Edith Houghton didn’t have her heart set on medical school. But after she graduated from Bryn Mawr in 1900, she packed her bags and headed for Baltimore. Her mentor, M. Carey Thomas, had taken an interest in Edith, who excelled in chemistry and math, and encouraged her to pursue further studies at Johns Hopkins Medical School, which Thomas had helped to finance.
Edith spent much of her time at Johns Hopkins working with gynecologist Dr. Howard Kelly. With him, she worked at outpatient clinics in Baltimore where she became alarmed by high rates of sexually transmitted infections. She was particularly fascinated by the way the infections manifested. It seemed that women and men were having different experiences, both medically and socially. Medically, ciswomen were less likely to notice mild symptoms of STIs, as they tended to overlap with common occurrences like discharge and heavy periods. As infections progressed, they became easier to diagnose but harder to treat. Oftentimes, care was sought only when an STI had morphed into a more severe ailment, like salpingitis, a pelvic abscess, or pelvic inflammatory disease. These could require serious treatments that sometimes rendered women unable to have biological children.
Edith felt for the women in this situation, especially because they were often unaware of the true nature of their maladies. The medical community debated whether they should tell female patients about their STIs. In November 1904, the Obstetrical Society of Cincinnati heard a paper called “The Ethics of Gonorrhea in the Female,” in which a Dr. Hall argued that a married woman shouldn’t be told about her infection. To disclose a married woman’s STI status would, he thought, reveal that her husband had committed adultery, which was one of the few grounds for divorce at the time. For that reason, Dr. Hall argued that it wasn’t “the doctor’s business to step in between husband and wife, cause disturbance and perhaps lay the foundation for a divorce suit.”
“When I was working out my apprenticeship in the hospital,” Edith noted, “these cases always seemed to me imbued with a peculiar bitterness. The woman was so sinned against, and yet the burden of disappointment was in such large measure hers alone to bear.”
In many ways, it was this inequity that ignited Edith’s passions most acutely – but her work did not continue at Johns Hopkins. She met, fell in love with, and married classmate Donald Hooker after he graduated in 1905. Edith was slated to graduate the following year, and perhaps would have, but instead she chose to travel with Don to Berlin, where he studied under German venereal disease experts Drs. Blaschko and Marcuse.
Blaschko and other experts believed they had identified the root of STIs – sex work. As urbanization and industrialization increased, so did sex work, and so did STIs. As Edith’s mentor, Dr. Kelly, had put it in 1905, “there would be no question as to . . . venereal diseases were it not for prostitution.” In Germany, attempts to regulate sex work in order to curb infections seemed to be ineffective, and Edith and Don, along with many others, came down resoundingly on the side of eradicating the practice altogether.
The Hookers returned to Baltimore in 1906. Don began teaching at Johns Hopkins and Edith set to work thinking about the best way to eliminate STIs. A 1907 report, spearheaded by Don, confirmed their fears that these infections were affecting a large portion of the population. The report found that, of 2,000 adult men who had sought care in Baltimore in 1907, 46% admitted to having had gonorrhea and 10% to having had syphilis.
Convinced that eliminating sex work was the key to eliminating these infections, Edith looked at the structural elements at play. Technically, sex work was illegal, but police officers – all men – tended to look the other way when patrons –also men – hired a sex worker. It was a gendered social problem in which the nominal laws against sex work were a farce. “Imagine for a moment,” she wrote in 1912,
a community in which 90 per cent of the voters admitted murder as an incident in their personal histories, and in which murder was licensed by the police and the officers of the law in certain districts, and in which it was an absolutely non-punishable offense if committed anywhere by a man. Would it not be very like attempting to lift one’s self over the fence by one’s own boot-straps for these unfortunates to attempt to eradicate murder in their midst, especially if the government provided absolutely no facilities for detective service? The situation is precisely the same with regard to the social evil [sex work]. Most men are or have been immoral, the law licenses immorality in certain districts, and immorality as such on the part of man is absolutely non-punishable anywhere. 
Edith proposed a simple solution to this thorny problem. If women could enter the political power structure through the vote, they could make sex work actually instead of nominally illegal. “The enfranchisement of women,” she explained, “is fundamental to the solution of the problem.”
And so Edith dedicated her life to suffrage and reform for the next decade. In many ways, this work was a natural fit, in line with the priorities of existing women’s reform movements. Groups like the Women’s Christian Temperance Movement had supported suffrage since 1881 and had long been concerned with STIs and gender parity in marriage. They were anti-alcohol and believed in banning sex work. Edith’s work fit into this tradition neatly.
As the 1910s proceeded, Edith became active in local, state, and national suffrage groups. She hung posters, distributed literature, held open-air meetings, and agitated for suffrage until 1920, when the 19th Amendment was ratified.
For all the public-facing work Edith did during this decade, she never spoke to a wide audience about the effects she believed suffrage would have on sex work and STIs. She focused instead on more socially acceptable talking points about how the vote would allow her, and all women, to be better wives and mothers.
But when women’s suffrage was finally legalized, it became clear that she had never forgotten her roots. “The emancipation of women,” she wrote in March 1920, “has now opened the door to reason and justice in the dark realm of sex, and the time has at last arrived when mankind may antiquate the solution of the social evil.” Hooker had never imagined suffrage as an instantaneous solution to the problem. She predicted in 1912 that efforts would “keep women busy for a generation or so after they become enfranchised, but then the social evil will begin to disappear.”
Edith “kept busy” in many different ways during this time. She advocated for women to have the right to sit on juries and run for office. She knew Margaret Sanger and advocated for early birth control methods, and wrote a book in 1921 called The Laws of Sex in which she pontificated on nearly every aspect of sex, marriage, and love.
During World War I, Edith became deeply concerned about how the government should handle STI rates in the army. In addition to providing information and treating any existing infections, some experts proposed providing prophylaxis. Edith was appalled. The army was clear in its messaging that extramarital sex was not to be tolerated. Providing prophylaxis was, then, in her mind, hypocritical. “There is but little use in verbally telling boys that immorality is an unnecessary evil,” she wrote, “if at the same time they observe that the state makes provision for it.”
Edith was convinced that sex, morality, STIs, and medicine were all inextricably tied together and that moral measures should solve medical problems. This is not to say that the line between “medical” and “not medical” is so well defined, or that instruction around behavior isn’t important, but her dogmatic approach to the issue is perhaps the most important takeaway when thinking about Edith Houghton Hooker’s life.
It is, after all, 2021, and both sex work and STIs are alive and well. The United States is now experiencing all-time highs of STIs. Edith’s theory that women’s suffrage would bring an end to both seems wrong by all measures. In fact, it seems clear that when rates of infection historically did go down, it was not as a function of “higher morality,” but instead of reliable medical intervention.
And while Edith’s ways of thinking may seem outmoded, these beliefs are still quite prevalent, and troubling. Thirty-four states require schools to “stress abstinence when sex education or HIV/STI instruction is provided.” This type of education rests on moral ideals about what sex is acceptable, rather than medical advice about how to prevent STIs. It has been proven to be significantly less effective than comprehensive sex education, which includes information about contraception. Yet abstinence-only sex education continues to be funded by the government, and its proponents remain vocal. It is clear that we have not yet disentangled medicine and morals when it comes to sexuality, and that it continues to be an urgent need.
- Leslie Mukau, “Johns Hopkins and the Feminist Legacy: How a Group of Baltimore Women Shaped American Graduate Medical Education,” American Journal of Clinical Medicine 9, no 3. (2012): 118. ↑
- E. S. McKee, “The Ethics of Gonorrhea in the Female,” Lancet-Clinic 54, no 1 (January 21, 1905): 74–77. ↑
- Edith Houghton Hooker, Life’s Clinic (Survey Associates, 1916), 5 ↑
- “Hooker-Houghton,” Society News, June 15, 1905. 6. ↑
- Edith Houghton Hooker, Laws of Sex (Gorham Press, 1921), 7. ↑
- Howard A. Kelly, “What Is the Right Attitude of the Medical Profession Toward the Social Evil?” Journal of the American Medical Association 44, no 9 (1905): 679. ↑
- Donald Hooker, “Some Facts Indicating the Importance of the Work Suggested by the Committee on Sanitary and Moral Prophylaxis,” Maryland Medical Journal 51, no 1 (February 1908): 58–65. ↑
- Edith Hooker, “The Solution,” Maryland Suffrage News, December 7, 1912. 144. ↑
- Ibid. ↑
- Edith Hooker, “Should Women Vote?,” Baltimore Sun, May 9, 1909. ↑
- Edith Houghton Hooker, “The Modern Social Hygiene Program: A Constructive Criticism,” The Survey, Social, Charitable, Civic: A Journal of Constructive Philanthropy 43, no. 19 (March 6, 1920): 707–12. ↑
- Edith Hooker “The Solution,” Maryland Suffrage News, December 7, 1912. 144. ↑
- Edith Hooker, “The Basic Argument Against Prophylaxis,” The Arbitrator 2, no. 5 (October 1919): 2–9 ↑
- S. O. Aral, et al. “Sexually Transmitted Diseases in the USA: Temporal Trends.” Sexually Transmitted Infections 83, no. 4, (2007): 257–66. https://doi.org/10.1136/sti.2007.026245. ↑
- “2021 Sex Ed State Law and Policy Chart” SIECUS. 3. ↑
Well done, Margaret! Very interesting. Wonder if we can claim any relation to Edith Houghton. Would be so proud to say we did!