnancy. If they did not hasten to the clinic’s doors, it was implied that their lengthy, disheartening trials were, to a greater or lesser extent, their own fault.

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Rhetoric produced by infertility clinic administrators and employees themselves in these years supported the idea that time was of the essence for patients and doctors alike. One of the more unique examples of the role that appeals to urgency played in even internal clinic communication emerged from papers related to the Rock Reproductive Clinic’s 1963–64 Scoop and Staff Show. Somewhere in the middle of juggling multiple research projects and unending clinical tasks, clinic physicians, nurses, and technicians also managed to script a number of humorous songs for a staff-only performance. Set to nursery rhymes and popular Broadway show tunes, compositions revealed the degree to which speed and appropriate timing were central to both clinic work and the demarcation of fertility writ large. For instance, a version of “Hickory Dickory Dock” jested, “The mouse ran up the clock: The clock struck nine, ovulation time! Oh, where is Doctor Rock?” And a rendering of the song “Get Me to the Church on Time” made famous by the 1956 musical My Fair Lady, intoned, “I’m getting fertile in the morning. . . . Dr. Zee says my cycle’s in its prime!” At the tune’s conclusion, the singer hopes that those accompanying her will get her not to a church with its faith- and morality-based approaches to involuntary childlessness but rather that they “get me to the clinic on time!” These lyrics made it clear that, even when they were making merry, Rock Clinic employees never forgot the tenuously temporal nature of their job. Fertility as Temporary

In view of the birth control pill’s widespread legalization, being “on time” to the clinic began to take on new dimensions of meaning. As journalist Helen McNamara explained in a 1977 Good Housekeeping article, “the Pill, and the fact that jobs have opened up for us, have given us a chance to postpone motherhood until we really know what we want to do with our lives.” In this context, what medical specialists, journalists, and women themselves began to communicate about was the possibility that women would wait “too long” in their chronological life cycle before trying to become pregnant and then find themselves having missed the opportunity entirely. Thus, the message that women should neither delay having children nor delay the process of obtaining infertility treatment became a constant theme in coverage of reproductive issues. Discussion of the “risk” of what would become known in the coming years as “age-related infertility” functioned as a pressing and repeated call to action. Rhetorician J. Blake Scott contends that “risk is always inherent in kairos,” as

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kairos entails a forecasting of events and consideration of the possible outcomes of intervening in said events, rhetorically or otherwise. In both technical and mainstream rhetoric, the possibility that a woman might soon become infertile because of her chronological age was discussed in terms of when infertility treatment (i.e., medical intervention) should be procured. In a 1968 clinical text, Roland argued that couples needed to visit an infertility clinic if, after two years of trying, they had not become pregnant. He added, however, that an “additional consideration is the fact that fertility has a physiologic component, namely, that it declines even in normally fertile women with increasing age.” Fertility, Roland argued, is fleeting even in the most “normal” women. Therefore, he reasoned that every woman inevitably faces something of a fertility deadline or countdown, which, as rhetorician Roger Stahl explains, is an “authoritarian discourse that preempts its own questionability” and functions to synchronize the “collective gaze.” In this specific instance, Roland advised that “couples” over thirty seek treatment after just one year of trying to conceive, though his previous reference to “women’s” declining fertility made it clear that he saw no actual deadline where men’s age was concerned. In subsequent years suggested waiting times for treatment were truncated, but the message that all women become less fertile and therefore more at risk for infertility over time remained steadfast. Journalist Andrea Thompson, writing for McCall’s in 1977, reported that “a couple should initiate the [infertility] workup, after six months—especially if the wife is over 30,” for “fertility decreases with age, and one in ten previously fertile women will be infertile by age 35.” The McNamara article of the same year suggested that over time women become less fertile not only physiologically but also psychologically. She wondered if, at thirty-eight, she was “easily ten years too old ever to adjust to giving up my freedom”—an argument with clear echoes of Helene Deutsch’s midcentury psychoanalytic theories of maternity and maturity. McNamara also discussed “risks” coming to light from the field of genetics indicating that “mongolism (Down’s Syndrome) is more likely to occur in babies born to women over 35,” a finding that she acknowledged was “anything but reassuring” for many readers. The underlying message in these articles was that women needed to act on their latent fertility early in life, long before they found themselves asking, “Doctor, am I too old to have a baby?” These sorts of preventative appeals—products, no doubt, of what sociologist Ulrich Beck deems a “risk society,” wherein “safety” is the “motive force”—solidified the idea that the infertile woman was out of time kairotically and, often, too late chronologically.

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Medicalization and the Biological Clock In a broad sense, I contend that this temporal conceptualization of infertility functioned to support infertility’s continued and increasingly multilayered medicalization in the 1960s and 1970s. As distinct fields of scientific study were integrated together under the transdisciplinary rhetoric of clinical timing, the “process” of medicalization, as sociologist Peter Conrad describes it, was inscribed with yet another interrelated layer of clinical oversight. This was not the “total” or “complete” medicalization that Conrad theorizes because, as the case studies discussed in this book illustrate, medicalization occurs in the context of broader rhetorical ecologies that incorporate points of resistance, co-optation, and chronologically distinct percolation, points that make completion on any front, at any one time, impossible. But while the medicalization process may not have reached a point of completion in the 1960s and 1970s, it had reached a dynamic point of interrelated complexity that would have been incredibly difficult, if not impossible, for its subjects to disentangle themselves from. Rhetorics of infertility at this time contended that not just the female reproductive body, not just the mind, but the supposed totality of all reproductive processes, parts, and interconnections—represented and studied by a diversity of scientific fields and experts—collated together as the combined, amalgamated product of medicine’s jurisdiction. As Havemann assured his Time-Life readers in 1967, “The most important news of all about childlessness is that it can now be treated like any other medical problem, often with great success.” Conceptualized as “any other medical problem,” infertility’s rhetorical positioning as within the medical clinic and of the female mind-body was certainly not lacking in precedent. It joined the ranks of any number of female-specific “problems” ranging from hysteria to childbirth to menopause and brought with it the moral imperative to situate one’s self firmly within the confines of the medical establishment. Individual women may not have been constituted in these discourses as necessarily or directly “at fault” for any one element of their reproductive troubles, but they were understood to be responsible for failing to obtain an early medical diagnosis or for otherwise neglecting medical dictates. Moreover, the construction of infertility as a manifestation of being “out of time” supported the ticking biological clock trope that began circulating in the 1980s and that remains omnipresent in mainstream media today. If fertility is the result of urgently taking advantage of precise opportunities in clinical time, as rhetoric from the second half of the twentieth century implied, then it follows

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that those women hoping to procreate must adopt meticulous time-management strategies and employ science and technology to claim their fertility. This line of reasoning became explicit in 1982, when the New England Journal of Medicine published a French study reporting that, beginning at the age of thirty, women experience a sharp decline in fertility. Subsequently covered by the New York Times and a wide range of other mainstream media publications, the argument spread that not only were women subject to a constantly ticking biological clock, but they had much less time on that clock than once imagined. This particular study would be critiqued heavily for drawing from a biased sample and employing faulty methodology. And by the mid-1980s it would be refuted more formally in a number of scientific counterstudies. This scientific rejoinder, however, received comparatively little attention, an omission that upheld appeals to the biological clock and, as health communication scholars Lynn M. Harter and colleagues explain, “reconfigure[ed] women’s relations with time by highlighting the constraints of time and timing on women’s reproductive successes and failures.” By this point, clinical timing’s disciplinary function had evolved far beyond the technical obscurities of scientific experimentation and clinical research to occupy the spotlight of mainstream media coverage concerning women’s health and reproduction. Popular-press publications such as Molly McKaughan’s 1987 The Biological Clock: Reconciling Careers and Motherhood in the 1980s, which reported on surveys of a thousand “working women” in their thirties, suggested not only that many women of the late twentieth century understood fertility as a product of timing but also that they had internalized the sense that fertility is an opportunity steadily slipping away. These so-called clock watchers balanced appeals to urgency induced by their biological clocks with the need to take advantage of other temporal opportunities often related to work and the professional world. This view of reproduction was grounded in a risk- or harm-reduction model of health that positioned individual women—specifically middle- to upper-class, white, professional women—as personally responsible for, and capable of “choosing,” their reproductive health and fertility. Women, in this context, had to get themselves (and, by extension, their male counterparts) to the clinic on time while also managing any number of other variables. Any embodied sense of timing and reproduction on their part was characterized as, at best, trivial and, at worst, meaningless. By contrast, experts’ sense of clinical time was argued to be permeated with meaning and significance in that they could use that sense to align infertile women within “normal” temporal perimeters and thereby induce

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fertility, even in those cases when individual women had reached a point that seemed to be too late. Today, this kairotic representation of women’s reproductive health continues to wield considerable persuasive force, as does the idea that science and medicine can, in some cases, overcome chronos through the careful consideration and application of kairotic interventions. In the conclusion, I argue that this ongoing, temporal regime of infertility has created a number of discursive fissures, wherein historical, scientifically disproven ideas—as well as what might be termed “outdated” narratives and tropes—concerning infertility have been especially able to percolate and generate renewed cultural capital. Attention to the clock has, in these contemporary cases, brought with it lackluster coverage of scientific refutation concerning reproductive health issues generally and infertility specifically.

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Conclusion

By all accounts, infertility in twenty-first-century Europe and the United States is no less medicalized, temporally defined, or conceptualized via transdisciplinary rhetoric than it was in the second half of the twentieth century, though how those features play themselves out differ in both big and small ways. The growing number of individuals who have turned to assisted reproductive technologies (ARTs) to become parents have described their experiences as riddled with seemingly endless waiting periods, precisely delineated—and therefore frequently disruptive—medical procedures, and all-consuming, longitudinal anxiety. A quick search online through the numerous “trying to conceive” (TTC) discussion boards and forums demonstrates that the imposition of clinical time and timing onto potential parents is not limited to those seeking infertility treatment. Rather, women contributing to these forums—and they all identify as women—confront conception in general as a process that depends on minute, ongoing attention to timing. Starting with the first day of the menstrual period, forum contributors count down the days and hours until ovulation, which they assess with at-home ovulation tests or temperature charting, and then time intercourse to correspond with egg release (male partners are rarely discussed on these forums in terms of their agency or separation from females, an apparent holdover from—or percolation of—twentieth-century infertility clinic rhetoric referencing the “patient” and her “husband”). This begins the “two-week wait,” when, if conception has occurred, the rapidly dividing blastocyst travels through the fallopian tube and implants within the uterine lining. Directly thereafter, the body begins to produce human chorionic gonadotropin (hCG), a hormone that prevents menstruation, and a pregnancy test will—in a matter of days—detect the hormone and show a positive result. For those in whom conception or implantation did not occur, menstruation recommences and the “dreaded” countdown begins again. Frequent topics of discussion among forum participants include tactics for assessing when ovulation might occur, the strategically best

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time to engage in intercourse, and the average number of days from conception to implantation and a positive pregnancy test. Attention to this type of temporal regimen was first ignited on a broad scale in 1996 with the publication of Taking Charge of Your Fertility: The Definitive Guide to Natural Birth Control, Pregnancy Achievement, and Reproductive Health by U.S. public health educator Toni Weschler. Since reissued in a tenthanniversary edition, Taking Charge of Your Fertility has been characterized as an attempt to provide women directly with the information necessary to control their own reproductive lives, a goal communicated—according to a review in the Canadian Medical Association Journal—with a “subtle” but consistent “antiestablishment bia[s].” In terms of its dedication to the creation of something like “vernacular healers,” the book shares more than a passing resemblance to Nicholas Culpeper’s 1651 Directory for Midwives. But where Culpeper advocated for achieving bodily equilibrium and establishing fertility through herbal infusions and protecting one’s self from the elements, Weschler contended that basal body temperature charting, cervical fluid monitoring, and the tracking of cervical positioning were the ways in which women could best promote their own reproductive health and “empowerment.” She argued that the “fertility awareness method” she upheld aided women in, first, interpreting their own embodied feelings and processes and, second, using those interpretations to meet their individual goals, whether those goals included becoming pregnant or avoiding pregnancy. Although charting and timing were central to this agenda, Weschler’s focus on women themselves as the truth-tellers and interpreters of their own experiences aligned reasonably well with philosopher Julia Kristeva’s theory of “women’s time” as embodied and lived. At the turn into the twenty-first century, similar books, though with less focus on “natural” (i.e., antiestablishment, antibiomedical) approaches and more attention to speed and efficiency, began flooding the market. The Impatient Woman’s Guide to Getting Pregnant and The Sperm Meets Egg Plan: Getting Pregnant Faster, to name just a couple, encouraged readers to chart, time, and measure their way to fertility and “quick” conception. Timing, in these cases, was characterized in turn as a necessary, external imposition and as a resource, something to apply to one’s self and others to prevent or overcome infertility. Continued appeals to women’s “biological clock,” whether in terms of slowing it down, manipulating it, or simply coming to terms with what economist Sylvia Ann Hewlett characterized in 2002 as a “desperate race against time,” only reiterated the import of temporality. These publications left little doubt that

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women, as well as their health care providers and the scientists who research infertility, must focus their gaze on the clock to facilitate conception, pregnancy, and the birth of a healthy child. To overlook such concerns, to turn one’s attention away from the countdowns and deadlines, is to risk not just infertility and childlessness for women but also failure on the part of reproductive medical specialists and negative health outcomes for women and offspring alike. To the latter, arguments about the dangers of “age-related infertility” and “advanced maternal age” imply that women can “choose” when, how, and if they conceive, that they are, as health communication scholar Jennifer J. Bute and colleagues explain, in complete control of “the choice to delay childbearing and the concomitant consequences of this choice.” This assumption of choice, however, overlooks—at the very least—the institutional and structural factors that shape reproductive outcomes, implying that all individual women are independent decision makers who negotiate the same circumstances. That institutional and structural disparities, which often play out in terms of “stratified reproduction,” have been so easily discounted has much to do, I argue, with this allencompassing focus on the clock. The argument that infertility is best understood in terms of being out of clinical time has, over the past decades, captured the “synchronization of the collective gaze.” The resulting absence of attention to infertility and reproductive health in a more inclusive, less synchronized sense has fostered a rhetorical landscape with a number of undetected discursive fissures through which ideas of old are (even more) free to percolate and reestablish themselves as part of a twenty-first-century public vocabulary of reproductive health. In this light, the problem with defining (in)fertility according to clinical timing may have less to do with the definition itself, or even with the implications of such temporal regimentation for individuals and societies, and more to do with the lack of attention left over for the consideration of diverse evidence, historical perspectives, and long-established scientific and cultural refutations. Indeed, as arguments and narratives long scientifically or culturally refuted have reemerged in the twenty-first century, “infertility” has become about timing, yes, but also about many of the definitions it assumed in years past. As philosopher Michel Serres explains, this pattern of repetition in history is unavoidable, but what is avoidable is the lack of recognition of such repetition and the failure to consistently draw from the past to re-refute what has already been deemed scientifically false or culturally harmful. This concluding chapter, then, is designed to draw from the findings of earlier chapters to highlight the

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historically repetitive yet chronologically disconnected nature of twenty-firstcentury infertility rhetoric. Such work, according to Serres, is the “only work left” if one aims to transcend the “bleak repetitions of history.” He argues—and I agree—that the goal in philosophy, history, and rhetoric is not just to analyze discourses of the past and present but also to engage in the “anticipation of future thoughts and practices.” This kind of anticipation necessarily involves the development of “common ground for future inventions,” which, according to the analysis offered here, would mean an infertility rhetoric that provides women (and men) with subjectivities that go beyond—yet still anticipate the reemergence of—topoi that blame individual women for their own infertility or frame (in)fertility in terms of gendered technological determinism. With that goal in mind, I adopt Serres’s comparative, topological methodology and consider disparate chronological moments through the lenses of their corresponding, repetitive (and generally scientifically and culturally refuted) arguments. First, I turn to the false science of seventeenth-century “maternal impressions theory,” which contended that women whose thoughts turned to horrific, lusty, violent, or otherwise “inappropriate” images during conception or pregnancy would imprint those images onto their unborn children. This process was said to induce thwarted conception, miscarriage, or the bringing forth of “monsters” who bore physically the markings of their mothers’ transgressions. While thankfully absent of Renaissance-era teratology, consideration of “how the experiences of pregnant women imprint on their descendants” has gained renewed traction via twenty-first-century research on the developmental origins of health and disease (DOHaD). Often referred to simply as Fetal Origins research, this growing scientific field focuses on the epigenetic changes that may unfold because of a child’s pre-conception and uterine environment. According to historian Sarah S. Richardson and colleagues, this research agenda has received significant attention from the mainstream media and from popularpress books, such as journalist Annie Murphy Paul’s Origins: How the Nine Months Before Birth Shape the Rest of Our Lives, published in 2010. Richardson notes that this coverage tends to oversimplify the effects of interuterine exposure, focus only on maternal (not paternal) influence, and extrapolate from animal experimentation to humans without qualification, which is problematic because animal placentas tend to be far more permeable than humans’. The resulting message in this mainstream coverage is, therefore, overly streamlined and deterministic, qualities that have been shown to be associated with information overload, and thus information rejection, among lay audiences. This

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framing implies that women’s choices, experiences, and behaviors before their children are born determines, to a large extent, the expression of their offspring’s DNA and thus their health for the rest of their lives. As Paul explains, DOHaD research is “turning pregnancy into something it has never been before: a scientific frontier.” As Richardson and others suggest, the implications of this line of reasoning are potentially no less misleading and harmful than those associated with the long-refuted and invalidated maternal impressions theory. First, the metaphor of the “scientific frontier” itself, which has been adopted by a growing number of journalists reporting on ARTs and reproductive health in the twenty-first century, is one that, according to rhetorician Leah Ceccarelli, “encourages themes of competitiveness and economic exploitation.” Rather than fostering a climate of mutual respect, understanding, and problem solving, characterizations of conception and pregnancy as a scientific frontier are likely to uphold the “race” mentality that came to the fore in the years leading up to the birth of the first IVF baby. Focus on efficiency, opportunity, and urgency subsumes the discussion, and potential parents—women in particular—are left with no other option than to become what journalist Sarah Elizabeth Richards describes as a “Clock Ticker,” assailed by the “loud hum of the clichéd biological clock.” Once pregnant, they must ask themselves, as the title of a 2015 Atlantic article did, “Should [They] Bring [Their] Unborn Baby to Work?” If undue stress, lack of sleep, and illness during pregnancy is believed to negatively affect the offspring’s genetic expression, as Fetal Origins research seems to suggest, might it not be prudent for them to abandon work outside the home if at all possible? Moises Velasquez-Manoff, the Atlantic article’s author, ultimately argues that, no, leaving work prior to or during pregnancy is probably not necessary, though access to extensive, paid maternity leave that may be taken during pregnancy or an altered work schedule to accommodate pregnancy likely is. What is startling here is certainly not the call for improved parental leave and support policies, but, rather, that this article cites and thereby recirculates the argument that women might best protect their own fertility and health, as well as that of their offspring, by staying out of—or at least taking leave from—educational and professional endeavors. This line of reasoning and the assumptions that it upholds about women and their rightful place in society might have been lifted straight from not only Aristotle’s Master-Piece but also the writings of either Dr. Edward H. Clarke in the 1870s or the psychoanalyst Helene Deutsch in the 1940s. By encouraging readers to contemplate whether it might be dangerous

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for women to work while pregnant or trying to conceive, Velasquez-Manoff reopened the door to considerations about long-refuted arguments concerning sex-specific reproductive differences. For instance, Deutsch argued in 1945 that “woman usually invests her creative urge in the reproductive task and the child; man invests his in his work,” and she also contended that sterility can result when a woman “devotes her life to an ideology or another emotionally determined interest. Here belong those women who play a part in great revolutionary movements, the artists, scientists, etc.” The assumption in both of these contentions—whether merely suggested via the Atlantic article or communicated explicitly in Deutsch’s The Psychology of Women—is that women are psychosexually, emotionally, and biologically different from men, and therefore they alone must devote their minds and bodies to reproduction if they desire healthy, biological children. Women can be scientists or they can be mothers, but they cannot be both. Although this idea has long been scientifically and culturally invalidated, kairotic appeals upholding the twenty-first-century transdisciplinary rhetoric of infertility function in many ways to overpower and thereby obscure such historical evidence. Beyond these contentions about the potential value in “protecting” women of childbearing age from the stresses of education and professional work, Fetal Origins research has also created an opening for the percolation of arguments about the inimitable dangers of the corrupted womb. Paul, for one, goes out of her way to highlight the positive role that a healthy womb can play in supporting the future health of its residents, noting, for instance, that such research has brought with it a “dawning sense that intrauterine conditions make a lot of things go right, that the prenatal period is where many of the springs of health and strength and well-being are found.” No matter her optimistic framing, though, the other side of the coin remains that an unhealthy womb—one that is diseased, poorly nourished, or contaminated by any number of harmful substances—is said to foster nothing less than lifelong disorder, abnormality, and dysfunction. Health campaigns related to the dangers of smoking and drinking alcohol during pregnancy, of course, are examples of the great good that can come from such messages. But there are a range of other examples—such as the “crack baby” scare of the 1980s—that could be said to have initiated more harm than good, as it became clear in subsequent years that babies exposed to, for instance, cocaine in utero suffered fewer and less severe long-term effects than had been prognosticated. This is not to say, of course, that pregnant women should engage in drug use or other behaviors deemed generally injurious, but it

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is to say that a framework for health is both problematic and misleading in which women of childbearing age in and of themselves are understood to be the primary source of their offspring’s long-term health (rather than, for instance, structural and institutional influences related to health care access, parental leave policies, health literacy, and educational infrastructure). A version of this particular, individualistic health framework initially garnered widespread symbolic force in the seventeenth century through works such as Aristotle’s Master-Piece. But while the monstrous maternal trope of yore played out in the midst of organic metaphors related to soil, seed, and fruit, the monstrous maternal trope of today—particularly in the context of infertility—has percolated and evolved into a cyborg, part human, part machine. Cyborg wombs, what media scholar Anne Balsamo deems a “metonym for the entire family body,” are said to put infants, bloodlines, and even societies at risk. Undertaking feats deemed unnatural to the human body (e.g., gestating six or even eight babies at one time; acting as surrogates for embryos conceived elsewhere), the cyborg womb orchestrates devastation the likes of which has (supposedly) never been seen before (e.g., perilous octuplet births; long-term health problems for offspring and mother alike; societies made up of unhealthy defectives). That this version of the monstrous maternal trope is no less gendered, raced, and classed than versions of the past—a point that rhetorician Natalie FixmerOraiz has made clear with her analysis of the pathologizing public discourse surrounding “Octomom” Nadya Suleman—speaks to the system of stratified reproduction from which it is today and long has been voiced. In these cases, the monstrous-maternal woman is enveloped within the realm of the technical because she has failed, somehow, in the realm of the natural. In Suleman’s situation, she enlisted ART to ultimately conceive and give birth to eight babies at once, a feat deemed especially problematic given her status as a single woman of color on welfare and already the mother of six older children. Although in recent years rates of childlessness have grown most sharply among minority women—particularly those who identify as black, Asian, or Latina—the twenty-first-century public profile of infertility and the involuntarily childless remains unyieldingly white and middle to upper class. Minority and immigrant women, by contrast, are still repeatedly situated as hyperfertile, a characterization that has facilitated major human rights violations such as the involuntary sterilization of hundreds of thousands of black women in the United States during the 1960s and 1970s, as well as pernicious, ongoing racial disparities in access to, and literacy about, reproductive health care options. Thus, it may not

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be surprising that public rhetoric constituted Suleman as what rhetorician Tasha Dubriwny labels a “vulnerable empowered woman” in that she was deemed responsible for her failure to conceive naturally (e.g., without ART) and yet lacking in either the expertise to oversee her cure or the “common sense” (read, racial identity) to achieve normalcy. These sorts of representations, which contribute to the assumption that women—regardless of their race, class, religion, or nation of origin—hold the sole responsibility for infertility, miscarriage, and birth defects in their offspring, are often justified by the contention that women’s bodies do the most and longest work toward reproduction and—unlike male bodies—are unduly complex. Claims of this nature have not so much percolated into the twenty-first century as they have endured despite pointed vocal opposition and mounting scientific evidence otherwise. When Dr. Sophia Kleegman discussed men’s “degree” of “fertility” in her 1938 speech before the Women’s Medical Society of New York State, for instance, she worked to shift collective attention from women as responsible for infertility to men and “couples.” She was among the first to call for the routine testing of men for signs of what she called “lowered fertility.” And while her evidence was deemed sound, and comprehensive infertility clinics ultimately integrated some such testing into their treatment regimens, the rhetoric of infertility has nonetheless remained stubbornly female-focused. As women’s studies scholar Janice G. Raymond explains, it is still “women who bear the burden of their own and their male partners’ infertility.” That so-called male-factor infertility is still regularly overlooked and underdiagnosed was once argued to be a relatively moot point, as treatment for conditions such as low sperm count was limited and largely ineffective. Today, however, technologies such as intracytoplasmic sperm injection have dramatically improved malefactor infertility treatment outcomes, a development that makes the continued overtreatment and mistreatment of women, as well as the undertreatment of men, especially egregious. Of present-day advocates attempting to shed light on this continued bias in infertility treatment, some, such as urologist Harry Fisch, have publicized what is increasingly being called the “male biological clock.” In his 2013 popular-press book The Male Biological Clock: The Startling News About Aging, Sexuality, and Fertility in Men, Fisch drew from emerging research in human genetics to contend that, as men age, “the genetic quality of the sperm declines significantly.” Thus, although men may still be able to produce offspring after age thirty-five or forty, the longer they wait the higher their risk for passing on genetic abnor-

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malities and long-term health conditions such as autism, schizophrenia, and bipolar disorder. Rather than advocating that men necessarily plan to have children earlier, however, Fisch provided them with strategies to “slo[w] down and even revers[e]” the effects of men’s biological clock. He argued “that problems with sexuality or fertility that arise at any point in a man’s life can usually be fixed.” In this case, then, turning the clock toward men did not function so much to turn its focus away from women—who, according to Fisch and a number of other popular authors such as Sylvia Ann Hewlett and Tanya Selvaratnam, have a far less forgiving clock—as it did to guide men to triumph over any sense that they too face an inescapable clock. Men may have a clock, Fisch argued, but they—unlike women—can overcome that clock “at any point” in their lives. Curiously, this characterization seems to conflict both with other claims made in The Male Biological Clock and with a statement put forth by Fisch, published in the Journal of the American Medical Association. Therein, Fisch and his colleagues contended that “women should thus no longer be viewed as solely responsible for age-related infertility and genetic problems. Infertility is not just a woman’s problem and awareness of the effects of the male biological clock will allow couples and their physicians to proceed with proper testing, diagnosis, and (if needed) treatment of the male partner.” But regardless of this technical call for a more inclusive understanding of the female and male factors that contribute to age-related infertility, Fisch’s popular representation of the so-called male biological clock as something that can be definitively surmounted functioned to position men as potentially beyond such concerns and thereby refocus attention on women as the sole temporal subject. This particular scenario highlights the potential that mainstream journalistic accounts of science have for diverging from scientific messages proper, a point made even more poignant in this case, as the same person authored both technical and mainstream publications but provided each group of readers with messages suggesting deviating conclusions and implications. One is reminded here of the complex, competing, and even resistive nature of forces interacting within broader rhetorical ecologies, particularly as those forces come together in the production of public vocabularies of science and medicine. The fact that recent popular-press publications such as The Male Biological Clock tend to find ways to focus on women as the major player in infertility scenarios—even as they explicitly promote a more inclusive agenda—likely ties into other rhetorical factors that position women in this way. For instance, although

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mid-twentieth-century arguments surrounding the concept of psychogenic infertility have been effectively and repeatedly revealed as groundless (e.g., that adoption promotes conception; that inability to conceive, pregnancy-related nausea, and miscarriage are the result of the woman’s psychosexual dysfunction), the rhetoric linking women’s reproductive body parts to their faulty mental processes has nonetheless percolated into the twenty-first century. For instance, technical and mainstream rhetoric alike repeatedly references the challenges to fertility for women who exhibit, for instance, “hostile cervical mucus,” “irritable uteri,” and “cervical incompetence.” Although technical articles and books are less likely to draw explicit connections between the state of these body parts and products and the mental health of women themselves, the titles of the conditions at hand nonetheless invite these sorts of conclusions, a point that some mainstream coverage of this topic makes clear. In a recent article featured in Salon, titled “Withered Uterus, Angry Vulva: ‘It’s Probably a Good Thing You Don’t Want Children,’ ” a writer both poked fun at the medical use of these descriptors and, at the same time, played off of the assumptions that they engender. She suggested that the trouble her doctor had in fitting her with a standard intrauterine device corresponded with her abnormal mental state, wherein she felt that “all I know is that I don’t want children—that the thought of growing a foreign body in my body keeps me up at night.” The inference of her argument, in this case, was that her cervix (and uterus and vulva) had been damaged somehow by her lack of desire for offspring. Fortunately, attempts to refute and even co-opt this type of reasoning are being made at both scholarly and mainstream levels. For instance, linguist Lynne Bowker’s scholarship is based on the argument that much technical language related to infertility is ingrained with a bias against women and therefore needs to change. She illustrates the vastly different ways that conditions related to infertility are labeled for women versus the ways in which they are labeled for men. Bowker finds—for one—that while women who develop antibodies that fight against their partner’s sperm are discussed in terms of their “hostile cervical mucus,” men who develop antibodies that fight against their own sperm are discussed in terms of their “autoimmunity.” There exists no medical or linguistic reason, she argues, why men in these situations could not be discussed in terms of, for instance, their “hostile sperm” or, vice versa, why women in these situations could not also be described in terms of their “autoimmunity.” Correspondingly, she demonstrates that amenorrhoea—lack of menstruation—tends to be labeled “failure of ovulation” or “abnormal menstrual cycle” in all but the most

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specialized of texts, while azoospermia—lack of sperm production—is referenced by its formal medical title across texts. Finally, Bowker reveals that, while a condition that corresponds with women’s “incompetent cervix” has indeed been identified in men, that condition is labeled “retrograde ejaculation” rather than, for instance, “incompetent ejaculation.” Like Bowker, sociologists Helena Machado and Paula Remoaldo argue that words such as “failure,” “incompetence,” and “inability,” particularly when employed in the context of infertility, “project frameworks of understanding that convey a sense of inadequacy for those individuals—in particular women—that have problems conceiving and having children naturally.” Ultimately, these authors go beyond suggesting alternative labels (e.g., trading “incompetent” for “retrograde,” “hostile” for “autoimmunity”) to put forth a general call for resistance to gender biases in medical terminology, not just among technical or mainstream communities but among the “discourse community as a whole.” Beyond these academic interventions, some recent mainstream news coverage of infertility issues has focused on what might be called rhetorical activism, in that it involves the conscious renaming of gender-biased medical terms. For instance, in September 2015 the Huffington Post featured a blog post in its UK edition publicizing a health campaign championed by the National Health Services, titled “Language Matters!” The blog’s author, health care advocate Leigh Kendall, explained therein that the campaign fights against the use of “terms such as ‘failure to progress’ and ‘incompetent cervix’ ” because this type of rhetoric “can inadvertently convey a sense of blame, leading the woman to feel she is a failure or incompetent, rather than elements of physiology that are beyond her control.” This critique was also communicated—albeit far less explicitly—in a 2010 episode of the popular television show Grey’s Anatomy. Therein, one of the show’s main characters—Meredith Grey, a doctor in her own right—was diagnosed with a “hostile uterus” following a miscarriage. Horrified by the label given her condition, she asked her partner, “How would you feel if [the doctor] called your penis angry or snide?” Her pointed commentary offered something of a perspective by incongruity for viewers, illustrating in satire reminiscent of Gloria Steinem’s 1978 essay “If Men Could Menstruate” how women’s reproductive bodies (and not men’s) are repeatedly censored and infantilized by standard, twenty-first-century medical rhetoric. The character’s positionality as both a medical professional and an involuntarily childless woman speaks to the ways in which technical, mainstream, and lay rhetoric about infertility are interconnected and mutually constitutive.

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Although not all the psychoanalytically derived labels for women’s reproductive issues have echoes in contemporary times (sociologist James H. Monach notes, for one, that diagnosing women with “frigidity” has happily fallen out of favor), there is no doubt that some psychoanalytic advice commonly offered to involuntarily childless women in the mid-twentieth century retains considerable resonance today. Resolve, a U.S. infertility association established in 1974, identified as common “myths” the ideas that conception and pregnancy are often induced by “tak[ing] a vacation” or “adopt[ing] a baby.” Of the latter, the group’s website explains that “this is one of the most painful myths for couples to hear. First it suggests that adoption is only a means to an end, not a happy and successful end in itself. Second, it is simply not true. Studies reveal that the rate for achieving pregnancy after adopting is the same as for those who do not adopt.” Similarly, Parents magazine also worked to identify and disprove these contentions, noting that—in terms of the adoption argument—“only about 5 percent of couples who do adopt later become pregnant. This success rate is the same for couples who don’t adopt and become pregnant without further treatment.” That this refutation is the same one that John Rock and a number of others provided statistical backing for as early as the late 1950s demonstrates that the publication of scientific evidence is not enough, in and of itself, to halt the circulation of a culturally resonant narrative. In this case and many others, science has been shown not to speak for itself but rather to require persuasive framing and advocacy to influence policy and the formation of public vocabularies. Rhetorical strategies related to, for instance, narrative extension and deflective pseudoscientific appeals can and do sway the constitution of public, lay, and even technical talk concerning science and health topics. To review, twenty-first-century public vocabularies of infertility are grounded— at least in part—in long-refuted psychoanalytically derived myths, arguments that position (white) women as solely responsible for infertility (and leave minority women out of the equation entirely), and delineations of reproductive health as measured by clinical timing. Any review of TTC websites or recent popular-press books about infertility will reveal that such vocabularies are also grounded in echoes of arguments related to biochemistry and the importance of hormones to reproductive processes. These days, however, such rhetoric makes clear that the right biochemical composition is necessary but definitely not sufficient for successful reproduction. In contrast to infertility rhetoric emerging from the 1930s and 1940s—rhetoric that characterized hormones, especially synthetic “super” hormones, as determinative agents of fertility—today’s infertil-

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ity rhetoric more closely resembles the tempered, even skeptical rhetoric of the 1960s and 1970s, wherein human attempts to artificially tamper with biochemistry were regarded with no little amount of suspicion. For instance, to achieve a mere “chemical pregnancy” is, according to recent TTC boards and scientific research alike, to have a very early miscarriage, one that would be all but impossible to detect but for the emergence of early pregnancy testing technologies that first came on the market in the late 1970s and, by the beginning of the new century, had improved to detect pregnancy even before a missed period. Those posting to TTC boards note that a chemical pregnancy occurs when one’s body is triggered by the joining of egg and sperm to produce the hormone hCG and prompt a positive result on a pregnancy test. But for any number of possible reasons, the resulting blastocyst does not survive long enough to be detected with ultrasound. In this respect, a chemical pregnancy is generally constituted by those trying to conceive as neither real (often the condition is termed a “false pregnancy”) nor evidence of one’s fertility in general. Similarly, in twenty-first-century scientific literature a chemical or “biochemical” pregnancy has been almost universally characterized as a negative outcome and the result of an “unsuccessful cycle,” though scholarship published in 2013 in the journal Fertility and Sterility has hypothesized that a chemical pregnancy after IVF may, in fact, “be a positive predictor for a subsequent live birth, especially in women under the age of 35.” That chemical pregnancies assume a positive valence in this latter case may have something to do with their tie to ARTs and the realm of the artificial. The underlying assumption in this situation is that, if one’s fertility is already in need of technological assistance, then a chemical pregnancy may, in and of itself, be a positive sign that it will be possible to artificially induce the development of a healthy pregnancy and full-term baby. This tension between “natural” (i.e., unassisted) and “artificial” (i.e., assisted) fertility is one that began emerging in the scientific literature as early as the mid-nineteenth century with the heroic interventions of Dr. J. Marion Sims, though arguments describing femininity (and thus reproductive potential and ability) in terms of certain natural states of being have a much longer history. Since Sims’s celebration of artificial intervention into the mechanistic female body, it seems that either one or the other—the natural or the artificial—has been upheld as an underlying value term in infertility rhetoric at any one moment, regardless of the diverse definitions put forth for “natural” or “artificial” in any particular instance. The turn into the twentieth century upheld moral

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physiology and the natural roles of men and women, the rise of reproductive endocrinology championed artificial hormones as superior, and the infertility rhetoric generated in correspondence with Freudian psychoanalysis espoused psychosexual normalcy as a characteristic of human nature. The closest such rhetoric may have come to a compromise between the two, one in which both the natural and the artificial were regarded as mutually valuable, was during the 1960s and 1970s, as diverse fields of scientific study came together in the establishment of comprehensive infertility treatment and transdisciplinary research centers. Even in this latter case, though, a certain degree of skepticism about the harms of artificial interventions was communicated through a number of different technical and mainstream sources. Similarly, for all the celebration and hope said to be provided by ARTs today, there exists an undeniable current of censure—particularly in the mainstream literature—for those who make use of such technologies and thereby achieve conception and pregnancy artificially. It could be argued that part of this censure has to do with the lack of longitudinal data about the medical and social effects of increasingly complex interventions on both women and their offspring. Whether it is newspaper articles discussing the possible long-term cancer risks to women who undergo hormonal treatment to conceive; television spots about the greater risk that babies born via ARTs have for complications at and following birth; or editorials about the legal and ethical implications of producing, for instance, “three-parent babies,” twenty-first-century infertility rhetoric is heavy on warnings about the real and imagined dangers of medical interventions and other artificial means for inducing fertility. The problem with this larger historical trajectory, wherein fertility is upheld as natural or artificial, is that such a dichotomy supports only two, overly simplified, subject positions for women in particular. If fertility is natural—a claim that generally engages organic metaphors and involves the warrant that women’s bodies and minds are divinely designed for childbearing—one who is infertile is a woman who has somehow thwarted this natural design. In this framing, she is individually responsible for her lack of children. By contrast, if fertility is artificial—a claim often communicated through inorganic metaphors and grounded in the idea that women’s bodies are machinelike—one who is infertile is quite separated from that process and requires the intervention of a technical expert to achieve relief. In this characterization, she is but an object to be worked on and restored to normalcy, one who is responsible only for positioning herself within, and subscribing wholeheartedly to, medicine’s jurisdiction. These sub-

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ject positions can be—and have been—combined to some extent, but their conflicting entailments in these cases have functioned to situate involuntarily childless women as existent within a double bind, wherein they are both responsible for their reproductive health problems and incapable of preventing or righting those problems. Ultimately, the processes surrounding women’s reproductive health are far more complex and dynamic than these accounts of (in)fertility make them out to be. If history tells us anything, it is that (in)fertility exists in a matrix of rhetorical, structural, and material variables; lived, embodied experiences; medical access and literacy; disciplinary and transdisciplinary rhetoric; a variety of positionalities related to sex, gender, race, ethnicity, nation of origin, and religion; and so much more. The “founding,” as Serres puts it, of a new (in)fertility rhetoric that complicates involuntary childlessness—one that accounts for the ways in which chronologically distinct configurations of infertility percolate in the present—will go a long way in the work of deciphering the subjectivities of those who are trying to conceive, pregnant, adopting, parenting, and otherwise reproducing the next generation. This new (in)fertility rhetoric would necessarily resist attempts to characterize reproductive health as something that can ever be entirely natural or artificial, individually procured or technologically determined. Rather, reproductive health and (in)fertility in this reenvisioned framework would be routinely situated within a broader complex of variables through rhetorical choices that highlight—rather than downplay—issues such as structural inequalities, lived material experiences, and a variety of relational encounters (e.g., doctor-patient, individual–family members). As part of this process, consistent attention must be directed both toward the rhetorical circulation of ideas and toward historical topoi and their percolation into contemporary times. This requires, first, detailed analysis of the flow and circulation of such topoi within chronologically related moments. The individual chapters in this book model several of the ways that this kind of analysis can unfold, specifically as they focus on the particular rhetorical ecologies at work in chronologically related periods. By contrast, this last chapter delineates the sorts of percolation- oriented claims that come together following, and in light of, these earlier analyses, to offer overarching, historically informed readings. Together, the parts of this project illustrate a trajectory for rhetorical history work that speaks to the diverse ways that arguments, appeals, and narratives come to be, circulating and percolating, flowing and repeating. Even Serres admits that “yes, time flows like the Seine, if one observes it well.”

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He goes on to contend, however, that this flow is anything but linear in that “all the water that passes beneath the Mirabeau Bridge will not necessarily flow out into the English Channel; many little trickles turn back toward Charenton or upstream. . . . Time flows in a turbulent and chaotic manner; it percolates.” In this way, Serres seems to suggest that, to get a sense of history as percolation, one must first “observe . . . well” the flow of arguments, appeals, and narratives in any one channel (e.g., moment). This type of focused analytic work, in combination with other such analyses concerning other, distinct periods, reveals the “extraordinarily complex, unexpected, complicated way” in which topoi are reenlisted and reconstituted in and through time. This trajectory—by accounting for both historical flow and percolation— speaks particularly well to questions of rhetoric as transdisciplinary because it provides mechanisms for exploring discourse as it moves through and traverses boundaries. For instance, one might productively employ this scholarly orientation to investigate what rhetorical apparatuses come into play when diverse fields of study attempt to interact or even meld together in more comprehensive scholarly efforts. Correspondingly, though not strictly transdisciplinary in nature, this type of rhetorical history work invites consideration about how contemporary definitions for culturally relevant topics might incorporate seemingly untimely, antiquated, or scientifically disproven ideas or how seemingly fieldspecific ideas might come to circulate in and thereby encounter mainstream and lay circles. Given that rhetoric is inherently a transdisciplinary discursive practice—less a static product than a moving, boundless process—situating its study within the context of circulating, dynamic rhetorical ecologies, as well as historically percolating topoi, ensures that movement plays a central role in its scholarly representation. In the case at hand, the transdisciplinary mechanisms that have supported the rhetoric of infertility in the mid- to late twentieth and early twenty-first centuries reveal as much about the discursive construction of infertility specifically as about the processes of medicalization and its formations more generally. Although sociologist Peter Conrad has theorized about medicalization as a process of “degrees,” wherein some conditions are only partially medicalized and others are situated within a state of “total” medicalization, the rhetorical history of infertility articulated here illustrates how medicalization forms via a layered topography, wherein disciplinary, mainstream, and lay rhetoric about a topic folds in on top of, and echoes, other such rhetoric over time and thereby situates that topic as more or less intricately medicalized. For instance, as Freudian

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accounts of psychogenic infertility folded in over—and seemed to extend— existing chemical narratives of infertility in the mid-twentieth century, such accounts incorporated not just the physical body but also women’s minds and psychology into the idea that infertility is under the jurisdiction of medical expertise. Such accounts also included echoes of early twentieth-century claims grounded in the narrative of energy conservation that espoused a telos of moral physiology and thereby conflicted with conclusions garnered from strictly chemical theories of reproductive health. The synergy among these different layers of rhetoric (and their conflicting echoes of historical topoi) functioned to complicate and diversify the medicalization process, just as different layers of soil pile on top of one another and then develop as interactive, inimitable, evolving systems. Today, as infertility is amalgamated with at least one additional layer of medicalization that emerged in correspondence with the comprehensive field of infertility studies, one might conclude that this topic has reached a stage of “complete” medicalization. Yet the analysis presented in this book demonstrates that, because medicalization is always in process, unfolding in the midst of resistance and ecological instability and fluctuation, completion only ever exists in an abstract sense. In this respect, although the medicalization process in this case and others can be subjectively more or less, comparatively intertwined or distinct, it can never be definitively complete or total. Moreover, these analyses also reveal that any understanding of medicalization as somehow formally at odds with moralization fails to account for the diversity of appeals and assumptions inherent in that process, appeals that, for instance, objectify subjects while also insisting on their compliance and adherence. Like the medicalization process itself, infertility is (and always has been) a diverse, moving target, one constructed out of historically distinct delineations and contemporary claims that must be considered in tandem and that can and will change as they continue to move, circulate, percolate, and reconfigure. This potential for movement, for change, means that it is indeed possible for the “infertility” of tomorrow to be constructed out of the old in ways that offer diverse and inclusive subject positions garnered from productive, complex, and even yet-unimagined public vocabularies of health and science.

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Notes

Introduction 1. Nicholas Wade, “In Vitro Fertilization Pioneer Wins Nobel Prize,” New York Times, October 4, 2010, A1; Thomas H. Maugh, “He Helped Millions Have Babies,” Los Angeles Times, October 5, 2010, A11. 2. Condit, “Hegemony,” 212. 3. ESHRE, “World’s Number”; CDC, Assisted Reproductive Technology. 4. Conrad, Medicalization of Society, 4; Conrad and Schneider, Deviance and Medicalization. See also Mamo, Queering Reproduction, 11. 5. Lay, Rhetoric of Midwifery; Davis-Floyd and Sargent, Childbirth and Authoritative Knowledge; Rothman, Recreating Motherhood; Barker, “Stormy Sea.” 6. Edbauer, “Unframing Models,” 20; Conrad, Medicalization of Society, 6. 7. Conrad, Medicalization of Society, 6. 8. Segal, Health, 22–23. 9. Medical historian Margarete J. Sandelowski has come to a similar conclusion, though without linking her work to theories of medicalization specifically (“Failures of Volition,” 479). 10. Serres, Conversations, 60–63. 11. Conley, Rhetoric, 30; Serres, Conversations, 58, 60–61. 12. Serres, Genesis, 100; Clayton, “Time Folded and Crumpled,” 44. 13. Koerber, Breast or Bottle?, 30. 14. J. Johnson, American Lobotomy, 17. 15. Ibid. 16. Serres, Conversations, 60–61; Serres, Genesis, 76–77. Even if one were to agree with Serres and argue that conceptualizations of chronological time as linear—and topoi as circulating—are only maps to the larger noise that is history, Serres also contends that such maps are necessary in the process of making sense of the multiplicitous state of that noise. Their failure to report on redundancies is what makes them dangerous. Thus, this project’s attention to chronology and flow, as well as to percolation, aligns with his overarching theoretical project (Genesis, 86). See also Clayton, “Time Folded and Crumpled,” 41. 17. Brown and Walsh-Childers, “Effects of Media”; Bute and Jensen, “Low-Income Women”; Jensen and Bute, “Fertility-Related Perceptions.” 18. Sandelowski, “Failures of Volition”; May, Barren; Laqueur, Making Sex. 19. Britt, “Medical Insurance,” 213; May, Barren, 183; Leavitt, Brought to Bed, 3. 20. Spar, Baby Business, 3; Almeling, Sex Cells; Britt, Conceiving Normalcy; Mamo, Queering Reproduction. 21. Van Balen and Inhorn, “Interpreting Infertility,” 17; Domar, Zuttermeister, and Friedman, “Psychological Impact of Infertility”; Williams, Marsh, and Rasgon, “Mood Disorders and Fertility”; Greil, Not Yet Pregnant, 55. 22. ASRM, “Protect Your Fertility.” 23. Colen, “Like a Mother”; Ginsburg and Rapp, New World Order, 13; Bridges, Reproducing Race, 10; May, Barren, 75. On the racial politics of pregnancy, see D. Roberts, Killing the Black Body, 9.

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24. Campbell, “Scientific Discovery,” 59. 25. Gross, “Roles of Rhetoric”; Edbauer, “Unframing Models.” On the relationship between biomedical public relations writing and the writings of scientists proper, see Lynch et al., “Bridging Science and Journalism.” 26. Lyne, “Rhetoric,” 147. 27. Ceccarelli, Frontier of Science, 13; Fahnestock, “Natural Sciences,” 184. 28. Haraway, Primate Visions, 5. See, for instance, Fisher, “Narrative Rationality”; Nash, Narrative in Culture; and Sheehan and Rode, “On Scientific Narrative.” 29. For refutations of the transparency thesis, see Andrus, “Legal Discourse of Transparency”; and Thornton, Brain Culture, 3–5. 30. Jasinski, Sourcebook on Rhetoric, xix–xx. 31. Preda, AIDS, 5. 32. See, for example, Pandora, “Knowledge Held in Common”; J. Johnson, American Lobotomy; and Johnson and Quinlan, “Technical Versus Public Spheres.” 33. Condit, Decoding Abortion Rhetoric, 228; Edbauer, “Unframing Models,” 19. 34. J. Johnson, American Lobotomy, 7; Britt, Conceiving Normalcy. 35. Wagner, “Vernacular Science Knowledge,” 11, 14. 36. McGee, “Fragmentation”; McKerrow, “Critical Rhetoric.” 37. Kline, “Cultural Sensitivity.” 38. Ray, Lyceum and Public Culture, 8. 39. Edbauer, “Unframing Models,” 9, 20. See also McKerrow, “Critical Rhetoric,” 101. 40. Edbauer, “Unframing Models,” 10. 41. Finnegan, “Review Essay,” 245. 42. J. Taylor, Public Life. See also Petchesky, “Fetal Images”; and D. Roberts, Killing the Black Body. 43. Latour and Woolgar, Laboratory Life, 45, 58, 61. 44. Rapp, Testing Women, 119. 45. Zarefsky, “Four Senses,” 30. 46. Serres argues that such chains of reason are harmful only inasmuch as they do not account for points of repetition (Genesis, 72, 76–77). 47. Duncan, Fecundity, 3. 48. E. Clarke, Sex in Education; Spencer, Principles of Biology. 49. Zschoche, “Dr. Clarke Revisited.” 50. Marsh and Ronner, Empty Cradle, 196. 51. Conrad entertains the possibility that medicalization can, in some cases, be “total” (Medicalization of Society, 6). The focus in this study on the many fragmented discourses, encounters, and other variables that function to uphold medicalization, however, demonstrates that the process of medicalization can never reach a state of completion.

Chapter 1 1. For definitional scholarship on metaphor and its rhetorical functions, see I. Richards, Philosophy of Rhetoric, 95; and Lakoff and Johnson, Metaphors We Live By, 5. 2. Black, “Metaphor,” 286–87; Osborn and Ehninger, “Metaphor in Public Address,” 226. 3. Ceccarelli, “Rhetoric,” 3. 4. Rorty, Contingency, Irony, and Solidarity, 16; Martin, “Egg and the Sperm,” 501. 5. Duncan, Fecundity, 3. Duncun defined “fertility” as “productivity,” or the “amount of births” a woman has, and “fecundity” as her “capability to bear” children (3). The latter term

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would come to be used almost exclusively in the realm of official medical discourses, whereas “fertility” would be taken up more broadly in mainstream and vernacular discourses delineating a woman’s potential to bear children and the number of births and children that she had. Many of these discourses accounted for the health of the infants born to a woman as a telling indicator of her overall fertility. That is, a woman who bore many children who were sickly or died after birth would not be deemed as fertile as a woman who bore many children who were healthy and survived into adulthood. 6. The idea of a voluntarily childless married woman was all but nonexistent at the time, in no small part due to most women’s lack of access to reliable, female-controlled contraceptives. It was not until the turn of the century that individuals such as journalist Ida M. Tarbell named and thereby constituted women who purposefully “shirked” motherhood by remaining single or using contraceptives or abortion (May, Barren, 78–79). 7. See, for example, Demircioğlu, “Rhetoric of Belief ”; Neff, “Social Construction of Infertility”; Upton, “Infertility Makes You Invisible”; and Culley, Hudson, and Van Rooij, Marginalized Reproduction. 8. Morice et al., “History of Infertility,” 497–99. 9. Sandelowski, “Failures of Volition,” 475. 10. Thulesius, “Nicholas Culpeper,” 556; Fissell, Vernacular Bodies, 155; Fissell, “Hairy Women,” 43; Bullough, “Early American Sex Manual,” 240; Sartin, “Father of Gynecology.” 11. Marsh and Ronner, Empty Cradle, 10, 25. 12. Mitchell, Picture Theory, 89. 13. Jensen, Doss, and Ivic, “Metaphorical Invention,” 335; Hulme, Speculations, 151–52. 14. Ivie, “Rhetorical Invention,” 167. 15. Ober, “Reuben’s Mandrakes,” 299; Gen. 1:28 (Revised Standard Version). 16. May, Barren, 34–35; Marsh and Ronner, Empty Cradle, 12, 16, 41. 17. Poynter, “Nicholas Culpeper,” 156; Fissell, Vernacular Bodies, 141. 18. Marsh and Ronner, Empty Cradle, 13; Culpeper, Directory for Midwives, 131. 19. Culpeper, Directory for Midwives, 135. 20. Thulesius, “Nicholas Culpeper,” 552; McLaren, Reproductive Rituals, 33–35. 21. Culpeper, Directory for Midwives, 22. 22. Ibid., 67, 7, 32, 134, 135. 23. Bullough, “Early American Sex Manual,” 236, 238, 244; Beall, “Aristotle’s Master Piece,” 208. 24. Aristotle’s Master-Piece, 3–4, 13. See also Marsh and Ronner, Empty Cradle, 15–17. 25. Aristotle’s Master-Piece, 7, 84. 26. Ibid., 123, 125. 27. Marsh and Ronner, Empty Cradle, 16; May, Barren, 27–28; Fissell, Vernacular Bodies, 83; Creed, Monstrous-Feminine, 43. For other depictions of the monstrous womb from this period, see Sadler, Private Looking-Glasse, 137–38. 28. Aristotle’s Master-Piece, 20–21; Braidotti, “Signs of Wonder,” 140. 29. Buchanan, “Study of Maternal Rhetoric,” 245–56. 30. Aristotle’s Master-Piece, 38–39; Creed, Monstrous-Feminine, 46. 31. Braidotti, “Signs of Wonder,” 135, 143. 32. Kristeva, Powers of Horror, 2; Creed, Monstrous-Feminine, 9, 44; Buchanan, “Study of Maternal Rhetoric,” 241. 33. Aristotle’s Master-Piece, 20–21. 34. Reiser, Reign of Technology, 82–83. 35. Sandelowski, “Failures of Volition,” 480. See also McLane and McLane, “Half Century of Sterility,” 853–61.

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36. McGrath, Seeing Her Sex, 31–32. 37. Applebaum, Encyclopedia, 501–2; Leder, “Tale of Two Bodies,” 20; Segal, Health, 121. 38. Reiser, Reign of Technology, 38, 55; McGrath, Seeing Her Sex, 30. 39. Marsh and Ronner, Empty Cradle, 10. 40. Walker, Inquiry, 2. Marsh and Ronner also mention the metaphors of machinery in Sims’s text (Empty Cradle, 58). 41. Sartin, “Father of Gynecology.” 42. McGregor, From Midwives to Medicine, 33–68; May, Barren, 54–55; Bernier, “Class, Race, and Poverty,” 118–19; Scheper-Hughes and Lock, “Mindful Body,” 22. 43. Reiser, Reign of Technology, 55. 44. Sims, Story of My Life, 267–96; Marsh and Ronner, Empty Cradle, 51, 56; Ellis, “Sims’ Speculum.” The Woman’s Hospital operated on a sliding fee scale and therefore was able to serve women representing a range of different social classes (McGregor, From Midwives to Medicine, 79–82). 45. Marsh and Ronner, Empty Cradle, 55, 61. 46. Sims, Notes on Uterine Surgery, 1–2, 54. For a discussion of medicalization, deviance, and normalization, see Conrad and Schneider, Deviance and Medicalization, 17–37. 47. Sims, Notes on Uterine Surgery, 1–2, 178, 214. 48. McGrath, Seeing Her Sex, 4. 49. For an analysis of contemporary depictions of reproduction framing the male as active and the female as passive, see Martin, Woman in the Body. 50. Sims, Notes on Uterine Surgery, 188. 51. Ibid., 14; Elkins, Pictures of the Body, 249–50. 52. Sims, Notes on Uterine Surgery, 17, 72–73. 53. Foucault, Birth of the Clinic, 215; Foucault, Discipline and Punish, 333; Conrad, “Medicalization and Social Control,” 216. 54. Sims, Notes on Uterine Surgery, 34. 55. Duncan, Fecundity, 3. 56. Pfeffer, Stork and the Syringe, 5; May, Barren, 44; Marsh and Ronner, Empty Cradle, 31, 75. 57. Lynch, What Are Stem Cells?, 6; Lessl, “Naturalizing Science,” 380, 387. 58. Sandelowski, Failures of Volition, 478. 59. Brandt, No Magic Bullet, 11. 60. E. Clarke, Sex in Education, 126–27, 131. Clarke’s arguments were publicly refuted by Dr. Mary Putnam Jacobi (Question of Rest). 61. Ceccarelli, “Confusing Cacophony,” 94, 103–4.

Chapter 2 1. Love, “Meddlesome Gynecology,” 237. 2. Hall, Adolescence, 505. See also Kelly, “Conservatism in Ovariotomy.” 3. Briggs, “Race of Hysteria”; Hayden, “(R)Evolutionary Rhetorics”; Hofstadter, Social Darwinism, 195. 4. E. Clarke, Sex in Education. 5. Spencer, Principles of Biology. On Spencer’s coining of the phrase “survival of the fittest,” see L. Newman, White Women’s Rights, 29. 6. Fiske, “Progress,” 252. 7. Griffin, Woman and Nature, xv.

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8. These refutations include, but are not limited to, Anderson, “Mind and Education”; Howe, Sex and Education; and Jacobi, Question of Rest. For scholarship arguing that the narrative of energy conservation failed to garner discursive power beyond the last quarter of the nineteenth century, see Frankfort, Collegiate Women, 87; and B. Solomon, Company of Educated Women, 57. It has been noted—though without an explicit emphasis on the narrative of energy conservation—that beliefs about menstruation as an energy-depleting process were central in arguing for early twentieth-century protective labor laws for women. See Delaney, Lupton, and Toth, Curse. 9. Zschoche, “Dr. Clarke Revisited,” 563. 10. Bryn Mawr University president M. Carey Thomas famously spoke of this force as a mere “gloomy little specter.” See “Present Tendencies,” 69. 11. Fisher, “Human Communication Paradigm,” 2. 12. Sharf and Vanderford, “Illness Narratives”; Harter, Japp, and Beck, “Vital Problematics.” 13. Haraway, Primate Visions, 5. See also Fisher, “Narrative Rationality”; Nash, Narrative in Culture; and Sheehan and Rode, “On Scientific Narrative.” 14. See Haraway, Crystals, Fabrics, and Fields. 15. I use the term “fiction(s)” much as rhetorician Jennifer R. Mercieca does in Founding Fictions to describe the stories that establish and envelop broader theories—in her case political theories, in the present case scientific theories. 16. Lyotard, Postmodern Explained, 77. 17. Spencer, Principles of Biology, 70–71; Fahnestock, Rhetorical Figures in Science, 91. See also Spencer, Principles of Psychology; and Spencer, First Principles. 18. Sims, Notes on Uterine Surgery; Spencer, Principles of Biology, 89. 19. Rhetoricians Michael Leff and Andrew Sachs label this type of interaction between “discursive form and representational content” iconicity and argue that it functions to add emphasis and meaning to the ideas expressed therein (“Most Like Things,” 257). 20. Spencer, Principles of Biology, 72. Darwin’s writings have also been shown to characterize the living world as awe inducing and superior for its transformative and progressive potential (Hayden, Evolutionary Rhetoric, 57). 21. Leibniz, “Nature of the Body,” 245–49. For an overview of what physicist Carolyn Iltis labels the “vis viva controversy” between Leibniz and René Descartes, see Iltis, “Vis Viva Controversy,” 21–35. 22. Spencer, First Principles, 185. 23. Spencer, Philosophy of Style. On Spencer’s theory of style and composition, see Conley, Rhetoric, 250–51; and Hirst, “Philosophy of Style.” 24. Holmes, “Herbert Spencer,” 539. 25. Spencer, First Principles, 249; McKinnon, “Energy and Society,” 441. 26. Spencer, “Psychology of the Sexes.” 27. Youmans, “Observations,” 399, 378, 401. 28. Fiske, “Progress,” 264, 255–56. 29. Ibid., 263. 30. Lamarck, Zoological Philosophy. See also Holmes, “Herbert Spencer,” 541. 31. Fiske, “Progress,” 294. 32. Kelves, Name of Eugenics, 91. 33. On falling birth rates among married Anglo-Saxons in the mid-nineteenth century, see Cassedy, Medicine and American Growth, 173–75; and Quine, Population Politics, 5. 34. Spencer, “Psychology of the Sexes,” 31, 36–37. 35. Ibid., 32, 36. 36. Burstyn, “Education and Sex,” 80.

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37. Holmes, “Herbert Spencer,” 542. 38. Miller and Halloran, “Reading Darwin, Reading Nature,” 107. 39. E. Clarke, Sex in Education, 61. 40. Rhetorician Michael Calvin McGee defines an ideograph as a “high-order abstraction representing collective commitment to a particular but equivocal and ill-defined normative goal” (“Ideograph,” 15). 41. E. Clarke, Sex in Education, 71. 42. D. Johnson, “Dawkins’ Myth.” 43. Cook, “Some Disorders of Menstruation,” 533–35; Thorburn, Female Education, 11. 44. E. Clarke, Sex in Education, 113, 37–38, 42. 45. See Briggs, “Race of Hysteria,” 249. For more on nineteenth-century rhetoric about the pathogenic consequences of progress—both industrial and otherwise—see Rosenberg, “Pathologies of Progress.” 46. E. Clarke, Sex in Education, 54, 39, 127. 47. Lancet, “Woman-Culture.” 48. Historian Joan N. Burstyn argues that Maudsley’s article introduced England’s general public to Clarke’s ideas about physiology and education (“Education and Sex,” 81). 49. Maudsley, “Sex in Mind,” 472. 50. Stormer, Articulating Life’s Memory, 76; Lessl, “Naturalizing Science,” 386. 51. Thorburn, Female Education, 12. 52. “Doctor Pierce’s Pleasant Pellets,” Wichita Daily Eagle, May 6, 1897, 2. See also “Doctor Pierce’s Common Sense Medical Advisor,” Philipsburg (Mont.) Mail, December 17, 1897, 1. 53. Thorburn, Female Education, 4. 54. E. Clarke, Sex in Education, 139, 140, 133. 55. Clegg, “Ailments of Woman,” 58. 56. Herndl, “Invisible (Invalid) Woman,” 132. See also Warner, Therapeutic Perspective, 58. 57. Clegg, “Ailments of Woman,” 58. 58. E. Clarke, Sex in Education, 21, 128. 59. Beard, American Nervousness, 50. 60. Beard, Practical Treatise; Beard, American Nervousness, 128. 61. Rosenberg, “George M. Beard,” 256; Rosenberg, “Pathologies of Progress.” 62. Beard, American Nervousness, 79. 63. Bigelow, “Nerve Pain in Gynecology,” 626. 64. Anderson, “Mind and Education,” 583–84. 65. Maudsley, “Sex in Mind,” 467. 66. Anderson, “Mind and Education,” 594, 584. 67. Ibid., 592, 585. 68. Zschoche, “Dr. Clarke Revisited,” 547; Howe, Sex and Education, 28, 15. 69. Zschoche, “Dr. Clarke Revisited,” 560n39. 70. Howe, Sex and Education, 20, 13, 14, 29. 71. Jacobi, Question of Rest; Bittel, Mary Putnam Jacobi, 127. 72. Jacobi, Question of Rest, 108. Incorporated into this claim was Jacobi’s rejection of prevalent ovulation theories contending that menstruation and ovulation occur at the same time. 73. Ibid., 112, 217–18; Sims, Notes on Uterine Surgery. 74. Jacobi, Question of Rest, 201n2; Duncan, Fecundity, 3. 75. Association of Collegiate Alumnae, Health Statistics of Women, 5; Zschoche, “Dr. Clarke Revisited,” 562. 76. Association of Collegiate Alumnae, Health Statistics of Women, 11, 7, 58, 78.

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77. Ibid., 62, 15. Annie G. Howes argued, also, that the sample probably included fewer married women because those alumnae who had gotten married since graduation were more difficult to find in light of subsequent name and address changes. 78. Association of Collegiate Alumnae, Health Statistics of Women, 17. 79. Ibid., 8, 6. 80. In 1886 even the British medical journal the Lancet employed a nuanced version of Duncan’s metaphor by referring to women’s potential for “infertility” (Lancet, “British Medical Association,” 313). 81. Caleb Williams Saleeby, “Is Falling Birth Rate Evidence of Racial Decay?,” New York Times, November 28, 1909, SM13 (emphasis added); Rodwell, “Dr. Caleb Williams Saleeby,” 23. 82. Hall, Adolescence, xviii, 230, 367, 540. 83. Malthus, Principle of Population; Foucault, History of Sexuality, 1:105; Greene, Malthusian Worlds. 84. On the cumulative and collective nature of scientific knowledge production, see Lyne, “Argument,” 186. 85. Saleeby, “Falling Birth Rate.” A similar view was offered by A. Maurice Low, “Lower Birth Rate and Higher Prices Signs of Progress,” New York Times, May 4, 1913, SM10. 86. Cattell, “School and the Family,” 84, 91. 87. M. Solomon, “Rhetoric of Dehumanization,” 242. 88. Kelves, Name of Eugenics; Hasian, Rhetoric of Eugenics. 89. Engelmann, “Increasing Sterility,” 891. 90. For instance, while Engelmann reported that women who enjoyed “greater luxury and wealth” had the highest rates of sterility, historian Elaine Tyler May identifies the “most alarming rate of sterility” at the time as existing among working-class black women (Barren, 75). 91. Engelmann, “Increasing Sterility,” 891, 895. 92. Sociologist Peter Conrad contends that medicalization is primarily a rhetorical act of naming and that it tends to transform the understanding of behaviors from that of moral failing to that of recognized illness. In the case at hand, however, the act of naming seemed to function to separate the legitimate or naturally occurring illness from that of the illegitimate or artificial (Medicalization of Society, 4, 6). 93. May, Barren, 74. 94. Ferguson, “Discussion,” 897; Porter, “Discussion,” 897. 95. Graham, “Discussion,” 897; Reagan, Abortion; Jensen, Dirty Words. 96. Porter, “Discussion,” 897. See also McCoy, “Discussion,” 897. The idea that those infected with gonorrhea may experience a latency period was first publicized in 1872 by Emil Noeggerath, a U.S. physician (Brandt, No Magic Bullet, 10). 97. H. Newman, “Gynecological and Obstetrical Significance,” 174–76. 98. Engelmann, “Increasing Sterility,” 891–95. 99. Hall, Adolescence, 493; Hill, “Menstrual Disorders,” 596–97. 100. Hall, Adolescence, xiv, 508. 101. English report, quoted in Bishop Boyd Carpenter, “Why Is the Birth Rate Constantly Declining?,” New York Times, July 16, 1916, SM16. See also Roosevelt, “On American Motherhood.” 102. Hall, Adolescence, xiv, 507.

Chapter 3 1. Brown-Séquard, “Effets produits.” 2. Henderson, “Ernest Starling and ‘Hormones,’ ” 5–6; “Pentacle of Réjuvenescence.”

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3. Aminoff, Brown- Séquard, 5. 4. Biesecker, “Coming to Terms,” 155. 5. Borell, “Organotherapy,” 6. In this respect, Brown-Séquard’s reasoning aligned with what historian Ben Barker-Benfield labels the “spermatic economy,” which was the prevailing theory of male sexuality throughout the nineteenth century and held that the loss of semen via sexual activity constituted a loss of vital energy (“Spermatic Economy”). 6. Roland, Management, 6. 7. The texts from which I draw for this analysis consist of key scientific books and articles consistently cited across historical accounts of the field of reproductive endocrinology; popular or mainstream books and articles authored by technical experts targeting lay publics; international newspaper coverage of infertility and reproductive endocrinology; and lay correspondence from and to endocrinologists concerning issues of infertility. Mainstream texts were selected for analysis either because, one, they had been cited by other historical accounts of infertility, or, two, they emerged from archival repositories as unique or as yet underrepresented according to a range of factors such as location of publication. 8. Fisher, “Human Communication Paradigm,” 7–8. 9. Condit and Lucaites, Crafting Equality, xiv; Crosland, Historical Studies, 3. 10. Lawrence Principe has recently argued that Boyle’s Sceptical Chymist has long been misinterpreted and does not, in fact, dispute alchemical principles and practices but rather argues against the unphilosophical, commercial, and therefore vulgar use of alchemy. Principe, like Thomas Kuhn, contends that singular revolutionary texts and ideas are inherently mythical, even though they nonetheless serve a narrative purpose in historical accounts (Principe, “In Retrospect”; Kuhn, Structure of Scientific Revolutions, 55). 11. Crosland, Historical Studies, 3, 30–32, 51; Scerri, Periodic Table, xvi. 12. Clow and Clow, Chemical Revolution; Siegfried and Dobbs, “Composition,” 281; Brock, Norton History of Chemistry, 76–77. 13. Zagacki and Keith, “Rhetoric,” 65. 14. Serres, introd. to History of Scientific Thought, 6. 15. Crosland, Historical Studies, 127–30; McEvoy, “Enlightenment,” 310. 16. Kuhn, Structure of Scientific Revolutions, 56; Mauskopf, “Chemical Revolution,” 555; McEvoy, “Enlightenment,” 321–22. 17. Siegfried and Dobbs, “Composition,” 276; McEvoy, “Enlightenment,” 321. 18. Dalton, New System; Brock, Norton History of Chemistry, 135. 19. Brock, Norton History of Chemistry, 128; Bensaude-Vincent, “Mendeleyev,” 563; Scerri, Periodic Table, xiii; Foucault, Order of Things, 57. 20. Miller, “Kairos,” 316. 21. Nielsen and Štrbáňová, Creating Networks in Chemistry; Spoel, “Science of Bodily Rhetoric,” 7. 22. Blondel-Mégrelis, “How to Popularize Chemistry,” 49–51; Ceccarelli, Shaping Science with Rhetoric, 4; Orland, “Chemistry of Everyday Life,” 332–33. 23. Orland, “Chemistry of Everyday Life.” 24. Bensaude-Vincent, “Name of Science,” 320–21; Eglash et al., Appropriating Technology. 25. Pandora, “Knowledge Held in Common,” 491, 497. Social psychologist Wolfgang Wagner defines vernacular science knowledge as a “widely distributed form of popular understanding of science” (“Vernacular Science Knowledge,” 11, 14). 26. Bensaude-Vincent and Stengers, History of Chemistry, 168; Orland, “Chemistry of Everyday Life,” 334; Bud and Roberts, Science Versus Practice, 59–63. 27. Homburg, Travis, and Schröter, Chemical Industry in Europe. 28. Science, “Popularization of Chemistry,” 302. 29. Ceccarelli, Frontier of Science, 13.

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30. Fruton, “Emergence of Biochemistry,” 327–30. 31. Bensaude-Vincent and Stengers, History of Chemistry, 148–52. 32. Fruton, “Emergence of Biochemistry,” 329–30; Florkin, Comprehensive Biochemistry, 30:183–88. 33. Quastel, “Development of Biochemistry,” 19; Kamminga, “Biochemistry, Molecules, and Macromolecules”; Zagacki and Keith, “Rhetoric,” 66. 34. The term “endocrinology” was not used until the early twentieth century; see Henderson, “Ernest Starling and ‘Hormones,’ ” 9. 35. Starling, Croonian Lectures; Henderson, “Ernest Starling and ‘Hormones,’” 5–9; Borell, “Organotherapy,” 9–13. 36. On the conceptual metaphor of the body as communication network, see Darwin, “Intelligent Cells,” 39–40. For a discussion of hormonal communication as a “transmission of affect,” see Brennan, Transmission of Affect. 37. Schäfer, “Hormones.” 38. Borell, “Organotherapy,” 8–14; C. Roberts, “Matter of Embodied Fact,” 11; Parkes, “Rise of Reproductive Endocrinology.” 39. Aberle and Corner, Twenty-Five Years, 1–8; Borell, “Organotherapy,” 18–19; Kleegman, “Medical and Social Aspects,” 728. 40. Aberle and Corner, Twenty-Five Years, 13–24; Borell, “Organotherapy,” 25; Oudshoorn, “Making of Sex Hormones.” It should be noted that the Committee for Research in Problems of Sex went to great lengths to separate its research from birth control advocacy and development, although its research endeavors were often directly applicable to those interested in establishing methods of hormonal contraception (A. Clarke, Disciplining Reproduction, 185–90). 41. Latour rightly problematizes traditional understandings of scientific discoveries by arguing that they are dependent on a number of different forces and connections rather than on the work of discrete actors (Pasteurization of France, 16). 42. Latour and Woolgar, Laboratory Life, 45, 58, 61. 43. Corner, “Knowledge”; Oudshoorn, “Making of Sex Hormones,” 22. 44. A. Clarke, Disciplining Reproduction, 122–28; Laqueur, Making Sex, 153. 45. Oudshoorn, “Making of Sex Hormones,” 8. 46. Heape, Sex Antagonism; Biggers, “Walter Heape, FRS,” 173–74. See also Frank, Female Sex Hormone; and Van de Velde, Fertility and Sterility. 47. P. Kruif, quoted in Oudshoorn, Beyond the Natural Body, 24; A. Clarke, Disciplining Reproduction, 125–26. 48. Fausto-Sterling, Sexing the Body, 183. 49. Zondek, “Mass Excretion”; Korenchevsky and Hall, “Manifold Effects”; Callow and Callow, “Isolation.” 50. Darwin, “Intelligent Cells,” 35, 40. 51. Oudshoorn, Beyond the Natural Body, 36; C. Roberts, “Matter of Embodied Fact,” 14. 52. This is not to say that scientists and clinicians were necessarily the first individuals to talk about reproduction in this way, but it is to say that they are the first ones currently on record as having done so. 53. Marsh and Ronner, Empty Cradle, 135. 54. Ramsey, George Washington Corner, 71. 55. Corner, “Menstruation and Ovulation,” 1838. 56. Ramsey, George Washington Corner, 64; L. Gordon, Moral Property of Women, 32. 57. Corner, “Menstruation and Ovulation,” 1838–39. See also Allen, “Time of Ovulation”; and Allen, “Further Evidence.” Corner’s frequent, unapologetic references to the slaying of animals for human study and benefit echo the writings of pre-Boyle alchemists.

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notes to pages 83–92

58. Frank, Female Sex Hormone, 290. 59. Hausman, “Ovaries to Estrogen,” 167. 60. William L. Laurence, “The Week in Science: The Hormones,” New York Times, September 24, 1933, XX8. 61. William L. Laurence, “Remedy Is Tested for Childlessness,” New York Times, October 26, 1934, 6; Laurence, “Week in Science.” 62. Edbauer, “Unframing Models,” 9. 63. George W. Corner, “Ovarian Therapy,” Speech Before the New York State Medical Board, May 15, 1934, box E–O, MS Collection 11, Corner Papers; Associated Press, “Fifty Percent Cure Is Reported in Childlessness: American College of Surgeons Told of Method of Ending Infertility,” Winnipeg (Manitoba) Free Press, October 20, 1934, 1. 64. Meaker, Human Sterility; William L. Laurence, “Cure of Sterility by Hormones Told,” New York Times, October 30, 1937, 11; Howard W. Blakeslee, “Male Sex Hormones: Now Produced Artificially,” Lethbridge (Alberta) Herald, September 12, 1936, back page. 65. Morris Fishbein, “The Family Doctor,” Chester (Pa.) Times, December 27, 1939, 7. 66. Corner, Hormones in Human Reproduction, ix; Corner, Ourselves Unborn; “Extracts from Reviews,” October 1, 1944, folder 8, box 18, George Washington Corner Lectures, Corner Papers, 8–9. 67. Corner, Hormones in Human Reproduction, 239. 68. Rorty, Contingency, Irony, and Solidarity. 69. Tobey, “Control of Human Sterility,” 421–23. 70. Associated Press, “Fifty Percent Cure.” 71. H. Smith, “Making It Possible,” 19. 72. E. Clarke, Sex in Education. 73. Meaker, Human Sterility, 8–9. 74. Serres, Conversations, 61, 63. 75. Meaker, Human Sterility, 3–7. 76. Meaker, Lawrence, and Vose, “Practical Details,” 756–57; Marsh and Ronner, Empty Cradle, 131. 77. For an example of coverage on male sterility from the 1930s, see Reader’s Digest, “TestTube Babies,” 18–20. 78. Kleegman, “Recent Advances,” 3, 1, 9. 79. Comment by Asta J. Wittner, following Kleegman, “Recent Advances,” 10. 80. Newsweek, “ ‘Ghost’ Fathers.” 81. H. Smith, “Making It Possible,” 19 (emphases added). 82. “Miscellaneous Inquiries from Laymen 2,” April 12, 1947, folder 60, box 16, Corner Papers. 83. “Miscellaneous Inquiries from Laymen 3,” September 1, 1955, folder 61, box 17, Corner Papers (italics added). 84. Oudshoorn, “Endocrinologists,” 164. 85. Fishbein, “Family Doctor.” 86. Corner, Hormones in Human Reproduction, 96. 87. Epstein, “Emotions”; Bonaccorso, Conceiving Kinship, 80. 88. Davis, “Why Don’t We?,” 12. 89. Goethe, Elective Affinities. See, for instance, Dreier, Human Chemicals; Dreier, We Human Chemicals; and Fairburn, Human Chemistry. 90. Davis, “Why Don’t We?,” 12–13. 91. Sjöström, “Discourse of Chemistry,” 83–84. 92. Meaker, “Two Million American Homes,” 546.

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93. Canada Press, “Collips Discovery Is Boon to Women,” Lethbridge (Alberta) Herald, May 28, 1932, 9. 94. Corner, Hormones in Human Reproduction, 242. 95. Laurence, “Week in Science”; Fishbein, “Family Doctor.” 96. Blakeslee, “Male Sex Hormones”; Meaker, Human Sterility, 3–7. 97. Corner, Hormones in Human Reproduction, 113, 232 (emphasis added). 98. “Sixty-Seventh Annual Report of the Free Hospital for Women,” 1942, folder 43, box 1, Rock Papers, 19. 99. Argumentation scholars Chaim Perelman and Lucie Olbrechts-Tyteca theorize about a switch in the value hierarchy of this philosophical pairing (i.e., artificial and natural), noting that this sort of switch is a dissociative move that functions to disqualify that which is not valued for its inability to meet the criterion upheld by that which is valued (New Rhetoric, 440–42). 100. Marsh and Ronner, Empty Cradle, 155–58; Schultz, “Maybe You Can,” 55, 59. 101. Associated Press, “Fifty Percent Cure”; Laurence, “Cure of Sterility.” 102. Davis, “Why Don’t We?,” 13. 103. John Rock, “Disorders in Menstruation and General Endocrine Aspects of Gynecology,” February 27, 1946, folder 30, box 19, Rock Papers, 26–27. 104. Schultz, “Maybe You Can,” 55. 105. Koerber, Breast or Bottle?, 18.

Chapter 4 1. Glaser, “Criminality Theories”; Freedman, “Uncontrolled Desires,” 90–91; Pettegrew, “Psychoanalytic Theory,” 50–52; Gibbons, “Beliefs About the Mind,” 428–41. 2. Deutsch, Psychology of Women, 2:90. 3. Sayers, Mothers of Psychoanalysis, 3–4. 4. Roazen, Helene Deutsch, 229; Deutsch, “Psychology of Women,” 411. 5. Deutsch, Psychology of Women, 2:107. 6. Epstein, “Emotions,” 199. 7. Freud, Psychoanalytic Movement, 1. 8. Schafer, “Problems in Freud’s Psychology,” 469; Freud, “New Introductory Lectures,” 131. 9. Freud, Psychoanalytic Movement, 5–6, 9, 12–13, 44. 10. Ibid., 10; Freud, Three Essays, 227; Freud, Interpretation of Dreams, 223. 11. Freud, Three Essays, 63; Freud, “Female Sexuality,” 229, 233. 12. Freud, “Female Sexuality,” 226–28. 13. Ibid., 226, 241; Freud, “Some Psychical Consequences,” 254, 257. 14. Freud, “Female Sexuality,” 230; Freud, “Dissolution” 179; Freud, “Some Psychical Consequences,” 256–58. 15. Ricoeur, Freud and Philosophy, 69, 74–75. See also Kanzer, “Principle of Constancy.” Freud discusses the “principle of constancy” in Beyond the Pleasure Principle, 4. 16. Freud, Three Essays, 85; Freud, Civilization and Its Discontents, 88. 17. Freud, Three Essays, 22, 36, 104–5; Freud, Civilization and Its Discontents, 26–27. 18. Freud, Ego and the Id, 15, 25, 15. 19. Freud, Civilization and Its Discontents, 36, 33, 44, 62; Freud, “ ‘Civilized’ Sexual Morality,” 186. 20. Freud, Civilization and Its Discontents, 43. 21. Ibid., 44, 51, 86. 22. Freud, Three Essays, 63.

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notes to pages 105–112

23. Freud, Civilization and Its Discontents, 50–51; Freud, “Some Psychical Consequences,” 257. 24. Fliess, Psycho-analytic Reader, 159; Roazen, Helene Deutsch, ix; Sayers, Mothers of Psychoanalysis, 3; Lola Jean Simpson, “A Woman Envoy from Freud,” New York Herald Tribune, August 3, 1930, 9. 25. Roazen, Helene Deutsch, 18, 231. 26. Deutsch, Sexual Functions of Women, 14, 50. 27. A Time article from 1941 named Deutsch and Horney “probably the outstanding women psychiatrists in the U.S.” but discussed Deutsch first and highlighted her close working relationship with Freud (“Women Doctors,” 56). On Deutsch’s second-wave feminist opposition, see S. Gordon, “Legacy of Freud”; Brownmiller, Against Our Will, 350–62; and Friedan, Feminine Mystique, 120–21. See also Poirot, Question of Sex, 68. 28. Deutsch, Sexual Functions of Women, 3, 81–82. 29. Wassersug, “More Help,” 870. 30. Schafer, “Problems in Freud’s Psychology,” 469. After Freud’s death, Deutsch would modify her stance to argue that “woman possess two sexual organs,” the vagina and the clitoris, though not necessarily to their benefit (Psychology of Women, 2:78). 31. Deutsch, Sexual Functions of Women, 14, 81, 84. For one of the earliest critiques of this claim, see Horney, review of Zur Psychologie, 98–99. 32. Freud did, in fact, offer a critique of Deutsch’s claim on this front, but he buried it within one of his many lectures and avoided attributing the conceptualization of “feminine libido” to Deutsch, choosing instead to endorse her findings related to the “erotic actions of homosexual women” (“New Introductory Lectures,” 131). 33. Deutsch, Sexual Functions of Women, 12–13, 38, 46, 68, 90. 34. Freud, “New Introductory Lectures,” 131. 35. Deutsch, Sexual Functions of Women, 14, 39, 76. 36. Deutsch, Psycho-analysis of the Neuroses, 11. 37. Roazen, Helene Deutsch, 131–34; Deutsch, Sexual Functions of Women, 88. 38. Sayers, Mothers of Psychoanalysis, 33; Deutsch, Psychology of Women, 2:146–47. 39. Beauvoir, Second Sex; C. Thompson, “Review of Deutsch.” 40. Deutsch, Psychology of Women, 2:106–7. 41. Ibid., 2:90, 106, 113; Van Balen, “Psychologization of Infertility,” 80. 42. Mizrachi, “From Causation to Correlation,” 317. 43. Roazen, Helene Deutsch, 92, 310; Powell, “Helen Flanders Dunbar,” 133. See also Dunbar, Emotions and Bodily Changes. 44. Squier and Dunbar, “Emotional Factors,” 174. 45. E. Taylor, Mystery of Personality, 93–94; Friedman, Menninger, 73, 201. 46. Cherlin and Furstenberg, “Changing European Family”; Marsh and Ronner, Empty Cradle, 3, 183. 47. Habermas, Knowledge and Human Interests, 246; Foucault, History of Sexuality, 1:56; Ricoeur, Freud and Philosophy, 32–36. 48. See Fisher, “Narrative Rationality,” 26. 49. Freud, Three Essays, 80–82; Starling, Croonian Lectures; Freud, “My Views,” 279. 50. George W. Corner, “Sex Research Talk in Edinburgh/Oxford, Speaking Notes,” March 2 and 3, 1953, box P–T, Corner, G. W., Notebook, MS Collection 11, Corner Papers. 51. C. Roberts, “Matter of Embodied Fact,” 14; Oudshoorn, Beyond the Natural Body, 36. For one of Freud’s earliest references to bisexuality, see Origins of Psycho-analysis, 289. See also Freud, Three Essays, 7, 23. 52. Deutsch, Sexual Functions of Women, 39, 48.

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53. Deutsch, Psychology of Women, 2:106. 54. Marsh and Ronner, Empty Cradle, 205. 55. H. Smith, “Making It Possible,” 19; Ratcliff, “Clinics for the Childless,” 854; “Yorkshire Country Doctor’s Plea for the General Practitioner,” Yorkshire Post and Leeds Intelligencer, July 1, 1948, 1. 56. Fisher, “Narrative Rationality,” 30; Kinsler, “State of Mind,” 110; Albrecht, “Childlessness,” 72. 57. Howard W. Blakeslee, “Science Finds Stork Lured to Adopters of Children,” Syracuse (N.Y.) Herald, November 15, 1936, 8; Orr, “Pregnancy,” 441; Schultz, “Maybe You Can,” 59; Milton S. Godfried, “Procedures in Infertility,” 1950, folder 27, box 179, Calderone Papers, 5. 58. Benedek, “Psychosomatic Defense,” 536–37 (emphasis added); Engle, “Have a Baby,” 8. 59. H. Smith, “Making It Possible,” 19; Blakeslee, “Science Finds Stork”; Parkhurst, “Facts About Sterility,” 715. 60. Orr, “Pregnancy,” 441; Lundberg and Farnham, Modern Woman, 3. For examples of references to compatibility in discussions of psychogenic infertility, see Benedek et al., “Some Emotional Factors,” 497; and Knight, “Functional Disturbances,” 25. 61. Wittkower, “Influence of Emotions,” 533; Wassersug, “More Help,” 834–35. 62. Benedek, “Psychosomatic Defense,” 527, 536–37; Plant, Mom, 3. 63. “Misery of Childless Marriages: Doctor Suggests Fertility Test,” Derby Evening Telegraph (UK), June 30, 1948, 1. 64. Marsh and Vollmer, “Possible Psychogenic Aspects,” 78; Rubinstein, “Emotional Factor in Infertility,” 81. 65. Kleegman and Gilman, “Why Can’t You?,” 68–69. 66. Deutsch, Psychology of Women, 2:114–15. 67. Ibid., 2:119. 68. Squier and Dunbar, “Emotional Factors,” 174; Ceccarelli, Shaping Science with Rhetoric, 5. 69. Squier and Dunbar, “Emotional Factors,” 166, 164, 174; Ceccarelli, Shaping Science with Rhetoric, 5. 70. Kroger and Freed, “Psychosomatic Aspects of Frigidity,” 530. 71. Kroger, “Obstetrics and Gynecology,” 504–5. 72. Marsh and Vollmer, “Possible Psychogenic Aspects,” 78 (emphasis added). 73. Heiman, “Psychoanalytic Evaluation,” 406; K. Menninger, “Somatic Correlations,” 516. See also Ford et al., “Psychodynamic Approach,” 458–59, 463–64; and Kroger, “Evaluation of Personality Factors,” 544. 74. Javert, Spontaneous and Habitual Abortion, 336, 383. 75. Freud, Three Essays, 17; W. Menninger, “Emotional Factors in Pregnancy,” 15–16. See also Roazen, Helene Deutsch, 180, 244–45. 76. Ricoeur, Freud and Philosophy, 33; Benedek and Rubenstein,“Sexual Cycle in Women,” 45. 77. Woliver, Political Geographies of Pregnancy, 136. 78. Stallworthy, “Facts and Fantasy,” 175–78. 79. Javert, Spontaneous and Habitual Abortion, 358; Marsh and Vollmer, “Possible Psychogenic Aspects,” 79. 80. Kinsler, “State of Mind,” 110; Albrecht, “Childlessness,” 46; Kinsler, “State of Mind,” 112. 81. K. Menninger, “Somatic Correlations,” 520–23; Wittkower and Wilson, “Dysmenorrhoea and Sterility,” 586–87, 590. 82. Eisenberg, “Clear and Pregnant Danger,” 115; Deutsch, “Psychological Problems of Pregnancy,” 14 (emphasis added).

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notes to pages 122–132

83. Jones, “Psychology and Childbirth”; Kroger, “Obstetrics and Gynecology,” 508; Mann, “Psychiatric Investigation,” 595–96. 84. Javert, Spontaneous and Habitual Abortion, 354. 85. Barber and Harper, Magnificent Maps, 165; Neidhardt, “Antisemitic Anti-Fascists?” 86. Javert, Spontaneous and Habitual Abortion, 351–54. 87. Ibid., 384. 88. K. Menninger, “Somatic Correlations,” 522; Cooke, “Differential Psychology,” 465. 89. Cooke, “Differential Psychology,” 471 (emphasis added). 90. Benedek, “Psychosomatic Defense,” 534. 91. Lundberg and Farnham, Modern Woman, 11, 123. 92. K. Menninger, “Organic Gynecological Conditions,” 50. 93. E. Clarke, Sex in Education, 133. 94. Cooke, “Differential Psychology,” 459; W. Menninger, “Emotional Factors in Pregnancy,” 21; Kroger, quoted in “Baby May Be Neurotic.” See also Javert, Spontaneous and Habitual Abortion, 310. 95. Newsweek, “Books Versus Babies.” 96. Freud, Civilization and Its Discontents, 82–83. 97. Kroger and Freed, “Psychosomatic Aspects of Frigidity,” 529; Knight, “Functional Disturbances,” 33. 98. Sanford, “College Education?,” 78. 99. See, for instance, Kroger and Freed, “Psychosomatic Aspects of Frigidity,” 528, 531; and Parkhurst, “Facts About Sterility,” 714. 100. Jones, “Psychology and Childbirth,” 695 (emphasis added); Javert, Spontaneous and Habitual Abortion, 313. 101. Martin, Woman in the Body; Martin, “Egg and the Sperm.” 102. L. Thompson, Wandering Womb. 103. Hanson and Rock, “Effect of Adoption,” 311–18; Tyler, Bonapart, and Grant, “Occurrence of Pregnancy”; John Rock, “The Rock Reproductive Clinic, Inc.,” 1963, folder 39, box 1, Rock Papers; “Have Few Children”; “Adoption Does Not Aid Infertile Couples to Conceive,” 1966, folder 28, box 2, Rock Papers. 104. Noyes and Chapnick, “Psychology and Infertility,” 554. 105. Sturgis, Taymor, and Morris, “Routine Psychiatric Interviews,” 525; Joseph Whitney, “Is Infertility a Psychic Problem?,” Kingston ( Jamaica) Gleaner, August 31, 1958, 15.

Chapter 5 1. John Rock, “The Rock Reproductive Clinic, Inc.,” 1963, folder 39, box 1, Rock Papers, 1–3. 2. Safford, “Tell Me Doctor,” 105. 3. Marsh and Ronner, Empty Cradle, 218. 4. Kristeva, “Women’s Time.” 5. Morgan, “Contested Bodies, Contested Knowledges”; Riessman, “Women and Medicalization”; Hahner, “Working Girls,” 290, 295–96. 6. Serres, Conversations, 58. 7. Jarratt, Rereading the Sophists, xv. Rhetorician John Lynch notes that kairos, for the ancient Greeks, meant not just timeliness alone but also “symmetry, propriety, profit, fitness, opening, and the fatal spot targeted by archers” (What Are Stem Cells?, 16). Contemporary discussions of kairos and kairotic appeals continue to encompass this nuanced conceptualization of being in time.

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notes to pages 132–140

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Roger Stahl demonstrates that rhetorical appeals to time often function as effective warrants for the establishment of prevention-oriented policies (“Clockwork War,” 88). Speaking to health contexts in particular, J. Blake Scott argues that kairotic appeals are constituted by arguments about assessing and managing potential risks through preventative action (“Indeterminate Risk Management,” 121). 8. J. Smith, “Time and Qualitative Time,” 47. 9. Corner, “Menstruation and Ovulation,” 1838; L. Gordon, Moral Property of Women, 32; Marsh and Ronner, Fertility Doctor, 91. 10. Marsh and Ronner, Fertility Doctor, 120–21; Meaker, Human Sterility, 82–83. 11. Marsh and Ronner, Fertility Doctor; 50–51, 73. 12. “Seventy-Third Annual Report of the Free Hospital for Women,” 1948, folder 49, box 1, Rock Papers, 31. 13. “Seventy-Fourth Annual Report of the Free Hospital for Women,” 1949, folder 50; “Seventy-Fifth Annual Report of the Free Hospital for Women,” 1950, folder 51; both in box 1, Rock Papers, 34, 27. 14. Burke, Counter- Statement, 115. Rhetorician Barry Brummett identifies efficiency as a core value of twentieth-century machine aesthetics (Rhetoric of Machine Aesthetics, 36). 15. American Society for the Study of Sterility, “Program: Eighth Annual Conference of the American Society for the Study of Sterility,” June 1951, folder 35, box 19, Rock Papers. 16. Pfeffer, Stork and the Syringe, 137. 17. “Infertility Clinics,” Lethbridge (Alberta) Herald, April 20, 1966, 23; Ann Shearer, “The Fertility Drugs,” Guardian (Manchester), October 3, 1968, 9. 18. Roland, Management, 6–8. 19. Ibid. 20. Havemann, Birth Control, 92. 21. Pfeffer, Stork and the Syringe, 137–38; Rorvik, “Hope and Help,” 79. 22. Rock Reproductive Study Center, “Publicity: General Information for Patients,” 1960, folder 33, box 1, Rock Papers. 23. Rock Reproductive Study Center, Rock Reproductive Clinic, 19. 24. Lyne, “Argument,” 186. See also Wastyn and Wastyn, “Scientific Debate,” for an illustration of the ways in which scientific arguments are constituted by cumulativity and collectivity. 25. Hawhee, Bodily Arts, 75. For discussion on kairotic entreaties, see, for example, Lynch, What Are Stem Cells?, 40–43. 26. Rock and Bartlett, “Biopsy Studies,” 2022–23, 2028. See also Rock, “Role of Endometrial Biopsy.” 27. Brummett, Rhetoric of Machine Aesthetics, 33–39. 28. “Sixty-Fifth Annual Report of the Free Hospital for Women,” 1940, folder 41, box 1, Rock Papers, 17. 29. Rock Reproductive Study Center, “Information for Rhythm Clinic Patients,” April 14, 1958, folder 34, box 1, Rock Papers, 1–2. 30. Barton and Wiesner, “Waking Temperature,” 663, 665, 668. Today Wiesner is suspected of having secretly used his own sperm as donor sperm and potentially fathering as many as a thousand children through his clinic’s AID procedures; see Rebecca Smith, “British Man ‘Fathered 600 Children’ at Own Fertility Clinic,” Telegraph (London), April 8, 2012. 31. Safford, “Tell Me Doctor,” 105. 32. Kristeva, Time and Sense, 167–98. 33. Abraham Marcus, “Simple Family Planning with New Test,” Observer (London), May 22, 1960, 12. Doyle, Ewers, and Sapit, “New Fertility Testing Tape.” 34. Hawhee, Bodily Arts, 65; Miller, “Opportunity, Opportunism, and Progress,” 85. 35. Planned Parenthood Federation, Those Denied a Child, 1.

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36. Rock and Hertig, “Human Ova,” 129, 139; Rock and Hertig, “Early Human Development,” 974, 977. 37. Rock and Hertig, “Early Human Development,” 977; Rock and Hertig, “Human Ova,” plate 6. 38. Jack, “Pedagogy of Sight,” 193. 39. Hertig, “Fifteen-Year Search,” 435. 40. “Seventy-First Annual Report of the Free Hospital for Women,” 1946, folder 47; “Seventieth Annual Report of the Free Hospital for Women,” 1945, folder 46; “SeventySecond Annual Report of the Free Hospital for Women,” 1947, folder 48; “Seventy-Fourth Annual Report of the Free Hospital for Women,” 1949, folder 50; all in box 1, Rock Papers, 30, 28, 17, 32; Foucault, Birth of the Clinic, x, xiii. 41. Cary, “Experience with Artificial Impregnation.” 42. Pommerenke, “Artificial Insemination,” 190–91; Roland, Management, 198. 43. Guttmacher, “Role of Artificial Insemination,” 442. See, for instance, Pilpel and Zavin, “Artificial Insemination”; “Mediocolegal Aspects”; Pommerenke, “Artificial Insemination”; Rosenfeld, “Science,” 37–39; and “Eighty-Fifth Annual Report of the Free Hospital for Women,” 1960, folder 61, box 1, Rock Papers, 18. 44. Mary Steichen Calderone, “Correspondence on Infertility, Artificial Insemination,” November 2, 1955, folder 161, box 179, Calderone Papers, 1–2. 45. Huxley, Brave New World; Kumar, Utopia and Anti-utopia, 388–89. 46. Miller, “Opportunity, Opportunism, and Progress,” 89. 47. “Sixty-Seventh Annual Report of the Free Hospital for Women,” 1942, folder 43; “Sixty-Ninth Annual Report of the Free Hospital for Women,” 1944, folder 45, both in box 1, Rock Papers, 17, 24. 48. Menkin, quoted in Marsh and Ronner, Fertility Doctor, 108; Menkin and Rock, “In Vitro Fertilization,” 443. 49. Marsh and Ronner, Fertility Doctor, 108. 50. “Seventy-First Annual Report of the Free Hospital for Women,” 1946, folder 47, box 1, Rock Papers, 29; Marsh and Ronner, Fertility Doctor, 279–80. 51. Zimmerman, “Test-Tube Babies.” See also Pilpel and Zavin, “Artificial Insemination,” 117; and Saturday Review, “Invit.” 52. Rorvik, “Test-Tube Baby,” 84; Miller, “Opportunity, Opportunism, and Progress,” 86. 53. Havemann, Birth Control, 95; Connell, “Causes.” 54. Masters and Johnson, “Advice for Women,” 70; Shearer, “Fertility Drugs.” 55. Block, “Babies They’d Always Wanted,” 40–41; Rorvik, “Hope and Help,” 150. 56. Rock Reproductive Study Center, “Scoop and Staff Show Scripts,” 1963–64, folder 24, box 1, Rock Papers, 2. 57. McNamara, “Doctor?,” 77, 122; Marsh and Ronner, Fertility Doctor, 234–35; Pfeffer, Stork and the Syringe, 23–24. 58. Harter et al., “Time, Technology, and Meritocracy,” 83. 59. Scott, “Indeterminate Risk Management,” 119; Roland, Management, 5. 60. Stahl, “Clockwork War,” 81, 83; Roland, Management, 5. 61. A. Thompson, “Help for Couples”; McNamara, “Doctor?,” 77, 122; Beck, Risk Society, 49. 62. Conrad, Medicalization of Society, 6; Havemann, Birth Control, 92. 63. Harter et al., “Time, Technology, and Meritocracy.” 64. Schwartz and Mayaux, “Female Fecundity”; Faludi, Backlash, 27–29. 65. Harter et al., “Time, Technology, and Meritocracy,” 90. 66. McKaughan, Biological Clock, 58. 67. Faludi, Backlash, 29; Bute et al., “Politicizing Personal Choices?”

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187

Conclusion 1. Benyamini, Gozlan, and Kokia, “Variability in the Difficulties”; Boivin et al., “Tackling Burden in ART.” 2. Weschler, Taking Charge; Roye, review of Taking Charge. 3. Fissell, Vernacular Bodies, 141; Culpeper, Directory for Midwives; Weschler, Taking Charge. 4. Weschler, Taking Charge; Kristeva, “Women’s Time.” 5. Twenge, Impatient Woman’s Guide, xvii; Roy, Sperm Meets Egg Plan. 6. Hewlett, Creating a Life, 22. See also Birrittieri, Every Woman; Selvaratnam, Big Lie; and S. Richards, Motherhood, Rescheduled. 7. Bute et al., “Politicizing Personal Choices?” 8. Colen, “Like a Mother”; Ginsburg and Rapp, New World Order, 13; Stahl, “Clockwork War,” 83. 9. Serres, Rome, 108. 10. Serres, Conversations, 86. 11. Richardson et al., “Don’t Blame the Mothers”; Jensen et al., “Including Limitations.” 12. Paul, Origins, 5. 13. Ceccarelli, Frontier of Science, 139; S. Richards, Motherhood, Rescheduled, 4. 14. Velasquez-Manoff, “Your Unborn Baby?” 15. Deutsch, Psychology of Women, 2:173, 116. 16. Paul, Origins, 4. 17. Buckingham-Howes et al., “Systematic Review.” See also Litt and McNeil, “Biological Markers.” 18. Balsamo, Technologies, 80. 19. Fixmer-Oraiz, “(In)Conceivable.” 20. Livingston and Cohn, “Childlessness,” 1. 21. D. Roberts, Killing the Black Body, 90–91; Greil et al., “Race-Ethnicity”; Tanzina Vega, “Infertility, Endured Through a Prism of Race,” New York Times, April 25, 2014. See also Collins, Black Feminist Thought, 230–31. 22. Dubriwny, Vulnerable Empowered Woman, 9. 23. Kleegman, “Recent Advances.” 24. Raymond, Women as Wombs, 1. 25. Laurie Tarkan, “Are Men Overlooked at Fertility Centers?,” New York Times, May 2, 2008. 26. Fisch, Male Biological Clock, 2; Schubert, “Male Biological Clock.” 27. Fisch, Male Biological Clock, 9; Hewlett, Creating a Life; Selvaratnam, Big Lie. 28. Lewis, Legato, and Fisch, “Medical Implications,” 2369. 29. See, for example, Helmerhorst et al., “Intrauterine Insemination”; Roberts et al., “Irritable Uterus”; and Rocco and Garrone, “Examination of the Cervix?” 30. Hannah Pittard, “Withered Uterus, Angry Vulva: ‘It’s Probably a Good Thing You Don’t Want Children,’ ” Salon, October 12, 2014, www.salon.com/2014/10/12/withered_ uterus_angry_vulva_its_probably_a_good_thing_you_dont_want_children/, para. 5. 31. Bowker,“Terminology and Gender Sensitivity,” 595, 597, 598; Machado and Remoaldo, “Incomplete Women,” 224; Bowker, “Terminology and Gender Sensitivity,” 606. 32. Leigh Kendall, “Language Matters! Maternity Experience and NHS Change Day,” Huffington Post, September 3, 2015, www.huffingtonpost.co.uk/leigh-kendall/maternityexperience_b_6829444.html, para. 12. 33. “Can’t Fight Biology”; Burke, Permanence and Change, 89–92; Steinem, “If Men Could Menstruate.”

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34. Monach, Childless, 34. 35. Resolve, “Myths and Facts,” para. 5; Parents, “Seven Myths About Infertility,” para. 5. 36. Jensen, “Using Science,” 237. 37. Han, “Chemical Pregnancy”; Baird and Strassmann, “Women’s Fecundability,” 128–29. 38. Annan et al., “Biochemical Pregnancy,” 269; Coulam and Roussev, “Chemical Pregnancies,” 323; Man et al., “Prognosis.” 39. See, for instance, Ryan Jaslow, “Ovarian Cancer Tied to Fertility Treatments: Cause for Alarm?,” CBS News, October 27, 2011, www.cbsnews.com/news/ovarian-cancer-tied-tofertility-treatments-cause-for-alarm/; Ian Sample, “IVF Babies Have Greater Risk of Complications, Study Finds,” Guardian (Manchester), January 8, 2014; and Rodgers, “Three-Parent Babies.” 40. Serres, Rome, 108. 41. Serres, Conversations, 58–59. 42. Conrad, Medicalization of Society, 6. 43. Ibid.

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Index

AAUW (American Association of University Women), 61 abortion habit, 120, 122–23 abortion neurosis, 122–23 abortions, 173 n. 6 Aristotle on, 25 bearing children after, 66 botched, 93 categorization of, 67 effects of, 70 history of, 35 morality of, 68 Spontaneous and Habitual Abortion ( Javert), 93, 122 thwarting nature with, 35 See also miscarriage absolute sterility, 66 addressing publics, 11 Adolescence (Hall), 64 adoption miracle of, 113–14 myths about, 4–5, 128–29, 164 psychoanalytic reasoning and, 115–17 as spur to pregnancy, 113 adultery, 35 age-related infertility, 148–49, 151, 155, 161 AID (artificial insemination by donor), 139, 143 AIH (artificial insemination by husband), 143 Albrecht, Margaret, 120 alchemy, 71, 73–74, 178 n. 10 Allen, Edgar, 82 AMA (American Medical Association), 2 amenorrhoea, 30, 162–63 American Association of Obstetricians, Gynecologists, and Abdominal Surgeons, 124–25 American Association of University Women (AAUW), 61, 63 American Chemical Society, 83 American College of Surgeons, 94 American Journal of Psychology, 64 American Medical Association (AMA), 2 American Mercury, 114

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American Society for Reproductive Medicine, 7 American Society for Research in Psychosomatic Problems, 117 American Society for the Study of Sterility, 114, 134 America Psychological Association (APA), 64 Anderson, Elizabeth Garrett, 57–58 Anglo-Saxon women birthrates among, 39, 48 cognitive advancement of, 55 compromising motherhood by education, 65 evolution of, 39 involuntary childlessness among, 50 over-civilization of, 52 protection of, 55 returning to Nature for fertility by, 63 risk factors for sterility for, 56 shaming of, 56 thwarted maternal endeavors of, 51 veneration of, 69 victimization of, 50, 54–57 animal research, 179 n. 57 An Inquiry into the Causes of Sterility in Both Sexes (Walker), 29 antagonism theory, 80–81 APA (America Psychological Association), 64 Aristotle’s Master-Piece, 19–21, 23–27, 30, 115, 157, 159 arrested development of women, 126–27 artificial fertility, 165–67, 181 n. 99 artificial insemination, 142–45 artificial insemination by donor (AID), 139, 143 artificial insemination by husband (AIH), 143 artificiality/the artificial concerns about, 142–45 moral physiology over, 67–69 versus natural sterility, 63 self-inflicted sterility, 66 upholding, 91–94 assisted reproductive technologies (ARTs), 153, 157, 159, 166 Associated Press, 85, 94 Atlantic, 158

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atomic theory, 73, 75 attraction, chemical, 91 autoimmunity, 162 azoospermia, 163 babies, borrowing, 116 “The Babies They’d Always Wanted” (Block), 147 balance/equilibrium, 22, 24, 43, 154 barrenness, 19, 21 cures for, 22 as fault of woman, 34 soil, seed, and fruit metaphors for, 20–26 See also childlessness; infertility; sterility Bartlett, Marshall K., 137–38 basal body temperature (BBT), 130, 134, 139–40, 154 Beard, George Miller, 56–57 Beauvoir, Simone de, 109 behaviors modification of, to achieve pregnancy, 6–7 during pregnancy, 158–59 reorganization for psychological dysfunction, 121 Benedek, Therese, 114 Better Homes and Gardens, 93, 95 biblical citations, 51, 53 Bigelow, Horatio, 57 biochemical composition and reproduction, 128 biochemical infertility, 128 biochemical matter, 80, 112 biochemical processes, 85 biochemical variability, 14, 72 biochemistry, 14, 72, 78, 80 of attraction, 86–88 degrees of fertility and sterility, 87 early inquiries of, 90 glandular balance, 120 of hormones, 81 influence of, 127 link between infertility and, 98 manipulation of, 124 mid-twentieth–century rhetoric on, 111–13 psychoanalytic theories and, 111–14 recognition and development of, 74 of vomiting in pregnancy, 122 biological clock, 132, 150–52, 154, 157, 160–61 birth control pill (The Pill), 129–30, 148 birthrates among Protestant Anglo-Saxons (1873), 39 declining Anglo-Saxon, 48 mid-nineteenth–century, 35

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bisexuality model of development, 112–13 “Black-Moor,” 27 Blakeslee, Howard, 93 blame/responsibility deflecting of, onto women, 132 for fertility/infertility, 90, 94–96, 160 for full-term pregnancy, 123–24 for involuntary childlessness, 36–37, 70, 97, 160 Block, Jean Libman, 147 blogs, language used in, 163 blood group incompatibilities, 134 bodily abstraction, 139–40 bodily equilibrium, 22, 24 body basal temperature of, 130, 134, 139–40 male, 32 mechanical functions of, 32 mother’s body and sin, 26 racialization of the monstrous, 26 See also mind-body discourse body-as-machine metaphor, 28–29, 32 body chemistry, 73–75 body-mind discourse. See mind-body discourse borrowing a baby, 116 Boyle, Robert, 73, 90 brain’s actions, 44, 135–36 brainwork, 46 British Association for the Advancement of Science, 83 British Journal of Obstetrics and Gynecology, 119 British Medical Journal, 71, 121 Brown, Louise, 1 Brown-Séquard, Édouard, 71–72, 74, 78 brute races, 45 Bulletin of the Menninger Clinic, 110 Calderone, Mary Steichen, 143 Canada Press, 92 Cary, William H., 142 castration theory, 108 Cattell, James McKeen, 65–66 cervical os, 122 cervix, 31–32, 61, 122, 162 Chapnick, Eleanor, 129 chemical agents, 82–85 chemical attraction, 90 chemical balance, 98 chemical elements, 75 chemical fertility, 94–96 chemical narrative, 111–13 chemical physiology, 77–78

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index chemical pregnancy, 165 chemical theories of infertility, 94–95, 98–99, 109, 124 chemistry balance of internal, 90 as cure for infertility, 91–92 early theories of, 74 of everyday life, 76 of female sex hormone, 83 of human body, 73–75 of life, 78–79 modern culture of, 73 organic, 77–78 public awareness of modern, 75–77 as relational science, 90 sexual differences in, 81 See also biochemistry childlessness conceptualization as medical problem, 150 as ideologically suspect, 111 involuntary (see involuntary childlessness) loveless lives with, 54 of married women, 45, 51 of native-born American women, 56–57 rates of, 159 voluntary, 69, 162, 173 n. 6 choice, assumption of, 155 civilization, nature versus, 103–5 Civilization and Its Discontents (Freud), 103–4 Clarke, Edward H., 35–36, 39–41, 49–55, 60, 64–65, 86, 95, 125, 157 Clarke’s theory, refutations of, 59 class status, 7–8 clinical fertility/sterility, 87 Clinical Notes on Uterine Surgery (Sims), 19, 29, 33–34. See also Sims, J. Marion clinicians, instruction in psychoanalysis for, 118–21 clinic specialists, 134 clock watchers, 151 coding system for patients, 134 cognitive function, 44 collectives, 43 college students, health conditions for, 61 Committee for Research in Problems of Sex, 79, 178 n. 40 Committee on Maternal Health, 79 comparative theory of time, 4 conception after adopting, 113–14 countdown to, 153 cultivating, 24

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early theories about, 21–22 failure to conceive naturally, 160 mechanical aspects of, 32 women’s attitude toward, 153 conceptual chiasmi, 117–18 Condit, Celeste M., 1 Connell, Elizabeth B., 146 conservation of energy. See energy conservation and human reproduction constancy, principle of, 102 contraceptives, 173 n. 6 consequences of using, 63, 67–70 hormonal, 79, 179 n. 40 The Pill (birth control pill), 129–30, 148 thwarting nature with, 35 “The Control of Human Sterility” (Tobey), 85 Cooke, William, 124 copulative act, 24, 32 Corner, George Washington, 82–84, 89–90, 92–93, 112 Coronet, 120 corpuscularism theory, 73 corpus luteum, 82–83, 138–39 corrupt society, 54–57 cravings during pregnancy, 121–22 critical rhetoric, 11 culdoscopy, 147 Culpeper, Nicholas, 146 A Directory for Midwives, 21–24, 26, 27, 30, 154 Dalton, John, 75 Darwin, Charles, 39, 46–47, 175 n. 20 deficit model of public understanding, 9 demographic groups, hyperfertility in some, 7–8 Derby Evening Telegraph, 116 Deutsch, Felix, 110 Deutsch, Helene, 97–101, 105–14, 116–17, 121–22, 129, 149, 157–58 Psychoanalysis of the Sexual Functions of Women, 106, 107 The Psychology of Women, 106, 109, 116, 158 See also psychoanalytic theory developmental origins of health and disease (DOHaD), 156–57 diagnostic techniques, 137–38 diet, 23, 47, 60, 85 A Directory for Midwives (Culpeper), 19, 21–24, 26, 27, 30, 154 doctrine of conservation of energy, 44 doctrine of prevention, 132

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214

index

DOHaD (developmental origins of health and disease), 156–57 Dunbar, Helen Flanders, 110, 111 Duncan, James Matthews, 18–19, 34, 61 dysfunction instruction in reproductive, 136–37 psychoanalytic, 121–22 psychological, 104–5, 113, 123, 124, 129 psychosexual, 121 dysmenorrhea, 121 economic class, 55 education of adolescents, 64 boys’, 58 interdisciplinary, 136–37 of men and women, 36 research for female students during menstruation, 59–61 rest for female students during menstruation, 54 uninterrupted study of adolescent girls, 58 of women, 35–36, 49, 62 Edwards, Robert G., 1, 145 efficiency as core value, 185 n. 14 twentieth-century appeals to, 133–37 eggs (ova) donation of, 1 imaging techniques for, 141 timing of introduction of sperm to, 144 travel time of, 133 tryst between sperm and, 140 viability of unfertilized, 143 ego, 103 The Ego and the Id (Freud), 103 ejaculation, abnormal, 162–63 Elective Affinities (Goethe), 90 elements, atomic, 75 emotional state, women’s, 120 endocrine action, 82 endocrine-oriented theories, 81 endocrine therapies, 93–94 endocrinology early, 78 endocrine system, 71 Freudian psychoanalysis and, 112 hormone replacement therapy (HRT), 71 reproductive (see reproductive endocrinology) See also hormones endometrial dating and irregularity, 137–39

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endometrium, 84–85, 138 energy (in general) libidinal, 102, 103, 104–5, 107, 108, 124 loss of vital, 178 n. 5 metaphors related to, 43–44 organic bodies as, 42 psychic, 102–3 women’s surplus of, 48 energy conservation and fertility, 9, 47 arrested development of women and, 127 changes in narratives on, 73 contexts for, 51 early twentieth century narratives on, 63–69, 146 introduction of public to, 85 latenineteenth-century narratives on, 49–57 logic-oriented refutations of, 39–40 Malthusian theory on, 64–66 nervous energy, 85 The Question of Rest for Women During Menstruation ( Jacobi), 59 refutations of narratives on: 1930s and 1940s citations of, 85–86; through linear argumentation, 57–59; through quantitative data, 59–61; through scientific data, 61–63 regulatory appeal of, 54 relationship of stress to sterility, 86 repairing nervous system, 71–72 slowing of narrative on, 70 women’s actions and, 126 energy deficiency, 45 Engelmann, George, 66–69 equilibrium/balance, 22, 24, 43, 154 erotic energy, 103 ethical issues assisted reproductive technologies (ARTs), 166 data collection methods, 29–30 social code of ethics, 53 eugenics, 67 evolutionary theory. See social evolutionary theory evolutionary value system, 107 examination table positions for women, 33 failure by Anglo-Saxon women, 54–57 to conceive naturally, 160 faulty semen and, 143 of female volition, 19

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index illness as moral, 3–4 of Nature, 93 pregnancy, 143 risking, 155 fallopian tubes blocked, 35, 61, 113 clearing blocked, 93–94 gamete intrafallopian transfer, 1 incompetence/irritability of, 128 observation of, 147 presence of sperm in, 143 spasms of, 120 surgical approaches to observing, 134 travel of blastocysts through, 153 false pregnancy, 165 fecundity/infecundity, 139 Federation of Fertility Societies, 135–36 female body basal body temperature (BBT), 130, 134, 139–40, 154 incompetence of, 128 machine metaphors for, 35 mechanics of, 32–33 mixed metaphors about, 34–35 as objective parts, 33–34 overtaxing the, 51 psychological portrayal of reproductive parts of, 119, 122 rhythms and phases of, 131 Sims’s depiction of, 32 female hormones, 81 The Female Sex Hormone, 83 feminine libido, 107 feminine-type men, 90 femininity acceptance of, 128 communication of, 112 degrees of, 89–91 descriptions of, 165 hormones as agents of, 80 rejection of, 121 unconscious conflict about, 115 feminists, 69 Ferenczi, Sándor, 121–22 fertility, 2 agents of, 95 biochemical degrees of, 87 chemical, 94–96 and compatibility of partners, 114–15 conceptualizations of, 89–90 continuum of, 86–87

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definitions of, 172–73 n. 5 degrees/continuum of, 87–88, 95 determinant of, 83 first use of word “fertile,” 18 French study on age-related decline in, 151 identification of, 129–30 influence of emotional factors on, 116 media coverage of new field of, 135 men’s degree of, 88, 160 mindless, 125–26 natural versus artificial, 165–67, 181 n. 99 as normal state, 94 psychological factors affecting, 129 Spencer’s use of term, 49 as temporary, 148–49 treatment for, 92 visualizing, 141–42 as woman’s issue, 129 Fertility and Endocrine Clinic (Harvard), 93, 133, 134, 144–45 Fertility and Sterility, 118, 129 fertilization process, 145 fertilized eggs, data on, 133 Fetal Origins, 156 Fetal Origins research, 156 Fiske, John, 45 Fortnightly Review, 58 Frank, Robert T., 83 Freud, Anna, 105 Freud, Sigmund, 15, 115 on biochemical agents and psychology, 112 on bisexuality, 112 Civilization and Its Discontents, 103–4 The Ego and the Id, 103 The History of the Psychoanalytic Movement, 100 interpretations of women’s health by, 111–13, 182 nn. 27, 30, 32 on lay analysts, 118–19 on sexual processes, 112 Three Essays on the Theory of Sexuality, 102, 111–12 Freudian theory in infertility rhetoric, 96 maternity and, 105–8 in maternity context, 105–11 Oedipus Complex, 101–2 principles of, 102–3 psychoanalysis, 47 psychogenic infertility, 169 See also psychoanalytic theory

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216

index

fruit metaphors, 127 functional infertility, 109 gender differences bias and, 162–63 biological, 47, 158 blame for infertility and, 95–96 competition between men and women, 49 curing infertility and, 115 Nature’s directives on boys and girls, 52–53 physical and mental, 47–48 psychosexual, 158 genetic abnormalities, 149, 160–61 Gilman, Mildred, 116 Good Housekeeping, 147, 148 Grey’s Anatomy, 163 Guardian, 146–47 guilt, subconscious, 108 gynecological theories, 38, 42 habitual abortions, 120, 122–23 Hall, Granville Stanley, 38, 64, 68–69 Hanson, Frederick, 134 Havemann, Ernest, 135, 146, 150 hCG (human chorionic gonadotropin), 153, 165 healthy women, evidence of, 126 Heape, Walter, 80 hermeneutics of the reproductive female, 99, 113, 117, 119, 124, 128 of suspicion, 119 Hertig, Arthur, 141 heterologous artificial insemination, 143 heterosexual hormones, 80–81 Hill, R. S., 67 historical rhetoric of abortions, 35 conceptualizations of infertility, 5, 6 of medicalization, 2–3 percolation model of history, 6, 167–68 theoretical depictions of infertility, 4–5 history percolation model of, 6, 167–68 theory of, 74 The History of the Psychoanalytic Movement (Freud), 100 hormonal theory of reproduction, 79 hormone replacement therapy (HRT), 71 hormones, 70 in 1930s and 1940s rhetoric, 164 as agentic, 86

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artificial, 166 artificial/synthetic, 93 biochemistry of, 81 as chemical messengers, 112–13 fertility-producing, 84 first use of term, 78, 82, 112 following conception, 153 gonadotropin, 134 heterosexual, 80–81 hormonal patterns, 80 human chorionic gonadotropin (hCG), 153, 165 microscopic study of, 138 ovarian, 79, 90 relationship between male and female, 81 reproductive, 83 research on, 179 n. 40 sex-related, 90 sex specificity and, 80–81 synthetic, 84, 94, 95, 143, 164–65 See also endocrinology The Hormones in Human Reproduction (Corner), 84, 90, 93 hormone therapies, 93–94 Horney, Karen, 105, 182 n. 27 Howe, Julia Ward, 59 Howes, Annie G., 61 HRT (hormone replacement therapy), 71 human body. See body; mind-body discourse human health, understanding of, 78 “The Human Ova of the Previllous Stage” (Rock and Hertig), 141 Human Sterility (Meaker), 84, 86, 87, 133 humoral theory, 22 husbands adultery by, 35 artificial insemination by, 143 infertility clinics for, 131 study and treatment of, 134 unconscious fears of, 129 id, 102–3 ideographs, 50, 176 n. 40 “If Men Could Menstruate” (Steinem), 163 imagetext, 20, 87, 91, 135, 141 imaging technologies, 141–42 immature women, 90 immigrant women, 159 The Impatient Woman’s Guide to Getting Pregnant (Twenge), 154 incompetent cervix, 122

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index “The Increasing Sterility of American Women” (Engelmann), 66 infantile uterus, 121 infertile couples, 8, 135 infertility 1930s and 1940s rhetoric on, 81–94 age-related, 148–49, 155, 161 alternative remedies for, 21 being out of time in, 145–48 body/mind, 127–29 causes of, 109–10 changes in assumptions about, 10 chemical theories of, 94–96 costs of treatments, 7 curing male versus female, 115 degrees of, 87 emergence of field of, 2–3 emotional and medical aspects of, 7 as female condition, 8 historical conceptualizations of, 5, 6 hostile environment and, 162 hostility toward men and, 121 identification of, 129–30 integrated fields of study of, 133–37 lack of attention to, 155 mainstream use of term, 34 medicalization of, 1–2 patients’ perceptions of, 9 psychogenic, 2, 100–105, 111–24, 169 question of what is, 3 repetitive aspect of rhetoric on, 155–56 responsibility for, 36–37, 160 seeking treatment for, 146 as somatic defense of women, 115 transdisciplinary rhetoric on, 16, 168–69 treatment for (see treatment methods) in twenty-first-century Europe and United States, 153 visual representations of, 12–13 See also childlessness; sterility infertility/sterility clinics, 93, 129–31, 133, 135, 147 inscription devices, 12 instincts drives toward pleasure and pain avoidance, 102–3 Freud’s theories of, 102–5 libido-directed, 100–101, 103 maternal, 62, 114–16, 115–16 maternal/paternal, 156 natural/reproductive, 126

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paternal, 115 procreative, 124 sexual, 102 women’s ability to come to terms with, 105 integrated fields of study, 133–37, 150 interdisciplinary training, 136 in vitro fertilization (IVF), 129 characterization of research in, 145 concerns about, 142–45 development and process of, 1 first child born via, 145 race mentality in, 157 involuntary childlessness, 29, 35 Anglo-Saxon women’s, 50 assumption of choice and, 155 causes of, 63 as failure of female volition, 19 fault for, 36, 70, 97 responsibility for, 36–37, 160 See also infertility; sterility irregularity, dating, 137–39 IVF. See in vitro fertilization (IVF) Jacobi, Mary Putnam, 59–61 JAMA ( Journal of the American Medical Association), 67, 82, 117–18, 142, 161 Javert, Carl, 93, 120, 122–23, 123–24 Johnson, Virginia, 146 Jones, Ernest, 122, 127 Journal of Nervous and Mental Disease, 121, 124 Journal of the American Medical Association ( JAMA), 67, 82, 117–18, 142, 161 kairology of infertility, 3, 4 kairos, 132, 184 n. 7 kairotic appeals, 132–49, 144, 185 n. 8 kairotic periodization, 145 kairotic window of opportunity, 140 Kingston Gleaner, 129 Kinsler, Vera G., 120 Kleegman, Sophia, 88–89, 116 Klein, Melanie, 105 Kristeva, Julia, 131 Kroger, William S., 118, 122, 125 Ladies’ Home Journal, 126, 130, 140, 145 Lamarck, Jean-Baptiste, 46, 51, 55 Lancet, 53, 122 language. See terminology/language Laurence, William L., 83 Lavoisier, Antoine, 75

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218

index

Leibniz, Wilhelm, 43 Lethbridge Herald, 93 LGBTQ community, 7 libidinal-directed instincts, 101, 103 libidinal energy, 102, 103, 104–5, 107, 108, 124 libido, feminine, 107, 182 n. 32 Liebig, Justus, 76 life cycles, 146, 148 lighthouse metaphor, 123–24 linear argumentation on energy conservation, 57–59 living force (vis viva), 43 logic, appeals to, 57–63 London Psychoanalytical Society, 122 Look magazine, 145 love Greek goddess of, 4 of the helpless, 47 of mother/father, 101–2 need for, in reproduction, 90 Love, I. N., 38 loveless lives, 54 machine aesthetics, 138, 185 n. 14 machinery (mechanistic) metaphors, 28–34 mainstream media on chemical agents, 83–85 constructions of infertility in, 5 encouragement for fertility treatment by, 146 language used in, 8, 9, 163 popular press publications, 151–52 research agenda, 156 uses of, 11 The Male Biological Clock (Fisch), 160–61 male body, Sims’s depiction of, 32 male fertility, 88, 160 male hormones, 81 male partners, in online fertility forums, 153 male sex hormone, 93 male sexuality, 178 n. 5 Malthus, Thomas Robert, 64–66 Malthusian theory, refutations of, 64–66 Mann, Edward C., 122 marriage, sterile, 88–89, 91, 96 Martin, Emily, 128 masculinity communication of, 112 degrees of, 89–91 hormones as agents of, 80 women’s, 121, 125 masculinity complex, 102, 108–9 Masters, William, 146

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masturbation, 107–8 maternal impressions theory, 25 maternal instincts, 62, 114–16, 156 maternal libido, 107 Maternal Research Council, 79 maternity Freud’s narrative and, 105–8 process of, 125 psychoanalytic theories of, 149 psychology of, 118 pursuit of, 49 rejection of, 39 maternity leave, 157 Maudsley, Henry, 53–54, 64 McCalls, 149 Meaker, Samuel, 84, 86, 87, 92, 133 mechanical functions of body, 32 mechanistic (machinery) metaphors, 28–34 media. See mainstream media medicalization definition, 2 history and process of, 2–3 as layered, 2–3, 150 moralizing with, 3–4, 169 as process of degrees, 2, 168–69 medicalization of (in)fertility biological clock and, 150–52 description of, 177 n. 92 furthering, 81–82 language of, 127 as layered, 2–3, 14–15, 99, 132, 145, 150, 168–69 process of, 150, 172 n. 51 realms included in, 117 tenets supporting, 72–73 of women’s experiences, 131 Mendeleyev, Dmitri, 75 Menkin, Miriam, 144 Menninger, Karl, 121, 124, 125 Menninger, William, 125 Menninger family, 110–11, 119 menstrual cycle abnormal, 162–63 amenorrhoea, 30, 162–63 dysmenorrhea, 121 early findings on, 132–33 follicle phase of, 138 hormonal drivers of, 80 irregular, 146–47 Jacobi’s theory of, 60 knowledge of cycle, 82 mental exercise during, 62

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index predictability of, 130 The Question of Rest for Women During Menstruation ( Jacobi), 59 rest for female students during, 54, 59–61 timing of ovulation in cycle, 137–38 withdrawal during, 51 mental dysfunction, 104–5 mental energy, 44–46 metaphors abortion neurosis, 123 biblical, 36 body-as-machine, 28–29 definition, 17 doctors as lighthouses, 123–24 as drivers of narratives, 40–41 early twentieth-century fertility/infertility, 63–64 energy as, 43–44 mechanical/machinery, 28–34, 52, 61, 127 mixed/mixing, 17–18, 34–37, 52–54 organic, 127 pregnancy as scientific frontier, 157 proliferation of humanity as stream, 55 reproductive, 19, 28 soil, seed, and fruit (barrenness), 20–26 women’s reproductive agency, 39 midwives/midwifery Directory for Midwives (Culpeper), 21–24, 26, 27, 30, 154 guides for, 21 as lay audience, 19 realm of, 29–30 roles of, 2, 23–24 mind-body discourse, 3, 44, 47 female-specific, 150 infertile body, infertile mind, 127–28 mechanistic illustration of, 135, 136 psychogenic infertility in, 52, 123–24 minority women, 159 miscarriages, 21, 25 detection of, 165 reasons for, 108, 156, 160, 162, 163 repeated, 122 See also, abortions mixed metaphors, 17–18, 34–37 Modern Woman, 115 monstrous births, 26, 27 monstrous maternal trope, 25, 159 morality, 49–57, 51 of abortions, 68 appeals to physical-psychological differences, 47 as delineated by Nature, 53

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and education of women, 59 illness as moral failing, 3–4 immoral rejection of nature, 67 neo-moral physiology, 126–27 social code of, 53 upholding moral physiology over artificiality, 67–69 mother-centric psychoanalysis, 100–108 motherhood as all-encompassing identity, 115 appeals to, 69 capability for, 121 careers and, 151 defenses against, 98 as definition of womanhood, 7 education and, 62, 65 fears and apprehensions about, 120 maturity through, 107 natural privileges of, 68 praise for, 111 renunciation of, 14 role of, 109 stresses of, 115 mucus, cervical, 122, 162 myths adoption and pregnancy, 4–5, 128–29 pregnancy after adopting, 164 Resolve’s identification of, 164 narrative of energy conservation, 49–54, 57–70, 77, 85–86, 94, 98, 102, 115, 126–27, 146, 169 extension, 10, 98–99, 106–7, 111, 131, 164 refutations, 57–63, 70 National Institutes of Health (NIH), 163 National Research Council, 79 natural fertility, 124–25, 165–67, 181 n. 99 nature civilization versus, 103–4, 103–5 definition, 99 improving on, 81–82 metaphors related to, 127 personification of, 53 remedies/enhancements for, 92–93 as restorative, 124 revenge on women by, 54 Nature as corrective, 52–54 design of women by, 53 desire for children and, 24 directives of, 52–53 failure of, 93

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220

index

Nature (continued) personification of, 100 thwarted, 62–63, 65 nausea during pregnancy, 125 neo-moral physiology, 126–27 nervous energy, 85 nervous system repair, 71–72 nervous theories, 79 neurasthenia (nervous exhaustion), 56 neuroendocrine regulation of ovarian cycle, 136 neuroses, 100 New England Journal of Medicine, 151 Newsweek, 88, 126 New York Fertility Research Foundation, 147 New York Herald Tribune, 105 New York Times, 64, 83, 84 NIH (National Institutes of Health), 163 Nobel Prize in Physiology or Medicine, 1 nonvital matter, 42 North American Review, 45–46 Noyes, Robert, 129 nutrition, 23, 47, 60, 85 obstetrics, psychosomatic, 110, 117 Obstetrics and Gynecology, 122 Octomom (Suleman, Nadya), 159, 160 octopus metaphor, 122–23 Oedipus complex, 101–2, 105, 112 online fertility forums, common topics on, 153 opportunity created (artificial), 142–45 twentieth-century appeals to, 137 organic chemistry, 77–78 organic matter, transformative potential of, 41–43 organic metaphors, 127 orgasms clitoral, 117 theories on, 22 vaginal, 121 vigorous, 110 Origins (Paul), 156–58 Ourselves Unborn (Corner), 84 ova. See eggs (ova) ovarian cycle, 135, 136, 138–39 ovarian hormones, 79, 90 ovarian therapy, 84 ovaries, 60, 78, 83, 90, 142 ovulation, 80, 82, 162–63 early findings on, 132–33 timing of, 138

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tracking basal body temperature for, 130, 134, 139–40, 154 oxygen theory of combustion, 74–75 pain, woman’s, 34 Parents magazine, 86, 113, 164 paternal instincts, 115, 156 Paul, Annie Murphy, 156–58 pedagogy of sight, 141–42 pelvic examinations, positioning of patients during, 32–33 penis envy, 101–2, 105, 108, 117–18 percolation model of history, 6, 167–68 periodicity, 64, 69 periodic table of the elements, 75 phallic stage of development, 101 phlogisten, 75 physiological reasoning, 53–54 physiology chemical, 77–78 of endocrine system, 113 Freudian psychoanalysis and, 112 language used to refer to, 163 of menstruation, 82–83 neo-moral, 126–27 by race, ethnicity, nation of origin, 55 women’s reproductive, 146 Pictorial Review, 90 The Pill (birth control pill), 129–30, 148 Planned Parenthood Federation of America, 143 Platonic Form, 5 popular press publications, 151–52 Popular Science Monthly, 47, 65 predictors of successful mating, 80 pregnancy after adopting, 164 avoiding the Act of Copulation during, 24 behaviors of women during, 158–59 chemical, 165 early theories about, 21–22 failed, 143 false, 165 missed opportunity for, 148 myths about, 4–5, 128–29 psychosexual diagnosis in, 121–24 before readiness for, 7 as scientific frontier, 157 vomiting and food cravings in, 121–22, 125 woman’s diet during, 23 prevention, doctrine of, 132 primitive reproduction, returning to, 124–26

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index principle of constancy, 102 The Principles of Biology (Spencer), 42 progesterone, 80, 82, 139 “The Progress from Brute to Man” (Fiske), 45 protection of women, 55, 158 Protect Your Fertility Campaign, 7 pseudoscientific appeals, 8, 114, 164 psyche, entities of the, 103 psychiatric interviews, 118–19 psychic apparatus, 102 psychic conflicts, 114 psychic energy, 102–3 Psychoanalysis of the Sexual Functions of Women (Deutsch), 106, 107 psychoanalytic dysfunction, 121–22 psychoanalytic theory, 47, 48 on adoption, 115–17 approach to human health using, 110 becoming a woman in, 97–98 development of, 111–13, 115 European (1920s), 121–22 mother-centric, 105–8, 105–11 nature metaphors in, 127 rejection of, 106 training for all clinicians in, 118–21 See also Deutsch, Helene; Freud, Sigmund; Freudian theory psychogenic infertility/sterility, 2, 97–98, 99, 100, 169 adoption, 113 characterizations of women with, 126–27 Deutsch’s description of, 108 effects of framing as, 124 first definition of, 109 mid-twentieth–century rhetoric on: adoption, 113–17; chemical narrative, 111–13; hermeneutics of the reproductive female, 117–24; nature as restorative, 124–27 mind-body entanglement and, 123–24, 127–28 psychological dysfunction, 104–5, 113, 123 causes of, 124 of husbands, 129 reorganization and behavioral change for, 121 psychological variances in reproduction, 47 psychology of infertility, 169 “Psychology of the Sexes” (Spencer), 44, 47 The Psychology of Women (Deutsch), 106, 109, 116, 158 psychopathology, 118 psychosexual development, 8, 97–99, 102–3, 105– 6, 108–11

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faulty, 113 Freud’s theory of, 107, 112 of girls versus boys, 101 personality traits and dysfunction of, 121 psychosexual diagnosis in pregnancy, 99–100, 121–24 psychosexual differences in men/women, 158 psychosexual normalcy/dysfunction, 15, 106, 120–21, 162, 166 psychosomatic medicine, 110 American Society for Research in Psychosomatic Problems, 117 The Question of Rest for Women During Menstruation ( Jacobi), 59 race issues, 157, 159–60 Anglo-Saxon women’s improvement of race, 56 brute races, 45 diverse evolutionary potential, 54 fertility and infertility across races, 8 midcentury medical rhetoric on, 125 potential to progress, 45 race-based medical philosophy, 55–56 race-preserving power, 48 racial categories, 54–55 racialization of the monstrous body, 26 in social evolutionary theory, 43–44 racial guardians, 54–57 Redbook, 146 refutations of Clarke’s theory, 59 of energy conservation and fertility narratives: 1930s and 1940s citations of, 85–86; through linear argumentation, 57–59; through quantitative data, 59–61; through scientific data, 61–63; of Malthusian theory, 64–66; quantitative data for, 59–61; terminology/language of, 63 regulatory appeals, on energy conservation and human reproduction, 54 relative sterility, 66 relaxation-inducing strategies, 116 religion, 51 reproduction biological and psychical differences in male versus female, 47 energy conservation and (see energy conservation and human reproduction) hormonal theory of, 79 metaphors for, 19

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222

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reproduction (continued) problems of, 56 psychoanalytic labels for, 164 social evolutionary theory, 46–49 stratified, 7–8 women’s versus men’s investments in, 158 re-production metaphor, 28 reproductive capacity, 87 reproductive endocrinology, 2, 72 hormones and sex specificity, 80–81 language of the chemical revolution in, 73–75 public awareness of modern chemistry, 75–77 rise of, 79–80 twentieth-century appeals to, 132–33 reproductive females, hermeneutics of, 99, 113, 117, 119, 124, 128 reproductive health of Anglo-Saxon women, 56 early twentieth-century rhetoric on, 40 explanations for women’s, 3–4 function and dysfunction, 136–37 kairotic presentation of women’s, 152 lack of attention to, 155 late eighteenth-century women’s, 49 midcentury women’s, 126 psychosexual development and, 97 unhealthy womb, 158 reproductive timing, 130–31, 141–42 basal temperature record for charting, 140 being out of time, 150–51 clinical, 137 normal, 142 observations of menstrual, 132–33 as resource, 154 rhythm system, 138–39 right moment in life for pregnancy, 131 studying, 134–35 timing of insemination, 144 rhetoric definition of, 11 evolution of, 12 historical, 4–6 rhetorical ecology, 2, 6, 11–12, 16, 72–73, 84, 150, 161, 167–68 rhetorical history, 4–6, 8, 11, 13, 16, 167–68 as circulating, 2, 6 n. 16, 13, 143, 150, 167–68 as percolating, 4, 6 n. 16, 9, 13, 15, 16, 37, 128, 140, 146, 150, 153, 158, 167–68 See also historical rhetoric; history rhythm system, 138–39 risk/gain tension, 144 risk society, 149

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Rock, John, 95, 130, 133, 137–38, 141, 144 Rock Reproductive Clinic, 130, 136, 138, 148 Roland, Maxwell, 135, 136 Rorvik, David, 145, 147 Royal College of Obstetrics and Gynecologists, 119 Rubin, I. C., 94 Saleeby, Caleb Williams, 64, 65 Salon, 162 Sanford, Nevitt, 126 The Sceptical Chymist (Boyle), 73, 74 Schäfer, Edward, 78 Schultz, Gladys Denny, 93, 95 science nature of, 10 nineteenth-century appeals to, 57–63 popular understanding of, 11 Science, 77 scientific data late nineteenth-century refutations using, 59–61 for refuting energy conservation and human reproduction, 61–63 scientific inquiry, 64–67 scientific laws, 43 scientific methods, illusion of, 50–51 scientific narrative extension process, 131–32 scientific rhetoric, 70 scientific versus mainstream media reports, 9 Scribner’s Magazine, 85 The Second Sex (Beauvoir), 109 seed metaphors, 21–22, 127 self-inflicted sterility, 66 self-preserving power, 48 semen donor, 143 loss of, 178 n. 5 timing of introduction of specimen, 142 See also spermatozoa semence theory of pregnancy, 21–22 Sex Antagonism (Heap), 80 sex-gland grafting, 112 sex hormones, 81, 90 Sex in Education (Clarke), 35–36, 39, 49–50 “Sex in Mind and in Education” (Maudsley), 53 sex instinct, 102 sex specificity, hormones and, 80–81 sexual act heterosexual coitus and procreation, 100–101 in social evolutionary theory, 46–49 sexual desire, repression of, 121–22

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index sexual impulses, 101–2 sexuality Freudian theory of, 101–2, 107 male, 107, 178 n. 5 robbing of, by civilization, 124 sexual maturity, female, 106–7, 109 Shearer, Ann, 146–47 Sims, J. Marion, 19, 29–34, 29–35, 38–39, 42, 52, 60–61, 72, 95, 165 Sims speculum, 29–30, 33 sin, mother’s body and, 26 slavery, 29–30 Smith, Helena Huntington, 86 social code of ethics/morality, 53 social collectives, 43 social evolutionary theory, 39, 55, 62 diffusion of, 48–49 energy as metaphor in, 43–44 logic and figures of, 41 mental energy and race in, 44–46 reenvisioning of, 50–51 scientific circulation and extension of, 44 sex, survival, human reproduction in, 46–49 transformative potential of organic matter in, 41–43 social forms, 5 soil metaphors, 127 speculums, development of, 29–30, 33 Spencer, Herbert, 39, 41–49, 50, 64, 65. See also social evolutionary theory Spencer’s law, 64 spermatozoa, 178 n. 5 analysis of, 89, 131 presence in fallopian tubes of, 143 quality of, 160–61 shapes of, 160 timing of introduction to ova of, 144 tryst between egg and, 140 See also semen The Sperm Meets Egg Plan (Roy), 154 Spontaneous and Habitual Abortion ( Javert), 93, 120, 122–23 Squier, Raymond, 110 Starling, Ernest Henry, 78 Steinem, Gloria, 163 Stekel, Wilhelm, 121–22 Steptoe, Patrick, 1, 145 sterile female bodies, 19 sterile marriage/couples, 88–89, 90, 91, 93, 96 sterility biochemical degrees of, 87 causes of, 133

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cures for, 29, 34 definitions of, 66 degrees of, 87 diagnosis of, 52 first use of term “sterile,” 28 mainstream use of term, 34 metaphors for, 19 natural versus artificial, 63 psychogenic, 97–98 risk factors for, 35 Sims’s categorization of, 31, 60–61 Spencer’s use of term, 49 surgical remedies for, 88 (see also Sims, J. Marion) types of, 66 See also childlessness; infertility “Sterility Can Be a State of Mind” (Kinsler), 120 sterility/infertility clinics, 93, 129–31, 133, 135, 147 stratified reproduction, 7–8 sublimation, in Freudian theory, 102–3 Suleman, Nadya (Octomom), 159, 160 superego, 103, 105 surgical remedies for infertility, 29–31 Clinical Notes on Uterine Surgery (Sims), 19, 33–34 survival of the fittest, 39, 46–47 in social evolutionary theory, 46–49 symbolic actions, 40 synthesis of materials, 76–77 synthetic correctives, 76 synthetic hormones, 84, 93, 94, 95, 143, 164–65 temperature. See basal body temperature (BBT) temporary fertility, 148–49 terminology/language bias in, 162–63 biochemistry, 78 of chemical agency, 84 chemical nomenclature, 74, 75 definitions for involuntary childlessness, 8–9 descriptions of married women without children, 17 discipline-related vocabularies, 117–18 fertility-related, 2 first use of “hormones,” 78, 82 “frigidity,” 164 infertile couples, 8 “infertility” in contemporary women’s health, 18 infertility-related, 71 in medicalization of infertility, 127

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224

index

terminology/language (continued) public vocabularies, 11 of refutations and appeals, 63 in Sex in Education, 50 shift from “barren” to “sterile,” 29 of sterility, 28 twenty-first century, 164–65 women’s reproductive health, 38 testicles, 71, 78, 79, 89 testicular extracts therapy, 71–72 test tube babies. See in vitro fertilization (IVF) Texas Health Journal, 55 theories antagonism theory, 80–81 atomic theory, 73, 75 castration theory, 108 chemical theories of infertility, 94–95, 94–96, 98–99, 109, 124 Clarke’s theory, 59 comparative theory of time, 4 corpuscularism theory, 73 dietary needs, 23 early chemistry, 74 early conception, 21–22 endocrine-oriented, 81 energy conservation and fertility, 64–66 evolutionary (see social evolutionary theory) gynecological, 38, 42 of history, 74 hormonal theory of reproduction, 79 humoral theory, 22 of instincts, 102–5 maternal impressions theory, 25 of maternity, 149 of menstrual cycle, 60 nervous theories, 79 of orgasm, 22 oxygen theory of combustion, 74–75 psychoanalytic (see psychoanalytic theory) psychosexual development, 107, 112 semence theory of pregnancy, 21–22 sexuality, 101–2 survival, 46–49 theoretical depictions of infertility, 4–5 Three Essays on the Theory of Sexuality (Freud), 102, 111–12 use-inheritance theory, 46, 51, 55 See also Freudian theory thermodynamics, first laws of, 43 Thompson, Andrea, 149 Thompson, Clara, 109

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Thompson, Lana, 128 Three Essays on the Theory of Sexuality (Freud), 102, 111–12 time, conceptualizations of, 171 n. 16, 184–85 n. 7 Time-Life books, 135, 146, 150 time-oriented research, 137 timing, reproductive. See reproductive timing tomboys, 121 top-down model of public understanding, 9 treatment methods access for LGBTQ community to, 7 chemical, 91–92 costs of, 7 endocrine therapies, 93–94 for fertility, 92 hormone therapies, 71, 93–94 for husbands, 134 insurance coverage for, 7 integrated investigation of, 134 medicalized, 1–2, 96 scientific advances in, 91–93 seeking, 146 submitting to, 96 success of, 147 surgical remedies for infertility, 29–31 testicular extracts therapy, 71–72 urgency for using, 142–45 See also in vitro fertilization (IVF) trying to conceive (TTC), 153, 165 “Two Million American Homes Childless” (Meaker), 92 unhealthy womb, 158 United States, in vitro fertilization procedures done in, 1 urgency for treatment, 142–45 use-inheritance theory, 46, 51, 55 uterus hostile/irritable, 119–20 infantile, 121 irritability of, 128 sedation of woman for calming, 120 Sims’s classification of, 31 utopianism, 143–44 vernacular healers, 21–24, 26, 154 vernacular rhetoric, 11, 59, 76, vesico-vaginal fistula, 29–30 victims, Anglo-Saxon women as, 54–57 visualization of uterus and ovaries, 142, 147 vis viva (living force), 43

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index vital forces, 42 vitalism, 77 vocabularies. See terminology/language voluntary childlessness, 66, 69, 173 n. 6 vomiting during pregnancy, 121–22, 125 Walker, James, 29 “Why Don’t We Have a Baby?” (Davis), 90 Wittner, Asta J., 88 womanhood, 7 women of color, 159–60 women’s rights movement, 67, 115 Worcester District Medical Society, 95

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working women, 55 careers and motherhood, 151 during pregnancy, 158–59 sacrifices made/not made by, 120–21 vital energy of, 86 World Congresses on infertility studies, 135–36 worldviews, oppositional, 50 Wright, Carroll, 61 Youmans, Edward Livingston, 44 Zimmerman, David R., 145

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