In this impressive first book, historian of medicine Janet Weston examines the evolution of medico-legal approaches to the sexual offender to show how this very specific type of “criminal” was addressed by medical and legal professionals in the context of wider beliefs about rehabilitation, sexuality, gender, class, and respectability. The analytical framework highlights the interconnectedness of a range of important historical topics, including medical expertise, forensic psychiatry, prison medicine, probation, and legal procedure in the assize and police courts; ancillary points include risk management, the significance of free will in criminal law, the rise of the welfare state, and changing definitions of “normality.”

Three key themes emerge: the flexibility of medical approaches to sexual crime, the preponderance of practical rather than theoretical solutions for offenders, and the need for the cooperation of patient-prisoners in their own treatment. The medico-legal goal was to explain and cure, which is in part why women and girls are largely absent from the analysis. Not only was the victim's perspective difficult to access via the available printed sources, but female offenders were both limited in number and seen as medically uncomplicated; their motives were taken to be excess sexuality and lax morals, which were socially unacceptable but not psychologically interesting. Male offenders, by contrast, posed a medical challenge if their offense was considered abnormal or perverted. Therefore rape and indecent assault of women and older girls could be considered understandable expressions of male sexuality, for which the appropriate sanction was not treatment but punishment. Instead, the main areas of focus for psychiatrists and prison medical officers were homosexual offenses, indecent exposure, and the indecent assault of children. There was no linear path toward judicial acceptance of medical opinion in such cases, but it had become more common by the 1950s, before wider social and cultural changes begun in the 1960s shifted medical interest away from perpetrators and toward “the prevalence of sexual crime and its impact upon victims” (131).

Research on sex offenders emerged during the interwar period, when a fall in the prisoner population gave prison doctors more time to study and attempt to treat the men in their care. There was also a rise in the number of reported offenses, and doctors and the general public shared the view that sex criminals suffered from some kind of mental abnormality, the hidden nature of which was crucial to understanding the prognosis for each offender. In chapter 1, Weston describes the growing reliance on medical evaluations in offender management, which peaked during the 1960s as a result of the Mental Health Act of 1959, while in the following chapter she investigates the scope of the research undertaken. In her third chapter, she focuses on doctors’ efforts to identify the causes of sexual crime and treat the perpetrators. A broad range of fetishisms and other criminalized behaviors were reflected in the diverse explanations and treatments proposed. The former included psychological and sexual immaturity, constitutional disorder or psychopathy, challenging personal circumstances, and physiological ailments.

International comparisons to the United States and Scandinavian countries help to explain why medical involvement in offender management was less influential in England: legal professionals were intent on punishing perpetrators held to be responsible for their actions but accepted medical opinion as a useful means of assessing culpability mainly for the purposes of sentencing. Treatment therefore occurred in prison or as a condition of probation; psychotherapy, especially group therapy, was favored, but hormone therapy, electroconvulsive therapy, and brain surgery might be used as a last resort.

The last two chapters are the most interesting and detailed: sexual offenders and their offenses emerge more clearly as part of Weston's analysis of the medical evidence given in court and attempts to cure “patient-prisoners.” A fascinating analysis links class and the ability to pay for legal counsel with the use and acceptance of medical evidence, the poor being thereby doubly disadvantaged until the creation of the National Health Service evened the field somewhat. Legal and penal practices often trumped medical opinion, but doctors responded by providing “practical solutions and concrete conclusions” (95). By the 1950s, however, the wider use of psychiatric evidence had had an unintended consequence: prison medical officers came to be seen as nonspecialists in mental medicine, and suspicion grew that medical witnesses for both prosecution and defense tailored their reports accordingly. Chapter 5 shows that a combination of medical and legal factors ensured that most prisoners never became patients, as cure came to be seen as less related to the nature of the crime than to the perpetrator's perceived degree of deviation from social and moral ideals. As demand began to exceed the availability of suitable treatment, and in the face of evidence that recidivism was common, the treatment option was increasingly restricted to those of appropriate age, respectability, intelligence, personality, and attitude. Remorseful, cooperative youthful first offenders met these qualifications and were consequently most likely to be deemed curable.

This book should be consulted by all scholars interested in the history of the relationship between law and medicine, twentieth-century criminal justice history, and the history of sex crime. It is stimulating, closely argued, and links context carefully to practices and outcomes. There are, however, some lapses in copyediting, and in places the book shows signs of its origin as a doctoral thesis. It is extremely compact—the notes, bibliography, and index occupy a third of its length—but despite the excellent summaries of argument and analysis provided at the end of each chapter, Weston repeats her main thesis too many times.