Mutants

by Armand Marie Leroi

  The pervasive attractions of height present us with a dilemma. As we learn more about the molecular mechanisms that control height, we will be able to manipulate with ever greater subtlety the size that we, or rather our children, grow to be. But what size should we be? The boundary between normal and pathological height is never distinct: it is a grey zone, dictated by clinical possibility, or even convenience. There are, it is true, many diseases, genetic or otherwise, of which shortness is symptomatic. But shortness, even when genetic in origin, is not always, or even most of the time, a disease. In the United States, some thirty thousand short children are currently being given recombinant growth-hormone supplements to make them grow. Most of these children are growth-hormone deficient, and for these the treatment is quite appropriate. But about a third of them have what is called ‘idiopathic short stature’. That is, they are not short because they are malnourished, or because they are abused, or because they have anything identifiably, clinically, wrong with them – they are merely short. They are given growth hormone because their parents would like them to be taller.

  I wonder if this is right. Giant dogs and dwarf mice suggest that growth hormone affects bodies in ways that we do not yet fully understand. Given this, it is surely neither radical nor Luddite to suggest that we should not manipulate our children’s height when there is no good medical reason to do so. It is not just a matter of growth hormone either. As we learn more about the molecular devices that make us the size we are, the temptation to apply them will become ever greater. The boundary between the normal and the pathological is not only indistinct; it is mobile, ever shifting, ever driven by technology. In a way this is just as it should be. The transformation of biological happenstance into definable, curable disease is little less than the history of medicine. Should it be also this way for height? Tallness may be correlated with all sorts of desirable things, and few short men may have become President of the United States, but these are not really terribly interesting observations. Studies of short children have shown what we might have guessed: that of all the things that might affect a child’s chances for happiness and success in life, height is among the least important, far less important than intelligence, health, or the quality of care the child gets from its parents. And as we mark, with pride or anxiety, the progress of our children on doorframes, it is this that we should remember.

  VII

  THE DESIRE AND PURSUIT OF THE WHOLE

  [On gender]

  IN FEBRUARY 1868, a Parisian concierge entered one of the rooms under his care. The room, a mere garret, dark and squalid, on the rue de l’École-de-Médecine, contained only a bed, a small table, a coal-gas stove, and a corpse. Cyan-blue skin and a dried froth of blood upon still lips showed that the stove had caused the death; the corpse itself was what remained of a twenty-nine-year-old man named Abel Barbin.

  The coroner would call the death a suicide, and without a doubt, so it was. But, as the autopsy report makes clear in the matter-of-fact prose of the morgue, the death of Abel Barbin was not a tragedy compounded merely from the usual ingredients of poverty and solitude, but also from an error that had occurred thirty years before. It was the long-delayed dénouement of a mutation that caused a single enzyme within Abel Barbin’s body to fail, and fail critically, somewhere around April 1838, seven months before he was born. We know this, for we know that when the future Abel Barbin was first lifted to his mother’s breast, it was not a son that she thought she held, but rather an infant girl.

  HERMAPHRODITUS ASLEEP. AFTER NICHOLAS POUSSIN 1693.

  This chapter is about the devices that divide the sexes and what happens when they fail; the errors that occur at that fragile moment in the life of a foetus when the events, molecule binding to molecule, take place that will decide its fate as a girl or a boy. It is about genetic mistakes that start as disorders of anatomy and end as disorders of desire. ‘A man shall leave his father and his mother and cleave unto his wife and they shall be as one flesh.’ Yes, but only if he is able: the biblical injunction, so blithely given, assumes so much. Not least that we know whether we should be man or wife, but that flesh will permit us to be one with another. But some of us do not know, and for some of us flesh does not permit. When it comes to sex, we are unforgiving of mistakes.

  The child who would become Abel Barbin was born in Saint-Jean-d’Angély, a quiet and rather dull town on the coastal plain of the Charente, four hundred kilometres south-west of Paris. She was baptised Herculine Adélaïde Barbin, though she would call herself Alexina. She had, by her own account, a happy childhood. At least, so she would recall, years later, when writing her memoirs. She was twelve and in love:

  I lavished upon her a devotion that was ideal and passionate at the same time.

  I was her slave, her faithful and grateful dog.

  I could have wept for joy when I saw her lower toward me those long, perfectly formed eyelashes, with an expression as soft as a caress.

  The object of her passion was an older friend, the daughter of an aristocratic family, fair and possessed of the delicate beauty and languor of the consumptive. Alexina, on the other hand, was dark, swarthy and graceless – or so she describes herself. What is more, she was from a poor family; was, indeed, a charity case in a convent school that catered to the local haute bourgeoisie and nobility. If the words with which she recalled her love seem to have a tinge of melodrama about them, we must remember that the language of Romanticism would have come naturally to a French schoolgirl of the 1850s; a language in which to love, to truly love, was to exalt the beloved, to abase oneself, to love without hope of return (one thinks of Stendhal’s De l’amour); and passionate friendships were nothing strange.

  Alexina was a model student, a favourite of the Ursulines who taught her. True, she would sneak to her blonde friend’s cubicle at night (and, when caught, was nearly refused First Communion by her much adored and adoring Mother Superior). But such peccadilloes aside, she prospered, and at seventeen was sent to the nearby town of Le Château to train as a teacher. There, another friendship was formed, a more overtly sexual one. This was more troubling to the nuns.

  From time to time my teacher would fix her look upon me at the moment when I would lean toward Thécla to kiss her, sometimes on the brow and – would you believe it – sometimes on her lips. That was repeated twenty times in the course of an hour. I was then condemned to sit at the end of the garden; I did not always do so with good grace.

  Troubling, too, was Alexina’s failure to menstruate. Her journal is allusive and shamefaced on the fact, but her meaning is clear. Cures and diets were tried to no avail. Her looks failed to cooperate as well. As classmates blossomed into rounded womanhood, she remained thin and angular. She became increasingly hairy and took to shaving her upper lip, cheeks and arms to avoid girlish taunts. Life in the convent had other torments as well. A trip to the seashore: the girls strip to their petticoats and frolic in the waves; Alexina alone watches, afraid to disrobe, rent by ‘tumultuous feelings’. She has disturbing dreams.

  The following year, 1857, Alexina Barbin obtained a post as assistant teacher in a girls’ school and began the love affair that was to prove her undoing. The beloved was one Sara, a young schoolmistress like herself, with a cot in an adjacent dormitory. Instantly close, their friendship became one of tender attentions. Soon Sara was forbidden to dress herself; Alexina alone would lace her up – but not without planting a kiss upon a naked breast. More kisses in the oak-wood, the intensity of which Sara found puzzling but not, apparently, repugnant. Passionate outbursts followed: ‘I sometimes envy the man who will be your husband!’ And then, one night, Alexina won all and became her friend’s lover. ‘Ah well! I appeal here to the judgement of my readers in time to come. I appeal to that feeling that is lodged in the heart of every son of Adam. Was I guilty, a criminal, because a gross mistake had assigned me a place in the world that should not have been mine?’

  But even as Alexina tasted the joys of requited love, rumour
s of the schoolmistresses’ fondness for each other began to circulate. Her health was deteriorating too: ‘nameless, unfathomable’ pains pierced her in – we are left to infer – the groin. A doctor was summoned, and left shocked by what he found (‘My God! Is it possible?’). He suggested to the school principal that Alexina be sent away, but did so in terms far too oblique for any effect. And so, happy in love, Alexina stayed. But, tormented by guilt, she confessed to Monsignor J.-F. Landriot, Bishop of La Rochelle. This elderly and worldly priest listened with compassion, and asked if he might break the seal of the confessional to consult his doctor, a ‘true man of science’. And it is here that Alexina’s story no longer depends entirely upon her opaquely allusive memoirs, for Dr Chesnet published:

  Is Alexina a woman? She has a vulva, labia majora, and a feminine urethra, independent of a sort of imperforate penis, which might be a monstrously developed clitoris. She has a vagina. True, it is very short, very narrow; but after all, what is it if it is not a vagina? These are completely feminine attributes. Yes, but Alexina has never menstruated; the whole outer part of her body is that of a man, and my explorations did not enable me to find a womb. Her tastes, her inclinations, draw her towards women. At night she has voluptuous sensations that are followed by a discharge of sperm…Finally, to sum up the matter, ovoid bodies and spermatic cords are found by touch in a divided scrotum.

  Chesnet knew well what he had uncovered: Alexina was a hermaphrodite. Medicine may have recognised hermaphrodites, but not so the law or society. A choice had to be made, and those ovoid bodies decided it. Since the seventeeth century, medical convention had held that, when gender is in doubt, gonadal sex is what matters; and Alexina had testicles. It is still so: a modern clinician would call Alexina a ‘male pseudohermaphrodite’, for she had only testes (‘female pseudohermaphrodites’ having only ovaries and ‘true hermaphrodites’ having both). Leaving her employment and her lover, Herculine Adélaïde Barbin shortly became, by legal statute, Abel. He appeared in public to general scandal, suffered a brief flare of notoriety in the press, and fled to the anonymity of the capital where he attempted to start life anew. And it is in Paris, just a few years later, that the memoir ends. It was found beside the bed on which he died.

  GENITALS

  To understand Abel Barbin and the many others whose lives have fallen, and fall, between the two sexes, would be to know all that makes us male or female. And yet his story can be simplified, reduced to its essentials. It is not merely that he fell in love with one gender rather than another, nor even that he found himself in a body whose gender was poorly suited to his desires, nor even yet that he lived in times that were unforgiving – such stories are familiar enough. No, his story is more remarkable than any of these. It is about having a body that failed to negotiate either of the two paths to gender in an altogether convincing fashion. It is, fundamentally, a story about genitals.

  When we consider the male and female body we see in each, without pausing to think about it, an identity, a homology, to the other. A heart is a heart no matter which gender it sustains. Genitals are not so obvious. Their fleshy intricacies seem less versions of each other than organs of radically divergent construction which, somehow, miraculously enough, work together. Below the navel, we are mostly interested in the differences.

  Anatomists, however, have other tastes. Confronted with diversity, their instinct is to simplify and unify, to search for schemes that will yoke together the most unlikely structures. This theme – the finding of homologies – runs throughout this book. But here we’re concerned with something a little different: not homology among species that have long evolved apart, but rather between the two sexes. The first reasonable account of the correspondence between male and female genitals was given in 1543 by Andreas Vesalius, the founder of a great school of Renaissance anatomists at the University of Padua. Ovaries, he argued, were equivalent to testicles. And each female fallopian tube was equivalent to a male vas deferens, as was the uterus to the scrotum, the vulva to the foreskin, while the vagina, a hollow tube, was the female version of the penis itself. For Vesalius, then, female sexual organs were the same as those of males, but merely located internally. This theory seemed to explain everything. To give it maximum effect he illustrated it with a depiction of the vagina, cervix and uterus as male genitals in a state of perpetual semi-erection.

  FEMALE INTERNAL GENITALIA. FROM ANDREAS VESALIUS 1543 De humani corporis fabrica.

  Sex-education manuals invariably depict the male and female reproductive systems in some detail, often as two-toned tangles of labelled tubes. Unappetising though such diagrams may be, they are reasonably accurate. The reader who recalls one of the female reproductive tract will immediately observe that it bears little resemblance to Vesalius’. A close look at his diagram, figure twenty-seven from the fifth book of De fabrica, shows that it is wrong in a host of details. Vesalius showed the vagina as a long, stiff, rod-like structure, but it is not; nor does it have a swelling at its tip where the glans would be. And though the scrotum may be divided into two halves (by the raphe – the point of fusion between the two foetal genital folds), the uterus is not. Some of Vesalius’ errors were surely simply made in haste. His diagram was based on the remains of a Paduan priest’s mistress that had been illegally exhumed by his students, and suggests a swift and brutal dissection. Even so, the errors are puzzling; Vesalius is usually so meticulous. One cannot help but think that the vagina he drew is as much a product of what he saw on his dissecting table as it is of his theory of the unities between male and female.

  That such unities – homologies – exist is certain; it’s just that they’re quite different from what Vesalius thought they were. But Vesalius’ errors were not merely a matter of a bump more or a groove less. Allowing that it is difficult for us to see the world as a sixteenth-century anatomist did – to truly know what he did and did not know – as one looks at Vesalius’ diagram, one senses that something is awry with the whole thing; that something is simply missing. Indeed, that is so. Intimate though his knowledge of the female reproductive tract was, Vesalius failed to put his finger on the most important bit of all.

  It was another Paduan anatomist, Renaldus Columbus – the same Columbus who got into trouble over an extra rib – who, in 1559, discovered what Vesalius missed: the clitoris. He called it ‘the Sweetness of Venus’, and his description is evocative, ecstatic, and imprecise: ‘Touch it even with a little finger, semen swifter than air flows this way and that on account of the pleasure even with them unwilling … When women are eager for a man’, he continues, it becomes ‘a little harder and oblong to such a degree that it shows itself a sort of male member.’ But then he places this delightful organ in the uterus. And it is by no means clear that Columbus was really that original. Rival anatomists accused him of naming a structure that was already known to the Greeks.

  Even Columbus failed to find all there was to the clitoris. In 1998, to the delight of all who have ever perceived that there is more to sex than the titillation of what is, after all, a tiny piece of flesh, the clitoris more than doubled in size. A team of Australian anatomists (headed, perhaps unsurprisingly, by a woman) working on fresh, young cadavers rather than the preserved, elderly ones that are the usual fare of medical students, revealed that the clitoris is not merely the smallish stalk of anatomy textbook and sexological dogma, but a large fork-shaped structure that surrounds the urethra and penetrates the vaginal wall.

  It seemed a remarkable discovery; perhaps even the incarnation of Sigmund Freud’s much derided vaginal orgasm. In Britain, newspapers hailed the discovery and wondered how so marvellous a thing could have been missed for so long. Of course, it hadn’t been. The new, improved, clitoris is merely an old and well-described landmark that has been repositioned and reassessed. It is a structure long known as the vestibular bulbs, two obscure lumps of spongy tissue deeply riven with blood vessels. The seventeenth-century Dutch anatomist Jan Swammerdam thought they were part of the clit
oris, but the greatest of all students of the genitals, Georg Ludwig Kobelt (author of Die Männlichen und Weiblichen Wollusts-Organe des Menschen und Einiger Saugetiere, 1844), considered them with care and decided, on balance, that they were not. The issue turns on whether these bulbs have the kind of rich innervation that the glans clitoris and the glans penis both have. If so, then perhaps it is reasonable to label them as part of the clitoris. Nerves there are, indeed, but it is still not clear what, if any, sort of sensations they transmit. And that is surely the critical point: an expanded clitoris that is devoid of feeling is probably unworthy of the name.

  CLITORIS AND VESTIBULAR BULBS. FROM GEORG LUDWIG KOBELT 1844 Die Männlichen und Weiblichen Wollusts-Organe des Menschen und Einiger Saugetiere.

  Large or small, Columbus’s identification of the clitoris as ‘a sort of male member’ was accurate, if rather phallocentric. It solved part of the homology problem (clitoris = penis), but left the rest still obscure. What, then, was the female equivalent of the scrotum? And where was the male vagina? It was only in the nineteenth century that embryologists, tracing the development of the embryo’s organs, truly clarified what was homologous between male and female genitals and what was unique to each.

  By day 28 after conception the embryo is about half a centimetre long, has four small limb-buds, and a tail. This is when the first external signs of sex appear: nothing remarkable, just a small bump between the lower limb-buds and above the tail. The bump is the genital tubercle and it is soon surrounded by two small sets of folds, one inside the other.