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 Medicine, the Penal System
and Sexual Crimes in England,
1919–1960s
 Medicine, the Penal System
and Sexual Crimes in England,
1919–1960s

Diagnosing Deviance

Janet Weston
 BLOOMSBURY ACADEMIC
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First published 2018

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Names: Weston, Janet, author.
Title: Medicine, the penal system, and sexual crimes in England, 1919-1960s :
diagnosing deviance / Janet Weston.
Description: London ; New York : Bloomsbury Academic, an imprint of
Bloomsbury Publishing Plc, 2018. | Includes bibliographical references and
index.
Identifiers: LCCN 2017025356 (print) | LCCN 2017045604 (ebook) | ISBN
9781350021075 (ePDF) | ISBN 9781350021082 (ePUB) | ISBN 9781350021099
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Subjects: LCSH: Sex crimes--England--History--20th century. | Sex
offenders--England--History--20th century. |
Punishment--England--History--20th century.
Classification: LCC HV6569.G7 (ebook) | LCC HV6569.G7 W47 2018 (print) | DDC
365/.667--dc23
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ISBN: HB: 978-1-3500-2109-9

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For Owen
 Contents

Acknowledgements viii
Abbreviations ix

Introduction 1
1 Curing Crime 19
2 Studying Sexual Offenders 39
3 Explaining and Treating 59
4 Giving Evidence 81
5 Delivering Cures 101
Conclusion 123

Notes 133
Bibliography 176
Index 202
 Acknowledgements

In many ways, this book was made possible by Birkbeck, University of London.
Directly, the research for it was funded by their School of Social Sciences,
History and Philosophy, and I would like to extend my thanks to the anonymous
donor whose generosity made this possible. Indirectly, it was enabled by the
opportunities for part-time and evening study at Birkbeck, without which I
would probably not have returned to academia at all.
I have benefited enormously from the wisdom and enthusiasm of many
scholars, at Birkbeck and beyond. Special mention must go to Joanna Bourke,
who has supported this work from the outset and has been unwaveringly
enthusiastic about its potential. Encouragement and advice at various stages
from Sean Brady, Matt Cook, Hazel Croft, Daniel Grey, Japhet Johnstone, Julia
Laite, Hilary Marland, Susie Shapland and Nikolaus Wachsmann has been very
much appreciated, as have the thoughtful comments of anonymous reviewers
for the Canadian Journal of History, where an early version of some of the
work behind this book appeared. I have also been lucky to find a welcoming
postdoctoral home at the Centre for History in Public Health at the London
School of Hygiene and Tropical Medicine, where this book was finished.
I am grateful to the archivists who have searched their repositories and
responded to my queries, even when their answers were in the negative.
Staff at Birmingham Archives and Heritage, the British Library, the London
Metropolitan Archives, the Modern Records Centre in Warwick and the West
Yorkshire Archive Service have all been especially helpful. I am also grateful to
the staff of the Centre for Crime and Justice Studies, who very kindly allowed me
access to their historical records.
My family and friends have excelled themselves in their displays of confidence
that this project was both achievable and worthwhile. For this and much more
besides, my particular thanks go to Owen Roberts. His boundless support and
encouragement, his imagination and his willingness to read and debate endless
drafts of this endeavour, have made all the difference.
 Abbreviations

BMA British Medical Association

BMJ British Medical Journal

DSM Diagnostic and Statistical Manual of Mental Disorders

ECT Electroconvulsive therapy

ISTD Institute for the Scientific Treatment of Delinquency

JMS Journal of Mental Science

KC King’s Counsel

NHS National Health Service

RAF Royal Air Force

SOTP Sexual Offender Treatment Programme

VD Venereal disease
 Introduction

In the late 1960s, Russell George, a convicted sex offender, reflected upon others
‘like me’ and wished vehemently that someone could ‘get them to see there is
something the matter with them, but that it’s something there’s treatment for,
that it can be cured’.1 This was a remarkable statement. Medical treatment to
‘cure’ offenders of their criminal conduct had been all but unheard of fifty years
earlier, and sexual crime had certainly not merited any particular attention from
doctors in England. And yet, by the time of Russell George’s prosecution and
referral to a psychiatrist, cures for criminal tendencies had achieved acceptance
in many quarters and treatment was being offered in a range of settings.
Treatment for sexual offenders still occupies something of a distinctive place
within many penal systems today, with specialist programmes (and even some
prisons) catering solely for this group. As ever-growing numbers of sexual
offences and offenders are identified in both the recent and more distant past,
ideas of illness and cure have adjusted to accommodate the apparent scale of the
problem: the early twenty-first century sees many nations, including England,
thinking about sexual crime as a matter of public health.2
This book examines the evolution of medical approaches to sexual offenders
in England. Why did doctors become involved in the case of someone like Russell
George? How did appointments with a psychiatrist instead of a sentence of
imprisonment emerge as one possible solution to his crime? What theories and
practices shaped the treatment he received? And why, if he was cast as a patient
in need of cure, were other sexual offenders ignored by doctors and simply
punished as wrongdoers? As we respond to an apparent epidemic of sexual crime
in our past, present and probable future, the answers to these questions offer
some context. They show how the idea of the sexual offender has been formed,
why some manifestations of sexual crime have generated particular concern
amongst medical and legal professionals, and how these ideas and fears related
to beliefs about punishment and rehabilitation, sexuality, gender, respectability
2 Medicine, the Penal System and Sexual Crimes in England, 1919–1960s

and of the role of the state. The chapters that follow also explore how doctors,
the judiciary and offenders themselves have made use of the remarkably flexible
system of beliefs that emerged over the early twentieth century in their struggle
to account for some forms of sexual misconduct. This flexibility has been vital
to the usefulness and longevity of medical models of sexual crime, but it has also
masked the contradictions and confusions that lie beneath.
This is a history of ideas and practices within medicine, and particularly in
psychiatry. Changing concepts of mental disease were vital in shaping medical
understandings of sexual crime, as were innovations in medical technologies
and evolving professional identities and specialisms. These specialisms and
innovations were not neatly contained within medicine, though. They also
involved legal and penal, ideas, experts and systems. As historians have begun
to argue, twentieth-century psychiatry operated in many non-clinical settings
and occupied the minds of many more than just its practitioners and patients.
Psychiatry was not so much expanding as becoming absorbed into a ‘complex
ecology of sciences, technologies, policies and actors’, all of which attempted to
address problems such as sexual crime.3 It is this ecology, approached through
medical thought but encompassing many other fields associated with criminal
justice, that this book will examine.
English doctors acknowledged sexual abnormality or disorder as an
acceptable medical specialism in the interwar years, as part of a broader interest
across medical, legal and penal fields in the rehabilitation and reform of the
criminal. Doctors working in prisons and in specialist clinics for the treatment
of delinquency had an important role to play in shaping medical approaches
to sexual crime. Virtually unchanged in twentieth-century law until the 1967
Sexual Offences Act, encompassing an enormous variety of offences, and
steeped in beliefs about morality and society, sexual crime attracted considerable
attention amongst medico-legal professionals and provided a welcoming arena
in which new ideas could be explored, and older beliefs could find validation.
The particularities and personnel of the English legal and penal systems were
also influential. Differences between English legal and penal traditions and their
counterparts abroad help to explain why the uses of medical theories about
sexual crime have had such different outcomes in different national settings: the
history of these traditions in England is therefore an important part of the story.
What follows makes the case that sexual crime and sexual offender are fruitful
categories of analysis. The sexual offender was often conceptualized as a particular
problem over the course of the twentieth century, presenting particular threats
or challenges and requiring special measures including medical interpretation.
 Introduction 3

Tracing the medical theories that emerged and the ways in which they were
used reveals important features of medico-legal thought and practice which are
at risk of being obscured if sexuality is considered more narrowly. Histories of
sexuality have tended to focus upon particular categories of sexual identity or
activity that are familiar and meaningful to us now, but may not have been so to
the historical actors under investigation. Homosexuality in particular has come
under scrutiny, in the form of projects to locate homosexual individuals and acts
in history, or to explore the ways in which same-sex intimate relationships have
differed from those of today. These efforts either to identify or to complicate
particular aspects of sexual life in the past with reference to contemporary sexual
identities, dubbed ‘ancestral genealogy’ and ‘queer genealogy’, respectively, by
cultural historian Laura Doan, may be productive on their own terms, but tend
to enforce distinctions that may be historically inaccurate.4 Moving away from
twenty-first-century conceptions and definitions of sexual deviance and sexual
crime therefore adds depth to our understanding of the history of sexuality and
its encounters with medicine.
This approach reveals that the precise nature of a sex crime was not disregarded
but that it was not always the most important consideration. Crimes considered
abnormal attracted more medical attention, but within this group the diagnosis
and prognosis could vary dramatically. Clinical theory and practice in relation
to sexual offenders were remarkably diverse, but this diversity was key to their
usefulness for doctors and the judiciary alike. Doctors did not generally adhere
to any single theory of causation, nor claim that any particular type of crime
or underlying disorder could always be cured by their methods of treatment.
Their careful weighting of many different possible factors, from personal
circumstances and age to sexual history and personality, allowed their diagnoses
and prognoses to remain extremely flexible. This acceptance of ‘ontological
anarchy’, a term coined by medical sociologist Martyn Pickersgill, allowed a
new and potentially fragmented profession to remain united.5 It also enabled
doctors to explain the wide variety of outcomes that appeared to emanate from
their research and treatments, and responded to judicial and penal concerns and
structures as well. The plurality of medical thought regarding sexual offenders
meant that expert evidence could be a necessary feature of one case but irrelevant
in another, allowing the judiciary to exercise their discretion and justifying a
range of conclusions about the sexual offenders appearing in court.
The growth of medical interest in sexual deviance was a gradual process,
with origins that predated the twentieth century. The starting point taken here
is a modest but significant development for the medical profession which took
4 Medicine, the Penal System and Sexual Crimes in England, 1919–1960s

place in 1919. At a meeting of the Birmingham judiciary that year, it was agreed
that in relation to many crimes, ‘some mental instability is the fundamental
cause’ and ‘the problem has now become acute’. In an experimental response
to this impending crisis, a section of Birmingham Prison’s hospital was set
apart for cases of ‘mental disturbance’, and ‘a special Medical Officer’ was
despatched by central prison management to assist. This Prison Medical Officer,
Dr Maurice Hamblin Smith, was something of an expert in mental disorder,
a self-professed ‘convinced and unrepentant Freudian’ whose two decades
of experience working within prisons would lead him to conclude that ‘every
offender presents a problem in mental pathology’.6 His role advising the worried
Birmingham judiciary on matters of mental illness was indicative of post-war
anxiety surrounding mental disturbance amongst demobilized soldiers, and a
growing interest in psychoanalysis and psychological explanations for crime as
well. As an innovation requested by the judiciary and endorsed by the Home
Office, it marked official engagement with medical approaches to criminality.
Over the next four decades, discussions proliferated around the use of
medicine in rehabilitating or even curing offenders. The sexual offender was
frequently cited as a type of criminal who was particularly likely to suffer from
mental disorder, and therefore demanded careful medical enquiry. However,
not all sexual crimes were given equal weight. Some offences generated
particular concern amongst medico-legal minds at particular times, such as the
well-documented flourishing of medical debate and interpretation regarding
homosexual offences in the years following the end of the Second World War,7
while others like rape and sexual assault of women were consistently ignored.
Medical models of abnormal and normal sexual conduct reflected broader
ideas about crime, mental illness and masculinity, while uses of medical models
revealed unspoken assumptions and practical considerations to do with gender,
respectability, treatment, punishment and the legal system itself. Although some
of the innovations that were introduced elsewhere in the world from the 1920s
onwards did not find favour in England, such as the use of surgical castration
or sentences for custodial psychiatric treatment, the middle of the century saw
considerable enthusiasm for the idea that at least some types of sexual offender
could be reformed. But the 1960s saw challenges to this mood of therapeutic
optimism. Changing attitudes towards gender and sex, medicine and psychiatry,
and the project of rehabilitation all tempered the energy of earlier years. Medical
approaches to sexual crime were more or less firmly established with the English
penal system by the end of the 1960s, but a modest golden age of research and
reform in the name of curing sexual deviance had come to an end.