One day in 1779, a London couple, seeking treatment for their seven-year-old daughter, showed up at the Soho Square Dispensary for the Relief of the Infant Poor. The first doctor thought she might have a hernia. The second had a different idea. 

“I shall not trouble the reader with the surprise into which the parents were thrown when I first told them their child was not a girl, as they had supposed, but a boy,” wrote the second doctor. The case was recently discovered in the archives of the University of Kansas and written up in the latest issue of the journal Sexualities.

In the early 2000s, Carol Warren—then a professor of sociology at the University of Kansas—was researching the history of electricity in the college’s rare books library when she noticed an old pamphlet with an eye-catching title: “The case of a boy who had been mistaken for a girl; with three anatomical views of the parts, before and after the operation and cure,” by a surgeon called Thomas Brand. “I was looking through a bunch of materials that had been shoved together, and this one appeared,” recalls Warren. 

According to Brand's report, published in 1787, he noticed an “irregularity” in the patient’s “external parts.” After further examination, he concluded that the child’s “part, which had the appearance of the labia pudenda, was in fact the scrotum,” and suggested an “operation to free the penis from its confinement.” He went ahead and made some alterations, enabling the child—whose name is unknown—“to urinate standing up, wear trousers, and enjoy the privileges of being a male.” Brand, who practiced at the Royal Hospital at Greenwich, was “not a quack,” according to Mary Fissell, a professor of the History of Medicine at Johns Hopkins who I spoke to on the phone. 

Sexualities

Eight pages long, with three illustrations of the child’s anatomy, the pamphlet may describe one of the earliest instances of sex-change surgery. “The first case that I found (in America) was in the 1840s, and it was received quite critically by fellow physicians,” writes Elizabeth Reis, author of Bodies in Doubt: An American History of Intersex and professor of women's and gender studies at the University of Oregon, in an email.

Brand saw the operation not as sex change, but as a means of returning the child to his “proper” gender; Brand seemed to believe that only two distinct sexes were possible. He denied the existence of hermaphrodites, although he was familiar with the concept: “The term ‘hermaphrodite’ is properly understood as an animal that has both the male and female organs equally and perfectly formed,” he wrote. “But,” he goes on, “There is no reason to believe that such a case ever had existence in the human subject.” 

Brand’s attitude toward sex and gender was consistent with the predominant view of his time; according to eighteenth-century norms, sex was a medical fact that had nothing to do with choice or personal expression. In fact, neither the patient nor his parents seem to have even been consulted. “Gender wasn't conceived of as a form of identity,” says Warren. “It was conceived of as a form of body.” The idea of a person being "transgender," of course, is not something that would enter common conception until about two centuries later.

“Certainly this is unusual for the time period,” says Fissell. But it isn’t necessarily implausible: “In the late eighteenth century, people were doing a little more adventuresome surgery,” she says. Hospitals in England were also growing, and new ones were being established; operations were becoming safer as reformers improved unhygienic practices; surgeons were gaining more experience, and becoming more experimental, as they learned to treat injuries from new types of weapons. The surgery Brand described fits in, broadly, with the historical record. “That's the kind of operative surgery they were doing at that point,” she says. “It’s not invading a major body cavity. It’s not opening up the abdomen or the chest. People wouldn’t have survived that.” Despite rapid advances, surgeons were limited by the lack of effective anesthesia and, without antibiotics, deterred by the possibility that any infection could be fatal. 

Some scholars, however, take issue with Warren’s labeling the surgery “gender reassignment.” From a technical point of view, it’s probably an exaggeration; and, in the history of Western thought on gender and sexuality, it’s out-of-place. “It's a little anachronistic to call it that,” says Fissell. “That’s not what he thought he was doing.” He didn’t believe he was changing or reassigning the patient’s sex—just “repairing.” Since the mid-twentieth century, it’s been medically possible for individuals identifying with a gender other than the one they were born with to undergo surgical procedures or hormonal therapy—the first known “gender reassignment” was performed in 1930—but the case Brand describes had nothing to do with the patient’s preference.

“I wasn’t surprised to read that the patient had little say in the matter," says Reis. “Even today, intersex activists are lobbying for physicians to give children born with atypical sex development more say in the way their bodies are treated; in other words, to hold off on genital surgery until their sense of their own gender identity has been formed, and they can decide whether they want any surgical or hormonal intervention.” Some things have changed immensely—others, less so.