In 1949 Cauldwell reported on the case of a woman who desired to become a man. He labeled the disorder "psychopathia transsexualis" and thereby introduced the term "transsexual" into the clinical literature. With some degree of chagrin, Pauly (1974a) noted that it took almost twenty seven years from the time of Hirschfeld's initial report of female transsexualism until Cauldwell's presentation in 1949. Pauly (1974a) stated that, "the interest in female cases of transsexualism as determined by publications in the literature, has lagged about a decade behind that for male cases."

Redmount (1953) was the first clinician to describe a case of female transsexualism in depth. He reported on a case of a 33 year old woman who "had assumed a male role all of her life." She had a severely deprived early developmental history, viewed her father as a "mean tyrant" and was relieved by his murder (she was twelve) because "he was mean to my mother and all of the kids." The woman claimed that after an appendectomy at age 17, the physician told her that "she had internal male organs but that they were in some way diseased or injured and were removed." There was no corroboration of her report. After the mother's death from cancer, the woman became quite distressed, and three years later (age 26) was admitted to a mental hospital and discharged with the diagnosis of psychopathic personality with homosexual and suicidal preoccupations. The patient had twice been married to females (one of whom had a child by a previous marriage). Throughout her life she was regarded as a freak. She also had a poor work history.

This case history is a pivotal one in that most of Redmount's conclusions about the dynamics of the case have been accepted and supported by other investigators (oftentimes with little or no mention of Redmount's contribution to our understanding of female transsexualism). Redmount's conclusions were that, "The patient's assumption of the male identity appears to represent both a defense of herself and a way of relating to the idealized mother whom she needed. Establishing herself as male like father she could offer herself as a protective substitute in relating to potentially supportive but vulnerable figures like the idealized mother." Redmount also noted how difficult it was for the woman to impersonate the male role and argued that "the problem of maturation in this role seems to have introduced new insecurities into her life." The importance of this case focused on two factors. The first factor was Redmount's recognition of the psychodynamic triad in female transsexualism: an abusive father with. whom the patient identified; a warm supportive mother who needed to be rescued (the patient reported that mother "was the only friend I had. When I lost her I had none."); and a daughter who attempted to rescue her mother and protect her from the father's onslaughts. The second factor was Redmount's opinion that the patient was severely disturbed psychiatrically (a factor which had not been reported in the majority of clinical case reports of female transsexuals). The patient also seemed to have a thought disorder focusing on her magical belief that if she cut off her arm (which she attempted during adolescence) she could then "kiss her elbow and become a boy." (see TRANSSEXUALISM: CROSS CULTURAL INFLUENCES (1940-80) PART II)